Defending the indefensible: Gary Taubes and *that* statement about gluttony.

Here's another "video" (it has sound and static images only). As I haven't learned how to embed a YouTube video that starts at a specific time, here's a link to it and a picture of it:- Gary Taubes' "Why We Get Fat" IMS Lecture On August 12, 2010 (Part 8 of 8), starting at 8 minutes and 8 seconds in.

To quote: "You can basically exercise as much gluttony as you want, as long as you're eating fat and protein."

I was told that Taubes was being ironic i.e. he was joking. I call bull-shit on that, for the following reasons.

1) You don't joke about something as important as diet, in a video that's likely to be heard by many people.

2) If you're foolish enough to joke about something as important as diet, you make 100% certain that listeners know that you're joking, by stating in the very next sentence that the preceding sentence was a joke. Taubes didn't do that.

3) I didn't hear chortling or any other audible clue that Taubes was joking. Did you?

I therefore conclude that the person who made the statement that Taubes was being ironic, is hearing (and seeing) the world through "cognitive bias" Weird Filters , resulting in her hearing what she wants to hear. Sorry!

No fat belly: no rocks and no hard places.

I finally defeated Google Image Search!

 Boo-Ya, Google!

I've been blogging about the problems associated with having a fat belly. It therefore figures that not having a fat belly is advantageous. I was asked whether "skinny-fat" people might have problems with high serum NEFAs when on a very-low-carbohydrate diet (≤50g/day of carbohydrate).

In my opinion, if fat cells in the belly area aren't stretched to the max, they won't be spewing NEFAs into the blood. Therefore, even "skinny-fat" people can safely go on a very-low-carbohydrate diet and stay on it indefinitely.

Not exactly rocket science, is it? Part 2

If there's a deficiency in "X", taking supplement "X" will correct the deficiency in "X".
If problem "Y" is caused by a deficiency in "X", then taking supplement "X" will fix problem "Y".

If there's no deficiency in "X", taking supplement "X" won't do anything.
If problem "Y" isn't caused by a deficiency in "X", then taking supplement "X" won't fix problem "Y".

If a person spends a lot of time outdoors in skimpy clothing in sun that's higher than 45deg in the sky, it's highly probable that they will not be deficient in Vitamin D3. Therefore, supplementing with 5,000iu/day of Vitamin D3 will highly probably do nothing.

If the above person has type 2 diabetes, supplementing with 5,000iu/day of Vitamin D3 won't fix their type 2 diabetes.

Not exactly...

Rocket Science!

There will be some people for whom all of the supplements & exercise that I recommend don't help their type 2 diabetes. Sorry about that. A low-carb (but not very-low-carb) diet will minimise your serum glucose level fluctuations without increasing your serum NEFA level excessively. See The problem with Diabetes.

Ketogenic diets - when they're not ketogenic.

High in the Arctic, Eskimo!

It's generally assumed that eating less than 50g/day of carbohydrate results in ketosis. Assume makes an ass out of "u" and "me". From Lyle McDonald's book The Ketogenic Diet:-

The Ketogenic Ratio (KR) = K/AK, where K = Ketogenic stuff and AK = Anti-ketogenic stuff.

K/AK =  (0.9*Fat + 0.46*Protein)/(1.0*Carbohydrate + 0.1*Fat + 0.58*Protein) where Fat, Protein & Carbohydrate are in grams.

For the treatment of epilepsy (very strongly ketogenic), K/AK must be greater than 1.5. For people who want to get into benign dietary ketosis, K/AK can be lower.

Eskimos eat a diet containing virtually zero dietary carbohydrate (~50g/day as muscle & liver glycogen). However, they are not in ketosis. See STUDIES ON THE METABOLISM OF ESKIMOS.

Eskimos eat so much protein that the Anti-ketogenic effect of Protein offsets the Ketogenic effect of Fat + Protein. Table IV is interesting, as it shows how much energy is lost as ketones on the third day of successive fasts in non-Eskimos (Subject #1 fasted once only). Note:- Beta-hydroxybutyric acid  produces 5kcals/g.

Subject #1:- 10.5kcals. ?kcals, ?kcals.
Subject #2:- 100.5kcals, 7.0kcals, 2.75kcals.
Subject #3:-  9.75kcals, 0.0kcals, 0.0kcals.

The answer is "not a lot" (except for Subject #2 on the first fast).

Can very-low-carb diets impair your mental faculties?

I wanna tell you a story...

In 2006, I had a test done on my pituitary gland*, called an Insulin Shock Test. It was pretty much what it said on the tin. I laid on a hospital bed, I was injected with an overdose of insulin and I was monitored for blood glucose and growth hormone levels every 30 minutes.

