Weight Loss — If You’re Overweight
GETTING IT OFF AND KEEPING IT OFF
There may be many mechanisms by which the thrifty genotype can cause obesity. The most common overt cause of obesity is over eating carbohydrate, usually over a period of years. Unfortunately, this can be a very difficult type of obesity to treat.
If you’re overweight, you’re probably unhappy with your appearance, and no less with your high blood sugars. Perhaps in the past you’ve tried to follow a restricted diet, without success. Generally, overeating follows two patterns, and frequently they overlap. First is overeating at meals. Second is normal eating at mealtime but with episodic “grazing. ”Grazing can be anything from nibbling and snacking between meals to eating everything that does not walk away. Many of the people who follow our low-carbohydrate diet find that their carbohydrate craving ceases almost immediately, possibly because of a reduction in their serum insulin levels. The addition of strenuous exercise sometimes enhances this effect. Unfortunately, these interventions don’t work for everyone.
If you’re a compulsive overeater, if you just can’t stop yourself from eating, and are addicted to carbohydrate, you may not be able to adhere to our diet without some sort of medical intervention (see Chapter 13). Carbohydrate addiction is just as real as drug addiction, and in the case of the diabetic, it can likewise have disastrous results. (In actual fact, excess body weight kills more Americans annually from its related complications than all drugs of abuse combined, including alcohol.) You need not despair of never losing weight, however. I have seen a number of “diet-proof” patients over the years get their weight down and blood sugars under control. Over the last several years, medical science has gained a much more sophisticated understanding of the interactions of brain chemicals (neurotransmitters) that contribute to emotional states such as hunger and mood. Many relatively benign medications have been successfully applied to the temporary treatment of compulsive overeating. There is no doubt that when used properly, many appetite suppressants are quite effective in helping people to lose weight. If you simply cannot lose weight, it may be helpful to discuss with your physician medicines that may be of use to you.
I have used more than 100 different medications with my patients and have found many of them to be of great value for treating carbohydrate addiction.
There is, however, a catch to this method. Over the years, I have found that none of these medications works continually for more than a few weeks to a few months at a time, a fact that many if not most medical and diet professionals may be unaware of.
I developed a reasonably successful method for prolonging effectiveness of some by rotating them weekly, so that from one week to the next a different neurotransmitter would be called into action to provide the sensation of satiety. I found that about eight different medications, changed every week for eight weeks, and then repeating the cycle, would perpetuate the effect for as long as people continued to take them. At one point this looked to be a very promising means to help get weight off and keep it off. I even acquired a patent for the technique. Over time, however, I found several significant reasons not to continue pursuing this route. The most insurmountable of these was that it was just too difficult for most people to follow their normal regimen of diabetes medications while at the same time changing their regimen of appetite suppressants from week to week. Add to that the difficulty of working with a patient over a number of weeks just to find eight medications that worked for them and could be rotated. What I did discover during all this trial and error were two effective methods of curbing overeating. The results my patients have had with them are so significant that I’ve devoted the whole next chapter to them.
Reducing Serum Insulin Levels
Another group of type 2 diabetics has a common story: “I was never fat until after my doctor started me on insulin.” Usually these people have been following high-carbohydrate diets and so must inject large doses of insulin to effect a modicum of blood sugar control.
Insulin, remember, is the principal fat-building hormone of the body. Although a type 2 diabetic may be resistant to insulin-facilitated glucose transport (from blood to tissues), that resistance doesn’t diminish insulin’s capacity for fat-building. In other words, insulin can be great at making you fat even though it may be, for those with insulin resistance, inefficient at lowering your blood sugar. Since excess insulin causes insulin resistance, the more you take, the more you’ll need, and the fatter you’ll get. This is not an argument against the use of insulin; rather it supports our conclusion that high levels of dietary carbohydrate—which, in turn, require large amounts of insulin— usually make blood sugar control (and weight reduction) impossible. I have witnessed, over and over, dramatic weight loss and blood sugar improvement in people who have merely been shown how to reduce their carbohydrate intake and therefore their insulin doses. Although
this is contrary to common teaching, you need only visit the reader reviews of the original edition of this book to read the similar experiences of many readers.*
Several oral insulin-sensitizing agents, which we will discuss in detail in Chapter 15, can also be valuable tools for facilitating weight loss. They work by making the body’s tissues more sensitive to the blood sugar–lowering effect of injected or self-made insulin. As it then takes less insulin to accomplish our goal of blood sugar normalization, you’ll have less of this fat-building hormone circulating in your body. I have patients using these medications who are not diabetic, and they work in a similar way: the body is more sensitive to insulin, so it needs to produce less, and there is, again, less of it present to build fat. One may also have less of a sense of hunger, and less loss of self-control.
