why we get fat and what to do about it v2


  • Although protein does not raise blood sugars as much as carbohydrate, it still requires insulin.
  • Dietary fat does not raise your blood glucose and is not insulinogenic.
  • Optimal nutrition is about maximising micronutrients while managing your glucose load so your pancreas can keep up.
  • In addition to managing carbohydrates, moderating protein, increasing fibre and maximising nutrition, are important to optimise body fat and normalise blood glucose.

background

Gary Taubes [1] has moved the needle in terms of the wider acceptance of the hormonal theory of obesity with his books Good Calories Bad Calories and Why We Get Fat and What to Do About It. 

The hormonal theory of obesity revolves around the idea that the food we eat affects our insulin levels which in turn governs how much fat is stored or used for fuel. [2] [3]

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With his focus primarily on carbohydrate, Taubes has not directly address the fact that protein also requires insulin, stating:

“the assumption has always been that the effect of protein has is small compared to that of carbohydrates, and that it is muted because protein takes considerably longer to digest.” [4]

This may be true to an extent, but could a better understanding of the insulinogenic effect of protein help us further refine the hormonal theory of obesity and our ability to improve blood glucose control, particularly for those who are not able to achieve their goals by simply reducing carbohydrates?

Recently people such as Steve Phinney [5] and Jimmy Moore [6] have brought increased attention to the ketogenic diet which takes the low carbohydrate dietary approach to the next level.  One of the observations from those measuring blood ketones and trying to achieve nutritional ketosis is that, in addition to limiting carbohydrates, protein needs to be moderated in order to register meaningful blood ketone levels.  Too much protein raises insulin and reduces fat burning.

So, using Gary Taubes analogy [7], what does the food insulin index data [8] tell us that would help us ‘push the rock a bit further up the hill’?

do calories count?

The antagonists to the hormonal theory of obesity point to numerous studies that show that if you put people in a metabolic ward and feed them a set number of calories and make them exercise the same amount they will lose or gain roughly the same amount of weight regardless of the macronutrient composition of the diet. [9]

This may be largely true, other than some exceptions as discussed below.  However in the real world most people eat when they are hungry and stop when full.  Most people do not count every morsel that goes into their mouth.

It should not be necessary to consciously control our appetite.  As the Paleo community point out, somehow we seemed to have done pretty well regulating our own appetite before recent times.  Something seems to have changed for the worse. [10]

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Most low carbohydrate diet studies allow the low carbohydrate group to eat to satiety while the low fat group has to count calories so they do not exceed their target intake.  Even under these conditions though, the low carbohydrate typically usually wins out. [11] [12]

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Isn’t finding a way of eating that will make us satisfied with fewer calories the dietary Holy Grail?  When a ‘diet’ becomes enjoyable and self-regulating it is no longer a ‘diet’, it’s just a way of eating!

So what is it about higher fat dietary approaches that leave people naturally satisfied on fewer calories?

what does insulin do?

The hormone insulin is a tangible reality in our family.  We have vials of it sitting in the fridge!

My wife has had type 1 diabetes for nearly three decades and wears a pump to deliver insulin through the day with extra doses at meals.

Helping her to refine her insulin doses has become a regular pastime for me, especially through our two pregnancies to try to give our kids the best chance of success.

I think it is helpful to look at diabetics to see what happens when we have too much or too little insulin.

Type 1 diabetics, before they start on insulin, are typically wasting away because their pancreas has stopped making enough insulin. Extremely low levels of insulin cause them to use body fat and muscle for fuel to a point where they waste away.

At the other extreme, diabetics often find that they gain weight quickly when they start injecting insulin.  Insulin is an anabolic hormone that regulates how we grow muscle and store fat.

The picture below shows “JL” one of the first type 1 diabetics to receive insulin in 1922.  The photo on the left is after diagnosis but before insulin.  The photo on the right is the same child two months after starting insulin injections.

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Check out this post to see photos of my kids when they were born after spending nine months in a high insulin environment.  It’s hard to argue that they were born big due to gluttony and sloth in utero!

