Fructose, Fat & Obesity
The other day, Stephan Guyenet shared some of his own thoughts on David Despain's can't-say-enough-nice-things-about-it interview with Dr. John Sievenpiper. In case you missed it, Stephan discusses his post looking at the links or lack thereof between sugar consumption per se and obesity. See: Is Sugar Fattening? At the end of the current post is the following footnote:
** If fructose is fattening due to its ability to become fat, then dietary fat should be even more fattening because it doesn't have to undergo an inefficient conversion process-- it's already fat.
Excellent point! I might add that if saturated fat is such a healthy fat for your body, fat produced by de novo lipogenesis -- mostly palmitic acid in the liver -- would be an even better source of that fat as it would give you a "metabolic advantage"! It takes almost no calories to digest and store dietary fat in body fat. It is highly energy intensive to convert fructose to fat, so you get some free calories!
The comments on Stephan's post demonstrate that those who have learned their biochemistry/metabolism from the likes of Taubes and Eades and Lustig, are woefully misguided in same. And this is the reason I will keep on keeping on doing what I do here to try to undo some of that "knowledge" learned from the damaging education they are getting. The vast majority of fatty acids that are "rebundled" by the liver are NEFA -- free fatty acids released by adipose tissue that were in excess of needs and are sent back to the fat tissue. See: Where do triglycerides come from? Part I , Part II , Part III. Another main conclusion of the radioactive tracer studies discussed in that series is that the increase in fasting VLDL-triglycerides on higher carb diets is attributable to reduced clearance, not increased production.
So what of the fate of VLDL. Well, when all is said and done, these lipoproteins carry the triglyceride load. They can "dock" and release that load to peripheral tissues or sent to fat tissue for storage. This is actually part of a "Fat Accumulation" series post I have on the back burner, but:
- There can be no doubt that ASP plays an integral role in fatty acid uptake and esterification by adipose tissue. This is likely the dominant player on the uptake side in the postprandial state.
- Women seem to have higher fasting ASP levels vs. men
- ASP seems to be a more adipogenic, "fattening", hormone in women than men
- ASP is responsive to chylomicron stimulus moreso than VLDL for fatty acid uptake
- NEFA release in the triglyceride/fatty acid cycle is more from upper body fat
- VLDL uptake seems to be greater in gluteofemoral (butt & thighs) fat than upper body fat.*
- Endogenous lipid production is a highly unlikely route to fat accumulation (aka obesity) in humans
What to make of all of this? Still putting some thoughts together, but ...
- Dietary fat is more likely to be incorporated into body fat than "triglycerides" transported from the liver -- VLDL -- including small amounts of fatty acids generated from carbs in general or fructose more specifically.
- Not all adipose tissue is created equally ... lots to sort out there, but the keys to female protection against CVD vs. men probably lie in fat bottomed girls ;-)
Hit it Freddy!
Comments
http://slowburnfitness.com/fat-regulation-insulin-or-asp/
From: Keith Frayn [mailto:keith.frayn@oxlip.ox.ac.uk]
Sent: Monday, February 14, 2011 2:45 AM
To: Fred Hahn
Subject: RE: A question on ASP
Hi Fred
My guess is that you are right: insulin is the primary regulator of both fatty acid uptake and fatty acid release. The ASP story was a nice one but I don’t think it’s been substantiated.
Best wishes
Keith
http://www.nejm.org/doi/full/10.1056/NEJMoa1105816
ASP-receptor knockouts exhibit the same phenotype as FIRKO.
Found this link in a forum post on his site:
Fat hits your waistline fast, study says
http://www.ottawacitizen.com/technology/hits+your+waistline+fast+study+says/6621179/story.html
Haven't been able to track down the study yet.
first, are emails peer reviewed these days?
Seriously, Taubes pushed his G3P by going with interviews and emails, not going through the peer reviewed lit.
And I demanded proof (pgp/gpg digests) when I saw it,
Fred has a history here, by the way. If he shows up again I'll endlessly repeat my question on smoking.
demanded proof (pgp/gpg digests) when I saw the alleged Frayn email.
http://deciencia.com.mx/media/articulos/Physical%20activity%20and%20exercise%20in%20the%20regulation%20of%20human%20adipose%20tissue%20physiology.pdf
There seems to be very recent study by Karpe & Frayn. I have found multiple, similar news reports of it that are dated around the middle of May 2012.
