Conquer Your Weight

Dr. Sarah Stombaugh: This is Dr. Sarah Stombaugh and you are listening to the Conquer Your Weight podcast, episode number five. Announcer: Welcome to the Conquer Your Weight podcast, where you will learn to understand your mind and body so you can achieve long-term weight loss. Here's your host, obesity medicine physician and life coach, Dr. Sarah Stombaugh. Dr. Sarah Stombaugh: Hey everyone, welcome back. Today we are going to start talking about why weight gain happens and the hormones in our body that cause weight gain. You can imagine there's a lot to unpack here. So this episode is going to be divided into two parts. We'll get started today and we'll finish everything out next week. It's so funny because as I was outlining this week's episode, a nasty gastrointestinal bug hit our family, and I'll spare you all the details, but we spent a few days in that recovery phase where all you can do is sip liquids and eat a few crackers and other bland foods. Have you heard of the BRAT diet? Bananas, rice, applesauce, toast? There's been data to come out recently to say a bland BRAT diet does not have to be followed. There's no reason you can't go back to eating regular foods, and I'm not sure if it's just me and my thoughts about it, but I swear to you, eating regular foods in the recovery phase of a GI bug sounds so awful to me. Our family lives on Pedialyte and saltine crackers. So here I am writing for you all about the role of insulin, insulin resistance and processed carbohydrates, and literally all we ate for a couple of days was processed carbohydrates. Oh, well. So we'll talk about mentality around food in the setting of illness at another time, but I think this is just the perfect example of listening to your body. When we really get in tune with our body, you get to listen to what your body needs, and if you need Pedialyte and saltine crackers for a few days, maybe that's okay. Another thing I found really interesting was watching my three-year-old recover from his illness. Another thing we haven't talked about too in depth yet is the primitive brain versus our developed brain or the prefrontal cortex. We have a whole episode on this probably in the next month or so, but this is just such a perfect example. I can't pass it up. So we're gonna do a little 101 on the topic. So our primitive brain is entirely survival based. It sends us urges for foods, drink, sex, shelter, basically anything that was needed to propagate our survival as a species. Our developed brain or our prefrontal cortex is our evolved brain that allows us to think about things and use logic to make the best for ourselves. We know that the prefrontal cortex is not fully mature until someone reaches their early to mid-twenties. So broadly speaking, one of the biggest roles that I see for myself as a parent is to use my own prefrontal cortex to help my children make the best decisions and work to develop their own prefrontal cor cortexes, cortices, , I'm not sure. But to develop those over time. For example, when you have a GI illness, you become really thirsty. You're losing lots and lots of fluids. I'm sure you can think back to a time this happened in your life, whether it was you, your child, or someone else. You've been sick and you have that urge, oh my gosh, I am so thirsty. I need to drink water right now. That urge is coming from our primitive brain. Our primitive brain is telling us you need fluids or you're going to die, and if you follow that urge and drink any meaningful volume of water, it's likely to come back up right away. We learn over time the way to keep fluids down is to take small sips every few minutes. This is an example of using our developed brain, the prefrontal cortex, to work together with our primitive brain to come up with a logical plan to rehydrate yourself without making the situation worse. Sometimes I like to imagine my prefrontal cortex has a voice and talks to my primitive brain to talk it down off a ledge. This voice sounds a lot like my mom voice. I know you're really thirsty, sweetheart, but if you drink too much too fast, you're going to get sick. Let's just focus on small sips. It's going to be okay. This was the exact situation my three-year-old son and I found ourselves in after getting sick. He was so thirsty and he just did not understand that he couldn't chug water to cure his thirst. At one point I made the mistake of letting him have literally like two ounces of water at once and it came back up right away. From that point on, I was offering him like one teaspoon or two teaspoons of water, and let me tell you, it did not go well. My poor son was sobbing like, "I'm so thirsty, I'm so thirsty, Mom." His primitive brain was screaming to him, must get water now, and he doesn't have that fully developed prefrontal cortex yet, so he can't understand why that's not a good idea. As his parent, I get to use my own prefrontal cortex to help him out. So ultimately we chose Popsicles, and I have to tell you, Popsicles aren't something we buy in this house. I literally can't remember the last time we bought Popsicles. Maybe I never have, but I spent some time brainstorming and decided that this was a fun solution for his rehydration