Thursday, February 14, 2019

Book Summary: The Obesity Code, Unlocking the Secrets of Weight Loss



by Dr. Jason Fung
Summary by Mounir Aswad,  


Inheritance is not the only factor for Obesity. Most obesity epidemics materialize within a single generation. An interesting facts is that we are starting to see children born obese. This book digs deep into the cause of obesity and provides a solution.
Re: my Summary: I changed the order subjects appear to what I think is most effective. For example, I summarized the solutions first, this way, one can review the solutions available and start his/her improvements program as soon as possible.

Re: File Format: this summary is written using Microsoft Word 365 and utilizes Heading Categorization, however, on the internet it losses this great functionality. If you are reading this on the web and would like to get the original file, email me: maswad@gmail.com. In MS Word, to navigate, click view and check Navigation Pane. Categories can be collapsed or expanded in both the navigation and the main window. 

Theories

1.      Thrifty gene hypothesis (the 1970s): All humans predisposed to gain weights.

2.      Other hypothesis related to Caloric imbalance

3.      Hormonal imbalance. The only theory that started to make sense

·       The body keeps to homeostatic balance,
·       The problem with Obesity is that the threshold the body aims to balance to, is higher than what is normal. 
·       Obesity takes many years, as the body raises the Body set weight gradually.
·       Newborn obesity can be explained for insulin resistance genes passed from mother to children.

Solution

Avoid Insulin Resistance

·       Insulin resistance happens on 2 conditions
o   There is a lot of insulin. This can be combated by less carbs.
o   This amount of insulin is persistent. This can be combated by eating less frequency or fasting (see below)

Avoid Artificial Sweeteners, why take a chance:

·       Artificial Sweetener increases not decrease obesity, increase Insulin and craving.
·       Agave nectar = 80% Fructose.
·       Stevia and aspartame = Highly processed, raises Insulin higher than table sugar (More research needed)
o   https://www.livestrong.com/article/536467-does-stevia-affect-insulin/
·       Erythritol = Associated with increased belly fat and weight in young adults. It is also being investigated for use as an insecticide!
·       Xylitol promising (More research needed)
o   https://medium.com/@reefwing/stevia-and-insulin-41ed4f323f4b
·       Sucralose raises blood Insulin by 20%

Minimize, eliminate Breakfast or Fast

§  Breakfast early in the morning,
in the early morning you have a system in place to give you energy producing the dawn phenomenon.
Hormones raised between 3-8 Am:  Glucagon, Cortisol, Epinephrine, growth hormone, cortisol.
Your body's way of giving you energy from Sugar it has in store.
When you eat in the morning you minimize or kill this initiative.
The worst thing you can have in the Morning is sugary food such as Cereal, Juices, and Carbs.
§  See Fasting Section

6 Steps for better you

1.       Reduce Sugar
·       Don't snack, make breakfast optional
·       Drink water use flavor as lime, lemon, oranges, tea, and coffee
·       Bone Broth 
2.       Reduce processed grains
·       Carbs from Vegetable is great such as Kale, broccoli
·       Quinoa high in fiber, low in GI
·       Chia, high fiber and minerals
·       Beans great option for Vegetarian
3.       Moderate Protein 
4.       Increase natural fat
·       Olive oil (Virgin cold pressed), butter, Beef Talo
·       Avocado
·       Nut, Dairy is Ok
5.       Eat organics, unprocessed food, home meals, avoid artificial foods
6.       Fast (See Fasting section)

Fasting

The missing piece in the weight loss puzzle.

§  The best way to reduce insulin levels.
§  Breaks the cycle of insulin resistance, by having a long period of time with low insulin levels...
§  Can be done for any number of hours, most commonly between 24-36 Hours
§  Calorie reduction diets don't have the fat adaptation benefit of fasting 
§  48 hours of fasting produce 3.6% increase in metabolic rate / in 4 days fast resting body metabolism is increased by 14% (Instead of slowing it down as in calorie reduction diets).

Note on Muslim Fasting 

§  Statistically, calories intake raises drastically during this month, causing you to forge any benefit you can gain, therefore always eat similar or smaller size meals to get the benefit. Reduce sugar and sweets.

