Genetic Study Supports Carbohydrate-Insulin Model of Obesity
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Does anyone know where the calories go if it isn't stored as fat? Glycogen stores? Or our digestive system just stops absorbing them?
Interestingly enough, your body also raises its level of activity in order to burn calories and maintain weight levels. I believe they've measured a surprising amount of excess calories burned from extra fidgeting when overfeeding people relative to their usual diet.
TL;DR: dietary fatty acids are disassembled and then reassembled into triglycerides which are stored in adipocytes (fat cells) until needed.
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.
Saw this first hand babysitting a kid a long time ago. He kept asking for glasses of water--almost begging for them while at the same time peeing frequently and then wetting the bed. Parents took him to the doctors and the diagnosis came swiftly.
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...
High fat diets also do a lot of bad things to your cardiovascular system. Proceed with caution.
https://www.nytimes.com/2018/01/01/science/food-fiber-microb...
Consuming fiber along with carbs dramatically changes their glycemic profile. Asians get away with eating so much white rice, for example, because they almost eat it along with a bunch of vegetables.
https://nutritionfacts.org/video/if-white-rice-is-linked-to-...
The slender Asians you see aren't the ones stuffing on huge amounts of rice, with or without veggies.
A huge plate of rice might be 1000 calories, but if all a person eats otherwise are some veggies and some tea, there is nothing unsustainable about that
I'm in Asia now (Japan). The predominant eating pattern is: tiny portions, by American standards. (Stuffing with large servings of rice is a Chinese or SE Asian thing. I have seen it too.)
Calories are inescapable. The body's output changes in compensation for incoming calories, but only within a certain range.
Also, there is all sorts of processed crap that's bad for you that qualifies as vegan because no animal products are involved. Hydrogenated vegetable oil, anyone?
You could be a potato chip and cookie vegan.
https://www.vegkitchen.com/nutrition/do-vegans-have-a-weight...
Sure, let's get our data from "vegikitchen.com", quoting from some vegan book by nutritionist quacks.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5466941/
Yeah pedantically you can nothing but Oreos and be "vegan". But FTA:
"In a cohort of 4384 Taiwanese Buddhists, vegetarian men had approximately half of the rate of diabetes (OR: 0.49, 95% CI: 0.28–0.89), and vegetarian post-menopausal women had one-quarter the rate of diabetes (OR: 0.25, 95% CI: 0.15–0.42), compared with their omnivorous counterparts, despite statistical adjustment for body mass index and other factors. Interestingly, the omnivores in this study consumed a predominantly plant-based diet with little meat or fish, again implying that small amounts of meat contribute significantly to the development of insulin resistance"
And the idea that fat = calories in - calories burned is a simplistic view that no serious nutritionist on either side of the debate believes.
I want to preface this comment by saying I am not attempting to be rude or combative, I am genuinely curious.
If a calorie is a measure of energy contained in food, and food is the only source of energy for a body, and one mechanism by which the body uses that energy is to store fat, then a positive change in fat matter stored can maximally be the value of calorie intake converted to mass (in some discrete time).
Or, a positive change in fat stored (mass) <= calories in (again, in some discrete time).
Is this still too simplistic?
[Edit: I hope it's clear that I don't advocate eating 1000 calories of any one food. :)]
Again, no. The reason obese people are so obese is because they are never satiated. You can eat potato chips and drink soda all day, without ever feeling full. Secondly, it's an addiction to refined sugars and super simple carbs. I'm not arguing that calories aren't calories, but your body reacts differently to a Snickers bar than it does broccoli.
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.
"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."
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.
I like Jason Fung's theory best too, but there still are some problems. Its true that I've mischaracterised it somewhat, but he seems to hold several theories at once, for example:
* The overflow theory: https://www.dietdoctor.com/new-paradigm-insulin-resistance
* The insulin desensitisation theory: https://www.dietdoctor.com/insulin-causes-insulin-resistance
The desensitisation theory (eating too many carbs too often without pause we desensitise our insulin receptors, causing increased insulin secretion) has the same problem as the lock-and-key/fat model - how come the liver receptors are still just as sensitive to insulin when it comes to producing fat? There is some inconsistency there, for sure - its either my lack of familiarity with the topic, or a problem with the theory.
IIRC a study showed low carb diets worked in a similar way, people just ate less as they found it harder to find enough calories.
It sounds to me as if it's the refined carbs/sugars that are the primary enemy.
* By cured, I mean they were able to get off of all medication. But if / when they revert their diets, the symptoms come back, and the meds are again required.
In general minimizing starchy carbs alone, along with refined sugars and grains goes a long way. If you eat vegan or keto/lchf. I've done both... with vegan, I still had to take a large amount of insulin and gained weight, even at 1500-1800 calories a day... on keto, I eat a little more but managed to lose 63# last year and come off insulin (mostly).
They never seem to walk anywhere, the moto is ubiquitous and the city is not build for walking. If I walk half an hour across town then they're astonished that I didn't take a tuk-tuk. Khmer people don't go to gyms.
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.
My Khmer tutor is a skinny 28-year old who has eaten white rice four times a day for her entire life. She's kinda typical here.
It's possible it's down to parasites. Foreigners routinely get amoebic dysentery here, but the locals don't. I have no idea how you build up an immunity to amoebas, maybe you just get used to them.
Personally, following a vegan, or even doctor recommended diet for diabetes I gained weight on both... on keto, I'm down 63# last year, and feeling much better and mostly off medication. I've also got a dysfunctional metabolism, so YMMV.
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.
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".
Isn't that precisely his point?