You can’t lose weight without managing insulin

My late friend Bruce told me the secret to financial security: Holding his right hand by his waist he said “you make this much money,” then he put his left hand a little bit lower, “and spend this much.” Bruce was a physicist, and had an exceptional ability to simplify complex problems, which we often discussed while walking our terriers in the Queen Anne neighborhood of Seattle. I miss our talks, despite often struggling to see how the laws of thermodynamics applied to our discussions.

Many doctors try to apply the same laws to weight loss, arguing that unintentional weight gain is simply the outcome of too many calories in and not enough calories out. "A calorie is a calorie,” they say. So, the reasoning goes, in order to lose weight you should simply practice being hungry all the time, and burn more than you eat.

How fat accumulates

One pound of body fat is equal to about 3,500 additional calories. If you drink two Coors a day worth of calories beyond your metabolic needs, for example, then you will gain 1 pound of fat in about 18 days. By that logic the solution is simple: cut out the beer (or any other unnecessary calories) and you will lose weight. But what if you’re not drinking beer every night or eating Cheetos, and you still can’t lose weight?

Journalist, Gary Taubes, explains that “If the conventional thinking and advice worked, if eating less and exercising more were a meaningful solution to the problem of obesity and excess weight, we wouldn’t be here.” 35% of American men wouldn’t have obesity.

Treat the cause

I approach weight loss with my patients like any other health problem: by treating the cause. And by this point I hope you see that hunger is a response to being overweight, not a cause. Put another way, you don’t get fat because you want to eat all the time; you want to eat all the time because you’re accumulating fat. In addition, the problem I have with solely relying on portion control is that the formula ignores predisposition for weight gain. It also ignores your environment, and it ignores the natural role of insulin, and insulin shouldn’t be ignored. Successful treatment of excessive weight gain depends upon lowering insulin levels, and the best way to achieve that is with your diet.

Nephrologist Dr. Jason Fung argues in his book, The Diabetes Code, that obesity is "a hormonal imbalance, not a caloric one.” The hormone in question, and the topic of this article, is insulin. Maybe you associate that word with diabetes and high blood sugar, which is accurate, but it’s also implicated in unintentional weight gain due to its effect on fat storage.

The biology of blood sugar

Your body doesn’t want a bunch of sugar floating around in the blood because it’s toxic to blood vessels, eyes, and nerves (among other organs). Insulin is the chemical your pancreas naturally makes to solve this problem and store all that glucose.

Imagine insulin as a suitcase and the sugar in your blood is the pile of clothes you’re trying to pack. The size of the suitcase limits the number of shirts you can bring with you to Hawaii, and once the suitcase is full that’s it—the rest of the shirts stay home. Or, you need another suitcase, which is lame because the airlines will charge you $50 and you can only carry so many suitcases.

Similarly, there is a limit to how much sugar insulin can manage, while the remainder has to stay in your blood. Your pancreas then needs to make more and more insulin. This is a bummer though because your body eventually becomes “resistant” to insulin and it stops working effectively. This is type 2 diabetes. The other issue with high levels of insulin in the blood is excessive fat storage.

The body has an evolutionary bias to store fat. It’s true, some people have a genetic predisposition that influences more or less fat storage, but in general, the body doesn’t want to waste the opportunity to store fat after a high-carb meal. It’s the strategy that once kept us alive when food was scarce. Our distant ancestors would get their hands on some carbs, tubers let’s say, then use some for immediate energy, while storing the rest as fat for later use when carbs weren’t around. Now that we don’t rely exclusively on hunting and gathering to eat, however, constant fat storage isn’t relevant.

This is a classic example of how the dose makes the poison. Insulin itself isn’t the problem, and neither are carbohydrates (at least the ones found in nature)—it’s years, decades even, of elevated blood sugar that’s the culprit. When we refine and process carbs, removing fiber, grinding them into a powder, and stripping out fats and proteins, we turn them into freaks of nature that the body mishandles. As you can see, it’s not how much we eat, it’s what we eat that leads to unintentional weight gain.

When you eat a meal that’s high in simple carbohydrates you initiate a 3-strike combo that causes weight gain.

First, your blood sugar spikes within 30 minutes of eating, and insulin is released. Next, insulin attempts to control your blood sugar by converting it into fat, and then promoting fat storage. The final straw is that when insulin is around, your body doesn’t break down fat. Do this daily and your body will gain weight from fat.

