Orthorexia prevention and treatment

Traditional Western-style diets put people at risk of orthorexia nervosa

So, you are working on improving your diet, spending lots of time planning your meals, making sure you only use healthy ingredients. You’re reading a lot about the latest health news, like how certain ingredients can prevent cancer and heart disease. Surely, this effort you are putting in to improve your health must yield good results! What could possibly go wrong?

You may think that nothing can go wrong. You are doing what many other people are doing, their testimonials on social media are clear: It works like a miracle! Surely, if what they are doing were bad for their health, they would have have noticed?

We tend to underestimate the robustness of the human body

Most people tend to think that their bodies are fragile systems. They believe that soon after starting a wrong diet they’ll notice bad results, and that good results imply that the diet is good. But the human body is actually an extremely adaptable, robust system as I’ve explained here. If you eat an unhealthy diet, then your body will compensate for most problems. While eating an unhealthy diet will negatively affect your long term health, this may not make you feel worse on the short term.

This robustness of your body provides for a lot of potential to drift away in the wrong direction. If you later get some complaints, then by that time you may be so convinced that your diet is right, that you’ll end up blaming the complaints on not being strict enough with your new diet.

If you become more strict with your diet,then your complaints may become less, not because the underlying cause is eliminated, but simply due to eating less or eating different foods. This creates the illusion that your diet has cured the problem. But in reality you are now eating an even unhealthier diet and spending a lot more time obsessing over every last detail of your diet.

Many people find themselves in this situation. When this gets to a point where it affects your social life and your health to the point that it affects your general well being, then this is called orthorexia nervosa.

Wrongful assumption of fragility of the human body keeps people trapped on the wrong diet

While the robustness of our bodies can allow one to drift away in the wrong direction, it’s the wrongful assumption of fragility that keeps people there. Pretty much all diets, including even the ones that I advocate for on this blog of the whole food, plant-based type, are often advertised for by misleading fragility arguments.

One of the most pervasive myths about diet is the need to count calories to prevent becoming obese. I’ve explained here why this is nonsense. But, of course, drastically reducing calorie intake will lead to weight loss and this keeps people believing in this myth. The real cause of weight problems is a poor diet. On a poor diet, eating enough calories to not feel hungry, causes us to become too heavy. It’s then the idea that the human body is a poorly designed system prone to weight gain that keeps people to stick to very unhealthy low calorie diets.

Another example is the extremely unhealthy keto diet. People who stick to this diet limit carb intake on the grounds that insulin inhibits fat metabolism. This simplistic reasoning totally ignores that this mechanism is just one tiny part of the entire metabolic system which in its entirety is an extremely robust system.

Healthy diets are not immune from this problem

Unfortunately, diets of the whole food, plant-based type that I’ve also advocated for on this blog, are often promoted based on the same sort of flawed fragility arguments. A well known argument is that fat damages arteries and we therefore need to reduce fat content. This argument is false, recent research has pointed out that dietary fat, even saturated fat, isn’t damaging to the arteries. Nevertheless there are other good reasons to reduce the amount of fat in the diet, as I’ve explained here.

Eating the right sort of diet based on the wrong fragility-type of argument is less of a problem compared to doing the wrong diet. Nevertheless, it will still cause people to focus on the wrong details, so their diets while broadly healthy, will be suboptimal. There will then even be a significant risk of people drifting away into an unhealthy direction.

Eating the right diet based on robustness of the human body prevents orthorexia

On this blog, I’ve approached diet from point of view that the human body is an extremely robust physical system. This differs from the conventional point of view that we need to micromanage the diet, as if the human body is a very fragile system prone to breakdown.

The optimal diet for us, is the diet that our bodies have evolved to eat, which is a whole food, mainly plant-based diet. This evolution happened a long time ago, well before we had any knowledge about calories, carbs, fats, proteins vitamins and minerals. The brains we’ve evolved were used to figure out how best to survive and find food, not to obsess about small details of our diet.

Eating this optimal diet will make us less likely to fall into the orthorexia trap. This is because a whole food, mainly plant-based diet has a very low energy density due to the absence of refined oils and fats. We must therefore eat large volumes of food just to get enough calories. We then almost automatically get more than enough of the essential nutrients.

As I’ve explained here, it does require many months to get gradually adapted to such a diet. But once adapted, the way you’ll be preparing your food and eat involving much larger amounts of food, will make you psychologically much more resistant against obsessing over small details of your diet. You’ll also notice that your body weight does not depend on calorie intake anymore.

No need to worry about occasionally eating unhealthy foods

There is no problem with eating unhealthy foods once in a while during festivities or birthday parties. Nor is there any need to eat less during dinner if you have eaten at fast food in the afternoon. You don’t need to watch your calorie intake, which actually makes your lifestyle healthier as you’ll keep on eating your normal healthy meals regardless of any occasional snacking on junk foods during the day.

You won’t obsess over having eaten junk foods, because you know that the damage done by junk food is not due to the sugars and fats in it. Junk food does damage on the long term for the same reason why the traditional Western-type diets are unhealthy. The fats and sugars are empty calories, the lack of fiber and certain minerals like magnesium and potassium are responsible for adverse health effects.

As I explained here, the body is in fact constantly repairing itself. It is constantly working to build itself, it has to constantly reverse damage done by the environment, including the (healthy) foods it eats. It therefore doesn’t make any sense to consider natural components in our diet like sugars and fats as a sort of poison.

Overall unhealthy lifestyle does the damage, not the occasional Big Mac

Real damage due to such natural compounds can only be done when the self-repair capacity of the human body is undermined. This can only occur as a result of a lifestyle that’s very far removed from the optimum. As I’ve explained here, the ability to respond to perturbations will become less efficient the farther removed we are from the ideal state. So, on a poor diet that doesn’t contain lots of fiber, minerals and vitamins, our bodies will be less good at repairing the damage that is caused by simply being alive.

