The 2011 InSanies

The first ever awards to be handed out here at My Carb Sane-Asylum.  We'll honor here the most insane goings on in the low carb world in 2011.  These honors are bestowed with lighthearted humor, even if some were earned for actions of a more serious nature.  So, with out further delay, in no particular order, I present

The 2011 InSanies

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Weight Loss Advocacy

Should I post the real version of this? 

Let's imagine that Jane Smith has a bit of a weight problem growing up, gets married, has a couple of kids and some acknowledged issues with "emotional eating".   Jane has tried everything and nothing else seemed to work.   Around a decade ago, at 180 lbs, she discovers Weight-B-Gone, just enough different that she decides she might as well give it a try.  Over the next year following the WBG program, Jane loses 45 lbs.  Jane loves the WBG!  Woo hoo!   Jane keeps the weight off for six months but then some life issues arise.  She stops going to the gym regularly and does the diet plan half-assed on and off for several years.  Four years later she finds herself weighing in at 210 lbs. 

Starch is Paleo?

Tsimblist brought this presentation Dr. Nathaniel Dominy to my attention recently. 

Something commonly raised in favor of a high (animal) fat diet in paleolithic humans is the notion that this was required and/or precipitated the increase in human brain size.  He seems to be saying this is not so much the case as is often cited.  (Around the 9 minute mark).  This is a huge point!!  Dominy does not come across as some vegan shill, that's for sure.  He pretty much comes out and says that meat eating is a no-brainer -- we're not herbivores -- but favors a higher percentage of plant foods likely comprising our ancestral diet.  Worth a watch/listen.

The Low Carb W.O.E.ating Disorders

Believe it or not, this post has been in my draft bin getting retooled and almost published several times over since last March!  But I've always never quite gotten it to publish ready, or whatever sparked the rant died down a bit so it got shelved for another day.  But recently the topic of eating disorders was inadvertently brought to the fore by Jimmy Moore in his Jessica Biel spiel.  So dust off this one I did ...  and still, it sort of languished until something happened the past couple of days over at PaleoHacks.  Someone asked about purging -- as in bulimia -- contemplating inducing vomiting to rid themselves of the holiday indulgences.  There were several, I thought, constructive responses and no nastiness ensued that I was aware of.  Perhaps the initial question was a joke or whatever, but in rather short order the question disappeared entirely!  Not closed, but vaporized.  Which left a bad taste in my mouth.  Not because of anything against the PH people, they are free to run their site by their rules and such, but because there seems to be a pattern I'm seeing in such circles of avoiding the topic of eating disorders altogether.  ED ain't paleo.  Shhhhhhhhh.....

Fat Tissue Regulation ~ Part VII: Changes in Fat Cells with Weight Loss

I came across this one a while back and found it fascinating.

The Physiologic Effects of Caloric Restriction Are Reflected in the in Vivo Adipocyte-Enriched Proteome of Overweight/Obese Subjects

In this study, 8 overweight/obese individuals (4M/4F, 30-60 y.o.a., BMI ≥ 27, otherwise healthy) were treated with a very low calorie diet (500 cal/day shakes + unlimited veggies) for 5 weeks followed by a weight stabilizing diet for 3 weeks.  Abdominal subcutaneous fat biopsies were taken before and after the 8 week intervention.  

There's a lot more here than what I'll address in this post.  I hope to return to this at some future date, but in keeping with this series, I want to focus on the fat storage portions of the study.  I have quite a bit in the pike regarding fatty acid transport and storage in various cell types.  While fatty acids can be transported into (and out of) cells by passive means, it became apparent to me a while ago that the relatively rapid clearance of fatty acids into fat cells after a meal likely involved some active transport mechanism.  As it turns out, uptake of fatty acids by adipocytes is facilitated  by a fatty acid binding protein, FABP4.  Triglycerides are stored in adipocytes (and other cells) in what are called lipid droplets, LD.  Although the name implies something like a glob of fat, the lipid droplet is "coming of age" of sorts being recognized as a metabolically active organelle within the cell in much the same way as fat tissue has long since come to be recognized as so much more than just some passive depot for caloric excesses.  This study looked at a protein known as vimentin which is possibly associated with lipid droplet formation/organization.  More on this in a bit.

