Category Archives: 20. Losing Weight

The Trouble with Iron Part III Diabetes

The Trouble with Iron Part III Diabetes

References: Cell MetabolismJ of Diabetes Research,

You were trained to think of iron as absolutely necessary to help fatigue. “Build up your blood!” and other such phrases are deep in our subconscious. We see blood and know it is the red of iron. Iron is critical for life, because it’s the key to carrying oxygen to the tissue so that we can make energy. No doubt, iron is important. But carrying oxygen is no mean feat, as it is such a reactive chemical, it needs the strong chemical bond of iron in heme to transport it. What happens when you get too much iron?

Two conditions of too much iron are thalassemia and hemochromatosis. Guess what happens to those folks? Hemochromatosis is also known as bronze diabetes. They fill up the islet cells of their pancreas with iron, and their insulin producing capacity fails. This can be reversed with removal of the iron.

And what happens to normal folks? Well, here again we find that the tendency to being diabetic goes along with the tendency to be iron overloaded. And the devil is in the details. It’s not just the total load of iron that causes damage. It’s not just the accumulation of iron in the islets of your pancreas. It’s the whole ecosystem effect of iron. Iron plays a role in every tissue that mediates energy metabolism, particularly the fat cell. There is a whole host of signaling that occurs when iron is present with intracellular and extracellular messaging. The nuance of it is still not anywhere close to being understood, but you can get a sense for its complexity by the review in Cell Metabolism.
And what have we done, with all of our good intentions, in America. We have devised guidelines for iron supplementation that serve young, pregnant women, well. We add iron to all our grains. It is the fortification you see on the label of every kind of flour product. When you eat most breakfast cereals, particularly the ones that claim to have you supplemented with great vitamins and minerals, you will find 18 mg of iron added to each serving. But it will also be in the flour of your bagel, your hotdog bun, your Danish, your french toast. And it interferes with your metabolism of carbs, immediately. On the spot.

This raises a fascinating conjecture. Is it the iron added to carbs that makes them so problematic for weight gain, insulin resistance and diabetes? Hmmm. There is enough evidence around iron to make it a perfectly reasonable hypothesis. That also explains a few conundrums that the pure carbohydrate hypothesis doesn’t solve. For example, why is red meat so insulogenic? You eat a large bloody red steak, dripping with heme, and you get a huge spike in insulin. And it may not be just the red meat per se, because we see a stronger effect with processed meats. The evidence seems to lean towards more complicated and nuanced reasons, like the amount of AGE’s and ALEs. (If you knew what those were before you read this: you are a star. AGE’s are Advanced Glycation End Products – made by roasting meat with sugared sauces and ALEs are Advanced Lipo-oxidation Products, that occur with food preparation of meats with protein and high fat content.) However it occurs, iron is in the middle of it.
Here are some tests this hypothesis. First, one must look for high ferritin in folks who have high cholesterol, moderate blood glucose and elevated insulin: all the people we thought were overindulging in carbs. So far, I’m three for three. The last one had a ferritin over 600. Another test…..why can’t women lost weight after menopause? Answer: They stop losing iron with menses after menopause, accumulate iron and have their insulin go up. That makes them gain weight. Hmmm. Ever seen that happen? They go carb free and eat more meat, and don’t lose weight. Hmmm. I’m about 400 for 400 on that one.

WWW: What Will Work for Me. I’ve paid a lot of attention to this topic in my own life. Right now I’m reading labels and finding secret iron everywhere. At the picnic last night, I avoided the hamburger offering and had two olive oil salads instead. I had just read that the iron in spinach is tightly bound by oxalates. And what about Vitamin C? It increases iron absorption 400%. Complex, isn’t it?

Pop Quiz

  1. Too much iron in you can cause you to become insulin resistant, thereby leading to diabetes risk and obesity? T or F                                                                              Answer: Bingo. True
  2. The mechanism for this cause is well known. T or F                            Answer: Well, it’s well known now but the mechanism is still murky. Too complex. The phenomenon has been observed. And ferritin is deposited into insulin cells in the pancreas, but the cellular mechanism is much more nuanced, probably because iron is so tightly regulated and bound.
  3. You should know your iron level and it should be?                              Answer:  Ferritin of 40 or so.
  4. If your ferritin is too high, you can reduce it by?                                   Answer: giving blood to the Red Cross. Come on in and we will phlebotomize for you if the Blood Donor Center won’t or can’t do it.  (Leaches.  Blood letting.  Hand to hand combat.)
  5. This iron topic is a whole new way of interpreting the problem with carbohydrates, because………..?                                                                                           Answer: we added iron to virtually all carbs in Western societies. It may be the iron, and not the carbs.  This is conjecture for now, but it sure fits.

LifeSpan versus HealthSpan

LifeSpan Versus Healthspan

References:  WEForum 2017Compreh Physiology 2012,  Med Sci-Fi Sport Exercise,

We are living longer. But are we living better? In the 20th century, we doubled our life expectancy with the miracle of antibiotics, clean surgical technique, X-rays, immunizations and clean water.  Babies being born today in advanced societies have a 50:50 chance of living to be 100. But living longer isn’t necessarily better. There have been some disturbing trends lately. Obesity has managed to reverse the climb to longer lifespan in some societies, namely the USA.