So, when you are on an optimum whole food, mainly plant-based diet, your body will be much better at repairing itself, and that includes repairing any damage due to eating fast foods. So, there is then no reason at all to worry about occasionally eating fast foods when sticking to this diet for the right reasons.

Conclusion: Orthorexia is the tip of the iceberg

Clearly, orthorexia is a debilitating problem for the people who suffer from it. But the underlying problem is something that almost the entire population of the civilized world is suffering from. A large fraction of the population has body weight problems. Almost 100% of the population has atherosclerosis when they are over the age of 40, while in indigenous populations, this percentage is an order of magnitude lower.

A quarter of the population will end up dying from cardiovascular disease, while in indigenous populations sticking to a whole food diet, this mortality rate is almost zero. We can thus expect lots of health benefits from switching to a whole food, mainly plant-based diet. While such a switch requires quite some effort, doing so will not just improve your physical health, it will also make you far less prone to fall into the trap of orthorexia.

If you want to get help with getting started on such a diet, you can fill in this contact form.

The best way to start eating healthier

Moving toward eating a whole food, plant-based diet

In the previous blogposts I’ve explained that a whole food, mainly plant-based diet is optimal for health. This sort of diet contains low amounts of refined oils and fats, low amounts of refined carbs, lots of fruits and vegetables. It can also contain small amounts of meat and fish. It then looks easy to just get started with this diet. However, people who are not used to eating like this will get bloating due to the large amounts of fiber. Also the sheer volume of food will likely cause abdominal discomfort.

Not everyone will experience problems, but the vast majority of the people who were able to start right away with this type of diet, were severely overweight and they started out on a very low calorie version of this diet. By starting out eating a large but manageable volume of food, they didn’t experience much problems. When they increased their calorie intake later that happened gradually, allowing their bodies to get used to eating vast volumes of food.

For people who are not extremely overweight, a different approach is needed. To get to a good method on how to get used to a healthy whole food diet, we first need to understand why eating lots of fiber can cause problems.

Low fiber diet undermines gut fitness

Our gut is the home of about 100 trillion microbes. They survive off the nutrients in our foods that we don’t absorb in our intestines, like fiber. These microbes produce compounds that are useful for us, such a butyric acid. These compounds are used by our body, for example butyric acid is an energy source for the cells in our intestines.

On a whole food, mainly plant-based diet, we’ll get at least 80 grams of fiber a day. This 80 gram of fiber should thus be capable of maintaining a healthy population of gut microbes. Most people, however, get less than 20 grams of fiber a day. That the human body can get less than a quarter of the optimal amount of an important nutrient and still keep on functioning, is due to its robust design. But there is a price to be paid for exploiting robustness to move so far away from the optimum.

Lack of dietary fiber has been linked to systemic inflammation, raised cholesterol levels, and many other adverse health indicators. And once your intestines have adapted to a low fiber diet, they cannot tolerate a high fiber diet straightaway. Your intestines not only contains less microbes, the diversity of microbes is also less. Eating more fiber can only regrow the microbes that are already present in your intestines. So, if you do this too fast, you’ll end up with the wrong balance of microbes.

No magic cure

It will take quite some time to acquire the right kind of microbes from, for example uncooked foods such as fruits. Your entire gut will have to reconfigure itself to function in a different way. There are no magic cures, pills, diets that can let this change happen overnight. The problem is thus completely analogous to having lost physical fitness and not being able to stick to a healthy exercise routine as a result.

If you have lost muscle mass, there is no magic cure to regain that overnight. You’ll need to gradually increase exercise intensity to regain muscle mass. Regaining gut fitness will also require a training of your intestines in the right way to get adapted to natural foods again.

Methods to increase gut fitness

Just like increasing physical fitness will always take time, increasing gut fitness will have to be done gradually. Anything that works great when you’re starting is only going to be your first step. It would be a big mistake to stick to that first step indefinitely. But doing the effort to embark on that first step that you can comfortably stick to, is important. You can then later fall back on that first-step diet when you experience problems with the next step.

First step: More vegetables, fruits, whole grains and less refined oils

Your first-step diet should be one that you can easily tolerate. You need to make sure that this diet is adequate. This requires keeping track of what you eat. Use a good kitchen weighing scale, measure and write down the amounts of ingredients you use. You can enter this data in online tools such as the Meal Plan Calculator to check whether you are getting an adequate amount of all the essential nutrients.

For example, while you can get minerals such as calcium from green leafy vegetables, your first-step diet likely won’t contain enough of these vegetables to allow you to stop eating dairy products.

You also need to keep a diary for physical problems associated with the diet, such as bloating. This is very important when moving from the first step to the next and beyond. Just like in case of physical exercise there is a “no pain, no gain” aspect to increasing gut fitness. Unlike conventional dietary advice that keeps you at step 1, you’ll have to breach your present limits to move to the next step. It’s therefore important to get a good idea of where your limits are.

If you don’t feel comfortable taking this first step yourself, you can follow the High Carb Fat Loss Program (paid link). This program will not go all the way to the end goal, but it’s a great way to get you started on the right track. You can also get personalized diet advice from me, you then need to fill in this contact form.

Moving from step 1 to step 2

After several weeks of eating a healthier diet with more vegetables, fruits, and whole grains it’s time to move on. Based on what you have documented in your diary, you’ll have a good idea what your average intake of nutrients is. You should be getting the adequate amount of all the essential vitamins and minerals. But you’ll likely not get more fiber than 40 grams a day. Suppose that your average fiber intake in now at 30 grams a day. The end goal is to boost this to 80 grams or more, but that goal is still way out of reach for now.

