SO MANY WAYS I CAN RESPOND TO THIS; AHH, LET ME COUNT THE WAYS...

High Fruit Low fat is the way to go. This man is a nutcase. Our body runs on simple sugar.
All the don't eat list he mentions is correct: Refined starchy carbs. But then he puts fruit in with that. And he recommends a high fat diet that means you will get high blood sugar because your blood is full of fat and it prevents insulin from working. He is insane.

 

 

This comment was posted in response to a presentation I gave in Northwest Indiana. Click Here to Watch. My immediate reaction was that this is exactly what most people out there believe. We, who understand the correct way to eat, never can forget there are still many people out there who believe what this person wrote. It is up to us, my fearless low carb warriors, to continue our crusade fighting the establishments. I could respond to these profoundly ignorant statements and ad hominem attacks with my biochemical wit, but it's just not worth my time. 

 

Oh, Natalie and Saicho, I didn't forget about you. Quick comment, benign dietary ketosis is just that, benign. This goes for our children as well. Doctors often confuse benign dietary ketosis with diabetic ketoacidosis, an entirely different and very dangerous and deadly physiological event. Full comments on ketosis to follow.

 

from your nutcase and insane....dr jim :-) 

 

 

 

 

 

Another Diabetic Discussion

I'm currently involved in training as part of a Care Management team approach, which will help prepare me for the implementation of the Patient Centered Medical Home. This is the concept that...wait for it...wait for it....physicians actually ask the patient what we as clinicians can do to help them care for themselves better. Call me crazy but doctors are actually being taught they have to talk to their patients and then really, truly actually listen to what they have to say...A concept whose time, ummmmm, should've already come.

This weeks discussion was on diabetes and I had alot to say, but kept it short, for, uh, brevity's sake. First off, who is brevity and second off, it wasn't short....

Enjoy!

Remember, my blog posts are for informational purposes only and are not intended to diagnose, treat or cure any diseases. However, they are intended to hopefully eradicate the nutritional ignorance of the medical profession...

Diabetes Forum;

As a family physician with a profound concern for the diagnosis and correct treatment of diabetes, and having been directly involved with the management and care of thousands of diabetics over my 20 years of practice; I can state without reservation that the current standards of care for diabetics is wrong. Unfortunately, organizations like the American Diabetes Association, American Dietetic Association, American Heart Association, American Cancer Society, the National Institutes of Health, the National Heart Lung & Blood Institute, the Surgeon General, TV personalities such as Dr. Oz and even the White House’s new My Plate campaign, all have it wrong as far as the correct way to eat is concerned.

My direct clinical experience has taught me that in order to correctly treat diabetics, carbohydrate  (carb) restriction is mandatory. The current ADA guidelines recommend that diabetics go no lower than 139 grams of carbs per day. This is wrong. Experience has shown me that when I reduce the carb count to 20 to 40 grams of carbs a day, dramatic sugar control becomes immediately apparent. Yes, you read that correctly; I did state that I reduce my diabetic pt’s carb intake to 20 to 30 grams a day.

This reduction is simple in a newly diagnosed Type 2 diabetic who is not on any medications; but if I get a diabetic already diagnosed on meds, the clinical approach needs to change. For instance, if I see a diabetic who is on insulin (and this can be a type 1 or 2 ) and I get the impression that they are serious about lowering their carbs to help lower their meds; I will immediately stop any short acting insulin (e.g. Humulog) and cut in half the long acting insulin they may be on. Also, meds like Byetta (a hormonal incretin analog which increases GLP-1 secretion) and Januvia (a dipeptidyl peptidase type 4 inhibitor which allows incretin analogs to stay in system longer) will be stopped as will any sulfonylurea (e.g. glimeprimide and glipizide, which work by stimulating an already fatigued pancreas to secrete more insulin hence facilitating B cell burnout and the eventual need for insulin).

The insulin can be stopped and adjusted and the meds can be d/c’ed because once a diabetic reduces their carb amount these meds are no longer needed. I have a big issue with any Type 2 being started on any sulfonylurea due to their mechanism of action. As a side note, if anyone has seen the black box warnings on sulfonylureas it includes ‘increased risk of cardiovascular mortality’ and that it ‘should not be used for prolonged therapy,’ a fact that most clinicians have either forgotten or had no idea about, because I still get diabetics in my office on these meds; usually for many years.

Getting back to adjustments and d/cing of meds, when one dramatically lowers their carb intake there will not be a large increase in post prandial serum blood sugar; therefore the short acting insulin (which is used to lower post prandial blood glucose) will not be needed. Meds like Byetta & Januvia also work by helping lower postprandial blood glucose and they will not be needed as there will be no large increase in post prandial blood glucose because of the carb lowering. The most dangerous of these meds are the sulfonylureas. These meds need to be stopped immediately once a pt implements low carbs. This is because the sulfonylureas will continue to force the pancreas to secrete insulin, irrespective of the blood glucose readings and dangerous life-threatening hypoglycemia can result. I have counseled many a pt who started a low carb regimen on their own, without stopping the sulfonylurea, and subsequently woke up in the hospital after their syncopal event. What’s even worse is that the ER doctor or nutritionist who sees the patient tells the patient they should never have lowered their carb intake; not understanding that is the wrong approach and the pt should have stopped the medicine, not increased their carb intake. Why? Because the pt was no longer consuming large amounts of carbs and does not need the med any longer. This would also be true of Byetta, Januvia, and short acting insulins.

