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When Willpower Isn’t the Answer

            In a world where food is plentiful, managing weight is challenging.  Even for the few that manage a trim look without effort, their labs often reveal that all is not quite so well on the inside despite the outward looks.  With nearly three-quarters of adult American men and more than 60% of women overweight, it’s clear that willpower alone isn’t working.  For children, the story is also troubling with nearly 30% of boys and girls under age 20 overweight (up from 19% in 1980.)  Due to diet, many 12-year-olds already show signs of atherosclerosis, a narrowing of arteries due to plaque buildup on the artery walls.

            These statistics are unfortunate given the number of chronic diseases that poor diet and excess weight can lead to as we get older.  If not mitigated by lifestyle changes, the accumulating negative effects usually lead to a decreased quality of life at about the time when most would prefer to retire, relax and enjoy a change of pace.

            Lack of willpower is often blamed for America’s growing waistline and poor health.  Interestingly, psychologist tell us there is no evidence that human willpower has undergone any change in the last sixty years.  What has changed, are the types of food available, environment, and physical activity.  In other words, it’s our lifestyle that has changed.

            Although the United States currently holds the record for developed countries with the most overweight people and the most people with type 2 diabetes, other countries appear to be catching up.  Having imported our fast food habits over the last few decades, many countries are gaining on us.  China now has one of the fastest growing epidemics of diabetes and Japan which once had almost no heart disease is now approaches America’s levels.  This is unfortunate given the loss in quality of life and incredible cost associated with managing these expensive health conditions.

            While a favorite excuse for weight gain is family genetics, the likelihood for this rationalization to be valid is extraordinarily small except in rare cases.  The weight gain epidemic is less than 60 years old.  For genetics to change noticeably, across a large population of people, it takes hundreds to thousands of years.  Confirming this, the data clearly shows that where food habits from the Standard American Diet (SAD) have taken hold in other countries, weight gain and diabetes are already on trajectories expected to match those for the USA.

            Type 2 diabetes is the poster child for metabolic issues because it is the silent precursor for dozens of other illnesses.  It’s usually associated with weight gain which in turn is strongly associated with animal protein and processed foods.  The solution seems so simple – just change the diet and take off the pounds.  With that simple prescription, you get a triple win that includes a cure for a wide range of chronic diseases, a fix for the national healthcare problem and a solution for the looming federal deficit which is increasingly driven by healthcare cost.  Unfortunately, the standard of medical care today is primarily focused on pharmaceutical solutions that manage the symptoms but don’t address the underlying causes.  In the case of weight gain, the root causes are many and include culture, self-image, epigenetics, environment, lack of food preparation knowledge, physical activity, stress, etc.  Further confusion comes from the media as their sponsors jockey for airtime with meaningless reports about short-term studies that are typically little more than good news about America’s favorite bad habits.  Most find themselves swimming against a tide of misinformation campaigns run by the food industries, charlatan weight loss experts and in no small part by the pharmaceutical industry’s assurances that “we’ve got a pill for that.”

            Doctors, for the most part, understand the health consequences of excessive weight gain and recommend eating healthy foods.  Of course, there is some reason for credibility concerns about their ability to be mentors given that one survey found almost 50% of physicians in some specialties overweight.  In part, this is a reflection of how physicians are educated.  Most physicians receive little nutrition education aside from classic nutritional deficiency diseases.  In essence, the training of most doctors focuses on the diagnoses and treatment of acute conditions.  To their credit, most doctors are superstars when you suffer from acute illnesses.  The problem is that almost 85% of illnesses today are chronic lifestyle diseases progressing toward an acute condition but not quite there.  For a real cure, the intervention most often needed is a lifestyle change before the inevitable acute conditions develop.

            Over the last 50 years, few doctors were trained to use lifestyle interventions for prevention or as a cure.  Making matters worse, few insurance plans reimburse doctors for the time required to mentor patients as they attempt lifestyle changes.  While our health care system is clearly in need of an upgrade, training the next generation of doctors may take 20 years.

