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Tag: obesity

  • Sugar and Gaining Weight  | NutritionFacts.org

    Sugar and Gaining Weight  | NutritionFacts.org

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    The sugar industry responds to evidence implicating sweeteners in the obesity epidemic. 
     
    In terms of excess body fat, the “well-documented obesity epidemic may merely be the tip of the overfat iceberg.” It’s been estimated that 91 percent of adults—nine out of ten of us—and 69 percent of children in the United States are overfat, a condition defined as having “excess body fat sufficient to impair health.” This can occur even in individuals who are “normal-weight and non-obese, often due to excess abdominal fat.” The way to tell if you’re overfat is if your waist circumference is more than half your height. What’s causing this epidemic? As I discuss in my video Does Sugar Lead to Weight Gain?, one primary cause may be all the added sugars we’re eating. 
     
    A century ago, sugar was heralded as one of the cheapest forms of calories in the diet. Just ten cents’ worth of sugar could furnish thousands of calories. Dr. Fredrick Stare, “Harvard’s sugar-pushing nutritionist,” bristled at the term “empty calories,” writing that the calories in sugar were “not empty but full of energy”—in other words, full of calories, which we are now getting too much of. The excess bodyweight of the U.S. population corresponds to about a daily 350- to 500-calorie excess on average. So, “to revert the obesity epidemic,” that’s how many calories we have to reduce, but which calories should we cut? As you can see below and at 1:33 in my video, the majority of Americans who fail to meet the Dietary Guidelines’ sugar limit get about that many calories in added sugars every day: Twenty-five teaspoons’ worth of added sugars is about 400 calories. 

    There are die-hard sugar defenders. James Rippe, for example, was reportedly paid $40,000 a month by the high fructose corn syrup industry—and that was on top of the $10 million it paid for his research. Even Dr. Rippe considers it “undisputable that sugars…contribute to obesity. It is also undisputable that sugar reduction…should be part of any weight loss program.” And, of all sources of calories to limit, since sugar is just empty calories and contains no essential nutrients, “reducing sugar consumption is obviously the place to start.” And, again, this is what the researchers funded by the likes of Dr. Pepper and Coca-Cola are saying. The primary author of “Dietary Sugar and Body Weight: Have We Reached a Crisis in the Epidemic of Obesity and Diabetes?…,” Richard Kahn, is infamous for his defense of the American Beverage Association—the soda industry—and he was the chief science officer at the American Diabetes Association when it signed a million-dollar sponsorship deal with the world’s largest candy company. “Maybe the American Diabetes Association should rename itself the American Junk Food Association,” said the director of a consumer advocacy group. What do you expect from an organization that was started with drug industry funding? 
     
    The bottom line is that “randomised controlled trials show that increasing sugars intake increases energy [calorie] intake” and “increasing sugar intake leads to body weight gain in adults, and…sugar reduction leads to body weight loss in children.” For example, when researchers randomized individuals to either increase or decrease their intake of table sugar, the added sugar group gained about three and a half pounds over ten weeks, whereas the reduced sugar group lost about two and a half pounds. A systematic review and meta-analysis of all such ad libitum diet studies—real-life studies where sugar levels were changed but people could otherwise eat whatever they wanted—found that reduced intake of dietary sugars resulted in a decrease in body weight, whereas “increased sugars intake was associated with a comparable weight increase.” The researchers found that, “considering the rapid weight gain that occurs after an increased intake of sugars, it seems reasonable to conclude that advice relating to sugars intake is a relevant component of a strategy to reduce the high risk of overweight and obesity in most countries.” That is, it’s reasonable to advise people to cut down on their sugar consumption. 
     
    Findings from observational studies have been “more ambiguous,” though, with an association found between obesity and intake of sweetened beverages, but failing to show consistent correlations with consumption of sugary foods. Most such studies rely on self-reported data, however, and “it is likely that this has introduced bias, especially as underreporting of diet has been found to be more prevalent among obese people and it is sugar-rich foods that are most commonly underreported.” However, one can measure trace sucrose levels in the urine, which gives an objective measure of actual sugar intake and also excludes contributions from other sweeteners such as high fructose corn syrup. When researchers did this, they discovered that, indeed, sugar intake is not only associated with greater odds of obesity and greater waist circumference on a snapshot-in-time cross-sectional basis, but that was also seen in a prospective cohort study over time. “Using urinary sucrose as the measure of sucrose intake,” researchers found that “participants in the highest v. the lowest quintile [fifth] for sucrose intake had 54% greater risk of being overweight or obese.” 
     
    “Denying evidence that sugars are harmful to health has always been at the heart of the sugar industry’s defense.” But when the evidence is undeniable, like the link between sugar and cavities, it switches from denial to deflection, like trying to pull attention away from restricting intake to coming up with some kind of “vaccine against tooth decay.” We seem to have reached a similar point with obesity, with the likes of the Sugar Bureau switching from denial to deflection by commissioning research suggesting that obese individuals would not benefit from losing weight, a stance contradicted by hundreds of studies across four continents involving more than ten million participants. 
     
    For more on Big Sugar’s influence, check out Sugar Industry Attempts to Manipulate the Science. 
     
    You may also be interested in some of my other popular videos on sugar. See related videos below.

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    Michael Greger M.D. FACLM

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  • The New Rule for Calories per Pound of Weight Loss  | NutritionFacts.org

    The New Rule for Calories per Pound of Weight Loss  | NutritionFacts.org

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    You may lose a pound of fat by skipping just 10 calories a day or as many as 55, depending on whether you’re improving food quality or restricting food quantity. 
     
    If the 3,500 calories per pound of weight loss rule is bunk, what’s the alternative? To lose a pound of fat, how many fewer calories do you have to eat or how many more do you have to burn? That’s the topic of my video The New Calories per Pound of Weight Loss Rule. 
     
    There are validated mathematical models that take into account the dynamic changes that occur when you cut calories, such as the metabolic slowdown, and they’ve been turned into free online calculators you can use to make personalized estimates. For instance, one is the Body Weight Planner from the National Institutes of Health (http://bit.ly/NIHcalculator) and another is the Pennington Biomedical Research Center’s Weight Loss Predictor Calculator out of Louisiana State University (http://bit.ly/LSUcalculator). 
     
    The NIH Body Weight Planner has been found to be more accurate because the LSU model appears to overestimate the drop in physical activity, but they both have their own pluses and minuses. The NIH Body Weight Planner tells you how many calories you need to restrict and/or how much more you need to exercise to achieve a specific weight-loss goal by a specific date. If you click on the “Switch to Expert Mode” button, you can get a graph and exportable chart showing your day-to-day weight-loss trajectory. See below and at 1:15 in my video to see the Body Weight Planner. 

    For instance, if you are a middle-aged, sedentary, average-height woman who is obese at 175 pounds and wants to be closer to her ideal weight within a year, consuming 2,000 calories a day would prevent future weight gain and taking in about 1,400 calories a day would bring down your weight, and you could maintain that lower weight at 1,700 calories a day. If you also walked a mile a day, you’d have a little more calorie leeway.

    The LSU Weight Loss Predictor, however, doesn’t allow you to tweak physical activity, but its advantage is that you don’t have to choose a goal or time frame. Just put in different calorie changes, and it graphs out your expected course, as you can see in the graph below and at 2:00 in my video. 

    Is there an easy rule of thumb you can use? Yes. Every permanent ten-calorie drop in daily intake will eventually lead to about one pound of weight loss, though it takes about a year to achieve half the total weight change and around three years to completely settle into the new weight. So, cutting 500 calories a day can cause the 50-pound weight loss predicted by the 3,500-Calorie Rule, but that’s the total weight loss at which you plateau, not an annual drop, and it takes about three years to get there. A 500-calorie deficit would be expected to cause about a 25-pound weight loss in the first year, followed by an additional 25 pounds lost over years two and three, but that’s only if you can maintain the 500-calorie deficit, as you can see in the graph below and at 2:38 in my video.


    If you’re eating the same diet that led to the original weight problem but just in smaller servings, you should expect your appetite to rev up by about 45 calories per pound lost. So, if you were cutting 500 calories a day through portion control alone, even before you were down a dozen pounds, you’d feel so famished that you’d be driven to eat 500 more calories a day and your weight loss could vanish. For this reason, if you’re dead set on eating the same diet with the same foods, just in smaller quantities, you have to cut down an additional 45 calories per pound of desired weight loss to offset your hunger drive. 
     
