Category Archives: 5. The Glycemic Index – The Trouble with Sweet

The Case Against Sugar: A Book by Gary Taubes

The Case Against Sugar, By Gary Taubes

Reference: The Case Against Sugar by Gary Taubes

It has been worth the wait. It was my Christmas present, and didn’t come till this last week. What a treasure. Gary Taubes new book has a different tone. He’s mad. We wants to know why sugar fell off the stage of scientific inquiry in the 1960s and 70s with fat becoming the enemy for the next forty years.

That’s what he details in this book. First of all, the curious addictive quality of sugar that we all demonstrate. Of course we act that we. It has served us well as long as we were living in the jungle and sweet only occurred just before the 6 month starvation season. Sugar makes you eat more so you put on weight, store calories and have enough to make it through the next dry patch.

But there is much much more. Did you know, for example, that the American cigaret industry really took off because they started soaking their tobacco leaves in sugar it allowed smokers to inhale much deeper, and get more seriously addicted? That was great for tobacco sales. Not so good for smokers. That’s still how cigarets are being made today.

But the most troubling part that Gary details is the clear historical record of populations being exposed to sugar, and then becoming fat, then obese, then diabetic, then cancerous, then heart attacks and kidney failure. Population after population showed this all around the world.

And our American scientific community blamed it on us. We were lazy and we ate too much. It could all be easily cured by better Puritan values of “eat less and exercise more”. We know that is what our health care system has said to us for years. Where did that come from? That’s the indictment. The sugar industry has funded critical players on the American nutrition scene for decades, never insisting that they tell outright lies, (well, maybe) but more that they focused the spotlight on fat and just ignored sugar, letting it slide out of sight. Because American medicine has not invested in its physicians understanding nutrition, there really hasn’t been the ability of American medicine to really understand adult human nutrition. We just learn by rote, memorize some convenient rules, and tell folks to get out there and eat less and exercise more.

As readers of this column you should know that it is not the calories you eat that make you fat, it is the hormonal effects of those calories that affects the amount that you eat for the next 12-24 hours.. For example, teens at a summer camp given identical calorie content of either high fat or high sugar breakfasts, are proven to eat more, later in the day, when they eat carbs. It is the insulin response to carbs, and sugar, that sets us off down the path of gaining weight and eating more. Insulin is your storage hormone, not your blood sugar controlling hormone.

Gary even has a nice section on the really dangerous chemical called fructose. It is half of table sugar (sucrose is a glucose hooked to a fructose). Fructose immediate damages your liver, forcing you to make small, dense, dangerous LDLs, making fatting liver, raising insulin, and starting the path to hypertension, diabetes, high cholesterol…….. Humans appear to tolerate fructose well enough when it comes in the package of an apple. But in table sugar, and in every form of added sugar (70% of all prepared foods have sugar added to them: bread, pasta sauce, ketchup, peanut butter etc) we get too much, to our peril.

The verdict is in. This is a brilliant book. He’s mad. There’s more in it about cancer, about kidney failure..the prosecutor is talking to the jury, and he’s mad. It’s a good thing some of those wicked food scientists who shaped American nutrition back in the 60s-80s are dead. Because they would have to hang their heads in deep shame. They harmed us so much, for a few pieces of silver.

WWW. What Will Work for Me. I just finished reading the book. It’s actually just as good as his others. The case is made for us cutting it out. Then I read today the study showing that our food stamp program has 10% of it spent on sugared sodas. And the food industry lobbies heavily to not let us restrict that. So our poor folks get sicker. So, let’s punish them and take their health care away now.

Pop Quiz:

‪1. Sugar is a natural food, but not so terrible other than it’s empty calories. T or F

False, false, false. It’s as dangerous as alcohol. Causes as many metabolic damaging effects. And probably just as addictive

‪2. About 20 years after starting to eat sugar, folks starting getting sick. T or F

That’s what hundreds of studies have detailed.

‪3. Cancer rates in societies without sugar are just the same as ours. T or F

False, false, false. Cancer rates rise in proportion to populations eating sugar. Insulin is one of cancers most potent growth factors.

‪4. I’ll be ok if I cut down and only have sugar on weekends. T or F

It may be true. If your fat cells are small enough, the human body has lots of resilience in it. You likely need to cleanse it out of you with good behavior for the next week.

‪5. If I eat a food with sugar secretly inserted in it, what happens next.

A: I eat more.

The Great Sugar Conspiracy

The Great Sugar Conspiracy

Reference: JAMA Inter Med Sept 2016,  Published Oct 3, 2016

If you are an average American, you are getting roughly 10-15% of your calories from sugar. Hmmm. Of 800,000 foods in America found by Lustig’s graduate students team, 600,000 of them have sugar added to them. When you go to the grocery store, you find cheerful markers on most food items claiming they are “LOW FAT” and hence, meant to be good for you. But low fat almost always means, high sugar. Where did this all come from?

It came from a remarkably successful PR campaign waged by the sugar lobby back in the 1960s. That’s what this week’s article details. The remarkable influence of the sugar lobby on the leading nutritional experts of the day. In the 1960s there were two leading nutritionists who held opposing views on how coronary artery disease wreaked its havoc. Angel Keys (The K in K-rations) was highly regarded because of his prominent role in Army nutrition. He advocated that fat was the enemy. John Yudkin believed it was sugar. He was off in England and what did those English know anyways!

