March 26, 2010

But...How Do I Feed My Family?

I've been noticing lately that one of the questions a low of newbies tend to ask is in regards to how to feed the family. They've read the book that accompanies their plan of choice. They understand the do's and dont's, the why's and what not's, but because they are new to this way of life, they can't quite wrap their minds around how to feed their family when they are doing low carb.

For some of us that really isn't an issue. We cook for the family the same way we cook for ourselves. And they either take regular lunches to work to get the extra carbs they need, or they snack on carbier choices. But for some, that isn't always an option for whatever reason.

I went to check out the blog of one of my new commenters the other day. It's called Tami's Kitchen Table Talk. And I particularly liked the way she does something called Menu Mondays. Now for myself, I'm not good at sticking to a weekly menu since my health tends to interfere with that more often than not. But I know how well the idea works because I used to do a weekly menu each week for the Boys Home.

What caught my attention at this particular blog, was the way in which she did two menus each week. One for the family, and then one adapted to low carb for herself.

I've been planning on spotlighting this blog ever since, but have been putting it off, because I wanted to take the time to collect for you the links to several weeks' menus, so you could see what I'm talking about. But when I went to Tami's blog this morning, I was completely surprised to see that Tami has now changed her blog format. Or maybe it was always like that and I was just dense the other day, LOL. I don't know.

We have low carb pictures of recipes and menus on the left, and pictures of recipes for the family and their  menu on the right. And links to several of her other weeks' menus right there.

A particularly nice set up that you ought to check out.

March 23, 2010

Is It Safe To Stay In Ketosis Indefinitely?

How Long Can I Stay in Ketosis?
Are You Putting Too Much
Attention on Ketosis?
There seems to be a lot of focus on the state of Ketosis these days, with many people asking the same questions:
  • Am I in ketosis?
  • How many carbs does it take to get thrown out of ketosis?
  • What should I do if the Ketostix aren't showing that I'm in ketosis anymore?
  • I'm only eating 20 carbs, why am I not in ketosis?
  • Is it safe to stay in ketosis indefinitely?
And while some of these questions are certainly important, like just how safe of a diet is the Atkins Diet long-term, overall it seems that the low-carb community is putting too much emphasis on the process of ketosis and not enough focus on nutrition.

With so many different versions of Atkins out there, and people still doing all of them, I don't see the questions going away anytime soon, so I thought I'd take a moment and do a post on my own personal views about ketosis and its long-term safety.

March 18, 2010

Fructose-Induced Leptin Resistance Study

Most low carbers are aware of the fact that high fructose corn syrup is associated with obesity. And that the problem is the fructose. But since fructose doesn't raise insulin levels, how does fructose do that?

I ran into an interesting study the other day while researching high fructose corn syrup. The running title is: Fructose and Leptin Resistance, and the hypotheses was 2-fold. 1) Chronic high fructose intake induces Leptin Resistance; and 2) Leptin Resistance leads to susceptibility to weight gain.

In the study, 23 male Sprague-Dawley rats, age 2-1/2 months, were first fed one of two diets: 1) 5.2% fat (lard), 60% corn starch, 18.3% protein (mostly casein), and 3.6 kcal/g; or 2) 5.2% fat (lard), 60.4% fructose, 18.8% protein (mainly casein), and 3.6 kcal/g. Since the hypotheses dealt with Leptin Resistance, all of the rats were tested with Leptin injections prior to putting them on the diets, and all of the rats responded to those injections by reducing their 24 hr food intake.

At 6 months, the rats were tested again. There was no noticeable difference between the fructose-fed rats and the control group in regards to food intake, (total food was left for them in the morning, and they were able to eat as much of it as they wanted, whenever they wanted), body weight, fat storage, blood leptin level, and metabolic syndrome markers except for raised Triglyceride levels in the blood of those rats on the high fructose diet.

All rats were again injected with leptin, but only the rats on the control group diet reduced their 24 hour food intake this time. The fructose-fed rats didn't respond to leptin at all. Plus other tests on the fructose-fed rats showed they all had Leptin signalling issues. So it wasn't just a matter of higher Triglycerides interfering with Leptin's ability to cross the Blood Brain Barrier. Though that was most likely a factor as well.

