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What Makes us Fat? Where I Stand in 2011

Posted Jan 13 2011 2:27pm

by Barbara Berkeley, MD

About ten years ago, on our annual family visit to the Bahamas, I had a sudden insight into what might be causing obesity.  I had been treating obese patients for some years and had been watching them relapse.  I also was watching the frustrating progress of my own weight.  I had always been thin, but during my forties I had grown twenty pounds heavier despite my usual schedule of  five-day-a-week high intensity aerobics.  The annual diet that preceded our vacation was no longer working and the few pounds that I was able to knock off came rushing back within a week or two of our return. 

In 1992, Don and I had moved to a country property.   Both of us had grown up in the crowded suburbs of New York City and longed for some contact with plants and other living things.  I, particularly, had always wanted animals.  About the best we were able to do in our small row house in Jersey City was provide shelter to a parakeet, a series of hamsters and some goldfish.   Now (thanks to my industrious and long-suffering husband) we became the caretakers of sheep, goats, horses, donkeys, turkeys, chickens, a dog, a parrot and a whole host of cats. As it happens in these situations, these animals gave us much more than we ever gave them.  The learning curve involved in their care was steep and the knowledge they imparted was fascinating.   

Our horses grew lean and shiny-coated on their summer grass, but became sluggish and fat-bellied when fed “sweet feed” (a molasses coated mix of grains).  Our golden retriever ran exhausting loops around our farm, but got fat on a standard dog food and as a result of eating morsels of feed that were dropped by the horses.   In an effort to slim him down, I learned of the “Bones and Raw Food” movement favored by some dog enthusiasts.  The idea was to re-acclimate dogs to foods that were more natural to them genetically.  I switched him, with excellent effect, to a dog food that paid attention the original nutrient balance of canines.   Our cat’s veterinarian was also invested in the idea of feeding cats the diet they were most genetically programmed to eat. 

Interestingly, our animals didn’t get fat from eating too much or exercising too little.  They were never overfed.  In fact, it took a startlingly small amount of the wrong foods to cause overweight.  Who would imagine that a 1200 pound horse could grow a big fat belly from an extra half a coffee can of grain a day?  Who would predict that a horse that size could graze on pasture all day and all night and remain as lean as Secretariat?  Who indeed?  Those who knew anything at all about horses!

It was with these new experiences  swirling in my subconscious that I had a moment of sudden clarity in the Bahamas.  I remember that I was about to have breakfast at the hotel buffet.  I was making my usual calculations:  if I ate that chocolate muffin now and skipped lunch,  maybe I’d be ok having my favorite chocolate mousse for dinner.   I plopped down into my seat feeling the irritating scrape of two fat thighs rubbing together.  Looking out through the windows onto the beach, it all came together over the turquoise blue of the sea.   Those palms were growing here, not in Cleveland, because they had certain programmed requirements.  The trim seagulls trolling the sand were looking for their particular diet of fish.  Our horses ate grass and stayed in perfect weight balance.  What I, their caretaker, was eating had absolutely nothing to do with what was natural to my organism: the human organism.  Even without researching it further, this seemed immediately obvious. 

I sat there and remembered the day that one of our high school teachers, a smoker, lectured us on the dangers of nicotine.  He lit a cigarette, took a deep drag, and exhaled through a clean, white handerkerchief he  had pulled from his pocket.  A dirty, yellow ring formed immediately, staining the white cloth.  “But if you know smoking does that,” we insisted, “why are you still doing it?”  With only a moment’s hesitation, he replied.  “I’m not going to anymore..”  He took the packet of cigarettes from his shirt pocket, ripped it in half and threw it in the garbage pail by his desk.  It was his moment of clarity.  He never smoked again.

I pulled myself out of my chair and approached the buffet feeling a strange and similar commitment.  It was fascinating.  What was likely to be “human” food?  The eggs?  Probably.  Some meat?  Likely.  The grits and butter?  I wasn’t sure.  But I would find out.  And I soon did, contacting various experts on original forms of human diet and researching what I discovered was already a well-established dietary approach for many.  

In the past ten years, nothing has occurred either in terms of my personal or professional experience, that has changed this basic tenet.  We are healthiest when we eat a diet that is familiar to our ancient genes.  We also will lose excess fat and remain lean if we do so.

But ten more years has added the benefit of additional observation in the real world.  For many years, particularly in the mid twentieth century, we humans stayed lean on diets that were full of hot dogs, apple pie,  hamburgers, ice cream and devil dogs.   Yes, but we exercised more …right?   Not on my block, where staying out till 8 pm in the summer meant sitting on your stoop and playing aggressive, calorie consuming sports like “hit the penny” and potsy. 

