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Genetic Study Supports Carbohydrate-Insulin Model of Obesity

160 points| ot | 8 years ago |medium.com | reply

78 comments

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[+] codingdave|8 years ago|reply
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|8 years ago|reply
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

[+] chadcmulligan|8 years ago|reply
The author has fairly impressive credentials, granted his style is unique.
[+] acchow|8 years ago|reply
> 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|8 years ago|reply
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.

[+] wutbrodo|8 years ago|reply
I think the main mechanism is that it doesn't get absorbed. For example, sugary urine is a well-understood side effect of diabetes that isn't well-managed, caused by your kidney draining excess sugar from your bloodstream into your urine.

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.

[+] jimrandomh|8 years ago|reply
They turn into glucose and hang out in the blood causing problems until the kidneys filter it out and excrete it.
[+] cageface|8 years ago|reply
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...

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

[+] toasterlovin|8 years ago|reply
Health outcomes for vegans are probably skewed heavily by the fact that the vegan sub-population consists of people who A) spend a lot of time obsessing over what they eat, and B) have the wherewithal to successfully pull-off a major dietary intervention (which is what veganism is, essentially).
[+] christophilus|8 years ago|reply
I think it's because of the high fiber, low processed sugar nature of the good vegan diets. There are very unhealthy vegans that eat lots of weird processed things. But yeah. Anecdotally, I know people who were "cured"* of type II diabetes, high blood pressure, high cholesterol, etc by switching to a high-carb (no refined carbs) vegan diet. I also know people who have had the same results by dropping carbs and moving to a high fat, high protein, high veggie diet.

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.

[+] ubiquitoust|8 years ago|reply
The American Standard Diet is high fat & high carb. High fat diet should be done with low carb e.g. ketogenic diet. Keto can be efffective in reversing type 2 diabetes. Same thing with high carb diets, it only works if it's low fat.
[+] Mikeb85|8 years ago|reply
Vegans (the healthy ones at least) tend to consume complex carbs and lots of fibre. Furthermore, due to self-selection (vegans tend to be more health-conscious than the general population) I'd wager that vegans are also more physically active.
[+] squids|8 years ago|reply
I think the theory was that vegan food is less palatable and often less calorie dense and harder to find so vegans eat less.

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.

[+] kazinator|8 years ago|reply
Fat vegans are out there. "Vegan" is no magic bullet.

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.

[+] spion|8 years ago|reply
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.

[+] vixen99|8 years ago|reply
Lots of videos and the odd link to a peer-reviewed paper on a site run by one physician doesn't add up to a 'lot of evidence'. That doesn't mean he's wrong but I'll agree with you on 'caution needed'.
[+] jlebrech|8 years ago|reply
those who eat a lot burn a lot too. it's the sugar go to sleep with that affect you, not energy that you actually use.
[+] jlebrech|8 years ago|reply
hgf-1 consumption is lower in vegans too
[+] sc4les|8 years ago|reply
It's not. People just love books about how good bacon, eggs, milk and cheese are for your health
[+] marcus_holmes|8 years ago|reply
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|8 years ago|reply
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|8 years ago|reply
Same here in Vietnam. Eating vegetables along with your rice, like SE Asians do, makes a big difference in how your body metabolizes carbohydrates.
[+] esaym|8 years ago|reply
Well, this makes me want to go straight to /r/keto ...
[+] lucidguppy|8 years ago|reply
What happens to the fat that you eat if you don't burn it off?
[+] sc4les|8 years ago|reply
Nice try, dairy industry
[+] Axsuul|8 years ago|reply
How would the dairy industry want this?
[+] jimrandomh|8 years ago|reply
> 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|8 years ago|reply
> 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?