Why You’re Fat and Sick

The conventional wisdom regarding eating, energy, and body weight is that calories are a form of energy, a fuel like gasoline.  The story goes something like this:  Your body needs the energy to live and move you around, so you have to eat to get that energy.  If you don’t get enough energy, you get weak and eventually die because you don’t have the energy to keep your heart beating and your lungs breathing.  Fat is just a way to store calories within the body.  So the way we get fat is by overeating.  We get rid of fat by eating fewer calories than we need to live, forcing the body to burn up some of that fat it keeps storing.  We can also burn up more energy by moving around more.  Everyone knows that exercise burns calories!  So we came up with the classic diet advice everyone knows is correct (even though it doesn’t work):  Eat Less and Move More.

If you have ever thought, “diets don’t work!” you were absolutely correct. This classic advice always fails.  As Hall and Kahan (2018) observed, “Weight loss can be achieved through a variety of modalities, but long-term maintenance of lost weight is much more challenging.”  These authors go on to state that “obesity interventions typically result in early rapid weight loss followed by a weight plateau and progressive regain.” Their meta-analysis of 29 long-term weight loss studies found that more than half of the lost weight was regained within two years, and by five years, more than 80% of lost weight was regained. In other words, most diets work, but the results don’t persist.

A disturbing consequence of the ultimate failure of weight loss efforts is that people decide the game is rigged and refuse to play. Failed attempts at achieving durable weight loss may have contributed to the recent decrease in the percentage of people with obesity who are trying to lose weight. Many now believe that weight loss efforts are futile.  Models of nutrition that revolve around a single “gas tank” view are doomed to fail.  The human body is much more complex than the fuel system of your F150.

The Body With Sugar

When we eat sugar (or carbs), the body moves it from the gut to the bloodstream relatively quickly.  If blood glucose levels rise too high, the situation is very dangerous.  For that reason, the body has a hormone called insulin that functions to remove the glucose from your blood, thus keeping your blood sugar at a reasonable level.  When the insulin in your body isn’t powerful enough to accomplish this task over time, you will be diagnosed with diabetes.  Type I diabetes means you were born with insufficiency of natural insulin.  Type II diabetes (also called adult-onset diabetes, which kids get these sugar-fueled days) means you have overwhelmed your body’s ability to produce enough insulin and store glucose.  This second type is the one that makes you fat and sick and is associated with metabolic syndrome.

When dealing with the extra blood glucose that threatens your health, your insulin tries to store it.  The first place it tries to pack the sugar is into your liver.  When the liver gets full, the sugar spills over into the pancreas.  Still got glucose?  The insulin will start storing it in the muscles.  No problems so far.  The problems arise when we never use up that glucose and keep piling on more carbohydrates that get turned into glucose.  The body is designed to feed and fast, and this stagnant glucose is detrimental to health.

Given this terrible diet Americans tend to eat, our insulin levels always stay high.  When insulin stays high, your body stays in storage mode, always trying to add to your fat collection.  This starkly contrasts with the natural up and down cycle the human body is designed for.  Constantly high levels of insulin eventually cause what is known as insulin resistance.  When the body’s cells become resistant to insulin, it takes more and more to get the job done.  It’s a downward spiral.  That is, insulin resistance results in higher and higher insulin levels.

It is important to note that the standard blood tests your doctor recommends don’t check for insulin.  They check for blood glucose.  You can get sicker for years with crazy amounts of insulin coursing through your veins, but this will go unnoticed by your doctor until you finally overwhelm your body’s ability to produce insulin and your blood glucose rises.  By the time your doctor tells you that you are “prediabetic,” you will most likely be seriously metabolically ill.  The human body is very, very tough. Still, you’ve been pounding it with poison for 15 to 20 years when it finally breaks down noticeably.

Many of us think we’re okay if we don’t develop full-blown diabetes.  This is not true.  High levels of insulin associated with insulin resistance cause many serious health problems, like hardening of the arteries, high blood pressure, and weight gain.  The best time to get your insulin levels under control was twenty years ago, and the second-best time is today.

