Thinking about obesity and diabetes

Outside of heart disease and statins, another area I have been studying for many years is diabetes. Not type I diabetes (caused by destruction of beta-cells in the pancreas and a lack of insulin), but type II diabetes. Type II diabetes has nothing to do with a lack of insulin, it is generally considered to be caused by insulin resistance i.e. enough insulin is produced, but there is ‘resistance’ to its effects.

This resistance firstly drives up the insulin levels. However, as it worsens, the raised insulin levels are no longer sufficient, so the blood sugar levels rise anyway. At first the fasting sugar levels may be normal, but the response to a sugar ‘test’ shows an abnormally high level about an hour later. This is why a glucose tolerance test (GTT) used to be the way of diagnosing early stage type II diabetes.

This has been superseded by the HbA1c test. This test, essentially, looks at the amount of glucose that has stuck to your red blood cells over the last month. Which gives an idea of what the ‘average’ sugar level has been over a longer time period. It is a better measure.

Anyway, without getting too bogged down in technical details, the model that is used to explain type II diabetes is very simple.

  • You eat too much
  • You become obese
  • As you become more and more obese you become more and more insulin resistant
  • Your insulin level rises to overcome this resistance
  • At some point the resistance become too much
  • You develop raised blood sugar levels aka type II diabetes

I call this the ‘blowing up a balloon’ model of diabetes. As the balloon expands, you need to blow harder to get more air in.

This model (or variations thereof) is almost universally agreed, by almost everyone. It should come as no surprise, therefore, that I do not agree with it. Yes, there is not the slightest doubt that diabetes and obesity are related. In fact, there is no doubt that obesity; insulin resistance and type II diabetes are closely related.

Equally, there is no doubt that if people lose weight, their diabetes can go into reverse, and ‘reversibility’ is one of the most powerful pieces of evidence possible in proving causality. So where exactly, you may think, is my problem?

My problems first started with the recognition that you can find far too many direct contradictions to this model. Just to look at two examples. First we can look at the least obese people in the world. Those unfortunates who have a condition called ‘Beradinelli-Siep generalised lipodystrophy’. In this condition you have no fat cells – at all. So, of course, the rate of type II diabetes in these people would be zero…right? Wrong, the rate of type II diabetes is 100%.

Then we have Sumo wrestlers, the single most obese group of people on earth. So, they all have severe insulin resistance and type II diabetes right…? Wrong, whilst in training, none of them have type II diabetes.

In short:

  • Thinnest group of people in the word, 100% diabetes
  • Fattest group of people in the world 0% diabetes

Or to put this another way round, it is clear that obesity is neither necessary, nor sufficient to cause type II diabetes. If you were a follower of Bradford Hill, or Koch, of Popper this, effectively, writes off obesity as a possible causal factor for type II diabetes.

But, but.

But what?

To move sideways for a moment or two. When you first read about type I diabetes, one of the things that stands out is that those diagnosed with type I (at least in the past) lost weight very rapidly. They grew thinner and thinner, becoming almost like skeletons – before they all died. Why?

Why, is because insulin is the energy storage hormone. It does not just affect blood sugar levels. In fact, the almost obsessive focus on the interplay between insulin and blood sugar has blinded almost everyone to the fact that insulin does far more than just lower sugar levels. It affects fat, protein and sugar metabolism. It interacts with many different pathways in adipose tissue, muscle cells and the liver. Lowering blood sugar may be, in some ways, the least important thing that it does.

The reason why you die in type I diabetes has little to do with blood sugar levels. You die because, without insulin, fats escape from adipose tissue and travels to the liver as free fatty acids. In the liver these fatty acids are automatically converted into ketone bodies (which the body uses for energy in a fasting state).

The ketone bodies are, in turn, acidic, and in a high concentration they cause ‘acidosis’. This acidity overwhelms the alkali buffering systems, and you die in a keto-acidotic coma. To reiterate, it is not the high sugar that kills you in type I diabetes, it is the uncontrolled release of fats. This has nothing to do with sugar at all – except indirectly. Which, although you may not think it, returns us to the matter in hand. Namely, what is the association between obesity and diabetes?

As we have seen, without insulin, fats escape from fat cells at a high rate, so you lose weight. If we turn this though one hundred and eighty degrees, it should be clear that, if you have too much insulin in your bloodstream, fat can no longer escape from fat cells, and you will get fatter and fatter.

Essentially, insulin is obesogenic. A fancy way of saying that if you produce too much insulin you will become obese. An amazing fact ‘discovered’ in August 2014

 

“DALLAS – August 25, 2014 – UT Southwestern Medical Center researchers have identified a crucial link between high levels of insulin and pathways that lead to obesity, a finding that may have important implications when treating diabetes.”[1]

Yes chaps, well done. You made a breakthrough discovery of the absolute bleeding obvious. You mean, insulin makes you fat? Well who’d a thunk? Well, lots and lots of people actually. At which point, let me introduce you to the Pima Indians of North America. This race has an almost unbelievably high rate of type II diabetes. It is greater than 50%. Perhaps more. Are they obese, yes? Of course. However, of greater interest is that Pima Indians, long before they become obese and/or diabetic, produce far, far, more insulin than any other race [2]:

‘The normal and prediabetic Indians had fasting and stimulated insulin levels during all the tests two-to-threefold greater than the Caucasians. Differences in insulin levels between the two races could not be explained by differences in glucose level, age, or obesity.’

Interesting… It is clear that the model with the Pima Indians is, as follows:

  • You produce too much insulin
  • You become obese
  • You become insulin resistant
  • You develop type II diabetes

Of course, it is not just the Pima Indians where this happens. This causal chain works for us all. It contains most of the same ‘factors’ as the blowing up a balloon model of diabetes (although you will notice it does not contain the ‘you eat too much’ factor). However, as you can also see, the facts are in a different order. I like to call this, the correct order.

In short, yes, obesity, insulin resistance and diabetes are closely associated. But not quite in the way that everyone believes.

Moving on. What, you might think, would cause people to produce too much insulin. Well, what foodstuffs cause the greatest rise in insulin levels? Why, let me think… Yes, carbohydrates would cause the greatest rise in insulin levels. So if you eat lots of carbohydrates, you will produce lots of insulin. Insulin forces fats into fat cells and stops it escaping. Insulin is obesogenic… Join those dots ladies and gentlemen.

P.S. Pop quiz. What do you think happens if you try to force blood sugar levels down in type II diabetes by prescribing insulin?

P.P.S. So why does everyone with Beradinelli-Siep syndrome have type II diabetes? Answers on a postcard please.

1: http://www.utsouthwestern.edu/newsroom/news-releases/year-2014/august/high-insulin.html

2: http://www.ncbi.nlm.nih.gov/pubmed/89223

165 thoughts on “Thinking about obesity and diabetes

  1. Jennifer

    Aw….c’mon Dr K…..I am trying to get your book read asap! But this new topic is just right up my street! Looking forward to all the excellent responses which will inevitably come in…..and what about the reactions from NHS? the mind boggles.

    Reply
  2. mikecawdery

    Dr Kendrick

    First, I must congratulate you on your book “Doctoring Data”. While I was aware of many of the points you made, your revelations in black and white rams these points home in all their starkness. After 60 years in research this loss of scientific integrity to Money and Status reminds me of the totally closed minds of fanatical ISIS followers. Wither medical science and particularly those “DIRECTIVES” issued by the medical establishment.( BMJ 2013;346:f3830 doi: 10.1136/bmj.f3830 (Published 14 June 2013) “Why we can’t trust clinical guidelines” by Jeanne Lenzer)

    “This model (or variations thereof) is almost universally agreed, by almost everyone. It should come as no surprise, therefore, that I do not agree with it. “

    Thank goodness for those that challenge the “consensus” because so often that consensus is driven to by science but by closed mind individuals and not by science (examples: six weeks “bed rest” for CVD; stress causes GI ulcers, No infection, etc).

    More importantly I believe that many chronic conditions, such as Diabetes T2, were/are caused by official advice/directives such as high carb and low saturated fat (Thanks to Ancel Keys,Stammler et al). When I was training diabetes T2 was unknown (shows my age) mellitus and insipidus only.

    Anyway please keep up your challenges to “consensuses”.

    Reply
  3. mikecawdery

    Sorry a correction required

    Dr Kendrick

    First, I must congratulate you on your book “Doctoring Data”. While I was aware of many of the points you made, your revelations in black and white rams these points home in all their starkness. After 60 years in research this loss of scientific integrity to Money and Status reminds me of the totally closed minds of fanatical ISIS followers. Wither medical science and particularly those “DIRECTIVES” issued by the medical establishment.( BMJ 2013;346:f3830 doi: 10.1136/bmj.f3830 (Published 14 June 2013) “Why we can’t trust clinical guidelines” by Jeanne Lenzer)

    “This model (or variations thereof) is almost universally agreed, by almost everyone. It should come as no surprise, therefore, that I do not agree with it. “

    Thank goodness for those that challenge the “consensus” because so often that consensus is driven not by science but by closed mind individuals and not by science (examples: six weeks “bed rest” for CVD; stress causes GI ulcers, No infection, etc).

    More importantly I believe that many chronic conditions, such as Diabetes T2, were/are caused by official advice/directives such as high carb and low saturated fat (Thanks to Ancel Keys,Stammler et al). When I was training diabetes T2 was unknown (shows my age) mellitus and insipidus only.

    Anyway please keep up your challenges to “consensuses”.

    Reply
  4. Flyinthesky

    Type II diabetes to me seems like a gigantic wheel of misfortune.
    I’m tending to think that type 11 causes obesity not obesity causes type II.
    The cycle starts by eating too much leading to a massive spike in insulin level, that spike in quite a short time leads to a large drop in sugar level, that drop then informs the body that it is in need of sustenance, a feeling of dire hunger falls upon the person. “I feel very hungry” so I must need a large intake of food to satiate it. The whole cycle starts again.
    Over time the body normalises to this elevated state of insulin leading to obesity and increased average blood sugar sugar tolerance.
    The “only” time I feel dire hunger is when I’ve eaten too much three or four hours earlier. The best response would be ignore the feeling or eat a very small snack.
    Hunger in people who eat far too much can manifest in different ways, the shakes, aggression, light headedness etc all down to rapidly falling blood sugar levels, the only relief to be gained is by starting the circle again.

    Any release date for the kindle edition yet, I can’t read physical books and can the bonus material given with the book be purchased separately.

    Reply
    1. mikecawdery

      Flyinthesky

      There is another (of many) book on Kindle that outlines the horrid history of the lofat/hicarb diet that has caused the epidemics of obesity, diabetes, deficiencies, neurological problems and goodness knows how many other chronic conditions over the last 50+ years.
      It was based on pseudo-science, non-science and political interference by fanatics with the zeal and venom that I associated with ISIS – but then.
      The book:

      Teicholz, Nina (2014-06-25). The Big Fat Surprise: why butter, meat, and cheese belong in a healthy diet (Kindle Location 2080). Scribe Publications. Kindle Edition.

      Reply
  5. cath

    Fascinating article. I am very interested in the subject of insulin. I have always had problems a few hours after eating sweet things during the day. A cake in the middle of the afternoon leads to a real drop in blood sugar a couple of hours later. I can feel pins and needles around my mouth and my vision becomes affected and I feel generally unwell. So, I don’t eat cake in the afternoon!!!. I am slim and eat very little carbohydrate and sugar. My doctor has always assured me that I must have high insulin levels and this explains what happens. I’ve never been convinced. Am now really confused! Can you please explain why I have such a dramatic drop in blood sugar? I don’t feel quite normal and am always being accused of ‘being good’ when I refuse cakes and snacks. This doesn’t seem to happen when I have sweet things after a meal? confused!!

    Reply
  6. Gretchen

    Two factors I think are of relevance:

    1. Genetic studies have shown that most of the genes associated with T2 affect beta cells, not IR.

    2. Hibernating grizzlys. In the fall, when they need to put on weight, they become very insulin sensitive. Then once they’re fat and in their dens, they become insulin resistant. This would mean they’d gain weight easily in the fall, and then when hibernating, the insulin resistance would ensure that the muscles didn’t burn much glucose, sparing it for the brain. The muscles would burn fat.

    The problem is in applying this to humans. If the same is true in humans, the insulin sensitive state would occur before significant weight gain and long before any hints of diabetes, so researchers wouldn’t think to look for it.

    One fact arguing against this is that nondiabetic relatives of people with T2 often show IR.

    People with diabetes have known for eons that going on insulin is associated with weight gain. Doctors (OK, *most* doctors) dismiss this by saying they were peeing away the extra calories before the insulin.

    Keep thinking outside the box. We need creative answers to this serious problem.

    Reply
    1. John U

      “One fact arguing against this is that nondiabetic relatives of people with T2 often show IR.”
      Could you provide some reference for this statement? I am surprised by it. I would like to know how the IR was measured.

      Reply
      1. Gretchen

        I don’t have the reference handy. I have about 300 references around waiting to be filed. Why don’t you google it?

  7. Ali

    As you say, Dr. Kendrick, *** obvious. Those of us who low-carb have been trying to get the message through for years. I find though, that I am so resistant, insulin barely works at all now. The only way I seem to be able to lose weight is to fast, but that triggers Ketosis big-time, so perhaps that isn’t the answer either. A plant-based diet maybe for a while to trigger Ketosis but help buffer the acids? Bit stuck between the Devil and deep blue sea. Carbs not good, Ketosis not much better. Sigh.

    Reply
    1. annewatts1

      Mild ketosis associated with normal blood glucose is not a problem. It’s only when you have high levels associated with high blood glucose due to low/no insulin and acidosis develops. Don’t fear mild ketosis of fasting and fat burning, you won’t be acidotic- it’s normal.

