ADSactly Health - How to lose weight

I do not know how it works for other countries, but here in the sunny Italy things are getting hot so people start to dress less, hang out until late and make new relationships. It seems a happy season, unless...you have some weight to lose.

As we get undressed, our hips, tummy, legs, breast become almost of public domain. We fear how people can judge us, we feel less attractive, and we become uncomfortable among other people. Most of time, these are the motivations that trigger the need to lose weight. Therefore, first thing people usually do to solve the problem is opening a web browser and type: "how to lose weight fast".

While the intent is good, this question has at least three big mistakes. I will explain it soon.

In this post, I will focus more on common mistakes and false myths about diet than talking about how much obesity is dangerous for your health: I think everyone knows that, since social pressure and medias keep spreading lot of dis/information about the topic. As MD, I worked during residency in a division of bariatric surgery for 4 years. I had to deal with obese and super obese patients (even people over 300 kg/ 670 lbs weight); I wrote a scientific paper about obesity and surgery as treatment and even made my thesis on sleeve gastrectomy: I can really put something personal on this topic.

How to lose weight fast: three important mistakes

The first thing people do for loose weight is trying to lose it as fast as possible. This is absolutely the biggest mistake that overweighed people can do. The thing is, our body need food to work properly: food is energy. Losing weight fast means most of time a great reduction of food intake. If we do not get energy from outside sources but we still move, talk and think then where this energy comes from? The answer is from ourselves. Our body literally starts to eat itself in order to get nutrients that are essential to keep us alive. This is the second mistake of the title: losing weight is a general statement and does not reflect our real intention. Up to 60% of the human adult body is water, and then we have bones, muscles and fat. It may happen than when we lose weight too fast, we lose mostly water and muscles and not the excess of fat. Third mistake is the answers we get from the internet: some of them are even dangerous for our health. We can read about magic diet that make us lose weight eating everything we want or eating just our preferred food; we can read about magic pills that let us lose weight while sleeping, exotic food or secret mixture that stop hunger and other incredible stuff like that. This is exactly why I am writing this post: to give a basic knowledge on how our body works and how we can adjust our food intake to be in the best shape for this summer. I will try to accomplish this by writing 10 facts about biology, common mistakes and false myths on the matter. Let’s start!

1 - Lose weight is a simple subtraction...or not?

_{A machine in Germany that was able to calculate the BMR of people, 1932. Bundesarchiv, Bild 102-14096 / CC-BY-SA 3.0}

To lose 1 kg or 2,2 lbs of body weight (intended as fat) around 8000 kilocalories (kcal) must be used or burned. Everyone has his own basal metabolic rate (BMR) which can differ depending on body weight, muscle mass, genetics and our hormonal profile. In other words, the BMR is the quantity of energy necessary for our body to function in a state of rest, which is calculated to be between 2000 and 3000 kilocalories on average. BMR is not the only factor that comes into play when burning calories: every activity we do uses energy. Therefore things like walking, running, talking, thinking and reading use energy that comes from burning stored carbs or fat: the sum of BMR and the daily energy consumption is also called daily intake. Please note that all numbers provided here are inaccurate: it is impossible to measure these kind biological value with precision as everything changes from person to person and during the day for the same person: we can only make estimates. Anyway, as you can see, if we need 3000 kcal to live and in order to lose 1 kg we need to consume 8000 kcal, it is almost impossible to lose fat very fast. Even if fasting, numbers suggest that we require almost 3 days to lose 1 kg of fat. This is why any low-calorie diet propose a simple diet scheme where the objective is to slightly reduce calories intake from food in order to be just under the daily requirements. If our body go in a slight calories deficit, it will start use stored fat to produce energy. Is this just all about math? In theory, it would be enough to know how many calories are consumed per day (f.e. 4000 kcal) and subtract to the caloric income (f.e. we eat 2000 kcal per day). With a deficit of 2000 kcal/day we could lose 1 kg in 4 days. It seems easy, but to achieve such high daily consumption you need to do an important physical activity! Let me stress out that why all these concepts are true, numbers are extremely different from person to person due to our biological variability. BMR and even calories we get from foods change accordingly to our muscles mass, our tendency to put on weight, our endocrine profile, our bowel activity and much more. So it’s not just about numbers!

2 - Magic drugs, pills and concoctions to make you lose weight in a short time are not real

Some old-school “doctors” (fortunately, they are extremely rare nowadays) still prescribe drugs to lose weight; more often it happens these drugs are passed off as miraculous food or natural herbs concoctions on suspicious websites.

