intermittent fasting and low carbohydrate diets work Whereas the Calorie counters

我們今天要談的主題是

It just doesn't seem to work right and the problem with the calorie

為什麼間歇性斷食法和低醣飲食是有效的

theory is [that] it's just like raw and

但計算卡路里的飲食法 卻似乎不太有效

Because we don't really understand obesity

對吧 而且

That's why we can't cure it right, so I'm sure many of you have seen this show. It's called the biggest loser and it's on

限制卡路里的理論的問題在於

North America, it's in Australia

它是 錯誤的

It's everywhere right and what people do is [they're] contestants that compete to lose weight, and they get put on a diet

因為我們不了解肥胖的成因

It's a calorie reduce diet and they do a lot of exercise, and you've seen Jillian Michaels screaming at everybody, right?

那就是為什麼 我們無法治癒肥胖

So it's a lot of exercise, and they don't show it on the show, but there's actually a fairly severe caloric restriction as well

所以

It's not a low carbohydrate diet

我相信各位都看過有個節目叫「減肥達人」 (譯註：「減肥達人」是一檔美國真人實境秀節目)

It's more of a kind of everything in moderation

在北美、澳洲、世界各處都在播

sort of an approach, so the problem of course is that this show has been running for a long time and

內容是參賽者互相競爭

Certain of the Contestants have come out and said well

看誰減最多體重

[you] know this really doesn't work now the reason more haven't come out is because they're essentially under a legal gag order, right?

節目的飲食方式

they're actually not allowed to say any of this stuff, but certain contestants have actually come out and

是限制卡路里的飲食

So this contestant Suzanne said well they never do a reunion show why they've all gain that weight again

而他們的確做了很多的運動

and

你也看過 Jillian Michaels 對每個人大吼

It's not it's not

真的非常大量的運動

Unique to the biggest loser [a] lot of diets and we've all done these Calorie reduce diets

雖然節目沒播出

it does the same for everything it does fine for about six months, but then after that it just

但他們相當嚴格地 限制飲食的卡路里

Keeps coming back your weight plateaus then it starts to come back and everybody knows this right because everybody's done this diet

不是低醣飲食方式

The question is why?

比較像是 各種食物都適量的方式

Right and that's what we really have to understand and that's what I mean by we have to solve the two compartment problem

這種方法的問題呢

And I'll explain that in a second so the biggest loser diet despite the fact that we all know it doesn't work is

這節目已經播出許多季

actually ranked very highly so Usa news for example just this past year put the biggest loser diet at

部份參賽者跳出來說

Number three for weight loss and number 11 overall so really a very good diet and why not it's a eat less move more

這個方法根本就行不通

Sort of approach, right cut your calories in increase your calories out and hey presto. You're going to lose weight

之所以沒有更多人跳出來

So that's why it does so well because all the doctors recommended and so on

是因為他們都簽了類似保密協定的文件

The thing is that there have been some studies that have been done [on] these contestants, and it's very interesting to [look]

他們無法表達自己的看法

Scientifically at what actually happens to these people as they do this sort of eat

但部份參賽者現身說法

Less news more approach now the biggest loser of course is that approach on

這個參賽者 Susanne 這麼說

Steroids [rates] or eating a lot less, and you're moving a lot more, and that's why you get these dramatic weight losses

「他們從來不辦同學會特別節目」

So one season they actually took these contestants made them signed consents

「為什麼呢？因為大家全都胖回去了！」

And then actually did metabolic studies on them and what's interesting is that at first it looks amazing, [right]?