      Reply
      1. Dr. Malcolm Kendrick Post author

        Yes, a good point. If anyone fears a bit of ketosis because of what I have written, please do not. I was talking about the catastrophic keto-acidosis of untreated type I diabetes only – prior to the discovery of insulin by three great men.

  8. Spokey

    It seems odd to me that insulin itself on its own causes insulin resistance, I’ve never quite believed it. I mean it doesn’t make sense, why would an organism develop a hazardous resistance to its own storage hormone? I feel like there has to be more to it than that.

    Reply
    1. Flyinthesky

      The human function has evolved over millennea, it’s predisposed to adapt to prevailing circumstance. We now have a situation where, unfortunately, the organism is trying to adapt. A bit of a case where 2+2 = 5.
      We are now eating carbs far in excess of our evolved capabilities. The body is trying to adapt but failing and returning the wrong solution.
      We have inherited a boat, some of us think it’s an aeroplane that can be made to fly, no it’s a boat, if you try to fly it you’ll sink it.

      Reply
      1. Sue Richardson

        Perhaps it’s worth considering that maybe we arent ‘adapting’ to our modern diet, because humans were not created to eat the things they eat now, and that’s why we are getting sick. If we had really been evolving over millions of years, wouldn’t we be evolving and adapting to our changing diet as well? There doesn’t seem to be a remote sign of it, and it is as you say, beyond our capabilities. If man has evolved over the millennia then perhaps we should sit back and say ‘ah well it will all be ok in a few million years, when we have adapted’. But we don’t because we know very well that we are eating the wrong diet and we need to put it right.

      2. Richard Gibbs

        I would dispute the assertion that humans have not adapted to the modern diet. The ability to digest certain foods and the toxicity of various foods is strongly linked to the ABO blood group for several reasons (Intestinal Alkaline Phosphatase (IAP) activity, specificity of various lectins for ABO type, and secretion of ABH antigens into the digestive tract where they are food for various bacteria and thus affect the composition of the digestive tract fauna). The ability to digest fats is related to IAP activity, which is very low for blood type A and high for type O. This is the reason for many type As doing poorly on a high fat low carb diet.

        Blood type A is very old and types O and B evolved from it. Studies have shown that type A probably disappeared, probably because it was at an evolutionary disadvantage for hunter gatherers. However type A reappeared as a result of the genetic interaction of types O and B. As humans started to eat cooked wild grains, at least 100,000 years ago, type A had an evolutionary advantage, so it survived; type As do much better on grains than type Os.

      3. Jennifer

        I have so far been reluctant to acknowledge the ABO blood connection with obesity, as mentioned by Richard Gibbs….but I mentioned this morning in my response to Mary, that I developed Type II and my husband landed in the obese league after about 40 years of a shared and very similar diet. (Except for the endless tins of Quality Street ever present on the Nurses’ station in years gone by). But I over-indulged in the size of sugary foods served, and he over indulged in the bread and potato as served….2nd helpings of puds for me…..2nd and 3rd chip butties for him.
        My B/P, glucose, triglycerides and (dare I say it) cholesterol, became way above the accepted norm….his all within acceptable levels.
        We both follow HFLC now, and my bloods etc are great….his remain the same. I have settled down to maintaining a 20lb weight loss, (BMI shifted from close over to close under 25), and he has maintained a 4 stones weight loss with his BMI settled nicely at about 26……better than at any time in his life.
        My blood group is O, and his is A.
        Carbs seem to be implicated…but differing types for different blood groups. I reckon it will take more than a postcard to fathom this out, so good luck with your investigations.

  9. Dillinger

    Pop Quiz #1

    You get fatter.
    You become more insulin resistant.
    You take more insulin.
    You get even fatter.
    You become even more insulin resistant and on and on until you pop your clogs which is a terrible shame but we all know Type 2 diabetes is progressive.

    Or b) you stop eating carbs and everything rights itself.

    Reply
  10. Jonathan Christie

    Brilliant!

    The remedy, accordingly, is to restrict carbohydrates.

    Dr Richard K Bernstein’s low carbohydrate diet permits normal blood sugars in most all diabetics who undertake it, including moi. Allick et al elucidated the mechanism in 2004: “We conclude that short-term variations in dietary carbohydrate to fat ratios affect basal glucose metabolism in people with type 2 diabetes merely through modulation of the rate of glycogenolysis, without affecting insulin sensitivity of glucose metabolism.” Low carbs, low glycogen, low glycogenolysis -> normal blood sugar. If the numties at The American Diabetes Association adopted this strategy, diabetics would live a lot longer …

    Reply
    1. Anne

      Moi aussi, as I wrote below, I’m a Type 2 diabetic who follows Dr Bernstein’s extremely low carbohydrate protocol. My blood glucose levels are normal. I’m thin, always have been. His dietary protocol works for both Type 1’s and Type 2’s, though obviously a Type 1 needs basal insulin and small amounts of insulin at meals….but only small amounts of carbs too.

      Reply
  11. Chris

    The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) is based at the National Institutes of Health (NIH) Headquarters in Bethesda, Maryland. On there pages I found the following, though dating it and attributing it isn’t easy. It mentions the Pima:

    http://www.diabetes.niddk.nih.gov/DM/pubs/pima/obesity/obesity.htm

    “World War II brought great social and economic change for American Indians. Those who entered military service joined Caucasian units. Many other American Indians migrated from reservations to cities for factory employment and their estimated cash income more than doubled from 1940 to 1944.

    “When the war and the economic boom ended, most Native Americans returned to the reservations, but contact with the larger society had profoundly affected the Pimas’ way of life. Ravussin says it is no surprise that the increase in unhealthy weight among the Pima Indians occurred in those born post-World War II.

    “During this century people world-wide experienced more prosperity and leisure time, and less physical work. Since the 1920s, all Americans have consumed more fat and sugar and less starch and fiber. The greatest changes have occurred in consumption of fat. In the 1890s, the traditional Pima Indian diet consisted of only about 15 percent fat and was high in starch and fiber, but currently almost 40 percent of the calories in the Pima diet is derived from fat. As the typical American diet became more available on the reservation after the war, people became more overweight.

    “The only way to correct obesity is to eat less fat and exercise regularly,” Ravussin says.”

    Erm, no:

    If insulin levels are high then carbs (that get converted to fats) and fats in the diet will be directed to fat cells to become adipose tissues.

    If insulin levels are lower then the fatty aspects of adipose tissues can be released from fat cells, shipped, and converted to fuel the body.

    Nothing leverages insulin levels to the extent that blood glucose does, and the source of that is refined carbohydrate. If fats in blood leveraged insulin to the extent that glucose does then the body would never be able to release and burn the energy stored as body-fat.

    Ravussin ought to go north to study the grisly.

    This bear has just 240 days to feed itself for a full year. It has to meet its energy budget for a full twelve months by feeding from just eight months. Just so long as it retires with enough condition (body-fat) to last a four month period of hibernation it can emerge in the spring ready to do it all again. With cortisol levels down, and insulin levels down, the hibernating bear enters fat-burning mode and it can sleep through, no need to visit the bathroom, and no compulsion to raid the larder. It doesn’t take exercise to lose weight, quite the reverse. The bear is extreme amongst mammals, but the basic physiology, cues, and responses are essentially common amongst mammals, including us.

    Also see:

    http://www.earthinginstitute.net/?p=2233

    .. .. in which Dr Stephen Sinatra discusses reversal or partial reversal of diabetes in relation to Earthing and Earthing theory.

    Reply
  12. Richard Gibbs

    People with Beradinelli-Siep syndrome have no adipose tissue, so they produce no adiponectin. From the Wikipedia article about adiponectin, http://en.wikipedia.org/wiki/Adiponectin, “Levels of the hormone are inversely correlated with body fat percentage in adults”, so obese adults don’t produce so much. Also “Adiponectin in combination with leptin has been shown to completely reverse insulin resistance in mice.” It seems to me that adiponectin is the hormone that signals that the body wants to store more fat, so when the body is obese the level drops and the body becomes insulin resistant.

    Reply
  13. raphaels7

    Your arguments and those of science journalist Gary Taubes put a whole generation of obesity researchers to shame, in part, because you both don’t shy away from falsifying you hypotheses. Maybe someone should whisper that to Dr.Stephan Guyenet…

    Reply
    1. mikecawdery

      “put a whole generation of obesity researchers to shame,”

      Indeed that is correct.. the whole history of the lofat/hicarb disaster is an example of pseudo-science, non-science and ignorant political interference based, at best on denial, hidden data and doctored data.
      For a good review:
      Teicholz, Nina (2014-06-25). The Big Fat Surprise: why butter, meat, and cheese belong in a healthy diet (Kindle Location 2080). Scribe Publications. Kindle Edition

      Reply
  14. elliesandiego

    A friend asked me how to subscribe to your posts and neither of us could figure how it’s done…Please make it more obvious–you are one of the few blogs I relish!  Ellie Winslow, Gaylord, OR http://beyondthesidewalk.com Author of five books for farmers and crafters–a trilogy to make the small farm profitable….and “Making Money With Goatsplus mindingthemiddleagedmiddle.com

    Reply
      1. Wendy G

        Dr. K – the “follow” button only works for fellow WordPress users. May I suggest you add a WordPress widget to your sidebar; the widget is called “Follow Blog”. People can then enter their e-mail addresses, and WordPress will e-mail these followers your new blog posts. I think this is what Ellie San Diego and her friend are seeking.
        Cheers,
        Wendy

  15. Professor Göran Sjöberg

    Great reading again!

    Sounds like you are closing in on the Swedish LCHF-movement 🙂

    The big problem is then, if I understand the equally great reading of your new book right, that you will also lose part of your health when you lose those extra kilos flying out with the carbs.

    I was ‘attacked’ recently by a woman standing behind me in the restaurant line at IKEA with my ‘large meat balls’ having declined all the extras except for adding a large cup of bernaise sauce. She exclaimed ‘LCHF!!!’. Turning my head this vert thin lady confessed being a ‘veggie’ and adding that her brother in law had turned ‘too slim’ on that ‘LCHF-stuff’ which made her real worried. And a type 2 friend of mine following my ‘teaching’, having lost all his extra weight and does not take any medicine for his T 2, is now being attacked along the same line by his daughters: “If you now get sick you will not have any backup resources left!”

    Having lost 20 kg myself and being stable, +/- 1 kg, at exactly ‘normal’ BMI (74 kg for 186 cm) for a few years now I would not cry if I could gain back some weight. Without adding carbs this fight though seems to be quite futile for me but works immediately on adding some carbs again but then, of course, I have to abandon my ‘FAITH’ and the good fat food.

    Reply
    1. mikecawdery

      Hi Prof,

      There is something called the “Obesity Paradox”. Apparently The “overweight” live longer than “normal” or “obese” (Flegal of the CDC 3 paper consistent) and the obese fare better after hospitalization (Am J Med. 2007 Oct;120(10):863-70.
      Obesity paradox in patients with hypertension and coronary artery disease.) Try Sandy Szwarc’s http://junkfoodscience.blogspot.co.uk/ for her take on the obesity paradox.

      Reply
    2. David Bailey

      Surely if someone really is getting ‘too slim’ on LCHF, the answer is to relax the regime slightly. Of course, maybe he wasn’t ‘too slim’, but only looked slim compared to his family!

      After 60 years of extreme diet advice – supposedly based on the best scientific evidence – I feel wary about taking diet advice too far in any direction. I have come to realise that dietary research in humans is very hard to do, and as Jerome Burne points out, even animal dietary research can be badly distorted:
      http://healthinsightuk.org/2015/01/05/why-high-fat-diet-studies-on-rats-and-mice-are-not-to-be-trusted/

      I feel that medical science really needs to embark on a phase of profound humility, and be far less inclined to hand out advice to well people, perhaps realising that, left alone, most people eat a reasonable diet – certainly better than current NHS guidance! I was given advise to take Simvastatin, and that might have put me in a wheel chair (and it also raised my blood sugar level). A humble medical science would adopt far more of an ‘if it ain’t broke, don’t fix it’ approach.

      I am convinced that LCHF does make sense, but who knows what may happen if it is taken to extremes.

      Even in the days when I believed and roughly followed the HCLF diet, I remained slim, as I am now on a somewhat LCHF diet (more of an ‘eat what you like so long as it isn’t sweet diet’), so I think individuals vary a lot.

      Reply
      1. Professor Göran Sjöberg

        As a ‘dead man walking’ since 15 years now the only one who has not been amazed by my comparatively healthy state after having refused all the medical treatments, was my latest (last?) cardiologist who made it clear during the very first few minutes of our encounter that he was not interested. Because he was the one who KNEW! And followed the GUIDELINES, period!

        After getting loose with two chain saws yesterday on the tree trunks taken down by a recent winter storm in my garden I must though admit the my muscles are rather sore today.

        My own ‘BELIEF’ is that when you have entered the so called metabolic syndrome you have been trapped by the excessive carbs in the officially recommended HC-diet and have worn out your insulin ‘recovery’ system. In other word you might have turned ‘allergic’ to the carbs as my T2 wife can be witness of.

        In my constant efforts to try to understand something about the medical profession my favourite subject is the molecular biology involved in our physiology. This has, however,made me completely exhausted when facing the incredible complexity of the chemical substances interacting with one another in our ‘homeostatic’ bodies.

        Now reading about our proteins (important bricks!) in the standard textbook on this subject (Alberts et al.) there are about 21 000 (equals the number of our genes) to start with but evidently many more can be produced by the subsequent interacting steps following the decoding of the genes. MIllions? Nobody seems to know! With that knowledge in the back of my head meeting with stern docs, like my cardiologist, does not instil much trust in me.

        I recently read in a newspaper for engineers that a Swedish professor (not me!) at the Royal Institute of Technology had successfully spent more than 10 million USD tracking where the ‘h..l’ all those proteins harbour in our bodies. He had been able to track about 10 000 of them – thus a ‘mere’ fraction of those roaming around. To his astonishment it seemed that all of them were present i almost all cells at the same time. Surprise, surprise!

