When Carbs, Proteins, & Fats Switch Metabolic Roles

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Strange Things Happening In The Islets Of Langerhans

It is generally known and widely accepted that carbs have the biggest effect on blood sugar levels (and thus insulin response), fats less so, and protein least of all.

And yet, there was a groundbreaking study published yesterday which found:

Glucose is the well-known driver of insulin, but we were surprised to see such high variability, with some individuals showing a strong response to proteins, and others to fats, which had never been characterized before.

Insulin plays a major role in human health, in everything from diabetes, where it is too low*, to obesity, weight gain and even some forms of cancer, where it is too high.

These findings lay the groundwork for personalized nutrition that could transform how we treat and manage a range of conditions.❞

~ Dr. James Johnson

*saying ”too low” here is potentially misleading without clarification; yes, Type 1 Diabetics will have too little [endogenous] insulin (because the pancreas is at war with itself and thus isn’t producing useful quantities of insulin, if any). Type 2, however, is more a case of acquired insulin insensitivity, because of having too much at once too often, thus the body stops listening to it, “boy who cried wolf”-style, and the pancreas also starts to get fatigued from producing so much insulin that’s often getting ignored, and does eventually produce less and less while needing more and more insulin to get the same response, so it can be legitimately said “there’s not enough”, but that’s more of a subjective outcome than an objective cause.

Back to the study itself, though…

What they found, and how they found it

Researchers took pancreatic islets from 140 heterogenous donors (varied in age and sex; ostensibly mostly non-diabetic donors, but they acknowledge type 2 diabetes could potentially have gone undiagnosed in some donors*) and tested cell cultures from each with various carbs, proteins, and fats.

They found the expected results in most of the cases, but around 9% responded more strongly to the fats than the carbs (even more strongly than to glucose specifically), and even more surprisingly 8% responded more strongly to the proteins.

*there were also some known type 2 diabetics amongst the donors; as expected, those had a poor insulin response to glucose, but their insulin response to proteins and fats were largely unaffected.

What this means

While this is, in essence, a pilot study (the researchers called for larger and more varied studies, as well as in vivo human studies), the implications so far are important:

It appears that, for a minority of people, a lot of (generally considered very good) antidiabetic advice may not be working in the way previously understood. They’re going to (for example) put fat on their carbs to reduce the blood sugar spike, which will technically still work, but the insulin response is going to be briefly spiked anyway, because of the fats, which very insulin response is what will lower the blood sugars.

In practical terms, there’s not a lot we can do about this at home just yet—even continuous glucose monitors won’t tell us precisely, because they’re monitoring glucose, not the insulin response. We could probably measure everything and do some math and work out what our insulin response has been like based on the pace of change in blood sugar levels (which won’t decrease without insulin to allow such), but even that is at best grounds for a hypothesis for now.

Hopefully, more publicly-available tests will be developed soon, enabling us all to know our “insulin response type” per the proteome predictors discovered in this study, rather than having to just blindly bet on it being “normal”.

Ironically, this very response may have hidden itself for a while—if taking fats raised insulin response without raising blood sugar levels, then if blood sugar levels are the only thing being measured, all we’ll see is “took fats at dinner; blood sugars returned to normal more quickly than when taking carbs without fats”.

You can read the study in full here:

Proteomic predictors of individualized nutrient-specific insulin secretion in health and disease

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  • Savoy Cabbage vs Pak Choi – Which is Healthier?

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    Our Verdict

    When comparing savoy cabbage to pak choi, we picked the savoy.

    Why?

    Looking at the macros first, the savoy has a little more protein, just under 3x the carbs, and just over 3x the fiber. A modest yet respectable win for savoy.

    In terms of vitamins, savoy has more of vitamins B1, B5, B9, E, K, and choline, while pak choi has more of vitamins A, B2, B3, and C. Thus, a 6:4 win for savoy.

