The CDC says 34% of US adults have pre-diabetes, and of those, 88% are undiagnosed[1]. Yes, about 29% of US adults have un-diagnosed pre-diabetes, or about 74 million people.
I think a significant cause is that testing blood glucose is thought of as something that only diabetics do, and as a result, most people have no idea how their bodies respond to meals they'd consider normal. The feedback loop is completely open. A typical Chipotle burrito has ~115 grams of carbs, often consumed in 20 minutes[2]. For some people, that's fine, and for others it's not, but the only way to know (other than waiting for problems) is to actually measure one's own blood glucose an hour later.
Until blood glucose testing is either (a) thought of more as data collection without fear or stigma, like a bathroom scale, or (b) made blood-less and automatic, like is rumored about the Apple Watch[3], many people won't learn the answer to that question until a symptom of pre-diabetes appears.
If you're reading this and haven't had your fasting blood glucose tested as part of a regular checkup, get that done. It's not nearly as informative as post-meal testing, but it's much better than nothing.
Also, if you're a diabetic who created a side project/hack because you wanted it, and at scale, that project could mitigate the public health impact of diabetes, feel free to contact me. I'd consider helping make it mainstream[4]. My interest is improving societal health (this will be a massive problem in 20 years if nothing happens now), not personal or financial.
I'm Director of Marketing for an early stage startup focused on this exact issue. Our founder's grandmother was diagnosed type 2 and he was aggravated with the pain points in the experience, along with the lack of information and tools. Then after doing research and running a health coach practice he realized the scope of the diabetes epidemic.
We're taking top notch educators and putting their knowledge in an app. We have many features to add along the way in our product map, but we're already starting to form partnerships and see value.
Company is called KingFit (https://kingfit.io). Drop me a line and I'd love to introduce you to the founders.
This sounds very interesting as another metric (like weight on a scale, as you put it) for someone trying to be conscious about their health. Is this something that a person could do cheaply at home with over-the-counter diabetic testing supplies? Could you be more specific or link to something about a protocol for e.g. measuring the effect of a meal on blood glucose and how to interpret those results?
Testing instruments are widely available and affordable too due to diabetes being such a widespread disease.
I've just started using Freestyle Libre[1]. It's quite affordable even though it's not as accurate as blood measurements. It's possible to have one sensor attached for up to two weeks. This should be enough time to assess your body's reaction to carbs.
I don't know how you would test for pre-diabetes but to test for diabetes you can basically just drink a lot of sugar-water and see what your blood does. There are levels you can't reach unless you're diabetic.
Personally I've switched to a mostly carb-free diet because managing sugar levels is much easier that way.
Have you tried to use it with xDrip plus[1] and an NFC capable Android phone? It allows you to calibrate the values using accurate blood glucose values. If you do a bit of research and do the calibrations right, it can be as accurate as the values from a fingerstrip reader.
Being a type 1 diabetic, this software has changed my life totally. It's just that good nothing else comes even close. I use Dexcom G4 as my CGM and I wrote an InfluxDB support to xDrip, so now I can use Grafana to monitor my glucose values in real time.
The development of xDrip plus is very active, so you probably want to use the nightlies.
You would need a blood glucose meter (BGM), lancets, and strips. About $50 to get started.
Taking the measurement by washing your hands or wiping off your finger with an alcohol wipe, let dry, prick finger, squeeze to produce a small blood droplet, touch the end of the strip to the blood.
As far as interpreting expected results an hour after a meal; it depends on about a half dozen primary factors.
- Baseline fasting glucose level
- # of carbs consumed
- Ratio of simple/complex carbs and how much associated protein and fat in the meal
8 carbs of juice will spike blood sugar a lot faster than 8 carbs of ice cream because fat/protein/fiber can all slow down absorption of the carbs.
But in general healthy glucose level is 90 - 120 mg/dL and I'd imagine an hour after eating you should be a bit higher maybe up to 140.
I did exactly this, at least here in the US the machines are very inexpensive and even free because manufacturers make $ from the strips. So for about $30 I was able to do readings several times a day for a week. My PCP was impressed.
Disclaimer: This is not medical advice and I'm not very knowledgeable, I'm just a data and public health geek. If you believe you may have diabetes or pre-diabetes, contact a doctor.
Yes, it's doable with over-the-counter products. You need a meter and lancet device, and then for each test, a single-use lancet insert (tiny needle) and test strip.
These are usually bundled together in a pharmacy for $25-$75. However, if you look or ask the pharmacist, there's often a 100% money back refund right in the store.
Additional test strips are $0.75-$1.75/strip in packs of 25, 50, or 100. While that sounds expensive (and for diabetics, is), for the purposes we're talking about, one could probably only test after high-carb meals and a few days of fasting readings. The included 25-50 test strips may yield enough data to act on, and if not, one more 25-50 pack probably would.
https://www.diabetesselfmanagement.com/blog/what-is-a-normal... has more about when to test (basically, 1 and 2 hours after the start of a meal) and what results to expect. Feel free to ask the pharmacist to show you how to use it and interpret the results.
Important note: this feels nothing like a blood draw. It's barely noticeable at all and not anything I'd call painful. There's a depth adjustment on the lancet, so it's the tiniest imaginable prick on the side of a finger. It yields less than a drop of blood, then immediately closes, ie, no bandage or bleeding.
I did this myself as an extension of quantified self in 2012 (https://twitter.com/troyd/status/281931325471068161), just because I wanted to see the readings and the process. I did it again this year to see whether the testing process had improved (no) or my results had changed (no). Other than some puzzled pharmacists who aren't used to people buying a meter for cash, there's really nothing to it. It'll also give a tiny peek at a process that millions of people do all the time.
It's fascinating to see how one's body responds, particularly to meals that aren't obviously unhealthy (and depending on the person, may not be). Some examples: sandwiches (especially on big hoagie/grinder-style refined bread), burritos (tortilla+rice+beans), any meals with 2 significant sources of carbs (sandwich with fries or potato, breakfast with toast and hash browns, etc), and pasta. These aren't inherently unhealthy, but they all significantly raise blood glucose, and the only way to see how much is to test. More on "glycemic load": https://www.google.com/search?q=glycemic+load
My mother and her sisters are all diabetic and while my yearly blood work always comes out fine, I've always wanted to do some additional testing because I've noticed my mood is affected by meals.
Thank you for taking the time to write out your comment, I will be buying the testing supplies in the coming days.
You can do an a1c test at home or in the doctor to identify chronically elevated glucose (prediabetes). It's insensitive to time of day or fasting status you can just take it every few years or so at your convenience.
Continuous blood sugar monitoring is probably overkill given how easy and cheap a1c tests are now.
Blood pressure, on the other hand, is still a nightmare. A good way of reliably and simply measuring resting blood pressure would be a game-changer.
Any location of the AnyLabTestNow nationwide lab network will also do an A1c test for about $50. They don’t require ID or a real name, just bring the receipt to pick up your results.
For most newly-diagnosed Type 2's, the disease management information out there, especially on the ADA, is terrible. Meter and strip accuracy is more off-kilter than many realize; calibrate against a venous draw-based blood glucose test. To calibrate my meter on a fine scale, I manipulated my glucose into multiple ranges, and went in for a venous draw each time on my own out-of-pocket money: 120+, 70-120, 60-69, 50-59, 40-49, 20-39. The last four required a water fast at one, two, three and four weeks, respectively. My meter and strips have to be adjusted +20 for 70 and up readings, but only +10 for 60-69 readings. If you're just curious, buy a starter meter kit over the Net (cheaper than what you can usually find in the pharmacies), and whatever reading you get, fudge it by about 10-15 points; you really want to see the trend, not an individual specific number at a single point in time.
Most doctors won't know about various antibody tests that can help refine a diagnosis, and avoid a mis-diagnosis of Type 2 when you really have adult-onset Type 1. If you test pre-diabetic, search on diabetes antibody tests.
Fastest results back to "normal" for most (not all) Type 2 and pre-diabetics come from cutting out net carbohydrates (far below what the ADA recommends), combined with strength training (weightlifting) and supplementing with HIIT cardio. It takes a serious time commitment to do that: 90-120 minutes a day, 3-5 days a week. While I'm diagnosed Type 2 for over three years, for the past two I've not been on any medications, my post-meal ("post-prandial" in medical lingo) glucose stays below 90 at one and two hours after the meal, A1c is 5.3, and cholesterol numbers are in the normal range; I keep my net carbohydrates below 20g per day, roughly half a single, unadorned bagel (my diet is mostly animal protein and green leafy vegetables). Intermittent Fasting helps, as does outright water fasting for 24 hours or longer, for many (again, not all) people.
My personal big revelation was learning the difference from limbic and true hunger, and my personal satiation patterns. Calories In Calories Out is true, but a vast over-simplification because it doesn't address the satiation issue. For me personally, I've settled on hitting at least 200g of animal protein per day, and as much Romaine hearts as I want, with 28g of grated Parmesan and a tablespoon of Caesar dressing on the side, mixed together and used a dip for the Romaine hearts. After that, I can manage the satiation issue with ancillary food. YMMV.
There isn't one single treatment path for everyone, though there are lots of commonalities; I suspect diabetes is a catch-all for a class of a multitude of metabolic disorders, either that or our individual body metabolisms are more wildly different than medical science admits so far. The key to getting back into the normal ranges is apply the scientific method to your body, try one change at a time, measure, repeat.
