Review: The Obesity Code

      136 Comments on Review: The Obesity Code

I recently wrote a couple of posts explaining that over the years, I’ve revised my explanation of “the alternative hypothesis” from this:

More Carbohydrates => Higher Insulin => Fat Storage

to this:

Damaging Diet => Hormonal Disruption => Fat Storage

It’s not the biologically beneficial rise in insulin after a meal that makes people obese, I said in those posts. It’s chronically high insulin (along with other hormonal disruptions) resulting from a bad diet.

In comments, a few of you suggested I read Dr. Jason Fung’s book The Obesity Code because it expresses similar ideas. Good suggestion. It’s an enlightening and very readable book – meaning it passes my “Aunt Martha” test. Your Aunt Martha could read this book without giving up because she doesn’t want to keep a medical dictionary on her desk.

As I expected, insulin is still front and center in Fung’s explanation of why we get fat. In fact, the book’s cover includes the subhead Why your body’s own insulin is the key to controlling your weight. After citing plenty of research to effectively dismiss the “it’s all about consuming too many calories” explanation of obesity in the early chapters, Fung begins chapter seven like this:

I can make you fat. Actually I can make anyone fat. How? By prescribing insulin. It won’t matter that you have willpower, or that you exercise. It won’t matter what you choose to eat. It’s simply a matter of enough insulin and enough time.

Wait … hasn’t Dr. Fung read on the internet that we mustn’t blame insulin because it’s actually a wunnerful, wunnerful appetite suppressant? Well, perhaps he has … but if so, I’m sure he laughed. He has years of clinical experience with the stuff, as he explains in the book’s introduction:

I’ve often watched patients start insulin treatment for their diabetes, knowing that most will gain weight. “Doctor,” they say, “you’ve always told me to lose weight. But the insulin you gave me makes me gain so much weight. How is this helpful?”

… Like many doctors, I believed that weight gain was caloric imbalance – eating too much and moving too little. But if that were so, why did the medication I prescribed – insulin – cause such relentless weight gain?

Fung answers his own question in chapter seven:

Everything about human metabolism, including the body set weight, is hormonally regulated. A critical physiological variable such as body fatness is not left up the vagaries of daily caloric intake and exercise. Instead, hormones precisely and tightly regulate body fat. We don’t consciously control our body weight any more than we control our heart rates, our basal metabolic rates, our body temperatures or our breathing.

But it isn’t just about insulin. Fung includes chapters on cortisol (which triggers weight gain partly by raising insulin) and other hormones, such as leptin, that are involved in weight regulation.

And insulin isn’t just about how many grams of carbohydrate we consume. As Fung writes in chapter nine:

The carbohydrate-insulin hypothesis, the idea that carbohydrates cause weight gain because of insulin secretion, was not exactly wrong. Carbohydrate-rich foods certainly do increase insulin levels to a greater extent than the other macronutrients. High insulin certainly does lead to obesity.

However, the hypothesis stands incomplete. There are many problems, with the paradox of the Asian rice eater being the most obvious.

… Indeed, many primitive societies that ate mostly carbohydrates have low obesity rates. In 1989, Dr. Staffan Lindeberg studied the residents of Kitava, one of the Trobriand Isands in Papua New Guinea’s archipelago – one of the last places on Earth where people ate a largely traditional diet. Starchy vegetables, including yam, sweet potato, taro and cassava, made up the basis of their diet.

It isn’t foods that raise insulin that make us fat, Fung explains in the following chapters. It’s foods that lead to insulin resistance. Once we become insulin resistant, the entire hormonal system goes out of whack. Fung spends the next few chapters describing the foods that likely make us insulin resistant (sugar being a primary culprit) and how insulin resistance makes us fat.

Insulin resistance is largely about what we eat. But rolling back the effects – and perhaps preventing insulin resistance in the first place – is also about when we eat. That was the most useful message in the book for me, since I’ve already read rather a lot about the effects of foods.