    So, to take off that one pound, instead of consuming just 10 fewer calories a day using the 10 Calories per Pound Rule, you’d have to eat 10 fewer calories on top of the 45 fewer calories to account for the revving up of your appetite. Thus, it would be 10 + 45 = 55 fewer calories. Indeed, just by changing diet quantity and not quality, it takes 55 fewer calories per day to lose a pound, so that daily 500-calorie deficit would only net you about a 9-pound weight loss over time instead of 50 pounds. That’s why portion control methods can be such a frustrating failure for so many people. 
     
    If you missed my first two videos on calories per pound, check out The 3,500 Calorie per Pound Rule Is Wrong and The Reason Weight Loss Plateaus When You Diet. 
     
    I have loads of other weight-loss videos, which you can see here on the topic page, and there are gazillions more coming soon, based on my book How Not to Diet.

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    Michael Greger M.D. FACLM

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  • New weight loss drugs are out of reach for millions of older Americans because Medicare won't pay

    New weight loss drugs are out of reach for millions of older Americans because Medicare won't pay

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    WASHINGTON — New obesity drugs are showing promising results in helping some people shed pounds but the injections will remain out of reach for millions of older Americans because Medicare is forbidden to cover such medications.

    Drugmakers and a wide-ranging and growing bipartisan coalition of lawmakers are gearing up to push for that to change next year.

    As obesity rates rise among older adults, some lawmakers say the United States cannot afford to keep a decades-old law that prohibits Medicare from paying for new weight loss drugs, including Wegovy and Zepbound. But research shows the initial price tag of covering those drugs is so steep it could drain Medicare’s already shaky bank account.

    A look at the debate around if — and how — Medicare should cover obesity drugs:

    The Food and Drug Administration has in recent years approved a new class of weekly injectables, Novo Nordisk’s Wegovy and Eli Lilly’s Zepbound, to treat obesity.

    People can lose as much as 15% to 25% of their body weight on the drugs, which imitate the hormones that regulate appetites by communicating fullness between the gut and brain when people eat.

    The cost of the drugs, beloved by celebrities, has largely limited them to the wealthy, A monthly supply of Wegovy rings up at $1,300 and Zepbound will put you out $1,000. Shortages for the drugs have also limited the supplies. Private insurers often do not cover the medications or place strict restrictions on who can access them.

    Last month, a large, international study found a 20% reduced risk of serious heart problems such as heart attacks in patients who took Wegovy.

    Long before Oprah Winfrey and TikTok influencers alike gushed about the benefits of these weight loss drugs, Congress made a rule: Medicare Part D, the health insurance plan for older Americans to get prescriptions, could not cover medications used to help gain or lose weight. Medicare will cover obesity screening and behavioral treatment if a person has body mass index over 30. People with BMIs over 30 are considered obese.

    The rule was tacked onto legislation passed by Congress in 2003 that overhauled Medicare’s prescription drug benefits.

    Lawmakers balked at paying high costs for drugs to treat a condition that was historically regarded as cosmetic. Safety problems in the 1990s with the anti-obesity treatment known as fen-phen, which had to be withdrawn from the market, were also fresh in their minds.

    Medicaid, the state and federal partnership program for low-income people, does cover the drugs in some areas, but access is fragmented.

    New studies are showing the drugs do more than help patients slim down.

    Rep. Brad Wenstrup, R-Ohio, introduced legislation with Rep. Raul Ruiz, D-Calif., this year that would allow Medicare to cover the now-forbidden anti-obesity drugs, therapy, nutritionists and dieticians.

    “For years there was a stigma against these people, then there was a stigma about talking about obesity,” Wenstrup said in an interview with The Associated Press. “Now we’re in a place where we’re saying this is a health problem we need to deal with this.”

    He believes the intervention could alleviate all sorts of ailments associated with obesity that cost the system money.

    “The problem is so prevalent,” Wenstrup said. “People are starting to realize you have to take into consideration the savings that comes with better health.”

    Last year, about 40% of the nearly 66 million people enrolled in Medicare had obesity. That roughly mirrors the larger U.S. population, where 42% of adults struggle with obesity, according to the Centers for Disease Control and Prevention.

    Notably, Medicare does cover certain surgical procedures to treat medical complications of obesity in people with a body mass index of 35 and at least one related condition. Congress approved the exception in 2006, noted Mark McClellan, a former head of the Centers for Medicare and Medicaid Services and the FDA.

    The 17-year-old law may provide a blueprint for expanding coverage of the new drugs, which mirror the results of bariatric surgery in some cases, McClellan said. Evidence showed that the surgery reduced the risks of death and serious illness from conditions related to obesity.

    “And that’s been the basis for coverage all this time,” McClellan said.

    Still, the upfront price tag for lifting the rule remains a challenge.

    Some research shows offering weight loss drugs would assure Medicare’s impending bankruptcy. A Vanderbilt University analysis this year put an annual price of about $26 billion on anti-obesity drugs for Medicare if just 10% of the system’s enrollees were prescribed the medication.

    Other research, however, shows it could also save the government billions, even trillions over many years, because it would reduce some of the chronic conditions and problems that stem from obesity.

    An analysis this year from the University of Southern California’s Schaeffer Center estimated the government could save as much as $245 billion in a decade, with the majority of savings coming from reducing hospitalizations and other care.

    “What we did is we looked at the long-term health consequences of treating obesity in the Medicare population,” said the study’s co-author, Darius Lakdawalla, the director of research at the center. The Schaeffer Center receives funding from pharmaceutical companies, including Eli Lilly.

    Lakdawalla said it’s nearly impossible to put a cost on covering the drugs because no one knows how many people will end up taking them or what the drugs will be priced at.

    The Congressional Budget Office, which is tasked with pricing out legislative proposals, acknowledged this difficulty in an October blog post, with the director calling for more research on the topic.

    Overall, the agency “expects that the drug’s net cost to the Medicare program would be significant over the next 10 years.”

    The cost of the legislation is the biggest hang up in getting support, Ruiz said.

    “When we talk about the initial cost, I often have to educate the members that the CBO does not take into account cost savings in their cost benefit analysis,” Ruiz told the AP. “Taking that number in isolation, one does not get the full picture of the full economies of reducing obesity and all of its comorbidities in our patients.”

    Doctors say weight loss drugs are only a part of the most effective strategies to treat a patient with obesity.

    When Dr. Andrew Kraftson develops a plan with his patients at the University of Michigan’s Weight Navigator program, it involves a “perfect marriage” of behavioral intervention, health and diet education, and possibly anti-obesity medication.

    But with Medicare patients, he is limited in what he can prescribe.

    “A blanket prohibition for use of anti-obesity medication is an antiquated way of thinking and does not recognize obesity as a disease and is perpetuating health disparities,” Kraftson said. “I’m not so ignorant to think that Medicare should just start covering expensive treatments for everyone. But there is something between all or nothing.”

    Lawmakers have introduced some variation of legislation that would permit Medicare coverage of weight loss drugs over the last decade. But this year’s bill has garnered interest from more than 60 lawmakers, from self-proclaimed budget hawk Rep. David Schweikert, R-Ariz., to progressive Rep. Judy Chu, D-Calif.

    Passage is a top priority for two lawmakers, Wenstrup and Sen. Tom Carper, D-Del., before they retire next year.

    Pharmaceutical companies also are readying for a lobbying blitz next year with the drugs getting the OK from the FDA to be used for weight loss.

    “Americans should have access to the medicines that their doctors believe they should have,” Stephen Ubl, the president of the lobbying group, Pharmaceutical Research and Manufacturers of America, said on a call with reporters last week. “We would call on Medicare to cover these medicines.”

    Already, Novo Nordisk has employed eight separate firms and spent nearly $20 million on lobbying the federal government on issues, including the Treat & Reduce Obesity Act, since 2020, disclosures show. Eli Lilly has spent roughly $2.4 million lobbying since 2021.

    Advocates for groups such as the Obesity Society have been pushing for Medicare coverage of the medications for years. But the momentum may be shifting, thanks to the growing evidence that the obesity drugs can prevent strokes, heart attacks, even death, said Ted Kyle, a policy advisor.

    “The conversation has shifted from debating whether obesity treatment is worthwhile to figuring out how to make the economics work,” he said. “This is why I now believe the change is inevitable.”

    ___

    Associated Press writers JoNel Aleccia in Temecula, California, and Brian Slodysko contributed to this report.

