Ketosis is a hack: here’s why

There are multiple distinct flavors of diabetes/obesity, as evidenced by the fact that some people have: 1) impaired glucose tolerance (but normal fasting glucose); 2) others have impaired fasting glucose (but normal glucose tolerance); and 3) others have both.  This means there isn’t a linear relationship between these phenomena*.  There are also: 4) obese patients with normal glucose metabolism; and 5) lean patients with type 2 diabetes.

*I think the great Dr. Kraft may have missed some of the nuances here.

There is not 100% overlap among these, suggesting [confirming] distinct diabetes/obesity phenotypes (and probably causes & best treatments).






Is ad lib keto optimal for all of them?  No, but it’s a great hack for at least some of ’em, for a specific period of time.  It works for people in whom the underlying pathology is related to insulin resistance.  And it loses efficacy when the underlying pathology is managed (I think).  How?  Unknown.

if you consider yourself nutrition-savvy and think “everyone needs SOME degree of carb restriction, the only question is: how much?”




For the record: I’m not backing down on ketoadaptation and physical performance.  If keto was a total exercise #fail, then it would be very clear in studies on athletes, Wingate performance, etc… some mixed findings out there (partly due to study design issues), but clearly not #fail.

Wingate, FYI:



But this post isn’t about that.


Consider two scenarios:

1. An obese insulin resistant patient with elevated fasting and/or postprandial insulin adopts a ketogenic diet. Appetite spontaneously declines, fat mass declines, and overall metabolic health improves. After a while, the patient needs to more closely monitor fat intake… worded another way, they need to start counting calories #CICO.  After a while, they may not need a pencil & paper, but still “not eating all the food” becomes important for weight loss maintenance.

2. But not all forms of obesity are associated with insulin resistance. See studies by Cornier and Pittas.  And studies by Cornier, Pittas, Ebbeling, and Johnston (although Johnston is admittedly a stretch on this point) show that treatment efficacy differs based on insulin sensitivity.  Some of these patients actually do better monitoring calories and restricting fat intake than with ad lib carb restriction.  This, I suspect, is due to different underlying pathologies (related to insulin in this case).

For the others, maybe it’s an inflammation/leptin thing.  Maybe it’s related to food additives or sensitivities or something else entirely.  Point is, keto isn’t the optimal diet for everyone – that’s like saying one cancer drug should cure all cancers.


New study: despite having less protein and more carbs, the Paleo diet outdid the ADA diet.  HbA1c, fasting glucose, and insulin sensitivity were all improved despite more carbz.


IMHO, Gary Taubes and Chris Gardner have greatly advanced our understand of obesity.  Alternatively, one could say Gardner has filled in one hole of Taubes’ theory, but I suspect there are many more holes…



Another pioneer is Nedeltcheva et al., who showed that simply sleeping better (despite eating same diet) improves body composition.

Artificial light and circadian disruption: no bueno.

Meal timing.

Try to find out the underlying problem before blindly advising carb restriction.  Sleep?  Stress?  Even fitness/sedentary’ness may be the low-hanging fruit for some.

Carbz are one piece of the puzzle, but if someone’s drinking regular soda and playing on their smart phone late at night, might be better to start there than jumping straight to KETO + IF.



circadian feedback NAMPT


CLOCK BMAL1 gluconeogenesis


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calories proper



P.S. please don’t come at me with some “ice age” fairy tales, or saying ketosis is the one true human diet, or that LCHF=effortless fasting.  I said “please,” bro 🙂

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  • Gerard Pinzone

    The more research is done, the more we seem to come around to an (original) Atkins diet. Restrict carbs heavily. Lose weight/fix metabolism begins. Slowly reintroduce carbohydrates into diet. And yes, keep all “second order” equation variables in check like meal timing, circadian rhythm, etc., too.

    • Thomas Hemming Larsen

      I know that Bill would say that circadian rhythm > macros 🙂

      • Gerard Pinzone

        Let’s put it this way: a type 2 diabetic with a poor diet and bad sleep patterns wants to make an improvement to their lifestyle. The answer would obviously be to change both, but let’s play “Sophie’s Choice” and pick only one: diet or sleep. Which do you choose?

