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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, October 11, 2011

Science Krispies ... with a Tall Glass of Leptinade!

Yes folks, Science Krispies are best enjoyed with tall cold glass of Leptinade, stevia sweetened of course.

Last week over at PaleoHacks, I've gotten to know a bit more about someone I'd heard much about on Jimmy's forum, but never really bothered to look into.  Dr. Ron Rosedale, author of The Rosedale Diet.  I have a post in mind on some of his claims but we'll see if it floats my boat to post it up.  It was an odd coincidence that I was also skim reading through the copy of Nora Gedgaudas' PBPM book a friend bequeathed to me, and came across the section on leptin resistance, complete with referencing and a quotation from none other than Rosedale.   And when at PaleoHacks, there's no avoiding "The Quilt", aka Jack Kruse Neurosurgeon!  (Whenever I see his name I imagine some movie announcer booming Neurosurgeon! in action hero voice, with Jack as Dr. Evil flipping epigenetic switches on Mini-Me).  Jack's stance on everything seems to boil down to either you're leptin resistant or you're sensitive, and all manner of things can be explained with this simple wave of the hand.  Can't lose weight?  Resistant.  Eat 50g protein within an hour of waking and in a few weeks you'll be able to walk on water eating 10,000 calories a day of dark chocolate covered macadamia nuts while losing weight, all thanks to having reclaimed your leptin sensitivity!  It's a wonderful philosophy to have because it explains everything!


I'm not going to sugar coat this, these three not only set my bullshit detector off rather quickly, but they peg the meter.  There's a lot there, but let's talk this notion of leptin resistance in general for today.  Now leptin resistance is certainly a legitimate recognized condition.  Much like insulin resistance is.  (Someday soon, we may be talking about ASP resistance ... yes, it's true!)  But as with IR, there remains much to be learned (more for leptin because it was discovered decades after insulin) as to the mechanisms, causes, and what actually comprises "resistance".  Consequently, there seems to be a lot of misinformation out there about LR, and thus it is a topic ripe for guru malarkey.  So let's begin with what the Leptinade Triplets say about how one determines if they are indeed leptin resistant.

Oh ... I don't know.  How about having leptin levels measured and see if you have hyperleptinemia?  For all the self-diagnoses and treating going on around the low carb community,  few seem to bother to actually know what's going on in their bodies.   Indeed one of the knocks on scientists, and those of us who read and discuss their work, is that there's too much of a focus on studies and science and not enough about the reality of what is seen in clinical settings and such.  That somehow the results in a metabolic ward do not extrapolate to free-living humans, as if somehow being confined in a controlled setting dramatically alters one's metabolism.  But some genetic knockout mouse?  Now that they seem to relate to.  Me, me, me!!   You can be obese w/o being hyperinsulinemic or IR.  If you just assume ... well ... you know where that gets you.