        Modern ‘precision medicines’ are known to be very good at targeting specific proteins and by plugging the specific receptors on the cell walls. With a typical medicine hitting ‘all cells’ at the same time collateral damages (side effects) should not come as a surprise to an informed patient.

        “Profound humility” would not hurt in medicine as you point out.

        Until then – my advice is keep away from the docs!

      2. mikecawdery

        BMJ 2013;346:f3830 doi: 10.1136/bmj.f3830 (Published 14 June 2013)
        Why we can’t trust clinical guidelines
        Despite repeated calls to prohibit or limit conflicts of interests among authors and sponsors of clinical
        guidelines, the problem persists. Jeanne Lenzer investigates
        Jeanne Lenzer medical investigative journalist

        Guidelines are really DIRECTIVES to working docs. The name guidelines is to protect the authors from litigation.

      3. Professor Göran Sjöberg

        To continue on the good idea of a humble medicine I read on page 123 in Alberts the following encouraging word towards such a goal.

        “The complexity of living organisms is staggering, and it is quite sobering to note that we currently lack even the tiniest hint of what the function might be for more than the 10,000 of the proteins that have thus far been identified through examining the human genome.”

        Well – molecular biology is to me science contrary to medicine.

        Science could not be science without the humbleness – it is inherent!

      4. mikecawdery

        supposedly based on the best scientific evidence…

        I like “supposedly”. Teicholz, Nina (2014-06-25). The Big Fat Surprise: why butter, meat, and cheese belong in a healthy diet (Kindle Location 2080). Scribe Publications. Kindle Edition. goes into the detail of the money and scams used to promote LFHC, trans fat safety etc for maintaining PROFITS for money greedy executives. The same scams have been used to promote drugs etc. Corrupt is the only word that I can use – the rest would upset the moderator

  16. Anne

    I am a thin Type 2 diabetic (very thin, always have been, BMI under 18). Of course endo doesn’t know exactly what I am, but I’m not insulin resistant and I haven’t got Type 1. I keep excellent control of my diabetes with an extremely low carbohydrate diet, 30 to 50g carbs per day spread out. Dr Richard Bernstein’s book ‘Diabetes Solution’ is an excellent book for both Type 1’s and Type 2’s – same extremely low carbohydrate protocol, in fact the Type 1’s, like Dr Bernstein, himself need to be especially vigilant about carbs because if they eat too many they will need more insulin to counteract the raised blood glucose and can get a see-saw effect of low and high blood glucose. Type 1’s who eat lots of carbs can even become insulin resistant if they are not careful and end up with Type 2 to boot !

    P.S. What do you think happens if you try to force blood sugar levels down in type II diabetes by prescribing insulin?

    They get fatter and more insulin resistant.

    P.P.S. So why does everyone with Beradinelli-Siep syndrome have type II diabetes?

    They are all insulin resistant so will get Type 2.

    Reply
    1. Gretchen

      “What do you think happens if you try to force blood sugar levels down in type II diabetes by prescribing insulin? They get fatter and more insulin resistant.”

      Sometimes blanket statements are dangerous. I’m a T2 and I take insulin, and I’m slowly losing weight. However, I’m on a LC diet.

      Reply
    2. mikecawdery

      I tried to get an insulin test at my local NHS Trust. They did not do the test because the “the treatments are the same for low and high insulin levels”
      I wrote to the makers of the sulfonylurea I am using (allergic to metformin) and asked about the concomitant pharmokinetics of gliclazide and insulin. The answer was that so far as they knew nobody had studied this issue.
      Not helpful!

      Reply
  17. Daniel

    Answers :
    1)They get fatter.
    2)Insulin keep rising as there are no fat cells to store excess energy and the body is looking for somewhere to store it.

    I’m an electrical engineer and these are my best guesses.

    Reply
  18. George Henderson

    Off hand I will guess that sufferers from Beradinelli-Seip syndrome have T2D because there is nowhere for fat to go except for the liver and pancreas, hence lipotoxicity is making alpha cells insulin resistant and there is thus a high output of glucagon. Which acts on all the free fat available.
    You are partly wrong about diabetic ketoacidosis, this is reliant on hyperglycemia which creates the state in which ketoacidosis is lethal, unlike the ketoacidosis of starvation. For example loss of fluid volume due to polyuria is a complicating factor and this is mainly due to hyperglycemia.

    Reply
  19. tcprag

    Thought provoking as always. Hopefully it won’t be too long before you turn your attention to hypothyroidism, another area where the “experts” are competent to deal with only the straightforward cases that respond to administration of levothryoxine.

    Reply
      1. mikecawdery

        How about something on selenium? Se is involved in the selenoproteins and the last time I checked there were some 30+ molecules, many associated with the thyroid.

      2. David Bailey

        I think another medical subject that you could usefully explore, is the plethora of new tests offered to well people as we get older.

        PSA, mamography, faecal blood detection, Alzheimer’s blood tests, and/or mental tests, etc. (The first two are mutually exclusive, of course).

        These all sound sensible, until you read that they can produce a lot of false positives, leading to more invasive tests, or even unnecessary treatments – not to mention the stress!

      3. Mary Richard

        Dr. Kendrick, I would also like to see alternate views on hypothyroidism. Both my children developed this as they entered puberty. Strange and shame on me because they had different fathers. I was divorced. I have never had it, however, I suppose it was the All American diet I fed them when I was none the wiser. Both children, however, have a keen interest in nutrition and weight management and do quite well in that arena. They are quick to read labels and are avid readers. However, at a very young age, my daughter, had to have her thyroid removed and it was malignant. So…I worry so about them both. I rather make a pest of myself when it comes to their health. They are champions of moderate fat, moderate carb, and fresh vegetables. Still, I worry and would love to hear others who have this condition give me some solid advice.

        This particular blog is fascinating.

        Dr. Kendrick, I watched your “extra” I got with Doctoring Data. It was very informative and of course, funny, too. What a gift for making others feel comfortable when one can poke fun at the ridiculous. It was so interesting and I will watch it again. But, there is one thing I would like to hear from you and that is: When do you feel medications are indicated? I know diabetes and cancers are hot topics, however, where do you draw the line professionally when it comes to medications? I am a little confused when I hear things like “stay away from the doctors”. Had I not brought my children to a doctor when they seem to suffer some kind of malaise I could not understand, I would not have known they had hypothyroidism. Or, is this too over diagnosed?
        Thanks,

      4. mikecawdery

        lorrain
        The RCP’s guidance is based on the opinion of an expert panel which was temporarily formed for this purpose.

        This is the problem. Personal opinion which may be conflicted but it does not excuse the absence of supportive references.

        Why we can’t trust clinical guidelines – Jeanne Lenzer. BMJ 2013;346:f3830 doi: 10.1136/bmj.f3830 (Published 14 June 2013).

        Prof Peter Gotzsche goes into this in detail in his book “Deadly Medicines and Organized Crime….The RCP’s guidance is based on the opinion of an expert panel which was temporarily formed for this purpose.

  20. Andrew Chitty

    Dear Malcolm

    This is very interesting. I have two comments.

    (1) The orthodox model for T2D is:

    excess food consumption
    causes obesity
    causes insulin resistance (which causes as a by-product high insulin levels)
    causes diabetes (= raised blood sugar levels)

    excess carbohydrate consumption
    causes high insulin levels
    causes obesity
    causes insulin resistance
    causes diabetes

    The last part of this model is the same as the standard model. (In the standard model insulin resistance also causes high insulin levels but this is not relevant for explaining why insulin resistance leads to diabetes, only for explaining why it takes some time to do so.)

    So like the standard model your model says that obesity causes diabetes. The difference from the standard model is only in how obesity is caused.

    But then why do Sumo wrestlers have no T2D?

    (2) This suggests a third model:

    excess carbohydrate consumption
    causes high insulin levels (which causes as a by-product obesity)
    causes insulin resistance
    causes diabetes

    So those who got became obese without high carbohydrate consumption would not tend to get diabetes.I don’t know what Sumo wrestlers eat but if they had a low carboydrate diet model 3 would explain why they don’t get diabetes.

    (3) How would you test these models?

    The difference between models 1 and 2 is a difference in their answers to the question ‘What causes obesity?’. Presumably you can test this (in mice) by feeding them different high-calorie diets and seeing which one makes them fat quickest.

    The difference between models 1/2 and 3 is a difference in their answers to the question ‘Does excess carboyhdrate consumption cause diabetes directly (regardless of whether it also makes the person obese)?’ You could test this in mice by feeding two sets of mice a high carbohydrate diet, one with an exercise regime to keep them slim, and one without any exercise so that they become obese. If both sets develop diabetes, model 3 is supported. If only the obese ones get diabetes, models 1 and 2 are supported.

    Reply
    1. Dr. Malcolm Kendrick Post author

      Thank you for your thoughtful reply. Sumo wrestlers do not have type II diabetes because they exercise a great deal. Exercise burns off visceral fat – which is the form of adipose tissue that is the problem in type II diabetes (an entire area of research here). Sumo wrestlers also eat a very high carb, low fat diet. They know that this is way to get fat – subcutaneous fat. In your body you have two type of adipose tissue. Subcutaneous and visceral/omental. Subcutaneous fat is, essentially, metabolically neutral. Visceral fat, however, is a very different thing indeed. If you remove visceral fat from diabetic rats, their diabetes resolves immediately. [BTW, nutritional experiments on mice are almost entirely useless, if you want to know what happens in humans. You might as well feed a cat a diet entirely made up of vegetables, watch it die, then conclude that vegetables are terribly unhealthy for humans]. The interplay between visceral fat, subcutaneous fat, glucagon and cortisol, the metabolism in the liver and skeletal muscle is a complex dance indeed.

      Here, however, are three other points to add in.

      1: subcutaneous fat is an, almost innocent, bystander in insulin resistance/diabetes
      2: exercise can ‘cure’ type II diabetes, even when it has no effect on BMI/obesity
      3: LCHF can ‘cure’ type II diabetes – because if you don’t eat carbs/sugar your storage systems cannot fill up with glucose

      Oh yes, indeed, complex it is young Obi Wan – just try looking up the effects of cortisol on visceral fat sometime.

      Reply
      1. Pat

        Thank you very much indeed for your blog and to others for their very interesting comments.

        Despite being of total Scottish origin I seem to have a thrifty genetic makeup like the PIMA Indians (I store fat well and so am a little fatty). Good for periods of severe famine which we, in GB, don’t have these days although there are many pockets of poverty left.

        I have been on low fat lower carb diets for years and exercised fairly well. After being diagnosed as T2D a higher carb diet helped me, during my first year, to reduce my wayward (out of approved arbitrary? range) blood sugar readings from half to about 10% and my HBA1c from 6.8 to 6.2. My exercise regime was exactly the same both years. Alas I did not loose much weight. I behaved myself by staying on the high carb diet for a long time because my readings were stable but I changed my exercise regime to a hard slog on an exercise bike for up to an hour a day. End result was a resting heart rate below 50, massive calf muscles, alas no real weight loss. I discovered an NHS web site where I put my details in and the response was surprising. I was told well done and keep up the good work despite not losing weight and it suggested I took up squash. I collapsed with laughter because I was 67 at the time. Someone forgot to include a what if in that computer program. I was naughty enough to tell my GP about this and he hit the roof and told me that it would kill me – he thought I was daft enough to take that advice.

        My HBA1cs have been in the 5.8 to 6.1 range and my self monitoring close to that over a decade or so. I have not stuffed myself I don’t like being over full. As a migraine sufferer you might believe that I do not get drunk. I find the peer pressure to eat what looks like interesting delicacies a real pain and I only drink water socially. Some people get very upset about this.

        Over the last decade I have seen a very slight upward creep in my own numbers from 5.9 to 6.2. Most of the time I have been on a high carb diet. During the last three or four years, in order to keep control of my blood sugar readings, evasive action has been taken and I have thrown out all of the carbs I added to my diet over a decade ago and a little more. 2007 was a good year for me with hardly any wayward readings and my average daily carb consumption was 187gm now it is 46gm. OK there is probably no formal definition of a ketonic diet but I have slight to feeble changes in colour in ketosticks.

        Side effects yes. I had a couple of evenings with gas and acid reflux which is unusual for me. I ate a little extra to help. It was included in my records. The first week I did not feel on top of the world and occasionally still feel a bit strange – woozy – but then I am loosing weight far too fast at an average of 1.1Kg a week over the last four weeks This is a pleasant problem I have not had for years.

        If anyone is in doubt about a high fat diet low carb diet I would suggest go for it. I did not loose much weight on a daily diet of 60gm of carbs.

        I will now confess my real sin – I do like fatty food much apart from cheese.

        I have only dipped into Dr K’s latest book since my husband is reading it but I am minded to change my target weight to a BMI of between 25 to 30!

        Thank you very much indeed Dr K and also to fellow bloggers for recommending Zoe Harcombe, Barry Groves, Dr Lustig, Dr Perlmutter, Dr Enig etc etc. I have had more help from this blog than from the surgery. This blog is very important to me. I may have protected myself from statins, BP lowering drugs, etc but I assure you I was persuaded to have one of the deadly medicines – not for long!

        Dr K I like your succinct description of the management of obesity but it does not go far enough for me. You forgot to mention their lack of understanding of basic stats. My euphemism for that was having no numerical commonsense. The main point is what management of obesity? You are all helping me with this. One size does not fit all.

        Regretfully on anger management I can only suggest a mild tonic for cat lovers. Try googling Simons Cats or buy a copy of Simon’s Cat by Simon Tofield published by Canongate Books Ltd.

      2. Pat

        Very sorry indeed my OH has pointed out a sloppy mistake towards the end of my response. I do not like fatty food much at all.

        It looks as if my long term bad habits of not eating much fat and eating too fast may have contributed to my diabetes.

