Saturday, February 23, 2008

Dr. Jamie Bailes: The Fat-Free Fallacy

Dr. Jamie Bailes, a pediatrician at Marshall Unieristy in Huntington, WV, recently penned an article for Diabetes Health - The Fat-Free Fallacy: Is it Obesity's Great Enabler?

Obesity in the United States is increasing in epidemic proportions. This is true in children as well as adults. It's estimated that the healthcare costs associated with obesity and its related complications will exceed $130 billion this year.

If something is not done to stem this burgeoning tide of obesity, then the healthcare system that we know will soon crumble.

Why are we seeing this dramatic increase in childhood obesity?

It is certainly true that children are not as active as they were 30 or 40 years ago. Television, video games and computers can entertain kids 24 hours a day. Parents are often relying on technology to babysit their children and are not spending as much time outdoors with them exercising or just playing.

Is this the only reason for the surge in obesity? As a pediatrician who specializes in childhood obesity, I see many children who are very active but they are also massively overweight. What about these children? I believe many of these children are victims of what I like to call the "fat-free fallacy."

Scapegoating Fat Backfires

In 1977 the U.S. Department of Public Health issued a statement encouraging Americans to eat less fat. In 1988 the U.S. Surgeon General recommended that we restrict our consumption of dietary fat. The assumption was that as we eat less fat the thinner we would become. The multi-billion-dollar food industry was quick to jump on the bandwagon. The race was on to produce fat-free everything. If food didn't have fat then it was OK to eat as much as you wanted.
Americans consumed more fat-free foods in the 90's than the previous three decades combined. This fat-free philosophy is exactly why we are becoming so obese as a society. Obviously if fat were the problem, then obesity would have decreased during this time. Instead, obesity did not decrease but skyrocketed to unprecedented levels.

But fat is not bad for you. Being fat is. The two are not related! Fat actually helps to satisfy our appetites and keeps us from eating too much or too often. Fat is also an important flavoring for food.

I, too, was a victim of this fat-free fallacy. I had been taught (brainwashed) that in order to lose weight we must eat less fat. I was a huge proponent of cutting back fat intake and watching total calories. I recommended at least 30 to 45 minutes of vigorous exercise daily.

I knew that it was very hard to lose weight. I didn't push overweight children to lose weight, thinking that if they could just maintain their current weight as they grew that would be significant progress. I felt like I was doing a good job. I believed whole-heartedly that I was explaining to these children the correct way to lose weight.

An Eye-Opening Study

In the late 1990's, a first-year pediatric resident physician at Marshall University did a required research project in which he looked at about 100 children whom I had counseled about weight loss. The results were astonishing to me. Not only did these children not lose weight or even slow down their weight gain, most gained weight at the same rate and some even faster.
The results did not lie. All of this time and energy that I had been spending to help children lose weight had been a waste of time. It just didn't work. A low-fat diet only worked for about one out of every 25 patients. Was this the best we could do?

I was determined to succeed. I began to look at other ways to lose weight. A third-year medical student at the time asked me about using a high-protein, carbohydrate-restricted diet for weight loss. At the time I knew very little about approach. This was not something that was taught in medical school. I couldn't believe that this would be successful or that it could be good for you, so I was very skeptical. How could eating high-fat foods not be bad for you? This is what I learned in textbooks from professors in medical school.

However, I still could not ignore the facts. We had cut back our fat intake and yet we were becoming fatter as a nation.

Low Carbs Make a Case

I researched and relearned the physiology and biochemistry behind low-carb diets. As I began to take a closer look, my findings were not what I expected. It all came back to insulin. Insulin is what causes fat storage. Insulin is what drives weight gain. Insulin is what is secreted when we eat carbohydrates. Insulin is one of the most powerful and efficient substances that our body uses to control the use, distribution and storage of energy. Insulin is essential for life. Without insulin, we would quickly waste away and perish. Just ask the teenager with type I diabetes who has been hospitalized for diabetic ketoacidosis because of not taking his or her insulin.

