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How We Got Fat and What We Can Do About It

One successful obesity doctor speaks out

Obesity doctor Sarah Hallberg calls insulin the “fat-storage hormone,” and according to her it’s the culprit behind the obesity epidemic currently facing the western world.

If you have diabetes or you’re close to someone who does, you know what insulin is. It’s the hormone which keeps your blood sugar in check. If you don’t make enough of it, your blood sugar goes through the roof and you end up with diabetic complications. If you make too much, your blood sugar crashes and you get shaky, weak, and confused. But there’s more to insulin than that. What you might not know is that this vital hormone also plays a pivotal role in obesity, weight gain, and weight maintenance. 

We already know that obesity, insulin resistance, and type 2 diabetes are intimately connected. Conventional wisdom says that obesity is the driving force behind insulin resistance and type 2 diabetes—that with each extra pound you carry you’re more at risk. But Dr. Hallberg says that medicine has got it all backwards. It’s a vicious cycle, she says, that begins not with weight gain and obesity, but with insulin. The key to combatting the obesity epidemic, according to Hallberg, is normalizing insulin levels. And her prescription for doing it is as simple as changing the way you eat.

 

The vicious cycle of insulin resistance, fat storage, and hunger

Today, nearly 50 percent of the adult U.S. population has either pre-diabetes or type 2 diabetes. However, it’s estimated that as many as 70 percent of adults are insulin-resistant. But many of these people may not even realize there’s a problem. In Dr. Hallberg’s words:

“Insulin resistance is essentially a state of PRE-pre-diabetes.”

A person may be insulin-resistant for years—even for decades—before the problem progresses to actual disease. But in the meantime that excess insulin may be causing us to pack on the pounds, leading to overweight and obesity. Why? Because, Dr. Hallberg says, one of the effects of insulin is that it makes our bodies more likely to store what we eat as fat. And as if that weren’t bad enough, it also makes us hungry.

Here’s how it works:

Before our bodies can use the food we eat, they must break that food down into useable components. When we eat an apple, for example, we don’t end up with tiny bits of apple scattered throughout our bodies; instead, it gets broken down into vitamins and minerals, water, fiber, etc. Fats get broken down into smaller fats, protein foods into their individual amino acids, and carbohydrates into sugar. If we eat more protein than we need, it too can be converted into sugar, but most is destined for building and repairing muscles and for building other proteins our bodies need.

The sugar released from food goes into the bloodstream and is carried to every cell in our bodies. Our cells then use this sugar for fuel, and one of insulin’s jobs is to help get it into cells so they can use it.

blood sugar, insulin, fat, body fat, obesity
Our bodies can only tolerate small amounts of sugar in our blood. When sugar levels get too high we produce more insulin, which leads to more fat storage.

But our cells can only hold so much, and once they’re fully fueled any extra sugar stays in our blood. However, our bodies can only tolerate a small amount and too much blood sugar causes damage. So insulin’s other job is to tell our bodies to store excess blood sugar as body fat.

It looks like this: eat food –> extract sugar –> use sugar for fuel –> store excess sugar as fat.

When everything is working properly, it’s a perfect system that keeps your blood sugar at a healthy level. Your body gets all the energy it needs, and you don’t gain weight unless you seriously overeat. But if you have insulin resistance, it’s another story.

If you’re insulin-resistant, your cells soak up some blood sugar but don’t respond well to the message to take in more. That leaves too much sugar floating around in your blood. So insulin tells your body to store that extra sugar as fat. The more insulin-resistant you are, the more insulin it takes to keep your blood sugar within normal limits and the more fat your body is likely to store. You just keep pumping out insulin.

And you stay hungry. Because your cells don’t respond correctly to insulin, they may think they’re not getting the energy they need even though there’s plenty of free glucose in your blood. The chemical signal to stop eating just never makes it through.

So you eat more. Which raises your blood sugar more. Which makes you produce more insulin. Which makes you store more fat…and get hungry.

It’s a vicious cycle. But there’s a simple way to break it, says Hallberg–and it all comes down to changing how we eat.

 

A recipe for obesity

Before 1980, obesity was uncommon and the percentage of obese people changed little from year to year. Type 2 diabetes was uncommon too, and was still called “adult-onset diabetes” because it primarily affected people middle-aged and older. But beginning around 1980 the rates of both obesity and type 2 diabetes began to rise at an astonishing rate.

In 1990 11% of the population was considered obese. By 2016, the number had grown to 29.8%. Today, nearly 40% of U.S. adults and 19% of children are obese. What changed in the intervening years? Are we really eating that much more?

Dr. Hallberg says the answer lies not so much in how much we’re eating but in what. And she should know what she’s talking about—she’s board-certified in both internal medicine and obesity medicine, and created the Medically Supervised Weight Loss Program at IU Health Arnett. As an obesity specialist, her job is to help people lose those unwanted pounds and she’s been extremely successful at it. And the problem, she says, lies in the push to eat a low-fat, high-carbohydrate diet.

food guidelines, USDA, four food groups, basic four
The “Basic Four” recommended eating only 4 servings of high-carb foods, with higher intake of dairy and meat than today’s guidelines.

