Dr. David Ludwig - 'The Carbohydrate Insulin Model of Obesity'
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- Опубликовано: 29 сен 2024
- David S. Ludwig, MD, PhD, is a practicing endocrinologist, researcher, and professor at Harvard Medical School and Harvard School of Public Health. He received a PhD and an MD from Stanford University School of Medicine and completed an internship and residency in pediatrics and a fellowship in pediatric endocrinology at Boston Children's Hospital.
Dr. Ludwig also directs the New Balance Foundation Obesity Prevention Center at Boston Children’s Hospital. His research focuses on the effects of diet on hormones, metabolism and body weight. He developed a novel “low glycemic load” diet (i.e., one that decreases the surge in blood sugar after meals) for the treatment of obesity-related diseases. In addition, his group has done some of the original studies linking sugar-sweetened beverages and fast food to excessive weight gain, heart disease and type 2 diabetes.
Described as an “obesity warrior” by Time magazine, Dr. Ludwig has fought for fundamental policy changes to restrict junk food advertising directed at young children, improve the quality of national nutrition programs, and increase insurance reimbursement for obesity prevention and treatment.
Dr. Ludwig is Principal Investigator on numerous grants from the National Institutes of Health, has published over 150 scientific articles, and served for 10 years as Contributing Writer for JAMA. He has also written several books for the public, including 'Ending The Food Fight' (2007), 'Always Hungry?' (2016) and the cookbook 'Always Delicious' (2018).
Someday this research will be considered a landmark in changing the understanding of obesity. Thank you Dr. Ludwig!
I am a Type 1 Diabetic and i was becomming fatter and sicker over the years, and my endo never said a word about restricting carbs. These videos helped my immensly not only with loosing weight, but also with bringing my blood sugar in a normal range (last Hba1c 5,2%).
Whats wrong with these doctors who just watch their patients health detoriate, and never even try to intervene? This destroys a lot of trust, if youtube and google are more helpful than these 'health professionals'.
I hope by now you've come across Dr. Richard Bernstein. He's the absolute master of managing Type 1 using low-carb.
Why would you choose to add fructose to the medium GI meal, yet dextrose (=glucose) to the high GI meal? Should this not be a confounder as to the role of instant oats vs. steel cut oats ?? (table of various GI-meals at time 10.30)
Every word of this is a perfect outline of my life story. Age 29, hiker, back-packer, weight 129 at 5’6” perfect blood work,”perfect health” I became a research subject for a family friend, INSULIN PIONEER Researcher University of Michigan Endocrinology Prof Stefan Fajans. Steve told me after our first session that the results of my 5 hr GTT GUARANTEED THAT I WOULD BECOME DIABETIC SOONER OR LATER. 6 months later, and pregnant,, I had Gestational Diabetes. Several years later, I went on the Atkins diet for weight control...I’m sure that my ignorant choice of a low carb diet saved my life. I’m almost 88, healthy and controlling my T2D with diet. ( Keto.). 🥇Dr Ludwig IS BRILLIANT-AND HE IS RIGHT! 🥇. ( It was my insulin all along!)
Excellent way to get the message across! 👍 Tired of people looking at me like I'm an idiot when I try to explain why I lost 50 lbs and feel like a teenager of the 1970's and I'm in my 50's ! Wake up America !
Our ancestors knew what they were doing when they created gravy from rendered fat drippings to put on rice/potatoes.
I was told a few days ago that "it is Impossible to lose 50 lbs in 2 months". That was After I had said I had done just that.
Most folks dont believe you can survive without eating for a few days, OR without carbs!
I will continue to prove them wrong with N=1 and watch the fat melt away. Dogma will take a long time to undo.
No wonder there was a lot of criticism, although undeserved. You really rocked the boat with this study.
The food manufacturers discovered a long time ago that sugars & refined starches are physically addictive. They are no different than the cigarette manufacturers that spent incredible sums of money to make cigarettes as addictive as possible.
Another lecturer at this event made that very same point. Brain scans showed that sugar/carb eaters lit up the same small region of the brain as drug and alcohol addicts.
The fact that medical authorities have perpetuated these myths for so long now makes me question everything else I hear on other subjects.
