Dietary Fat and Hyperinsulinemia

posted in: Health and Nutrition | 71

I’ve often recommended switching to a diet higher in natural fats and lower in refined carbohydrates. What’s the deal with dietary fat? Simply put, dietary fat does not raise insulin. And hyperinsulinemia is the main driver of obesity. Hyperinsulinemia means literally, high insulin in the blood (hyper means high, and -emia means blood levels).

So, logically, switching refined carbohydrates (raises insulin) for dietary fat, can lower insulin levels significantly even if you take the same total number of calories. But what is so different about dietary fat compared to both protein and carbohydrates that makes this true? It all comes down to the different ways that proteins and fats are metabolized.

Carbohydrate-Insulin Hypothesis
Carbohydrate-Insulin Hypothesis

This also illustrates the difference between the insulin hypothesis and the carbohydrate-insulin hypothesis( CIH). The carbohydrate-insulin hypothesis holds that insulin is the main driver of obesity, and that the main driver of insulin is carbohydrates. Therefore, if one simply reduces carbohydrates, insulin is reduced as well. I think this is not entirely true. Animal protein, for example, is highly insulinogenic (provokes an insulin response), even to the same degree as many refined carbohydrates. If you eat according to this hypothesis, you should be able to eat as much protein as you like without problems. But this is not true.

The insulin hypothesis, or the Hormonal Obesity Theory (HOT), is a more complete, nuanced version of the CIH. Insulin is still the main driver of obesity, but there are many different ways that insulin can be raised or lowered. For example, insulin resistance, fructose, animal proteins, incretins, vinegar, and fiber can all be incorporated into this more complete model of obesity, which still holds insulin at the center of the web.newhot9-incretin

In this case dietary protein is not given a free ride, since it stimulates insulin. If you overeat dietary protein, according to the HOT, you can still develop obesity. This is the key insight behind the more recent LCHF (Low Carb, High Fat) movement rather than the pure Low Carb movement (Atkins and others) which do not restrict either fat or protein.

But there’s a fundamental difference in dietary fat metabolism that differentiates it from both proteins and carbs. It has almost no insulin effect. Why not? Because it doesn’t use the liver for metabolism. Insulin is only necessary for burning glucose, not fat.

So, during normal metabolism, the three macronutrients are absorbed and metabolized completely differently. Let’s start with carbohydrates. These are chains of glucose, mostly as amylopectin or amylose. There are different forms of amylopectin (A,B, and C) which are metabolized differently. Amylopectin A is the most easily digestible and the form found in bread. Amylopectin C is the least digestible and is found in beans. The reason beans make you ‘toot’ is because much of the indigestible amylopectin C makes it way into the colon where bacteria ferment them and create gas which comes out the bottom end to the endless amusement of little boys everywhere. Bananas contain amylopectin B, which is intermediate between A and C.

This difference becomes obvious in the glycemic index, which is a good indicator of the insulin effect for carbohydrate foods. The GI for wheat is very high, and for beans, it’s quite low. So, carbs are not equal, and not even amylopectin is equal. It is the insulin that drives weight gain, not the carbohydrates, so beans and bread are not equal despite the fact that they are both carbohydrates and both amylopectin.amylopectin

The amylopectin and amylose molecules are broken down into it’s component glucose molecules and absorbed into the portal circulation. This is the bloodstream that takes the absorbed glucose and carries it directly to the liver. In the liver, it is reformed into long chains called glycogen, which is a storage form of glucose (plants use amylopectin and amylose, animals use glycogen). However, storage capacity is low so the rest is turned into fat via De Novo Lipogenesis. This newly created fat is highly saturated palmitic acid, which is how high refined carbohydrate diets increase the blood levels of saturated fat, which is linked to heart disease.

