Found this info-graphic while surfing Banner Health’s information pages. Many of my patients get a very confused look on their face when I ask them to restrict carbohydrates. Sugar is the most prevalent form of carbohydrate in the Standard American Diet or SAD diet. Sugar comes by more than one name. This info-graphic is actually very helpful. All of these names are synonymous with weight gain and cholesterol formation.
We just got a sample pack of Lily’s Chocolate. This is a Stevia and erythritol sweetened chocolate that has no aftertaste and doesn’t cause the stomach upset that many experience with chicory root based products. I am always looking for good low carbohydrate alternatives for snacks, as rescue foods, or to assist in baking.
My wife found this chocolate in a recipe that Carolyn Ketchum had posted on her website, All Day I Dream About Food. It is quite tastey!! Thanks, Caroyln!! (By the way, I dream about food all day long, too.)
I scanned a copy of the wrapper for the Salted Almond & Milk Flavor. I have to admit, I ate half the bar. It was that good!!
For those looking for an alternative chocolate for a snack or to use in a recipe, this may be the answer. You can find their whole line of chocolates here.
Hope this helps.
I have multiple patients that come to my office that we follow and treat for weight loss and metabolic syndrome. They are discouraged that their weight loss has stopped or is very, very slow. The most frequent problem I find when they bring in their food journals is the “healthy chicken salad.”
“What?! But, Doc, Chicken Salad is healthy?! RIGHT?”
The chicken salad shows up on their journal almost daily. Somehow, we’ve been indoctrinated that the chicken salad is good for us. I want you to look closely at the image that was recently shared on the internet below. How is the nutrient value of your chicken salad any different than the Big Mac?
Why is this unhealthy? The carbohydrate content greater than 20-30 grams will cause a spike in insulin. When insulin spikes, the body is told to store fat (and it will store fat for up to 12 hours) . . . Yes, the 24 grams of fat in the salad now become dangerous in the presence of an insulin spike. In my patients with metabolic syndrome, they will produce between two and ten times the insulin and store two to ten times the fat. (Ten Big Macs would have tasted better . . . )
There is actually more carbohydrate in your salad than in the big mac. Why not add a strawberry shake just to finish putting the nail in the coffin? And we wonder why we are having trouble with weight loss?
The other issue, and probably of even greater importance, is that chicken breast has the second highest content of lysine & argenine (two of the 10 essential amino acids) count of all the poultry family. This is second only to turkey breast, which also contains a large amount of tryptophan (a third essential amino acid that spikes insulin). Why is this a problem? Because argenine, tryptophan and lysine all stimulate an insulin response on their own, separate from glucose. We need these amino acids, however, when our meals contain a predominance of these amino acids, it rasies insulin significantly in those who are insulin resistant (pre-diabetic).
Those 43 carbohydrates, plus the stimulus from a meat high in argenine, lysine and tryptophan, spike your insulin, kick you out of nutritional ketosis and slow weight loss for up to 48 hours.
Please, if you are following a low-carb or ketogenic diet, get rid of the chicken salad.
If you want to learn more about this, read my article on the eight most common reasons you can’t lose weight.
A number of patients come in to the office struggling with loosing weight. When I review their dietary journals with them, I notice that many of them never stop eating fruit (because, fruit is good for you, right?!). Well, lets put it this way:
One banana for breakfast is equal to . . .
. . . just over seven (7) teaspoons of sugar.
Count them . . . seven (7) teaspoons.
If your eating a banana for breakfast, it is halting your weight loss for up to 12 hours. Give the banana’s to the monkeys and cook up some sausage and eggs for breakfast tomorrow.
Just thought you should know . . .
A friend posted this image and I couldn’t help but think about this little cartoon throughout the day. In the 15 years that I have been in medical practice, it was re-emphasized to me that my definition of cure and the patient’s definition of cure may at times be notably different or even in opposition.
I am reminded of a sweet a patient in her early nineties that was brought in by her three well meaning and very caring daughters. This patient was a type II diabetic and, for the most part, her blood sugar was in pretty good control. To put it in medical terms, her morning blood sugars were in the 120 range and her Hemoglobin A1c (HbA1c) was a 6.4%. She was obese by the standards of her body mass index (BMI) and her cholesterol was elevated.
The concern of her three daughters, “there to rat her out,” as the patient put it, was that she was eating donuts for breakfast each morning for the last few months. I noted that her HbA1c had gone up from 5.9% at the last visit. We discussed the fact that the change in her dietary intake appeared to have caused the rise in her blood sugar and her cholesterol.
With my affirmation of the cause as ammunition, the patient’s daughters began to individually take shots at her choice of meals over the last year. They did it, I could see because they loved and cared for heir mother. But I noticed the patient’s demeanor change suddenly, and a bit of trust between me and my patient began to slip.
This sweet centenarian turned and looked at me, square in the eye, and then proceeded to give me an education.
“Dr. Nally, do you know how old I am?” she asked.
“Why, yes, you are 93 years old,” I replied.
“And do you know how much longer I am going to be alive on this earth?” she inquired.
“Well, no. I do not know how much longer you will be alive, but I can tell you that you have out lived most of your peers and the average age of most Americans.”
“Then, why the hell are you, and my daughters, worried about me eating a damn do-nut?” she yelled. “My blood sugar is still pretty good and I figure that if I have to be around on this earth any longer, then by stars, I am going to enjoy my favorite breakfast. If it kills me, then so be it. I am going to enjoy it.”
Well, that was that. The cure was to enjoy her last few years upon this earth.
She did just that.
The first answer to a Common Core math question that I actually agree with . . .
BuzzFeed’s Christine Byrne has a great article on 31 ideas for Low-Carb breakfasts . . . I’m going to have to try some of these. The “Eggs in a Cloud” looks fantastic . . .
You can find the article here. Thanks BuzzFeed!
There are a number of recipes for “Fat Bombs” on the internet, but this one is my wife’s version. These have been a lifesaver for starting and maintaining a Low-Carbohydrate or Ketogenic diet over the last few years. They are fantastic mid-meal or anytime Low-Carb snacks, full of satiating fat, that really help during the holidays. I mentioned Fat Bombs to my patients in my Low-Carb Group Visit Class today and I promised to post them here:
Fat Bombs:
1 stick of real Butter softened
1 cup Coconut Oil
1/2-2/3 cup Erythritol
1 tsp liquid Stevia
1/3 cup Cocoa Powder
1 cup Peanut Butter or Almond Butter
2 cups chopped Macadamia Nuts or slivered Almonds
1-2 cups of Coconut
Mix together and place 1-2 table spoon sized scoops in small muffin tin or on wax paper. Must be kept refrigerated to remain firm.
Enjoy!!
Many of you have already seen my article about sweeteners, which ones work well and which ones make you fat. If not click here for the article. Stevia is one of those sweeteners that doesn’t spike your insulin as long as it isn’t crystallized with dextrose or maltodextrin. I actually found the stevia plant at one of my nearby nurseries, thanks Moon Valley Nursery.
Here is the plant after two weeks in my aquaponics garden.
The leaf can be dried, crushed then used to sweeten food or drink. Can’t wait to try it.
