There’s a lot of contention about the carbohydrate-insulin-obesity (C-I-O) hypothesis to explain obesity. In my opinion, some of this can be traced to Gary Taubes’ abrasive personality. Gary is someone that a lot of people love to hate and he seems to like to help them hate him (Gary Taubes BLOG on this subject).
One of the leading voices against C-I-O is Stephan Guyenet. His BLOG frequently takes on Gary Taubes and the C-I-O hypothesis. In this post he takes on one of the more reputable proponents of C-I-O (Testing the Insulin Model: A Response to Dr. Ludwig. Saturday, January 30, 2016).
Gary Taubes’ main objection is to the Calories-In-Calories-Out (CICO) model. Stephen Guyenet isn’t a supporter of CICO but he sees Taubes’ objections as against a caricatured strawman. Guyenet recognizes the weakness of the CICO model. One of his more salient points is:
This [CICO] model seems to exist mostly to make lean people feel smug, since it attributes their leanness entirely to wise voluntary decisions and a strong character.
Stephen provides a critique of the Carb-Insulin hypothesis that lists a large number of studies that provide evidence against the predictions that the C-I-O hypothesis generates.
I will take some time in the future to look at his lines of evidence against C-I-O but my own interest in Low Carb was from the effect on T2 diabetes and not so much in obesity. Weight loss is just a nice side effect of Low Carb. I have struggled more with Low Carb to reach maintenance than I have with weight loss. I have no doubt that Low Carb works well for Type 2 diabetes. Whether or not the issue is the hormone Insulin or some other cause matters less to me than the effect. I think the evidence is that Low Carb does a better job at managing T2D without medications than either the Zone or Paleo diets.
Stephen’s Model of Obesity
Stephen goes on to presents a third model to answer the basic questions.
This model centers around Leptin and Insulin and places the brain at the center of weight control. Stephen presents his view in this paper (Stephan J. Guyenet and Michael W. Schwartz. Clinical Review. Regulation of Food Intake, Energy Balance, and Body Fat Mass: Implications for the Pathogenesis and Treatment of Obesity. J Clin Endocrinol Metab. 2012 Mar; 97(3): 745–755). From the paper:
The increase of energy intake that has fueled the U.S. obesity epidemic is linked to greater availability of highly rewarding/palatable and energy-dense food.
Obesity occurs in genetically susceptible individuals and involves the biological defense of an elevated body fat mass, which may result in part from interactions between brain reward and homeostatic circuits.
Inflammatory signaling, accumulation of lipid metabolites, or other mechanisms that impair hypothalamic neurons may also contribute to the development of obesity and offer a plausible mechanism to explain the biological defense of elevated body fat mass.
This is where Low Carb can work well since it eliminates these highly palatable food. However, Stephen doesn’t see a particular advantage to Low Carbohydrate diets.
Among various scientific rationales that have been advanced for such diets is that excessive insulin secretion induced by rapidly digested carbohydrate foods causes a subsequent, transient fall of plasma glucose levels; this, in turn, triggers excess feeding and ultimately causes obesity. …. Although clinical trials have established that reduced carbohydrate diets can safely induce modest long-term weight loss, the mechanisms typically advanced to explain this benefit have little in the way of experimental support and are not informative with respect to the control of food intake.
I think there’s something to the fall of blood sugar stimulating hunger. The reason I think that’s true is that it is my experience. I get hungry a few hours after eating a protein meal. Stephen’s explanation is that it is because my stomach is emptying and sending a signal to the brain. It would be interesting to note the difference in someone with a different reaction to protein meals. This theory is old and is presented here (Jean Mayer. Glucostatic Mechanism of Regulation of Food Intake. N Engl J Med 1953; 249:13-16).
Protein Dilution Theory
An alternate explanation of the data is the Protein Leverage Hypothesis. The increase in obesity is explained by an increase in food consumption since 1980 which matched a relatively stable absolute level of protein in the diet. If the total calories are going up but the protein calories are constant it means that the protein is being diluted. The theory is that we seek out a constant level of protein which means we need to eat more food to get our protein if the protein content of food is decreasing. Ted Naiman states this as (Diet 2.0 – Homo sapiens diet):
Today, modern agricultural practices and modern food processing have dumped a massive quantity of refined carbohydrates (sugar and flour) and refined fats (oils) into the food supply, creating protein and nutrient dilution. Because humans eat to a tightly regulated protein and micronutrient satiety drive, we frequently overeat empty calorie carbs and fats just to get adequate protein and micronutrients.
Ludwig’s Latest Paper
Ludwig produced a paper recently ( Ludwig David S, et.al. The Carbohydrate-Insulin Model of Obesity: Beyond “Calories In, Calories Out”.
JAMA Intern Med. 2018 Aug 1;178(8):1098-1103).
See Ludwig’s earlier response to Guyunet (Defense of the Carbohydrate-Insulin Model Redux: A Response to Kevin Hall).