A significant problem with this is that no drug can bring down insulin levels.  The only way to bring down insulin levels is for your body to stop sending the signals to make more of it; then, levels can eventually drop.  Keep in mind that the signal to make insulin comes from eating.  Eating sugar and carbs causes massive insulin spikes, and even eating proteins cause some insulin production.  Eating pure fats doesn’t seem to spike insulin much, but blubber nuggets are tough to source.

Suppose you severely restrict the sugar and carbs you eat. In that case, insulin levels will decrease, and the body can shift from fat-storing mode to fat-burning mode (as evidenced by the presence of ketones in the blood and urine).  Fasting has the same effect as a ketogenic diet, with the added benefit of eliminating insulin spikes from consuming proteins.  This is the mechanism that underlies ketogenic diets. It is believed that such diets can reverse nearly all conditions associated with metabolic syndrome.  We will delve into both of these diet options in later chapters.

When a person diets by reducing calories and not carbs, they usually do more harm than good.  The Eat Less – Move More diet is doomed to failure because it doesn’t flip the metabolic switch to move the body from burning glucose to burning fat.   When the body is in sugar-burning mode and there isn’t enough sugar, the body has to compensate by slowing down the amount of energy it burns.  That means that your metabolism slows down.  Sadly, it doesn’t ramp back up when carbs are increased.  Before your diet, you could maintain weight by eating 2500 calories daily.  Now you can do it on 2100; if you consume more, you gain weight.  This is why the diets that seem so impressive on reality television don’t have reunion shows.  Everyone is fat again within a few years because their metabolisms have slowed down to a crawl.

    The Body without Sugar

The basic mechanism of depriving your body of sugar (through fasting or ketogenic diets) is to allow your body to do what it was designed to do.  The body was designed to feast and fast, not feast all of the time.  When we constantly eat (the Standard American Diet), we continuously produce massive amounts of insulin, which causes us to store many calories as fat.  When we eat these sugars and starches, they are quickly converted to the most basic sugar, glucose.  That glucose works its way into your circulatory system and becomes “blood glucose.”  That’s the stuff that diabetics (and many others) have too much of.  When the blood glucose gets really high, it is very dangerous.  Blood glucose levels start to fall after about 4 hours without eating carbohydrates.

If we burn up all that free-floating blood glucose, the body starts to get it from other places (most notably the liver) in a bit different form called glycogen.  You can think of glycogen as something like stabilized gasoline.  It is designed to store sugar for a period when it won’t be used immediately.  The body can happily use glycogen for about 18 hours before that starts to run out.

At this point, the body flips the fuel switch and starts to burn stored fat.  Keep in mind that the body doesn’t burn these fuels simultaneously. Metabolically, they are two different fuel systems.  If you are burning glucose, you aren’t burning fat in any meaningful way.  Since the body burns the easily accessible glucose first before it does the work to liberate stored fat for fuel, you can’t burn fat without depleting the glucose supply.  That is a massive oversimplification.  The body uses insulin to regulate how glucose is stored or allowed to float freely in your blood, and it also uses it to flip the fuel switch.  To burn fat, you must lower levels of insulin.

It is important to remember that the human body is designed to be a dual-fuel machine.  It is supposed to alternate between sugar and fat.  Given the standard American diet, it never makes the switch to fat burning.  Why on earth would you store something you never plan to use?  Our modern practice of eating tons of unhealthy sugar (and carbs) has caused us to hijack the body’s fuel system.  Sugars, as prior generations knew, make you fat.  Carbohydrates, which the body readily turns into sugar, also make you fat.  The idea that “fat makes you fat” is pretty much a lie.  Consuming massive amounts of calories will result in fat storage, regardless of what category the food falls into.  However, if you don’t allow yourself to burn the fat, you will always be stuck with it and likely add to it.

It must be understood that the standard American diet calls for frequent meals composed primarily of sugar.  That is disastrous because it prevents the body from switching to fat-burning mode.  If the body never switches to fat-burning mode, you will not only stay fat, but you will get fatter.  And that isn’t the only problem.  When we keep piling on the sugar which the human body was never designed to utilize in large quantities, we create a condition known as insulin resistance.

This is the cause of metabolic syndrome.  Heart disease, kidney disease, diabetes, high blood pressure, and a host of other health problems (for which medicine has no cure) are sugar problems.  A few drugs like metformin can reduce insulin levels, but this doesn’t get to the root of the problem.  It’s a little like putting duct tape on a bullet wound.   Insulin resistance is terrible, and insulin sensitivity is good.  A primary goal of a truly healthy diet for us is to increase insulin sensitivity.

