
Genetic Study Supports Carbohydrate-Insulin Model of Obesity - ot
https://medium.com/@davidludwigmd/genetic-study-supports-carbohydrate-insulin-model-of-obesity-327d84be6d2b
======
codingdave
You don't even need to get into the science to dislike this article. And I'm
not trying to argue against low-carb... I feel better on low-carb diets
myself. But this article lays out a couple scientific facts, while shaming the
reader into unquestioning agreement by saying, "This is X 101". But then lists
a pseudo-scientific premise tied to their third "fact", and tries again to
shame the reader into agreement. This is simply a manipulative writing style,
and we should be ignoring it, not discussing it.

~~~
gjem97
This is the medium post to garner attention for their journal article [1].
Admittedly the style seems like something out of the "self help" section of
the bookstore, but my takeaway was: "look at this new result, it supports
adopting a new theory of obesity, and I personally think this theory is the
right one."

[1]
[http://clinchem.aaccjnls.org/content/64/1/192](http://clinchem.aaccjnls.org/content/64/1/192)

------
acchow
> Insulin is the Miracle-Gro for your fat cells. A child with new onset type 1
> diabetes — unable to make enough insulin — will invariable lose weight until
> receiving treatment, no matter how many calories she consumes.

Does anyone know where the calories go if it isn't stored as fat? Glycogen
stores? Or our digestive system just stops absorbing them?

~~~
memsom
My stepson is type 1, so saw this first hand.

Slowly the child loses weight. It's initially not very noticeable, but for
example - in our case he stayed with his father over the summer and when he
came back he was noticeably thin.

The child begins drinking a lot. It starts off with an excessive thirst. Can't
go more than an hour without drinking. But ends up with them not being able to
do anything, peeing constantly and never being able to quench their thirst.
When he came back to us, he was close to this stage. He was constantly eating
ice cubes as they melted slowly enough so that he felt like he was constantly
moistening his mouth. After about 3 days we took him to the doctors office,
where by he went to Hospital.

Fatigue - the child has zero energy and when they are not drinking they can
barely move. This was rapid. He came home on a Sunday evening, and by
Wednesday morning he looked like pure death.

Ketones in the blood skyrocket. This is incredibly dangerous. When blood sugar
rises above about 15 mmol/L (270 mg/dl) things start getting quite nasty.
Health is put in jeopardy. Quite often the child will go in to a coma if they
get too high.

All of the sugars are peed out. The child's pee will smell very strongly and
be a very dark colour if they are anything like my stepson.

It was basically horrific. But as soon as we got him treatment, he bounced
back quickly.

We now use a carb counting system supported by a device that tracks is blood
sugar and insulin intake. Regulating his insulin is a constant battle as he
still thinks he is indestructible, and convincing a 14 year old boy that
skipping "a few" shots every day or injecting a guesstimate as he is "too busy
to do it properly" is a bad idea is not easy.

~~~
cellularmitosis
I wonder if there is an idea for a service here? If over-reporting of e.g.
violence on the news can alter people’s perception, maybe we can use that
vulnerability to our advantage? If your son received a text everyday about
someone going blind or having limbs amputated, maybe you can bias his
perception by over-reporting bad outcomes?

~~~
johnchristopher
[https://en.wikipedia.org/wiki/Tobacco_packaging_warning_mess...](https://en.wikipedia.org/wiki/Tobacco_packaging_warning_messages)

------
cageface
If this is true then why have many many studies shown that vegans, who
generally eat a relatively high-carb & low fat diet, are the _only_
demographic with normal body mass index and also have much, much lower chances
of developing type 2 diabetes?

