My journey as a healthcare provider has always revolved around the mind/body connection. I believe, deep down, that no one willfully harms himself and it is my passion to empower patients to regain charge of their health. It gives me the greatest joy and personal reward when a patient returns smiling, recharged in their spirit, having adopted a lifestyle change over the long-term which actually allows me to reduce their medication.
When it comes to obesity more often than not we blame our hormones, insomnia or lack of time. We look for quick-fix methods, hoping to lose weight either through crash diets or weight-loss medications.
The truth about weight-loss drugs
Let’s face it—there is no magic pill for weight loss. If it existed, all of us would be on it and not reading this article. Since the 1930s, there have been at least 10 drug classes introduced for weight loss, most of which attempted to suppress appetite. Of all the weight-loss drugs, only one remains on the market today—orlistat, which works on reducing intestinal absorption of fat that is consumed. The other drug classes had to be banned due to serious safety concerns.
My take: From my endocrinology background, I know that the simplified version of appetite regulation involves over 20 chemicals [hormones and neurotransmitters] and over 10 genetic pathways. Why did Mother Nature spend so much DNA storage capacity of the genetic code on regulating appetite? Because it helped humans survive, adapt and become the most intelligent species on earth. The phenomenon of appetite regulation is a miraculous creation. Do we really think Nature will allow a single tablet to block our appetite? No way! I am convinced that Nature will adapt and find a way to bypass the drug block, because the momentum of evolution’s design to ensure our survival always triumphs. No wonder then that we face dangerous side effects when we try to block one of the strongest survival mechanisms that kept us alive through famine: the drive to find fuel. Tough luck that most of the readers of this magazine aren’t living in conditions of famine or energy shortage!
As for orlistat? It causes a slight weight reduction to the extent that the excess fat gets eliminated from the body as sticky greasy stools. I’d much rather modify the way I eat and reduce the amount of fat that goes in my tummy. Orlistat does nothing for the behaviour or lifestyle that is causing the extra fat to be consumed.
I don’t prescribe diets because I feel they distract from where the main focus needs to be: lifestyle change. Mindful eating is the way to go.
Want to eat something greasy? Go ahead, but do it mindfully.
Feeling hungry all the time? Mindfulness will help you decipher true hunger from sensations commonly mistaken as hunger.
Getting hungry sooner? Meals that are loaded with carbohydrates create an insulin rise-and-fall that stimulate hunger hormones more frequently. A meal with adequate protein will keep hunger hormones in check for longer.
My take: I’m against typical diet plans/diet charts/crash diets/rigid rules/lists that separate foods into ‘good’ or ‘allowed’ versus ‘bad’ or ‘not allowed’.
I believe that we all know how to eat in a way that is right for our body, and we need to relearn that inner wisdom. Dieting is not sustainable over the long term and all foods can be taken safely [keeping in mind any medical diagnoses] as long as they are eaten with awareness. The more something is proscribed, the more we crave it and end up overeating. The tragic aspect of this is that once someone gives into that ‘craving’, society makes them feel guilty as if they have committed a grave sin. This is a huge disservice to the individual, because the fault lies in the non-sustainable diet approach. Most rapid weight-loss plans cause loss of precious muscle, bone and water, while most of the fat remains intact. Most weight regained after a crash diet ends is in the form of fat, resulting in a slower metabolism.
Whether you’re someone struggling with your weight, cholesterol or diabetes, let nutritional information be a tool, not a weapon or a set of handcuffs. It’s all about balance, variety and moderation.
Once we learn to eat in a mindful way, the extra weight will go away. Besides, we are meant to savour delicious flavours and use food as a part of celebration, pleasure and love. That’s why we have taste buds on our tongues, not our stomachs.
Only a significantly raised level of thyroid-stimulating hormone [TSH], a condition called hypothyroidism, causes weight gain. Most people struggling with weight have normal TSH levels that establish the innocence of the thyroid gland.
