Here's $5, Kevin Hall, go buy yourself a clue

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Kevin Hall, the senior NIH researcher recently published a paper in AJCN that has received alot of media attention. This study, he claims, completely refutes the insulin hypothesis so completely that it is now ‘dead’. That’s interesting, I thought, as I sat down to read the article.

Kevin Hall

Kevin Hall

It was a little surprising, therefore to read this paper and realize that Hall’s conclusions were entirely his own opinion. He suffers so badly from confirmation bias that he may as well have written “My mind is already made up regarding the insulin hypothesis. Please do not confuse me with facts”. Confirmation bias is a well-known psychological phenomenon whereby facts that agree with your pre-formed opinion are accepted as true and those that are not, ignored. All facts become filtered through this bias to confirm your previously held opinion. It’s also known as a closed mind.

This happens far more frequently than is often realized or admitted. A similar situation exists in the research behind the weight losing effect of breakfast. Researchers used this question of the proposed effect of breakfast on obesity (PEBO) to look at how researchers consistently interpret results depending upon their beliefs. If you believed breakfast made you lose weight, then studies were interpreted to support this view even if it did not.

Two specific tactics are used – Research lacking Probative Value (RLPV)(association data that can’t prove anything) and biased research reporting (BRR). As more and more people believe something to be true, the effect becomes worse since all research is now interpreted to fit the preconceived facts.BeliefBeyond Evidence2

Starting with the preconceived notion of ‘A’, all research is interpreted to support this belief (B), and all negative studies are ignored (C). This only reinforces the belief (D) which then leads to biased research reporting. This, of course, is a vicious cycle. The same effect is obvious in the Calories In, Calories Out (CICO) diehards.

So, let’s take a closer look at this paper and its claims. The paper is titled “Energy expenditure and body composition changes after an isocaloric ketogenic diet in overweight and obese men“. Let me give you some background. The award winning science journalist Gary Taubes believes that obesity is essentially a disease of too much insulin – hyperinsulinemia. Since refined carbohydrates stimulate insulin more than fat or protein, reducing said carbs will result in greater fat loss.

He set up the non profit organization NuSi to raise money to fund research and this paper is the first one published. 17 overweight men were admitted to a metabolic ward where all the food they ate were carefully measured. There was a 4 week run-in phase to establish a baseline where men would eat a high carbohydrate, high sugar diet and then switched to a carefully designed low carbohydrate, low sugar diet. Various measurements were then taken, including energy expenditure (EE – how many calories the body is burning), over the next 4 weeks. The basic question is this – does a ketogenic diet (KD) cause fat loss?Kevin Hall 1

Here’s the result. Over the 4 week KD, yes there was fat loss. There was an initial period of greater weight loss which all agree may be some diuresis. We can also agree that insulin levels were brought down by the KD. Secondly, using measures of EE there was an increase in calories burnt. Those are all facts, not opinions, derived straight from the study. Isn’t that a good result?

Well, if you’re Kevin Hall, no. You need to find a way to spin this in a negative way. Then you can tell all your friends in the media so you can declare ‘I was right’. Let’s see how this was done.

When patients embarked on their run in phase, they were switched to a 2700 calorie/day high sugar high carb diet, meant to replicate the Standard American Diet (SAD) that caused the obesity epidemic. Nobody actually believes that this is a healthy diet, and nobody believes it should cause fat loss. But it did. Why? Anybody who has done research knows why. It’s the effect of going into a study and knowing that people are testing you. It’s a universal effect. That’s the precise reason why we have run-in phases. To establish a proper study baseline when people know they are being watched.

So, people lost weight on this SAD diet. But instead of using this new baseline, Hall decides that the downward trend is the new baseline. The unspoken premise or assumption is that if these people had taken another 4 weeks of the SAD, they would continue to lose weight at the same rate indefinitely. WHAT? Are you out of your mind? That’s completely illogical.

Let’s take an analogous situation. Suppose we are teaching math. We teach a semester with no tests, no exams, no checking of homework and no projects. Students are just supposed to spend 1 hour in class and 1 hour of homework a day. They all say they do it. Then, unbeknownst to them, we test them on a standardized test. They do really bad and score 65%.

Next semester, we have daily tests, a final exam, and daily checking of homework. They still spend 1 hour in class and 1 hour of homework. Scores should be theoretically unchanged, because they were doing the same amount of work. Of course, in reality this is completely false. Because they know we are regularly checking them, they do a better job. Now they score 80%

This is the same effect we see when people enter a study. No matter what we are measuring, things improve simply by entering a study. It happens with blood pressure, blood sugars, cholesterol, diets, depression – everything. But the results do not get better indefinitely. It’s a one time benefit. Students score might improve from 65 to 80 in one semester. This does not mean that another semester of testing will raise their scores to 95. Instead they will likely stay at 80. But this is exactly what Hall does – he assumes that this one-time benefit will persist indefinitely.

By making this assumption that the SAD diet will continue to cause fat loss (which logic tells us is false) you can make a positive result negative. So, yes, KD does cause fat loss, but does not INCREASE fat loss and then you can make this your conclusion. Since most of Hall’s journalist friends never read the paper and only the abstract, it’s easy to convince them.

According the Halls assumption, you should therefore simply continue eating the SAD with 25% sugar and expect to lose weight indefinitely. Go ahead. See what happens. I already know. So do you. You’ll get fat, you’ll get type 2 diabetes, and then eventually, I’ll put you on dialysis and chop off your feet when they go gangrenous. But at least Hall can say that he was right.Kevin Hall 2

The second major issue is regarding EE. When you switch from the baseline diet to the KD, the number of calories stays the same. If it causes continued weight loss, then you might expect to see an increase in EE in order for the body to lose weight. This is called a metabolic advantage. Surprise, surprise – that’s exactly what happened. So how can you spin this one? With language.

Look at how Hall describes the absolutely critical increase in EE. Here’s what he writes “the KD coincided with increased EEchamber (57 ± 13 kcal/d, P = 0.0004) and SEE (89 ± 14 kcal/d, P < 0.0001)” (emphasis mine). Hall is telling you that this was merely a coincidence that patients are all burning an extra 57 calories per day. WTF??? There is nothing coincidental about it. You switched them to a KD. EE increased. The P value of 0.0004 means that there is a 99.96% chance that this is NOT COINCIDENCE. Hall knows this as well as I do. This is basic statistics 101. Hall, a mathematician is surely aware of this.Kevin Hall 4

Hall is saying “Oh, we switched their diet to test if EE would increase. It really was just a huge coincidence that all 17 men simultaneously increased their EE altogether at exactly the moment we thought it would. Ignore this, guys. Just write your newspaper article about how this proves it didn’t happen.”

So EE increased and yes, the effect waned over time. What did he expect? That things would continue indefinitely in a straight line? Life doesn’t work that way. Hall had assumed this would happen for fat loss during the SAD, but then correctly points out that EE does not. If doesn’t in either case, dude. Get a clue.

The reason why EE is so critically important is that this is the key to lasting weight loss. Hall had just been profiled in the New York Times cover page measuring the EE of Biggest Loser Contestants. The reason they all regained their weight was that their EE slowed to such a degree that caloric reduction could not keep up. So, an intervention like a ketogenic diet that increases EE is HUGE, GREAT NEWS. Except, of course if you’re Kevin Hall, because it means you were wrong. And you care more about your reputation than people’s health and well-being.Ludwig EE

Dr. David Ludwig, a researcher from a little place called Harvard had shown exactly this same thing in his study from 2012. This study also tested for difference in energy expenditure following different dietary strategies. Once again, as Hall had shown, the EE is best with a very low carbohydrate diet. So Halls study merely confirmed what had already been known.

