Natural History Phase 2 – T2D 33

posted in: Diabetes, Health and Nutrition | 49

Type 2 diabetes actually happens in two phases. The first phase, which lasts approximately 10-15 years shows a slow increase in insulin resistance. However, the body compensates by increasing insulin levels. This keeps blood glucose relatively normal.

But something suddenly changes after approximately a decade of rising insulin resistance. Hyperinsulinemia can no longer keep up with the pace of insulin resistance. Pancreatic beta cells, responsible for insulin production are unable to keep up. As this compensatory mechanism fails, the blood glucose rises quickly. It takes only two years or so before full-blown type 2 diabetes is diagnosed.

Beta cell production peaks and eventually starts to fall. The progressive decline in insulin production is often called beta cell dysfunction or sometimes pancreatic burnout. But what caused this burnout?

One thought is that hyperglycemia destroys the beta cells. But there’s an obvious problem. During the development of type 2 diabetes, blood glucose stays relatively controlled. Not until after beta cell dysfunction develops does the glucose go way up. The beta cell dysfunction caused the high blood sugars, not the other way around. This crucial point is often forgotten or ignored – especially by academic physicians and people focused on type 1 diabetes such as Dr. Bernstein.

Others have suggested inflammation or free radicals as the mechanism. However, none of these theories can explain how type 2 diabetes is so readily reversible with dietary changes. The use of anti-inflammatory or anti-oxidant medications is useless in the treatment of type 2 diabetes. That is, if free radicals caused the T2D, why does dietary change reverse it where anti-oxidants are completely useless?

The prevailing concept is the pancreatic beta cells are simply worn out from massively overproducing insulin for so long. Like a decrepit engine that has been revved too many times, irreversible damage is done over many years by the excessive workload. Certainly some evidence exists to support this concept, but only in the very end stages of type 2 diabetes. Autopsy studies occasionally show scarred and fibrotic beta cells in the pancreas of long standing diabetics.

However, three main problems exist with this paradigm. First, the suggestion that beta cells are irreversibly damaged and function is permanently lost is clearly false in the vast majority of cases. Studies of bariatric surgery and weight loss have conclusively shown that type 2 diabetes is reversible and therefore the beta function can be recovered even in massively obese patients with decades of disease. Further, Dr. Roy Taylor, of the Newcastle University in the UK specifically demonstrated pancreatic function recovering with an ultra-low calorie diet. There is no permanent burnout in most cases.

Secondly, beta cell burn out implies that damage occurs only due to long standing excessive use. With type 2 diabetes now being diagnosed in children as young as three years old, it is inconceivable that any part of their body has already burned out. Disease reversal with dietary intervention in that case emphasizes that type 2 diabetes is not an irreversible process.

Finally, with excessive use, the body generally responds with increased, not decreased function. If you exercise a muscle it gets stronger, it doesn’t burn out. With overactive secretion, glands generally get larger, not smaller. If you think too much, you get smarter. Your brain doesn’t burn out. It takes decades of over-activity to produce scarring and fibrosis.

The same holds true for the insulin producing cells. They should grow larger (hypertrophy) and not smaller (atrophy). The rising epidemic of type 2 diabetes in children and adolescents clearly proves this concept false.

So, here’s the million-dollar question. What causes the beta cell dysfunction in the first place? Recent research has identified the likely culprit. Fatty liver and fatty muscles produced the increased insulin resistance. Fatty pancreas creates the beta cell dysfunction. The pancreas is clogged with fat.

49 Responses

  1. The recent central injection of FGF1 protein induced substained remission in rodents/mice study by Dr Michael Scharwz group suggest an additional pathway…
    http://www.nature.com/nm/journal/v22/n7/abs/nm.4101.html

    Brain control of glucose homeostasis and the future of diabetes treatment
    https://www.youtube.com/watch?v=qSE-H3mTNKM

  2. Michele W

    A disproportionately large proportion of cancer cases among people I know has been and continues to be pancreatic cancer. As I understand it, the incidence rate and death rate are still on the rise. I’m sorry to say that I haven’t researched this yet, but it does seem like a high carbohydrate/high sugar diet on the way towards type 2 diabetes would be a continuous double whammy for the whole pancreas, including the beta cells. Creating a super-metabolic cancer. Any thoughts?

  3. This blog post surprises me, coming from someone who understands the role of hyperinsulinemia in type 2 diabetes. High blood sugar cannot be caused by lack of insulin when there is not a lack of insulin but an excess of insulin. Insulin function does get downregulated as T2 progresses but this is actually a protective mechanism.

