Look at how tight the HbA1c trends are on the ketogenic (second graph).
6.0% is still not good enough, but there is no doubt it’s a better treatment than the standard of care. If the Diabetic peak bodies keep sticking to their High carb Low calorie recommendations then surely the lawsuits are not far behind.
Also they observed higher LDL in the first 6 months on the low carb diet but not significantly after 12 months. Which indicates people’s concerns of a high fat diet blowing up your cholesterol ( /not that there’s anything wrong with that/ ) may be misplaced and it is just a transitory effect during the initial weight loss phase.
If I could play with the actual data used to make that plot, I bet that the entire uptick in the A1C of the VLC group comes from that one patient who had the highest rebound of A1C and if you remove them, there’s no uptick. (The patient who’s the upper most trace on the left, and went from highest A1C at the start, to slightly below the top of the error bar at 6mos back up to the highest A1C at one year.)
Two things I would really like to see from a study like this is how changes in HBA1c correlates to weight loss, and also if there is any improvement on an oral glucose tolerance test.
The interaction between a VLC/ketogenic diet and insulin resistance is very interesting to me. I have no doubt that a VLC diet is the preferred diet for T2DM and can drastically reduce or possibly even remove completely the risks of complications from the disease, but it’s not clear if it’s fixing the underlying issue of impaired glucose regulation or if it’s circumventing the issue. For people with T2DM it doesn’t matter as much because avoiding the symptoms is more important, but for people with pre-diabetes and high insulin resistance who still retain normal glucose regulation it matters.
There are a number of things that have made me question that the mechanism behind insulin resistance is a high carb diet and chronic insulin exposure as such and that it’s not just a correlation. One study I found particularly interesting was the one I linked in this topic: A very low calorie but high-carb (relatively speaking) 3 month dietary intervention was shown to reverse T2DM even 9 months after the intervention ended. Even though it was a very-low-calorie diet and therefore carbohydrate was also reduced, the intervention diet still contained 120g carbs per day which is fairly high in the low-carb world.
I would just point out that “insulin resistance” is by definition an abnormality of glucose regulation. If the insulin were properly regulating the glucose, there would be no resistance.
No, impaired glucose regulation is diabetes. The pancreas is able to compensate for insulin resistance by increasing insulin secretion and thereby maintain proper glucose regulation even in the face of a high degree of resistance. It takes a long period of constantly straining the glucose regulation capabilities of the body before it fails.
Suspicions aren’t evidence, unfortunately. It seems pretty clear that it does circumvent the lack of glucose regulation, and I’m also fairly confident that it reduces insulin resistance to some degree, but the question is if there’s some reduction offered by the reduction of carbohydrates specifically.
Yeah, possibly more to do with fat loss which is hastened by carb elimination. I’m hoping for long term improvement in insulin sensitivity from keto and fasting but it does seem that the scientific community is still in infancy with their understanding of insulin resistance.
It’s actually not shown that a VLC diet causes more fat loss than any other diet with equal calories either. It’s not shown that it doesn’t cause more fat loss either, and it’s quite possible that it’s easier to maintain a large calorie deficit on a VLC diet, but so far science has not shown a correlation between fat loss and any other variable independent of calories.
Either way, fat loss has been shown to improve insulin sensitivity, VLC diets have been shown to be effective at causing fat loss and therefore VLC diets should improve insulin sensitivity. Whether it’s actually superior from a mechanistic standpoint is pretty much a moot point as the most important facets on an individual level is ease of adherence and results. The question individuals looking to lose fat or improve their insulin sensitivity should ask is therefore which diet that’s proven to work (so no idiotic fad diets) am I able to adhere to until the desired result is achieved.
Which is a different question from the scientific question of if carbohydrate restriction has some impact on fat loss and insulin sensitivity that’s independent from calories.
You can say that again. It’s true for all of nutrition science, really, but if what you’re asking is “how does food affect human physiology” you shouldn’t be surprised that the scientific field trying to answer you has an especially troublesome childhood given the complexities of the systems involved and the difficulty and expense in doing studies.
Im not sure how you can argue that i wouldn’t lose more fat eating 2000 cal of bacon vs 2000 cal of high fructose corn syrup. Amount of calories as an indicator of weight loss or gain is practically pseudoscience. Hormones are the significant player in the equation, specifically insulin. By saying that a low carb diet hasn’t been proven to cause weight loss when compared to a high carb diet of equal calories, you’re saying that i could be eating lucky charms every day and lose weight whilst maintaining a calorie deficit. However, eat less, move more has been proven to be a faulty concept. The metabolism adjusts to a calorie deficit and weight loss comes to a halt. But stop giving a type one diabetic insulin and you can throw all the calories you want at them. Sugar and carbohydrates have the most insulin response and elevated insulin prohibits the body from accessing fatty acids. So, not sure how you claim that a low carbohydrate diet hasn’t been proven to show more weight loss. The basis science of humans and our metabolic systems dictate that in the presence of sugar the body stores fat, in the absence of sugar the body burns it. It’s not only proven in the lab but the American obesity epidemic catapulted when the government issued guidelines on increasing carbohydrates and moderating saturated fat. The food companies conformed and catered to these dietary guidelines and the country got fat and sick.