To safely increase your fiber intake, you can exploit the fact that your fiber intake of 30 grams a day is only an average. On some days it will have been higher. You should then look into your diary and see if you got physical problems when the intake was higher, particularly when that happened few days in a row. If you find that you only occasionally got problems when the fiber intake was, say 50 grams, you can safely increase your fiber intake to 40 grams a day.

Eliminating problems

Suppose you find that you quite frequently get problems at a fiber intake of 40 grams a day. It’s then worthwhile to analyze if this is correlated with eating certain types of vegetables that are more prone to cause problems such as bloating. For example, cruciferous vegetables such as cauliflower and broccoli can cause bloating. This is then caused by short-chained sugar molecules contained in these vegetables that are broken down by our gut microbes.

Once you have good idea what kind of foods cause problems, you can attack this problem by eating these foods more frequently in smaller quantities. The net intake of the problem foods can then increase while you stay below the amounts that give you problems. The larger intake of the problem foods will cause the composition of your gut microbiome to change toward becoming able to process the problem foods better. After a few weeks you can then attempt to move to step 2 by eating more vegetables, whole grains and starches and less fat.

Onward to step 3 and beyond

If you’ve made it to step 2 then after a few weeks, you should repeat the same process that brought you from step 1 to step 2, to move to your next goal of an even higher fiber intake. The volume of food will now start to become quite large. It can then help to spread the meals better over the day. Also exercise such as brisk walking, jogging or running can help with the digestive processes.

As the fiber intake from your larger intake of whole grains, starches and vegetables increases, your protein intake from these sources will also become significant. This gives you some room to reduce the intake of dairy products, meat and fish. But it’s important to aim for a net higher protein intake of around 2.5 g/kg bodyweight. Recent research has shown that a protein intake this high is better than the traditional advice of 0.8 g/kg bodyweight.

Another thing to keep in mind is that a high fiber diet will have a lower bioavailability of nutrients such as protein but also minerals. So the intake of nutrients must be higher. The protein and other nutrients that we don’t absorb don’t go to waste, they are needed by the gut microbes.

Best foods to eat

A big mistake made by many people is to focus on very specific foods. Our bodies have evolved to thrive on whatever nature provides, we can do well on a wide range of diets that do not contain any of the so-called superfoods. However, specific foods can be used temporarily in a therapeutic sense. For example, one may use certain types of fermented foods to help build a healthy microbiome faster. This book (paid link) contains lots of recipes for fermented foods, including advice on specific fermented foods to treat specific complaints.

Many people will struggle already at step 1 due to their taste buds having gotten used to large amounts of salts and sugars. This can be dealt with by preparing your meals with herbs and spices. There are many good cookbooks for preparing healthy and tasty plant-based meals. One of the best books that will fit in well with the ideas presented here is the Forks over Knives Cookbook (paid link).

We can thus eat a whole food, mainly plant-based diet without worrying too much about the details. As we can all check using online tools such as the Meal Plan Calculator, pretty much any random collection of whole, plant-based foods that gets you to your required calorie intake will contain more than enough of the essential nutrients. This means that you have lots of freedom to choose those foods that you like to eat. There are many resources available to help you make the choices that work the best for you.

Conclusion

Eating a healthy diet is to your gut similar to what taking regular strenuous exercise is for your muscles, heart and lungs. There is no way you can start to eat a truly healthy whole food mainly plant based diet, for the same reason why a couch potato cannot start with running ten miles a day. No diet plans that currently exist takes this fact into account. There is no concept of gut fitness in the existing diet plans, as a consequence no existing diet will bring you beyond step 1.

The methods presented in this blogpost are thus unique, they allow you to achieve optimal gut fitness and health over the course of several months to a few years.

The best diet for health: What the science really says

On this blog I’ve argued in favor of a whole food, mainly plant-based diet. My argument so far has been based on evolution. In this blogpost, I’m going to review the results of scientific studies on the health effects of such diets.

Randomized controlled studies versus observational studies

To compare the health effects of whole food diets to other diets, we can look at the results of scientific studies. In observational studies one compares the health of groups of people who stick to that diet to the health of another group of people who stick to some other diet. In randomized controlled studies, one recruits people for a diet study and assigns the participants randomly to one or the other diet.

In the scientific literature, randomized controlled studies are considered to be far more reliable than observational studies, as the latter type of studies can be affected by many confounding factors. Unfortunately, it’s almost impossible to do a randomized controlled study comparing a strict whole food diet to a normal Western-type diet where a significant fraction of the calories comes from refined fats and sugars.

The volume of the food for a fixed amount of calories will be much larger in case of a whole food diet compared to a Western-type diet. Just 8 spoons of olive oil contains the same amount of energy as 2 pounds of potatoes. It would take many months for people to get adapted to a strict whole food diet, making a randomized controlled study impractical.

Observational studies are also hard to perform. Here the problem is that very few people eat a strict whole food diet. A large fraction of the people who do eat such diet are on weight loss programs or have suffered cardiovascular problems and use this diet as a complementary treatment. These and other confounding factors make it difficult to get to reliable results.

One can also attempt to extract the health effects of a whole food diet by studying the few populations on Earth that stick to a whole food diet. The problem with this is that these populations live in Nature far from civilization. There is then a lack of reliable medical data. Also the members of such populations have a low life expectancy due to a lack of medical facilities.

Nevertheless, despite these difficulties a few studies have been performed. Let’s start with looking at a few population-based studies.

