Fat Chance

If you want to skip to the specific recommendations out of the book, scroll down to the section in purple below.

Part of what I do to motivate myself is read books about diet and exercise and health. The topic interests me, and it affects what I actually do and eat.  So the latest one, picked from hearing interviews with the author on the radio book tour circuit, is Fat Chance, by Robert Lustig. This is much more about health than about diet, and has added to my understanding of what is going on inside me and everybody else.  I've read a lot about how we metabolize fat and sugar and this book didn't contradict what I thought I knew, but adds depth to this in a very relevant way for me.

Dr. Lustig is a pediatric endocrinologist, where for decades he has worked with children that have extraordinary weight problems, sometimes as incidental to much more serious problems.  Here, in the order I happen to remember them, are some of the observations in this book.

He starts from the premise that Gary Taubes introduced me to:  we don't grow fat through sloth and gluttony, ie not through eating too much and moving too little. Turn that upside down: we eat too much and move too little because of genetically and environmentally driven imperatives.  When a teen age boy eats his way through the whole refrigerator in a few hours during his growth spurt, we don't say he grows tall because he eats. We say he eats because he is growing tall. So it is with our body shape and our weight: how much we are driven to eat and how much or little we move is a result, not a cause, of our body chemistry.  Why our body chemistry is driving these imperatives is not necessarily (yet) well understood and agreed to, but never-the-less this point is critical:  it is not just a matter of will power.  Not only is it not our fault for being a slothful glutton, but even if we exercise more and eat less we might not lose weight. Taubes cites research on squirrels that are genetically driven to add weight in the fall - they can literally starve to death from organ failure while their body chemistry is diverting food energy to fat deposits.  Lustig has plenty of examples as well of abnormal children whose bodies are driven to add fat. He has to change something in their interior chemistry for them to be able to lose weight.

Lustig also distinguishes between health and fat.  Part of it is by distinguishing between types of fat: subcutaneous fat (big butt fat) and visceral fat (beer belly fat). It is the second that is unhealthy, and it is the fat that coats your internal organs. You can be skinny to the outside eye but be coated with visceral fat inside. He notes that a significant portion of "normal weight" people have unhealthy diets and internal fat. A significant portion of overweight people are quite fit, though they may have big butts. You might be better off being slightly overweight than underweight, at least in terms of how long you live.  But being morbidly obese certainly drives many major health issues. It is the collection of symptoms known as metabolic syndrome that comes from being obese that he is targeting his effects at.

Sad news: Lustig says pretty much no one will lose weight from exercise. Your body will compensate, and you will burn less calories when you sit and and sleep, and your appetite will increase. However, exercise is still the magic bullet for health.  You are probably swapping bad visceral fat for muscle or better (if unsightly) big butt fat, and there a gazillion other benefits.

Lustig also distinguishes between carbs, going much deeper than Taubes. He goes down to the molecular level of different sugars to discuss how they impact our health. His conclusion as I understand it: fructose is the worst for us, whether it comes from cane sugar or high fructose corn syrup. Anything that tastes sweet is bad.  But fiber offsets the bad impacts of fructose. This is why fiber-rich starchy foods can be fine for us (including whole fruit, but not fruit juice or even smoothies). He goes deep into the hormonal system (makes sense, he's an endocrinologist), and frankly I decided not to try to follow it all.

This was the first explanation about how both meat-centric low carb diets and bean and whole grain vegan diets can be equally healthy that made any sense to me.  Being a bread-itarian won't work - white rice and white bread, even without sugar, are calories that will drive fat storage. He also notes that processed food almost always has eliminated fiber and added sugar, and explains why that makes perfect sense from the producer's point of view: it actually makes it last longer. Our industrial food system requires us to make, package, and ship food over long distances and times. Grocery store bread will last on the counter for up to a couple of weeks, in contrast to home made bread which goes bad in a day or two.

Lustig is careful not to paint anything with too broad a brush. He distinguishes between ethnic populations, nations, and specific genetic conditions. He has a sweeping survey of environmental things that might be bad for us. We can't change our genetics, but we can change our environment and what we eat, and thus change our biochemistry.

So what does he recommend we actually do as individuals?  First, he says he really doesn't care much about weight, only health.  But we can do three things:  eliminate the poison, and take the two antidotes.

The poison is sugar, and it is insidiously everywhere.  Almost everything that has a bar code on it has sugar added to it. He sees no reason to ever drink any sugar.  Soda, frappuccinos, and fruit smoothies are almost equally bad for you, according to Lustig. He also condemns artificial sweeteners, for driving certain chemistries or responses. He actually recommends a national level public health intervention to counteract sugar's pervasiveness in our food, and in the meantime, he notes that only Americans above a certain income level or in a certain environment can afford the time and money to find, cook and eat foods without sugar.

The two antidotes:  fiber and exercise.  He makes a persuasive case that fiber causes our bodies to process sugar differently and better. He notes that the new Atkins prescription aims at many grams of fiber from vegetables, but few people achieve those levels (me included). Meat is so much easier to prepare, and it lasts longer and can be frozen and defrosted more easily.

I won't go into the benefits of exercise, which we all believe. It adds muscle, and it lowers insulin resistance, and it counteracts depression. We should all do more of it. Yes of course.

So what does this mean for me? I have not lost any weight this week, according to my weekly averaging. My body seems to be stabilizing a few pounds above where it was before the holidays. No. I can't allow this. I have tracked my food faithfully for the past few weeks, and my carbs have been around 100 grams a day, (this is about a half to a third of a normal American's diet, according to Atkins) with 10-20 grams of fiber (about average for Americans, but less than recommended). Yesterday's food was crazy, with grazing all evening while home alone. I'm going to go purely Atkins for a couple of weeks, and see if I can blast through this plateau.  I am also going to up the exercise, only to try to keep the body from shutting down. I'm going to hunt for fiber, and fill up on hunks of meat (not sausages or meatballs). I'll try to erradicate sugar, including no nightly treat - only a weekly one. We'll see how it goes, because I don't control my life completely but I've been at this long enough to know some of the things I need to do.