It is truly frightening. Once you see the inconsistences that are dismissed and ignored throughout the scientific community, as well as the fact that much of the research that is used to make policy is never actually replicated, you start to sound like a conspiracy nut. 🙂
what happens in "medicine" is specialization. So primary doctors, especially family practice, are treating many age groups & must diagnose ALL disease processes.
what is missing in the endocrine world where I have taught people for 30 years now is information on glucagon. Now this research is coming forward.
Congratulations, Lisa!!! That is a GOOD thing.
We all need to re-learn the art of critical thinking, questioning and examining everything we are told. And examine our beliefs to see how many of those are really ours, how many are based on evidence... and how many we simply 'inherited' from our family, religion, and society. Or were 'implanted' in our minds via education, music, TV, movies, advertising, etc.
When we are willing to consider that everything we know may be wrong, this is the beginning o independent thought.
Diabetes, cardiovascular disease, these are all disorders of the human energy system. This also bleeds into the probabilities cancer and other metabolic disorders. Those f--king c--k suckers are with malice of forethought poisoning us.
23:23 - What happens when we shut off the supply of glucose from the diet (via sugars and starches) and switch to a LCHF diet, how dies the brain get fed while ketone levels are still low? Dr. Ludwig says that one can expect to lose about a pound of 'lean mass'. Yet muscle is not the only lean mass in the body. Dr. Jason Fung's presentations on RUclips, and those by his partner in Intensive Dietary Interventions, Megan Ramos, both cover this in more detail.
Glycogen from the liver is retrieved for the first few hours. Then ketone production ramps up rather quickly. In fact the first few days there is excess ketone production.
Dr. David Ludwig needs to do a presentation at USDA before they release their next "food pyramid"
@Karen C
Those at the USDA are captured by Big Ag , Big Pharma and big insurance and will NOT change from the HIGH CARB RUBBISH DIET !
The scientific report guiding the US dietary guidelines: is it scientific?
www.bmj.com/content/351/bmj.h4962
www.washingtonpost.com/news/wonk/wp/2016/04/12/this-study-40-years-ago-could-have-reshaped-the-american-diet-but-it-was-never-fully-published
The Great USDA nutrition debate !
ruclips.net/video/feCpP40ZHqI/видео.html
Dr Troy Stapleton LCHF DIET
ruclips.net/video/epsSVosmtUc/видео.html
COMMENTS TO THE USDA 7/11/19
0:03 Dr. Sue Wolver
3:06 Dr. Priyanka Wali
6:08 Nina Teicholz
9:18 Dr. Darren Smith
11:48 Dr. Cate Shanahan
14:52 Dr. Christine Najjar
17:36 Dr. Georgia Ede
20:37 Dr. James Bailes
23:28 Dr. Sarah Hallberg
26:33 Dr. Tamara Hazbun
29:42 Dr. Eric Sodicoff
ruclips.net/video/y25aGM547Wk/видео.html = Commenter 8 - Dr Susan Wolver - General Internist Practicing Primary Care - VCU @low_carb_doc
"Implore you to use a low carb diet. First 24 years recommended exercise, fruits, veggies, whole grains, lean meats, and nuts. I tried a low carb ketogenic diet and lost weight effortlessly."
ruclips.net/video/y25aGM547Wk/видео.html = Commenter 13 - Dr Priyanka Wali - Virta Health - California @walipriyanka
"I'm here today because I'm very concerned that the current nutritional guidelines do not reflect the current health status of our nation. You know, if laughter was the best medicine, then the nutritional guidelines are best practice because they are a JOKE, a joke that's fallen flat and I believe that's because the committee has forgotten the number one rule when it comes to joke writing - know your audience. Well, let me tell you about your audience. 1 in 5 americans has diabetes, 1 in 3 has prediabetes. This is a disease that will kill you slowly by eating away at your brain, your vision, your vital organs. We suspect that 50% of Americans right now have prediabetes, they just don't even know it. These are diseases caused by high insulin levels which is caused by carbohydrates and it d oesn't matter if it comes from whole grains, or cane sugar, or hundred percent fruit juice. A carb is a carb is a carb. If you have prediabetes, you are essentially carb intolerant.....Please reduce the recommended sugar intake from
As someone who has been very low carb since July 2019, I can attest that it is a sustainable lifestyle and if anything I had to focus on not losing too much weight. My fasting insulin and glucose are nice and low and I feel quite well.
