The Carbohydrate-Insulin Model of Obesity

Here’s a very fresh study published in JAMA (David S. Ludwig, MD, PhD; Cara B. Ebbeling, PhD. The Carbohydrate-Insulin Model of Obesity: Beyond “Calories In, Calories Out”JAMA Intern Med. Published online July 2, 2018.). From the abstract:

According to the carbohydrate-insulin model (CIM) of obesity, recent increases in the consumption of processed, high–glycemic-load carbohydrates produce hormonal changes that promote calorie deposition in adipose tissue, exacerbate hunger, and lower energy expenditure.

Basic and genetic research provides mechanistic evidence in support of the CIM. In animals, dietary composition has been clearly demonstrated to affect metabolism and body composition, independently of calorie intake, consistent with CIM predictions.

Meta-analyses of behavioral trials report greater weight loss with reduced-glycemic load vs low-fat diets, though these studies characteristically suffer from poor long-term compliance.

Feeding studies have lacked the rigor and duration to test the CIM, but the longest such studies tend to show metabolic advantages for low-glycemic load vs low fat diets.

Beyond the type and amount of carbohydrate consumed, the CIM provides a conceptual framework for understanding how many dietary and nondietary exposures might alter hormones, metabolism, and adipocyte biology in ways that could predispose to obesity.

Pending definitive studies, the principles of a low-glycemic load diet offer a practical alternative to the conventional focus on dietary fat and calorie restriction.

Here’s a good graphic from the paper:

Worth a read.


One of the Good Guys – Dr. Benjamin Bikman

I’ve spent too much time covering the keto hucksters (OK, mostly just Jimmy Moore but he’s a big enough target) so I thought I’d switch it up and look at one of the good guys – Dr. Benjamin Bikman (our YouTube playlist of Dr Bikman). I mentioned Ben in (Great BLOGs). He is a PhD who teaches at BYU and he’s got a lot to say about Protein over at his InsulinIQ site.

Here’s a video (High Intensity Health Episode 200) where he is interviewed.

Ben is one of the folks who came to nutrition from the exercise side. Ben really gets it about Insulin and obesity.

A video on Insulin and Glucagon.


Vegan Diet Blood Test Results

No, don’t worry. I have not gone vegan.  I took a look at another FASTER study participant (Damian Stoy) over on the Low Carb Studies Athletics BLOG (FASTER Subject 43). Damian is a vegetarian (or maybe vegan I can’t tell the difference). One of the results that Damian posted was his blood tests. They are generally pretty good but there’s one number that stood out.

Damian’s platelet count is below the reference range. What causes this? Turns out there is a study of this (Obeid R1, Geisel J, Schorr H, Hübner U, Herrmann W. The impact of vegetarianism on some haematological parameters. Eur J Haematol. 2002 Nov-Dec;69(5-6):275-9.).

CONCLUSION: vitamin B12 and iron status were compromised by a vegetarian diet. Variations in mean corpuscular volume were determined by iron and vitamin B12 status. Lower lymphocyte and platelet count were accompanied by metabolic evidence that indicated vitamin B12 deficiency.

Another study (Fisher M, Levine PH, Weiner B, Ockene IS, Johnson B, Johnson MH, Natale AM, Vaudreuil CH, Hoogasian J. The effect of vegetarian diets on plasma lipid and platelet levels. Arch Intern Med. 1986 Jun;146(6):1193-7.).

…platelets, which may also play a role, have also been observed to have aberrant functions in vegetarians.

This post has some suggestions for vegans to raise their platelet levels (Golden Vegetarian Eatery).

Or just eat some meat. Folic Acid.


The Big Fat Hack – Day 4

Jimmy Moore is doing a big fat hack. He’s on day 4. And Jimmy is producing more drama than ketones at this point.

Jimmy’s claim to have developed glucagon resistance is a curious one. Jimmy may have actually dropped his glycogen stores down to where there’s not enough glycogen to convert to glucagon when needed. Since Jimmy eats low protein he lacks protein as a substrate for GNG.

We know that Jimmy does everything possible to keep GNG from refilling his glycogen stores (other than stop eating fat). Does Low Carb PLUS Low Protein create a problem in refilling glycogen? This article has the clues (Glycogen Stores in Low Carb).

If that’s the case it really could be true that Jimmy’s low blood sugar isn’t met by glucagon. Equally, I don’t know how someone could differentiate between glucagon resistance and a lack of production of glucagon.