How do I know if I am "leptin resistant"?
Any, but not necessarily all, of the following symptoms can indicate that you are leptin resistant:
  • Being overweight
  • Fatigue after meals
  • The presence of "love handle"
  • High blood pressure
  • Constantly craving "comfort foods"
  • Feeling consistently anxious and/or stressed out
  • Feeling hungry all the time or at odd hours of the night
  • Having osteoporosis
  • Unable to lose weight or keep weight off
  • Regularly craving sugar or stimulates (like caffeine)
  • Having high fasting triglycerides over 100 mg/dL -- particularly when equal to, or exceeding cholesterol levels
  • A tendency to snack after meals
  • Problems falling or staying asleep
  • Your body seems to look the same, no matter how much you exercise
... Any of this sound familiar?            
Nora Gedgaudas, p. 149 Primal Body - Primal Mind
I must be leptin resistant.  Oh wait.  Since taking selenium I'm no longer LR as I'm sleeping better.  Phew!  How about Kruse?
1. First make sure you really are Leptin resistant (LR) to begin with.
The easiest way to do this if you are heavy is to look in the mirror. If you’re overweight you definitely are Leptin resistant. If you still have a large appetite and crave carbohydrates, especially at night, these are also signs that you are likely Leptin resistant. If you are fit or in decent shape and not sure based upon the above symptoms, I would tell you to go get a blood test and check your reverse T3. It will be elevated. I also recommend simultaneously checking a salivary cortisol level. With LR, you will always see higher cortisol levels later in the day.
Well, at least he recommends some tests, but the blue emphasis is mine.  Now folks, we KNOW that there are a lot of overweight and even obese people who aren't insulin resistant.  It's a bit of a stretch, then, to presume all overweight are LR.  So following his plan:
Here are my questions for assessing a patient’s Leptin status……..
Do you notice you sweat more and have less muscle fatigue when you exercise now? Have your carb cravings gone away? Is your hunger under control now? And are you waking up more refreshed?
When these questions are all yes, then I push the button and tell them to start exercising more with intensity and duration first using weights but never using aerobics. The reason for weight lifting first, is that it generates less ROS in the muscle at the mitochondrial level, and more importantly that it stimulates the release of growth hormone to fire up muscle activity via the neuroendocrine system. It also more quickly reestablishes the Leptin sensitivity of the furnaces that our muscles contain to burn the fat we want to get rid of. As they improve, more weight comes off and the exercise plan increases. So far this plan has not failed me because it is not based upon my opinion. It is based upon our biochemistry that is 2 million years old! Most of my neurosurgical patients get this treatment before I will operate on them because outcomes are better when the patient is metabolically fit for recovery. If you are a patient who is Leptin resistant, and work too hard too quickly with exercise as you drop weight, the risk is generating too much ROS and depleting your stem cell supply. (Levee 17) The short term effect will be weight loss and a good result, but the long term effect may be faster aging and decrease longevity!
This is where the DigitalSurgeon and many trainers don’t see eye to eye. I don’t recommend conventional wisdom…….I rely on the knowns of biochemistry.

In case anyone is wondering what a levee is, this should clear it up.   Here I thought they were something you found in Denmark and New Orleans.  OK ... and in the comments section:
Carol asks:  Yes, I’d like to see the biochem please… why do you recommend three meals w/o snacks rather than 4-5 small meals please? I can definitely feel my blood sugar taking a dive between meals if I don’t eat a sizable meal… and I never feel like eating that much at one time.
Jack responds:   Why? my favorite question!…..4-5 meals consistently raises your insulin levels. Insulin is released biphasically, Short and long term. I would suggest you get a reference book like the biochemistry book link below to check this out. Anything that raises insulin chronically promotes fat storage when your leptin resistant and makes gluconeogenesis (glucagon) inefficient. Read my posts carefully, because the answer is already there. Your symptom is proof you have leptin resistance at your liver level. This information is in the leptin deux post! And it is contained in any biochemistry book on humans you find. The problem is diet guru’s make their recommendations on others opinions. I choose to go use evolution’s dictionary……2 million years of proven human biochemistry. And…….your blood sugar dives because you have hepatic leptin resistance and your liver cant stabilize your blood sugar because glucagon no longer is working. That can easily be fixed. You constantly eating just makes you worse because it increases your leptin resistance.  (links to Lehninger biochem text)
Kruse loves to send people to basic biochem books to support his assertions.  I've asked for specific citations for some of his claims and been told he's not going to do my reading/research for me.  Okey dokey!!  So, how about Rosedale?  Take this Quiz!!
1. When you go on a weight loss diet, do you have trouble losing fat, that is, do you lose pounds but still remain flabby?
2.  Do you have trouble keeping weight off after dieting?
3.  Are you constantly hungry?
4.  Do you crave sweets?
5.  Do you wake up hungry at night?
6.  Do you have a “spare tire” or an apple shape?
7.  Are you losing muscle mass despite the fact that you are exercising?
8.  Do you feel stressed out?
9.  Have you been diagnosed with high triglyceride levels?
10.  Do you have high blood pressure?
11.  Have you been diagnosed with osteoporosis? 
Hmmmm.... Guess we see where Nora got her list?  Here's a few more I found:
  • If you've ever watched Big Bang Theory on TV (reference to Rosedale's affection for cosmology)
  • If you've ever had a nubbin.
  • Were you born on the first Monday, second Tuesday, third Wednesday or fourth Thursday of any month?  
  • Is your index finger longer than your ring finger?
  • Is your ring finger longer than your index finger?
  • Have you ever wanted to get a tattoo?
  • Have you ever wanted to pierce your body?
  • Do you have saddle bags?
  • Can you not eat just one Lays?
  • Were you bottlefed?
  • Do you get tired while food shopping at the end of a long workweek?
  • Do you like to listen to loud music?
  • Do you like pina coladas?
  • Do you like getting caught in the rain?
  • Do you like making love at midnight?
  • Can you name the artist responsible for those last three questions?
  • Are you pigeon-toed?
  • Do you walk like a duck?
  • Do you quack like a duck?  
OK ... enough of CarbSane being silly (don'tcha just love the 3rd person?) and making shit up.   Here's my point.  These lists are nonsensical, especially when you say "any" or "just _____ (fill in with some small number)" of a long list of general things.  So a bunch of people will follow these plans that are VLC, lose some weight, see improvements in things like triglycerides and IR (during and following weight loss).  And two of these three have MD after their names so they must be speaking truth to power and all that jazz.  