Now, 60 years later, letters written between scientists and public policy folks are in library archives and open for the public. When these letters were unearthed and examined, the authors of this review find a terribly inconvenient truth.

Rojer Adams, a professor at the University of Illinois, was on the Sugar Research Foundation’s scientific advisory council. His letter, written to Mark Hegsted, professor of nutrition at Harvard, asking him to write a review of article on the mechanisms and risks of sugar versus fat is the smoking gun. Hegsted was also on the Sugar Research Foundations research council. He agreed to write a review article downplaying the risky components of sugar and emphasizing the problems with cholesterol and fat.

Angel Keys rose in time to greater and greater prominence, and he carried the torch forward. He was a bully in public and at meetings of anyone who disagreed with him, and literally hounded any opposing opinion off of the agenda of national meetings. High fat was his bugaboo. As chair of the NIH funding committee for research, you crossed Ancel Keys at your peril.

Early research suggested that sugar was in fact, the enemy. The Sugar Foundation swung into action and started Project 226, essentially to pay Hegsted and his boss, Stare, at the Harvard School of public health to write a review article downplaying sugar and pointing the problem to fat. That article was written, and published in the New England Journal of Medicine without mentioning its Sugar industry sponsorship. Hegsted got paid.

From there, it’s all history. It was the 1980s and food guidelines came out recommending lowering dietary fat, which means more sugar of one kind or another. Over the next 20 years, every food in America became low fat and consequently high carb. Ancel Keys ruled at the NIH and no-one question the hegemony of Hegsted and Keys. You gained 20 pounds.

This was the biggest public health policy disaster in American History. We didn’t let good science be conducted because secret, behind the scenes, payments led to the corruption of our medical research process. It took 20-30 years to fully correct that error. We are still struggling with it today.

WWW.What Will Work for me. It’s a struggle to avoid sugar. It tastes good and all of us are vulnerable to its effects. You eat sugar, you want more and you eat more. I’m so aware of my own sugar sensitivity. If I eat regular peanut butter on a spoon, I stop at one spoon and feel full. If I eat a brand name that has sugar in it, I can have 4-5 spoonfuls before I stop. But the science is now solid. Avoid sugar. If you want to escape the damage of heart disease and Alzheimer’s.

Pop Quiz

‪1. Sugar isn’t as harmful as people make out? T or F

False. It’s the core enemy of metabolic problems. MUCH worse than fat.

‪2. Our belief that cholesterol is the problem is the result of a carefully crafted PR campaign based on bribery to key doctors, paid for by the Sugar Industry. T or F

Spot on.

‪3. Our food guidelines followed the outcome of the PR guidelines, and suggested we eat a ceiling of 35% fat. T or F

True. That’s how we got there.

‪4. 35% fat should be the floor of our eating, with encouragement to go higher – aka, to 50% or the Mediterranean Diet. T or F

Again, true.

‪5. It’s critical for all published research to have openness as to funding sources. T or F

True. (Same idea would be good for politics, don’t you think?)

What Carbs Should I Eat?

What Carbs Should I Eat?

Reference: Low Glycemic Food Table, Cox Diabetes Clin Research, J. Geriatrics Oct 2015, Paleo Diet Glycemic Index,

We humans are a unique bunch. We developed big, energy hungry brains in the last 2 million years. To keep that development moving along, we had to adapt to diets with more calories in it. Fat provides more calories.   Eating animals provides a great way to get more fat. Cooking allows plants to be easier to digest and get access to more calories.   Cooking started, by our best archeological guess, over a million years ago. But prior to that, we had a metabolism set by mammalian history over 65 million years since the dinosaurs crashed out of existence and the first mammal crawled out its den.

Those first mammals were vegetarians. And likely remained mostly so except for those branches that turned into top tier carnivores. Carnivores develop different teeth, different intestines, different metabolisms. Most hominids (monkeys and apes) remained vegetarian. To this day, they are still mostly vege munchers.   Orangutans eat some 20-25 pounds of green plants a day – leaves. With fruit season, they switch to pure fruit for two months and eat sweet sugar and gain weight. Chimps do the same. They eat some 150 different plants but prefer fruit when its around. Once in a while they chance upon a small mammal they kill and eat, but it’s rare. And you can’t count the few ants they lick off sticks as a major component of their caloric intake. Humans got big brains and smaller muscles.

That’s the world we came from, plant eaters. Hence, our basic, core metabolism started about being adapted to plants.   Plants make carbohydrates.   As a rule, there are two kinds of plant foods.   Leaves and stems (spinach and broccoli) are green, have carbohydrate bound up in the cell well, have a lot of fiber and often as much protein as carbohydrate.   Roots and fruits are the other class of plants that result from the plant storing carbohydrate, often with the seed for propagation. (Think potatoes, apples, corn, rice, pears, almonds, walnuts, cherries.)

In that world, we adapted our hormones that manage carbohydrates to absorb and use the fuel we got from them.   That fuel is glucose and a tiny bit of rare fats, usually in the form of omega fats but sometime saturated fat like coconuts.

What is the hormone most tasked with managing carbohydrates? Insulin!   (And about 30 others in a beautiful nuanced ballet of control.) But insulin is the big kahuna of carbohydrate control. Insulin pushes glucose into fat storage. We secrete insulin in proportion to the rate of rise of blood glucose.   Green plants release glucose so slowly, usually because the fiber is spinach, broccoli (etc) pushes the food down into the colon where our biome releases it for us to use, very, very slowly.   So slowly, in fact, that you almost don’t need any insulin at all.

