SHOW NOTES:
Study - Carbohydrates, insulin, and obesity - John R. Speakman and Kevin D. Hall. SCIENCE. May 7th, 2021.
All additional references mentioned in the show can be found in the main article
5:57 - Explanation of the previously adopted “carbohydrate-insulin model” (CIM) of obesity
It is proposed that fat gain results from carbohydrate intake -> insulin spike -> increased energy storage and increased energy intake
Insulin sends circulating fuels to storage -> reduces energy available to muscles -> signals more food intake and reduces metabolic rate
Therefore, carbohydrate mediated insulin responses cause weight gain according to the CIM
The solution would be a low carb diet
It is unethical to randomize humans in a long term study, so we are limited to short term human studies and animal research
11:01 - Does a keto diet lead to less food intake as proposed by the CIM?
In mice following a high-carb/low-fat vs high-fat/low-carb diet, the high-carb mice ate fewer calories and gained less weight despite higher insulin
These results were replicated in a short-term human study. Subjects followed a keto diet, then a high-carb plant-based diet. The high-carb condition ate 700 fewer calories per day despite higher insulin. They also lost significant body fat
Another study found significantly increased satiety after 10-15 weeks of a high-carb diet
A 1-year study in freely living individuals randomized to consume low-carb vs high-carb diets found no differences in energy intake. Long-term average weight loss was almost identical, and individual differences in postprandial insulin secretion did not predict weight loss
16:39 - Does keto lead to weight loss? (due to less insulin and alleviated muscle starvation)
Studies show that when obese subjects restricted carbohydrates causing decreases in insulin, they lost less weight than an isocaloric high carbohydrate group in 1-2 months
18:44 - Does keto increase energy expenditure?
In one study, a low-carb diet reduced energy expenditure, in another, it increased briefly
Other studies show an increase in energy expenditure with keto, but the authors believe that it was miscalculated
20:12 - Does insulin relate to weight gain?
Inhibition of insulin can reduce body fat in the absence of diabetes
Hyperinsulinemia is not associated with meaningful differences in adiposity. Insulin does not result in weight gain or predict future weight changes
“Therefore, the extent to which susceptibility to obesity is explained by differences in insulin secretion or insulin action is uncertain, but the direct action of carbohydrate-driven postprandial insulin on adipose tissue is unlikely to be the dominant driver of common obesity, as proposed by the CIM.”
22:37 - What is the alternate model?
Basal insulin may be more important than post-prandial insulin in determining weight changes
Reduced intake of dietary fat decreases basal insulin to a similar degree to an isocaloric reduction in carbohydrates, indicating that basal insulin may respond to overall energy intake, rather than specific macronutrients
Not that keto diets aren’t effective, insulin is just not the primary mechanism of action
26:00 - Why does keto work?
In the study by Hall et al., 2021, both diets were minimally processed, which is likely why the low-carb group ate fewer calories
However, in real life, 58% of the average American diet comes from ultra-processed foods (Steele et al., 2016)
Keto might work because when someone goes from a typical American diet to keto, they likely dramatically reduce intake of ultra-processed foods, which can cause weight gain (Hall et al., 2019)
Ultra-processed keto snacks are becoming more and more available, which may decrease the effectiveness of keto for weight loss
Bailey mentions Episode 12 with Alex Scoloveno
Lena and Bailey talk about the issues with modern diet culture
For full show notes including links to studies, and resources mentioned, go to www.wellness-nerds.com/podcast/013