Is there any such thing as "safe fat" for diabetics?
So some of the AHS12 videos are now online, HERE. I'll have some comments on particular presentations, though by no means a majority. Still, I had to, of course, watch the Safe Starches panel. For the record, I think Paul & Chris did a good job, especially considering the circumstances, but this thing was an abomination in the making from the get-go. I'll have more on that in another post.
The whole "debate" goes back to Jimmy Moore's "data dump" post on safe starches. You remember that one, right? Is There Any Such Thing As ‘Safe Starches’ On A Low-Carb Diet? As I said, I'll have more to say on this follow-up, but as one would expect Jimmy expresses his concerns over the safety of starches, and around the 5 minute mark essentially tries to take Paul to task for using the term "safe"! Citing Webster's Medical Dictionary
SAFE: not causing harm or injury; especially : having a low incidence of adverse reactions and significant side effects when adequate instructions for use are given and having a low potential for harm under conditions of widespread availability
First of all, this is a medical definition that refers to treatments and drugs ... not food! But the definition of "harm" is where the LC community takes great liberty. No doubt rampant hyperglycemia leading to significant and persistent glycation does harm. But we're talking only a segment of the population for whom carbohydrate ingestion is even a small part of the picture. I post this here from time to time in case new readers have not yet seen it: Insulin: understanding its action in health and disease. Yes it's a peer-review journal review article, but it is not overly jargon-laden and technical. The bottom line is that the glucotoxicity of untreated diabetes is due to the lack of insulin and thus failure to suppress endogenous glucose production. Yes, insulin facilitates glucose clearance, but the problems in a T1 are far more complex than hyperglycemia, and even on a zero carb diet, the untreated T1 will still be hyperglycemic. In the pre-insulin era, a 10 year old diagnosed with diabetes had a life expectancy of under 18 months. Further:
Before the introduction of insulin, a person with acute-onset diabetes had a short life expectancy and died in ketoacidosis.
Regardless of the various myths swirling as to the etiologic cause of T2 diabetes, nobody (hopefully) would suggest that T1 is caused by eating too much glucose. Starch is a food. Nobody is suggesting it as a treatment for T1's, but to suggest fat is really much better is folly -- after all, it is ketoacidosis (due to unchecked NEFA levels) that is truly lethal for T1's.
So anyway, the knock against starch (spoken or implied) is that for "some people" it is not "safe" ... those "some people" being those who are diabetic. So because "some people" will experience soaring glucose levels for a few hours after ingesting starch, it is somehow irresponsible to consider any starch safe. Nonsense!! And further nonsense if some of those "some people" are folks like Fat Head (I consumed around 100 grams of carbohydrates per day during my fast-food diet and still lost weight.... my glucose level is usually around 90 to 100 mg/dl. If I eat a white potato, it shoots up to 175 or so and stays elevated for two hours or more.) who have turned themselves into glucose-intolerant functional diabetics. Doing so doesn't make starches unsafe for you, you've made yourself dysfunctional. In addition, that there are those for whom certain foods are indeed legitimately unsafe, e.g. those with Celiac or peanut allergies, doesn't make those foods unsafe to recommend to the general population.
Let's switch things up a bit to demonstrate the folly of demonizing large classes of food. As everyone knows, if you take the carbs out of the diet, you must replace it with something for calories. Enter the high fat meal. You want "harm" ... I'll give you harm: Acute Elevations of Plasma Asymmetric Dimethylarginine and Impaired Endothelial Function in Response to a High-Fat Meal in Patients With Type 2 Diabetes.
Asymmetric dimethylarginine (ADMA), a compound detectable in human plasma, is an endogenous inhibitor of NO synthase. Endothelial dysfunction is an early event in atherogenesis, and large-vessel atherosclerosis is a major cause of morbidity and mortality in patients with type 2 diabetes mellitus.
The study involved 50 T2's (34M/16F, 42-75 yo, avg 62) that ingested a liquid meal (75% fat/15% carb/10% protein, 1265 calories with 105 g fat/52 g saturated fat, 48 g carb, 32 g protein, 300 mg cholesterol, Vitamin A (100 000 IU/m2 added.) and were assessed for TC, LDL-C, HDL-C, TGs, VLDL TGs, and ADMA at baseline and 5 hours post-meal. Controls were some patients who ingested a comparable sized non-fat meal on another visit, and some patients who repeated the high fat meal following nitroglycerin-induced vasodilation. Results:
- Plasma ADMA increased from 1.04±0.99 to 2.51±2.27 μmol/L
- Brachial arterial vasodilation after reactive hyperemia, a NO-dependent function, decreased from 6.9±3.9% at baseline to 1.3±4.5%
- These changes occurred in association with increased plasma levels of triglycerides and very low density lipoprotein triglycerides, with reduced low density lipoprotein cholesterol and high density lipoprotein cholesterol, and with no changes in total cholesterol.
- The increase in plasma ADMA in response to a high-fat meal was significantly and inversely related to the decrease in percent vasodilation.
- In 10 of the subjects studied with a similar protocol on another day, no significant changes in the brachial artery flow responses or in plasma ADMA were observed 5 hours after ingestion of a nonfat isocaloric meal.
Conclusion: The data suggest that ADMA may contribute to abnormal blood flow responses and to atherogenesis in type 2 diabetics.
This is but one study, and there's nothing definitive in all of this biomarker stuff, but there are lots of studies out there discussing detrimental effects following high fat meals. By lots, I mean an enormous amount of peer-reviewed scientific literature looking at the immediate impact on vascular function in response to high fat meals, and these changes in "at risk" populations such as those with diabetes and dyslipidemia. One of the ways folks dismiss studies like this one is that the "high fat" meal is often a mixed meal with high carbs. This was a large "meal" but it wasn't particularly high carb by percent (only 15%). Another way folks dismiss such studies is that "nobody eats like that". Which, outside LLVLC-land is a valid point upon which to dismiss them! Who eats 100g of fat in one meal? That's over 3/4ths of a stick of butter. Ahhh, but we do know someone who eats this way, and has been eating this way for quite some time now. We know that someone has seen deterioriating lipid profiles despite consistent carbohydrate restriction.
Is it safe to romanticize super high fat diets and promote "nutritional ketosis" in diabetics and the dyslipidemic? Crunched down further, we can ask, "Is There Any Such Thing As A Safe Fat?". The answer, by carbophobe logic, would be no. Because if a lot of fat causes problems, then fat = poison, and a little fat = a little poison, and you wouldn't advise that, right? Yet Paul Jaminet is suggesting a rather modest intake of starches. If you cannot process PHD levels of carbs, it might be time to consider your activity level, overall caloric intake, and/or if changes there fail, having your insulin response evaluated and addressed. And let's not put this entire onus on Paul's shoulders as there are lots of paleos out there who advocate eating whole starchy foods, and many who would advocate eating even more of them (and less fat) as part of a healthy diet. I don't know of any proponents of low fat diets who encourage unrestrained consumption of refined carbs. That's the biggest strawman of all, because sugar was always up there on the very tip of the pyramid, and never given a pass. Whole grains as the starch source at the base may have been misguided, but this never meant Wonder bread and donuts. Meanwhile, Volek and Phinney are advocating very high fat intakes, and Jimmy Moore is encouraging others to follow his lead down the tallow brick road. Safe? I'd say the potential for this advice to be harmful to others is high, while the potential for following PHD or Voight's potato diet to be harmful is quite low.