By Dr Andrew Jenkinson
Dr Andrew Jenkinson is a bariatric surgeon and consultant at University College London Hospital He specialises in weight loss and diet and has been performing bariatric surgery for 15 years – seeing – treating – and talking to over 3000 patients in this time
Why we eat too much — I’ve really gone to town with a précis on this book. There’s a lot to read here if you want to understand weight and weight loss. Is you haven’t time and want to lose weight go to the end bit and read that.
Metabology for beginners
The secret of sustainable and successful of weight loss is to understand how our bodies regulate the body set point. Its not as simplistic as energy in and energy out. Now we know that the set point is a master controller of our weight so we need to find out how our brains calculate where it is set.
Various factors in our environment, our history, and family background determine our individual set point – whether it will be set as slim, obese, or somewhere in between.
We will find out how to identify the signals ( in the type of food we eat and the way we live) that control our weight set point. Once we understand these signals , our weight set point, and therefore our weight, will finally be under our control.
The Secret Cow
How does a cow explain the human obesity crisis?
Farmers can make a cow grow bigger by:
- Feeding them an unnatural special diet. ( a grain/oil mixture)
- Selective breeding the bigger cows rather than the smaller cows ( un-natural selection)
We find that when it comes to humans we are just like the cows and human populations become more obese.
- When they are fed a western diet ( grain/oil mixture)
- When the population has experienced extreme trauma ( famines, migrations) that selected only the largest and most metabolically efficient to survive (natural selection or ‘ survival of the fittest)
A human population that has survived extreme trauma will become enormously obese if exposed to a western diet ( Pacific Islanders, Pima Americans )
In addition to our genetics and environmental obesity triggers we looked at a new area of epigenetics This confers an added layer of risk directly onto the genes of people whose mothers experienced famine, or obesity when they were pregnant. This explains why each generation of children suffers even more with obesity.
The latest research seems to validate ‘its in the genes’
Our sedentary and sugar laden lifestyles don’t affect everyone in the same way, our genes are triggered by our environment and control our weight set point If you have the wrong genes in the wrong environment you are going to struggle with weight control. If you try to fight against your
weight set point and attempt to manipulate your weight downward by dieting you may make things worse. The solution is to try and create your own personal environment, one that insulates you from obesity triggers that your genes are looking for You have to understand why your brain wants a high weight set option. What signals is it receiving that it needs extra fat stores These are the signals that are key to obesity and how to control it.
Dieting and the biggest losers
The metabolic processes regulate our weight. The energy reserves ie; how much fat our bodies carry are controlled by our sub conscious not our conscious brain. We can override our subconscious brain for a time by dieting but ultimately our negative feedback processes will draw us back to our personal set point This weight set point is calculated by our brain from our environment, our history and our genes. It can be altered up or down if we understand the processes in this . If we over eat or under eat and our weight goes up or down compared to our set point then our basal metabolic rates are switched up or down to restore us to our set point weight.
Metabolism is adjusted like a dimmer switch. If our body wants us to lose weight it will increase metabolic burn. There is evidence that this burn or metabolic adaptation to overeating is controlled via a sympathetic nervous system activation. When this is active we feel the consequences of this. Some are good – clear thinking or absence of well being. Some not so good- higher blood pressure and glucose levels. In addition SNS activation causes excess energy to be lost by switching on thermogenesis in the muscles. As a result we may feel hot and sweat more easily as the body cools down to compensate for the muscular heat generation.
When our body wants us to gain weight because our weight is lower than our set point ( ie; during a diet) our metabolism can decrease dramatically . When this occurs the parasympathetic nervous system becomes more active This reduces energy expenditure by the heart ( blood pressure becomes normal) and shuts off thermogenesis in the. Muscles – making us feel cold
Metabology Rule 1 Our first law of thermodynamics ( energy stored – energy in-energy out) now seems a lot more dynamic. Energy out varies dramatically – metabolism cannot be controlled by our free will
We can now examine the energy in part of the equation. Can we consciously control the amount of food and calories that we take in over a period of time or is this also under some kind of subconscious control?
