The Damaged Metabolism Part I

This post is a bit of a "rush to publish" w/o any scientific literature or blog linking, etc.  I'll hopefully get to put the finishing touches on further installments addressing some studies (some James Krieger has discussed in posts on his blog and in comments here, and some others) and such.  

But the discussion came up again in the comments HERE , and I figured this might be as good a time as any to put at least a few general comments together.

We hear this term a lot.  The "damaged metabolism".  What does that mean really?  Near as I can figure, there are a group of people who believe that "metabolism" refers mostly "glucose metabolism" ... and this is assessed not by the metabolism of glucose (glycolysis) but rather by the ability to properly clear glucose from circulation.  This in and of itself is a misnomer.  Actual defects in glucose metabolism -- glycolysis -- are quite rare.  Indeed they are likely fatal if significant because we need glucose and the ability to "burn" it for ATP/fuel production to survive.  Indeed most cases of "glucose intolerance" are linked to defects or problems in what is known as non-oxidative glucose disposal.  Not the metabolism of glucose for fuel but a defect in the metabolic pathway for storage as glycogen.  There is evidence that a pre-disposition towards this problem is genetic, though environment (diet and inactivity) clearly contribute in just about every case.  Further, changes in diet and activity can dramatically improve this defect.

So ... damaged?  Perhaps, but well within our ability to influence through diet and, more importantly, activity.  And just about any activity, contrary to what you might have heard!  Measures of peripheral insulin resistance are generally measures of glucose clearance from circulation.  And IR can be improved by exercise varying from the now much maligned "chronic cardio"/endurance exercise to HIIT, to more classic resistance training.  While some strict application of one type may be better than another, if you have a damaged glucose metabolism, what to do?  Get up off that computer chair and move.  Just move.  You'll do your metabolism -- glucose that is -- wonders.

OK, but can you do permanent damage?  Well, yes.  If you've progressed to being an insulin dependent diabetic (even through no lifestyle fault of your own as in T1 and autoimmune types) there's likely a permanent damage to your glucose metabolism.  I'll be taking on the debate of whether reducing carb consumption to a bare minimum or ingesting reasonable carbs and supplementing with insulin is preferable here.  But, that said, if you're recently diagnosed or merely obese and very insulin resistant, your metabolism is deranged, impaired, out-of-whack, etc. -- it is showing the signs of temporary damage -- but you can take your body to the shop and fix it.  Perhaps like tuning up an old engine it's not like having a brand new car, but it's still more than capable of doing the job.  From the gastric bypass results, to that crash diet cure, to intensive early insulin therapy -- all have shown a high success rate for not just glycemic control, but actual "cure" for the diabetic state where a high percentage can enjoy normal or close-enough-to-normal glucose tolerance.  That, my friends, would be a "refurbished metabolism" in my book.

So ... this notion of some permanently damaged "glucose metabolism" is, IMO, largely bunk.  Yes, if your pancreas has indeed suffered irreparable damage, then yes, it is permanent.  But if not, it can be restored, perhaps through diet only, and perhaps with temporary pharmaceutical intervention.

Then there's the other "damaged metabolism" that is often referred to.  Does dieting -- caloric restriction -- damage one's metabolism?   I think there's no doubt that it does.  In study after study when it's been measured, both basal and total energy expenditure tends to go down with prolonged caloric restriction.  This is metabolic adaptation.  A survival mechanism.  But for the individual, this is complicated in the "anecdote" by the fact that once you weigh less, you will actually need less.

There is a body of animal and human evidence that shows that caloric restriction, even mild forms, results in an efficiency that preserves lean mass but favors saving fat for a rainy day over building lean mass.  The body becomes more efficient in the face of scarcity just as we do in our daily lives.  Reduced obese have lower energy expenditures than never obese weight-matched peers.  This seems so depressing on its face.

