Understanding Weight Gain and Weight Loss
I am not a weight loss specialist, but I have a pretty straightforward take on the issue of weight loss. My approach is to give people a clear understanding of why people gain weight and outline a path to weight loss that makes sense within this framework. My suggestions may not work for everyone, and some people may have underlying psychological and emotional reasons for overeating that they also need to address, but generally, losing weight is not rocket science.
In my practice, I focus on health, not weight. I don’t like weighing people, and I don’t calculate body mass index (BMI) or other parameters of that sort. People’s goal really should be to get as healthy as possible, and, by definition, being healthy usually means that they will end up at their optimal weight. People’s ideal weight will vary, depending on a lot of known and unknown factors, so their goal cannot be simply to attain a specific number.
There are people who pursue weight loss by eating a diet of four to six hundred calories per day. I can tell you that while they will definitely lose weight (and maybe even become underweight), they will probably have a miserable life and will be hungry all the time. The goal should not be to achieve a certain BMI for its own sake but rather to be as healthy, strong and fit as possible—and feel well. For some people, weight loss will naturally result from the process of becoming healthier.
UNDERSTANDING WEIGHT GAIN
How many people remember Jackie Gleason? He played Minnesota Fats in the 1961 Paul Newman movie The Hustler, and he was the laughable “fat guy” later on in the 1960s. If you met the 1960s Jackie Gleason today, however, you would consider him relatively slim. He was a little overweight, but he wasn’t obese. He was very agile and nimble. Today, he actually would be in the bottom 20 percent of fifty-year-old men, weight-wise. Over the half-century since Gleason, we’ve been told a lot about weight loss. It hasn’t accomplished much.
The flip side of asking how to lose weight is to ask, “Why do people gain weight?” Obviously, there are all kinds of books and studies that address this question, but for me, it’s actually pretty simple. Basically, people gain weight because of insulin.
Insulin is the endocrine hormone made by the pancreas. Insulin helps remove sugar from the blood and take it into the cells, where it is stored as fat. Despite the persistent belief that weight gain is all about calories, without insulin it is impossible to gain weight and become fat, no matter how many calories someone takes in. We know this because someone who loses the ability to make insulin, which we call a type 1 diabetic, can eat five thousand calories—two times the norm for any person—and still starve to death. People who stop making insulin will starve and go into a diabetic coma unless somebody gives them insulin. Weight gain is not about the calories.
Insulin production is the body’s way of saying that it is overfed with sugar. In evolutionary terms, this is a good thing. If you have the option of being overfed, you take it, and then—because the body has to do something with the sugar—you have an endocrine organ, the pancreas, which makes a hormone (insulin) specifically designed to store some of that sugar as fat. So if something you are doing in your life is causing you to make more insulin, you will store more fat. If you want to understand why you get fat or why you create fat in your body, then you simply need to look at what is happening with insulin.
At this point, some people might ask me to prove my assertion by testing insulin levels. There were points in my career where I did just that—testing people’s fasting insulin levels throughout the day. My experience with that approach led me to conclude that testing insulin levels is very unrewarding and unhelpful because of the nature of hormones. For example, testing insulin levels at a certain point may yield one level, depending on certain things that happen. If you test again in another hour or two, insulin could be at a totally different level. Unless you’re testing every two hours throughout the day for a month—which is expensive and impractical—you will not get any clinically useful information. I now go with what I see, which is, “You’re storing fat, you have too much insulin.”
The next logical question is, “What makes people chronically have too much insulin?” The answer to that question is very simple and straightforward: “You are not eating a balanced diet.” I know that eating a “balanced diet” is everybody’s road to heaven, and if you’re sick or unhealthy, it’s because “You’re not eating a balanced diet,” but I’m going to give you a very specific definition of what I mean by a balanced diet.
From a macronutrient (meaning large nutrient) perspective, there are three food groups: fat, protein and carbohydrates. That’s it; it’s pretty easy to remember. Setting aside the vitamins, minerals, antioxidants and so forth that also contribute to a healthy diet, I’m talking about the basic dietary building blocks that build up human beings and give them the energy to move and do activities.
In the classic macronutrient profile, each macronutrient serves a purpose. The reason we eat fat is to make hormones to regulate inflammation and as a back-up source of energy. We eat protein to build the structure and integrity of our body. Protein also can be a back-up source of energy. Finally, we eat carbohydrates to make fuel to do activities. From an energy standpoint, all carbohydrates—whether in white sugar, brown rice, carrots or any other carbohydrate-containing food—are the same (although clearly there are other ways in which they are not at all the same). Carbohydrates break down into glucose and pass into the bloodstream. Glucose provides cellular fuel when it converts to adenosine triphosphate (ATP), the molecule that carries energy to where it is needed. Fats and proteins are the car that we make in the assembly line, while carbohydrates are the gasoline.