I would like to share an anecdote.
In March 2016, I was weighing 96 kilograms (211.64 pounds). I made just one change during that time which is to stop having anything with sugar. I continued to take other natural sweeteners like jaggery and honey. The rest of my diet remained the same and my activity level remained the same ( I work in IT as a network engineer in a desk job)
In October 2016, I was weighing 72 kilos (158.73 pounds).
I am still maintaining that same weight between 70 to 72 kilos since then. Incase if it is relevant, I am a 29 year old guy with a height of 172 cm (5 feet 7 inches).
Along with that, I got several other benefits such as being more energetic, not feeling sleepy all the time, general improvement in mood etc.
All this just with stopping of sugar and nothing else changed.
I can share even more side benefits which I got, but it will seem more unbelievable because I have observed that the general population is still unaware of the extremely harmful effects of sugar.
EDIT: I had typed October 2017 when I had intended to type October 2016. It was just 7 months.
Oddly enough, I can share an anecdote too. After a health scare, I decided to change my diet. I didn't think that I was self disciplined enough to count calories, so I arbitrarily eliminated certain things from my diet, most notably butter.
My exercise didn't change much: Cycling to work every day. I got a new bike, but it didn't make me go that much faster.
Within a few months, I went from 175 to 150 pounds (about 79 to 68 kg), and have kept it off.
Now, this goes against the current "ketogenic" hypothesis, and is actually kind of puzzling, but I realize that butter makes things tasty, and I was just eating a lot less food overall because it was less pleasant. So it probably was a reduction in carbs.
It took more than a year before I could enjoy a piece of toast without anything on it.
I remember reading a study that indicated that simple carbs combined with fat are worse than either fat or simple carbs alone. I can't find the study at the moment, but the gist of it was that a high fat, high sugar, meal will be metabolized differently than either in isolation and also that it triggers cravings for more fat and sugar.
So, a keto diet is fine. Eating bread every now and then is fine. But, something like a fast food meal consumed with a sugary soda may be particularly unhealthy and may cause you to eat more and crave more similar foods.
I don't know all the mechanisms at play, and I don't think even experts have a really good understanding of how our very complex digestive and metabolic systems (and the bacterial colonies that live in our guts) interact. It's clear that caloric reduction works for weight loss, even if you're eating mostly carbs or mostly fats. Some people report better management of cravings and hunger on different kinds of diets, and the research indicates that a low-fat or low-carb diet results in weight loss at about the same rate (contrary to popular belief about low-carb diets lately).
But, really, if you run a caloric deficit, you'll lose weight. Cutting arbitrary foods can do it for some folks. Some folks like keto or other relatively extreme restrictive diets. Some folks do intermittent fasting (I've been intermittent fasting for several months and have lost a little over 20 pounds). No matter how you do it, if you cut 500 calories off of your diet, you'll lose weight at a healthy clip.
I haven't seen a specific study but I have read assertions along the same lines: either low-fat or low-carb can work.
I believe the insulin-centric explanation (I'm a low carb eater and this is the perspective I tend to see) would be something like:
- Low carb and high fat: The fat goes to your fat cells (that is, whatever fat you don't burn for fuel immediately after eating), but since your insulin is low the fat is readily burned off relatively soon.
- Low fat and high carb: The carbs cause an insulin spike, and insulin inhibits fat burning, BUT since you haven't stuffed much fat into your fat cells, there isn't much to burn off when your insulin eventually comes back down. You need to be relatively insulin sensitive, so that your insulin level does come back down. Even if you're insulin resistant, this diet might still work if you eat only a tiny amount of fat.
- High fat and high carb: Fat goes to your fat cells and insulin levels are high, which inhibits fat burning, so you gain fat faster than you burn it.
(Edits: I thought Markdown lists would work but they didn't.)
"Low carb and high fat: The fat goes to your fat cells (that is, whatever fat you don't burn for fuel immediately after eating), but since your insulin is low the fat is readily burned off relatively soon."
- The fat you eat does not have to be stored as fat, the raised insulin levels are necessary for the body to store energy as fat.
"Low fat and high carb: The carbs cause an insulin spike, and insulin inhibits fat burning, BUT since you haven't stuffed much fat into your fat cells, there isn't much to burn off when your insulin eventually comes back down. You need to be relatively insulin sensitive, so that your insulin level does come back down. Even if you're insulin resistant, this diet might still work if you eat only a tiny amount of fat."
And in fact they have to be converted to fat. There are only two other options:
stored in muscles as glycogen - however, the muscle stores can only store up to 1600 calories so they may be full. Also, once sugar gets into a muscle it can't get out - it can only be used by that particular muscle.
used by the brain - however the brain doesn't need more than 500 kcal per day. (and can live with as little as 120 kcal / 30g of glucose provided that the rest of the energy is supplied by ketones)
So... exercise doesn't help lose weight, but it sure helps prevent weight gain when eating carbs. With the amount of carbs we eat nowadays and the low amounts of physical activity, its no wonder at all we store a lot of fat.
No, that's definitely not related to what I'm talking about. I don't believe I've ever seen any good evidence related to the notion of "alkaline" and "acidic" foods. The top result for "dissociated diet" doesn't sound credible at all, to me. (Sure, it offers reasonable advice, like "eat lots of vegetables", but its reasoning is completely made up, as far as I can tell.)
And, the example meal plan on the same first result page is for a 1200 calorie diet! That's a massive caloric deficit for any adult; of course you'll lose weight if you follow it!
I was specifically talking about a study on sugar and fat and how they might trigger cravings and overconsumption, and possibly also cause metabolic effects that can cause weight gain and other problems, and not at all about alkaline/acidic food combining theories.
Sorry, IIRC it was called alimentación disociada in Spanish. I tried the probable translation, made a search and assumed the links were pointing to the same thing. I just browsed the book 20 years ago and it said nothing about ph, but about avoiding certain mixes of proteins, carbs and fats. The owner of the book said it had helped him a lot, but I didn't take much interest because that guy was not exactly thin and low-carb worked fine for me... actually it seemed like a softened keto diet, designed to make it a little funnier.
Ah, thanks for clarifying. I've got several friends who believe in various forms of the pH diet. They also tend to be folks who believe in a lot of other woo, so I'm a bit trigger happy in shooting down pH-based diet theories (those diets are particularly ridiculous because they often categorize quite acidic foods into the alkaline category and vice versa). If there's ever been a good study about it, I'd certainly read it.
I think there's a lot of superstition in general, but one could certainly have independently noticed that eating sugar or fat alone (say butter or honey) is somewhat self-regulating. You get sick of it pretty quick. But, put them together in a pie or pastry or donut or something and suddenly it gets really easy to eat hundreds of calories worth of sugar and fat in a few quick bites.
I saw that study. I never saw if they kept the amount of protein people ate constant. Do you know? It seems mysteriously lacking the third macronutrient. And I can't tell from the article if there was a control "eat fat and carb" group.
Before assigning top much blame on butter, remember that being on any diet, including e.g. taking only placebo diet pills, will lead to improvement. When you are on a diet you are on a diet you pay attention to what you are eating, and that helps in itself. This is probably why there are so many kinds of diet - most diets work.
I think this is important, and that the food industry has been progressively making food more and more yummy over the past few decades. So far I really don't have a good answer for how to reduce consumption without reducing pleasure, at least in the short term. Developing a taste for food that isn't designed to be addictive, probably requires a long term change of habits.
Good one, with that comes increased water intake due to increased thirst, therefore quicker satiation due to being full quicker.
Restaurants like salt because customers won't order water (even though tap water is free here in NL it makes one look as too much of a cheapskate); they'll order a drink like wine which they can upsell and already has large profit margins.
Nephrologists won't be happy though (although it does generate them more customers, they probably got more than enough as it is).
My suggestion would be: less salt + umami + herbs.
Herbs is a bit vague, it really depends on the dish (and there's more than herbs; look at things like garlic, ginger, and turmeric you can buy these dried as well, in same tins or glasses as herbs are).
Personally, I'm a fan of the Italian spices as well as mixes like baharat and ras el hanout even though I don't have a background in any related culture (I'm Dutch).
You can achieve umami in various ways: yeast extract, Vetsin, E621, MSG, etc. In the end its all the same, but I put the one consumers fear the least first in the list wink
The reason why our satiety mechanisms don't work is because carbs upregulate insulin, which supresses leptin [1]. Leptin and ghrelin are the two main hunger hormones; leptin tells our brain we're full. The signal doesn't work too well in the presence of high insulin, and gets worse with insulin resistance, causing people to have a "second stomach" for sweet foods.
I find a great substitute is olive oil where I'd use butter for non-cooking (eg. instead of butter on pasta or instead of butter on bread). It's not quite as tasty but still a huge improvement over dry, and it's healthier.
For cooking, I understand olive oil is unhealthy (I think you create carcinogens as a side-effect), as are many other oils, but that coconut oil doesn't do this because of its different melting temperature.
> For cooking, I understand olive oil is unhealthy (I think you create carcinogens as a side-effect), as are many other oils, but that coconut oil doesn't do this because of its different melting temperature.