Pass the Leptinade!

22 comments:

Melissa said...

Don't forget, according to Rosedale, because you've been bad and eaten some carbs, you also have diabetes. I do too! Isn't it amazing? I can't wait to call in sick at work and tell them an MD told me I have teh diabeetus.

Mirrorball said...

I'm thinking about making some easy money and writing a diet book. What do you guys think? In the introduction, I'll choose a random hormone (say, what about a very unlikely one such as aldosterone? Or should I pick a more ordinary one, for instance, cortisol?) and explain why it's the cause of all obesity. Emphasis on why obesity is not the obese person's fault, but the government's or the food industry's or the scientists'. Then I'll explain the diet itself, which will be almost identical to the Atkins Diet, but the phases will have different names (any suggestions?) and there will be some random rules added in, to make it new. Exercise is also mandatory. It's a good plan, I think.

MM said...

I really do not understand why all these low carb gurus hate aerobics (cardio? Is that the same thing?) Kruse claims it raises ROS. I'm not sure why the others hate it. So, I decided to check it out. Found this study (can't get full text.)
Generation of reactive oxygen species after exhaustive aerobic and isometric exercise
http://www.ncbi.nlm.nih.gov/pubmed/10994907

So, it seems the main problem with aerobics is that you take in more oxygen doing it. Is that really a bad thing? Should we be trying to breathe as little as possible then?

Kindke said...

I have to say Jack has some funny stuff on his site, and something feels funny about the leptin resistance theory, ItsTheWooo has blogged alot about how the idea behind leptin resistance is just wrong and I tend to agree.

The idea to me is simple, there is a finite number of leptin receptors in your body, once they are all saturated, excess leptin probably just floats around in your blood. Getting fat increases fat cell volume and number, which means more leptin is getting produced, BUT, does that also mean our cells are making more leptin receptors, probably NOT.

So we have a static number of leptin receptors but an increase in leptin production. the excess leptin just floats around in the blood in my opinion. This is what is detected in the blood tests of obese people.

I dont want to make an analogy with insulin and insulin resistance here because clearly what causes cells to sport insulin and GLUT receptors on thier surfaces is a complicated matter.

Matthew said...

It is hard not to notice the good doctor duvet on paleohacks now. Ego you could bounce bricks off.

He is very hard to argue with directly. If you do ever pin him down on any of his claims he just ignores you.

By the way I get the impression he finds you quite threatening for some reason :)

Tsimblist said...

@Mirrorball

How about "Cruise Ship or Nursing Home"? Wait, that's already been done.

Galina L. said...

Yes, strange test, probably everybody who at least once tried to loose weight had trouble to keep it of, fortunately not all of such folks are hungry at night, have a high blood pressure or suffer from an anxiety disorder.

Right now it is normal that people self-diagnose themselves rightly or wrongly based on some criteria without any testing. I think I was insulin-resistant before I started my diet 4 years ago, but I never got it tested.It is the perfect situation for mass-confusions and delusions.