The table below summarizes the metabolic markers which were assessed in Week 6 immediately following the 5 week VLCD.  

So the subjects lost an average of 9.5 kg or just over 20 lbs body weight, 7.1 kg (almost 16 lbs) of which was fat.  Now I'm sure we'll get the usual "well, the diet was so low in calories it was effectively low carb" spiel as to why this diet worked, but such shake diets often do contain more carbs than some low carbers eat in a month.  In any case, let's focus on that dastardly hormone insulin.  Imposing a significant energy deficit on the adipocytes resulted in a more than 25% decrease in fasting insulin levels (the p-value of > 0.05 would not be statistically significant) and a 7% decrease in fasting blood glucose (the p-value of about 0.01 is statistically significant).    Check out those NEFA/FFA!!    Circulating free fatty acids were almost dropped in half!!  You see, when the 8 subjects were weight stable at approximately 20 lbs heavier weights, their blood was swimming with free fatty acids -- you know, those NEFA the low carb shills claim are being locked away in your fat cells by your carb-induced insulin baths.  

Here's what else they found:

... the uptake of fatty acids seems improved because on average there is a 40% increase in the abundance of FABP4 after the intervention. ... this provides evidence that weight reduction, in particular loss of fat mass, stimulates the basal function of triglyceride storage by adipocytes.

Note the adipocyte proteins were assessed after the full 8 weeks (3 weeks energy balance) so that the effect of an energy deficit was eliminated (or at least mitigated).  From a formerly obese point of view, this is somewhat depressing news as always.   At first glance, it seems that losing weight only primes the fat cells to gain it back.  But let's pan back a bit and look at this whole picture of the purpose of our fat cells:  to store energy for when we need it and keep excessive levels from circulation.  So this is actually good news!  Just 5 weeks and adipose tissue is dramatically transformed from overfilled and dysfunctional to doing it's thang protecting your non-adipose tissue from metabolic damage!

But here we see yet another contradiction in the woefully misguided TWICHOO.  Yes, folks, what happens when you lower insulin, as was done in this study?  The fat cells seem to have established a more fat-accumulation friendly environment upregulating FABP4.  But something else also happens, what is described as "a reduced intracellular scaffolding of GLUT4"  Hmmmm.  So fewer glucose transporters but more fatty acid transporters.  Remind me again what we store in our fat cells?   Perhaps some comedians should stick to their day jobs rather than formulating garbage theories about how our fat mass expands to accomodate glucose.  Sigh.  But to sum up:

• Before:  Higher insulin, higher GLUT4 scaffolding (to support glucose transport), lower FABP4 (to facilitate fatty acid uptake), elevated circulating NEFA.
• After:  Lower insulin, lower GLUT4 scaffolding, higher FABP4, lower circulating NEFA.

Fat cells don't go wild accumulating fatty acids, rather they're fed up and just can't take it anymore!  OK, sarcasm aside, this is yet another study that shows some rather dramatic changes in metabolic health with relatively minor changes in weight.  I believe the findings here are important with respect to hormones and circulating metabolites.  Although not statistically significant (probably due more to the small sample size and variation in levels than anything), the observed drop in fasting insulin levels of 25% is physiologically significant, and yet this was accompanied by an only 7% reduction in fasting glucose.  What, yet again, seems to have changed the most?  Those NEFA.  

