Diet tips that work rather than ‘eat less’ what the body sees as ‘perceived starvation’
DIETING FOR YOUR PATIENTS, AT LEAST THE “EAT LESS FOOD” KIND, may not be such a good idea. Fat cells produce a hormone called leptin. The hypothalamus in the brain monitors leptin levels. When you diet, you lose fat. This reduces the amount of leptin perceived by the hypothalamus. Your body interprets this as starvation. People who carry around a lot of extra fat make a lot of extra leptin. The hypothalamus gets used to the high levels of leptin. This is known as leptin resistance, and it gets in the way of losing weight.
So even if your patients are overweight, losing too much weight is still perceived as starvation.3 This is the reason yo-yo dieting happens (it has nothing to do with will power). A second hormone, ghrelin, is known as the hunger hormone. When we lose weight, the stomach releases greater amounts of a hormone called ghrelin. This hormone makes us feel hungry. If someone has been overweight and then loses weight, ghrelin increases.
Eat less? The body and ‘perceived starving’
The body does several things when it perceives that it is starving:
- The metabolism slows down — Weight loss affects the thyroid, which is the thermostat of the body. The patient produces less “T3”, which is the active thyroid hormone. This means that for any given activity, fewer calories are burned.1,2
- Hunger ensues — When you eat less to the extreme the brain thinks the body is starving because of the drop in leptin levels. Ghrelin levels also increase after a diet.4
- The patient craves high-calorie and processed food — Processed food, much of which is high in sodium and high fructose corn syrup, may increase ghrelin levels,5,7,8 thus increasing hunger. Processed foods interfere with feeling satisfied after a meal.
Diet makes the leptin level drop, the patient becomes really hungry and eats a “McMeal.” The McMeal is high in calories but does not fully satisfy your patient’s hunger. They eat more of the “wrong stuff.” Eating a highly processed diet does not provide enough nutrients to run the Krebs cycle (the series of chemical reactions to release stored energy through the oxidation of acetyl-CoA derived from carbohydrates, fats and proteins). Energy decreases and cravings increase.
If dieting doesn’t work, what does?
Chiropractors and their wellness patients need to address insulin insensitivity (aka insulin resistance or pre-diabetes), address the microbiome and address insulin resistance.
If weight is an issue, so is insulin. Insulin transports sugar into the cells. When exposed to insulin, 80% of the body’s cells allow sugar to enter. Sugar, which is received from carbohydrates in the meal, is used as fuel.
Some of it is stored in the short term for later use of energy as glycogen in the liver. If there is more than the body can store as glycogen, it stores it as fat through a process called lipogenesis. In lipogenesis, excess sugar is converted to triglycerides and then to fat. High triglycerides can mean that the body is getting more sugar than it can handle and is producing a lot of insulin. Over time, your body does not respond well to insulin. The patient develops insulin insensitivity, which can eventually lead to Type 2 diabetes.
In Type 2 diabetes, the body makes plenty of insulin, but does not respond to it. The patient may also develop metabolic syndrome (high cholesterol, low HDL, low LDL, high triglycerides and sometimes high blood pressure). About half of your patients with hypertension also have insulin insensitivity.
The following strategies will help:
Eat foods with a low glycemic load — Glycemic load is a measurement that helps you determine how much insulin is produced with a certain food. You want them to only eat foods with a glycemic load of 10 or less.
Exercise — Daily light exercise (they do not need to do heavy workouts) can help bring insulin insensitivity under control. There are literally hundreds of studies that demonstrate the benefit of exercise for those with insulin insensitivity. The authors of one study stated, “Diet and/or exercise interventions led to a significant decrease in the incidence of diabetes over a six-year period among those with IGT [glucose insensitivity].”9
Intermittent fasting — This is a well-researched way to get insulin insensitivity under control and to lose weight. You have an eight-hour window to eat. There needs to be 16 hours between dinner and breakfast the next morning. If you eat dinner at 5 p.m., breakfast is at 9 a.m. the next morning. It works because when you fast you produce glucagon, which is a hormone that helps to break down fat.10,11 Also, have patients stop snacking. When you eat, you produce insulin, which stores calories. After three hours, you begin to produce glucagon, which enables you to burn those calories. Snacking prevents the production of glucagon and causes insulin to be produced.
Magnesium orotate — Producing excess insulin interferes with the absorption of magnesium,12 so most people with insulin insensitivity tend to be magnesium-deficient. Magnesium is also important for blood sugar control and can help prevent the transition from prediabetes (insulin insensitivity) to diabetes.13,14,15 Magnesium has also been extensively studied for its cardiac benefits. Orotate and orotic acid have been found to be cardioprotective, even without the magnesium.33,34,35,36,37
Multiple vitamins that address insulin insensitivity — Many of the supplement companies make a multiple vitamin intended for patients with insulin insensitivity. The formulas vary, but these usually contain nutrients to make the Krebs cycle work more efficiently, or that have otherwise been shown to have a positive effect on insulin insensitivity. Vitamins D and K also directly address insulin resistance.16,17,18,19 Similarly, biotin20 and B vitamins21,22,23 like niacin, B1223 and thiamin23,24,25,26 have all been studied. Minerals, like zinc, chromium,27 molybdenum, vanadium,28,30 and especially magnesium31,32 have all been shown to have a positive effect on insulin insensitivity. Lysine and taurine both improve glucose tolerance.38,39
Berberine has been well-researched and shown to reduce blood sugar and A1C. Studies have shown that berberine can help and that berberine performs similarly to metformin. Subjects have had significant decreases in A1C, fasting blood glucose, postprandial blood glucose, and plasma triglycerides.40,41,42,43,48 It has even been shown to lower cholesterol,42,45,46 reduce BMI,49 and it may also help with fatty liver disease.47
Address the microbiome — Bacteria are like little chemical factories. Good flora produce vitamins, heal the intestinal lining, break down toxins and suppress bad flora. Bad flora produce toxins, irritate the intestinal lining and suppress good flora. New research is showing that the type of bacteria that grows in the intestine can determine if you are overweight or not.