Hypertension (elevated blood pressure) is one of the triad symptoms of metabolic syndrome. I see this to some degree a very large majority of the people seen in my office. Many people are so used to having borderline or elevated blood pressure, and not successfully controlling it through caloric restriction, they are told it is a “genetic problem,” placed on blood pressure medication and sent on their way. The problem is that most of these people will have a progressive elevation in blood pressure over time and these medications are continually raised until the person is on four or five different blood pressure medications at maximal doses. Again, their genetics are blamed and that is the end of it. Or is it?!
When I first started treating the insulin resistance problem in the human, rather than the blood pressure problem, I began to see immediate reductions in blood pressure within one to two weeks. So much of a reduction that if I didn’t warn the patient that they should begin to back down their medications, they would experience symptoms of dizziness, light-headedness, headache and a few patient’s nearly passing out. I often wondered why applying a ketogenic diet had such a profound effect on blood pressure so quickly. Dr. Robert Lustig helped answer that question for me.
In order to understand how the Standard American Diet (we call it the SAD diet in my office) raises your blood pressure, it is important to understand how the body processes the basic sugar molecule. Sugar is one glucose molecule bound to a fructose molecule. This is broken down in the body and 20% of the glucose is metabolized in the liver, the other 80% is sent on to be used as fuel throughout the body. Fructose, however, is where the problems arise. 100% of the fructose is metabolized in the liver, and the by product of fructose metabolism is increasing the liver’s production of MORE glucose and the byproduct of uric acid. Uric acid is produced and this inhibits the production of nitric oxide. The diminished nitric oxide in the presence of an increased level of glucose (stimulating increased insulin production) constricts the blood vessels and raises blood pressure. Yes, that donut you just ate raised your blood pressure for the next 12 hours.
All of this can be seen in the really complex diagram found in Dr. Lustig’s 2010 article:
So, how do you lower your blood pressure through diet? First, cut out all the simple sugars. These include anything with table sugar, high fructose corn syrup and corn syrup.
Second, limit your overall intake of other sources of carbohydrates including any type of bread, rice, pasta, tortilla, potato, corn and carrots. Realize that fruit is fructose, and when taken with other forms of glucose can have the same effect as table sugar.
Third, if you are taking blood pressure medications, see your doctor about close monitoring of your blood pressure as it can drop within 1-2 weeks of making these dietary changes.
A few of my patients have come in struggling with their weight this week, following what they assumed to be a low carbohydrate diet. They were eating yogurt for breakfast, a chicken salad for lunch, and chicken and vegetables for dinner. A true low carbohydrate diet is ketogenic (it derives fuel from ketones) and is the byproduct of fatty acid metabolism. That means your fuel is coming from fat, not protein or carbohydrate. The presence of glucose, fructose, lactose or other sugars (or many sugar alcohols) shut fatty acid metabolism down and halt the process of weight loss and frequently increase weight gain. Too much protein does the same thing. A chicken salad is not ketogenic. It may be low carb, but without adequate fat, the absence of glucose drives the body to use protein as it’s primary fuel source. It is essential to maintain ketosis that a low carbohydrate diet moderate the protein and increase the fats to upwards of 60-70% of the total caloric intake.
Bacon is a 50/50 food. (I’m not talking about turkey bacon . . . that’s not real bacon). Each slice of real bacon is at a minimum 3 grams (50%) fat, and 3 grams (50%) protein. No carbs there, either.
So, if you’re struggling with your weight loss on a low carb diet . . . your first step should be “BLT” it!
“You want me to eat WHAT?! But that’s . . . ,it’s . . . FAT, really?”
” Yes, it is.”
Every day, instruction to my patients is initially seen as Food Pyramid heresy and My Plate iconoclasm. Yes, I want you to flip the Food Pyramid on its head, and push everything off My Plate and fill it with fat. . . Really. . . Yes, I do.
I was counseled by many school professors over the years that there are two things you should avoid talking about: Religion & Politics. The ketogenic or low carbohydrate dietary conversation involves both. “Fat Phobia” is a Religion. We have demonized fat and sainted the treadmill. You see, fat got a bad wrap when the bomb calorimeter was invented. We realized that there was twice as much energy found in fat that there was in carbohydrate or protein. Early nutritionists, understanding that heat is a form of energy, and realizing that energy is conserved, found that food substrates contain a set amount of energy that can be measured in a closed environment. Naturally, the Law of Thermodynamics got applied to lend understanding in how people gain or loose weight. We coined the term “you are what you eat” based upon our understanding of the Laws of Thermodynamics. The calorie became “king.”
For the last sixty years (an entire generation of humans) we have based our diet around the calorimetry of food and have labeled them as good or bad based upon calories. To loose weight, we are taught, you either have to eat food containing fewer calories (fat has the most calories per volume so it must be bad!) or burn it off faster than you take it in (did you go exercise at that new gym next door), right? Wrong.
First, you and I are not bomb calorimeters. We are not closed systems. We harbor variable levels of symbiotic bacteria (these also burn fuel at variable rates) and our body temperatures fluctuate to regulate other enzymatic and hormonal processes.
Second, bomb calorimetery functions on the premise that volumes are also held at a constant. Human volume and density change daily. Simple chemistry tells us that volume = mass / density. The average human mass fluctuates by 5lbs every day and our density changes based upon our hydration status (the amount of water we drink). Because these two variables are not constant in a human being, it is impossible to correctly apply the Laws of Thermodynamics to the human body and accurately predict weight gain or loss.
Third, hormones! (Anyone married to a pregnant female understands that nothing is as it seems when hormones are involved.) We have a plethora of hormones that change the rate in which fuels are burned or stored in the human body. Our GI flora (symbiotic bacteria in the human gastrointestinal tract) are also affected by hormones and do not have set rates of fuel use or breakdown. What this means is that you and I process food at different rates and derive different levels of energy and fuel from the same donut. Genetics plays a leading role in how these hormones are used and turned on and off. Fat is burned or stored in the body based on a hormonal mechanism I described in a previous post you can read here.
Asking patients to reduce carbohydrate intake to less than 20 grams per day and increasing fat intake to up to 70% of total caloric intake is essentially 20th century nutritional apostasy.
The dietary concepts from the Food Pyramid and My Plate have been embraced by our country for over sixty years. Changing our views on these as a country will be for many like changing religions. For those of us “with eyes to see and ears to hear” our work is cut out for us.
A number of my patients have asked what I use personally as a protein supplement and whether I use protein shakes. I’ve struggled to find a great tasting protein shake that does not contain any artificial sweeteners (see my article The Skinny On Sweeteners) that raise the insulin levels. Most of the pre-prepared shakes (including the Adkins, EAS, Muscle Milk, and many others) will significantly slow weight loss and knock you out of ketosis due to an insulin response stim
ulated by drinking them.
My sweet wife just perfected our family’s favorite high fat, low carbohydrate protein shake. Oh, it’s good and it’s filling. You’ll love it and you won’t be hungry for at least 3-4 hours after savoring this sweet taste-bud sensation.
This is a great shake for a mid-meal snack or a quick meal on the go.