The amount of protein and fat that make up a balanced diet will depend on a person’s body size, whether they have a disease and how much repair they need. At the same time, we have a very good internal feedback system that lets us know whether we’re overeating fat or protein. Most people who eat way too much fat or protein will feel sick or nauseated. (If you don’t believe me, try eating fifty eggs or a jar of ghee or coconut oil.) Although these are good foods, somewhere along the way your body will say, “I’ve had enough.”
Whereas it’s an unpleasant experience to overdose on even the best fat, I have seen a lot of people, including my children and probably even me, easily eat a box of Kellogg’s cornflakes, a box of doughnuts or any sugary carbohydrate. If you go to a macrobiotic center, especially where they don’t eat any animal products, you’ll see how much rice they eat. Apparently, there is no internal mechanism that tells us to stop eating foods that are mostly carbohydrate. Excess carbohydrate doesn’t make you sick the way excess fat and protein do.
If you didn’t do anything all day except sit on the couch, you would need about sixty grams of carbohydrates a day to make fuel to generate energy to keep yourself going. That’s the baseline level of carbohydrate. Given that an apple is about thirty grams and a small bowl of rice might be another thirty, sixty grams is hardly anything. I can tell you that nobody is eating just sixty grams of carbohydrate a day unless he is trying to limit to sixty grams intentionally. It doesn’t happen on its own. Nonetheless, for a person sitting on the couch all day, a balanced diet would mean lots of fat, modest protein, lots of non-starchy non-carbohydrate vegetables and about sixty grams of carbohydrates.
People who run a marathon every day would require a different balance. While they might eat roughly the same amount of protein and fat (or possibly a little more protein to repair the body), they would need substantially more carbohydrate (a fair guess might be three hundred grams) because they are doing a lot of energetic work that demands fuel. From my standpoint, therefore, it is nonsense to talk in the abstract about requiring a certain number of grams of carbohydrate, because your carbohydrate intake should entirely depend on your activity level. The problem in the U.S. and the world is that we eat like marathon runners but never get off the couch. That means that people eating like marathon runners can end up with two hundred and forty grams of carbohydrate that serve no physiological function.
MACRONUTRIENTS AND INSULIN
Generally speaking, fats and proteins have no impact on one’s production of insulin (except in extreme situations), and the body does not need insulin to assimilate them. Carbohydrate metabolism, on the other hand, is directly related to insulin. This is because the body has only two mechanisms to deal with blood sugar that goes too high: exercise and production of insulin. When someone consumes carbohydrate foods that chronically raise the blood sugar in excess of the amount of energy needed by the muscles for exercise, over time that person starts making more and more insulin. Over a period of five, ten or thirty years, that person becomes prediabetic and then diabetic. At a certain point, insulin resistance sets in, meaning that the insulin is no longer as effective as it should be. Because insulin is more effective on muscle cells than it is on fat cells, there is also a feedback loop in which the more fat one stores, the more insulin-resistant one becomes.
We do not want to be in an overfed state because insulin is a very inflammatory hormone. If you have high insulin levels, you will create a lot of inflammation in your tissues. Arthritis is an example of a condition that thrives in a high-insulin environment. People with diabetes are nearly twice as likely to have arthritis as those without diabetes. Insulin also signals the body to retain fluid, which fosters high blood pressure; furthermore, it is a growth hormone, which is implicated in the development of cancer. A high-insulin environment contributes to broad metabolic deterioration and is not a harmless situation.
STEPPING IT UP
When you are gaining weight, the physiological reality is that you are in a chronically overfed state. If you are pursuing improved health (with a related goal of weight loss), the first step is to adjust your carbohydrate level to be 10 to 20 percent lower than your activity level so that you are in a slightly underfed state. For example, if you insist on sitting around and never getting up off the couch, you might limit yourself to forty-five grams of carbohydrate a day. With sixty grams as the baseline but consumption of only forty-five grams, your body will have to convert your fat stores into sugar to keep you from getting hypoglycemic—this is in situations where you don’t exercise at all, so it is much better to exercise and have a somewhat higher carb consumption.
Glucagon, the insulin antagonist, will signal the body to break down fat and mobilize the fat into sugar in your blood. (Note that if you don’t eat any carbohydrates at all, you can turn your protein into sugar using the pathway called gluconeogenesis, which means new glucose production. This, however, does not enter into most people’s situations.)
