Yup, still working overtime at the job.  They want me to use up the hours budgeted for fiscal year 2016 (which ends July 1st) because any unspent dollars go POOF!  (And then some unidentified programmer’s PC turns into a pumpkin.  Or his shoes turn into glass slippers.  Don’t remember exactly, but something bad happens.)

I couldn’t possibly put in enough hours this week to soak up the entire balance, but I’m doing my best.  So it’s long days of coding for me … for a few more days.

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The most recent Dietary Guidelines declared that cholesterol is “no longer a nutrient of concern.”  Yup, after nearly 40 years of warning people away from egg yolks, the government folks finally checked the actual science and then sort of admitted being wrong.  It was a step forward.  But, government being what it is, I suppose a corresponding step backwards was inevitable.  Here are some quotes from a recent article in The Chicago  Tribune:

The Obama administration is pressuring the food industry to make foods from breads to sliced turkey less salty, proposing long-awaited sodium guidelines in an effort to prevent thousands of deaths each year from heart disease and stroke.

So the Obama administration must have solid scientific evidence that reducing sodium in food products will prevent heart attacks and strokes … just like the First Lady must have solid evidence that telling kids “Let’s Move!” and cutting the fat and calories in their school lunches will reduce obesity.  But we’ll come back to the salt-cardiovascular disease evidence.

The guidelines released Wednesday by the Food and Drug Administration are voluntary, so food companies won’t be required to comply, and it could be a year or more before they are final. But the idea is to persuade companies and restaurants — many of which have already lowered sodium levels in their products — to take a more consistent approach.

Ah, I see: the guidelines are voluntary.  Based on government history, here’s how that will work:

“Hey, food companies, we’d like you volunteer to reduce the sodium in food.”

“No thanks.  People don’t like the food as much when we lower the sodium.”

“You don’t seem to understand.  We’re asking you to do this voluntarily.”

“Got it.  Voluntary guidelines.  So we choose not to follow them.”

“Well, then, we’ll have to force you to follow them.”

“But you said the guidelines were voluntary.”

“Yes, but you didn’t volunteer, so now we’re imposing them.”

Sodium content already is included on existing food labels, but the government has not set specific sodium recommendations. The guidelines suggest limits for about 150 categories of foods, from cereals to pizzas and sandwiches. There are two-year and 10-year goals.

And a five-year plan issued by the Kremlin.

Health officials from the FDA and the Centers for Disease Control and Prevention said overwhelming scientific evidence shows that blood pressure increases when sodium intake increases, increasing the chances of heart disease and stroke.

Overwhelming evidence, eh?  That would mean 1) the science shows that high sodium intake leads to heart attacks and strokes, and 2) the science also shows that most Americans have a high sodium intake that puts them at risk.  And let’s add a third point: before issuing a “voluntary” guideline for lowering the sodium in food, we’d want to be sure that people don’t respond to low-sodium foods by reaching for the salt shaker – which is what I do.

So how much sodium are we consuming, anyway?

Americans eat about 1½ teaspoons of salt daily, or 3,400 milligrams. That amount hasn’t gone down over the years, and it’s about a third more than the government recommends for good health. Most of that sodium is hidden inside common processed foods and restaurant meals, making it harder for consumers to control how much they eat.

I just explained that I have no trouble controlling how much sodium I eat.  Give me low-sodium food, I reach for the salt shaker.  That’s because 1) I like salt on my food, and 2) I’ve actually looked at the science – something regulators at the FDA apparently haven’t. Here’s a quote from a 2011 article in Scientific American:

A meta-analysis of seven studies involving a total of 6,250 subjects in the American Journal of Hypertension found no strong evidence that cutting salt intake reduces the risk for heart attacks, strokes or death in people with normal or high blood pressure.

And here are some quotes from a recent article about a new meta-analysis:

 A controversial new study contends that a low-salt diet could be dangerous for your heart health.

Notice how it’s only “controversial” if a study concludes that government advice is wrong?

Restricting dietary salt to below 3,000 milligrams a day appears to increase the risk for heart disease similar to that of high blood pressure patients who eat too much salt, said lead researcher Andrew Mente.

He said his study results showed that a low-salt diet increases the risk of heart attack or stroke 26 percent for people without high blood pressure and 34 percent for people with high blood pressure.

For those with high blood pressure, too much dietary salt increases their risk 23 percent, the study said.

On the other hand, a diet with excess salt doesn’t increase the risk at all if blood pressure is normal, the study reported.

“Most of the population eats what they’re supposed to eat, based on the data,” Mente said. “They fall in the middle and that’s actually the sweet spot — the safest range of intake.”

Mente’s study is observational, and you know what I think of observational studies are far as demonstrating cause and effect.  But keep in mind that if A causes B, A and B will be correlated.  So if A isn’t correlated with B, A doesn’t cause B.  Mente found that a normal sodium intake – the 3400 milligrams the government says is too much – isn’t associated with heart attacks of strokes.  But a lower sodium intake is.  So naturally, the FDA wants us to cut back.  And they’re (ahem) “asking” food companies to volunteer to help.

