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Always Hungry? Your Fat Cells May Be to Blame

Great info if you want to lose weight or just eat better….

Always Hungry? Your Fat Cells May Be to Blame

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Pop quiz: What raises your blood glucose and insulin the most, calorie for calorie? A baked potato, ice cream, or pure table sugar? Contrary to what you might think, it’s actually the baked potato. In his new book Always Hungry, Dr. David Ludwig writes his own guidelines on what to eat to satisfy your appetite without piling on pounds. His one-line mantra? “Forget calories. Focus on quality. Let your body do the rest.” Read an excerpt from the book here.

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David Ludwig

David Ludwig is author of Always Hungry (Grand Central, 2016). He’s a practicing endocrinologist at Boston Children’s Hospital and a professor of nutrition at the Harvard School of Public Health in Boston, Massachusetts.

The following is an excerpt from Always Hungry? by David Ludwig.

In our weight-obsessed culture, it’s common to disparage the fat in our bodies. But body fat (scientifically termed “adipose tissue”) is a highly specialized organ, critically important for health and longevity.

Among its many functions, fat surrounds and cushions vital organs like the kidneys and insulates us against the cold. Body fat also signifies health, conferring beauty when distributed in the right amounts and locations. But critically, fat is our fuel tank—a strategic calorie reserve to protect against starvation.

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Always Hungry? Your Fat Cells May Be to Blame

Compared to other species our size, humans have an exceptionally large brain that requires an enormous amount of calories. The metabolic demands of the brain are so great that, under resting conditions, it uses about one of every three calories we consume. And this calorie requirement is absolute. Any interruption would cause immediate loss of consciousness, rapidly followed by seizure, coma, and death. That’s a problem, because until very recently in human history, access to calories had always been unpredictable. Our ancestors faced extended periods of deprivation when a hunt or a staple food crop failed, during harsh winters, or when venturing out across an ocean. The key to their survival was body fat.

If we go for more than a few hours without eating, the body must rely on stored fuels for energy, and these come in three basic types, familiar to anyone who reads a nutrition label: carbohydrate, protein, and fat. The body stores accessible carbohydrate in the liver and protein in muscle, but these are in dilute forms, surrounded by lots of water. In contrast, stored fat is highly concentrated, since fat tissue contains very little water. In addition, pure carbohydrate and protein have less than half the calories of pure fat, making them relatively weak sources of energy. For these reasons, liver and muscle contain only a small fraction of the calories in fat tissue (less than 600 compared to about 3,500 per pound). In the absence of body fat, even a muscular man would waste away in days without eating, whereas all but the leanest adults have enough body fat to survive many weeks.

And these fat cells aren’t just inert storage depots. Fat cells actively take up excess calories soon after meals and release them in a controlled fashion at other times, according to the body’s needs.

Fat tissue also responds to and emits a multitude of chemical signals and neural messages, helping fine-tune our metabolism and immune system. But when fat cells malfunction, big problems ensue.

HUNGRY FAT

We generally think that weight gain is the unavoidable consequence of consuming too many calories, with fat cells being the passive recipients of that excess. But fat cells do nothing of consequence without specific instructions—certainly not calorie storage and release, their most critical functions.

Insulin: The Fat Cell Fertilizer

Many substances produced in the body or contained in our diet directly affect fat cell behavior, chief among them the hormone insulin.

Insulin, made in the pancreas, is widely known for its ability to lower blood sugar. Problems with the production or action of insulin lead to the common forms of diabetes, specifically type 1 (previously called juvenile diabetes) and type 2 (a frequent complication of obesity).

But insulin’s actions extend well beyond blood sugar control, to how all calories flow throughout the body.

Soon after the start of a meal, insulin level rises, directing incoming calories—glucose from carbohydrate, amino acids from protein, and free fatty acids from the fat in our diet—into body tissues for utilization or storage. A few hours later, decreasing insulin level allows stored fuels to reenter the blood, for use by the brain and the rest of the body. Although other hormones and biological inputs play supporting roles in this choreography, insulin is the undisputed star.

Insulin’s effects on calorie storage are so potent that we can consider it the ultimate fat cell fertilizer. For example, rats given insulin infusions developed low blood glucose (hypoglycemia), ate more, and gained weight. Even when their food was restricted to that of the control animals, they still became fatter. Conversely, mice genetically engineered to produce less insulin had healthier fat cells, burned off more calories, and resisted weight gain, even when given a diet that makes normal mice fat.

