Bump: The Diabetes "Crash" Cure & Pancreatic Fat

Today's 8/15/13 bump was inspired by a comment by Tsimblist (thanks!) alerting me to this paper:  Type 2 Diabetes Etiology and reversibility

Reversal of type 2 diabetes to normal metabolic control by either bariatric surgery or hypocaloric diet allows for the time sequence of underlying pathophysiologic mechanisms to be observed. In reverse order, the same mechanisms are likely to determine the events leading to the onset of hyperglycemia and permit insight into the etiology of type 2 diabetes. Within 7 days of instituting a substantial negative calorie balance by either dietary intervention or bariatric surgery, fasting plasma glucose levels can normalize. This rapid change relates to a substantial fall in liver fat content and return of normal hepatic insulin sensitivity. Over 8 weeks, first phase and maximal rates of insulin secretion steadily return to normal, and this change is in step with steadily decreasing pancreatic fat content.

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Must See "TV" for those suffering from CDS

BUMP!  Original posting:  1/24/11

CDS = Calorie Denial Syndrome

BBC Story about Low Carb Dieting - Part 1
BBC Story about Low Carb Dieting - Part 2
BBC Story about Low Carb Dieting - Part 3
BBC Story about Low Carb Dieting - Part 4
BBC Story about Low Carb Dieting - Part 5

(HatTip to Wolfstriked for linking to this in comments.)

Just a few thoughts on this aside from the content so that my opinions will not cloud your listening of the presentation:

I found it interesting that they showed both Westman and Foster exercising (running and playing basketball) in their intros in the piece.  Indeed they are interviewed in their gym clothes!  Then there's Dr. Mary Vernon horseback riding.  Did we need so many closeup chewing scenes?  And, lastly, was the full rear (albeit blurred) Sipowitz moment in the shower, actually that rather lengthy soaping/showering scene, really necessary as a backdrop to the discussion of ketosis?

Hardwired Calories Out

If you've heard it once, you've probably heard it a thousand times, that ELMM = Eat Less Move More is a failed strategy for weight loss.  The rationale is something like one or more of the following:

• A calorie is not a calorie, because two people who eat the same amount won't weigh the same, or gain or lose the same amount of weight
• The 3500 cal/pound fat figure is wrong because with deliberate overfeeding or caloric restriction, people don't gain or lose exactly as this formula would predict 
• If you eat less your metabolism will just slow down to compensate
• If you move more deliberately, aka exercise, you'll just move less later in the day and/or be so hungry you'll compensate by eating more. 

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Exercise & Adipose Tissue ~ Part I: Adipose Tissue & General Relationship

From the great research group of Keith Frayn, Aging Hippie linked to this article recently:

PHYSICAL ACTIVITY AND EXERCISE IN THE REGULATION OF HUMAN ADIPOSE TISSUE PHYSIOLOGY

In composing this post, it started to get rather long so I'll break it up into parts.  I'm going to do a bullet-pointed summary and excerpts for you.  Direct quotes will be in italics, regular font is my paraphrased summary, and non-indented/bulleted text is my general commentary.

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LC v. LF Diet Comparison Study Shows Calories Determine Weight Loss

This time in a somewhat heterogeneous (mixed) population of Type 2 diabetics.  In type 2 diabetes, randomisation to advice to follow a low-carbohydrate diet transiently improves glycaemic control compared with advice to follow a low-fat diet producing a similar weight loss

From the paper:

In the low-fat group, the mean age was 62.7±11 years, there were 13 men and 18 women and the mean duration of known diabetes was 8.8±6.2 years.Corresponding figures for the low-carbohydrate group were 61.2±9.5 years, 14 men and 16 women and a duration of known diabetes of 9.8±5.5 years. Age, sex distribution and known duration of diabetes did not differ between the groups (all p>0.5).

