The Etiology of Obesity
We often accept the fact that the three primary causes of obesity are:
Sugar-sweetened beverages [actually sweet beverages]- Portion size
- Processed foods and the chemicals in those foods
The one exception to the silliness of labeling a food as “bad” would be sugar-sweetened beverages, which deliver an enormous amount of sugar in a mindless way and which lead to untoward negative effects.
Keep in mind that it is not just sugar. The problem really shouldn’t be described as “sugar-sweetened” beverages; it should be “sweet beverages.” Orange juice is no gift. The data in a recent article demonstrates that artificial sweeteners also lead to problems. As do all the “replacements.”
- Arnold Amanda R, Chassaing Benoit. Maltodextrin, Modern Stressor of the Intestinal Environment. Cell Mol Gastroenterol Hepatol. October 17, 2018;7(2):475-476. doi:10.1016/j.jcmgh.2018.09.014.
So, potentially we need to even go beyond the proscription of sugar-sweetened beverages to sweet beverages. That would not only wipe out sodas and excessively sugary juices but actually all juices and artificially-sweetened drinks. This would return human beings back to what they have drunk for a long time — which is mainly water. Ouch. But, actually pretty simple. Drink water, tea, and “real” coffee – the kind that is coffee and water and a tiny amount of milk/sugar to counteract the bitterness.
This brings us to the issue of wine. And, of course, wine has a caloric load. Here, the issue may actually be portion control. The incidence of alcoholism in France is not negligible. It is just not the same version of alcoholism as in America. Among the French that are not alcoholics, wine isn’t causing obesity. So, it may not be water vs. wine, but more related to the fact that (again) portion control is the primary distinguishing factor. The French are demonstrating portion control in their use of alcohol with the exception of those who are at genetic risk for addiction to alcohol.
In contrast, if you look at the population of beer drinkers in America, obesity is pretty common. The predominance of weight gain due to beer would argue that the same logic would put beer in the category of “eliminate.” Sorry, beer industry.
Portion
So, there are two elements:
Awareness of the risk- Development of a strategy
Unlimited Access to Food/Drink
I have talked before about buffets on cruises as a contribution to the cause of obesity. If one goes into a cruise or to a buffet/pot luck with a strategy, one can win. But, without a strategy [or, even worse, without recognition of the risk of weight gain due to excessive eating], when placed in a situation where food is unlimited, one will inevitably gain weight.
The Preparation and Purchase of Food
Here, too, there is both a recognition of risk as well as a need to develop strategies. Don’t cook too much, save what is left for leftovers. In other words, leftovers are okay. And, don’t buy too much. This totally fits with the value of low carb diets (no one says zero carbs) and it’s multiple benefits.
- Hyde Parker N, Sapper Teryn N, Crabtree Christopher D, et al. Dietary carbohydrate restriction improves metabolic syndrome independent of weight loss. JCI Insight. June 20, 2019;4(12). doi:10.1172/jci.insight.128308.
The French may love bread, but they wouldn’t bother to eat 99% of the bread in the US.
Food Size
One would need to reject food that comes in too large of a quantity. That is, perhaps it would be okay to accept the occasional small cookie, but one should reject a large cookie. Only eat 1/2 a bagel. Similarly, a bite of cake might be seen as okay versus having an entire huge slice of cake.
In fact, I have recommended this strategy to many folks with obesity and it works quite well. The way one would implement the cake strategy would be to not order a slice of cake, but share a piece with others you are dining with. In almost every situation, the person will find out that a bite or two is really all they wanted. And that they really had no desire to have a complete slice of cake. My guess is that this is how the patisseries in France do not lead to obesity. In essence, one buys a single pastry and shares it among 5 people. Each gets a bite of an incredibly tasty dessert and is able to satisfy their palette. It isn’t the quality of the food that’s the issue, it’s the quantity of the food.
This, too, is not a novel concept and has been well described. Many folks say that when one is ordering in a restaurant, one should ask for half the food and ask that the other half be put in a takeout container to be brought home.
What About Vegetables?
Limit them, too. Excess food stretches the stomach, so it will increase hunger later. Work toward a smaller stomach that is happy with what it gets. Ditto beans, rice, whole grains, you name it. Portion control.
The big difference that I’m highlighting here is a recognition and strategy approach that is well described. The difference is that portion control should be the most significant effort.