*At www.amazon.com and www.diabetes-book.com.
Increasing Muscle Mass
The above suggests what we have been advocating all along—a low carbohydrate diet. But what do you do if this plus one of the above medications does not result in significant weight loss? Another step is muscle-building exercise (Chapter 14). This is of value in weight reduction for several reasons. Increasing lean body weight (muscle mass) upgrades insulin sensitivity, enhancing glucose transport and reducing insulin requirements for blood sugar normalization. Lower insulin levels facilitate loss of stored fat. Chemicals produced during exercise (endorphins) tend to reduce appetite, as do lower serum insulin levels. People who have seen results from exercise tend to invest more effort in looking even better (e.g., by not overeating, and perhaps exercising more). They know it can be done.
HOW TO ESTIMATE YOUR REAL FOOD REQUIREMENTS
Now suppose you have been following our low-carbohydrate diet, have been conscientiously “pumping iron,” and are, in effect, “doing everything right. “What else can you do if you have not lost weight? Well, everyone has some level of caloric intake below which they will lose weight. Unfortunately, the “standard” formulas and tables commonly used by nutritionists set forth caloric guidelines for theoretical individuals of a certain age, height, and sex, but not for real people like
us. The only way to find out how much food you need in order to maintain, gain, or lose weight is by experiment. Here is an experimental plan that your physician may find useful. This method usually works, and without counting calories.
Begin by setting an initial target weight and a reasonable time frame in which to achieve it. Using standard tables of “ideal body weight” is of little value, simply because they give a very wide target range. This is because some people have more muscle and bone mass for a given height than others. The high end of the ideal weight for a given height on the Metropolitan Life Insurance Company’s table is 30 percent greater than the low end for the same height.
Instead, estimate your target weight by looking at your body in the mirror after weighing yourself. (It pays to do this in the presence of your health care provider, because he/she probably has more experience in estimating the weight of your body fat.) If you can grab handfuls of fat at the underside of your upper arms, around your thighs, around your waist, or over your belly, it is pretty clear that your body is set for the next famine. Your estimate at this point need not be terribly precise, because as you lose weight your target weight can be re estimated. Say, for example, that you weigh 200 pounds. You and your physician may agree that a reasonable target would be 150 pounds. By the time you reach 160 pounds, however, you may have lost your visible excess fat—so settle for 160 pounds. Alternatively, if you still have fat around your belly when you get down to 150 pounds, it won’t hurt to shoot for 145 or 140 as your next target, before making another visual evaluation. Gradually you home in on your eventual target, using smaller and smaller steps.
Once your initial target weight has been agreed upon, a time frame for losing the weight should be established. Again, this need not be utterly precise. It’s important, however, not to “crash diet.” This may cause a yo-yo effect by slowing your metabolism and making it difficult to keep off the lost bulk. Bear in mind that if you starve yourself and lose 10 pounds without adequate dietary protein and an accompanying exercise regimen, you may lose 5 pounds of fat and 5 pounds
of muscle. If you gain back that 10 pounds from eating carbohydrate and still are not exercising, it may be all fat. After crash dieting, once you’ve reached your target, you may go right back to overeating. I like to have my patients follow a gradual weight-reduction diet that matches as closely as possible what they’ll probably be eating after the target has been reached. In other words, once your weight has leveled off at your target, you stay on the same diet you followed while losing weight—provided, of course, that you don’t continue losing weight. This way you’ve gotten into the habit of eating a certain amount, and you stick to this amount, more or less, for life.