While I was young and single, my fit (regularly running and lifting weights) weight was around 185 lbs. After getting married and having kids, my weight slowly crept up to a peak of 231.6 lbs on 2008-09-21. Afterwards, my weight would drift between 212 to 220 lbs. Besides the unhealthiness of being overweight, I didn't like the way I looked. I have been slowly working to become much leaner but, like for many people, this has not been easy. Over the years, my weight increased but every summer I had ambitions of burning off the extra pounds with exercise (biking, cutting my lawn, splitting wood, etc). By winter, I saw that the weight I had lost by autumn was temporary and insufficient. As I got older and heavier, my blood sugar increased and eventually needed medication to control diabetes.
In February of 2018, my doctor switched me to new medication that caused me to excrete excess glucose, which resulted in an immediate weight loss and reduction in my blood glucose. This also resulted in a reduction in my other medication. Although I thought I was eating reasonably well, I was pretty much following the recommendations of Canada's Food Guide to eat healthy carbohydrates and avoid saturated fat. With advice from the diabetic clinic's dietitian, I started to cut back on carbs and eat more protein. I've now lost about 30 pounds since the dietary and medication changes.
The population of western societies and especially those living in North America tends to be overweight. The obvious causes are poor diet and a lack of exercise due to a sedentary lifestyle. When it comes to shedding excess weight, exercise for the sole purpose of losing weight is unsustainable. It is important to stay stay active and keep moving as much as possible - easier said than done though.
- A Brief History of Fat, and Why We Hate It | Slate
- Why Am I Still Fat? | ABC
- What if we're wrong about diabetes? | Peter Attia | TedMed
- The mathematics of weight loss | Ruben Meerman | TEDxQUT (edited version)
The states of being overweight and obese are medical classifications based on BMI (Body Mass Index). Dr Arya Sharma explains that a person's highest body weight becomes the normal state that the body attempts to maintain at all times. If a person loses weight, the body has a various of responses that try to return the body to the "normal". Whatever method is used to lose weight is the method that must be continued to remain at that weight. Effectively, this means that obesity should be treated as a medically chronic condition. This is the reason that fad diets generally do not work in the long term and result in yo-yo weight loss. If it took years to become overweight, it is completely unrealistic to expect to lose it (and keep it off) in a matter of weeks or months.
- How to Lose 50 Pounds and Keep Them Off | Arya Sharma | TEDxUAlberta
- Obesity as a chronic disease Dr Arya Sharma (Webinar)
- Is your diet bulls**t? (CBC Marketplace)
- The Mindset for Healthy Eating | Gillian Riley | TEDxChelmsford
- Why dieting doesn't usually work | Sandra Aamodt | TEDGlobal 2013
- Dr. Jason Fung - 'A New Paradigm of Insulin Resistance'
A good mental attitude is crucial. People want to become less overweight for a variety of reasons (need to fit into dress for an occasion, going on vacation and want a beach body, etc). This will not work in the long term and will set you up for failure. Instead, a better reason is because you want to become slimmer because YOU like the way you look and feel. As you start to shed weight (or rather fat), the changes will be positive reinforcement for your efforts.
DISCLAIMER: My background is engineering and what I have written here is from my personal interest in staying healthy. If you disagree with any of it, let know what you feel is inaccurate and include some references so I can make corrections. This is a work in progress so check back often for updates as I continue to learn. CONSULT WITH YOUR DOCTOR BEFORE MAKING DIET AND LIFESTYLE CHANGES.
Obviously, if you want to lose weight, you need to "burn" (metabolize) your fat stores and the common wisdom is to eat less and exercise more. If you don't succeed, you're obviously lazy and not trying hard enough. However, this is supremely poor advice because it neglects your body's endocrine system, which heavily affects its metabolic state: fed or fasted. Your pancreas produces many hormones but the one that determines its metabolic state is INSULIN. The FED state is characterized by high insulin while the FASTED state is characterized by low insulin. One of insulin's jobs is to regulate blood sugar (ie, serum glucose) and the macronutrients (carbohydrate, protein, fat) in your meal have a huge effect on serum glucose. The Randle Cycle describes the process the body uses to determine whether it is the fed or fasted state.