  • Is anyone really promoting ketosis or low carb for all? Who are the Keto Zealots?

    • Gerard Pinzone

      I think the better question is, “Who shouldn’t do keto and why?”

      • Sky King

        Type 1 diabetics, for one. Women who are pregnant or trying to get pregnant. Children who are still in the growing stage. Also those who are doing perfectly fine with whatever diet they’re on, whether it be a very low-C or moderate C-diet.

        I think of Keto Diets as a possible THERAPEUTIC aid for those who really might benefit from it. But as I mentioned, not everyone needs it. As an analogy…. glasses are also a safe and effective remedy for those with poor vision, but that doesn’t mean that people who can see perfectly well already should all go out and get them.

        • CynicalEng

          Don’t agree on the pregnancy, severla women have got pregnant through low carb dietary approaches.

          • Sky King

            Does this study change your mind?

            The issue wasn’t about the ketogenic diet’s effect on a woman’s ability to get pregnant, but on the developing fetus.

          • interesting. It could be a general issue due to “growth,” as the KD moms were ~10g lighter by E17.5

          • CynicalEng

            nope. A mouse study is trumped by human keto mothers I have met.

          • This Old Housewife

            PCOS was probably involved.

        • Gerard Pinzone

          I’m very interested about the problems Type 1 diabetics and pregnant women experience in ketosis. Please provide whatever information you have.

          You’re analogy is a bit off. Let me (hopefully) provide a better one:

          A drug company has developed a new pill. It improves health in just about everyone who tries it. It’s not a cure-all, but it’s the safest medication ever developed. The only downside is that you need to keep taking it to remain healthy. (Great for the drug company!) Some people need to take the pill every day, while others can take it less often. However, there’s no harm to anyone taking it daily. There have been some reported side effects when first going on the pill, but they can be mitigated and go away within the first week or so. The costs for this pill are minimal to zero. People who are already considered healthy can take it, too. Some already healthy people report an improvement in physical performance, but others do not.

          Assuming the above is true, do you think the following advice is sound?: “Everyone should try this pill.”

          • Sky King

            “To date, no studies
            have thoroughly investigated the direct implications of a gestational ketogenic diet
            on embryonic development.” So, the research out there is limited, but after reading this study… would you try and convince your daughter/wife to go on a ketogenic diet if she were pregnant?

            Sorry, but your drug analogy is absolutely ridiculous! A drug (shoe) that will one day improve (and fit) the health of “everyone” who tries it…!!! What year in the future are we talking about and on what planet? But for argument’s sake…. let’s take the example of say, aspirin. It’s probably the greatest drug ever discovered, but even it has side effects. The majority of people can and will take it for pain, but they do so until their symptoms subside.

            Should they take it everyday as a preventative since it’s fairly harmless? Some will take it as a blood thinner to prevent heart attacks, but constant use is known to cause ulcers and bleeding and the FDA no longer sanctions it for heart attack prevention.

            Need I say more…??

          • Sky King

            And just as Bill already mentioned, “Ketosis = NORMAL response to starvation”…. should developing fetuses and growing children be put on a “starvation” diet in order to produce ketone bodies? O_o

            And from where will all the necessary nutrients needed to grow healthy tissues come from? Ketone bodies? Fats?

          • Gerard Pinzone
          • Sky King

            Clearly a case of the kettle calling the pot…!! ;-P

          • Sky King




            If you need some pie charts, venn diagrams or perhaps even Bill to help you assimilate the information I’ve just given you links to, please don’t hesitate to ask!

            You’re dismissed!

          • my take: children & pregnant women require protein and calories. If they can’t get enough of these on whatever diet, no bueno.

          • Sky King

            Eggsactly! I agree totally. I think some folks are just searching for one diet protocol to stick with, possibly for a lifetime, but a Keto Diet is not it. I agree with you that it’s just a “hack” to try and help certain folks deal with whatever medical condition they’re dealing with at the time.