Why we eat
We learn that our appetite ( that uncontrollable urge to eat) and our feeling of satiety ( that feeling that sufficient food has been taken in ) is strongly controlled by newly discovered hormones that originate in our stomach and intestines. The stomach hormone – ghrelin – tells us to go our and seek food- its the signal to take in energy in the form of food . The hormone peptide -Y-Y originating in the intestine sends us the message to stop eating.
These hormones are powerful and are designed to be part of the negative feed back loop – trying to keep our weight at the brains perceived safe weight set-point. Loose too much and you will be ravenous and never feel full. Gain too much and you will loose your strong appetite and feel satisfied without food In the fight for your weight your subconscious brain will always win – forcing you to take in the energy that it wants.
When combined with the dramatic decease in our metabolism ( energy expenditure) it can occur to stop weight loss . The old school weight loss equation- energy in (food) – energy out (metabolism)= energy stored (fat)- is not under our conscious control .
Leptin – the hormone produced by our fat cells is the master controller of our weight
It works to stop us getting too fat by telling the brain how much energy is already stored – by acting in the same way as a petrol gauge on a car. Too much leptin means little appetite and a high metabolism- producing weight adjustment back down to the set point. It helps direct both metabolism and appetite/satiety to keep our energy reserves on an even keel, preventing runaway weight gain and weight loss. In many people leptin is the reason why their weight is not an issue. They don’t count calories because leptin is in charge. When this hormone is deficient ( a rare condition ) staggering and rapid weight gain occurs.
But if leptin is really the master controller why do people with obesity have high levels in their blood stream from their fat? Why is leptin not working for them.
The Glutton
Leptin resistance – its like you think your car has no petrol but in fact the petrol gauge is broken
Likely causes are a combination of;
1 The hormone that controls the glucose level in our blood stream – insulin.
2. A protein that controls inflammation in the body called TNF-alpha that triggers inflammation of the weight control centre of the brain and the need for even more insulin .
Leptin is the long term controller of our weight and works by attaching to special receptors in the hypothalamus where it sends signals ( too much fat). But the strength of the signal to the same cell can be diluted by insulin
So high insulin – leptin resistance – and a higher weight set point.
When there is a high combination of high insulin and lots of inflammation in the body – leptin will stop working
The leptin-insulin-inflammation interaction becomes a downward spiral once it gets started . Insulin ( caused by too much sugar ) dilutes the effect of leptin
Inflammation ( caused by the Western diet) stops the dilute leptin being sensed in the brain.
Inflammation blocks insulin-signalling in the cells so more insulin is needed , and so the cycle continues.
But …studies have shown that leptin resistance can be reversed by changing the quality of food that is consumed . You can’t fight against your weight by dieting – the only way to beat it is to understand it
The Master Chef
Our cells process energy and how we are reliant on ATP micro batteries follow ancient rules set down 4 million years ago when cellular life began. It wasn’t until over 3.5 billion year ago when our one called ancestors took in and nurtured the mitochondria using oxygen to supercharge the micro batteries This energy is used by all animals including us .
Humans could not develop their large energy sipping brains without sacrificing another organs use of their limited energy budget.
Prior to Homo sapiens developing our nearest relative Homo erectus tamed fire. They used fire to break down the energy in food making it more digestible —. We call this cooking The energy saved by starting the digestion process of foods before they were eaten rendered our long digestive system redundant As time past we evolved shorter guts and the energy saved we could afford to develop a larger brain.
This instinct to control food led us to develop agriculture and then trade food in markets Then we learnt to process food so it could be preserved for overseas trade becoming a business commodity. Sugar and wheat became staples in our diet.
Finally, controlling the production was not enough We wanted to understand it .