      1. Professor Göran Sjöberg

        Gretchen

        I have read that as well and for sure the sumos are retiring early.

        I have also read that there are two levels among these wrestlers. The higher ones, the more athletic, are ‘feeding’ on 60 % carbs and with more muscles whereas the lower level sumos are feeding on 70 % carb, at the highest level of the dietary guidelines.

        So I wonder where the horse and where wagon are placed when it comes to carbs, obesity and diabetes. My guess is the the carbs is the horse.

        By the way, earlier in Sweden we used the name ‘sugar sickness’ for diabetes, might be a similar expression in english (?), which tells you what it is all about but my guess is that name was not popular among Big Pharma and their dieticians and thus dropped.

      2. Gretchen

        Forgot to add, I think the “sugar” refers to sugar in the urine, to distinguish from diabetes insipidus, not sugar in the diet. But folk wisdom does blame getting type 2 on eating a lot of sugar. In the month or so pre-Dx, I really craved sugar. One time I drove 17 miles because I was out of it. I suspect this is common, and “folk” have noticed it and concluded that the sugar had caused the disease.

  21. Liz

    Thank you, thank you for that lucid explanation.
    You always look under the surface, see the bigger picture.
    The trouble is; the establishment goes for easy, obvious answers.
    I am a T2, shocked by early retinopathy, I started ‘eating to my meter’ (ie, lowering my carb intake so that my blood glucose stayed under 8 mmol/l) 8 months ago. I have indeed reversed my T2, latest HbA1c 33 and lost 6 stone.
    However, a couple of months ago, weight loss stalled because my glucose meter told me I could eat more carbohydrate. My T2 was better, I could eat more and still keep my blood glucose normal. I am still 3 stone overweight, so I have had to reduce my carb intake to 40g per day again to continue losing weight.
    This proves your theory in my eyes (which I have always suspected). The underlying defect of carbohydrate metabolism is what makes T2’s fat, not overeating. We just cannot handle carbohydrate.
    The current medical advice to T2’s to eat complex carbohydrate is crazy. Brown rice, pulses had the same effect on my blood glucose as pure sugar. The GI theory is nonsense. It is often difficult for T2’s to be prescribed test strips for meters. so we are told to eat carbohydrate and are given no way to determine what effect this has on our bodies. I had to buy my own meter. It is rare to be given them by the NHS. Yet the £100 or so that it spent on my test strips has done more for my health than anything else they have ever done for me.
    The main advice for treatment of T2 is to lose weight. If only they could come up with a workable strategy for that! There is more likelihood of being cured of cancer than obesity.
    I would like to hear your views on the current management of obesity Dr Kendrick. There’s an awful lot of bunk talked there too.

    Reply
    1. Dr. Malcolm Kendrick Post author

      My current views on the management of obesity have to be edited due a tendency to use far too many swear words. In short, it is thus… ‘They are all a bunch of complete idiots with no understanding of human physiology or biochemistry.’ Message ends.

      Reply
    2. Jennifer

      Liz, I stopped telling myself that I am ‘diabetic’….but, I still tell the world I am ‘diabetic’ because the population instinctively understand why I avoid carbs. But, I consider myself ‘carbohydrate intolerant’. It is only words, I know, but ‘diabetes’ suggests being ill, whereas ‘CHO intolerant’ allows me to think that my fantastic physiology displays a superior attitude to the rubbish sold in the name of ‘food’.
      In other words I am now a ‘food snob’, and all the better for it.
      A diagnosis of ‘Diabetes’ is music to the ears of Big Pharma.
      ‘CHO intolerant’ is anathema to the food industry, which thrives on cheap carbs with long shelf lives.
      I am the sort of person who is the but of jokes….so that is why I use ‘diabetic’ in public, but at home, those who love me, know the truth…..I am carb intolerant.
      Carbs are not essential for any body functions! yes…..they are as tempting to me as a fag is to the smoker….but…..just as dangerous, and to be avoided as best I can….then…no need for glucometers…..finger pricks….carb counting….oh…the liberation!!!!!
      p.s. completed The Book last night…..loved every word of it. Well Done, Dr K.

      Reply
      1. Liz

        Jennifer, I agree wholeheartedly with every word you say.
        At one point, I was frightened my GP would stop prescribing my strips but I don’t even test anymore. My DM is tightly controlled by avoiding carbs and I am becoming svelte and lovely too! This I see as a sustainable way of life, but it sure is hard to explain socially while all around you are tucking in to starch and fructose. At a potluck supper the other day, I had to explain 5 times why I wasn’t joining in. They looked at me with various levels of incomprehension and dismissed me as a faddy dieter. This is no fad it is my health and the route to enjoying a healthy old age.
        They think that you are a greedy, weak willed slob for acquiring T2, they think you are nuts when you do something about it. We can’t win.

    3. Professor Göran Sjöberg

      Liz

      My wife had really serious peripheral neuropathy 5 years ago (gradually coming on during a couple of years) – that was how we realised she was a severe T2 case. (The health service had, scratching their heads, not figured that out!) Doing some ‘homework’ her T2 case was crystal clear to us and we decided from one day to the next that if she gets sick from ‘sugar’ we better cut everything that has to do with raising blood sugar levels – read all carbs.

      In three (!) days 30 year old problems with the bowel disappeared, her severe neuropathy improved immediately and was virtually gone within about a year. Her impaired vision in darkness that made her unable to drive when it was dark outside returned within about half a year. Her glaucoma diagnosed earlier had disappeared completely. As a bonus she lost 12 kg without intention and is completely ‘normal weight’.

      Without any medicine at all blood sugar meter levels are now constantly around 5 for both of us.

      Just thinking of what is going on in ‘health service’ relating to T2 world wide makes me feel sick again. 200 million (or is it 400 million?) T2 cases and rapidly growing means great business as long as they stay within the health service realm and not start doing any thinking on their own.

      Isn’t this a grotesque situation we are in?

      Reply
  22. mikecawdery

    ‘They are all a bunch of complete idiots with no understanding of human physiology or biochemistry.’

    Dr Kendrick That really is a most trenchant remark and sums up most effectively the real truth.

    However, I suspect it will generate more of the “You are killing your patients” criticisms

    Reply
    1. Dr. Malcolm Kendrick Post author

      As some people have said apropos of many other things… ‘Bring it.’ I think they will fear arguing this area too strongly as they must know that, deep down in the place where they fear to look too closely, that they are utterly and completely wrong.

      Reply
  23. anglosvizzera

    Dr Kendrick, I wish you had a counterpart who had an interest in mental health issues for young people…..the treatments are sorely in need of an overhaul (eg taking diet and nutrition into account and correcting deficiencies/providing sufficient supplements before throwing drugs at everyone!!)

    Reply
    1. Professor Göran Sjöberg

      anglosvizzera

      Well – I fully agree with your concerns. The field of psychiatry seems to me to be the most corrupt part of medicine. One of my former students was actually ‘lost’ in this medical marshland. These kind of pills is to me like throwing stones on someone who is drowning at the same time as you are telling him that you are saving him. Ugh!

      If you want, like me, to get really turned into ‘fire’ – you could watch the following short interview with, unimaginably low key, professor Peter Goetzsche who like Dr. Kendrick is fighting the penetrating corruption of Big Pharma.

      http://www.madinamerica.com/2015/01/dreams-quick-fix-gone-awry/

      By the way, the journalist of science, Robert Whitaker has written two books on this issue which are leaving the emperor of psychiatry with the same dress as in which he was born. Chocking heretic reading indeed!

      Reply
    2. Mary Richard

      Anglosvizzera,
      I so agree. Just talk to any teacher in elementary and high schools (in the U.S.) and you will see that something is deeply disturbing about these children’s behaviors. My sister is a teacher. She has been attacked, bitten, cursed at (by parents as well) and stalked. And…she is an elementary public school teacher. There is no telling what these kids are eating at home, but the diets in the school cafeterias are utterly disasters waiting to metabolize. Something is amiss and I fear it is so much more than diet but also sociological.

      Reply
  24. Stephen Rhodes

    There seems to be a concensus here that if carbs are avoided we will all become healthier.

    I suspect that it is rather more complicated than that.

    Historically there are groups of humans who have thrived on many disparate diets, including diets high in carbs.

    The only factor in common among the diets eaten is the absence of sugar and processed grains. The suggestion being that these are the ‘carbs’ that should be avoided. (e.g. in ‘Death by Food Pyramid’ Denise Minger). There are other very recent additions to our diet, such as chemically extracted omega-6 polyunsaturated oils, that also appear to be problematic in the quantities now consumed, regardless of whether they were present in the historic diets we had become adapted to.

    The secret, if such a thing exists, is discovering who your inner ‘Eskimo’ or ‘Pima’ is i.e. the genetic adaption your ancestors had to the diet they ate for millennia, then should that not be enough, you will have to investigate how the environment your mother carried you in modified your genes i.e. the epigenetic adaptation.

    Research continues apace (i.e. Future management of human obesity: understanding the meaning of genetic susceptibility at http://www.dovepress.com/getfile.php?fileID=22699 ) but diagnostic advances seem slow to appear.

    The recent (2008 onwards) ‘discovery’ of a link between the number of copies of the AMY1 gene and obesity would suggest that testing for this genetic variation may help in weight control. You really should avoid carbs if you have a low number of copies, but not so much if you have many. But there is still no research that ‘discovers’ how the link ‘works’.

    Reply
  25. DBM

    Dr Kendrick

    I spent an absorbing Saturday last week reading your new book and was completely enthralled and entertained, I agreed with every word. Thank you for writing such an important, brave and funny book.

    I glad you have decided to tackle this subject as it is something that has piqued my interest in the last few years ever since I read your first book and then Gary Taubes’, Why We Get Fat and Good Calories Bad Calories . I was complety convinced that LCHF was the way forward, lost over 2 stone effortlessly and wouldn’t shut up about it. There is no doubt that the LCHF approach to diabetes and obesity is very effective and I have seen fantastic results when my patients have taken my advice to take this up.

    However, just because LCHF can reverse the markers of diabetes , improve BMs ,HbA1c and reduce weight, it does not necessarily follow that low fat high carb diets cause diabetes. There are plenty of people world wide who eat a high carb diet and are perfectly slim and not diabetic. While I would not advocate veganism or frutarianism at all, there are folk out there who stuff their faces with starch and fructose and look pretty healthy and slim and seem to tolerate ridiculous amounts of carbs without any difficulty.

    Remember, people with diabetes are metabolically broken and can not tolerate carbs, LCHF can reverse the effect of diabetes but it does not cure it. As soon as they start eating excess carbs things start going south again; they remain glucose intolerant. If it hurts raising your hand above your shoulder, not raising your hand stops you from experiencing pain but it doesn’t fix your shoulder problem.

    I am well aware of the LCHF narrative that the last 30 years of fat phobia has driven the current epidemic of dia-besity but I think that is slightly missing the point ;It is not so much fat phobia but fear of saturated fat particularly that has been the problem. The fear of saturated fat has resulted in its substitution with vegetable oil. Over all fat consumption may have decreased over the last few decades but vegetable oil consumption has increased massively , I think over the last century its consumption has risen 1000 fold , could it not be that this hugely significant change is not the slightest bit to blame for most of our current, modern maladies?

    I think that increased insulin resistance is caused in large part by increased consumption of polyunsaturated fats. Sumo wrestlers get fat because they eat an enormous amount of food , up to 10,000 calories a day but this is mainly from noodles, rice, beer, vegetables, chicken and fish maybe they are protected by developing diabetes as this diet is relatively low in poly-unsaturated fats.

    In the same way people who eat high carb and low (polyunsaturated) fat, for example kitavans and okinawans, and don’t experience diabetes and obesity. In fact low fat high carb diets end up being high saturated fact diets as the excess carbs are converted to saturated fat for storage in the form of palmitic acid and mead acid and the high levels of fibre are converted to butyrate by gut micro-biome.

    Reply
    1. Dr. Malcolm Kendrick Post author

      You raise very good points. It is always necessary, in a blog, to use broad brush strokes. It is clear that there are many players in this field. I am not entirely sure about the connection between unsaturated fats and diabetes, but as a general rule I am guided by ‘Did billions of years of evolution create biological entities (e.g. humans) able to eat vast quantities of substances never before seen on earth e.g. artificially created polyunsaturated fats?’ Answer, no. So, could these things be damaging to health. Answer, probably yes.

      Reply
      1. DBM

        Thanks for the reply. I’ve been reading a lot of Ray Peat’s work recently. He is quite a lot like you; in the field of research he is goat stuck in a flock of sheep. He has a number of views and theories which counter the conventional wisdom and his main, recurring, theme is that that polyunsaturated fats are essentially toxic ,cause mitochondrial damage and adversely affect metabolism. Once your mitochondria are dysfunctional they are not able to oxidise glucose effectively and glucose intolerance ensues.

        Adding to this, mitochondrial dysfunction is most likely a key player in the genesis of cancer, which is probably why there is such a close association between cancer and diabetes. As with obesity and diabetes, LCHF diets hold huge promise in the treatment of cancer. Ketogenic diets have proved to be very effective for astrocytomas particularly.

        For more on this I highly recommend ‘Tripping Over the Truth, The Metabolic Theory of Cancer’ by Travis Christofferson. It’s an excellent account of the history of the treatment of cancer and how all the research has been barking up the wrong tree for the last 80 years, chasing the genetic cause for cancer whilst over looking the one fact that is common to all cancers; they all have mitochondrial dysfunction and are not able to oxidise glucose. The consequence is that glucose is permanently fermented and the lactate that is produced plays a large role in the formation of mutations that characterise cancer.