This was a two year study with assessments at 6, 12 and 24 months along with an additional assessment of intake at 3 months.  These time frames match up with Shai.   Unlike Shai, the dietary prescriptions for both LF and LC were calorie restricted -- 1600 cal/day women, 1800 cal/day men and for LC there was no induction/phasing in more carbs.  Average intake was assessed with 3 days of journaling including 1 weekend day.  The oral medication usage at baseline was quite a mixed bag but similar between groups.  For LF/LC the numbers were:  diet only - 2/2,  oral hypoglycemics - 13/15, oral hypo + insulin - 11/10.  The breakdown of statin use by number of patients wasn't reported, though average dosage was provided in the summary table.  

For most of the participants, the intervention was comprised of some initial dietary instruction and monthly group meetings.  Dietary instruction was provided at baseline, 2, 6, and 12 months by different physicians.  A dietitian provided the first week's menu, recipes, and was available to ask questions at group meetings but individual counseling was not provided for all.  For some reason, during the first year, the dietitian had individual consultations with 4 LC'ers and 3 LF'ers.  Retention was good as only 3LF/4LC were lost for failure to attend meetings.    However at 24 months, the dietary record submission was quite different between groups with only 4 LF'ers (out of 28 completers) not submitting records while 10 LC'ers (out of 26 completers!) did not submit.

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Energy deficit w/o LC alters resting carb oxidation and FA availability

Originally lucky post #13 made on March 23, 2010

In light of all of the "fat burning" , respiratory quotient and mitochondrial mayhem discussions of damaged metabolisms, I thought this might be a fitting post to bump to the top today.  The take home message of this study, IMO, is that the body burns what it needs to burn, and hormone levels adjust accordingly, not so much the other way around.  

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Energy deficit without reducing dietary carbohydrate alters resting carbohydrate oxidation and fatty acid availability

Reduced carbohydrate (CHO) availability after exercise has a potent influence on the regulation of substrate metabolism, but little is known about the impact of fat availability and/or energy deficit on fuel metabolism when dietary CHO availability is not reduced. The purpose of this study was to determine the influence of a postexercise energy deficit, independent of CHO availability, on plasma substrate concentrations and substrate oxidation.

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Just eat half a pizza and be done with it!

If you haven't already done so, I highly recommend an internet bop on over to Anthony Colpo's blog to read his awesome interview with Muata Kamdibe.   Muata made a number of great points in that interview that resonated with me and that I've been meaning to blog on before this past week's little diversion.  So this probably won't be the last post inspired by that interview.  I first "met" Muata on James Krieger's Weightology website, and you may recognize the unique name as someone who comments here occasionally. So in the context of discussing getting obsessed over PubMed studies and scientific minutia (yes, I'm guilty of that quite often!), Muata said:

Also, folks who do actually realize that “Eat Less, Move More” is simply a template, tend to get carried away with macro breakdowns; however, they aren’t willing to track their calories for more than a few weeks. Give me a break! I mean, how silly is it for an obese person to really concern him or herself with how many grams of protein vs. starchy carbs they eat before noon? Yes, I understand that macros are of some importance, especially for athletes, but I still contend that folks needing to lose 75 to 100 pounds need to focus on simply eating less food! The reality is that if you’re used to eating a whole damn pizza in one sitting, a good starting point to lose the chub is to just eat half, pat yourself on the back, and call it a day.

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Does a "calorie not in" equal a "calorie out"?

Apparently not!

According to this study, how one creates a caloric deficient can make a difference.

The Impact of Exercise Training Compared to Caloric Restriction on Hepatic and Peripheral Insulin Resistance in Obesity

Context: It has been difficult to distinguish the independent effects of caloric restriction versus exercise training on insulin resistance.

Objective: Utilizing metabolic feeding and supervised exercise training, we examined the influence of caloric restriction vs. exercise training with and without weight loss on hepatic and peripheral insulin resistance.

Design, Participants, and Intervention: Thirty-four obese, older subjects were randomized to: caloric restriction with weight loss (CR), exercise training with weight loss (EWL), exercise training without weight loss (EX), or controls. Based on an equivalent caloric deficit in EWL and CR, we induced matched weight loss. Subjects in the EX group received caloric compensation. Combined with [6,62H2]glucose, an octreotide, glucagon, multistage insulin infusion was performed to determine suppression of glucose production (SGP) and insulin-stimulated glucose disposal (ISGD). Computed tomography scans were performed to assess changes in fat distribution.

