Paleo2.0 brought this up as a comment in another question. Is everything that Dr. Kruse has to say about leptin wrong? What has Dr. Kruse said that is correct? Citations would be helpful for many reading here.
Loon, thank you for your critical comments and this thread.
Kruse asks questions... and I enjoy all the questions.
I love all of our paleo gurus because they each bring unique backgrounds, varied frameworks (high carb v. low carb v. WHOTHE#*@CARES), rockstar qualities, brainaic summations, non-degrees v. academic power, etc.
And same with PH'ers!
For me I see Kruse getting a ton of things right which trump minor personality quirks. I find the science he highlights, his interpretations and translation into practical settings STERLING. Few paleo peeps even know what adrenal fatigue is much less be able to address and improve it. Kruse and the few that 'get it' do it (like Robb Wolf and Whole 9). Unfortunately, there are a ton things that somehow CW medicine misses...
Like grains, gluten, lectins, phytates... Like intestinal permeability/leaky gut/FODMAP-intolerance... adrenals, pituitary/hypothalamus, leptin, testosterone, fertility, s*xxx...
What Kruse nails like a nail in the coffin of the SAD/USDA/FDA/EPA/ADA/AHA/AMA/BigPharma/BigAgri/BigMilitary myth factory:
--I concur w/Kruse: IMHO Paleo is great for 1-2 standard deviations of the population that try it and don't need further biohacking. They're perfect. However, for the 2.5-3 SD'outliers' paleo just aint gonna cut it. Mild to extreme hacking improves to acceptable or even perfection. I love the stories on PH where after a hack or two, everything is fine. My thoughts are that biohacking is a must to fix deep neuro-endocrine-HPA-gonad S.A.D. damage.
--Kruse, you get it.
--you understand the recent and super new biochemistry (PPAR!!!!)
--the literature for both evolutionary biology and clinical medicine, you appear to have a good grasp of
--you promote paleo/primal/ancestral eating
--you are one of the few paleo AND integrative 'coaches' (ditto Robb Wolf! and Whole 9!!!)
--you are one of the few paleo AND integrative 'coaches' AND share what ya learn (ditto Robb Wolf! and Whole 9!!!)
--you practice what you preach, you're transparent (ditto Robb Wolf! and Whole 9!!!)
--your patients are verbal and appear to love you (ditto Robb Wolf! and Whole 9!!!)
--you take time to explain, break it down and point people to potential solutions (ditto Robb Wolf! and Whole 9!!!)
--you are not only MD trained but a surgeon; you really gore and hack your patients ha
--you cannabalize your own spine surgery practice by promoting optimal health
--you promote paleo/primal/ancestral eating and optimal health with your colleagues
-- " " with the world on the blog, MDA and PH
--(not related but thank God PH'ers harassed [SCRATCH] helped you evolve into blogging...I love the 'quilt' and cellular terroirs...)
A lot of what he says is scientifically sound, but I think his attempt at creating (what looks to me to be) a unified theory of disease that centers around leptin/epigenetics/leaky gut (brb epileakyleptingenetics.com) has yet to be proven. I agree more with Paul Jaminet that malnutrition is the root cause of nearly all disease, though I suppose you could argue that leptin/epigenetic/leaky gut issues only occur in a state of malnutrition.
The problem that most have with him is that he is intentionally vague, which is probably necessary if you're a practicing doctor giving health advice over the internet. You'll never squeeze a dosage of something like K2 out of him because he's not your doctor and can't act as one. I guess those of us who are totally unqualified and un-credentialed have an advantage. Ahem. I suspect that the specific advice that he lays out for his actual patients is quite effective in improving their health and addressing whatever maladies they may have. I wouldn't be surprised if he didn't mention leptin to most of them. I don't think I've ever seen him give advice that would necessarily harm someone, so I think all told he's a net benefit to the community, especially when he talks about the things he does in his day job. If you have a slipped disc, you want to talk to him, not any of the rest of the people out there.
I've definitely gone in certain directions after reading something he's written that have improved my understanding of various things.
Let's not forget that this here internet is 99.9999999999% noise with the faintest coherent signal of what we might call truth trying to be heard. I've seen outright troll/spam posts that have introduced some new idea or sent me in a useful (non-Viagra) direction. I've talked to what must have been clinically insane homeless people in real life who have said profound things (amidst plenty of gibberish). Nearly everyone you meet has something to offer you in one way or another. I used to write people off as soon as they appeared to be unreliable in one way or another, but I've since become far more tolerant of the noise because when you wait it out, an interesting signal usually comes.
