Friday, May 29, 2009
Chapter 9 of Genocide:How Your Doctor's Dietary Ignorance Will Kill You
CHAPTER NINE-PARTIALLY HYDROGENATED OILS
My six-year-old daughter understands the dangers inherent in partially hydrogenated oils. When we are at a restaurant she will ask if what she is eating is low carb and will oftentimes ask the server, "Are there partially hydrogenated oils in this food?" Of course the servers have not a clue what my daughter is talking about even though she is asking about the presence of the most dangerous fat out there. Partially hydrogenated oils are nothing more than a FAKE fat created in laboratories for ease of use by food manufacturers.
Partially hydrogenated oils are also known as trans fats. You know they are present when you review the ingredient list and see 'partially hydrogenated soybean oil or partially hydrogenated cottonseed oil', the two most common. By law now the ingredients must list the amount of trans fats. But do not get too complacent.
A lot of side packaging labels will have zero grams of trans fat, but when you read the ingredient list you will notice it contains partially hydrogenated soybean oil. Well, what's up with that? The reason the food industry can get away with this is that if there is less than half a gram (0.5 grams or 500 milligrams), they are allowed, by law, to put zero.
Well, I am sorry, but the presence of 500 milligrams is not zero at least not in my book. No pun intended. And the other problem is that it only takes microscopic amounts to wreak havoc on our systems. So what exactly is it about a trans fat that makes it so dangerous?
Well, a trans fat is so named because of how the molecule looks. A trans fat contains what are known as double bonds. Think of a trailer attached to a car by a hitch. Usually there is only one hitch. Now pretend that for a particular trailer you need to have two hitches attached to the car. This is kind of what a double bond is. It just means that things are attached to each other with two attachments rather than one.
If a molecule contains a double bond things can be attached above or diagonally opposite in relation to the double bond. Don’t get too crazy trying to visualize this. Suffice it to say that when things are attached diagonally opposite to the double bond it is referred to as trans. When things are placed above the double bond it is called cis. These are just the words we biochemists use to describe where things are located in relation to the double bond.
Now if we have a double bond in a fat where the attachment just happens to be diagonally opposite it is called a trans fat. Trans fats are fake, they are artificially produced. Since these fats are fake and artificial our bodies do not know how to break these trans fats down. In fact, we do not have any way to break these fats down safely. Specifically, we do not have the proper enzymes to get rid of these fats. The only fats we can break down are the cis fats.
When our bodies attempt to break down trans fats we produce a thing known as a free radical. Go to your computer, pick your search engine and put in free radicals and cancer, or free radicals and heart disease. How many hits did you get? I know, a lot.
Free radicals are scary. Very scary. They wreak havoc on our systems because they want to attach to everything they come across. When we eat anything that contains a trans fat we cannot break it down and it just goes throughout our bodies causing damage. The damage is generally on our arterial walls. This is why there is now said to be a correlation between trans fats and heart disease as well as cancer.
At the cellular level trans fats may act as signals for cells to turn cancerous. Remember I am referring to very small amounts of trans fats, which may cause this damage. Even half a gram, which may not seem like a lot, may be enough to cause arterial wall damage and possibly turn on cancer genes.
As a side note, in New York City there is a new law which bans trans fats from being used in public restaurants. This is a major step in the right direction. Trans fats should be illegal. No one should have to worry about coming across this deadly FAKE fat.
Some organizations are still promoting margarine as a substitute for butter. Margarine is a trans fat. We now should be able to figure out from our discussion that butter is very good for us. We know that eating butter will raise our HDL and will help us lose weight, as long as we are not putting the butter on a loaf of bread.
Now enter margarine. A trans fat. I told you above what trans fats are and why they are deadly, not just dangerous. Why would anyone in the world advertise margarine as safe? You got me. You now know better. So do not eat things with trans fats in them.
As another interesting side note I came across an e-mail about how plastic and margarine were only one molecule away from being the same. I did some research and found this to be not entirely accurate.
Specifically, when making vinyl plastic molecules of a substance known as ethylene are forced by heat to attach to one another. It appeared as if there were only single bonds present, not the trans bonds we talked about above. In reality margarine more closely resembles rubber. Rubber contains double bonds like margarine although in a cis configuration, not trans. I am not sure what causes me more concern, food resembling plastic, or foods related to rubber. You be the judge.
The e-mail did mention that if you left margarine out in your backyard no insects would touch it. I have not tried this experiment yet, but I will, and report back on my results later. I will not be surprised if no insects are found trying to 'eat' margarine as margarine is devoid of any useful nutritive value for us humans as well. And I am picking on us doctors because some of us have promoted margarine as being safe, when it is not. Here it appears insects are smarter than us doctors.
Dr. James E. Carlson B.S.,D.O.,M.B.A.,J.D.
To purchase my book go to Amazon.com or go to DrJamesCarlson.com to request a digital copy of my book for only $11.99!
My six-year-old daughter understands the dangers inherent in partially hydrogenated oils. When we are at a restaurant she will ask if what she is eating is low carb and will oftentimes ask the server, "Are there partially hydrogenated oils in this food?" Of course the servers have not a clue what my daughter is talking about even though she is asking about the presence of the most dangerous fat out there. Partially hydrogenated oils are nothing more than a FAKE fat created in laboratories for ease of use by food manufacturers.
Partially hydrogenated oils are also known as trans fats. You know they are present when you review the ingredient list and see 'partially hydrogenated soybean oil or partially hydrogenated cottonseed oil', the two most common. By law now the ingredients must list the amount of trans fats. But do not get too complacent.
A lot of side packaging labels will have zero grams of trans fat, but when you read the ingredient list you will notice it contains partially hydrogenated soybean oil. Well, what's up with that? The reason the food industry can get away with this is that if there is less than half a gram (0.5 grams or 500 milligrams), they are allowed, by law, to put zero.
Well, I am sorry, but the presence of 500 milligrams is not zero at least not in my book. No pun intended. And the other problem is that it only takes microscopic amounts to wreak havoc on our systems. So what exactly is it about a trans fat that makes it so dangerous?
Well, a trans fat is so named because of how the molecule looks. A trans fat contains what are known as double bonds. Think of a trailer attached to a car by a hitch. Usually there is only one hitch. Now pretend that for a particular trailer you need to have two hitches attached to the car. This is kind of what a double bond is. It just means that things are attached to each other with two attachments rather than one.
If a molecule contains a double bond things can be attached above or diagonally opposite in relation to the double bond. Don’t get too crazy trying to visualize this. Suffice it to say that when things are attached diagonally opposite to the double bond it is referred to as trans. When things are placed above the double bond it is called cis. These are just the words we biochemists use to describe where things are located in relation to the double bond.
Now if we have a double bond in a fat where the attachment just happens to be diagonally opposite it is called a trans fat. Trans fats are fake, they are artificially produced. Since these fats are fake and artificial our bodies do not know how to break these trans fats down. In fact, we do not have any way to break these fats down safely. Specifically, we do not have the proper enzymes to get rid of these fats. The only fats we can break down are the cis fats.
When our bodies attempt to break down trans fats we produce a thing known as a free radical. Go to your computer, pick your search engine and put in free radicals and cancer, or free radicals and heart disease. How many hits did you get? I know, a lot.
Free radicals are scary. Very scary. They wreak havoc on our systems because they want to attach to everything they come across. When we eat anything that contains a trans fat we cannot break it down and it just goes throughout our bodies causing damage. The damage is generally on our arterial walls. This is why there is now said to be a correlation between trans fats and heart disease as well as cancer.
At the cellular level trans fats may act as signals for cells to turn cancerous. Remember I am referring to very small amounts of trans fats, which may cause this damage. Even half a gram, which may not seem like a lot, may be enough to cause arterial wall damage and possibly turn on cancer genes.
As a side note, in New York City there is a new law which bans trans fats from being used in public restaurants. This is a major step in the right direction. Trans fats should be illegal. No one should have to worry about coming across this deadly FAKE fat.
Some organizations are still promoting margarine as a substitute for butter. Margarine is a trans fat. We now should be able to figure out from our discussion that butter is very good for us. We know that eating butter will raise our HDL and will help us lose weight, as long as we are not putting the butter on a loaf of bread.
Now enter margarine. A trans fat. I told you above what trans fats are and why they are deadly, not just dangerous. Why would anyone in the world advertise margarine as safe? You got me. You now know better. So do not eat things with trans fats in them.
As another interesting side note I came across an e-mail about how plastic and margarine were only one molecule away from being the same. I did some research and found this to be not entirely accurate.
Specifically, when making vinyl plastic molecules of a substance known as ethylene are forced by heat to attach to one another. It appeared as if there were only single bonds present, not the trans bonds we talked about above. In reality margarine more closely resembles rubber. Rubber contains double bonds like margarine although in a cis configuration, not trans. I am not sure what causes me more concern, food resembling plastic, or foods related to rubber. You be the judge.
