Sunday, February 7, 2016

Conquering Hunger

A couple years ago I implemented an eating plan of two days a week with virtually no carbs and the rest of the week a Mediterranean diet consisting of few carbs, many vegetables, lean meats and fish, and small amounts of unsaturated fats as recommended in the book The 2-Day Diet: Diet Two Days a Week, Eat Normally for Five, by Dr. Michelle Harvie and Professor Tony Howell. Over the course of several months of following this regimen more or less (I became less strict about portion sizes over time), I lost 30 pounds. The book recommended maintaining the eating plan, but dropping the two days of zero carbs to keep weight off, but to go back to it if need be. Though I largely stuck to a Mediterranean diet, I fell back into some bad habits regarding carbs, eating whole wheat crackers and cheese as a snack, and allowing myself a glass or two of wine at dinner and to browse the snack tables at parties. As of January of this year, I had added back 15 pounds over the last year and a half.

While I was following the plan, I had largely learned to control my hunger, at least compared to any other time in my life. I learned to become much more aware of levels of hunger, and began to separate the feeling of an empty stomach from a feeling of hunger. The book explains what I had learned but never quite internalized: carbs are addictive, especially “simple carbs”: sugars, potatoes, and refined grains, also known as foods with a. high glycemic index. Foods with a lower glycemic index (this is something that diabetics learn about, but is also important to the rest of us) take longer for the digestive system to turn into a form we can use—sugar. When we eat high glycemic index food our blood sugar levels spike. It doesn’t take long before it dives, and when it gets low our body starts craving more food. This process can make us binge, or at least it can cause us to eat more and more often than we should.

Having this knowledge, and even having had the experience of losing the weight, did not make it easier for me to hold the line and return to the 2 Day Diet eating plan, though I tried a few times. I needed some inspiration, and after hearing a radio program, “The People’s Pharmacy,” featuring a scientist describing his research on dieting, I bought his book, Always Hungry? Conquer your cravings, retrain your fat cells, and lose weight permanently, by Boston Children’s Hospital and Harvard Medical School endocrinologist Dr. David Ludwig.

His approach is very similar to Harvie and Howell’s, especially regarding the role of carbs in weight gain. As you might surmise from the title, he promises that following his plan will teach you how to reach your “set point” or healthy weight, by controlling hunger rather than counting calories or measuring food portions. As with any good book that purports to help people eat a more healthy diet that will help them lose excess weight, he offers a lot of advice about recognizing and implementing habits and behaviors that trigger overeating and might undermine your efforts. I am at a point where I don’t feel I need that help. What I found most helpful was the detailed science that he provided.

Ludwig explains that we need body fat. (I’m going to do my best to summarize the science, but I may get some details wrong). Our large brains use about 1/3 of the energy we consume, even when resting. If we had no reserves, we would lose consciousness and die in a relatively short time. So our body relies on stored fuel, and fat cells are the containers. Fat tissue contains about 3,500 calories per pound, while carbs and protein (found in liver and muscle) have only about 600. Fat cells take up excess calories when we eat and release them for use when they’re needed.

Insulin is the hormone that orchestrates this. It is the insulin level in the blood, or lack of it, that creates hunger. Insulin levels rise as we eat to do their job: they regulate the metabolism, the rate at which our body uses the available sugar in our blood, sends it to storage in fat cells, or frees it from fat for use. When we eat high glycemic index foods, the pancreas produces too much insulin, which triggers fat cells to hoard their stores—they shouldn’t be needed since there is so much sugar in the blood. So when the blood sugar level drops quickly and we get hungry, the fat cells don’t release their stores, and now our body tells us to EAT or DIE! If we don’t eat, if we exercise amazing will power, the fat cells will eventually respond and release needed stores, but how many of us will wait? No, those of us susceptible to these carb cravings (and judging by obesity rates, it must be well over 50% of us) are much more likely to have a little snack—some chips, candy, a cookie, crackers and cheese. 

For dieters who try to restrict their calorie intake and/or increase their activity, Ludwig has some bad news, especially if you’re eating processed carbs, even the ones made from whole grains. If you’ve experienced the thrill of starting a diet and losing a few pounds in the first days or week and then hit a wall despite not increasing your food intake, he confirms that your body can and will slow down your metabolism to protect its fat stores. The cycle of peaking blood sugar, insulin production, and the extreme hunger that follows he says produces stress hormones in an effort to unlock fat stores, but “if these cycles occur frequently, our metabolism suffers a slowdown, which can make weight loss nearly impossible.”

His recommendations: at least for a time, cut out all carbs from processed foods, including whole grain products from flour. Stick to whole or mostly whole grains themselves, like brown rice, bulgur wheat, quinoa, steel cut oats. Avoid all “fat free” products, because they often add sugars. Eat seeds, nuts, whole fat dairy products like yoghurt and cottage cheese (all in moderation, of course). Use olive oil or other mono- and poly-unsaturated fats, and for a sweet treat, eat dark chocolate with at least 85% cocoa (15% or less sugar). 

His promise is that this will end the carb addiction cycle. His book includes 3 phases, or levels, of carb strictness to begin your journey, but as I’ve been practicing a diet so similar for a few years, I don’t feel a need to follow his specifics or use his recipes and behavior logs, etc. But if much of this is new to you, I recommend following his plan. For the past couple weeks, I’ve cut out the bread, crackers, and “fat free” foods I had been eating and have found my appetite reduced to a level in which I can even comfortably well past noon or six pm without feeling like I need a snack to “hold me until dinner.” If, like me, those words are part of your daily vocabulary, you may be a carb addict as well.