January 27, 2023

A new paper explores the mine field of why some people get obese and not others. Is it all about energy balance? Is it all about carbs and insulin? The paper does a fantastic job of exploring the details and the specifics. It isn’t about “who wins.” It’s about understanding the complex field of nutrition and obesity and how that affects people in the real world.

A new landmark paper was just published in the american journal of clinical nutrition titled the carbohydrate insulin model a physiological perspective on the obesity pandemic now is this just another paper trying to say carbohydrate insulin model is better we win our side has the truth your side doesn’t or is this an exploration of trying to figure out why some

People get obese in different ways or in different percentages or more likely to or less likely to is it a way to try and unpack this whole mess of nutrition that has gotten into these like camps and these wars well i think it’s the latter and i’d like to explain it a little bit more and go into a little deeper dive here i’m dr brett sher the medical director at

Dietdoctor.com and the first thing to point out about this paper is that sure there are people who are there are authors who have been long proponents of carbohydrate insulin model and long proponents of low carb nutrition but they aren’t the only authors there are also authors who have been involved in the u.s dietary guidelines there are authors who who believe

In epidemiology and whole grains and fruits and vegetables right there’s there’s a mix of people who authored this paper which is one of the the most exciting parts to start that it really was trying to sort of bridge the gap and bring in people from different areas but as you go through the paper i think it’s clear that they’re not trying to say like we win

We’re better right they’re really trying to to lay out the the whole framework of what this what this minefield of obesity and nutrition looks like so we have to acknowledge the energy the energy balance model the calories in calories out model and i think they did a great job of saying that look the first law of thermodynamics holds true right we’re not saying

That’s false in order to lose weight you need to burn more calories than you bring in but that’s although that may be true it’s completely unhelpful to tell somebody right it’s the old saying to have more money you have to make more than you spend right like it’s a truth but it doesn’t tell somebody how to do it and i like how that’s where sort of the carbohydrate

Insulin model can fit in because it’s trying to have a slight negative energy balance that doesn’t lower your resting metabolic rate and doesn’t drive your hunger because those are the things that both physiologically and practically are going to just turn this energy balance model on its head and make it not work because if you’re cutting your calories and you’re

Driving your hunger you’re not going to stick to it if you’re cutting your calories and your metabolic rate decreases then physiologically you’re not going to be able to lose weight so how can we cut our calories have a slight calorie deficit in ways that don’t do that well a big part of that likely has to do with what’s going on with your insulin and that’s

Where the carbohydrate insulin model and the energy balance model sort of comes together that’s sort of my words my interpretation the paper doesn’t say it quite like that but i like how the paper explores um all the different concepts and options and i hope to have dr david ludwig back on the diet doctor podcast to go into this in in greater detail but i think

The keys are its calories and its hormones and how those work together as gary tobbs who’s one of the authors has pointed out in in his books if you look at the the biochemistry textbooks the biochemistry of obesity is linked to insulin no question about it so our approach to obesity and curing or treating obesity likely should also therefore be linked in some

Way to insulin so it’s likely that hormones affect energy balance and energy balance affects hormones so they both are certainly interrelated and that’s where i think the energy balance and carbohydrate insulin come together now interesting there’s also a big section about hyper palatable foods and i guess from my perspective they sort of downplay the effect of

Hyperpalatable foods and i’ve done you know podcasts with michael moss and this concept of hyperpalatable foods i’m a believer in but it actually brings up a good concept like hyperpalatable to who right they have scientists trying to study the bliss point and the the texture and the crunch and all these things to get you to eat more but some people may find these

Disgusting and so why do some people not eat these at all and other people can’t stop eating it’s it’s clear there’s there’s individual variation there but i think maybe the hyper palatable foods have more to do with it than than what they examined but defining it is very interesting how do you define you know ultra processed and hyper palatable but dr ludwig also

Has done some studies showing that just carbohydrates by themselves can increase brain reward so i think it has to do with those people who are more susceptible maybe to brain reward and that can be hardwired it can be epigenetic whatever the case may be but without going too much into a rabbit hole in the hyper palatable foods i still think that plays a big role

And just availability um you know what you’re like with the rest of your lifestyles like how you prioritize food intake if you’re just eating at convenience stores you know all those things play into it too so certainly that’s not that’s not um brought into the energy balance model right how you live your life and what your logistics of your life are don’t have

Much to do with energy balance but they may be affecting your hormones because of the foods you choose to eat may be raising your insulin more maybe driving your hunger more and then of course there’s the whole protein leverage hypothesis as well which plays into this and we’ve done podcasts with professors robin heimer and simpson who came up with the protein

Leverage hypothesis that plays into it as well because some high carb foods are going to be lower in protein and some higher protein foods are probably going to be lower in carbs and are going to affect insulin a lot less so that plays into it as well and in this paper they go through so many different aspects the hormonal response to glycemic load the insulin and

Tissue specific insulin sensitivity tissue specific insulin sensitivity and fat storage insulin glucagon and adiposity and insulin glucon ratio which is really interesting and that might be part of why protein although increasing insulin doesn’t have the same hyperinsulinemic effects and the same you know hunger driving effects as other high insulin stimulating

Foods so they really unpack a lot of details in here but i guess my sum up and and this doesn’t do it all justice it might be a little too superficial but it really is this sort of confluence of the energy balance model carbohydrate insulin model and protein leverage hypothesis and it’s not one of them wins and one of them is right and one of them is wrong it’s

Really factoring all of them together and putting that into our nutritional lifestyle right in our nutritional environment and that’s what drives either obesity metabolic health or the lack of of those and that that’s where i think we need to really see the bigger picture and not say it’s one model or the other so again hopefully i’ll be able to engage some of

These experts to have more detailed discussions on the diet doctor podcast i i’m staying saying it here to hopefully make it happen because these do deserve deeper discussions but i want to give the authors credit for coming together sort of coming across the aisles because maybe they didn’t agree on everything and they’re not in the same camp but they thought

It was important enough to say let’s explore the concepts of obesity the different models of obesity and see where we we can come together to solve this problem i love that coming together to try and solve the problem and that’s what we’re trying to do here at dietdoctor as well um so if you thought this was helpful please give us the thumbs up and the subscribe

Because we’ll give you more videos along these lines to try and help solve this issue and if you’re a clinician looking for resources to help your patients with metabolic health and with low carb living we have a new program called diet doctor pro or dd pro designed specifically for you so please go to dietdoctor.com ddpro to learn more reach out to me individual

Individually because it’s one of my pet projects that i really want to engage more clinicians to help more people improve their metabolic health improve with healthy weight loss and improve their lives all right take care everybody bye

Transcribed from video
Landmark paper explores the carbohydrate insulin model of obesity By Diet Doctor