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Friday, June 10, 2011

Is LC Morphing to HAES? Part V: Health and Insulin Resistance

So let's continue with this look at the "low carbing for health" irrespective of weight loss trend.  The topic of this thread will be insulin resistance.  

I believe the misguided notion that carbohydrates cause insulin resistance, as put forth in GCBC by Gary Taubes, is one of the single-most potentially harmful theories circulating about the LC webosphere.  The research just doesn't support this etiology of pathological IR.  This is complicated further by confusing physiological IR with pathological.

I think it's pretty fair to say that most of the big names in the field - from McGarry to Boden to Frayn to Bierman and so many others - point to pathological insulin resistance, either innate to someone's fat metabolism or induced by over-stuffing the fat cells, begins with the fat getting "sick" and resistant to insulin.  This leads to elevated free fatty acids (NEFA) and all the implications thereof.  Clearly there's something more to it than just elevated NEFA levels -- there are indications that flux rates are important, and/or an inherent metabolic defect -- that makes for the progression to IR and frank type 2 diabetes.  But lipotoxicity is a very real issue to be concerned with as regards proper cellular function of every organ, system and tissue in our bodies.  NEFA levels clearly play a role in pancreatic beta cell function in both the basal state and glucose stimulated insulin secretion.  

A comment I've often received is if LC seems to have "cured" so many low carbers of their diabetes or MetS, how can this diet possibly cause insulin resistance.  After all, this would indicate a reversal.   To them I would answer as follows:
  • IR measured as whole body glucose disposal is indicative of an over-nourished state.  This will be ameliorated by inducing an energy deficit state.  Since many low carbers spontaneously reduce intake far more than standard caloric deficit diets, it's not surprising that we see short term improvements.
  • Long term studies with low carb tend to increase carbs well above ketogenic levels and do not resemble the diets many long term low carbers follow and advocate.
  • Improvements in insulin sensitivity may well be due to weight loss/caloric deficit alone (and/or to including exercise in one's regime).
IR really is the underpinning of the problems with obesity.  There can be little doubt about that.  Some obese do not become IR -- for those, they can be healthy from a CVD point of view.  These are mostly those who carry their fat below the waist, thighs specifically.   This is also why we have those "metabolically obese normal weight" people.  These just exhibit the insulin resistance sooner -- they don't have as many fat cells or have low inherent fat buffering ability.

I really don't think that we can ignore that the biggest contributor to physiological insulin resistance in the SAD is the fats.  While Gary Taubes has shifted his focus a bit to fingerpoint at fructose, you really have to be consuming a huge amount of sugar to exceed the thresholds in any of the studies demonstrating this effect.  Therefore someone drinking 2L bottles of Coke might exhibit signs of impaired glucose disposal, and may well lead to IR in the liver - which plays a key role in distributing insulin to the rest of the body.  But what excessive fructose does is top off glycogen stores thus limiting non-oxidative glucose disposal (glycogen synthesis).  All that is needed to reverse this is to drain the glycogen stores.  This is not all that unlike how the overnutrition of a high fat meal impairs glucose oxidation temporarily.  

In any case, Jimmy Moore is shooting his business in the foot exposing some low carb products for what they are lately.  Jimmy is big on promoting how healthy his diet is despite his wild weight fluctuations, significant regain and persisting obesity.  And he's adamant about the "proper" low carb diet being high in fat.  Very high frankly.  I noticed something a little different than apparently others did about the results of Jimmy's experiments.  His fasting blood glucose levels for the 5 days he tested ranged from over 95 to just under 105.  That's bordering on or officially "prediabetes".  Elevated FBG is indicative of hepatic insulin resistance.  I'm not surprised by this.   Was it worse when he was 410 lbs?  Perhaps and likely when one looks at his former eating habits ... but is low carbing despite maintaining a considerable amount of total weight loss keeping insulin resistance at bay?  Seems not.  I might add that Jimmy's lipid profile is at the very least far from normal!  Seven years and counting pretty consistently low carb.

