Maybe Glycation isn't so bad after all

Higher HbA1c levels predict better outcomes in advanced heart failure with diabetes  (free registration required)

"We're finding that in heart failure [plus diabetes], higher HbA1C levels are associated not with worse outcomes, but with better outcomes," lead investigator Dr Tamara Horwich (University of California, Los Angeles) told heartwire. This suggests that for patients with both diseases, "the focus should not be on lowering the HbA1C levels to as low as possible," she said, adding that "aiming for a midrange of 7.2% to 8.2% may be very reasonable."
OK, this is in people with established heart disease and diabetes, but lower is, apparently, not always better.  And what is it we keep hearing about all these damaged metabolisms and all ...


Unknown said…

"in someone with advanced heart failure who may be having difficulties with hypoglycemia or other adverse effects of diabetic medications, less stringent glycemic control (HbA1C <8%) may be acceptable," he said. On the other hand, "if patients are tolerating the medications without difficulties, current glycemic guidelines should continue to be followed as we await further information from prospective clinical trials."
Nigel Kinbrum said…
On a "conventional" high-GL diet + high insulin doses, blood glucose level has large positive & negative excursions from the mean.

The lower the mean, the lower the blood glucose level goes at the dips, causing more fatalities.

The higher the mean, the higher the blood glucose level goes at the peaks, causing more damage.

On low-GL/keto diets + low/no insulin doses, there are no large excursions in blood glucose level from the mean. Therefore, the lower the mean, the better the outcome.
Bill said…
I don't think Horwich is saying sugar-is-good-for-you-after-all; Nigel's got the gist of it.
SamAbroad said…
Could it be that those with lower hbA1c are subject to heavier medication to get in line with guidelines?

There was also that trial recently that was agressively lowering BG with medication and had to be stopped as people were dying in the intervention arm.

I don't think this is a case that 'more glycation might be good', just 'more drugs might be bad'
Johnny said…
And what is it we keep hearing about all these damaged metabolisms and all

I don't know, what? [Argument:unfunny joke] ratio is pretty low 'round heah about the existence of metabolic damage or derangement. Is it a made up thing, or not? Is Mat Lalonde a dumbass? I'd sure like to know.
Woodey said…
The title of this blog reminded me of Greg Ellis from Bye Bye Carbs, anyone have any info on him and his nutritional advice?
Woodey said…
"Damaged Metabolism" is the quick fix explanation for diet failure or stalling. Now that I threw up the kool-aid it means jack to me.

"You ain't leadin' but two things right now, Jack and sh*t, and Jack left town." - Ash
CarbSane said…
My apologies for the little bit of sarcasm at the end there. I was just reminded that Ron "everyone's a diabetic" Rosedale, Cate "sugar is sticky because it's reacting with (glycating) your skin" Shanahan, and Jack "your leptin receptor can't handle electrons from carbs" Kruse are going to be discussing starches at AHS12 with Jimmy "fix me I'm broken" Moore moderating. Having just read Jimmy's latest I then came across this headline in my email.

To be clear, I'm not saying glycation is good, just that it may not be so bad. Or another way to put it, lowering glucose by any means may not be the be all and end all. People seem to get this re LDL.

As regards metabolic derangement -- that is real, and when it occurs with obesity (in all but rare genetic cases), the obesity -- or rather the chronic caloric excesses and/or overfilled adipose tissue -- causes the derangement, no the other way around. The "damaged metabolism" may be possible, but trying to micromanage hormones through diet and supplements seems more a lucrative endeavor for the purveyors of this notion. Woodey is right I think, when you look at who is pushing this most -- beginning with Taubes in WWGF and interviews and including overweight low carbers like Jimmy -- it's easy to see through it. It's a quick fix explanation as to why the rest of us should do as they say and just accept this is the best we can do for ourselves.
Rad Warrier said…
I don't think this is a case that 'more glycation might be good', just 'more drugs might be bad'

I am in full agreement with SamAbroad here. The paper, I believe, is about diabetic patients already on significant amount of medication. When they "lower their glycation", or in other words lower their Hb A1c, it is through more medication which often results in more hypos (i.e., dangerously low blood sugar levels) which, needless to say, causes the "outcome" (in terms of health and mortality) to be worse.

Type 2 diabetics like me who control their blood sugars primarily through diet and exercise never have hypos -- our blood sugar levels do not dip to dangerously low levels. I lower my glycation (i.e., lower my A1c) through eating better and exercising better. The "outcome" in our case is always better, the lower the glycation (A1c).

