Monthly Archives: February 2008

Metabolic Syndrome # 5 Here Comes the Proof: It’s the Carbs!

Metabolic Syndrome # 5  Here Comes the Proof:  It’s the Carbs!

Competency # 20 Lifestyles of the Long-lived

Reference: Reference:  Am J Clin Nutrition.  Feb, 2008:87:339 Halton and Hu

From the Harvard School of Public Health and the Nurses’ Health Study

Well, we’ve set the table.  Insulin is the prime enemy in metabolic syndrome and metabolic syndrome is the mess most of us are in.  Insulin resistance is the fundamental cause of metabolic syndrome.  The story we’ve told over the last two months has been the conundrum we are in with the advice to eat a low fat diet, while intuitively recognizing that a low fat diet, the current recommendation of the American Diabetes Association, ends up being a high carbohydrate diet by default.  And that diet makes metabolic syndrome worse.  What’s a gal/guy to do?  Is eating a low fat diet the right diet?  Low fat/high carbs, officially sanctioned now for 30 years has correlated with all of us gaining weight by the truckload.  The world seems upside down and backwards.  Is there any evidence to suggest we should do something else?

YES!  THIS MONTH!  Frank Hu is one of the prime leaders of the Nurses’ Health Study and his group has just published what I believe to be a major study looking at a prospective view of 85,059 nurses and their consumption of carbs.  Head to head, low fat (AKA, higher carb) versus low carb diets (AKA: higher protein and fat).  They now report a 20-year follow-up comparison.  This isn’t a short-term study.   Nor is it small.  So it carries some weight.  They looked for the onset of adult onset diabetes with one diet or the other.  What they found was that the low carb diet DID NOT increase the risk of diabetes.  In fact, diets high in vegetable protein and fat “may modestly reduce the risk of diabetes”.

Metabolic syndrome is actually most accurately described as insulin resistance as the core problem.  Diabetes shows up only after many years of insulin resistance.  Catching the metabolic process early on is the best and simplest way to prevent diabetes.  All the other components of metabolic syndrome can be interpreted as reflections of the core problem.  High blood pressure may be driven by elevated insulin levels as much as any other cause.  Elevated lipids may have all the same cause.  Obesity is clearly correlated.  The problem is that we can’t measure insulin resistance easily.  It’s much too complicated to measure.  It’s easy to measure your waist, your blood pressure and your blood fats.  (Did you know that cardiovascular risk starts with a blood glucose of 83?  Not 110, the definition of borderline diabetes.  So risk for a heart attack starts with insulin resistance at a level of 83, not when frank diabetes shows up.)

The story probably revolves around the type and quantity of the carbs we eat.  Glycemic load is the concept to put it all together, and Hu’s study confirms that.  Glycemic load is the “area under the curve” of glucose rise in response to foods.  It takes into account the type of carbs and the total amount you eat.  So, you can cause as much trouble eating huge amounts of low glycemic foods as you can be eating small amounts of pure sugar.  This study found that high glycemic diets “strongly correlated” with the risk and onset of diabetes.  So, eating below the “Insulin Line” works.  (You start to secrete more insulin with foods over a glycemic index of 55.  But you will still secrete insulin if you eat pounds of low glycemic carbs or a higher glycemic load.)  High protein, high fat results in less diabetes.  Low fat doesn’t work.  The world has been upside down.  Let’s put it right.

WWW.  What will work for me? My fasting blood sugar was 99 this year.  That’s over 83.  So, I’m in this mess too.  It’s the carbs, and the type of carbs.  Benefit comes in the form of vegetable sources of fat and protein.  More olives, nuts, avocados, beans, peas, lentils, soy!  Carbs should look like pears and apples, broccoli, carrots and beans: whole foods.  Eat less pasta, rice, potatoes, bread, donuts and brownies.  It’s eating “Below the Insulin Line”.  85,000 nurses for 20 years is pretty good proof.  I’m still grieving the thought that those donuts have gotta go…

Metabolic Syndrome IV: Eating Below the Insulin Line

Eating Below the Insulin Line:  Strategies for a safer diet

Competency # 20 Lifestyles of the Long-lived

Reference: :  Dietary Strategies – A state of the Art Paper,  American Journal of Cardiology, Jan 2008  pp 249-55 O’Keefe et al

Refers to:  Competency 5.  Insulin, Sugar and the Glycemic Index

This article is huge!  Post-prandial dysmetabolism is the term.  That’s basically the post Thanksgiving Dinner Football coma we all subject ourselves to once a year.  Well, once a day?  Three times a day?  Yes, three times a day if you don’t choose your foods well. Finally, the official house of medicine is beginning to swing to a new way of defining what is state of the art.  The house is being turned upside down.  No longer is the official literature stating that we must eat low fat as our organizing principle.  Instead, this article refers to the rush of calories that floods our bodies after meals high in processed foods. White bread, white rice, white potatoes, white sugar and high energy density foods are the core enemy.

