Medical aspects of the low carbohydrate lifestyle

[karloc]

Very interesting video, quite long but worth watching, I would say.

Makes a lot of sense to me, what do you think?

 

[Eddy Edson]

Just to note that Tim Noakes is widely regarded as a quack.

https://rationalwiki.org/wiki/Tim_Noakes

Also, researchers have proved that Youtube is a slightly worse source of medical advice than random strangers down at the pub.

 

[karloc]

Just to note that Tim Noakes is widely regarded as a quack.

https://rationalwiki.org/wiki/Tim_Noakes

Also, researchers have proved that Youtube is a slightly worse source of medical advice than random strangers down at the pub.

Maybe he is a quack and maybe he is wrong and we should all be on high carb diets. Or maybe one day we will discover the world is in fact round 😉.

I would be interested in the research proving youtube is worse than a stranger down the pub. Does it depend on which pub? and what subjects on youtube.


He is not the only source that has led me to believe that my issue has been having insulin levels too high and the knock on effect that this has had. And as my insulin production relates to my carb intake that I need to control my carbs to control my insulin.
I am open to reading about if this is not the case.

 

[Eddy Edson]

Maybe he is a quack and maybe he is wrong and we should all be on high carb diets. Or maybe one day we will discover the world is in fact round 😉.

I would be interested in the research proving youtube is worse than a stranger down the pub. Does it depend on which pub? and what subjects on youtube.


He is not the only source that has led me to believe that my issue has been having insulin levels too high and the knock on effect that this has had. And as my insulin production relates to my carb intake that I need to control my carbs to control my insulin.
I am open to reading about if this is not the case.

Tim Noakes' quackery is most evident in his evident support for anti-vax woo and also in statements to the effect that carbs cause cancer etc. For more detail see https://nutritionalrevolution.org/2019/01/27/1-3/

I wouldn't call him a really quacking quack for his advocacy of carbohydrate-insulin model of obesity, because there's a plausible concept behind that. Unfortunately, although plausible, it turns out to be wrong. This has been shown in multiple studies, with probably the biggest blow coming a few years ago with the work of Kevin Hall, lead obesity researcher at the US NIDDK, including this study: https://academic.oup.com/ajcn/article/104/2/324/4564649\

(Ironically, that study was funded by a body founded by Gary Taubes, another anti-carb quack fanatic. He wasn't happy.)

EDIT: For a video, a really good recent presentation by Hall of his lab's work, starting at around 1:30, covering this & other issues. He's pretty widely recognised as a leader in the weight-studies field and he's a govt employee not trying to sell you anything/

https://videocast.nih.gov/summary.asp?Live=34719&bhcp=1

On the carb-insulin model, his experiments basically showed that, yes, you will get insulin reduction and fat burning with lower carb, but for weight, that will be more than counter-balanced by the extra fat you eat.

Low carb will indeed be good for T2D post-prandial BG levels, but this is a separate issue from the liver-driven gluconeogenesis dysregulation that Noakes (as far as I can see) focuses on. That's driven by hepatic insulin resistance which is generally driven by liver fat, and there's no evidence that a low carb diet is better for that than any other equal-calorie diet.

 

[karloc]

Tim Noakes' quackery is most evident in his evident support for anti-vax woo and also in statements to the effect that carbs cause cancer etc. For more detail see https://nutritionalrevolution.org/2019/01/27/1-3/

I wouldn't call him a really quacking quack for his advocacy of carbohydrate-insulin model of obesity, because there's a plausible concept behind that. Unfortunately, although plausible, it turns out to be wrong. This has been shown in multiple studies, with probably the biggest blow coming a few years ago with the work of Kevin Hall, lead obesity researcher at the US NIDDK, including this study: https://academic.oup.com/ajcn/article/104/2/324/4564649\

(Ironically, that study was funded by a body founded by Gary Taubes, another anti-carb quack fanatic. He wasn't happy.)

I think that study fails to understand the low carb idea tbh, or at least my understanding. Plus it did show Insulin levels were lowered which is good for either insulin resistant people or anyone who will eventually reach insulin resistant time (seams heavy genetic input as to if / when it will happen).

Whilst, especially in the low carb world it is often said calories are irreverent and to a point this may appear to be the case as your body has no mechanism for counting calories so after high carb, high calorie food your body may still tell you 'I'm hungry, feed me now'. Not so much the case after fat intake. Plus more processed stuff confuses our bodies even more.
BUT
After saying that calories (with the one exception that there are some calories that can't be broken down by the body so just pass through) are a physics calculation of energy. And the physics at a simple level is Energy (measured by calories) in = Energy out (movement, thinking, laying down fat etc).
So as this experiment had everyone taking the same energy in and the same energy use I would expect every ones results to be pretty much the same as they were. Which is good else it would have broken our understanding of physics and energy. Glad I don't need to go back and learn it again.

