No, I mean, has anyone shown that it works in practice? That is, are the effects statistically significant and confirmed under controlled conditions?
All your cites seem to be about cholesterol, not insulin resistance.
Not sure what we are arguing about?
Insulin triggers the “please store sugar as fat for future” response, IF (if!!) the cells are already full of the regular stored energy (ATP?) and there is an excess of sugar in the bloodstream.
So does it cause obesity? Yes, it triggers it, which satisfies the definition of “cause” for me - if the person has also consumed excess sugar and not exercised enough to need that sugar - because that’s what triggered the excess insulin. The high insulin level does not come from nowhere - it is a result of excess sugar. Mind you, combining excess sugar with the starch of a normal or excessive (large portion) diet simply adds to the amount carbohydrates which will get stored as fat. So that’s where portion size hurts. Then, in the quest for weight loss, the sugar industry has (allegedly) demonized fat, so people choose “low fat” foods which tend to substitute sugar for fat to make low fat food taste good. Chugging sugar-water probably doesn’t help the situation. (Carbs -starches - by themselves are considered less of an issue because the breakdown of starch into sugar is a slower process so there is not a huge spike suddenly after eating.)
Eat too much sugar and starch. Generate high blood sugar, which generates high insulin, which causes storing the excess sugar as fat.
Of course, eating a lot of sugar or carbs and generating a lot of insulin is probably OK if you just finished a marathon or your daily 10K run.
I think the central question is, if you ingest the same amount of calories, but change your eating pattern to keep your insulin level low for a larger fraction of the day, would you lose weight? I haven’t seen any evidence that it does.
Diets work because it makes you more selective and careful about what you eat, and as a result, you end up consuming fewer calories. That’s it. Fasting works because you end up eating less (some cites here).
People eat too many calories and don’t exercise enough. This is not unique to the US, the top 120 countries cited in the OP have a BMI>25.
Michael Moss, in his book “Salt, Sugar, Fat” shows companies and restaurants believe that people buy food since it tastes good. The easiest and cheapest way to do this is to crank salt, sugar and fat levels into a “bliss point” range. When his daughter complained she was not allowed to eat cake for breakfast, a cereal company executive was inspired to make breakfast cereal that was mainly sugar and market this for kids.
While portion sizes are bigger, people are cooking less or eating highly processed convenience foods that are not nutritionally ideal. Many cannot cook at all or interpret nutrition labels, which are a fairly recent thing. Until recently, it wasn’t easy to know how many calories were in fast food.
Burgers may be vilified, but a bigger problem is the sugary soda and large fries. Fast food can be part of a good diet. John Berardi was right about nutritional timing - ideally one saves big pizza and pasta meals to just before or after a workout. Eating five servings of vegetables everyday would work wonders for most people.
Mothers thought juice and low-fat sugary foods were healthy options for their family. But they aren’t. There is an extremism about diets, exercise and nutrition which is counterproductive. People who make drastic (and hard to sustain) changes like vegan, paleo, raw or keto diets give the impression any unhealthy temptation is wrong. In fact, small changes add up - getting enough fibre and vegetables means less room and desire for an unhealthier snack. But if you eat well 90% of the time you could enjoy less healthy snacks periodically and still be very healthy.
Exercise is the other issue. Time spent on screens is not always productive. Walking or engaging in social exercise, plus two days of strength training, would work wonders for most people. Again, extreme exercising amongst marathoners, powerlifters and serious Crossfitters gives the impression exercise has to be difficult and intimidating. But it doesn’t, again small changes matter and consistency wins out over a drastic lifestyle overhaul. Exercise reduces stress and helps socialization. You can be overweight and metabolically healthy, but diabetes will shorten your quality and quantity of life, while exercise will aid these.
In short, because tempting and unhealthy foods, nutritional advice, and healthy alternatives have never been so available, many people are confused.
