Category Archives: insulin

Insulin vs. fat metabolism FTW

Insulin is there to grow fat tissue for the obesity epidemic, not replenish glycogen after yoga.

Teaser: insulin-induce hypoglycemia can get deadly quite fast, and there is no equivalent for the effects of insulin on fat.  However, the effects of insulin on fat are 100 times more powerful.

Background: Hormone sensitive lipase (HSL) responds to insulin by inhibiting lipolysis.  It halts fat burning.  It got its name because it’s THEE most hormone-sensitive lipase in the body.  The hormone about which we are speaking is of course insulin.  And the enzyme, or at least one of the enzymes as it were, is HSL.  To be clear, it takes very little insulin to inhibit HSL.  Just a dollop, in fact.

Effect of very small concentrations of insulin on forearm metabolism.  Persistence of its action on potassium and free fatty acids without its effect on glucose.   (Zierler and Rabinowitz, 1964)

Expt 1.  Since we’re all about jabbing people with insulin lately, let’s get at it again.  Jab someone with about 100 uU (/min*kg), and muscle and fat vacuum glucose out of the blood.  Same goes for potassium; and adipose gets all stingy too… it stops releasing and starts storing fat.  This is “healthy,” and its part of why people say insulin, and by extension carbohydrate, causes lean people grow fat tissue.

What do you think would happen in an insulin resistant obese crowd.  Less glucose vacuuming, but scrooge adipose will still responds with gravitas, by saving more and spending less?  Likely.  HSL is like the little piggy’s straw house.  The strong young wolf can blow it down.  The COPD emphysema wolf can blow it down…  because it’s made of straw.


Thus, insulin causes lean people to grow fat tissue, and it causes obese people to grow more fat tissue.

In other words, with regard to common obesity, being resistant to insulin means postprandial hyperglycemia; you can’t handle sugars proper.  but it’ll still make you fat(ter).

Expt 2. The interesting part.  Try jabbing healthy people with 10x less insulin.  Looks like IR obesity!  Adipose gets stingy, potassium scrams, but no effect on glucose uptake.

In the figure below: A-DV is muscle; A-SV is adipose.  Glucose uptake into fat & muscle is unaffected by a low dose of insulin.glucose on 10uU

Second figure: with the same dose, adipose goes on a budget SAVE MORE SPEND LESSFAs on 10 uU

Conclusion.  In a healthy person, (eg, healthy person), even very low doses of insulin cause fat growth.  This isn’t an issue of high vs. low glycemic issue.  The insulin dose used in this study was less than that expected from a respectable low glycemic index meal.  This is probably why the glycemic index hasn’t cured the obesity epidemic.  On the other hand, dietary fat doesn’t stimulate insulin…  just sayin’

Furthermore, perhaps glucose uptake into adipose promotes fat storage under certain conditions, but it’s clearly neither necessary nor essential.  Insulin can Miracle Grow fat mass without affecting glucose uptake one iota.  I imagine the abundance of 3C precursors simply isn’t “the limiting factor.”  And it works just as good with Whole Foods Low GI pa$ta and Wonderbread.buttressed

Translation: insulin buttresses fat growth.  and it doesn’t matter how much.  FYI this probably seems nonsensical at first: carbs stimulate insulin in order to dispose of said carbs, like a logical feedback mechanism.  Perhaps.  But said insulin cares far more about fat than said carbs.  On a scale of 1 to 10 (ie, putting things into “perspective”): insulin is there to grow fat tissue for the obesity epidemic, not replenish glycogen after yoga.

 

 

Part II.

Dose-dependent effect of insulin on plasma free fatty acid turnover and oxidation in humans (Bonadonna et al., 1990)

There are a lot of data in this paper, but here are the relevant points:

Infuse insulin at various rates.  In the lowest infusion rate, the only aspect of glucose metabolism to respond is hepatic glucose production (second line; HGP declines from 2.0 to 1.34 at the lowest dose):glc turnover

WRT low dose insulin on glucose metabolism: liver responds, not skeletal muscle.  Skeletal muscle doesn’t even look at glucose until insulin infusion reaches 250 – 500 uU, which is probably why back in ’64 they saw absolutely no effect at 10 uU.  At 100 uU they saw an effect, but according to these data, it was likely due solely to liver, because skeletal muscle doesn’t seem to care until levels exceed 250 uU (it’s an infusion rate, not an absolute concentration.  But that’s neither here nor there).  To be clear, 10 uU insulin infusion doesn’t affect glucose metabolism (1964).  period.  100 uU modestly affects it (1964), and this is probably so modest because only liver is helping out (1990).  At 500 uU, full scale attack on blood glucose.