As Fung explains, insulin is supposed to rise after meals. But then it’s supposed to drop and stay low for several hours. Back when few Americans were overweight, that’s what happened — because we ate three meals per day, period. Now we add constant snacking into the mix. When I was shooting interviews for Fat Head, Dr. Eric Oliver, author of Fat Politics, said that while people like Morgan Spurlock want to blame obesity on restaurants for serving larger meals, the real problem seems to be how often we eat between meals. Fung explains why that’s such a problem:

The balance between the fed state (insulin dominant) and the fasted state (insulin deficient) has been completely destroyed. We are now spending most of our time in the fed state.

… We are taught to eat the moment we roll out of bed. We are taught to eat throughout the day and again just before we sleep. We spend up to 18 hours in the insulin-dominant state, with only six hours insulin-deficient.

A lousy diet, of course, makes snacking irresistible. Refined carbs jack up your blood sugar, and your body responds by flooding your bloodstream with enough insulin to give you low blood sugar. If you work in an office, I’m sure you’ve seen exactly what Fung is describing. I see people eat their white-bread sandwiches at noon, and by 3:30 they’re back in the cafeteria, trying to decide if they should raise blood sugar with a candy bar, a bag of chips, or some microwaved popcorn.

Fung describes this as the vicious cycle that leads to insulin resistance. When insulin is too high, too often, cells down-regulate their insulin receptors. Then the body cranks out more insulin to try to lower high blood sugar. Then we get fatter. And hungrier. And snack more often.

Part of the cure is real food, and Fung devotes a good chunk of the book to the topic. But another part of the cure is to dial back insulin resistance through intermittent fasting. As you know, I’m a fan of the Wisdom of Crowds. Fung reminds the reader that in nearly all ancient cultures, periodic fasting was considered a boon to good health. It was part of their wisdom.

In the final chapter, Fung lays out the why and the how of intermittent fasting. Here’s part of the why:

To break the insulin-resistance cycle, we must have recurrent periods of very low insulin levels. But how can we induce our body into a temporary state of very low insulin levels?

We know that eating the proper foods prevents high levels, but it won’t do much to lower them. Some foods are better than others; nonetheless, all foods increase insulin production. If all foods raise insulin, then the only way for us to lower it is to completely abstain from food. The answer we are looking for is, in a word, fasting.

In the rest of chapter, Fung describes the hormonal effects of fasting and dispels the many myths about going without food … such as “it will depress your metabolism.” Interestingly, the research he cites here and in other chapters shows that while living on a low-calorie, low-fat diet will indeed slow down your metabolism, periodic fasting doesn’t. Apparently we’re built for it. Given that paleo man’s hunts weren’t always successful, that makes sense.

Jimmy Moore and Dr. Fung are co-authoring a book titled Fasting Clarity that’s scheduled to be published later this year. I’m looking forward to reading the expanded version of this topic.

In the meantime, The Obesity Code is definitely worth adding to your library of diet and health books.

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136 thoughts on “Review: The Obesity Code

  1. Neelesh

    Hi Everyone, This is Neelesh from India. Very recently came across Dr. Fung’s book.

    I am suffering from hypothyroidism from last 3 years and gained almost 16 kg weight. Tried many times low calorie diets in addition of strenuous exercise. I didn’t help me at all.

    Now very excited to start the IF for at least one months.

    Interestingly, Dr. Fung didn’t mention anything about the connection of weight gain, hypothyroidism and insulin resistance. I will be glad if anyone of you have any idea.

    Thanks

    Reply
  2. Neelesh

    Hi Everyone, This is Neelesh from India. Very recently came across Dr. Fung’s book.

    I am suffering from hypothyroidism from last 3 years and gained almost 16 kg weight. Tried many times low calorie diets in addition of strenuous exercise. I didn’t help me at all.

    Now very excited to start the IF for at least one months.

    Interestingly, Dr. Fung didn’t mention anything about the connection of weight gain, hypothyroidism and insulin resistance. I will be glad if anyone of you have any idea.

