Transcription
Last week, we started a fun little new thing called the Metabolic Classroom, and combined with Dr. Binkman's laboratory. Yeah, I'm confused. So, so, uh, we started it last week, and we had, we had really a great response. And what Ben did is he introduced a topic that he had done a little research on that week. We kind of opened it up for discussion, and Dr. Barry had a few things to add, and so did Rich. And we're going to do that again today.
And so the thing that's that started this discussion today, I need to have Parker share this, uh, slide with you. So on Dr. Bickman's Instagram page, uh, and one of the posts that he did last week, we had a comment. And it's, uh, from a guy that we know who's a very, I'm not going to mention his name, but he's a very thoughtful and very smart guy in this space. And, and he challenged us a little bit, and we like challenges. Oh, yeah. And so we decided that we're going to address his concerns. And it's because we want you to know we're not afraid to answer any question. I mean, if we're wrong, we're wrong, right? Yeah, just say we're wrong. No big deal.
But let me read this to you. If it's on screen, you read along with me. Ben, I assume that you've seen the DIETFITS study, partly founded by TOBS, which directly compared low-fat versus low-carb and stratified for insulin sensitivity based on a glucose challenge. No difference in fat loss were seen. Insulin had no predicting ability for the volume of fat loss. I agree with you that if you're insulin resistant, low or lower carb is a great option. But to suggest that people who choose to follow a low-fat diet for weight loss won't be successful if they're insulin resistant is not sufficiently supported by the weight of scientific literature. And frankly, it's completely misleading. When you put your bias will, when will you put your biases aside and start out? When will you put your biases aside and start to let the data guide you? You love keto, great. But your knowledge is only supporting your echo chamber. Time to expand it. Yeah.
So, wow. So we like, hey, no problem, man. If you want to challenge us, please do it. We're happy to do it. And in this case, we're just going to talk about it. So Ben has prepared a little bit. I'm going to turn the time over to Ben and have a little discussion. Yeah.
So that comment is based on the study I shared on my Instagram, um, channel page, account, account, um, which was itself an analysis of a study called the A to Z study. And, and we'll get into, we'll compare two general studies. That comment is, uh, you know, a call to weigh the sum of all evidence. And that is most assuredly what I do. Rest assured, I'm not going to, I don't come to conclusions lightly, especially the conclusion that if someone is insulin resistant, a low carbohydrate diet is superior. I appreciate that the commenter acknowledges that, but then goes on to say the sum of data doesn't support it. Let's look.
So the DIETFITS study is a study published recently in the Journal of the American Medical Association, or JAMA. Let me just let our audience know, we're going to have our team paste the links into the stream so that if you want to pull up those studies and follow along, uh, we have those links. And I think Parker's going to flash some pictures of it, so you'll see the titles. So that's the DIETFITS study. And what we can do is compare that with a study that had been done about 10 years before that one, actually with some of the same people at Stanford. So there are a lot of really great similarities here that help us wipe out some confounding variables potentially. It's at the same school, same general population. In fact, many of the same scientists, and they also recruited the same way in these two studies. The A to Z study and the DIETFITS study, they had similar age, similar ethnicity, similar body mass index, or BMI, so body size. So they controlled, um, well, two separate studies, but a lot of these confounding variables were just eliminated right from the get-go.
So the DIETFITS study showed that whether they put people on a low-fat diet or a low-carbohydrate diet, there was really no clinical differences across all the, all the, all the study subjects. In contrast, the A to Z study found stark differences. And the A to Z study is fascinating because they compared four different diets: the Atkins diet, the Zone diet, the Ornish diet, and the LEARN diet. L-E-A-R-N. It's an acronym. The LEARN diet. Those four diets, and they differ in the ratio of, of with macronutrients with regards to carbohydrates and fats. Now, they both were about 12 months in in length, so that was a similarity across the studies. And I already mentioned that the overall population of this, of the study subjects was very similar. Now, the diet, however, is quite different. And that's what I, I kind of resent, uh, people, you know, well, using terms incorrectly. Unfortunately, there's a lot of ambiguity with regards to what some might call a low carbohydrate diet. For example, the A to Z study, that was the study that was done in the late, about 10 years prior to the DIETFITS study. The low-carb diet group had, at the most, over the length of the study, was 50 grams of carbohydrates per day. It started at 20 grams of carbohydrates and then it went to 50 grams of carbohydrates. In contrast, the DIETFITS study, they, the group started at 100 grams of carbohydrates and by the end of the study, it was up to over 130 grams of carbohydrates per day. That's quite a difference.