Potentially, emphasis related to carbohydrates vs. protein or fasting or hunger vs. satiety or other elements are actually not all that valid. That also explains why no diet has a tremendous effect, though they have a mostly similar effect. They all seem to have the same common element – they limit what you eat to some category of food (vega, vegetarian, low-carb, Mediterranean, DASH, low-fat, etc.)
Simple Food
The data is clear. The biome and body are unfamiliar with the chemicals in processed food, especially emulsifiers and sweeteners (e.g., maltodextrin, sucralose, et al.), as their impact is unpredictable and likely quite negative. It’s best to consume only foods that the biome and system are familiar with. These articles focus on inflammation, but much of the data translates to an impact on obesity as well.
- Per Chassaing Benoit, Koren Omry, Goodrich Julia, et al. Dietary emulsifiers impact the mouse gut microbiota promoting colitis and metabolic syndrome. Nature. March 5, 2015;519(7541):92-96. doi:10.1038/nature14232.
Artificial sweeteners, which have been rigorously demonstrated not to cause acute toxicity or cancer at physiological doses, have been shown to have clear effects on the microbiota in both mouse and humans in a manner that promotes dysglycemia, which is one of the primary conditions many consuming these products are seeking to avoid. Thus, the notion that a food additive is considered safe by regulatory agencies does not preclude detrimental effects on the microbiota or host.
- Arnold Amanda R, Chassaing Benoit. Maltodextrin, Modern Stressor of the Intestinal Environment. Cell Mol Gastroenterol Hepatol. October 17, 2018;7(2):475-476. doi:10.1016/j.jcmgh.2018.09.014.
Moreover, studies investigating the effects of maltodextrin on the central nervous system and behavior may shed light on yet another mechanism by which maltodextrin promotes metabolic abnormalities. Indeed, a recent study found that Splenda alters neuronal activity in the ventromedial hypothalamus and hippocampus of rats, 2 areas of the brain known to play an important role in food intake, food preference, obesity, and energy homeostasis.
Some additions to the diet may be helpful in terms of impacting the biome, but I would want to keep it simple and not mention tryptophan or resistant starch.
And, in case you wonder if the biome is that important, look at the results from an open-label trial of Microbiota Transfer Therapy (MTT) that combined antibiotics, a bowel cleanse, a stomach-acid suppressant, and fecal microbiota transplant.
- Kang Dae-Wook, Adams James B, Coleman Devon M, et al. Long-term benefit of Microbiota Transfer Therapy on autism symptoms and gut microbiota. Sci Rep. April 9, 2019;9. doi:10.1038/s41598-019-42183-0.
Based on the Childhood Autism Rating Scale (CARS) rated by a professional evaluator, the severity of ASD at the two-year follow-up was 47% lower than baseline (Fig. 1b), compared to 23% lower at the end of week 10.
At the beginning of the open-label trial, 83% of participants rated in the severe ASD diagnosis per the CARS (Fig. 2a). At the two-year follow-up, only 17% were rated as severe, 39% were in the mild to moderate range, and 44% of participants were below the ASD diagnostic cut-off scores (Fig. 2a).
The parent-rated Social Responsiveness Scale (SRS) assessment revealed that 89% of participants were in the severe range at the beginning of the trial, but the percentile dropped to 47% at the two-year follow-up (Fig. 2b), with 35% in the mild/moderate range and 18% below the cut-off for ASD.
For the parent-rated Aberrant Behavior Checklist (ABC), total scores continued to improve, and were 35% lower relative to baseline (versus 24% lower at the end of treatment, relative to baseline; Fig. 1d).
The Parent Global Impressions-III (PGI-III) scores remained similar to the scores at the end of treatment (week 10) of the open-label (Fig. 1e).
The Vineland Adaptive Behavior Scale (VABS) equivalent age continued to improve (Fig. 1f), although not as quickly as during the treatment, resulting in an increase of 2.5 years over 2 years, which is much faster than typical for the ASD population, whose developmental age was only 49% of their physical age at the start of this study.
Moreover, we observed improvement in behaviors in most sub-categories (Supplementary Figs S2c,d, and S3 for ABC, SRS, and VABS, respectively)
Summary
Water is key. All sweet beverages remain in the “avoid at all costs category.”- Portion control is essential. Wine is probably the only alcoholic drink, but it should also be in the portion control group, along with everything else.
- Focus on foods that have a single ingredient or minimal processing and read the label to reject foods laden with chemicals.
It sure is a lot simpler than all the diets out there. It might even work.
