Do All Diets Fail? – How to Lose Weight XI

All diets fail. Long term dieting is sheer futility. After initial weight loss, the dreaded plateau appears, followed by the even more dreaded weight regain.

What do I mean? Weight loss follows the same basic curve so familiar to dieters the world over. Whether it is the Mediterranean, the Atkins, or even the old fashioned low fat, low calorie, all diets in the short term seem to produce weight loss. Sure, they differ by the amount – some a little more, some a little less. But they all seem to work.

However, by 6 months to 1 year, weight loss gradually plateaus followed by a relentless regain despite continued dietary compliance. This occurs regardless of the dietary strategy. In the 10 year Diabetes Prevention Program, for example there is a 7 kg weight loss after one year. The dreaded plateau, then weight regain, follows. So all diets fail. The question is why.  Sure there are those that seem to maintain their weight loss for year, but we cannot ignore the majority that struggle with weight loss.  Further, most academic research seems to indicate that most diets fail, whether it stops to work, or whether it is due to lack of compliance.

This happens because the body reacts to weight loss by trying to return to its original body set weight (BSW).  This is the body weight ‘thermostat’, variously called the appestat, or the lipostat.  Even the low carbohydrate diets, proven to have superior weight loss effects in the short term, show the same inexorable plateau and weight regain.

We hope the BSW will decrease over time, but this hoped-for reduction does not materialize. Why does the BSW still stay high even if we are eating all the ‘right’ things? This is because insulin levels stay elevated. Only half of the problem has been addressed. Two main things maintain high insulin levels. The first is the foods that we eat. This is what we usually change when we go on a diet. But we fail to address the other main concern. This is the longer-term problem of insulin resistance or ‘When to Eat’.

Insulin resistance maintains high insulin levels. High insulin maintains the high BSW. This inexorably erodes weight loss efforts. Hunger increases. Metabolism (TEE) relentlessly decreases until it falls below the level of energy intake. Body weight plateaus and then ruthlessly increases back to the original BSW, even as the proper diet is maintained. For some, changing ‘what we eat’ is clearly not enough. This is the problem we are all familiar with. All diets fail.

To succeed, we must break the insulin resistance cycle. But how? Consider the analogous problem of antibiotic resistance. If antibiotics are used at persistently high levels, resistance develops. How do you break antibiotic resistance? The knee-jerk reaction is to use even higher doses of antibiotics to ‘overcome’ the resistance. But this will only encourage the development of more resistance. The answer is the exact opposite. The answer is to reduce use of antibiotics. Having periods of very low antibiotic usage breaks the resistance.

The same logic applies to insulin resistance. The body’s knee-jerk reaction to insulin resistance is to increase insulin levels. But this only creates more insulin resistance. The answer is the exact opposite. We must create recurrent periods of very low insulin levels, since resistance depends on persistent, high levels. But how can we create those very low levels of insulin?

So the forgotten question of weight loss is “When should we eat?” We don’t ignore the question of frequency anywhere else. Falling from a building 1000 feet off the ground once will likely kill us. But is this the same as falling from a 1-foot wall 1000 times? Absolutely not. Yet the total distance fallen is still 1000 feet.

The first step is to eliminate all snacking in between meals and at bedtime. This is hardly some far-fetched idea. We are simply turning back the clock to the 1960s. Eating snacks or eating at a place other than a table was actively discouraged. There was no eating in the car, or in front of the TV.

If all meals were eaten between 8am to 6 pm, this was enough to prevent obesity. So, even though they were eating white bread and pasta, there was minimal obesity compared to today. I mean – who ate whole wheat bread in the 1960’s?  Nobody sold multigrain bread.  Rye?  Please.  And don’t get me started on whole-wheat pasta – that didn’t even exist then. Ask for quinoa and people thought you were swearing in spanish.

All foods will increase insulin levels to some degree. Eating the proper foods will prevent high levels, but won’t do much to lower levels. Some foods that are better than others, but all foods still increase insulin. The key to prevention of resistance is to periodically sustain very low levels of insulin. If all foods raise insulin, then the only logical answer is the complete voluntary abstinence of food. The answer we are looking for is, in a word, fasting.

See the lecture The Aetiology of Obesity 2/6 – The New Science of Diabesity

See the lecture The Aetiology of Obesity 4/6 – The Fast Solution

Update April 5, 2015

I got a question whether I disagreed with Dr. Andreas Eenfeldt who argues that diets work if you can stick to it, and his post makes a terrific case.  This is my response:

I’m a huge fan of Dr. Eenfeldt’s http://www.dietdoctor.com blog. It is consistently one of the most useful sources of nutritional information on the Internet. However, I have a slightly different view of how diets ‘fail’. Whether a diet fails because of lack of effect, or due to lack of compliance, to me, it is the same end result. The weight is still not controlled.