The e-mail did mention that if you left margarine out in your backyard no insects would touch it. I have not tried this experiment yet, but I will, and report back on my results later. I will not be surprised if no insects are found trying to 'eat' margarine as margarine is devoid of any useful nutritive value for us humans as well. And I am picking on us doctors because some of us have promoted margarine as being safe, when it is not. Here it appears insects are smarter than us doctors.
Dr. James E. Carlson B.S.,D.O.,M.B.A.,J.D.
To purchase my book go to Amazon.com or go to DrJamesCarlson.com to request a digital copy of my book for only $11.99!
Thursday, May 28, 2009
Chapter 8 of Genocide:How Your Doctor's Dietary Ignorance Will Kill You
CHAPTER EIGHT-INSULIN-The Root of All Evil?
I can make this complicated or I can make this simple. After all, I am a doctor. Since I like to keep things simple, we will stick to keeping it simple. Ahhh, Insulin, what can I say about insulin that has not already been said? Well, actually, a lot.
First off, let me be the first to tell you to be afraid of insulin, be very, very afraid. It is actually insulin that controls how and when sugar will be changed into cholesterol and fat. So the more insulin we secrete the more cholesterol and fat we make. And as a little aside insulin also increases our risk of developing and spreading cancer, which I will explain later. So now you must be wondering,” What is insulin and where does it come from?"
Insulin is referred to as a polypeptide hormone. Hormones come in many shapes and sizes. Some are made up of proteins others are created from cholesterol. That is correct, cholesterol is necessary for the development of many very important hormones. I mentioned this before. Testosterone, estrogen, and cortisol are but a few. Without these hormones, we die. So, without cholesterol, well, I am sure you get it…
A hormone brings messages that control the activities of our cells. They are very important for normal cellular function. We are taught in biology classes that the main role of insulin is to allow sugar to get into the cell. This is true. Without insulin sugar has a very difficult time getting into cells.
The pancreas in response to the presence of carbohydrates secretes insulin. So, whenever we eat carbohydrates and/or food containing sugar the pancreas will squirt out insulin. Now it is true that one of insulin's roles is to help sugar get into cells; but insulin does a lot more. A whole lot more.
As I started to mention above it is insulin that controls many of the very important steps which allow our bodies to make cholesterol. Insulin also sends the signals for us to make more triglycerides. And it is the presence of insulin which prevents us from losing weight.
All doctors know that in medical language insulin is referred to as an anabolic hormone. Anabolic simply means growth promoting. Some of my readers will recognize anabolic as preceding the word steroid, such as anabolic steroids used by athletes. And it means the same thing there; anabolic steroids promote growth.
The reason insulin is anabolic is because, again, it sends all the signals to our body’s cells to make fat and to prevent us from losing weight. Insulin controls key enzymes for cholesterol synthesis most notably HMG CoA reductase (also known as 3-hydroxy-3-methylglutaryl CoA reductase). When insulin is present it will tell this enzyme to make more cholesterol.
Remember insulin is secreted every time we eat carbohydrates (unless you are a Type I diabetic, which I will discuss a little later). Insulin will then tell the very thing that helps make cholesterol, HMG CoA reductase, to make more cholesterol. Oh yeah, do not forget that our bodies actually use sugar to make cholesterol.
So let me make this perfectly clear. Not only by eating carbs are we giving the body what it needs to make cholesterol; when the body secretes insulin in response to carbohydrates, the insulin actually speeds up cholesterol production. When we eat carbs we are giving the body everything it needs to make more cholesterol.
Now this HMG CoA reductase thing is not just a way for me to show off and say big words. It is very important for cholesterol production. In biochemical language we refer to this enzyme as the rate-limiting step in cholesterol synthesis. This is a fancy way of saying that once this enzyme gets started it is going to finish what it started doing and there aint no turning back. So once insulin encourages this enzyme to work it will make cholesterol no matter what.
For our body's sake it is better that it sees as little insulin as possible. The only way to have any effect on insulin's presence is by lowering the carb intake. That is it. There's no other way to really, truly have an effect on insulin levels in the blood other than by lowering your carb intake.
Lower your insulin level and you lower the activity of that HMG thing. Oh, and something else. Remember when I mentioned a little while ago that eating cholesterol lowers your body’s production of cholesterol. Guess how it does it? Well, when you eat cholesterol it actually combines with the HMG CoA reductase and tells it not to work as hard. The cholesterol in the foods we eat actually turns off the enzyme that makes itself. But it does not stop there. The cholesterol in the foods we eat will also tell the cells which make cholesterol to make less of the very enzyme that makes itself.
So eating less carbs helps by not giving the body what it needs to make cholesterol. Lowering the carb intake also means less insulin secretion. Less insulin secretion, less stimulation and production of HMG. Less stimulation and production of HMG, less cholesterol production.
When I place a patient on a low carb diet I also encourage them to eat more cholesterol, not high, simply more. Let us simplify what happens when we eat cholesterol-containing foods. More cholesterol in the diet, less stimulation and production of HMG. Less stimulation and production of HMG, less cholesterol is made. So, by eating lower carbs and more cholesterol, we make less cholesterol.
What is also very interesting is how the major drugs we docs use to lower cholesterol work. These meds are referred to as statins. The statins actually prevent HMG CoA reductase from working. By doing this these meds lower cholesterol production.
But we can have a similar and more dramatic effect when we lower the carbs and eat more cholesterol. When we eat this way we are manipulating the ability of HMG to make cholesterol and we are also telling the body to stop making HMG. The cholesterol lowering meds do not go this far. They only work on the HMG. With low carbs we lower cholesterol naturally and we can avoid medication all together.
Another question which may come up is, "How does insulin affect the TG number and our fat stores?" Well, when the pancreas in response to a carb meal secretes insulin the insulin will also interact with the enzymes responsible for fat production and utilization.
"Insulin inhibits lipolysis." (1) This is a statement found in a Biochemistry book I read more than a few times in college. This statement is so very important, yet I did not understand the profoundness of it until nine years ago. What the statement means is that insulin slows down the breakdown of fat in our body. In fact, when insulin is present our body is sent the signal to not only stop burning fat, but to make more fat. The more insulin and the more difficult it is to lose weight. And weight gain is inevitable the longer insulin is around. What keeps insulin around? Eating carbs. So if you want to make it very difficult to lose weight eat more carbs. Exactly what we do when we follow a low fat, low cholesterol diet.
Another hormone, glucagon, is also secreted by the pancreas. When this hormone is secreted it has a reverse effect than that of insulin. The more glucagon the more fat we burn and fat storage is prevented. What causes a release of glucagon? Avoidance of carbs and the consumption of protein in the diet.
It might be a good time to re-visit the whole concept of the calorie and why the calorie is irrelevant in human nutrition. Remember we discussed that calories were measured in a closed system where we knew everything about the system. I also mentioned that our bodies are open systems where it is impossible with our knowledge today to measure everything that is happening in the body. A great example of this open system concept is glucagon and insulin. Once we eat a food substance the hormones insulin and glucagon (among many hundreds, thousands? of other hormones and digestive enzymes) are secreted. The interplay between even these two hormones is complex, but just remember this; insulin makes us get fat and stay fat; glucagon sends the signal to lose fat and to not gain weight. Eat carbs and insulin is secreted and you get fat; eat less carbs and more protein, less insulin and more glucagon will be secreted, and this helps us lose weight.
There is no way to measure exactly what is happening, that is, how much glucagon was secreted versus how much insulin? Ok, well maybe we can measure in the bloodstream these two hormones, but what about the hundreds of others, what about the digestive enzymes, what about all the things we have not even discovered yet? I am getting a headache just thinking about it. Since a calorie is measured in a closed system and our bodies are open systems, again, using the term calorie to help understand any nutritional concept is like comparing apples to kites. They just are not the same. The calorie is irrelevant; do not use it, ever, unless you are a quantitative heat chemist.
We need to get into a little more detail about how insulin actually works. I said earlier that insulin is important as it allows sugar to get into our cells. Without insulin sugar cannot get into our cells very well.
As an aside, when we are exercising our muscle cells allow sugar in with very little or no help from insulin. But how exactly does insulin help sugar get into our cells?
In order for insulin to allow sugar into our cells it first binds to the outside part of the cell. This outside part is known as a cell membrane. When insulin binds to the cell membrane it sends a message to the inside of the cell. Insulin can do this because the place where insulin attaches to goes through the entire cell membrane and causes changes to the inside of the cell. These changes that occur are what allow sugar to finally get into the cell.
Since insulin is the first thing that carries the message, the message to let sugar in, it is called the first messenger. Once insulin attaches to the cell surface it sends a signal through the cell membrane causing a release of chemicals called the second messengers. It is these second messengers that eventually let sugar into the cell and it is the overuse of these second messengers that gets us into trouble. How many people know that insulin causes cell damage in and off itself? We need to examine what, exactly, these second messengers do to give the cell the message to let sugar in.