Dietary protein is broken down into its component amino acids and absorbed. Some is required for protein turnover, but the amount is debatable. If you are trying to build muscle (body building) you require relatively high levels of protein. For the rest of us, a moderate amount is needed. How much? The Recommended Dietary Allowance is 0.8 g/kg lean body mass. For a 70kg man, this is about 56 grams of protein. For reference, this would be about 3 ounces of chicken, 3 ounces of tuna, a glass of milk and 1/2 cup of beans. That would be the protein needed for the entire day! You can see that most North Americans eat far, far in excess of the RDA. Consider that a typical burger now is 1/2 pound (or 8 ounces) by itself. There are many who argue that 0.5 g/kg is sufficient, too.

So what happens to the excess amino acids? They cannot be stored directly as energy, so they are converted to glucose via gluconeogenesis. This is a metabolic pathway that generates glucose out of non carbohydrate molecules. Here there are differences between amino acids as well. Some amino acids are able to produce glucose (glucogenic), some produce ketones (keogenic) and some do both.epic-study

Once again, these amino acids are absorbed into the portal circulation and directed towards the liver where excess amino acids get turned into glucose. Since it requires liver processing, insulin is required as a signalling molecule. Since the protein does not raise blood glucose, even though it raises blood insulin, glucagon is also stimulated, as well as incretins that help mitigate this effect and prevent hypoglycemia. It is a surprise to some, that certain proteins stimulate insulin as much as the refined carbohydrates. Animal proteins have more insulin effect than plant proteins. Does this matter? Maybe. There is a higher risk of diabetes for increasing quartiles of animal protein.

Dietary fat, on the other hand is metabolized in a completely different manner than both carbs and proteins. Dietary fat broken down into fatty acids by pancreatic enzymes (lipases) and bile salts. They are then absorbed into the lymphatic system as fat droplets (fat is insoluble in water) called chylomicrons. These do not go into the portal system and do not enter the liver. Then empty directly into the bloodstream through the lymphatic circulation and then to the thoracic duct.

This is the reason why dietary fat does not require insulin. There is no further processing or handling, so insulin signalling in the liver is not required for metabolism. This dietary fat can be stored or used for energy. If you were to eat pure fat (say, Bulletproof Coffee), then no glucose or protein is ingested and insulin stays low. The body then simply burns fat.

Burn Sugar or Burn Fat

There are essentially two fuel systems for the body. You can either burn fat, or burn sugar. These two fuel systems are separate and do not interact (see Randle Cycle for more details). When insulin levels are high, then the body runs on glucose. During that period, there is simply no reason for your body to burn body fat. Why would it? It’s there in case of emergencies, in case there is nothing to eat as a store of calories. It’s like a back-up generator. If you have power in the house, then the generator stays off and none of the fat is used up.

However, if you switch to a low carb, high fat diet, then there is little glucose available to run that fuel system. In this case, the ‘backup generator’ will kick in and start burning fat for fuel. That’s great, because more than anything else, we want to burn fat.cih-vs-ih

According to the older Carbohydrate-Insulin Hypothesis, Carbs are fattening, whereas Protein and Fat are not. Yet grouping protein and fat together makes no sense because protein metabolism has much more in common with carbohydrate rather than fat metabolism.

The more insulin-centric Hormonal Obesity Theory leaves dietary fat distinct from both carbs and protein. Both agree that refined carbohydrates need to be restricted. However, because excess protein is converted to glucose, it can stop ketosis and weight loss efforts. So here, carbohydrates and excess protein are treated similarly, where fat is distinct. This reflects a far more physiologically accurate picture of metabolism.lchf-before-and-after

So, if you eat a low carb meal, but eat high protein (protein bars, protein shakes, whey powder etc), then your body will still be burning glucose as it ramps up gluconeogenesis to convert that excess protein to glucose. You are stuck in the ‘Burn Glucose’ fuel system. So you don’t burn fat. You want to lose body fat? You gotta burn it off.

It’s the reason Dr. Ted Naiman called his website burnfatnotsugar, whiere you can still see a picture of him pre-LCHF as a pasty white 98 pound weakling when he was a sugar burner. You can see he was still allergic to wearing shirts back then too.

What keeps you on the ‘Burn Glucose’ side? Insulin. Obesity is a disease of hyperinsulinemia. It’s the insulin, stupid! The solution then, is obvious – Low Carb, Moderate protein, High fat diets.