Back to the Tribune article:

Some companies have worried that though the limits will be voluntary, the FDA is at heart a regulatory agency, and the guidelines are more warning than suggestion.

Gee, do you think?

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It’s been awhile since I’ve done one of these posts, so here some letters from viewers.  Actually these are follow-up letters from people who’ve written to me before.  Their letters are most of the post, so I’m not going to use quotes.  The letters appear in regular text.  My comments are in italics.

Down 40 pounds in mere months

Hello, Tom —

I wanted to follow up with you. I originally emailed in February, then again in April. June is here and I am now down 40 pounds! I started out at 245 lbs and I’m at 205. I feel great. My wife has lost about 20 lbs. Again for her to have lost this much weight is truly amazing — she’s never been able to lose it and keep it off because of PCOS and other factors. She’s seeing consistent loss, but in her case the measurements are really amazing. She’s lost 4 inches from her waist and several inches in other areas!

We don’t really count carbs, but generally get anywhere from 25-100 carbs a day. The carbs come from homemade sourdough bread (using natural yeast rather than quick rise stuff — no more than 1 slice a day), berries, and some veggies (above ground varieties). Once a month we might go each a small pizza or something not strict low carb, but for the most part we are avoiding a lot of the processed stuff we used to survive on.

Our typical breakfast is eggs with either bacon, sausage or made into an omelet with veggies. I add 2-3 tablespoons of cream to the eggs and whisk them up in a bowl. I also add 1-2 tablespoons of butter to the pan to help the eggs fry. Lunch is usually a big salad (homemade ranch dressing using ranch dressing mix, full fat greek yogurt and heavy cream) and some type of fatty meat – burger patties, 1/2 of a rib eye, or leftover beef stew (with real bone broth).

Dinner is usually veggies with cheese and/or butter on them and a meat – rib eye, ground beef, bone in skin on fried chicken, etc. For dessert we’ve stuck with berries and cream (thank you for introducing me to that!) and we have 1 piece of dark chocolate with each meal (>75% dark, each piece has 1g sugar). Let me tell ya, starting the day off with a piece of dark chocolate and having no guilt over doing it- – totally awesome.

Doing everything the modern American medical system tells me should make me fat, yet I’ve lost 40 lbs in 6 months and 0 exercise. My wife and I do go on maybe 1-2 walks a week and we’re active around the house, but I dont count that stuff as exercise. I do understand the importance of exercise, especially being behind a computer all day, but not solely for weight loss!

It is amazing to go through this journey. Friends and co-workers have noticed the weight loss and I have shared your movie, facebook groups and website with them, since it all started with Fat Head. Some friends of ours switched to a lower carb lifestyle a few days ago and have already seen results.

A good friend of mine and I were having a discussion and he asked me what I was doing. This guy is a skinny guy who runs 6 miles 2 or 3 times a week and has competed in Tough Mudder several times. He’s recently put on some weight and wanted to know what I was doing. I shared my story and what I’d learned about cholesterol. His cholesterol is at 250 and his doctor wants to put him on statins. I told him to never go to that doctor again and sent him several links, including some videos on YouTube from Fat Head the Movie. I couldn’t believe a doctor actually wanted to put this guy on statins!

Look forward to your book — thanks for everything you do.

Matt

Thank you, Matt.  I’m looking forward to seeing the book too.  Chareva is still drawing some of the characters, and I’m lovin’ what she’s doing with them.

Folks, notice Matt and his wife have kept losing weight, but haven’t been at 20 carbs for months on end.  Some days it’s 25, other days they go up to 100.  Exactly the point I was making in my previous couple of posts. It’s not necessary to aim for never-ending ketosis to lose weight and become healthy.

A five-year follow up on the whole family

Hi Tom,

My name is Lorraine and I wrote to you once in September 2011. It has been almost 5 years and I feel obligated to thank you again for the changes you have instilled in my life and also the people I love.

A few months after writing you, I did achieve my goal weight.  I have been able to maintain my weight (between 125-130 pounds) effortlessly.  Re-reading that post has reminded me of how dire my life was at 25.  I was so very depressed and unhealthy, and I’ve nearly forgotten that dark time.  I am now 30 years old and things have changed.

After my depression, I started to enjoy all the old things I used to love, like reading, video games, and social events.  I also found new hobbies including biking, sprinting, weight training, and hiking. I started living again.  I have completed graduate school.  I am a physician assistant practicing for almost two years in an emergency department in a busy city hospital.  I am also engaged to be married this coming fall.  However, this e-mail isn’t really about me.  It is more about those around me you have changed after I wrote that e-mail.

My father at the time was over 50 pounds overweight.  He was pre-diabetic and had an awful lipid profile.  Deep down, I knew he was teetering on the edge of full-blown heart disease.  The odds were against him.  After my success, he wanted to know what he was doing wrong.  He was constantly dieting and failing.  I had him watch your documentary.  He found you amusing, but he was very doubtful.

