Carb Camp or Insulin Camp?
I am Dr. Chad Larson. I’m going to talk about weight loss, and there’s so many different ways that we could discuss the whole concept of weight loss. I’m going to talk about a very particular aspect of it. There’s entire books written about weight loss, there’s entire weekend courses for hours and hours that can talk about weight loss. So I’m going to talk about a very specific thing that’s going on in the industry of body weight management. And that is this really, I think, kind of dumb argument between carbohydrates and insulin as a model of weight loss and calorie restriction or calorie reduction as the other model. And it’s almost like you have to pick what camp you’re in and then you have to believe everything that’s in that camp. As a clinician, that’s so dumb. That’s kind of what PhD researchers get really into and they argue with each other and say “no, it’s this and no, it’s that.” As a clinician, I just want to do what works. And what often works is a little bit of both of those things. Imagine that. You could actually incorporate both of those concepts in the same person and it works fantastic.
Are you Metabolically Healthy?
So where do I fall in the continuum if the carbohydrate-insulin model is on one end of the spectrum, and the caloric model is on the other end? I’m slightly off of the center toward the insulin model, but I’ve got a very particular reason for that. The reason is that there’s a great study that was published a couple years ago, and it explains to us that only 12% of adults in the U.S. are metabolically healthy. That means 88% are metabolically unhealthy. What do we mean by that?
- We mean that the 88% of people who are metabolically unhealthy have got blood sugar dysregulation, or they might have some degree of heart disease, or their triglycerides are probably elevated.
- Their waist circumference is above 40 inches in men and 35 inches in women, and they probably have high blood pressure.
Any one of those symptoms or signs puts somebody in the metabolically unhealthy camp. And this research actually includes 20 year olds. Twenty year olds are typically healthier than 45 year olds or 60 year olds, so I think their inclusion in this study dramatically influences those percentages. If we actually kept the study to people aged 40 years and older, that 88% would probably go to something like 98%. In other words, we’d probably find that only two to five percent of adults ages 40 and older are metabolically healthy. So it’s a big, big problem in the U.S. It’s major. I think it’s the problem of our time, especially as a healthcare provider.
That’s the reason I lean toward focusing on the importance of insulin. It’s because most people who are metabolically unhealthy and have excess body fat need help managing their insulin. I’ll come to calories in just a moment. But insulin is the gatekeeper of whether you are in fat burning mode or fat storage mode. I look at everybody’s fasting insulin, and if your insulin is elevated, you are in fat storage mode. You can’t fight through the insulin to make your body start using fat for fuel. If the gas pedal is stuck on insulin production, you are in fat storage mode. That’s just a physiological process that happens to the body. For people in this situation, we really have to focus on getting their insulin down before we can even talk about their macronutrients and proteins, their carbohydrates and fats, before we can talk about their calories, we have to be able to bring their insulin down. That’s why this is often a big part of initially helping somebody to become more what we call fat adapted, the ability to use fat for fuel. We have to manage their insulin.
Most patients when I see them for the first time, if they’re overweight and want help to instigate fat burning, I find that their fasting insulin is very high. Maybe their glucose is even normal. And we can talk more about that probably some other time, but it’s the insulin that’s really the gatekeeper when it comes to this kind of fat burning. That’s the important influence of insulin in dictating whether the body is storing fat or is able to burn fat.
But how do calories fit into the model? We can put somebody on, let’s say, a really low carbohydrate diet, and then I follow up with their fasting insulin. I like to see most people’s fasting insulin below 10. And if they’re more metabolically fit, we can get that figure below 5.5, which would be great. But where do calories come in? Many times I’ve looked at someone’s blood work and their fasting insulin is clearly below 5.5. Awesome. They’ve become more metabolically fit. But it’s possible that they’re not quite burning fat the way they want to, or the way that I want them to. So what’s the missing piece? Although they’re metabolically fit and their insulin is in a healthy position, they’re overconsuming calories. This is where both camps are absolutely important. This is how it comes down to the individual, instead of talking about people as averages.
If somebody is very metabolically fit and their insulin looks fantastic, but they’re still not quite burning the fat that we would like them to, then we have to start messing with their calories. So where do we start with that? It’s kind of like going to a financial planner and saying, “I’ve got some financial goals. I would like for you to help me with this.” The financial planner would say, “Okay, I just need to know what your income is, and I need to know what your expenses are.” That’s what we need to do with their calories.
Tracking Carbohydrates, Fats, and Proteins
First of all we have to find out where they’re currently at. There are some great apps for this, and you can get hard copy diet diaries, so there are ways we can calculate and quantify their current caloric intake and their macronutrient breakdown, the percentages of carbohydrates, fats, and proteins. Then we want them to start tracking. This is kind of a magic situation for somebody who truly has that kind of stubborn fat in their system that their body just doesn’t seem to be working with. There are some great studies that confirm that diet tracking makes a difference. It’s a fantastic tool, number one, for helping us understand where the calories are going and how they’re being burned. How much is actually in the system. Because the thing is, we are notoriously terrible historians of how many calories we consume. If you were just to ask someone how many calories they think they had, we’re all way off when we just kind of do it off the top of our head. But if we can actually quantify it, then I know that we can start to put the right pieces together to help anyone start burning fat.
So that’s what I wanted to discuss in this whole concept of weight loss and fat loss. This weird, kind of binary thing: you’re either in the insulin camp or you’re in the caloric camp. They both matter. That’s the key thing. They both matter.
-Dr. Chad Larson
BMI is not the Best Tool
There’s one last little tidbit that I wanted to throw out there. The way most people get their body fat analyzed is using the BMI, the body mass index. It’s a calculation that is largely based on age and weight. But it’s actually not a great formula for certain body types, especially certain muscular body types. There are some body types for which the BMI just doesn’t work very well. It determines that they are totally overweight, above 25 on the BMI, or obese is above 30, yet the person clearly isn’t. But there’s a whole different concept for assessing body fat and that’s body composition, or, how is the weight distributed in the system. And there’s a really simple at-home tool that you can use to measure your degree of unhealthy body fat.
Waist to Height Ratio is Better to Evaluate your Body Composition
The unhealthy body fat is what we call the visceral adipose tissue, and that’s the kind of fat that we’re really trying to go after from a health standpoint. This is the fat that sits around the abdominal section and it’s easily measured with a tape measure. We measure around the waist, and women want to measure at the level of the belly button and then also at the most narrow part, and men can just measure straight around the belly button, and that gives us our waist circumference. Then we measure our height. And then we just divide one by the other to get our waist-to-height ratio. It’s a very simple ratio. And basically we want your waist circumference to be less than half your height. So if you do this in inches, if you’re 70 inches tall, we want your waist to be 35 inches or less. That would be a really good balance and we know that that person is probably more metabolically healthy. And I think this is way better than the BMI. There’s another one called the waist-to-hip ratio, which is fairly similar. There are some good studies that have recently been published on the waist-to-height ratio. It’s a really great way to evaluate your body composition, where the BMI would be a little bit less dependable.
So those are a few tidbits on weight loss. It’s one of those key things. With 88% of adults in the U.S. being metabolically unhealthy, it’s something that I see every single day in my practice. And it’s a key feature among things that we want to try to improve in people. So those are a few ways that I look at it. I hope that was helpful and useful. I will keep reading the studies and bringing you the information. Until then, keep it real.
*The midlife health minute in this episode of Keep It Real with Dr. Chad Larson is possible with the help of Pure Prescriptions.