Addendum to Do all Diets Fail?

//Addendum to Do all Diets Fail?

From several comments to the previous blog post “Do all Diets Fail?”, it seems that some have interpreted this to mean that I do not support any particular diet.  This is despite the fact that I have spent over a year and 60+ blog posts, and 8 hours of YouTube lectures explaining why diets that reduce insulin (particularly a Low Carb, High Fat diet) are an integral part of a weight reducing strategy.  Also despite the fact that I use LCHF in the IDM clinic on literally hundreds of patients with type 2 diabetes.

However, my point is this.  Obesity is a multi-factorial disease, as I previously wrote about.  This means, that there must be multiple targets in the pathway to obesity.  A LCHF diet, for some people will be sufficient for weight loss.  Many do extremely well.  But we cannot ignore those for whom LCHF is not enough.

Let’s take an analogy of heart disease.  Smoking, high blood pressure and family history all contribute to heart disease.  So, simply stopping smoking is important but not the only strategy to use.  We must also treat high blood pressure.  This does not, in any way, mean that stopping smoking is incorrect.  It is only incomplete.

In the same way, obesity has many facets, one of which is the diet.  Treating only the diet is enough for some, but not enough for others.  We cannot pretend that a LCHF will make 100% of people lean again.  Let’s take a thought experiment, as one of my heroes Gary Taubes is fond of doing.

Suppose, I give you prednisone, the synthetic form of cortisol.  It causes obesity.  As you get fatter and fatter, I, as your physician advise you to go on a LCHF diet.  Will it work?  Of course not.  Your diet was not the problem.  Your problem was the excess cortisol I prescribed to you.  The answer, of course is simple.  Reduce the cortisol.  You must treat the underlying cause of the obesity.  You must understand the aetiology of obesity.  Diet, in this case, is not enough.

In the same way, suppose your problem with obesity is the time dependent development of insulin resistance over two decades.  That insulin resistance is the major pathway by which your insulin stays elevated.  Now, I tell you to watch your diet.  Will it work?  Not likely.  You have addressed the insulinogenic diet, but not the insulin resistance.  Sure, changing you diet will lead to a lowered insulin resistance in 5 years, but that’s not good enough.  (If it took 20 years to develop, doing the reverse will similarly require that amount of time).

Suppose your problem with obesity is due to excessive cortisol due to stress and sleep deprivation.  Or chronic pain from fibromyalgia.  Will a prudent diet help?  A little bit.  A good diet is not going to reduce your cortisol.  If cortisol is the main pathway, that is what needs to be addressed.  I have, in fact, patients in the Intensive Dietary Management Program who I cannot help because their problem is caused by, say anti-psychotic medication that stimulates insulin.  Or fibromyalgia that stimulates cortisol.  Unless I can deal with their underlying cause of obesity, I cannot treat it.  But I certainly can understand it.

So, with regards to diet, refined carbohydrates stimulate insulin the most, and dietary fat the least.  So the most logical dietary treatment is Low Carb, High Fat.  Yes, I am still a firm believer in that.  But sometimes, we need to move past that.

2017-10-19T14:44:22+00:00 0 Comments

About the Author:

Dr. Fung is a Toronto based kidney specialist, having graduated from the University of Toronto and finishing his medical specialty at the University of California, Los Angeles in 2001. He is the author of the bestsellers ‘The Obesity Code’ and ‘The Complete Guide to Fasting’. He has pioneered the use of therapeutic fasting for weight loss and type 2 diabetes reversal in his IDM clinic.

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22 Comments on "Addendum to Do all Diets Fail?"

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Sergio Castorena
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Doctor Fung,
Excellent post, I guess that Obesity is more than just the mantra “eat less and exercise more”. We must in some cases address the correct root cause and not only a correct diet is the option.
Speaking of hormonal obesity, what do you think of Probiotics as a way to reduce the metainflamation that can be generated by a disbiosis leading to endotoxemia and thus Obesity?

Moriarty
Guest
IGNORANCE of the Biochemistry is the reason why most dieters will put back on the weight they have lost. If they fully understood the biochemistry at play, they would keep the weight off, simple as that. The only reason they will put that weight back on is ignorance. I know this for a fact because I was ignorant. Twice in the past I have lost a lot of weight through calorie restriction and willpower only to put it all back on and then some. I had no idea what Insulin was or what it did despite having a brother who… Read more »
Rebecca Latham
Guest
Moriarty, Even people who are informed of the Biochemistry can put the weight back on. It is not as simple as you think it is. I think the whole point of this post and others is that, for some, eating the right things is only a temporary “fix”, and the weight will be regained because there were other factors at play that are not being addressed. By the way, I am a “Fat Head”, too, and appreciate the movie and the man and all I have learned from them. But even though I have been diligently low carb for six… Read more »
Glenda Glayzer
Guest
” (If it took 20 years to develop, doing the reverse will similarly require that amount of time).” This says there is no hope for me, then? I am a 70-year-old female and have been eating LC since 1972. Genetically, diabetes was on my horizon and I’ve managed so far to keep it away. I only learned about your protocol in February 2015 and following it has allowed me to lose weight for the first time in 6 years. I don’t know if I can go on fasting for the next 40 years. I take only one pharmaceutical, which is… Read more »
kfacwpup
Admin

Absolutely not. LCHF is a great start but not always sufficient. Intermittent fasting a good adjunctive measure.

Geoff Smith
Guest

You are saying that it will take as long to undo the insulin resistance as it took to create it “If it took 20 years to develop, doing the reverse will similarly require that amount of time”
If so then Bariatric surgery would not reverse diabetes as quickly as it does for some many obese patience…. yet it does.

kfacwpup
Admin

No – bariatric surgery, and fasting is much more drastic than the diet that led to insulin resistance. Therefore, it will give much, much faster results – often within 2 weeks.

