The Prevalence of Obesity

Right now, the trend of obesity has been increasing worldwide. The causes of obesity are often
complex or not well understood. In addition, different people from different professional
backgrounds also see the problem from different points of views and identify many different
causes.

Resources:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5673154/

Low Carb Diets

The reason why low carb diets have gained popularity is because there is actual scientific
evidence that a low-carb diet can help you lose more weight in the short-term than a low-fat diet.
(1) This is because carbohydrates are metabolically our primary source of energy. When we
don’t consume enough carbohydrates, the body will begin relying on fat sources to provide
energy. This is good in the short term, because if you hold this diet for a few weeks or months,
your body will need to be using more fat stores for energy.

But, where this can get dangerous and undesirable is where the side effects come in. Our body
needs carbohydrates and it is our primary source of energy for a reason. They are more readily
available to our muscles and organs to make ATP or energy and when we starve our body of this,
we begin feeling fatigued, having muscle cramps and headaches, or feeling weak. “Because there
is an obligatory requirement for glucose in several organs such as the brain, a spontaneous
increase in food intake is seen when the diet has a low-carbohydrate, high-fat content. Therefore,
the present nutritional advice of increasing the proportion of carbohydrate energy while
decreasing that of fat in the everyday diet has strong scientific support in terms of the regulation
of the energy balance.” (3)

The ketogenic diet specifically requires the body to be consuming about less than 50g of carbs
per day. (4) This causes glycogen stores to be depleted and the body will go into
gluconeogenesis to make glucose, and then it will slip into ketogenesis when gluconeogenesis
can no longer meet the energy demands of the body. (4) In ketogenesis, ketone bodies replace
glucose as the primary source of energy. This is important because during ketogenesis, insulin
secretion is much lower and therefore fat and glucose storage are also much lower. Also, ketone
bodies are metabolized from fatty acids which is what causes the fat loss.

“The nutritional ketosis state is considered quite safe, as ketone bodies are produced in small
concentrations without any alterations in blood pH. It greatly differs from ketoacidosis, a life-
threatening condition where ketone bodies are produced in extremely larger concentrations,
altering blood pH to acidotic a state.”

Positive Effects
- Ketone bodies can actually produce more energy than glucose, so it can keep efficient
fuel production
- Ketone bodies decrease free radical damage and enhance antioxidant capacity
- Overweight individuals with metabolic syndrome, insulin resistance, and T2DM could
benefit from a well-made very-low carb diet as it can improve insulin sensitivity.
- Proven to be good for weight loss in the short term (but not the long term). However,
much of the initial weight loss is water loss.
- Known to suppress hunger

Negative Effects
- Long-term side effects (2+ years) are not well known, but can include hepatic steatosis,
hypoproteinemia, kidney stones, and vitamin/mineral deficiencies.
- Most common short-term side effect of a ketogenic diet are flu-like symptoms and
difficulty in exercise tolerance.
- Can cause dehydration, electrolyte disturbances, and hypoglycemia
- Very difficult to maintain long-term: very limited choices of food
- Weight loss from low-carb diet for more than 12 months tends to be the same as being on
a normal, healthy diet (5)

References:
https://www.mayoclinic.org/healthy-lifestyle/weight-loss/in-depth/low-carb-diet/art-20045831
https://www.bmj.com/content/363/bmj.k4583
https://www.ncbi.nlm.nih.gov/pubmed/8116550
https://www.ncbi.nlm.nih.gov/books/NBK499830/
https://www.everydayhealth.com/diet-nutrition/ketogenic-diet/comprehensive-ketogenic-diet-
food-list-follow/
Plant-Based Diets
To start off, plant-based diets are those “that encourage whole, plant-based foods and
discourages meats, dairy products, and eggs as well as all refined and processed foods.” (1) With
plant-based diets, research shows it is a cost-effective and low-risk way to lower BMI, blood
pressure, HbA1C, and cholesterol. Many patients have also been able to lower the number of
medications needed to treat their chronic diseases. Not only are these diets known to be best for
avoiding obesity and chronic disease, but they are also being recommended as first lines of
treatment prescribed by physicians.