Fasting Stages from burning Glucose (Short term) to burning fat (Long term)

1.       Feeding: Insulin levels raise, Glucose uptake by muscles and brain. Access glucose stored as Glycogen in the liver.
2.       Postabsorptive phase 6-24 hours,
§  insulin level start to fall
§  Breakdown of Glycogen releases glucose for energy, Glycogen stores last ~24 hours
3.       Gluconeogenesis, 4 hours - 2 days
§   (GNG) is a metabolic pathway that results in the generation of glucose from certain non-carbohydrate carbon substrates.
§  Liver manufacture new Glucose from Amino Acids and Glycerol
o   Also called Glycerine or Glycerin;) is a simple polyol compound. It is a colorless, odorless, viscous liquid that is sweet-tasting and non-toxic. The glycerol backbone is found in all lipids known as triglycerides.
·       Glucose levels fall but still in normal range (for non-diabetic).
§  Ketosis 1-3 Days
·       Triglycerides (Storage form of fat) broken to the Glycerol backbone and 3 fatty tissues.
o   Glycerol used for Gluconeogenesis
o   Fatty acids may be used directly by many tissues of the body but not the brain.
o   Ketone bodies are capable of crossing blood/brain barrier. They are produced from fatty acids.
o   Ketone can supply up to 75% of the energy used by the brain.
o   Ketone types:
§  β-hydroxybutyrate (BHB) is created from acetoacetate.
§  Acetoacetate (AcAc) is created first
·       Acetone is a spontaneously created as side-product of acetoacetate.
o   Ketones Synthesis and Utilization
o  
§  Protein conservation phase After five days.
·       High level of Growth Hormone maintains muscle mass and lean tissues.
o   Growth Hormone, increase availability and utilization of fat for fuel and helps to preserve muscle mass and density
o   Growth hormone more than doubles in 5 days
·       Energy for maintenance of basal metabolism is met by the use of free fatty acids and ketones.
·       An increase of Neuoperaphran (Adrenaline level) prevents a decrease in metabolic rate.
o   This process starts in 24 hours, 
o   48 hours of fasting produce 3.6% increase in metabolic rate (compare to the metabolic shutdown you see in calorie reduction diets)
o   in 4 days fast resting body metabolism is increased by 14% (Instead of slowing it down)

General guidelines, what you can have

·       Water/Mineral water, 2 L is good practice
·       Start day with 8 ounces of cold water
·       Add a squeeze of lemon/orange
·       Dilute apple vinegar to help with blood sugar
·       All types of tea are Ok; you can add nutmeg or cinnamon 
·       A small amount of cream/milk is Ok
·       Coffee
·       Chia seeds, soak in water for 30 mins, can be eaten dry or made into jelly/budding.
·       Homemade bone broth (after removing fat) with vegetables and herbs as flavors
o   One teaspoon of vinegar, pepper, salt, ginger root to taste
o   Simmer for 2-3 hours
o   Strain and remove fat
·       Hunger comes in waves, ride the wave.
·       You can participate in all type of exercise during fasting. It is significant to exercise in a fasted state to take advantage of Growth Hormone level rise.
·       To avoid dizziness and headaches make sure you drink enough water and salt. 
·       To prevent muscle cramps add magnesium supplement. 
·       To prevent heartburn, stay upright after fast for 1/2 hour
·       Try mindful meditation during fast to reduce stress (20-30 mins)

Sugar; Toxicity from Glucose to Fructose to other sweeteners

Risk of Artificial Sweeteners, why take a chance:

·       Artificial Sweetener increases, not decrease, obesity, increase Insulin and craving.
·       Agave nectar = 80% Fructose.
·       Stevia and aspartame = Highly processed, raises Insulin higher than table sugar (More research needed)
o   https://www.livestrong.com/article/536467-does-stevia-affect-insulin/
·       Erythritol = Associated with increased belly fat and weight in young adults. It is also being investigated for use as an insecticide!
·       Xylitol promising (More research needed)
o   https://medium.com/@reefwing/stevia-and-insulin-41ed4f323f4b
·       Sucralose raises blood Insulin by 20%

Glucose

·       The energy source for the brain
·       Imported from the blood by muscles for quick energy use.
·       Red blood cells can only use Glucose for energy
·       Glucose can be stored as Glycogen in the liver
·       if Glucose runs low liver create more gluconeogenesis
o   Gluconeogenesis (GNG) is a metabolic pathway that results in the generation of glucose from specific non-carbohydrate carbon substrates. ... In many other animals, the process occurs during periods of fasting, starvation, low-carbohydrate diets, or intense exercise.