Some people have also noted that this study controlled calories so it negates one of the KD’s biggest advantages, which is that it makes you feel full. Well, sorry, guys, that’s not the question it is designed to answer. Same goes for the fact that there are only 17 people in it. Again, that’s the study design, so it is what it is, and there’s no use complaining about it.

In the end, the main problem is not the study data. The data are excellent. The problem is the ‘spin’. Here’s the conclusion Hall writes in the abstract’s conclusion (which is the single most important few sentences of the paper, the one that everybody reads)

The isocaloric KD was not accompanied by increased body fat loss but was associated with relatively small increases in EE that were near the limits of detection with the use of state-of-the-art technology.

I’ve highlighted what is fact. I’ve crossed out what is pure spin. Did the KD cause body fat loss? Yes it did. And that’s really, really important. Hall spins it this positive into a negative by moving the goalposts – “Oh but it didn’t do better than before. People eating a 25% sugar diet will continue to lose fat indefinitely at the same rate”. Umm… What planet are you from, Kevin Hall?

Then he says the increase in EE is “relatively small’. So what? Did it increase or not? In fact, your own study from the Biggest Loser suggests that weight loss from constant calorie reduction will DECREASE EE, so even the stabilization (let alone the increase) of EE is critically important. That’s the gold medal, buddy! You just threw it in the garbage.

Hall then downplays this relationship by calling it an ‘association’. As if the change in EE just happened to occur at the same time as the change in diet. What a load of crap. You changed the diet and measured the change in EE. Nobody doubts that. It’s causation, pure and simple. So why try to spin this as an ‘association’ which is a mere ‘coincidence’? Pure spin.

Hall then further tries to downplay the importance of stable EE by saying it’s ‘near the limits of detection with the use of state-of-the-art technology’. So what? Who cares? Did it stabilize or not? Isn’t that great news? Did you not just show that weight loss efforts fail because of decreased EE?

Unfortunately, spin-doctor Hall is now entering a logic free zone, and many journalists like Julia Belluz and other bloggers are happy to take what is shared at face value. “In this first Biggest Loser study, I demonstrate why stable EE is the most critical factor for weight loss. In this second study I’ll show how stable EE is absolutely worthless. Ta Da!” Hall wants desperately to save his own reputation, even if he has to sacrifice your health to do so. Sad. So sad.

The facts alone, without any spin would be this. A ketogenic diet, independent of calories causes fat loss and causes an increase (or at least the stabilization) in EE. That’s the facts. And I love it. Because I can use these fact to help heal patients and save lives. Luckily, I can see Clueless Kevin Hall’s blatantly biased reporting for what it is – the final gasp of the dying paradigm that all calories are equal.

2017-09-02T11:54:09+00:00 145 Comments

About the Author:

Dr. Fung is a Toronto based kidney specialist, having graduated from the University of Toronto and finishing his medical specialty at the University of California, Los Angeles in 2001. He is the author of the bestsellers ‘The Obesity Code’ and ‘The Complete Guide to Fasting’. He has pioneered the use of therapeutic fasting for weight loss and type 2 diabetes reversal in his IDM clinic.

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145 Comments on "Here's $5, Kevin Hall, go buy yourself a clue"

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Ryan
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I’m curious what Taubes and Attia have to say to hall about this. Pretty sad for them, that couldn’t have been a cheap study and they chose him to run it.

BobM
Guest

Attia is no longer involved with NUSI, for reasons that are not clear and have not been provided. I personally think that’s a travesty. Someone should say why he’s no longer there.

Martin
Guest

Seems obvious, when looking at Hall’s spin and the fact that he got away with it. I have seen his ridiculous conclusions debunked multiple times now. If I was Attia and at the Helm of NUSI and my researchers would be allowed to spew this kind of nonsense – and get away with it – I would also throw the towel. Pure speculation though.

leavemealonegoaway
Guest
Theory: Attia probably saw that Hall was setting it up so that no matter what happened, Hall would have his ‘way’. Maybe Hall threatened to ‘expose’ that NuSi was trying to ‘interfere with science’ unless they backed off. Attia then walks. Who knows? Meanwhile, today everybody is upset that Hall is selling tickets to sail the Titanic (the actual trip), despite knowing the ending. However, nobody is PRAISING Hall for publishing the actual data!! Hall knows the data shows what it does, actually PUBLISHES IT, then spins it sideways for people with other agendas. The S Fungs of the world… Read more »
Craig
Guest

Did you send him cash or check?

Dr. Jason Fung: LOL. He’ll have to call me to collect

honeycomb
Guest

The whole industry (of funded research) is a fraud.

And to add insult to injury they will protect their golden thesis above all else.

Good work Jason.

Phyllis Collins
Guest
Dr Fung, I have read all of your articles, your book, watched your videos, and listened to many of your podcasts. I’ve considered myself to be a big fan of yours. Although I do not have Diabetes, nor am I a LCHF person, I have chosen to respect you and work to follow your advice when it’s been applicable to my body. One of the things I’ve admired most about you is your open acceptance of the fact that there is not a one-size-fits-all solution for Obesity, and that people are different, and many different factors exist. Everyone – including… Read more »
BobM
Guest

What were the “hateful” comments in his article? To me, it’s just a difference of opinion. It also points out that people who are in “charge” will do anything to remain that way, including putting a spin on results. It happens all the time. (And that’s true of Dr. Fung, too: His view will be clouded by his own beliefs.)

Walt
Guest
Oh, let’s see Bob, how about: “It was a little surprising, … that Hall’s conclusions were entirely his own opinion. He suffers so badly from confirmation bias that he may as well have written “My mind is already made up regarding the insulin hypothesis. Please do not confuse me with facts”. … a well-known psychological phenomenon whereby facts that agree with your pre-formed opinion are accepted as true and those that are not, ignored. All facts become filtered through this bias to confirm your … closed mind”. I have to agree with Phyllis on this one. It’s tone was not… Read more »
palo
Guest

Hall lied on the study’s result, Dr, Fung exposes him and Dr. Fung is bad because he didn’t just say naughty naughty, you can’t do that!”

Never mind the real actual results of the test.

Who do you think you are fooling?

NIAO
Guest

Did he?
Or is it just too hard for Dr. Fung to face the results of the study?
why cling to a mere use of a single word, as a reason to condemn the whole study?
and why pick one single point in time, instead of looking at the trend line?

Krista
Guest

I love Dr Fung’s passion and attitude in this post! He’s CORRECT and FEARLESS! It’s obvious he is attacking Kevin Hall’s ridiculous (yes, meaning ‘worthy of ridicule’) conclusions, based on KH’s own scientific findings, and NOT KH’s personality or methods. The victimization that you perceive is on you, not him. Scientific truth doesn’t care about your feelings, or anyone’s.

seebrina
Guest
Face results? Apparently you’ve never met anyone who was treated for diabetes by the past and current medical community. I watched them kill my mother with their ‘this is a progressive disease’ mantra. Adding insulin to a saturated with insulin problem, coupled with the ada sad american diet insured she couldnt get better and died at age 62 after a slow death struggle with diabetes for 30 years. And to know that all she had to do was get off those horrible medications and sad diet to a diet with fats veggies and fasting and I would still have her… Read more »
Krista
Guest

I was going to write a similar post as Phyllis Collins, but I will just affirm many of her comments regarding this blog posting. Dr Fung your work and writing has been an immeasurable help to me in losing weight. However, I felt the tone of this article was unhelpful in establishing your argument. This blog post is being shared widely on the internet and I think a more professional rhetoric would have made a more positive impact.

