las

Welcome all seeking refuge from low carb dogma!

“To kill an error is as good a service as, and sometimes even better than, the establishing of a new truth or fact”
~ Charles Darwin (it's evolutionary baybeee!)

Tuesday, March 22, 2011

Insulin Resistance ~ Taubes v. McGarry ~ Speaking of Banting ...


This post is fast fowarding to the final contribution to the field by JD McGarry.  I'll back track and be posting works in between in coming weeks.  According to this tribute to McGarry, he was quite ill by this point, and indeed he was unable to deliver the lecture, but was present at its delivery.  It is unfortunate that Taubes has misrepresented McGarry's work, because as I read more and more about this man and from this man, he really was a scientist in the vein of bucking conventional wisdom ... something that should have perked Taubes' interest.




It's odd to me, that after citing McGarry in GCBC, blogged on previously, Taubes goes on to cite only Neel's work from a decade earlier (1982) to derive what he presents as the most plausible of Neel's three hypotheses on insulin resistance.  Taubes did not do as he claims and "follow the evidence forward in time from the point at which a consensus was reached to the present, to see whether these competing hypotheses were confirmed or refuted by further research."   There was almost a decade of work left to be found bearing McGarry's name dealing with the etiology of diabetes/IR that should have been considered.  Especially since he left many questions unanswered in the famous 1992 Minkowski paper.  One has to wonder why Taubes chose to go back a decade, rather than forward to see what became of McGarry's hypotheses and questioning.


Before going further, I would like to highlight the reference in it to that 1992 paper:
What has defied explanation in biochemical terms is precisely what causes this insulin resistance in the first place and how it relates in a temporal sense to the accompanying hyperinsulinemia. Also enigmatic has been why, in a presumably genetically programmed subset of obese individuals, the -cell fails, leading to frank diabetes. Is it possible that one of the reasons for this impasse might relate to the fact that traditional views on the metabolic derangements of diabetes have been largely “glucocentric” in nature and that a more “lipocentric” approach to the problem might be more rewarding (1)?
McGarry was not saying that anything that raises insulin (e.g. carbohydrates = glucose) causes insulin resistance!  Indeed McGarry seems to be a scientist after my own heart, in that he addresses the other metabolic substrate at the dance.  The forgotten wall flower:  free fatty acids.  Contrary to the beliefs of many of my detractors, I have no dog in any fight on these issues.  I would be more than happy to discover that I'm wrong on this issue.   So it's especially irony-dripping to keep finding "leads" to my POV amongst Taubes' references.


McGarry continues ...
In support of this line of thinking, it has long been known that, in addition to hyperglycemia, the type 2 diabetic individual almost invariably manifests a serious breakdown in lipid dynamics, often reflected by elevated levels of circulating free fatty acids (FFAs) and triglycerides (TG), together with excessive deposition of fat in various tissues including the muscle bed (2,3). Less clear has been whether this breakdown in lipid homeostasis is a result of the diabetic state or in fact is instrumental in its development. We and others have suspected for some time that the latter is probably the case. More specifically, we believe that a compelling argument can now be made for the notion that an abnormal accumulation of fat in muscle and other tissues plays an important role in the etiology of insulin resistance and possibly also in the demise of the ß-cell in type 2 diabetes.

There is MUCH more in this paper that I'll be discussing in the future, including some works of McGarry in the intervening years.  But I'm not some crazy bunny-eared loon here making absurd statements.  I think J. Denis McGarry, may he rest in peace, might think otherwise.  I doubt he would have been pleased with the context of his mention in GCBC.



WHY IS THE INCIDENCE OF TYPE 2 DIABETES INCREASING SO RAPIDLY, AND WHAT CAN BE DONE ABOUT IT?
As discussed, the combination of the modern diet and sedentary lifestyle has resulted in an increase in obesity/type 2 diabetes. It is evident that if people would eat fewer calories and increase their activity level, then this would reverse ectopic fat accumulation and lessen insulin resistance. However, compliance with such a strategy is clearly difficult. 
Is anyone aware of any studies on IMCL for low carb diets?  Especially in maintenance phase?  We don't seem to have a whole lot to go on in this regard.  Anecdotally, low carbers seem to have more rapid initial results but these seem to diminish as time goes on.  Are early improvements more due to caloric deficit  cleaning out the gummed-up works?  I don't claim to have the answers, but too many are advocating a diet that has NOT stood any test of time in rigorous clinical studies and for which there is no epidemiological evidence in support of.

Insulin's made for more than glucose disposal.  I maintain that improving our sensitivity to its action is by far more important to life and health than any intervention to simply minimize it's secretion.














48 comments:

Stephan said...

The FFA hypothesis of insulin resistance is interesting, but I still haven't seen any convincing evidence that it's the primary cause of insulin resistance. I do believe that it exacerbates insulin resistance in people with diabetes and extreme abdominal obesity. But how do FFA become elevated to begin with? Insulin resistance. So it's a bit of a circular argument.

I still favor the idea that insulin resistance is caused by cells being exposed to more energy than their mitochondria can effectively metabolize. According to this idea, FFA are especially damaging in diabetics because they're paired with high glucose, meaning that cells are exposed to an abnormally high energy level.

There's evidence from independent labs that insulin resistance is a cellular antioxidant defense mechanism initiated by mitochondria in the presence of more energy flux into the cell than they can metabolize effectively. Exogenously or endogenously increasing mitochondrial ROS defenses prevents diet-induced insulin resistance in rodents. There's also evidence that excessive tissue ceramides and diacylglycerol contribute to IR, perhaps by a different mechanism.

This explains why exercise and polyphenols reduce insulin resistance-- both increase the mitochondrial energy flux capacity by increasing ROS defenses and/or mitochondrial volume.