Let me just jump in here, Ben, and talk about that a little bit. What does it do to insulin's mechanisms when you're dealing, when you're calling that a low-carbohydrate environment? What's insulin's response with that kind of carbohydrate load in the body? Yeah, of course. If it's, it's two to three times higher in the DIETFITS study, the amount of carbohydrates per day than it is in the A to Z study. It stands to reason that insulin is going to be elevated two to three times more, right? Yeah, I mean, it actually would be probably higher than that, frankly, because it's not one-to-one. Yeah. And as you've taught us, insulin is a key player in stimulating your body's fat cells to store energy in the form of fat. So the more carbohydrates you have, the more insulin, and the more weight you're going to store. That's the body's efficient mechanism to do that. And, uh, when I, when I read this study, the DIETFITS study, the DIETFITS study, I commented to Ben, I said, with the students that we have in Insulin IQ, that would not be considered a low-carbohydrate diet. And this wouldn't even qualify as a successful attempt at being a low-carb, high-fat nutrition. And low-carb, high-fat nutrition. So I wish they would have defined how they arrived at their carbohydrate level because those are levels far above what I tell my patients. When my patients have diabetes, I tell them a prescription is low carb. It's like medicine because I don't see any effects on their blood sugars. The type 2 diabetics, when they're eating 100 plus grams of carbohydrates a day, they still need just as much medicine. They need significantly less carbohydrates to improve their blood sugar control. So I, I already have a problem with how they design their studies. Yeah.
So a huge difference in the carbohydrate load that each group is getting. Now, I should add, the A to Z study itself didn't look at insulin resistance or insulin sensitivity as a split with regards to the study population. That was a follow-up study that was published a few years after, which then took the A to Z data and then explored inherent differences with insulin. Now, the insulin is another variable. So the first one is the amount of carbohydrates vary greatly. And what was called the low-carbohydrate diet in the DIETFITS study, by any met, by any definition, would not be low carbohydrate. It would be lower, lower carbohydrate. They were eating up to 130 grams per day. The low-fat, high-carbohydrate group was eating 240 grams per day. So a difference of only 110 grams of carbohydrate is what defined the, the low-fat and, and the low-carb. That to me is a little too small. That's a few pieces of bread a day. Yeah. Yeah.
So that was one difference: the carbohydrate load itself. Second, the way they looked at insulin. So the DIETFITS study actually, when they were splitting the group up with regards to insulin sensitivity, they were looking at, as the comment noted, um, what they were actually looking at was something called the insulin at 30 minutes. In contrast, the A to Z post-hoc analysis paper, they looked at fasting insulin levels. Now, it would be debatable which one is an actual marker of insulin resistance. I actually would lean on the fasting insulin personally. The 30-minute, 30-minute insulin is interesting, but when you don't have the subsequent time points, you can't determine either what's called the Hayashi method or the Kraft method to determine insulin resistance. Those have to be multi-point measurements over two to three hours. This was a one-time measurement of insulin at 30 minutes. And they looked at that insulin at 30 minutes measurement to say, well, did, is, did someone with a high insulin response respond better to to the low-fat or the low-carb diet or the low insulin response? As opposed to the A to Z analysis, they just said, we looked at people based on their fasting insulin. The people with high fasting insulin were considered insulin resistant. The people with low fasting insulin were considered insulin sensitive. And that's the study that noticed the difference. But in DIETFITS, we didn't know their condition prior to taking that glucose challenge and measuring their insulin response. No, there could be wide variables. Some people could have been fasting, some people could have just eaten. Yep.