That is why it is necessary to have more than one way of achieving the same goal – reducing insulin and thereby reducing weight. If you can stick to a 20gm carb diet in the long term, you will likely do well. But what if you cannot? Are you doomed to failure? Not at all. You can achieve the same result by using a different pathway of insulin reduction.

I am completely in agreement with Dr. Eenfeldt’s approach, and I think it makes absolute sense.  I’ll note, too that he is a proponent of intermittent fasting.  I tend to emphasize the IF strategy because it is conceptually, a much simpler proposition for patients to follow.

This post is not meant to be pessimistic despite the title (All Diets Fail), but actually optimistic (a certain strategy may fail, but you can use another one to achieve the same goal).  This will become clearer in future posts.

2017-10-28T21:41:45+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.

Leave a Reply

avatar
  Subscribe  
Notify of
TD
Guest
TD

I’ve been following the fasting diet for about 14 months now. Disclaimer: my fasting diet means I don’t eat breakfast, just a modest lunch and normal dinner. Ive did this for the entire time. I’ve lost all the fat I likely can, only a small amount of fat remains on my lower abs and obliques. I still have no hunger pains and feel quite good and presently I have yet to see the fat start to come back. My plan is to continue this fasting method for another 10 months to see what happens – whether I will start gaining… Read more »

Geetha
Guest
Geetha

Do you drink coffee before 8 am?

fyoung
Guest
fyoung

yes, Bulletproof coffee with 1-Tbl Gras-Fed Ghee butter and 1-Tbl Heavy Whipping Cream and whip it up in your blender. What a great tasting coffee that gives you energy and will suppress your appetite.

John C
Guest
John C

I’ve been in the Intensive Dietary Management Program for six months now. I had previously normalised my glucose levels on a low-fat calorie-restricted diet for a year but it was a struggle with obsessive calorie counting and hunger between meals. I hoped only that IDM would help me to maintain my reduced weight but I soon lost another ten pounds and I was no longer hungry between meals. I think my body is at its set weight now, just a few pounds more than I was over forty years ago. I have gradually resumed eating in restaurants (one or two… Read more »

Adrienne
Guest
Adrienne

Uh, I think you have an idealized view of the 60s in America. Swanson had a very successful campaign to sell tv dinners to the public in the mid 50s and this was such a wild success that the product line was increased in the 60s to include breakfast and lunch frozen meals and desserts. The whole idea of “tv dinners” was to encourage eating in front of the tv. In any event, closing the pie hole after 6:00PM is totally unrealistic for many nowadays because they do not get home from work until after 8:00 Pm and both parents… Read more »

TD
Guest
TD

Yes I love my nap each day, we need all got to get back to that. I remember eating TV dinner but it was always at the dinner table and few got fat in those old days because there was no snacking. Let’s face it, the food companies changed society for the worse. I believe in tough love and stating that if you will it you can stop snacking and start losing weight. Our society is a society of excuse makers, full of people who refuse to take responsibility for their actions. My opinion of course.

Garry Lee
Guest
Garry Lee

Jason, something you’re spot on about. Snacks. When I was young, in Cork, Ireland, this is how we ate. Breakfast. Porridge (I usually didn’t have it as I didn’t like it), a fry with rashers of bacon, sausages and a fried egg. A slice or two of toast or brown sodabread, an Irish speciality. We often had an orange. Lunch: (was our dinner and we called it dinner). Soup, meat, fish or liver, potatoes, vegetables. Usuals in our house were peas, carrots, turnip (rutebago or something you call it), cauliflower etc. Dessert. That would be rice pudding, or apple sponge… Read more »

Walter Bushell
Guest
Walter Bushell

And the bread was not fortified. Fortified alone makes the bread an industrial food even beyond the refining of the flour. If you must eat pasta, I understand Italy does not fortify their wheat products, so they would be a less bad alternative.

