Alex Leaf

The cure for most cases of type 2 diabetes (T2DM) requires fat loss. This thread will discuss research showing restoration of carbohydrate tolerance in those with T2DM through addressing the underlying pathology (ectopic fat) rather than just focusing on symptom management.

@brianatheroux This picture does not do justice for how sexy you look in person

Day 2 look: Country Concert🎶

@WildernessBabe Sounds like a modest protein-sparing modified fast. Very effective for fat loss.

@Alexleaf I’ve been attempting what I consider low fat AND low carb. Below 70 g fat and 50 g carbs and the rest protein. Very difficult to design meals. Not adding hardly any fats to recipes but having to force down nonfat dairy and chicken breast everyday to get my macros

Fat loss: there’s no clear advantage of low-carb over low-fat on an empirical level. People struggle with both equivalently. It's far better to work with the person as an individual and determine what diet they can sustain. Blood pressure: cutting sugar and refined carbs can help by lowering insulin levels, but hypertension isn’t one thing. Some people are salt-sensitive. Others are driven by excess body fat, poor metabolic health, low potassium, stress, or sleep. If you don’t identify the cause, you’re just playing guessing games. Type 2 diabetes: low-carb diets can put diabetes into remission, but reversal often requires reduced energy intake and fat loss. That loss of body fat (especially in the liver and pancreas) is what restores insulin sensitivity. We really need to stop looking for dietary villains to demonize.

@MiraCB007 Your anecdote is perfectly compatible with everything I said.

@Alexleaf Not comparable. If on low carb (and 15:9 - 18-6, blood glucose is stable and you are not hungry. Not the case with carbs.

I published a review of overfeeding controlled trials back in 2017 if you are interested. I can't really comment on the anecdote without reading the published case study (do you have a link?), but my hunch is that it didn't account for digestible energy intake nor body composition changes. pubmed.ncbi.nlm.nih.gov/29399253/

@Alexleaf Sure, no difference

@BrundoCoban For some people, sure. For others, nope. On average? Nah.

@Alexleaf fat loss

I personally use remission to indicate that a disease state has its signs and symptoms suppressed, while reversal indicates that the disease itself (the underlying pathophysiology) no longer exists. So, I do think that the artificial lowering of glucose and insulin with a low-carbohydrate diet counts as remission, just as removing gluten puts Celiac disease into remission. And remission is important when reversal isn't possible, as is the case with Celiac disease and those who have pancreatic damage leading to insulin insufficiency. But for most people with type 2 diabetes, reversal through fat loss is possible and the best option.

@Alexleaf Besides, does a low-carb diet really put type 2 diabetes mellitus into remission, or does it merely mask it and for how long? In some ways, it is a bit as with cœliac disease: removing gluten from the diet does not put it into remission. It simply removes the problem substance.

@geoff_l Most of the hyperpalatable ultraprocessed foods are high in carbs and fats, and there are many unprocessed single ingredient foods high in carbohydrates alone (fruit, tubers, roots, other vegetables, legumes, etc.).

@Alexleaf high carb foods are likely to be highly processed food built by corporations and chemists high fat foods (steak, eggs, bacon) are single ingredient. They will not cause you to overeat. They will solve your insulin resistance and obesity.

@BrundoCoban Wins for what?

@Alexleaf Low-carb wins easily.

@upRootNutrition Beyond sleep, it has amazing data for metabolic health with 3-10 mg doses in clinical trials. Super potent antioxidant molecule, especially within mitochondria.

Holy fuck, melatonin is based. 😮

I love us🥰

I appreciate your clarifications and don’t disagree with you that anecdotes have value, but we need to be precise about how they’re used. In pharma, adverse event reporting isn’t treated as evidence of causation. It’s treated as a signal generator (e.g., something might be happening here, so let’s investigate). That’s very different from using anecdotes as evidence that something is happening, which is the distinction Im making. If people say they feel better on a carnivore diet, I believe them. That’s a real observation. But that observation alone doesn’t tell us what specifically changed, what mechanism is responsible, whether there are tradeoffs, or whether it holds long-term. You could just as easily find anecdotes of people thriving on completely different diets. Without controls, you can support almost any conclusion you want. I'm sure I can find plenty of vegans who don't supplement who say they feel great and healthy, and the carnivore crowd would ironically tear them down for the exact reasons I'm making here. Anyway, where we probably agree is that if you’re going to claim that a diet fundamentally changes human nutrient requirements, that’s not something anecdotes can establish. That requires actual evidence showing what changes, in what direction, and to what degree.

Thanks Alex I'd like to clarify my point about anecdotes. I'm not saying that we only need anecdotes or that they alone render study data irrelevant. I'm saying that we ignore anecdotes at our peril. Study data and anecdotes alike should be given consideration in decision making. And I can offer some support for this. I worked in the biotech industry for over 10 years. Was literally married into it. My ex-wife is an MD researcher who designs clinical trials. Eventually became the CMO of a publicly traded biotech company. In my IT work I designed and built validated GxP lab and manufacturing systems and networks. Participated in regulatory audits. The works. This is all to say: I'm not just parroting contrarian social media takes. I was a long term active participant & front row passenger and I know how the sausage is made. In bio/pharma there is a process called adverse event reporting. Patients reporting something that was different from what the trials said should happen. Another word for this would be: anecdotes. They're an important and legally required aspect of the industry. Each report is given consideration against all available data. The reason for adverse event reporting is because even the most comprehensive and well designed trials cannot account for all variables or be assumed useful & safe for all people. Even after Phase 3 and FDA approval. The results of these anecdotes can range from no actions, to label changes, or all the way to a drug being pulled from the market. Then there's the flip side of that. After a Phase 3 trial showing little to no statistically relevant improvement from a compound, it didn't mean nobody saw improvement. We had patients travel to DC and beg the FDA for approval because it was the first time in their lives they experienced relief for their debilitating conditions. For some people, being the outlier or a part of the cohort that was dismissed as not statistically relevant winds up being critically important at an individual level. Billions of dollars and years of research are spent on these trials. And yet they're still incomplete without real world reporting. So I can't just accept RDA guidance at face value without some level of real world reporting to consider along with it.

My last post about the nutrient inadequacy of ground beef received some interesting comments from the carnivore crowd claiming that the RDA is irrelevant for them. It's common enough that I thought it deserves a post on its own, because it seems that many of these people simply don't understand what the RDAs represent and are engaging in motivated and other fallacious reasoning. First, the RDA is a statistical estimate derived from the average requirement (EAR), set high enough to cover ~97–98% of the population and prevent deficiency. They’re not perfect. They’re not individualized. And they’re definitely not optimal. They are simply safe intake levels to prevent deficiency in nearly everyone. They definitely shouldn't be seen as the goal, so to speak. Protein is a great example of this, where the RDA (0.8 g/kg) consistently underperforms for improving muscle mass, metabolic health, and healthy aging compared with higher intakes. It's absolutely true that many people require less than the RDA value for a given nutrient. That's built into the statistics of the RDA. But again, the RDAs should be seen as a floor, not a ceiling. And yes, nutrient requirements can shift depending on countless variables. Higher protein intake increases demand for cofactors like B6. Lower PUFA intake reduces the need for vitamin E. Being athletic increases the requirements for certain minerals. The issue with the carnivore crowd, in general, is that they seem to just assume that their diet reduces requirements for nutrients. If metabolism is truly changing, requirements should plausibly shift in both directions, not just conveniently downward. It's entirely plausible that a carnivore or ketogenic diet influences nutrient requirements. It's a completely different metabolic state than the general population that was studied for determining the RDAs. But which nutrients, to what extent (magnitude), and in which direction remain unknown because that research hasn't been conducted (as far as I'm aware). So, if you want to claim that nutrient requirements on carnivore meaningfully change in a certain direction, the burden of proof is on you to show a clear biological mechanism, controlled data demonstrating altered requirements, and/or long-term outcomes showing no deficiency or functional decline. Without any of that, you aren't making a scientific argument, you are just trying to rationalize your preferred way of eating. It's ideologically motivated and intellectually dishonest. And you can point to people who claim to eat carnivore for long periods of time, but anecdotes aren’t data. Not only do we have no way of determining what these people are actually eating or supplementing, but there's no controlled investigation of health outcomes. Just saying "they are doing fine" is ridiculous, especially because short-term tolerance isn’t long-term sufficiency and the absence of overt disease does not equal optimal nutrient status. I strongly recommend reading about Bruce Ames' Triage Theory which discusses how, during conditions of nutrient shortfall, the body prioritizes processes needed for survival over those needed for long-term health. You can run suboptimal levels for years before anything obvious shows up. So, if you want to argue that a carnivore diet meaningfully changes human nutrient requirements, go for it. But do it properly. Show the mechanism. Show the data. Show the outcomes.

You’re misrepresenting what I said. There’s no contradiction in calling the RDA a floor while also acknowledging it wasn’t derived from a carnivore population. The reason it’s a floor is simple: Below the RDA, risk of deficiency increases, while above the RDA, risk generally decreases up to a much higher threshold where toxicity becomes relevant. So the safe zone exists above the RDA, not below it. I’ve already acknowledged that nutrient requirements can shift with diet. But you don’t get to assume they shift downward just because it’s convenient. If requirements truly change on a carnivore diet, then which nutrients change, in what direction, and by how much? That requires evidence, not assumptions or anecdotes. Also, anecdotes are, by definition, the most confounded form of evidence we have. You don’t know what someone is actually eating, supplementing, or doing lifestyle-wise, and you have zero control over variables. That’s exactly why the scientific method exists to filter signal from noise. Saying anecdotes should carry equal weight to controlled data is just abandoning any attempt to reliably understand the world. And to be clear, I never said carnivores are deficient or “killing themselves.” That’s a strawman. My point is simply that if you’re going to claim that a diet fundamentally changes human nutrient requirements, then you need to demonstrate that rather than vaguely gesturing that its the case to justify your preferred way of eating.

It seems like you're trying to have it both ways here. On the one hand, you cite RDA as being a floor not a ceiling. But at the same time you acknowledge that RDA was not calculated based this style of eating. So how can you conclude if it's a floor or a ceiling? And on which specific nutrients? With regard to studies, I don't think they should carry any more relevance to a person's decision making than anecdotes. In even the most carefully controlled and rigorous studies, there is never an absolute 100% result. Some percentage of the cohort responds counter to the rest - or to a statistically insignificant degree that is unexplainable in the data. So unless a person was actually one of the study participants, the results are just a signal. They're not a foregone conclusion about what *will* happen to every person. This is where anecdotes can make all the difference. Taking cues and evidence from the world and people around us is as human as anything else we do. Dismissing it as unscientific is just modern semantics. Testimony, judging people's credibility, ad hoc experiments, and personal trial & error are how people stayed alive and evolved long before journals were elevated to the status Holy Scripture. Where I agree with you: Carnivore deserves more academic level study. I think the combination of personal experiences with controlled data will make for better guidance on how people approach the diet. Until then, the critics of carnivore are guilty of the same charge they levy against those on the diet. They're drawing conclusions in the absence of the very kind of evidence they insist is needed before reaching a conclusion. And their conclusions are always negative. The critics ought to be the ones proving something if they're so sure about it. Finally, suggesting that carnivores are all nutrient deficient and killing themselves, when nearly everyone on the diet looks and feels better than they did on omnivore diets, is peak gaslighting. Trying to convince the people that they're not actually healthier than they used to be. That kind of criticism diminishes the credibility of those who render it.

@drjamesdinic Yeah, the anecdotes are such a lazy argument.

@Alexleaf This was perfect timing.

@ZKForTre Well thank you!

@Alexleaf Have really enjoyed your measured responses of late.

@popeyecubs68 The RDA is an estimation based on averages that would cover the requirements of 95% of the population. People need different amounts of each, so this attempts to cover all the bases since you have no way of knowing how much you actually require.

@Alexleaf Aren't RDAs an average? Wouldn't those smaller people need less than the average?

Here's the nutrient profile for 2 lbs of ground beef, by the way. Obviously not a complete source of nutrition, especially for smaller people with lower energy requirements.

@Tellit007 @bigfatsurprise @dramerling @SamaHoole Lmao, thinking Sama has "compelling posts" is a lighthouse notice for not having any critical thinking ability. Roughly 90% of his content is complete bullshit.

@bigfatsurprise @dramerling @SamaHoole You congratulated someone for calling Keys "fraudulent junk science." The accusation is itself based on a misreading of the primary sources. One that your book helped popularize.

This was a major stepping stone for fraudulent junk science. @bigfatsurprise

Editor's note: there's no empirical evidence suggesting that "dysfunctional hormones trap fat in storage". In fact, those with obesity and insulin resistance often have leakage from their fat stores into circulation because insulin can't keep it locked away. Maybe there is some wonky condition out there where this is genuinely the case, but that would be an overwhelmingly rare exception to the rule and unapplicable to most people.