- Author: [[Jason Fung and Timothy Noakes]] - Full Title: The Obesity Code - Tags:: books [[inbox]] -  - ### Highlights first synced by [[Readwise]] [[2020-09-03]] - So we discriminate against people who are obese. We both pity and loathe them. ([Location 262](https://readwise.io/to_kindle?action=open&asin=B01C6D0LCK&location=262)) - The decision to eat or not is principally hormonal. ([Location 495](https://readwise.io/to_kindle?action=open&asin=B01C6D0LCK&location=495)) - Body-fat regulation is under automatic control, like breathing. We do not consciously remind ourselves to breathe, nor do we remind our hearts to beat. The only way to achieve such control is to have homeostatic mechanisms. Since hormones control both Calories In and Calories Out, obesity is a hormonal, not a caloric, disorder. ([Location 496](https://readwise.io/to_kindle?action=open&asin=B01C6D0LCK&location=496)) - The problem of fat accumulation is really a problem of distribution of energy. ([Location 566](https://readwise.io/to_kindle?action=open&asin=B01C6D0LCK&location=566)) - Reducing Calories In works only if Calories Out remains stable. What we find instead is that a sudden reduction of Calories In causes a similar reduction in Calories Out, and no weight is lost as the body balances its energy budget. Some historic experiments in calorie reduction have shown exactly this. ([Location 575](https://readwise.io/to_kindle?action=open&asin=B01C6D0LCK&location=575)) - The body reacts in this way—by reducing energy expenditure—because the body is smart and doesn’t want to die. ([Location 626](https://readwise.io/to_kindle?action=open&asin=B01C6D0LCK&location=626)) - “Eat Less” does not work. That’s a fact. Accept it. ([Location 768](https://readwise.io/to_kindle?action=open&asin=B01C6D0LCK&location=768)) - whether physical activity increases or decreases, it has virtually no relationship to the prevalence of obesity. ([Location 816](https://readwise.io/to_kindle?action=open&asin=B01C6D0LCK&location=816)) - Total energy expenditure = Basal metabolic rate + Thermogenic effect of food + Nonexercise activity thermogenesis + Excess post-exercise oxygen consumption + Exercise. The key point here is that total energy expenditure is not the same as exercise. The overwhelming majority of total energy expenditure is not exercise but the basal metabolic rate: metabolic housekeeping tasks such as breathing, maintaining body temperature, keeping the heart pumping, maintaining the vital organs, brain function, liver function, kidney function, etc. ([Location 842](https://readwise.io/to_kindle?action=open&asin=B01C6D0LCK&location=842)) - Exercise is still healthy and important—just not equally important. It has many benefits, but weight loss is not among them. Exercise is like brushing your teeth. It is good for you and should be done every day. Just don’t expect to lose weight. ([Location 866](https://readwise.io/to_kindle?action=open&asin=B01C6D0LCK&location=866)) - Caloric intake and expenditure are intimately related: increasing one will cause an increase in the other. This is the biological principle of homeostasis. The body tries to maintain a stable state. Reducing Calories In reduces Calories Out. Increasing Calories Out increases Calories In. ([Location 893](https://readwise.io/to_kindle?action=open&asin=B01C6D0LCK&location=893)) - YOU CAN TEMPORARILY force your body weight higher than your body wants it to be by consuming excess calories. Over time, the resulting higher metabolism will reduce your weight back to normal. Similarly, you can temporarily force your body weight lower than your body wants it to be by reducing calories. Over time, the resulting lowered metabolism will raise your weight back to normal. ([Location 993](https://readwise.io/to_kindle?action=open&asin=B01C6D0LCK&location=993)) - The problem in obesity is that the set point is too high. ([Location 1004](https://readwise.io/to_kindle?action=open&asin=B01C6D0LCK&location=1004)) - Our body is not a simple scale balancing Calories In and Calories Out. Rather, our body is a thermostat. The set point for weight—the body set weight—is