Over the last few years much of what we thought of as established ‘science’ about weight loss and healthy diets has gone out the proverbial window. Indeed many medical ‘facts’ over time become replaced by newer facts. What changes in medicine is really the definition of normal. And yes there are new discoveries that change what we thought of as normal.

An important ‘change’ in official recommendations about diet happened about a year ago. After having advised people to cut down on fat and cholesterol in diet for decades the official recommendation changed. It became obvious that consumption of cholesterol in food did not really change the level of cholesterol in the body and did not as such influence the heart artery damage that leads to heart attacks. Not eating fatty foods, people ate more carbohydrates like bread and pasta to fill themselves up. Consumption of these high calorie foods led to increased caloric intake and increased the chance of becoming overweight. Being overweight in turn leads to an increase in the incidence of adult diabetes. And diabetes in turn leads to increased risk of heart artery blockages. The law of unintended consequences!

Dietary recommendations no longer emphasise reducing cholesterol intake. The new recommendations do not mean that one can now live on ‘nihari’, siri payas’, and ‘halwa-puri’. But what it does mean is that eggs and butter are just fine if eaten in moderate amounts. And yes red meat will not kill you any more than white meat. In short it all came back to old fashioned advice; eat whatever you like but in moderation. Moderation has been around as dietary advice for centuries if not more. The relationship between eating too much and becoming fat has been established even before anybody had heard about cholesterol or coronary arteries.

The problem now is that after years of telling people that they should avoid high cholesterol foods it is difficult to suddenly start telling them that it is alright to eat eggs and butter and an occasional marbled steak. So there is at present considerable confusion about what dietary recommendations are appropriate especially for people worried about heart problems. This entire confusion is compounded by the strong medicines available now called ‘Statins’ that can lower cholesterol levels in the blood. So you can actually eat more than an occasional egg and still keep your cholesterol level down with Statins. Frankly some of lefty doctor friends are convinced that the increased use of these medicines coinciding with increased consumption of fatty foods is a commercial conspiracy.

Conspiracy theories aside the fact is that over the last couple of decades there indeed has been increase in obesity and in the incidence of adult onset diabetes. The problem then for health professionals is what to do about this increase in the number of obese people since obesity besides being a risk for diabetes can also by itself increase the risk of things like high blood pressure, heart blockages, strokes and many other problems. So it is definitely of benefit if people don’t put on too much weight to start with and to lose weight if they indeed put on too much weight. Prevention of obesity is a major public health goal in many western countries. And perhaps there seems to be some improvement in the incidence of childhood obesity that then leads to adult obesity.

But what to do about people that have already packed on a few too many kilos. Here an important medical point needs to be emphasised. ‘Central’ obesity or belly fat is worse for health than fat spread all over the body. Most measures commonly used to define obesity depend on height and weight. In general this is fine expect when it comes to people that have a big belly but are otherwise quite thin. Such people will often have a normal or acceptable Body Mass index (BMI) and yet will be at a greater risk for heart disease than people who have much higher BMIs. So we must also include the relatively acceptable BMI measurement central obesity in any discussion about obesity in general.

How then can we lose weight? Over the years I have suggested often enough that unless we cut down on the number of calories consumed to below the level of the calories expended by the body, we cannot lose weight. Most ‘diets’ that restrict calories consumed are successful in bringing down total body weight over the course of the diet. Increasing physical activity through exercise greatly assists weight loss but is insufficient by itself. So most healthcare professionals recommend calorie restriction combined with exercise as the best way to lose weight. This works very well but calorie restriction cannot be maintained by normal people for any prolonged period of time.

So let us call a spade a spade. Calorie restriction is akin to starvation. People restricting calories are going to be hungry all the time. And being hungry is not a pleasant way to be especially if it goes on for a relatively long time. So calorie restriction works only for relatively short periods of time. Frankly nobody likes going around feeling hungry all the time. After having lost a lot of weight, most people will eventually increase the amount they eat and regain most if not all the lost weight. The concept involved is not some lack of will power but rather a hormonal imperative that forces most obese people to re-achieve their ‘normal’ weight. What we have then is a situation where the body itself prefers to stay at a particular weight and works for it and diets just make the weight go down and up like a yoyo.

The really obese might still benefit from diets that include adequate volume but somewhat fewer calories (think vegetables) and a more physically active lifestyle. This might not make them lose much weight but will make them ‘healthier’. However people that put on a lot of weight over a short period of time will benefit from many of the weight loss regimens that are going around. Also because their bodies are not yet used to their higher weight they have a better chance of keeping it off.

Finally, we have a rather confounding ‘new’ thing to think about in terms of food and general health. This new thing is the emerging importance of the human ‘micro-biome’. Evidently around a ‘trillion’ bacteria weighing up to a couple of kilos live in our intestines. These not only participate in digestion but there is evidence that these bacteria also influence a lot of body functions even evidently our moods. Antibiotic use can damage this micro-biome and allow dangerous bacteria to grow unopposed. Serious bacterial infections can thus occur in patients on strong antibiotics for prolonged periods of time. Another reason to avoid antibiotics if you can.

The damaged micro-biome can be replenished by eating foods like yogurt or ‘kimchee’ that contain beneficial bacteria in them. Such foods are called ‘probiotic’ and help rebalance the human micro-biome. Presently probiotics are being sold in tablet form. More about probiotics another time.