Sugar vs fat on BBC: which is worse?

Sugar or fat, which is worse? That’s the question in the BBC documentary “Sugar vs. Fat” that aired the other night. And it’s been a long time since I got so many e-mails asking me for comments!

It’s an interesting setup. Two identical twin brothers – both of them doctors – go on a diet for a month. One on an extreme low fat diet, one on an extreme low carb diet (not even vegetables are allowed!). Here’s some background information:

MailOnline: One twin gave up sugar, the other gave up fat. Their experiment could change YOUR life

You can watch the show online here.

Unfortunately they end up mostly “confirming” their preconceived ideas. Ready? Here comes the spoilers:


Obviously when there is only one person on each diet, chance plays a big role. But I think the findings were more or less what could be expected, it’s mostly the ignorant (or TV-drama) explanations I have objections to.


First thing first. Even though both brothers were at a fairly decent weight to start with, the low-carb brother lost the most weight: 4 kg (9 pounds) vs only 1 kg (2 pounds) for the low-fat brother.

As study after study show more effective weight loss on a low-carb diet, this should be no surprise. The loss of fat was 1,5 kg on low-carb (a good result in a month) and 0,5 kg on low-fat. Most of the rest was probably fluid. On a very strict low-carb diet you quickly lose a kilo or two of glycogen and water weight.

How much – if any – muscle mass the participants lost is impossible to know as the BodPod test only measures fat mass vs. non-fat mass (including water).

Brain function

For testing the brain function of the brothers the producers chose to make them do stock trading with fake money.

This shows that the producer is ignorant or just interested in a dramatic show. Why? Because short-term stock trading – without insider info or other illegal tricks – is a game of pure chance. It’s been convincingly shown that a trained monkey has a 50% chance of beating a well-educated stock broker. Why? Because it’s all chance.

In other words this test is rubbish, but the low-fat brother wins.

More interesting and relevant is that the low-carb brother complains of feeling “thick-headed”. I’m sure he’s honest. Going on an extreme low-carb diet – without even vegetables – can absolutely result in problems concentrating etc. for a week or even more, before the body and brain adapts to burning fat and ketones.

This problem can often be partially avoided by increasing the intake of fluid and salt. And after a week or two it’s normally gone.


For testing their exercise capacity the brothers do “long sessions of uphill cycling”. The low-carb brother predictably loses badly.

Why? Two things: the body needs weeks or sometimes even months to adapt to high-intensity exercise, using mostly fat and ketones. And even then you might need a little bit of carbs for explosive and anaerobic sports like this.

I’ve interviewed Dr Peter Attia who successfully races his bicycle for hours on a very low-carb diet. Even he uses a little bit of slow-release starch for maximum performance on his long training sessions:

YouTube: Very Low Carb Performance


Finally the icing on the (diabetes) cake. The doctor claims that the low-carb brother has become “almost” pre-diabetic by eating low-carb! The word “almost” should actually be interpreted as “not”. I wonder if the doctor knows the first thing about low-carb and diabetes. In fact I wonder how much he knows about diabetes at all.

The low-carb brother has a fasting glucose of 5,1 before the diet (normal) and a fasting glucose of 5,9 after the diet (normal). Did you catch the word “normal” twice? Yes, thats right, a fasting glucose of up to 6,0 mmol/L is considered normal, at least in Sweden. It also varies significantly from day to day. If we tested the doctors’s own fasting blood glucose it might be 5,9 today and 5,1 tomorrow.

The result could be due to chance but sometimes the fasting glucose level actually gets slightly higher on an LCHF diet, while the glucose levels during the day (after meals) is way lower. This is probably because the body is adapted to burning fat and so the need for burning glucose when fasting is lower. Thus you don’t get the same fasting “dip” in sugar levels.

They also did glucose tolerance tests – a much more relevant test. But the result of the low-carb brother is never mentioned. I guess it was normal.

The fact that diabetes is effectively treated with a low-carb diet should tell us everything we need to know. You don’t get type 2 diabetes by eating a diet that can cure diabetes. And you certainly don’t get type 2 diabetes (strongly correlated to obesity) by losing 4 kilos of excess weight in a month.


The documentary concludes that it’s not about fat or sugar, it’s about avoiding processed food with both fat and sugar in it. I’m sure that strategy would work fine for these two fairly fit brothers. It’s an excellent start. But it’s not enough for everybody.

In people with obesity and diabetes studies convincingly show that low-carb diets are more effective.

Finally, while a super-strict low-carb diet is not necessary for everyone and has possible side-effects (especially during the first week or two) it certainly do not result in diabetes. That’s just ignorant.

What did you think about the documentary?


Diabetes – How to Normalize Your Blood Sugar

New Study: A Low-Carb Diet and Intermittent Fasting Beneficial for Diabetics!

Football Champions on a Low-Carb Diet

Swedish Expert Committee: A Low-Carb Diet Most Effective for Weight Loss

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  1. Murray
    Francois, thanks for that. I gain more understanding and working knowledge from successful clinical interventions based on known metabolic understanding and adapted in response to experience, such as Dr. Fung's work, than tier one studies that require massive funding and are invariably designed to please the source of funding. These days, I don't put much stock in any tier one study the results of which did not shock those who designed it. None of Darwin, Snow or Semmelweis had tier one studies. Patterns present themselves through experience and the great scientists excel at hermeneutics. Proof follows later, after a generation or two have died out (or patents have expired). So the question is, how good are your interpretive skills to make sense of clinical experience and extend your health span (length of healthy, active, mentally engaged life) before the means to proof beyond doubt overwhelm vested commercial, governmental and ideological interests?

    My qualifying observation here is that which is curative is not necessarily preventative or optimal for those not needing the cure. That said, ketosis seems optimal on a lot of fronts, with the trade offs becoming less significant as I age. Sure, an Olympic-winning performance in a high burst sport, such as ice hockey, will require more carbs. If I were 20 again this might be a greater concern for me. At 54 I am content to have spent all day yesterday downhill skiing aggressively for the first outing this season (been busy lately) with the front of the pack after skipping breakfast (just some bulletproof rooibos tea and 100% chocolate), with no stiffness today. Another body with another agenda would have another diet.

  2. FrankG
    Well I managed to sit through this programme last night. Their bias was of course obvious from the outset. The assumption that the "high fat" diet (looked like high protein to me, based on what little we were shown) would inevitably lead to bad breath and constipation as just one of many examples... nothing like prejudging a test before you have even started eh?