Let’s take some time to discuss insulin and its role in the treatment of diabetics. There are four types of diabetics; Type 1 DM whose pancreas’s no longer can make insulin so they need to take it exogenously; the Type 2 DM whose pancreas is actually hyper-secreting insulin and represents the most common type. This hyper-secretion can go on for years which is why eventually the B cells can burn out (a process facilitated by sulfonylureas and assuaged somewhat by the use of exogenous insulin). This hyper-secretion is also the reason the cellular insulin receptors become resistant due to receptor down regulation as one of the contributors; and this is also the main reason we should never, ever use a sulfonylurea to treat a type 2 diabetic, as their pancreas is already overworking and these meds facilitate its demise. There is also a less recognized type of diabetes known as type 1 and a half or type 3 diabetes. This type of diabetic is one who is insulin requiring, but now has developed resistance to exogenous insulin, a situation we are seeing more of as more clinicians are using insulin in the initial treatment of even type 2 diabetics (a treatment I do agree with but with some caveats). The fourth type is gestational diabetes and these pts do very well with carb restriction which is safe in pregnancy, so long the pt is eating more fat, cholesterol and protein. Some authors have argued there are at least two more types (drug induced diabetes as one sees with steroid use and Juvenile onset type 2 diabetes, which is self-explanatory) but for brevity’s sake we’ll limit our discussion to the 4 types above.

Now let’s get back to insulin. We all learned in nursing or medical school that insulin helps to lower serum blood sugar. This is done via a second messenger system specifically the Inositol 1-4-5 triphosphate, e.g. IP3 and the diacylglycerol or DAG molecules. This fact was learned when we took biochemistry but unfortunately was quickly forgotten. Analyzing this second messenger system further and looking specifically at the DAG molecule, we need to note that one of the ‘acyl’ groups is arachidonic acid which when metabolized releases pro-inflammatory mediators (Click Here for more on Arachidonic Acid). It is these mediators that can and do cause a cellular apoptosis. What’s even more of a concern is that some of these mediators have been shown to be oncogenic. The possible end result of allowing our cells to see too much insulin is the eventual death of the cell. Said another way, not only does the elevated blood sugar cause cellular damage, but so too insulin can cause cellular damage or death (culminating in organ damage) and this is a point missed by most clinicians. Therefore I disagree with the intensive insulin therapy and do agree with lowering the carb intake in our 60 yo female pt.

While some may be thinking it difficult to lower the carb intake so strictly, I must state that the majority of my patients are very happy to have this option to treat, an option too few doctors even know about. As far as motivational interviewing is concerned it really is a treatment that sells itself. Most pts do not want to take meds and they especially do not want to take insulin as this requires a needle. I have successfully treated thousands of diabetics with a low carb approach with success nothing short of miraculous. The only problem is that most clinicians, dieticians, nutritionists, and politicians do not even understand the correct way to eat.

I want to get back to insulin a little while longer because it is such an important hormone to understand. When a healthcare professional is asked to describe the effects of insulin secretion, all will correctly state that it helps lower serum blood sugar; but insulin has many more effects biochemically which I want to discuss further, as it directly affects diabetes care. Insulin also increases the activity of HMG Coenzyme reductase as well as acetyl Coenzyme A carboxylase. The first enzyme catalyzes the rate limiting step in cholesterol biosynthesis; the second enzyme catalyzes the start of the biosynthesis of fatty acids. Therefore, any increase in the secretion of insulin which occurs via the consumption of carbs, will also increase the biosynthetic rate of both cholesterol and fatty acid synthesis. The end result is progression of atherosclerosis, elevation of triglycerides, lowering of HDL, and increases in weight all of which contribute to the manifestation of ‘the metabolic syndrome’ which culminates in development of overt type 2 diabetes. In fact, the treatment and reversal of not only type 2 diabetes but of the entire metabolic syndrome is so easy; it should be an embarrassment to the medical community that we haven’t been able to do this yet on a widespread scale. As a side note, there is a website that lists doctors who understand the importance of low carbs in the treatment of disease, just go to LowCarbDoctors.com

Now it is easy to say we need to dramatically lower our carb intake to experience better and ultimate sugar control, but we aslo have to analyze further what exactly carbs are and this is where it can become controversial. Everyone knows that cakes and candies are bad for us as well as the white starchy foods; but what about whole grains, muti-grains, whole wheat pasta, brown rice, yogurt, oatmeal and fruit? Are these foods safe for a diabetic to eat? Well, let’s analyze those foods further. Diabetics are often told that they can eat whole grains and the like, and that fruit is fine to eat too. This is false. Whole grains are complex carbs and as such contain many sugar molecules (one grain contains 6 x 10 exponent 1017 molecules which is a 6 times 10 to the 1017 power!) and one slice of whole grain bread may contain even more carbs (even after subtracting the fiber) than its white counterpart. The body will break down these complex carbs into simple sugars and that’s where the trouble starts. One may not see an immediate rise in blood sugar for an hour or so after consuming complex carbs, but it will happen if one keeps checking blood glucose levels. Another side note is that blood sugar should always be normal, it should never be elevated. This sounds like a tautology but let me explain further. I use a normal range of 80-100 and I warn my diabetics they should always be in that range. That any increase in blood sugar will create cell damage and is dangerous to their organs. I am confused as to why the ADA allows a post-prandial increase in blood sugar and considers this to be ‘normal.’ It is not and any rise above 100 should be evaluated. In fact, I tell my patients who are going to get their labs drawn to not fast, as fasting is cheating and changes the blood chemistry into what it truly isn’t and we want to see what the blood normally looks like. Another fact is that a simple 6 hour fast (and a lot of clinicians tell their pts to fast 12-14 hours) can normalize blood sugars and triglycerides, and the clinician will not know a pt is over consuming carbs and cannot counsel the pt effectively. Another reason blood sugar should always remain normal is that the attachment of glucose molecules to cells in our organs occurs via a nonenzymatic pathway, referred to as nonenzymatic glycosylation. What this means is that glucose attaches to the cells in a concentration dependent manner and no intermediaries are needed for this to happen. This glycosylation process is what leads eventually to end organ damage and the only way to prevent this is by having normal blood sugars all the time.