      2. bernard

        On the link between cancer and mitochondria, please think that MgCl2 is scientifically proven to be the best catalysor of all ATP cycle in mitochondria, and that Delbet published a book in 1944 showing that when ground contains Mg, then cancer rate is 10 times lower. Now we should make the line between the points 🙂

      3. BobM

        I never ate polyunsaturated fat, but ate very low fat (less than 10% of my daily calories from fat) and developed insulin resistance and gained weight while exercising a lot. My normal meals would be oats/some other hot cereal product for breakfast, pasta for lunch with red sauce (lowest fat stuff I could buy), and brown rice and beans with salsa for dinner. Maybe some rice cakes for snack. I ate only lean meat, if I ate meat at all, and only vinegar on salads (no oils whatsoever). I almost never had prepared foods. In my opinion, polyunsaturated fat has little or nothing to do with insulin resistance.

        Now, i eat as much fat as possible per day. However, I still avoid polyunsaturated fats (other than the omega 3 type) to the extent I can.

      4. Chris

        Barry Groves researched high carbohydrate and highly polyunsaturated diets and didn’t much care for them, nor the ‘healthy’ claims generally made for them. See his book, Trick or Treat.
        I began with concern for polyunsaturated fats a full seven years ago, DBM, and I too think overconsumption of polyunsaturated fats, especially the preponderance of the omega-6 types found in marg and veg oils, constitutes an un-healthful trend. However I have long given up thinking any disease has one single cause to do with habit or cause. I think key hormones, along with their balances and cycles, rank as the ‘Crewe Junction’ (a busy rail interchange) between cause and effect.
        In order to link cause with effect in the domain of chronic disease I think you have to think in terms of a trend towards physiological and cytological dysfunction that; a) drives the advance and arrival of symptoms, while b) can be linked with the environmental, lifestyle, and dietary misdemeanour’s that give rise to them. And I think it ranks as a major transition in cognition when persons concede it is largely the job of biochemicals to maintain physiological balance, general homoeostasis, and cytological function inside the body, when what’s offered to the body in the way of food, experience, and lifestyle choices, that can be so variable and contrasting. Hormones headline the act here, but so do biochemicals called eicosanoids, and so do a number of several possible cholesterol oxides.
        Loosely speaking this makes hormones (and perhaps other key biochemicals) the middle-men between those perceived risk factors that are genuinely causal, and not false, and any effect. Once you begin to factor hormones into the causal chain (just as Dr Kendrick did in his great post above) then old faithful hypotheses begin to look a bit old-hat. There exists many an endocrinologist who seems to know their subject but cannot drop what they know into the greater context.
        Just about every living thing (be they plants or animals) has light sensitive traits. Key hormonal balances shift on diurnal and circadian bases and drive patterns of activity and rest, sex and reproduction. Our own relationship with light has consequence for cortisol, and my has our relationship with light and with sleep altered since Thomas Edisons great light-bulb moment. Dunlop never tired of rubber, but the advent of shoes made with soles of rubber and plastic have consequences for cortisol.
        The glucocorticoids (hormones like cortisol) and corticosteroids, when they are present in higher concentrations, plausiby compete for antioxidants, thus altering balance in supply and demand of antoxidants, and oxidative stress, and accumulated attrition from oxidative stress, likely contributes to the advance towards many a case of many a chronic disease.
        With this model the details are a bit sketchy on account of their sheer scope, but suddenly diverse and isolated risk-factors and outcomes are bridged by something that makes for a great deal of contextual sense.
        To avoid diabetes (probably) don’t over-consume veg oil and marg, sleep in a room that is adequately dark and sleep when it is dark outside, get plenty of sleep, ‘earth’ yourself while sleeping, enjoy the outdoors as often as you can, walk often and shun the alternatives, and remember fibre and fats in a meal take the glycaemic sting out of the more highly glycaemic carbohydrates. Also remember these habits ought to have the ‘off’ or ‘on’ switches that can apply to individual genes better maintained and deployed more correctly, so your genes do not have to start adjusting to your own maladaptive habits.

        Top tip: If buttered toasts is a guilty pleasure then take the toast sparingly, channel your guilt at the toast and not the butter, and bear in mind that Marmite (or other yeast extract), rather than jam or marmalade, supply helpful antioxidants, but without all that sugar.

      5. Ali

        I wonder about this too. Dr. Mary Enig did loads of research on dietary fats and the roles they play in the body.

        Boiled Flax (Linseed) oil is traditionally used to make varnish. Anyone who has ever used polyunsaturated vegetable oils in a fryer will know how tough it is to scrape congealed oil off the pan. It does turn to varnish.

        Unlike saturated fat that melts and sets, PU oils actually change their properties when heated. If it congeales like that on a fryer, what the heck is it doing to the cells in our bodies, and can the body ever get rid of it???

    2. David Bailey

      I keep thinking about just how much we can ever really know about what constitutes the best diet. I mean, if 60 years was not long enough to exonerate saturated fats – even when researchers knew the original evidence had been faked – how can we ever hope to apportion blame between sugar, other carbohydrates, polyunsaturated fats, salt, assorted deficiencies, and simply eating the wrong amount of food?

      Add to that, the evidence that epigenetic factors can play a role – so children of parents brought up with ready access to food, metabolise food in a slightly different way from children of parents who experienced starvation conditions, and I seriously wonder if science should admit defeat, and simply encourage people to try to eat sensibly (by their own definition) and take exercise.

      Malcolm, when you talk about “substances never before seen on earth”, are you talking purely about trans fats, or are there also cis-polyunsaturated fats that worry you?

      Is it possible that the ‘broken metabolism’ that DBM talks about, might be caused by something other than food altogether – e.g. a virus – but that it was the advice to treat high blood sugar with more carbs that really turned a problem into a catastrophe!

      People

      Reply
      1. Stephen Rhodes

        It is rather trite to say it, but “we are all different”.
        Groups of us who lived together and shared a common diet for thousands of years probable became adapted to that diet. As Denise Minger notes in her book, ‘Death by Diet Pyramid’, there were many such groups around various so called ‘uncivilised’ parts of the world when travel was restricted to the wealthy back in the 19th century and before. In her book she recounts the studies of such groups of people by a North American dentist called Weston A. Price into what turned out to be the health damaging effects of a ‘western’ diet.
        While individuals in these groups shared strong beneficial adaptations to the diets they ate and also knew which foods were important to them for e.g. fertility, the genetic mixing that has occurred over the last 150 years has meant that while almost none of us eat what our ancestors ate, we are also now a mish-mash of many genes which collectively won’t necessarily make us well adapted to any particular diet.
        In her book, Denise Minger concludes that there is no such thing as the ‘best’ diet, but that there are many diets that we have thrived on which are only distinguished by the ‘foods’ that they all either don’t include, or only include in small quantities.
        That we can achieve reasonable health by excluding particular foods is a good start, but it may be difficult to move on from first base considering how ‘mixed’ our genetic adaptations to diet have become – and that, as you point out – is before you factor in the effects of our epigenetic inheritance.

      2. Alan

        Epigenetics is about the effect of environmental factors on cell receptors and DNA but has no inheritance component. At least that’s how I understand it.

      3. mikecawdery

        Re the “unnatural molecules” derived from heated poly-unsaturates, Teicholz goes into the details. Incidentally, it seems that the poly-unsaturated oils used in industrial fryers pose a massive problem in cleaning; and one eats these substances! From anti-saturated fats to lofats to polyunstaurates to trans-fats to unnatural fats – a process from pan to fire repeated and getting worse at each transition.

        Teicholz, Nina (2014-06-25). The Big Fat Surprise: why butter, meat, and cheese belong in a healthy diet (Kindle Location 2080). Scribe Publications. Kindle Edition.

      4. Stephen Rhodes

        Hi Alan,

        The point I wanted to make was that we all inherit a capacity for the environment to have an effect on our cells, so not all of us respond in the same way to our environment – in short your ‘epigenetic’ responses are dependent on your genetic inheritance as well as the environmental ‘stimulus’ to effect change.

  26. bernard

    Hello,
    Nice to read your explanation. I arrived to a close idea, because some years ago i decided to stop industrial sugar (but kept everything else, even carbohydrats).

    The result was that during 10 weeks i was losing 1 kg per week : this was my overweight. But i did not eat 1kg of industrial sugar per week before (or did i ?) ! So i concluded that the industrial sugar has “added signal” to the body, meaning “increase storage”, and with this signal off, the body was not storing, thus decreasing storage.

    Now i avoid the most industrial sugar i can :-).

    Reply
  27. LaurieLM

    Good Doc Malcolm thank you so much for all you think and write; and thank you Liz for this spectacular summation…..”They think that you are a greedy, weak willed slob for acquiring T2, they think you are nuts when you do something about it. We can’t win.”

    I cannot help but be reminded of what (one small thing among a vast amount of larger items) Gary Taubes’ taught me through his first book GC,BC.

    I didn’t see it at first…… He said a pre-teen who is accused of growing because he is eating more- well that is not correct. He’s eating more because he’s growing.
    A person who is accused of getting fat by overeating…….it’s really that.they are eating more because they are growing fatter…. Subtle, but important and telling differences.

    Reply
  28. Jennifer

    DBM. As I said at the top of the blog…..I just KNEW there would be great responses to this new topic, and you have not let me down.
    The topic is interesting, and it is as well that scientists are working away at the basics of our physiology, fathoming out its complexities. As a layperson, I believe that if we can get the simple message across to the masses, i.e. “carbohydrates are the demon responsible for much ill health”, we would be doing human kind a good service.
    Keep repeating the main headline…..
    “Carbs are NOT needed for health, and actually cause ill health”.
    We must learn to disregard the ambiguities of this message, constantly manipulated by the media (such as blaming one type of glucose against another.)…as it is simply a ploy to confuse the masses, and protect the media’s lucrative income from food and pharmaceutical advertising.
    Just keep repeating the critical message…..”carbs cause ill health”.
    Now, some folks will poo-poo the headline, and some will take it on board and perhaps start researching for themselves……as I did. But, repetition, repetition, repetition of the main point is the way forward.
    The story of glucose metabolism and development of cancer is so interesting, and must be studied, but is of little interest to the masses who are busy going about their own business.
    I read out loud this blog to my husband, and as soon as I said the words “mitochondrial dysfunction” he glazed over….whereas I got more interested…..that’s human nature….we react in different ways. (in my mind’s eye, I saw those little red power stations in my A and P books of years passed….simplicity is good at times.)
    BUT…..keep the headline story simple…..”Carbs are NOT needed for health, and actually cause ill health”.

    Reply
    1. DBM

      Hi Jennifer,

      To be honest if someone had said mitochondrial dysfunction to me a few years ago I would have glazed over too, its amazing what a bit of enthusiasm and passion about a subject can do. The problem with being a little obsessed about a subject is that you tend to become a little blinkered and wilfully blind. Selection bias becomes a huge problem and soon you start reading articles and blogs and listening to podcasts that confirm and reinforce your own ideas and prejudices (been there done that). You become convinced of your new ‘truth’ and want to convert others to see things from your point of view. And thats when things become dodgy and one has to be careful about developing a dogmatic and almost religious approach to this.

      After all the reason we got into this mess was because of dogma and misguided guidance; I’m not sure countering this with even more (diametrically opposed) guidance will help as we have to be mindful of unintended consequences. The whole low fat and ‘evil saturated fat’ dogma was exploited by big business for predictable financial gain and who’s to say that the same won’t happen if things are suddenly reversed and the ‘Carbs are Evil’ becomes the new mainstream dogma.

      A case in point is coke and diet coke . Coke has been around for over a hundred years and diet coke was released in 1982 (around the start in the obesity epidemic) to provide for a market that was starting to worry about sugar and calories, and to mitigate potential losses from health conscious people who were worried about drinking full sugar coke. However, in a recent study it has been shown that diet soda drinks can cause obesity via changes in the gut micro biome (sterile mice who had feacal transplants from mice fed diet soda quickly became fat with no other changes to their diet).

      While it is perfectly true one can function perfectly well without any carbs it does not necessarily mean that one should. While humans can survive without carbs it does not necessarily mean that they can thrive without them. I’ve read plenty of accounts of people who have run into significant health issues low carbing for a while so it all massively depends on context and everyone should think for themselves and do what works for them. After all that is the main drive of Dr K’s approach, challenge and question everything even (especially) your own prejudices.

      Andrew Chitty

      I have no studies to hand but the following blog post is an interesting start, a word of warning though , the title is called Diabetes, Dangerous Fat and Protective Sugar….

      http://www.andrewkimblog.com/2013/03/diabetes-dangerous-fat-and-protective.htm

      Reply
      1. Jennifer

        DBM.
        I understand what you are saying regarding me, perhaps, showing a blinkered bias regarding my message that “carbs are NOT needed for health, and actually cause ill-health”. I was wanting to get a message across in a few words, which is bound to be wrought with pitfalls and open to criticism.
        It goes without saying that few will ever eat a diet completely devoid of carbs….it is almost impossible, e.g. double cream is about 50% fat….but 2% carbs sneak in. The fact remains that humans do not require carbs for health. It is not an instruction, merely a fact.
        On the 2nd point, that “carbs cause ill health”. Yes, they do….and if I used a longer sentence, I would expand by saying….”over-indulgece of carbs over a long time will insidiously catch up with the most enlightened and athletic foodie”. Middle aged spread is a good way of showing how even a moderate intake of carbs catches us out, and it is a fact that the conversion of excess carbs into visceral fat, causes ill-health. Fats and proteins are not the culprit…..unless their consumption has been mistakenly restricted whilst getting energy from non-essential carbs.
        By all means, let folks make up their own, informed minds, but give them the truth…and they will thrive, believe me.
        Comparing various forms of Coke is a red herring, in line with the false dichotomy of headlines playing one carb source against another. We don’t need carbs, and we certainly don’t need Coke.
        ‘carbs are NOT needed for health, and actually cause ill-health”.
        Keep the message brief and to the point for the majority, but encourage the minority to objectively seek verifiable facts.