I believe the situation with oil is a bit more complicated than that, and you're generally fine with olive oil unless you make it smoke, which is fairly non-trivial to do, despite its low smoking point. There seems to be some debate on the topic: http://www.seriouseats.com/2015/03/cooking-with-olive-oil-fa...
Coconut oil in particular actually has a low smoking point. If you want to be safe, you want Avocado oil.
I encourage you to try some top-shelf olive oil, if you haven't already -- I find that it blows butter out of the water in most cases.
I initially felt the same way as you wrt tastiness, but had a friend bring me back a tin of oil from Italy recently and whoooo boy it's just the most phenomenal thing. Add a bit of salt & pepper to a shallow bowl of oil for dipping bread.
You can click the comment permalink (the age indicator) and on that page you have the option to vouch for the person /comment if it seems appropriate. I did so and they appear to be visible again. I've seen it take two vouch operations before though.
It is a study of 14 people that self reported how hungry they were and how much they ate on their own. I don't think we can get to advice stating "most people" should do anything from that. It is an example of how bad science gets translated to bad advice and bad behavior. Not picking on you, you are responding rationally to a headline or blurb about the study. But it is a worthless study.
Yes, that was probably a lot of it. I have no doubt that my caloric intake decreased more than just from butter, and next on the list would most likely be carbs. I started eating more of some other things such as lean meats and beans.
There is _no_ amount of butter (or fat, in general) that you can eat that will make you gain weight, provided there is no sugar in your diet. You will physically not be able to eat more than your body can deal with, this is because fat, unlike sugar, triggers the i-am-full hormones which make food impossible to eat.
No, that is plain wrong. Calories count, no matter where they are from.
Ketogenic diets might increase your metabolism and reduce your appetite and hunger, which makes weight loss easier, but you'll still gain weight if you eat too many fat calories each day. Even if you cut out carbs entirely.
This has been thoroughly disproven for ages -- starting with the naive assumption that you can just eat X amounts of anything and it doesn't affect anything else in your health/apetite/metabolism.
I know we like to one up each other on HN, but you're just talking past the main point.
Calories matter. If you eat too many, you get fat. Some calories might be "better" than others, but they are a standard of unit of energy for a reason. A calorie is a calorie.
Would you like to try the butter diet? I can guarantee you you'll get fat.
>Calories matter. If you eat too many, you get fat. Some calories might be "better" than others, but they are a standard of unit of energy for a reason. A calorie is a calorie.
That's quite irrelevant though (besides tautological), as we don't just eat calories, we eat food that has calories and tons of other stuff in different arrangements.
A calorie being a calorie doesn't cover whether the food you got the calorie from makes you satiated, or conversely makes you eat more, or makes you feel more energetic, or makes you store it as fat, or brings hormonal changes, etc.
A "milligram is a milligram" too, a standard unit of weight, but 1mg of cyanide can kill a person, and 1mg of water won't do anything to them.
>Would you like to try the butter diet? I can guarantee you you'll get fat.
Again this presumes that people can just eat, regardless of what they eat -- and continue to eat it without that affecting anything else. I guarantee you if I ate just butter, I'd threw up after several hundred grams, and feel quite bad and stop the diet after some days.
Surprisingly, you wouldn’t. I basically have been on your “butter diet” for over a year. I get about 80% of my calories from fat, much of it saturated. The rest is protein. I’ve lost about 50 pounds, normalized my blood pressure & cholesterol, and feel amazing.
How many calories were you eating pre and post diet?
2 sticks of butter is almost 1800 calories, that would be a weird diet with lots of hunger. There probably are a lot of sources of fat that work better than that.
To illustrate the point: dietary fiber, which contains a lot of calories, is not digestible. Eat as much as you can, but you will not get one calorie of energy from it. So just based on that, where calories come from matters.
There is a difference between fat metabolism and sugar metabolism. They use different metabolic pathways, in other words the process by which a fatty acid molecule becomes ATP (the ultimate source of cellular energy) is very different from how fructose (which has to first be converted to glucose in the liver) becomes ATP.
No, the article is saying that people are getting obese and diabetic because of sugar.
Its further pointing out that there are calories ("sugars") which make it much easier to gain weight. I didn't disagree there either.
The article never claims that you can eat any amount of calories as long as you leave carbs from the table. And thats the only thing i pointed out. Because thats just plain wrong. If you eat too many calories, you will gain weight. And if you're predisposed to obesity, you will eat more calories when you're flavouring stuff with sugar.
This will, as the author pointed out, cause you to get even more obese and eventually get diabetes.
Calories are calories (it's literally a measure of energy!) The packages they come in will effect hormonal and psychological responses differently which may affect the amount you would take in if intake is left unmonitored. To that extent, it's wise to take in foods which don't nudge you towards over consuming, but if you can be disciplined and take in a quantity of energy less than you expend on a consistent basis, eating that intake as sugar rather than other macros isn't going to magically make you gain weight.
You are making the same semantic argument I was criticizing. In the context of this discussion we aren't talking about the literal measure of energy, but the package. I.e., is a quantity of sugar that has a calorie of energy the same to the body as a quantity of fat or fiber that contains a calorie of energy. That's what someone is claiming when they say a calorie is a calorie. And to that question, the evidence bears out that it the effects are not just psychological, and don't just affect desire to eat. If you took two twins, and fed one 2000 calories of cane sugar a day, and fed the other 2000 calories of raw broccoli, after a month, they wouldn't have the same weight.
Sure, it is a measure of energy, but it is not a measure of of how much energy we as humans will utilize from the food. Some calories are much more efferent for us to extract than others. Some can't be extracted at all.
Are you aware of how calories are measured? They essentially set the food on fire and count how long it takes to go out.
Does our body digest things by acting like a furnace? No. There are different ways to extract energy from food and our body does things that aren't accounted for by the nutrtional facts blurb on the box. In some cases the food will just go straight through you, such as when you eat loads of fat. All those "calories" don't necessarily translate into x pounds on your body in new fat.
This is exactly what puzzles me. Increasing your metabolism should increase your body temperature, all other things being equal. I still suspect that sheer reduction of calories is the main driver of weight loss, and if anything, fine-tuning one's metabolism plays a minor role.
I'm just talking anecdotally here but yes, the body temperature does increase significantly. Keto wasn't for me, especially because of the increased food budget, but it sure did help with my chronically cold feet/hands.
But I'd still agree with your second assessment: the biggest contributor is the decreased hunger/appetite after the first few weeks.
If I have to choose between "don't eat artificially added sugar but don't feel like I'm eating less" and "don't eat butter, and by extension eat less because food tastes worse", I can tell you I'll choose the former in a heartbeat.
I'd estimate that my family of four was going through a pound of butter a week. As I mentioned above, I doubt that butter alone was the cause, since the butter was always accompanied by something else.
My whole family has reduced our butter intake quite drastically, so I don't have a good estimate of how much I was personally consuming.
The main difference was more closely spaced gears (9 instead of 3) allowing me to find a better cadence at higher speeds. So I was going faster and working harder. No free lunch. But it wasn't enough to account for my weight loss. My commuting is only about 1600 miles per year.
I quit sugar over two years ago. It has had zero noticeable affect on my average weight. Dieting is the only way I've been able to keep my weight in check. Anecdotal evidence has little value.
I hear these anecdotes in many forms, and in my experience the real shared causative factor is making a decision to change, and acting on it. I don't know if it matters what that change is, as long as it's healthy and changes the math of caloriesin - caloriesout. In other words, I wonder if it's the decision and willingness to make hard changes, rather than the specific nature of those changes, which is the real active ingredient in weight loss; I suspect so.
Examples:
Started walking.
Started cycling.
Cut out processed foods.
Switched to a specific lifestyle diet.
Took up some kind of sport.
Cut out sugar/went Atkins/Keto/Paleo.
I don't think there's a wrong way to break a series of bad habits and build new ones, and I think the hardest part is deciding to do it, and sticking with it.
One of our employees decided to cut out fast food completely. Total weight loss in over 6 months of doing this? 0 pounds.
Why? Because his at-home diet was still full of sugar and carbs (and he admitted as much..."I'll never give up bread!")
Meanwhile, I did a low-carb "lazy Keto" diet where all I did was keep carbs under 20g net per day. I continued to eat fast food at least a couple times a week (I ate a lot of burgers with no buns.)
Total weight loss? 25 pounds over 8 months, and have kept it off. I started the diet December 1 of last year, so it's now been almost a year.
It really is the carbs and sugar that do you in, no matter how organic or home-cooked/homemade those carbs may be.
The million dollar question is: "Did you (w/your N=1) try the exact same calories as your keto diet, but then with more carbs?" No, you did not, and because it is hard to eat foods which adhere to the keto formula you lose weight on a keto diet.
What people also fail to mention with their anecdotal evidence is their age and gender. It is relevant because young bodies and brains are still growing, increasing calorie demand compared to a middle age adult.
> It really is the carbs and sugar that do you in, no matter how organic or home-cooked/homemade those carbs may be.
It really is the calories that do you in, no matter what type of calories or how you restrict yourself otherwise. All the diets are just some kind of abacadabra (or facade or placebo effect if you will) to make you focused on your calories intake, for example with specific rules about having to avoid certain products or ingredients which make it difficult to follow so that e.g. the subject cannot snack in between meals.