I found this explanation from Robert Lustig helpful to understand how insulin affects our appetite, energy levels and fat storage.

If we are consuming highly insulinogenic meals a little bit extra energy gets stored away each time we eat.  Unfortunately this extra food does not help us feel full or provide more energy, it just gets stored as fat and we just have to eat more at the next meal.  If we also try to restrict calories to lose weight we feel sluggish and have low energy and our metabolism down-regulates to compensate!

This chart from Richard Feinman’s The World Turned Upside Down illustrates the process of cumulative fat storage in a high insulin environment.

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The Atkins approach recommends that you reduce your carbohydrates to less than 20g per day during the two week ‘induction phase’ and then allows you to wind them back up slowly to the point that you stop losing weight. [13]

With Atkins however there is no consideration of the insulinogenic effect of protein.  Unlimited fat and protein are allowed as long as you are limiting carbohydrates.  The problem is if you just increase protein and still fear fat you may not get enough reduction in insulin to allow your body to properly access fat for fuel.

Richard Feinman uses the analogy that insulin is like a tap that controls fat storage.  Without high levels of insulin we can not store as much fat, and thus we have more calories available for energy and therefore do not feel the need to eat as much.

Conversely, if we eat meals that generate less insulin we will be more likely to be able to access our body fat stores for fuel (i.e. ketosis).

This net flow of energy from (rather than into) our fat cells leaves us a little less hungry at each meal because we are getting calories from our fat stores, and hence we are less like likely to overeat without consciously trying.

meal timing

In the past, the nutritional community has looked to the ‘healthy’ body building community as the model to follow.  Bodybuilders often eat five or six meals a day to make sure they gain muscle and ‘keep their metabolism high’.  Food manufacturers have been only too willing to design foods for every occasion, with a burgeoning protein and supplement industry.

The problem is, unless you’re a body builder aiming for ‘mad gainz’, working out intensely, meticulously planning your meals and tracking every calorie, increased meal frequency  is probably not going to end well for you.

The figure below demonstrates how obese people generally have elevated insulin levels throughout the day.  By contrast, lean people tend to have more punctuated bursts of insulin, with the bursts balanced by  with periods of lower circulating insulin when the body is able to access stored body fat for fuel.

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Like me with my caffeine addiction, constant use of anything will lead to tolerance and insensitivity. [14]  Many find they become insulin resistant due to a diet of fsat digesting highly processed carbohydrate based foods.

One option that has become more popular in recent times is the concept of intermittent fasting. [15]  [16] [17] Going for period without food (or at least carbohydrates) enables your body to decrease insulin levels and allows it to access body fat for fuel.

The increased use of body fat for fuel during the fasting period typically results in a reduction of total food intake across the day.

Some people who have tried low carbohydrate diets with limited success find that intermittent fasting is what allows them to achieve the improved blood glucose and / or weight loss they are after.

I know for me it was intermittent fasting that helped me to improve my blood sugars, raise ketone levels and kick-start fat loss that I had been striving for but not achieving, even on a low carbohydrate Paleo approach.

when a calorie is not a calorie

You may be aware that gluconeogenesis is the process where the body can produce glucose from protein.  I only realised recently that protein is made up of glucogenic amino acids (approx. 78%), ketogenic amino acids (approx. 12%) and amino acids that can be either glucogenic or ketogenic (approx. 14%). [18]

Digestion breaks protein down into amino acids which circulate in our bloodstream until they are required for muscle growth and repair (i.e. protein synthesis) or to balance blood sugars (i.e. via gluconeogenesis).

When we do not eat protein or carbohydrate for a long period the body can obtain glucose from muscle via gluconeogenesis.  This is how we can survive long periods of starvation and still supply adequate glucose to the brain.

“In fasting and on a low carbohydrate diet as much of the amino acid carbon as possible will be used for gluconeogenesis.” [19]

For someone on a low carbohydrate diet this means that nearly 90% of protein not used for muscle growth and repair can be converted to glucose!

The fact that protein can turn to glucose just like carbohydrate at first sounds absurd, then scary.  However it is possible to use the glucogenic properties of protein as a ‘hack’ to help you achieve weight loss and / or normal blood glucose levels.