            Personally, I’m BIG on FASTING as a hack, short term (1-5 days) and/or long term (14-30 days). And fasting, of course, will get you ketones, but I don’t practice it for that reason in particular. There are many health benefits to be gained from practicing fasting which has been practiced for thousands of years by people of all cultures.

          • This Old Housewife

            Remember when Sanjay Gupta wanted to put statins in the drinking water? Tell me a baby needs to be taking in statins!

        • type 1 diabetics w/ epilepsy have done well on keto

        • DJuggernaut

          Keto Diet are ideal for Type 1 Diabetics… Many Type 1 Diabetics also suffer from Insulin Resistance. Lower inputs of Carbs = Reduced insulin injections = better control. Why on Earth would it not work for T1DM. I’m Type 1 and have followed Keto for 5 years.

      • Some insulin sensitive obese patients, because they lose more body fat and have better adherence to low fat diets.

      • This Old Housewife

        It just might be an easier one to answer (not by me, of course).

    • Sky King

      Jimmy Moore, for one. While I think going Keto for awhile is a great idea for a lot of people (not everyone) especially if they are insulin-resistant and suffering from Metabolic Syndrome, I think something takes place in our bodies that causes adaptation and the benefits start to dwindle.

      Besides that… what advantages does continuing a Keto diet indefinitely have on body composition as far as muscles, bones and your major organs? Surely you will need to up the protein intake eventually. Oui? Non? Oui?

      • Jimmy M. seems like a terrible person to get advice from. I only listened to 3 of his podcasts – even he said low carb isn’t for everyone in 2 of them.

        So, who are the Keto Zealots?

        • rs711

          he says it all the time, true. so there’s that. but if pressed on giving advice, he’d likely, imo, propose keto (maybe LCHF?) as a first pass.

          nothing wrong with that. but it’s the only tool he knows. he’s got no actual medical/scientific training so that’s understandable.

          i think he’s sincere and has helped more people than he’s hindered. more than a lot of docs can say, unfortunately 🙁

        • Sky King

          Depends on what’s your definition of a “zealot”..!?

      • This Old Housewife

        I notice he’s upped his carb intake through more veggies lately–no more 5 eggs and a stick of butter once a day.

      • Chupo

        I’d like to see Jimmy Moore do a TRULY low fat, whole foods, starch-based diet. I think he’d do better on that than keto. Raymond Cool, a star McDougaller, reminds me of Jimmy in a way. He lost nearly 300 pounds on it and is volume eater like Jimmy. See: where Jimmy ate literally 30+ slices of pizza in a single sitting while on vacation! ¡Dios mío! I thought *I* was a volume eater by being able to down a single XL pizza in one sitting!

        Anyway, alternating between some liver, oysters, eggs, or sardines once a week for B-12, preformed vitamin A, zinc, etc. will make the diet complete. This is mainly where I differ from Dr. McDougall (aside from the attitude). He says to avoid all animal products or risk sparking cravings for them. I don’t think it’s the animal products per-se that spark cravings. It’s the hamburgers, pizza and other such crapola.

  • George

    I came across an interesting fact about ketosis. We’re all about ketone bodies being substitutes for glucose, but of course as Acetyl-CoA precursors they’re also substitutes for fatty acids – which is why TGs go down, and also adipocyte FFAs, when the liver makes ketone bodies from fats.
    It’s free money in every currency, and this is part of the hack – you get a bit of a rest from both sugars and lipids.

  • TechnoTriticale

    «Point is, keto isn’t the optimal diet for everyone –»

    Different people might need different diets? Why didn’t the USDA, ADA, ACA, AMA or NHS tell me about this?

    All seriousness aside, KD-for-everyone is a bit of a straw man, and is not a widely held position, even among ardent diet dissidents.

    Your point, however, is well taken in that VLCHF (plus some other considerations) is a great place to start for someone, but they need to not be surprised if it isn’t a prompt or total answer.

    «…that’s like saying one cancer drug should cure all cancers.»