He felt hopeless so he gave it a shot.  In his 50s, he lost all the weight in only a few months.  He began weight training, and as a 59-year-old man continues to weight train 3-4 times a week.  He is no longer pre-diabetic and his lipid profile is as his doctor described “that of a 20 year old.”  He too has been able to maintain his weight with ease.  Because of your documentary, he was able to see the birth of his granddaughter (my niece) and he will be able to see my upcoming wedding.  I honestly can say that I don’t know if that would have been possible at the rate he was going.

I met my fiance, a nurse, a little over 2 years ago.  He is a type 1 diabetic.  He had a hard time controlling his blood sugars so his A1C was never ideal.  On his own accord, he started following a low-carb lifestyle.  Moving downstate to be closer to me, he found a new endocrinologist.  When he told his endocrinologist what he had changed, she gleamed.  She and her husband (another doctor) follow a paleo lifestyle.  A huge proponent of low-carb lifestyles, she recommends it to everyone, including all her diabetic patients.  His A1C is now in an ideal range and his sugars remain controlled throughout the day.  He no longer has bad highs, or even worse, bad lows.  Also, the amount of insulin he administers daily has dramatically decreased by nearly 25-50%.

My sister was a few pounds overweight when she became pregnant.  She was terrified of possibly gaining too much weight during pregnancy as many of her friends have done.  She was fearful of conditions like gestational diabetes and preeclampsia.  She decided to start following a low-carb lifestyle as well.  I gave her recipes, meal plans, and healthy snacking ideas.  She was able to maintain a healthy weight throughout her pregnancy and gave birth to a healthy, 7-pound baby girl.

There are others you also helped including my mother, my mother-in-law, many coworkers, many friends, and even my future family.  Proponents of the low-carb lifestyle, like you, are a catalyst to creating future healthier generations.  Keep up the amazing work.

A million thanks,

Lorraine

A million thanks you to, Lorraine, for letting me know how much you and your loved ones have improved your health.  I wish you and your fiance a lovely wedding and a wonderful life together.

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A few random thoughts that occurred to me after my previous post on the “alternative hypothesis”:

1. Too many carbs as an explanation for the rise in obesity and diabetes is still largely correct.

If we were Kitavans and got our carbs from sweet potatoes and other unprocessed foods, maybe the increase in carb intake since the 1970s wouldn’t have been such a problem.  But we’re westerners, and a disproportionate share of our carbs come from processed grains.  They spike blood sugar (which probably leads to insulin resistance over time) and they provoke inflammation (which probably leads to insulin resistance over time).

In Denise Minger’s book Death by Food Pyramid, she recounts the story of Luise Light, a government scientist who was given the task of writing new nutrition guidelines in the 1970s.

Unlike previous food guides, Light’s version cracked down ruthlessly on empty calories and health-depleting junk food.  The new guide’s base was a safari through the produce department – five to nine servings of fresh fruits and vegetables each day.  “Protein foods” like meats, eggs, nuts and beans came in at five to seven ounces daily; for dairy, two to three servings were advised.

The guide kept sugar well below 10 percent of total calories and strictly limited refined carbohydrates, with white-flour products like crackers, bagels, and bread rolls shoved into the guide’s no-bueno zone alongside candy and junk food.  And the kicker:  grains were pruned down to a maximum of two to three servings per day, always in whole form.

The USDA, of course, took her guidelines and mutated them into a pyramid that suggested 6 to 11 servings per day of grains.  Light later commented that “no one needs that much bread and cereal in a day unless they are longshoremen or football players” and warned that the six-to-eleven servings of grain per day could spark epidemics of obesity and diabetes.

And so they did.  We can blame it on hormonal disruption instead of too much insulin per se, and we can argue about whether or not eating more sweet potatoes and green bananas would have been good or bad.  But we were told to eat more breads and cereals, and those foods are a big part of the problem

2. Many of the people currently beating up on Atkins, Taubes, etc., owe them a huge thanks, whether they’ll admit it or not.

Yeah, you can say it’s not all about the carbs.  You can say it’s not about the temporary insulin spike after a meal.  You can say it’s more about food quality than macronutrients.  Heck, I’ll even agree with you.  But I suspect if there were no Dr. Atkins and no Good Calories, Bad Calories, a lot of current whole-foodies and paleo types who slam low-carb diets would still be afraid of saturated fats and cholesterol and trying to live on low-fat diets.

Honestly, how many of you out there were aware of all the bad nutrition “science” before Taubes starting writing about it?  I certainly wasn’t.  When I worked for a small health magazine in the 1980s, I quoted the USDA and the American Heart Association as reliable sources in my articles – because I assumed they were reliable sources.

3.  Mixing it up is probably the way to go.

Based on glowing reviews from readers, I recently read three books by Nassim Nicholas Taleb.  Great reads, all three of them.  In Antifragile, he makes the point that biological systems are often made stronger by doses of randomness.  If you do the same repetitive motion every day, you’ll likely injure yourself.  But if you lift weights now and then – a random stressor – you get stronger.  Taleb eats meat, but goes vegan for several days now and then.  He fasts now and then.  I recently heard legendary strength coach Charles Poliquin say (on a Tim Ferriss podcast) that he loves nuts, but he’s careful not to eat the same ones day in and day out.  The reason?  You can develop an intolerance if you eat the same foods over and over.  You need to mix it up.

