A Weighty Tale, part I

Ok, ready to get away from the politics for a while?  I’ve been promising you guys I would write an article on weight loss.  Every time I start to write it, I realize how huge a subject this is and the article could go on for pages and pages.  So we’ll break it up, with this first part being about my recent experiences and the current battle between the “old and busted” healthy eating line of thinking involving high carbs and low fat, and the “new hotness”, LCHF–low carb high fat diets.  I’ll take some time to explain some of the terms as we go.

So like everyone else, I like to eat. This leads to a problem. I gain weight.  Given that my dad had a massive heart attack (but survived) at the age of 59.5, and I’m 47, it is natural that I concern myself with weight control.  So when I hit 213.5 pounds, I decided I need to shed some weight. Being that I am 5ft 10in tall, my ideal body weight is around 173 pounds.  I’m somewhat stocky, so I set my first goal for weight loss at 185 pounds.  I hit that goal this week, having dropped 28.5 pounds over the last few months.  And I have exercised very little–just some weight training now and then, with little to no cardio. How?  Well first of all, let’s go back in time, and I’ll explain.
The Resident and Dr. Atkins.

We shall set the time machine back to 1998.  A young(er) Doc Holliday is a 2nd year resident in a busy Family Practice residency, and the busy nature of the job, the 60, 80, or 100 hour work weeks left little time for exercise and much time for snacking.  Result?  I was gaining weight, and didn’t like it.  At this same time, the Atkins diet was becoming wildly popular, and I was receiving questions about it on a daily basis from my patients.  Medical School teaches virtually nothing about nutrition, so I read Dr. Atkins’ book and decided to try it, so I would have something to tell my patients–did it work, or not? 

My medical question was this: Can you REALLY make yourself ketotic while eating?

(Ketotic means burning fat–the ketones are the last thing created as fat burns–it’s the exhaust created by fat consumption–and they’re normally only present if you don’t have food.) 

In other words, could you trick your body into believing it was starving while still eating?

The answer, it turned out, was yes.

I lost 17 pounds in 2 weeks on a strict Atkins diet which involved limiting carbohydrates to less than 20 grams a day. 

The drawback was it was expensive, and believe it or not, you can get tired of bacon.  And if you went back to your old eating style, the weight would come back.  

So my initial impression for my patients was “Heck yeah it works–for a while, but then it gets tiresome.”  I did not go all the way through the program, which had three progressively less restrictive steps, but now I could at least tell my patients this was a good kick start diet.  As major research on the long term effects was lacking, I could not say more than that, and I left it there until such time as that research became available.

I repeated this “learn about and try it” concept with other diets–South Beach, Weight Watchers, etc–so as to be able to talk about it with my patients.  

There was no question that Atkins–Low carb, high fat–was the best in terms of weight loss.  Nothing else even came close except South Beach, which is a similar idea from a different perspective.
Hormonal versus caloric

So what was the deal?  Why did eating a bunch of protein and fat without much carbs make me lose weight like water flowing over a waterfall?  To answer, we have to understand the effects of the hormone Insulin.  

Most of you have heard of insulin as the hormone that is missing in diabetes.  Insulin is the “key” which unlocks the cells to allow the entry of sugar (carbohydrate is a fancy name for sugars of various types).  Insulin is produced in the pancreas in special cells called Beta Cells, arranged in little groups called the Islets of Langerhans.  In type I diabetes, the Beta cells are destroyed and the body can’t make Insulin, so it never “sees” the sugar to take up and burn, and instead begins to burn fat–and the sugar just builds up and finally causes the patient to begin to dehydrate, and that will eventually lead to DKA–diabetic keto acidosis, which can be lethal.  Therefor the presenting symptoms of diabetes are “The Three Polys”–polyuria (it makes you pee when your sugar goes up), polydipsia (it makes you thirsty), and polyphasia (it makes you hungry as you begin losing weight).  In a normal person, Insulin levels fluctuate with intake of sugar, and so if your intake of carbohydrates is very low, the insulin stays very low and the body switches to burning fat, and you begin to lose weight–so these diets are essentially telling the body, burn fat, not sugar–and the body obliges.

I hear you now–But wait, Doc!  Doesn’t eating all that fat and protein make me gain weight? Nope

Wont I get low on vitamins? Nope

Will I damage my kidneys? Nope

Will I begin to lose muscle? Nope

Will I get bad cholesterol readings?  Not really–totals may go up but ratios of good to bad improve.

