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The diabetes, heart disease, and the lipid hypothesis

It boggles my mind that high-carbohydrate diets are recommended to diabetics even though the carbohydrates will increase their insulin needs. The recommendations come out of a faulty belief in the lipid hypothesis. The intent is to prevent the heart disease that often accompanies diabetes. Those on the lipid hypothesis bandwagon like to cite Ancel Keys, but his study fell apart when confounding factors such as accuracy of the reporting of cause of death country to country were looked at. High- carbohydrate diets do lower cholesterol. I can even attest to that from my own experience with the vegan diet. But more recent studies are showing that there is no clear relationship between cholesterol and heart disease. T. Colin Campbell could not find one in his extensive study of the Chinese, and he very much would have liked to since it would have supported his assertion that a vegan diet is healthier. Never mind that the vegans were dying of infectious diseases and malnutrition at a higher rate.

Have you noticed that guidelines relating to cholesterol have been changing? It used to be that they told us that all cholesterol was bad. Then they told us that HDL was a good cholesterol and needed to be high and LDL was the bad cholesterol. Now they’re telling us that not all LDL is bad. It’s only the small dense LDL that’s bad. Such a change over the years! By the way, a high-carbohydrate diet increases the harmful small dense LDL. Some studies do show that heart disease improves when cholesterol is lowered by cholesterol drugs. But there may be another effect at work. The American Heart Association published a study showing that statins decrease inflammation, and this effect may actually be the beneficial action of the drugs.

With the lipid hypothesis falling apart, the rationale for recommending a low-fat/high-carbohydrate diet to diabetics falls by the wayside, or at least it should. Doctors who have suggested anything else have lost their jobs even though their results have proved their recommendations to be valid. So there’s a disincentive in the industry for jumping off the high-carbohydrate bandwagon even if it might actually be wrong. Many doctors are frustrated by the lack of improvement in their diabetic patients, but they’re also afraid to stray from the standard recommendations. A high-carbohydrate diet increases the need for insulin, which is a dangerous situation for a diabetic. Plus, as mentioned, it increases the worst kind of cholesterol. It’s far better to pursue a diet that decreases the need for insulin, I think.

Triglycerides have been shown to be more strongly linked to heart disease than cholesterol is. A high-carbohydrate diet increases triglycerides, too. If you are trying to prevent heart disease and diabetes, a closer look is definitely warranted. The standard protocol may not be the best one.

The positive correlation of wheat to heart disease proved to be interesting. Wheat has a correlation of 0.67 with heart disease—which is the strongest association between any food and heart disease found in the China Study. This is of particular concern given that the recommended high-carbohydrate diet often contains a lot of wheat. I picked the correlation out of a table from a post on animal protein, but apparently I was not the only one to notice. The blogger, Denise Minger, did an entire post on that correlation elsewhere in the blog. She took the data from China Study II and attempted to determine if the wheat/heart disease correlation was confounded by any other factors. With every combination she tried, the wheat/heart disease correlation held up. T. Colin Campbell, an author of China Study II, wrote a paper on the link back in 1996. The theory is that the correlation has something to do with the insulin index of wheat compared to rice. The insulin index of the rice is quite low compared to its glycemic index while the insulin index of wheat is high. In other words, wheat stimulates a higher output of insulin than rice does. I took a look at a chart listing the insulin scores of foods compared with their glucose scores. Rice did indeed have an insulin score much lower than its glucose score, both for brown rice and for white rice, which made it rather unique among carbohydrate sources on the list.

Denise Minger looked through the literature to see if there were any research studies relating to wheat and heart disease. Apparently, there were very few. It isn’t something researchers are looking at. Most wheat related research looked at things like whole grain vs. processed grain. She did find an old rabbit study that looked at wheat germ vs. various oils and atherosclerosis and a human study that looked at wheat bran vs. flaxseed and insulin sensitivity and C-reactive protein. In both studies, the wheat group fared worst. The wheat connection is definitely something that deserves a closer look. Hopefully, other scientists picked up on it and will do some studies.

It would not surprise me if the link held up under closer scrutiny. Gluten, a protein in wheat, has already been found to cause problems in relation to other disorders. I am at present trying to get my daughter to try a gluten free diet to see if it will help improve her neuropathy. The doctors think now that the neuropathy is a rare autoimmune reaction related to her cancer. Supposedly, gluten-free diets have improved neuropathy. Gluten-free diets have been shown to help other autoimmune disorders as well.

T. Colin Campbell. The China Study: The Most Comprehensive Study of Nutrition Ever Conducted And the Startling Implications for Diet, Weight Loss, And Long-term Health. BenBella Books (May 11, 2006).
Denise Minger. “Forks Over Knives”: Is the Science Legit? (A Review and Critique), Raw Food SOS.
Denise Minger. The Truth About Ancel Keys: We’ve All Got It Wrong, Raw Food SOS.
Denise Minger. The China Study: My Response to Campbell, Raw Food SOS.
Denise Minger. Heart Disease and the China Study, Post #1.5, Raw Food SOS.
David J. Lefer, PhD. Statins as Potent Antiinflammatory Drugs, Circulation 2002; 106: 2041-2042, American Heart Association.