So I like the approach Rob Faigin suggests in Natural Hormone Enhancement: eat a low-carb/high-fat diet for a few days to promote weight loss, then mix in a day with higher carbs and lower fat.  Or maybe a few days now and then.

Tim “Tatertot” Steele wrote an interesting book called The Potato Hack.  The “hack” is eating nothing but potatoes for a period of several days.  Salt and liquids like vinegar or chicken broth are allowed for flavor, but no fat.  Some people have reported losing a pound per day on the diet.  I tried it for three days in May and lost … nothing.  No change.  But the interesting part is that my blood sugar didn’t go through the roof like I feared it might.  I usually peaked at around 140 briefly, then dropped well below 100 by an hour after eating.  I boiled the potatoes and let them cool in the fridge overnight before reheating them for meals, so perhaps the resistant starch helped keep the glucose level down.

Kudos to Tim, by the way, for not letting his enthusiasm for the potato hack blind him to the danger for diabetics.  He tells readers trying the diet for the first time that they absolutely must check their glucose response.  He shows what normal responses should look like.  He also shows what a diabetic response would look like and says “If your numbers look like this, DON’T DO THIS DIET.  You are a diabetic and need to see a doctor.”

Anyway, if you decide to try Faigin’s mix-it-up approach, Steele’s potato-hack meals fit the “higher carb, low-fat day” prescription.

4. Never-ending low-carbing can cause problems for some people, but that doesn’t mean everyone should carb up.

Like I said in my previous post, I would never tell type II diabetics to run out and eat potatoes just because they seem to benefit me.  We’re all different.  Jimmy Moore interviewed Chris Kresser about diet and thyroid back in 2012, and Kresser made exactly that point.  Some people go VLC and they’re fine.  They feel great.  They don’t develop thyroid issues.  But some people do.  They stop converting as much T4 (the inactive thyroid hormone) to T3 (the active hormone) and their metabolisms slow down.  They’re surprised when Kresser has them eat more carbs and they begin losing weight again.

Too little glucose in the diet can clearly cause problems for some people, but so can too much glucose.  In my previous post, I linked to a study demonstrating that going VLC can cause some men to produce less testosterone – not a happy result if you want more muscle and less fat on your body.  But I should mention that other studies demonstrate that too much glucose in the system also reduces testosterone.

Here’s the conclusion from one study:

Glucose ingestion induces a significant reduction in total and free T levels in men, which is similar across the spectrum of glucose tolerance.

And from another study:

Oral glucose administration acutely lowers LH and total T concentrations by suppressing pulsatile LH secretion and basal T secretion commensurately.

Too little glucose, your testosterone drops.  Too much glucose, your testosterone drops.  Paul Jaminet got it right.  There’s an ideal range for glucose.  For most of us, it’s not zero … but it’s also nothing close to 300 grams per day.

While digging those studies out of my database, I also came across two that demonstrate the importance of the right fats.  Here’s the conclusion from this study:

Our results indicate that in men a decrease in dietary fat content and an increase in the degree of unsaturation of fatty acids reduces the serum concentrations of androstenedione, testosterone and free testosterone.

And from this study:

Production rates for T showed a downward trend while on low-fat diet modulation. We conclude that reduction in dietary fat intake (and increase in fiber) results in 12% consistent lowering of circulating androgen levels.

Studies have shown that men today have lower average testosterone levels than men in previous generations.  We’ve been jacking up our glucose levels with junk carbs and eating less saturated fat since the 1970s.  Could be a coincidence, but I doubt it.

So regardless of whether you stick with VLC or decide to mix it up with higher-carb days, here’s the take-home message for guys:  skip the cereals and eat your damned bacon and eggs.

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Pardon the delay in posting and responding to comments. I was on Dauphin Island off the coast of Alabama for a wedding last week. I couldn’t ask The Older Brother to sit in, since it was his Middle Son getting married.

Anyway … in my last post, I commented briefly on a video presentation of a study that, in some people’s minds, nailed the coffin-lid shut on the Carb-Insulin hypothesis. I replied that I don’t believe the hypothesis is dead, but needs some revising. Based on personal experience, lots of reading and listening to podcasts, conversations with other people and so forth, I’ve been slowly revising it my own head for years. So let me reach up there between my ears and pluck out some thoughts, then see if I can work them into a coherent post.

More Carbohydrates => Higher Insulin => Fat Storage

That’s the Carbohydrate-Insulin hypothesis in a nutshell. The more carbohydrates you eat, the more insulin you produce, and the more insulin you produce, the fatter you become. Or to express it in reverse for those trying to lose weight: the fewer carbohydrates you eat, the less insulin you produce, and the less insulin you produce, the leaner you become.

