Most people
with a weight problem have tried some sort
of weight-loss product or programme in the
past. Each week the market is flooded with
even more new products or programmes. In other
parts of the world, particularly in the U.S.
parts of Europe and South America and even
many parts of East Asia, plastic
surgery seems to be the trend, especially
when it comes to excess fat because of the
speed of a liposuction
procedure. Yet, on a daily basis, patients
ask us the same three questions:
“How do these
diets and products work?”
“How do they differ from each other?”
“Which one is the best?”
Although all three questions
are obviously valid, they prove one thing
- most people do not even understand the basics.
Weight loss is a basic medical science and
there is no magic or mystery involved. Besides
basic habits, tastes and lifestyles, each
patient is also bio-chemically and emotionally
totally unique. This makes both the problem
and the solution rather complex.
Let us start
by looking at the complexity of ‘energy
restriction’, or ‘eating
less’, as a single entity. On
the other hand, many people have a weight
problem, not because they eat too much, but
because of their abnormal and excessive ability
to store energy as fat. Telling these people
to eat less makes no scientific sense. They
may eventually lose weight with a starvation
type diet (800 Cal or less) but their metabolic
rate drops and they become biochemical, more
efficient at storing energy. Statistically,
they almost always ending up heavier than
before when their normal lifestyles are resumed.
But besides
using ‘energy restriction’ to
lose weight, there are many other techniques,
all belonging to their own scientific categories
and all equally complex. The truth is that
most people with a weight problem know very
little about the science behind weight loss.
It is therefore not surprising that they are
very vulnerable to exploitation and failure.
How can anybody realistically expect to succeed
with anything in life without an understanding
of the basics?
In order to lose weight,
one can…
1) Decrease energy intake
by eating less.
2) Block energy in the intestines and prevent
it from entering our system.
3) Slow down the rate at which energy enters
our system.
4) Change the "type" of energy that
enters our system
5) Influence of the hormones that determine
whether energy will be stored as fat or not.
6) Raise the metabolic rate with medication
and burn fat.
7) Do cardiovascular (aerobic) exercise.
8) Do resistance (anaerobic) exercise.
All current solutions
can be placed into these 8 sub-categories.
By the way, if you yourself have tried a weight
loss strategy in the past, try and fit your
solution into the correct category. Many people
are surprised to discover that they have tried
the same solution, albeit under a different
guise or name, on many occasions in the past.
But even worse, they usually also fail for
the same reason each time, a reason that they
themselves often do not truly understand.
1)
Decreasing energy intake by eating less.
This is a large category and most of the better
known programmes belong here. Some measure,
others weigh food items. Points are often
allocated. The dietician, able to deliver
a more customised diet for each patient, deserves
the tip of the pyramid. At the bottom one
finds the hundreds of energy restrictive diets,
commonly found in glamour magazines, the back
of the breakfast cereal box, the latest fad
diet, etc.
If you eat food of a
lower energy value, i.e. the low fat diet,
you are also decreasing your energy intake.
All surgical procedures
to restrict energy intake, such as wiring
your jaw, stapling your stomach, inserting
an inflatable ring around your stomach, etc.
belong to this group.
All forms of medication
that suppress your appetite and make you eat
less also belong to this category.
But let’s face
the facts: energy restriction on its own has
failed – nowhere in the world has it
statistically proved sustainable results.
2)
Blocking energy in the intestines and preventing
it from entering the system
The basic principle behind this category is
that energy passes your lips but does not
enter your system. It allows you to ‘eat
more’ but ‘absorb less”.
Chitosan, made from
the ground-up shells of shellfish, is a popular
and well advertised product, quick to lay
claim to these effects. Unfortunately, medical
science does not agree, and chitosan has persistently
failed to show convincing results in numerous,
well orchestrated scientific trials.
Orlistat, a ‘lipase
inhibitor’, certainly works, but remains
expensive and has some unpleasant side effects
like faecal incontinence.
3)
Slowing down the rate at which energy enters
our system.
Before one can elaborate on this category,
one needs to mention the biochemical effects
of the hormone insulin. Immediately after
a carbohydrate meal, the glucose that is absorbed
causes the release of insulin, and levels
rise rapidly. Insulin, in turn, stimulates
the uptake and storage of glucose by almost
all tissues of the body, but especially by
cells in the muscles, fatty tissue and liver.
This function ensures that glucose is always
readily available for energy purposes inside
the cell, if and when the cell requires it.
