Module 21 QUESTIONS ANSWERED BY GARY TAUBES 2012, 2015 Integrative Nutrition, Inc.
2 Q What, if any, of the traditional lipid profile biomarkers should be considered indicative of heart disease or inflammation? A All of the traditional lipid profile biomarkers have trouble accurately predicting heart attacks. Total cholesterol and LDL cholesterol are arguably the worst. If we have to rely on traditional biomarkers, I d say elevated triglycerides and low HDL are the best as together they signal the presence of insulin resistance. If we can use 21st century biomarkers, then the most reliable appear to be LDL particle number or apob number. Since ApoB is the protein component of LDL and VLDL particles, and since there s far, far more LDL particles in the blood circulation than VLDL, these two numbers closely parallel each other.
3 Q Why does excess fat cause us to overeat rather than just using that fat as fuel? A This is a tricky question. First, how do we define excess fat? A diet of mostly fat with little to no carbohydrates is a weight loss diet, even though it s high in fat. So in this question fat consumption is defined as excess because of the assumption that we re getting fatter eating our hypothetical high-fat diet. But as I just said, a high-fat diet with little or no carbs is going to lead to weight loss, so if a high-fat diet is going to lead to weight gain, it has to have significant carbohydrates and it s the carbohydrates that are driving fat accumulation. So why does this happen? First we secrete insulin in response to the carbohydrates, and the insulin works to fix fat in the fat cells and tells the lean tissue cells to burn the carbohydrates, not the fat. So we burn the carbohydrates first and store the fat. If insulin stays elevated, as will happen if we re insulin resistant, we may never get around to burning all the fat we stored with the meal, and so the fat accumulates. We get fatter, but we get fatter because of the carbohydrates, not the fat.
4 Q Can insulin resistant individuals manage weight with the calories in vs. calories out method? A In the short run anyone can lose weight by reducing calories significantly, although I d argue that the fat loss is primarily because of the restriction of carbohydrates that comes naturally with the calorie restriction. The question is, will this work in the long run and would our insulin resistant individual (or non-resistant, for that fact) fare far better on a carbohydrate restricted diet, unrestricted in calories? The clinical trial evidence suggests that the answer to the first question is no, and to the second is yes.
5 Q Scientifically, how does malnutrition/undernutrition work to cause overweight/obesity? A It s not that undernutrition causes obesity, but that it s possible to have obesity in populations that are what we d describe as undernourished, in that they re not getting enough food to stay healthy. How does this work? I d argue that the sugar in the diets cause insulin resistance. This takes time to manifest itself, so you see it in the adults not in the children. Once the adults are insulin resistant, they over-secrete insulin in response to all the carbs in the diet. This hyperinsulinemia, as it s technically known, causes them to partition more of the calories they re consuming into their fat tissue. They compensate by expending less energy in metabolic processes and physical activity. Their bodies become more efficient and they re less motivated to be physically active. As this process continues more calories partitioned into storage in the fat tissue and a greater compensatory reduction in energy intake eventually these individuals reach a point where they can remain fat on a diet that doesn t provide enough calories and nutrients for their growing children. The carbohydrates in these diets literally make these people fat and the amount of calories they consume is almost irrelevant.
6 Q Are poor populations overweight because of the types of food they eat or is it a result of severe calorie restriction and fat accumulation as a survival response? A Because of the types of food they eat the effect of the refined grains and sugars in the diet leads to fat accumulation. All species of animals go through periods of severe calorie restriction winter, for instance and they ve all evolved mechanisms to cope with it migration and hibernation, for instance. Yet none of them get chronically obese as humans do when food is plenty. So I m arguing that it s not the quantity of the food humans eat (or don t eat) that makes them fat, but the quality the refined grains and sugars that stimulate insulin levels and cause fat to accumulate.
7 Q Why do you think doctors tell obese patients to eat less instead of teaching them how to eat healthily? A First of all, if they told them to eat healthily, as it s currently defined, they d tell them to eat low-fat, carbohydrate-rich diets and that s part of the problem. Secondly, doctors are taught the conventional wisdom in medical school and through the journals they read, and the conventional wisdom is that obesity is an energy balance problem and the way to lose weight is to eat less and exercise more.
8 Q If exercising more to lose weight doesn t work then why do doctors and researchers still use the calories in, calories out model when treating overweight patients? A The natural tendency is to assume that the patient didn t exercise enough. After all, we all know from watching The Biggest Loser that if obese people just exercise enough say, six hours a day and, yes, starve themselves while they do it, they lose significant weight. But these interventions are unsustainable in the long run. And they don t speak to the question of what makes these people fat to begin with.
9 Q If overeating and inactivity doesn t cause fat gain then what does? What regulates fat accumulation? A The hormone insulin is the primary regulator of fat accumulation in fat tissue. This is true for most everyone, although other hormones also play a role estrogen, testosterone, stress hormones, etc. The easiest way to learn about this is to get an endocrinology textbook and go to the section on adipocytes (or fat cells). The book is likely to tell you that obesity is caused by eating too much and inactivity, but it will also discuss (in a different section, of course) the hormones and enzymes that regulate fat accumulation in fat cells and how they do it. If you want to know how to learn what foods regulate fat accumulation, the easiest way is to remove the foods from your diet beginning with the carbohydrates.