Disconnect Seen Between PCPs, Obese Patients

This was the headline of an article I just read this morning in Family Practice News, the April 1, 2010 edition Vol. 40, No. 6. The article itself was on page 5. Basically the article goes on to say that 'Patients want information on weight control, but physicians say they don't have enough training.'

It was very encouraging reading that statement because it is true. We physicians receive very little instruction in the treatment of obesity and what we do learn in medical school, internship, residency and at our conferences is just plain wrong. I received 2 weeks of 'formal'instruction in nutrition in medical school taught to me by an overweight dietitian. I didn't learn the correct way to eat until many years later.

I would go on to add that not only do physicians need more information on the treatment of obesity, but heart disease and type 2 diabetes as well. You see, the common denominator in the treatment of these diseases is the understanding that it is sugar molecules (glucose, fructose, galactose) that the body converts into plaque forming deadly cholesterol and makes us fat. Until physicians are taught this, we will not solve any of the medical problems as delineated above.

I gave a lecture to a small group last night and one of the participants stated her doctor told her flat out that carbohydrate consumption does not increase inflammation in the body. This is false, it does. I bet this same doctor does not understand that cholesterol and fat production starts with sugar molecules, yet, it does.

My point is that when doctor's believe certain things, like what they are taught in medical school, they hold on tenaciously to that belief despite overwhelming contradictory evidence proving otherwise. Beliefs are hard to crack.

We need to start educating our health care providers on the correct way to eat so they can properly educate the millions of patients they collectively see throughout our nation.

dr jim 'the shock doc'

"Tell your doctor his chemistry is wrong, cholesterol and fat are not made from sugar..."

Really? You mean I have it all wrong?

This was a statement said to me by a patient who told his sister to check out my videos (or book, he wasn't sure which one she saw or read); and that was her comment back to him. I would have no problem if this statement was uttered by a layperson, but it turns out she happens to be a pediatrician. This frightened me because as a pediatrician she obviously sees children and if she does not understand the basics of biochemistry she cannot tell the parents the correct way their children should be eating.

Does this scare anyone? It scares the crap out of me and is the reason I so titled my book the way I did.

We have a childhood obesity pandemic, we are seeing diseases we only saw in adults now in children under 10; and this will never change until we start teaching our medical students the correct biochemical approach to eating. We doctors are not the solution, we are the problem and are making it worse.

As I am writing this my Nurse Practitioner saw what I was writing and stated "Well, that makes for an interesting debate?" But I propose that there is no debate. I am dealing with the facts of nutritional biochemistry. It's like debating that 1+1 is not 2, it could be 3 or even 4. Any doctor, nutritionist, or dietitian who thinks that cholesterol and fat production does not start with simple sugars (glucose, fructose) has forgotten their basic foundational biochemistry, period.

You see, it starts with a process called glycolysis which yields a molecule called Acetyl Co A. Turns out, Acetyl CoA is a pivotal biomolecule and can be the starting point for both cholestrol and fat production. Anybody reading this can type in 'glycolysis' in any search box and see the pathway yourself.Then type in Acetyl CoA and see what hits you get. Then review the pathway for cholesterol synthesis and notice what molecule starts the whole process. That's right, Acetyl CoA.

A few weeks ago a good friend of mine Greg e-mailed me because he got into a discussion with a biochemist who told him that cholesterol and fat production does not start with simple sugars. The biochemist, being skeptical not cynical, told Greg he would do a little research and get back to him with his results. After he did his research he notified Greg and stated that he, the biochemist, was wrong and that Greg was indeed correct. The glaringly obvious point is that here's a biochemist who wasn't trained the correct way, even though he studied all the pathways, it just wasn't tied together for him; he had to do that for himself after his 'official' training.

Make no mistake about it, cholesterol and fat production starts with simple sugars. If you do not understand or want to debate me, you are part of the problem, not the solution and you should not be educating people on the correct way to eat!

dr jim 'the shock doc'

OMG!

Ok, so I found out what PGPR was. Remember, it was one of the ingredients in the Land O Lakes 'Light' Butter.

Click Here to read the full description.

dr jim 'the shock doc'

LEAVE MY BUTTER ALONE!!!!!!!

Ok, so I'm shopping for eggs and stuff to eat for today and when I'm grabbing my regular butter my eyes wandered and I caught a glance of Land O Lakes 'LIGHT' Butter. My first thought was, "It feels like it weighs the same to me" but then I went into low carb mode (like when am I not in low carb mode?).

All of us low-carbers already have figured out what 'Light' butter is all about; that's right, just another way to ruin the food by taking the fat out of it. So I'm standing there reading all the information on this psuedo food product and it occurred to me that the continued dietary ignorance just wont stop.

One statement on the packaging was"50% less fat and 47% fewer calories than regular butter." I'm thinking, "Uh huh, good job you morons. First off we need the fat, and second off CALORIES DONT MEAN ANYTHING!!!!." Of course I'm muttering under my breath and the people around me gave me glances like "I think this guy just escaped from some insane asylum" and they quickly scurried away. Scary thing was that most people grabbed the "Light' version of the butter and I just shuddered (yes, scaring even more people away).

So there I am all pissed off in the dairy aisle and what do I do, knowing full well it will send me into a low carb vitriolic tirade; drooling at the mouth, temporal artery visibly pulsating; I go and read the ingredient list....