I think he supports the fundamental tenets of Paleo that MANY people would agree with
EDIT - My open disagreements notwithstanding, I have never said Quilt was completely wrong. Far from it and I am not alone here. People reacting negatively to the other thread seem to think that it is black or white. I prefer my 60" HD color TV in the 21st century.
Here is what I suggest. Find one thing that Dr K has said with which you disagree. Make sure that your disagreement isn't trivial - i.e., that the outcome has important health implications. Find the place where he talks about it on his blog, which you can do by Googling 'Jackkruse' plus the main word that you are interested in. I recently did this to quickly find his comments on carnosine, for example. Formulate your disagreement as a question. Post it as a comment (on his blog). He will respond.
Kruse is cool like that. Dislike his style all you want, but he seems to take pleasure in defending himself. I'm pretty sure that he doesn't say anything without having a reason for it. This has some downsides. However, it also has a major upside: if ask him about it, he'll respond, and often in a spirited fashion.
There is no need to complain about Kruse. It's probably not the most productive option. I suggest talking to him about it. For a busy doctor, Kruse is surprisingly available.
In the most general sense, my perception is that Dr. K is saying a messed up "broken" metabolism can impede weight loss and in his best judgment leptin may be the most important factor to consider in effecting recovery to your metabolism. He's also sharing a remedy that seems to work for many people.
He speaks with a loud voice to me because he has seen ravaged metabolisms up close both directly and indirectly because he's simply in the right place to make relevant observations.
In my opinion he is right about many things. However...he is wrong about things also. And I find it is in his inability to admit he's wrong or admit that he might not know everything about everything.
He makes claims on here that need to be substantiated - he is not making n=1 statements; he is making blanket statements based on 'hundreds and thousands of patients'. He MUST hold himself accountable for these claims. The burden of proof is on him with such huge statements!
As many have stated it is in his delivery where he needs a little work. His dismissive tone to some is quite condescending - and I have a problem with that. I don't think that anyone likes being dismissed as uninformed or downright stupid.
I truly beleive that his heart is in the right place. And I think that ph is a more interesting place with him.
Oh and here's my mothering for the day: ((I think we're in need of a serious group hug here on ph!))
He's pretty right about leptin and it's importance. I've not found anything to contradict anything he says, here's a partial list....
Directly affects TRH (Guo and others 2004)
Stimulates the sympathetic nervous system (Ren 2004)
Works on the same receptors as insulin; insulin is an endogenous leptin antagonist (Lustig AHS)(Walder and others 1997; Ceddia and others 1998)(Kieffer and others 1997; Lam and others 2004)
Leptin reduces GLUT2 glucose transport (Lam et al. 2004)
Obesity is related to an impaired regulation of leptin by insulin, since leptin levels increased in lean men but decreased in obese men following a high-fat meal. (Imbeault and others 2001)
Decreases hepatic cholesterol synthesis, promotes hepatic uptake of plasma cholesterol (VanPatten and others 2001)
Testosterone lowers leptin (Ogura and others 2000; Soderberg and others 2001; Casabiell and others 2001)
Leptin inhibits cortisol and corticosterone secretion (Szucs and others 2001)
Growth hormone lowers leptin (Isozaki 1999)
Fructose decreases leptin (Teff and others 2004)
Leptin activates fatty acid oxidation and decreases TG content in the heart (Atkinson and others 2002)
Plasma leptin levels are controlled by production rate rather than clearance rate. (Schoeller and others 1997)
Leptin reduces the rate of glucagon-stimulated glycogenolysis. (Ceddia and others 1999)
ROS are involved in leptin signaling; chronic oxidative stress in endothelial cells under hyperleptinemia may promote atherosclerosis (Bouloumie and others 1999)
Leptin regulates endocrine and immune functions, playing a role in innate and acquired immunity. (Faggioni and others 2001)
Leptin may be a sweet-sensing suppressor (Kawai and others 2000; Shigemura and others 2004)
Vitamin D inhibits leptin (Menendez and others 2001)
