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Interesting article, especially on the MHO issue. I never thought obesity as a healthy response to high blood sugar.
I agree with you that leanness is our natural state and being obese is unnatural and unhealthy. I have some spare tire myself from years of eating lots of bad stuff like wheat, sugar and vegetable oil. Is going low carb the best way to reduce my visceral fat? -
In short: eliminate wheat and dramatically reduce fructose and omega-6 fat consumption, eat fatty fish with high levels of omega-3 a few times a week, normalize your vitamin D levels, address any thyroid issues (if present), manage stress and restore adrenal function.
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Very interesting. I am eagerly waiting for the second part and hope to find out more about my condition. I am a skinny 5’6″ 134 lb male with impaired glucose handling. Despite not eating simple sugars, white rice and soda, I have ended up with a condition where my 2HPP glucose levels over between 180-200. I have given up wheat (but do eat some barley – is it bad?) completely, eat lots of fish and eggs. I sure hope to make better sense of my health with your next installment.
Thanks! -
Would taking inflammation reducing supplements like Zyflamend and/or a Tumeric extract (curcumin) help in weight loss?
I have an interesting story relating to these in how they might have helped me carpal tunnel syndrome and as a side effect kick started my initial 50 pound drop in weight.
In 2007 I was 100 pounds overweight. I started an overnight job working in a freezer. This drastic change forced me to intermittent fast daily as I wasn’t hungry at night and slept through the day. I also started eating lower carb although not strictly. I wasn’t trying to diet at the time I just started eating that way because of circumstance. 3 months went by and I lost about 10 pounds.
Then I developed carpal tunnel (cold environment, repetitive motion) and decided to try a natural regimen first. I’m glad I did. Within a month of using Zyflamend and a separate Curcumin extract the carpal tunnel went away. Well, so did the fat. As in about 50 more pounds seemed to disappear in the next month. People thought that I was sick it went away so fast. I was definitely in a ketogenic state as I had no cravings whatsoever for anything and had to force myself to eat once a day. I had incredible energy and felt the strongest I had ever felt in my life.
Full disclosure: I’m sure the 4 cups of coffee (no sugar) had something to do with it as well…but what do you think about the anti-inflammatory supplements?
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Thanks for your advices. I guess I should take in account my vitamin D levels and my thyroid functions too.
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When you say “fructose” do you mean fruits too? or are you meaning the fructose adding in other products?
Great blog ! -
Plagiarizing Paul of PerfectHealthDiet: a leaky gut, caused by a bad diet (consumption of grains and fructose+omega 6 in excess), could lead to more pathogenic infections and thus increasing inflammation and diabetes incidence? There seens to be a connection between diabetes and some infections (Pubmed 11417300, 20632447, 20508853, for some examples). On this line of thinking, Pubmed 20415859 seems to be an interesting article! Too bad it’s not open access.
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Yes, I also mean fruits. A small amount of fructose from fruit (say from 2 servings per day) is okay, but beyond that fructose begins to be harmful.
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Mario: yes, there’s definitely a connection there. As I’ve been arguing in this series, T2DM is an autoimmune, inflammatory disease involving a pathological expression of innate immunity. This is characteristic of other Th1-dominant autoimmune diseases, like Crohn’s and Hashimoto’s. We know that infection can trigger those conditions, and of course some believe that they are caused by an unidentified, persistent chronic infection. They hygiene hypothesis has been advanced as a possible explanation for autoimmune disease, and pig whipworm (which provokes an immune response) therapy has been used successfully to treat Crohn’s, ulcerative colitis and some autoimmune allergy conditions.
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Yes, anti-inflammatory supplement can help. I do a weight loss program with my patients that is based on a 3-week elimination diet and anti-inflammatory cleanse. It’s remarkably effective.
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Good stuff. One question:
“Chronically high levels of circulating leptin cause leptin resistance.”
Do we know this to be true? I ask because low-carbers used to think that high insulin levels alone (from high-carb eating) caused insulin resistance, but healthy and trim high-starch societies seem to prove that wrong, and I think we know now that something else has to get the insulin resistance started, like the chain of events that you describe involving inflammation.
I think that’s an important question because, if high leptin levels cause leptin resistance by themselves, then people who are already obese would seem to be stuck. Even if they eliminate all other unhealthy factors, their obesity will keep leptin high, keeping leptin resistance up, keeping leptin high, etc. The only way out would be liposuction — actually removing fat cells to cut leptin production (I’m just guessing that would do it) — or a drug that blocks leptin production (if one exists). But if other factors (like gluten or PUFAs) cause the leptin resistance, there’s hope of breaking the cycle. -
Aaron:
Chronically high insulin levels do cause insulin resistance. Insulin surges (from natural carbohydrates) in the absence of inflammation, lipotoxicity and genetic factors do not.