Am I missing missing something? What is the absolute impact here instead of relative impact.
"If you are hypocaloric, then you are consuming too much energy..."
Hypocaloric = caloric deficit
Hypercaloric = caloric excess
"Am I missing missing something?"
Macro ratios affect appetite & activity levels in many people, so they indirectly affect energy balance.
Look at the body compositions of fruitarians.
Low carbohydrate intake -> low fasting serum TGs.
High fat intake -> high postprandial serum TGs (as chylomicrons), VLDL, LDL (whatever the particle size), IDL & HDL.
Aside: http://carbsanity.blogspot.com/2012/05/another-fun-tactic.html?showComment=1338355906470#c989217924276359944
Susanne & Galina are talking sourdough. Maybe you want to share your recipes?
High doses of liquid sugars do seem to temporarily impact the liver, but so would high doses of MCT fats!
I see that AH found the review paper that was mentioned. I scanned through it and didn't find any reference to their study.
I haven't done any rye sourdough, but I might chime in anyway.
"White lie when necessary but only when absolutely necessary in order to get the greater good point across."
source of quote
I gotta say, I do not understand the utility of publically stating that it's ok to lie. It damages credibility and I can’t see how that can be anything but a disadvantage when you’re trying to advance an argument. Every time you relay a compelling anecdote, people will be wondering if it’s one of your ‘white lies’. I don't get it...
Body fat percentages are primarily controlled by dietary intakes not composition. There are plenty of fat under muscled omnivores eating relatively high protein and shredded high muscle mass vegans eating average amounts. The Kitavans eat relatively low protein, those guys looked adequately muscled to me :) Better than average really.
Low fasting Trigs would be expected on VLC.
Scary. If this is how some do science, I worry about our future as a species.
"TAG's"
"milieu's"
Are you really Jack Kruse or did you both just happen to get the same training in English and Biology?
Ryan said…
“Dietary fat in large quantities does not lead to same hostile hormonal environment (as long as it is not consumed in conjunction with excess fructose or glucose). If you don’t believe me, check your fasting TAG’s…”
You have completely overlooked postprandial TAGs (in chylomicrons), which increase greatly after eating fat and reduce at a rate determined by activity level (as TAGs go into both fat mass and active muscle mass). In sedentary people, postprandial TAGs remain high for over 6 hours.
William Davis M.D. blogged about it in Gretchen’s postprandial diet experiment. I can’t see Figs 1 & 2 on Firefox, but clicking on the space where they should be displays them.
"In a nut shell, calories should be thought of as effectors of hormonal signaling that lead to downstream changes in the gene expression patterns of the cells."
Is this you speaking (the "") or is this a quotation from a book? Either way, what the heck does it mean? Calories are units of energy -- chemical potential energy when we're talking about food calories.
Fructose in large quantities (cokes, cakes, doughnuts)is bad because of the hostile hormonal environment it creates, the individual molecule and its fate as an energy source are harmless. Dietary fat in large quantities does not lead to same hostile hormonal environment (as long as it is not consumed in conjunction with excess fructose or glucose). If you don't believe me, check your fasting TAG's, then drink one coke a day for two weeks and recheck them.
What does fasting triglycerides have to do with hormonal environment? What hormones? How about if someone has low fasting TAG but LDL of 285? What does that say about hormones? Sounds like something's outta whack there, right?
They will go up, why, because fructose metabolism by passes the rate limiting step in glycolosis which then shunts the energy to de novo lipogensis in the liver, but it also leads to hormonal changes that favor energy storage on a cellular level "ie insulin resistance, leptin resistance, etc"
Sounds like you should read my series on triglycerides based largely on the radio label work of Marc Hellerstein's group. http://carbsanity.blogspot.com/2011/05/where-do-triglycerides-come-from-part-i.html
I can see where Kurt's question came from as it sounds like you're saying that eating a banana in January is telling my body I'm at the equator even though I'm in NY and this alters my gene expression. But you say if I don't believe that then I'm arguing against evolution? Forgive me, but your comment just doesn't make a lot of sense to me except for the fact that the optimal diet for each of us is highly individual based on our ancestry.