_{Thinogenics is an example of "diet pill" containing hormones. It's now banned by FDA and retired for its dangerous effects on health.}

Let’s take as example diet pills. Most of them are banned by the FDA (U.S. Food and Drug Administration) and even on websites, despite they sell them as natural herbal product, their useit is not recommended in those suffering heart disease, are pregnant or otherwise are not totally healthy. Why not? Because in the majority of cases they contain thyroid hormones that increase BMR and lead you to a rapid but not lasting weight loss and, more important, to extremely harmful consequences to health. Iatrogenic hyperthyroidism (caused by external source hormones intake) increase MBR but can also lead to arrhythmias, changes in thermoregulation, sleep disorders, tremors, mood changes and many other pathological conditions. Moreover, our body becomes addicted to these hormones and it start to no longer produce them autonomously. This means if we suddenly interrupt the medication the consequence will be a state of iatrogenic hypothyroidism (the thyroid is atrophied given the "disuse" and does not produce more hormones) that will lead us to a rebound weight increase and the chance of developing a real thyroid goitre with the need to do a surgery. Concoctions and miraculous food often consists in drugs, medications or herbs with thyroid hormone-like effects. Stay away from them!

3 – Herbal teas, diuretics and draining agents: watch out!

During summer, our body absolutely need to replenish the fluids lost through sweating. It is true that draining works in losing weight, but it is just a loss of body water and not fat. The adipose tissue (fat) is able to bind about 10% of the body's water (a truly remarkable quantity) and it is concentrated mainly in some body areas like abdomen, legs and breast. If hips are slimmer after using draining agents or diuretics, it is only because the loss of water decreased the adipose tissue volume. However, the loss of water, especially during summer, is very risky. Dehydration can be lethal in children, aged people, people who practice sports and in people who suffer hearth disease with consequences ranging from fainting to renal and cardiac failure. The best and safest draining effect can be achieved easily…by drinking!

4 - Water that removes water

_{PTo remove all the excess of salt contained in a pizza we will need to drink a lot of water for few days!}

The title is not wrong: drinking lot of water, especially the low mineralized one, is able to eliminate the excess water from our body in a natural way without any complications. The problem of fluid retention increasing our leg and hips size, it is not related to water itself but in the salt: the increase of salt in our body cause the retention of water. Have you ever felt heavier after eating a delicious pizza? This usually happens because pizza is a very salty food, which makes us drink a lot with consequent expansion of our body liquid volume. To remove excess salt, all you need to do is to drink low-mineralized water and let our kidney do the entire job, eliminating salt and water in excess. Unlike diuretics and draining concoctions, drinking water it’s cheap, has no side effects, helps keep us hydrated (as opposed to diuretics and draining that can lead us to have electrolyte disorders) but above all, it helps the renal function keeping our blood clean from toxins and reducing the risk of developing kidney stones.

5 - Fasting and skipping meals

Our body is a marvellous machine and if we start to skip meals or start fasting, our metabolism will adapt accordingly. Glucose is the preferred source of energy for brain: it is found in our blood and it can be quickly used by cells. When we start fasting, the glucose level decrease and our body start using other sources of energy. After the first 24 hours of fasting our main energy source become the glycogen (a complex carb) stored in the liver and fat stored in adipose tissue. Once glycogen deposition ends up, the liver starts a process called gluconeogenesis, which create glucose from amino acids. The bad thing is that the main source of amino acids is muscle tissue: after 24 hours of fasting we basically start to eat ourselves. As a result, after some days of fasting, we will be surely slimmer but we will have lost more lean mass (muscles) than fat. Losing lean mass is big deal: not only will we have to work hard to put it back on, but we will decrease our BMR (the muscles consume energy even if we are not working on) and therefore we will gain weight much faster. Skipping meals will have also other side effects like increase hunger during next meal often leading to large binges or eating high-calorie foods. This is because fasting or skipping meals have a bad impact on our mood especially on overweight people. In fact, food and especially sweet food, make our brain release endorphins which boost our mood: overweight and obese people tend to be addicted to these substances and so they mostly fall into large binges when they are forced to skip meals or to fast.

6 - Little and often, but be careful!

Eating little and often is good advice and has been a golden rule of different types of diet until a few years ago. The main concept behind this is that digestion is an intense metabolic process that consumes energy. In very elementary terms, digesting, absorbing and storing substances contained in food requires a certain amount of energy and consequently burns calories. In other words, eating little and often will trigger all metabolic processes, consuming energy. However, you should not abuse it in order not to stress too much the gallbladder and stomach: keeping them always active can lead to gastric disorders (gastric reflux) or pathologies related to the gallbladder (like slow digestion or gallstones). Moreover, recent studies describe the benefits for health when applying a diet style called “intermittent fasting”. In this kind of diet, people split the day in different time window: one to eat and another one of complete fasting. For example, the 16/8 diet consist in 8 hours where you can eat normally, and 16 hours of fasting. It seems that during the fasting window, our body restore cells and tissue, build up muscles uses the fasting hours, neuronal connections and it also improve mood and sleep.

7 - Light, without added sugar, without fat: look at the label.

It is a very common mistake to be fooled by labels that promise super light products that will not affect our figure. Now that you know what are calories and BMR, take a look at food labels in your house and see for 100 grams of product how many calories that food provides. A light food, at least for me, does not have more than 20-30 kcal per 100 g, almost the same calories of a vegetable. A "light" cheese that has 140 kcal per 100 g is not so light! Know how to read the food labels will also help you to better manage your diet: if you know that three delicious biscuits provide you with almost 400 kcal maybe you will tend for a more substantial and less caloric snack as some crackers with some ham!