As we live longer, we have more choices about lifestyle, making research into factors affecting confoundingly complex. It becomes impossible to do “randomized, placebo controlled” studies over decades without limiting free choice and spending more money than could be allocated. This article, from the World Economic Forum this year, offers insight into the laboratory of fitness, namely masters athletes. I have a dozen or so men and women older than 60 in my practice who would qualify as exceptionally fit. And I see their lab results and their vitality. They are aging differently than those of us who are less active.

Sedentary behavior is being increasingly recognized as the driver of many of our modern conditions. Part of this discernment comes from the recognition that athletes, (high end performers) have a disproportionately share of good health. They don’t get in trouble. They still die, but their time of end-of-life disability is markedly compressed, compared to the majority of the sedentary population. They become a unique research cohort, one that we couldn’t duplicate with “randomized research”. In effect, what happens with athletes is that they reach their peak in their 30s, like all of us, but then don’t show much decline until close to the very end. The rest of us show inexorable, linear decline. “Patch, patch patch, after 40!,” we say.

At every age in life, starting exercise of any kind has benefit. And the risk of complications from exercise is far lower than the risk of remaining sedentary. The real risk is sitting. Considering computer games at home, TV, computers at work and cell phones in-between, we are mesmerized by electronic distractions that leave us sedentary. In fact, research in 2009 of 17,000 Canadians of all ages showed a dose relationship of sedentary behavior to all cause mortality, regardless of levels of exercise. That means 30 minutes in the gym does you no good if you are sitting the rest of the day. Bother.

The Author cites four strategies with references on each: 1) Move More (Just get started and move more), 2) Move Slow, (Aim for 10,000 steps a day) 3) Move Fast (Add some high intensity something, even for just 10 minutes) and 4) Move Heavy (Add some weights). Read those hyperlinks. It’s the best of our knowledge.

WWW.What will work for me. Sedentary behavior is the new smoking. If you want to live better, longer, you have to do it. Build it in every day. A day without exercise is as bad as a day of smoking.

Pop Quiz

1. Our grand-kids are likely to live to be 90+. T or F Answer: False if they are sedentary, but true if they get the exercise bug and take care of their diet.
2. Our society is becoming more active. T or F Answer: Mixed picture. But as a general rule, false. Bless those who make the answer slightly true.
3. 30 minutes at the gym has beneficial effects? T or F Answer: Sure, it helps. Its benefit may be completely erased by an 8 hour day of sitting.
4. There is a dose relationship between exercise and good health. T or F Bingo
5. Getting sweaty isn’t necessary. T or F Answer: False, if you want optimal results. Getting sweaty 3-4 times a week is much better for you.


How The Bacteria in Your Gut Make You Fat

How Your Gut Bacteria Make You Fat

References: Science News, Nature,  Published August 29, 2016

Ok, this isn’t in humans, it’s in rats, but we share a lot of their basic physiology, and they are easier to cut open and examine and sample. If this holds up in humans, we will have gained quite a lot. The signal is as follows. Acetate is a two carbon acid that is a break down product of both carbs and fats. It makes its way back to the brain. The brain turns on signals via the vagus nerve to the islets cells in the pancreas to make insulin. Insulin makes you store calories.

But that isn’t all the acetate does. It also turns on ghrelin, your hunger hormone. You eat more. You gain weight. Coordinated processes by which you just pack it on. Acetate. Now the researchers found this by noting that infusing acetate causes rat pancreases to put out insulin. That was in earlier research. Feeding rats a high fat diet also turns on acetate production.

Now, kill all the bacteria in the rat’s gut and in a germ free rat, see how much acetate they make. None! Restore their gut biome and watch the difference, acetate shows up, particularly on eating fat. Following the line of logic, the researchers then found that the acetate didn’t do it directly. It worked through the brain, which then turned on the pancreas.

Now, in humans, it is known that we turn on acetate production when we eat carbs too. Humans have switched their biology in the last 5 million years to being less vegan and more fat consumers. In that process, the weight and source of acetate may have changed. But this research opens a whole new understanding of how our gut and it’s population of bacteria play on our own metabolism. The production of acetate in our gut may be a big key to sort out this conundrum.

www.What will work for me. There is certainly contrary evidence between eating carbs versus eating fat for optimal weight loss. What is clear is that the production of fine flours containing ground up carbohydrates are easily digestible, stimulate insulin directly instead of through gut bacteria. Fine white flour was available to us as human only after the 1870s when John Stevens of Neenah Wisconsin, invented the high efficiency flour mill. Then we added sugar and got extra acetate directly bypassing much of the bacterial biome. No wonder we gained weight, we are overwhelming our internal signals with free acetate.

Ergo: stop eating flour and sugar, deep fried in fat: donuts.


Pop Quiz:

‪1.  Rats, fed high fat diets, make acetate in their guts which gets to their brains and turns on insulin and gherkin production. T or F

That’s about the sum of it.