            To be sure, there are conflicting opinions about what is an optimal lifestyle and in particular, an optimal diet.  Many physicians still recommend a high protein/low carb diet from foods like dairy, eggs, or meat.  Some even suggest “lean” or “free-range” as the important choice.  Usually, these recommendations are based on short-term studies that produced excellent numbers during the study but prove unsustainable over longer periods.  The saying that statistics never lie but liars sure use statistics is at the heart of commercial interest that perpetuated misinformation.  Unfortunately, for most sedentary people, animal protein from meat, eggs, and dairy products only further fuels insulin resistance which in turn promotes weight gain, chronic inflammation, cancer, and dyslipidemia.  For anyone enchanted by America’s favorite foods, it’s worth considering, is there any food that tastes as good as good health feels.

            At the heart of the nutrition problem is the need for a major redo of the health education in public schools.  The advice to eat healthy leaves most confused as they explore choices in a typical grocery store.  Many food labels promote their nutritional value by emphasizing some positive quality while downplaying the ingredients used to make the product more addictive.  Often our first impression is not a fair assessment.  Blueberry yogurt is a classic example.  While blueberries are a healing food, when mixed with yogurt, blueberries lose their antioxidant advantage.   If laced with sugar, blueberry yogurt is on par with junk food.  While food labels are truthful, they rarely convey the information needed to make an informed decision.  At the heart of the food labeling problem is a simple flaw, the macronutrient content of a food is a poor predictor of the foods nutritional value.  So, how can anyone hope to make wise decisions?  A good starting place is the increased use of plant-based whole foods along with an ample dose of advice from Dr. Michael Greger at NutritionFacts.org.

            Ideally, the first choice for avoiding or curing lifestyle-related diseases is a lifestyle change. Unfortunately, few take this recommendation.  The alternative then becomes a lifetime of medical management.  Of course, there are conditions that cannot be completely reversed by lifestyle change alone.  For these conditions, pharmaceutical and surgical approaches have their place.  The downside is that relying on medical management alone typically leads to lifetime prescription medications or medical procedures that must be monitored for potential side effects.  In the case of surgical procedures for weight loss, it’s important to know that the surgery does nothing to treat the underlying cause.  Each situation is different and for some conditions, lifestyle change alone will never be an adequate solution.  Fortunately for the willing, these situations are not the norm.

            An examination of evidence from global populations that live the longest with the highest quality of life, there is a common theme.  First, none eat a diet like the Standard American Diet (SAD).  Second, none eat a low-carbohydrate diet like the Atkins diet or South Beach diet.  In all cases, the diets with the best health outcomes are mostly plant-based whole food diet with infrequent or no meat intake, little to no dairy, whole grains, and beans, lentils or legumes.  In essence, it’s a diet with adequate protein, high in fiber and high in micronutrients.

            In contrast, the Standard American Diet (SAD) provides far too much protein, often 90 grams/day or more.  This excess protein overtaxes the liver, overtaxes the kidneys, adds to food cost, and can set us up for a wide range of unnecessary health risk.   Fortunately, eating a variety of plant-based whole foods supplies all essential amino acids need to fulfill our protein needs.  In contrast, a low-carbohydrate, high-protein diet (Ketogenic) can look promising short term but is rarely sustainable long term.  Paleo diets that supposedly mimic what Paleolithic humans ate have also gained popularity.  Unfortunately, opinions about what Stone Age people ate is debatable.  The best science available suggests that the Paleo diet was primarily a plant-based from a wide variety of ever-changing plant foods.  The typical Paleo diet is believed to be from foods that supplied up to 100 grams of fiber daily.  In contrast, the Standard American Diet typically supplies about 15 grams of fiber per day.  Few people promoting the virtues of a Paleo diet care to mention that it likely involved eating lots of insects.   While meat was part of the diet, it would have only been from wild animals since this predated animal domestication as a food source.  While there is a certain romanticism surrounding a Back to Eden Paleo diet, it’s worth noting that the Paleo crowd didn’t live very long for various reasons.  For insight into answers about what contributes to longevity beyond age 30, we must look to a population that has a history of success. To be sure, this wasn’t the Paleo crowd.