I was just needling you over the weird apostrophes in your plurals. The only other notable person I've seen do that in writing is Jack Kruse. Sherpa's instead of Sherpas....
I would take issue with this sentence, which is much more Jack Kruse flavored than macro-ratio-agnostic archevore:
"Through an evolutionary lens the various types of calories and the macronutrient ratios consumed in meals have profound implications on our body composition, hunger, and nutrient partitioning."
I view macro ratios as largely irrelevant to health outside of very wide parameters. Eating enough carbs to keep you out of ketosis and lots of animal fat on one extreme and eating a vegetarian version of archevore (where is your guest post Aravind??) with butter and eggs as the main animal products are both equally practicable options for any given human animal. Neither carbs nor natural fats are per se poisons or dangerous.
I don't generally agree that macro ratios have profound implications for health, body composition and nutrient partitioning as long as protein and micronutrient needs are met and one is not eating in energy excess.
Ancel Keys, TC Campbell, Gary Taubes, and Robert Lustig are all wrong. (Yes, fructose is probably only a NAD when it makes you eat more in the form of added sugar, HFCS and various tasty treats.)
I welcome you as a fellow MD to the world of thinking about evolutionary medicine. I strongly suggest you take a break from everything and read The Human Career by Klein in its entirety. Then peruse John Hawk's excellent blog. As doctors, we need to focus on our weaknesses - in my case it's the "evolutionary" part of the dyad - "evolutionary medicine"... I suspect it will be the same for you, unless you have a background in evolutionary biology, paleoanthropology and genetics.
Art De Vany:
Posts:743
How long have I been saying this? You can't go crazy on fat.
Saturated fat is still a big source of energy, a hit to your beta cells on the pancreas, and your body can make almost all of it that it needs. Palmitic acid is how the body stores excess energy.
Posted: 01 Jun 2012 11:30 Back to top
v
Posts:175
I eat burgers and meatballs made with ground beef and fatty pork and my total LDL is only 89. don't i eat a lot of saturated fat? i also have some fat on my abdomen. why is my LDL so low compared to Alexander's? shouldn't mine be higher? why isn't it? as of nov. 2011 total cholesterol 177 tris 58 HDL 76 VLDL 12
i take no omega 3 supplements
I prefer Carbsane because she cuts through the crap and makes her points in ways everyone can understand. That's her agenda, use science and break it down so everyone can benefit, and not just uppity *ssholes who can appear to talk a good talk. Hell I can listen to Taubes talk if I want to be around smugness and pseudoscience.
So yeah I can try and wade through what you say or I can listen to someone who uses science and common sense and puts it in layman terms that will help me make better decisions about nutrition.
Post above you said: “I am not on board with strict low carb, nor do I view carbs and sugar as safe substances in certain situations.”
Your about you post:” I am a firm believer in the primal/paleo nutrition model and will use this blog as a forum to expose all the fallacies in the current dietary dogma that is the low fat/whole grain(fat gain) SAD American diet.”
You like to dance, but you can’t have it both ways.
On your blog you post an obese person eating and then below it show a picture of Mark Sisson. You compare the two and indicate that following some primal paleo diet will transform a person. What kind of a jerk are you? Wake up and smell what you’re shoveling.
I have new goal: Dog you at every post you make on here. Dog you till Carb bans me. Hell why not, I’m so tired of bottom feeders selling false hope and picking on people’s insecurities.
http://dietarysanity.blogspot.com/2011/10/humans-de-evolving.html - Reading that made me ill, you’re pathetic. Carb will be nicer to you, but I have little respect for certain types of people and have not the care in the world if I look civilized or am loathed by my comments. I will gladly do the dirty work for other people.
On a side note I do have some skin issues on my rear end I would like some advice on. Nutritional advice, no thanks, maybe you can peddle your wares over on Paleo Hacks.
Cheers
Ps. Nice rip-off of Susan Powter with the “STOP THE INSANITY” phrase on your blog post. I have more respect for her nutritional advice than yours.
Make up your mind.
FYI, evolution isn’t linear.