      2. mikecawdery

        Jennifer,
        Diabetes is complex as you certainly are aware. I agree entirely with your statement on carbs but I would add that the “unnatural molecules” created from PUFAs may well be involved as well. Teicholz has researched this aspect in some detail and has shown that the politics, science and commercialism has led to a series of “frying pan to fire” changes with each step compounding the disaster of the preceding step.
        Some informative references on the generality of the problem of mis- dis-information are:
        PubmedBMJ 2012;345:e8462 doi: 10.1136/bmj.e8462 (Published 14 December 2012) Page 1 of 2
        Views & Reviews

        Big pharma often commits corporate crime, and this
        must be stopped
        Peter C Gøtzsche professor, Nordic Cochrane Centre, Rigshospitalet, Blegdamsvej 9, DK-2100
        Copenhagen, Denmark

        BMJ 2014;349:g6714 doi: 10.1136/bmj.g6714 (Published 30 December 2014)

        “Human guinea pig” asks for animal studies

        Peter Gotzsche

        BMJ 2013;346:f3830 doi: 10.1136/bmj.f3830 (Published 14 June 2013)

        Why we can’t trust clinical guidelines

        Jeanne Lenzer

        #(Teicholz, Nina (2014-06-25). The Big Fat Surprise: why butter, meat, and cheese belong in a healthy diet (Kindle Location 2080). Scribe Publications. Kindle Edition.)

      3. Jennifer

        Mike, I have now spent over 2 hours closely watching the video by Prof Roger Unger, (after watching it straight through last night), just to convince myself that I did indeed understand what he was saying. I think his research is so interesting, but what is concerning me is that it seems to have been/is being suppressed.
        As a Nurse, ( in pre-leptin days, I have to say), two of my longest appointments were:-
        1) working on a cardiac ward…….lots of experience in diabetic management.
        2) general surgery composing vascular work, and unfortunately amputations….again lots of diabetes management.
        I have to admit that I was confused with the conventional management of all types and stages of diabetes, because it was pretty obvious to me that we were losing the battle.
        I could never get a decent dialogue going…..little time for discussion, and lets face it….. we were all singing from the same song book anyway. However, there was a young Senior House Officer, who during a particular diabetic crisis, suggested to me that it was glucagon that was driving the hyperglycaemia. I just hope that doctor is keeping up to date, because he was ahead of his time.
        Why does interesting research take so long to hit the headlines? and more importantly…implemented.
        Anything that is counter-intuitive is so difficult to overturn….e.g……just look at the cholesterol hypothesis.

      4. mikecawdery

        but what is concerning me is that it seems to have been/is being suppressed.
        I am sure that a lot of data and alternative hypotheses are being hidden and suppressed. Only what “supports” official beliefs is allowed! It is only in books, Youtube and blogs (they are not refereed) that people like Drs Kendrick, Graveline, Ravnskov, Bernstein, Gotzsche, Sinatra, Roberts, Kauffman and so many others can express their views. When I retired in the late 80s, we went on a lofat/hicarb diet and despite the fact that I was exercising far more I put on weight and ended up with Type II. Back now to the weight I had over 50 years ago. Banting back in the mid 1800s was right then and still is 150 years later.
        Incidentally in the mid 1950s Type II was virtually unknown. The distinction between insulin sensitive and insulin resistant diabetes was made in the 1930s, but the terms type 1 and type 2 diabetes (first proposed in 1950) were not adopted until the 1970s

        http://www.diapedia.org/type-2-diabetes-mellitus/historical-aspects-of-type-2-diabetes

        Rates of type 2 diabetes have increased markedly since 1960 in parallel with obesity which correlates with the beginning of the hicarb/lofat concept of heart disease.

        http://en.wikipedia.org/wiki/Diabetes_mellitus_type_2

        You mention cholesterol; while this and the diet-heart hypothesis have evidentially been shown to be doubtful, to say the least, low cholesterol, low saturated fat still pervade the supermarkets even to lofat butter with huge shelf space areas dedicated to carbs+sugar products. The problem is that even now TC and LDL are gospel despite the fact that “fluffy” LDL is known to be important in the immune process with VLDL being associated with CHD; high triglycerides are now dangerous(?) and a “good” marker is TRI/HDL < 2 (??).

        What is one to believe? According to Lenzer (BMJ 2013;346:f3830 doi: 10.1136/bmj.f3830 (Published 14 June 2013); Why we can’t trust clinical guidelines) even the official Directives (aka guidelines) can not be trusted.

      5. Professor Göran Sjöberg

        DBM

        I think your comments are very apt and which go well along a humble scientific basic approach to any subject.

        Being strongly tempted by chemistry since childhood I now consulted my new sixth edition of Alberts et al., “Molecular Biology of THE CELL” which I am currently slowly digesting or rather endeavouring. However I could not see where and how your quoted reaction entered the metabolism.

        What most fascinates me is the last figure in the Chapter 2 “Cell Chemistry and Bioenergetics”, Figure 2-63 – ‘Glycolysis and the citric acid cycle are at the center of an elaborate set of metabolic pathways in human cells.’ Here ‘some’ 2000 (!) metabolic reactions are shown shematically in there connections. (Your reaction must probably be among one of those.)

        Pondering on that figure emphasises your points and adds to my present view of the goodness of an humble attitude.

        Still it ‘seems’ as a ‘no carb’, no vegetable PUFA, no transfat attitude works wonder on most, but certainly not all, people trapped in T2 and the metabolic syndrome. If it works the wonders on yourself, like on me and my wife, you should be aware the a strong FAITH is close by.

        Such experiments performed on yourself have already altered some, most stubborn, professor minds in nutrition.

      6. mikecawdery

        Many thanks for the link which includes further information on PUFA, lipid peroxidation processes, and the implications for atherosclerosis and diet etc. This ties in with Dr Kendrick’s “unnatural molecules” and Teicholz’s explanation.

      7. David Bailey

        DBM,

        Your link did not work – .html instead of .htm !

        http://www.andrewkimblog.com/2013/03/diabetes-dangerous-fat-and-protective.html

        That aside, I agree strongly with you that fad rebound diets are not a good idea – certainly if one is otherwise healthy. The best reaction to discovering that saturated fat is not bad for you, is simply to stop excluding foods containing saturated fat from your diet!

        We are meant to eat a varied diet, and once you start excluding particular molecules, that must get rather difficult!

        Alan,

        As I understand it, epigenetic effects are indeed passed on to offspring via methyl and acetyl groups attached to DNA. For example:

        http://learn.genetics.utah.edu/content/epigenetics/inheritance/

        http://www.medicaldaily.com/starvation-and-epigenetics-dna-can-hold-memory-starvation-three-generations-and-now-297054

        The underlying DNA is unchanged, but while the small groups remain attached to the DNA, its expression is modified.

  29. Andrew Chitty

    Dear DBM

    Your point that it doesn’t follow from the fact that low carb diets reduce the symptoms of diabetes that a high carb diet causes diabetes is absolutely right.

    On the idea that polyunsaturated fats cause diabetes, can you point us to any original properly controlled research studies that provide convincing evidence of this view? (Not in the sense that their results are consistent with this view – this is much too weak a criterion – but that their results cannot be explained except by assuming this view.)

    Reply
  30. John U

    I seem to recall from reading blogs and books that (pathological) insulin resistance results when cells are exposed to too much glucose for too long and the cell receptors responsible for transporting glucose into the cells start to stop functioning due to the excess of glucose available. Once our stores of glucogen are refilled, the remaining glucose must be consumed by our muscles or be stored into our fat cells via the liver and triglycerides. I suspect that a lifetime of eating a hight carb diet has probably had a negative effect on our cell glucose receptors, and insulin resistance developed to effectively save the cells from excess glucose. Once a large number of our receptor stop functioning, glucose remains in our circulation for a longer time period, and insulin levels remain high also to keep trying to get rid of the glucose. Hence this situation should be characterized by high sugar readings on the blood meter and high insulin levels postprandially for many hours rather that just 2 or 3.

    This situation, I think, would be typical of an untreated case of T2D. Weight gain would be usual in these circumstances since a sense of hunger would be expected followed by food consumption when the glucose is gone from the circulation but insulin levels are still high.

    So T2D is not caused by the weight gain – it is caused by whatever causes insulin resistance. Is it whatever drives the receptors to stop functioning? I don’t know, but I believe that weight gain is just a by product.

    So:
    “What do you think happens if you try to force blood sugar levels down in type II diabetes by prescribing insulin?” I think it would cause the person to gain weight if that person was consuming a lot of carbs. But not so if the diet was mainly fat.

    “So why does everyone with Beradinelli-Siep syndrome have type II diabetes? Clearly since the key word is “everyone”, it must mean the result is independent of diet. Whatever nutients B-S people consume, whether carbs, fats, or proteins, these must get consumed or wasted. I would expect the process of wasting the excess nutients is slow, so perhaps glucose levels and insulin levels remain higher that normal for longer than normal, which leads to the same results as insulin resistant cells, i.e. T2D.

    Just a guess.

    Reply
  31. Catherine Reynolds

    I was reading a well-known women’s magazine at the weekend (a dark secret of mine!), and found myself fascinated by the story of an eight year old boy who started showing symptoms of autism when he was about 18 months old, having previously developed what we perceive to be normally. He lost speech, he lost social skills, would not make eye contact, threw tantrums if his routines were changed, etc. His mother refused to accept the “nothing can be done” verdict given to her by doctors, and researched the condition tirelessly, eventually hitting on the story of another boy, whose autism had apparently been “cured” by changing his diet. The mother resolved to try this, as they had nothing to lose, and, within a year of cutting out sugars, refined carbohydrates, gluten, and other starchy foods, her son was almost back to the boy he’d been before autism hit him. The article did state that where this has been tried, it works best in younger people (presumably because they’ve not been exposed to the harmful stuff for as long as an adult). I actually laughed out loud, not because I thought it was ridiculous, but because this is one more condition where it has been shown that removing highly processed, starchy, sugary foods from someone’s diet reduces, if not eradicates, their symptoms. I’ve read that a ketogenic diet can be very helpful in respect of some cancers, and also in epilepsy. I totally agree with the person who posted about illnesses/conditions where the sufferer is not automatically assessed for their diet and general eating habits before being prescribed strong medication. Should this not be the first port of call? If a change in what you eat relieves your symptoms/condition, that must surely be a preferred treatment? As always, Dr K, a wonderful article, and I always enjoy your no-nonsense approach to authority!

    Reply
    1. Professor Göran Sjöberg

      Catherine Reynolds

      Interesting story you are relating!

      Lately I have come to take an interest into the connection between diets and what is happening in our central nervous system and ended up with a Doctor Natasha who in her clinic of psychiatry treated children with diets which could be classifies as extreme LCHF regimes with the main purpose of restoring the gut flora or rather replace a bad gut flora with a good one which can be a tough long fight. She seems to have considerable clinical experience on this matter.

      http://www.doctor-natasha.com/gaps-book.php

      In her books she are to my opinion convincingly advocating an explanation of what is happening when the gut wall lining, the epithelium, is corrupted by the bad bacteria clinging to the wall and then starts to leak. Sugar, especially the disaccharides seems to be the favourite food for these bacteria.

      To me she is almost 100 % hippocratic in her approache:
      “Let the food be your medicine, let your medicine be your food.” or how he now put it 2500 years ago.

      Reply
  32. DBM

    BobM

    I don’t think that poly-unsaturated fats are the only thing to be concerned about in what you eat, in fact there are a lot of factors to consider outside of diet. Obviously, when talking about blood glucose there is a focus on insulin and insulin resistance.We assume that insulin levels are high but these are rarely measured and other hormones are not even considered.

    Chronic stress caused by feeling miserable, overexercising (especially chronic cardio), undereating and sleeping poorly all raise cortisol. High levels of cortisol make you feel anxious,depressed and stressed and this impacts badly on sleep which impairs glucose tolerance and increases risk of developing obesity, diabetes CVD etc.

    High levels of cortisol and other stress hormones are in themselves obesogenic and diabetogenic so it is important to manage your stress levels, now I’m sure that this has been mentioned on this site before.

    The other hormone that gets neglected is glucagon which is the ying to insulins yang and raises blood glucose so if this is out of control or out of balance compared to insulin you can get into trouble. This is more of a issue for type 1 diabetes but the following lecture on youtube is fascinating (well for some anyway) if you have 45 mins to spare a new biology for diabetes https://www.youtube.com/watch?v=VjQkqFSdDOc .well worth a watch

    Reply
    1. Gretchen

      This is a good lecture, but anyone watching should be aware that Unger sometimes says up when he means down, etc. So if something doesn’t make sense, go back and see if it makes sense reversed.

      Reply
    2. Jennifer

      DBM.
      Many thanks for this video, which is a good example of us needing to keep an open mind. These brilliant researchers are questioning the hard-wired comfort zones which have dominated conventional physiology for decades.
      I feel that stress gets relegated out of the equation because it is associated with “the psyche”…..and how could that “possibly” affect the physical? But the physical and mental are so intertwined, that they must be considered equally.
      As to discussing hormones. Well, insulin, once hailed as the life-saver, is now being demonised, yet if we are honest, we know that cannot be so. Insulin is but one part of the interactive endocrine system, each with its part to play in homeostasis.
      I still do blame non-essential carbs for much ill health, ( that’s the stubborn side of my character showing through!), but their damage is compounded by the consumption of industrialised PUFAs and nasty toxic chemicals, which disrupt the delicate hormonal balance at cellular level…..it can so easily spiral downhill therafter.
      Generations have eaten moderate quantities of carbs, but the phenomenon of diabesity over the last 60 years leads me to conclude that the PUFAs and chemicals are the real bogey men.
      Hope we are still friends!

      Reply
      1. mikecawdery

        I would prefer the word “debate” or “discuss” rather than argue. In my experience on your blog discussion has been the usual procedure – not argumentative discourse.