Two things relay the second message. One is a substance called IP3 (inositol 1,4,5-triphosphate) and the other is DAG (diacylglycerol). These two things come from the breakdown of something called phosphatidyl inositol 4,5-bisphosphate (also known as PIP2). (2). Now don't lose me; it really is not difficult to follow through.
To recap, insulin binds to the outer part of the cell and is referred to as the first messenger. The attachment of insulin to the outer part of the cell sends a message to the inside of the cell. The message insulin brings is to break apart PIP2 into IP3 and DAG. It is IP3 and DAG which are the second messengers.
Now this does not seem like a big deal. Heck, we need to get sugar into the cell. We would rather have it inside the cell instead of outside the cell. In fact, if sugar stays outside the cell as I have mentioned before it will start to attach to things it should not and will cause a malfunctioning of cells and then organs. This is what causes the side effects of diabetes, which we will discuss in Part 2.
Anyway, in order to get the sugar into the cell we need the help of IP3 and DAG. The problem is not with IP3. The problem lies with DAG. DAG stood for diacylglycerol, just a fancy way of saying 2 acyls and a glycerol. It is with one of these acyl things that all havoc breaks lose.
Now acyl is just a big fancy way of saying a long fat chain. So this diacylglycerol contains two long fat chains as di means two. The problem is that one of these fat chains is something called arachidonate. Arichidonate is the starting point for the creation of extremely important signaling molecules. These are known as prostaglandins, prostacyclins, thromboxanes and leukotrienes. (3) The other term we use for these signaling molecules is eicosanoids. (An excellent review of this whole process can be found in Barry Sears, The Zone.)
In fact, an enzyme known as diacylglycerol lipase breaks down DAG into arachidonate. Then the signaling molecules, the eicosanoids, can be made. My physician readers will recognize most, if not all, of these signaling molecules.
The problem with these signaling molecules is that they may not send nice messages to our cells. The prostaglandins are known to allow us to feel pain and to promote the development of clot formation by making platelets stickier. Thromboxanes have the opposite effect, they make platelets less sticky. The leukotrienes will allow us to experience a worsening of allergy symptoms, including asthma.
Arachidonate has also been implicated in sending signals for tumor (cancer) growth as well as sending signals to allow cancer to spread (metastasize). If you want to scare yourself go to your favorite search engine and perform a search of arachidonic acid and cancer. How many hits did you get? It has been known for years that arachidonate sends cancer-promoting messages to our cell’s DNA. Obviously not a good thing, but more about the cancer and carb connection later.
Let me put this all together. When we eat carbs our pancreas secretes insulin. Insulin allows us to make more cholesterol. Insulin also is anabolic in a sense that it prevents us from losing weight and helps us to gain weight. We also now know that insulin acts through a second messenger system. We also found out that one of these messengers, DAG, can be extremely dangerous. The more DAG, the more bad messages can be sent within our cells. The problem is that the more insulin we secrete the more DAG is created. But it all goes back to what? Carbs. Carbs set into motion all of these bodily processes which are not good for us.
So it is essential we do not over eat carbs. What would be considered overeating? Well, if any of you have a medical problem requiring medication, you probably should not allow yourself anymore than sixty grams a day of carbs. If you are a diabetic, then no more than twenty or thirty at the most. Remember, it is absolutely imperative that before any of you start a low carb diet, you need to find an experienced low carb doc who can watch you like a hawk. Do not, I repeat, do not under any circumstances start a low carb diet without first consulting your doc. If your doc tells you that you should not start a low carb diet-----find another doc who knows what they are talking about.
I know this has been a long chapter, but it is an important one because it shows how insulin is involved in creating some very bad things. Now do not get me wrong insulin is needed in small quantities and without it we would die. But the amounts that a typical person secretes each day are extraordinarily high. And it all goes back to carbs. It was the consumption of carbs which caused the insulin to show up in the first place. A little bit of insulin, fine. But the amount of insulin most people squirt out, well, it encourages cholesterol production, allows us to get fatter, and from the discussion above, sends signals to allow us to experience more pain and can increase our development of cancer. And this is just the tip of the proverbial iceberg. We all need to be afraid of insulin; we need to be very, very afraid.
Dr. James E. Carlson B.S.,D.O.,M.B.A.,J.D.
Please go to Amazon.com to order my book or go to DrJamesCarlson.com and request a digital copy of my book for only $11.99!
I can make this complicated or I can make this simple. After all, I am a doctor. Since I like to keep things simple, we will stick to keeping it simple. Ahhh, Insulin, what can I say about insulin that has not already been said? Well, actually, a lot.
First off, let me be the first to tell you to be afraid of insulin, be very, very afraid. It is actually insulin that controls how and when sugar will be changed into cholesterol and fat. So the more insulin we secrete the more cholesterol and fat we make. And as a little aside insulin also increases our risk of developing and spreading cancer, which I will explain later. So now you must be wondering,” What is insulin and where does it come from?"
Insulin is referred to as a polypeptide hormone. Hormones come in many shapes and sizes. Some are made up of proteins others are created from cholesterol. That is correct, cholesterol is necessary for the development of many very important hormones. I mentioned this before. Testosterone, estrogen, and cortisol are but a few. Without these hormones, we die. So, without cholesterol, well, I am sure you get it…
A hormone brings messages that control the activities of our cells. They are very important for normal cellular function. We are taught in biology classes that the main role of insulin is to allow sugar to get into the cell. This is true. Without insulin sugar has a very difficult time getting into cells.
The pancreas in response to the presence of carbohydrates secretes insulin. So, whenever we eat carbohydrates and/or food containing sugar the pancreas will squirt out insulin. Now it is true that one of insulin's roles is to help sugar get into cells; but insulin does a lot more. A whole lot more.
As I started to mention above it is insulin that controls many of the very important steps which allow our bodies to make cholesterol. Insulin also sends the signals for us to make more triglycerides. And it is the presence of insulin which prevents us from losing weight.
All doctors know that in medical language insulin is referred to as an anabolic hormone. Anabolic simply means growth promoting. Some of my readers will recognize anabolic as preceding the word steroid, such as anabolic steroids used by athletes. And it means the same thing there; anabolic steroids promote growth.
The reason insulin is anabolic is because, again, it sends all the signals to our body’s cells to make fat and to prevent us from losing weight. Insulin controls key enzymes for cholesterol synthesis most notably HMG CoA reductase (also known as 3-hydroxy-3-methylglutaryl CoA reductase). When insulin is present it will tell this enzyme to make more cholesterol.
Remember insulin is secreted every time we eat carbohydrates (unless you are a Type I diabetic, which I will discuss a little later). Insulin will then tell the very thing that helps make cholesterol, HMG CoA reductase, to make more cholesterol. Oh yeah, do not forget that our bodies actually use sugar to make cholesterol.
So let me make this perfectly clear. Not only by eating carbs are we giving the body what it needs to make cholesterol; when the body secretes insulin in response to carbohydrates, the insulin actually speeds up cholesterol production. When we eat carbs we are giving the body everything it needs to make more cholesterol.
Now this HMG CoA reductase thing is not just a way for me to show off and say big words. It is very important for cholesterol production. In biochemical language we refer to this enzyme as the rate-limiting step in cholesterol synthesis. This is a fancy way of saying that once this enzyme gets started it is going to finish what it started doing and there aint no turning back. So once insulin encourages this enzyme to work it will make cholesterol no matter what.
For our body's sake it is better that it sees as little insulin as possible. The only way to have any effect on insulin's presence is by lowering the carb intake. That is it. There's no other way to really, truly have an effect on insulin levels in the blood other than by lowering your carb intake.
Lower your insulin level and you lower the activity of that HMG thing. Oh, and something else. Remember when I mentioned a little while ago that eating cholesterol lowers your body’s production of cholesterol. Guess how it does it? Well, when you eat cholesterol it actually combines with the HMG CoA reductase and tells it not to work as hard. The cholesterol in the foods we eat actually turns off the enzyme that makes itself. But it does not stop there. The cholesterol in the foods we eat will also tell the cells which make cholesterol to make less of the very enzyme that makes itself.
So eating less carbs helps by not giving the body what it needs to make cholesterol. Lowering the carb intake also means less insulin secretion. Less insulin secretion, less stimulation and production of HMG. Less stimulation and production of HMG, less cholesterol production.
When I place a patient on a low carb diet I also encourage them to eat more cholesterol, not high, simply more. Let us simplify what happens when we eat cholesterol-containing foods. More cholesterol in the diet, less stimulation and production of HMG. Less stimulation and production of HMG, less cholesterol is made. So, by eating lower carbs and more cholesterol, we make less cholesterol.