    When it comes to minerals, savoy has more copper, magnesium, manganese, phosphorus, potassium, selenium, and zinc, while pak choi has more calcium, iron, and potassium. So this time, a 7:3 win for savoy.

    On the other hand, pak choi scores higher on the polyphenols side, especially in the categories of kaempferol and quercetin.

    Still, adding up the sections, we conclude this one’s an overall win for savoy cabbage. Of course, enjoy either or both, though!

    Want to learn more?

    You might like to read:

    Fight Inflammation & Protect Your Brain, With Quercetin

    Take care!

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  • Avocado Oil vs Olive Oil – Which is Healthier?

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    Our Verdict

    When comparing avocado oil to olive oil, we picked the olive oil.

    Why?

    Avocados and olives are both very healthy foods. However, when they are made into oils, there’s an important distinguishing factor:

    Olive oil usually retains a lot of the micronutrients from the olives (including vitamins E and K), whereas no measurable micronutrients usually remain in avocado oil.

    So while both olive oil and avocado oil have a similar (excellent; very heart-healthy!) lipids profile, the olive oil has some bonuses that the avocado oil doesn’t.

    We haven’t written about the nutritional profiles of either avocados or olives yet, but here’s what we had to say on the different kinds of olive oil available:

    Is “Extra Virgin” Worth It?

    And here’s an example of a good one on Amazon, for your convenience 😎

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  • Staying Alive – by Dr. Jenny Goodman

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    A lot of “healthy long life” books are science-heavy to the point of being quite challenging to read—they become excellent reference sources, but not exactly “curl up in the armchair” books.

    Dr. Goodman writes in a much more reader-friendly fashion, casual yet clear.

    She kicks off with season-specific advice. What does that mean? Basically, our bodies need different things at different times of year, and we face different challenges to good health. We may ignore such at our peril!

    After a chapter for each of the four seasons (assuming a temperate Northern Hemisphere climate), she goes on to cover the seasons of our life. Once again, our bodies need different things at different times in our life, and we again face different challenges to good health!

    There’s plenty of “advice for all seasons”, too. Nutritional dos and don’t, and perennial health hazards to avoid.

    As a caveat, she does also hold some unscientific views that may be skipped over. These range from “plant-based diets aren’t sustainable” to “this detox will get rid of heavy metals”. However, the value contained in the rest of the book is more than sufficient to persuade us to overlook those personal quirks.

    In particular, she offers very good advice on overcoming cravings (and distinguishing them from genuine nutritional cravings), and taking care of our “trillions of tiny companions” (beneficial gut microbiota) without nurturing Candida and other less helpful gut flora and fauna.

    In short, a fine lot of information in a very readable format.

    Order your copy of “Staying Alive” from Amazon today!

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  • AI: The Doctor That Never Tires?

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    AI: The Doctor That Never Tires?

    We asked you for your opinion on the use of Artificial Intelligence (AI) in healthcare, and got the above-depicted, below-described set of results:

    • A little over half of respondents to the poll voted for “It speeds up research, and is more methodical about diagnosis, so it’s at least a good extra tool”
    • A quarter of respondents voted for “I’m on the fence—it seems to make no more nor less mistakes than human doctors do”
    • A little under a fifth of respondents voted for “AI is less prone to fatigue/bias than human doctors, making it an essential new tech”
    • Three respondents voted for “AI is a step too far in medical technology, and we’re not ready for it”

    Writer’s note: I’m a professional writer (you’d never have guessed, right?) and, apparently, I really did write “no more nor less mistakes”, despite the correct grammar being “no more nor fewer mistakes”. Now, I know this, and in fact, people getting less/fewer wrong is a pet hate of mine. Nevertheless, I erred.

    Yet, now that I’m writing this out in my usual software, and not directly into the poll-generation software, my (AI!) grammar/style-checker is highlighting the error for me.

    Now, an AI could not do my job. ChatGPT would try, and fail miserably. But can technology help me do mine better? Absolutely!

