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Wednesday, January 18, 2012

Paula Deen ~ A Classic Case of Type II Diabetes

Was anyone surprised by the revelation that Paula Deen has type 2 diabetes?   See here and here, for example.  Full disclosure here.  I'm a NorthEast girl and was raised pretty agnostic in terms of regional foods/cuisines.  Still, as an adult I've enjoyed learning different cooking styles, flavors and ways of preparing foods and I'm an admitted Food Network junkie.  But Paula?  She was not one I ever watched much (unless she was judging on a competition show).  Sure, I love some Southern foods -- chicken fried steak w/gravy anyone?? -- but most of those foods are reserved for traveling to where they are local fare (although Chili's does make a pretty good version of the aforementioned steak).  And I find her accent and delivery just a wee bit over the top.  But I think every time I've ever seen the woman cook, I've seen her put half sticks of butter in a pan while saying jokingly that she's adding "a little".  Butter and Paula are synonymous in my mind -- if someone said Paula Deen in a word association game, butter would be the word that popped out of my mouth.

Now I'm not sure if Deen has the genetic predisposition towards T2, but aside from that, she's got all the lifestyle risk factors:  She's 64 or 65 depending on the source, which means she was over 60 when diagnosed -- IOW she's your classic example of why T2 used to be called Adult-onset diabetes.  She's overweight and was admittedly inactive.  She also consumes a very high fat diet and a considerable amount of sugar (she says she used to drink a lot of sweet tea).  

I can see the low carbers now screaming how it wasn't the butter and all that fat that made her diabetic.  Carbohydrates did that!  I remember someone on Jimmy's forum trying to tell people that Deen's cuisine was great except for the carbs and Julia Child basically cooked low carb.  Advocates from all corners of the health sphere have had their knives out for Deen and her diet.  Folks, her cuisine has a demonized macro or food for everyone.  There's the sat fat, the whole fat, the meat, the cholesterol, the wheat, the carbs, the sugar.  Did I miss anything?

It's funny, though, nobody seems to have a problem looking at the overweight Paula and blaming that she eats "fattening foods".  The TWICHOOBS are predictably clinging to the "it was the carbs" chant, absolving the hundreds of calories of butter she put into every dish she made.  No offense to Southerners, but few cuisines I can think of have succeeded in making even vegetables fattening.  Grok didn't smother his greens with rendered wild boar fat.  

So Paula Deen is a classic T2.  Perhaps she had the genetic susceptibility, but she overate and was either in caloric excess or caloric balance at a weight exceeding the ability of her fat stores to properly buffer lipid levels in circulation.  In the next week or so I'm going to flesh this out with some research.  But as it turns out , our current knowledge points mostly to the fat in her diet that put her over the edge, as her fat cells were no longer able to efficiently clear the fatty acids from her high fat meals from her bloodstream.   I have no doubt that if she's had the scans, she has considerable ectopic fat deposition in muscles, liver and pancreas.  Drinking sweet tea throughout the day probably compounded her liver fat and hepatic insulin resistance.  

If she were my mom, I would find a way to encourage her to lose weight fast.  I'd probably (gasp!)  advocate a low carb diet (a sane one where she's cutting back on that butter too).  The reason being I think that for the short run she could probably eat similarly foodwise to how she does now and achieve the dramatic caloric deficit that seems to do well to drop pounds fast, but more importantly, drain the ectopic fat swamps.  She's already doing the other thing I would suggest -- being more active.  Once insulin sensitivity is improved, it's time for some dietary changes to a more balanced macro ratio.  That's if she were my Mom ... because otherwise Paula would become an amalgamation of two well known low carbers making sugar free cakes and pies and loading down veggies and meats with butter and such.   And long term VLCHF does not have a good track record in populations outside the Inuit either for weight maintenance or glycemic control.

The predictable reactions amongst LC'ers to Paula are evidence that much needs to be done to educate people on what IS known about the causes of diabetes.   The scientists don't have all the answers yet, but where diet is concerned, they have provided us with knowledge of the diets that promote diabetes in susceptible populations.  Here is where Taubes has done the most damage with his lies about the Pima.  Yes, lies.  In Taubes' version of history, the traditional Pima diet was relatively low carb, although in his lectures he tends to slip in the truth that agriculture was integral to their culture.  As Gary tells us, after they assisted white settlers, those settlers returned the favor by diverting the Pima's river and hunting their game to extinction, thereby impoverishing them.  The Pima experienced a period of famine and were essentially converted to eating a diet of government rations.  The human part of this history lesson is true.  The dietary part?  Pure figment of Taubes' cherry-pickin' imagination.  The traditional Pima diet" although seasonably variable, was [estimated] ∼ 70–80% carbohydrate, 8–12% fat, and 12–18% protein. "

The story of the Pima has been repeated  with cultures around the globe as these formerly isolated cultures were exposed to Western foods.  This continues today on a different level as more developed yet somewhat traditional cultures are now exposed to the more modern processed/refined/convenience foods permeating the West.  The story for the Pima was NOT, as our intrepid science journalist concocted, a poisoning by carbohydrate.  It was eating a more SAD-like diet.  And while I'm on the subject of misrepresentations and outright lies, the obese Pima, and the obese in general in this country, do NOT eat the USDA Food Pyramid or anywhere near something resembling a low fat diet.  Most of these cultures ate far less fat than what we consider "deprivingly" low fat at 20%.  The dietary recs are for 30% -- hardly low fat -- but the obese tend to eat closer to 40% fat.  Interestingly enough, two regulars here at the asylum have each lost like 20 lbs this past year eating ... SAD macronutrient proportions!  30-40% fat, 15-20% protein, 45-55% carb.  But that's just FYI anecdotes.

It wasn't increasing carbs, and the supposed postprandial insulin spikes they elicited that spurned the obesity and diabetes epidemics in the Pima.  IF we're going to blame a macro, it is the fat.  A return to traditional diets is almost invariably cutting fat from the modern diet, with that one exception of the Inuit we know we all really descended from.   Even if the Pima tale were true, Taubes' insistence that anything that increases postprandial insulin leads to IR is just simply NOT supported by the peer review literature.  There is support for the notion that the 65% high carb diet advocated by the ADA may not be high enough in carbs!  Carbophobic TWICHOOB's can't wrap their heads around this.  All I can say to those people is to KEEP reading and keep an open mind when doing so.  In researching some of the Rosedale safe starches posts, I darned near converted to a low fat diet in a fit of panic!   Some historical posts here on this notion of carbs causing insulin resistance.


You might recognize the first commenter on that second post (from March 2011) - one Dr. Stephan Guyenet.  He's taken quite a beating on many blogs for going insane, changing his mind, etc.  Oddly enough from some of the very same people who decry intransigence in scientists for failing to "think outside the box".  That's not the way I see it.  Stephan is a good scientist and offers his interpretations based on the evidence available.  The role of free fatty acids in the etiology of diabetes is unmistakable, but there are gaps in the knowledge as to exactly how.  Also, acknowledging this role does not compete with the known detriments of hyperglycemic glucotoxicity.  But the notion that glycemic control is all there is too it is oversimplified.  Hyperglycemia -- aka what is diagnosed as diabetes -- is the end result of the pathologic progression.  It may well be that when one is at the cusp of beta cell malfunction, excessive postprandial glucose excursions put you over the edge, but they are not what "wore your beta cells out" or even what caused the basal hyperinsulinemia that is exhibited by the "classic" T2's and existed for some time prior to progression to frank diabetes.
EDIT 10/10/13:  Since this article was written in Jan. 2011, I have continued to read and research on diabetes.  The aforementioned beta cell dysfunction does appear to occur much earlier on than previously thought.  These posts may be of interest:  
β-Cell dysfunction vs insulin resistance in type 2 diabetes: the eternal “chicken and egg” question
Insulin/Proinsulin/etc. in Normal, IGT and T2 Diabetics 
What is Diabetes?       /END EDIT
This is the sort of thing that I was saying when I said that, in the end redux, "science" as put forth by Taubes will ultimately undermine the forward path of good science.  Too many have been misled into believing that eating carbs causes hyperinsulinemia, insulin resistance and basal hyperglycemia (e.g. elevated fasting glucose).   There are sooooooo many research groups working on this problem.  Public and private monies spent by public and private entities to find answers.  We are to believe that Hope Warshaw and the ADA, in cahootz with Big Pharma just want to keep us all fat and diabetic so we need to buy their books, services and drugs.  Only Paula Deen wasn't listening ... and worse, she was teaching untold numbers of fans how to cook like she does.  And so now Paula reveals she's diabetic and low carbers everywhere are screaming about how it's sooooo unfair that they are blaming their beloved butter so many appear addicted to.  (Yes, I said addicted.  If someone wants to presume anyone who binges on carbs from time to time -- heck, even the many who simply consume them in normal portions on a daily basis! --  is carb addicted, I'm going to call all the fat bingers  addicts too.)   It was the sweet tea and flour can't they all just see that?  Dang the government My Plate -- Low fat made Paula fat!  Oh wait ....