Besides determining the metabolic state, insulin has a major effect on the body's ability to shed weight because insulin is THE fat storage hormone. When insulin is elevated, Lipoprotein Lipase (LPL) is activated which splits Triglyceride (TG) molecules into glycerin and fatty acids to allow fatty acids to diffuse into the fat and muscle cells. Insulin also activates the GLUT4 transporter, which is the gate through which glucose enters fat and muscle cells. When insulin is low, Hormone-Sensitive Lipase (HSL) allows fat cells to release TG back into the blood stream. The net result is that you MUST have low insulin to lose weight. Long-term caloric restriction (ie, eat less, move more) causes two more insults to dieters: 1) LPL becomes much more active when insulin is elevated, thereby making fat cells better at growing and 2) Ghrelin and Leptin (hunger hormones) also become more active. The more and longer you increase the caloric deficit, the hungrier you and your fat cells become. Low insulin inactivates LPL and actives HSL. In addition, low insulin levels increase LPL activity in muscle cells, thereby helping them to shift to fatty acid metabolism.
- Dr Paul Mason: Fat Cell Growth
- Weight reduction increases adipose tissue lipoprotein lipase responsiveness in obese women
- Calorie-restricted weight loss restores ghrelin sensitivity
- Appetite hormones may predict weight regain after dieting
Carbohydrate is the only macronutrient that contains sugar and this can take the form of monosaccrarides (ie, glucose, fructose, galactose) or disaccharides (ie, lactose, maltose, sucrose) or starches (long chains of glucose). Since your body tries to tightly control serum glucose, insulin is used to store excess in muscle and fat tissue. Protein isn't really a fuel (unless you're starving) and your body primarily uses protein to maintain its structure. Depending upon the type of ingested fat (short, medium, or long-chain), your body will either preferentially metabolize it or store in fat tissue and fat elicits a much lower insulin response for storage than glucose. Your microbiome ferments soluable fibre carbohydrate into short chain fatty acids but, with a rudamentary cecum (appendix), humans evolved away from herbivory. Unlike most natural foods, dairy is the one food group that contains all 3 macronutrients and is beneficial for growth in children. Lactose (milk sugar) definitely raises serum glucose, which will shift the body to the fed state. To minimize this effect, fermented full-fat dairy products (cheese, yogurt, etc) are a better alternative to milk in adults because of reduced sugar content. Fermented foods are generally beneficial because bacteria have converted sugars into short chain fatty acids.
In order to maintain a low insulin level, the obvious thing to do is minimize carbohydrate consumption and those on a carnivore diet avoid carbs completely. This is contrary to government food guides but there are NO essential carbohydrates - only essential proteins and essential fats. "Essential" means that the human body cannot synthesize these nutrients itself and requires their consumption. If you don't eat carbs, you still need to maintain your body's caloric requirements so you need to get fuel from another source, which is fat. Although some tissues in your body absolutely require glucose (ie, red blood cells and some brain cells), your body has the ability to manufacture ALL of the glucose it needs on demand from adipose tissue (fat cells) via gluconeogenesis in the fasted state. Fat is also converted to ketone bodies (acetoacetate, beta-hydroxybutyrate, acetone) in the liver via ketogenesis and the brain readily switches over to ketolysis when ketones are available.
Processed foods are typically made in factories by industrial processes and characteristically contain high amounts of carbohydrates and fats [usually in the form of industrial seed (vegetable) oils]. Besides the obvious high caloric content of processed foods, highly processed foods cause a much higher insulin response than those foods in their whole-food form due the disruption of their cellular structures. A food's fibre content is more of marker of its degree of processing than its nutrition so added fibre is NOT beneficial. Vegetable oils also play a huge role in cardio-vascular disease, especially when they become oxidized from heating. Basically, if the food is manufactured, don't eat it - no matter how healthy it says on the label.
- Gabor Erdosi: Part 2 of 2 - Insulin, Incretins - and the Perils of Processed Food Carbs
- Dr. Michael Eades - 'Incretins, Insulin, and Food Quality'
One of insulin's many effects is causing the kidneys to retain salt. When lower insulin levels, your body will excrete more salt with an accompanying decrease in blood pressure. If you're on hypertensive drugs, you may need to get your doctor to adjust your medication to prevent hypotension (low blood pressure) and you may also need to consume more salt to prevent the "keto flu" (fatigue, brain fog, headaches, muscle cramps, etc). Adequate salt consumption is necessary for good health so don't be afraid to add salt according to taste or have a glass of salty water if you're having keto flu symptons. Adequate potassium intake is important and potassium-enriched salt may be helpful. Cutting salt intake is ineffective at lowering blood pressure and it tends to worsen insulin resistance. The net result is that cutting your salt intake could worsen your diabetes, which implies that insufficient salt could elevate insulin. Again, only make electrolyte changes under the supervision of a doctor.