    The idea that we do not secrete enough insulin because our blood sugar is high is a very dangerous one and is what fundamentally drives the mismanagement of our disease. It is completely foolish to look at beta cell capacity and then say well it’s reduced so our insulin levels must be as well, without looking at where these levels actually are. When we do though, a completely different story is told.

    It is complete nonsense actually to even think that reduced insulin secretion is the problem with T2DM, that is a complete fairy tale.

    The two million dollar question is, why do we think this beta cell dysfunction is making us worse? Fatty liver does contribute to insulin resistance, fat in general does, but where does all this extra fat come from? It comes from insulin excess. So do type 2 diabetics still suffer from insulin excess? Let’s peek inside Pandora’s box. Wow, what do you know, or levels are pathologically high typically, not low. So maybe our treatment goal of treating us like we are insulin deficient is dangerously mistaken.

    Beta cells do get damaged from glucotoxicity and liptotoxicity, which are both driven by an excess not a deficiency of insulin, so unless we correct this and seek to balance this hormone more, we’re just going to keep getting worse. That’s diabetes though as they say.

    Strategies like dietary restriction that are promoted on this site do take us in the right direction though, looking to reign in our excessive insulin secretion, but in the case of insulin excess, the problem cannot, in any way, be due to insufficient secretion, when our plasma levels are several times higher than what is healthy.

    I’ve been looking into insulin clearance a lot more lately, and that’s part of the problem for sure, but no matter, plasma levels are plasma levels, and too much is not a good thing regardless of the cause.

    • Ken, if you haven’t already, please view the below referenced talk given by Dr Roy Taylor (Reversing the Irreversible), the Dr/Professor credited with discovering T2D was reversible. At about the 26 min mark he displays 4 graphs, the first is the control group showing a normal insulin secretion rate over time. The second is the diabetic insulin secretion rate should an almost non-existent phase 1 rate and pathetic phase 2. Then he shows his study group at 1 week on a 700kcal diet, then after 4 and 8 weeks. The 8 week graph is pretty much identical, arguably better, than the control (non diabetic) results.

    • Hi Ken,
      You are absolutely in agreement with Dr. Fung as far as insulin is concerned, but today you seem to think that he states that type 2s have too little insulin. I don’t feel this to be true at all, he says too little insulin to overcome the resistance, not lower than normal levels. And, eventually, very late during the disease, there might be too little insulin. I like your blog by the way.

    • Dr Peter Haynes

      For goodness sake Ken, you have completely misread this blog and your comment leads me to believe that you have not read any previous blogs from this site. Jason has written nothing that contradicts you. He refers to a ‘relative insulin deficiency’ not an absolute one.

      Please re-read the article.

    • I know the answer on this one, had the same discussion a couple of weeks ago somewhere else:

      As usual, it’s a matter of semantics.

      What do we mean by too much/too little insulin? too much/too little for WHAT?

      It’s like this: T2D is related to IR, and the pancreas will overcompensate by secreting more insulin. So too much insulin.
      Yet, since this will make IR raise and raise, the pancreas is actually not able to secrete enough insulin to stabilize BG. So too little insulin.

      Woot?? Yes, it can be both too much and too little: too much compared with healthy, non-T2D people, but still too little to properly perform as expected re: BG control.

      Additionally, it seems that in the final stages of pre-T2D things rapidly ramp up: IR is sky-high, but pancreas is clogged with fat and beta-cells don’t work properly…

      …so now we have BOTH KINDS of too little insulin, and fasting BG just skyrockets.

  4. Thank you Dr. Fung for this article/this blog and your book on fasting.

    Last year, I experienced a burn out state in my health, specifically my digestive function and nutritional balance. After enduring and managing chronic diarrhea for several weeks (which I sort of managed with chicken broth and very mild foods), I sought the professional advice of a new doctor, who upon test results, concluded I was possibly on the early stages of T2D, as in the way you characterize in this article. I had not advanced to full blown T2D, but my test results indicated concerning levels of fasting glucose, insulin resistance and some liver enzymes levels that clued him into the possibility of fatty liver.

    In doing online research I came across your videos on YouTube, and gave fasting a try. Though I had been doing some intermittent fasting, I had not stuck with it thinking it was a bad thing to do. But I am thrilled, to say the least, about how much my understanding has changed about fasting. I read your book on fasting and felt like it was probably the best thing to do to reverse my metabolic condition and to lose excess weight.

