The World Turned Upside Down: The Second Low-Carbohydrate Revolution by Richard David Feinman Page B
Authors: Richard David Feinman
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"Western diet," as they call it in the nutrition
literature,
does not mean a high fat diet.
It is widely said that association
does
not imply causality. More
accurate is that association does not necessarily imply causality. Few people would deny that the association of dietary
calories
and body mass is causal, however non-linear the association might be.
Whether
the association between increased carbohydrate intake and increased
calories is
causative is one of the themes in this book.
Figure
2-2 . Consumption of macronutrients during the
epidemic of obesity
and diabetes. Inset: number of people with diabetes. The horizontal
axis
represents the period in which NHANES ( National Health and Nutrition
Examination Survey) collected data. The left vertical axis is the
absolute
energy input in kcal. The right axis is the % change in calories. The
ratios of
macronutrient is shown along the top.
We also ask whether the inset showing
the
carbohydrate-diabetes
association in Figure 2-2 tells us about what causes what. The argument will be that, given the
effectiveness
of low-carbohydrate (high-fat) diets as a treatment (sometimes a
virtual cure)
for diabetes, it would be surprising if carbohydrates were not involved
in some
way in a causative role.
Finally, there is an obvious
association between the
official advice of the USDA, the AHA and just about everybody else to
reduce
fat and increase carbohydrates and what people actually did. They
reduced fat,
at least as a percentage of calories and they dramatically increased
carbohydrates.
Looking ahead, one way to test
whether
there is a causal link
between carbohydrate intake and obesity, is to simply reduce
carbohydrates and
see if total caloric intake goes down or, in fact whether diabetes
incidence
goes down. There are some good experiments that test this. The results
are as
expected and the details of one experiment are described in Chapter 9.
Whatever
else can be drawn from these data, the association between increased
carbohydrate/decreased fat and obesity and diabetes is the single
result that
makes the largest impact on our medical students and remains an
undercurrent in
any analysis of the role of macronutrients.
4. The
macronutrient most likely to raise blood glucose in people with type 2
diabetes
is:
__ X _
Carbohydrate.
_____ Protein.
_____ Fat.
_____ Alcohol.
This is, or should be obvious. The
correct
answer was chosen by
83 % of our students. The surprise is probably that anybody got it
wrong.
Diabetes is fundamentally a disease (really several diseases) of
carbohydrate
intolerance. People with type 1 diabetes cannot produce the hormone
insulin in
response to blood glucose. People with type 2 have progressive
deterioration of
the insulin-producing beta cells of the pancreas. They do produce
insulin but
their cells respond poorly. They are said to show insulin resistance.
Insulin
has effects on many tissues, particularly adipocytes (fat cells).
Diabetes is
as much a disease of fat metabolism as of carbohydrate metabolism: the
primary
effect of insulin is on synthesis and breakdown of fat and a person
with type 2
diabetes may have excessive fatty acids in their blood. Nonetheless,
the most
obvious characteristic and the major risk for other symptoms is the
hyperglycemia (high blood glucose). Different carbohydrate-containing
foods
raise blood glucose to different extents but the general principle
holds.
The dietary requirement
for carbohydrate
5. The
dietary requirement for carbohydrate is:
_____ approximately 130 g/day
_____ approximately 50 % of calories
_____ as much as possible
__ X _
there is no dietary requirement for carbohydrate
Student
Performance on Question 5
There is no requirement for dietary
carbohydrates as there is for
the so-called essential amino acids or essential fatty acids. This does
not
mean that anybody recommends doing without them altogether even if this
were
possible (even meat has a small amount of
literature,
does not mean a high fat diet.
It is widely said that association
does
not imply causality. More
accurate is that association does not necessarily imply causality. Few people would deny that the association of dietary
calories
and body mass is causal, however non-linear the association might be.
Whether
the association between increased carbohydrate intake and increased
calories is
causative is one of the themes in this book.
Figure
2-2 . Consumption of macronutrients during the
epidemic of obesity
and diabetes. Inset: number of people with diabetes. The horizontal
axis
represents the period in which NHANES ( National Health and Nutrition
Examination Survey) collected data. The left vertical axis is the
absolute
energy input in kcal. The right axis is the % change in calories. The
ratios of
macronutrient is shown along the top.
We also ask whether the inset showing
the
carbohydrate-diabetes
association in Figure 2-2 tells us about what causes what. The argument will be that, given the
effectiveness
of low-carbohydrate (high-fat) diets as a treatment (sometimes a
virtual cure)
for diabetes, it would be surprising if carbohydrates were not involved
in some
way in a causative role.
Finally, there is an obvious
association between the
official advice of the USDA, the AHA and just about everybody else to
reduce
fat and increase carbohydrates and what people actually did. They
reduced fat,
at least as a percentage of calories and they dramatically increased
carbohydrates.
Looking ahead, one way to test
whether
there is a causal link
between carbohydrate intake and obesity, is to simply reduce
carbohydrates and
see if total caloric intake goes down or, in fact whether diabetes
incidence
goes down. There are some good experiments that test this. The results
are as
expected and the details of one experiment are described in Chapter 9.
Whatever
else can be drawn from these data, the association between increased
carbohydrate/decreased fat and obesity and diabetes is the single
result that
makes the largest impact on our medical students and remains an
undercurrent in
any analysis of the role of macronutrients.
4. The
macronutrient most likely to raise blood glucose in people with type 2
diabetes
is:
__ X _
Carbohydrate.
_____ Protein.
_____ Fat.
_____ Alcohol.
This is, or should be obvious. The
correct
answer was chosen by
83 % of our students. The surprise is probably that anybody got it
wrong.
Diabetes is fundamentally a disease (really several diseases) of
carbohydrate
intolerance. People with type 1 diabetes cannot produce the hormone
insulin in
response to blood glucose. People with type 2 have progressive
deterioration of
the insulin-producing beta cells of the pancreas. They do produce
insulin but
their cells respond poorly. They are said to show insulin resistance.
Insulin
has effects on many tissues, particularly adipocytes (fat cells).
Diabetes is
as much a disease of fat metabolism as of carbohydrate metabolism: the
primary
effect of insulin is on synthesis and breakdown of fat and a person
with type 2
diabetes may have excessive fatty acids in their blood. Nonetheless,
the most
obvious characteristic and the major risk for other symptoms is the
hyperglycemia (high blood glucose). Different carbohydrate-containing
foods
raise blood glucose to different extents but the general principle
holds.
The dietary requirement
for carbohydrate
5. The
dietary requirement for carbohydrate is:
_____ approximately 130 g/day
_____ approximately 50 % of calories
_____ as much as possible
__ X _
there is no dietary requirement for carbohydrate
Student
Performance on Question 5
There is no requirement for dietary
carbohydrates as there is for
the so-called essential amino acids or essential fatty acids. This does
not
mean that anybody recommends doing without them altogether even if this
were
possible (even meat has a small amount of
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