Tatsuo said...

"But how do FFA become elevated to begin with? Insulin resistance."

Hi Stephan, is this true for both fasting and postprandial FFA? (I'll take your word for it, but any refs would also be great)

Thanks,
Bill

Nigel Kinbrum said...

I also think that high serum FFAs/NEFAs are a red herring and are either a sign of over-stuffed adipocytes in people who aren't fasting, or mobilised fuel in people who are fasting.

RE Your "funny turns" while on VLC: What do you think of "Funny turns": What they aren't and what they might be?

Mirrorball said...

@Stephan
Unger and Scherer (2010) suggest that accumulation of fat in muscles and the liver causes insulin resistance (not is caused by insulin resistance). It is itself caused by leptin resistance and "our ability to expand fat pads productively" (without inflammation, necrosis etc). They say leptin is protective because it induces fatty acid oxidation. But of course it all begins with excess energy consumption/reduced energy expenditure, so what you and CS are saying doesn't seem very different to me.

[1] Unger, R. Scherer, P. Gluttony, sloth and the metabolic syndrome: a roadmap to lipotoxicity. Trends in endocrinology and metabolism: TEM, 2010.

CarbSane said...

Oh No! You Di-in't!! You cited the Gluttony & Sloth paper! LOL For this, I cannot defend you Mirrorball :-)

Physiologically what causes abnormally elevated FFA's seems to be fat cells becoming insulin resistant first. Frayn sure seems to feel pretty strongly on the evidence of this, as does McGarry (slightly different take in earlier works) and Boden, amongst others.

So the whole sudden cardiac death issue aside (really, nothing would make me happier than to be wrong on that one!) it remains that the elevated levels themselves lead to ectopic accumulation, insulin resistance and beta-cell dysfunction. Given that insulin release is crucial for proteins as well as having action in just about every tissue in the body, even in the absence of carb loads, I don't see how this can be a good thing in the long run.

CarbSane said...

Hi Nige, Just popped over to your blog and commented there. I've not really had this happen much this go round, but I'm pretty sure it was hypos I was dealing with at the time.

I would add that I guess "harmless" is in the eye of the beholder at times. Feeling like crap, like my heart is never going to slow down and I could puke it up at any moment can't be a good thing. I do think perhaps eating more protein this time and interspersing "carb ups" may have been what did the trick. Thanks for your article!

CarbSane said...

@Stephan: Do you not find Frayn at all convincing?
Adipose Tissue and the Insulin Resistance Syndrome

Stephan said...

Hi Tatsuo,

Yes, although I don't have refs on hand, sorry.

Hi CarbSane,

I don't disagree with Frayn, I'm just not convinced that the mechanism he outlines is broadly applicable (to people other than diabetics and the very obese). Here's why:

Correct me if I'm wrong, but the studies showing elevated FFA with elevated fat mass were done with very obese people, typically upper body obese, and even then the effect was not always consistent across studies. I'd like to see studies where they looked at people who were more representative of the general overweight population, and showed a similar effect. The problem with this is that you can't just correlate insulin sensitivity to FFA levels, because it doesn't tell you what caused what.

Also, studies using infusions of lipid plus heparin are interesting, but not physiologically relevant to most people.

Mirrorball said...

CS, why don't you like the gluttony & sloth paper (besides the title and moralistic implications)?

kds said...

CS: Attributing muscle and hepatic steatosis to simply getting fat is not a satisfying explanation for insulin resistance, particularly because when you compare diabetic obese subjects with non-diabetic obese subjects who have been matched for age, sex, BMI, and body fat mass, the non-diabetic subjects appear to be normal in terms of plasma FFA, insulin levels, and gluconeogenesis rates (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC442833/pdf/jcinvest00045-0183.pdf).

I think it's safe to say that obesity and excess caloric intake, in and of itself, is somewhat of a causative red herring in light of the sheer number of people who are obese or super-obese and still not insulin resistant. IOW, the lipid homeostasis derangement instrumental in the development of IR is not 'caused' by obesity or overstuffed adipocytes per se, but rather obesity appears to be somewhat of a necessary state that allows an underlying genetic pathology to reveal itself.

CarbSane said...

I have no problem with it - although I would have left out that terminology too were I the author. Just don't tell Kurt & Peter >8)

Kurt G. Harris MD said...

@ All

I agree about the poor title but I do happen to believe that gluttony exists and some people are fat because of it. (perhaps unlike GT, I hesitate to add)

The brain is a powerful organ and normal homeostasis can be overriden. Even when there is no organic pathology. Think of Hollywood actors like DeNiro in raging bull or Christian Bale - twice now - gaining or losing substantial weight for movie parts.

I also have no doubt that some who are "broken" need conscious control to avoid obesity or to avoid death (Anorexia Nervosa) - maybe forever. I don't think this is most people, though. And if you are an emotional eater you can VLC all day long and gain like heck. I've seen it.

Much of the problem with dietary discussions and the nutrition literature is that obesity is a SIGN, not a disease. It can be a sign of excess intake due to metabolic derangement - a la metsyn, or a sign of conscious overeating like DeNiro in the latter half of the movie. We know that obesity can occur early and protect us from type II DM, or it can occur late and be a sign of its presence.

Just like blood pressure, it can indicate lots of different states, physiologic or not. With BP, we can predict someone who has it is likely to have metabolic syndrome, but they may have a pheocromocytoma instead.

With obesity, it's the same. Marlon Brando showed up obese on the set of apocalypse now and it was a surprise. DeNiro overate on purpose for his part in raging bull. Which one was more likely to have liver IR? Or to spontaneously return to normal weight?

Physiologic starvation causes fat wasting to keep us alive. Anorexia Nervosa results in death in the presence of abundance. Cancer causes cachexia - wasting. Who thinks simply being thin means you have to have AN or cancer?

