@haidut
As always, we separately address different topics.
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Insulin Resistance (the original topic of the thread)
We cannot simply apply simple thinking to topics like insulin resistance. So what if it an "endocrine disorder". What is driving that disorder?
I am not dismissing any evidence whatsoever. I am taking high level mechanics (hormones), low level mechanics (mitochondria), everything in between, marrying that to circadian rhythms (which have HUGE effect on insulin activity), and then showing that one can weave an explanation that suits a particular context.
The fact is that we have all sorts of phenotypes, and insulin resistance is just one facet of the organism as a whole, and obviously shows wildly varying levels in all sorts of different people. Or as Bill Lagakos put it:
There are insulin sensitive obese people & IR lean people.
Tell me again how insulin resistance causes obesity?
see the whole post for details -- Insulin resistance and obesity
I am completely warranted in saying that there is no way to give generic advice regarding diet macronutrient ratios without knowing the person's context. The real world results speak for themselves, with so many different insulin sensitivity phenotypes experiencing so many different results with the same stimulus.
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Cortisol
In clinical practice, we see all sorts of patterns that make no sense whatsoever.
@paymanz post here is actually representative of many of the horrible cases that my doctor friends see -- Insulin Resistance As An Endocrine Disorder
For example, one of them told me: "Super High AM, then tanked .... Most of the bad cases either have curves like this or all flat. I have never seen an upside down curve"
Therefore, how do you know that:
There may be a post-meal cortisol spike (which is not normal), and certainly in most cases, cortisol drops after a meal -- Cortisol responses to mental stress, exercise, and meals following caffeine intake in men and women
See figure 1 (Cortisol responses to mental stress, exercise, and meals following caffeine intake in men and women), and note that:
- 200mg caffeine causing increased cortisol in the face of both mental stress and exercise
- mental stress was by far the overriding factor
- how this sort of not-too-stressful exercise barely budges cortisol
- how a mixed meal decreased cortisol levels
For every study like this, I can cite another one using people in a completely different context, and show different results. (eg: chronically exercising athletes, who are consistently over-taxing their system, showing chronic cortisol dysfunction -- Increased Cortisol Production in Women Runners* | The Journal of Clinical Endocrinology & Metabolism | Oxford Academic)
So yes, a change in context can invalidate all mechanics. That is point that I've been trying to get across. Context-free discussions are meaningless. Context must be qualified, and then each individual can decide if the mechanics can be generalised beyond that context, and under what new conditions / constraints.
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And of course, if PUFA is such a big deal with stress, prove it . Prove that there are generic mechanisms whereby PUFA is the make-it-or-break-it factor when it comes to stress, rather than just some gross trauma or energetic deficit to the tissue.
We know the dangers of PUFA peroxidation on cell membranes, especially on high energy membranes like mitochondrial membranes. Good, scope the mechanics upon that context, and note that membrane PUFA peroxidation is bad.
Now what? Does this randomly scale up to the inter-organ level? Of course not ...... How do we know how one person manages the PUFAs on their membranes. How do we know if they are even going to mobilise a lot of that PUFA. How do we know that they transport it into the cell. How do we differentiate between the different types of PUFA (they all have different effects). How do we know that PUFA isn't beta-oxidised instead.
Want to talk about PUFA as hormone-like ligands? Sure, we know delve into the complicated as hell world of PPARs -- Circadian rhythms, Wnt/beta-catenin pathway and PPAR alpha/gamma profiles in diseases with primary or secondary cardiac dysfunction
There is no answer here .... sure, we can mechanistically describe how certain PUFAs activate PPAR gamma activity (which BTW, is supposed to upregulate carbohydrate metabolism). Now what? Look at that paper, and all the life-threatening illnesses associated with PPAR gamma deficiency, and all the life-threatening illnesses associated with excess activity PPAR gamma. Screwed either way? No, this is part of a fine balancing system that is highly tuned to the context of the organism.
The PPARs are heavily regulated by all the circadian machinery in the body -- https://www.hindawi.com/journals/ppar/2014/653017/ . RXRs, G-coupled protein receptors, etc .... They are truly "at the crossroads of circadian signalling and metabolism".
And tying back to cortisol, look how powerful light (ie: circadian modulators) is in changing the cortisol response -- http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0155601
Just look at Figure 3 and the huge changes in HOMA-IR just by using blue light exposure. Blue light => worst insulin sensitivity. But Blue light => less cortisol .....
I can just as easily claim that chronic unnatural light exposure in today's world, coupled with night-time eating, is responsible for systemic Insulin Resistance. There is more than enough evidence to prove this as a dominant factor in people's lives, but it is a dominant factor in "this particular person's life"? No clue, experiment and find out.
Context mang! Take someone, deprive them of sleep for a day, and all metabolic parameters change.
The practical takeaway from that should have been, "Night time .... Go to sleep!", instead of worrying about macronutritional balances and PUFA mechanics.
SIDENOTE: as an aside, it is usually much better for recovery of circadian cycles, to skip eating during circadian disruption, and then re-start eating during the next circadian morning.
This generalises to everything from staying up too late (no late night snacks), to flying across multiple time zones (try to time flight arrival in morning, do not eat along the way).
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Mechanics be come with qualified Context , and that includes all up- and down-stream side effects of that particular mechanic.
I will always err on the side of uncertainty, and never claim to generalise any mechanics beyond the exact context that there were elucidated within.
I have also provided so much counter evidence to show how all these various mechanics at the various hierarchies of the organism can interact in seemingly wildly contradicting ways.
eg: high serum FFA can lead to insulin resistance via the Randle Cycle (serum level). high PUFA flux through mitochondria leads to insulin sensitivity (intercellular level). Which one dominates? Dunno, ask the organism .....
The type of narrative one wants to weave can be completely biased by working only on a particular hierarchy of the system. I'd rather stay honest and say, "wow this is complex, I try my best to tell an accurate story based on existing observations, but you guys interpret this for yourself".
"What is the context of the mechanics I am discussing?", and of course, "How can I apply this to my life? And how do I know if the intervention is working?"
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My statements also come from working in a metabolic ward a few days of the week. You want proof for PUFA's role in cortisol and stress? Ingest 5g of arachidonic acid at 3pm when your cortisol is supposed to be lowest. Better yet, test both before/after you ingest. Then test your cortisol and TNFa, estradiol, insulin, and CRP 90min - 120min later. You will find out just how "unique" and "unpredictable" your response would be. Not!
All of the things I mentioned about NSAID, serotonin antagonists, inflammation, etc were all derived experimentally. Maybe there is some deep, complicated mechanism behind it, or maybe it's quite simple. Until I see solid evidence invalidating (falsifying) the role of PUFA and inflammation (coupled with chronic stress, both of which PUFA can trigger) in insulin resistance, diabetes and even cancer I will keep doing what works based on that hypothesis. As far as proof for PUFA being bad - there is no definitive proof. As you know, science can only falsify. But here are some things to consider. If PUFA is a bonafide endocrine disruptor and a carcinogen then why wouldn't one want to be careful with it?
PUFA Is Estrogenic And Androgen/Progesterone Antagonist
Pufa Stimulates Cortisol Production Even In The Absense Of Acth
Omega-3 (DHA, EPA) Degrades The Androgen Receptor
Inhibition Of PUFA Metabolism (LOX) Trigger Immediate Apoptosis In Prostate Cancer
PUFA are carcinogenic, dietary glycine blocks their effect
Contradictory Information On PUFAs
Contradictory Information On PUFAs
Over the last 6 months the clinic where my associates work has used experimentally the drug mifepristone (RU486) to treat diabetes II. It succeeded in every single case. FDA has already approved it for diabetes II but insists it should only be used on people with diabetes caused by the Cushing syndrome.
Mifepristone (Korlym): First FDA-Approved Medication for the Treatment of Cushing’s Syndrome - CSRF - Cushing's Support & Research Foundation
"...There have been scattered case reports over the past 15 years of the use of mifepristone for the treatment of patients with all forms of Cushing’s syndrome (pituitary-ACTH-secreting tumors, ectopic ACTH-secreting tumors, and adrenal tumors). Recently, Corcept Therapeutics (the company who manufactures mifepristone) conducted a multicenter, 24-week study in the United States of 50 patients with various types of Cushing’s syndrome who had failed surgery or who were not candidates for surgical intervention. This study showed a rapid improvement in glucose control in patients with type 2 diabetes due to Cushing’s syndrome. In addition, approximately 50% of the Cushing’s syndrome patients with hypertension had either improvement in their blood pressure or decrease in their antihypertensive medications. Most importantly, an independent review panel evaluated the responses of the patients to many parameters including glucose levels, blood pressure, lipids, weight, body composition change, neuropsychological factors, and physical appearance. Their analysis showed that clinically significant improvement occurred in 87% of patients treated with mifepristone."
Of course, the idea that maybe all diabetes II is caused by high cortisol and inflammation would be too much to bear for the sensitive souls at FDA. Be that as it may, RU486 is now a mainstream diabetes II therapy (off-label) in many clinics across the USA, regardless of Cushingoid status. Do you think there is a hidden epidemic of Cushing-caused diabetes that was a subset of all diabetes cases and was undiagnosed until RU486 was approved? No, the much more likely scenario is that most (if not all) diabetes II is a neuroendocrine disorder caused by HPA dysregulation. PUFA and stress are the primary causative factors in that.
I am not interested in arguing about this any more. In fact, I am not interested in arguing at all. I try to find what works. When so many human clinical trials with diabetes and/or insulin resistance with different drugs targeting the same target (HPA) through different pathways (serotonin, inflammation, cortisol, lipolysis, etc) succeed the case is closed to me.