Why we stall


(Richard Morris) #1

If you want to know why people who are insulin resistant stall, you have to understand why they put on weight in the first place. The root cause is that they make slightly more insulin to the same dietary challenge (glucose, and alanine). We’re born that way. This starts off small but it compounds over decades, because chronic exposure to insulin increases insulin resistance. Exposure to our modern diet exposes us to high ranges of glucose, so that gives us a rocket booster to diabetes.

Our bodies are run not by a little man in our head with levers, but by millions of feedback loops all affecting each other. But we have some big ones we can focus on.

The simplest feedback loop I can think of for increasing insulin resistance, is when we have insulin and free fatty acids in our blood we make MORE insulin until the free fatty acids spigot is shut off. The spigot is our fat cells, when insulin is low they release energy, when high they sequester energy. So as out fat cells become incrementally more resistant, we make increasingly more insulin. Eventually fat cells are unable to sequester any more energy and you have the overflow problem where they are just dumping free fatty acids into our blood streams.

But that’s just supply side. If that were all there was to the story no-one would become super obese because once fat cells stopped sequestering energy you would burn it, and they would become more insulin sensitive - and you would cycle between the top and bottom of the overweight range.

There is also a demand side part of the story. Insulin inhibits the carnitine shuttle used to move long chain fats into the mitochondria to be oxidized. If Insulin is high, they pool in lipid droplets which drive insulin resistance in the peripheral cells (intramyocellular lipids), and they are slowly broken up in peroxisomes into MCTs that can perfuse the mitochondrial membrane - but in a process that generates significant peroxide (a very reactive oxygen species).

So what happens when you change the diet that is keeping insulin elevated. Well you are insulin resistant so you still make a LOT. But your fat cells are still ignoring that, and if you can make just enough to turn on your carnitine shuttle - then you are off to the races all those FFA’s being dumped into circulation by your broken fat cells you can burn as long as you keep insulin below the threshold that inhibits the carnitine shuttle.

The stall, when it happens is actually a good thing. It’s the return of insulin sensitivity to your fat cells. You still make high insulin, even when you eat nothing - so your now healthy fat cells are doing their job and sequestering energy.

To get down from that stall you have to lower insulin.

If at a stall you decide, Oh well I’ll just eat less that will do it … what your body will do is lower your metabolic rate and go looking for energy because your insulin is TOO high to release any from body fat.

What does your body do when it can’t get enough energy from fat, and you aren’t giving it any glucose? It burns protein.

So for people who are type 2 diabetic and stalled out, going on a calorie restricted diet will reduce your weight but it will slow your metabolism (so you feel like shit), you’ll burn protein for energy, and you’ll be hungry all the time. AND if you ever stop caloric restriction you will yo yo back up like a former Biggest loser contestant.

A better strategy is to adequately fuel your body from dietary fat, eat your maintenance amount of protein, reduce carbohydrates as much as you can and let TIME at a lower chronic level of insulin reduce your insulin resistance so you need to make less. And you can try some of the exercise, fasting and pharmaceutical strategies to reduce your insulin resistance.

In other words … Keep calm and Keto on.


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(Retta Stephenson) #2

By pharmaceutical strategies, do you mean the exogenous ketones?


(Mark) #3

Fung and Phinney seem to have opposite views on fasting,would you advise a type 2 to never do an extended fast,because I have been doing 3 and 4 day fasts and seem to be doing fine,but I do have Phinneys voice bouncing around in my brain,I feel great that I can go that long without eating,it has complely changed my relationship with food,I know you do fasting with your Diabetes that you’ve talked about, maybe I missed the point of your post,I really like reading your posts but this one leaves me a little confused, I will go back and read it again to see if I can grasp it better, keto on richard


#4

I listened/read both of them extensively and read their books.

Although I deeply respect Dr. Phinney, I think his interpretation of the studies he cites (or maybe the studies themselves) assume the catabolized amino acids are coming from muscle and not just the circulating amino acid pool and those released from autophagy/autolysis which scavenge the junk protein including those from tumors as seen from people like Dr. Valter Longo and Dr. Satchin Panda.

