Once we understand that obesity is a hormonal imbalance, we can begin to treat it. If we believe that excess calories cause obesity, then the treatment is to reduce calories. But this method has been a complete failure. However, if too much insulin causes obesity, then it becomes clear we need to lower insulin levels.
My back story, which isn't necessary for this review: About a year ago, my sister-in-law invited me to join a “boot camp”-type gym with her at a time when they were starting a ten week “body transformation challenge”. A half hour, intense, workout at 6:45 every morning and a calorie-restrictive nutrition plan did lead to weight loss and a general uptick in my overall fitness, but within six months or so, my results plateaued (leaving me in not a bad place, but still, I had to wonder what changed). This gym apparently understands the phenomena of weight loss plateaus and began a new challenge at around that same time: a Whole30 nutrition plan, with many of its what-to-eat recommendations contradicting what I had been told six months earlier (in particular, the zero calorie artificial syrup that I had been putting on my daily protein pancakes – which syrup I had never heard of before they told me to buy it – was now a poison). This worked for me, too, but I found Whole30 to be unsustainable (and the “30” in Whole30 does indicate you're only supposed to eat this restrictively for a month at a time). I was now very confused about what to eat, so I went to a Registered Dietician, and after keeping a food log for her for a week, she told me I was eating very well and to keep it up; follow Canada's new Food Guide for life and I'd be healthy forever. That didn't feel helpful; I was still not convinced that I knew how to eat anymore, and that made me feel stupid at my age. Six months later, my weight has been creeping back up despite restricting calories and there's a new challenge at the gym: I'm precisely counting macros, weighing my chicken breasts down to a fraction of a gram and only eating my macros in certain combinations at certain times of the day; and yes, it's working for weight loss, but I don't want to do this for the rest of my life either. I'm doing everything recent medical wisdom has been recommending – eating less and moving more – but I can feel that there's a set weight that my body wants to be at and I'm getting tired of feeling like I'm fighting my own body to make it healthier. Once again, my sister-in-law had a recommendation: Rudy heard that The Obesity Code by Dr. Jason Fung (a Toronto nephrologist who treats the end stages of livers damaged by “diabesity”) has a radical new theory of what makes and keeps us overweight; so I bought and read the book in an evening. I can report that Fung's conclusions make sense (they certainly explain my own experience), and with humour and easy-to-understand analogies, his book is a very readable scientific history of how the medical and dietary establishments have failed in their recent approach to fighting obesity (it's no coincidence that obesity rates rose dramatically at the same time both were pushing low fat/high carb diets). But as readable as I did find Fung's history of scientific research into obesity, I don't know if this is what everyone is looking for in a book like this: my sister-in-law, who is not a reader, would do well to take it as given that Fung has properly read and interpreted the studies and skip right to the last two chapters on what to eat and when to eat. His basic conclusion: Excess calories don't make us gain weight, excess insulin does. Excess insulin is produced when we consume too much added sugar, too many overprocessed carbohydrates, or eat too often during the day so that our insulin levels never have a chance to go down. Persistent excess insulin leads to insulin resistance, which forces us to eat more and spike our insulin higher, leading to even more weight gain. This eventually sets our body weights higher – so that if we consume fewer calories, our bodies will compensate by burning fewer calories – leading to weight loss plateaus that can only be overcome by changing up our dietary plans every few months or intermittent fasting. Everything Fung writes makes total sense; so many ideas made me think, “But I knew that already, didn't I?” That's the long and longer of it and I'll just add a few more ideas that were particularly interesting to me (also not necessary to read as part of this review):
Hormones are central to understanding obesity. Everything about human metabolism, including the body set weight, is hormonally regulated. A critical physiological variable such as body fatness is not left up to the vagaries of daily caloric intake and exercise. Instead, hormones precisely and tightly regulate body fat. We don't consciously control our body weight any more than we control our heart rates, our basal metabolic rates, our body temperatures or our breathing. These are all automatically regulated, and so is our weight. Hormones tell us when we are hungry (ghrelin). Hormones tell us we are full (peptide YY, cholecystokinin). Hormones increase energy expenditure (adrenalin). Hormones shut down energy expenditure (thyroid hormone). Obesity is a hormonal dysregulation of fat accumulation. Calories are nothing more than a proximate cause of obesity.I appreciated how often Dr. Fung reiterated that “Move more, eat less” simply doesn't work – even if this maxim has made it very easy for doctors and laypeople to fat shame those who are persistently overweight (that plus-sized person is both gluttonous and slothful; two of the Deadly Sins; obviously no self-control), that's not how weight gain works. We do have control over what and when we eat – which does cause weight gain – but with the medical establishment and government food guides both giving us bad advice for the past fifty years (carbohydrates should not make up the base of the food pyramid; there is zero evidence that fat accumulates in the arteries to cause heart disease; breakfast is not the most important meal of the day and can be safely skipped in order to prolong insulin depletion), so many people are in the same boat as I am: simply no clue how to eat. Fung's prescription:
Reduce your consumption of added sugars. Reduce your consumption of refined grains. Moderate your protein intake. Increase your consumption of natural fats. Increase your consumption of fiber and vinegar.In addition, Fung recommends only three meals per day (it is also no coincidence that obesity started to rise in conjunction with the idea that we need snacks in between meals; humans are not grazing animals) and to stretch the fasting period between our last meal of the day and our first for as long as possible. And when weight loss plateaus, it's time to fast: Fung adds an appendix to this book which shows how to achieve a twenty-four or thirty-six hour fasting schedule, and with plenty of fluids (including broth at midday), he assures the readers that they won't be uncomfortable after the initial jolt; and besides, intentional fasting has always been a part of traditional human society:
This is the ancient secret. This is the cycle of life. Fasting follows feasting. Feasting follows fasting. Diets must be intermittent, not steady. Food is a celebration of life. Every single culture in the world celebrates with large feasts. That’s normal, and it’s good. However, religion has always reminded us that we must balance our feasting with periods of fasting – “atonement,” “repentance” or “cleansing.” These ideas are ancient and time-tested. Should you eat lots of food on your birthday? Absolutely. Should you eat lots of food at a wedding? Absolutely. These are times to celebrate and indulge. But there is also a time to fast. We cannot change this cycle of life. We cannot feast all the time. We cannot fast all the time. It won’t work. It doesn’t work.Overall, I trust that Fung is onto something with his insulin-resistance theories; obviously, what I've been told about appropriate nutritional choices my entire life isn't the whole picture. I'm not, however, 100% convinced that his approach in this book – while admittedly of adequate interest to me personally – will be engaging for every reader: you need to get through many pages of “The government pushed cheap, processed carbs as the bulk of the recommended diet for decades because they also subsidized farmers who grew wheat and corn, leading us to overpaying taxes to both produce our own poisons and medically treat their effects after the case” and “The medical establishment continues to push 'Move more, eat less' as the key to weight loss because, even though it doesn't work, it puts the onus on the patient to manage their own care and relieves them of responsibility”: a little too much smacks of conspiracy theory, which I've seen far too much of in books on nutrition. However: I have learned over the last year that eliminating processed foods and refined carbs makes food that tastes good and makes me feel good. The piece I was missing, I guess, was the intermittent fasting – and I'll have to really consider if that will make sense for me.