problem. A Popsicle is rehydrating, but inherently you can't eat a Popsicle too quickly. I looked up some recipes for making Popsicles, but we don't have any of the supplies and I don't like the clutter of kitchen gadgets that you're gonna use like once a year or once every couple of years. I also wanted Popsicles right now. So waiting for homemade popsicles to freeze didn't feel like a great option either. So I went to the grocery store super early the next morning and I walked up and down the freezer aisle checking out my options. Ultimately, I landed on some Halo Top coconut Popsicles that claim to have 50% of the sugar of quote, regular Popsicles, whatever that means. So actually with rehydration some sugar is important because it helps the salt to get reabsorbed with our in our body. So I was okay with him having some sugar and these seemed like a great option because of the coconut. They had both sodium and potassium, and then they only had seven grams of sugar, which is a little bit less than two teaspoons in one Popsicle, and my son loved them. I'm not sure if it was just the tincture of time, but he finally started to turn a corner after his day of eating Popsicles. So I totally realize the irony about talking about Popsicles on a weight loss podcast. So if you're sick, it's probably not the best idea to just run out and treat yourself to a Popsicle, even a low sugar Popsicle. But this is an example of how you can use your prefrontal cortex to solve a problem. Your primitive brain is screaming, I'm thirsty. I'm thirsty. When we stop and use our developed brains, that prefrontal cortex, we can come up with a good solution. We can often come up with many good solutions. Our prefrontal cortex is one of the best tools we have for long-term success with weight loss. Alright, so you've been waiting to hear about the role of hormones and weight gain. Thanks for enduring my tangents about our recent illness, and I'll add we're all doing. Okay, now we're finally back to eating regular foods. So let's talk about those hormones. A lot of what we're going to talk about today is basically a summary of a book, The Obesity Code by Jason Fung, MD. Hands down this is my favorite book about weight gain. He does such a nice job explaining the physiology of weight gain and why weight gain happens. In the latter part of the book, he explains what to do about it. I also love Always Hungry? by David Ludwig, MD. He has a similar approach and the last third of his book is dedicated exclusively to a diet plan so it gets a little bit more specific about foods that you could or couldn't eat if you wanted to follow his plan. A hundred years ago, it was generally accepted that carbohydrates were fattening. Many of the leading books on nutrition reinforces to be true. However, in the mid-1950s, there was a perceived epidemic of heart disease. Interestingly, it wasn't so much that heart disease was increasing, but that things like infectious diseases, pneumonia, tuberculosis, gastrointestinal infections, these all became curable and people were no longer dying of these conditions. As a result, the proportion of deaths from things like heart disease and cancer increased. Furthermore, because of these infectious diseases were curable, the life expectancy of Americans increased as well. As we lived longer, we were more likely to suffer from things like heart disease or heart attacks. In the 1960s, medical groups and researchers were determined to figure out why there was an increase in heart disease besides the decrease in infectious disease, was there anything else that was causing it? Was anything in our diets causing it? People had started to question the role of fats and the role of sugars. While sugars had been a treat for humans for the longest time, they had only been available to the wealthiest people. Interestingly, it was only in the very late 1800s and early 1900s that sugar became more broadly available in the United States. In 1967, the Sugar Research Foundation paid three Harvard scientists to publish a review of the research on sugar, fat, and heart disease. The article was published in the New England Journal of Medicine, which is even to this day, one of the most prestigious academic medical journals, but this was long before they required articles. In 1967, the Sugar Research- In 1967, the Sugar Research Foundation paid three Harvard scientists to publish a review of the research on sugar, fat, and heart disease. This article was published in the New England Journal of Medicine, which to this day is still one of the most prestigious academic medical journals, but this was a long before the journal required authors to disclose their funding sources. And one of the interesting things that we know is that disclosures are always so important because if you have someone paying you, for example, if the Sugar Research Foundation is paying you to review the literature, it's possible that they are influencing that data and unfortunately that's what happened. And so this review article said that fat was linked to heart disease. Sugar was not linked to heart disease, and it set forward a lot of things that have really shaped how we've thought about sugar and fats over the last 50 