Richard S Stone
Guest
Phyllis, I disagree entirely. As Dr. Fung points out the analysis by Kevin Hall is essentially fraudulent, utterly deserving of our contempt and ridicule. The gross error needs to be exposed and the errors described in a way to make it noteworthy. And Hall’s error is not just some minor issue. The misuse of the data is so gross and blameworthy that it cannot be just accepted as a minor error, or a difference of opinion. The facts from the study are plain to see. Kevin Hall has essentially lied about the state of the research and he is endangering… Read more »
Sue
Guest
Well said Richard. My husband and I are living proof that diabetes can be completely reversed by doing exactly what Dr. Fung advises. I’m very sad at how Dr. Fung is being spoken to given he is VOLUNTEERING HIS TIME HERE! Look, we can all take or leave what he has to say, but to be so rude and condescending to Dr. Fung is beyond the pale. How ungrateful. Thanks again for your post Richard S Stone. And thank you Dr. Jason Fung, most of us are very, very grateful for all of your hard work and advise. Sue and… Read more »
MachineGhost
Guest

Spinning mind-independent facts contrarywise in abstracts is unfortunately not uncommon in studies. Researchers know journalists and laymen are lazy and ignorant.

Danielle
Guest
I get what you mean Phyllis but sometimes this kind of tone is useful in making people wake up and smell the coffee. We are talking people’s LIVES and LIMBS because conventional approaches let us down! How can a “scientist” realistically call himself so when he sees EE dropping as a BAD inevitable thing in the Biggest Loser Study and then downplays EE maintaining (or maybe increasing) in the Keto study. This is at best BAD SCIENCE or at worst SELF-SERVING SPIN. Boo hoo if someone is offended. In any other arena Kevin Hall would get the sack for this… Read more »
Sue
Guest

Well said Danielle. I’m glad Dr. Fung says it like it is.

Debra Smith
Guest
Phyllis, I agree. The tone was angry and ridiculing. However, if you think about, it’s because Dr. Fung cares about his patients and wants to share his scientific theories with anyone willing to have an open mind. I’m a retired nurse and I have been exposed to the toll of suffering. Millions of people, more than the hallocaust, are being made sick, kept sick, and are suffering excruciating pain. Legs are whittled away, blindness, heart disease, kidney failure, terrible infections…..the list goes on and on. Until you smell your fellow man from the hallway, with a gangrenous foot, don’t be… Read more »
Sue
Guest

Thank you for such a good post in support of Dr. Fung. And this folks, coming from a retired nurse. I’m with you Debra. Job well done Dr. Fung!

Amy
Guest
Me too. Well said Debra! Thank you for your professional opinion in support of Dr. Fung. I am just a lay person with my own evidence but no funded research or study. I have been angry for a while now because of bad information given by doctors to my sister (type 1 diabetic), my dad (kidney failure), both of my grandfathers, and now my husband (type 2). I am sitting on the sidelines watching this train wreck. I have type 2 but have been reversing it since October 2015 with NO medications only LCHF, IF, and recently added regular exercise… Read more »
monica
Guest

I agree, Dr. Fung’s tone was one of attack and ridicule. However, I do not find this to be very remote from his usual tone. A mild-mannered, polite doc would not manage to get his against-dietary-recommendations message across. For those of us who owe Dr. Fung gratitude, he could not have done it without a belligerent attitude. Cheers.

Jack
Guest

With half-assed attitude like yours, millions of diabetic in the world will continue to suffer and die. Cowards like you are directly responsible for this disaster. You should be ashamed, you protect the $y$tem.

Corey
Guest

It is not anger but passion. One is from hatred, the other is from love.

R Z
Guest

Dr. Fung has always been witty and hip. This is nothing too new from his rhetoric. Is it effective for the laypersons? Yes I believe it is. Is it wholly professional? No, but this is not a comment in a scientific journal, there is no need to be. It’s a different medium, it calls for different rhetoric. For a blog post, this is fine.

Jerome Benthamite
Guest
Dr. Fung I love your work. Nevertheless there is a more direct explanation concerning the spin by Kevin Hall. I present another analysis based on the fact that KOLs (Key Opinion Leaders) are made by industry based upon their loyalty. This is another example of spin favoring industry. I strong recommend if you want to know how bad it is to read, and reread the BMJ award winning book by, Prof Peter Goetzsche, Deadly Medicines and Organized Crime: How Big Pharma Has Corrupted Healthcare, and also Bad Pharma by Prof. Ben Goldacre, Kevin is a KOL (Key Opinion Leader), and… Read more »
DRR
Guest

They labeled the low carb diet as KD (ketogenic diet) but they made no attempt to verify if the people were in ketosis, and the period of time they were on the low carb diet was very short, they probably were never in ketosis. It did seem that the total number of grams of carbs were too high.

PhilT
Guest

I believe the full published paper does show blood ketone levels at about 0.8 mmol/l from memory.

The study was supposed to be isocaloric and eucaloric so there should have been no ongoing weight loss by the end of the run-in phase.

Personally I think any ketogenic study needs to start after at least 2 weeks on Atkins Induction or similar to at least get “in the zone” otherwise we’re doing science in an unstable transitional state which is seldom good when trying to understand long term effects.

David
Guest
I normally agree with you Dr. Fung, but I find this study to be quite weak. Small sample size (17 men), small duration in time (4+4 weeks), and no control group. The phase-in was 4 weeks of 2,700 calories a day of SAD. But for all we know these men used to eat 3,500 calories a day. They were obese men, if that is the case the phase-in would need to be a lot more than 4 weeks. In other fields of science, periods of “phase-in” are used for computer simulations, and they continue until the distribution converges to an… Read more »
Jason
Guest
David, You’ve missed the most important thing that Dr. Fung points out: Dr. Hall’s sign is wrong. I used to work with a very smart analyst who had gotten his doctorate at Rand. His favorite saying about analysis was: first, make sure that you get the sign right. Is this a positive effect, or a negative effect? Then and only then, try to measure how much of an effect there is. Doing what Dr. Hall advocates (Calorie Reduction) produces a lowered Energy Expenditure (EE). Due to the lowered EE, it becomes impossible to stay in the weight loss period, or… Read more »
sten bjorsell
Guest

I checked and you are spot on ! The abstract says that the diet was reduced by approx. 300 kcal per day, or 10%. The result states marginally increased energy expenditure, absolute minimum absence of reduction also by Kevin Hall’s report, which as you point out is the complete opposite to a standard calorie reduced diet. Thanks!
It means the insulin hypothesis is a step closer to be fully proven.
For full proof a longer study including control group.

sten bjorsell
Guest

Surprised they did not have a low fat control group. Just splitting this group in half would have told more than now, guess at same cost. Since reduced calorie ketogenic diet does not reduce EE but reduced calorie SAD or low fat diet reduces EE, the missing comparison study is obvious and would end the debacle, since opposite EE trends hardly can be explained away.

Bob
Guest

Yes, David, study is weak, but it is still important to acknowledge that Hall’s interpretation of it is off, to say the least.

Jerome, Hall did not set up NuSi. Those who did made a big mistake dealing with him.

Dr Fung, your reliance on the idea that people magically do better when tested worries me a bit. This was a metabolic ward study afterall. Can you help me out?

Craig
Guest

Bob:
ever heard of the placebo effect? We’ve found people become stronger, faster, healthier, and overall better at everything once they are part of a study. We’ve even had disease symptoms disappear just by putting people in studies. It’s very powerful, which is why most studies have a control group. It’s a known scientific fact that once you observe something, what you are observing will change from baseline.