Sugar Molecule structure:

·        Fructose
o   Found in fruits
o   Metabolized only in liver, muscles, and blood can't use fructose for energy
o   Eating Fructose doesn't change blood glucose levels
o   Both glucose and fructose are single sugars (monosaccharide)
·       Table sugar (Sucrose)
o   Consists of 1 molecule of Glucose to 1 molecule of fructose.
o   Sucrose is 50% Glucose and 50% Fructose
·       High Fructose Corn syrup
·       55% Fructose and 45% Glucose

Carbohydrate

·       Composed of Sugar
·       Simple Carbohydrate: when they contain single sugar (monosaccharide) or 2 (disaccharide)
·       Complex carbohydrate; Hundreds or thousands of sugars linked to long chain (polysaccharide), and a smaller portion as Amylose (See starches below)
·       Refining and over processing is the major problem of processed carbohydrate. I.e.; turning wheat into powder or over processing.

Starches,

·       Hundreds of sugars linked together. Most 75% in white flower is organized in a chain called Amylopectin, and the rest is Amylose.
o   Amylopectin is a water-insoluble polysaccharide and highly branched polymer of α-glucose units found in plants. It is one of the two components of starch, the other being Amylose.
o   There are several branches of Amylopectin A,B,C
§  Amylopectin C
·       Poorly digested, as the undigested portion passes through the colon, the gut flora produces gas.
·       Legumes
§  Amylopectin B,
·       intermediate absorption
·       Banana, Potato   
§  Amylopectin A, 
·       Fastest absorption converts to sugar more than any starch
·       Wheat 

Classification based on Molecules structures

·       Proved not effective
·       Complex carbohydrate thought to raise blood sugar slower. 
·       White bread composed of complex carbohydrate causes the same spike in blood sugar similar to sugary drinks and sweets

Classification moved to how fast food raises blood sugars (Glycemic index) 

·       Better categorization but also not effective
·       Bread now, white or whole-wheat, has Glycemic index of 73
·       Coca-cola GI = 63
·       Peanuts = 7
·       Fructose has a very low GI because GI measures blood Glucose not Insulin levels

Glycemic Index vs. Glycemic Load

·       Glycemic Index
o   Carbohydrates with a low GI value (55 or less) are more slowly digested,
o   GI only measures Glucose effect in Carbohydrates (Protein and Fat are excluded)
§  Uses 50 grams of carbohydrate 
o   But servings of food may not contain 50 gram of food, for example, 2.2 lb. of watermelon will need to be eaten to give you 50 gr of carbohydrate
o   This measure of GI helps diabetes patients but not as effective for weight control. Measuring Insulin is more important for weight control and there are many other factors that lower and increase insulin (see protein)
·       Glycemic load
o   Calculates Glucose effect based on serving size.
o   Glycemic index * Number of grams of carbohydrate,