      2. mikecawdery

        In short, the entire “DIRECTIVE” aka guideline system is at fault. See BMJ 2013;346:f3830 doi: 10.1136/bmj.f3830 (Published 14 June 2013)

        Why we can’t trust clinical guidelines

        Jeanne Lenzer

    3. Mary Richard

      DBM and others I have tried to read all the responses so don’t know if someone else put this out there, but let us not forget leptin (the satiety hormone) that also regulates fat storage. I often wondered how some people became morbidly obese. I thought that someone would have to throw up a lot to get to a morbidly obese state, but so many hormones are involved in the metabolic process. I guess that if you push enough and store too much fat, the leptin hormone malfunctions in some way and competes with the ghrelin hormone (the hunger hormone). One gets to a point where they are never satisfied and always hungry. These along with other hormones play a significant role in the process of homeostasis. It is quite complicated but the more fat is stored, the less effectively leptin works to signal satiety. It may very well be why when one starts a weight loss program, it can take up to one month for any change in weight to occur. It just takes a long time for the changes one initiates to catch up with the messages being sent to several sites within our bodies. People can have those plateaus in the weight loss process whereby they give up on losing weight as they feel the effort it is not working. But, it really is or can be. Effective long lasting weight loss and maintenance takes real commitment. That may also be why the morbidly obese seek the gastric by-pass surgery as a quick fix. They just feel defeated and no doubt scared when they develop diabetes. It is like behavior mod therapy in psychology.

      One can change behaviors on a cognitive basis, but the reason effective long lasting change is a challenge is that the feelings are always the last to change. I guess that is just how the body and mind work. It all takes enormous discipline and understanding of self along with support from others. All things seem to be an effort to return to the norm in one way or another.

      I, too, am concerned about children and the manifestations of maladaptive behaviors, learning or developmental delays and psychiatric problems so widespread today. I rather agree with Professor Goran that Dr. Natasha’s analyses of how our children’s bodies and minds might well be influenced by toxins both environmental and in our food supply seem to make sense. I like to watch her speak. She presents with conviction and purpose. I have actually implemented some of her dietary advice at home (did not work during the holidays…I blew it). I like the way she thinks and so much of what she has to say is common sense as well as scientific. Very interesting.

      Reply
      1. Jennifer

        Mary, I so much enjoy your contributions. Earlier this week I attempted to produce a short, sharp message to give to the majority in order to minimise the risks associated with poor diet. I reduced the message to merely blaming carbs for many ills. I understand that the public may require a bit more explanation, and your message today would be perfect for a pamphlet to read in the Drs surgeries whilst waiting around.
        As to the set-in-stone dogma of our health workers….here’s another one to be considered,( although not about diet):-
        We just ‘know’ that a reduction in oxygen perfusion stimulates our involuntary intake of breath. In fact, it is counter intuitive to accept that for folks with certain lung diseases, it is the build up of carbon dioxide level that stimulates the intake of breath.
        The cognitive dissonance regarding caring for (some) breathless patients has to be fully understood and accepted, and was a prime feature of my nurse training……we just HAD to understand the mechanism.
        In this case, the physiology of the ill person has adapted over time to respond in a different way than that of the healthy person, and I think that the obese body has adapted over years, to cope with excess carbs, by laying down fat. It is a safety mechanism which clears the excessive glucose out of the vascular system to avoid damage.
        Except in my case…..I was never obese, just slightly overweight….and I developed Type II, whereas hubby just put on weight!

      2. Richard Gibbs

        From what I have read, a high leptin to apiponectin ratio is correlated to insulin resistance. Adiponectin is produced by adipose tissue, but the more fat that is stored, the less adponectin is produced.

  33. Mary Richard

    Pop Quiz question #1 Answer: If you give insulin to those with Type II diabetes, they just get fatter. It is the chronic ELEVATION of insulin in the bloodstream that causes insulin resistance. You must get those levels to a place where your system is sensitized to insulin so that your body works more efficiently at a metabolic level.
    Pop Quiz question #2 Answer: The tissues in those with Beradinelli-Seip Syndrome cannot recognize insulin in the bloodstream and are, therefore, insulin resistant from very early on. They develop diabetes very early on though their bodies have virtually no adipose tissue. The fats are stored in the liver and muscles, causing serious problems in adolescence and beyond.

    Reply
  34. Pingback: 2015 DIABETES CLASSIFICATION

    1. Dr. Malcolm Kendrick Post author

      I think that everyone should watch this. I agree with everything… up to the last five minutes or so. I don’t think he has quite got it fully sorted yet. Hope he does, before he dies. However, I love it when people turn conventional thinking upside down like this.

      Reply
      1. Mary Richard

        I got your book and am quite fascinated, Dr. Kendrick. I actually “cheated” and read the chapters on Bariatric surgery. I did this for a reason. My late husband who had CAD and hypercholesterolemia among many other things. He would never take any dietary advice and ate his way to a weight that allowed him to have bariatric surgery. I begged him not to do it. I promised to cook, exercise with him, and help him to lose weight and reverse Diabetes type 2 he also developed. He was determined to have this surgery. He did. In addition to his inability to deal with not eating larger portions of food (causing him to vomit if he ate too fast), I noticed one other very unforgettable “side effect” of this surgery. Oh, he got rid of the diabetes, however, he became alcohol intolerant. Now, my husband was a Scotsman through and through. He was a driven, risk taking, tough individualist. And…he loved to drink, maybe too much, but he could “hold his liquor” better than any man I had ever seen. His favorite? A good quality Scotch!! After the surgery I noticed that he could drink a glass of wine and become drunk!!! I mean like falling down, can’t pick yourself up drunk. So one of the long term effects is one people may want to watch before opting for bariatric surgery as a solution to a weight problem. There is no replacement for the good old fashion means of weight loss. Watch what and how much you eat and exercise. It was sad that the two things he loved to do because it tasted good to him and relaxed him a bit, were gone. He just could not handle liquor or food any longer. He died anyway…way before his time. Be careful what you wish for. If it sounds too good to be true…it probably is.

        I am really enjoying your book, Dr. Kendrick. I never realized how some procedures have never had associated studies done on them. I wish I had known then what I now know but I shall not look back unless it is to help others not make the same mistakes. Thanks for your wonderful contribution.

      2. DBM

        It blew my mind when I saw this, but the real shocking thing about it is the fact that a lot of this research is really quite old. I guess he won’t be getting his Nobel prize in the next 360 days..

      3. Professor Göran Sjöberg

        I am amazed!

        My simple view on insulin resistance blown away just like that! It might though be that I could not follow all turns in my one view of this video with my background.

        Since I have had a different attitude to the official one about diabetes for some years now I just wonder why this anti-dogma hypothesis has not surfaced in one way or another. It must have been around for a while. Is it too controversial? What is at stake?

      4. Dr. Malcolm Kendrick Post author

        Goran. I have sort of been hinting over time that diabetes cannot be viewed as a simple condition. The current view that both forms of diabetes can be seen as a sugar/insulin problem is nuts and clearly wrong. I am more of a follower of Lenin in such matters. ‘Everything is connected to everything else.’ Particularly true in the human body.

  35. mikecawdery

    A quote from Teicholz referring to the AHA-ACC guidelines “show bias and habit present powerful, if not impenetrable, barriers to change” with respect to saturated fat intake. In short, professional status is more important than human health!

    Incidentally, I asked the DoH and Public Health England for details of iaotrogenic deaths in England because of the high level of deaths due to this cause in the US (~200,000 p.a.). Both organizations knew anything about this. More hidden data I suppose.

    Reply
  36. Gordon Rouse

    Before you even go there, you need to rethink the whole idea that obesity is just plain old “eating too much”. Sure, you need calories to put on weight, but the whole notion that our conscious minds control how many calories we consume is so obviously ridiculous and yet is also so universally accepted. The theory goes something like this – in the past we barely scraped by, there was never an excess of food so we never got fat, now, and only now do we have too much food so we over-eat. Quite clearly this assumes for most of human history we lived in a delicate balance.

    Further, now some people are fat and some are not, so the theory would have us conclude that fat people just have no self-control, which is also clearly bollocks, unless you don’t actually know any fat people personally.

    We know from experimentation that humans have weight set-points, an amount of adipose tissue that our body defends. Lose this weight, and the body goes into starvation mode, lowering metabolism, and creating a psychological state that makes us obsessed with eating. On the other hand, if we over eat, the body does everything it can to return to its lower state, raising metabolism and creating a psychological state that deters us from eating – see a naturally skinny Morgan Spurlock induce this state in himself in ‘Supersize Me’.

    These observations tell us that obesity is not a result of over-indulgence, but a natural condition for the body that is determined by genetics and epigenetic factors. An experiment that demonstrates this is “Jed Friedman’s Monkey experiment” – a rather poor experiment in some ways, yet quite conclusive to the role of epigenetics in obesity and maybe even diabetes.

    http://www.denverpost.com/news/ci_11560032

    Please note that I happen to have an interesting unpublished insight into this experiment that the researcher accidentally divulged to me. When questioning Prof Friedman as to why he thought saturated fats were the factor triggering obesity, he replied that the O6/03 ratio in blood was higher in the mothers of the more effected offspring (more obese), a measure he was using as a proxy for saturate fat intake. Hmm, good ol’ “heart healthy” Omega 6 popping up again leaving its fingerprints around but always innocent of the crime?

    On the issue of weight loss ‘curing’ type II diabetes, I think health researchers are completely oblivious to the huge elephant. If weight loss is not sustainable, then it is not a cure! Sure, weight loss improves the numbers, but so far, no one has shown how it can be sustained, or whether it improves health. Most worryingly, weight loss seems to increase mortality, although this is only observational studies: http://sciencenordic.com/new-report-weight-loss-increases-mortality

    So here is my controversial suggestion: obesity is a protective mechanism. Throw heaps of sunflower oil and sugars at an unborn baby, and it will protect itself by developing a high weight setpoint – a means of shunting omega 6 and sugars away from harm. Those with the genetics to switch this on will do best, but if you don’t have the genetics to be fat – and you are bombarded by sugars and omega 6 in the womb, then you will probably suffer worse liver damage. Hence why being overweight gives people the best mortality outcomes.

    Reply
      1. David Bailey

        I know someone who accidentally found a use for statins!

        While taking them, she found she felt quite unwell, and didn’t want to eat – so she lost weight! Needless to say, she has now stopped the statins, and will probably put the weight back on again!

        Malcolm, I think broadening your blog to cover some other medical areas would definitely be of interest. Ever since I stumbled on the fat/cholesterol/statins scandal, I have been wondering just how many other areas of medicine are in a similar parlous state.

    1. Professor Göran Sjöberg

      Gordon Rouse

      I think you are quite right. Gary Taubes in his “Good Calories & Bad Calories” made me start thinking in those terms of about how utterly ridiculous the overeating hypothesis is when you really start ‘thinking’ about what is involved.

      If you, as the overwhelming majority of people do, because it is SOO obvious, adhere to that dogma and by pointing to thermodynamic (my favourite subject) it turns all into nonsense as an explanation for the obesity epidemic but of course not to why a sumo wrestler CAN increase in weight to the desired level or for that matter the nobel women in Ethiopia to reach their super-oversize model ideal of that culture about a hundred years ago..

      The point is, to put it simply, that you gain your mostly unwanted overweight over the years – typically 30 kg over 30 years or so. That is 1 kilo each year or 3 grams per day or ONE gram of overeating per meal.

      Conclusion!

      “You are such a slough, totally without willpower, since you can not even restrain from one single gram on your plate – an that is actually NOTHING!”

      When I confront even the most stubborn, vicious advocates of the current dogma with this argument I have not been able to get a single one up in the court to take a real fight. It is like metabolism to all these people is occurring at a constant rate and that the parameters, around 20 000 in fact, of the thermodynamics involved to control that rate of metabolism in our bodies are not related to one another, thus viewed as so called independent parameters in thermodynamics, and on top then specifically claim that the metabolic rate cannot even alter with 3/1000 – corresponding to that one gram up or down on your plate. It is just about fundamental thermodynamics and they don’t have the faintest clue of what it is all about. Like the inquisition at Galileos time they simply refuse to look into the telescope because that would blow their whole world apart.

      Reply
      1. Jennifer

        Professor Sjoberg.
        I expect you are re-watching Prof Roger Unger’s video, which I have needed to do today. (there are other great videos of him on youtube)
        I am slightly disappointed that he mentions “calorific intake’, rather than “carbohydrate intake”, but that aside, he is very convincing, and exceedingly modest with it.
        This blog is so informative, (and such fun), isn’t it?

      2. Professor Göran Sjöberg

        Jennifer

        I agree – this is a great blog with informed people willing to fight the medical corruption!

        Well – I will for sure watch Unger’s video again. It is quite ‘revolutionary’ to me!

        I noted, as you point out, Unger’s ‘mistake’ and reflected that the ‘caloric’ view on obesity is so ingrained in medicine that you almost have to be outside the medicine filed to realise that almost all ‘medicine men’ have not the faintest idea that they are here actually believing in a flat earth dogma – i is so fundamental. My belief is though that Malcolm belongs to the exclusive few who don’t.

        If you are trained in physics and thermodynamics, as Gary Taubes and myself to some extent, it is probably easier to grasp the utmost importance of the fact that you must be sure that the parameters, like calories in and calories out, in an equation e.g. stating ‘the first law of thermodynamics’, must be independent from one another if that equation should make unique sense. The possibility that they should be independent taking the complexity of our metabolism into consideration is however beyond my comprehension. Turned in another way: “Why should they be independent?”

        What has struck me is though how difficult i seems for ‘ordinary people’, although well educated, to see through and ‘understand’ what even the most elementary algebraic equation actually tells you. People tend to get alarmed when they see an algebraic equation with symbols written on a paper and seemingly lose most of their analytical ability.