Dr. Nally’s Low Carb High Fat Protein Shake:
[One serving (~ 2 cups) is 4.5 grams of carbohydrate]
Blend to preferred texture. . . (may add more heavy whipping cream if it is still too thick).
Enjoy!!
Did you fall off the low-carbohydrate wagon this week? Did those donuts just call out your name as you walked by the bakery in the grocery store? Maybe you feel like you were shot out of the carbohydrate cannon, landing in the nearby Potato County? If so, you probably had a relapse. You were doing so well, then all the sudden, your will-power caved.
Relapse is not uncommon when making a dietary lifestyle change. What causes relapse? I often see people relapse back to the Standard American Diet, the SAD diet, because of a number of reasons.
First, it is important to recognize that there are a milieu of neuro-hormones that drive hunger cravings or suppression. Anything that triggers a change in these hormone levels can cause the carbohydrate cravings to kick in . . . and you find yourself stuffing yourself with “carbage.”
Second, is boredom. Many people find an increased nervousness when they get bored. They find that eating, with it’s calming parasympathetic nervous system effect, diminish the nervousness that arises out of boredom. They often create a near Pavlov’s type trigger to eat when they experience boredom and it is quickly interpreted as hunger. There is actually a release of endorphin associated with eating and chewing that suppresses stress and or anxiety. Reduction of stress, exercise, and journal writing have been found to help patient’s reduce the food cravings associated with boredom. It is important to have “rescue foods” like string cheese, a handful of almonds, beef jerky, or “fat bombs” available that can be used when you experience these symptoms.
Following the line of triggers, Pavlov demonstrated that repeated actions associated with rewarding consequences will form a physiologic trigger. Frequently. our desire to eat carbohydrates (“carb cravings”) are often tied to triggers. For example, growing up in my home as a child, our family frequently would relax by watching prime-time television while eating a large bowl of popcorn and a Pepsi. To this day, whenever I turn on the television in the evening, I get cravings for carbohydrates. It is important to look at what you were doing or what was going on around you at the time the craving occurred. Substitution of foods has helped to solve these cravings by replacing the popcorn and Pepsi with pork rinds and Diet Dr. Pepper. (Don’t cringe, pork rinds and guacamole tastes fantastic and is a very low carbohydrate substitute that works for me.)
Lastly, many patients fall off the wagon when they visit or have a meal with family. They are often made to feel guilty if they don’t eat Aunt Velda’s homemade chocolate chip cookies. They are afraid of offending their relatives if they don’t partake of those tasty cookies. The challenge is that cheating by eating the cookies causes an insulin spike and leads to 24-72 hours of carbohydrate cravings thereafter. Are those cookies worth 72 hours of carbohydrate cravings? Maybe. But it is important to consider helping Aunt Velda to understand what those cookies will do to you, and that you still care for Aunt Velda even if you don’t eat her chocolate chip cookies.
In many families, food is often associated with love. “If you don’t eat the food I made for you, you don’t really love me” is an underlying tone that can be found in many family dynamics that I see in my office. Some times bringing your own low-carb chocolate chip cookies, and offering one to Aunt Velda, will stimulate a conversation about your dietary changes and diffuse the guilt and offence that might arise.
Often, knowing what will cause you to fall off the wagon, helps to keep you on the wagon. What challenges have you had staying on the wagon?
Intent
The intent of this brief is to analyze the burden of obesity in the United States and to recommend policy changes to reduce the medical costs of obesity imposed upon the individual and country as a whole.
Introduction
Conventional fat reduction/caloric restriction guidelines for the treatment of obesity and associated cardiovascular disease, diabetes, cancer, and hypertension have been recommended since the early 1970’s. Because these guidelines are based on questionable evidence, the cost of obesity has dramatically risen to almost 21% of overall health care costs in the United States (1). This brief will analyze the current medical cost of obesity and will explain why the current obesity reduction guidelines perpetuate the problem. In addition, the brief will examine the impact of government agricultural policy on dietary habits, and will recommend changes to farm subsidy legislation in order to reduce the incidence of obesity and decrease costs to the healthcare system.
History & Background
The Cost of Obesity on the Nation
As of 2012, obesity accounts for nearly 21% of overall health care costs in the United States. An obese person incurs $2741 more in medical expenses per year than his or her non-obese counterpart (1). Medicare spending has increased per person per year by $600 for each obese beneficiary (includes out-patient and prescription drugs) and Medicaid beneficiary prescription drug spending increased by $230 per year per obese person. Private insurance has increased by $248 for prescription drugs and $443 for in-patient services for each obese beneficiary per year (2). That adds up to $190.2 billion spent annually on obesity-related medical problems (3). This is a drastic change. Health care costs related to obesity were $85.7 billion (9.1% of overall health care costs) in 2006 and $61.2 billion (6.5% of overall health care costs) in 1998 (4).
The most recent Center for Disease Control statistics reveal that 35.7% of the U.S. adult population is currently obese and another 33% is overweight. Over 78 million adults and 12.5 million children are obese (5). The addition of 30 million people to the health care roles (current estimation of the Affordable Care Act including Medicaid expansion) means that an estimated $27 billion (in 2012 dollars) more will be spent per year on obesity-related health care costs.
Impact of Government Policy on Consumption
The ‘Farm Bill’ was originally enacted as part of President Franklin D. Roosevelt’s Agricultural Adjustment Act of 1933, which provided subsidies to American farmers in the midst of the Great Depression. Since that time the federal government has paid farmers not to grow seven specific crops – known as commodities – with the intent of decreasing the supply, increasing the demand, and thereby raising the price (7). Dr. Susan Blumenthal, former Assistant Surgeon General and current SNAP to Health project director, writes, “The Farm Bill has since expanded to include many different categories or ‘titles.’ The last bill to be authorized, in 2008, had 15 titles, including nutrition (food stamps), crop subsidies, conservation, livestock, crop insurance and disaster assistance. The 2008 Farm Bill approved $300 billion in spending: 67% was spent on food stamps; 15% on agricultural subsidies; 9% on conservation; and 8% on crop insurance” (8).
The U.S. Department of Agriculture (USDA) Subsidy Programs tend to favor, either directly or indirectly, foods that increase obesity and other diseases. These subsidies support commodity crops, specialty crops, dairy products, livestock, and federal purchase programs. Their justification is that they help to stabilize prices in agricultural commodity markets by balancing supply and demand (9). Between 1995 and 2011, $277.3 billion were given in farm subsidies to almost 40% of U.S. farmers. Arizona received $1.1 billion (mainly for cotton); however, only 7% of Arizona farms received subsides during this period (10). These subsidies are incentives to grow and produce specific commodities that have a higher monetary return. Subsidies also act as a disincentive for farmers to grow fruits and vegetables which fall under the “specialty crops” category. This restricts both small and large farmers from diversifying their crops, and limits fruit and vegetable production (11).
