I just attended an obesity treatment conference that was held right here in Philly at the Hilton, Penn's Landing. What a bargain! No airline ticket! No hotel room! I just rolled out of bed and shot down the schuylkill to listen to some of the world's biggest names in nutrition. Honestly, I went to hear just two guys Robert Lustig, MD and Jeff Volek, PhD . Lustig the pediatric Neuro-endocrinologist who has made sugar today's giant dietary villain. If you haven't heard his most famous seminar entitled, Sugar the Bitter Truth on the topic, I urge you to do so. Of course, he spoke about the evils of fructose; his signature topic. He also had interesting thoughts on differentiating the possible causes of obesity based on their response to insulin secretion. Insulin hyper-secretors and insulin resistant patients need to be treated differently. (at least in kids) Low carb diet works best for hyper-secretors and metformin is for the resistant. He does a 15 minute insulin/glucose test. This sounds a whole lot more feasible in the real work than the 3 hour Kraft assay. Additionally, Lustig basically shot down another conference speaker whose topic was mindful eating. He quoted recent studies that found it is ineffective for obesity treatment,
Dr Jeff Volek also gave his famous talk The Art and Science of Low Carbohydrate Living.
He is one of the guys who has made huge contributions to the understanding of the biochemistry and physiology of ketogenic diets. He reports that Beta-hydroxybutyrate, the major blood ketone, can fuel the brain even when blood sugar is extremely low. It also activates genes that promote anti-aging effects and promotes antioxidant activity. This possibly is a reason why low carb diets are thought to be cancer-preventing.
Some attendees were observed wolfing down handfuls of the meal replacement bars samples that the salespeople in the lobby were giving away. I'm pretty sure that's not how they're intended to be used...
I don't prescribe meal replacements because:
Meal replacements are not real food. They're made from the same stuff all all processed food. That's grains, isolates, artificial sweeteners and industrial seed oils.
They are calorie restricted. Once you've eaten your allotted calories, you're done and probably still hungry. They are too high in protein to suppress insulin so once the program is complete weight regain is the norm. Then there is the question of how to transition from meal replacement food to real food or non-replacement food. If all you know how to do is to tear open packages of bars, shakes or TV dinners then you will be ill prepared to eating normally for the rest of your life.
Meal replacements are mostly about increased revenue for the company who makes them and the people who prescribe them but not for long term weight loss.
Dr. Lazarus gave a lecture on weight loss meds. These are possibly useful for people who struggle to hit targets.
Getting people to break free of the notion that weight gain is a strict calories in versus calories out problem can be a challenge. Becoming fat is a fat cell regulation disorder first and foremost.
Here's how I explain it using sink in my exam rooms:
A malfunctioning fat cell is similar to a clogged sink. Imagine that your bathroom sink starts filling with water instead of draining promptly when the faucet is on. You call a plumber to look at your sink. You might be pretty mad at the plumber if he said, "Well, it looks like your sink is full. You need to use less water to balance the water in to the water out. Maybe you should bail water out with a cup."
Your response to him should be, "Aren't you gonna unclog the drain you moron?!"
Unfortunately, with regard to weight, most doctors' and dietitians' advice is as useless a our hypothetical plumber. We tell people, your fat cells are full. You should really eat less and exercise more. Your response should be, "Aren't you gonna unclog my fat cells?"
A clogged fat cell doesn't release it's stored fat when the rest of the cells in the body needs a steady supply of energy between meals. The fat cell drain (scientists call it Hormone sensitive lipase) (also Known as HSL) is clogged. The hormone that HSL responds to is insulin. Insulin causes fat to enter fat cells and it also prevents it from exiting. Insulin clogs the fat cell drain.
If you have super abnormally high levels of insulin your fat cells will be clogged and you will get fat. Insulin resistance causes high insulin levels.
What reduces insulin? What unclogs your fat cell drains? It's the absence of carbohydrates. Dietary fat doesn't stimulate insulin production and doesn't cause the clog that's why it's weight loss food.
Lunch today was provided by our friendly and generous drug rep! They served pizza and brownies and were selling the meds people must take if they've eaten too much pizza and brownies. Yup.. this cocktail of meds is useful to treat metabolic diseases you get when you chronically eat starch and sugar. Ironic no?
There is a great web site and video series called "Butter makes your pants fall off". Its' author is a 50 plus year old working class guy from Tennessee who lost a hundred plus pounds on high fat low carb diet. Now he is out there telling everyone how he did it. It's a great site to motivate anyone but especially older guys.
Eric Sodicoff MD
Member: Obesity medince Association