Health and diet of traditional Ugandans

When Uganda was a British colony, the African population was eating a reasonably strict whole food diet, while the Asian population there was eating a diet containing significant amounts of refined oils and fats. A study published in 1959 in the Lancet (free reprint), showed that there were huge differences in the incidence of heart disease in both populations:

In the African population of Uganda coronary heart disease is almost non-existent. This statement is confirmed by adequate necropsy evidence1. In the Asian community, on the other hand, coronary heart disease is a major problem.

Shaper, A. G., & Jones, K. W. (1959). SERUM-CHOLESTEROL, DIET, AND CORONARY HEART-DISEASE IN AFRICANS AND ASIANS IN UGANDA. The Lancet, 274(7102), 534–537.

The diet of the Africans was as follows:

The staple foods, green plantain and sweet potatoes, are steamed in banana leaves; cassava, yams, maize, and millet are also staple commodities in particular of the non-Baganda groups, while pumpkins, tomatoes, and green leafy vegetables are taken by all. The adequacy of protein in the diet depends almost entirely on the extent to which pulses, groundnuts, and cereals are used. Most meals are served with a sauce made of groundnuts, beans, and a mixture of vegetables, and occasionally meat or fish, and these are fried in very small amounts of fat. 

The amount of fat varied between 16 to 20 grams for the poorer people to about 40 grams for richer people on a 2000 Kcal diet. So, at most the Africans were getting less than 20% of their calories from fat. The difference in cardiovascular disease incidence between the Asians and Africans was spectacular, and according to the article, this was due to the low fat content of the African diet leading to low cholesterol values that don’t increase with age.

Health and diet of the Tsimané people

The Tsimané people of Bolivia have until recently stuck to a whole food diet. We can read here:

The Tsimane diet was characterized by high energy (2422–2736 kcal/d), carbohydrate (376–423 g/d), and protein (119–139 g/d) intakes; low fat intake (40–46 g/d); and low dietary diversity relative to the average US diet. Most calories (64%) were derived from complex carbohydrates. 

Kraft, T. S., Stieglitz, J., Trumble, B. C., Martin, M., Kaplan, H., & Gurven, M. (2018). Nutrition transition in 2 lowland Bolivian subsistence populations. The American Journal of Clinical Nutrition, 108(6), 1183–1195. 

Their diet is now changing due to the availability of Western-type foods. Like in case of the Ugandan population, the incidence of heart disease is very low. A recent study done using mobile CT scanners revealed that the Tsimané have very low levels of arterial plaque:

Despite a high infectious inflammatory burden, the Tsimane, a forager-horticulturalist population of the Bolivian Amazon with few coronary artery disease risk factors, have the lowest reported levels of coronary artery disease of any population recorded to date. 

Kaplan, H., Thompson, R. C., Trumble, B. C., Wann, L. S., Allam, A. H., Beheim, B., … Thomas, G. S. (2017). Coronary atherosclerosis in indigenous South American Tsimane: a cross-sectional cohort study. The Lancet, 389(10080), 1730–1739.

The diets of the Tsimané and Ugandans are quite similar and the health effects as far as cardiovascular health is concerned is also similar. The incidence of cardiovascular disease in both populations is an order of magnitude less than in the Western population.

Other population-based studies

Similar effects have also been noted in other indigenous populations who survive on a whole food, mainly plant-based diet, but not in populations whose diets include large amounts of animal products. Recently the widely held belief that Eskimo’s rarely get heart disease was debunked.

Studies of populations living in the civilized world, such as the Adventist Health Studies and the Okinawan diet studies are consistent with the general pattern that a whole food diet that’s mainly plant-based is the best diet for health. However, in these studies less spectacular reductions in heart disease are found compared to the findings of studies in indigenous populations. The difference between the whole food diets eaten by populations in the civilized world and indigenous populations is that the civilized world-variants of this diet contains a lot more refined fats.

Controlled studies

Dr. Esselstyn has performed a clinical study of a strictly whole food plant-based diet. Heart patients were put on a very strict whole food plant-based diet. The results were quite spectacular:

Of the 198 patients with CVD, 177 (89%) were adherent. Major cardiac events judged to be recurrent disease totaled one stroke in the adherent cardiovascular participants—a recurrent event rate of .6%, significantly less than reported by other studies of plant-based nutrition therapy. Thirteen of 21 (62%) nonadherent participants experienced adverse events.

Dr. Esselstyn demonstrates the changes in the angiogram of one of his patients in this video:

Reversal of coronary artery disease via plant-based nutrition

Other such studies with smaller groups of patients have yielded similar results when the diet was as strict as in this study, while less spectacular results have been obtained using diets that are less strict. For example, this randomized controlled study by Dean Ornish found significantly less cardiac events in the diet group compared to the control group.

Other studies

The vast majority of the studies looking into the relation between health and diet have focused on variants of the Western diet. Only a small fraction of the World’s population eats the RDA for fruits and vegetables. This RDA is already much lower than the quantities one would need to eat when on a whole food plant-based diet. Many of these studies have been conducted in scientifically very rigorous ways, the results of such studies then end up forming the basis of the official guidelines for the diet.

The problem is then that the information obtained from these studies is then only valid for diets that are close to Western-type diets. It’s not always possible to extrapolate the results to diets such as a whole food diet that are very different from the Western diet. Suppose that the relationship between a disease risk and the diet is as follows:

Example of disease risk vs. diet that can be extrapolated to pwhole-food region from conventional study results
Fig. 1. Example of a disease risk vs. diet in a case where conventional study results will get the global picture qualitatively correct

Then studies performed at diets that are between 15% and 25% similar to an optimal whole food diet would miss the global picture but the conclusions extrapolated toward 100% similarity would still be qualitatively valid. Such results have e.g. been found for the relation between dietary fiber and cardiovascular disease. But it’s entirely possible that far away from the true optimum one or more local optima exist.