    Dr Lustig gets to have some say (after a "joke" about pigging out on donuts) but then his ideas are dismissed offhand by one of the twins at another location.. in such a way that Dr Lustig has no opportunity to respond. Last word eh?

    Where were the exports on LCHF, nutritional ketosis etc... all very one-sided.

    Not impressed with the researchers at all... a fasting BG of 5.1mmol/L is not very good? On what planet?

    As for the Professor in the darkened room writing on an overhead projector (all very dramatic I'm sure) she apparently has financial ties to WW and another weight-loss company.

    Overall I think this was just sensationalist TV and I wonder who sponsored the whole thing?

    This movement to buoy up sugar against the unfair claims of these "faddish" LCHF diets... I can't help but ask, where the heck were these same voices when we were all advised to go on the "faddish" low-FAT diet?

    I hope the take away message for at least some is that: for young, relatively lean people, avoiding processed, packaged, manufactured "food" goes a long way to staying healthy but I doubt that is what many will take away from this opinionated and agenda-driven work of fiction...

    In my youth, the BBC was a trusted source for unbiased reporting of science and current events.. nowadays it seems they have gone the way of the tabloids. For shame.

  3. NS

    Thank you for mentioning Dr. Fung's contributions to the debate and to his patients. What he has done is quite impressive. I would recommend anybody interested in diabetes and obesity to see his website and youtube videos. What seems to be not expressed enough here however is one over-riding fundamental truth, which incidentally is the bridge (of truth) between low carb advocates and proponents of more established methods or CICO, and that is, that calories themselves - ALL CALORIES - are insulogenic, despite carbohydrates being the worst offenders. Fasting, the functional result of gastric bypass surgery, reverses diabetes precisely because there is a virtually insurmountable cap on the amounts of food that can be consumed. All one needs to do is watch some youtube videos of the diets of post-op patients, the overwhelming majority of whom lose - and keep - their weight off, long-term. The amounts are quite small, but despite the fact that most of them contain moderate amounts of some carbohydrate foods, the "forced" meal plans work. What greater evidence does one need demonstrating the absolute supremacy of the significance and impact of calories?? What greater evidence does one need demonstrating the absolute necessity of judging the worth/detriment of specific macro-nutrients, only in the context of one's overall calorie intake?? In case anybody needs reminding, gastric bypass surgery is among the most successful obesity management therapies currently available. Dr. Fung's approach, not dis-similar to the approach and efforts of Dr. Eenfeldt, is to mimic the behavior of post op patients without the surgery, hence, his fasting regimen, and like those meal plans, carbohydrates, even (whole) grains, are not off limits....even fresh fruit consumption is encouraged! The fundamentalist Jimmy Moore types and others who continuously bash CICO, who continuously glorify fat to absurdly irrational degrees, are doing no favors to their readers who eventually realize the hard way through weight management failure/gain and/or nightmarish cholesterol/lipoprotein numbers the fantasy land nonsense that is the "calories don't matter' mantra.

    Replies: #64, #73
  4. FrankG
    ... except that I am not eating CALORIES but rather FOOD (steak, bacon, eggs... cooked with coconut oil, butter and garlic, as I write this) Another point overlooked by this sham of a "documentary" is that we don't just eat for energy... we eat to nourish our bodies and the QUALITY of what we eat has a direct and measurable effect on how that food is digested, metabolised, partitioned etc...

    Carbohydrates being the "worst offenders" in terms of being insulinogenic IS significant.

  5. Pingo
    We all know that it takes 3-4 months for the body to be completly adapted to a high fat diet and doing a test after just one month indicates that this TV show had stacked the cards in advance. I believe it was on purpose.

    The muscles are not adapted after only 4 weeks and that was obvious when they did the bicycle test.

  6. FrankG
    And day-trading as a test of mental acuity?!? Are we supposed to accept that because they are identical twins, then they must be identical in all respects? Equally intelligent? Equally adept at the same type of tasks? Where was the crossover trial? What was their performance as day-traders on their "normal" diet?
  7. BobTB
    The irony of folk here bemoaning the lack of scientific fortitude in this show is pretty funny.Considering the propensity of cherry picking data of often dubious scientific value to support the "agenda" of the Doc.

    As has been pointed out by others the very first sentence in the LCHF for beginners page says this

    "Do you want to eat real food (as much as you like) and improve your health and weight?""

    That is total and utter nonsense , irregardless of the way your body deals with different foodstuffs , the absolute bottom line is that a calorie deficiency is the only way to lose weight whether you do it by reducing calorie intake or by expending more energy . "eating as much as you like " especially of calorie dense foods like butter unchecked will have one result. If the suggestion had been that eating a smaller amount of LCHF foods will in theory at least satisfy you more than other eating plans then that is different.

    The tabloid headlines and rampant defensive posts of anything that does not support the agenda of LCHF is actually very damaging for the credibility of the underlying message.

    Replies: #58, #61
  8. Sami
    The idea is to eat fat (which is the most efficient energy source) so that you satisfy your needs, hence you will eat "as much as you like", which in reality will give a majority a calorie deficiency.

    I don't see the need to tell people in the very first sentence what they will find out themselves, either by reading up on the subject or learn by experience.

  9. NS

    Your writings are very interesting. We seem to appreciate similar styles of thought. That you brought up Semmelweis is very compelling indeed and so pertinent to the entire discussion here. I suspect you would appreciate then this poorly rephrased passage from Merleau-Ponty's, The Visible and Invisible:

    "Western history reasonably thought it could by suspending phenomena to search for the reasons behind them explain with absolute certainty that which we have yet to understand. The problem however is that it is clear in the case of phenomena and reasons, it is always the case that the former comes BEFORE the latter and the latter are only there to confirm our thoughts when they are shaken, that is, when we stop SEEING."

    Knowing of Semmelwies, knowing the lessons of Meno's paradox, it baffles the mind how people of intelligence, open minds, can take absolute positions, particularly in nutrition where the contexts are nightmarishly and increasingly complex. Incidentally, are you aware of the incredibly depressing realities that face ME/CFS patients or those with chronic viral syndromes that do not resolve and how that relates to the entire discussion here? It is becoming increasingly clear that the entire human population is quickly heading in that direction. The consequences for the picture of obesity and insulin resistance, among all of the other lovely coming symptoms and ill health of the species, are too devastating and monstrous to imagine. You might be interested in these:

    Replies: #63, #65
  10. Nan
    I was very disappointed in the sloppy nature of this quasi-experiment. I would dearly love to see rigorous testing with or without twins.
  11. Miriam
    I watched the documentary and found it worrying. I found myself thinking, oh no, what if I'm giving myself diabetes, doing this? Who the hell are we supposed to believe?