Getting back to the whole grains (and this goes for any grain, oatmeal etc.) once they are metabolized to simple sugars, insulin will be secreted form the pancreas and this will facilitate persistent insulin resistance as well as increase the biosynthesis of cholesterol, free fatty acids, help to lower HDL, encourage weight gain, & create pro-inflammatory mediators via the second messenger system. This cascade of events will occur with any glucose molecule. The glucose released from complex carbs is not ‘special’ in any sense. To think that at the level of the cell a cell can ‘recognize’ a glucose molecule as being from whole grains, oatmeal, white starchy food or a chocolate bar is wrong. Cells are not cognizant of where a glucose molecule comes from, they just do biochemically what they’re programmed to do when glucose enters them; make us fatter, create plaque forming deadly cholesterol and of course elevate blood glucose serum levels.

And now a word about fruit. I tell my diabetics that fruit is a poison and they should stay away from it. Any diabetic who actually checks their blood sugar level after eating fruit knows this. I am utterly confused as to why the organizations as delineated above refuse to understand this. Another biochemical fact is our cells use both glucose and fructose to make cholesterol and fat and that fructose is actually transformed into cholesterol & fat faster than glucose. This means that when one eats a piece of candy and piece of fruit, the fructose in the fruit will be converted more quickly into fat & cholesterol, than the glucose in the piece of candy will be. This is a biochemical fact. Why? Quite simply because fructose enters the glycolytic pathway about a third of the way in and needs to be modified less than glucose. So, no, diabetics should not be eating fruits as allowed by the ADA guidelines.

I want to take time out now to dispel a few myths about glucose. Glucose is not the primary energy source of the body. I know this is a controversial statement but let me explain further.  The fact is that our skeletal muscles, renal cortex and myocardium all prefer free fatty acids for fuel, not glucose. Also, when given the choice the brain prefers ketone bodies for fuel over glucose. Interestingly enough, the breakdown products of fatty acid metabolism (in a process referred to as beta-oxidation) are ketone bodies. Another interesting point is that some will claim that the only way glycogen can be stored (in the liver and muscles) is by the consumption of carbs, which allows glucose to be stored as glycogen. This is not true. We can also make glucose from the glucogenic amino acids as well as the glycerol backbone chain found in triglycerides. The utilization of free fatty acids for energy comes from shuttling 2 carbon acetyl fragments into the Kreb’s cycle then onto the oxidative phosphorylation pathway, not by creating glucose (this is the beta oxidative pathway).

Another misconception I wish to clear up is the whole ‘burning of fat’ or ‘burning of calories’ notion. When we catabolize or breakdown macronutrients (fat, carbohydrates or protein) this is not a combustion process, it is a digestive process. For example, the breakdown of carbohydrates begins when a carb is ingested. If it is a complex carb, it will be acted upon by different enzymes (mono & disaccharidases) to release a glucose molecule(s). This glucose molecule will then enter the cell and be shuttled into the glycolytic pathway. The end result of this pathway is the creation of a molecule (actually 2) of pyruvate which then will be transformed to Acetyl CoA. I often refer to Acetyl CoA as a pivotal biomolecule because its fate depends upon how much carbohydrate one has consumed. If there is an overabundance of carbs ingested, the Acetyl CoA will be shuttled into the cholesterol and fatty acid biosynthetic pathway. If there is not an overabundance of carbs consumed it (Acetyl CoA) will then move into the Kreb’s cycle and then finally into the oxidative phosphorylation pathway (the final step in the oxidation of glucose.) It is important to stress that nothing is burned because it creates a misunderstanding of what really is happening biochemically. Glucose is metabolized to create either ATP (the energy currency of our bodies) or is used to make cholesterol or fat, there is no actual burning. The same is true of fat and protein digestion, they are not combustion processes. This is so germane to a diabetic (and anyone) because we are told to count calories. This is wrong. We often hear the phrase ‘I need to burn up my calories,’ and this, too, is wrong. We are not burning any calories or fat. We metabolize fat, protein and/or carbs to either create biomolecules and/or to create ATP. Again, there is no combustion going on here.

