Health and wellbeing. Such buzzwords these days. Seems like everyone knows exactly what we should be doing, and yet year after year we just keep getting fatter, sicker, and more tired. Surely we must be doing something wrong, or at least not doing it hard enough. In order to move health and wellbeing away from a religious practice and into a science, we must learn!!! So be prepared for a long journey!
As we age, many of us get to a point – maybe its somewhere in our 20’s or 30’s, or for some later, but we realize that things are not going all too great healthwise. Now, don’t be too hard on yourself, it’s becoming a global thing, but still, maybe it’s time for a few changes. I don’t think anyone really minds making changes if they understand them and have a reasonable assurance that benefit will be seen. Advice without understanding – it just doesn’t seem to work long-term, especially if benefits are delayed or subtle. You need the power of understanding to make it stick.
So why should you care? I don’t know, maybe you like to be alive? We’ve all got our reasons. It wasn’t until I had a couple kids that I actually started to even consider my longevity, and then suddenly a little heart burn or gas pains and I was worried about heart attacks. Oh crap! Health? What do I do to improve that? So that was the start of the journey for me.
Too many family and friends have had lives cut short, and many more are suffering from some sort of condition or disease that reduces their quality of life, and then there is the whole financial burden. I guess that the case is already very clear why we should care, but the question remains of “What are we going to do about it?” What strikes me is the fact that metabolic syndrome related issues represent the leading causes of death and the biggest cost to insurance, and yet our medical system continues to offer little support or helpful information in regard to overcoming this challenge and avoiding the cascade of events that will likely lead to our early demise. Doctors are great for many things, but this seems to be one of their blind spots. It’s not their fault, well at least not initially. They just aren’t trained in this area yet. Maybe you can help change that eventually?
So, with that in mind, perhaps we should take it upon ourselves to learn a little more about metabolic health if we ever hope to be healthier, live longer, and lower our health expenses. We don’t have to stumble through this blindly as most of us have been doing (myself included up to a few years ago). We live in a world of science and technology, so why not use it. There is no shortage of scientific knowledge and evidence out there related to this topic, and while not all science is good science, there does seem to be enough decent information out there to help get us going in the right direction. We just have to re-evaluate what we think we know, and apply some critical thinking to see what really makes the most sense. Dispelling some of the false dogmas is really one of the hardest parts.
As I’ve gained a few years (and a few pounds), had children (and gained a few more pounds), I gradually became concerned with my health and potential longevity, and I reached a point where I wanted to start taking better care of myself. Searching the internet for guidance, I quickly realized that in the mainstream media there was no clear consensus for practically anything related to nutrition and health. Even the major news outlets were constantly publishing contradicting pieces, sometimes simultaneously within the same organization. How could this be? Either we just aren’t smart enough to figure out this mystery, or we are being led astray by those who either do not really understand what they are talking about, or by those who would profit from our misguidance. The news outlets don’t profit by always being right, but rather by catchy headlines that attract attention, so they certainly have played a big role in further confusing the matter, and even the editors of prestigious scientific and medical journals are no longer out of reach of the influence of corporate interests. Businesses tend to optimize for profits, which often does not align with what would provide you with the biggest health benefit.
In order to make any sense of this media fight, I took a reverse engineering approach: starting with the disease and tracing backwards to its roots (seeing how I had some family history, I was mostly interested in cardiovascular disease at first). By gaining a better understanding of some biological mechanisms that contribute to the problem, it becomes clearer as to what some of the contributing factors really could be. However, in this case I realized how much more complicated the problem was than I had presumed.
I was surprised to find that metabolism appears to be at the root of almost all the common chronic diseases (such as cardiovascular disease, type 2 diabetes, Alzheimer’s/dementia, a number of others, and even cancer). Maybe I shouldn’t have been that surprised. After all, if you put the wrong fuel in your car, or even just screw up the air to fuel ratios, the performance will be compromised (if it even runs), and it could lead to a whole host of mechanical breakdowns. We are a very flexible fuel organism, however, our bodies are not well adapted to some of the newer (more refined) fuels, so sustained high levels of consumption of the wrong things will gradually throw the whole system out of balance. And every system needs some downtime, even digestion, so without that, we can also find ourselves in an unbalanced situation.
To be honest, I initially had a pretty naive view of what defined metabolism, thinking it was simply how fast we burned calories. In reality, metabolism encompasses a huge range of things – such as how our bodies absorb and utilize nutrients, manage available energy sources and storage (fat), orchestrate cellular growth and repair, hormone production, control total energy expenditure, immune system function, inflammation, cognitive function, methylation and genetic expression, DNA repair, etc. So things that influence our metabolism, influence basically everything about how we feel and how optimal our systems will perform, including our susceptibility to illness, chronic diseases, and even cancer. Some of the things that influence metabolism are impossible to control (like genetic code), while others are difficult, but addressable (like stress, sleep, exercise, etc), while diet (both what and when we eat) is considerably easier to control (provided that we are following an effective approach that minimizes hunger). Will changing your diet fix everything? Obviously not. One puzzle piece doesn’t make a picture, but it’s still critical, and giving you more energy to think clearly, maintain positive mood, and move about can help tilt the scales in your favor as you tackle other challenges.
In my quest for answers, I was fortunate enough to find a number of likeminded individuals who were already on this path, and had a good deal of science/biology based information available. With this knowledge, it’s much easier to make steps in the right direction, and in return reap the benefits of improved health, increased energy, improved immune response, and delayed progression of many chronic diseases. To adequately address the problem, you need to have some understanding of what all is involved, so here we go!
So let’s start out by clarifying what is meant by metabolic syndrome:
“Metabolic syndrome, sometimes known by other names, is a clustering of at least three of the five following medical conditions (giving a total of 16 possible combinations giving the syndrome):
abdominal (central) obesity (cf. TOFI)
high blood pressure
high blood sugar
high serum triglycerides
low high-density lipoprotein (HDL) levels
Metabolic syndrome is associated with the risk of developing cardiovascular disease and type 2 diabetes. In the USA, about a quarter of the adult population have metabolic syndrome, and the prevalence increases with age, with racial and ethnic minorities being particularly affected.”
Having just one of these conditions doesn’t mean you have metabolic syndrome. However, any of these conditions increase your risk of serious disease. Having more than one of these might increase your risk even more.
If you have metabolic syndrome or any of its components, aggressive lifestyle changes can delay or even prevent the development of serious health problems. https://www.mayoclinic.org/diseases-conditions/metabolic-syndrome/symptoms-causes/syc-20351916
Essentially insulin resistance (or more accurately the resulting hyperinsulinemia) is the driving force behind metabolic syndrome. This is when insulin begins to be less efficient at getting glucose out of the bloodstream and into the cells, and requires higher levels of insulin to get the job done. It’s not an all or nothing type of thing, but more of a continuum ranging from healthy (not resistant or insulin-sensitive), to moderate (prediabetes), to severe (advanced type 2 diabetes). The medical conditions listed in the above definition are symptoms or markers of the underlying insulin resistance/hyperinsulinemia. While you can mask a symptom with medication, it does little to improve overall health because you haven’t done anything about the root cause. Some classes of type 2 diabetes medications have even been shown to increase the progression of the disease. This is because high blood sugar is a symptom, not a cause. Giving someone insulin pills/injections improves that one symptom, but worsens other symptoms (like weight gain, inflammation, heart disease, and cancer risk) because it worsens the underlying cause (insulin resistance and high insulin levels). Their blood sugar is better controlled, but no net health benefit is obtained, and their lifespan is most likely shortened.
Despite sharing the symptom of high blood glucose, type 2 diabetes is essentially the opposite of type 1. Instead of too little insulin (type 1) resulting in glucose not getting into the cells, we have too much glucose and too much insulin. If excess glucose is the problem, overriding your body’s natural defenses and forcing it from the blood into the tissue is not getting rid of the problem, it’s just moving it somewhere else. What it was trying to avoid is now forced upon it, and the cascade of diabetic complications will progress despite the well-controlled blood sugar levels. Did you think that your cells just suddenly became stupid and forgot how to use insulin? No! They know what is best for them; they just don’t need any more glucose at the moment.
Excessive weight gain is another symptom/side effect of insulin resistance. Since the fat itself is not the primary cause of the other symptoms, physical removal by liposuction or other physical methods will do little to improve overall health.