It is also very common to talk about broken metabolism while discussing trouble loosing weight, while it is more the figure of speech than test-based condition.

The ItisWooo is an exception - she was tested and diagnosed with low leptin level, given leptin supplements and manage to achieve what looks like a permanent weight loss from morbid obesity to normal low weight. Not a common occurrence.

Fashiontribes Diet said...

@ Matthew "good doctor duvet" cracked me up - good one! maybe we could quilt him a superhero cape to assist with brick-bouncing & egos that leap tall buildings

Lerner said...

"and more importantly that it stimulates the release of growth hormone to fire up muscle activity via the neuroendocrine system"

that is very true (and also true for testosterone) but IIRC any benefit from that transient BIG spike doesn't necessarily materialize system-wide. Also, btw, eating kills the spikes.


The biggest trend now is not just High Intensity (over the lactate threshold) but more so HIIT - with Intervals involved. That might indeed be the best - at least for some.

But being correct doesn't make something trendy - as mentioned, it's always that same old thing about being a 'rebel'.

Steve Parker, M.D. said...

Whether I agree with your or not, CarbSane, this is just good writing! Thanks for the chuckles (and I mean that as a compliment).

-Steve

Evelyn aka CarbSane said...

@MM: I'm going to post today or tomorrow on respiratory quotient and longevity. In the study, the long-lived (avg 97 yo) had higher breathing volume than their aged (avg 73 yo) counterparts. Higher RQ, higher RMR. Interesting stuff! I think the knock on chronic cardio is somewhat misguided in that they look at other outcomes (injury, compensatory reward eating and such)

@Steve: THANK YOU!!

@Matthew: Doctor Duvet ... LOL!! Actually I had no intention of going back to PH after the rocky foray a while back. Jack is responsible for me going back b/c he linked to a PH discussion when I pressed him on his blog to support the contention he made that Mg deficiency always comes first. I bug him b/c I won't take "just look in any biochem book" for an answer ;)

@Kindke: A saturable leptin receptor is feasible. The whole "resistance" term is too broad anyway, but I do believe there's support for LR. Woo seems to rely on her n=1 serious outlier experiences to look at physiology. It's hard to make heads or tails of it. I note she's also had fat-reduction surgery. She's leptin deficient but that's really not the issue with how most get to be obese in the first place.

Matthew said...

@Evelyn: Are you not aware that any biochemistry text book holds the answer to every question you could possibly ask?

I don't know why biochemists carry on working really.

Evelyn aka CarbSane said...

@Mirror: Heck, why pick a hormone ... why not just make one up?!

@Matthew: That's funny but sad. My biggest peeve is when someone makes an assertion and can't back it up. Rosedale cited "robust evidence" that insulin spikes cause IR, but when I pressed him there was the excuse that such are "harder to find" because basically Big Pharma swamps out funding for unpopular opinions. Finally one cite that didn't seem to be relevant to what he claimed. To me, when someone claims the studies exist, surely that means they found them! Shouldn't a few bookmarked links be at the ready then? Dr. Duvet lists a bunch of cites at the end of each post. I hate that! Nora's entire book is referenced loosely in this manner. She refers to various things without the specific citation then lists a bunch of texts, articles and such at the end grouped by topic. This is very poor form but probably how Nora escaped too much fact checking of her work. (She refers to that Swedish Paleo v. Med study but darned if I can confirm it's the same one I'm thinking of ... I shouldn't have to dig through a list of references to find out). At least ol' Wheat Belly included his refs by number inline with the text.

Matthew said...

@Evelyn: I agree that is a very annoying habit when it comes to referencing and sadly all to common.

Another habit, one that the Quilt is often guilty of, is weaving together a complex narrative to support a statement or argument.

This usually contains many scientific facts that are hard to dispute however the stated causal interrelationship between these facts often seems much less certain. These relationships are very hard to question. Even more so to question whether these relationships are biologically relevant if they are true.

These types of argument sound highly plausible to many people and make the writer appear very knowledgeable.