It is worthy of note that I have presented the fuel that your body uses as a binary proposition.  Either you are burning sugar, or you are burning fat.  That is admittedly an oversimplification.  Even when you are in full-blow fat-burning mode, you are still burning a little sugar.  In reality, it’s more about ratios than binary states.  While not absolutely correct in a precise technical sense, I think the oversimplification makes things easy to understand and does no actual harm to the regular person who is sick of being a fat ass.  Medical students and dieticians will differ.

A Brief History of Eating

Few will argue with the fact that people have been eating for a long time.  Our ancestors have been eaters since time began.  For most of human history, people ate what they could find through “hunting and gathering.”  If a band of hunters took down a big animal, they would eat like pigs and wolf down (think about where that expression comes from) as much meat as they could.  They had a limited time before the meat spoiled, and they had no idea when they would get another kill.

Food storage was very limited before refrigeration and the invention of beef jerky.  Food was best stored as body fat for most of human history.  Note that super-concentrated forms of sugar like table sugar and high fructose corn syrup did not exist.  If you wanted some sugar, you found some fruits or berries that had some in them.  This was very seasonal, so it represented a special treat.  Raiding a beehive was a special treat that didn’t occur very often.

If you watch survival shows on television, you will note that contestants have a tough time finding adequate calories.  Often, your favorite contestant will be taken off the show for medical reasons.  They’ve lost so much weight the medical team gives them the boot.  Hunting and gathering are hard; anyone doing it will fluctuate between feeding and fasting.  Sure, our ancient ancestors were probably a little better at finding food. Still, they weren’t eating high fructose corn syrup and getting fat.  They weren’t likely suffering from obesity, heart disease, diabetes, and gout.  The availability of very calorically dense foods is a recent phenomenon, and our biology just can’t cope.

Several relatively recent events happened to food to make the problem into a catastrophic pandemic:

• • • Commercial food that is highly processed came into vogue
    • High fructose corn syrup replaced table sugar, making sugar dirt cheap
    • Fats were demonized, and sugar levels increased dramatically to make highly processed, low-fat foods palatable

The metabolic damage done by sugar is dose-dependent, much like alcohol.  Just a little, and you won’t do any harm.   Take in obscene amounts, and you will get very, very sick.  Once you get the liver involved significantly, you have crossed a threshold.  Most Americans do this every single day.   Like the alcoholic, continued abuse leads to catastrophic bodily harm.  If you are reading this book, you are probably in the fat-ass category.  People like us are the metabolic equivalent of an alcoholic, and we can’t afford to touch the stuff.

The real culprit in the metabolic disease epidemic sweeping the world is the vast amount of added sugar that we find in everything.  The table sugar versus high fructose debate is pure silliness.  Metabolically, they are equal.  Both are dangerous.  And they are in everything.  You have to stop eating concentrated (refined) sugar if you want to be healthy.  Metabolically healthy people can tolerate a lot of glucose, especially if they are burning it.  Elite athletes can drink Gatorade because they burn massive amounts of glucose in marathons.  They can use all that glycogen that is produced.

Most of us have no business eating that much of any kind of sugar.  We are not elite athletes.  The only fructose most metabolically healthy people should consume, however, is in the form of the whole fruit.  Notice that I said metabolically healthy people.  You, my fat-ass friend, aren’t metabolically healthy.  You are a sick fat ass.  You must stop eating sugars and starches entirely until you bring your metabolic syndrome under control and become metabolically healthy.

What Your Doctor Got Wrong

If you are a fat ass, your doctor probably told you to lose weight.  She probably also told you to eat healthily, eat less, and exercise more.

If you have high insulin, you can’t burn fat in a meaningful way.  If your doctor argues with this, make them re-read their cell biology textbook.  So if you dramatically cut calories, you don’t have enough energy to supply the body.  In the calories in calories out model, you should start burning fat.  The problem is, this doesn’t work.  What happens if you eat carbs too often and have high insulin levels is that your body doesn’t have enough energy.  You didn’t eat enough, and it can’t get to the stored fat.