In terms of long-term sustainability, it can be very hard to go 110% and adopt a vegan plant-
based diet if it is a very big change from your current diet. However, plant-based diets do have
tons of delicious options that won’t feel so much like restriction. If you are planning on trying to
switch to a plant-based diet, start with small changes first. A good first step could be to simply
add in a serving of vegetables with every meal you have. Once that becomes a habit, then begin
replacing big sources of animal-products in your diet with lower fat ones, such as egg whites and
skim milk. As stated in the literature, “… it is time to get away from terms
like vegan and vegetarian and start talking about eating healthy, whole, plant-based foods
(primarily fruits and vegetables) and minimizing consumption of meat, eggs, and dairy
products.” Animal products in a plant-based diet can be included, but they are not the main
components of the diets.

 Vegan (or total vegetarian): Excludes all animal products, especially meat, seafood,
poultry, eggs, and dairy products. Does not require consumption of whole foods or
restrict fat or refined sugar.
 Raw food, vegan: Same exclusions as veganism as well as the exclusion of all foods
cooked at temperatures greater than 118°F.
 Lacto-vegetarian: Excludes eggs, meat, seafood, and poultry and includes milk products.
 Ovo-vegetarian: Excludes meat, seafood, poultry, and dairy products and includes eggs.
 Lacto-ovo vegetarian: Excludes meat, seafood, and poultry and includes eggs and dairy
products.
 Mediterranean: Similar to whole-foods, plant-based diet but allows small amounts of
chicken, dairy products, eggs, and red meat once or twice per month. Fish and olive oil
are encouraged. Fat is not restricted.
 Whole-foods, plant-based, low-fat: Encourages plant foods in their whole form,
especially vegetables, fruits, legumes, and seeds and nuts (in smaller amounts). For
maximal health benefits this diet limits animal products. Total fat is generally restricted.
Positive Effects
- Plant-based diets may be better for weight management and more nutritious than diets
that include meat.
- Plant-based diets contain a significantly lower amount of fat, especially saturated fats.
- Plant-based diets are very high in nutrients/nutrient dense
- Very good for preventing and managing diabetes and heart disease
- Most plant-based patients are NOT at a risk for protein deficiency
- Plant-based diets are “a way of life tailored to each individual.”

Negative Effects
- May need supplementation or special attention to certain minerals such as calcium, iron,
and zinc.
- Will need an alternate source of Vitamin B12 through a supplement or fortified products,
as this vitamin is found in animal products.
- Vitamin D deficiency is also common and should be consumed in a plant-based diet
through fortified products or a supplement if they are at risk for low bone mineral density
or are Vitamin D deficient.
- This diet requires extra planning, reading labels, and discipline

References:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3662288/

Intermittent Fasting Diets

Restricting daily food intake results in weight loss (which we know is associated with better
health through triglycerides, total cholesterol, low-density lipoprotein cholesterol, blood
pressure, glucose, insulin, and C-reactive protein). (1) With intermittent fasting, the person is
choosing to restrict food intake for a certain part of the or for certain hours, and they alternate
cycles of eating and fasting. An example of this is ADF (Alternate Day Fasting), where the
person will eat 20% of their energy requirements on a fast day and eat as much as they want on a
feeding day. This type of diet style has been shown to be efficient in reducing weight
irrespective of BMI. However, further studies need to be conducted to determine the long-term
success and effects of this style of eating. The reason this has been working successfully is
because people are creating a big enough calorie deficit overtime from the fasting days. The
problem is that it may be easier to overeat on non-fasting days and therefore negate the deficit
from fasting days.