Now the process to determine how many calories are in an item of food is indeed a combustion process. We’ve all come across the calorimeter; a cylindrical metal device containing water, a thermometer, a lid and a heat source. To determine the amount of calories we simply place an item of food inside, heat it to reduce it to carbon, and record the temperature rise of the thermometer. The temperature rise is how we actually measure calories. In fact, the definition of a calorie takes all this into account; i.e. a calorie is the amount of heat needed to raise the temperature of 1 gram of water by 1 degree Celsius. All this is very important to understand when caring for a diabetic. Only by realizing that the calorie is irrelevant in human nutrition, that the burning of anything from a nutritional standpoint is a fallacy, can we better care for our diabetics. The bottom line is that we need to be counting grams of carbs, not calories. Also, by focusing on calories and suggesting they be lowered, will often deprive the pt of important sources of fat & cholesterol in the diet.

With this introduction I will now move onto the questions for this week’s forum;

1)    What might you assume is causing the patient’s blood sugar variability?

We have here a 60 yo female suffering from diabetes for 8 years, stated as non-compliant, with concomitant diagnoses of CVA, HTN and depression; she’s also stated to be ‘maxed’ out on oral meds. My first encounter with this pt would consist of an in depth discussion with the pt about her diabetes, determine exactly why pt is experiencing difficulty with blood sugar control and ascertain how much her depression contributes to her ‘non-compliance.’ I put non-compliance in quotes because I have seen many a pt whose sole reason for non-compliance was a lack of understanding about their disease and not a voluntary attempt to disregard the advice of the physician or nurse.

I would also address the 2 other medical conditions (HTN & CVA) and discuss with pt that many people experience depression with having only one medical condition e.g. diabetes, but she is dealing with 2 more, greatly increasing her risk for depression. I would then add that many pts can get depressed from the simple act of taking meds on a daily basis; this increased risk of depression (& frustration) increases the more meds one has to take. It also needs to be ascertained exactly what type of CVA pt suffered and if (depending on area of brain involved) the location of CVA is contributing to depression e.g. deep limbic system, pre-fontal cortex, anterior cingulate gyrus, basal ganglia &/or temporal lobes. It should be noted that evidence based studies have shown antidepressants to be ‘modestly beneficial’ with ‘adverse events significantly more common.’ (Hackett, Anderson, House; Cochrane Database Syst Review 2008.)  Also, psychotherapy was shown to have ‘no evidence of benefit.’ (Ibid). Another trial revealed ‘that a care management program, which included depression education, antidepressant treatment guided by algorithm, and monitoring of therapy was more effective than usual care’ i.e. discretionary use of antidepressants. (Stroke. 2007;38(3):998) Further studies go on to state an ‘eight-week psychosocial-behavioral intervention plus antidepressant therapy was superior to antidepressant treatment alone.’ (Stroke. 2009;40(9):3073) With all this conflicting data it is easy to see why the treatment of depression of this pt that’s post-CVA can be a challenge. That said, a care management approach, which is exactly what these tutorial sessions are teaching us, appears to be the best approach.

After discussing with pt her individual med conditions and assessing where her knowledge base is at, I would then go over her medications with her, again asking what she takes and how she takes it. For my own edification, I also review the med list from a pharmacodynamic and pharmacokinetic perspective.

The med list appears to only list the diabetic meds and it immediately became apparent to me that meds the pt may be taking for her HTN or CVA could be contributing to her depression; for brevity’s sake I will only focus on the diabetic meds. The first med listed is metformin. This is a safer med for diabetics to take as its mechanism of action is to help increase a cell’s sensitivity to insulin and also decreases gluconeogenesis in the liver; this has the effect of more effective utilization of circulating insulin and diminished ‘dumping’ of blood sugar into the serum. This is a medication that does not (usually) cause a precipitous drop in blood glucose, so I can safely allow my pts to continue this drug when starting a low carb regimen. Both glimeprimide & glipizide are sulfonyl ureas and stimulate an already overworked pancreas to secrete even more insulin. As mentioned above, but it bears reiterating, this will have the effect of increasing insulin resistance (despite the package insert’s contradictory comments), increasing the likelihood of beta-cell burnout, increasing the intracellular production of both cholesterol & triglycerides (which directly increased cardiovascular morbidity & mortality), increasing cellular apoptosis via the use of the second messenger system, and slowing down and/or preventing weight loss by its inhibitory action on hormone sensitive lipase; this is not an exhaustive list but I will stop here.

Now the next 2 meds, Byetta and Januvia are an interesting combination and it appears the prior physician was using them for their complimentary actions. Januvia was the dipeptidyl peptidase type 4 inhibitor which interestingly enough,  would prevent the Byetta from being metabolized, allowing Byetta to exert its physiological effects longer (increasing glucose dependent insulin secretion, decreasing glucagon secretion, slowing gastric emptying…) As a side noted, studies have shown Byetta to reduce the HgA1c by 0.5-1%,( immediate release) to 1.5-1.9% (sustained release), which would reduce our pt’s HgA1c to 12.0 (sustained release), which is a negligible lowering of average blood sugar. In addition, post-marketing studies have shown increased risk of pancreatitis with Byetta use.

After review of her med list. I would immediately begin counseling on carb counting and would gauge pt’s motivation for starting. If I sensed she would seriously consider starting to lower her carbs, I would stop the glimepiride, glipizide, Byetta and Januvia.