The old BS about calorie restriction is just an unfortunate obfuscation of the poorly understood reality.
@richard has made a very strong case that calorie measuring and hoping to actually understand what energy is actually used by the body is a fools errand. As the Wittrock overfeeding experiment heavily suggests, calories are not relevant if they are the right calories (e.g. the nutritional irrelevance of massive excess fat in the absence of carbs… and low insulin one assumes). We may be a long way from knowing the exact interactions of all the pathways and mechanisms in each individual’s metabolism but we are pretty sure that calorie restriction is not a strong, predictable or sustainable lever. Suggesting that various macro ratio diets are equal via calories is just wrong.
There was a guy named Mark Haub, a professor of human nutrition at Kansas State University, who wanted to prove the Calories IN:Calories OUT hypothesis so he went on a diet of only hostess Twinkies for 2 months … but he limited himself to 1800 calories which was less than his body was at that point burning … and he lost 27 lbs of weight. And he published a study on it, and it became general knowledge that you can lose weight on Twinkies if you have few enough calories of them.
The dirty little secret is that he was paid by Coca-Cola as part of their energy balance program to convince the world that sugar doesn’t specifically cause obesity, but it is the number of calories in the diet that do.
I suspect if he had maintained his diet for much longer his metabolic rate (which starts dropping as soon as you go on a low calorie diet - and more so the more carbohydrates are in the meals) would have caught up to his intake and he would be putting weight while trying to eke out adequate nutrition from 1800 kCal of Twinkies a day.
There is no science showing that you wouldn’t. In calorie matched studies comparing a keto diet to a high-carb diet there has not been shown to be a difference (this review has a nice summary of sources). If there is a metabolic advantage to keto it remains hypothetical at this point. Furthermore, the link between energy balance and change in fat mass is very well established by science at this point. I am very confident in saying that everyone who lost weight through a lifestyle change did so by creating a negative energy balance, and I’m very confident in guessing over 99% did it by reducing calorie intake, not increasing expenditure.
However this does not mean that calorie restriction is necessarily the right way to go. There is a very large gap between the biology and biochemistry of energy balance and changing fat mass and obesity and weight loss. It is not necessarily the case that a long term calorie restriction strategy will result in calorie reduction. Just as sure as I am that everyone who lost weight did so by creating a negative energy balance, I’m equally sure that fact says nothing about how to create that negative energy balance, or conversely how the positive energy balance that made people fat in the first place was created. This is a very important distinction that I feel is being missed. This conflation is why the idea that CICO is the only way to lose weight exists (which is clearly wrong and probably harmful to society), but it also causes some ketoers to frankly spout unscientific nonsense.
I know there are several blog posts and several talks given on calories by keto community pillars. If you pay attention to what they say none of them actually contradict the energy balance theory of weight gain. Even if they say things that on the surface seems like they’re doing exactly that (“calories don’t matter”), when it’s put in context it’s always arguing against using energy balance as the foundation of weight loss strategy, not it’s ability to explain historical weight change. Many of the arguments for keto indeed relies on energy balance being directly correlated to change in body mass, for example that it is a very satiating diet.
Furthermore, the hormonal theory of obesity does not compete with the energy balance theory in any way. In fact, energy balance is a key component of the hormonal theory, but the hormonal theory also tries to explain how an energy imbalance can come to be.
Regardless of who paid him the study shows is that a man ate less calories than he used and lost weight. I’m really curious about what you hypothesize in the last paragraph, but so far it’s just speculation.
I actually hate that study for several reasons. First, n=1 so it’s main value is as a publicity stunt, not science. Second, as you said, 27 pounds in 2 months eating only twinkies is not terribly interesting. Until he’s been on the twinkie diet for up to a year to really see what the results of a hypocaloric twinkie diet would be. Lastly, I hate the spin Coca-Cola is trying to put on the whole sugar issue. The energy balance theory being true doesn’t prevent sugar from causing obesity, it just makes it so that it causes obesity by causing excess calories.
Well i guess it’s anecdotal evidence that I’ve lost weight without calorie reduction but merely eliminating sugar. I don’t suppose you’ve read anything by dr. Fung or gary taubes if you’re still dead set on energy balance being the primary factor on weight loss or gain. Both of these gentlemen point to many examples where hormones were clearly the biggest factor and calories did not necessarily play a role.