Simple is certainly appealing. But I happen to know the linear equation of more carbs = more body fat isn’t true in my case.

But wait … didn’t you finally lose weight after going low-carb?!

Why, yes, I did. And it was easy. Unlike when I tried low-fat/low-calorie diets based on cereals, pasta, bread and rice, I dropped the pounds fairly quickly and wasn’t hungry. Like a lot of people, I figured if low is good, lower is better.  So I stayed on a very-low-carb diet for a long time.

But after reading The Perfect Health Diet, I put real-food starches like potatoes and squashes back into my diet. After listening to Jimmy Moore’s podcast with the guys who designed the Carb Nite protocol, I started enjoying a high-carb Saturday night (but with a Mexican dinner, not donuts). After reading about the gut microbiome, I started eating tiger nuts for the fiber and resistant starch. After reading a book called Natural Hormone Enhancement, I decided to mix things up even more. Some days my diet resembles The Perfect Health Diet. Some days it resembles an Atkins induction diet, all meats and eggs and green vegetables. Some days I skip breakfast. Some days I fast until dinner. Saturday is still the high-carb night.

I average more carbs per day now than I did a few years ago, but haven’t gotten any fatter. So more carbs = more body fat clearly isn’t true for me, at least not as a linear relationship.

Does that mean insulin doesn’t drive fat accumulation? Nope, not at all. I don’t think we’ve seen the final word on the research, but let’s just say I’ll be stunned if turns out insulin has little to do with gaining weight.

Insulin inhibits lipolysis — the breakdown and release of fat from fat cells. Any book on metabolism will tell you so. That’s one of insulin’s many jobs, and it’s a crucial one. When you eat a meal that raises your blood sugar, insulin brings the blood sugar down partly by storing fat and keeping it stored. That way your cells burn the glucose first.

Take a look at this graph from a study by Dr. Jeff Volek. It shows the relationship between the concentration of insulin in our blood and the ability to release fat.

Here’s a quote from text accompanying the graph in the Volek paper:

Adipose tissue lipolysis is exquisitely sensitive to changes in insulin within the physiological range of concentrations. Small to moderate decreases in insulin can increase lipolysis several-fold, the response being virtually immediate. Insulin also stimulates lipogenesis [creating new body fat] by increasing glucose uptake and activating lipogenic and glycolytic enzymes. Small reductions in insulin levels, such as that easily achieved with dietary carbohydrate restriction, remove the normal inhibition on fat breakdown.

I’ve seen several studies in which giving diabetics higher concentrations of insulin made them fatter. In a study of the effects of obesity on rats, the researchers stated matter-of-factly that they made the rats obese by pumping them full of insulin. When they stopped pumping the rats full of insulin, the rats returned to their normal weights. So yes, high insulin levels encourage fat accumulation and inhibit fat breakdown. And yes, your body releases insulin when you eat carbs.

But it’s not the temporary spike in insulin after a meal that makes you fat. That’s when insulin is doing exactly what it’s supposed to do: partitioning nutrients, shuttling glucose into cells, storing fat so glucose is burned first when glucose is high, etc. Later, insulin is supposed to drop and allow fat to flow from the fat cells.  Lower insulin also allows glycogen to be converted to glucose.  It’s all about keeping glucose within a safe range.

In a lecture I watched online, a biochemist described insulin rising as the building/storing phase and insulin dropping as the burning/using phase. Both phases are necessary for good health. The problem is that for metabolically damaged people, insulin stays high when it ought to be low. They spend too much time in the building/storing phase, and not enough time in the burning/using phase.

During his presentation on hyperinsulinemia on the cruise, Dr. Ted Naiman showed a chart of the insulin responses of normal vs. obese/insulin-resistant people to the same meal. The obese people not only had a much higher initial insulin spike, their insulin levels stayed higher for several hours. Take another look at Dr. Volek’s graph. It doesn’t take much extra insulin to inhibit lipolysis rather dramatically.

But those are metabolically damaged people. (We’ll get to what I believe causes the damage shortly.) For metabolically healthy people, a high-carb meal will certainly raise insulin temporarily — as it should — but that doesn’t necessarily mean insulin will stay high. When I first started hearing from paleo types that tubers have been part of the human diet for eons and are perfectly fine foods, they usually pointed to the Kitavans – native people who live on a high-carb diet (mostly sweet potatoes), but aren’t fat or diabetic.

So I looked up some articles and a study of the Kitavans. Yup, they eat a lot of sweet potatoes and they’re not fat or diabetic. But here’s the interesting part: their average insulin level is 24 pmol/L. If you check Volek’s chart, you’ll see that’s down in the range where fat breakdown occurs. (By contrast, one study puts the average insulin level for American adults at around 60 pmol/L.)  So for the Kitavans at least, a high-carb diet of whole unprocessed foods doesn’t lead to high insulin levels throughout the day. In other words, they don’t become insulin resistant. I’m sure we could find plenty of other paleo people who ate natural starches without becoming fat and diabetic. Quite a few Native Americans, for example, grew squashes and beans.

