Caveman Doctor was recently arguing with another physician about the cause of the obesity epidemic. Caveman Doctor was trying to explain that people are “eating too many carbohydrates and modern/processed foods”, while the other doctor was falling back on the typical conventional wisdom. He kept saying things like it’s all about calories in (how much we eat) versus calories out (exercising), and people have become essentially lazy and poor decision makers, thus why they are obese. They started to get into the data, and Caveman Doctor became furious as he realized, once again, the other doctor has never even looked at the data but was merely following recommendations from the “authorities”. Caveman Doctor became so enraged that he challenged the other doctor to a good ole club off. Caveman Doctor is now looking for a new job, so if you know anyone who is hiring, please contact him on the internet (whatever that is).
Maybe we’re not all just fat, lazy, and stupid: The psychological advantage of fats over carbs
In 1977, after intense discussion on the state of the diet of the people of the US, the McGovern Committee issued a set of nutritional guidelines they thought would “combat” heart disease, cancers, stroke, high blood pressure, obesity, and diabetes. Three years later, the official Dietary Guidelines for Americans were made, with fat chosen as public enemy number one. The guidelines can be summed up by the infamous Food Pyramid above. Thus the low-fat campaign began in this country, demonizing fats, and especially saturated fat. Since then, saturated fat has been held responsible for obesity, diabetes, cancer, the Pittsburgh Steelers losing to the Cowboys in ‘95, and even the fall of the Soviet Empire (okay, maybe not the last two, but almost any health problem was linked to fat). With fat now no longer part of a healthy diet, it had to be replaced by some other food source, and the experts recommended we start eating more carbohydrates. Never mind that we only consumed carbohydrates in small amounts over the past several million years; they were the new health food. Here is how we have done with obesity since these recommendations (adapted from the National Health and Nutrition Examination Survey [NHANES] database)1:
Even a caveman could look at this graph and follow the pattern, and it looks like something changed right around 1977 (the same year as the McGovern report). We started demonizing fat, and fat sat by, laughed a little, and watched the weight of our population grow to epic proportions. The exactness of this graph is absolutely remarkable, down to the very year. This is not surprising though. Take a look at the food pyramid below, which is the visual aid of our government’s recommendations. I can’t even imagine eating 11 servings of bread or pasta a day: I would gain a ton of weight and would be tortured by the blood sugar highs and lows.
What do we make of the obesity epidemic that seems to have started at the exact time we shifted the dietary paradigm? While we all agree it’s concerning, I disagree with many of the “experts”, who will essentially tell you the reason people are all getting fatter is:
- People are stupid (they can’t follow the dietary recommendations).
- People are lazy (they just don’t exercise as much).
- People are gluttonous (they are eating way too much).
Notice these are all based on the premise that the recommendations are 100% appropriate. The recommendations can’t be wrong, but rather people are fat, lazy, and stupid. How do you feel about this? Well, it bothered me, so I started to think about it more… A lot more. Actually, I thought about it nonstop for the past several weeks and did some research. As a result, I have a slightly different theory.
Caveman Doctor’s Theory
- People aren’t stupid (most people actually follow the US dietary guidelines).
- People have decreased their activity thanks to technology, but this is not fully responsible for us getting bigger.
- Certain foods make people more gluttonous.
Let’s review both sides of the argument.
Expert Theory 1: People are stupid and can’t follow guidelines.
Caveman Doctor’s Theory: We are smarter than they think and actually are just following their stupid directions.
First off, let’s look at hot we did at following these new recommendations – are we really that stupid? Here is a recent graph from the NHANES Database showing the percentage of calories, carbohydrates, fat, and protein in our diet over thirty years:
It looks like we are actually doing very well following the recommendations. Fat intake has consistently dropped, while carbohydrates have replaced them to a greater degree, just as our authorities told us. This data has been confirmed in several other nutrition and diet databases and published,3 leading the authors to conclude:
“It appears that efforts to promote the use of low-calorie and low-fat food products have been highly successful and have been in line with the objectives of the US Public Health Service.”