Liz
Guest
Liz

Interesting that fasting appears to be as effective for maintaining weight loss as it is for initiating it. Do you think it is the intermittent nature (body does not begin to conserve calories anticipating a famine) of it or simply the reduction of insulin overall? It would be interesting to hear in a future post how the fasting protocol might vary in frequency or duration for weight loss and maintenance. I was there for the 60s. Yes, we had Swanson dinners, eaten off of TV trays. In our home they were a Rare Treat, once maybe twice a month, if… Read more »

bill
Guest
bill

Dr Fung:

Do you disagree with Dr Eenfeldt’s post today?
http://www.dietdoctor.com

kfacwpup
Guest

Not at all. I’m a huge fan of Dr. Eenfeldt’s http://www.dietdoctor.com blog. It is consistently one of the most useful sources of nutritional information on the internet. I have a slightly different view of how diets ‘fail’. Whether a diet fails because of lack of effect, or due to lack of compliance, to me, it is the same end result. The weight is still not controlled. That is why it is necessary to have more than one way of achieving the same goal – reducing insulin and thereby reducing weight. If you can stick to a 20gm carb diet in… Read more »

Samuel
Guest
Samuel

I have developed a keen interest in this subject over the last five years, but it is not because of abnormal weight. It was because I was trying to affect my lipid profile, and more recently , dry eye. The lipid profile was easy to deal with because standard low-fat dogma is so preposterous you can get a handle on it right after you go buy your first NMR Lipoprofile. However, after approaching my diet from an athletic perspective involving a low carbohydrate approach, and including what might be described as fasting, it seems to make a substantial difference in… Read more »

JW
Guest
JW

Don’t get me wrong I am LC but Peter D from Hyperlipid and Paul Jaminet Perfect Health Diet wrote about LC causing lack of mucus resulting in dry eye etc, if you google you will find. From memory Paul recommended having a spoonful of rice when dryness occurs. I haven’t had rice in 4 years…so please…I’m not a carb pusher but it may be worth looking into, especially as Peter and Paul both address this issue.

Samuel
Guest
Samuel

I read The PHD, and I tried what was suggested. You are dealing with small changes and this may work for some people. I could not see a consistent difference. When you make nutritional/dietary changes you never know if they are real and long term in their effect. I went off Restasis about four months ago. So far, so good. I attribute it to increased lipid intake, 4-6g sodium per day. The lipids are coming from what I eat and a dose of cod liver oil, and two tbs of a 3-6-9 oil per day. However, I will have to… Read more »

erdoke
Guest
erdoke

Insufficient amounts of mucus is more likely to come from lacking certain amino acids, such as glycine/proline. Do not forget that mucin is a glycoprotein rich in mentioned amino acids. Add more gelatin/collagen in the diet and reduce lean meat.

Marty Kendall
Guest

I would be interesting to track blood sugar and ketones as well as weight.

I would think if they if people were eating to keep their blood sugars optimal and sitting in some level of ketosis (i.e. low insulin) their diet would be much less likely to fail.

Kindke
Guest
Kindke

The start of the post was good, but then you fell into the same thinking that everyone is stuck in ”

I.E.

To get adiposity X ,… we HAVE to do Y

“To succeed, we must break the insulin resistance cycle.” …… you see what I mean? “we have to do this, or that, blah blah blah. “

kfacwpup
Guest

I appreciate your sentiment. In fact, if you follow my posts, you’ll see that I go through 5 separate pathways to obesity as well as 3 different protective pathways against obesity. So, breaking the insulin resistance cycle is a only one of 5, although a major player. We CAN’T just do Y. We have to do X, Y, Z, A, B and C to combat obesity – it is a multi-factorial disease and needs a multi-factorial solution, as I detailed in a previous post.

Eric
Guest
Eric

Can you talk about fasting with jimmy moore this week. The time recommended varies from mark mats onto others Eric
I art mine from 18 to 49 hours

trackback

[…] 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 […]

webgrrrl
Guest
webgrrrl

And surprisingly I agree with greensleeves on Andreas’ blog. IF doesn’t work for most women. It is true that it will cause many women to cease menstruating, as it will convince the body over time that you are starving and can’t afford to reproduce. Since most of the people on this diet/lifestyle are actually women, why can’t give advice that works for them? Or is at least relevant to them? It used to be possible to be thin without having to abandon your fertility. I’ll bet when Andreas’ wife wanted to have her baby she ate, and ate plenty. 30g… Read more »

Robin 'Slim'
Guest

I have found, through my own experience (& those of over 200 others who have followed the programme) that; “It’s not so much the food we eat that makes us fat. It’s the thoughts we think & the emotions we feel . . . that cause us to eat the types of food that ‘make us fat’. ” -RDP With my experience I can now look at someone’s body, and by where the excess weight is, can tell what the ‘dominant’ emotions are in their life. I ask a few questions and they confirm by their responses. Listen to the… Read more »

Walter Bushell
Guest
Walter Bushell

Correlation does not prove causation. It may be fat accumulating in certain places causes those thoughts and emotion or they could be caused by a common factor.

