Sunday, May 04, 2008

Weight loss; when it's hard

This post is a set of jottings on weight control when it's difficult. It's essentially unreferenced and was produced in response to the enquiry by Windmill/Windmum (same person) in the comments after this previous post.

Many posts ago I mentioned the thought that it was probably perfectly possible to gain weight on a low carb/high fat diet, provided there were adequate calories involved. Because insulin appears to be very important in controlling the activity of lipoprotein lipase, that enzyme which gets fatty acids out of lipoproteins and in to fat, there has to be some other way of doing this transfer when insulin levels are low.

Chris found the enzyme, it's ASP. You can read more here. ASP is Acylation Stimulating Protein. Let's stick to ASP.

This is completely logical. Those of us who eat combined high fat with LC tend to have rather low levels of insulin in our blood stream. Low levels of insulin mean low levels of activity in the lipoprotein lipase just outside our fat cells. If there was no other way of getting fat out of chylomicrons or VLDL particles and in to adipocytes, we LC eaters would be as chronically hypertriglyceridaemic as a diabetic on a low fat diet. No one would want that.

In to the gap steps ASP, which allows us to store the fat from our current meal as adipose tissue for use in the time before our next meal. On intermittent fasting or once daily eating we HAVE to store an awful lot of fat until we next eat. ASP gets fat in to adipocytes for us, without needing an insulin spike. Good.

What gets the fat out of adipocytes? That's hormone sensitive lipase (HSL from here onwards). Actually, even in HSL knockout mice it is quite possible to get fat out of adipocytes and in the circulation. Which system does this I've no idea and, because none of us is a HSL knockout mouse, I don't much care! If HSL is really working well, it will do the job.

So, say we are eating once daily, we can assume ASP will store any fat we eat in excess of our immediate needs, tucked in to our adipocytes. What reduces our weight is when the release of free fatty acids (FFAs) from our adipocytes via HSL is greater than the input via ASP.

Getting FFAs out easily means optimising the activity of HSL. That means lowering insulin. Low insulin allows HSL to work effectively. An effective HSL supplies FFAs to allow our metabolic activity requirements to be met from adipocytes. A freely available energy supply from adipocytes should reduce the need to obtain energy from food, ie less hunger. Ineffective HSL means you need to eat more, because your fat cells are hanging on to their contents. To paraphrase the whole of Good Calories Bad Calories in one phrase:

Excess weight is the result of a failure of adipocytes to release energy, hunger is needed to supply any shortfall needed for metabolism.

Working on this basis, the requirement for weight loss must be to minimise insulin. This allows metabolism to run on the surplus of adipose tissue energy released over dietary energy consumed. On a high fat diet with low insulin levels ASP will still rapidly store most meal derived fat, HSL will subsequently release it as needed.

Ultimately weight loss boils down to lowering insulin levels. So we end up with a need for minimal carbohydrate. On the Optimal Diet basis that would be the lowest amount for a sedentary person to avoid ketosis, say 0.5g/kg of "ideal" weight. If a person is well adapted to a LC/high fat diet then protein requirements can be as low as 0.8g/kg ideal weight. Protein metabolism requires some insulin response and any excess protein will be mostly converted to glucose, which requires a considerable amount of insulin to be used. Fat intake should be relatively low (by Kwasniewski standards only!) to keep total calories below those needed by our metabolism, otherwise ASP will store more fat than HSL will release. HSL will only ever release enough FFA for the metabolic needs in a healthy person.

On top of that basic plan, the basal metabolic rate must be normal. If a person is hypothyroid they will require far less FFAs for their metabolism and so HSL will adjust to this and minimise fat break down. ASP won't, so a high fat diet will produce weight gain if calories are in excess of metabolic needs. Correct and well monitored thyroid medication is needed for this. As most common thyroid problems seem to be auto immune in origin, avoiding gluten seems like a good idea, if it isn't always a good idea. Which it is. BTW both hypo and hyper thyroidism appear to cause insulin resistance. That seems a bit bizarre to me, but there you go.

There seem to be a few teaks available. Tinkering with insulin sensitivity may be worthwhile. If your muscles need a certain amount of insulin to dispose of a given amount of glucose, then the pancreas will produce that insulin. In addition to helping the muscles take up glucose that insulin will inhibit FFA release from adipocytes. Resistance exercise seems to be the best way to increase insulin sensitivity. Doing this shifts that same given amount of glucose on less insulin. Less insulin means less inhibition of HSL, so easier fat loss.

Improving insulin sensitivity can also be achieved by avoiding medication which interferes with the action of insulin. There has to be a balance here. If dumping your antidepressant makes you suicidal, don't do it! Most blood pressure medications can be gradually reduced as blood pressure tends to normalise on LC eating. Corticosteroids are a real bugbear. Again, if they are life saving you have no choice, keep taking them and accept the weight they make you carry. If you are corticosteroid dependent, never forget that acute withdrawl can be fatal.