Obesity is often associated with insulin resistance, BUT it does not CAUSE insulin resistance. While it’s more common that obese people are insulin resistant, there are still quite a few that are insulin sensitive. On the flip side, some non-overweight/non-obese people have severe resistance, despite no obvious outward physical signs of this imbalance. The negative health complications are mostly driven by the high insulin levels/insulin resistance and ectopic fat (as well as too much glucose in the tissues and bound to proteins), not the general level of obesity, so focusing only on obesity can be misleading. The likely complications are many and severe, such as greatly increased risk of heart attack, stroke, kidney failure, blindness, foot ulcers and amputations, PCOS, cancer, etc. https://blog.thefastingmethod.com/end-organ-damage-t2d-17/, so maybe not something to be taken too lightly. If this doesn’t seem clear to you, see Dr. Jason Fung’s blog or his books for more details and discussion, as he really has a great understanding of this area.
Any attempts to overcome metabolic syndrome, its symptoms, and any of the related health conditions need to focus on ways to improve insulin resistance. To do that, we must evaluate which factors are driving it up (for each individual) in the first place. Too much glucose into the system is a pretty common contributor, but other factors are often involved as well.
This information is summarized from a number of different sources (academic papers, podcasts, videos, text books, etc.). More specific info I will provide links, but general concepts not so much. There is absolute mountains of information out there already, with more being published every day, so this is a start at best, and by no means complete. True science is continually evolving. New information and technologies bring new understandings, and many older known “truths” or “knowledge” are often modified or proven to be false as time goes along. We need to be willing to question what we currently know, and be willing to adjust or discard this knowledge if the new information seems sufficiently compelling. So essentially none of this is set in stone, but anytime we have a good understanding of the underlying biological mechanisms by which something operates, we can feel a little more confident that we are closer to the truth.
I myself am a fairly skeptical person, and as annoying as that may be at times, I’ve come to learn that is an essential part of good science, and also helpful in navigating through the continuous onslaught of BS that has become our world. As you read, I fully encourage you to be skeptical, and to question and research on how any part of this could or could not be accurate (to the best of our knowledge), and/or to better understand the underlying biology or mechanisms being discussed.
This isn’t about what specific diet is best, that will be up to you to figure out what works best for your body. It’s simply information/resources to help educate yourself on the topics of metabolism and endocrinology (basically how our bodies react and utilize food, and how hormones control everything that’s happening). Why is this important? Let’s say I’m an engineer and just designed a beautiful skyscraper by hand (no computers, no tables or charts, maybe I used a calculator, or maybe I didn’t) then I told you that I don’t know any math or structural mechanics, and just did what looked good or felt right. Would you still go inside? I hope not! No, we would want someone who knows what they are doing when it comes to something that could come crashing down and end your life. Someone who actually takes an interest and actively seeks out more knowledge. We should hold the same high standards when it comes to nutritional advice, because this all really can come crashing down and end your life too (eventually). However in the current health industry, many nutritionists and most doctors have a vague, incomplete, or outdated understanding of these concepts, and their nutritional advice will reflect that understanding. We don’t require that doctors and nutritionists have advanced training in metabolic health and endocrinology in order to give out nutritional advice, but we definitely should!!!! Most chronic diseases have a major metabolic component, and by ignoring this, we are missing a major part of the equation. Plus, the science is advancing at an amazing pace, so if a physician is not actively learning, then their knowledge is probably not all too accurate anymore.
I may not be a professional in this field, but I have a slight obsession with it, so I would rate my knowledge as pretty good. However, I’m still learning, and what I want to learn keeps getting bigger, so I always feel relatively less educated than where I would like to be. I’m an engineer, so maybe it’s not that surprising that I would read this stuff for “fun”. Myself, I wouldn’t really call it fun, but useful, so I continue. So anyways, at this point its become apparent that much of the nutritional advice we have been getting throughout the years has been, and sadly continues to be inaccurate and often counterproductive (not to say that scientists haven’t been fighting this all along, they just have been effectively kept out of the spotlight). Think about it – as a population we have been trying the current approach (low fat- low calorie) for 40+ years, but the results have been terrible, essentially moving backwards; higher rates of obesity, more severe obesity, and higher rates of heart disease, diabetes, cancer, etc. At what point do we consider re-evaluating our methods and understanding? Rather than blaming us for our apparent lack of discipline or willpower, maybe we have just been getting advice that doesn’t work for most people’s biology. (If you need further convincing, read this blog post by Dr. Peter Attia: https://peterattiamd.com/success-versus-failure-stark-juxtaposition/)
Now is a good time to ask a very serious question that no one seems to ask – If something is low in calories and mostly nutritionally devoid, then why on earth would you eat it? Why do we eat food? Its not just to feel full, but to get nutrients and energy. We need to power our brain and every other cell in our body. Low-calorie is the sales pitch for the desperate, which well to boost profits, but not so much for controlling or losing stored fat. Learning how to fuel your body while positively influencing its chemical communication system is how to conquer the beast. We don’t need to be afraid of food, we just need to learn how to work with our body instead of against it.
========================================
But we already know what is healthy. Right???
Being an engineer, I believe in the benefits of science and the scientific process. In order to solve a problem, we need to understand its roots, and trace them back until we can figure out what most likely the true cause or contributing factors. Gary Taubes’ books “Why We Get Fat…” and its longer textbook-like version “Good Calories Bad Calories” really served as an eye opener to me in regard to all the very poor science that has surrounded the field of nutrition. Learning that much of our popular nutritional philosophy was never really based on any actual scientific evidence, and often ignores the biological processes that occur within the human body, I found quite shocking. NOTE: evaluating correlations in multi-variable population data CANNOT provide proof of cause, and is generally not considered scientific evidence. Not to mention that taking surveys of what people remember they ate the previous week is not at all scientific, nor is it accurate in terms of assessing macronutrient or micronutrient content. I hardly remember what I ate yesterday, nevermind 5 days ago.
Why would we pretend to know something when we don’t? While there is no short answer to that question (mostly politicians, business interests, poor scientific standards, big egos, and good-willed ignorance), it does make me feel the need to wave a flag and bring this to attention. When you look a little into the details, it becomes less of a surprise that we are so far off base. The standard dietary recommendations have changed very little in the last 40+ years. Considering the rapid pace of science and technology, that makes this knowledge next to ancient, and is probably not something you want to bet your life on. There are a lot of things we thought were true 40 years ago, but eventually learned otherwise. Want to keep using a 40 year old computer? I wouldn’t even know how to make it work (Punch cards? WTF?). Want to use 40 year old surgical procedures? Yikes! Why are we so resistant to change in this area? This idea that dietary fat was responsible for obesity and heart disease was an untested hypothesis at the time, in the late 70’s, (and highly influenced by the Sugar Association), and has since been shown to NOT be supported by evidence in scientific controlled study after study when not in the context of high sugar. And if we did truly have this all figured out decades ago, then why are things still getting even worse? It’s easy to remember when I was in elementary school which kids were the few chunky ones, and the one kid who unfortunately was quite obese. 30 years later, that obese kid wouldn’t really stand out anymore, because there is a whole new level of fatness, and at much younger ages. I saw a 3 or 4 year old struggling to walk through the park the other day. She knew how to walk fine, but was almost as wide as she was tall, so every step took great effort and balance – it just breaks my heart to see such a thing. I wanted so much to offer up some helpful advice or steer the mom in a better direction, but to do that in a smooth non-offensive way requires some serious tact. Maybe my wife could pull something like that off, but I know my limitations.
Keto diets are all the buzz lately. They are on all the grocery store magazines, promising ridiculous weight loss rates. And really, why else would you buy the damn issue? But truly, a well formulated low-carb higher-fat diet will often yield decent results (like a few pounds a month maybe) for many people, but to know why it works, you must delve into a bit of biology. What? You want me to care what happens inside my body? That’s crazy!
Believe it or not, our stomach is not just a big sack of food where anything extra just gets stored as fat. We actually have a chemical messaging system to ensure that fat gets stored when we tell it to. We have evolved with feast and famine (and of course a little in between), oscillating between storage and usage modes both frequently and seasonally, but now days most people stay in storage mode almost the entire day, 365 days a year. We want to lose weight. We want to be healthier, have more energy, and feel better, but if our eating patterns and food-like selections keep us in a perpetual state of storage, then we will surely suffer the shame of failure. Plus we will feel like absolute crap, because we are storing energy instead of using it. To ensure success, we must learn a little of the language our body uses. Once you do that, and begin to see real results, it gets a whole lot easier. One thing that I have found is that knowledge beats the hell out of blind willpower any day! You want to make a change? Educate yourself and you will find willpower you never knew you had.