Ok, so regular butter's ingredients are cream and salt. The ingredients for the 'light' version were as follows, you ready?

Butter, water, food starch-modified, and less than 2% of the following; tapioca, maltodextrin,salt, vegetable mono and diglycerides, lactic acid, potassium sorbate, sodium benzoate, PGPR (emulsifier), xanthan gum, natural flavor, Vitamin A palmitate, and lastly beta-carotene.

Like WTF bigtime, and most people were buying this and would soon be putting this crap in their mouth and eating it. I don't even know what PGPR is (I'll look it up for you), and as far as the rest of the ingredients, I mean come on...obviously another example of profound dietary ignorance.

Do I really blame Land O Lakes? Not really. All they're doing is trying to sell a product and are providing what they think is the, and I use this term loosely, healthier alternative. But this low fat or no fat pseudo food is everywhere; most people think it's the safer way to go and do consume these dangerous foods being masqueraded as healthy on a daily basis.

This is a major problem and is not going away any time soon. Dr. Oz continues with his low carb mantra; the Today show is in love with the writer/editor of the "Eat This, Not That' book and have had this person on their show promoting and perpetuating the "Saturated fat and cholesterol is bad myth' and continue to think that the calorie actually means something in human nutrition.

The last Today Show I saw they were comparing foods and stating which had more saturated fat and more calories and I'm there yelling at the TV, and of course Matt Lauer (spelling?), screaming "Saturated fat is good for us and calories dont mean anything, nothing, zilch, niente', neechavo" wondering if my neighbors could hear me and scaring my poor yellow lab to death. As a side note, there was a show on CNN or some channel like that that was discussing how other cultures eat dog and it is considered a delicacy, and I wondered aloud "I wonder what dog tastes like?"

She doesn't really get too close to me anymore...hmmmm....

Oh yeah, while I'm mentioning CNN they had this Fit Nation segment, of course, espousing all the wrong dietary info. and get this, it was sponsored by Whole Wheat Cheerios; woo hoo, way to go CNN, you should rename your show 'Unfit and Obese Nation.'

Ok, I guess I'll stop this non-sequitor post and leave you with one last question;

So I'm picking up my Mich-Ultra at the distributor and decide to read most of the side labels to compare the calorie, fat, protein and carb amounts of the lite beers. Turns out beer has no fat in it, that is, it contains zero grams of fat. Even regular beer has zero grams of fat in a 12 ounce serving. Most beer had anywhere from 0.5 to 0.7 grams of protein (with Michelob Light the highest at 1.4 grams of protein per 12 ounces, but unfortunately it had around 8 grams of carbs; BTW, dont confuse Mich-Ultra with Michelob Light, the latter has a higher amount of carbs).

OK, so my question is this; If eating, or in this case drinking fat is supposed to make us fat, and there is no fat in beer, then how does one get a beer belly?

I know, I know kinda silly, but it is low-carb food for thought :-)

OK, gotta go. I'm preparing rabbit for tomorrow's Easter Dinner. Yummy...

dr jim 'the shock doc'

Defiance At Its Finest

Ok, so I'm eating lunch with my daughter yesterday when she shares with me that she had a nutritional quiz last week. Of course I'm thinking "Uh oh" and am wondering what kind of questions, or should I say, brainwashing, is going on at the fourth grade level.

Before I had a chance to ask her what kinds of questions they asked her she told me one of them;

The question asked "Pick the healthiest snack from the foods listed below;"

A. apple
B. potato chips
C. cookie
D. ice cream

So what does my daughter do, who btw knows the correct way to eat? She tells me that she wrote an E. under the D. and writes 'none of the above' and circles that as her answer. Yes, the water I was drinking did indeed come out of my nose.

So then I asked how she did on the test to which she happily exclaims "Oh, I failed that one." Then she quickly added that it was a practice quiz and didn't count as her grade. When I asked her what her teacher thought would be the right answer she said 'apple' and then immediately responded that an apple contains way too much sugar and is a dangerous thing to eat as a snack.

You go girl!

So here's just another example as to how my daughter knows more about nutrition than the vast majority of medical professionals.

dr jim

Hypothyroidism and Depression

Here's a few questions/answers on hypothyroidism I just answered today.

1) How prevalent, if known, is depression as a secondary problem to hypothyroidism?

While listed in the textbooks as a common symptom of hypothyroidism, clinically, most depression I see is not associated with hypothyroidism.

When I see a patient with depression one of the first things I do is run routine lab tests. Part of these tests includes a check of thyroid function (TSH,T3,T4). The vast majority of the time the thyroid functions are normal.

Interestingly enough, most patients I diagnose with hypothyroidism do not have any symptoms of depression at all and if they do have symptoms it is usually fatigue.

2) Can hypothyroidism first begin progressing very gradually, and then suddenly escalate?

Yes, it can. We know this by watching the TSH (Thyroid Stimulating Hormone), a hormone secreted by the front portion of the pituitary. A high TSH indicates an under active thyroid gland (hypothyroidism); while a low TSH indicates over activity of the thyroid (hyperthyroidism).

This is counterintuitive to most people, as one would think the opposite to be true. I.e. Low TSH=Hypothroidism; High TSH=Hyperthyroidism.

This is the case as it is the pituitary that is secreting the TSH, not the thyroid. If the thyroid is not secreting its hormones (T4, T3) effectively, the pituitary will know (because it ill see less of those hormones) and will increase its secretion of TSH. If the thyroid is secreting too much T4, T3, this will tell the pituitary to secrete less TSH.