Under these conditions, the body slows down and doesn’t burn as many calories.  Just staying alive takes a lot of energy; this is called your basal metabolism.  Even someone in a coma needs to eat to stay alive, and they burn a lot of calories.  On the Eat Less-Move More diet, your basal metabolism slows down.  This is disastrous when you are a fat ass and are desperately trying to get rid of energy, not conserve it.

This is  what Dr. Jason Fung calls a “two-compartment problem.”   The body can burn glucose, and it can burn fat. But it can’t do both at the same time.  You can burn body fat and thus lose weight, but you can only do this once you’ve flipped the metabolic switch over to fat burning.  The only way to do this is to create a scarcity of blood glucose.  This becomes more and more difficult the more insulin resistant you are.  As a general rule, the fatter you get, the harder it is to lose the fat.  Many people claim that ketogenic diets and fasting are extreme.  Even if that were true (it isn’t), extreme measures seem appropriate if you are severely metabolically ill.

Caloric restriction in the presence of elevated insulin lowers your metabolic rate and does it long-term.  Ketogenic diets and fasting don’t affect your basal metabolic rate, so you don’t regain lost weight nearly as quickly as with standard diets.

When you are metabolically ill like most Americans, you can’t lose weight on a standard Eat Less – Move More diet.  Even if you soldier on and do exactly what the sheet your doctor gave you says, it won’t work.  It will fail 99% of the time.  She may not say it, but the doctor will blame you for your gluttony and sloth.  That is a load of bullshit, and you should ignore it.  Understanding Dr. Fung’s Two Compartment Model is game-changing.  Once you learn that you have to 1) flip the metabolic switch and then 2) cut calories, you will start to lose weight sustainably.  If you skip directly to step two like your doctor probably suggested, you will fail.  That’s your doctor’s fault for giving you shoddy advice. (Thus, the title of this book).

The bottom line is that (as recommended by the government, societies, and associations) low-fat diets have to replace those missing fat calories with something.  That something has been massive amounts of dangerous, highly processed carbs, and that tragic mistake has proven disastrous. Those guidelines are upside down and backward, but they aren’t likely to change because the professional reputations of those involved would be damaged if they came out and admitted they were wrong. America is fatter and sicker than ever.

Some of the most profitable companies in America (Big Food, Big Pharma, Big Healthcare) have a vested interest in killing as many Americans as they can slowly and cruelly.  It is easier to blame the victim and tell individual sick people to quit being gluttonous and lazy.  We’ve been conditioned to respect medical professionals for so long that we don’t even think to call bullshit.

On a more fundamental level, the biggest problem with medical professionals is the focus on treating disease.  I respect the hard work and sacrifice of medical professionals.  Med school is hard as hell and costs a vast fortune.  I believe that, for the most part, they are good people trying to do good in the world; they are just too narrowly focused on the wrong thing.  When you think about pathologies and treating them with drugs, you lose sight of the big picture.

Modern medicine is way more concerned with alleviating symptoms than it is with making people healthy.  If we were honest, we’d quit calling it “health care” and start calling it “symptom management.”  I know some doctors take a holistic view of health and read the current research.  My hat is off to them.  That, however, is the exception and not the rule.

Let’s look at the example of how we treat Type II Diabetes.   We measure your blood glucose, and it is high.  That’s dangerous, and we need to get those numbers down.  We give you insulin, which forces the body to cram glucose into the cells of your organs.  That gets it out of your blood.  We then pat each other on the back and say we are “managing your diabetes.”  We ignore the root cause of diabetes (i.e., too much insulin) and don’t even consider that giving you more of what’s making you sick is a bad idea.  The real solution that cures the disease is to lower insulin, not raise it.

Of course, we can’t let blood glucose run rampant while fixing the insulin problem.  The symptom focus, however, will never make you well.  An insulin prescription is a life sentence, and it culminates in death. It’s a short-term fix for a long-term problem that makes you fatter and sicker and eventually kills you.

The following quote is from a journal article that typifies the prevalent medical thinking:

A wide range of pharmacologic interventions (e.g., statins, antihypertensive drugs, insulin sensitizers, and thiazolidinediones) have been shown to be effective in controlling the individual components of metabolic syndrome. Obesity, which is a necessary component of metabolic syndrome, has reached epidemic proportions in the United States. Although lifestyle management or medications can control the underlying risk factors and most of the components of metabolic syndrome, long-term weight loss is difficult to achieve (Fonseca, 2005).