Not "eat less, move more", but "eat more meat, move more".
This video aged well
That was great. It means I can effectively lower my energy intake by 3xx kcal only changing macro proportion from carbs most to fat most!
That last slide was awesome. They’ve always known. Great stuff, Dr !
I knew this model was actually correct! Not many low carb/keto people talk about this model for some reason.
Potatos has the highest satiety index, and very high GI as well. Can you link to these studys?
Thank you, always good information 👍
@10:50
what is with that study that looks intentionally designed to make carbs look bad?
All the carbs on the Low GI meal are whole foods. The next two meals are both using several teaspoons of highly refined simple carbs. The test seems flawed in that they could have used higher GI whole foods rather than taking what could have still been ok breakfasts and then just adding a tablespoon of refined sugar on to each meal.
The meals were designed to resemble generally recommended breakfasts (including limits on added sugar). Note that the oatmeals have about the same amount of sugar and fiber, but produced marked differences in metabolic responses as a result of food processing and glycemic index
It's irrelevant if it's low or high GI, the sugars eventually have the same load on the pancreas , the carb diet has no advantage over Keto
I noted the previous lectures information that Gluten vastly increased the creation of fat as opposed to no gluten, or insulin alone. Likewise the recent idea that ketosis caused coupling in muscle cells, and uncoupling in fat cells and thus fat cells burned more energy,
The processed food company grows a lot of extra wheat and corn and potatoes. The junk food is getting sweeter and softer. Even if you don't have good teeth, you can eat it. The processed food in the supermarket is much more than meat and vegetables because it is easy to store.
中国透析的比例越来越高，即使您呆在家里，也可以用手机购买各种塑料包装外卖。
Plz try to number the lectures.
What is hard for me to figure out is that we still question insulin as a weight gain hormone...He shows this with the rats quite clearly & the picture of the autopsied rats is where he shows it.
Simplified, carbohydrate(sugar) is fat storing. This happens particularly because carbs effect the greatest insulin response, which down regulates gluconeogensis, the metabolic pathway where by the body uses fat for energy. This also reduces your TEE(total energy expenditure) which makes it a lot easier to store energy as fat.
Since Insulin also crashes on blood sugar, physiologically this will increase hunger. Its why sugar isn't satiating and why people binge on these kinds of foods.
Fat is the opposite because its the least insulinogenic. Its used directly as energy and is not stored as body fat immediately. Anecdotally you can test this with eggs, where most feel satiated for hours, typically till about supper time. Meat is also not so insulinogenic as well, as it has an enzyme called glucaon which mediates insulin response, so you'd have to eat a ton of it in a single sitting to get a high response.
The wieght was controlled for both groups. The difference is visceral fat storage and lower metabolism in the high glycemic diet.
How many calories are in a turd? Nobody seems to even address the fact that we waste calories in our turds. When is someone going to address this? How many calories are in a big fat giant shit?
Eating something quite sweet, like chocolate, I notice for me creates an Immediate strong hunger for more, so much so I can eat the whole block of chocolate immediately. That first bite seems to create a ravenous hunger for more of it. The beauty of the Keto diet is that there is no volume of food restriction, but eventually you lose your appetite and end up eating quite a lot less calories in the day. I planned to lose 9kg and ended up losing 18kg and had to find a way to put weight back on.
Me too
Once we are fully fat adapted, and we have burned off all the excess fat we wanted to lose, we have to remember to increase the amount of fat we consume. Dr. Stephen Phinney, ND PhD has several excellent presentations on RUclips, and he covers this in most all of them.
Bacon, real sausage, full-fat cheese, cream, butter, the fattier cuts of meat - and ask the butcher not to trim all the at of - duck is delicious and high in fat, and so is goose. Duck and goose eggs are also higher in fat than chicken eggs. Coconut oil and cocoa butter...