My blood glucose fell and fell and fell and fell until it reached ~1.5mmol/L (~27mg/dL). What happened was interesting. I came out in a cold sweat and developed a tremor. Apart from that, I felt fine. The consultant in charge was chatting to me and I was chatting to him. Eventually, I was given a sandwich, a yoghurt and a banana to eat.

Some time later, when I had stopped sweating and shaking, the consultant returned and told me that I had become confused. My brain had ceased to function correctly due to a lack of blood glucose (the insulin had totally suppressed serum FFAs and ketones, so there were no other brain fuels available), but I was too mentally-impaired to know that I was mentally-impaired. As far as I was concerned, everything was fine & dandy. This is the Dunning-Kruger effect.

Referring to Blood Glucose, Insulin & Diabetes, as blood glucose falls due to either starvation or a lack of dietary carbohydrate, insulin falls and glucagon rises, stimulating the liver to convert liver glycogen into glucose for export to the blood. Eventually, liver glycogen becomes depleted and blood glucose falls again. The pituitary gland notices this and secretes AdrenoCorticoTropic Hormone (ACTH) which stimulates the adrenal cortex to secrete cortisol. The adrenal glands are also stimulated to secrete adrenaline (a.k.a. epinephrine). Cortisol increases the conversion of amino acids and other substrates into glucose by the liver and kidneys. If blood glucose continues to fall, the pituitary gland secretes growth hormone (GH), which has an anti-insulin effect.

From http://anthonycolpo.com/boosting-growth-hormone-with-diet-training-fact-or-fiction-part-2/:-
"after the zero-carb phase, subjects reported symptoms of hypoglycemia that included weakness, irritability, mental confusion, nausea, hunger, cold sweating and disturbed co-ordination. GH levels were higher during exercise after the low-carb phase, but so too were levels of other fuel mobilizing hormones such as epinephrine, glucagon, and cortisol." Epinephrine, glucagon, and cortisol are stress hormones. Chronically-high blood levels of stress hormones disrupt sleep and cause irritable, aggressive behaviour.

Ethanol inhibits gluconeogenesis in the liver (possibly also in the kidneys) resulting in worse hypoglycaemia. Worse hypoglycaemia results in more ACTH & adrenaline secretion and worse hypercortisolaemia, which can adversely affect the hippocampus, impairing memory.

In conclusion, if you want to eat a very-low-carb diet, long-term:-1) Don't do much high-intensity exercise. See "Funny turns": What they aren't and what they might be.
2) Don't drink much (if any) booze.

See also Can Low-Carb Diets Make You Crazy?

*My pituitary gland failed the test by secreting only 40% the amount of GH that it was supposed to. For six months, I was given GH to inject using a special pen with a 8mm x 0.3mm needle. By the end of the six month trial, I had perfected the art of painless injection. The trial was discontinued due to lack of any noticeable benefit (17 days supply of GH @0.3mg/day cost £120!).

Low-glycaemic diet seen to reverse diastolic dysfunction of diabetes.

From http://www.medscape.com/viewarticle/802947?nlid=30763_1301&src=wnl_edit_dail (Medscape log-in required):-

"Of 32 overweight or obese diabetic patients (mean body-mass index, 34) without cardiac disease who were engaged in a "rehabilitation program in order to lose weight" that included two hours of supervised aerobic exercise per day, half followed a low-glycemic diet (25% carbohydrate, 45% fat, 30% protein) and the other half a low-fat diet (55% carbohydrate, 25% fat, and 20% protein) for three weeks. The diets provided the same amount of calories. Those on the low-fat diet then switched to the low-glycemic diet for an additional two weeks"

"....the two diets led to about the same declines in weight and waist circumference..."

The diet was 25% carbohydrate, 45% fat, 30% protein.
It was a low-carbohydrate/low-glycaemic load diet.
It was not a very-low-carb diet.

Dr. Richard K Bernstein on insulin for type 2 diabetics, and some definitions.

Dr. Richard K Bernstein:-

Dr. Richard Bernstein, the world's leading low-carb diabetologist, says in Diabetes: The Basics:-
"Many people (including the parents of diabetic children) view having to use insulin as a last straw, a final admission that they are (or their child is) a diabetic and seriously ill. Therefore they will try anything else - including things that will burn out their remaining beta cells - before using insulin. Many people in our culture have the notion that you cannot be well if you are using medication. This is nonsense, but some patients are so convinced that they must do things the “natural” way that I practically have to beg them to use insulin, which is as “natural” as one can go. In reality, nothing could be more natural. Diabetics who still have beta cell function left may well be carrying their own cure around with them - provided they don’t burn it out with high blood sugars and the refusal to use insulin."

Some definitions:-

From Low-carbohydrate diet:-
"The term "low-carbohydrate diet" is generally applied to diets that restrict carbohydrates to less than 20% of caloric intake, but can also refer to diets that simply restrict or limit carbohydrates."
A typical woman consumes ~2000kcals/day. A typical man consumes ~2,500kcals/day. Therefore...