Are we to just rely on “authorities” to inform us what to do to be healthy, and hope that they know what they are talking about, and don’t have a conflict of interest. Change can be difficult if we are merely following advice, unaware if its working or not. Plus we have no clue if they were right from the start. However, if we learn not only WHAT we should be doing, but also the specifics of WHY, it can make all the difference in giving us the power to change our behavior. Plus, we will be more equipped to make an educated guess as to how effective the next new diet craze or news headlines concerning nutrition might actually be.
I know it’s not quite as exciting as watching tv or video games, but if we spend even a tiny bit of time learning a little about how our bodies work in regard to what we eat, it can have a major beneficial impact upon our lives. Remember back when you had a little more zip and felt pretty good? That’s not necessarily gone for good. We often think that we’re just getting old, and now we are feeling it, but more likely we just got our metabolism really screwed up. The good news is that with the right approach, it can be corrected. You will have to do your homework, but it’s completely within your grasp – it just takes a little time and effort. Working out is a great step in the right direction, but why spend countless hours at the gym, if what you eat when you come home largely un-does all the metabolic benefit of the workout you just got. Personally I wish I would have known this stuff 25 years ago, but better late than never. I highly recommend reading at least the two books at the top of the links section. Again, read those two books!!! Libraries still exist if you don’t feel like buying them yourself. They are definitely worth the time spent, but even if you don’t have much time for reading, at least watch some of the videos to see if any of this makes sense to you.
Last year my work sent out a wellness report with some pretty staggering trends. Staggering NOT in a good way! Year after year, we are getting worse and worse. Sicker and more costly. And it’s not just my workplace, it’s everywhere. It’s a community thing. It’s national thing. It’s even a global thing!!! Not to say that I’m surprised, but rather alarmed. It seems evident that if we don’t change, and the system doesn’t change, then we are in for a world of sickness and financial turmoil. (Check these charts out – https://www.cdc.gov/diabetes/statistics/slides/maps_diabetesobesity_trends.pdf – the difference between 1994 to 2015 is staggering!!!).
From my experience, most people certainly want to be healthier, and most do make a good effort at doing what they think will help them to be successful, but unfortunately that doesn’t mean that they will get healthier. It will only work if the advice they have been following is truly fixing the issues that plague them. For most of us (obesity, fatigue, T2-diabetes, heart disease, cancer etc.) this issue is directly related to metabolic syndrome and insulin resistance. Some of us can remember when our metabolism “changed”, and we suddenly couldn’t just eat whatever anymore, while others never had that luxury in the first place. I heard countless variations of this growing up – “Enjoy that while you are young, but one day it will go right to your hips”, or belly in my case. The problem is that we think it’s just the natural progression of growing older. We don’t even consider that a problem exists, let alone try to devise a strategy that will fix it. To confuse things more, there are even a few people that don’t get obese, but still have the all the other disease risks, known as TOFI (thin-outside-fat-inside).
This change in metabolism is not a natural part of aging, but rather a progressive failure of our biological systems due to extreme and sustained demand. Basically, our body begins to get worn out from too much bombardment of glucose (blood sugar) and the resulting high sustained levels of insulin that develop due to our cells attempting to limit uptake. The body begins to have problems clearing the excess sugar from the blood quickly, resulting in higher levels of insulin being required to get the same job done, and taking more time for it to do it. While a higher level of insulin works to reduce your blood sugar, it is very harmful in numerous ways. If not resolved, this eventually can progress to Type 2 diabetes, and is also linked to atherosclerosis/heart disease/stroke/Alzheimer’s, a number of other ailments, and can even play a role in causing cancer development and increasing its aggressiveness. All the while, much of the excess sugar that cannot be shoved into your cells still needs to be cleared from your bloodstream, and so it is eventually converted by your liver into triglycerides and stored as fat in your liver and throughout your body (and it’s not just stored in the fat cells under the skin, but also within muscle tissue and vital organs, which impairs their function). Too much fructose consumption has a special place in hell in regards to liver fat accumulation and damage, but more on that later.
So many consulting firms these days are all promising “to reduce their risk of Diabetes and other chronic diseases”. At work I got a little excited when I first looked at the new one – Omada. Are we finally going to take a step in the right direction? However, looking further I saw no mention of a different approach, just applying the same classic recommendations, but adding in more technology to attempt to keep you on track. Once again, the repeated message is that we know what you need to do, but you just suck at doing it, so here is a new scale and a phone app. Surely it will work this time. They said it was based on science, but I had to read on to find out that it was behavioral science. Bullshit!!!! The added technology and social support could be helpful if they have already tackled the metabolism issue, but as a standalone it will probably not help very much in the long run for most people. It’s not all that hard to lose a little weight for a few months to a year, but keeping it off long-term is much more difficult unless you are taking a more effective approach. To what degree and how accurately are they addressing the causes we will have to wait and see; maybe they just want to keep their smoking gun secret, but quite likely they don’t have one. On their website under outcomes, after 1 year on the program they show very marginal reductions in 5yr risk for diabetes(-30%), stroke(-16%), and heart disease(-13%). This is not nearly as substantial as I would expect to see if they were aggressively targeting the root cause, especially if these are already high risk individuals. Basically after a whole year on the program, they are still high risk! WTF? Type 2 diabetes is a curable disease in most people within a timespan of a few months (but only with a dietary intervention, not with medications), so I would expect a huge reduction in risk for that if they were actually doing things right. (Look up Virta Health and you will see significantly more encouraging statistics related to diabetes reversal and other clinically important biomarkers, and one of the pioneers in the field – Intensive Dietary Management (IDM) also works on similar objectives/outcomes.) Furthermore, Omada doesn’t mention any other risk assessment metric aside from weight loss, so if they are basing their reduction in risk on just weight loss alone, then they could be dead wrong regarding risk to stroke and heart disease. Weight loss is not always equal to fat loss, as muscle can be lost as well, which would actually make things worse. There is a lot more going on that needs to be looked at (Keep in mind that a few performance athletes have dropped dead from advanced cardiovascular disease, despite being in great shape, and many others may find themselves prediabetic or even a few T2D). And most importantly, where are these people 1 or 2 years later? Did they keep the weight off easily, or did it come back? Unless they are taking a drastic change away from the standard “eat less, move more” approach, which fails to really capture the whole concept, then I can’t see how they can really be accurately addressing the root causes. Read this for a better review of this concept: https://idmprogram.com/evidence-caloric-restriction/. This constant advice that we are just supposed to ignore hunger, and will ourselves through it is a little crazy if you ask me. A better idea would be to eat in a way that doesn’t provoke constant hunger, and allows our bodies to have free access to our energy reserves (body fat) for as much of the day as possible, while at the same time allowing the part of our brain that regulates weight to turn things back down to where we really want to be. Dr. Fung goes through this in his book, or a short but less detailed overview can be found here https://idmprogram.com/how-to-control-the-body-weight-thermometer/.
If we eat the standard recommended, high carb – low fat diet, which induces high insulin levels, then our body will be forced to burn glucose for energy as its primary fuel, and because of the high insulin level, access to fat stores will be mostly cut off. So if we then reduce intake below our current expenditure as an attempt to lose weight, since high insulin is blocking access to fat stores, eventually our body has to balance the equation by reducing energy expenditure (i.e. lowering metabolic rate), which means spending less energy on growth and repair, movement, heat production, hormone production, etc. So not only will we NOT continue to lose weight, but we will feel cold, tired, and very hungry. Plus we may potentially experience more severe side effects such as reducing our body’s ability to heal, as well as impair hormone and neurotransmitter production, which can affect many different systems in the body (thyroid, sex hormones, memory, emotions, etc.). Sounds pretty bad! No wonder nobody can keep this up for very long; it’s basically torture. Fortunately there are ways to reduce and improve nutrient/energy intake without the dire consequences on your metabolic rate.
Time to move beyond consulting firms and the half-ass logic that some of them may be using this month, and learn what we need to know to survive longer. We really should not be waiting for the shit to hit the fan, and then start caring. Everyone should know what they need to do to reduce their risk of developing these diseases, not just the few individuals whose health puts them CURRENTLY at high risk. We all should know – our families and kids included! There needs to be a major focus on prevention, not just waiting for a systemic failure. These diseases take a long time to develop; warning signs can be seen that things are not well at least 10-15 years or more before the train really comes off the track, so a little bit of preventative effort can make a world of difference down the road. By the time your blood sugar is finally starting to rise and become uncontrolled, or you have your first heart attack, your train is officially way off the tracks; this isn’t the beginning of a problem, you are neck deep. We have a lot of faith in our health industry to fix us when we’ve broken, but unfortunately chronic diseases are not their specialty (and there is often no fix). They will certainly make a valiant effort (provided that you are insured), but effectiveness is not great with standard industry approaches, and the term “cure” is generally not used, but rather “management”, mostly through the use of expensive pharmaceuticals. Myself, I will aim for prevention. Chronic diseases will happen eventually, as they are natural parts of aging, but deranged metabolism will accelerate the aging process, bringing about these conditions decades earlier than normal. Since we don’t have the technology to turn back the clock on aging, taking our foot of the gas is our best option to living longer and better.
