10 ms·

Genetic Study Supports Carbohydrate-Insulin Model of Obesity

160 points by ot 9y ago

acchow 9y ago
> Insulin is the Miracle-Gro for your fat cells. A child with new onset type 1 diabetes — unable to make enough insulin — will invariable lose weight until receiving treatment, no matter how many calories she consumes. Does anyone know where the calories go if it isn't stored as fat? Glycogen stores? Or our digestive system just stops absorbing them?
- wutbrodo 9y ago
  I think the main mechanism is that it doesn't get absorbed. For example, sugary urine is a well-understood side effect of diabetes that isn't well-managed, caused by your kidney draining excess sugar from your bloodstream into your urine. Interestingly enough, your body also raises its level of activity in order to burn calories and maintain weight levels. I believe they've measured a surprising amount of excess calories burned from extra fidgeting when overfeeding people relative to their usual diet.
  - hycaria 9y ago
    No, its the other way round : Kidneys let glucose through into the filtrate, but have a limited capacity of glucose reabsorption. In case of diabetes melleitus you "saturate" the pumps, hence the resulting glycosuria.
  - maxerickson 9y ago
    Yeah, the name "diabetes mellitus" comes from passing large volumes of sweet urine.
- jimrandomh 9y ago
  They turn into glucose and hang out in the blood causing problems until the kidneys filter it out and excrete it.
  - acchow 9y ago
    And if the diet is very high in fat? The body will convert the fat to glucose?
    - tzahola 9y ago
      To ketones.
      - randomThoughts9 9y ago
        True is you manage to get into keto. But what happens if you get close, but not quite?
        tzahola 9y ago
        https://en.wikipedia.org/wiki/Fatty_acid_metabolism https://en.wikipedia.org/wiki/Fatty_acid_metabolism TL;DR: dietary fatty acids are disassembled and then reassembled into triglycerides which are stored in adipocytes (fat cells) until needed.
- memsom 9y ago
  My stepson is type 1, so saw this first hand. Slowly the child loses weight. It's initially not very noticeable, but for example - in our case he stayed with his father over the summer and when he came back he was noticeably thin. The child begins drinking a lot. It starts off with an excessive thirst. Can't go more than an hour without drinking. But ends up with them not being able to do anything, peeing constantly and never being able to quench their thirst. When he came back to us, he was close to this stage. He was constantly eating ice cubes as they melted slowly enough so that he felt like he was constantly moistening his mouth. After about 3 days we took him to the doctors office, where by he went to Hospital. Fatigue - the child has zero energy and when they are not drinking they can barely move. This was rapid. He came home on a Sunday evening, and by Wednesday morning he looked like pure death. Ketones in the blood skyrocket. This is incredibly dangerous. When blood sugar rises above about 15 mmol/L (270 mg/dl) things start getting quite nasty. Health is put in jeopardy. Quite often the child will go in to a coma if they get too high. All of the sugars are peed out. The child's pee will smell very strongly and be a very dark colour if they are anything like my stepson. It was basically horrific. But as soon as we got him treatment, he bounced back quickly. We now use a carb counting system supported by a device that tracks is blood sugar and insulin intake. Regulating his insulin is a constant battle as he still thinks he is indestructible, and convincing a 14 year old boy that skipping "a few" shots every day or injecting a guesstimate as he is "too busy to do it properly" is a bad idea is not easy.
  - cellularmitosis 9y ago
    I wonder if there is an idea for a service here? If over-reporting of e.g. violence on the news can alter people’s perception, maybe we can use that vulnerability to our advantage? If your son received a text everyday about someone going blind or having limbs amputated, maybe you can bias his perception by over-reporting bad outcomes?
    - johnchristopher 9y ago
      https://en.wikipedia.org/wiki/Tobacco_packaging_warning_messages https://en.wikipedia.org/wiki/Tobacco_packaging_warning_mess...
esaym 9y ago
Well, this makes me want to go straight to /r/keto ...
jimrandomh 9y ago
> Insulin is the Miracle-Gro for your fat cells. A child with new onset type 1 diabetes — unable to make enough insulin — will invariable lose weight until receiving treatment, no matter how many calories she consumes. Give that child the right amount of insulin, and weight trajectory returns to normal. Give that child (or an adult with type 2 diabetes) too much insulin and excessive weight gain will predictably result. This is just Endocrinology 101. This is incorrect. Giving too much insulin to a type 1 diabetic causes rapid death, not weight gain. Giving no insulin to a type 1 diabetic causes weight loss because most calories leave through urine rather than getting used or stored, not because insulin is "miracle-gro for your fat cells".
- rjtavares 9y ago
  > Giving no insulin to a type 1 diabetic causes weight loss because most calories leave through urine rather than getting used or stored Isn't that precisely his point?
sc4les 9y ago
Nice try, dairy industry
- Axsuul 9y ago
  How would the dairy industry want this?
  - deleted 9y ago
    [deleted]
  - mathw 9y ago
    Dairy products are high in fat...
    - sjwright 9y ago
      Full cream milk is 4% fat. That's not very high.
      - toasterlovin 9y ago
        A good amount of the calories in whole milk come from fat. In post-milk dairy products, though, it’s a much higher percentage, since much of the carbohydrates have been removed. After all, it’s removing the carbohydrates (lactose) that makes dairy products viable for the lactose intolerant. Take a look at the fat content of butter, cheese, yogurt, sour cream, etc.
      - mjmasn 9y ago
        It's 49% calories from fat, that's pretty high. A healthy diet is <20% calories from fat. Even that is much more fat than we need.
        tracker1 9y ago