So new observation number one is that something has changed.  While we’ve probably always been best served by eating a close approximation of the original human diet, we used to be able to get away with cheating quite a bit.  Now we can’t anymore.  Why not?  The possible candidates are legion.  An environmental exposure to some toxin or chemical.  A small change in the way our genes are expressed which may be stimulated while we are in utero (epigenetic change).  An increase in the load of fructose or some other specific substance or additive in our diet.  The reaching of a specific threshold, beyond which our bodies can’t tolerate fake food.    It would be interesting to know, but it almost doesn’t matter.  If you want to win at hide and seek---don’t ask why you’re still at large----just  high tail it back to base and yell, “Home Free All!”  That base--- and I hope you’re headed there---is our original diet. 

Observation number two is that many people use “low carb diet” as a shorthand for the original human diet.  And this is not a bad way to look at it, but it misses some fine points.   I personally adhere to the belief that we get fat because we start to store and trap fat inappropriately.   Since insulin is the primary hormone that controls fat storage, I favor the belief that this problem occurs when insulin gets out of control and stops working properly.    If we drop most carbs out of the diet, leaving only carbs like veggies and low sugar fruits,  our insulin falls back into the low range and fat can be released and gotten rid of.  Fat also can’t be stored if insulin is low.   The original human diet is low in carbohydrate because it lacked all grains and most sugars, so there is an approximation there.   However,  the idea of eating more originally is to avoid other potential pitfalls of the modern diet, not just obesity.  For this reason, I also advocated eating animal proteins that look more original…meaning have more omega 3 and fewer omega 6 fats.  We can do this more easily today with the availability of grass fed meats and free range poultry.   We also may want to pay attention to modern additives like growth hormones and antibioltics—certainly not ancient.

Observation three is that we get fat because we are “stuck on fill”.  I’ve used that term before to mean that the system (controlled primarily by insulin) that decides if we will burn food or fill the fat cells with it is actually stuck like a jammed valve.  This valve can get stuck when we eat too much modern food laden with carbs.  But it also can get stuck through forced overfeeding.  We can essentially eat ourselves sick.   As most of you know, I loathe the blame placing that goes on around overweight.  I’ve been known to wade into discussions with verbal guns blazing when I hear these words, “I don’t know why fat people can’t just stop eating!”   Being fat means having a storage disorder that triggers more hunger.  Whether this is because big insulin surges are making hunger or because all of the needed energy is trapped in fat cells and the body needs more food to go on, we’re not sure.  Whatever the cause, for most overweight people, reducing fat mass by lowering carb intake (and therefore insulin) will get rid of the big hunger.   The last ten years have taught me, though, that there is a subpopulation of people who do eat strictly for emotional reasons.  Once they become overweight or obese, the problem is intensified and the weight gain can be large and rapid.   I think it’s important to recognize this because the treatment for this particular group of people should include therapy.  Having  said this, I have found that 80% of the overweight people I see in my office think that they eat emotionally. They’re right.  We all do. Eating emotionally in the United States of 2011 is a given.  But is it their major problem or just a sidebar?  Until you have tried a diet that lowers insulin significantly and have given hunger levels a chance to abate, it is hard to know why you are eating.  You may find that your drive to eat is more biological and less psychological than you thought.

Observation four is that serious maintainers must stop playing with addictive substances…and by this I mean sugar and starch.  I have a number of patients who actually use the word “play” when describing their mini-binges with doughnuts and potato chips.   What they don’t realize is that the food is playing them, not the reverse.  Insulin stimulating foods are seriously addictive.  Enough so that several of the new obesity drugs in the pipeline rely on the same mechanisms that block other addictions like those to heroin and nicotine.  Since we don’t want to remove everything pleasurable from our diet, it is vital to establish a number of things that give you a carb-like “hit” but without the after-cravings.  I have referred to these in previous posts as NTTs or Non Triggering Treats.  

So in summary:  as 2011 begins, here’s where I’m sitting.  We are fat because a problem in our fat storage mechanism which “gets stuck” and diverts too many of our calories into fat cells, trapping them there.  This process can be reversed and permanently bypassed by getting rid of starches and sugars in the diet.  You should continue to eat vegetables and low sugar fruits.  Most people will be able to eat low fat dairy (milk products do stimulate insulin, but don’t seem to be an issue for many).  I personally don’t eat grains, whole or otherwise.   I also avoid legumes like starchy beans.

 The fat storage problem we so easily acquire in today’s world is like the first push on a stack of collapsing dominoes.  It throws off blood pressure, messes up cholesterol, inflames the insides of your arteries, exposes you to intensified cancer risk, and creates diabetes.  Reverse this disorder and you reverse all the others along with it. 

I remain open to new studies, new information and new ideas.   As of January 2011, I believe that the basic concept  as I’ve described it makes sense both scientifically and experientially.  It works.  I’ve seen it.  I live it.  Each of you will find your own variations.  I wish you health and success.

Happy New Year to all!

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