Wednesday, September 3, 2014

Fat Trap or Cognitive Dissonance?

For 15 years, Joseph Proietto has been helping people lose weight. When these obese patients arrive at his weight-loss clinic in Australia, they are determined to slim down. And most of the time, he says, they do just that, sticking to the clinic’s program and dropping excess pounds. But then, almost without exception, the weight begins to creep back. In a matter of months or years, the entire effort has come undone, and the patient is fat again. “It has always seemed strange to me,” says Proietto, who is a physician at the University of Melbourne. “These are people who are very motivated to lose weight, who achieve weight loss most of the time without too much trouble and yet, inevitably, gradually, they regain the weight.”
Anyone who has ever dieted knows that lost pounds often return, and most of us assume the reason is a lack of discipline or a failure of willpower. But Proietto suspected that there was more to it, and he decided to take a closer look at the biological state of the body after weight loss.
Beginning in 2009, he and his team recruited 50 obese men and women. The men weighed an average of 233 pounds; the women weighed about 200 pounds. Although some people dropped out of the study, most of the patients stuck with the extreme low-calorie diet, which consisted of special shakes called Optifast and two cups of low-starch vegetables, totaling just 500 to 550 calories a day for eight weeks. Ten weeks in, the dieters lost an average of 30 pounds.
At that point, the 34 patients who remained stopped dieting and began working to maintain the new lower weight. Nutritionists counseled them in person and by phone, promoting regular exercise and urging them to eat more vegetables and less fat. But despite the effort, they slowly began to put on weight. After a year, the patients already had regained an average of 11 of the pounds they struggled so hard to lose. They also reported feeling far more hungry and preoccupied with food than before they lost the weight.
While researchers have known for decades that the body undergoes various metabolic and hormonal changes while it’s losing weight, the Australian team detected something new. A full year after significant weight loss, these men and women remained in what could be described as a biologically altered state. Their still-plump bodies were acting as if they were starving and were working overtime to regain the pounds they lost. For instance, a gastric hormone called ghrelin, often dubbed the “hunger hormone,” was about 20 percent higher than at the start of the study. Another hormone associated with suppressing hunger, peptide YY, was also abnormally low. Levels of leptin, a hormone that suppresses hunger and increases metabolism, also remained lower than expected. A cocktail of other hormones associated with hunger and metabolism all remained significantly changed compared to pre-dieting levels. It was almost as if weight loss had put their bodies into a unique metabolic state, a sort of post-dieting syndrome that set them apart from people who hadn’t tried to lose weight in the first place.
“What we see here is a coordinated defense mechanism with multiple components all directed toward making us put on weight,” Proietto says. “This, I think, explains the high failure rate in obesity treatment.”
This is one of the most interesting articles on fat loss I’ve ever read - I’ve read it several times - that does nothing to help anyone lose weight or be healthy.  The point of the article seems to be “it’s hopeless, you may as well not even bother.”  

And that is an experience with weight loss many people encounter, some many times in their lives.  As I read it, I try to stack up my own experience - that my body weight is very responsive to carbohydrate restriction and to “eating quality food”, and that I’m 35 pounds lighter than I was 8 years ago when I was 42, and that I know I’m not working out more or exercising generally more than I was then.

The article is lengthly and detailed and describes what is known at the starvation response - the tendency of the body to increase appetite and decrease activity when it is subjected to caloric deprivation over a long enough period of time.  One of the story’s protagonists is getting all scientific about the mechanisms that enable the body to conserve energy, but to me there’s a huge pink elephant in the article - at no time does the author delve into the question of what type of diet the researchers are using to get their fat loss-to-starvation-response cycle?

Here’s why this is a pivotal question to me.  Nearly every study on the topic shows that those who lose weight by restricting carbohydrates have lower appetites and spontaneously reduce food intake.  So if you and your buddy both diet, and the buddy goes with caloric restriction (and perhaps exercise), and you just cut carbs (smartly) and sit on the couch texting with your significant other, you very well may lose as much fat, and with less hunger.  