At this point, 1/2 of the fructose-fed rats and 1/2 of the control group rats were placed on a high-fat diet of 60% kcal/g from lard, to replace the fructose, 7% kcal/g from sucrose, and 5.24 kcal/g. They didn't say what the protein intake was, but I suppose it was the same.

At 2 weeks, the rats were tested again, but this time there were significant differences. Both the control group and fructose-fed rats now eating a high-fat diet increased their food intake and therefore incurred significant weight gain. But the rats previously fed a high-fructose diet demonstrated higher calorie intake, higher weight gain, and higher fat storage.

While glucose and insulin levels were not affected in any of the rats, in non-fasted blood samples, uric acid levels increased in all rats being fed the high-fat diet, but not in those on just high fructose. Triglycerides were elevated with the high fructose diet, but not in those on no-fructose high-fat. This showed that a high-fat diet didn't affect Triglycerides, while fructose feeding doubled Triglyceride levels. Plus, as body fat storage went up, so did Triglyceride levels.

The study is significant because it shows Leptin Resistance to be at the heart of the current Obesity Epidemic, possibly driven by a high fructose intake then coupled with an excess intake of calories/fat, and that Insulin Resistance does not cause obesity.

Now before you start screaming that this study is flawed and throw it out because you don't like the idea that a high-fat diet led to excess fat storage, and increased Triglycerides and uric acid, keep in mind that the diet also contained a 7% sugar intake. Plus it's extremely possible that the same results would have occurred with any kind of excess of calories.

Leptin Resistance plus a high-fat diet together may or may not be significant. It's still too early to know for sure.

March 17, 2010

10 Ideas For a No-Frills Low Carb Cuisine

I came across a food article a couple of days ago on a website called Wallet Pop that dealt with how to feed a college kid for only $35 a week. That comes to about $5 a day. Among his tips on how to do it, he posted a sample week's menu which he clearly announced was a no-frills, survival menu only. He also placed a disclaimer right above the menu that said prices will vary depending upon where you live and shop.

But the whole thing really got the commenters into an uproar.

His menu was plain, and extremely repetitive, which it very much could be if you were a college boy with little money and didn't know how to cook. Plus it was greatly lacking in fruits and veggies. However, he did explain that those types of items could be easily replaced for some of the choices he had made in his fake shopping trip. But most of the things he said went totally over the readers' heads.

After reading through 16 pages of comments, I was left with a disheartened kind of feeling, because most of the comments were pretty much the same as when a low carber over at Low Carb Friends attempted to revamp the dad's menu into something that would work for a low carb diet. Most criticisms on the blog, as well as the Low Carb Friends' thread, were about the menus themselves, rather than the principles put forth in the article meant to help the reader to design their own no-frills menu.

In fact, there wasn't a single comment on any of those principles. Just comments showing that the reader wanted to be told exactly what to do. They wanted to know exactly what to eat. They didn't want to be taught how to fish, so to speak. "I can't do it here, for what you can do it there." "Tell me where you shop so I can go there too."

The vast majority of comments feverishly centered around the nutrition of the sample menu. How to do it better, or what was missing. But the advice was conflicting, depending on the nutritional dogma that each commenter was bringing to the table. Some wanted a menu with fewer processed, refined carbs. Some wanted a menu without meat. Some wanted to know where the fruits and veggies were. Others fought among each other as to whether or not fresh fruits and veggies were better nutritionally than frozen.

And most of them kept asking where you could buy a gallon of milk for $1.89 even though several previous commenters who supported the dad's prices, specifically told them where they live, and where they shop.

The commenters at Low Carb Friends weren't any better, criticizing the posters prices, and telling her she was crazy because "they" couldn't buy the foods she chose, for the prices the poster was able to buy them for.

I can't help but wonder what is WRONG with people? Why have we turned ourselves into such a dumbed-down species? Why couldn't even the low-carb group see and understand that the reason why the poster went to all of the trouble revamping the article into a low carb menu was to show low carb folks that healthier choices doesn't really cost more than cheap, highly refined carb living.