Jimmy’s ketones and blood sugar were:

Here’s Jimmy’s recovery strategy. Note the strategic placement of the F-Bomb products (one of the products Jimmy Moore promotes).

Looks like the big fat hack may have stopped his big fat hack.

Fasting and Gluconeogenesis

In my previous post (Low Carbs and Gluconeogenesis) I took a look at the low carb diet and Gluconeogenesis (GNG). The study found that GNG was increased by 14% in low carb diets. For folks who view GNG as the enemy that is challenging. After all, why go on a diet which makes your GNG even worse?

But, did you know that fasting increases GNG even more? This study looked at fasting and GNG (Landau BR, Wahren J, Chandramouli V, Schumann WC, Ekberg K, Kalhan. SC. 1996 Contributions of gluconeogenesis to glucose production in the fasted state. J Clin Invest. 98:378–385.):

The contribution of gluconeogenesis to glucose production was 47+/-64% after 14 h, 67+/-64% after 22 h, and 93+/-62% after 42 h of fasting.

It would be wrong to think this means we should get up in the middle of the night to eat in order to prevent GNG. We should not fear GNG since it is necessary. Our bodies produce the amount of Glucose that our bodies need for those parts of the body which require Glucose. When we are on Low Carb diets we produce Glucose in response to demand.

A more interesting question is why GNG is overdriven in Type 2 Diabetics. This is the paper for that subject (Song S, Andrikopoulos S, Filippis C, Thorburn AW, Khan D, Proietto J. Mechanism of fat-induced hepatic gluconeogenesis: effect of metformin. Am J Physiol Endocrinol Metab. 2001 Aug;281(2):E275-82.).

The high-fat diet increased endogenous glucose production (21.9 +/- 4.4 vs. 32.2 +/- 4.8 micromol x kg(-1) x min(-1), P < 0.05) and alanine gluconeogenesis (4.5 +/- 0.9 vs. 9.6 +/- 1.9 micromol x kg(-1) x min(-1), P < 0.05).

Excess supply of dietary fat stimulates alanine gluconeogenesis via an increase in fructose-1,6-bisphosphatase protein levels

Looks like substrate availability can increase GNG – when the substrate is fat.



Low Carbs and Gluconeogenesis

There’s an unwarranted fear of Gluconeogenesis (GNG) in some parts of the Keto/Low Carb community. I think it comes out of the Diabetic community where diabetes is understood as high blood sugars. The idea that the body makes extra glucose is scary and limiting that production seems desirable.

But, did you know that the Low Carb diet itself increases Gluconeogenesis? Here’s the study which compared rates of GNG between high and low carb diets (Bisschop, P.H., A.M. Pereira Arias, M.T. Ackermans et al. The effects of carbohydrate variation in isocaloric diets on glycogenolysis and gluconeogenesis in healthy men. J. Clin. Endocrinol. Metab. 85:1963-1967, 2000.).

Gluconeogenesis was about 14% higher after the very low carbohydrate diet (6.3 6 0.2 mmol/kgzmin;P 5 0.001) compared to the control diet, but was not different between the high carbohydrate and control diets (5.5 6 0.3 vs. 5.5 6 0.2 mmol/kgzmin).

The reason this happens is that GNG is necessary in the low carb diet. The body has a minimal need for glucose that exceeds what is provided on the low carb diet. The extra required glucose must be made via GNG.

People on higher carb diets get a glucose shot with every carb meal. It’s during the times of sufficient dietary carbs there’s no need for the body to do GNG. Hence, a lower level of GNG. But during those overnight hours there’s no food coming and and everyone uses GNG to keep up their blood sugar levels.

Jimmy’s Big Fat Experiment – Part 2

Jimmy had Keto Savage, Robert Sikes, on his podcast (19: The 90 Percent Fat Hack Protocol With Robert Sikes). Jimmy called him a nutritional expert (@4:20, 4:50). I have nothing against being self-taught on nutrition – that’s what I am. But I don’t think that Keto Savage is a nutritional expert. He is a body builder who does Keto. The thing I like best about Robert is that he publishes what he eats and his results even if they contradict the keto narrative. He doesn’t cherry pick through the data.

One thing that Jimmy could learn from Keto Savage is Robert’s own 4,000 calorie fat challenge. Robert went on a 2 month diet with low carbs and high fat and took his body fat from around 4% to 10%. If you are not used to looking at body fat numbers he went from very low to less low. I wrote about Robert’s test (Does Fat Make You Fat?).

To Robert’s credit he tried to do his best with Jimmy’s request since he viewed Jimmy’s calorie choices as too low on the low fat diet.