Joy
Guest

I have spent the last 10 days reading your blogs and have had many years of “nutritonalist” thinking challenged. How I ear has changed and my practice as a Dietitian will be following. I need to be clear as to what you mean when you say “intermittent fasting”. Is it one day in 7 with no food, only bone broth?

BTW, my bone broth is simmering on the stove until tomorrow (Vietnamese pho), so having this clarified would be very helpful.

Thanks very much,

Joy

kfacwpup
Admin

I will address this more fully in the upcoming series. Short answer is that you can do as much or as little as you like.

Dr.Garry Lee
Guest
There is something to avoid, Jason, and that’s the blanket statement “all diets fail”. I’ve considerable experience of this, being 65 is one week and having overweight and type 2 dm on my father’s side (grandmother and uncle) though my dad who was always heavy lived till 96 and never became diabetic, or if he did, his geriatrician did not diagnose it. I first became fat at about 24 and since then I’ve had a struggle with my weight. I’ve never been obese and my worst BMI was 28.5, despite more or less lifetime exercise as an adult, but I… Read more »
kfacwpup
Admin
You are right, of course. Blanket statements cause a bit of upset. I actually don’t mean to poo hoo anybodies chances of success – only to show that there are different ways to success. From a practical standpoint, I view a diet that fails due to non compliance the same as a diet that simply doesn’t work. As a physician, to me, the end result is the same – weight regain. What I need is a diet that works AND people can follow. That is our challenge. One that I mean to answer in the upcoming posts.
Joy
Guest
I am a Registered Dietitian in private practice and a friend of mine, a physician, shared the link to this blog with me several weeks ago. Everything both of us have believed to be true is being positively challenged and I am needing to rethink what best clinical practice is have used the Diabetic Exchanges for years rather than Canada’s Food Guide, but am now challenged to rethink the “3 meals, 3 snack” paradigm. Aiming for 20g of carbs per day over 3 meals, no snacks and a 12 hour period of fasting from the evening meal until the morning… Read more »
kfacwpup
Admin
Intermittent fasting must be done very carefully if somebody is taking diabetic medications. For this reason, all fasting schedules are personalized in our clinic. Furthermore, careful blood sugar monitoring and adjustment of meds is crucial to avoid both hyper and hypoglycaemia. Guidelines are difficult. For example, you cannot write a guideline such as “Give 20 units of insulin for blood sugar of XXX” as some patients will be hypoglycaemic with that dose and others will not drop their sugars at all. It is the same with fasting. I only have a rough guess as to how the body will respond.… Read more »
erdoke
Guest
This is certainly a very good discussion which I have been following both here and over at the DietDoctor’s site. I agree that saying “all diets fail” was a bold statement, but I believe you have supplied enough arguments to the case to support your view. The adherence part is extremely important when talking about or comparing diets. In my opinion this is one of the important aspects where LCHF really shines, because of natural control of hunger by the two most satiating food components: protein and fat and also by the right hormonal approach to satiety. So it is… Read more »
Moti
Guest

what is the cure for fibromyalgia?

kfacwpup
Admin

I wish I knew.

Joy
Guest
Thanks for your reply regarding intermittent fasting for diabetics, but in my case, no medication is involved. Yes I am a Dietitian that became diabetic *after* losing 50 lbs and keeping all but 10 off. Following current “best clinical practices”, I became diabetic. Your approach makes physiological sense, and since the 3 “meals / 3 snacks” with 45% of calories as carbs got me where I am, continuing makes no sense. My blood glucose has been well managed by diet (and I thought exercise), but I understand now how following current Dietetic / medical recommendations has only increased my insulin… Read more »
Faith
Guest
You should get his book Obesoty Code or else watch all the videos/ read all the blogs. Many of us in the FB group Im in fast on a regular basis but mix it up. 24hr, 36, 48 and some go much longer. But then putting in feed days of LCHF in between. The key fir all of us is testing our BS (specially a.m. fasting) to see how we are doing. Mine has been coming down the last week or so n I have been doing this since Jan. But I still have more weight to lose too. Good… Read more »
K
Guest
As always, a great posting, Dr. Fung. Thanks for sharing your knowledge and experience with us. While I am not overweight or diabetic, diabetes and blood sugar issues run in my family, so I am hyper conscious of keeping myself in the best shape possible. I’ve been dabbling in IF for a few years, beginning with the Warrior Diet and Fast-5, but haven’t been terribly strict. The more I read your site and watch your videos, the tighter I think I should keep my diet and fasting practice. Kind of an off-topic question, but at least directly related to fasting.… Read more »
JW
Guest
Thank you for your blog! There is so much BS about diet/nutrition and your blog is just luverly to read, the voice of clarity and reason. I wish my mother was around to heed your advice; she wouldn’t have died early from years of T2 complications eating her low fat carbs including snacks every 2 hours to keep her blood sugars stable (Dr’s advice of course). Hopefully with Dr’s like yourself daring to go against the standard advice and educate people I may be able to avoid following her health problems (and my children). The only problem I struggle with… Read more »
NS
Guest
Excellent article. You are perhaps the ONLY LCHF proponent/supporter that is not an ideologue. Very refreshing. Here’s the problem Dr. Fung. Just as eloquently as you write about the many causes of obesity above, exemplifying the case of cortisol, there are in fact tons of other causal factors in obesity that are not even recognized yet at the moment. That will change of course in the future… but the damage done will be so great by then. I can post hundreds of links on the high association between viral syndromes and insulin resistance. Even some mainstream doctors/researchers are beginning to… Read more »
NS
Guest
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