        It seems to be (forget which studies) that we need 40-60g of fat/day for dietary needs and for good digestion (keeping bile/gallbladder running). If that's <20% of your calories, you're either eating a lot, and depending on activity that is fine, or you aren't getting enough fat. Personally, following a vegan, or even doctor recommended diet for diabetes I gained weight on both... on keto, I'm down 63# last year, and feeling much better and mostly off medication. I've also got a dysfunctional metabolism, so YMMV.
cageface 9y ago
If this is true then why have many many studies shown that vegans, who generally eat a relatively high-carb & low fat diet, are the only demographic with normal body mass index and also have much, much lower chances of developing type 2 diabetes? In fact we have a lot of evidence linking high-fat diets to diabetes: https://nutritionfacts.org/2016/11/17/fat-is-the-cause-of-type-2-diabetes/ https://nutritionfacts.org/2016/11/17/fat-is-the-cause-of-ty... High fat diets also do a lot of bad things to your cardiovascular system. Proceed with caution.
- kazinator 9y ago
  Fat vegans are out there. "Vegan" is no magic bullet. Calories are inescapable. The body's output changes in compensation for incoming calories, but only within a certain range. Also, there is all sorts of processed crap that's bad for you that qualifies as vegan because no animal products are involved. Hydrogenated vegetable oil, anyone? You could be a potato chip and cookie vegan.
  - cageface 9y ago
    Data >> anecdotes https://www.vegkitchen.com/nutrition/do-vegans-have-a-weight-loss-advantage/amp/ https://www.vegkitchen.com/nutrition/do-vegans-have-a-weight...
    - kazinator 9y ago
      No amount of data or ancdotes beats calories in. Fact is, not only is it possible to eat strictly vegan and get fat, it's not even difficult. If the majority of vegans avoid that, it's not simply due to being vegan. Sure, let's get our data from "vegikitchen.com", quoting from some vegan book by nutritionist quacks.
      - cageface 9y ago
        It was what was handy on my phone. Here's a recent published NIH article: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5466941/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5466941/ Yeah pedantically you can nothing but Oreos and be "vegan". But FTA: "In a cohort of 4384 Taiwanese Buddhists, vegetarian men had approximately half of the rate of diabetes (OR: 0.49, 95% CI: 0.28–0.89), and vegetarian post-menopausal women had one-quarter the rate of diabetes (OR: 0.25, 95% CI: 0.15–0.42), compared with their omnivorous counterparts, despite statistical adjustment for body mass index and other factors. Interestingly, the omnivores in this study consumed a predominantly plant-based diet with little meat or fish, again implying that small amounts of meat contribute significantly to the development of insulin resistance" And the idea that fat = calories in - calories burned is a simplistic view that no serious nutritionist on either side of the debate believes.
lucidguppy 9y ago
What happens to the fat that you eat if you don't burn it off?
codingdave 9y ago
You don't even need to get into the science to dislike this article. And I'm not trying to argue against low-carb... I feel better on low-carb diets myself. But this article lays out a couple scientific facts, while shaming the reader into unquestioning agreement by saying, "This is X 101". But then lists a pseudo-scientific premise tied to their third "fact", and tries again to shame the reader into agreement. This is simply a manipulative writing style, and we should be ignoring it, not discussing it.
- chadcmulligan 9y ago
  The author has fairly impressive credentials, granted his style is unique.
- gjem97 9y ago
  This is the medium post to garner attention for their journal article [1]. Admittedly the style seems like something out of the "self help" section of the bookstore, but my takeaway was: "look at this new result, it supports adopting a new theory of obesity, and I personally think this theory is the right one." [1] http://clinchem.aaccjnls.org/content/64/1/192 http://clinchem.aaccjnls.org/content/64/1/192
marcus_holmes 9y ago
I live in Cambodia. The Khmer people here eat white rice for every meal, four times a day. They nap at lunchtime because of carb overload. They're not fat.
- vinceguidry 9y ago
  How active are they?
  - marcus_holmes 9y ago
    not very, lol. It's common to see Khmer sleeping in hammocks in the streets (not homeless, just napping). They never seem to walk anywhere, the moto is ubiquitous and the city is not build for walking. If I walk half an hour across town then they're astonished that I didn't take a tuk-tuk. Khmer people don't go to gyms.
- VLM 9y ago
  That's a fairly insightful observation in that in the old days in the agricultural high carb west we balanced the obesity causing nature of extremely high carb diets against malnourishment, internal parasites, and periodic regular famines. We eliminated all three in the last century while keeping the ultra high carb diet, in fact boosting the carb intake to levels never seen before, and unsurprisingly the obesity level exploded. For example five minutes with google searching for "khmer malnurishment" will find that about a third of the kids have some kind of malnutrition problem. Admittedly those stats come from people who's salaries depend on the problem existing and are therefore untrustworthy, but I'm sure real world rates none the less exceed a quarter. Kinda the whole point of the obesity epidemic in the post-green revolution west is we don't have 1/3 of the population dying of scurvy regardless of how much carb they eat, and by definition we never ever fast or have any carb intake limit at all. Its entirely possible that an ultra high carb diet as experienced in the west until the 1970s is perfectly stable as long as you have repetitive unintentional fasts (aka famines) and massive infestation of tapeworms and other intestinal parasites combined with universal vitamin deficiency such that everyone's a little sick all the time. Its interesting to think about intestinal parasite eradication in terms similar to current discussion of probiotics and antibiotics in food. Tapeworms are gross, but so is dying 20 years earlier due to obesity... Its not a huge step in the probiotic marketing sense from unicellular parasites to multicellular parasites.

