Robert Lufkin, MD
Robert Lufkin, MD, is a practicing physician who has served as a full professor in the medical schools of UCLA and USC. He is author of Lies I Taught in Medical School.
RobertLufkinMD.com
Modern medicine does a wonderful job treating acute conditions. If you break a bone or catch an infectious disease, you’re likely to be in good hands when you see a doctor. Unfortunately, our health-care system is far less effective when it comes to chronic conditions such as obesity, diabetes and heart disease.
Bottom Line Personal asked Robert Lufkin, MD, a professor who has served at both UCLA and USC medical schools and author of Lies I Taught in Medical School, about the incorrect and potentially dangerous guidance you might receive on these topics…
More than two-thirds of American adults are overweight or obese. Those surplus pounds can lead to a range of health problems, including increased risk for diabetes and cardiovascular disease. Excess weight is among the most serious health challenges facing this country, but not all of the health-care industry’s advice in this area is accurate. What’s true and what’s not…
The standard weight-loss advice—eat less and exercise more—isn’t the ideal strategy. This seemingly obvious advice is rarely questioned. If your goal is to lose weight, surely you need to consume fewer and burn more calories. In the health-care community, this is known as the energy balance model of obesity.
Reality: Exercise usually doesn’t lead to significant weight loss—the math just doesn’t add up. Example: You would have to jog for 40 minutes or walk for two hours to burn off the roughly 500 calories in a single blueberry muffin. What’s more, exercise itself often makes people hungrier. Exercise is very beneficial for the body in many ways, such as for cardiovascular health, but it may not be the best method to lose weight.
Cutting calories, on the other hand, can lead to significant weight loss. But simply eating less is not a very efficient way to achieve this goal. A better solution is to cut back your consumption of the macronutrient at the core of weight gain—carbohydrates. The other two macronutrients, fat and protein, are necessary to sustain life…but carbohydrates aren’t necessary, and they stimulate the production of insulin, the body’s primary weight-gain hormone. In other words, when you consume carbs, you’re not only eating a macronutrient that you don’t really need, you’re also encouraging your body to store those calories as fat.
When you eat also affects your ability to lose weight. If you eat sporadically throughout the day, you’re less likely to lose weight than if you consume the same number of calories during a window of no more than 12 hours each day, then fast for the other 12-plus hours. Fasts lasting 12 hours or longer encourage the body to burn stored calories. Several studies have confirmed the weight-loss advantages of intermittent fasting, including one by researchers at University of Alabama.
What to do…
Don’t just cut calories to lose weight…cut carbs, possibly by following a low-carb diet such as Keto or Atkins.
Don’t eat anything between dinner and the next day’s breakfast. Better yet, skip breakfast, and don’t eat between dinner and the following day’s lunch…or to maximize the power of intermittent fasting, do all of your day’s eating during a single meal.
Caution: Anyone with a medical condition should consult with his/her doctor before starting any new diet or fasting program.
Cutting down on sugar intake won’t work if you replace sugar with artificial sweeteners. Diet snack foods and beverages often trumpet that they’re sugar-free and lower calorie than comparable nondiet. But replacing sugary foods and drinks with low-cal or no-cal diet alternatives can lead to weight gain, according to a review of dozens of studies by researchers at University of Manitoba. Problem: Diet snack foods and beverages often cut their calorie counts by replacing sugar with artificial sweeteners…but those artificial sweeteners tend to increase people’s insulin levels, spurring weight gain and increasing diabetes risk. This is true even of “natural” sugar replacements such as stevia. Some artificial sweeteners even have been linked to increased cancer risk and microbiome problems.
What to do: Don’t use artificial sweeteners as a crutch to help you cut back on sugar. If you crave sweet foods, eat fruit—it’s the healthful sweet snack. Good news: The more you cut back on foods and beverages that contain sugar and/or artificial sweeteners, the sweeter fruit will taste to you.
The standard approach to treating type 2 diabetes—insulin injections—treats only one symptom. People with type 1 diabetes have abnormally low insulin levels because the pancreas doesn’t produce enough of the hormone. People with type 2 diabetes have chronically high insulin levels, which leads to insulin resistance—that is, their bodies become less sensitive to insulin so they require more and more of it over time. People with type 1 diabetes must take injected insulin to control their glucose levels…but those injected doses of insulin do not treat the underlying problem for people with type 2 diabetes—their insulin resistance. In fact, insulin injections slowly make that problem worse by further increasing insulin levels.
What to do: People with diabetes should take insulin as necessary to control their glucose levels. But those with type 2 diabetes also should take action to reduce their long-term insulin levels and insulin resistance—lose weight by reducing carb consumption and practicing intermittent fasting (described earlier) and exercise. Several studies, including a 2021 study by researchers at Central Michigan University College of Medicine, have concluded that one or both of these strategies can be effective treatments for type 2 diabetes. In fact, a 2023 study conducted by researchers in the UK and published in British Medical Journal found that following a low-carb diet even results in full remission for a significant percentage of people with type 2 diabetes—remission occurs most often among those who have been only recently diagnosed with diabetes. If the diabetes is longstanding, it is harder to reverse with diet alone. Discuss your diet-modification plans with your doctor to confirm that they’re safe for you.
Cardiovascular disease is the world’s deadliest health problem, claiming close to 18 million lives each year, so you might imagine that the health-care industry has excellent advice to offer on the subject. Instead, questionable guidance abounds…
Statins—widely prescribed to lower cholesterol—have less upside than patients realize and significant side effects. Approximately one of every four Americans over age 40 takes a statin to control high LDL cholesterol levels and thus reduce their risk for cardiovascular problems. Statins are indeed effective at reducing LDL cholesterol levels—but they reduce the odds of heart attack by only 1.3% and overall mortality from cardiovascular problems by only 0.8%, according to a 2022 meta-analysis of 21 earlier studies by an international team of researchers and published in JAMA Internal Medicine.
If you’re wondering how statins could do a good job controlling LDL cholesterol but barely reduce heart attack and mortality risk, it’s because LDL cholesterol isn’t as closely tied to heart attack risk as patients are led to believe. Three-quarters of patients hospitalized for heart disease have healthy LDL levels, according to a study by researchers at UCLA Medical Center.
Many people will conclude that statins still are worth taking even if their benefits aren’t that impressive. That’s fair—but it’s worth noting that statins can have substantial side effects, including brain fog and muscle pain.
What to do: If you experience side effects from statins, such as brain fog or muscle pain, speak with your doctor about whether these drugs are truly worthwhile for you.
The advice for improving cardiovascular health—consume fewer trans and saturated fats—might be only half right. There is significant evidence that consumption of trans fats—found in baked goods, fried foods, snacks and many prepared foods—has heart-health risks. But the evidence is far less compelling when it comes to foods containing saturated fats, such as red meat and dairy products. Examples: A recent study by researchers at University of Sydney that tracked nearly 10,000 Australian women for 15 years found that saturated fat intake was not associated with increased rates of cardiovascular disease or mortality. An earlier large-scale meta-analysis by researchers at Harvard School of Public Health found that red-meat consumption was not associated with higher risk for cardiovascular problems, but processed meats were—perhaps the preservatives and/or sodium in processed meats are the problem, not the meat itself.
What to do: Avoid trans fats and processed meats, but don’t necessarily eliminate saturated fat from your diet. Like polyunsaturated fats (found in nuts, seeds, flaxseed oil and fatty fish) and monounsaturated fats (in olive oil, nuts, seeds and avocados), saturated fats are probably not as bad for us as has long been claimed.