Along with obesity, nonalcoholic fatty liver disease (fat deposits in the liver tissue, which impairs proper function) has been increasing dramatically in adults, and even in CHILDREN (17% of kids from a sampling done at autopsy of accident victims), so this philosophy of eat whatever you want when you are young and just learn to care when you are older – maybe not such a good idea for our kids. I know, it’s a huge daily challenge to keep kids away from all the crap that surrounds us and to get them to eat something healthy, and what they eat at school is mostly out of our control, but if you explain why they should not eat much of these foods, they will eventually start to get it. Sugar is addictive, but no kid wants to end up sick and fat, so if they can muster up a little self-control and learn things that they like to eat that satisfy their hunger, then there is hope.
This surge in fatty liver in children is largely due to increased consumption of sucrose (a molecule consisting of glucose and fructose joined together), with fructose being the more troublesome part. While it doesn’t raise blood glucose or raise insulin, it can only be processed by the liver, and is often converted by the liver into fat. High consumption will lead to accumulation of liver fat, which impairs liver function and causes insulin resistance.
A random fun fact: the liver is the only organ that can regenerate itself (in mass, not shape), which it can do from as little as 25% remaining. This if probably do to the fact that it regulates somewhere in the neighborhood of 500 processes in your body, and is absolutely critical to sustaining life and health. Clearly just as important to sustaining life as your heart or your brain. So yes, stuffing it so full of fat to the point of impaired function and damage is not recommended. The liver stands as the gatekeeper between your digestive tract and the rest of your body, and plays a huge role in energy regulation, digestion, bile secretion, and nutrient absorption, thyroid levels, protein and hormone production, detoxification, and many other things. Basically, if your liver is in poor health, you are in poor health. Non-alcoholic fatty liver disease is becoming very common, and usually isn’t obvious until damage is severe, so someone may be suffering symptoms and not even realize where the problem lies.
So why have we been getting such poor diet advice? (Gary Taubes’ books are a good place to start if you are looking for a decent explanation). It’s a bit complicated, but mostly a mixture of ignorance, arrogance, and corporate interests. What is healthy eating, and what’s not? The problem starts when we think we know the answers already; this blinds us from learning things that could be really helpful. Plus, we keep hearing the same repeated message – that we eat too much, and don’t exercise enough. Sounds reasonable enough, but if we have it all figured out, then why isn’t it working? Unfortunately the scientific process has not been used as frequently as most of us would like to believe in the development of nutritional advice. Diet and nutrition science has been poorly utilized, or knowingly ignored when not supporting the official advice being offered by many government and medical bodies, and in many cases their advice was based on loosely assembled correlations and not on actual scientific evidence. Part of the problem began back in the 70’s by letting politicians/business people develop health policy despite it NOT being an area of their competence, and with their potential conflicts of interest. Additionally, a great ongoing disconnect exists within the medical community; we have scientists and physicians doing all kinds of great research, but their knowledge is not getting transferred through to most of the general practice doctors. And just to further complicate things, big business has been lobbying congress, getting individuals onto advisory boards, and also funding their own research to help confuse any consensus on matters that would hurt their profits (the Sugar Association has been doing this since the late 60’s – http://www.motherjones.com/environment/2012/10/sugar-industry-lies-campaign/). A potential roadblock to progress now exists as the medical and pharmaceutical industry has built a massive business model around our sickening population (diabetes costs were $176 billion a year in the US, not including lost productivity, and globally somewhere around $1 trillion). Do you think the US government is going to put your personal health ahead of the corporate interests who give their campaigns millions of dollars a year trying to protect their profits? Maybe they will, but personally I’m not so optimistic, so I don’t expect to hear anything helpful from them until they are paying the bill (which seems like a reasonable explanation as to why there is so much resistance to public healthcare). Read the first paragraph of this article (https://www.today.com/health/why-fat-your-diet-good-weight-loss-glowing-skin-t102800, or this one https://www.theguardian.com/society/2016/sep/12/sugar-industry-paid-research-heart-disease-jama-report), and here: Industry battles tax in UK. As much as I would love to think this can all be blamed on ignorance, I just don’t find that explanation very realistic. It certainly isn’t the first time business and politics have gotten in the way of science or public health (I believe we were told that smoking was totally safe at one point in time https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1470496/). Here is an example of massive amounts of money spent lobbying congress to avoid additional painkiller regulations: https://www.theguardian.com/us-news/2017/oct/19/big-pharma-money-lobbying-us-opioid-crisis. I could keep finding more, but you get the point. Don’t just take their word for it, look for the science AND the underlying biological mechanics, and only then can we find something that actually works.
Until fairly recently, Cocoa Puffs boasted the American Heart Association’s heart healthy logo (notice the sneaky use of the word “may” in fine print). Really? Cocoa Puffs??? I mean I loved them as a kid, but I don’t think at any point in my life I would have thought they were healthy. Seriously, after you are done with the sweet chocolate crunchy goodness, there is so much left over that washed off, that you get chocolate milk. Gotta be good for my heart. Right, sure. AHA, you shameless bastards!
How much can you really trust the recommendations of an organization that sells the use of their heart healthy logo for marketing on many industrially produced food-like products that are clearly not part of a healthy diet? If they were really just trying to help guide us, then they wouldn’t allow it to be used to sell crap food, and they would allow any food that meets said requirements to use the logo for free, rather than generating a significant income. Cocoa Puffs no longer appears to use this logo, so maybe the AHA has realized that their credibility is starting to look bad and changed some of their standards. Not to say that they have completely pulled their head out of their ass, but they see how continuing this practice could be bad for business, and have taken action. However, they still continue to defend the same old low-fat recommendations that may be supported by evidence (some heavily biased corporate sponsored science).
Details please! Oh right, were getting there – Food is more than just differing densities of the same unit of energy (calorie), as different components of that food are processed and interact differently in our body. Whether we consciously believe this or not, we all know that this is true, but we tend to ignore the implications that this has. Obviously coffee or tea (almost calorie free) does have an effect, otherwise many of us wouldn’t be drinking it to help get going. We don’t drink it to rehydrate, nor for the miniscule amount of calories is has, but because the caffeine stimulates hormones to release in our body and blocks receptors for others, with the net effect that we feel more energetic and awake. To phrase this another way, the coffee we drink isn’t giving us any more energy than a hot cup of water, but rather it sends a message through our body to release energy for use that is already stored inside us and to ignore signs of energy depletion. If you try to just keep drinking coffee, eventually you just crash and burn, because there is really no energy gained (aside from heat) and your body needs to rest and restore.
And clearly it’s not the calories that we are seeking when we drink a beer or some wine, etc. Ever wonder why switching to diet soda isn’t getting the desired result? Maybe the calories were never the main problem. Everything we put into our body affects hormones to varying degrees, and hormones control everything that goes on in our body, with insulin being the primary hormone responsible for determining if and where we will store/accumulate fat. Also, elevated levels of insulin stops the body from accessing fat stores. So when insulin levels are high we do NOT burn fat, and we will convert and STORE excess energy (both glucose and fatty acids) as fat through a biological process called lipogenesis. Only when insulin levels fall back down can we begin burning our stored fat for energy. What causes the biggest insulin response? Carbohydrates – specifically the highly processed and easily digestible ones like sugar, starch, and flour. And since they provide almost zero nutrient benefit, there is really no reason that you would need to keep them in your diet. At some point, understanding all this might make you a little bit less comfortable with some of your favorite comfort foods. Want to tell your body to stop storing excess energy as fat? Then do everything you can to keep your insulin levels low. For a better understanding of why simply reducing calories has little benefit, see this post: https://idmprogram.com/obesity-solving-the-two-compartment-problem/
Timing is also a very critical component of this. Despite what you may have heard, snacking or eating small meals all day long is very bad – leading to greater insulin resistance, especially if the snacks are high in easily digestible carbs and will spike your insulin levels. It’s well known that our body develops resistance (commonly we say “builds up a tolerance”) to frequent exposure to alcohol, caffeine, painkillers, and pretty much any other drug or chemical, with the result that over time it takes more to get the same effect. Insulin is no different. The more often you eat insulin spiking foods, the greater the exposure of insulin to your cells, resulting in the buildup of tolerance/resistance. The cells have a limited glucose disposal capacity, and eventually begin to protect themselves from glucose overload by limiting receptors/transport. The insulin begins to not do its job as well, and so your body releases more to compensate, but the now higher doses of insulin lead to even greater resistance. Over time this becomes a viscous loop, and can be hard to break free (general reference to a repeated idea from Dr. Fung). The longer you have been insulin resistant, the more effort and time it may take to correct, but it is possible (more on this further below). By not snacking and having longer breaks between meals, we give our body a chance to improve sensitivity to insulin. Skipping a meal occasionally is actually good for you provided that you don’t have any snacks or drinks that raise insulin significantly.
