Participants: N. David Emerson
Series Code: WM
Program Code: WM000432
00:35 Hello, I'm Dr. Emerson
00:37 I am Medical Director at Eden Valley Lifestyle Center 00:40 I'd like to talk to you today, again about obesity 00:45 and weight control. 00:46 Last session, you may recall that we found that low-calorie 00:51 diets do not work well for weight loss... 00:55 They'll cause an initial drop in weight, but then the body 00:59 adapts to this stress that it has been put under 01:04 It responds by lowering your metabolism, 01:07 and making you feel kind of miserable, weak... 01:10 And when you then come OFF of your low-calorie diet, 01:14 the body says, "We better get ready for the next starvation" 01:19 So the way we'll get ready for the next starvation is 01:21 we'll keep the metabolism low, 01:23 so we're burning less calories... 01:24 We'll keep the muscle mass low, 01:26 so we'll have less muscle to feed, 01:28 and we'll keep the body fat even higher, so we'll have 01:30 more fat to feed less muscle. 01:32 So that with repeated dieting, we find that the weight actually 01:37 slowly increases as the metabolism slowly decreases 01:42 and muscle mass drops. 01:43 We found that the Atkins Diet works also by 01:47 calorie restriction, in a sense that when people are 01:51 restricted from carbohydrates 01:53 Their actual calorie intake and appetite is suppressed... 01:58 they have no appetite for the foods that are available 02:01 They're only eating about 66% of the calories that 02:05 they would normally eat... 02:06 and various studies have actually shown that this 02:09 is the reason for the initial 02:11 weight loss in the Atkins Program 02:14 It is then followed by a weight-rebound, 02:20 and it's not tolerated well... 02:22 And so when patients come off of the program, 02:24 the weight, again, comes back up, 02:26 just like in any calorie-restricted diet 02:29 Weight Watchers is another program that many people are on 02:35 This is essentially a low-fat diet, 02:40 and that's a step in the right direction 02:42 but it also restricts calories, and is, therefore, 02:47 prone to the same problems that any low-calorie diet has 02:50 when you come off of the problem 02:53 In a study published in the "Annals of Internal Medicine" 02:57 in 2004, they did a 2-year randomized control study 03:02 and they found that with the Weight Watchers Program, 03:05 the average weight loss, after I believe it was 3 years, 03:11 was only 6.4 pounds... 16% of them achieved 03:16 and maintained a weight loss of 10% or more 03:19 The controls that were NOT on the program only lost... 03:25 well, 6% of them lost 10% as well 03:28 So, calorie intake isn't really the answer to obesity. 03:33 If calorie restriction isn't the answer, what is? 03:39 Well, what about activity? 03:41 Is this the ultimate solution to weight loss? 03:45 And what we'll find will present evidence to this effect 03:48 that activity can help weight loss, 03:52 but only to a certain point. 03:54 You'll find that if you can get out of the inactive range 03:56 into the active range, there is a drop in weight; 03:59 however, once you're in the active range, 04:02 further activity does not drop the weight significantly. 04:06 This was first demonstrated in rats... 04:11 in some rat experiments... 04:17 they tested rats and they found that rats put in a cage 04:21 and exercised on a treadmill had different weights 04:26 based on their activity level. 04:27 Some rats were not allowed to exercise at all... 04:30 Some rats were put at 20 minutes a day, 40 minutes a day, 04:33 and then 60 minutes a day, 04:36 and at those levels, the weight dropped 04:40 when they went from 0 to 20, to 40, to 60 minutes per day 04:43 with the rats. 04:45 But, once they hit 60 minutes a day, 04:47 further exercise duration per day, 04:51 from 1 hour to 2 hours, 3, 4, and 5... 04:54 they found the weight plateaued. 04:56 There was no significant increase or decrease 04:59 at that point, the weight had stabilized. 05:01 The only time the weight started dropping AGAIN, 05:04 was at about 5-1/2 hours 05:06 ...the weight again dropped, 05:09 but this was because the rats had gone into extreme fatigue 05:13 They were falling into the treadmill... 05:15 They had no appetite. 