    That assumes cancers need a “cure”. It may turn out that they are just a mal-expression latent in all cells, and may yield to a combination of interventions (almost none based on the pretty much flat-lined somatic hypothesis).

    • rs711

      “KD-for-everyone is a bit of a straw man, and is not a widely held position, even among ardent diet dissidents.”

      totally agree

    • “KD-for-everyone is a bit of a straw man”

      you’d be surprised at what pops up in my Twitter feed from time-to-time. Mostly zealots (&/or trolls), but many believe this ‘One Ring to rule them all’ BS

      • Probably trolls. Twitter brings out the worst in us.

      • Bob Briggs

        This “one ring to rule them all” is just a way to get the importance of the idea into the mind, to focus. For me, and many others, defeating insulin resistance has been life changing to say the least, I’ve lost 150 lbs and met many others who have done something just as astounding astounding this. Average people who who took this simple idea and chabged their life, not zealots or trolls.
        Are there other issues? Sure. Are those other issues most people’s problem, I would guess, NO. If these others were the biggest problems, then obesity would have been a problem before the 1980s. Most are fat, sick and hurting because they store too much fat either on their waistline or in their liver. Showing them how to reverse this actually helps many, endless debates about the other possible problems doesn’t help them. It makes the commenters sound educated and you get to call people like me a zealot or troll for thinking a poetic way to help people understand the underlying hyper insulin problem is associated with many illnesses , but it doesn’t actually help very many. If LCHF and intermittent fasting doesn’t work, what have these people lost? A little time, but at least they will be eating better. If it doesnt work, then they can look at meds, that cause weight gain, or sleep, or stresss, or _____.

  • Kasha

    Mmm… I’m on a modified keto diet & have never heard anyone say it’s best for everyone. There’s no particular “diet” that’s best for everyone. My problem was leptin/gherlin and the modified keto diet is working for me. The RNY surgery probably changed that rather than the diet. But the diet seems to increase wakefulness for the few people I know on it with the same or similar sleep disorders. Keto was never meant to become a fad, it was created for people with epilepsy. It takes incredible dedication to practice keto so I don’t really see many jumping & staying on the bandwagon.

    • James L

      Again it’s about context, and as usual the answer is ‘it depends’. However, my broad view (just my opinion) is that Carbs, Pro & Fat are available on planet earth for human consumption for a reason – basically extreme anything is always going to be suboptimal! Rather than looking for a black & white solution, this study shows this or that study shows that, I don’t feel the need to support a certain camp, I just accept that the closer we move to extremity, the further we move from optimal!
      Consume and enjoy carbs in the correct context; not EXTREMELY low or high 🙂

  • Great post + agree.
    In the real world i would argue the majority of significantly obese or overweight people have an IR->hyperinsulinemia/reactive hypoglycemia issue. Keto or even limiting carbs in some way is an effective treatment.

    Beyond that, with milder wt problems, people who have lost wt already and no longer very IR (which you mention), or people with less typical forms of obesity? The diet might not have any impact. I have spoken with women (usually women) who go LC, in spite of being very overweight, and NOTHIGN happens. No appetite reduction, no wt loss. That, however, is rare. MOST overweight ppl go on the diet, spontaneously eat less, lose wt… but simply quit because they want to nom carbs and hate resetricting them.

    They make up fake reasons it was a “health reason” they had to quit when in reality they were eating terrible unbalanced diets and this is not a fault of LC itself. Eat a damned avocado if you have palpitations. chicken breast every night and binging on lindt chocolates once a week is retarded.

    I’m not a LC zealot. Keto diet is hammer, not all forms of obesity are receptive nails. Most are, however, which is why the obesity problem seems to travel pretty well with junk food/HFCS/lack of home cooked meals.

    • This Old Housewife

      Keto diet is hammer, not all forms of obesity are receptive nails.

      Amen to that!

  • rs711

    please keep banging the circadian rhythms drum, it’s really underestimated (but you know that) 🙂

    sleep makes a world of difference for me in terms of strength & fasting BG -right on.