The next crucial step is to step up your game, so to speak. If we go twelve hours without eating any food—protein, fat or carbohydrate—we run out of the stored glycogen starch in our liver, which is there to get us through a twelve-hour fast. After twelve hours, the hormonal situation switches over to make glucagon, which says to the body, “Now you have to mobilize the fat and turn that into sugar in the blood.” If you eat every eight hours every day of your life, you will never even tap into the glycogen stores in your liver, let alone create the hormonal environment to mobilize your fat.
The rule, therefore, is to fast for longer than twelve hours on a consistent basis to mobilize fat and lose weight. This is called intermittent fasting. Note that if you fast for twelve hours and then eat, that doesn’t do any good, but if you fast for six more hours (bringing your total to eighteen hours), in those final six hours you are creating an anti-inflammatory, anti-insulin and glucagon-rich environment. It’s probably the best anti-aging strategy you can adopt. Intermittent fasting also unequivocally helps with detoxification.
A lot of people, especially those who are otherwise unwell, have trouble getting past twelve hours of fasting. You have to work on that and keep going so that, over time, you can build it up to eighteen hours. I tell people who really need to lose weight in order to regain their health, “You need to do eighteen-hour intermittent fasting six days a week, but you can do whatever you want on the seventh day.” I do not recommend intermittent fasting for people who are underweight, because fasting in that situation will break down muscle, but if someone has fat to burn, their body will burn the fat.
You can do this in one or two ways. I tell people to stop eating or drinking, except for water, from six o’clock in the evening until noon the next day. The only thing you can have—which does not seem to interfere with the hormonal situation and maybe even helps—is any kind of caffeinated beverage like coffee or black tea with pure fat in it like coconut oil or ghee, but you don’t have to do that. I would not recommend bone broth during intermittent fasting time because it has too much protein in it and you could possibly turn that protein into sugar.
Build up to eighteen hours slowly until you get used to it. Remember that for some of the eighteen-hour fast, you are sleeping. It may seem hard to do without ruining your family and social life. Nonetheless, I do this three times a week myself, so I’m not talking about something I don’t like to do or haven’t tried. I spread the three days throughout the week, so I’m not fasting three days in a row. Based on the results that I’ve seen and experienced, the eighteen-hour time frame seems like a good choice because you still get to eat every day. I miss eating too much if I fast for more than a day. You will get used to it, and I can almost guarantee you that the time between six and noon (assuming you skip breakfast and eat lunch and dinner) you will feel the best you have ever felt in your life. You will not only enjoy but almost crave those times.
There is one caveat here. Do not sit around and look at the refrigerator. A trick is to go out and be as physically active as you can during those hours. Personally, that’s when I do 99 percent of my gardening. I go out, dig and shovel, spread compost and transplant. When you’ve been doing this for years and you’ve got a clear plan for physical activity during those times, you get to a point where you don’t even think about the fasting. And then, a light goes off around 11:30 AM and you go get some food. You eat thirty grams of carbohydrate, an unlimited amount of fat, a modest amount of protein, and lots of different kinds of vegetables—green, red, purple and so forth. After the noon meal, you don’t eat again until 5:30 PM Following the Wise Traditions dietary principles, eat plenty of butter, cream, coconut oil and duck fat. Generally speaking, you also can eat grains if they are properly grown, harvested and soaked. At six o’clock, you are done eating.
Note that if you fast for more than eighteen hours, you start to intensify the detoxification reaction. This can have some definite therapeutic benefit, but that’s an entirely different story from the intermittent fasting that I’m referring to here. From my standpoint, longer-term fasting is disease repudiation. I don’t see any need for an otherwise normal person to do that.
What about exercise or movement? The second parameter that you can fiddle with besides your carbohydrate intake and intermittent fasting is how much you move. How much you move is somewhat related to your fat and muscle ratio. Because muscle cells take up more sugar than fat cells, any time you build muscle, you’re improving the situation, even though you’re not actually losing weight. There are two principles at work here. One is that if you want to be effective at soaking up the sugar and, therefore, losing weight, you need to build up strength, meaning muscle integrity. The more muscles you have, the less restrictive you have to be in your carbohydrate intake, because your muscles essentially eat the carbohydrates more than your fat. Second, building up strength is also good for your overall health.
