“Prolonged Exposure Of Our Muscles To High Levels Of Fat Leads To Severe Insulin Resistance, With Saturated Fats Demonstrated To Be The Worst”

When cells become resistant to insulin, blood sugar goes up. Fat raises blood sugar because it makes cells resistant to insulin. Insulin resistance is a hallmark of type 2 diabetes.

Dr. Greger posted this video about 5 years ago. He summarized some of the science behind the link between fat and insulin resistance. I linked the studies in it because I want to visit them later. But the concept isn’t new. You’re seen it here for years:

Prolonged exposure of our muscles to high levels of fat leads to severe insulin resistance, with saturated fats demonstrated to be the worst.
– Dr. Greger

Here are the studies he cites in the video:

Mechanisms For Insulin Resistance: Common Threads And Missing Links, Cell, March 2012

Free Fatty Acids And Skeletal Muscle Insulin Resistance, Progress in Molecular Biology and Translational Science, June 2008

Oxygen-Carrying Proteins In Meat And Risk Of Diabetes Mellitus, JAMA Internal Medicine, July 2013

Intramyocellular Triglyceride Content Is A Determinant Of In Vivo Insulin Resistance In Humans: A 1H-13C Nuclear Magnetic Resonance Spectroscopy Assessment In Offspring Of Type 2 Diabetic Parents, Diabetes, August 1999

Lipotoxicity: Why Do Saturated Fatty Acids Cause And Monounsaturates Protect Against It?, Gastroenterology and Hepatology, May 2009

Role Of Insulin In The Pathogenesis Of Free Fatty Acid-Induced Insulin Resistance In Skeletal Muscle, Endocrine, Metabolic and Immune Disorders Drug Targets, March 2007

Lipotoxicity: Effects Of Dietary Saturated And Transfatty Acids, Mediators of Inflammation, January 2013

Substituting Dietary Saturated For Monounsaturated Fat Impairs Insulin Sensitivity In Healthy Men And Women: The KANWU Study, Diabetologia, March 2001

Mechanisms Underlying Skeletal Muscle Insulin Resistance Induced By Fatty Acids: Importance Of The Mitochondrial Function, Lipids and Health and Disease, February 2012

Vegetarian Diet Affects Genes Of Oxidative Metabolism And Collagen Synthesis, Annals of Nutrition and Metabolism, October 2008

Veganism And Its Relationship With Insulin Resistance And Intramyocellular Lipid, European Journal of Clinical Nutrition, November 2004

Higher Insulin Sensitivity In Vegans Is Not Associated With Higher Mitochondrial Density, European Jurnal of Clinical Nutrition, October 2013


The association between fat and insulin resistance is now widely accepted–so-called ectopic fat accumulation–the accumulation of fat in places it’s not supposed to be, like within our muscle cells. But not all fats affect muscles the same. The type of fat–saturated or unsaturated–is critical. Saturated fats like palmitate, found mostly in meat, dairy, and eggs, cause insulin resistance, but oleate, found mostly in nuts, olives, and avocados may actually improve insulin sensitivity. What makes saturated fat bad? Saturated fat causes more of those toxic breakdown products and mitochondrial dysfunction, and increases oxidative stress, free radicals, and inflammation, establishing a vicious cycle of events in which saturated fat-induced free radicals cause dysfunction in the little power plants within our muscle cells, which causes an increase in free radical production and the impairment of insulin signaling.

Fat cells filled with saturated fat activate an inflammatory response to a far greater extent. This increased inflammation, along with eating more saturated fat, has been demonstrated to raise insulin resistance through free radical and ceramide production. Saturated fat has also been shown to have a direct effect on skeletal muscle insulin resistance. Accumulation of saturated fat increases the amount of diacylglycerol in the muscles, which has been demonstrated to have a potent effect on muscle insulin resistance. It doesn’t matter if the fat in our blood comes from our own fat, or from their fat.

You can take muscle biopsies from people and correlate the saturated fat buildup in their muscles with insulin resistance.

While monounsaturated fats are more likely to be detoxified or safely stored away, saturated fats create these toxic breakdown products, like ceramide, that cause lipotoxicity. Lipo- meaning fat, as in liposuction, and toxicity. This fat toxicity in our muscles is a well-known concept in the explanation of the trigger for insulin resistance.