Next up, Dana Carpender.  She's  a 15 year veteran of "fighting the low fat lie".  Near as I can tell, this woman is a lot like Jimmy in the adherence department.  A bit of carb creep here and there but rather mostly maintaining an LC lifestyle.  Lately rarely over 30 grams, if 20 at that, from what I recall from recent posts.   And yet, in this past year she was diagnosed with PCOS and put on Metformin.  OK ... so the usual retort is to say well, suppose she hadn't lost 40 lbs 15 years ago and was eating carbs.  Ummm .... well, we DON'T know!  We do know that low carbing hasn't prevented her from demonstrable -- almost diabetic level -- FBG's  indicative of hepatic insulin resistance.  Because, as we know, it ain't coming from her diet.  And she does seem to carry a significant amount of central adiposity.

A somewhat lesser known person, nonetheless active long term low carber is Mary Titus.  In this interview with Dr. "Carbs Can Kill" Su, Mary discusses her low carb life and how she was diagnosed with prediabetes.  But ... again ... we have that it couldn't be her diet.  And again, I ask, do we know?  The alternative is her diabetic Mom who ate a SAD.  That's not the proper comparison.  Sorry.

Amy Dungan disclosed that she, too, was diagnosed recently with prediabetes.  Now at this point I don't quite know what to make of Amy and her conflicting accounts regarding adherence to the low carb WOE for a decade.  But either way, whether she's just made a few bad choices here and there but mostly been low carb, or, if she's been more on and off all the time, there's a lesson to be had anyway.  Insulin resistance resulted.

So ... there you have a few examples of prominent, dedicated (to the cause at least) low carbers who are exhibiting the signs of insulin resistance.



Mario Iwakura said...


If fat consumption and obesity is connected with IR and diabetes, how can we explain the high incidence in Japan?

Perhaps is not the diet per si, but the toxins in it. Healthy fish consumption is associated with higher risk of type II diabetes:

As well as heavy metals, like mercury, lead, etc:

Melissa said...

T2 Diabetes is increasingly viewed as an autoimmune disorder.

I seriously doubt though that the bloggers mentioned here are suffering from too much fish 0_o. I think they should try a more anti-auto-immune approach a la Failsafe or The Paleolithic Solution. I'd be curious how Jimmy reacts to Erwan Le Corre's Movnat Clinic, where he serves a relatively lean(in comparison to more low-carbers) and restrictive diet with vegan lunches. I thought it was a great diet, but some of the folks there had A LOT of trouble adapting.

Melissa said...

I also wouldn't be surprised if some of these bloggers are micronutrient deficient.

Thomas said...

Holy cow! JM's former diet is incredible. Hard to believe someone can eat so much garbage. It doesn't take LC to improve upon that. Based on that account, I doubt the fact that his weight loss diet was LC was a significant factor at all. If he were to eat the same volume of LC, high fat food, he'd weight 800lbs! I think a calorie reduction (reduced food volume for those who think "calorie" is a bad word) is the likely culprit for any of his weight loss success.

Thomas said...

@carbsane-I've asked this of stephen and Don Matesz, and I'm wondering if you would respond as well (Stephen has answered, Don not yet)? I've read and heard this from people (especially LC advocates) quite a bit "I gained weight on a 1000 calories per day". Question: Do you think it's possible to gain or maintain body fat on a 1000 calorie per day diet with a BMR that is over 1000 calories?

Melchior Meijer said...

Feed Jimmy a strict but ad libitum paleo diet (meat, eggs, fish, fish row, fruit, vegetables, starchy roots, but no grass seeds, dairy, no added sugar and fat), let him start most of his days with a short bicycle trip to the swimming pool, followed by half an hour of gently doing laps and a short ride home, throw in some brief weight baring exercises throughout the day and within six months Jimmy will be the male equivalent of the gorgeous Sarah Fragosso (no sexism involved here, just plain admiration).