Resting muscle tissue,
however, does not need glucose as its source
of energy, and uses fatty acids instead. The
principal reason for this is that the normal,
resting muscle cell membrane is only slightly
permeable to glucose, except when the muscle
fibre is stimulated by insulin. (As mentioned,
this happens after a meal, when rising glucose
levels stimulate insulin secretion.) Insulin
strongly inhibits the flow of fatty acids
from the fatty tissue to the rest of the body,
and thereby effectively stops muscle from
using fatty acids.
Excess glucose can be
stored in liver and muscle cells, by a chemical
process that joins individual glucose molecules
together in a more space efficient molecule
called glycogen. As soon as the ‘glycogen
store’ is full, insulin promotes the
conversion of all excess glucose molecules
into fatty acids. These fatty acids are then
subsequently packaged as molecules called
triglycerides, and transported to the fatty
(adipose) tissue by specialized fat transporting
proteins called lipoproteins. In the fat cells,
the triglycerides are deposited and stored
as fat, which obviously also causes your midline
to expand.
In the absence of insulin,
however, all aspects of fat breakdown and
its use in providing energy are greatly enhanced.
This occurs normally between meals when insulin
secretion is minimal, but it becomes extreme
in Type 1 Diabetes when insulin levels are
almost zero. (Type 2 Diabetes is different)
During the Type 1 diabetic state, fat deposits
are broken down and mobilized so efficiently
that extreme concentrations of cholesterol
and other detrimental fats fill the bloodstream.
Rapid weight loss is also a feature.
If having both too little
and too much insulin are detrimental to the
body, it becomes clear that something ‘in-between’
is essential. Preventing a surge in insulin
by regulating its secretion is obviously also
essential to weight maintenance.
The Glycaemic Index
(GI) is a new classification of carbohydrates
based on the speed of which individual food
items release glucose into the system and,
therefore, their ability to raise blood glucose
levels. Food items with a high GI value raise
blood glucose levels much faster than food
items with a low or intermediate GI value.
If glucose enters the system at a slower rate,
less insulin is also secreted. The result
is that less fat is deposited.
Various factors affect
the Glycaemic Index of food. Individual properties
relating to each food substance, the presence
of fat, fibre and protein in meals (mixed
meals) and different food production or processing
techniques are primarily responsible for these
variations.
In order to reap any
rewards from this category, one obviously
needs to educate oneself about the GI values
of food.
Medication can also
influence the GI value of food.
This category was previously
reserved for the diabetic patient, but everyone
with a weight problem should incorporate these
principles into their daily lives. Because
your blood sugar level stays elevated for
a longer period of time, it is also a good
way to control you appetite.
4)
Changing the ‘type’ of energy
that enters our system
Basically, it boils down to the effects of
insulin once more. As carbohydrates, especially
large quantities of the high GI group raise
insulin levels and cause the deposition of
fat, the theory goes that if one kept your
insulin levels low one would obviously deposit
less fat. The so-called ‘ketogenic diet’,
however, takes this to the limit, and no process
can lower serum insulin levels more. ‘Lipolyses’,
the medical term for ‘fat-breakdown’,
is music to the ears of those that are overweight.
As fat molecules (triglycerides) are broken
down for metabolic purposes, small carbon-containing
molecules (called ‘ketone bodies’)
are released. The process is therefore called
‘ketogenesis’. The ketogenic diet
says it all – fat is being broken down!
Each ketone body contains a small amount of
chemical energy, but cannot be used by the
body. Ketones (along with their energy) therefore
naturally pass through the kidneys and are
lost through the urine.
Because insulin is released
when carbohydrates are consumed, the ketogenic
diet allows you to consume the same amount
of energy, but from sources other than carbohydrates,
namely protein and preferably unsaturated
fats. The process is quite simple; all it
involves is to limit or cease the intake of
as many dense-carbohydrate food items as possible.
The common ones are wheat (which includes
all forms of bread and pasta), rice, corn
and potatoes.
The late Dr. Atkins
is both famous and controversial for his stance
on the ‘ketogenic diet’. He has
stood alone amongst a sea of criticism from
the orthodox dieticians advocating a low fat,
predominately carbohydrate diet as the solution
to the world growing obesity problem.
The fact of the matter
is that a ketogenic diet allows you to derive
your energy from sources other than carbohydrate,
namely protein and fat, allowing you to fill
your stomach with more protein and fat and
less carbohydrate for a change. It is therefore
referred to as a ‘high protein diet’.
