Ran across an older study (The American Journal of Clinical Nutrition, Volume 83, Issue 5, 1 May 2006, Pages 1055–1061. Ketogenic low-carbohydrate diets have no metabolic advantage over nonketogenic low-carbohydrate diets. Carol S Johnston Sherrie L Tjonn Pamela D Swan Andrea White Heather Hutchins Barry Sears) which indicates that LDL is directly tied to BHB levels:

LDL cholesterol was directly correlated with blood β-hydroxybutyrate (r = 0.297, P = 0.025)

The study was only six weeks so it was too short a term to provide much of value in the critique of ketogenic low-carbohydrate diets. The main criticism was that people had a lack of energy on low carb during what we now know is the adaptation phase.

More details:

Compared with baseline, the 6-wk LDL concentrations increased in 5 KLC dieters (0.08, 0.13, 0.41, 0.44, and 0.52 mmol/L, respectively) and decreased in the remaining 4 KLC dieters (0.57 ± 0.18 mmol/L)

Another interesting point:

 Weight-adjusted REE increased in both diet groups over the 6-wk trial, but blood β-hydroxybutyrate concentrations were not correlated with REE (r = −0.014, P = 0.921), which indicates that the protein content of the diet, rather than the severity of the carbohydrate restriction, likely contributed to the elevations in REE.  These data support the contention that calorie-reduced diets high in protein facilitate weight loss, in part, by preserving the metabolic rate (7818).


Low-ish Carb Diet and Diabetes

A five week long study was conducted to determine the effect of a non-ketogenic but still low-ish carb diet on blood sugar numbers in diabetes (Diabetes 2004 Sep; 53(9): 2375-2382. Effect of a High-Protein, Low-Carbohydrate Diet on Blood Glucose Control in People With Type 2 Diabetes. Mary C. Gannon and Frank Q. Nuttall).

The study compared diets with two different macros. The carbohydrate:protein:fat ratio of the Low Carb diet was 55:15:30. The test diet ratio was 20:30:50. Again, note this was not ketogenic levels of carbohydrates. The diet was “weight-maintaining”.  Assuming this is a 2000 calories a day diet that would be 2000 * 0.2 = 400 calories or 100 grams of carbohydrates a day.

The subjects were tested and their Plasma and urinary β-hydroxybutyrate were similar on both diets indicating that the lower carb group was not in nutritional ketosis.

The results were favorable for the Low Carb group.

The percentage of glycohemoglobin (HbA1c) was 9.8 ± 0.5 on the control diet and 7.6 ± 0.3 on the Low Carb diet. It was still decreasing at the end of the Low Carb diet. Thus, the final calculated glycohemoglobin was estimated to be ∼6.3–5.4%.

The reason they estimated the final HbA1c numbers would be lower was that:

The mean 24-h integrated serum glucose at the end of the control and LoBAG diets was 198 and 126 mg/dl, respectively.

Carbohydrate Control is the Key to Blood Sugar Control

As the study noted:

Data obtained in our laboratory (1–3) as well as from others (reviewed in 4) indicate that glucose that is absorbed after the digestion of glucose-containing foods (carbohyrates) is largely responsible for the rise in the circulating glucose concentration after ingestion of mixed meals. Dietary proteins, fats, and absorbed fructose and galactose resulting from the digestion of sucrose and lactose, respectively, have little effect on blood glucose concentration.

The study did increase protein by 2x but a previous study had isolated the protein affects on HbA1c:

We previously reported that a diet in which the protein content was increased from 15 to 30% of total food energy, with a corresponding decrease in carbohydrate content, resulted in a moderate but highly statistically significant mean decrease in glycohemoglobin (8.1–7.3%) after 5 weeks on the diet. This was the consequence of smaller postmeal glucose increases. The fasting glucose concentration was unchanged (12).

Thus, the increase in Protein did help the HbA1C due to the decrease in carbohydrates that came along with that increase.

The conclusion was unavoidable given the data:

Thus, the dietary modification that we refer to as the LoBAG diet has the potential for normalizing or nearly normalizing the blood glucose in people with mild to moderately severe type 2 diabetes.

Not as well as the ketogenic diet, but pretty good nevertheless. I did low carb some time back and get my HbA1C to 6.4 (with other meds). But I like my 5.2 number better now.


Exercise and Stress

There are plenty of sources of stress in our lives. Exercise both helps with stress and causes stress. Here’s a good survey of the subject (Expert Rev Endocrinol Metab. 2006 Nov 1; 1(6): 783–792.  Stress and the neuroendocrine system: the role of exercise as a stressor and modifier of stress. Anthony C Hackney, PhD, CPH).