So I'm not going to come up with any kind of a false menu plan. Instead, I'm going to give you the 10 principles this particular dad laid out in the original article:

1. Discipline. Sometimes if you really don't have the money to spend, discipline might not be a problem. For example, right now, we have very little money coming in, so everything we do get goes straight to bills. We are pretty much living on whatever I have in the house. If your situation is a bit less extreme, it's going to take the right frame of mind, and the desire to save money to do this. That's because stores are designed to get us to spend our money. Their motive isn't to help us save anything.

2. Shop Cheap. The suggestion given was to do most of your shopping in a discount supermarket. The one in my own area is a Super Walmart, but prices aren't necessarily cheaper than the other 2 stores in my area. The other suggestion was to let go of name brands and buy generic and store brands. I do that when I can, but my gluten intolerance won't always allow me to do that, as I have to buy what's gluten free. Which is why these principles are meant to be guidelines only. Take what you can use, and toss the rest.

3. Shop for staples every couple of weeks. The less time you spend in the grocery store, and the fewer trips you make each month or week, the less chance there is for the store to rob you of your funds through impulse purchases.

4. A survival diet is a bare-bones, basic diet. While it should be as nutritious as one can make it, there are times when you aren't going to be able to eat what you know to be good nutrition. Not even good low carb nutrition. In my own current circumstances, for example, we are eating very few veggies and fruit and lots of starchy carbs right now because that's what I have in the house.

5. Cruise the aisles. Spend some time checking out all the stores in your own area. For me, that's a Super Walmart and a couple of independent grocery stores. Spend some time checking out what types of low carb foods are available, and what their prices for those foods are. See if you can come up with new and different alternatives to what you've been currently buying.

In our area whole chicken are high, $6 or $7 each which would give us 2 meals. A 10-lb bag of chicken leg quarters is the same price, but would feed us twice as many meals, plus soup.

Ground beef is pretty expensive here too. $2.50 to $3.00 a pound for the medium fat kind. But one of the independent grocery stores has a marked down meat section where I can get regular and medium fat ground beef for $1.29 when they have it. So I generally wait for them to mark it down, then buy everything they have at that reduced price.

If I can't get marked down ground beef, I substitute ground turkey which runs $1.89 here at full price, and around $1.49 when Walmart marks it down.

6. Go for weekly variety rather than daily. Let's face it. We're pretty spoiled. Most of us are used to eating whatever we want to eat, whenever we want to eat it. And that means daily variety. But when you're following a tight budget, that isn't always possible. If you buy a 10lb bag of chicken leg quarters, for example, you might have to eat chicken 3 or 4 times that week. Next week you might buy a large package of pork steaks and eat those instead of the chicken. If you can shop less often, like bi-weekly or even monthly, variety will be easier to come by.

7. Cook with leftovers in mind.  In the sample menu offered, there was 3 main dishes planned that were alternated throughout the week. I tend to cook the same way. With only 2 of us to cook for most of the time, I still use a lot of main dishes meant to serve 4 or 6. Then we eat the leftovers scattered throughout the week.

8. Save what you have leftover each week to add to next weeks purchases so you can spend a bit more on something that is more special. You don't have to spend your full budgeted amount each week. If your budget is $35 and you only spend $32, then save the $3 to add to next week's purchases.

We really, really like salmon, which is sold in large 2lb packages here for about $7. That comes to $3.50 per meal which is higher than I normally spend on meat. Especially when I can pick up cheap rib steaks for $1.99 a pound. So it isn't something that we are able to buy every week. However, if  I saved the little bit I didn't spend this week to go with next week's menu, I could put that $3 towards the purchase of salmon.

9. Make a list of everything you like to eat, and arrange it in order of cost.  I did this when I was working at the Boys' Home. It was the only way to feed the 24 people I was feeding for $335 a week. I had to generally know what each main dish cost, so I could base most of my week's menu on the lower cost main dishes, plus juggle the go-withs to stay within a certain dollar amount per meal.