Joy
Guest
Joy

Dr. Fung,

Do you think there could be a role for an “insulinometer” that could be used to monitor one’s insulin response to specific foods, much the way a glucometer is used for post prandial blood glucose levels (especially for those with Type 2 Diabetes?
Do you think there are medical equipment manufacturers that might be willing to develop such a device?

Thanks,

Joy

trackback

[…] reminded of this studying a brand new weblog publish by the incredible Dr. Jason Fung – All Diets Fail – How to Lose Weight XI. I like to recommend his blog and lectures (though in case you wait just some weeks you possibly […]

Rebecca Latham
Guest
Rebecca Latham

Dr. Fung, If I understand, insulin resistance is caused by eating foods that raise insulin (with a possible genetic propensity) and can be treated by eating the right things at the right times. So far, so good. Here is my question: Once insulin resistance has been reversed and insulin is no longer being over-produced, does “treatment” have to continue for life? Once you are insulin sensitive again (metabolically healthy), do you stay that way, or do you have to continue to try to reduce insulin by eating the right things at the right times. I am not suggesting that a… Read more »

kfacwpup
Guest

Sometimes breaking insulin resistance requires more than just the proper diet. You can become metabolically the same as the person who never had a weight problem, but it may require rather more fasting than most people wish to do.

Nell
Guest
Nell

how does this relate to plateaus? I am very strict with my diet and walk 30 min a day but there is always the inevitable plateaus. It happened with low carb then Keto and now with the fasting? I thought of shaking up my fasting between the 24 and the 36. I am currently doing the 24 every other day and eating very low carb on the alternate days. I did lose 20 lbs but now that has slowed and I do still need to lose more. my BG are quite good still!

AreWeThereYet
Guest
AreWeThereYet

Dr. Fung — When you say “more fasting than most people wish to do” to get excess insulin healed, are you talking about:
1. Fasting but taking bone broth, decaffeinated coffee with heavy cream, green tea OR just water
2. Weeks? Months? Years?

Thank you

kfacwpup
Guest

We don’t advise water only fasting due to potential loss of sodium and electrolytes which bone broth provides.

To fully and completely reverse insulin resistance often takes an equal amount of time to how how you have had the IR. So, if you have been insulin resistant (obese) for 10 years, it may take up to 10 years to fully fully reverse with a relatively mild fasting schedule. Obviously, if you do more intensive fasting, it will take less time.

Walter Bushell
Guest
Walter Bushell

If someone has been insulin resistant for 50-60 years, that leaves little room for hope. I’ve only managed to fast for 3-5 days max.

Seng Goh
Guest
Seng Goh

I have been doing IF for a few months and following your blog. I have type II Diabetes, weighs 62 kg, lean and strong. I exercise regularly. I started by skipping breakfast before my morning exercise which consists of 15 minutes to 20 minutes resistance ( 7 mins APPS + some weights and chin ups. After than I go for a tennis game for about 90 minutes and have my breakfast at about 10 am ( high fibre no sugar cereal + banana, berries, with almond milk, and some YAM ). I skip lunch and have dinner at about 6… Read more »

Michael McEvoy
Guest
Michael McEvoy

Dr Fung – I am an FP with a strong interest in nutrition. I generally advise LCHF approaches to living – certainly if metabolic syndrome is lurking as it does in a large segment of the population. I have also measured C-Peptide and LP-IR in many individuals. Yet I do NOT see a consistent relation between IR and weight . I have found several people with low IR and high weight . Do I just surmise these are overeaters? How did they get obese while even at a low IR? In addition, I have tried to anticipate that a given… Read more »

Tom
Guest
Tom

I’ve been fasting since October and lost from 214 down to 191 by mid-December, but I’ve been stuck at this weight since. I had been eating only dinner between 6 and 10 pm and limiting calories to 1500-1800. Recently, I’ve tossed in a couple alternate day fasting as well. I’ve been using a fitbit and averaging about 17,000 steps/day with at least 40 minutes of cardio and occasional resistance training. I try to get in 2 HIIT using the Takada method per week. I need to loose another 15 lbs, so to get through this plateau, I’m considering, jumping calories… Read more »

Christina Carter
Guest
Christina Carter

I’m a huge fan of everything you do here and just got done reading Obesity Code. But I still have one question that I missed in the book and can’t find the answer to it here. Call it not picky but I’m curious. What specifically about insulin resistance “controls” the Body Set Weight or causes it to increase or decrease? I get how insulin and insulin resistance cause is to store fat and gain weight but why then do we reach a state of homeostasis that is so above normal for what we started at? I hope my question is… Read more »