While India has the largest number of underweight persons in the world comprising a 40% global share, we are also one of the five most obese nations on the planet (with USA at number one). Traditionally, obesity has been viewed as a disorder of caloric imbalance i.e. when more calories are consumed by our bodies vs. being burned. This serves to create an impression that weight gain is a function of our inability to control our appetite and/or a lack of exercise courtesy one's lethargic self. If this were the entire truth, we would not have a mounting burden of obesity amidst flourishing gyms, nutritionists, health and fitness gurus. Over the past two decades, a realisation is sinking that a simple calorie in-calorie out view is incomplete.
The missing link is now known to be insulin, the hormone responsible for carbohydrate metabolism. Every time we consume carbohydrates, especially simple carbs (e.g sugar, wheat products), insulin is secreted by our pancreas. This hormone not only helps in digesting the said carbs, but also inhibits the breakdown of fat. After the requisite calories are consumed via digestion and physical activity, the residual carbs get deposited as fat under the influence of insulin. With continued dietary intake of excess carbs (as is common practice), insulin stays permanently elevated and results in something called insulin resistance.
This implies that over time the body would require more insulin to digest the same amount of carbohydrates. On one hand, insulin also pushes carbs to become the body’s preferred fuel (being the easiest to digest) while everything else (excess carbs and fats) gets deposited as fat. On the other, it exhausts the pancreas (the manufacturer of insulin), resulting ultimately in a predisposition to diabetes, high blood pressure, and cholesterol. Described in medical parlance as Syndrome X, this constitutes upper body obesity, hypertension, high triglycerides (a type of cholesterol) and impaired glucose tolerance (the precursor to diabetes).
Simply put, simple carbs raises our insulin levels and if continued over the long term, will cause us to grow more fat. Obesity then is not a disorder of eating or laziness, but a hormonal one.
This does not imply that net food intake has nothing to do with obesity. Of course it does! But what we eat is a much more important driver than the total number of calories we consume. Though an abundance of food, lack of exercise, and sedentary lifestyles have a role to play, they are not directly responsible. Otherwise, we would not have found obesity amongst Black people or Pima Indians, which are by average a poorer demographic in American society. In fact, poorer people are more likely to be obese (6 times more likely in females and twice more likely in males in the US). It is the quality of food which matters, as celebrated author Gary Taubes writes in “Good Calories, Bad Calories”.
[Listen in to understand some broad thumbrules around good Nutrition and Fitness from Dr Chopra.]
There is little data to support the myth that fats are the true drivers of obesity and heart disease. Definitive evidence comes from a PURE study published last year in the prestigious medical journal Lancet, involving over 135,000 individuals in 18 countries including India, tracked for a mean duration of 7.4 years.
High dietary intake of carbs (over 60% of daily calories) was correlated with a 28% higher relative risk of total mortality, while higher intake of fats was associated with an over 20% lower risk of total mortality and stroke, and was not correlated with risk of heart attacks or cardiovascular deaths, in what was a searing indictment of the traditional calorie and fat-causing-obesity and heart disease hypothesis.
What is the message for the average adult who wants to maintain the appropriate weight?
We need to cut our intake of simple carbs (sugary snacks and drinks, baked items, ice creams, wheat and wheat products), substituting them with healthy fats and proteins. This is not a license to consume fried foods in an unbridled manner - they are loaded with trans fats that are harmful for our heart. Instead healthy fats from nuts, seeds, eggs, milk, meat (not fried) may be combined with fibre and vitamin rich carbs (vegetables, salads, beans, lentils and some fruits) for a balanced diet. Apart from nuts, seeds, beans, milk and milk products, vegetarians can eat green leafy vegetables, broccoli, soybeans, hummus, quinoa, and oats.
You will notice that healthy fats and proteins coexist in nature. Both fats and proteins are much harder to digest than carbs and take much longer in digestion as well, so they cause a much longer suppression of appetite. Carbs, on the other hand, are easily digestable in 2-3 hours, leading to a fall in blood sugar levels and pushing for a tendency to snack on anything sweet or savory.
Proceeding on these principles is initially difficult, but would eventually become easier by following the premise that one does not have to stay hungry at any point of time. The craving for snacks will come down, but if needed, one can consume nuts (almonds and walnuts are the best), sprouts, 1-2 servings of seasonal fruits, boiled eggs, and salads. Tea and coffee with small quantity of milk is acceptable (but no sugar, and at most 2-3 tablets of a sweetener per day). The initial trouble in weaning off excess refined carbs will ultimately pay in terms of better health and fitness.
This is a recurring column published every Sunday under the title: What is Nutrition. Next week I will do a deep-dive on “Weight Loss Exercise Doesn't Work Without a Healthy Diet”. Stay tuned.
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