Blood Sugar Rises

It is common and well documented by Cahill in his landmark studies on starvation that at the start of carbohydrate restriction blood sugar often goes up in the first few days before it starts to drop.

I’ve seen this myself with long fasts (greater than 4 days). The first few days result in your body making a lot of glucose in spite of low carbs in your diet.

It takes several days for your ketone production to kick in. That’s why the body dumps glucose.

I’ve also noticed an association between weight loss and blood sugar. My blood sugar is often up on the day before I drop in weight. In reverse, my blood sugar is lower when my weight goes up.

Diabetes and Weight Loss

A typical explanation for those of us who reversed our diabetes is that we did so because we lost weight. That can be found in a quite a few places like this (Nicola D. Guess. Dietary Interventions for the Prevention of Type 2 Diabetes in High-Risk Groups: Current State of Evidence and Future Research Needs. Nutrients 2018, 10(9), 1245).

Weight loss appears to be the primary driver of type 2 diabetes risk reduction, with individual dietary components playing a minor role. 

I don’t buy it. I got off Insulin in two weeks. Can it be based on weight loss? I don’t believe so. The reason is that I was diabetic over a wide range of weights – from the 230’s into the 280’s. At the time I went on LCHF + IF I was at 285. I didn’t drop below 230 in two weeks. Here is my weight loss chart. 

Associations

I’ve been meaning to write on bad associations for a long time but there are so many other good articles on it that I’ve saved my fingers until now. I really enjoy a lot of Marty Kendall’s Nutrient Optimising (British spelling) material but I’m getting a bit annoyed at some of the association data that is being put forward. I guess I should be as annoyed at the ketogenic community associations as well. None of them meet the Bradford Hill criteria

So I am going to play the same game. My theory is that fresh broccoli causes obesity.  Check out the blue graph below.

Here’s the chart for obesity.

Here’s a chart for the total calories in the food supply.

So it looks to me like obesity is caused by too much broccoli.

And when the rooster crows the sun comes up.

And fallacies go on and on.

Blood Sugar Roller Coaster – Part 2

A good small study comparing the blood sugar and insult responses to breakfasts with different fat/carb/protein values at the same number of calories (Paula C. Chandler-Laney, et.al. Return of hunger following a relatively high carbohydrate breakfast is associated with earlier recorded glucose peak and nadir. Appetite. Volume 80, 1 September 2014, Pages 236-241).

Turns out that a Low Carb High Fat breakfast results in a lower Area Under the Curve (AUC) for Insulin and higher blood sugar levels hours after breakfast. The lower AUC makes sense since there’s less glycemic load from lower carbohydrates. However, the glucose response may be counter-intuitive. It happens because the problem with higher glucose in meals is a larger drop in glucose after the meal digests. Eating lower carbs results in less of a drop in blood sugar. And it also results in less hunger.

The study protocol was:

Overweight but otherwise healthy adults (n = 64) were maintained on one of two eucaloric diets: high carbohydrate/low fat (HC/LF; 55:27:18% kcals from carbohydrate:fat:protein) versuslow carbohydrate/high fat (LC/HF; 43:39:18% kcals from carbohydrate:fat:protein). After 4 weeks of acclimation to the diets, participants underwent a meal test during which circulating glucose and insulin and self-reported hunger and fullness, were measured before and after consumption of breakfast from their assigned diets.

The results of the study were:

The LC/HF meal resulted in a later time at the highest and lowest recorded glucose, higher glucose concentrations at 3 and 4 hours post meal, and lower insulin incremental area under the curve.

Participants consuming the LC/HF meal reported lower appetite 3 and 4 hours following the meal, a response that was associated with the timing of the highest and lowest recorded glucose.

Credit to Ted Naimam for pointing out this study.

Ancel Keys – History Lesson.

From this site

The story of Ancel Keys is told in a way intended to correct the predominent keto narrative of Keyes as Anti-Christ (Denise Minger. THE TRUTH ABOUT ANCEL KEYS: WE’VE ALL GOT IT WRONG). Denise includes a table that looked at all cause mortality and not just the fat/cardio chart that Keyes is infamous for producing. Read Denise’s excellent BLOG post for the background of this table.

A positive number is an association. The larger the number, the larger the association. Of course we know that association is not causation.  All cause mortality is associate the most strongly with carbohydrates (+0.396) and the least with calories from fat (-0.340).

This is also the subject of another paper (Pett, et.al. Ancel Keys and the Seven Countries Study: An Evidence-based Response to Revisionist Histories).

Here is another related BLOG post (From Ancel Keys and the diet-heart hypothesis to LCHF may not be a huge leap.).

