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Friday, May 3, 2013

Revisiting Taubes' Four Facts from the Sixties

In Good Calories Bad Calories, Gary Taubes wrote the somewhat shockingly definitive summary paragraph below (I've separated out the numbered statements for clarity):  
By the mid-1960s, four facts had been established beyond reasonable doubt:
(1) carbohydrates are singularly responsible for prompting insulin secretion;
(2) insulin is singularly responsible for inducing fat accumulation;
(3) dietary carbohydrates are required for excess fat accumulation; and
(4) both Type 2 diabetics and the obese have abnormally elevated levels of  circulating insulin and a “greatly exaggerated” insulin response to carbohydrates in the diet, ... (Kindle Locations 8010-8014)

I had addressed this in one of my early posts here at the Asylum (here, dated 6/28/10), but some parts of it need expanding and updating. My original responses will be bold/small/gray font.

Carbs Singularly Stimulate Insulin
We know this isn't true, protein elicits an insulin response. Furthermore fats have been shown to at least amplify insulin responses by, for example, stimulating GLP-1.
It is interesting looking back how one commenter wanted to argue the meaning of "singularly". Nobody can be absolutely certain if Taubes knew about protein stimulating insulin, but there is no mention of this obvious "confounder" to his various hypotheses in GCBC that I am aware of.  Feel free to provide me a citation.  

There are citations too numerous to include here that counter this "fact", but here are two that should have at least been considered in what Taubes describes as his 3 PhD thesis equivalent, five year research effort:   Insulin Index of Foods, Holt 1997 and Effect of Protein Ingestion on Glucose and Insulin Responses to Oral Glucose, Nuttall 1984.  Some have claimed that concurrent glucagon release stimulated by protein is a factor here, but this was not discussed in GCBC other than glucagon being listed as acting on adipose tissue circa 1965 understanding.  Glucagon's direct action on fat tissue metabolism is an unsettled matter, but current consensus seems to be little if any.

I would add that roughly half of the total 24 hour insulin secretion on a "standard" diet is basal secretion.

Insulin Singularly Induces Fat Accumulation

Insulin is key regulator in the Fatty Acid/Triglyceride cycle, but when you think about it, aside from moving glucose into the fat cells, it is not heavily involved in policing the entry door. This appears to be ASP which itself can stimulate glucose uptake. Insulin does have an indirect role in this as it has been shown to increase ASP activity approximately 2-fold, but this is a much lower response than to chylomicrons (dietary fat). Fat accumulation (net flow in) occurs each and every time fat is ingested. Whether or not it stays accumulated depends on energy requirements. Eat too much, gain fat mass. Simple. Taubes acknowledges the continual nature of the FFA/trig cycle then goes on to make absolute statements of how the fat is "trapped" in the fat cells. How can as much as 60% of mobilized fat get re-esterified to triglycerides in a continuous cycle be explained?? If you eat too much fat it will stay in the fat cells, and if it is mobilized, elevated NEFA/FFA are NOT a good thing!

