I Can Make You Thin…Insulin – Hormonal Obesity V

Click here for Hormonal Obesity Part I, Part II, Part III and part IV.

To start at the beginning – start with the Calorie Series here.

 

According to Hormonal Obesity Theory (HOT), we postulate that high insulin levels causes obesity.  We can give insulin or insulin stimulating drugs (sulphonyureas) and cause weight gain, despite all attempts to lower caloric intake.

If this theory is true, we should also expect the opposite.  That is, if we somehow reduce insulin to low levels, we should expect significant severe weight loss despite all attempts to increase calories.

In fact, this is exactly what we find.  Type 1 Diabetes is an autoimmune disease of the pancreas.  The insulin producing cells of the body are destroyed.  Therefore, insulin levels fall to extremely low levels.  Blood sugar increases in the blood.  But the hallmark of this disease is severe weight loss.

Aretaeus’ classic description of type 1 diabetes “Diabetes is … a melting down of flesh and limbs into urine”.  That is, in spite of whatever calories you try to eat, the untreated type I diabetic is not able to gain any weight.  Until the discovery of insulin, this disease was often fatal.

In essence, insulin is the signal to the body to gain weight.  If we give insulin, the body will gain weight.  If we take insulin away, we will lose weight.  Put another way, insulin is one of the major controllers of the body set weight (BSW).  If insulin levels go up,  our body is commanded to gain weight.  This will now trigger the response to increase eating.  We will become hungry and be compelled to eat.

If that does not work, then we will decrease our Total Energy Expenditure (TEE) or Calories Out so that we will gain weight in response to whatever number of calories we do take in.

Eating more and moving less is the result of obesity not the cause of obesity

As the great Gary Taubes puts is –

We do not get fat because we overeat

We overeat because we get fat

That sets us up perfectly to ask the correct question.  Why do we get fat?  We get fat because our insulin levels are too high.

In a majority of cases, insulin is the main player in obesity.  However, it is not the only hormonal control of weight – cortisol also plays a role.

 

Cortisol is the so called stress hormone.  If we hypothesize that excess cortisol may also cause obesity, then we should be able to give somebody cortisol and observe weight gain.  We can observe cases where cortisol is overproduced in the body.  This is called Cushing’s disease or Cushing’s Syndrome.  The hallmark of this disease?  Weight gain.

There is a synthetic form of cortisol – a very commonly used as a medication called prednisone, which is a corticosteroid.  It is a powerful anti-inflammatory and often used in the treatment of asthma, lupus and other inflammatory disorders.

So, if we give somebody prednisone, what happens?  They develop what is called cushinoid syndrome.  In other words, these patients look like they have Cushing’s Disease.

Mostly they notice that they gain weight.  There is also a particular distribution to this weight gain which is called truncal obesity, which means that fat is gained on the trunk rather than on the extremities (arms and legs).

What about the opposite?  If we believe that cortisol can cause obesity, then what if cortisol levels were to drop to extremely low levels?

We have this exact situation in the case of Addisons disease.  This also know as adrenal insufficiency.  The adrenal gland produces cortisol and when it is damaged, cortisol levels as well as other hormones go very low.

The hallmark of Addison’s disease?  Weight loss.

Hormones are the key to obesity.  These are causal relationships.  One thing causes the other.  This is a much more powerful relationship than most correlation studies (see rule #2 – Correlation studies are mostly crap)

If we increase insulin, we gain weight.  If we decrease insulin, we lose weight.  Our body weight (as well as everything else in the body) is regulated by hormones.  Such an important physiological variable such as body weight is not left up to the vaguaries of daily caloric intake and output but instead is precisely regulated by hormones – mostly insulin, but also cortisol.

This makes a lot of sense when you think about it.  Consider this.  If we eat 2000 calories/day, that amounts to 730,000 calories in a year (2000*365 = 730,000).

Many people, gain 1-2 pounds per year.  Not a lot, but over 25 years, this adds up to 50 extra pounds.  In calorie terms, this amounts to a caloric excess of 7,200 calories over 1 year assuming that 1 pound of fat is roughly 3,600 calories.  This is an error rate of not even 1%.

If we are responsible for keeping track of how many calories we eat and how many calories we burn, do you think that we could be so incredibly precise?  Most of us don’t even know how many calories we are eating or burning at any given time!  How can this possibly be controlled by our rational brain?

We don’t control our body weight any more than we control our heart rates.  This goes on automatically under the influence of hormones.  Hormones tell us we are hungry.  Hormones tell us we are full.  Hormones tell us when to increase energy expenditure.  Hormones tell us when to ‘shut down’ energy expenditure.  Obesity is a hormonal dysregulation of fat accumulation.

When we throw these hormones out of whack, we get diseases such as obesity.  If we can understand that obesity is a hormonal imbalance, then we are set up perfectly to ask the next question – how do we treat obesity?

If we believe that excess calories caused obesity (Caloric Reduction as Primary) then the treatment is to reduce calories.  This was a complete and utter failure.  If we understand that obesity is caused by too much insulin, then we need to lower insulin.

In fact, we see that our understanding of obesity has really changed very little since the time of William Banting (mid 1800′s).