A few closing comments on the circumstances surrounding Paula's disclosure and endorsement of the diabetes drug Victoza.  First, for those not aware, Victoza is a GLP-1 mimetic, like Byetta.  GLP-1 is an incretin -- secreted in the gut primarily in response to fatty acids.  It slows gastric emptying, stimulates insulin secretion, reduces glucagon secretion and may have insulin sensitizing effects.  Oh ... and in the case of Byetta, many experience weight loss (so much for insulin = fat accumulation).   I have no idea if the scenario I'm about to propose is even remotely true, but starting with the facts, let's use some TWICHOO logic and see where that gets us with fat intake and GLP-1.   GLP-1 is secreted by intestinal cells in response to fat, therefore, a high fat diet should result in GLP-1 spikes, and hyperGLP-1-emia which would lead to GLP-1 resistance and decreased action of GLP-1.  Eventually we would burn out the GLP-1 secreting capabilities of the intestinal cells.  The "cure" here would be a low fat diet ...  To be clear, I'm just doing some Metabolic Mad Libs.  Think about this for a minute ... she's not taking insulin to "cover" her carb intake, she's taking GLP-1 to "cover" her fat intake.  

So I've seen two criticisms of Paula on the disclosure/endorsement front:
  • Timing of the disclosure, coming some 3 years after diagnosis:  Look, at what point does being a TV celebrity chef require disclosure of medical records?  She need never have disclosed this information, in my opinion.  Unless perhaps she were promoting "Healthy Southern Living".   Nobody would ever be under the delusion that Deen's cooking was intended for those looking to improve the healthfulness of their diet.  Nobody buys her books or even the Smithfield hams she endorses because of any sort of schtick.  I'm sure if Dana Carpender's upcoming LC cooking gig comes to pass, that she'll be hawking her recipes for health and weight loss/management.  After all, Dana owes her fame to her weight loss, something she no doubt considered as she scrambled to lose weight for TV.
  • Endorsing Victoza:  Well, presuming that the drug is helping her manage her diabetes, along with lifestyle changes including dropping the sweet tea, eating lower fat foods, and exercising (yikes!!), what's the problem?  Or are only folks like Robb Wolff, Jimmy Moore and Mark Sisson allowed to cash in on their "brand".  Isn't it ironic that Carpender herself took Victoza for some time?  Should she disclose that as she creates "healthy" 75% fat low carb meals for her new show? 
In the end, Paula is a classic T2.  If her diet didn't cause her diabetes, it's a good bet it contributed to it's progression.  She was counseled by conventional medicine to enact lifestyle changes.  No doubt those were part of the original advice, and we don't know if they were tried first prior to the Victoza.  If Victoza was started right away, perhaps her diabetes was severe enough to require immediate treatment to maintain glycemic control.  Presumably it is working for her.  You know, Jenny Ruhl of Diabetes 101 takes metformin and Prandin, an insulin secretagogue (I'm not aware that this caused weight gain for her either).  For all the wonderful glories heaped on Westman for his study in which we're told 95% of the VLC diet group "reduced or eliminated medications".  Had someone other than a LC darling Atkins author Doc like Westman made that claim, they would have been criticized for exaggerating the efficacy of their intervention, because this is exactly what he did.  See:  Diabetes "Crash" Cures: VLCal vs. VLCarbMost of the reductions were in insulin, duh eat less carbs need less pp insulin, while oral medications often remained at pre-intervention levels.  This is only a big hoorah if one considers insulin an evil hormone, rather than a life sustaining one.  A thought process that is inconsistent with acceptance that thyroid supplementation is appropriate for an underactive thyroid ... insulin therapy is merely the same for a malfunctioning pancreas!

In conclusion, I'm rooting for Paula.  I think just giving up the constant sweet tea should produce some weight loss.  Coupled with reducing some fat (calories!!) and moving more, perhaps this weight loss may be more significant.  Perhaps Victoza has the weight loss effect as well.  In a year, it would be great to read of Paula's cure!  Eh ... But I'm a realist and I don't see this happening.  Why?  Paula is known for her over the top use of butter in those foods she's been making for a decade on TV.  Either she needs to do a major 180 and supreme transformation, or she'll need to maintain at least some of her persona/brand moving forward.  Given that she took 3 years to divulge her disease and is taking Victoza now, and presumably for some time.  So it seems to me that the mid-60's Deen is likely stuck in her ways and not interested in reinventing a Lean Mean Nondiabetic PaDeen.  Will her "celebrity chef" brand suffer?  Eh ... only because it took so long to divulge her condition, if at all.  It's not the "crime", it's the coverup.  As I said at the outset, it is doubtful that any of her fans were looking to her for advice on cooking healthy meals for the family anyway.  Her persona was always authentic in that regard.  So it will depend on whether or not keeping this from her fans offends them.  I'm thinking not, but in the end I really don't care much as I'm not a fan.  Make room for another Adam Gertler show, I find him far more entertaining.  And please, they are just too darned cute, so I don't want to hear of any diabetes diagnoses for the Neely's. 

UPDATE 10/10/13:  I saw some footage from Paula Deen's recent "comeback" appearance.  She appears to have maintained her weight loss and perhaps lost even more.  It would also appear that the stressors of basically losing her career/franchise are taking a huge toll.   It would be interesting from an anecdotal angle to get an update on her diabetes, but I doubt that will be forthcoming.

72 comments:

foodteacher said...

I left the states in 1994 and was unaware of Paula Deen until I discovered her on Youtube last year. I teach a healthy eating unit at school and the videos of her making mash potatoes and sweet potato balls (they don't know what candied yams are over here) and of course the clip of her deciding to a HUGE slice of lasagne between two HUGE slices of garlic bread and eating it on camera are an interesting talking point. The kids are just horrified by it and it really does reinforce the 'All American's are fat because they just eat way too much weird stuff' (I of course remind them that the Brits are catching up quick). I find her being a spokes person for a pill company weird, but I would find it even weirder if she suddenly became some sort of healthy eating guru...

Tsimblist said...

I wonder of she might also be a victim of the "statins increase diabetes risk" thing that recently hit the news:
http://www.medicalnewstoday.com/articles/240148.php

Jes said...

I'm fascinated by this post, since I am also battling Type II. I can't comment on any of the research, but I would share, briefly, my personal experience.

I initially tried a lower-fat, moderate carb, high fiber, calories counting weight loss plan to control my blood sugar and lose weight. Even though I am "only" considered "borderline" diabetic, this diet kept my sugars *just a bit* too high (FBS in particular). I was still in a range where my Dr. wanted me on medication.

A low-er carb diet - not VLC - but around 20-30 NET carbs/day. moderate fat, high fiber diet has caused my blood sugar readings to drop to a healthy range. I also noticed a marked decrease in irritability. With these numbers, my Dr. does not feel I need any medication. Weight is dropping as well.

Is my diet causing other problems/disease progression even as it is lowering my blood sugar? Possibly. So, too, would medication carry risks, as would eating more carbs and simply letting my sugars run high.

There's no perfect "win" here for the diabetic. There's only the belief that as my weight drops and insulin sensitivity improves, I can add more foods to my diet and avoid any "extremes."

Obviously, anyone with Diabetes needs to test, test, test and find out what works best for them.

Evelyn aka CarbSane said...

It's possible. I'm trying to get my own Mom off those things.

Evelyn aka CarbSane said...

Yes! Test, test, test.

I think VLC diets are probably the best first course of action for diabetics unless they are willing to do one of the "crash diet" courses. I know if I got a diagnosis I'd protably try a whole-foods protein sparing low cal/low fat/low carb crash diet first. Of course I wouldn't do that forever, but I don't think VLC is the best thing for insulin resistance over the long haul in maintenance.