I’ve talked about the role saturated and trans fats contribute to the progression of other diseases, like autoimmune diseases, cancer, and heart disease, but they can also cause insulin resistance, the underlying cause of prediabetes and type 2 diabetes. In the human diet, saturated fats are derived from animal sources while trans fats originate in meat and milk, in addition to partially hydrogenated and refined vegetable oils.

That’s why experimentally shifting people from animal fats to plant fats can improve insulin sensitivity. Insulin sensitivity was impaired on the diet with added butterfat, but not on the diet with added olive fat.

We know prolonged exposure of our muscles to high levels of fat leads to severe insulin resistance, with saturated fats demonstrated to be the worst. But they don’t just lead to inhibition of insulin signaling, the activation of inflammatory pathways, and the increase in free radicals. They cause an alteration in gene expression, leading to a suppression of key mitochondrial enzymes, like carnitine palmitoyltransferase–which finally solves the mystery of why those eating vegetarian have a 60% higher expression of that fat-burning enzyme. They’re eating less saturated fat.

So do those eating plant-based diets have less fat clogging their muscles and less insulin resistance too? There hasn’t been any data available regarding the insulin sensitivity or inside-muscle cell-fat of those eating vegan or vegetarian, until now.

Researchers at the Imperial College of London compared the insulin resistance and muscle fat of vegans versus omnivores. Now those eating plant-based diets have the unfair advantage of being so much slimmer, so they found omnivores who were as skinny as vegans to see if plant-based diets had a direct benefit, as opposed to indirectly pulling fat out of the muscles by helping people lose weight in general.

They found significantly less fat trapped in the muscle cells of vegans compared to omnivores even at the same body weight. They found better insulin sensitivity, better blood sugar levels, better insulin levels, and, excitingly, significantly improved beta-cell function–the cells in the pancreas that make insulin in the first place. They conclude that eating vegan is not only expected to be cardioprotective, helping prevent our #1 killer–heart disease–but that veganism may be beta cell protective as well, helping also to prevent our seventh leading cause of death–diabetes.

This is too big of a chunk for me to digest in one sitting. I hope to post some smaller bites later.

Parboiled Rice Removes Arsenic, Retains Nutrients

All rice, both organic and conventional, contains arsenic. There’s no getting around it. Right now, I cook my rice using the “excess water” method. Similar to cooking pasta, you bring a large amount of water (just a few cups more than normal) to a boil, add washed rice, cook, pour through strainer, cover and let sit for about 10 minutes. I’m happy with this method, but it does discard more nutrients than just allowing rice to absorb all its fluid.

Here’s an alternative. Parboil for 5 minutes then allow rice to absorb fresh water:

News summary:
New Way Of Cooking Rice Removes Arsenic And Retains Mineral Nutrients, Study Shows, PhysOrg, 2 November 2020

Improved Rice Cooking Approach To Maximise Arsenic Removal While Preserving Nutrient Elements, Science of the Total Environment, 29 October 2020

I haven’t tried it yet. The only drawback is that extra step of adding fresh water and waiting for it to heat up. So, a little more time and attention but perhaps a healthier product.

Thanks to David.

20% Of Grocery Workers In Boston Store Had COVID-19, Most Didn’t Have Symptoms

Photo source: MedPageToday

Association Between SARS-CoV-2 Infection, Exposure Risk And Mental Health Among A Cohort Of Essential Retail Workers In The USA, Occupational and Environmental Medicine, 29 October 2020

Methods: This cross-sectional study was conducted in May 2020 in a single grocery retail store in Massachusetts.

Results: Among 104 workers tested, 21 (20%) had positive viral assays. Seventy-six per cent positive cases were asymptomatic.

Conclusions: In this single store sample, we found a considerable asymptomatic SARS-CoV-2 infection rate among grocery workers. Employees with direct customer exposure were five times more likely to test positive for SARS-CoV-2.

As to mental health, the prevalence of anxiety and depression was 24% and 8%, respectively. Those able to practice social distancing consistently at work had odds of 0.3 and 0.2, respectively.

CNN covered it:
About 20% Of Grocery Store Workers Had Covid-19, And Most Didn’t Have Symptoms, Study Found, CNN, 29 October 2020

These workers likely became a “significant transmission source” for Covid-19 without even knowing it because most in the study were asymptomatic.