But potatoes and mangos cause a jolt in blood glucose, and insulin surges with the result that we then store those calories as fat. Getting fat once a year before a long spell of reduced calories makes sense. But it doesn’t make sense year around.

Insulin lasts 6-8 hours.   Think about that. If insulin lasts that long, throughout most of our evolutionary history, the majority of our food must have been of they type that releases glucose over the time period that insulin lasts.   It would not make sense to have foods that make us secrete insulin dramatically and push calories into storage.   Hence, those are the foods we are best served eating the most of.

Did you get that?   Green plants that release glucose over 6-8 hours are our perfect match. They fit our basic hormone of glucose metabolism to a T.   We call them “low glycemic” or cucumbers, Brussel’s sprouts, asparagus, cabbage, spinach, lettuce, – or any green plant that grows above ground.   Green peppers, eggplant probably fit too.

WWW.   What will work for me? We were designed, one way or another, to eat lots of green plants. Lots and lots. And some fat and protein whenever we could. But the green plants came first.   If you did that today, you would be skinnier, healthier, have less cancer, less heart disease, less diabetes. We could call it the alkaline diet, the Pritikin diet, the Esselstyn diet, the anti cancer diet.   Or just the human diet. Enjoy Thanksgiving!

 

Pop Quiz

 

  1. Insulin pushes sugar into storage to it should be called our blood glucose controlling hormone. T or F

False, false, false. Way too simplistic, thought that’s what modern health care calls it.   It is our storage hormone, waiting there for you to find caches of free carbs in that month just before winter, (aka, Thanksgiving)

  1. We are designed to eat potatoes year around. T or F

False, false, false. Potatoes dramatically push glucose into your blood, forcing your to make insulin, forcing you to manufacture fat, forcing your LDLs up, forcing your to get fat. You want potatoes only when you want to store fat so that you can make it through winter. (aka: Thanksgiving)

  1. Our brains need a lot of calories, easily supplied with a raw, vegan, green diet. T or F

False, false, false.   Our big, energy hungry brains want fat and B12 is critical for survival. No B12 in plants. Found only in animal.   (Think Turkey)

  1. Insulin lasts 6-8 hours. That suggests that most of our carbohydrate calories should come from foods that release their glucose over 6-8 hours. T or F

That’s the hypothesis of this treatise.

  1. Humans like to have a big feed when they can? T or F

True. It’s how we express love and affection for each other when we can find all those calories. (Think Thanksgiving)

  1. It’s ok to get fat once in while.

Another premise of this talk: we have put one weight and lost weitht throughut human history. So, enjoy putting it on once in a while. Make sure you do it with lots of love and company.   (Think Thanksgiving)

  1. So Happy Thanksgiving.

 

Insulin Index is the Way to Understand Weight Loss and Diabetes Control

The Insulin Index: The Best Way to Manage Diabetes and Weight Loss

Published: Nov 9th 2015

Reference:   AJCN Miller, AJCN Holt and Miller,   Diabetes Blog,

What’s the Insulin Index? It’s the measure of how much your insulin goes up in response to a standard dose of any given food, when compared to a standard dose of white bread (1000 kjoules worth or about 250 calories.)   We know white bread provides you with very easily digestible carbohydrates, and has a “high” glycemic index. We want to know how much insulin you secrete in response to foods, because that is what really controls diabetes and weight gain/loss.

Dr Miller has developed this idea over the last 20 years and now has over 180 foods posted on line. You can easily look up many lists.   The core finding is essentially that the more sugar (which is a pure carbohydrate of two kinds: glucose and fructose) and carbohydrate (which is mostly glucose in very long strings that have to be broken down to simple glucose) foods have, the higher the insulin release. The wild card to be put in here is that protein itself becomes insulogenic when eaten in large quantities.   That is because your liver is quite competent at converting extra amino acids into glucose. You can only use so much protein to build or replace muscle. After that, the building blocks of protein, amino acids, are easily converted into glucose, and that spikes insulin.

How does that convert into information you can use?   Well, the highest insulin index foods will be those made from pure glucose.   Hence Jelly Beans (117) and Pancakes (110) will be very high compared to white bread (100).   But so will baked beans (88) and boiled potatoes (88).   That happens because those are foods filled with carbohydrates – imagine a baked potato is nothing more than a bucket of Mardi Gras necklaces in which each bead is a glucose. When you eat food made from those carbohydrates, your body can unzip those strings of carbs very effectively and rapidly, and that leads to the release of insulin. These are also foods that have been altered from their native state, altered by farmers to be larger and more carbohydrate filled, and finally, cooked in a fashion to make the carbohydrate much more accessible.

Now, what is intriguing is that a lot of low fat dairy ends up being very insulogenic. Low fat yogurt, for example has a glycemic index of 31 but an insulin index of 84.   Skim milk has a glycemic index of 29 but an insulin index of 60. Low fat cottage cheese has a glycemic index of 10 but an insulin index of 52.   Why?   Dairy doesn’t have glucose in it in a pure form but rather in the form of lactose, that takes a while to digest. But the extra protein floods in rapidly.

And what is the role of fat? It’s insulin neutral so has little effect.

