Does Fat in a Diet Increase Insulin Resistance?

A study answered that question (Dietary Fat and Carbohydrates Differentially Alter Insulin Sensitivity During Caloric Restriction).

The subjects were:

Twenty-two obese subjects (body mass index, 36.5 ± 0.8 kg/m2) were randomized to an High Carbohydrate (>180 g/day) or Low Carbohydrate (<50 g/day) energy-deficit diet. A euglycemic-hyperinsulinemic clamp, muscle biopsy specimens, and magnetic resonance spectroscopy were used to determine insulin action, cellular insulin signaling, and intrahepatic triglyceride (IHTG) content before, after 48 hours, and after ∼11 weeks (7% weight loss) of diet therapy.

They found:

Our results refute our original hypothesis that an LC diet will cause insulin resistance because of increased adipose tissue lipolytic rates and excessive free fatty acid release into the bloodstream. In fact, we found that LC intake rapidly caused a greater reduction in IHTG content, improvement in hepatic insulin sensitivity, and decrease in endogenous glucose production rate than consumption of an isocaloric low-fat diet.

 

Effects of Eating Protein

From (The Truth About Protein Absorption: How Often You Should Eat Protein to Build Muscle):

When you eat protein, your stomach uses its acid and enzymes to break it down into its building blocks, amino acids. These molecules are transported into the bloodstream by special cells that line the small intestine, and are then delivered to various parts of the body. Your small intestine only has so many transporter cells, which limits the amount of amino acids that can be infused into your blood every hour.

The article goes on to say that different proteins sources are absorbed at different rates.

According to one review, whey clocks in at 8 to 10 grams absorbed per hour, casein at ~6.1 g/hr, soy at ~3.9 g/hr, and cooked egg at ~2.9 g/hr.

Here’s a really interesting point that I didn’t know about:

For instance, the presence of protein in the stomach stimulates the production of a hormone that delays “gastric emptying” (the emptying of the food from the stomach). This slows down intestinal contractions and thus how quickly the food moves through the small intestine, where nutrients are absorbed. This is one of the ways your body “buys the time” it needs to absorb the protein you eat.

That seems to be the mechanism by which protein gets processed by the body. That’s how the area under the curve for protein is so long.

The article goes on to say that:

Carbohydrates and fats can move through your small intestine and be fully absorbed while the protein is still being worked on.

The page then quoted a study (Protein feeding pattern does not affect protein retention in young women) which indicated that it doesn’t matter if the protein is consumed all at one time (Intermittent Fasting style) or over the course of the entire day.

It was higher during the experimental period, but not significantly different in the women fed the spread or the pulse patterns [59 +/- 12 and 36 +/- 8 mg N/(kg fat-free mass. d) respectively]. No significant effects of the protein feeding pattern were detected on either whole-body protein turnover [5.5 +/- 0.2 vs. 6.1 +/- 0.3 g protein/(kg fat-free mass. d) for spread and pulse pattern, respectively] or whole-body protein synthesis and protein breakdown. Thus, in young women, these protein feeding patterns did not have significantly different effects on protein retention.

Interesting…

 

Keto Calculator – Macronutrients

How many macronutrients do you need to do LCHF? There’s an on-line Keto Calculator.

KetoCalc

It projects your rate of weight loss based on the values you selected. You can even download this data as a CSV (EXCEL) file.

Here’s my daily macronutrient goals (yours will vary):

KetoCalc-Numbers

I have been shooting for a higher percentage from fat due to my Diabetes. I am too good at converting protein into glucose.

 

Caloric Restriction vs Intermittent Fasting

A 2011 Meta-Analysis (Intermittent versus daily calorie restriction: which diet regimen is more effective for weight loss?) looked at the difference between calorie restriction and Intermittent Fasting. The study looked at 18 trials and examined the results across each of them. 11 of the trials were for Caloric Restriction alone and 7 were for Intermittent Fasting.

The study termed both diets as Calorie Restriction because they both result in less net calories. The fast day wasn’t an actual fast, but a caloric restriction to 25% of a normal day. The difference is on the feed day the subjects could eat whatever they wanted to eat.