If you take in a lot less calories than the amount you require, you'll burn fat quicker. You'll lose weight quicker as well (although if you also start exercise, muscles weight more than fat). A lot more calories leads to building up fat quicker and gaining weight quicker. Both, eventually, until you are on the level of your calorie intake.
It furthermore also stands to reason that something with sugar is more difficult to limit than keto products because the former is more tastier. From an evolutionary PoV it makes sense because the sugar from fruits was a quick way to give us energy.
Furthermore, you should ask yourself whether the ingredients of the high carb food are needed. You'll find that you don't need them in the first place, possibly not in the amounts you eat them, but if you eat one cookie with the coffee in the evening that doesn't suddenly "ruin your health" because it is high on sugar. It doesn't "ruin your diet" either. The problem is that people cannot stick with one cookie in the evening with coffee. They snack far more, between meals. Yeah that adds up. Look on the packages and do the maths.
All the bad stuff is on the packages as well, very convenient: saturated fat, sugar, and salt. What a coincidence that our governments demand this being listed!
Carbs increase insulin. Insulin increases the level of lipoprotein lipase (LPL) in your body. LPL dictates how much energy you store as white fat. No carbs --> low insulin --> low LPL.
So FWIW @ericabiz is correct "It really is the carbs and sugar that do you in".
You also responded to @kichuku regarding sugar being sugar:
> The natural in sugar is irrelevant. Sugar is sugar; as in fructose is fructose, and glucose is glucose.
Not exactly. Fructose doesn't initiate an insulin response in the body... so it doesn't increase LPL... there are other problems with fructose but the 'natural' in the sugar shouldn't be dismissed.
> So FWIW @ericabiz is correct "It really is the carbs and sugar that do you in".
Its not. The people who are obese mostly [1] consume too much, and often carbs are the culprit. If they reduce their calorie intake, they lose weight. It doesn't matter if they use a keto pseusoscience with that, go to a dietist to follow a raw food pseudoscience diet, or diet solo without a dietist limiting caloric intake on sheer willpower (a proven method based on decades of science). Even people who don't get into a "state of ketosis" because they diet on raw food or willpower lose weight. The thing they all have in common is: limiting the caloric intake.
[1] "Mostly" as there are some diseases which are exceptions, an example could be thyroid problems. I'm not gonna comment on this, not familiar with all the English terms on the exceptions.
> Not exactly. Fructose doesn't initiate an insulin response in the body... there are other problems with fructose but the 'natural' in the sugar is important.
Cane and beets are natural sugar as well. All sugar is natural, except artificial sugar, but then we call it artificial sugar. The term sugar doesn't tell us which sugar (e.g. glucose or fructose or lactose) but neither does the term natural sugar.
Its akin to denoting to stating "[..] fruit apple [..]". An apple is always a fruit. There is no need to underline that.
"keto pseudoscience" is loaded phrasing for a mechanism that has been understood and uncontroversial for 200 years.
If you are unfamiliar... the core insight is that obesity is an endocrine disorder; your hormones — not your caloric intake nor the amount you exercise — is the primary reason you gain or lose fat.
Here is a short explanation as to why this is:
* [enzymes] whether you store fat or not is determined by enzymes — specifically hormone sensitive lipase (HSL) and lipoprotein lipase (LPL)
* [hormones] production and inhibition of those enzymes is controlled by your hormones — including insulin, adrenaline, cortisol, estrogen and others.
* [diet] the easiest way to control your insulin levels is to keep your blood sugar low; the easiest way to control blood sugar is to eliminate carbs from your diet.
As I mentioned above... this can be simplified as...
No carbs —> suppressed insulin —> maximum HSL production.
'limiting the caloric intake' -- as you suggest -- is a blind alley when discussing this mechanism. It is a necessary but not a sufficient condition to lose weight. Your body won't draw on your fat reserves if it doesn't have to. i.e. it will happily extract the energy it needs from your gut all day long, provided your gut is full. That means you are partially correct; if LPL is low and if you are in a deficit then the body will draw down on your reserves and you will lose weight. But the opposite isn't true. If LPL is high, irrespective of your deficit or your willpower, then you won't lose weight. Conversely 'eating too much' isn't a diabetes risk... provided your hormones are in order.
If you have any sources that contradict the endocrine hypothesis, I would be keen to see them.
> "keto pseudoscience" is loaded phrasing for a mechanism that has been understood and uncontroversial for 200 years.
Certainly not 200 years, and also certainly not "understood and uncontroversial". Atkins/keto goes against the conventional science of dieting from the 20th and 21st century because it doesn't follow the caloric intake affecting weight loss premise (though it can have that effect, like almost every diets can). It goes against the convention that saturated fats are unhealthy, and should be severely limited. Finally, we should remember that transfats were only in recent decades found unhealthy, mostly due to research in 00s by M. Katan. Your Atkins diet during its hype in 70s didn't exclude transfats.
> not your caloric intake nor the amount you exercise
I didn't claim the amount one exercises significantly matters in weight loss. In fact, I wrote throughout the thread that muscles increase weight.
However, having more slightly more muscles than the default 9 to 5 job (lack of muscles) helps with doing tasks like grabbing your bicycle to do a grocery, assembling an Ikea wardrobe, carry your toddler around, that type of activity. Being fit allows endurance. Both are arguably useful motivators.
The Atkins hype is recent (and the keto hype is more recent), not 200 years old. Its also not established by our governments (the equivalents of NHS, Voedingscentrum, etc).
Voedingscentrum has this to say in summary: "Het Atkins-dieet levert gewichtsverlies op, omdat de voeding in totaal minder calorieën bevat. Uiteindelijk gaat het erom de gezondheidswinst die dit oplevert vast te houden met een gezond, gevarieerd en volwaardig eetpatroon.
Diabetes-patiënten en mensen met een gestoorde nierfunctie kunnen dit dieet beter alleen volgen in overleg met hun arts en onder begeleiding van een diëtist." [1]
Which boils down to: "The Atkins diet achieves weight loss because the diet contains a total of less calories. Ultimately, it is about retaining the health gain that results in a healthy, varied and full-bodied eating pattern.
Diabetes patients and people with impaired renal function are better off only following this diet in consultation with their physician and under the guidance of a dietitian."
Compared with various other diets they're not even that negative about Atkins. Many alternatives are worse established.
If you got any sources where government organizations like the ones I mentioned recommended 200 years ago the Atkins or keto diet I'd love to read about that. Or perhaps sources where they actively recommend it to this day, including the theory behind it. Any government health service sources supporting it, also welcome. The burden of proof lies at you.
And of course there are tons upon tons of articles which suggest Atkins/keto don't work, complete with test subjects losing weight at start, finding diet not practical, and a yo-yo effect. Here's a quote from one of the many [2]: "[...] These observations led Sacks et al. to conclude that behavioral factors rather than macronutrient composition are the main influences on weight loss [...]" Recommend reading entire article.
Small point first… eating the same amount but exercising more equals a caloric deficit in the same way that exercising the same amount but eating less does. I am not following your point about muscles specifically but I think we can let that go provided you agree that being in a caloric deficit needn’t mean you eat fewer calories. That is all I was trying to say regarding exercise.
Second point… confusion is not the same as controversy. Even though people might be confused how the mechanisms and pathways work doesn’t mean they are controversial. Hormones dictate weight gain and weight loss. See pregnancy or puberty or menopause. (You even mentioned Thyroidism.) It’s not controversial. Calling it pseudoscience seems over the top. See the green house effect (first argued in 1824) for an analog.
Third point… my claims pertain to the biology not to the marketing behind certain diets. I don’t believe that the atkins diet is ketogenic… nor do I think the Voedingscentrum is correct in saying the diet has a ‘varied and full-bodied eating pattern’, but I also don’t care. As you say… it is hype. But if your counter-examples have no explanatory power, then they are just as worthless. More on this below. In the very least don’t equate the hormone hypothesis with an endorsement for Atkins.
Fourth point… I concede that my rhetoric is not iron clad. Since science is a process and certainty is always a question… it is hard to ever win an argument about this stuff… as Katan points out doing double-blind studies is near impossible so that makes claims in nutrition science doubly fraught. Having admitted that… I stand by my statement that the hormone hypothesis is not controversial. Yes the lipid hypothesis had sway in American culture in the mid 20th century but evidence to back it up was never produced. If any controversy existed, I would say it lay with the lipid hypothesis not with the endocrine one.
As to the bonfides for sugar induced obesity I would point to Jean Anthelme Brilliat-Savarin (writing in 1825), Alfred Moore (writing in 1860), John Harvey (writing in 1861) , and William Banting (1863). Their accounts were accepted by medical schools in the US and the UK, with varied levels of understanding, through to the 20th century… where Thomas Cleave and John Yudkin were their antecedents. Does that make my 200 year claim iron clad? Not really but I think it is good enough for arguments sake.
Last point… you haven’t made a case for an alternative to the hormone hypothesis. The links you included don’t do it. Your examples don’t do it. The Katan article doesn’t say that low carb doesn’t work… let alone provide an alternative mechanism for losing weight. As I wrote above… caloric reduction is a associated with instances of losing weight… but it doesnt CAUSE you to lose weight. Hormones do.