Johnny said…
The "damaged metabolism" may be possible, but trying to micromanage hormones through diet and supplements seems more a lucrative endeavor for the purveyors of this notion.

Doug McGuff, for example, and other high-intensity exercise proponents suggest exertion causes fat loss through a better hormonal environment, not through a simple # of calories burned. For example, this horseshit is STILL on McGuff's website:

In your estimation, is McGuff a liar, or is he stupid?
Lerner said…
Don't forget about methyglyoxal, which leads to creation of AGEs and is itself elevated in Atkins dieters - ostensibly because the elevated ketones lead to creation of more methyglyoxal.

The LCers would say that the amount is too small too matter and that glycosylation creates more methygloxal than ketosis does. Whether or not that is true (I don't know), there is a third argument that methygloxal does more good than harm, e.g. in cancer. That sounds interesting and relates to this article topic.

There is also the consideration that proteins are damaged in three main ways: not only glycation but also oxidation and nitration. Since this happens naturally regardless, the body has builtin mechanisms to eliminate and replace irreversibly damaged proteins. The trick is have replacement not be less than damage, so that AGEs etc do not accumulate.

Replacement of such damaged proteins creates the necessity for a basal rate of protein turnover, even in the sedentary who have no need to replace proteins that are damaged via exercise.

Btw, one means of reducing AGEs is via acetaldehyde dehydrogenase - which is the same enzyme that breaks down the primary metabolite of ethanol. It's possible that accounts for the health benefit of alcohol.

SENS5 - Increased damage to proteins in ageing

which I was led to through
Unknown said…

Laboratory studies in healthy young volunteers have shown that experimental sleep restriction is associated with a dysregulation of the neuroendocrine control of appetite consistent with increased hunger and with alterations in parameters of glucose tolerance suggestive of an increased risk of diabetes. Epidemiologic findings in both children and adults are consistent with the laboratory data.

Maybe we just don't get enough sleep??
Woodey said…
Maybe metabolic derangement is misused and pushed as a way to corral people and keep them in line? I do agree that it exists, but I don't think its as wide spread as claimed.
Lerner said…
oops, replace "glycosylation creates more methygloxal than ketosis does" above with "glycolysis creates more methygloxal than ketosis does"

c'mon, google - give us the facility to edit comments already - it's not so hard to implement
Lerner said…
now just for curiosity sake, there is an example of deliberately forming crosslinking -- in order to stabilize collagen as a treatment for an eye malady called keratoconos. The eye has a weak spot which results in a conical protrusion of the cornea. So docs use UVA radiation to crosslink - which apparently works well for keratconos, but you wouldn't want that effect on your skin.
Lerner said…
video of keratoconus Tx:

(correct sp = keratoconus)
bentleyj74 said…
All things considered I think the real "problem" with medications is that they work too well in the short term. Like a tourniquet. You were bleeding out, now you're not. No one is going to argue that this is a bad thing but it's well known that there are potential consequences. You may survive minus a few choice body parts you would have rather kept. When medication becomes the solution to a problem caused by lifestyle the tourniquet has become the treatment. People have a dangerous perception shift when they make the numbers and the artificial management of the numbers the single relevant variable without regard for their overall health and vitality.

Take Jimmy Moore for example. A single serving of sweet potato results in a slightly but not dangerously elevated blood sugar and bingo...this healthy, wholesome, and inexpensive food is bad and scary. Back to the hot wings and cheesecake it is with no fear despite obviously bad outcomes.
Woodey said…
"My apologies for the little bit of sarcasm at the end there"

Bah, I love sarcasm. It makes the world a better place. :)
Lesley Scott said…
@ bentleyj74 " healthy, wholesome, and inexpensive food is bad and scary" ah, therein lie$ the rub methinks. It's an inexpensive food but unfortunately hasn't seen fit to $ponsor some podca$t$ nor buy some banner ads. Should the Guild of Sweet Potato Growers or whatever their trade association is start advertising in the blogosphere, I wonder how quickly the winds of LC dogma would suddenly shift in favor of Mr. Sweet Potato?
Woodey said…
I agree with that and I see Jimmy swinging the other way on the pendulum. It sounds as if Jimmy might have an eating disorder and he's chasing his tail instead of sitting down and thinking things through. Which being a self-declared figurehead in the low carb community he has an obligation to those that follow him to do something about it. His issues are only going to lead other people to follow suit and that's not good.

