...
How can I be sure it was low enough for that persons insulin resistance? You mean beyond some carbohydrate intolerance threshold? If so, that is a fair point in the sense that in those that low CHO did not work for, was the carb still set too high. I could not say as I did not have the time with those particular people to trial various ratios.
The diets were designed to provide around 50g of CHO per day and from what I recall were calculated to 10-15% of energy needs. I kept protein to roughly 20% of energy needs. Such diets should have caused a decent drop in insulin (these were not measured) and so not seeing weight loss in those whose diets were matched to their energy needs (I wasn't expecting any - blood sugars were generally better) would need to be explained if the insulin theory (independent of calories) is correct.
As I say, you make a fair point regarding needing to trial different carb amounts - which my knowledge and experience is lacking in - but surely you'd agree that insulin reduction per se should create at least some weight loss if it is the major driver of weight/fatness?
You ask how this fits in those with insulin resistance yet I have seen T2DM patients lose weight on low calorie diets frequently and studies that looked at whether insulin resistance affect weight loss found it didn't whilst numerous studies show people losing weight - many low CHO V High CHO studies have shown this
That is an incredible story, a lot of hardship but many triumphs too. I think it is a testament to your character and that you kept going and found a way - many may have become angry and or given up. You worked it out for yourself, and regardless of how - the point is it does and it has made you much better. This is incredibly helpful and rewarding to me because either I do what many do and disregard such experiences because they do not fit the text book theories of what should happen or try to find out why and convince others in these fields.Hi Sean thanks for your gracious post.
My medical history started the day I was born. But that is a very long story.
Poverty covered my school years, hunger was a bad friend.
I was always told to eat what was put in front of me. But I couldn't.
The dairy intolerance was evident from childhood, I was ill often with nausea and diahorrea. And butter would have me vomiting, milk would bloat me, it seems that sterilized milk was better than pasteurised. The lactose intolerance is in my family and in my close family, an uncle, an aunty, my niece, my grandson. But all the others are not. I have been told that.it having butter or spread on a sandwich is so unusual, the question is asked, what do you have instead? Nothing!
Cooked vegetables especially the greens, I couldn't eat, my taste buds wouldn't allow it, so I was often in trouble at school for not eating, cabbage, sprouts, carrots, turnips, cauliflower and spinach, but I could eat the carrots and spinach as pert of a salad with lettuce, toms, cucumber etc. That is how I get my veg micronutrients.
I enjoyed my junior school, swimming, football, cricket and others who like me, there only real food was school dinners. But home life was hard, not much room, lots of chores because my mum worked but my dad had malaria twice and was only able to do light work, but his health was very poor, heart and low blood pressure.
Grammar school wasn't any better, like a fish out of water. Yes, I passed my 11+
But the grammar school was beyond my social class. We were tolerated to some degree but it was really bad. As a school.
Typically I was a very good sportsman, and I played representative cricket at the age of nine and ten for my local area. I was probably the best cricketer in the school, but because of my class, I didn't get picked until my last year, I never made the football, swimming, rugby team even the chess team was no go.
You knew what you were and the posh kids told you. The master's were worse.
So I really had a bad start to life, but it never deterred from bettering myself.
I got a couple of A levels in history and art, how I don't know. I got o levels in geography, maths, chemistry, English.
I wanted to be a machine printer, I passed the test and IQ test, to get my apprenticeship but could not find a firm to take me on. So the day I finished school, the next day, I got a job as a do everything that happens in a printing company.
I was there for two years, before going onto a car manufacturer. I spent 35 years there. Until 2007.
I was doing shifts, eating or not at stupid o'clock, lots of rubbish, white bread, , and after I married, helping out to feed four kids and yourself, so convenient food and a rubbish diet, I was still quite fit because of walking, on my feet at work and at home.
I was a team leader and supervision over thirty men at times. My job was stressful but there was so many good times.
So you could say that I worked my way to a decent job, improved my life and started getting the benefits of a family life with little monetary issues.
During my last ten years I got abroad through my job and visited plants in Germany, Belgium, France and Spain. I was also down south with engineering on pilot.
I got interested in electric powered vehicles and worked on a prototype electric vehicle, but it was too heavy to be a production car. The battery life was poor and too big and heavy. The transformation in the last twenty five years has been unbelievable.