The above quote is an excellent example of how medical professionals are so obsessed with treating symptoms with drugs that they forget that the ultimate goal of healthcare is—or at least should be—health.  The critical factor in that quote is the vague reference to “lifestyle” management.  It would be more appropriate to say “diet management.”  It doesn’t take a medical degree to make sense of the idea that a food problem probably needs to be fixed with food.  It is possible to have some of the symptoms of metabolic syndrome as stand-alone diseases, but it is unlikely.  If you have a cluster of them, it is a near certainty that you have an insulin issue underlying all your metabolic problems.

If I take my truck to the mechanic, I expect him to fix it correctly and for a reasonable price.  I’m paying a premium for his expertise and professionalism.  I plan to drop off the truck, go to work, and pick it up when it’s fixed.  You can’t look at your relationship with your doctor this way.  If you go to the doctor’s office to be fixed, you are going to get fat, sick, and eventually die.  You have to look at your doctor as a consultant.  It is up to you to figure out the proper lifestyle and diet for you, and then use your doctor as a sounding board and diagnostician.  Remember that some symptoms must be addressed while you get your shit together.  High blood pressure and other factors involved in metabolic syndrome will kill you.  A quality physician is indispensable for this reason.

Note the phrase “quality physician.” Suppose you’ve been on a handful of pills, and all your doctor does (during your three minutes every six months) is tell you to increase the dose periodically. In that case, you need a new doctor. If your good old doctor brought you into the world, that doesn’t mean he won’t take you out of it with terrible advice.

What is the Proper Human Diet?

Few people will argue that the human body needs protein.  You need it to stay alive.  No major nutritional theories hold protein accountable for metabolic disease.  Proteins are the building blocks of the body.  The biggest question about the proper diet is what to fuel the body with.  There are two options, and in truth, we need both carbs and fats.   Unless you are very extreme (e.g., the carnivore diet), your diet will consist of a ratio of carbs and fats (mediated by protein levels).

Not all carbs are created equal.  Examining the glycemic index and fiber content is an excellent way to grasp how high carbohydrate foods impact insulin levels.  The glycemic index is just a ranking system that assigns a number from 1 to 100, and the higher the number, the more that food spikes blood glucose.  The insulin index may be a better tool for those who are fat and sick.  This looks at how much food impacts insulin in the body on average.

It is vital to realize that there is no one magical optimal diet for human beings.  There is a lot of variation between people, and some of us fatten up much more quickly than others.  Research by Stunkard and his colleagues (1990) suggests that about 70% of the variation in people’s BMI can be explained by genetics. (A fact that fit nutritionists and doctors tend to overlook).  Environmental, cultural, and a host of other factors play a role in determining whether or not you are a fat ass, but genetics is enormous.  This provides a possible explanation as to why some people can remain healthy on a high-carb diet, and others get very fat and very sick.

When some fit skinny person tells you to eat lots of pasta and drink lots of fruit juice to get healthy, just don’t listen.  You have to figure out what will work for your body, not some fictitious generic human “type.” If your biological mother and/or father were fat and sick, you’re likely facing an uphill battle.  You can beat your genetics, but it will require much effort.  Life just isn’t fair.

In short, metabolic syndrome is, to a large degree, genetic, and there is nothing you can do about that.  You have to play the hand you were dealt.  It is essential to understand that lifestyle factors are potent tools that largely overcome these genetic predispositions.  You just have to do the work.  If you really want to go down the rabbit hole of genetic causes of obesity, see the (2017) review by Thaker.

There is plenty of convincing evidence that nobody should live on a high-fructose diet and that junk food is, well, junk.  However, there is a lot of debate about how much of a percentage of your diet should be composed of carbs.  My argument is that if you are fit and metabolically healthy, eat as many carbs as you can like and maintain your metabolic health.  You likely have metabolic syndrome and insulin resistance if you are fat and sick.  You can’t fix that by eating a lot of carbs.  The only real options to improve the underlying cause of your myriad illnesses are fasting and a ketogenic diet.