The bottom line of how you build muscle is very simple. You tell your muscle to do something that it can’t do. In other words, you’re going to lift weights. Once you do it, it won’t even hurt that much. Another way of doing this is really slow—this is called Super Slow Weight Training—with as much weight as you can do for about a minute. It can be unpleasant but you keep going. The signal helps your muscles to realize, “What is this about? If you’re going to do this again, I had better be stronger so that this does not hurt so much next time.”
I have two techniques that I do personally as quickly as possible and because I don’t like going to the gym. I admit that not everybody who wants to lose weight can do this. The first basic step is, as soon as you wake up, particularly on the days of fasting, you drink a glass of ice-cold water and do deep breathing thirty times. The reason for the deep breathing is to oxygenate yourself, so it is important to do it slowly and deeply—you do not want to hyperventilate. On the last breath, you breathe out and then you do as many push-ups as you can, holding your breath, even if you can just do one. I can do thirty-three. When I started a few years ago, it was really unpleasant to do six, and now it’s really unpleasant to do thirty-three. Six seems like nothing now.
I suggest doing continuous, very slow pushups. Go up and down as slow as you can, even if you can just do one. You will eventually get to the point where you can’t even move and your muscles start to shake; at that point, you just hang in there. What we’re training the muscle to do is get more efficient at utilizing oxygen, which is the definition of muscle health. The fact that it works is proven by the fact that thirty-three push-ups now feels the same as six push-ups two years ago. Whereas I was getting lactic acid build-up and pain with six push-ups before, now I don’t feel a thing with six. The explanation is that the muscles have adapted to be more efficient so that they can make the same effort without any lactic acid build-up at all. If you are prudent and judicious about it, you’ve actually trained yourself to be healthier. That’s the whole point.
A guy named Wim Hof, otherwise known as “The Iceman,” has a great TED talk that is worth watching. He’s the guy who immersed himself in ice-cold water and then ran six miles barefoot in the Arctic Circle in twenty-below weather. Wim Hof trained people to withstand cold through a combination of the abdominal breathing exercises and training the body to withstand pain. (If you soak yourself in ice-cold water, you better have figured out how to withstand pain!)
Stretching follows the breathing step. The stretching positions that I do are from Bikram yoga, which I do for about five minutes. Then I stand with my back against the wall and knees bent like a chair and do it for three minutes. I couldn’t do it for three minutes in the beginning, so you might do it for thirty seconds and do it for five seconds more each time you do it. You do not have to hold your breath for this step. I do this technique three times a week on days that I do intermittent fasting. The other thing I do is stretch and walk for a little bit and then run up the stairs as fast as I can. I run up and walk down the stairs as many times as I can, until I almost want to throw up, and then I stop. I do this once a week.
Finally, if you want to burn fat, you have to be able to generate some heat, which increases your metabolic rate. The way to do that is cold thermogenesis therapy, otherwise known as taking cold showers. You can start by washing your face with ice-cold water and by drinking ice-cold water. When you drink cold water, you force your body to increase its metabolic activity, which translates to losing weight. Some people will say to only eat warm foods and take warm baths, but my experience with my patients and myself is that it makes you weaker. If you regularly immerse yourself in cold showers, you actually will feel warmer most of the time. The feeling of warmth afterwards and the warmth you will feel all day is worth it. Do not do thermogenesis, however, until you’ve learned the breathing exercise and can withstand pain.
In my experience, the process of losing weight entails a restricted carbohydrate diet, intermittent fasting, strength training to improve the integrity of your muscles and cold thermogenesis. If you use these techniques, not only will you be healthy but you will get down to somewhere near your optimal weight. I have worked with a number of people who have had a lot of success doing exactly what I’ve described—and it works.
This article appeared in Wise Traditions in Food, Farming and the Healing Arts, the quarterly magazine of the Weston A. Price Foundation, Spring 2017.🖨️ Print post
Rose Hart says
I am so happy I found this article!
I have an issue with retaining fluid; don’t have any lymph glands in my left foot. I’m 81 and gained about 5 pounds last holiday season and cannot seem to shed it. Also, I’m eating massive amounts of proteins erroneously thinking the protein will help with my congenital water retention issue and thus I’ll lose the weight. After reading here, I’m excited to start interval fasting because I’m thinking maybe eating so much protein is what causes the excessive water retention now and high blood pressure???
To begin this program, I need to know what “modest protein” means. Would you be able to suggest number of grams? I’m basically at 56 with my protein drink now and strive to hit 80 over the course of the day. And, of course, I’m ingesting more calories! Yikes! I lift weight three times a week and walk 30 min. most days except Sunday. Thank you and I hope to hear from you soon!
