Yesterday I didn’t eat until nightfall.  It was Yom Kippur, the Jewish Day of Atonement.  Putting aside for now the reasons why someone might do such a thing, I’d like to talk about the results of such an endeavor, the what happens when you fast.  Well, for one thing, I didn’t do a whole lot of anything else.  Fasting really takes it out of me.  I certainly didn’t have enough energy to go for a walk, for example.  So, except for a short mid-afternoon nap, I spent almost the entire day sitting still.  A lump on a log.  Starvation mode. 

I spent most of the day yawning, which is something I tend to do when I’m hungry.  It can be a bit problematic for patients whose appointments fall between 11 and noon.  But I promise I’m not bored; I’m just hungry. 

When I dressed in the morning, I picked out a large woolen scarf to wear over my clothes.  I do this every Yom Kippur, whether the outside temperature is 40 degrees or 80.  That’s because I spend most of the day freezing cold.  Basically, I left home yesterday morning wearing a wool blanket.  It was large enough to cover not only my own shoulders, but also those of others who might happen to be seated close by.  I was very grateful for the ability to wrap myself up and stay warm. 

I’m starting to see a pattern.  I skipped breakfast, didn’t feel like moving, was freezing cold, and exhausted.   I was conserving energy.  What does that sound like?  Well, I’ll tell you — it sounds like some of my obese patients.  And that’s not a coincidence.

Now I’m going to guess that the thought has entered your mind that obese people would do themselves a world of good if they would go for even a short walk every day.  One stereotype of obesity is that people get that way because they’re lazy.  Well, I’m going to challenge that assumption.  What if heavy people aren’t lazy at all?  What if the reason they don’t move around much is because they’re starving?  I skipped my walk yesterday, remember?

You may have heard some people say that they can’t understand why they are fat, because they eat so much less than everyone else.  “Yeh right,” you may have said to yourself.  Well, guess what?  I believe them.  Notwithstanding those folks battling a serious addiction to potato chips, soda, and doughnuts, many obese people are struggling along on 1500 kcal/day of nutrient-poor, manufactured calories. 

Obese patients are routinely deficient in B vitamins, magnesium, Vitamin D, and other nutrients.  In medical school, I learned that these were markers of malnutrition.  Think alcoholism when you see these deficiences, I was taught.  But a much more common cause, it appears to me, is obesity.  Normal levels of Vitamin D run around 40-50, but I routinely see Vitamin D levels below 10 in my most obese patients.

I don’t think this is just about vitamins either.  I think it’s about protein and fat as well.  I’ve written in the past about how some people seem to need more water, or calories, than others.  So it does not seem far-fetched that some people need more protein than others.  Or fat, for that matter.  What if a low-fat diet is well tolerated by some people, but causes others to go into starvation mode?  What if some people get enough total calories, but not enough protein?  What would that look like?  How many calories of protein does it take to sustain a body that weighs 300 pounds?  A lot more than you might think. 

Many overweight people carry their extra weight in their abdomen and below their chin, a sign of insulin resistance, which is caused by excessive amounts of processed carbohydrate.  Their skin, especially around their eyes, looks very pale and puffy.  This is a sign of protein deficiency.  As people increase the amount of quality protein they eat, that puffiness resolves.  Their skin becomes bright and smooth.  Their friends sometimes ask if they’ve had a haircut, or even a face lift! 

People who get adequate nutrition become less lethargic, and begin to move around more.  Maybe, instead of sending a child, or waiting until they’ve saved up a list of reasons to make the trip, they’ll surprise themselves by going upstairs to get a different sweater, or downstairs to change a lightbulb.  Believe it or not, many of my obese patients need to eat more, and not less, food.  Some people are obese because they are in starvation mode, conserving energy and calories to the greatest extent possible.  It’s wrong to assume that laziness causes obesity.  If anything, I believe, it’s the reverse. 

And that is one of many things I pondered on Yom Kippur this year.

**************************************************************************************************************************************
Follow Dr. Sukol on Twitter at RoxanneSukolMD.
Follow Dr. Sukol on Facebook at Roxanne Breines Sukol.
Follow Your Health is on Your Plate on Facebook.