las

Welcome all seeking refuge from low carb dogma!

“To kill an error is as good a service as, and sometimes even better than, the establishing of a new truth or fact”
~ Charles Darwin (it's evolutionary baybeee!)

Friday, October 31, 2014

Thermodenyics in the Incestral Health Community: It Began with Atkins

For the past couple of months, I've been somewhat obsessing about thermodynamics having written the AARR piece and a few blog posts, not to mention revisiting several dating back to near the beginnings of this blog.  I began this a while ago as a single lengthy post, but it's gotten out of hand and finding time to tidy up such a post vs. publishing shorter chunks in parts became impossible.  Not sure how many parts this will have.  This series will put several members of the IHC "on the record" so to speak.  While I've done so in the past, the hope is to have it all in one place.

Robert Atkins the Calorie Guy!   


Surely Atkins is an honorary member of the IHC, even though he passed away over a decade ago before this community reached the level that it has.  Most of the "greats" have learned something (perhaps essentially everything) they know about low carb diets and tangentially about thermodynamics/calorie theory from the "late great one" himself.


In 1972, Atkins came out with his first book, Dr. Atkins' Diet Revolution, with the subtitle "the high calorie way to stay thin forever".  I have the paperback version of this from Bantam Press (1973) though it went through many reprintings.   Atkins never intended to be a calorie guy.  After all he titled Chapter 8:  To Stay Fat - Keep On Counting Calories, wherein he attempted to debunk the "calorie hoax" and repeatedly blasts this as failed.  Interestingly, he even states that we'd been counting calories for 60 years, which would put our national obsession with such dating to the early 1900's ... an odd claim to be sure.    On page 94 in that chapter, Atkins wrote:
The calculation of calorie outflow is based on the assumption that fat, as it is burned in the body, is completely degraded (biochemically broken down) to yield all the potential heat (energy) that it contains. (The end products are the basic substances, carbon dioxide and water.)  If a portion of the fat molecule were to leave the body in another form containing potential energy, the calorie theory would be proved wrong.
In actuality, this is not true!  Atwater and others have always taken into consideration what was excreted unabsorbed (feces) and incompletely metabolized (urine, breath).  Atkins goes on to make this rather exciting claim:
We already know about our wonderful friends those ketone bodies and how they are being excreted in the urine.  We measure them with our "turning-purple" sticks.  Dr. Kekwick and Dr. Pawan, in their pioneering research, were the first to point out that a significant amount of latent energy is excreted in this form.  On a low-carbohydrate diet nearly three times as much energy is lost in the urine and stools, mainly in ketones, as on a high-carbohydrate diet. (italics are Atkins')
Atkins goes on to exaggerate the additional ketones lost in breath.  The above (highlighted) claim is probably factually accurate, perhaps even a conservative estimate.  But it is misleading as the amount of ketone energy lost to the urine is minuscule and three times minuscule is still going to be pretty minuscule!   Atkins sought to replace the existing calorie theory with what he called The Diet Revolution Calorie Theory.  I snapped a picture of this on my cell phone and augmented it a bit for effect.


This was over 40 years ago.  Atkins merely misrepresented the First Law or Calorie Theory or whatever you want to call it, (noting that calories in are chemical potential energy of absorbed molecules):

replacing 
Calories In = Calories Expended + Energy Stored 
with
Calories In = Calories Expended + Energy Excreted + Energy Stored

It's not really anything groundbreaking or different. Atkins just grossly misrepresented the magnitude of the energy excreted as being quantitatively significant (which it is not).  A formal complete accounting of energy in the human body -- no gimmicks required -- would include energy excreted.  Most don't because this has been measured to be on the order of less than 1% of total energy in the low carb dieter.

Atkins version 1.0 = First Law of Thermodynamics or CaloriesIn-CaloriesOut energy balance.  That's the bottom line.  Ketones were simply a "magic" CO term in the CICO.


Atkins Said Something Really Dumb!


... but Dr. Mike can forgive the man as a doctor, not a scientist.  In 2007, the co-author of Protein Power, wrote a blog post entitled:  Thermodynamics and weight loss.  Seven years ago now, he wrote: 
Probably no laws of physics have been so over invoked and less understood than the laws of thermodynamics. Everyone it seems is using the laws of thermodynamics to justify every position imaginable in the field of weight loss. Journalists often throw out the laws of thermodynamics to prove or disprove dietary regimens they’re writing about. Authors of various blogs and other online sites rabbit on about how the laws of thermodynamics are aligned with their pet theories. And even worse, research scientists – who really should know better – more often than not misquote the laws of thermodynamics, especially when talking about the possibility of a dietary metabolic advantage. ‘It can’t be valid,’ they sniff, ‘it violates the laws of thermodynamics.’
So, I figured is was time to delve into these mysterious laws so that readers of this blog at least can know thermodynamic nonsense when they see it.
Snicker.  That second paragraph can be read as if Eades is about to serve up a load of thermodynamic nonsense.  Heck ... can I snicker again?  :-)  I'll get to the thermo per se in a moment, but first ...
And it helps to understand the vituperation heaped on Robert Atkins who wrote one of the most hubristic and outright ignorant statements imaginable showing a total lack of understanding of the laws of thermodynamics when he said:
  • When I make this claim, that you can lose more weight on a higher number of calories, I seem to be breaking the law—one of the hallowed laws of thermodynamics. Many powers-that-be get terribly provoked when I repeal their laws. But the calorie theory is a false law that is meant to be broken, and ketosis/lipolysis is the instrument for breaking it.
Actually, it's only Atkins' schtick that got him in trouble when ketosis was the instrument, he just meant the "simple calorie law that ignores excreted ketones" was a hoax.  After all, IF excreted ketones were of a quantitatively significant caloric amount, his original claims didn't violate any inviolable laws after all!


Lipolysis, Ketosis and Breaking the Law


One of the things I love so about internet search engines, is that when someone like Eades quotes someone without sourcing the quote, it's not all that difficult to find it.  As it turns out, Atkins wrote the above in Dr. Atkins' NEW Diet Revolution.   DANDR is like the low carb Bible of the IHC.   It turns out what Atkins put forth in that book did violate the First Law, but also a more fundamental concept that one barely needs to understand any science to accept.  I'm talking about conservation of mass, which boils down to:  what goes in must come out, or it adds to the number on the scale.    It is important to understand that all absorbed fatty acids make their way out of the body in only one quantitatively significant manner: 
         
Fatty Acid  → [ β-oxidation + Krebs ] → CO2 


The β-oxidation + Krebs part is the "metabolism" of fatty acids resulting in production of some heat, some ATP, and a large number of so-called "reducing equivalents" that will produce much more ATP (cellular energy currency) in the Electron Transport Chain.  You don't see mass escaping your body, but the carbons that were originally contained in the larger fatty acid molecules are exhaled as carbon dioxide. Atkins' original claim was that enough molecules escaped the Krebs cycle and were excreted before being fully metabolized for their caloric content.  The vast majority of β-oxidation to burn fat for energy occurs in organs like the heart and skeletal muscle.  Once a fatty acid is committed to the β-oxidation pathway they are oxidized completely down to carbon dioxide.

