A Glass of Extra Virgin Unspiked Lepitinade Please!

Why do some of these things land in my lap when life gets so busy?  Over on Mercola's site, I've been tangling up a bit with Ron "Spiked Leptinade with my Science Krispies" Rosedale.   Now I don't expect Rosedale to start following my blog or anything, but I did post links to certain posts over there to support my contention that carbs do NOT spike leptin.  By any definition, they do not.  Instead of recognizing this and backing off (and hoping nobody notices, a la Taubes), Rosedale has doubled down on his assertion that carbs spike leptin.  In support of his contention, the science he offers up is ... drumroll please ... a more than decade old study on isolated cultured rat adipocytes.  This wouldn't drip so with irony were it not for the fact that Rosedale shoves his massive clinical experience with live humans in yo' face every chance he gets.  You see, I don't possess his vast clinical experience so I must be in error interpreting the whole blood v. plasma blood glucose level data in a 45+ year old study (more on that to come!!)  Yet, when presented with a sampling of human data from clinical studies ... then Rosedale turns a blind eye.  It gets worse.  I called him on relying on this study to advance his point.  His response?  More of the same about how I don't know the science.  Here's what he said:

@CarbSane; apparently you not only do not know the science, but you refuse to learn it also, even when spoon fed. Nutrients spike leptin significantly, typically much more than sleep; see article I posted for your benefit at start of this thread. It is one of many. I will repost;

The Effects of Insulin, Glucose, and Pyruvate on the Kinetics of Leptin Secretion Endocrinology 142: 3558–3562, 2001
"The purpose of this study was to determine whether the secretagogues, insulin, glucose, and pyruvate, enhance leptin secretion…For 60 min after the addition of secretagogues, leptin synthesis rapidly increases, leptin increases intracellularly by approximately 60% (P<0.05). After 60 min, leptin is significantly released from cells. At 120 and 240 min, secretagogues enhance leptin secretion into the medium by 35% (P < 0.05) and 40% (P < 0.01), respectively."
Yes, repost the same old isolated rat fat cell study.  What about those humans you treat in clinical settings?  This would be all fine and well were it not for the fact that we simply don't see postprandial leptin spikes in whole, real, live human beings ... aka you and me.  In case anyone reads this post, let me repost for the record the original pp leptin and insulin graphic.  (Top is women, bottom is men).  I see some insulin spiking going on (left) but do you see a leptin "spike"??  Unless one redefines the term, I'm saying no.  Indeed in the immediate postprandial period, 2 to 3 hours, leptin levels are "anti-spiked".  Dietary nutrients suppress circulating leptin levels as seen in the plots.  I have no idea why I even bothered to look further, but perhaps it's his insistence on the role of blood glucose levels in all of this.  But a Google scholar search turned up this study:  A High Glycemic Meal Suppresses the Postprandial Leptin Response in Normal Healthy Adults.  Were I a cherry pickin' science journalist, I would probably have skipped right on by that title for fear of being confronted with contradictory evidence.  But that's not me.  I was intrigued.  Well, it turns out the "response" is not that imaginary spike Rosedale speaks of ... turns out quite the opposite, though without the spikiness.  Thanks to MM for the full text of this one.  The subjects were all within 20% of normal body weight, glucose tolerant, and all that, included 6 men and 4 women aged 18-37.  For two days prior to each test day, they were counseled and instructed to eat a standard 55% carbohydrate, 15% protein, and 30% fat diet.  After a 12 hour fast, on the test day they consumed either a high GI corn flake cereal meal, or a low GI FiberOne cereal meal with water, within 10 minutes (Yum!  LOL).   The GI of the response was directly measured compared to a 50g oral glucose load, and cereal serving size was standardized to provide 50g available carb (aka net carbs in LC circles).  Below are the plots of the results from this study.  

GI Index compared to 50g glucose.
High GI is 125, Low GI about 50
Looks like a significantly
nastier glucose spike to me!

The insulin behavior tracks the glucose response, predictably.
The low GI carb barely suppresses leptin in the 2 hours after eating.  

The total insulin response for Low GI carb is roughly half that of High GI,
The relative leptin responses?
Following the High GI meal, total leptin is roughly 1/3rd that following the Low GI meal.
What we have here folks is what a certain former amateur boxer might call a one-two punch.  Punch 1:  The leptin and insulin responses to differing GI meals do not correlate, rather they are in opposition.  Punch 2:  Rather than spiking leptin, carbohydrate suppresses it in the immediate postprandial phase.  Carbohydrates, if anything, "unspike" leptin.  What cannot be reconciled here is this whole notion that insulin resistance and leptin resistance, caused by spiking insulin and leptin levels, go hand in hand with carb consumption.  It's plain as day that the in the postprandial state, the effect is, if anything, reciprocal.  Blood glucose suppresses leptin in living intact human beings.