He will also become insulin sensitive. Why? I don't know. But I see this happening in the obese and insulin resistant people who go paleo a la Robb Wolf. If I were Jimmy, I would hire Wolf and follow his advise to the letter.

I can predict some reactions. 'He only needs to do the exercise part to get the results you describe.' I doubt that.

CarbSane said...

Hi Mario, I think you've posted here before, but if not it can't hurt to extend a duplicate greeting. So, welcome!

I tend to think the trends in the Japanese reflect what is happening to us in the West - IOW increased industrialization of the diet, and obesity rates.

The hypothesis put forth in the subject of this blog post appeals to me.
Basically that we exceed some critical level of adipose tissue then things go awry. Perhaps historically lean cultures are predisposed to IR at lower thresholds of excess fat in the diet? This is consistent with Frayn's discussion on the progression of IR/T2 blogged on here:

I'm beginning to wonder about my own fish consumption based on some thyroid discussions with, among others, another Mario here!

@Thomas: Even in my bingiest days I could not have eaten all of that. Jimmy still eats a lot sometimes, like when he ate 25 chicken wings in one setting. Now when one thinks 25 wings - perhaps they're little - that doesn't sound like so much food, but go out and order that once and see how much food it is. I think LC is working to keep him gaining it all back because it's more difficult to overeat protein and fat in combination, and he's a professional dieter - so he can eat LC and extreme versions when he's throwing down his latest challenge. Still each time he does that, he's rebounded back up a little further. I pointed that out to him once or twice. He's not listening.

As to the 1000 cal/day. No, it's impossible to gain weight IF one's BMR IS indeed 1000 cal/day. With caloric restriction, we do tend to partition more energy to fat vs. lean. I think what happens in those who report gaining on 1000 cal/day is that (a) they're probably eating more than that at least every now and then, and (b) eating at that level, their metabolisms have been dialed down to where that's maintenance.

CarbSane said...

@Melchior: What's sad is that Jimmy has interviewed many like Wolf, and commenters too numerous to mention have suggested what you're suggesting and he mostly ignores (and worse often barks back "who asked you") the advice.

That diet would improve insulin sensitivity because it would cause him to lose the excess weight, and including some carbs in the form of potatoes would mean less fat in the diet - even if all of his meats are fatty. Carbs promote IS not IR!

You have to follow this man's menus a bit and one sees he adds a crapload of additional fats to his menus. Like this pizza:
I'm thinking the two slices of Purity bread are not his ultimate problem.

CarbSane said...

@Melissa: I'm sure it's an autoimmune disorder in some, but that we can induce it through diet alone argues against that being the major cause to my mind. Micro deficiencies? Well, Jimmy eats a lot of food and takes a ton of supplements. Mary is big into trying various supplements like Mg and VitD to manage her blood sugars and has shared a lot of that over at Jimmy's forum. Dana has described herself as an accomplished swallower (unfortunate self-reference ;) ) so unless she's taking all the wrong supps that would rule her out too. Don't know about Amy though she does mention taking her supplements.

The more paleo diets, even the higher fat versions unstarchy versions tend to come out at around 60% fat and LOWER calories. All of these 4 seem to aim for 75% fat or higher. At maintenance or above maintenance levels this is a LOT of fat in absolute terms. I've yet to understand why 80% or even 85% ground beef need be fried in anything.

Mario Iwakura said...


I'm the "other" Mario! ;-) Just altered my blogger profile to show my first and last name.

I think you didn't read the japanese I post... Diabetes incidence is very high among 50-59, 60-69 and >70 years old japanese. I don't think this is reflecting westernization or industrialization of their diet neither obesity rates.

My father, for example, eats pretty much what he have been eating his hole life (he's 75): a tipical japanese diet, high in fish. He is not obese, and yet has type 2 diabetes...

Melissa said...