If you live as far north as Finland then checking and correcting your vitamin D status would be well worth while.

Anyone reading Chris or Emma's blogs will realise that aspirin, and possibly other related salycilates from plants, cause the pancreas the secrete extra insulin. Avoid. Gluten and wheat germ agglutinin (both from wheat, barley and rye) are (or contain) insulin mimetics, avoid. Casein stimulates insulin secretion, avoid. Pharmaceutical NSAID probably do the same as salycilates, avoid if possible.

Coconut oil is interesting. It has a reputation for assisting weight loss, but if gavaged in to the stomach of a chow fed lab rat it will decrease blood glucose and increase blood insulin levels. You don't want to increase your insulin levels if you want to loose weight. There are other plus and minus sides to coconut oil, but I'd keep life simple and avoid it.

That's quite a list. There are probably loads of other tweaks that I've not thought of...

If you are in the same position as Windmill, that must all be pretty depressing to read. If you want to adjust your weight downwards to where you would like it to be, you are stuck with a pretty extreme version of the Optimal Diet, low but adequate in protein, low in carbs, probably eaten as starches as part of the evening meal, fine tuning your thyroid meds and replacing coconut oil with lard. Lard at a moderate level that is. Do everything practical to maintain your insulin sensitivity.

This seems to work (from an off blog comment from Windmill).

The trouble is that it is HARD. This is not OD as myself or Stan eat it. This is kitchen scales, bathroom scales, portions, calculations, limitations, problems eating out, vegetable avoidance, cheese avoidance, gluten avoidance....... Arghhhhhhh

So there is a trade off. It's one hell of a big trade off. Some of us (most of us probably) have it easy, certainly easier than Windmill. But ultimately there is that balance between fats in to adipocytes and fats out of adipocytes. ASP and HSL. Even worse, there is a trade off between what you know you can do, that you have already done successfully in the past, and the real bind of allowing your diet to rule your life and putting some pretty draconian limits on your eating. Does anybody want to do this? Long term, for ever? That's a very personal decision.

Also the final thought must be: What is the healthiest weight, personal preferences aside?

I don't think we know.



.^ said...

Great post. I don't need those tips just yet, but I might later on.

Weight loss is not my top priority--health is--but that doesn't mean that I wasn't watching it like a hawk. In that sense my bathroom scales breaking turned out to be a 'lucky' break, because since then I haven't thought too much about my weight.

I suspect it's still very, very gradually coming down, but the more gradual the change the harder it is to detect.

Watching your weight is like watching the pot that never boils--it's excruciating. The daily fluctuations and occasional inexplicable blip upward are really frustrating.

(Addressing Peter's audience) I know it's more easily said than done, but if you've put the fundamentals in place I would recommend only weighing yourself every month--or two-weeks at the most.

Scott W said...

Very informative. Thanks for the thoughts on coconut oil as I have seen much conflicting information. Personally, I have not had good luck stomaching it and have not seen any great metabolic benefit.

But...thoughts on MCT oil? Derived from coconut oil, I know, but instead of being half medium chain triglycerides (as is the case with coconut oil) it is 100%.

Given what I believe is the accepted science on MCT's, seems like one would tend to lose weight with it and may not have to watch quantities as much.

What I understand is that it is more easily digested than other lipids since it does not need bile. And that it more easily/quickly enters the bloodstream since it does not have to cycle through the lymphatic system before reaching the liver as, once again, with other lipids. So we have a fairly quick energy source, which is not the point for fat loss.

What I further understand, however, is that the body's cells cannot really hold onto MCT's. Meaning they migrate into the mitochondria of their own accord, without the need of the carnitine transport system.

So...and this would fall under the category of tweaks, I could tend toward using MCT oil to replace other fats (while still controlling over all fat consumption) and the MCTs would not add to adipose tissue, thereby at least minimizing the accumulation of fat. Although one would still need to run a deficit to lose it.

What do you think?


Stephan Guyenet said...

What about intermittent fasting for regaining insulin sensitivity? I know it sound extreme to some, but I think it's actually very natural for us as a species.

IF forces your body to mobilize fatty acids from adipocytes for energy. Maybe it's the jump-start some people need to get their insulin sensitivity back.

Stephan Guyenet said...

Oh and by the way, it seems like rodents react differently to a high-fat diet than humans do, so I'm suspicious of the gavage study.

Unknown said...

If low insulin levels are so crucial for weight loss why is it possible to lose weight with a hypocaloric HC-diet? According to Colpo there is no medical ward-study showing a weight loss advantage of LC vs. HC.