The well-intentioned McGovern group gave us this diet in 1977, mostly in an effort to avoid heart disease and cancer. It boils down to this: replace high fat foods that we have been eating for millions of years and those which our bodies process like a well-oiled machine, with high doses of modern carbohydrate-laden grains. It looks like not only were we all smart enough to comprehend the new guidelines, but we ate them up – literally! The foundation of our diet, just like the food pyramid, became grains. Think about the average daily meals most people eat:
- Cereal, oatmeal, or bagel for breakfast (grains, and massive carbohydrate amounts)
- Slice of pizza, quesadilla, or sandwich for lunch (even more grains and carbs)
- Potatoes, rice, beans along with meat and vegetables for dinner (more grains…)
And notice, this would be a “healthy” diet! I didn’t even get into fries, potato chips, pasta, or sweets. Grains and carbohydrates have become a major part of every meal for most Americans, under the direction of our leaders. Not only are we smart, but we are a trusting people: we trusted the “authorities” enough to follow their recommendations. In conclusion, we are not too dumb to follow directions. We are just misdirected.
Expert Theory 2: People are lazy (they just don’t exercise as much).
Caveman Doctor’s Theory: We could benefit from increased activity, but this hardly accounts for the massive increases in obesity, especially in the past decade.
Less Walking, More Driving:
I was recently giving a talk on cancer and low-carb/high-fat diets to an audience of medical personnel. As always happens, the conversation took a turn to low-fat diets surely being the best for cardiovascular health and fighting obesity. A friend of mine who has closely followed a caveman diet (i.e., high fat and low carb) for a year lost 10 pounds and watched her cholesterol levels dramatically improve. I shared her story, and her labs, as proof of my argument. The viewers were in disbelief – rightly so as it was in contradiction of everything they were taught in medical school. The next questions was the classic response, “Yes, but how much has her exercised increased?” Amazingly, before I could answer, a physician stood up and exclaimed: “I am on the same diet and made no alterations in my activity levels. Yet, I witnessed the same changes in my weight and lipid levels, irrespective of exercise.” An amazing moment for sure and extra amazing as it shows more people (and physicians) are returning to the diet we are meant to eat.
This is another simple topic that has eluded our nation’s best and brightest policy makers. However, if you go to your local gym and ask the first jock you see how to lose weight, he’ll tell you that he “cuts carbs” before the beach or a bodybuilding competition to “get ripped”. In fact, many body builders do no more cardio than 30 minutes on the treadmill a day walking. Granted, they are lifting heavy weights, but the point here is that activity can stay the same and restricting carbohydrates alone results in cutting fat and extra pounds.
However, let’s look at the data below. Did people mysteriously turn very lazy overnight, roughly around 1977? Or did something else happen at this period that can explain it? A common remark is that people used to be much more active. While that’s true, it’s not the whole story as you’ll see below. Another similar common criticism is that we used to walk everywhere, and now we drive everywhere. This lack of walking is a major cause of the obesity crisis. However, if you look at the graph below (adapted from the Federal Highway Administration), we stopped walking and started driving a lot sooner than 1980. In fact rates shot up far before this period and as of recently, they are plateauing!
Yearly Miles Driven Per Capita and Per Licensed Driver
This next graph shows the percentage of those that engage in no physical activity during their free time from 1988 to 2008. Unfortunately, data is limited prior to this time period. While the graph shows an amount clearly lower than we would all like to see, the rates changed little in almost 20 years and have actually decreased since 1996 (adapted from data from the CDC)4. Other data supports the minimal change in activity levels during this time.3 Yet, obesity has continued to explode during this time.
Better, yet, let’s look at recent gym membership trends (from Google Trends):
And the trend continues to increase. How many people belonged to gyms in the 50’s, 60’s, 70’s, or even 80’s? It was pretty much limited to Gold’s Gym in California, Arnold, Franco Colombu, Lou Ferrigno, and Joe Weider. Did people go jogging during these periods? Nope. So while some people are becoming more sedentary, many people are likely becoming MORE active.