Another anecdote: I'm in the "I'll never give up bread!" camp; I have never been on any kind of specialized diet, and I have never been obese. At one point I wanted to lose 10 LB, and I just counted calories, and it worked, albeit slowly.
Given that bread is a fairly old food, while the obesity problem seems recent, something seems off with the idea that we should all be on a keto diet.
I think sugar is really what pushes societies from healthy and slightly stout to obese and diabetic, since those diseases are issues of insulin resistance. If you eat too much sugar, your insulin resistance will go through the roof because excess fructose (which makes up ~50% of sugar) leads to a fatty liver, which leads to insulin resistance. The liver is the only organ that can process fructose. Bread, on the other hand, will get metabolized into glucose (oversimplifying a bit here) and every muscle in your body can use glucose for energy, so it's a lot more evenly distributed.
If you're in the "I'll never give up bread!" camp, I would encourage you to try and find sugar-free bread. I tried doing that, and let me tell you, it is extremely difficult. Even your healthy looking whole grain, multi-seed, organic superfood bread usually has a ton of sugar. But it can be done :)
You're likely correct in most situations. Some people have major hormone imbalances that may prevent weight loss (or make it difficult), like the article suggests, but for most people it's as simple as eating healthier and exercising. It's not sexy, new, or fun, so people are always looking for the magic bullet.
I'm a sugar bug, I can buy a bag of Reese's and eat the entire thing without problem. When I eat more sugar, I gain weight, when I eat less, I lose weight, and exercise obviously has its natural results.
I'm 17x cm and weigh 7x kg. I run (mostly 10K, completed a half-marathon recently) and lift weights semi-regularly. I have a relatively low sugar intake. I don't feel energetic at all. I get home from work and more or less lay down until I fall asleep. Gabriel Iglesias seems to be way more energetic than me.
Jaggery seems to be 50% sucrose, and honey is mostly glucose and fructose. Shouldn't it have the same effect on blood sugar levels?
I think it's not just about GI, jaggery would have more GI, I am not sure, but you could think of another angle - jaggery is unrefined sugar retaining the dietary fibre - that could result in a lower GI also some other benefits which we might be still discovering.
but it occupies liver with processing fructose which iirc is disruptive to ketone production and does maintain a level of blood sugar that prevents body from entering ketosis.
If you’re purposefully consuming normal levels of carbohydrates you’re not going to be in ketosis anyways. Unless you’re maintaining a ketogenic diet there’s no reason to worry about your glycosis/ketosis state after a meal. A teaspoon of honey isn’t going to ruin your body. Likewise, if you’re over indulging it doesn’t matter much if it’s “better” sugar or “worse” sugar. I’m willing to bet the poster isn’t drinking a honey sweetened soda.
* I did the same at the beginning of the summer, cutting out most processed sugar (glucose) and corn syrup while increasing fruit intake (but not by much).
* I also starting skipping meals/moving meal times around, and eating less at dinner, but otherwise did not change the things that I ate.
* I am exercising a lot less than before, owing to a foot injury in the middle of the summer.
I've dropped nearly 20 pounds, from a starting point of just above 200 pounds to between 182 and 185 (varies by day). I think a decline in daily caloric intake owing to fewer sugary foods and smaller meal portions can explain the weight loss. I hope I can keep it up, because I do like sugar and because we have kids there is a lot around the house.
I mentioned this to a relative who is a GI doctor and researcher and he says it's easier for men to lose weight than women through diet.
Consider maybe cutting out your kids' sugar as well. No need for them to be eating all those sugary foods if you've found it to be unhealthy (and it is).
Can confirm a very similar experience: a drop of 12kg from 86 to 74. No change in physical activity. Also work in IT. Only dietary difference is cutting out all sugar and as many carbs as I can.
I cut thirty pounds in four weeks (yes, thirty pounds in four weeks, the first twenty of which were gone in two) by making no change in my behavior or diet other than cutting out the sugar I was putting in my coffee. I drink coffee all day long as a programmer, and used quite a ton of sugar. Double or triple what you're thinking. Anyway, the only change I made was cutting out that sugar, and I dropped thirty pounds in four weeks.
Good for you! You should know, though, that this is primarily water weight lost, and it's common when first starting a diet. 30lbs of fat lost would be a caloric deficit of around 100k calories. Don't get discouraged if you can't replicate that result with further time. What's the change in your waist size been like?
Well, I didn't start a diet. All I did was cut sugar. I did and still do run a couple of miles and lift weights a few times per week, and ate the same meals every day (because I buy in bulk and prepare them ahead of time). I track all my food and water intake and exercise activity with my Fitbit (unintentional plug). It was an environment with tightly controlled variables. Nothing in my routine changed except the subtraction of sugar from the coffee I was drinking.
I lost ~10Kg and all of my belly fat after cutting off cakes and cookies (the only sugary things left in my diet). I still eat plenty of carbs though (bread/pasta/semolina/müesli/fruits and sometimes honey). I've stabilized at a weight slightly below the one I had when I was 18.
It freaked me out initially, I didn't expect such a large (or any) drop.
Your comment directly contradicts everything claimed in the article. Specifically, it makes the case that all calories are not created equal, and sugar in particular heavily impacts metabolism and fat accumulation.
Whether this is true is up for debate, but you haven't brought any evidence to the table.
You must mean "stop having anything with added sugar" because humans need sugars to survive, nearly all food has natural sugars in it, and if you ate 0 grams of sugar for more than a couple of weeks you would die.
I'm being a bit pedantic because it's important to understand that moderation is the key, not trying to completely eliminate one family of molecules from your diet.
if you ate 0 grams of sugar for more than a couple of weeks you would die
No you absolutely would not. Your body can synthesize glucose from protein and fat, you can survive indefinitely on zero sugar. This is called ketogenic diet.
IIRC both combat divers and people with certain kinds of epilepsy benefit from carb free diets as it reduces risk of passing out (for combat divers with rebreathers) and epileptic attacks (for epileptics).
What do you think a 'carb free' diet excludes? What does it include? I'm asking, because I'm genuinely confused by the fact that all plant (veggies, fruits, seeds/grains, all of it) matter contains sugars. Do a lot of folks really sustain themselves on meat alone? Hell, not even my 100lb german shepherd can live on only meat (IIRC carnivores frequently eat stomach contents of herbivores they kill/find to get nutrients [hint: it would include sugars])
I am vegetarian on a very low carb diet. No fruit, no high starch vegetables. It is possible to eat zero added sugar and almost zero natural sugar. As mentioned above your body can synthesize glucose from protein, to the extent that on a keto diet you must be sure not to consume too much protein, lest your body convert it to glucose.
Considering that many essential nutrients are provided by plants which also provide sugars, you'd have to eat synthetic 'food' in order to avoid all sugars.
> Considering that many essential nutrients are provided by plants
None that I can think of that are proven "essential" in the absence of all carbs. "Phytonutrients" aren't proven essential. Vitamin C ("ascorbic acid") is 100% inessential & optional in the presence of plenty of the (actually essential) ascorbic molecules that are all furnished by fresh meat, including carnitine, creatine etc.
For homo sapiens, there is no essential carbohydrate and no essential plant food. Something to chew on!
Late edit: of course none of this disputes or negates "that many essential nutrients are provided by plants" --- many indeed are. Just none that are essential that aren't furnished in sufficient amounts in a sizable helping of fresh-fatty-mammal-meat =) but the parent didn't even say "only by plants" so not sure why I reacted as if he did
In the end, the one-year project stretched to four years, during which time the two men ate only the meat they could kill and the fish they could catch in the Canadian Arctic. Neither of the two men suffered any adverse after-effects from their four-year experiment. It was evident to Stefansson, as it had been to William Banting, that the body could function perfectly well, remain healthy, vigorous and slender if it used a diet in which as much food was eaten as the body required, only carbohydrate was restricted and the total number of calories was ignored.
> I guess technically you are right, even meat has some carbs in it because muscles hold some glycogen
Near-zero because muscle glycogen is used up upon death in a process called "rigor mortis" (not the case for liver glycogen however AFAIK). The fatty marbling luckily remains.
"if you ate 0 grams of sugar for more than a couple of weeks you would die"
This is completely false. Indeed, depending on your body composition, you can do a water fast for two weeks and be completely fine. I've done it, I know.
Getting this stuff right can change lives; please think twice about engaging in uninformed pedantry and FUD.
The recent demonization of sugar substitutes hasn't helped either. The problem with studies that link them to weight gain is that they confuse correlation and caution then make some wild unsubstantiated stab at causation by guessing that maybe they cause insulin issues. I went looking for information on that, and found and excellent article by a diabetic site summarizing the evidence and treating each substitute as its own compound. The bulk is the data is that they have no correlation (there is some in vitro evidence for a couple of lesser used sweeteners but under very contrived circumstances). As long as we deny the existence of usable substitutes, we are making this harder on ourselves.
"The Obesity Code" by Jason Fung goes into all the issues from the article in more detail. He references studies that seem to prove sugar substitutes cause weight gain rather than correlate with weight gain:
Sucralose raises insulin by 20 percent, despite the fact that it contains no calories and no sugar. This insulin-raising effect has also been shown for other artificial sweeteners, including the “natural” sweetener stevia. Despite having a minimal effect on blood sugars, both aspartame and stevia raised insulin levels higher even than table sugar.