Woodey, dont be so angry with me, I may be just a skin doctor, but I had to study a hello of lot science to get here. To call me pathetic is just plain mean. I just want to keep kids from becoming obese and give obese and overweight people good advice so they dont keep suffering from chronic disease. To personally attack me over comments and a blog post is not cool.
Archevore PGY-1
Ryan
Your comments triggered his bullcr*p detector.
> To call me pathetic is just plain mean
I hope this is not indicative of thin skin; the webz are NOT hospitable to that trait
> Woodey, dont be so angry with me
He doesn't sound like the type to respond well to orders ... especially if they sound authoritative & emphatic. Just my own mind reading.
That statement is more what I'm referring to, the person only knows me through a few posts on the internet and that is his new mantra. My skin is thick, but personal attacks like that are out of line when I am just expressing an opinion. Sorry if my blog post offended you Woodey. I just want to help people find good health, most will never look like Mark Sisson, it's just a dramatic example meant to emphasize a point that our current environment isn't working well for us as a species. I personally think paleo/primal nutrition is part of the solution.
https://www.youtube.com/watch?v=qUp_6n8x3D0
"Dr. Richard G. Klein - Out of Africa and the Evolution of Human Behavior - The Forum at Poly"
He says that at 50 ka, humans had a sharp jump in intelligence whereby they started to fish and also became better hunters. That changed diet and also led to increased population. I'd think that would affect claims about the effect of 1,000,000 years of evolution.
Also, have you noticed that the carb eating Japanese weren't fat through the generations? That the insulin-centric GCBC never mentions insulinogenic proteins? That history's (supposed) greatest researcher apparently has never looked at a GI table? That Kurt has, in my view, repudiated most/all of what Taubes preaches as his misnamed CIH?
Anyway, welcome. And btw, Sisson apparently always looked like that, even when he presumably was a carb eater.
I personally think that some people do best on low carb, some on low fat, and for some (like me) the ratio doesn't matter as far as composition goes.
She was big in the 90s with her very successful 30 minute weight loss infomercial, "Stop the Insanity". Her idea was that calories eaten as fat could be directly stored as fat, whereas calories eaten as carbs had to be converted to fat via DNL before being stored as fat - thereby requiring energy expenditure for the conversion. IOW, you could eat more carbs than fat for the same result. I think that in theory she was correct; though of course in practice people can (and did) out eat any theory, and so they became fatter eating more and more.
Hers is a good example of the many diets that come with a big splash, and then go. Oddly, some years ago when I still had cable hooked up to the boob tube, I saw her in a short interview. She was triumphantly claiming that history had proved her right. I don't know why she thought that.
It's an endocrinopathy that leads to weight regulation problems and chronic disease. If you are not sedentary, are a normal weight with a normal body fat percentage you are very unlikely to have insulin signaling issues and hyperinsulinemia. Carbs are not a problem for this group.
It's the group with the insulin resistance issue that requires resistance training and crab restriction/calorie restriction to fix the metabolic derangement. Once it is fixed carbs can be added back, but if they overeat on fat and carbs and are sedentary again they will be right back where they started. It's a vicious cycle, but living in ketosis and sitting on the couch surfing the net is clearly not the answer.
Catherine, as to HFCS -- well, I'd say that if you avoid it you'll be avoiding all sorts of other nasty stuff in processed foods. But it's not going to kill you in small amounts -- the reason for one of my "you need to check in if" points. Not everyone can afford organic, grass-fed, pastured whatever. And even if they can, it's not always convenient. So when I can get a large rotisserie chicken from Costco for $5, and I don't sweat small stuff if there might be sugar or HFCS in the brine. I get a salad or two topped with chix breast, and two snacks of a chix leg. Then the rest makes amazing bone broth for home made chicken soup or stew. All far healthier for me than stressing over a microgram of HFCS.
Eat, enjoy, do it in moderation and live your life. If its possible go to a community college and take a nutrition 101 class (a lot of classes are online), it will do you more good than buying a fad diet book or reading 90% of the blogs on the internet.
The other thing you can do that will be beneficial is to talk to a nutritionist. They have a lot of schooling and can steer you in the right direction when it comes to diet. Unfortunately the internet enables morons to spread disinformation and downplay dieticians, much like it has done to create a greater mistrust of doctors. This is why people like Tom Naughton and Jimmy Moore are evil in my eye, purposefully misleading people for their own selfish gain.