BobM
Guest

There have been studies where they tell people they’re getting a placebo, and the people still perceive an improvement. EG:
https://www.theguardian.com/science/2010/dec/22/placebo-effect-patients-sham-drug

I think anytime you are watched at anything, you’ll be better that that thing. This is particularly true in nutrition, especially for things like food diaries. If you have someone weigh all their food, you’ll get a much better sense of intake then if they write a food diary (where they’ll conveniently “forget” they ate that evil hamburger with its saturated fat).

robert lipp
Guest
Wenchypoo
Guest

“My mind is already made up regarding . Please do not confuse me with facts”

This is American politics all over–especially the GOP right now. Is Kevin Hall by chance a Republican? 🙂

George Thomas
Guest

“hurr durr republicans r stoopid hurr durrrrr”

So brave.

seebrina
Guest

I would say the same about the liberals. Not a fact in sight just everyone pooping sparkles as deemed by the liar hill

Carl Franklin
Guest

Well said, Jason. This is exactly what we’ve been saying when asked about this study.

Richard David Feinman
Guest

Jason,
It is not necessary to evaluate Hall’s study. The list of studies from your Youtube, I think called Etiology of Obesity, shows direct link between insulin and weight gain. I think it would be good to lay out the details of those studies. If you send me the direct links or better, the pdf’s of the papers, I will do it (I wish I hadn’t said that).

JW
Guest

@Richard David Feinman wow good on you what an offer!

Ann Patterson
Guest

Dear Dr. Fung, Thank you for once again clearly cutting through the bullshit. In Taube’s desire to bring new, credible and unbiased research to this arena, it seems he let the fox into the hen house. Wonder how he’s feeling about the value of NUSi after this release. Fondly, Ann

RaceRealist
Guest

Taubes allowed the fox to guard the hen house be he wanted a researcher who didn’t believe the insulin hypothesis.

Robert Lockridge
Guest
Dr. Fung, what matters is that you are saving lives in your clinic. Your methods are based on a preponderance of the evidence, which in such a complicated field as nutrition’s relationship to disease is all we’re going to get. At almost seventy years of age, I have lost fat, gained strength and muscle mass, greatly alleviated my idiopathic peripheral neuropathy, and gained mobility and energy using intermuttent fasting and a low carb diet. My trygs are 43, HDL 63. Pretty strong ratio. I credit you and others like you, including Dr. Feinman, Gary Taubes, Nina Teicholz, Denise Minger and… Read more »
R Z
Guest

If you did look at the study, change from the SAD to ketogenic diet also resulted in the greatest decrease in triglycerides.

Jerome Benthamite
Guest
A second look at Halls work reveals the straw man criticism. The RC (restricted carbs) was not a ketogenic diet. As pointed out in the Obesity Code (190-193, the stomach and the duodenum cause the production of insulin through the release of incretin hormones. The insulin index of fish is 59, meat 51, and cheese of 45,yet they have near zero carbohydrates. Apples is 59, white pasta 40, and croissants 79. Thus a lower carbohydrate diet does not equate to a low protein diet. Moreover the carbohydrate percentage was reduced; it wasn’t a ketogenic diet. Lower carbs is not the… Read more »
Sean Wilson
Guest

Table 2, page 5 of 10 of Hall’s study: Carb intake g/day 35.8 +/- 4.7, <2% from sugars; Fat intake, g/day 242 +/- 8.2; protein g/d 104 +/- 4.1; energy intake 2738 +/- 108. Carb: Fat: Protein ratio 5.2%: 79.5%: 15.3%. Low carb diet was most definitely ketogenic. More to comment on regarding this blog and others but will leave that for my upcoming response at http://www.FitGreyStrong.com

Gogo
Guest

Hi Jason do you know that, bros write blogs .Why don’t you go ahead and comment in the paper? It takes courage, isn’t it?Good luck and looking forward to some actual discussion and coming up with a solution rather than blogging . Hope you don’t censor this comment.

RaceRealist
Guest

So Dr. Fung doesn’t come up with solutions? Are you reading the same blog as I am?

R Z
Guest

Dr. Ludwig has commented in response to Dr. Hall. Don’t believe Dr. Fung needs to do the same. Instead Dr. Fung has written a blog post reaching a wider audience. Check it out here
Comments: https://www.ncbi.nlm.nih.gov/myncbi/david.ludwig.1/comments/
Dr. Ludwig’s blog response: https://medium.com/@davidludwigmd/defense-of-the-insulin-carbohydrate-model-redux-a-response-to-kevin-hall-37ea64907257

Anthony
Guest
As a former low carer and one who was in ketosis for 12 weeks, I did in fact lean out. The problem for me was that I could not perform at a high level in my chosen sport (ice hockey). I just did not have any explosive anaerobic power and everyone was asking what was wrong with me. Now at 52, I still play ice hockey with the young folks, I do carry more bodyfat than I want, but it is what it is.my ideal carb intake of about 200gr per day provides what I need. No diabetes, no unstable… Read more »
Robert Lockridge
Guest
Some pretty convincing work done at UCSF seems to show that LCHF is most effective for folks with some degree of insulin resistance, while insulin sensitive subjects do ok on higher carbs. When you think about it, this is not surprising. Since T2D is a disease of insulin resistance, I think LCHF should at least be tried. We all have to do our own n=1 trial and adopt what is most beneficial for us. The dangerous aspect of Hall’s analysis is that it implies that this study categorically refutes the working assumption that LCHF can reduce insulin levels and thereby… Read more »
AJ
Guest
I agree with the above two points anecdotally. I’m 40, have about 18% bodyfat and did try 12 weeks of ketogenic diet to make sure I gave it a fair shot and I was keto adapted. I also used ketostix to ensure I was in ketosis. Yes, I did lean out (from prior 25% bodyfat) but was completely lacking power in the gym and the depression hit like a Mack Truck. Like sitting in my car crying depression. I function better at around 200-250 grams carbs. Having said that I fully agree with the science and even for high-carbers, a… Read more »
R Z
Guest

You can also consider a cyclical ketogenic diet. (Eat Carbs before hockey -> glycogen depletion -> keto)

Sam
Guest

Science and evidence about breakfast, body weight and obesity:
http://theobesebrain.blogspot.com.es/2016/07/breakfast-body-weight-and-obesity_19.html

Deb Griffith
Guest

They don’t have to do expensive studies and trials to prove that low carb works(proving the low insulin theory is very much alive and well). All they have to do is cou t us hundreds of thousands of older people who spent decades on the CRAP or cico or SAD methods of eating and stayed fat, who are now called SKINNY at family functions after a year of LC and IF.

Sue
Guest
Well said Deb. My sister works with a nurse. She is 64 years young. 10 years ago she had suffered 3 heart attacks, , 7 stents, had high blood pressure and was T2D. As a NURSE she went completely against all advise and tried LCHF. Today, she is in perfect health. Her weight is good, takes no medication and is free of her T2D. She has been on the diet for 10 years. That speaks volumes. LCHF + fasting works for her, it has worked for us and if people followed the advise like they should, it will work for… Read more »
Sue and Tony
Guest
Dear Dr Jason Fung, As for my husband and myself we will be eternally grateful for all of your hard work and effort on the behalf of good medicine and excellent communication. We have followed your advice verbatim and without a doubt, my husband most certainly wouldn’t be where he is today (in perfect health) had it not been for you. And we LOVE your “tone”. There is nothing wrong with calling it like it is without the sugar coating. (Another reason to hate sugar 😉 Lively conversation is one thing, but to criticize how you volunteer all of your… Read more »
marty kendall
Guest
I think the last paragraph of the paper is the most interesting… “However it is possible that dietary carbohydrate restriction might result in decreased ad libitum energy intake – a prediction of the carbohydrate insulin model that we as not tested in the current study but deserves further investigation.” Hall’s closed system model does not account for insulin resistance or appetite which are critical. Sunk Cost Fallacy = “Your decisions are tainted by the emotional investments you accumulate, and the more you invest in something the harder it becomes to abandon it. It would be a bad Hall indeed if… Read more »
Walt
Guest
“because they can’t access their own fat stores when they are feasting on carbs.” When you hear people saying they go to the gym and simply can’t do their usual workout, that’s them saying they aren’t tapping their fat reserves either. Marty, I’ve been doing low carb/IF for 2 months now and gained weight… I have gotten very skeptical about all the happy ears on this whole Fung bandwagon. I’ve asked for clarification on points only to hear just the crickets. If I am not mistaken comparing ketogenic to low carb is misleading as keto, to my understanding is VLC… Read more »
marty kendall
Guest