Fung, Jason. The Obesity Code: Unlocking the Secrets of Weight Loss (p. 172).
I've been on a ketogenic (very low carb, no sugar) diet for a little over a year. At the beginning of the diet, I started eating MORE than I used to, and tracking calories religiously, including weighing my food. I never miss a meal now and eat breakfast every day. The biggest thing I cut out was sugar.
In that time, I lost 45 lbs, going from 210 to 165. I didn't exercise or do anything else. That weight came off in about 3 months.
I am now commuting 11mi by bicycle most days, I feel better than I ever have. I fit perfectly into a few things I owned in HS (I'm in my 40s and was a skinny kid).
Fad diets like keto offer something very important, a model of nutrition. Currently heuristic based eating like "natural" or "non-processed" work, but the knowledge doesn't compound and is brittle. In eastern cultures especially there is a huge body of heuristics for eating. In Chinese culture there is a concept of hot/cold foods and despite it not being accepted in the west, it still has predictive ability above chance.
The end goal I would like to see is healthy off the shelf long lasting processed food that tastes great. It runs contrarian to "eat local and natural, big food is evil" but it solves a huge problem.
Of course on the way imperfect models will yield bad results and heuristics are all we have. When doctors refused to wash their hands because they didn't know germ theory despite the massive heuristic evidence, people needlessly died.
I tried keto for a very short time, found it difficult to meet such dietary restrictions. Not gonna be shocked if we find out in 10 years that eating keto is actually horrible for your cholesterol or something, and then it's gonna be too late for the early adopters. As an anecdote, I noticed some people advocating that diet literally eat bacon and steak all the time and justify it. They're probably gonna have major health problems one day because it's not actually a good rule, it's just a rule that sounds good and tastes delicious.
Most of our popular models of diet are basically unscientific quackery. Maybe they are bad models? You are right of course in simply having a set of rules to follow seems to help.
Not many people can afford 2000 calories of steak every day. Result from anecdotal evidence: "eating steak causes health loss."
> Most of our popular models of diet are basically unscientific quackery.
The most conventional holds up: the one that consuming too many calories causes one to gain weight, and consuming not enough calories causes one to lose weight.
If I'd go with what's popular on my gf's FB, I'd end up believing vegan diet is the panacea. We're living in our bubbles. Your mistake in thinking is the assumption that diets like keto and atkins are popular. They're not popular. They're just hypes in certain circles like silicon valley.
Another thing you'll find is that there are government (based on science) recommended daily intake on things like vitamin D, iron, vitamin B12, etc etc and with a keto diet or high carb diet or whatever diet this may be difficult to reach. Although that's not directly related to weight, it is related to health.
What I see happening is many morbidly obese people who adhere to keto will initially drop weight, roughly until their BMI reaches around the upper normal range. Then CICO kicks in with a vengeance, and they have to be much more careful compared to before. Keto is a useful on-ramp for many to a fitness (or at least more-fit) lifestyle, but not a magic bullet, and I don't see anyone claiming you can skip counting calories while on keto, then still reach 12-15% body fat, and reveal abs. If you see someone writing that, then yes, they're quacks.
My personal rough rule of thumb is once you reach the low 20s percentage body fat, you either keep increasing cardio (preferably HIIT), or dropping counted calories, until your moving average weekly weight keeps trending down. Fit keto around that or even drop it, and it won't matter (unless you're the same subtype diabetic like me, and then keto is an essential ingredient to avoiding medication).
If you go in once a quarter for a VAP lipid panel (the most extensive lipid panel I could find), then as long as those numbers trend in the right direction, keep on doing whatever works for you. After being diagnosed with Type 2 and having to figure out myself how to beat the fucker into remission, I've concluded that medical science can give rough guidelines for describing metabolic processes, but it is up to each of us to hack our own bodies. Try one change, test the change with measurements, and repeat; commit the changes that work, fork away from the changes that don't, accept failures and setbacks as signals of what not to do, and move on.
Definitely agree with the sentiment about heuristics. The French are a great example: lots of butter and carbs but strict rules about snacking and smaller portions in general. Long meals also help prevent some overeating. Not all French people I’m sure, but that was my experience.
How Big Business Got Brazil Hooked on Junk Food[1]. "As their growth slows in the wealthiest countries, multinational food companies like Nestlé, PepsiCo and General Mills have been aggressively expanding their presence in developing nations, unleashing a marketing juggernaut that is upending traditional diets from Brazil to Ghana to India." "a growing number of people are both overweight and undernourished." "The diet is killing us." Nestlé: "We didn’t expect what the impact would be".
I have been through countless dirt-street towns from Guatemala to Mali where the local store has a few moldy potatoes, coke and Doritos.
All the kids are eating the coke and Doritos as a meal, and of course there is nobody telling them not to, or that they should be brushing their teeth or anything like that. It's a massive, massive disaster.
Sugar's role in diabetes seems likely to be true, but to say that CICO is false and a mutually exclusive explanation compared to the way in which insulin affects one's metabolism is empirically false [0].
Taubes would be hard pressed to explain how you could lose weight on a diet of Twinkies or how those subsisting on high carb, low fat, low protein diets that fail to meet their caloric needs in famine-afflicted regions remain thin.
The way insulin works and the way the body requires a caloric surplus to gain weight are not remotely mutually exclusive ideas and to suggest otherwise requires cherry-picking the literature in a way that's scientifically irresponsible.
CICO is not 'false', per se, but it's fundamentally misleading and tautological. Yes, people will lose weight on a calorie restricted diet of just twinkies. However, their bodies metabolic rate will decrease gradually to the point where continuing to maintain a caloric deficit will be unsustainable (i.e. a 500 calorie deficit if your basal metabolic rate is only 750 or 1000), at which point they'll stop losing weight, but still be 'skinny fat'. They'll also cause potentially irreparable harm to their liver and pancreas, and if they do manage to sustain it for longer periods, be on the express track for diabetes and heart disease. The difference between eating equivalent calories of twinkies or a salad is that one is a toxic substance and the other isn't. In the same vein, as another poster mentioned above, you can say that a milligram is a milligram, but a milligram of cyanide will kill you while a milligram of water is harmless. That's why more and more people are challenging CICO; it gives you the false sense that replacing meat and vegetables with coke and doritos is harmless as long as they're equivalent calories.
Nobody is suggesting that CICO and the insulin theory are mutually exclusive; what the author is saying is that CICO is a profoundly unhelpful statement for people looking to lose weight, improve their health, or reverse diabetes/heart disease.
> Taubes would be hard pressed to explain how those subsisting on high carb, low fat, low protein diets that fail to meet their caloric needs in famine-afflicted regions remain thin.
Thin doesn't mean healthy. We're talking about disease, not necessarily weight, and you can have metabolic syndrome even if you're considered 'thin'. Most people who are thin with a poor diet have visceral fat (fat around the organs) which is far worse than subcutaneous fat (as a risk factor).
If your BMR is 750-1000, you're likely a female shorter than 5' and/or weighing less than 100 lbs. At that point, you are likely severely underweight and probably shouldn't be trying to lose weight.
I'm not denying that there are other reasons to eat a diet with greater nutritional density, but trying to convince people that CICO is wrong is far more harmful than trying to convey that it is literally the most important factor in trying to modify your weight.
If you want to make changes in your life, you need to know the right things to measure, and your caloric intake relative to how your weight changes is the single most important factor for people trying to lose weight. If you're not even doing that, it's unlikely you'll succeed, as millions of people who struggle with their weight will understand.
Once you've convinced people of the value of that, it then becomes more productive to go into the value of high protein intake and strength training to further improve body composition, the importance of eating a diet centered around fruits and vegetables, etc.
For people that are severely overweight, getting their weight down will have the highest impact on their health.
>Nobody is suggesting that CICO and the insulin theory are mutually exclusive;
Taubes literally argued this in the paragraph where he quoted the biochemistry text.
How is it unhelpful? For the obese, it presents the simplest and most actionable advice that has the highest relevance to their most pressing health problem.
The CICO message has been part of diet advice for decades. If hearing this message in and of itself were helpful, one would expect that we wouldn't be observing the current levels of obesity in the US. The biology and human behavior are more complex than that.
There are simpler explanations. People have no idea how much they consume and frequently underestimate how much they eat. Inaccurate measurement and non-existent tracking systems sabbotage people's attempts at modifying their weight.
This is frequently solved by getting people to buy a food scale and weigh everything they eat for a few weeks and calculating the actual caloric content of their food. Food scales are frequently all people need to make real and persistent changes to their weight.
The biology isn't complex enough that ignoring CICO or telling people that it's wrong is useful or helpful and not harmful.
> People have no idea how much they consume and frequently underestimate how much they eat. Inaccurate measurement and non-existent tracking systems sabbotage people's attempts at modifying their weight.
I agree, and believe this is part of it. People aren't paying attention to what they eat. This is specifically why understanding human behavior is important and that only repeating CICO is not useful.
If people are interested in understanding how metabolism regulation works and finds that it's useful in modifying their diet to help them be healthier, that should be encouraged, shouldn't it? If understanding how different foods affect hunger, insulin levels, diabetes, muscle gain, fat loss, I think that should be a good thing. If someone focuses purely on calories, they can easily deprive themselves of nutrients and hungry, making it hard to keep themselves on the diet and failing to get or keep themselves healthy.