I recently watched Fat Head. In that movie Naughton said he had no blood sugar issues. Now he claims a small potato will spike BG through the roof. I don't know what you call that -- he most certainly has beta cell dysfunction if that is the case.

bentleyj74 said...

Reply function doesn't work for me :( but at least blogger hasn't told me to step off in a while.

If I was type 2 and early I'd prolly go for meds + cal restriction + exercise. Same as Evelyn but I didn't see exercise mentioned :)

Evelyn aka CarbSane said...

Almost forgot: One reason LF approaches may not work is that they are too moderate. If you search on "safe starches" or "Rosedale" you should come across the post where I listed quite a few metabolic ward studies where VHC thus VLF diets rapidly reversed IR in diabetics.

Mostly VLC diets seem to work initially because of the caloric deficit and weight loss. But the reason I keep bringing up these low carbers is that Jimmy Moore was always normal but now his fasting glucose levels fell in pre-diabetic range often during his n=1 tests. There's another low carber who is less well known who was diagnosed with prediabetes after 10 yrs of low carbing (consistently), and Dana Carpender is now having to resort to every-other-day 1000 cal/day fat fasts to keep her blood glucose under control. Lots of low carbers are buying into this "beneficial" physiological insulin resistance. Near as I can tell this is not a term accepted in any medical context, it is a made up term. Now some are trying to say that low carbers develop benign fatty livers too. Sigh.

Princess Dieter said...

Her empire could crumble for all I care--never watched her show, read her cookbooks, or need to tempt myself with "fried" or "uberbuttered" anything. I was on the verge of T2 myself, and got a "prediabetes resolved" note last year from the doc...and now I gotta keep that up. I don't want to take drugs--insulin or otherwise. I'd love to see Paula re-invent Southern Cooking. "Paula Goes Primal...Southern Style!" "Paula Does Lowfat, Lowcal"...hahahahah.

Actually, I might watch a reinvented Paula. I think if she finds a way to eat and move to reverse the T2, that will be an even BIGGER empire for her, given all the diabetics and prediabetics in our fat nation. I'd be interested in THAT....

Evelyn aka CarbSane said...

As you can see bentley, the reply function is working only intermittently for me today!

I did mention exercise in a round about way. Most of what I've read on Deen in the past day stated that she had started an exercise program of some sort, so I said: "She's already doing the other thing I would suggest -- being more active. "

Evelyn aka CarbSane said...

You know, if Richard Simmons can become a fitness guru (I love his quirky outrageousness!) anyone can make a go of lifestyle change.

Funny you should mention portion sizes. I'm sure a LOT of Paula's antics -- like the big bites she takes on TV -- are just that. Part of the entertainment value. I've seen Giada prepare some pretty decadent food too ... you think she eats like that every day? How about Bobby Flay's two beanpole female sidekicks on Throwdown (though I think he probably eats similarly to how he cooks because he also runs marathons). I see Jimmy is having a hissy fit on his blog that Deen doesn't have a disclaimer with every show: Don't eat like this at home, I don't eat like this every day. What a moob.

Speaking of portion sizes, the chicken fried steak (it's called country fried steak on Chili's menu) dinner is not all that big a piece and comes with mashed potatoes and gravy. Even when hubby and I weighed around a collective 600 lbs we would share one of those entrees and add a veggie. Outrageous portions here in the US are a big problem.

Jes said...

No reply function for me.

I haven't seen FatHead, but obviously, Type II risk increases with age, so someone who didn't have it 10 years ago can develop it regardless of what they eat/weigh, I am not sure I understand how following a VLC diet would cause someone to *develop* blood sugar issues, but I am always interested in reading more and revising my opinion. I am not "married" to LC at all and certainly would have preferred calorie restriction.

Bently - I don't think Evelyn was recommending calorie restriction plus meds. I think she was suggesting low cal PLUS low carb/fat and exercise. Which is more or less what I am doing except I keep the fat moderate.

Lol at Princess!

Tonus said...

"And I find her accent and delivery just a wee bit over the top."

I find that after the third or fourth "YAWL" I am about ready to slit my wrists. Then I realize that there are still 29 minutes and 50 seconds to go, and I change the channel to something less abrasive, like an Ozzie Osbourne interview.

Anyway, I agree that if she drops the sweet tea and wallows in some mangalitsa lard, she'll be on the road to proper health in no time. What... that isn't what you advised?

eulerandothers said...

I read about the statin-diabetes study results in Heartwire.

This particular sentence in the article seemed important:'In June, Dr Kausik Ray (St George's University of London, UK) and colleagues published a meta-analysis of PROVE-IT, A to Z, TNT, IDEAL, and SEARCH—five trials testing high-dose statin therapy—and found a significant increase in risk of diabetes with higher doses of the lipid-lowering drugs. A meta-analysis published in the Lancet in 2010 by Dr Naveed Sattar (University of Glasgow, Scotland) also showed that statin therapy was associated with a 9% increased risk of diabetes.'

The recent study of WHI data has this abstract:
http://www.ncbi.nlm.nih.gov/pubmed/22231607

The conclusion states:
'Statin medication use in postmenopausal women is associated with an increased risk for DM. This may be a medication class effect. Statin medication use in postmenopausal women is associated with an increased risk for DM. This may be a medication class effect. Further study by statin type and dose may reveal varying risk levels for new-onset DM in this population.'

If I could highlight that last sentence, I would!

Tsimblist said...

"One reason LF approaches may not work is that they are too moderate."

The McDougall Program is a starch based, whole food, low fat lifestyle that has a number of diabetes success stories:
http://www.drmcdougall.com/stars/star02.html

It was what I used to get off my statin prescription.

bentleyj74 said...

@Jes

In one of the studies on this site [Evelyn could find it for you quicker than I could] I'm almost sure oral meds were included. That's why I included it :)

Evelyn aka CarbSane said...

Ozzie LOL ... for me it would also be listening to Bob Dylan ;)

And I don't know who has the worse fake teeth, Deen or Wolfgang Puck!

Evelyn aka CarbSane said...

@Jes,bentley: I'm not sure if I did an extended blog post on it or not, but I have discussed the study that REVERSED diabetes in the newly diagnosed with short term (a few weeks if memory serves) insulin therapy. Said diabetes remission lasted for a year in a high percentage.

Personally my personal progression would be crash diet -> moderate diet + exercise (I'm not sure exercising would be a good idea on those low calorie levels) and meds if that didn't work.

@Jess: FatHead is available free on Hulu.com if you're interested. It was made in 2008 so we're not talking a long time ago and he's lost weight since. Glucose tolerance generally doesn't deteriorate with weight loss but it did for Tom. Dana has been eating VLC for 15 years and has been diagnosed prediabetic and with PCOS (insulin resistance related) and was put on Victoza and metformin. Nobody can know if her diet contributed, but now she's doing 1000 cal/day alternate days to manage her blood sugar. Probably repeated myself there with another comment but so be it. If what you're doing is working keep it up, I say! It's if it stops working that there's a problem. And when folks see increasing FBG's but they control postprandial spikes by not eating carbs, they are essentially masking hyperglycemia. Good to avoid the negative effects of runaway glucose levels and glycation, but not helping unknown other functions of insulin in the body -- e.g. amino acid transport into cells that it also mediates.

bentleyj74 said...

"Personally my personal progression would be crash diet -> moderate diet + exercise (I'm not sure exercising would be a good idea on those low calorie levels) and meds if that didn't work."

Yeah, I imagine those stores would be emptied out simply by the low cals. At higher intakes the exercise could really help with glucoregulation.

eulerandothers said...

The erroneous repetition in the conclusion of that abstract is all on me - don't know how I did that!

Diana said...

I'd be a little more pro-Paula if she weren't now a paid spokeswoman for a drug company hawking diabetes meds. Of course, I wish her well in terms of her health, but her example is disgusting.

Southern cooking is a GREAT cuisine, when done well. The very best cooking for a group I ever ate was in Nashville, when I spent a week at a fiddle camp. The food was marvelous.

But Paula Deen doesn't do that kind of cooking. Any idiot can dump a load of butter and sugar into a dessert and make it kind of edible. It takes a decent cook to make a great fruit crumble. Of course, the fruit crumble will have butter and sugar. But it's a supporting role to the fruit.