The Heart of the Matter
But…. since the 1950s scientists have disagreed over whether sugar or saturated fat is a cause of heart disease In the end the financial might of the sugar industry helped win this battle
The outcome ? Natural saturated fats – particularly cholesterol – were identified as being bad for us Plenty of research sponsored by the food and pharmaceutical industries ( first sugar money then statin money ) has perpetuated the diet/heart hypothesis .
The scientific battle over sugar and fat culminated in 1977 US government advice ( the first ) on what to eat and what not to eat. As a result a decrease in the amount of saturated fat, an increase in the amount of sugar and an explosion in the amount of vegetable oils consumed occurred from the 1980s onwards, leading to a sudden rise in the incidence of obesity in Western populations.
The Omega Code
We have learned that the type of fat we eat is so important to our health and weight.
There are two particular fats —-omega 3 and omega 6— that cannot be made within our bodies, and like vitamins are essential in our diet ( Thats why they are called essential fatty acids) These two fats compete with each other for space in every cell in our bodies with the amount of each omega fats we eat regulates the amount seen in our cell walls. The amount ( or ratio) of the two fats on our cell walls have profound effects on our metabolism, our weight and the degree of inflammation within our bodies
From the 1980s onwards, scientists ( and governments) recommended we change our fat consumption away from natural saturated fats and towards polyunsaturated vegetable oils Vegetable oils have extremely high levels of omega 6 fat which makes them stable and less prone to oxygenation ( or going off ) and therefore a suitable addition to a foods that require a long shelf life
The consumption of seed oils ( sunflower, rapeseed, soya) has tripled in three decades. The resulting excessive amounts of omega 6 consumed in the Western diet translate directly into the make up of cell wall fats. The ratio of omega 6 to omega 3 in a populations food supply is also mirrored in their cell walls The change in the type and amount of fats consumed in the Western diet has resulted in an increase in the omega 6 to omega 3 ratio from a natural level of four
omega 6s for every one omega 3 to a current level of up to fifty omega 6s for every one omega 3.
Increased cellular omega 6 levels cause an increase in inflammation ( contributing to a range of Western diseases) Increased inflammation ( via TNF- alpha ) leads to poorer functioning of insulin and a dulling of the effect of leptin ( the hormone produced by fat cells that keeps us thin). Poorer insulin function means more insulin is required within the blood. Higher levels of insulin also result in a dulling of the leptin signal. All these effects result in a rise in the weight set point and then, inevitably…..weight gain.
There is some evidence that the foods that hibernation animals eat before winter sets in as a trigger for rapid weight gain. The signal comes from a shift in food availability in the autumn?winter towards nuts and grains ( omega 6) and away from shoots and leaves ( omega 3) which affects the animals cellular omega 6 to omega 3 ratio and triggering weight gain.
In fact the Western diet has a much stronger effect on our own omega 6 to omega 3 ratio than can be seen in a switch from spring to autumn foods because the Western diet remains the sane whatever the season. This could produce a permanent signal to gain weight and a strong contributor to the development of obesity in some people.
Just like deficiency diseases of the past – beriberi, scurvy – could a relative shortage of omega 3 compared to omega 6 be an important trigger to todays health epidemic – obesity?
The Sugar roller coaster
Insulin produces blood sugar to be stored in cells to be used later
If insulin levels in our blood stream are high then our weight set point will be raised
If insulin levels are low then weight loss will follow
Higher insulin = higher weight set point
Lower insulin= lower weight set point
Insulin > leptin resistance > lower metabolism > higher weight set point
Decreasing insulin level> decreased weight
The Omega foods that influence Insulin levels
Western diet > higher omega 6 to omega 3 ratio > insulin resistance >more insulin > higher weight set point.
High omega 6 to omega 3 ratio> inflammation> insulin resistance > higher weight set point
Put simply.