    I have been intermittent fasting (5:2) since January 2013. After losing about 3 stones in weight I dropped to 6:1 in September. I am vegetarian - I was vegan and to that I owe my serious overweight, I am sure. Reading the 5:2 forum led me to this LCHF site and the Jason Fung documentaries. Accordingly I stopped eating wheat about 4 months ago and my weight has dropped another stone. I do not think I do LCHF 'properly' as I don't eat meat or fish and I have not given up root veg apart from potatoes. I have never felt better and my weight loss has now slowed down. I changed my doctor last week and at the obligatory check-up my blood pressure/sugar and weight were all good for a 61-year old, 5'11" woman. I work out with weights twice per week, there seems nothing wrong with my muscle-tone and I can run easily uphill. I'm told I look good but I can't comment on that. I can't ask for more at my age, really!

    I was relieved to read the Diet Doctor's views on the BBC programme and all the apparently informed comments on it which I have found reassuring.

    Call me perverse but I was also glad to see your comment, Bob. I do not regard LCHF, 5:2, paleo or wheatbelly etc as religions - many followers seem to, in my opinion and theycannot stand anyone taking issue with them - and it is very clear that what suits one person will not work for another. Lots of my friends hate 5:2 and refuse to do it, for, example.

    I did think that the BBC documentary was biased, sensationalist (apart from the 50:50 fat/sugar sensible stuff) but it does my head in that the occasional poster here thinks that the signed-up pro-establishment corporate entity ('C' stands for corporation after all) that is the BBC should be 'left-wing.'

    Also, sorry to be a pedant, Bob, but there is no such word as 'irregardless'. I might add that the poster who mentioned 'political correctness' should be aware that this is a right-wing invention, albeit a very clever one which I think is here to stay.

    Whatever lifestyle you follow, Bob, good health to you!

  12. Sharon
    I really enjoyed the show. It makes sense that the twin eating a lot of fat became pre-diabetic - high blood fat causes insulin receptors to lose their sensitivity. Low sugar/carb diets only reduce diabetes symptoms. To prevent or reverse diabetes, dietary fat must be lowered to very low levels. Read George Barnard's book on reversing diabetes. Or learn about how insulin receptors work. Low carb (high fat) diets are bad news for diabetes risk.
    Replies: #67, #75
  13. Murray
    Thanks, NS. Lots of homework for me there.

    Yes, I read a lot of Merleau-Ponty, Paul Ricoeur and Martin Hiedegger, while studying philosophy of science. Part of the toolkit.

  14. Murray
    NS, in my experience not all calories are equal in effect and so the CICO model is misleading at best. For example, I read research that cells low in energy signal to the liver to produce more bile, to ingest more fat from the gut. This seemed to me to be an expensive metabolic signalling system to evolve and sustain unless not all fat is otherwise ingested from the gut. So I did an experiment and ate as much fat as I could stand for three weeks, some 5000-8000 calories per day, working a an office job, doing elliptical for 30 minutes three times per week and no other exercise other than walking around as per usual. The result was zero weight gain and floating feces. Extra fat just passed through and I remained at 8% body fat.

    I have also noticed that having loads of fat with modest protein and little carb results the next morning for me medium blood sugar (4.3 mmol/L) and high ketones, which implies low insulin. Big protein results in higher blood sugar (4.8-5.1 range) and lower ketones (0.8-1.2 range). More carbs than usual results in medium blood sugar (around 4.3 mmol/L) and low ketones (0.6-0.9). So that shows there is or has been insulin to knock down the ketones, to lower blood sugar. To get blood sugar below 4.0, I need to do caloric restriction. This is much easier (in terms of feeling like eating) on mostly fat (I get by well on a few snacks of a few lightly roasted cacao beans). This lowers blood sugar to as low as 2.8 but usually around 3.6, with higher ketones, sometimes going over 5.0. No problem at all with the lower blood sugar, due I expect, to the elevated ketones.

    I have also seen ingenious experiments where obese mice were made to starve on a calorically restricted high carb diet where they remained obese despite starving. Presumably the insulin response to the carbs blocked metabolic access to stored fat.

    So I conclude that I can eat as much fat as I like, and do, and do not gain any weight. I do not lose weight eating loads of fat, but I am already fairly low body fat. If I were obese, I might well burn body fat. I expect that the extent to which fat cells are replete influences how easily that fat can be accessed for energy. At low percent body fat, I expect it is more difficult to mobilize stored fat and more dietary fat is necessary to sustain high energy levels. So cells would signal the liver to make bile and the rate of fat absorption from the gut would exceed the rate of fat extraction from adipose tissue. For someone with high adipose fat, the rate of extraction may supply sufficient energy to cells such that no bile request signal s sent and excess body fa is burned in preference to absorbing fat from the digestive tract. So one might lose body fat eating high fat high calorie until some cross-over point and then fat loss will stall without caloric restriction.

    This was my experience. I lost stored fat easily for a while and then had to do calorically restricted LCHF to lose more weight. I did this on a two week trip to Italy, essentially a LCHF dining tour eating a lot of high fat cheese (I discovered Burrata) but not overly high calorie (little hunger with 200 grams of Burrata for breakfast) and walking a lot, and I came back at my lowest weight since I was 14, with less than 6 percent body fat. Several years earlier working out 90 minutes per day five days a week and riding mountain bike on the weekends eating low fat I was stuck at 15 percent body fat.

    So calories are relevant, but more important is managing appetite, and high fat does tha very well for me. I can consciously control my percent body fa so long as I am LCHF.

  15. Murray
    Thanks, NS, very interesting references. I note a couple of things. Phinney and Volek cute research showing wide variation in the percent carbs on diet at which people start steeply increasing liponeogenesis from carbs. Some shoot up with as low as 20% calories from carbs. So perhaps viral infection in part accounts for wide variation in this carb tolerance.

    I also note that my lifelong cold sore has been almost entirely in remission since going LCHF and having a few cranberries daily. So much of the success of LCHF might be in enhancing the immune system and withstanding better the effects of viruses.