You can't claim that understanding how metabolism works is useful and suggest that understanding how CICO works isn't useful in the same breadth.
Understanding CICO is sufficient to derive all useful, actionable advice for healthy weight management (e.g., maybe you're measuring wrong, stop eating calorically dense foods, eat foods that are more satiating, etc.).
Understanding the difference in how fructose is metabolised compared to glucose is majoring in the minors and is far less likely to help someone achieve their goals.
CICO is the most important factor and the simplest to understand. Suggesting people teach themselves biochemistry and physiology without understanding the basics is silly and far less realistic. Ignoring CICO is setting people up for failure which will discourage compliance and further improvements.
> You can't claim that understanding how metabolism works is useful and suggest that understanding how CICO works isn't useful in the same breadth.
I believe you're misreading what I'm saying: I'm saying that only repeating CICO is not helpful. That itself does not give people the tools they need to be able to maintain health. You yourself point this out in saying it's "sufficient to derive all useful, actionable advice for healthy weight management": Not everyone is able to derive things from first principles.
Perhaps we're talking past each other. I'm more satisfied understanding human behavior and metabolism regulation than only repeating CICO and expecting people to derive everything else from there.
You might be right. I think we agree more than we disagree.
I'm certainly not against giving more advice than CICO and I'm not saying we should expect people to derive things from first principles, just that any method of weight loss that works will be working by CICO and understanding that is far more useful than not, and that it is outright harmful for people to suggest that it doesn't work.
I actually wrote a rather long comment a few months ago about my thoughts for healthy living in general if you wanted to know my thoughts beyond CICO: https://news.ycombinator.com/item?id=14681035
CICO-based treatment has been popular for decades yet the problem has continued to get worse (much worse).
I know it works for some but it has not worked for many more. We can stick our heads in the sand about this or admit that we need to be looking for a better answer.
When it doesn't work for someone, that means they were doing it wrong rather than that they were defying the laws of thermodynamics.
The useful thing to do at that point is to diagnose what they were doing wrong and how to correct for that instead of claiming they were defying the laws of physics.
Just an aside that struck me. The phrase "laws of thermodynamics" when applied to diet has always felt a bit off and I think I put my finger on why. The laws of thermodynamics is used in physics while diet is in the realm of biology or biochemistry. While of course chemistry and biology aren't in opposition to the physics, there's a reason it's useful to treat them separately.
Anyway, none of this is meant as criticism or argument. Perhaps not much more than a personal insight into phrasing.
Here's a study showing Metabolic and behavioral effects of a high-sucrose diet during weight loss: https://www.ncbi.nlm.nih.gov/pubmed/9094871
It shows when kcals are equated,there is no difference in fat loss in high vs low sugar intake.
I find Layne Norton a good resource for science related information about nutrition.
I will say he is an outspoken critic of Taubes. Here is one of Layne's articles on sugar with references: https://www.bodybuilding.com/content/the-science-of-sugar-an...
This about sums it up:
"A far more parsimonious hypothesis is that the same thing that makes our fat cells fat makes us fat: ‘high blood glucose’ and concomitant elevated levels of insulin and the insulin resistance itself, both caused by the carbohydrate content of our diets. Insulin is secreted in response to rising blood sugar, and rising blood sugar is a response to a carbohydrate-rich meal. Sugar is implicated, in particular, because its chemical structure includes a large proportion of the carbohydrate fructose, and fructose is preferentially metabolised in the liver. As such, it is a prime suspect for the fat accumulation in liver cells that is hypothesised to be the trigger of insulin resistance itself."
Short take: this is adapted from ‘The Case Against Sugar’ by Gary Taubes, a science writer who's been a long-standing campaigner against dietary carbohydratesa and sugar'.
Is he bashing vegetables and fruits? The average US citizen does not eat the recommended minimum amount for fiber. Is he bashing the 3500kcal diet of average US citizen or is he purposefully demonizing a single macronutrient group?
What I get out of it is, the problem with refined carbs is both how fast it gets absorbed in you gut/stomach thus spiking your blood sugar and the sheer amount you can eat. I think those two play off each other. With unprocessed vegetables generally you get a lot of bulk fiber and water along with the carbs. If your gut is full of fiber you tend to not be hungry. If it's mostly empty then you tend to be hungry.
Also one thing I've read more recently is the gut has it's own nervous system and hormonal signaling. It's high;y away of what is going on in it's world. However mostly that information isn't available to your brain. But what it can do is control your feeding behavior. If your gut is full and busing extracting nutrients, then it signals your brain to stop feeding. Ever wonder why if you eat a good meal you can got for hours without wanting to eat anything? That's why.
Fiber has 0 calories, which implies people in the US in general barely eat fruit and vegetables. No one overdosed on fiber. It's quite silly to claim that 2000kcal of legume carbohydrate (more than 300 grams of carbs) will alter my hormones or metabolism in a negative way, so demonizing a macronutrient is bad science.
> Fiber has 0 calories, which implies people in the US in general barely eat fruit and vegetables
This is true. The vast majority of Americans do not eat sufficient fruit and vegetables. This 2015 CDC study [1] concluded that only 13.1% of the population consumes enough fruit, and only 8.9% eat enough veggies.
> It's quite silly to claim that 2000kcal of legume carbohydrate (more than 300 grams of carbs) will alter my hormones or metabolism in a negative way, so demonizing a macronutrient is bad science.
Nobody claims that. You obviously haven't read the article.
The excess of carbohydrates in today's diets doesn't come from fruit and vegetables (as [1] clearly shows), but from added sugar and refined grains. The article explains the critical role a chronically high level of insulin in the bloodstream plays in throwing the body's metabolic processes out of balance, leading to both obesity and type-2 diabetes.
Commenter above me equated sugar with carbs, and hinted a government conspiracy theory of how its recommendation influenced people to overeat sugar and become sick.
The largest hormonal change we experience isn't puberty - it's night, under the aegis of the master hormone melatonin. Almost every hormone changes.
I was overweight and had an appetite out of control a couple decades ago. For other health reasons, I adopted a natural night (real dark, can't see you hand in front of your face) and exactly the same lights on and lights off time. My extra weight vanished. My appetite didn't just lower, it changed away from salt fat and sugar (exactly what you want when starving) towards veggies and salads.
(Ten hour nights recommended as your sleep will bifurcate.)
Recommended. Nature ain't all wrong, it turns out.
This sounds very wooey. Do you have anything to show this isn't the result of you wanting to change, changing habits, and your excitement at attempting change carrying through to produce some kind of placebo effect?
I get similarly suspicious when people talk about how going on keto radically changed how they felt. Maybe it is true, but in an sea of anecdotes, it's really hard to figure out what is real. Do you notice how almost all of these turn into "this is how nature actually works"? That similar belief has led people to not get cancer treatments and then die horribly, so there's gotta be more than "this is how nature works".
There's no way to demonstrate that as one individual, full stop. The burden of proof you require to consider whether a valuable benefit could potentially be derived is unacquirable.
A more interesting test is to measure the difficulty of trying a certain anecdote yourself. How easily can you 'black out' your bedroom and sit, lay, or sleep in it for a 10 hour window at night for 30 days in a row?
If you can do such a test easily, and you are invested in seeing a certain change that you think may result from it, then it does you no material harm to try it. Worst case scenario, you lose sleep for a few days and abort the experiment. Best case scenario, it has a positive impact. The results could be anywhere between those two endpoints.
So, that makes this a 'safe' test to apply to your own personal body system, which is not necessarily applicable to any others.
Anecdotes that require you to alter what you ingest (food, water, supplements, medicines etc) are much riskier, yet people constantly try these out endlessly under the rubric of "diets" without a second thought for the potential of months of damage to their gut biome, muscle mass, hormone levels, and so on. It's been demonstrated by a vast array of people that it's relatively safe to cut out all the sugar from your diet, but you have to make sure you don't let your blood sugar levels fall too low in the process.
Anecdotes that require you to alter your body (e.g. stomach stapling) are even riskier than those, as we have very little experience in this space compared to diets or other non-consumption non-modification approaches.
You are absolutely correct to be suspicious, but consider also the level of suspicion appropriate for the context. "Try blackout curtains for a month at night and charge your phone face down" is a far lower bar to be 'worth a shot' than "Remove all carbs from your diet". And if you see others failing to take this into account, remind them of the inherent level of risk in what they're considering. It's not always about being right or wrong, but instead about e.g. "how much harm could come to me if I try keto diet?".
EDIT: There's very much a personal overtone to these risk assessments as well. My personal mental stability hinges critically on getting enough sleep, so I am unusually wary of anything that messes with sleep, because I need mental stability far more than I need the benefits such an experiment may or may not produce for me.
EDIT: Harness the placebo effect! Believe that what you're trying could help when you try it. If you're doubtful and pessimistic and cynical about something you're trying, be especially careful to focus every day on why you're trying it. Doing so makes it more likely that the placebo effect will enhance your results, and less likely that the nocebo effect will diminish them. This relates directly to a lot of "woo-woo" thinking, but apply my logic above. What's the level of risk of trying a placebo-welcoming approach? You could mislead yourself into thinking something helped when it didn't. Keeping a careful journal about your experiments is an effective treatment for that problem for many folks, and the placebo effect is really powerful. No point in setting aside a useful tool just because it's mind-body.
