Insulin Sensitivity - What is the science

(James Aquilina) #1

Not sure if this is the right category for this post. New to the forums and feel like a keto-kid in a butcher shop.

I just listened to the Peter Attia podcast where he interviews Jason Fung (https://peterattiamd.com/jasonfung/). I’m very interested in the science behind a lo-carb, ketogenic diet (and fasting) and how it’s one way of managing hormones in the body (exercise and medications being others). Fung’s few of Hyperinsulinemia as the root cause of Type 2 Diabetes does help explain much of the empirical and clinical data collected.

But I’m also curious about what’s going on with those people who can sustain a hi-carb diet; maintain a healthy weight; and keep all of their health bio-markers (triglycerides; A1C, etc.) in good standing. If insulin resistance isn’t the best way to explain Type 2 Diabetes (vs. Hyperinsulinemia) what is the model behind the assumed “insulin-sensitive” individual. It seems they can manage healthy insulin and glucose levels despite a hi-carb diet. So what is their body doing with all of that glucose? Burning it?

(Central Florida Bob ) #2

I hesitate to answer this because I can’t bring a study here but once something enters the body, we either metabolize it or excrete it. So, yeah, chances are they’re fueling themselves on the glucose and never access fat storage.

(James Aquilina) #3

So does that suggest a higher metabolism? Not sure if the science behind that term either

Thanks for the response!

(Allie) #4

@James_Aquilina I’ve moved this to the “Show me the science” section where you may get more responses.

(Andi loves space, bacon and fasting. ) #5

I don’t know that there’s been any research on this. The answer is probably multi-factorial (to borrow a Fung phrase). There’s always variation in a species, so we should expect some humans to 1) produce less insulin, 2) burn glucose more efficiently, 3) be more tolerant to high levels of insulin, or some combination of those factors. There are always members of a species that don’t get sick from a plague, and there are certainly some humans who are surviving the carbpocalypse.

(Central Florida Bob ) #6

I’d say not necessarily higher, just different.

There are people who stay lean no matter what they eat, and I think of those people as the higher metabolism.

(Bob M) #7

It’s also variability in how the body processes different foods. You and I could eat the exact same meals and experience completely different results:

As expected, age and body mass index (BMI) were found to be associated with blood glucose levels after meals. However, the data also revealed that different people show vastly different responses to the same food, even though their individual responses did not change from one day to another.

“Most dietary recommendations that one can think of are based on one of these grading systems; however, what people didn’t highlight, or maybe they didn’t fully appreciate, is that there are profound differences between individuals–in some cases, individuals have opposite response to one another, and this is really a big hole in the literature,” says Segal, of Weizmann’s Department of Computer Science and Applied Math.

(James Aquilina) #8

Thanks

(Carl Keller) #9

I was insulin sensitive for the first 35 years of my life. I could literally eat ice cream and potato chips for dinner, three times a week, and not gain a pound. I remember people close to me wondering if there was something wrong with me because I was constantly going #2 (sometimes three times a day) so in my experience, it appears most of that extra glucose went right through me.

(Boston_guy) #10

In this fantastic talk - https://www.youtube.com/watch?v=ZEr9AjjL3No - he cites China’s historically high intake of rice, without diabetes… but pins the blame on Fructose fattening the liver, and causing insulin resistance. Says China has overtaken the US in T2D.

(CharleyD) #11

High metabolism or more precisely metabolic flexibility is the answer.

The respiratory quotient test can tell you what you are burning and how efficiently your mitochondria are doing it.

Someone who is young, lean, and athletic will be able to switch fuels without too much fuss, ie: glucose in the fed state, and then free fatty acids from fat stores in a fasted state.

Their RQ values will show by how much O2 is burned what fuel is used and how much CO2 is released.

#12

IME in China they didn’t eat rice the way we do mixed in with the other food-- it was more a filler after the meal if you’re still hungry. Which would imply that historically people who needed calories (i.e no meat/fat) ate more rice and people who had more meat/fat ate less rice. Of course in any case China now has much more of the same processed food as the US has.

(Paul H) #13

Welcome @llolly Sorry China. At least rice is real food. Ya never know what’s truly in processed foods. Label are so often Fake News.

#14

Loved that podcast. Dr. Fung really got into details with him. (I have to side with Attia on the causal effects on RnY bypass on the duodenum though, and I think inflammation is one of the long term causes of increased insulin response, but I digress…)

As others have said, insulin resistance can creep up on you over a number of years eating inappropriate foods. And by that I mean highly refined, high added sugar, PUFA-laden stuff that damages an otherwise healthy system over time. Sometimes decades. Other factors come into play, like thyroid function and cortisol, but those can be worsened by bad food choices too. What works for a growing, energetic teenager doesn’t pan out so well later in life.

There is a predisposition for some people to be on the lower insulin side of the bell curve from birth. These are what used to be called the “hard gainers” or “98 lb weaklings” etc. There’s an incentive for these people to eat highly insulinogenic foods so they can gain weight and put on muscle. Hyperthyroidism might play a role in this too. Unfortunately, people who have either a normal insulin level or an elevated insulin level following the same dietary advice find themselves in trouble either quickly or eventually.

[Oh, and don’t even get me started on the microbiome, because that’s a largely unexplored rabbit hole :rabbit: :hole: ]

P.S.
These same food choices alter appetite and thus energy balance even in otherwise healthy people. Small but highly controlled study: ultra-processed foods hijack health - 5/16/19 Journal of Cell Metabolism

#15

Nice article!

The individualized feedback yielded many surprises. In one case, a middle-aged woman with obesity and pre-diabetes, who had tried and failed to see results with a range of diets over her life, learned that her “healthy” eating habits may have actually been contributing to the problem. Her blood sugar levels spiked after eating tomatoes, which she ate multiple times over the course of the week of the study.
“For this person, an individualized tailored diet would not have included tomatoes but may have included other ingredients that many of us would not consider healthy, but are in fact healthy for her,”

This is why there should be no one-size-fits-all dietary guidelines. Even on keto.

(Mark Rhodes) #16

There is a greek guy in Gabor Erdosi’s FB page Lower Insulin who has alot of research into this and maintains that he is still producing ketones even though he is Low Fat High Carb Moderate Protein. You might wish to check that out.

#17

I think I’ve seen him post about the ketones. I suspect it’s a Pritikin-type response he’s getting. I think I’ve narrowed this down to the role bile plays in hepatic glycogen replenishment.

I do still chat with Gabor sometimes. He gave me links to some FGF21 studies but there are only so many hours in the day my brain wants to wade through acronym jungles. He’s “moved on” to FGF19 now, whatever that is, it has something to do with bile. :thinking: https://science.sciencemag.org/content/331/6024/1621