The escalation of hypothyroidism will be seen biochemically as an increase in the TSH. The physician will then increase the amount of thyroid hormone they are giving the patient. The escalation can also be seen clinically, usually as an increase in fatigue, prompting the astute clinician to check the TSH with subsequent manipulation of the thyroid med dose.

3) Must a person take thyroxine lifelong, or can this disorder spontaneously remit?

When dealing with true hypothyroidism spontaneous remission will not occur. I make this statement definitively as hypothyroidism is a result of the thyroid gland losing its ability to make the thyroid hormones T4 and T3. These hormones are made via the modification of a substance within the thyroid known as thyroglobulin.

In the most common type of hypothyroidism known as Hashimoto’s Thyroiditis, the body begins to think the thyroglobulin is a foreign invader and begins to attack it. This is an autoimmune phenomenon as antibodies are created that then destroy the thyroglobulin. If there is no thyroglobulin, the body has no way to make the thyroid hormones. Thus, the only way to get the hormones would be via medication i.e. Thyroxine.

The medication will have to be taken for the person’s entire life.

4) Is the depression from hypo any different from a clinical depression that just comes for no reason, or the type that is triggered by chronic stress?

Yes, it is. Clinically, patients present more with fatigue complaints than with true clinical depression. When a patient presents with classic clinical depression, they are rarely hypothyroid. Even if a patient does have depression with concomitant hypothyroidism, treatment of the hypothyroidism will generally not eradicate the depression. Even though we learn in medical school and residency that we should always think of hypothyroidism when we diagnose depression, it is rarely the case that it is found.

Hope these answers help!

dr jim

Me and Mr Bones, fighting the fight against the medical establisment's dietary ignorance and we will not stop until everyone knows the truth.

Look for me and Mr. Bones March 6th on TV 55 (7:30 am-8:00 am)!

Glyceroneogenesis and Weight Loss

Huh? Lol.

Here was my response to questions posed to me on my fan page in face book.

The Question;

Yesterday, JayCee mentionned something about a mechanism where your body can accumulate or at least not lose fat because of dietary protein intake. I've heard about diabetics having to restrict carbs and protein. If someone is experiencing a weight loss stall while keeping the carbs very low, they should eat less meat/protein, not less fat.

How many grams of protein do you think is too much?

Do you have to use a glucometer to know? Are milk proteins worse than other proteins?

I've heard cheese is insulinogenic. I don't really know what that means practically. Does it mean we should avoid cheese for weight loss purposes?

My response:

Alrighty, finally read through the link as posted by JayCee. Very interesting read. Now I must state at the outset I had never come across the term Glyceroneogenesis, so the article was helpful in defining that term.

Yes, glycerol is the backbone of the triglyceride molecule and once released from the 3, what are referred to as acyl groups (an acyl group is simply one of the fatty acid chains that was attached to glycerol) it (the glycerol molecule) can now be used to make glucose. I knew that glycerol was not created from glucose, but yes, other biomolecules such as amino acids can produce glycerol.

Now let me get to some very insightful questions. Let me just also add that I am absolutely astounded at the depth of biochemical questions coming from non medical people. WOW. I wish the doctors would start asking questions as thought provoking as these are.

Ok, with a weight loss stall one definitely has to lower protein intake. Proteins are made up of amino acids. Amino acids can be either glucogenic, that is, they can be used to make glucose; or ketogenic, and they can be used to make ketone bodies. When an amino acid is used to make a glucose molecule that process is referred to as gluconeogenesis. That was what I thought JayCee meant when I originally read the word glyceroneogenesis.

Now I knew all about glycerol production and degradation, I just never knew they developed a term to define it. So just like gluconeogenesis literally translated means the production of new glucose; the term glyceroneogenesis would refer to the production of new glycerol molecules.

Ok, so back to protein. Yes, one can definitely over consume protein, allowing the glucogenic amino acids to be converted to glucose, this can cause a sugar rise, subsequent release of insulin and that is what is causing your weight loss stall or possibly weight gain. Yes, you can use a glucometer to see if you are consuming too much protein, good call. I’ll often tell my diabetic patients, or my patients trying to loose weight, that if they are consuming low carbs and their sugars are still elevated, or if they cannot loose weight, to back off of their protein intake.

Click on the link to see the glucogenic (and ketogenic) amino acids;

http://en.wikipedia.org/wiki/Glucogenic_amino_acid

Now, here’s where we have to be careful. Let us not forget about that glycerol molecule which formed the backbone of triglycerides. Glycerol can also be converted to glucose, so theoretically on could eat too much fat, create too much sugar, and now your problems start all over again. JayCee’s link was correct in stating that protein consumption, like carbohydrates, can cause a release of insulin at the level of the pancreas. Fat does not tend to do this.

Your next question asked was/is milk protein worse than other proteins. About 80% of the protein found in milk is casein. Now milk is an interesting topic because we humans are the only species that consume milk beyond our infancy; and also the only species that consumes other species milk. In nature, you do not see a calf suckling on a deer teat, or a pig suckling on a cow teat, well, you get my point I’m sure. I have a problem with milk in general because as an adult, we probably shouldn’t be consuming milk in the first place. Many people have milk allergies and this is due to the casein found in milk. Another problem is that some studies have suggested a link between milk proteins and autoimmune diseases, such as type 1 diabetes. I generally tell my patients to avoid milk.