Rigorous scientific results can be misleading

The relationship between a disease risk and diet can look like this:

Fig. 2. Example of a disease risk vs. diet where conventional study results will miss the correct global picture.

Studies done on people sticking to Western-style diets between, say, 15% and 25% similarity to optimal whole food diets will then only detect the region near the sharp local minimum. Many of the recent controversies in the debate on diets may be caused by such an effect. Take e.g. the recent debate on fat intake in relation to heart disease or whether a moderate salt intake is better than a low salt intake.

Reaching a local optimum far away from the true global optimum for a very complex system like the human body that have multiple redundant mechanisms, will in general require some fine tuning. The optimum then isn’t very broad, the way we need to eat to get to such a result will then differ from person to person and will also change over time. Exactly such a result has been found in the recent Predict Study. It suggests that we would all need personalized diets for optimal health.

Conclusion on best diet for health

Scientific results when properly interpreted, overwhelmingly support the idea that whole food, mainly plant-based diets are the best for health. The results are fully consistent with what one can guess based on the arguments from evolution that I’ve elaborated in in the previous blogposts here:

Living organisms are extremely robust physical systems, they’ve been optimized under natural conditions where they would eat foods they can find in Nature. This suggests that the best diet for us should have the following properties:

  • High in whole grains and starches
  • High in fruits and vegetables
  • Moderate amounts of nuts and seeds
  • Low in refined fats
  • Low in refined carbs
  • Low in animal sources of foods
  • Low in salt

In Nature, we would be able to find carb-based foods more easily than foods rich in fats such as nuts and seeds. We would have to do without any refined oils and carbs. We wouldn’t get much salt either.

Now,there are many possible variants of this type of diet. One can have preferences for particular types of vegetables, whether or not it’s a strict vegan diet, whether or not refined oils are totally banned or allowed in limited quantities and many other details. Do we expect such details to matter? The Tsimané study suggests not, they have excellent cardiovascular health despite eating a rather one-sided diet.

It’s no surprise that the optimal diet should not be sensitive to the precise details. Animals have evolved to get adapted to an environment that isn’t constant. The food animals can find will fluctuate due to seasonal changes, prolonged droughts or other weather events. So, we should expect that we’re optimally adapted to a wide range of natural whole food diets.

Conversely, a type of diet that requires getting a lot of the details right in order to get enough of the essential vitamins, minerals and amino acids, is unlikely to be a healthy diet. For optimal health we need to get a lot more nutrients than just the essential nutrients, many new discoveries are made on a regular basis.

For example, getting up to 2.5 grams per kg bodyweight of protein is likely better than the RDA of 0.8 grams per kg bodyweight. On a whole food diet you would have gotten this larger amount of protein all along, while on most other diets, you would likely have gotten a lot less. And it’s not easy to get enough protein on these other diets without using protein powder supplements.

We can easily verify that a whole food diet does indeed yield enough of the essential nutrients without requiring it to be fine tuned. We can use online tools such as the meal plan calculator to compose meals based on only whole foods. When the total amount of calories reaches 2500 Kcal, then the amount of protein, vitamins and minerals is typically going to be more than the RDA. An exception here is vitamin A, this will fluctuate significantly. It’s then no surprise that the body stores vitamin A.

In the next blogposting I’ll write about the best way to get started on a whole food diet. If you want personal assistance to start on this type of diet, contact me via this contact form if you also need to lose weight, or via this form if weight loss is not the primary concern.

Losing weight without eating less calories

In the previous blogposting, I argued in favor of a whole food diet. Such a diet allows us to lose weight without eating less calories. The argument was based on invoking the extreme robustness of living organisms. Evolution should not have made us prone to becoming overweight when we eat as much as we please! Animals in the wild don’t get obese, so why are we prone to getting overweight?

Could it be that most animals in the wild are just at the limit of being in calorie deficit? This is the traditional explanation, but it’s not all that plausible given the robustness of living organisms in their natural environment. If our ancestors in the wild were teetering at the edge of starvation, we wouldn’t be here. Nevertheless, this is a popular view and it misinforms us about the way we should tackle the obesity problem.

Animals in the wild are generally not teetering at the edge of starvation, they are thriving. Their bodies simply adjust the metabolic rate to balance their energy budget. They maintain a healthy setpoint for their fat reserves.

The reason why we’re prone to becoming overweight is because the food we eat is not natural. Our food contains an unnaturally high amount of refined fats and sugars. The key to long term sustainable weight loss is then to eat whole foods. But why would this make a difference given that most of us do get the recommended amounts of vitamins and minerals?

As I pointed out here, getting all our calories from whole foods will yield far more fiber and magnesium, about double the RDA. So, boosting the fiber content of the diet by eating more whole foods is an obvious way to improve the diet. In this blogposting I’ll consider why eating more fiber will lead to weight loss. I’ll conclude with my recommendations for getting started with losing weight according to the methods I advocate.

Eating more fiber lowers the bodyweight

As I explained here in the previous blogpost, the amount of fat reserves we have is regulated with the aim of keeping our energy reserves stable. This is implemented by hormones excreted by fat cells. If fat cells become emptier, the metabolic rate will be slowed down. Fat cells will then start to accumulate more fat as a result. Traditional dieting methods don’t work well, as they fight this mechanism.

The smart way of losing weight is therefore to lower the setpoint for body fat. Once the setpoint is lowered to the target body weight, you can eat pretty much as much as you like, and you’ll not gain much weight. If you do gain a bit of weight, e.g. after Christmas, you’ll be back to your ideal weight within a matter of days, without having to diet.