Very-low-carb diet = <10% energy from carbs ≡ <~50 or ~62.5g carbs/day.
Low-carb diet = <20% energy from carbs ≡ <~100 or ~125g carbs/day.
"Healthy eating" = >55% energy from carbs ≡ >~275 or ~344g carbs/day.

The unusual suspects.

In The usual suspects., I banged on about deficiencies in Vitamin D3, long-chain omega-3 fatty acids (EPA & DHA) and Magnesium.

It's the one on the right. Our right, not their right.

According to Jane Karlsson, the iron-manganese ratio and the zinc-copper ratio are also very important. Very-low-carb diets can in theory cause iron overload (if lots of red meat is eaten) and deficiencies in manganese and copper. This may be why people on such diets often find that their glucose tolerance doesn't improve.

Dietary copper and risk of coronary heart disease.
Meat diets and fragile bones: inferences about osteoporosis.
PubMed search for Klevay LM[Author]

For the top 999 foods highest in Manganese per 100g serving, see HERE.

For the top 468 foods highest in Copper per 100g serving, see HERE.

Everyone is Different, Part 2.

Cont'd from We are not all the same.

A long, long time ago...


I learned that Everyone is Different, thanks to a study by Julia H. Goedecke, Alan St Clair Gibson, Liesl Grobler, Malcolm Collins, Timothy D. Noakes and Estelle V. Lambert.

Well, stone the flamin' crows! Timothy D. Noakes' name just popped up in Alan Aragon's article 2013 NSCA Personal Trainers Conference: Looking Back at my Debate with Dr. Jeff Volek. Dr. Noakes has had problems with his blood glucose level and has adopted a very-low-carb/ketogenic diet.

What also caught my eye in Alan Aragon's article was (Note: TTE = Time To Exhaustion):-
"However, the authors’ conclusion is misleading since 2 of the 5 subjects experienced substantial drops in endurance capacity (48 and 51-minute declines in TTE, to be exact). One of the subjects had a freakishly high 84-minute increase in TTE, while the other increases were 3 and 30 minutes."

I expect that the subjects with 84 and 30 minute increases in TTE would be praising ketogenic diets, whereas the subjects with 48 and 51 minute declines in TTE would be cursing them and the subject with 3 minutes increase would be "Meh". Vive la difference!

Also note that sprint capability...remained constrained during the period of carbohydrate restriction. As mentioned in It's all in a day's work (as measured in Joules), exercise above a certain intensity (~85%VO2max) burns significant amounts of carbs, no matter how fat-adapted someone is.

Cont'd on Everyone is Different, Part 3.

Not exactly rocket science, is it?

If Paul (astrophysicist) Jaminet met Jack (neurosurgeon) Kruse ;-)

The paleo diet was recently ridiculed as a food fad in Natural’s Not In It. It also came last in a US News Best Diets survey.

Ways of eating such as very-low-carbohydrate, low-carbohydrate, low-reward, paleo, primal, ancestral, just eat real food etc discourage the consumption of manufactured food products and encourage the consumption of produce. If a large percentage of the population stop filling their shopping baskets with manufactured food products and start filling them with produce, who suffers? Not exactly...

This is why the food manufacturing industry tries to ensure that the population gets the best nutritional and dietetic advice that money can buy. See also New study: Big Food’s ties to Registered Dietitians.

While libertarians and anarchists moan about freedom from government interference, the food manufacturing industry has the freedom to crap all over the aforementioned diets and influence people to buy manufactured food products. Morbidity is also very profitable for healthcare and drug companies.

I think that I've now flogged this particular horse to death!

A comment, a simile and insanity.

A lot of my recent titles contain three items.

1) The comment: I'm just about to leave the following comment on Peter (Hyperlipid)'s blog post Insulin and the Rewards of overfeeding. I thought that it was so good at summing-up, I'll post it here first!

"All,

Insulin increases the amount of glucose & FFAs entering fat cells, muscle cells & the liver.

Insulin decreases the amount of glycerol & FFAs exiting fat cells & the amount of glucose exiting the liver.

Hyperinsulinaemia (which can produce sedation) results when one or more of the following tissues loses insulin sensitivity:- fat cells, muscle cells & the liver.

So, why do people keep saying that hyperinsulinaemia locks nutrients away in fat cells only, thus robbing other cells of nutrients, thus causing lethargy?

The relative insulin sensitivity of tissues determines the relative partitioning of nutrients into those tissues.

When tissues lose sensitivity to insulin, blood glucose control becomes impaired. This results in a roller-coaster blood glucose level after eating high-glycaemic carbohydrates. A rapidly-falling blood glucose level can cause ravenous hunger. I have experienced this during medically-monitored tests (OGTTs & an insulin shock test).