    I will watch for more on this topic. Thanks again.

  16. Sharon
    *Neal Barnard.
  17. Galina L.
    As far as I understood, the LC twin did not became a pre-diabetic, his fasting blood sugar which is normally fluctuates was slightly higher at the last testing , who knows how it normally fluctuates in his case .I guess, the pre-diabetic speculations were added for an extra dramatization normal for a TV show. It was not a prober scientific experiment. Does anyone remember Steffanson Why not to refresh in a memory another, but well-designed, research when two men lived on a meat-only diet for a year, not only for a month?
    "At the end of the year, the subjects were mentally alert,
    physically active, and showed no specific physical changes in any
    system of the body. "
  18. Peter
    Zoe Harcombe has her say on the programme (hint, she's not impressed) -
  19. Galina L.
    Don't worry, Chris,
    Here is another programmer, he found out LC is helping him , and that government guidelines on statines may even give him an advantage -

    "That’s when I realized how much your new guidelines will benefit me personally. You see, as a software programmer, I’m what’s known as a “knowledge worker.” My livelihood depends entirely on my ability to memorize, conceptualize, and think my way through complex problems. In my field, experience is considered a major asset, largely because solving a software problem often involves recalling how we solved a similar problem in the past. It’s no coincidence that most of the other programmers I work with are in their 40s or 50s."

  20. Jin
    The most annoying statement in this documentary for me was when the high fat eater stated that he was sticking to "healthy" polyunsaturated and monounsaturated fats. At this point the doctor lost all credibility in my eyes.
    Although he did acknowledge saturated fats were making a comeback, he was clueless about the inflammatory nature of his choice of fats.
    Reply: #104
  21. paleozeta
    "am i overweight ?". we need to check your BMI. wtf!!
    you have just done the body composition scan!! and it is 26% fat.
    you are not a scientist man.
    bmi means nothing!
  22. NS

    Thank you for the comprehensive responses. Your experiments and experiences are quite interesting. I'm glad that you have found something that works for you. Unfortunately, there are many obese individuals who do not respond to that kind of treatment. As you mentioned, "calories are relevant but satiety is key." I completely agree with this. For me, getting to satiety on non-starchy veggies, including low sugar root veggies like uncooked carrots and daikon radish with small amounts of fat and protein is much easier and sanity conducive and than bacon and butter all day. I often wonder whether a diet higher in calories but virtually ketogenic can offer more benefits than a low calorie basic low carb plan. Also, high fat meals always exacerbate my acid reflux symptoms. I've tried HCL but to no avail. In any case, for sure protein and fats are "safer' than carbs but one always has to still be mindful of calories while at the same time trying to attain satiety. I don't know if you've encountered her yet, but one of the best blogs I've found on the net is the itsthewooblogspot. She often writes about the tension between calories and ketosis.

    With respect to pathogens and obesity, the situation is extremely bleak and will only get worse until science develops some way to mange or treat viral infections. By 2020, virtually every human being will be infected with a chronic viral syndrome of some sort whose symptoms never resolve and only increase in severity with the passage of time. My own guess as to why insulin resistance is so associated with those conditions is actually rather simple....all diseases accelerate the aging process, perhaps by mechanisms related to insulin. As people age, their insulin sensitivity worsens. This, I believe, is the basic mechanism.

    Reply: #74
  23. Francois
    Sorry for the late reply: work keeps me very busy. A precision is warranted here: carbs are by far the macronutrients that stimulate insulin. Very high intake of protein many also have a significant insulinogenic effect. Fats, not quite so. The most interesting demonstration is seen in a very recent paper by Yoshifumi and coll ( Yoshifumi Y, Uchida J et al., A non-calorie-restricted Low-carbohydrate Diet is Effective as an alternative therapy for patients with Type 2 Diabetes.
    Intern Med 53: 13-19, 2014). The article is available free online. I strongly advise you take a look at figure 2.
    The authors compared two diets on their effect on HbA1C and on triglycerides in type 2 diabetics. The first was a calories-restricted with no restriction on carbs. The second was a somewhat restricted carbs diet (70-130g carbs per day) with no caloric restriction. In the lowER carb diet, "Total carbohydrate intake to be <130 g/day, lower limit of carbohydrate intake to 70 g/day to prevent ketosis, target carbohydrate content in each meal was 20-40 g to prevent postprandial hyperglycemia, 2 x 5g sweets allowed for a total carbohydrate intake of 70-130 g/day. INTAKE 29.8±12.5% CARBS, 25.3±7.3% PROTEIN and 45.4±8.9% FAT in the low-carbohydrate group". So nothing ketogenic, by far.

    Nonetheless, there are major differences with the two approaches. The carb-somewhat restricted diet people had an immediate decrease in their HbA1C AND triglycerides (the latter being expected)while the caloric restricted but carb plentiful diet produced no effect either on HbA1C or triglycerides.

    What is fascinating is that after four months, HbA1C started creeping up slowly in the carb somewhat restricted diet. In diabetics, it seems an intake of 70 grams of carbs per day is still too much. Dr Fung, to whom I alluded in a previous post, gets HbA1C to normal (and TG) with a combination of LCHF diet and breakfast skipping.

    So there is a major difference between macronutrients. The question is therefore not if is is feasible to thrive on a ketogenic diet: the proof has been made for thousands of years by the Eskimos and, more recently, by those white men who adopted their diet, both in the North and in new-York city in a diet experiment. In the western word, it would be rather difficult, if not impossible. It is nevertheless possible to eat a HFLC diet (and even a ketogenic diet) in the western world. And the more sick people are, the more ketogenic their diet should be: it has had major positive effects in epilepsy, cardiovascular disease, diabetes, Alzheimer's and cancer.

    That even keto-adapted people need more carbs when very physically active is commonly said. After reading Peter Attia's blog and seeing what the Inuits have done, I doubt this is true. There is definitely no danger in adding carbs up to 40% of the total caloric intake in healthy people but anything over 40% of caloric intake will switch on inflammation at the epigenetic level.

    Reply: #103
  24. murray
    NS, I'm partial to black radishes. I have a good source of local black radishes at the market for most of the year. Lots of zing when eaten raw. The grower of course touts them as some immune system miracle food or whatever, but I get them for taste alone.