Results: Body weight decreased similarly in EWL and CR, and did not change in EX and controls. The reduction in visceral fat was significantly greater in EWL (−71 ± 15 cm2) compared to CR and EX. The increase in SGP was also almost 3-fold greater (27 ± 2%) in EWL. EWL and CR promoted similar improvements in ISGD [+2.5 ± 0.4 and 2.4 ± 0.9 mg · kg fat-free mass (FFM)−1 · min−1], respectively.

Conclusions: EWL promoted the most significant reduction in visceral fat and the greatest improvement in SGP. Equivalent increases in ISGD were noted in EWL and CR, whereas EX provided a modest improvement. Based on our results, EWL promoted the optimal intervention-based changes in body fat distribution and systemic insulin resistance.

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Another 1500 Calorie Lesson in Reality

The apparent ineffectiveness of "conventional diets" for weight loss was somewhat lost in the excitement of the recent intermittent LC study.  Well, maybe not lost entirely ... there's always lots of "see, counting calories is useless" to go around.  But it struck me, yet again, that part of the problem with such traditional weight loss diets is that they are simply too high in calories to produce significant losses.  

Harvie's group has done a number of studies (I hope to discuss some when I get time and if I can get the full text of some) in pre-to-post menopausal age women with a focus on breast cancer risk.  Her group's "standard diet" seems to be a 1500 cal/day diet.  In the study presented at the San Antonio conference, the control group followed a 1500 cal/day Mediterranean style diet, and lost a piddly 4 pounds over 4 months.  See?  They don't work!!  Perhaps the reason why they don't work, however, is because that is simply not a weight loss level of calories for most women.  Now, this is a tough pill for many of us to swallow, but swallow it we must or we'll tear our hair out wondering over our metabolic derangements and hormonal dysfunction (or is that metabolic dysfunction and hormonal derangements ... or does it matter? ...).

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A Potentially Useful Weight Loss Tool?

Body Weight Simulator

Hat-tip to Sanjeev for finding this.  It might be helpful for those trying to lose weight in a more structured manner.    

Any time I see Hall's name, I can't help but be reminded of my good buddy Taubes.  He is one of those "smart young biophysicists at NIH" who kept trying to set Gary Taubes straight.  See Conservation of Energy -- Biophysicist Style , Gary Taubes Names Names.  In my opinion, Taubes deliberately misleads his audience on the works of Kevin Hall (and Carson Chow) when he claims that these two still agreed with him that insulin so fundamentally regulates fat mass the whole G3P thing is ultimately irrelevant.  For starters, the "can't store fat w/o carbs" used to be a key part of his hypothesis.  For another, Taubes is left with scrambled eggs all over his face (cue Frasier episode ending theme) about the G3P issue.  This is something when supposedly answering his critics, Taubes preferred ad hominem attacks on yours truly (I'm so confused!) than to address his Newsholme & Start problem.  

Taubes insists it's still all about the insulin though, and others will have you think you're at the mercy of your cortisol, leptin, thyroid, etc.  A problem here is that no doubt there are those who are legitimately genetically predisposed towards obesity in the mix of those afflicted in the course of this epidemic.  For these relatively few, their hormonal milieu is such that their basal metabolisms are unusually slow and their substrate oxidation rates and preferences dysfunctional, etc.   This can lead to increased energy intake due to an insatiable appetite or unconquerable fatigue. In this vein, the whole Eat Less Move More, ELMM, prescription may seem cruel (and ineffective) for this small proportion of the obese.  But, it does not invalidate the "tautology". And, frankly, it does not speak to those who have become obese (including myself) as part of the wave of the epidemic.   

I note that nowhere in this program is there a place to enter one's hormonal status.  This model is based on predictions obviously calculated from "average" data.  Do hormones come into play?  Sure.  And metabolic adaptations (reductions in RMR) are highly variable, but no doubt the simulator takes observed averages of this into account as well.   Still, basically *if* one can consistently control intake and deliberately maintain a degree of activity, the result will be reduced weight for good.  