People have been after Deen for years to come clean about her health issues and to stop contributing to the obesity epidemic by in effect legitimizing huge portions of calorie dense foods.

Comparing her to Julia Child is ludicrous. First of all, the technique that Julia had to develop compared to Deen is like comparing a trained artist to a monkey with a painting set. Second, when Julia was attacked in the 1980s for her buttercentricity, she stressed portion control. She didn't have to stress that when she started because everyone took that for granted.

bentleyj74 said...

I love southern cooking. Anecdotally my paternal grandmother was a southern belle who was tiny and lean all of her life eating butter and cornbread. I love the southern accent :) PD is over the top. IRL it's so soft and demure I feel harsh and gutteral by comparison.

Evelyn aka CarbSane said...

I'm with you! One thing that does bug me, however, about the insulinphobia of low carbers is that may of the so-called 1.5's are misdiagnosed. They have some T1-like beta cell insufficiency. If that were my case, I would rather take some insulin and eat normally than not ... sort of like if I'm hypothyroid I would not hesitate to take appropriate thyroid meds. Similarly MaryDan Eades has used bioidentical HRT and if what I'm using now didn't seem to be working to a point, I would consider same myself.

The Deens of the world don't bother me. She's not making/influencing policy, she's not advocating a lifestyle per se or acting like a role model. So eh? I can take her or leave her and I wouldn't worry if I had kids that she might impact their school lunches and such. I feel similarly about Oprah except that she HAS achieved a position of influence that might impact the aforementioned in a meaningful way. Now if any of these celeb chefs were touting the healthfulness of their cooking, THEN they better be up front on whether they eat that all the time, etc. So far I don't see much I would construe as misleading coming from the food network. I know I'm hard on some LC'ers, but it's because they ARE eating this way and touting it as healthy, and having a go at others who take meds. Well, I doubt they will be changing dietary course anytime soon, and disclosing their health issues in disclaimer trailers on their cooking shows -- probably with "healthy" in the title or sprinkled liberally throughout descriptions of their dishes.

Evelyn aka CarbSane said...

Just to clarify, I don't think anyone ever compared Julia and Paula, it was more this notion but what for a carb here or there either could be LC ... and that Julia actually almost was as is.

Reminds me of when Alton Brown lost weight -- it was heralded as LC. When I pointed out that his morning fruit smoothie and a few other things put him well into over 100g range, the crickets chirped. I recall he did an episode on his diet and a few more health conscious things ... and we don't watch regularly as we're more into TripleD and Best Thing I Ever Ate these days, but it seems he's not cooking his new cuisine for the cameras.

Yeah, profiting from diabetes seems distasteful, OTOH if she has made some lifestyle changes, is actually taking it and it is effective, I can't begrudge her living the life that makes her happy. Anybody who goes on a drug because Paula Deen takes it is nuts anyway. And I think anyone who blames her for the obesity epidemic is grasping at straws!

Fashiontribes Diet said...

@ evelyn " I see Jimmy is having a hissy fit on his blog that Deen doesn't have a disclaimer with every show: Don't eat like this at home, I don't eat like this every day. What a moob." what, the answer doesn't lie with "paleo" almond flour and stevia???

I dunno why I do this to myself, but I proceed to read some of the comments to that post. This was my fave in response to a poster BHI who had the noive to suggest maybe Paula should lay off the fat. "Question for you, @BHI: How can the fat in her diet/anyone's diet be implicated--as the cause of diabetes? Diabetes is a disease of CARBOHYDRATE metabolism. Fat has no effect--NONE--on insulin levels." This is what you're up against. *sigh*

Cliff said...

I think the reason why "low fat" diets for diabetics usually fail is because they are based around the wrong type of carbohydrates, fats and proteins. High PUFA and High fiber are both a disaster for diabetics and most probably avoid sugar too which is the best possible thing they could be eating. Add plenty of cooked lean protein without the organs/skin and you have a horrible diet.

"In 1878, instead of restricting sugar, Dr. William Budd decided to "replace" the glucose being lost in the urine with white sugar (sucrose). The results?

"But here we have a diabetic patient eating from five to eight ounces of sugar daily, and not only rallying from a stage of disease which Dr. Prout describes as being all but irretrievable, but adding in little more than a month a full seventh part to her weight, and becoming the while gradually less diabetic."

O3 deteoriates glycemic response-
"Average blood glucose concentrations during the third week were significantly higher fasting (+ 15%, p < 0.01), and during the day at 1100 h (+18%, p < 0.001) and 1500 h (+ 17%, p=0.002) on PUFA than on the saturated fat diet."

http://onlinelibrary.wiley.com/doi/10.1111/j.1464-5491.1992.tb01748.x/abstract

Fatty acid tissue composition and diabetes-
"The FA composition of serum phospholipids (S-PL) measured by gas liquid chromatography and insulin action during a 2-step hyperinsulinemic isoglycemic clamp (1 and 10 mU/kg. min) were determined in 21 newly diagnosed DM2 subjects (DMN), in groups of long-term DM2 patients treated with hypoglycemic agents (DMH; n = 21) or diet alone (DMD; n = 11), and in 24 healthy subjects (HS)....Increased contents of highly unsaturated n-6 family FA (P <.01), arachidonic acid in particular, were found in all groups of diabetics compared with HS."

http://www.ncbi.nlm.nih.gov/pubmed/11735096

Dietary supplementation with n-3 fatty acids may impair glucose homeostasis in patients with non-insulin-dependent diabetes mellitus.-
"The blood glucose concentration tended to increase during MaxEPA treatment, and to decrease during the placebo period, the changes under the two regimes being significantly different (P less than 0.01). In addition, the rate constant for glucose disappearance (k value) for the intravenous insulin-tolerance test, which reflected the peripheral insulin sensitivity, tended to decrease during MaxEPA treatment and increase during administration of the placebo, there being a significant difference (P less than 0.03) between the changes during the two treatments."
http://www.ncbi.nlm.nih.gov/pubmed/2394967

Fructose improves glycemic response to glucose-
"In conclusion, low dose fructose improves the glycemic response to an oral glucose load in normal adults without significantly enhancing the insulin or triglyceride response. Fructose appears most effective in those normal individuals who have the poorest glucose tolerance."

http://www.ncbi.nlm.nih.gov/pubmed/11134101

Accute effects of fatty acids on insulin secretion-
Fatty acids (0.5 mM) acutely stimulated insulin release from rat islets of Langerhans in static incubations in a glucose-dependent manner. The greatest effect was seen at high glucose concentration (16.7 mM) and little or no response was elicited at 3.3 or 8.7 mM glucose. Long-chain fatty acids (palmitate and stearate) were more effective than medium-chain (octanoate). Saturated fatty acids (palmitate, stearate) were more effective than unsaturated (palmitoleate, linoleate, elaidate).

http://www.ncbi.nlm.nih.gov/pubmed/8721768

Craig in CT said...

@ Evelyn aka CarbSane

Regarding this: "I'm with you! One thing that does bug me, however, about the insulinphobia of low carbers is that may of the so-called 1.5's are misdiagnosed. They have some T1-like beta cell insufficiency.If that were my case, I would rather take some insulin and eat normally than not ... "

I'm not diabetic (yet, knock on wood), so I don't speak from first hand experience but.... I don't think controlling blood sugar with injected insulin is nearly as easy as boosting thyroid hormone levels with medication.

The real issue is the degree of control that can be achieved without risking fatal over corrections (severe hypoglycemia) or organ-damaging under-corrections (excessive hyperglycemia). In a person with a healthy pancreas and metabolism, the body is constantly sensing blood sugar levels and constantly making very small adjustment in insulin secretion to keep blood sugar in a narrow range. By contrast, an insulin dependent diabetic measures blood sugar maybe 4 or 6 times a day, guesses at dosages, and hopes they don't swing too far in either direction. Because the penalty for over-correcting by injecting too much insulin could be a fatal hypoglycemic reaction, the bias is to go easy on the insulin, and tolerate running to the high side on blood sugar. It means fewer trips to the ER, but comes at the cost of chronic organ damage. (So do you want the frying pan or the fire?)

The theory behind low carbing for insulin dependent diabetics is that no carbs means less control action required (lower doses), and thus fewer excursions to either the positive or negative side. The proponents argue that they can maintain a lower average blood sugar, with less risk of either kind of excursion.