I'm going to save my analysis of Keith Frayn's latest review paper for the new year, but the findings here dovetail nicely with Frayn's more recent thinkings on fatty acids.  Specifically, that adipocyte IR on the release side (inefficient suppression of  HSL )  may be less important in the etiology of metabolic syndrome and diabetes, but rather that the defect occurs at the uptake side of the equation.  This leads to inappropriately elevated basal circulating free fatty acids as well as inappropriately elevated postprandial NEFA with the composition of said fatty acids being potentially troublesome.   Both lead to too much fatty acid storage in inappropriate places.   Metabolically healthy lean individuals would have highly responsive fat tissue, presumably with sufficient FABP levels to whisk fat out of the bloodstream when called upon.  That the obese have less fat accumulating proteins than their leaner selves is also in contrast to TWICHOO.  The leaner "after" folks here had a more fat-trapping milieu than their "before" situations.  The lean generally trap fat very  efficiently (though some with insufficient adipose tissue do not).  Clearly, the individual components of what drives fat uptake/esterification and lipolysis/release, do not regulate the NET accumulation of fat.   This study adds to the evidence in support of this statement.

Before I go ... speaking of Frayn ... If you're relatively new to the Asylum, you may hear his name bantied about here often, but I've not blogged all that much on his work of late.  If you don't know what I was talking about just now, may I suggest the following older blog posts (in reverse chronological order):  Fatty Acid Trafficking , Adipose tissue as a buffer for daily lipid flux ~ Keith Frayn 2002 , Non-esterified fatty acid metabolism and postprandial lipaemia , Insulin Resistance ~ Taubes v. Frayn.

Merry Christmas!!

I wanted to take this opportunity to wish each and every one of you who celebrates the birth of Our Savior a very Merry Christmas!  May you stay safe, warm and healthy at this joyous time.   

While many bloggers will probably be scarce until after the New Year, yours truly will likely be blogging up a storm as my day job is on hiatus for a month.  Hope to "see" you around, but if not, that's OK too ... I'll see you in 2011.  This afternoon I'm cooking up traditional Christmas Eve fare of my husband's ethnic tradition.  Perhaps I'll have some pics to post over in the Culinary Concoctions blog.  

Thanks for reading and contributing here, it means a lot to me.

Insulin: A-to-Z and More

Well folks, as 2011 draws to a close, it seems the reason for the Asylum's very existence has all but evaporated into thin air.  What?  You didn't know?  Yes indeed!  Apparently my work here is done as nobody really believes that carbs cause insulin cause fat accumulation stuff anymore.  But I'm hopelessly mired in debunk mode so, of course, I just happen to glance at the insulin levels in studies when I read them, and so it was when I revisited the Dansinger diet study recently.   And so, just in case there's even a single person out there who still believes that their low carb diet is working by lowering their insulin levels, I thought I'd start this first ever compilation post here.

OK, I'll knock off the sarcasm now.  Yes, I know most of my readers will find this post repetitive of what I've already presented ample evidence for here.  But since part of the purpose of this blog in the first place was for me to organize information I gather, I thought having a post like this, that I will update with data from any studies providing relevant information, would be just that sort of thing.  Depending on how often I add to this, I may bump it each time I update, or just periodically (I have no intent of this post cluttering feed readers out there every few days!).  So, without further ado ...

Just for the fun of it ...

From the comments on PaleoOD, something Kurt Harris said prompted this t-shirt slogan idea by bentleyj74:

"I'm wrong with all the right people"

Which got me thinking ... would you rather be:

• Wrong with all the right people ... or
• Right with all the wrong people??

Of course, I'm always right so ...

Just kidding ... If this generates some discussion I'll chime in on the comments with my own thoughts.

Random(ized) Thoughts on Replication and Control

I had started this post as a follow-up to my A Matter of Control post before Chris Masterjohn posted the following over on his Daily Lipid blog:  When Standing At the Brink of the Abyss, Staring Into the Great Unknown, We Randomize.  