05:16 They were getting injuries. 05:18 And, of course, we want to avoid that range 05:22 What they also found was interesting... 05:26 was that appetite dropped 05:28 during their increase in activity 05:32 When they went from 0 to 20, to 40, to 60 minutes, 05:36 the intake of calories actually DROPPED until it hit, again, 05:42 1 hour, and at 1 hour, the weight plateaued 05:44 and further exercise above 1 hour, 05:48 the weight increased again to match the increased 05:52 demands they were putting on the rats from activity. 05:56 We're finding that the initial drop in calorie intake 06:03 was related mainly to the decrease in weight, 06:07 and the decrease in surface area. 06:08 They found that with less surface area, 06:10 the rats were radiating less heat, 06:13 and so, as the weight dropped, they found that the 06:18 calorie intake actually dropped, 06:21 and the amount of calories they were radiating dropped. 06:24 So the appetite dropped from 0 to 1 hour, 06:27 and then once the weight plateaued, 06:28 the calorie intake was now 06:30 proportional to the activity level... 06:33 and the appetite actually helped control and maintain 06:37 that stable weight. 06:39 So there was really no problem with the appetite mechanism 06:41 with the rats. 06:45 We're not rats, we're people... 06:48 so, the same people that tested the rats, then said... 06:52 "Well, we need to check this on people. " 06:55 So they went to a mill in India, 06:57 and they looked at humans working in the mill 07:01 ...and they divided them based on their activity level, 07:04 according to the job they had. 07:07 There were the sedentary workers who were the 07:08 stallholders, the supervisors, and the type 1 clerks 07:12 ...then you went from sedentary to light work 07:15 and you found that these were the clerks, 07:17 the class 2 to 4 clerks, the mechanics 07:21 Then they found the medium workers... 07:23 as the next increase in activity level... 07:26 These were the drivers, the winders, the weavers, 07:28 the baggers, the twisters 07:30 Then they went to HEAVY work... 07:33 These were the mill waste carriers, the pilers, selectors 07:36 Then they went to VERY HEAVY WORK... 07:39 the ashman, the core men the blacksmiths, 07:41 the cutters, the carriers... 07:42 And what they found is that as the activity, 07:46 the daily activity level increased, the weight dropped 07:50 from an average of 170 to about 115 07:53 Now these were smaller-framed people, and 115 was considered 07:58 fairly normal weight for them 08:00 At 115, the weight then plateaued... 08:06 and, as you went from the moderate activity 08:10 further on out, the weight did NOT continue to drop, 08:14 but it plateaued 08:15 Calorie intake ALSO decreased. 08:18 As the weight dropped from 170 down to 115, 08:21 the calorie intake dropped from 350 calories per day 08:26 to about 250 calories per day until the weight plateaued 08:30 Further increase in activity now increased their appetite 08:35 and their appetite was now proportional to 08:38 their activity level, and that's what maintained their weight 08:42 So the question then is... 08:43 "How do we get from the sedentary phase 08:47 to the active phase? 08:49 What works? What doesn't work? 08:51 Well they looked at 34 subjects, 08:54 and these were tested to find out if activity could actually 09:00 help control their weight. 09:01 And, they wanted to find out which type of activity 09:05 would control their weight most effectively 09:09 These were people who had previously 09:11 tried low-calorie diets throughout their lives 09:14 They had lost weight, promptly regained it coming off 09:16 the low-calorie diet. 09:18 So they were asked to exercise at least 30 minutes a day 09:22 If they could exercise 30 minutes a day, 09:23 they qualified for the program. 09:25 There was no restriction on calories 09:27 They were told to eat as much as their appetite told them to eat 09:31 Well, out of the 34 subjects, 5 couldn't do it because 09:36 they couldn't devote enough time required on a daily basis 09:41 Six of them chose jogging... 