No doubt the potatoes and other starches I eat now temporarily spike my insulin. So why haven’t I gotten any fatter? Well, I don’t have any way of checking my fasting insulin level at home, but I’d wager a large sum it’s no higher now than it was a few years ago, when I rarely ate starch. I’d also wager a large sum that when I was living on low-fat cereals, low-fat pasta, whole-wheat bread with margarine and other vegetarian delights, my fasting insulin was much higher.

So the first revision of the “alternative hypothesis” I carried around in my head looked something like this:

Damaging Diet => Chronically High Insulin (Insulin Resistance) => Fat Storage.

What is or isn’t a damaging diet certainly varies among individuals. Back in this post, I recounted a section from Denise Minger’s excellent book Death By Food Pyramid in which she wrote about the huge variations in how much amylase we produce. People who produce little amylase experience much more dramatic blood-sugar surges when they consume starch than people who produce a lot of amylase. The low-amylase producers are also eight times as likely to become obese.

I doubt that’s a coincidence. Excess glucose damages cells. It makes sense that cells would protect themselves against high-glucose assaults by developing resistance to the insulin that’s trying to shove glucose through the door. So perhaps for some people, it really is as simple as too many carbs => insulin resistance.

But having said that, I doubt many type II diabetics got that way by eating potatoes and fruit. I think it’s much more likely that the carb culprit was processed carbs. It isn’t just that they spike blood sugar (although they certainly do). These “acellular” carbohydrates also produce inflammation – and inflammation is a likely driver of insulin resistance.

Which brings us to a major non-carb culprit: the crap oils that have been displacing natural fats in our diets for decades. We didn’t just start eating more breads and cereals after the Food Pyramid came around. We also started replacing butter and lard with soybean oil, cottonseed oil and other industrial horrors that drive inflammation. If inflammation in turn drives insulin resistance, then the “heart healthy” diets people started adopting in the 1980s were a double whammy: too many processed carbs, combined with industrial oils. Pass the (ahem) “whole wheat” toast with margarine, please, because I’m being good to my heart.

The second revision of the “alternative hypothesis” I carry around in my head took it from this:

Damaging Diet => Chronically High Insulin (Insulin Resistance) => Fat Storage.

To this:

Damaging Diet => Hormonal Disruption => Fat Storage.

Yes, insulin resistance is a form of hormonal disruption, and yes, I believe chronically high insulin drives fat accumulation. But other hormonal disruptions can make us fat too. I’ve mentioned seeing a documentary called The Science of Obesity that featured a woman who’d been lean her entire life, then started blowing up. She cut her calories to 1500 per day and still got fatter. Doctor after doctor accused her of lying about her diet.

But finally an endocrinologist ran some tests and found she had a small tumor on her brain. The tumor was preventing her brain from sensing the hormone leptin. Since leptin tells the brain how big our fat stores are, her brain concluded that she had no fat stores and needed to build them up. Fat stores are, after all, a crucial part of our fuel system. So each time she restricted her calories more, her body responded by slowing her metabolism more.

Few obese people have a brain tumor, but once again, a bad diet can lead to leptin resistance. Inflammation may cause leptin resistance directly, and chronically high insulin can block the leptin signal from reaching the brain. So we’re back to the same likely suspects: processed carbs and crap oils.

A baked potato with butter contains neither, which is one reason I now eat the occasional baked potato with butter. I may have surprised a few people on the low-carb cruise by eating the potato that came with my dinner on several nights. Then again, I saw others in our group doing likewise. Like I said, the low-carb movement is becoming more of a real-food movement, at least among the people I know.

But I don’t just eat the potato because I think I can get away with it. I eat the potato because I believe I’m better off with it than without it. Yup, you just heard me say that … er, write that.

Once again, the reason has to do with hormones. Going down to near-zero on the carbs and staying there can cause hormonal disruptions in some people. In the Natural Hormone Enhancement book I mentioned above, author Rob Faigin praised low-carb diets as a way to jump-start weight loss, but cautioned that going very-low-carb permanently can reduce testosterone and raise cortisol in men. He cited several studies to back up the point. Here’s one I just dug up.

He also cited evidence that going permanently low-carb can lead to a slower thyroid. I know Dr. Ron Rosedale insists the change in thyroid hormones is a healthy adaptation, but come on … if you’re trying to lose weight, do you really want a “healthy” slower thyroid?

Faigin’s solution is to mix it up: a VLC diet five days per week to promote weight loss, then high-carb (but not processed carbs) with reduced fat two days per week to prevent hormonal disruptions. The Carb Nite protocol is based on a similar idea. Paul Jaminet’s solution, of course, is to eat some “safe starches” daily while still keeping carbs on the lowish side overall. I can’t say if one solution is better than the other. It probably depends on the individual. Like I said, I mix things up and go with different diets on different days.

