Dr Andreas Eenfeldt aka The Diet Doctor – Weight Control: A Question of Calories or Insulin? at The Old Mutual Health Covention

Is obesity the result of bad food or bad character? Is it just from people eating too much and exercising too little – in other words, just gluttony and sloth?

  • Food companies tell us it doesn’t matter what you eat, only how many calories you eat. They say there is no bad food, especially not their food. There is only bad character. It’s as if they are saying that people have suddenly developed bad character, what I call the lazy, Homer Simpson virus. Is that true?
  • Lots of people have become obese in the last 30 years. The question is why, and what can we do about it.
  • Look at the basic view of human evolution. It took millions of years for our bodies and genes to change from ape to human. But it took just three decades for our body shape to change again: In 1985, US obesity levels were at 10% of the population. In 2013 that figure was 35%.
  • Obviously this is not a sudden genetic problem, because everybody does not mutate at the same time. It must be something in the environment.
  • But what?
  • The most common explanation the experts give is that people globally are just eating too much, taking in more calories than they expend. It’s as if people have become lazy, stupid, gluttons, as if a Homer Simpson virus spread across the world.
  • This theory given by some experts – CICO (calories in, calories out) –is what the junk food industry desperately wants you to believe. It’s what they spend billions of dollars trying to convince you of, because then they and their products are innocent of causing the obesity epidemic.
  • Just look at what food and drink companies get up to: Coca Cola, Pepsi and Kellogg’s sponsor America’s largest association of nutrition professionals. In Canada, Ontario’s Healthy Kids Strategy that has the goal of reducing childhood obesity by 20% over five years is sponsored by Coca Cola.
  • Clearly, just blaming the victims of obesity – and suggesting that overweight is simply from a lack of willpower or bad character – is not the solution. We need a deeper understanding of the underlying problem.
  • So what really happened 30 years ago?
  • In the US, the government launched a campaign to teach the American people to fear fat, and that foods like bacon and eggs could raise cholesterol in their blood and give them heart disease. This is what is known as the diet-heart hypothesis. This was a largely unproven theory, and we now know more or less that this was a mistake.
  • So, if it isn’t the fat in our diets, not the butter, eggs, bacon and meats that are making us fat, what if it’s too many carbs, especially the bad, highly processed, refined carbohyrate foods?
  • Sugar and other carbohydrate foods, including starchy vegetables such as potatoes, and grains, raise the blood sugar, raising insulin. And insulin is our main fat-storing hormone. That could be why people are putting on weight. They eat foods that make them store fat, by releasing the body’s main fat-storing hormone.
  • It sounds like a reasonable hypothesis. Let’s have a closer look at it.
  • The idea behind official dietary guidelines was that if people ate less fat, they would be more hungry and eat more of something else that was good for them.
  • The only problem with that was that they didn’t replace fat with vegetables. They replaced it with bad carbs – processed foods, sugared drinks, French fries, hamburgers with buns – that turn into simple sugars when they hit the stomach and raise the blood sugar, causing more insulin to be released.
  • But there are anomalies in obesity. And it is possible to be thin and unhealthy. So how we explain common obesity? What is the typical difference between an obese and a thin person?
  • I’m a family doctor, I’ve spent a lot of time treating obese patients and reading and thinking about this. I used to find confusing. But it’s possible to make sense of it.
  • An obese person usually has abnormally high levels of insulin. A thin person usually has low, or normal, levels of insulin. This has been shown in a number of studies, it’s not controversial.
  • When I test obese patients in my clinic, their insulin levels usually are very high. Were not talking slightly higher insulin, we’re talking about levels elevated by 500% or even 1000%. Now imagine what happens if any important hormone in the body is ten times its normal rate. That is likely to upset the body’s endocrine system, and since insulin is a fat-storing hormone it makes sense that overweight and obesity will follow.
  • We see that in type 2 diabetics. They usually have high levels of insulin and gain weight – and over time, they become more obese.
  • We also see it in type 1 diabetics, who lose their ability to make insulin. Their insulin levels are extremely low and their weight plummets without treatment.
  • Early treatment of type 1 diabetics with insulin helped them gain weight. So higher doses of insulin mean more weight gain.
  • And when diabetics inject insulin into the same place everyday for years, research shows that they accumulate fat in those areas, sometimes so badly, it looks as if they have had silicone injections. They get fat accumulation.
  • Clearly, injecting insulin leads to fat accumulation. Avoiding insulin leads to fat loss.
  • There is a disease that results when the body makes too much insulin: insulinoma, that results in a rare tumour producing too much insulin. These patients often become ravenously hungry and quickly gain weight.
  • And what happens if you block the body’s production of insulin? A drug called Octreotide does that, and has been used as a treatment for some obese patients, according to studies by Prof Robert Lustig. But let’s leave aside all these diseases and drugs.