Let's take a trip in the way back machine, shall we?

It's been exactly one year since this Gary Taubes interview with Jimmy Moore aired.  In one of Gary's emails to me he stated that this was taped on June 14, 2010, two weeks after your's truly published "Da Bomb":  Glyceroneogenesis v. Taubes.  I'm not aware of what other bloggers were talking about this specific issue at the time.  I'm going to ask you to give me about 10 minutes of your time to listen to what Gary was saying then about errors in GCBC.  It is important, I think, to listen to his "voicey language" as I call it.  The hesitation, high pitch at some points, throat clearing, etc.  Because there can be no doubt that the question was set up between Jimmy & Gary to give him a platform to set the record straight.  He was prepared for this ... he was not put on the hot seat in any way, and Jimmy would certainly not be trying to trip the guy up.   

FF to about the 38:30 mark

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Addressing Andreas (and Taubes): On Relevancy, Reality, Inconvenient Facts, and Internetiquette

OK ... Just so you know, dear readers, I thought a bit on whether Andreas Eenfeldt's response to my post was worthy of responding to, and on the best way to do so.  To respond to comments on his blog or a separate post here.  As you can see, I chose the latter, largely because he has allowed his comments to devolve with various and several scurrilous accusations of stalking, questionings of my mental capacity and stability, etc.  To engage in this environment is not appealing to me, and shame on you Dr. Eenfeldt for publishing such disgusting commentary on your blog.

I'm hoping this will be the last post on this particular topic, but who knows ... It seems a blogger's work is never done trying to debunk LC mythology, and for now Andreas is the only (somewhat?) credible voice speaking up in Taubes' defense.

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Grey & Kipnis ~ Hyperinsulinemia and Diet Paper

It appears that the website that formerly hosted the full text PDF of the Grey & Kipnis study I cite quite frequently here has been taken down.  I'm sad to see this.

I've linked to that hosted copy so many times it would be impossible to go back and change them all at this point.  Instead I'm posting this up if anyone ever needs to find the reference in an older post, and I'll use my new Google docs host link in all future posts.  

Here it is:

Effect of Diet Composition on the Hyperinsulinemia of Obesity

Guyenet v. Taubes: Is There a Working Hypothesis for Obesity?

In re-reading this I realize there are a number of redundancies and it is hopelessly long.  I don't really have the time/desire to chop it down to a more concise version, so posting it up as is with apologies!

With his English language blog, appearances at various conferences and LLVLC events/cruises, and the apparent rise in popularity of low carbing in Sweden, Andreas Eenfeldt is a rising star promoting low carb diets.  Therefore, I think his comments on Stephan's recent debunking of Taubes Wrong Insulin Carbohydrate Hypothesis Of Obesity, TWICHOO, and the post on his blog about same deserve some attention.   One of the things that is disturbing about GCBC and Taubes' presentation of the science is that he frequently says "we don't know XYZ because the experiments haven't been done".  The "Diet Doc" seems to have taken this to heart as he views TWICHOO as a "working hypothesis" and he seems unaware of the state of knowledge possessed by researchers on various obesity related topics.  

Some excerpts of Andreas' first comment in response to Stephan's debunking:

First of all: You state that low carb diets do indeed work well for weight loss most of the time, and that you see that as a fact. Kudos to you for acknowledging it. However, you can't say for sure why they work, if not through insulin, so maybe we should not rush to conclusions yet.

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Lessons from my cat ...

I was feeding my low carb house carnivore this morning and a couple of things occurred to me in light of the discussions on what causes obesity.  Many of these theories are based on the knowledge of a presence of an energy homeostasis mechanism and how something goes awry with this.  

My kitty eats about 1.5 cans of food per day.   I put his food out a full can at a time and when the plate is empty I put out another can.  Therefore there's really no fixed time when a fresh can gets put out and sometimes he has to wait.  This morning was one such time as he was low on food last night before I went to bed, but since I want him to finish the old stuff I won't put out a fresh can.  So this morning he greeted me meowing at the plate and as soon as I put the food he went to town.  I'd say he ate about a third of the can and walked away.   He knows where the food is and that it will be there all day, but he probably won't go back for more until noonish.

