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Why fasting with low carb diet works for T2D and obesity

There are many different diets and fasting programs, what I have present below is found in the extensive body of published scientific research.  This paper is for an audience of the long-term obese, and those with t type-2 diabetes (T2D).  I start with the relevant basics science:  knowing the basics answers about the processes supports the recommendation of fasting and cutting refined carbs.  It is essentially consistent with Dr. Fung’s clinic practices and his search of the literature—to his videos. 

Obesity and Type-2 Diabetes:  Healing, What To Do and Why   7/23/16 (see first definitions below)

The systems and why it fails:  There are 2 main systems for producing the energy molecule ATP, one of burning glucose, the other of fats.  Obesity & T-2D result from a defect in the fat-weight-regulatory system.  All mammals have a complex regulatory system for appetite, rate of metabolism, and fat storage.  There are over eighty hormones involved in the systems.  The Western diet has 30% calories from sugars (788 calories), mostly from sucrose.  The most reactive sugar is fructose; it is one half of the disaccharide sucrose.  It accumulates in the liver because that is where it is metabolized.  There it damages the liver through the process of glycation.  Glycation is the process of a sugar and its metabolites randomly attaching to proteins.  This damage in the liver causes insulin resistance (IR) which entails a higher than normal level of insulin is necessary to promote the uptake of blood glucose by cells throughout the body.  Refined & also easily digested carbohydrates such as from rice and potatoes accelerate the process leading to insulin resistance and fatty liver disease (NAFLD) because they cause a very high blood glucose level.[1]  Insulin direct cells throughout the body to absorb blood glucose which the cells will burn (metabolize).  To promote glucose burning, insulin also signals cells to stop burning fat and thus STORE THE FAT.   Thus IR causes an excess in fat storage.   Some of that fat is stored in the liver, and in excess (2-3 pounds) this further damages the liver.  These stresses upon the liver (from glycation & excess fat) are what throws-out of balance the weight control system. Too much fat in the pancreas damages the pancreas causes T2D.  The US western diet with its average of 151 pounds yearly of sugar has caused through liver damage a health disaster. 

A few more pieces to the system:  more on what you need to know are the causes so that you will know how fasting and low sugar diet fixes the weight-regulatory system.  Fructose is a 7.5 times more reactive than glucose, and it takes twice as long as glucose to be cleared from the liver; thus it damages the liver at 15 times the rate of glucose. Experiments have shown that high fructose diet causes liver inflammation.  Galactose from milk sugar lactose is also very reactive.  Incretins are hormones produced in the stomach and duodenum in response to foods.  They stimulate the release of insulin by the pancreas.  This explains why all foods cause the release of insulin even the ones that don’t have glucose (carbs).  See Insulin Table at the end for the amounts.  It is another reason why a very low carb diet fails long-term, because the insulin in response to proteins prevents the clearance of fat from the liver and pancreas.  Insulin also regulates the hormone leptin.  Having IR will over time result in leptin resistance (excess leptin).  Leptin produced by fat (adipose) tissue and functions to maintain at a fixed level of fat through its affects upon appetite and metabolism.  When the fat level stored drops low it functions to both increase appetite and cause a major reduction in metabolism.  This leptin system with other hormones functions to restore weight, a good thing if you are thin, but a bad thing if you are long-term overweight.  This leptin production by fat tissues explains why it is so hard for some people to lose weight and keep it off—the yo-yo diets.  Western diet has through excess insulin made many of us overweight, obese, and diabetic.  Exercise more and eat less doesn’t fix the system.      

[1] Note:  those who eat a very low sugar diet, such as the traditional diet of the Japanese do not develop IR or NAFLD, and therefore have a very low--compared to those on the Western diet—incidence of T2D, heart attack and obesity (sugar is only 14 grams a day).

The fix:  Cleanse the fatty liver & pancreas through extended periods of low insulin.  At night after the food has been digested and blood glucose returns to the fasting level (which is what your doctor measures with blood work in the morning) the body is metabolizing fats, insulin is very low.  This period of fat burning, if frequent and long enough, will burn the excess fat in the liver and pancreas.  When on a low carb/sugar diet helped along by fasting, this will permit the liver and pancreas to heal and function normally:  the cure for NAFLD, IR and T2D.  Merely low carb or low calories will not keep insulin sufficiently low to allow the metabolism of the excess fat in the liver or to avoid the lipophilic effect of leptin to restore the fat by increasing appetite and lowering metabolism.   Remember that leptin is secreted in response to insulin.  Fasting enhanced by low carbs avoids the drop in metabolism that occurs through leptin to restore fat Cleansing the liver of fat prevents the yo-yo diet.  