    In just 4 weeks of implementing a 36-hour fast, which I do three times a week, I have lost inches, and tomorrow will find out how many pounds I’ve lost in this time period. I am guessing it is around 5 to 7 pounds…

    Though that is certainly very exciting to me, I find the matter of fasting to be the best therapy I’ve come across for many reasons. I am looking forward to totally reversing my metabolic condition and to normalizing my weight, but the other exciting thing is the issue of autophagy.

    Thank you for educating the public on all these topics related to metabolic syndrome and the benefits of fasting!

  5. Diane T

    How does one avoid a fatty pancreas? My diet is low-carb and higher healthy fat. I do intermittent fasting. I am borderline pre-diabetic. Last A1c was 5.7 Don’t know what else to do to come down to a healthier number. I also have higher fasting glucose in the morning (sometimes upper 90’s and even upwards of 108). Dawn effect? High cortisol?

    • 5.7 is not bad Diane. Upper 90’s is still normal range. It’s hard to characterize cortisol as, to do so, would mean quantifying your stress level. Do you feel anxious about anything, social life, finances, work life, security? If you suspect undue stress, try meditation, massage, thoughtfulness (I think that’s what the new thing is called). Dr Fung, to my recollection, says dawn phenom is a 4am thing prior to and in preparation of, you waking up.

    • Stephen T

      I wouldn’t worry, Diane, you’re clearly on the right path.

      I’ve never had any tests, but lost weight easily, felt much better physically and mentally and don’t feel hungry. I don’t need tests to tell me I’ve done the right thing.

  6. Congrats on finally mentioning the pioneering work of Dr Taylor

    https://campus.recap.ncl.ac.uk/Panopto/Pages/Embed.aspx?id=c3bef819-e5f4-4a55-876f-0a23436988ed

    This video is a must view!

    Diabetologia. 2011 Oct; 54(10): 2506–2514.
    Published online 2011 Jun 9. doi: 10.1007/s00125-011-2204-7
    PMCID: PMC3168743
    Reversal of type 2 diabetes: normalisation of beta cell function in association with decreased pancreas and liver triacylglycerol
    E. L. Lim,1 K. G. Hollingsworth,1 B. S. Aribisala,1 M. J. Chen,1 J. C. Mathers,2 and R.

    Paragraphs 1 and 2 should reference the pioneering work of Dr Joseph Kraft on categorizing the 5 distinct patterns gleaned from over 14,300 glucose tolerance tests over 20 years from Euinsulin to diabetes-in-situ and finally, type 1 diabetes.

    • Diabetes Epidemic & You by Dr Joseph R Kraft is copyrighted 2008 and available in the usual places (Amazon) and likely many others.

      The X axis on the first graph above is time and the original of that reflected weeks 0-8 weeks in Dr Taylor’s 8 week trial(s). It reflects the recovery of insulin secretion from baseline to end of study. Dr Taylor has done many iterations of this study to add questions to be answered such as recovery against duration of t2d diagnosis and replicating the results in a non-hospitalized (primary care) environment.

  7. Max Salogni

    Interesting doc, as always. I just tweeted back one question, perhaps Twitter not the right place for that. Sorry if not adeguate.

    Anyway, I read your book on “The Obesity code” many times (I think more than 4 !) to grasp all possible details and info.
    I have no medical education at all but I feel as being extremely curious and willing to learn more especially about healthy food.
    My son (now 14 yo) has developed T1DB when he was 3 yo.
    For the first 8 years we have been following carefully all the instructions received from the hospital’s dieticians, learning to count the carbs and so on and going on with bread or biscuit for breakfast, then white pasta for lunch, bread for dinner and so on.

    4 years ago I started reading books: The Paleozone, then GRAIN BRAIN: The surprising truth about wheat, grain, sugar. Dr. D. Perlmutter, then several others including “Diabetes Solution ( Dr. Bernstein).
    My feeling about eating to many carbs was probably right.
    With the help of an Italian doctor, expert on Paleo diet, we started modifying our diet (Actually I was the first cavia in the family).
    The insulin usage taken by Mirko dropped about 30%, much easier to control IPO and more stable trends.
    Mirko could start eating good things, until he feels full (this is important for kids !).
    We happily cut sugary things (drinks, sweets, cakes, sugar is everywhere !) in favour of dark chocolate, home made cakes and cookies.
    We (I mean the whole family) do not eat “white pasta” any more (higly refined 00 flour): we moved to legums flour or high quality pasta high in fiber content).
    We eat small portions of pizza, not more than once per month (lunchtime only).
    We don’t eat bread anymore (Glicemix index will skyrock aftert white bread !).

