 Okay, I'll talk about a hot topic today the carb controversy and how you could help paleo save America This is a basic view of human evolution and as you know this took millions of years Right while the modern obesity epidemic most of it has happened in 28 years. So why is this? Well the conventional answer is that people just eat too much too many calories They've all turned into gladdens, right? So has this way of thinking helped us? No, hardly because more and more Americans are becoming obese and according to this new prognosis Extreme obesity is just exploding in America and this is going to bring the US healthcare system to his knees It's going to bring the US economy to his knees and it's going to bring enormous amounts of suffering and disease So it has to be stopped Luckily paleo came along and emphasized the quality of the food and this Merry band of rebels. They were led by the brave Mark Sisson The wise Lorencordain and the cute one Rob wood and in their books They told people that it's not the fact you need to fear. It's the refined sugar and the grains And specifically they said that if you eat a low carb or low low glycemic load diet You will lower your insulin and this will help with weight loss But this is all being questioned today on influential paleo blogs discussion forums and and so on and we're seeing a backlash and a comeback of calories calories are striking back and the argument is that Carbs doesn't matter and macronutrients don't matter and an insulin has nothing to do with weight gain And this this old simplistic calorie thinking meaning it's all about calories. This thinking is now wrapped up in something called Food reward Which is interesting and I'm gonna talk more about it But my point here is that as paleo has grown and become more popular It's being sucked back into old failed conventional wisdom and I fear that if the calorie counter is win Would be like putting a lipstick on a pig The pig being Failed old simplistic calorie thinking in the Lipstick food reward So this could be the future of paleo a pig with lipstick meaning People will be eating a hundred calorie packs of gluten-free junk food marketed as paleo And that's not gonna solve much. It's not gonna stop the epidemic. We need a better foundation So What is the difference between an obese and a thin person? How do we explain? Common obesity Well, I'm a family doctor. I treat a lot of obese patients. I read about this think about this and I used to find it confusing still But I think it makes sense because an obese person Usually have high levels of insulin abnormally high while a thin person has low or normal insulin And this has been shown in a number of studies It's not controversial and when I test my obese patients in my clinic their insulin level is usually very high but it gets more interesting because You can raise your insulin in a variety of ways and usually you're gonna gain weight too first example type 2 diabetes These people usually have high levels of insulin and they usually gain weight every year become more obese another way of seeing it going down from a high insulin level to Lower usually leads to weight loss and the most striking example, of course is type 1 diabetes which is The body can't produce Insulin so the levels are extremely low and the weight plummets without treatment It's a sad picture It's from the early 1900s and kids with type 1 diabetes basically start to death But not it's this not this kid He was fortunate enough to be one of the first to be treated with insulin and his weight returned and his life Was saved so I think he would smile a bit more perhaps So loss of insulin loss of weight and going the other way with insulin and injections means weight gain more insulin more weight gain It's a common side effect Now what this is looks like a guy who got silicone implants in a weird place Of course, it's not silicone. It's fat deposits and this is a type 1 diabetic And for 31 years he injected this insulin either to the left or to the right of his belly button So this is the local effect of of high-dose insulin and Anyone who looks at this picture and says that Insulin has nothing to do with fat accumulation. Well, that person must be blind, right? It's obvious so Injecting insulin means weight gain and avoiding insulin avoiding insulin is actually a common and dangerous eating disorder in Type 1 diabetics they let their blood sugar get high Because they know which it's very bad for the health obviously because they know that less insulin means they will lose weight Okay, so this is different kinds of diabetes and and injecting insulin But what about if the body makes too much insulin for a completely different reason? Well, there is a disease called insulinoma Which is a rare tumor that produces insulin and these patients they usually They can become grabbinously hungry and quickly gain weight and a colleague told me a story about an elderly lady who got this disease and She was old and she didn't want to have surgery didn't want to take the tumor out So it grew and grew and eventually she had to use her alarm alarm clock to get up every two hours during the night to eat And she became massively obese Going the other direction again if we block the body's production of insulin What happens? Well, there's a drug doing that. It's called octreotide And it's actually a good treatment for some obese patients Like professor Robert Lustig talks about his studies But leaving all these diseases and drugs The easiest way by far to raise your insulin and the tastiest way of course is high carb junk food like this and I don't think it's controversial to say that this is the number one problem of weight control and I don't think it's a coincidence that This is also the most effective way to raise your insulin So high carb junk food more insulin more weight opposite low carb diets Lower your insulin the most simplest way to do that and they're also