10. Think volume, rather than what you would like to eat. When money is tight, and you are cut to a bare-bones menu what fills your tummy and keeps you satisfied is going to count the most. Whipped cream topped sugar-free jello is nice, but doesn't go very far when you're hungry and need a real snack. Deviled eggs, tuna with mayo, celery with peanut butter is far more filling.

Well, that's the 10 principles I was able to find in the above referenced article. Did you find any others that I missed?

March 14, 2010

How to Handle Weight Loss Stalls

If you spend any amount of time on the various low-carb boards and egroups, the one type of post that tends to come up over and over again, is in regards to the speed of weight loss. Generally these people are those who've lost a lot of weight on Induction, but are now in a weight loss pause, and the pause has scared them.

Typically, they're depressed, whiny, analytically frustrated because they are losing weight as quickly as they believe they should. Or as quickly as they did in the beginning. Or as quickly as someone else is losing.

Now there's a lot of information on the web about what might be causing the plateau or stall, and what one can do about it physically to try and change the situation. But let's be honest here. The answers conflict and results from trying all of those things vary so greatly from person to person, that in the meantime, it can flat out drive you crazy enough to just give up on the whole diet thing.

So what's a person to DO while they're experimenting with upping/lowering protein, upping/lowering carbs, upping/lowering calories, drinking more water, or trying out a new plan?

The first thing to do is to take a breath, step back just a pace, and accept the fact that most people who complain they are stalled, really aren't. Why? Because the body doesn't like shrinking fat cells, it doesn't like all of the yo-yo stuff we do to it, and it especially doesn't like the dehydration and water loss we've inflicted upon it by forcing it to call upon our liver glycogen reserves.

So it fills the fat cells with water to compensate. Not permanently, but sometimes for a long enough time to make us freak out a bit. Long enough to make us believe that we are never going to reach our weight loss goal. That we're never going to be able to become anything close to normal. Whatever we define that to be.

That makes the problem not really one of initiating fat loss as much as it makes the problem one of motivation, because most folks who are freaking out about their weight loss plateau are generally doing so after not having lost any weight for a mere 3 days, or perhaps a week. They think back to the amount of weight they lost during Induction, and want to know why that rate of loss isn't continuing. What's wrong with them...what's wrong with the diet...if it's not going to work, they might as well eat carbs.

Okay. I can understand where their head is at. I really can. As I've been at this diet thing for over 3 years now, and I'm still just a little more than halfway to goal. And while I can't relate to freaking out after 3 days or a week, I can relate to the notion that if this thing isn't going to work, I might as well eat carbs. Because the truth is, I've done that. I've actually tried that approach.

But you know what?

What stops me each and every time, after a few pounds gain, is the reality that I really, Really, REALLY do not want to go back to who and what I was before. I don't want to go back to weighing 256.5 lbs, and wearing size 3x's. I don't want to go back to the Neuropathy that was so bad I couldn't walk 2 steps without putting on my good, solid tennis. I don't want to live with the heart palpitations, the high blood pressure, and the irratic blood glucose levels the doctor keeps insisting is a fluke.

So I do a fast 180-degree turn, and come back.

I come back each and every time I stray because even though low-carb is no longer working for me, and raises my blood glucose levels to pre-diabetic levels, it helps me from undoing everything I've achieved so far. Real honest to goodness fat loss. It allows me to walk around my house in my stocking feet without having to wear shoes every waking minute of the day. And it helps me make more nutritious choices, like all of the veggies I otherwise wouldn't eat.

I suppose in the position I'm standing in right now, it would be easy to chuck it all for something else. But I can't help but ask myself what's the worse thing that could happen to me if I stayed at the weight I am right now? If all of my future twists and turns don't pan out, and don't get me moving downwards ever again, would that really be so bad?

Probably not--not when you consider what the alternative to that actually is. Is it better to live out the rest of my life on some type of doable low-carb maintenance plan as a size 14, or on a high carb plan that reaps me a size 26?

Okay. So I'll take the doable low-carb maintenance plan as a size 14.