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  • Why Weight Loss Plateaus on Diets  | NutritionFacts.org

    Why Weight Loss Plateaus on Diets  | NutritionFacts.org

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    What are the metabolic and behavioral adaptations that slow weight loss? 
     
    Thanks to millions of years of evolution hard-wiring us to survive scarcity, our body has compensatory survival mechanisms to defend against weight loss. When we start losing weight, we may unconsciously begin to move less as a “behavioral adaptation” to conserve energy. There are metabolic adaptations as well; our metabolism slows down. Every pound of weight loss may reduce our resting metabolic rate by seven calories a day. This may only translate to a few percent differences for most, but it can rapidly snowball for those who achieve massive weight loss. I discuss this phenomenon in my video The Reason Weight Loss Plateaus When You Diet.

    During one season of the television show The Biggest Loser, some of the contestants famously had their metabolic rates tracked. As you can see in the graphs below, above and beyond the hundreds of fewer calories it takes to just exist when more than a hundred pounds lighter (at 0:55 in my video), by the end of the season, their metabolic rates had slowed by an extra 500 calories a day (at 1:03 in my video). 

    What’s mind-blowing is that when they were retested six years later, they still had the 500-calorie-a-day handicap. So, the contestants had to cut 500 more calories than anyone else their size to maintain the same weight loss. No wonder the bulk of their weight loss was regained. As you can see in the graph below and at 1:23 in my video, most remained at least 10 percent lower than their starting weight, though. 

    Even a 7 percent drop has been shown to cut diabetes rates about in half, as seen in the graph below and at 1:31 in my video. Still, the metabolic slowing means you have to work that much harder than everyone else just to stay in place. Analyzing four seasons of The Biggest Loser minute-by-minute, researchers noted that 85 percent of the focus was on exercise rather than diet, though the exercise component accounted for less than half of the weight loss. Even six years after their season ended, the contestants had been maintaining an hour of daily, vigorous exercise, yet still regained most of the weight they had lost. Why? Because they had started eating more. They could have limited their exercise to just 20 minutes a day and still maintained 100 percent of their initial weight loss if they had just been able to keep their intake to less than 3,000 calories a day. That may not sound like much of a challenge, but weight loss doesn’t just slow your metabolism. It also boosts your appetite.

    If it were just a matter of your weight settling at the point at which your reduced caloric intake matches your reduced caloric output, it would take years for your weight loss to plateau. Instead, it often happens within six to eight months. You can see illustrative graphs below and at 2:34 and 2:43 in my video. You may know the drill: Start the diet, stick to the diet, then weight loss stalls six months later. What happened? Don’t blame your metabolism—that only plays a small part. Instead, you likely stopped sticking to your diet because your appetite went on a rampage. 

    Let’s break it down. If you cut 800 calories out of your daily diet—going from 2,600 calories a day down to 1,800, for instance—and your weight loss stalls after six months, what may have happened is, at the end of the first month, you think you’re still cutting 800 calories, but you may actually only be down about 600 calories a day. By month two, you may only be down about 500 calories, 300 by month three, and, by month six, you may only be eating 200 calories less than before you went on the diet. In other words, you may have inadvertently suffered an exponential increase in caloric intake over those six months. But, you may not even realize it because, by that time, your body may have ramped up your appetite by 600 calories. So, it still feels as if you are eating 800 calories less, but it’s actually only 200 fewer calories. Since an 800-calorie drop in intake may slow your metabolism and physical activity by about 200 calories a day, with no difference between calories in and calories out at six months, no wonder your weight loss grinds to a complete halt.

    The slow upward drift in caloric intake on a new diet is not because you got lazy. Once your appetite is boosted by 600 calories after dieting for a while, eating 200 fewer calories at the end is as hard as eating 800 fewer calories at the beginning. So, you can maintain the same disciplined level of willpower and self-control yet still end up stagnating. To prevent this from happening, you need to maintain the calorie deficit. How is that possible in the face of a ravenous appetite? 
     
    Hunger is a biological drive. Asking someone to eat smaller portions is like asking someone to take fewer breaths. You can white-knuckle it for a bit, but, eventually, nature wins out. That’s why I wrote How Not to Diet. There are foods that can counter the slowing of our metabolism and suppress our appetite, as well as ways of eating to counter the behavioral adaptation and even eat more food—yet still lose weight. 
     
    Due to “the ongoing slowing of metabolism and increased appetite associated with the lost weight,” sustained weight loss requires a persistent calorie deficit of 300 to 500 calories a day. This can be accomplished without reducing portion sizes simply by lowering the calorie density of meals, which can result in the rare combination of weight loss with both an increase in quality and even quantity of food consumed. (See the two graphs below and at 5:34 and 5:40 in my video.) The bottom line is that sustainable weight loss is not about eating less food. It’s about eating better food.

    In my previous video, I dive into how The 3,500 Calorie per Pound Rule Is Wrong. In that case, what’s The New Calories per Pound of Weight Loss Rule? Watch that video to find out. 
     
    My book How Not to Diet is all about weight loss and how to break the diet cycle. For more on weight loss, see related videos below.

    See the Weight Loss topic page for more relevant videos. 

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    Michael Greger M.D. FACLM

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  • Debunking the 3,500-Calorie-per-Pound Rule  | NutritionFacts.org

    Debunking the 3,500-Calorie-per-Pound Rule  | NutritionFacts.org

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    How many fewer calories do you have to eat every day to lose one pound of body fat? 

    The first surgical attempt at body sculpting was in 1921 on a dancer “who wanted to improve the shape of her ankles and knees.” The surgeon apparently scraped away too much tissue and tied the stitches too tight, resulting in necrosis, amputation, and the first recorded malpractice suit in the history of plastic surgery. Liposuction is much safer today, killing only about 1 in 5,000 patients, mostly from unknown causes, such as throwing a clot into your lung or perforating your internal organs. You can see a “Cause of Death” chart below and at 0:37 in my video The 3,500 Calorie per Pound Rule Is Wrong. 

    Liposuction currently reigns as the most popular cosmetic surgery in the world, and its effects are indeed only cosmetic. A study published in the New England Journal of Medicine assessed obese women before and after having about 20 pounds of fat sucked out of their bodies, resulting in a nearly 20 percent drop in their total body fat. Normally, if you lose even just 5 to 10 percent of your body weight in fat, you get significant improvements in blood pressure, blood sugars, inflammation, cholesterol, and triglycerides. But liposuction sucks. None of those benefits materialized even after massive liposuction, which suggests that the problem is not subcutaneous fat, the fat under our skin. The metabolic insults of obesity arise from the visceral fat, the fat surrounding or even infiltrating our internal organs, like the fat marbling our muscles and liver. The way you lose that fat, the dangerous fat, is to take in fewer calories than you burn. 
     
    Anyone who’s seen The Biggest Loser television programs knows that with enough caloric restriction and exercise, hundreds of pounds can be lost. Similarly, there are cases in the medical literature of what some refer to as “super obesity.” In one case, a man lost a massive amount of weight “largely without professional help and without surgery” and kept it off for years. He dropped 374 pounds, losing about 20 pounds a month by cycling two hours a day and reducing his daily intake to 800 calories, which is down around what some prisoners got at concentration camps in World War II. 
     
    Perhaps “America’s most celebrated weight loss” seen on television was Oprah’s. She pulled out a wagon full of fat, representing the 67 pounds she had lost on a very-low-calorie diet. How many calories did she have to cut to achieve that weight loss within four months? If you consult with leading nutrition textbooks or refer to trusted authorities like the Mayo Clinic, you’ll learn the simple weight loss rule: 1 pound of fat equals 3,500 calories. Quoting from the Journal of the American Medical Association, “A total of 3500 calories equals 1 pound of body weight. This means if you decrease (or increase) your intake by 500 calories daily, you will lose (or gain) 1 pound per week. (500 calories per day × 7 days = 3500 calories.)” 
     
    It’s the simple weight-loss rule that is simply not true. 
     
    The 3,500-calorie rule can be traced back to a paper published in 1958. The author noted that since fatty tissue in the human body is 87 percent fat, a pound of body fat would have about 395 grams of pure fat. Multiplying that by nine calories per gram of fat gives you that “3,500 calories per pound” approximation. The fatal flaw that leads to “dramatically exaggerated” weight-loss predictions is that the 3,500-calorie rule fails to take into account the fact that changes in the Calories-In side of the energy-balance equation automatically lead to changes in the Calories-Out side—for example, metabolic adaption, the slowing of metabolic rate that accompanies weight loss. That’s one reason weight loss plateaus. 
     