They may not know what healthy foods and portion sizes are. There is a lot of bad nutritional info out there (you need to specifically eat expensive food X because it is high in antioxidants and anthrocyanins), or simply not read or know how to read a nutritional label or fast food calorie guide. They may have been misled by nutritional claims for juice or low-fat Snackwells.
They may have difficulty avoiding tempting foods when stressed. Fast food tastes great. Ice cream is awesome. Most people can enjoy these as part of a healthy diet if they limit frequency and portion size. An extreme diet is less likely to be sustainable than gradual changes.
People need to exercise more, but also more smartly. Strength training is a real superstar in this regard but gyms may be expensive or intimidating. This doesn’t need to be the case. But one has to consciously choose to walk more, take the stairs or schlep to the gym twice a week to lift increasingly heavier weights (and starting from zero is just fine).
I doubt any of these issues is unique to America. People like convenience, are stressed, and frequently give in to temptation in any country. Some cultures prefer fat and find it attractive. There is indeed a genetic component to metabolism. And eating well and exercise have a considerable “nurture” component.
Finally, after recently reading Cialdini’s “Influence”, I am persuaded doctors and others do a poor job of messaging these concerns.
It isn’t easy to do in practice. In over 15 years in family and emergency medicine, you could cause offence even bringing up this topic delicately. A very overweight family once offered to buy me a sundae, to thank me during a very busy shift. They scowled when I thanked them and said they could get me a small one.
Sometimes I used techniques similar to smoking cessation — would you like me to give you any advice regarding weight or exercise?
That said, social proof is important. Saying “most people are overweight, don’t exercise enough…” actually makes it more acceptable and makes action less likely. Saying “most people know they need to eat better and exercise more” is very different, even if it seems similar. I think tying weight to health so directly, even if somewhat validated, is counterproductive.
I’m not familiar with Jason Fung but Valter Longo’s team at USC recently showed that simply eating a low-Calorie (~800 Calories/day), low-protein, low-sugar, low-saturated fat diet for 5 consecutive days, once a month, improved fasting blood glucose plus a number of other biomarkers:
Interestingly, in animal studies, the fasting-mimicking diet actually increased lean body mass.
Pubmed is your friend:
It says “without caloric restriction” but the abstract doesn’t mention whether they made an effort to make the total caloric intake the same as before, or just didn’t try to reduce it below a certain level.
Also, it seems to be saying fasting causes high blood pressure and high cholesterol?
If you’re too lazy to go on a diet, you can always find some excuse not to.
I travel into the western states ocassionaly and there is a noticeable difference as soon as I cross the border into Washington. The people are huge. It’s amazing that little line on a map, the border, makes such a difference.
But as I travel further south into Oregon, people are slimmer, not much different than home.
Northern California is the same until one gets into the Greater Los Angles region where they start becoming bigger. Not sure why. More Hispanics maybe.
But there are definitely regional differences.
Gary Taubes isn’t exactly someone well respected in the evidence-based nutrition world. Harriet Hall on this book specifically:
Here’s some evidence that it’s calories overall, but more fat calories than sugar:
This is one of the worst faults of Taubes. He’s teaching something that is not science. It’s not the insulin. This isn’t debated in nutritional science. Here is a good debunking:
Excellent cites.
More on fat increase over the decades compared to sugar:
[See link for chart]
Obesity or opioids, seems parallels can be similarly drawn, the weak should be punished regardless, and the predators are to be celebrated.
We all have a choice but goddamn can’t I get a salad commercial every now and then? Lol
Yet, the US has a much higher percent of people who have a BMI>30. From the link in the OP, America has 36.2% in contrast to Canada which has 29.4% or the UK, with 27.8%. Japan is much lower with only 4.3%.
But again, why are there so many Americans who have such high BMI?
Fat shaming doesn’t prevent obesity. There’s a TON of fat shaming going on in the US, and people are still obese.
I think I’ve mentioned it before, but it’s interesting to watch old movies from the 1930s and 40s. Especially ones like the Thin Man series, where there’s a lot of drinking going on. The cocktail glasses were teeny. They held about the equivalent (or less) of a shot glass today…and even shot glasses are sometimes bigger today. In one scene, William Powell has lined up something like six martinis in front of him at the bar. There’s probably no more than two drinks’ worth of alcohol in those six glasses than in one current cocktail glass size. And alcohol has a huge amount of empty calories.