How do I synthesize all this information? I believe our metabolism was shaped by millions of years of eating green plants which have carbs tightly wrapped up in fiber. These got digested in our colons, very slowly.   We still have those foods.   We call them spinach, asparagus, cucumbers, broccoli, eggplant – any green vegetable that grows above ground. Civilization has led us to grow and manufacture foods that are richer in carbs than we have ever seen before. They get digested in our small bowels. They used to be seasonal, and available only I the fall, but are now available year around. They cause a dramatic spike in glucose, which causes a dramatic spike in insulin. During most of human history, that was very beneficial because that led you to store calories in September and October so that you had a calorie reserve for January and February.

WWW. What will work for me.   I measure my insulin and glucose and those of my clients and find this to be very true. Many folks, trying to lose weight and control their diabetes, can’t succeed because they are eating too much protein. When you shift them to more fat, and more green vegetables, their insulin goes down and you can measure it. They lose weight, their diabetes gets better. They use less insulin, if they are taking it as a medication. I’m fascinated how sabotaging dairy is for weight loss. At least low fat dairy.   In my home, we have the full fat stuff, or whipping cream.   I suspect the admonition to drink low fat dairy and eat low fat yogurt is exactly opposite what we should be doing.

 

Pop Quiz

  1. The insulin index measures how much insulin my body makes in response to different foods. T or F
  2. True
  3. Foods very high in simple glucose like pancakes, have very low insulin indexes. T or F
  4. Exactly false. If you said true, go to jail, go directly to jail and read the article again. Dramatically opposite
  5. Dairy is an insulogenic food. Why?
  6. It has low level of pure glucose but a flood of animal protein, which can also set off insulin.
  7. Insulin serves as my storage hormone, saving calories to burn later in the year when the times are leaner. T or F
  8. For the last 65 million years of mammalian history. Changed recently in the last 10,000 years with agriculture and dramatically in the last 100 years with industrial civilization
  9. To lose weight, I have to get my insulin level down, so that I stop storing calories.
  10. It’s easier to control my diabetes if I’m not shifting calories in and out of fat cells all the time and just use them slowly as they show up.
  11. Perfect, which is what green plants will do for you as they are digested very, very slowly by the wonderful biome of helpers in your colon.

 

Kidneys, Insulin and Salt Retention

Why You Can Lose/Gain 5 Pounds in One Day – Insulin, Kidneys and Salt

June 29th, 2015

Reference: Horita, Int Jr of Hypertension

Ever stepped on the scales and gained five pounds in a day?   Better yet, ever started a diet and lost 5 pounds the first week? “It’s just water weight, “ you say. And you are correct. But the details are pretty elaborate.

Here are the details, as elaborated by Horita in his review article.   There are likely four or five key reasons why being overweight leads to high blood pressure, but leptin resistance is certainly in the mix.   Leptin is your “stop eating hormone” made by fat cells that goes back to your brain and signals that you have had enough to eat. As we get overweight, we become leptin resistant. Long term elevated leptin leads to increased adrenaline in the blood, raising blood pressure. And as we get heavier, we also become insulin resistant, with gradually rising blood insulin first, then rising glucose later.   In addition to leptin, there are arcane hormones such as tumor necrosis factor (TNF) that causes sodium excretion at high concentrations and retention at low concentrations.   Figure that out?!@   Or angiotensin that saves salt and is closely related to insulin resistance.   Then, there is the WNK family with its five subtypes and you get the picture of increasing complexity. Insulin affects all the WNKs. Whew.

But what is the effect of insulin on the kidney? That is the key to discuss today.   Insulin, the hormone your body makes to store glucose, has another effect entirely on the kidney. It essentially turns on sodium retention in virtually every part of the kidney.   When you save sodium, you save water too.   When you hang onto water, you increase the volume of your vascular tree. (Blood vessels.)   That’s a bit like adding more water to a fixed size water balloon. The pressure has to go up.   Now, interestingly enough, insulin also stimulates the production of nitric oxide, the chemical your body uses to relax your blood vessels, making your total volume of body water go up. So, your balloon gets a bit bigger.   Did you get that? With a bigger balloon, you gain water weight. With insulin, you stuff more water in it.

This becomes a pretty simply formula to gain weight.   A piece of chocolate cake for dessert is just 200 calories and weighs less than 4 ounces. But you add ice cream on the side and you just turned on insulin in a dramatic fashion.   With that you start the whole cascade of saving salt water.   You gain 5 pounds.

And what happens when you diet?   You avoid carbs and sugar for a day or two. You just eat “salad”. Salad is composed of low glycemic spinach and arugula, with tomatoes and cucumbers, topped with olive oil – none of which stimulates insulin. Your insulin level starts to fall.   If you are overweight, your insulin level starts out at 11-20, which is supposedly normal, but enough to stimulate sodium retention.   After a few days of consistently low glycemic food, and fat, your insulin level keeps drifting down and your kidneys get the memo, “No insulin”.   Your retention of sodium slows down dramatically, your volume of distribution, the size of your water balloon, shrinks. Your weight suddenly looks like you just lost 5 pounds.   Voila, you feel so proud.

This is the mechanism of every ad shouting at you, “Lose 15 pounds in the first two weeks”.   You can lose 15 pounds in the first two weeks.   Thirteen and a half of water.   You actually lost one and a half fat pounds! But that’s one and a half you weren’t able to lose before. Just don’t get discouraged when those 13 come back.

