How Do We Become Fat?

Listening to Leonard Lopate's show Please Explain on WNYC last Friday, I was struck dumb by some of the information his two guests -- Dr. Louis Aronne Clinical Professor of Medicine at Weill-Cornell Medical College-NY Presbyterian Hospital and Director of the Comprehensive Weight Control Program and Dr. Kelly Brownell Director of the Rudd Center for Food Policy and Obesity at Yale University -- had to offer.

The discussion was about obesity -- why and how we get fat. Drs. Aronne and Brownell offered up all of the stock notions that lead or cause obesity such as inactivity, eating too many calories, a toxic environment, eating too much fat, eating too much sugar and fat, hunger signals not getting shut off due to eating the wrong foods (meaning eating too many calories), and more. They went 'round and 'round and flitted about the issue but never once got to the heart of the matter -- why do we accumulate excess fat if we eat too much, are sedentary, eat toxic foods, etc.

They spoke as if becoming fatter was a complex, convoluted process. They went on about the issue and used words such as 'multi-factorial' and other such non-specific, broad terms that would make the English logician William of Occam gyrate in his grave.

Clearly these are learned men. But bright as they might be, they are apparently afflicted by a 'paradigm paralysis.' In this case, the paradigm is that obesity is an outcome of eating too many calories and sloth-like behavior (caused by A, B, C, D, E, F, G....).

So if the answer is so simple, why do we get fat even if we are slug-like, eat too much and are glowing from too many toxins? If one day I woke up and I had $40,000,000 in the bank, I would sure like to know why. If I asked the bank manager and he said "More money has been deposited than withdrawn." I would say "Obviously sir -- but why did it get deposited?" Why didn't the $40,000,000 get spent? Why is it in my account? I'm not interested in the cause -- I'm interested in the process.

In thinking about this, I've noticed that when I hear experts discuss the issue of obesity, using the word 'cause' causes a veil of idiocy to drape over them. If instead the word 'process' was used, I think this shroud would be lifted. So instead of saying "The cause of obesity is..." it would be better to say "The process of obesity is..." Saying it like this, it would seem silly to say "The process of obesity is eating too many calories and being inactive." That's not really a process. And it leaves a chasm. To me, this chasm is the main reason why we are getting nowhere on the obesity front. So many experts allow themselves to fall into that abyss. "The cause of obesity is (insert abyss) eating too many calories and inactivity."

Said better: "The cause of obesity (remove chasm by adding...) is elevated blood sugar, which can result in excess circulating insulin, which allows for excess fat storage and confinement which can be caused by eating too many calories." If said like this, the chasm would vanish and the solution would be revealed.

Clearly then, getting fat is not just about eating too many calories or not expending them. There is a process that must occur in order for fat to accumulate. $40,000,000 doesn't come from nowhere. There is a process that causes the accumulation of such wealth.

My friend Gary Taubes, author of the NY Times bestselling masterpiece Good Calories Bad Calories explains the process of obesity thusly:

Obesity is a disorder of excess fat accumulation. So the question everyone should be asking and always should have been asking is what factors regulate fat accumulation? As it turns out we've known that since the 1960s and it is not controversial. You can find it in endocrinology and biochemistry textbooks, just not obesity textbooks. Fat accumulation is fundamentally determined by the hormone insulin and our insulin levels go up and down with the quantity and quality of carbohydrates we consume. The more carbs we eat, the more refined they are and the sweeter they are (the more fructose in them, in other words), the more insulin we will ultimately secrete. The higher our insulin levels, the more fat we accumulate.

This is what one of the people who commented on the Lopate show called "endocrinology 101." Gary calls it "Adiposity (fat accumulation)101."

Carbohydrate drives insulin, insulin drives fat accumulation. This simple and pure explanation would make William of Ocaam smile big. "The process by which you obtained the $40,000,000 dollars was your brother sold your shares of Berkshire-Hathaway and deposited it into your account."

Gary also found the following quote in the Fifth edition (2009) of Lehninger Principles of Biochemistry (which is probably the most respected biochemistry textbook in the business):

High blood glucose elicits the release of insulin, which speeds the uptake of glucose by tissues and favors the storage of fuels as glycogen and triaglycerols, while inhibiting fatty acid mobilization in adipose tissue.

There you have it. You wonder how the good doctors Brownell and Aronne missed this information. These facts must be in their heads. Why the disconnect? Could they really be so paralyzed by the 'calorie is a calorie' paradigm?

