Aug. 1 Over the Hump Bump: Baby Your Pancreas? Part II: Go all Jillian Michaels on your Liver?

On Facebook today, Mark Hyman MD (functional medicine doc) posted:
There are no essential carbohydrates. There are essentials fats and essentials proteins, but if you never had any carbohydrates again, you would survive.
The Teaspoon Party
This was brought to my attention but also reminded me that Richard Feinman is at it again with a recent blog post on this no essential dietary carb canard, couched in a history lesson of sorts:  Revolutions. Political and Scientific.  He discusses Claude Bernard finding sugar in a dog that hadn't been fed any carbohydrate.  The question is why ... again ... why ... now?   This idea has earned him an honored place in the group at right.

Feinman writes:
We now understand that animals (including humans) don’t need any carbohydrate. Whatever you think is a desirable amount of sugar and starch, whatever tastes good to you or appears to be a fundamental feature of your life style, you have to know that you don’t need to obtain any carbohydrate from what you eat.
As I commented on Hyman's FB, we also don't need certain amino acids.  We also don't need monounsaturated fats or saturated fats.   But talking about an absolute need for survival is a spurious context if you ask me, because the goal should be thriving not just surviving.  If we're talking lifestyle, Feinman is hooked on this "we replaced fat with carbs and look where that got us" {paraphrase} idea, and yet even if we had enacted the recommendations to reduce fat consumption from ~40% to ~30% (a 25% reduction) we would come nowhere near the fat levels consumed by various long-lived societies (many of which consume only 10% total calories as fat, and 20% would be considered "high fat").  So if we want to nit pick at people's "perceived needs" versus actual needs, I'd say don't throw rocks if you live in a glass butter dish.    The point being, while there is a dietary need for fat, it is far lower than we are conditioned by Western standards and high fat diet promoters to be.  Feinman uses the case of folks stranded for a few weeks surviving as evidence that we don't need dietary carbs, well those same folks didn't need fat either.  Eventually a zero fat diet would cause problems, but nobody responsible advocates that! 

So slightly related, I bumped this two-part discussion on lowering insulin needs vs. stressing the liver.  I think the LIRKO mouse is the best evidence we have as to the resiliency of the pancreas to do its thing without wearing out.  Granted the livers are defective in these mice (small and unhealthy resulting from knocking out insulin receptors), but early on they are hyperinsulinemic and hyperglycemic ... later on they are just hyperinsulinemic and may well be hypoglycemic as the livers give out.  

Some other blog posts of interest:  There's no dietary need for saturated fat ... , Lessons from LIRKO.

Lastly, I thought I would share one last quote from Feinman with my stalkers:
This was a revolution. Animals burned their food for energy.  Lavoisier showed that.  More than 100 years before the Second Republic he had built a whole animal calorimeter, a device that measures the heat generated by an animal.  He showed that food was burned in an animal in roughly the same way that metals or other substances are oxidized.
Some about the internet have been questioning what someone with an undergraduate degree in Biology from a prominent engineering school with an MS in Materials Science (where I clarified that it was Metallurgy focused) might have to know or understand about calories and metabolism.  Well, Dr. Richard Feinman just pointed this out.  My research was of corrosion processes, and corrosion is oxidation.  My MS thesis and planned PhD thesis were studying pitting corrosion and surface film phenomena -- e.g. electrochemical cell potential, breakdown and enhanced localized corrosion.  Yeah, nothing I learned in metallurgical thermodynamics or electrochemical kinetics has any meaning in the human body.  After all, we never talk about oxidation reactions, redox couples, coupled reactions, membrane potentials or chemiosmosis.  Nah .... 

Original Publish Date:  7/27/11

This is more of a philosophical post/question that I'm putting out there.  Part I was more about the notion of the "tired pancreas" -- basically whether or not we need to "baby" our pancreas.  But now, let's presume that we do.  So we send it to the day spa by adopting a VLC diet.  What does this do?

Well initially, a VLC diet may do some favors for your liver.  Especially if you've been in a state of over-nutrition all along.  But after this initial respite, VLC now requires your liver to get on the exercise cycle to power the aromatherapy machine.  That silly analogy, of course, refers to the fact that the liver will be tasked with generating nearly all of the glucose your body needs to survive.  Gluconeogenesis (GNG) is a perfectly normal process, and essentially a nice recycle system for byproducts of less efficient metabolic pathways.  The human liver also seems capable of using GNG to provide all the glucose our bodies need.  But the question is, is this the optimal way to provide glucose to our cells - obligate or otherwise?

