Are You Always Hungry? In the book, “Always Hungry,” Dr. David Ludwig provides compelling evidence that excess weight gain is caused by certain types of food that upset the hormone balance. This imbalance then sets off a cycle of cravings, hunger, and overeating. His premise is that processed carbohydrates are the primary villains, especially high glycemic foods like sugar and refined grains. So far, no surprises. Like many diet books, the target audience is people not ready to give up all of the foods they love for the love of good health. For many, a step in the right direction will be the best they can imagine tolerating. If this is you, then you may have found the right book. While realistic goals are smart goals, there are better diets for those seeking more weight loss or more health improvement. If looking for an approach that takes small steps in the right direction, then the three-phase approach Dr. Ludwig walks the willing through could certainly lead to weight loss and better health for someone starting from the Standard American Diet (SAD). In the first phase, processed carbohydrates, added sugars, and all grain products are removed from the diet for two weeks. The allowable carbohydrates include a range of non- starchy vegetables, fruits, and beans. After two weeks, the second phase begins. With this new phase, whole kernel grains, potatoes (except for white potatoes), and a little added sugar is allowed. When weight finally drops to a lower set point, adding back some processed carbohydrates is allowed unless weight gain resumes. After a few months, phase 3 begins. This last phase is about customizing the diet to keep it sustainable. In effect, this amounts to adding back enough refined carbohydrates to keep the diet interesting. One might argue that this is akin to giving an alcoholic just enough booze to keep attending AA meetings. While there is some merit in the analogy, food is different in that alcohol isn’t necessary for life but food we must have. For the willing, a far better approach is to recognize that all taste are acquired through repeatedly making them part of our diet. In time, new foods can replace refined carbohydrates in our diet. A conundrum Dr. Ludwig observed, and which led to his diet approach, was that simply cutting back on calories often makes weight loss more difficult. When we cut back on calories, our body usually responds by increasing hunger and slowing metabolism in an effort to save calories. In essence, a low- calorie diet creates a battle between mind and metabolism that most will lose. He also observes that overeating doesn’t make you fat. Rather, the process of getting fat makes you overeat. Contrary to conventional thinking, your body does not see excess weight as a state of excess calories but rather as a state more akin to starvation. At the cellular level, if the fat cells are storing too many calories, the body doesn’t have access to enough energy to keep the metabolism running properly. In response, the brain orders us to eat more in an attempt to solve that problem. In response, we overeat and temporarily feel better. So, if the fat cells are taking in ever more calories leaving too little available in the bloodstream, we still feel hungry. This never-ending cycle of overeating has only one end result, more weight gain. With regard to good fats vs. bad fats, Dr. Ludwig advises that we stop thinking about saturated fat as either good or bad. The goal is to include fats at part of whole foods with the objective of including a balance that that includes lots of monounsaturated and polyunsaturated fats like those found in olives, nuts, avocados, and flaxseed. As for saturated fats from plant sources, when eaten as part of a whole food and not to the exclusion of other healthy fats there is no evidence they are unhealthy. Unlike advice given in many diet book from the 1960s through the 1990s, saturated fat as part of a whole food is not Public Health Enemy #1. When saturated fat, or for that matter any fat, is refined into pure vegetable oils, it does become a problematic food that needs to be reserved for occasional use in small quantities. The book “Always Hungry” was published in 2016. A glance at the references indicates that most research was from 2013 or earlier. While the recommendations given have merit, more effective diets are available. The epilogue is the best part of the book. This is where Dr. Ludwig presents an overview of how national food policy has contributed to creating a country of people with chronic diseases that’s unprecedented in its scope. While only 9 pages long, his assessment needs to be required reading by every person that passes through the public education system. In these few pages, the essence of why national health is deteriorating and what to do about it is presented in a way that is enlightening, somewhat depressing and yet curiously humorous. The book, “Always Hungry,” is about escaping the Standard American (SAD) diet in baby steps. For some, this will be a workable plan. Can the diet work as a lifetime plan? More likely it’s the type of diet that starts with a bang and later loses its appeal as refined carbohydrates battle for your attention in a calorie balancing act that never ends. Have questions or need more information about healthy food plans? Let’s talk about it at your next appointment. Nancy Neighbors, MD Huntsville, Alabama More Highlights From The Book • “The forty year fat folly began