Arizona farms received $25.3 million in dairy subsidies from 1995-2011 and $29.5 million in livestock subsidies during that same period (9). Arizona ranks 2nd nationally in its production of cantaloupe & honeydew melons, head & leaf lettuce, spinach, broccoli, cauliflower and lemons, all of which are “specialty crops” and do not receive subsidies (12). The most recent statistics show that the top five states receiving subsidies are Iowa, Texas, Illinois, Nebraska and Minnesota, with Kansas coming in at a close sixth. The majority of these subsidies are for corn ($81.7 billion), soybeans ($26.4 billion), rice ($13.3 billion) and wheat ($34.4 billion) from 1995-2011 (10). It is important to note that the Renewable Fuel Standard of 2012 (legislation protecting the corn-ethanol lobby) mandates that 37% of the corn harvest be used in ethanol production (13).
The food subsidies above have been in place since the Food, Conservation & Energy Act of 2002 and renewed in 2008. They were only to be available for a period of five additional years and were set to expire September 30, 2012. However, the American Taxpayer Relief Act of 2012 (H.R. 8), enacted by Congress and signed into law by President Barack Obama, included provisions that extended these subsidies until September 30, 2013 (20).
For many low-income Americans and especially children, federal programs have a direct and significant influence on food choices. 
Over 30 million children receive government subsidized school lunch through National School Lunch Program (NSLP) administered by the USDA Food and Nutrition Service (14). USDA-purchased meats, dairy products, grains, fruits, and vegetables are supplied to schools for use in meal programs. Current school lunch recommendations on calorie intake set by the USDA and The Healthy, Hunger-Free Kids Act of 2010mandate school lunches provide 650-850 calories per meal to the 30 million children currently enrolled in this program (15). Interestingly, that is the same caloric count of a Big Mac®, small fry and Diet Coke® from McDonalds® (16). The rational for these purchase decisions are based upon agricultural support goals and adherence to national dietary guidelines (14). A study published in the journal Economics and Human Biology reveals that a person’s body mass index (BMI) increased faster if that personwere on food stamps, and the BMI increased at a faster rate while on the Supplemental Nutrition Assistance Program (SNAP). “We can’t prove that the Food Stamp Program causes weight gain, but this study suggests a strong linkage,” said Jay Zagorsky, co-author of the study and a research scientist at Ohio State University’s Center for Human Resource Research (17). However, much of the food available through the SNAP programs are refined, subsidized high-carbohydrate containing foods.
The price of food influences an individual’s consumption choices (6). Foods that are refined contain increased amounts of sugar or high-fructose corn syrup. These foods contain more caloric density and are often cheaper and more easily accessible. These are foods that are usually found in the center of the grocery store and frequently on sale at the end-caps of each isle. Nutrient-dense, higher fiber foods are frequently associated with higher prices and are consumed less often. These are the foods you usually find around the peripheral areas of the grocery store (fruits, vegetables, etc.) Current food subsidy policy found in the Food, Conservation and Energy Act of 2008 extension mandated by the American Taxpayer Relief Act of 2012 drives up the price of fruits, vegetables, and meats. This policy also turns people toward lower cost foods that are higher in simple carbohydrates and caloric density. Thus, current policy is actually making obesity worse and making America fatter. Research completed at the University of Illinois at Chicago reveals that small taxes or price changes do not produce a change in a person’s BMI; however, more significant price change has a measurable and significant effect on weight in both adults and children. Price increases of 100-150% have been shown to change purchasing behavior and thereby affect health (18). An example of this is the tax levied on cigarette smoking.
The USDA disagrees with the amount of influence they have over the individual American’s food choices. They state openly on their website that “Some public health advocates have argued that falling real, or inflation-adjusted, prices for many high-calorie foods encourage people to buy and consume more of these foods, leading to poor diet quality and rising rates of obesity. A closer look at how consumers respond to food price variation–over time, across geographic markets, in different types of stores, and in response to taxes and subsidies–reveals how food prices affect people’s food choices, and their waistlines. In short, price matters, but not very much, and it is not the only factor” (19).
Why Current Dietary Guidelines Have Not Been Effective
Why do we get fat? Why have we not been successful in losing weight via diet and exercise? The obesity paradox was described by Jules Hirsch of Rockefeller University, who proposed two opposing hypotheses:
The 1977 Dietary Goals for the United States – the first comprehensive statement by any branch of the federal government about the American diet – supported the first theory. The Guidelines were heavily influenced by the American Heart Association’s position that fat intake alone would cause heart disease. The USDA 2011 Dietary Guidelines imply that the “people who are the most successful at achieving and maintaining a healthy weight do so through continued attention to consuming only enough calories from foods and beverages to meet their needs and by being physically active.” (15)
Current research contradicts the caloric restriction or “calorie in – calorie out” theory. Scientific evidence clearly demonstrates the domino effect of carbohydrate or starch intake increasing insulin levels which thereby stimulates obesity by raising cholesterol and triglyceride levels. Time Magazine recently published evidence that the longstanding recommendations to “eat less high-fat red meat, eggs and dairy and replace them with more calories from fruits, vegetables and especially carbohydrates” is now seen as incorrect (45). Even our medical textbooks from 1965, like the introductory chapter of the Handbook of Physiology, make it clear that carbohydrate intake cause weight gain and raise triglyceride and cholesterol levels (22), (23), (24).
Current Policy
The current version of the Farm Bill was set to expire September 30th, 2013. If it had been allowed to expire, the results would have returned us to the 1949 Farm Bill legislation and theoretically double the price of milk. However, this would have had the effect of freeing up over $5 billion dollars of federal spending per year and would also lead to decreased consumption of a major source of carbohydrates in the standard American diet like wheat and corn. Senator Debbie Stabenow (D-MI), and chairwoman of the Senate Agriculture Committee, had repeatedly said she was opposed to an extension; however, she agreed to a compromise extending the bill for another year to help the farmers experiencing serious drought conditions in 2012 (7). Two additional extensions were passed in the House and Senate, but because these differed so significantly, it was referred to a House-Senate Conference Committee to work out the compromise details. With only $23 billion in spending reductions, The Agricultural Act of 2014 was passed on January 29, 2014 (46).
Outcomes and Stakeholders
If the United States continues its current course, up to 58% of the population will be obese by 2030 (26). Many believe that the USDA Dietary Guidelines are to blame. Richard David Feinman, President of the Nutrition and Metabolism Society and Professor of Cell Biology at SUNY Downstate Medical Center said, “The previous Guidelines have not worked well. It is unreasonable to ask the Dietary Guidelines Advisory Committee (DGAC) to audit its own work. An external panel of scientists with no direct ties to nutritional policy would be able to do a more impartial evaluation of the data. This would be far better for everyone.” (27) A recent Gallup Poll reveals that 63% of Americans believe the USDA Guidelines that a low fat, calorie restricted diet will help in reduction of obesity, and the same study showed that 48% of Americans worry about their weight “all of the time or some of the time” (28). Recent evidence from the Women’s Health Initiative Dietary Modification Trial studying 49,000 women supports Dr. Feinman’s conclusion above. It did not show any statistically significant evidence that following a low-fat or caloric restricted diet had any effect upon obesity (29). Other nutritional experts from the Salt Institute and the National Health Coalition have expressed their support for significant changes to the USDA Dietary Guidelines (30). The Weston A. Price Foundation, which according to its website is “dedicated to restoring nutrient-dense foods to the human diet through education, research and activism,” also supports the view that the current USDA Dietary Guidelines have been a significant cause of obesity and have been an active voice promoting legislative change (31).