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The Dietary Strategy of Separating Carbs & Fats

The recent post on the Harcombe Diet reminded me of some things that I've posted here regarding the separating carbs and fats in one's diet.  Almost a year ago now, I wrote this post:  Separating Fats & Carbs

In that post I laid out my rationale for this dietary strategy to prevent obesity.  It is also a strategy I generally employ to this day for maintaining my losses thus far.  Personally, I doubt this is a viable ad libitum strategy for weight loss that I'll discuss later.  

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Zoe Harcombe ~ Credentials?

We've discussed this lady before here at the Asylum, but I was recently made aware of some additional information about her that folks might find interesting in assessing the information she promulgates or to counter those who tout her work in LC circles.  

Let's review.

Zoe Harcombe is the author of a few diet books who hopes to take the world by storm and fix the obesity epidemic in the UK.  She has a story to tell about weight loss after a history of eating disorders in college and 15 years of maintenance.  But as commendable as conquering ED's is, there's no indication this woman ever had significant excess weight she had to lose.   

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Set Point ~ Settling Point Part II: Substrate Balance & Body Composition

Continuing the discussion of Point 9 from this paper, and Part I,

Although less obvious than the fact that energy intake must be equal to energy expenditure, weight stability also requires that the substrate mixture oxidized be equivalent, on average, to the composition of the nutrient mix consumed. When “substrate balance” is not achieved, changes in body composition occur, which in time are bound to elicit adjustments in food intake.

The contributions made by carbohydrate and by fat to the fuel mix oxidized is reflected in the ratio of CO2 produced to O2 consumed. This ratio is known as the “respiratory quotient” or “RQ.” It varies between the values of 1.0, when CHO is the predominant fuel, and 0.7, when oxidation of fat provides most of the body's energy. The ratio of CO2 produced to O2 consumed during the biological oxidation of a representative sample of the diet consumed is defined as the “food quotient” or “FQ”. Stable body compositions will only be sustained if the average RQ matches the average FQ of the diet.

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Dr. Eades on Starvation Diets

When the recent news broke that a Crash Diet (600 cal/day) cured diabetes, discussed HERE,  HERE,  HERE, there was the inevitable invoking of the Minnesota Starvation Experiment in the low carb circles.   A while back, I addressed the MSE in a post entitled Starvation Diets shortly after I had blogged on a study in which one part involved putting three obese women on a 1500 cal/day liquid reducing diet.

The point of that last blog post was that  in the 1970's, the average intake of American women was 1550 cals.   Now folks, keep in mind that averages mean that some women ate less and some ate more.   Dr. Michael Dansinger -- he of the famous diet comparison study and consultant on The Biggest Loser -- told Jimmy during his interview with him that they generally cut the contestants' intake in half on that show.  I don't have time to go back and listen, and the exact numbers aren't really all that important, but the women generally start out eating around 3000 cal/day, so their reducing diet is 1500 cal/day.  Lots of low carbers sneer at TBL as, of course, being the wrong way to lose weight, they could just go low carb and achieve the same results by eating more.  

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Government Guidelines - Let's Get Real!!

** I'm updating and bumping this post because my omission of a link to the blog post has led to some confusion as to the reference to Dr. Jeff Volek in the second to last paragraph.

Here's the blog post I was discussing:  http://livinlavidalowcarb.com/blog/jimmy-moores-may-2010-testimony-before-the-usda-regarding-the-2010-dietary-guidelines/10989

-------------- original post -------------

So ...

If I've heard it once, I've heard it a thousand times. The USDA's misguided nutritional advice has wreaked havoc on our population and spawned the obesity epidemic.

Really?

Firstly, let me state flat out that I agree that the old pyramid was misguided. And I believe the newer guidelines are even more misguided. They aren't going to solve the problem. Basing a diet on whole grains and encouraging grain consumption when whole grains equates with flour and highly processed foods is absurd.  

That said, let's be honest here. When a 275-ish pound Jimmy Moore testified before the Congressional committee and made the following statements:

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