Cheese being insulinogenic? Dunno. Of course we get cheese from milk, which is where the whey protein comes in, and whey is often touted as being a highly absorbed protein, but how would it be insulinogenic. Well, I know some cheeses do have some glucose, also it’s that whole glucogenic amino acid thing all over again; maybe that’s what’s happening. I’ll have to do a little more research on that one.

No, I generally don’t tell my patients to avoid cheese.

Hope that helps and thanks for the great questions!

dr jim

Click here to watch my Ultimate Wellness! shows.

How A Low Carb Lifestyle Has Similar Effects As Aspirin

A question was asked as seen below about low carbs and aspirin;

Do you advise your patients to take a low dose aspirin each day if they are on a low carb diet?

My Response;

Before I start anyone on aspirin I will perform a carotid doppler to check the carotid arteries (the arteries that supply the brain with blood). If there is even mild thickening I will start them on 81 mg of aspirin a day. If there is no thickening and they are on low carb, I tell them not to take aspirin.

The reason I start aspirin on even mild thickening is that a study was performed about 4 years ago (in the Journal 'Stroke') which showed that even mild thickening of the carotids equated with thickening within the smaller diameter coronary arteries, with a subsequent increased risk of heart attacks seen.

Now here's where it gets very interesting from a biochemical perspective. Aspirin works by irreversibly inhibiting an enzyme known as cyclooxygenase. This enzyme creates prostaglandin and thromboxane, two chemicals which act to make our platelets more stickier, hence facilitating the formation of clots. Stop the production of those chemicals, stop the creation of clots.

It's that simple.

Guess what else inhibits that cyclooxygenase thing. That's right, a low carb diet. This is where it gets a little trickier but here's how it works;

When we eat less carbs, we release less insulin. Insulin exerts it's effects on cells by working through something known as the second messanger sytem. One of these messangers found inside the cell contains a molecule known as arichidonic acid. What i didn't mention above is that cyclooxygenase works on arichidonic acid to create thromboxane and prostaglandin. When we eat less carbs we have less arichidonic acid around for the creation of those 2 molecules that make clots. Thus, low carb diets equate with thinner blood so to speak and this is why people on a low carb diet can get away without taking aspirin.

Hope I didn't confuse you.

I guess the short answer is if we are on a low carb diet, we will biochemically create less clots. I should've just said that, but I like the biochemical explanation as well.

dr jim

Here's A Question About Kidney Stones

The question,

If you have a patient who comes in with kidney stones do you have him do a glucose tolerance test or something? I was listening to Mary Vernon and I think she said that high insulin creates calcium oxalate crystals. Did I get that right? Were you aware of this? Its the first time I am hearing this. Thanks in advance!

My response,

If I have a patient who presents with kidney stones the first thing I do is analyze what the stone is made of. There are different types of stones and calcium oxalate is just one type and is the most common. There are also calcium phosphate, cystine stones (due to a genetic defect) and struvite stones.

I dont immediately think of diabetes as a cause of stones, but with the right genetics and the dehydration that results from diabetes, there will be a more favorable physiological environment for the creation of stones.

No, i didnt know of any connection between insulin and calcium oxalate creation, but I wouldnt be surprised if there was. I have treated many patients with kidney stones (the calciun oxalate type) and had them start low carbs, and sure enough, they generally dont have any more stone problems. It's when they start eating more carbs that stone formation becomes an issue.

As I answer your question it becomes apparent to me that another disease can be cured/treated successfully with low carbs. I didnt even put this in my book. There's just so many positive benefits to low carbing that I guess even I forget them all.

Thanks for a great question! Keep the questions coming and have a great day!

dr jim

Here is the Actual Dismissal E-mail from Google

Hello,

While going through our records recently, we found that your AdSense account has posed a significant risk to our AdWords advertisers. Since keeping your account in our publisher network may financially damage our advertisers in the future, we've decided to disable your account.Please understand that we consider this a necessary step to protect the interests of both our advertisers and our other AdSense publishers. We realize the inconvenience this may cause you, and we thank you in advance for your understanding and cooperation.If you have any questions about your account or the actions we've taken,please do not reply to this email.

Sincerely,

The Google AdSense Team

Gee, thanks Google, especially the part where I cannot even question your decision, even though we all know why I was kicked off. How cool is that, Google hates me now.

Will I have any friends when this battle is over? We'll see, and unfortunately for Google my fight has only just begun.

Dr Jim and Mr Bones, Fighting The Fight!

'Your Google Adsense Account Has been Disabled

Apparently I must have pissed off the people at Google Adsense. I get this message in my e-mail with a more detailed message about how it would be in the best interest of Google and the people who advertise through Google to not allow any more advertisements on my wwwdrjamescarlson.com site or through my Blog as well.

Now these were advertisements that were placed on my sites. For anyone who actually clicked on them, they deal mainly with other diets and meds and just other health food products. Funny thing is, most of the advertisements were for diets that just are not right and for products that are a bunch of malarkey.

So why would I allow these ads to be placed on my site in the first place; especially if I disagree with the vast majority of them? Well, why not? Any one who clicked on an add could easily ask me what my thoughts were on a particular product or service; and you have. I felt they stimulated useful dialogue. And most of the time, like I already stated, the product or service was either not helpful and just a waste of money; or in some cases even harmful.