So I continue to say there are many different reasons one displays the sign of obesity.

It's not all carbs. It's also not only failure to weigh and measure and "move".

Because obesity per se is not a disease. It is just a physical sign that in our culture happens to correlate quite often with metabolic syndrome.

Frank said...

@all

I'm personally more than happy to see people such as Kurt, Stephan, and other (kds), having a great exchange and seeing that overall, everyone pretty much agree on many things.

"It's not all carbs. It's also not only failure to weigh and measure and "move"."

This, Kurt, is absolutly true and there can clearly be physiological situation that promote obesity (althought, in my opinion, they eventually affect the energy balance equation on one side or another and hence cause weight gain) and I think that what CS is trying to do is showing that the carbo-centric view embrace by many individual right now is counter productive and based on many false premises.

I'm glad to have such a great opportunity to learn from many ppl that I respect :)

CarbSane said...

@Kurt:

I agree about the poor title but I do happen to believe that gluttony exists and some people are fat because of it. (perhaps unlike GT, I hesitate to add)

I dare you to say that over at Jimmy's forum ;-)

I do believe that this is one reason GT is so popular amongst the low carb community - a goodly portion of which remain obese/overweight despite diligent low carbing. It is always nice to have something to blame besides our own behavior. Gluttony and sloth are just more objectionable terms for overeating and being lazy.

The ready availability of fiber devoid, calorie dense, packaged and restaurant foods makes it easier to "overeat" without being the classic picture we all envision would go with the term glutton in the dictionary. There's even a term for this in the literature! It's called passive overeating.

Similarly nobody likes to be called lazy, and being active may not protect someone from gaining if they don't watch the intake, but if you're circling a parking lot for 10 minutes waiting for a spot up front to open up .....

If people can't admit to themselves that they are ultimately responsible for their condition, they'll never change it. Is the metabolic deck stacked against some more than others? Sure. Deal with it.

I'm sure I just pissed off a whole lot of people saying that. But I know why I became obese. It sure wasn't from eating the food pyramid (however misguided that might be)! It wasn't from getting too many omega 6's or being force fed fructose or because my gut microflora extracted too many calories from my food. It wasn't the fried calamari, it was eating that for dinner too many nights of the week. It wasn't french fries, it was eating those with dinner too many nights of the week. It wasn't any food carb, fat or otherwise. It was eating them over choosing more nourishing real foods prepared at home.

Nigel Kinbrum said...

Tough love really hurts! I'm going for another walk.

Kurt G. Harris MD said...

@CS

I don't disagree that it's possible that you may be in a state now where you have to monitor the amount you eat or even that you must tolerate hunger.

I do disagree that this is the normal state of nature.

And my central thesis is indeed that the western diet has particular agents - the NAD - that can upset the normal fat homeostasis we are all born with

If I were to consciously overeat and be totally sendentary, my weight might climb to 170. When I go VLC with fasting workouts and two meals a day, I drop to 150. (Currently I am 158 due to more weight training) This, I am sure you would admit, is a very narrow range. My fat setpoint allows a narrrower range with dietary variety than is typically found in folks who have trouble with fat gain.


In an earlier post, you mentioned that you had margarine growing up. I have eaten butter, eggs and red meat, and whole milk since day one and have never eaten margarine, ever.

What makes you so sure the difference between us has nothing to do with omega 6 or trans fats, or even fructose exposure? Have you read Stephan's posts on how metsyn and obesity track omega 6 consumption or Peter's posts on n-6 and n-3 and fatty liver?

The Kitavans and the plains indians at any age didn't need to count, weigh or measure, or "work out" and neither do I. Although I had a fair amount of sugar growing up, it was a very animal fat heavy diet relatively light on wheat and excess LA compared to the SAD.

I think there are explanations for these observations, and dietary history of exposure to particular factors outside of our evolutionary experience may account for them.

And contra the assertions of Nigel or others who claim that we must be sure to "keep moving", both my weight and fat mass vary inversely with total physical exercise. When i ran 25 miles per week on the SAD, I weighed 170. When I was VLC and dropped to one workout per 10 days a la McGuff my intake sponateously dropped and I weighed 149 lbs. Now I run and lift 3 times per week and I weigh 158. And remember, I never count or measure. The point is just as Taubes says, exercise makes me eat more, and I add both muscle and fat with more exercise.

I am not saying that applies to everyone, but I am saying lack of exercise is absolutely not the "cause" of diseases of civilization. Fat people I see at the "Y" burn more calories weekly than many HG tribes, who basically hang around when they don't have to do work, just like I do most of the time...

CarbSane said...

@Nige: I'll join you :-)

@Frank: I'm very happy to have you here and contributing!

Nigel Kinbrum said...

Kurt,

In my case, "keep on movin'" is a great improvement over "keep on lyin' on the sofa surfing the interwebs."

Would you agree that many health problems are caused by excessive sedentariness? You look as though you have high NEAT/SPA. I don't!

Nige.

Mirrorball said...

KGH: 'I am saying lack of exercise is absolutely not the "cause" of diseases of civilization.'

Paul Jaminet has cited in one of his recent posts a meta-analysis that shows exercise causes all-cause mortality to be reduced by 33%. It's pretty clear that lack of physical activity is killing us and what else can we call it but a disease of civilization?

Sanjeev said...

Kurt Harris wrote:
> history of exposure to particular factors outside of our
> evolutionary experience may account for them.

It's a promising guess.

much as I like it, I mostly don't see rigorous enough analysis and suggestions for proving it, using intervention trials, for example ... mostly I see it employed as a post-facto rationalization.