The conclusion was interesting.

In sum, intermittent CR and daily CR diets appear to be equally as effective in decreasing body weight, fat mass, and potentially, visceral fat mass. However, intermittent restriction regimens may be superior to daily restriction regimens in that they help conserve lean mass at the expense of fat mass. These findings add to the growing body of evidence showing that intermittent CR may be implemented as another viable option for weight loss in overweight and obese populations.

Another great result for Intermittent Fasting!

I know as a dieter which I would prefer. If you told me I had to diet every other day and could eat what I want on the other day and that I would do just as well as if I had dieted every day that doesn’t sound like a hard choice at all.

Another study reached similar conclusions (Short-term modified alternate-day fasting: a novel dietary strategy for weight loss and cardioprotection in obese adults).

Here’s a third study on Alternate Day Fasting (The effects of modified alternate-day fasting diet on weight loss and CAD risk factors in overweight and obese women).

 

Dietary Control Blood Sugar via Counting Calories

The Mayo Clinic site we saw earlier recommends counting calories as a way of preventing weight gain when taking Insulin. Sounds good in theory. After all energy out has to match energy in. If you take in more energy than you put out you gain weight. If you take in less energy than you put out then you lose weight.

The only problem is that it is much, much more complicated than that. Here’s what I see as both sides of the question.

Positive Side of Counting Calories

  • Can be reduced to simpler terms, like exchanges.
  • Can eat until we reach our calorie limit and then stop for the day. This produces an extended fasting time which is good.
  • Being aware if how much we eat by logging can show we are eating a lot more calories than we think we are.

Negative Side of Counting Calories

  • Calories don’t take into account the type of calories consumed and their impact on blood sugar control. A packet of white sugar and a piece of lean chicken breast could have the same number of calories but a completely different response in a T2D. We don’t process them at the same rates (previous BLOG post on this).
  • As an example of the type of calories mattering a controlled study was performed which showed the higher protein and lower carbs group had improved insulin sensitivity and cardiometabolic profile in overweight women. So if the advice is to count calories with the goal of restricting calories then the type of calories need to be considered as very important.
  • The type of calories consumed also affected the bounce back after the diet (Study here: Diets with high or low protein content and glycemic index for weight-loss maintenance). Bottom line is higher protein is better.
  • Counting calories is the standard weight watchers approach and thousands of other companies which want to sell you books and meal plans. It doesn’t work in the long run except for getting repeat customers.
  • My own experience is that I still pick up stuff I buy and look at the labels to see what is in them. I don’t eat bread very often and stay away from most carbs and still have way too much weight.
  • Most of the people I know comment on how I never eat. It’s not like I am secretly binging either. I have been on many restricted calorie diets.
  • The Biggest Loser show does the most extreme intervention of restricted calories and exercise possible and many/most of the people gained the weight back. The ones that only had a modest gain were those who worked as trainers.
  • The biggest problem is the reduction in our metabolism that inevitably happens with a restricted calorie diet. This is a long term effect. That is my problem personally and with this sort of diet. In the case of the Biggest Loser show the study concluded:

By the finale, all their metabolisms had significantly slowed down due to the weight loss from diet and exercise routines, and their bodies were not burning enough calories each day to maintain their thinner frames. This was not a surprise to scientists, because studies have previously found that everyone’s metabolism slows down after a diet. But it was shocking that over the next several years, their metabolisms did not recover and return to the normal rate for a person of their size. Instead, their metabolisms became even slower, which caused the pounds to pack back on.

That is the key and the problem with the counting calories form of dieting. Sure you can lose weight but your metabolism drops.

The advice I give my own children is to not go on a diet to lose. Weight. They will gain the weight back and then more when they permanently alter their metabolism.

Insulin and weight gain

The connection between insulin and weight gain is well understood and acknowledged. From the Mayo Clinic website.

When you take insulin, glucose is able to enter your cells, and glucose levels in your blood drop. This is the desired therapeutic goal. But if you take in more calories than you need to maintain a healthy weight — given your level of activity — your cells will get more glucose than they need. Glucose that your cells don’t use accumulates as fat.

