I mean literally, where did thin go? Both as a word and a concept, thin no longer takes part in any type of biological or medical setting. We no longer regularly use the word to describe people who have a low fat to muscle ratio, mainly because this group of folks is disappearing. From a scientific standpoint, we know what thin is, but it doesn’t get mentioned much because a thin person today is as rare as hen’s teeth! The term is also on the outs with the general population, because very few people living in modern cultures today are truly thin. If nobody talks about thin, or if one rarely observes thin in the world around us, thin likely will follow the carrier pigeon to extinction.
The Scope of the Problem
One the other hand, the term obesity is everywhere. It permeates medical discussions and popular discourse in most developed countries. The experts have now defined the opposite of thin using two categories: overweight and obese. The CDC breaks it down this way:
- If your BMI is less than 18.5, it falls within the underweight range.
- If your BMI is 18.5 to <25, it falls within the healthy weight range.
- If your BMI is 25.0 to <30, it falls within the overweight range.
- If your BMI is 30.0 or higher, it falls within the obesity range.
Obesity can be further broken down into:
- Class 1: BMI of 30 to < 35
- Class 2: BMI of 35 to < 40
- Class 3: BMI of 40 or higher. Class 3 obesity is sometimes categorized as “severe” obesity or morbid obesity.
The United States now has the highest rate of combined overweight and obesity in the world at 70%. It’s important to remember that these figures are based on Body Mass Index or BMI. Overweight and obesity are defined as excess body fat, but BMI doesn’t measure the amount of fat in a person’s body, because it reflects size rather than body fat. Thus, a big muscular person with no “excess body fat”, could have the same BMI as a flabby fat person. The experts understand this, but years ago they decided that it’s too expensive and difficult to measure a person’s body fat, so they decided to use BMI to define overweight and obesity.
Measure the Parameter that Defines the Illness
I later learned that this decision was a massive mistake. At the time I was operating my own primary care practice. I decided that I needed to measure the body composition of my patients, so I purchased two pieces of equipment that measure body composition. Over decades, I measured the body composition of every patient at every visit, eventually accumulating over 10,000 such measurements. I soon found out that there is often a poor correlation between “true obesity” based on body composition and “fake obesity” based on BMI. For example, many people with a normal body composition have excessive body fat. This group has been classified as “skinny fat” or metabolically obese normal weight (MONW).
Now let’s get back to a truly thin person—someone with a normal BMI and body composition. Based on the measurements that I took, this group likely makes up about 15% of the adult population in the United States today. These folks tend to be trim and fit with their muscles covered with a thin layer of fat. They are “lean and mean”, and they are often quite attractive. They are often athletic and perform well in pickup sports, or just about any physical activity. You don’t need to measure anything because you can clearly see that these thin folks are healthy by simply looking at them. In today’s world a truly thin person is hard to find, but this is only a recent development. My good friend Andy Steinfeldt who often edits my posts, is one of the few truly thin people I know! Andy is short but very muscular with no excess body fat, yet the experts consider him to be “overweight”. So much for the experts!
The Singing Thinsters
This fact really hit home for me when we recently traveled from Boston to our second home in Greece. Per usual I decided to pass the 8+ hour flight watching movies. One film immediately caught my eye: The 1979 “No Nukes Concert” by Bruce Springsteen. I’ve always been a Springsteen fan, so I decided to watch it. The fact that the film was shot almost 45 years ago immediately hit me because:
- Many of the people were obvious hippies, with the males sporting long hair and sideburns, and just about everyone wearing bell bottoms. The above photo demonstrates this point.
- The complete absence of cell phone lights in the audience.
- Virtually all the performers and most of the audience were clearly “thin”.
I found this last point to be the most interesting. How could we possibly go from virtually 98% thin to 15% thin in only 50 years? And the thin of 1979 was clearly not anything unusual. This was the established human pattern going back into ancient history. What the heck happened to thin? Am I the only person on the face of this earth to notice this drastic change in the human condition? Before writing this post, I Googled the phrase “What Happened to Thin”, and I couldn’t find any discussion about health issues. Thin isn’t just disappearing form our sight, it’s also fading from our language!