            In a world of scarcity almost any source of macronutrients is better than none.  The dilemma is that although we have adapted to eat a wide range of foods that can keep us alive when nothing else is available, they are not all equally supportive of longevity and quality of life.  Of course, living through a famine is a better quality of life than starving, it’s just not the quality of life most look forward to in the last half of life.

            Just as Paleo man seemed to survive on a diet that included animal protein, in our modern world we can also do pretty well on a similar diet up to point.  The problem is when we want to live another 60+ years or more beyond age 30.  It’s during these later years that the effects of diet go from being of little obvious effect to becoming a dominant factor in health and survival.

            From a wide range of independent research, we know that animal proteins and associated saturated fat cause vasoconstriction, increase inflammation, create negative effects on gut microbiota, negatively affect metabolic pathways, create an environment conducive to cancer, and lipid dysmetabolism.  Because cholesterol only exists in animal cells, eating plant foods solves cholesterol problem except when unusual genetic conditions are a factor. 

            While in our youth the accumulating effects of diet may not be noticeable.  In time, however, the accumulating effect can take their toll on even healthy looking athletes.  Over 50 cases of athletes dropping dead during marathons and iron man competitions have been recorded.

            If wondering what you would eat after transitioning to a healthier diet, expect a pleasant surprise as you learn new recipes.  In most mega grocery stores, a variety of fruits, vegetables, whole grains, beans, nuts, and seeds are available.  When not available, seeds, beans, and whole grains can be obtained at specialty stores like Whole Foods or online at internet stores.  In the springtime, farmer’s markets are within a few miles of most people.  As for cost, a large bag of whole grains and dry beans comes in as the best bargain in food.  Add vegetables and fruits (fresh or frozen) and you have the basics for an excellent diet.  For anyone wanting the best in organic fresh food at the absolutely lowest cost, a backyard garden can’t be beaten.  With periodic replanting as the seasons change, it’s possible to have a year-round supply of superfoods from your yard.  While organic foods may be better for you, plant-based whole foods of almost any type trump processed foods. 

            Understandably, changing food preference can be challenging.  Often the best path to dietary success is to begin by eating minimally-processed foods.  The good news is that most can reset their taste to a plant-based diet in 60 days and often far less.

            If hungry for more about why our health care system needs a makeover and what to do about it read, “A Medical Case for a Whole Food, Plant-Based Diet.”

            Now, I’ll give you the good news in a sentence.  If you are one of many that have more weight than is good for your health then it’s not your fault.  Most likely you were taught counterproductive nutrition habits at home and in school.  Most likely, the medical professionals you encountered over the years were minimally trained to provide helpful lifestyle change advice.  Interrelated cultural and psychological issues also play a part.  To top it off, you have been the victim of a food industry that becomes cleverer each year at fooling your natural ability to limit calorie intake.  While it sounds nice to advise eating less, it’s not a recommendation that works for more than 2% of people. For most, it takes a mentor to bridge the multiple roadblocks before lasting change can happen.

            Helping you sort through the confusion and make a wise decision is the first step in understanding that willpower is not the problem.  The secret is overcoming misconceptions that can set you up for failure.  As a lifestyle mentor, I look forward to helping you find the path that’s right for you.

            One path I’m particularly fond of winds around the lakes at Jones Valley Farm Park.  Join me Saturday morning for a 7:00 am walk and talk about your lifestyle goals.

            Nancy Neighbors, MD

By Nancy Neighbors, MD

... Dr. Neighbors provides a blend of traditional family medicine and evidence-based lifestyle medicine in Huntsville, Alabama. When indicated, lifestyle change is recommended as the first line of therapy.

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