I think Chris highlights some of the reasons why randomization is important in studies, but in my opinion, he does overreach some as to the power and purpose of randomization. I'll address those concerns towards the end of this post.  Still, his post is spot on regarding two of the important reasons why randomizing is important in studies:

1. Selection (self or assigned by investigator) bias, and 
2. Unknown confounders

PaleOD

I'm sure I'm not alone in this, but is anyone else suffering Paleo Fatigue Syndrome?  Over dosing on just hearing the term "paleo" these days?   

I am.  

I've spent some stretches hanging out over on Paleo Hacks, and I keep my eye on various blogs and such low carb, which, these days, seems to be all the rage paleo.  My blog feed is even included at PaleoBuzz.com.

But, does anyone else find it strange when Mister Livin la Vida Low Carb himself now promotes "XX new blogs posts" with the word Paleo BEFORE low carb?  (Not to mention some paleo speakers on the 2012 cruise are decidedly not low carb dogmatists!)  I don't think Jimmy reviews his latest and greatest lists too well (hee hee, I made one I think sometime summer 2010 back when he only listed like 25 at a pop).  It wouldn't surprise me if along with some blogs that haven't been updated in months you might just find a carbivore paleo or three.  But I digress ...

Fasting Insulin & Diet ~ Time for some Cognitive Dissonance?

Reader Josh brings this study to our attention:

High saturated fat and low starch and fibre are associated with hyperinsulinaemia in a non-diabetic population

Huh?  They compared dietary intake (24 hour recall) for 1069 non-diabetics (assessed by administering a glucose tolerance test) with fasting insulin levels.  

Subjects were seen for up to three visits from 1984 to 1992. A 24-h diet recall and fasting insulin concentrations were collected at all visits....

... High total and saturated fat intake were associated with higher fasting insulin concentrations after adjusting for age, sex, ethnicity, body mass index, waist circumference, total energy intake and physical activity. Dietary fibre and starch intake were inversely associated with fasting insulin concentrations....

... Associations were similar in men and women and for active and inactive subjects, though associations of fibre and starch intake with insulin concentrations were strongest in lean subjects. 

Safe v. Non-Toxic

I've been listening and reading about the web, and the "buzz" over so-called "safe starches" continues.  One of the sentiments that goes with this is the idea that somehow Paul Jaminet is being irresponsible by promoting starch consumption.  The rationale is that because some minority of the population is intolerant to certain starchy foods, at best we should be labeling foods like potatoes and white rice "non-toxic" starches.  I disagree.  Firstly, in their book and on the blog, the Jaminets' reason for designating certain starches as safe couldn't be much more clear.   Secondly, I don't like the word toxic associated with a substance found in natural foods that has sustained billions of human lives throughout many millenia.  

There are a certain number of people who are wildly allergic to peanuts.  Should every book or nutritionist that allows peanuts, or even encourages peanut butter as a good choice for snacks tag them semi-toxic?  In my opinion, the fact that there are some folks with celiac does not justify the demonization of wheat consumption for all people.  Then we have nightshades.  Should we start talking about "non-toxic" fruits and veggies because some seem sensitive to these foods?  

Another 1500 Calorie Lesson in Reality

The apparent ineffectiveness of "conventional diets" for weight loss was somewhat lost in the excitement of the recent intermittent LC study.  Well, maybe not lost entirely ... there's always lots of "see, counting calories is useless" to go around.  But it struck me, yet again, that part of the problem with such traditional weight loss diets is that they are simply too high in calories to produce significant losses.  

Harvie's group has done a number of studies (I hope to discuss some when I get time and if I can get the full text of some) in pre-to-post menopausal age women with a focus on breast cancer risk.  Her group's "standard diet" seems to be a 1500 cal/day diet.  In the study presented at the San Antonio conference, the control group followed a 1500 cal/day Mediterranean style diet, and lost a piddly 4 pounds over 4 months.  See?  They don't work!!  Perhaps the reason why they don't work, however, is because that is simply not a weight loss level of calories for most women.  Now, this is a tough pill for many of us to swallow, but swallow it we must or we'll tear our hair out wondering over our metabolic derangements and hormonal dysfunction (or is that metabolic dysfunction and hormonal derangements ... or does it matter? ...).

