Dr. Samuel Klein Second take Carbohydrate-Insulin Model podcast illustration

Counterpoint: The Carbohydrate-Insulin Model Debate, Revisited

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Intellihealth’s Dr. Louis Aronne and Dr. Katherine Saunders talk with Dr. Samuel Klein about the links between obesity and metabolic disease, along with his critiques of the carbohydrate-insulin model.

Is a calorie just a calorie, or does obesity depend on the kind of calories you eat? This question lies at the core of a key discussion among obesity specialists today, about the carbohydrate-insulin model and the link between obesity and metabolic disease. 

Dr. Samuel Klein, director of the Center for Human Nutrition at Washington University in St. Louis, argues that though low-carbohydrate diets may offer metabolic health benefits, the carbohydrate-insulin model is ultimately flawed. 

In this episode of Weight Matters, Dr. Louis Aronne and Dr. Katherine Sanders talk with Klein about his perspective about the role of carbohydrates. He also discusses the metabolic health issues that often accompany obesity, and he describes some promising advancements he’s seen in obesity medicine.

Critiques of the Carbohydrate-Insulin Model

To understand the idea behind the carbohydrate-insulin model, it’s important to first know about the basic connection between calories and obesity.

“In everyone who is obese, it has to be because they eat more calories than they burn up over a long period of time,” Dr. Klein explained. “The increased calories lead to an increase in body-fat mass, and then they must maintain that increased calorie intake in order to maintain that new larger body size, because a larger body size requires more energy to maintain itself.”

The carbohydrate-insulin model argues that obesity has more to do with the types of calories a person consumes, specifically carbohydrates. When you eat a high-carbohydrate diet, the model says, this drives energy into your adipose tissue (also known as body fat).

Dr. Klein takes issue with this model, citing studies that show that even when someone eats a high-carbohydrate meal, most of those carbs do not get turned into fat. 

“It’s very difficult and energy expensive to confer carbohydrates to lipid-adipose tissues,” he explained. 

Obesity and Metabolic Disease

While there are some exceptions to the rule, Dr. Klein believes it’s important for people to understand that the vast majority of people with obesity are also metabolically unhealthy.

This is difficult to classify, as the field lacks one standard definition of metabolic health, and often the agreed-upon criteria are actually too wide.

“Most studies define metabolically healthy obesity as having two or fewer metabolic syndrome criteria and being obese. That means you just don’t have metabolic syndrome,” Dr. Klein explained. “You can actually have type 2 diabetes and be considered metabolically healthy obese if you don’t have the other criteria of metabolic syndrome. So the definition really needs to be ramped up.”

In his own work, Dr. Klein examines metabolic health by measuring factors like glucose tolerance and insulin sensitivity. 

“When you do that, you find that very few obese people are truly metabolically healthy. And that’s why so many obese people who are considered metabolically healthy given the current, very loose criteria for metabolic health, 50% of them convert to metabolically unhealthy obesity over 20 years,” he shared.

How to Improve Metabolic Health

Since there’s a direct link between the two health issues, Dr. Klein is interested in finding out how different interventions for obesity also impact metabolic health. His research shows that exercise can lead to dramatic improvements when paired with weight loss.

“We’ve just finished a study right now that shows that if you match people in 10% weight loss, but one group had supervised exercise every day, pretty intense exercise, compared to a group who just lost 10% of their body weight, that you improve insulin sensitivity 50% more in those who exercised and lost weight than those who lost weight alone, despite having identical weight loss,” he shared. “So exercise may not be very important in helping people lose weight, but it’s very important in metabolic health.”

On the other hand, liposuction is effective for removing fat, but does not impact metabolic health.

In a recent study, “We found that by removing the fat by liposuction, there was absolutely no difference at all in glucose tolerance, blood lipids, blood glucose, insulin or insulin sensitivity,” Dr. Klein explained. “Removing fat by liposuction removes billions of fat cells, but it doesn’t do the same thing as reducing fat by eating less calories than you burn up, because when you do that, you shrink the size of your remaining fat cells and you also reduce fat in certain organs.”

Follow Weight Matters wherever you get your podcasts to never miss an episode. To learn more about Dr. Sanders and Dr. Aronne’s work to transform specialized treatments for chronic conditions through the best in medical science and advanced digital technologies, visit www.intellihealth.co/podcast

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