But...I don't know that I've made myself a HAPPY lifestyle choice by doing that. Maybe because I haven't yet found that maintenance level of good health that will net me something more sustainable than pre-diabetic glucose levels. And maybe it's because I haven't yet thoroughly explored all of the possible alternatives. All of the maintenance possibilities that will grant health along with my current size.

I do plan to do that when my current situation betters a bit, like drastically lowering my omega 6 intake, (which I think is why I'm beginning to lose heart with the South Beach Diet), and become more dedicated to eliminating fructose from my diet, since I have to read each and every label anyways due to the gluten intolerance. Experiment with a few healthy carbs like brown rice and sweet potatoes, rather than high carb, high fat desserts.

However, I'm not so sure that focusing on food, even healthy food, is really the best choice when one has been stalled for a couple of years now. 

I'm beginning to think that the answer, the real answer, centers around gratitude. Because I really am grateful to Dr. Atkins and Dr. Eades who have made possible what I've been able to accomplish so far. I really am grateful to Lyle McDonald for helping me understand thermodynamics and leptin and how all of that pertains and is applicable in the context of fat loss. I really am grateful to Dr. Agatson of South Beach, and the author's of the Sugar Busters diet (can't remember their names right now), for giving me a different way of approaching food and carbs without all of that counting that can get so obsessive.

And now I'm really grateful to Matt Stone of 180-Degree Health who's writings that I have read to date have given me a new sense of hope. While he tends to be quite controversial and totally anti-lowcarb, and maybe even a bit crazy in his beliefs, he does give one pause for thought on so many issues low carbers are generally not willing to even look at. Let alone experiment with. Like over-consumption of omega 6, high cortisol levels, and a depressed metabolism.

All things I'll be looking into in the near future.

But for now...I'd also like to say that I'm very grateful for all of the people on the various boards and egroups who have highly influenced me in my journey to date. My readers who ask me hard questions, and make me rethink my current positions. Because throughout all of this, I've come to understand that our journey to health isn't something we do by ourselves. Not really.

Even though we each have to take the actual steps, our journey to health is a collective, inter-mingling effort. And as such, it takes us all to make that happen.

March 06, 2010

Insulin Resistance in the Fat Cells

The first step in Insulin Resistance is fatty deposits in the liver. At this stage, it's not too big of a problem, as there aren't that many symptoms. So we keep on eating the way we always have.

Next comes Insulin Resistance in the muscles. At this point, we begin to put on excess weight. We begin experiencing glycogen storage issues and symptoms, blood glucose problems, excess blood fats, and tiredness. We begin experiencing serious health issues from the Insulinemia.

Sometimes our ill health is enough to cause us to change our lifestyle. To go on a diet. To get up off of the sofa and exercise. But sometimes, it's not.

Sometimes we rationalize all of our health problems away in an attempt to justify our current, unhealthy lifestyle. We blame the excess weight on age. We blame our inability to stay on a diet on our food addictions and social behavoirs. We say we don't care that we've put on a few extra pounds. That it's normal in our current society. We don't want to look like Twiggy anyway.

If we keep on eating the way we always have, if we keep on embracing our sedentary ways, all of those excess calories have got to go someplace. And while we may, or may not be overeating in regards to volume of food, the liver and muscle glycogen dysfunction is serious enough to either make us obese, with all of those extra health issues, or turn us into what is known as Metabolic Syndrome.

Now we come to the end of the road, where even the fat cells begin to rebel. Because their job isn't to continuously fill themselves up with fats. Their function is to switch between fatty acid uptake, and release. Their function is to buffer the flux of fatty acids in the circulation in the face of dietary input of fatty acids. The role of the fat cells is to absorb fatty acids when there are too many around, then release them when they are scarse.

But if they're never scarse, if the buffering capacity gets overwhelmed by consistant intake of dietary fats over and above the rate of oxidation, all of those fats have got to go somewhere. And that somewhere is the liver, muscles, pancreas, and adipose tissues; thus eventually causing full body Insulin Resistance.