71 Responses

  1. “You can see he was still allergic to wearing shirts back then too.” HAHAHAHAHA + infinity.

  2. That’s the problem with getting thin, many people develop allergic reactions to wearing shirts.

  3. Dr. Fung I have just discovered your website and Youtube videos and want to thank you for all the quality information you are sharing with the public. I am one of those people who believed all the low fat nonsense for decades..and am now not only overweight but also insulin resistant. I just started a LCIF and IF routine, and will be charting my glucose to see if I can turn this train around before getting full blown Type 2 diabetes.

    Thank you again for all the information and for speaking truth to power. I feel like I have gained IQ points just by listening and learning from your lectures and blog posts. 🙂

    • Try his book–or just wait for the arrival of his newest book due out in October. I’ve got the existing one, and am on the pre-order list for the next one.

  4. Great information, thank you. I do wonder for instance with Bulletproof coffee, it’s high fat, so your body has to burn off the fat from that before pulling from your reserves. So, for weight loss, should you still eat high fat, or pull back a bit on the fat to allow your body to run off your reserves?

    • You would need to limit dietary fat so your body can “eat” its own fat. Body fat is part of your macros.

    • to lose weight, you reduce both carbs and protein to like 5/15 and then 80 for fat. Then calculate how many calories you want to ingest, and then take 20 grams of carbs (=80 kcal), 60 grams of protein (240 kcal) and then fill the rest with fat grams in which x=9. So say you need 1700kcal per day to maintain weight, you should probably do 1400 or even less to lose. You have 320 from carbs and protein so you need 1400 – 320 from fat = 1080/9 = 120 grams of fat. Your body will then burn the deficit from your body once you are fat adapted

      • What the hell?

      • I try to eat a healthy higher fat whole foods normal calorie diet on eating days (one or two meals) and nothing on fasting days. Yes, I’ve found skipping a whole day easier to balance and more effective for losing fat.

        Eating a calorie deficit diet every day over a long period of time is proven to lower metabolism. We call it a CRaP diet.

        Dr Fung wrote about it here https://intensivedietarymanagement.com/caloric-reduction-vs-fasting-part-9/

      • Hi Philipp,
        “So say you need 1700kcal per day to maintain weight”: how did you (anyone) come with a number? How do you know how many calories you body burns? how much of the calories your body is buring are coming from your fat store, your muscle break down, or from your dietary intake? depending on the day you do more or less exercices, you sleep more or less too, you can be stress or not, fighting a slight cold or not, etc… You can’t tell how many calories your body need or is using, too many variables.

        I’ve stopped counting calories, no point. I just try to eat more or less the right amount of protein and stay low carb. The rest is healthy fat. Then my hunger will let me know If I need to eat or not. This is quite simple and I happy this way. I am 1.81cm, 73kg (lost 4kg) and 10/11% body fat.

        • Phillip Actor

          so say implies : estimate, no certainty. The person in question asked how to determine a departure point. Your hunger feeling is a result of your ketosis, that you weren’t in before you departed. I find that people have trouble getting into ketosis unless you give them a rational handle instead of a feeling.

    • My understanding is that the body cannibalizing itself is a necessary outcome of a caloric deficit.

      With that said, on a low insulin diet, the body is more likely to burn its own fat for energy than to simply reduce it metabolism, as it is proven to do on high-insulin, low-calorie diets.

  5. Nice article, and I am looking forward to your Fasting book being released in the UK.
    I am training for a marathon on a ketogenic diet, and find your information very useful.
    http://ketogenicendurance.com

    • Martin Williams

      It’s been on sale in Britain for months, mate.

      • His new book hasn’t been released yet. It’s going to be available on Amazon around October 18, 2016.

  6. Thank you for the great article.

    As an aside, I wouldn’t place too much emphasis on glycemic index (or load). Look at this study, for instance:

    http://www.newswise.com/articles/view/660109/?sc=mwhn&utm_content=buffer35175&utm_medium=social&utm_source=twitter.com&utm_campaign=buffer

    “Glycemic index values appear to be an unreliable indicator even under highly standardized conditions, and are unlikely to be useful in guiding food choices,” said lead study author Nirupa Matthan, Ph.D., scientist in the Cardiovascular Nutrition Laboratory at the USDA HNRCA. “If someone eats the same amount of the same food three times, their blood glucose response should be similar each time, but that was not observed in our study. A food that is low glycemic index for you one time you eat it could be high the next time, and it may have no impact on blood sugar for me.”