160 points by ot 9y ago

> Insulin is the Miracle-Gro for your fat cells. A child with new onset type 1 diabetes — unable to make enough insulin — will invariable lose weight until receiving treatment, no matter how many calories she consumes. Does anyone know where the calories go if it isn't stored as fat? Glycogen stores? Or our digestive system just stops absorbing them?

wutbrodo 9y ago
I think the main mechanism is that it doesn't get absorbed. For example, sugary urine is a well-understood side effect of diabetes that isn't well-managed, caused by your kidney draining excess sugar from your bloodstream into your urine. Interestingly enough, your body also raises its level of activity in order to burn calories and maintain weight levels. I believe they've measured a surprising amount of excess calories burned from extra fidgeting when overfeeding people relative to their usual diet.
- hycaria 9y ago
  No, its the other way round : Kidneys let glucose through into the filtrate, but have a limited capacity of glucose reabsorption. In case of diabetes melleitus you "saturate" the pumps, hence the resulting glycosuria.
- maxerickson 9y ago
  Yeah, the name "diabetes mellitus" comes from passing large volumes of sweet urine.
jimrandomh 9y ago
They turn into glucose and hang out in the blood causing problems until the kidneys filter it out and excrete it.
- acchow 9y ago
  And if the diet is very high in fat? The body will convert the fat to glucose?
  - tzahola 9y ago
    To ketones.
    - randomThoughts9 9y ago
      True is you manage to get into keto. But what happens if you get close, but not quite?
      - tzahola 9y ago
        https://en.wikipedia.org/wiki/Fatty_acid_metabolism https://en.wikipedia.org/wiki/Fatty_acid_metabolism TL;DR: dietary fatty acids are disassembled and then reassembled into triglycerides which are stored in adipocytes (fat cells) until needed.
memsom 9y ago
My stepson is type 1, so saw this first hand. Slowly the child loses weight. It's initially not very noticeable, but for example - in our case he stayed with his father over the summer and when he came back he was noticeably thin. The child begins drinking a lot. It starts off with an excessive thirst. Can't go more than an hour without drinking. But ends up with them not being able to do anything, peeing constantly and never being able to quench their thirst. When he came back to us, he was close to this stage. He was constantly eating ice cubes as they melted slowly enough so that he felt like he was constantly moistening his mouth. After about 3 days we took him to the doctors office, where by he went to Hospital. Fatigue - the child has zero energy and when they are not drinking they can barely move. This was rapid. He came home on a Sunday evening, and by Wednesday morning he looked like pure death. Ketones in the blood skyrocket. This is incredibly dangerous. When blood sugar rises above about 15 mmol/L (270 mg/dl) things start getting quite nasty. Health is put in jeopardy. Quite often the child will go in to a coma if they get too high. All of the sugars are peed out. The child's pee will smell very strongly and be a very dark colour if they are anything like my stepson. It was basically horrific. But as soon as we got him treatment, he bounced back quickly. We now use a carb counting system supported by a device that tracks is blood sugar and insulin intake. Regulating his insulin is a constant battle as he still thinks he is indestructible, and convincing a 14 year old boy that skipping "a few" shots every day or injecting a guesstimate as he is "too busy to do it properly" is a bad idea is not easy.
- cellularmitosis 9y ago
  I wonder if there is an idea for a service here? If over-reporting of e.g. violence on the news can alter people’s perception, maybe we can use that vulnerability to our advantage? If your son received a text everyday about someone going blind or having limbs amputated, maybe you can bias his perception by over-reporting bad outcomes?
  - johnchristopher 9y ago
    https://en.wikipedia.org/wiki/Tobacco_packaging_warning_messages https://en.wikipedia.org/wiki/Tobacco_packaging_warning_mess...