This man has been doing LC/Paleo for 8yrs or so....GODDAMN! He looks so much like Mark Sisson!! Actually he looks more like a before picture...oh well. He does like to use "metabolic derangement" as an excuse. I'm beginning to think the English translation for metabolic derangement is - one who likes to eat.
This is why low carb/paleo works well in this group, it is treating the underlying hormonal problem they have, which is hyperinuslinemia. Think of hyperinsulinemia like other hormonal disorders, ie hyperthyroidism, cushings disease (hypercortisolemia), primary hyperaldosteronism, all of these disorders have a hormone that is elevated above normal physiological levels. The treatment is addressing the hormonal elevation.
Insulin resistance is also hyperinsulinemia ie. you need more insulin to get the job done, so you end up with chronically elevated insulin levels above normal physiological levels. This has metabolic consequences just like other hormonal diseases. The reason carbs are not good in this group is due to the insulin it generates, not the carbs per say. In other words, restricting carbs is decreasing the amount of circulating insulin, therefore treating the underlying problem.
Are carbs the reason all this happens, no, its inactivity (leading to muscle insulin resistance) and overeating (leading to liver insulin resistance) that pushes people into a hyperinsulinemic ie insulin resistant state.
Dietary proteins produce an insulin response (some quite large) and dietary fats increase the insulin response produced by the other macronutrients. See Fig. 1 B in The Degree of Fat Saturation Does Not Alter Glycemic, Insulinemic or Satiety Responses to a Starchy Staple in Healthy Men.
IMO, the advantage of restricting carbohydrate is in the more stable blood glucose level that results, leading to better appetite control (or even appetite suppression if serum ketones are significant), leading to reduced food intake, leading to weight loss and the emptying of over-full fat, muscle & liver cells, leading to improved insulin sensitivity in fat, muscle & liver cells.
Physical activity is also required, to increase muscular insulin sensitivity. Low-carb diets tend to reduce drowsiness and lethargy, which helps to increase physical activity.
As a nutritionist myself, I can tell you that people in this profession promote 2 things that reduce the effectiveness of their message: 1) avoid saturated fat, and 2) eat tons of vegetables.
Most people hate that advice and will refuse to follow it. I don't need to tell you why saturated fat is not bad to consume (milk, eggs and beef are not good for you?).
The vegetable issue really bugs me though. Humans cannot digest cellulose (the main component of the cell wall in most non starchy plants), so the actual nutritional value of vegetables is much less than promoted. Plus, they taste pretty bad to most people. They are expensive compared to the actual nutrition they provide.
A modern human can be perfectly healthy eating a diet that consists of animal products, fruits and starch. Yummy, sounds good to me!
Mechanical digestion (chewing and smooth muscle contractions in the digestive tract) will, by force, break some of the cell walls in veggies and allow the contents to be absorbed, but the majority of the contents will pass though your digestive tract untouched (and will make a big poop).
But, there is no reason to avoid vegetables. They taste good to a lot of people. I like salsas in my burritos, and onions on my hamburgers, but I have no notion that they have some magical effect with the antioxidants and polyphenols that are supposed to make me healthy. Again, those things are within the cell wall and mostly not used by the body.
Kurt Harris discusses this here:
http://www.archevore.com/panu-weblog/2011/2/28/william-munny-eats-his-vegetables.html
Be aware, if any of your comments are not displayed
This statement also means lower 24 hour serum insulin. If your liver is insulin resistant (from overeating) and your muscles are insulin resistant (from inactivity) the glucose load from carbs is a problem. The reason involves the increased amount needed to bring the sugar down after a meal.
Lets use examples
Paul is a 30 year old weightlifter at 11% body fat, he gets home from a workout and eats a mixed meal with 150g of Carbs, Glucose goes up, insulin goes up, muscles and liver listen, sugar comes down, insulin comes down, no hyperinsulinemia (ie insulin does its appropriate job, it is not a culprit of disease)
Tom is a 30 year old male with a desk job, muscles are deconditioned and he is 30% body, mild but clinically undetectable hepatic steatosis, with liver and muscle insulin resistance. He gets home and eats 150g of carbs in a mixed meal, blood sugar goes up, insulin rises, liver and muscle don't listen, pancreas still sees the sugar in the blood, insulin goes up some more, muscles still don't listen, liver and fat starts to listen, sugar gradually comes down, insulin was abnormally elevated in response to the meal, and stays abnormally elevated until the next meal. At this point insulin is a problem, because he has supraphysiological levels circulating in his body.