09:43 but 3 got injuries from the jogging, 09:46 and another 3 couldn't exercise over the 30 minute time limit 09:49 long enough to get a significant change in the weight 09:52 Three chose cycling, but couldn't continue the cycling 09:56 ...the bicycling long enough to control 09:58 and affect their weight 10:00 Three chose swimming, but again, they couldn't tolerate 10:04 the swimming long enough on a consistent basis 10:06 to affect their weight. 10:08 Eleven of them chose walking... 10:10 and ALL of these were successful and all of them were able 10:13 to exceed 30 minutes a day of daily walking 10:17 What they found, as they charted the amount of minutes 10:20 per day that they walked, versus their weight loss, 10:24 they found that, indeed, weight loss was related to 10:28 the duration of walking up to about 90 minutes a day 10:33 Weight loss going from 10:35 90 minutes to, say, 2 hours a day... was not confirmed as 10:40 being beneficial 10:42 They weren't able to test for that... 10:44 But, if you plateaued at 60 minutes, 10:46 and you went from 60 to 90 minutes, 10:48 there was again, another weight loss that was documented. 10:51 Some contestants found that when exercising, 10:59 if they got sick for 2 weeks, and their exercise 11:01 stopped for 2 weeks, their weight would take a little blip 11:04 ...go up a little bit 11:06 Once they got on the program again, 11:08 the weight would then normalize out 11:11 They found that their skin fold thickness 11:14 which is a measure of body fat decreased significantly 11:19 Skin fold thickness is pretty easy to check... 11:21 They have little calipers they would just squeeze 11:23 the skin and find out how thick the skin was 11:26 and that was relating to the amount of fat under the skin 11:32 So, if you're trying to get out of the sedentary range, 11:36 into the moderate activity range, 11:39 what you'd like to do is choose an exercise that is easy, 11:44 and enjoyable. 11:46 The one that is found to be most successful was walking 11:50 The daily amount of exercise that you take should start 11:59 with something you can tolerate 12:02 What you could do is start with 5, 10 minutes a day 12:07 Walk 5 minutes OUT from your house, 12:09 turn around, come back, and walk 5 minutes to your house 12:13 They found that weight loss is proportional to duration 12:18 of exercise up to a point 12:21 Exercise is good in that it eliminates fat, not muscle 12:26 You want to choose an exercise that you can enjoy and tolerate 12:30 I have some friends that seem to do well on a treadmill 12:35 I found treadmills to be somewhat difficult because 12:38 they're somewhat boring... you don't have any 12:40 change of scenery... 12:41 There's really no joy, at least for me, in walking 12:46 I prefer the outdoor activities where you can actually 12:49 get a change in scenery. 12:51 There are some benefits in just walking 12:56 Now, what about a gym? 12:58 There are some benefits to gyms 13:01 They do have weight equipment which can be beneficial 13:04 There are some downsides, however... 13:06 There is a cost, but the biggest thing I found was 13:09 that the time involved in a gym... 13:11 When I tried a gym, at one point in my life, 13:13 I found that I had to get my clothes together, 13:16 get in the car, drive to the gym... 13:19 which may take 1/2 an hour 13:20 When I got there, I had to change... 13:22 do the 1/2 hour workout... change, take a shower, 13:25 get dressed, drive home... 13:27 It may take me 2 hours, to do a simple 30 minute workout 13:31 On the other hand, if I come home from work, 13:34 in my work clothes, I can put on some shoes, tennis shoes 13:39 I can either go for a walk, I can go for a run... 13:41 I can go for a bicycle ride... 13:44 And when I come home, I can change out of my 13:46 work clothes, take a shower, my PJs on... 13:51 There's no extra time out of my schedule, 13:55 and the only time, really, spent for the exercise 13:59 is the actual exercise time which is 30 to 45 minutes 14:05 Is exercise the ultimate answer to obesity? 14:10 It is a help, but it's actually not the ultimate answer 14:14 and it's not the reason for the epidemic of obesity 14:18 that we see in America today 14:20 Dr. John McDougall tells a story about a 14:28 private interview with Carl Lewis... 14:30 They were actually being interviewed on a talk show 14:33 and Carl Lewis is the fastest man on earth! 