    What I mean is obviously is no easy, especially in the beginning. You have to get rid of “everyghing seem to be normal” outside.
    It even seems we are not normal anymore ! Astonished people asking: How can you avoid all that ?
    In truth, it is not so difficult: When you start seing the results and the benefits.
    Obviously you need to be able to understand that: you need open mind and reasonable people to understand that.
    Out there, it seems that people is now used to not feeling well: this is the new standard.
    For almost everybody it seems normal to “take pills”. You know, there is a pill for everything and everybody takes pills.
    “Why shoud I modified my diet and get rid of T2DB when I can solve the problem with pills as all the others are doing ? You know, they are still eating pizza and pasta all the times”.

    Sorry for being so long but I would like to thank you because you’ve helped me and my family a lot. You and other doctors like you, people that haven’t followed “standard tracks”.

    Just one questions:

    1) What kind of sympthoms and alarms should apparently healthy people look for ? I mean all those people eating mainly pasta, bread, French fries, pizza, cola but seems in good shape (no fat at all ?)

    Thanks again.
    Max and family from Italy

    • Max, I am going to answer you, at least in part, as I am pretty sure Dr Fung will not. He doesn’t seem to. I suspect the principal reason is there is a fine line between stating general stmts and giving medical advise. There is an ad on these blog entries for Dr Doctor. On there are often Q&As with Dr Fung.

      You did say you cut out bread, yet you have pizza regularly. Pizza dough is bread, by any other name. Pills do not solve the problem, they mask it. The problem occurs long before the addition of pills and insulin and exist long after. Type 1 is a different animal, as I am sure you know. For normal people it depends. Buy the book I mentioned by Dr Kraft, Diabetes Epidemic & You. If you are concerned where on the scale of normal to diabetic you are, ask your doctor to order a glucose tolerance test instead of FBG. In general terms though, I suspect Dr Fung would tell his patients, cut out (or dramatically reduce) sugar, and white flour (bread, pasta, thickeners (cornstarch)). Different people have different tolerances to carbs, esp simple carbs. Some could eat birthday cake every day of the week and twice on Sundays and be normal enzymes and hormones and weight. Others would react badly to a single piece. Normal is 1,000 shades of gray. The other advice is to get an annual physical from your doctor.

      • sorry, I meant Diet Doctor

      • Max Salogni

        Thanks Walt, I agree with yoy even though I wasn’t actually asking for medical advise.
        Pizza is only once per month (one pizza is divided in 4 portions and each of us has a slice), not even regularly. I’ve been checking GI after pizza and see very high values even after 3-4 hours !
        However, I’m not sure if all these thin people eating high sugary producs are “well equipped” and able to handle that by nature.
        I think perhaps 2-3% could do but the others perhaps haven’t started yet to have problems, so they cannot recognize their bad eating habits.
        It will be interesting to understand something more about “different tolerances to carbs”: is it inherent genetic ? Is it triggered by food? Is it a body adaptation ?
        Thanks for you interest anyway…

        Max

        • All of the above, plus age. People’s metabolism change with age. I’ve been on here over a year now and ppl ask Dr Fung questions all the time, I’ve not seen hide nor hair of him on here in about that same length of time. But, try Diet Dr link and/or fasttalk w/Jimmy Moore.

    • Questo sarebbe interessante per Lei, Max. Il libro da Dr Valter Longo. Non e ancora disponibile in Ingelese. Si chiama “La dieta della longevita. Dalla scienzato che ha rivoluzionato la ricerca su staminali e invecchiamento, la dieta mima-digiuno per vivere sano fino a 110 anni” .
      He devised the fasting mimicking diet for therapeutic purposes after he had difficulty finding enough cancer patients willing to do extended water fasts.
      He has published over 400 peer reviewed scientific articles and there are many interviews with him, and lectures by him on YouTube. His primary interest is not diabetes, but his work and interests dovetail nicely with the work of Dr Fung. He is a Professor at the University of Southern California – a cell biologist and biogerentologist. He researches the role of fasting and nutrients in disease and ageing.

    • Stephen T

      Max, you’re not solving any problems with drugs as an alternative to dietary changes. That’s just hiding the problem until it’s done so much damage that it can’t remain hidden any longer. If you really like pitza, have it occasionally, within a usually low carb framework and with some fasting. Dietary changes for most people, don’t have to result in the perfect diet, but I prefer to avoid sugar and wheat whenever I can.