What is also very interesting is how the major drugs we docs use to lower cholesterol work. These meds are referred to as statins. The statins actually prevent HMG CoA reductase from working. By doing this these meds lower cholesterol production.
But we can have a similar and more dramatic effect when we lower the carbs and eat more cholesterol. When we eat this way we are manipulating the ability of HMG to make cholesterol and we are also telling the body to stop making HMG. The cholesterol lowering meds do not go this far. They only work on the HMG. With low carbs we lower cholesterol naturally and we can avoid medication all together.
Another question which may come up is, "How does insulin affect the TG number and our fat stores?" Well, when the pancreas in response to a carb meal secretes insulin the insulin will also interact with the enzymes responsible for fat production and utilization.
"Insulin inhibits lipolysis." (1) This is a statement found in a Biochemistry book I read more than a few times in college. This statement is so very important, yet I did not understand the profoundness of it until nine years ago. What the statement means is that insulin slows down the breakdown of fat in our body. In fact, when insulin is present our body is sent the signal to not only stop burning fat, but to make more fat. The more insulin and the more difficult it is to lose weight. And weight gain is inevitable the longer insulin is around. What keeps insulin around? Eating carbs. So if you want to make it very difficult to lose weight eat more carbs. Exactly what we do when we follow a low fat, low cholesterol diet.
Another hormone, glucagon, is also secreted by the pancreas. When this hormone is secreted it has a reverse effect than that of insulin. The more glucagon the more fat we burn and fat storage is prevented. What causes a release of glucagon? Avoidance of carbs and the consumption of protein in the diet.
It might be a good time to re-visit the whole concept of the calorie and why the calorie is irrelevant in human nutrition. Remember we discussed that calories were measured in a closed system where we knew everything about the system. I also mentioned that our bodies are open systems where it is impossible with our knowledge today to measure everything that is happening in the body. A great example of this open system concept is glucagon and insulin. Once we eat a food substance the hormones insulin and glucagon (among many hundreds, thousands? of other hormones and digestive enzymes) are secreted. The interplay between even these two hormones is complex, but just remember this; insulin makes us get fat and stay fat; glucagon sends the signal to lose fat and to not gain weight. Eat carbs and insulin is secreted and you get fat; eat less carbs and more protein, less insulin and more glucagon will be secreted, and this helps us lose weight.
There is no way to measure exactly what is happening, that is, how much glucagon was secreted versus how much insulin? Ok, well maybe we can measure in the bloodstream these two hormones, but what about the hundreds of others, what about the digestive enzymes, what about all the things we have not even discovered yet? I am getting a headache just thinking about it. Since a calorie is measured in a closed system and our bodies are open systems, again, using the term calorie to help understand any nutritional concept is like comparing apples to kites. They just are not the same. The calorie is irrelevant; do not use it, ever, unless you are a quantitative heat chemist.
We need to get into a little more detail about how insulin actually works. I said earlier that insulin is important as it allows sugar to get into our cells. Without insulin sugar cannot get into our cells very well.
As an aside, when we are exercising our muscle cells allow sugar in with very little or no help from insulin. But how exactly does insulin help sugar get into our cells?
In order for insulin to allow sugar into our cells it first binds to the outside part of the cell. This outside part is known as a cell membrane. When insulin binds to the cell membrane it sends a message to the inside of the cell. Insulin can do this because the place where insulin attaches to goes through the entire cell membrane and causes changes to the inside of the cell. These changes that occur are what allow sugar to finally get into the cell.
Since insulin is the first thing that carries the message, the message to let sugar in, it is called the first messenger. Once insulin attaches to the cell surface it sends a signal through the cell membrane causing a release of chemicals called the second messengers. It is these second messengers that eventually let sugar into the cell and it is the overuse of these second messengers that gets us into trouble. How many people know that insulin causes cell damage in and off itself? We need to examine what, exactly, these second messengers do to give the cell the message to let sugar in.
Two things relay the second message. One is a substance called IP3 (inositol 1,4,5-triphosphate) and the other is DAG (diacylglycerol). These two things come from the breakdown of something called phosphatidyl inositol 4,5-bisphosphate (also known as PIP2). (2). Now don't lose me; it really is not difficult to follow through.
To recap, insulin binds to the outer part of the cell and is referred to as the first messenger. The attachment of insulin to the outer part of the cell sends a message to the inside of the cell. The message insulin brings is to break apart PIP2 into IP3 and DAG. It is IP3 and DAG which are the second messengers.
Now this does not seem like a big deal. Heck, we need to get sugar into the cell. We would rather have it inside the cell instead of outside the cell. In fact, if sugar stays outside the cell as I have mentioned before it will start to attach to things it should not and will cause a malfunctioning of cells and then organs. This is what causes the side effects of diabetes, which we will discuss in Part 2.
Anyway, in order to get the sugar into the cell we need the help of IP3 and DAG. The problem is not with IP3. The problem lies with DAG. DAG stood for diacylglycerol, just a fancy way of saying 2 acyls and a glycerol. It is with one of these acyl things that all havoc breaks lose.
Now acyl is just a big fancy way of saying a long fat chain. So this diacylglycerol contains two long fat chains as di means two. The problem is that one of these fat chains is something called arachidonate. Arichidonate is the starting point for the creation of extremely important signaling molecules. These are known as prostaglandins, prostacyclins, thromboxanes and leukotrienes. (3) The other term we use for these signaling molecules is eicosanoids. (An excellent review of this whole process can be found in Barry Sears, The Zone.)
In fact, an enzyme known as diacylglycerol lipase breaks down DAG into arachidonate. Then the signaling molecules, the eicosanoids, can be made. My physician readers will recognize most, if not all, of these signaling molecules.
The problem with these signaling molecules is that they may not send nice messages to our cells. The prostaglandins are known to allow us to feel pain and to promote the development of clot formation by making platelets stickier. Thromboxanes have the opposite effect, they make platelets less sticky. The leukotrienes will allow us to experience a worsening of allergy symptoms, including asthma.
Arachidonate has also been implicated in sending signals for tumor (cancer) growth as well as sending signals to allow cancer to spread (metastasize). If you want to scare yourself go to your favorite search engine and perform a search of arachidonic acid and cancer. How many hits did you get? It has been known for years that arachidonate sends cancer-promoting messages to our cell’s DNA. Obviously not a good thing, but more about the cancer and carb connection later.
Let me put this all together. When we eat carbs our pancreas secretes insulin. Insulin allows us to make more cholesterol. Insulin also is anabolic in a sense that it prevents us from losing weight and helps us to gain weight. We also now know that insulin acts through a second messenger system. We also found out that one of these messengers, DAG, can be extremely dangerous. The more DAG, the more bad messages can be sent within our cells. The problem is that the more insulin we secrete the more DAG is created. But it all goes back to what? Carbs. Carbs set into motion all of these bodily processes which are not good for us.
So it is essential we do not over eat carbs. What would be considered overeating? Well, if any of you have a medical problem requiring medication, you probably should not allow yourself anymore than sixty grams a day of carbs. If you are a diabetic, then no more than twenty or thirty at the most. Remember, it is absolutely imperative that before any of you start a low carb diet, you need to find an experienced low carb doc who can watch you like a hawk. Do not, I repeat, do not under any circumstances start a low carb diet without first consulting your doc. If your doc tells you that you should not start a low carb diet-----find another doc who knows what they are talking about.
I know this has been a long chapter, but it is an important one because it shows how insulin is involved in creating some very bad things. Now do not get me wrong insulin is needed in small quantities and without it we would die. But the amounts that a typical person secretes each day are extraordinarily high. And it all goes back to carbs. It was the consumption of carbs which caused the insulin to show up in the first place. A little bit of insulin, fine. But the amount of insulin most people squirt out, well, it encourages cholesterol production, allows us to get fatter, and from the discussion above, sends signals to allow us to experience more pain and can increase our development of cancer. And this is just the tip of the proverbial iceberg. We all need to be afraid of insulin; we need to be very, very afraid.
Dr. James E. Carlson B.S.,D.O.,M.B.A.,J.D.
Please go to Amazon.com to order my book or go to DrJamesCarlson.com and request a digital copy of my book for only $11.99!
Wednesday, May 27, 2009
Chapter 7 of Genocide:How Your Doctor's Dietary Ignorance Will Kill You
CHAPTER SEVEN-SUGAR IS SUGAR IS SUGAR
Sugar is very important to discuss. I have already mentioned sugar a bunch of times. I have already shared the biggest secret that fat and cholesterol production starts with sugar. So now let us really learn about sugar.
We all have heard of sugar. It comes in many varieties. There are your simple sugars like glucose (the most popular) and fructose (found in fruit). Then you have the weirder ones like galactose, xylose, allose, and ribose. The big fancy way to refer to these sugars is by calling them monosaccharides since they only consist of a single sugar molecule. Some of these you may have heard of, others even your doctor has never heard of.