I agree with the start of Insulin therapy, but I would need clarification of what ‘intensive insulin therapy’ means. The orders do not reveal if we are adding Insulin in addition to or are we eliminating any meds once starting insulin? These orders immediately reminded me of a study I read a few years back which suggested that tight HgA1c control (<6 .5="" 3="" about="" all="" am="" amp="" and="" answer="" as="" associated="" be="" better="" blood="" bolt="" came="" certainly="" death="" disease="" end-organ="" equates="" finally="" greater="" i="" in="" into="" less="" me="" morbidity="" morning="" mortality.="" of="" one="" over="" read="" regulation="" researchers="" sat="" seeing="" so.="" so="" study.="" study="" style="mso-bidi-font-style: normal;" sugar="" sure="" t="" taught="" that="" the="" this="" tissue="" to="" upright="" was="" wasn="" we="" were="" weren="" why="" with="" would="">the increased morbidity & mortality was not due to the tight control of the HgA1c

, it was due to all the meds the pts were on to get the HgA1c lower. The pt’s blood sugars were not being controlled through the correct way to eat, but through the use of these medications and the pts were suffering because of this.

Getting back to my pt, I would stop the meds as described and start solely on long acting insulin (assuming pt allows), and yes, using the pens makes it much easier (some insurances wont allow), discuss the importance of low carbs, and have the pt call my office on a daily basis with blood sugar results. Now some may immediately become concerned at me stopping 4 PO meds and starting on just long-acting insulin stating (correctly) that the pt’s blood glucose will almost certainly rise. That is correct, but it is OK. Hypoglycemia is more dangerous in the short term than hyperglycemia, so I’m ok allowing my pt to run a little higher as we figure out the correct dose of insulin. Another couple points about insulin. Once we take more than 20 units at once (some authors say 10 units), there can be erratic absorption so it is best to ‘split’ the dose above, say, 30 units; i.e. give 20 units SQ in one area and 10 units SQ in another. Also, we run the risk of creating more insulin resistance by using increasing doses of insulin; thus the pt runs the risk of developing type 3 diabetes. This is where metformin is helpful because it helps maintain insulin sensitivity.

In 1 week pt will return with both a sugar and food diary (remember she was in contact with me daily all week) and we will discuss the results.

As far as what’s causing the blood reading variability, it is because pt most likely received inadequate diabetic teaching (or more importantly, the incorrect diabetic training) and may possibly be ‘afraid’ to use the insulin; this is why it’s important to have pt come back with not only a sugar diary, but a food diary as well and we would want to ask exactly how she is taking insulin.

Looking at pt’s labs reveals a diabetic nephropathy as microalbuminuria is elevated with an elevated Cr. I would like to stress that the correct approach is to not restrict protein intake, but encourage increased consumption of protein, fat and cholesterol and to lower the carb intake. What is happening in diabetic nephropathy (as well as all the other end-organ damaging effects) is that the aforementioned non-enzymatic glycosylation is occurring at the glomerular level and this impairs the filtration mechanism of the nephron. This impaired filtering mechanism, with the subsequent increased proteinuria, is not from the consumption of protein, but from the overconsumption of sugar. Eating more protein will not create more kidney damage as is commonly thought. In fact it’s beneficial. I have seen microalbuminurias in the 100 range (highest 800) revert to normal upon eating the correct way. This is a reversal of the nephropathy. In addition, other end organ damage (eye and nerve) can also reverse when a pt begins to eat the correct way. A quick note about the lipid profile; the triglycerides are elevated. These will also lower once the pt lowers their carbs and begins to eat more fat, cholesterol & protein.

2)    What would your next steps include in care-managing this pt?

A full discussion of diabetes including the correct way to eat; recommended reading: my favorite is Dr. Bernstein’s Diabetes Solution by Richard K. Bernstein (2007).; I would have anyone on my care management team read this book and keep it as a handy reference; training of my support staff as to the correct way to eat for counseling our pts….

I have so much more to say, but I think this is a good primer for continued study J

OOPPS !!!! I DID IT AGAIN!

Yes, I did, much to my chagrin.....So we're eating these delicious MISSION CARB BALANCE 'Whole Wheat Tortillas' when my wife starts to read the ingredient list....and we can all guess where this is going... "Jim, what's interesterified soybean oil?" Yes, the tortilla I was currently masticating fell out of my mouth (but I managed to save the meat part)....

"Goshdarnit!!" I exclaimed. And yes, I really did say goshdarnnit...I immediately recognized that type of soybean oil as I had done a radio show on it a few years back. Interesterification is a process that switches around the fatty acids on a triglyceride molecule. Remember that a triglyceride molecule contains 3 (the tri part) fatty acids connected to a glycerol backbone chain. These fatty acids are connected to the glycerol backbone chain through what are known as 'ester' linkages; hence the 'ester' part of inter'ester'ification. Now, vegetable fats generally have specific fatty acids at the 1 and 3 position of the glycerol backbone (stearic & palmitic which are saturated) and an unsaturated fatty acid (oleic or linoleic) at the 2 position. The interesterification process will remove the # 2 fatty acid and replace it with a more saturated one.

Ok, I can hear some of you saying "So what's the problem with that? Now you have a triglyceride that's completely saturated and haven't you been saying all along Dr Jim that saturated fats are better for us than mono and polyunsaturated?"

