Stephan J. Guyenet

Excellent review paper by Roy Taylor on his journey to verifying the cause of type 2 diabetes. Aptly titled: "Aetiology of type 2 diabetes: an experimental medicine odyssey" (PMID: 40316731). I wanted to share two quotes from the conclusion, because there still seems to be a tremendous misunderstanding of this disease among both scientific and layperson communities. "The original destination of this experimental medicine odyssey was to identify the cause of type 2 diabetes and now this can simply be stated. If a person develops type 2 diabetes, they have accumulated more fat than can be tolerated by their own genetic constitution." "There is a single environmental, modifiable cause. Type 2 diabetes only develops if an individual has eaten more than they require over a long period. However, there are two important stop–go stages, both determined by the lottery of inheritance. Diabetes appears only when fat can no longer be stored safely under the skin... Even if fat spills over into ectopic sites, diabetes will only occur if there is also genetic susceptibility to fat suppression at the level of the beta cell... Even if full genetic susceptibility is present, the writing is clearly on the wall: no positive energy balance, no diabetes."

@radfugee @Alexleaf Yeah, I was thinking the same

@sguyenet @Alexleaf His result is about as interesting as someone with FH having no disease at age 10

I can't say I've ever encountered someone who conflates elevated LDL with heart disease. Most operate, rightly so, from the standpoint that heart disease is a probabilistic outcome influenced by numerous factors, one of which is circulating LDL / apoB concentrations. This is entirely compatible with Nick's personal experience. Since his anecdote has zero external validity, it can rightly be ignored in favor of population-level data and mechanistic inferences when dealing with literally any person other than Nick himself. Most importantly, is there any health benefit from maintaining higher vs lower levels? What, exactly, is the point of keeping LDL extremely elevated when it probabilistically increases disease risk?

@CaloDefici Added fats are one of the most effective way to get a caloric surplus in an ad libitum diet

@sguyenet Not true. Calorie surplus makes you fat. Not fat consumption.

We've confirmed it's an unpopular point of view 😁 Nevertheless true. Added fats like oil and butter increase calorie intake and body fatness in a variety of species, including humans. doi.org/10.1093/ajcn/4… doi.org/10.1016/j.cmet… doi.org/10.1093/ajcn/6…

@crumulusXII Not what I'm saying. "Adding concentrated sources of fat to the diet, like oils and butter, tends to make people gain fat"

@TheNashvillian I expect people to have enough reading comprehension that when I say "added fat" and "oils and butter", they understand I'm not talking about nuts, meat, eggs, etc.

@sguyenet But you included oils. And when you start a conversation by telling people they’re going to get fat by eating fat, they’ll easily see all fat as fungible.

@lumiferrous I'm talking about which foods are selected in a free-living diet, which is the most relevant framing for most people. The problem with added fats is that they mostly add to the diet rather than replacing, because they have very low satiety per kcal.

@sguyenet You're now talking about *replacing* some foods with others. There's a lot of variation in there, the averages aren't very useful, and the topic becomes satiety, tastiness, and general preferences.

@TheNashvillian I specified added fat

@sguyenet OK, but maybe just a bit oversimplistic? We do need a certain amount of healthy fat that can come in the form of olive, fish, or flax seed oil. Will your message keep people from adding avocado or slivered almonds to their salad? Nutrition education must have nuance.

@cadospharma It sounds like your situation is confounded by other dietary changes. Your profile says PE. The easiest way to mess up PE is added fat. I'd love to see scientific evidence for the claim that all else equal, adding fat to a diet causes weight loss 😁

@sguyenet The view is not unpopular, it is not scientific. The more i eat butter, MCT oil, and meat, the more i loose weight. The stronger i get, so i dont listen to any more epidemiology studies because there are thousands and have different conclusions. epidemiology is not science

@DIY_Tardis The difference between those diets is mostly added fat. Oils, butter, cream. It doesn't need to be low-carb to demonstrate the point that added fat increases calorie intake and is fattening.

@sguyenet First one I looked at . 45% from fat so McDonald's and pizza hut. Not even low carb at 45% fat and likely high in pufas

@lumiferrous In a typical ad libitum diet, adding lean protein will typically lower total energy intake, and added fats will typically increase total energy intake more than most other types of food

@sguyenet As stated, the claim is true for any caloric food. *Adding* carbs and proteins is fattening as well.

@BradChilmeran Relative to not adding fat, yes

@sguyenet Is it fattening to add olive oil to a salad?

Added fat is fattening. It may not be a popular point of view these days, but it remains true.

@cremieuxrecueil @JacobGudiol Yes, she doesn't accept corrections

@JacobGudiol Oh wow, that is egregious.

It bothers me that everything I've been told about Ancel Keys until I started actually reading his stuff was a slanderous lie Grifters actually lie and say he committed fraud when he was completely fine as a researcher But I thought otherwise because I trusted people not to lie

@carnivorlifter @cremieuxrecueil Not sure what point you're trying to make. What I'm saying is that Ancel Keys' work has been portrayed in a very misleading way by Taubes etc.

@sguyenet @cremieuxrecueil So the science is settled then? Heard that before somewhere, haven't we? Conclusions driven by money, fame and pharma have established the status quo.

@maxkshen Biologically, it's in the brain, but much of the experience of it is felt in the body. There's no incompatibility there.

"The body does not keep the score" — new opinion piece by Kotler, Mannino, Fox, and Friston the title is inflammatory and in my view misleading. the basic claim is ‘trauma is more like a trapped prior than an inscription”. trauma is an maladaptive lack of responsivity, not like a bullet wound or physical injury but there are two parts to the debate here: Anti-inscription - their main argument: we should not think about trauma as something that is stored and accumulated (they are basically pushing back against the ‘storehouse model’ of trauma). Brain-only - trauma is in the brain, not the body They smuggle in ‘Brain-only’ when really they are arguing about ‘Anti-inscription. But we can look at these in turn. I think anti-inscription is basically right. van der Kolk’s The Body Keeps the Score is vague on what constitutes trauma. “the score” he refers to is about debt, like an accounting debt, but he also uses metaphors like ‘watchtower’ and ‘smoke detector’ throughout the book — though the end message is that you need to get into the body to resolve the stored trauma. Kotler et al. say that this is wrong. you shouldn’t see the body as ‘storing’ trauma. most people don’t get PTSD from war, death of a spouse, etc (though very many do) — which would not happen if it were permanently inscribed in the body. (note: i doubt anyone (incl van der Kolk) believes that trauma is permanently inscribed in the body; ‘watchtower’ and smoke alarm are pretty compatible with the trapped prior view of trauma) instead, kotler etc say that trauma is about a stuck prediction. “loss of metastability — the brain’s ability to fluidly switch among semi-stable network states”. They try to relate everything to free energy minimization — a move that I’ll just note confuses more than clarifies things for me. This is basically compelling, and I do think ‘trapped prior’ is far better than ‘storehouse’ for how to think about trauma. Then they basically try to explain that because trauma is about predictions, it must be about the brain (which they use interchangeably with the central nervous system). my basic objection to this is that it is experientially obvious that memories in general (not just trauma) involve parts of the body outside the central nervous system. very obviously, the enteric nervous system and cardiac neurons encode memory that can be linked with trauma. more speculatively, i think something like @johnsonmxe idea of smooth muscle acting as a form of ‘prior’ is quite plausible. annoyingly, this whole piece feels like an old rehash of the perennial mind-body debate, where the predictive processing people are insisting ‘trauma is in malformed prediction (mind)’ and the somatic people insist ‘trauma is in the viscera (body)’ the way forward is what the somatic scientists like Thomas Hanna and Feldenkrais gestured at, which I think in principle the PP people should be on board with, but probably in part because there isn’t yet a mature science of somatic memory tend to default to reducing everything to the brain.

@jerryteixeira @MattBMartin Yes, it's multi-factorial nejm.org/doi/full/10.10…

@MattBMartin To be fair, according to CDC, smoking rates in the US have fallen approx 73–74% (from 37.4% in 1970 to 9.9% in 2024) (This isn’t an anti statin take, by the way)

I don’t know who needs to hear this but deaths from heart disease have fallen >50% since statins were introduced in the 1970s. This guy = 🦆🦆🦆