We Are Not Alone

“Paying attention is a form of reciprocity with the living world, receiving its gifts with open eyes and an open heart.” Robin Wall Kimmerer

Regardless of whether you eat a Keto diet, practice intermittent fasting, count calories, or focus on exercise, there are some generally accepted guidelines most people follow to maintain a healthy weight. Within our culture, we tend to believe that weight gain is driven by an energy imbalance, so any loss must be initiated by eating less and moving more. Some people regulate their weight by eating a healthy breakfast, treating it as the most important meal of the day as it helps to regulate their appetite and boost metabolism. Many weight loss recommendations include drinking 64 fluid ounces of water daily, as staying hydrated impacts our sensations of satiety and our energy levels. And most of us agree that some type of regular movement is important, so getting in 10,000 steps per day is an effective way of making sure we get a healthy amount of physical activity. Most recently sleep has taken center stage in our battle of the bulge, with recommendations of anywhere from 6 to 8 hours per day considered essential for the regulation of the hormones that control appetite and satiety.

Even if you are not trying to shed pounds, following these guidelines can go a long way to help us stay healthy. Trouble is, none of these practices are backed by sufficient evidence related to their effectiveness in losing weight. This is not to say that they are dangerous or a waste of time, but, to date, there is no evidence to suggest that any of these practices are the holy grail of weight loss. After decades of research, we have clues and associations related to weight gain and loss, but very few definitive answers. What our volumes of research related to obesity does show is that it is a highly complex, multifactorial condition that defies simple behavioral solutions, and that it is particularly resistant to a one size fits all strategy.

If the scientific data does not support these common weight loss beliefs, how did they originate? Most likely one or two small studies found a connection with certain behaviors. These findings found their way to a news source, which reported the results on the national news. Since our culture views being overweight as a straightforward problem of “calories in, calories out”, we assume that its treatment should be equally straightforward. We are drawn to simple solutions, so a report related to a small behavior change—drinking water, getting 10,000 steps per day--quickly morphs into truth.

A great deal of research has provided insight into the socioeconomic and global factors related to obesity, and the results are surprising. These studies have identified the factors that are shared by obese populations around the world. If we look at the usual suspects--the introduction of a western diet (i.e., McDonald’s, Cheetos, soda, etc.), moving to urban areas and adopting a sedentary lifestyle, or becoming immersed in westernized culture, we find that they are not uniformly correlated with increased obesity. Instead, the common denominator points to the impact of modernization, which tends to shift an individual’s lifestyle to practices that run contrary to our deeply ingrained evolutionary blueprint of being human.

Research has identified seven factors related to modernization that are globally linked to obesity: sleep deprivation, disruptions to the circadian rhythm, chronic stress, changes in one’s food consumption, labor saving devices, pharmaceuticals, and disruptions in hormone production. Global studies suggest that improvements in modernization that elevate a person’s quality of life can also create downstream disruptions in health. For example, the introduction of electricity to some remote villages improves educational opportunities for children but can also significantly disrupt a family’s sleeping patterns. Since the light bulb was introduced into homes in the late 1800’s, humans experienced an average decrease of two hours of sleep per night; we can only assume that amount has further degraded as modernization takes hold, as street lamps, televisions, and electronic devices flourish with the introduction of an electric grid. Darkness is essential for good quality sleep and insufficient or poor-quality sleep is associated with an increased risk of obesity in some people. The light bulb is just one example of how modernization can solve a host of socioeconomic problems but open the door to health risks down the road.

Most of the seven factors related to modernization are reflected in our western guidelines related to diets, sleep, and physical activity. Why, then, don’t our general assumptions about weight control hold up to the rigors of scientific scrutiny? Although we have identified factors that obese populations have in common, these factors are not, by themselves, the cause of obesity. Instead, they are conditions that make weight gain more likely. What science is showing is that becoming overweight is a complex process that involves numerous factors, some of which are within our behavioral control, while others are stimulated by complex regulatory processes that require several interventions. However, there is evidence to suggest that the condition of obesity and overweight has one common denominator: a change in the composition and healthy functioning of our gut microbiome.

Anyone who has tried to lose a significant amount of weight and keep it off is well aware of how hard this process can be. We all seek a simple, straightforward solution to weight control, identifying the one diet, exercise plan, or set of lifestyle guidelines that will deliver the healthy body we desire. We want to believe that obesity is simply an accumulation of fat that results from eating more and moving less. But science is telling us otherwise, continuing to disprove what is referred to as the “Eat Less, Exercise More”, or ELEM model. Approaching obesity and overweight as a simple energy equation fails to recognize the complexity of living in the natural world, while underappreciating the intricacies of our physical bodies. Being human requires that we live in reciprocity with the world around us and, as we are now learning, the world that resides within us. Research into our microbiome is showing that, not only do we co-exist with the environment and other people, we also live in a relationship with the microbes that have made our bodies their home.