Low-carb/ketogenic diets don't result in a roller-coaster blood glucose level and therefore don't cause ravenous hunger. Simples!

Over-eating due to ravenous hunger is NOT gluttony, just as under-moving due to sedation is NOT sloth.

THIS is gluttony."

EDIT: This didn't go in my comment but should have:- "Low-carb/ketogenic diets result in the avoidance of moreish & calorific foods such as sweets, chocolate, cake, biscuits, pizza, Pringles etc. A single bite of such foods has a negligible effect on blood glucose & insulin levels, but encourages another bite and another and another ad nauseam due to Food Reward.

2) The simile: I use similes. I used the simile "As happy as a pig in shit" in a comment somewhere on Woos blog. Now, you may (or may not) have noticed that my user-name is Nigeepoo. We Brits are obsessed by two things - The weather and our bowel movements. I find things to do with poo and farting amusing (schoolboy humour, I know!). I used the simile "As happy as a pig in shit" because it is amusing to me.

3) The insanity: According to Woo in the following comment:-

"Re: the comment...Sorry, not convinced.
You are basically refusing to admit your choice of words implied moral judgement. The phrase "happier than a pig in shit" is always applied to examples of people being content in immorality/bad behavior particularly gluttony and sloth... unless it is used ironically. Only an autistic or a non-english speaker would believe this crap."

Woo, you are as mad as a March hare. IMO of course, like everything I write. Duh!

Look after your brain, Part 5.

This is another bookmarking post.

I spotted an article by Emily Deans M.D. called Nutritional Brain Bomb - Thiamine Deficiency.

So there's yet another way to knacker the brain, resulting in Wernicke's encephalopathy and in severe cases, Korsakoff's psychosis. Both of these conditions are partially irreversible due to neuron death. Both of these conditions are partially reversible by high-dose thiamine therapy.

Thiamine 500mg/day is one last therapy to try mum on after I've got her back on Vitamin K2 (hopefully today).

Continued on Quality >> Quantity.

New beginnings, cot'd.

As a result of New beginnings. , I've demolished my wall and I now want to start a new relationship. I've got a lot of love to give and I want to find that special lady to give it to. Here's the ideal music video.


I won't be blogging so much in future.

P.S. Mum had a Mini Mental State Examination today. She got a score of 12 (out of 28 things that she was physically capable of). 6 months ago, she got a score of 9 (out of 27 things that she was physically capable of). Ketogenic Diet For The Win.

She'll be tested again next year. I found out on Wednesday 23rd March that she is being given 5,000iu/day of D3. I didn't expect that to happen.

Mum's Proposed Ketogenic Diet for Dementia.

The following diet is not intended to induce deep ketosis. It's intended to be a trade-off between ketosis, palatability & simplicity.


Feedback from the nurse on duty:- "Eggs shouldn't be in the "unlimited" list. You're not supposed to eat more than two eggs a week because of the cholesterol". God Bless the NHS! The British Heart Foundation doesn't impose a restriction on egg consumption.

Eggs can be eaten as part of a balanced diet.

Mum's currently eating two eggs a day in her cooked breakfasts.

Effect of dietary egg on human serum cholesterol and triglycerides.

Old people have the lowest mortality when their serum cholesterol is higher than average.

Total cholesterol and risk of mortality in the oldest old.
Cholesterol and all-cause mortality in elderly people from the Honolulu Heart Program: a cohort study.
Low total cholesterol and increased risk of dying: are low levels clinical warning signs in the elderly? Results from the Italian Longitudinal Study on Aging.
Higher total serum cholesterol levels are associated with less severe strokes and lower all-cause mortality: ten-year follow-up of ischemic strokes in the Copenhagen Stroke Study.
Serum total cholesterol levels and all-cause mortality in a home-dwelling elderly population: a six-year follow-up.
Lipid-lowering treatment to the end? A review of observational studies and RCTs on cholesterol and mortality in 80+-year olds.

Paul Jaminet has done a series on ketogenic diets.
Ketogenic Diets, I: Ways to Make a Diet Ketogenic
Ketogenic Diets 2: Preventing Muscle and Bone Loss on Ketogenic Diets

Also: See Branched chain amino acids as adjunctive therapy to ketogenic diet in epilepsy: pilot study and hypothesis.

Polite Requests.

I delivered a large wad (0.25"/6mm thick) of studies with a covering letter to my mum's new GP on Monday 17th Jan 2011. Here's what I wrote in the covering letter:- Personal information deleted.

"Dear Sir/Madam,

I have some requests concerning Mrs *****.

