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(Editor's Note: This article was orginally published in the April 2008 edition of Diabetes Health and later online as article 5658. We are reproducing the article in light of the American Medical Association's recent decision to treat obesity as a disease. That decision will spur much debate, and we think this article will help add some perspective to the discussion.)
Obesity in the United States is increasing in epidemic proportions. This is true in children as well as adults. It's estimated that the healthcare costs associated with obesity and its related complications will exceed $130 billion this year.
If something is not done to stem this burgeoning tide of obesity, then the healthcare system that we know will soon crumble.
Why are we seeing this dramatic increase in childhood obesity? It is certainly true that children are not as active as they were 30 or 40 years ago. Television, video games and computers can entertain kids 24 hours a day. Parents are often relying on technology to babysit their children and are not spending as much time outdoors with them exercising or just playing.
Is this the only reason for the surge in obesity? As a pediatrician who specializes in childhood obesity, I see many children who are very active but they are also massively overweight. What about these children? I believe many of these children are victims of what I like to call the "fat-free fallacy."
Scapegoating Fat Backfires
In 1977 the U.S. Department of Public Health issued a statement encouraging Americans to eat less fat. In 1988 the U.S. Surgeon General recommended that we restrict our consumption of dietary fat. The assumption was that as we eat less fat the thinner we would become. The multi-billion-dollar food industry was quick to jump on the bandwagon. The race was on to produce fat-free everything. If food didn't have fat then it was OK to eat as much as you wanted.
Americans consumed more fat-free foods in the 90's than the previous three decades combined. This fat-free philosophy is exactly why we are becoming so obese as a society. Obviously if fat were the problem, then obesity would have decreased during this time. Instead, obesity did not decrease but skyrocketed to unprecedented levels.
But fat is not bad for you. Being fat is. The two are not related! Fat actually helps to satisfy our appetites and keeps us from eating too much or too often. Fat is also an important flavoring for food.
I, too, was a victim of this fat-free fallacy. I had been taught (brainwashed) that in order to lose weight we must eat less fat. I was a huge proponent of cutting back fat intake and watching total calories. I recommended at least 30 to 45 minutes of vigorous exercise daily.
I knew that it was very hard to lose weight. I didn't push overweight children to lose weight, thinking that if they could just maintain their current weight as they grew that would be significant progress. I felt like I was doing a good job. I believed whole-heartedly that I was explaining to these children the correct way to lose weight.
An Eye-Opening Study
In the late 1990's, a first-year pediatric resident physician at Marshall University did a required research project in which he looked at about 100 children whom I had counseled about weight loss. The results were astonishing to me. Not only did these children not lose weight or even slow down their weight gain, most gained weight at the same rate and some even faster.
The results did not lie. All of this time and energy that I had been spending to help children lose weight had been a waste of time. It just didn't work. A low-fat diet only worked for about one out of every 25 patients. Was this the best we could do?
I was determined to succeed. I began to look at other ways to lose weight. A third-year medical student at the time asked me about using a high-protein, carbohydrate-restricted diet for weight loss. At the time I knew very little about approach. This was not something that was taught in medical school. I couldn't believe that this would be successful or that it could be good for you, so I was very skeptical. How could eating high-fat foods not be bad for you? This is what I learned in textbooks from professors in medical school.
However, I still could not ignore the facts. We had cut back our fat intake and yet we were becoming fatter as a nation.
Low Carbs Make a Case
I researched and relearned the physiology and biochemistry behind low-carb diets. As I began to take a closer look, my findings were not what I expected. It all came back to insulin. Insulin is what causes fat storage. Insulin is what drives weight gain. Insulin is what is secreted when we eat carbohydrates. Insulin is one of the most powerful and efficient substances that our body uses to control the use, distribution and storage of energy. Insulin is essential for life. Without insulin, we would quickly waste away and perish. Just ask the teenager with type I diabetes who has been hospitalized for diabetic ketoacidosis because of not taking his or her insulin.
Let's look at what happens after a meal that is high in carbohydrates. Carbohydrates are broken down into thousands of molecules of glucose that are quickly absorbed through our small intestines into our bloodstream. Our body has the ability to monitor this rapid rise in blood sugar and quickly secretes insulin to counterbalance this. This is true if we do not have diabetes. Our nervous system keeps our blood glucose levels very steady no matter what we eat. These values almost never get above 120 or less then 70mg/dl. This is true whether we eat a meal that consists of pure sugar, a meal loaded with complex carbohydrates, a meal consisting of only protein or fat, or when we have fasted for two or three days. Almost all of our cells use glucose for energy.