As fat cells fill up with Triglyceride, they become resistant to Insulin, causing even more Triglyceride to build up in the bloodstream and body organs. Hence the Metabolic Syndrome. Not a good thing as far as heart disease, stroke, and other fat-related diseases are concerned.

This is the point where quite a few folks decide that they want to enter into the Low Carb Lifestyle. And as far as low carbing goes, total body Insulin Resistance is a good position to be in. Especially if you have only a moderate amount of weight to lose. Because at this point in the progression, the body is no longer in fat storage mode. So when you eliminate most of the carbs from your diet, irregardless of the level of insulin, the fat just falls off of you.

Atkins' Magic. Metabolic Advantage. Whatever you want to call it, the results seem to defy the laws of Thermodynamics. And if it's your first time of attempting a low carb diet, you can get very good results with any of the low-carb programs, provided you stick with it, change your lifestyle, and make it all the way to goal weight. Then follow the Maintenance Program for life.

Not everyone chooses to do that though. Some of us didn't understand the consequences for not turning low-carb into a lifestyle the first time that we tried it. Some of us left the movement for various reasons, good or bad, only to find that upon our return, our bodies didn't work quite the same way as they did before. Some still found magic, just a little bit slower. And some of us found absolutely no metabolic advantage at all.

So I want to apologize a bit here for being so cynical in regards to low carbing lately. I just really want to figure all of this out, what is actually happening to me, so that I can make the adjustments I need to make in order to finally reach a healthy weight.

All of the research I've done on Insulin Resistance lately points to the fact that the problem I'm having with a low-carb, high-fat diet not working for me, might not be because low-carb itself doesn't work. Maybe it has something to do with the fact that low-carb the first or second time around healed the adipose tissue insulin resistance, which then made it harder to lose the weight from thereon in. Low carb, or not.

Maybe the reason why I've had to lower my fat and calorie intake almost from the very start of my journey this time around, is because I'm battling liver and muscle insulin resistance, rather than total body insulin resistance. And as a result, dietary fat and overall calories matter more than they otherwise would.

I don't know. What do YOU think....

March 05, 2010

Insulin Resistance in the Muscle

Those who have Insulin Resistance generally have a higher baseline insulin level, because the body is always fighting to overcome the resistance. But it isn't the insulin that is causing the problem. When you reach the point of muscle Insulin Resistance, it's excess Triglycerides.

Now, the adipose tissue at this point is still highly sensitive to insulin, so after food intake, blood flow is increased. But that exposes the muscle fibers to excess fatty acids being made by the liver, as well as dietary fats. Excess being the key word here. And when that happens, just like in the liver, fat tends to be laid down in the muscle, which then causes the muscles to become resistant to insulin.

This increased fatty acid availability decreases glucose utilization in the muscle, since fats compete with the available glucose. If the fatty acid wins, the muscles are unable to store glycogen very well, and the excess glucose provides the stimulus for Insulinemia.

With the muscles' diminished capacity to store glycogen, everything not immediately used for fuel either backs up in the bloodstream, or is stored in the liver, muscles, and fat cells. But fatty acids can't be converted into fuel fast enough to supply the body with immediate energy, and since the build up of fats in the muscles can also cause a defect in muscle fat oxidation, the result is increased Insulin Resistance, nausea, tiredness, brain fog, disorientation, and just flat-out feeling like crap.

What athletes call "hitting the wall."

Now this caught my attention, because it was a perfect description of what happens to me when I go too low in carbs for any length of time. I start out feeling pretty good for a couple of days, but around the time that liver glycogen gets depleted, I feel tired and nauseated. I'm more prone to vertigo attacks. And yep, just as the description says, I flat-out feel like crap. Which only gets worse as the dieting at that carb level continues.

What I didn't know was that glycogen stores are supposed to refill, even on a low-carb diet. And that the body will do whatever it has to do, to make that happen. However, since the liver is resistant to insulin, and in constant glucose production, and since the muscles are not able to store the glucose being made by the liver, (and probably the liver either, for that matter, which might be why I tend to need more carbs than others), it's no wonder that one can suffer from runaway glucose production, even on a zero carb diet. As well as fat gain.