So, is it then plausible that getting more fiber in the diet will lower the body fat setpoint? Why would fiber have such an effect? It’s perhaps better to ask why not getting the naturally normal amount of fiber will have the opposite effect.

Why does eating more fiber lower the body weigh?

A diet low in fiber in the natural context means that we’re not eating a normal amount of plant-based foods. We would instead be surviving on animal food products. Such a situation could be typical for a harsh winter, or a drought and it comes with a high risk of famine. Clearly, this would have led to a body design via natural selection that would increase the body fat setpoint when eating a low fiber diet, if such a body design were physiologically possible.

So, is it possible for the body to increase the body fat setpoint if we change the amount of fiber in the diet? If we change the amount of fiber in the diet, does the body get a signal that it can act on to modulate the metabolic rate?

How fiber is able to change the body fat setpoint

What is known is that the fiber we eat is food for our intestinal microbes. The more fiber we eat the more intestinal microbes we have and we’ll also have a more diverse set of such microbes. These microbes produce chemical compounds, some of which such as butyrate play a role in many biochemical processes in the body.

The net effect of these chemical compounds is still the subject of scientific investigations. But the mere existence of all these chemical compounds that are capable of influencing metabolism, makes it possible for fiber to modulate the metabolic rate. We can then assume that as a result of evolution we would have ended up with a body fat setpoint that depends on fiber intake.

Other ways to influence bodyweight

Besides eating more fiber, we can think of other ways to get to a lower body fat setpoint. Let’s first look at sleep. It is known that sleep deprivation tends to lead to weight gain, biochemical pathways by which this happens in case of accute sleep loss have recently been uncovered. But it’s helpful to try to understand why evolution would have led to this outcome.

Why sleeping less causes weight gain

Why would animals in nature sleep less? Typically this will happen if they need more time to find food. This is then a signal that points to an increased risk of food shortages. One should thus expect that sleep deprivation will cause to the setpoint for body fat to increase.

Exercise

The effect of exercise on bodyweight is usually assessed via the amount of energy burned in exercise sessions. One then reaches the conclusion that exercise isn’t all that effective compared to an energy restrictive diet. It takes a massive amount of exercise to burn off the energy consumed in one big meal. However, as I’ve pointed out in this and the previous blogpostings, what matters more for the bodyweight on the long term is the setpoint the body chooses to maintain.

Why would the setpoint for body fat change due to exercising regularly? When living in nature, being physically fit means that you are able to walk larger distances to find your food should that be necessary. This thus lowers the chance of experiencing food shortages. But it’s no good if far away you can find a lot of food, if it takes more energy to get there than is present in the food. But the lower the body weight the less energy it costs to walk long distances.

The fitter you are, the lower your body fat setpoint

So, the fitter we are the more advantageous it is to have a lower bodyweight to prevent food shortages. We should thus expect that evolution has led to a body design that lowers our setpoint of body fat if we become fitter. Exercise is thus a good way to maintain a healthy bodyweight. Even short bouts of exercise that don’t burn a significant amount of calories can be helpful. What matters is then that physical fitness is maintained, rather than any individual exercise session.

Intensive exercise sessions that do burn lots of calories are, however, going to be more effective. If you burn 1000 Kcal by running for an hour then that will give you a lot of room to eat a lot more. It also enhances the appetite you need to eat healthy foods.

Eat at least 80 grams of fiber a day

As I pointed out here, eating 2500 grams of whole foods typically yields 70 grams of fiber. But we don’t eat only energy rich foods, we also need to eat vegetables and fruits and these foods also contain lots of fiber. A good diet based on whole foods should then yield at least 80 grams of fiber.

The problem is then that eating this way requires gradually getting used to the large amount of fiber. Also the volume of the food will be much larger than people are used to eating. Indigenous populations who eat this way who come into contact with Western civilization very quickly start to eat the Western-style low fiber high fat diet and then start to experience high levels of obesity and type-2 diabetes.

Once accustomed to the Western diet there is no easy way back to the original diet. Just like our muscles, the gut also degenerates when you don’t use it. Not eating enough fiber means that you lose the gut flora and it takes lots of time and effort to regain it. It this makes sense to think of this issue as a “gut fitness” issue. I’ll discuss this in the next blogposting. I’ll also talk about other health aspects of a whole food diet besides obesity.

Getting started on losing weight without eating less calories

If you want to lose weight by eating more fiber, I can recommend starting slowly by getting used to a low fat, high carb diet. This diet program (paid link) is an excellent way to start. You’ll then gradually eat more fiber while you’ll start to lose weight. It’s also helpful to learn to prepare tasty healthy meals. I can recommend this book (paid link) on vegan recipes. Even though I’m not advocating veganism, it’s still healthy to eat vegan menus, and one can always add some meat to a vegan plant-based meal.

A more rigorous way to get started is to follow the Forks over Knives diet (paid link) . This is again a vegan diet but a low fat one,it will you bring close to what I’m arguing for here. My arguments presented in this blog are not always in agreement with these vegan programs or the arguments presented in the high carb weight loss program, but what matters is that the conclusion on what type of a diet is the best to eat, is quite similar.

Another possibility is to lose weight under my personal guidance. You then need to fill in this form.

How to lose weight without eating less calories

We all know that we can lose weight by eating less calories. When the body uses more energy than it is taking in, this result in fat loss. A deficit of 3500 Kcal of energy will result in one pound of weight loss. However, many people who do successfully lose weight end up struggling to prevent weight gain. They need to stick to a low calorie diet and have to tolerate being hungry all the time.

But many people won’t put up with this struggle, they may moderate their calorie intake a bit and as a result they end up not losing enough weight. Having to tolerate discomfort in order to be at a healthy weight doesn’t sound like a natural state for the human body. Surely there must be a more natural way to achieve a healthy bodyweight? In this blogpost I’ll dig deeper into this issue to see where the real problem lies. This will then suggest far better ways to tackle the problem.