Most people have 5 litres of blood in their body. Imagine a bucket of blood. We only need to mix in one teaspoonful of sugar in that to reach our optimum blood level of 80mg/dl. There’s large reserves of sugar in our muscles and liver but only one teaspoon in our blood The glucose transporting hormones – especially insulin – keep us alive Any carbohydrates we eat puts glucose in our blood stream When insulin levels are high the body switches to storage mode
Alcohol… is made from sugar. But don’t think about the calories we consume in alcohol ( a beer contains approx 200 calories). Think about how it affects our weight set point
Insulin is released by the pancreas when we have too much sugar ( or refined carbohydrate like wheat ) in our blood The blood sugar levels spike resulting in a powerful insulin response. The high insulin causes the cells to suck too much sugar from the blood, which leads to blood sugar that is too low which then causes a craving for more sugar. The sugar roller coaster – fluctuating blood sugar levels throughout the day – increases our average insulin levels
The US government guidelines to reduce saturated fats in the diet have led many food companies to increase the amount of sugar in their ingredients to keep the food palatable. The result has been a 20% increase in the amount of sugar consumed in the population since 1980. In addition the recommended dietary changes led to vegetable oil consumption skyrocketing and this led to an increase in omega 6 in the content of our cells The result is a decrease in the efficiency of insulin, which means that more insulin in now needed
The recent changes in our diet and the new snacking culture have led to a much higher insulin levels and a resulting higher weight set point for most of the population Changes to an individual’s insulin profiles can be made by changing dietary preferences. Lowering insulin levels by dietary changes will lead to weight loss
The French Paradox
Over the last 40 years nutritional scientists have told us that
Fat makes you fat
Saturated fat causes heart disease
There is now a growing body of evidence that these pillars of dietary advice are built on shaky foundations As the French, the Masai and the Inuit have shown
We now know that fat causes a more immediate satiety response than carbohydrate, then the hormones then act on our weight control centre in the hypothalamus to stop us eating
Food cultures pay a critical part in the health of the population. From the raw fish and rice of Japan, the noodles of Indonesia, from the salads and olive oil of southern Italy to the steak and red wine of France Food cultures have developed over generations and more importantly they encourage social interaction. When the Western world embraced nutritional science it threw away generations of accumulated food wisdom These food cultures encourage cooking fresh and local ingredients
The Miracle Diet Book
A great way to make money is to write a diet book
Phase 1 :Inspires readers to go on a new ‘cannot fail’ diet. They lose weight between 3 and 7 kg in the first few weeks They tell everybody
Phase 2 : their friends buy the book
Phase 3 : Interest spreads like a Ponzi scheme …social media chatter
Phase 4 : the chatter and interest dies down. Everyone starts to gain weight and they blame their own willpower
Phase 5: this is the stage when readers weigh more than when they purchased the book
Phase 6 : the author returns from his/her Caribbean beach house bought with the proceeds of the book
Low calorie diets like the Cambridge weight plan,Slimfast, LighterLife are examples of very low calorie diets In the long run they raise the weight set point
Low fat diets like Slimming World does not restrict the amount of food but replaces high fat food with lower fat filling foods The benefit of Slimming World is that it encourages home cooking and consumption of more natural foods. The drawbacks are that you may switch to a higher carb content of food. But these dieters are cutting down on ultra refined carbs ( contained in the Syns) and could lower the weight set point slightly
Low carb diets lower the carb intake to under 20 grams a day where ketogenesis occurs . It is effective in loosing weight but it has a catch. A very unpleasant side effects are from pounding headache , constipation, nausea to flu like symptoms By not taking in any food that can be broken down into glucose you are forcing your body to use the reserves stored in the liver . The Liver acts as an energy store where there are 2-3 days of energy stored there. The initial weight loss of any calorie restriction diet is from the stores in the liver, as this energy is used up the water in the liver required to hold the energy storied there is also lost. The result is an initial weight loss but none of it is fat – it’s water. Another drawback is that for it to be successful you have to be on it for the rest of your life and be very determined Reverting to a more normal diet would mean regaining the lost weight and more.