1) Please monitor Mrs *****’s serum B12 & homocysteine. Until Jan 31st 2010, Mrs ***** was receiving 1,000ug/day methyl B12. This was stopped by the management of Lashbrook House after I complained too much. Long-term use of PPIs in old people can adversely affect B12 absorption (evidence attached).

2) Please advise the staff at Acacia Lodge to walk Mrs ***** using the 3-wheeled rollator that I bought for her as often as she is able. Prolonged inactivity results in Insulin Resistance (IR) in skeletal muscle (evidence attached). IR results in hyperinsulinaemia on eating sugars & starches. Hyperinsulinaemia results in drowsiness and stupor (which makes it more difficult for Mrs ***** to do anything).

3) Please advise the staff at Acacia Lodge to reduce Mrs *****’s intake of sugars & starches. A low-carbohydrate/ketogenic diet is beneficial for people with impaired cognitive function (evidence attached). I have recently persuaded Acacia Lodge to give Mrs ***** cooked breakfasts and have supplied Acacia Lodge with Burgen Soya & Linseed bread (12g carbs/slice). This has resulted in improved cognitive function in the mornings.

I don’t want to impair Mrs *****’s quality of life, so she can still have chips or mashed potato (not both in the same meal as happened on Fri 10th Jan, after which I found Mrs ***** asleep in her wheelchair slumped over with her nose squashed against the arm of the chair). She can also have desserts and the occasional chocolate and/or biscuit.

4) Please allow Mrs ***** to have 5,000iu/day Vitamin D3 (provided by me), as UVB cannot penetrate window glass. 5,000iu/day is much greater than the RDA of 600iu/day but it’s a safe amount (evidence attached). That amount of Vitamin D3 has many beneficial effects (rather a lot of evidence attached!) other than bone health (for which 600iu/day is sufficient).

Thank you,

Nigel Kinbrum (son & attorney)
01252 ****** (24-hr Ansafone)
07768 ******"

The GP phoned me on Friday 21st Jan. He's taking my requests seriously and has asked for a week to read all of the evidence that I provided. Here's hoping!

We are not all the same.

Cont'd from Everyone is Different.

Lyle (McDonald) brought the following study to my attention to illustrate that "We are not all the same":- Some Metabolic Changes Induced by Low Carbohydrate Diets. On a very-low-carb diet, one subject’s total cholesterol rose to 12.9mmol/L (500mg/dL in US units). The others didn't.
See also LDL cholesterol goes sky high on fatty diet.

I posted the study in various blogs to make the above point. Here are some of the replies I got:-
"Lyle? Lyle McDonald? Is that where you got that study, Nigel?" and... "I’m usually a pretty polite guy, Nigel. But based on this quote from the beginning of the study you mentioned, the people who wrote this study were a bunch of f**kwads, and really don’t deserve our attention. It’s a hatchet job."
"That was a weird study (1967) what I could make of it." and... "The men did all the stages but the women only did 3 stages of the diet."
"The fats were mostly omega-6 PUFA 13-35 grams worth..."
"The report you cite is so old and out of date that it makes me cry..."

My point was well & truly missed. I got the distinct impression that people thought I was criticising very-low-carb, high-fat diets. I wasn't. The simple fact is that there is no "One True Diet" that suits absolutely everybody. In the olden days everywhere & in poor countries nowadays, people that ate/eat the wrong diet for their body died/die young. Nowadays in rich countries, they get put on drugs e.g. oral hypoglycaemics (to lower blood glucose) & hypolipidaemics (to lower blood cholesterol/triglycerides).

Please note that omega-6 PUFAs tend to lower serum cholesterol rather than raise it, as per Fig. 2 of Types of Dietary Fat and Risk of Coronary Heart Disease: A Critical Review. However, don't rush off and eat shed-loads of omega-6 PUFA (e.g. corn oil) in the mistaken belief that it will make you live any longer. See (1971) Incidence of cancer in men on a diet high in polyunsaturated fat - Pearce.

Finally, for a little light relief, here is the latest result for Google Fight between "Healthy "low-fat diet"" and "Healthy "low-carb diet"". Oh, YES!

Cont'd on Everyone is Different, Part 2.

Look after your brain, Part 4.

Ketogenic Diet REALLY WORKS!!!
WHAT IF THERE WAS A CURE FOR ALZHEIMER’S DISEASE AND NO ONE KNEW?
High fat, low carb diet may help Alzheimer's sufferers.

The above popped-up when I Googled for "ketogenic diet" alzheimer's.

See also
D-β-hydroxybutyrate protects neurons in models of Alzheimer's and Parkinson's disease ,
D-β-hydroxybutyrate rescues mitochondrial respiration and mitigates features of Parkinson disease ,
Ketones: Metabolism's ugly duckling ,
Ketone bodies, potential therapeutic uses ,
Neuroprotective and disease-modifying effects of the ketogenic diet ,
Ketone bodies as a therapeutic for Alzheimer's disease ,
Altered lipid metabolism in brain injury and disorders ,
The ketogenic diet: uses in epilepsy and other neurologic illnesses and
Branched chain amino acids as adjunctive therapy to ketogenic diet in epilepsy: pilot study and hypothesis.

