Always Hungry?: Conquer Cravings, Retrain Your Fat Cells, and Lose Weight Permanently by David Ludwig
My rating: 4 of 5 stars
David Ludwig MD/PhD is an endocrinologist and researcher at Boston Children's Hospital and Harvard Medical School. He has become a staunch advocate for a version of healthy eating that roughly mirrors the Mediterranean diet.
In Ludwig's opinion the obesity epidemic and diseases linked to obesity are being driven by our out-of-control consumption of unhealthy processed foods which happen to be high in refined grains and sugar (aka bad carbs.) He also goes out of his way to vindicate fat, claiming that the public's fear of fat is not only unfounded but is partly what led to the real culprit behind our expanding waistlines, the abundance of sugary low-fat alternatives that flooded our grocery store shelves back in the eighties, products that despite backlash movements like Atkins, Paleo, and Keto are still perceived by many to be "healthier" by the general public because they are low-fat.
While he throws in a little science to keep it interesting, the first half of the book could be summarized like this. Fat was wrongly demonized. Sugar soon replaced the fat as manufactures scrambled to give us what we wanted (cheap, fast, tasty food that is also healthy), and consumers gobbled down these low-fat, fat-free, sugar-laden supposedly healthier foods. What nobody told us was that sugar and highly refined grains like white flour lead to huge insulin spikes, and these insulin spikes favor fat storage. They also leave us feeling hungry soon after a meal. But more importantly, thanks to repeated exposure to high levels of insulin, over time our bodies metabolic system has become dysfunctional...favoring fat storage and leaving us feeling hungry, despite eating more than sufficient calories. According to Ludwig, the solution is simple if not intuitive. Want to lose fat? Eat more fat.
The second half of the book is a "how-to" step-by-step process. Ludwig's diet starts off with lots of fat. Though he briefly addresses saturated fat, acknowledging that it may be linked to negative health outcomes, he mainly stays away from this particular topic.
The first (and most restrictive) stage of the diet encourages people to eat 50% fat, 25% carbs, and 25% protein. Heavy on fat and light on carbs (with no grain, sugar, or starchy veggies), this stage is supposed to jump-start weight loss by "healing" the fat cell so that our bodies can get back to doing what they were designed to do: keep us within a healthy weight range.
In stage two, fat decreases to 40%, carbs increase to 35%, and protein stays at 25%. In addition, dieters can begin to add back in whole grains and starchy vegetables with the exception of potatoes (oh the poor potato.)
Stage three provides more options as dieters experiment to find the right macronutrient mix for their body but will generally be closer to 40% fat, 40% carbs, and 20% protein. During this stage, dieters can start adding back in carbs (even some of the bad ones), but are cautioned to limit refined grains and sugar. In the end, the amount of carbs unrefined and refined will vary from person to person.
Ludwig provides recipes, downloadable grocery lists and a whole cache of other forms designed to assist dieters in planning and tracking what they eat as well as documenting how they feel in response to tweaks in the diet. To his credit he also briefly addresses sleep and stress, though not in any great depth.
Conclusion: Much of what Ludwig says is spot on and consistent with the existing research. His diet is designed to be a common sense approach to eating that mirrors the Mediterranean diet. The book is peppered with personal excerpts in which people rave about the results. That said, knowing the statistics on weight loss, I'd be interested to know what the 2-year or 3-year success rate for the plan was. Do the individuals in this book actually successfully keep the weight off? Do they continue to eat in a manner that allows them to maintain their healthy weight?
And while the goal here is to help people make better choices, it feels an awful lot like a diet. In that sense, the book's biggest weakness is that while it tries to appear as if it is an individualized program focused on making sensible, healthy choices, it really isn't. It's a diet, or at least it starts off that way.
My guess is that many people will have success, at least initially. But what I've found in working with people in the real world is that real and lasting behavior change usually takes more than a book (even one advocating for a reasonable approach) and a few months making better food choices.
Getting people to change their diets over the long haul is no easy feat, especially when instant weight loss isn't guaranteed. Of course, Ludwig's first phase of the diet is designed to foster some quick weight loss. Unfortunately, I'm not sure Ludwig's approach will really make any difference for most people as there are already lots of reasonable dietary approaches out there. He seems to suggest people fail on diets because they get hungry, and they won't get hungry on his diet therefore people will not fail on his diet. I, on the other hand, think many people succeed on many different diets because they work in the short-term. Then most people gain it back because life and habit take over and they haven't yet developed the long-term strategies, motivation, and support systems necessary to foster lasting change.