On the other hand, the Sugar Association has issued statements that sugar is not the cause of obesity and “continually eating too much food and sedentary lifestyles are the major contributing factors to increasing rates of obesity – not sugar intake” (32). In addition, the American Beverage Association has stated that sugars are not the problem with obesity, but instead, “overweight and obesity are a result of an imbalance between calories consumed and calories burned” (33).
Attempts at modifying the Farm Bill with legislation like the 2012 DeMint Amendment (SA 2276 ) were supported by both Arizona Senators McCain (R-AZ) and Kyl (R-AZ) with a “Yes” vote, as well as Senators Ayotte (R-NH), Brown (R-MA), Burr (R-NC), Coats (R-IN), Coburn (ROK), Cornyn (R-TX), DeMint (R-SC), Graham (R-SC), Hatch (R-UT), Heller (R-NV), Johnson (R-WI), Lee (R-UT), McConnell (R-KY), Murkowski (R-AK), Paul (R-KY), Rubio (R-FL), Sessions (R-AL), and Toomey (R-PA). However, because of a large lobbying agricultural coalition, it was voted down (34). Changing farm subsidies will be a great challenge as 40% of the farmers in the U.S. now have some degree of dependence upon these subsidies. The following agricultural groups have historically had significant monetary interest in the farm subsidies that these amendments would affect:
The following groups have formed coalitions in support of the Farm Bill: Health/Food Justice/Farm Group partnerships, Specialty Crop Farm Bill Alliance, Community Food Security Coalition, Center for a Livable Future at Johns Hopkins University, Collaboration for a Healthy Sustainable Food System, and the Healthy Farms, Healthy People: A Farm & Food Policy Summit for a Strong America.
The American Heart Association’s position is that the Farm Bill needs to be modified to include increased access to fruits and vegetables (35). The American Medical Association’s position in 2008 and 2011 has been for cutting the size and budget of the current Farm Bill (36). The American Osteopathic Association does not currently have a formal position on the Farm Bill.
If certain crops like corn or wheat were no longer subsidized,drastic changes will be likely in the food manufacturing industry, which would likely be the largest proponent against change. Unintended consequences of modifying the Farm Bill and not extending its subsidies could have the short term effect of escalating the price of a number of commodities to two to three times their current price. For example, the price of milk would increase to $6-$8 dollars a gallon without federal subsidies (37). This would likely deter the use of carbohydrates containing dairy products, but may also increase the price of meats and cheeses as well.
The USDA’s Rural Development Progress Report claims that the subsidies it distributed “saved more than 75,000 jobs” in 2006 and over 400,000 jobs in 2011 (38), (39). They claim that without federal farm subsidiesthere would be significant loss of jobs; however, studies from the Cato Institute actually show the opposite.
“Job gains are weak and population growth is actually negative in most of the counties where farm payments are the biggest share of income. Job growth is decidedly weak in the counties most dependent on farm payments. The vast majority of such counties (483) had job gains below the 19 percent national average from 1992 to 2002. A considerable number (167) had outright job losses over the period. In short, farm payments are not yielding robust economic and population gains in the counties where they should have the greatest impact. If anything, the payments appear to be linked with sub-par economic and population growth. To be sure, this quick comparison cannot answer whether growth would have been even weaker in the absence of the payments. Still, farm payments appear to create dependency on even more payments, not new engines of growth” (40).
As of 2010, obesity costs about $73.1 billion per year in lost productivity in the United States (43). The worsening obesity epidemic poses further workforce productivity losses up to 20% more by 2030. Even small improvements in obesity will improve workforce productivity and has substantial potential for savings. Currently, the Affordable Care Act allows employers to charge obese employees 30-50% more for health insurance. Without correcting this epidemic, it may be impossible for many to afford health care, opting out to pay the less expensive tax penalty. This would have the effect of increasing commercial premiums across the country, feasibly pushing private insurance companies out of business and forcing a single payer governmental system.
Recommendations
This brief points out that the overall U.S. healthcare costs associated with obesity have increased by 68% in the last fourteen years. It provides evidence that using current dietary low-fat caloric restriction guidelines show poor statistically significant improvements in obesity. And it provides evidence that obesity is not caused by excessive caloric intake and fat, but by insulin response to carbohydrate intake. Lastly, this analysis provides evidence that the Farm Bill propagates continued worsening obesity rates in the US by providing access to cheap, fattening food.
The USDA 2011 Dietary Guidelines need to be revised to reflect current evidence-based obesity prevention and weight reduction research. The guidelines should include information about limiting the intake of foods high in carbohydrates.
The food subsidy extension provided in the American Taxpayer Relief Act of 2012 was extended five years by the Agricultural Act of 2014. Had it been allowed to expire, it would have saved the country over $200 billion over the next ten years. However, because of so many entitlements involved in this bill, the House and Senate convened in Conference that resulted in a compromise of only $23 billion dollars in spending reductions, the first SNAP reforms since 1996 reducing waste, but did nothing in eliminating subsidies that drive or influence eating behavior (46).
When significant price changes occur, eating behavior will change. As the price of fattening carbohydrates increases, people will eat less of them, leading to a national decrease in obesity and overweight. The current reforms did nothing that will change our dietary behavior.
1. Cornell University. Obesity accounts for 21 percent of U.S. health care costs, study finds. Science Daily. [Online] April 9, 2012. [Cited: January 5, 2013.] http://www.sciencedaily.com/releases/2012/04/120409103247.htm.
2. Annual Medical Spending Attributable To Obesity: Payer-And Service-Specific Estimates. Eric A Finkelstein, Justin G Trogdon, Joel W Cohen and William Dietz. Health Affairs, 28, Bethesda, MD : Project HOPE, 2009, Vol. 5. 10.1377/hlthaff.28.5.w822.
3. Begley, Sharon. As America’s Waistline Expands, Costs Soar. Reuters. [Online] Thompson Reuters, April 30, 2012. [Cited: January 5, 2013.] http://www.reuters.com/article/2012/04/30/us-obesity-idUSBRE83T0C820120430.
4. Ungar, Rick. Obesity Now Cost Americans More In Healthcare Spending Than Smoking. Forbes. [Online] 4 30, 2012. [Cited: January 5, 2013.] http://www.forbes.com/sites/rickungar/2012/04/30/obesity-now-costs-americans-more-in-healthcare-costs-than-smoking/.
5. Ogden CL, Carroll MD, Kit BK, Flegal KM. Prevalence of obesity in the United States, 2009–2010. NCHS data brief, no 82. Hyattsville, MD : National Center for Health Statistics, 2012, 2012.
6. Poverty and Obesity: The Role of Energy Density and Energy Costs. A Drewnowski, SE Specter. s.l. : American Journal of Clinical Nutrition, 2004, Vols. 79:6-16.
7. Laprete, Jay. U.S. Farm Bill. Times Topics. [Online] The New York Times, December 31, 2012. [Cited: February 11, 2013.] http://topics.nytimes.com/top/reference/timestopics/subjects/f/farm_bill_us/index.html?offset=0&s=newest.