I agree it’s not just as simple as IF plus LCHF for lots of people. Calories still do count. Lots of people can get caught with “fat to satiety” and satiety doesn’t always kick in in time. It some people more than diet and IF to change their metabolism to the point that they can tap into their fat stores. Personally I’ve found the approach detailed in this article useful to make sure I’m moving forward. https://optimisingnutrition.com/2016/02/15/how-to-use-your-glucose-meter-as-a-fuel-gauge/

Krista
Guest
Thanks Marty for your comments. I agree that the “eat fat to satiety” can be bad advice. I know that one of the things that has kept me overweight has been that I don’t understand true satiety. If I’m honest I know that often my hunger knows no bounds. This is not just biological, something that can be solved by “eating a pat of butter”, but is also psychological, and a need to use food for stress relief and comfort. I have lost 37 pounds (25 more to goal weight) since April 26 following LCHF and IF, but I have… Read more »
Walt
Guest
@Krista, one thing to keep in mind… The brain has a very hard time distinguishing thirst from hunger. So, perhaps, much of the time you feel hunger, it is entirely possible you are actually dehydrated. Some say have 8 glasses of water/day. Some say have 2 liters of water per day, some say have so many oz of water per pound of body weight per day. I believe the safest advice is you want your urine to be just faintly colored. If there is any appreciable color to it, you are dehydrated. But, I am not a doctor. I think… Read more »
sten bjorsell
Guest

Hello Walt!
Carbs alone doesn’t count the insulinogenic foods…
Check post above by Jerome Benthamite !
If still not sure, check that your fasting insulin is well below 5 !
Cheers!

RobC
Guest
@Walt, I’ve read your comments on the previous blog entry too and see you are getting frustrated. What you have described, eating one meal of 800 cal/day, I don’t believe is intermittent fasting. It’s modified long term fasting. I think Dr Fung recommends you eat till satisfied to complete the cycle. Earlier you asked what is the functional or metabolic difference between a continuous intermittent 24 hour fast, a daily single low calorie meal and water and vitamins only? I don’t have an answer, but I understand that low or zero calorie fasts longer that 5 days will slowly lower… Read more »
Walt
Guest
Hi Rob, how perceptive! That was a nice way of putting it. The 800 came from fusing the Taylor/Mosley protocol with the Fung protocol. How’s that saying go, “when you find you’ve been digging yourself into a hole, STOP DIGGING”. I had found no conclusive, ‘now that you’ve screwed your metabolism…” so, yeah, I was very concerned. I was not looking for free medical advice, rather, was I misinterpreting the book and, if so, how. Plus, frankly, there are contradictions in the book that one was either left to noodle through themselves guessing at a missing differentiator, or chalk it… Read more »
RaceRealist
Guest

What points would you like clarification on?

remberto
Guest

I have normal weight (23 BMI) and wonder if I ever became insulin resistant and adopted the fasting and LCHF protocols, wouldn’t I become too skinny?

Brad
Guest
Gogo
Guest

Low carbs followers usually starts out misinformed ,pigs out and develops IR and then preaches low carb.Lift weight ,would you?I have never gained so much fat to loose.Guess what I am more informed than most of IR guys on low carb.

sten bjorsell
Guest
Since food intake was down 10% on the ketogenic diet and metabolism did not drop – which it does on calorie restricted SAD diet for most, the study results show that ketogenic calorie restriction does not reduce metabolism and therefore works fine for weight loss while SAD reduces metabolism as seen earlier with poor weight loss as discussed above by/with Jason. A few things missing to get full proof in a single study: 1/ A control group on same calories as the ketogenic group eating SAD is required. 2/ Fasting insulin (lowest cost measure of insulin resistance) required at start… Read more »
Walt
Guest
Hi Sten, This is ever so frustrating for me. In a word, it’s not working and, trust me, I so want it to. My journey, for lack of a better word, started with trying to replicate the results of the New Castle study that, after a mere 8 weeks, reversed T2D in a number of diabetics of various length of the disease. Eight week on a CRaP diet. This was Dr Roy Taylor. His results have been reproduced by others and replicated in follow on studies with people with longer periods of T2D. Initially, I did not have their diet… Read more »
sten bjorsell
Guest
Hi Walt, I followed Dr Fung’s fasting “the longer the better” way last April. I planned to do 2-3 days fasting in a row, as the time to bring down the insulin at the start of each fast would then not be lost. I mean there is hardly any fat burning until insulin is down enough, which can take 1 – 2 days of water fasting! (i drank water with a lemon squeezed in 2 liters ow pure water. Added a bit of gray sea salt after a few days..) After the 2nd day fasting like that I had so… Read more »
Walt
Guest
Thank you Sten! That was an outstanding reply…and actually answered, in part, a question I had asked weeks ago, blogs ago. If you look at page 239 (I know it by heart now) and look at the categories, specifically post absorbtive phase, if that occurs up to 24 hrs after feeding stops but you do a 24hr fast, which really means 18:6 or 20:4 or 22:2, how does phase 2 ever start? Ditto, and worse, with gluconeogenesis and, even more the case, ketosis? Absent a response to that (prior to yours just now) I figured it was a flaw in… Read more »
Walt
Guest

Sten, a very important fact I failed to mention. In my last, likely over 8 weeks, there have been, with very rare exception (1/2 slice cheese cake 50% fat 50% carbs) there have been NO sugars and no refined carbs.

sten bjorsell
Guest

The cheese cakes have to go, at least if you get through my reply above…. But not on all days you don’t fast although don’t treat yourself the days just before next fast, clear from above too.

Walt
Guest

🙂 That was a birthday thing coupled with having lost over 100lbs over the course of the prior 11 months. That was my ‘brass ring”.

Richard S Stone
Guest
If i understand what Dr. Fung is proposing, throughout his work, it is that the cause of obesity is insulin, but that insulin resistance (diabetes…) is a far more important issue. Still, if you reduce insulin you will lose weight. Second, “diets” don’t work at dealing with either issue on a long term basis. The one and only thing that works long term is fasting: Not Eating. Not Eating works because if you don’t eat you simply Do Not generate any insulin. Insulin is generated mainly by consumption of carbohydrates/sugars; And, more surprisingly, by protein. Fat isn’t an issue. Green… Read more »
Walt
Guest
I should probably clarify what I said earlier for the benefit of the reality tv folks and Jerry Springer fans cheering on Dr Fung’s retort to Dr Hall. First off, I did not weigh in on the efficacy of a LCHF diet vs an Atkins style or HCLF. I do question how many posters here actually read his book, as he states very clearly: 1) all diets work, all diets fail. (that, btw, includes LCHF). 2) In referring to the decline of the Atkins diet, Fung states, regarding the carbohydrate-insulin hypothesis (the basis for Atkins) “The hypothesis stands incomplete. There… Read more »
sten bjorsell
Guest
Walt, I reply briefly down here instead on your question above: “…The 24hr fasting, which is to say, the 21:3 fasting I tolerate near perfectly. I’d say most days perfectly, rarely though, it is a real struggle come about early to mid afternoon. How did you find four to five days? Again, thank you!” Fasting more than a meal can be hard with SAD eating moving to 24 hrs is really hard. But on a keto diet things become easy! The lower the carbs and proteins are on the keto, the easier it is, as it is then closer to… Read more »
Walt
Guest
Thanks Sten. I do take one liberty with the fast portion of the day. Let’s say the fast begins at 8pm (or 6pm or 7pm), about 12 hours later I do have coffee. Both Drs Fung and Mosley say a splash of milk or cream is acceptable. I use 2 mini-moos, 10 cal from fat each. I, generally have 2 coffees in the morning. I have the coffees 8 hours before supper. I figure since fat essentially doesn’t raise insulin I am being faithful to the 21-ness of the 21:3 fast. Again, with the exception of whatever sugar was in… Read more »
sten bjorsell
Guest
I think you misunderstand. It is not fasting or KD per se that increases metabolism or resting EE. It is insulin levels and food supply that sets up resting EE. Eat a lot and it goes up and body temperature goes up, but you gain weight. Fast for a few days and EE goes DOWN, UNTIL you are fat burning adapted = keto adapted, which translates in that the ‘high insulin imposed’ nutrient shortage disappears and body fat can be burnt, again. Low insulin means no more blockage to burn body fat. That is the “holy grail of weight loss”… Read more »
Walt
Guest