Now there are your more complex types of sugars where two sugars are attached to one another. The three most common are sucrose (table sugar), lactose (found in milk) and maltose. These sugars need to be broken down before our body can use them. They are referred to as disaccharides with the di referring to the fact there are two sugar molecules attached to one another.
Let us now talk a little bit about carbs and where they fit in. Carbs are basically glucose molecules all strung together like beads on a string. The beads would represent a glucose molecule. Sometimes these string beads are short. Sometimes there are millions of beads on a string.
Before we can use the glucose in a long string the string would need to be broken down into its single beads or glucose molecules. After the body has done this the glucose may now be treated in different ways. If there is an overabundance of glucose in the system, as is often the case, the glucose will be stored first in the liver and then in muscles. After the liver and muscles have their fill the glucose molecule will be used to make cholesterol and TGs and the extra TGs will be stored as fat on our bodies. It does not take long to fill up our livers and muscles with glucose. Since it does not take long to fill up our livers and muscles and since most people eat more glucose then they should, there is plenty of sugar left over to make cholesterol, TGs and to store as fat.
The current recommendation for carbohydrate intake is somewhere between two hundred to two hundred fifty grams of carbohydrates per day. No one, and I mean no one, should be consuming this amount of carbs in their diet. Obesity, heart disease, diabetes, and cancer (and I will discuss the link between carbs and cancer later) are being seen more and more in our society. We are even seeing in children younger than ten what were once thought to be diseases of adults; that is, obesity and diabetes.
Most of the medical profession is scratching their heads trying to figure out why this is so. The answer sadly enough is right before their eyes, but the medical physicians just cannot see it. We have more and more people on low fat, low cholesterol diets and this includes our children. When we follow a low fat, low cholesterol diet, we must consume more carbs. As we consume more carbs we send all the signals to our body to get fat and make more cholesterol. Eating less cholesterol sends the signal to make more cholesterol. We are shortening the life expectancy of our children by the continuous propagation of the low cholesterol, low fat diet.
To me, being a part of the medical profession that is promulgating this deadly diet is embarrassing. Why is it that more docs have not figured out that when one follows a low fat, low cholesterol diet, they wind up less healthy then when they started?
Why?
Again, it is because we are not trained to think for ourselves in medical school. We are told to just listen and leave all the thinking to the specialists, or the doctors on the 'special' committees.
Unfortunately, it is these specialists or committee members who are the blindest. They continue to espouse low fat, low cholesterol diets, continue to tell us that eating whole grains and fruits are good for you and continue to mistakenly believe that it is a lack of physical exercise which is the main contributor to the obesity epidemic. This is just plain wrong. Why is it that I have had many cases where I have dealt with morbidly obese patients who I start on a low carb diet, who lose significant amounts of weight before they even start an exercise regimen? Yes, these patients start to lose weight and lots of it, before they started exercising. If what the experts say is true this should not be happening. But it does, every single day in my practice.
Now do not get me wrong. I am not saying exercise is not important. It is and it is very important. It does accelerate weight loss when done correctly. But to tell a patient with knee pain to start walking when they are three hundred pounds is negligent. How about we take some weight off, say, fifty pounds and then have them start walking. This way there is less stress and strain on the hips, knees and ankles when they start walking. This just makes sense to me.
OK, I digressed again, let us get back to our discussion of sugar.
Another huge problem is that our medical professionals would like you to believe that the same sugar molecules are somehow different. For instance, that if the sugar molecule is from fruit, it is natural and that is OK. Or, if it comes from whole wheat, again, it is natural and that's fine.
Well, I am here to stop that myth. Please remember that sugar is sugar is sugar. Repeat it to yourself a hundred, no wait, a thousand times a day. I tell my patients this all the time. What that means is that a glucose molecule from whole wheat bread is no different than if it came from broccoli, or a snickers bar, or from table sugar, and on and on and on.
The fact is when glucose is presented to our cells our cells cannot distinguish where that glucose molecule came from, because all glucose molecules look exactly the same to the cell.
Glucose is no good to us unless it gets inside our cells, which is where all the modifications to it take place. The thing that allows glucose to get into the cell is something called insulin. The pancreas makes insulin and squirts it into our bloodstream every time the pancreas sees sugar. If glucose cannot get into the cell it will remain in the bloodstream. When glucose stays in the bloodstream it begins to attach to the cell’s outer surfaces causing distortions and malfunctioning of organs. This is why diabetics have problems like blindness, need dialysis and may have to have amputations.
Again, it is all about the sugar. I will be talking more about diabetes in a later chapter.
To think that our cells can tell where the glucose came from, say from a vegetable or a snickers bar, is ignorant. In order for the cell to do this it would need to be able to know what we ate. And then the cell would have to say to itself, "Ah hah, this glucose molecule came from a snickers bar, so I'm going to do bad things with it." Or the cell would say, "Alright, this glucose molecule came from broccoli so let's do good things with it." And what would happen if we ate a snickers bar along with broccoli would our cells be able to tell the difference between the glucose molecules now?
Of course not, but this is exactly what medical professionals suggest when they say snickers bars have bad sugar and broccoli has good sugar. There is no such thing. Sugar is sugar is sugar. And it is all treated the same way when it gets to the cell.
Now do not think for a second that I do not care what you are eating sugar wise. I would much prefer the green leafy vegetable to the snickers bar. My point is that when following a low carb diet, all sugars count.
One of the most interesting things that started happening when I first started placing patients on low carb diets (and from now on when I say low carb, you probably already figured out I also mean more fat, more cholesterol and more protein) was that they would say they were doing low carb, but their cholesterol and TGs would come back elevated. As a doctor I am unique as I actually listen to and believe my patients. Most docs would suspect their patients were lying, but I do not until the evidence presents itself to the contrary. Anyway, when the TG and cholesterol numbers came back elevated I began to ask about everything my patients were eating. No luck, all low carb.
I was perplexed and left scratching my head, then, Eureka! I got it.
I was asking them what they were eating, but I was not asking them what they were drinking. I know it sounds ignorant on my part and it was.
When I began to ask what my patients with the elevated TGs and cholesterol were drinking it almost always turned out to be some kind of fruit juice. When I asked them to stop drinking the juice I would always get these weird looks. Some would say "What do you mean, everyone knows fruit juice is good for you because it is a natural sugar." Guess what happened to the TGs and cholesterol numbers when the juice was stopped. Good guess, you figured out immediately that the TG and cholesterol numbers dropped, sometimes significantly. Here's why.
The sugar in fruit is fructose. It is not too much different in structure when compared to glucose. Fructose is easily changed to glucose by a simple method. (Called isomerization.) Once fructose is changed to glucose, it is treated the same way extra glucose is; it is converted to TGs and cholesterol. So the sugar in the fruits we eat can and will be converted into the very things fruit does not contain, that is, fats and cholesterol. Let us hear another big Oopps!
OK, here is one for you. What would you say if I told you that if you eat a piece of fruit and a snickers bar the sugar from the fruit will wind up in the fat cells a lot quicker than the sugar in the snickers bar. So we get fatter, quicker, by eating fruit. The reason: because the sugar in the snickers bar, mainly glucose, has to go through the liver before it can get to the fat cell. Since the number one storage fuel molecule in our fat cells is fructose and since the sugar in fruit is already fructose; less change is needed and the fructose from the fruit goes directly into the fat cell. Yes, we do get fat by eating fruit.
"But Hey," I hear everyone yelling, fruit is natural, so it has to be good. My comment, arsenic and cyanide are natural, but I would not eat them. Ok maybe a bad comparison, but is it? This so called natural sugar will allow us to get fatter, increase our TGs, lower our HDLs, worsen our diabetes, increase our blood pressure and increase our risk of cancer. And I can go on and on. I tell my patients fruit is a poison, especially to diabetics and I mean it when I say, don’t eat it!
Enough about sugar. Let us talk about something really interesting. Let's talk about what I like to call the dirty little hormone; Insulin.
There are risks and costs to a program of action. But they are far less then the long range risks and costs of comfortable inaction
-John F Kennedy
Dr. James E. Carlson B.S.,D.O.,M.B.A.,J.D.
Please go to Amazon.com to order my book or go to DrJamesCarlson.com and request a digital copy of my book for only $11.99!
Sugar is very important to discuss. I have already mentioned sugar a bunch of times. I have already shared the biggest secret that fat and cholesterol production starts with sugar. So now let us really learn about sugar.
We all have heard of sugar. It comes in many varieties. There are your simple sugars like glucose (the most popular) and fructose (found in fruit). Then you have the weirder ones like galactose, xylose, allose, and ribose. The big fancy way to refer to these sugars is by calling them monosaccharides since they only consist of a single sugar molecule. Some of these you may have heard of, others even your doctor has never heard of.