It is important to note that there is little evidence to show ADF produced more weight loss than a
normal weight loss diet. (2)
Positive Effects
- Proven to be effective and safe for short-term weight loss (1)
- Can reduce basal concentrations of insulin and glucose
- Little evidence that intermittent fasting is physically or mentally harmful (2)

Negative Effects
- Restricting food continuously can often times lead to overeating and feeling extra hungry
(3)
- Calorie restriction can cause fatigue
- This diet can be very difficult to adhere to, especially in the long-term
- Long-term effects are not yet well-studied (2)
- Could lead to vitamin deficiency and muscle loss (3) if diet is already poor in vitamins
and protein
- Doesn’t work well as part of a life schedule … not sustainable (3)

References:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6128599/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4516560/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3652955/

Detox and Cleansing

“Although the detox industry is booming, there is very little clinical evidence to support the use
of these diets.” ~ Journal of Human Nutrition and Dietetics. A lot of the clinical studies that are
used to support commercial diets showed that liver detoxification was improved, but these
studies were found to have flawed methodologies and small sample sizes. Also, according to this
journal, no randomized, controlled trials have been performed to test the effectiveness of
commercial detox diets on humans, and most detox studies have been done only on animals. (1)

Usually, when people lose weight from these types of diets it is because the diet is naturally just
very low in calories. (2) The Academy of Nutrition and Dietetics also brings up the point that the
body naturally detoxifies itself with the kidneys and liver, and that there are safer ways to
support this system of your body without fasting and only drinking juices. (3)

So, what are the toxins? Toxins are produced in the body (ex. lactic acid, urea, and waste) and
also come from outside the body (ex. pesticides, mercury, lead). (3) People give reason to detox
diets because of the fact that our bodies can store toxins depending on our health, lifestyle, and
environment, and this can negatively affect our health. (3)
Unsafe Detoxing and Cleansing can look like the following things: (2)
- Fasting
- Consuming only juice or liquid
- Eating a very restricted selection of food
- Using dietary supplements/commercial products
- Using enemas, laxatives, or colon hydrotherapy
- Combining the above

How to Support Your Body’s Own Natural Detox System: (3)

- Stay hydrated with clean water
- Eat 5-9 servings of fruit and veggies per day
- Consume enough dietary fiber
- Include cruciferous vegetables to support detoxification pathways
- Consume enough lean protein (to maintain glutathione: a detoxification enzyme)
- Eat naturally fermented foods to promote a healthy gut

Positive Effects
- May give cause weight loss in the short term
- Focus on the tips to support your body’s natural detox system if detox is your goal

Negative Effects
- The USDA and FTC have taken action against several detox companies because they
contained harmful ingredients and used false claims in their marketing. (2)
- Large quantities of juice may be harmful for those with kidney disease
- These diets usually don’t lead to lasting weight loss and may not provide all necessary
nutrients
- Using laxatives can lead to severe dehydration
- There are many people who claim to be experts in this topic but aren’t (3)
- Likely will not leave you feeling satiated

References:
https://www.ncbi.nlm.nih.gov/pubmed/25522674
https://nccih.nih.gov/health/detoxes-cleanses
https://www.eatright.org/health/weight-loss/fad-diets/whats-the-deal-with-detox-diets

Maintaining Weight

“Comparison of patients who have maintained their weight loss more than re-gainers shows that
the subjects in first group stay late less at night, have increased physical activity after weight
loss, drink less sugar sweetened beverages, eat less calorie from protein, and they have more
emotional support.” (1)
“The one thing I tell patients all the time is that life is short,” adds Freedland. “Eating perfectly
and exercising like crazy doesn’t mean you will live forever. So, we need to make our time here
on earth enjoyable. If that means you enjoy having a sundae, by all means, have a sundae. Just
have it on Sunday. And not also on Monday and Tuesday and Wednesday and Thursday.” (1)

Note: Notice what has been the common denominator in making each of these diets most
effective? A balanced diet and limiting saturated fats. What is important is how sustainable the
diet is to you. The longer you can keep it going, and whether or not you can make it your
lifestyle, are big factors on whether the diet will help you lose weight and keep it off, while
enjoying your life and food to the max! Also, notice how most of these diets haven’t been
studied heavily on long-term success. That is because some of these diets can be unsustainable
and difficult to keep up with. Instead, try keeping these things in mind and keeping an overall
balanced and healthy lifestyle.

Also, a good thing to keep in mind is that these “commercialized diets” are not proven to be safe
and are not heavily studied as well. Just like supplements, they aren’t regulated by the FDA and
they often times use false claims or poorly formulated research techniques. In my opinion,
companies like these are in it for the money and not to actually help their clients and see results.

References:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3652955/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4061651/