So the study proves that Physics is correct and not that the carb-insulin model is wrong.

As I understand it one 'advantage' of low carb and the metabolic rate, which is what study was looking at but missed the point.
If you lower your calorie intake to below your usage - you may not loose weight as your body will slow down to adjust to the fewer calories.
If you do the same on a low carb diet - your body is less likely to slow down your metabolic rate.
And on top of that everyone is individual so its even possible that it will be the opposite as so much will depend on activity level which I would say is so much a mind game also.


The cancer thing, I have heard this before from other sources but from my understanding (which is very limited) the theory is more along these lines...
With 'fasting' the body is more likely to 'fix' damaged cells but with plenty of fuel the body discards and makes new cells (this 'photo copying' of cells is at increased cancer risk).
With high carb diet, especially with snacks part of it, you have very few fasting periods. With low carb high fat diet especially with no snacks (which because of fullness are less likely) you will have larger fasting periods.
I can see 'some' logic in this but have no idea if this is the case or if it could be proved in either way as almost everything we interact in life are carcinogens so the factors involved are stupidly large.

As a side not I liked this quote from the research - sort of sums up an issue of high carb diets. 😉

the BD did not include large quantities of added or liquid sugars. In that regard, the BD may have differed somewhat from the customary diets of these subjects

 

[Shooter007]

Very interesting video, quite long but worth watching, I would say.

Makes a lot of sense to me, what do you think?

Excellent

 

[ianf0ster]

Just to note that Tim Noakes is widely regarded as a quack.

https://rationalwiki.org/wiki/Tim_Noakes

Also, researchers have proved that Youtube is a slightly worse source of medical advice than random strangers down at the pub.

Eddy, if Tim Noakes is wrong about low Carb, how did he put his T2D into remission?
I believe him on Low Carb for 2 reasons:
1. He had a worldwide reputation in the field of Sports Nutrition until he was diagnosed with T2D (which killed his father). He followed the conventional medical advice until he was infuriated by a book by scientist he knew claiming benefits for 'The New Atkins Diet'. He was so angry that he started work on a rebuttal, but while trying to find evidence to refute them discovered that on the contrary it was the original Ancel Keys study that didn't stand up to scrutiny ( Cherry picked data from 7 countries and discarded the data from the other 15 which didn't match his theory, did not account for smoking (for obvious reasons at that time) in his study i.e. one of one of the biggest CVD and Cancer contributing causes.
I tend to think those who have changed their minds about something and then change their position against convention and risk loss of livelihood, loss of reputation and prosecution, do so out of conscience rather than self-aggrandisement. He was cleared of giving dangerous advice on newborn diet to a mother - turns out the advice he gave was completely in line with that of the published information of the organisation testifying against him!

2. His Low Carb approach has served me well and put me into what Diabetes UK call remission (personally I don't think I am there yet, since my HbA1C is only in the pre-diabetes range so far plus I think I need to still show remission held for at least 1year. No doubt you are also aware that the Southport GP Dr David Unwin @lowcarbGP ( a e-learning trainer) for the Royal College of GPs also uses Low Carb for his T2D's and has a 50% remission rate (over 2years) for all who try it.

 

[karloc]

EDIT: For a video, a really good recent presentation by Hall of his lab's work, starting at around 1:30, covering this & other issues. He's pretty widely recognised as a leader in the weight-studies field and he's a govt employee not trying to sell you anything/

https://videocast.nih.gov/summary.asp?Live=34719&bhcp=1

On the carb-insulin model, his experiments basically showed that, yes, you will get insulin reduction and fat burning with lower carb, but for weight, that will be more than counter-balanced by the extra fat you eat.

Low carb will indeed be good for T2D post-prandial BG levels, but this is a separate issue from the liver-driven gluconeogenesis dysregulation that Noakes (as far as I can see) focuses on. That's driven by hepatic insulin resistance which is generally driven by liver fat, and there's no evidence that a low carb diet is better for that than any other equal-calorie diet.

Only just noticed your edit @Eddy Edson

Interesting video. So their research shows no major difference - just need to eat less in general and do more 🙂. I have basically looking at these things as a Type 2 Diabetic so low carb is good for low BG and I have been doing reduced calories and trying to be more active for the weight loss. I am slightly concerned about my fat liver, if its not skinny after I have lost the weight not sure what the best thing to do will be - some time to consider that 😉.
I don't quite understand why it's just low carb, high fat. My thoughts would be replacing carbs with both fat and protein.
I have been high protein + high fat (percentage high as i'm low calorie ish).

