— Topics —
Carbohydrate

2022.12.18

The Atkins Diet: What Were the Long-Term Effects of Weight Loss?

Contents

  1. What is the Atkins diet?
  2. Comparative study of various diets in weight loss
  3. What were the long-term results of the Atkins diet?
  4. Why was obesity rare among rice-eating Asians?
  5. Is the Atkins also ineffective for weight loss?
    <The bottom line>

1. What is the Atkins diet?

The Atkins diet is a type of low-carbohydrate diet proposed by cardiologist Robert Atkins that restricts the amount of carbohydrates for energy and instead uses "fat" as an energy source. It is characterized by limiting carbohydrates to twenty to twenty-five grams per day for the first two weeks and then gradually increasing.

According to Dr. Fung, the author of “The Obesity Code,” Dr. Atkins weighed nearly one-hundred kilograms in 1963, and when he began working as a cardiologist in New York City, he needed to lose weight. 

However, he couldn’t lose weight successfully on a conventional calorie-restricted diet, so he tried the low-carb diet based on the medical literature, which worked well as advertised, and he recommended it to his patients. 

In 1972, he published "Dr. Atkins' Diet Revolution," which quickly became a bestseller.

At the time, it was said that the American Medical Association still considered high fat in the diet to be a cause of heart disease and stroke, and the "low-carb diet," which allowed people to eat as much meat and fat as they wanted, was not accepted.

Despite this, the low-carb diet’s popularity, rekindled in the 1990’s, led to a trend in the Atkins diet. In 2004, twenty-six million Americans said they were on some kind of low-carb diet .

New studies started appearing around 2005, comparing the Atkins diet to other diets that were once considered the standard, and what were the results?[1]

Let's take a look. I would like to express my thoughts on this at the end of this article

2. Comparative study of various diets in weight loss

"In 2007, the Journal of the American Medical Association published a more detailed study: Four different popular weight plans were compared in a head-to-head trial.

One clear winner emerged-the Atkins diet. The other three diets (Ornish, which has very low fat; the Zone, which balances protein, carbohydrates and fat in a 30:40:20 ratio; and a standard low-fat diet) were fairly similar with regard to weight loss. 

nurse and patient

However, in comparing the Atkins to the Ornish, it became clear that not only was weight loss better, but so was the entire metabolic profile. Blood pressure, cholesterol and blood sugars all improved to a greater extent on Dr. Atkins's diet. 

In 2008, the DIRECT (Dietary Intervention Randomized Controlled Trial) study reaffirmed once again the superior short-term weight reduction of the Atkins diet. Done in Israel, it compared the Mediterranean, the low-fat and the Atkins diets. 

While the Mediterranean diet held its own against the powerful, fat-reducing Atkins diet, the low-fat AHA standard was left choking in the dust–sad, tired and unloved, except by academic physicians.[2]" 

3. What were the long-term results of the Atkins diet?

"Longer-term studies of the Atkins diet failed to confirm the much hoped-for benefits.
Dr. Gary Foster from Temple University published two-year results showing that both the low-fat and the Atkins groups had lost but then regained weight at virtually the same rate. (*snip*) 

A systematic review of all the dietary trials showed that much of the benefits of a low-carbohydrate approach evaporated after one year.

sweets,desserts

Greater compliance was supposed to be one of the main benefits of the Atkins approach, since there was no need for calorie counting.

However, following the severe food restrictions of Atkins proved no easier for dieters than conventional calorie counting.

Compliance was equally low in both groups, with upwards of 40 percent abandoning the diet within one year.

In hindsight, this outcome was somewhat predictable. The Atkins diet severely restricted highly indulgent foods such as cakes, cookies, ice cream and other desserts. 

These foods are clearly fattening, no matter what diet you believe in. We continue to eat them simply because they are indulgent. (*snip*)The Atkins diet does not allow for this simple fact, and that doomed it to failure.

The first-hand experience of many people confirmed that the Atkins diet was not a lasting one. Millions of people abandoned the Atkins approach, and the New Diet Revolution faded into just another dietary fad. (The company Dr. Atkins founded in 1989 went bankrupt.)

But why? What happened?
One of the founding principles of the low-carbohydrate approach is that dietary carbohydrates increase blood sugars the most. High blood sugars lead to high insulin. High insulin is the key driver of obesity. Those facts seem reasonable enough. What was wrong?[3]"

4. Why was obesity rare among rice-eating Asians?

Experts who advocate low-carbohydrate diets seem to think that carbohydrates cause weight gain because they eventually stimulate insulin secretion.

However, Dr. Fung mentioned that the carbohydrate-insulin hypothesis is incomplete. Various problems are cited, but he raised the "paradox of the Asian rice eater" and the "diet of Kitava Island, in Papua New Guinea" as notable examples.  

Most Asians have been eating a diet based on refined rice as their staple food for at least the last five decades; a study conducted in the late 1990’s found that carbohydrate intake in China and Japan was similar to or rather, higher than in the U.K. and the U.S. 

rice-eating Asians

Nevertheless, until recently, obesity was not a significant problem in both countries.

Also, according to a study conducted by Dr. Staffan Lindeberg in 1989 on the diet of the Kitava islanders,  even though they were getting sixty-nine percent of their calories from carbohydrates such as yams, sweet potatoes and cassava, etc., their insulin levels were low and few people were obese [4].

Since Dr. Fung just mentioned the paradox of the Asian rice eater, I would like to mention this.

I am Japanese and was born in 1970, and I think that I should know how our diet has changed in the last five decades, and as a result, how obesity has increased in our society. 
(This is explained in more detail in the following blog.)

[Related article]  Why Does the Body Perceive That It Is More Starved than in the Past?


In short, I believe that carbohydrates are a contributing cause, but not the quantity itself.
Japan was basically an agrarian society, and rice cultivation has always been important. Until at least 40-50 years ago, I believe most Japanese people had eaten a lot of rice as it is called the staple food, but at the same time, they also ate a lot of fibrous vegetable dishes using roots or stems of plants, fermented soybean product called “natto,” and fish and meat dishes. Rice cakes called “mochi” and Japanese sweets as well.

At least in my family, my father was strict about family members eating meals three times a day at a regular time, every day.
  

I think the recent increase in the obesity rate in Japan can be explained due to a combination of many factors, including easily digestible carbohydrates such as bread and noodles, unbalanced diets with few vegetables, eating out, instant foods, and irregular life rhythms such as skipping breakfast or late dinners. 

What I have seen in my experience is that many young women who go on a diet and then come off, some of them further increase their maximum weight.

irregular life rhythms

(Irregular lifestyle)

I believe that the "three factors plus one" of my intestinal starvation theory can explain how the various factors intertwine, and how weight gain occurs. It's not just the amount of carbs eaten that matter.

5. Is the Atkins also ineffective for weight loss?

The "Do calories make people fat, or carbs?" concept is said to be a debate that has been going on since the 1800’s [5], and I think both are true in some ways, but neither is perfect.

If you reduce the amount of any energy source beyond what your body needs, it’s obvious that you will lose weight in the short term. However, if you go back to your original diet, in the long run, you will also regain the weight you had lost, as various studies have confirmed, and as most people who have been on a diet have probably realized.


The reason for this is that the human body, I believe, basically works to maintain the status quo. I introduced "base weight" to describe the body weight based on that. So, the point is that in order to avoid rebounding, you must lower your base weight itself. 

(For more information on how to do this, please see the following article.)

[Related article]  There Are Two Steps to Lose Weight the Right Way


In terms of this rebound in the Atkins diet in section three, I don't think it necessarily means that low-carb diets, including Atkins, are ineffective. I’m positive that it’s the one of the correct ways to lose weight.

However, if we focus too much on blood sugar and insulin levels, we lose sight of another important point.

What I mean is that, the point of a low-carb diet, I believe, is not only the reduced carbohydrate amount, but also "how we increase the amount of other indigestible foods including meat, fat, fibrous vegetables, dairy products, etc." By sending plenty of indigestible foods to the gastrointestinal tract, we should feel less hunger and, in turn, the absorption rate should decrease. In particular, fats and oils in the diet should not be reduced, but rather should be consumed at every meal and even when having snacks.

From that point of view, I think that dieticians did not need to ban sweets such as chocolate, candy, ice cream, etc. so strictly. What is important is to be able to have them occasionally and not be too hard on yourself.

  

<Reference>
[1] Dr. Jason Fung, The Obesity Code, 2016, Pages 96-99.
[2][3] Pages 100-103.
[4] Pages 103-105.
[5] Gary Taubes, Why We Get Fat, 2011, Pages 148-162.

The bottom line

(1) In the early 2000’s, the Atkins diet became a huge trend in the U.S., inspired by the low-carb diet that was rekindled in the 1990’s. In the short term, the Atkins method not only helped people lose weight, but it also significantly improved blood pressure, cholesterol, and blood glucose levels.


(2) However, in long-term studies, the subjects rebounded, as seen with low-fat diets. After one year from the end of the study, all the benefits of Atkins diets were gone.

Dr. Fung considered the "carbohydrate-insulin hypothesis" an incomplete theory. Carbohydrate intake itself was not the problem.


(3) My thoughts. If there is no change in your base weight, rebound can occur if you eat as you used to. In order to lose weight correctly, your base weight itself needs to be lowered.


(4) The point of a low-carbohydrate diet is not just  the amount of insulin secreted. I believe that it’s rather important
to "take in more indigestible foods other than carbohydrates, and not feel hungry." 

     

2021.10.15

The Combination of Undernutrition and Obesity Among the Poor Can be Possible

Contents

  1. The case of undernutrition and obesity
  2. What should we do?
  3. Underweight and overweight can coexist. My thoughts

Most of the parts of this article are citations from a book, but at the end of this article, I will explain how it is related to my experience.

[Related article] → Wealthy Ones Get Fat? Poor Ones Get Fat?

  

1. The case of undernutrition and obesity

"This combination of obesity and malnutrition or undernutrition (not enough calories) existing in the same populations is something that authorities today talk about as though it were a new phenomenon, but it's not. Here we have malnutrition or undernutrition coexisting with obesity in the same population eighty years ago.[1]

(In the mid-1930s, New York City)

In 1934, a young German pediatrician named Hilde Bruch moved to America, settled in New York city, and was “startled,” as she later wrote, by the number of fat children she saw—“really fat ones, not only in clinics, but on the streets and subways, and in schools. (*snip*)

But this was New York City in the mid-1930s. This was two decades before the first Kentucky Fried Chicken and McDonald's franchises, when fast food as we know it today was born. This was half a century before supersizing and high-fructose corn syrup.

More to the point, 1934 was the depths of the Great Depression, an era of soup kitchens, bread lines, and unprecedented unemployment.

One in every four workers in the United States was unemployed. Six out of every ten Americans were living in poverty. In New York City, where Bruch and her fellow immigrants were astonished by the adiposity of the local children, one in four children were said to be malnourished. How could this be?(*snip*)

It was hard to avoid, Bruch said, the simple fact that these children had, after all, spent their entire lives trying to eat in moderation and so control their weight, or at least thinking about eating less than they did, and yet they remained obese.[2]
     

(The case of a native American tribe, the Sioux, in 1930's)

Two researchers from the University of Chicago studied Native American tribe, the Sioux living on the South Dakota Crow Creek Reservation. These Sioux lived in shacks “unfit for occupancy,” often four to eight family members per room. Fifteen families, with thirty-two children among them, lived “chiefly on bread and coffee.” This was poverty almost beyond our imagination today.


Yet their obesity rates were not much different from what we have today in the midst of our epidemic:
40 percent of the adult women on the reservation, more than a quarter of the men, and 10 percent of the children, according to the University of Chicago report, “would be termed distinctly fat.”

But the researchers noted another pertinent fact about these Sioux: one-fifth of the adult women, a quarter of the men, and a quarter of the children were “extremely thin."

  

The diets on the reservation, much of which, once again, came from government rations, were deficient in calories, as well as protein and essential vitamins and minerals. The impact of these dietary deficiencies was hard to miss: “Although no counts were taken, even a casual observer could not fail to note the great prevalence of decayed teeth, of bow legs, and of sore eyes and blindness among these families.[3]
     

(In the slums of São Paulo, Brazil)

This is from a 2005 New England Journal of Medicine article, “A Nutrition Paradox-Underweight and Obesity in Developing Countries,” written by Benjamin Caballero, head of the Center for Human Nutrition at Johns Hopkins University.

Caballero describes his visit to a clinic in the slums of São Paulo, Brazil. 

The waiting room, he writes, was “full of mothers with thin, stunted young children, exhibiting the typical signs of chronic undernutrition.

Their appearance, sadly, would surprise few who visit poor urban areas in the developing world. What might come as a surprise is that many of the mothers holding those undernourished infants were themselves overweight.(*snip*)

If we believe that these mothers were overweight because they ate too much, and we know the children are thin and stunted because they're not getting enough food, then we're assuming that the mothers were consuming superfluous calories that they could have given to their children to allow them to thrive.

In other words, the mothers are willing to starve their children so that they themselves can overeat. This goes against everything we know about maternal behavior. (*snip*)

Caballero then describes the difficulty that he believed this phenomenon presents: “The coexistence of underweight and overweight poses a challenge to public health programs, since the aims of programs to reduce undernutrition are obviously in conflict with those for obesity prevention.”

Put simply, if we want to prevent obesity, we have to get people to eat less, but if we want to prevent undernutrition, we have to make more food available. What do we do?[4]
    

2. What should we do?

In the early 1970s, nutritionists and research-minded physicians would discuss the observations of high levels of obesity in these poor populations, and they would occasionally do so with an open mind as to the cause. (*snip*)

Here's Rolf Richards, the British-turned-Jamaican diabetes specialist, discussing the evidence and the quandary of obesity and poverty in 1974, and doing so without any preconceptions: “It is difficult to explain the high frequency of obesity seen in a relatively impecunious [very poor] society such as exists in the West Indies, when compared to the standard of living enjoyed in the more developed countries.

Malnutrition and subnutrition are common disorders in the first two years of life in these areas, and account for almost 25 per cent of all admissions to pediatric wards in Jamaica. Subnutrition continues in early childhood to the early teens. Obesity begins to manifest itself in the female population from the 25th year of life and reaches enormous proportions from 30 onwards.

Lots of carbs

When Richards says “subnutrition,” he means there wasn't enough food. From birth through the early teens, West Indian children were exceptionally thin, and their growth was stunted. They needed more food, not just more nutritious food. Then obesity manifested itself, particularly among women, and exploded in these individuals as they reached maturity.

This is the combination we saw among the Sioux in 1928 and later in Chile— malnutrition and/or undernutrition or subnutrition coexisting in the same population with obesity, often even in the same families. (*snip*)

Referring to obesity as a “form of malnutrition” comes with no moral judgments attached, no belief system, no veiled insinuations of gluttony and sloth. It merely says that something is wrong with the food supply and it might behoove us to find out what.(*snip*)

Again, the coexistence of underweight and overweight in the same populations and even in the same families doesn't pose a challenge to public-health programs; it poses a challenge to our beliefs about the cause of obesity and overweight.[5]"
      

References:
[1](Gary Taubes, Why We Get Fat, 2010, Pages 24)
[2] P. 3, 4
[3] P. 23,24
[4] P. 30,31
[5] P. 29-32

3. Underweight and overweight can coexist. My thoughts

<About undernutrition and overweight>

First, I would like to explain, based on my experience, that the coexistence of undernutrition and obesity are not contradictory messages.

I repeat that when I was very thin, under forty kilograms, at first, I was eating  high-calorie foods such as deep-fried foods or sweet, but I couldn’t gain weight. And then, I realized that I could gain weight by digesting all the foods in my whole intestines and inducing intestinal starvation.

The easiest way to induce intestinal starvation was to eat refined carbohydrates (starches) and a little easy-to-digest protein (and not to eat other foods), but since it lacked energy and essential nutrients for my body, I felt dizzy from the undernutrition. 

If I ate eggs, vegetables, beans, or fish, or drank milk to add more essential nutrients, though the nutritional profile was better,  I couldn’t gain any weight. For me, it was because I couldn’t digest them well. 

In short, a higher ratio of carbs in the meal (not an amount of carbs) and eating fewer fibrous vegetables and nutritious foods are more likely to induce intestinal starvation and cause you to gain weight. It’s probably certain that a deficiency of vitamins and/or minerals can cause illnesses, but being overweight is not contradicting being in a state of undernutrition.
  

<About the coexistence of being underweight and overweight>

Getting back to what Caballero refered to, even if people eat similar foods in the same group, it may lead to a different result in the body.
Some people who digested all the foods in their whole intestines may have gained weight—which means their base weight value went up by intestinal starvation— and ended up becoming overweight. 

However, those who were not able to digest all the foods in their whole intestines remained underweight. I believe that leaving Just a little bit of undigested food in the intestines makes it hard to induce intestinal starvation. (Being extremely thin can cause poor digestion, so it makes it harder for them to induce intestinal starvation.) A small difference sometimes makes a big difference in the end result.

To sum up, what happened in the groups in poverty situations is a similar phenomenon that is happening in our modern society.

When someone doesn't eat much and is fat, we tend to assume that they are inactive or have a slow metabolism. And when someone who eats a lot but is thin, we tend to assume that they are active or have a fast metabolism. 

Most researchers just try to fit everything into the theory that “fat people eat too much or are physically inactive” for some reason.

However, if we look at these ideas I’ve presented with an open mind, we can say that this is the same phenomenon as the "coexistence of thin and obese" in the same population. At the risk of repeating myself, being overweight is not necessarily the consequence of overeating. 

2019.01.04

The Dilution Effect/ Pushing Out Effect of Carbohydrates: Does This Cause People To Gain Weight?

Contents

  1. If there were no carbohydrates
  2. With indigestible foods, it is difficult to gain weight
  3. The effect of carbohydrates that make it easier to gain weight
    (1) Dilution Effect
    (2) Pushing out Effet
    The Bottom Line

When we consider that “eating a lot leads to gaining weight,” I believe you have the image of carbohydrates like bread, rice, and noodles in mind.

This time, I am going to explain the reason why carbohydrates (*1) make it easier for people to gain weight, not because of an increase in calories or of its tendency to raise blood sugar levels, but by other indirect ways.

(*1) Although technically sugar is also a sort of carbohydrate, I use the word carbohydrate here to mean polysaccharide” such as starches, bread, and rice.

1. If there were no carbohydrates

When my total body weight fell to under forty kilograms, it would have been impossible to have gained weight without the help of carbohydrates.

In my case, neither fat nor sugar could have done that... In other words, I would never have gained weight by eating cream-filled cakes or oily pork cutlets and fatty Chinese food. Next, I am going to explain the reason why.

To be precise, I don’t mean all carbohydrates, just refined digestible carbohydrates such as white bread, rice porridge, potatoes, starches, etc.

Thus, in the case of brown rice, fried rice, whole-grain bread, cold rice, and al dente cooked pasta, etc., the result may be different, even though they are the same type of carbohydrates. These are known as foods that won’t increase blood sugar levels much (low glycemic index, resistant starches) but in short, they are indigestible.
  

2. With indigestible foods, it is difficult to gain weight

When you always eat indigestible foods, such as the above-mentioned carbohydrates that don’t raise the blood sugar level, fat, fibrous vegetable, seaweed, and dairy products, intestinal starvation is less likely to occur and you are less likely to gain weight, which means the base weight value in my definition is unlikely to go up.

I’m simply saying that it is hard to gain weight if a thin person eats them properly every day.
Although a person who has already gained weight (or who is already overweight) may not lose weight by eating some indigestible foods, I consider that it may be possible to lose weight depending on how you eat them, since these foods are always discussed in dieting techniques.
  

3. The effect of carbohydrates that make it easier for people to gain weight

On the contrarily, refined digestible carbohydrates (rice, rice porridge, white bread, potatoes, starches, etc.) will promote digestion. By eating them together with digestible proteins, they make it easier to  induce intestinal starvation. Those are two effects that I can think of so far.
    

(1) Dilution Effect 

If you proportionally increase digestible carbohydrates in the meal, the percentage of side dishes such as fat, meat, fish, and vegetables will be relatively smaller. The density of a spoonful of oil will be lower if you eat more bread or rice portions with soup (water). 

meat and bread

When you eat some meat together with a slice of bread and soup, the density of the meat will be lower.

In other words, easily digestible carbohydrates and water are added and mixed in the stomach, and then the diluted nutrients are sent to the intestines. So, it will be easier to get hungry and induce intestinal starvation.

For example, let’s say you eat a hamburger and a potato, plus another piece of bread and tea. If we mix all of these in a blender, it will be something like meat diluted with starch and water.

Dilution effect

In contrast, if we remove the bread and add mixed beans-mayonnaise salad… the dilution effect of carbohydrates will be less, and fiber and fat will be added.

On a caloric basis, mixed beans-mayonnaise salad is, e.g. 100kcal. However, adding it to the meal doesn’t have the same meaning as adding another piece of bread. This is why calorie intake basis thinking may go wrong.

Mixed beans

Moreover, as seen in low-carb diets, what would happen if you decrease the intake of carbohydrates  in the meal and instead increase proteins such as meat and fish, fat, and vegetables? 

In this case, the opposite effect of the dilution effect occurs: dense nutrients are delivered to the intestines, which slows digestion and undigested food always remains in the gastrointestinal tract.
    

(2) Pushing out Effect 

"Balloon effect"

When we eat carbohydrates together with water, our stomach expands (I’ll call this the “balloon effect” of the stomach). And, if we eat carbs together with digestible side dishes such as stew (onion, potatoes, low-fat chicken, etc.), its holding time in the gut will be shorter since it’s easy to digest, and the food will be pushed out of the stomach fairly soon. Also, our intestines start to move actively and smoothly.

Soba noodle and rice

I had the problem with my stomach and intestines and often suffered from constipation or diarrhea.

But, when I ate Japanese soba noodles(*2) and small rice bowl dishes (chicken and egg over rice), it promoted regular bowel movements and relieved my symptoms several times.

(*2) If you don't know much about it, it may be easier to imagine ramen noodle and rice. 

On the other hand, you may think that eating fatty foods or deep-fried foods give us stamina. It actually means that those foods fill us up better than carbs do, and its energy could be sustained during sports such as a marathon or a soccer match.
That is to say,
undigested foods stay longer in our stomach and intestines, so it’s more difficult to induce intestinal starvation.

The Bottom Line

(1) Simply put, poorly digestible foods are not fattening. In contrast, refined grains, starches, and other easily digestible carbohydrates tend to make people fat. These polysaccharides may have a "dilution effect" or "push-out effect" in the digestive process.


(2)I consider sugar (monosaccharides, disaccharides) and polysaccharides (starch, flour, rice, etc.) can not be put into the same category since they have different characteristics based on my theory. Recent popular low-carb diets focus primarily on the blood glucose-raising properties of carbohydrates, which alone is not a sufficient explanation for why it is necessary to add more meat, fat, vegetables, and other side dishes in the diets.


(3) Obesity among poverty-stricken people worldwide can be understood as the influence of cheap refined carbohydrates and unbalanced diets (lack of vegetables, etc.). Considering them, it may be easier to imagine that they are not gaining weight due to taking too many calories or sugar, but rather from consuming cheap carbohydrates as mentioned above.
[Related article] 
Wealthy People Get Fat? Poor People Get Fat?


(4) Also, the fact that sumo (Japanese national sports) wrestlers eat digestible hot pot dishes called “chanko” with a lot of rice two times a day in order to make their bodies larger is a very logical view in this sense.

2018.10.21

Do Carbohydrates Make Us Fat or Do Too Many Calories?: The Debate Since the 1800's

Contents

  1. Low carbohydrates go way back
  2. The reason why doctors couldn’t accept carbohydrate restriction
  3. Carbohydrates and fat have opposite properties. My thoughts
    The bottom line 

First, as many of you know, even carbohydrates contain four kcal of energy per gram. So, some readers may think, "After all, isn't being overweight ultimately caused by too many calories?"

But if you think, "too many calories are the cause," you should try to reduce the total amount of calories in your overall diet, mostly focusing on fat/oil intake, which has nine kcal per gram.

On the other hand, the argument that “too many carbohydrates cause weight gain” allows you to eat any amount of meat and fatty/oily foods as long as you cut back on carbs.

In this article, I will look back on the historical argument of whether carbohydrates or calories are the cause of weight gain, and at the end of this article, I would like to share my thoughts.

1.Low carbohydrates go way back

In Japan, a low-carb diet was trendy around 2015, but when we look around the world, this way was repeatedly conducted since the 1800’s. Please note that there are many quoted parts. I needed to share this information with you to explain my theory.
  

"Jean Anthelme Brillat-Savarin was born in 1755. (*snip*) His passion, though, was always food and drink, or what he called the “pleasures of the table.” He began writing down his thoughts on the subject in the 1790s; Brillat-Savarin published them in a book, The Physiology of Taste, in December 1825. (*snip*)

“Tell me what you eat,” Brillat-Savarin memorably wrote, “and I shall tell you what you are." (*snip*)

Over the course of thirty years, he wrote, he had held more than five hundred conversations with dinner companions who were “threatened or afflicted with obesity,” one “fat man” after another, declaring their devotion to bread, rice, pasta, and potatoes. This led Brillat-Savarin to conclude that the roots of obesity were obvious. 

The first was a natural predisposition to fatten. “Some people,” he wrote, “in whom the digestive forces manufacture, all things being equal, a greater supply of fat are, as it were, destined to be obese.”

The second was “the starches and flours which man uses as the base of his daily nourishment,” and he added that “starch produces this effect more quickly and surely when it is used with sugar."

This , of course, made the cure obvious as well, ...(*snip*)  (Brillat-Savarin wrote) ...”It can be deduced, as an exact consequence, that a more or less rigid abstinence from everything that is starchy or floury will lead to the lessening of weight.” (*snip*) 

What Brillat-Savarin wrote in 1825 has been repeated and reinvented numerous times since. Up through the 1960s, it was the conventional wisdom, what our parents or our grandparents instinctively believed to be true."[1]

・By the time, a French physician and retired military surgeon named Jean-Francois Dancel had come to the same conclusions as his countryman Brillat-Savarin. Dancel  presented his thoughts on obesity in 1844 to the French Academy of Sciences and then published a book, Obesity, or Excessive Corpulence: The Various Causes and the Rational Means of a Cure.

Dancel claimed that he could cure obesity “without a single exception” if he could induce his patients to live “chiefly upon meat," and partake “only of a small quantity of other food." 

Dancel argued that physicians of his era believed obesity to be incurable because the diets they prescribed to cure it were precisely those that happened to cause it. (*snip*)

“All food which is not flesh ―all food rich in carbon and hydrogen [i.e., carbohydrates] ―must have a tendency to produce fat,” wrote Dancel. (*snip*)

Dancel also noted that carnivorous animals are never fat, whereas herbivores, living exclusively on plants, often are.[2]

▽Until the early years of the twentieth century, physicians typically considered obesity a disease, and a virtually incurable one, against which, as with cancer, it was reasonable to try anything. Inducing patients to eat less and/or exercise more was just one of many treatments that might be considered. (*snip*)
    

(1950's)
The effects of a carbohydrate-restricted diets were then confirmed in the 1950s by Margaret Ohlson, head of the nutrition department at Michigan State University, and by her student Charlotte Young.

When overweight students were put on conventional semi-starvation diets, Ohlson reported, they lost little weight and “reported a lack of ‘pep’ throughout... [and] they were discouraged because they were always conscious of being hungry.” 

When they ate only a few hundred carbohydrate calories a day but plenty of protein and fat, they lost an average of three pounds per week and “reported a feeling of well-being and satisfaction. Hunger between meals was not a problem.” 

The reports continued into the 1970s. (*snip*)

The diets were prescribed for obese adults and children, for men and women, and the result were invariably the same. The dieters lost weight with little effort and felt little or no hunger while doing so."[3]

2.The reason why doctors couldn’t accept carbohydrate restriction

As you can see, by cutting back on carbohydrates and eating more of other foods such as meat and greasy food, the problem of being overweight seems to be solved...but this is where the "calorie principle" comes into play. 
   

"By the 1960s, obesity had come to be perceived as an eating disorder. (*snip*)

 Adiposity 101 was discussed in the physiology, endocrinology, and biochemistry journals, but rarely crossed over into the medical journals or the literature on obesity itself. 

When it did, as in a lengthy article in The Journal of the American Medical Association in 1963, it was ignored. Few doctors were willing to accept a cure for obesity predicated on the notion that fat people can eat large portions of any food, let alone as much as they want. This simply ran contrary to what had now come to be accepted as the obvious reason why fat people get fat to begin with, that they eat too much. 

But there was another problem as well. Health officials had come to believe that dietary fat causes heart disease, and that carbohydrates are what these authorities would come to call “heart-healthy."(*snip*)

After all, if dietary fat causes heart attacks, then a diet that replaces carbohydrates with more fatty foods threatens to kill us, even if it slims us down in the process.  As a result, doctors and nutritionists started attacking carbohydrate-restricted diets. [4] (*snip)  

fat and oil

(In 1965)
The Times article, “New Diet Decried by Nutritionists: Dangers Are Seen in Low Carbohydrate Intake,” quoted Harvard's Jean Mayer as claiming that to prescribe carbohydrate-restricted diets to the public was “the equivalent of mass murder.”
(*snip*)

Well, first, as the Times explained, “It is a medical fact that no dieter can lose weight unless he cuts down on excess calories, either by taking in fewer of them, or by burning them up." We now know that this is not a medical fact, but the nutritionists didn't in 1965, and most of them still don't. 

Second, because these diets restrict carbohydrates, they compensate by allowing more fat. It's the high-fat nature of the diets, the Times explained, that prompted Mayer to make the mass murder accusation.[5] "

医師2

References:
[1](Gary Taubes, Why We Get Fat, 2010, Pages 148-149)
[2] P. 151, 152
[3] P. 151, 157-158
[4] P. 159,160
[5] P. 161

3. Carbohydrates and fat have opposite properties. My thoughts

I ‘d like to talk about this controversy.

Several studies have shown that how we combine the three macronutrients (protein, fat, and carbohydrates) in the diet produces different results in body fat accumulation. It is thought that even the same one calorie has different energy used for digestion and absorption, different hormones to stimulate, and different pathways of how the calorie is metabolized in the body.

Of course I think these studies are great, but the point I'd like to add based on my theory is that "carbohydrates and fat are close to having opposite properties in their digestive processes."

  

First, refined carbohydrates are more easily digested than meats and fats, and the "dilution effect" or "push-out effect" they have makes our digestion go even faster and makes us feel hungrier.

If we eat an unbalanced diet that lacks vegetables, fat, and dairy products,etc., we are ultimately more prone to inducing intestinal starvation.

meat,fat,oil

In contrast, fats and meats are less digestible. The time required for digestion depends on the quantity and type of food consumed, how we prepare food, or individual differences in digestive ability, but it is generally estimated to be 3-4 hours for proteins and 6-8 hours for fats. Fat, in particular, secretes a hormone (GIP) that suppresses the function of the stomach when it reaches the intestines, and it can cause stomach upset.

Plus, a diet low in carbohydrates and high in protein and fat sends dense nutrients to the intestines, which slows digestion and suppresses hunger, which in turn, causes the absorption rate to decrease.

That is to say, depending on how we structure our diets, there may be a weight-loss effect even with increased caloric intake (for those who can digest protein and fat quickly, the weight-loss effect may be less pronounced) .
   

The bottom line 

・From the early 1800’s through the 1960’s, several studies had shown that overweight people could lose weight without difficulty by replacing some carbohydrates in their diet with a lot of meat and fat. By that time, however, obesity was understood as an eating disorder, and this diet method was discussed only in physiology, endocrinology, etc.

・From the 1960’s to the late 1970’s, few physicians accepted the idea that fat people could lose weight by eating lots of meat and fat, because it obviously violated the "calorie principle.

・In addition, health experts came to believe that fat in the diet caused heart disease and that carbohydrates were "heart-healthy." As a result, doctors and nutritionists began attacking low-carb diets.

・My thoughts: Both sides have a point, but the caloric intake does not determine everything. Different combinations of foods, even with the same calories, have different effects on weight management. In particular, carbohydrates and fat are close to having opposite properties in their digestive processes.

2018.10.02

A Low-Carb Diet:Is Lowering Insulin Secretion the Key to This Diet?

Contens

  1. What’s Locabo?
  2. Sugar Busters
  3. Indirect significance of reducing carbohydrates. My thoughts
    The bottom line

In Japan, since around 2015, the low-carb diet-we call "Locabo" based on the English term "a low-carb"-has been catching on among many people. Japan is traditionally a rice-eating culture, but after World War II, more and more people preferred bread and noodles, and with increasingly westernized diets, many feel that we are gaining weight as well. 

This time, I’d like to introduce the Locabo diet in Japan and Sugar Busters in the U.S., which is believed to be effective not only for losing weight but also for lowering abnormal blood sugar levels and other lifestyle diseases.

At the end of this article, I'd like to weigh in on this. To get straight to the point, the right way of losing weight, my thinking is closer to that of a Locabo and a Sugar Busters diet, but I’m wondering if the hormone insulin is the key to these diets.

1.What’s Locabo?

"In Japan, the phrase “carbohydrate restriction diet” has been generally used, but the word “restriction” has a somewhat negative image.

Therefore, we had to use some different words. We came up with the new word “Locabo” after the English phrase “low-carb” and then it spread throughout Japan. 

Locabo is not strict but rather a loose carbohydrate restriction.
By definition, the diet tries to keep the carbohydrate intake amount per day to around seventy to one hundred and thirty grams in total, by taking twenty to forty grams per meal, three times a day and also a dessert or sweets up to ten grams. 

The difference from a strict carbohydrate restriction is that by eating at least seventy grams of carbohydrates, it avoids an extremely low-carbohydrate condition that results in “Ketosis.”

Also, a strict carbohydrate restriction diet makes food choices very limited, but Locabo has a variety of foods you can enjoy.
As long as you keep adjusting carbohydrate intake, you can eat a variety of foods such as meat, fish, cheese, and vegetable dishes without thinking about calories."
[1]

<Old history of low carbohydrate diets>

In Japan, when the Locabo diet first garnered attention around 2015, people thought it was a new dieting method. However, it seems to be a way that has been repeatedly conducted around the world since the 1800’s. I’ll explain this in the link below.

 Do Carbohydrates Make Us Fat or Do Too Many Calories?: The debate since the 1800's
    

2. Sugar Busters

I’d like to introduce “Sugar Busters,” which was a trend since the late 1990’s, especially in the U.S. (New Orleans) and was called the “food revolution.” 

Those who advocated the Sugar Busters diet said that the point of Sugar Busters was to regulate the secretion of insulin. They also said that insulin control depends on restricting carbohydrate intake. 

fish dish

In other words, as long as you restricted carbohydrate(sugar) intake, you could enjoy steak, grilled fish, cheese, etc. without thinking about calories. 

It is said that restaurants in the town created the Sugar Busters menu and this made the movement even stronger. It’s surprising that this was done more than fifteen years before the rise of the low-carb trend in Japan.[2]

3. Indirect significance of reducing carbohydrates. My thoughts

The way of losing weight on these low-carb diets is close to my idea, but from the perspective of my theory, the implications are a little different. Allow me to explain.

I feel that carbohydrates are treated as culprits that make people fat in this diet method because they stimulate insulin secretion. I agree that abnormal blood glucose levels are associated with various diseases and that carbohydrates are a major contributing factor that make people fat.

However, I would like to believe that insulin secretion, even though it promotes fat storage, does not create the fundamental difference between people who are obese, and lean people.


As I have mentioned many times in this blog, the root cause of being overweight, in my opinion, is an “increased base weight,” which is caused by intestinal starvation. And this is more likely to occur with digestible carbohydrates and protein, even in small amounts, combined with an unbalanced diet.

Such a diet, for sure, tends to raise blood sugar and stimulate insulin secretion, but it is a different mechanism that increases base weight value and makes people fat, and regarding my theory, insulin  doesn't have much to do with it.

What does have an effect, then, is the "dilution effect" or "push-out effect" that carbohydrates (polysaccharides) have. That, in combination with other factors, indirectly makes people more likely to induce intestinal starvation. (It’s “indirectly” that matters).

[Related article]
The Dilution Effect/ Pushing Out Effect of Carbohydrates

On the other hand, if you want to lose weight, I believe, as Locabo and Sugar Busters do, that reducing the percentage of carbohydrates in the diet and conversely increasing meat, fat, vegetables, and dairy products, etc. is effective.

In this case, the direct implication of reducing carbohydrates is to cut back on glucose that provides immediate energy. So, the body must obtain energy from protein (amino acids) and fat. It is also said to be useful in improving lifestyle-related diseases because it suppresses the rise in blood glucose levels.

meat,fat,oil

The indirect effect is to send, conversely, dense nutrients into the intestines by increasing the proportion of indigestible food. Because of this, it takes us more time to digest and keeps undigested food in the intestines for a longer period of time.

As a result, we don’t feel being hungry so much, which in turn it decreases absorption ability. 

If you simply reduce overall food intake including meat, fat, and vegetable, etc., which means that you are "eating less and feeling hungry," and some studies have shown that such diets do not work in promoting weight loss in the long run. 

In other words, I believe that carbohydrates are not the culprit that directly make people fat. It is more important to eat in balance with relatively more meat, vegetables, cheese, and fat, etc., and to feel less hunger. 

Some people who advocate a low-carb diet say, "As long as you adjust your insulin secretion, you can eat anything without worrying about calories, even fatty foods, cheese, and meat. And since that's how you lost weight, it was the carbohydrates, not the caloric intake, that was the reason." 
I don’t think this explanation is correct.

References:
[1]Satoshi Yamada, The Truth of Carbohydrate Restriction, (山田悟, 「糖質制限の真実」)2015, Pages 114-7.
[2]H. Leigton Steward, Morrison Bethea, Sam S. Andrews, and Luis Balart, Sugar Busters, 1998.

The bottom line

(1) Since around 2015, the low-carb diet has become a trend in Japan, not a fad diet. This is due to the fact that many people prefer diets high in carbohydrates (rice, bread, noodles, etc.) and along with that, obesity and diabetes are on the rise. (In fact, many still believe in the "calorie principle," so they are cutting back not only on carbohydrates, but also on calories.)


(2) In the U. S. (New Orleans), the Sugar Busters was a trend in the late 1900’s. This was more than fifteen years before a low-carb diet became a trend in Japan.


(3) Doctors and others who advocate low-carb diets say
that regulating insulin secretion is the key to this diet, but I beg to differ. I believe it is worthwhile to reduce carbohydrate intake while increasing the intake amount of meats, fat, vegetables, and dairy products, etc. This allows undigested food to remain in the intestines for a longer period of time, resulting in less hunger, which in turn reduces absorption ability.

2017.12.10

Wealthy People Get Fat? Poor People Get Fat?

Contents

  1. Wealth is said to be the cause of obesity....
  2. The case of poverty and obesity
  3. Why were they fat?
  4. Though we have become wealthy, how is the quality of our food? My thoughts

I would like to share with you an interesting story based on profound research that is also relevant to my theory. I will conclude this post with my thoughts.

 【Related article】The Combination of Thin and Overweight in the Same Poor Group Is Not Contradictory

1. Some believe that wealth is said to be the cause of obesity...

 "Ever since researchers at the Centers for Disease Control and Prevention (CDC) broke the news in the mid-1990s that the epidemic was upon us, authorities have blamed it on overeating and sedentary behavior and blamed those two factors on the relative wealth of modern societies.

<In 2003>

"Improved prosperity" caused the epidemic, aided and abetted by the food and entertainment industries, as the New York University nutritionist Marion Nestle explained in the journal Science in 2003. “They turn people with expendable income into consumers of aggressively marketed foods that are high in energy but low in nutritional value, and of cars, television sets, and computers that promote sedentary behavior. Gaining weight is good for business.”


The Yale University psychologist Kelly Brownell coined the term "toxic environment" to describe the same notion. 

toxic environment

Just as the residents of Love Canal or Chernobyl lived in toxic environments that encouraged cancer growth, the rest of us, Brownell says, live in a toxic environment "that encourages overeating and physical inactivity.

"Cheeseburgers and French fries, drive-in windows and supersizes, soft drinks and candy, potato chips and cheese curls, once unusual, are as much our background as tree, grass, and clouds. Computers, video games, and televisions keep children inside and inactive,” he says.(*snip*)

▽The World Health Organization (WHO) uses the identical logic to explain the obesity epidemic worldwide, blaming it on rising incomes, urbanization, "shifts toward less physically demanding work...moves toward less physical activity...and more passive leisure pursuits."

Obesity researchers now use a quasi-scientific term to describe exactly this condition: they refer to the “obesigenic" environment in which we now live, meaning an environment that is prone to turning lean people into fat ones.[1]"
    

In Japan as well, this idea is widely accepted, and most experts on television explain that overeating and physical inactivity are the causes of obesity.
  

2. The case of poverty and obesity

However, what we have to consider here is that obesity is spreading in the poor layers of society, too.
 

"One piece of evidence that needs to be considered in this context, however, is the well-documented fact that being fat is associated with poverty, not prosperitycertainly in women, and often in men. The poorer we are, the fatter we're likely to be. (*snip*)

In the early 1970s, nutritionists and research-minded physicians would discuss the observations of high levels of obesity in these poor populations, and they would occasionally do so with an open mind as to the cause.(*snip*)

This was a time when obesity was still considered a problem of "malnutrition" rather than "overnutrition," as it is today.[2]

Between 1901 and 1905, two anthropologists independently studied the Pima (Native American tribe in Arizona), and both commented on how fat they were, particularly the women.
Through the 1850s, the Pima had been extraordinarily successful hunters and farmers. By the 1870s, the Pima, however, were living through what they called the “years of famine.”
(*snip*)

When two anthropologists (Russell and Hrdlička) appeared, in the first years of the twentieth century, the tribe was still raising what crops it could but was now relying on government rations for day-to-day sustenance.

What makes this observation so remarkable is that the Pima, at the time, had just gone from being among the most affluent Native American tribes to among the poorest.

Whatever made the Pima fat, prosperity and rising incomes had nothing to do with it; rather, the opposite seemed to be the case. (*snip*)

(A quarter-century after Russell and Hrdlička visited Pima)

Two researchers from the University of Chicago studied another Native American tribe, the Sioux living on the South Dakota Crow Creek Reservation.

These Sioux lived in shacks “unfit for occupancy,” often four to eight family members per room. Many had no plumbing and no running water. Forty percent of the children lived in homes without any kind of toilets. Fifteen families, with thirty-two children among them, lived "chiefly on bread and coffee." This was poverty almost beyond our imagination today.

Yet their obesity rates were not much different from what we have today in the midst of our epidemic : 40 percent of the adult women on the reservation, more than a quarter of the men, and 10 percent of the children, according to the University of Chicago report, “would be termed distinctly fat.[3]
     

1950-1980’s 

This combination of obesity and undernutrition existing in the same populations have been found and reported from around the world, including the West Indies, South Africa, Chile, Ghana, and Jamaica.

3. Why were they fat?

<About the case of Manhattanites, in the early 1960's>

"This was first reported in a survey of New Yorkers-midtown Manhattanites-in the early 1960s: obese women were six times more likely to be poor than rich; obese men, twice as likely. (*snip*)

Can it be possible that the obesity epidemic is caused by prosperity, so the richer we get, the fatter we get, and that obesity associates with poverty, so the poorer we are, the more likely we are to be fat?

It's not impossible. Maybe poor people don't have the peer pressure that rich people do to remain thin. Believe it or not, this has been one of the accepted explanations for this apparent paradox.

Another commonly accepted explanation for the association between obesity and poverty is that fatter women marry down in social class and so collect at the bottom rungs of the ladder; thinner women marry up.
  

A third is that poor people don't have the leisure time to exercise that rich people do; they don't have the money to join health clubs, and they live in neighborhoods without parks and sidewalks, so their kids don't have the opportunities to exercise and walk.

These explanations may be true, but they stretch the imagination, and the contradiction gets still more glaring the deeper we delve.[4]

 

<About the case of the Pima (Native American tribe in Arizona >

So why were they fat? Years of starvation are supposed to take weight off, not put it on or leave it on, as the case may be. And if the government rations were simply excessive, making the famines a thing of the past, then why would the Pima get fat on the abundant rations and not on the abundant food they'd had prior to the famines?

Hrdlička also thought that their physical inactivity was the cause of obesity because they were sedentary in comparison with what they used to be. This is what Hrdlička called “the change from their past active life to the present state of not a little indolence.” But then he couldn't explain why the women were typically the fat ones, even though the women did virtually all the hard labor in the villages—harvesting the crops, grinding the grain, even carrying the heavy burdens.

Perhaps the answer lies in the type of food being consumed, a question of quality rather than quantity. This is what Russell was suggesting when he wrote that “certain articles of their food appear to be markedly flesh producing.”

The Pima were already eating everything “that enters into the dietary of the white man,” as Hrdlička said. This might have been key. The Pima diet in 1900 had characteristics very similar to the diets many of us are eating a century later, but not in quantity, in quality.[5]"
    

4. Though we say we have become wealthy, how is the quality of our food? My thoughts

I want to explain my consideration based on numbers one to three.
First of all, 
when considering "obesity," isn't it too simplistic to think that obesity has increased since we have become wealthier? 

It is true that our lives are wealthier than we used to be in terms of freedom of choice and an abundance of goods.  If we have a certain income, we can do what we like and eat what we want.

However, when the income is low, we can’t spend a lot for food. Also, we don’t have enough time to eat, since many of us are so busy at work or with household chores. 

light meals for lunch

We might eat an unbalanced diet leaning toward carbohydrates (and not enough vegetables) such as eating toast and coffee for breakfast, and a burger or a cup of noodles for lunch. We might skip breakfast or lunch. 

In addition, those who gain weight easily try to eat a simple light meal or skip a meal, since they ate a lot the day before. The idea of offsetting an over-intake of calories from yesterday, eating less today, is wrong.

That is to say, even if someone is said to be wealthy, with regards to food, there are many things in common with groups that live in poverty with a high rate of obesity. As Mr. Taubes says, what is important now is the “quality” of food rather than the “quantity.”

In an extreme argument, obesity with poverty can be explained by the same mechanism that people who are on a diet end up gaining more weight after they stop dieting, even though they reduced the caloric intake.
 

"Not all of us get fat when we eat carbohydrates, but for those of us who do get fat, the carbohydrates are to blame; the fewer carbohydrates we eat, the leaner we will be.

These foods are also, almost invariably, the cheapest calories available. This is the conspicuous explanation for why the poorer we are, the fatter we're likely to be.[6]"

References:
[1](Gary Taubes, Why We Get Fat, 2010, Pages 17-18)
[2] P. 18, 29
[3] P. 20-24
[4] P. 18-19
[5] P. 22-23
[6] P.134, 150