Blood work?

[Sakly]

You gain visceral fat from overnutrition, whether carb or fat.

Right. That sounds different to what you wrote above, but probably this was only my interpretation.

Sugar (fructose component) and alcohol in excess of your energy burn go directly to liver fat.

Fully agreed and this is well known by science.

Your normal subcutaneous adipose tissues say "no more" and your organs start to take it up. In the case of carbs, your body manufactures the fatty acids; in the case of fats it largely onboards them directly.

Also agreed.

Main factor not taken into account is the hormonal response from the body and this is quite different between carbs or fats as main dietary fuel.

[gvcormac]

You gain visceral fat from overnutrition, whether carb or fat.

Right. That sounds different to what you wrote above, but probably this was only my interpretation.

I think we're conflating visceral fat and insulin resistance. There's a strong correlation, and overnutrition is the primary cause of both. It does appear that saturated fat promotes higher insulin resistance than other macros, other factors being equal.

[Sakly]

You gain visceral fat from overnutrition, whether carb or fat.

Right. That sounds different to what you wrote above, but probably this was only my interpretation.

I think we're conflating visceral fat and insulin resistance. There's a strong correlation, and overnutrition is the primary cause of both. It does appear that saturated fat promotes higher insulin resistance than other macros, other factors being equal.

No, I don't think so.
Clearly overeating is the main cause for weight gain. But it makes a huge difference WHAT you overeat and what side effects you get.
If you mainly overeat fats, body will respond with storing fat and gaining new fat cells as well. But very likely you will not get symptoms related to high blood sugars and their toxic outcome like blindness, kidney failure or amputees. This is driven by carb overload and destroying your machinerie to deal with them. Blood sugar level must be tightly regulated, therefore carbs will always be burned and stored first using insulin and fat metabolism will be stopped as long as high blood sugar levels drive high insulin levels. If you go on with overeating carbs in this state (and that's the typical western diet and what many people do), cells will resist to take up more energy, blood sugar levels will increase, therefore insulin has to increase even more to push it into cells anyway (-> this is why it is a good marker to measure insulin resistance, HOMA IR), fat metabolism is shut off even longer.

Latest study I heard of, had the outcome that transfats are a huge driver. But that is another thing than saturated fats, which in fact are the most stable energy source for the body. Why else would the body use the same type of fat to store its energy?

[Sakly]

To get an idea of ranges and "normal" it would be helpful to know more details about your diet (mainly about macros and where they come from).
Your physical activities can be seen in the training thread, so there is info about it.
To put the values into perspective in a better way, it would also help to measure insulin, as this is one of the main marker of insulin resistance (aka T2D) and needed for HOMA IR.

Diet is what I would consider "animal based"; animal protein centric with fruits and vegetables. Most protein is coming from beef and eggs with a bit of hard cheese and rather unprocessed greek yogurt. I don't necessarily go out of my way to add fat to a lot of meals but will cook with a small amount of butter or have avocado added to some leaner meals. One of the things I will eat, not regularly, but about 2x a month with my wife and kids, is sushi.

Generally, 2-3 meals a day - if 2, they are about 8 hours apart; if 3, they are about 4 hours apart. It works out to be roughly a 16:8 type setup without that being the intention.

I like to do my morning training fasted and start eating after that but I don't like to eat within 2-3 hours of bed as it seems I don't sleep as well and my resting HR stays higher.

I do track macros and calories from time to time to see where things are but because I have been eating this way for several years, its not a daily thing as I tend to eat the same things over the course of a week or so. I did track them Mon-Wed this week though just to get a sense of where things are at - ended up pretty close to 175g protein and 175g fat each day. Carbs were around 60g on Monday and Wednesday and around 100g on Tuesday (ended up with a bit more fruit as I did a bit more quality training).

Macros probably could be a bit off in direction carbs+protein for your expectation of lower A1C. Excess protein is used for energy and converted to glucose as well.

But I was wondering about your absolute macros, they are roughly about 2500kcal - fairly low, but probably I have a wrong view on your activity level. I compare to myself, as I'm the same body type, 177cm, 80kg. But when I tracked my macros during my low carb phase, I got ~150g protein, 30-50g carbs, but was around 300g fats.

I agree - I would like to have fasting insulin checked. I am going to look into an HOMA-IR test as I am not familiar with it. I also want to have cortisol and C-reactive protein looked at as neither were tested.

I would suggest to go for hsCRP. You won't get any info from CRP, if you have no real inflammatory issues. The high sensitive CRP can show some low inflammatory signs.

With my familial history, keeping an eye on any/all markers related to diabetes is important. I've chatted with my wife about the idea of wearing a CGM for a month or so just to get an idea of how things look at a more granular level but haven't pulled the trigger on it yet.

Also thought about a CGM only put off interest, but did not dive into it yet.

[gvcormac]

Right. That sounds different to what you wrote above, but probably this was only my interpretation.

I think we're conflating visceral fat and insulin resistance. There's a strong correlation, and overnutrition is the primary cause of both. It does appear that saturated fat promotes higher insulin resistance than other macros, other factors being equal.

No, I don't think so.

As I mentioned, avoiding sugar and starch will mitigate the effects of insulin resistance. However, there is no evidence that sugar and starch cause insulin resistance any more than fat, and some evidence that saturated fat (and trans fat, I think) exacerbates insulin resistance. There is also no evidence that avoiding sugar and starch cures insulin resistance. So if one keeps on overnourishing but substituting saturated fat for carbs, they may have symptomatic relief, at least for a while, but that's not the same as reversing the insulin resistance. People with normal insulin sensitivity can deal with sugar and starch as a substantial fraction of their caloric intake, and there's no evidence it does them any harm so long as they are not gaining weight.

[Sakly]

I am not telling that insulin resistance is caused by carbohydrates. I only mention that the hormonal effect of carbs is different to that of fats and triggers other symptoms (mainly when overeating, this is agreed).
T2D is definitely driven by carbs, as this relates to chronically high blood sugar levels, which can only occur if you overeat and stuff your body with carbs to increase blood sugar levels to these high levels and the body has no capabilities to store the stuff to anywhere anymore.
A fat based diet does not increase blood sugar, so does not drive insulin. If not overeaten also does not drive insulin resistance - as carb based diet does not in this case as well.

The second finding on your linked page says in its abstract, that there is no evidence that saturated fats contribute to insulin resistance or T2D:

There is no evidence that dietary saturated fatty acids from varied food sources affect the risk of insulin resistance or T2DM, nor is intake of full-fat dairy products associated with this risk.

That was my understanding/knowledge from other sources as well.

[jcross485]

Macros probably could be a bit off in direction carbs+protein for your expectation of lower A1C. Excess protein is used for energy and converted to glucose as well.

But I was wondering about your absolute macros, they are roughly about 2500kcal - fairly low, but probably I have a wrong view on your activity level. I compare to myself, as I'm the same body type, 177cm, 80kg. But when I tracked my macros during my low carb phase, I got ~150g protein, 30-50g carbs, but was around 300g fats.

I would suggest to go for hsCRP. You won't get any info from CRP, if you have no real inflammatory issues. The high sensitive CRP can show some low inflammatory signs.

Also thought about a CGM only put off interest, but did not dive into it yet.

Much appreciate your insight!

Just to make sure I understand:

- Protein and carbs a bit high currently; either drop both a bit and increase fats to keep cals where they are (currently maintaining weight pretty well) or I would like go the other way of more balanced protein/carbs with lower fats. I personally like how I feel on lower carbs so I would likely opt for the former.

- Definitely would look at hsCRP as I don't feel or see any obvious signs of inflammation.

- CGM: I mentioned this to my wife and while we are both independent people who make our own decisions, we like to have each others support and buy in. This is something she is 100% on board with, especially given my family history. I'm looking at the Dexcom product now, will let you know if I make the leap.

[Sakly]

- Protein and carbs a bit high currently; either drop both a bit and increase fats to keep cals where they are (currently maintaining weight pretty well) or I would like go the other way of more balanced protein/carbs with lower fats. I personally like how I feel on lower carbs so I would likely opt for the former.

Don't get me wrong, I don't think you need changed in your diet or macros. It was related to your expectation of lower A1C.

- CGM: I mentioned this to my wife and while we are both independent people who make our own decisions, we like to have each others support and buy in. This is something she is 100% on board with, especially given my family history. I'm looking at the Dexcom product now, will let you know if I make the leap.

Definitely a good approach to support each other.
Anyway, a CGM is low risk and low impact, so not a big deal. Cost is another part, but I think this is also not so much?!
A CGM can help to detect high blood sugar spikes you won't see in A1C, but also contribute to some symptoms.
I wouldn't expect to see much high spikes in your measurements, when I read about your diet. But you did not give so much details, probably I'm wrong

[gvcormac]

In today's New York Times:

https://www.nytimes.com/2023/10/20/well ... betes.html

[jcross485]

Don't get me wrong, I don't think you need changed in your diet or macros. It was related to your expectation of lower A1C.

Definitely a good approach to support each other.
Anyway, a CGM is low risk and low impact, so not a big deal. Cost is another part, but I think this is also not so much?!
A CGM can help to detect high blood sugar spikes you won't see in A1C, but also contribute to some symptoms.
I wouldn't expect to see much high spikes in your measurements, when I read about your diet. But you did not give so much details, probably I'm wrong

Got it - thanks!

I might take a few days to experiment with a bit higher fats to see how I feel overall, see if there is any immediate (notable) impact on performance, see sleep data and whatnot, etc.

The CGM cost on the surface might look like a bit ($375 for a month without insurance) but if it provides valuable data, I would consider it a good investment. I am going to chat with my doc on Monday to see if he will write me a script for one so that insurance will cover it ($35 for a month). Regardless, once I get one, it will give me a solid 30 days to run a few small experiments within.

In today's New York Times:

https://www.nytimes.com/2023/10/20/well ... betes.html

Thanks for sharing! I didn't read the full article as I am not a subscriber so access was limited but I will dig to see if I can find it or the study itself.

For reference, my undergraduate and graduate work was in public health (undergrad had a concentration in biostatistics, graduate had a concentration in epidemiology). I'm pretty long removed from that field but try to keep my skills fresh with respect to reading and interpreting studies and data in a variety of areas. A lot of epidemiological studies or research are criticized using the phrase "correlation =/= causation" and I can certainly agree, even with someone who has a pro-epidemiology bias, but at the same time, these types of studies help point in the direction of the additional analysis, study, or testing needed (IMO), if that makes sense.

I mention that because, at least from my experience, I tend to be a bit skeptical of the way a lot of studies are reported on. I don't necessarily think the way they're reported is 100% inaccurate, rather it tends to be very much generalized with a grabby headline. It can be hard to really narrow down all of the parameters or factors surrounding the result that is put in a headline, hence why I try to find the study itself.

[gvcormac]

Here's the Harvard hype, from which the NYT article was probably cribbed.

https://www.hsph.harvard.edu/news/press ... etes-risk/

I agree with you that press (and press release) interpretations of research often miscontrue or overgeneralize individual studies or meta-analyses.

Also, I'm sure you have also noticed that many influencers dismiss any and all epidemiological evidence with the mantra "correlation is not causation."

[jcross485]

Here's the Harvard hype, from which the NYT article was probably cribbed.

https://www.hsph.harvard.edu/news/press ... etes-risk/

I agree with you that press (and press release) interpretations of research often miscontrue or overgeneralize individual studies or meta-analyses.

Also, I'm sure you have also noticed that many influencers dismiss any and all epidemiological evidence with the mantra "correlation is not causation."

Very helpful, thank you very much! I’ll be reading this later while my son is at his piano lesson.

Agreed w/ the “influencer” sentiment. Most are just parroting what they’ve heard and while epidemiological studies have flaws, they also have tremendous value if you can understand some of the flaws or caveats. And on the other side, clinical trial studies also have their flaws or caveats that people tend to disregard. Almost everything provides value in the right context, similar to a toolbox with a lot of tools. It’s all about using the right one at the right time for the right purpose.

[gvcormac]

they also have tremendous value if you can understand some of the flaws or caveats. And on the other side, clinical trial studies also have their flaws or caveats that people tend to disregard. Almost everything provides value in the right context, similar to a toolbox with a lot of tools. It’s all about using the right one at the right time for the right purpose.

I prefer the term "limitations" to "flaws." But you're right, it is common to cherry-pick limitations in studies whose results are contrary to your world view, and to ignore limitations in studies whose results reinforce your world view. Worse still, it is common to promote the fallacy that limitations in a study concluding X are evidence against X.

[jcross485]

I prefer the term "limitations" to "flaws." But you're right, it is common to cherry-pick limitations in studies whose results are contrary to your world view, and to ignore limitations in studies whose results reinforce your world view. Worse still, it is common to promote the fallacy that limitations in a study concluding X are evidence against X.

Very well stated all around.

[jcross485]

A bit of a follow up after today's appt:

- Doctor is not overly concerned with LDL numbers because of good blood pressure, good HDL numbers, decent triglyceride numbers, and low VLDL. No desire to prescribe or try a statin, even at a low dose. I don't use any supplements currently besides creatine monohydrate so he did recommend trying 3g EPA/DHA through a high quality Omega-3 supplement over the next few months, more testing in about 3 months or so to see what, if any, impact it has. He did mention to keep mental note of any major diet changes during this time as well to rule out confounders.

- Doctor is not overly concerned with H1C numbers as they're not in the pre-diabetic range. He understands my concern given familial history and the fact I am not eating a lot of processed foods or carbohydrates for that matter but it's something he wants to test again in about 3 months to see if there is much meaningful change. He did mention to keep mental note of any major diet changes during this time as well to rule out confounders.

- He did note he though hormone numbers were ok; not optimal but within range. He mentioned looking at a combination of both numbers and any other symptoms that are being reported that might be tied to hormonal imbalances. There are some present which I am dealing with on a day to day basis but he was hesitant to want to do much more because numbers are in range. He is going to test hormones again in about 3 months but much more thoroughly - Test, Free Test, Estradiol, SHBG, and Cortisol.

There were a few other recommendations he made which I found interesting:

- We went through all nutrition that was tracked over the last month. Even though weight has been pretty steady, he thinks my overall calorie intake for my expenditure is a little low. He recommended seeing if there are incremental changes that can be made so that average calories daily can get closer to 3000 as opposed to 2500 or so without a substantial change in body weight.

- We went through all training over the last month. He didn't come out and say I am doing too much but said that calories not being all that high and a decent volume of training might be contributing. He made it clear he is not a trainer, exercise science guy, etc., but noted how much more aerobic work (ie. rowing, running) I have been doing as opposed to strength work and seems to think that incorporating more strength work or some more short, high intensity work along with a few days a week of aerobic work might make a difference.

Now I am not going to say with certainty how I might apply the recommendations at this point but I was already looking at making it a point to strength train at least 2x a week consistently, if not 3x, depending on volume per session or how its structured. The fish oil recommendation seems to be a relatively easy thing to implement so going to start that here soon.