Coming back after a break of few weeks, let us try to find answers to some difficult questions on long term health and weight loss.
An important question is “What works?”, or rather “What works in the long-term”? The answer, as fitness coach Dan John puts is:
“Everything…at least in the short-term.”
Whether it is restriction of total calories or fats or carbohydrates, or intermittent fasting vs small meals, or any type of exercise – aerobic, resistance training or yoga…everything works for a while!
The point is, what works long-term? Let me try and answer this.
Any meal containing a substantial amount of refined carbs is followed by a rise in blood sugar and a resultant release of insulin. Though this promptly helps in their digestion, it also diverts consumed fat and proteins towards fat cells. Moreover, when there is significant insulin in blood, nothing other than carbs can be used by the body as a fuel, and fat breakdown is inhibited. Considering that carbs form the bulk of our diets (even so-called complex carbs like potatoes, cereal and bread break down in our body essentially to simple carbs), it is no wonder that we find it hard to lose fat (beyond an initial ‘dieting’ period).
Repeated exposure to carbs with a genetic predisposition can lead to a state of insulin resistance, where higher levels of insulin are required for the same carbohydrate load. This causes hyperinsulinaemia (high insulin levels in the blood), basically pushing our metabolism towards a carbohydrate-burning mode. Hence fats and proteins are unable to burn and are regularly packed off to fat cells while glucose is used for providing energy.
Here is how our metabolism works: sugar and refined carbs are the most easily digestible foods (taking around 2-3 hours). Eating these results in a sugar high, associated with good taste and immediate satisfaction.
But, a couple of hours later the blood sugar crashes once digested, and one craves a snack (the typical mid-morning snack with tea/coffee). The snack is happily partaken and gives another burst of energy, which only lasts another couple of hours or so. If one takes lunch by then, all is seemingly well. But if there is a delay, then one is irritable, snappy and tired. This cycle repeats itself throughout the day (the popular small, frequent meal plan), and one has peaks and troughs of enthusiasm and listlessness, which add up to the familiar fatigue by the end of the day!
Attempting to cut carbs at this stage is very difficult – the body wants only carbs, leaving the individual with two choices; either over-eat carbs and obtain enough energy but gain weight, or starve but face lethargy and fatigue and still fail to lose weight with high insulin preventing fat loss. Ironically the body is suffering from starvation in midst of plenty; there are enough fat reserves to provide energy, but fat cannot be broken down due to excess insulin.
This sort of a situation plagues a large chunk of our population, especially middle-aged people (females more than males). To put things into proper perspective, insulin receptors are found in liver, skeletal muscles and fat cells. The sensitivity of these to bind insulin tends to diminish with age; however, insulin resistance is in general higher in muscle and liver than in fat cells. The implication is that our food when digested is taken up predominantly by the fat cells, as liver and muscle are unable to take up enough. The result is fatigue, lack of energy, fatty liver and weight (mostly fat) gain.
Restore Insulin Sensitivity: Exercise and Fasting
The logical solution here is to restore insulin sensitivity. One obvious solution to improving insulin sensitivity of muscles is to exercise – walking, running, swimming, weightlifting – all of them work.
The more difficult problem is the liver itself. Here, only one thing can work – somehow reduce the repeated exposure to insulin, to allow the sensitivity to improve. This can happen through refined carb restriction, which implies replacing them with fats and proteins. Further, fasting is a big help: 6-12 hours or more (within limits as prescribed by a physician) without any food is the best way to improve insulin sensitivity, especially in the liver. This ensures that fats and proteins are effectively metabolised by the body and fat loss results. Of course, it is important to continue to consume fibre and vitamin rich carbs-veggies, especially leafy ones, salads and some fruit.
Understanding the Fasting Ritual
Fasting recommendations are varied, ranging from long duration gaps to small frequent meals. Recent years have witnessed a proliferation of recommendations to have small, frequent meals through the day to ensure stable (? high) blood sugar. Never did humans have access to so much food all the time; never has humanity been as obese. Our ancestors managed well enough with 1-2 meals a day; even our parents and grandparents were happy with 2-3 sumptuous meals, giving at least 6 hours to our body to digest and assimilate food. Further, they took a healthy proportion of fat and proteins as well, which leave us feeling full for longer.
Fasting is a ritual in many societies, and it works to help our body clear the muck that accumulates due to indiscriminate eating habits. Long duration fasting may be even more beneficial. Eating nothing after dinner for 10-12 hours and eating as few snacks as possible in the day helps keep our insulin level in check for several hours, thus allowing fat burn to occur.
The other extreme that is commonly believed, i.e., small, frequent meals, ironically evolved from the ‘large and frequent’ diet staple for elite athletes and bodybuilders, who could not consume enough calories for their punishing schedule from three square meals a day. It’s healthy for them; some bodybuilders even get up in the middle of the night to eat and grow.
That is not our goal – the average working adult can easily manage without it. Hence eating every 2-3 hours a day (albeit in small quantities) will just make us dependent upon continuous snacking, increasing our craving for carbs and make us fatter in the process. Since controlled trials are hard to perform, let us just look at it logically – to lose fat do we need to eat more often or less often?
In summary, overweight and obesity are strongly associated with insulin resistance, which is worsened by frequent meals / snacks consisting mainly of carbs. The solution is to restore insulin sensitivity by cutting down on carbs, replacing them with healthy fat and proteins, increase intervals between meals and exercise regularly. That should work in the long run.
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