By analogy, imagine driving your car at night on a winding road: as long as your lights are on, and you can see the curves ahead, you can drive fairly fast. You just can't go so fast that you overdrive the headlights. But now imagine that your lights flicker on and off, and you can only see the road for 10 seconds out of every minute. What are you going to have to do to keep from flying off the road? Go one hell of a lot slower.... Low carbing equivalent to driving a hell of a lot slower....



B

Melchior Meijer said...

Hi Evelyn,

I'm curious how you interprete the recent work done by Berit Johansen, an old time 'heroe' of mine. She has been meassuring the expression of certain key genes while feeding different macro combinations (in humans) and claims that we should generally go lower carb (but not too low, curiously) in order to avoid out of control chronic inflammation and chronic disease.

Here's the press release by the NTNU, her university. There's no paper yet, at least I'm not aware of it.

http://www.ntnu.edu/news/feed-your-genes

I'm re reading GCBC and start doubting the whole CICO thing again. Happily accepting the idiot status in advance. Even if insulin is not the main driving force, the idea that an organism can control it's weight by consciously taking in and expending a certain amount of energy (day after day) is very far fetched. Someone who has to weight watch to keep 40 excess kilo's off is sick, is controlling a pathological condition. Our environment is acting on hormones and feed back sytems, which in turn determine how much fat we accumulate. Well, that's what I still (again) think.

Cheers,

Melchior.

Nigel Kinbrum said...
This comment has been removed by the author.
Jes said...

This is fascinating stuff, Evelyn. I thank you again for posting (from one Long Island gal to another). Perhaps I am too single-mindedly trying to avoid medication vs. taking a longer view.

My A1C is 6, and it's thought that I am right on the "cusp" of being able to completely reverse this through lifestyle. That's great, but it's almost as though I have too many options. There's no real protocol. The only thing more or less guaranteed to help is exercise and weight loss.

I can't tell you how glad I am that you wrote about this - perfect timing for me (selfishly).

Rip & Clip said...

Maybe you should wait to make conclusions till we actually see the study and what they ate. These studies are more often than not total fail.

Nigel Kinbrum said...

"Even if insulin is not the main driving force, the idea that an organism can control it's weight by consciously taking in and expending a certain amount of energy (day after day) is very far fetched."
It's normally unconscious.
However, there are a lot of factors that disturb the feedback mechanisms in humans and dealing with these requires conscious effort.

Cliff said...

PUFA restriction would probably be the easiest thing to do with the biggest amount of results imo.

Diana said...

(reply feature still not working on Google chrome)

@Evelyn,

Actually, many people have compared Julia and Paula throughout the years, usually to defend Paula. Paraphrasing: "If Julia used butter (and sugar) liberally, why slam Paula? This is just classism and snobbery." I always conceded that they had a narrow point, because macronutrient-wise, there is little or no difference between a Paula gooey buttercakes and a classsic genoise with buttercream frosting.

But I do maintain that there is a huge psychological difference between a hamburger in a donut (I didn't make that up) and Julia Child's thoughtful mature cuisine. I learned from YOU!! (among others.) There's a difference between the all-out gluttony of Paula Deen, and the discriminating taste of Julia Child (who was not a snob - she liked Mickey D's on occasion).

I totally admit that any kind of food can become the gateway for obesity, and you can be skinny on Paula's deep-fried stuffing pops. But let's be honest. The implicit message behind Paula Deen's cooking is: pig out.

"Yeah, profiting from diabetes seems distasteful, OTOH if she has made some lifestyle changes, is actually taking it and it is effective, I can't begrudge her living the life that makes her happy."

I beg to differ. She is now saying, eat a slice of cake and take your diabetes meds. No. Bad message. And she's known about her diabetes for three years. This is a careful campaign to position herself, salvage her career, and make money. The backlash has been intense and I read that she is now going to donate some of the millions she is receiving from Novo Nortis to the American Diabetes Association. I think this is totally disgusting. She's rich enough. She shouldn't take a penny from Novo Nortis. She should use this as an opportunity to help people. She's using it as an opportunity to make money. I think they should kick her azz off the Food Network.

Diana said...
This comment has been removed by the author.
Diana said...

I felt a little guilty writing the previous comment. But after I read this, my guilt vanished.

""Diabetes is the most expensive illness to treat," said Wolper. "It does not go away [NOTE: it can be beaten, but only if you do what Deen never would, for a few months] and requires drugs every day, and often many drugs... The obesity and diabetes in the US is costing us all a fortune, and causing health insurance costs to skyrocket."

Nope, no guilt at all. Deen is a horrible role model. And she does have some influence. Blaming the obesity epidemic on her is crazy, but she's a horrible influence.

Link:

http://abcnews.go.com/Health/paula-deen-confirms-type-diabetes-teams-novo-nordisk/story?id=15378730&page=2#.Txgn529SRg4

bentleyj74 said...

A hamburger in a donut?! [***heave***]

" The implicit message behind Paula Deen's cooking is: pig out."

Agree, it's the content of the message moreso than than the content of the food that I'd be wary of.

On the other hand PD is quite overweight, looks 20 years older than she is, and will be sick for the rest of her life.

Julia Child was not a glutton, she had an appreciation for food but also for culture. A single small slice of her buttercream confection would be served with coffee and company at a beautifully laid out table. Paula by comparison seems to be just fine stuffing something weird into something else and huddling in a dark corner preferably alone to gorge on it to the last crumb.

I have without a doubt encountered culture shock moving far away from my extended family norms. In the not too distant past [decade or so?] an older woman at a town function actually attempted to force one of my then toddlers to "clean" her plate rather than walk away when she was finished.

I was of course shocked and appalled because the implicit [and sometimes explicit] message for me had always been "you are not a dog, don't lick your bowl clean". It had never even occurred to me as an option to insist that someone continue to eat beyond desire. I had to wonder would I at least get bonus "good Mommy" points if she vomits right here on the table?

Yet, if I disagree I am

A) Disrespectful
B) Wasteful
C) A snob
D) All of the above.

Culture is relevant.

Jes said...

Cliff: I agree in concept. However, I just wanted to note that PUFAs have never been a part of my diet other than via fish oil.

And on another note (this is not directed at Cliff or anyone else), I'd like to point out that not all of us who are overweight and pre-diabetic were ever mainlining donuts like Deen.

I - personally - gained most of my current weight on bed rest while pregnant and have been eating probably close to the "old" USDA pyramid for years. Inactivity and lack of tightening up on my portion sizes has kept me from losing much of the weight I gained, although I have lost some. More now that I am moving more and testing my blood sugar regularly. :)

Even whole foods can cause weight gain when eaten to excess. I would eat two bowls of lentil soup or a without a thought to the 600 calories - after all, it's a healthy food!

That's why Evelyn really struck a chord with me. Because even someone like me, who cooks whole foods every night and is aware of basic nutritional principals can still be overweight and unhealthy simply due to, well, gluttony in general. Calorie restriction was the missing link for me. Now that I am eating lower carb, my calories are simply much lower for all the reasons Evelyn has mentioned here.

The lower carb is keeping my sugars low, but I believe it's the caloric restriction that is finally causing my weight to drop.

Great discussion here! Thanks again.

Galina L. said...

@ Evelyn,
It is a very interesting conversation, but I can't participate much today due to dealing with other things, but I want to make a quick remark about mom's care. On one hand, it is not desirable(just my opinion) for an elderly person to develop even physiological IR. I have a gut feeling, the older the person, the more problematic and pronounced it could be. So - carbs level better be not too low (may be 50 gram). On another hand, as I noticed it with my mom, LC allowed to take her from the blood pressure medication. So, carbs should be low enough for that effect to continue. Can't go into details right now, but it looks like everybody should be doing some personal experimentation. I also noticed IF is working well for me when I feel like there is a flue coming, my mom doesn't want to do IF, so it is a fat fast when she needs to stop a flue on it tracks. Last February she had a big straggle with a nasty flue turning into bronchitis for almost 2 months. I don't want the repeat of it. Especially with me being so far away.

Diana said...

@Bently 7:07 a.m.

Yes, a hamburger in a donut sandwich. There's worse. She has a fried stuffing on a stick recipe. I'll spare you and stop there.