- Dietary Sodium Restriction Impairs Insulin Sensitivity in Noninsulin-Dependent Diabetes Mellitus 1
- Effect of potassium-enriched salt on cardiovascular mortality and medical expenses of elderly men
- Insulin resistance and hypertension: new insights
- Urinary Sodium and Potassium Excretion, Mortality, and Cardiovascular Events
When fat is metabolized, ketones are produced and diets that maintain low insulin levels tend to result in ketone production from fat metabolism. A ketogenic.diet (low carb, high fat) is essentially the opposite of the standard [American, Canadian, Australian, etc] diet (high carb, low fat) and is effectively the US Food Pyramid turned upside down. While it has been known a long time that insulin lowers the basal metabolic rate (BMR, ~ 300 calories/day difference between the fasted and fed states), Dr Ben Bikman's research has found that ketones increase the metabolic rate because they cause white adipose tissue to become uncoupled so that they generate heat like brown adipose tissue. High ketone levels also tend to waste fat via respiration and urination while also improving metabolic health.
- Dr. Benjamin Bikman - 'Insulin vs. Ketones - The Battle for Brown Fat'
- Dr. Benjamin Bikman - 'Insulin vs. Glucagon: The relevance of dietary protein'
- Dr. Benjamin Bikman - 'Ketones: The Metabolic Advantage'
- Dr. Benjamin Bikman: Insulin vs Ketones. The battle for the mitochondrion
- Dr. Michael Eades - 'A New Hypothesis of Obesity'
- Dr. Paul Mason - 'Evidence based keto: How to lose weight and reverse diabetes'
- Increased energy expenditure in poorly controlled Type 1 (insulin-dependent) diabetic patients
- Effects of a low carbohydrate diet on energy expenditure during weight loss maintenance: randomized trial
Many people believe that the reason that they've gained weight and have such a hard time losing weight is because their metabolic rate (how fast they're burning fuel) has slowed down as they've become older. According to the 1992 Baltimore Longitudinal Study on Aging. a better predictor of weight gain (and loss) is the Fasting Respiratory Exchange Ratio (FRER), which is the ratio of CO2 exhaled to O2 inhaled and is reflective of the degree to which a person is burning glucose to fat. Basically, burning more glucose increases FRER and burning more fat lowers FRER and the study showed that higher FRER results in the higher long-term weight gain and the lower FRER results in the lower long-term weight gain. The actual metabolic rate (determined by body mass) had NO effect on long-term weight gain or loss. Although increased muscle mass requires more energy, you lose more weight by burning fat rather than by how much fuel you're consuming.
While exercise is highly beneficial for multitude of reasons, it is nowhere as effective at weight loss compared to diet. Exercise doesn't burn-off nearly enough calories as you would want although you're probably not snacking while you're exercising. In addition to insulin's effect on the BMR, it's a lot more effective to avoid ingesting unnecessary calories than it is to metabolize them . For example, a 300 calorie doughnut will require about 60 minutes of walking (3.5 mph / 17 minutes/mile) or 30 minutes of running (5 mph / 12 minutes/mile) for a 155 lb person. See Calories burned in 30 minutes for people of three different weights.
Ben Bikman PhD recommends only consuming whole foods and has an easily-to-remember macronutrient alliteration for maintaining low insulin levels:
- Control Carbohydrates (< 50g/day from unprocessed, low glycemic index foods)
- Prioritize Protein (1-2g per kg of body weight per day)
- Fill with Fat (all remaining caloric needs from animal & fruit)
According to Dr Bikman, fat and protein should ideally be in a 1:1 ratio as is found in animal-sources food such as eggs and meat. Keep in mind that your own body fat counts in your fat consumption, which is why you need to have sufficient protein intake for tissue maintenance and we need more protein as we become older (1.0-1.2 g/kg/day and 1.2-1.5 g/kg/day for those with acute or chronic diseases). Since the body has no ability to store protein, excess protein is excreted and there appears to be no evidence that high levels of protein consumption is deleterious. The healthy fats that we should be eating are saturated. The degree of saturation depends upon the amount of hydrogen atoms that fatty acid chain contains and the difference between between beef tallow (containing stearic acid) and olive oil (containing oleic acid) is one carbon double-bond and 2 less hydrogen atoms, which makes olive oil a mono-unsaturated fat of the same 18-carbon chain length. All of the body's nutritional needs can be supplied from animal-sourced foods and plant-sourced foods often have antinutrients in them, which makes them even less nutritious. Another benefit of a high-fat diet is gall bladder health due to increased bile use.
