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The Carbohydrate-Insulin Model

Intellihealth’s Dr. Louis Aronne and Dr. Katherine Saunders talk with Dr. David Ludwig about the science behind the carbohydrate-insulin model and its implications for obesity treatment. 

Even when people successfully lose weight temporarily, they often gain it back because of physiological mechanisms the body uses to make sure it’s getting enough fuel. 

That’s why Dr. David Ludwig wants more people to understand that weight loss requires much more than decreasing your calorie intake or burning more calories with exercise. Dr. Ludwig is an endocrinologist at Boston Children’s Hospital, professor at Harvard Medical School, and the lead author of a paper outlining the carbohydrate-insulin model, which presents a new perspective on obesity.

In this episode of Weight Matters, Dr. Louis Aronne and Dr. Katherine Sanders talk with Ludwig about his research. He explains why the carbohydrate-insulin model matters, and discusses the ways it could impact our approach to obesity treatment and health policy in the future. 

Physiological Challenges for Weight Loss

If you’ve ever tried to lose weight, you’ve probably heard the age-old maxim: “Eat less, move more.” This strategy works in the short term, but it doesn’t actually provide a sustainable change for most individuals, Dr. Ludwig explained.

“The body isn’t a passive energy-storage depot, it’s a dynamic organism that fights back against calorie restrictions. So we know that when you cut back calories or you try to burn off more calories with exercise, typically we get hungrier and hungrier. It isn’t just a fleeting feeling. It’s a primal biological signal that your body wants more fuel,” he shared.

And even if someone does have the willpower to ignore their hunger for months or even years, the body will continue to fight back by slowing down its metabolism.

“So as we continue to lose weight and metabolism slows down, we need fewer and fewer calories to keep the weight off, even as our hunger and desire for those calories increase,” Dr. Ludwig said. “And unless we understand this alternative view of cause and effect, treatment approaches will be at best symptomatic and not effective over the long term.” 

The Carbohydrate-Insulin Model

Dr. Ludwig believes the carbohydrate-insulin model can help people better understand the physiological factors that cause obesity and in turn create a weight-loss strategy that works for the long-term.

The model focuses not on the amount of calories someone eats, but instead on the types of carbohydrates they include in their diet and how quickly those carbohydrates are digested. For example, someone who eats a large amount of fruit is likely healthier than someone who eats a large amount of processed carbohydrates, because less processed foods take longer to digest, and as a result, they don’t flood the body with insulin. 

“The carbohydrate-insulin model focuses on something called glycemic load, which reflects not just the amount of carbohydrate, but how rapidly it’s digested,” Dr. Ludwig explained. “For most people, it’s entirely possible to eat plenty of carbohydrates and maintain a healthy weight, as long as that carbohydrate is more natural, less processed, and slower digesting.”

And though some people may benefit from a low carb lifestyle like the ketogenic diet, Dr. Ludwig does not believe that is necessary for the majority of people.

“Why shouldn’t we give up all carbohydrates? Well, first of all they’re tasty, and there probably is no reason for everybody to do so,” he argued. “For people without diabetes, just focusing on reducing the processed carbohydrates will be sufficient. In general, we want the maximum of benefits with the minimum of deprivations.”

Making Healthy Eating Accessible

The carbohydrate-insulin model doesn’t only show the science behind obesity, it also can provide a roadmap for health policy moving forward.

“Unfortunately the calorie in, calorie out energy balance model has been promoted by the government, the food industry, and many nutrition professionals,” Dr. Ludwig shared. “Why is it that a healthful diet is expensive, inconvenient, and possibly inaccessible for some people, whereas these highly processed, low-quality nutrition foods pervade the inner city, the rural communities, and make it really hard for people who were already nutritionally compromised or at risk for diet-related diseases?”

To change this would require a fundamental shift in the way our food industry works.

“And just as government policies and investments helped create this problem, I think government policies and investments can help solve the problem,” Dr. Ludwig argued. “We want a supply-and-demand market that incentivizes food manufacturers to produce more healthful foods and helps people afford those foods.”

Follow Weight Matters wherever you get your podcasts to never miss an episode. To learn more about Dr. Sanders and Dr. Aronne’s work to transform specialized treatments for chronic conditions through the best in medical science and advanced digital technologies, visit www.intellihealth.co/podcast

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