> 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?
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.
No, its the other way round : Kidneys let glucose through into the filtrate, but have a limited capacity of glucose reabsorption. In case of diabetes melleitus you "saturate" the pumps, hence the resulting glycosuria.
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.
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?
>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.
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.
> 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".
A good amount of the calories in whole milk come from fat. In post-milk dairy products, though, it’s a much higher percentage, since much of the carbohydrates have been removed. After all, it’s removing the carbohydrates (lactose) that makes dairy products viable for the lactose intolerant. Take a look at the fat content of butter, cheese, yogurt, sour cream, etc.
It seems to be (forget which studies) that we need 40-60g of fat/day for dietary needs and for good digestion (keeping bile/gallbladder running). If that's <20% of your calories, you're either eating a lot, and depending on activity that is fine, or you aren't getting enough fat.
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.
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.
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:
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.
Boiled rice is not calorie dense; it has a large volume due to water, which reduces it almost down to 1 kcal/g. Asians do not all eat lots of white rice. Not all eat purely white rice. On the other hand, not all eat a lot of vegetables. Asians are not immune to obesity and diabetes. They certainly do not get away with overeating white rice or anything else.
If you go for a second and third helping of rice without additional vegetables, I doubt it. Vegetables aren't a magic bullet. Calories are calories. Maybe vegetables can slow down the absorption so smoothing and flattening out the "transient sugar peak" that the liver has to deal with after meal, but that can be overwhelmed with a big enough intake.
The slender Asians you see aren't the ones stuffing on huge amounts of rice, with or without veggies.
I've spent the last seven years in Asia watching very skinny people eat huge plates full of rice that would shock the average American. I always have to ask for less rice than they usually dish out because I can't finish it all. Yet these people are mostly skinny as rails. And no, calories are not just calories.
Calories are calories. People can eat huge plates of rice because that is all they eat and don't snack or drink soda.
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
Calories aren't just calories, and there's not a lot to support that outside of calorimeters, which our bodies are somewhat more complex than. Check NCBI/PubMed for some great insight into why the molecules matter.
Why in the world would calories just be calories - it’s an insane oversimplification. We’re not perfect absorbers, different people absorb foods differently, and the source matters.
You're simply cherry-picking evidence which supports your belief and ignoring contradictory evidence, and other factors. Have you tracked any particular one of these skinny Asian round-the-clock over a period of time? One observation of a meal doesn't tell you everything.
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.)
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.
Yeah that's true and it's the reason talking about "carbs" makes as much sense as talking about "drugs". There are different kinds with very different properties. There's a huge difference between eating whole grain, complex carbs along with other fiber-rich foods and eating a slice of Wonder Bread.
Only within reasonable limits. There may be some points in favor of not eating the sugar close to going to sleep: earlier in the day rather than later. However, sufficiently fierce face-stuffing will overcome this advantage.
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?
No amount of data or ancdotes beats calories in. Fact is, not only is it possible to eat strictly vegan and get fat, it's not even difficult. If the majority of vegans avoid that, it's not simply due to being vegan.
Sure, let's get our data from "vegikitchen.com", quoting from some vegan book by nutritionist quacks.
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.
> 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).
I think that saying: "A calorie is a calorie" is too simplistic because it's never just calories vs calories. 1000 calories of bananas comes with a lot of other content vs 1000 calories of ice cream. You get a lot of different nutrients, you get a lot of fiber, etc. The holistic combination of things you get in unrefined foods makes an impact on how your body processes and stores calories.
[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 thing about calories is that the high side is easier and greater than the low side. But it is easy to accumulate with excess calories. There is a severe limit on how much of a deficit you can establish relative to a baseline energy intake, but a wide-open range in the area of excess intake. Furthermore, fat is easy to store but hard to mobilize. So if you eat 15000 calories one day, then create a 1000 calorie deficit over 15 days, it won't average out to the effect of a regular intake over 16 days. The body finds ways to economize energy use and hang on to the fat.