When all this started, I was hardly aware of who Paula Deen was. I'd seen her once, and I admit that I had a mild distaste for her "hi y'all" shtick, which I immediately pegged as real but fake. I looked at a few of her recipes and was underwhelmed. A few months ago I heard rumors that she had diabetes and now this. So I looked more carefully into her recipes and was totally shocked and disgusted.

Then, I read that she's accepted several millions from Novo Nortis to hawk their meds, and I realized that she's been positioning herself for three years (date of original diagnosis) to do this. That's when I lost all sympathy.

Mainly, my disgust rests on the fact that she doesn't know anything about cooking, she just slaps together ingredients in the crudest possible fashion. And makes out like a bandit. It's the dumbing down of America, in addition to the rest, that gets me.

On the other hand, I love Shirley Corriher. She knows cooking, and she's real Southern. Yes, she's way fatter than Deen and I guess wish she would lose weight, but IMO, her obesity doesn't detract from her "message" because she doesn't really have a message other than to know what you are doing in the kitchen. Her books are gems.

http://www.youtube.com/watch?v=7baqgejDqfU

Evelyn aka CarbSane said...

@Diana, bentley & others: I do want to make sure that I'm on the record as not being a fan of Deen in any way. I've never understood her appeal for many of the same criticisms that have been leveled against her in terms of her cuisine and demeanor. But I don't think many of her fans would care either way whether or not she did eat like that every day or was diabetic or whatever.

Evelyn aka CarbSane said...

@Cliff: Welcome! Lots to mull over there. When I was looking into safe starch stuff, I did come across a lot about why PUFA may be detrimental to diabetics (cause?), but there is far more evidence in support of high MUFA content in the diet AND fiber both being very beneficial. I'm trying to track down if there's research on why sucrose is so apparently insulinogenic. I've found some, but I'm not there yet. I put all your links on the HD "to read list" Thanks!

@Craig: I am not advocating insulin for everybody and/or high carb diets either. What I am saying is that diabetes is a term that covers a variety of pathologies. True T1's make no insulin and very high carb diets would not seem advisable. However there have been many improvements in insulin therapy since the LC granddaddy of diabetes, Bernstein, came on the scene. Insulin pumps are a great advance in the treatment as are long acting insulins, and the sheer availability and relative affordability of testing supplies. Clinical studies have demonstrated that many (most?) Type 2's do very well on a VERY high carb diet (like 75%) thus very low fat diet ... this seems to restore insulin sensitivity in rather short order. The 1.5's do have it tougher to figure out. In an ideal world diabetes screening/diagnosis would involve fasting insulin and glucose, NEFA's, and oral glucose tolerance test AND an oral lipid clearance test, both with insulin levels measured, AND assessment of beta cell mass and lipid content. That's a lot but I think it's important to know where you stand.

Traditional T2 oral meds helped glycemic control but failed to forestall disease progression. There is too much evidence of reversal of the disease to throw in the towel on diagnosis, and early insulin therapy has a pretty darned good track record in the (admittedly small) studies I've seen. I research a lot about the free fatty acids and a lot of that research leads to diabetes research so I've come across a lot of studies that don't really fit in my interest window, but that I've read abstracts for nonetheless. There is a lot of promise for medications based on the incretins, especially GLP-1 even for T1's.

Given the myriad other functions of insulin in the body, I just think it is myopic to manage the endline symptom (hyperglycemia) without fixing the underlying pathology. Treatment of T1's should be moving towards reinstating as normal a physiological insulin level/function as possible, not minimizing how much insulin needs to be used. Hopefully some day that means cell transplants or a true 'artificial pancreas'. T2's have functioning but dysfunctional beta cells. So long as someone has those treatment should focus on improving the cell function.

I'm not a doctor, but the ultra low carb high fat diet for a type II seems ill advised. LC early on to manage glucose levels in the immediate AND lose weight, yes. If you're not losing weight, and long term in maintenance, high fat "moderate protein" diets don't have a good track record for improving beta cell function. Anecdotally, most see deteriorating glucose control as time goes on.

bentleyj74 said...

Probably not. There is a sort of proudly defiant element despite obvious negative consequences. I disagree with JM that she should have a disclaimer [don't try this at home kids...don't eat like this every day!]. Instead...own it. I eat like this every day. As much as I want. Smoke too. If you want to be diabetic with false teeth and grim prospects for the future come get in line behind me. Waaaaay behind me naturally. Let's get real. You aren't making money off you the way that I am and won't get VIP treatment but still...PIE!

eulerandothers said...

@melchior meijer,

I really enjoyed looking at the article you provided a link for. This sentence immediately caught my attention:
'The answer researchers have come up with may surprise you: the best diet, from a gene's standpoint, is one-third protein, one-third fat and one-third carbohydrates. That's what the research shows is the best recipe to limit your risk of most lifestyle-related diseases.'

This is the Zone-ish ratio I have set as a goal in the past. To find out how devilishly difficult it is, measure the food that you eat carefully and enter it in fitday.com (my choice because I have used it for years, and also because it gives an immediate visual depiction of the ratios in the form of a pie chart.)

What I experience, and I think anyone would, is an immediate urge to cut fat, not carbohydrates. The smallest amount of fat, because it has twice the calories of carbs OR protein, skews the balance. Immediately, outrageously, and that is quite a shock.

"Both low-carb and high-carb diets are wrong," says Johansen. "But a low-carb diet is closer to the right diet. A healthy diet shouldn't be made up of more than one-third carbohydrates (up to 40 per cent of calories) in each meal, otherwise we stimulate our genes to initiate the activity that creates inflammation in the body."

Cutting carbs means adding lean lean protein to bring the desired balance in line. I have tried to do this with skim milk, egg whites (no yolks), fat-free cheeses, hmmm... you do run out of fat-free protein pretty quickly! I've never had to cut carbs (only those that contain fat because they are processed and have fat added) but pumping up protein without adding fat.... is really difficult!

The one thing that helps: finding foods or prepared frozen meals (which can be high in sodium) that already have that correct balance.

Lerner said...

Emeril says he is not T2 but does have the Fx.

BHI said...

Yep that was me. It fascinates me to hear what some of the diehard low carbers have to say, very cult-y if you ask me. When I mentioned fat induced insulin resistance and also the fact that if carbs per se caused diabetes then majority of the world's population who eat high carb would be diabetic, the crickets chirped. sigh

Melchior Meijer said...

That's an interesting perspective, Euler. Thanks!

Johansen herself doesn't seems do the math differently. From the article:

"Genes respond immediately to what they have to work with. It is likely that insulin controls this arms race," Johansen says. "But it's not as simple as the regulation of blood sugar, as many believe. The key lies in insulin's secondary role in a number of other mechanisms. A healthy diet is about eating specific kinds of foods so that that we minimize the body's need to secrete insulin. The secretion of insulin is a defense mechanism in response to too much glucose in the blood, and whether that glucose comes from sugar or from non-sweet carbohydrates such as starches (potatoes, white bread, rice, etc.), doesn't really matter."

And:

Johansen explains that many of us do not realize that all the fruits and vegetables we eat also count as carbohydrates -- and that it's not just sweet carbohydrates that we should watch out for. "Salad is made up of carbohydrates," says Johansen. "But you have to eat a lot of greens to get a lot of calories. Steamed broccoli is a great alternative to boiled potatoes. Fruit is good, but you have to be careful not to eat large quantities of the high-glycemic fruits at one time. Variety is important."
The best is to cut down on potatoes, rice and pasta, and to allow ourselves some of the good stuff that has long been in
the doghouse in the refrigerator. "Instead of light products, we should eat real mayonnaise and sour cream," Johansen says, "and have real cream in your sauce, and eat oily fish. That said, we should still remember not to eat too much food, either at each meal or during the
day. Fat is twice as calorie-rich as carbohydrates and proteins, so we have to keep that in mind when planning the sizes of our portions. Fat is also different. We shouldn't eat too much saturated animal fat, but monounsaturated vegetable fats and polyunsaturated marine fats are good."

Melchior Meijer said...

That should read 'seems to do the math', sorry, blonde.

Ooops, I realize poor Berit could become the new Anti Christ in this cosy echo chamber. She's using the I-word, whaaaaa!!!!

Evelyn aka CarbSane said...