As usual, I have some thoughts flying around in my head about now on the ramifications of the results seen here.  I have to put them together with some info I've been reading on high fat meals and postprandial leptin levels.  Perhaps the mixed meal is striking again as an issue here.  That is (and it remains to be seen) if diet has any significant effect on long term, "global" if you will, leptin levels and signalling.  

Damn those "inconvenient facts" eh, Ron?  I would suggest that rather than trying to put me down by making ridiculous statements about how I don't know the science, Rosedale should do some scientific damage control in his scripture.  Somehow I doubt he'll heed my advice.  Meanwhile over in the "we're all gonna die from ..."  Mercola-land, not only are we warned of the dangers of two natural foods (potatoes and rice will whack the mole outta your blood glucose!!!!!!), but his readers have been warned about reading my posts.  Yep ... I've earned a "Dissenter Badge" there.  Wow!  That's a badge I wear with honor:
CarbSane has a Dissenter BadgePlease be aware that this user has posted comments that are in serious disagreement with Dr. Mercola's position and their comments should be viewed with caution.
You've been warned here first.  Meanwhile, at least Mercola hasn't censored me (yet).  I'll get to Ron's issues with scientific debate soon.  Have a great night folks!

Make my next leptinade ultra-virgin please!  


perishedcore said…
When two high volume quacks take serious ad hominem aim at you (cause what could they use - surely not science and evidence), that raises my interest enough to check their prof bios and licensure. Haven't done so yet for Merchthant of Mercola, but Rosedale is interesting: licensed in CO with a HI address. Not licensed in HI. No statement that I can find as to post graduate education, board certification or specialization. What exactly is this guy selling? He doesn't appear to have a physical presence in CO - no clinical practice.

Emily Deans called him a quack on her blog. Them's fightin' words - he could try to sue her for defamation. Usually MDs pussy foot around each other when they spy quacks in their midst.


Anonymous said…
Aw, man, I was going to play a joke on you by heading over into the comments and downvoting everything you said, but someone beat me to it! LOL.

Your dissenter badge is fabulous.
Perishedcore, as far as I am aware, Dr. Deans did NOT call either Rosedale or Mercola a quack on her blog. I know she finds the science questionable, but I think she was careful to be explicit about that.
Tonus said…
I would point out that in low-carb land, NOT having academic or medical credentials can give a person a great deal of legitimacy, as it implies that they are not part of the great conspiracy to sell us grains. In other words, dissent is very good and meaningful...

...until it's someone dissenting from their point of view, anyway. The Dissenter's Badge is a particularly interesting approach. It allows Mercola to ostracize those who disagree with him, while pretending to take the high road. We're not really saying you're wrong, Evelyn dear. And if you'll just hold still while we fasten this scarlet letter onto your blouse...
Wright Mind said…
Beth: Emily Deans called him a "whackjob;" see http://bit.ly/u0IMVR. See also http://bit.ly/uaYWSw for context. This was in her twitter feed, not her blog.
CarbSane said…
Hee hee Steph, LOTS of folks beat you to it!

@aek: Rosedale shows up on one or two of those MD check out sites. Dunno. Re Deans, I don't read her blog so have no clue what her opinion is. I'll take Beth's word on that one.

@Tonus: Chuckle :) I started out as a Stumbler there so I've progressed ;p
Quarrel said…
--generalising rant--

I really don't get what it is about people with MDs that make them think they're special. They seem to be on a plane above- "oh you only have a Phd?" is the kind of thing you'd hear from many a typically inflated MDs mouth ..

Yes, you once went to med school. We get it. Yes, you treat common colds with antibiotics day-in-day-out. Ok. good for you.

But please, med school (in and of itself!) barely teaches you to read, let alone understand, real science studies. Anatomy memorised, tick! Pharmaceuticals memorised, tick! Basic stats, well, not so much. Reading graphs, whoa there- advanced maths ahead ... etc...

I'm all in favour of academic credentials- I just think that an MD isn't particularly a good one to spout forth on research. It's a trade, ala dentistry, or plumbing.