A recent article50 gave an overview of the role of the microbiome in weight control. The authors concluded, “While diet and behavioral modification programs aiming to reduce weight gain and promote weight loss are effective in the short term, they remain insufficient over the long haul as compliance is often low and weight regain is very common. As a result, novel dietary strategies targeting the gut microbiota have been successful in decreasing obesity and metabolic disorders via different molecular mechanisms.” Additional research supports this idea.51.52
What you eat affects the microbiome, and polyphenols are the key — A diet that is 75% (by volume) fruits and vegetables will help grow a healthy microbiome. Vegetables are high in polyphenols (not to mention fiber, which has also been shown to balance the microbiome and reduce insulin resistance). Polyphenols are micronutrients that are obtained from plants. They are rich in antioxidants and research has demonstrated many health benefits resulting from the consumption of polyphenols. They are produced by the plant to protect itself from ultraviolet radiation and pathogens. They are powerful antioxidants.
Polyphenols affect the microbiome in a way that assists in weight loss. Resveratrol (a polyphenol you may have heard of), for example, helps reduce insulin resistance.53 Other studies have shown that polyphenols help alter the gut microbiome in a way that improves health.54,55,56,57
The specific carbohydrate diet
What you eat and how you eat affects the content of the microbiome. Gluten, for example, has been shown to create problems with the microbiome in many patients (not just those with celiac disease).73
Avoiding chemical additives, GMOs and refined foods is vital. The specific carbohydrate diet was developed by Sidney Haas, MD, in the 1940s. It was made popular by Elaine Gottschall in her book, “Ending the Vicious Cycle.”
The diet has been well-studied and found to be effective in many cases of inflammatory bowel disease58,59,60,61 as well as cases of IBS and SIBO. Although it was developed to combat inflammatory bowel disease, it is designed to balance the bowel flora. Many practitioners have found that it addresses most digestive complaints. For our purposes, balancing the microbiome will help the patient achieve a normal weight.
The mechanism that leads to the digestive problems that Gottschall suggests is Incomplete digestion, Growth of improper GI flora, Irritation of the SI mucosa, Decreased production of enzymes from the SI (disaccharidases), Incomplete digestion, More improper flora, etc.
Poor digestion can cause inappropriate bowel flora to grow. Complex carbohydrates, in general, seem to have the potential to disrupt the microbiome. This may explain the popularity of ketogenic and Paleo diets.
What about probiotics? Many who take probiotic supplements find that they have to keep taking them. The good bacteria do not colonize because of poor living conditions. It is a lot like dropping polar bears off in the jungle or leaving tropical birds in Antarctica. They do not survive. You need to create an environment that is friendly to the new bacteria. Diet, chewing food thoroughly, and addressing the initial phase of digestion need to be addressed if you want the desirable bowel flora to survive.
What you eat and when you eat
When it comes to the diet, what you eat and when you eat is more important than “eat less” and how much you eat.
Eat foods with a glycemic load of 10 or less. Avoid chemical additives, refined food, sugar, GMOs and processed vegetable oils. These things burden the liver, perpetuate insulin insensitivity and disrupt the microbiome.
Go Paleo — The Paleo Diet is almost the same as the Specific Carbohydrate Diet. This will help create an environment for good flora and help heal and support the intestinal mucosa.
Fresh produce should be 75% of the food eaten (by volume) — Fiber and polyphenols in produce help support healthy bowel flora.
Chew food until liquid — This will help patients to be satisfied with less food. It also unburdens the digestive tract.
Light exercise 30 minutes/day — This helps improve insulin insensitivity.
Intermittent fasting — This may be a hard sell. At the very least, no eating between meals. Especially do not eat between dinner and bedtime.
Magnesium orotate — Everyone with insulin insensitivity needs magnesium. It should be taken on an empty stomach (magnesium binds to fats in the diet). Have patients take it the very last thing at night for bowel tolerance (too much magnesium will lead to soft stools). Gradually increase the dose. Take one the first night, two the second night, three the third and so on. If stools become too soft, back off. The dose is as much as they can take without causing diarrhea.
Berberine — This will not only help with insulin insensitivity, it also kills undesirable flora (without harming normal flora). Give 500 mg, 3x/day.
Probiotic — Give one per day.
Thyroid function, stress and adrenal issues, exposure to toxins and other issues can also affect weight. It is not possible to go into these issues here. The thyroid alone is an extensive topic. As many as 13 million Americans may have undiagnosed hypothyroidism, and there are issues with the accuracy of routine testing. Chemical exposure, fatty liver and biliary stasis are also topics that can be explored in great depth.
The good news is that focusing on insulin insensitivity and the microbiome will help your patients a great deal.
PAUL VARNAS, DC, DACBN, is a graduate of the National College of Chiropractic and has had a functional medicine practice for 34 years. He is the author of several books and has taught nutrition at the National University of Health Sciences. For a free PDF of the functional medicine book “Roadmap to Health,” email him at firstname.lastname@example.org.