@bentley: I think I read your comment wrong and we are in agreement -- no disclaimer needed on Paula. I don't think we are in any danger of losing a generation of kids to her cuisine ... she "speaks" for herself. However, I'm willing to concede and say that every TV chef, cookbook author, advocate of a lifestyle, etc. should be required to divulge their degree of compliance with that they cook/advocate along with current regular full length pictures in normal clothes (no baggy labcoats, ahem WheatBelly, on anyone, no suitjackets or untucked shirts for the men, no mumus for women). And I hereby crown Princess Dieter Empress of the Compliance Board. But it is ridiculous that I don't think I've ever heard the word "healthy" come out of Deen's mouth (well, perhaps until now), yet we hear it daily from LC advocates.

Tonus said...

I thought "insulin" was a bad word in the LC world, not here? *checks his scorecard*

Evelyn aka CarbSane said...

Hi Melchior,

Johansen seems to have published in rather prolific fashion on phospholipase A2 http://scholar.google.com/scholar?q=berit%20johansen&um=1&ie=UTF-8&hl=en&sa=N&tab=ws
I was struck, as was euler, by the Zonish recommendations. I'm not sure what Norway is eating to get them to 65% carb (contrary to popular opinion, the "habitual eating" assessed in study after study for the SAD comes out in 40-55% range, usually in the upper 40's. And the same goes for fat which is NOT low except in a small segment of the population. Again, it usually comes out in the 35-40% range depending on the study group, higher for obese, lower for lean and perhaps down to the low 30's for the latter. And protein then seems low by Johansen's recs pretty consistently around 15%, but as low as 10%.

So two grad students fed some slightly overweight people some food and looked at gene expression and have concluded that protein/fat/carb should be roughly 1/3, 1/3, 1/3 in 5-6 small meals per day. Sounds like my diet these days (sans grazing all day)... guess I'll live ;)

Evelyn aka CarbSane said...

@Melchior:

Johansen's math was about 1/3,1/3,1/3 but she did say up to 40% carb by calories. Given that 33% protein is a bit high, let's even do 30% protein, and I'll even go to 30% carb that leaves 40% for fat. What euler was saying is that's pretty difficult to do AND eat full fat mayo and cream. No, 40% fat is not difficult, but it is when eating that much protein. One HAS to select some lean sources if you're going to use any added fats as Johansen suggests. Even salmon is 45% fat, my "low fat" (2%) cottage cheese is still 25% fat. I do not consider Sisson's menu to be as outrageously fatty as some other paleo/primals in terms of his choices ... yet it comes out over 50% fat. Interestingly her macro ratios are similar to Eaton's paleo estimates. But they are nowhere near pretty much any known traditional human diet which tend to be higher fat or much higher carb, mostly the latter. The "sprightly" traditional Pima ate <15% fat ... I guess those who studied them missed their rampant inflammation.

The characterization of insulin as a "defense mechanism" is ridiculous, sorry Dr. Johansen. She speaks of so many variables (type of fat for example) that I really will wait to see the studies before commenting further. How long on the diets? How were the baseline diets assessed. How did they vary the macros for each subject. If I were a subject, would they take my intramacro composition and hold it constant as they altered the macros themselves? IOW if I eat bread and butter, did they cut the bread and put olive oil on my salad? Too many questions and ambiguities.

I'm disappointed Melchior. First you call the commenters here buttlickers, now you characterize this place as an echo chamber. That Johansen says lowering insulin yet specifically says too LCHF is not good either means that either (a) she's being PC because the fat police will come down on her, (b) she's seen that high fat diets trip inflammatory genes on, or (c) despite the bluntness of the press release wording, she understands that it's not just diet that determines insulin levels and is aware of the role of high fat low carb diets in creating an undesirable insulin resistant state. So ... I look forward to her published research.

I forgot to address the caloric control. This is a strawman IMO. I would love to find some magical diet that if only I ate that I would effortlessly return to a normal body weight. I'm not a mouse in a cage being fed only what some unintentionally sadistic tech feeds me. I'm also not a genetic mutant. There are many here who employ different ways to control intake and lose/manage weight -- Galina controls hunger with LC and intake with IF. Several count calories in various ways. I've got some Weight Watchers here. Diana did one day a week fasts with moderate eating the rest of the time. I lost weight doing VLC most of the time with planned cheats that weren't binges. MM has lost 20 lbs abandoning LC and eating roughly SAD macro ratios. Tsimblist eats McDougall, ejazz eats DASH to control diabetes. OnePointFive eats oatmeal despite WheatBelly's hysterics. Some eat PHD starches only, some eat wheat! Echo chamber? You must be kidding me. :(

I'm hoping that Johansen's research is sound and here's why. I tend to eat high protein and make leaner selections probably 2/3rds to 3/4ths of the time. I've upped my carbs into 100g range (not counting non-starch veg which probably add another 25 or so more). In other words, I come out Zone-like ratios. However in most head-to-head comparisons these ratios seem outperformed by more extreme diets on metabolic risk factors in clinical trials.

I would also point out that in that Paleo v. Med trial, BOTH diets were of similar macro ratios in this range with different results. All of this tells me that focusing on macros and a single hormone is myopic to the nth.

Evelyn aka CarbSane said...

I saw that :( This is Taubes' lasting legacy and it is really sad. If you look at Jimmy himself, he's posted enough labs and information over the years to indicate he is clearly devoping hepatic insulin resistance, and likely fatty liver. On more than one occasion when he loses weight fast he gleefully reports his fatty poop (really!). In 2008 he had low fasting insulin (7 or 8) and FBG in the 80's. Most of his FBG's during his n=1 experiments have been in the 95-110 range. There are others like Dana Carpender. Makes me wonder what "great friends" all these folks are since they seem to have no clue what's really going on. Dana looks fine but she's blogged about a list of health issues a mile long all the while claiming how healthy her diet is. If you're eating VLC for a decade, and your fasting blood glucose goes outta whack, it's just pathetic that you wouldn't at least CONSIDER that your "aim for 75% fat" diet has nothing to do with it or at the very least might be part of the problem!

Ahh but Gary tells us scientists are all idiots, so ALL that peer review literature clearly demonstrating how fat contributes to IR is just biased stuff done by the ADA and Big Pharma to keep us sick. Yeah, BHI, *SIGH*

Fashiontribes Diet said...

@ BHI re crickets chirping - good analogy. imho that forum & comments section is an echo-chamber if ever there was one.

@evelyn I was so glad you tweeted that link to the Emily Deans post about the fact conventional wisdom isn't wrong - it may skew in certain directions, reflecting special interests, but the foundation upon which various theories & thoughts are based don't emanate simply out of thin air (or 3-PhD'wannabe book advances).

I know it's anecdotal, but I had so many thyroid & kidney issues from VLC. In a way, the speed at which that way of eating bit me in the ass with health issues was a blessing because it knocked some dietary sense back into me & quick-like. I know there's been discussion about eating more sugar, which I tend to avoid because it seems unhealthy to eat too much of (but that's just my spidey sense & completely not based on any science other than grandma was probably right, as usual), but I tell you, I'd rather hang out with a happy sugar fiend who scarfs down oatmeal for breakfast than a dour LC'er with a laundry list of health issues and fatty poop (ugh *shudder*) and smug true-believer attitude.

Diana said...

@bentley,

" There is a sort of proudly defiant element despite obvious negative consequences."

I've been thinking about what it is about Paula Deen that bothers me. I love Shirley Corriher, for example. (Google her if you don't know the name.)

Shirley is also Southern and she is way more....ample....than Paula. James Beard was a fat guy. (He's passed on, so no feelings to hurt.) It's wrong to ridicule a chef based on their physical appearance, although the temptation is irresistible. Whenever I see a pastry chef, I do take note of their weight.

So what is it? It comes down to this. I think Paula Deen is a crap cook. She doesn't know what she's doing, and her food sucks - but it's full of all that hyperpalatability stuff that makes people want to eat it. Food doesn't have to be good to be hyperpalatable.

Shirley on the other hand has a degree in chemistry, has written books about how chemistry affects what you do in the kitchen. She knows her stuff. I have a bedrock of respect for her.

And, though Shirley is now a pitchwoman for a flour company, I don't begrudge her. She bakes. I bake. Bakers use flour. There's nothing wrong with pitching a brand of flour, unless you are Wheat Belly.

Shorter version: it's not what PD is, it's what she does.

Hope that makes sense.

bentleyj74 said...

@Diana...