The point I'm trying to make is that insulin is just like any other hormone in your body in that abnormal levels have consequences, not enough(type 1 diabetes)=bad, normal levels=no issues, abnormally elevated levels(pre-diabetes, insulin resistance, metabolic syndrome)in response to food=bad.
Insulin resistance and high insulin are not a problem in Tom's case at all; they're NECESSARY to maintain whatever health he person currently has in the face of those incitements/provocations/circumstances/history.
Or would you prefer Tom's insulin levels stay low and insulin resistance stay low ...
+ muscles already full of glycogen taking in glucose with no capacity to dispose of it+ adipocytes removing trigs and glucose from the blood, making them unavailable for energy
+ chylomicrons from the intestines, full of dietary fat remaining in blood (for all the times you type "insulin" you don't bother to type ASP once, so this is a valid outcome in your world)
+ Tom EATING MORE because the satiety hormone insulin is not going high[0], (which would, in the circumstances, be the body's appropriate, SATIATING response), and thus not signalling satiety, worseining all these problems
[0] because of low insulin resistance
if you're addressing Tom Q Public why even bring up insulin in the first place? Think you'll motivate him? with by an oversimplified biochem lecture?
> Think of hyperinsulinemia like other hormonal
> disorders, ie hyperthyroidism, cushings disease
> (hypercortisolemia), primary hyperaldosteronism,
> all of these disorders have a hormone that is
> elevated above normal physiological levels.
This just makes no sense to me at all. And when the water level in the Mississippi is too high you try to lower it. When bad stuff happens people try to fix it. SO WHAT ???
They're alike ... strictly in terms of hormone levels? Then this statement is so broad as to be meaningless for further discussion of specifics of any kind.
And if you meant anything other than that broad, meaningless meaning ...
statements offered without proof can be discarded without proof. And "proof" these days and in this context means a lot more than hyper-wide analogysing
You don't even provide enough detail in the assertion to know what needs to be proven ... in what SPECIFIC, provable ways are these disorders alike?
And WTHeck is Tom Q Publc to make of that assertion .., Tom with a non-tech business degree or an arts degree or an engineering degree that demanded reading zero bio/biochem literature?
http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001398/
> Graves disease is the most common cause of hyperthyroidism. It is caused by an abnormal immune system response
Yeah, hyperthyroidism (immune system) is JUST like hyperinsulinism (overeating) ... yeah
Maybe the next one's caused by overeating
http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001388/
> Cushing's disease is caused by a tumor or excess growth (hyperplasia) of the pituitary gland. This gland is located at the base of the brain.
> Treatment involves surgery to remove the pituitary tumor, if
Yep, they're trying to lower the level... no, they're not, unless removing a tumor is "like" lowering a hormone level.
And for whose benefit is this invalid comparison of overeating to pituitary hyperplasia? Catherine who commented below?
And adds 1800 calories per day of fat because he reasons
"INSULIN's the problem therefore CARBs are the problem... control that & I'm HOME FREE"
so now Tom's insulin is low. wheeeeeeee ....
CONGRATULATIONS Ryan ... a success !!
People DO think[0].
Drone endlessly on the evils of insulin and never once mention they can still get obese on low carbohydrate and they will put 2+2 together.
Guys like Lyle McDonald have been writing stuff like
"just because I wrote xxx does NOT mean my diet permits you to exceed calories and stop exercising"
IMHO If you're writing diet stuff you MUST take into account
1 people will cheat
1a people will mis-report, which is not the same as lying
2 people will twist the meaning of your words so they can consume more
3 people will twist the meaning of your words to they can exercise less
[0] often involving extreme BS, like hyper analogising and confusing natural body responses with disease states
> "just because I wrote xxx does NOT mean my diet permits you to exceed calories and stop exercising"
IIRC it's been more than a decade since I first read that sentiment, if not those exact words from LM.