The mantra “you are what you eat” is wrong.  The phrase “you are what you metabolize” should replace it.   

A Tale of Two Hypotheses

In about the sixth grade, I learned that a hypothesis is an “educated guess.”  Most of the just-so stories about nutrition are precisely that—guesses.  The education part is what is lacking.  The sad part is that we know what is going on from the advanced biology classes doctors had to take to get into medical school.  They just don’t apply that basic knowledge to nutrient metabolism in any meaningful way.  They fall back on hypotheses that don’t hold water, much like religious dogma.

The traditional model of calories and weight gain is mainly based on what science students will recognize as the First Law of Thermodynamics, which states that the total energy inside a closed system remains constant.  From this viewpoint, calories are energy, and it doesn’t matter where those calories come from.  If you take in calories, the hypothesis goes, you will either burn them or store them.  Thus, if you are fat, you are taking in too many calories and not using enough calories.  Put in moral terms, you are guilty of the sins of gluttony and sloth.

Amazingly, the entire world decided to become soulless sinners in 30 years.  A more likely scenario is that the West exported its diet, which has made the whole world sick (minus a few pockets of poverty where people eat traditional, natural foods).  What is it about the Western diet that is making the whole world fat and sick?  It must be saturated fat, right?  That, after all, is public enemy number one.  That argument doesn’t stand up to scrutiny either.  The real culprit, it seems, is fructose.   Fructose is public enemy number one.

True, we are eating a lot more.  But we haven’t gotten more glutenous.  We’ve just screwed up the system that gives us feedback that we are full.  You guessed it: It’s the carbohydrates.  It isn’t gluttony; it’s a screwed-up diet that the government told us to adopt, and essentially we did it.  They said it was a good idea to get rid of fats and replace them with carbohydrates.  Eating too many sugars is what makes everybody fat and sick.  That doesn’t happen overnight, of course, so we aren’t so aware of it.  One soda per day doesn’t sound too bad, but 15.5 pounds of fat is added to your fat ass every year when you do that consistently.   But it isn’t the calories that make you fat.  This book’s central point: Sugar makes you sick and fat.  That is especially so when that sugar is fructose.

Before the carb epidemic, America’s energy balance stayed pretty stable.  Of course, there were obese people, but it wasn’t an epidemic.  What changed when we added all that sugar?  One bullet was a hormone called leptin.  Leptin is a hormone produced by fat cells that acts mainly to regulate appetite and fat storage.

Before 1975, nobody was exposed to high fructose corn syrup.  By 2009, Americans consumed an average of 63 pounds of the stuff.  I will give the corn refiners credit where it is due.  They advertise that high fructose corn syrup isn’t any worse than table sugar (sucrose).  I agree. They are both, in fact, poison.  It’s not as benign as the “empty calories” nutritionists have warned us about for years.   The vast amount of sugar added to soft drinks and every other food product (if it is fair to call them food) is killing Americans at an alarming rate.

Many political forces have been at play in these disastrous dietary changes.  In the early 1970s, Nixon’s war on poverty generated a mandate to make food cheap for Americans.  In an exceedingly rare event, government action was successful.  Food got more affordable, but unfortunately, there was no safety mandate to go along with the cost mandate.  High fructose corn syrup (HFCS) was introduced to the American market in 1975, shortly after HFCS was invented.  The fact that a “food” needs to be “invented” should have been a red flag.

From a health perspective, high fructose corn syrup isn’t any worse than sugar, but it does cost around half the price.  Mechanized corn farming and mechanized processing make the commodity much cheaper to produce.  This meant that you could make fat-free cardboard more palatable by making it sweet on the cheap.  The human body is designed to crave sweet crap; if you make it cheap, people will buy tons of it.  If you convince the suckers it’s healthy, they’ll feel good about killing their kids.  This gave rise to the fat-free craze in ultra-processed “foods” that we know and love today.

The evil soft drink industry and Big Food aren’t the only evildoers out there.  Perhaps more insidiously, “healthy fruit juice” contains as much or more sugar than chemically formulated soft drinks.  There is plenty of evidence that juice makes you fat, just like soft drinks.  Yet the United States government provides it to poor kids.  Fructose, such as HFCS or table sugar, is a deadly poison.  So much for evidence-based nutrition in US government circles.  I say the USDA is complicit in genocide.

