The carbohydrate-insulin model: a physiological perspective on the obesity pandemic

Ludwig, David S.; Aronne, Louis J.; Astrup, Arne; Cabo, Rafael de; Cantley, Lewis C.; Friedman, Mark I.; Heymsfield, Steven B.; Johnson, James D.; King, Janet C.; Krauss, Ronald M.; Lieberman, Daniel E.; Taubes, Gary; Volek, Jeff S.; Westman, Eric; Willett, Walter C.; Yancy, William S.; Ebbeling, Cara B.

doi:10.1093/ajcn/nqab270

Cited by 156 publications

(122 citation statements)

References 158 publications

Supporting

Mentioning

115

Contrasting

Unclassified

Order By: Relevance

“…Some impoverished obese adults held physically demanding jobs and consumed low calorie diets with little access to healthcare and limited resources. Dual burden populations challenge the energy balance hypothesis of obesity, which implies that mothers overeat and underfeed their children ( 8 ). Unlike adults, underfed children cannot lower their metabolic rate until they have lost more than 30% of their weight ( 154 ).…”

Section: Discussionmentioning

confidence: 99%

“…Debate persists on the roles of energy balance, total fat, SFAs, sugar and refined carbohydrates, total calories or inactivity as primary cause(s) of obesity. Medical orthodoxy holds that positive energy balance (calories consumed exceed those expended) causes obesity, while others argue that sugar/refined carbohydrate-induced metabolic alterations drive obesity and NCDs via metabolic syndrome (2)(3)(4)(5)(6)(7)(8)(9). They are not mutually exclusive.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Dietary Transitions and Health Outcomes in Four Populations – Systematic Review

et al. 2022

View full text Add to dashboard Cite

ImportanceNon-communicable chronic diseases (NCDs) such as obesity, type 2 diabetes, heart disease, and cancer were rare among non-western populations with traditional diets and lifestyles. As populations transitioned toward industrialized diets and lifestyles, NCDs developed.ObjectiveWe performed a systematic literature review to examine the effects of diet and lifestyle transitions on NCDs.Evidence ReviewWe identified 22 populations that underwent a nutrition transition, eleven of which had sufficient data. Of these, we chose four populations with diverse geographies, diets and lifestyles who underwent a dietary and lifestyle transition and explored the relationship between dietary changes and health outcomes. We excluded populations with features overlapping with selected populations or with complicating factors such as inadequate data, subgroups, and different study methodologies over different periods. The selected populations were Yemenite Jews, Tokelauans, Tanushimaru Japanese, and Maasai. We also review transition data from seven excluded populations (Pima, Navajo, Aboriginal Australians, South African Natal Indians and Zulu speakers, Inuit, and Hadza) to assess for bias.FindingsThe three groups that replaced saturated fats (SFA) from animal (Yemenite Jews, Maasai) or plants (Tokelau) with refined carbohydrates had negative health outcomes (e.g., increased obesity, diabetes, heart disease). Yemenites reduced SFA consumption by >40% post-transition but men's BMI increased 19% and diabetes increased ~40-fold. Tokelauans reduced fat, dramatically reduced SFA, and increased sugar intake: obesity and diabetes rose. The Tanushimaruans transitioned to more fats and less carbohydrates and used more anti-hypertensive medications; stroke and breast cancer declined while heart disease was stable. The Maasai transitioned to lower fat, SFA and higher carbohydrates and had increased BMI and diabetes. Similar patterns were observed in the seven other populations.ConclusionThe nutrient category most strongly associated with negative health outcomes – especially obesity and diabetes – was sugar (increased 600–650% in Yemenite Jews and Tokelauans) and refined carbohydrates (among Maasai, total carbohydrates increased 39% in men and 362% in women), while increased calories was less strongly associated with these disorders. Across 11 populations, NCDs were associated with increased refined carbohydrates more than increased calories, reduced activity or other factors, but cannot be attributed to SFA or total fat consumption.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Dietary Transitions and Health Outcomes in Four Populations – Systematic Review

et al. 2022

View full text Add to dashboard Cite

show abstract

“…Details of the mechanisms underlying the proposed adaptive survival advantages of IR, hyperandrogenism, enhanced energy storage and subfertility have been obtained from paleolithic records, animal models and human populations exposed to adverse environmental conditions such as war and famine-inflicted starvation [14,16,62,63]. Multiple lines of evidence support the maladaptive response of human populations to rapidly changing nutritional, physical, psychological and cultural environments, in the modern world [5,11,14,75]. These "adaptations" result in pathological responses to IR, hyperandrogenism, enhanced energy storage and ovulation (Figure 1).…”

Section: Evolutionmentioning

confidence: 99%

Polycystic Ovary Syndrome: An Evolutionary Adaptation to Lifestyle and the Environment

Parker

O’Brien

Hawrelak

et al. 2022

IJERPH

View full text Add to dashboard Cite

Polycystic ovary syndrome (PCOS) is increasingly recognized as a complex metabolic disorder that manifests in genetically susceptible women following a range of negative exposures to nutritional and environmental factors related to contemporary lifestyle. The hypothesis that PCOS phenotypes are derived from a mismatch between ancient genetic survival mechanisms and modern lifestyle practices is supported by a diversity of research findings. The proposed evolutionary model of the pathogenesis of PCOS incorporates evidence related to evolutionary theory, genetic studies, in utero developmental epigenetic programming, transgenerational inheritance, metabolic features including insulin resistance, obesity and the apparent paradox of lean phenotypes, reproductive effects and subfertility, the impact of the microbiome and dysbiosis, endocrine-disrupting chemical exposure, and the influence of lifestyle factors such as poor-quality diet and physical inactivity. Based on these premises, the diverse lines of research are synthesized into a composite evolutionary model of the pathogenesis of PCOS. It is hoped that this model will assist clinicians and patients to understand the importance of lifestyle interventions in the prevention and management of PCOS and provide a conceptual framework for future research. It is appreciated that this theory represents a synthesis of the current evidence and that it is expected to evolve and change over time.

show abstract

“…Atkins diet is one of the most popular low carbohydrate weight loss programs which consists of <40% of kilocalories from carbohydrates per day, ∼30% from protein and 30-55% from fat (2). Facing the public health failure that obesity rates remain at historic highs despite a persistent focus on eating less and exercising more (guided by the energy balance model), recent studies are highlighting an alternative paradigm, the carbohydrate-insulin model (CIM) (4). CIM proposes that hormonal responses to a high-glycemic-load diet increases fat deposition in the body and drives positive energy balance.…”

Section: Introductionmentioning

confidence: 99%

Dynamics of the Gut Bacteria and Fungi Accompanying Low-Carbohydrate Diet-Induced Weight Loss in Overweight and Obese Adults

Xie

Chen

et al. 2022

Front. Nutr.

View full text Add to dashboard Cite

BackgroundLow-carbohydrate (e.g., Atkins) dietary pattern is one of the most effective diets for weight loss, but little is known about the characteristics of the gut microbiota accompanying low-carbohydrate diets-induced weight loss. This study aims to profile dynamics of gut bacteria and fungi accompanying modified Atkins diets-induced weight loss among overweight and obese adults.MethodsOverweight and obese adults were screened to follow a modified Atkins diet plan (30% of energy from protein, 40% from carbohydrate and 30% from fat). We longitudinally profiled dynamics of gut bacteria and fungi based on 16S rRNA and ITS rRNA gene sequencing data, respectively.ResultsA total of 65 participants followed the modified Atkins diets for 20–231 days, with 61 and 27 participants achieving a weight loss of at least 5 and 10%, respectively. Most of the participants who achieved 10% weight loss also experienced improvements on metabolic health. The diversity of gut bacteria and fungi increased after a weight loss of 5% and kept stable thereafter. Bacteria genera including Lachnoclostridium and Ruminococcus 2 from Firmicutes phylum were depleted, while Parabacteroides and Bacteroides from Bacteroidetes phylum were enriched after weight loss. The inter-kingdom analysis found an intensive covariation between gut fungi and bacteria, involving more than half of the weight loss-associated bacteria.ConclusionsThis study confirmed the modulation of bacterial and fungal composition during weight loss with the low-carbohydrate diets and showed previously unknown links between intestinal bacteria and fungi accompanying the weight loss.

show abstract

The carbohydrate-insulin model: a physiological perspective on the obesity pandemic

Cited by 156 publications

References 158 publications

Dietary Transitions and Health Outcomes in Four Populations – Systematic Review

Dietary Transitions and Health Outcomes in Four Populations – Systematic Review

Polycystic Ovary Syndrome: An Evolutionary Adaptation to Lifestyle and the Environment

Dynamics of the Gut Bacteria and Fungi Accompanying Low-Carbohydrate Diet-Induced Weight Loss in Overweight and Obese Adults

Contact Info

Product

Resources

About