WWW.   What will work for me.   If you weigh yourself daily, you see your weight bounce up and down by 3-5 pounds all the time.   When I stay off carbs completely for 4 days in a row, I feel mercilessly dizzy if I don’t eat extra salt.   With that extra salt, usually in the form of Tobasco sauce or “Slap Ya Mama” Cajun spice, I feel just fine.   And my blood pressure is down 15-20 points in just a week. If my blood pressure can do it, so can yours!   What’s the wise person to do? Calculate your basal metabolic rate for your age, height, weight and gender, add your exercise calories, and eat less calories a day than that result.   Make sure they are low glycemic vegetables, fat and modest protein calories.   And watch your blood pressure fall.

 

Pop Quiz

  1. Insulin, your natural calorie storage hormone also affects how much salt your kidneys hang on to. How?

By stimulating your kidneys to reabsorb most of the salt that passes through

  1. Insulin also increases the size of your body water? T or F

True. It stimulates Nitric Oxide production which increases the “size of the water balloon.”

  1. Insulin resistance is strongly related to high blood pressure. T or F

True. (If you didn’t get this one by now, I would be distressed)

  1. It makes sense to lump high blood pressure together with high blood glucose, cholesterol and high insulin.   T or F

True. That’s why we call the collection of them the metabolic syndrome.

  1. Fat has no effect on insulin. T or F

True.   As long as it’s natural fat, not manufactured, transfat or vegetable oil.

  1. You can lower your blood pressure by getting off sugar, wheat, flour, bread and all root vegetables and grains. T or F

Bingo.   Give it a try.

Food and Inflammasomes

Fire, Fire, Cells on Fire: Inflammasomes II

Reference:   Scientific American June 2015, Wen Nature Immunology

June 1, 2015

We learned last week that inflammasomes are activated when “stranger” and “danger” signals are present.   Bacteria and viruses can do it, but so can foreign chemicals like asbestos and amyloid in our brains.   The inflammasome is essentially a little factory that propels the inflammatory process forward and turns on the signaling in the cell and its surroundings that trouble is brewing.   When you have a cut finger and get redness around it, it is because your local macrophages have made inflammasomes inside themselves that are putting out the chemicals that make that factory become assembled, and then produce its inflammatory signaling messages.

But that’s not all. Food can do it. Eating too much food sets off inflammation.   Fatty acids can do it too.   A healthy liver has many immune cells within it, and is the first recipient of calories after a meal. The liver can become inflamed and swollen when it is overwhelmed with too many calories.   We have an epidemic of fatty liver in obese children right now. It appears that fructose plays a central role in that process.

What happens when you eat too much fructose (sugar)?   We know that it essentially exhausts your liver because it forces the liver to use up its ATP, resulting in a burst of uric acid and a burst of triglyceride release – as dramatic as with drinking alcohol.   Your liver gets swollen and doesn’t work very well.   You can see large globules of fat in it.   It can’t make an orderly progression of LDLs to transport the extra calories to your fat cells, where the fat can be stored. Instead, you have a wild, uncontrolled release of free fatty acids into the blood.   We call those triglycerides.

We know that triglycerides reflect a higher risk for heart disease than total cholesterol, particularly in women. And that would make perfect sense because triglycerides reflect the presence of inflammation in the liver, spewing out inflammatory messages to the whole body.

The interesting thing about food is that its inflammatory effect seems to be about 24 hours and then it cools off. Immune cells stop responding to the inflammatory messages after a while. The next door to be opened is just what on earth keeps the inflammatory process going and going.   Adenosine may be that signal. And when you eat fructose and overwhelm your liver, you break down ATP and make adenosine. That points a particular finger at fructose again!

How can we turn all this off? Fasting! Or eating a “ketogenic” diet that makes you put out beta-hydroxybutyrate.   Imagine, turning off inflammation by eating fat.

WWW. What will work for me. I know this is true. Eating fat reduces inflammation. My 70% fat diet for the last 4 months has reduced my CRP from 3.8 to 0.3, in just 4 months.   I’m getting better at saying no to sugar if I can just keep away from brownies and chocolate.   I believe that the alleged triglyceride activation of inflammasomes is actually a misplaced association – the triglycerides reflecting the excessive intake of fructose/sugar we Americans are obsessed with. It’s the sugar.

Pop Quiz

  1. Inflammation can be started by eating too much food? T or F

True

  1. Sugar seems to be able to turn on inflammation as well? T or F

Perfect

  1. Fructose, from sugar, makes for fatty liver? T or F

T

  1. Inflammasomes in the liver are caused by eating too much food and too much sugar. T or F

I’m beating a dead horse here, but I want you to get the point.

  1. You can turn off inflammation by eating a keto-genic diet – aka, high fat? T or F

True

  1. Beta-hydroxybutyrate is the compound your body puts out when you are burning fat, either from your fat cells or from the food you eat – and it happens only when you eat less than 20 grams of carbs a day. T or F

Pretty close to accurate. Some quibbling on details.

Inflammasomes – a Primer on Inflammation

Inflammasomes: a Primer on Inflammation

Reference:   World Jr Diabetes, Scientific American May 2015,

Diabetes, gout, Alzheimer’s, asbestosis, erectile difficulty, heart attacks all have something in common. They are primarily diseases of inflammation. Yup, inflammation is the problem. (Redness, swelling, pain, warmth) All of these “diseases” share a common pathway. They may affect different organs (fat tissues, liver, joints, brain lung, heart) but they share a common pathway on how the illness comes about.   That changes the way we think about them. Instead of treating the organ, it’s time to start thinking about treating the underlying pathway.   That means we have to understand the underlying pathway. Inflammation.

