Insulin Injection Effect on Fat Tissue

I'm sure most of you are familiar with the picture of the unfortunate woman below from Gary Taubes repeated use of this picture in lectures.    The top is a screenshot from Google Books of Endocrinology:  An Integrative Approach, 2001, Nussey & Whitehead, page 31.  At the lower right, I've copied the discussion of Box 2.8 from the previous page.

Now, here's a slide from an April 2010 lecture (~7:40 mark)

This is quite par for the course for Mr. Taubes.  Nowadays he has had to drop some of the major reasons insulin via carbohydrate intake is fattening based on the overwhelming evidence against them existing in the scientific literature and textbooks predating GCBC.  The first to go was the ("" are to delineate phases, not direct quotes) "up to 30% of carbs in a meal is converted to fat", "excess carbs are turned to fat",  and "de novo lipogenesis of fat from glucose that is taken up by fat cells into fat" memes.  This one fell by the wayside fairly quickly in his lectures.  The "you need carb to store fat", "alpha glycerol phosphate rules", "carbs increase G3P increases esterification" memes took far longer to excise (because removing this gutted his hypothesis).

And yet we still see the picture of this woman with more or less of a caption accompanying it.  It is critical what Taubes chose to leave out of the caption on his slide.  The fat accumulation in this woman injecting supraphysiological levels of insulin into her thigh fat, repeatedly, without proper rotation to other sites, for almost 50 years produced the rather disfiguring fat distribution.  But Taubes left out the explanation from the textbook: 
Whilst this was likely to have been caused by de novo lipogenesis from glucose, it is generally believed that on a Western diet, triglycerides are usually accumulated in adipocytes by uptake from plasma.
In other words, local injection of insulin likely stimulated de novo lipogenesis in the adipocytes in the area, thereby creating fat from carbohydrate and accumulating fat in these cells.   The text authors are quick to point out that this is not analogous to the normal processes by which fat tissue grows in the intact human eating a (fattening) Western diet.   This woman's fat did not become "lipophilic" sucking fatty acids out of circulation.  The localized injections stimulated a metabolic pathway not quantitatively significant by endogenous stimulation.

Yes, this is a relatively small quibble.  But the sheer number of these quibbles alone, leaving aside the major mangling of the science, is staggering.


cwaiand said…
just curious as to why you posted this?have you not been over this a million times already?seams something more productive of your time may be more helpful to folks.
Sanjeev said…
WOW, thanks for this

When that first came from Taubes as it did after several hits to his supposed reputation[0] I took it at face value.

(this is the "man am I dumb" voice): I shoulda know-ed. Dis alleged skeptic dat is me shoulda been doin da knowin and da shakin wit da head ting when da Taubes be talkin

Lesson learned, Nothing, but NOTHING out of Taubes' mouth will be taken at face value again.

[0] amazing that it's still intact in some places. It's much more like the doomsday cults that get stronger when the date the earth's supposed to be destroyed comes and goes with nary a whimper
Sanjeev said…
> much more like the doomsday cults

than any kind of genuine seeking by the curious or a good faith search for "Truth" (big ones like what causes obesity) or even "truth" like what I should have for breakfast?
CarbSane said…
Came across it while working on my video blogumentary. Never looked at this book. There's so much nonsense still predicated on the "knowledge" Taubes bestowed on people. I also came across recently that diabetes, T2, involves an impairment of both glucose uptake by adipocytes and de novo lipogenesis in adipose tissue. While adipose DNL may not be quantitatively significant in developing obesity, it may well be important in signaling.

There is much work to be done on the misguided carbs/insulin causes IR front.
ItsTheWooo said…
If both thighs are subjected to this growth, she WAS rotating sites. AS a nurse I promise you the majority of diabetics rotate between two areas - left/right arms, left/right abdomen, or left/right thigh. No diabetic does arms, abdomen, and thighs. This woman's injection patterns are unremarkable.

If we are going to take offense at this example, it would be the fact what has occurred here rarely occurs with modern insulins and it is associated primarily with animal insulins that cause greater immune complications. In school we were taught this hypertrophy of fat tissue was associated with animal derived insulin, and has been eliminated with the development of human recombinant insulin. Indeed, the caption states the woman used bovine insulin, which resulted in this noted side effect of hypertrophy of local fat tissue.