My take: Too many people are given flawed forecasts that once they become a thyroid patient they are destined to be overweight. This is not true. Once your TSH is in the normal or sub-clinical hypothyroidism range [whether via thyroid hormone replacement or otherwise] your weight gain is coming from someplace else. Hormonal causes of obesity are extremely rare.
In India, we are losing too many young people to complications of insulin resistance. A majority of this epidemic is caused by worsening lifestyles and imbalanced nutrition. To add to that, Indian genes are prone to insulin resistance. The most reliable way to estimate insulin resistance is to measure glucose levels and glycosylated haemoglobin.
My take: Many people with diabetes and PCOS are on more medication than they truly need—all because they are not making the required lifestyle changes. Unfortunately, a large proportion of Indians have resigned themselves to that bulge around the middle, and it is due to that bulge that diabetes and polycystic ovarian syndrome [PCOS] worsen. The fat around the waist directly prevents our body’s own insulin from doing its job. So as a doctor, shouldn’t I help the person restore their own insulin sensitivity by reducing their tummy girth and building muscle, rather than pushing up one medication after the next? And no, liposuction doesn’t remove the offending section of fat.
Has someone advised you to stop eating pulses and to start taking allopurinol for your slightly high uric acid levels? Uric acid levels go up due to insulin resistance. Reverse the insulin resistance through lifestyle change and the uric acid will improve. By stopping lentils, you might be falling short of your protein requirement and hamper your muscle composition.
Muscular development is ignored in India. Protein intake is drastically below the required 0.8 gram per kg per day in most Indians. Having toned muscles that are of gender- and age-appropriate bulk are major insurance policies against progression of diabetes and PCOS. This means reducing the carbohydrate intake, increasing protein in our diets, and yes, cardiovascular plus resistance exercise to build muscle.
No time to exercise? Time won’t arrive gift-wrapped in a box. We all get 24 hours. We all have jobs, families and homes filled with drama. You have to find a way.
My take: Mindfulness will help you see where you are spending time which, instead, needs to be diverted towards your health and wellbeing. Besides, mindfulness also helps you realise that exercise is not some punishment for eating or some form of barbaric torture. Exercise is a way to enjoy the experience of an active, fit and energetic body.
Disturbed sleep or night-shift work worsens struggles with weight and increases the chance of diabetes. Undiagnosed sleep apnoea causes significant cardiac and metabolic risk. There are delicate hormone systems called orexins that connect appetite and the day-night cycles of sleep.
My take: Sleep deprivation makes weight-loss attempts harder and also increases appetite. Remember the extra hunger after pulling an all-nighter or the extra weight gained during exams? Our bodies aren’t designed hormonally to process food efficiently after it gets dark outside.
Good quality sleep is essential for metabolic health. But night-shift workers for instance can’t quit their job. They need their incomes and society needs them too. If you get up feeling tired, get tested for sleep apnoea when you can. Do you feel unable to fall asleep? Or, if you wake up at night, are you unable to fall back asleep without eating something? Undoubtedly there is something wrong with your sleep process. Nearly always, food is not the right answer. You need to diagnose what is really going on when you sleep. Let food have the place in your life it deserves.
Eating helps temporarily sooth negative emotions just like it allows us to celebrate a happy occasion. The hormonal changes that happen after eating something pleasurable increase our ‘feel-good’ chemicals by stimulating the reward centre in the brain. Foods rich in fat, sugar, salt and caffeine, are all very potent at this.
My take: In moderation, there is no problem with eating any food. But when it becomes a pattern of seeking short-term relief from unpleasant emotions through food, then it starts to take on an addictive quality and then the only solution is mindful eating.
It is possible, necessary and rewarding to take charge of your health. Just by being more mindful of your lifestyle choices, you can reduce—and in some cases even reverse—metabolic disorders, and cut down medication. Isn’t that worth a try?
This was first published in the September 2014 issue of Complete Wellbeing.
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