8. SNAP to Health. U.S. Farm Bill: Frequently Asked Questions. SNAP to Health. [Online] CSPC / Snap to Health, 2013. [Cited: February 11, 2013.] http://www.snaptohealth.org/farm-bill-usda/u-s-farm-bill-faq/.
9. USDA. Agricultural Marketing Service. Commodity Purchasing. [Online] January 22, 2013. [Cited: February 10, 2013.] http://www.ams.usda.gov/AMSv1.0/ams.fetchTemplateData.do?template=TemplateQ&navID=Commodity%20Purchasing%20Main%20Page&rightNav1=Commodity%20Purchasing%20Main%20Page&topNav=&leftNav=CommodityPurchasing&page=CommodityPurchasing&resultType=&acct=cmdtyprchs.
10. Environmental Working Group. United States Summary Information. EWG Farm Subsidies. [Online] 2012. [Cited: February 10, 2013.] http://farm.ewg.org/region.php?fips=00000.
11. Monke, Jim. Farm Commodity Programs: Base Acreage and Planting Flexibility. Washington, DC : Congressional Research Services, 2003.
12. Arizona Farm Bureau Federation. AG Facts. Arizona Farm Bureau. [Online] 2013. [Cited: February 15, 2013.] http://www.azfb.com/ag-facts.html.
13. Children of the Corn: The Renewable Fuels Disaster. The American. [Online] American Enterprise Institute, January 4, 2012. [Cited: February 15, 2013.] http://www.american.com/archive/2012/january/children-of-the-corn-the-renewable-fuels-disaster.
14. USDA Food & Nutrition Service. National School Lunch Program. USDA Food & Nutrition Serivce. [Online] June 21, 2012. [Cited: February 15, 2013.] http://www.fns.usda.gov/cnd/lunch/.
15. U.S. Department of Agriculture (USDA). USDA 2010 Dietary Guidelines. USDA Center for Nutrition Policy and Promotion: Dietary Guidelines for Americans. [Online] U.S. Government Printing Office, January 31, 2011. [Cited: January 5, 2013.] http://www.cnpp.usda.gov/Publications/DietaryGuidelines/2010/PolicyDoc/Chapter2.pdf.
16. ABC News. ABC News. Medical Unit. [Online] ABC News Internet Ventures, September 30, 2012. [Cited: April 14, 2013.] http://abcnews.go.com/blogs/health/2012/09/30/school-lunch-showdown-850-calorie-meals-compared/.
17. Ohio State University. Food Stamp Use Linked To Weight Gain, Study Finds. Science Daily. [Online] August 12, 2009. [Cited: April 13, 2013.] http://www.sciencedaily.com /releases/2009/08/090810122139.htm.
18. Food Prices and Obesity: Evidence and Policy Implications for Taxes and Subsidies. L Powell, F Chalupka. 1, Illinois : The Milbank Quarterly by Wiley Periodicals Inc, 2009, Vol. 87.
19. Jessica Todd, Biing-Hwan Lin. Amber Waves Online Magazine. U. S. Department of Agriculture Economic Research Service. [Online] September 2012. [Cited: February 10, 2013.] http://www.ers.usda.gov/amber-waves/2012-september/what-role-do-food-and-beverage-prices.aspx.
20. American Taxpayer Relief Act of 2012. U.S. Government Printing Office. [Online] Jan 12, 2012. [Cited: February 10, 2013.] http://www.gpo.gov/fdsys/pkg/BILLS-112hr8enr/pdf/BILLS-112hr8enr.pdf.
21. Bruch, Hilde. The Importance of Overweight. Michigan : Norton, University of Michigan, 1957.
22. Taubs, Gary. Good Calories, Bad Calories: Fats, Carbs, and the Controversial Science of Diet and Health. New York : Anchor Books, 2007. 978-1-40000-3346-1.
23. Role of Insulin in Endgenous Hypertriglyceridemia. GM Reave, RL Lerner, MP Stern, JW Farquhar. s.l. : Journal of Clinical Investigation, 1967, Vols. 46(II):1756-67.
24. High-Carb Diets Questioned. Kolata, G. 235(4785):164, s.l. : Science, 1987, Vol. 9.
25. U.S. Department of Health and Human Services. The Surgeon General’s Call to Action to Prevent and Decrease Overweight and Obesity. Washington, D.C. : U.S. Government Printing Office, 2001.
26. Global Burden of Obesity in 2005 and Projections to 2030. T Kelly, W Yang, C-S Chen, K Reynolds and J He. 8 July 2008, New Orleans : International Journal of Obesity, 2008, Vols. 32, 1431–1437. doi:10.1038/ijo.2008.102.
27. In The Face Of Contradictory Evidence: Report Of The Dietary Guidelines For Americans Committee. Adele H Hite, Richard D Feinman, Gabriel E Guzman, Morton Satin, Pamela Schoenfeld, Richard J Wood. 10, s.l. : Nutrition, 2010, Vol. 26. DOI: 10.1016/j.nut.2010.08.012.
28. A Dugan, F Newport. Gallup Wellbeing. Gallup. [Online] August 17, 2012. [Cited: April 13, 2013.] http://www.gallup.com/poll/156710/americans-say-low-fat-diet-better-low-car.aspx.
29. Low-fat dietary pattern and weight change over 7 years: the Women’s Health Initiative Dietary Modification Trial. . Howard BV, Manson JE, Stefanick ML, et al. s.l. : JAMA, 2006, Vols. 295:39-49. doi:10.1001/jama.295.1.39.
30. Healthy Nation Coalition. Healthy Nation Coalition. Healthy Nation Coalition. [Online] Adrienne Larocque, PhD, 2012. [Cited: March 8, 2013.] http://www.forahealthynation.org/.
31. Judith McGeary, Esq. Legislative Updates. The Weston A. Price Foundation. [Online] December 11, 2012. [Cited: March 9, 2013.] http://www.westonaprice.org/legislative-updates/policy-update-farm-bill-and-gmos.
32. The Sugar Association. Sugar and Your Diet. Sugar.org. [Online] 2012. [Cited: March 9, 2013.] http://www.sugar.org/sugar-and-your-diet/caloric-intake.html.
33. American Beverage Association. Obesity. American Beverage Association. [Online] 2013. [Cited: March 9, 2013.] http://www.ameribev.org/nutrition–science/obesity/.
34. Library of Congress. S.Amdt.2276 to S.3240. Congress.Gov. [Online] March 8, 2013. [Cited: March 9, 2013.] http://beta.congress.gov/amendment/112th-congress/senate-amendment/2276.
35. The American Heart Association. Policy Brief – The Farm Bill. The American Heart Association. [Online] 2012. [Cited: April 14, 2013.] http://www.heart.org/idc/groups/heart-public/@wcm/@adv/documents/downloadable/ucm_429110.pdf.
36. AMA: Report of Reference Committee . Malechek, Lindsay. 2011.
37. Wolf, Jim. Senate, House agriculture committees in deal to avert milk price spike. Reuters. Sun, Dec 30, 2012, 2012.
38. USDA. USDA Rural Progress Report. USDA. [Online] December 2006. [Cited: April 14, 2013.] http://www.rurdev.usda.gov/rd/pubs/2005_06_Prog_Report.pdf.