Unless someone has a chronic ailment that cannot be fixed by diet or medical procedure (surgery or physical therapy among others) then obviously they need to take the meds. What I do find happening more often than not is people treating the symptoms and not the problem. Instead of taking a prescription med for heartburn, stop eating the food that is causing it. Unless of course its from something else, which hopefully your doctor will look into if he/she is good.

For myself I took blood pressure medication for years blaming my obesity for it. I went low carb and my blood pressure dropped and I stopped taking them. I did so under doctor advisement, I didn't just declare myself free from them on my own. I'm still a tubby, but the change in diet has eliminated a few things that I only thought possible unless I was thin.
Woodey said…
"I wonder how quickly the winds of LC dogma would suddenly shift in favor of Mr. Sweet Potato?"

I would say instantly...or as quickly as it would take for people like Fat Head, Sisson, and Moore to approve.
Unknown said…
Smart people can make themselves believe stuff that isn't true, I'm not dumb but for a couple of years I was a hard core Taubian. If what is convenient for you to believe also gets you a lot of attention it's even harder to turn your back on it. I had trouble giving up VLC and I don't even have a website.
Tonus said…
"It sounds as if Jimmy might have an eating disorder and he's chasing his tail instead of sitting down and thinking things through."

I've always felt that he has the same eating disorder that a lot of us have, in that we simply don't manage our diets as well as we should. Or the lack of commitment that turns many weight loss stories into weight regain stories. He latched on to a dietary approach that is sold as self-regulating; that you don't have to manage your diet or count calories or control your impulses. I think that his struggles should come as no surprise to anyone who doesn't believe (or no longer believes) that LC is a self-regulating magic diet.
bentleyj74 said…
"Unless of course its from something else, which hopefully your doctor will look into if he/she is good."

But there's the rub of course. It's not a needle in a's a needle in a stack of needles. You have to get the obvious stuff out of the way for the outlier issues to be visible.
Woodey said…
"He latched on to a dietary approach that is sold as self-regulating; that you don't have to manage your diet or count calories or control your impulses."

Like fungus to damp dark places, so it goes for people who love to eat and see the low carb mantra of 'don't exercise and eat as much as you want.'

I had to find out the hard way that this is not going to work unless I cut calories and exercise. It went against everything that I believed, but I saw people's results and read WWGF and watched Fat Head. From that moment on I was hooked, then yo-yo'ed. Fortunately I have not gained it all back and I am reworking my plan. But it wasn't examples or advice from Jimmy that has helped me work things out, its people like Carbsane and others comments on here. Carbsane is more than a clever ID.:)
Woodey said…
This is very true and I have had my own experiences with that. I was more implying that a good doctor will listen and dig to try and narrow down the cause of affliction, instead of handing out meds and sending you out the door. I have had doctors who listened and the problems got solved quicker, but I have had the ones who didn't listen and had me go through all sorts of tests that did not even come close to fixing the problem (Kaiser Permenente doctors, hate em), but that can also fall under sorting out the obvious. But that's my bias, I'm sure there are good Kaiser doctors....maybe, possibly.

I'm like anyone else in that when I have a health issue I want it solved immediately and the temptation can be to think the doctor is a quack if it doesn't get taken care of right away. Sometimes its justified, sometimes not. My mom spent months in pain with something wrong with her shoulder and arm. One doctor said it was something in her nerves, another something else. Finally a doctor sat down and was thorough with her shoulder, took x-rays and got a cat scan done. Had nothing to do with nerves but a torn rotator cuff which required surgery. When she told the doctor what she had previously been told he just shook his head.
bentleyj74 said…
Propaganda is the tool of predators :) There should be T-shirts.
Woodey said…
I'd buy it! Much better shirt than "Wheat is Murder".
Lerner said…
Here's something recent: Published on Apr 16, 2012 by insidermedicine

Sleep deprivation and disrupted day/night cycles, like those experienced by shift workers, can slow metabolism and suppress the body's production of insulin, according to research published in Science Translational Medicine.
Galina L. said…
It looks like I can't live a comment on Jimmy's blog (something about eating less and no need 3 Tbs of butter and sweetener for 1/2 of sweet potato). It is either some malfunction or I am banned too. How does it looks like when you are banned?
Woodey said…
I got about halfway through the comments and its pretty much a kiss ass session. Those that in anyway offered a different opinion than what he wants get some hostility from him and his minions. For someone with a hair trigger he shouldn't be blogging or at least sharing personal stuff. I think not being able to post is a good thing.
Woodey said…
I made a comment that was not favorable to one of the suck ups on his blog, but what the guy said was just so crazy I had to say something. It says "comment waiting for approval". I don't think it will get approved.

