Thursday, January 23, 2020

Retrospective #341: “Obesity is Protective,” says Jason Fung, MD

“Obesity is not widely considered a protective mechanism,” Jason Fung began a 2016 blog post. “Quite the opposite,” he says. “It’s usually considered one of the causal factors of the metabolic syndrome and insulin resistance.” Lamentably, most physicians think this way. In large part it is what government research, insurance reimbursement and medical association Clinical Guidelines are predicated upon. And so it is the Standard of Care of most physicians. Who can blame them for believing it?
Jason Fung, however, is a thinker (and a Canadian nephrologist), and he boldly has freed himself from those constraints – like south African Tim Noakes, and Australian Gary Fettke both of whom fought and won in court, and John Ludkin (UK) and Robert Atkins (U.S.), who were cast out by their profession. The list of heretics is long, including Vilhjalmur Stefansson from the 1920s.
Science writer Gary Taubes started it all again in 2002 with his “What If It’s All Been a Big Fat Lie,” and later his seminal tome and magnum opus, “Good Calories, Bad Calories” (2007), whose audience was medical professionals. But Jason Fung also deserves singling out because he is a trailblazer. And unlike Gary Taubes’s GC-BC, Jason Fung’s “The Obesity Code” (2016), is accessible.
“I think obesity is a marker of disease,” Dr. Fung continues, “but ultimately it serves to protect the body from the effects of hyperinsulinemia. Let me explain.” Fung then references a 2016 New York Times article by Gina Kolata about a rare case of a genetic disorder called lipodystrophy (a lack of fat cells). Fung calls this case “very interesting” and goes on to explain how it relates in a causal way to metabolic syndrome and insulin resistance. It’s a fascinating hypothesis. In an earlier blog post he calls it the new paradigm of insulin resistance.
“We need to understand the new paradigm of insulin resistance to understand how insulin resistance, obesity, fatty liver, and fatty pancreas are actually all the different forms of protection our body uses. But what is the underlying disease? Hyperinsulinemia,” Dr. Fung says.
Fung then elaborates further upon the physiological mechanisms of action that the body uses to protect itself from these manifestations. His writing style is easy to follow – just ignore the charts and figures and follow the prose. You’ll get it, I promise. And, if you seek this knowledge and understanding, it’s a worthwhile read.
However, if you want to cut to the chase – the bottom line – these excerpts from Fung will spell it all out for you:
“There are many possible causes of too-much-insulin, but one of the major ones is excessive dietary intake of refined carbohydrates and particularly sugar.
“Insulin has several roles. One is to allow glucose into cells. Another is to stop glucose production and fat burning in the liver (gluconeogenesis). After this stops, then it stores glycogen in the liver and turns excessive carbohydrates and protein into fat via de novo lipogenesis. Insulin is basically a hormone to signal the body to store some of the incoming food energy, either as glycogen or fat.”
“There are two main problems with metabolic syndrome: Glucotoxicity and insulin toxicity. It does no good to trade the increased insulin toxicity to reduce glucotoxicity. That’s what we do when we treat people with insulin or sulfonylureas. Instead, it only makes sense to reduce BOTH glucotoxicity and insulin toxicity. Drugs such as SGLT2 Inhibitors do this, but diet is obviously the best way. Low Carb diets. Intermittent Fasting.
In the end, obesity, fatty liver, and type 2 diabetes and all the manifestations of the metabolic syndrome are caused by the same underlying problem. NOT insulin resistance. The problem is hyperinsulinemia. It’s the insulin, stupid.
“The power of framing the problem in this way is that it unveils the solution immediately. The problem is too much insulin and too much glucose. The solution is to lower insulin and lower glucose. How? Nothing simpler. Low Carb, High Fat diets. Intermittent Fasting.”
Dr. Jason Fung has really nailed it here. I wonder how long it will be before he is tarred and feathered and held in infamy by his chosen profession. As Richard Feinman says in “The World Turned Upside Down” (2016), being heretical is the price to be paid for being right. Or, has the profession begun to turn the corner…and seen the light? Naaaw…

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