39. —. USDA Rural Developement 2011 Progress Report. USDA Rural Developement. [Online] December 2011. [Cited: April 14, 2013.] http://www.rurdev.usda.gov/Reports/RD%20Progress%20Report%202011–Smallest(2).pdf.
40. Slivinski, Stephen. Rural Subsidies. Cato Institute. [Online] July 2009. [Cited: March 9, 2013.] http://www.downsizinggovernment.org/agriculture/rural-subsidies.
41. Obesity prevention: the role of policies, laws and regulations. Swinburn, Boyd A. New Zeland : BioMed Central Ltd., 208, Vol. 5:12. 10.1186/1743-8462-5-12.
42. Begley, Sharon. As America’ss Waistline Expands, Costs Soar. Reuters. [Online] Thompson Reuters, April 30, 2012. [Cited: January 5, 2013.] http://www.reuters.com/article/2012/04/30/us-obesity-idUSBRE83T0C820120430.
43. The Costs of Obesity in the Workplace. E Finkelstein, M DiBonaventura, S Burgess, B Hale. 10, Illinois : Lippincott Williams & Wilkins, 2010, Vol. 52. doi: 10.1097/JOM.0b013e3181f274d2.
44. Rudd Center For Food Policy & Obesity. Search Legislation Database. Yale Rudd Center. [Online] Rudd Center, 2013. [Cited: January 5, 2013.] http://www.yaleruddcenter.org/legislation/search.aspx.
45. Walsh, Bryan. “Ending The War on Fat.” TIME Magazine. June 12, 2014.
46. Lucas, Frank D. “Agricultural Act Summary.” House Agricultural Committee. [Online] Jan 29, 2014. [Cited June 28, 2014.] http:// http://agriculture.house.gov/farmbill
The only way to successfully loose weight is to modify or turn off the mechanisms that stimulate fat storage. For years we have been told that this was just a problem of thermodynamics, meaning the more calories you eat, the more calories you store. The solution was, thereby, eat less calories or exercise more, or both. We are taught in school that a 1 gram of carbohydrate contains 4 kcal, 1 gram of protein contains 4 kcal, and 1 gram of fat contains 9 kcal.
It’s easy to see that if I’m going to limit my calories, cutting out fat is the first step. For the last 65 years, we as a society have been doing just that, cutting out fat, exercising more and eating fewer calories. What has it done for us? It’s made us fatter! (1)
Some may argue that we really aren’t eating fewer calories and exercising more. But most people I have seen in my office have tried and tried and tried and failed and failed and failed to loose weight with this methodology. The definition of insanity is “doing the same thing over and over and expecting a different result.”
Most of my patients are not insane, they recognize this and stop exercising and stop restricting calories . . . ’cause they realized, like I have, that it just doesn’t work! If you’re one that is still preaching caloric restriction and cutting out fat, I refer you to the figure above and the definition of insanity . . .
So, if reducing the calories in our diet and exercising more is not the mechanism for turning on and off the storage of fat, then what is?
Before I can explain this, it is very important that you appreciate the difference between triglycerides and free fatty acids. These are the two forms of fat found in the human body, but they have dramatically different functions. They are tied to how fat is oxidized and stored, and how carbohydrates are regulated.
Fat stored in the adipose cells (fat cells) 
as well as the fat that is found in our food is found in the form of triglycerides. Each triglyceride molecule is made of a “glyceride” (glycerol backbone) and three fatty acids (hence the “tri”) that look like tails. Some of the fat in our adipose cells come from the food we eat, but interestingly, the rest comes from carbohydrates
(“What! Fat comes from sugar?! How can this be?!!“)
We all know that glucose derived from sugar is taken up by the cells from the blood stream and used for fuel, however, when too much glucose is in the blood stream or the blood sugar increases above the body’s comfort zone (60-100 ng/dl), the body stores the excess. The process is called de novo lipogenesis, occurring in the liver and in the fat cells themselves, fancy Latin words for “new fat.” It occurs with up to 30% (possibly more if you just came from Krispy Kream) of the of the carbohydrates that we eat with each meal. De novo lipogenesis speeds up as we increased the carbohydrate in our meal and slows down as we decrease the carbohydrate in our meal. We’ve known this for over 50 years, since it was published by Dr. Werthemier in the 1965 edition of the Handbook of Physiology (2).
While we know that fat from our diet and fat from our food is stored as triglyceride, it has to enter and exit the fat cell in the form of fatty acids. They are called “free fatty acids” when they aren’t stuck together in a triglyceride. In their unbound state, they can be burned as fuel for the body within the cells. I like to think of the free fatty acids as the body’s “diesel fuel” and of glucose as the body’s version of “unleaded fuel.” The free fatty acids can easily slip in and out of the fat cell, but within the adipose cell, they are locked up as triglycerides and are too big to pass through the cell membranes. Lipolysis is essentially unlocking the glycerol from the free fatty acids and allowing the free fatty acids to pass out of the fat cell. Triglycerides in the blood stream must also be broken down into fatty acids 
before they can be taken up into the fat cells. The reconstitution of the fatty acids with glycerol is called esterification. Interestingly, the process of lipolysis and esterification is going on continuously, and a ceaseless stream of free fatty acids are flowing in and out of the fat cells. However, the flow of fatty acids in and out of the fat cells depends upon the level of glucose and insulin available. As glucose is burned for fuel (oxidized) in the liver or the fat cell, it produces glycerol phosphate. Glycerol phosphate provides the molecule necessary to bind the glycerol back to the free fatty acids. As carbohydrates are being used as fuel, it stimulates increased triglyceride formation both in the fat cell and in the liver, and the insulin produced by the pancreas stimulates the lipoprotein lipase molecule to increased uptake of the fatty acids into the fat cells (3).
So when carbohydrates increase in the diet, the flow of fat into the fat cell increases, and when carbohydrates are limited in the diet, the flow of fat out of the fat cells increases.
Summarizing the control mechanism for fat entering the fat cell:
These two mechanisms ensure that there is always unleaded (glucose) or diesel fuel (free fatty acids) available for every one of the cells in the body. This provides the flexibility to use glucose in times of plenty, like summer time, and free fatty acids in times of famine or winter when external sources of glucose are unavailable.
The regulation of fat storage, then, is hormonal, not thermodynamic. Unfortunately, we’ve know this for over 65 years and ignored it.
We’ve ignored it for political reasons, but that’s for another blog post . . .
References:
1. James, W. J Intern Med, 2008, 263(4): 336-352
2. Wertheimer, E. “Introduction: A Perspective.” Handbook of Physiology. Renold & Cahill. 1965.
3. Taubs, G. “The Carbohydrate Hypothesis, II” Good Calorie, Bad Calorie. Random House, Inc. 2007, p 376-403.
Many patients come to my office desiring to loose weight, but complain of no self-control. They feel they cannot loose weight because they don’t have the willpower. Willpower, or self-control, is an elusive and mysterious thing. “If only I had more self-control,” I hear people say, “I could . . . ” exercise regularly, eat right, avoid drugs and alcohol, save for retirement, stop procrastinating, achieve a noble goal, or loose weight. A 2011 American Psychological Association study reveals that almost 30% of those interviewed felt that lack of willpower was the greatest barrier to making a change in any of these areas.