Basically someone tried to tell Jimmy that he finds it hard to believe he gained five pounds in a month by eating 1200-1500 calories a day. So someone responded with that by using the "we all are different" yadda yadda and that he gained eight pounds in a month by eating only 800-1000 calories a day. Ummmm well I guess its possible, but unless there was something else going on that made this happen its bunk.
Johnny said…
Nope, you're either f'n stupid, or engaged in deliberate chicanery. Those are the only options.

Now, what motivates your lies? Well, they might be for financial gain, or you could just be evil, or perhaps even a terrorist. That last bit is for you to figure out.

If you're stupid, I guess you're motivated by cake, or hugs, or something.
Galina L. said…
It probably was some sort of malfunction after all, one of my two comments went through in a wrong place after unusually long delay. My opinion about JM troubles - he is too good in explaining away failures. It is really ridiculous to put 3 Tbs of butter on half of sweet potato and some sweetener. His reasoning - he wanted to slow away the processing of carbs, however brats cooked in butter were not fat tree at all. He doesn't understand how normal food taste like.
Woodey said…
I'm glad you got posted. A question I have is if avoiding sugar and carbs in general is supposed to kill the sweet tooth (something Naughton claims) then why is Jimmy using sweeteners on what sounds like a daily basis?

"he is too good in explaining away failures." From what I read so are his fans. I should probably avoided making a comment, but a person got attacked who constructively tried to help Jimmy out. It pissed me off.
Galina L. said…
It is true what Tom claims,I have the same experience, after avoiding sweet things normal foods(steamed green beans, raw cashew)start to taste slightly sweet and sweet food is often too sweet,even sweet potatoes, grapes, pears. If somebody needs 1Tbs of honey to sweeten 1/2 of sweet potato after years on a LC diet,it looks like a red flag for me . What he was eating? It is a tragedy, he lost so much weight, managed to build his carrier around his diet, has an access to different resources and can't avoid regaining.
bentleyj74 said…
"Ummmm well I guess its possible"

I think this is one of those things that we say to seem polite and reasonable [There could always be that one weirdo who just shows up to rub your face in your own ignorance with an offended stomp huff and sniff, right?] that actually undermines the position of SANITY and creates a vulnerability/failure to discriminate when necessary. If I can't call bullsh*t on an 800 cal a day weight gain I'm in trouble when neurosurgeons start claiming to have injected themselves with MRSA then performed operations on themselves w/out anesthesia all on account of their cold adaptation without evidence.

Unless we are "different" because one of us lives in an alternate dimension or is an alien hybrid the more likely explanation is that one of us is wrong.
CarbSane said…
Dilly, What is your purpose here? You are being deliberately offensive and presenting folks with straw man choices. Lots of smart people fall for things -- especially if they are smart in another field and the person packaging up their message has science "cred". Smart people are no less susceptible to group think than the average human either. It can be powerful.
CarbSane said…
Stop pointing out so many inconvenient facts Lerner! As to editing comments, yeah, it would be nice, but on the other hand I'm not a big fan of that anyway. So far I haven't had to deal with too many trollies here, but if that ever happens, comment wars get especially dicey when someone fiddles with the comment content.
CarbSane said…
VERY interesting Lerner. I wonder if some of the LC'ers who have trouble sleeping have higher FBG because of low basal insulin. Then again Jimmy had a fasting insulin level of 4 in 2008 with FBG of 87.
Unknown said…
It's amazing how some people do a complete 180 - like don matesz

This what he now recommends

Hunter-Gatherer Diet Guide


1. Vegetables, herbs, and spices, including roots, bulbs, stems, leaves, mostly cooked.
Emphasize green leafy vegetables because these have the highest nutrient density of any foods, including a high protein content.
Eat as wide a variety as possible.
Proper cooking increases net nutrient delivery.
2. Fruits and berries (includes avocados and olives).
3. Nuts and seeds (almonds, coconuts, walnuts, hazelnuts, pecans, brazil nuts, macademias, pumpkin, sesame, sunflower, hemp, etc.)
4. Legumes (beans and peas, including soy and peanuts)
5. Whole cereal grains and whole grain products (rice, bread, pasta, pastries, etc.) and grain-like seeds of dicot plants (quinoa, amaranth, buckwheat, teff, etc.

Take at least ~80-90% of your diet from the list above.