Inflammation increases leptin (Gualillo and others 2000)
Diurnal leptin rhythms are entrained to meal patterns (Schoeller et al. 1997)
Ghrelin levels are affected by meal timing (Kim and others 2004)
Leptin increases FA oxidation in skeletal muscle of lean, but not obese humans, thus demonstrating the development of peripheral leptin resistance in obese human skeletal muscle. (Steinberg and others 2002; Van Heek and others 1997)
In obesity leptin receptors and subsequent signaling events are down-regulated and basal insulin signaling is impaired (Brabant and others 2005)
Hyperleptinemia correlates with hyperphagia, insulin resistance and other markers of the metabolic syndrome including obesity, hyperlipidemia and hypertension, independent of total adiposity. Elevated plasma leptin levels may be an independent risk factor for the development of cardiovascular disease. (Ren 2004)
Chronic fructose consumption induces leptin resistance prior to body weight, adiposity, serum leptin, insulin, or glucose increases, and this fructose-induced leptin resistance accelerates high- fat induced obesity.(Shapiro and others 2008)
Triglycerides are an important cause of leptin resistance as mediated by impaired transport across the BBB. Decreasing trigs may potentiate the anorectic effect of leptin by enhancing leptin transport across the BBB. (Banks and others 2004)
NPY neurons are a major target for leptin action and partly explain the hyperphagia seen when leptin signalling is defective, and the accompanying decrease in energy expenditure (Wilding 2002)
In most overweight individuals, physiological regulation of body weight by leptin seems to be disturbed, representing “leptin resistance.” This leptin resistance at the level of the pancreatic B-cell may contribute to dysregulation of the adipo-insular axis and promote the development of hyperinsulinemia and manifest type 2 diabetes in overweight patients. (Seufert 2004)
Leptin increases hypothalamic mTOR activity, and the inhibition of mTOR signaling blunts leptin’s anorectic effect. Thus, mTOR is a cellular fuel sensor whose hypothalamic activity is directly tied to the regulation of energy intake.(Cota and others 2006)
Ghrelin appears to block leptin action (Wilding 2002)
Leptin can rescue normal pulsatile GH secretion by preventing the inhibitory action of NPY on GH secretion. (Vuagnat and others 1998)
NPY/AgRP neurons are inhibited by leptin, insulin and PYY, whereas they are stimulated by ghrelin (Morton and others 2006)
Obese have more AgRP than non-obese (Katsuki and others 2001)
Agouti inhibits the anorexic effects of leptin, up-regulates adipocyte leptin expression, and regulates adipocyte lipid metabolism, functioning both to increase the expression and activity of lipogenic genes and to inhibit lipolysis. (Zemel 1998)
Agouti increases leptin synthesis and secretion.(Claycombe and others 2000)
Insulin resistance upregulates cholesterol synthesis (Gylling and others 2010)
Atkinson LL, Fischer MA & Lopaschuk GD. 2002. Leptin activates cardiac fatty acid oxidation independent of changes in the AMP-activated protein kinase-acetyl-CoA carboxylase-malonyl-CoA axis. J Biol Chem 277(33):29424-29430.
Banks WA, Coon AB, Robinson SM, Moinuddin A, Shultz JM, Nakaoke R & Morley JE. 2004. Triglycerides induce leptin resistance at the blood-brain barrier. Diabetes 53(5):1253-1260.
Bouloumie A, Marumo T, Lafontan M & Busse R. 1999. Leptin induces oxidative stress in human endothelial cells. Faseb J 13(10):1231-1238.
Brabant G, Muller G, Horn R, Anderwald C, Roden M & Nave H. 2005. Hepatic leptin signaling in obesity. Faseb J 19(8):1048-1050.
Casabiell X, Pineiro V, Vega F, De La Cruz LF, Dieguez C & Casanueva FF. 2001. Leptin, reproduction and sex steroids. Pituitary 4(1-2):93-99.
Ceddia RB, Lopes G, Souza HM, Borba-Murad GR, William WN, Jr., Bazotte RB & Curi R. 1999. Acute effects of leptin on glucose metabolism of in situ rat perfused livers and isolated hepatocytes. Int J Obes Relat Metab Disord 23(11):1207-1212.
Ceddia RB, William WN, Jr., Lima FB & Curi R. 1998. Leptin inhibits insulin-stimulated incorporation of glucose into lipids and stimulates glucose decarboxylation in isolated rat adipocytes. J Endocrinol 158(3):R7-9.
Claycombe KJ, Xue BZ, Mynatt RL, Zemel MB & Moustaid-Moussa N. 2000. Regulation of leptin by agouti. Physiol Genomics 2(3):101-105.
Cota D, Proulx K, Smith KA, Kozma SC, Thomas G, Woods SC & Seeley RJ. 2006. Hypothalamic mTOR signaling regulates food intake. Science 312(5775):927-930.