Of course the LC schtick on all this is that because you get to eat high calorie, you avoid the fate of those hapless calorie restrictors.  Ummm ... no.  If you truly are eating more on LC and losing weight you have a "damaged digestive system" -- as in a fat absorption problem, and should probably see your doctor.  Otherwise, if you're losing weight you are doing so by having established a caloric deficit and your BMR and/or TDEE will also go down accordingly.  Perhaps in the short run there is an increase in NEAT (non-exercise activity).  But carbohydrate restriction is the SAME metabolically as starvation for the body.  I think this is the reason so many long term low carbers (excepting those who were never obese or significantly overweight to begin with) struggle so.  If calorie restriction tanks one's metabolism, then carbohydrate restriction seems to do this doubly so over the long haul.  

So ... what of the damage to your metabolism of dieting?  My personal experience leads me to believe that this damage is not permanent -- or at least not completely so.  There's no way to know what my TDEE or BMR would be today had I not gone through all the cycles and such in my life, but it's not zero.  And it does appear to have rebounded considerably (although that is my impression since I never had it measured or kept much in the way of meticulous records).  Still, I don't struggle against an appetite to prevent regain.  (My issue is with losing more.)  And even if our "dieted" bodies are more efficient in energy utilization to move, walking a mile still burns more calories than not doing it.  So what if Frank burns 120 cals and Sally burns 100 and I only burn 80.  I still have the ability to burn the 80 -- and in doing so do something about that other "damaged metabolism" I addressed up on the top of the page.

When you lose weight you lose some lean mass.  Getting sufficient protein seems to minimize this, but it is not a total stop gap.  And, frankly, you don't really want that b/c you just don't need the organ capacity to sustain the smaller organism you've become.  But just because you've lost it doesn't mean you can't enact strategies to help build muscle.  Here is where a high carb, moderate-high protein diet seems to outperform a high fat, moderate-high protein diet.

In closing I'll leave you with this.  And perhaps it's Pollyanna wishful thinking, but it beats defeatist negativism in my book.  There's almost no such thing as the hopelessly damaged metabolism.  In almost all cases, one can repair and rebuild to live fully another day.  < /corny >


piranha said…
Hi carbsane! I've been really enjoying your blog for the past few months, however confused I may be by some of the terminology (my interests lean more towards the artsy fartsy). I was diagnosed with bipolar disorder when I was 18, and I'm now 22. I've been able to keep it fairly under control with medication, but I still have ups and downs. I'm now seeing a practitioner who bases his work on the "paleo template", and he's prescribed a ketogenic diet a la Perfect Health Diet by Paul Jaminet (50 g carbs/day) to help combat my mood swings. I have terrible digestion from an anorexic history, but now have an overeating problem that's packed on 20 pounds (150, 5'6) above my healthy weight (130-135). I'm curious what your thoughts are on the long-term effects of such a diet. I don't expect you to prescribe anything or be able give me all the answers, that'd be unfair and of course everybody's different, but I would really appreciate any comments from your very learned self on the subject :)
ejazz1 said…
I seem to be a perfect example of being insulin resistance type 2 diabetic that had a damaged metabolism. When diagnosed I weighed 323 lbs, lost 150 lbs changing my diet by following the dash diet and and started to exercise. I don't consider myself cured of diabetes but I do have it well under control, my a1c results have been 4.2 for the last six years and I'm able to eat a large amount of carbs but not any product made from refined flour, white rice or large amounts of sugar. But I also believe there is a heredity factor, at least in my case. Both my parents were type 2, both my sisters are overweight and in their 50's but are not and my aunt who has never weighed more than 130 lbs in her life has been a type 2 for almost 20 years.
Anonymous said…
Piranha, just an unsolicited response! Have you looked at the supplement recommendations the Jaminets make? I ask because I found they made a difference for me, re: OCD and anxiety. (Not the same as bipolar, I realize.)