I liked the 'spanner' in the works at the end - heavy processed foods may well be bad but don't know why yet. I have seen a few theories on this - like the body thinks its getting fat for example and reacts to that and does not 'notice' the 'hidden' sugar type of thing. So even a fully working body may well just not create the hormone balance it tries to do.

I have a suspicion that one of the reasons why a low carb diet can work really well for some who have struggled with low fat is that so often low fat foods are heavily processed.
I also believe as people are developing type 2 diabetes and fatty liver more than in the past when not overweight at a point in time when diets are higher in carbs than ever - there has to be something in that.

So in conclusion, nobody knows and we are all different 🙂.

I am doing super low carb firstly for my Insulin, secondly using the lower insulin levels to help stimulate fat loss through low calorie / fasting and as I loose more weight increasing my activity levels.
When I am no longer fat and lazy but am skinny and fit my intention is probably to add back some level of carbs but healthy ones - probably keeping them on the lower side for years as I suspect insulin resistance will be a long haul to over come, if even possible.

I think there are many part truths on all sides and probably finding something that helps motivate you from these part truths is probably the best path. Don't suspect we will fully understand in my life time 😱

 

[Eddy Edson]

finding something that helps motivate you from these part truths is probably the best path

I think that's very wise!

 

[Eddy Edson]

I am slightly concerned about my fat liver, if its not skinny after I have lost the weight not sure what the best thing to do will be - some time to consider that

Just on this: looking at your morning BG levels, I would bet any amount of money you care to lend me that you've got this sorted. For T2's generally, those morning levels mainly reflect how much gluconeogenesis yr liver has been doing over night. Fat in the liver => hepatic insulin resistance => liver doesn't get the message to ratchet down production of glucose from amino acids, trigs etc when there's enough in the blood to keep the brain alive. More or less. Anyway, if you're seeing non-diabetic waking BG levels, then I think it probably means you've lost enough weight to clear fat from the liver & restore hepatic insulin sensitivity.

That's what happened with me. Started with waking levels in the mid-teens, lost about 10kg inititally by reducing calories, brought waking BG down to the levels you're seeing now. While I was getting things under control I cut down on carbs but always trying to keep eating as much fruit etc as my bod could deal with. Now I eat as many "good" carbs as I want to and my BG profile is absolutely "normal", better than non-diabetic median, way better if I believe my Libre. I'm still a bit nervous of grains but even with them, things are generally just fine.

If you haven't already, it's worth checking out the work of Prof Roy Taylor etc on remission via weight loss. Again this another partial piece of The Truth, probably, but conceptually very useful to me at any rate. Though I think the 800 cal per day part of it is a bit of red herring; Taylor himself says it doesn't really matter how you lose the weight, and grinding off half a kilo per week like I did is just fine.

https://www.ncl.ac.uk/magres/research/diabetes/reversal/#publicinformation

 

[grovesy]

Only just noticed your edit @Eddy Edson

Interesting video. So their research shows no major difference - just need to eat less in general and do more 🙂. I have basically looking at these things as a Type 2 Diabetic so low carb is good for low BG and I have been doing reduced calories and trying to be more active for the weight loss. I am slightly concerned about my fat liver, if its not skinny after I have lost the weight not sure what the best thing to do will be - some time to consider that 😉.
I don't quite understand why it's just low carb, high fat. My thoughts would be replacing carbs with both fat and protein.
I have been high protein + high fat (percentage high as i'm low calorie ish).

I liked the 'spanner' in the works at the end - heavy processed foods may well be bad but don't know why yet. I have seen a few theories on this - like the body thinks its getting fat for example and reacts to that and does not 'notice' the 'hidden' sugar type of thing. So even a fully working body may well just not create the hormone balance it tries to do.

I have a suspicion that one of the reasons why a low carb diet can work really well for some who have struggled with low fat is that so often low fat foods are heavily processed.
I also believe as people are developing type 2 diabetes and fatty liver more than in the past when not overweight at a point in time when diets are higher in carbs than ever - there has to be something in that.

So in conclusion, nobody knows and we are all different 🙂.

I am doing super low carb firstly for my Insulin, secondly using the lower insulin levels to help stimulate fat loss through low calorie / fasting and as I loose more weight increasing my activity levels.
When I am no longer fat and lazy but am skinny and fit my intention is probably to add back some level of carbs but healthy ones - probably keeping them on the lower side for years as I suspect insulin resistance will be a long haul to over come, if even possible.