Let's look at what happens after a meal that is high in carbohydrates. Carbohydrates are broken down into thousands of molecules of glucose that are quickly absorbed through our small intestines into our bloodstream. Our body has the ability to monitor this rapid rise in blood sugar and quickly secretes insulin to counterbalance this. This is true if we do not have diabetes. Our nervous system keeps our blood glucose levels very steady no matter what we eat. These values almost never get above 120 or less then 70mg/dl. This is true whether we eat a meal that consists of pure sugar, a meal loaded with complex carbohydrates, a meal consisting of only protein or fat, or when we have fasted for two or three days. Almost all of our cells use glucose for energy.

Our bodies are extremely efficient energy machines. Only a small part of what we eat is actually used or needed by the muscles or other cells for energy. If these energy-using cells do not need any extra energy what happens to the majority of the glucose that we ingest? Insulin converts a portion of that glucose to another starch, called glycogen. Glycogen is stored in the liver and can maintain our blood sugar levels in the normal range for several hours after a meal. This is why we do not have to eat continuously. Glycogen can quickly be converted to glucose whenever glucose is not readily available in the bloodstream.

Why Low-Fat Diets Don't Work

What about the rest of the glucose? Where does it go after a meal? Herein lies the answer to why most low-fat diets do not work. The extra glucose is converted to fat. Fat is our main storage area for energy. Let me say this again: insulin promotes the production and storage of fat. That's right, even without eating fat our body produces fat from sugar.

Insulin is an extremely efficient hormone. It is the master hormone of our metabolic system. Its most important function may be the control and maintenance of our blood sugar, but insulin performs a myriad of other activities. In the appropriate amount, insulin keeps the metabolic system running smoothly and everything in balance.

However, in great excess it becomes a dangerous hormone wreaking havoc through the body. Mountains of scientific evidence implicate insulin as the primary cause or significant risk factor for high blood pressure, heart disease, arteriosclerosis and high cholesterol. It may also have a causative role in type 2 diabetes.

With type 2 diabetes our body needs extra insulin to help to maintain our blood sugar. The insulin that is available just does not work as well and we become resistant to its effects.
With type 1 diabetes we have a little different story. Our body can no longer make the insulin that we need therefore we have to take manufactured insulin to maintain our blood sugar. More carbs equals more insulin.

Teenage girls with diabetes know that insulin causes them to gain weight. Many recent studies have shown that in order to keep from gaining weight a very high percentage of teenagers with diabetes omit their insulin. We cannot continue to allow this to happen. This leads to uncontrolled diabetes and horrible long-term complications.

More Protein = Greater Insulin Control

So, how can we control our insulin requirements? The key to good blood sugar control, the key to weight loss and the key to lowering our insulin secretion is very simple. Eat fewer carbohydrates and eat more protein.

Protein keeps us from being hungry. A meal high in protein stays with us a lot longer than a meal high in carbohydrate content, which is quickly absorbed and does not satisfy our appetite as long. When we eat protein our body does not need as much insulin. Our blood sugar values are much steadier and we do not have the wide fluctuations that we see with high carbohydrate foods. This dietary approach works whether you have diabetes or not. It is perfect for anyone who is overweight or has type 2 diabetes. Type 1 people with diabetes can benefit by improved blood sugar values and lower insulin requirements.

I have seen hundreds of children actually lose weight with our plan. Eight and nine year old kids have lost 40 to 50 pounds. Obviously, the health benefits are tremendous, but the greatest improvement is what we see with self-esteem. Children's energy and blood pressure improve, and their lipid profiles universally improve. Before-and-after pictures of these successful children can be viewed on our website

In general, the fewer carbohydrates we eat the better. However, we should get a minimum of 30 grams of carbohydrates per day. The standard approach of 60 to 75 grams of carbohydrates per meal and 30 grams per snack is way too much. If you do not want to restrict carbs to 30 grams per day, then somewhere between 60 to 100 grams per day will still allow for weight loss if it is combined with exercise.