A great example of the many critical roles of insulin would be the scenario of type 1 diabetes: damage occurs to the pancreas, causing it to stop producing sufficient insulin. The lack of insulin results in glucose not getting into many types of cells where it is needed and builds up in the bloodstream.
The lack of insulin also signals the body to shift way too far into burning fat for energy (through ketogenesis), causing dramatic/rapid weight loss and excess production of ketone bodies. Without insulin, a person cannot store fat! A person with this condition can eat absolutely whatever they want and they will continue losing weight, up until they eventually die if left untreated. This becomes a life threatening situation as the excessive ketone production changes the PH of the blood together with the high blood sugar, and will damage your organs and cause death if not treated promptly (ketoacidosis). In any person with a normal functioning pancreas, ketone production is limited at a safe level due to the presence of insulin.
Other roles for insulin – Dr. Robert Lustig mentions that muscle cells do not require insulin for glucose uptake, but do require insulin for amino acid uptake, so without insulin muscle growth/repair will be impeded. (However, insulin does appear to affect the vasodilation in muscle tissue, and can increase glucose uptake in the muscle in a non-IR person, thereby affecting the ability of the muscle to increase glucose uptake to protect against high plasma glucose levels.)
So that’s the first half of the story, which made enough sense to me, so I found it fairly easy to accept. The second half took me quite a bit longer to digest and eventually believe, and changing my habits and diet has taken some effort. Being a kid in the 80’s and 90’s, I grew up surrounded by a food culture that knew that dietary fat, especially saturated fat, was really bad for you, and so we should eat more carbohydrate rich foods to satisfy our energy needs. I never even questioned it. Why should I? It sounded right – eat fat… get fat, and if the government is making this recommendation so strongly, then it must be based on really good science and amazing data, and there must be no doubt that it’s true. After all, why would the government lie to us? (Yes, I was quite naïve in this sentiment.) Long story short – no such damning evidence ever existed, then nor now (for obesity risk, OR heart disease risk if you exclude hydrogenated fats). 35+ years and billions of dollars spent, and scientific study after study fails to support their claim. Unfortunately, policy makers and politicians in the 70’s didn’t have the time/patience to wait multiple years to see the actual results, so they took one scientist’s (Ancel Keys) untested hypothesis and ran with it as if it were undoubted knowledge. Change the world for the better they thought, and people listened and lowered their fat and saturated fat intake, and instead ate more carbohydrates. Well look around, are we better? No? So what went wrong? Look at these obesity rate charts shown below (from the NIH government website https://www.niddk.nih.gov/health-information/health-statistics/overweight-obesity). Keep in mind that just before 1980 is when they started pushing this new concept. So not only did things NOT get better, but they actually got way worse. Their recommendation was not just ineffective, but actually outright harmful!!!!!
Today we have the advantage of time and experience. Many scientific studies have been done, and the results are fairly consistent. Natural dietary fats (even saturated for most people) does not appear to increase the risk of obesity or heart disease. Less natural and more processed fats do seem to pose more risk (like highly processed oils such as soy, canola, etc), and obviously hydrogenated fats (trans-fats) are commonly accepted as harmful – which can still be manufactured until June 18, 2018, and sold until Jan 1, 2020 (and now some approved for mfg 2019 and sold by 2021), so keep an eye on food labels. These dates are likely to keep getting pushed back until people just stop buying products that contain them.
But this 80’s evil fat idea is so firmly cemented in our heads that it’s really hard to quit thinking of it that way. On the other hand, biological pathways exist, and scientific studies have indicated that high carbohydrate consumption (especially sugar) does increase your risk for developing metabolic syndrome, which does cause/contribute to obesity, diabetes, arthrosclerosis, stroke, Alzheimer’s, fatty liver disease, and even cancer. Our bodies need energy, and too much protein will also raise insulin to the point where you stop burning fat, so to be successful in reducing your carbohydrate consumption without starving, or having a mental breakdown, it is essential that you eat more natural fats. Our body is very good at burning fat for energy, provided that we allow it to by not raising our insulin too high for long periods of time. Why else would we store excess energy as fat? Semi-starvation is not required to lose weight. A low fat and low calorie diet with higher carbohydrate content can actually cause your body to begin consuming its own muscle tissue, because it is not able to access its fat stores due to the elevated insulin levels in your blood. Fat is not a hazardous food additive, but rather an essential nutrient that has been a major staple of our diet as long as we have been on the planet. Rather than filtering the fat out or cutting it off, we need to turn around and embrace it, and find ways to get more back into our diet, while dialing back the processed carbohydrates. The best part is that fatty foods taste great and you feel full for much longer; we are basically hard-wired to want to eat more of it (up to a point). I’m not saying you should grab a stick of butter for a snack, but definitely don’t shy away from adding more to your food, and certainly don’t strain it out or cut it off. Steps like steering away from sugar and more towards natural unprocessed fats can help get you going in the right direction, like adding heavy cream to coffee and leaving out the sugar. While you can drop off the sugar as fast as you feel comfortable, if you have been eating a low fat diet, then cranking up the fat in your diet should probably be done at a reasonable pace, and not zero to 60 in three seconds. The reason being is to avoid pushing out any sludge or gallstones that you may have developed through under-utilization of biliary acids when following a low fat diet.
Is saturated fat bad? To be fair, people differ greatly in their response to many different substances. Similar to allergies, what may be safe and healthy for most people, might range from slightly harmful to detrimental for a special few individuals. Nuts are typically viewed as healthy, except when you are allergic, then they can be deadly. Others might have a mild intolerance of nuts, perhaps damaging the body in less obvious ways. The same may hold true for other foods such as dairy, which we tend to tolerate less as we age. Whether it be a specific length fatty acid or saturated fat, protein (such as gluten or casein), or lactose, if our body does not tolerate it well, then it may set off a cascade of damaging events (inflammation, LDL-particle increase, etc.). If you react badly to something, try to figure out what it is, and then reduce or eliminate it from your diet. Taking medications to cover symptoms may make you feel better, but it is not going to counteract the damage caused.
Saturated fat has such a stigma these days, but most people have no idea what it really is. The name prompts us to think “it’s saturated with fat”, like your fingers or napkin after touching greasy food, but really it is just a fatty acid that is fully saturated with hydrogen atoms, meaning it has no double bonds. To someone like me (with very little organic chemistry knowledge) it’s structurally not all that different than a mono or poly-unsaturated fatty acid, but surely does have some unique properties, the most obvious being solid at cooler temperatures. It is also more stable, so less prone to heat damage or going rancid (both good things). There does seem to exist a small subset of the population that has problems when consuming large amounts of saturated fat from certain sources (perhaps more to do with a specific fatty acid chain length, and not all forms of saturated fat). So yes, there are people who need to be careful of what sources of fat they consume, but 80-90% of people should have no problem at all (see the ketosis section for more info). Which are you? You will only know if you get advanced blood testing done. What is your LDL-P? hsCRP? The fact that most people don’t even know what those are is a sign of what a total crap job our “amazing” medical system does at chronic disease prevention screening.
This is no small topic, as there are numerous varieties (lengths) of saturated fatty acids (https://www.healthline.com/nutrition/saturated-fat-types#section7), and many more variations of mono and poly unsaturated fatty acids. To even try to guess how much of any particular type of fatty acid you are eating is enough to make your head spin, which really makes me wonder about any sort of conclusion anyone could offer about the health benefits or dangers of different levels of consumption. Most recommendations are based on rough associations between health outcomes and self-reported consumption, and being just an association, the observed effect may not even be related. Now, understanding some of the biochemical processes that some of these fatty acids are involved in can shed light on potential benefits or ill effects, but without knowing potential side effects or other affected processes, it’s hard to tell if a NET benefit or harm will occur from overabundance or deficit of any one particular fatty acid.
While there is plenty of wild speculation, our current level of science is unlikely to provide any real knowledge anytime soon.