Minimize or Avoid

1. All types of fish, eggs, poultry, dairy products, and red meat, no matter the feeding strategy.
2. Separated animal fats and fruit or nut oils (olive, avocado, coconut, palm, almond, etc.), oil seeds and seed oils (corn, safflower, sunflower, sesame, hemp, etc.)3. Refined sugars, including cane sugar (white, brown, organic, whatever), honey, maple syrup, rice syrup, agave syrup, etc.
4. Any food to which you have an allergic reaction.
Johnny said…
You are being deliberately offensive and presenting folks with straw man choices.

There's one to grow on for ya, CS.

IF the word "stupid" is too strong for you -- wow, but OK -- let's just say feeble-minded (to include all manner of lazy thinking, groupthink, clinical idiocy, etc.)

But the fact is, McGuff wrote a book, for MONEY. So, when he wrote something incorrect, which happens to be in his favor, did he fall victim to lazy thinking, or is he deliberately fraudulent? They are obviously incorrect ideas that oh-by-the-way put money in his pocket, after all.

He might think that he's helping people but at some point, his convenient falsehoods need to be exposed to sunlight. These pseudoscientific ideas about exercise are really dangerous, aren't they? Don't let him hurt more people! Silence is compliance.
CarbSane said…
He might think that he's helping people but at some point, his convenient falsehoods need to be exposed to sunlight. These pseudoscientific ideas about exercise are really dangerous, aren't they? Don't let him hurt more people! Silence is compliance.

I don't have time to assess every scammer out there. If you think McGruff is a scammer, why don't you start your own blog?

I don't think the word stupid is too strong. I'm saying that you are giving people two choices with your words. Either someone is f'n stupid or engaged in chicanery. I think in most cases there are other options ... right? Next you'll be asking me if I stopped beating my cat.
Woodey said…
"It is true what Tom claims,I have the same experience"

If I were to take that same logic then I would have to say its not true, because I didn't experience that. This is what can be misleading about personal experience, it can't be applied to everyone, it's not universal, after living 40 years not much is.

This is a common theme I have seen within various groups and not just with the low carb community. It would be safer to say that the sweet tooth diminishes, but even then you can't apply it to everyone, not even to the majority. Seven billion people in the world and low carb is a very very very very small community, in the big picture of things its insignificant.

Religion does the same thing. In Western cultures Jesus is the way, in the Middle East its Muhammad, the Orient its Buddha. Yet their is a battle over who is right and wrong, a battle that is absurd and built on arrogance more than fact.

The issue I am having is people like Jimmy, Tom, and Gary make claims and then say they aren't scientists and more studies need to be done, but they as well as their followers run with it like its gospel. I know because I was a part of it and I did run with it.

I won't deny your experience and that's great that you lost your sweet tooth. But its not a universal truth. Even if 10,000 people did its still not a universal fact. Ask yourself this question, why are artificial sweeteners so often used by the low carb community if the sweet tooth is truly dead? Why did Tom recently post on Facebook a low carb dessert recipe if the sweet tooth is truly dead?
Galina L. said…
This comment has been removed by the author.
Galina L. said…
I think different people defined a "sweet tooth" differently. I knew somebody with almost uncontrollable, maddening desire for sweets, it happens. About such situation I have no particular opinion, just some guesses. While all people appreciate sweets and have a desire to eat it, different individuals are satisfied with different amounts, and that amount could be a subject for change. I think the only universal thing about taste preferences is that people are adaptable. I remember being adapted to less salt in my diet when long time ago I was pregnant and my OB doctor told me to go almost salt-free. I noticed the less I exposed to some food sensation (sweet, salty, hot) the more I am sensitive to it. The same is true for noise, smells, temperature. Probably, somebody who likes sweets too much will never be able to shake it off completely, but will be able to train himself/herself to be satisfied with smaller amounts. The fact that Jimmy NEEDED to put one TABLE spoon of honey (and 3 Tbs of butter) on his potato is a very clear indicator for me that he eats too much of sweet things and dulled his taste for sweets. Actually, I am not sure his meal was any healthier that glazed doughnut with a burger.
I eat some sweets too but in small amounts, less sweetened and not every day. When I am in an unfrequent decadent mood, I cut halt of banana in slices, put some pats of almond butter on it and have it with my coffee. It tastes very sweet now.
I don't agree with everybody and everything in a LC community, if some people capable to take as a gospel something what GT or JM are saying, it is just too bad. I had to find my own path to get the result I wanted. I am not a religious person, and not in the search of the group I want to belong. Since I left my native country, I got used to be on my own.