    I get a lot of satiety from green vegetables. Leftovers from dinner Saturday included Brussels sprouts (parboiled in bone-broth chicken stock, then sauteed gently in the stock, cream and thyme) and braised greens (two kinds of kale and chard, braised in butter and reduced stock). I ate large plate-filling portions of these for lunch the next day and it was a very satisfying meal with just that. I taste the sugars in cooked greens and Brussels sprouts--so they are a like a savory dessert treat for me--but not enough sugar to throw me out of ketosis. My hypothesis is that highly cell-encased carbs with a low ratio of sugar to cells have a slower rate of absorption and are largely consumed by good bacteria in the gut, so 50 grams sugar in fruit and 50 grams in vegetable have different effects. I eat a baseline amount of fennel, cabbage, celery, lettuce or such to ensure I have sufficient sugar to feed my good bacteria. I can eat a satisfying amount without affecting my ketone levels.

  25. Paul the rat
    "...Low carb (high fat) diets are bad news for diabetes risk…"

    are they ?

    (by the way Sharon please tell Neal Barnard either to make an effort to grasp the basic principles of human glucose biochemistry or just treat his patients for colds, cuts and bruises)

    Mol Cell Endocrinol. 2012 Nov 25;364(1-2):1-27. doi: 10.1016/j.mce.2012.08.003. Epub 2012 Aug 10.
    The molecular mechanisms of pancreatic β-cell glucotoxicity: recent findings and future research directions.
    Bensellam M, Laybutt DR, Jonas JC.
    Author information

    It is well established that regular physiological stimulation by glucose plays a crucial role in the maintenance of the β-cell differentiated phenotype. In contrast, prolonged or repeated exposure to elevated glucose concentrations both in vitro and in vivo exerts deleterious or toxic effects on the β-cell phenotype, a concept termed as glucotoxicity. Evidence indicates that the latter may greatly contribute to the pathogenesis of type 2 diabetes. Through the activation of several mechanisms and signaling pathways, high glucose levels exert deleterious effects on β-cell function and survival and thereby, lead to the worsening of the disease over time. While the role of high glucose-induced β-cell overstimulation, oxidative stress, excessive Unfolded Protein Response (UPR) activation, and loss of differentiation in the alteration of the β-cell phenotype is well ascertained, at least in vitro and in animal models of type 2 diabetes, the role of other mechanisms such as inflammation, O-GlcNacylation, PKC activation, and amyloidogenesis requires further confirmation. On the other hand, protein glycation is an emerging mechanism that may play an important role in the glucotoxic deterioration of the β-cell phenotype. Finally, our recent evidence suggests that hypoxia may also be a new mechanism of β-cell glucotoxicity. Deciphering these molecular mechanisms of β-cell glucotoxicity is a mandatory first step toward the development of therapeutic strategies to protect β-cells and improve the functional β-cell mass in type 2 diabetes.

  26. Paul the rat
    Zoo Biol. 2014 Jan 13. doi: 10.1002/zoo.21115. [Epub ahead of print]
    Implementing a low-starch biscuit-free diet in zoo gorillas: The impact on health.
    Less EH, Lukas KE, Bergl R, Ball R, Kuhar CW, Lavin SR, Raghanti MA, Wensvoort J, Willis MA, Dennis PM.
    Author information

    In the wild, western lowland gorillas consume a diet high in fiber and low in caloric density. In contrast, many gorillas in zoos consume a diet that is high-calorie and low in fiber. Some items commonly used in captive gorilla diets contain high levels of starch and sugars, which are minimal in the natural diet of gorillas. There is a growing concern that captive gorillas may qualify as obese. Furthermore, the leading cause of death for adult male gorillas in zoos is heart disease. In humans, a diet that is high in simple carbohydrates is associated with both obesity and the incidence of heart disease. In response to these issues, we implemented a biscuit-free diet (free of biscuits and low in fruit) and measured serum biomarkers of obesity and insulin resistance pre- and post-diet change at three institutions: North Carolina Zoological Garden, Cleveland Metroparks Zoo, and Columbus Zoo and Aquarium. We also added a resistant starch supplement to gorilla diets at two of the above institutions. We anticipated that these diet changes would positively affect biomarkers of obesity and insulin resistance. Both diet manipulations led to a reduction in insulin. Resistant starch also decreased overall serum cholesterol levels. Future research will examine these health changes in a greater number of individuals to determine if the results remain consistent with these preliminary findings. Zoo Biol. 9999:1-7, 2014. © 2014 Wiley Periodicals, Inc.

  27. Paul the rat
    Cancer Metastasis Rev. 2014 Jan 17. [Epub ahead of print]
    Calories, carbohydrates, and cancer therapy with radiation: exploiting the five R's through dietary manipulation.
    Klement RJ, Champ CE.
    Author information

    Aggressive tumors typically demonstrate a high glycolytic rate, which results in resistance to radiation therapy and cancer progression via several molecular and physiologic mechanisms. Intriguingly, many of these mechanisms utilize the same molecular pathways that are altered through calorie and/or carbohydrate restriction. Furthermore, poorer prognosis in cancer patients who display a glycolytic phenotype characterized by metabolic alterations, such as obesity and diabetes, is now well established, providing another link between metabolic pathways and cancer progression. We review the possible roles for calorie restriction (CR) and very low carbohydrate ketogenic diets (KDs) in modulating the five R's of radiotherapy to improve the therapeutic window between tumor control and normal tissue complication probability. Important mechanisms we discuss include (1) improved DNA repair in normal, but not tumor cells; (2) inhibition of tumor cell repopulation through modulation of the PI3K-Akt-mTORC1 pathway downstream of insulin and IGF1; (3) redistribution of normal cells into more radioresistant phases of the cell cycle; (4) normalization of the tumor vasculature by targeting hypoxia-inducible factor-1α downstream of the PI3K-Akt-mTOR pathway; (5) increasing the intrinsic radioresistance of normal cells through ketone bodies but decreasing that of tumor cells by targeting glycolysis. These mechanisms are discussed in the framework of animal and human studies, taking into account the commonalities and differences between CR and KDs. We conclude that CR and KDs may act synergistically with radiation therapy for the treatment of cancer patients and provide some guidelines for implementing these dietary interventions into clinical practice.