This rather long-winded blogpost is organized as follows. In the next section I’ll consider the energy balance aspect of weight loss. This will lead to the insight that fat tissue influences metabolism. I’ll then present another argument based on evolution that corroborates this.

To get to better ways to lose weight, we must find factors that influence the way the fat tissue affects metabolism. The arguments that can lead us to the answer will again be based on evolution having led to a robust body design. I’ll then first explain why we can trust these sorts of argument.

I then conclude this blogpost by identifying the main properties of a diet and lifestyle that should lead to a healthy bodyweight without having to stick to an energy restrictive diet. Impatient readers may want to jump ahead to that section straightaway.

The fundamentals of weigh gain and weight loss

So, we know that eating less calories will cause weight loss, it’s then tempting to think that eating too many calories is the cause of being overweight. But that’s false! What is true is that eating more calories than you burn will cause weight gain. But once you are at a certain weight and you are not gaining or losing weight, you are burning as much energy as you are absorbing from your diet.

Example: Jane wants to lose weigh

Suppose that Jane is overweight, she weighs 220 pounds while 175 pounds is her ideal weight. She is now eating 2500 Kcal a day and not gaining or losing any weight. A 1700 Kcal diet will bring her at her target weight in about 7 months time. But she wants to avoid the burden of being in calorie deficit and having to fight off your body’s tendency to move back to her old weight. So, we need to ask why Jane can’t be at 175 pounds while eating 2500 Kcal.

Jane’s body mass of 220 pounds can be considered to be the sum of 45 pounds of excess fat she wants to get rid of and the 175 pounds she wants to keep. Now fat has a metabolic activity of 2 Kcal per pound per day. So, Jane’s body minus the 45 pounds worth of fat tissue is actually using 2410 Kcal a day. Part of this energy use comes from the burden of having to carry 45 pounds of weight.

Now, this burden of carrying that excess body fat can be replaced by exercise once Jane is at her target weight. And that exercise is what she is already doing now by carrying her excess body fat, so this won’t require gaining physical fitness. So, it should in principle be possible for Jane to weigh 175 pounds and still eat about 2400 Kcal by exercising more. Nevertheless, the fact that people tend to regain their weight when they stop dieting, suggests otherwise. What’s the problem?

Why does overweight Jane have a faster metabolic rate than slim Jane?

What’s the difference between Jane weighing 220 pounds with 45 pounds excess fat and Jane having lost 45 pounds of weight, carrying a rucksack weighing 45 pounds all day long as exercise? Why can she eat 2500 Kcal with no weight gain in the former case while in the latter case she’ll gain weight until she’s back at her old weight?

The difference can’t be explained by the 90 Kcal energy use of the 45 pounds of fat tissue. Muscle tissue uses 6 Kcal per pound per day at rest but much more during exercise. After exercise muscle tissue will also use more energy which is needed for recuperation. While this is known to play a role when people have lost a significant amount of muscle mass, people experience problems maintaining their new weight regardless of muscle mass loss.

Fat tissue influences metabolism

There is then only one possible explanation left. Fat tissue must influence the metabolism, more body fat causes the body to rev up the metabolism. How can this work? It is known that fat cells produce hormones. If fat cells become full, they the produce the hormone leptin that will suppress hunger. This hormone was only discovered in 1994. Since then other hormones produced by fat cells have been discovered:

Recently discovered hormones produced by fat cells

Some of these hormones influence metabolism, they have been discovered only in the last few years. So, it’s quite plausible that there are many more such hormones to be discovered. Now, we arrived at the conclusion that fat tissue is involved in regulating metabolism by invoking the fact that people tend to regain their old weight after weight loss if they stop dieting. Let’s consider a more powerful argument based on evolution that can guide us to find the right diet for weight loss.

Bodyweight regulation

Human beings are warm blooded mammals. Our bodies constantly burn energy at quite a fast rate. Clearly mammals could only have evolved under circumstances where food is not scarce. However, there are always fluctuations in the amount of food an animal is able to find. This requires the animal to have sufficient energy reserves.

It’s then also necessary to regulate the metabolic rate to make sure the energy reserves won’t get depleted or won’t grow out of bounds. Without such a regulatory system, an animal could starve to death if it had to expend just a little amount of energy more to find its food, or become extremely obese due to eating just a little more and becoming just a a little less active.

Suppose for example that we would expend 150 Kcal a day more and eat 150 Kcal a day less. Then that’s a deficit of 300 Kcal per day, causing us to lose 1 pound of body fat in about 12 days. If this were to go on indefinitely, we would eventually starve to death.

Fat tissue modulates metabolism to keep energy reserves stable

It’s just not plausible that warm blooded organisms could have evolved without a feedback mechanism that modulates the metabolic rate depending on how much energy reserves the animal has. So, if fat cells are full, the metabolic rate should be higher than when they are empty. This way the energy balance is stabilized on the long term and large fluctuations in the bodyweight are prevented.

But this then seems to imply that the amount of fat reserves is fixed at some level. However, evolution will have led to a mechanism that regulates the metabolic rate, so that animals can survive large shortfalls of food for long enough. This then translates into some setpoint for the amount of body fat, which in turn is determined by other factors that determine how much body fat is necessary to survive for some time without food.

We can then speculate about these other factors based on the idea that evolution should have led to a well designed, robust body. But since we’re then going to run way ahead of the science, let’s first consider how reliable we can expect such arguments to be.