So is the “calories in-calories out” model complete bullshit?  No, and that’s a problem.   The Laws of Thermodynamics are solid.  But the calories in calories out model is based on a closed system.  So the model is not wrong in what it says; it just doesn’t say enough.  A ton of metabolic stuff is going on that can’t be ignored.  This means we have to figure out what kind of energy is entering the system and how we get energy out of the system.  Calories and exercise don’t do a good enough job to be meaningful in a practical way.   All metabolic syndrome diseases—including being a fat ass—can’t be fixed with magic bullets like drugs and supplements.  We can help control the symptoms, but long-lasting good health requires lifestyle changes.  The calories in-calories out model represents not only a law of physics but a paradigm of human behavior as well.  As a law of physics, it’s terrific.  As a paradigm of eating, it totally sucks.

If you want to dig into the scientific papers and books on this stuff, you need to know how scientists and doctors talk about these hypotheses.   According to a commonly held “scientific” view, the obesity pandemic is caused by the overconsumption of modern, highly palatable, energy-dense processed foods, worsened by a sedentary lifestyle.  The key phrase here is overconsumption; you should eat less if you’re fat.  However, obesity rates remain at historic highs, despite a persistent focus on eating less and moving more, as guided by the energy balance model (EBM).  This energy balance model is the Eat Less-Move More model that doesn’t work but is what your doctor tells you to do.  It is the one compartment thermodynamic model.

The EBM has been a massive public health failure.  It fails 99% of the time.  This public health failure may arise from a fundamental limitation of the EBM itself. Conceptualizing obesity as a disorder of energy balance restates a principle of physics without considering the biological mechanisms that promote weight gain. An alternative paradigm, the carbohydrate-insulin model (CIM), proposes a reversal of causal direction. According to the CIM, increasing fat deposition in the body (resulting from the hormonal responses to a high-carb diet)  drives positive energy balance.  If you don’t buy the CIM hypothesis, delete this book.  That is the theoretical foundation of everything I say.

Whole Foods

For the rest of this book, I’ll drop the phrases “whole foods” and “real foods” like you know what I’m talking about.  For many of us, “Whole Foods” is just a fancy grocery store where tree-hugging hippies shop.  It has nothing to do with tree hugging or being liberal.  The phrase “whole foods” means looking at your plate and saying precisely what you are eating.  “Whole foods” means the food grew in the ground or was raised on a farm.  A green bean is obviously a green bean on your plate.  No chemicals you can’t pronounce were added to it, and nothing was removed to make it shelf-stable. It comes to you as nature intended it.  Orange is really orange. You peeled it and knew nothing was added or taken away from it.  If you strip out all of the fiber, add a few chemicals, and market it as “orange juice,” you’ve processed it and made it very unhealthy.  Fried eggs and ribeyes are whole foods.  Mystery meat in a can is processed food.  Interesting egg substitutes in milk cartons are processed foods.  Many processed foods are referred to as refined.  Gasoline is refined; do you want to drink that?  Sugar is a refined product; it doesn’t exist in nature.  Don’t eat it.

You can’t trust packaging and food marketing if you want to be healthy.  You can’t trust restaurants, especially chains with trucks delivering food from a central warehouse hundreds of miles away.  You have to prepare your own whole foods at home.  YouTube is your friend.  Lots of good, whole foods can be prepared in a tasty way with little time and effort.  Frozen vegetables (which are minimally processed) can be steamed in the bag in the microwave.  One-pot wonders abound.  If you enjoy cooking (both indoor and out), then you’ll enjoy learning to cook healthy meals.  If you hate cooking, you can find tons of hacks on the internet that make life painless and easy.  You can never be healthy if you don’t give up your fast food and sugar habits.

If you are still young and relatively healthy, ditching processed foods and getting the fructose out of your diet may be all you need to do.  Who hasn’t heard someone say they lost 30 pounds by ditching soda for a year?  My view is that metabolic wellness is a spectrum.  Most Americans (including children) are metabolically unwell because of fructose.   Get rid of that, and you will start to heal.  Those of us who are older and have been punishing our bodies for much longer have much more work to do.  If you are 45+ years old, have a BMI of 40+, have high blood pressure and high blood sugar, you have a lot of work to do!  Just cutting out soda will not fix the problem in a reasonable amount of time.  At this phase, you are metabolically sick, insulin resistant, and leptin resistance.