  28. Paul the rat
    more carbohydrates in diet = more LECT2; less carbohydrate, more fat in diet = less LECT2; less LECT2 = increased insulin sensitivity

    Diabetes. 2014 Jan 29. [Epub ahead of print]
    LECT2 functions as a hepatokine that links obesity to skeletal muscle insulin resistance.
    Lan F, Misu H, Chikamoto K, Takayama H, Kikuchi A, Mohri K, Takata N, Hayashi H, Matsuzawa-Nagata N, Takeshita Y, Noda H, Matsumoto Y, Ota T, Nagano T, Nakagen M, Miyamoto KI, Takatsuki K, Seo T, Iwayama K, Tokuyama K, Matsugo S, Tang H, Saito Y, Yamagoe S, Kaneko S, Takamura T.
    Author information

    Recent papers have reported an association between fatty liver disease and systemic insulin resistance in humans, but the causal relationship remains unclear. The liver may contribute to muscle insulin resistance by releasing secretory proteins, termed hepatokines. Here, we demonstrate that leukocyte cell-derived chemotaxin 2 (LECT2), as an energy-sensing hepatokine, is a link between obesity and skeletal muscle insulin resistance. Circulating LECT2 positively correlated with the severity of both obesity and insulin resistance in humans. LECT2 expression was negatively regulated by starvation-sensing kinase adenosine monophosphate-activated protein kinase (AMPK) in H4IIEC hepatocytes. Genetic deletion of LECT2 in mice increased insulin sensitivity in the skeletal muscle. Treatment with recombinant LECT2 protein impaired insulin signaling via phosphorylation of JNK in C2C12 myocytes. These results demonstrate the involvement of LECT2 in glucose metabolism, and suggest that LECT2 may be a therapeutic target for obesity-associated insulin resistance.

  29. NS

    Thank you for the paper. I reviewed the results and enjoyed reading it. I am not disputing any of its findings and am a low-carb subscriber myself. My point was not to argue in favor of calorie restriction instead of low carb but in addition to or along side low carb. An unrestricted low carb diet and even in some cases an unrestricted ketogenic diet many times fails its participants, despite compliance. Atkins, Taubes, and Eades all concede the inviolability of calories. The nonsense ideas of "eat as much as you want without consequence" of some of their followers is puzzling and absurd. People who fail long term on Atkins/LCHF are either eating too much, or are not compliant, or have serious mitochondrial dysfunction issues, perhaps as a result of underlying chronic infection, or are victims of their own genetics, or simply need to increase their energy output through exercise. In any case, one can never dismiss the ultimate significance of calories under any circumstances. With respect to worst offenders, it is true that carbs are the most damaging in terms of insulogenicisity and fat is the least damaging. But least damaging does not equal non-damaging. All calories are insulogenic; it does not make any sense in the least from an evolutionary perspective to have fat or protein as non-energy creating and storing. How would the Inuit or those Alaskan bears survive otherwise?

    Further, there is an abundance of evidence of formerly obese people who have lost weight and kept it off for longer than five years on lower calorie diets (WLS surgery patients for instance or those registered on the US National Weight Loss Registry who have followed non-low carb regimens) which included far higher ratios of carbs than what would be allowed on typical low carb regimens. You might be interested in this woman's story for instance:

    Of course, like you, I believe that it is healthier in the long term to eat predominantly lower carb nonetheless because of its very effective ability to lower triglycerides, increase HDL, lower blood pressure, dramatically lower inflammation, lower insulin, etc....But starvation and exercise are far more efficient at reducing insulin than any diet regimen and we cannot escape basic thermodynamics...

    Also, I am fond of Dr. Fung's fasting protocol. But you should know a few things. He does not necessarily advocate a low carb regimen, but rather, a lower carb and a refined grain free, especially wheat, regimen. His 24 and 36 hour intensive programs allow patients to 1) eat "all the fruit [they] want" if they so choose as well as 2) legumes and whole grains in moderation, if they so choose. He links in his videos the fiber contained in rice and other whole grains to why Asians (at least until the introduction of the western diet) were largely free of diabetes and almost entirely of obesity. (Speaking of which, I have lived in Asia for many years and the idea that they eat brown rice instead of white is utter nonsense. White rice is THE staple dish at every meal and at three meals a day. People who eat brown rice there do it mostly for health reasons. What I have observed however is that their portions are surprisingly small, they do not eat so much protein, and they eat very little fat. They sometimes snack on junk but their overall daily caloric intake is not high. Also, they move far, far more than westerners do.) So, in essence, the Fung program, is essentially a lower calorie program. That he links his ideas together with lower carb and insulin reducing processes such as fasting makes his protocol very interesting and perhaps a beacon of hope for those who fail or don't thrive on low carb.

    Finally, the other point I hoped to get across is that there are conditions of disease that significantly contribute to, or may even be causal of, insulin resistance and obesity - mainly emerging viral/bacterial pathogenic infectious agents. For the most part, doctors and scientists completely dismiss this at the moment but they are dead wrong. As Murray alluded to above and I pointed out, it is always - always - the phenomena that come first, and our understanding/explanations of them, later. Those arrogant doctors who dismiss and blame patients today will soon regret their actions and thoughts when they themselves as well as their own children soon become sick.

    Replies: #80, #89
  30. murray
    "To the things themselves!" as Edmund Husserl would say. Or as the jurist Oliver Wendell Holmes Jr. observed, "The life of the law has not been logic; it has been experience." (Few appreciate the founder of modern scientific method, Sir Francis Bacon, wrote novum organum while chief justice of England.)
  31. NS

    "The Hermit doubts whether behind every one of his caves, there is not always another, deeper, richer one, more comprehensive in meaning.......that shakes the ground beneath and even the idea of 'grounds' itself." - Zarathustra

    "If I have no idea what I'm looking for, then how can I begin to search for it......and if I already know exactly what it is I'm looking for, then why should I bother searching for it?" - Meno

  32. NS
    Speaking of sugar or fat, I just found this to my dismay. I was wondering if any experts who may be reading can comment on this. Are there dangers to LCHF that we should perhaps be more mindful of?"

    "Ketoacidosis during a Low-Carbohydrate Diet"

    Replies: #83, #84
  33. murray
    Curious they did not measure blood ketones.

    The blood sugar was extremely high. I've been very low carb for six years and have yet to measure blood glucose above 100 mg/dL, even after meals, usually around 80 mg/dL (4.4 mmol/L). With her HbA1c at 5.4, it seems her blood sugar was not high continuously. So her episodes appear to have been discrete disturbances to metabolism triggered by something (a virus?) rather than a continuous condition.