Chris said...

Very helpful post Peter. (although - to be honest - I didn't find ASP, but reported what I'd read about in a Lyle McDonald book )

Thanks for writing this - it ties some things together.

lylemcd said...

"Working on this basis, the requirement for weight loss must be to minimise insulin"

In a controlled calorie setting, carb based diets work just as well as low-carb.

In the real world, people have and will contiune to lose weight and fat eating carbohdyrates and no amount of incorrect rhetoric about insulin will change that.

This whole insulin nonsense is just that, nonsense.


EJD said...

"In a controlled calorie setting, carb based diets work just as well as low-carb." - lylemcd

They certainly do in athlete's and body builder's bodies due to the sheer amount of activity these people do. Hence muscle heads like Lyle McD and A Colpo have these prejudices because they can't see how it might be different for anyone else.

But carbs/insulin/fat don't act that way in my diminutive, female, fibromyalgic body. And believe me, I've tested out regular carb calorie controlled diets for weight loss. The thing about those calorie chamber studies is they only ever use healthy people for the tests...

Peter -- my weight loss diet consists of very fresh beef, lamb, white fish, eggs, butter, double cream, and controlled amounts of sheep/goat milk/yoghurt. The casein is possibly different (though don't quote me on that!). It's also calorie restricted. Anything else tends to stall me.

And yes - coconut oil gives me energy but makes me dreadfully hypoglycaemic.

Peter said...

Hi Scott,

I went back and checked the paper and the rats were actually gavaged with MCT, not coconut oil (sorry, the paper was peripheral to what I was thinking about). I agree MCTs are dealt completely differently from most lipids but ultimately, unless there is a major increase in heat generation, the calorie throughput on a given level of activity must be the same. The worry about the insulin spike is that it produces a few hours when HSL is inactive. OK, you'd be burning MCTs, but we could say the same about glucose replacing palmitic acid oxidation after a high carb meal (except I doubt the insulin spike is as big after MCTs as after glucose, but they didn't check this in the paper). Actually, what this suggests is logical, the body wants MCTs out of the way asap (from the way it deals with them). I can see some logic to inhibiting HSL while the MCTs are oxidised.

BTW I used this paper for the MCT info.


Peter said...

Hi Stephan,

Yes, IF should be on the list. BTW I put the link to the paper re MCTs in the reply to Scott


Peter said...

Hi Sven,

Careful, you almost sound like you might be suggesting that there might a metabolic advantage. Shrug. I'm not interested in metabolic advantage, more in sourcing normal calories for normal metabolism. If you can get them out of your fat in excess of putting them in to your fat, you loose weight. How you do that is what interests me.

Even on the Ornish diet people loose weight. Fasting insulin level (while there was some adherence to the diet) was down 1% or so. Though we don't get the information on 24h insulin concentrations, I guess there must be times when HSL was working.

Bear in mind that insulin inhibits lipolysis at concentrations that don't touch glucose, there have to be times when HSL works.


Peter said...

Hi Emma,



TuulisMumma said...

Thanks Peter!!!

First I leave out coconutoil...

Thyro med. is 0.1mg thyroksin and lab. S- TSH less than 0.01 and S-T4V 15.6...

Is that fatfast necessary now...Last time ketosis went high, ketostix showed black...over 16?´

Strict controlling of eatings sounds easy, if it is all that needed..
Cheese I don´t eat daily...perhaps one-two times a week..

When I tried once-a-day eating, fastsuger was 7.7..
Now it is 5.1.

Sorry my bad english!

mtflight said...

"If low insulin levels are so crucial for weight loss why is it possible to lose weight with a hypocaloric HC-diet?"

IIRC insulin levels indeed go down on hypocaloric conditions (not as well as hypocaloric lc diets), and they also go down on IF.

paul said...

"Also the final thought must be: What is the healthiest weight, personal preferences aside?"

Is it a well-formed question? Two people could have the same BMI but one could be carrying excess abdominal fat and the other not, for example. Of course it's no good being at the extremes of BMI but I am saying that the middle range of acceptability is so big that there is no healthiest weight. It does raise a question of what targets to aim for if not BMI (normal blood glucose? bus-catch-ability? etc).

p.s. I know that a graph of mortality versus BMI does show a peak, but as for the significance of that...

mtflight said...

body fat percentage would be the best alternative to BMI. maybe impeadance testing could be standardized.

paul said...
This comment has been removed by the author.
paul said...

My last (deleted) post was mentioning Fat Free Mass (new to me) but I sent a bad reference for it. Here's a paper

Here's a calculator for 'Fat Free Mass Index', assuming you know your body fat percentage

Anonymous said...