Lingering Flavors ... Emulsifiers & Stabilizers

You can file this one in the random thoughts file ;-)

Think about foods you tend to overeat once you have some.  Nuts come to mind.  They are usually salted, and something about the yummy nut flavor mixed with the salt seems to stay on the tongue longer.  It lingers.  I know that if I'm having cashews (yes, I know, not technically a nut) I want more and more and more if there is a ready supply of more.  So I tend to grab nuts, when I do, in single serve packets or on the way out the door.  If I have them in the house, I take a handful or whatever from the kitchen and go eat in another room.  But when that handful is done, while that flavor persists in my mouth, I always want more, and it's not hunger or craving or any desire to binge.  It seems to be the lingering flavor.  (Brushing one's teeth helps with this big time!)

So wheat gives the dudes moobs ...

... but the ladies will go from deflated flatter chested pears, to round and perky Barbies if they just lose the wheat.  Yeah, that's how it's always worked for me!  WheatBelly is a JOKE.  Odd none of the LC ladies will call this guy on this crap ...

The Latest LC Beats Other Diets Study

I'm hesitant to discuss this one, because we don't even have an abstract of a published paper.  But since it's going to be bantied about the LC web anyway, I might as well comment on what information we have.

Here's the press release from the conference at which it was presented:

Intermittent, Low-Carbohydrate Diets More Successful Than Standard Dieting, Present Possible Intervention for Breast Cancer Prevention

Here's an article that provides some additional info:  Cutting carbs just 2 days a week can spur weight loss

Piecing together the information provided together it appears that they compared weight loss and changes in biomarkers for breast cancer risk in women over a four month period.  The diet details are sketchy, but it seems they compared the following diets:

A Matter of Control

It seems to me that many people misinterpret -- at least in their minds -- the meaning of this word when it is used in the scientific context.   While most of those no doubt understand the concept, after hearing the term enough, it just seems it comes to mean something else to them after a while.  I submit as evidence, statements made by two popular bloggers.  

First up, J. Stanton at gnolls.org with How “Heart-Healthy Whole Grains” Make Us Fat.   Wait!!  Did you click that link already?  I forgot to caution you that the post you are about to read contains science, so you might want to proceed with caution.  < / sarcasm > .  Anyway, the study he discusses in that post is:  High Glycemic Index Foods, Overeating, and Obesity.  Stanton prefaces his discussion with the following:

Yes, I admit to a degree of hyperbole—but this study is so well instrumented and controlled, and its results so informative, that I believe it’s important for everyone to read it.

Scientist Bashing II ~ The only sport approved by your favorite VLC guru?

As mentioned in my first rant on this issue, I had intended this post to be part of it.  But it's a somewhat different topic -- condescension of gurus sporting MD's against those lowly PhD's, or "just scientists" in general -- and lengthy enough (per my usual - grin) in its own right.

A short while back, Dr. Mercola weighed in on the whole "safe starch" debate.   However collegial the meeting at the WAPF conference between Paul Jaminet and Mercola, it did not keep Mercola from taking pot shots.  The evolution of the title of the piece is interesting in and of itself.   Mousing over the tab on my browser, and the URL reveal the original title: "Experts Discuss The Benefits of a Low-Carb, High-Fat Diet", but on the actual post?  Initially it was:  "Expert_ {singular} Explains Why You Don't Need Non Fiber Carbs". Huh?  That sounded strange for a post that prominently displayed the PHD Apple/Plate, but OK.  But shortly after that it was changed to:  "These Two Natural Foods Will Throw Your Blood Sugar Out-of-Whack".  Well, that's more what you might (or what I might expect) from Dr. Mercola.  Although Mercola seems to be receptive to Paul & Shou Ching's diet, it is clear which side he comes down on and who he feels is the real "expert" here:  Rosedale.  If there was any doubt, here is what Mercola says almost from the get go:

This might be interesting - Totally Anonymous Medicine

I was thinking about the state of medical care lately and thought this would be an interesting experiment (but not likely doable).