Now there are your more complex types of sugars where two sugars are attached to one another. The three most common are sucrose (table sugar), lactose (found in milk) and maltose. These sugars need to be broken down before our body can use them. They are referred to as disaccharides with the di referring to the fact there are two sugar molecules attached to one another.
Let us now talk a little bit about carbs and where they fit in. Carbs are basically glucose molecules all strung together like beads on a string. The beads would represent a glucose molecule. Sometimes these string beads are short. Sometimes there are millions of beads on a string.
Before we can use the glucose in a long string the string would need to be broken down into its single beads or glucose molecules. After the body has done this the glucose may now be treated in different ways. If there is an overabundance of glucose in the system, as is often the case, the glucose will be stored first in the liver and then in muscles. After the liver and muscles have their fill the glucose molecule will be used to make cholesterol and TGs and the extra TGs will be stored as fat on our bodies. It does not take long to fill up our livers and muscles with glucose. Since it does not take long to fill up our livers and muscles and since most people eat more glucose then they should, there is plenty of sugar left over to make cholesterol, TGs and to store as fat.
The current recommendation for carbohydrate intake is somewhere between two hundred to two hundred fifty grams of carbohydrates per day. No one, and I mean no one, should be consuming this amount of carbs in their diet. Obesity, heart disease, diabetes, and cancer (and I will discuss the link between carbs and cancer later) are being seen more and more in our society. We are even seeing in children younger than ten what were once thought to be diseases of adults; that is, obesity and diabetes.
Most of the medical profession is scratching their heads trying to figure out why this is so. The answer sadly enough is right before their eyes, but the medical physicians just cannot see it. We have more and more people on low fat, low cholesterol diets and this includes our children. When we follow a low fat, low cholesterol diet, we must consume more carbs. As we consume more carbs we send all the signals to our body to get fat and make more cholesterol. Eating less cholesterol sends the signal to make more cholesterol. We are shortening the life expectancy of our children by the continuous propagation of the low cholesterol, low fat diet.
To me, being a part of the medical profession that is promulgating this deadly diet is embarrassing. Why is it that more docs have not figured out that when one follows a low fat, low cholesterol diet, they wind up less healthy then when they started?
Why?
Again, it is because we are not trained to think for ourselves in medical school. We are told to just listen and leave all the thinking to the specialists, or the doctors on the 'special' committees.
Unfortunately, it is these specialists or committee members who are the blindest. They continue to espouse low fat, low cholesterol diets, continue to tell us that eating whole grains and fruits are good for you and continue to mistakenly believe that it is a lack of physical exercise which is the main contributor to the obesity epidemic. This is just plain wrong. Why is it that I have had many cases where I have dealt with morbidly obese patients who I start on a low carb diet, who lose significant amounts of weight before they even start an exercise regimen? Yes, these patients start to lose weight and lots of it, before they started exercising. If what the experts say is true this should not be happening. But it does, every single day in my practice.
Now do not get me wrong. I am not saying exercise is not important. It is and it is very important. It does accelerate weight loss when done correctly. But to tell a patient with knee pain to start walking when they are three hundred pounds is negligent. How about we take some weight off, say, fifty pounds and then have them start walking. This way there is less stress and strain on the hips, knees and ankles when they start walking. This just makes sense to me.
OK, I digressed again, let us get back to our discussion of sugar.
Another huge problem is that our medical professionals would like you to believe that the same sugar molecules are somehow different. For instance, that if the sugar molecule is from fruit, it is natural and that is OK. Or, if it comes from whole wheat, again, it is natural and that's fine.
Well, I am here to stop that myth. Please remember that sugar is sugar is sugar. Repeat it to yourself a hundred, no wait, a thousand times a day. I tell my patients this all the time. What that means is that a glucose molecule from whole wheat bread is no different than if it came from broccoli, or a snickers bar, or from table sugar, and on and on and on.
The fact is when glucose is presented to our cells our cells cannot distinguish where that glucose molecule came from, because all glucose molecules look exactly the same to the cell.
Glucose is no good to us unless it gets inside our cells, which is where all the modifications to it take place. The thing that allows glucose to get into the cell is something called insulin. The pancreas makes insulin and squirts it into our bloodstream every time the pancreas sees sugar. If glucose cannot get into the cell it will remain in the bloodstream. When glucose stays in the bloodstream it begins to attach to the cell’s outer surfaces causing distortions and malfunctioning of organs. This is why diabetics have problems like blindness, need dialysis and may have to have amputations.
Again, it is all about the sugar. I will be talking more about diabetes in a later chapter.
To think that our cells can tell where the glucose came from, say from a vegetable or a snickers bar, is ignorant. In order for the cell to do this it would need to be able to know what we ate. And then the cell would have to say to itself, "Ah hah, this glucose molecule came from a snickers bar, so I'm going to do bad things with it." Or the cell would say, "Alright, this glucose molecule came from broccoli so let's do good things with it." And what would happen if we ate a snickers bar along with broccoli would our cells be able to tell the difference between the glucose molecules now?
Of course not, but this is exactly what medical professionals suggest when they say snickers bars have bad sugar and broccoli has good sugar. There is no such thing. Sugar is sugar is sugar. And it is all treated the same way when it gets to the cell.
Now do not think for a second that I do not care what you are eating sugar wise. I would much prefer the green leafy vegetable to the snickers bar. My point is that when following a low carb diet, all sugars count.
One of the most interesting things that started happening when I first started placing patients on low carb diets (and from now on when I say low carb, you probably already figured out I also mean more fat, more cholesterol and more protein) was that they would say they were doing low carb, but their cholesterol and TGs would come back elevated. As a doctor I am unique as I actually listen to and believe my patients. Most docs would suspect their patients were lying, but I do not until the evidence presents itself to the contrary. Anyway, when the TG and cholesterol numbers came back elevated I began to ask about everything my patients were eating. No luck, all low carb.
I was perplexed and left scratching my head, then, Eureka! I got it.
I was asking them what they were eating, but I was not asking them what they were drinking. I know it sounds ignorant on my part and it was.
When I began to ask what my patients with the elevated TGs and cholesterol were drinking it almost always turned out to be some kind of fruit juice. When I asked them to stop drinking the juice I would always get these weird looks. Some would say "What do you mean, everyone knows fruit juice is good for you because it is a natural sugar." Guess what happened to the TGs and cholesterol numbers when the juice was stopped. Good guess, you figured out immediately that the TG and cholesterol numbers dropped, sometimes significantly. Here's why.
The sugar in fruit is fructose. It is not too much different in structure when compared to glucose. Fructose is easily changed to glucose by a simple method. (Called isomerization.) Once fructose is changed to glucose, it is treated the same way extra glucose is; it is converted to TGs and cholesterol. So the sugar in the fruits we eat can and will be converted into the very things fruit does not contain, that is, fats and cholesterol. Let us hear another big Oopps!
OK, here is one for you. What would you say if I told you that if you eat a piece of fruit and a snickers bar the sugar from the fruit will wind up in the fat cells a lot quicker than the sugar in the snickers bar. So we get fatter, quicker, by eating fruit. The reason: because the sugar in the snickers bar, mainly glucose, has to go through the liver before it can get to the fat cell. Since the number one storage fuel molecule in our fat cells is fructose and since the sugar in fruit is already fructose; less change is needed and the fructose from the fruit goes directly into the fat cell. Yes, we do get fat by eating fruit.
"But Hey," I hear everyone yelling, fruit is natural, so it has to be good. My comment, arsenic and cyanide are natural, but I would not eat them. Ok maybe a bad comparison, but is it? This so called natural sugar will allow us to get fatter, increase our TGs, lower our HDLs, worsen our diabetes, increase our blood pressure and increase our risk of cancer. And I can go on and on. I tell my patients fruit is a poison, especially to diabetics and I mean it when I say, don’t eat it!
Enough about sugar. Let us talk about something really interesting. Let's talk about what I like to call the dirty little hormone; Insulin.
There are risks and costs to a program of action. But they are far less then the long range risks and costs of comfortable inaction
-John F Kennedy
Dr. James E. Carlson B.S.,D.O.,M.B.A.,J.D.
Please go to Amazon.com to order my book or go to DrJamesCarlson.com and request a digital copy of my book for only $11.99!
Tuesday, May 26, 2009
Chapter 6 of Genocide:How Your Doctor's Dietary Ignorance Will Kill You
CHAPTER SIX- CALORIES
This topic really burns me up. OK, sorry. I couldn't resist. So who can tell me what a calorie is? Any takers? Give up? All right, a calorie is the amount of heat needed to raise the temperature of one gram of water by one degree in the Celsius scale. This definition is referenced and repeated in numerous scientific and medical textbooks. Now the next question I ask is, "What the heck does this have to do with human nutrition?" The short answer is absolutely nothing. Now the longer answer.
It seems that wherever you turn someone is harping on the calorie. Calorie this and calorie that. Lower your caloric intake and you will lose weight. Increase your calories and stop exercising and you will gain weight. I am here to tell you that this is simply false.