But fatty acids are obliterated with 5 – 50 x less:FA turnover

It worked with 10 uU in ’64, and it worked just as well with 100 uU in ’90.  (FYI the first paper was published in 1964; this one in 1990).

Furthermore, in the table above glucose metabolism was progressively affected with increasing insulin concentrations.  Not so much with FAs:FA suppression

FA flux is rapidly and completely shut down with a dollop of insulin.  Indeed, it is obliterated.  Giving more insulin doesn’t do anything, because, well, when you blow down a straw house, it tends to stay down.

 

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40 years ago a group of researchers turned ketosis into poetry.

But first, a brief primer.  In red.

“The glucose muscle-sparing effect of fat-derived fuels” 

or, the Randle Cycle 2.0.  it’s like a course in life enhancement.

Part I.  Intermediary metabolism

The glucose-fatty acid cycle
The Randle Cycle, as originally proposed, states that fatty acid oxidation inhibits glucose oxidation.  This is good because during starvation, every tissue than can survive on fatty acids instead of glucose should do so, sparing as much precious glucose as possible for the brain.

The glucose-sparing effect of fat-derived fuels
A critical vital horcrux to this is in the oh-so-humbly-disguised phrase “fat-derived fuels.”  The fat-derived fuels are ketones, and they are rescuing the brain from starvation (ie, neuroglycopenia); they do so by supplementing glucose as a fuel source.  Ketones are good at this; many tissues are happy to oxidize ketones when they are available.

The glucose muscle-sparing effect of fat-derived fuels
Ketones are derived from fat.  During prolonged starvation, glucose comes from skeletal muscle amino acids (eg, alanine).  Ketones spare glucose.  Thus, ketones spare muscle.  QED.

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obesity sans overeating :(

As stated in the Laws of Energy Balance, you can get fat without eating more, and unfortunately there are about a thousand different ways to do so.  Here is yet another:

Long-term, intermittent, insulin-induced hypoglycemia produces marked obesity without hyperphagia or insulin resistance: a model for weight gain with intensive insulin therapy (McNay et al., 2012)

While it has a lot in common with fat gain diet-induced insulinemia and diabetic insulin therapy, this isn’t the greatest “model for weight gain with intensive insulin therapy.”  But it’s an interesting one nonetheless.

chocolate peppermint doughnuts

In this model, normal rats are fed the standard fare, but once weekly get jabbed  with 10 U/kg insulin; enough to drop glucose to ~35 mg/dL (seriously hypoglycemic).  Yes, this is an insulin spike, but not like the ones we normally see – usually, carbs cause the insulin spike but also provide the glucose necessary to prevent hypoglycemia.  These rats weren’t so lucky.

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Biohacking holiday weight gain

What should you eat before the big feast?  (hint: eggs.)  And don’t try to compensate in advance by eating less, this will only make you hungrier.  Furthermore, foods in your regular diet are probably healthier than holiday fare, so you definitely don’t want to eat fewer healthy foods to make room for empty calories.

Tip 1. 

Variation in the effects of three different breakfast meals on subjective satiety and subsequent intake of energy at lunch and evening meal (Fallaize et al., 2012)

Participants were served only one of these for breakfast:

And given unlimited amounts of these for lunch and dinner:

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Philosophy of the faux-low carb mouse and others like it

The Laws of Energy Balance are always maintained.  Here are some insights into how this is accomplished from a mouse perspective.  A hormonal milieu which is unfriendly for fat storage will make you lean, but not by magic.  We’ve got: 1) reduced food intake; and/or 2) increased energy expenditure.

Recall the faux-low carb mouse (Ins1+/-; Ins2-/- aka InsKO; Mehran et al., 2012).  They can’t get fat because of an inability to develop hyperinsulinemia.  Food intake isn’t reduced, so energy expenditure goes up.  Since the fat isn’t stored, it needs an “out,” so it either inhibits food intake or ramps up energy expenditure; InsKO gives us the latter.

While not hormonally-mediated, PPARg+/- mice can’t get fat because of defective adipogenesis and they handle this problem both ways; by reducing food intake and increasing energy expenditure (Kubota et al., 1999).  Similar to InsKO, PPARg+/- have lower insulin, but the primary defect in these mice is defective adipogenesis.  They can’t store fat, so this unstored fat: 1) tells the brain there’s plenty of fuel around so stop eating; and 2) ramps up energy expenditure to burn itself off:

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The faux-low carb mouse and a diatribe

The faux-low carb mouse

Hyperinsulinemia drives diet-induced obesity blah blah blah (Mehran et al., 2012)

The researchers generated a mouse with half as much insulin as normal mice.  Physiological insulin levels remain intact, but hyperinsulinemia is genetically inhibited.  For the sake of simplicity, we’ll call them “InsKO.”