In the normal overnight fasted state, the liver mostly releases glucose into circulation to maintain levels by breaking down glycogen - a net energy releasing process.  The "carb fasted" person, with depleted glycogen, forces their liver to produce the glucose via GNG - a process that requires energy.  Indeed the proponents of the so-called "metabolic advantage" point to GNG as higher energy out.  An argument could be made that a high carb consumer is "stressing" their liver constantly by forcing it to synthesize glycogen from excess glucose, but I would argue that massive overfeeding studies indicate a high capacity for glycogen so daily "filling of the tank" is hardly stressing the liver's capacity for glycogen synthesis, and let's not forget that our skeletal muscle provides a much larger sink for glucose disposal and glycogen stores.

OK, but what about de novo lipogenesis (DNL)?  Surely the high carb fed liver is constantly being stressed to convert all that excess sugar into fat, right?  Well, as we've discussed here many times, DNL is not a major contributor to the triglycerides "pumped out" by the liver and generally only accounts for a few grams of fat with massive overfeeding.  I would also point out that production of fatty acids from surplus acetyl CoA (it's not made from glucose) is not an obligate function of the liver for survival.  In other words, if somehow the liver is overstressed or we max out its ability to engage in DNL, no immediate harm comes to our beings.  For one, our skeletal muscles can also assume this function, and for another, transient hyperglycemia and such do not pose an imminent danger -- hypOglycemia, on the other hand, does.

What else does our liver do?  Well it packs up fatty acids, repackages the leftovers of dietary fat (chylomicron remnants) and sends them back out into circulation.  Inasmuch as LC'ers highlight lower triglyceride (VLDL output) of the liver, a high fat diet is inevitably going to create more chylomicrons and thus remnants the liver must handle.  In the lipid handling realm, it would seem at best a wash, but possibly putting more stress on the liver.

But fructose!  Well, OK, a VLC diet is better than a diet of Coke and Little Debbies.  You got me there :-)  But if you buy into the "fructose is poison" because, like alcohol, it is obligatorily metabolized by the liver, then  you have to acknowledge all of the other tasks/demands a particular diet puts on the liver.

Just my opinion:  Long term, babying your pancreas by going all Jillian Michaels on your liver seems ill-advised.


shaun said…
You may have to change your name from Carbsane to Carb Common Sense. This is what happens when people only evaluate little bits and pieces of the science without putting it into perspective by stepping back and looking at the whole picture.

Somehow having a nice body qualifies one as an expert in the science, I guess, just like being an investigative reporter does. It always amazes me how the experts are always wrong, part of some great government conspiracy, yet these other people should be taken at face value.

Maybe we should be focusing is excess calories period regardless of what brand they happen to be. This is what the current research on diabetes is telling us. And when evaluating foods we should be looking at their nutrient density, what they offer per calorie as opposed to what type of macronutrient they are.

But then of course...that is what nutrition experts have been telling us for years, at least until it gets distorted by all the "fitness/nutrition experts". Big food and the fitness industry needs something flashy to entice the masses and keep them interested.

They need something that will sell books.

I will concede the diet that works best for an individual may vary depending on many factors. Science is ever changing building on itself. You need to consider these factors in your choices. But if you have followed nutrition for any period of time you will see that the "carb craze" is a fad and a tired one at that. Maybe it will help someone along the way...maybe, and maybe it will hurt someone as well.

Ironically, the high-protein, high-fat fad started with Atkins over 10 years ago and last time I checked obesity is still on the rise.

Not saying you can't be healthy on a high-fat high-protein diet but you can also be very unhealthy. Just like you can be healthy on a low-fat diet. However, if you are eating low-fat but also eating lots of sugar and processed grains instead of whole grains, lean meats and fish and veggies...well, then not so healthy. It goes both ways though.

Plus as you point out, it is easy to skew the science to make a point, but without true perspective that point isn't always honest or accurate.

Love your blog!
Andrea said…
Also worth noting is the effect of high protein diets on the kidneys. If we baby the pancreas and shift the workload to the liver, the liver is going to send all that urea down the pike to the kidneys to excrete. So, while the pancreas is enjoying its holiday at the beach, the kidney and liver are working overtime.