At this point, the muscle is unable to protect other tissues from a daily influx of dietary fatty acids. The result is more and more build up of fat deposits in muscle, liver, fat cells, and now the beta cells of the Pancreas. In the case of the B-cells, fat deposits can cause impairment of insulin release in response to glucose. Creating a situation which is sometimes called Diabetes 1.5.

In some of my own, personal dietary experiments, I've often wondered about that. Am I Insulinemic, or do I not put out enough insulin? Because sometimes it seems like I don't make enough insulin to handle what is going on. However, resistance itself can cause the same symptoms. So without proper testing, one cannot know for sure.

The thing to remember, is that glucose issues don't fit into a single mold. It isn't always about an insulin spike in regards to eating too many carbs. Sometimes it's a matter of not putting out enough insulin. Sometimes it's a matter of being Insulin Sensitive, rather than Insulin Resistant. And that means the very plan that one looks to for salvation could be actually fighting against you.

And then could just be that we are now standing in a place of partial healing, and more aware of the symptoms we didn't notice when we first went through the progression of Insulin Resistance.

March 04, 2010

Insulin Resistance in the Liver

Insulin Resistance is believed by some to progress in a particular order. But I couldn't find anything to actually back that up. However, since insulin resistance in the liver is characterized by insulin's inability to turn off glucose production (Gluconeogensis), it does make sense that Insulin Resistance would begin with the liver.

Since glucose production no longer shuts off, both obese and Lypodystrophic patients (those with no adipose tissue for storage purposes) with Insulin Resistance have an increased amount of fat hidden in the liver. Liver cells, as well as the spaces in the liver fill with fat, so the liver becomes enlarged and heavier. Plus you may also have gallstones composed of cholesterol and bile salts.

When the liver is full of fat, it can't filter and cleanse the blood as efficiently, so the bloodstream becomes clogged with toxins and excess fatty acids (Triglycerides). The liver will also overproduce most of the known cardiovascular risk factors such as VLDL, glucose, CRP (C-reactive Protein), PAI-1 (Plasminogen Activator Inhibitor-1), fibrinogen, and coagulation factors. Poor liver function can also lead to autoimmune issues and Diabetes.

Fatty liver is the most common cause of increased liver enzymes, a sign of inflammation and liver damage. And among the obese, fatty liver is seen in 90% of adults and 53% of children. However, while 90% shows the magnitude of the problem of Insulin Resistance, at least at beginning levels of the syndrome, it also shows that for 10% of the obese population there is no fatty liver, and therefore no Insulin Resistance. Those 10%, even though obese, are actually Insulin Sensitive.

Development of fatty liver comes from an imbalance between the influx and production of fatty acids, and the use of those fatty acids for oxidation or the secretion as VLDL Triglycerides. There is a strong relationship between increased liver fat and the overproduction of large VLDL particles, since insulin is unable to regulate their production. So while large, fluffy VLDL particles are a good thing as far as not being able to slip underneath blood vessel linings, a large amount of them circulating in the bloodstream is a sign of fatty liver disease.

Excess glucose produced in the liver is not the only source of excess Triglyceride. Alcohol, sugar/fructose, high-fat foods (especially red meat and dairy), all play a role. So do birth control pills, steroids, and diuretics, as well as medical conditions like hypothyroidism and kidney disease.

Even the fat that is stored in your adipose tissue is Triglycerides, so the more body fat you have, the higher your overall Triglyceride levels will be. Plus, they also tend to increase the older you get.

And let's not forget heredity.

The good thing is that in addition to weight-bearing exercise and aerobic activity, a low carb diet is set up in such a way as to help you burn a lot of those excess, damaging Triglycerides. So blood Triglyceride numbers tend to improve greatly once you enter into a low carb diet, without having to do anything else.

The bad news is it's extremely hard to burn liver fat. Making complete liver Insulin Resistance reversal hard, but not impossible if you take your total body fat stores down low enough. Plus, when the body is burning viseral fat, it doesn't always show up on the scale, or in inches, so there's the temptation to abandon the diet, even though it's actually working.