> IMHO If you're writing diet stuff you MUST take into account
> 1 people will cheat
I know because I did
http://180degreehealth.com/2012/06/glucose-clearance
> Graves disease is the most common cause of hyperthyroidism. It is caused by an abnormal immune system response
Yeah, hyperthyroidism (immune system) is JUST like hyperinsulinism (overeating) ... yeah
Maybe the next one's caused by overeating
http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001388/
> Cushing's disease is caused by a tumor or excess growth (hyperplasia) of the pituitary gland. This gland is located at the base of the brain.
> Treatment involves surgery to remove the pituitary tumor, if
Yep, they're trying to lower the level... no, they're not, unless removing a tumor is "like" lowering a hormone level."
First, off you are missing the big picture. I know what graves disease and Cushing's disease are, and they involve elevated hormone levels. There is Cushings syndrome often caused by a pituitary tumor, and in that case the surgeon is lowering a hormone by removing a tumor, and it is Cortisol. The tumor in the pituitary is secreting ACTH, causing chronic stimulation of the Zona fasciculata of the adrenal cortex, leading to chronically elevated cortisol levels, that lead to a host of clinical symptoms associated with chronic hypercortisolemia (weight gain, osteoporosis, striae, etc). So the surgeon is lowering the cortisol level by cutting out the tumor.
In your second example of graves disease, again treatment involves lowering the abnormally elevated thyroid hormone level. Normally, the pituitary sends a signal called TSH to the thyroid, it binds a receptor called TSH receptor and thyroid hormone is made in the appropriate amount, In Graves disease your immune system starts making an IgG antibody that binds the TSH receptor causing chronic stimulation and abnormally high levels ie hyperthyroidism. This lead to all the symptoms associated with the disorder(atrial fibrillation, weight loss, anxiety, etc), again the treatment involves inhibiting thyroid action with Propylthiouracil or radiothyroid ablation.
In both examples an underlying problem lead to elevated hormone levels, that lead to clinical symptoms, the treatment involved lowering the level of the abnormally elevated hormone. In insulin resistance, insulin is abnormally elevated. This leads to the clinical signs and symptoms of metabolic syndrome. Again, the goal in this case should be lowering insulin, similar to the goals of treatment in the two scenarios listed above.
Right now I eat about 40% carbohydrate, maybe a third from fruits (bananas, blueberries raspberries and citrus) and maybe two thirds from potatoes, beans and white rice.
As in the linked essay, I do think there is hormetic benefit to leafy greens and colorful vegetables due to the flavonoids therein. My consumption of these lately depends mostly on my wife's desire to make elaborate salads that contain them.
I've found that avoidance of liquid calories and hyper palatable foods (manufactured foods and home-made concoctions like casseroles and complicated dishes in addition to the obvious baked goods and breads) is the main way to keep caloric intake down and keep off excess weight without counting anything. A narrow eating window and no snacking helps a lot, too. The macro ratios have nothing to do with fat loss if you are avoiding "high reward" food - food that is engineered by either industry or your grandma to make you eat a lot of it and come back for more...
"In insulin resistance, insulin is abnormally elevated. This leads to the clinical signs and symptoms of metabolic syndrome. Again, the goal in this case should be lowering insulin, similar to the goals of treatment in the two scenarios listed above."
Your analogy of hyperinsulinism in the condition of metabolic syndrome to these other diseases of elevated hormones fails thusly:
1) In these other states, there is an abnormality intrinsic to an endocrine organ that is causing elevation of the relevant hormone, whether tumor or autoimmune attack. The hormone elevation is pathologic, i.e, not at all appropriate and especially not contributing to homeostasis - in fact disrupting homeostasis.
2) In the case of hyperinsulinism in metabolic syndrome - the analogy is not apt, as the elevated insulin here is a defensive - pro- homeostatic - response to the metabolic syndrome - which is in turn all related to the condition of being in energy excess. As Sanjeev has pointed out, if one were to take away the insulin without correcting the IR, or even to "correct" the IR without solving the condition of energy excess, the result would be to make the organism less healthy - the opposite of homeostasis. Lower insulin with no change in IR means frank diabetes. "Correcting" IR while still overloading the cells with energy means more lipotoxicity.