effective for weight loss in fact, there are a number of studies testing this comparing low fat diets to low carb diets for weight loss and time after time Turns out low carb means you get a more effective weight loss without without hunger and if you look at all the statistically significant results 17 studies now show that low carb gives you better weight loss than low fat I know of no such study showing the opposite and if you want to take a look at these you can find them on my blog dietdoctor.com so Low carb diets are good for weight loss But and despite what some people claim they also lower insulin Not by a little but by a lot. Take a look at look at this Here's insulin levels After eating and after three different kinds of of diets and the red line is A low carb diet Here's another study showing the exact same thing Not a little lower insulin, but a lot lower. So insulin plummets on a strict low carb diet Low carb means Weight loss and lower insulin finally exercise You know sedentary living means that you're gonna burn less carbs and when you eat carbs They will raise your insulin higher and it's also connected to weight gain Opposite exercise means you burn more carbs your insulin will stay lower after Eating carbs and is connected to weight loss So whichever way you look at it More insulin more weight and vice versa But some people don't believe in this anyway, they have objections and Let's have a quick look at the four main ones The first one of course is that only calories matter, right? allegedly Weight gain results from a positive caloric balance while weight loss results from a negative one And the problem with this is it's very simple seductive, but it's an over simplification The problem is that it ignores the causes for example the causes we just discussed And to put this to have an example to make it a bit more clear Take a look at constipation now has anyone in here ever been constipated could you raise your arm a few people? Yeah, so you know there are different causes to constipation, right? like dehydration like iron supplements and so on and if you want to Avoid getting constipated or treated you better treat these causes, right? But a calorie counter would tell you that that is irrelevant. He would say that this constipation thing only has one cause and that is a positive Is is is true? It is true. Don't let and If you were constipated he would tell you ignore all these quack advice All you need to do is to eat less and defecate more And It's a smart ass comment, right? It's silly Well, same thing with calories because if we ignore the causes Then we can't treat it effectively. So this is a simplistic old advice. We need to get beyond that because it's not very helpful Second objection is that this is all about the hormone leptin controlled weight You know leptin It's the hormone from our fat stores going to our brains Telling us that we have plenty of energy stores, right? We don't need to eat problem is a chronically high insulin can block this effect So the brain can't see the fat stores thinks we're starving even though we're not and that is how how insulin Can override leptin if it's chronically elevated and that's why if your insulin is sky-high Your leptin is not gonna save you And we shouldn't be surprised because same thing is true for other hormones like cortisol stress hormone, right? If it's really high you gain weight Leptin don't save you there either Same thing with the incident third objection and really interesting one is that only food reward matters so Food reward fear it says that some food is so rewarding so palatable that we can't stop ourselves from eating too much of it Interestingly, this is often the same high-carb junk food That is highly rewarding whether to be fair sometimes can be a good idea to add a little bit of fat to make it even more irresistible, right And and food reward could be a topic for an entire lecture, but I'll get straight to the bottom line what we're talking about is addictive properties of food and food addiction and And fast food can be a addictive and indeed food Manufacturers they they go out of their way to make it as addictive as they possibly can Because that way they sell more right What happens if you get addicted to high-carb junk food? Well Your insulin is gonna rise high and you're gonna gain weight So I don't think we need to choose between insulin and food reward to Explain obesity because they work perfectly together and food reward while it might be might be Important it's not the entire puzzle. We need more explanations than that So the fourth and last objection. What about what about them? Right, what about the thin Asian? What about the Japanese what about the Chinese they eat all that rice, you know it and they're thin and What about the Kitarovans and all the other guys? I mean there's loads of these populations you can pull out So I think just by looking at this. It's obvious that Everybody doesn't have to avoid all carbs avoiding just the worst ones like refined sugar flower can be enough Question is can you tolerate safe carbs safe starches? Well You look like this or a female version of him then the answer is probably yes and Empelio isn't necessarily a very low carb diet if you're thin if you're metabolically healthy You can probably tolerate all the fruit you want. I think but the problem is that most Americans and Western people in general don't look like this anymore a lot of people are looking more like this right with their Weight issues high blood pressure perhaps even a borderline diabetes and then very few carbs are safe and A very low carb diet may be the best way to go So sensitivity to carbs vary from person to person But there is one thing that is a disaster for anybody and that's to do what most Americans outside of this room are doing right now eating high-carb junk food once in a while and Leading sedentary lives this will sooner or later result in weight loss