Not everyone is willing to do what it takes to reverse Insulin Resistance. But for those of us who are, it's very  important to work on making our current dietary lifestyle a way of life, rather than something we plan on doing just for the short term. Because if we return to our old ways and habits, the Insulin Resistance will also return.

March 03, 2010

What Causes Insulin Resistance?

I was reading over at Lyle McDonald's "nice" forum the other day, and came across a thread on Insulin Sensitivity and Resistance. His view peaked my interest, because it was so different from the typical low carb viewpoint. So I went out into the Blogosphere to see if I could find the studies he was discussing that would back up his opinion.

Now, the typical low carb view of how the body works is that when you eat carbs, especially high-glycemic ones, blood glucose rises which triggers insulin release. The majority of low carbers believe this is not a healthy response to carbs, and that over time, cells will become less sensitive to the effects of all of that insulin. As a result, blood glucose levels will creep up, basal insulin levels will rise, and the result will be disease and bad health.

The standard low carb belief is that cutting out most carbs from the diet will reverse the cycle. That as a result of eating a low carb diet, insulin levels will remain low, even after eating, blood glucose levels will be controlled, and all disease and ill health issues that came attached to the high insulin and elevated blood glucose levels will magically disappear.

What isn't presented in this view, is why high levels of insulin cause Insulin Resistance.

When I went into the scientific literature the other day, I couldn't find a single study that supported the general low carb view that Insulin Resistance causes obesity. What I found was that obesity causes Insulin Resistance, because high fat stores and high circulating Triglycerides down-regulate insulin receptors, causing resistance to the circulating insulin, irregardless of the level.

Now, in a normal functioning body, glucose levels in the blood rise when you eat. This triggers a rise in insulin. The rise causes insulin-sensitive tissues to take the glucose out of the blood and into their cell Mitochondria to be processed. This rise in blood sugar and insulin isn't a bad thing. It's how the body was designed to work.

What isn't immediately needed for fuel is sent to the liver to be converted to glycogen. This causes blood glucose levels to fall, and beta cells in the Pancreas to reduce their output of insulin. None of this is bad either. It's what keeps our blood glucose levels steady, with a normal glucose level of about 80 to 90 mg/dl.

Glycogen is stored in the liver and muscles for future use. Not a bad thing either. In fact, if we don't replace our glycogen stores, the liver will make the glycogen it needs for that purpose out of protein, and sometimes fats. Glycogen stores is how and why we are able to do sprints and other fast energy movements. 

But when glycogen stores are full, and this is the real key to obesity, any excess glycogen is converted into Triglycerides and stored in our fat cells.

So, if you're eating exactly what the body needs to provide itself with fuel and glycogen storage, with no excess glucose and therefore no excess glycogen, the carbs in your diet will not make you fat. It is only the excess carbs over and above what you need to keep your glycogen stores replenished that cause the problem. And even then, only if our calories exceed our energy output. Since our fat stores are used during times of fasting, like when we're sleeping.

Therefore, Insulin Sensitivity is about how well the body responds to insulin. And is often associated with body fat level.

Under normal conditions, it doesn't take much insulin to get blood glucose into cells. However, the amount of insulin that is released at any given meal is somewhat individual. It isn't always in direct relationship to the amount of glucose in the blood.

While carbs tend to have the greatest impact on insulin secretion, dietary wise, that doesn't mean they cause Insulin Resistance. Because Insulin Resistance isn't about the amount of insulin secreted. It's about the failure of the body to get the glucose in the blood into the cells and Mitochondria where it can be burned. It's about eating more than the body needs for fuel.

Therefore Insulin Resistance isn't a carb problem. It isn't an insulin secretion problem. It's an insulin receptor problem. With higher circulating insulin levels being a symptom. Not the problem itself. Though insulin does cause havoc in the body, that's a totally different issue.

March 01, 2010

Do You Need A Little Inspiration?

If you're struggling with your diet today, and need a little bit of inspiration, check out the Before and After thread over at Low Carb Friends. They got some great pictures. The dramatic effects of following a low carb diet.