What you probably won’t hear this from your doctors and corporate media:  Medical schools do not have a course in nutrition.  The influence of the pharma and food manufacturers also extends to clinical trials and who rises to be a key opinion leaders and what they teach.  Because it is not in their financial interest to fix the NAFLD and IR with diet and thereby prevent all the comorbidities, your doctor is taught that the ketogenic diet is dangerous, fasting doesn’t work, and he will advises you to eat less and exercise more.  The same message is taught dieticians and repeated in the corporate press.  They are taught the fix is to eat less and exercise more and for diabetes to tightly manage glucose with drugs, and that diabetes is a progressive disease.  It is tragic that industries are alloed in our corporatist state to pollute the evidence, corrupt medical education, and clinical practices. 

JK short fast (SF):  go on a 16 hour fast (7 PM until 11:00 AM) or longer, thus extending nighttime fat burning to midday.  At night because of not eating there is low glucose and thus low insulin.   If hunger becomes an issue, than drink tea or coffee without sweeteners or milk.  Yes, no artificial sweeteners[1].  If quite hungry then eat a little celery with cheese or peanut butter, or similar small snack to kill hunger pangs.  If progress is slow than lower carbs more and progress to the alternate day fasting.  You can still delay your first meal on the non-fasting days.  Choose whichever fast has the best compliance, Dr. Fung prefers alternate day fasting, but uses either based upon compliance.     

The fat burning diet: It starts in the supermarket: buy low net carb foods (net carbs = total carbohydrates minus fiber content in grams), and clean out your cupboards and fridge.  It is easier to say “no” in the market then in the kitchen.  We are a social animal, thus enlist the support of your family and friends.  A positive vicarious social contact arises from watching the diet and diabetes documentaries and lectures on YouTube; and it enlists the support of the rational side of your brain.  An extensive list of YouTube videos with description is at  Keep a log of your diet and fasting including how you feel.  Start the log a couple of weeks before starting your diet and fasting.  For some the gradual approach is best.  With this method you can reduce your carbs gradually and substitute corn syrup for sugar.  Karo is the leading brand; it is pure glucose (no fructose).  Biologically it is equivalent to rice and potatoes.  It took me 3 months to lose my craving for sweets; a year to reduce to 1/3rd refined carbs—and I have always been slim.   Right from the start I increased saturated fats (butter) to replace the reduction in carbs. Yes, fats are much better for you than refined carbs and yes, saturated fats are the best, followed by monounsaturated fats.  (See links section below for the science behind why saturated fats are much better than the cheap unhealthy processed polyunsaturated fats which food manufactures along with added sugars use).  To obtain the long periods of low insulin requires fasting.  An early, small dinner, low in carbs and high fat, moderate protein[2] entails more hours at night in the fat-burning state.  If short-term fasting isn’t working to cure T2D and obesity, then switch to alternate day fasting and continue to reduce the carbohydrates.

Additional good diet practices: 

To lower insulin spike when eating refined carbs include a liberal dose of fat and/or protein

Exercise prior to and subsequent to eating, thus lowering blood glucose and thus insulin

Smaller meals have lower insulin spike and quicker clearance from gastro-intestinal track

Preferentially buy carbs that are high in resistant starches (see /rh/id3.html) such as from legumes and/or fiber such as green-leafy vegetables

Increase saturated fats to supply the energy that carbs were supplying & greater satiety   

Avoid the products of the food manufactures; for they are have added sugar, refined carbs, polyunsaturated and trans-fats, and chemical additives 

At meal-time eat slowly and stop before stuffed

Have handy low carb snacks, small snacks to kill hunger pangs

LINKS: The best source on what to eat for health, for diet, and related topics is at Concise.  In the rh section are articles which lay out the evidence for what is found there and dja has journal articles on rancid fats, diet, etc.  Important are Part 5 on supplements, Part 6 which covers many of the topics here, and Part 10 on the New Atkins low-carb diet.  The large Videos library with brief descriptions has links to YouTube.  It confirms the claims here--and other health topic.  The links to ABC, CBC, BBC, ABC again national networks; they expose what U.S. media hides.  The leading authority with results is Dr. Fung of Toronto; his videos on YouTube are on fasting, T2D, fats, & insulin.   I highly recommend his book “The Obesity Code:  Unlocking The Secretes of Weight Loss” (a book on fasting is coming out in October of 2016).  For those with T2D, for a minimal fee your he will work with your doctor, click on the link to his clinic.

[1] Artificial sweeteners have been shown to stimulate the production of the  signal the release of insulin because of their taste.

