A New Understanding of Weight Loss, Part 1

Weight Loss

Weight loss has been an interest of mine for a long time. This is partly because so many people have asked me to help them lose weight over the years. The other reason is that since I have been alive, there has been so much, often contradicting, information about diet and how to eat right that I simply wanted to figure out the right answer. Some of my patients trying to lose weight were not able to achieve satisfactory outcomes with methods that proved to be successful for others. Often, there was no apparent rhyme or reason.

Few topics in medicine receive as much attention as weight loss. Magazines and blogs are full of newly invented diets and the total U.S. weight loss market is a $72 billion industry. Weight Watchers, Atkins, South Beach, Bulletproof, The Whole 30, Paleo, you name it…. Why are there so many new diets each year if one of them would really work for everyone? According to a 2017 Forbes article, 70% of Americans are either overweight or obese. And the most important question remains. Why are so many people overweight these days?

Inflammation & Weight Loss

Clearly, the topic of weight loss is a complex and complicated one. I have seen plenty of patients who were really adamant about following whatever was prescribed but were not able to shed sufficient pounds. For many of those avoiding foods that caused them systemic inflammation finally did the trick. One of my patients initially lost 14 lbs in two weeks and made NO changes other than to avoid foods that cause systemic inflammation. One year after following this approach, he has lost 35lbs, does not need his cholesterol medication anymore, and even got rid of his stubborn psoriasis. Because he also has a significant family history of heart disease, I am extra glad that his health could not be better now.

Why So Much Inflammation?

When I started practicing medicine over 20 years ago, inflammation was already one of the biggest topics in medicine. It seemed like everywhere you turned people were talking about inflammation. Sales of prescription and OTC anti-inflammatory drugs became staggering. Scientists identified chronic inflammation as being the root cause behind all leading causes of death in the US and other industrialized countries, except accidents.

Some Brief Statistics

Chronic inflammatory diseases are the most significant cause of death in the world. The World Health Organization (WHO) ranks chronic diseases as the greatest threat to human health. Diseases associated with chronic inflammation are expected to increase persistently for the next 30 years in the United States. In 2000, nearly 125 million Americans were living with chronic conditions and 61 million (21%) had more than one. In recent estimates, nearly 60% of Americans had at least one chronic condition in 2014, 42% had more than one, and 12% of adults had 5 or more chronic conditions. Worldwide, 3 of 5 people die due to chronic inflammatory diseases like stroke, chronic respiratory diseases, heart disorders, cancer, obesity, Alzheimer’s disease, and diabetes.

A Profound Discovery

It has long been understood that chronic inflammation is a disease of affluence. Eating too many calories, sugar & processed foods, exposure to toxins & chemicals, and stress all have long been known to cause chronic inflammation. But until recently, one astonishing discovery that goes back almost 2 decades had not yet received the attention it deserved. In 2000 Dr. Allesio Fasano, a gastroenterologist at Harvard Medical discovered that depending on their genetic makeup, people can have different reactions to certain foods causing the release of the protein zonulin. He particularly researched zonulin in the context of Celiac disease and other gluten-related disorders. With over 24 million people affected by gluten-related disorders, it shows that there are many more people affected by this than we previously thought. And those are only the ones reacting to gluten!

Gluten, Zonulin, Lectins, and Weight Loss

Gluten is essentially a lectin and part of the lectin-family. There are many different lectins found in nature. Although many lectins are beneficial or at least harmless, others can be quite harmful. Some lectins found in certain fruits and vegetables can trigger the same release of zonulin as seen with gluten. In the small intestines, large amounts of zonulin can cause barriers, called tight junctions, to open for extended periods of time. These barriers are normally very selective in whom they grant entry. The uncontrolled opening allows substances to slip into the bloodstream that are simply not supposed to be there. Because they are regarded as invaders, they are tagged for removal and an immune response (inflammation) is mounted. People affected by this might not be aware of what is happening in the beginning. Symptoms arising from this can be quite subtle for many years. But the underlying inflammation keeps on going, breaking down tissues and “corroding” the body.

How Does Inflammation Inhibit Weight Loss?

• Inflammation, especially chronic one, is a state that requires a lot of energy. Therefore, the body stores whatever excess calories it can get into our most effective energy storage system – fat.
• Inflammation can interfere with the body’s response to leptin. Leptin tells the body when you had enough to eat. If this response is blocked you will most likely eat much more than you need.
• Pro-inflammatory cytokines interfere with the body’s insulin response. When this leads to insulin resistance, the body has to release massive amounts of insulin to get sugars out of the blood. These high levels of insulin lead to weight gain, especially in the abdominal area.

What Can You Do for Weight Loss?

Remember, the most important issue with being overweight is not an aesthetic one – it is a medical one. Being overweight does not only increase your risk to develop a serious medical condition. It can also cause depression, arthritis, fibromyalgia, back pain, and joint pain. Another important fact to consider is that it is actually really hard to lose weight only with exercise. I know this might sound strange to you. But after decades of studying this subject, take my word for it. Of course, regular exercise is really important and should be done at least 5 days per week. The benefits of exercise are plentiful. But losing weight only by increasing your exercise will be difficult. So what should you do? Below are some pointers that I will reiterate and explain in greater depth in part 2 and 3 of this post:

• Eat good food. Processed foods are loaded with calories and often have additives that make you crave more of what you just ate. Unfortunately, our general understanding of what should be on the list of ‘good foods’ is not always clear to everyone and will most likely change significantly in the next 5-10 years. Therefore I decided to listen to pioneering thinkers in the field rather than wait for mainstream science to arrive at the same conclusion years later. The results I see applying this knowledge in myself and my patients speak for themselves. As they say – the proof is in the pudding!
• Consider strategies like intermittent fasting. Your stomach is a creature of habit. By strategically skipping certain meals or snacks you can cut down on a lot of calories without feeling hungry
• Identify trigger foods. As mentioned earlier, certain foods can cause chronic inflammation or disrupt your metabolism in other ways that make you gain weight. As science is just starting to take a closer look at this subject, it is important to familiarize yourself with and identify potential foods that make you sick.
• Make sure you get plenty of good sleep.
• Get regular exercise. High-intensity interval training is very efficient. In less than 30 minutes you can do an incredibly effective workout and keep your metabolism stimulated for hours.
• Weigh yourself once to twice per week at the same time of day preferably without clothes
• Eat until you feel satisfied, not full
• Skip the alcohol and sodas. Mineral water with added natural flavors can be a great substitute. Always remember that after a few days your body will have adopted this new “habit” and cravings will stop
• If you have a sweet tooth switch to salty. Even if you transition from ice cream to sweet-potato or salted plantain chips as a treat you are still better off to achieve weight loss. You will be in even better shape if, after a while, you can then transition from the chips to salted popcorn. Please note here that I’m not advocating to snack on chips here. But before you whip out the Haagen Daz, the salty alternatives might be a saving grace.