A new slimming technique?

    My 'normal' weight is around 235 pounds (107 Kg) or just under 18 stones.

    On 23rd August of 2005 I became ill with what transpired to be a gallstone lodged in my main bile duct (not uncommon). This stops the liver working, which is obvious because you pee orange juice and crap a rather disgusting whitish mess. The effect of a blockage in your bile duct is that you can't make any use of the food you eat. You are, in effect, starving to death.

    I had an endoscopy on 7th Nov. This is a procedure where they put a tube down your throat which goes all the way through the stomach to the liver. It has some 'tools' on the end with which they can move a gallstone and widen (cut) blocked valves. It's not at all painful, though it is pretty unpleasant.

    Here is a plot of my weight over a period of nearly two years, starting from the point where I fell ill:

    The red line is a simplification of the actual graph and divides into three sections:

    First Phase: Starving

    During the first 12 weeks I lost 13 Kgs (29 pounds). Unfortunately I didn't start accurate measurements straight away, but the loss was pretty uniform and it averages nearly 1.1 Kgs or 2.4 pounds per week.

    Conclusion 1: Don't believe anyone who says you can lose more than 3 or 4 pounds per week.

    The oft-quoted "20 pounds in 10 days" is nonsense, and could only happen through dehydration, which isn't real slimming.

    A pound of fat is 3500 calories, so 2.4*3500/7 equals 1200 calories a day, which is just about right for the average basal metabolic rate (what it takes you to live without any exercise). You could burn maybe another 400 calories a day in exercise, although not if you're starving. It is true that you would be unlikely to live for 12 weeks with no food at all, so it's probable that my liver was still working to some degree.

    During this period I got gradually weaker until it became really difficult to walk 100 yards to my nearest shops. However I didn't feel at all hungry. At first sight that's surprising since you read stories of concentration camp prisoners risking death to steal a single potato because they were starving. The difference is that, although not hungry, I continued to eat, more or less as a matter of habit.

    Conclusion 2: Hunger is controlled by what passes down your throat, not by what your stomach processes.

    If this were not so then people who have stomach bypasses performed would be plagued by hunger. And it's certainly clear that thirst is quenched by the act of drinking, long before the liquid has any chance to have any useful effect. No doubt this is a necessary evolutionary feature, to stop us continually eating or drinking too much.

    Second Phase: Recovering

    They failed to remove the gallstone by endoscopy, so they fitted a stent (a plastic collar) which stopped it blocking the bile duct. Within a week I was feeling as right as rain, and in fact a lot healthier than my pre-illness state, because I was a lot lighter. It's entirely irrelevant to the account, but the marker "Pico Turquino" refers to the date when I climbed Cuba's highest peak, 2000 metres, or over 6000 feet. Admittedly I started at 1000 metres, but I did descend all the way to the sea. At 107 Kgs I simply could not manage that now.

    After the endoscopy I started recording my weight every day on a digital scale. The local fluctuations are more likely to be due to the scale inaccuracies than any genuine variations. Because a plastic stent is not a viable long-term solution, 24 weeks after the endoscopy they took me into hospital again. They attempted to remove the gallstone and stent by endoscopy but again failed. So they tried laparoscopy (keyhole surgery) but that failed too, and I finished up with full-scale surgery. This left me with an infection that lasted 6-7 weeks at the severe dip in the plot at the "Operation" marker. Why this should cause weight loss I don't know, but it seems somewhat remarkable that the my weight resumed its inexorable rise, as soon as I recovered.

    Needless to say I desperately wanted to retain my low weight, and practically lived on fish and skimmed milk in my attempt not to gain weight. All to no avail. At the marker "Normality", 69 weeks after the endoscopy I was back at my original weight, having gained a pretty steady 1/13 Kg (or 1/6 pound) per week.

    1/6 pound per week is only about a third of an ounce per day, a miniscule amount. It corresponds to 600 calories worth of fat per week, or a measly 85 calories a day - ten minutes on an exercise bike, at most, As it happened I was burning around 200 calories a day on the bike at the time, but I don't believe for a second that burning another 85 would have stopped the weight rise.

    Conclusion 3: The oft-quoted equation 'calories consumed = calories burned' is nonsense.

    It is really surprising how often slimming programs on TV and other literature quote the above as a 'rule'. It's obvious not only that the equation ignores the calories you pass out through your bowels, but also that this neglected item is vastly bigger than the calories any normal person could burn. Your typical food consumption is 3500 calories a day. Take away 1200 for the base metabolism and you have 2300 still to burn. For me that would correspond to 4 hours of strenuous exercise biking. At my fittest I've never managed more than 30 minutes. Put another way a bar of chocolate contains enough calories to walk 20 miles.

    Third Phase: Normality

    When I got to March 16th 2006, the position of the "Normality" marker, I had no idea that my weight wasn't going to go on increasing forever. What is really remarkable is that it flattened out at exactly the weight I was before the whole business started. Since then I have started eating cheese and chocolate again (not together) and I'm afraid I've more or less given up exercise biking. It hasn't made any significant difference.

    Conclusion 4: Your "normal" weight is controlled by something other than the food you eat.

    Since the world is full of people who diet and who make their living out of dieting, I ought to qualify this statement. Clearly if you starve you lose weight. Clearly if you overeat then you will become obese. However there is a huge range of food intake, probably between a little less than 2000 calories and a little more than 4000 calories a day, where it makes very little difference. Your body can adapt between those extremes to maintain an almost invariant target weight. "Champion Slimmers" are simply people who have moved through one of the endpoints of the range.

    Of course exercise makes a difference. Our bodies have evolved to store fat against the lean times. The heavier among us are better adapted to survive famine, the lighter among us to run and hunt. If you exercise significantly then your body will adapt from fat to muscle. This is good for you but has little to do with calories in = calories expended.

    The 'obvious' explanation as to how my body zeroed-in so accurately to its target weight is that it has only a prescribed number of fat cells. (Generally, fat cells are not created after puberty.) So arguably my inexorable weight rise continued until all my fat cells became 'full'. However there are some things wrong with this. 1) You certainly put on weight (and a lot of it) as you grow older. 2) If you overeat you put on fat that wasn't there before.

    But I am assuming that in principle evolution intends us to have a strict pot of reserve fat, which is very difficult to reduce or increase.

    My Slimming Proposal

    Endoscopy is far less invasive than bariatric (gastric bypass) surgery. Although psychologically unpleasant it does not involve any cutting or bleeding and the recovery time is only a few hours. Why not develop a sterile stent that can be lodged in the bile duct and which partially blocks it? In fact it should not be beyond today's technology to have a stent where the degree of blockage can be controlled from outside the body, e.g. magnetically. Then you could control your own weight.

    Of course there are a number of things that could go wrong. Maybe you cannot lodge any object, no matter how sterile, in the bile duct indefintely without risking infection. Maybe any reduction of weight achieved in this way, even if small, is only achieved by partial starvation, with its accompanying lethargy and weakness.

    But I would like to know if its been tried.

    Comments? Email Chris Paradine

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