So I retired, and I was already under my doctors due to my issues with my stomach problems, hence the heliocobacter pylori infection was part, that was when my battles with the medical profession started, as described in my last post, they were just following the usual dietary advice. If I had a insulin test instead of the usual blood panel done then, I am convinced that my hypo hell might not have happened.
But I was getting symptoms akin to a metabolism problem, the doctors never took it seriously, especially after my first endocrinologist dismissed me. The one thing I repeated every time was I'm not eating a lot and I'm working, walking all day, and I'm getting heavier. So because I was down on my medical history as prediabetic, T2, not one of the doctors listened or even thought of getting me an endocrinologist. They were dismissive about my symptoms and didn't believe my intake, no alcohol and my lifestyle. I did get in a bit of a kerfuffal with one of the receptionists. But I had to apologise, to see my doctor again.
So as my symptoms were increasing, my impatient followed, and a lot of what happened during these years is missing, even some important celebrations, and Christmas. There was quite a few deaths in the family, within five years, I lost my mother (I was on death watch for a total of ten days, she was in a coma) and two brothers, one to cancer and the other to a massive coronary. The wife lost her mother and also two brothers since. I was getting bigger and heavier and my health was going downhill fast.
I could only work part time and it was a struggle, I had a few incidents that required hospital treatment and even one blood finger prick test read normal. So nothing was said.
Yes, very tough especially frustrating because I didn't have a clue what was happening to me.
So since diagnosis and losing all the weight I put on, within two years my health returned, all my organs were good, all my symptoms mainly went away, no insulin resistance and because I wasn't on the hypo rollercoaster, my hyperinsulinaemia cured itself. My NAFL went, my function results were normal. My fasting bloods were normal, my Hba1c levels were normal, my cholesterol came back at around 4 in total.
For a man of my age and gone through all my troubles, with the family history of heart problems, mine came back normal. Go figure?
My specialist endocrinologist who always smiled when in consultation and was shocked at my weight loss. This began the drug tests and more glucose tolerance tests.
So, no incretins, and yes, secondary insulin is the overshoot. So, yes, it is the insulin that drives me into hypo and yes, the only other way to boost glucose levels is to eat, that is why it is recommended to eat every three hours. But that is unnecessary if you don't eat carbs. And because of no carbs it doesn't trigger a spike, and no insulin overshoot, no hypo! And more importantly, not many symptoms. And also the threat of going hypo overnight. Staying in normal range of blood levels works.
Yes, by a look at reactive hypoglycaemia, there isn't a lot of research especially in this country, I have read papers from the USA and other countries.
I have scoured the internet, Wikipedia is reasonably accurate and some good information there.
This is why, I had to find out about how my weird body worked, my new GP in 2013, labelled me so and my specialist endocrinologist confirmed this when having a humorous moment.
Thanks again, it is a good thing that we learn about others and not fall into the trap of lumping every one into labels of conditions. Every one is different, fingerprints, eyes, gut bacteria, even our response to life, why is there so many different side effects from certain drugs and not everyone?
To share my personal experience:
Traditional low calorie dieting, under medical supervision for 10 months when first diagnosed as pre-diabetic over 9 1/2 years ago.
First 6 months: 1200 Cal's a day. Weight gain of 6lbs total. No change in blood sugar levels.
Next 4 months: 1000 Cal's a day. Weight stable. Minimal improvement in blood sugar levels. I weighed and measured every morsel of food and drink.
Then I ditched traditional advice and switched to low carb, medium fats. Not watching calories but estimate around 1800-2000 Cal's a day from looking back at my records.
I lost 22lbs and within 3 months my blood sugar levels were normal and have continued to be normal in the intervening 8 years.
My weight stalled at 100g approx of carbs a day. A month ago I reduced my carbs to 50g a day and replaced the calories with fats and proteins. I have lost 10 lbs in the past 4 weeks.
I am not, and never have been on diabetes meds.
I hope my lived experience for over 9 years is of use in your musings. Please let me know if you would like further information or clarification.
My starting weight was 20 stones 8lbs. I am now around 18 stone. I am 5' 2" tall. I am sedentary and have ME.
Hi.To share my personal experience:
Traditional low calorie dieting, under medical supervision for 10 months when first diagnosed as pre-diabetic over 9 1/2 years ago.
First 6 months: 1200 Cal's a day. Weight gain of 6lbs total. No change in blood sugar levels.
Next 4 months: 1000 Cal's a day. Weight stable. Minimal improvement in blood sugar levels. I weighed and measured every morsel of food and drink.