Low Carb vs Reduced Calorie

An interesting study that took a look at an ad libitum Low Carb diet compared to a Low Calorie diet (Foster, Gary D. et.al. A Randomized Trial of a Low-Carbohydrate Diet for Obesity. New England Journal of Medicine, 2003, VI 348, pp 2082-2090). The groups were:

We conducted a one-year, multicenter, randomized, controlled trial to evaluate the effect of the low-carbohydrate, high-protein, high-fat Atkins diet on weight loss and risk factors for coronary heart disease in obese persons. The subjects were randomly assigned to follow either a low-carbohydrate, high-protein, high-fat Atkins diet or a high-carbohydrate, low-fat, energy-deficit conventional diet.

The Low Calorie group was pretty restrictive:

1200 to 1500 kcal per day for women and 1500 to 1800 kcal per day for men, with approximately 60 percent of calories from carbohydrate, 25 percent from fat, and 15 percent from protein

You’d think that with the Low Carb group able to eat what they want that the calorie restricted group would beat them hands down. The results were:

Subjects on the low-carbohydrate diet had lost more weight than subjects on the conventional diet at 3 months (mean [±SD], –6.8±5.0 vs. –2.7±3.7 percent of body weight; P=0.001) and 6 months (–7.0±6.5 vs. –3.2±5.6 percent of body weight, P=0.02), but the difference at 12 months was not significant (–4.4±6.7 vs. –2.5±6.3 percent of body weight, P=0.26). After three months, no significant differences were found between the groups in total or low-density lipoprotein cholesterol concentrations. The increase in high-density lipoprotein cholesterol concentrations and the decrease in triglyceride concentrations were greater among subjects on the low-carbohydrate diet than among those on the conventional diet throughout most of the study. Both diets significantly decreased diastolic blood pressure and the insulin response to an oral glucose load.

Energy Expenditure in Hunter Gatherers

Eat less – Move More? Are we fat because we have become sedentary?

Study of the Hadza (Pontzer H, Raichlen DA, Wood BM, Mabulla AZP, Racette SB, et al. (2012) Hunter-Gatherer Energetics and Human Obesity. PLOS ONE 7(7): e40503.).

average daily energy expenditure of traditional Hadza foragers was no different than that of Westerners after controlling for body size.

The metabolic cost of walking (kcal kg−1 m−1) and resting (kcal kg−1 s−1) were also similar among Hadza and Western groups. The similarity in metabolic rates across a broad range of cultures challenges current models of obesity suggesting that Western lifestyles lead to decreased energy expenditure. We hypothesize that human daily energy expenditure may be an evolved physiological trait largely independent of cultural differences.

Pontzer H, Raichlen DA, Wood BM, Mabulla AZP, Racette SB, Marlowe FW. Hunter-Gatherer Energetics and Human Obesity. Chehab FF, ed. PLoS ONE. 2012;7(7):e40503. 

Satiety Index

There’s a study that was done of food satiety (Holt SH, Miller JC, Petocz P, Farmakalidis E. A satiety index of common foods. Eur J Clin Nutr. 1995 Sep;49(9):675-90) (PDF).

Isoenergetic 1000 kJ (240 kcal) servings of 38 foods separated into six food categories (fruits, bakery products, snack foods, carbohydrate-rich foods, protein-rich foods, breakfast cereals) were fed to groups of 11-13 subjects. Satiety ratings were obtained every 15 min over 120 min after which subjects were free to eat ad libitum from a standard range of foods and drinks.

A satiety index (SI) score was calculated by dividing the area under the satiety response curve (AUC) for the test food by the group mean satiety AUC for white bread and multiplying by 100.

Thus, white bread had an SI score of 100% and the SI scores of the other foods were expressed as a percentage of white bread.

The results were:

There were significant differences in satiety both within and between the six food categories. The highest SI score was produced by boiled potatoes (323 +/- 51%) which was seven-fold higher than the lowest SI score of the croissant (47 +/- 17%).

Most foods (76%) had an SI score greater than or equal to white bread.

The amount of energy eaten immediately after 120 min correlated negatively with the mean satiety AUC responses (r = -0.37, P < 0.05, n = 43) thereby supporting the subjective satiety ratings. SI scores correlated positively with the serving weight of the foods (r = 0.66, P < 0.001, n = 38) and negatively with palatability ratings (r = -0.64, P < 0.001, n = 38).

Protein, fibre, and water contents of the test foods correlated positively with SI scores (r = 0.37, P < 0.05, n = 38; r = 0.46, P < 0.01; and r = 0.64, P < 0.001; respectively) whereas fat content was negatively associated (r = -0.43, P < 0.01).

This goes a long way to explain the Kitavan diet which is largely sweet potatoes. Can you imagine eating sweet potatoes every day as a main staple? Even though they are high carbohydrates it would be tough to over eat them.