    I find this to be true. I basically eat the same lunches at work. For very similar lunches, my blood sugar ranges from -3 to +25 about an hour after eating from my pre-eating blood sugar level. Same meals, different results. I haven’t figured out why.

    I also find that low glycemic foods like grapefruit cause my blood sugar to go through the roof and cause all kinds of cravings. I avoid eating basically all fruit other than berries because of this.

    On the other hand, this weekend I ate a large bowl of chili and then had additional chili on hamburgers, and the chili had a high number of beans in it. That did not seem to affect me and I was able to stay in ketosis with that meal.

    This brings up another point, which is that the glycemic index only tells you (assuming it works at all) what happens if you eat ONLY one thing, such as beans. What happens if you eat beans and ground meat in chili and then add cheese and more ground meat in hamburgers? The glycemic index is useless for that.

    For more detail, see:

    https://proteinpower.com/drmike/2006/11/07/what-is-the-glycemic-index/?utm_content=buffer1af67&utm_medium=social&utm_source=twitter.com&utm_campaign=buffer#more-300

    • Dr Fung may intervene here, but I think if you are eating something with fiber fiber will win. so rice and beans has a GI closer to the beans. But if you put butter on your bread you are probably going to get close to the GI of bread. It is something that interests me too, since ketogenic diets seem to be lacking in K, Mg, vitamin C, folates and PQQ among other things. I have accepted the need to eat spoonfuls of ghee, melt spoonfuls of lard in my bone broth, I have ramped up greens consumption, specially chicory greens, I have even started buying crabapples instead of apples. but I am not ready to give up apples, beets, carrots, beans, natto and other high mineral, high gut health foods.

  7. if you are losing weight and producing blood ketones well into nutritional ketosis (averaging 2 mmol now) but still taking 1,2 gr/lean kg in protein, how is this possible if 0.8 is the actual number ? Are you sure it is not 0.8 gr per lean POUND ? If I eat at what you mention (I have experimented a bit) I remain hungry but am in ketosis. A 50% difference is not because all humans differ I think ?

  8. Doctor, I know you mention coffee as a good thing to drink, but I wonder if the cortisol from caffeine is something to worry about?

    Btw thanks for your book, my blood sugar is near normal, my a1c was 4.5 and I’ve dropped 30 pounds. I needed this info 40 years ago, I’m angry at the system doc and grateful for finding your book on Amazon last April. You should devulge this info at a doctor conference I would like to see the Coca-Cola reps jaw hit the floor.

  9. When govt. scientists ran experiments determine the RDA for protein, they found that .4 grams per kilogram was sufficient for 98% of the population. To ensure that everyone received sufficient, they doubled the RDA. Kind of like they did with the salt, which negatively impacted a minority of folks, so they recommended to lower it for everyone.

  10. Andrea stizza

    This article has been very eye opening. I have watched all your videos read your book n have preordered the fasting book . Can’t wait to read it. I am a retired RN n worked night shift most of my 50year career. I gradually put on weight as I got older n could never get it off until I started fasting in the spring. It worked great. Lost 20 lbs n still dropping. I have told everyone I know about your info. It is so different from what the medical community tell us. I do have 2 questions. What r your thoughts on using Bone broth and the use of Branch chain amino acids?

  11. Amazing as always! Thanks for taking the time to share your expertise and understanding!

  12. Dr Fung, there is disagreement in the keto community about this idea that excess protein causes an increase in gluconeogenesis. For example, see this:

    http://ketogains.com/2016/04/gluconeogenesis-wont-kick-you-out-ketosis/

    There are quite a lot of people successfully following the Ketogains protocol that includes macros of 0.8 to 1.0 gram per pound of lean body mass (more than double the amount of protein you cite here) and they are not getting kicked out of ketosis.