14:37 He set the world record in the 100 yard dash 14:40 And before they got on stage, he shared with Dr. McDougall, 14:46 he said, you know, "I have a problem with weight" 14:48 "If I eat too much, I start gaining weight. " 14:51 And McDougall, kind of tongue- in-cheek said... 14:53 Wow... you? Nobody exercises more than you do! 14:55 You have a problem with weight? He said... "Yes, I do. " 14:58 And then McDougall said something very profound 15:00 He said, "Well, you know, actually anybody on the 15:03 American diet will have a problem with weight 15:06 no matter how much they exercise. " 15:09 If you go on a plant-based diet, you won't have a problem. 15:12 Well, a year later, "Sports Magazine" interviewed 15:16 Carl Lewis, and he indicated that he had changed 15:20 to a vegan diet, and he no longer had an issue with weight 15:23 He could eat as much as he wanted. 15:25 Also, his performance improved. 15:28 That's another topic for another time. 15:29 So, if exercise isn't the answer, what is the answer? 15:36 Well, we're going to find that the answer is actually 15:38 found in the insulin resistance syndrome 15:41 Now what is the insulin resistance syndrome? 15:45 Well, as we mentioned on other talks, it's a combination 15:50 of things that happens when you have insulin resistance 15:54 Remember... insulin resistance occurs when you 15:57 take in the animal products. 15:58 The way your body is supposed to work... 16:00 You take in sugars or starches, your blood sugar RISES, 16:03 the pancreas releases INSULIN, which is a little key... 16:05 it goes to each of the cells of your body, 16:07 it goes in the keyhole, opens up the cell door 16:10 and allows sugar to leave the blood and go in the cell, 16:13 and get burned, and that brings your blood sugar down. 16:15 When you take the animal products, those go in, 16:17 and they PLUG UP the KEYHOLES 16:21 Now when you eat sugars or starches, the blood sugar 16:24 rises, insulin is released, but it can't get in the keyhole 16:27 The doors stay shut, and the blood sugars rise, 16:30 and that is the result of insulin resistance... 16:32 and it can lead to DIABETES 16:35 But we're now finding that this insulin resistance causes 16:38 other problems. 16:39 As we discussed earlier, it causes high blood pressure, 16:42 it also causes high blood sugars... 16:45 but it also causes obesity 16:47 And one of the criteria for the insulin resistance syndrome is 16:52 ...if your a man, if your waist is over 40 inches, 16:55 or for a woman, if it's over 35 inches 16:57 ...those are 2 criteria 16:59 Insulin resistance also includes high triglycerides... 17:01 that's the fat in the blood, over 150 17:04 It includes a low HDL... the HDL is the good cholesterol 17:08 in your blood. 17:10 If your a man, if it's below 40, or for a woman, below 50, 17:13 that's another criteria for the insulin resistance syndrome 17:16 and if you have 3 out of 5 of those symptoms, 17:19 you have the insulin resistance syndrome 17:22 Well, the question then follows... 17:24 What is it about the insulin resistance syndrome that 17:28 causes weight gain? 17:31 Well what we find is that when you have insulin resistance 17:36 the body starts to compensate by releasing more insulin 17:44 What happens is the pancreas says... 17:46 "You know, the normal 30 units of insulin a day that used to 17:50 control the blood sugars, is not working anymore. " 17:53 "Blood sugars are rising because of this 17:55 insulin resistance... What am I going to do?" 17:57 "I know what I'll do... I'll just release more INSULIN" 18:01 So the pancreas releases more insulin, 18:04 and now is able to overcome the insulin resistance 18:07 ...Maybe it has to release 35 units a day, 18:10 40 units a day, whatever it takes to keep the blood sugars 18:14 down! 18:16 This insulin resistance is typically measureable 18:20 as many as 12 years before the diagnosis of diabetes 18:25 As insulin resistance increases over the years, 18:29 your body produces more insulin and your insulin levels 18:34 slowly increase. 18:35 Is this a problem? Well, yes... 18:38 because insulin not only drives sugar into the cells 18:42 to be burned, or stored as glycogen in the liver, 18:45 it also drives fat into the fat cells to be STORED 18:50 and it prevents fat from being BURNED 18:53 So, as you are having increasing insulin resistance over 12 years 18:57 ...your insulin levels RISE over those 12 years 19:00 and your body fat increases over those 12 years... 