Saturday, March 31, 2012

Spark on Taubes/Guyanet

I would argue that the rapidly growing health problem is not simply obesity, but metabolic syndrome (remember obesity is only one symptom, and there are thin people with metabolic syndrome too). We want to understand both how we arrive at metabolic syndrome (so our children can avoid it), and also how to treat it for those who did not avoid it. It is clear "carbohydrates" across the board are not causal in the development of metabolic syndrome. Stephan provides several counter-examples; another is the Tarahumara, who like the old-school Pima subsist largely on corn, beans, and squash, but who have one of the lowest rates of Type 2 diabetes in the world.
But the cure is not necessarily the reverse of the cause when it comes to disease. Metabolic syndrome brings a whole host of issues, not the least of which is broken carbohydrate metabolism. So while carbs in general may not lead to metabolic syndrome, once you've arrived dumping carbohydrates on your broken carbohydrate metabolism is tantamount to doing jumping jacks on two broken legs. I believe the science (along with a massive stack of anecdotal evidence) is pretty clear here, in that the most successful treatment for metabolic syndrome is carbohydrate restriction.

I've enjoyed this reconciliation of the work done by Taubes and Guyanet, along with what I heard from Matt Lalond on a recent Jimmy Moore podcast (well worth listening to). 

In short, the author posits that they may both be right, and wrong.  That is to say, carb restriction may be the only and best treatment for those with metabolic syndrome and it's manifestation as the "pot belly" which is so closely associated with non-alcoholic fatty liver disorder.  That does not mean that we should conclude that carbs are bad for everyone at every time. 

More from the pithy Spark:  "It is important to remember that carbohydrate restriction is successful as a treatment for a disease, but it doesn't necessarily follow that all carbs are bad for everybody."

However, even Spark is willing to bite on the problems associated with, in particular, modern wheat.  Which is to say, as regards wheat, just say no.

I have begun to form a concept of how Guyanet and Taubes may be right, with Guyanet's work applying more to how the metabolic system "should" work for healthy folks.  I have wondered, for example, how some folks can run well and perform well on well under 10% body fat, and others need more.  There are too many variables to be certain of any one answer - variables such as macronutrient ratios, genetics, type of exercise, prior metabolic injury, climate, exposure to cold water, and micronutrient intake to name just a few.  But one model that seems useful is simply that the body adapts to what is demanded of it - so if one demands that one's body run on fat, the body might become more adept at giving up fat for fuel at every lower body fat levels.  In other words, if you run well at 15% body fat, that means the body is at least capable of liberating the body fat you need - amount X per minute - to feed your cells in the event you don't have carbs for several hours.  If you stay in that state - a carb fast so to speak - for longer, you may be successful in getting your body to the point that it can liberate 1.1X per minute.  Etcetera.  And I could very easily see that the "ponderostat" powered by leptin as posited by Guyanet and his mentors might have a role in that process. 

But, what do you do if you have glucose regulation issues?  What do you do if you have the signs and symptoms of metabolic syndrome (big belly and one or more of:  high average glucose, hypertension, dislipidemia)?  Restrict your carb intake, please, since it is the fastest way to right the wrongs you've put your body through (and pay particularly close attention to reducing fructose intake to a MAX of 15g/day).

If you want to fool around with Guyanet's "plain food" ideas after that - low fat, low salt, low sugar - be my guest!  For my money, I can manage eating high fat and high salt just fine, it's the sugars that buggar my appetite, metabolism and health.

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