    What are your thoughts on that?

    • Phillip Actor

      Exactly as I stated and how I eat; have lost 22 kilo in 6 months and am deep in ketosis, inspite of averaging 100 gr or so of protein daily on a 67 kilo lean body mass. I think the kg got mixed up with pounds somewhere in Jasons version 🙂

  13. You say the dietary fat can be stored or used for energy. Is it difficult for dietary fat to go into storage? Isn’t this storage of excess dietary fat able to happen even with low levels of insulin? Why are we not being cautioned against consuming more fat than our body uses, if we store what we don’t use?

    • I’ve been wondering the same thing! I’m not scared of fat, like some people who were raised in the 1980’s, but wondering if I’m exceeding my fat limits.

    • Christopher Chadrick Hamilton

      Dr. Fung wrote a series some time ago and he discussed this. The mistake is in the assumption that the caloric needs of the body remain constant, they don’t. If you are taking in more calories than you consume AND your insulin isn’t out of control then your body will ramp up calorie burn to compensate for the additional calories from fat. Remember the body has a “set weight” that it will try to maintain regardless of varying calorie intake.

      • Exactly! I think a lot of folks missed that talk or don’t remember that aspect. If you have stable insulin, over eating is not going to cause much fat gain.

      • WHY does the body have a set point? How does insulin drive glucose into cells? Is the insulin broken or the set point thermostat? What organ is the thermostat controlled in? This reads like a virus that nobody can see. Science does that but…..it’s hard to be sure what is really going on. Most doctor’s think mind controls everything, and everything is a mental problem and walk around with a pack of psyche meds that are their favorite at any one time. There’s a lot more to go.

  14. With regard to the animal protein vs plant protein chart, the amounts of plant protein in quartiles are actually very small. For example, this is probably comparing about 7%E plant protein in the upper quartile with 18%E animal protein. It is not comparing like with like. Comparing the upper quartile of plant protein with the lower quartile of animal protein is comparing two similar amounts, and there is no difference.
    In normal metabolism the glucagon response to protein cancels out the lipogenic effect of insulin.

  15. Dr. Fung, isn’t this a game changer for LCHF? Now, two of the three micronutrients make us fat (carbs and excess protein). Are we going to find out that healthy fat is not as healthy as we thought it was? “Moderate protein” is very vague. This is a wonderful article, but it kind of makes me loose faith in all that I’ve learned from you about LCHF. I guess the “only” thing that truly works is intermittent fasting. I hope that doesn’t change.

  16. Dr. Fung: I’ve watched many of your YouTube videos (which are fantastic) and I have a question about bone broth consumption while on a fasting regimen. I purchased 2 different single-serve cartons (8 oz. each) of Pacific Organic Bone Broth, and they both have 0g of fat; 0g of carbohydrates; and 9g of protein. One is chicken bone broth, and the other is turkey bone broth. I thought the protein content would trigger an insulin response? Am I missing something? Could you possibly clarify this issue? I’m confused…. I would LOVE to drink the bone broth while fasting, but I don’t want to defeat the entire purpose and benefit of fasting! Thanks very much!!!!

  17. Of course, you’re not telling people to skimp on protein, and IF is a good way of keeping essential protein (which is essential, whilst carbs are not) within a sensible range…?

  18. Having looked at the EPIC paper in detail, the upper quartile of plant protein ate 33 g/day and the lowest quartile of animal protein ate 35g/day. If you want to compare like with like, there is absolutely no difference.
    Although the difference seems greater expressed as 10g increases, these are increases from different baselines, and very few people ate enough vege protein for this measurement to have much meaning; in fact the trend for the first 10g increase, the most common one in terms of plant protein IRL, is the same (1.04) as that for animal protein (1.05), except that plant protein is non-significant because of smaller numbers. This is also supported by the HR for total protein (1.06 per 10g) being higher than that for animal protein (1.05).
    There is nothing magic or protective about vegetable protein in this study, it just looks like there is from the way it’s written up.
    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2797984/

  19. Dr Fung, are there any medications on which IF would be ruled out?

  20. Excess protein won’t be stored as glucose or fat. Gluconeogenesis from protein is a costly process for the body, better breaking down the triglycerides. Excess protein will be your muscle mass if you do sport and the nitrogenous urea will be wasted as in urine..