The first benefit is that glucose from protein is accessed as required from the amino acids circulating in the blood stream rather than raising blood sugar immediately, as is typically the case for carbohydrate, particularly if our liver and muscle glycogen is already full.

The second benefit is that it takes extra energy to convert protein to glucose before it can be used for energy.  This is sometimes known as the ‘thermic effect of food’. [20]

You are likely aware that one gram of carbohydrate will digest into on gram of glucose that will provide four calories to be used by the body for energy.  If you burn one gram of protein in a calorimeter you’ll get four calories of heat.

However to convert one gram of protein to glucose takes approximately one calorie, so you only get three calories for energy or body fat storage.  [21]  Viola!  A calorie is not a calorie when it comes to protein being converted to glucose via gluconeogenesis.

Sam Feltham did an interesting n=1 experiment where he compared the effect of 21 days of excess calories on a high carb diet versus the same number of calories on a LCHF approach.  The results are summarised in this chart.  The weight gain on the LCHF approach was minimal, with waist measurements coming down.  However on the high carbohydrate approach the weight gain was basically as per the calories in calories out formula.  Interestingly, the vegan approach was only slightly better than the high carbohydrate approach.

Day21Results

fat and insulin

When it comes to insulin demand and fat storage, dietary fat is unique.

The major theme that reappears throughout Richard Feinman’s The World Turned Upside down is that

“carbohydrate and protein can be turned to fat but, while glucose can be made from protein, with a few exceptions, you can not make glucose from fat.”

Excess glucose from carbohydrate and protein enters our blood stream and is removed, with the help of insulin, to be stored as fat (i.e. lipogenesis).

The chart below shows that the body secretes less insulin in response to higher fat foods. [22]

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If you turn things around to look at insulin demand in terms of non-fat calories (i.e. carbohydrates plus protein) we see that there is effectively no insulin response to fat!

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What this means is that the low fat foods we have all been eating to avoid getting fat and getting heart disease are the number one way to increase insulin, which facilitates fat storage as well as increasing insulin resistance which is the primary thing that drives heart disease! [23] [24]

If we eat fewer calories overall the body will use our body fat for energy, but only if insulin levels are low enough to allow the fat to be released for fuel.

If we are trying to lose weight the highest priority is to reduce the insulin load of our diet.  We can then eat fat to satiety while maximising nutrition.

can you eat too much fat?

So can eating too much fat make you fat?  Yes and no.

If we eat a high fat diet that is also high in carbohydrates and protein we will have high insulin levels and most likely a calorie excess.  This will lead us to store the glucose from the carbohydrates and protein as fat. [25]

However if our diet is low in carbohydrate and moderate in protein such that our insulin levels are reduced, we will be able to access our body fat for fuel, and therefore be less hungry.

In the absence of significant amounts of insulin we typically do not overeat fat.  A low carbohydrate, moderate protein, high fat diet will typically lead to reduced hunger, reduced calorie intake and typically lead to weight loss.

If you are struggling to drop weight on a high fat diet, then a period of intermittent fasting and/or tracking your food in a food diary (e.g. MyFitnessPal or Cronometre) might help establish your target macronutrient ratios and avoid overdoing the calories.  After this period of ‘retraining’ you should ideally be able to just eat when you’re hungry and stop when you are full.

The figure below shows the macronutrient ratio of four phases of a ketogenic diet according to Steve Phinney. [26]   Note how in the early phases of the ketogenic approach the dietary fat percentage does not necessarily have to be high.  Carbohydrates are low enough to reduce insulin levels to the point that body fat can be used for fuel.

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Once the desired weight loss is achieved carbohydrate levels can come up a little with fat increasing significantly to supply adequate calories for weight maintenance.

carbohydrate

The food insulin index data below shows us that carbohydrates are the primary macronutrient that generates insulin. [27]

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Carbohydrate is typically the body’s primary source of glucose.  We need some glucose for the brain to function (about 40g to 160 calories per day minimum), however the body can obtain this from protein via glycogenesis if there is no carbohydrate available.