The author of the article is an interesting study - to the best of my knowledge, she avoids the topic of low carb because she hob nobs with the scientists who have been in vogue over the last ten years or more who advocate a low fat diet for health and weight loss.  When our society went all fat crazy starting about forty years ago - we began to tell people not to eat saturated fats (“bad for your heart”), and to tell people to eat industrially produced polyunsaturated fats (“heart health fats”) - we also began a long experiment with the “a calorie is a calorie” idea.  That is to say, we looked at the first law of thermodynamics, which states that energy may not be created or destroyed it simply changes forms, and extrapolated that the human body worked like a bomb calorimeter.  

If you stuff a quantity of fat, protein or carbohydrate into a steel ball, and ignite the contents, and measure the change in heat that results from the incineration, you can derive that fat yields 9 kcal/gram, and protein/carbohydrates yield 4 kcal/gram.  With this nifty bit of data, folks decided that fat loss should be a simple proposition - eat less, move more.  

If you combine these two unproved propositions - fat is bad and has more calories - then fat loss and health should magically result when we eschew fats and exercise more.  After all, people who exercise are leaner than those who do not.  

Only one problem - systematically depriving an overfat person of calories via a low calorie and low fat diet with exercise only works for a while.  And if you read the whole article above several times, that is the stunning conclusion.  And the prestigious scientists the author quotes are figuratively scratching their heads like the clowns in the Monty Python skit trying to sort it all out, since it doesn’t fit their “calorie is a calorie” paradigm.  They have cognitive dissonance - “we’re doing everything right, we have to figure out why these peoples’ bodies are fighting so hard to regain the lost fat so we can create a drug to circumvent that.”  
The question for me is - are they asking the right question?  Are they really doing everything right?  What if the problem is just this simple - they are feeding humans low quality food they were not meant to eat (IOW low cal low fat), and humans are reacting with predictable problems.  What if a simple restatement of the topic of this very long, and very detailed article published in the new york times is “We fed people a small amount of stuff they were never designed to eat and it didn’t work out so great.  They acted like they were starving.”

The section of this article - which in some ways seems to be a lengthy defense for why the NYT editor for a wellness blog is 60 pounds overweight - which is most resonant for me is the portrait of a lady who has taken the calorie in calorie idea to its natural conclusion.  She spends what seems like every waking moment making sure she gets only the right amount of calories and the right amount of exercise, every single day of her life.  Her story is an amazing show of discipline and determination.  This lady is used by the author to kind of illustrate how nearly impossible it is to lose fat and keep it off.  

For the record, I think it is in fact just about this impossible to lose fat and keep it off for some people.  Fat storage is a function of hormonal and other responses that have been refined over the entirety of animal existence on this planet.  The human genome you have was developed to make sure you had just the right amount of fat stored on your body to optimize your chances for survival through reproduction (and survival of your offspring).  It is an impossibly well developed system, that worked nearly without fail until we starting eating the crap we eat now.  I’m not sure it is possible to undo a lifetime of eating like we eat, at least not for all people, and not in terms of getting to an keeping an idea body weight.  

And the problem is not just what we eat.  It’s how we sleep or don’t sleep, and how our hormonal cycles seem to have been disrupted by the ways we no longer live as we were designed to - the novelty of lights, the sleep disruption, the non-optimal food, and the loss of seasonal food variation, the practice of fasting and seasonal carb restriction; and who knows what else.  I’ve recently been around a female who is working to get her hormones optimized - better living through chemistry - and the way her body deposited fat changed over night.  So, yes, I think there’s more to the “fat trap” than just the “low calorie, low fat, more exercise” hoax.  

“Well, how will you wrap this one up Paul?”  Here’s the wrap up - start out by eating for healthy blood sugar levels.  Attack the problems that remain one by one.  Body fat - there are things you can do if you find that just eating good food isn’t enough to get lean.  Sicknesses?  There are things you can do to to heal the gut and for many that addresses autoimmune and inflammatory processes.  The road that has worked for me is chasing improvement over time, which for me started in about 1996, but didn’t really become consistent in my life until 2007, when I found a way to eat that I could live while I stayed/became more healthy.  Prioritize health, and get better day after day, week after week.

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