Along that line, have you looked at True Hope's multi Empower Plus? I find it interesting, as it features most of the vitamins and minerals recommended by PHD (minus the K2, which I just get as a separate supplement). It was developed for bipolar, and is also being tested for OCD, ADHD, and other conditions.

I'm not doctor, of course! Just an enduser, passing this on. Good luck!
CarbSane said…
Welcome piranha! How long have you been doing this and is it helping? There seems to be a big difference between essentially no carbs (<20g mostly from non-starchy veggies) and around 50g in terms of the long haul. For me I've decided to eat a few more than that (75-100g/day) because I see potential (emphasis on potential) risks for a high fat VLC diet. However, what you're discussing is a therapeutic diet to treat a condition, and in this regard, whatever risk must be considered against the benefit and/or risks of the alternatives. And, as you've recognized I'm not a doctor or in the advice business, but I'll answer this in the context of "what would I do". Were it me, if I could avoid medications for this condition through diet, any possible risk of the diet would be outweighed by the benefits ... especially because most of the pharmaceuticals carry with them far more risk and undesirable side effects. It may be that the diet doesn't do the full trick, but even then it should minimize need for meds.

Do stop back and let us know how you're doing!! And if you haven't already, Steph's suggestion on the supplements sounds great. Paul is most generous with his time over on his PHD website so I would definitely pick his brain too if you haven't already :)

Best to you!
piranha said…
To Steph: Thanks for the advice! I've never heard about empower plus, but I'll look into it, sounds interesting. I just bought the PHD book and am looking through more of it now, so I'll look through what supplements he recommends. I do take a multi and a magnesium supp, along with B12 and a few herbal blends for my anxiety and ADHD isssues.

To CS: Thanks for responding! My practitioner is an awesome one, I just like to hear from others :)
Yes, I completely agree with you when it comes to weighing the benefits against the negatives. The keto diet has given me a bit of relief, my energy is more consistent and the mood dips (mine are always manic depressive) aren't as low, unless I'm on my period, in which case ALL my symptoms rear their fire spitting, medusa-like heads. Medication right now is an absolute must (wellbutrin, lamictal, adderall). Without them, life is unbearable. I also agree that VLC diets seem to have their downfalls, either rebounding weight gain or in the case of that Polish diet who's name I'm completely blanking on, stomach cancer. No bueno.
Other therapies I'm trying: Gaps diet for digeston, blue light therapy, vit D supp.

I'll definitely keep you updated on my progress with the diet and maybe swing over to Paul's blog and send him a message. In the meantime, keep up the good work!
RRX said…
I like that you mentioned lean body mass. I think the distinction is crucial about what components make up LBM in order to understand that it's ok to lose some with weight loss. As you said, larger organs are just not necessary. For me, the parts of LBM that are important to try to maintain during weight loss are the ones we can do so with more protein and with weight-bearing exercises - bone density & muscle mass. Even muscle mass is variable, I think, depending upon the body part. For example, when I first got to 180 lbs I had some amazing calf muscles that busted out all the time. But, they were not made for 180 lbs me. They were for walking 300 lbs me around. A year later, they were MUCH smaller. Many years later still, they're WAY smaller than they initially were - especially since I am not interested in their size or in spending any time on trying to get them larger.

Essentially, I agree that LBM is going to also be lost during weight-loss and that isn't necessarily a bad thing outright. And with that comes a loss of kcals/day required to support that mass/musculature. There's some lowered metabolism there. Sure, it would be nice to have a higher metabolism from that mass, but I am not going to put in the work to get the mass to increase my metabolism. All in all, I'll take the hit on my metabolism. My time is better spent on things other than calf raises. Lol. If someone else wants to, then go for it. I'll make sure to compliment 'em on their calves.
Duffy Pratt said…
Are there studies showing that weight loss on a low carb diet also leads to a lower metabolic rate? Or is it a conclusion you have drawn from other information (e.g. that an effective low carb regime also reduces calorie consumption)?