Disagree with limiting coconut oil. That will help many lose weight, as will raw foods. Where is the ref to show that coconut oil will increase insulin? The qualification you make that this occurs with "chow fed lab rat" subjects is telling. Such chow is typically full of refined sugar, casein, and high-PUFA oils. coconut oil normalizes the thyroid and many other problems which may never find resolution if you avoid coconut oil on the basis of rat chow studies.

I protest strongly against reaching conclusions based if rat chow diets and worse yet force-feeding. Such a study only shows that it may be bad to force-feed yourself coconut oil, while eating a rat chow diet.

Anonymous said...

Stephan: "Oh and by the way, it seems like rodents react differently to a high-fat diet than humans do, so I'm suspicious of the gavage study."

Yep. Also, it should be pointed out that rat chow is usually high-carb, with refined sugar and casein being prominent calorie sources. Peter is constantly saying that fat makes a high-carb diet even worse, like his post "When is a high-fat diet not a high-fat diet?" He should apply the same logic to this rat study. Also, it would be good to know what would happen in the long-term.

Scott: "Thanks for the thoughts on coconut oil as I have seen much conflicting information. Personally, I have not had good luck stomaching it and have not seen any great metabolic benefit."

Many are allergic to virgin coconut oil. They thrive on "76 degree melt white" coconut oil. It's under $2 a pound. You can find it easy online. Spectrum Naturally Refined Coconut Oil might be a good substitute. Try either a more pure coconut oil or a less processed one. I like the raw, unheated coconut oil. Look for ones made by centrifuge or fermentation. Here are two good sources.

Peter's advice to eat lard instead of coconut oil reveals a pattern of bias. I wouldn't eat a lot of lard unless I made it myself, from pork leaf fat. The lard you get in most stores is full of toxic additivies, as is the pork meat itself. Saying to eat lard instead of coconut oil is unwise, IMO. Coconut oil speeds up metabolism, but the sad fact is that most people can't notice this effect, because their bodies are so unhealthy. You will lose weight by eating coconut oil or cooking with it. Just find one you can tolerate and give it a fair chance.

Anonymous said...

Sven: "According to Colpo there is no medical ward-study showing a weight loss advantage of LC vs. HC."

The problem with Colpo is that he talks about weight loss without considering weight gain or weight maintenance. Also, his studies are based on homogenous groups of people. For example, one study might use obese people, while another uses normal weight people. What does this prove, when people like Gary Taubes are suggesting that obese people have a metabolic defect? They fatten easily, esp on carbs. Studying a homogenous group proves nothing. If you look at Colpo's metabolic ward studies, you see a lot of junk. One of them limited the high-fat and low-fat groups to the same amount of saturated fat. In short, they ate totally different food. The high-fat group got a high-PUFA diet. I agree with him that the high-fat diet won't provide any advantage in that situation, but let's see the results if the high-fat low-carb group also eats a low-PUFA diet.

Peter: "the body wants MCTs out of the way asap (from the way it deals with them)."

One could use the same argument against alcohol, but that doesn't mean MCTs or alcohol should always be avoided. I've heard you mention a fondness for certain alcoholic beverages. Do you deny that the body burns alcohol first as if it wants it out of the way ASAP? One could also say the same thing for PUFAs. The body burns them first. This was my conclusion based on reading the textbook Modern Nutrition in Health and Disease and Chris Masterjohn has come around to the same conclusion. See his Special PUFA Report, where he cliams that we only need 0.1-0.5% PUFAs (by calories) from animal foods. That's for pregnant/nursing women and children. He says that the need for PUFAs in adults is "infinitesimal if it exists at all."

Coconut oil speeds up the thyroid. People with a high sensitivity to salicylates should try "76 degree melt white" coconut oil - not the virgin oils. Ray Peat says people are often allergic to virgin oils and they do best on the naturally refined 76-melt coconut oil. It's much more affordable, too.

mtflight said...

Informative comments, Bruce K.

Regarding coconut oil, I noticed my triglycerides were very high while on it, as was my LDL. I made so many changes at once it is hard to see what caused what, but definitely puzzled me.

I'm speculating MCTs raise triglyceride levels, see my comment on one of Peter's posts here, and let me know if I'm far off.


Kevin said...

Hi Peter,

I just found your blog and I'm glad I did. On an Atkins diet I lost weight but eventually stalled at 20% body fat. It is only since forcing myself to count calories that I'm seeing more improvement. 30 years of lowfat dogma has made But 30 years of lowfat dogma left me unwilling to stomach animal fat.

BTW, I think we've led parallel lives. We're the same age with the same educational backround. I'm a DVM.


paul said...

"Regarding coconut oil, I noticed my triglycerides were very high while on it, as was my LDL. I made so many changes at once it is hard to see what caused what, but definitely puzzled me."