That being said, @richard is correct in pointing out that if you can’t release enough energy from bodyfat to meet your daily expenditure the body will trigger gluconeogenesis from lean body mass in a way the exceeds that seen in beneficial autophagy.

Finally, don’t forget that fasting triggers increased HGH levels and prepares the body for sparing lean body mass.


Dr. Phinney's take on fasting
(Richard Morris) #5

Metformin reduces insulin resistance. So does Berberine.

Exogenous ketones wouldn’t lower your insulin resistance, they would just be a more expensive version of eating fat for energy. And if you ate ketones but didn’t restrict carbs and protein they would be worse for your insulin resistance.


(Richard Morris) #6

Well said Bill.

The protein requirements for fasting are complex and a lot less than the assumptions made in Cahills studies that Dr Phinney apparently relies upon for his 1/4 lb of muscle loss per day.

In 2016 I did an 18:6 intermittent fast on most days, and once a month I did a 3-10 day water fast. This appears to have lowered my fasting insulin - but I confounded it by going off metformin in August.

Fasting works for me to reduce my fasted insulin, but that number for me appears to still be too high to burn a lot of body fat. I am profoundly metabolically deranged and have to do a lot of things to start to bend the needle.


(Mark) #7

Thanks for the additional info and it does seem to be a complex issue and I had read about it being muscle sparing,which made me feel better about sticking with it,I guess I just have to stick with the we are all unique snowflakes theory, and keep calm and keto on


(Marty Kendall) #8

@rettakat I think the ex ketones actually increase insulin.


(Retta Stephenson) #9

@Marty_Kendall Thank you for the link to this article. Amazingly helpful to me.
I think I see my problem: I am trying to address 2 separate issues at once, yet they actually need slightly different approaches.

First, I need to lose as much weight as possible for impending cancer surgery in March or April. It will be much safer for me, per the surgeon. Even though I’ve lost almost 150 lbs, I’m still considered at risk, since still around 310.

Second, I was trying to stop/slow tumor growth by depriving it of it’s preferred energy source (glucose and perhaps glutamine from too much protein), so as to prevent recurrence after said surgery.

It never occurred to me that I needed to approach these goals sequentially until I read that article! I’ll do some more thinking and research, and prioritize my goals. Again, thank you!


(Mark) #10

I pray your your surgery goes well,God bless you


(Retta Stephenson) #11

@Bacon, thank you so much.


(Richard Morris) #12

good luck with your pre-surgery preparations, the op, and your post-op recovery.

You can make something like 100g/day of ketones in your liver burning fat.

Exogenous ketones are $85 for 5 days worth (about 30g of D-BOHB).

Your liver is making you about $300 worth of the stuff every day. I think that’s a pretty good deal. And it’s drawing down body fat as a nice bonus.


(Simon Saunders) #13

If you are in a ketogenic state, and proven by producing “some” ketones, there may be a third road to consider.

A study in Rome published in 2016 found a VLCK protocol not only cut 7% Body Fat in 3 Weeks it also Increased lean Mass by 4%.

They found remarkably, the reduction of visceral mass was more intense in the VLCK diet group than it was in the LC diet group, and this difference was observed even at 24 months, with a reduction of 706 vs. 212 cm3 , respectively (p < 0.001)—or, in fat grams, 666 g vs. 200 g, respectively (p < 0.001) (Fig. 4b).

The important thing isn’t comparing the LC group but that a VLCKD program not LOST visceral “Belly” fat but also increased lean mass, so there is something else happening when fats are lower while in a fat adapted state.

This is not about raising the level or protein, its about keeping it the same, its just lowering refined fats lower for a temporary amount of time, similar approach to how we implement fasting.

Is this the only option?
No there is raising metabolic rates, fasting, TRE, IF, cold exposure the list goes on and on.

In the end this is another option in the toolbox for us following a keotgenic lifestyle.


