Fat Thoughts . . .

As a bariatrician, I think about fat all the time.  I guess you could say I have a lot of "fat thoughts."

I frequently hear patient's tell me, "Dr. Nally, I'm eating RIGHT, but I'm just NOT losing weight!"

If you're not losing weight, your not eating correctly. 99% of your weight loss success is related to your diet. We have been poorly misinformed over last 40 years as to what a "correct" diet contains. We've been told to follow a low fat diet for the last 40-50 years.  However, it is very apparent as patient's follow a low fat diet that only a small percentage of them have success in weight loss, and the majority actually gains more weight and remains significantly hungry.  When you look at the body's physiology, fat restriction only stimulates increased hunger.  The intake of any form of carbohydrate, whether that be simple or complex, stimulates an insulin response.  Based on our genetics, that insulin response can be variable. some of us respond normally and others respond with between 2-10 times the normal insulin surge.  Insulin is actually the hormone that drives weight loss or weight gain.

You and I will not be able to effectively lose weight until we control the response of insulin, and this can only be done through carbohydrate restriction.

Low Carbohydrate Diets Finding Great Success

Spent part of the morning reviewing 20 years of journal articles on the "Science of Dietary Carbohydrates, Glucose and Insulin."  Fascinating reading. It is interesting that prior to the advent of insulin as a treatment for diabetes, the most common treatment from 1915-1920 used by William Osler for diabetes was significant carbohydrate restriction.

In 1999 a study was published in Pediatrics looking at twelve obese teenage boys.  They were randomly fed low glycemic equal calorie meals followed by high glycemic index meals or vise-versa.  The fascinating result was that when fed following a low glycemic meal, the boys at 81% more if the meal was high in glycemic index.  The fascinating factor is that their insulin levels were much higher which would correlate with notable weight gain and cholesterol rise based on other research.
Another study completed in 2005 helps to quash safety concerns about low carbohydrate diets and shows them to be just as effective in weight loss and more effective in lowering triglycerides, raising HDL in patients with type II diabetes then low fat diets.

My patient's in the office have had tremendous success with low carbohydrate dietary changes over the last 12 months. Every patient in my practice following a very low carbohydrate diet has drastically improved their cardiovascular risk, lipid profile, and significantly reduced their weight. In those patient with type II diabetes, they have additionally had significant improvement in their blood sugar control, average blood sugars (HbA1c) and there triglycerides (on of the lipid measures placing these patients at risk for heart disease). This correlates closely with recent studies reflecting similar results in the medical literature.  It is essential, however, to be monitored regularly on these types of diets, as rapid and significant metabolic changes can and do occur. Medications, blood pressure, and blood sugar control need to be closely monitored when following a low carbohydrate diet. Close follow up with your physician is highly recommended.

If You Have Diabetes, Metabolic Syndrome, or Insulin Resistance Take Your Folic Acid

Recent study published in Obesity ((23 September 2010) | doi:10.1038/oby.2010.210) reveals exciting information about protecting the blood vessels of patients with diabetes, metabolic syndrome and insulin resistance.

It is a well known fact that excessive small blood vessel damage in these patients leads quickly to renal failure, macular degeneration (damage to the retina of the eye), and painful numbness and neuropathy in the hands and feet.  Patients with metabolic syndrome and diabetes have been shown to have increased levels of nitric oxide in their small blood vessels. This is thought to be one of the major causes of the damage that occurs in these patients. Much attention and monitoring is given to these patient in attempts to protect their blood vessels from ongoing damage.
Recent data showed that in just four weeks folic acid decreased the amount of nitric oxide present in the blood vessels of  patients with metabolic syndrome thereby implying significant vascular protection and health.  Further study is needed to determine the degree of protection folic acid renders in these patients, but until then, I'm taking my folic acid!!