Dude, what? This is nonsense. If you're sucking down potato chips, cookies, and processed shit, you're not a Vegan; you're a moron. Eating a diet based on vegetables, fruits, beans, and nuts will absolutely change an overweight persons life.
Many people are vegan because of ideological principles not having anything to do with weight management. (Such as not killing animals or keeping them in miserable conditions.)
You can in fact stuff yourself on vegetables, nuts, fruits and beans and maintain a high body fat percentage. (Potatoes and such are vegetables, by the way). Fruits are high in sugar. You're also forgetting grains.
I've been vegan for 25 years and my weight has been up and down both before and after being vegan. The one thing that everyone should agree on is that there are a TON of factors that influence weight gain/loss. Obviously anyone will lose weight on a calorie restricted diet, but it isn't that simple in the real world--specifically, the level of effort involved in maintaining a low calorie diet varies greatly for different people.
There are people who can skip meals and not notice, there are others who are constantly hungry. I'm excited that we're slowly figuring out why that is.
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.
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.
"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.
You've severely mischaracterized Jason Fung's work.
>but that doesn't fully explain how there are people who do lots of heavy physical activity yet remain obese and insulin resistant.
The only reason "that doesn't fully explain [x]" is because you've mischaracterized Fung's work in the first place. He discusses a great deal more than what you deem "the overflow hypothesis." And his model does fully explain why there are people who do a ton of physical excercise and are still obese — it's because they eat in such a way that it raises their insulin. I seriously don't even think you've read Fungs work and you're just seizing the opportunity to present your little pet theory, because in reality Fung has a far more developed and rational model of human biology than you've just articulated.
Hi ericschmidt, your comment is dead for some reason, so I'll reply here
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 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.
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'.
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).
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.
I was vegan for a while (McDougall), so I'm aware of the evidence for this. But I don't know if I buy it. I don't remember seeing any studies that focused on people who had high-fat + low sugar diets. Most of them compared typical western diets with (undeniably) healthy vegan diets. The typical western diet is indeed high fat, but is also crazy high in refined sugars.
cardiovascular issues seem to be centered around inflammation not specifically fat. Not dietary cholesterol or saturated fat. There's lots of evidence to also support intermittent and extended fasting.
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).
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.
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."
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.
not very, lol. It's common to see Khmer sleeping in hammocks in the streets (not homeless, just napping).
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.
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.
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.
The proportion of the American diet that was carbs has risen since the 60s, not decreased. In the 50s and before the average American ate a larger portion of their diet as fats, butter and oils were very common and heavily used in western diets before the anti fat craze.
The malnourishment problem is seen out in the provinces, maybe, still. In the city it's not a problem. Kids get enough to eat these days, and you can see the height difference between the under-20's and the over-30's, it's significant.
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.
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[ 1.4 ms ] story [ 171 ms ] threadDoes 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.
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?
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.
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.
You can in fact stuff yourself on vegetables, nuts, fruits and beans and maintain a high body fat percentage. (Potatoes and such are vegetables, by the way). Fruits are high in sugar. You're also forgetting grains.
There are people who can skip meals and not notice, there are others who are constantly hungry. I'm excited that we're slowly figuring out why that is.
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.
>but that doesn't fully explain how there are people who do lots of heavy physical activity yet remain obese and insulin resistant.
The only reason "that doesn't fully explain [x]" is because you've mischaracterized Fung's work in the first place. He discusses a great deal more than what you deem "the overflow hypothesis." And his model does fully explain why there are people who do a ton of physical excercise and are still obese — it's because they eat in such a way that it raises their insulin. I seriously don't even think you've read Fungs work and you're just seizing the opportunity to present your little pet theory, because in reality Fung has a far more developed and rational model of human biology than you've just articulated.
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).
[1] http://clinchem.aaccjnls.org/content/64/1/192
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.