    References

    1. McGuire M, Beerman, KA.: Nutritional Sciences: From Fundamentals to Food. 2nd edn. Belmont, CA.: Wadsworth Cengage Learning; 2011.
    2. Gropper S, Smith, JL., Groff, JL.: Advanced Nutrition and Human Metabolism. 5th edn. Belmont, CA.: Wadsworth Cengage Learning; 2009.
    3. Bray GA, Smith SR, de Jonge L, Xie H, Rood J, Martin CK, Most M, Brock C, Mancuso S, Redman LM: Effect of dietary protein content on weight gain, energy expenditure, and body composition during overeating: a randomized controlled trial. JAMA 2012, 307:47-55.

    • Excess protein not stored as muscle can be oxidised or used in gluconeogenesis. In Dr Fung’s regime the lack of carbohydrate intake means gluconeogenesis using protein is inevitable.

      • Gluconeogenesis is a demand driven process and more of a constant background process, the rate for gluconeogenesis process is unaffected by excessive protein intake.

        Unless you are diabetic or hyperinsulinemia

  21. Thorsten Bremen

    I tried whey protein for weeks (only ) and lost no weight. I tried tuna for five weeks only and gained 1,5 kg. I blamed LCHF for this and thought it’s all crap like the other diets and empty promises.
    Now I have an explanation and I think, gluconeogenesis matters.

  22. I just have to share this. Several months ago my FBS was 126 and today it is 89. All I did was fast 48 hours per week and do various hours of IF the rest of the week. I only lost 15lbs but I am so impressed with my blood sugars that I will keep going.
    I am no longer insulin resistant too, I tried a milkshake last weekend and with an hour my BS had returned to normal. I am also no longer obese but still need to lose 40lbs to be what I should weigh. I secretly wish I had lost more weight.

    • Good for you. I have been 22:2 since May 2016 and 2day/week water fasting since the last week of June 2016. Progress on insulin resistance seems slow, but I am giving it one year to realize results. When you say “several months” do you recall about how many months it was for you to realize improvements in your insulin resistance.

      • I started in February and in June my FBS finally started to come down a little and in August in came down a lot. It is now September and my Blood pressure is really coming down too to normal like 110 over 75 instead of 125 over 90. I am in however in a plateau with weight loss. One thing I can say now is I try to stay low carb here and there but since June I have not done very well with low carb. I always found Keto too hard to stay with. Fasting however has made the biggest difference for me. I try to eat one meal per day but sometimes when really hungry I eat a small lunch. I have never made it past about 50 hours at one time but I would like someday to do a 3-5 day fast at least once.
        I am trying to make this a lifelong change and not a diet.

  23. Thanks for this post. I have been eating ketogenically for 5 months and finally have a concise, evidence-based, physician-authored blog post to point to for people who have been questioning my sanity! The post has me questioning how I calculate my macros. I have been basing them on ratios while keeping carbs fixed at 20-30g per day. But now it seems proteins should be also be a fixed, calculated amount, not a ratio. Then upfill fats to meet daily calorie target.

  24. How many grams of protein does one need to get the essential amino acids?

  25. Kathy Meyer

    I’m interested in the idea from Dr. Westman that a person trying to lose weight needs to also keep their fat intake relatively low, as the total amount of fat macros should include a certain percentage of your own body fat. I think the theory here is that your body doesn’t need to release it’s own fat if it has enough readily available from the diet.

    But if the theory is that fat does not raise insulin, and insulin is the main driver of fat storage, why would this be true? Or maybe it’s true that fat doesn’t make you store more, but that excessive fat prevents it from being released and used for energy?

    It’s somewhat confusing to know how much fat to eat at this point. I do think Dr. Fung mentioned somewhere that 1gram of fat for each kg of ideal body weight? (Some say .5-1 gram) Or did I find that elsewhere. At that point, you really are monitoring your fat intake, so I wonder if it’s because of the Westman reason.