EDIT: Ketones give the brain two fuels to run on instead of one (glucose). This improves mental function considerably. However, it can't repair the damage done to the brain by amyloid plaques, protein tangles etc. Sadly, this damage is progressive and permanent. Therefore, coconut oil can't cure Alzheimer's Disease, Lewy Body Dementia etc. It just delays the inevitable.

It's mum's 80th Birthday today so I'm off to see her now.

Continued on Look after your brain, Part 5.

Everybody knows.........Part 2

.........that ketogenic diets like the Atkins diet destroy your kidneys and rot your bones, right? Wrong!
.........that the Atkins diet causes ketoacidosis which is a very dangerous condition requiring urgent hospital treatment, right? Wrong!

There's a lot of nonsense spoken about ketogenic diets by people who really should know better. I suspect that they have been taught wrongly at uni or med school as per the quote in Everybody knows.........Part 1.

Benign Dietary Ketosis is NOT Ketoacidosis.

Consider the following four cases:- Note: Figures are from "Introduction to Nutrition and Metabolism" By David A Bender (Senior Lecturer in Biochemistry, UCL)

1) Healthy human, fed state: Glycogen stores are replete. Serum glucose = ~5.5mmol/L. Serum fatty acids = ~0.3mmol/L. Serum ketones = 0mmol/L. No gluconeogenesis is taking place. Amino acid pool is replete. Cortisol level is normal so there is no loss of muscle mass.

2) Healthy human, fasting for 7 days: Glycogen stores are depleted. Serum glucose falls to ~3.5mmol/L. Serum fatty acids rise to ~1.2mmol/L. Serum ketones (mainly D-3-hydroxybutyrate) rise to ~4.5mmol/L (not high enough to cause acidosis). Gluconeogenesis is occurring. Amino acid pool is depleted. Cortisol level is high, causing slow loss of muscle mass. This is bad ketosis.

3) Healthy human, low-carbohydrate diet: Glycogen stores are depleted. Serum glucose falls to ~5mmol/L.
Serum fatty acids rise to ~1.2mmol/L. Serum ketones (mainly D-3-hydroxybutyrate) rise to ~4.5mmol/L (not high enough to cause acidosis). Gluconeogenesis is occurring. Amino acid pool is replete (due to protein intake). Cortisol level is normal so there is no loss of muscle mass. This is good ketosis.

4) Human with untreated type 1 diabetes: Glycogen stores are depleted. Due to lack of insulin, the Glu-T4 transporters in cells cannot move to the surface so glucose cannot enter cells. Serum glucose = >20mmol/L. This causes major damage to kidneys, arteries, eyes, nerves etc by cross-linking with proteins (glycation) resulting in major disability and eventual death. As the body is forced to run on fatty acids & ketones, metabolic processes are out of control and ketones rise to much higher levels than in 2) or 3) (I don't know how high exactly) resulting in acidosis and eventual death. This is ketoacidosis.

Conclusion: Low-carbohydrate, very-low-carbohydrate & ketogenic dieting is similar to fasting in that serum glucose levels are lower than normal and glycogen stores are depleted. The body is encouraged to burn less glucose and more fatty acids & ketones, but the metabolic processes are all under control. The big difference between low-carbohydrate dieting and fasting is in the amino acid pool and cortisol levels.

Everyone is Different.

Updated text in bold green.
If there is one thing that I have learned over the years of research into Diet and Nutrition, it's this: Everyone is Different. When I first discovered Low-carb Diets (thanks to the late Dr Atkins), I thought that it was the One True Diet, and I became a bit of an "Atkins Diet" bore telling everyone how wonderful it was and suggesting that everyone should be on it.

I now know that what suits me doesn't necessarily suit someone else. So why do "Healthy Eating" guidelines assume that everyone is the same and tell everyone to get 15% of their total calories from proteins, 55% from carbohydrates and 30% from fats?

To illustrate just how different people are, here's Fig. 2 from Determinants of the variability in respiratory exchange ratio at rest and during exercise in trained athletes. Used with permission.

Respiratory Exchange Ratio (RER) (a.k.a. Respiratory Quotient (RQ)) is the ratio of carbon dioxide breathed out to oxygen breathed in. This ratio depends on the fuel that the body is burning for energy. For example, if the body is burning 100% fat, RER = 0.7. If the body is burning 100% carbohydrate aerobically, RER=1.0. If the body is burning 100% carbohydrate anaerobically (flat-out sprinting), RER > 1.0. RER goes up and down depending on intensity of exercise, food intake (eating protein and/or carbohydrate increases it and extended fasting reduces it). Increasing cardiovascular fitness reduces RER.