More from Gary:

High blood glucose comes from eating carbohydrates. (Blood sugar is a carbohydrate -- glucose). That prompts the secretion of insulin, which speeds the uptake of glucose by tissues and favors the storage of fuels as fat. So long as the insulin stays elevated, it will inhibit the release of fat from the fat tissue. So you raise insulin levels, you store calories as fat and you don't get them out. Eventually you become insulin resistant. Now your insulin levels remain abnormally elevated most of the time and so your fat tissue tends to work mostly in one direction -- storage rather than mobilization of fat. In short, you get fatter.

Bear in mind that this is not Gary's opinion -- these are facts -- processes of biochemistry.

It's interesting when you think about it -- if a child grows to be 7 foot tall by the time he's 15, do we blame this cellular explosion on eating too much food? No. We know that his pituitary gland has gone bonkers producing too much human growth hormone (HGH) and the process gigantism begins.

If a person has a giant tumor growing in or on their body, either cancerous or some other type of group of growing cells, do we blame this condition on eating too much food? Of course not.

Anytime cells grow out of control, experts know that hormonal havoc is at the forefront except when it pertains to obesity. What do the experts claim is the cause of fat cells growing out of control? Eating too much food. All thoughts of hormones or the process are expunged and tossed aside like so much flotsam.

Gary discusses these issues at length at the Dartmouth Grand Rounds. It's worth your time to listen to this lecture.

During the Lopate show on obesity, a caller asked Dr. Aronne about the role of exercise. He mentioned something to the effect that research reveals that interval exercise (walking slowly, then walking briskly) was the best form of exercise for fat loss. I am unaware of such research and could not find it after searching. Truth be told, exercise does very little if anything to affect fat loss. More than likely whatever positive effect exercise does have on fat loss comes from an improvement in insulin sensitivity, not from caloric expenditure as is commonly thought. But this improvement is slight. You can't exercise your fat away ladies and gentlemen. You have to speak the correct language to your body if you wish it to release fat from your fat cells. And now you know what that language is.

The answer to obesity is simple. Always has been and always will be. Don't let your body over-secrete insulin, the hormone that causes the accumulation and incarceration of fat.

Sugar (not fat, calories or sloth) is the big fat slob.

Here's the plan:

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Comments

[dsws]

The shift from tautological "why" to substantive "how" is good.

But it's not just insulin. There's glucagon. There's ghrelin. There's cortisol. There's innervation of adipose and endocrine tissues formerly thought to be unaffected by any signals from the nervous system. There's interaction with the immune system.

Eating a jar of mayo every day would be very unhealthy, even if you ate enough protein, vitamins, fiber, and assorted phytochemicals along with it. Eat the same number of fat calories from a mix of flax, olive, corn, fish, insect-fed-chicken eggs, and grass-fed animal fat, along with the same sources of protein, fiber, etc., and you'd probably be just fine. Mayo is basically soybean oil with enough factory-farmed egg yolk to emulsify it. Soybean oil is a very unbalanced fat, in terms of the length of fatty-acid chains and where they're unsaturated.

[Fred Hahn - Huffpost Blogger]

This blog post was written to explain how we accumulate fat , not how healthy or unhealthy certain fats are.

And yes - you can eat a very low carbohydrate diet and if other hormones are out of whack gain body fat. Perhaps I should have been more specific about the role of the liver and cortisol. Still, the easiest thing a person can do to combat obesity is to lower their carbohydrate intake not to lower calorie intake or exercise more. That was the main point.

[bowseat93]

This is a really great post. I'm only sorry that diet composition is so polarized between the low-carb and low-fat folks -- I believe the truth is somewhere in the middle. In fact your friend Michael Eades recently tweeted about a study promoting the benefits of a "high protein" diet that was 40% carbs! http://twitter.com/DrEades/status/3196768954

Seems to me that folks would be far more compliant (and even better off) if we looked at moderate carb diets more. I'm not particularly fat phobic, but am not particularly interested in a life in ketosis either.

[Fred Hahn - Huffpost Blogger]

What's more important is the type of carbs. If 40% of your diet is carbs but consist of veggies and some fruit only, you're good. If instead your carbs are primarily starches and junk, you're asking for it.

You don't have to induce ketosis to live well and stay on a low sugar diet. A VLCKD is usually used for health issues and obesity and used for a short time.

Thanks for reading!

[bowseat93]

I am with you on the primarily starches and junk being problematic, but think that a life of carbs solely from veggies and some fruit is nearly as restrictive (and unappealing) as a very low-carb diet. Surely there is room in one's diet for some healthy starches: beans, legumes, whole grains?

[Yan Fayman]

Interesting hypothesis. If it is correct, you should be able to eat a jar of mayo(no carbs) every day and not get fat. How confident are you in your beliefs? I'm not sure about what results you will recieve since I have never done this. In order to get away from the current paradigm, we need data to show that calories don't really matter. I'd be interested to see your results.