years. In 1977, the United States government set the very first dietary goals for the United States, and these goals were based on a committee's opinion of nutrition, which is not always the most reliable evidence. As part of these goals, it was recommended to us that we increase the amount of carbohydrates in our diet and decrease the amount of fats in our diet. They decided there was concern not just that fat was causing heart disease, but that it was also causing obesity because fat is calorically dense. So for example, fat has nine calories in just one gram, where one gram of carbohydrates or one gram of protein only have nine cal, or excuse me, only have four calories. So fat has nine calories per gram, or carbohydrates and protein have four calories per gram without any hard evidence. We launched into decades of preaching a low fat diet, and sadly, the low fat diet hasn't had the impact on heart disease and obesity that everyone had hoped. It's not clear that the low fat diet can take credit for helping to reduce the risk of heart disease over the same period of time. A lot of other factors have changed that played a role in decreasing heart disease as well. Two of the most important examples is that people are smoking a lot less tobacco than they were 50 years ago. And two statin medications, which are the main medications that help to lower cholesterol were discovered in the late 1970s, and they have been used widely since that time. We know that elevated cholesterol is one risk factor for heart disease, so a medication that decreases it can really reduce that risk as well. Certainly the low fat diet hasn't helped the United States. Obesity rates, which have dramatically increased starting in 1980 when those dietary guidelines were originally published and continue to increase year after year. The challenging thing about a low fat diet is there's only three macronutrients. We have carbohydrates, proteins, and fats. Carbohydrates encompass everything from whole grains, breads, pastas, fruits, starchy vegetables like potatoes or root vegetables like carrots to candy, cookies, pastry sodas, and other sweetened beverages. Proteins on the other hand are usually meat, poultry, fish, eggs, soy, certain dairy products, certain whole grains like oats or quinoa, beans, and other legumes where fats are often found in animal products like meat, poultry, fish, and dairy. And in foods like nuts, avocados, olives, and other oils, some foods can be labeled as one single macronutrient. A banana, for example, is nearly 100% carbohydrate or a slice of bread is nearly 100% carbohydrate as well. However, most foods are comprised of multiple macronutrients in varying quantities. So almonds, for example, are about 50% fat, and then equally 25% carbohydrate, 25% protein. A full-fat plain Greek yogurt is 50% protein, 30% fat, 20% carbohydrate. A skirt steak is about two thirds protein, one third fat and avocado is 60% fat, 30% carbohydrate, 10% protein, and a whole grain liked cook. Quinoa is about 75% carbohydrate and 25% protein. So most foods are not actually one single macronutrient but are divided among the different three macronutrients, carbohydrates, protein, and fat. The challenge with a low fat diet is that when we decrease one of the three macronutrients, something else must increase. So while trying to limit fat, many people were trying to limit things like eggs, meat, and dairy because those are all sources of both fat, but they were also sources of protein. So it made it hard to increase protein without increasing fat. As such, most people were increasing carbohydrates as they decreased fat, and it's what the dietary guidelines told us to do. We were told that carbohydrates were healthy, sadly because fat is so flavorful, cutting out fat meant cutting out a lot of flavor as well. You may have experienced this if you've tried the full fat version and the reduced or low fat or no fat version of something. If not, let me give you an example. I can tell you that a serving of full fat plain Greek yogurt is decadent and rich. I eat it for breakfast a few days per week. On the other hand, a serving of fat-free plain Greek yogurt is unnecessarily tart and lacking the depth of flavor of its full fat sibling because the fat-free versions of many foods didn't have that same rich flavor compared to the full fat versions. Food manufacturers starting adding sugar in the place of fat. They needed their products to taste good, and sugar was a way to do that. In the example of Greek yogurt, a few teaspoons of sugar can absolutely hide the tartness and blandness of a fat-free yogurt. Many popular brands of Greek yogurt will have nine to even 20 grams of sugar in a single serving of their flavored yogurt options. There are four grams of sugar in one teaspoon. Can you imagine dumping up to five teaspoons of sugar into one of those teeny tiny yogurt cups? I'm such a visual person, so I like to mentally picture getting outta teaspoon, getting out a sugar jar and scooping out five teaspoons of sugar into my food. That's a lot of sugar. And while the dietary GUI guidelines were pretty clear that we should be limiting sugar, people were so obsessed with demonizing fat that we didn't pay much