The top diagram is a histogram of fasted RER and % fat oxidation vs. number of subjects. At the left-hand end of the histogram, there are two cyclists with a fat oxidation of 93 - 100%. At the right-hand end of the histogram, there is one cyclist with a fat oxidation of 20 - 27%.

There's a helluva big difference between burning 93 - 100% fat at rest and burning 20 - 27% fat at rest. Interestingly, average fat oxidation is 66%, which means that average carb oxidation is 34%. So, on average, at rest, people burn twice as much energy from fat as from carbs. So why do current "Healthy Eating" guidelines recommend almost twice as much energy from carbs as from fats for everyone, including sedentary people?

As exercise intensity increases, the peak in the histogram shifts to the right as shown in the lower diagram. At 25% full work-load, mean fat oxidation is ~53%. At 50% full work-load, mean fat oxidation is ~37% and at 75% full work-load, mean fat oxidation is ~13%.

I suspect that at 100% full work-load, mean fat oxidation is 0% i.e. 100% of energy is obtained from carbs when sprinting flat-out. Somebody on a very low carb diet like Atkins induction (~20g net carbs/day) could keel over with hypoglycaemia if they exercise for any length of time at this rate.

As there is so much variation from person to person, you must find out for yourself your own optimum proportions of proteins, fats and carbohydrates and these depend upon the intensity and volume of exercise you do. It all sounds a bit complicated but it isn't really.

Just apply the principle of "Eat, monitor and adjust accordingly" as Toxic Toffee (ex-Muscletalk member) always used to say. The eating bit I will advise on in future Blog posts. The monitoring bit does not involve the use of bathroom scales.

Hang on, isn't "dieting" all about losing excess weight? Not necessarily. Remember the old joke: Q. What's the best way to lose 5lbs of ugly flab? A. Cut your head off! As your body is made up of water, muscle, fat, bones, cartilage, tendons, organs, glycogen, skin etc and your scales can't tell the difference between them, losing weight the wrong way can make you less healthy. However, losing weight the right way will make you more healthy.

If you starve yourself or skip breakfast or go for a fast run before eating breakfast, as your body is lacking in glycogen and amino acids, a large amount of a corticosteroid hormone called cortisol is secreted which converts muscle into amino acids, then glucose. It also suppresses your immune system and weakens your skin and bones.

Unless you have a lot of muscle to spare, it's body-fat that you should be losing, and to monitor this, either use a tape-measure around your waist, or check how loose/tight your clothes are, or strip-off and jump up and down in front of a full-length mirror. As Big Les (Muscletalk Moderator) says, "If it jiggles, it's fat!".

So, what happens if you eat too many carbs but your body doesn't burn them fast enough? Initially, carbohydrate intake tops-up liver and muscle glycogen stores, which increases carb-burning to compensate. The liver can store about 70g of glycogen and muscles can store about 400g of glycogen. If, despite increased carb-burning, more carbohydrate is consumed than is burned, glycogen stores continue to fill. When glycogen stores become full, RER increases to 1.0 and 100% of energy is derived from carbohydrate. Getting 100% of energy from carbohydrate means that zero fat is burned, so filling glycogen stores by eating loads of carbohydrate is not a good idea if you want to burn body-fat. Once glycogen stores are full, any additional intake of carbohydrate beyond that which is burned passes through the lipogenesis pathway - this basically means that carbs are turned into fat - which you end up wearing as body-fat. But there's even worse news. On the way to being worn as body-fat, fat is in the blood as triglycerides. This is bad for the cholesterol particles in your blood. See the Blog on Cholesterol and Coronary Heart Disease. What happens if you eat too few carbs? As stated above, a "carb-burner" taking in insufficient carbs could get hypoglycaemia.

How many grams of carbohydrate per day does it take to promote lipogenesis? Someone at rest burns ~1kcal/minute. If this is derived 100% from carbohydrate, this is equivalent to 0.25g of carbohydrate /minute, or 15g of carbohydrate /hour, or 360g of carbohydrate /day. Therefore, sedentary people who consistently eat more than 360g of carbohydrate /day will produce significant triglycerides. People who have The Metabolic Syndrome/Syndrome-X (a high proportion of people who have excess belly fat) have increased lipogenesis and higher serum triglycerides than healthy people.

Just discussing weight again for a moment, it's often said that all diets are the same, as weight loss is all about calories. This is true. See Is a Calorie a Calorie? However, body composition is determined by a combination of macro-nutrient proportions (i.e. the relative amounts of protein, carbohydrates and fat that you eat) and the intensity and volume of exercise.