Those of a certain age may remember the “four food groups” — meat, fruits and vegetables, cereals and breads, and dairy products. Before the 80’s we were advised to eat a moderate amount from the four food groups. The recommended amount was four servings of dairy products per day, four or more servings of fruit and vegetables, two or more servings of meat (which also included eggs, dry beans, and peanut butter) and only two to four servings of cereals or grains. Then in 1980, the first version of the USDA’s Dietary Guidelines for Americans was released, and the four food groups were turned on their heads.

Overnight we were told to eat six to 11 servings of carbohydrate-rich breads, cereals, grains, and pasta. We were told to eat less dairy, less fat, less meat, and about the same amount of fruits and vegetables. It was a recipe for weight gain across the board. And for those with insulin resistance, it was even worse.

 

High-carb + insulin resistance = obesity

To get a real picture of the change, consider this: with the Four Food Groups, we were advised to eat two (and later, four) servings of grains daily. Eating from a variety of grain sources, that’s roughly 378 calories and 72 grams of carbs.

The 1992 USDA Food Pyramid recommended making high-carbohydrate foods the basis of our diet, with over half our calories coming from carbohydrates.

But with the Food Pyramid (released in the early 90s to illustrate the recommendations of the Dietary Guidelines), we were told to increase that to six to 11 servings. If you’re eating 11 servings of grain products, that’s an increase of a thousand or more calories and over a hundred grams of carbs per day.

If you’re insulin-resistant, your body might be able to cope with the 50 or so grams of carbs provided by four servings of bread, or even the hundred or so grams from four servings of rice or pasta. But an additional hundred grams of carbohydrate creates an impossible burden, causing your body to pack on the fat in order to keep your blood sugar from soaring to dangerously high levels. Why? Because your body turns carbohydrates straight into glucose, and it does it quickly.

Carbohydrates are nothing but strings of sugar molecules. When you eat carb-heavy foods, your body breaks these chains apart and turns them into glucose, which then enters your blood. Shortly after you eat high-carb foods your blood sugar rises. And the more carbs you eat in one sitting, the higher your sugar gets.

Proteins, on the other hand, are much harder to break down. And once they are broken down, your body uses them for dozens of other jobs before it even considers turning them into sugar. Processing protein into glucose is your body’s last resort. And fats? They simply remain fats, which are broken down into their component fatty acids. They have practically no effect on your blood sugar. And they don’t cause your body to produce insulin—which is a good thing if you’re insulin-resistant. 

This graph shows the rise in blood sugar levels after eating carbohydrates, protein, or fat. As you can see, carbs cause a sharp spike in sugar levels, protein a smaller and slower rise, and fat almost no change.

A diet high in carbohydrate, on the other hand, sets off a chain reaction that quickly spirals out of control. Dr. Hallberg explains it like this: 

“Think about the last time you ate an American version of Chinese food. We all know [there are] rules associated with this, right? And the first rule is: you’re going to  overeat. Because the ‘stop’ signal doesn’t get sent [from your body to your brain] till you are literally busting at the seams. Rule number two is: in an hour, you’re starving. Why? Well, because the rice in that meal caused glucose and insulin to skyrocket, which triggered hunger, fat storage, and cravings. So if you’re insulin-resistant to begin with and your insulin levels are already higher, you really are hungrier all the time. And we have this setup: eat carbs–your glucose goes up and your insulin goes up and you have hunger and fat storage.”

Eat carbs —> blood glucose goes up —> insulin goes up —> body stores more fat –> hunger isn’t satisfied —> repeat –>

In other words: 

High-carb + insulin resistance = obesity

 

Dr. Hallberg’s prescription for sustainable weight loss

“We wouldn’t tell someone who’s lactose-intolerant to drink more milk,” Hallberg says. So why are we telling people with insulin resistance to eat more carbs?

The current epidemic of obesity and type 2 diabetes, says Hallberg, is a direct result of the diet we’ve been encouraged to eat for the past 40 years. Because the dietary advice we’ve been given has affected more than our personal eating habits—it’s influenced everything from school lunches to food advertising to medical advice.

As an example, she cites the conventional dietary advice given to type 2 diabetics—a group of people who are already taking medication in an attempt to keep their blood sugar under control. Type 2 diabetics are routinely advised to eat 40-60 grams of carbohydrate at each meal, and to consume more as snacks.

That, says Dr. Hallberg, is just crazy. “We are essentially recommending,” she says, “that they eat exactly what’s causing their problem.” And the same logic applies to people with insulin resistance. Which, she reminds us, is roughly 70% of the adult population. It makes even less sense, she continues, when we consider that carbohydrate is the one nutrient that our bodies don’t need at all.

That’s right. While most of us believe that we simply must have carbohydrates for energy, nothing could be farther from the truth. Although we do rely primarily on carbs for fuel, it’s not because we actually need to. It’s just that carbs are so readily available in our diets. When carbs are taken off the table, our bodies are perfectly capable of using fat for fuel.