vigorously defended against both increase and decrease. ([Location 1017](https://readwise.io/to_kindle?action=open&asin=B01C6D0LCK&location=1017)) - Assumption 1: Calories In and Calories Out are independent of each other. THE HORMONAL THEORY explains why Calories In and Calories Out are tightly synchronized with each other. Assumption 2: Basal metabolic rate is stable. THE HORMONAL THEORY explains how hormonal signals adjust basal metabolic rate to either gain or lose weight. Assumption 3: We exert conscious control over Calories In. THE HORMONAL THEORY explains that hunger and satiety hormones play a key role in determining whether we eat. Assumption 4: Fat stores are essentially unregulated. THE HORMONAL THEORY explains that fat stores, like all body systems, are tightly regulated and respond to changes in food intake and activity levels. Assumption 5: A calorie is a calorie. THE HORMONAL THEORY explains why different calories cause different metabolic responses. Sometimes calories are used to heat the body. At other times, they will be deposited as fat. ([Location 1124](https://readwise.io/to_kindle?action=open&asin=B01C6D0LCK&location=1124)) - INSULIN, BODY SET WEIGHT AND OBESITY OBESITY DEVELOPS WHEN the hypothalamus orders the body to increase fat mass to reach the desired body set weight. ([Location 1184](https://readwise.io/to_kindle?action=open&asin=B01C6D0LCK&location=1184)) - We can resist the urge to eat and restrict our calorie consumption. Doing so will thwart the hypothalamus for a while, but it has other means of persuasion. The body conserves calories needed for fat growth by shutting down other functions, and metabolism slows. Increased Calories In and decreased Calories Out (eating more and moving less) does not cause obesity, but is instead the result of obesity. ([Location 1187](https://readwise.io/to_kindle?action=open&asin=B01C6D0LCK&location=1187)) - The question is not how to balance calories; the question is how to balance our hormones. The most crucial question in obesity is how to reduce insulin. ([Location 1373](https://readwise.io/to_kindle?action=open&asin=B01C6D0LCK&location=1373)) - So does prednisone cause obesity? Absolutely! Weight gain is one of prednisone’s most common, well-known and dreaded side effects. ([Location 1426](https://readwise.io/to_kindle?action=open&asin=B01C6D0LCK&location=1426)) - And so, by extension, stress causes weight gain—something that many people have intuitively understood, despite the lack of rigorous evidence. Stress contains neither calories nor carbohydrates, but can still lead to obesity. Long-term stress leads to long-term elevated cortisol levels, which leads to extra pounds. ([Location 1452](https://readwise.io/to_kindle?action=open&asin=B01C6D0LCK&location=1452)) - There are many time-tested methods of stress relief, including mindfulness meditation, yoga, massage therapy and exercise. Studies on mindfulness intervention found that participants were able to use yoga, guided meditations and group discussion to successfully reduce cortisol and abdominal fat.20 ([Location 1456](https://readwise.io/to_kindle?action=open&asin=B01C6D0LCK&location=1456)) - SLEEP DEPRIVATION IS a major cause of chronic stress today. ([Location 1461](https://readwise.io/to_kindle?action=open&asin=B01C6D0LCK&location=1461)) - Population studies consistently link short sleep duration and excess weight,24, 25 generally with seven hours being the point where weight gain starts. Sleeping five to six hours was associated with a more than 50 percent increased risk of weight gain.26 The more sleep deprivation, the more weight gained. ([Location 1465](https://readwise.io/to_kindle?action=open&asin=B01C6D0LCK&location=1465)) - SLEEP DEPRIVATION IS a potent psychological stressor and thus stimulates cortisol. This, in turn, results in both high insulin levels and insulin resistance. A single night of sleep deprivation increases cortisol levels by more than 100 percent.27 ([Location 1470](https://readwise.io/to_kindle?action=open&asin=B01C6D0LCK&location=1470)) - Getting enough good sleep is essential to any weight loss