Yes, you are correct in your understanding that saturated fats are the safest & healthiest fats to consume (I can hear the gasps of incredulity from anyone new reading my Blog who doesn't understand the correct way to eat; and btw, I broke 45,000 views this month, woo hoo, there goes my ego again....or is it superego....or the id? Aw heck, what did Freud know anyway...:-)

Ok, so back to that newly created saturated fat from the interesterification process; the first problem is that we are creating a fatty acid that our bodies may not have seen naturally before. What this means is that like trans fats where our bodies do not have the necessary enzymes to break them down, resulting in the buildup of free radicals; so too is my concern that we may not have the necessary enzymes to break down this 'new' fat created by the interesterification process; will this result in the creation of free radicals as well?

There have been studies looking at the effects of the interesterified fats on human blood chemistry and while the number of subjects were low, the results were cause for concern. One study revealed that the HDL (our good cholesterol) lowered and that insulin levels dropped dramatically causing blood sugars to raise by about 20%. It is important to note that this study looked specifically at postprandial blood levels not fasting blood levels (postprandial simply means after eating). Other studies revealed no changes in blood sugar, but this study was reporting the effects on fasting blood sugar only. Now it needs to be stressed that fasting blood levels do not truly reveal what's going on in our bodies. Labs analyzed after a 12-14 hour fast do not reveal the true biochemistry of our blood; it is what I call cheating. We should always measure non-fasting labs if we want a true idea of what is really happening in our bloodstreams.I immediately recognized that fact when I saw the researchers had performed the analysis under a fasting state, this is not telling us what is really going on with our blood biochemistry.

If all of this isn't enough , a quick review of how an interesterified fatty acid is created should be enough to scare the fecoliths out of ya.... This is, once again, a highly industrialized process using bleaching detergents, carcinogenic solvents, dangerous metallic alloys, and deodorizing. This last step, referred to as deodorizing, can actually cause trans fats to appear in the mix; ummm, not good.

So the moral of this story is please read your side packaging ingredient list; you'd think I would've learned my lesson with the whole Green Giant debacle....And no, I'm not eating the rest of those tortillas. An interesting side note is that not all Mission low carb wraps have the interesterified fatty acids; so again, my mistake was that I assumed that because I had read through the ingredients before and didn't see partially or interesterified fats, that I was ok......and let's all remember what happens when we assume...

Have a great rest of your weekend everyone! And thanks to everyone who helped me break the 45,000 view mark!

dr jim :-)

Author; GENOCIDE: HOW YOUR DOCTOR'S DIETARY IGNORANCE WILL KILL YOU!

YOU HAVE GOT TO BE KIDDING ME GREEN GIANT!!!!

Ok, so I'm sitting down with my beautiful wife eating our grass fed beef and eating Green Giant broccoli in cheese sauce when my wife remarks "Hey, there's partially hydrogenated oil in this!" I couldn't believe it! So I grab the box from her and low and behold there's partially hydrogenated oil in the ingredient list. Needless to say I wasn't very happy. Actually, I was downright angry. I went to the freezer and checked the cauliflower & cheese and sure enough, it too, had partially hydrogenated oil in it as well.

I purchased these products because they are low in carb, but shame on me, I never glanced at the ingredient list. So yes, my bad on this one. I mean like, really, why in the world would anyone feel the need to put in a broccoli and cheese (or cauliflower) partially hydrogenated oils? To this I say, shame on you Green Giant for adulterating your food with trans fats!

Now I do take all the blame for not checking the side-packaging label. Whenever we are shopping my wife will always ask, usually throwing whatever food item it is halfway down the aisle (she would make the Manning brothers quite envious with her throwing arm) "Hey, is there partially in that?!" When I was on the receiving end of the Green Giant stuff I have to admit I really didn't check because, well WHO IN THEIR RIGHT MIND WOULD EVEN THINK OF PUTTING TRANS FAT IN A SIDE DISH LIKE THIS!!

That's correct......Green Giant would.

What makes me even more frustrated is that if you look at the labeling it claims to have 0 grams of trans fat per serving; this is NOT true. Just so we're all on the same page, if the serving size has less than 500 mg of trans fat the Federal Government allows the food manufacturer to proclaim 'zero grams' trans fat per serving. If this doesn't alarm anyone, it should. Let's face it, who eats just one serving size? I could easily eat the whole box of that broccoli & cheese stuff, so then how many grams of trans fat am I getting now?

What got me even more angry was that on one of the boxes it stated "Redeem this lid to help in the fight against breast cancer." I found this quite interesting as trans fats have indeed been implicated in increasing one's risk for cancers; does this seem contradictory to anyone? Oh yeah, and on the upper right part of the box is an endorsement from Weight Watchers. Apparently, the biggest weight loss consortium out there is unaware of the adverse effects of trans fat on our health (increased risk of cancer and heart disease etc...etc...).

I guess the take home message here is to make sure you read the ingredient list on anything you buy; don't assume anything; you see, even I make mistakes. And remember, if you see partially hydrogenated oil (usually either soybean or cottonseed) in the ingredient list that food contains trans fats so avoid it like the plague.

Happy Holidays to All!

dr jim :-)

Author, GENOCIDE: HOW YOUR DOCTOR'S DIETARY IGNORANCE WILL KILL YOU!!!

Watch my critique of the 2010 USDA Dietary Guidleines.

BE DAZZLING LECTURE!

I was privileged and honored to be invited to speak about nutrition at an event hosted by the Franciscan Alliance in Northwest Indiana. The event was called Bedazzling and it was attended by well over 400 women as it focused mainly on women's health. This was a great opportunity to get the word out about the correct way to eat, especially to women. Now nothing against the male gender, but my experience over the years has been that it is women who seek and want the truth about how to get and stay healthy. Being able to reach this large an audience at once was a great way to spread the truth about proper nutrition!