Faggioni R, Feingold KR & Grunfeld C. 2001. Leptin regulation of the immune response and the immunodeficiency of malnutrition. Faseb J 15(14):2565-2571.
Gong DW, He Y, Karas M & Reitman M. 1997. Uncoupling protein-3 is a mediator of thermogenesis regulated by thyroid hormone, beta3-adrenergic agonists, and leptin. J Biol Chem 272(39):24129-24132.
Gualillo O, Eiras S, Lago F, Dieguez C & Casanueva FF. 2000. Elevated serum leptin concentrations induced by experimental acute inflammation. Life Sci 67(20):2433-2441.
Guo F, Bakal K, Minokoshi Y & Hollenberg AN. 2004. Leptin signaling targets the thyrotropin-releasing hormone gene promoter in vivo. Endocrinology 145(5):2221-2227.
Gylling H, Hallikainen M, Pihlajamaki J, Simonen P, Kuusisto J, Laakso M & Miettinen TA. 2010. Insulin sensitivity regulates cholesterol metabolism to a greater extent than obesity: lessons from the METSIM Study. J Lipid Res 51(8):2422-2427.
Imbeault P, Doucet E, Mauriege P, St-Pierre S, Couillard C, Almeras N, Despres JP & Tremblay A. 2001. Difference in leptin response to a high-fat meal between lean and obese men. Clin Sci (Lond) 101(4):359-365.
Isozaki O, Tsushima, T., Miyakawa, M., Demura, H., Seki, H. 1999. Interaction between leptin and growth hormone (GH)/IGF-I axis. Endocr J. 46(Suppl):S17-24.
Katsuki A, Sumida Y, Gabazza EC, Murashima S, Tanaka T, Furuta M, Araki-Sasaki R, Hori Y, Nakatani K, Yano Y & Adachi Y. 2001. Plasma levels of agouti-related protein are increased in obese men. J Clin Endocrinol Metab 86(5):1921-1924.
Kawai K, Sugimoto K, Nakashima K, Miura H & Ninomiya Y. 2000. Leptin as a modulator of sweet taste sensitivities in mice. Proceedings of the National Academy of Sciences 97(20):11044-11049. Kieffer TJ, Heller RS, Leech CA, Holz GG & Habener JF. 1997. Leptin suppression of insulin secretion by the activation of ATP-sensitive K+ channels in pancreatic beta-cells. Diabetes 46(6):1087-1093.
Kim HH, Lee S, Jeon TY, Son HC, Kim YJ & Sim MS. 2004. Post-prandial plasma ghrelin levels in people with different breakfast hours. European Journal of Clinical Nutrition 58(4):692-695.
Lam NT, Cheung AT, Riedel MJ, Light PE, Cheeseman CI & Kieffer TJ. 2004. Leptin reduces glucose transport and cellular ATP levels in INS-1 beta-cells. J Mol Endocrinol 32(2):415-424.
Menendez C, Lage M, Peino R, Baldelli R, Concheiro P, Dieguez C & Casanueva FF. 2001. Retinoic acid and vitamin D(3) powerfully inhibit in vitro leptin secretion by human adipose tissue. J Endocrinol 170(2):425-431.
Morton GJ, Cummings DE, Baskin DG, Barsh GS & Schwartz MW. 2006. Central nervous system control of food intake and body weight. Nature 443(7109):289-295.
Ogura T, Tobe K, Mimura Y, Otsuka F, Yamauchi T, Imai A, Tsukamoto C, Iwasaki Y & Matsuura K. 2000. Testosterone modulates serum leptin concentrations in a male patient with hypothalamic hypogonadism. J Endocrinol Invest 23(4):246-250.
Ren J. 2004. Leptin and hyperleptinemia - from friend to foe for cardiovascular function. J Endocrinol 181(1):1-10.
Schoeller DA, Cella LK, Sinha MK & Caro JF. 1997. Entrainment of the diurnal rhythm of plasma leptin to meal timing. J Clin Invest 100(7):1882-1887.
Seufert J. 2004. Leptin effects on pancreatic beta-cell gene expression and function. Diabetes 53 Suppl 1:S152-158.
Shapiro A, Mu W, Roncal C, Cheng KY, Johnson RJ & Scarpace PJ. 2008. Fructose-induced leptin resistance exacerbates weight gain in response to subsequent high-fat feeding. Am J Physiol Regul Integr Comp Physiol 295(5):R1370-1375.