You may have heard that the body has no need for carbohydrates and that there is no such thing as an essential carbohydrate.  This is true, however you should keep in mind that many important vitamins come packaged with carbohydrates (e.g. vegetables).

The optimal approach is to obtain high levels of nutrients while avoiding excessive insulin and normalising blood sugar.   We can do this by selecting high nutrient density, low insulin, and high fibre vegetables such as those contained in the food lists here.

fibre

While the low carbohydrate diet crowd tend to prioritise avoidance of carbohydrate-containing foods to improve blood glucose levels and achieve weight loss, many people also do well using a high fibre high vegetable approach. [28]

Most agree that eating lots of vegetables is a good idea.  As discussed in this article there is a strong basis for a low calorie density, high nutrient density diet for weight loss and health.

The insulin index data also supports this approach.  As detailed this article, the insulin demand of foods is better predicted by net carbohydrates (i.e. total carbohydrates minus indigestible fibre) than by only considering carbohydrates.

The insulin index data also supports this approach.  As detailed in this article, the insulin demand of foods is better predicted by net carbohydrates (i.e. total carbohydrates minus indigestible fibre) than by only considering carbohydrates.

Indigestible fibre effectively neutralises the insulinogenic effect of carbohydrates. Fibre also adds to the bulk of our food which helps with satiety and also feeds our gut bacteria, which is highly beneficial. [29]  [30]

Rather than taking fibre supplements, the ideal approach is to select high fibre foods that also have a low insulin load.  Some examples of these are spinach, mushroom, broccoli, and Brussels sprouts.  More options are detailed in these optimal food lists.

High fibre foods also often have a high nutrient density and a low calorie density.   By eating this type of food we ensure we are getting excellent nutrition, tend to be satisfied on fewer calories and also keep our insulin load down.

We are now learning the importance of fibre for our gut bacteria which influences the rest of our health.  Reducing the sugar and process carbohydrates will help to avoid manage any overgrowth in ‘bad bacteria’.

People who do not have blood sugar issues may do well on things like sweet potato, rice, lentils and tomatoes (these foods are included in this list of foods for the metabolically healthy).  However if you’re struggling to control your blood sugars you should be mindful that these foods will add to your insulin load and should be minimised (these lists of optimal foods for weight loss or optimal foods diabetes and nutritional ketosis are more ideal if you are struggling with high blood glucose levels).

In summary, maximising fibre is another tool that we can use, in addition to minimising carbohydrates, moderating protein and eating fat to satiety, to manage blood sugars and obesity.

protein

High protein foods do not generate a sharp rise in blood sugar compared to high carbohydrate foods because the digested amino acids circulate in the blood for use as required to raise blood sugar, rather than directly spilling into the blood stream in the same way that simple carbohydrates would raise your blood sugar if your glycogen stores were already full.

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Protein is also satiating and typically leads to a reduction in overall calories.  Your body will continue to search out food until it obtains adequate protein.  Once you obtain adequate protein you will be more likely to stop eating. [31]

Protein also contains a range of essential and non-essential amino acids that are required for muscle growth and repair as well as mental function.  Maximising the amount and variety of amino acids that come from our diet is the ideal approach rather than trying to supplement.

As noted above, increasing your protein intake is a possible ‘hack’ for diabetics to obtain glucose without spiking blood sugars.

Diabetics and ‘low carbers’ will often limit carbohydrates but compensate by increasing protein.  This is generally not a problem because protein is slower to digest than carbohydrate and hence the blood sugar rise from protein is slower and more manageable in comparison to carbs.  The body also releases glucagon to offset the protein used in protein synthesis which also helps to stabilise blood sugars.

However, just because protein does not spike blood sugars as aggressively as carbohydrate does not mean that it does not require insulin.    The food insulin index data indicates that while the blood sugar response is less than carbohydrates, the insulin demand of protein is still significant.

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According to Nuttall and Gannon between 32 and 46g of high quality dietary protein is required to maintain protein balance.  This represents around 6 to 7% of the calories in a 2000 to 2500 calorie diet being taken off the top for growth and maintenance.  Protein in excess of this level is available for gluconeogenesis.