    Imagine a sedentary, 30-year-old woman of average height who weighs 150 pounds. According to the 3,500-calorie rule, if she cuts 500 calories out of her daily diet, she’d lose a pound a week or 52 pounds a year. In three years, she would vanish. She’d go from 150 pounds to -6. Obviously, that doesn’t happen. Instead, as you can see in the graph below and at 4:33 in my video, in the first year, she’d likely lose 32 pounds, not 52. Then, after a total of three years, she’d probably stabilize at about 100 pounds. This is because it takes fewer calories to exist as a thin person.  


    Part of it is “simple mechanics”: More energy is required to move a heavier mass, in the same way a Hummer requires more fuel than a compact car. Think how much more effort it would take to just get up from a chair, walk across the room, or climb a few stairs if you were carrying a 50-pound backpack. Even when you’re at rest, sound asleep, there’s simply less of your body to maintain as you lose weight. Every pound of fat tissue lost may mean one less mile of blood vessels through which your body has to pump blood every minute. So, the basic upkeep and movement of thinner bodies take fewer calories. As you lose weight by eating less, you end up needing less. That’s what the 3,500-calorie rule doesn’t take into account. 
     
    Imagine it another way: A 200-pound man starts consuming 500 more calories a day, maybe by drinking a large soda or eating two donuts. According to the 3,500-calorie rule, in ten years, he’d weigh more than 700 pounds. That doesn’t happen because, the heavier he is, the more calories he burns just by existing. If you’re 100 pounds overweight, it’s as if there’s a skinny person inside you trying to walk around balancing 13 gallons of oil or lugging around a sack filled with 400 sticks of butter. As you can see in the graph below and at 6:13 in my video, it takes about two donuts’ worth of extra energy just to live at 250 pounds, so that’s where you’d plateau if you kept it up. Given a certain calorie excess or deficit, weight gain or weight loss is a curve that flattens out over time, rather than a straight line up or down. 


    Nevertheless, the 3,500-calorie rule continues to crop up, even in obesity journals. Public health researchers used it to calculate how many pounds children might lose every year if, for example, fast-food kids’ meals swapped in apple slices for french fries. You can see the “Counting Calories in Kids’ Meals” graphic below and at 6:39 in my video. 

    They figured that two meals a week could add up to about four pounds a year. The actual difference, National Restaurant Association–funded researchers were no doubt delighted to point out, would probably add less than half a pound—ten times less than the 3,500-calorie rule would predict, as you can see below and at 7:06 in my video. That original article was subsequently retracted. 

     
    The 3,500 Calorie per Pound Rule Is Wrong is the first of 14 videos that are part of my fasting series, about which I did two webinars. The videos are on NutritionFacts.org, or you can get them all now in a digital download at Intermittent Fasting. You may also be interested in my webinars on Fasting and Disease Reversal and Fasting and Cancer.

    Other videos in this series are included in related videos below. 
     
    Check out some other popular videos on weight loss.

    I also recently tackled the ketogenic diet.

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    Michael Greger M.D. FACLM

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  • Keto Diets and Diabetes  | NutritionFacts.org

    Keto Diets and Diabetes  | NutritionFacts.org

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    Ketogenic diets are put to the test for diabetes reversal. 
     
    As you can see at the start of my video Does a Ketogenic Diet Help Diabetes or Make It Worse?, ketogenic diets can lower blood sugars better than conventional diets. So much so, in fact, that there is a keto product company that claims ketogenic diets can “reverse” diabetes. However, they are confusing the symptom (high blood sugars) with the disease (carbohydrate intolerance). People with diabetes can’t properly handle carbohydrates, and this manifests as high blood sugars. Clearly, if you stick to eating mostly fat, your blood sugars will stay low, but you may be actually making the underlying disease worse at the same time. 
     
    We’ve known for nearly a century that if you put people on a ketogenic diet, their carbohydrate intolerance can skyrocket within just two days. Below and at 0:46 in my video, you can see a graph from the study showing the blood sugar response two days after eating sugar. On a high-carb diet, blood sugar response is about 90 mg/dL. But, the blood sugar response to the same amount of sugar after a high-fat diet is about 190 mg/dL, nearly double. The intolerance to carbohydrates skyrocketed on a high-fat diet. 

    After one week on an 80 percent fat diet, you can quintuple your blood sugar spike in reaction to the same carb load compared to a week on a low-fat diet, as you can see in the graph below and at 1:12 in my video. 

    Even a single day of excessive dietary fat intake can do it, as you can see in the graph below and at 1:26 in my video. If you’re going in for a diabetes test, having a fatty dinner the night before can adversely affect your results. Just one meal high in saturated fat can make carbohydrate intolerance, the cause of diabetes, worse within four hours. 


    Given enough weight loss by any means, whether from cholera or bariatric surgery, type 2 diabetes can be reversed, but a keto diet for diabetes may not just be papering over the cracks, but actively throwing fuel on the fire. 
     
    I’ve been trying to think of a good metaphor. It’s easy to come up with things that just treat the symptoms without helping the underlying disease, like giving someone with pneumonia aspirin for their fever instead of antibiotics. However, a keto diet for diabetes is worse than that because it may treat the symptoms while actively worsening the disease. It may be more like curing the fever by throwing that pneumonia patient out into a snow bank or “curing” your amputated finger by amputating your hand. One of the co-founders of masteringdiabetes.org suggested it’s like a CEO who makes their bad bottom line look better by borrowing tons of cash. The outward numbers look better, but on the inside, the company is just digging itself into a bigger hole. 
     
    Do you remember The Club, that popular car anti-theft device that attaches to the steering wheel and locks it in place so the steering column can only turn a few inches? Imagine you’re in a car at the top of a hill with the steering wheel locked. Then, the car starts rolling down the hill. What do you do? Imagine there’s also something stuck under your brake pedal. The keto-diet equivalent response to this situation is who cares if you’re barreling down into traffic with a locked steering wheel and no brakes—just stick to really straight deserted roads without any stop signs or traffic lights. If you do that, problem solved! The longer you go, the more speed you’ll pick up. If you should hit a dietary bump in the road or start to veer off the path, the consequences could get more and more disastrous over time. However, if you stick to the keto straight and narrow, you’ll be a-okay! In contrast, the non-keto response would be to just unlock the steering wheel and dislodge whatever’s under your brake. In other words, fix the underlying problem instead of just whistling past—and then into—the graveyard. 
     
    The reason keto proponents claim they can “reverse” diabetes is they can successfully wean type 2 diabetics off their insulin. That’s like faith-healing someone out of the need for a wheelchair by making them stay in bed the rest of their life. No need for a wheelchair if you never move. Their carbohydrate intolerance isn’t gone. Their diabetes isn’t gone. In fact, it could be just as bad or even worse. Type 2 diabetes is reversed when you are weaned off insulin while eating a normal diet like everyone else. Then and only then do you not have diabetes anymore. A true diabetes reversal diet, as you can see below and at 4:58 in my video, is practically the opposite of a ketogenic diet: getting diabetics off their insulin within a matter of weeks by eating more than 300 grams of carbs a day! 
    The irony doesn’t stop there. One of the reasons people with diabetes suffer such nerve and artery damage is due to an inflammatory metabolic toxin known as methylglyoxal, which forms at high blood sugar levels. Methylglyoxal is the most potent creator of advanced glycation end products (AGEs), which are implicated in degenerative diseases—from Alzheimer’s and cataracts to kidney disease and strokes, as you can see below and at 5:31 in my video. 

    You get AGEs in your body from two sources: You can eat them preformed in your diet or make them internally from methylglyoxal if you have high blood sugar levels. On a keto diet, one would expect high exposure to preformed AGEs, since they’re found concentrated in animal-derived foods high in fat and protein, but we would expect less internal, new formation due to presumably low levels of methylglyoxal, given lower blood sugars from not eating carbs. Dartmouth researchers were surprised to find more methylglyoxal! As shown in the graph below and at 6:11 in my video, a few weeks on the Atkins diet led to a significant increase in methylglyoxal levels. Those in active ketosis did even worse, doubling the level of this glycotoxin in their bloodstream. 

    It turns out that high sugars may not be the only way to create this toxin, as you can see below and at 6:24 in my video. One of the ketones you make on a ketogenic diet is acetone (known for its starring role in nail polish remover). Acetone does more than just make keto dieters fail breathalyzer tests, “feel queasy and light-headed, and develop what’s been described as ‘rotten apple breath.’” Acetone can oxidize in the blood to form acetol, which may be a precursor for methylglyoxal.