19:04 until at the end of, say, maybe 10-12 years, 19:06 the pancreas can no longer keep up with the high insulin level 19:11 the high insulin resistance you have at that point 19:13 and so now, the pancreas can't keep up, 19:17 the fasting sugars start to rise 19:20 And then you see your doctor, and the doctor says... 19:22 "Well, you have diabetes because your blood sugars are high 19:26 and you are too heavy, and that's causing your diabetes 19:35 Well... that's not actually correct 19:38 What we find is that he has obesity BECAUSE he has 19:42 the diabetes and the insulin resistance, 19:44 and the increased insulin levels causing that 19:47 fat storage in the body. 19:51 So these increased insulin levels, cause increased weight 19:58 There was a man who was diagnosed with diabetes 20:05 and his insulin resistance had increased to the point 20:09 where we had to increase his insulin levels, and I said... 20:13 "You know, we have to increase your insulin dose"... 20:15 and he said, "OH! Please don't do that... 20:17 don't do that... I said, "Well, why not?" 20:18 He said, "Because my weight is going to go UP! 20:22 He knows that once you're diagnosed with diabetes, 20:24 and we start you on insulin the more insulin we give you, 20:27 the higher your blood sugar goes. 20:30 Now, when a person is typically diagnosed with diabetes, 20:33 the first drugs that came out on the market were the 20:36 sulfonylureas... 20:37 These are drugs which stimulated the pancreas 20:40 to release more insulin 20:42 So we'd start a patient, a newly diagnosed diabetic 20:45 on these sulfonylurea drugs... 20:47 It stimulated the pancreas to release more insulin, 20:49 and that allowed the blood sugars to be controlled again 20:53 BUT, at the expense of higher insulin levels, 20:57 and the weight would then increase. 21:00 A quote from one of the medical journals talked 21:05 about diabetic drugs... 21:06 This was from an up-to-date journal, 21:08 said... "Insulin stimulates weight gain, and the 21:12 sulfonylureas that increase insulin release, 21:16 ALSO increase weight! 21:19 Now today, there are some drugs that do NOT increase weight 21:22 that are used for diabetes... They have some pros and cons 21:25 which we can't discuss at this time but there are other options 21:30 There was also a "United Kingdom Prospective Diabetes Study" 21:35 The UK PDS that reviewed 2,520 subjects 21:41 What they did was they tried to control their blood sugars 21:43 4 different ways... 21:45 One with just a low-calorie diet 21:48 One was diabetic pills; 2 types of pills which 21:53 increased insulin release by the pancreas 21:55 And the last, was just to use insulin injections 21:59 And what they did was, they measured how much these 22:03 different approaches increased insulin levels in the blood 22:07 They found that with the low-calorie diet, 22:10 it really didn't affect their insulin levels THAT much 22:13 and there was no significant weight change 22:17 But the pills, they found roughly... 22:19 the higher the insulin level increase in the blood 22:24 from the medication, the higher the weight gain 22:27 ...That it was roughly proportional to the level 22:31 of insulin increase in the blood 22:35 They did another test... another large control trial 22:40 called... "The Diabetes Control and Complications Trial" 22:43 and what they found in it was that the weight gain effect 22:48 of insulin is dose-dependent 22:51 as illustrated in "The Diabetes Control and Complications Trial" 22:55 where the mean increase in weight was 5.1 kilograms 23:01 in the patients with the intensive treatment group 23:03 In other words, they took a group of patients, 23:05 they gave them LOTS of insulin to get their blood sugars 23:08 very well controlled, and they found that their weight 23:10 increased dramatically 23:13 In the other group, that was controlled less intensely, 23:18 they used lower doses of insulin, had higher blood sugars 23:21 but they found that the weight increase was only 2.4 kilograms 23:26 ...much less than those with the intensive treatment 23:30 They also measured A1c Well, what's A1c... 23:34 Well what happens when you have high blood sugars 23:37 the sugars can combine with the hemoglobin 23:40 and the percent of hemoglobin that is in the blood 23:43 that is combined with sugars... 