Of course pastured poultry and pork from independent farms that raise their animals without chemicals and on species-appropriate diets is best. And 100% 'grassfed' beef, lamb and other meats - venison, bison, etc. Not only is this better for the environment and local economies, the nutrient levels are higher in animal-source foods raised on eco-farms. compared to industrially produced livestock.
Heritage breeds tend to be higher in fat, especially pork, but also beef, lamb, and chicken. Best of all is the FLAVOR! Enjoy!
I don't think you are explaining a ravenous hunger. I would propose you are describing the relationship between a junkie and his drug. It's not the chocolate you were jonesing for..
Me that’s me too!
The comment that some people are "excessive insulin producers" leading to fat storage and glucagon malfunction, while others, not so much. Excessive insulin producers via genetic trait or as a result of years of excessive carb and sugar consumption?....or some other reason?
Yes. For the purpose of this study, it didn't matter. The impact of carb intake had the same result.
yes. look at any lab for fasting insulin normals & you see a range. Look online www.thebloodcode.com/insulin-resistancet2-diabetes-map-test-results/
Great question! No doubt genes play a role - yet as geneticist Michael Bowling used to say, 'No gene operates in a vacuum' (accompanied with a cartoon showing a double helix in a Hoover). Genes cannot turn themselves on, and cannot turn themselves off, so environment is ALWAYS important.
In addition to years and decades of high carb consumption - and this is true even for most people who eat what we are told is a 'healthy' diet - other hormones also play a role. Epinephrine, aka adrenaline, release, as mentioned in the talk spiking in consumers of high glycemic meals several hours after they eat, is usually accompanied with increased levels of cortisol. Stress becomes chronic stress... and high cortisol levels lead to increased fat storage, especially around the midsection.
Changes in certain reproductive hormones can also create insulin resistance.
In most people, it is likely that the combined effect of high carb intake over decades, and chronically eleveat4ed stress hormones over time are key drivers of insulin resistance - which results in increasing levels of insulin being produced. This can explain why many people who eat a high carb diet when young tend to gain weight as they enter their 30s or 40s. Add in the shifts in reproductive hormones, and the phenomenon of post menopausal women who gain weight easily and lose it slowly and with difficulty, even when they are very active, can be accounted for.
Those whose ancestors ate a diet high in animal-source foods and low to extremely low in carbs are likely to be more vulnerable to the ill effects of a high carb diet. Those whose ancestors come from northern Europe often find that they can no longer consume a high-carb diet as they pass 30 or 5 without gaining weight. People hose ancestors adopted 'modern diets' more recently, like the indigenous people of the North American continent, are more extreme examples, as they are highly carb intolerant even in childhood.
Gut biome is part of this. People vary greatly and at different times and conditions / infections
dude, i know you're american but stick with metric units pls.
the only criticism of Dr. Ludwig's study he covers at the end of this talk is we need to know the estimated body fatness of his participants before he has them eating the measured foods he provided & the "heavy water" he gave them. Clearly they could have drank water from the tap & diluted their consumption of heavy water. There is no perfect research study. I wanted to know the estimated "body fatness" of the participants due to old information I acquired that lean people burn more calories at rest than heavier people because reportedly muscle tissue has a higher metabolic rate than fat tissue. I think the work of Dr. Herman Pontzer with the Hadza shows some interesting results with folks that are very thin & very physically active.
Did you miss the slide that showed the average BMI of the participants (~32)?
I don't think the leanness explains the changes in metabolism, unless body composition drastically changed as well. The participants were kept at a steady weight after all.
and where does he talk about intermittent fasting? Yeah, that's what I thought.
Why confound the study?
He address that here: www.drdavidludwig.com/intermittent-fasting/
Why did you reply to your own question?
Some laws of thermodynamics aren’t possible when applied in outer space. Gravity is a law as well. The environment of such laws count a great deal. The human body doesn’t actually “burn” energy like a calorimeter in a lab does. A calorimeter doesn’t have hormones either.
Anyone know of a doctor in NYC that subscribes to this thinking?
People are having great success by reading about it and watching youtube and using phone apps for tracking. Maybe look for dieticians or nutritionist rather than MD's.
I'm not in NYC, but my physician had never heard of it. By my second visit after starting his plan, she wrote down the name of the book my results were so good.
