Wonderfully Made

Obesity: The Ineffectiveness Of Low-calorie Diets, Pt 2

Three Angels Broadcasting Network

Program transcript

Participants: N. David Emerson

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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


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Revised 2014-12-17