Eating less carbohydrate keeps your insulin
levels low and causes less fat to be deposited.
It also allows you to eat more food than most
low calorie diets that some doctors and dieticians
torture their patients with.
But, as usual, things
are not that quite that simple. Let us imagine
that someone ate too much food. This person
ate, on average, certain quantities of protein,
carbohydrate and fat per day, in a X:Y:Z ratio
for example. If this person ate less food,
but only less carbohydrate, the X:Y:Z ratio
would change, in other words, the fat and
protein ratio would now be higher than before.
Can one, however, use the term ‘high
protein diet’ to describe this person’s
new diet? Surely a ‘carbohydrate diminished’
diet would be more appropriate?
To complicate the issue
further, all protein sources contain carbohydrate.
Glycogen, the store form of glucose, is present
in muscle – all meat (muscle) sources
therefore contain carbohydrate. Eating ‘more
meat’ means that you also eat ‘more
carbohydrate’ in a way.
Carbohydrates are made
by plants from sunlight. Animals, or rather
mammals, are also able to manufacture a carbohydrate
source, namely milk sugar (lactose). All dairy
products, packed with protein, therefore also
contain lots of carbohydrate. All carbohydrate
plant sources, however, also contain protein.
This includes all grains, fruit, vegetables
and legumes. With wheat, probably the most
common source of dense carbohydrates consumed
in the Western world, the agent that frequently
leads to intolerance and allergy is ‘gluten’
- a protein, not a carbohydrate. So, if you
eat fewer carbohydrates, you also start eating
less protein in a way. From this complexity
alone one can see why one should be cautious
to make bold statements.
Eating more food and
gaining less weight sound almost too good
to be true. There are, however, many medical
problems and health risks associated with
this category.
By the way, there is
a new rather impractical theory about your
blood group and eating style. The proponent,
also a doctor, stands alone amongst a sea
of criticism from the scientific community.
All individuals with the O-type blood group
are told to stop eating wheat. As wheat forms
the basic carbohydrate of the Western world
these individuals lose weight because of the
principles of ketogenesis.
5) Influencing the hormones
that determine whether energy will be stored
as fat or not.
There are many dishonest and ridiculous claims
made in this category. Of the many hormones
involved in fat deposition, (consult the section
on the role of hormones) only two are of any
practical value, namely growth hormone and
insulin.
Growth hormone has powerful
fat-burning properties, as it opposes insulin’s
effects on the cellular use of glucose. It
also stimulates the mobilization of fatty
acids from fatty tissue, and this mobilized
fat is utilized for energy purposes by the
muscles in preference to both carbohydrates
and proteins.
Growth hormone supplements,
sometimes alluded to as ‘secretegogues’,
are widely sold by unscrupulous businessmen.
The New England Journal of medicine recently
published a study that disproves their theory
- there is no scientific evidence that it
works. Growth hormone in its pure form can
certainly not be taken orally, as stomach
acid destroys it, and L-arginine, an amino
acid required for its production, may help
to a minuscule degree, but only if taken in
quantities of at least 500mg on an empty stomach.
Injecting pure growth hormone is also no solution,
as it stimulates the division and enlargement
of all cells in the body capable of growing
and causes the limbs and face to become disfigured.
There is, however, a
wonderful and healthy way to stimulate your
body to release large quantities of growth
hormone. It’s called exercise.
‘Insulin resistance’
is a medical term that refers to insulin becoming
‘less effective’. The exact reason
for this phenomenon is not clearly understood,
but for some reason, in the presence of excess
body fat, insulin requirements increase because
its effects / function become diminished.
The end result is that the body compensates
by releasing more insulin to do the same job.
The end result? More fat gets piled on. (This
process eventually leads to type 2 diabetes)
Addressing ‘insulin
resistance’ keeps insulin levels in
check by lowering blood glucose levels and
insulin requirements. There are two ways to
address insulin resistance; a) Exercise –
this significantly increases insulin’s
function and is by far the best method. B)
Medication.
An interesting point
is that your waist circumference usually determinates
the presence of insulin resistance. If you
are female with a circumference of more than
88 cm, or male with a circumference of more
than 102 cm, you statistically have a good
chance of having the early stages of this
prevalent condition.
6)
Raise the metabolic rate and burn stored fat
Ephedra (and
its synthetic derivative ephedrine) is the
most commonly used agent in this category.
