Diet and the Obesity Code. So how should we eat? and what?

This is part of my series on the Obesity Code.  It is a great book, and I am sure I am not doing it justice.  Dr. Fung backs his arguments with lots of studies and a fair amount of common sense.  As he comments, what we have been doing for decades is not working. Obesity and diabetes are rising- we need to change. These are his opinions, and again well supported in his book.

For what and how you should eat, let’s start first with the how.

Your body needs time of low insulin levels.  This means you need to have time where you are not eating.

• Do not snack.  Studies show you eat more calories when you snack, they tend to be high in processed sugars (though protein and fat snacks did not fare better in analysis), and they do not allow your insulin levels to go down between meals.
• No breakfast.  You do not need it to give you energy for the day. There is a natural cortisol and adrenalin release which gives you glucose. Studies show lunch and dinner sizes are constant whether you ate breakfast or not.  Foods tend to be processed and the “Big Food” companies are marketing you to make you think you need to eat first thing.
  • If you are hungry, then eat breakfast.  But avoid sugar and refined carbs.
• If you are not hungry, don’t eat.  Overlook social cues and scheduling to tell you when to eat.  Eat when you are hungry.

What to eat.

• Unprocessed Fruits and Vegetables. Chock full of nutrients, antioxidants, and fiber.  But you should only eat tons of them if they are replacing unhealthier foods in your diet.  And you need them whole- not squeezed into juice or a shake.
  • “Replace, not add.”
  • Beware of fructose in fruit.
• Protein.  Makes you feel full.  Eating lots of protein is okay as long as good kidney function.  But protein is a mixed picture.
  • Incretin is secreted by stomach.  Amino acids in protein cause incretin release.  Incretin causes insulin release (uh oh), BUT it also slows the emptying of your stomach, so it creates more satiety (good).
  • So which proteins stimulate insulin the most?
    • DAIRY.  Dairy has proteins whey and casein.  Whey is worse for stimulating insulin release, but it also makes you feel full longer. And you tend to eat small portions.
    • MEAT, including seafood.
    • Best proteins? Vegetable.
  • It is a mixed picture.  Proteins do lead to insulin release, but they also make you feel sated.  And protein is hard to process, which slows the emptying of contents of the stomach–> slower glucose absorption and you feel full so you snack less.
  • Why did Atkins diets fail?
    • One study showed high meat intake causes weight gain. He states this may be due to grain fed beef- hence the argument grass fed beef is better- the same true for farm raised fish.  Current meat food sources are stuffed with grains.
    • Lean and processed meats don’t have the FAT of natural meats, and they are processed which removes some of the fiber and other factors.
    • Another study showed large dairy intake, though it causes insulin release is NOT linked to weight gain. (Milk and cheese were neutral, and yogurt slims perhaps due to fermentation process)
      • Skim milk was not good.  You need the full fat stuff.
      • And he thinks dairy is hard to eat large portions of, so even if it stimulates insulin more, you just can’t eat as much of it as meat.
    • Increased meal frequency doesn’t give you the protection of the incretin effect.  Needing “time to digest” makes you eat less between meals or even skip a meal.
• Fats.
  • Pure fats (olive oil) do not stimulate glucose or insulin.
  • It stimulates insulin less than carbs or protein.
• Carbohydrates.  Oh how they have been vilified.  But not all carbohydrates are bad. FIBER IS GOOD. It makes you feel full, and causes slower rise of glucose and insulin, and helps food exit out of your colon. It reduces absorption and digestion. REFINED carbs (think white sugar and flour) cause the highest insulin levels.
  • The glycemic load index took this on to figure out which carbohydrates cause a change in blood sugar for a typical serving size. But remember blood sugar doesn’t matter like insulin levels do.
  • GOOD carbs.  whole fruits and veggies.
  • BAD carbs.  Sugar and flour. Processing the foods removes fat, fiber, and protein.  It allows the carb to be digested and absorbed quickly.  Think oranges (lots of fiber) vs. orange juice (processed, fiber removed, each glass is equal to 4-5 oranges).
• Sugar is bad.
  • Terminology:
    • Glucose is a sugar. It can be used by all cells, and is found naturally in the blood. Monosaccharide.
    • Fructose is found naturally in fruit. It is metabolized only in the liver and does not circulate in blood.  Monosaccharide.
    • Sucrose.  Table sugar. They link glucose to fructose. Think corn syrup.  Disaccharide.
    • If you link these into long chains, polysaccharides, they are considered “complex carbohydrates.”.
  • Fructose is really bad.  It has a low glycemic index (raises blood sugar less), so it was thought to be good.  It is sweeter than glucose, extends shelf life, keeps bread soft.  It is frequently seen as high fructose corn syrup.  It is in everything- drinks, snack foods, etc.  So it is an all natural fruit sugar, low glycemic index, how could it be bad?
    • • It is only processed and used by the liver. High levels of fructose cause fatty liver, which leads to insulin resistance.
      • In one study, the fructose group (not the glucose group) got pre diabetes by 8 weeks!
      • It can take YEARS to see the effects of fructose.
  • Sucrose is doubly bad because it has glucose which raises insulin, and fructose which causes insulin resistance.
  • Artificial sweeteners.  Remember calorie reduction is not the cure for obesity. Lowering insulin is.
    • Diet sodas are (shocker here) not good. Those who consume have higher rates of metabolic syndrome, increased risk of stroke and heart attack, weight gain is higher.
    • Agave nectar- low glycemic index but mostly fructose (read above)
    • Aspartame and Stevia- little effect on blood sugar, but raises insulin levels more than table sugar (sucrose).
    • AND they cause cravings.
    • Be wary of some studies which are funded by the “Big Food” companies themselves.
• Vinegar is good.
  • It is thought to reduce insulin resistance.
  • People use it in food (rice vinegar, pickled veggies, ) or take two tablespoons at bedtime.
  • A study showed if you take 2 tsp before a meal, it reduces insulin by as much as 34%.

And with all of this, he says diet only accounts for 30% of insulin release.  We still don’t understand 70% of the release.

In summary, he advocates for

• fiber.
• whole foods.
• fermentation
• addition of vinegar (acetic acid)
• and addition of chili peppers (capasaicin)