When fed a high fat diet, normal mice become markedly hyperinsulinemic (pink line) whereas InsKO mice maintain relatively normal insulin levels (red line).  Blue lines are chow-fed mice; similar trend but less interesting.

divide and conquer

InsKO mice don’t get fat,

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Sir Philip Randle and the effects of blocking fat oxidation

The Randle Cycle, put forth in 1963, dictates that increased fatty acid oxidation inhibits glucose uptake and increased glucose oxidation inhibits fatty acid oxidation – it just makes sense.  Insulin enhances glucose uptake and oxidation while suppressing lipolysis; growth hormone, cortisol, and adrenaline enhance lipolysis and fatty acid oxidation which suppresses glucose oxidation.  Low carbohydrate diets reduce insulin, and the reduced glucose oxidation is metabolically irrelevant because of reduced glucose intake (by definition).  This is critical information.  And as a student of basic intermediary metabolism, I prefer the Randle Cycle over any number of alphabet soup recipes to explain metabolic phenotypes (eg, fat and carbs as opposed to IRS, Akt, Jnk, ERK, etc., etc.).  Many valuable lessons can be learned from understanding permutations of the Randle Cycle.

For example,

Inhibition of carnitine palmitoyltransferase-1 activity alleviates insulin resistance in diet-induced obese mice (Keung et al., 2012)

divide and conquer

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Exenatide and tapeworms, Op. 116

The great Dr. Schoeller can polish a turd like no other.  Dale Schoeller’s claim to fame is his extensive work on one of the best ways to measure total energy expenditure in free-living individuals: doubly-labeled water.  In doubly-labeled water, subjects drink stable isotope-labeled water; instead of hydrogen + oxygen = H20, the stable isotope-labeled water is deuterium + oxygen-18 = D218O.  Deuterium is excreted just like hydrogen, in water as urine & sweat.  Oxygen-18 is excreted just like oxygen, in water and carbon dioxide.  So the subjects lose deuterium & oxygen-18 in water at equal rates, but only oxygen-18 in carbon dioxide; so this technique basically measures carbon dioxide production, which is proportional to energy expenditure.  Clever. 

Being that Schoeller practically invented the technique, his interpretation of these total energy expenditure data are not flawed, but that’s not where he went astray.

Alterations in energy balance following exenatide administration (Bradley et al., 2012)

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“An adult conversation” about the Look AHEAD study

Extra! Extra!    Read all about it!  (after you sign up for the new EMAIL NOTIFICATIONS on the right)

Moderate weight loss alone doesn’t lower heart disease risk in diabetics, study shows
Diabetes study ends early with a surprising result
NIH trial of lifestyle intervention for type 2 diabetes stopped for futility after 11 years

Notice none of the headlines read “Low fat diet is not heart-healthy for diabetics,” but that’s exactly what the latest epic fail demonstrated.  Reminiscent of the Women’s Health Initiative (circa 2006), the Look Ahead study tested a long-term low fat diet in diabetics.  If a protective effect had been shown, this study would’ve gone done in the history books as definitive proof that a low fat diet is superior.  But it wasn’t, and unfortunately that probably won’t count as anything for the opposition.  In brief, the planned 14 year study was stopped after 11.5 years because cardiovascular events weren’t lowered by the low fat diet (and might even have been increased; the manuscript hasn’t been published [yet?]).

The Women’s Health Initiative, which cost taxpayers something in the ballpark of $625,000,000 (six hundred twenty five million dollars > a half billion), showed that reducing dietary fat by 8 percentage points (from 37.8% to 28.8%; a 23.8% reduction) for 8 years had no effect on heart health and was even detrimental for people with CVD at baseline.  I repeat: CVD patients assigned to the low fat dietary intervention experienced more cardiovascular events than those in the control group (you heard it here first).  But for some reason, the Look AHEAD researchers thought they might get a different result if they tried this in diabetics?  A low fat high carb diet in patients with bona fide carbohydrate intolerance?  really?

REALLY?

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Metabolic rate per se

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Admittedly, the effect of diet on metabolic rate is small (i.e. statistically non-significant in most cases), but its incredible consistency across space and time suggest it could be true.  And given the difficulty of maintaining a reduced body weight after dieting, it might even be important.  The following studies are examples of widely differing subject populations in various metabolic conditions; yet the effects of diet on metabolic rate exhibit a phenomenal degree of similarity.

disclaimer: I don’t know what’s more important – metabolic rate per se, the diet behind it, or the resulting hormonal adaptations.  All of the diets that are associated with a higher metabolic rate are also predicted to result in lower insulin levels and higher fat oxidation.  Thus, we are left with a triumvirate of diet, hormonal milieu, and energy expenditure… all of which are important for body composition and quality of life.

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