So why shut me down now Google? Obviously someone over at Google, or maybe it was one of their advertisers who actually read the contents of my website or Blog and since I sit at odds with a lot of these useless or even harmful products or diets; they pulled their ads from my sites. I guess Google feared that it would lose millions (billions?) in advertising funds because of me telling the truth.

Am I becoming more popular than I realize?

Hmmmmm...

dr jim

Can Low Carbs Reverse Prior Damage Done to Our Bodies?

Here is another question from my website, and please keep them coming, I enjoy answering them. Just be patient with me because I do receive a bunch a day. Thanks!

The question;

I found you on Jimmy Moores site and you totally make sense! I have gone low carb and am reaping the benefits. Will this lifestyle reverse any previous damage of 30 years of poor nutrition? I was taking HB meds and I had my thyroid irradiated in the 80's and will take thyroid meds forever.

Thanks
60 years young.

My response,

Hi There!

I am so glad you have realized that eating low carbs, and more protein/fat/cholesterol is the correct way to eat. Not only does it make sense , it is the right way for humans, with rare exceptions, to be eating. As far as reversing any previous damage your body may have realized, it all depends upon what damage was done.

Looks like you're off your BP meds, excellent!

Lowering carb intake will have an independent effect on lowering BP, before any major weight loss is even seen. It will also raise your HDL, lower triglycerides, normalize blood sugar, stop any further plaque build-up on our arteries (most notably the coronary and carotids), eliminate heartburn (which will stop any further irritation via acid on the lower part of our esophagus's, within the stomach itself and upon the first part of the small intestine, known as the duodenum), helps to lessen the irritation of many different skin conditions such as eczema, psoriasis, any hyperpigmentation skin problems, will decrease the pain associated with colitis; will help someone with irritable bowel disease become more regular; helps diminish a good part of the inflammation seen with fibromyalgia; can help decrease intraocular pressure seen in glaucoma; will help a woman who experienced problems in a prior pregnancy such as pregnancy induced hypertension, gestational diabetes, preeclampsia to not have those problems in a future pregnancy. Has been shown in my practice to help with Multiple Sclerosis flare-ups and it has also helped my patients with severe asthma to become better controlled on less meds.

So I guess I am right back to my answer as above; it all depends upon what damage was done. Certainly, no further damage will occur once you begin a low carb eating lifestyle change and depending on the medical problems you had, reversal can occur. This is because you have stopped giving the body what was causing the problem in the first place, and are now giving the body what it needs to repair itself, that is, fat/cholesterol and protein.

A great example of reversal of damage is seen in my diabetic patients whose kidneys have been affected by the elevated blood sugar. This is referred to as diabetic nephropathy. In this condition the elevated blood sugar creates subcellular chages, altering the kidneys ability to function. One of the many functions of our kidneys is that of filtration. In diabetic nephropathy, this filtration mechanism is altered and large amount of protein will be seen in the urine. Normally, the urine does not contain large amounts of protein, but since the elevated blood sugars have altered the kidneys ability to filter properly, the protein winds up in the urine. It is also true that when the kidneys fail to filter protein appropriately, this is the first step towards kidney failure and the subsequent need for dialysis.

Now here is where the medical profession's ignorance in nutrition really worsens a diabetics condition. The 'powers to be' especially in this case the American Diabetes Association, your Endocrinologist, your Nephrologist, and anyone with formal training in medicine, thinks that the damge to the kidneys is from increased protein intake, not the sugar (carbs), and will incorrectly tell the diabetic patient to eat less protein not more; and to increase their sugar amount. This will cause more damage to the kidney, accelerate the failure, and congratulations, the diabetic will now require dialysis sooner than later.

In my practice, I have had people with large amounts of protein in their urine (over 1000 in some cases) have their kidney function go back to normal, by greatly lowering their sugar/carb amount and eating more of the very stuff they were told not to eat.

Another example of reversal of disease damage is steatosis of the liver. This is just a fancy way of saying fatty liver. Since the vast majority of medical professionals think a fatty liver is from eating too much fat, they tell their patients to eat less fat/cholesterol which makes this condition worse. Fact is, a fatty liver comes from the over consumption of carbs/sugar, not from eating too much fat. This condition is completely reversible by lowering one's carb intake and, again, eating more of the very things they tell you not to eat, that is,fat/cholesterol and protein. Unfortunately i have a patient right now whose fatty liver progressed to cirrhosis and now she needs a liver transplant to survive. She came to me too late and the very people who were trying to help her, sealed her fate. What's worse, she cant even sue for negligence (not that I promote law suits but this should be one, and yes, I do have a Law Degree), because everyone would agree that what she was told dietarily was correct, when in fact in this case it was wrong, dead wrong.

Hope this helps!

dr jim

PS Oh yeah, welcome to the club!

Enjoy and have a great weekend everyone!

Is it okay to run on an empty stomach?

This was an interesting question posed to me, here's my answer;

The quick answer is, it all depends. If one has not eaten in 5 to 6 hours then it would probably not be a good idea to go running. But then this would all depend upon many things. What was the person’s last meal, are they a seasoned/conditioned runner, do they suffer from any medical problems most notably diabetes, heart disease, high blood pressure.

If the person is already a conditioned runner and does not have any medical problems for which they take any meds for, they could most likely run in the morning before having anything to eat. I have patients in my practice who run first thing in the morning without any adverse effects. But it needs to be stressed they are in shape and are not amateurs to the running world.