It's not that I think it is risky; there's probably no risk at all from making a room darker when you go to sleep. I know people who can't sleep without a sleeping mask and they've been alternately skinny and fat all the same.
What I'm asking is whether that test, as an individual, can actually prove anything? What you think is an actual effect might not be any effect at all. Without something more rigorous, your "test" is that of a magician. It's easy to forget how suggestible we are as humans.
Do you believe that if you pray to god to confirm himself to you and you feel a "burning in your bosom" that the Book of Mormon and the LDS church are right about reality?
One always wants larger experimental groups, but remember that one self-experiment was quite important in conquering malaria. If the result is striking enough, it's worth some attention. This result has held for two decades.
This is the truth. There's a lot more to this - so much so that I decided to make a documentary about it. I don't mean to promote it (there is nothing to promote yet, for now it's just a website), but here it is if anyone is interested http://FoodLies.org
I have one of these thought leader doctors on board. Would love any feedback or help from the community to get this made.
Well, in the best case I guess, seems you think the textbook is just a bunch of lies and there won't even be half of the pages left in there?
Just hoping that you won't further the spread of the many myths about nutrition that are so popular today. There are for instance actually still people who don't think calories in vs calories out determines weight change.
The relevant question of course is what determines calories in and out if you aren't counting it manually.
But why has obesity not been such a problem in the past, despite sugar being available?
One point to make from the article, though: "They suggested that the physician-authors were trying to con the obese with the fraudulent argument that they could become lean without doing the hard work of curbing their perverted appetites."
If you want to really confuse what's going on, turn to moralism. Desire to judge and to avoid being judged completely messes with incentives and people will line up to the "hard working" side while avoiding the "lazy" side, regardless of what is actually true.
> But why has obesity not been such a problem in the past, despite sugar being available?
Sugar, usually in the form of HFCS is added to almost any processed food these days, to make it more delicious and to make the food more profitable. HFCS is very, very cheap to produce. You're eating more sugar without perhaps even knowing you are. Low fat foods, introduced in the late 70's have the same amount of calories, but sugar was added to make the food more palatable.
Sugary items, like sodas, are also coming in larger portions, as well.
Sugars from fruit are less of a problem, as the fruit also contains fiber, which slows down the absorption of the fructose, and helps to not overload your liver.
Calories in the form of glucose are digested differently than fructose or HFCS - the latter two which are processed in your liver. You shouldn't worry about eating too much bread - you should be looking at if the bread contains added sugar.
Sugar was available in boatloads in the 70's in Europe. Liters of soda and candy were consumed by kids, yet fat kids were a rarity. 'Normal' food didn't have all the hidden sugars, and was far less 'designed'. Also, meals were 3 a day, and 'sncking' frowned upon by parents. Another big difference was that kids and even adults naturally excersized all day, running, cycling, playing outside. The 80's made the streets unsafe to play do to the massive increase in car traffic, and those same cars made sure adults remained seated all day. The food industry had breakthrough successes in finding out ways to get people to eat more and more without reducing the hunger/craving, and started campaigning for 'snacking'. The resulting obesity crisis also needed to be social engineered so that people wouldn't stop overeating because of the unavoidable effects on body and health. So the fat-pride movement was nudged into existence, and even discussing the subject outside of the well controlled message of 'you don't get fat from eating' made taboo, while installing a victim culture externalizing all factors.
Not really for the masses, since it wasn't cheap or plentiful. The wealthy that consumed high quantities of sugar did have the same illnesses that are so prevalent today.
I've been trying to cut sugar out of my diet recently. Eventually I'd like to at least feel comfortable treating it like alcohol: only for consumption in social settings and not too often.
Ever notice how since the 1980 the mantras changed from 'eat less, exercise more' to 'fad' diets whose one common theme was 'don't consume less, but eat different'. Subsequently obesity skyrocketed and the fat-lobby made sure that anyone who even pointed out the problem got demonized. Meanwhile 'food-scientists' silently made designer drugs out of daily consumables leading to a feeding frenzy and an obesity pandemic.
I remember 1980 and it's not clear to me that the popularity of "eat less, exercise more" as advice has increased or decreased; it seems comparable (but less justifiable since it's been so ineffective in the face of obesity taking off while exercise has increased). "Fad diets" were very much seen as such well before then. By contrast, I don't remember "fat acceptance" as a thing at all back then.
I'm lean and I eat a lot of sugar. Sugar is not a toxin. It's a source of energy. I'll eat some sugar and go to the gym. I'll come back and eat more sugar to replace the glycogen I drained.
What happens to overweight people has NOTHING to do with lean people who exercise.
In this episode of the Waking Up podcast, Sam Harris speaks with Gary Taubes about his career as a science journalist, the difficulty of studying nutrition and public health scientifically, the growing epidemics of obesity and diabetes, the role of hormones in weight gain, the controversies surrounding his work, and other topics.
Not meaning to be rude or ignorant, but was anyone actually doubting this? I thought that the link of sugar to diabetes and obesity was common knowledge.
So I wonder... is the effect of sugar on your body permanent, building up over time? Or would stopping the intake of refined sugars restore your system?
The worst effects of excessive Insulin, non alcoholic fatty liver and insulin resistance (which becomes type 2 diabetes after some time) can be reversed pretty easily by cutting sugar, fasting or a diet with extremely low levels of carbohydrates (Ketogenic Diet). Check Dr. Jason Fung and Robert Lustig on youtube. They both have done a great deal of research about the topic and have published very interesting material.
I have adopted a very high fat, low carb diet (LCHF) and avoid all sugar for a couple months now and it is absolutely incredible how it changes your body, makes you loose fat and increases overall energy. Gone are these cycles of high and crashing after meals etc. I am absolutely convinced, that we will have a wake up to the toxicity of sugar very similar to that of cigarettes. Especially cancer and sugar seem to have a very strong and under researched relationship.
There is be a cliff, over which the damage is permanent. If you change habits soon enough, then we know many avoid it the permanent damage altogether. This is due to the beta cells in the pancreas; destroy to many, and go below a critical threshhold, then they don't seem to be repaired/regenerated enough forever more.
After I ran into Dr Lustig's stuff which I found was also backed up by other pediatric endocrinologist, I cut out as much sugar and processed carbs as possible. Not as hard for me as I'm a meat and vegi kinda guy anyways. My thought was worst case avoiding sugar, processed carbs, and beer isn't going to be bad for you. Best case, avoid Type II diabetes.
Also following Lustig's advice on sugar and alcohol, make it count.
Author contrasts two explanations of the obesity and diabetes crises: A) that the root of the issue is caloric intake stemming from low-self-control or B) that the root of the issue is high blood-sugar and its subsequent effects.
Author explores the long history of this debate and presents points for both sides. Author admits the thermodynamic validity of caloric math but cites that at a cellular glucose levels cause insulin levels to rise that cause the cell to take on fat. Author cites other research, such as increased appetite among obese animals, suggesting a systemic effect. Author cites ketogenic diets as evidence (which restrict sugars but not total calories).
Author contrasts the moral interpretation of each theory. Proposes the caloric consumption model places blame on the individual, whereas the glucose explanation places blame on the FDA.
And yet, behavioural biology tells us that the development of the pre-frontal cortex is heavily influenced by genetics, epigenetics, and early-years experiences. The PFC appears to influence things like rates of risk-taking behaviour, addiction, and ability to choose long-term rewards... Of course, we wouldn't want to pass the buck of choice back to societal influences.
Not that I know anything, I've just watched and read Robert Sapolsky's material.
I think a significant cause is that testing blood glucose is thought of as something that only diabetics do, and as a result, most people have no idea how their bodies respond to meals they'd consider normal. The feedback loop is completely open. A typical Chipotle burrito has ~115 grams of carbs, often consumed in 20 minutes[2]. For some people, that's fine, and for others it's not, but the only way to know (other than waiting for problems) is to actually measure one's own blood glucose an hour later.
Until blood glucose testing is either (a) thought of more as data collection without fear or stigma, like a bathroom scale, or (b) made blood-less and automatic, like is rumored about the Apple Watch[3], many people won't learn the answer to that question until a symptom of pre-diabetes appears.
If you're reading this and haven't had your fasting blood glucose tested as part of a regular checkup, get that done. It's not nearly as informative as post-meal testing, but it's much better than nothing.
Also, if you're a diabetic who created a side project/hack because you wanted it, and at scale, that project could mitigate the public health impact of diabetes, feel free to contact me. I'd consider helping make it mainstream[4]. My interest is improving societal health (this will be a massive problem in 20 years if nothing happens now), not personal or financial.
[1]: CDC National Diabetes Statistics report, 2017: http://cdc.gov/diabetes/pdfs/data/statistics/national-diabet... (page 7)
[2]: Chipotle nutrition calculator: https://www.chipotle.com/nutrition-calculator
[3]: "Apple CEO Tim Cook test-drove a device that tracks his blood sugar": https://www.cnbc.com/2017/05/18/apple-ceo-tim-cook-test-drov...
[4]: https://twitter.com/troyd/status/920747116703518720, https://twitter.com/troyd/status/921409373661884416