Mother Nature Knows Best
To better understand what’s driving this bus, we need to go back to some basic human physiology. What determines how much fat we store in our bodies? The obvious answer is evolution. Based on eons of evolution, Mother Nature determined the ideal amount of fat to store in humans to get us through times when food was scarce. If you didn’t have enough stored fat, you ended up on Mother Nature’s list of those who don’t survive when there was a famine. Those who stored too much excess body fat likely had a difficult time traveling through rough terrain and chasing game, once again making it unlikely they would survive the tough times. Once Mother Nature through trial and error determined the ideal amount of fat for humans to carry, she used the lower brain centers to regulate metabolism and fat storage through the hypothalamic pituitary axis (HPA). This would assure that humans would always store the ideal amount of fat, through feast or famine. And yes, this ideal person would appear to be thin!
So what happened since Springsteen rocked those tunes to make just about everyone overweight or obese? The experts blame “hyper-palatable food” for driving the fat bus. In my opinion, this is only partially correct, and I believe they missed the most important elements of this saga. Hyper-palatable foods are often referred to as highly-processed food containing high levels of sucrose, high glycemic carbohydrates, excess omega-6 fatty acids relative to omega-3 fatty acids, and salt. Think potato chips, Big Macs or Twinkies!
Diet Draining the Brain of Monoamines
The experts have demonstrated that this type of food leads to the release of excessive amounts of monoamine neurotransmitters like dopamine and serotonin in the brain, making the food almost irresistible. During my decades of practice, I also recognized that process in my patients. At one point I worked with some researchers who were using urine tests for these neurotransmitters, but they didn’t know how to interpret the results. I was given access to some of these tests to play with, and I eventually used the tests for patients undergoing glucose tolerance tests. I immediately noticed something odd. Shortly after getting a glucose load, these patients would fill up their urine with monoamine neurotransmitters. It made no sense that Mother Nature would pee away these valuable chemicals, so I assumed that this was a pathological rather than physiological response. I believe this is how things unfold. The massive glucose spikes set off by highly-processed food triggers a massive release of monoamine neurotransmitters from neurons, which overwhelms the re-uptake recycling system to preserve these valuable chemicals. These neurotransmitters are then taken up by the blood stream and cleared by the kidneys. This pathological process eventually leads to a condition where all the monoamines become depleted, resulting in 22 distinct monoamine depletion symptoms. This led to massive diagnostic confusion because these symptoms overlap with many traditional psychiatric disorders. Because this process seemed to fit the pattern of a disease, I decided to name it Carbohydrate Associated Reversible Brain syndrome or CARB syndrome.
The glucose spikes associated with highly-processed food are also associated with a quick drop of glucose to low levels immediately after the spike. The brain evolved to interpret low glucose levels as a sign of a possible approaching famine, so it puts the body in a fat storage mode where excess body fat is stored at virtually any caloric intake. The lead symptom of CARB syndrome is having strong cravings for sweet and starchy food, pushing people to consume more of the very food that is frying their brain! Thus all people who fit the CARB syndrome pattern have excess body fat regardless of their size or weight.
A New Disease Model
Because the symptoms of CARB syndrome overlap with many traditional psychiatric disorders, this leads to a great deal of diagnostic and therapeutic confusion. For example, CARB syndrome can be associated with feelings of depression, but it’s not quite the same as true major depression. If you treat them only using SSRI type medications, over time they will get worse rather than better and they tend to store even more body fat. Voilà—you now have the makings of a massive obesity epidemic and thin is heading to the land of the dinosaurs.
Thus, if we want to get out of this mess and put thin back in the game, we need to understand exactly what is driving the obesity bus, and you obviously can’t fix a disease that you don’t understand. To treat CARB syndrome, you need to do the following:
- Take a supplement containing L-tyrosine and 5-htp, the neurotransmitter precursors that are needed to restore dopamine and serotonin levels.
- Take the amino acid L-glutamine to suppress cravings for sweet and starchy food.
- Eat a healthy, whole foods diet and avoid all highly-processed food.
- Exercise on a regular basis.
I outline exactly how to diagnose and treat CARB syndrome in more detail in my book “Brain Drain”. Avoid reading it at your peril. I wish you well on your challenging journey back to thin.