plan. ([Location 1484](https://readwise.io/to_kindle?action=open&asin=B01C6D0LCK&location=1484)) - High insulin levels cause weight gain. Food choices play a role in raising insulin levels. But we are missing yet another pathway that increases insulin, one that is both time dependent and independent of diet: insulin resistance. ([Location 1666](https://readwise.io/to_kindle?action=open&asin=B01C6D0LCK&location=1666)) - As we develop insulin resistance, our bodies increase our insulin levels to get the same result—glucose in the cell. However, we pay the price in constantly elevated insulin levels. Why do we care? Because insulin resistance leads to high insulin levels, and as we’ve seen, high insulin levels cause obesity. ([Location 1684](https://readwise.io/to_kindle?action=open&asin=B01C6D0LCK&location=1684)) - In the case of insulin resistance, it comes down to both meal composition and meal timing—the two critical components of insulin resistance. The types of food eaten influence the insulin levels. Should we eat candy or olive oil? This is the question of macronutrient composition, or “what to eat.” However, the persistence of insulin plays a key role in the development of insulin resistance, so there is also the question of meal timing, or “when to eat.” Both components are equally important. Unfortunately, we spend obsessive amounts of time and energy trying to understand what we should be eating and devote virtually no time to when we should be eating. We are only seeing half the picture. ([Location 1838](https://readwise.io/to_kindle?action=open&asin=B01C6D0LCK&location=1838)) - Insulin resistance requires persistently high levels. ([Location 1850](https://readwise.io/to_kindle?action=open&asin=B01C6D0LCK&location=1850)) - But in the development of obesity, the increase in meals is almost twice as important as the change in diet.11 We obsess about what we should eat. We eat foods that practically didn’t exist ten years ago. Quinoa. Chia seeds. Acai berries. All in the hopes of making us slim. But we spare not even a single thought as to when we should be eating. ([Location 1871](https://readwise.io/to_kindle?action=open&asin=B01C6D0LCK&location=1871)) - Whereas almost every cell in the body can use glucose for energy, no cell has the ability to use fructose. Where glucose requires insulin for maximal absorption, fructose does not. Once inside the body, only the liver can metabolize fructose. Where glucose can be dispersed throughout the body for use as energy, fructose is targeted like a guided missile to the liver. ([Location 2423](https://readwise.io/to_kindle?action=open&asin=B01C6D0LCK&location=2423)) - Fiber and fat, key ingredients, are removed in the refining process: fiber, to change the texture and make food taste “better,” and natural fats, to extend shelf life, since fats tend to go rancid with time. And so we ingest the “poison” without the “antidote”—the protective effects of fiber is removed from much of our food. ([Location 2721](https://readwise.io/to_kindle?action=open&asin=B01C6D0LCK&location=2721)) - There are no long-term data on the use of vinegar for weight loss. However, smaller short-term human studies suggest that vinegar may help reduce insulin resistance.27 Two teaspoons of vinegar taken with a high-carbohydrate meal lowers blood sugar and insulin by as much as 34 percent, and taking it just before the meal was more effective than taking it five hours before meals.28 The addition of vinegar for sushi rice lowered the glycemic index of white rice by almost 40 percent.29 Addition of pickled vegetables and fermented soybeans (nattō) also significantly lowered the glycemic index of the rice. In a similar manner, rice with the substitution of pickled cucumber for fresh showed a decrease in its glycemic index by 35 percent.30 ([Location 2767](https://readwise.io/to_kindle?action=open&asin=B01C6D0LCK&location=2767)) - Dairy also shows the largest discrepancy between the blood glucose and insulin effect. It scores extremely low on the glycemic index (15 to 30), but very high on the insulin index (90 to 98). ([Location 