Shigemura N, Ohta R, Kusakabe Y, Miura H, Hino A, Koyano K, Nakashima K & Ninomiya Y. 2004. Leptin modulates behavioral responses to sweet substances by influencing peripheral taste structures. Endocrinology 145(2):839-847.
Soderberg S, Olsson T, Eliasson M, Johnson O, Brismar K, Carlstrom K & Ahren B. 2001. A strong association between biologically active testosterone and leptin in non-obese men and women is lost with increasing (central) adiposity. Int J Obes Relat Metab Disord 25(1):98-105.
Steinberg GR, Parolin ML, Heigenhauser GJ & Dyck DJ. 2002. Leptin increases FA oxidation in lean but not obese human skeletal muscle: evidence of peripheral leptin resistance. Am J Physiol Endocrinol Metab 283(1):E187-192.
Szucs N, Varga I, Jakab C, Patocs A, Glaz E, Toth M, Kiss R & Racz K. 2001. Leptin inhibits cortisol and corticosterone secretion in pathologic human adrenocortical cells. Pituitary 4(1-2):71-77.
Teff KL, Elliott SS, Tschop M, Kieffer TJ, Rader D, Heiman M, Townsend RR, Keim NL, D'Alessio D & Havel PJ. 2004. Dietary fructose reduces circulating insulin and leptin, attenuates postprandial suppression of ghrelin, and increases triglycerides in women. J Clin Endocrinol Metab 89(6):2963-2972.
Van Heek M, Compton DS, France CF, Tedesco RP, Fawzi AB, Graziano MP, Sybertz EJ, Strader CD & Davis HR, Jr. 1997. Diet-induced obese mice develop peripheral, but not central, resistance to leptin. J Clin Invest 99(3):385-390.
VanPatten S, Ranginani N, Shefer S, Nguyen LB, Rossetti L & Cohen DE. 2001. Impaired biliary lipid secretion in obese Zucker rats: leptin promotes hepatic cholesterol clearance. Am J Physiol Gastrointest Liver Physiol 281(2):G393-404.
Vuagnat BA, Pierroz DD, Lalaoui M, Englaro P, Pralong FP, Blum WF & Aubert ML. 1998. Evidence for a leptin-neuropeptide Y axis for the regulation of growth hormone secretion in the rat. Neuroendocrinology 67(5):291-300.
Walder K, Filippis A, Clark S, Zimmet P & Collier GR. 1997. Leptin inhibits insulin binding in isolated rat adipocytes. J Endocrinol 155(3):R5-7.
Wilding JP. 2002. Neuropeptides and appetite control. Diabet Med 19(8):619-627. Zemel MB. 1998. Agouti/melanocortin interactions with leptin pathways in obesity. Nutrition Reviews 56(9):271-274.
In a discussion about the medical field, Dr. Kruse suggested I not be passive when it comes to my health care, be aggressive, and ask for what it is I really want. He was right about that.
@ Quilt above
Funny? Not really given our nipple phobic society. Women are the worst. Check out all the fashion "experts" gals listen to who say you must wear a bra. Tatas must be uplifted for a more "flattering look." How come these same experts don't push bras on all the estogenifed men waddling with breasts...or maybe single cup bras for beer bellies. No, this wouldn't happen because men would tell them to f off. But women -- oh, we bitch and moan about oppression yet line up like mindless sheep to purchase whatever Madison Avenue says will "fix" us. All one has to do is look at the suit of armor type bras people wear nowadays to see we are sexually conflicted. On the one hand "hook-ups" (aka one night stands) are de rigour -- but yet women wear suit of armour padded or these weird hard cup bras to conceal their nipple erections. We are inundated with in your face porn and yet people are scared of freaking female nipples. I know men who love strip joints but get all purile if confronted with a woman breastfeeding in public. But seriously, women are the worst. They are the first to say -- "you need a bra" or "put on a bra" - - that's how conditioned they are to be ashamed of their own sex's anatomy. First corsets, now suit of armour bras. Some things never change...oh, except now padded bras are now being marketed to 5 year olds...Don't get me started on what constant contact with toxic chemical fake material bras worn all day and some even wear them all night too could do to health of breast tissue over time. If someone wants to wear a bra -- some big boobed gals get back/shoulder issues without a bra -- fine -- but it should be a personal choice -- not dictated by our nipple phobic society. Rant over. Need an oxytocin hit to calm down now...