[2] Proteins in meats fish and poultry and an intermediate high insulin index number though they don’t have carbs because of the incretin system—see Insulin Index table at end.  This is why calorie restricted and very low carb diets for the long-term obese nearly always fail because they don’t cleanse the liver.  This requires fast.    

Definitions:  body & food basics 

Adipocytes (lipocytes) fat cells compose adipose tissue & secrete hormones resistinadiponectinleptin and apelin.  

ATP, Adenosine TriPhosphate (adenosine with 3 phosphate molecules (PO4) attached), transfers chemical energy within the cell through the loss of one or two of its phosphate groups.  In the mitochondria ATP returns to the high energy state 3(PO4) through absorbing energy from the metabolism of carbohydrates & fats.  ATP provides the energy for over 90% of the biosynthesis:  for muscle contraction, hormones, collagen, etc. and for intra & intercellular active transport.

Cardiovascular disease (CVD) main cause (besides cigarettes) is a high carb diet which causes endothelial dysfunction of the cells lining the artery walls, which in turn causes the inflammatory response that leads to  atherosclerosis thus CVD

Carbohydrate (carb):  fiber, fructose, glucose-glycogen, starch, sucrose, lactose, net carbs (total carbs minus fiber):

Fiber, vegetable fiber, roughage, the carbohydrate component not broken down by digestive enzymes, but some is by gut bacteria.  Fiber has more than ten sugar units.  It lowers the insulin spike when consumed with refined carbs. 

Fructose (fruit sugar) a monosaccharide found in fruits.  Main sources are the disaccharide sucrose, fruits, and high   fructose corn syrup.  It is metabolized in the liver into either glucose, or fat which when insulin is stored there to cause fatty liver.  Also fructose is 7.5 more reactive then glucose and by glycation damages the liver, etc.

Glucose a monosaccharide is the main energy storage molecule for plants; in humans 1-2-lbs is stored as long-chain glycogen a backup energy source stored in muscles, fat, and liver cells.  Glucose is as one half of sucrose, and is also obtained from the hydrolysis of the digestible starches.  Glucose and fat are the main sources for production of ATP.

 Starch is long chains of glucose units.  This polysaccharide is produced mostly by green plants for energy storage. 

 Sucrose, table sugar, produced by plants; it is the readily hydrolyzed disaccharide consisting of fructose and glucose. 

Glycation:  a process where a monosaccharide (simple sugar) randomly attaches to proteins or lipid; this adversely affects their functions, thus glycation is a major cause of our chronic age-related diseases. 

Fat (Free Fatty acids and triglycerides): up to 24 carbon molecules with an organic acid or glycerol molecule on end.

Incretin: class of hormones secreted by the stomach and intestines which causes insulin secretion and produces satiety.

Insulin: a gateway hormone is produced by the pancreas.  Its main function is to have cells absorb glucose and store fat.  Insulin also regulates other hormones including leptin.  Low insulin is the cause of type 1 and 2 diabetes. 

Insulin resistance (IR):   a condition of higher than normal amount of blood insulin to manage blood glucose due to a diminished response to insulin by various tissues.  The pancreas then releases even more insulin to lower blood glucose.

Ketogenic diet (very low carbohydrate diet):  it forces the body to metabolize just fats to produce ATP, and with fasting cleanses the liver & pancreas of excess fat to cure NAFLD & T2D.  It is named for the ketones produced in the process.

Leptin:  produced by fat cells is in part regulated by insulin.  Leptin in the brain suppresses appetite and it also regulates metabolism.  Leptin is responsible for the 25% reduction in metabolism plus increased appetite that eventually occurs during an energy-restricted diet.  Leptin functions to maintain fat storage and to restore weight even years later.  

Lipids are a group of naturally occurring fat like molecules including waxes, sterols, fats, phospholipids, and others.

Metabolism in reference to diet refers to the metabolic conversion of mainly either fat or carbohydrate into the energy molecule ATP mostly by the mitochondria.  Under conditions of starvation proteins also can be used to make ATP.

NAFLD (Non-Alcoholic Fatty Liver Disease):  the accumulation of fat by liver cells sufficient to significantly downgrade their various functions.  The NHANES survey 2011 found NAFLD in 30% of adult population—similar % for Europe. 

Type-2 diabetes (T2D): occurs when the pancreas fails to produce enough insulin to lower glucose to its normal range; it results from chronic IR and the accumulation of fat in the pancreas which eventually causes the decline in insulin.