In humans, high rates of insulin release from the pancreas due to genetic variants or other reasons cause weight gain. People with type 1 diabetes who receive excess insulin predictably gain weight, whereas those treated inadequately with too little insulin lose weight, no matter how much they eat. Furthermore, drugs that stimulate insulin release from the pancreas are also associated with weight gain, and those that block its release with weight loss.

If too much insulin drives fat cells to increase in size and number, what drives the pancreas to produce too much insulin? Carbohydrate, specifically sugar and the highly processed starches that quickly digest into sugar. Basically, any of those packaged “low-fat” foods made primarily from refined grains, potato products, or concentrated sugar that crept into our diet as we single-mindedly focused on eating less fat.

Our Fat Cells Make Us Overeat

All this is just Endocrinology 101, well-established information every first-year medical student should know. But it leads to a stunning possibility. The usual way of thinking about the obesity epidemic has it backward. Overeating hasn’t made our fat cells grow; our fat cells have been programmed to grow, and that has made us overeat.

Always Hungry?: Conquer Cravings, Retrain Your Fat Cells, and Lose Weight Permanently

Too much refined carbohydrate causes blood glucose to surge soon after a meal, which in turn makes the pancreas produce more insulin than would have ever been the case for humans in the past. High insulin levels trigger fat cells to hoard excessive amounts of glucose, fatty acids, and other calorie-rich substances that circulate in the blood. It’s like those floor‑to‑ceiling turnstiles you might see at a ballpark or in the subway.

People can pass freely in one direction, but horizontal crossbars prevent movement the other way. Insulin ushers calories into fat cells, but restricts their passage back out. Consequently, the body starts to run low on accessible fuel within a few hours, more quickly than normal.

When that happens, the brain registers a problem and transmits an unmistakable call for help—in the form of rapidly rising hunger. Eating is a sure and fast way to increase the supply of calories in the blood, and processed carbohydrates act the fastest. The brain exploits this fact, making us crave starchy, sugary foods, more so than anything else.

What would you rather have when your blood sugar is crashing: a bowl of fruit, a tall glass of full-fat milk, a large chicken breast, or a cinnamon sticky bun (each with the same number of calories)?

As usually happens, we give in to temptation and have the sticky bun, or the myriad other formulations of processed carbohydrate so readily available today. But this solves the “energy crisis” only temporarily, sets up the next surge-crash cycle, and, over time, accelerates weight gain.

 


Excerpted from the book Always Hungry? by David Ludwig, MD, PhD. Copyright © 2015 by David Ludwig, MD, PhD. Reprinted by permission of Grand Central Publishing. All rights reserved.

Mindful Mantras For Weight Loss

Jean Kristeller's 10-week program in The Joy of Half A Cookie is designed to curb overeating, help you feel your hunger and trust your taste buds.

Jean Kristeller’s 10-week program in The Joy of Half A Cookie is designed to curb overeating, help you feel your hunger and trust your taste buds.

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Every now and then, a Julia Child or Michael Pollan come along and changes the way we eat.

Could Jean Kristeller, America’s leading mindful eating researcher and the author of a new self-help book, The Joy of Half a Cookie, published Tuesday, be next? I’m of a mind to say maybe.

Back when Kristeller, now a professor of psychology emeritus at Indiana State University, was a grad student at Yale in the late 1970s and early 1980s, she had a compulsive overeating problem. She had been meditating for years, and decided to apply what she was studying about eating regulation and the mind-body connection toher overeating. As she writes, it was transformative. Once she got a handle on it, she developed a mindfulness training for a variety of eating issues called Mindfulness-Based Eating Awareness Training, or MB-EAT, and set out to test its effectiveness.

The Joy of Half a Cookie
The Joy of Half a Cookie

Using Mindfulness to Lose Weight and End the Struggle With Food

by Jean Kristeller and Alisa Bowman

Hardcover, 278 pages

In several studies, Kristeller has shown that the practice of mindfulness meditation and mindful eating effectively decrease binge eating and increase an inner sense of control overeating.