Robustness of living organisms

When we go about our usual business, we tend not to consider that we are extremely complex self-maintaining machines. This is not how we perceive our own body. Our self-image when taken literally is overly simplistic. In our minds our bodies are simple machines that we use in our daily lives, like cars or refrigerators. To get an idea of the real complexity of life, let’s watch this short excerpt of a video by Jack Szostak on the origin of life:

Excerpt from Jack Szostak’s video on the origin of life where he discusses the complexity of modern life.

So, each cell in our body harbors an enormously complex biochemical machinery. One cannot compare a single cell with a machine like a car. A single cell is more similar to the set of all machines in all factories in a small country. At that level there are regulatory mechanisms like managers of companies, a political system, there exists an economy that feeds back on how the factories are operated.

This extremely complex system has been shaped by evolution to optimize the physical properties of the body as a whole needed for survival. We should thus expect living organism in their natural environment to be extremely robust systems.

Algorithmic view of life

The biochemical machinery in our cells implements algorithms that make our body function in a very robust way. We’re able to deal with many problems that can arise within a broad range of natural conditions. A perturbation away from an ideal condition will trigger a reaction that will counteract that perturbation. Each cell in your body is constantly at work maintaining the right conditions. The collective effect of all the actions by all cells in an organ make that organ function in the right way, and all the organs in the body make the entire body function as a robust system.

The enormous complexity of the biochemical machinery in each cell originally evolved to let microbes survive in a challenging environment. When multicellular life evolved, part of this complexity could be used for the benefit of the organism as a whole. Evolution has optimized the available cellular machinery into useful tools for the organism it is part of. This has then led to organisms that are very adaptable to challenging environments.

The four zones of life

A perturbation away from an ideal state will lead to lots of biochemical processes that will undo the effects of the perturbation. The stronger the perturbation, the more urgent it becomes to counteract the perturbation. However, any organism will have physical limits to what it is able to deal with. This means that up to some limit, it will be able to respond to stronger perturbations with with faster and more elaborate restorative processes. We can schematically illustrate this using the following diagram:

Diagram illustrating the perturbations away from the ideal state
The green zone represents states that are close to ideal, the orange zone represents less than ideal states, the red zone represents states that are not survivable on the long term and require emergency actions to move back to the orange region, the black zone represents states where the organism is dead or irreversibly damaged and dying as a result.

In the green zone, the organism is close to its ideal state, but there can still be significant perturbations here that are dealt with vigorously. In the orange zone the internal state of the organism has been compromised to such a degree that this affects its ability to deal with additional perturbations. The organism is then in an unhealthy state. It may then resort to stronger restorative actions that in the green zone would not be taken. It may e.g. react with an inflammation to an infection when that same infection in the healthy green zone would not have led to an inflammation.

In the red zone, the health of the organism is so bad that it’s going to die on a short time scale unless it is able to move to the orange zone. A movement into the red zone will trigger very strong biochemical responses to steer the organism back to safety.

For example, if the organism is deprived of oxygen, it will gasp for air, it will do everything it can to move as fast as possible to the orange zone. If it is unable to do that, its biochemical machinery will get damaged beyond its repair capability. It will then end up in the black zone which corresponds to the dying or dead state.

Maintaining optimal health and fitness in our modern society

The problems many people have with weigh loss seems to contradict the robustness of the human body. While we have seen that we can explain many of the problems people experience with controlling their weight from the point of view of robustness, the setpoint for the amount of body fat seems to be too high. The explanation for this can only be that our lifestyles in our modern society is too far removed from the natural lifestyles our bodies have evolved to adapt to.

What are then the relevant differences between the modern diet and the diet our bodies have evolved to eat? As I’ve pointed out in this comment in the British Medical Journal, a very important difference between the modern diet and a diet based on whole foods, is the amount of fiber and certain minerals like magnesium.

High ratio of fiber and magnesium to calories in whole foods

It turns out that the ratio between fiber and calories is remarkably similar for many of the natural energy rich foods. Even when comparing foods rich in fats like nuts to foods rich in carbs like potatoes yields a similar order of magnitude.

Getting 2500 Kcal should then yield at least 70 grams of fiber, which is way more than the RDA of just 40 grams, which in turn is way more than the 20 grams most people get. By not getting enough fiber, we deprive our intestinal microbes of enough food, so we end up with a microbiome that’s not as robust as it should be.

For the mineral magnesium, which is known to play an important role in metabolism , the same is true. Getting 2500 Kcal from natural foods should yield at least 0.7 grams, which is almost double the RDA, while most people get a lot less than the RDA.

Eliminate refined fats and sugars from the diet

The reason why most people end up eating way less than than the natural amounts of fiber and magnesium, is because a significant fraction of the calories in modern our diets comes from refined fats and sugars. This causes us to eat far less of the natural sources of energy that contain fiber and magnesium.

The key to getting to a healthy body weight is thus to get the calories from the natural sources. But because fat and sugar are extremely compact sources of calories, this requires getting used to eating vastly larger volumes of food. A change to a natural diet has to be done gradually, not just to get the body chance to get used to the large volume of food, but also to get used to the far higher fiber content of the diet.

One can then ask why eating more fiber and magnesium will cause the setpoint of the amount of body fat to be set to a lower value? I’ll answer this question in the next blogpost. I’ll also discuss the effect of exercise and proper sleep on the bodyweight.

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A new approach to health, fitness and diet

This blog’s main focus will be on health related topics, such as fitness and diet approached from the point of view that living organisms are extremely robust physical systems. Most health guidelines are based on the idea that our bodies are fragile, which leads to advice on diet, fitness and health that is far from optimal.

I will discuss many different topics from the perspective of inherent robustness instead of inherent fragility. In many cases this will suggest far more efficient measures to improve one’s health and fitness compared to conventional approaches.