I agree that it's of utmost important to look at the body as a whole.
CarbSane said…
Good point Andrea. I didn't mention the kidneys because this can be taken a bit out of context, but, especially if one accepts Davis' assertions about our hobbling pancreas, they must also accept that the kidneys have probably been somewhat compromised. So while increased protein won't necessarily harm healthy kidneys, it may well stress and potentially harm already damaged ones.

The mild acidosis some experience (noticeable in Gary Taubes' blood tests) also put added stress on those kidneys.
This is tangential: I just wandered in here the other day, thanks to a link from Diet Blog. Oh, my--what a relief to see some sanity, and somebody who actually understands science, on the Internet!
CarbSane said…
Thanks LBC! Welcome :-)
Karen said…
So, again I ask still with no answer, how does one go higher in carbs without gaining weight? Karen
CarbSane said…
Hi Karen,
The "simple" answer is to cut your fat and calories. I'm not at my ideal weight but I was petrified last summer of eating just a few more carbs. The solution was simple and painless but I suspect would be even more painless for the "slather on the fat" crowd. Letting go if lipophobia is tough, but correcting carbophobic lipophilitis is easy when one lets go of scientifically bereft dogma.

Karen, on a personal note, I lost interest in devoting time to your questions when I read a rather nasty comment from you about me on Facebook. Two faces are never attractive.
Bris Vegas said…
Sorry Evelyn but you are completely and utterly wrong. CICO Is dead and buried. Obesity and metabolic disease is primarily caused by a dysfunctional gut microbiota.

You need to throw away your mouldy old textbooks and read some CURRENT science.

Here's a nice summary fro no-scientists.
carbsane said…
First, as discussed with you many times, my information base is not limited to old texts. I do limit it somewhat where science journalism goes.

"Studies have found that obese people have microbes that cause them to absorb kilojoules and store them as fat much more efficiently than someone who is slim, he says, which means they absorb and use the calories from a piece of chocolate much differently to people of a healthy weight."

I would like to see these studies.

"He discovered that locusts will form swarms and eat everything in sight until they have satiated their need for protein. Once they have consumed enough, the swarm stops. Humans too have an in-built threshold to the amount of protein that can be absorbed and Professor Simpson suspects, like locusts, people eat their way through foods – often the wrong types of foods – until a protein target is met.

But it could be that some people have microbes that more efficiently allow the absorption of protein and, therefore, a feeling of satiety, which is why experts in seemingly unrelated fields are working together to figure out why people are eating the foods they do and what happens as it passes through the body."

Same professor, same obese person. These two mechanisms are inconsistent. The first paragraph of this second one is where I think more keys lie. Junk foods tend to be lower in protein by percent, but this doesn't explain why billions of humans eating less protein that the SAD are not ravenous and obese.

"The ration of toxic to healthy microbes leads to an altered microbiota that promotes, for example, the extraction of more calories and sugar from food and can trigger an insulin response. This can lead to the development of diabetes, obesity and insulin resistance."

IF the bacteria extract calories from sugar, that is less for the host ...
lucyricardanon said…
For one thing, the theory that gut bacteria are major players in obesity and metabolic disease is in its infancy, and AFAIK human studies are lacking. There may well be something to it, but even if there is, it does not invalidate CICO. The bacteria do not work by magic; if they help a person lose weight without changing what or how much they eat, they're still changing the *effective* amount of energy absorbed (CI) and/or energy spent (CO).

I see people make this claim a lot - "CICO is invalid because X" where X is something that simply modifies CI and/or CO. That just doesn't make any sense.
carbsane said…

Also, I am very skeptical when I hear the meme that we have more bacteria than human cells. It's sensationalistic, and as if the number of cells has any meaning at all wrt the importance of their function. I'm sure there are more fill-in-the-blank cells in our bodies vs. brain cells, but that doesn't tell us much now does it!

Brisvegas subscribes to the "we all eat a high fat diet" philosophy of the late Barry Groves. Energy extraction by gut bacteria has been studied in humans and because of the nature of our digestive system, it is simply not a significant factor. The claims like those made in this article are counterintuitive. Good bacteria turn indigestible fiber into metabolizable energy (SCFA) ... bad bacteria feed on sugars and starches using some energy that would otherwise be absorbed. Various gut disorders invariably lead to malabsorption -- if anything.