- Dr. Nadir Ali - 'Why LDL cholesterol goes up with low carb diet and is it bad for health?'
- Dr. Paul Mason - 'Saturated fat is not dangerous'
- DavDavid Diamond - An Update on Demonization and Deception in Research on Saturated Fat...
- Evidence-Based Recommendations for Optimal Dietary Protein Intake in Older People: A Position Paper From the PROT-AGE Study Group
- Why chicken is killing you, and saturated fat is a health food, with Nina Teicholz
- How much food is 20 or 50 grams of carbs?
- Dr Michael Eades - 30 years of flawed nutritional science
- Georgia Ede: Brainwashed — The Mainstreaming of Nutritional Mythology
Eat when you're hungry and don't when you're not. Don't count calories. A lean physique is a characteristic of metabolic health. Rather than focussing on losing weight, it is far better to become healthy and the weight will come off and stay off. To see how I've reversed my own Type 2 Diabetes, see Metabolic Health..
Dr Michael Eades: We didn't evolve to eat meat. We evolved because we ate meat.
Miki Ben-Dor PhD's research suggests that humans (or rather the genus Homo) have been hypercarnivores throughout our 2.5 million year evolutionary history. Throughout human evolution, humans were apex predators that specialized in hunting very large animals, which resulted in physiological adaptions to meat consumption and especially fat consumption. That is, humans are lipivores (fat eaters). Amber O'Hearn makes the case that humans have evolved to become lipovores (fat eaters) rather than carnivores (meat eaters) and that our large brains are the result of our lipivore diet. The expensive tissue hypothesis explains that, as our brain increased in size, our digestive system correspondingly decreased in size in order to reduce its metabolic requirement (as dictated by Kleiber's Law), which in turn caused us to rely on nutrient-dense food. Agriculture only began about 11,500 years ago, which coincides with the extinction of Pleistocene megafauna . Humans may have precipatited megafauna decline as consequence of being superpredators. Miki Ben-Dor's research suggests that the human evolutionary diet was protein-limited and he uses a physiological protein limit of 35% of caloric intake, with the balance made up from fats and carbohydrates. As hunter-gathers, humans would have needed to to make up the remaining 65% primarily from fat. Because animal fat content becomes increasing greater with animal size, humans became specialized to hunting large, fat-rich animals
- The evolution of the human trophic level during the Pleistocene
- Humans were apex predators for two million years
- AHS18 Miki Ben-Dor - Are We Carnivores?
- ‘Superpredator’ humans are hunting other animals out of existence
- L. Amber O'Hearn - 'The Lipivore: What is Fat for?'
- Dr. Michael Eades: Paleopathology and the Origins of the Paleo Diet
- Miki Ben-Dor, PhD — “How Much Protein? The Evolutionary Answer“
The calorie content of macronutrients is: 4 kcal/g for protein, 4 kcal/g for carbohydrate, and 9 kcal/g for fat. Human daily caloric requirements may be calculated from your estimated BMR. Assuming a daily requirement of 1800 kilocalories (calories) and a body weight of 90 kg, the 35% protein limit works out to 630 calories/day or 157.5 g/day (or 1.75 g/kg BW/day).
Related to the physiological protein limit is the Protein Leverage Hypothesis. Basically, we will eat until we have reached our physiological protein requirement, which depends upon a variety of factors and is specific to each individual. The net effect is that, if your diet is protein deficient, you will continue to eat until you have consumed enough food to meet this need. This can lead to obesity because protein-deficient foods will cause you to overeat and injest more calories than required. Conversely, consuming more protein than physiologically necessary will result in the injestion of less calories than required.
Dr Ted Naiman has developed the Protein:Energy Ratio [P:E Ratio = protein/(carbohydrate + fat)] in gram units as a means of estimating the amount of macronutrients required for weight loss. He recommends a P:E Ratio of ≥1.0 to maintain lean body mass while reducing fat mass. Basically for the P:E Ratio calculation, your daily protein requirement in grams is your weight in pounds, which means a 90 kg person requires 198 g/day. Assuming that we restrict carbohydrates to 20 g/day, we could consume up to the remaining 178g/day with fat. Ben Bikman states animal-sourced food typically has around a 1:1 ratio of protein to fat so you would have to eat lean meat and/or supplement with protein isolates and/or eliminate carbohydrates completely. The body has very little ability to store protein and the limited carbohydrates result in low insulin, which puts the body into ketosis thereby causing it to burn stored fat. A person should lose weight even if the P:E Ratio's total daily calories are higher than what would be calculated from BMR. However, eating primarily very lean protein for a very high P:E Ratio diet is likely unsustainable in the long-term due to rabbit starvation from exceeding the physilogical protein limit.