This is an excellent article. It’s good to see insulin levels put centre-stage, as they should be. And it’s good to see fat welcomed, as it should be.
However, I think there’s still a tendency to see carbohydrate as “the fuel”. So for example we have:
“People who run a marathon every day would require a different balance. While they might eat roughly the same amount of protein and fat (or possibly a little more protein to repair the body), they would need substantially more carbohydrate (a fair guess might be three hundred grams) because they are doing a lot of energetic work that demands fuel”
But actually this is not true. Research scientists Steve Phinney and Jeff Volek have shown that not just marathons but even ultra-marathons can be “run on fat”. And their guy won the Western States 100. There’s a brief write-up by Shelly Schlender here:
This should surprise no-one. As Stefansson pointed out a long time ago, if humans couldn’t be fuelled by fat the fur trade would have been impossible, because the voyageurs were living off pemmican.
The point I’m making here is not that absolutely everyone should eat a super low carbohydrate diet all the time (although Dr. Cowan’s suggestion of 60 grams per day for the average person is a good starting point). It’s quite simply that carbohydrate is not the only fuel – not even for marathon runners. And in fact, carbohydrate is probably not the best fuel source for long-distance runners, since they need to keep eating carbohydrate as they go (there being a limited amount that the body can store) which causes gastric distress and potentially diarrhoea and vomiting.
James Hart says
Can this intermittent fast from 6 PM to 12 PM the following day work for me if I get up typically at 11:30 AM? I work 2nd shift
Great piece. I am a big fan of Cowan and consider him a wise fellow. I think if your diet leads with quality fats and proteins the carbs will more or less follow. Your body will begin to recognize overly processed carbs as toxic and you’ll orient to the good stuff in measured amounts. Sourdough bread with butter is more than just a guilty pleasure, and will do you no harm.
There is so much wrong with this article that I don’t know where to start. But basically: insulin and carbs again? Sigh. Too simplistic and increasingly disproven. Read Prof Tim Noakes’s work and get a clearer,more up to date view.
And I agree with Michael: Dr Cowan is also out of date thinking that carbs are a necessary fuel, even (especially) for mararthon running – optimal fuel source is totally dependent on INTENSITY.
And, if you look at the brain, it is exemplary in that it can run on glucose, ketones and/or lactate.
One major error: insulin is NOT inflammatory, as Dr Cowan says.
From a 2014 review article in World Journal of Diabetes: “As the only glucose-lowering hormone in the body, insulin not only alleviates the detrimental effects of hyperglycemia through its metabolic regulation, but also directly modulates inflammatory mediators and acts upon immune cells to enhance immunocompetence. In this sense, hyperglycemia is pro-inflammatory whereas insulin is anti-inflammatory. Therefore, during the past 50 years, insulin has not only been used in the treatment of diabetes, but has also been put into practical use in dealing with cardiovascular diseases and critical illnesses.” (Sun Q, Li J, Gao F. New insights into insulin: The anti-inflammatory effect and its clinical relevance. World Journal of Diabetes. 2014;5(2):89-96. doi:10.4239/wjd.v5.i2.89.)
Major error/out of date thinking 2: lactic acid does not cause pain in muscles (or anywhere else) and doesn ‘t actually “build up” – it is immediately split into lactate (a useful fuel source, preferred by the heart and brain when under extreme exertion) and ahydrogen ions (which MAY be acidic and MAY cause muscle shut-down, although this is still being researched). Dr Cowan’s push-ups are easier because his muscles have done what muscles do – adapted to a progressively increasing training load and got STRONGER.
Wim Hof. The Iceman runs at 14%-ish body fat, according to the University of Maastricht researchers who study him continually. That’s not “fat” by current “normal” standards, but certainly fat by most non-recreational endurance athletes’ standards (this article referred to marathon runners in the headline). Wim Hof achieves his feats because he has genetically-gifted stores of brown adipose tissue – a type of fatty tissue that generates heat. (He has a twin brother who has the same deposits and runs at 18%-ish body fat without doing any of the cold thermogenesis protocols that Wim does, and leading a comparatively extremely sedentary lifestyle as an international truck driver.)
And finally: all that in an effort to substantiate a claim that “For some people, weight loss will naturally result from the process of becoming healthier”? SOME people?
Ali Tejeda says
Great article and so basic, he hit it right on. This can help so many people.
A brilliant and invaluable article! I have already begun to drop excess pounds in following the WAPF way of life, but especially these wise recommendations by Mr. Cowan. Thank you for your wonderful work, even though “thank you” doesn’t feel like enough.