這不是減肥達人特有的現象

[and] [we've] all seen [that] show right the before on the after it looks amazing and

很多飲食方式

the studies really bear that out, so if you look at the before [and] after if you look at the

我們都親身經歷這種 限制卡路里飲食

composition of weight loss so at week [six] and week 30 at the end of the

但結果都是一樣的

Show is week 30 you can see that. They've lost a lot of weight right. This is 60 kilograms right and this is

差不多前六個月都很順利

Fat mass so most of it is fat right everybody says [aw], you're going to lose muscle. You lose muscle another losing mostly fat

但在那之後呢

There's a little bit of muscle loss, but it's mostly fat

體重就一直回升

and this is their body fat percentage you can see it's follows a pretty steady trend downwards and

你卡在體重停滯區

the average went from

然後體重開始回升

329 pounds to 202 pounds so an amazing result right body fat [went] from 49% to

大家都知道

28% so at the end of the show you get these great results

因為大家都試過這種飲食

You have the end of the show everybody wins and they pretend like everything's fine, but we know that it isn't

到底是為什麼呢

And why not? What's the problem? It sounds like it should work, right?

這就是我們必須深入了解的部份

You keep doing what you're doing, and you'll keep losing weight

這就是我指的

But you don't and the reason and we've known this for [at] least a hundred years is

我們需要解決兩個倉儲所造成的問題

that your metabolism starts to slow down, and this is what happened to the metabolism of all these contestants, and you can see in the

我後面會解釋這部份

Solid bar that's their baseline rate of metabolism

減肥達人的飲食

Before they start at this and the open circles is that afterwards you can see that in virtually every case

雖然事實上 我們都知道那是行不通的

These people are cutting the amount of calories they expend by a lot

在評鑑中是名列前矛的

okay, so you can look at some of these dramatic examples, so this fellow for example [list] starts out by

例如 在去年的 USA News 評鑑中

Earning Thirty five hundred calories a day and he's dropped all the way to about seventeen hundred [calories] a day, right

在減重飲食項目「減肥達人飲食」名列第三

And it's not just him. It's everybody

在所有飲食中也排名到第11名 (譯註：其他的飲食包括降血壓、改善老年痴呆症等…)

if you take the entire group of people

所以看來是個非常好的飲食

the average

當然囉

Decrease in metabolism is over seven hundred calories a day

它是所謂「少吃多動」的方式

right, so [if] you start by burning Thirty five hundred

減少攝取的卡路里

Which is a lot, so you start at two thousand you're going to drop down to like

增加消耗的卡路里

Twelve Thirteen hundred by the end of the show so you wonder why you're not losing weight?

體重就減少了

well

這就是為什麼飲食這麼風靡

It's because your metabolism has slowed down so much that if you're burning thirteen hundred and you are eating

而且所有的醫生都推薦

[1,500] remember that's still a lot less than you used to eat

事實上

You're going to gain the [weight] back

有些針對「減肥達人」參賽者的研究

That's exactly what we all know happens

從科學的角度來看是很有意思的

you feel cold [you] feel tired if you're hungry, [you] feel like shit and

他們在配合「少吃多動」的方法時

The weight is going back up

身體到底發生什麼變化

Right and that's the problem right we all know that's the problem. It's the decrease in metabolism

「減肥達人」的方法就是「少吃多動」的極致

So you can try to make up for it with more exercise, right?

吃非常少 運動非常多

And that's what they pretend that you can do so you can see that baseline. There's a certain amount

那就是為何能得到如此有效的減重成果

Which is resting metabolic rate certain amount of exercise?

在其中一季

During the show they burn a hell of a lot of calories as exercise you see that the gram tops your total energy expenditure

節目要求參賽者簽署同意書

Is better but when you stop exercising for like you know five hours a day?

配合節目進行代謝方面的研究

Then your exercise goes down, but look at what's happened to your basal metabolism

有趣的是

This is your resting metabolic rate. It's already gone down by week six okay, so don't kid yourself

一開始 結果非常好

This is happening all the time

我們都看過那節目

But by week [thirty], it's gone down even or and that's the whole problem you get this

前後差異比較 太驚人了

Metabolic Slowdown and because you're not burning as much energy. You don't have that you know liveliness

而研究的結果也顯示有效

You don't feel very good

仔細看看前後的比較

And you can see this

看體重減少的成份 (譯註：左圖)

In this graph you can see this is the biggest loser contestants, and you see that the basal metabolic rate just keeps on going down

第六周和第三十周的比較

But there's a similar

這季結束時 是第三十周

Extreme measure that doesn't seem to have this problem and the question is why?