Even if the person does take meds for certain medical problems, as long as they gradually built themselves up to the level they are at, they’ll be fine too. It’s all about consistency and continuity.

One very, very important side note. I have had many a patient over my nearly 20 years in the practice of medicine who I have ordered stress tests on who responded back, “Well, I don’t need a stress test, I run 20 or so miles a week; surely if something was wrong with my heart I would know it.” My response is always the same, “When you are running, you are not being monitored like you are on a treadmill in the cardiologist’s office.” And yes, if I had a nickel for every runner that I found out had blockages in their coronaries, due to my gentle but firm persuasion to have a stress test…well, we all know the rest

Now, if one is just starting out on a running routine, they would want to have had a meal at least 2 hours prior to the run. This meal should, interestingly enough, consist of more protein/fat/cholesterol with minimal carbs (carbohydrates). The carbs, contrary to popular belief, will actually make one more tired prior to a run. The carbs in the diet will be stored first as glycogen (muscle and liver) and then as fat, and will also cause a shift in the ratio of sleep inducing amino acids causing the patient to experience the classic ‘food coma.’ Another biochemical fact is that after the glycogen stores are used up, the body has to rely on free fatty acids for fuel (fuel in the form of something known as ATP, our life molecule, we really don’t ‘burn’ anything) and this is what the skeletal muscles and heart will use to function.

Of course the converse of this question would be “Is it OK to run on a full stomach” and the answer would be a resounding no. This is because as we exercise we will shunt blood from the gastrointestinal track to the muscles and this will slow down the digestive process and could cause abdominal cramping, pain and diarrhea.

dr jim

Dr Jim and Bones Fighting the Fight against the Medical Establishment's Dietary Ignorance!

Plaque Builup

Hi Doc,

I just discovered your blog, and I'm liking it very much!

You mention in one of your posts that you want to see a Trig/HDL ratio that is 2 or less, and if it's higher you worry about a plaque rupture until it comes down (enter statins). Can you explain how lowering this ratio reduces the risk of a plaque rupture (as opposed to further plaque build-up)? Also, can switching to a low-carb diet reverse plaque build-up?

Thanks,JW

My answer;

Hi There!

Yes, I want a TG/HDL ration at or under 2 as this equates with a lower relative insulin level in the bloodstream. Now its not so much that this will lower the possibility of plaque rupture, it is more to prevent the further buildup of plaque, which increases the possibility of rupture. More plaque= higher probability of plaque rupture since there is more plaque within the arterial wall, which could rupture.

This goes for all arteries, not just the carotid or coronary.Since the plaque buildup comes from the transformation of sugar molecules into cholesterol, following a low carb diet will not give our bodies what it needs to create the plaque in the first place.

It's interesting that we have no studies which show that the fat/cholesterol in the diet has ever been linked to the plaque buildup within our arteries; but we do have studies that every carbon atom in cholesterol can come from sugar. Also, a review of the biochemical pathways reveals the direct way that a sugar molecule will be transformed to cholesterol.Also, the only thing that I've seen significantly raise the good cholesterol, the HDL, has been the consumption of more saturated fat/cholesterol in our diet.

The whole system, and all the organizations promoting low fat/low cholesterol are so bass ackwards, it'd amazing we all aren't dropping dead from heart disease...oh, wait a minute we are...

Dunno if a low carb diet will reverse plaque buildup, no studies I know about, but it will certainly halt the creation and buildup of anymore plaques and this will be very advantageous for us.

Hope this helped!

Thanks for the questions!

dr jim

Go to Shock Doc to subscribe for free to watch me give the correct dietary advice!

Back to That Calorie Thing.....?

Another question....

Hi, Doc,I read your chapters online the other day and ordered the book from Amazon and got it today. Very interesting, thanks for writing it.

I do have a question about calories, though. You say calories don't count. I follow your explanation on this, it makes sense, and I do understand about the effects of insulin---been reading and doing low carb diets on and off for 12 years. But you must have some handle for judging the amount of total food that anyone needs to eat this way, don't you?

I mean, a woman of 125 pounds is going to eat differently (or should, I expect) than a woman who weighs 225 or 325 pounds and needs to reduce that weight, doesn't she? Or do you simply look at it as, say, eat 50 grams of protein and 20-30 grams of carbs and the fat wherever it ends up that day and everyone eats the same?

Thanks,

My Response;

Hi There!

First off, thanks for reading my book! And yes, you are correct; people of different weights will eat/require different amounts of food, measured in carbs of course, not calories. But here's where it gets weird. A woman who is 200-300 Lbs will actually require more calories, yes, I did say calories (lol) than a woman who weighs less. This is because the heavier woman requires more fat and protein for her physiology than the lighter woman.

Think of it this way. If you weigh, say, 120 Lbs and place another 100 Lbs on your shoulders, you will need to create more ATP (our life molecule) to get you through the day. So it is so with the woman who weighs an extra 50, 100 Lbs or so. Since they are carrying around more weight on their frame they need to create more ATP to carry this extra weight around, which is why the caloric need actually increases in a person carrying around more weight. As the weight comes off, the person will need less and less in the way of protein/fat to get them through the day, and yes, I hate to say it, but now the caloric need lowers.

Since the calorie, unfortunately, is intricately related to protein/fat/carbs; it's hard to stop using that term. And as a quick side note, that life molecule, ATP, will be created from fat/protein (and of course carbs) which is why a heavier person needs more of these foods (with the exception of the carbs), not less (hence the caloric need increases).