Then I ditched traditional advice and switched to low carb, medium fats. Not watching calories but estimate around 1800-2000 Cal's a day from looking back at my records.
I lost 22lbs and within 3 months my blood sugar levels were normal and have continued to be normal in the intervening 8 years.
My weight stalled at 100g approx of carbs a day. A month ago I reduced my carbs to 50g a day and replaced the calories with fats and proteins. I have lost 10 lbs in the past 4 weeks.
I am not, and never have been on diabetes meds.
I hope my lived experience for over 9 years is of use in your musings. Please let me know if you would like further information or clarification.
My starting weight was 20 stones 8lbs. I am now around 18 stone. I am 5' 2" tall. I am sedentary and have ME.
Not sure if you have ever considered Dr Joseph Kraft's study on hyperinsulinemia. But I think that is central to understanding the conflicting low cal/carb results that is often generated. While some takes fasting insulin measurements, almost non seems to document the post meal insulin response in the detailed way that Dr Kraft had.
https://denversdietdoctor.com/diabetes-vascular-disease-joseph-r-kraft-md/
And what may be insightful is that a person with normal fasting glucose/insulin level may have post meal insulin response that is many times the baseline. Resulting in extended high level of circulating insulin levels that goes unaccounted for.
Perpahs this is the elephant in the room and fills many gaps.
If the low cal diet is predominantly carbs based, patients with excessive insulin response will have much more difficulty losing fats.
Which brings me to the next point that we often consider weight loss without factoring changes in body composition, thinking there's no apparent success. Yet we frequently find people on low carb diet with little weight loss, yet could see inches melt away...
If it is already known that the predominant function of insulin is to inhibit lipolysis, then there will be a level where lack of insulin will allow lipolysis to occur. The challenge is to find that level for the individual and if there are other hormonal conditions that interfere with this... Carbs/Insulin model may not explain everything, but appropriately applied, via low carbs/keto/fasting... it has proven to be successful and sustainable for many...
That is an incredible story, a lot of hardship but many triumphs too. I think it is a testament to your character and that you kept going and found a way - many may have become angry and or given up. You worked it out for yourself, and regardless of how - the point is it does and it has made you much better. This is incredibly helpful and rewarding to me because either I do what many do and disregard such experiences because they do not fit the text book theories of what should happen or try to find out why and convince others in these fields.
As I have said, I have no doubt low carbohydrate works for people, I just struggle with the explanation which as a clinician is important for me for many reasons - such as being able to justify why I might use them. Thankfully, incorporating low carbohydrate diets (not ketogenic ones) into a dietary plan isn't quite as difficult as it was even 5 years ago. However when I work for a particular trust they will have programmes for weight loss, diabetes etc and I have to stick with these broadly speaking. Luckily I can justify adapting the approach if their programmes do not work - there is no clear evidence reduced carbohydrate diets are risky, unhealthy etc (some argue they are). The issue is explaining to peers how it works to convince ha ha.
To you I say well done on doing what top medical practitioners in their respective fields could not do and thank you for sharing it with me and others.
The study clearly states that there was a reduction in calorie intake. This explains the weight loss not the reduction in circulating insulin.
Hi.I apologise for taking so long to reply to this. My brain is still struggling with long covid and the article was too difficult for me to read again until now.
I am not sure you read the link properly.
The reduction in calorie intake was BECAUSE insulin was suppressed. There was no dietary intervention. We often say that carbs are addictive and make you hungrier, but maybe it's the insulin that makes us crave the carbs. A true vicious circle then. The easiest way for us to break this vicious circle is to reduce carb intake.
From the 2nd link I posted:-
"Subjects were allowed to eat ad libitum, and neither dietary nor exercise interventions were recommended.
Concomitant improvements in body composition occurred with insulin suppression. Weight and BMI decreased during the 24-week study period.
Both leptin and fat mass decreased, consistent with changes in weight and BMI. Total caloric intake, carbohydrate intake, fat intake, and protein intake decreased despite the absence of a dietary intervention. Carbohydrate craving was also significantly decreased in the entire cohort. Self-reported physical activity was unchanged during the study period.
This study supports the primary role of insulin in the genesis of obesity in some individuals.
