Diet and Nutrition
Diet versus “A Diet”
First let us get this out of the way, there is no magic “diet” in existence. Every year we see another new diet which promises to burn fat, lose weight, increase muscle mass, increase health, increase longevity, etc etc. We have gone from Atkins no/low carb diet to high carb diets, to paleo protein diets and everything in between. While there are certainly important things to consider besides caloric intake, and we will discuss them here, you should start at the most basic level and for a moment disregard the incredible amount of “diets” that are out there. At the most basic level you need to remember a single idea: If you take in more calories than you burn you will gain weight. If you take in less calories than you burn you will lose weight. If you take in the same amount of calories that you burn your weight will remain the same. Quite often I have to tell patients and clients to remember to keep it simple. Shaping ones diet, not “A diet”, but ones everyday eating pattern is much simpler than we’ve been programmed to believe by all the diet fads.
Ignoring for a second the negative health effects of Twinkies, there is a fascinating self study by a nutrition professor who only ate Twinkies for 10 weeks. His daily caloric intake was calculated to be 2600 calories per day, but he only ate 1800 calories of Twinkies and other assorted junk foods, he also had a daily protein shake and some vegetables, and a multivitamin but fully 2/3 of his caloric intake was from the junk food. At the end of his “diet” he had lost 27 pounds and his body mass index (BMI) had dropped from 28.8 to 24.9, essentially dropping him from the “obese” bracket into the “normal” bracket. His body fat dropped from 33.4% to 24.9%. Don’t focus on the Twinkies part of the diet as he used this on purpose to make an extreme statement about what types of food you eat to lose weight versus how much food you eat to lose weight.
In terms of nutrition and health there are indeed some fascinating results from this self study with some theories on why this would be the case. Things you would expect to worsen actually improved. For example his LDL, which is “bad” cholesterol, actually decreased. Alternatively his HDL “good” cholesterol increased. While the study was far from scientific and doesn’t allow us to truly point out why these “good” factors got better on such a bad but caloric deficient diet, we can begin to get a picture of the negative health effects of simply being overweight and eating more calories than we burn. Currently 2/3 of the U.S. is obese, which means morbidly overweight, which means it has an adverse effect on health which will lead to a decreased life expectancy. Some researchers predict that by 2050 42% of the U.S. will be obese!
Now please don’t go and begin your “Twinkie Diet” tomorrow, this is just an extreme example to begin a discussion on nutrition and keeping it simple. The worst case scenario would be if you kept your diet exactly the same as it is today but simply cut calories by simply taking a portion of the food off your plate, simple. It’s the simple things which we can understand, simple things we can adhere to. Of course we can see much more benefit from going to the next level, but don’t underestimate the power of simply taking in less calories than you burn.
Just as you put gas in your car in order for it to have energy to run, you must also put food into your body for it to also run. The body takes in primarily 3 forms of energy: carbohydrates, proteins and fats. Each of these forms of energy are stored in different manners, are used as energy in differing ratios and orders, and can be manipulated to a certain extent for benefits or negative effects on our health. These food types have also been the subject of an incredible amount of hype seeking to capitalize on a little bit of science and a lot of marketing in the plethora of fad diets we are bombarded with on a daily basis. The reality of how your body utilizes these foods is much less glamorous, but remember that keeping things simple is what allows us a greater degree of adherence to diet instead of “a diet”.
Lets tackle probably the most glamorous food source and the object of so many fad diets today. A carbohydrate is simply a conglomeration of glucose, this is a bit of a simple explanation but we will delve more into it as we go along. Glucose is a simple sugar which is the building block of carbohydrates. The body breaks carbohydrates down in the small intestine to glucose, which are then stored inside cells and inside the primary glucose storage in the body which is the liver. There is always a certain amount of glucose which circulates in the bloodstream, ready to be shuttled inside a cell which needs to create more energy for whatever function it has. The body primarily manages this through insulin, which is a hormone which signals the glucose to leave the bloodstream into the cell, there are hormones which also do the opposite and increase blood glucose as well. A high glucose level in the blood can signal a pre-diabetic or diabetic condition which we will discuss in a little bit. Glucose is the bodies primary source of energy and its preferred source, although keep in mind that the body is always using all three sources of energy but what varies is what ratio it uses those sources of energy compared to each other.
So keeping in mind that food is energy the way we calculate how much energy that food produces is by a calorie. A carbohydrate releases 4 calories of energy per gram. Keep in mind that there is an energy cost to actually break down food into the smaller basic blocks of energy or storage the body utilizes, this is called your metabolic rate and we will get more into this as it is very important in maintaining weight.
The interesting thing about carbohydrates is that they release different levels of insulin, which directly affects the level of blood sugar. The glycemic index is a measure of the effects of carbohydrates on insulin, to put it simply it is a list of carbohydrate food sources which rates them on a scale of how much insulin they release. The lower on the glycemic index a carbohydrate is the slower it is absorbed and broken down, inversely the higher on the index the faster the carbohydrate is broken down. Glucose is used as the highest glycemic index food as a marker at 100. High glycemic index foods are those foods over 70 on the index such as white bread, medium foods between 50-69 include foods such as whole wheat products and potatoes, and low index foods include fruits, vegetables, non processed grain and nuts.
Obesity not only leads to heart disease but it also leads to Type II diabetes. This is when the hormone insulin, which functions to lower the glucose or sugar in your blood, does not function properly leading to a high level of blood sugar. Glucose is one of our bodies primary sources of energy, it is taken into the cell and broken down into energy. If there is an insulin resistance then the glucose remains in the blood and this can cause a host of health issues. Type II diabetes has been associated with a ten year shorter life expectancy. (1)
Much ado has been made about the glycemic index, with some research showing that consistently eating high glycemic index foods can lead to Type II diabetes. It’s interesting to note that although the accepted theory is that obesity leads to type II diabetes some researchers theorize that type II diabetes comes first and leads to obesity in some cases. Just to sidetrack for a second it’s interesting to note that several research articles in the recent past have noted that weight loss surgery, which essentially causes food to bypass the upper 3rd of the small intestine, has literally cured type II diabetes in these patients, and this has been noted before they lost any weight due to the surgery. The reason is unclear at the time, although researchers theorize about certain amino acids produced in the upper 3rd of the small intestine which may have a connection to insulin sensitivity.
It is also interesting to note that while the accepted paradigm is to primarily eat low glycemic index foods certain countries primarily eat very high glycemic index foods yet have a very low rate of obesity and type II diabetes. The American Diabetes Association officially states that the amount of carbohydrates is more important than specifically eating lower glycemic index foods, they specifically state as one of their grade A recommendations “With regard to the glycemic effects of carbohydrates, the total amount of carbohydrate in meals or snacks is more important than the source or type.” (2) There has been research which shows that lowering caloric intake yields better health results than keeping the same caloric intake but eating lower glycemic index foods. (3) Following the glycemic index can be confusing and misleading because many things can confound a foods glycemic index rating, the type of carbohydrate, the amount of carbohydrate, what you eat the carbohydrate with, how you cook the carbohydrate, etc.
It’s just becomes too complex to follow when all we want to do is keep it simple. Later on we will go into some interesting periods when your insulin sensitivity is actually increased such as after fasting (example breakfast) or after a workout and will talk about those benefits.
(1) Williams textbook of endocrinology. (12th ed.). Philadelphia: Elsevier/Saunders. pp. 1371–1435. ISBN 978-1437703245.
(2) Sheard et al. (2004). “Dietary carbohydrate (amount and type) in the prevention and management of diabetes: a statement by the american diabetes association.” Diabetes Care;27(9):2266-71