    That may be why keto dieters can end up with levels of this glycotoxin as high as those with out-of-control diabetes, which can cause the nerve damage and blood vessel damage you see in diabetics. That’s another way keto dieters can end up with a heart attack. The irony of treating diabetes with a ketogenic diet may extend beyond just making the underlying diabetes worse, but by mimicking some of the disease’s dire consequences. 

    This is part of a seven-video series on keto, which you can find in related videos below.

    I also recently tackled diabetes.

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    Michael Greger M.D. FACLM

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  • Muscle Shrinkage and Bone Loss on Keto Diets?  | NutritionFacts.org

    Muscle Shrinkage and Bone Loss on Keto Diets?  | NutritionFacts.org

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    Ketogenic diets have been found to undermine exercise efforts and lead to muscle shrinkage and bone loss. 
     
    An official International Society of Sports Nutrition position paper covering keto diets notes the “ergolytic effect” of keto diets on both high- and low-intensity workouts. Ergolytic is the opposite of ergogenic. Ergogenic means performance-boosting, whereas ergolytic means performance-impairing. 
     
    For nonathletes, ketosis may also undermine exercise efforts. Ketosis was correlated with increased feelings of “perceived exercise effort” and “also significantly correlated to feelings of ‘fatigue’ and to ‘total mood disturbance,’” during physical activity. “Together, these data suggest that the ability and desire to maintain sustained exercise might be adversely impacted in individuals adhering to ketogenic diets for weight loss.” 
     
    You may recall that I’ve previously discussed that shrinkage of measured muscle mass among CrossFit trainees has been reported. So, a ketogenic diet may not just blunt the performance of endurance athletes, but their strength training as well. As I discuss in my video Keto Diets: Muscle Growth and Bone Density, study participants performed eight weeks of the battery of standard upper and lower body training protocols, like bench presses, pull-ups, squats, and deadlifts, and there was no surprise. You boost muscle mass—unless you’re on a keto diet, in which case there was no significant change in muscle mass after all that effort. Those randomized to a non-ketogenic diet added about three pounds of muscle mass, whereas the same amount of weight lifting on the keto diet tended to subtract muscle mass by about 3.5 ounces on average. How else could you do eight weeks of weight training and not gain a single ounce of muscle on a ketogenic diet? Even keto diet advocates call bodybuilding on a ketogenic diet an “oxymoron.” 
     
    What about bone loss? Sadly, bone fractures are one of the side effects that disproportionately plague children placed on ketogenic diets, along with slowed growth and kidney stones. Ketogenic diets may cause a steady rate of bone loss as measured in the spine, presumed to be because ketones are acidic, so keto diets can put people in what’s called a “chronic acidotic state.” 
     
    Some of the case reports of children on keto diets are truly heart-wrenching. One nine-year-old girl seemed to get it all, including osteoporosis, bone fractures, and kidney stones, then she got pancreatitis and died. Pancreatitis can be triggered by having too much fat in your blood. As you can see in the graph below and at 2:48 in my video, a single high-fat meal can cause a quintupling of the spike in triglycerides in your bloodstream within hours of consumption, which can put you at risk for inflammation of the pancreas.  

    The young girl had a rare genetic disorder called glucose transporter deficiency syndrome. She was born with a defect in ferrying blood sugar into her brain. That can result in daily seizures starting in infancy, but a ketogenic diet can be used as a way to sneak fuel into the brain, which makes a keto diet a godsend for the 1 in 90,000 families stricken with this disorder.

    As with anything in medicine, it’s all about risks versus benefits. As many as 30 percent of patients with epilepsy don’t respond to anti-seizure drugs. Unfortunately, the alternatives aren’t pretty and can include brain surgery that implants deep electrodes through the skull or even removes a lobe of your brain. This can obviously lead to serious side effects, but so can having seizures every day. If a ketogenic diet can help with seizures, the pros can far outweigh the cons. For those just choosing a diet to lose weight, though, the cost-benefit analysis would really seem to go the other way. Thankfully, you don’t need to mortgage your long-term health for short-term weight loss. We can get the best of both worlds by choosing a healthy diet, as I discussed in my video Flashback Friday: The Weight Loss Program That Got Better with Time.
     
    Remember the study that showed the weight loss was nearly identical in those who had been told to eat the low-carb Atkins diet for a year and those told to eat the low-fat Ornish diet, as seen below and at 4:18 in my video? The authors concluded, “This supports the practice of recommending any diet that a patient will adhere to in order to lose weight.” That seems like terrible advice. 

    There are regimens out there like “The Last Chance Diet which consisted of a low-calorie liquid formula made from leftover byproducts from a slaughterhouse [that] was linked to approximately 60 deaths from cardiovascular-related events.” An ensuing failed lawsuit from one widower laid the precedent for the First Amendment protection for those who produce deadly diet books. 

    It’s possible to construct a healthy low-carb diet or an unhealthy low-fat one—a diet of cotton candy would be zero fat—but the health effects of a typical low-carb ketogenic diet like Atkins are vastly different from a low-fat plant-based diet like Ornish’s. As you can see in the graph below and at 5:26 in my video, they would have diametrically opposed effects on cardiovascular risk factors in theory, based on the fiber, saturated fat, and cholesterol contents of their representative meal plans. 

    And when actually put to the test, low-carb diets were found to impair artery function. Over time, blood flow to the heart muscle itself is improved on an Ornish-style diet and diminished on a low-carb one, as shown below and at 5:44 in my video. Heart disease tends to progress on typical weight-loss diets and actively worsens on low-carb diets, but it may be reversed by an Ornish-style diet. Given that heart disease is the number one killer of men and women, “recommending any diet that a patient will adhere to in order to lose weight” seems irresponsible. Why not tell people to smoke? Cigarettes can cause weight loss, too, as can tuberculosis and a meth habit. The goal of weight loss is not to lighten the load for your pallbearers. 

     
    For more on keto diets, see my videos on the topic. Interested in enhancing athletic performance? Check out the related videos below. 

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    Michael Greger M.D. FACLM

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  • 4 Japanese Concepts That Will Improve Your Well-Being

    4 Japanese Concepts That Will Improve Your Well-Being

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    Embark on a journey to well-being with these four profound Japanese concepts: Ikigai for purpose, Moai for community, Hara Hachi Bu for mindful eating, and Kintsugi for resilience. Discover insights to a healthier and happier life in the modern world by embracing the ancient wisdom of Japanese culture.

    Culture is a powerful force that influences the type of person we become. In the pursuit of well-being, different cultures can often teach us different lessons on what it means to live a good life.

    First, what is culture? The American anthropologist Edward T. Hall created the “Cultural Iceberg” framework to help us analyze the many factors that determine what a culture is. The theory illustrates that only 10% of culture is what we see (language, diet, music, fashion), while 90% of culture is hidden from us (beliefs, values, norms, and expectations).

    Here’s what the “Cultural Iceberg” looks like:

    cultural iceberg

    Generally we see the culture we grew up in as the default mode of being. This includes how people dress, what people eat, and what music they listen to, but also deeper aspects of life such as beliefs, values, morality, and how people approach life from a broader perspective.

    Culture, tradition, and social norms shape our map of reality, the choices we make, and how we navigate our world. If you’re raised in a society that only values materialistic goals like money, fame, or popularity, you’re naturally going to live a life in accordance with those values, especially if they go unquestioned.

    When we explore new cultures through traveling, reading, or meeting new people, we learn that there are many different ways we can approach life and the way we were raised isn’t necessarily the only way to live.

    One simplified but general way we can categorize different types of culture is Western vs. Eastern ways of thinking. Western cultures tend to be more individualistic, rational, and materialistic, while Eastern cultures tend to be more collectivist, holistic, and spiritual.

    Keep in mind, these are broad categorizations. Every country and culture is different. This also isn’t a judgment of “right” or “wrong” ways of thinking, but rather observing different personality types on a cultural scale.

    My experience from a Western perspective is that learning about various aspects of Eastern culture and philosophy (such as Buddhism, Taoism, or Confucianism) gave me a taste for different ways to look at the world and different perspectives on life that I otherwise wouldn’t have been exposed to.

    One popular country to look at is Japan which has a rich history, deep cultural roots, and long-held traditions that have been passed down over multiple generations. In this article, we’re going to cover four powerful Japanese concepts that provide universal lessons on how to live a healthier and happier life. Each concept reveals core values and beliefs that shape the way many Japanese people live.