So what is “willpower” or “self-control?” It is the ability to resist short-term temptations in order to fulfill a long-term goal. 
I meet and work with people every day who feel they have no willpower. In actuality, will power and self-control are learned behaviors that develop over time. Anyone can have willpower, you just have to understand how willpower in certain areas can be strengthened and what makes it weak. In fact, a 2005 study showed that self-discipline or willpower was more important than IQ in academic successes. This study also found that increased self-discipline lead to less binge eating, higher self-esteem, higher grade point averages, better relationship skills and less alcoholism. Fascinating isn’t it!?
The answer can be found in a quote from Henry P Liddon, “What we do upon some great occasion will probably depend on what we already are; and what we are will be the result of previous years of self-discipline.” This means that willpower or self-control can be learned or improved. How, you ask?
First, you must establish and write down a reason or motivation for change. In addition, that change must fulfill a clear goal. Just wanting to loose weight isn’t good enough. You have to be motivated because of a consequence that arises from the obesity or overweight. And, you “loosing weight” isn’t a clear goal. You must set a weight reduction goal. It has to be clearly written down with your motivational reason. Willpower or self-control cannot begin to form until these two steps occur.
Second, you must begin to monitor your behavior toward that goal. When it comes to weight loss, I ask every one of my patient’s to keep a diet journal. In this journal they are asked to write down every thing they eat and drink. The night before, they are to write down their plan for tomorrow’s meals, then the next evening, they account for their success or failure by journaling on that same page what they actually ate and drank, then after comparing what they did, they plan for tomorrow and journal why they were successful or why they weren’t. It’s the last part that is so powerful, a short 3-5 minutes of self-introspection. Self-introspection is the key to behavioral change. It is the key that allows a person to see their habits and then make very small changes that break bad habits, solidify good habits and strengthens willpower.
Third, willpower is developed over time. It is developed by being accountable to ones-self on very little things every single day. But it MUST be written down. If I planned to eat bacon and eggs for breakfast and I didn’t, why? When I look at my day, I may realize that I went to bed too late to get up early and cook bacon and eggs. So, instead, I ate a yogurt that was in the fridge. I am accountable to myself. If I plan to eat bacon and eggs tomorrow, I must either go to bed earlier, prepare them the night before, or throw out the yogurt . . . so not to be a temptation again. This is written down and I make a very small change tomorrow.
Over time, this self-introspection becomes easier and easier, to the point that you do it sub-consciously. It is this sub-conscious self-introspection and change will be seen by others as self-control or willpower. Just like a working or strengthening a muscle, recording short goals and and accounting for them makes your self-discipline stronger. The self-discipline muscle becomes more powerful. In time, a split second decision not to binge on that piece of cake will be seen as strong willpower by those around you. You’ll recognize that it’s just flexing your self-discipline muscle.
So, my next question to you is . . . where’s your diet journal?
While on the 2014 Low-Carb Cruise a few weeks ago, I had the wonderful pleasure of being interviewed by “N=1 Health‘s” Howard Harkness. We had very nice conversation and discussed a number of topics relating to obesity medicine, weight loss, carbohydrate restriction and some of the history of medicine. Take a look at the interview here on N=1 Health.
Thanks, Howard!
How are your stress levels lately? Are you struggling with your finances? Struggling with your job? Do you have troubles in your personal relationships? Are you carrying a heavy load in school? Do you have a horse that just won’t behave?
If you’re in the woods and you stumble upon a bear, the sudden recognition of significant danger will stimulate an immediate release of protective hormones into your blood stream including adrenaline and cortisol. (Your brain also know that those extra few donuts you ate will make you quite the tasty treat for the bear.)
Adrenaline increased your heart rate, dilates the blood vessels to your muscles and increases your respiratory rate. Cortisol is the hormone that stimulates increased glycogen release from the liver. Glycogen is a form of sugar made available so that you can immediately fight the bear or run from the bear. The glycogen response raises your insulin level so that that fuel can be pulled right into the cells needing it. The adrenalin and cortisol, among other hormones, are released so that blood can be shunted from your stomach and intestines to your muscles and brain to more effectively enable you to finish fighting the bear, or out run that drooling growling bear hot on your heels.
Most of us will never “stumble across a bear.” However, your boss may confront you about how you handled a recent assignment or may drop an extra pile of work on your desk. You may run short on your finances this month, have a serious disagreement with your significant other, or someone may cut you off in traffic causing a near accident. Any or all of these stimulate the identical “fight or flight” response. Whether it is an actual bear or the stress from traffic, the same adrenalin and cortisol response occurs.
How does that keep you from loosing weight? The elevated cortisol causes a cascade effect raising your insulin levels. Insulin will remain effectively elevated in the blood stream for the next 2-12 hours. Insulin is the primary hormone driving and stimulating weight gain. If you’ve had 2 or 3 stressful events throughout the day, and you have not had the opportunity to physically burn off these stress response hormones, your body will store and/or continue to gain weight throughout the entire day. If you have been trying to loose weight, the spike in the insulin from this cortisol cascade halts the weight burning process and may actually bump you out of ketosis (the process by which we burn fat as the primary fuel source) for the next 4-12 hours.
How do you prevent this from happening? A simple 15-20 minute walk 3-5 times per week is enough to decrease the stress hormone surge that occurs from a “fight or flight” response. Any regular exercise program will decrease these stress hormones. Adequate sleep also decreases these hormones.
Berberine, the active ingredient in tumeric, is also helpful in controlling blood sugar spikes and helping those with insulin resistance to handle stress and inflammation. I’ve been using berberine daily for years personally and with many of my patients. I love it so much, I designed my own formulation. You can find it along with my other supplement line at ketoliving.com.
If your job, school or life is stressful, incorporating an exercise program as simple as a daily walk for 15-20 minutes per day will keep the proverbial “bear in the woods” from catching up to you because of your weight. Controlling your blood sugar is the other key. The correct diet and supplements play a huge role combined with exercise.
Check out my diet page if you’d like a copy of my ketogenic dietary program. Check out my YouTube page for hundreds of free videos and DocMuscles.Locals.com for additional information for my followers. And, look at my membership programs available here.
Mother’s Day is a great event in our home, and traditionally, it is a chance to make breakfast for Mom.
Because I’ve found that Splenda© spikes the insulin and slows weight loss in a significant percentage of my patient’s we’ve changed up the sweetener below.
Mom’s Cream Cheese Waffles:
My amazing wife, among her many talents, makes a wonderful low carb cheese cake. She has taken the recipe found in Maria Emmerich’s “Secret Weight Loss Recipes” and modified it to our family’s taste. It has quickly become one of my family’s favorites.
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| Low Carb Cheesecake = 1 gram carb per serving Individual spring-form serving pans |
I love chocolate chip cookies! However, over the last seven years, as I have followed a low carbohydrate diet I have not been able to indulge my chocolate chip cookie craving — until recently.
I frequently hear patient’s tell me, “Dr. Nally, I’m eating RIGHT, but I’m just NOT losing weight!”