Despite studying for many years, there isn't enough time to learn all things about all diseases. So if we want our doctors to know details about treating and to know new scientific discoveries about our specific disease, we must study the research and give it to our doctor. Thus, we work together with our doctor to improve our health.
I gave my doctor a copy of "The Obesity Code" by Dr. Jason Fung, MD. A year later, my doctor had implemented the information to improve his and his family's health. Also, the book helped him improve his treatment of other patients.
I don't see how "calories in" "calories out" model is incorrect?
Not necessarily Incorrect but certainly Inaccurate, when taking into account several physiological factors like hormones (insulin) that not only influence metabolism of macronutrients like carbohydrates, but also hormones that influence rates of hunger (Ghrelin) and fullness (leptin). See the study at 16.40 regarding calories in and out. It is a rodent study but we cannot discount it, at least in part because the calorie in and out principal should remain true across the board.
It is overly simplistic. The quality of calories consumed significantly effects the metabolic rate. You don't necessarily have to go for a walk or to the gym, your MR may well go up or you feel less lethargic because high carb diets leave you lethargic feeling.
simple.
Some foods are more difficult to digest while some are easier to digest.
Some foods you can get more net calories from them while others you get less.
Things like fiber are not always fully digested.
Your body can absorb and store fats easier than carbs as carb conversion to fat is more energy consuming, i.e. less efficient.
Just because a food that you eat has, say 100 calories if you measured it in a lab by burning it and measuring all of the heat that it generated does not mean that you will get 100% of that energy potential when you eat it. If that was the case your poo would be nothing but ash and bacteria.
A calorie is simply a measure of energy so yes, literally a calorie is a calorie is a calorie but we aren't eating calories (the energy in the food). We are taking in the food and then having to break it down. Simple carbs and fats are the easiest to deal with. Complex carbs (think whole plant foods and grains with intact fiber) are harder to digest with proteins being the hardest. Proteins in a whole food form, no whey powders or soy powders.
Interesting reads for you (or anyone else):
"Postingestive fuel selection favours the oxidation of dietary proteins and carbohydrates, whereas dietary fats are preferentially stored as triacylglycerol in adipose tissue"
www.ncbi.nlm.nih.gov/pubmed/12174324
"These data indicate an added energy-cost associated with high-protein, low-fat diets and may help explain the efficacy of such diets for weight loss."
www.ncbi.nlm.nih.gov/pubmed/11838888
If a calorie was a calorie regardless of the macro nutrients then if you had two twins and had one of them eat 2,500 calories of fast food and the other one eat 2,500 calories of a no refined food diet, no added sugar diet and only whole plant foods, whole grains, and lean meat then we should expect the same physical result from them....which we will not see.
It is not incorrect, but just unsatisfactory as it ignores the impact of hormones. Insulin determines whether your body can access its own body fat or not and it may drive your blood sugar far down, especially when eating refined carbs. The first one will lower your base metabolic rate and the second effect will make you hungry. And those two mess up your calories in/out.
Perhaps this quick explanation from Dr. Ludwig can help clarify: ruclips.net/video/6xl8Pd73ZrE/видео.html
Good science.
5:15 40% reduction to 30% is NOT low fat!!! low fat would be around 10% or less. So whats presented there is actually high fat, high refined carb foods. Yet again these MD's fall into the trap of labeling them low fat. A banana or apple has 2-3% cal from fat .. now that is low fat. ruclips.net/video/UfFoqXJouOI/видео.html
thanks. i always like the lectures on this channel.
but i have a different problem where i did not find a solution yet:
i lost 25kg on keto on the first year, which is great.
but on the second year i gained back 5kg on keto. so keto is not working anymore. i need some kind of optimization.
maybe i find it in a high-carb low fat day twice a month (not the same like cheat day with random macros).
Have you tried intermittent fasting, extended fasting or the zerocarb aka carnivore diet?
37:06 shows that there is more to losing fat than diet such as, sleep and stress. Also an input to "Insulin secretion" should be eating frequency. An additional way to reduce insulin secretion is to eat less frequently. The less frequent I eat, the easier I find it to eat less frequently. I started with intermittent fasting, then one meal per day, now 2-4 day fasts whenever I feel like it.