So, if all you're interested in is weight loss, just count calories. If however, you wish to lose body-fat without losing muscle, you need to know how to determine what proportions of proteins, carbs and fats to eat (it's not that critical, but many people get it totally wrong). You need to know the difference between good carbs and bad carbs and good fats and bad fats. You need to know the best times to eat proteins, carbs and fats (it's not that critical, but many people get it totally wrong). You need to know the difference between good exercise and bad exercise.

Cont'd on We are not all the same.

It's all about ME, baby! (1997 - present)

If you're wondering "Who is this Nigeepoo geezer and why is he wittering-on about Cholesterol, Diabetes & Vitamin D?", read on...

The story starts in 1997. I'd just come through an acrimonious divorce and I was tired, bloated, 17st 7lb and depressed. Then a pamphlet dropped through my letterbox. It was from Agora Lifestyles, promoting a book by a Dr. Robert C. Atkins (never heard of him!). I didn't buy his book, but I read the pamphlet from cover to cover, and it described sleepiness after eating meals high in carbohydrate. Since childhood, I would feel very sleepy after eating starchy meals but I never knew why. So, despite my disbelief that Atkins' diet could work, I cut out bread, pasta, potatoes, rice, cereals etc - all of the things that we are constantly told are good for us because they are "low-fat".

Within days, I felt like a new man (oo-er, missus!) The sleepiness was gone, my weight slowly decreased and the heartburn I used to get was also gone. I was a total convert. By nature I'm very curious (which is why I became an Engineer), so I wondered how Atkins' diet worked. In 1999, I got Internet access at work and was delighted to see that there were people out there (some of them doctors) other than Atkins who were saying much the same thing.

In 2001, I got a shock when the company for which I'd worked for 24 years lost a "must win" contract and I was put on the redundancy list. My health began to deteriorate and I was referred to an endocrinologist. It turned out that my pituitary gland was failing and it was no longer secreting enough TSH to stimulate my thyroid gland to secrete thyroxine. I was therefore prescribed levothyroxine. The upside to all this is that I am now exempt from all prescription charges. I also get regular blood tests, so that I can see the results of any diet/supplement/exercise change on my bloodwork.

As well as having a dysfunctional pituitary, I also had "Metabolic Syndrome" (a.k.a. "Syndrome-X" in the US). This is a fancy name for pre-type 2 diabetes and it's caused by Insulin Resistance (IR). This meant that my fasting serum glucose, triglycerides, total cholesterol, LDL & uric acid were higher than they should have been and my HDL was lower than it should have been. It just so happens that a diet low in sugary & starchy carbohydrates suits people with this condition.

I still didn't understand how Atkins' diet worked, so I studied some biochemistry web-sites to get a better understanding of human metabolism. In November 2002, I joined the Muscletalk forum after e-mailing James Collier BSc (Hons) - Moderator and Contributor to Muscletalk as an Expert in Nutrition, criticising the article on ketogenic diets that he had written. Username "Nigeepoo" was born. Why Nigeepoo? I have a rather odd sense of humour and think that putting "poo" on the end of a word is hilarious. It also suits my warm & fluffy nature!

This was the beginning of a new phase in my learning. From there, I found a US & then a Canadian (now closed) bodybuilding forum which allowed me to learn even more about nutrition. In January 2003, the BBC series "Diet Trials" studied the Atkins diet amongst others. At the end of the series, viewers were referred to a BBC Nutrition & Fitness board (now closed) and a Healthy eating board (now a Food Q&A board) where I posted. As a result of various recommendations, I bought some books on running, diet & nutrition, metabolism and biochemistry. I also surfed PubMed and various journals, looking for studies on ketogenic diets and the effects of different proteins, fats and carbohydrates on subjects. See How stuff works.

In 2004, my pituitary stopped secreting sufficient LH & FSH and in 2005 it stopped secreting sufficient GH, so I decided to take early retirement and take things a bit easier as I was having trouble with my memory & concentration. I decided to dump my nutritional knowledge to hard-copy before I forgot it, so I wrote an e-book, "Nigee's Guide to Losing Body-fat Healthily". That's not the only reason why I wrote it....you'll have to read it to find out the other one. Was that hint subtle enough? Please note that the information in the e-book is frozen and is now completely out of date. The information in this blog is kept up to date.

Discovering Vitamin D3 at the beginning of 2007 was a major breakthrough, in terms of memory, concentration, mood and the Metabolic Syndrome. My endocrinologist was so pleased with my last set of blood and urine tests (all normal except for slightly raised cholesterol) that I don't need to see him anymore. I'll still have annual blood tests, to monitor my condition.

Discovering the bad effects of a sedentary lifestyle at the end of 2010 was another major breakthrough in terms of tackling IR.

Right, that's enough about me, baby! Tomorrow, it's back to boring old nutritional stuff again.

Cheers, Nige.