Why the global diabesity (obesity & diabetes) pandemic:  We are living with the results of perverse system which places profits before people, while of course pretending to serve us first.  Thus what we are told about diet is based on what is good for the food manufacturers, and it is sold to us as heart and body healthy.  Refined carbs (especially sugars) are the cause of the global diabesity (obesity & diabetes) pandemic.  The healthful saturated fats have been demonized and thus replaced with the unhealthy, cheaper polyunsaturated fats and trans-fats.  Then we were advised to cut fats, thus those calories were replaced with refined carbs, most of which are supplied by the food manufacturers.  At the same time fruits were bred to be higher in sugars.  They knew of the neural mechanism which makes sweetness positively reinforcing and addicting, thus the food manufactures steadily increased the amount of sugars in their products.  The result is for the US, an average of 151 pounds of sugars per person per year.  Over half of our population consumes even more.  Unlike paleo peoples whose fruits are far less sweet and seasonal, our sugars and refined carbs are year round.  Often through scarcity, they are forced to fast.  We have the perfect storm of a steady diet high in refined starches especially sugars, plus unnatural highly processed vegetable oils[1] and not fasting.  Cancer, cardiovascular disease, strokes, heart attacks, T2D, Alzheimer’s disease, macular degeneration, diabetes, osteoporosis, ulcers, colitis, and arthritis are all quite rare among the elderly paleo peoples on traditional diets, and there is great variation depending on region (compare the Intuits of Canada to those living on pacific islands with their taro as staple starch).  Year-long high sugar is missing from the traditional diet. 

Each portion of food contained 240 Calories—score relative to white bread which was set at 100

Peanuts                   20


Fish                            59


Grapes                           82

Eggs                          31


Oranges                    69


Crackers                         87

All bran                    32


Potato chips            61


Ice cream                       89

Porridge                  40


Brown rice               62  


Cookies                          92

Brown Pasta          40


Special K                   66


Whole Bread                96

White Pasta           40


Honey smacks         67


White Bread               100

Cheese                    45


Coco Pops                71 


Yogurt sweetened    115

Granola plain         46


French Fries             74


Baked Beans can       120

Beef                         51


Corn Flakes              75


Potatoes                      121

Popcorn                  54


Croissants                79


Mars Bar                      122

Grain bread            56


White Rice               79


Jelly Beans                  160

Lentils                      58


Bananas                   81


Fats                                  10

Apples                     59


Cake                          82




Detail explanation of testing

These figures are based on test results for an ideal group:  average age 22 and BMI of 23.  Foods needing preparation such as potatoes and pasta were boiled, stored overnight in the refrigerator then warmed the next day in a microwave.  Test score was based on the average insulin level over 120 minutes divided by that for white bread times 100.   There were 503 tests total test for the 36 listed foods.  Breakfast cereals were served with milk.  “Plasma insulin concentrations were measured in duplicate by using an antibody-coated tube radioinmmuonoassy kit (Coat-A-Count; Diagnostic Products Corporation, Los Angeles)”at 1997, p. 1295.  Samples of 1.5 to 2.5 mL. of blood were obtained at 15 minute intervals over the 2 hours test period.  Unfortunately this table lacks important foods of vegetables, milk, soda, diet soda, and fat (which I included from another source--Dr. Fung’s book The Obesity Code p 193).                                                                                                                                                                            

The goal is to maximize the rate of fat burning which requires a low insulin diet.  Insulin causes fat storage.   Since protein is needed to maintain muscle mass, it must be restricted but only somewhat.  The USDA dietary recommendations are high.  Thus I recommend cutting it to 35 grams women, and 45 grams men--for those of average body frame size.  This is sufficient to prevent muscle loss.[2]  The effect of protein upon insulin and thus fat storage explains why short-term and alternate day fasting make a very significant improvement upon the low carb ketogenic diet.[3]  For most on a ketogenic diet, after a couple of months the rate of weight loss will decline, the effect of insulin upon leptin.  Fasting prevents this phenomenon.

[1] Most authorities know of the health issues with trans-fats; however, they miss the fact that polyunsaturated facts are subject to rancidification (oxidation) in the body and while cooking.—a thing known for over 5 decades.  Oxidized polyunsaturated fats are comparable to trans fats in that they don’t work as well as natural fats.  A large body of research exposes this danger.  And polyunsaturated fats from grains are high in omega 6 oils which block the healthful omega 3.  

[2] The science on the effects of elevated insulin due to protein when carbs are low is very incomplete.  For one thing, with a high-protein-low carb diet (once popular in the 1920s and before) proved successful.  Obviously the when there is no glucose to burn the body will continue to burn fat; however there could be for those who don’t fast a point where metabolism declines. 

[3] There is a second hormonal system, one not affected by glucose, stimulating the release of insulin from the pancreas.