In all reality, nutritional science is damn hard to conduct in humans. Even the most detail orientated controlled clinical trial looks rather sloppy when compared to any modern animal trial. Not to say we shouldn’t try, but we have to be realistic as to what type of experiments are feasible, and how powerful of an effect do we need to see to really consider something as relevant. Even an extremely well-controlled trial (in which you somehow manage to control the food intake, meal timing, and daily physical activities) still has a ton of uncontrollable variables such as genetic diversity, physical stress, emotional state/stress, cognition expenditure, overall metabolic rate, gastro-intestinal tract, liver, and other organ/systems function, gut microbiome diversity, sleep quality and duration, etc. Plus long-term effects are basically impossible to evaluate in a well-controlled manner for even the food aspects. While we may be able to do more controlled studies on mice, mice are not humans, and have evolved eating a substantially different diet, with substantially different seasonal behaviors and survival tactics. What’s good or bad for a mouse is not necessarily the case for humans. Also, what often gets ignored is how much sugar content varied between groups, which is a common example of just plain bad science (having a multi-variable experiment, but only reporting results on one). High fat diet in mouse studies is almost always high fat and high sugar. Here is a review of one recent such example: https://peterattiamd.com/lack-context-may-fuel-spread-unintended-consequences/. Personally, concerning nutritional scientific controlled trials on humans, I am quite cautious about assuming any conclusion can be made unless the measured effect is very large.
Can fats be bad? Probably, and the more processing that’s been done, the more caution should be used. We have a tendency to think that because it came from a plant, that it must be healthy. While I previously would have blamed hippy thinking for this type of sentiment, I’ve come to realize that big business has played a major role in the popularization of this ideology. The right marketing campaign can turn a surplus waste product into gold (see history of cottonseed oil https://idmprogram.com/the-shocking-origins-of-vegetable-oil-garbage/ https://en.wikipedia.org/wiki/Cottonseed_oil). When we take an unsaturated oil and artificially saturate it by bubbling hydrogen through it, this creates artificial saturated fat or partially saturated fat. This is done to stabilize the fatty acids and extend shelf life, and is commonly known as hydrogenated fats or partially hydrogenated (trans-fats), which are now generally thought to be harmful. As far as I know the exact mechanism of harm is not well understood. However, naturally occurring trans-fats are generally considered NOT harmful. https://www.healthline.com/nutrition/why-trans-fats-are-bad#section2. When solvents (often hexane) are required to extract the little bit of oil that is found in a seed, such as canola, soy, corn, cotton seed, etc, this may be something you don’t want in your body. Maybe the oil itself is ok, or maybe too much oil itself could be harmful, but regardless, the solvent is most definitely not good. They may say it’s 100% removed, but that’s just not physically possible, and some chemicals may be harmful at as little as a few parts per million (“harmful” may take many forms, and is much harder to measure than “fatal” or acutely toxic). Also, the processing typically involves a degumming/neutralizing/bleaching through the use of more chemicals, and significant heating, which can damage the more susceptible unsaturated fatty acids, which could produce problems on its own. Now take the solvent and chemical laced oil, with trace levels of Glyphosate (Roundup Ready grains) and heat-damaged fatty acid molecules, and then bubble hydrogen through it. Wow, what a combination! I want to eat that! Yeah, no thanks. Yet it’s in quite a number of products that might be called food by many – that would be partially hydrogenated corn oil, soybean oil, canola, etc. which is not such a rare sight on a food label. Even non-hydrogenated forms of these oils tend to be pro-inflammatory. They are in everything, but I still make my best effort to limit my consumption of them.
Again, the reoccurring theme seems to be that the more processing that is used, the less healthy a product is, and a diversity in types of fats is probably better than too much of any one type. We don’t hear recommendations to avoid amino acids, or to favor one type over another; we know that we need ample amounts of all required types, and need to avoid deficiency in order to build and repair muscle and other tissues. The same recommendation should probably apply to fatty acids, since they are a critical component of building cell walls and cellular structures, hormones, as well as an efficient fuel source. A variety of different fatty acids is thought to be required for proper membrane structure in order to optimize effective cell signaling (I believe this insight was from Dr. Dayspring). I want to repeat that point so you don’t gloss over it: not all fat is burned for energy, stored, or excreted, but like protein (and even some forms of sugars like ribose, glycerol, etc.), it’s a substrate that is actually used to build new cells and cellular components. Deficiency is going to cause problems! Whole foods tend to have a variety of different types of fats, so maybe that’s what we should be eating. Kind of a crazy thought right?
Check out the relative fat percentages of many foods listed here https://en.wikipedia.org/wiki/Saturated_fat
Many health professionals and nutrition programs are slowly beginning to acknowledge that the old fat-phobic advice from the 80’s isn’t getting the desired results and are beginning to change their recommendations, but it’s kind of like watching a glacier – way too slow and way too subtle! And many mixed messages too; like now advising people to limit added sugars and simple carbs, but still recommending low or no-fat dairy and “lean protein”. A whole grocery store isle full of horrible fat-free yogurt. Like a couple brands isn’t enough? WTF? Oh, but now it’s low sugar, cause they jacked it up with aspartame, sucralose, or maybe went all natural with stevia. Gross!!! After 4 years of dwindling down my sugar intake, I finally re-tried some plain whole-milk Greek yogurt (Greek Gods) this past week, and it was actually good this time.
The mainstream media have slowly been coming to terms with this concept of healthy fats. They don’t usually have ALL their facts right, but at least they are starting to get the idea. This first article is really good and worth the read, the second two are just examples I only skimmed over – http://www.healthline.com/nutrition/saturated-fat-good-or-bad#section1, https://www.today.com/health/why-fat-your-diet-good-weight-loss-glowing-skin-t102800, https://greatist.com/health/saturated-fat-healthy.
Is it possible to eat too much fat? Reason would tell us that pretty much anything taken to the extreme would be bad for us. Even water can be dangerous if you drink way too much too fast. Most people can tolerate a pretty high level of fat intake without any negative consequences in relation to cardio vascular risk, but there are a few (some experienced physicians like Peter Attia have mentioned around 20% of people) who will see a spike in their LDL-particle levels if they push the limit too far with certain saturated fats. So if you do decide to do an extremely high-fat ketogenic diet (were talking 80-90% of calories from fat), you will probably want to get advanced lipid testing done to make sure you are not causing any harm. But that’s an awfully high percentage of fat. Unless you are specifically trying to treat epilepsy or cancer, a modified or intermittent ketogenic diet is probably going to be healthier and easier to sustain in the long run for most people. And surely if you eat too much fat you won’t lose any weight, because you are supplying your body with all that it needs without needing to dip into storage.
Can we store the fat that we eat as fat in our bodies? Well yeah, but we don’t have to. To store it away would require insulin to be high – chemical signaling in your body telling it to store this away. Don’t spike your insulin levels, and that dietary fat remains available energy, to burn or to excrete, but is not directed to be stored. The second that you give in to that sweet craving after a meal, and eat some carb-rich or sugary dessert, you have just switched gears into storage mode, and much of the extra glucose and fatty acids will be shuttled away and stored as fat. Remembering this concept has given me the power to resist indulging my sweet tooth on many occasions.
Two main processes that are involved in gaining or losing weight are lipogenesis and subsequent triglyceride synthesis (which is the production of fatty acids from glucose, and then the assembly of fatty acids into triglycerides) and lipolysis (basically the opposite of lipogenesis, being the breakdown of the triglycerides into its components, glycerol and fatty acids, to be used as an energy source). Insulin promotes lipogenesis and inhibits lipolysis, so it promotes fat storage and stops fat burning, which is obviously NOT desired when trying to lose weight. The main point here: the only way to get the fat out of our fat tissue and use it for energy is to keep insulin sufficiently low for as much of the day as possible. This means eating foods that minimize the level and duration of the insulin spike, and also eating fewer but larger meals, not snacking, and possibly some occasional fasting.
image source – https://en.wikipedia.org/wiki/File:Saccharose2.svg
Are all carbohydrates equal? Obviously not. Glucose itself is a vital component required for life, but prolonged elevated levels can cause harm. Typically the more processing that a carbohydrate based food has gone through, the quicker and higher it drives blood glucose and insulin.