So what you are saying in a nutshell is that PD is the Hardees of cooking :). Not even up to McDonalds standards but toss enough salt/fat/sugar in there and people will eat it.

bentleyj74 said...

@Evelyn

"In other words, I come out Zone-like ratios. However in most head-to-head comparisons these ratios seem outperformed by more extreme diets on metabolic risk factors in clinical trials."

Didn't seem to be a problem for Jen Aniston. :)

I'd imagine that more equal amounts of all macros would have a higher reward value but still think that's subjective with regard to all the other variables. My diet lands naturally at the higher carb end [which suprised me because I do eat meat and use butter etc] largely because it is the way that I was raised and I'm accustomed to it. If I had spent my youth in the midwest rather than a pacific island that might be different.

Galina L. said...

My guess is one has to over-eat to a great degree in order to achieve a fatty poop. My gallbladder was removed approximately 10 years ago, before gall-bladder removal I also tried to eat lean in order to keep down energy intake. My food often has a high fat content now, but I don't experience that phenomenon. Some time after the surgery I had a diarrhea regularly after eating fat food , it was the main reason why my diet was very low in fat previously to LC. I had to gradually increase fat content while limiting portions - no fat poop, but my fat consumption is higher now than before. It is possible I never reached really high-fat eating compatible with the JM level just because I started on a quite low level. It is a lot in my perception, but may be not so for somebody else.

rodeo said...

Carbsane: I think the reason zone isn't working for most people is that it's really hard to get to that level of protein and still eat carbs+fat with every meal. You can't eat stuff like cheese, egg or most kinds of meat (most is higher fat than protein) and then add som carbs to that. You are more likely to end up with 20-25% protein and really no change in your diet.

I eat a higher protein diet due to weight lifting and my means of acheaving that level of protein is whey powder, low fat dairy products, lean meat and chicken breasts. It's not something normal people likes to eat and actually quite low reward since you can't mess up the macros by adding a sauce or a dessert and forget about juice or soda.

People think they eat protein when they eat sausages or vegetarian protein sources like lentils, nuts or soy products but these food stuffs are cumbersome to work into your diet if you want to stay above 30% protein.

Tsimblist said...

@rodeo

I just learned that protein lesson a few days back. I itemized Wednesday's meals into Fitday to get an idea of where I was at. It put me at 49% (of calories) fat, 40% carbs & 12% protein. And I have been trying to up my protein with whole plant foods. I have certainly fallen off the McDougall LF wagon.

Sanjeev said...

>> Most of his FBG's during his n=1 experiments have been in the 95-110 range

Maybe he's not complying with the instructions to go off low carb for a couple of days before hand?

How much carb is needed though? Lyle McDonald in his "Ultimate diet 2" has people come out of a low carbohydrate week by eating 10 to 20 grams of glucose coming out of the low carb phase to "clear out the blood lipids" in preparation for a hard workout that is immediately followed by a massive 3 day carbohydrate load. If UD2-ers maintained insulin resistance into that 3 day carb load they would be in trouble. (10 to 20 grams was the point before I rambled[0])

Although if Petro's "physiological resistance due to palmitate" is what's being measured, one might expect a steady, not a worsening, number.

Jimmy's also probably running into another effect Lyle wrote about: gut downregulation of the digestive machinery for macro nutrients. Lex Rooker suffers from this IMHO. He seems unable to tolerate much carbohydrate at all.

[0] me, rambling? (usually with lots of parentheses[1]?) say it ain't so

[1] (like this (in case you needed an example))

Diana said...

@bentley, dunno what Hardee's is but I can guess. (I live on a remote island.)

My physical therapist is a fit young guy of Asian origin. He loves Paula's desserts. He told me that when he eats dessert, he wants it super-sweet, and easy to make. He says he likes to cook but I don't think so. I think he likes to fling things together, and to assemble.

Steph said...

Here's what surprises me about Paula Deen - she got her diagnosis three years ago? You can do a ton of good in three years - lose significant weight, totally overhaul your diet, get fit. And she can afford a personal trainer. Other than giving up sweet tea, I can't tell that she's changed much. She's still on diabetes drugs, and she still looks to be the same weight. It seems like there's some serious denial going on.

dallasmsl said...

Paula Dean is doing what everyone else does when they learn they are T2 - they look for immediate replacements and substitutions but refuse to change their lifestyles. They want fake sugars to use when making their pies and cakes! As for statins, yes, her doctor probably has her on those. Good for him - make that money. Instead of telling her to start eating only natural foods and to stay away from white bleached foods. My mother is T2 as I am (and I'm a bodybuilder) and she has hers totally under control. She's literally the "Food Nazi". And she doesn't have high cholesterol but her doctor has her on Statins!!! Just because she's T2! I told her to stop taking that crap. Instead, she now uses pure Sea Salt (not the Morton crap) and unrefined sugar as well as fruits, veggies, and as many natural foods as possible.

bentleyj74 said...

@Steph

This is one of those places where the perception distortion really sort of...shows. It was always there but maybe not so obvious?

I've seen people rubbing their stump with one hand and plowing through their stash of ding dongs with the other JM style [whole boxes at a time chased with a 2 liter]. Those same people would look you straight in the eye and insist that they are diet compliant.

'Nother anecdote re denial. We had a break in last Oct. Our teenage daughter ran into our room and told us that there was a man walking around down stairs. My H went to check it out and found a very disoriented older teenager wandering incoherent and aimless. The kids mother insisted...really emphatically...that he wasn't drunk or high WHILE he was face down in handcuffs on our porch still totally unaware of where he was or what was going on.

Let's say that she's right. He's a snowflake whose had some sort of dissociative break from reality that's both random and involuntary. Is that really better than just being out of control drunk/high? I know for sure which option I'd prefer if it were my own kid, kwim? I can't ground you out of serious mental illness but your lack of discipline and self control reflects badly on me as a parent therefore what should be a horrific possibility becomes the preferred option and the one that protects me from personal accountability. As a matter of fact I might even soak up sympathy over the whole thing like a little sociopathic sponge.

Lerner said...

@BHI: ahaaa! yes, the thunderous silence of the chirping crickets. I remember it well from various occasions and that was a main reason why I stopped posting and then stopped reading on any site that is Paleo or even LC. They're mostly all about "us vs them" and essentially are emotionally based. I don't know if vegans are the same, but I'd guess that they are indeed the same type.

Galina L. said...

@ Steth,I yet to see a newly diagnosed D2 who lost weight (I am sure such people exist but not common) soon after the diagnosis, why Paula should be an exception?

Evelyn aka CarbSane said...

Better not say that on a low carb forum!

Evelyn aka CarbSane said...

Yeah ... I don't watch her much but she guest judges and such on shows I do watch. Don't recall her looking any slimmer. That's why I made the "realist" comment. Sad, really, but it's her life.

Evelyn aka CarbSane said...

Welcome to the Asylum! I didn't know that statin treatment was so pro forma for diabetics until my type 1 cousin said she's been on them since forever. Sometimes you can't blame the docs though, if a patient doesn't want to change, you can't force them the other 360ish days of the year :(

Evelyn aka CarbSane said...

This is an excellent point. Whether it's reward or not, Zone allows for lots of carb/fat mixed foods which are what tend to get most people in trouble (and they just did a study on this, see my Twitter feed for my retweet of Beth@WeightMaven). I think this is where low carbers going Perfect Health Diet may get in trouble as well -- especially since they still advocate high fat.

My individual meals don't come out Zone at all. I try to eat LF or LC in any one meal. Seems to work better than balanced meals throughout the day.

Galina L. said...

@ Evelyn,
I didn't get it about LC forums. Among people I knew personally who were diagnosed as diabetics 2 , no one was a LCarber, they all were "everything in moderation" believers, were sure they did enough exercise because they did some, also thought that giving up any item in their menu would be unthinkable. In my sport club some ladies comment from time to time on my weight loss, some of them are diabetics 2. When I said how I lost it, no one got interested - it sounds too extreme. People prefer not to change their life too much.

bentleyj74 said...

Hey reply works for me on firefox.

I'm probably using "reward" as a sloppy and easily shot down form of shorthand for things that people over eat unrelated to macro ratio.

Hopefully I can improve on that in the next few years after I decide between biology and physiology :)

Did I mention this whole thing has been sort of stimulating for me [read consuming]. Egad.

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