Sorry about that :)

CarbSane said…
Oops! Welcome to the Asylum Newell! Thanks for the links.
CarbSane said…
Hi Q, I'm going to blog a rant of my own along similar lines. This does not mean an MD may not possess the skill set for research, but it's not a skill set used much in their training while it is used frequently during one's graduate career on a PhD track. Indeed in many ways someone with a PhD in sociology may be better suited to interpreting peer review literature than many an MD. Mercola wasn't high on my list of MD's worth listening too (he's just far too alarmist about everything for me, the noise:signal ratio drowns out anything constructive he might contribute IMO), but he went down quite a bit with that "only a PhD" dig at Paul. It was uncalled for and disrespectful.
MM said…
OMG is the "Dissenter Badge" real? I thought you were making a joke, but from the others' comments it sounds real. If that isn't an example of wacko cult behavior I don't know what is. It kind of makes my stomach turn.
CarbSane said…
Yep ... it's real! I'm only surprised the X icon next to my name is a plain gray one, and red (or a skull and crossbones!
CarbSane said…
above should read "and NOT a red one"
Anonymous said…
FWIW Dr. Deans called Mercola a quack in the Cross Fit post over at Perfect Heath Diet blog.
OnePointFive said…
I think you should wear your badge with pride. I've just looked at the comments on the Mercola site.
For someone who I gather claims to be a diabetes specialist, Dr R doesn't seem to know much about the various types.
He says childhood T2 is MODY, it's not the same thing at all. They thought it was back in the 70s and 80s, hence the name, but knowledge has moved on since then.
MODY is diabetes caused a defect in insulin secretion caused by an inherited mutation of a single gene.
If he's wrong about that, a fairly simple thing, what about the rest?
Anonymous said…
"Dietary nutrients suppress circulating leptin levels as seen in the plots."

why would someone want to NOT spike their leptin when they eat...i am confused if nutrient dense food does not spike leptin... if its always suppressed are you gonna gain fat?
I read Dr. M's newsletter and filter out the hysterical stuff and see what may be useful. I have an inherent distrust of people pushing health products, because, of course, they're gonna make it seem like it's dire and critical and watch out if you don't take these supplements.

The dissenter's badge is ridiculous. He needs to get rid of that. He should welcome debate. Are his readers so dumb that they can't tell a dissenter just by the content of a comment that..er..dissents. It has to be labelled??? Um...really???

Rock on, Evelyn. I hope the LC community can value what you bring to the table. Lock-step is a dangerous thing...
Jeff Rothschild said…
Hi Evelyn, I have enjoyed your blog for quite some time! I haven't followed the drama on Rosedale's or Mercola's site so I apologize if these have been addressed...

Here are two studies that show carbs spiking leptin



But on the other hand, if high GI meals lowered leptin, as shown by Barkoukisc et al, wouldn't that be a factor in overeating?
Steph, Dr. Deans didn't comment at all on that blog post.
Newell, technically she said "Most MDs reading those posts will consider him a whackjob" ... probably just enough semantics for a lawyer to differentiate what somebody calls someone vs what they say others will consider him! At any rate, unlikely to be defamatory.

And at any rate, what Dr. Deans said on her blog or another blog or Twitter pales in comparison to what Dr. Mercola is passing along as nutrition advice.
M. said…
Beth, Dean's quack comment ("I think Mercola is a quack") was in the other Crossfit post -

Anonymous said…
"Emily Deans called him a quack on her blog. Them's fightin' words - he could try to sue her for defamation. Usually MDs pussy foot around each other when they spy quacks in their midst."

Mercola and Rosedale are both quacks.

Mercola on blood type diet (among other things) and Rosedale on Leptin, Insulin and blood glucose physiology.

They are also both public figures and it is therefore neither illegal nor tortious for other writers to characterize the quality of their public pronouncements on science in any way that fits...

This is the USA, not the old Soviet Republic or even Britain.

And I frankly don't think it is worth any effort to engage either one of them, any more than debating raw vegans like "Durianrider" or actual scientologists.

But thanks for taking the time, Evelyn ; )
Anonymous said…

My mistake, Dr. Deans' comment was in the summary post that included the Crossfit talk.
Lerner said…
of interest, in the calories-not-composition vein, from today:


Obese patients with type 2 diabetes who consumed a severely restricted diet of just 500 calories a day for four months showed a reduction in pericardial fat and improved the function of their heart, researchers for a small study said here at the Radiological Society of North America (RSNA) 2011 Scientific Assembly and Annual Meeting.


Adhering to 500 calories per day might seem a daunting prospect, but Hammer said his patients were highly motivated to stick to the restrictive diet. "In fact, all of the patients who started the study completed the full four-month study period. They literally saw their glucose levels drop before their eyes, and most important, from day one they did not need insulin injections, which proved to be a major motivator."