I know it’s not really a big surprise, but sugar (sucrose), a disaccharide composed of half fructose/half glucose, is substantially more harmful. High fructose corn syrup would be slightly worse, but not all that much (about 55% fructose). As mentioned previously, the fructose half of the molecule is primarily metabolized by the liver, and is a major cause of fatty liver disease and directly causes insulin resistance. I’ve even seen some products (such as Lite chocolate syrup) that have taken to adding fructose itself, being a very potent sweetener, in an attempt to reduce grams of added sugar but maintain sweetness. This may seem like a good thing to have fewer grams of sugar, but if you know the true hazards of fructose, then it’s obviously a much more harmful product. High sugar beverages like soda/cola, sweetened juices, and even natural fruit juices are about the worst offenders, due to their quick absorption rate putting a heavy load upon the liver.
Good discussion on fructose: https://peterattiamd.com/roblustig/
As Robert Lustig mentions in the podcast linked above, glycation is when sugars get bonded to proteins or fats, creating something called AGE particles (advanced glycation endproducts) which impairs function. Consumption of these can increase inflammation, while internal formation (endogenous) of these can lead to stiffening of tissues and eventual damage, as well as protein accumulation. AGE particles have been found to play an important role in many chronic and degenerative diseases. Also, fructose rapidly enters the liver in an unregulated fashion, forms AGE particles at a much higher rate than glucose (7x), and also produces way more ROS (reactive oxygen species), so a few more good reasons to minimize consumption.
Additionally fructose can induce gut-dysbiosis, which will increase exposure to many undesired things such as bacteria, virus, endotoxin, intact proteins like gluten, etc., as well as alter bacteria populations, and the ensuing immune response will increase inflammation.
One caveat worth mentioning – apparently if you consume high amounts of glucose, the body can transform/metabolize some to fructose, so simply substituting glucose in for fructose without reducing sugar consumption may be helpful, but excessive amounts of glucose can still be problematic for your liver and inflammation.
Paper: Fructose and sugar: A major mediator of non-alcoholic fatty liver disease https://www.journal-of-hepatology.eu/article/S0168-8278(18)30066-7/fulltext
Many physicians received little (if any) education on diet and nutrition while in medical school. This would suggest that the medical system either feels it’s not important, or perhaps other powers have expressed their influence on how it would be bad for business. Here is one physician’s point of view (Dr Fung’s recent post) which explains some of the reasons why historically it hasn’t been a focus of the medical field: https://idmprogram.com/therapeutic-nutrition-paradigm-21st-century-medicine/.
Here is another jaw dropping view from inside the top level medical establishment. Dr. Otis Brawley, chief medical officer and executive vice president of the American Cancer Society, speaks out about the corrupted system. Also, the discussion surrounding prostate cancer screening was absolutely upsetting: https://www.youtube.com/watch?v=3ho_LMBiHVg
Another thing to keep in mind with physicians: While a few may have gone into the profession because of a profound interest in biology and medicine, motivation for many others may have been money, prestige, family expectations, or other less noble causes. If they never really had a profound interest and just plowed their way through school, then their knowledge and desire to learn new useful things will be undoubtedly less than someone who has a genuine interest in it. Something you might want to reflect upon when trying to find a doctor that is right for you.
Aside from whatever initial teaching they may or may not receive, scientific fields such as these are continually evolving, so if they are not getting frequent updates from reliable sources, then they are no longer equipped with the best tools for preventing many of the most prevalent diseases of today. While this works out well for pharmaceutical companies and hospitals (a lot of unnecessary prescriptions and procedures to alleviate or mask the symptoms of something that otherwise may have been avoidable or greatly delayed for most people), it does not work out well for us patients. But there must be some doctors that have kept up with the times, and do understand the importance of all this, so while it may take some effort and digging, I would highly encourage you to find one that does.
So what to do about insulin resistance? (In this section I am talking about the most common form – dietary induced insulin resistance – NOT fasting or glucose sparing, pregnancy, tumor, etc. induced.) Insulin resistance itself is a protective mechanism – something that your body is intentionally doing (quite well and correctly) in order to reduce effects from too much insulin and too much glucose. While glucose is a primary fuel, and essential for certain types of cells, letting too much glucose into the cell can be dangerous to the cell’s health. The body has a preferred concentration of blood sugar to which it will perform optimally, but if we continually push our blood sugar out of this range for long periods of time, then it becomes necessary for the cells to protect themselves from the continued onslaught. Theoretically, if a cell cannot defend itself from taking in too much glucose, then it will be pushed into fermentation (Crabtree effect), which if sustained could cause damage to the cell and mitochondria from high ROS production and lactate production, and if it manages to survive could push towards a fermentation dependent cancerous phenotype (Warburg effect). So clearly insulin resistance is a good defense mechanism, but needing to depend on insulin resistance is a sign that we are probably exposing our cells to a toxic level of glucose far too frequently. Yes, this is an oversimplification, as there are other factors to consider in the glucose regulation systems, such as stress (cortisol), sufficient sleep, exercise, etc, but diet induced glucose surges are relatively easy to control, and reductions here will have a big impact, so while it may not be the only thing you need to pay attention to, it’s a great place to start.
So if too much exposure to insulin (both high levels and high frequency) is the trigger causing the resistance, then reducing exposure is going to be the required solution. If you are young and not too metabolically deranged, then it’s as simple as dialing down the sugar and simple carb consumption, and changing your diet and eating patterns so that you can avoid falling further into this downward spiral, and slowly recover metabolic flexibility. For many of us with more progressed insulin resistance, since insulin resistance itself causes higher and prolonged levels of insulin, which only works to increase the level of resistance, it can become a perpetual loop; very difficult to break free once established. The more severe level of resistance that you have developed, and the longer you have been at this level are both factors that make it more difficult to get things back in control – meaning more intense corrective measures will be required (see Dr. Fung’s literature for deeper understanding of insulin resistance). This basically means that we will need a recovery phase of eating where you highly restrict sugars and carbs, including the restriction of some more natural sources like starchy vegetables and certain fruits. Eventually some of the fruits, breads, and starchy veggies can be worked back into the diet once insulin resistance has been improved and weight loss goals have been met and you are mostly just trying to maintain.
IR TOOLS: The most effective dietary tools that I’m aware of to improve insulin resistance are time restricted eating, ketogenic diet, intermittent fasting, and extended-periodic fasting (adults only) (see discussion sections on these topics for more info). Time restricted eating is basically a form of short duration intermittent fasting that ideally would be done daily). All of these tools work in a similar way – it’s all about reducing insulin levels. A ketogenic diet focuses on eating foods that have a low insulin response, while water-only fasting (and maybe some black coffee or tea) is not eating anything that will have an insulin response at all. Time restricted eating provides a longer fasting window on a daily basis, whereas periodic single or multi-day fasting will provide a much longer fasting duration but done less frequently. Periodic fasting is undoubtedly a more aggressive approach, and therefore you could expect to see results faster. This may even be required to break the cycle in someone with severe insulin resistance, but it could be much less pleasant for some people if not yet keto/fat-adapted.
Wait… fasting? WTF? Are you kidding me? Now, if you had suggested that I try fasting 5-10 years ago, I would have thought you were stupid and crazy, then I would have told you where you can go. But really, it’s actually not all that unpleasant, and it has a ton of benefits, so I now consider myself a big fan. Trust me, I love really good food, so to go a couple-few days without eating is a huge personal sacrifice, but truly worth it! I’ll put together a section on it, so look it up for more info.
Now most people that I know like eating, so intentionally not eating isn’t too popular an idea when you first hear it. You need to know why you are doing it. Fasting also effects other nutrient sensors (like AMPK and mTOR), greatly increasing autophagy and sirtuin activity (DNA repair and many other activities), and has additional health benefits that a ketogenic diet cannot adequately provide, so there are some pretty good reasons to fast at least a few times a year. Typical reasons someone may do a multi-day fast (3-7 days) aside from weight loss and insulin resistance improvement – reduce cancer risk, dampen auto-immune issues, rejuvenate the immune system, heal gastro-intestinal tract, upregulate autophagy and induce apoptosis to fix or eliminate damaged and/or senescent cells and cellular components (including mitochondria), and rebalance many metabolic parameters that correlate with vascular disease. Just a few minor things.
These IR tools can (and should) be combined together for maximum effectiveness. Like using a fighter using a combination attack rather than a simple jab or kick. Do you want to win this fight, or are you just dancing around?
Extra bonus – once you are adjusted to a ketogenic diet, fasting becomes much easier to tolerate. Your body just switches to burning fat quickly, resulting in high levels of energy and less feelings of hunger. For that reason alone I would recommend changing your diet first, getting used to it, and then begin to experiment with fasting when you feel ready. If you are not getting the results you want, or have hit a plateau, then maybe further restrict your daily eating period, eventually targeting 6-8 for maximum benefit (and finishing eating 3-4 hrs before bed), or start throwing in an occasional fast (24hr, 36hr, 48hr, etc.), or cut out even more simple carbohydrates from your diet. However, if you just really like the idea of fasting, you could start with that right away too. NOTE: if you are on any medication, especially for the treatment of type 2 diabetes, then you must consult with your doctor before making any major changes to address dosage concerns, and have a plan for managing blood sugar balance issues. Don’t use it as a cop-out excuse for not trying to improve your health, just know it’s going to be a little more complicated for you.