3) The proper disease with analogy to these other hormonal aberrations is the beta cell tumor, not metabolic syndrome. Surgical excision cures the hyperinsulinemia and restores homeostasis.
The state of hyperinsulinemia as a SIGN of metabolic syndrome has nothing whatever to do with all these other states of pathologic hormone elevation.
And the cure for hyperinsulinemia in metabolic syndrome has nothing to do with CHO consumption directly and everything to do with energy balance. Eating less calories is the way to address it. No need to invoke or even speak of insulin as anything other than a marker for the metsyn, as the insulin is NOT CAUSING ANYTHING*, IT IS A SIGN OF THE PATHOLOGY YOU NEED TO FIX, WHICH IS CHRONIC ENERGY IMBALANCE.
* Of course there are knock on effects of high insulin, but these are a secondary phenomenon to the metsyn. metsyn is not caused by high insulin, or everyone with an islet cell tumor would have metsyn, which they do not...
1. Avoid grains
2. Eat fat and protein in every meal, but don't go crazy(one must still maintain a calorie deficit)
3. Large muscle group resistance training (I think this is critical)
4. Establish feeding windows and eliminate snacking(8 hours - 2 meals with 16 hours of fasting seems to work well for me) Again I think this is also critical, because it addresses the problem of the chronic fed state (also lowers circulating insulin levels considerably)....I already know your on board with this one.
Ryan
3) The proper disease with analogy to these other hormonal aberrations is the beta cell tumor
____
my "duh" moment ... something was tugging at me, yelling and waving its arms around for attention off to the side somewhere but I just couldn't pin it down specifically and had to settle for describing it as an invalid analogy
I've been off the grid for months now (in part motivated by a comment you made to me a while back), but a friend mentioned you referenced me, hence I made an exceptional visit. The extirpation of technology vis-a-vis nutritional inquiry has been so profound that it has been arguably as important as NAD elimination for my health and well-being.
My WOE - lacto/ovo veggie Archevore - has not changed one bit since I left the Interwebz. I'm now down over 35 lbs and at my college fighting weight on a 60% carb, low reward diet and the healthiest I've EVER been. And ironically my dietary compliance has notably increased since I stopped obsessing about nutrition. While I've missed out on the latest cacao nipple rub theorizing by neurologists from Tennessee, it doesn't seem to be negatively impacting my health. Curious.
Specific pathologies notwithstanding, there are diminishing returns to nutritional inquiry. After we last corresponded, I had originally started writing a post on veggie Archevorism but it morphed into the "misapplication of the Pareto Principle in diet and nutrition". I certainly have strong opinions regarding the ability to be a vegetarian "Paleo" eater, but I've realized the banter between omnivores and vegetarians (not talking about vegans) is largely a waste of time.
I will reach out off-blog to you. Thanks for the shout out. Hope all is well with you.
Aravind
I couldn't agree more. I've found that staying away from processed foods and caloric drinks to be the best way to maintain or lose weight. Its way to easy to drink 1-2k worth of calories in a day, couple that with calorie dense food and one will easily surpass their daily need.
Kudos for using one of my favorite actors of all time playing the ubber character William Munny on the blog post you linked. Quite a bit of information in the post, I will need to go through it again to let the info sink in.
Thanks for the info on bugs in the colon. Eating fruit is something that I haven't been able to fully embrace yet. Spending a year listening to Taubes has made me fruitaphobic, eating strawberries is a big accomplishment for me. I want to branch out to bananas and mangoes, just not there yet.
Glad you both find the post and diet plan useful. I get a lot of emails about it still, but it's nice to hear how it works here in the commentosphere...
Everyone knows I was fruit-skeptical years ago, being convinced that fructose in excess was a NAD - now having seen more ethnographic and medical evidence I think added sugar and HFCS are an issue when they lead to a hyper caloric state and that real fruit intake can be pretty much ad libitum. I find the water and fiber pretty filling when I eat oranges and grapefruit.
Bananas and citrus are cheap, ubiquitous, full of micronutrients and relatively free of food sensitivity issues. And they are dead simple to "prepare"....
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