    Thanks

    Reply
  3. Chantal Black

    Im wondering about something, keeping in mind that i have not read the book and did not read this entire thread-my eyes are tired haha…

    a friend told me she had read this book and is working on losing her weight using these principals-i applaud her for that…

    my son is a type 1 diabetic and i wondered (having seen diabetes mentioned somewhere above, forgive me if someone went into more detail, as i mentioned i didn’t read every post) I wondered-if he were to take his insulin regularly (he is 27 and a stubborn diseased (so sick from diabetes that he simply cannot compute how sick he really is) shit that i have to pray for ever bloody day since i can’t pin him down and jab him four times a day with insulin pens…)

    if he were to take insulin regularly, would he get fat? or is this different in people whose body’s do not make any insulin at all? and whereby the only insulin they get is controlled….(i think i may have actually answered my own question)

    ultimately, the gentleman was referring i am guessing to type 11 diabetics who had complained the insulin made them fat….

    Reply
    1. Tom Naughton

      Several studies have demonstrated that people on high doses of insulin gain more weight than people on lower doses. But if your son is type I, my guess is that he’s simply injecting the amount of insulin his pancreas would otherwise be making. It’s type II diabetics who often inject higher and higher doses of insulin in order to overcome the insulin resistance.

      Reply
      1. Walter

        The trick is to use the proper amount, neither too much nor to little.
        Difficult!

        Teenage girls in particular type 1 diabetics know that if they skip the insulin they can eat anything they want and not gain weight.

        *Not a good idea.*

        Reply
  4. Chantal Black

    Im wondering about something, keeping in mind that i have not read the book and did not read this entire thread-my eyes are tired haha…

    a friend told me she had read this book and is working on losing her weight using these principals-i applaud her for that…

    my son is a type 1 diabetic and i wondered (having seen diabetes mentioned somewhere above, forgive me if someone went into more detail, as i mentioned i didn’t read every post) I wondered-if he were to take his insulin regularly (he is 27 and a stubborn diseased (so sick from diabetes that he simply cannot compute how sick he really is) shit that i have to pray for ever bloody day since i can’t pin him down and jab him four times a day with insulin pens…)

    if he were to take insulin regularly, would he get fat? or is this different in people whose body’s do not make any insulin at all? and whereby the only insulin they get is controlled….(i think i may have actually answered my own question)

    ultimately, the gentleman was referring i am guessing to type 11 diabetics who had complained the insulin made them fat….

    Reply
    1. Tom Naughton Post author

      Several studies have demonstrated that people on high doses of insulin gain more weight than people on lower doses. But if your son is type I, my guess is that he’s simply injecting the amount of insulin his pancreas would otherwise be making. It’s type II diabetics who often inject higher and higher doses of insulin in order to overcome the insulin resistance.

      Reply
      1. Walter

        The trick is to use the proper amount, neither too much nor to little.
        Difficult!

        Teenage girls in particular type 1 diabetics know that if they skip the insulin they can eat anything they want and not gain weight.

        *Not a good idea.*

        Reply
  5. Deborah

    I found The Obesity Code to add the final bits of revelatory information that I needed, despite having low-carbed for 16 years now, and having read all the usual LCHF books (Taubes, Teicholz, etc). Although I lost 100 pounds initially when I started low-carbing, I gained 30 through pregnancy, and then nothing but nothing helped me shift them, despite continuing to low-carb. And over the years, the frustration of that situation led to less control over my eating, and more splurges, which led to yet more weight gain. And all this while still eating low-carb 99% of the time! The splurges were very rare. But over 8 years, it led to another 25 pounds gained. I was getting desperate and even considering bariatric surgery, since lchf just wasnt’ cutting it anymore. And then I read the Obesity Code. I’d known about intermittent fasting, but this laid out the science behind it. And the fact that insulin is raised by sweeteners. It was tough to start – tough to quit all sweeteners, for one thing, but in the past few months I have lost 25 pounds and am on my way to getting back to where I once was. IF is infinitely flexible, you can change it depending on what’s going on in your life in a particular week. I usually do 2 24 hour fasts and 1 36 hour fast a week, although recently broke a stall by doing slightly longer fasts. I also have terrible stomach issues – throwing up, severe trapped wind, even fever – during menstruation and that almost disappears as long as I don’t eat. So I do longer fasts around that time. I was so, so fed up with gaining weight while still eating LCHF 99% of the time… Dr Fung gave me back hope.