But But But Doc!  What about the dread word….CALORIES?

To most of the advocates of the Low carb, high fat diets, Calories don’t matter.

Let me repeat that.

Calories don’t matter.

Now this is one place where I am a little skeptical of these diets, but the experiences of other researchers are pretty impressive, with some researchers eating 4000 calories a day in fat, only to lose weight. 

So what does matter?

The hormonal response to the food.  Insulin is the key. Keep it low, and you WILL lose weight.  

Now for the shocker–exercise is NOT A PRIMARY WEIGHT LOSS TECHNIQUE. During my trip down in weight, I have done very little exercise over the past two months. As noted above, the occasional weight training session is it.  No running, no cycling, no jumping rope, nothing.  Just walking around and watching what I eat.  

Hard to believe?  Not really.  Multiple studies show exercise is ineffective for weight loss.  In fact, there have been 60–yes, sixty–studies showing just that.  Exercise has MASSIVE health benefits in terms of strength, endurance, blood pressure control, cholesterol levels, sugars levels, psychological health, physical appearance, etc.  But weight loss? Nope.  That’s not what the commercials for expensive exercise equipment tell you, but that’s the way it is.    

So what will help if you want to maximize your weight loss?  Intermittent fasting and something called OMAD.

Intermittent fasting is simple to understand–daily, or several days a week, you designate a period of time to eat, and you don’t eat otherwise.  So, let’s say you designate a long lunch time from 12-4 as your eating window.  Ok fine, eat then, and eat a lot.  But don’t eat again until the next 12 noon rolls around. So between 4pm and 12 noon the next day, no food. That’s 20 hours of intermittent fasting.  You don’t have to start with that long a gap–the results start showing up when you get to 14-16 hours.  Whole books have been written on this–there are also multiple good youtube videos about how to do it.  

Then, intermittent fasting’s tougher cousin is OMAD.  The acronym means One Meal A Day.  So this is a single meal in the time slot you designate.  It’s just a stricter Intermittent fast. 

And what combo works best?  A low carb, high fat meal as your OMAD.  Your insulin stays low, and the body burns fat.  

So there you have it, for now.  Notably I did NOT do intermittent fasting or OMAD, and I have still lost significant weight.  Some other truths I have found–the weight loss is not linear, it goes in steps.  You’ll initially lose a bunch, then plateau, then start down again, plateau, etc.  You will continue to lose if you just stick with it.  Also, an occasional cheat meal once a week ( we do Friday night) helps make it more tolerable and also alleviates some of the constipation that goes along with these diets.  Also, like all diets, men seem to lose weight easier than ladies (sorry ladies, blame you estrogen, progesterone, and testosterone ratios).  However, it will work for ladies as well, it just may be a little slower.  Finally, as with all diets, you will find people selling stuff to make them work better.  None of that is necessary.  

As noted earlier, I could write for days on this, but instead here are some interesting people to watch on Youtube who know way more than I do about this:

Dr. Ken Berry, MD–this guy is awesome, is not selling anything, and has numerous videos–plus he sounds like me! (He’s from Tennessee)  Look up all his videos on keto diets, and especially his video on ketorade, which is a homemade gatorade for prevention of cramps if you decide to do this type of diet.  In my mind, he is The Man when it comes to all things keto/intermittent fasting/OMAD, etc.

Dr. Jason Fung–one of the true scientific authorities on all this stuff.  Be prepared to listen for a while–he can really talk, and he gets deep in the weeds if you want heavy duty scientific explanations.

Dr. Eric Berg–this guy is actually a chiropractor (!) but does some really nice, easy to understand and very well illustrated talks.  Be aware though, he has a line of supplements, which is fine, just not really needed.

And a book–The Real Meal Revolution, by Professor Tim Noakes, Jonno Proudfoot, and Sally-Ann Creed.  This book is about Banting diets, which are the original LCHF diets–the history is amazing, and the explanation at the front and back of the book is outstanding–and in-between, there are pages and pages of delicious recipes. Dr. Noakes is from South Africa, and is a Marathoner and a nutrition expert, in addition to being an MD.  He made these diets popular again, so the powers that be tried to put him on trial and shut him down–seriously!  The Big Agriculture people didn’t like what he was preaching.  (He won, but they continue to harass him)  We’ll discuss some of the history in the next article, if you like.  

So that’s about it for now.  We’ll let the questions guide what else is in the next article.  Have at it!

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