From the summary:

  • Physical exercise is a stressor to the human body and serves as a robust activator of the neuroendocrine system, provided that the exercise is of sufficient volume (i.e., intensity and/or duration). The magnitude of the neuroendocrine stress response to exercise seems directly proportional to the volume of exercise exposure. These stress hormone responses are typically very transient in nature and do not last longer than a few minutes to hours into recovery.
  • Chronic exposure to exercise training results in adaptations in the neuroendocrine system, such that there is a reduction in hormonal stress response to submaximal exercise and, in many cases, reduced circulating basal stress hormone levels. This abatement of the hormonal stress response with exercise training has implications for dealing with many chronic stress-related health problems.
  • The adaptability and plasticity in the neuroendocrine system to exercise training has limits. Excessive exercise training can push the neuroendocrine exercise stress response to become inappropriate, resulting in the potential development of chronic fatigue and the overtraining syndrome condition.


Greg Glassman’s Offensive Tweet

CrossFit’s Greg Glassman posted a Tweet which was taken as offensive by some diabetics. Here’s the Tweet:

The criticism came largely from people who were Type 1 Diabetics since this tweet implies that diabetes is a choice of whether or not to drink sugary drinks. And it is true that for Type 1 Diabetes it’s not a lifestyle choice that leads to the Type 1 Diabetes.

But it’s true for both Type 1 and Type 2 diabetics that sugar isn’t their friend.  This is a helpful graphic that makes the point. Which diabetic can take that much sugar without affecting their blood sugar? More importantly what value does that sugar bring to anyone’s life – diabetic or not.

At the risk of offending a Type 1 diabetic sugar is your enemy. Same for a Type 2 Diabetic. Yes, the type 1 diabetic can’t cure their diabetes by eating a low sugar diet. But your diabetes can be controlled much more easily with less sugar. You will take in less Insulin. Even Type 1 Diabetics can become Insulin Resistant.

And I have zero doubt as a former Type 2 Diabetic that the vast majority of Type 2 Diabetics have no business drinking any sugary drink. Yes, those drinks are killing you by raising your blood sugar.

Diabetes professionals know better, though. From (Diabetes Care 2004 Feb; 27(2): 538-546. Carbohydrate Nutrition, Insulin Resistance, and the Prevalence of the Metabolic Syndrome in the Framingham Offspring Cohort. Nicola M. McKeown, PHD, James B. Meigs, MD, MPH, Simin Liu, MD, SCD, Edward Saltzman, MD1, Peter W.F. Wilson, MD4 and Paul F. Jacques, SCD)

the prevalence of the metabolic syndrome was significantly higher among individuals in the highest relative to the lowest quintile category of glycemic index (1.41; 1.04–1.91).

And shame on the Diabetic community for not recognizing the role of sugar in both Type 1 and Type 2 diabetes.

Yes, Glassman is right. #SugarKills


Robb Wolf – Split from CrossFit

Eat meat and vegetables, nuts and seeds, some fruit, little starch, and no sugar

–Greg Glassman

I’ve been asked about the CrossFit split from Robb Wolf (Paleo Diet) and how/why CrossFit embraced the Zone Diet. After all they are vastly different approaches to eating. I have opined on the Zone Diet here.

Robb wrote about the split here.

Robb also was in a podcast where he talked about CrossFit:

Here’s another related video where Robb talks about Paleo and training.


Strength Training and Mortality

From (Prev Med. 2016 Jun;87:121-127. Is strength training associated with mortality benefits? A 15 year cohort study of US older adults. Kraschnewski JL, Sciamanna CN, Poger JM, Rovniak LS, Lehman EB, Cooper AB, Ballentine NH, Ciccolo JT.):


During the study period, 9.6% of NHIS adults age 65 and older (N=30,162) reported doing guideline-concordant ST and 31.6% died. Older adults who reported guideline-concordant ST had 46% lower odds of all-cause mortality than those who did not (adjusted odds ratio: 0.64; 95% CI: 0.57, 0.70; p<0.001). The association between ST and death remained after adjustment for past medical history and health behaviors.


Carbs After Workouts?

If you are exercising to improve your insulin sensitivity, then Carbs after workouts are bad. Here’s the science (Nutrients. 2018 Jan 25;10(2). pii: E123. PostExercise CarbohydrateEnergy Replacement Attenuates Insulin Sensitivity and Glucose Tolerance the Following Morning in Healthy Adults. Taylor HL, Wu CL, Chen YC, Wang PG, Gonzalez JT, Betts JA.)