A previous study reported the efficacy of insulin suppression in promoting weight loss using diazoxide. However, the magnitude of the effect of insulin suppression on weight loss was confounded by the concomitant use of a low-calorie formula diet in all patients, limited period of insulin suppression (8 weeks), and failure to examine insulin dynamics. This is the first study that prospectively evaluated the effect of chronic insulin suppression on fat mass and body weight in severely obese adult subjects without dietary or exercise intervention.
We found that insulin suppression for 24 weeks was associated with marked weight loss (mean 12.6 kg) in 18% of an otherwise healthy subpopulation of adult obese subjects, and a small but significant weight loss (mean 3.6 kg) in another 57%. This weight loss occurred without dietary or exercise intervention, and occurred slowly but without asymptote.
The role of increased carbohydrate craving and intake has been previously suggested to play a contributory role in the development of obesity. However, the connection between insulin and carbohydrate craving and intake is less clear. The frequent intake of highly refined carbohydrates may induce weight gain by initiating and sustaining a chronic state of hyperinsulinemia. Carbohydrate intake stimulates insulin secretion, raising circulating insulin levels, which in turn favours increased fatty acid uptake, lipid biosynthesis, and inhibition of lipolysis, leading to energy storage. Conversely, it had been suggested that insulin stimulates hyperphagia and fosters carbohydrate cravings, producing increased levels of insulin that promote insulin resistance and exacerbation of the hyperinsulinemic condition. This suggests that a vicious cycle is set in motion that perpetuates hyperinsulinemia and weight gain, and that breaking this cycle can promote weight loss.
Our data suggest that insulin hypersecretion plays a role in the pathogenesis of obesity. Decreasing this hyperinsulinemic state promoted body weight and fat mass loss with concomitant modulation of appetite and food preference in our cohort. These changes were associated with improvements in insulin sensitivity and clearance, and without glucose intolerance or diabetes. Our results propose that suppression of insulin secretion may represent a viable approach in some obese individuals to break the vicious cycle of hyperinsulinemia, insulin resistance and weight gain and to modulate appetite, food preference, and body weight in a beneficial manner."
First. Even if the drop in insulin led to reduction in calorie intake that would still mean that the weight was lost because of reduced intake rather than any direct effects of insulin on fat tissue Many believe insulin directly makes you fat so reducing its levels makes you lose weight - calories are not so important. This is a bit of a different hypothesis.
My main sticking point with insulin being the cause of fat gain is that the cell doesn't take direct orders from Insulin. Insulin sends a signal which the cell isn't obliged to follow - the cell will first look at ratios of specific elements to gauge energy status before deciding if it should follow Insulins request. This is because of allosteric control - essentially regulation by enzymes and biological substances (it is very technical but I can put together an explanation more detailed than the one I previously posted a few days ago). The release of Insulin is not the be all and end all of fat burning because the body hasn't evolved direct fat burning/storing pathways that simply say yes or no. Insulin is a hormone which is subject to regulation and can be overridden.
It is at this level, beyond hormonal control, that I am revisiting to see if there is someway these regulatory processes can fail because many on her clearly reduced calories and didn't lose weight but reduced carbs whilst eating more calories and still lost weight.
Ketone body metabolism is a central node in physiological homeostasis. In this review, we discuss how ketones serve discrete fine-tuning metabolic roles that optimize organ and organism performance in varying nutrient states, and protect from inflammation and injury in multiple organ systems. Traditionally viewed as metabolic substrates enlisted only in carbohydrate restriction, recent observations underscore the importance of ketone bodies as vital metabolic and signaling mediators when carbohydrates are abundant. Complementing a repertoire of known therapeutic options for diseases of the nervous system, prospective roles for ketone bodies in cancer have arisen, as have intriguing protective roles in heart and liver, opening therapeutic options in obesity-related and cardiovascular disease. Controversies in ketone metabolism and signaling are discussed to reconcile classical dogma with contemporary observations.
Hi.
Regarding Insulin stimulating appetite - I had a discussion on here a while ago regarding this. My argument then was that the evidence strongly leans towards Insulin being a satiety hormone - making a person feel full - so reducing intake. I do not recall seeing any convincing evidence that indicates it promotes appetite. I'll look at those studies you posted and comment on them when I can.
Thanks
Hi.
I know you posted 2 links but I believe they were to the same Study?