With this in mind, in order to treat the cause of weight gain, the logical solution is to lower insulin, and a trending way to do this is with a low-carbohydrate diet that’s high in healthy fat—aka ketogenic.

In The Case for Keto, Gary Taubes lays out the history, biology, and even a plan for eating low carb, high fat. As an investigative journalist, Taubes interviewed doctors, dietitians, and patients, culminating with the following conclusion:

“Carbohydrate-rich foods—grains, starchy vegetables, and sugars—work to keep insulin elevated in our circulation, and that traps the fat we eat in our fat cells and inhibits the use of that fat for fuel. That’s what the obesity research community should have been trying rigorously to resolve or refute for the past sixty years.”

A diet to lower insulin

Unlike other low-carb diets, the ketogenic diet emphasizes high fat intake from foods like fish, olive oil, and avocados. But do you need to be in ketosis to lower insulin (ie your body is burning fat instead of carbs to make energy)? No, you don’t. Any diet that prioritizes foods rich in healthy fats and proteins, while limiting highly-processed, high-carbohydrate foods will lower insulin and therefore lower weight gain. Paleo is a good option, the Pegan diet is a shiny new option, but feel free to create your own, based on foods you enjoy.

Here are some high carbohydrate foods to avoid or limit in any healthy diet:

The obvious: Soda, doughnuts, bagels, white bread, white rice, fries
The less obvious: Whole wheat bread, breakfast cereal, potatoes, and yams

Here are some healthy fats to add: Fatty fish (especially wild-caught salmon, or tuna), whole eggs, avocados, nuts (preferably a variety), seeds (hemp, pumpkin, and chia seeds are my go-to), olive or avocado oil.

And fats to avoid: Trans fats (including hydrogenated oils or shortening, and processed deli meats like hot dogs or cured meats), and fried foods.

The holistic approach to weight control

The challenge, and maybe you’ve experienced this, is that insulin is affected by more than your diet. Addressing your daily movement, sleep, and stress will each impact blood sugar, too. That brings us again to the requirement of a holistic approach for weight management, since changing only your diet won’t treat the whole picture.

I hope this isn’t overwhelming. Yes, it’s a lot of work and is much easier with a doctor, but consider that you thought you’ve tried everything to lose weight, but there are actually more options available. As a bonus, these changes will translate to improved health across the board. You may even notice that eating this way can also improve your mood and your energy as well.

A few more tips to make this change sustainable

Weight is often a poor predictor of health. If, however, you and your doctor agree that weight loss would decrease your risk of chronic illness then I suggest you begin by addressing your insulin levels. Avoid the get-hungry-and-stay-hungry technique, and instead experiment with a diet low in carbohydrates and high in healthy fats. This is the best way to control the hormonal signals you receive from food.

For this to work, it really has to be a lifestyle change, not simply “trying a new diet.” At the beginning, I encourage you to be honest with yourself: Are you a moderator or an abstainer? If you know it will be too hard to eat less processed foods, then avoid them all-together. This is where you will get long-term results, especially if you avoid refined, processed carbs like sugars, flour, bread, pasta, muffins, donuts, rice, and potatoes. If you're a moderator then go easy on the carbs, and instead get more calories from natural fats like avocados, olive oil, nuts, and other healthy saturated fats.

Talking about this with my friend and editor, Ethan Strong, we agreed that most people feel pressure to be an abstainer any time they're making a lifestyle change. This is problematic because it’s not always realistic for people to quit carbs cold turkey, instead of tapering-off like you would with any other addictive substances.

Focus on all the things you can eat. Replace carbs with whole foods, vegetables and legumes, as the fewer the ingredients, the better it is for your health. Remember, if you bring food into your house, even if it’s for your kids, you are probably going to eat some too, so be intentional at the grocery store. Plan meals ahead of time. Look at the label, and avoid foods with added sugar. Lastly, I believe it’s possible to lose weight with any diet modification, but maintaining this weight loss is the biggest challenge. To remedy this, I recommend individualized guidance from a dietician or a naturopathic doctor as you begin, which I’ve found is the most sustainable option.

Note: I understand that writing about weight loss is different from trying to lose weight. I do not have first-hand experience with the struggle of trying yet another diet, but I have guided patients through this type of eating. It’s hard work, and I’m impressed with your interest.