        Mathematics is not science and will never be! It is a good ‘cleaning brush’ i physics used properly but in medicine the abuse of mathematics, not least through ‘advanced’ statistical analysis, is a means for huge profits (which is the whole purpose of the mathematical treatment of obvious facts) mainly due to the fact that the majority of readers of medical papers are so ignorant of what is involved in ‘equations’, but the readers still tend to get very impressed of what may appear to them as being ‘science’ – but there is no science. It is just a mathematical ‘cover up’ – a sweeping under the carpets! And it takes huge Cochran efforts to fight on the same battlefield as Big Pharma to uncover the reality of what has intentionally been covered with the mathematics for profit. Peter Goetzsche is here worth all acclaim in his efforts in this way to pinpoint the present corruption.

    2. Mary Richard

      Gordon, I find your post quite interesting. It is, no doubt, a very complicated process. I was a chubby child. In fact, I was the only “chubby” child in my family of three (one brother passed away at five years old so actually four). I was the replacement child. My mother was quite depressed and grieving when she carried me. She said she gained the most weight with me. When asked why…she simply stated that she ate lots of chocolate pies, anything she could get her hands on and gained fifty pounds. At the age of about 8, I began to be “chubby”. I think my mom fed me (this is a psychological perspective now) more to keep me from harm. Fortunately my pediatrician (who made house calls by the way) had a talk with me, and I went home and lost the weight and kept it off (pregnancies excluded) pretty much my whole life. However, I had to be ever vigilant. That is why diet and exercise has always fascinated me. I have to really work at it. And…I have to be patient. I don’t lose weight as easily as some. Your assessment makes a lot of sense. I shall file it away and hope we can blog about it in the future.

      It is quite complicated, the diabetes thing. I have never had it at all. But, I know what it feels like to be teased when chubby in school. And…when I shed those pounds, I could not believe boys would look at me. However, interestingly, I was always attracted to young men (boys) that were slightly overweight, not obese but just a little over weight. Having been in all girl schools, I was amazingly awkward. I think a lot of psychological issues go with the science of weight management. It can be many things and those that are quite simple. Inside…I still am that chubby child. Go figure. I wish she would get the hell out of town!!! LOL

      Jennifer,
      You are a dear. And you always teach me something new and exciting that I did not know. The tendency to lay down is interesting. And I have known a few morbidly obese on my mother’s side, but not father’s. No one was severely overweight at all on that side of the family. I so appreciate all you have done for the health and well being of others. Don’t look back at what might have been unless it teaches you something you can use in the here and now. You are the teacher par excellence. Thanks for being here. Dr. Kendrick keeps good company!

      Reply
    3. Mary Richard

      Where does one’s self determination and free will come into this paradigm? I get what you are saying, but if that individual appreciates the value of maintaining a “healthy weight”, which is variable according to one’s own comfort zone, then those people can and do work at it regardless as to the protective mechanism. It takes discipline and pretty soon, it becomes habit and that habit becomes the norm. Not everyone wants to be pencil thin, but a weight at which one feels good and comfortable is a reasonable goal that is attainable. And, I am inclined to believe one who is somewhat overweight is probably a little healthier. So who decides who and what overweight is. It is a personal decision based on what feels comfortable. Besides if and when you grow older, that excess weight might serve you well!! I say be your own BMI judge.

      I hear talk about humility. And humility is the equivalent of open mindedness in science, I am sure of that. I hope to never tire of learning. So, let us delve into this more. It is a hot topic. I see more curves ( in women) in pop culture. So…what is that about? Professor Goran, I am not watching too much T.V. either, but we must keep up with the times and what is going on in politics and society in general. I love talking to my great husband in the early morning, too LOL.

      Reply
      1. Professor Göran Sjöberg

        Mary

        Well – it is a fact that we are ALL physiology creatures and part of that physiology is our central nervous system where our constantly disputed WILL ‘dwells’ as I understand this. If you want to dig deep into the philosophy about this you my consult my favourite philosopher Schopenhauer and his main tour de force “The World as Will and Perception”. That was great reading to me and greater minds than mine as Einstein and Wittgenstein to name two. All philosophers have though this subject as their main theme as I have understood.

        No one can claims that our neurological physiology is not a part of our metabolism after a few cups of coffee or any stronger drug. So, what about carbs? Drug or not?

        If we believe that sugar ‘addiction’ exists (metabolic syndrome?), which is for sure a part of the ‘key values’ (but not publicly expressed) of some gigantic corporations ruling the world today, it might be a good idea to stay clear of all food kicking your blood sugar values out of bound. If you have been there like me and my wife LCHF seems to work wonders for health restoration. There are piles of books written about ‘carb addiction’ where “Grain Brain” by doctor David Perlmutter could be an interesting reading.

        The weight loss, 20 and 12 kg respectively, to gain ‘perfect normal weight’ was though unintended in our case and as a mere bonus if you see it that way. My wife has, by the way, always had a keen eye for chubby guys, make her heart beats extra, but she says that I’ll still do in my present state – I am not thin – I am just ‘standard’ perfect.

        Not many of us deny being social creatures and part (the main?) of this is to talk al lot WITH (I guess not TO, too often 🙂 ) your closest partner in life. We have found reading together every day to be a good habit and our present reading is a book written by Professor Emeritus David Lewis-William, “Inside the Neolithic Mind” which dwells on the fact that we seem to be neurologically ‘hard wired’ to devour supernatural realms for social purposes from the beginning. Interesting reading – new ideas!

  37. Jennifer

    Thankyou, this topic does need sorting out.
    Lets hope I live long enough to experience an accurate solution.
    In the mean time, my no-drug regime, alongside LCHF eating, is proving fine for me and I accept that it may not be the be-all and end-all for everyone. It is the best I have to hand at present…..not a cure, but a more satisfactory regime than offered me by the NHS.

    Reply
      1. Professor Göran Sjöberg

        DBM

        I am sure the discussion will return revitalised in future threads on Malcolm’s ‘great blog’.

  38. LaurieLM

    Thermodynamics is a ‘state’ function. ONLY the endpoints are part of it. The path, however, that it takes (mechanism, how, rate to get to the end) is concerned with other than the endpoints.

    For obesity, if you wake up this morning heavier than you were one year ago it means that ,over the year, you consumed more calories than you burned. If you woke up this morning lighter than you were one year ago, then you burned more than you took in over the year. We do not eat for fuel only….we eat for raw materials too……but just considering calories…

    The path- how you got fat this past year- for the weight gain scenario is an unpublished (by me) version of the explanation below.

    If you look at the common metabolic intermediate of burning fats vs. carbohydrates, the intermediate is Acetyl~S~CoA.

    Metabolically, 4 moles, 720 grams and therefore 2880 Kcal of glucose vs. less- only 1 mole, 256 grams and 2304 Kcal of fat, well… each yields equal moles (8) of Acetyl~S~CoA. It is popularly reported that there are 9 Kcal/g in fat, and 4 Kcal/g in carbohydrate- true. But, 720 grams of carbohydrate is more total Kcals (at 4 Kcal/g) than is 256 grams of fat (at 9Kcal/g)! How much more? 720 X 4 = 2880 Kcal for carb, and 256 X 9 = 2304 Kcal for fat. 2880 – 2304 = 576 Kcal overage- EXTRA- calories from carbs. Carbohydrates are a much less efficient fuel to burn than fat.

    Whatever the daily production amount of Acetyl~S~CoA required, metabolically, it takes more glucose Kcals to supply it solely from carbohydrate (576Kcal more) than solely from fat Kcals. The excess from the less efficient carbohydrate suppliers……..you can bet will be stored- as fat.

    Reply
    1. Professor Göran Sjöberg

      LaurieLM

      You are quite right about the basic thermodynamic parts in your comment and no sane person in my own world would start arguing about the ‘state variables’ in thermodynamics – though the definitions of these variables could make you think ‘deep’ which might not hurt with all nonsense in referring to thermodynamics – especially around the second law. Test Karl Popper on this one – especially his early works are of interest here.

      However, without putting your thermodynamic into a physiological context and above all into its parametrical complexity over time it is, sad to say, just futile to point to the ‘First law of thermodynamics’ as an EXPLANATION to why we get fat. It is just a tautology. You can as well say, and much much simpler, that the food you are eating but not ‘burning’ at the same rate must be stored away but this does not explain WHY this is happening. You are getting fat because you store away fat which might be good for you but anyway has very little to do with basic thermodynamics.

      What makes me so extremely sad is that otherwise so very ‘clever’ people in medicine are so easily pulled by their nose by anyone waving with the flag of thermodynamics and that this someone is just get away with his oversimplification. To me it is just shear stupidness. The saddest part for me is though that this tautological stupidness is THE actual foundation of the established views in medicine about the CAUSE of the present day obesity epidemic as it has been for more than a hundred years now.

      “You are getting fat because you are eating one gram too much each meal – understand!”

      “But YOU! Don’t you SEE that the sun circles the earth.”

      “Put him on the stake and hand me the matches!”

      Reply
  39. Helen

    As a humble humanities graduate with an interest in science, I’m not even going to pretend that I understand many of the posts here, fascinating though they all are. I eat a LCHF diet in the hope of losing excess weight, which hasn’t happened, but then I’m a postmenopausal woman with a severe thyroid problem, and those two factors appear to trump just about any diet. At least I don’t feel hungry all the time any more, and I may now be at lower risk of the T2 diabetes that has afflicted one side of my family.

    I would like to add my voice to others here calling for a post on hypothyroidism. Oh, and another on pernicious anaemia/B12 deficiency too, please! Current medical understanding of, and treatment for, both these conditions is utterly f***** u*, leaving patients with profound health problems to resort to self-treatment, at significant, lifelong expense.

    Reply
    1. David Bailey

      B12 would interest me too! I got a low measurement for B12, and was told this was very common in older people, and the result of pernicious anaemia (though this was just assumed because of my lack of B12) – the answer was B12 injections for the rest of my life. This was at the time when I was having statin-induced problems in my leg, which meant I was consuming diclofenac to try to deaden the symptoms, which in turn meant I was consuming omeprazole to counter the stomach acidity created by the diclofenac!!!

      As I gradually recovered from simvastatin poisoning, I was taking less and less diclofenac and omeprazole, and so I suggested to my doctor that my low B12 might just have been caused by the low acidity in my stomach! He tested me again for B12 levels, and sure enough, they were nicely in the normal range again!

      If I hadn’t suspected the simvastatin, I might still be taking simvastatin, diclofenac, omeprazole, and having regular B12 injections – no doubt at considerable expense to the NHS – while feeling bloody awful!

      Reply
      1. Dr. Malcolm Kendrick Post author

        A common tale indeed. The idea that we can stick several highly active chemical compounds into people without adverse consequences is, frankly, ridiculous. Polypharmacy is the great disease burden of the current age.

  40. mikecawdery

    Off topic but for those with pain from statins, the following from Dr Duane Graveline – Spacedoc – may be of interest.

    https://www.facebook.com/pages/Spacedoc/373791966069660?fref=nf

    Spacedoc
    29 January at 22:47 

    MY VIEWS ON THE CANNABIDIOL (CBD) VAPOR PEN

    I have been using this unique device for a month now and feel qualified to share with readers what I have learned. First of all you have to know that I have been on narcotics for four years now to get at least some relief from the chronic pain in my back and legs. According to my neurologist, after nerve conduction and muscle biopsy studies, my diagnosis is statin associated peripheral neuropathy. My biopsy showed denervation atrophy of myofibrillar elements. In plain English this means when the nerve degenerates the muscle it serves must also degenerate from what amounts to disuse atrophy. The pain reflects my sensory nerve involvement in addition to motor nerve elements. This all started in the year 2000 shortly after Lipitor was prescribed to me for mild hypercholesterolemia provoking strange amnesias. Just 3 months after I had made the decision to stop the statins forever because of these recurrent amnesias I became aware of pain in my back and legs, weakness and loss of balance on walking. Slowly these symptoms have progressed. I have been on a walker for almost a decade. The use of narcotics has made me more comfortable but the side effects are terrible. For years I had been giving talks at libraries and radio talk shows on the subject of statin drug damage but with the start of narcotics I had to give up all public talking. My immediate recall just could not handle it and the bowel problems have been disabling. Philip Blair MD, a retired Army doctor, introduced me to Elixinol CBD and the inhalation technique using a vapor pen. The pain relief has been truly amazing. Within a two week period I have been able to reduce my narcotics dosage by 60% with no withdrawal effects, no tolerance and no adverse reactions that I have recognized. And, I am hoping to totally discontinue narcotics in the coming weeks. In my judgment CBD has a tremendous future in medicine for pain control, inflammation and, no doubt, much more. Anyone can consult Dr. Blair at CBD.md@MEDusacbd.com

    Reply
  41. Jennifer

    Exactly!
    David gives a real example of what so many of us have suffered from….but such anecdotes have been dismissed….because they are anecdotes. What a dismal state of affairs. ‘computer says’.
    And the government are wanting a shorter time scale in which to train
    doctors?
    Much of the present curriculum will need to be re-written for a start, before the learning proper begins. That should include a chunk of time discussing ethics and building strength of character.
    Lets be honest here…..such bright sparks ought to be able work out the A and P, and medical proceedures, but ethics is a big subject, and hardly measurable by the 5 *A’s used as entrance to some medical establishments.

    Reply
  42. Matiss Stein

    The truth is, a healthier future is a truly a practical option when we implement more SIMPLE, usable measures like this, not more technology and gadgets (like the fitbit which seems to be losing credibility) Not only are we Americans unhealthy, we’re unhappy: 91% of women in a recent survey said they are unhappy with their bodies. As a cancer survivor and former yoga teacher, I’m a big advocate for meditation and mental health as a key to physical health and even teach it, and I think it’s VITAL we start a discussion about how our minds affect our bodies

    Reply

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