  34. Boundless
    "... it is physiologically impossible to induce DKA in anyone that does not have T1D or very, very, very late-stage T2D with pancreatic “burnout.”
    DKA is only a risk for people who produce little or no insulin. This would be Type 1 diabetics, those with LADA, and advanced T2Ds.

    Even for people who are low insulin, such as T1Ds, the condition can be managed, with minimal drugs, via a ketogenic diet (e.g. Dr. Richard Bernstein). It requires some care.

    Waving the DKA flag is usually an indicator of someone stuck in old dogma.

  35. Suzie
    Re: the "thick-heddiness" one of the twins refers to.

    If low carb diets really would affect your brain long term, how come I was able to qualify for Mensa on strict LCHF? Just sayyin'....

  36. Inge-Mo Haraldh
    Bra hel sändning av första delen
  37. Huib
    The BBC docu was pure rubbish. What can you expect as a result with these two diets with only 2 persons over 1 month? The outcome is of now value at all. The participants were both doctors. Weren't they aware of the fact that this trial had no scientifical merit at all?
    It brings to mind annathoer BS series by the BBC The truth about food (2007?) in which similar nonsensical tests were performed. It is unbelievable to me that the BBC produces this kind of simplistic programs and even gets real scientists to collaborate.
  38. Dale
    Well I'm depressed!! I've been on low carb since August 2013. I lost about twenty lbs. and that's it. I need to lose 100 lbs. Now this story comes out. I read all the responses and now I'm more confused than ever. I'm 63 and three years ago I had a quad heart bypass operation. Luckily I did not suffer a heart attack first so there wasn't any damage to my heart. I tried the vegetarian route, only to gain more weight. I've also tried low calorie but couldn't stick to it. I'm on BP medicine as well as a statin. I truly thought that the LCHF route would work for me. I knew it would take time, but it was something I could stay on for the rest of my life. Now the postings on your site relating to the BBC program have me wondering if this route will work. I should mention that my cholesterol levels are good and triglycerides are low (according to last blood work). I was consuming around 30 net carbs per day, but this week I've lowered that to 15. Any suggestions? I'm ready to give up.
  39. bill
    NS said:

    'The nonsense ideas of "eat as much as you want without consequence" of some of [LCHF] followers is puzzling and absurd.'

    So you think eating as much as I want is absurd? If I don't
    eat as much as I want, I go hungry. Do you think it's
    absurd that people should not go hungry?

    Have you thought this through?

  40. Terri
    Francois thanks for the Japanese study. It was very good shame it was so underpowered with only n=12 per group. But good to see well set up, etc. Although most changes were not statistically significant it was interestign to see a drop in albumin creatinine ratio showing good kidney function a small drop on BP and a drop in LDL with LC
  41. John
    I watched the Horizon programme and thought it was a poor experiment.
    I dont think 1 month is long enough to see any real meaningful results.
    I was suprised though that the high sugar diet didnt show worse results for the High sugar brother, and I am concerned about the results of the insulin in the High fat brother, and although some people have tried to explain this I think it needs a further research.
    However from my experience I think that low carb high fat with fibre is the way to go, and from my experience I have lost weight, and feel healthier, have more ENERGY have lower blood pressure following a higher fat diet. I dont have the luxury of knowing my insulin levels on a regular basis, but have had blood taken during the first few months of being on an high fat diet and was not made aware of any issues.
    For the normal average Joe, which I am, i find alot of the comments re this subject really confusing, some misleading etc. One person thinks (or knows ) one thing, the other says another, I supose we are to take the ones who can back it up with research more seriously.
    I would like to find the real answer so we can all lead a healthier lifestyle and I can bring my children up following the right eating way.

    At the conclusion of the programme they talked about the results showing that a 50:50 diet was probably the worst.
    I dont think that we should ignore this finding, as this is how most western people eat and could be why there is the obesity epidemic. Again from my personal experience this has certainly been the most tempting food to me over the years, Milk chocolate, buns, pastries etc.
    Then one has to ask why then do the French not have so much of a problem and the Italians who eat plenty of bread, pasta, and deserts. There seems to be no easy answers and maybe the real but predictable, realistic, every day persons defeatest answer is: (Im gonna write a book). Everything in moderation.
    But please someone come up with a real answer for the average human.

  42. royal
    Doctors dont get wealthy from healthy people. With more and more ill people throughout the world the doctors incomes are skyrocketing. So tell me where is the motivation to make people healthy going to come from?These two doctors with their crocked planning, illogical rationale and indifference to getting it right are no different to all the other Ancel Keys of this world.
    Reply: #93
  43. Paul the rat
    I second that.
    Talking to fresh graduates from medical schools is depressing, for 99.9% of them diseases are natural states of humans, which are temporarily mended with drugs (as it is nicely demonstrated by these two morons on the video).
  44. Marjorie
    I couldn't watch the BBC content here in the States, but saw a clip on a local show and read some articles.
    Am I correct that the sugar-less twin gave up all vegetables and fruits? Though fruits would not be considered low sugar, giving up all vegetables meant that he also gave up many important nutrients. Moreover, many cheeses naturally contain carbohydrates in quantities comparable to low-carb vegetables, therefore eliminating veggies was bogus and undoubtedly contributed to his feelings of ill health.
    Reply: #95
  45. Paul the rat
    "..therefore eliminating veggies was bogus.."

    Absolutely, considering the quality of meats and fats so called sugar-less (and probably well paid) automaton ate.
    One can go without any plant derived food-stuffs for long time UNLESS one consumes variety of good quality meats, such as of organ meats, muscles of free roaming (working muscles) of animals et cetera. As we know composition of muscle meat of a cow, which stands in a barn and is fed cut grass, grains and hay differs beyond recognition from a muscle meat obtained from a free-range cow.
    For example running muscle meat contains conjugated linoleic acid :

  46. Paul the rat
    Evid Based Complement Alternat Med. 2013;2013:429393. doi: 10.1155/2013/429393. Epub 2013 Nov 25.
    Antiproliferative Action of Conjugated Linoleic Acid on Human MCF-7 Breast Cancer Cells Mediated by Enhancement of Gap Junctional Intercellular Communication through Inactivation of NF- κ B.
    Rakib MA1, Lee WS2, Kim GS3, Han JH4, Kim JO5, Ha YL6.
    Author information

    The major conjugated linoleic acid (CLA) isomers, c9,t11-CLA and t10,c12-CLA, have anticancer effects; however, the exact mechanisms underlying these effects are unknown. Evidence suggests that reversal of reduced gap junctional intercellular communication (GJIC) in cancer cells inhibits cell growth and induces cell death. Hence, we determined that CLA isomers enhance GJIC in human MCF-7 breast cancer cells and investigated the underlying molecular mechanisms. The CLA isomers significantly enhanced GJIC of MCF-7 cells at 40  μ M concentration, whereas CLA inhibited cell growth and induced caspase-dependent apoptosis. CLA increased connexin43 (Cx43) expression both at the transcriptional and translational levels. CLA inhibited nuclear factor- κ B (NF- κ B) activity and enhanced reactive oxygen species (ROS) generation. No significant difference was observed in the efficacy of c9,t11-CLA and t10,c12-CLA.