  8. It appears fasting is the most helpful thing we can do for ourselves if we have T2.

    http://www.cell.com/cell/pdf/S0092-8674%2817%2930130-7.pdf

    If Longo’s Fasting Mimicking Diet has the ability to regenerate beta cells, would water fasting get better/quicker results?

    • They don’t actually regenerate, they were clogged with fat. Regeneration implies they were dead or non-existent. Dr Taylor disproved that notion. I would disagree actually in that the singular best thing you can do is cut out simple carbs, sugars, refined flour, any flour, starches, anything that grows underground. T2D comes about by high and persistent insulin levels. Nothing triggers insulin levels as much as simple carbs. Cutting out mid meal snacks, like breakfast – snack – lunch – snack – dinner – snack is imperative as well as that becomes the persistent in the persistent and high. An exaggeration of that would be stop eating altogether. So, yes, one could water fast every other day and eat chocolate cake with chocolate syrup on the feast days and likely they would get worse. Ergo, cut out the between meal snacks then cut out flour and sugar and if that all proves insufficient to what you are aiming for, then consider cutting out meals, like breakfast every other day or breakfast and lunch every other day. FWIW, I’d look for published sources like those on NIH.

      • You obviously didn’t read the article I posted. Dr Longo et al did find that cells regenerated. Indeed, that’s in the title of the article.

        • right, I have no clue what cell.com is. I do know what National Institute of Health is. I do know that the work of Dr Taylor has been replicated and peer reviewed. For all I know Dr Longo is a chiropractor or PhD in mechanical engineering. See the difference?

          • Stephen T

            Walt, Dr Valter Longo is a widely respected professor in California who studies fasting in connection with health. Someone as interested in the subject as you would almost certainly find his work to be valuable and high quality.

            https://www.youtube.com/watch?v=d6PyyatqJSE&t=1459s

          • Charles

            Walt

            http://gero.usc.edu/faculty/longo/
            Valter Longo, Ph.D.
            Edna M. Jones Professor of Gerontology Professor of Biological Sciences

            Overview
            Dr. Longo is the Edna Jones Professor in Gerontology and Professor in Biological Science. He is also the Director of the USC Longevity Institute. He is interested in understanding the fundamental mechanisms of aging in yeast, mice and humans by using genetics and biochemistry techniques. He is also interested in identifying the molecular pathways conserved from simple organisms to humans that can be modulated to protect against multiple stresses and treat or prevent cancer , Alzheimer’s Disease and other diseases of aging. The focus is on the signal transduction pathways that regulate resistance to oxidative damage in yeast and mice

            https://bluezones.com/2016/04/fasting-for-longevity/
            Fasting for Longevity: 9 Questions for Dr. Valter D. Longo

            https://www.youtube.com/watch?v=d6PyyatqJSE
            Valter Longo, Ph.D. on Fasting-Mimicking Diet & Fasting for Longevity, Cancer & Multiple Sclerosis

          • Guys, as mentioned earlier, I tend to limit my sourcing to that vetted by NIH. Too many internet drs and non-peer reviewed ‘data’.

      • Charles

        Walt

        Are you familiar with studies showing reversal of T2D within 21 days on a high carb low fat macrobiotic diet?

        http://sci-hub.bz/10.1002/dmrr.2519
        Ma-Pi 2 macrobiotic diet and type 2 diabetes mellitus: pooled analysis of short-term intervention studies

        http://www.hoajonline.com/internalmedicine/2052-6954/2/3
        Ma-Pi 2 macrobiotic diet intervention during 21 days in adults with type 2 diabetes mellitus, Ghana 2011

        http://www.medicc.org/mediccreview/articles/mr_119.pdf
        Ma-Pi 2 Macrobiotic Diet Intervention in Adults with Type 2 Diabetes Mellitus

        https://nutritionandmetabolism.biomedcentral.com/articles/10.1186/1743-7075-11-39
        The effect of the macrobiotic Ma-Pi 2 diet vs. the recommended diet in the management of type 2 diabetes: the randomized controlled MADIAB trial

        Your thoughts

    • I would certainly think so. Wasn’t Dr Valter Longo trying to micmick the effects of multi days extended water fast? 😀

  9. Roger Bird

    My million dollar questions is, What constitutes an “ultra-low calorie diet”?