I have tweaked my diet a lot since 2006, and I have tried to get a sense of the relationship between specific foods and my general health but it's beyond me. Most of the changes I have made are based on intellectual arguments, like the ones here in hyperlipid, rather than personal proof that the change was good. Does anyone think they have a good system for testing how, say, the presence or absence of coconut oil affects them? I'm self-disciplined and kept a food/health diary for a while, but I found the amount of detail it required to cover everything also made it unuseable to analyze how I was reacting to things. Am I missing a good way to do this?

Peter said...

Hi Kevin

Welcome. How do you cope clinically, knowing most of what we do is putting sticking plasters on the damage done by Hills etc? BTW this dropped out of Pubcrawler today, a follow on to the initial publication. My facetious take home is that the less Purina you feed to your dog the longer it will live! Puts a dent in the sales of meloxicam too! Bad for business.....


Peter said...


It's hard on a day by day basis, particularly as we don't know what the parameters we measure really mean. Triglycerides are usually a marker of carbohydrate intake (a la Kitava). That's only bad if you're insulin resistant... But elevated trigs at 400 plus is a sign of insulin resistance per se. Where's the switch???? Are there problems at 100, at 150, at 200? And some people seem to get elevated trigs with weight loss which normalise with time... I settle for normoglycaemia, but accept high FFAs mean moderately elevated fasting glucose despite low markers of glycosylation. And who ever controls their variables? High sat fat, low pufa, low sugar, reduced vegetables, get out in the sun, take some D3, start going to the gym, have your son wake you 4 times a night for 8 months.....

As the Red Hot Chili Peppers say, life is not a read-through...


paul said...


Thanks. It does give one a bit of respect for maligned epidemiologists when one finds that, even on a personal basis and with motivation, it's tricky to identify trends and effects. On the topic of maligned epidemiologists, I am trying to figure out why Walter Willett (Harvard epidemiologist) does not like saturated fat, even though all the original Ancel Keys stuff is long discredited. I guess it's the kind of thing I can google out for myself, but I will lazily accept any offered help! Is the science ambiguous? Is there some complication to interpreting the results, such as the larger context of the diet in addition to the actual saturated fat intake? Just trying to get the very high-level one-sentence explanation.

Thanks for any thoughts or pointers!

Peter said...


The ref is in reply to Scott but here it is again. It's MCT, not coconut oil. MCT spikes insulin.

You want Fig 2 page 52.

Re "out of the way", I certainly would use the same argument re alcohol. My own personal impression is that alcohol and fructose seem to be the worst. Then MCTs, then PUFA or glucose, the sat fats, in terms of priorities of metabolism.

I got Chris Masterjohn's report on the day his newsletter came out. Still thinking.

How do you quantify the thyroid "speed up"?

I can understand why someone would be intolerant of a high salycilate oil, and yes coconut is the highest. I find it dificult to tell where refining stops being good and starts being bad!

I'm not anti medium chain triglycerides, I eat enough in butter. I'm just not convinced that people gavaging themselves (even just with a tablespoon rather than stomach tube) will necessarily help weight loss. Perhaps you have the studies. I'm perfectly willing to believe they're out there but unwilling to do the hunting.


Peter said...

Hi Paul,

Willet has spent too long writing grant applications and seems to have lost the plot. Check out Regina's post here. I have to say I find it impenetrable that Willet is not a LC sat fat promoter, but he's not. Regina's husband is a gynecologist.


Kevin said...

Hello again Peter,

I think it means just what it says: calorie restriction serves us better than low carb. I show clients exactly how much science diet per day the patient requires (and not one dog cookie more) and I've done my job. That 90% of clients ignore my suggestion stopped bothering me about 10 years ago.

HeartCipher said...

Hi Peter,

Your blog continues to be a must read...

Seems like you may have missed something that also appears to contribute to insulin resistance and it's the one thing that is my biggest addition... Perhaps it accounts for the difficult I face in losing weight?


Am I missing something or misread the article?

Thanks for doing your blog!

Chris said...

Heartcipher - here is another one just published about coffee and glucose metabolism

ItsTheWooo said...

Hello Peter,
I have lost 160 lbs following a low carbohydrate diet. I have maintained this diet without any relapses in carb eating or major weight gain for over 5 years. My BMI is 20 (5'5 and 121) prior to weight loss it was 46 I think.

I agree it is hard and difficult but I think that you are not helping by leading people to believe that your exacting super high fat and extremely food restricted way of eating is necessary simply to acheive a healthy weight. Personally I could never, and would not, want to live the rest of my life eating nothing but pure fat (butter and lard and what not). I don't mean to knock your way of eating, I'm simply saying that it is not necessary to lead people to believe that it is necessary to succeed at normalizing weight.