The Rosedale Diet for improving leptin function

I was surfing the web yesterday looking for information about Rabbit Starvation, the result of exclusively eating lean meat, when I came across information about the Rosedale Diet on the Ketogenic Diet Resource site. The Rosedale information talks about how the hormone leptin figures into aging and overweight. Science hasn’t known about leptin for very long. It wasn’t discovered until 1995. Leptin helps to control hunger and fat burning, among other things. Usually, when leptin is low, that signals hunger. When it goes up, that tells the body to burn fat. At least that’s how it’s supposed to work. Scientists thought when they first discovered leptin that the answer to obesity could be as simple as giving leptin supplements to obese people. But they found out that obese people tend to have very high levels of leptin already. They figured out that people can become leptin insensitive just as they can become insulin insensitive. Dr. Rosedale believes that overweight and obesity are the result of a derangement in the functioning of insulin and leptin. Overeating of carbohydrates can cause this derangement. Other materials I have read focused on the insulin alone, so this is a bit different. Dr. Rosedale determined that his low-carb/high-fat/controlled-protein diet can restore proper leptin functioning in the body. As he says, fat doesn’t make you fat; the inability to burn fat makes you fat. Restoring leptin function corrects the body’s ability to burn fat and thus allows the body to burn its stored fat. The result of weight lost this way is a trim, lean, muscular body and not just a thin version of a fat person. I decided to buy Dr. Rosedale’s book and learn more about how leptin functions since I haven’t seen much about it up until now.

Rethinking dietary advice

What if popular dietary advice was just plain wrong? Mainstream dietary thinking tells us that the number of calories in must balance the number of calories out. They tell us that the best way to make sure that the number of calories in is less than or equal to the number of calories out is to decrease our fat intake. They tell us that we should balance our diet with a certain amount of complex carbohydrates. They tell us that exercise can also alter the equation of calories in versus calories out. So what if all that was just plain wrong? What if the real cause of overweight was metabolic disturbance caused by an imbalance of hormones?

I am currently reading Good Calories, Bad Calories: Fats, Carbs, and the Controversial Science of Diet and Health by Gary Taubes which proposes exactly that theory. I am further inclined to believe that metabolic disturbance theory given my own anecdotal experiences. Firstly, I have been diagnosed with bipolar disorder and have consequently been prescribed various medications to treat that. Fortunately, these medications have been effective in controlling the bipolar disorder, but they have also led to side effects, most notably with some of the medications, weight gain. The worst of these medications for me was Depakote, an anti-seizure medication. I gained crazy amounts of weight on this medication without corresponding dietary alteration, so much so that I told my doctor to change the medication or he would have a noncompliance problem on his hands.

More recently, our dog was diagnosed with epilepsy, and Phenobarbital was prescribed to her. Before her seizure episodes and consequent prescription, we were able to feed her as much food as she wanted without her gaining weight. After she started her medication, she started gaining weight on much less food. At first, we cut back on her food to the level prescribed on the back of the bag. When she continued to gain weight, we consulted her vet and decided upon an amount of food that was even less than is typical for an active dog like her at her weight. We have since been able to control her weight at this lower consumption. Given that she is still an active dog and yet must eat less than her peers, we must assume that her medication causes some sort of metabolic disturbance.

In the book, Good Calories, Bad Calories, Gary Taubes puts forward the theory that overweight is caused by excess insulin. Excess insulin, in turn, is caused by excess carbohydrate in the diet. When carbohydrate is restricted, weight loss occurs even when calories are not restricted. The author cites studies in which carbohydrate restricted diets exceeded 3,000 calories a day and yet weight loss still occurred. Actually, they had difficulty getting their subjects to eat this amount of non-carbohydrate food, not due to boredom as has been postulated, but because the subjects had no appetite for higher consumption. Modern dietary advice tells us that all calories are created equal. Gary Taubes puts forward that this is not the case. Carbohydrates are uniquely fattening because they increase the secretion of insulin. Insulin drives the blood sugar into adipose tissue, often depriving the muscle tissue of that energy. This leads to increased food cravings, which are often satisfied with additional carbohydrates. This leads to a vicious cycle in which carbohydrates are consumed to offset an energy deficit that is redirected to the fat instead.

So let’s go back to my medications, particularly the Depakote. So why did Depakote cause such weight gain even though my dietary intake had not increased, and in fact, I was trying desperately to control my weight? As it turns out, Depakote is associated with hyperinsulinemia, which is an overproduction of insulin. Phenobarbital is likewise associated with changes in glucose metabolism. Given these effects, it is not surprising that both I and the dog would gain weight when prescribed these medications.

Recently, Woman’s World published an article promoting the use of coconut or MCT oil for weight loss. I did a little research to look into this further and found out that MCT oil is most effective for weight loss when associated with a ketogenic diet. This is a diet severely restricted in carbohydrates and high in fat. I did a little bit more research and found out that a ketogenic diet is often prescribed to epileptics. I found this particularly interesting because anti-seizure medications are often prescribed to bipolar patients. I wondered if maybe the ketogenic diet had been found effective in treating bipolar disorder. Particularly, I wanted to know if there was any contra-indication advising against a bipolar patient following a ketogenic diet. I found out that the ketogenic diet had been effective in animal studies of bipolar disorder, but that human studies have not been done. Stanford University wanted to conduct a study of the ketogenic diet for bipolar patients, but was unable to find participants for its study. Given what I have read and given my experience, I am ready to be a guinea pig for such a study.