Over the last nine years of starting my patients on low carb, more fat, more cholesterol and more protein diets, I have seen HDLs double, type 2 diabetics cured, blood pressures that were once difficult to control become normal, thousands of pounds lost, TGs lowered to normal; all this while usually increasing the caloric intake.
I actually had one patient who went from consuming 2000 calories a day to eating 6000-8000 calories a day and while keeping his exercise regimen the same, lost weight! That is correct, he increased his caloric intake, did not increase his exercise level and lost weight. This seems to defy the senses. My patient did not understand it. I did not understand it because I was ignorant. Then I did what very few doctors even dare to do when it comes to nutritional science. I started to think for myself. And I figured out why using the calorie as a dietary guide is a waste of time.
I defined what a calorie is above. But how do we go about determining how many calories are in, say, a burger, or a piece of lettuce. When we buy a food product at the supermarket there is nutritional information on the side-packaging label. One of the first things we are told to look for is 'how many calories are there per serving.' So we look and we see how many calories there are.
But I still have not answered the question as to how we actually measure calories. Well it is really quite simple. What we do is we take the food item we wish to measure and burn it in a closed container. This container is filled with water and also has a thermometer in it. We watch how many degrees change on the thermometer and each degree change represents a calorie. So for instance, if we burn a quarter pound of meat in this container (called a calorimeter, by the way), and the temperature goes up two hundred degrees, that represents two hundred calories.
Generally only a single food item is burned. But one can burn the whole, say, quarter pounder with cheese and see what the degree change is; thus arriving at how many calories existed in that particular food item.
The problem with the calorie is that this measurement occurs in a closed system. A closed system is one where we know everything that is happening within that system. And I mean everything.
For instance, I know what the thing weighs that I am burning; I know the size of the container I'm using; I know the starting and ending temperature on the thermometer; I know how much water is in the container, and so on.
Now, our bodies are not closed systems they are open systems. This means we have only a general idea of what happens when we eat, say, a quarter pounder. So what happens when we eat a quarter pound of meat? Well, first we need to chew this food and then swallow it. It gets to the stomach where the digestive process continues. When the meat leaves the stomach and enters the small intestine this is where the problems start.
When the quarter pound of meat finds its way into the first part of the small intestine (known as the duodenum), pandemonium begins. A bunch of enzymes and hormones are released from the pancreas and small intestine, bile is secreted from the gallbladder to help with digestion and all of these enzymes interact in such a complex way that we are still trying to figure out what is going on. If any of you doctors think we, as physicians, understand the whole digestive process all I can say is sitagliptin.
For my non-physician readers I apologize, but I need to make a point to underscore the continued ignorance of us docs. For my docs, please do not take offence and do not confuse ignorance with stupidity. Stupidity is difficulty in understanding a topic, and I do not like the word at all.
Ignorance occurs when we really, truly, honestly just do not know because we just have not been smart enough to discover something yet.
OK, so I said sitagliptin. This is a new medication for type 2 diabetics only. It is a dipeptidyl-peptidase 4-enzyme inhibitor. This newly discovered entity works by interfering with certain things secreted by the intestine. No, this is not the part of the book where I lose everyone. I am just trying to make a point. We docs only found out about this over the last few years and we had no idea how important this thing was in sugar regulation. So for anyone who thinks we know it all by now, especially with digestion, you are sadly mistaken because we have only just uncovered the proverbial tip of the iceberg.
So getting back to where we were there is no way to exactly measure anything other than the weight of what you ate. That is it. Once we swallow the food so many complex things occur there is absolutely no way to keep track of everything that happens during the digestive process.
So let us put everything together. Remember the closed system versus the open system. In a closed system we know everything and I mean everything that is happening. In the open system we know very little as there are so many different variables. So my problem with the calorie is that it is only useful if you want to know how much heat will be generated from the food you ate. That is it.
Not to sound silly but when we eat food the food does not just go into the belly and get burned up and that's it. Humans do not burn food, we digest it. To say there is four hundred calories in a given food item disregards the fact and I mean fact, that the calorie only tells us how much heat will be given off when you burn the food in a closed, regulated environment.
I ask again, "What does the calorie have to do with human nutrition?' And my answer remains the same--Nothing. That is why when many of my patients increase their caloric intake, which we know now means nothing anyway, they lose weight. This is because they are eating foods which encourage the whole fat burning process. And when you put into motion the fat burning process not only are you not storing fat, but also you are not making cholesterol, your blood pressure lowers and your blood sugars normalize. But these are subjects for other chapters.
If, on the other hand, one eats carbs now you wll set into motion all the body needs to make all the bad stuff. It just so happens that one-gram of carbs and protein contain four calories, whereas one gram of fat contains nine calories. This is why we are told to avoid fat because it has more calories than carbs and protein per gram. The reasoning is that if we eat fat we ingest more calories to burn as opposed to the consumption of carbs and protein. And then, the argument continues, you will get fatter by eating the fat, again, because it contains more calories.
As a side note, notice that whenever we talk about calories we use the word 'burn'. Like, since you ate all that fat, now you have to 'burn' it off. Or, I ate so much when I was on vacation I have to 'burn' it all off now. Well, where do you think this term 'burn' is derived from? Exactly, from the same way we determined the calorie in the first place; remember we 'burned' the stuff in the container.
So when I am in the examining room with my patients and the term calorie comes up, I immediately tell them that the calorie is irrelevant. I tell them that a calorie measurement is only useful if you want to know how much heat is given off when you burn something. I also add that our bodies do not work that way, we do not burn, we digest. I explain about the calorimeter and tell them this container burns things, it does not digest like we do. And the final thing I say is that if "I were king for a day, I would eliminate the term calorie from all the side packaging information labels." What would I put there? How many carbs, protein, fat, cholesterol, vitamins, minerals, fiber, sugar alcohols (which we will talk about later), and to list the presence or absence of trans fats (which we will talk about later as well).
Myths which are believed in tend to become true
-George Orwell
Dr. James E. Carlson B.S.,D.O.,M.B.A.,J.D.
Please go to Amazon.com to order my book or go to DrJamesCarlson.com and request a digital copy of my book for only $11.99!
This topic really burns me up. OK, sorry. I couldn't resist. So who can tell me what a calorie is? Any takers? Give up? All right, a calorie is the amount of heat needed to raise the temperature of one gram of water by one degree in the Celsius scale. This definition is referenced and repeated in numerous scientific and medical textbooks. Now the next question I ask is, "What the heck does this have to do with human nutrition?" The short answer is absolutely nothing. Now the longer answer.
It seems that wherever you turn someone is harping on the calorie. Calorie this and calorie that. Lower your caloric intake and you will lose weight. Increase your calories and stop exercising and you will gain weight. I am here to tell you that this is simply false.
Over the last nine years of starting my patients on low carb, more fat, more cholesterol and more protein diets, I have seen HDLs double, type 2 diabetics cured, blood pressures that were once difficult to control become normal, thousands of pounds lost, TGs lowered to normal; all this while usually increasing the caloric intake.
I actually had one patient who went from consuming 2000 calories a day to eating 6000-8000 calories a day and while keeping his exercise regimen the same, lost weight! That is correct, he increased his caloric intake, did not increase his exercise level and lost weight. This seems to defy the senses. My patient did not understand it. I did not understand it because I was ignorant. Then I did what very few doctors even dare to do when it comes to nutritional science. I started to think for myself. And I figured out why using the calorie as a dietary guide is a waste of time.
I defined what a calorie is above. But how do we go about determining how many calories are in, say, a burger, or a piece of lettuce. When we buy a food product at the supermarket there is nutritional information on the side-packaging label. One of the first things we are told to look for is 'how many calories are there per serving.' So we look and we see how many calories there are.
But I still have not answered the question as to how we actually measure calories. Well it is really quite simple. What we do is we take the food item we wish to measure and burn it in a closed container. This container is filled with water and also has a thermometer in it. We watch how many degrees change on the thermometer and each degree change represents a calorie. So for instance, if we burn a quarter pound of meat in this container (called a calorimeter, by the way), and the temperature goes up two hundred degrees, that represents two hundred calories.
Generally only a single food item is burned. But one can burn the whole, say, quarter pounder with cheese and see what the degree change is; thus arriving at how many calories existed in that particular food item.
The problem with the calorie is that this measurement occurs in a closed system. A closed system is one where we know everything that is happening within that system. And I mean everything.
For instance, I know what the thing weighs that I am burning; I know the size of the container I'm using; I know the starting and ending temperature on the thermometer; I know how much water is in the container, and so on.
Now, our bodies are not closed systems they are open systems. This means we have only a general idea of what happens when we eat, say, a quarter pounder. So what happens when we eat a quarter pound of meat? Well, first we need to chew this food and then swallow it. It gets to the stomach where the digestive process continues. When the meat leaves the stomach and enters the small intestine this is where the problems start.