Having said all that, I would never encourage type II diabetics to run out and eat potatoes. During a Q & A session on a previous low-carb cruise, Denise Minger put it something like this: a low-carb diet is an effective treatment for type II diabetes, but that doesn’t mean metabolically healthy people have to give up fruit and potatoes to avoid diabetes. In other words, just because someone with a broken leg needs crutches, it doesn’t mean we must all use crutches to avoid breaking our legs. On the other hand, just because people can eat potatoes and fruit without becoming diabetic, it doesn’t mean diabetics should eat potatoes and fruit. In other words, just because walking without crutches won’t break your leg, it doesn’t mean people with broken legs don’t need crutches.

So to wrap up a very long post:

I don’t believe obesity is as simple as the more carbs we eat, the higher the insulin, and the higher the insulin, the more fat accumulation. Losing weight also isn’t as simple as the fewer carbs we eat, the lower the insulin, and the lower the insulin, the leaner we become. Cutting carbs can certainly promote weight loss (as it did for me), but when most of us go low-carb, we not only cut out the acellular processed carbs completely, we also embrace real fats and give up the crap oils. We eat bacon and fry our eggs in real butter. So I suspect the benefits are partly the result of reducing inflammation, which in turn reduces insulin resistance and perhaps leptin resistance.

To keep the benefits coming, it’s not necessary (or even advisable for many people) to stay at near-zero-carb levels permanently. For non-diabetics, I believe it’s better for overall hormonal health to mix it up, adding in some real-food starches, or cycling VLC days with higher-carb days.

To me, the golden nugget of the “alternative hypothesis” is that getting fat isn’t about calories; it’s about hormones. When our government told everyone to eat plenty of grains and cut the arterycloggingsaturatedfat!, following that advice created hormonal disruptions for many, many people. The cure is to 1) eat real, unprocessed food and 2) reduce the carbs to a level appropriate for your metabolism.

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While I was on the cruise, this YouTube video made a splash. It was hailed as the death of the carbohydrate-insulin hypothesis. Take a look:

Several readers emailed to ask what I thought, and I replied that since I hadn’t seen the study itself, I had no opinion yet … although little alarm bells went off in my head when I saw that the researcher being interviewed was Kevin Hall. If the name sounds familiar, perhaps it’s because he was the lead researcher on a recent study that was reported in the media with headlines like FOR FAT LOSS, LOW-FAT DIETS BEAT LOW-CARB DIETS HANDILY, NEW RESEARCH FINDS.

I wrote about that study in this post. The (ahem) low-carb diet provided 140 grams of carbohydrate per day – including 37 grams per day of sugar.  Yeah, just like Dr. Atkins recommended.  The low-fat diet, meanwhile, was truly a low-fat diet: just 7.7 percent of calories from fat.

Hall responded to that criticism by saying he had to choose a moderate-carb diet to keep protein constant across both diets.  Several readers responded to that response by producing (within minutes) two low-calorie diet plans, one very low-fat, one very-low carb, both with identical protein.  So Hall’s explanation doesn’t hold up.

The diets lasted a whopping six days each (everyone in the study was supposed to do both diets), and the difference in weight loss was a non-significant one-tenth of one pound.

In the full paper, I saw that 19 people completed the sort-of-low-carb diet, but only 17 completed the low-fat diet … and yet the researchers didn’t restrict their comparison to the 17 people who completed both diets, and didn’t provide individual data for any of the dieters. And the paper included this strange paragraph:

The data were analyzed using a repeated-measures mixed model controlling for sex and order effects and are presented as least-squares mean ± SEM. The p values refer to the diet effects and were not corrected for multiple comparisons. One female subject had changes in DXA % body fat data that were not physiological and were clear outliers, so these data were excluded from the analyses.

My impression was that Hall designed the “low fat beats low carb handily” study to get the results he wanted — perhaps assisted by tossing out a data point or two.  Clear outliers, ya know.

Those complaints about his earlier study notwithstanding, if a study is conducted and analyzed honestly, then the data is what the data is. Like I said, I haven’t seen the study he’s explaining in the video. But Dr. Mike Eades took a careful look at the video, screen-capping some of the charts so he could analyze them, and also dug up the abstract. I’d suggest you read his entire post, but here’s the first punchline:

In the video, Hall declares that the study shows there’s no metabolic advantage to a ketogenic diet. Got that? No metabolic advantage. But the title of the abstract is … wait for it … Energy Expenditure Increases Following An Isocaloric Ketogenic Diet in Overweight And Obese Men. And a sentence in the abstract clearly states:

Therefore, an isocaloric ketogenic diet was associated with increased energy expenditure of ~100 kcal/d.

Perhaps it depends on your definition of “advantage,” but that sounds like an advantage to me.

After watching the video and reading Dr. Eades’ post, here’s my opinion of the study: I don’t really care either way. As Paul Jaminet pointed out during a podcast, there are more than a million diet studies in PubMed. You can find almost any result you want. I’ve seen studies in which a lower-carb diet led to more weight loss, even on the same number of calories. This one, for example:

On the 1,800-kcal reduction diet consumed over a 9-week period, diet A contained 104 g carbohydrate/day; diet B, 60 g; diet C, 30 g. The three-man subgroups were matched as closely as possible on the basis of maintenance caloric requirement and percent body weight as fat.