But always remember, the calorie indeed means nothing and is misleading, very misleading if a person is obese, that is because they will require more calories, not less, in the beginning of their weight loss quest.

Thanks for the question!

Now go have a steak to start the day off right!

If you haven't done so already, go subscribe for free to my Ultimate Wellness! show on the Internet. Go to You Tube and type in 'shock doc dr james carlson' and enjoy the show!

dr jim

Another Question on My Website...Keep 'em coming!

Hi Dr. Jim,

I've read the first 10 chapters of your book, and would like to find out how I can get a digital copy. I also plan to get a hard copy from Amazon to share with my in-laws, and quite possibly my doctor, who is progressive, holistic, and still not quite on-board with low carb (yet!).

You mentioned in your blog about cholesterol profiles that you would start your patients on a baby aspirin if there was mild thickening on the carotids, which indicates probable thickening on the smaller diameter coronary arteries.

I am 40, and have been back and forth between low carb and the see-food diet (you see food, you eat it), for probably 5 years. I have also been taking a baby aspirin daily for about that long (or nearly daily -- I tend to slack off on supplements when on the see-food diet, ugh).

Should I be overly concerned with coronary plaque, or do you think that I may have headed some of it off with intermittent low carb and the baby aspirin?I have made the commitment for 2010 to go fully low carb, and stay there. No more back and forth. This is a lifestyle change I feel strongly about, and it's time I "git r done."

Also, at some point, would you be willing to do a blog on what effect low carb diets have on thyroid function (if any, good, bad, otherwise)?

Thanks!

My response;

Hi There!

Getting a digital copy is easy. Just send $11.99 to my PayPal account using drjim@drjamescarlson.com as the -e-mail and I'll e-mail a copy right on over.

Ahhh, the infamous see-food diet. LOL.

Being that you've been going back n forth between low carb and not, you most likely have little if any coronary artery plaque buildup. Don't know if you're a smoker or overweight, both of which ten to facilitate plaque buildup; if the answer to those 2 questions is no; I would think you'd have very little plaque on those coronary arteries of yours.

Have you had a carotid doppler? I see no reason to even bother if you start and continue forever on a low carb, more fat/cholesterol/protein regimen. Now lets get r done!

As far as the aspirin is concerned, it is only effective while on it and then for about a week after stopping. Remember, aspirin is a platelet inhibitor, making platelets less likely to stick together forming a clot; so the protective effect only lasts while you are on it. As a side note, you can get a similar effect by taking fish oils. These also make the platelets less sticky and have a vasodilatory effect on our arteries, coronaries included.

And yes, I will absolutely blog on low carbs and it's effect on thyroid function.

Bye for now,

dr jim

A Question About Water and Weight Loss

3) Why is water so important for weight loss?

Actually, it isn’t. The only thing water is important for is to help us stay hydrated. Yes, there are many diets out there or statements in general that claim we must consume anywhere from 6 to 8 eight ounces of water a day. This is fine as it helps prevent dehydration, which helps our kidneys to function, helps to maintain an appropriate blood pressure, provides the aqueous medium our tissues need to allow our electrolytes to work properly (electrolytes refer to sodium, potassium, magnesium, chloride, bicarbonate etc.).

But it must be emphasized that one can consume too much water. Unfortunately we live in a society where if a little is ok, then more is better. I more than occasionally have a patient who I have to admit to the hospital due to water intoxication. In this clinical scenario, the person has actually drunk too much water. When someone over consumes water, it will dilute out and cause a lowering of the important electrolytes as mentioned above.

The one electrolyte that appears especially vulnerable is sodium. When sodium levels are low this is referred to as hyponatremia. This is a very serious condition. The person who is experiencing hyponatremia will present with the appearance of being intoxicated on alcohol, they may have seizures, and they will certainly feel weak and confused. This is a condition that requires hospitalization to correct, and deaths have resulted from improperly raising the sodium level too quickly. A condition known as central pontine myelinolysis (CPM) can occur which is basically a disruption of the central nervous system function, with seizures and death possibly a result.

Now the consumption of water before a meal, it has been said, fills up the stomach, giving you a fuller feeling before you eat. The theory is that if you have a fuller feeling before you eat, well, you’ll tend to eat less. A simple understanding of physiology will help dispel this myth. When we consume liquids, they will pass into and out of the stomach a lot more quickly than solids. This is because some digestion of solids does occur at the level of the stomach, mainly with a protein meal, but the stomach also helps digestion of non protein solids as it has a ‘grinding/mashing’ effect on solid food, helping in the digestive process. The more ‘mashed’ up the solid food is before it arrives at the small intestine, the easier it is for digestive enzymes to work.

Since liquid passes pretty quickly into and out of the stomach, the full feeling does not last all that long and the person will start feeling hungry again, sooner than they thought. And yes, they will most likely overindulge hindering efforts at weight loss. Especially if they're not eating low carbs.

dr jim

Fatty acid and Cholesterol Digestion

Here is my answer to a question proposed to me by a fellow low carber;

Dr. Jim,

You explain quite often how carbohydrates and sugar (whoops, they are both the same!) are processed in the human body. Could you explain how dietary fat and cholesterol are processed in the body?

Also, is Ultimate Wellness still on the air? I hope the link did not change.