    Reply
  6. Deborah

    I found The Obesity Code to add the final bits of revelatory information that I needed, despite having low-carbed for 16 years now, and having read all the usual LCHF books (Taubes, Teicholz, etc). Although I lost 100 pounds initially when I started low-carbing, I gained 30 through pregnancy, and then nothing but nothing helped me shift them, despite continuing to low-carb. And over the years, the frustration of that situation led to less control over my eating, and more splurges, which led to yet more weight gain. And all this while still eating low-carb 99% of the time! The splurges were very rare. But over 8 years, it led to another 25 pounds gained. I was getting desperate and even considering bariatric surgery, since lchf just wasnt’ cutting it anymore. And then I read the Obesity Code. I’d known about intermittent fasting, but this laid out the science behind it. And the fact that insulin is raised by sweeteners. It was tough to start – tough to quit all sweeteners, for one thing, but in the past few months I have lost 25 pounds and am on my way to getting back to where I once was. IF is infinitely flexible, you can change it depending on what’s going on in your life in a particular week. I usually do 2 24 hour fasts and 1 36 hour fast a week, although recently broke a stall by doing slightly longer fasts. I also have terrible stomach issues – throwing up, severe trapped wind, even fever – during menstruation and that almost disappears as long as I don’t eat. So I do longer fasts around that time. I was so, so fed up with gaining weight while still eating LCHF 99% of the time… Dr Fung gave me back hope.

    Reply
  7. Debbie

    A couple of questions please –
    When referencing a “low carb diet” – how to equate with difference between simple & complex carbs?
    With the prolonged (anything over 16 hrs) how does the value of adequate nutrition for optimum health factor in – in other words , are proponents of this as a healthy lifestyle believing nutrition optimum scan be achchieved?

    Reply
    1. Tom Naughton

      Yes, but if you’re eating less often, you want to make sure you’re eating nutrient-dense foods. I don’t separate carbs into simple and complex; I separate them into processed and non-processed. The processed carbs spike glucose much faster and are the ones to avoid. Non-processed carbs from real foods are usually more nutrient-dense and don’t (most of them, anyway) spike blood sugar so quickly.

      Reply
  8. Debbie

    A couple of questions please –
    When referencing a “low carb diet” – how to equate with difference between simple & complex carbs?
    With the prolonged (anything over 16 hrs) how does the value of adequate nutrition for optimum health factor in – in other words , are proponents of this as a healthy lifestyle believing nutrition optimum scan be achchieved?

    Reply
    1. Tom Naughton Post author

      Yes, but if you’re eating less often, you want to make sure you’re eating nutrient-dense foods. I don’t separate carbs into simple and complex; I separate them into processed and non-processed. The processed carbs spike glucose much faster and are the ones to avoid. Non-processed carbs from real foods are usually more nutrient-dense and don’t (most of them, anyway) spike blood sugar so quickly.

      Reply
  9. JCHris

    Thank you for all the information. I hope to get some insight:
    I am a vegetarian and will stay one. The Paleo Diet is not doable for me. Is it useful for me to buy Dr. Fung’s book?

    Reply
  10. JCHris

    Thank you for all the information. I hope to get some insight:
    I am a vegetarian and will stay one. The Paleo Diet is not doable for me. Is it useful for me to buy Dr. Fung’s book?

    Reply
    1. Tom Naughton Post author

      Yes. You’ll want to understand the biochemistry, whether you’re a vegetarian or not.

      Reply
  11. Olga

    That nice to read all this comments , sound promising, so I did start my starving and looking forward to have result to loose extra fat and became pretty and healthy!

    Reply
  12. Olga

    That nice to read all this comments , sound promising, so I did start my starving and looking forward to have result to loose extra fat and became pretty and healthy!

    Reply

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