The Sufi poet Rumi reminds us that “You are not a drop in the ocean, you are the entire ocean in a drop.” Most likely he was reminding us of our interconnectivity, but his quote is relevant to our growing awareness and appreciation of our symbiotic relationship with the microbiome that resides within us. Rather than a collection of blood, bones, organs, and tissues, our bodies are a rich, thriving environment of microorganisms—there are thousands living within us-- some of which are belligerent houseguests that can cause disease, but many that are friendly and essential to our overall well-being. These organisms have shared space with us from the onset of our species; in the process they have learned quite a bit about us, adapting with precision and skill to our evolving behaviors, diets, and environments. They are highly adaptable and keep our bodies in balance, but disruptions in their rhythms can instigate disease. But while our microbes understand us, we know very little about them. During their millions of years of evolution, they have found ways to communicate with us, but because we are generally oblivious to the needs of these tenants, we typically ignore their messages. We are not the most gracious of hosts. We may give them an occasional nod, perhaps eating a “probiotic” yogurt or two, but generally we ignore their presence and the important role they play in our health. But we discount these organisms we share space with at our own peril. Currently we have cultivated and understand only 5 percent of our microbial environment, and what we have learned about the potency of their crosstalk hints at the vast role they play in our health. Perhaps it is time we listen a bit more closely and get to know our neighbors more intimately.

If you are suspicious of the important role microbes play in our health, simply consider what happens with the overuse of antibiotics. By disrupting the delicate balance of gut flora, some pharmaceuticals can have serious long-term consequences on our immunity by creating inflammation and sparking endocrine disorders. Viral infections can trigger debilitating long term illnesses, such as Fibromyalgia and long COVID. More recent research related to the development of Parkinson’s disease suggests that imbalances in the gut microbiome early in life lays the groundwork for expression of the disease that grows slowly over decades before manifesting symptoms. And studies of the gut–brain axis is showing that our microbiome may play a critical role in neurodegenerative diseases such as Alzheimer’s and dementia.

Our gut microbiome plays a critical role in what is known as the gut-brain axis. We tend to think of our brain as the control center of the body, the hub where all our thoughts, physiological processes, and emotional processing takes place. But our growing understanding of the gut microbe questions this “top down” approach to body regulation. It seems our physiology operates more like a two-lane highway than a one-way street, with signals flowing bi-directionally between the gut and the brain. Our microbiomes are quite sensitive to environmental factors, particularly those that are related to our modern lifestyle. The more subtle pressures that are associated with modernization such as chronic stress, changes in our food quality, and disruptions to circadian rhythms, can seriously impact the microbiome. Microbes have their own circadian rhythms, and they send out signals when they are disrupted, much like an alarm system that has been activated. These signals can trigger changes in our regulatory systems—they can even influence our thinking processes. It seems the brain is not the body’s top CEO; our microbiome controls us as much as we control it.

In the case of obesity, much of the research on the role of the microbiome suggests that we need to change our definition of being overweight as a simple condition related to excessive eating and limited exercise. This is not to say that calories and exercise are not important—they are, but only to a point and not in all circumstances. There are more than one hundred different types of obesity, all of which are influenced by a number of environmental factors and regulatory systems. Some people respond very well to a change in diet and exercise. Some may even shed pounds by simply reducing stress with a regular meditation practice. But simple solutions are typically the exception, not the rule. Most people need a combination of different treatments, so approaching weight issues with a multifactorial and personalized approach is increasingly seen as the most effective form of treatment. As of now we are just beginning to gain clarity on the complicated nature of obesity and the role our microbiome plays in its development; how we treat it is still a question that will remain unanswered for some time into the future.

Many a best seller has been published on “leaky gut” and the role of microbes in weight loss. Most of these publications are not based on solid science. We are far from understanding these important organisms that live in relationship with us. Our understanding of the role the microbiome plays in weight regulation is still in the early stages, far from a point at which we can use it as a treatment for obesity. Although taking a probiotic can be helpful in certain circumstances, as when we take a dose of antibiotics, we should remain somewhat skeptical of fantastic claims related to the establishment of a healthy gut. Just like other accepted but unsupported lifestyle guidelines, probiotics won’t hurt you, but it is too early to know for sure if it will help.

With our growing but still limited understanding of these important tenants who share our world, perhaps the best we can do is recognize that we are caretakers of a body that hosts a vast array of important life forms that are working to keep us healthy and thrive. We may not know much about them, but we can be mindful of their presence and open to their influence. As we grow in appreciation of how we are, as Rumi reminds us, “an entire ocean in a drop”, we can only hope to become more sensitive and gracious hosts to our tenants. This awareness may give us pause as to how we go through our day. Can we learn to live in reciprocity with our guests, establishing a strong and viable relationship in which we support them as they support us? Although for some it may seem a bit creepy, I invite you to go forward this week with an awareness of the thriving world within you. What kind of a host will you be?