  • For many people, the easiest and tastiest way – by far – to raise insulin, is by eating high-carb junk food. The easiest way to reduce insulin is simply by eating low-carb nutritious foods, and increasing intake of fat, including saturated fat, and protein, because these do not raise insulin levels.
  • In study after study – RCTs – comparing low-fat or low-carb diets for weight loss, the most effective diet turns out to be: low-carb – if you look at statistically significant results. Low-carb diets don’t just lower insulin, they lower it a lot. Insulin plummets on low-carb diets.
  • Yet experts still advise people with type 2 diabetes to eat a diet that includes carbs, and to eat often every 2-3 hours, even if they are not hungry. Maybe the single most bizarre advice today is to eat extra food, even if you don’t want to, to lose weight!
  • What that advice does is to make sure insulin is always elevated, and the person will always be storing fat.
  • The opposite – intermittent fasting, short periods of fasting – makes much more sense. It means eating less. It is a simple and popular way not just of losing weight, but reversing all the symptoms of diabetes. And of course fasting is a naturally low-carb diet
  • So whichever way you look at it: more insulin, more weight gain and vice versa.
  • This does not convince some people. They have objections that include: .
  • Only calories matter
  • This is an oversimplification. It ignores the causes, and if we ignore the cause, we can’t fix it.
  • Only leptin matters
  • Leptin is important, but it’s not everything. All important hormones, including insulin, need to work to maintain a proper body weight.
  • Only food reward matters – aggravated by a toxic obesogenic environment
  • It’s not about rewarding yourself with food. What we’re talking here about addictive properties of food. Food manufacturers go out of their way to make food as addictive as they possibly can, so that way they sell more. Food reward is part of temptations in the toxic environment. It is an important piece of the puzzle, but it’s not everything. There’s no reason to choose between insulin or food reward to explain common obesity. They work perfectly together.
  • Another objection is that insulin should predict weight gain. The problem is, it doesn’t always. There are many anomalies. People with high insulin levels do not necessarily gain more weight than others.
  • There are many examples of populations eating starchy carbs without problems – such as traditional Japanese and Chinese societies, who ate a lot of rice. It’s clear that not everybody needs to avoid carbs. Just avoiding the worst carbs, such as refined sugar and flour, can often be enough to avoid obesity for some people.
  • Some people appear able to tolerate ”safe” carbs – the slow carbs, good carbs, unprocessed, unrefined, fibre-rich carbs. The paleo diet, for example, isn’t necessarily a very low-carb diet, and many people do well on it. Thin people who are metabolically healthy can probably have all the fruit they want.
  • But that’s not true for most people in the western world any longer. They are plagued with weight issues that include high blood pressure, heart disease, pre-diabetes and full-blown type 2 diabetes. For these people, a low-carb intake is best. .
  • The biggest problem is the Western diet – most people eating too many high-carb junk foods too often. It’s easy to do in an obesogenic environment, the junk food is rarely far away, not even 200m; it’s often within arms’ reach. This will sooner or later result in high insulin – and weight gain.
  • Willpower is not enough for them to resist the temptations, and lack of willpower is not the problem. We need a better solution. We need to get more people to understand the fundamental importance of the fat-storing hormone, insulin.
  • A better strategy is to get rid of the junk food from people’s lives and get them eating some form of low-carb diet – or at least lower carb for those who need it most.

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4 Responses to “Dr Andreas Eenfeldt aka The Diet Doctor – Weight Control: A Question of Calories or Insulin? at The Old Mutual Health Covention”

  1. Bernard P.

    One has to agree with almost all what you are saying, except for one thing: I understand that protein also raises insulin, in some cases as much as carbs. See this reference:


    That is one of the reasons why intermittent fasting is so effective, as it forces the body in a long period of low insulin levels. In turn, these repeated prolonged low levels of insulin progressively lead to an increase in insuline sensitivity.

    • Karen Thomson

      Dear Bernard,
      Thank you so much for your comment. I do believe that intermittent fasting can be beneficial to certain individuals. We always encourage doing it under the supervision of a medical doctor.


  2. JayCee Botha

    I fail to understand how a calorie has any relevance whatsoever in human nutrition. The mere definition of it clearly shows that it’s something that can only ever happen outside the human body. It’s a combustion term. We don’t burn food for energy, we utilize free fatty acids for energy. Combustion and digestion are two concepts light years apart from each other. Yet the experts want to use this “caloric intake” it as THE measurement of ATP energy utilization in our bodies. We clearly need to find a new measurement name for what happens inside our bodies. It’s not calories. One cannot “eat” a calorie or “burn” it. Simple as that 🙂


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