Side note: I’ve grown to love time restricted eating. Best part is that anyone can do it regardless of what ever diet you choose. I didn’t just jump right into it, but rather we would skip breakfast a couple days a week as a sort of intermittent fast. Weekday mornings suck!!! Trying to get ourselves and two little kids woken up, dressed, fed, lunches packed, water bottles filled, hair brushed, teeth brushed, shoes and jackets on, and ready to go out the door is painful and upsetting. It was an amazing change to skip our breakfast, saving the 20-30 minutes it takes to make and eat it, and be able to just sit for 10 minutes and relax, chat, and drink some coffee. Holy freakin wow! Stress run run vs relaxation. After a few months we just didn’t even think about eating breakfast anymore. It took me a long time to really get it – meaning I didn’t even realize how much better I felt not eating so early in the day until I noticed the correlation with feeling really tired on days that we actually did eat an early breakfast. So now, even on weekends I try not to eat anything until close to 11am or noon. I like feeling energetic and ready to get shit done; I don’t want to screw with that! Personally, I find that if I have fasted long enough, then eating a big meal doesn’t slow me down nearly as much.
Watch Rhonda Patrick interview with Dr Sachin Panda (1, 2) for some great info on benefits of time restricted eating. From what I’ve learned, a 6-8 hour eating window is ideal (finishing at least 3-4 hours before bed most nights for better quality sleep, which affects everything). I myself, find it easily sustainable. Also, when you do eat, eat! Don’t worry about portions if it’s good healthy food. When you only eat two meals a day it becomes very hard to overeat. I eat a ginormous lunch (seriously huge), a cup of coffee in the afternoon, and by dinner I’m barely hungry yet most days, so a smaller dinner, and that’s it. But that’s just what works for me. To each his/her own.
Eventually you need to greatly reduce your consumption of processed packaged shit food (PPSF), and instead eat real food, but the first critical step towards improved health is the need to greatly reduce or eliminate added sugars, artificial sweeteners, and other starches and refined carbohydrates from your diet. If your kitchen sink is plugged and the water is overflowing everywhere, the first thing you do is to shut off the water. You don’t leave it running while you look for your plunger or call for help. Similarly, in treatment of diseases resulting from too much consumption of glucose and fructose (such as insulin resistance and type 2 diabetes), if we don’t remove or reduce what is causing the problem, treatment is going to be a losing battle. This is exactly what we see with pharmaceutical approaches. They ignore the cause, patch you up with some medications to mask the symptoms. After prolonged deterioration, they may put you on insulin to better control the blood sugar levels, but this only increases the hyperinsulinemia, causing it to spin more out of control, and eventually different systems in your body begin to fail. Good fun!
My approach – I slowly cut away my sugars and processed carbs over the course of a couple years. Every couple months I would cut my intake in half, going from very high to almost none. This slow transition made it fairly easy for me, but others might prefer a more dramatic change. There is no right way; just do what is sustainable for you. If you slip up a little here and there, it’s no big deal, just keep at it, and it will get easier. It is very much an addiction for many people. Your brain will fight you on it at first, but eventually your brain will adjust, and most people find greater mental clarity once they are free. If I really pay attention to how I feel after I indulge in some sort of amazing sugary dessert, my body’s reaction is often enough punishment to remind me not to do it again for at least a little while.
What gives you power to avoid sugar? Knowledge! Learning about the multitude of ways in which sugar is harmful can be very motivating. Also, it may be best to think of sugar as a drug. A highly concentrated component of something found in nature. Like cocaine is to coco leaf, or heroin is to opium poppy plant, sugar is the potent extract from sugar cane (or beets), boiled down from the sweet cane juice until all that remains is the sweet crystal S. The longest running cartels.
Doubt it as a drug? Ever watch babies or toddlers eat candy? They don’t know what it is, but they want more! At an egg hunt one easter, I watched a 2yo chew through the fucking package cause he couldn’t figure out how to open it. Nothing was stopping him from getting at those little brightly colored balls of sweetness. Or here is an experiment that I would not advise doing – put some candy or chocolate in your drawer or on your desk, and see if you can forget about it. Not that easy.
If you need extra reasons to avoid sugar – search out “glyphosate to ripen sugarcane” or sugar beets. They use it on other crops too, but rather than simply speed up harvest, in sugarcane it actually increases the sugar content, so you can bet your ass it’s going to be more commonly used. Here is LSU to teach us the benefits, including increased sugar yield per ton of cane, and how to best do it. Always profits over health you corporate bastards! Such a mystery as to why the cane workers are dying of kidney failure in Latin America. Hot, sweaty, and covered in glyphosate, just can’t figure that one out, such a mystery! (Guardian articles – 1, 2, 3)
Some of you may be thinking that this sounds a bit like the Atkins diet, but that would mostly be the part of avoiding processed carbs and sugars, and the acceptance of eating more fats. While Dr. Atkins understood the disastrous effects of sugar and some types of carbs on insulin, he didn’t quite understand the number of other factors that also influence insulin levels and insulin resistance. I don’t claim to know the entire specifics of the Atkins diet, but a few differences that I can point out:
1) Avoid snacking!!!!
2) Excessive protein can reduce or stop weight loss for an insulin resistant person. The response is less than that of processed carbohydrates, but protein does indeed induce an insulin response. You need enough protein to sustain your muscles, so by all means don’t avoid it, but too much will keep insulin levels elevated, inhibiting fat utilization, and counteracting efforts to reduce insulin resistance. Fat and natural fiber added to anything tends to lower the insulin rise and keep you full for longer, so a double bonus. Not all proteins impact insulin the same – refer to the “insulin index” link below for more info. Also, excessive protein can be converted to glucose by the body. Probably don’t use protein supplements or protein powders; while you need protein to build and maintain muscle, if you eat real food you will get the protein that you need, together with natural fats, vitamins, and minerals, and you will feel fuller for longer. Building and maintaining muscle is very important, but because insulin has another function of helping get amino acids into your cells (which is required for muscle protein synthesis), if you are insulin resistant, then this isn’t going to happen as efficiently either. To better your ability to build muscle, you need to first get the insulin resistance under control.
3) Avoid processed foods to the greatest extent possible. This also includes most vegetable oils that require a substantial refining process (corn, canola, soybean, etc). The healthier plant based oils being less processed ones like olive oil, coconut, avocado, palm, etc. There are not many foods that can sit on a grocery store shelf for months or years and still be fairly healthy. I can only think of nuts at the moment, but I’m sure there are a few other things. (I suspect that old meat products don’t hold the same value that fresh meat would, and could potentially cause harm by introducing degraded or oxidized proteins or fats.)
4) Some people don’t respond well to dairy. They may feel fine, but it sometimes can impede weight loss, or contribute to chronic inflammation. So if you are doing everything else right, but still not getting results, maybe try scaling back the dairy a bit. It’s actually the dairy protein that triggers the insulin rise, not so much the lactose, and can also be a cause for some people’s dairy intolerance.
5) There is no need to change your diet completely from one day to the next, and you don’t need to get into ketosis right away, or stay in ketosis constantly. Small changes every couple weeks can give your body time to adjust, making things easier to maintain. The key is to make this sustainable, not just something you try for a couple weeks.
6) Variety! Our body needs a variety of food sources. While I don’t see how eating something like red meat could be bad for you (organic, grass-fed, not burnt), taken to the extreme of eating way too much at a time or eating it constantly, or the other extreme of not eating it ever, may not be great for maximizing health. There is no food that contains 100% of what we need to survive, so we need to eat a variety of things to get what we need. Obviously broccoli is healthy, but if you eat nothing but broccoli you will surely end up with multiple nutritional deficiencies. A greater variety of whole foods will also help promote a more diverse gut microbiota.
7) Food timing!!!! When you eat and when you don’t eat can have a huge affect on your metabolism. How long you go from finishing dinner till that first bite of food is also important. Not eating for extended periods of time can work to reset/balance certain metabolic parameters.
Insulin Index: see appendix 3 for list (FII column) https://ses.library.usyd.edu.au/bitstream/2123/11945/2/Bell_KJ_thesis_2.pdf
Here is a link that I found doing an image search that shows a table version of a few selected foods: