Carbohydrate-insulin model of obesity is false

Azdak
Azdak Posts: 8,281 Member
edited November 14 in Health and Weight Loss
http://www.nature.com/ejcn/journal/vaop/ncurrent/full/ejcn2016260a.html

This may be more frustrating to present because I can't access the entire article and it is pretty complex.

Here is the abstract:

"The carbohydrate–insulin model of obesity theorizes that diets high in carbohydrate are particularly fattening due to their propensity to elevate insulin secretion. Insulin directs the partitioning of energy toward storage as fat in adipose tissue and away from oxidation by metabolically active tissues and purportedly results in a perceived state of cellular internal starvation. In response, hunger and appetite increases and metabolism is suppressed, thereby promoting the positive energy balance associated with the development of obesity. Several logical consequences of this carbohydrate–insulin model of obesity were recently investigated in a pair of carefully controlled inpatient feeding studies whose results failed to support key model predictions. Therefore, important aspects of carbohydrate–insulin model have been experimentally falsified suggesting that the model is too simplistic. This review describes the current state of the carbohydrate–insulin model and the implications of its recent experimental tests."

The takeaway: there is no evidence to indicate that elevated insulin levels from ingesting higher amounts of carbs have any effect on stored body fat INDEPENDENT of energy balance.


Replies

  • walkdmc
    walkdmc Posts: 529 Member
    As a recent fan of ketogenic diets and fasting, I'm really interested in this topic. I would geek out over this study but the link requires $32 to access the article which I'm not paying.

    I'm a bit biased in that I wholeheartedly believe insulin is a growth factor and excess levels lead to weight gain. I don't think it's the only cause of weight gain but it's a major player, IMO. Given those beliefs, I'd like to know exactly what the "refeeding" diet included. How many patients were enrolled? How did they determine insulin is not an independent factor for weight gain? And probably most importantly, who funded this study? I guess I need a lot more info. than what was provided.

    I find it interesting at the end of the abstract (but honestly, that wasn't even an abstract, didn't outline the study design or specific results) they state, "Therefore, important aspects of carbohydrate-insulin model have been experimentally falsified suggesting that the model is too simplistic." I'm not 100%clear on what they intended with that statement but I *think* they're just reaffirming their study results which we don't really know. I would apply the same statement to the old CICO model.
  • Alyssa_Is_LosingIt
    Alyssa_Is_LosingIt Posts: 4,696 Member
    walkdmc wrote: »
    As a recent fan of ketogenic diets and fasting, I'm really interested in this topic. I would geek out over this study but the link requires $32 to access the article which I'm not paying.

    I'm a bit biased in that I wholeheartedly believe insulin is a growth factor and excess levels lead to weight gain. I don't think it's the only cause of weight gain but it's a major player, IMO. Given those beliefs, I'd like to know exactly what the "refeeding" diet included. How many patients were enrolled? How did they determine insulin is not an independent factor for weight gain? And probably most importantly, who funded this study? I guess I need a lot more info. than what was provided.

    I find it interesting at the end of the abstract (but honestly, that wasn't even an abstract, didn't outline the study design or specific results) they state, "Therefore, important aspects of carbohydrate-insulin model have been experimentally falsified suggesting that the model is too simplistic." I'm not 100%clear on what they intended with that statement but I *think* they're just reaffirming their study results which we don't really know. I would apply the same statement to the old CICO model.

    Re: the bolded - you'd apply the same statement to the laws of thermodynamics?
  • AlabasterVerve
    AlabasterVerve Posts: 3,171 Member
    I can't remember if it was Hall's study or not but I think there's supposed to be a recent study where they injected glucose or insulin or some such intravenously and it had no impact on hunger? I wonder if that's this study.

    I'm sure we'll hear more soon.
  • GottaBurnEmAll
    GottaBurnEmAll Posts: 7,722 Member
    edited January 2017
    cwolfman13 wrote: »
    walkdmc wrote: »
    As a recent fan of ketogenic diets and fasting, I'm really interested in this topic. I would geek out over this study but the link requires $32 to access the article which I'm not paying.

    I'm a bit biased in that I wholeheartedly believe insulin is a growth factor and excess levels lead to weight gain. I don't think it's the only cause of weight gain but it's a major player, IMO. Given those beliefs, I'd like to know exactly what the "refeeding" diet included. How many patients were enrolled? How did they determine insulin is not an independent factor for weight gain? And probably most importantly, who funded this study? I guess I need a lot more info. than what was provided.

    I find it interesting at the end of the abstract (but honestly, that wasn't even an abstract, didn't outline the study design or specific results) they state, "Therefore, important aspects of carbohydrate-insulin model have been experimentally falsified suggesting that the model is too simplistic." I'm not 100%clear on what they intended with that statement but I *think* they're just reaffirming their study results which we don't really know. I would apply the same statement to the old CICO model.

    How could it be a factor independent of energy balance? If I'm in an energy deficiency, I'm not going to have net fat storage...same in maintenance.

    If you look at blue zone regions of the world, their traditional diets tend to be higher carb, moderate protein, and lower fat (not low fat)...if the carbohydrate/insulin model panned out, they wouldn't be "blue zone"...they'd all be obese or over fat.

    Insulin is a growth factor which is why when someone is training and bulking, that carbs are king...but they're also in a calorie surplus...

    The carbohydrate-insulin theory of obesity discounted the role of energy balance in any of these equations.

    That's the whole problem with it. The theory rested solely on the role of insulin causing fat storage.

    The only mention that I can recall off the top of my head in the whole thing about energy had to do with increased energy expenditure due to fat oxidation if eating a high fat diet. I believe that was supposed to be the mechanism for weight loss.

    From what I can also recall, that increased energy expenditure effect only lasted three weeks.

    My recall might be faulty here.
  • GottaBurnEmAll
    GottaBurnEmAll Posts: 7,722 Member
    AlabasterVerve wrote: »
    I can't remember if it was Hall's study or not but I think there's supposed to be a recent study where they injected glucose or insulin or some such intravenously and it had no impact on hunger? I wonder if that's this study.

    I'm sure we'll hear more soon.

    Hall did say he was going to come out with more later on the whole hunger aspect when that initial study was released. You might be on to something here.
  • AnvilHead
    AnvilHead Posts: 18,343 Member
    GottaBurnEmAll wrote: »
    cwolfman13 wrote: »
    walkdmc wrote: »
    As a recent fan of ketogenic diets and fasting, I'm really interested in this topic. I would geek out over this study but the link requires $32 to access the article which I'm not paying.

    I'm a bit biased in that I wholeheartedly believe insulin is a growth factor and excess levels lead to weight gain. I don't think it's the only cause of weight gain but it's a major player, IMO. Given those beliefs, I'd like to know exactly what the "refeeding" diet included. How many patients were enrolled? How did they determine insulin is not an independent factor for weight gain? And probably most importantly, who funded this study? I guess I need a lot more info. than what was provided.

    I find it interesting at the end of the abstract (but honestly, that wasn't even an abstract, didn't outline the study design or specific results) they state, "Therefore, important aspects of carbohydrate-insulin model have been experimentally falsified suggesting that the model is too simplistic." I'm not 100%clear on what they intended with that statement but I *think* they're just reaffirming their study results which we don't really know. I would apply the same statement to the old CICO model.

    How could it be a factor independent of energy balance? If I'm in an energy deficiency, I'm not going to have net fat storage...same in maintenance.

    If you look at blue zone regions of the world, their traditional diets tend to be higher carb, moderate protein, and lower fat (not low fat)...if the carbohydrate/insulin model panned out, they wouldn't be "blue zone"...they'd all be obese or over fat.

    Insulin is a growth factor which is why when someone is training and bulking, that carbs are king...but they're also in a calorie surplus...

    The carbohydrate-insulin theory of obesity discounted the role of energy balance in any of these equations.

    That's the whole problem with it. The theory rested solely on the role of insulin causing fat storage.

    The only mention that I can recall off the top of my head in the whole thing about energy had to do with increased energy expenditure due to fat oxidation if eating a high fat diet. I believe that was supposed to be the mechanism for weight loss.

    From what I can also recall, that increased energy expenditure effect only lasted three weeks.

    My recall might be faulty here.

    I believe that was already addressed by Krieger in a previous research review: http://weightology.net/weightologyweekly/index.php/free-content/free-content/volume-1-issue-7-insulin-and-thinking-better/insulin-an-undeserved-bad-reputation/


    tl;dr - insulinz iz not da debilz.
  • GottaBurnEmAll
    GottaBurnEmAll Posts: 7,722 Member
    AnvilHead wrote: »
    GottaBurnEmAll wrote: »
    cwolfman13 wrote: »
    walkdmc wrote: »
    As a recent fan of ketogenic diets and fasting, I'm really interested in this topic. I would geek out over this study but the link requires $32 to access the article which I'm not paying.

    I'm a bit biased in that I wholeheartedly believe insulin is a growth factor and excess levels lead to weight gain. I don't think it's the only cause of weight gain but it's a major player, IMO. Given those beliefs, I'd like to know exactly what the "refeeding" diet included. How many patients were enrolled? How did they determine insulin is not an independent factor for weight gain? And probably most importantly, who funded this study? I guess I need a lot more info. than what was provided.

    I find it interesting at the end of the abstract (but honestly, that wasn't even an abstract, didn't outline the study design or specific results) they state, "Therefore, important aspects of carbohydrate-insulin model have been experimentally falsified suggesting that the model is too simplistic." I'm not 100%clear on what they intended with that statement but I *think* they're just reaffirming their study results which we don't really know. I would apply the same statement to the old CICO model.

    How could it be a factor independent of energy balance? If I'm in an energy deficiency, I'm not going to have net fat storage...same in maintenance.

    If you look at blue zone regions of the world, their traditional diets tend to be higher carb, moderate protein, and lower fat (not low fat)...if the carbohydrate/insulin model panned out, they wouldn't be "blue zone"...they'd all be obese or over fat.

    Insulin is a growth factor which is why when someone is training and bulking, that carbs are king...but they're also in a calorie surplus...

    The carbohydrate-insulin theory of obesity discounted the role of energy balance in any of these equations.

    That's the whole problem with it. The theory rested solely on the role of insulin causing fat storage.

    The only mention that I can recall off the top of my head in the whole thing about energy had to do with increased energy expenditure due to fat oxidation if eating a high fat diet. I believe that was supposed to be the mechanism for weight loss.

    From what I can also recall, that increased energy expenditure effect only lasted three weeks.

    My recall might be faulty here.

    I believe that was already addressed by Krieger in a previous research review: http://weightology.net/weightologyweekly/index.php/free-content/free-content/volume-1-issue-7-insulin-and-thinking-better/insulin-an-undeserved-bad-reputation/


    tl;dr - insulinz iz not da debilz.

    Yup. I love that.

    I always say that people who say "insulin makes carbs store as fat" are only telling half the story because of what I learned from reading Krieger.
  • lemurcat12
    lemurcat12 Posts: 30,886 Member
    Here's a good explanation of Hall's past 2 studies, especially the second one. There's an interview between him and Yoni Freedhoff included:

    http://www.thenutritionwonk.com/single-post/2016/05/02/Is-the-Insulin-Theory-of-Obesity-Over
  • GottaBurnEmAll
    GottaBurnEmAll Posts: 7,722 Member
    lemurcat12 wrote: »
    Here's a good explanation of Hall's past 2 studies, especially the second one. There's an interview between him and Yoni Freedhoff included:

    http://www.thenutritionwonk.com/single-post/2016/05/02/Is-the-Insulin-Theory-of-Obesity-Over

    So it's still... satiety and energy balance.

    Whod've thunk it.

    I find the increased EE in the very low fat diet interesting, though. I eat low fat, but I don't think I could go as low as the test subjects did in that first study.
  • AlabasterVerve
    AlabasterVerve Posts: 3,171 Member
    I like Hall, Guyenet, Freedhoff and the rest but I don't believe the insulin hypothesis of obesity is quite as dead and buried as they believe. It just makes so much sense and seemingly fits my experience to a T - a low carb diet shuts down that drive to eat and keep eating like a light switch for me.

    I think the hypothesis still has merit and is worth investigating further.
    The existing paradigm doesn’t work and it’s time for new thinking! The Calories In, Calories Out model states that weight control is simply a matter of eating a bit less, and moving a bit more. Although our modern food environment may offer many temptations, it’s ultimately a question of will power. However, this way of thinking disregards a century of research showing that body weight is controlled more by biology than will power over the long term. Indeed, the obesity epidemic has progressed despite an incessant focus on calorie balance by the government, professional nutrition establishment, and, recently, the food industry (witness the 100 Calorie Pack). To add insult to injury, the conventional model blames people with obesity for failure to control their calorie balance. But if conscious control of calorie balance were so crucial, how did people manage to avoid massive swings in weight before the notion of the calorie was invented a century ago?

    Contrary to claim, the Insulin-Carbohydrate model is founded on solid science, as detailed above and summarized here:
    • The body fights back against calorie restriction, with increased hunger and lower metabolic rate — biological adaptations that make weight loss maintenance progressively more difficult over time.
    • Metabolic dysfunction involving fat cells has been definitively shown to precede overeating, at least in some models of obesity.
    • Primary hypersinsulinemia promotes calorie storage in adipose tissue, lowers the concentration of calories in the blood stream, triggers overeating, and causes long-term weight gain. In a state of hyperinsulinemia, restriction of food intake may diminish the rate of weight gain, but does not prevent excess adiposity.
    • Highly processed carbohydrates cause more insulin secretion, calorie for calorie, than any other food, and are consistently associated with the most weight gain in the best cohort studies [Mozaffarian].
    • The highest quality weight loss diet trials — with measures to assure differentiation between treatment groups — show clear advantages of a reduced glycemic load diet compared to a low fat diet.
    • Reducing glycemic load appears to attenuate the biological adaptations antagonizing weight loss, including decreased energy expenditure [Pereira, Ebbeling].

    Thus, the Insulin-Carbohydrate model argues that calorie restriction causes a state of deprivation in the body, resulting in the hallmarks of starvation: rising hunger and falling energy expenditure. This pushback from the body can be mitigated by diet quality — especially by reducing consumption of highly processed carbohydrates — resulting in long-term weight loss with less difficulty. The Insulin-Carbohydrate model also provides a more plausible explanation than lack of willpower for the poor results of conventional diets (as most people with obesity have a strong desire to achieve lasting weight loss).

    Of course, much more research will be needed to reach a full understanding of the etiologies of obesity and individual variability in response to treatment. Until then, we must keep our minds open to new, potentially more effective approaches to the public health crisis of obesity-related disease.

    Ludwig
  • Gianfranco_R
    Gianfranco_R Posts: 1,297 Member
    AlabasterVerve wrote: »
    I can't remember if it was Hall's study or not but I think there's supposed to be a recent study where they injected glucose or insulin or some such intravenously and it had no impact on hunger? I wonder if that's this study.

    I'm sure we'll hear more soon.

    I think you are referring to this one:
    https://www.ncbi.nlm.nih.gov/pubmed/27356203
    (K.Hall is not among the authors)
  • walkdmc
    walkdmc Posts: 529 Member
    Yesterday I tried to respond to someone on the first page who questioned whether I *really* believed insulin was an independent factor in weight gain but failed (lost my c&p, then forgot...old person's issues).

    I believe it's an independent risk factor but that differs from saying it's the exclusive risk factor. Calories matter, sure, but I think we need to acknowledge that we've been lauding the CICO model for weight loss at the exclusion of other factors, for too long. For like 30 years CICO has shown time and again it's not great for maintenance of weight loss. There are human studies that show with a drop in caloric intake, there's a reciprocal drop in metabolic rate.

    Maintenance is the key factor to study, not weight loss. People lose weight all sorts of ways but we all know that stat of 90-95% gain it back. Sure, there are a anecdotal reports all over MFP of users doing only CICO, eating anything in moderation and losing weight. However, we should be looking at long term weight loss maintenance instead because that's where we'll spend most of our time (hopefully).

    As far as doing a randomized, double-blind clinical trial on thousands of people to determine insulin's role in weight gain, you'll likely not see one. It would require something like an identical twin study where both are the same weight, free of diabiates, eat the same foods but one is injected with insulin and one, saline. That kind of study will never be approved in a responsible nation. So, we rely on vague stats and loads of opinions. I think, then, we really need to figure out who has the most valuable opinion. I look to physicians who have had hundreds and sometimes thousands of patients on low carb, low sugar, some variant of fasting-type diets. I look at their writings, listen to their podcasts, scan the original human studies they cite.

    Gah, that was so long but it's based on the frustration of seeing the beating of the CICO drum repeatedly, for decades, with complete disregard for the role sugar and carbs play in our weight and health. (You can thank big food/agriculture lobbyists for that). When I read about people asking, "can I eat (insert high sugar processed food)?" and others respond with "IIFYM" and "no foods are bad"....ugh, I can't even. There are bad foods. Can you eat them? Absolutely. Can you eat them daily? You can but it's a horrible idea.
  • lemurcat12
    lemurcat12 Posts: 30,886 Member
    edited January 2017
    Editing to break this up:
    walkdmc wrote: »
    For like 30 years CICO has shown time and again it's not great for maintenance of weight loss. There are human studies that show with a drop in caloric intake, there's a reciprocal drop in metabolic rate.

    I don't think this is true at all. Societally calories have gone up and up over the past 30 years. Yes, when you lose weight you need to eat less to maintain it, but that has nothing to do with CICO. Also, yes, there's often a metabolic effect of being overweight and losing weight (although how much and how permanent is to be determined), but again that's not contrary to CICO or supportive of the insulin theory (nor is there evidence that low carbing prevents it).

    Are there other kinds of studies you are referring to?
    Maintenance is the key factor to study, not weight loss. People lose weight all sorts of ways but we all know that stat of 90-95% gain it back.

    Because they eat more than they burn again. The issue is the factors that help people not overeat, but that has nothing whatsoever to do with calories in vs. calories out being an accurate explanation or not. They do mean that more is typically needed for many to help with psychological factors (IMO, this is largely about structure). And, as Side Steel said low carbing definitely could be the answer for some. But not because insulin trumps calories.

    (Also, there's no evidence that low carbing has a better success rate than any other diet. Might it for you? Sure. Just as 80-10-10 vegan might for someone else.)
    As far as doing a randomized, double-blind clinical trial on thousands of people to determine insulin's role in weight gain, you'll likely not see one. It would require something like an identical twin study where both are the same weight, free of diabiates, eat the same foods but one is injected with insulin and one, saline.

    The Hall study was pretty close -- did you follow my link?

    One group ate very low carb and did have a huge decrease in insulin, but that didn't lead to more fat loss.

    But sure, if you just want someone to agree with your opinion, you can find a diet guru and podcasts saying that. I like nutrition podcasts and have listened to lots of low carb and paleo leaning ones, as well as lots of plant based, low fat ones. Eh, they all say basically the same thing in support of their own pet ways of eating. I think CICO is what matters and beyond that we have to figure out what works for us to have a sustainable, healthy diet that is calorie-appropriate. (My carbs would likely be considered low by many although they are nowhere near keto.) What I find irresponsible and annoying is to tell people that your way is the only workable way.

    One last point before I respond to the complaints about diet advice given on MFP, and an important one -- eating a healthful diet or not has nothing, nothing whatsoever to do with the insulin hypothesis. I hope you understand that. You can eat a very low carb diet with little insulin response that is extremely unhealthful and fails to meet nutrient needs. And, you can eat a very high carb diet that has a much higher insulin response that is nevertheless extremely healthful and easily goes way beyond many nutrient needs (I think this is even easier, but I've played around with WFPB diets). Most "junk" food isn't "carbs!" but about half carb/half fat.

    (Response to the "people on MFP don't give the right nutrition advice" in a following post.)
  • lemurcat12
    lemurcat12 Posts: 30,886 Member
    AlabasterVerve wrote: »
    I like Hall, Guyenet, Freedhoff and the rest but I don't believe the insulin hypothesis of obesity is quite as dead and buried as they believe. It just makes so much sense and seemingly fits my experience to a T - a low carb diet shuts down that drive to eat and keep eating like a light switch for me.

    I don't think they are claiming this part of it is disproven, but then I haven't seen the newest study yet. I would consider this separate from the insulin hypothesis (as Freedhoff and Hall explain in the interview I linked, for example).

    I do think there likely is an appetite effect in some people, whether it's insulin or something else (I've seen other theories on that).
  • lemurcat12
    lemurcat12 Posts: 30,886 Member
    walkdmc wrote: »
    ...the frustration of seeing the beating of the CICO drum repeatedly, for decades, with complete disregard for the role sugar and carbs play in our weight and health.

    Nope. It's the claim that carb percentage makes a whit of difference in health that I think is a hobbyhorse of many, despite the fact that the evidence doesn't back up the scapegoating at all. Look at traditional diets that have excellent health results, throughout the world. Blue zones in particular. Many are reasonably high carb, even compared to the US, but do nothing negative for health. This idea that carbs (as if carbs were even one thing) are making us sick makes no sense. Is the US diet on average bad? Yes, but not because 50% carbs is inherently bad. Do any nutrition guidelines recommend eating lots of junk food or sugar? No, they don't. If you chose to eat lots of processed high sugar products and not much veg, that was NOT the result of nutrition recommendations and is not a problem with "carbs" generally.
    (You can thank big food/agriculture lobbyists for that).

    Actually, Stephan Guyenet (who I am a fan of) recently did a good analysis of the too often unexamined claim that US guidelines of the past pushed us into overeating sugar (and it's worth noting that one thing we did not do was actually decrease fat, despite that being part of the recommendations). Anyway, despite what you may hear on your podcasts, it is false. I think this is worth reading -- the diet recommended is quite a good one and NOT like people ended up eating, of course: https://www.cato-unbound.org/2017/01/11/stephan-guyenet/americans-eat-too-much-cake-government-isnt-blame
    When I read about people asking, "can I eat (insert high sugar processed food)?" and others respond with "IIFYM" and "no foods are bad"....ugh, I can't even. There are bad foods. Can you eat them? Absolutely. Can you eat them daily? You can but it's a horrible idea.

    You are distorting the advice given, so I have to ask why?

    I know this, because I often give the advice. What is said is that you should eat a healthful diet that meets nutrient needs and is calorie appropriate -- for health. Moderate means that if you want to you can include within that diet amounts of your favorites that don't happen to be especially great for meeting nutrient needs (one of mine is really good cheese), within your calories and nutrient requirements (and macros if you watch those specifically).

    What is NOT said, ever, is that you should ignore nutrition or it doesn't matter.

    Now, if someone asks specifically about the mechanics of weight loss -- can I lose weight eating only Twinkies? Then people will usually say "yes, but obviously no one does that -- but for an experiment, of course -- and it's not a good idea, and it will be easier to meet calories and you will be healthier and feel better if you eat a good diet."

    So why distort what is said as if it were something else? I really am curious. I hope it's because you somehow misunderstood and not merely because it's easier to argue against.

    I also say, btw, that for satiety and satisfaction you should experiment with macros and lower carbs do help some portion of the population, especially those with IR.
  • ahoy_m8
    ahoy_m8 Posts: 3,053 Member
    edited January 2017
    lemurcat12 wrote: »
    AlabasterVerve wrote: »
    I like Hall, Guyenet, Freedhoff and the rest but I don't believe the insulin hypothesis of obesity is quite as dead and buried as they believe. It just makes so much sense and seemingly fits my experience to a T - a low carb diet shuts down that drive to eat and keep eating like a light switch for me.

    I don't think they are claiming this part of it is disproven, but then I haven't seen the newest study yet. I would consider this separate from the insulin hypothesis (as Freedhoff and Hall explain in the interview I linked, for example).

    I do think there likely is an appetite effect in some people, whether it's insulin or something else (I've seen other theories on that).

    Agreed.... Hall & Freedhoff specifically stated that insulin impact on satiety & hunger merit separate study. That is apart from the insulin-weight gain hypothesis. Looking at the biological mechanisms, they are two separate results (appetite & weight). Looking at practical application, though, it feels like a fine distinction, as hunger/satiety and CICO are related, perhaps inextricably.
  • lemurcat12
    lemurcat12 Posts: 30,886 Member
    ahoy_m8 wrote: »
    lemurcat12 wrote: »
    AlabasterVerve wrote: »
    I like Hall, Guyenet, Freedhoff and the rest but I don't believe the insulin hypothesis of obesity is quite as dead and buried as they believe. It just makes so much sense and seemingly fits my experience to a T - a low carb diet shuts down that drive to eat and keep eating like a light switch for me.

    I don't think they are claiming this part of it is disproven, but then I haven't seen the newest study yet. I would consider this separate from the insulin hypothesis (as Freedhoff and Hall explain in the interview I linked, for example).

    I do think there likely is an appetite effect in some people, whether it's insulin or something else (I've seen other theories on that).

    Agreed.... Hall & Freedhoff specifically stated that insulin impact on satiety & hunger merit separate study. That is apart from the insulin-weight gain hypothesis. Looking at the biological mechanisms, they are two separate results (appetite & weight). Looking at practical application, though, it feels like a fine distinction, as hunger/satiety and CICO are related, perhaps inextricably.

    One reason I think it's a very important distinction is that the insulin hypothesis would be true for everyone. The appetite thing could be true only for some people (consistent with how low carb seems to have a beneficial effect on IR people in some studies while IS people do better with low fat in those studies, as well as with the fact that satiety seems to be quite individual).
  • cwolfman13
    cwolfman13 Posts: 41,865 Member
    walkdmc wrote: »
    Yesterday I tried to respond to someone on the first page who questioned whether I *really* believed insulin was an independent factor in weight gain but failed (lost my c&p, then forgot...old person's issues).