Intermittent fasting diets means eating normally for a few days and then limiting the food intake for a couple of days to 500 or 600 cal. It does work for some people It works by simple calorie restriction, to avoid processed and junk foods so the omega profile and ratio will be improved and the weight set point improved
Vegan and vegetarian diets could be from a concern for the environment and animal welfare
Most vegetarians and vegans eschew processed foods because they contain animal products This will have a positive effect on the amount of sugar and omega 6 oils they take in. But consuming foods in omega 6 and consuming nuts and seeds ( all high in omega 6) will have a detrimental effect on their omega profile especially as fish is excluded from the diet —a valuable source of omega 3. A pitfall for vegans is that bread, pasta and rice are increased to make up their daily energy requirements with a detrimental effect on their insulin profiles and ultimately their weight. Vegans and vegetarians are much more aware of the quality of their food and may cook more and exclude processed and fast foods If they can avoid too much sugar and carbs their weight will fall
Blueprint for a Healthier Weight
Prepare to Do it yourself
Prepare to reset
Realistic expectations
It is unlikely that you will ever reach the weight you were when you where 18 as your body will be biologically different. Allow time and expect to be healthier
Eat more, Rest more
Instead of dieting change the environmental signals the body is picking up. These will reset the weight set point at a lower level then the hormonal and metabolic signals will drive weight down
There are three steps – the first is easy , the second enjoyable and the third more difficult. Everyone has different goals whether losing 5kg or 20kg and as every person has different genes some will find it more difficult than others When you reach your target goal you can stop there if you want to – it isn’t a whole race, but it really is a lifelong plan. This is the only way of losing weight and keeping it off for good.
Step 1-eat more
Eat three meals a day
Have a high-fat/protein and low carb breakfast
Cook/prepare your own food
Avoid sugar, wheat, corn,and fruit juices
Snack if required
Clear out the pantry
Of all foods with sugar
Of all foods with wheat
Replace with a fruit bowl – 2 a day
Replace with healthy snacks – meat /cheese /boiled eggs/ hummus /yogurt/ avocados /baked vegetable chips
Breakfast – avoid toast ,cereals that contain sugar /wheat or corn, yoghurts that contains sugar, fruit juice
A traditional English breakfast is fine or avocado/salmon or eggs
NO bread
Cook your evening meal – no excess of wheat, sugar or corn
Remove vegetable oil from your home
Cook with olive oil and/or butter
Cut out vegetable oils seeds. ( corn, rapeseed etc) ( including grains) and processed foods
Do not eat foods cooked with vegetable oil – fast foods, crisps, fried snacks, health bar as, ready made cooking sauces , margarines and oily spreads
Avoid foods containing high omega 6
( ie cured meats and tofu )
Nuts and seeds have a high omega 6
Choose meat and fish with a high omega 3 level:
Grass fed beef
Lamb( usually 100% grass fed)
Line caught fish ( if they are from a fish farm their diet will be grain fed and a higher omega 6)
Canned fish in brine not oil
Avoid grain fed chicken
Omega 3 comes from green leaved plants and any fish or animal that eats leaves or grass or algae is good for omega 3. Remember that farms feed their animals with an unnatural grain based diet to grow them faster (. This is relevant for humans too)
Eat as many fresh vegetables and dairy products as you like
Don’t buy anything your great grandmother would not have recognised as food
Don’t buy any food that DOESN’T go off
Don’t buy foods that are packaged , especially if they have more than five ingredients or are labelled as healthy ‘ low fat’ ‘ no added sugar’ ‘ low cholesterol’
Try and buy your food locally from a traditional greengrocer or butcher
Get some exercise
Exercise>lower cortisol>lower set point
Exercise>improved insulin sensitivity > lower insulin> lower set point
Reduce your insulin by reducing the glycemic index of food. This describes the speed that food releases carbohydrate energy into the bloodstream The higher the GI the faster it releases energy
Ie White potatoes GI. 29. Sweet potato. 20
White rice. 2. Wild rice. 16
White bread. 14. Brown bread. 10
Some foods have a low GI. Meat fish eggs cheese Fruit and Veg. You need to look this up
But this isn’t about the calories you consume its about the quality of food
Get more sleep