From DANDR:
The definition of lipolysis sounds like Nirvana to a person longing to lose weight. It means "the process of dissolving fat."  Isn't that exactly why we're all gathered here today? Now I will tell you the "secret" to unlocking the latent power of lipolysis.    When you burn fat, it breaks down into glycerol and other fatty acids.  How does the process actually work? Are there any drawbacks? There are plenty of laypeople and even physicians who think there must be.
So it would appear that confusing lipolysis with β-oxidation is yet another common gimmick that can be traced back to the "late great one".   Gone from the new book was the Diet Revolution Calorie Theory as Atkins instead threw calories completely out the window as there were even grander claims to be made!
As for the weight loss phases of Atkins, they are simple and overwhelmingly effective.  I don't see any reason why I should understate the facts. Lipolysis is one of life's charmed gifts.  It's as delightful as sex and sunshine, and it has fewer  drawbacks than either of them!
Wow!  Sign me up for unrestrained lipolysis right away!!  
In the earlier editions of this book ... I said: "The term `ketosis,' when it applies to the benign, diet-induced type we're talking about, is really a shortening of the term ketosis/lipolysis, which is enough of a tongue twister that you can see why it is commonly referred to only by the name ketosis." ...  The Atkins Nutritional Approach stimulates the process of lipolysis, a state I hope you are always in: burning your fat for energy.  A secondary process of lipolysis is ketosis. Ketosis occurs when you are taking in a low level of carbohydrates from the food you eat, as you will during the Induction phase of Atkins. Lipolysis results in the creation of ketones (that's ketosis), a perfectly normal and natural function of the body.
Lipolysis does not make the index of the original book.  Perhaps its in there, but I have neither the time nor inclination to even drudge back through the entire sections on ketosis.  In the end it doesn't really matter if he equated ketosis with lipolysis back then, he did it here and "now" with DANDR first copyright in 1992.  And in that book he also coined the term "Metabolic Advantage" ... a term that has come to mean different things to different people in the 20 or more odd years since.   This next and last paragraph cuts to the core of the scientific bankruptcy of advocates of LC diets.  I'll break it into bullet points in order to make comments directly to each issue:
  • How does lipolysis work? Lipolysis simply means that you're burning your fat stores and using them as the source of fuel they were meant to be. 
WRONG:  Lipolysis is the breaking apart of triglycerides into fatty acids and glycerol.  Fat burning is the breakdown of the fatty acids into CO2.
  • The by-products of burning fat are ketones. 
WRONG:  Ketones specifically produced, mostly from fatty acids, by the liver.  Most fatty acids are "burned" completely to CO2 in the heart, other organs and skeletal muscle.
  • When your body releases ketones -which it will do in your breath and your urine- it is chemical proof that you're consuming your own stored fat. 
WRONG:  Medium chain triglycerides have been known to generate ketones without carbohydrate restriction.  Further, on a high calorie high fat diet, there is no evidence that stored fat is the source of those fatty acids, nor that even if burned, there is a net loss of body fat in the process.    Also, see Jimmy Moore in 2014 :-)
  • Once more, for emphasis: When a person on a safe, controlled carbohydrate plan such as mine is releasing ketones, he or she is in the fat-dissolving state of lipolysis. This process is simply the most efficient path ever devised for getting you slim. And the more ketones you release, the more fat you have dissolved. 
From Guyton & Hall
Textbook of Medical Physiology
GIMMICK & HYPE:  (Also wrong.)  Ketones in a state of ketoacidosis are indeed the result of unrestrained lipolysis and excessive fatty acid delivery to the liver.  Those fatty acids are "released" from their proper storage depots (fat cells) but not released from your body.
The plot at right is for glucose, FFA and ketones after removal of the pancreas (in dog).  Both glucose and FFA level off at an elevated level because glucose eventually exceeds re-uptake thresholds and is excreted in the urine (CO!) while FFA diffuse into non-adipose tissue such that the maximum level of fatty acids is roughly double the usual circulating amount.  Note that the ketones keep rising. 
Another way to look at this is that ketoacidosis would not be possible if the body had an efficient way of ridding itself of these molecules.  Yet another way of looking at this is that if carbohydrate restriction "unlocked" your fat in the manner claimed, you would be looking at ketoacidosis instead of the mild ketosis observed under even the most stringent of conditions.
  • Lipolysis is the biochemical method of weight loss -the alternative to using glucose for fuel, the very process that has made you heavy.
WRONG:  Using glucose for fuel doesn't make you heavy so long as your total caloric intake doesn't exceed expenditure.  
  •  Lipolysis can be your life raft, giving you both slimness and health, and distancing you from the obese person's perils of diabetes, heart disease and stroke. 
WRONG:  Lipolysis -- or unrestrained lipolysis accompanied by inadequate recycling within the adipocyte -- is what leads to the "perils of diabetes" associated with obesity.  Most of the obese have long ago used this "life raft" unwittingly, as most obese have elevated circulating levels of free fatty acids.
  • Most of all, of course, it is the key to achieving your goal to use up the fat stored on your body. 
WRONG:  To repeat, lipolysis is not fat burning, and therefore not a route out of your body for stored fatty acids.  
  • The phenomenon of lipolysis or fat burning being the major alternative fuel system has been so well researched that it is simply not disputed in academic circles. It is scientific fact. 
THIS CANNOT BE MORE WRONG:  Yes, these metabolic pathways are well researched.  Yes, they are a matter of scientific fact at this point.  But -- to repeat once more -- lipolysis is NOT fat burning.

The Thermodenyics of Atkins:


To sum up this first installment then, Atkins didn't really begin as a First Law denier or what I'll call a Thermodenialist.  He merely misunderstood the process of constructing a valid equation based on the principle of conservation of energy.   However in DANDR, Atkins earned his full PhD regalia from the school of Thermodenialism.  While he still hung his hat on ketosis, the new calorie balance equation that factored in ketone energy losses went missing, replaced by the magic of lipolysis and the flat-out erroneous notion that lipolysis is synonymous with fat burning.  

Once you absorb the molecules=calories, any explanation of what comes next must comply with the laws of thermodynamics (most specifically the First Law, or more broadly the Law of Conservation of Energy).  Even Dr. Eades stated this point blank.   Lipolysis, the breaking down of triglycerides (storage form of fat) to free fatty acids (transport/usage form of fat) and glycerol, is not the rate limiting factor in what comes next:  the breaking down of fatty acids to CO2.

Furthermore, one might ask themselves why, if ketones are evidence of body fat burning, they are not present at similar levels in all humans who are actively losing body fat?!  

Stay tuned ... A Thermocraptastic exposé of the mirdled low carb guru is in the queue.

98 comments:

Aaron said...

Incestral health community? I guess it is important to focus on health when your babies are coming out with webbed hands and stuff.

carbsane said...

Hey Aaron ... Incestral Health Community is a term I "coined" a couple of years ago now to encompass the greater low carb/paleo/WAPF/etc. online nutrition community. It is indeed "incestral" as the ties within and between are a very tangled web. There are certain themes running through and spanning various ideologies that are common, and they tend to trace back to a single individual or few individuals who are parroted and "shared" on social media.

Gordon said...

Um ... wouldn't that be "thermodenymics"? LOL

carbsane said...

Quayle says potatoe ... I say potato ;-)

Screennamerequired said...

When I re-read the old Atkins book, I couldn't help but notice how well he sells his diet to people who love food. Lobster with butter, Whipped heavy cream with berries, low-carb ice-cream sweetened with stevia. etc. I'll be honest, when I first read that book it sounded like a panacea, and when I actually lost weight eating that way I became a low-carb zealot for a while. Robert Atkins obviously loved luxurious foods, as we all do to some extent.



The implication that I was peeing out most of these luxurious foods via ketones was even more marvelous. I feel a bit embarrassed admitting this, but I actually even ordered some ketostix online via ebay at one stage.

Snarks said...

I wouldn't be embarrassed about that. What is the point of straining to reach a goal if you can't measure to see if you've reached it? To me, it would be about as embarrassing as admitting I owned a bathroom scale or a measuring tape, or saying that I use flash cards and end of chapter questions to make sure I remember topics in study material.

Sanjeev Sharma said...

> Atkins goes on to exaggerate the additional ketones lost in breath.


ketones in the breath is the building 7 of these denialists; probably real fat burning beasts produce thermite in their stool ... imagine the amount of energy lost there.

Snarks said...

Is the argument that acetone breath is like smoke from the metabolic fire blazing inside these guys, or is it more like "Eat lo-carb - calories just evaporate! No, really!"

And where do farts figure into the equation?

Nutrivorous said...

That which is measured improves and that which is measured and tracked improves exponentially. There's nothing wrong with trying different things and seeing how it affects you.