I would like to see more and more rigorous work on how the guess should be tested (in other words, experiment design), and no one I've read to date has played it out all the way; "to its logical conclusions"[0], as it were ... one of which is, why are these neolithic agents associated with increased disease AND with increased life expectancies? I really don't think medical advances have increased average life expectancy much (not lately anyway ... and if you believe the nay sayers, much of the current medical/drug intervention is misguided and counter-productive) but life expectancies have been rising, even in already highly developed places.
__________________
Mirrorball wrote ...
Paul Jaminet has cited ... exercise reduces all-cause mortality by 33%

interesting ... despite the fact that exercise probably increases all kinds of risks

Kurt G. Harris MD said...

@Mirrorball

These are the same type of observational studies that show meat consumption increases mortality. They are confounded by other healthy behaviors. Although PaNu and PHD are in practice nearly the same, I don't agree with all of Jaminet's claims. I also don't think "infection" is the TOE (theory of everything) he makes it out to be. So bottom line is I stand by my assertion - distinguishing exercise from normal activity of course. lying in bed is not good but running marathons is not good either. Exercise may help mitigate the damage of the SAD, but is a tweak if you eat properly and are metabolically healthy.

@Sanjeev

I've seen no evidence that consumption of 12% of calories as n-6, or 150 lbs a year of sugar or any amount of wheat improves life expectancy. Have you? Uness you mean these "foods" are preferable to starvation.

Life expectancy aside, these are the agents that differ most between current and ancestral diets - the diets where even old people are free of hypertension, obesity, diabetes.

If you want to wait for a randomized trial, fine, but I go on the assumption that avoiding things that are not food has little downside when there are other things to eat that are better, even if the DOCs turn out to be caused by "infections" or whatever...

And that is all I advocate, and all I do.

@Nige

In another post here I referred to a heirarchy of metabolic damage. If you are in a category that LC and avoiding the NAD ala PaNU or PHD does not work for, then more conscious effort may be required, I agree. I don't agree with using that as an argument to say that LC does not work long term or that CICO and ELMM is the only real way to lose weight and keep it off. For you activity may suppress appetite, for me it makes me ravenous and I have to be careful not to eat the whole house post workout!

I've had and seen to much success for me to believe either of those.

As far as women and LC, no doubt women that were morbidly obese have more difficulty in general - women always have higher obesity rates in almost all cultures, that's the way it is. It should not surprise us if morbibly obese females have the most trouble losing weight with the double whammy of sex and likely metabolic damage that may be permanent (that's what morbid obesity indicates, IMO).

My wife has eaten VLC/LC for 4 years -5' 6"" aged 52 - initial weight 138lbs, dropped to 119 over few months and steady at that weight ever since with no weighing or measuring, ever and no regular exercise (although very physically active - walking and gardening etc.) Had she been heavier for many years, maybe it would not work, but ask any woman who feels like she doesn't look good as a size 8 that being able to drop to size 3/4 is not "success" - see what they say. And every health parameter we've measured is better as well.. And no more cold sores or yeast infections or UTIs. ever. But then, it's not just LC, its PaNu.

Paleo 2.0

Nigel Kinbrum said...

Kurt G. Harris MD said...
@Nige
In another post here I referred to a heirarchy of metabolic damage. If you are in a category that LC and avoiding the NAD ala PaNU or PHD does not work for, then more conscious effort may be required, I agree. I don't agree with using that as an argument to say that LC does not work long term or that CICO and ELMM is the only real way to lose weight and keep it off. For you activity may suppress appetite, for me it makes me ravenous and I have to be careful not to eat the whole house post workout!
Sometimes, intelligent people (I include you, me and Gary in that category) can't see the bleedin' obvious.

Like you, exercise makes me ravenous and I used that as an excuse to stay lyin' on the sofa. One day, a lady who was visiting her sister at mum's nursing home told me the solution to this thorny problem. The solution was so simple that I couldn't believe it had never occurred to me. It looks as though it has never occurred to you or Gary either! What is it?

Read my blog! Here's a bijou clue-ette: Eat Less, Move More: Solutions to problems.

Nige.

Mirrorball said...

@KGH You know that these observational studies are adjusted for known confounders ie smoking. What about the new studies that show sitting is associated with increased mortality *regardless* of formal exercise levels? Also, not being sedentary and exercising doesn't equal running marathons. BTW there is almost no evidence from randomized trials that excess omega 6 and grains are bad for you, but you don't see any reason to deviate from ancestral diets. I don't, either; and I've lost 70 lb on Paleo, without counting calories OR going VLC/LC (I eat several servings of fruits and tubers every day and I was actually obese before). I also think that spending your whole time sitting and lying deviate too much from ancentral lifestyles. I'm becoming more and more convinced that physical activity is essential for health and the reason so many people nowadays can't handle a single sweet potato. Exercise does increase insulin sensitivy acutely as per tightly controlled trials.

Kurt G. Harris MD said...

@Mirrorball

You cannot really adjust for confounders accurately in these studies - it is basically just a guess. Please google hormone replacement therapy and get back to me.

I am sure you know I am not advocating sitting and lying around all the time. What I mean is that doing cardio or aerobic exercise in a prescribed protocol, beyond normal human levels of activity, has not been prospectively proven to increase longevity. I did not say it does not make you more functional or happier. That is why I exercise. I don't do it to save my life.

Ancestral populations don't exercise. They just live.

Certainly if you have a completeley sendentary job you should go for a walk frequently. But I don't call that exercise. That is just normal activity.
Gardening, yard work, making furniture, building things... these all mimic ancestral movement patterns and are not programmed exercise.

I am talking about running, stairmasters, gym memberships, etc.

Kurt G. Harris MD said...