In this study they put participants on a 90-minute treadmill at 70% of their VO2max. At the end they gave the participants either a placebo (no carbs) or maltodextrose that matched the caloric expenditure. Researchers then measured the glucose and insulin responses with an Oral Glucose Tolerance Test (OGTT) the following day and found that the participants who had the carbohydrates had reduced Insulin Sensitivity and increased blood glucose levels.

The practical conclusion of this is that to maximize Insulin Sensitivity it is best to both eat low carb and take no carbs after exercise. Decreased Insulin Sensitivity is one of the markers that lead to Diabetes and increasing Insulin Sensitivity is an important part of reversing Diabetes.

This study is the first to show that feeding carbohydrate to replace that utilized during exercise can reduce insulin sensitivity and glucose tolerance the next morning in healthy adults, when compared to a preservation of the exercise-induced carbohydrate deficit. Furthermore, carbohydrate replacement suppresses subsequent postprandial fat utilization. The mechanism through which exercise improves insulin sensitivity and glucose control is therefore (at least partly) dependent on carbohydrate
availability, and so the day-to-day metabolic health benefits of exercise might be best attained by maintaining a carbohydrate deficit overnight.

For those people who are not particularly concerned about their risk of getting Diabetes it’s worth noting that if they refill their Glycogen stores quickly with carbohydrates they are not burning fat. If they let the Glycogen stores be low then their body will burn fat.

Want to burn fat? Work out and don’t eat carbohydrates after working out.


Protein RDA Values

A metabolic unit study was performed to determine the effects of eating higher protein levels than the RDA and weight loss. (Pasiakos, S. M., Cao, J. J., Margolis, L. M., Sauter, E. R., Whigham, L. D., McClung, J. P., Rood, J. C., Carbone, J. W., Combs, G. F., Jr., Young, A. J. Effects of high-protein diets on fat-free mass and muscle protein synthesis following weight loss: a randomized controlled trial. FASEB J. 27, 3837–3847 (2013).) The study:

…assessed body composition and muscle protein synthesis responses to controlled diets manipulating protein intake over a range that spans the current acceptable macronutrient distribution range during short-term Energy Deficit (ED).

The study concluded:

…determined that consuming dietary protein at levels exceeding the RDA may protect fat-free mass (FFM) during short-term weight loss.

In summary, consuming twice the amount of dietary
protein than current recommendations measurably
protects FFM and promotes the loss of body fat during
short-term weight loss, likely through the maintenance
of muscle anabolic sensitivity to protein ingestion.
However, consuming dietary protein at 3 times the
RDA does not appear to confer any additional protective



Jason Phillips – Anti-keto Crusader

For some dumb reason I’ve started to listen to podcasts with Jason Phillips. He’s a macros diet guy. They maybe have even turned the generic word macros into a trademark or something.

My main objection to much of this sort of material is to take the dietary advise of someone who advises top athletes. At first blush it seems like you’d want to fuel your workout like the top athlete but you are doing nothing remotely similar to what they do for daily volume. So to say that nobody who is a top athlete in CrossFit does Paleo is not all that relevant to me as a local participant in CrossFit.

Phillips has a video against Paleo and keto diet on YouTube where he claims that the flight or fight response of intense exercise like Crossfit can only be handled by eating carbohydrates.

His claim is that you don’t get insulin from eating proteins and fats. It is true that the body does not produce much of an Insulin response to fats. But his claim is not true in the case of protein. In fact, your body has as much of a response to protein as it does to carbohydrates when it comes to using Insulin.

From (Effect of Protein Ingestion on the Glucose Appearance Rate in People with Type 2 Diabetes. M. C. Gannon J. A. Nuttall G. Damberg V. Gupta F. Q. Nuttall. The Journal of Clinical Endocrinology & Metabolism, Volume 86, Issue 3, 1 March 2001, Pages 1040–1047):

When beef was ingested there was a prompt rise in mean insulin concentration (∼3-fold). … at 2.5 h, the insulin concentration was still at a maximum at that time. The insulin concentration did not return to a fasting value until 7 h after the meal (Fig. 2).

In fact, your body creates Glucose out of protein. From the same page:

ALL OF THE amino acids commonly found in proteins can, at least in part, be converted into glucose, with the exception of leucine. Indeed, conversion of amino acids derived from either endogenous or exogenous proteins is the major source of new glucose formation