As it appears my stalkers have initiated a disinformation campaign regarding this topic, I will be setting the scientific record straight when time permits later this month.  In GCBC, Taubes writes:
With the invention by Rosalyn Yalow and Solomon Berson of their radioimmunoassay to measure insulin levels, it quickly became clear that insulin was what Yalow and Berson called “the principal regulator of fat metabolism.” Insulin stimulates the transport of glucose into the fat cells, thereby effectively controlling the production of glycerol phosphate, the fixing of free fatty acids as triglycerides, and all that follows. The one fundamental requirement to increase the flow of fatty acids out of adipose tissue— to increase lipolysis— and so decrease the amount of fat in our fat tissue, is to lower the concentration of insulin in the bloodstream. In other words, the release of fatty acids from the fat cells and their diffusion into the circulation require “only the negative stimulus of insulin deficiency,” as Yalow and Berson wrote. By the same token, the one necessary requirement to shut down the release of fat from the fat cells and increase fat accumulation is the presence of insulin. When insulin is secreted, or the level of insulin in the circulation is abnormally elevated, fat accumulates in the fat tissue. When insulin levels are low, fat escapes from the fat tissue, and the fat deposits shrink. (Kindle Locations 7916-7925)
Right after this Taubes presents the 1965 understanding of adipocyte hormonal control.  In a table he lists 8 hormones that work to get fatty acids out of adipocytes.  What of these?  I realize that acylating stimulating protein, ASP, was not yet known in 1965, but it had been studied quite a bit by the time of GCBC.  I addressed this more specifically beginning in September of 2011 with The Full Physiological Regulation of Fat Tissue ~ Part I of ?  That post contains excerpts from Keith Frayn's Metabolic Regulation, 3rd Ed 2010, the most important of which is:
The complement story is interesting. Some years ago adipocytes were found to express in large quantities a protein that was called (for want of a better name) adipsin. Later, adipsin was found to be identical to factor D, a component of the so-called alternative complement pathway. Now we know that adipocytes produce several factors involved in this pathway and that these may interact, somewhere outside the fat cell, to produce a fragment known as acylation stimulating protein (ASP).  ASP is a potent stimulator of fatty acid esterification in adipocytes.  Thus, adipocytes seem to act locally to regulate their own fat storage.  (Kindle Locations 3437-3441)
The role of ASP and how it works is discussed in several posts here on my blog, but I'll direct you towards two important ones:  Fat Tissue Regulation: Part IV ~ How Acylation Stimulating Protein Works and Fat Accumulation: Taubes v. Frayn ~ ASP in vivo in humans.   The first link demonstrates how ASP directly stimulates the enzyme that goes by the acronym DAGAT, a key enzyme in the esterification (creation of triglycerides from fatty acids) process.  In doing so, ASP enhances FA uptake into adipocytes directly.  The second link was done in living breathing humans and clearly demonstrated that ASP is the primary hormone involved in the uptake of chylomicron (dietary) triglycerides/fatty acids.  The same study discussed there also demonstrated that insulin's most prominent effect was to reduce circulating NEFA by suppressing lipolysis.  Insulin also seems to stimulate RE-esterification within the adipocyte but I have yet to find confirmation that it does this like ASP by upregulating DAGAT or other enzyme specifically.  Please, if you know of this evidence I would be interested in this!

So anyway, I don't believe insulin or ASP is functioning to regulate fat mass, said belief (discussing insulin only) I outlined here:  What Does Insulin Regulate Anyway?.  There is a hormone charged with regulating fat mass, that would be leptin.  There is only one mention of this hormone in GCBC vis a vis weight regulation.

So, I'm going to move on for now, but it is important to keep in mind that much of what was written in posts circa 2010 was written in the environment where the predominant "Gary tells us" meme in the community was that you can't store fat without carbs, and by inference, insulin. Thus at the time the mere existence of ASP presented a problem for TWICHOO and clearly this hormone plays a role in "fixing" fat in our fat tissue. The concept of not being able to store fat without carbs was tied in with the whole glycerol-3-phosphate aka alpha glycerol phosphate story that seemed to Taubes to be that "secret" to it all that nobody put together before. So ...

Carbs are Required to Accumulate Fat
Patently false. Since Fred Hahn is advocating dietary experiments over at weightology at the moment, I've got one for him and Gary. Drink 5000 cals of olive oil a day and protein to meet needs for a few weeks. Report back on your fat mass.
The G3P story is old but not forgotten.  Gary Taubes had probably intended to highlight it in WWGF rather than leave it out.   But the pesky discovery of his knowledge of glyceroneogenesis by a very obscure blogger prompted Taubes to take to the LLVLC airwaves to address unnamed bloggers who were bringing up the subject.  We later learn that scientists like Drs. Kevin Hall and Carson Chow (GT felt it important to repeatedly remind his readers/listeners that these two were *young*) had been challenging him on this for months, but he doggedly hung onto this aspect of TWICHOO including it nervously in his lectures.  In that first interview with Jimmy, Taubes, after lots of hemming and hawing and throat clearing,  admitted that it looked like the G3P story was not correct after all.  He didn't correct the record fully, but more tellingly he (I'll be generous with my wording here) misspoke and stated that all the fuss was not over something he wrote in GCBC but just stated in the lectures -- that something being that you needed carbs to store fat.  A concept skeptics and non-believers were shouted down with routinely back when I first began blogging.  This is simply not true, however, because he did say it in GCBC:
Just a few more details are necessary to understand why we get fat. The first is that the amount of glycerol phosphate available to the fat cells to accumulate fat— to bind the fatty acids together into triglycerides and lock them into the adipose tissue— also depends directly on the carbohydrates in the diet. Dietary glucose is the primary source of glycerol phosphate. The more carbohydrates consumed, the more glycerol phosphate available, and so the more fat can accumulate. For this reason alone, it may be impossible to store excess body fat without at least some carbohydrates in the diet and without the ongoing metabolism of these dietary carbohydrates to provide glucose and the necessary glycerol phosphate. (Kindle Locations 7974-7979)
Had Gary Taubes read his own seminal reference on this topic, Newsholme & Start (from which his early lecture slides were obtained), this would have never made the book.  Because (see:  GCBC Reference Check ~ Part III of ? ~ Is glycerol phosphate rate-limiting?):
"there is no evidence that the concentration of glycerol phosphate is limiting for the process of esterification."
Insulin does play a role in glucose transport into fat cells and stimulates G3P production in the postprandial state for the purpose of facilitating triglyceride formation.  I would stress that this is good and desired for metabolic health because it is important to efficiently clear fats from circulation!  But this is only part of the picture, and that is really what is wrong with Taubes' hypotheses.  And lastly:

The Obese and T2s are Hyperinsulinemic - Basal and Postprandial 
True, but they also have elevated NEFA's!
That short response back then was in reference to the whole notion that this hyperinsulinemia is somehow trapping and accumulating fatty acids in the fat cells.  In the book, the four facts are preceded by a discussion of "internal starvation".  Yet this abundance of "free" fatty acids in and of itself counters TWICHOO.  But for today let's address the insulin levels.

First the obese.  Where basal hyperinsulinemia is concerned while many obese are hyperinsulinemic, not all are.  I blogged on a study Lustig was involved in a little while ago:  Hyperinsulinemia, Insulin-Suppressive Drugs & Obesity (and Lustig).  That study, involved giving octreotide to obese patients but there was some pre-screening for postprandial insulin hypersecretion -- only 28% of the initial obese candidates made that cut.  In normal weight individuals, even rather extreme postprandial hypersecreters had normal basal insulin levels.  Hopefully I can come back and flesh out a few more links here, but the bottom line is that basal insulin and postprandial spikes (you know, the ones that are trapping your fat in your cells and causing your "hyperinsulinemia") are not necessarily related.

Which brings me to the diabetics that generally have elevated basal insulin levels but as disease progresses definitively lack the appropriate postprandial insulin spike and later even total response.  This dysfunction is essentially a compensatory insulin secretion to attempt to compensate for the hyperglycemia resulting from early insufficiency of insulin secretion.  Does the hyperinsulinemia prevent weight loss?  You would think so if it were the cause of the weight gain ... er ... fat accumulation.  But it appears not.

In conclusion, then, the "facts" put forth in GCBC were not facts at all.  If they were ever, circa 1960's, newer information (most if not all predating GCBC) has demonstrated them inaccurate.

That's all for now.  I will expand on some other points when time frees up.


Karin said...

Is Taubes still a factor? I just realized I haven't heard about him in quite a while. For the longest time commenters would go on about, "Taubes says..." and "GCBC states that..." However, I haven't seen that lately. Maybe people are still using his ideas from GCBC and that's how he still has influence. Generally, he seems to me to be old news and people have moved on to other gurus.

Sharon Badian said...

Has enough influence to get an essay published in the British Medical Journal:

It's from April 16, 2013. Not free though. I know I read the full text somewhere but can't remember how I found it.

Sanjeev Sharma said...

shrillness comes and goes, volume of posts waxes and wanes ... par for the course.

IMHO right now they're holing up in insulated conclaves - on many online fora they've kicked out anyone who questions the dogma

the diet "works"[0] enough that some will be able to have a career for life coasting on the last few years' inertia.

[0] or worked temporarily, enough to make converts of some for life, even if they're now more obese than when they started. After all, homeopathy "works" for some.

Ash Simmonds said...

Re the 5000 calories thing, I would suggest that it be only of animal fat/products, olive oil appears mostly benign compared to other plant-based oils, but I still think it might be somewhat pro-inflammatory compared to animal based fats.

I'm still searching for any info for/against weight gain as a carnivore, FWIW I can't find anything which indicates any significant weight gain in this scenario, however there's so few with any data to draw from. All I can point to right now is a couple anecdotes - including this one where a guy ate over 4,000 calories/day for a month:

And then there's my own challenge from June last year where I tried to eat steak for every meal for a month - - usually had small amounts of other stuff with it, and I tracked all my grog also. I haven't bothered to do the math as I don't care about calories, but many days would be in the 4,000-6,000 calorie range, I fluctuated ~2kg throughout the whole month (normal) but ended up the same weight.

Here's what I ate for a month if anyone cares to waste time counting calories:

Total steak eaten: 13kg
Total other food: 17 eggs, 1.8kg processed meat, 900g chicken, 350g pork, 1.65kg seafood, 1.075kg carby stuff, 1.3kg vegetables
Total alcohol: 46 beers, 12.5 bottles champagne, 11 bottles white wine, 19.5 bottles red wine, 0.5 bottles rosé, 83 gins, 5 vodkas

carbsane said...

He's a journalist, right now BMJ is soliciting content. His essay is noted as
"Commissioned; not externally peer reviewed." But, sadly, he is still getting "aired" on venues such as BMJ and Nature for which he wrote an editorial a few months ago. Interestingly, however, no scientist in the field has ever signed on .....

BMJ is offering free (2 min quick and easy) 7day trial right now. Anyone who would rather not bother can ping the doc on my Google Drive for access.

carbsane said...

My look about the web is that low carb has seriously waned such that it is now masquerading as paleo in considerable swathes of that community. Heck, even Dana Carpender, the Splenda Queen, wrote a paleo cookbook that was featured in the opening book parade of the Dr. Oz paleo episode. The paleos are more concerned these days with the toxicity of certain carbs like sugar, but there is still the insulin and blood sugar swing and whatnot.

On a related note, 4 days ago on his LLVLC blog, Jimmy Moore reported on the death of Barry Groves. Still nothing on Google News this morning.

lian johnston said...

Cause of death unknown? He seemed to be in pretty good health. My guess would be some kind of heart disease

Johnathan Doe said...

Why aren't you using Taubes latest book? It provides updated information on the role of insulin.

Nigel Kinbrum said...


carbsane said...

There is no updated info in WWGF.

carbsane said...

I'd rather not speculate but Jimmy mentioned he was on a lengthy vacation prior to this which since there's no mention would mean he was in good health and perhaps something happened on that vacation. I wonder if we'll ever know.

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Kade Storm A.K.A. Hedonist said...

Much appreciated, Evelyn. Thanks.

Blind Doggie said...

Is excess insulin leading to weight gain really a contentious issue? Surely not. Way before Taubes (and the rest) T1 diabetics recognized and still do that insulin promotes weight gain which is why so many exercise or lower their carbohydrate intake as a means of injecting less. Isn't it that straightforward?

Interestingly I (a LC T2) and my son (a LC T1) have different blood glucose reactions to protein. He most certainly has to account for it when working out his insulin dosage however I rarely see any significant rise in blood glucose from protein. Protein obviously produces an insulin response as the insulin index research you mention proves that quite neatly. The difference in how we react is simply that protein is effectively a very slow acting food and thus, simplistically my partially functional T2 pancreas can cope with the rate of production required whereas my son who produces zero insulin has to account for the amount required in his insulin dose.

It is though an issue of scale! Many T1 diabetics who follow a traditional high carbohydrate diet tend not to count for protein because the amount of carbohydrates consumed and the resultant insulin dose required largely swamps any requirement to consider the additional requirement for protein As you swap increasingly to a LC regime the requirement to account for protein becomes apparent to the extent that some LC T1's maybe taking 50% of their protein intake into consideration.

Kade Storm A.K.A. Hedonist said...

Interesting. Cheers for the share.

If you don't mind my asking, how did this pan out for your health markers and general day to day performance? (Aside from what's already been expressed on the forum.)

Nigel Kinbrum said...

With T1DMs, too much exogenous insulin lowers BG too much resulting in the munchies, as per

Stephan Guyenet said...

He has been getting press in scientific journals since obtaining $40 million for NuSI via the Arnold foundation, which will be funding scientists who read the journals he's publishing in. Note that both of his recent editorials in scientific journals took time to discuss NuSI. Neither one was peer reviewed.

carbsane said...

To channel Taubes, when a T1 gains weight when insulin is restored, this is more "correcting" weight and metabolic dysfunction resulting from a lack of insulin.

I think the difference between you and your son is attributable to glucagon. Glucagon stimulates glucose production by the liver that you apparently make enough insulin to counter whereas your son does not and requires more. I came across quite a lot of information about glucagon suppression in conjunction with insulin a while back.

Ash Simmonds said...

Health markers? I'm as fit and healthy as ever - AFAIK - but don't have any biomarkers to prove it.

carbsane said...

Honestly I don't understand the point or utility of such experiments except for you Ash. I'd have to ask "why?" (and what's up with all of the alcohol?) . We do have individual biovariability that effects how much we absorb, and our metabolic adaptability. It doesn't change the facts of biochemistry and metabolism, however.

carbsane said...

Thanks for the input Stephan! I eagerly await announcement of NuSI's first comissioned study!

Jane Karlsson said...

Evelyn, I spent some hours on Monday looking up ASP to find out what pathways it uses and whether they overlap with insulin's. I especially wanted to know whether insulin has any effect on DAGAT. I didn't find anything specific, but it seems ASP activates it via PKC-beta, which activates a phosphatase that dephosphorylates it. Now insulin increases transcription of the PKC-beta gene, which suggests insulin does indirectly increase DAGAT activity.

carbsane said...

THANKS Jane! What has always fascinated me is the FIRKO and the C2L5KO (ASP Receptor KO) having similarities. In and

It doesn't seem all that controversial in the scientific literature that ASP stimulates chylo TAG uptake. It is those trying to take the basal TAG/FA cycle and postprandial fluxes out of context that have created needless controversy and confusion.

Cianflone's group has published some new ASP related research lately (there wasn't much last time I had checked). I hope to get to look at it in more detail.

Jane Karlsson said...

Thanks for those two links. Yes it looks like ASP does exactly what you say. It would be very interesting if it does it via PKC-beta because PKC-beta is an 'obesity gene' which is upregulated in response to a high fat diet.

carbsane said...

Yes, it would be interesting. It's not something I have looked into much recently. There are also gender differences where ASP is more active in gluteofemoral subQ "female" fat (if memory serves, it has been a while). If there is to be a targeted hormonal intervention for obesity, ASP would seem a better target as it does not appear to be such a whole-body important hormone like insulin is. On the flipside, where would the fats go, and would they be burned off with increased oxidation rates like we see in rodents? IOW if ASP is responsible for the bodyfat that is less associated with and even sometimes described as protective against metabolic disease, would interfering with that adiposity be a good idea?

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