@ Nigel

I didn't say it was a problem I need to solve. Most of the weight I gain is muscle, so there is no problem to solve. I just said exercise made me hungry. I enjoy the hunger and eating afterward actually. I have no desire to change my current weight. I am glad you have it all figured out for yourself, though.

CarbSane said...

Hi Kurt: I think you misread. Margarine was never in my home. Mom did use safflower oil (Hain cold pressed) on salads and the rare times she fried anything. Frying was not a common mode of cooking. We had whole milk but never drank it. We didn't eat much wheat, maybe a slice or two of multi-sprouted grain bread. We ate a lot of veggies. Carb would mostly be steamed brown rice with curry powder or boiled potatoes. Red meat was somewhat of a rarity (Mom doesn't eat it), protein was mostly tuna, cheese and chicken. We never ate skin. A lazy night might be Mom getting KFC and removing the breading.

My weight problems started with eating BK for lunch too often and going on my first diet. Combined with distorted body image issues things went from there.

I get the impression that you interpret my acceptance of CICO/ELMM and the laws of thermo as being that conscious monitoring and restriction of calories is necessary. It's not. That's why I did LC for crying out loud! It's a "lazy" way to, for me, dramatically reduce intake w/o going hungry! But, as was the purpose of my most recent post, I'm by far not alone in it only taking me so far.

I've read about O6's and all of that and I'm just not convinced on the causal nature of metabolic derangement coming first leading to the overeating and the obesity. Contribute to diseases? Yes. Cause of obesity & diabetes, not so much convinced.

I'm also unconvinced on the concept of the permanently damaged metabolism for one reason: A high percentage (80+ even) of diabetic morbidly obese gastric bypass patients have their diabetes completely reversed within days/weeks before even significant weight loss.

So T2 diabetes - to me the disease is impaired pancreatic beta cell dysfunction, hyperglycemia is the result - is reversed meaning something about the GBP (I suspect GLP-1 holds the key there) restores metabolic balance and pancreatic function quite rapidly, even in some of the most deranged metabolisms.

Thus I consider it fatalistic on the parts of many in the LC realm to paint the picture of a hopelessly damaged metabolism. I think eating lower fat than most and perhaps my cheating prevented me from this (I monitored BG quite regularly for several months in 2009 on my own accord just to see).

This remains why I don't consider treating diabetes by managing just blood glucose through VLC a "cure" at all in the long run. The VLC'er will fail an OGTT and many see creeping FBG's indicating hepatic insulin resistance. In energy deficit we see improvements, often greater in low carbers, but in maintenance this is not always the case. McGarry's mindset on this seems very similar to mine. The results for diabetics in Shai go ignored. *sigh*

I've never said the diabesity epidemic was due to some failure to weigh and measure. But it cannot be explained by some sort of mass metabolic derangement due to a particular macronutrient or even subclasses thereof.

For the record, I'm not doing the triathlon to lose weight. It's more of one of those milestone things. I did one in 1991 and would like to do one now. It's hardly a marathon: 1/2mi swim, 12mi bike, 3mi run event. But, 1991 did mark my lowest body weight in my adult life post freshman year in college. I expect I'll lean out a bit and I will be consciously trying to do so before I formally train. It sure can't hurt at this point in time.

My weight and size befuddles me Kurt. I think I look my weight in pictures, but I know I don't look it in person. Twenty-something hunks don't eyeball up and down and make passes at middle aged 200 lb women who look like they weigh that much!

Nigel Kinbrum said...

@Kurt: Eating the whole house PWO sounded like a problem to me!

Sanjeev said...

I read your Alberto Salazar/Jim Fixx article when you first posted it, and I'm glad I never took up running
____________
Kurt Harris wrote:
@Sanjeev
If you want to wait for a randomized trial, fine, but I go on the assumption that avoiding things that are not food has little downside when there are other things to eat that are better, even if the DOCs turn out to be caused by "infections" or whatever...
_________________________
Funny, no I'm not waiting ... I AM on a paleo diet.

And very funny, the above is the exact reason I completely reject " ... conservation laws tell us nothing interesting ..."

I gained fat mass doing paleo so I count calories.

And While others in my situation may say " ELMM and CICO tell us nothing interesting" and wait for somebody to find "something interesting", I take the stance that the only interesting thing is that which works, and take the appropriate action and count my calories and ELMM.

Conservation laws, after all, are NOT a guess, as paleo is (a guess I agree with, but my agreeing with it and eating in accord with its dictates doesn't make it less of a guess)
_______________
The observations on the rural Punjabi diet were just me passing along anecdotes, not meant as any kind of rebuttal to paleo. While I suspect that people whose family lived in that area ancestrally have had huge selection pressures to adapt to that diet, it amazes me that there are still celiacs in that population - perhaps the human population that has had pro-wheat selection pressures for the longest period of time.

Mirrorball said...

@KGH
"I am talking about running, stairmasters, gym memberships, etc."

I do the Primal Blueprint Fitness program. It is definitely exercise, but doesn't include aerobics and running. I'm the last person you will see running. I was the classic "last kid to be chosen for any team in gym class".

Exercise, physical activity doesn't equal running or even going to the gym, and studies on exercise include activities such as gardening and walking and "what ancestral populations do" as physical activity too. That's why they are studies on physical activity, not on running. It's true that cardio "beyond normal human levels of activity" isn't healthy, just like most things we overdo, but this doesn't negate the benefits of moving beyond average levels for Western populations, which are below "normal human levels of activity". We need more exercise just to get to normal levels.

I've google hormone replacement therapy and learned a lot of things about it and how it interacts with exercise (increases muscle gains for instance), but I still don't know why you asked me to do that.

CarbSane said...