From the mid 1800′s to the mid 1900′s we believed that sugars and starches caused obesity.  Obesity was treated by reducing sugars and starches.  And hey, guess what, it worked pretty well.

From the 1950′s to the 2000′s we believed that calories caused obesity.  This led to numerous calorie restricted diets – the large majority of which were complete failures.  And hey, guess what, obesity rates exploded.

Now, with a greater understanding of the hormonal underpinnings of obesity, we see that we have come full circle and have recognized again that refined carbohydrates were the cause of the obesity epidemic.  The key is to restore insulin, and to a lesser degree cortisol levels to normal.  The key is NOT balancing calories – it is to balance hormones.

Continue to Exercise series – part I here

Begin here with Calories I

See the entire lecture – The Aetiology of Obesity 1/6 – A New Hope

2018-05-26T11:39:45-04:0020 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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[…] “I can make you thin – Insulin – Hormonal Obesity – Part 5:  HERE […]

Jay
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Jay

A 5-part series on hormones and how they relate to body weight control and leptin is not mentioned at all.

Esmee La Fleur
Guest

Thanks for all your great posts.

Judy warner
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Judy warner

I am wondering if I could be too insulin sensitive, of sorts. I am not a diabetic, do not have any problems with elevated blood sugars. I have always been a person that gains weight “at the drop of a hat, or just by smelling food” as the saying goes. Instead of being insulin resistive am I too efficient with my insulin. Does fat storage not stop,mor not get turned off? Once the increased blood sugar from a meal is properly delt with, does any excess insulin that was not used continue to store fat? Do I produce too much… Read more »

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[…] פוסט זה מוגש כשירות לציבור. הזכויות על התוכן שייכות לכותב של הפוסט המקורי. את הפוסט המקורי ניתן למצוא בכתובת הזאת. […]

John
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John

I am so glad to have read your site! I already knew some of this from my own research and experience But it was amazing to see how complete the answer is, then weight gain IS NOT a result of being a pig. I had been morbidly obese, lost it all with some diets, got to a normal BMI, that is something 1 in 1,000 morbidly obese people manage to do apparently, but then I could not remain on the raw food diet I was on, and I regain the weight and picked up more, as the familiar story goes.… Read more »

Vijay Sinha
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Vijay Sinha

This is the most amazing health website on the internet. I never believed the big government but to see them peons of big pharma, MNC, and Agriculture powerhouses (Cargill, Monsonto, Dow) is eyeopening. Another thing, the doctors who we trust with our bodies, never questioned the storyline from FDA. This is insulting to Science. When we are presented with alternative hypothesis, the scientist has a responsibility to examine it at least. I do not know how Dr. Fung discovered all the crap we are fed by the medical community. It would be a gritty story. I would love to hear… Read more »

DIANA
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DIANA

How did you use intermittent fasting? What us your diet now?

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[…] The association between how fat you are and how high your constant background insulin levels are, could be pictured as an internal fat thermostat which has been called the “body set weight”. […]

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[…] in calorie out. There is a bigger picture involving hormones you should know about. Read this post here which explains it in much more detail.In fact that whole series will blow your mind! Carbs require […]

Hank
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Hank

I have been eating clean and low carb (<70g/day) for months, with the goal of getting down to 9% body fat. I am currently at 11%. I also do cardio and resistance training. What I have seen from my own experience is that calories DO matter, there is no question about this. However, admittedly it seems that they matter more as carbs (i.e. insulin) is removed from the equation. In other words, once insulin is low and stable, a reduction in calories will result in a reduction in body weight and vice-versa. I experienced this first-hand. I got to 14%… Read more »

Sally Bergmoser
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Sally Bergmoser

Can a person be allergic to insulin ? Is there another drug like Metformin ?

Pat
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Pat

How can I combat the insulin related weight gain even with increased exercise and restricted carb diet? I am so frustrated that I am gaining weight in spite of my efforts….

Maa
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Maa

Intermittent fasting.

Molly Mosher
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Molly Mosher

Dr. Fung- I am reading your book and love it, I have learned so much. I have recently acquired asthma and am now taking singulair as well as using 2 different corticosteroid inhalers. I just learned from your book that these inhalers can be raising my glucose/insulin. If I need to use them but want to follow a ketogenic diet what am I to do?? If it’s not possible for me to stay in ketosis while using these and I must use them, what diet should I follow. Thank you for all of your help!

Hectoplasm
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Hectoplasm

I am not sure about this. When I eat excess calories over a period of weeks or months, I gain fat, regardless of whether those excess calories are fat or carbohydrate. I did two experiments on this, in 2015 and 2017, with 4,000 calories per day. I am otherwise lean and very insulin sensitive with low BF%. My weight went from ~150lbs to 170-180 in each experiment. It seems pretty straight forward to me. If someone enjoys eating a lot they are likely to eat more than they need to maintain weight, and will gain weight by eating too much.… Read more »

Jim Harless
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Jim Harless

Well, this does sound correct, but far too many private and public professionals miss the boat. Jim

Jim Harless
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Jim Harless

I appreciate the wisdom. How. Can I get my own medical team to be informed??

Jim
Guest
Jim

Dr Fung. Good points. Thanks.

Jim
Guest
Jim

Dr Fung. Great article.