I am certainly reconsidering/reviewing what I had thought I satisfactorily understood. I have looked at this many times before and always came back to calorie ultimately being the cause of weight gain although what drives excess energy intake is far more complicated. I 've had success reducing calories so it is a workable option but for many it clearly isn't - regardless of having T2DM or not. For many on here it does seem calories is just an impossible explanation based on their own self experiments.I think that the impossible fact of calories not being entirely real is beginning to dawn on you - so many believe it implicitly and I am not the only one to experience the venom of a doctor who has been told that the diet isn't working - I have even had one doctor threatening to have my children taken away and me locked up because I questioned his advice on diet.
I'll look at the study!Have you considered the role that ketones may contribute to this cellular energy regulation process? Especially when cells become insulin/glucose resistant...
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5313038/
Abstract
I apologise for taking so long to reply to this. My brain is still struggling with long covid and the article was too difficult for me to read again until now.
I am not sure you read the link properly.
The reduction in calorie intake was BECAUSE insulin was suppressed. There was no dietary intervention. We often say that carbs are addictive and make you hungrier, but maybe it's the insulin that makes us crave the carbs. A true vicious circle then. The easiest way for us to break this vicious circle is to reduce carb intake.
From the 2nd link I posted:-
"Subjects were allowed to eat ad libitum, and neither dietary nor exercise interventions were recommended.
Concomitant improvements in body composition occurred with insulin suppression. Weight and BMI decreased during the 24-week study period.
Both leptin and fat mass decreased, consistent with changes in weight and BMI. Total caloric intake, carbohydrate intake, fat intake, and protein intake decreased despite the absence of a dietary intervention. Carbohydrate craving was also significantly decreased in the entire cohort. Self-reported physical activity was unchanged during the study period.
This study supports the primary role of insulin in the genesis of obesity in some individuals.
A previous study reported the efficacy of insulin suppression in promoting weight loss using diazoxide. However, the magnitude of the effect of insulin suppression on weight loss was confounded by the concomitant use of a low-calorie formula diet in all patients, limited period of insulin suppression (8 weeks), and failure to examine insulin dynamics. This is the first study that prospectively evaluated the effect of chronic insulin suppression on fat mass and body weight in severely obese adult subjects without dietary or exercise intervention.
We found that insulin suppression for 24 weeks was associated with marked weight loss (mean 12.6 kg) in 18% of an otherwise healthy subpopulation of adult obese subjects, and a small but significant weight loss (mean 3.6 kg) in another 57%. This weight loss occurred without dietary or exercise intervention, and occurred slowly but without asymptote.
The role of increased carbohydrate craving and intake has been previously suggested to play a contributory role in the development of obesity. However, the connection between insulin and carbohydrate craving and intake is less clear. The frequent intake of highly refined carbohydrates may induce weight gain by initiating and sustaining a chronic state of hyperinsulinemia. Carbohydrate intake stimulates insulin secretion, raising circulating insulin levels, which in turn favours increased fatty acid uptake, lipid biosynthesis, and inhibition of lipolysis, leading to energy storage. Conversely, it had been suggested that insulin stimulates hyperphagia and fosters carbohydrate cravings, producing increased levels of insulin that promote insulin resistance and exacerbation of the hyperinsulinemic condition. This suggests that a vicious cycle is set in motion that perpetuates hyperinsulinemia and weight gain, and that breaking this cycle can promote weight loss.
Our data suggest that insulin hypersecretion plays a role in the pathogenesis of obesity. Decreasing this hyperinsulinemic state promoted body weight and fat mass loss with concomitant modulation of appetite and food preference in our cohort. These changes were associated with improvements in insulin sensitivity and clearance, and without glucose intolerance or diabetes. Our results propose that suppression of insulin secretion may represent a viable approach in some obese individuals to break the vicious cycle of hyperinsulinemia, insulin resistance and weight gain and to modulate appetite, food preference, and body weight in a beneficial manner."
Because that was the only thing they artificially altered. You stated that the weight was lost because calories were reduced, and it seemed like you were saying this was there was a calorie limit placed on the participants.May I ask why you say the weight loss WAS because of reduced insulin.
That is really interesting. I have, since the beginning of April, started eating whatever fat comes with my protein. So Ribeye steak, shoulder of lamb and pork, cheese, eggs, chicken and oily fish but drastically cutting down on the double cream to only 20ml a day.On the other side the diabetic solution genius Dr. Bernstein is of the view that you eat fat whatever come with the protein, which is a good way to manage your fat intake. Thirdly, i read that not everyone's response to fats is similar, so you can try a low carb high fat diet and do check your lipids and based on results, tweak your fat intake.
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