Is grey sea salt a different animal than normal sea salt? I mean aside from it being ‘collected by hand using traditional Celtic methods and wooden tools’? Isn’t it just NaCl plus minerals?

Walt
Guest
On day 2 of water only fast! I woke up at 1:30 with very cold feet. Within the hour, while not feeling warm, they were no longer cold. I weighed myself this morning and that weight gain I had mentioned as been removed. Allow me to clarify my question. Yes, I understand as we lose weight our BMR or total energy requirement drops, being there is less of us to maintain. If we lose 10lbs or 100lbs our BMR will be proportionately lower and be expected to remain there. My understanding from all the research papers and blogs on ‘damaged… Read more »
Valerie
Guest
Hi Walt, I’ve read a few of your comments, and you seem absolutely confident that fasting raise (or at least doesn’t lower) metabolism. I would suggest you do some research on this question outside of Fung’s writting. From my own searches, it seems that most studies on fasting do show a reduction in metablism, while a few show an increase. Also, after a massive weight loss like yours (congrats!), I would expect your insulin sensitivity to have greatly improved. In fact, I don’t think your current metabolism issues are related to insulin, but rather to leptin. Your leptin level has… Read more »
Walt
Guest
Hi Valerie. Thanks for your reply. Frankly, I see that issue you mentioned as one of the ‘magic happens here’ moments in Dr Fung’s thesis. I’ve asked for clarification on how is it a SAD or a high carb or a whatever would lower metabolism below what should be expected but, magically, not a fast. I don’t know enough to call him out on that. I believe, however that his arch nemesis, Dr Hall, agrees on that point, I think. So, no, I am not absolutely convinced of anything. I do know I lost over 100lbs on a CRaP diet,… Read more »
SomePerson
Guest

So, I know this comment thread is from months ago, but I’m wondering if you ever got your answer Walt. You appear to have been a very similar trajectory to me, but only about 5-6 months ahead and I wondered if you figured things out. I’m pretty sure I’ve figured them out for myself, but time will be the ultimate arbiter of that in the end. I figure you probably ended up landing somewhere similar to myself, but was curious.

Valerie
Guest
Hi again Walt, I’m replying higher up your thread because the comments are getting too narrow on my screen. I hope you see this reply. Cold by not hungry? 1- Worth getting your thyroid tested, I guess. 2- It reminds me of a video by a guy named Jim McCarter who went on a ketogenic diet for a year. He felt mostly fine except for the cold. He used to swim a lot but now dreaded getting in the water, as it felt much colder than before. In his talk, he says that eating (a lot) more salt solved the… Read more »
Walt
Guest
Hi Val, yep I had thyroid added to the list as I go for my 90 day A1C, CMP etc this week. Yes, I too am skeptical. I asked Fung on here, on email, I asked Megan, if she is ghost writing for him nothing. I have officially started day three of water only fast 3 hours ago. I just got out of 30mins in a Jacuzzi to warm up my insides. Yes, not hungry cold hands and esp feet. Stuff I’ve read points to ‘oh that’s brown adiapatic fat diverting blood from extremities to get glucose. Also, I maybe… Read more »
RobC
Guest
I haven’t found any studies or useful discussions of how to increase EE. I think, when the time comes, eat more and move more combined with eating whole/real foods and IF (IF to control insulin and fat gain and get HGH boost). Check out how Sam Feltham experimented on himself by eating 5700 cals/day with LCHF for 21 days and then again HC I think the EE boost from fasting comes from noradrenalin released – so it’s temporary. However lean muscle mass gained due to HGH should be persistent if exercising. I think loosing fat/weight is a polar opposite goal… Read more »
Walt
Guest
Thanks Rob! Yeah, as of this morning, 187, by the end of the week, sub 185 perhaps. I kind of tend to agree with you on the EE normalization. It is unfortunate I didn’t even know of Dr Fung’s existence until the bulk of my weight loss had occurred. As for exercising, I did that, like a fiend which may or may not have helped for 10 months. I built up to 660 cal / day 6 days/week. There were the occasional weeks where, yes, I did lose 3lbs (2 from the 1,000 cal/day deficit off of BMR*1.2) plus 1lb… Read more »
RobC
Guest

In regards to increasing metabolism, I meant when you have reached your target or are ready to take a break from loosing weight (ie stop being calorie negative). Then you can try experimenting with excess calories combined with LCHF and IF to control fat gain and increase EE.

Sam Feltham didn’t mention metabolic increases on his 5700 kcal/day LCHF diet, but did mention a decrease in waist size and a small increase in weight. (I’d post a link but my comment wouldn’t publish so I removed it)

Walt
Guest
Interesting news. I’ll try to get the blood work done tomorrow. I am winding down on day 4 of the water only fast. Yesterday I lost .8lbs. This is really nice as the scale is not bouncing all over the place weight wise. .8lbs is 2800 cal, given a lb is 3500. So, is it far to assume that my REE is currently 2333cal as that times 1.2 (sedentary lifestyle) is 2800? On page 241, Dr Fung describes Adrenalin as, at 48 hrs, increasing metabolic rate by 3.6% and by day 4 by 14%. My ketostrips arrived and I am… Read more »
RobC
Guest

Concentrated ketones can also be a sign you aren’t drinking enough water.

Dr Fung says FBS frequently goes down to the 50’s during multiday fasting.
http://www.dietdoctor.com/intermittent-fasting-faq#blood-sugar-fasting

I believe ketones replace some of the glucose in the blood. You are probably good as long as you are feeling fine, in ketosis, and not on any medication that affects blood sugar.

I’m sure you already know, but just in case, remember to break your fast gently. Perhaps with a few nuts or small serving of soup roughly a half hour before eating a normal meal. For me, the first meal runs through very quickly…

seebrina
Guest
Hi walt- I understand exactly what you are saying. I have run the gambit of all of these methods and despair to see any progress. It occurred to me that I should also try and heal my thyroid since my temp was 94.6 for years. I see what you mean about getting less and less to eat and then where does it end? I put on weight due to hormone issues / menopause/ and couldnt lose a pound. Low carb didnt work, fat fast didnt work, I have now been doing IF 22 hours fasts everyday with a 2 hour… Read more »
Robin
Guest
The way I read, it Dr. Fung says that if you have insulin resistance from some combination of eating too many carbs, eating too often, bad genetics, etc. you will have high insulin levels 24 hrs/day. However, one of the first things that happens when you stop eating is that insulin goes down. Operating on the premise that constant high insulin levels cause insulin resistance, insulin levels should gradually go down. Cells will become more insulin sensitive. Keep in mind that this is a THEORY. Dr. Fung read that LCHF and fasting can cause some hormonal changes, he tried it… Read more »
Walt
Guest
Hi Robin, I am going to respond as if you were replying to my post. Yes, I have read Dr Fung’s OC twice and done selective re-reads for clarification on certain points. Further, I’ve viewed his 6 part YouTube series on Aeitiology of Obesity at least twice plus, perhaps most of, his one off casts. Actually it’s 120 or so at this point. No, I have a few more to go. I think the overly stressing part is what I am resolving, off meds, lower bp, lower fbg. You could start at the top of this blog post or go… Read more »
seebrina
Guest

Walt- Are you reading labels? I bet there is corn syrup in the hormel product. Its in everything nowadays. Corn syrup is the only thing that shoots my sugar up to 200. Bad stuff..