    These powerful ideas include: Ikigai (“a reason for being”), Moai (“meeting for a common purpose”), Hara Hachi Bu (“belly 80% full”), and Kintsugi (“golden repair”). Now let’s dive deeper into each one!

    Ikigai

    a reason for being

    The Japanese concept of “Ikigai” is about finding a purpose in life. It directly translates to “a reason for being,” and it’s often described as the intersection between what you love, what you are good at, and what the world needs.

    Ikigai is a combination between intrinsic motivation (an activity you enjoy doing) and extrinsic rewards (an activity that creates value in the world and improves people’s lives). Psychology research has shown that ikigai is associated with elevated feelings of dedication, accomplishment, meaning, and fulfillment.

    This is in contrast to a lot of other cultures that just see work as a means to a paycheck or higher income, rather than reframing work as something that serves a higher purpose, both to yourself and society as a whole.

    Ikigai has been shown to benefit both physical and mental health. It can reduce stress and anxiety, which contributes to longer lives and less risk of cardiovascular disease and other ailments. In addition, ikigai is associated with greater resilience in the face of negative events. One interesting study found that ikigai helped people better cope with stress after an earthquake or natural disaster.

    Here’s a visual of what constitutes ikigai:

    ikigai

    If you can find activities that meet all of these requirements, then you’ve found your ikigai.

    Discovering your ikigai can take time and patience though. It involves careful introspection, understanding your strengths, passions, and talents, and finding ways to use those powers to fulfill the needs of the world.

    Once you find your ikigai, it’s important to align your daily activities with it if you want to build a more purposeful and meaningful life.

    Moai

    meeting for a common purpose

    Human connection is vital for our well-being, and the Japanese practice of “Moai” emphasizes the strength of communal bonds.

    Moai refers to a group of people who come together for a shared purpose, providing emotional, social, and even financial support. Often a moai includes family, friends, and neighbors within a local community. They will see each other frequently, talk and catch up on each other’s lives, and organize group activities such as game nights, fitness groups, music performances, or dance parties.

    This tight sense of community provides an important sense of belonging. It also comes with physical benefits like healthier lifestyles, exercise, social connection, and financial support if someone finds themselves in a tough situation.

    In today’s world, many people are suffering from loneliness and depression. One major cause of this is hyper individualism and atomistic lifestyles that no longer promote community values. Many Americans report having zero close friends and only 38% say they have “5 friends or more.” This is in stark contrast to the moai way of life which can often include 10-12+ lifelong friends.

    While there’s plenty of research showing the physical and mental benefits of social support, one of the most common examples of moai can be found in Okinawa, Japan, which has been identified as a “blue zone.”

    Blue zones are places around the world that are associated with better health and longevity. Often there are high numbers of centenarians in them (or people who have lived over 100). The recent Netflix documentary Live to 100: Secrets of the Blue Zones by public health researcher Dan Buettner has a great episode dedicated to Okinawa that shows how the moais work there.

    Many health professionals and experts are now claiming we are in a “loneliness epidemic,” with over 1 in 4 adults saying they feel socially isolated. This can have serious health consequences such as increased risk of anxiety, depression, heart disease, stroke, dementia, and overall shorter lifespans. The negative effects of loneliness have been compared to the effects of daily cigarette smoking.

    As communities continue to decline and feelings of social alienation increase, the moai mentality is needed now more than ever.

    Hara Hachi Bu

    belly 80% full

    In a culture often associated with healthy living and longevity, the Japanese concept of “Hara Hachi Bu” teaches us the art of mindful eating. Translated as “belly 80% full,” this practice encourages moderation in our meals.

    Obesity is a growing problem around the entire world. Recent reports show that 39% of the global population in 2023 is obese or overweight, and this is a sharp increase from 23.9% in 2008. If this trend continues, researchers predict that over half of the global population will have obesity by 2035.

    One factor in this rise in obesity is having abundant access to ultraprocessed foods, including the convenience of fast food and junk food. The modern diet is filled with supernormal foods that hijack our natural instincts for sugar, salts, and rich flavor, which is why many people end up over-eating during meals or late night binging.

    The lesson of Hara Hachi Bu is more relevant now than ever. By reminding ourselves to only eat until we are 80% full, we encourage slower and more mindful eating. This lets you enjoy your meal more by paying attention to each bite and savoring it, rather than quickly moving from one bite to the next without fully appreciating it.

    Many people eat unconsciously. Often it’s eating while watching TV/movies, checking their phones, scrolling social media, or socializing with friends. Their main focus is on one thing, while eating is just something happening in the background. These distractions can lead you to eat more than you otherwise would.

    Slowing down your eating will lead to less consumption, better digestion, and improved body awareness of how you respond to certain foods, the best times of the day to eat (or not), and what it feels like to be “50% full” → “80% full” → “100% full” → “110% full.”

    Adopting Hara Hachi Bu not only contributes to physical well-being by maintaining a healthy weight but also cultivates a mindful approach to eating that can lead to a stronger connection with the food we consume.

    Kintsugi

    golden repair

    Derived from the Japanese words “kin” (golden) and “tsugi” (repair), Kintsugi is the art of repairing broken pottery with lacquer mixed with powdered gold, silver, or platinum.

    Here’s what it looks like:

    kintsugi

    Instead of hiding the cracks and flaws, the practice of kintsugi embraces the broken parts by highlighting them in gold. It celebrates its imperfections, while at the same time making them stronger and more beautiful.

    Many find inspiration when applying this concept to their personal lives. It helps them to accept the challenges and obstacles they’ve had to face over the years – the physical, mental, and emotional battle scars – and see them as jumping points for growth and improvement.

    No one’s life is perfect. We all suffer from weaknesses, flaws, insecurities, and vulnerabilities. Our instinct is to hide them, ignore them, or deny them, but the paradox is that when we accept them is when we actually become stronger.

    Kintsugi promotes resilience, growth, and grit. It shows that no matter how many times you get broken, you can always repair yourself in gold.

    Conclusion

    Each of these Japanese concepts – Ikigai, Moai, Hara Hachi Bu, and Kintsugi – offers a kernel of wisdom that we can all apply to our daily lives.

    While these ideas are ancient, they are more relevant to modern living than ever before. Ikigai teaches us meaning and purpose, Moai teaches us social connection, Hara Hachi Bu teaches us mindful eating, and Kintsugi teaches us growth and resilience.

    Which concept do you need to embrace the most right now?


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    Steven Handel

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  • New Case Western Reserve University study finds diabetes drug may reduce risk for colorectal cancer

    New Case Western Reserve University study finds diabetes drug may reduce risk for colorectal cancer

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    Newswise — CLEVELAND—A groundbreaking study by researchers at Case Western Reserve University suggests a class of medications used to treat type 2 diabetes may also reduce the risk of colorectal cancer (CRC).

    The findings, published today (Dec. 7) in the journal JAMA Oncology, support the need for clinical trials to determine whether these medications could prevent one of the deadliest types of cancers. Eventually, the medications may also show promise in warding off other types of cancer associated with obesity and diabetes.

    “Our results clearly demonstrate that GLP-1 RAs are significantly more effective than popular anti-diabetic drugs, such as Metformin or insulin, at preventing the development of CRC,” said Nathan Berger, the Hanna-Payne Professor of Experimental Medicine at the Case Western Reserve School of Medicine and the study’s co-lead researcher.

    Glucagon-like peptide-1 receptor agonists, or GLP-1 RAs, are medications to treat type 2 diabetes. Usually given by injection, they can lower blood-sugar levels, improve insulin sensitivity and help manage weight. They’ve also been shown to reduce the rates of major cardiovascular ailments.

    Importantly the protective effect of GLP-1 RAs are noted in patients with or without overweight/obesity.

    “To our knowledge,” said co-lead researcher Rong Xu, a professor at the School of Medicine, “this is the first indication this popular weight-loss and anti-diabetic class of drugs reduces incidence of CRC, relative to other anti-diabetic agents.”

    Berger and Xu are members of the Case Comprehensive Cancer Center.

    National health problem

    Being overweight or obese or having diabetes are risk factors for increasing incidence of CRC and for making its prognosis worse.

    The National Institutes of Health (NIH) defines being overweight and obese as an increase in size and amount of fat cells in the body above certain levels. These conditions are common nationally and are caused by several factors—among them diet, lack of sleep or physical activity, genetics and family history.