Fructose: a Most dangerous form of sugar

·       Does not raise blood glucose
·       linked to Obesity more than Glucose
·       Naturally, we consume very little from natural sources (15-20 gr)
·       High Fructose Corn Syrup
·       Developed in the 1960s as
·       Has economic benefits, shelf lives, sweetener
·       Much cheaper than sucrose 
·       Averaged around 9% of total calories in the 2000s
·       Adolescence are heavy users of Fructose (72.8 gr) a day
·       Has very low GI and cause mild raise in Insulin
·       Uncovering the deadly side of fructose
o   Studies started in 2000 linking an increase of obesity to Fructose
o   Body cells can't use fructose and don't require insulin for maximum absorption
o   Fructose only metabolizes in the liver and put excessive pressure on the liver
o   in the liver, fructose metabolizes into Glucose lactose and Glycogen
o   Consumption:
§  Glucose:
·       Body handles excess glucose consumption through Glycogen storage and de-novo-lipogenesis (creation of new fats)
·       Serve the purpose of converting excess carbohydrates into lipids (fats) for storage, because lipid is much more energy-dense than carbohydrate and is, therefore, a more efficient storage form.
§  Fructose:
·       No such system exists for Fructose
·       Thus, High level of Fructose causes fatty liver which causes Insulin Resistance in the liver (several studies since the late 1990s)
o   2009 Study Pre-diabetes can be induced only in 8 weeks
o   6 days of excess fructose will cause insulin resistance
o   8 weeks pre-diabetes is established
o   Mechanism
§  Excess fats in the liver causes the liver not to accept any more from the blood causing Insulin Resistance in the liver.
§  As the liver doesn't accept any more Glucose and instead tried to convert its access glycogen into the blood where Extra insulin is required to push it back to the liver 
§  Insulin resistance leads to higher insulin levels 
§  High insulin levels encourage storing more sugar and fat in the liver which causes more insulin resistance 
§  Vicious cycle
o   Fructose causes fatty liver and insulin resistance

Hormones responsible for Body Set Weight

Insulin

·       Produced in the pancreas.
·       Proven to be the single hormone responsible for body weight. 
·       Insulin given to anyone regardless of his/her regimen causes the person to gain weight, Obese people tend to have a higher fasting insulin

The vicious cycle

·       Insulin is raised, the receptors become less responsive, the body releases more insulin which makes the receptors even further resistant.

Insulin resistance happens in 2 conditions

·       There is a lot of insulin; this can be combated by fewer carbs
·       The amount of insulin is persistent; this can be combated by eating less frequency

Insulin resistance is departmentalized

·       Insulin resistance developed in muscles (due to lack of movement and exercise), liver (due to persistent high insulin) and hypothalamus
·       The brain itself doesn't become resistant, and get the message that the excess insulin must be needed to keep the body weight high and thus raises the body set weight.

Cortisol, the Stress hormone

·       Produced in the Adrenal Cortex
·       Cortisol when part of medication makes you fat ; (Prednisone used to treat allergic reactions)
·       Insulin and Cortisol play a role in carbohydrate metabolism: 
·       Prolong Cortisol stimulation raises Glucose (for energy) which raises Insulin resulting in weight gain
·        In a short period, i.e., when facing a predator, Insulin level goes back to normal shortly after.
·       in chronic stress (Work, Family, lack of sleep) Insulin stay elevated for a prolonged period causing weight gain

Leptin

·       Leptin hormone regulates energy balance by inhibiting hunger. 
·       Adding Leptin doesn't cause one to be fat

Fiber & Vinegar as Antidote for Carbs and Sugar

·       Undigested part of the food.
o   Processing of food removes a lot of fiber from food
o   The Factor of Fiber reducing Cancer and other diseases was shaky at best while the high-fat diet did help (olive oil and nuts).
o   Fiber can be thought of as an Anti nutrient for carbs.
§  Fiber not needed as much for Fat and Protein
§  Fiber reduces the absorption of carbs and sugar
o   Since process food removes fiber (and fat) to increase shelf life, you are left with carbs (the poison) without the antidote (fiber).
o   Certain satiety hormones respond to fiber and fat; these are removed from processed food.
o   Soluble
§  Beans, oat bran, avocado, berries
§  Absorbs water to form a gel, increasing it its volume.
o   insoluble
§  Whole grain, wheat germs, beans, flax seed, leafy vegetables, and nuts.
o   Fermentable & Non-Fermentable
§  Normal bacteria in the large intestine can ferment certain undigested fiber into Short-chain fatty acids SCFA
·       Acetate    
·       Butyrate    
·       Propionate
§  Usually, Soluble fiber is more fermentable than insoluble.
o   Vinegar
§  Unfiltered vinegar contains mother (Protein, enzyme, and bacteria to make it)
§  Apple Cider Vinegar contains vinegar (Acetic acid and Pectin (from apple cider, type of soluble fiber).
§  Proven to help in weight loss in diluted format
§  To reduce the effect of carb, two tablespoons before meals (lower rice by ~40%)
§  Diluted before bedtime reduces morning blood sugar for diabetes.
§  Increases satiety.
§  The effect is similar to fiber for weight reduction.
§  Oil and vinegar dressing lowers cardiovascular diseases (Due to alpha-linolenic acid, but study not completed)