‪2.  Acetate is a natural break down product of fat and carbs? T or F

True. (But in this study, it was fat in rats that set it off the most)

‪3. The brain reacts to acetate but signaling an increase in what hormones?

Insulin (drives calories into storage) and gherlin (increasing appetite)

‪4. Rat metabolism is identical to humans? T or F

Close but no cigar. Humans have adapted to fat, but not to sugar and abundant flour.

‪5.  In the rat model, acetate didn’t happen without the right gut bacteria? T or F

That’s one of the key messages of this study. Very intriguing.

Why is My Diet Not Working – aka – Why can’t I Lose Weight

Why is My Diet Not Working – aka – Why can’t I Lose Weight

Reference: Zeevi Cell Nov 2015

Eating like a bird and still not losing weight?   Hmm. Your dietician, your doctor, your family all say, “Must be cheating and is just in denial!”. You might even be tempted to say that about yourself.   But maybe not.   It may not be you that’s cheating. It may be your gut biome. Maybe the bacteria in your colon are configured in a way to confound whatever you do.

How do we know that? Well, Zeevi and Segal in this month’s Cell Journal detail the blood sugar responses of 800 people every 5 minutes to some 47,000 meals. By collecting blood glucose every 5 minutes, they could tell the blood sugar rise to different foods. A rise in blood sugar inspires your pancreas to put out insulin. Insulin forces your fat cells to go into “storage mode” instead of “sharing mode”. In storage mode, the fat cell can only import energy. To lose weight from fat, you have to be in “sharing mode”. That only happens when your insulin is below 5-7. Better yet, 2-3.   (It’s not a sudden cliff.) Otherwise, the only calories your body will give up are from your meager glycogen stores (1500 calories or less), or muscle. (Bad idea- they are precious.)   Exercise is a potent “anti-insulin” effect on fat cells, as is pregnancy. The pregnancy hormone HCG opens up fat cells so that the fetus gets food, regardless of the mother having morning sickness or not.   The problem with pregnancy and exercise is you soon develop a voracious appetite to catch up.

It turns out that different folks have quite different configurations of foods to which they have blood sugar spikes. That’s the key. Some folks spike to Sushi (white rice) but not to glucose. Some folks spike to tomatoes! And the criteria by which they spike is partially what they eat, yes, processed carbs wreak havoc most of the time, but also how much and how well they sleep, exercise, eat fiber and…..the biome of bacteria in their gut.

Now Zeevi is being quite coy in his article. He talks about how he developed a personalized algorithm that successfully predicted how one’s sugar will rise, and thereby stress your system out, making you gain weight, develop heart disease, cancer and Alzheimer’s. His predictions were based on what your gut biome has in it, in addition to how you make lifestyle and dietary choices.   But he doesn’t share the details of his algorithm. To me, that means he is coming out with a commercial product that can help you determine what your diet should be to avoid blood glucose rises, and thereby weight gain. There is money to be made in the weight loss world with helping folks understand how to make their own metabolism work better. If I can tell you how to predict your blood glucose spikes after a meal, I can reliably tell you how to lose weight.

But his real and valuable contribution is to identify the fact that you really do vary in your blood sugar responses to different foods. The knowledge of just what bacteria you need to have in your gut is becoming more clear.

Without using his “secret algorithm”, can you fix your gut and adjust your diet? Probably.   Here are 5 steps to heal your gut, mature your biome – and thereby lose weight, avoid heart disease and cancer.   One, cut down on sugar and simple carbs.  They switch your biome Two: Eat more fiber: more dense, coarse, unprocessed foods. (Think flax seed, Brussel’s sprouts, broccoli (green vegetables) Your goal, 30 grams a day for starters, more if you can.   Three: reduce stress. Your gut, brain and immune system are one functioning triad of integrated systems. If you feel stressed, your gut feels it, your immune system feels it. Your biome gets it in the teeth. Four: Drink more water.   Soda and coffee don’t count. Half your weight in pounds, in ounces per day of pure, clean, unchlorinated or fluorinated water.   Five: consider adding a good probiotic. Live cultures, kept in the fridge.   Florigen is one you can get from many pharmacies. Aim for 40 billion colonies a day. If you are constipated, have IBS, have heartburn or gas, you need to do it.


WWW. What will work for me? American food is all carbs with some protein or fat. The fat is usually awful. I’m working on more butter, less sugar. When I travel, I don’t succeed as well as I do when I’m at home.   The simplest formula that works foe me is eggs for breakfast and lunch. Put some butter on them.


Pop Quiz


  1. My blood sugar response to food determines if I gain or lose weight from any given food. T or F


  1. A bowel of rice makes everyone’s blood sugar rise.   T or F

False. As a general rule, yes, but not everyone.

  1. Lifestyle choices like sleep, exercise, processed carbs, fat in my diet all affect the biome in my gut? T or F


  1. The blood glucose rise after a meal determines my gaining or losing weight. T or F


  1. A high fat meal has little effect on insulin. T or F

True, if the high fat meal has no carbs in it, and only modest protein.   High fat means HIGH FAT. (70%)

  1. I should aim to eat at least 15 grams a day of fiber. T or F

Trick question. Of course at least 15, But don’t stop there. Go for 35045.