As a family physician, patients are always coming to me for help with weight loss. Until this year, I felt incapable of helping them since I was struggling with my own weight. During my first three years as an attending physician, I had two babies and thirty pounds of excess weight accumulated while pregnant and breastfeeding. I was twenty pounds overweight, exhausted, achy, and constantly sick with every cold virus my babies brought home from daycare. There was no mystery to my weight problem. I was eating a diet consisting almost entirely of processed carbohydrates, working 12 hour days, sleeping a maximum of 5-6 hours a night, and not exercising at all. I gave myself all the same excuses my patients gave me: I have no time to exercise, I cannot eat healthy because the drug reps bring donuts and bagels and pizza and pasta and cookies to work, and my husband cooks unhealthy food and brings home chips and cookies and candy and ice cream. Deep down, I knew that I did not want to give up these foods because eating had become my only pleasure. I did not enjoy exercise, and I wanted to spend the little free time I had sitting on the couch watching Netflix and eating.
Most physicians do not get much training in nutrition, obesity and weight loss, and we give the same bad advice that you hear from non-physicians: always eat breakfast, eat small meals and snacks throughout the day, follow a high-carb, low-fat, low-calorie diet, and exercise daily. I knew that this advice did not work because it had never worked for me or for any of my patients. I read several books and was surprised to learn that the medical literature has always supported a low-carb, high-fat diet for weight loss and that exercise does not play a significant role in weight loss.
The most influential book I read was The Obesity Code by Jason Fung, MD, a nephrologist. He explains the role of insulin in weight gain and how weight loss can be achieved by lowering your insulin level. Insulin is a hormone which causes weight gain through building muscle and storing fat. Insulin levels rise when you eat, so the more often you eat, the higher your insulin levels get. Insulin rises more with higher glycemic index foods, such as processed carbohydrates, specifically foods containing sugar and flour. Insulin rises the least when you eat fat, followed by protein, then low glycemic index carbohydrates like leafy green vegetables, then higher glycemic index carbohydrates like fruit, grains, and starchy vegetables such as corn and potatoes, and finally by highly-processed carbohydrates such as alcohol, sugar and flour. Another great book which explains the relationship between insulin and the foods we eat is The Thinsulin Program by brothers and physicians Charles Nguyen, MD and Tu Song-Anh Nguyen, MD.
In addition to choosing foods which are less likely to spike insulin levels, it is also important to decrease the frequency of eating to keep insulin levels low. The concept of fasting often freaks people out, but you probably fast every day. Most people fast for approximately 8 hours daily while sleeping and pretty much eat constantly during the other 16 hours of the day, which ensures that the body has a constant fuel source and that weight loss remains impossible while weight gain is likely. Just eliminating snacks helps to decrease insulin levels and allow the body to burn fat stores between meals. Intermittent fasting is nothing more than an extension of the normal daily fast and may involve eating breakfast later and dinner earlier without any late-night snacking resulting in an 8 hour eating window with a 16 hour fasting window each day. It may involve skipping breakfast altogether and eating two meals daily during a 6-8 hour eating window. Once you are fat-adapted, meaning that your body preferentially burns fat rather than sugar for fuel, your body will more readily access your own fat stores for fuel during a fast, and you will not feel hungry during fasting.
Insulin is also affected by stress and sleep deprivation. When you get less than 7 hours of sleep per night or when you are under constant emotional stress, your cortisol levels rise. Cortisol is a stress hormone, and higher levels of cortisol produce a rise in insulin levels. Getting plenty of sleep and finding ways to reduce emotional stress are important for weight loss. If exercise is enjoyable and helps with stress-reduction, it may be helpful for weight loss. However, exercise may actually impede weight loss for those who do not enjoy it or who sacrifice sleep in order to make time for exercise. Also, weight training will raise insulin in order to build muscle, which will cause weight gain rather than weight loss.
In six months, I lost over 30 lbs, mainly by eliminating sugar and flour from my diet. I try to get 7-8 hours of sleep every night, but I rarely exercise. In a typical week, I do one yoga class. I have a ton of energy, no pain, and I have not been sick once this year. I think I’ve actually had a few viruses, but my symptoms were so mild, that it’s hard to tell. Sugar and other processed carbohydrates have an inflammatory effect on the body and are the main cause of diabetes, heart disease, liver disease, kidney disease, autoimmune diseases, arthritis, and even dementia. I am so excited to share the cure for obesity, chronic fatigue, chronic pain, and most chronic diseases: eliminate sugar and other processed carbohydrates from your diet. It sounds impossible, but if I can do it, anyone can, and it is SO worth it.