Thank you for all that you are doing to promote proper nutrition!

My response;

Hi there!

First off, yes Ultimate Wellness! is still on the air, but the format has changed. It is now a free subscription and the segments are much shorter, 6-8 minutes to be precise. There will be about 1-3 videos per week. Go to http://www.youtube.com/watch?v=sfvdJVrQ1ZA to subscribe and watch the first video. As always feedback is greatly appreciated!

Yes, I do talk alot about carbohydrate digestion, so lets talk a little bit about fat and cholesterol digestion :-)

Fats are found as triglycerides in most of the foods we eat. A triglyceride is simply 3 fatty acid molecules all linked to another molecule known as glycerol. So when we break down a triglyceride we wind up with 3 fatty acids and a glycerol molecule. The fatty acids can be used for the production of ATP or stored as fat, and this is all dependent upon how much sugar was consumed with the fat. If we eat alot of carbs with a fatty meal, the body will store not only the carbs as fat, but the triglycerides as well. If the fat is consumed with very little to no carbs, it will be utilized for the production of ATP, thus, it will not be stored. Notice how I am refraining from using words like 'burned for fuel' or other words which imply a combustion process.

Always remember, digestion is not a combustion process. It is a controlled process which creates our ultimate energy molecule, ATP, with the release of CO2 and O2 in the process. This is why the calorie is irrelevant. Calories are determined via a combustion process, not a digestive process, so it is ok to ignore them.

Now what happens with cholesterol in the foods we eat?

Cholesterol digestion is different as it is not digested in the true sense of the word, the molecule isn't broken down like carbs, fats or proteins; cholesterol is already in its most basic form. Remember that carbs are broken down into sugars (the most basic part), proteins are broken down into amino acids (its most basic part) and triglycerides are broken down into fatty acids and glycerol.

The cholesterol molecule will be encapsulated by bile acid pigments in the small intestine and transported to the liver where it can meet many fates. Since cholesterol is a type of fat, a sterol to be precise, it cannot be transported in our blood stream without a carrier molecule. This is because our blood is more of a watery (aqueous) environment and we all know that fat and water dont mix. Without these special carrier molecules, cholesterol would just all clump together (as would triglycerides which also need a carrier molecule, known as chylomicrons and VLDL) and it couldn't get anywhere in our body. The carrier molecules for cholesterol are referred to as the HDL, LDL and the lessor known IDL. Adding all of these carrier molecules together is how we derive our total cholesterol.

Now I stated that the fats in the foods we eat will either be stored or used for the production of ATP. So what happens to cholesterol after it gets to the liver? It can have many fates. It can either be carried out of the body via the stool; it can be used to create steroid hormones like estrogen, testosterone, progesterone, bile acid pigments or cortisol etc; it can be used to turn off the very enzymes that make cholesterol that is HMG Co-A; it can diffuse into the nucleus of the cell and attach to RNA, DNA and turn off the very creation of the enzymes that make cholesterol.

Another thing I have seen with increased cholesterol consumption is an increase in the amount of HDL circulating in the blood.

Hope this helps!

Thanks again for the questions!

dr jim

Here's My Answer to a Great Question On Insulin Resistance.

Hi Jim

I have heard that the body can repair itself by creating new cells etc.

Is the same true for insulin resistant cells ? Can they be fixed or even better, automatically be replaced by NEW non-insulin resistant cells ?
regards

JayCee

My answer;

Hi JayCee!

In insulin resistance, there is an increase in the amount of insulin circulating in the blood. Due to the increase of insulin in the bloodstream when the insulin gets to the level of the cell, there is a down regulation of the insulin receptors. All this means is that since the cell is seeing alot more insulin than it should the cell says to itself-"Hey, I don't need all these receptors cause I got alot of insulin around me" so the cell starts decreasing the amount of receptors.

If the insulin levels remain high, and it will if the person continues to consume carbohydrates, there will be such a dramatic decrease in insulin receptors, that the body will then see a rise in circulating sugar. It is at this point, with the rise of blood sugar due to extracellular insulin receptor downregulation, that the person now becomes a type 2 diabetic.

This process is completely reversible in most people. How, by just starting them self on a low carb regimen. I see this in clinical practice all the time. The current thought is that one needs to be obese to be insulin resistant. This is not true. It is insulin resistance which occurs first, then one has the propensity to become over weight.

In fact, elevated triglycerides are due to insulin resistance at the level of the adipocyte (or fat cell). Normally, an adipocyte in the presence of insulin will increase its storage of triglycerides. But if the adipocyte is resistant to insulin, this cannot occur and the cell will start to breakdown triglycerides and this will cause a rise in the fat level in the blood.

Yes, cells have a lifespan, so the insulin resistant cells will eventually die off to be replaced by new ones. If the high insulin levels have not been corrected, for instance, the person is still eating too many carbs, these new cells will not manufacture enough insulin receptors to correct the problem.

Now, if the person is fortunate enough to have the proper dietary advice, the insulin level will fall, receptor up regulation will occur, and then there will be enough insulin receptors now to correct the problem.

So, yes, this whole insulin resistant, metabolic syndrome, obesity, CAD, type 2 diabetes etc can all be CURED by avoidance of carbs. And yes, I used the word cured...

And yes, another great question from JayCee!

Hey, JayCee, do you just like stay up at night (or for me it'd be the morning) and think these questions up? LOL.

Have a great day my friend!

jim