    Healthcare providers use body mass index to measure body fat based on height and weight. Nearly 75% of adults ages 20 or older in the United States are either overweight or obese, and nearly 20% of children and teens ages 2 to 19 have obesity, according to the NIH.

    Obesity is a chronic health condition that raises the risk for heart disease—the leading cause of death in the United States—and is linked to many other health problems, including type 2 diabetes and cancer.

    The American Cancer Society estimates CRC is the third-leading type of cancer in both sexes, with 153,000 new cases per year. It is also the second-leading cause of cancer mortality with 52,550 deaths per year.

    The study

    Since GLP-1 RAs have been shown to be effective anti-diabetic and weight-loss agents, the researchers hypothesized they might reduce incidence of CRC.

    Using a national database of more than 100 million electronic health records, the researchers conducted a population-based study of more than 1.2 million patients. These individuals had been treated with anti-diabetic agents from 2005-19; the CWRU team examined the effects of GLP-1 RAs on their incidence of CRC, as compared to those prescribed other anti-diabetic drugs.

    Population-based research means matching as many people as possible with the same characteristics—sex, race, age, socio-economic determinants of health and other medical conditions—to accurately compare the drug’s effects.

    Among 22,572 patients with diabetes treated with insulin, there were 167 cases of CRC. Another 22,572 matched patients treated with GLP-1 RAs saw 94 cases of CRC. Those treated with GLP-1 RAs had a 44% reduction in incidence of CRC.

    In a similar comparison of 18,518 patients with diabetes treated with Metformin, compared to 18,518 patients with diabetes treated with GLP-1 RAs, had a 25% reduction in CRC.

    “The research is critically important for reducing incidence of CRC in patients with diabetes, with or without overweight and obesity,” Berger said.

     

                                                                ***

    (Initial data for this manuscript was developed last summer by Lindsey Wang and William Wang, Orange High School students whose work was sponsored by the Case Comprehensive Cancer Center and National Cancer Institute-funded Scientific Enrichment Opportunity/Youth Engaged in Science Program. Lindsey Wang is now a first-year undergraduate at Case Western Reserve in the pre-professional scholars program, planning to enroll at the Case Western Reserve School of Medicine.)

    ###

    Case Western Reserve University is one of the country’s leading private research institutions. Located in Cleveland, we offer a unique combination of forward-thinking educational opportunities in an inspiring cultural setting. Our leading-edge faculty engage in teaching and research in a collaborative, hands-on environment. Our nationally recognized programs include arts and sciences, dental medicine, engineering, law, management, medicine, nursing and social work. About 6,200 undergraduate and 6,100 graduate students comprise our student body. Visit case.edu to see how Case Western Reserve thinks beyond the possible.

     

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    Case Western Reserve University

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  • The Safety of Keto Diets  | NutritionFacts.org

    The Safety of Keto Diets  | NutritionFacts.org

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    What are the effects of ketogenic diets on nutrient sufficiency, gut flora, and heart disease risk? 

    Given the decades of experience using ketogenic diets to treat certain cases of pediatric epilepsy, a body of safety data has accumulated. Nutrient deficiencies would seem to be the obvious issue. Inadequate intake of 17 micronutrients, vitamins, and minerals has been documented in those on strict ketogenic diets, as you can see in the graph below and at 0:14 in my video Are Keto Diets Safe?. 

    Dieting is a particularly important time to make sure you’re meeting all of your essential nutrient requirements, since you may be taking in less food. Ketogenic diets tend to be so nutritionally vacuous that one assessment estimated that you’d have to eat more than 37,000 calories a day to get a sufficient daily intake of all essential vitamins and minerals, as you can see in the graph below and at 0:39 in my video. 


    That is one of the advantages of more plant-based approaches. As the editor-in-chief of the Journal of the American Dietetic Association put it, “What could be more nutrient-dense than a vegetarian diet?” Choosing a healthy diet may be easier than eating more than 37,000 daily calories, which is like putting 50 sticks of butter in your morning coffee. 
     
    We aren’t just talking about not reaching your daily allowances either. Children have gotten scurvy on ketogenic diets, and some have even died from selenium deficiency, which can cause sudden cardiac death. The vitamin and mineral deficiencies can be solved with supplements, but what about the paucity of prebiotics, the dozens of types of fiber, and resistant starches found concentrated in whole grains and beans that you’d miss out on? 
     
    Not surprisingly, constipation is very common on keto diets. As I’ve reviewed before, starving our microbial self of prebiotics can have a whole array of negative consequences. Ketogenic diets have been shown to “reduce the species richness and diversity of intestinal microbiota,” our gut flora. Microbiome changes can be detected within 24 hours of switching to a high-fat, low-fiber diet. A lack of fiber starves our good gut bacteria. We used to think that dietary fat itself was nearly all absorbed in the small intestine, but based on studies using radioactive tracers, we now know that about 7 percent of the saturated fat in a fat-rich meal can make it down to the colon. This may result in “detrimental changes” in our gut microbiome, as well as weight gain, increased leaky gut, and pro-inflammatory changes. For example, there may be a drop in beneficial Bifidobacteria and a decrease in overall short-chain fatty acid production, both of which would be expected to increase the risk of gastrointestinal disorders. 
     
    Striking at the heart of the matter, what might all of that saturated fat be doing to our heart? If you look at low-carbohydrate diets and all-cause mortality, those who eat lower-carb diets suffer “a significantly higher risk of all-cause mortality,” meaning they live, on average, significantly shorter lives. However, from a heart-disease perspective, it matters if it’s animal fat or plant fat. Based on the famous Harvard cohorts, eating more of an animal-based, low-carb diet was associated with higher death rates from cardiovascular disease and a 50 percent higher risk of dying from a heart attack or stroke, but no such association was found for lower-carb diets based on plant sources.  
     
    And it wasn’t just Harvard. Other researchers have also found that “low-carbohydrate dietary patterns favoring animal-derived protein and fat sources, from sources such as lamb, beef, pork, and chicken, were associated with higher mortality, whereas those that favored plant-derived protein and fat intake, from sources such as vegetables, nuts, peanut butter, and whole-grain bread, were associated with lower mortality…” 
     
    Cholesterol production in the body is directly correlated to body weight, as you can see in the graph below and at 3:50 in my video. 

    Every pound of weight loss by nearly any means is associated with about a one-point drop in cholesterol levels in the blood. But if we put people on very-low-carb ketogenic diets, the beneficial effect on LDL bad cholesterol is blunted or even completely neutralized. Counterbalancing changes in LDL or HDL (what we used to think of as good cholesterol) are not considered sufficient to offset this risk. You don’t have to wait until cholesterol builds up in your arteries to have adverse effects either; within three hours of eating a meal high in saturated fat, you can see a significant impairment of artery function. Even with a dozen pounds of weight loss, artery function worsens on a ketogenic diet instead of getting better, which appears to be the case with low-carb diets in general.  

    For more on keto diets, check out my video series here. 

    And, to learn more about your microbiome, see the related videos below.

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    Michael Greger M.D. FACLM

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  • Can You Sustain Weight Loss on Ketosis?  | NutritionFacts.org

    Can You Sustain Weight Loss on Ketosis?  | NutritionFacts.org

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    Might the appetite-suppressing effects of ketosis improve dietary compliance? 

    The new data are said to debunk “some, if not all, of the popular claims made for extreme carbohydrate restriction,” but what about ketones suppressing hunger? In a tightly controlled metabolic ward study where the ketogenic diet made things worse, everyone ate the same number of calories, but those on a keto diet lost less body fat. But, out in the real world, all of those ketones might spoil your appetite enough that you’d end up eating significantly less overall. On a low-carb diet, people end up storing 300 more calories of fat every day. Outside of the laboratory, though, if you were in a state of ketosis, might you be able to offset that if you were able to sustainably eat significantly less? 
     
    Paradoxically, as I discuss in my video Is Weight Loss on Ketosis Sustainable?, people may experience less hunger on a total fast compared to an extremely low-calorie diet. This may be thanks to ketones. In this state of ketosis, when you have high levels of ketones in your bloodstream, your hunger is dampened. How do we know it’s the ketones? If you inject ketones straight into people’s veins, even those who are not fasting lose their appetite, sometimes even to the point of getting nauseated and vomiting. So, ketones can explain why you might feel hungrier after a few days on a low-calorie diet than on a total zero-calorie diet—that is, a fast. 
     