This should not be taken to mean that extremely low amounts of protein are optimal for health or obtaining glucose from protein via gluconeogenesis is necessarily bad thing.   As noted in Phinney’s WFKD below protein levels can range between 10% and 30% while still being ketogenic.  The optimal approach revolves around maximising the amount of amino acids from protein and vitamins and minerals from generally carbohydrate based foods while at the same time keeping the glucose load low enough for your pancreas to keep up to optimise your blood sugars.

Ingested protein not used for growth and repair of the body does not magically disappear.  A small amount (approx. 12%) will be converted to ketones and used as it if were fat.  About 14% can be used either as glucose or fat.  But around 80% of protein can only be used as glucose.

This glucogenic protein in excess of the body’s requirements will also require insulin to be used for energy in the mitochondria or to be stored in the fat cells.

High levels of protein will generate insulin which will reduce fat metabolism (i.e. lower levels of ketones).  If your pancreas is struggling to supply enough insulin to maintain blood sugars then the insulin load from protein will make it harder for your pancreas to keep up and achieve optimal blood sugars.

If you are trying to lose weight then excess insulin (over and above the amount used for protein synthesis that receives glycogen) will also promote fat storage.

nutrient hunger

Similar to the concept of protein hunger, if you are not giving your body the vitamins and minerals it needs it will keep on seeking out more food.

In his Perfect Health Diet, Paul Jaminet notes that

“a nourishing, balanced diet that provides all the required nutrients in the right proportions is the key to eliminating hunger and minimising appetite and eliminating hunger at minimal caloric intake.”

It makes sense that eating a nutrient dense diet would help our body to heal and recover from anything else that might be causing insulin resistance and obesity.

Many people talk about the benefits of various supplements for different ailments and performance enhancement, but surely the best approach is to maximise the quality and range of nutrition from the food you eat every day before investing in supplements?

liver storage and insulin sensitivity

A healthy insulin sensitive person will store glucose in their liver as glycogen with minimal rise in blood sugars after eating, regardless of the macronutrients.

A person with type 2 diabetes however will often spill excess glucose into the blood stream which will cause the blood glucose levels to rise and thus additional insulin will be necessary to clear excess glucose from the blood.  Excess protein not used for protein synthesis will contribute to refilling the glucose stores in the liver and muscles. [32]

It makes sense in this situation that you would want to limit the insulin load (i.e. carbs and excess protein) to starve the liver (or ‘dry up the root’ to quote Bob Briggs) such that it is not over full in order to reduce spilling of excess glucose into the blood.

practical application

Steve Phinney is probably the most well respected authority on the ketogenic diet.  His ‘well formulated ketogenic diet’ versus other dietary approaches shown in the chart below is quite useful.

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You will notice that the WFKD space is a triangle indicating that you need to balance your carbohydrates and protein levels in order to manage your insulin load and achieve nutritional ketosis.

You can have 30% protein and 5% carbs, or 20% carbs and 10% protein and still be within the bounds of the WFKD triangle.

However if you run with 30% protein and 20% carbs you will be well outside the realms of a ketogenic diet because you will be producing too much insulin, meaning that you will be ‘kicked out of ketosis’ (i.e. your fat burning will be slowed).

Understanding your insulin load may be the difference between achieving your desired goals from a low carbohydrate diet and not quite getting there.

For a more detailed discussion of how to tweak your glucose load to achieve your goals check out the article the Goldilocks glucose zone.

summary

  • Although protein does not raise blood sugars as much as carbohydrate, it still requires insulin.
  • Dietary fat does not raise your blood glucose and is not insulinogenic.
  • Optimal nutrition is about maximising micronutrients while managing your glucose load so your pancreas can keep up.
  • In addition to managing carbohydrates, moderating protein, increasing fibre and maximising nutrition, are important to optimise body fat and normalise blood glucose.