The caption still does not argue against the insulin hypothesis. Whether or not the fat gain was a result of DNL, or triglyceride synthesis, is irrelevant; both of these mechanisms of fat growth require and are stimulated by insulin.

I do agree the pictures are not particularly good evidence , but this is mainly because the side effect is purely a result of non-human insulin being used in human beings, and no longer is observed with the invention of human insulin.
Woodey said…
You've probably seen this blog post, but he uses another picture claiming the same thing.
CarbSane said…
Yes, I'd seen that before & blogged on it somewhere, but that's a good catch Woodey. Because he now posted the "answer" -- I note they also say it's due to increased glycemic flux -- e.g. more glucose transported in and presumably then converted to fat by DNL. The local concentrations of insulin are ridiculously high compared to circulating endogenous levels.
Woodey said…
When he first posted that I viewed it as poor man's fear tactics, one of those pics aimed at scaring people who didn't possess the knowledge to debunk it. Yet another reason for why I am glad you speak up.
Jason Sandeman said…
As a nurse - you understand that what you are calling "rotation" is anything but. Rotation means you let the injection site rest and heal. There are times after injection I can feel a lump. After a few days, it dissapears.

Plus, human insulin is not available for injection. There is a choice - either animal, or synthetic. Most older diabetics I know gained weight when they went to synthetic. Tells you something about that.
Drew said…
I mean this very respectfully, because I'm truly trying to figure this out and I like your blog-- definitely interesting, thoughtful writing. I'm just trying to figure out what the point of it is? You imply that a lot of low carbers are scamming people-- are you saying that LC doesn't work or that Atkins is ineffective? That quality of food, macronutrients don't matter, vitamins, minerals, etc... don't matter? Simple as calories in, calories out?

I, for one, am living breathing proof that reducing calories and upping exercise couldn't be all there is to it. I know that there's no way to prove that -- just like LC people don't believe that you are counting all your carbs-- people who say you are simply eating too many calories and not getting enough exercise don't believe that you are in fact restricting caloric intake and exercising vigorously enough. I'm finally losing some weight low carbing below 30 grams (I had already cut my carbs but nothing happened) and slowly dipping into numbers that I thought I would never see. I don't have a lot to lose, but I can tell you that I have been trying to lose these 25 lbs for 5 years-- hired trainers, gone to weight watchers. I even tried a raw vegan regime-- even though I've been a follower of Weston A. Price for years and think that animal fat is an essential part of a healthy diet-- and I've only been able to lose 5 lbs then it stalls and shoots back up if I deviate. With low carbing, I'm definitely seeing a change and I've broken the 170 plateau. Am I leading myself down the primrose path, is this all going to turn around and turn me fatter eventually? I've looked at Jimmy Moore's menus and I agree with you how could anyone say this is a reasonable meal on a daily basis. My idea of a low carb meal is a couple of lamb chops with parsley salad leave off the potatoes (though I fully plan to bring them back someday), sparkling water and some good cheese for dessert. I think quality counts enormously, but I can't prove it. Didn't Atkins himself advocate reintroducing most healthy carbs? Am I crazy or are we fighting straw men?
I think Taubes is a bit of blowhard and not a very effective speaker, but-- call me an idiot for falling for it-- his book raises some interesting points about energy balance chicken and egg. I can tell you this from watching my children. One of them is a bit husky and he is the most active and least interested in food. My others who are very skinny would be happy sitting around eating sugar, fat, etc... and play video games. I'm far more worried about their future health then the 'chubby' one. My point being that Taubes' posit that x happens then people start feeling tired, being lazy, constantly hungry, and gaining weight makes more sense to me than people are heavy because they eat so much. Some skinny people eat huge, disgusting amounts of food but we're not disgusted because they don't disgust us. Jimmy Moore bothers us because it's hard to see fat man eating oversized portion. America hates fat people;-)

I personally think people are overweight for a variety reasons just like people are skinny for a variety of reasons (diligence, luck, athleticism, lack of food, illness, smoking, for example). But I don't know. I would like to, though, because what I fear more than anything is managing to lose this weight but it coming back on with a vengeance despite my best efforts.

I've digressed quite a bit and suppose I just need an 'obesity theory' pen pal, but I really am trying to go through all of your posts and figure out if there's evidence that low carb doesn't really work or it's setting me up for a massive regain. I guess I would rather be overweight at the weight I am now than yo-yo back to this and more.