esaym 9y ago

Well, this makes me want to go straight to /r/keto ...

jimrandomh 9y ago

> Insulin is the Miracle-Gro for your fat cells. A child with new onset type 1 diabetes — unable to make enough insulin — will invariable lose weight until receiving treatment, no matter how many calories she consumes. Give that child the right amount of insulin, and weight trajectory returns to normal. Give that child (or an adult with type 2 diabetes) too much insulin and excessive weight gain will predictably result. This is just Endocrinology 101. This is incorrect. Giving too much insulin to a type 1 diabetic causes rapid death, not weight gain. Giving no insulin to a type 1 diabetic causes weight loss because most calories leave through urine rather than getting used or stored, not because insulin is "miracle-gro for your fat cells".

rjtavares 9y ago
> Giving no insulin to a type 1 diabetic causes weight loss because most calories leave through urine rather than getting used or stored Isn't that precisely his point?

sc4les 9y ago

Nice try, dairy industry

Axsuul 9y ago
How would the dairy industry want this?
- deleted 9y ago
  [deleted]
- mathw 9y ago
  Dairy products are high in fat...
  - sjwright 9y ago
    Full cream milk is 4% fat. That's not very high.
    - toasterlovin 9y ago
      A good amount of the calories in whole milk come from fat. In post-milk dairy products, though, it’s a much higher percentage, since much of the carbohydrates have been removed. After all, it’s removing the carbohydrates (lactose) that makes dairy products viable for the lactose intolerant. Take a look at the fat content of butter, cheese, yogurt, sour cream, etc.
    - mjmasn 9y ago
      It's 49% calories from fat, that's pretty high. A healthy diet is <20% calories from fat. Even that is much more fat than we need.
      - tracker1 9y ago
        It seems to be (forget which studies) that we need 40-60g of fat/day for dietary needs and for good digestion (keeping bile/gallbladder running). If that's <20% of your calories, you're either eating a lot, and depending on activity that is fine, or you aren't getting enough fat. Personally, following a vegan, or even doctor recommended diet for diabetes I gained weight on both... on keto, I'm down 63# last year, and feeling much better and mostly off medication. I've also got a dysfunctional metabolism, so YMMV.

cageface 9y ago

If this is true then why have many many studies shown that vegans, who generally eat a relatively high-carb & low fat diet, are the only demographic with normal body mass index and also have much, much lower chances of developing type 2 diabetes? In fact we have a lot of evidence linking high-fat diets to diabetes: https://nutritionfacts.org/2016/11/17/fat-is-the-cause-of-type-2-diabetes/ https://nutritionfacts.org/2016/11/17/fat-is-the-cause-of-ty... High fat diets also do a lot of bad things to your cardiovascular system. Proceed with caution.