MM said...

Evelyn,

I think I understand why low carb gurus (or anyone) would be against chronic cardio. Although I'm really not sure how that is defined. Is it more than 2x/wk? More than 45min per session? Well, anyway my point is that the low carb gurus seem to think that *any* cardio is bad and will cause you harm. That is the position I don't understand.

Evelyn aka CarbSane said...

@MM: I think it's part of "challenging conventional wisdom" and appealing to the "quick fix no-effort" gene at the same time. The mainstream is wrong, so ELMM is wrong and certainly nobody ever got fat by eating too much or sitting on their butts too much either. I've seen studies on all sorts of exercise. Yeah ... running marathons isn't for everyone, or even for most. But walking an hour 3-4 times a week at a brisk pace -- for me -- that is doable. And I've seen studies showing improvements with all sorts of exercise so just do something would be my advice these days!

Lerner said...

I agree with Evelyn saying do something/anything, at least at first. Then a person can find what suits them. It used to seem that we had mainly vegetarian marathoners on one extreme and steroid-junkie bodybuilders on the other, but there's really an almost limitless variety anymore.

I've always disliked trends and the current trend is toward more intensity, but still the intensity might actually be the correct thing to aim for. But seriously, would anybody use HIIT (High Intensity Interval Training) for something like cardiac rehab?

Try here:

http://suppversity.blogspot.com/2011/09/hiit-is-hit-interval-not-steady-state.html

Where HIIT does as good or better on various parameters. So... you never know.

That evidence-based blog is written by a physics professor in Germany. I see him as looking for the truth rather than being an advocate - sort of like here at Evelyn's. I recommend it to anybody who'd like to get an overview of exercise & nutrition science from a blog writer who reads all the studies etc so you don't have to.

There was one article where he used research to conclude that a popular supplement was actually useless, and included a link to that same supplement on his one sponsor's site. So it's not the kind of thing you might typically expect.

Muata said...

@Lerner - thanks for the link to the blog; it's been added to my reader!

Lerner said...

@Muata - see you around at the suppversity. I looked at your blog [ http://www.mrlowbodyfat.com ] and see you have quite a good number of readers yourself.

That's quite a set of transformation photos, too. That's what I'd call being self-made.

Muata said...

@Lerner - Thanks for the compliments on my "seldom" updated blog and my continued transformation ;) Suppversity seems like just the kind of blog I'm going to enjoy reading. It reminds me of Alan Aragon's Research Review ... thanks again.

Evelyn aka CarbSane said...

@Lerner: I second Muata's shout out about the suppversity blog. Thanks!

Re: "I agree with Evelyn saying do something/anything, at least at first. Then a person can find what suits them."

I think sometimes the "experts" forget who they are talking to. When someone is truly obese, HIIT style exercise is probably the last thing they should be doing. They just need to move more. Slow strolling, even walking in place for short stints. While the Biggest Loser reminds me what I can do, it's not wise to run, for example, when you're significantly overweight. I'm in pretty good "shape" in terms of endurance and strength, but I very quickly shelved the idea of doing the sprint tri b/c running ain't in the cards for me yet -- having to do with my knees don't care if they're being jarred with XX more pounds of force of muscle or fat or whatever.

So this notion that this exercise is "the best" and some sort of notion that exercise "of the wrong type" can be harmful for weight loss but ignoring injury potential (not to mention possible underlying threatening medical conditions) and such with those recs doesn't cut it for me.

Lerner said...

@Evelyn: good, then you can counter anything pro-Taubes when I'm not there :) and tell 'em I sent you ;)

btw, AMPK has been big there, which has cemented my mantra that "breakfast is the most important meal of the day - TO SKIP"

ASP has been unmentioned there so far.

wrt running, keep in mind for the future that with slow running you can run with minimal up and down motion, which will minimize downward force on the knees as well as be more efficient. Almost like gliding or shuffling, just a bit faster than race walking (a' la the Olympic sport).

Running up steep hills also spares the knees to some degree, and is a lung buster.

There is also "pose running" which tends to put more strain on the calves and off the knees.

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