Yes, it's interesting/scary that I do know so many people who ate well and remained lean, but developed type 2. There is some evidence that if you grew up in a bad environment (war, not enough food, etc.) you will be predisposed to these things, esp if your diet is higher in calories.

I don't think supplements are very good for you. All those bloggers would probably be better without them. There is ample research that they cause problems that are not caused by the nutrients in foods.

I think there is some difference in the paleo community among those who are coming from conventionally healthy diets and those coming from SAD like Jimmy. Erwan and I were raw vegans. Even now I'd never touch something like meatza or cauliflower cheese casserole.

Thomas said...

@Melissa-can you point me toward the the supplement research you just mentioned (I'm interested, it's not a challenge). I have a hard time trusting those in the nutrition world who have a financial interest in their beliefs or their science. This includes Jimmy Moore and anyone hocking supplements. I think the majority of supplements are likely useless for most healthy people, but can be used by a competent person in helping to treat illness (like drugs). There are some "supplements" that are really more of a food, including fish oils, and green drinks. These are highly processed, however, so I'm not sure about their benefits vs. risks. Any thoughts?

Jim said...

I think the main question this topic raises is "Is there an optimal amount of dietary fat to maximize insulin sensitivity?" Cordain et al quote a rat study that says the fat optimum is under 37% of calories, but my n=1 experiments show that the fat quantity is a constant that does not vary with carb level. For me, it is 0.8 grams times lean mass in pounds, which incidentally, also seems to be the protein optimum. When fat goes lower, it seems to overwhelm limited glycogen stores, and when fat goes higher, I feel the worsening mood and worsening physical performance of insulin resistance.

CarbSane said...

@Jim: Welcome if you're new here (I lose track with common names). You raise a good point too as regards fat intake - that is also % vs. absolute amount.

Since at least in the research papers I'm reading, chronic insulin resistance is related to the cyclical fat metabolism - IOW our fatty acid/triglyceride cycling - and disruptions in it that and the "buffer" function of our fat tissue - it would seem that there's an absolute amount of fat we should eat at any time to not disrupt things.

I think the metabolic changes with long term VLC also don't bode well for those who periodically go off LC (my interest as well), especially if they binge or overeat (gain weight).

My n=1 experiences (that seem to be evident in pictures of Amy Dungan through the years) have been that I've gained weight in different areas than I used to - and we're talking yo-yo ing for 15+ years on every sort of diet program before ever trying Atkins.

Sanjeev said...

>> optimum is under 37% of calories, but my n=1 experiments show that the fat quantity is a constant that does not vary with carb level.
You really piqued my interest there.

What self-experiments are you doing that are capable of determining optimality?

CarbSane said...

@Mario: I did read the paper but not thoroughly. The focus seemed to be the increasing incidence of diabetes over a 10 year span.

There's lots of information out there of metabolic problems post famine or nutritional deficiencies in mother's diet, infancy or growing years that manifests itself in adulthood. The "saying" goes the women tend to get obese, the men become diabetic.

Your dad is my folks' age which means he was a growing kid during WWII.

Jim said...

@Sanjeev: I wrote a nutrition program that can plan meals with specific macronutrient levels. It is available at I also own a bathroom scale that reads body fat percentage. My software can do linear regression on daily weight and body fat measurements to determine calorie balance. Now, I can vary macronutrient levels and see what happens. Well, what happens is pretty obvious; when fat goes high I feel crummy unless I am gaining weight.

Jeff Borsato said...

what makes people feel full?
for me its burger king triple whoppers.

if i eat the whole thing minus the bread and fries and instead double up on the ketchup, mayo and more meat i will never approach the kind of satisfied fullness i feel if the bread or fries are included. thats just me.

thats also likely the hoards of LC folks who cant keep eating more protein/fat to fullness because they find that carbs seem to be the right fit to fill them up to the point of true satisfaction. regardless what happens hours later or the next day.

dieters know that its those first few minutes or hour that are hard, attempting to resist the urge to binge or eat foods we deem no good.

the trick is to consider not so much how many calories but what strategy keeps your hunger in a controlable tolerable range that you can stop eating. if a bit of bread or carbs can do that, then why instead eat copious amounts more of meat and fat that likley exceed the caloric content exponentially just because you dont want a slice of bread?

i find i can avoid the carb binges if i eat small amounts of them, and that its much more sustainable than avoiding them outirght or VLC which again i believe is wildly overstated in the public, i would be the majority of people who believe are VLC are eating double the carbs they think via sauces, and hidden thickeners and willfully misrepresenting how many of those brownies they really ate at the office bake sale!!!