kazinator 9y ago
Fat vegans are out there. "Vegan" is no magic bullet. Calories are inescapable. The body's output changes in compensation for incoming calories, but only within a certain range. Also, there is all sorts of processed crap that's bad for you that qualifies as vegan because no animal products are involved. Hydrogenated vegetable oil, anyone? You could be a potato chip and cookie vegan.
- cageface 9y ago
  Data >> anecdotes https://www.vegkitchen.com/nutrition/do-vegans-have-a-weight-loss-advantage/amp/ https://www.vegkitchen.com/nutrition/do-vegans-have-a-weight...
  - kazinator 9y ago
    No amount of data or ancdotes beats calories in. Fact is, not only is it possible to eat strictly vegan and get fat, it's not even difficult. If the majority of vegans avoid that, it's not simply due to being vegan. Sure, let's get our data from "vegikitchen.com", quoting from some vegan book by nutritionist quacks.
    - cageface 9y ago
      It was what was handy on my phone. Here's a recent published NIH article: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5466941/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5466941/ Yeah pedantically you can nothing but Oreos and be "vegan". But FTA: "In a cohort of 4384 Taiwanese Buddhists, vegetarian men had approximately half of the rate of diabetes (OR: 0.49, 95% CI: 0.28–0.89), and vegetarian post-menopausal women had one-quarter the rate of diabetes (OR: 0.25, 95% CI: 0.15–0.42), compared with their omnivorous counterparts, despite statistical adjustment for body mass index and other factors. Interestingly, the omnivores in this study consumed a predominantly plant-based diet with little meat or fish, again implying that small amounts of meat contribute significantly to the development of insulin resistance" And the idea that fat = calories in - calories burned is a simplistic view that no serious nutritionist on either side of the debate believes.

lucidguppy 9y ago

What happens to the fat that you eat if you don't burn it off?

codingdave 9y ago

You don't even need to get into the science to dislike this article. And I'm not trying to argue against low-carb... I feel better on low-carb diets myself. But this article lays out a couple scientific facts, while shaming the reader into unquestioning agreement by saying, "This is X 101". But then lists a pseudo-scientific premise tied to their third "fact", and tries again to shame the reader into agreement. This is simply a manipulative writing style, and we should be ignoring it, not discussing it.

chadcmulligan 9y ago
The author has fairly impressive credentials, granted his style is unique.
gjem97 9y ago
This is the medium post to garner attention for their journal article [1]. Admittedly the style seems like something out of the "self help" section of the bookstore, but my takeaway was: "look at this new result, it supports adopting a new theory of obesity, and I personally think this theory is the right one." [1] http://clinchem.aaccjnls.org/content/64/1/192 http://clinchem.aaccjnls.org/content/64/1/192

marcus_holmes 9y ago

I live in Cambodia. The Khmer people here eat white rice for every meal, four times a day. They nap at lunchtime because of carb overload. They're not fat.

vinceguidry 9y ago
How active are they?
- marcus_holmes 9y ago
  not very, lol. It's common to see Khmer sleeping in hammocks in the streets (not homeless, just napping). They never seem to walk anywhere, the moto is ubiquitous and the city is not build for walking. If I walk half an hour across town then they're astonished that I didn't take a tuk-tuk. Khmer people don't go to gyms.
VLM 9y ago
That's a fairly insightful observation in that in the old days in the agricultural high carb west we balanced the obesity causing nature of extremely high carb diets against malnourishment, internal parasites, and periodic regular famines. We eliminated all three in the last century while keeping the ultra high carb diet, in fact boosting the carb intake to levels never seen before, and unsurprisingly the obesity level exploded. For example five minutes with google searching for "khmer malnurishment" will find that about a third of the kids have some kind of malnutrition problem. Admittedly those stats come from people who's salaries depend on the problem existing and are therefore untrustworthy, but I'm sure real world rates none the less exceed a quarter. Kinda the whole point of the obesity epidemic in the post-green revolution west is we don't have 1/3 of the population dying of scurvy regardless of how much carb they eat, and by definition we never ever fast or have any carb intake limit at all. Its entirely possible that an ultra high carb diet as experienced in the west until the 1970s is perfectly stable as long as you have repetitive unintentional fasts (aka famines) and massive infestation of tapeworms and other intestinal parasites combined with universal vitamin deficiency such that everyone's a little sick all the time. Its interesting to think about intestinal parasite eradication in terms similar to current discussion of probiotics and antibiotics in food. Tapeworms are gross, but so is dying 20 years earlier due to obesity... Its not a huge step in the probiotic marketing sense from unicellular parasites to multicellular parasites.