[1] http://garytaubes.com/

[2] https://intensivedietarymanagement.com/tag/hormonal-obesity-theory/

[3] http://www.ncbi.nlm.nih.gov/pmc/articles/PMC329588/pdf/jcinvest00481-0161.pdf

[4] http://www.healthcentral.com/diabetes/c/36758/20088/gary-round-3/

[5] http://www.amazon.com/Keto-Clarity-Definitive-Benefits-Low-Carb/dp/1628600071

[6] http://www.artandscienceoflowcarb.com/

[7] http://ses.library.usyd.edu.au/handle/2123/11945

[8] https://www.bulletproofexec.com/gary-taubes-bad-science-gut-health-nusi-223/

[9] https://www.youtube.com/watch?v=aRCv5RWXWx8

[10] http://nchstats.com/2010/01/14/obesity-americans-still-growing-but-not-as-fast/

[11] http://www.sciencedirect.com/science/article/pii/S0899900714003323

[12] http://jama.jamanetwork.com/article.aspx?articleid=205916

[13] http://www.atkins.com/how-it-works/atkins-20/phase-1

[14] My 23andMe genetic testing tells me that I am likely to be able to metabolise caffeine quickly however I am prone to type 2 diabetes and obesity!

[15] https://intensivedietarymanagement.com/category/fasting/

[16] http://www.eatstopeat.com/

[17] http://thefastdiet.co.uk/

[18] http://en.wikipedia.org/wiki/Glucogenic_amino_acid

[19] https://www.dropbox.com/s/4dkl03mz2fci71v/The%20metabolism%20of%20%E2%80%9Csurplus%E2%80%9D%20amino%20acids.pdf?dl=0

[20] http://en.wikipedia.org/wiki/Specific_dynamic_action

[21] If you want to dive into the detail on this I recommend you check out Chapter 14 of Richard Feinman’s The World Turned Upside Down.

[22] http://ses.library.usyd.edu.au/handle/2123/11945

[23] http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2628708/pdf/361.pdf

[24] http://www.cardiab.com/content/12/1/164

[25] http://www.sciencedirect.com/science/article/pii/S0026049514001115

[26] https://www.youtube.com/watch?v=8NvFyGGXYiI&index=1&list=PLrVWtWmYRR2BlAsGG9tr6T-B4xSum8SCc

[27] Data from http://ses.library.usyd.edu.au/handle/2123/11945

[28] http://www.mangomannutrition.com/

[29] http://www.drperlmutter.com/health-depends-gut-bacteria/

[30] http://www.drperlmutter.com/tag/type-2-diabetes/

[31] http://jn.nutrition.org/content/137/6/1478.full

[32] https://www.dropbox.com/s/4dkl03mz2fci71v/The%20metabolism%20of%20%E2%80%9Csurplus%E2%80%9D%20amino%20acids.pdf?dl=0

25 thoughts on “why we get fat and what to do about it v2”

  1. Excellent and thorough article! Though as you know I do quibble with the amount of protein you continue to recommend. Nuttall and Gannon did not FIND protein needs to be at the level you mention (32 – 46 g/day), they merely repeated the USDA’s stated protein needs – and only at a level to avoid “chronic disease” not achieve optimal health. And, BTW those USDA guidelines are the same ones that say “avoid cholesterol” and so are just not credible.
    Jimmy Moore has (as you may know) suffered massive weight regain that he is trying to figure out the cause of. I wouldn’t adopt his recommendations to decrease protein, unless I were willing to risk his results – massive regain of weight. I’m not, so I don’t.
    Finally, if you work out the numbers in Steve Phinney’s “Four Phases” chart (in your section, “can we eat too much fat?”) you’ll see that in those four phases, protein consumption goes from 140 g/day, to 130 g, to 120g and finally 110g. Just to throw his numbers into the mix of the range of actual numbers people may consider eating.
    This is all friendly, of course. Your article is fantastic, but my own (more friendly) view of protein has not yet been put down by our (I hope continuing) discussion, or my or other’s results to date. Diabetics being in a different camp, naturally.

    Liked by 1 person

    1. Thanks for the ongoing banter Wendy!

      Just to be clear, I’m not trying to advocate for any particular protein intake. The reason I keep banging on about it is that I think it’s important for people with insulin sensitivity issues to consider protein as part of the mix in terms of glucogenic inputs – it’s not just a freebie.