Walt
Guest

Hi Seebrina, nope. 0 carbs, 0 sugars, only fat and protein.

Etienne Juneau, PhD
Guest

Awesome critique Jason. Best I’ve read. Well done. Keep up the good work. You’re smarter than most scientists.

James H
Guest
Jeez, the above commenters disappointed about the good doctor’s passionate response to Kevin Hall’s paper remind me of those special snowflakes on a college campus that, upon hearing a disagreeable word, seek out their little safe space and curl up with their teddy bear while sucking on their thumb. Dr. Fung sees the damage done by diabetes everyday and as an obviously caring individual he gets mad when someone implies it is okay to continue what is an apparently harmful course of action. The internet is awash with subjective tales–anecdotes–of people having cured their T2 diabetes by avoiding refined carbohydrates… Read more »
Michael
Guest

All this stuff is resolved pretty simply by adding another groups. For starters it’s always a must in modern studies to add a control group. More than that for this purpose you should keep people on SAD to compare the two diets. It’s simply badly designed study that’s all. You can’t make bad science and expect correct results

Brian Gurwitz
Guest

Dr. Fung,

Why do you assume from the evidence in this study the SAD diet weight loss would stop or slow, but weight loss on the isocaloric KD would continue?

Look forward to seeing you speak this weekend in San Diego.

sten bjorsell
Guest
Early up Dr Jason wrote this: “When patients embarked on their run in phase, they were switched to a 2700 calorie/day high sugar high carb diet, meant to replicate the Standard American Diet (SAD) that caused the obesity epidemic. Nobody actually believes that this is a healthy diet, and nobody believes it should cause fat loss. But it did. Why? Anybody who has done research knows why. It’s the effect of going into a study and knowing that people are testing you. It’s a universal effect. That’s the precise reason why we have run-in phases. To establish a proper study… Read more »
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[…] roligt exempel på det här är när Jason Fung i sin text som är publicerad både på hans sida och på Kostdoktorns engelska sida kritiserar studien för att man i den skriver […]

sten bjorsell
Guest

I recommend you to practice reading and writing more English so you can see and comment on what we already have written here. Swedish does not fit in here, really. Cheers!

RT
Guest

Dr. Fung, I am essentially in agreement with you on this. I have one question, though. By what mechanism or process would the participants lose weight initially on the SAD? I mean, with the math course analogy, it’s how much homework and study, etc. being consciously done. Regarding the Initial SAD consumption in this experiment, do you mean that the initial 2700 calories they consumed was possibly fewer calories than they typically consumed before the experiment began, resulting in the initial weight loss? Or that they actually consumed fewer than the 2700 calories they were assigned to eat?

sten bjorsell
Guest

The typical diet was 3,000 calories, 10% reduction. Link to study is above. Also see my comment about pre-study snacks never accounted for just above here, and the important comment by Jason July 21 above.

JW
Guest
Dr Fung shows his anger and frustration in this post – I’m angry as well. My poor mum suffered horribly the last 10 years of her life with diabetes. The doctors advised her to “eat low fat, count calories, eat every 2 hours so your blood sugars don’t fall, barley sugar candies when you feel dizzy, ooh you’re not controlling your diabetes, naughty-naughty let’s up your insulin”…. she lived off wholewheat low fat cardboard crackers, cottage cheese, low fat yoghurt, low fat 99% fat free chemical frankenfoods, margarine etc and as a result hungry..always hungry..chewing her arm off practically in… Read more »
Walt
Guest
(Another) Moment of clarity (request) please. OC pg 239. phase 3 Gluconeogenesis 24-48 hrs after feeding; Insulin levels begin (I assume ‘being’ was a typo) to fall. The breakdown of glycogen releases glucose and from amino acids and glycerol. In non-diabetic persons, glucose levels fall but remain in the normal range. What happens to diabetic persons? Is that the insulin reaction where they have to eat a Snickers bar or take glucose tabs? Even though last summer I was declared diabetic and last dec my summer a1c went from 8.5 to 5.8. I’ve never experienced, to my knowledge, an insulin… Read more »
sten bjorsell
Guest

Please extract some clarity from Dr Fung’s excellent article about high morning glucose and the causes of it here: https://intensivedietarymanagement.com/dawn-phenomenon-t2d-8/
It takes time for a liver full of sugar and fat to become “normal”. High insulin can give low FBG while a little lower insulin can give very FBG and normalized insulin and insulin sensitivity eventually gives good FBG. Read his article carefully!

Sue
Guest
Sten, I have a friend that follows a very strict LCHF diet. Her highest blood sugar is her fasting 1st am reading typically between 115-130. After meals she is well under 115. She has done several 5 day fasts and her 1st am readings drop to 80-90. She has also gotten her insulin tested and during those fasts she is at 1 or below. It would see to me, that if it is dawn phenomenon during her long fasts her 1st am readings would be high, since low insulin lets the liver dump. She/we can’t figure out why her morning… Read more »
sten bjorsell
Guest
Sue, your question is very interesting and should really be put to Dr Fung but I think he is busy preparing for a big event right now. Impressive getting the fasting insulin down to 1! What would her fasting insulin be when eating regularly and obtaining the 115-130 ? If it is a lot higher then maybe it has to be kept down longer to “fully reset” ? Maybe it depends on age and regulation reduces as we age? Here a possible plan to try: Set up 4x 5 day fasts over 8 weeks and check FBG in eating weeks… Read more »
Sue
Guest

Wow, thank you so much Sten! And I have posed this question to Dr. Fung but certainly understand he is unable to answer every question. And yes, so happy that her fasting insulin is so very, very low!! She is having a hard time finding a doctor who is willing to do all the tests that she wants, when she wants them! 🙁 I believe all that you have said is what I am thinking, it’s nice to see you’re in agreement with me. LOL .

I surely appreciate your response. CHEERS!

Valerie
Guest
Hi Sue, My understanding is that the liver dumps its glucose (glycogen) in the blood in response to cortisol (and other counter-regulatory hormones). The higher the glycogen level in the liver, the more glucose it dumps in the blood in response to the same hormonal input. A low-carb diet will reduce the day-to-day glycogen content of the liver, but a fast will lower it even more. Hence, your friend can see her dawn phenomenon when she eats, but not when she fasts. Bill Lagakos had a series of blog posts (on caloriesproper) where he suggested that eating more in the… Read more »
Sue
Guest

Thank you Valerie! All of that makes sense! I’ll take a look at Bill Lagakos…. thank you so much for your good advise!