你可以看出他們減了相當多的體重

So you can look at bariatric surgery so bariatric surgery is stomach stapling surgery, right?

這是60公斤

So you cut your stomach into the size of a walnut you

而這是減去的脂肪重量 (譯註：約50公斤)

Really just can't eat and you can't eat for months and months and months and guess what the weight goes down, right?

所以減掉的 大部份是脂肪

That's not a surprise

每個人都說「你會減掉肌肉、你會減掉肌肉」

the surprise is that it works to keep weight off in the long term yeah, there are a lot of problems with this okay, so

並不是 大部份是脂肪

Let's be clear. I'm not recommending it for anybody, right?

是有掉一點肌肉

but if you look at the resting metabolic rate

但絕大部份是脂肪

with a similarly sort of extreme measure it goes back up the

而這是他們的體脂率

[question] is why so this is another?

你可以看出

Study of the long-term effects of bariatrics and you can see that a baseline and a follow-up. This is several [years] [later]

以非常穩定的斜率下降

The resting metabolic rate and the total energy expenditure how much energy you're burning has really not gone down

平均體重 從329磅降到202磅

Right as opposed to the eat less move more where it keeps going down keeps going down until you fail, right?

相當驚人的結果

That of course is the saddest part of all right the saddest part of the entire thing is that we know about this

體脂率 從49%降到28%

metabolic slowdown this was shown in

所以當季結束 得到很好的結果

1915 so we've known about it for a hundred years

大家都開心

what I think is sad, is that we give people this really horrific advice to eat less and move more and

然後他們假裝之後一切都很好

Then when they fail, we blame them for it

但我們知道事實不是這樣

Right and that's basically. You're blaming the victim because here's this poor fellow or poor lady

怎麼會這樣呢

Who's victimized?

問題在哪呢

Because they're suffering from obesity from type 2 diabetes you give them really bad advice

(這理論)聽起來就應該會成功 對吧

Which you know is going to fail because we've all done it it fails every single time and then when the weight goes back

你持續「少吃多動」 體重應該持續下降

You say yeah, you should have listened to me better. You should have had more willpower

但卻沒有

you shouldn't have eaten that bagel or whatever it is you tell people right and that's really the saddest [part] of all is that we

而原因呢

Try to pretend that the advice that we give is really good and the failure lies with all of you

其實我們一百年前就知道了

Right, but doesn't doesn't make any sense right? How can like?

因為你的代謝率開始下降

forty fifty percent of the population

這就是所有參賽者代謝率的變化

Be so morally bankrupt that they let this happen to them is it not more

這些實心圓點

Logical that the advice that we gave was just really crappy that seems to me much more sensible

那是他們的開始前的代謝率

So we're going to explain why this

而空心的圓點 是三十周時的代謝率

sort of discrepancy exists

你可以看出 實際上

So in order to do that you have to understand what happens when you eat, okay?

每個參賽者

[so] what happens when you eat? Is that insulin goes up? So most foods almost all foods have a

這些人的「每日消耗卡路里」下降很多

mixture of macronutrients [fat]

你可以看看這些極端的例子

Carbohydrates and protein so your insulin goes up to a varying degree and insulin

比如以這個人為例

Basically is the hormone that [tells] your body to store fat

剛開始 一天燃燒3500大卡

So it stops your body from burning fat you start to store some of the sugar and store some of the fat

到了最後 他降到一天只燒1700大卡

Okay, and this is normal. This is a normal situation

而不是只有他

so

每個人都這樣

Carbohydrates get turned into glycogen which are chains of glucose so chains of glucose in the liver?

如果你以整體來看

Is basically a storage form of sugar okay? And when you have too much of that then your liver produces?