Added: Gary Taubes takes on the palatable foods cause obesity theory (CATCHING UP ON LOST TIME – THE ANCESTRAL HEALTH SYMPOSIUM, FOOD REWARD, PALATABILITY, INSULIN SIGNALING AND CARBOHYDRATES… PART II(E, AS IN “END” AND “ENOUGH ALREADY”). Gary has some good points about the usefulness of this idea.

What We Used to Eat

The Paleo diet seeks to eliminate food which are not a part of our ancestral heritage. This paper presents a good defense of that position (Loren Cordain, S Boyd Eaton, Anthony Sebastian, Neil Mann, Staffan Lindeberg, Bruce A Watkins, James H O’Keefe, Janette Brand-Miller; Origins and evolution of the Western diet: health implications for the 21st century. The American Journal of Clinical Nutrition, Volume 81, Issue 2, 1 February 2005, Pages 341–354). Here’s the foods that are “new” to our diets.

Eliminating these foods eliminates the diseases of modern civilization. Other than dairy and fruit this is consistent with the Low Carb diet.

Cafeteria Diet?

There’s a term, the “Cafeteria Diet” (CAF) that is used in research literature to describe a diet which is high in hyper-palatable food (described in the literature as “food regularly consumed by humans, including high‐salt, high‐fat, low‐fiber, energy dense foods such as cookies, chips, and processed meats“). These foods tend to be higher carbohydrate as well.

There are quite a few studies which looked at CAF as the explanation for Metabolic Syndrome. Here’s one of the studies (Sampey, B. P., Vanhoose, A. M., Winfield, H. M., Freemerman, A. J., Muehlbauer, M. J., Fueger, P. T., Newgard, C. B. and Makowski, L. (2011), Cafeteria Diet Is a Robust Model of Human Metabolic Syndrome With Liver and Adipose Inflammation: Comparison to High‐Fat Diet. Obesity, 19: 1109-1117). The study looked at the difference between a high fat diet and the cafeteria diet.

To investigate the obesogenic and inflammatory consequences of a cafeteria diet (CAF) compared to a lard‐based 45% HFD in rodent models, male Wistar rats were fed HFD, CAF or chow control diets for 15 weeks.

Body weight increased dramatically and remained significantly elevated in CAF‐fed rats compared to all other diets. Glucose‐ and insulin‐tolerance tests revealed that hyperinsulinemia, hyperglycemia, and glucose intolerance were exaggerated in the CAF‐fed rats compared to controls and HFD‐fed rats. 

The two diets were both high fat compared with the control diet. Both of the high fat diets resulted in increased body fat. The difference was that the CAF diet caused inflammation in white fat.

Although both high fat diets resulted in increased adiposity and hepatosteatosis, CAF‐fed rats displayed remarkable inflammation in white fat, brown fat and liver compared to HFD and controls. 

The study indicated that the CAF was a good model of Metabolic Syndrome.

In sum, the CAF provided a robust model of human metabolic syndrome compared to traditional lard‐based HFD, creating a phenotype of exaggerated obesity with glucose intolerance and inflammation. This model provides a unique platform to study the biochemical, genomic and physiological mechanisms of obesity and obesity‐related disease states that are pandemic in western civilization today.

This is interesting since the Diet Induced Obesity (DIO) models usually work in rats by feeding the rats a High Fat diet (HFD). The study concluded that the CAF diet was actually more effective at creating the Metabolic Syndrome than the High Fat Diet (HFD).

Our study has revealed that rats fed human nutrient poor foods develop severe metabolic syndrome which is more robust than the effect of traditional HFD exposure.

The power of these sorts of studies is that that were done on ad libitum fed rats. That is, they ate as much as they wanted to eat. They did not feed the rats a diet limited in any way. They simply presented the food and measured what was left to determine what the rats ate.

This can’t be blamed on sugar since the Low Fat diet contained the most sugar. It can’t simply be blamed on carbohydrates although CAF had higher carbohydrates. 

The high fat diet also had a self-regulating capacity which the CAF diet lacked. As the study noted:

…study revealed that while HFD-fed animals decreased food intake in terms of total grams to maintain caloric intake comparable to LFD and SC control, CAF-fed animals lacked this autoregulatory mechanism… CAF-fed rats were hyperphagic, eating 40% more calories/day compared to the HFD.

This may be a part of the advantage of the Low Carb High Fat diet for diabetics. To summarize:

Our study has revealed that rats fed human nutrient poor foods develop severe metabolic syndrome which is more robust than the effect of traditional HFD exposure. CAF-diet fed rats exhibited voluntary hyperphagia and grossly elevated fat intake which resulted in dramatic and rapid weight gain.

Furthermore, CAF diet feeding promoted a prediabetic condition with elevated glucose, insulin, and nonesterified fatty acids, accompanied by decreased glucose and insulin tolerance. In addition, chronically inflamed liver and adipose tissues and distorted pancreatic islet architecture were prevalent.