Weight loss, fat loss, and percent weight loss as fat appeared to be inversely related to the level of carbohydrate in the isocaloric, isoprotein diets. No adequate explanation can be given for weight loss differences.

But I’ve also seen studies in which restricting calories led to the same average weight loss whether the diet was low-fat or low-carb. And I suppose if someone did enough digging, he could find a metabolic ward study where people lost more weight on a high-carb diet than a low-carb diet.

Again, I don’t really care. People don’t live in metabolic wards where their food intake is carefully controlled. They live in the real world. And in the real world, people respond to their appetites. For many people, myself included, switching to a low-carb diet resulted in (after years of frustration) losing weight without going hungry.

AHA! THAT MEANS YOU CONSUMED FEWER CALORIES THAN YOU BURNED!

Of course I consumed fewer calories than I burned, you @#$%ing moron! That is always HOW we lose weight. And consuming more calories than we burn is always HOW we gain weight. But as I’ve said many times (and will keep saying until I’m blue in face), HOW we get fat isn’t the same as WHY we get fat.

I tried explaining the difference in this post by pointing out that HOW your toilet overflows (more water entering the bowl than draining out) isn’t the same as WHY your toilet overflows (a clog in the drain pipe). But toilets don’t have appetites, so let’s use (or re-use) a different analogy:

Suppose I have a rather serious alcohol problem that’s affecting my life, and not in a good way. After getting a snootful, I tend to become annoyed by friends and acquaintances who haven’t fully recognized my superior understanding of all things and thus have the gall to disagree with me now and then. So I get in touch to correct their erroneous beliefs and offer strongly-worded advice on how they should fix their lives, careers, diets, social media sites, professional relationships, or whatever – for their own good, of course. As a result, my friendships soon have the life expectancy of a second lieutenant on Iwo Jima.

Waking up with a hangover one afternoon and recognizing the problem may actually be with me instead of everyone else, I vow to limit my drinking to two scotches per day from now on. But no matter how sincere the promise, one drink always leads to another and another and another. Next thing I know, I’m getting punched by strangers in bars for reasons I can’t accurately recall. I curse my lack of discipline and wonder what the @#$% is wrong with me. I really, really, really want to drink less but can’t seem to do it. So I turn to science.

“Why do I drink so @#$%ing much?” I ask the science world.

“Because you’re an alcoholic,” the researchers answer.

“But WHY am I an alcoholic?” I ask.

“Because you drink too much,” the researchers answer.

See the problem? The amount of alcohol I consume only explains HOW I get drunk. It doesn’t explain WHY I get drunk. Because you drink too much isn’t an answer; it’s simply a restatement of the problem.

But now let’s suppose something amazing happens. After making significant changes in my diet, I find my urge to drink has dwindled. I can go out on Saturday night and have two glasses of wine with dinner, then stop. That craving for a third, fourth and tenth drink just isn’t there anymore. (Long-time readers may recognize that this is partly a true story.)  It’s not a character issue, because I’m not resisting an urge.  The urge is gone.

“Why don’t I get rip-roaring drunk every time I drink like I used to?” I ask the science world.

“Because you don’t drink as much as before,” the researchers answer.

“But I used to have this powerful urge to keep drinking, and now I don’t. So it must have something to do with biochemical changes brought on by the new diet.”

“No, no, no,” the researchers reply. “We’ve done studies on this. If we get 20 people drunk for a week by having them knock back 10 scotches per day, then lock them all in a cell and give them two drinks per day for another week, they’re all equally sober at the end of the second week. Doesn’t matter if they’re alcoholics or not, and it doesn’t matter if we feed them chips or cheese while they’re drinking. So obviously the cause of alcoholism is drinking too much, and the cure is to drink less. It’s simple.”

That two-drink-per-day study may exist, and it may have been honestly conducted and analyzed. But I don’t care. It doesn’t tell me diddly about WHY alcoholics drink too much. It also doesn’t explain WHY a change in diet caused my appetite for alcohol to shrink.  Everyone remains equally sober on two drinks per day isn’t useful information for a problem drinker trying to walk past an open bar.

Several studies, including this one, have demonstrated that switching to a low-carb diet causes many people to eat less – even though they’re not counting calories or trying to eat less:

On the low-carbohydrate diet, mean energy intake decreased from 3111 kcal/d to 2164 kcal/d. The mean energy deficit of 1027 kcal/d (median, 737 kcal/d) completely accounted for the weight loss of 1.65 kg in 14 days.

If you spontaneously cut your calories by more than 1,000 per day – and yes, end up consuming fewer calories than you burn as a result – then something very positive has happened to your metabolism.  But I don’t think it’s quite as simple and direct as Fewer Carbs => Less Insulin => More Fat Burning.  Or to state it in reverse, I don’t think getting fat is as simple as More Carbs => More Insulin => More Fat Storage.

This is already getting to be a long post, so I’ll explain why I believe the “alternative hypothesis” needs some revising in my next post.

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