When your weight is down, and your health numbers are pretty good, you can start to eat a more typical diet.  You cannot ever go back to the Standard American Diet.  To be successful in the long term, you must commit to focusing your diet on whole foods.  You can have some cheat days for weddings and birthdays, but high fructose processed junk needs to be reserved as a once-per-month thing, not a once-per-day thing.

Example Progressions

Given this wide variation in what people need to become healthy, I suggest the following “Levels” as higher and higher discipline approaches to good health and weight loss.  These are arbitrary divisions, and I just made them up.  Still, I think it is helpful to look at a progression of strategies.  Try each for a few weeks and see what happens to your numbers (you did start that notebook described in chapter 1, didn’t you?)  Note that every level includes the changes made in the previous levels unless otherwise noted.   Keep in mind that the descriptions below are for comparing and contrasting different approaches; details on each strategy are provided in later chapters.

Level 1:  At this level, you just get rid of the very worst stuff in your diet.  Everyone should be doing this level at all times.   The level below this one is the Standard American Diet (SAD), and nobody should be SAD.  The principal objective is to cut out fructose, so no high fructose corn syrup, table sugar, or other “natural” sweeteners.  Kick the sugar addiction, and you’ll notice rapid improvements in health.  You also want to ditch highly processed foods, so get rid of the bready stuff and other stuff in boxes and bags.

Level 2:  At this level, we want to further reduce the body’s exposure to sugar by lowering all carbohydrates.  So start limiting the number of starch vegetables and prefer the lower carb ones.   Also, move toward time-restricted eating.  Never eat anything past 6:00 PM.  This is an excellent level to start the 16:8 diet, where you fast for 16 hours and do all of your eating within an 8-hour window.

Level 3:  If you didn’t see adequate progress trying levels 1 and 2, it might be time to try some more powerful (and harder to tolerate) strategies.   Here, you may want to try eliminating breakfast and only having two meals per day on an 18:6 schedule.   Also, start paying attention to your total carb intake.  This requires some label reading and internet searching to figure out where the hidden carbs are.  Try to keep them under 100 grams per day.

Level 4:  If you still haven’t seen any acceptable results, you may need to move toward an actual ketogenic diet.   For this diet, you will bring your total carbs down to under 20 grams per day.  That is very hard to do without studying the nutritional content of foods.  You can use internet meal plans and youtube videos to plan meals that meet the requirement.  You don’t have to become a nutrition expert to get started.  You have to be very wary of hidden carbs, and you will likely want to check your ketone levels to verify that you are doing well.

Level 5:  At this level, you’ve gotten very serious.  You have implemented a full-blown ketogenic diet and restricted yourself to a reasonably narrow feeding window.  If that hasn’t worked (or you’ve plateaued), you may want to consider moving to one meal per day (OMAD).

Level 6:  By the time you reach this stage, you are no stranger to fasting or the ketogenic diet.  If you are still not seeing adequate progress to reverse your health problems, you may want to bring out the big guns and move to alternate day fasting (ADF).  With this strategy, you eat one day and then don’t eat at all the next.  You may also want to eat keto on your feeding days.  This is the most extreme level and the most you can do regularly.  You can try a long-term fast for a period, but those periods must come to an end within a reasonable amount of time.

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References

I’ve added a complete reference page to my book on this site.  I’ve also included “further reading” articles in books on this site, organized by the book chapter headings.  Book links to Amazon are affiliate links, and if you happen to buy something via one of those links, I get a small kickback from Amazon to help keep this site up and running.  Thank you for your support!

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If you want to get a grip on how sugar is killing America, look no further than Dr. Jason Fung.  Dr. Fung is a kidney doctor by trade, and crusades against the sickness and death of the global population in his free time.  He is a YouTube sensation and a prolific writer.  The video below briefly describes his take on why you have to control insulin to control weight.

If you want a deep dive into how you got sick and fat (way more sciencey than my book), check out Dr. Fung’s fat manifesto below:

 

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Last Modified: 01/06/2023