Protein

Reducing insulin causes Kidney to retain less water, which may be good news for swollen ankles.
A diet composed of mostly protein didn't prove to work for weight loss (Atkins version 2).
Protein causes a surge in Insulin; this fact was missed as Glycemic index doesn't measure protein.
Incretin effect & Cephalic phase explained why mainly protein diet causes weight gain

Cephalic Phase

·       The cephalic phase of digestion is the gastric secretion that occurs even before food enters the stomach, especially while it is being eaten. It results from the sight, smell, thought, or taste of food and the higher the appetite, the more intense is the stimulation.

Incretins

·       Incretins are a group of metabolic hormones that stimulate a decrease in blood glucose levels.
·       Incretin effect & Cephalic phase explained why mainly protein diet causes weight gain
·       Increasing Insulin: 2 hormones that increase insulin release by the pancreas. Fat, amino acid and Glucose (including artificial sweeteners)  all stimulate incretins and increase insulin 
o   Glucagon-like (peptide 1 Glp1)  
§  Formed in the pancreas, promotes the breakdown of glycogen to glucose in the liver
o   Gastric inhibitory polypeptide (GIP) or Gastroinhibitory peptide
§  Also known as the glucose-dependent insulinotropic peptide, is an inhibiting hormone of the secretin family of hormones.
§  While it is a weak inhibitor of gastric acid secretion, its primary role is to stimulate insulin secretion.
·       Decrease Insulin: Both previous hormones are deactivated by hormone:
o   Dipeptidyl peptidase-4 (DPP4).
o   DPP4 plays a significant role in glucose metabolism. It is responsible for the degradation of incretins such as GLP-1. Furthermore, it appears to work as a suppressor in the development of some tumors. DPP-4 also binds the enzyme adenosine deaminase specifically and with high affinity.
·       Incretins are released after eating and augment the secretion of insulin released from pancreatic beta cells of the islets of Langerhans by a blood glucose-dependent mechanism.
·       Gastrointestinal tract with nerve cells, receptors and hormones function like a second brain
·       Other incretins jobs/effects
o   Incretins second job is to delay stomach content into the small intestines which slow down glucose absorption thus increasing satiety
·       Amino Acid Lucien and Glucose taking orally cause insulin release much more intravenous (where Glucose bypasses stomach).
·       Whey protein raises Insulin (by raising GLP1 much more than Glucose BUT has a satiety effect due to raising DPP4 and delaying contents from the stomach (second effect of incretins effect)
·       Vegetable protein raises insulin minimally.

Notes

·       When choosing Beef, make sure it is organic, grass fed.
·       Don't eat protein isolated (chicken breast) or add fat
·       To help with the satiety benefit of the incretins system, if you are not hungry don't eat.
·       Paleo diet is a good diet but can't have yogurt. However, LCHF (Low Carbohydrate High Fat) diet is similar but allows dairy products and stricter on fruits which makes more senses.
·       Reduce processed foods to the minimums including protein bars, meal replacement, proceed meet and carbohydrate.
·       Fast to offset a bad diet

Fat

Fat (including olive oils) has the weakest stimulating effect from Fat, Protein, and Carbohydrate.
Mono Saturated show to protect against CHD