Keto works fine, but calories still matter. No knowledgeable person claims that keto allows for an "unlimited" intake of food, so the likely cause of your weight regain is that you are consuming more energy (calories) than you need, or you are experiencing carb creep and are really no longer in ketosis. Many people will also gain lean body mass on the ketogenic diet, especially when coming from a state of poor nutrition and/or beginning a weight lifting routine.
The extensive weight loss at the beginning of the diet includes liver/muscle glycogen and its attached water, as you know. However, the second component of this large initial loss is the reduction of systemic inflammation also reduced by lowering your insulin level. I have seen some extremely obese men lose 40kg+ in their first month, so that is not body fat.
After you have lowered your circulating insulin level and "healed" any insulin resistance issues, then perhaps your metabolism is behaving more like a "normal" metabolism, and the Calories In, Calories Out model becomes more applicable.
maschinenraum you’ve likely just let some carbs slip back in to your everyday diet.
I would first go back to a strict diary of food intake.
This lecture would be great if large parts of it were not in English.
Translate the Medicalise into common English and it would be more helpful.
This guy suffers from a common problem: failing to consider the relationship between the syntax and vocabulary of the presentation and who is actually being addressed.
Isn't the purpose of a lecture to communicate a vital message rather than send the listener flying to a medical dictionary every other sentence?
A really "wok" person would consider the person being spoken to.
He would be sure to give the quick, plain answer, and only then follow it with the long and perhaps labyrinthine explanation.
If I were giving such a lecture (I have done so many times in my field) I would want the listener to have the answers to a few specific, critical questions: Specifically, exactly, what is the basic message I can carry away? How can I apply it to accomplish what I have in mind?
Short on theory, long on practice.
That's how I see it. Say with the goal being when all is said and done the listener knows in the most basic form what you know.
Otherwise, most listeners won't stay to the end.
Sorru William, but first this man is a real researcher and this event was made not for broad yt publicity. Therefore more demanding language. Honestly - I would suggest you prepare yourself better biochemically/scientifically so you can also digest more from what was said.
I understand about the vocabulary. I encourage you to read books from the Demystified series that's printed by McGraw-Hill.
"Anatomy Demystified"
"Physiology Demystified"
"Chemistry Demystified"
"Medical Terminology Demystified"
Etc.
Those books are great for studying on your own.
Will power is a biological system, it just needs development and nurturing.
What if I am at a normal weight? Is it ok to eat lots of high glycemic food? My diet is awful. The other day I skipped dinner and just ate pound cake and chips. I often eat the smallest meals possible and just snack for the rest of my calories. But my body is good regulating how many calories I eat. For example, if I overeat one day, my body will make me less hungry the next day and so on. I do get full easily and these days eat an average of 1500 calories per day (I just eat junk food until I'm full). I'm an adult female at 4'11 and about 95 pounds. I used to weigh 100 pounds before the pandemic (used to eat closer to 1800 or 2000 calories) but since then I've stopped eating out and lost 5 pounds. Yesterday I ate 1200 calories because thats just how much I needed until I was full (since I stopped exercising since quarentine started my appetite decreased). How unhealthy is it for me to continue living like this? I am techincally at a normal weight...
I'm confused because from the videos I'm learning that all the sugar that I eat (I eat a LOT of simple carbs and sugar... basically my whole diet) that my insulin levels should be so high that my body is converting sugar to fat right away but I'm not obese. I do not have a fast metabolism. I'm 4'11, 95 pounds and eat about 1500 calories per day and never exercise. My question is why am I not overweight?
If I switch to 1500 calories of healthier foods, would I lose weight because of a lower insulin load...
OK I finished watching the video. NVM. It's still not healthy even at a normal rate to eat a high glycemic idex diet. That could explain my normal weight but high body fat physique ... Alright time to eat healthier lol
You are spiking your insulin perpetually, snacking throughout the day on those junk foods. Your insulin spikes every time & probably never goes down enough until another spike. You don’t have to be obese to develop type2 diabetes. In fact, lacking the ability to gain weight forgoes the warning sign that there’s something wrong.