    Keto is normal; keto is a context-specific hack, too. Can’t both be true?

    LC/Keto isn’t a panacea (duh); but that fact doesn’t mean that it’s “bad” for those for who it isn’t optimal…IRL Practicalities call for adopting strategies that aren’t optimal at a population level but that are for that particular individual (again, duh).

    Lets separate diabetes and obesity because despite their overlap they’re not “diabetes/obesity”. Whether you have IFG, IGT or both…you’re still diabetic. In other words, your insulin dynamics are messed up, regardless of the breakdown between between your early or late phase response.

    “4) obese patients with normal glucose metabolism”. (correct me if I’m wrong but by that do you mean they don’t have IFG or IGT?) If so, do you assume their insulin dynamics to be equally normal? Seems to me this would be a bit of a leap. Granted, the former does make the latter more *likely*.

    “in a world where carbs are bad- shouldn’t 40% ALWAYS be better than 60%? And when it’s not: hypothesis over” ==> not if you look beyond CHOs for a second & consider other explanations. What if, for e.g., the -20% CHOs are replaced by obesogenic soybean oil? Or some other terrible dietary component? Aka the #context of confounding variables. Her statement is superficial thinking imho.

    Actually, the ‘fresh off the presses’ Paleo vs ADA diet for T2D *might* be a good example of that. The CHO level was nearly the same (+3.8% Paleo)…so “more carbz” = lol 🙂 Yet IS improved, although that “improvement” isn’t anything to write home about. Personally I wouldn’t recommend either diet to a diabetic.

    “Paleo group, the HbA1c declined by 0.3% over the 3 weeks of the study (P=0.04) and 0.2% in the ADA group (P=0.04)” 0.3% is tiny but it is only 3 weeks…just need longer studies.

    “After the diet, the mean change in M/LBM/I was 1.0 mg/min/kg/mU insulin (P=0.1) in the ADA group and 1.3 in the Paleo group (P=0.09)”…0.3 change in insulin is *something* but will it really change all-cause mortality? doubt it. although a longer study might do it more justice. until then…

    Fructosamine was much better in Paleo group but I’m ignorant as to its significance so i’ll just say thumbs up 🙂

    For diabetics I wouldn’t necessarily go straight keto + IF (for practical reasons) but I certainly would a least start with LC, then LC + IF & (ideally, on average) keto + IF.

    Lastly…agreed, Gardner highlighted limitations & there definitely are more to figure out.

  • CynicalEng

    Trying to find a box to put myself in. Low carbing >4 years let’s say 30 g/day carbohydrates (solid British ones, no fibre included) impaired fasting glucose & pre-diabetic 6.8 mmol/l 38 mmol/mol protein typically <100 g/day. Generally follow circadian rhythms, have been doin gmore protein for breakfast. BG 7 mmol/l (126) 2 hrs after zero carb egg & bacon breakfast.

  • Dr. Spencer Nadolsky

    Good stuff

  • NY

    Do we really know that physiologic insulin resistance on keto/VLC diet would not raise insulin levels over time leading to hyperinsulinemia?

    • There is no reasonable mechanism for this conjecture, and it has never been reported on either (although many ancient peoples, and a huge number of modern LCHF folks are deploying the treatment). Lowering carbohydrate is the first line strategy for improving insulin response when hyperinsulinemic/diabetes in situ (i.e. most US citizens). The evolutionary control system responds with a perfectly reasonable physiological insulin resistant state to manage the remaining exogenous glucose efficiently. What’s not to like….once you don’t hit your system with carb after sorting yourself out 🙂

      • “Lowering carbohydrate is the first line strategy for improving insulin response”

        have any go-to studies on this?

      • NY

        “What’s not to like”

        Can’t have bit of sweet potato or rice here and there without spiking BG into danger zone of >140, although briefly, and consequent rise in insulin.

  • Thomas Hemming Larsen

    Awesome post Bill! So simple, yet so insightful.
    I think this is spot on when someone is saying that keto should be the default diet for anyone. I’ll refrain from making a long post to bore everyone. Good stuff!