Either way, I’m not a scientist and don’t have enough knowledge to convince you. I’m not sure why you are a member of a keto forum if you think it’s a fad and that you can get the same results simply by cutting calories. All are welcome here, but you certainly have some troll like characteristics. Debating science is fun, but there are a lot of people here that will certainly die if they don’t follow the keto lifestyle. I can see how it becomes a little cult like and not everything is 100% scientifically proven, but the alternative for many is death. Some people need extreme measures to get healthy after years of abuse. Regardless, i still maintain that your conclusions are false. N=1 is sufficient for me. I tried eat less, move more and it left me hungry and never worked long term. I’m convinced that insulin is the primary factor and you not only can but should eat maintenance calorie levels to lose weight
I think you have completely misunderstood my position. Once again, energy balance explains changes in fat mass, but purposefully restricting calories doesn’t always result in a long-term negative energy balance for everyone. Keto is sometimes necessary to create that negative energy balance, and in many cases the easiest way to do it, and the reason keto is very often easier and better than simply cutting calories is explained by the hormonal theory.
So far nothing about the hormonal theory disproves the energy balance theory. It does contradict the calorie restriction as primary intervention model of fat loss and the official dietary guidelines for public health. It is still an open question if there is any metabolic advantage to a keto diet that doesn’t work through the mechanism of energy balance both for fat loss and for reducing insulin resistance.
Since you mentioned Gary Taubes I’ll just point out that while he believes that such a metabolic advantage exists he also admits the science doesn’t show it just yet, which is why he founded NuSci, a non-profit organization trying to fund research that attempts to suss this out. So far they’ve funded one pilot study which found no difference between a ketogenic diet and a high-carb control when calories were controlled for.
There is pretty good evidence for a drop in metabolic rate to meet a drop in caloric intake - the Leibel study for example shows the homeostasis kicking in. As they overfed subjects to gain 10% of their body mass their RMR increased by almost 300 kCal/day, as they underfed them to lose 10% and then 20% of their body mass their RMR decreased by almost 500 kCal/day.
Reduce calories coming in and your body responds by using fewer, increase calories coming in and your body uses more energy. Of course you also respectively draw down storage, and divert energy into storage but that is just ephemeral. Keep up a moderate caloric restriction for long enough and your consumption of calories becomes low enough that your system is in a caloric surplus again and you can put weight back on again.
Kevin Hall showed if you keep up the apparent caloric restriction (eat less and move more) for long enough you gain all the weight back because the metabolic slowdown of your energy homeostasis can outlast any dietary regime.
Perhaps you meant my comment that metabolic rate drops
There is evidence from David Ludwigs group
The second chart in figure 3 is total metabolic change in response to hypocaloric intake, and the very low carb arm (compared to low GI, and low fat - increasingly more carbohydrates) had the least reduction in metabolic rate.
If you feel more comfortable talking about energy balance - you can think of it this way. The very low carb cohort had the greatest caloric deficit in an isocaloric intake because their metabolism slowed the least.
The reality is that less than 5% of people who fight their energy homeostasis by reducing intake and increase energy use lose more than 10% of body weight and keep it off for more than a year. However this group has hundreds who lost more than 30% of body weight and have kept most of it off for many years by changing the regulator of their energy homeostasis.
Not that weight is a primary outcome to a type 2 diabetic about to lose a toe.
In his discussion of the “calories in, calories out” hypothesis as against the “hormonal regulation” hypothesis, Taubes cites the phenomenon of the teenaged growth spurt. Yes, he says, the Second Law of Thermodynamics applies, but the child does not grow into an adult because he or she eats more, but rather the child eats more because hormones are signaling the body to grow, thus requiring the extra fuel.
In other words, he says, the causality is reversed: the energy surplus or deficit is the result of other factors that cause the food we eat to be partitioned differently under different circumstances. And it has been settled science for many decades that the level of serum insulin is primarily what determines whether muscle cells will burn glucose or fatty acids, and whether fat cells will store fatty acids or mobilize them.
The organization is NuSi, not nusci. Very different groups. I’m not sure where you’re seeing results of the pilot study. Estimated completion of the Framingham State Food Study was December but i haven’t seen any posted results yet.
Either way, i think you missed my point that you’re a “negative nancy” And by throwing fuel on the confusion fire, you’re likely to cause more harm than good in this forum. People are just trying to get healthy here, not hand out nobel prizes for research. The American health guidelines and constant studies contradicting each other have confused people to the point of not knowing how to heal their bodied. Hopefully the study can show conclusively that the hypothesis of dr. Ludwig and Mr taubes were correct and that federal guidelines are a cancer on a sick world
I understand that you want to see the science and don’t want to blindly follow something without evidence from studies. I just think that debating the fundamental belief structure of many of the people in this forum could be harmful, and not just facilitate playful debate. Not everyone has time or education level to explore every study so they listen to the largest voices in the keto community. Saying that gary taubes and dr. Ludwig are preaching unproven theories is probably not going to have a positive impact on people in a ketogenic forum. But freedom of speech is freedom of speech and i hope you are incorrect as calorie deficit doesn’t work long term. Being cold and hungry sucks
To be fair, they are the first to say that more research has to be done. On the other hand, though, Dr. Ludwig is doing some of it, and Mr. Taubes is trying to get high-quality studies funded. Not only that, but the science we already do have makes the hormonal regulation hypothesis look a lot more plausible than Keys’ diet-heart hypothesis.
(Dr Phinney) made 5 years ago
