If you are reading the low-carb, and some of the anti-low carb, blogs these days, you will find them buzzing with discussions about the recent Ancestral Health Symposium held in Los Angeles last week. The famous Loren Cordain described it as: “The Woodstock of Evolutionary Medicine”. It gathered together a bunch of the prominent researchers, clinicians and bloggers who are pursuing paleo/low-carb/ancestral diets of one sort or another. By all accounts it was a huge success. I have to admit that I wish I had attended. I was invited to speak but decided, for a number of reasons, not to go. Now I am regretting that decision.
At some point the lectures will be available for viewing on the web. I look forward to seeing them, but, as with all events of this type, it is the rubbing of shoulders, the hallway chats and the peripheral breakfasts and dinners with colleagues where one gets the most benefit. It would have been a chance to catch up with old friends like Richard Feinman, Gary Taubes, Mike and Mary Dan Eades, Jimmy Moore and others and to finally meet some of the nutritional iconoclasts whom I have been admiring from a distance; people like Tom Naughton, Loren Cordain, Robert Lustig, Denise Minger, Chris Masterjohn, and many more.
There are a number of reports and discussions I have been reading this past week. Perhaps one of the most interesting is a debate on the validity of Gary Taubes’ ideas on the aetiology of obesity which can be found at the blog of Stephan Guyenet who spoke at the symposium and was challenged by Gary in the Q&A. There is video of this exchange on the web and some buzz because people thought Gary was rude. This is interesting because I have heard that from other people, too, and it is sometimes used as a justification for rejecting his ideas. For the record, I have never found Gary to be rude to the point of objection. I would say he does not always suffer fools gladly and is averse to sugar-coating a blunt message. Perhaps it is because I survived a medical education where those were the orders of the day, or maybe it’s because I pretty much agree with everything he says (and remember, I come from Canada where it is more important to be nice than it is to be right), or maybe I am tone deaf to rudeness, but any way you slice it I think Gary has a lot of very important things to say and we should listen. So, I don’t find Gary’s challenge to Stephan to be objectionable. Beyond that, however, it seems to have become a point of departure for a debate on the merits of the carbohydrate hypothesis. I would encourage you to have a look at Stephan’s blog (www.wholehealthsource.blogspot.com) if you are interested in some thoughtful discussion on this topic. For the record, none of the counterarguments so far have swayed my conviction that carbohydrate-restriction is the preferred therapy for the range of conditions associated with insulin resistance.
There’s nothing like a good debate, however, to sharpen your focus and make you re-evaluate your evidence. No harm in that.
Now, I am trying to insert a photo here to show what I would have missed had I gone to the symposium but I can’t get the photo uploaded. If anyone with WordPress expertise can help me troubleshoot this, I would appreciate some advice.
I am convinced that both the insulin/carbohydrate/insulin/leptin issue and rewards both chemical and physical are issues for myself. The chemical part is addiction. I have have lost 55 kgs, and unable to eat cheese or nuts without finishing the package. Perhaps it is a compulsion, low impulse control or something else, but it cannot be insulin issue. I expect it is a chemical reward- opioid? dopamine? bacterial byproduct? The treatment is the same – complete avoidance.
I gave up sugar in all forms, and most grains, and those appear to be a insulin/leptin issue. Once off, the craving reduces, just like an addiction.
For these reasons I think they are both right, but which is more primary is just an ego thing.
Dr Jay’s Reply:
I agree to the extent that I think there are addictive qualities to carbohydrates. I think both seratonin and dopamine systems are involved. I like Bart Hoebel’s work on the addictiveness of sugar, for instance. I also have heard that a significant proportion of people who are compulsive eaters suffer from a D2 receptor deficiency. I have a colleague who finds that Zyban or nicotine patches help them overcome this when they are dieting.
So, there are layers upon layers, ranging from the hormonal to the psychological. In the end, though, a very low-carb diet seems to work for the majority of people suffering from conditions associated with insulin resistance. Some of the psychological or neurological issues will come to bear on whether they can remain compliant so that is certainly an area still worth exploring.
Seems it’s become fashionable to trash Taubes 🙁
Having just read GCBC I don’t see him as having all the answers but as asking all the right questions – AND backing them up with valid research, there’s too much shooting of the messenger going on.
My physiology reacted spectacularly well to carb reduction, I doubled my HDL and reduced my trigs to 10% of what they were, dropped my BP and got my BG back into nondiabetic range. Oh and lost all the weight the dietician’s low fat high carb diet put on, and refound all my missing energy.
IMO insulin and IR are not the *only* factors but major players which influence most of the other subsystems involved, such as leptin and leptin resistance, ghrelin, adiponectin, SIRT, MToR, etc. most of which were unknown in Ancel Keys time and are still unknown to many “authorities”.
Stephan generally comes up with good stuff, particularly the overuse of Omega 6s vs Omega 3s, but as a non-IR person himself he lacks the personal experience of shutting down food storage genes.
Dr Jay’s Reply:
I have a great deal of respect for Gary for his tireless effort to improve our understanding of nutrition and health. I believe him when he says he came to this subject as an agnostic and ended up being a low-carb advocate because that’s where an honest, objective evaluation of the science took him. At the end of GCBC, he pleads for a study to test the hypothesis that it is carbohydrates at the root of our chronic disease problems. For that he has become a whipping boy for all sorts of followers of different dietary belief systems. I am sure he would be the first to admit that he is not infallible and that there may be flaws in his hypotheses. Unfortunately, there are very shrill people around who have almost religious fervour in their dietary beliefs who go to extremes to attack Gary. I think it is because he does represent a huge threat to belief systems that are not solidly grounded in good science. I also think that it wears him down a bit as he is constantly having to fend off these attacks many of which are directed at him personally, challenging his honesty and integrity. It’s really a travesty that this happens but not that surprising. I think it was Margaret Mead, the famous anthropologist, who once said, “I would sooner change a man’s religion than his diet”.
Phew, I’m halfway through reading the Taubes-trashing and had to come up for a breather.
As you’ve probably noticed there’s a lot of trashing of experience which goes against “research”. OK my experience is N=1 but it’s Gold Standard as it is before and after on the same subject and not subject to statistical distortion.
Over time I’ve seen hundreds, maybe thousands of other N=1s. So why doesn’t “research” echo this?
I’m sure you’ve noticed many diabetes papers specifically exclude well controlled diabetics, in some cases exclusion criteria include an A1c below 8. And the papers that *do* include them are discounted as “evidence”. Likewise a lot of dietary/metabolic research specifically excludes the obese, people with diabetes or other cardiovascular diseases etc. and then the results are applied to the excluded populations. Then “peer review” often consists of “does this paper reinforce current dogma? If yes then publish”
All power to anyone who breaks through this. Taubes puts together a lot of information into a compelling pattern. More to the point he suggests things that work more often than they don’t. Can George Bray make that claim?
He didn’t get everything right, particularly he missed out a lot of information that wasn’t discovered at the time he was writing (!) but insulin is something that can be relatively easily manipulated via diet and due to the complex interractivity of the endocrine system changing insulin levels and insulin resistance knocks on to most of the other players. How do you manipulate leptin levels? Manipulate insulin levels and wait . . .