What is inflammation?   Everyone is familiar with “stranger” inflammation. When a bacteria invades your body because you cut your finger, your innate immune system recognizes that it is a stranger, just like a virus, a parasite or a fungus, and your innate system puts out signals that danger is at hand.   Besides “stranger” initiated inflammation, there is also “danger” initiated inflammation. If you crush a cell with trauma, pieces of DNA, or ATP or fatty acids show up in the space between cells where they aren’t normally present. Your guardian immune cells assume that “strangers” must be around for damage to be there, and also set off the initiation of inflammation.   Beta-amyloid in your brain, uric acid in your joints, cholesterol in the wall of your arteries can all the set off the same sequence – without a stranger being there to start it all. See the common pathway? The core concept is that seemingly common things, in the wrong place in your body can also inadvertently set off the fire alarm.

For the last decade or so, we thought there was a hopeless maze of signaling that was complex beyond comprehension. Not so. There is a common pathway.   Certain cells called macrophages have the responsibility to eat up “danger” and digest it. They are our body’s garbage trucks.   Here is where it gets interesting. These macrophages respond to broken bits of DNA, or RNA or other DAMPs (Danger associated molecular patterns) with two patterns. One is to initiate the production of danger signals. The other pattern is to assemble a factory to process those signals. That factory is called the inflammasome.

The job of the inflammasome is to process the chemical signals of inflammation and activate them. Finally, it ships them out of the cell to call for help and keep the process going.   IL-18 and IL-1β are the two principle signaling molecules. Those two compounds circulate around, increasing blood flow, making tissue swell and all the other processes of what we call inflammation.

Now, if you want to sound particularly savvy, you can say the phrase, “I’m going to suppress my NLRP3 inflammasome today.” the next time you are offered a brownie and you really didn’t want the carbs.   The modulation of inflammasomes is the future of medicine.   The NLRP3 inflammasome may be one of the most influential because it is the one in Alzheimer’s that responds to amyloid and goes about killing off brain cells. And why is it important?   Because your can shut it down and turn it off by a chemical called beta-hydroxybutyrate. And what is beta-bydroxybutyrate? It’s a ketone body, release by fasting and eating a low carb diet.

WWW.   What will work for me?   Hmmm. I can turn off the inflammatory process by fasting? That’s no fun. But a low carb diet is good for me? Yup, this is how it works.   On a low carb diet, your body turns on fat consumption, and that releases the ketone called beta hydroxybutuerate.  And that turns off your inflammasome.   So, practice this phrase with me. “I’m turning off my NLRP3” as a way of giving yourself the willpower to resist that almond extract flavored chocolate chip triple chocolate chewie gluten free brownie sitting in the fridge.   I need the practice, because I had four of them yesterday.

 

Pop Quiz

  1. Inflammasomes are the factories our bodies make inside of cells that start the process of inflammation. T or F

True

  1. Inflammation is when your tissue gets cold, white, quiet and numb. T or F

False. Red, hot, painful and swollen

  1. Your body can respond to “danger” and “stranger” signals in the same way. T or F

Sounds like you are getting it

  1. The particular inflammsome called NRLP3 can be turned off by fasting. T or F

In a nutshell, that’s it. The ketone body called beta-hydroxybuturate is a ketone body you naturally make when you are digesting and releasing fats – and that turns NLRP3 off

  1. Inflammasome explain how many diseases are caused by the same cellular process – just showing up in different cells and tissues. T or F

Yes – this common pathway gives us reason for much more hope at turning those diseases off.

What Happens When I Cheat? With Insulin…

Hunger and Insulin, aka: What happens when I cheat.

Reference: Rodin, Health Psychology, Schloegl Diabetes Metab Res Rev

What happens with appetite and insulin when I’m on a low carb diet, high fat diet, and then eat some carbs (cheat)?   If I read the medical literature, there isn’t a clear consensus because it gets so complex, you get lost in a maze of contradictory claims and literature. There are many hormones that affect hunger and appetite, and the maze becomes confusing.

I am putting forward a hypothesis there in which I will insert the facts, as I understand them, in order to attempt some accurate simplification.   See if you agree or disagree and send me your thoughts.

My hypothesis is that eating a small amount of glucose (or flavor sweet), when you are in ketosis, will make your insulin burst up, and lead you to eating MANY more calories because you get much more hungry right away.   In this situation, insulin increases appetite.