And taking carbs off the table is exactly what Dr. Hallberg advises her patients to do. Patients at her clinic are put on a low-carb diet and the weight comes off. Reducing carbohydrate intake removes the blood sugar spikes which provoke the insulin response, short-circuiting the cycle of rising glucose, rising insulin, and fat storage. Not only that, they improve their health outlook overall.

So what does this kind of diet look like?

“First,” says Hallberg, “let me tell you what it’s not. Low-carb is not zero-carb and it is not high-protein. These are common criticisms that are so frustrating because they’re not true.” But if we’re cutting carbs, we have to replace them with something, right? There are only three macronutrients, and if we cut down on one another has to increase. What do we eat in place of the carbs we’re not eating?

Fat, dietary fat, healthy fat, low-carb, obesity, weight loss
The secret to weight loss, says obesity doctor Sarah Hallberg, is replacing most of our carbs with fat. This avoids blood sugar spikes and the resulting high insulin levels.

“Fat,” says Hallberg. “My patients eat fat, and a lot of it.”

After decades of warnings about the dangers of fat, the idea of increasing fat in our diets may strike fear into the hearts of some people. But the scientific and medical view of the effects of dietary fat have shifted radically in the past few years. Hallberg is far from alone when she points out that there’s really no convincing scientific evidence linking dietary fat to heart disease. On the contrary, she says, there are many studies showing that people eating a low-carb, high-fat (LCHF) diet fare better on standard health markers such as cholesterol and triglycerides than people eating either a conventional diet or a low-fat diet.

But most importantly, a LCHF diet reduces blood glucose and insulin levels. One of the largest health studies ever, the NHANES study, found that insulin resistance was the single biggest risk factor for coronary artery disease—responsible for 42% of all heart attacks. Adopting a low-carb diet, Hallberg says, reduces this risk by taking insulin resistance out of the picture. “Remember,” she says, “fat is the only macronutrient that’s going to keep our glucose—blood sugar—and insulin levels low. And that is so important.”

 

Dr. Hallberg’s rules for healthy eating


Dr. Hallberg says she follows five simple rules in her own eating and teaches them to her patients too. “These rules are going to be even more important,” she says, “if you are one of the tens of millions of Americans who have trouble with insulin levels.”

  • Rule #1: If it says “light,” “low-fat,” or “fat-free” it stays in the grocery store

    —because, she says, if they took the fat out then they put carbs and chemicals in.

  • Rule #2: Eat food

    It’s the most important rule in low-carb nutrition, according to this obesity doctor. Real food, she says, doesn’t come in a box, and no one should have to tell you that real food is “natural” by advertising it on the package. It should be obvious when you look at it.

  • Rule #3: Don’t eat anything you don’t like.

  • Rule #4: Eat when you’re hungry. Don’t eat when you’re not

    …no matter what the clock says.

  • Rule # 5: No GPS—that is, grains, potatoes, or sugar.

Sugar is an obvious health issue, but the message that whole grains are good for us, Hallberg tells us, has caused an unimaginable amount of damage. “If you’re one of the truly insulin-sensitive people,” she says, “you can eat real whole grains. But if you are in the enormous slice of our population with insulin issues, it’s making things worse.”

While the official organizations such as the American Diabetes Association argue that there isn’t sufficient evidence for the benefits of low-carb eating, there are nearly four decades of evidence showing that the current guidelines don’t work, Hallberg says. As a result, low-carb programs like hers are springing up all over the western world. 

And they’re all getting the same type of results. People are losing weight, and they’re doing it without depriving themselves. They’re doing it while eating delicious real food. They’re doing it without obsessively counting calories, or exercising six hours per day. They’re doing it without going hungry. And across the board, they’re reporting that not only is their weight going down, their blood glucose is going down too. Their blood pressure, if it was high, is going down. Their “bad” cholesterol is going down and their “good” cholesterol is going up. Their triglycerides are going down. They’re healthier than they’ve ever been.

So why is a low-carb diet not standard treatment for obesity and its associated diseases like type 2 diabetes? According to Dr. Hallberg, there are two primary reasons. 

“Number one,” she says, “[is the] status quo. It is hard to break. There are many agendas involved. We got this notion decades ago that low-fat was the way to go. But a recent study just came out showing that there was zero randomized-control evidence to recommend to Americans to remove the fat from our diet, and that was how the carbs got added in. It was essentially a huge experiment on millions of people. And it failed miserably.”

The second reason, Hallberg says, is money. “Make no mistake,” she tells us. “There’s a huge amount of money to be made from keeping you sick.” And obesity itself, she says, is a disease; a disease resulting from insulin resistance and brought on by an overload of carbohydrates. The solution to the Big Three health issues–obesity, type 2 diabetes, and heart disease–is simple.

“Stop using medicine,” she says, ” to treat food.”

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The Obesity Epidemic: How We Got Fat and What We Can Do About It
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The Obesity Epidemic: How We Got Fat and What We Can Do About It
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Obesity doctor Sarah Hallberg calls insulin the “fat-storage hormone,” and according to her it’s the culprit behind the obesity epidemic currently facing the western world.
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