Tag Archives: sugar

The carb/insulin model of obesity was tested again, and it fared better this time.

Effects of a low carbohydrate diet on energy expenditure during weight loss maintenance: randomized trial (Ebbeling et al., 2018)

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This is another NuSi study designed to evaluate certain aspects of the carb/insulin model of obesity. Understanding the design of this study is critical to being able to properly evaluate the results.

Very important:

 

1. All food was provided, all the diets were healthy, and most people complied.

2. This was a very expensive study. They used great methods.

Study design: during the “Run-in diet,” everyone followed the same diet (C/F/P: 45%/30%/25%) at 40% caloric restriction in order to lose about 10% of their initial body weight.

Importantly, insulin sensitivity was assessed and this may have influenced what happened next, in the weight maintenance phase. I used to put a lot of weight on this theory — eg, the top 25% most insulin sensitive people will do better on low fat whereas the bottom 25% insulin sensitive people (the most insulin resistant, ie) will do better on low carb — this theory has fared better or worse depending on which study you look at. In this study, it did pretty well.

 

 

In the end, we had 38 people in the entering into the high carb arm of the weight maintenance phase and 43 on low carb.

Remember, they all lost weight on the same diet. Now they’re being fed enough to maintain body weight (low carb, moderate carb, or high carb) and we’re measuring things.

Really exciting stuff!

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Allu-lujah: the new Quest Hero bars

On that sweetener in the new Quest Hero bars: allulose (formerly known as D-Psicose).

1. I’m sure they were quick to adopt the alternate nomenclature because it’s hard not so say Piss-cose lol

2. Nutrition-wise, Hero bars are basically Quest Lite. A bit less fibre. But I really think they’re getting much better at texture.

3. On to allulose. It’s not really like sugar – even though the FDA says it must be labeled as such – because it carries virtually no calories and actually blunts the blood glucose spike from a meal.

 

Exhibit A. n=20 healthy peole: 7.5 g D-psicose alone, 75 g maltodextrin alone, 75 g maltodextrin + 2.5, 5, or 7.5 g D-psicose (Iida et al., 2008)

amazeballs

 

 

 

 

 

Exhibit B. n=26, zero or 5g psicose with a standardized meal (Hayashi et al., 2010). Note: there are ~12 grams of allulose in a Hero bar.

It works better in diabetics.

 

 

They did a 12-week study where psicose was dosed 3 times a day, 5 grams each time, and showed it was perfectly healthy. Some markers even improved.

 

Exhibit C. Psicose metabolism (Iida et al., 2010)

In doses ranging from 5 to 30 grams, up to 70% is excreted intact and the rest does not go to farts.

It’s virtually calorie-free:

 

 

and is barely fermentable (compared to FOS):

 

 

compare to other low carb protein bars here, get the new Quest bars here, or just buy some straight allulose and experiment with it!

Mechanisms? 1) it’s not sugar, but it still enhances glucose disposal; and 2) some animal studies show it enhances liver glucose uptake. Idk.

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The DietFits Study

Preliminary results from Chris Gardner’s follow-up to this study suggest insulin resistance may not be as big an influence on the success of LC/LF diets as prior studies have shown.  Maybe I was wrong.

We aren’t given many details in the abstract or interviews, and there are still some good studies showing otherwise (eg, those by Cornier, Pittas, Ebbeling, and Gardner himself), although this one is bigger (n = 609) and longer (1 year).  However, the range of weight change was huge, something like +20 lbs to -80 lbs, so the devil might be in the details… time will tell.  Might be subtle yet important changes in body comp or other metabolic indicators.

If it turns out to be true, my best guess: they were all following Hunger-Free Diet(s)… which work regardless of whether low fat or low carb.

 

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The Hunger-Free Diet(s)

It started out as “lose weight without hunger on LCHF” and went all the way to “effortless fasting on keto.”  Works for some and it might be true, but the same can be said for low fat diets!  The key, I think, in both contexts, is simple: fewer processed & refined foods… something the Paleo movement got right, imo (although I still think many low-calorie sweeteners are way less unhealthy than HFCS & sugar).

The logic:

1) add “good calories” like almonds to your diet and appetite spontaneously compensates by eating less other stuff: energy neutral

2) you don’t compensate for added “bad calories” like sugar-sweetened beverages: positive energy balance

3) remove bad calories from your diet and you don’t compensate by eating more other stuff: negative energy balance

 

Book: Good Calories, Bad Calories

 

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Keto myths & facts

:::begin rant:::

Trigger warning?  Maybe.

Disclaimer: I’m pro-LC (P<0.05), but not anti-LF because LF works better than LC for some people.  And with the exception of things like keto for neurological issues, I think macros take a back seat to many other factors.

Myths: carbs cause insulin resistance (IR), diabetes, and metabolic syndrome.  Carbs are intrinsically pathogenic.  If a healthy person eats carbs, eventually they’ll get sick.

And the only prescription is more keto.

 

cowbell

 

And of course all of this could’ve been prevented if they keto’d from the get-go.