in the 1960s. By the 1970s prominent nutritionist began recommending that everyone follow a low-fat diet in the belief that lower calorie intake would promote weight loss. For a time, the fad was to reformulate foods as low calorie for better health. Four decades later it became apparent that fat wasn’t the problem. The problem was not the amount of fat in the diet as much as it was the types of foods we ate. In general, foods that contain naturally occurring fat are better for us than foods that contain added fats from refined sources. This makes olives a nutritious food that helps us resist weight gain in contrast with olive oil, a refined oil, that can promote weight gain. In fairness to olive oil, it is 85% unsaturated fats and one of the healthiest plant- based vegetable oils. Used sparingly, olive oil can be quite useful. When used as a significant part of daily calories, it becomes a nutritional negative.” • “I came to see food as more than just a delivery system for calories and nutrients. Although a bottle of coke and a handful of nuts may have the same calories, they certainly don’t have the same effect on metabolism.” • “The central concept of Always Hungry is that while cutting calories will decrease weight for a short while, the body resists by increasing hunger and slowing metabolism. Sooner or later we succumb, and weight tends to pop back, like an air-filled balloon being pushed into a bucket of water. In contrast, improving the quality of what we eat will reprogram fat cells to store fewer calories, in effect reducing the ‘body weight set point’ As a result weight lowers naturally as the balloon would if some water were drained from the bucket in which it floats.” • “According to the MyPlate website, reaching a healthier weight is a balancing act. The secret is learning how to balance your energy in and energy out…A secret indeed! In reality, no one, not even nutrition experts, can accurately practice calorie balance. Without elaborate technology, it’s virtually impossible to estimate to within 350 calories a day now much we eat and burn off. A calorie gap of that magnitude can mean the difference between remaining thin and developing morbid obesity in just a few years. For that matter, if counting calories were key to weight control, how did humans manage to avoid massive swings in body weight before the very concept of the calorie was invented.” • “Physical activity has many benefits. But, short of marathon level intensity, lower body weight isn’t usually one of them. This is not to suggest a sedentary life. Physical exercise has many health benefits and is a component of all healthy weight management programs.” • “All breakfast foods are not created equal. For example, instant oatmeal is technically a whole grain but more often a highly processed carbohydrate. While not as bad as many kinds of boxed cereals, blood sugar still rises very rapidly. Unfortunately, what goes up must come down and hunger will soon manifest. A better food is old fashion rolled oats or steel cut oats where the kernel is left mostly intact. As a result of having been processed less, old fashion rolled oats and steel cut oats take longer to cook and longer to digest.” For a more about the difference in oats, read the full story about “The Manufacturing Process for Steel Cut Oats vs. Rolled Oats.” Nutrition Quiz Here is a quiz that might help you decide if Dr. Ludwig’s book is right for you. If you score 80% or better, skipping the book is probably right for you although the epilog is must reading for everyone. Score 50% or less, then adding the book to your reading list might be a good idea. Be forewarned, there are a couple of trick questions. Not to worry, the book is available with full explanations from the public library. Q1. What is the minimum amount of carbohydrate required for long-term survival? Q2. Which of the following raises blood glucose and insulin the most after consumption, calorie for calorie? 1. White potato (baked). 2. Ice cream, 3. Pure table sugar Q3. Which has the most protein, ounce for ounce? Hard-boiled eggs, Chicken nuggets, Hot dogs, or Tempeh (a soybean product) Q4. True or False: The microbes in our intestinal tract outnumber the cells in our body? Q5. Is fructose toxic? Q6. True or False: Sodium consumption should be reduced as much as possible. Q7. How many food additives are FDA approved? Q8. Which biological factor best predicts how individuals will respond to diets with varying amounts of carbohydrate? Blood type, Eye color, or Insulin secretion Answers to Quiz A1. Zero. Although not a healthy diet, protein, and fat are the only essential macronutrients. A2. White potatoes (baked). If you missed this one don’t feel bad. While potatoes are an excellent food, the kind you eat, how much you eat, and how you cook them makes a big difference. For example, baked Russet potatoes have a higher glycemic index than pure sugar. Since you will probably not eat potatoes without other foods, glycemic index alone gives a false warning about nutritional value. A better measure of how potatoes affect blood sugar is glycemic load. Still puzzled about the answer? Read more at “Potato Nutrition – 5 Common Potato Myths Debunked.” For more insights pick up a copy of James Wong’s book, “How to Eat Better,” at the local library. A3. Tempeh A4.True A5. No A6. False (the body needs some salt) A7. More than 3,000, not including substances generally recognized as safe A8. Insulin secretion |