    I am currently doing about 200 to 250 calories per day, which is roughly a 92% reduction in calories. It is very high fiber and ketogenic. Is that fasting? Is that ultra-low calorie? My metabolism has not tanked, and I can easily tell because I am too wired to get all of the sleep that I would like, and my hands are warm, although my feet are a little cool.

    What say you, one and all?

    • High fiber? Why? I find fiber=bad. (Add to fiber, resistant starch=bad.)

      Personally, I try to mix things up. I fast some longer periods, some shorter periods, and have weeks where I don’t fast (other than skipping breakfast). I find long fasting periods make me colder. The shorter ones don’t seem to have the same effect.

      • Roger Bird

        No very satisfactory. I am asking if I am stopping autophagy and apoptosis.

      • There has been NIH cited research on autophagy in the brains of mice and it merely requires food, presumably caloric, reduction. What Dr Fung has said re: fasting vs water fasting is what you’re doing accomplishes the bulk of what a water only fast would do. As for fasting it is the duration between meals, is it 12 hrs, 23/24 hrs or 3 hrs. If you went from 6pm to 8am that would be 14 hrs, 6am to 12pm, 18 hrs. You want to break the persistent part of persistent and high. As for fiber, yes it is better than no fiber (like Triscuits vs pasta) but it is still wheat, a carb.

        • Roger did not specify where his fiber is coming from. There are many sources of fiber that are not wheat based (psyllium husk, chia, even many vegetables could be considered high fiber). He made no mention of wheat at all.

          • Walt

            Yes, LyndaF, very good point. I stand corrected.

    • In short I think that is reasonable, if not too low cal. What you describe is my reaction too, unless I screw up and bounce myself out of ketosis. Being warm or even start sweating w/o exertion, is likely the body raising metabolism to burn excess dietary cals. When I am in ketosis at night my feet might intermittently feel cool, but never cold. Ditto with hands. What you could do is slowly start adding carbs back in to see where your personal threshold for carbs is. For instance, some could eat a huge piece of chocolate birthday cake and the next day still be firmly into ketosis. Others might not even be able to have a small bite of it. So just for your own edification, you might find knowing that threshold, informational.

      • Roger Bird

        Walt, I salute you for testing on yourself. I do that also. And I thank you for your suggestions.

    • FWIW, that NIH study I cited was the effect of autophagy on Amyloid-B (a precursor to Alzheimer Disease) in the brain. AD is also referred to as Type 3 diabetes affecting the brain. The theory is the mechanism of Amyloid destruction, therefore no plaque, is somehow short circuited due to insulin resistance in the brain, which leads to AD. But studying it in mice (easier to examine the brains of) that fasting or otherwise restricted food actually accelerates the process of autophagy in the brain, removing or impeding the build up of Amyloid-B.

  10. True fasting (water fasting) is taking in zero calories. If you are fat adapted, you will be burning fat from day one of your fast. If you then eat pure fat during the fast, for example a spoon of coconut oil, you will temporarily stop buting body fat while you burn the dietary fat, once the dietary fat is finished you will continue burning body fat. If however, you eat some carbs during your fast, you will not only stop your fast but you will also stop fat burning as your body will now begin to burn the carbs.

    • That would be real purist. Looking at Fung’s fasting or even the grand-daddy Atkins that does allow or suggest a small amount of carbs, i.e. ketogenic is <20g Atkins Induction phase is < 20g. Certainly 0 is less carbs but protein and even fat will cause insulin spikes. Fung as well as other keto experts warn your body only uses one form at a time, as you said. However the brain still needs glucose for at least 30% as ketones only supply 70% of what the brain requires. Where there is individual thresholds is what level of carbs will transition one to out of fat adapted.

      • Stephen T

        Walt, won’t your body produce any carbs the brain needs through gluconeogenesis?

        • I believe from what Dr Fung has said the body will use fat before it uses protein. Protein is not stored so it’s used from dietary or lean muscle. But fat is favored over converting lean muscle to glucose. Species survival and evolution wise that makes sense.

    • correction – eating pure fat is still consuming calories, just the least prone to spiking insulin, therefor addressing the high part of persistent and high insulin resulting in IR.

  11. Roger M. Moery

    Tons of respect for your work and contribution. I also have the same respect for Dr. Bernstein and his work. He has worked almost anonymously for decades and now the rest of the world is finally becoming believers. I am confused at to why you want to call him out by name. It seems to me that you somehow have an axe to grind with him. On one of your podcasts you were critical and you podcast host made a snarky comment about him. Why not give him his due and respect for what he has accomplished. Don’t see where the criticism advances the LCHF movement.

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