for the large majority of weight gain for the large majority of people on the other hand, there's you guys and My guess is that you have probably been eating a Low carb diet or at least lower carb slower carb than most people and doing some form of exercise And that is and you understand how this works and that is why you could help to save America because we can spread this message and we can break this epidemic and we can inspire people to Improve their lives one person after another friends and family like these three people who let me share their success with Giving up sugar and starch. This is David before and after without hunger This is Josephine before and after without counting any calories And this is Freddy before and after With a lower insulin and and then this this is the kind of change that we can inspire in others and Here's my daughter who's 11 months old and as she grows older, I would I hope that She never feels the need to be hungry never bothers counting calories and never sees food as an enemy. I hope Her future is brighter So what will the future look like? Well if we can inspire most people To eat real food and avoid bad carbs that could revolutionize the health of the world and that is How paleo could save America? We can take a few questions until the next presentation is ready to go What's happening in Sweden? Well? We we've experienced a bother shortage Because people eat more fat and less less bread and less sugar. So low carb diets are very popular Yeah, well, there's a survey from last year that found that 23% of the population were eating some form of low carb diet and and 5% we're eating a very strict low carb diet So and I think it's even more popular today This big it's getting big. Yes How I feed my daughter well I can give it to you right now. Yeah, well, I don't have my computer with me. It's well. No serious so She's still breastfeeding and she eats real food. She eats some carbs like Little bit of potatoes and vegetables and so on but she's real food She's basically what the same thing as her mom and I eat so Just have a question. Yes. Yeah, great talk and certainly this whole approach worked for me And I think it's great But one of the objections you hear comes from people who did actually lose quite a bit of weight on a low carb diet and They stalled and they feel that somehow or other It's not enough and so that they then have to on top of it even though their insulin is reduced Reduced calories. So they're the ones who often challenge the theory because they say hey if this is the only Thing I have to worry about why can I why am I stuck here? Why am I plateaued? I have another 20 pounds to lose. I'm low-carb. I'm stuck. So what do you say to those people? Well? Obviously, there's not one solution that works perfectly for all problems and there can be other problems That are not really necessarily related to high insulin. I mean, they could be Stress hormones that could be have something to do with sex hormones like extra estrogen and so on So I think if you have a problem on a strict low carb diet, you may have to look for other parts of the solution Basically, could part of it be that there are other causes of insulin and resistance That are still try possible. Okay. Can we have one more question over on the right? Yes, Andreas. Hi Stefan. Um, I Had a couple brief points. I want to make one of them is that I totally agree that food reward is not The only cause of obesity and I certainly hope that that's not being attributed to me But the other thing I wanted to say I just wanted to explain a couple of the more straightforward reasons why the insulin idea of obesity has very little traction among obesity researchers and one of them is You know, you see elevated insulin in obesity But the problem is that you have a concomitant increase in insulin resistance So I mean what really matters is the amount of insulin signaling that's occurring not the amount of circulating insulin and what you see you know, obesity is actually a reduction in total insulin action on both lean and fat tissues and so The other thing is that, you know, there are various experimental models of obesity and There are some pretty straightforward means of blocking insulin resistance that typically develops on those diets And one of the things that's been observed is it actually has No impact on the rate of that game block the hyperinsulinemia and insulin resistance that occur on these diets So and that's been demonstrated in a few different species So I was curious to hear your thoughts on that. Sure. I mean, of course, there are Objections different kinds of objections, but I think you look at the whole picture You what emerges is something that's fairly strong and robust anyway Obviously, if you have an obese person with a high insulin level, he's probably gonna be insulin resistant to and and what comes first it's like a chicken or the egg kind of problem and some obesity researchers like you say are sure that is the insulin resistance first Other people think the other way and if you ask me, I would say I think they develop together sort of step-in-step But sure, there are valid objections, but I still think it's a on the whole It's a it's a robust theory and it's basically on the bottom line. Anyway, is it it works for a lot of carbohydrate restriction works, but low fat Unrestricted in calories diets Do cause that loss just to a lesser degree than carbohydrate restricted diets. Yeah, and and I Absolutely agree that there are lots of different kinds of diets that that work Some people say that all diets work and I think the reason is that What we're transitioning from the standard American diet is the most toxic diet known to man Any change is an improvement Certainly Restriction of variety essentially in any form will Typically result in fat loss as well. Sorry. Don't mean to butt in we'll have to move this into a steel cage somewhere Thank you very much