attention to sugar at all. In addition to sneaking sugar into foods to help mask those bland flavors, many companies use the demonization of fat to their marketing advantage as well. I remember seeing Twizzlers advertised as a fat-free food. Well, yes, technically they're fat free, but they are pure sugar, and when you eat sugar that your body doesn't need, it stores it away as fat for later. So much for a fat-free food. It makes me so sad to think that a person might have chosen Twizzlers as a snack over an avocado because Twizzlers are low fat, where an avocado is high fat. But you might be asking, well, why is it that increasing carbohydrates and decreasing fats led to weight gain? So let's talk a bit about why a diet heavy in carbohydrates, particularly those processed carbohydrates leads to weight gain. When we eat carbohydrates, they're broken down into sugars which enter the bloodstream as blood glucose to provide energy for our body. We may need some of that energy right away. So for example, if you're doing a strenuous workout, your muscles can utilize that glucose right away to help fuel your workout. We generally take in more energy at meal times than we need right away, and that's okay. That's expected. That's where the hormone insulin plays a role. Insulin is released to help store away that extra blood glucose so that we can use it for later. The first and preferred storage tank for extra glucose is the liver. Insulin converts blood glucose into glycogen, which is stored in the liver for later use, and the body can make this change easily. It easily converts glucose to glycogen and glycogen stores back to blood glucose. So during times of short fasts, like in between meals are in our overnight fast from dinner until when we eat food the next day. The body can easily convert glycogen stores from the liver back into blood glucose so that it can be used throughout the body. The backup storage tank for extra glucose is fat stores. Our liver only has a limited capacity to store glycogen. If our liver is full of glycogen, the body is going to store away extra blood glucose as fat. Insulin also helps to regulate this process, which is called de novo lipogenesis. This literally means making new fat cells. Your body is not going to let that extra blood glucose go to waste. It's going to save it for times of prolonged fasting when food is not readily available. Unfortunately, we never find ourselves in a situation where food is not readily available. In the modern world, food is always readily available and we are encouraged to eat it. A hundred years ago, people ate three meals per day. A thousand years ago, some people ate food even less regularly depending on their access to food. However, over the last 50 years, our culture has been taught that snacking is good, and even that snacking will keep us thin. Ironically, snacking might be one of the biggest factors that has led to the rapid rise of obesity in America. Generally speaking, we are either in energy storage mode or an energy burning mode. We can't do both things at the same time. So when we eat breakfast, snack, lunch, snack dinner, and another snack, we are inundating our body with food. Our body is constantly storing away energy. It never has the opportunity to utilize those energy stores. The problem when we take more carbohydrates and our body needs is that we've filled up all of our liver stores with glycogen and our body has no choice but to store away the extra as fat. Over time, you store away more and more fat cells, but then we don't use them. In theory, we'd be in this perfect balance such that we have enough glycogen stored away to get us through natural short-term fast, with maybe just a little extra fat on our bodies just in case. Instead, we've eaten so much food and so many carbohydrates day to day that we only need to dip into our glycogen stores. We never deplete those glycogen stores because we're constantly refilling them. Your body has no need to access the fat stores, but we keep storing away more and more and we watch our weight creep up and up. And up next week we're going to talk about the adaptive hormonal changes that happen over time that can make it challenging to lose weight. We're going to talk about why these hormonal changes happen and what does and doesn't lead to successful weight loss. Alright, that's it for today. If you're interested in learning more about me, head on over to my website, www.sarahstombaughmd.com. That's S-A-R-A-H-S-T-O-M-B-A-U-G-H-M-D, as in medical doctor, dot com. If you live in Illinois or Virginia and you are interested in working one-on-one with me and my weight loss practice, go ahead and fill out the form on my website and we'll connect. If you don't live in one of those states or maybe you aren't interested in one-on-one visits, stay tuned. I will have group coaching available nationwide, likely starting in early 2023. If you've enjoyed today's podcast, please subscribe wherever you listen to podcasts, and please share this with anyone who you think may benefit. Thank you so much for joining me today. I look forward to seeing you next week where we'll finish talking about why weight gain happens and what you can do about it. Take care.