Shannon said...

New here and very interested. I can't wait to read everything. Eating fat and adding fat to foods makes me feel ill. Seriously ill. I know a lot of LC people and paleo/primal people do that, but it makes me want to vomit to think of fatty meat, thick sauces, etc.

@Melissa, I am so glad your posted about Erwan's menu at his MovNat clinics. I googled it and came up with some great that actually sounds appetitizing to me. For so long, I've thought something was wrong with me because all the added fat and fatty meats do not sound good to me. It seems like so many paleo/primal people are drowing everything in fat and I found some pictures of Erwan's food at the clinics and they look DIVINE. So glad I found this site.

I had WLS (unfortunately) 2 years ago. Even at my highest weight of 365 I was never diagnosed as IR, diabetic, or as having MetS. Everything was (and is) normal. My last fasting glucose was 70 and fasting insulin was <2 (lowest value). And I'm still a fat butt. I was dx'd with Hashimoto's at age 16, but I don't know how much that has to do with it -- although by that age, I was 265 pounds. I'm 32 and about 250 now, but it is really, really hard to lose more weight, even with a smaller stomach. I crave food and I think it's because my body is below its set point possibly (since I've been big all my life). My surgery has also left me with acid reflux, for which I have to take Prilosec OTC and thus don't absorb nutrients as well. I can say that since I've increased my protein and decreased grains, my hunger is decreased. I love reading about health and nutrition and am excited to learn. Thank you, Evelyn, for being a voice of reason.

CarbSane said...

Welcome Shannon!

One thing that bothers me lately is that all obese think they must somehow be on the verge of diabetes and it's just not so. Clearly a much greater proportion of the population is *at risk* of developing it, and obesity is definitely a triggering condition for those more genetically predisposed. This is why, IMO, we are seeing the rise in incidence with the rise in diabetes, with it occurring at younger ages, etc.

I hope you'll find much of use and interest to you here. I also hope you can find ways to improve your WLS-associated symptoms. A very nice lady by the name of Katie Jay runs NAWLS. I don't know much about her group or her nutritional/dietary philosophy (other than she was embracing LC for a good time back in 2009 but isn't very publicly active doing so (on anyway) these days. But may be worth checking out.

CarbSane said...

Oops should be the rise in incidence of diabetes with the rise in obesity there. More people are getting obese and younger.

Shannon said...

Evelyn, thanks for the info about NAWLS. I am definitely going to check that out. I think I need a kick in the butt. The truth is, I've regretted my surgery for quite a few reasons (reflux, fatigue, anemia, low in all B-vitamins, etc). But it is done and I need to put a new spin on it and see it in a new light. Living with regret isn't living. I now know it wasn't the right thing to do; but that doesn't change the fact that it's done.

CarbSane said...

I've known a few who've regretted their surgery. It is not free to join, but getting the support or talking things out with others who I'm sure feel the same way will surely help. You are right "living with regret isn't living". So look at the positives going forward and hopefully you can at least improve some of those health issues. Down 100 lbs is nothing to sneeze at. Congratulations to you for that, even with WLS assist it's not easy to lose/keep off the weight. Best to you :)

wholesaleherbs said...
This comment has been removed by a blog administrator.
lynn said...

Shannon - Have you checked out Most hypo people have difficulty losing weight until they get their frees optimised, yet most docs simply look at the TSH, which won't help at all.

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