    Can we then exploit the appetite-suppressing effects of ketosis by eating a ketogenic diet? If you ate so few carbs to sustain brain function, couldn’t you trick your body into thinking you’re fasting and get your liver to start pumping out ketones? Yes, but is it safe? Is it effective? 
     
    As you can see below and at 1:58 in my video, a meta-analysis of 48 randomized trials of various branded diets found that those advised to eat low-carb diets and those told to eat low-fat ones lost nearly identical amounts of weight after a year.

    Obviously, high attrition rates and poor dietary adherence complicate comparisons of efficacy. The study participants weren’t actually put on those diets; they were just told to eat in those ways. Nevertheless, you can see how even just moving in each respective direction can get rid of a lot of CRAP (which is Jeff Novick’s acronym for Calorie-Rich And Processed foods). After all, as you can see in the graph below and at 2:37 in my video, the four largest calorie contributors in the American diet are refined grains, added fats, meat, and added sugars. 

    Low-carb diets cut down on refined grains and added sugars, and low-fat diets tend to cut down on added fats and meat, so they both tell people to cut down on donuts. Any diet that does that already has a leg up. I figure a don’t-eat-anything-that-starts-with-the-letter-D diet could also successfully cause weight loss if it caused people to cut down on donuts, danishes, and Doritos, even if it makes no nutritional sense to exclude something like dill. 

    The secret to long-term weight-loss success on any diet is compliance. Diet adherence is difficult, though, because any time you try to cut calories, your body ramps up your appetite to try to compensate. This is why traditional weight-loss approaches, like portion control, tend to fail. For long-term success, measured not in weeks or months but in years and decades, this day-to-day hunger problem must be overcome. On a wholesome plant-based diet, this can be accomplished thanks in part to calorie density because you’re just eating so much food. On a ketogenic diet, it may be accomplished with ketosis. In a systematic review and meta-analysis entitled “Do Ketogenic Diets Really Suppress Appetite,” researchers found that the answer was yes. Ketogenic diets also offer the unique advantage of being able to track dietary compliance in real-time with ketone test strips you can pee on to see if you’re still in ketosis. There’s no pee stick that will tell you if you’re eating enough fruits and veggies. All you have is the bathroom scale. 

    Keto compliance may be more in theory than practice, though. Even in studies where ketogenic diets are being used to control seizures, dietary compliance may drop below 50 percent after a few months. This can be tragic for those with intractable epilepsy, but for everyone else, the difficulty in sticking long-term to ketogenic diets may actually be a lifesaver. I’ll talk about keto diet safety next. 

    The keto diet is in contrast to a diet that would actually be healthful to stick to. See, for example, my video series on the CHIP program here. 
     
    This was the fourth video in a seven-part series on keto diets. If you haven’t yet, be sure to watch the others listed in the related videos below. 

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    Michael Greger M.D. FACLM

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  • Man loses 400lbs in three years by starting with this small change

    Man loses 400lbs in three years by starting with this small change

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    A man who shed 400 pounds in the space of three years has revealed the small change that helped him begin his weight loss journey.

    Aged just 20, Zach Muncy from Ohio was told by doctors he might not see his 25th birthday. Tipping the scales at 700 pounds, he was largely confined to a wheelchair with a bleak prognosis for his future.

    “Everything was stacked against me,” he told Newsweek. “I was battling depression and physically unable to walk more than a few steps, it felt impossible.” But that moment in the doctor’s office proved to be Muncy’s catalyst for change. Now 26, Muncy, recalled that conversation.

    He said: “My doctor told me I would be lucky to see the age of 25 given the number of health issues that kept popping up. So I took that as the motivation to finally work on getting my mental and physical health together.”

    Muncy’s situation at the time was far from being an outlier; America is firmly in the grip of an obesity epidemic. According to figures compiled by the National Institute of Diabetes and Digestive and Kidney Diseases, 42.4 percent of U.S. adults have obesity while 9.2 percent have severe obesity. The CDC estimates that the prevalence for obesity among U.S. adults aged 20 to 39 is 40 percent .

    Step by Step

    Though Muncy was determined to remove himself from the extreme end of those statistics, getting started was tough. “The hardest part was definitely coming to terms with how far I’d fallen in terms of health,” he said. “When I started this journey I was wheelchair bound.”

    “Everything was stacked against me,” he said. “I was battling depression and physically unable to walk more than a few steps, it felt impossible.”

    However, in acknowledging his situation, Muncy was able to set himself small achievable goals. His weight loss journey began in July 2019 with one small change. “I knew I needed to take it day by day, step by step. I started with doing exercise on the edge of my bed.”

    Muncy then built on that foundation, saying he then began “laying out my own nutrition plan and grocery lists with a calorie goal and, with the help of my family and friends, cooking the meals.”

    Those first few steps soon yielded positive results. “Within the first four months I was down over 70 lbs,” he said. By that point, Muncy was spending “countless hours” online learning about nutrition and was working towards not only a healthier body but also a healthier mind.

    “I got back into therapy and worked through my eating disorder,” he said. “I was working day by day, step by step slowly learning to love myself more than the day before.”

    Zach Muncy has lost 400Ibs. He now requires surgery to remove his excess skin.
    Zachloss

    Moderation Over Deprivation

    While weight loss is achievable, studies have shown that it can sometimes be difficult to keep it off in the long term. A study published in The American Journal of Clinical Nutrition found that just 20 percent of Americans who lost weight were able to keep from regaining it.

    From the start though, Muncy took a different, more sustainable, approach to his diet that he describes as “moderation over deprivation.” It was more small changes that yielded big results.

    “If I wanted pizza, I had pizza, I just got a small one instead of an extra large for myself,” he explained. “Once I realized that I could still eat the food I enjoyed while still losing weight if I just tracked everything and maintained my calorie goal it unlocked a whole new realm of possibilities and mindfulness about eating for my physical and eating for my mental health.”

    Again, setting himself small achievable goals as part of a moderate approach was crucial to sustained access. “Once that mindset was in place and I lost 70 pounds with it, I finally understood I could do this. I built the road I knew I’d be successful on and I just had to walk down it,” he said.

    It’s a road he’s been walking down for the past three years and one that has yielded incredible results. Muncy has lost over 400 pounds. He’s also taken to regularly chronicling his weight loss journey on TikTok, posting under the handle Zachloss.

    In 2020, there were days when Muncy would barely move. That’s changed dramatically since then. “I go to the gym three days a week for strength training and aim for 10,000 steps every day as a baseline goal of overall movement,” he said. “If I want a piece of cake I make it work within my daily calorie goal.”

    Unhealthy Relationships With Food

    Muncy hopes that posting videos to social media chronicling his journey will inspire others struggling like he was to make the necessary changes, whether it be through seeking therapy or taking those first important steps to achieving a weight loss goal.

    “If you think you have an unhealthy relationship with food, you probably do,” he said. “Keep your mindset on a day by day basis. don’t think about the 200 lbs you need to lose for the long term, just the baby steps you can complete on a daily basis that will make the healthy foundation you are trying to build even more secure for the long term.”

    Muncy’s journey is far from complete, though. Not only is he continuing to lose more weight, but he’s currently in the process of trying to raise funds to have the excess skin left over as a result of his drastic weight loss removed through surgery.

    “My next loose skin removal surgery is in March of 2024 and that will be the next big chapter in my journey,” he said. Every weight loss journey has a beginning but by making those small, realistic changes, slowly but surely, Muncy is reaching the end of his.

    Zach Muncy before and after weight loss.
    Muncy before and after. The 26-year-old always makes sure he walks a minimum of 10,000 steps a day.
    Zachloss

    Sustainable and Safe Weight Loss

    Martin Sharp, who is a personal trainer, fitness coach and the founder of Sharp Fit For Life, believes a sustainable and safe amount of weight to lose on average is around 2 pounds per week.

    Sharp told Newsweek, when it comes to sustainable weight loss, the key is “finding something that fits in with your lifestyle is the main thing because weight loss (or preferably fat loss) takes momentum, repetition, perseverance and consistency towards a goal.”

    Muncy’s success has been grounded in the fact his approach is tailored to his own specific needs and motivators and that’s something Sharp sees as a crucial starting point in any weight loss or fitness journey.

    “Understand what you truly value, not the things others expect or the to-do list that you’ve read about eating healthy and exercising daily,” he said. “Your true deep down values that drive you and get you out of bed each day, is where you can start.”

    Do you have an incredible weight loss story? Let us know via life@newsweek.com and your story could be featured on Newsweek.