(Richard Morris) #14

I think you might have conflated two studies, the one you linked was the Pronokal :tm: commercial diet study that went for 2 years. It didn’t find an 4% increase in LBM after 3 weeks or if it did I missed it. But it did find the 666g fat mass lost on the VLCK vs 200g on an LC diet.

I will say a couple of things about that Pronokal :tm: diet and the study (which was paid for by Pronokal) not that there’s anything wrong with that.

#Intervention: very low calorie ketogenic for 2 months diet

The Pronokal :tm: diet is 3 phases.

Phase 1: Is the only ketogenic phase is really a protein sparing modified fast eating 600-800 kCal made up of 50g carbs, 10g fat, and 0.8-1.2g/kg LBM of their powder protein supplement - 5 times a day for about 2 months.

Phase 2: a regular low calorie (800-1500 kCal) balanced diet for 6 months

Phase 3: a higher calorie (1500 - 2250 kCal ) balanced diet for maintenance

So I think it’s pretty obvious that this was not ketogenic at all after 2 months, and was a pretty awful variant of a ketohgenic diet for those first 2 months with people losing on average 3.1 kg of lean tissue :black_medium_square: after 2 months and only 10.7 kgs of fat mass :black_circle: according to the composition graph. So clearly short changing these subjects for calories in that time forced their bodies to recruit protein as an alternate substrate. That’s what having only 10g of fat in your low carb diet will do for you.

Control: The 10% caloric deficit balanced diet

Another interesting point to make about from this study is the Low Calorie control arm. It was calibrated to 10% below calculated metabolic requirements based on a FAO/WHO model using age, body weight, height, gender, and a fudge factor for how energetic your day has been.

That there should give some hint as to why it’s not possible for us to calculate metabolic requirements better than our own bodies which factor in thousands of parameters.

You can see the failure of the CI:CO model in the weight loss from a balanced diet following a 10% deficit looking at the change in body fat X and lean mass :small_red_triangle: on the control (LC) arm. In the first 2 months as the subjects went from their calorically sufficient diet to a 10% deficit …

They lost weight. Losing 3.9 kg fat mass ( :triumph: ), and 1.9 kg lean mass ( :scream: ). But then their losses of body fat plateaued out around 6 months despite a continual 10% deficit. And the Lean body mass loss increases.

#Why if we were reducing Calories in by a consistent 10%?

Because the bodies homeostatic regulation kicks in and adapts (lowering BMR undetected by all the cleverness of of the FAO/WHO BMR calculation)

This then is the fundamental problem with the whole “Just eat less” furphy, your body is much cleverer than that and will adapt.

If you want to lose 35kgs and keep it off for 3 years as I have done then you don’t do that by setting up an energy deficit, you do it by setting up a surplus of energy by lowering insulin and letting your body manage the calculus.


(Jamie Hayes) #15

Fascinating and deep topic.

Regardless of how one ketoes on, I’d encourage everyone to do whole body high intensity resistance training, which can be done safely at any age and weight, and only takes 30 minutes twice a week. This can help stimulate muscle maintenance re-growth.

To this I’d add some type of HIIT (High Intensity Interval Training) which again can be done safely at any age and weight. This may also help insulin sensitivity.


(Simon Saunders) #16

Good points Richard, will have to expand my knowledge base in this subject, willl utilise your notes to build up mine, thank you so much for diving deep on it, once I get the information clearer I’ll post up most information, as it’s a complicated one.


(Richard Morris) #17

Yeah it’s quite a rabbit hole and the deeper I go the less I know. I am not even the tiniest fraction of the way … and somewhere down below me, beneath the quantum foam I can just make out the grin of Dr Jack Kruse, but I’m not sure if he’s the Cheshire cat or the Hatter.


(Pete Shearer) #18

WOW, @rettakat! Great work. I hope your impending surgery goes well!


(Stickin' with mammoth) #19

Where can I get a t-shirt that says this?


(Keto Troll) #20

He’s a combination of both.