平均代謝率的下降

Lipids which is called

超過每日700大卡

De Novo lipogenesis, and it basically stores fat okay, so when you don't eat when you're fasting

所以如果你一開始每天燒3500大卡

So fasting is merely the absence of eating your insulin levels fall

呃 太多了

And that's a signal to start pulling some of that energy out

假設是2000大卡

Right so you're going to start by pulling some energy out from the glycogen

到後來你會降到

Which is your stored [sugar]?

每天只燒1200或1300大卡

And you're going to pour some pull some energy out [of] the stored fat so you can think of it the glycogen

所以你想不透 為何體重不再下降了

Like a refrigerator right you're storing food energy

那是因為你的代謝率實在下降太多了

And the reason it's like [a] refrigerator

下降至你每天只燒1300大卡

Is that it's easy to access so [you] can get put food in easily you can take food out easily, right?

而你吃進的熱量是1500大卡

It's just food energy and the fat is more like your freezer

這可遠比你之前通常吃的少很多

Okay, so you can store more of it, but it's in your [basement]

但你會胖回來

You know it's hard to get to it's hard to get out

這完全是我們預料中的事

It's hard to put in so you generally prefer to use your refrigerator

你覺得冷

and it's the same idea you have two storage forms of energy one easy to use and one not so easy to use the

你覺得累

refrigerator though has a limited capacity

你覺得餓

[so] if you put if you have too much stuff you have no choice

你覺得情緒down到谷底

But to put it in your freezer

而且體重開始回升

Now the reason that the calories don't work is that they operate on what I call a one compartment model

那就是最大的問題

Okay, so that means they pretend that all your calories goes in to your body

我們都知道那就是問題所在

And it's all the same all your calories are the same

是因為代謝率下降

they're stored in one giant compartment like this sink and

你可以試著用更多的運動來克服

When it comes to taking out energy it all comes out of the same thing

他們假裝 這是個解決方案

right therefore if you follow this sort of very simplistic

請看起始點 (最左邊)

Incorrect model what you see is that if you simply reduce the calories going in?

其中一部份是靜態代謝率

You'll reduce your weight and if you increase the calories out you'll increase the rate

另一部份是運動消耗的

but the entire premise of this sort of calories in calories out model is

節目中

completely fictitious

他們以運動的方式燒了不少卡路里

because we know that's not what happens in the body the body doesn't have some giant vat of

中間的柱狀 可看出總能量消耗值 增加了

Calories right you can store sugar you can store fat. It's not some giant vat of calories

但當你停止運動

That's held somewhere in your liver, right?

不再每日運動5小時那麼多

But that's what they all pretend it is so if you have the entire wrong idea of why this should work?

當然

Then it's not going to work

你運動消耗的會降低

What instead is?

但看看你的基礎代謝率

A better model is a two compartment model that is there are two places in the body where you can store food?

也就是你靜態代謝率

You've got your fridge

在第六周時就已經下降了

And you've got your freezer your calories goes in into your fridge calories goes

所以不要自欺欺人了

From the fridge because that's the easiest place it goes, but there's a third thing that you have to consider

這現象一直存在

And that is how much food goes back and forth between the freezer and the fridge because that's what we're really interested in

到了第30周 下降更多了

this

這就是癥結所在

the fat, but that's the one that's much harder to get to

你得到的是代謝率變慢

Right and the question is what's controlling this?

而當你不像之前燃燒那麼多能量

because that's really the key and

你不可能覺得精神煥發

It turns out that the main player is insulin we know this because insulin

你會覺得渾身都不對勁

inhibits lipolysis

另外 你可以看看這個

Right what that means is it stops you from getting the fat coming out? That's a job

在這個圖中

That's a normal job. So if you have a lot of insulin

這是「減肥達人」的參賽者

right so normally if you eat a huge meal your insulin is high it's going to tell the body to move all the

他們的基礎代謝率就是持續地下降

Storage in this way if your insulin is very high then you can't get the food back out this way

但有另一種類似的極端手段