Walt
Guest
Hi Sten, I have read that but where I was going, asking, is his clause ‘for non-diabetics FBG lowers but status in the normal range”. Normal I assume is 70->100. The other day I was in the 80’s high 70’s. This evening it was 70 on the nose. I understand HIGH fbg, I was asking about low. For a diabetic, which I’d like to think I am not at this point, low fbg precipitates an insulin reaction forcing the snickers bar or glucose tabs. So I believe, that was his point by specifying for non-diabetics it will drop but stay… Read more »
Walt
Guest

I should clarify. I do not test fbg in the morning, I test it before, what would otherwise be, supper. Consequently, what happens when I am asleep is not a factor here, plus it talks about rising fbs.

sten bjorsell
Guest
When one eat a low carb diet BG of 70 (3.9 mml/l) or lower is usually compensated by higher ketones meaning it is not a “diabetic blood sugar fall”. I have that reading most of the times when I eat once a day. Without the hypoglycemic symptoms like feeling dizzy or very tired, low BG is compensated and no need to eat anything. Keep up the IF and you will be fine! To keep you there, read about the dangers of eating 3 high carb meals per day and what high FBG does for cardiovascular health, or “how I became… Read more »
Walt
Guest
Sten, you are a steely-eyed master at this! This is day 5 of a water only fast. I just had my blood draw which includes thyroid. I am dropping like a rock. No euphoria..yet. Odd thing, yesterday ketostik was registering 16 (far right), this morning, a color pane or two below that reading. I am dropping roughly a pound per day. Intermittently my feet are still very cold, especially if my legs are crossed. If I put it on the ground it immediately warms up. Do or did you experience that? I am within spitting distance of declaring victory. I… Read more »
Walt
Guest

Sorry, next A1C should tell the tale, NIDDM wise.

sten bjorsell
Guest

Walt, Jason Fung is the master! Your full body heat will return I am sure! Thanks for your good example of 2:5 , this other way!

Walt
Guest
Well, I’d feel more like that but I finally put together a list of all my questions asked from various blog entries that were merely clarification type, things that seemingly contradict other statements, and emailed them. Yeah, I am certain he is a busy guy what with a 2 yr or really long waiting list for patients and speaking engagements. So I finally thought maybe that’s Megan’s role as she owns the LDP. Finally I sent another one asking if there was some policy about dialogs with non-patients. I could have sworn I was clear. So, where you’ve answered many/most… Read more »
Walt
Guest

Someone, I think it was either Ann or Valerie, asked me to post my last A1C results that I was preparing myself for being higher than I wanted. It was 5.6. FBG was 69, considered low. By the end of the day when I tested it here, it was 78, normal. I am aiming for my next A1C in Oct, to be in the 4’s. They didn’t test, Cholesterol or triglycerides, which strikes me as odd.

seebrina
Guest

Walt- Have you considered your circulation? Not sure you mentioned your activites but I sit at a desk to work and am cold. As soon as I do a few laps Iam much warmer.

Walt
Guest

Sten, measured fbg this afternoon, 78. So I am am feeling feeling better about any precipitous drop.

sten bjorsell
Guest

Hi Walt! It may take some time for circulation to be fully restored in the feet. When fasting with physical activity both metabolism and circulation are increased. Let us know if any difference after 2 days with 30 minutes walks! I had cold feet every night going to bed before my fasts and cannot recall when it stopped. I am walking 30 mins per day since. Now kicking away the blanket from feet almost immediately after going to bed. Sten

Walt
Guest
Sten, interesting use of ‘two days’. Here’s why. I broken fast last Thursday as Fri is ‘date night’ here and I wanted to be sure there were no ill-effects from a Friday night meal. Both Thursday and Friday night meals were around 1,500 calories, enough to take me out of ketosis. I resume my fasting after Friday night’s meal. Friday night, I believe my feet were fine, and not too bad on Saturday night. Sunday night (last night) was bad even with wool socks on. Over the weekend I was periodically checking my keto output which remained zero or imperceptible… Read more »
monica
Guest

Hi Walt, I am guessing here: if you ate enough fat during Thu-Fri, you might stay in ketosis. If so, maybe your body will adapt to fasting without the ups and downs. Thanks for your posts, and I am looking forward to my Walt-inspired fasts, starting tomorrow.

kfacwpup
Admin
I say “follow the money” with respect to this John Hall character. He was probably influenced by big pharma, the food industry, and/or the diet industry. You may be thinking, “but wait, he works for the National Institutes on Health, a government agency. He’s objective.” The fact is special interest groups lobby government agencies and government employees all the time, and succeed. That’s how ketchup got classified as a vegetable (for public school lunch programs) , why GMO foods aren’t labeled, and why companies who label their dairy products free of bovine growth hormone were almost banned from doing so.… Read more »
rick mccarthy
Guest

Thanks Dr. Fung for showing me how to eliminate the problems of Type 2 diabetes. I have an unrelated question to put to the good Doctor. Is it possible that the rise in obesity is due to the increase in CO2 in the atmosphere

Pierre
Guest

Keep hammering them Dr. Fung, I am as angry as you are about the perversion of science for political ends. People are dying. People are losing limbs and it is because people like Dr. Hall are given a pass by the polite people.

Kelly
Guest

If no one calls out the misinterpretation and misrepresentation of scientific studies, then the funding for expanded studies of these results will not be available.

The forked tongue interpretation of results leads to a fork in the road by which the lemmings will follow each other off a nutritional cliff. Ancel Keys, much?

James R.
Guest

Dr. Fung, I think you were too nice. We trust researchers to check their personal biases when doing science. We trust them with our lives.

Xanthra
Guest
It is refreshing to listen to the voice of educated reason in Dr. Fung as he is yelling, “The emperor has no clothes.” I’m diabetic and taking the path he has outlined in his book, generous blog and website. If some of you want to argue that the buttons on the emperor’s jacket are not shiny enough, go ahead. I need the voice of reason to reverse my diabetes and it is all starting to make sense because of Dr. Fung’s research and care to take the time to inform us. Don’t dwell on the nay sayers Dr. Fung they… Read more »
Eric
Guest

Look at the results in light of DR PANDAS WORK on time restricted feeding. Many people eat 15 or.more hours a day. Fewer eat 12 hours and few eat 9 and fewer still restrict eating to 5 or 6 hours. So in the artificial lab time restrictions of Halls study maybe the Time restrictions are the driving factor.

Mike
Guest

Increased EE for a little over a week and then back to baseline… that’s not going to do anything long term. The benefits of keto has nothing to do with increased EE. The end.

Eric
Guest

Can you or we do better? Yes, call it intermittent fasting or time restricted feeding!
Use to Salk institute app from doctor Panda and collectively create your own study of one. Or many.
Test time of eating window
Macro nutrients
Calories
Eric

Ash
Guest

You know what would be interesting? Do a 4 week run in phase on a strict keto diet, then an actual experiment with the standard American diet. I have a hypothesis at what the results would be and wonder how Kevin Hall could spin that?

jesse
Guest
ultimately, who cares? YOU can’T change people, even DR. FUNG can’T change people people have to want to change themselves – THEN they can change all we can do is show those who want change, how to accomplish it we must BE the change we want to see in the world we must DO lc/hf, and do it well when we drop weight, get healthy, look better, feel better, and get OFF of prescriptions. . . those who WANT change, will come to us and ask how they can too. THEN we are preaching to the right people the carbohydrate… Read more »
Eric
Guest

I am looking forward to more on fasting time restrictions and macro nutrient research.

Maybe restricted feeding research will show 8 hours on SAD junk food is better than 15 hours of keto or vegan or palio? Maybe 8 hour feeding blunts differences in macro nutrient?

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[…] to Kill the Insulin Hypothesis with Pure Spin – Dr. Jason Fung’s response to Dr. Hall: Here’s $5, Kevin Hall, go buy yourself a clue – Dr. Michael Eades’ response to Dr. Hall: Contradictions and Cognitive Dissonance: The […]

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[…] piece by Anthony Colpo, the excellent analysis by Stephan Guyenet, to the cringe worthy blog of Jason Fung. Indeed, many noses were put out of joint and so dismayed were some, that the rebuttals transcended […]

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