Our bodies are extremely efficient energy machines. Only a small part of what we eat is actually used or needed by the muscles or other cells for energy. If these energy-using cells do not need any extra energy what happens to the majority of the glucose that we ingest? Insulin converts a portion of that glucose to another starch, called glycogen. Glycogen is stored in the liver and can maintain our blood sugar levels in the normal range for several hours after a meal. This is why we do not have to eat continuously. Glycogen can quickly be converted to glucose whenever glucose is not readily available in the bloodstream.
Why Low-Fat Diets Don't Work
What about the rest of the glucose? Where does it go after a meal? Herein lies the answer to why most low-fat diets do not work. The extra glucose is converted to fat. Fat is our main storage area for energy. Let me say this again: insulin promotes the production and storage of fat. That's right, even without eating fat our body produces fat from sugar.
Insulin is an extremely efficient hormone. It is the master hormone of our metabolic system. Its most important function may be the control and maintenance of our blood sugar, but insulin performs a myriad of other activities. In the appropriate amount, insulin keeps the metabolic system running smoothly and everything in balance.
However, in great excess it becomes a dangerous hormone wreaking havoc through the body. Mountains of scientific evidence implicate insulin as the primary cause or significant risk factor for high blood pressure, heart disease, arteriosclerosis and high cholesterol. It may also have a causative role in type 2 diabetes.
With type 2 diabetes our body needs extra insulin to help to maintain our blood sugar. The insulin that is available just does not work as well and we become resistant to its effects.
With type 1 diabetes we have a little different story. Our body can no longer make the insulin that we need therefore we have to take manufactured insulin to maintain our blood sugar. More carbs equals more insulin.
Teenage girls with diabetes know that insulin causes them to gain weight. Many recent studies have shown that in order to keep from gaining weight a very high percentage of teenagers with diabetes omit their insulin. We cannot continue to allow this to happen. This leads to uncontrolled diabetes and horrible long-term complications.
More Protein = Greater Insulin Control
So, how can we control our insulin requirements? The key to good blood sugar control, the key to weight loss and the key to lowering our insulin secretion is very simple. Eat fewer carbohydrates and eat more protein.
Protein keeps us from being hungry. A meal high in protein stays with us a lot longer than a meal high in carbohydrate content, which is quickly absorbed and does not satisfy our appetite as long. When we eat protein our body does not need as much insulin. Our blood sugar values are much steadier and we do not have the wide fluctuations that we see with high carbohydrate foods. This dietary approach works whether you have diabetes or not. It is perfect for anyone who is overweight or has type 2 diabetes. Type 1 people with diabetes can benefit by improved blood sugar values and lower insulin requirements.
I have seen hundreds of children actually lose weight with our plan. Eight and nine year old kids have lost 40 to 50 pounds. Obviously, the health benefits are tremendous, but the greatest improvement is what we see with self-esteem. Children's energy and blood pressure improve, and their lipid profiles universally improve. Before-and-after pictures of these successful children can be viewed on our website www.nomorefatkids.com.
In general, the fewer carbohydrates we eat the better. However, we should get a minimum of 30 grams of carbohydrates per day. The standard approach of 60 to 75 grams of carbohydrates per meal and 30 grams per snack is way too much. If you do not want to restrict carbs to 30 grams per day, then somewhere between 60 to 100 grams per day will still allow for weight loss if it is combined with exercise.
Remember: Eat all the protein you desire. Do not worry about where the protein comes from or how it is prepared. People who eat more protein end up eating fewer total calories. Protein keeps us from being hungry and satisfies our appetite more than any other macronutrient. This is the key for successful weight loss. It is hard to lose weight if you are hungry all the time.
Dr. Bailes is a pediatrician at Marshall University in Huntington, W. Va. He has developed a successful weight loss program in his book, No More Fat Kids: A Pediatrician's Guide for Safe and Effective Weight Loss. It is available at www.nomorefatkids.com
Diabetes Health is the essential resource for people living with diabetes- both newly diagnosed and experienced as well as the professionals who care for them. We provide balanced expert news and information on living healthfully with diabetes. Each issue includes cutting-edge editorial coverage of new products, research, treatment options, and meaningful lifestyle issues.