“The hypothesis of this review is that specific dietary strategies can dramatically and immediately improve post-prandial glucose and lipid levels, inflammation, and endothelial dysfunction, and if used in the long – term will also improve cardiovascular health.”  In other words, we can fix the dangerous chemical state you are in after meals, if we pick our food well.  “Resorting to drug therapy for an epidemic caused by a maladaptive diet is less rational than simply realigning our eating habits with our physiological needs.”  In other words, eat differently.  It works better than drugs.

Here’s my proposal.  What’s the insulin line?  It’s the level of “glycemic index” above which you secret insulin.  When you eat low glycemic foods, you have less of a post-meal burst in glucose.  For example: white bread and jelly is pretty quickly digested into pure glucose in your blood.  It’s glycemic index is about 80, which means it’s 80% as fast as eating pure glucose.  Take that same slice of bread, turn it into whole grain, whole wheat, and put peanut butter on it (oil slows digestion) and the glycemic drops to 50.  Something magical happens in your body below a glycemic index of about 55.  You don’t secrete insulin.

When you don’t secrete insulin, you don’t force your fat cells into storage mode.  You don’t force your liver cells to make triglycerides.  Your inflammatory markers go down.  What foods are below the line?  Whole foods, whole fruits, whole vegetables, whole grains, whole nuts, whole olives.  Nothing processed or artificial.  No flour.  Lots of protein.  Read the article.  I have it attached.

WWW:  What Will Work for Me.  I’m thrilled.  This is a break-through article.  I believe the science will get on with details and more and more will come out about insulin.  There are fun extra tricks in the article.  I’m adding more vinegar to my diet. Vinaigrette! Lowers the glycemic index below the insulin line.  Almonds do it too!  Whey protein.  This is a tipping point.  The road ahead is much more fun, with delicious food to enjoy.

Metabolic Syndrome VI: Fructose and AGEs

Metabolic Syndrome # 6:  AGEs and Fructose Link

Competency # 20 lifestyles of the Long-lived

Reference: Miller Curr Opin Gastroenterol 2008 Mar;24(2):2004-9 Dietary fructose and the metabolic syndrome;

Jandeleit-Dahm Clin Exp Pharmacol Physi8ol 2008 Mar: 35(3):329-3Date:  2/08

AGEs and AGEs ago we wrote an article with that “pun” about AGEs.  Advanced Glycation Endproducts are an important concept to revisit.  The reason is that they may be the “Holy Grail” of what sets off metabolic syndrome.  Our last article, last year, was how cooking foods over high heat make more AGEs.  I got much negative feedback from many back yard barbeque gurus who can’t stand the thought of eating nothing but minimally boiled meat.  Last week, we accused white carbohydrates as being part of the problem with setting off metabolic syndrome.  But the picture is a bit more complex and I’ll try and share that complexity.

AGEs are what happens to your blood when you have high glucose levels for a long time.  Glucose molecules get spastically attached to protein molecules, without the benefit of an enzyme to attach them in a precise place.  That protein then functions poorly because it’s got an interfering glucose molecule hanging out in the wrong place.  The most famous AGE is hemoglobin A1c. We can measure it in diabetics as an indication that their diabetes is in good control, or out of control. Someone with high glucose, for a long time, in other words, poorly controlled diabetes and really bad insulin resistance (in adult onset diabetes) will have higher and higher Hemoglobin A1c.  But that’s not the only AGE out there.  High glucose results in many glucose molecules getting stuck out there all over the place.  That may happen for several reasons.  Free oxygen radicals (what anti-oxidants gobble up) might be what fires up the glucose to make it more chemically reactive, and then it sticks to just about anything.

The review articles I site above are all about AGEs and the receptor they interact with.  When you block AGE accumulation you reduce vascular disease.  The second article refers to how fructose, by itself, may be the missing link in setting off metabolic syndrome, in which insulin resistance gets started.

Here’s the proposed sequence of ideas that set off metabolic syndrome.  (1.) You eat too much fructose in either table sugar or fully sugared sodas and fruit juices. (2.) That starts you down the road of insulin resistance.  (3.) Once you start insulin resistance, white carbs make your blood glucose build up, (4) AGEs start to accumulate,  (5) proteins get injured with glucoses attached to them, (6) blood vessels get stiffer, (7) blood fats get inflamed and (8)stick to the injured blood vessel, and  (9) we get vascular disease.  For the science works out there, these two articles that explain that sequence caught my eye.

WWW: What will work for me?  The big picture continues to implicate fructose and white carbs, in combination and in excess.  Metabolic syndrome is the disease of the day.  60% of us have it for 20 years before we get a diagnosis of high blood pressure, or diabetes, or heart attack.  If we want to catch it early, and change our risk by our own lifestyle changes, the time is now.  We can reverse it, in its early stages.  So, I put the “Tres Leche” cake leftovers back in the fridge and brought an extra pear to work today instead.  What a good food choice, the natural sugar of a sweet pear instead of unbelievably delicious table sugar.  This is self-righteousness in its purest form. AKA: STOP the SUGAR in any form.  It’s got fructose in it.