Stuart Phillips PhD often mentions a protein intake of at least 1.2-1.6 g/kgBW/day to maintain lean body mass as well as a physiological protein limit of 35%. Seniors require more protein to compensate for their reduced ability to synthesize muscle (anabolic resistance). The best way to maintain lean body mass or gain muscle is through resistance training. Complete proteins (particularly those rich in leucine) help but it is the exercise that is most anabolic and provides 80% of muscle synthesis.
- Dietary Protein in Weight Loss: Advantage Protein by Stuart Phillips, PhD
- Dietary protein for athletes: From requirements to metabolic advantage
- Stuart Phillips: All THINGS PROTEIN myths & truths
- ProteinMobility in Muscle Loss - Video (Stu Phillips)
- 5 questions with Stuart Phillips, Ph.D. about protein needs and exercise science research
- Optimizing Adult Protein Intake During Catabolic Health Conditions
- Perspective: Protein Requirements and Optimal Intakes in Aging: Are We Ready to Recommend More Than the Recommended Daily Allowance?
- Is Chicken A Good Protein Source for Building Muscle? Dr. Benjamin Bikman
- Why Fat Should Be Consumed with Protein *Muscle Protein Synthesis* Dr. Benjamin Bikman Ben Pakulski
- Protein Leverage Hypothesis & Why Prioritize Protein by Dr. Benjamin Bikman
- The protein leverage hypothesis
- What is the PE Diet? | The Protein To Energy Diet Explained
- Lager Lecture Online: Move It or Lose It w. Dr. Stu Phillips
Unless you're an athlete, the practical aspect of the high protein consumption is that it can be challenging to consume 1.2 g/kgBW/d of protein and even harder to achieve the P:E Ratio's daily protein target. For improved muscle synthesis, it is better to injest protein over several meals (eg, 3 x 0.4 g/kgBW) rather than one large meal. Examples of how much food is required to acheive 100 g/day of protein:
- 17 large eggs: one large egg contains 6 grams of protein and 5 grams of fat
- ½ whole chicken: one 1.4kg Costco roasted chicken contains 216g of protein and 123g of fat
- 1½ 8oz round steaks: 3oz / 85g round steak contains 24g of protein and 12g of fat
MY Recommendation: Limit carbohydrates to a maximum 20 g/day of low glycemic vegetables and fruit and consume animal-sourced whole foods to satiety. Eat ONLY when you're hungry and don't when you're not. DO NOT count calories but DO consult with your doctor.
If you're wondering what I've been eating lately, the following list is what my daily meals typically look like. As I become fat-adapted, I've increasingly been doing one meal a day (aka, OMAD) so I eat breakfast when the rest of my family has supper. Minimizing carbohydrate consumption allows my body to have a very steady blood sugar, which allows me to have a better gauge as to when I'm actually ready to eat. I don't count calories and eat as much as I want but only when I'm hungry.
My progression to OMAD:
- Dietitian's advice: Reduce cold cereal consumption to 1 cup portion, including 1/4 cup of seeds (I chose sunflower and pumpkin).
- Substitute 2 eggs for cold cereal.
- Defer breakfast progressively later in morning as per continuous glucose monitor (CGM, Freestyle Libre).
- Eliminate lunch by having breakfast at noon. Switch to 3-egg breakfast.
- Defer breakfast progressively later in the afternoon as per CGM.
- Have breakfast with the rest of the family's supper, eat until no longer hungry. Compress eating window to a few hours (say 3pm to 6pm).
I found that mindless evening snacking (like while watching TV) is a great way to ingest unnecessary calories. Having a high fat (ie, healthy saturated fats) afternoon meal with sufficient protein is enough to prevent any craving for an evening snack. I like cheese but try to eat it in moderation due to its high calorie content. The ketogenic diet's need for increased salt consumption often presents as hunger so a glass of salty water between meals can be satiating. I find that moderate exercise (walking, biking, etc) with intermittent high intensity (ie interval training) is easily doable and evening walks (30-60 minutes) are a great post-supper/breakfast activity. A morning walk would also be helpful to deal with the Dawn Phenomenon, which tends to be exacerbated by the adaptive glucose sparing effect of fat adaptation. People also tend to sleep better on an empty stomach so avoid eating for several hours before bed-time.
(mid to late afternoon)
|Snack - varies
(evening - if hungry)