Overall though, yes, many people are likely less active. Can this explain the ever-climbing trends in obesity? No. Especially if you look at data from the last ten years or so. The two factors of activity and weight gain are uncoupled, and, as in this case, are not always directly proportional to each other.
Expert Theory 3: People are gluttonous (they are eating way too much).
Caveman Doctor’s Theory: Certain foods make people more gluttonous.
Returning to the graph above, people are eating more and more carbohydrates each year, while dropping the amount of fat and even protein. Let’s look at calories eaten:
So it would appear that people have slightly increased their caloric intake according to the CDC (Center for Disease Control). However, compilation data from several databases actually shows that caloric consumption actually decreased by 4% from 1976 to 1991, the same period where the initial surge in weight gain occurred.3 People love to look at all these factors individually, as if there is no connection between increased carbohydrate intake and increased caloric intake. Fat usually has the bull’s-eye on its behind because it has nearly double the calories per gram than carbs or protein, but this is a shortsighted view as we are ignoring the physiological and hormonal response to eating carbohydrates.
When we eat carbohydrates we get a physiological response that makes us eat more food. The increased carbohydrates cause large increases in insulin and a plummet in our blood sugar (after the initial spike). This then stimulates our hunger, leading us to eat more carbs or anything else around (but especially carbs, as they can quickly spike your blood sugar back up, leading to a vicious cycle). And let’s not forget that sugar and carbohydrates affect the same area of your brain where cocaine and drugs act.5-8 Some of my patients tell me they are “addicted” to bread, and they are right in a very real way. All food is not created equal, nor does all food have the same effect on your body.
Tom Naughton explaining why we get fat.
A simple way to view this is to ask yourself how many times have you binged on pure fat and protein foods. A salty steak is absolutely delicious. How many times have you eaten one and just HAD to eat another steak or two? How many times have you lathered vegetables with some grass-fed butter and salt and became out of control and couldn’t stop eating them?
Replace those vegetables with a piece of bread. How many times have you had “just one” piece of bread only to turn possessed and finish the basket? Caveman Doctor tried bread once, and after he went savage on the restaurant to get more, even his simple mind realized that there is a lot more to this food than its caloric content. Something different happens when we eat carbohydrates.
Looking at things from the perspective that we are made to process the same foods we have eaten for millions of years, this makes perfect sense. Fructose, a sugar that makes our brain go a little crazy for food every now and again, has been found in safe food sources throughout the lifetime of humans: fruit. Fruit, and by fruit I mean mostly fibrous smaller-sized fruits in small amounts(not the modern fruits that are loaded with sugar and the size of your head), has been a safe food for us has been around for millions of years (unlike grains). Therefore, it is not surprising that it activates a part of our brain that says “good stuff here”. Unfortunately, even small amounts of carbohydrates hit the same receptors in our body and make us crave more food, especially more carbs. When we changes this to large amounts of carbohydrates, all bets are off.
Telling people to eat more carbohydrates and less food overall is not a diet, it is torture. It is the ultimate test of someone’s willpower. When carbohydrates hit our brain and turn our blood sugar levels into a roller-coaster ride, we crave more and turn into gluttons. The recommendations to eat more carbohydrates are the CAUSE of our current gluttonous state, NOT THE RESULT of it – down to the exact date of these recommendations!
People have been fighting about whether eating fat gives you a metabolic advantage over carbohydrates for years. Well, we can ignore the controversial, but very compelling “metabolic advantage” theory of fats versus carbohydrates9,10 and turn our attention to the “psychological advantage” of eating fats over carbs, which can be viewed all around us. Let’s stop blaming people for gaining weight. Let’s at the very least re-examine the recommendations.
The “experts” have updated the food recommendations with the recent “Food Plate”, which pushes fruits, grains, protein, vegetables, and a side of dairy. There is once again a general theme of avoiding fats, which, depending on how you look at the table, can actually make up no part of the diet. Judging by the past, I would expect such recommendations to have little effect on reducing the weight of our nation.