Click Here to watch my lecture!

Hope everyone enjoys!

dr jim :-)

Author; GENOCIDE: HOW YOUR DOCTOR'S DIETARY IGNORANCE WILL KILL YOU!

Watch my critique of the USDA 2010 Dietary Guidelines!

Actually, It Was Eratosthenes...

So just for the heck of it I decided to see if I had any more reviews of my book on Amazon.com and came across this one from August (the fact that it took me nearly three months to realize I had a review pretty much reveals how often I check); the review is italicized below,

3.0 out of 5 stars Too many errors please re-edit! Galileo did not prove the earth is round., August 7, 2012 By Odile S. Brock "Small stuff" (APO AE) - See all my reviews (REAL NAME) This review is from: Genocide: How Your Doctor's Dietary Ignorance Will Kill You!!!! (Paperback)   I know that what the author says about diet is correct. I've been on a low-carb diet (the GAPS diet, to be exact) for 1 year today and have cured my hypertension, constipation, lowgrade UTI and more. I'm 58, weigh 112 lbs and I'm full of energy. What I'm looking for is a book TO HELP ME CONVINCE FAMILY AND FRIENDS that they should also change their diet to low-carb. I don't want my siblings to die young. I want my mother to live many more healthy years. Unfortunately, I KNOW my family will be turned off by the myriad errors in spelling and style (there are a lot of teachers in my family). I'm pretty sure everyone in my family will read the paragraph about Galileo and say: something like: "What?! Galileo didn't prove the earth was round! He proved the sun didn't revolve around the earth. Magellan, who circumnavigated the globe, proving it is round, died before Galileo was even born. If the author makes such a basic mistake why should I keep reading?" That is where I stopped reading, anyway. Please re-edit this book. I'll be happy to proofread it for you! Do your homework about Galileo and other items not in your field. Also, please use another word than Genocide. Genocide is defined as "the deliberate and systematic destruction, in whole or in part, of an ethnic, racial, religious, or national group." Please use a less politically and emotionally charged title so that thoughtful, educated people can read your book. I like the rest of what I read. I'm still looking for the right book.   My first response was "Ouch, that wasn't very nice," but I also felt privileged that not only did Odile take the time out to purchase my book, but went the extra step to write a review of it; so to this I say 'Thank You.'   I congratulate this critic on understanding the correct way to eat, thank goodness for that. I also understand the fervor you have to want to make the rest of your family and friends understand the right way to eat. As far as convincing family and friends as to the correct way to eat all I have to say is 'Good Luck with that." Despite my nearly twenty years of clinical experience and deep understanding of the correct way to eat, I often face a challenge every time I attempt to explain the correct way to eat to colleagues of mine. Very, very frustrating indeed.  I must admit I'm a little confused about a few things you wrote. You stated that you stopped reading after my unforgivable mistake of saying that Galileo proved the earth was round, when you stated he simply revealed that we live in a heliocentric not a geocentric universe. But despite the fact you say you stopped reading my book after my most egregious error, your second to last line reads "I like the rest of what I read" So my question is 'did you really stop reading?' Hmmmm...   As far as the 'myriad errors' in spelling and style, I'm not sure what you mean. The only word I consistently and purposely misspelled was oopps! There I go again. If there are any other spelling errors please point them out to me. As far as style is concerned I did have a few 'expert' editors attempt to edit my book , but when they were done I didn't like my book at all. It just wasn't me. You see, I write in what I like to refer to as 'a conversational tone.' Anyone who has met me and has had a conversation with me will immediately understand that how I wrote my book is how I speak. One common criticism is that I used too many commas, well, too bad, they were necessary, to depict, the way, I actually speak. As an interesting side note, all the critics of my style of writing have never written a book themselves; just thought I'd throw that out there...   Let's see, as far as mistakes in books go; having obtained a Bachelor of Science Degree, a Medical Degree, a Masters of Business Degree and a Law Degree and having read a few hundred books to obtain those degrees (I'm being modest here as I have no idea how many books I had to read, was it a thousand or so?); let's not forget all the other hundreds upon hundreds of non-fiction books I've read over the years; I have never read a book that did not contain at least a few errors in it. While we're pointing out errors in my book one you failed to mention although it was obvious to me after my book was published; I incorrectly defined lacto-ovo vegetarians as 'not' drinking milk or eating eggs, when in fact I know they do; it was just something that despite the fact I read my manuscript dozens of times I just missed it. And even more interestingly enough, I had a good friend who is a vegetarian proofread for subject matter errors 'And he missed it too!' OOpps...  Ok, let's get back to my alleged Galileo faux pas. You're correct that Galileo is widely known to have correctly depicted that the sun is the center of our planets's (heliocentric) revolvement, not the earth (geocentric) as was thought by the Catholic Church at the time. This is why he was placed under house arrest. By the way he has since been exonerated by the Pope and has achieved the status of the "patron of the dialogue between faith and reason". Since Galileo was completely aware of Copernicus's work and why he suggested his heliocentric theory, and since I was already completely aware not only of Copernicus's 'assumptions' but that Galileo was also very much educated in Copernicus's work; and since Copernicus's assumptions underlying the heliocentric view are replete with the words 'celestial circle or sphere,' 'lunar sphere,' celestial sphere,' mention of the 'earth's radius,'our sphere,' etc..., it is easy to see why I mistakenly made the comment that I did. Oopps.... As far as Magellan is concerned let me ever so politely educate you that Magellan himself did not complete the entire voyage around the world, having been killed during a battle which occurred in the Philippine's. So, ummm, no, Magellan was not the first person to realize the earth was not flat. As a side note, our planet is considered a flattened sphere last time I checked, so it isn't really round per se. Ok, so who really was the first person to prove that our planet is round? It was a Greek mathematician and astronomer by the name of Eratosthenes in the 3rd century BCE. This genius calculated, correctly, the circumference of the earth; something he wouldn't have even wasted his time on if he thought the world was anything but round. So it appears we're both wrong, doesn't it... It was interesting my critic suggested that I 'Do your homework about Galileo and other items not in your field'.  Again....ouch! Well, I do have a strong interest in Astrophysics and Quantum Mechanics which is why I went as high as differential equations in undergrad to help me understand the theory more; but I must admit I am certainly not a Galileo historian, so,yes, my apologies are in order. Let's see, what else; Oh, my critic wanted me to change the title of my book as it evokes negative emotion. Let me just say I am totally aware of the definition of Genocide. It is a terrible, horrific word created by Raphael Lemkin in 1943. When one looks at the etymology of the word it is easily apparent as to why the use of the word Genocide is appropriate. In fact, it really is a Global Iatrogenocide meaning that it is the doctors all over the world holding on tenaciously to an ignorant view of how we should eat, that may ultimately be our downfall. And the comment "Please use a less politically and emotionally charged title so that thoughtful, educated people can read your book"  is an interesting one. While I am certainly not a best-selling author.......yet....; more than a few very erudite people have indeed read my book and not only did they learn a lot from it, they thoroughly enjoyed it. Among these people are teachers at every level including college professors, doctors, nurses, lawyers, mechanics, iron workers, truck drivers, retail workers, fellow authors, nuclear and particle physicists and the list goes on and on. In fact, to make the comment "so that thoughtful, educated people can read your book' is a direct affront to all those wonderful individuals who have read my book. I believe you are denying your friends and relatives access to the very book which will convince your family and friends as to the correct way to eat. That's too bad... As a side note, when I went to see reviews of other books you may have reviewed there was only one other, which you gave 1 star to; I guess I should be flattered that you gave me 3. It was apparent by looking at your other reviews that I needed to be a fork, a knife or a juice press to receive 5 stars; hey, wait a minute, doesn't juice contain a lot of carbs? Just saying... Oh yeah, and the "Please re-edit this book. I'll be happy to proofread it for you!" just sounds like a dig to me. If you're going to proofread, shouldn't you be editing? I have to admit that the first time I read this review it didn't occur to me, but as I read it again there was, at least to me, a bullying undertone. Also a strong sense that I was some kind of moron because how could I not have known it wasn't Galileo who revealed the world was round and also that I was an idiot for not realizing something everybody knows........except for me.... Look, I said it before and I'll say it again, I will be the first to tell ya I don't know everything; but about the correct way to eat...well, that I do understand. Have a great weekend everyone! dr jim :-) Author of GENOCIDE: HOW YOUR DOCTOR'S DIETARY IGNORANCE WILL KILL YOU! Watch my critique of the 2010 USDA Dietary Guidelines down in D.C.

