I was miserable for the first two months of my “diet”. Although I physically felt better and was pleased to see the numbers on the scale dropping and to feel my body shrinking, I was in a state of emotional turmoil. I grimly ate my grilled chicken and salmon and salads and steamed broccoli while watching others enjoy pizza and French fries and cookies and soda. I told myself sternly “You can’t eat those foods” and I suffered from this perceived deprivation. I had to wrestle with my desire for sugar and use huge amounts of willpower when anyone offered me a delicious forbidden treat or when the donuts called to me from the breakroom or the Girl Scout cookies beckoned from the freezer.
My plan from the very beginning was to reach my pre-pregnancy weight and then return to all of my favorite comfort foods. In fact, that was my main motivation. “Hurry up and lose the weight, so you can have ice cream!” my brain shouted. As someone who has always struggled with my weight, gaining and losing the same thirty pounds over and over again, I knew this was not logical. However, I could not conceive of a life without sugar. The prospect seemed so bleak.
When I had lost over half of my excess weight, I discovered a weight loss podcast by a fellow physician, Katrina Ubell, MD. Her words completely changed my perspective. She said “I want your food to be boring and your life to be exciting.” I teared up thinking of all of the times I declined invitations to go swimming because I did not want to wear a swimming suit in public. I even stayed home when my family went to California because I was overweight and did not want to pose for vacation photos in shorts. I realized that I was hiding from my life and that only by releasing this obsession with food would I be free to chase after the things I truly want.
I started working on my thoughts about food with the help of Katrina Ubell and Brooke Castillo, life and weight loss coaches. I stopped saying the word “diet” and starting thinking about what I ate in terms of an eating protocol: all of the foods that I choose to eat on a regular basis because they make me feel good physically and support a healthy weight. I stopped telling myself that I can’t eat certain foods. Instead, I tell myself that I can eat anything I want whenever I want, but there are certain foods that I choose to avoid most of the time because they make me feel poorly and will lead to weight gain if consumed regularly. Instead of “cheating on my diet”, I plan ahead to eat off my protocol. I find that I make much better decisions ahead of time than I do in the moment. I have also noticed changes in my body every time I consume processed carbohydrates. For two days after eating Halloween candy as planned, I experienced nausea, stomach discomfort and fatigue. When I eat popcorn at the movies, my allergy symptoms worsen with increased post-nasal drainage and a dry cough.
Slowly but surely, these techniques have decreased my desire for sugar and flour. I used to believe there were only two ways to respond to an urge to eat a certain food: eat that food or use willpower not to eat the food. Eating the food does not decrease your desire for the food, and using willpower actually increases your desire for the food. There is a top secret third way to respond to an urge which decreases your desire: simply allow it. Even now as I search for the right words, I have an urge for that leftover Halloween candy. Amused, I relax and allow myself to want the candy. Of course I want Halloween candy. I have always loved candy and maybe always will. I check with myself to make sure that I’m not hungry. Nope, not hungry at all, I just want candy and am feeling a little restless as I write. I am not surprised, frustrated or disgusted by my desire for candy. As I explore this desire, I realize that my desire not to have any candy is stronger than my desire to eat candy, and the urge fades away. I feel so confident in my ability to maintain my weight because I love the way that I eat and think about food. I no longer feel restricted or deprived because I can and do eat whatever I want, I just want to eat healthy foods most of the time. The urges still occur, but not as often as they used to, and the drama has been quieted.
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.