Proponents of these myths are referring to regular food carbs, not limited to things like Oreo Coolattas (which would be more acceptable, imo).  Taubes, Lustig, Attia, and many others have backed away from their anti-carb positions, yet the new brigade proceeds and has even upped the ante to include starvation.  Because “LC = effortless fasting?”

Does this sound sane?

“No carbs ever,
no food often…
otherwise diabetes.”

 

 

oreo-coolatta

 

no one in their right mind would say lentils & beans cause diabetes

 

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Ketones, carbs, and physical performance.

Or more specifically, ketone monoesters and carbs.  Literally, this study was a high-dose ketone monoester supp sans caloric or carb restriction.  I know, weird right?

 

Ketone ester

 

Non sequiter nutrition notes, #context, etc.:

1) ketone esters =/= ketone salts.  Ketone salts are either sodium or potassium-dominant.  Ketone esters are essentially salt-free.  Possibly helpful background reading here.

2) nutritional ketosis =/= starvation ketosis =/= ketone supp ketosis.  Because #context.

Starvation ketosis, but not nutritional ketosis, is muscle-sparing.  Ketone supps sans carb restriction might be.

3) the theory of ketone supps for sport is: 1) ketones are an energetically favorable fuel; and 2) they’ll spare glycogen, theoretically allowing prolonged duration of moderate-to-high intensity performance.  Adding in carbs will likely further this.

4) I have no studies to support this, but the idea of ketone supps in the #context of high carb doesn’t sit will with me.  Seems like high levels of both substrates = mitochondrial overload and oxidative stress.  Maybe.

5) there’s a gradient of fuel use during exercise:

-explosive power: creatine, anaerobic

-high intensity: glycogen, anaerobic

-low intensity: fatty acid oxidation, aerobic

But it’s a gradient with a lot of overlap, and ketoadaptation further blurs the lines.

 

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the insulin-obesity hypothesis is under attack

…but it isn’t dead, imo, because that would be really hard to do.  Like, seriously.

 

 

side note: please consider the modern views of Taubes, Lustig, Gardner, Attia, and others on Carbs™.  They’re less “Carbs-cause-obesity, keto-for-all, etc.,” and more thinking it might not be Carbs™ per se, but rather processed and refined foods.  And #context…  And I tend to agree at the moment (nuances and caveats are subject to change, as more evidence accumulates).

 

disclaimer: I haven’t seen the full text of Hall’s recent study, but that’s not really relevant to what I want to discuss.  In other words, I don’t think the full text will provide any additional details on this particular point.

 




 

Tl;dr: this study was not designed to prove or disprove metabolic advantage or the insulin-obesity hypothesis.

It’s in the study design:  four weeks of low fat followed by four weeks of low carb.  We KNOW that weight loss slows over time (especially if calories are controlled, as they were in this study).  It has to do with the order of treatments.

Weight loss-slowing over time in the Minnesota Experiment:

 

 

Minn-Starvation-weight

 

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Insulin resistance is a spectrum

The history of low fat diets is riddled with crappy low fat food-like products.

Food quality matters.

Free full article on Patreon! <- link

Take a group of obese people and assess insulin sensitivity however you like: some researchers demand nothing less than a hyperinsulinemic-euglycemic clamp (Gold Standard), others are OK with insulin levels during an oral glucose tolerance test.

Next, divide the people up based on this — there are a few ways you can do it.  You can: take the top half vs. the bottom half (a method which includes everyone); take the top third vs. bottom third (excluding the middle third); take the top quarter vs. bottom quarter (excluding the middle 50%), etc.

THIS MATTERS because in referencing this topic, many people claim most obese are insulin resistant.  They may be more insulin resistant than lean people, but even within obese people, there’s a spectrum, and the spectrum matters in this #context.

 

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The “Insulin Index”

Similar to the glycemic index, which is an estimate of the rise in blood glucose after eating a particular food, the insulin index is an estimate of the rise in insulin after eating a particular food.  In general, these indices are obvious: processed carbs have high glycemic and insulin indices, whereas whole foods are lower.  Some exceptions are things like dairy and lean meat, which induce more insulin than you’d expect given to their low carbohydrate content…

STORY TIME

When some protein-rich foods were discovered to induce insulin secretion, people thought this information might help type 1 diabetics more accurately calculate their insulin dose.  Interesting rationale, worth testing.

Tl;dr: it didn’t work very well.

More of the protein-derived amino acids may have been incorporated into lean tissue, but the extra insulin load ended up causing hypoglycemia more often than not.  Hypoglycemia is acutely more harmful than hyperglycemia, and is still quite harmful in the long-term.  Some studies on incorporating the insulin index for type 1 diabetics are mixed, ie, increased or no change in risk of hypoglycemia, but no studies show it reduces the risk.

 

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Saturated fat, cholesterol, and carbohydrates

“You catch more flies with honey…”

^^^good policy in general, but especially for debating in the realm of nutritional sciences.

 

A short while back, Nina Teicholz discussed low carb ketogenic diets and plant-based diets with John Mackey.  Although I disagree with the dichotomy (keto vs. plant-based), it’s well-worth a watch:

 

 

Three topics that could not be avoided in such a discussion: saturated fat, cholesterol, and carbohydrates.

 

 

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