The analysis … is the first to demonstrate the significant asymptomatic infection rate, exposure risks and psychological distress grocery workers have felt during the pandemic.

Workers who dealt with customers were five times as likely to test positive for Covid-19 as colleagues in other positions. But three out of four of those who tested positive had no symptoms.

Dr. Justin Yang, study author: “This is definitely very alarming as it means that retail grocery store employees are exposed to customers and sort of serve as a middleman for the virus – like a super spreader almost.”

Non-union grocery workers often have little to no healthcare coverage, meaning they could potentially face expensive health care bills if they contracted Covid-19.

An infection rate of 20% is crazy high. Yang said the infection rate in the surrounding community was less than 2%. And this was in early May, a time when cases were lower than they are today.

Buying groceries has become risky.

The Rose Walk, Giverny – Monet

From Wikipedia: Claude Monet:

Oscar-Claude Monet was a French painter, a founder of French Impressionist painting. The term “Impressionism” is derived from the title of his painting Impression, soleil levant (Impression, Sunrise), which was exhibited in 1874.

The Rose Walk is one of his later paintings (1920-1922). He was suffering failing eyesight at the time, cataracts. They became so bad that shortly after he painted this he underwent operations for them. “The paintings done while the cataracts affected his vision have a general reddish tone, which is characteristic of the vision of cataract victims.”

Drinking Water Increases Metabolic Rate, Increases Thermogenesis (Heat Production), Can Assist Weight Loss

Drinking two cups of plain water can produce “a 60% surge in the adrenal hormone noradrenaline within minutes, as if you just smoked a few cigarettes or downed a few cups of coffee, which boosts your metabolic rate up to 30% within an hour.” – Michael Greger MD.  Photo: Cooks Illustrated

Dr. Greger just posted this video about water and metabolism. The concept is new to me. Beneath the video are 9 studies I pulled from his presentation and a quote or paraphrase about each. Beneath that is the video’s transcript if you’d prefer to read. Greger does a great job of summing this all up in 5 minutes. At the very end are my comments.

1. Water-induced Thermogenesis And Fat Oxidation: A Reassessment, Nutrition & Diabetes, December 2015

The increases in REE [resting energy expenditure] over 90 min post drink found in the two studies conducted in the laboratory of Boschmann et al. [they are the following 2 studies] using the same fixed water volume (500 ml) and same water temperature (21–22°) are uniquely spectacular.

2. Water-Induced Thermogenesis, The Journal of Clinical Endorinology and Metabolism, December 2003

Drinking 500 ml of water [16 ounces or 2 cups] increased metabolic rate by 30%. The increase occurred within 10 min and reached a maximum after 30–40 min.

In men, lipids mainly fueled the increase in metabolic rate. In contrast, in women carbohydrates were mainly used as the energy source.

The increase in energy expenditure with water was diminished with systemic β-adrenoreceptor blockade. [So, taking a beta-blocker – say, for high-blood pressure – would defeat this increase in metabolism.]

3. Water Drinking Induces Thermogenesis Through Osmosensitive Mechanisms, The Journal of Clinical Endorinology and Metabolism, August 2007

Context: Recently, we showed that drinking 500 ml water induces thermogenesis in normal-weight men and women.

Objective: We now repeated these studies in a randomized, controlled, crossover trial in overweight or obese otherwise healthy subjects (eight men and eight women), comparing also the effects of 500 ml isoosmotic saline or 50 ml water.

Results: Only 500 ml water increased energy expenditure by 24% over the course of 60 min after ingestion, whereas isoosmotic saline and 50 ml water had no effect. Heart rate and blood pressure did not change in these young, healthy subjects.

Conclusions: Our data exclude volume-related effects or gastric distension as the mediator of the thermogenic response to water drinking. Instead, we hypothesize the existence of a portal osmoreceptor, most likely an ion channel.

4. Influence Of Water Drinking On Resting Energy Expenditure In Overweight Children, International Journal of Obesity, July 2011

A subsequent rise in REE [resting energy expenditure] was observed, which was significantly higher than baseline after 24 min and at most time points thereafter. Maximal mean REE values were seen at 57 min after water drinking which were 25% higher than baseline.

5. The Osmopressor Response To Water Drinking, American Journal of Physiology, January 2011

Indeed, water drinking raises resting energy expenditure in normal weight and obese subjects. The stimulus setting off the response is hypoosmolarity rather than water temperature or gastrointestinal stretch.

The increase in metabolic rate with water drinking could be systematically applied in the prevention of weight gain and associated metabolic and cardiovascular risk factors. In essence, water drinking provides negative calories.

6. Drinking Water Is Associated With Weight Loss In Overweight Dieting Women Independent Of Diet And Activity, Obesity, September 2012

Results: Absolute and relative increases in drinking water were associated with significant loss of body weight and fat over time, independent of covariates.

7. Effect Of ‘Water Induced Thermogenesis’ On Body Weight, Body Mass Index And Body Composition Of Overweight Subjects, Journal of Clincal and Diagnositic Research, September 2013

This was an odd study. 50 young women drank 2 cups of water 3 times a day, before meals, in addition to any other beverages. After 8 weeks, the women lost weight, their BMIs went down, they lost body fat. However, you don’t know if all that water before meals affected calorie intake. Also no control group. Nonetheless, they drank water and lost weight without dieting.

8. Water Consumption Increases Weight Loss During A Hypocaloric Diet Intervention In Middle-Aged And Older Adults, Obesity, February 2010

Weight loss was ~2 kg greater in the water group than in the nonwater group, and the water group showed a 44% greater decline in weight over the 12 weeks than the nonwater group.

Thus, when combined with a hypocaloric diet, consuming 500 ml water prior to each main meal leads to greater weight loss than a hypocaloric diet alone in middle-aged and older adults. This may be due in part to an acute reduction in meal EI following water ingestion.

9. Efficacy Of Water Preloading Before Main Meals As A Strategy For Weight Loss In Primary Care Patients With Obesity: RCT, Obesity, August 2015

After adjustment, the water preloading group (500 ml 30 min before meal) lost about 1.2 kg (2.6 pounds, not much) more than the comparison group over 12 weeks. Barely reached significance: P = 0.063. However, those who actually DID drink the water 3 times a day lost about 9.5 pounds from baseline.

Here’s the transcript:

Given the 60 percent surge in the adrenal hormone noradrenaline within minutes of just drinking two cups of plain water, might one get the weight-loss benefits of noradrenaline-releasing drugs, like ephedra, without the risks? You don’t know until you put it to the test. Published in the Journal of the Endocrine Society, the results were described as “uniquely spectacular.” Drinking two cups of water increased the metabolic rate of men and women by 30 percent. The increase started within 10 minutes and reached a maximum within an hour. In the 90 minutes after drinking a single tall glass of water, the study subjects burned about an extra 25 calories. Do that four times throughout the day and you could wipe out 100 extra calories— more than ephedra! You’d trim off more calories drinking water than taking weight loss doses of the banned substance, ephedrine—the active component of ephedra—three times a day. And we’re just talking about plain, cheap, safe, and legal tap water!

Using the 10-Calorie Rule I explained previously, unless we somehow compensated by eating more or moving less, drinking that much water could make us lose 10 pounds over time. “In essence,” concluded one research team, “water drinking provides negative calories.”

A similar effect was found in overweight and obese children. Drinking about two cups of water led to a 25 percent increase in metabolic rate within 24 minutes, lasting at least 66 minutes until the experiment ended. So, just getting the recommended daily “adequate intake” of water—about 7 cups a day for children ages 4 through 8, and for ages 9 through 13, 8 cups a day for girls and 10 cups for boys—may offer more than just hydration benefits.

Not all research teams were able to replicate these findings, though. Others only found about a 10 to 20 percent increase, a 5 percent increase, or effectively none at all––pouring cold water, one might say, on the whole concept. What we care about, though, is weight loss. The proof is in the pudding. Let’s test the waters, shall we?

Some researchers suggest, “The increase in metabolic rate with water drinking could be systematically applied in the prevention of weight gain….” Talk about a safe, simple, side-effect-free solution—in fact free, in every sense. Drug companies may spend billions getting a new drug to market; surely a little could be spared to test something that, at the very least, couldn’t hurt. That’s the problem, though. Water is a “cost-free intervention.”

There are observational studies suggesting those who drink, for example, four or more cups of water a day appear to lose more weight, independent of confounding factors such as less soda or more exercise. But you don’t really know until you put it to the test.

And finally, in 2013, “Effect of ‘Water Induced Thermogenesis’ on Body Weight, Body Mass Index and Body Composition of Overweight Subjects.” Fifty overweight “girls” (actually women, ages 18 through 23) were asked to drink two cups of water, three times a day, a half hour before meals, over and above their regular water intake, without otherwise changing their diets or physical activity. And, they lost an average of three pounds in eight weeks. What happened to those in the control group? There was no control group, a fatal flaw for any weight loss study due to the “Hawthorne effect,” where just knowing you’re being watched and weighed may subtly affect people’s behavior. Of course, we’re just talking about water; so, with no downsides one might as well give it a try. But I’d feel more confident if there were some randomized, controlled trials to really put it to the test. Thankfully, there are!

Oh, I hate it when the title ruins the suspense. Overweight and obese men and women randomized to two cups of water before each meal lost nearly five pounds more body fat in 12 weeks than those in the control group. Both groups were put on the same calorie-restricted diet, but the one with the added water lost weight 44 percent faster. A similar randomized controlled trial found that about 1 in 4 in the water group lost more than 5 percent of their body weight compared to only 1 in 20 in the control group.

The average weight loss difference was only about three pounds, but those who claimed to have actually complied with the three-times-a-day instructions lost about eight more pounds compared to those only did the extra water once a day or less. This is comparable to commercial weight loss programs like Weight Watchers, and all they did was drink some extra water.

Not cited by Greger but related:
The Pressor Response to Water Drinking in Humans, Circulation, February 2000

Conclusions — Water drinking significantly and rapidly raises sympathetic activity. Indeed, it raises plasma norepinephrine as much as such classic sympathetic stimuli as caffeine and nicotine.

In sum … Drinking a cup or two of water on an empty stomach raises metabolism. Less than that or drinking tea, soda, beer, or other beverage won’t work. Mechanism: When a dilute solution passes over a cell (possibly in digestive tract, liver, or hepatic portal vein), a receptor on the cell’s surface senses that extracellular hypoosmolarity (water is hypoosmotic).

It’s vital that a cell be able to sense what’s going on around it, because:

Extracellular hyperosmolarity causes cell shrinkage, whereas extracellular hypoosmolarity causes cell swelling.

Either of those sets off a chain of events, e.g.

Indeed, osmotic cell swelling activates anabolic processes including glycogen and protein synthesis in the presence of suitable substrates.

Also, Did you notice? If your metabolic rate goes up and you produce heat, you need to be burning a fuel. What’s the fuel? It’s different for men and women:

In men, lipids mainly fueled the increase in metabolic rate. In contrast, in women carbohydrates were mainly used as the energy source.

There is a whole lot going on here, a whole lot to learn.

Drugs That Reduce Stomach Acid Secretion – Proton Pump Inhibitors (PPIs) – Increase Risk For Diabetes

The single most important thing you can do to prevent diabetes is lose weight. It almost doesn’t matter how – diet, exercise, fasting, surgery. I advocate a low-fat, plant-based diet because it improves health in so many other ways. But it’s not the only way to lose weight.

There are other factors that increase risk for diabetes besides being overweight … family history, having diabetes while pregnant, air pollution, exposure to endocrine disruptors (like BPA) and other environmental pollutants. And now, taking PPIs:

Regular Use Of Proton Pump Inhibitors And Risk Of Type 2 Diabetes: Results From Three Prospective Cohort Studies, BMJ Gut, September 2020

Conclusions: Regular use* of proton pump inhibitors (PPIs) was associated with a higher risk of type 2 diabetes and the risk increased with longer duration of use. Physicians should therefore exercise caution when prescribing PPIs, particularly for long-term use.

* Regular use was defined as 2 or more times a week

Regular Use Of Acid Reflux Drugs Linked To Heightened Risk Of Type 2 Diabetes, BMJ Newsroom, 28 September 2020

PPIs are used to treat acid reflux, peptic ulcers, and indigestion. They are among the top 10 most commonly used drugs worldwide. Long-term use has been linked to an increased risk of bone fractures, chronic kidney disease, gut infections and stomach cancer.

A mounting body of evidence suggests that changes in the type and volume of bacteria in the gut (the microbiome) may help explain the associations found between PPI use and an increased risk of developing diabetes.

Examples of PPIs:
Omeprazole (Prilosec)
Lansoprazole (Prevacid)
Esomeprazole (Nexium)