When it comes down to it, weight loss is fairly simple... you need to lower your insulin, and you need to increase the metabolic factors that move fat out of cells. This is accomplished very simply by a combination of carbohyrate restriction and calorie restriction. Calorie restriction is very important factor for reducing overall glucose and insulin levels (even if carbs are equal, reducing fats can improve insulin sensitivity by allowing the mitochondria to more easily metabolize glucose for energy... so calorie restriction is always going to promote weight loss even if none of the calorie restriction came from carbohydrate). Most of us failing to lose weight by carb restriction alone would find moderate and healthy calorie restriction would work well. Another issue is protein overloading, too often I notice people trying to do high calorie high protein diets and speaking personally protein is like mini carbohydrate, it messes up my blood sugar and insulin and sets me on an eating jag big time.

Anyway... point is, it's really quite simple to do. Lower carbs, lower calories, and body fat will be released for energy. While it is a good idea to eat first from fat strict restrictions on protein are clearly unnecessary. Eating no vegetables is also unnecessary and I actually find vegetables with vinegar dressings greatly reduce my insulin and aid in weight loss (as opposed to extra fat or definitely protein.
Having a bulk of calories from pure lard is also unnecessary.

I don't have a problem if you prefer it this way but I don't see the point of presenting this as necessary for basic health (reasonable weight).

Dr. B G said...


Thanks for the article... as a self-confessed caffeine addict it's kinda hard to look at caffeine like that! ;D

There are many other problems with caffeine -- studies shows excessive quantites increases cortisol. So for individuals already with elevated cortisol, i.e. sleep-deprived, mentally stressed, carry toxic belly fat colonies (see Art DeVany -- although his site is down currently), fatty liver, Cushing's disease, Metabolic Syndrome/insulin resistant, T2DM, etc... Cortisol is already a slightly big problem already.

Some practitioners are advising no caffeine (like DR. Perricone of longevity/skin-care fame -- he's actually pretty got his stuff together). Spiking cortisol can cause more wrinkles according to Perricon (and obviously systemic inflammation).

Caffeine can also increases irregularity of the heart rhythms:

Dobmeyer DJ, Stine RA, Leier CV, Greenberg R, Schaal SF.

The arrhythmogenic effects of caffeine in human beings.
N Engl J Med. 1983 Apr 7;308(14):814-6. No abstract available.
PMID: 6835272

With all that said...'Drink and be Merry' *heh j/k!*


HeartCipher said...

Hey Chris...

Thanks for the link... By the way, I found your ConditioningResearch site a few months ago... A must read...

Your site is what led me to discover Kettlebells... my new favorite exercise.

Your blog has made a positive difference in my life (like Peter's) and I thank you very much for that.

Peter said...

Hi HeartCipher, g and Chris,

The subject of caffeine and blood glucose has been a recurrent topic of great debate on Dr Bernstein's forum, the general opinion being that YMMV and serious addicts are committed to their herb! I was getting through about 3 or 4 pints of Java coffee a day before I went LC. As my introduction to LC was the Atkins diet I went through a significant caffein withdrawl headache for about a week. As this resolved I realised the slightly "odd" feeling I'd had in my left face for several months had gone. At the time I knew nothing about anything, but Atkins said drop the coffee so I dropped the coffee. Looks like he may have been on the right track here.

I wonder if tolerance to the stimulant effect also produces tolerance to the insulin resistance effect... Not everyone on Dr B's forum had problems after caffeine and almost all were diabetic.


.^ said...

I'm currently struggling with the coffee thing. I know there are those, such as Mike Eades, who can't see why it's a big deal, but that's like someone who enjoys a wine of an evening wondering why alcoholics make such a big deal about it.

For me, the symptoms are similar--though not so intense--as giving up smoking was. It's not just that I need the hit and crave it; it's not just fear of physical symptoms of withdrawal; it's that life without coffee seems like the prospect of moving to (the former) East Germany--I anticipate a grey, bitter, depressing experience.

I was unaware of the weight-loss connection, but this gives me all the more motivation to give it up.

For the record, I find caffeine makes me anxious in large quantities (and I seem unable to keep the quantities small), it disrupts my energy levels badly: giving me highs when I don't need or want them and lows when I need to get things done. And, of course, it interferes with sleep.

I'll even go so far as to say that the benefits I've experienced from (fairly strict) low-carb have been undermined and vitiated by the effects of caffeine, and that's why I can't say as Peter can that I feel better than I did as a teenager.

I can't see any way but to cut down on a strict schedule--i.e. mixing decaf with espresso. I have actually made some 'feints' to this effect, but end up reverting to the normal coffee compulsively.

Peter said...

Hi Chainey,

If you browser the junkie sites on the net the most successful approach to breaking opioid addiction appears to be cold turkey, except for codeine where the seizures are problematical. The benzo folks seem to use the paring down approach but that may simply be a practical problem a la codeine.