It is possible to restore insulin sensitivity to varying degrees. Our body is a dynamic and adaptable system. In the presence of too much of a hormone, the cells downregulate receptor site expression to avoid overload. When levels of that hormone drop, the cells increase receptor site expression (which improves sensitivity). The same is true for leptin.
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Thanks, Chris, I see what you’re saying. Even constant potato eaters would only have surges after meals, not high insulin levels all day every day without other contributing factors, so that makes sense.
But if leptin works the same way, how does someone who is already leptin resistant AND obese (and presumably producing chronically high leptin levels) break out of that cycle? When levels of the hormone drop, sensitivity will improve; but how do you get the levels to drop in the first place when leptin resistance and inflammation from overloaded fat cells are causing your hypothalamus to say, “Supersize those fries!”? If that’s still coming in your series, I’m looking forward to it. -
I wanted to ask same question as Aaron did because it sounded like “high insulin causes insulin resistance” which is false.
Insulin resistance is caused atleast partly by elevated FFA and it is related to inflammation since activation of innate immunity in fat tissues increase lipolysis of stored fat from adipocytes. Inflammation could be behind leptin resistance also because SOCS-3 has been strongly connected to the development of leptin resistance:
http://www.ncbi.nlm.nih.gov/pubmed/18560028
SOCS-3 is part of inflammation responce to the activation through TRL4 by LPS:
http://www.jimmunol.org/cgi/content/abstract/179/9/5966
In conclusion I’d suggest that activation of innate immunity in adipose tissue could cause leptin resistance through SOCS-3. -
I don’t disagree that inflammation plays a role. In fact, I just wrote an entire article about that a few days ago. However, although it’s true that insulin surges don’t cause diabetes, it’s still true that chronically elevated insulin levels do. That’s just basic hormone physiology. There are also studies of both lean and obese diabetics that don’t have elevated levels of inflammatory markers, so inflammation isn’t always the primary causative agent. These conditions are complex and multifactorial.
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“There are also studies of both lean and obese diabetics that don’t have elevated levels of inflammatory markers, so inflammation isn’t always the primary causative agent.”
It does not have to be inflammation that drives the disease progress. Lack of things related “anti-inflammatory system” can make the difference too. I think it’s much more crucial than all of these pro-inflammatory stuff. Loss of tolerance is the key. -
“However, although it’s true that insulin surges don’t cause diabetes, it’s still true that chronically elevated insulin levels do.”
What causes chronically elevated insulin? Here’s one possibility:
http://www.ncbi.nlm.nih.gov/pubmed/3905458
I haven’t been able to find full text. If you are interested and manage to get it from somewhere I’d love to read it. -
I’ll be writing an article about the connection between the gut microbiota and diabesity soon. I don’t have access to the full-text of this particular study, but I’ve seen others like it.
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So which method will allow for successful weight loss? Since you say weight loss is possible, I’m assuming you can point to a peer-reviewed study that shows some method successfully allows people to get down to a “normal” weight and keep the pounds off for at least 5 years. I’ve been searching for such a study, and can’t find one. I really hope you’ve found one, because otherwise telling fat people to lose weight is like telling a short person to get taller.
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Show me a study that uses the methods I’m advising people to use (paleo-type diet, high-intensity strength-training, thyroid normalization, anti-inflammatory detox, stress management) and I’ll show you a study where people lose weight and keep it off. Also, keep in mind that there ARE people who lose weight and keep it off in those studies – but there are an equal number who don’t. That’s not the same thing as saying “telling fat people to lose weight is like telling a short person to get taller.” Not even remotely.
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You’ve proven that it works for you. Which is great. In those studies there are 5% of people who lose weight and keep it off, not 50%. Let’s say it was only 50% though… that means a 50% chance of losing weight and a 50% chance of getting even fatter. Not the best odds.
I am very glad that you’ve found a way of eating that works for you. -
I’m not just talking about myself. I’m talking about the patients I treat and the many, many readers who’ve written in with success stories. I get between 3-5 emails a day with reports like this.
There are many non-dietary causes of weight gain, and limiting factors to weight loss. I’ll be writing more about those in the future. It sounds like perhaps you’ve had a difficult time losing weight. I’m sorry to hear that. But that doesn’t mean that weight loss is a hopeless endeavor for everyone else. Far from it.
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Well, they do have a 5% chance.
Honestly, my hope is that you can go on to prove your diet works and keeps weight off, then publish how to do it and make scads of money, because then I will have hope. Until then though, I’m not going to try another diet that will result in weight gain. I just have too much to lose, pardon the pun.
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