Where I think some of the low carbers go wrong is they see their weight dropping when their ketones go up and then they start to pay more attention to the number on the ketostick than things like portion sizes and whether or not they're actually losing weight.


Near as I can tell, a ketone meter will respond either to: A) someone losing weight or B) someone eating lots of coconut oil or butter. So the person might start out restricting their carbs, restricting their protein and inadvertently restricting their calories and losing weight. But then they get addicted to the number on the ketone meter and wind up just eating a lot of butter.


It amazes me that some of these people will prick themselves with a needle 6 times a day and pee on a ketostick and count carbs and count protein grams and monitor the omega 6 to omega 3 content of every nut and seed on the planet, and parse the difference between a grass fed cow and a grain finished cow or a pastured egg vs a free range egg, but they can't be bothered to simply measure their portions or count calories.

Nutrivorous said...

I believe the acetone breath is supposed to be an indicator that you have elevated levels of ketone bodies and therefore you are in ketosis and therefore you are a fat-burning beast.


The argument as I understand it is that if you are in ketosis, it's because your body 'prefers' to be burning fat, and therefore will dip into your fat stores for fuel, while the body of a 'sugar-burner' will simply get hungrier and hungrier until the poor sod stuffs their mouth with every slice of bread, bowl of cereal, and bag of sugar in the house.


The farts, as I understand it, are mostly generated by bacteria in the lower gut who eat the food that the bacteria in the upper gut won't touch. In Atkin's day, this was 'dietary fiber', and he gave that stuff a free pass. It didn't count toward your 'net carbs', and you could eat it freely.


This led to quite a few low-carb junk food products where the "net carb" count was manipulated or even flat-out fabricated. Plus, it turned out that a lot of these carbs actually were being converted into calories by the bacteria. So, some of the low carb clinicians started using "total carbs" again.


Recently, the low-carb community has discovered that resistant starch, which naturally occurs in things like navy beans, and is also formed when foods like potatoes are cooked and cooled, has similar benefits. But instead of, you know, deciding that maybe beans and potatoes aren't really that bad after all, some of them took to eating spoonfuls of uncooked potato starch with their coconut oil and butter. Which in turn has led to a lot more discussions about flatulence than one usually associates with optimum health.

MacSmiley said...

Good one!

Snarks said...

I'm sorry - I should have made it more clear that I was being a smartass. Thanks for the thoughtful reply though.

StellaBarbone said...

The annoying thing about these claims is the fact that they are so easily quantified. You don't need a massive RCT to determine whether enough calories are wasted through ketosis to be clinically relevant for weight loss. You just have to take a couple of people to a metabolic lab and do some measurements.

Hey Snarks! I hope you stopped the vitamin D. My mom just told me she stopped vitamin D at the beginning of October and has been pain free for almost a week now, off all medication. She started the D two years ago, developed intractable radiculopathy attributed to spinal stenosis about a year and a half ago and had two subsequent laminectomies which provided little relief. Whoops! She has crazy good bone density, spends hours outdoors every day, lived below the 38th parallel at high altitude in sunny Santa Fe and has absolutely no reason to take oral vitamin D, but, hey, it's good for you, right?

Snarks said...

I did stop it - thanks - I've actually stopped taking all supplements except pro and pre biotics for the time being. To be clear, though, I was taking it because of repeated blood tests showing insufficiency, not because it was trendy or paleo approved. I'm waiting to see if things look better on my next blood tests after adding (hopefully) whole grains and legumes back to my diet and rearranging my macros some.

Nutrivorous said...

I often take cod liver oil as a supplemental food. One teaspoon provides a full day's supply of vitamin d and vitamin a, plus more Omega-3 than you would find in 22 servings of grass-fed bison.

Nutrivorous said...

The problem is, you can't think of a dietary regimen so ridiculous that someone else hasn't already tried it. "Hey, you know what would make a great weight loss meal? A stick of butter mixed with a jar of coconut oil plus a pint of whipped cream and a block of full fat cream cheese."

StellaBarbone said...

I had a blood test too. My D level was at the very bottom of the normal range -- in March, at the end of winter -- and I was advised by a very conventional MD to take vitamin D. One of my former partners, very smart and very conventional, was a fanatic on the subject and since I knew there was a lot of good stuff about it coming out of small trials, I went along with the suggestion. The other two women that I know who are feeling so much better after stopping D supplements are both sun-belt golf fanatics who had "low levels". My mom was also living at altitude and getting plenty of UVB year round. I was surprised that she was taking the stuff too. I question the reference range for "normal" since so many people that I know are below normal in southern California.

Jane Karlsson said...

Ultraviolet Radiation Suppresses Obesity and Symptoms of Metabolic Syndrome Independently of Vitamin D in Mice Fed a High-Fat Diet

Abstract
The role of vitamin D in curtailing the development of obesity and comorbidities such as the metabolic syndrome (MetS) and type 2 diabetes has received much attention recently. However, clinical trials have failed to conclusively demonstrate the benefits of vitamin D supplementation. In most studies, serum 25-hydroxyvitamin D [25(OH)D] decreases with increasing BMI above normal weight. These low 25(OH)D levels may also be a proxy for reduced exposure to sunlight-derived ultraviolet radiation (UVR). Here we investigate whether UVR and/or vitamin D supplementation modifies the development of obesity and type 2 diabetes in a murine model of obesity. Long-term suberythemal and erythemal UVR significantly suppressed weight gain, glucose intolerance, insulin resistance, nonalcoholic fatty liver disease measures; and serum levels of fasting insulin, glucose, and cholesterol in C57BL/6 male mice fed a high-fat diet. However, many of the benefits of UVR were not reproduced by vitamin D supplementation. In further mechanistic studies, skin induction of the UVR-induced mediator nitric oxide (NO) reproduced many of the effects of UVR. These studies suggest that UVR (sunlight exposure) may be an effective means of suppressing the development of obesity and MetS, through mechanisms that are independent of vitamin D but dependent on other UVR-induced mediators such as NO.
http://diabetes.diabetesjournals.org/content/63/11/3759.full

Jane Karlsson said...

Magnesium deficit - overlooked cause of low vitamin D status?
http://www.biomedcentral.com/1741-7015/11/229



Study Results

Deng et al. [5] used two large National Health and Nutrition Examination Surveys data sets to assess interactions between Mg intake, vitamin D status and outcome. According to the Institute of Medicine (IOM) classification, circulating 25-hydroxyvitamin D (25OHD), the generally accepted indicator of vitamin D status, was within the deficit range (<12 ng/ml) in 12% of participants and the insufficiency range (12 to 20 ng/ml) [6] in 30%. Mean energy-adjusted total Mg intake (dietary and supplemental) was clearly below the recommended daily allowance, which is between 310 and 420 mg depending on age and gender [7]. High Mg intake was associated with reduced risk of vitamin D deficit or insufficiency. ...

Nigel Kinbrum said...

You used to be an MD, yes? Your mum took supplements without...
a) Asking your advice?
b) Asking her MD's advice?
c) Getting an independent serum 25(OH)D test?
I do not believe she wanted to be doing that!

How much Vitamin D was she taking? Everything is bad for you in excess, even water (where consuming a mere 10 x RDA is fatal).

John Smith said...

I'm not ashamed to say that I used to pee on the stix. It made me feel victorious.

Jane Karlsson said...

Nigel, I need to ask you something. I remember you had an OGTT years ago and found you had pre diabetes. You took vitamin D and it went away, according to a second OGTT. What's bothering me about this is that your first OGTT was for 5 hours, and showed reactive hypoglycemia at 3 hours. The second OGTT was only for 2 hours, but your endocrinologist declared you cured. My question is, do you know whether you still have 3-hour reactive hypoglycemia?

Jane Karlsson said...

'Although the principal mineral element affected by vitamin D appears to be calcium, positive effects of vitamin D on absorption or metabolism have been demonstrated for strontium (Greenberg, I945), lead (Sobel & Burger, 195 s), magnesium (Meintzer &
Steenbock, 1955), beryllium, barium, zinc and cadmium (Worker & Migicovsky, 1961 a, b), cobalt and caesium (Wasserman, 1962) and iron (Masuhara & Migicovsky, 1963). It has also been suggested that a relationship exists between vitamin D and manganese (Ministry of Agriculture, Fisheries and Food, 1963), a slight deficiency of either being counteracted by a larger intake of the other ...'
http://journals.cambridge.org/download.php?file=%2FBJN%2FBJN21_03%2FS0007114567000558a.pdf&code=ef7326f83288f7ce9ea5704c1f57a0b3

Nigel Kinbrum said...

Hi Jane. That's not quite right. The results from the 5-hour OGTT in 2003 were:-
T(min) , BG(mmol/L)
0 , 5.8
30 , 7.9
60 , 9.3
90 , 10.3
120 , 8.7 (<7.8 = O.K. >11.1 = Diabetes)
150 , 7.1
180 , 5.3
210 , 4.3
240 , 3.9
270 , 3.9
300 , 4.4
The nadir occurred at 4-4.5 hours post-glucose, and I wasn't technically hypoglycaemic, as 3.9mmol/L doesn't count as hypoglycaemia.

The results from the 2-hour OGTT in 2008 were:-
T(min) , BG(mmol/L)
0 , 5.0
120 , 3.7
My endocrinologist said that I still had Metabolic Syndrome, even though I had a print-out of Chiu et al (http://ajcn.nutrition.org/content/79/5/820.full ), which stated that Insulin Sensitivity was inversely proportional to 2-hour BG value. My endo' said that I didn't need to see him any more, as I had got my serum TG's down to 1.4mmol/L without medication (it was 4.95mmol/L), and BG was no longer on the high side. I haven't seen him since.

N.B. To convert BG from mmol/L to mg/dL, multiply by 18.

Jane Karlsson said...

Thanks, that's a great help. May I ask one more question please? Did you change your diet after 2003? If not, do you think the fall in your serum TGs was due to the vitamin D? I do remember you take Mg as well.

StellaBarbone said...

No, all three of us took D on the advice of our physicians. I don't advise family members on medical matters and believe that only a fool has himself for a physician. We all had vitamin D levels, but my results were not considered with respect to the season. I initially scoffed at taking vitamins, but then decided to do as I was told. It took a while for the pain to develop, so the source wasn't obvious. I only stopped it after reversing every other change from the previous year and losing 20+ lbs (starting from "normal" weight by BMI). Stopping D was a Hail Mary pass.

All three of us live well below 38 degrees in latitude where we are exposed to adequate UVB year round and have no other need for D supplementation (i.e. we go outside most days which a nursing home resident, for instance, might not). My mom was also living at high altitude. Someone living further north might benefit from judicious D supplementation, but right now it's being promoted as a magic cure-all for whomever and whatever. Unlike the UK, a good portion of the US lives in a location where D supplementation should not be necessary.

Sorry to hijack your blog, Evelyn, but I was in a lot of pain and now it's gone and it's hard not to be a crusader. I've been arguing alternative medicine topics on-line for 20 years now and diet claims are just a subset for me. I do believe that conventional medicine has it's flaws, particularly a lemming like need to adopt "alternatives" that are even slightly plausible....

Nigel Kinbrum said...

Sorry for being so inquisitive, but...
What was your serum 25(OH)D level, pre-Vitamin D?
What Vitamin D dose were you prescribed?
Was it D2 (ergocalciferol) or D3 (cholecalciferol)?

What was your serum 25(OH)D level, post-Vitamin D?


It's annoying when something is touted as a "universal panacea", as it's like "the boy who cried 'wolf'". When the health problem is caused by a lack of Vitamin D, someone might refuse therapy on the grounds that Vitamin D has become "woo".

Nigel Kinbrum said...

I can't remember specific details of my diet. It changed in November 2002 from VLC to low/moderate carb. When my serum TG's peaked at 4.95mmol/L, I was prescribed various medications (fenofibrate, then Niaspan), but none of them got my TG's below 1.8mmol, so they were discontinued before I started supplementing with 5,000iu/day of D3.

I started taking ~400mg/day of Mg (also 15mg/day of K2) in 2003, after the osteoporosis diagnosis. I'm on the same dose of Mg, but I'm taking 5mg/day of K2 as a maintenance dose.

carbsane said...

On the contrary, I've been following along and I'm glad that this issue has been brought up.


I jumped on the Vitamin D bandwagon b/c of some improvements folks were seeing and "it can't hurt". I didn't notice joint pain, but I developed high blood pressure. Granted this was one data point, but even at my heaviest my BP was only high normal. This reading was taken after losing around 100 lbs and the nurse looked at me askance -- do you have high blood pressure? I was also having strange "dizzy" spells. I don't know how else to describe that but when I would roll over in bed my head would spin. All of this went away when I stopped taking VitD. So not everyone is deficient and there can be negative outcomes.

To all: I've been reading all comments but dealing with a ton of family issues for the past couple of weeks. Trying to keep a trickle (for me) of blog posts going and phone is good to keep tabs but no good for typing out replies.


Carry on!!

StellaBarbone said...

25(OH)D level was 30.6 ng/mL drawn on March 11, 2013. "normal range" 30-50 ng/mL. I was taking Trader Joe's D3 1000iU about 5 days per week, with no other vitamin tablets, supplements or regular intake of any form of vitamin fortified food. The pain didn't start for several months. I stopped walking the dogs in August, 2013 because of increasing pain, but I'm not sure when I started the D supplement between March and August, probably Junish. At that point I was maybe taking it 2-3 days per week. In September I started PT and moved the D supplement to the coffee supplies cabinet where I would remember to take it more frequently. I assumed that my increasing pain was due to PT. In December I began to experience pain in hands, wrists, medial elbows, my "good" foot and ankle and my patellas.

I googled to find the dose of the TJ D3 I was taking and up popped numerous blog posts singing the praises of vitamin D for the treatment of everything. The top post was Seth Roberts on the use of vitamin D for the treatment of insomnia. I can not even find negative reports on Medline, because I'm too impatient to search theough all of the laudatory small studies.

I can believe that vitamin D causes hypertension. It's part of the renal axis. I had BPs elevated to "pre-hypertension" levels for the first time ever this past winter. I had assumed weight (BMI 25) genetics and age, but the BP post Weight Watchers (BMI 22) and vitamin D cessation is now 110/70.

Note that in California anyway, the only legal rat/mouse poison is D3. Warfarin is no longer available.

StellaBarbone said...

I'll add that my thnic heritage is 3/4 British and 1/4 German and I'm pretty underendowed in the melanin department. I don't need much UVB to make adequate D.

StellaBarbone said...

Mice have very different vitamin D metabolism than humans. That's why we use D3 as a rodent poison.

charles grashow said...

http://jaha.ahajournals.org/content/3/5/e001169.full

Low Carbohydrate Diet From Plant or Animal Sources and Mortality Among Myocardial Infarction Survivors

Abstract

Background
The healthiest dietary pattern for myocardial infarction (MI) survivors is not known. Specific long‐term benefits of a low‐carbohydrate diet (LCD) are unknown, whether from animal or vegetable sources. There is a need to examine the associations between post‐MI adherence to an LCD and all‐cause and cardiovascular mortality.

Methods and Results
We included 2258 women from the Nurses' HEALTH STUDYand 1840 men from the Health Professional Follow‐Up Study who had survived a first MI during follow‐up and provided a pre‐MI and at least 1 post‐MI food frequency questionnaire. Adherence to an LCD high in animal sources of protein and fat was associated with higher all‐cause and cardiovascular mortality (hazard ratios of 1.33 [95% CI: 1.06 to 1.65] for all‐cause mortality and 1.51 [95% CI: 1.09 to 2.07] for cardiovascular mortality comparing extreme quintiles). An increase in adherence to an animal‐based LCD prospectively assessed from the pre‐ to post‐MI period was associated with higher all‐cause mortality and cardiovascular mortality (hazard ratios of 1.30 [95% CI: 1.03 to 1.65] for all‐cause mortality and 1.53 [95% CI: 1.10 to 2.13] for cardiovascular mortality comparing extreme quintiles). An increase in adherence to a plant‐based LCD was not associated with lower all‐cause or cardiovascular mortality.

Conclusions
Greater adherence to an LCD high in animal sources of fat and protein was associated with higher all‐cause and cardiovascular mortality post‐MI. We did not find a health benefit from greater adherence to an LCD overall after MI.

Kindke said...

"Once a fatty acid is committed to the β-oxidation pathway they are oxidized completely down to carbon dioxide"



Im interested in this comment, can it be explained in more details, ......where does it come from? ..... and from what references does it gain support?

Jane Karlsson said...

Thanks.

Jane Karlsson said...

Do they? In what respect? I've just been looking it up and can't find anything.

Jane Karlsson said...

Kindke, Evelyn is very busy right now with family matters. Could you expand on your question so that others here (eg Charles) can help?

Nigel Kinbrum said...

I'm amazed that 1,000iu/day had such a large effect on you, as it would raise your serum 25(OH)D by only ~8ng/mL.

Snarks said...

Sorry to hijack, but do you have any pointers to good info about hypo?

I seem to have "postprandial syndrome" or whatever it's being called now - my blood glucose peaks shortly after a meal (usually no higher than around 140), and then crashes pretty quickly, but never drops lower than 70s (according to the meter I picked up). I get jitters, massive headaches, difficult focusing, and heart racing kind of effects from it.

Fat seems to blunt this effect quite a bit (I can eat potato chips, for instance), low-fat starch with protein is the worst possible combo (6 oz chix breast with 2 cups of rice and a cup of squash nearly finished me).

Initially I figured I had nuked my glucose sensitivity and that I had too much glucose in my blood, but it seems like that's the opposite of the issue now. Aside from "give up - starch is not for you - hope you like veggies" I'd like to figure out if there's something better I can do, besides eat an ounce of potato or rice at each meal and see how badly things go.

Thanks.

StellaBarbone said...

Google d3 and rodenticide. The revolting little beasts are more sensitive to D3 than other species which makes D a good choice for rat poison since it decreases risk to domestic animals and secondary poisoning of predators. I may be part mouse.

Bris Vegas said...

My sister lives in the subtropics (27S) and spends a lot of time in the sun. Despite being a light skinned with blue eyes blonde she has a clinical deficiency in Vitamin D.

It seems the Vitamin D story is incredibly complex.

Jane Karlsson said...

Yes I looked it up when you first mentioned it, I had no idea it was used to kill rodents. Then I looked some more and found that they can tolerate very large doses without problems. So the rodenticide dose must be really enormous.
http://www.fasebj.org/cgi/content/meeting_abstract/21/6/A1110-c

I thought you might mean, that rodents are nocturnal so they don't normally get their vitD from sunlight. I've been puzzling about that. Then I remembered I used to have very nice little mice living in my garden, and I'd see them during the day. They would come to collect bits of peanut dropped by the birds from the bird feeder. They could have come at night, and maybe they did, but not always.

Yesterday I found out that plants can make D3. Until recently it was thought they could only make D2. Some plants make such a lot that animals grazing on them get calcium intoxication.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3651966/

So I suppose, rodents deal with vitD much like we do. Some comes from the sun, and some from their food. And they can tolerate large doses just like (some) humans. But really huge doses kill them, and maybe they kill humans too. I told you about my friend and her mother who both died not long after starting on high dose vitD.

StellaBarbone said...

Serum levels of magnesium are notoriosly bad estimates of body Mg stores, ferritin and other serum iron indicators are nearly as poor indication of iron stores. Platelet and WBC counts are quite noisy. Blood sugar, of course, is highly volatile. Steroid hormones like testosterone and cortisol have a circadian rhythm. Vitamin D certainly has a seasonal variation, so my first question is how accurate serum 25(OH)D is as a marker for deficiency. Additionally, what effects are there when endogenous production is surpressed by supplementation? Are vitamin D levels merely a marker for something else?

A couple of weeks ago I posted a long list of "miracle" supplements that have been touted in my life and which have, on closer inspection, proved to be useless. I suspect that D falls into that same category for most healthy people and that, except in very specific cases of renal disease, supplementation may be useless to harmful.

Snarks said...

Well, there's multiple issues to consider, for sure. The most obvious is that supplements = $$$ so what's pushed my men's health and Dr oz may be suspect. Lots of folks make good money from either selling them directly or pushing them for other sellers. Go to either Mercola's site or Fuhrman's site for examples from either end of the spectrum. Honestly, they pale in comparison to folks like Gary Null.



Then there are the fringe woo-tastic nutters who take anything and everything (Null again), the more bizarre the better, and there's plenty of bleed over between life extensionists, vegans, paleos, etc that what may have started off as "hey, this may be worth more study" in a study abstract soon gets a few billion google hits on "mainstream" health blogs or fitness magazines and is reposted in a few hundred alt health mommy blogs. See above for affiliate $$$ as well here.


There's the obvious issue with supplemental XYZ most likely not being nearly as valuable as XYZ as a dietary component. There's also the folks who see "500 mg of vitamin c per day may be good for [heart health|longevity|immunity|cognition|etc]" in some study and extrapolate that to mean that 50 grams of vitamin c per day would make them immortal.


The internet has made all of this *much* worse. It used to require direct marketing to bilk folks. Now there's a universe of folks actively searching for wonder crap online.

Snarks said...

Actually, never mind. Considering I can't even find consistent GI/GL lists (see potato or carrots for instance), and how bad this makes me feel, I *am* giving up. It would be nice to be able to add inexpensive foods like grains and potatoes back to my diet, but this is seriously not worth it. I doubt RH or wtf it is gets better with gradual exposure to trigger foods, and if it does, I'm certainly not seeing that effect personally. I'll just stick with veggies and fruits.

Jane Karlsson said...

Snarks, I think Nigel would agree with me that this looks like delayed
insulin secretion and overshoot. Your beta cells are not sensitive
enough to glucose, so they don't secrete insulin at once when glucose
starts to rise. Later they secrete too much, and blood sugar plummets.
Then you get counter regulatory hormones which give you the nasty
symptoms.


Your beta cells probably need repairing. If you look up 'beta cells autophagy' you will find what I am talking about. They should normally be going through cycles of breakdown and re-synthesis of cell components, and this process needs micronutrients. Especially the ones found in whole grains and legumes, which of course give you the nasty symptoms. I don't know what to suggest.

Snarks said...

Hi Jane,


Thanks for the reply and for the info. Whatever the issue is, my body seems to be learning how to produce the effect more efficiently, and there definitely seems to be a tie in with protein + carbs. I just produced the effect with 6 egg whites cooked in a little olive oil and a large apple for breakfast. I guess that kind of points towards all carbs rather than just grains (beans don't seem to be an issue, other than the usual "musical fruit" effects).



The highest my meter has even gone is low 160s, and the lowest has been low 70s, checked at 15 min intervals. Unregulated highs and lows of BG doesn't seem to be the issue. I'm wondering if the issue is adrenergic, honestly - I feel, if this description makes any sense, like I had *way* too much coffee and just narrowly avoided an auto accident, plus I have a splitting headache.


All the pseudo-hypoglycenia info I have read has been very cursory, and often suggests it's all in the head of the patient, using words like nervous or anxious to describe the person. I'll admit to being somewhat of a hardass IRL, but I'm neither nervous nor anxious, generally speaking.


Thanks again for the input. I'm clearly going to have to do more work to figure out what my issues are.

Nigel Kinbrum said...

Hi Snarks,
It sounds as though you don't have much, if any, first phase insulin response. The $64,000 questions are:-
Why?
What can be done to fix it?
For a few ideas, see http://nigeepoo.blogspot.co.uk/2011/02/insulin-resistance-solutions-to.html specifically, also http://nigeepoo.blogspot.co.uk/search/label/Insulin%20Resistance generally. Hope that helps.

Snarks said...

Hi Nigel,

Thanks a lot for the reply. If I eat a high carb, high protein meal (say, 2 cups of rice and 6 oz of chicken breast) and track my BG every 15 min using a store bought meter, the highest I've ever seen would be around 8.8 - 8.9 mmol/L anywhere from 30 min to 45 min PP, and the lowest reading around 3.9 - 4 mmol/L shortly after that (60 or 75 min PP). My understanding (based on consulting Dr. Google, not based on any medical consultation) is that these readings are neither very high nor very low, is that correct?

Based on that assumption, the next thing I've seen referenced that makes any sense to me is that sometimes the rate of the BG drop can be problematic, even when the actual peaks and valleys are not extreme. Most of what I've seen is "in passing" though, and in reference to people using fast acting exogenous insulin. Have you heard or read anything similar?



The only other thing I've seen referenced that makes any sense is adrenaline response to BG spikes or drops. Lots of the very cursory descriptions of this kind of issue I've seen mentioned seem to imply that it's maybe make-believe, or possibly just psychosomatic. I suppose it's possible, since at the onset, I almost feel vasovagal, but OTOH, I'm very keen to be eating more carbs and less fat/protein, so it's not like I'm in fear of food here.



My Dr is very pro-paleo/low carb, so I doubt that I'll get a lot of good advice from him, but he'd probably be willing to at least send me for a glucose test if there's any point in it.


Thanks again for your input.

Snarks said...

I should probably mention that I'm gaining weight, too, and not just water, unless it's normal to continue to gain water in your tummy fat way past when glycogen would have been replenished. Starting weight was a fairly lean 190-ish - not ripped, but I didn't have much of a belly - I'm currently around 202 and had to let my belt out a notch. This is on appx 1800 - 2000 cals/day, which is what I usually eat regardless of macro ratios.

I'm a cico believer, but I can't argue with reality.

carbsane said...

Snarks -- It's sad when you can't recall the post on your own blog where you shared something, but there is a post here somewhere that discusses various postprandial glucose profiles and their cause. I think you need to have an OGTT with insulin at a minimum done. It's not standard but man would it be nice to get proinsulin.


One cause of your type of response may be that you are MODY (2 I believe). This person has all the machinery working but the glucose sensor is not so good. What happens is that it takes higher glucose to finally elicit the insulin response, by which time some glucose is already on the way into cells without the insulin and/or the insulin secretion is in excess of what it should be leading to a "hypo" that may or may not be medically hypo (but who cares, I've known lots who feel shaky in the low 70's and 60's including myself in the low 60's).


There is not dietary cure for MODY so you can manage with LC or low glycemic index, but there is a med for this type of MODY called Prandin that will trigger your insulin release sooner. May be worth the genetic test to find out or see from an OGTT if this is what's happening.

Snarks said...

Excellent info, thanks - I'll look for that blog post.

Out of curiosity, I've tested myself a few times when I notice that I'm feeling reasonably good, and I am always just a little over 100. On rising, I'm usually upper 80s to low 90s.

Yes, I think at this point I'm going to have to ask for a glucose test. I've more or less exhausted what little I can determine with a cheap meter and sore fingers.

StellaBarbone said...

Some people are just more aware of their inner workings than others. You're getting a pretty normal blood sugar profile:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2769652/#!po=44.1176

You tolerate legumes because they have a super low glycemic load (Beano, man, Beano! ... one of the few supplements that actually work). You're still eating a weird, restricted diet. Egg white omelet? Two cups of rice and some chicken? Ick! The only reason to ever eat two cups of rice is risotto, rich with olive oil, butter, and parmigiano which will considerably lower the glycemic index of the rice. I still think you should start with the starchy vegetables and introduce grains slowly. Since you can tolerate legumes (2 Beano tabs with the first bite will eliminate the music), eat those in conjunction with a small serving of rice and see how it goes.

Snarks said...

Yeah, I agree that my BG seems pretty normal, so the question is why does it make me feel so awful?

It was just egg whites, not an omelet, and I was using them up as a quick breakfast this am since I spent a good bit of my morning helping my kid finish a project for school. All I can say about the rice is that I like rice, and may have gone a little overboard.


It's been a very long time since I've just eaten for pleasure, so I guess what I eat might seem weird to people regardless of what the macros look like. Not that I never eat for pleasure, but "hmm, what sounds good today?" is almost never a consideration. This is for monetary as well as intolerance reasons, but basically, food is just fuel most of the time. In that instance where I had chix with rice, I replaced greens with rice, since I usually eat *tons* of greens and veggies, but I had some dental work done recently and eating crunchy stuff is a challenge.

Snarks said...

Oh, and the rice was just an example. I have the same issues with potatoes/sweet potatoes and chix, too. If I add a bunch of olive oil or butter to the mix, things do seem to go better, so if the issue is just that I need to wade in rather than doing a cannonball off the lifeguard tower, I guess that would work. It doesn't feel like anything is getting better, though.

Nigel Kinbrum said...

The post you've forgotten may be http://carbsanity.blogspot.co.uk/2013/03/insulinproinsulinetc-in-normal-igt-and.html
I only know this 'cos I used your graphic in http://nigeepoo.blogspot.co.uk/2013/05/impaired-glucose-tolerance-also-between.html :-D

Nigel Kinbrum said...

How rapidly did your BG drop from the peak (which isn't very high) to the trough (which isn't very low)?

I don't know how Glu-T1 transporters work, but if it involves enzyme up & down-regulation, there may be an issue with rapidly-falling BG starving the brain of glucose (due to slow up-regulation), resulting in a "panic response" of ACTH secretion & possibly also vagal nerve stimulation (I'm guessing, as I don't know) resulting in high serum adrenaline & cortisol, and ravenous hunger.

Jane Karlsson said...

If I might make a suggestion, it would be to get your gut bacteria sorted out. They might not like egg whites very much. If they're well fed, they will give you things your beta cells need, eg magnesium.
http://www.ncbi.nlm.nih.gov/pubmed/12514257

Some of your symptoms sound to me like magnesium deficiency.

Jane Karlsson said...

White rice or brown rice? White rice has had nearly all its magnesium removed.

Nigel eats white rice and takes extra Mg. He does not take extra manganese as far as I know, although he has updated the blog post he linked to include a recent paper showing Mn deficiency causes diabetes. White rice has very little Mn. I am waiting for him to ditch the Mg and eat brown rice.

StellaBarbone said...

You've established that you have a normal glucose response to a carb load. You've established that you feel best at a normal glucose level. You've established that you don't feel good when you eat a whopping carb load naked of moderating fiber, fat and protein or a whopping protein load without the other macronutriente. I'm not sure that I understand the problem. I know that I feel best when I eat a moderate load of protein and carbs at breakfast. Without the first I'm hungry again in 3 minutes, without the latter I'm still hungry when I finish the meal. I eat mine with fiber and fat because carbs and protein don't taste good all alone. I suggest you chuck the glucometer and have a small, real egg veggie omelet cooked in a good dab of butter with a piece or two of toast and see how it goes.

Nigel Kinbrum said...

50g (dry weight) of white Basmati has bugger-all difference in micronutrient content compared to 50g (dry weight) of brown Basmati. If my diet comprised almost entirely white Basmati, it might matter. it doesn't.

Jane, take your OCD about copper, manganese & magnesium elsewhere, or get it treated. Hell will freeze over before I ditch the Mg, or eat brown rice. Now, GIVE IT A REST.

Jane Karlsson said...

I hope Snarks will answer my question about whether it was white rice or brown rice.

Nigel Kinbrum said...

Here's a thought:- http://nigeepoo.blogspot.co.uk/2013/05/curves-and-u-curves-vitamins-d3-and-k2.html

You might be in the top 2.5% of subjects who suffer problems above a certain serum 25(OH)D level. Do you eat much fermented foods?

Snarks said...

Hi Jane,

Thanks - I'm working on it (and have been working on it). Fiber, both insoluble and soluble, is going to be a priority for me going forward. TBH, I was shocked to learn how little I was getting from eating several lbs of veggies each day, but I guess "roughage" doesn't equate to dietary fiber.

Snarks said...

Hi Nigel,

Thanks again for the response. The results I have in front of me from the most recent experiment (potatoes, squash, greens and chicken that I ate in about 10 min) are:

pre-test, fasting - 89
15 - 164
30 - 166
45 - 153
60 - 107
75 - 103 or 98 (had a lot of trouble with first test)

90 - 89
105 - 84
120 - 88


This is fairly typical of the tests I've done. My notes indicate that I started to feel pretty lousy between the 30 and 45 min tests, and really bad between 60 and 75 min.


I'm going to return to my paleo-esque diet for a while and get an OGTT that focuses on hypo rather than hypergycemia (or try, idk what's available here). I really screwed myself with that stupid egg whites and apple breakfast (which, again, isn't something I'd consider tasty, or a normal part of a diet, but sometimes we can't be picky, especially when it comes to leftovers).


Thanks again for the links to your blog posts - they were interesting.

Snarks said...

Either, actually. Medium grain standard brown rice, brown, "texmati" rice, white jasmine, and white basmati all had the same effect. Red and white quinoa as well. I enjoy eating all of them, with different kinds of food, so there's no issue with "eww, whole grains" here. Honestly, I'd *love* to have a few slices of sprouted wholegrain bread (think Ezekiel) but I'm not ready to face gluten yet.

Snarks said...

Hi Stella,



Thanks for the reply. While I disagree with you about what I've shown (those were just examples, and maybe poor ones, since you seem to have fixated on the rice or egg white aspect of them), I agree that I'd probably be doing better with more moderate loads eaten with more fat. Hunger isn't really an issue for me unless it's making me grouchy.



My issue is not that I have a problem with that, it's that I *really* wouldn't expect to get sick sometimes, and still do. While an egg white and apple breakfast (again, the eggwhites were leftover from making hollandaise) might be gustatory blasphemy, short of actually being allergic to one of those things, I would not expect to get sick from that meal. Instead, it totally torpedoed my entire day. Unlike true hypo, whatever my issue is, I cannot seem to fix it by eating a little sugar or a little fat or a little protein.


In any case, thanks again for you input.

billy the k said...

"...pointers to good info about hypo?"

a.
 Assuming you'd like to continue to enjoy your carbs, I'm sure 
you do know that the higher your post-meal insulin level rises, the 
greater the likelihood that you'll "overshoot" on the return to a normal 
BG level.  The biggest factor in avoiding this overshoot is to maintain a fully functioning intact & robust Phase-1 insulin response [so do not mess around with VLC diets!—i.e., be sure to have enough daily carbs to avoid "obliteration" of your Phase-1 insulin response]

The other major factor is the way you put your meals together. For the reason why your lean protein + low-fat starch meals result in your post-meal BG "crashes", compare the insulin and glucagon and liver glucose production (HGP) levels in the following various metabolic states:

Meal...................Insulin level.........Glucagon level.............HGP
None.........................+...............................+..........................+
Carbs (small)......... ..++............................ ± .........................0
Carbs (large)....... ....+++.......................... ± .........................0
Protein................. ... ++............................++........................+
Protein & Carbs......++++......................... ± .........................0
Prolonged fast..... .... ± ...........................++.........................+
Diabetes....................0..................... ....++++......................+++

You can see that no meal or meal-combo provokes a larger insulin response than does Protein & Carbs.
[from: George Cahill. Physiology of Insulin in Man. (1971) Diabetes. Vol 20, No. 12. (p.791)

b.
 Do you think it's a good idea to have TWO cups of rice with your 6 oz chicken breast?  That's ~88g of net carbs! (if long grain white)—and if you prefer brown rice that's still ~42g net carbs.  If your aim is avoid these post-meat BG crashes you will benefit by paying attention to all the factors that provoke especially large insulin 
responses.  You will not want to, for example, be drinking milk when having a big plate of spaghetti!  Doing so will provoke "unphysiologically" high levels of insulin in healthy individuals—and chronic exposure to 
such levels may reduce insulin sensitivity and predispose you to the metabolic syndrome.☞
http://onlinelibrary.wiley.com/doi/10.1301/002966402320243278/abstract

c.
 I recall reading in a book about children with Type-1 diabetes 
that researchers were surprised to find that Type-1's could indeed 
have a serving of potato chips and not experience the expected disastrous hyperglycemia—despite NOT injecting the typical insulin 
dose calculated to "cover" the carbs.  The reason, they found, was that unlike putting butter on potatoes or olive oil on pasta, the modern methods of producing regular commercial chips results in a near "bonding" of the potato starch to the fat, such that we have to first work on breaking down the fat before our guts can have access to the starch that is locked-up inside that fat.  Resulting in a much slower release of BG raising starch.  Just be sure to have the regular high-heat processed chips (Lay's regular, for ex.) and not the lower-heat "kettle-cooked" chips—which do not have the same fat-starch "bonding."

carbsane said...

http://carbsanity.blogspot.com/2014/11/fat-burning-101-biochemistry.html
:-)

Nigel Kinbrum said...

Hi Snarks,

Thanks for the information. Two things come to mind.
1. I think that you haven't lost your 1st phase insulin response, due to the speed at which your BG returned to baseline level (only 90 minutes).
2. You ate the entire meal in only 10 minutes! Does eating more slowly make a difference (in terms of reducing the magnitude of BG fluctuations)?

I can't correlate your feelings with your BG levels.
In what way did you feel lousy @30-45 minutes? Hot? Nauseous? Sleepy? Headachy? Something else?

Ditto @60-75 minutes?

StellaBarbone said...

I explained badly. If anyone eats a meal of nothing but lean protein (eg egg whites) or a giant carb load (eg two cups of white rice), then they will have a big glucose spike and a crash. Some people will be more aware of that up and down response than others. It's not a sign of a medical problem that you didn't feel well after those meals. They were inadequate meals.

carbsane said...

Hey Nige, that's actually not the one. It was a few years ago and it was like several possible glucose profiles depending on what may be the cause.

Snarks, I generally agree with Stella here in that there may not be a "problem" at all here.

The thing is that there can be a number of scenarios that can produce the same blood sugar responses. So an OGTT with insulin levels can help sort that out. If your doc is willing, perhaps you can do one with white rice and egg whites rather than a sugar solution. There are enough medical mysteries where it is difficult to pinpoint a cause, but this need not be one of them. Insulin hypersecretion is a real thing in some. If you are the type of MODY I described then you may want to induce an insulin response and then eat most of the meal later, or go with the "manual start".


Lots of great advice here on things to try but everyone is just brainstorming and you can save yourself some time and perhaps trauma by knowing exactly what is going on.


Best of luck and let us know how you are getting along!

Anonymous said...

What happened to the "EDIT" option??? Without this option, readers are unable to correct inadvertent errors in their comments...

Scott Peterson said...

What is this so called 'English' you speak? Really though,


Brown rice tastes like licking the devil's taint, or as Bris said in a different post, like "dog shit."

Jane Karlsson said...

It tastes bad? I think it tastes wonderful. I don't like long grain brown rice because of the texture, but short grain brown rice is chewy and nutty. My partner and I used to eat Chinese style stir fry with brown rice every evening. You save the (unsalted) rice cooking water and add it to the stir fry at the end.

Scott Peterson said...

I was being dramatic there. Every time I try to say I'll eat more brown rice, the bags gets used once and then just sits in the shelf forever!

carbsane said...

I am not a fan of brown rice b/c if you're going to have the "whole" it should taste better! Whole soft wheat berries are delicious but whole wheat pasta? Not so much. If I want a nutty rice I get the sprouted GABA rice. Quite tasty!


I think it is nit picky if one is only eating a small portion daily or not even that to concern over this. I love Trader Joe's white basmati rice for dishes involving rice - which is maybe twice a week if that? Otherwise give me wild rice mixed with white (1:1 is good) and I'm a happy camper :-) Wild rice is best in soups or on its own as a side, not a base for something like an Asian stir fry.

Jane Karlsson said...

Evelyn, I'm not sure this is being nit picky. We don't know, and can't really know, whether eating white rice a couple of times a week is OK. Here is my own experience. Before I changed my diet to a Hunza one, I was eating very healthily by most people's standards. I was scared of putting on weight, so I ate less than I really wanted. Just one big meal, in the evenings, and I drank sweet coffee during the day 'to keep my blood sugar up'. When I changed to a Hunza style diet with no refined carbs at all, I stopped being hungry, and I could eat more (I started eating breakfast) without putting on weight. I never again felt the awful sensation I thought was normal hunger. It was not normal.

I also had a lot more energy, and I slowly realised my mitochondria had been starved of minerals. To my mind, eating food which should have high levels of minerals and doesn't, is insane. But then, people who have not had my experiences will be unaware of these things. I hoped for years that I could help people avoid the nasty experiences, but I have given up that hope. People like Nigel and Wooo have convinced me that all I will get is insults and abuse if I try.

Nigel Kinbrum said...

"Evelyn, I'm not sure this is being nit picky."
You've gone waaay beyond nit-picky, Jane.

"I also had a lot more energy, and I slowly realised my mitochondria had been starved of minerals."
According to your theory, my mitochondria must be completely starved of copper & manganese, as I don't eat whole grains. As I'm not suffering from chronic hunger or a lack of energy, that indicates that my mitochondria are not starved.
∴ Your theory is dis-proven. Q.E.D.

"To my mind, eating food which should have high levels of minerals and doesn't, is insane."
To my mind, constantly repeating that copper & manganese deficiencies due to not eating whole grains are causing illness in many people, is insane.

" People like Nigel and Wooo have convinced me that all I will get is insults and abuse if I try."
Wuchtamsel and Sanjeev also "insulted and abused" you, on this blog. Anthony Colpo "insulted and abused" you (backed-up by evidence), on http://anthonycolpo.com/the-whole-grain-scam/ . People like Jimmy Moore, Fredrick Hahn, Jack Kruse, ItsTheWoo and you have convinced me that the internet world of Diet & Nutrition attracts delusional people.

If our (and other animals) guts weren't so efficient at absorbing minerals and our kidneys so efficient at retaining them, we'd have long since gone extinct.

Nigel Kinbrum said...

To me, most rices have virtually no flavour. Basmati has a bit of aroma & flavour, but I was using it to bulk-out meals containing more flavourful items. I wasn't eating it for its flavour.

StellaBarbone said...

You have not had Lundberg Wehani rice. it smells like buttered popcorn It's Lundberg's own whole-grain, basmati hybrid and it's delicious .

billy the k said...

For years my favorite was to mix Lundberg's organic long-grain brown rice with it's Wehani @ 2:1 ratio by weight; e.g., 28g Wehani +
56g long-grain brown with 226g H₂O; bring to a boil in the top section of a double boiler, then set that covered top-section atop the already gently boiling water in the bottom-section, let it cook for 60 minutes, voila. Yummy rice [that would even satisfy Ms Karlsson!]

Greta Carbo said...

Ha ha, good one Jane! Although Mr. Kinbrum has an excellent and informative website he is sometimes a little too snarky I think. And nit picky about getting enough minerals in the diet, from food, is a good thing.

Jane Karlsson said...

I think Nigel will come round in the end. Evidence is coming out all the time showing that the manganese and copper researchers were right.

I think he's frustrated because he has tried reading the literature on these metals and found out how impossibly complicated and contradictory it is.

Nigel Kinbrum said...

Oh, rats! British diet? From which era?
I have only this to say to you Jane, from now on:- http://anthonycolpo.com/the-whole-grain-scam/ :-D

Nigel Kinbrum said...

If you had to deal with all of the nutters & cranks out there that I do, you might be "a little too snarky" on-line. If you don't like snark, what are you doing on this blog? ;-) :-D

Jane Karlsson refuses to take one single bite of white rice or any other refined carb. That's Disordered Eating (a mental illness), not nit-picking. As Anthony Colpo demonstrated in http://anthonycolpo.com/the-whole-grain-scam/ , there's not that much difference in mineral content (in absolute terms) between brown rice & white rice.

Nigel Kinbrum said...

The only thing that frustrates me at the moment is your refusal to "Let it go."

Stop mentioning my name on-line and stop interacting with me. In other words, GO AWAY.

Oh, and everybody should read http://anthonycolpo.com/the-whole-grain-scam/ :-D

Jane Karlsson said...

This is not true. 70-80% of the magnesium is removed. 60-70% of the manganese. 40% of the copper, if I remember correctly. Not trivial when food contains so little nowadays anyway. The copper content of UK veggies has declined since 1940 by 76%, according to government figures.

Nigel Kinbrum said...

Which part of "in absolute terms" did you not understand? Also, which part of "Stop mentioning my name on-line and stop interacting with me. In other words, GO AWAY." did you not understand?

Everyone should read http://anthonycolpo.com/the-whole-grain-scam/

It speaks volumes that I have blocked you from emailing me & leaving comments on my blog, but I haven't blocked Razwell.

Now LEAVE ME ALONE.

Jane Karlsson said...

If Colpo really did demonstrate there isn't much difference in mineral content between brown and white rice, you should be able to quote him. Nobody is going to read The Whole Grain Scam because it's far too long and boring. Just give us the quote, there's a good chap.

Nigel Kinbrum said...

GFY, you utterly disrespectful woman.

carbsane said...

Come on Nigel. Is this really necessary?


I'm aware of some testy exchanges from time to time, but this isn't your blog and nobody has flagged any posts as inappropriate so I generally let things go and presume that we're dealing with adults.


Let's all take a deep breath ... engage when it's productive ... and just step back when it gets heated. OK?

Nigel Kinbrum said...

Sorry Evelyn, but I've told Jane to leave me alone twice. Twice she's disregarded my requests. I'm really not in the mood to see any more Disqus notifications of replies from that mentally ill woman. I can't see any way of blocking Disqus notifications from specific people.

carbsane said...

I must say I have a hard time understanding the Disqus thing. I might suggest that it is always an option to just ignore. To each their own. Just not getting that ... but it's OK.

Jane Karlsson said...

Evelyn, Nigel really does believe I am mentally ill. I have had many conversations with him over the years, some by email, and I now realise that he has never believed anything I said. He does not believe I have spent 30 years studying the scientific literature, he does not believe I have Oxbridge degrees, he does not believe I have longstanding friendships with Oxford scientists and go to their research seminars. What can I do? How can I prove these things are true? I can't, unless Nigel emails the head of Oxford Pharmacology and asks him if he knows me. I have told him Nigel might do this.

Jane Karlsson said...

One other thing Nigel does not believe is that I am the author of these papers.
http://www.nature.com/nature/journal/v279/n5712/abs/279426a0.html
http://dev.biologists.org/content/61/1/303.short
http://dev.biologists.org/content/59/1/315.short
http://dev.biologists.org/content/65/Supplement/37.short
http://dev.biologists.org/content/66/1/117.short

They are on tissue regeneration, which is roughly the same thing as maintenance and repair, the process which goes wrong in degenerative disease. After this work was completed I spent many hours (actually years) in the Biochemistry library trying to find out what enzymes were important in these processes. I found that a number of the key enzymes were activated by manganese or copper, and I realised with shock that these metals are removed from a large part of our food. Then I read about the Hunza, who did not have our diseases and did not remove the metals from their food.

Many years later I tried to tell Anthony Colpo about these things, in the email conversation Nigel has linked, which Colpo published on his blog under the heading The Whole Grain Scam. He did not realise I was trying to help, he thought I was attacking him. He thinks I am a 'government shill' trying to force people to eat whole grains, and he is protecting them from me.

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