So what is their advice for avoiding this situation? Summarized as

  1. Count Calories
  2. Don’t skip meals
  3. Get aerobic activity
  4. See your doctor about getting on [more] medications
  5. Don’t skip taking your insulin

They pulled out the old tried-and-believed-to-be-true words. That don’t work at all. Nothing makes you feel deprived more than counting your calories. Skipping meals allows your insulin levels to drop. Exercise sounds good in theory but rarely ever gets put into practice. Get more meds which are going to push harder to get the glucose out of the blood into your cells? Sounds like the kind of advice you’d give someone for weight gain, not loss. Finally, don’t go off your insulin for weight loss purposes.

Most of what they say is well-intentioned but completely wrong. All of this explains why we got fat but doesn’t really help us get control of our insulin resistance. Why not tell people that they can skip meals as a way of getting their insulin resistance to improve? Are they so afraid someone will go too low that they don’t want to see people improve their core issue?

Here’s what the advice should be when targeted towards improving insulin resistance.

  1. Don’t count calories. Nothing makes you feel more deprived than counting calories and nothing sets you up for feeling more like a failure. Restricted calorie diets lower your metabolism and you will be worse off for years after the diet since your set point will then be lowered.
  2. Skip meals. At the very least don’t eat just because it’s time to eat. Eat because you are actually hungry. Understand that the fast you did from 7 PM to 7 AM could be stretched out till noon without harming you.
  3. Exercise is always good. If you fast you get more energy and more active naturally. Exercise has lasting effects on blood sugar levels.
  4. Find a doctor who is willing to work with you and explore options that he may not have learned about in medical school. At the very least one that understands what the meds she prescribes to you do and their effects on insulin resistance. At least find a doctor that acknowledges your problem is insulin resistance. (Added List of Low Carb Doctors).
  5. All other things being equal, you can only reduce your insulin needs by lowering your insulin resistance. The goal, therefore, is to figure out how to reduce your insulin usage. Don’t just stop taking insulin and let your insulin levels get really high. I’ve lost a friend recently to DKA so I take this very seriously. She was an undiagnosed T2D but in retrospect she had all of the external markers of a T2D adult.

It might be beneficial to do a post on each of the above treatment points but focus the points on the treatment I am doing now, 18/6 Intermittent Fasting.

TED Talks

Want to spend a very confusing day? Watch a bunch of TED talks on the T2D subject by different speakers.

Here’s a sampling:

  1. Vegetarian guy who says meat is the problem with everything that ails us. His buddy the vegan weightlifter. Another vegetarian guy. They tell me I am not getting enough starch. They have not got the slightest clue about insulin resistance. My conclusion is they own stock in casket manufacturers.
  2. Paleolithic diet critic who is an archaeologist who points out the holes in the Paleo diet. Seems like the truth is we no longer have the ancient grasses food nor range fed animals so we are pretty much screwed either way.
  3. Food pyramid critics who say all those carbs aren’t all that good for us. (All of them fall into this category).
  4. Fat has been good for us all the way along woman. She is right. The belief that fat makes us fat is flawed and disproven.
  5. Guy who says everything we can possibly eat is poison.
  6. Sugar is the problem guy.
  7. Throw out the food pyramid woman. Fits in with Low Carb advocates.

They all have some unique insights. They all have some overlapping points.

The last one is the best (IMO) of all of the talks. Her key points are:

  1. Carbs are making us sick.
  2. We don’t need carbs.
  3. Cutting carbs helps T2Ds by lowering their insulin.
  4. 40%+ of heart attacks are caused by insulin resistance.
  5. Lowering carbs lowers insulin requirements.
  6. Diabetes is reversible via low carb diet.
  7. Protein and carbohydrates all create glucose.
  8. Fat is what remains and it is good.

Practically this means eating food from the outside ring of the supermarket. Nothing out of the middle rows. No pasta, no cereal, nothing made of wheat, none of the processed foods in the middle. Outside ring is vegetables, meat, dairy, eggs. Maybe 15% of the stuff in the store.