  • This Old Housewife

    some people have: 1) impaired glucose tolerance (but normal fasting glucose); 2) others have impaired fasting glucose (but normal glucose tolerance); and 3) others have both.

    Could it be that different parts of the pancreas are malfunctioning? This can occur (at least in cats)–one end responsible for classic diabetes, while the other end is responsible for digestive disorders.

    Even though the organ(s) theoretically have only one function, it just might be that they’re really a whole system wrapped up in an organ, and when part of that system fails (but not the whole organ), you’re going to get weird stuff happening like what’s listed above.

    I’m just spit-balling from a Cat Mommy/Nurse point of view. From a diabetic spouse point of view, I’d have to look at nutritional deficiencies–a lack of sufficient biotin is our latest discovery. Even though biotin is supposed to be B-7, there’s no RDA, no way to test for deficiencies, nor is it included in most B complex formulas. Yes, you can get it from food, but what happens when there’s food allergies involved, or the food is not liked by the person deficient?

    Other than nuts, Hubby is up against this very problem. Due to the Omega-6 problem, I don’t let him eat his fill with nuts, and have chosen to supplement instead until we figure out what dose he needs. I’m also on the lookout for a B complex that includes biotin (B-7) as well as inositol (B-8)–a missing ingredient for the person with off-the-chart LDL-P (it help metabolise cholesterol). Once again, we’re up against food issues here, a lack of an RDA, and lack of testing for deficiencies for both substances.

    I imagine a whole host of diabetics are running around here with deficiencies of the same nature, and if they were/could be diagnosed and diet re-directed, there would be a huge implosion in the sales of statins and insulin. If only Hubby would eat avocados! Oh well…

  • Great stuff @DrLagakos:disqus.

    We see lots of overweight, metabolically normal, euglycemic and weight loss resistant women in our office. Calorie restriction and appetite control are most important as you say, not KETO. Do you think there’s and optimal macro-nutrient mix for them?

    Also, Dr. Kraft notes that he did found euglycemic and euinsulinemic individuals. Still the majority of subjects > 70% had hyperinsulinemia.

    And, there is “one ring to rule them all” but only if your from the land of Mordor (insulin resistance). Call me a Zealot but when the ring smells of Mt. Doom…

    • “Do you think there’s and optimal macro-nutrient mix for them?”

      it’s possible, but figuring it out will be a case-by-case thing… eg, which intervention works with this person’s lifestyle, tastes, etc.

      it’s also possible that their weight problem isn’t due to diet or “macro’s” per se, but other things going on in their life.

  • Jack Kruse

    You can’t out supplement, out hack, out exercise, or out eat a bad environment………that is the story of the ubiquitin marking of proteins. It’s nature’s axiomatic rules of engagement. So until that time you, the patient, athlete, or the clinician must realize that the patient is trading wellness for time………..Many people have mentioned Jimmy Moore. I wrote an entire blog about his real problem, his environment and not his diet. It is never about food.

    There is no set point for metabolism; too many patients and clinicians however, believe otherwise and this is why diet is their first tool to engage. Metabolism is on a sliding scale of natural selection built into ubiquitin. Ubiquitin is the interaction of light with nitrogen in proteins.. Its boundaries are limited only by the how we account for and assimilate and contain the photons and electrons from our environment. Set points are creations of concrete reductive minds. That is not the work of evolutionary biology nor is it following nature’s law’s.

    If you believe the nonsense about food and metabolism ask yourself this: At what age do you hit your set point? The concept is vacuous. It confuses negative and positive feedback loops with an attempt to attain a steady-state outcome. I spoke about this in webinars and in the ubiquitin series at length. Jimmy’s issue is in Ubiquitination 6. Loss of negative feedback is deadly in a far from equilibrium state, why? In that scenario when control is lost both prey and predator die. In a non-linear system, there may be no equilibria or there may be many. Either one is possible. That makes it fundamentally quantum because many possibilities exist simultaneously. Possibilities exists until the waveform is collapsed by the environment you allow. I think the 900 pound plus people we have in the USA and OZ have gone into a zone of the non-linear dynamics where the negative feedback loops in our cells ceases to limit fat mass as a protective mechanism of a toxic environment to our surface chemistry.