If you've done and dropped nicotine you certainly have my respect. I'm not caffeine free as I still eat chocolate, but this has never had the CNS effects of Java. I still drink decaff, which also has some caffeine, and life is fine.

A friend moved from West Germany, probably Frankfurt, to Leipzig when the wall came down and is happy he did, especially as he has watched life there get back to normal


.^ said...

Cold turkey, eh? Well, that's cold comfort. Isn't turkey supposed to be low-fat? Shame on you.

Couldn't you at least offer me Wild Turkey, which I believe is a brand of bourbon whiskey?

And I don't want to hear about caffeine in chocolate: I eat plenty of that too. Mind you, without coffee to go with it ...

Peter said...

Hi ItsTheWoo,

Very valid, and works for most. My particular slant was taken this time as Windwill had already tried Kwasniewski and found it worked but, as you point out, upward drift of protein is a problem. Hee hee, lard wound up Bruce too. OK, any predominantly saturated far would do. Once you limit your carbs, essential to any LC plan, keep your protein to levels that minimise the insulin spike many of them produce, and keep your fat as saturated as practical, you tend to end up with Kwasniewski anyway. Just using egg yolks as a major multivitamin completes it...

Of course there are less stringent ways of living LC. For some people that's not enough, for Windwill we talked about this off blog and it appears to have applied to her.


PS The prime reason for this blog is how I live and what drives me. If anyone wants to use the information, that's fine. But there must be thousands of sources of more moderate information for those who would like a more mainstream LC approach????? I'm just me and this is what I do! Generally, anyone who thinks I'm not seriously biased hasn't read many posts, even though I'm very interested in when my biases may be misplaced, as in Astrup's initially "worrying" diazoxide paper and the faults in the original diazoxide paper which I noticed and placed in the take 5 post. Go to consider my biases may be wrong.

donny said...

"Normal weight men and overweight/obese men with an elevated intra-abdominal AT accumulation had comparable plasma ASP concentrations (50.0±48.5 vs. 53.9±56.8 nmol/L, NS). However, plasma ASP concentrations were found to be the highest among overweight/obese men with a low intra-abdominal AT accumulation (81.5±94.1 nmol/L, p<0.02 in comparison with the two other subgroups)."

That's from this;

This strongly suggests that ASP is not the villain in the case of visceral fat. INSULIN. Waist circumference decreasing in the absence of actual weight loss is pretty commonly claimed on low-carb discussion boards.

Peter said...

Hi Donny,

Nice link. Personally I like ASP, I'd certainly rather have my chylomicrons and VLDLs off loaded in to my adipose tissue, rather than hanging around to glycate. Given a low enough level of insulin I can always get at my adipose tissue whenever I need to... Interesting to see that visceral adipose tissue is not where ASP directs storage. Yes, nice paper.


Chris said...

"luccy" has been spamming me too....

Peter said...

Yes Chris, bit of a pain. These people are so pathetic with their need to take money from desperate people to market potentially lethal drugs. But I'm loathe to moderate comments when I'm away so much... Stuff would grind to a halt even more without the input from yourself and others while I'm off surfing....

Have a great 2009


Administrator said...

hi, you have article or your writing about obesity or overweight?

Alexandra said...

Hi Peter. I apologize in advance for some very basic questions. Yours is probably not the "right" or the "best" place to ask these questions, but your writing and thinking is very compelling to me.

I'm looking for basic information on getting started (and continuing!) with a high-fat diet. Perhaps Dr. K's site is the best place to go - but I find his site overwhelming.

Here is my situation, and what I'm looking for: I am 230 lbs, female, age 42. I am not sedentary. I was diagnosed with extremely severe obstructive sleep apnea about a year ago, which followed about 5 years of declining health. Largely because (I think) I don't fit the profile of the typical OSA sufferer, I was not diagnosed until I was truly in very dangerous territory - with unexplained tachycardia and resting 02 levels below 90% when awake. I am 100% compliant with CPAP therapy which reduces my OSA to non-existent levels (AHI below 3 events per hour).

I realize now that I spent the years leading up to my diagnosis eating to stay awake, and then eating to fall asleep. I gained about 50 lbs (and also had three pregnancies during that period).

Add, too, that I was raised in a very strict vegan household. I have been hungry my whole life.

I would now like to reduce my weight to ... I don't know what amount. 180 lbs? 160 lbs? I have been eating a high-fat diet for exactly ONE week so far (mimicking what you've posted as your wife's typical input) and have been VERY happy with my energy levels and feelings of well being.

So - where do I start? Do I just continue to do what I am doing? I don't think I have lost any weight (yet?) (I have no scale at home but weighed myself in preparation for this comment.) Is there a site which will guide me through the process of losing fat?