  26. Dr. Fung, I have a quick question and would be very appreciative if you could respond! I was just wondering if it would make a significant difference to get all of your (moderate) protein in one meal or to break it up into smaller portions throughout the day?

    My thinking was that eating your protein in one meal would raise insulin higher than it would if you broke up the protein throughout the day, but I’m not sure…

    Thanks!

  27. Dr. Fung,

    I actively follow you and your work, your articles and videos are amazing. I’m following your intermittent fasting advice. With LCHF I’ve dropped the 20 pounds I’ve been trying to lose for 30 years and (bonus!) dropped my blood pressure by 20 points!

    However, with gluconeogenesis, it seems the studies are not clear on the effects of protein intake and its effect on gluconeogenesis. From what I’ve read gluconeogenesis is more of a constant background process, unaffected by excessive protein intake. Please read the following (there are studies referenced) and I’d love to hear your views:

    http://www.ketotic.org/2012/08/if-you-eat-excess-protein-does-it-turn.html

  28. Dr Fung, Thank you for all the good work you do here. Can you comment on Type 2 diabetics that have always been a healthy weight. I have been Type 2 for 20 years with recent C Peptide confirmation. Two months back I decided to go LCHF with IF and this is great for weight lose, I am down from 175 to 160 lbs. losing weight is the easy part and I do not want to lose more. Where I Struggle is with glucose numbers, averaging 9 to 12 daily since starting LCHF I F which is a big improvement from when on oral medication where I would average 8 to 20 everyday. I have learned over the past several years there is just no way to strike any good balance on meds, having givin up completely for months, trying different kinds etc all with the same failing results. Nothing worked. Do you have any suggestions how a person like me can maintain my current weight and get a little better blood sugar numbers. Thanks so much,

    Derek

  29. Dr Fung, I’m an endocrinologist treating patients in Tel Aviv. I’m recommending the LCHF diet as part of my treatment. I was wondering how you handle patients with diabetic nephropathy with GFRs below 40. Are you still recommending this diet? What is your experience? I cannot find anything online except for the study in mice. Thanks !

  30. This discussion is very interesting, but how can I get access to Dr Fung’s replies? I don’t see any in the ‘comments’.
    Thanks

  31. Theresa Unter

    Dr Fung do you have more information on applying intermediate fasting to Type 1 diabetes?

  32. leavemealonegoaway

    Everybody’s success story has a different history and trajectory. I started LCHF early Feb this year, and promptly lost 35 lbs by June. Since then, I have tried varying IF regimens with another 15 gone. The lessons I learned for myself is DON’T COUNT CALORIES or track ratios compulsively.

    I simply keep carbs minimal, eat small protein portions, and (most importantly) never eat if I don’t feel like it. I last anywhere between 12 and 36 hrs between proper meals, and never feel hungry or feel a need to stick to a 5:2 or whatever.

    My special ‘secret weapon’ is an Olive Oil bar I’ve assembled (think Scotch bar). Now and then I take a shot of EVOO, analyze the aroma, mouth feel etc..ie all that crap Scotch geeks do. I know it technically breaks my ‘fast’, but sipping EVOO now and then keeps all hunger at bay. I suspect I could go weeks sipping from my EVOO bar lol.

    PS When I was tracking, my intake was always less than my BMR..I don’t bother anymore..it’s wonderful just to live and not calculate macros all the time.

    • I love the idea of setting up an “Olive Oil Bar”.. I want to do the same but add other oils to sample too, like virgin coconut oil, macadamia oil, ghee, butter, etc.

  33. Hi Jason, just a quick one – what would your relatively high levels of protein be for someone trying to build muscle? thanks

  34. Excess carbs get stored as excess fat, but what about intake of excess fat? What happens to it?

  35. For Dr Fung, or anyone else out there in interweb land that has knowledge and experience. For those of us who are looking to build muscle what would you recommend (roughly) as a good protein intake? Given that the RDA, as set forth in the article, is 0.8 g/kg lean body mass for those just wanting to be healthy, how much should it be for building. I’m guessing it doesn’t actually need to be that much more and I don’t really want to be kicked out of ketosis by taking too much (unless a short term kick out is just something I need to accept). I am currently doing 22/2 IF (staying LCHF when I eat) Monday through Friday and eating three meals a day (still LCHF) on weekends and doing resistance training four days a week.

