Why we get fat and what to do about it

🚀 The Book in 3 Sentences

🎨 Impressions

Not that interesting, I worked a little with dietary medicine and it was a nice way for me to have a base knowledge for the job.

✍️ My Top Quotes

Fifty years ago, one in every eight or nine Americans would have been officially considered obese, and today it’s one in every three
First, when insulin levels are elevated, we accumulate fat in our fat tissue; when these levels fall, we liberate fat from the fat tissue and burn it for fuel. This has been known since the early 1960s and has never been controversial. Second, our insulin levels are effectively determined by the carbohydrates we eat—not entirely, but for all intents and purposes. The more carbohydrates we eat, and the easier they are to digest and the sweeter they are, the more insulin we will ultimately secrete, meaning that the level of it in our bloodstream is greater and so is the fat we retain in our fat cells.
“Carbohydrate is driving insulin is driving fat,”
It helped that Mayer promoted his pro-exercise message with a fervor akin to a moral crusade. And as Mayer’s political influence grew through the 1960s, this contributed to the appearance that his faith in the weight-reducing benefits of exercise was widely shared. In 1966, when the U.S. Public Health Service first advocated dieting and increased physical activity as the keys to weight loss, Mayer wrote the report.
They’re taking a law of nature that says absolutely nothing about why we get fat and a phenomenon that has to happen if we do get fat—overeating—and assuming these say all that needs to be said. This was a common error in the first half of the twentieth century. It’s become ubiquitous since. We need to look elsewhere for answers.
“Obesity is a complex, multifactorial chronic disease that develops from an interaction of genotype and the environment,”
The most fattening foods are the ones that have the greatest effect on our blood sugar and insulin levels. These are the concentrated sources of carbohydrates, and particularly those that we can digest quickly: anything made of refined flour (bread, cereals, and pasta), liquid carbohydrates (beers, fruit juices, and sodas), and starches (potatoes, rice, and corn
Imagine how many more dead diabetics we’d have if victims of that disease were treated by psychologists instead of physicians.
When people accumulate excess fat, this tells us that something has gone awry in the careful regulation of their fat tissue. What we need to know is what that defect is and what to do about it.
Obesity can be caused by a regulatory defect so small that it would be undetectable by any technique yet invented.
Whatever makes us both fatter and heavier will also make us overeat. This was the ultimate lesson of Wade’s rats. It may be counterintuitive, but it has to be true for every species, for every person who puts on pounds of fat. It’s arguably the one lesson we (and our health experts) have to learn in order to understand why we get fat and what to do about it.
Von Bergmann’s approach to obesity was straightforward: he considered it a disorder of excess fat accumulation and then set out to learn what he could about the regulation of our fat tissue.
As it happens, fat is continuously flowing out of our fat cells and circulating around the body to be used for fuel and, if it’s not used for fuel, returned to the fat cells. This goes on regardless of whether we’ve recently eaten or exercised. In 1948, after this science was worked out in detail, Ernst Wertheimer, a German biochemist who had emigrated to Israel and is considered the father of the field of fat metabolism, put it this way: “Mobilization and deposition of fat go on continuously, without regard to the nutritional state of the animal.”
Insulin plays many roles in the human body, but one critical role is to keep blood sugar under control. You’ll start secreting insulin (from the pancreas) even before you start eating—indeed, it’s stimulated just by thinking about eating
In a world without cigarettes, lung cancer would be a rare disease, as it once was. In a world without carbohydrate-rich diets, obesity would be a rare condition as well.
Putting fat on below the waist and behind them also balances the weight of the child growing in their womb in front.
(Insulin also tells muscle cells and others in the body not to burn fatty acids but to continue burning up blood sugar instead.) This means that when fatty acids do escape from a fat cell, if insulin levels happen to be high, these fatty acids won’t be taken up by the muscle cells and used for fuel. They’ll end up back in the fat tissue.
Because the insulin level in the bloodstream is determined primarily by the carbohydrates that are consumed—their quantity and quality, as I’ll discuss—it’s those carbohydrates that ultimately determine how much fat we accumulate. Here’s the chain of events: You think about eating a meal containing carbohydrates. You begin secreting insulin. The insulin signals the fat cells to shut down the release of fatty acids (by inhibiting HSL) and take up more fatty acids (via LPL) from the circulation. You start to get hungry, or hungrier. You begin eating. You secrete more insulin. The carbohydrates are digested and enter the circulation as glucose, causing blood sugar levels to rise. You secrete still more insulin. Fat from the diet is stored as triglycerides in the fat cells, as are some of the carbohydrates that are converted into fat in the liver. The fat cells get fatter, and so do you. The fat stays in the fat cells until the insulin level drops.*
So, on seeing the lion, you secrete adrenaline, and the adrenaline, among other things, signals your fat tissue to dump fatty acids into the circulation. These fatty acids, ideally, will then provide all the fuel you need to make your escape. In this sense, every hormone but insulin works to release fat from our fat tissue. They make us leaner, at least temporarily.
This belief in the carbohydrate as “heart-healthy” started in the 1960s and it couldn’t be reconciled with the idea that carbohydrates make us fat. 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.
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; why, as I discussed at the outset, it’s all too easy to find extremely poor populations, past and present, with obesity and diabetes rates that rival those in the United States and Europe today
“It is often said and not without reason,” as Pavlov wrote more than a century ago, “that ‘hunger is the best sauce.’
All food does this to some extent, because that’s what the reward system apparently evolved to do: reinforce behaviors (eating and sex) that benefit the species. But sugar seems to hijack the signal to an unnatural degree, just as cocaine and nicotine do. If we believe the animal research, then sugar and high-fructose corn syrup are addictive in the same way that drugs are and for much the same biochemical reasons.*
Now, how’s that for a vicious cycle? The foods that make us fat also make us crave precisely the foods that make us fat. (This, again, is little different from smoking: the cigarettes that give us lung cancer also make us crave the cigarettes that give us lung cancer.)
Banting credited Harvey for the diet, but it was Banting’s name that entered the English language (and the Swedish) as a verb meaning “to diet,” and it was Banting who took the heat from the medical community.
On average, we get 15 percent of our calories from protein, 33 percent from fat, and the remainder (more than 50 percent) from carbohydrates. But these modern hunter-gatherers ate quite differently, and so in all probability did our Paleolithic ancestors.
Their diets were high to very high in protein compared with today (19 to 35 percent of calories), and high to very high in fat (28 to 58 percent of calories).
Nutritionists will say that 120 to 130 grams of carbohydrates are required in a healthy diet, but this is because they confuse what the brain and central nervous system will burn for fuel when diets are carbohydrate rich—120 to 130 grams daily—with what we actually have to eat.
And this is why severely carbohydrate-restricted diets are known as “ketogenic” diets. The rest of the energy required will come from glycerol, which is also being released from the fat tissue when the triglycerides are broken down into their component parts, and from glucose synthesized in the liver from the amino acids in protein.
That the official embrace of low-fat, high-carbohydrate diets coincided not with a national decline in weight and heart disease but with epidemics of both obesity and diabetes