Not popular amongst doctors because of its
high side effect profile, it is often disguised
with pseudonyms such as Ma huang, Mormon tea
and Sida cordifollia in herbal products –
all plant species with a high concentration
of the ephedrine alkaloid. Most of these agents
are ‘sympathomimetics’, meaning
that they mimic some of the effects of the
body’s own sympathetic (stimulant) hormones
such as adrenalin and noradrenalin.
7)
Burning energy by doing cardiovascular / aerobic
exercise
Many people who are overweight will tell you
that they hate their additional fat so much,
that, out of desperation, they will do anything
to lose weight. When questioned they will
also tell you that they have tried every possible
diet and have spent a fortune on weight-loss
medication. Most of them, however, will also
tell you that they are sedentary and do no
additional exercise.
Besides burning calories
and raising your Metabolic Rate, exercise
has numerous other benefits and it is a scientific
fact that regular exercise improves life expectancy.
This is achieved by improving heart and lung-function,
which leads to better blood circulation and
increased tissue oxygenation. (This is also
applicable, and has been statistically proved
to be so, with people who start exercising
late in life)
The lesser-known advantages
of regular exercise include its ability to
regulate your normal sensation of hunger (satiety).
It also reduces stress and depression, thereby
improving general well-being, self-confidence
and self-image. Emotional well-being, in turn,
leads to better self-control in all aspects
of your life, but especially when it comes
to deciding on your food intake.
Exercise is for obvious
reasons the easiest way of to tip the Energy
Equation towards weight loss and to use that
extra fat that your body has been storing
for the famine that will never come.
8)
Burning energy by doing resistance training
/ anaerobic exercise.
Resistance / anaerobic training is intended
to develop the musculoskeletal system. This
implies that not only do the muscles benefit
from this form of exercise, but also the bony
skeleton. Both these two systems deteriorate
with age, and each individual will lose, on
average, about 200g of muscle and about 1%
of their bone mass per year. Doing regular
resistance training will prevent both these
degenerative conditions.
This category is suited
to everyone and even mature ladies will benefit
from regular resistance training. Resistance
training is a powerful stimulus for the release
of growth hormone, a powerful fat-burning
substance. Of all the bodily tissues, the
muscle is the biggest consumer of energy.
A stronger, more developed muscle also needs
more energy during rest, laying true claim
to the popular advertising statement ‘burn
fat whilst you rest’.
You do not have to go
to gym to do weight training - our programme
gives you a basic set of exercises that you
can do in front of your TV with a set of dumbbells.
The
Role of Hormones
The hormonal system
is also referred to as the endocrine system,
and is responsible for regulating most biochemical
processes which take place within the body.
These biochemical processes can all be switched
on, turned up or down, or switched off, directly
as a result of the particular hormone that
is responsible for the regulation of its specific
chemical function.
Hormones are released
into the system and circulate through the
body until they reach their place of work.
Some travel far, while others go to work just
around the corner. Their functions are determined
by their design, and they are therefore only
able to “touch or tweak” certain
“levers and switches”.
The medical term for
the “levers and switches” that
hormones interact with is “receptor”
and every cell in the body has a fair number
of these. Receptors mimic door locks, allowing
only certain keys (hormones) to unlock them.
Once “unlocked” or activated,
numerous biochemical processes begin within
the cell.
The endocrine system
is vast and complex, and not surprisingly,
many things can and will go wrong. Some hormones
have more than one function. Too much or too
little of one function may not matter, but
too much or too little of another may be detrimental.
Hormones often oppose each other, affecting
the final outcome of the intended biochemical
process either for better or for worse. Many
factors influence their behaviour, which often
lead to disease. Drugs are designed to mimic
or inhibit the effects of hormones, which
explain their high side effect profiles.
It is common for patients
with a weight problem, especially those with
an excessive energy storing ability, to blame
their hormones. Scientists totally agree.
The only problem is that although many people
have inherited a combination of hormonal tendencies
that lead to the excessive storage of fat,
the knowledge of such an abnormality offers
little to no practical solution. Treating
the endocrine system is in some ways like
fixing a computer with a sledge hammer.
Even worse, the engorged
fat cell, or adipocyte, previously thought
to have a mere energy storage and insulation
function, is now recognised as an important
endocrine organ, releasing many hormonal like
substances that lead to disease. Even worse,
in the presence of excess body fat, many normal
hormonal functions become impaired, making
weight loss even more difficult. (See insulin,
leptin and growth hormone)
Fat metabolism, fat
deposition, appetite control and especially
the regulation of the basic metabolic rate,
are all affected by the following hormones:
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