  36. charles grashow

    Dr Fung

    Care to comment about this recent video?

    https://vimeo.com/183282494

  37. As fiber is protective in carbs so fat seems to be in proteins. See (from page 17):
    https://ses.library.usyd.edu.au//bitstream/2123/11945/2/Bell_KJ_thesis_2.pdf
    For example compaire whole milk and skimmed milk; low fat cheese to cream cheese.

  38. I think there is a typo in this article.

    The RDA for protein is 0.8g per kg of body weight (not per kg of lean body mass as stated). The Harvard website link in the article reflects this correction as does the example given for a 70kg man – assuming the man actually weighs 70kg – his protein need in the example is based on his total weight, not his lean body mass.

  39. […] we discussed last week, excessive protein is turned into glucose and then to fat. But how much protein is excessive? […]

  40. “bacteria ferment them and create gas which comes out the bottom end to the endless amusement of little boys everywhere.” I am at 7 days water fasting, and this brings delight to my otherwise struggling days. (:->)

    I love your writing style.

  41. In order to have a full understanding of obesity and how to deal with it you need to explain what happened to Professor Mark Haub when he went on the infamous “Twinkie Diet” several years ago. While eating mainly junk food he lost 27 pounds, his body composition improved and his cholesterol dropped. Dr. Fung’s hormonal theory doesn’t seem to address this outcome but I will attempt to do so in my next blog post at: http://carbsyndrome.com/

    I would welcome any comments from Dr. Fung.

  42. I have since learned that Mark Haub has taken money from Coca Cola yet he failed to disclose this fact. Another unethical researcher bites the dust. It appears that Dr. Fung is right when it comes to diet and weight loss. I have just ordered his new book “The Obesity Code” and I am looking forward to reading it.

  43. Rajan Thomas Choondal

    Dr Fung : You have explained that diabetes is disease of insulin resistance that has gone out of control. So it makes sense that measuring insulin resistance will tell you the state of diabetes. Could you advise what kind of tests can give information about insulin resistance ?

    • From visiting doctor’s for 60 years, they seem to be allowed to diagnose by symptoms, like all the years nobody ever saw a virus, they knew it wasn’t a bacteria. Symptoms are belly fat, belly sagging pooch, fat in general, fatigue, mental dysfunction brain fog and a few other’s but I haven’t read his book. Dr Berg is big on this too, on youtube but Fung goes more distance so far. High insulin can be tested for as well as blood sugar not going down fast enough is diabetes or prediabetes.

      My question is what’s up with excess insulin, or excess broken insulin it seems he is saying, so what broke the insulin or cells reject the insulin so maybe it lost it’s ability to penetrate the cell.

  44. how many hours of fasting does it take to use up ones stored glucose, before the body converts over to burning fat?

  45. Hmm, interesting that you include a picture of Dr. Ted Naiman here. I saw in an article somewhere that he eats about 150 grams of protein a day – hardly moderate.

  46. Dr. Fung – I’m a regular on your site, read both of your books this year and began following your program in late July. Since then, I’ve lost 35 pounds. I had blood work at that time, and again last week. I had been fasting for 36 hours last week, but was ending a 5 day fast during the first blood draw. Why would my fasting insulin go UP in these past 3 months? It went from 8 to 12 uIU/ml. I’ve spent about 2/3 of this time with ketones .5 or higher, with regular fasting. My A1C was 5.4 in July and was 5.6 last week. My BHB was 2.7 in July and 1.3 during last week’s draw. I’m sorry to trouble you with this question, but saw my doctor today – who is helping me and doing all the tests for me that you cited in The Obesity Code, but self-admittedly she does not know how to advise me. THANK you for your help. Rosemary

Leave a Reply