      For type 1 diabetics this might help them with their insulin dose calculation. For type 2s this may help them avoid a HIGH protein approach that could be more glucogenic than they anticipate from current advice. Jason Fung points highlighted for me that some Atkins dieters may be thrawrting their efforts to be ketogenic by overdoing the protein.

      There are a lot of ways to look at optimal protein intake. The Nuttal and Gannon reference is about the amount of protein canabalised from the body in a starvation situation, not optimal dietary protein intake. I think the USDA recommendation for an RDA is about 0.8g/kg LBM which is adequate for 50% of the population e(i.e. not ideal). Keto body builders without blood sugar issues tend to hit about 2.2g/kg LMB. The Phinney four phases plot uses 20% protein which is a pretty good starting place. I just heard an interview of Francisca Spritzler with Sam Feltham where she recommended 1.2 to 1.7g/kg LBM which seems like a pretty good

      As you infer, fat is also not a freebie if it is in excess of caloric needs. Seyfriend suggests that overdoing fat, even with ketogenic macros can lead to insulin resistance and weight gain due to the excess calories. See http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1819381/

      I see Jimmy Moore is showing off his ketogenic meals with heaps of veggies lately which is great. I think over emphasising fat at the expense of fibre and nutrition can be dangerous. I also can’t speak for Jimmy and whatever health issues that may be driving his weight gain and whether or not he’s overdoing the calories. Ketogenic dietary approaches that work tend to have some component of intermittent fasting which will help people not to overdo the calories.

      Finding a balance point between nutrition (both aminos and vitamins) and blood sugar control is a great option for most people. Some people add fasting to this and get great results if they need to take it to the next level. Some who still can’t get control of their blood sugars may benefit from something like Metformin or perhaps insulin rather than living on a very high fat diet (say greater than 80%) that might be deficient in vitamins and aminos in the long term.

      If you look at the meals and foods that the system brings to the top I think they look pretty good – not really low protein or extremely high fat!

      https://optimisingnutrition.wordpress.com/category/recipes/

      https://optimisingnutrition.wordpress.com/2015/03/22/cheat-sheets/

      Thanks Wendy for the continued discussion.

      Liked by 1 person

      1. I agree that neither protein not far is a freebie. And I don’t mean to pick on Jimmy at all, I am a fan and supporter and I hope he figures out the teams he needs to regain control of his weight. I’ve been happy, to, to see more veg (and more meat!) in the meals he’s been sharing. Chronic undereating

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      2. Oops. Meant to say – chronic undereating of protein for years send to me could cause far gain by lowering BMR and also decreasing lean mass, which would also decrease BMR and leave you less healthy and strong to boot. The primary reason for my comment is that, as a reader, it definitely does come across as you advocating this 32-46g protein level as being proper. Every time you repeat this assertion, it comes across (to me) as further entrenching that idea, but yet, without any scientific support. That’s the real reason for my comment – to combat that level of protein becoming some sort of conventional wisdom, here out anywhere else. All best.

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      3. Point taken. That’s definitely not my intention. I’ll see what I can do to refine and polish to make sure it can’t be taken that way.

        Hopefully featuring the meals and featuring worked examples optimising meals to show optimal protein and vitamins while demonstrate what this looks like in practice.

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      4. I’ve added another para under the Nuttal and Gannon para. I think the overall flow of the article ends up being a bit klunky, but hopefully it clarifies that I’m not trying to advocate for minimum protein. See what you think.

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      5. I love Franziska Spritzler, she has incredible knowledge and experience! She actually eats a bit more protein than what you mention are her recommendations. She eats 100g/ day, which she says is just over 1.75xbody weight (*not* LBM) g/kg for her. IIRC she weighs about 125 and is 5’2″, again just to put some real numbers out there that look nothing like the USDA (cited by Nuttall and Gannon) “avoid disease” numbers. Cheers Marty!