  1. Losing weight reduces the size of your fat cells, lowers your blood glucose and reduces your risk for heart disease, cancer, Alzheimer’s, stroke. Hmmm, I want to lose weight.
  2. To lose weight, you must burn more calories than you consume.
  3. There is good evidence that high fat diets turn off insulin and assists weight loss from fat cells – which neither low fat nor high protein will do.
  4. High fat diets lower insulin and blood glucose levels promptly, resulting in reduced calorie intake, but opening up fat cells. Aka: weight loss.
  5. Ketosis results from high fat intake, with low protein and low carb intake.
  6. Ketosis means you are burning fat, either from diet or fat cells, but your fat cells are open and releasing their stored calories. You can lose weight.
  7. Exercise is a potent form of insulin substitution, so your insulin goes down and stays down, relative to a sedentary person, for at least 24 hours.
  8. The brain can run on ketones just fine, but will switch back to carbs on a moments notice. (Insulin levels < 5)
  9. To get back into ketosis takes a couple of days – up to 10.
  10. Once exposed to carbs, insulin level rises and appetite goes up. (My teleological explanation for this is the brain senses glucose, which in human history meant it was September-October, the season to gain weight to prepare for winter. Time to gorge.)
  11. Once we put on weight, our fat cells get insulin resistant and our signals get all messed up. Insulin then has no effect on appetite, or increased effect, but we have high insulin levels relative to ketosis season. (Insulin > 5)
  12. Modern medicine calls normal insulin 2-24.   Normal is <5. Most modern American’s are badly insulin resistant: hence we are getting heart disease.
  13. Someone in ketosis will instantly switch to “Gorge Mode” when given enough carbs to stimulate insulin. (Chocolate cake) At this point, insulin turns on appetite.
  14. A TINY dose of insulin reverses ketosis (both in dieters and in diabetics in ketoacidosis. Dieters still have an alert, functioning pancreas, so ketosis is healthy and natural.)
  15. You can stay in ketosis longer by eating 20 grams of carbs from spinach (low glycemic index) versus the alcohol in beer (which gets metabolized faster than glucose) or orange juice (pure sugar – bursts into your liver), or bread.
  16. Cheating once a week may be sufficient for you to plateau and stop losing weight.  Cheating with as little as a cashew snack (which you thought was all fat and ignored the carb content) might do the trick and sabotage your efforts.

WWW.   What will work for me.   I find I see all these changes in myself when I follow a ketogenic diet, and then experiment with having some chocolate cake.   I can feel the pull of appetite, which is very hard to resist.   On some days I can, and some days I can’t.   What starts out as a great day, with good fat content, can degenerate into a spasm of gorging on too many calories when I have a chocolate truffle, a piece of cake, a half scoop of ice cream.   Before I know it, I’ve eaten other foods in addition.     I would love to hear from anyone with any evidence to the contrary.

Pop Quiz

There is consensus in the medical literature on insulin and appetite. T or F

False. It’s all over the map, because no one has identified normal insulin.

  1. Normal insulin should be defined by what state of metabolism you are in, with < 5 being normal when you are trying to lose weight, and >5 when you are trying to gain weight to make it through the winter.

T

  1. Exercise confuses everything, but is explained by it’s persistent insulin like effect. T or F

True.   I may be hungrier, but I’ve burned more calories.

  1. Ketosis is our natural state during winter? T or F

True, until 10,000 years ago when we got civilization and started storing carbs to spread around all year.

  1. All of our modern diseases can be traced back to the dysfunctional metabolism too many carbs cause in our blood.

That, my friend, is true.

Diabetes Should Have It’s Guidelines Changed

Diabetes Turned Upside Down

Reference: Feinman Nutrition 2015

This is it! We have been doing it backwards for 50 years and now is the time to challenge the old treatment method for diabetes and turn to what works. If you or anyone you know has diabetes, send them this article. This review is a challenge to the status quo. It is time to turn our national guidelines on their head. Our health care systems should hear the clarion call and change their education, their dieticians teaching, their handouts, their clinical pathways.

Here is the evidence, as presented in this article. There are 12 points of evidence, as summarized here.

Point 1. Hyperglycemia is the most salient feature of diabetes. Dietary carbohydrate restriction has the greatest effect on decreasing blood glucose levels

Point 2. During the epidemics of obesity and type 2 diabetes, caloric increases have been due almost entirely to increased carbohydrates

Point 3. Benefits of dietary carbohydrate restriction do not require weight loss

Point 4. Although weight loss is not required for benefit, no dietary intervention is better than carbohydrate restriction for weight loss

Point 5. Adherence to low-carbohydrate diets in people with type 2 diabetes is at least as good as adherence to any other dietary interventions and is frequently significantly better.

Point 6. Replacement of carbohydrate with protein is generally beneficial

Point 7. Dietary total and saturated fat do not correlate with risk for cardiovascular disease

Point 8. Plasma saturated fatty acids are controlled by dietary carbohydrate more than by dietary lipids

Point 9. The best predictor of microvascular and, to a lesser extent, macrovascular complications in patients with type 2 diabetes, is glycemic control (HbA1c)

Point 10. Dietary carbohydrate restriction is the most effective method (other than starvation) of reducing serum TGs and increasing high-density lipoprotein

Point 11. Patients with type 2 diabetes on carbohydrate-restricted diets reduce and frequently eliminate medication. People with type 1 usually require lower insulin

Point 12. Intensive glucose lowering by dietary carbohydrate restriction has no side effects comparable to the effects of intensive pharmacologic treatment

“The need for a reappraisal of dietary recommendations stems from the following:

  • General failure to halt the epidemic of diabetes under current guidelines.
  • The specific failure of low-fat diets to improve obesity, cardiovascular risk, or general health (points 1 and 4).
  • Constant reports of side effects of commonly prescribed diabetic medications, some quite serious (points 12
  • Most importantly, the continued success of low-carbohydrate diets to meet the challenges of improvement in the features of diabetes and metabolic syndrome in the absence of side effects.”

WWW.   What will work for me. I’ve followed a high fat, low carb diet for four months and lowered my own borderline high sugar from 102 to 73. I lost 25 pounds.   I raised my HDLs to 61 from 28.   It was so simple. And I didn’t feel hungry. If your doctor tells you to follow a low fat diet, leave him/her and follow your own common sense.   Read this article, word for word and save your own life. It’s going to take 10 years for health care to get its act together and change.