HUMAN MADE NUTRITIONAL DISASTERS!!!!

I borrowed that caption from Dr. Donald W. Miller after I watched his captivating lecture today on YouTube. This is a video everyone must watch! I found it both educational and highly entertaining. It's about 53 minutes long, but entirely worth every minute of it. I like the fact he brings up a whole host of studies and states the facts and clears up the misconceptions behind them.

CLICK HERE TO WATCH!

As I watched this video I kept screaming out loud "THAT'S EXACTLY WHAT I ALWAYS SAY!!!" Of course my wife who was watching with me kept telling me to 'Hush Up Dr Know-it-All', while simultaneously rolling her eyes and laughing at my adolescent antics." She said I was acting like the Giants had won the Superbowel again...Ha ha, I just wrote Super bowel by mistake, not Superbowl; is that like a euphemism for megacolon (just a little GI humor for everyone today :-) I am sure my non NY Giant fans out there can go off on that typo, but this a G rated blog, alright maybe sometimes PG 13, so be nice....

OK, I confess, I was jumping up & down every time Dr. Miller would repeat or show a study that I relate to my patients on a daily basis; I guess giving ghost high fives and thumbs up, with the cool head nod of "Yeah, that's right..who's the man now, huh..." while watching the video classifies as 'adolescent.' I guess what got me excited about the whole video was that I didn't know about Dr. Miller and this was the first time I had come across this video. I also feel embarrassed because I should've come across this video a long time ago.

If only more docs would open their minds to understand the truth about nutrition. My next phone call is going to be to Dr. Miller; let's see if they put me through :-) to relate to him that calories mean nothing in human nutrition as I didn't hear that point made in his lecture.


dr jim :-)

Author of GENOCIDE: HOW YOUR DOCTOR'S DIETARY IGNORANCE WILL KILL YOU!

Watch my critique of the 2010 USDA Dietary Guidelines down in D.C.

P.S. I'll let ya'll know if I actually get to speak to him. Going to find his podcast he did with Jimmy Moore now and listen in.