    These results suggest that the anticancer effect of CLA is associated with upregulation of GJIC mediated by enhanced Cx43 expression through inactivation of NF- κ B and generation of ROS in MCF-7 cells.

  47. Paul the rat
    Anticancer Res. 2013 Oct;33(10):4395-400.
    Conjugated linoleate reduces prostate cancer viability whereas the effects of oleate and stearate are cell line-dependent.
    Hagen RM, Rhodes A, Ladomery MR.
    Author information

    In this study, responses to fatty acid treatments in commonly used prostate cancer cell culture models and variability of gene expression between them were determined.
    PC3, DU145, LNCaP, VCaP and PNT2 cells were treated with 100 μM of either oleate, stearate or conjugated linoleate. Cell proliferation and viability were assessed using trypan blue and 3-(4, 5-dimethylthiazol-2-yl)-2, 5-diphenyltetrazolium bromide (MTT) assay respectively. Gene expression was measured using real-time polymerase chain reaction (PCR).
    Conjugated linoleic acid reduced cell proliferation and viability in all prostate cancer cell lines, whilst the effects of oleic and stearic acid on proliferation were found to be cell line-dependent. A reduction in gene expression of fatty acid desaturases was observed in prostate cancer cell lines compared to normal prostate cells.
    Differential responses of the cell lines investigated here to fatty acid treatment suggest that multiple prostate cancer cell line models should be used when designing experiments aimed at examining lipid metabolism in prostate cancer.

  48. Paul the rat
    Integr Cancer Ther. 2013 Nov;12(6):496-502. doi: 10.1177/1534735413485417. Epub 2013 Apr 30.
    Effect of conjugated linoleic acid supplementation on inflammatory factors and matrix metalloproteinase enzymes in rectal cancer patients undergoing chemoradiotherapy.
    Mohammadzadeh M, Faramarzi E, Mahdavi R, Nasirimotlagh B, Asghari Jafarabadi M.
    Author information

    The aims of this study were to determine the effect of conjugated linoleic acid (CLA) supplementation on inflammatory factors and matrix metalloproteinase (MMP) enzymes in rectal cancer patients undergoing chemoradiothetrapy.
    In this randomized, double-blind, placebo-controlled pilot study, 34 volunteer patients with rectal cancer undergoing chemoradiotherapy assigned into the CLA group (n = 16), receiving 3 g CLA/d, and placebo group (n = 18) receiving placebo capsules (sunflower oil) for 6 weeks. The supplementation began 1 week before starting RT (loading period) and continued every day during treatment. Before and after intervention, serum tumor necrosis factor α (TNF-α), interleukin 1β (IL-1β), IL-6, MMP-2, MMP-9, and high-sensitivity C-reactive protein (hsCRP) were measured by enzyme-linked immunosorbent assay (ELISA) kits and immunoturbidimetric method, respectively. Independent t tests and paired t tests were used to compare parameters between and within groups, respectively.
    In the CLA group, the mean serum TNF-α, IL-1β, hsCRP, MMP-9, and MMP-2 levels reduced insignificantly. However, significant changes in TNF-α (P = 0.04), hsCRP (P = 0.03), and MMP-9 (P = 0.04) concentrations were observed in the CLA group when compared with the placebo group. The mean serum IL-6 level remained unchanged in the CLA group but increased remarkably in the placebo group.

    According to our results, CLA supplementation improved inflammatory factors, MMP-2, and MMP-9 as biomarkers of angiogenesis and tumor invasion. It seems that CLA may provide new complementary treatment by reducing tumor invasion and resistance to cancer treatment in patients with rectal cancer.

  49. Paul the rat
    Biochim Biophys Acta. 2013 Apr;1831(4):759-68. doi: 10.1016/j.bbalip.2013.01.005. Epub 2013 Jan 15.
    Trans-10, cis-12 conjugated linoleic acid induced cell death in human colon cancer cells through reactive oxygen species-mediated ER stress.
    Pierre AS, Minville-Walz M, Fèvre C, Hichami A, Gresti J, Pichon L, Bellenger S, Bellenger J, Ghiringhelli F, Narce M, Rialland M.
    Author information

    Dietary conjugated linoleic acids (CLA) are fatty acid isomers with anticancer activities produced naturally in ruminants or from vegetable oil processing. The anticancer effects of CLA differ upon the cancer origin and the CLA isomers. In this study, we carried out to precise the effects of CLA isomers, c9,t11 and t10,c12 CLA, on mechanisms of cell death induction in colon cancer cells. We first showed that only t10,c12 CLA treatment (25 and 50μM) for 72h triggered apoptosis in colon cancer cells without affecting viability of normal-derived colon epithelial cells. Exposure of colon cancer cells to t10,c12 CLA activated ER stress characterized by induction of eIF2α phoshorylation, splicing of Xbp1 mRNA and CHOP expression. Furthermore, we evidenced that inhibition of CHOP expression and JNK signaling decreased t10,c12 CLA-mediated cancer cell death. Finally, we showed that CHOP induction by t10,c12 CLA was dependent on ROS production and that the anti-oxidant N-acetyl-cysteine reduced CHOP induction-dependent cell death.

    These results highlight that t10,c12 CLA exerts its cytotoxic effect through ROS generation and a subsequent ER stress-dependent apoptosis in colon cancer cells.

  50. Paul the rat
    So all you Aussies out there - go for the kangaroo and lamb meat - it's bloody beauty !! (it's might be even good foya!!}

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