Yet, fat is getting the last laugh as we now have anecdotal evidence and high quality level I evidence that a low-carbohydrate and high fat diet is vastly superior to a low-fat diet in not only weight loss, but also in reducing inflammation, blood sugar, insulin, and triglyceride levels, while increasing HDL (healthy cholesterol)11-15. The fact that it actually improves cholesterol is perhaps the bitterest pill to swallow for our health leaders that have been clinging to these horrendous recommendations.
Here is what the simplistic real food pyramid should look like:
If you are struggling with losing weight, maybe it’s not just you. Maybe you are just following bad advice. You are not a lazy, gluttonous, stupid person.
1. Ogden CL: Prevalence of Overweight, Obesity, and Extreme Obesity Among Adults: United States, Trends 1960–1962 Through 2007–2008, 2010
2. CDC: Trends in Intake of Energy and Macronutrients — United States, 1971–2000, 2004, http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5304a3.htm
3. Heini AF, Weinsier RL: Divergent trends in obesity and fat intake patterns: The american paradox. The American journal of medicine 102:259-264, 1997, http://linkinghub.elsevier.com/retrieve/pii/S0002934396004561?showall=true
4. CDC: Physical Activity Statistics, 2012, http://www.cdc.gov/nccdphp/dnpa/physical/stats/leisure_time.htm
5. Avena NM, Hoebel BG: A diet promoting sugar dependency causes behavioral cross-sensitization to a low dose of amphetamine. Neuroscience 122:17-20, 2003, http://www.sciencedirect.com/science/article/pii/S0306452203005025
6. Avena NM, Rada P, Hoebel BG: Evidence for sugar addiction: Behavioral and neurochemical effects of intermittent, excessive sugar intake. Neuroscience & Biobehavioral Reviews 32:20-39, 2008, http://www.sciencedirect.com/science/article/pii/S0149763407000589
7. Colantuoni C, Schwenker J, McCarthy J, et al: Excessive sugar intake alters binding to dopamine and mu-opioid receptors in the brain. NeuroReport 12:3549-3552, 2001, http://journals.lww.com/neuroreport/Fulltext/2001/11160/Excessive_sugar_intake_alters_binding_to_dopamine.35.aspx
8. Rada P, Avena NM, Hoebel BG: Daily bingeing on sugar repeatedly releases dopamine in the accumbens shell. Neuroscience 134:737-744, 2005, http://www.sciencedirect.com/science/article/pii/S0306452205004288
9. Feinman RD, Fine EJ: “A calorie is a calorie” violates the second law of thermodynamics. Nutrition journal 3:9, 2004, http://www.ncbi.nlm.nih.gov/pubmed/15282028
10. Fine EJ, Feinman RD: Thermodynamics of weight loss diets. Nutrition & metabolism 1:15, 2004, http://www.ncbi.nlm.nih.gov/pubmed/15588283
11. Forsythe C, Phinney S, Feinman R, et al: Limited Effect of Dietary Saturated Fat on Plasma Saturated Fat in the Context of a Low Carbohydrate Diet. Lipids 45:947-962, 2010, http://dx.doi.org/10.1007/s11745-010-3467-3
12. Forsythe C, Phinney S, Fernandez M, et al: Comparison of Low Fat and Low Carbohydrate Diets on Circulating Fatty Acid Composition and Markers of Inflammation. Lipids 43:65-77, 2008, http://dx.doi.org/10.1007/s11745-007-3132-7
13. Hite AH, Berkowitz VG, Berkowitz K: Low-carbohydrate diet review: shifting the paradigm. Nutrition in clinical practice : official publication of the American Society for Parenteral and Enteral Nutrition 26:300-8, 2011, http://www.ncbi.nlm.nih.gov/pubmed/21586415
14. Volek J, Phinney S, Forsythe C, et al: Carbohydrate Restriction has a More Favorable Impact on the Metabolic Syndrome than a Low Fat Diet. Lipids 44:297-309, 2009, http://dx.doi.org/10.1007/s11745-008-3274-2
15. Westman EC, Yancy WS, Edman JS, et al: Effect of 6-month adherence to a very low carbohydrate diet program. The American journal of medicine 113:30-36, 2002, http://www.sciencedirect.com/science/article/pii/S0002934302011294
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