In fact we have a lot of evidence linking high-fat diets to diabetes:

[https://nutritionfacts.org/2016/11/17/fat-is-the-cause-of-
ty...](https://nutritionfacts.org/2016/11/17/fat-is-the-cause-of-
type-2-diabetes/)

High fat diets also do a lot of bad things to your cardiovascular system.
Proceed with caution.

~~~
spion
Most nutritionists like to cherry pick studies that support their cause (even
when they're low quality observational studies) and attack studies that oppose
it. Michael Greger (the author of nutritionfacts) is quite the typical example
(don't get me wrong, Gary Taubes has done that too in the "opposing" camp)

The most likely theory I've seen is:

1\. We have a certain amount of genetic propensity for higher-than-necessary
insulin secretion

2\. How we develop that propensity is still unknown (!).

Gary Taubes likes the sugar hypothesis (i.e. something about fructose
metabolism in the liver causes the system's self-regulation to fail) but thats
mostly supported by observational studies - the mechanics aren't clear at all.

Michael Greger likes the lipid hypothesis (fat inhibits muscle ability to
absorb carbohydrates i.e. causes insulin resistance) but that doesn't explain
why the liver continues to produce tons of fat despite its insulin receptors
being clogged.

Jason Fung likes the overflow hypotheis (as the muscles get fuller of
glycogen, they're less able to store blood glucose, which means more insulin
is needed to do it - however the liver isn't resistant and insulin upregulates
its fat production) - but that doesn't fully explain how there are people who
do lots of heavy physical activity yet remain obese and insulin resistant.

Its possible that any subset of the above could be a cause if excessive enough
- high GI carbs to raise the blood sugar, fat to slow sugar absorption and
lack of exercise to keep your muscle cells overfilled with glycogen all
contribute to high insulin secretion, together.

3\. Insulin definitely regulates fat accumulation in fat cells. No doubt about
it - more insulin means less fat released by fat cells and more carbs
converted to fats by the liver and stored in fat cells. Insulin also blocks
leptin which signals our brain that we're full, so we feel hungrier.

4\. Keto and fasting definitely work in that they remove the primary reason
for insulin to secrete. You can't have raised insulin secretion if you don't
have a lot of sugars in your blood to start with.

5\. Its possible that vegans (on average) also remove the _secondary_ reason
for insulin to over-secrete, whatever that is. Keep in mind that vegans on
average are more mindful about having a healthy lifestyle, so it could be any
number of things (correlation is not causation). But if veganism itself was
the definite fix, we would expect to see no long-term vegans that are obese.
Good averages to compare would be long-term vegans with long-term "ketoers"

Keep in mind, the mechanisms to prevent weight gain are very different from
those needed to actually lose weight. The first one is about maintaining a
stable homeostatic state while the second one is about deliberately causing a
different non-homeostatic state.

~~~
cageface
[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5466941/](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5466941/)

"Replacing carbohydrates (mainly refined starches and simple sugars) and
saturated fats with monounsaturated and polyunsaturated fats lowered
hemoglobin A1c and improved insulin resistance; polyunsaturated fats were also
noted to improve insulin secretion. The authors concluded that in comparison
to carbohydrates and saturated fats, monounsaturated and polyunsaturated fats
had the most favorable effect on glycemia, insulin resistance, and secretion.
In terms of foods, these findings support consumption of vegetable fats (e.g.,
nuts, avocados, olives) in place of animal fats and refined grains."

~~~
spion
Thats a great meta-analysis referenced there
([https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4951141/](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4951141/)),
but the table of studies only contains baseline measures
([https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4951141/bin/pme...](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4951141/bin/pmed.1002087.s003.pdf))
- I can't find the original non-aggregate data on the after-effect (benchmark)
measurements of each of the analysed studies.

One thing it seems to assume is that effects of carbohydrate reduction are
linear, which might not be the case. The study analysed the effect of
"replacing 5% energy from carbohydrate with SFA" and found it had no
significant effect on fasting glucose - this might be true even if ketosis
works perfectly, since on average the trials listed there are medium-to-high
carb. It would be very useful if they also had listed a table with the
individual study outcome data.

Another thing that seems weird is that they deem an increase in insulin
secretion capacity as good. Increasing insulin secretion capacity and insulin
sensitivity will lower blood glucose, but at the expense of increased obesity
- the blood sugar is going _somewhere_ and its either the muscles or fat. So
it seems to me that in T2D the increase of secretion capacity only postpones
the problem. Ideally what you want is the (fasting) insulin levels to drop
while maintaining the same or somewhat lower blood glucose.

------
marcus_holmes
I live in Cambodia. The Khmer people here eat white rice for every meal, four
times a day. They nap at lunchtime because of carb overload. They're not fat.