I think there are many part truths on all sides and probably finding something that helps motivate you from these part truths is probably the best path. Don't suspect we will fully understand in my life time 😱

I have found over the years what worked for me has changed and I had to adjust what and how much of things I eat. I used to be ok with a couple of new potatoes, spoon of rice or pasta, now I rarely have.

 

[karloc]

Just on this: looking at your morning BG levels, I would bet any amount of money you care to lend me that you've got this sorted. For T2's generally, those morning levels mainly reflect how much gluconeogenesis yr liver has been doing over night. Fat in the liver => hepatic insulin resistance => liver doesn't get the message to ratchet down production of glucose from amino acids, trigs etc when there's enough in the blood to keep the brain alive. More or less. Anyway, if you're seeing non-diabetic waking BG levels, then I think it probably means you've lost enough weight to clear fat from the liver & restore hepatic insulin sensitivity.

That's what happened with me. Started with waking levels in the mid-teens, lost about 10kg inititally by reducing calories, brought waking BG down to the levels you're seeing now. While I was getting things under control I cut down on carbs but always trying to keep eating as much fruit etc as my bod could deal with. Now I eat as many "good" carbs as I want to and my BG profile is absolutely "normal", better than non-diabetic median, way better if I believe my Libre. I'm still a bit nervous of grains but even with them, things are generally just fine.

If you haven't already, it's worth checking out the work of Prof Roy Taylor etc on remission via weight loss. Again this another partial piece of The Truth, probably, but conceptually very useful to me at any rate. Though I think the 800 cal per day part of it is a bit of red herring; Taylor himself says it doesn't really matter how you lose the weight, and grinding off half a kilo per week like I did is just fine.

https://www.ncl.ac.uk/magres/research/diabetes/reversal/#publicinformation

@Eddy Edson
Thanks, Some very interesting information.
I am keeping my BGs low by taking in very few carbs - about 10-20g a day as well as loosing weight through limited calories.

One interesting point he made was that it does not matter how, you just need to loose the weight and you need to find a method that works for the individual.

Maybe I have been focusing on the BG before the weight loss (but weight loss has always been big goal) and maybe the weight loss is actually the most important. But at the moment I am happy with my BG and the weight loss is going well so my approach is working for ME and that is the important part.

I guess the main reason that we can all become a bit "this is the way to do it" is when we find a method that works for us and others show a method that just would not work for us, we think "well that's rubbish". Plus there is so much money in diets etc, it's easy to see the thinking behind, this worked for me and I can make money off it and to sell an idea it's always "Miracle cure for all!" - that's just the world we live in.

At the very start of my journey I was suffering many issues from having far to much sugar around my body and suddenly ditching this made me feel so much better so especially in my case smashing my BG down has helped in so many ways. I think partly because of this I really don't want to risk my BGs going up and whilst I have dropped 2 stone I think I still need to loose another 2 stone. According to my scales (which I know is not a 'true' figure) my body fat% is down from 34.8% to 23.5%.

 

[Eddy Edson]

@Eddy Edson
Thanks, Some very interesting information.
I am keeping my BGs low by taking in very few carbs - about 10-20g a day as well as loosing weight through limited calories.

One interesting point he made was that it does not matter how, you just need to loose the weight and you need to find a method that works for the individual.

Maybe I have been focusing on the BG before the weight loss (but weight loss has always been big goal) and maybe the weight loss is actually the most important. But at the moment I am happy with my BG and the weight loss is going well so my approach is working for ME and that is the important part.

I guess the main reason that we can all become a bit "this is the way to do it" is when we find a method that works for us and others show a method that just would not work for us, we think "well that's rubbish". Plus there is so much money in diets etc, it's easy to see the thinking behind, this worked for me and I can make money off it and to sell an idea it's always "Miracle cure for all!" - that's just the world we live in.

At the very start of my journey I was suffering many issues from having far to much sugar around my body and suddenly ditching this made me feel so much better so especially in my case smashing my BG down has helped in so many ways. I think partly because of this I really don't want to risk my BGs going up and whilst I have dropped 2 stone I think I still need to loose another 2 stone. According to my scales (which I know is not a 'true' figure) my body fat% is down from 34.8% to 23.5%.