8 - Eat fruit and vegetables at will.

Eating anything in excessive amount is always dangerous to our health. Even what seems to us more harmless, in the wrong quantities is harmful. Fruits and vegetables are no exception. Vegetables are good for our bowel function and contains very few calories because they are made mainly of water and vegetable fibres that we cannot digest.

_{Watch out for calories on food labels!}

On the one hand, vegetables does not compensate for the need for carbs and proteins that our body needs. This is why we need to eat large amount of vegetables to be satiated: our brain detect the low carb and proteins intake and interrupt the satiety signals. Also, eating so much, will enlarge our stomach, increasing its capacity and making us eat even more. Lose weight eating only vegetables? It is true, but we will lose lean mass for the low protein intake. Let’s also clear the false myth where we can eat as much fruit as we want: it is true that fruit is good and it is recommended in every diet, but it is still a type of food containing sugar and so it’s not such a low in calories. A diet with high dose of sugar like a fruit-only diet, will alter intestinal flora, promoting the growth of "bad" bacteria and consequently can create various intestinal disorders. Moreover, eating too much fruit does not make you lose weight: they have more calories than vegetables and they still are low on proteins. Let it be clear: in the context of a balanced diet, fruits and vegetables are a really addition given their ability to slow down intestinal absorption increasing satiety time and granting a good supply of vitamins; it's their bad use that is harmful. The expression "at will" must always be contextualized in a balanced diet.

9 - A balanced diet is not always sufficient

When the energy balance is negative, after some time our body adapts, starting to slowly demolish lean mass. It is a primitive mechanism that grants our species the ability to survive in conditions of food scarcity. Consequently, by decreasing the muscles, our basal metabolic rate also decreases and therefore, the daily energy requirement. If before our daily caloric need was 4000 calories, after 1 month of diet with a caloric deficit, we will need only 3500, and to lose 1 kg we will have to cut the intake even further, feeding a vicious circle. If instead we combine a physical activity, even light, to the diet, we will give a clear signal to our body: we need the muscles, do not demolish them. The ideal are prolonged physical activities (aerobic): they consume mainly fat, help to raise muscle tone and they are a very powerful anti-stress. In this case, a balanced diet becomes even more important: in order to maintain and increase lean mass, we will need proteins, something that vegetables and fruit unfortunately give us in low quantities. The primitive mechanism described above can be partially avoided if the weight loss is slow and steady, this way our body will reduce the muscle demolition rate and we will keep our BMR intact.

10 – Key word: Zero.

Stevia and Acesulfame K are two new sweeteners; the first one is natural and the second one is artificial. Both are gaining more and more attention thanks to their ability to give the pleasant sugary flavour to drinks and food, but with zero calories.

_{Stevia plant, whose extract has a sweetening power 200 times more than common sugar.}

Used initially in drinks, they are also entering into the composition of foods. From a scientific point of view we know that these substances are not harmful in the short term for our health, but there are no studies on the effects of these substances in the long term. Some researchers hypothesize that they are carcinogenic, others hypothesize that they can be addictive, others that despite they do not have calories they activate the same hormonal / metabolic pathways of the common sugar and therefore they can provoke the same effects of its abuse (diabetes, humoral alterations, chronic fatigue to name a few). If you can avoid them, better: for sure I do not advise you to use them every day!

Last but not least: be comfortable with yourself.

I’m pretty sure most of people get fat in times of high stress. The food, especially the sugar, is a panacea for our nerves: the sweet determines the release of substances that stimulate the sense of contentment, allowing you to relax a moment. But this lasts just a moment: the effect of the dessert is indeed short and we often abuse it, with subsequent passing from an euphoric state to the following psychophysical "crash". Losing weight to get back into shape must start from our head: it should not be seen as an imposition from the outside, from society, from friends or from the partner who "wants" us in a certain way. You simply have to do it for yourself, because you will keep yourself healthy and fit. In times of extreme stress, do not throw yourself on food but use two zero calories anti-stress: physical activity and a good chat with friends/partner to let off steam. Remember that physical activity is not just “gym”: if you are like me and get bored running on treadmill or repeating same exercise for hours, just organize bike rides, long walks, small hikes with nice picnic or simply put your favourite songs in your room and dance; in short, anything that doesn’t make you standing still. As for food intake, more than following a specific diet, I suggest you to take a food diary. Since now you know a bit more about calories, intake, metabolism, it should be easy to write down everything you eat during the day and do an approximate calculation of calories in order to use these information to balance you weekly calories intake. This is the best option: it does not force you to eat something specific, saves money and let you keep track what and when you eat things, making you totally aware of what are you doing.

All images provided in this post, where not specified otherwise, are under CC0 license (Public Domain)