Peter said...

Hi Alexandra,

Sorry to be slow, simple answers are quick, more complex ones take time (and occasionally get forgotten!).

First is that OSA is not as simple as being caused by excess weight and there are anecdotes, mostly from Dr Eades, that it improves rapidly on LC eating, well before significant weight loss. This, to me, suggests that there is hyperglycaemia based nerve damage to the nerves of the pharynx. A big chunk of this reverses rapidly with normoglycaemia. The rest of the improvement is very slow, just as in diabetic neuropathy.

The follow on to this is that I am more interested in normoglycaemia without excess insulin than weight. Health matters more than weight and weight reduction is a secondary goal. As you are aware, a BMI of 26ish on the SAD is ideal and has better all cause mortality than BMI 20...

A very simple approach is to use fatty meat with eggs and mostly non-root vegetables, without fruit, as the carb source. Run at 50g/d of carbs and see what happens. That will certainly get you used to LC eating and, if weight loss turns out to be hard, then it is easy enough to tighten down the carb amount, tighten down the protein and calculate everything the way JK does. But not everyone needs to do this. Start off with Lutz/Groves levels of carbs and see how you get on. No oils, only butter/animal fat. Use to monitor carbs, initially you can ignore fat and protein if the sources are meat and eggs.

Also bear in mind Jenny Ruhl's ideas that 10% weight loss is easy-ish long term but bigger reductions seem to be harder. I doubt this applies to everyone but certainly to some and ultimately normoglycaemia matters more than what the scales say.

Oh, don't forget the offal, once a week is probably loads, you do need some vitamins and minerals!

Hope that helps


Alexandra said...

Peter: it is very helpful (because it gives me lots of areas for further inquiry) and you are very kind to respond. By the way, I'd be very happy with a BMI of 26 - that would put me at about 165 from my current 230. Also: I do not believe my weight is the cause of my OSA, although it possibly has increased the severity. I am fine with continuing to be compliant with a CPAP machine. Thank you again - I will check in after a month or so to let you know how I am doing.

John Speno said...

Hi Peter,

I know this is old, but while learning about all this I found the name of another lipase that works with Hormone Sensitive Lipase (HSL) to break TGs in the fat cell into FFAs. It's Adipocyte Triglyceride Lipase (ATGL).

TuulisMumma said...

Hi, Peter...
How low the calories can be in a long run.
If my basic need is about 1400 kcalories, how much should I have /day???
Do I spoil my metbolism by restricting calories to 1200...and is it any more OD...
Emma said fat is possible to eat 1.5 x loose weight.

Peter said...

Hi Windmill,

I think Kwasniewski says about 0.8g/kg ideal weight protein, 0.3g/kg carbohydrate and fat less than 2g/kg. So he sets a maximum fat intake, but no minimum.

I have to always keep coming back to health. There is nothing about a BMI of 21 that is any healthier than a BMI of 27, given normal levels of insulin and glucose in both situations (as should occur on the OD).

So health comes first, wellbeing should come from that, and calorie restriction to a preferred weight comes last... Both JK and Lutz do comment that there are a subset of people, mostly female and past reproductive age, for whom weight loss is extremely difficult. The question is what do you need to do to achieve weight loss and why? I would suspect 1.5g/d of fat is likely to be fine but I don't think anyone really knows what effect long term low calorie diets have when they are still low in carbs and high in healthy fats like butter.

Simple CRON diets might well damage you (eg Roy Walford), but CRON based on fat, there's an unknown...


Nettie said...

Slaicylates have now been shown to DECREASE blood glucose levels by increasing cellular uptake and reducing hepatic outpur NOT by increasing insulin production.
Section E

Olga said...

Hi Peter:

Do you have any insights on the claims made by the Jaminets, and other paleo followers in general, that claim that low carb lead to T3 suppression and hypothyroidism? Seems strange to me, but several quite clever people seem to be commenting on this. Thanks

Olga said...

Hi Peter:

Do you have any insights on the claims made by the Jaminets, and other paleo followers in general, that claim that low carb lead to T3 suppression and hypothyroidism? Seems strange to me, but several quite clever people seem to be commenting on this.

mniccum said...

I have been in ketosis for a few months now. I ate coconut oil and tested with ketostix and measured in the 60-80 range after a few weeks. I did a test and removed the coconut oil for nearly a week and my ketostix dropped to 5-10. I started taking coconut oil again and it took a few days but it went back to 60-80. For what it's worth.

Jr. Williams said...

I drink an extra two glasses a day of water because i read for every cup of coffee add a cup of water because it can retain water and dehydrate you, is this true? Im kind of hooked on coffee so i'm hoping it is not bad for my diet.