  • My impression from Kraft’s book is that he sees a linear progression from health to IR to diabetes, without acknowledging the possibility of multiple distinct pathways, eg, some that pass through IFG and others that don’t.

    • Hey Bill…I think in fairness that Kraft is a mechanistic, mathematical and clinical core-issue guy – regardless of sub-paths via the glucose abnormalities, the end game is hyperinsulinemia/diabetes in situ – that’s where the pathology lies. You either have this ultimate unambiguous condition (and the associated nasty pathology) or you don’t. Glucose-centric metrics won’t give diagnosis. His actually will. He suggested lowering carb as an effective method to back off from diabetes in situ physiology, but it was not the only strategy and in fact he never really pushed it even – exercise and losing weight was his broad brush approach (he admits in the interview that he never had the courage to be prescriptive on the dietary stuff – he says that there is far too much insanity out there in this field to even get involved). Interestingly, he left all of his low-carb patient data out of the book, in spite of the shocking effectiveness it demonstrates (and I mean shocking – pattern II-IV collapsed away to euinsulinemia in a few months). Btw he is an utter gentleman in the flesh, and a brilliant mind for analysis and problem solving – we need more of him !

  • weilasmith

    has anyone heard of this guy cosmo and his site infinome? i’m considering linking my 23andme data to his site, but i am trying to see if he is the real deal or not.

  • Hey Bill, great post – only thing not sure of is ‘Kraft missing the nuances’ – I think in fairness it might be better to phrase it as ‘he had no interest in pursuing them’. Interviewed him last week and he explained his lack of interest in the glucose metrics – because the big disease game for him was the hyperinsulinemic pattern that betrays ‘diabetes in situ’ (which is actual diabetes – the occult nature due to inadequacy of current measures doesn’t affect the actual diagnosis). So whatever about losing weight etc., the big game for him is the pathology and early death that results. For him the weight gain was a purely cosmetic issue in a sense – all that matters is the pathology of vascular degeneration, which steals away ones life (it doesn’t respect how one looks in the mirror….! 🙂

    • Thanks, Ivor!
      Imho, the optimal intervention may differ for IFG, IGT, and CGI. Sadly, no one is looking into this and most barely look beyond carbs. LC is admittedly effective in many cases, but may not be the best or even easiest answer.

      and yeah, the vascular complications are obviously more important than ‘cosmetics’

      P.S. still looking forward to this interview!

      • Nothing to Imho to really I think, as Kraft hardly mentioned carb restriction at all in his book (even though he had truly dramatic results with it). Exercise and losing weight was his broad brush approach in public comments (he admits in the interview that he never had the courage to be prescriptive on the dietary stuff – he says that there is far too much insanity out there in this field to even get involved!). This is impressive given the shocking effectiveness it can demonstrate (and I mean shocking – pattern II-IV collapsed away to euinsulinemia in a few months – saucy stuff).
        At the end of the day Kraft is a mechanistic, mathematical and clinical core-issue guy – regardless of sub-paths via the glucose abnormalities, the end game is hyperinsulinemia/diabetes in situ – that’s where the pathology lies. You either have this ultimate unambiguous condition (and the associated nasty pathology) or you don’t – whatever about your ability to fit into a tight pair of jeans 🙂 Interesting though they are for the sub-causes, glucose-centric metrics sadly don’t give accurate diagnosis of the crucial pathological state, though as you pointed out they will indicate where you might target your strategy – I know that bad sleep and other factors push me towards hardcore IF to keep the weight off (can’t fix the sleep issue due to work overload, so have to deploy IF in response!).
        Btw he is an utter gentleman in the flesh, and a brilliant mind for analysis and problem solving – we need more of him !

  • P.S. all the way! good post!

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