Experiments & Studies

§  1948 Harvard University began a decade long of diet Framingham, Massachusetts
o   Every 2 years all residents would go under screening for blood work and questionnaire
o   High Cholesterol in blood was associated with heart disease.
o   initially, it was thought that high dietary fat was the reason
o   early in 1960s result didn't find any link between fat and heart disease and didn't find anything. 
o   On the Wiki link, there is no mention of fat at all, up to the latest information in the 2000s
§  A Review on Cholesterol from Harvard 
o   2014 the most recent update states "Cholesterol is not considered a nutrient of concern for overconsumption.
o   Trans fat associated with more heart attack unlike "butter"
§  Chicago Western Electric Study (1963)
o   Amount of dietary fatty acids from diet didn't affect CHD significantly 
o   The study did show the relationship between body weight and CHD
§  "Increase in body weight during young adulthood (estimated from the body mass index calculated from self-reported weight at age 20 and measured height and weight at the initial examination) was positively associated with risk of CHD death in never smokers but not in current smokers."
§  Puerto Rico Heart Health Program (PRHHP) 1965-1980
o   Objective:  o investigate morbidity and mortality from CHD in Puerto Rican rural and urban men. The goals of the study were: (1) to identify factors related to the development of CHD, (2) compare the etiology of disease in rural versus urban men, and (3) determine the prevalence and incidence of CHD and other cardiovascular disorders in Puerto Rican males.
o   Urban dietary intakes were significantly higher in total fat and lowered in carbohydrate, mainly starch
o   Average cholesterol intakes were 83 mg/day higher in urban than rural men.
o   Saturated fat intake couldn't be linked to heart disease and failed to reach statistical significance.
§  Diet-heart hypothesis, 1958
o   Diet-heart hypothesis formed in  1958 by Ancel Keys (the 7 country study): Saturated fats thought to cause heart diseases by raising cholesterol but this study proved wrong in many ways. There were many instances found not to be taken into consideration. Causes of heart diseases could be attributed to many other reasons, such as industrialization, glucose, consumption, and consumption of processed food. The result of Ancel Keys approach was the reduction of saturated fat, vegetable oil including margarine consumption increased, increasing the inflammatory omega 6 drastically.
§  2006 women health initiative dietary modification trial and the low-fat dietary pattern in risk of cardiovascular disease study
o   "a dietary intervention that reduced total fat intake and increased intakes of vegetables, fruits, and grains did not significantly reduce the risk of CHD, stroke, or CVD in postmenopausal women and achieved only modest effects on CVD risk factors, suggesting that more focused diet and lifestyle interventions may be needed to improve risk factors and reduce CVD risk."
o   Reducing cholesterol didn't make the cell, as it is found that every cell in the body can make Cholesterol
o   however this was proved wrong, cholesterol is a crucial building block in membrane surrounding 
o   Update on SAFA partial replacement may decrease CHD
o   "Studies on SAFA intakes and risk of ischemic stroke are inconsistent. Compared with the abundant data on SAFA consumption and risk of CHD, there is insufficient evidence to support dietary SAFA recommendations to reduce stroke risk."
§  Dr Richard Cross study
o   21 Study 347000 patients
o   no significant evidence of saturated fat risk of CHD., but even show a protective effect on stroke.
§  Japan collaborative cohort study for evaluation of cancer risk
o   14 year, > 58,000 of cancer patients and 10 years follow up study of over > 43000 men
§  O'ahu, Hawaii, USA, ten year study
o   "it is impossible to conclude that men can lower their risk of developing an aggressive form of prostate cancer by reducing their intake of saturated fat, the type of fat that increases serum cholesterol,"
§  Nurses' Health Study
o   Over 80,000. Concluded, total fat intake was not related to CHD and found many other factors
o   Dietary cholesterol was also determined to be safe.
§  The Swedish Malmo diet and cancer study, and 2014 meta-analysis
o   reached a similar conclusion as the Nurses Health Study

Trans Fat

·       In Americas people were switching from Saturated fat to vegetable oils, although this didn't reflect well in the latest CHD studies.
·       1990s marked the beginning of the end of Trans fat, Dutch researchers concluded PUFA increased LDL and lowered HDL
o   2% in trans fat will increase CHD by 23%
·       Update in 2008 links further the trans fat to raising the LDL and lowering of the HDL
    • "More recent inquiry (independent of the dairy industry) has found in a 2008 Dutch meta-analysis that all trans fats, regardless of natural or artificial origin equally raise LDL and lower HDL levels.[59] Other studies though have shown different results when it comes to animal-based trans fats like conjugated linoleic acid (CLA). Although CLA is known for its anticancer properties, researchers have also found that the cis-9, trans-11 form of CLA can reduce the risk for cardiovascular disease and help fight inflammation."
    • Denmark, Switzerland and Iceland band trans fat for human consumption. 









No comments: