Ray Peat - Cortisol and Diabetes

"Oxidation of sugar is metabolically efficient in many ways, including sparing oxygen consumption. It produces more carbon dioxide than oxidizing fat does, and carbon dioxide has many protective functions, including increasing Krebs cycle activity and inhibiting toxic damage to proteins. The glycation of proteins occurs under stress, when less carbon dioxide is being produced, and the proteins are normally protected by carbon dioxide."


I won’t go into this too much, as this was the topic in a recent blog post on sugar and carbon dioxide, but I do believe, especially considering my own experience with both a very high carbohydrate and a very high fat diet, that for things like vasodilation and athletic performance and recovery – a carbohydrate-based diet is vastly superior. Even something as simple as breathing through my nostrils is easier on a carbohydrate-based diet. While it is possible that there is no “best” form of fuel for the human body, nearly all top athletes in the world eat predominantly carbohydrates to increase speed, performance, recovery, and so on. It’s very possible there is a “best” form of fuel for the human body, and that glucose is it.

"When sugar (or starch) is turned into fat, the fats will be either saturated, or in the series derived from omega -9 monounsaturated fatty acids. When sugar isn't available in the diet, stored glycogen will provide some glucose (usually for a few hours, up to a day), but as that is depleted, protein will be metabolized to provide sugar. If protein is eaten without carbohydrate, it will stimulate insulin secretion, lowering blood sugar and activating the stress response, leading to the secretion of adrenalin, cortisol, growth hormone, prolactin, and other hormones. The adrenalin will mobilize glycogen from the liver, and (along with other hormones) will mobilize fatty acids, mainly from fat cells. Cortisol will activate the conversion of protein to amino acids, and then to fat and sugar, for use as energy. (If the diet doesn't contain enough protein to maintain the essential organs, especially the heart, lungs, and brain, they are supplied with protein from the skeletal muscles. Because of the amino acid composition of the muscle proteins, their destruction stimulates the formation of additional cortisol, to accelerate the movement of amino acids from the less important tissues to the essential ones.)"

It’s certainly interesting to note in the first sentence of this passage that any fat that is manufactured in the body is saturated or monounsaturated – mostly palmitic acid and Mead acid. In fact, Peat strongly believes that eating lots of carbohydrates, even if they are converted to fat as in fructose being converted to palmitic acid in the liver, is highly beneficial. Palmitic acid displaces omega 6 (linoleic acid), and is one of the tools in Peat’s toolbox for purging the body of excess polyunsaturated fat.

The rest of the passage is all a pretty accurate portrayal as far as I’m concerned, and is the reason why low-carbohydrate diets can be so metabolically destructive if continued long-term. Simply put, a lack of glucose subjects the body to an increased amount of pro-aging, pro-stress hormones. That’s not to say, as JT has alluded to in the comments in the past (despite the fact that he ended up with severe adrenal fatigue after prolonged carbohydrate restriction) that it’s impossible for you personally to not improve your health on a low to moderate carbohydrate diet. It may be very possible that producing a little more adrenaline and cortisol may help balance out an individual’s physiology – where others need to produce less and derive more of their energy from carbohydrate consumption.

But that is just a theory. Experiment for yourself, but watch out for increased pain, irritability/anxiety, cold fingers and toes, loss of appetite, and other negative signs that can occur when you consume a high ratio of protein to carbohydrate at a meal.

"The diabetic condition is similar in many ways to stress, inflammation, and aging, for example in the chronic elevation of free fatty acids, and in various mediators of inflammation, such as tumor necrosis factor (TNF)."

I used to believe, like Joseph Mercola and other low-carb zealots, in the Obeaster bunny. You know the story, you eat too many carbohydrates, this stimulates insulin, and if you keep at this long enough the obeaster bunny will come and bring you a basket with lots of sugar (high blood sugar/insulin resistance, metabolic syndrome, type 2 diabetes). Yeah, I like that idea. The Obeaster basket. Perhaps if we started calling “Syndrome X” the “Obeaster Basket” people would finally catch on.

But then I encountered a more accurate depiction of what’s really going on – inflammation and cortisol (from psychological stress, sleep loss, chronic infection, chemical contamination, and any number of other things that can trigger the identical hormonal chain reaction) cause a chronic elevation of free fatty acids, which cause insulin resistance and interfere with glucose clearance. I came to the same conclusion as Peat long before I looked closely at his work, only to discover that he saw it the exact same way (but in much greater and elegant detail) and has for decades. The irony is that to keep cortisol down, it requires frequent carbohydrate feedings – what most diabetics have been led to believe by guys like Mercola as being the CAUSE of diabetes. Many of these “alternative renegades” are swimming in the complete wrong direction. Carbohydrate restriction should be reserved only for those who do not produce sufficient insulin, and even in that case it might still be better to eat lots of carbohydrates and take a larger insulin dose.

"Rather than the sustained hyperglycemia which is measured for determining the glycemic index, I think the “diabetogenic” or “carcinogenic” action of starch has to do with the stress reaction that follows the intense stimulation of insulin release. This is most easily seen after a large amount of protein is eaten. Insulin is secreted in response to the amino acids, and besides stimulating cells to take up the amino acids and convert them into protein, the insulin also lowers the blood sugar. This decrease in blood sugar stimulates the formation of many hormones, including cortisol, and under the influence of cortisol both sugar and fat are produced by the breakdown of proteins, including those already forming the tissues of the body. At the same time, adrenalin and several other hormones are causing free fatty acids to appear in the blood."

Again, I’m not sure where he gets the idea that starch is a pro-cancer and pro-diabetes substance in and of itself. An insulin spike in the absence of carbohydrate as happens when you consume protein by itself probably shouldn’t be compared to an insulin spike from starch, which is accompanied by lots of carbohydrates to keep the blood sugar from falling. While some people very well may feel symptoms of adrenal hormone activation from eating starch, many feel this activation from eating sugar but NOT when they eat starch. Again, know what it feels like to be having a surge of adrenaline (cold fingers and toes, irritability, appetite suppression, etc.) and try to figure this out for yourself – free of mental interference from biochemical oversimplifications like the one Peat uses in the above paragraph.

"Since the work of Cushing and Houssay, it has been understood that blood sugar is controlled by antagonistic hormones: Remove the pituitary along with the pancreas, and the lack of insulin doesn't cause hyperglycemia. If something increases cortisol a little, the body can maintain normal blood sugar by secreting more insulin, but that tends to increase cortisol production. A certain degree of glycemia is produced by a particular balance between opposing hormones."

This is more of Peat’s genius shining through. Many hormones are involved in blood sugar regulation. Insulin sends blood sugar down and cortisol sends blood sugar up. Yet, low-carb authors believe that eating carbohydrates, which generally raise insulin and lower cortisol, is the cause of diabetes. Clearly there is more to the story.

The work of Cushing showed the effects of cortisol excess. The disease Cushing’s Disease, which is basically a severe manifestation of metabolic syndrome that is typically caused by taking corticosteroid medication, shows the basic impacts of cortisol excess in the human body. Abdominal obesity, PCOS, moon face, stretch marks/striae, hyperglycemia/diabetes, increased heart disease risk, high cholesterol and triglycerides – you get the picture. It is very clear.
Houssay was a Nobel Prize winner who, at one point in his career, supposedly cured diabetics with sugar and coconut oil according to Peat. I do believe that sugar could very well be a wonderful anti-diabetic tonic (assuming most cases are caused by excess cortisol exposure, which I believe they are), and not the cause of diabetes as many falsely believe. But most comparisons that I’m aware of hint that sugar tends to cause greater levels of free fatty acids in the blood than starch, which would make starch hypothetically preferable to sugar in the treatment of diabetes based on this assumption.

"Tryptophan, from dietary protein or from the catabolism of muscles, is turned into serotonin which activates the pituitary stress hormones, increasing cortisol, and intensifying catabolism, which releases more tryptophan. It suppresses thyroid function, which leads to an increased need for the stress hormones. Serotonin impairs glucose oxidation, and contributes to many of the problems associated with diabetes."

Here Peat thinks that tryptophan might have a role in hyperglycemia, and I have a hunch that all of Peat’s villainous amino acids (tryptophan, methionine, cysteine) may be a very big factor in the grand scheme of things. I know personally that reducing animal protein consumption provides the greatest immediate improvement in overt inflammatory issues I’ve struggled with since my early teens (back pain, pain in lower calf muscles similar to shin splints, asthma). These problems seemed to come to a peak during my milk diet experiment, in which I consumed nearly 200 grams of dairy protein per day (dairy protein is one of the richest sources of tryptophan). And, it’s worth mentioning that virtually every book published on reversing type 2 diabetes or claiming to have dramatic success with the disease is by a vegetarian zealot (Fuhrman, McDougall, Barnard, Whitaker, etc.).

"“Diabetes” is often the diagnosis, when excess cortisol is the problem. The hormones have traditionally not been measured before diagnosing diabetes and prescribing insulin or other chemical to lower the blood sugar. Some of the worst effects of “diabetes,” including retinal damage, are caused or exacerbated by insulin itself."

Every diabetic on earth should know that cortisol can and often is a root cause of insulin resistant diabetes. Unfortunately, cortisol tests are very unreliable and do not test intracellular cortisol – something authors Shawn Talbott and Jon Gabriel have both mentioned being more significant than the amount of cortisol showing up in blood or saliva. Malcolm Kendrick reports that those with high baseline cortisol will have low cortisol levels in response to stressors – similar to how those with high baseline insulin will generally have a low insulin response to food. Like I said, unreliable. But the evidence against cortisol is too strong to seek for an alternate prime suspect in the causation of most cases of diabetes.

Of course, the root causes are very individual if cortisol is the chief culprit – as hundreds of diet, lifestyle, hereditary, and psychological factors can cause hypercortisolism. A very individual investigation is the only way to flush out the root cause(s), but in the meantime one can probably make great improvements by focusing on diet and lifestyle modification that is anti-stress and anti-inflammatory (such as getting lots of sleep, staying well-hydrated, increasing meal frequency, eating plenty of calories, minimizing omega 6 consumption, eating plenty of carbohydrates at each sitting, and decreasing animal protein in the diet).

"Antiserotonin drugs can sometimes alleviate stress and normalize blood sugar. Simply eating sucrose was recently discovered to restrain the stress hormone system (“A new perspective on glucocorticoid feedback: relation to stress, carbohydrate feeding and feeling better,” J Neuroendocrinol 13(9), 2001, KD Laugero)."

Got that? Eating sucrose stifling the stress hormone system… Interesting that diabetics often crave sugar like a mofo, but are afraid to eat it because they are under the impression that sugar caused their diabetes. This may be a tragic mistake akin to thinking that water causes thirst, and avoiding it when you are thirsty – only to finally cave into cravings for water and beat yourself up over a lack of willpower. But there is still much controversy here. Like Rosenfelt has been so good about in the comments section of late – there is a study showing an increase in the stress system when ingesting sugar instead of fat or starch. Saying that sucrose lowers stress hormones as if it were textbook truism may be too great of a leap.

"The free fatty acids released by the stress hormones serve as supplemental fuel, and increase the consumption of oxygen and the production of heat. (This increased oxygen demand is a problem for the heart when it is forced to oxidize fatty acids. [A. Grynberg, 2001]) But if the stored fats happen to be polyunsaturated, they damage the blood vessels and the mitochondria, suppress thyroid function, and cause “glycation” of proteins. They also damage the pancreas, and impair insulin secretion.


A repeated small stress, or overstimulation of insulin secretion, gradually tends to become amplified by the effects of tryptophan and the polyunsaturated fatty acids, with these fats increasing the formation of serotonin, and serotonin increasing the liberation of the fats."

We know that the stored fats in modern humans have become increasingly polyunsaturated due to massive changes in the type of fat consumed over the past century. So at this point the conversation becomes incredibly interesting if polyunsaturated fats really do indeed have such a powerful anti-metabolic and protein-glycating effect. Author Barry Sears who has taken a similar physiological approach to understanding modern disease as Peat has, has dubbed this fat “toxic fat,” believes that storing this fat is actually protective in a sense, and that releasing it into the body via standard dieting can be very poisonous. In my experience, losing fat has been highly detrimental to health and metabolism without exception, and my primary strength has been helping people recover from losing fat, so it’s an interesting point of view. It would be funny if the increasing body fat that Americans see with advancing age was really a great protector against the Standard American Diet. I’ve argued all along that the human body is not stupid, and does the best it can with the tools it is presented with. Keep in mind that in elderly Americans, as was found in the compiled NHANES survey data, the obese (BMI 30-35) have the best mortality and morbidity statistics.

Stay tuned for our next conversation on glycation – a term frequently abused in the carbohydrate witch hunt, and much more about polyunsaturated fat’s role in diabetes.

Ray Peat - Starch and Obesity

Warning all Vietnamese people!  Ray Peat says that people in countries that eat a lot of full-fat dairy products are lean, and that starch is more fattening than sugar and seems like the reason for the rising obesity rate in the United States.  Put the rice down, and swap it out with Haagen Dazs ice cream or else you guys are gonna get fat! 

Sorry, but I had to go there.  I visited Vietnam in my mid-20's and remember a group of young guys in their early 20's in some sort of Navy or something cruising up to the beach I was hanging out on one day.  The boys jumped off the boat and started running around tackling each other in their Speedos and other weird things that only someone who has traveled to Vietnam could grasp the true strangeness of.  Anyway, even though I was 5'9", 175 pounds soaking wet, several of the boys ran up to me, asked me how old I was, and started pinching the 1-inch of extra fat around my abdomen and laughing.  They of course played with my arm hair too, which seems almost like a pasttime of Vietnamese citizens in the presence of an apelike foreigner like myself. 

Anyway, the point of the story is that, even though I was lean by American standards, and didn't consider myself fat at all, I was still fat enough for these boys to look at it like it was some kind of novelty - like they had never seen a guy my age with a body fat percentage above 10%.  And I must say, during that trip I did not see a single male with a waist that appeared larger than mine, which was somewhere between 33 and 34 inches at the time.  This was typical of every rice-based culture I have ever had the opportunity to see (I have visited 7 Asian countries), with the exception of Japan - where at least you did see an occasional overweight person.   

With that, we will resume our starch vs. sugar conversation and breakdown or Ray Peat's article Glycemia, Starch, and Sugar in Context. 

"More important than the physiological vacuity of a simple glycemic measurement was the ideology within which the whole issue developed, namely, the idea that diabetes (conceived as chronic hyperglycemia) is caused by eating too much sugar, i.e., chronic hyperglycemia the illness is caused by the recurrent hyperglycemia of sugar gluttony. The experiments of Bernardo Houssay (1947 Nobel laureate) in the 1940s, in which sugar and coconut oil protected against diabetes, followed by Randle's demonstration of the antagonism between fats and glucose assimilation, and the growing recognition that polyunsaturated fatty acids cause insulin resistance and damage the pancreas, have made it clear that the dietetic obsession with sugar in relation to diabetes has been a dangerous diversion that has retarded the understanding of degenerative metabolic diseases."


Peat is getting onto something with this passage. Perhaps the 2nd largest pseudoscientific sasquatch of them all (behind the belief that eating saturated fat and cholesterol is the cause of heart disease), is that eating carbohydrate somehow causes insulin resistance, metabolic syndrome, and type 2 diabetes after the insulin mechanism “wears out” from repeated carbohydrate ingestion – sugar in particular. It doesn’t. In fact, fat competes and interferes with glucose’s journey out of the bloodstream and into cells, which is why the hormone cortisol, which dumps fatty acids into the blood, is such a powerful root cause of insulin resistance as Peat goes on to discuss.

"Starch and glucose efficiently stimulate insulin secretion, and that accelerates the disposition of glucose, activating its conversion to glycogen and fat, as well as its oxidation. Fructose inhibits the stimulation of insulin by glucose, so this means that eating ordinary sugar, sucrose (a disaccharide, consisting of glucose and fructose), in place of starch, will reduce the tendency to store fat. Eating “complex carbohydrates,” rather than sugars, is a reasonable way to promote obesity. Eating starch, by increasing insulin and lowering the blood sugar, stimulates the appetite, causing a person to eat more, so the effect on fat production becomes much larger than when equal amounts of sugar and starch are eaten. The obesity itself then becomes an additional physiological factor; the fat cells create something analogous to an inflammatory state. There isn't anything wrong with a high carbohydrate diet, and even a high starch diet isn't necessarily incompatible with good health, but when better foods are available they should be used instead of starches. For example, fruits have many advantages over grains, besides the difference between sugar and starch. Bread and pasta consumption are strongly associated with the occurrence of diabetes, fruit consumption has a strong inverse association."

I have no idea what planet Peat was on when he wrote this paragraph. It makes absolutely no sense and is totally incongruent with reality. The meal that produces the most postprandial insulin is a high-starch, low-fat meal. Interestingly, a high-starch, low-fat diet, during overfeeding, has been shown to be the least fattening – corresponding with the higher insulin levels.  http://www.ajcn.org/content/62/1/19.full.pdf+html At the same calorie levels, the subjects with the lowest insulin levels (because they were eating more calories as fat and thus not spiking insulin as high) stored more fat, had less of an increase in thermogenesis (heat production), and less of an increase in lean body mass.

A rise in insulin causing more fat storage? This just doesn’t make sense. It should cause more muscle storage and less fat storage, as insulin, if anything, is the primary anabolic muscle storage hormone. Insulin does not cause carbohydrates to be converted to fat, and the little bit of carbohydrate that may be converted to fat is a very inefficient process compared to storing fat that you ingest as fat that is already pre-packaged and ready to find its home in adipose tissue.

Increasing insulin makes a person eat more? This really pisses me off. That’s like saying that stapling someone’s stomach makes them eat more, as both stapling your stomach and insulin are known to have an anti-hunger effect. Sure, inject insulin into someone without carbohydrate being ingested along with it, and they will get super hungry from blood glucose dropping to dangerous levels – appetite is stimulated because it’s a better option for the body than dying. But the normal rise and fall of insulin and blood sugar levels to baseline (not below baseline as is commonly seen in hypoglycemia after sugar ingestion) in response to eating is not something that should be construed as appetite-promoting.

Of course, this is only a glimpse of the frustration I have with this myopic view of one isolated and rather insignificant variable. It ignores the more complex science of satiety, which doesn’t have much to do with how much insulin you produce after eating a meal, and a lot more to do with the palatability of the food, water content, fiber content, chewing time, particle size, and countless other factors that affect the dopaminergic system and beyond – including even lighting, social setting, food texture, salt content, packaging, and so on. One biggie that Peat doesn’t account for is the appetite stimulation caused by sweetness, which fructose has the most of in the carbohydrate realm. Starch is not sweet. What, are we gonna call shit fattening if we find out it triggers a greater rise in insulin upon ingestion vs. an isocaloric amount of apple pie a la mode?

One really needs to look at the whole picture. A person who is susceptible to fat gain (which I propose is, in many cases, a person who eats out of addiction to satisfy reward centers in the brain vs. eating strictly to satisfy physiological appetite) can easily get fat eating to appetite of a diet containing lots of burgers, pizza, pork ribs, soda, beer, ice cream, chicken wings, French fries, chocolate, peanut butter, apple juice, milkshakes, bread, pasta, and potato chips because this diet as a whole promotes greater calorie consumption without much of a corresponding rise in metabolic rate or drop in appetite. Even I, with an average rectal temperature during the day of around 100 degrees F can gain fat rapidly eating a diet like that, because my calorie consumption goes to the stratosphere and I even feel MORE hungry than I do eating 2,000 fewer calories of less stimulating foods (I even start to get major hunger pangs in the late evening when I do that consistently for a week or longer).

"Although pure fructose and sucrose produce less glycemia than glucose and starch do, the different effects of fruits and grains on health can't be reduced to their effects on blood sugar."

Ah, finally talking some sense here!

"After decades of “education” to promote eating starchy foods, obesity is a bigger problem than ever, and more people are dying of diabetes than previously. The age-specific incidence of most cancers is increasing, too, and there is evidence that starch, such as pasta, contributes to breast cancer, and possibly other types of cancer."

Oh yeah, there's a lot of scientific integrity in that paragraph. You know we all followed the dietician’s advice to the letter. Oh wait, the biggest changes in the diet in recent times are an increase in sugar, poultry, and vegetable oil intake – which displaced the mostly wheat, corn, and potato-based diet of the United States prior to that. But even that is probably less significant than the fact that we started eating more food at restaurants and less at home, we saw the introduction of powerful flavor enhancers like MSG, aspartame, “natural flavors,” “artificial flavors,” and the increased sweetness of high fructose corn syrup – not to mention the general increase in the sophistication of the food scientists who have had several more “decades” to perfect their craft at making “products” more interesting than old-fashioned food.

"The epidemiology would appear to suggest that complex carbohydrates cause diabetes, heart disease, and cancer. If the glycemic index is viewed in terms of the theory that hyperglycemia, by way of “glucotoxicity,” causes the destruction of proteins by glycation, which is seen in diabetes and old age, that might seem simple and obvious."

True, unless you turn the epidemiological data right-side-up and see that the eaters of starch-based diets all over the world – particularly Asians and Africans, have far lower rates of diabetes, heart disease, and most cancers – especially those living in the greatest isolation from food “products.”

"But there are many reasons to question that theory."

I wouldn’t consider it a valid theory at all anymore, especially when people eating starch-based diets have far lower levels of fasting and postprandial glucose levels – showing clearly that such a diet, when looked at as a whole, lowers “glucotoxicity” and glycation. Meanwhile, real practicing doctors like Terry Shintani and John McDougall are lowering glucose levels, including overcoming type 2 diabetes, with starch-based diets (note, I’m sure a fruit-based diet could perform just as well).

Anyway, that’s enough for the sugar vs. starch masturdebate. There are advantages and disadvantages to all forms of carbohydrates. What is probably the most useful to you as an individual looking to improve your health is finding which type of carbohydrate triggers the greatest heat production – keeping fingers and toes warm in between meals and body temperature elevated, and seems to yield the greatest amount of health benefits. But even this is usually a mixed bag. Displacing tons of starch with fruit and juice, for me, has had many health positives – everything from increases in vasodilation, energy levels, exercise recovery, heat production, breathing, and, shockingly, a complete elimination of tooth pain. But it has also given me more pimples on my back and gums that bleed more easily. Even in my mouth it has had both a positive and a negative effect! Ha!  A blend of plenty of starch and sugars seems to be the best fit for me personally, and is the most palatable, socially functional, and economical. 

So play with this for yourself, just don’t play WITH yourself. Actually, see which type of carbohydrate or combination of carbohydrates makes you want to play with yourself the most, and stick with it!
Stay tuned for the next Peat post, as we get into Peat’s more interesting views about sugar and carbon dioxide, the superiority of glucose oxidation, and the role polyunsaturated fat plays in insulin resistance.