Imagine, if you will, a one month Metabolic Cruise.  To replicate real life as much as possible, no food or drink would be free.  It would be available as it is in every day life at normal market values in a variety of stores, restaurants and bars on the ship.  There is 24/7 video surveillance and each person has a GPS tracking advice.  Each person uses a card to purchase what they consume and places unconsumed foods in a receptacle to be analyzed.  In other words, a sort of free-living metabolic ward.  Of course rooms would need a kitchenette too.  But this cruise to nowhere would not allow for foods from outside sources.  Legally solid assurances were made from the outset that all video and such would be destroyed following analysis for compliance.    

Scientist Bashing I ~ The only sport approved by your favorite VLC guru?

This started as a comment over on Stephan's blog, but started getting a bit long.  So I hope Stephan won't mind too much if I move it over here.   Plus it contains thoughts about various and sundry names in the LC webosphere with whom I've had brief exchanges.  Those exchanged have had these thoughts brewing for quite some time, but in the end it seems to go back to the ultimate arrogant anti-scientist supreme:  One Mr. Gary Taubes. 

When I first read Taubes, I got the impression that he had little understanding of how science really works.  That first impression has been confirmed many times over in the intervening years.  I have always wondered over why medical schools and such would bring in a science journalist to lecture medical students on such a topic.  If one doesn't have a PhD in the exact field these days it is difficult to teach at the college level at all for example.  Gary has a bachelors in physics, with no apparent experience as a "scientist".  Apparently he practically lived in a lab for a while, and I guess this is where he believes he amassed the knowledge to view researchers critically and offer up his sage advice on how they ought to be doing their jobs.  Given his influence in certain circles, I think he's responsible for the wave of scientist bashing replete with a warped understanding of what science actually is and how it's done.  

The Best Diet & Fitness Regime for Health, Weight Loss

There's a nice conversation going on in the comments of my last post about the state of the nutrition and fitness communities.   One comment exchange just summed it all up and struck me as a "Nail ... Head" moment.  Before I highlight it, let's all think for a moment why we're in this in the first place.  For me?  I achieved significant but not complete weight loss and vastly improved health eating a pretty clean (no frankenfoods) VLC-based diet with planned cheats on those "normal" foods I enjoyed eating from time to time.  When the weight plateaued out, I wanted mostly to assure myself that the way I was eating was going to be healthy for me in the long haul.  And I've shared many of those concerns here before.  Regardless of how I felt, there was always this nagging concern over the shift of the distribution of where I carried the fat that remained, as well as racing heart issues I had experienced a prior stint eating this way.

Why is it never their diet for "Healthy" Low Carbers?

Before I get to the subject of this piece, allow me to remind older readers, and inform newer readers of "where I'm coming from".  I used a VLC diet (with planned cheats) to lose a ton of weight several years ago.  After plateauing out, I wanted to assure myself that the way I was eating was the healthiest for me in the long term.  That way was such second nature to me I truly wanted to find that it was optimal.  Now two and a half years into that inquiry, I still don't have all the answers, but I have become more and more skeptical that a VLC diet is advisable for the long term.  I remain a huge fan for the approach for weight loss.  

I've been criticized for being critical of the weights/appearances of low carb advocates.  While possibly fair, I think these critics don't really get the point here.  If So-and-So is saying "my diet rocks, baybeee!", goes on and on about how they are never hungry, healthy as a horse, etc., etc., I would say looks and results most certainly matter.  I'm also well familiar with the fact that, without surgery, it is almost impossible for someone who has been truly obese to return to a normal weight/size and not have lingering baggage (aka sagging skin and such).  And many of us struggle mightily with weight as we reach middle-agedom regardless of our diets.  I get it.  Really,  I do.