CarbSane said…
Thanks OnePointFive! I read that comment and was thinking it didn't sound right. Rosedale has made some comments that are, in my view, unacceptable for an MD. It's one thing to have a different approach, and certainly a virtually zero carb diet has its place in the treatment of diabetes. But for someone to say that insulin has no place in the treatment of T2 diabetes, after I showed him that study where half of those who received just a few weeks of early insulin therapy were still diabetes-free after one year, it's downright irresponsible.

This view of insulin as a deleterious force in our bodies has got to stop!
CarbSane said…
Hey Lerner, This would be the second *idiotic and dangerous* crash diet that improved health. Interesting how, like in the diabetes crash diet, fat content in an organ (this time the heart) remained low even after some regain on followup.

That is encouraging for all of us! Perhaps things build up slowly through the years, but reverse rather quickly with drastic intervention. After several years I suppose the problem may re-manifest if habits aren't changed, but still.
CarbSane said…
Related to Lerner's cite: http://www.diagnosticimaging.com/conference-reports/rsna2011/content/article/113619/1998117
CarbSane said…
Another version of Lerner's cite for those who don't want to register at the heart.org site: http://www.medscape.com/viewarticle/754289
CarbSane said…
Welcome Jeff! Your second study is actually the one I blogged on previously from which the first graphic in this post came. I wouldn't call the delayed rise in leptin levels a "spike" by any stretch of the imagination. The other study discusses leptin levels going down with carb restriction. Given that this occurs in fasting, and many features of fasting/starvation are thought to be linked to glycogen depletion/glucose availability, this is no surprise.

Leptin is an interesting hormone. In another study, high protein decreased the overnight leptin peak but was correlated with satiety, spontaneous reduction in intake and weight loss. I've seen studies where leptin is "all over the map". Clearly leptin is involved in energy homeostasis, but its also a very complicated relationship because increased leptin is supposed to suppress appetite, and yet when leptin falls, in prolonged fast, we also experience reduced appetite.
CarbSane said…
Hi Mal: I tend to think leptin is not a postprandial hormone like insulin. Insulin has a clear role in regulating circulating nutrient levels. Leptin really seems to be more complicated than that and acts in the long term. Perhaps this is why although it clearly has an appetite suppressive role, it hasn't worked very well in that capacity exogenously.

Thanks for that catch Nigee, it's fixed now :)
CarbSane said…
@Beth: I think MD's not criticizing other MD's on the internet is more of a professional courtesy thing (when warranted) rather than a defamation thing. This is what Kurt seems to be saying as well.

@Princess: Yeah, there is some worthwhile stuff there, but I think I've already gotten too cynical ;) When I read "the sky is falling" on his website it just seems that more often than not, it's the other way around. So if folks link to an article of his, I'll read it. But I'm less and less appreciative of writings that merely prompt us to kick the tires these days. When all the "ground breaking" and "new paradigms" keep coming up empty, it's an awful waste of energy that might otherwise go towards finding real solutions to real problems.
Lerner said…
wrt to theheart.org, I don't think they could improve much on the way they handle their articles on new studies. After the efficient and concise overview, they'll almost always have comments from a study author (or from some authority in agreement) giving their insight, then most often statements from someone giving a critique. All of that puts things in perspective.

Then the comments section gives an idea of how clinicians see the study and whether or not they think it's sufficient to make them change practice. They, of course, are also very well acquainted with all the "new paradigms" that have come down the pike over the years.

Their free CME stuff is great, too.
Lerner said…
wrt to defamation, there's the oft-heard saying that 'anybody can be sued for anything'. But winning is another matter. So then you'd get into whether there was fed diversity jurisdiction or whether it was all in-state - which relates to any loser-pays rules that apply.

I'd also wonder if the public figure can sue a competing author by claiming malice (to e.g. bolster the competing author's own revenue) in the purported defamation.

Then there are those weird laws about interfering with commerce.

All in all, nothing is likely to be likely, but you never know.
OnePointFive said…
@ Lerner,
Fat surrouding the the heart was reduced and this was sustained. Nevertheless this was no miracle 'cure' for T2.
Regrettably, 18 months after the start of the intervention both fasting plasma
glucose and HbA1c levels had returned to baseline values.
CarbSane said…
Great job tracking down the actual study there OnePointFive. I had no such luck :( Here's the direct link to the "summary" article: https://openaccess.leidenuniv.nl/bitstream/handle/1887/17801/09.pdf?sequence=6

Interesting. In the Crash Cure, the followup period was only 3 months where the diabetes "cure" persisted. Here the followup was 18 months and the "cure" was no longer. Unfortunately these observations are both accompanied by weight regain. Perhaps there's a place for intermittent very-low-calorie "phases" as an approach here. Also, if any maintained the weight loss I wonder if they fared any better retaining their "diabetes cure" as well.
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