Remember: Eat all the protein you desire. Do not worry about where the protein comes from or how it is prepared. People who eat more protein end up eating fewer total calories. Protein keeps us from being hungry and satisfies our appetite more than any other macronutrient. This is the key for successful weight loss. It is hard to lose weight if you are hungry all the time.


  1. WOW, Regina! That was beautiful! Pure and simple!

  2. Yup....some things don't need anything from me - they stand on their own, so I just post 'em here!

  3. I am so happy for those kids in the before and after pictures.

  4. I would add "do not restrict fat". It is hard to truly over-consume fat long-term, especially if the carbs are restricted and high quality protein is adequately provided. Fat does not promote an insulin response and is very satisfying to the appetite.

    I see too much advice to consume only lean protein, such as skinless, boneless cuts, instead of rich, flavorful more fatty cuts (which is more economical, too). Braised pork belly is head-and-shoulders better in every way than boneless, dry, bland boneless pork chops. Additionally, meat, poultry, and fish cooked with bones intact add bioavailable minerals to the diet, in addition to packing a flavor punch. Traditionally raised is far better than factory-farmed too, but that is another rant.

    Modern cooking habits that feature last-minute, quick-cooking, pricey and less nutritious "convenience" cuts, such as 20 and 30 minute recipes (boneless, skinnless premium cuts) are also part of the problem. Meals deserve more than 20 minutes of panicked attention, but that doesn't have to mean slaving over a hot stove, either.

    Long-simmered "grandmother" or "peasant" foods can fit into modern lives with a little forethought and planning. Slow cooker appliances are a great option if no one is home to tend the kettle and can provide enough cooked food for several convenient meal remakes (not necessarily leftovers). Our great-grandmothers didn't laboriously cook every meal, but made larger quanties of some things to cut prep time on other meals.

    Male or female, it doesn't matter, everyone should know how to feed themselves and their families with real food. If cooking and nourishing one's self and family isn't enjoyable or rewarding, then it isn't being done right or it is time for a reordering of priorities. It's long past time to put real, whole nourishing food and meals back into our lives, instead of hiring it out to the lowest bidder, lowering its priority, cheapening its significance, and suffering the health, weight, and cultural/societal consequences.

    Ok, rant over. I liked the post :-).

  5. It's great to see a doctor re-examine his beliefs and change his approach based on the evidence - and be willing to talk about it - without worrying about being "wrong". Good for him! And good for the kids too :)

  6. Anonymous12:19 PM

    Bravo Dr. Bailes!

  7. I hope he's using 'protein' in the old sense of the word. Living on tunafish or chicken without the skin won't get you where you want to be.

    When I briefly fell under the low-fat spell, I remember the shock at learning the fat content of foods that had always been referred to generally as 'protein': steak, eggs, and milk- foods which are once again my best friends.

  8. Hi Dr,

    most impressive content there my head is absoloutly spinning i had to stop half way through...
    i agree protein satisfies our appetite better then any other type...

  9. Anonymous1:02 PM

    How about sticking to a healthy diet? FAD Diet's epically fail! This is nutrition quackery! Keep your portion sizes in check, eat a variety, stick to fresh food. Don't buy processed foods. Eat whole fruits, whole vegetables, keep your intake of starchy foods to 1/2 cup per meal. Amazingly if you do this! 1/2 cup fruit/meal, 1/2 cup vegetables, 1/2 cup grains, 3-4 oz of protein/day, Add a few snacks inbetween meals and wow! You have at low carb, not adkins low carb but no carb none the less and stuck to what is recommend to keep you from getting a nutrient deficiency.

    How many people actually stick to the atkins diet? How many people gain the weight right back or more. Stick to an approach that is life changing, not a get slim quick then gain it back plus more scheme!