FWIW, I would say you're doing really, really well and you should keep doing what you're doing 🙂

 

[Eddy Edson]

On a related note, another dubious-science-but-maybe-results-can-be-OK type pushing similar messages is Jason Fung. Stephan Guyenet, an actual expert and sometime collaborator with Kevin Hall, has founded a site for expert reviews of popular diet/health books. The latest is Jason Fung's "The Obesity Code": https://www.redpenreviews.org/reviews/the-obesity-code-unlocking-the-secrets-of-weight-loss/

We evaluated three core claims in TOC:

1. Reducing calorie intake does not lead to weight loss
2. Elevated levels of insulin are the primary cause of obesity
3. Intermittent fasting is particularly effective for long-term fat loss

These received an overall score of 1.2 out of 4, indicating that they are poorly supported as a whole.

A nice summary of the scientific evidence.

 

[ianf0ster]

On a related note, another dubious-science-but-maybe-results-can-be-OK type pushing similar messages is Jason Fung. Stephan Guyenet, an actual expert and sometime collaborator with Kevin Hall, has founded a site for expert reviews of popular diet/health books. The latest is Jason Fung's "The Obesity Code": https://www.redpenreviews.org/reviews/the-obesity-code-unlocking-the-secrets-of-weight-loss/

We evaluated three core claims in TOC:

1. Reducing calorie intake does not lead to weight loss
2. Elevated levels of insulin are the primary cause of obesity
3. Intermittent fasting is particularly effective for long-term fat loss

These received an overall score of 1.2 out of 4, indicating that they are poorly supported as a whole.

A nice summary of the scientific evidence.

Sorry Eddy, but I have to respectfully disagree with you and that review.
Firstly, Jason Fung is an expert. A qualified Neprologist who has run a clinic for mainly Morbidly Obese for over 10yrs in Toronto, Canada.
Secondly, I know that Intermittent Fasting works for me for both weight loss and for controlling Blood Glucose.

Now lets take the points one by one:
1. This one is taken out of context in order to make it sound ridiculous. However reducing Calorie intake doesn't necessarily lead to weight loss.
This high quality study published in the BMJ shows that the Calories In - Calories Out model does not hold true.
https://www.bmj.com/content/363/bmj.k4583
Three groups on pre-trail adjusted calories for individual weight maintenance. One Low(er) carb, One Medium Carb, one High(er) carb.
The resting metabolic rate (energy expenditure) was highest for Low carb and lowest for High Carb. Blood Glucose, Triglycerides and
HDL all improved most in the Low Carb group.

2. Insulin is the energy regulating (including energy storage) for Glucose in the body.
Insulin causes Blood Glucose to be swept from the blood either into muscle cells (for consumption) or into Fat cells for storage.
When the normal sub-cutaneous fat cells become full, Insulin forces the Glucose into fat around the internal organs.
I don't know of any reputable doctor or medical scientist who dispute this.
Thus is it not at least plausible that raised Insulin causes both Obesity (or TOFI for those with limited sub-cutaneous fat cells) and thus Type 2 Diabetes ?

3. Absolutely all studies show that Intermittent Fasting works well for Fat Loss. Which contradictory study does the review quote to back up their claim?

Edited: for correction from grovesy that Dr Fung is a Nephrologist, not endocrinologist.

 

[grovesy]

Dr. Fung is a medical doctor but his speciality is Nephorology , not Endriconology.

 

[everydayupsanddowns]

Just a gentle reminder to folks to respect different points of view than your own. Diabetes is a complex condition and even the most clear cut research evidence that we currently have is open to question and counter-argument from other perspectives.

That’s how science moves on.

Mainstream thinking tends to move quite slowly*, and there are very few if any certainties when it comes to diabetes. There are plenty enough spats, arguments, claims and counter-claims in the academic world without us having disagreements here.

All we really have is our own N=1 ‘best guess’ at what we believe is the right thing to do for us as an individual to lower our own risk of nasties and live well with diabetes.

* Edited for clarity - but that doesn’t necessarily mean that it’s wrong... things only get to be ‘mainstream advice’ when there is quite a lot of evidence and observation all pointing in that direction. But neither does in mean that newer ideas are necessarily wrong either, just because they don’t have the weight of decades of studies that were all looking for clues/answers in similar places.

 

[Lizzzie]

I haven't watched this but there was a BBC one called the truth about carbs recently which I thought was excellent - and the evidence there seems to strongly support a low-carb diet, not just for type 2 Ds but as a predictor a life expectancy.

Not sure how the 2 films compare.... but wondered if times are changing and we diabetics will have to adapt to our truths becoming out dated and the possibility that it's possible that carbohydrates have been given too much emphasis in the western diet?

When I was in Japan, traditional diets seemed to be protein rich and life expectancy was celebrated.