Pop Quiz

  1. Current guidelines from the American Heart Association and American Diabetes Association advocate control of diabetes through the use of a low fat diet. T or F

True

  1. This has resulted in good control of Americans’ diabetes. T or F

Patently false

  1. We, as a nation, have made an enormous health care blunder. T or F

True

  1. It’s time to make a radical shift and change our approach. T or F

As fast as possible

  1. If you have a blood sugar above 90, you will serve yourself and your health better by eating eggs and bacon for breakfast instead of oatmeal? T or F

True.

 

Eggs and Butter get a Pardon

Reference: Washington Post Feb 2015, 2015 Executive Summary, New York Times

The new Guidelines for 2015 are out!   And a subtle shift is happening of monumental proportions. Eggs are back! The long standing hostility to eggs and butter has been lifted with simply silence.   No one is saying, “We were dead wrong” but instead have come out with a much, much stronger recommendation that we eat less sugar.

The core diet they are recommending is less sugar, more vegetables, less red and processed meat (sausage, baloney, hotdogs) and more healthy fats from nuts and seeds and “vegetable oils.”   (Here is where I take difference with them.)

But eggs are back! You can eat eggs again. They admit that the very tiny percent of people whose dangerous blood fats go up with eggs are too small a minority to justify guidelines for the whole population.

They do recommend that a broadly shaped “Mediterranean Diet” be followed that has more vegetables, less sugar, more white meat. But I remain skeptical as to just what part of the Mediterranean they are talking about. There are some 14 – 16 countries that are around or in the Mediterranean, and each has a different cuisine.   I suspect there is an amalgam of ideas with more olive oil (really good for you) and fish (even better) and vegetables (best) but the recipes are different everywhere. Fresh, locally grown food with fish and vegetables are common in Thailand, the Philipines, Japan, Peru, Ecuador, South Africa….on and on. Aren’t they Mediterrean too?

What they don’t strictly address is how to lose weight. Maintaining is one thing, losing is another. I would maintain that this is the revolution that ultimately needs to happen. Teach us how to lose weight, effectively and forever!   The Guidelines Committee made the horrific blunder in the late 70s of telling us to eat more carbs and less fat, and we all got horribly obese. They were dead wrong.   Just plain wrong. They have yet to admit guilt and say sorry. I would like a sorry.

But the science is now there about how to lose weight.   And hints of it are in the guidelines. The best hint is the recognition front and center how dangerous sugar is. Sugar, even the flavor sweet, turns on insulin. Insulin is also turned on by the flavor sweet.   And even more devious, too much protein (More than 1-1.5 grms per ideal kg body weight per day) and your body turns the extra protein into glucose, and that turns on insulin. To lose weight, you must simply turn off insulin. With insulin gone, your fat cells open up and share their calories seamlessly and effortlessly with your body. That’s it. Simple. You have to turn off insulin. (Note, you also lose weight if you eat low enough glycemic carbs: alkali diet or vegan).

The “teleological explanation” is helpful. The time of year we naturally want insulin is August and September, when carbohydrate foods are plentiful, delicious and winter is just around the corner. To survive winter, we should gorge and fatten up. Insulin is the tool to do that. But come winter, to survive, we need access to that which we stored.   If you eat carbs, your body thinks it’s September. Plain and simple. If you eat fat, your metabolism thinks it’s winter, and your insulin is turned off. Anytime you eat any carbs, you put out insulin and for the next 12 hours, you won’t lose an ounce of fat weight. Insulin is intimately tied up with your appetite. (There are many more but I’m simplifying it).   If insulin is turned off, your fat cells open up and your appetite stays in control. Your brain learns to run on ketones (pieces of fat being chopped up).   You can get along on 1400 calories a day and feel fine. And that’s called weight loss.

Long term, what do you want?   Here, the Guidelines committee is finally getting it right (mostly). Much less sugar, less refined flour. More vegetables.   More omega fat containing meats. Less fake meats. Less feed lot meats. It’s clear that in the long term, more red meat makes for turning on cancer genes and acidifying you. In the short term, it’s far more important to lose weight than worry about the risk of red meat. Lose the weight, then lose the red meat. (Be like the eskimos, eat the fat of the caribou and save the meat for dogs.)

But central to all of this is the admonition to avoid fat is lifted. Eggs are two thirds fat, one third protein. They are ideal weight-loss foods. You can eat eggs. All the eggs you want. And your weight will go down and your waist will go down.

WWW. What will work for me. I embarked on a weight loss program on Dec 29th. I’m eating 4 eggs every day. Two for breakfast and two for lunch. No bread. I’m not hungry. I’m averaging about 1200 calories a day and feel fine. I do need an extra blanket and a sweater to stay warm. That could be the 5 degree temperature outside. (I’m down 16 pounds in 8 weeks.)   My body believes it’s winter.   It’s sharing its fat with me.

 

Pop Quiz

 

  1. Eating eggs will help you lose weight?   T or F

True

  1. Why

Because they are high fat, modest protein and make you feel full with only 90 calories each.

  1. Why do you feel full?

Because your insulin is turned off and your appetite doesn’t kick in

  1. What season does your body think it is if you are eating just fat?

Winter

  1. Our bodies were designed to eat what in winter?

Fat

  1. To lose weight, you have to eat fat. T or F

True

  1. That makes eggs?

“The perfect food for weight loss”. Back in style.   Eat up. (Buy the good ones naturally raised with more omega fats in them)