    And still, I dismiss a lot of the AI’s suggestions, because I know my field and can make informed choices. I don’t follow it blindly, and I think that’s key.

    AI is less prone to fatigue/bias than human doctors, making it an essential new tech: True or False?

    True—with one caveat.

    First, a quick anecdote from a subscriber who selected this option in the poll:

    ❝As long as it receives the same data inputs as my doctor (ie my entire medical history), I can see it providing a much more personalised service than my human doctor who is always forgetting what I have told him. I’m also concerned that my doctor may be depressed – not an ailment that ought to affect AI! I recently asked my newly qualified doctor goddaughter whether she would prefer to be treated by a human or AI doctor. No contest, she said – she’d go with AI. Her argument was that human doctors leap to conclusions, rather than properly weighing all the evidence – meaning AI, as long as it receives the same inputs, will be much more reliable❞

    Now, an anecdote is not data, so what does the science say?

    Well… It says the same:

    ❝Of 6695 responding physicians in active practice, 6586 provided information on the areas of interest: 3574 (54.3%) reported symptoms of burnout, 2163 (32.8%) reported excessive fatigue, and 427 (6.5%) reported recent suicidal ideation, with 255 of 6563 (3.9%) reporting a poor or failing patient safety grade in their primary work area and 691 of 6586 (10.5%) reporting a major medical error in the prior 3 months. Physicians reporting errors were more likely to have symptoms of burnout (77.6% vs 51.5%; P<.001), fatigue (46.6% vs 31.2%; P<.001), and recent suicidal ideation (12.7% vs 5.8%; P<.001).❞

    See the damning report for yourself: Physician Burnout, Well-being, and Work Unit Safety Grades in Relationship to Reported Medical Errors

    AI, of course, does not suffer from burnout, fatigue, or suicidal ideation.

    So, what was the caveat?

    The caveat is about bias. Humans are biased, and that goes for medical practitioners just the same. AI’s machine learning is based on source data, and the source data comes from humans, who are biased.

    See: Bias and Discrimination in AI: A Cross-Disciplinary Perspective

    So, AI can perpetuate human biases and doesn’t have a special extra strength in this regard.

    The lack of burnout, fatigue, and suicidal ideation, however, make a big difference.

    AI speeds up research, and is more methodical about diagnosis: True or False?

    True! AI is getting more and more efficient at this, and as has been pointed out, doesn’t make errors due to fatigue, and often comes to accurate conclusions near-instantaneously. To give just one example:

    ❝Deep learning algorithms achieved better diagnostic performance than a panel of 11 pathologists participating in a simulation exercise designed to mimic routine pathology workflow; algorithm performance was comparable with an expert pathologist interpreting whole-slide images without time constraints. The area under the curve was 0.994 (best algorithm) vs 0.884 (best pathologist).❞

    Read: Diagnostic Assessment of Deep Learning Algorithms for Detection of Lymph Node Metastases in Women With Breast Cancer

    About that “getting more and more efficient at this”; it’s in the nature of machine learning that every new piece of data improves the neural net being used. So long as it is getting fed new data, which it can process at rate far exceeding humans’ abilities, it will always be constantly improving.

    AI makes no more nor less fewer mistakes than humans do: True or False?

    False! AI makes fewer, now. This study is from 2021, and it’s only improved since then:

    ❝Professionals only came to the same conclusions [as each other] approximately 75 per cent of the time. More importantly, machine learning produced fewer decision-making errors than did all the professionals❞

    See: AI can make better clinical decisions than humans: study

    All that said, we’re not quite at Star Trek levels of “AI can do a human’s job entirely” just yet:

    BMJ | Artificial intelligence versus clinicians: pros and cons

    To summarize: medical AI is a powerful tool that:

    • Makes healthcare more accessible
    • Speeds up diagnosis
    • Reduces human error

    …and yet, for now at least, still requires human oversights, checks and balances.

    Essentially: it’s not really about humans vs machines at all. It’s about humans and machines giving each other information, and catching any mistakes made by the other. That way, humans can make more informed decisions, and still keep a “hand on the wheel”.

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  • Healing Cracked Fingers

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    It’s Q&A Day at 10almonds!

    Have a question or a request? You can always hit “reply” to any of our emails, or use the feedback widget at the bottom!

    In cases where we’ve already covered something, we might link to what we wrote before, but will always be happy to revisit any of our topics again in the future too—there’s always more to say!

    As ever: if the question/request can be answered briefly, we’ll do it here in our Q&A Thursday edition. If not, we’ll make a main feature of it shortly afterwards!

    So, no question/request too big or small

    ❝Question. Suffer from cracked (split) finger tips in the cold weather. Very painful, is there something I can take to ward off this off. Appreciate your daily email.❞

    Ouch, painful indeed! Aside from good hydration (which is something we easily forget in cold weather), there’s no known internal guard against this*, but from the outside, oil-based moisturizers are the way to go.

    Olive oil, coconut oil, jojoba oil, and shea butter are all fine options.

    If the skin is broken such that infection is possible, then starting with an antiseptic ointment/cream is sensible. A good example product is Savlon, unless you are allergic to its active ingredient chlorhexidine.

    *However, if perchance you are also suffering from peripheral neuropathy (a common comorbidity of cracked skin in the extremities), then lion’s main mushroom can help with that.

    Writer’s anecdote: I myself started suffering from peripheral neuropathy in my hands earlier this year, doubtlessly due to some old injuries of mine.

    However, upon researching for the above articles, I was inspired to try lion’s mane mushroom for myself. I take it daily, and have now been free of symptoms of peripheral neuropathy for several months.

    Here’s an example product on Amazon, by the way

    Enjoy!

    Don’t Forget…

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  • In Crisis, She Went to an Illinois Facility. Two Years Later, She Still Isn’t Able to Leave.

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    Series: Culture of Cruelty:Inside Illinois’ Mental Health System

    State-run facilities in Illinois are supposed to care for people with mental and developmental disabilities. But patients have been subjected to abuse, neglect and staff misconduct for decades, despite calls for change.

    Kaleigh Rogers was in crisis when she checked into a state-run institution on Illinois’ northern border two years ago. Rogers, who has cerebral palsy, had a mental health breakdown during the pandemic and was acting aggressively toward herself and others.

    Before COVID-19, she had been living in a small group home; she had been taking college classes online and enjoyed going out with friends, volunteering and going to church. But when her aggression escalated, she needed more medical help than her community setting could provide.

    With few viable options for intervention, she moved into Kiley Developmental Center in Waukegan, a much larger facility. There, she says she has fewer freedoms and almost nothing to do, and was placed in a unit with six other residents, all of whom are unable to speak. Although the stay was meant to be short term, she’s been there for two years.

    The predicament facing Rogers and others like her is proof, advocates say, that the state is failing to live up to the promise it made in a 13-year-old federal consent decree to serve people in the community.

    Rogers, 26, said she has lost so much at Kiley: her privacy, her autonomy and her purpose. During dark times, she cries on the phone to her mom, who has reduced the frequency of her visits because it is so upsetting for Rogers when her mom has to leave.

    The 220-bed developmental center about an hour north of Chicago is one of seven in the state that have been plagued by allegations of abuse and other staff misconduct. The facilities have been the subject of a monthslong investigation by Capitol News Illinois and ProPublica about the state’s failures to correct poor conditions for people with intellectual and developmental disabilities. The news organizations uncovered instances of staff who had beaten, choked, thrown, dragged and humiliated residents inside the state-run facilities.

    Advocates hoped the state would become less reliant on large institutions like these when they filed a lawsuit in 2005, alleging that Illinois’ failure to adequately fund community living options ended up segregating people with intellectual and developmental disabilities from society by forcing them to live in institutions. The suit claimed Illinois was in direct violation of a 1999 U.S. Supreme Court decision in another case, which found that states had to serve people in the most integrated setting of their choosing.

    Negotiations resulted in a consent decree, a court-supervised improvement plan. The state agreed to find and fund community placements and services for individuals covered by the consent decree, thousands of adults with intellectual and developmental disabilities across Illinois who have put their names on waiting lists to receive them.

    Now, the state has asked a judge to consider ending the consent decree, citing significant increases in the number of people receiving community-based services. In a court filing in December, Illinois argued that while its system is “not and never will be perfect,” it is “much more than legally adequate.”

    But advocates say the consent decree should not be considered fulfilled as long as people with disabilities continue to live without the services and choices that the state promised.

    Across the country, states have significantly downsized or closed their large-scale institutions for people with developmental and intellectual disabilities in favor of smaller, more integrated and more homelike settings.

    But in Illinois, a national outlier, such efforts have foundered. Efforts to close state-operated developmental centers have been met with strong opposition from labor unions, the communities where the centers are located, local politicians and some parents.

    U.S. District Judge Sharon Johnson Coleman in Chicago is scheduled in late summer to decide whether the state has made enough progress in building up community supports to end the court’s oversight.

    For some individuals like Rogers, who are in crisis or have higher medical or behavioral challenges, the state itself acknowledges that it has struggled to serve them in community settings. Rogers said she’d like to send this message on behalf of those in state-operated developmental centers: “Please, please get us out once and for all.”

    “Living Inside a Box”

    Without a robust system of community-based resources and living arrangements to intervene during a crisis, state-operated developmental centers become a last resort for people with disabilities. But under the consent decree agreement, the state, Equip for Equality argues, is expected to offer sufficient alternative crisis supports to keep people who want them out of these institutions.

    In a written response to questions, Rachel Otwell, a spokesperson for the Illinois Department of Human Services, said the state has sought to expand the menu of services it offers people experiencing a crisis, in an effort to keep them from going into institutions. But Andrea Rizor, a lawyer with Equip for Equality, said, “They just don’t have enough to meet the demand.”

    For example, the state offers stabilization homes where people can live for 90 days while they receive more intensive support from staff serving the homes, including medication reviews and behavioral interventions. But there are only 32 placements available — only four of them for women — and the beds are always full, Rizor said.

    Too many people, she said, enter a state-run institution for short-term treatment and end up stuck there for years for various reasons, including shortcomings with the state’s discharge planning and concerns from providers who may assume those residents to be disruptive or difficult to serve without adequate resources.

    That’s what happened to Rogers. Interruptions to her routine and isolation during the pandemic sent her anxiety and aggressive behaviors into overdrive. The staff at her community group home in Machesney Park, unsure of what to do when she acted out, had called the police on several occasions.

    Doctors also tried to intervene, but the cocktail of medications she was prescribed turned her into a “zombie,” Rogers said. Stacey Rogers, her mom and legal guardian, said she didn’t know where else to turn for help. Kiley, she said, “was pretty much the last resort for us,” but she never intended for her daughter to be there for this long. She’s helped her daughter apply to dozens of group homes over the past year. A few put her on waitlists; most have turned her down.

    “Right now, all she’s doing is living inside a box,” Stacey Rogers said.

    Although Rogers gave the news organizations permission to ask about her situation, IDHS declined to comment, citing privacy restrictions. In general, the IDHS spokesperson said that timelines for leaving institutions are “specific to each individual” and their unique preferences, such as where they want to live and speciality services they may require in a group home.

    Equip for Equality points to people like Rogers to argue that the consent decree has not been sufficiently fulfilled. She’s one of several hundred in that predicament, the organization said.

    “If the state doesn’t have capacity to serve folks in the community, then the time is not right to terminate this consent decree, which requires community capacity,” Rizor said.

    Equip for Equality has said that ongoing safety issues in these facilities make it even more important that people covered by the consent decree not be placed in state-run institutions. In an October court brief, citing the news organizations’ reporting, Equip for Equality said that individuals with disabilities who were transferred from community to institutional care in crisis have “died, been raped, and been physically and mentally abused.”

    Over the summer, an independent court monitor assigned to provide expert opinions in the consent decree, in a memo to the court, asked a judge to bar the state from admitting those individuals into its institutions.

    In its December court filing, the state acknowledged that there are some safety concerns inside its state-run centers, “which the state is diligently working on,” as well as conditions inside privately operated facilities and group homes “that need to be addressed.” But it also argued that conditions inside its facilities are outside the scope of the consent decree. The lawsuit and consent decree specifically aimed to help people who wanted to move out of large private institutions, but plaintiffs’ attorneys argue that the consent decree prohibits the state from using state-run institutions as backup crisis centers.

    In arguing to end the consent decree, the state pointed to significant increases in the number of people served since it went into effect. There were about 13,500 people receiving home- and community-based services in 2011 compared with more than 23,000 in 2023, it told the court.

    The state also said it has significantly increased funding that is earmarked to pay front-line direct support professionals who assist individuals with daily living needs in the community, such as eating and grooming.

    In a statement to reporters, the human services department called these and other improvements to the system “extraordinary.”

    Lawyers for the state argued that those improvements are enough to end court oversight.

    “The systemic barriers that were in place in 2011 no longer exist,” the state’s court filing said.

    Among those who were able to find homes in the community is Stanley Ligas, the lead plaintiff in the lawsuit that led to the consent decree. When it was filed in 2005, he was living in a roughly 100-bed private facility but wanted to move into a community home closer to his sister. The state refused to fund his move.

    Today, the 56-year-old lives in Oswego with three roommates in a house they rent. All of them receive services to help their daily living needs through a nonprofit, and Ligas has held jobs in the community: He previously worked in a bowling alley and is now paid to make public appearances to advocate for others with disabilities. He lives near his sister, says he goes on family beach vacations and enjoys watching professional wrestling with friends. During an interview with reporters, Ligas hugged his caregiver and said he’s “very happy” and hopes others can receive the same opportunities he’s been given.

    While much of that progress has come only in recent years, under Gov. JB Pritzker’s administration, it has proven to be vulnerable to political and economic changes. After a prolonged budget stalemate, the court in 2017 found Illinois out of compliance with the Ligas consent decree.

    At the time, late and insufficient payments from the state had resulted in a staffing crisis inside community group homes, leading to escalating claims of abuse and neglect and failures to provide routine services that residents relied on, such as help getting to work, social engagements and medical appointments in the community. Advocates worry about what could happen under a different administration, or this one, if Illinois’ finances continue to decline as projected.

    “I acknowledge the commitments that this administration has made. However, because we had so far to come, we still have far to go,” said Kathy Carmody, chief executive of The Institute on Public Policy for People with Disabilities, which represents providers.

    While the wait for services is significantly shorter than it was when the consent decree went into effect in 2011, there are still more than 5,000 adults who have told the state they want community services but have yet to receive them, most of them in a family home. Most people spend about five years waiting to get the services they request. And Illinois continues to rank near the bottom in terms of the investment it makes in community-based services, according to a University of Kansas analysis of states’ spending on services for people with intellectual and developmental disabilities.

    Advocates who believe the consent decree has not been fulfilled contend that Illinois’ continued reliance on congregate settings has tied up funds that could go into building up more community living options. Each year, Illinois spends about $347,000 per person to care for those in state-run institutions compared with roughly $91,000 per person spent to support those living in the community.

    For Rogers, the days inside Kiley are long, tedious and sometimes chaotic. It can be stressful, but Rogers told reporters that she uses soothing self-talk to calm herself when she feels sad or anxious.

    “I tell myself: ‘You are doing good. You are doing great. You have people outside of here that care about you and cherish you.’”

    This article is republished from ProPublica under a Creative Commons license. Read the original article.

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