Hi Stephan, Frayn describes how the FFA's explain the "metabolically obese" lean people. Elevated FFA's seem to directly impact beta-cell function and it doesn't appear to matter why they are elevated. In energy balance this does not seem to be a desired chronic metabolic state. I've got another McGarry paper on this to blog on in the future.

CarbSane said...

@Kurt: I'm curious about this whole "it's not interesting" angle. I don't think any other hypotheses I've seen bantied about tell us anything more interesting. There's a reality that if CI>CO you will get fat. I really don't care why Joe Schmoe ate too much. If people (not you) want to believe that an apple caused them to eat an apple pie because of the insulin and glucose spike, so be it. For those of us who have been obese, we know that CI<CO must be achieved an sustained. There's no magic to it. Plain LC or Paleo does that spontaneously for many but not all. And those, like me who has lots of company in this regard, that do lose weight tend to plateau out at higher than desired weights.

This notion that we can re-tune metabolism and spontaneously our bodies will achieve some "corrected" weight does not jive with the whole of the observation.

I suspect that you would probably be lean eating junk as most of my male college buddies remained eating much the same crap and then some at 2am as us gals. But we humans tend not to eat simply for physiological hunger and therein lies another problem.

Mirrorball said...

@CS: Does Frayn explain why lean people sometimes become metabolically obese? My leanest friend starts shaking if she doesn't eat frequently and has totally irregular periods.

CarbSane said...

@MB: I think his thesis is similar to the "critical VAT" theory: http://carbsanity.blogspot.com/2010/08/critical-visceral-adipose-tissue-theory.html

Some have insufficient fat to properly buffer dietary intake and/or an inherent metabolic dysfunction in their trig/FFA cycle.

Lean men seem to be particularly at risk perhaps because they don't have high visceral fat capacity and yet they tend to partition fat to those depots. Women OTOH, tend to have the lower body, especially thigh, depots.

Kurt G. Harris MD said...

"This notion that we can re-tune metabolism and spontaneously our bodies will achieve some "corrected" weight does not jive with the whole of the observation."

Really? How many have you worked with and treated personally?

It fits my observations with acquaintances and patients and readers who adopt my WOE - It does not work for everyone, probably not you. But it works better than pretending all calories and even all carbs are the same and I've seen it work for people who have had zero luck with your CIO ELMM paradigm.

"I suspect that you would probably be lean eating junk as most of my male college buddies remained eating much the same crap and then some at 2am as us gals."

I've already posted here about my wife and I both losing nearly 40 lbs between us - 20 lbs each - and keeping it off with no weighing or measuring and with results independent of exercise - for 4 years.

My waist was 34" before and is 30" now. That's not nothing, is it? You can deny to yourself all day long that this works, but in my experience real foods paleo with limited wheat, fructose and linoleic acid works better than anything else. If it doesn't work for you, life sucks, but that doesn't mean repeating the CICO tautology tells us anything at all or that it did not work for me. My extra 20 lbs was a gut and I also have several health issues that have totally resolved without wheat or excess LA in my diet. Is fat loss the only thing that interests you? Where is your scientific curiosity?

You could just keep saying "eat less" over and over and over again....

Then I could say "how?" and you might then see how pointless it is to keep repeating CICO...CIC..CICO...like you're at a rally or something.

CICO is not interesting because the fact that the fastest sprinter in a given race always wins is not a hypothesis, it a tautology. True and not interesting.

You lost fat means there was a caloric deficit, somewhere. OK. So?

But that is not what your blog is about. It is of course all about claiming that we -those of us who believe there is more that you can do than just freaking COUNT simple calories or macro ratios - are wrong or lying or misguided or stupid or wasting our time.

Your responses seems to indicate that fat is or should be the main concern. I suppose it would be for me if I were 100 lbs overweight, but something is causing cancer and diabetes irrespective of weight, and that concerns me much more. I've never seen anyone directly die of obesity.

What bugs me is the assumption that because you might be too damaged to do LC or because you had tachydcardia on VLC, the many among us that have had great success with these tricks must be making it up or spreading lies.

Do you think humans normally need to have calculators or scales or that everyone on the planet is so damaged that only counting and weighing are to be countenanced for fat loss and nothing else can be considered?

"I really don't care why Joe Schmoe ate too much."

It really puzzles me that you keep saying that. That is the coach saying he does not care why his team keeps losing on the ball field.

Kurt G. Harris MD said...

@CS

"I've never said the diabesity epidemic was due to some failure to weigh and measure. But it cannot be explained by some sort of mass metabolic derangement due to a particular macronutrient or even subclasses thereof."

Forgive me for thinking that was your explanation.

If the first sentence - basically saying that humans normally need to monitor and have knowledge of the energy content of food before they consume it - is not your hypothesis, and you also disagree with me and Stephan and Peter and GT and many others that there indeed might have been some mass metabolic derangement due to particular agents that are outside of our evolutionary experience, then what is your explanation?

And Sanjeev and others:

The failure of real foods paleo or PaNu or any particular approach to reverse obesity or indeed any disease at all does not mean that adopting such a strategy will not PREVENT these diseases. It may just be too late.

For example, Type I DM is autoimmune and likely related to wheat consumption. But no one thinks that once you've been shooting up insulin for 20 years you are going to be cured of Type I by going off wheat. But wheat avoidance in a population would help decrease the incidence.

This kind of thinking indeed informs my approach. If someone eats low carb junk all his waking hours because of something related more to his brain than his liver, that doesn't prove anything fundamental about LC or VLC eating, anymore than knowing someone who died of pneumonia despite antibiotics would prove the inefficacy of antibiotics.

Just because something is the best we have doesn't mean it will always work. Even the most efficacious medical regimens are never 100%. Why should diet be any different?