        Liked by 1 person

  2. Hi Marty,

    Thanks for your great work. I found, the following things maybe could have been presented better:

    1. You quote Gary Taubes with regrads to protein without acknowledging that time and again he has empahadised on protein to be moderate.

    2. You cherry pick Paul Jaminet’s comment about nutrients without bringing into light his take on VLC and getting glucose via gluconeogenesis.

    3. Ketosis is the only cure- comes out as a conclusion of this post. We know ketosis is not for everyone, perhaps not for the majority to follow long term and it has its own issues.

    4. When you fail on low carb, try to starve yourself by intermittent fasting. Intermittent fasting is being promoted as a magic pill by low carb gurus whereas starving yourself for 16-18 hours on ANY diet will produce great results SHORT TERM. Many obese people can’t even do IF and this kind of recommendation is a bigger punishment for them than asking them to eat less on low fat.

    5. From this post fat comes out as a free fuel. It has minimal effect on insulin on its own but is also insulinogenic via contributing towards insulin resistance when combined with other foods and no one eats pure fat on its own.

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    1. Thanks for taking the time to read and comment:
      1. Do you have any references where Taubes promotes moderate protein specifically and the basis for this? Personally I think higher protein is probably ideal from a nutrition perspective, but many will need to bring it back down if they have issue regulating their blood glucose levels.
      2. I’m not sure about Jaminet’s position on GNG. Based on his response to a question on his PHD Facebook page it seems he would rather avoid GNG and get your glucose from carbs. His book is definitely an amazing nutritional reference though.
      3. The intended theme was to bring your glucose load (from protein and carbs) to within your tolerance level I’ll review to make sure that comes out.
      4. Most people resort to long term calorie restriction and calorie counting. I think intermittent fasting to provide periods of low insulin when we can restore insulin sensitivity is useful and easier than consistent long term starvation which the body tends to adapt to.
      5. Fat doesn’t seem to generate insulin. Most people find a high fat keto style diet quite satiating. But if you do eat a calorie excess with a high fat diet you won’t be letting your body burn its own fat stores so you won’t get the benefits. Some people do eat lots of fat. It’s called keto.
      It’s amazing what you can learn from testing your own blood sugars in response to your own diet. If it raises your blood glucose levels then it’s probably not working for YOU, either the macros or amounts. The food insulin index data helps us better understand the wider response to macros wrt glucose and insulin response.

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  3. Hi Marty,

    Thanks for your detailed response.

    Here is one of Gary’s quotes from his countless lectures and podcasts where he says that protein should be moderate:

    “actually, what you want to eat is a moderate protein, high fat diet. Fat is the one nutrient that does not trigger insulin secretion. So if you are already overweight, obese, or Type 2 diabetic, protein levels in the diet should also be kept relatively low. Although you could eat a meat-rich diet and still not get a lot, 15-20%, of your calories from protein.” He says this in response to the questions at 9.08.
    http://www.econtalk.org/archives/2012/07/taubes_on_why_w.html

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    1. Hey thanks for that. I’ll check out the vid. I’m hoping that the insulin index data will help people (particularly diabetics) fine tune their diet to balance nutrition and insulin load. I think having the data behind it is helpful to better understand the mechanics of it all.

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  4. Indeed Marty and you are doing great work. I wish we had more rigorous data on insulinogenic foods, and I wish I could monitor my insulin along with BG. I personally feel that we know VERY little about human body and its interactions to diet and environment because of individual variability.

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  5. As we are trying to keep insulin levels and IGF-1 levels low, I came across Dr Thierry Hortoughe, MD today who believes insulin and IGF-1 hormone therapy reverses ageing, he has been taking IGf-1 for 17 years and looks pretty good at 54. Now this is completely opposite of what we learned from Dr Ron Rosedale. Nutrition and health is rampant with opposing views which means we dont know much about it. Here is the youtube link:

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  6. Well, having listeneted to various talks of Dr Thierry Hertoghe, I get the impression that he does not seem to have an indepth understanding of metabolism and he consistenly maintains that his hormone therapies don’t work without paleolithic diet which makes me wonder whether the positive results he is seeing are coming from hormone therapies or the diet.

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