23:44 what they call the percent A1c or the hemoglobin A1c 23:48 it's related to your average blood sugars 23:51 over the last 3 months 23:53 And in this trial, the better control they had, 23:57 the lower the A1c levels they got... 24:01 the greater the weight gain 24:03 In other words, if they were using lots of insulin 24:06 to get better blood sugar control, 24:09 there was higher weight gain 24:11 In this trial, they found something very significant 24:14 They found that there was NO relationship 24:16 between calorie intake, and weight gain 24:20 Those eating lots, those eating little... 24:22 did not affect their weight 24:24 What did affect their weight was their insulin levels 24:28 and how much insulin they were getting. 24:30 There was also NO relationship between EXERCISE in weight gain 24:35 in this study 24:36 They could be exercising, or not exercising, 24:39 the weight was more strongly controlled 24:44 by the insulin that they were getting 24:47 It trumped the other causes of weight problems. 24:52 Now, this puts us in somewhat of a dilemma because physicians 24:57 now have a problem 24:59 Are we going to control their blood sugar with more insulin? 25:02 Or are we going to try to control their weight by 25:05 cutting back on the insulin? 25:07 And, it seems like there's not a good solution, 25:11 but in fact, there IS on a plant-based diet 25:14 you can actually DECREASE your insulin-resistance 25:17 which would then require less insulin... 25:21 which would then help to drop your weight 25:24 And that is, indeed, what we found to be most effective 25:28 is a plant-based diet to decrease insulin resistance 25:31 and allow weight loss. 25:32 Our experience has been, most people will lose 25:34 about 2 pounds a week on a vegan-type diet 25:39 where you eliminate meat products and dairy products, 25:41 the oils, and concentrate on the fruits, nuts, grains, 25:45 vegetables and legumes. 25:49 Is insulin resistance prevalent enough to account for the 25:54 diabetes epidemic that we have in America? 25:57 As we mentioned in one of our earlier talks... 26:00 diabetes increased 500% 26:04 in America in the span of 36 years... it's epidemic 26:08 Americans, 1 out of 4 has the insulin resistance syndrome 26:13 ...30% of overweight adolescents have the 26:16 insulin resistance syndrome 26:18 What this is telling us is that... yes, 26:21 the insulin resistance syndrome is certainly prevalent enough 26:26 to account for the massive increase in obesity 26:30 that we have in America today. 26:33 So, what ARE the foods that can decrease insulin resistance? 26:38 Monosaturated fats can help decrease it. 26:42 The olive oil as eaten in the olive... 26:45 Please get it in the olive, that's the best place... 26:48 try to avoid the refined oils That can be very helpful 26:52 Polyunsaturated fats... found in safflower oil, 26:55 sunflower oil, corn, and soybeans can also be helpful 26:59 But again, try to get the oils in the plant in the natural form 27:04 For instance, to get 2 tablespoons of corn oil, 27:10 requires 14 ears of corn 27:13 Most of us don't eat 14 ears of corn at a time 27:17 We're not really designed to get that much oil at one point 27:19 So, if you can eat the oil IN the natural form, 27:24 you're going to limit it naturally 27:27 Fiber can help reduce insulin resistance 27:30 ...Whole grains can also. 27:31 Remember, the foods that increase insulin resistance, 27:34 is saturated fats, including the flesh and the dairy, 27:36 trans fats from the margarines, the shortenings 27:39 the fats from frying, partially hydrogenated fats 27:42 in the trans fats... 27:44 If you can avoid these, you can help reverse the 27:47 insulin resistance syndrome, and your weight will come off 27:50 We're hoping that you can try some of these approaches 27:55 monitor your weight, and get the benefits that 27:59 God desires you to have May God bless... 28:02 We look forward to seeing you as we cover some last topics 28:05 in diabetes in our next talk |
Revised 2014-12-17