She’s also been exploring MB-EAT for weight loss in a study which began in 2004 and compared MB-EAT to a widely used meditation program (Mindfulness-Based Stress Reduction) and a standardized Cognitive Behavioral Therapy. She has yet to publish this study, but the preliminary data show that MB-EAT’s added calorie-cutting suggestions and healthy eating strategies dofacilitate significant weight loss in the short-term. (The study subjects — 225 obese men and women binge eaters — lost about a pound a week on average.) Whether or not the training facilitates significant long-term weight loss (at the 18-month follow up) is still to be determined.

The 10-week plan involves a combination of mindfulness meditations and mindful-eating practices, healthy eating and calorie-cutting strategies. More specifically, it’s designed to curb overeating, help you feel your hunger, trust your taste buds and become deeply satisfied with the quality, rather than quantity, of food.

If I hadn’t seen the transformative effect of Kristeller’s proven practices in my own practice as an eating disorder therapist, I probably wouldn’t bother reading yet another mindful eating book. (I’ve read many.) But I had, so I did, and I’m thrilled this research psychologist has transformed her group training into a do-it-yourself plan.

I put Joy of Half a Cookie up there with Mastering the Art of French Cooking and The Omnivore’s Dilemma because I’ve seen the measurable and pleasurable difference Kristeller’s plan has made to me and my clients. Although she and I have traversed the same territory for decades, the one time I heard the describe her training, it forever changed the way I work with the range of eating issues.

Still, I had some concerns and questions I wanted to run by Kristeller. What follows is an edited version of that recent exchange.

Before you discovered mindful eating, you describe being trapped in a vicious cycle of under-eating by day, overeating by night. How did you discover that mindfulness could break that cycle?

My first transformative eating experience was inspired by Susie Orbach’s Fat Is a Feminist Issue. For one week, I permitted myself to lunch on high-fat, high-sugary foods [as recommended by the book]. The first few days, I savored snack machine chips and cookies. They tasted pretty good, but I didn’t crave more after dinner. When the packaged snacks lost their appeal, I went for fresh croissants one day, a few pizza slices the next. By week’s end, I was starting to tune into my hunger, fullness and food enjoyment with what I would now call “mindfulness.”

You say MB-EAT isn’t a diet, but you recommend weighing and measuring portions and other dieting strategies. What’s the difference?

Diets prescribe certain foods and amounts of food for relatively rapid weight loss. They bear little relationship to a flexible, sustainable eating approach. Yet calories do “count.”

I don’t recommend aiming for a certain number of calories per day. Rather, I encourage a more exploratory approach to calorie content — noticing the amount of cereal in your bowl, butter on your toast, meat on your plate. Like a budget, you wouldn’t shop without looking at price tags. And, if your income dropped by 25 percent, you’d need to cut expenditures, but not watch every penny or always spend exactly the same amount.

Given that caloric restriction can be a recipe for overeating, if not disordered eating, for some people, why do you challenge readers to cut 500 calories per day, forever, from their diet?

Most diets drop caloric intake by at least 1,000 calories per day. The 500-calorie challenge is about finding sustainable ways to cut calories, which is neither overly restrictive nor, in our experience, does it trigger overeating. Rather, I encourage people to cut “mindless calories”: forego extra servings, refrain from cleaning your plate when full, swap higher calorie snacks for enjoyable lower calorie ones.

Nowhere do you mention how much weight study subjects lost. How muchdid they lose?

Average weight loss was relatively modest — about one pound per week or seven pounds. Some lost over 20 pounds, and some lost little, but, unlike our first NIH trial, which focused on binge eating, not weight loss, none gained weight. However, even in that study, a third of participants lost weight just eating mindfully.

According to a recent systematic review, mindfulness training decreases binge and emotional eating, but fails to facilitate significant weight loss. So why do you prescribe mindfulness for weight loss?

Mindfulness greatly decreases the struggle with food. Weight loss happens slowly, as is appropriate. Although some effects can and do happen quickly, learning to apply them in range of situations takes time and an ongoing sense of discovery.


After some hemming and hawing, my conclusion is as follows: If you want to lose weight and end the struggle with food, by all means, dive into Kristeller’s practices for cultivating inner wisdom.

But can you achieve long-term weight loss with this? Only time and the results of her follow-up research will tell if, in fact, her approach works.


Jean Fain is a Harvard Medical School-affiliated psychotherapist and the author ofThe Self-Compassion Diet.

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