How the Hormonal Effects of Modern Foods Are the Real Drivers of Obesity—not Gluttony and Sloth.
What if everything we’ve been told about food and exercise for the past 30 years is dead wrong?
That's the searing question that filmmakers tackle in the documentary entitled, Fed Up.
During the film's limited release, my wife and I had the privilege of viewing it from the vantage point of soft reclining chairs in San Francisco’s Embarcadero Landmark Theater. The venue was small and posh. The movie was big and gritty.
Fed Up debunks the myth that you can just exercise your way out of a bad diet. It convincingly demonstrates that this myth is nothing more than propaganda from Big Food to keep you buying into the American dream (come nightmare) of industrial farms, processed food, and sugar, sugar, sugar.
The film particularly addresses childhood obesity.
As a clinician, the film hit home. I couldn’t help but agree that it is cruel and unusual punishment to tell our increasingly chunky children that their industry-sponsored, super-salty, sicky-sweet school lunch is just fine, and if not, well, they can just go "work it off" in PE.
Because of course, when people routinely eat this way, they can't just "work it off", and when they fail, they assume that the defect lies with them, that they must be committing some great sin of Gluttony, or Sloth, or both. They feel judged. And they judge themselves. Pretty harshly.
The film suggests that maybe we should be teaching our children to judge the food supply, not their character supply.
Why This Matters More Now Than Ever.
The issue of sugar matters more than ever these days. According to SugarScience.org, added sugar is hiding in 74% of packaged foods, just skulking there, ready to ambush your trusting heart (the part of you that still wants to believe the health claims on the label) and crash your system with a giant fat-packing spike of insulin.
Once again, we're talking about 74% of packaged foods. That's three quarters of the foods we buy most often.
To make foods “low fat” companies replace the fat with sugar. Hence the irony: those foods with the loudest health claims often contain the most hidden sugar, like yogurt and energy bars.
I've had so many female patients complain to me that they can't lose weight and then add plaintively, "...and all I have for breakfast is low-fat yogurt!".
Um, about that.
There are 10 grams of sugar in that friendly little, microscopic-sized, 6-oz container of Yoplait Light Yogurt. The American Heart Association recommends a maximum of only 24 grams of sugar per day for a women. So, yes. Just one “light” yogurt for breakfast wipes out nearly half of Oprah's total sugar allowance for the day. As Dr. Hyman says, "That’s not breakfast; that’s dessert." And who eats just one anyway? You could eat 2 or 3 of those dainty little sugar silos before you ever knew what hit you.
So just because something's "light" on fat doesn't mean it will be light on your fanny. The deliberateness of the confusion out there makes my eyes water sometimes. Whatever happened to good ol' fashioned scrambled eggs for breakfast—glycemic load: Zero?
Even some savory foods are often full of added sugar, like pasta sauces, bread, salad dressings, and ketchup.
And just in case you read labels, the food industry’s got their game-face on for you there too; they invent new names for sugar all the time to keep you guessing. Currently there are 61 names for sugar and counting. Maybe if you’re really good at scrabble, you can keep up:
Agave nectar, Barbados sugar, Barley malt, Barley malt syrup, Beet sugar, Brown sugar, Brown Rice Syrup, Buttered syrup, Cane juice, Cane juice crystals, Cane sugar, Caramel, Carob syrup, Castor sugar, Coconut palm sugar, Coconut sugar, Confectioner's sugar, Corn sweetener, Corn syrup, Corn syrup solids, Date sugar, Dehydrated cane juice, Demerara sugar, Dextrin, Dextrose, Evaporated cane juice, Free-flowing brown sugars, Fructose, Fruit juice, Fruit juice concentrate, Glucose, Glucose solids, Golden sugar, Golden syrup, Grape sugar, HFCS (High-Fructose Corn Syrup), Honey, Icing sugar, Invert sugar, Malt syrup, Maltodextrin, Maltol, Maltose, Mannose, Maple syrup, Molasses, Muscovado, Palm sugar, Panocha, Powdered sugar, Raw sugar, Refiner's syrup, Rice syrup, Saccharose, Sorghum Syrup, Sucrose, Sugar (granulated), Sweet Sorghum syrup, Treacle, Turbinado sugar, Yellow sugar.
How and Why We Get Fat
When I first saw Fed Up, I was attending the IFM International Conference on Food and Nutrition. Perfect timing. One of the key note speakers for the conference was Dr. David Ludwig, director of the Obesity Prevention Center at Boston Children’s Hospital. He kicked off the conference by bluntly flipping years of dietary dogma on its head. Here’s the gist of what he and other presenters said:
The quality of your diet matters far more than the quantity of calories in it. Different foods have different hormone-signaling effects on the body. And therein lies the key to being fat or thin.
A thousand calories of broccoli and a thousand calories of soda do not have the same effect on the body. Any 4th grader knows this intuitively. And now adults can finally know this scientifically (or stop denying it). Contrary to what Big Food wants you to believe, the idea that a calorie is a calorie is a calorie, is simply no match for real human physiology.
Because a thousand calories of broccoli signals the body to burn fat. While a thousand calories of soda signals the body to store fat, which effectively takes calories out of circulation, causing you to feel all the more anxious to fill up again ASAP.
In other words, it’s being fat that makes you overeat—that makes you hungrier instead of “fuller”. It’s a feed-forward cycle, a totally unfair paradox that can only be fixed long term by focusing on WHAT you eat rather than on how much you eat. It’s about sending the right signals to your body with the right foods and not sending the wrong signals with the wrong foods. Because food is information, not just calories.
I found some of this counterintuitive at first, until I was asked to consider another growth scenario: that of a child outgrowing his clothes. The child “over eats” because he is growing. His little cells are reading genetic packets of information that code for hormones that drive growth. And his growth, in turn, drives hunger. He eats you out of house and home. He gets pimples and blows through pair after pair of Nike shoes. We all understand this.
A similar situation exists in the obese person, whose fat cells have taken on a life of their own, funneling nutrients towards themselves, because they have been instructed to do so, primarily by the anabolic imperatives of insulin. Grow. Grow. Grow. (You can almost hear insulin cheerleading.) And again, this growth drives appetite, which is the final outcome we all see, and promptly condemn.
In both cases, it all begins with information—cell signaling—not calories per se. A spike in hormones drives a spike in hunger and we start wolfing down calories, so that’s what we focus on: calories. This is probably why we find it so easy to mistake the last effect for the first cause. But calories only drive growth once the floodgates have been opened by a another player. In the case of obesity, the biggest player is insulin.
When the whole system revs up, it looks something like this: Sugar --> drives insulin --> drives fat. Growth --> drives appetite --> drives growth.
So it turns out that obesity is really more about malnutrition and disturbed metabolism than it is about gluttony or sloth. Because you don't have to eat that much or be that lazy to get fat, if insulin has its foot on the accelerator. It is therefore less about food moderation than it is about food modification. In a food culture that celebrates sugar and starch, that could mean some serious modification for us. Data from the USDA suggest that since 1970 our meat and dairy consumption has remained about the same, while our intake of grains, sugar, and corn sweeteners has skyrocketed. It’s probably no coincidence that over the same period of time, obesity has exploded like a mushroom cloud.
After the conference, Ludwig’s research went viral in different forms. It received coverage in Time Magazine, The New York Times, and the Journal of the American Medical Association. Check out the links for a more detailed discussion.
David S. Ludwig MD, PhD is director of the Optimal Weight for Life program and Obesity Prevention Center at Boston Children’s Hospital. He is professor of Pediatrics at Harvard Medical School and professor of nutrition at Harvard School of Public Health.
A Case in Point
I'd like to show you a stark illustration from The New England Journal of Medicine, which shows the direct lipogenic effect (fattening effect) of insulin on human tissue.
The man shown here has Type I diabetes, which means he can't produce insulin. He has been injecting insulin in the same two spots on his belly for 31 years. Slowly but surely, this recurring hormonal cue to store fat has caused melon-sized fatty deposits to build up directly under his injection sites. We call this side-effect of insulin therapy, Lipohypertrophy, or "fatty enlargement".
I'm not trying to demonize the use of injectable insulin. This man would have died long ago without it. I'm merely demonstrating how inexorable the fat-stimulating effects of insulin really are.
Thank God most of us don't need to inject insulin, right? But then, what is sugar but an injection of insulin?
And how many times a day, a week, a year are we willing to inject ourselves without a prescription?
Some Conclusions and Suggestions.
Let's wrap this up: In the modern era, obesity is primarily a nutrient-hormonal problem—not a gluttony-sloth problem. It’s about malnutrition and metabolic disruption. Our genes are just following the instructions handed to them on a silver platter by our dominant source of calories: highly processed, easily digestible carbs. In this environment, you will never beat your genes by beating yourself up for gluttony and sloth—only by changing the informational content of your food.
So try this: stop thinking of food as fuel. Instead, start thinking of food as spaghetti lines of computer code dangling from the end of your fork. Imagine this code interacting with other code, in every brain cell, every muscle cell, and every fat cell of your body. Try this visualization for a week. And let me know what break-throughs you have. Food is information.
But, but, but...
Of course, food is also fuel, but so what? The effect of that fuel, the effect of those calories, is dependent on the instructional content of the total package. That’s why food really is more like information than energy. Or, if you like, food is information about energy—about how energy is to be partitioned in your body. Shall we partition it to muscle cells for energy release, or to fat cells for energy storage? Your food actually contains such information. Crazy.
What about genetics? Is it nature or nurture?
Yes. Both. Some folks do have genes that make them more susceptible to the fattening effects of insulin and its triggers. Nature is not democratic about that. But the good news is, this accounts for the minority of the effects we see. And if you do have a body that seems to easily partition fuel into the rainy-day compartment (fat compartment)—if you have the so called "thrifty gene"—then that is all the more reason to keep your insulin levels as low and level as you possibly can with foods that have a low-glycemic load.
So love yourself. Embrace who you are. Work with your genes, not against them.
What about exercise?
Exercise is awesome. Always has been. But again, you cannot exercise your way out of a bad diet. At the end of the day, hormones are simply more powerful than the gym, and they will win, every time.
So it's not about eating less and exercising more. It’s about eating differently and exercising without the tug-of-war. Without exercise pulling you one way and hormones pulling you the other.
Where Do We Go From Here?
Let the war be over this year.
If you still want to fight something, then by all means, here’s to a year of judging the food supply, instead of judging yourself.
Here are some useful links to accompany you, as you optimize your nourishing routines this year:
Read my post Carbs: The Good, The Bad, and The Ugly. In this article, I come along side you and show you how it's not about getting a carbohydrate divorce; it's about choosing your carbohydrate source.
Watch this 5-minute TED Talk. Why is sugar so addictive? Haven't we had enough already? This brilliantly-illustrated video explains how sugar (unlike other foods) never gets boring to the brain. Why the more we eat, the more we eat.
Watch Fed Up.
Visit SugarScience.org, bookmark it and share it with your friends.
Yours in Health and Resilience,
Nutritional Therapist, MD.
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Lead photo credit:
soda-riffic, by dcJohn on flickr