    I believe it's an independent risk factor but that differs from saying it's the exclusive risk factor. Calories matter, sure, but I think we need to acknowledge that we've been lauding the CICO model for weight loss at the exclusion of other factors, for too long. For like 30 years CICO has shown time and again it's not great for maintenance of weight loss. There are human studies that show with a drop in caloric intake, there's a reciprocal drop in metabolic rate.

    Maintenance is the key factor to study, not weight loss. People lose weight all sorts of ways but we all know that stat of 90-95% gain it back. Sure, there are a anecdotal reports all over MFP of users doing only CICO, eating anything in moderation and losing weight. However, we should be looking at long term weight loss maintenance instead because that's where we'll spend most of our time (hopefully).

    As far as doing a randomized, double-blind clinical trial on thousands of people to determine insulin's role in weight gain, you'll likely not see one. It would require something like an identical twin study where both are the same weight, free of diabiates, eat the same foods but one is injected with insulin and one, saline. That kind of study will never be approved in a responsible nation. So, we rely on vague stats and loads of opinions. I think, then, we really need to figure out who has the most valuable opinion. I look to physicians who have had hundreds and sometimes thousands of patients on low carb, low sugar, some variant of fasting-type diets. I look at their writings, listen to their podcasts, scan the original human studies they cite.

    Gah, that was so long but it's based on the frustration of seeing the beating of the CICO drum repeatedly, for decades, with complete disregard for the role sugar and carbs play in our weight and health. (You can thank big food/agriculture lobbyists for that). When I read about people asking, "can I eat (insert high sugar processed food)?" and others respond with "IIFYM" and "no foods are bad"....ugh, I can't even. There are bad foods. Can you eat them? Absolutely. Can you eat them daily? You can but it's a horrible idea.

    If you are losing weight with a keto diet, you are by default dropping caloric intake. People fail to maintain because they fail to actually adopt healthy habits and go back to basically eating the SAD and dropping exercise once they've lost weight.

    I'm going on four years maintenance...my maintenance level of calories is higher now than it was before because I'm more active. I eat around 3,000 calories per day to maintain...more during cycling season.

    CICO is just the equation...it applies to all diets...you consume more energy than is required, you gain weight...you consume less energy than is required, you burn body fat to make up the difference...you consume a balance of energy, you maintain weight.

    I eat vegetarian about 3 days per week and I eat quite a few vegetarian meals on omnivore days as well...vegetarians tend to eat higher carb...my staple foods consist of lentils, legumes, whole food starches like potatoes and sweet potatoes, etc. Even in a cut I'm getting around 200+ grams of carbs per day with the way I eat...I'm in very good health. Carbs do not equal "junk food" and just sugar. As I stated previously, most of the blue zone traditional diets are higher carb...they are some of the healthiest cultures on the planet. Look at the Mediterranean diet...it is considered one of the overall healthiest diets out there...tends to be carby...

    When people respond that others can eat those "bad" foods, they're talking about eating them in moderation...not all of the time or having one's diet consisting primarily of those foods. Like I said, I eat very healthfully...I'm very fit and healthy...I eat well and exercise on the regular...I also take my kids out for pizza after their soccer and football games on Saturday...pretty sure I'm ok with that.

    Like I said...4+ years maintenance.
  • ndj1979
    ndj1979 Posts: 29,136 Member
    walkdmc wrote: »
    As a recent fan of ketogenic diets and fasting, I'm really interested in this topic. I would geek out over this study but the link requires $32 to access the article which I'm not paying.

    I'm a bit biased in that I wholeheartedly believe insulin is a growth factor and excess levels lead to weight gain. I don't think it's the only cause of weight gain but it's a major player, IMO. Given those beliefs, I'd like to know exactly what the "refeeding" diet included. How many patients were enrolled? How did they determine insulin is not an independent factor for weight gain? And probably most importantly, who funded this study? I guess I need a lot more info. than what was provided.

    I find it interesting at the end of the abstract (but honestly, that wasn't even an abstract, didn't outline the study design or specific results) they state, "Therefore, important aspects of carbohydrate-insulin model have been experimentally falsified suggesting that the model is too simplistic." I'm not 100%clear on what they intended with that statement but I *think* they're just reaffirming their study results which we don't really know. I would apply the same statement to the old CICO model.

    CICO is not a model, it is a mathematical equation
This discussion has been closed.

Categories