2874](https://readwise.io/to_kindle?action=open&asin=B01C6D0LCK&location=2874)) - Despite the fact that its consumption causes big increases in insulin levels, large observation studies do not link dairy to weight gain. If anything, dairy protects against weight gain, as found in the Swedish Mammography Cohort. ([Location 2937](https://readwise.io/to_kindle?action=open&asin=B01C6D0LCK&location=2937)) - There are no intrinsically bad foods, only processed ones. The further you stray from real food, the more danger you are in. Should you eat protein bars? No. Should you eat meal replacements? No. Should you drink meal replacement shakes? Absolutely not. Should you eat processed meats, processed fats or processed carbohydrates? No, no and no. ([Location 2993](https://readwise.io/to_kindle?action=open&asin=B01C6D0LCK&location=2993)) - Cholesterol is often portrayed as some harmful poisonous substance that must be eliminated, but nothing could be farther from the truth. Cholesterol is a key building block in the membranes that surround all the cells in our body. In fact, it’s so vital that every cell in the body except the brain has the ability to make it. If you reduce cholesterol in your diet, your body will simply make more. ([Location 3043](https://readwise.io/to_kindle?action=open&asin=B01C6D0LCK&location=3043)) - THERE ARE TWO prominent findings from all the dietary studies done over the years. First: all diets work. Second: all diets fail. ([Location 3208](https://readwise.io/to_kindle?action=open&asin=B01C6D0LCK&location=3208)) - In the short term, we can use various diets to bring our actual body weight down. However, once it falls below the body set weight, the body activates mechanisms to regain that weight—and that’s the long-term problem. ([Location 3217](https://readwise.io/to_kindle?action=open&asin=B01C6D0LCK&location=3217)) - STEP 1: REDUCE YOUR CONSUMPTION OF ADDED SUGARS ([Location 3283](https://readwise.io/to_kindle?action=open&asin=B01C6D0LCK&location=3283)) - Asking how much sugar is acceptable is like asking how many cigarettes are acceptable. ([Location 3309](https://readwise.io/to_kindle?action=open&asin=B01C6D0LCK&location=3309)) - STEP 2: REDUCE YOUR CONSUMPTION OF REFINED GRAINS ([Location 3447](https://readwise.io/to_kindle?action=open&asin=B01C6D0LCK&location=3447)) - REFINED GRAINS SUCH as white flour stimulate insulin to a greater degree than virtually any other food. ([Location 3447](https://readwise.io/to_kindle?action=open&asin=B01C6D0LCK&location=3447)) - STEP 3: MODERATE YOUR PROTEIN CONSUMPTION ([Location 3471](https://readwise.io/to_kindle?action=open&asin=B01C6D0LCK&location=3471)) - IN CONTRAST TO refined grains, protein cannot and should not be eliminated from your diet. (For more on protein, see chapter 17.) Instead, moderate the amount of protein in your diet to fall within 20 percent to 30 percent of your total calories. ([Location 3472](https://readwise.io/to_kindle?action=open&asin=B01C6D0LCK&location=3472)) - STEP 4: INCREASE YOUR CONSUMPTION OF NATURAL FATS ([Location 3481](https://readwise.io/to_kindle?action=open&asin=B01C6D0LCK&location=3481)) - In addition to healthy fats, nuts are naturally high in fiber and low in carbohydrates. Walnuts in particular are high in the omega 3 fatty acids. ([Location 3502](https://readwise.io/to_kindle?action=open&asin=B01C6D0LCK&location=3502)) - STEP 5: INCREASE YOUR CONSUMPTION OF PROTECTIVE FACTORS ([Location 3509](https://readwise.io/to_kindle?action=open&asin=B01C6D0LCK&location=3509)) - Stress relief is an active process. Meditation, tai chi, yoga, religious practice and massage are all good choices. Regular exercise is an excellent way to relieve stress and lower cortisol levels. ([Location 4034](https://readwise.io/to_kindle?action=open&asin=B01C6D0LCK&location=4034)) - Social connectivity is another great stress reliever. ([Location 4038](https://readwise.io/to_kindle?action=open&asin=B01C6D0LCK&location=4038)) - The power of human touch also cannot be underestimated. Massage can be beneficial for this reason. ([Location 4040](https://readwise.io/to_kindle?action=open&asin=B01C6D0LCK&location=4040))