~~~
VLM
That's a fairly insightful observation in that in the old days in the
agricultural high carb west we balanced the obesity causing nature of
extremely high carb diets against malnourishment, internal parasites, and
periodic regular famines. We eliminated all three in the last century while
keeping the ultra high carb diet, in fact boosting the carb intake to levels
never seen before, and unsurprisingly the obesity level exploded.

For example five minutes with google searching for "khmer malnurishment" will
find that about a third of the kids have some kind of malnutrition problem.
Admittedly those stats come from people who's salaries depend on the problem
existing and are therefore untrustworthy, but I'm sure real world rates none
the less exceed a quarter.

Kinda the whole point of the obesity epidemic in the post-green revolution
west is we don't have 1/3 of the population dying of scurvy regardless of how
much carb they eat, and by definition we never ever fast or have any carb
intake limit at all.

Its entirely possible that an ultra high carb diet as experienced in the west
until the 1970s is perfectly stable as long as you have repetitive
unintentional fasts (aka famines) and massive infestation of tapeworms and
other intestinal parasites combined with universal vitamin deficiency such
that everyone's a little sick all the time.

Its interesting to think about intestinal parasite eradication in terms
similar to current discussion of probiotics and antibiotics in food. Tapeworms
are gross, but so is dying 20 years earlier due to obesity... Its not a huge
step in the probiotic marketing sense from unicellular parasites to
multicellular parasites.

~~~
cageface
I see the same thing in Vietnam, and it’s not because of malnutrition or a
massive epidemic of parasites. It is mainly to do with the fact that people
also consume vegetables (ie fiber) with their rice, and that they tend to be
more physically active than Westeners.

------
esaym
Well, this makes me want to go straight to /r/keto ...

------
lucidguppy
What happens to the fat that you eat if you don't burn it off?

------
sc4les
Nice try, dairy industry

~~~
Axsuul
How would the dairy industry want this?

~~~
mathw
Dairy products are high in fat...

~~~
sjwright
Full cream milk is 4% fat. That's not very high.

~~~
mjmasn
It's 49% calories from fat, that's pretty high. A healthy diet is <20%
calories from fat. Even that is much more fat than we need.

~~~
sjwright
You say that as if it were objectively true, but in fact it's just opinion,
which has the unremarkable honour of being the most popular view of current
mainstream diet "experts".

Further, it's absurd to focus on the macro-nutrient ratios of a single calorie
source. For most people, dairy is almost invariably balanced against other
calorific sources, many of which are almost entirely carbohydrate, like wheat,
rice and refined sugar.

------
jimrandomh
> Insulin is the Miracle-Gro for your fat cells. A child with new onset type 1
> diabetes — unable to make enough insulin — will invariable lose weight until
> receiving treatment, no matter how many calories she consumes. Give that
> child the right amount of insulin, and weight trajectory returns to normal.
> Give that child (or an adult with type 2 diabetes) too much insulin and
> excessive weight gain will predictably result. This is just Endocrinology
> 101.

This is incorrect. Giving too much insulin to a type 1 diabetic causes rapid
death, not weight gain. Giving no insulin to a type 1 diabetic causes weight
loss because most calories leave through urine rather than getting used or
stored, not because insulin is "miracle-gro for your fat cells".

~~~
rjtavares
> Giving no insulin to a type 1 diabetic causes weight loss because most
> calories leave through urine rather than getting used or stored

Isn't that precisely his point?

