Standards for nutrition textbooks, say good by to “we are what we eat,” and hello to “Who we are determines what we eat, or more precisely, how we eat.”

That was so well said, I can’t believe it’s not butter.

Yours truly,

Mark R.

Use the wrist measurement below to determine a small, medium or large frame size:
· Small = wrist size 5.5″ to 6.5″ (14 to 16.5 cms)
· Medium = wrist size 6.5″ to 7.5″ (16.5 cms to 19 cms)
· Large = wrist size more than 7.5″ (19 cms)

Most importantly, please understand that the idea that “weight gain is simply a matter of eating too much” cannot be correct for a number of fairly obvious reasons. Let me offer a few.

First: There are approximately 36,000 Calories in a pound of fat. If a person’s weight is to remain stable (say, plus or minus a couple of pounds) over a period of a few years, as many people do (even overweight and obese people) then such people
must be balancing their caloric intake vs. calories burned, on average, to less than 10 Calories per day! Think about it. Nobody consciously does anything like that! No diet plan ever suggests that and neither you or I believe that such dietary control is possible. So how is it possible for anyone to maintain a constant body weight UNLESS there are automatic, internal mechanisms that “tune” the body? The answer is there are internal mechanisms for setting body weight. The question becomes “What are the mechanisms that set body weight?”

Second: Many people use the second law of thermodynamics (calories in must burned or turned into excess weight) to explain why eating too much causes people to gain weight. While it is definitely true that calories, energy, don’t just disappear, nothing about the second law explains what drives any of the three parts of the equation. “Calories in” is somehow related to hunger. Most people stop eating when they feel full. What causes people to feel full? “Calories burned” is highly variable. A large fraction of calories burned maintain body temperature and small changes in clothing and vasodilatation can greatly affect the calories needed to do this. How is that all regulated? Given the first two items, “calories left over” can be large or small, positive or negative, and the second law says nothing about how much it might be. Gary Taubes uses the wonderful analogy: observing a restaurant full of people says nothing about why it is full. Maybe it’s slow service, maybe it is very popular, maybe it is the only restaurant in town. Saying it is full because more people have entered than have left, while definitely true, is not a meaningful explanation for why it is full.

Third: Adipose tissue is not an uncontrolled recipient of excess calories any more than, say skin or muscle or any other tissue are uncontrolled recipients. Adipose tissue responds to hormones, primarily insulin, and extracts fuel from the
bloodstream in accord with the level of insulin in the bloodstream. It is precisely because adipose tissue extracts fuel that people with excess adipose tissue (fat people) appear to eat too much. It is backward thinking to believe a fat person eats too much and therefore gets fat; rather, a fat person’s adipose tissue removes lots of fuel to make fat cells bigger. In order to have fuel left over for other metabolic functions a fat person needs to eat more. The real question is why does adipose tissue extract so much fuel? Answer, primarily, is too much insulin from eating too many carbohydrates.

Have you seen the recent physician training photo in the NEJM? (Go to garytaubes.com) It shows Insulin Lipohypertrophy. The photo shows the front of a normal weight male with two grapefruit sized fat nodules on either side of his navel. The diagnosis is repeated injections of insulin at those two locations. Locally high levels of insulin, over time, told the fat tissue in those areas to
grow.

If you’ve read this far, thank you. It is important for people to start getting the fat story right. The implications for diabetes, cardiovascular disease and probably cancer and Alzheimer’s are enormous.

I, and some of my friends, have had the same failures using calorie control for decades. Then, with the insight of insulin, I quit eating carbs seven years ago and almost immediately weight became a non-issue. 35 lbs. fell off over the next 18 months without ever restricting calories once. I eat as much as I want, as often as I want, and am confident that my 23.7 BMI is not going to go up as long as I don’t eat carbs.