How would you do this? Other than eating one big/sugary meal a day (as a following post shows, has a result) or eating much less sugar and carbs, to reduce insulin levels, which doesn’t prove anything.
Yes, I was well aware while reading *Case Against Sugar *that the guy was marginally sounding like a nutbar on a diatribe. But, the basic theses are not too far off. Insulin may not be the major villain, but there is some cause and effect. Sugar industry people may not be acting out a conspiracy, but there’s no doubt that fat has been vilified and sugar more ignored as the cause of obesity, and “big sugar” has some fairly decent lobbying on par with any other US agricultural organizatoins.
As for whether sugar or starch cause obesity versus fat - I have tried the Atkins diet. It worked, I was for a while losing a pound a day, going from 235lb to 208lb while not worrying about how much protein or fat I ate. Of course, once I stopped I eventually put it all back on.
You didn’t take your time reading the links I provided, did you?
Yet in multiple posts you mention what a book says that sounds to you like it was written by a nutjob marginally.
Yes, they are far off. And you have provided nothing to prove your case. The weight of the literature is not on your side. One can cherry pick a study here or there written up in the NY Times or link to a Taubes type guru, but the majority of studies show calories in and calories out is what it comes down to.
You might not read the following with a skeptical eye, either, but here’s an excellent takedown:
My cites with evidence for whether or not sugar or fat consumption has increased more is more relevant than stone throwing.
And of course you are mentioning this because you think it’s evidence that one can eat a lot of “other stuff” because calories either don’t matter at all or they matter much less than insulin levels, right? Of course that’s why you’re mentioning it. Your marginal nutjob Taubes and Atkins have made similar claims. You’re wrong. Diets where large groups of food are eliminated frequently end up with one on a calorie deficit, even though one doesn’t realize it. And don’t forget the traditional Okinawan diet, dairy, etc. You really should read those links I provided.
There are definitely benefits on paper to defaulting to higher protein as it helps retain lean mass, has a higher thermic effect of food and helps with satiety (as does fat) but the vast majority of strong evidence still show weight loss comes down to calories:
Comparison of a low carbohydrate and low fat diet for weight maintenance in overweight or obese adults enrolled in a clinical weight management program - PMC (One of the researchers works for Veronica Atkins, Chairperson of the Board of Directors for the Robert C. Atkins Foundation and the Atkins Foundation provided partial support for this project)
Comparison of Weight-Loss Diets with Different Compositions of Fat, Protein, and Carbohydrates - PMC
And plenty of people just adhere to diets better when they don’t fall for the demonization of an entire macronutrient.
My posts give many reasons people are gaining weight. You could quibble about BMI cutoffs or BMI applying to populations and not dedicated weightlifters.
America in many ways is a global leader. It innovated sugary cereals, highly processed foods, neurological food research and fast food chains promoting combos that add bacon, fries and increasingly large sodas to your order for bargain prices. But these have spread to other countries due to multinationals and foreign business inspired by successful American ideas. The US had a head start and gained BMI earlier but there is plenty to go round.
My experience in the US is limited but in many places it seems difficult or unpleasant to walk short distances more designed for travel by car. I did not find American portion sizes much bigger than in Canada, but buffets seemed to be much more popular — you are aware of psychology experiments where people eat 70% more soup if unknowingly given a “self filling” bowl. I think there are cost and knowledge barriers to eating well. And there are cost and psychological barriers to exercise — is your city safe enough to take a night time jog? Is the infrastructure adequate? Are there local stores selling fresh vegetables at reasonable prices?
American media and fitness enthusiasts often seem to gravitate towards making fairly extreme changes - but you don’t need to be in ketosis or become a marathoner to walk more and eat more vegetables and less sugary treats. But you do need motivation and knowledge.