So if Sanjeev could not avoid weight gain on paleo, that doesn't prove that if we took 100 people and applied it to them it would not on average make them, or even Sanjeev, healthier - just that one person may not have responded the way we wanted in terms of fat loss.

I admit that much of what I advocate is based on informed guessing and reasoning, and that fat loss is a minor concern for me. But on average the people I see minimizing the NAD see big health benefits and there is essentially no downside to their limitation.

They don't all necessarily find love and happiness and their stocks don't all go up. But most don't want to go back. A few of them don't lose much weight, especially if they were morbidly obese or if they are emotional eaters (think brain, not liver). But if Sanjeev was one of my patients and he got fatter just by limiting wheat fructose and LA, he would definitely be the first.

Kurt G. Harris MD said...

@Mirrorball

http://www.newscientist.com/article/dn2522-new-data-halts-largest-hrt-trial.html

For decades doctors prescribed HRT to millions of women to prevent heart disease based on large observational studies that showed heart disease benefit. It turned out once randomized trials were done that, despite their attempt to adjust for confounding variables, the observational studies still were confounded by the healthy patient bias. HRT - at least using horse urine pills, increased the cardiac risk. Oops.

Until someone does an RCT on gym type exercise or running there is no proof of mortality benefit.

Most people think programmed exercise, like at the gym, has proven health benefits. This is what I mean by exercise and what the man on the street thinks of when you talk about exercising. They don't think gardening and puttering about, even if you and I agree that kind of activity is "ancestral" and is good for you...

CarbSane said...

@Kurt: Regarding exercise, I'm personally not advocating "programmed exercise" per se, but man was not intended to be sedentary. Insulin levels rise with age because aging causes IR to increase. Thus (and I've read this in several research publications) the evidence seems to indicate that it's not the insulin levels that are bad, it's the IR. Exercise of all types has been shown to improve insulin sensitivity. To me maintaining our sensitivity to insulin is the goal.

At the very least "sport", aka superfluous activity, has existed in just about every culture. What also occurred at feasting festivities? Some sort of "dance/ritual".

Just sitting vs. standing or lying down makes a huge difference. Historically there were few sedentary jobs to drive to.

I'm not into "torturing" kids with a whole lot of exercise, but as kids we definitely moved more than kids today. A lot more. (I'm younger than you but not by much). There were only one or two "fat kids" in my class. I live in the neighborhood I grew up in. I don't know if the parents are so fearful of their kids being abducted or what, but if I leave for work around 8:30, I have to take a detour or get caught in the long line of cars backing up to drop the kidlets off. I used to walk to school and home, and sometimes from and to at lunchtime. If it weren't for school and Halloween, you wouldn't think there were so many kids in my neighborhood!

I'm not sure most people don't think activity is good for them. I know lots of gardeners who do it for just that reason. This winter, I "worked out" by bringing wood up from our woodpile, stacking it on the deck, then later bringing it into our house. Wheel barrow (the big one) sprints up a small hill was quite a workout. But I think some would find this lacking the structure and would prefer the progress marking of a weight lifting routine. Make sense?

CarbSane said...

Oh, should clarify, different types of exercise, e.g. endurance v. resistance training, can have different effects, but I've seen studies looking at all types and it seems moderate intensity + time or high intensity seem to produce similar improvements.

CarbSane said...

@kds: Have you read Frayn?

CarbSane said...

If the first sentence - basically saying that humans normally need to monitor and have knowledge of the energy content of food before they consume it - is not your hypothesis, and you also disagree with me and Stephan and Peter and GT and many others that there indeed might have been some mass metabolic derangement due to particular agents that are outside of our evolutionary experience , then what is your explanation?

I'm going to address this in another of those "clearing up misconceptions" posts as soon as I get a chance. But I think it's fair to summarize that there's some sort of perfect storm in our culture of convenience and "value" and trends/fads that has culminated in this epidemic. They say on average we Americans consume 300 cal/day more than we used to. That's one "tall" (12 oz smallest size, grande = 16, vente = 24!) Starbucks Caffè Vanilla Frappuccino® made with whole milk and served with whipped cream.

CarbSane said...

I would add that, as Lyle McDonald pointed out recently, many of those who do exercise for weight loss/control but find it unhelpful are likely overestimating the amount of calories they are expending in activity. That said, my raquetball club back when had a bar in it - a real bar that served snack foods and such too. Sometimes after playing we would pony up to the bar, knock back a few beers and share nachos. I was in great shape that year because I would still have done the beer & happy hour snacks with friends from work, but w/o the activity. I also had many friends at the time who ran at lunch time and would grab a small snack at around 3pm having not eaten since breakfast (if they did, I have no way of knowing if they ate at home).

So I do think certain exercise fads had the potential for ultimate weight gain with conscious overcompensating (reward) coupled with overestimating the actual expenditure.

Sanjeev said...

Kurt,
I think you may be mixing up CS and me.

CS doesn't count calories, I do. She specifically follows low carb because for her it obviates the need to count.

> You lost fat means there was a caloric deficit, somewhere. OK. So?

sounds to me (please correct me) like you're trying to minimize and dismiss a strategy that could be workable and effective for millions.

consciously measuring food and exercising
the conscious application of science

is far different than a disembodied,
" ... there was ... deficit" -
as if this happened by magic, by a fairy waving her wand.

> But that is not what your blog is about. It is of course all about
> claiming that we -those of us who believe there is more that you can
> do than just freaking COUNT

Again, CS isn't pushing calorie counting - neither am I actually - just noting that it worked for me. I don't need to minimize anyone[1] else to make the point. Anyone looking to be healthy should be eating non-manufactured food.

>simple calories or macro ratios - are
> wrong or lying or misguided or stupid or wasting our time.

Until someone calls me stupid or writes that I lied I don't assume "you are wrong" or "you are wasting your time" means those things.