Now, another point of interest, um, in the DIETFITS study, the amount of carbohydrates as a percent of calories was about 30%. So 30% of their calories were coming from carbohydrates. That's not particularly low carb. In the A to Z study, it's interesting to note because one of the diets actually matched that perfectly, and that was the Zone diet. So in the A to Z study, the Zone diet was 30% carbohydrate, just like what was called the low-carbohydrate diet in the DIETFITS study. Does that make sense? Am I making it easy? So you would need to compare the DIETFITS low-carb study to the A to Z Zone diet. And it's interesting because the Zone diet, which was 30% carbohydrate, had no significant weight difference. Parker, I'm not sure if you can even zoom in. Can you are you able to zoom in on this from where you are? Anyway, on this figure? I'll just narrate it. Parker, don't bother. I'll just sort of talk you through it. The Zone diet did not have a significant change in body weight. Figure two of the study. When we opposed it. Yep. The Atkins diet, or the low-carb diet, did. And so this, once again, we were sort of challenged with regards to how we compare the carbohydrates. But I'd intended to leave that topic. The insulin, how they measured insulin and insulin resistance differed between these studies. And I strongly contend fasting insulin is a better marker than just insulin 30 minutes of insulin sensitivity and insulin resistance. If insulin at 30 minutes had been matched with other measurements at 60 minutes, 90 minutes, 120 minutes, and so on, then that would be more useful, perhaps, than fasting insulin. But as it is, it's hard to compare them.
Now, there were a lot of other things that were similar. The way they coached the people through the groups, through the diet, how they, how they measured the adherence to the diet, all that was still pretty similar. Not surprising because it's the same group of scientists at the same institution. But I think those two key variables are what explains the differences in these studies. One, the DIETFITS study had significantly more carbohydrate, and by by almost no definition would be considered low carbohydrate. And the way they measured insulin resistance and insulin sensitivity was also different. Um, once ag, so again, to confirm my thought is, if we are to look at the efficacy of a low-carbohydrate diet or low-fat on someone who's insulin sensitive or insulin resistant, a fasting insulin will reveal that better than an insulin at 30 minutes. And that's why I lean on, in these, in the face of these two aspects of challenging data, I lean on the A to Z analysis more than the DIETFITS. But lest someone think we only have these two studies, truly, I could have brought in dozens of studies that would have compared low-fat to low-carbohydrate. And never once, to my knowledge, has there never once been a study that shows a statistically significant greater weight loss on a low-fat diet. In contrast, there are dozens that support a statistically significantly greater fat loss or weight loss on the low-carbohydrate. Now, those studies, however, didn't attempt to look at insulin sensitive or insulin resistant. They just found, in in everyday people, the low-carb diet beats, uh, the, the low-fat diet with regards to weight loss and insulin reductions. The power with the DIETFITS and the A to Z analysis studies is that they did attempt to look at the underlying insulin resistance or insulin sensitivity status. And so we have to just compare these two studies head to head. There are inherent differences. I hope all of you can appreciate there's quite a difference in how they measured insulin resistance, fasting versus 30 minutes, and the amount of carbohydrates they gave them. Those, those differences are just so great. 130 grams per day at 30% of calories as opposed to about 50 grams per day, roughly 10% of calories. Pretty meaningful differences between the two. Yeah.
Well, Jack, I have a comment. Eight years ago, when I jumped on this, um, I started looking at the science behind, you know, high-fat, low-carb. I was, you know, I was implementing the Zone diet to our clients. I mean, that was it. Eight to 10 years ago. I mean, the Zone diet was really popular and it helped people initially because most of my clients wanted on the American standard, standard American diet. If they were awful, the Zone diet kind of helped them bring it in, eat better, and it helped, but not long-term. And I was frustrated. And that's when I really started to look at the data. And that's when I made the switch eight years ago. And it just hasn't even compared. Yeah. All right. The success. I mean, I don't know about these studies because you work with people that come in, almost always that are somewhere towards type 2 diabetes. They come in, most of them are overweight, insulin resistant. I mean, Ben, almost, it's almost frightening. Almost 100% of our clients that come in, I mean, it's just, oh my gosh, it's just their diabetes medications are gone. Their, you know, hypertension medic is gone. You know, again, we don't focus on weight loss, but, you know, they typically lose a lot of adipose tissue when they do this, and they feel better. They're able to fast. And, and I mean, I guess you could come up with a thousand studies here, but from our study at my gym and implementing Insulin IQ's program, it's just a no-brainer.