[1] Except of course the elephant in the room who definitely appears to have misquoted and propgandized while claiming to be an even handed 3rd party (a "journalist", not an axe-grinder), Taubes

Sanjeev said...

CarbSane wrote:
> I'm not into "torturing" kids with a whole lot of exercise, but as kids we definitely moved more than kids today.

Sounds like your neighbourhood has houses and yards.

Can you imagine being a kid growing up in a downtown condo, surrounded on all sides by miles of restaurants, theatres and more condos ... and more condos ...

Sanjeev said...

> If Sanjeev was one of my patients and he got fatter just by limiting
> wheat fructose and LA, he would definitely be the first.

what advice do you have in your back pocket for your first patient that kept to the recommendations and started gaining fat mass?

Harry said...

@ Kurt

From a philosopher to a philosophy enthusiast (as per your web site), please allow me to pull you up on a couple of points of informal logic:

"Really? How many have you worked with and treated personally?

It fits my observations with acquaintances and patients and readers who adopt my WOE"

An argument from authority, a straw man, and a hasty generalisation (I doubt you want me to spell it out, but I'm happy to if desired).

Suffice it to say, CarbSane's observations as a researcher may or may not be as comprehensive as your own...the mode of the observations (i.e. treating patients directly as opposed to reading results of such treatments) is irrelevant to the conclusions being argued.

"...pretending all calories and even all carbs are the same"

Straw man par excellence. Who claims that?

"...that doesn't mean repeating the CICO tautology tells us anything at all"

Please, please stop claiming that the energy balance equation is tautologous with weight gain/weight loss...it's not even close to being a tautology (as I've comprehensively explained in terms of sufficient and necessary conditions in this thread: http://carbsanity.blogspot.com/2011/03/insulin-caused-cerebral-stress.html). If it were tautologous then the prescription "Lose weight by eating less and moving more than you currently do" would mean the same thing as "Lose weight by losing weight", which it clearly doesn't (e.g. body-builders find the first declaration meaningful and potent; no one can action anything with the latter statement).

"Is fat loss the only thing that interests you?"

For Chris-sake Kurt! Have you read CS' stuff on NEFA and VLC diets? This kind of straw man rhetoric is beneath you.

"You could just keep saying "eat less" over and over and over again....
Then I could say "how?" and you might then see how pointless it is to keep repeating CICO...CIC..CICO...like you're at a rally or something"

Another straw man (sigh). CS' response to the 'how' question has always been consistent: 'anyway that works for you, and isn't deleterious to your health' (hence her concerns about VLC diets at maintenance or above).

"It is of course all about claiming that we -those of us who believe there is more that you can do than just freaking COUNT simple calories or macro ratios - are wrong or lying or misguided or stupid or wasting our time"

CS doesn't count calories or macro ratios. QED.

"Just because something is the best we have doesn't mean it will always work"

This statement could apply equally well to ELMM. It clearly works at a physical level (works so well that you call it tautologous with weight loss!), but isn't the kind of advice that secures success with all dieters. So far ELMM and LC seem to be on par...

"So if Sanjeev could not avoid weight gain on paleo, that doesn't prove that if we took 100 people and applied it to them it would not on average make them, or even Sanjeev, healthier - just that one person may not have responded the way we wanted in terms of fat loss"

And there's the problem with WOEs that don't address the energy balance equation...they don't work for everyone (especially, I would add, those that want/need to achieve a very lean body comp, and smaller/lighter females). Conversely, ELMM (when actually applied by the subject, as opposed to when merely advised by the weight loss advice provider) always works. Period.

I think this last point is why CS keeps trying to refocus your attention on energy balance...not because your NAD theory isn't interseting (or even true), but because its tangential to weight loss. It may 'contribute' to weight loss (and of course to health), but applied ELMM 'secures' weight loss.

Cheers
Harry

CarbSane said...

@Harry: Thank you for this and taking the time to take on Kurt's strawmen. I have limited time and mental energy to expend on such of late, and what I do I would rather channel into the various posts I have in the pike rather than answering to misrepresentations/misconceptions of what I believe.

Bottom line Kurt, CICO is a reality. I think you and many others overestimate the portion of the population that can revert to an ideal weight without some conscious attention to CICO. Any method that does work, however, addresses this. For me, low carbing did a huge "service" reducing the CI without trying or counting, but I've long since ridden that ride to the end. I'm interested in my health, not just weight loss. That's why I started looking into things and I suggest you read my most recent post as of this comment.

Mirrorball said...

@KGH

It was very enlightening (and a bit frightening) reading about HRT. So no more observational studies. If you search for "randomized controlled studies exercise" without the quotes in Google Scholar, you'll get several interesting results:

http://scholar.google.co.uk/scholar?hl=&sourceid=navclient-ff&rlz=1B5_____en-GBBR336BR336&ie=UTF-8&q=randomized+controlled+trial+exercise

All of them make it clear that researchers consider that exercise is a lot more than cardio or running or going to the gym (for instance, "home based exercise" is featured in several titles).

"This is what I mean by exercise and what the man on the street thinks of when you talk about exercising."

And to the man on the street, carbs are white bread and cake, protein is a McDonald's hamburger and fat is Crisco, but we should know better, shouldn't we?

Anonymous said...

Many loan applications by individuals with bad credit are declined by lenders.
With a bad credit payday loan it is created for people with bad credit and nearly everyone is accepted.
Lenders have the ability to do this due to the fact that your payment is immediately deducted from your account on payday.
This indicates that the loan provider makes certain you are going to be able to pay back the money
you have borrowed from them.

Feel free to visit my web-site; Bad Credit Credit Payday Loans

Post a Comment

Moderation is currently on. Thanks in advance for your patience.