When the quarter pound of meat finds its way into the first part of the small intestine (known as the duodenum), pandemonium begins. A bunch of enzymes and hormones are released from the pancreas and small intestine, bile is secreted from the gallbladder to help with digestion and all of these enzymes interact in such a complex way that we are still trying to figure out what is going on. If any of you doctors think we, as physicians, understand the whole digestive process all I can say is sitagliptin.
For my non-physician readers I apologize, but I need to make a point to underscore the continued ignorance of us docs. For my docs, please do not take offence and do not confuse ignorance with stupidity. Stupidity is difficulty in understanding a topic, and I do not like the word at all.
Ignorance occurs when we really, truly, honestly just do not know because we just have not been smart enough to discover something yet.
OK, so I said sitagliptin. This is a new medication for type 2 diabetics only. It is a dipeptidyl-peptidase 4-enzyme inhibitor. This newly discovered entity works by interfering with certain things secreted by the intestine. No, this is not the part of the book where I lose everyone. I am just trying to make a point. We docs only found out about this over the last few years and we had no idea how important this thing was in sugar regulation. So for anyone who thinks we know it all by now, especially with digestion, you are sadly mistaken because we have only just uncovered the proverbial tip of the iceberg.
So getting back to where we were there is no way to exactly measure anything other than the weight of what you ate. That is it. Once we swallow the food so many complex things occur there is absolutely no way to keep track of everything that happens during the digestive process.
So let us put everything together. Remember the closed system versus the open system. In a closed system we know everything and I mean everything that is happening. In the open system we know very little as there are so many different variables. So my problem with the calorie is that it is only useful if you want to know how much heat will be generated from the food you ate. That is it.
Not to sound silly but when we eat food the food does not just go into the belly and get burned up and that's it. Humans do not burn food, we digest it. To say there is four hundred calories in a given food item disregards the fact and I mean fact, that the calorie only tells us how much heat will be given off when you burn the food in a closed, regulated environment.
I ask again, "What does the calorie have to do with human nutrition?' And my answer remains the same--Nothing. That is why when many of my patients increase their caloric intake, which we know now means nothing anyway, they lose weight. This is because they are eating foods which encourage the whole fat burning process. And when you put into motion the fat burning process not only are you not storing fat, but also you are not making cholesterol, your blood pressure lowers and your blood sugars normalize. But these are subjects for other chapters.
If, on the other hand, one eats carbs now you wll set into motion all the body needs to make all the bad stuff. It just so happens that one-gram of carbs and protein contain four calories, whereas one gram of fat contains nine calories. This is why we are told to avoid fat because it has more calories than carbs and protein per gram. The reasoning is that if we eat fat we ingest more calories to burn as opposed to the consumption of carbs and protein. And then, the argument continues, you will get fatter by eating the fat, again, because it contains more calories.
As a side note, notice that whenever we talk about calories we use the word 'burn'. Like, since you ate all that fat, now you have to 'burn' it off. Or, I ate so much when I was on vacation I have to 'burn' it all off now. Well, where do you think this term 'burn' is derived from? Exactly, from the same way we determined the calorie in the first place; remember we 'burned' the stuff in the container.
So when I am in the examining room with my patients and the term calorie comes up, I immediately tell them that the calorie is irrelevant. I tell them that a calorie measurement is only useful if you want to know how much heat is given off when you burn something. I also add that our bodies do not work that way, we do not burn, we digest. I explain about the calorimeter and tell them this container burns things, it does not digest like we do. And the final thing I say is that if "I were king for a day, I would eliminate the term calorie from all the side packaging information labels." What would I put there? How many carbs, protein, fat, cholesterol, vitamins, minerals, fiber, sugar alcohols (which we will talk about later), and to list the presence or absence of trans fats (which we will talk about later as well).
Myths which are believed in tend to become true
-George Orwell
Dr. James E. Carlson B.S.,D.O.,M.B.A.,J.D.
Please go to Amazon.com to order my book or go to DrJamesCarlson.com and request a digital copy of my book for only $11.99!
Friday, May 22, 2009
Chapter 5 of Genocide:How Your Doctor's Dietary Ignorance Will Kill You
CHAPTER FIVE-THE FRIEDEWALD EQUATION-AN EXTREME DEMONSTRATION IN PHYSICIAN IGNORANCE
There is a show out now called, 'Are You Smarter Than A 5th Grader?'
For most docs when it comes to understanding math, I mean really basic math, the overwhelming answer will be no. Let's face it, when most people hear the word math, they cringe, their bellies tighten up and some of us may even vomit. But I am not talking about calculus or even algebra. What I am referring to here is simple addition, subtraction and division. You do not even need to multiply (thank goodness).
Let me explain what this equation is and why it is important you understand it.
So what exactly is this Friedewald Equation anyway? In the US when you go to the lab to have your lipid profile checked there are only three things measured. These are the Total Cholesterol, the HDL and the triglycerides. These three values are then used to calculate the LDL. It is important to realize that the LDL is not measured directly from the blood. This has profound implications when one is trying to interpret the lipid profile.
The equation states that the LDL is equal to the Total Cholesterol minus the HDL and subtracted from this is the triglycerides divided by 5 (see below).
LDL (calculated) = Total Cholesterol - HDL - TG/5
So when you give your blood the numbers of the total cholesterol, the HDL and TGs are placed into the equation and voila, out comes your LDL. Now look very carefully at how simple this equation is. It is simple, is it not? What do you notice? There is a lot of subtraction going on and one fraction. This fraction is important because as you divide the same number into a lower number what do you think happens? For instance, divide one hundred by five. You get twenty of course. Now divide fifty, a lower number, by five. Now we get ten. So dividing a lower number by the same number results in a LOWER number.
It is quite simple.
This lower number is particularly important because it is being subtracted from another part of the equation. So what happens if you subtract a lower number from something? Unless you are dealing with negative integers you will get a HIGHER number. As an example, subtract five from ten. The result is five. Now subtract two, a lower number from ten and eight is the result. Eight is higher than five. Still not so tricky.
Now let us digress a little and talk about what the total cholesterol really means. We have not done this yet and it really is quite simple. The total cholesterol is just that, the total cholesterol. We arrive at the total cholesterol by adding together the HDL, LDL (remember the LDL is calculated here, not measured) and the VLDL (for some reason the IDL does not even get honorable mention). So the equation looks like this:
Total Cholesterol = HDL + LDL + VLDL; where VLDL = TG/5
Now, what do you think happens to the total cholesterol if you increase, say, the LDL? That is correct, the total goes up. What about if the VLDL increases? Uh huh, the total goes up. Wait a minute. What if the HDL goes up? Bingo, so too will the total cholesterol.
As a very, very important side note, this is why when one begins to lower their carbs and to eat more fat and cholesterol the total cholesterol may increase. So it is very important NOT to panic. A very common scenario is the following; a patient figures out that the correct way to eat is to eat less carbs and to eat more fat, protein, and cholesterol. They go for their lab work and their doc notices that while the HDL went up dramatically the total cholesterol went up too. Then the patient is admonished against what they did. They are told those diets are bad for you. Then they are told to start a low fat, low cholesterol diet and guess what; when they check their numbers out in a few months they are so bad they wind up on cholesterol lowering medications.
This is an absolute tragedy. The physician who advises their patient to abandon a low carb, more fat, more cholesterol, more protein diet because the total cholesterol went up, but so, too, did the HDL, is demonstrating extreme ignorance of what total cholesterol is all about. This should never happen, but yet it happens every day. Every single day in almost all physician’s offices all over the world. But wait, it gets even worse.
Remember I said it is important to know that LDL is calculated, not measured. The reason this is important is because when the HDL goes up the total cholesterol may go up. And when the TGs go down you wind up subtracting a smaller number from the rest of the equation. Well, look at the equation. What will happen to your total cholesterol when you raise your HDL? That is correct, it will go up. Again, look at the equation. What do you think you will get when you subtract a higher HDL from a higher total cholesterol? And remember, the total cholesterol is higher because the HDL is higher. Let us do some math together to figure it out.
Subtract thirty-five, a common HDL to see, from a total cholesterol of two hundred thirty. You get one hundred ninety five. Now subtract fifty, a pretty common rise to see when you are eating the correct way, from a total cholesterol of two hundred sixty five. We now get two hundred fifteen. Do some more to prove it to yourself. The point, to say it again, is that when we subtract a higher number from a higher number we wind up with a higher number. Now when we subtract a smaller number from this higher number the result will be a higher number. The smaller number we are subtracting results from the TGs being lower when we lower our carb intake and eat more fat and cholesterol. And from the above discussion we have seen that when we divide a lower number by the same number the result is a lower number. It is this lower number we are subtracting form the higher number we arrived at above.
So the end result to the calculated LDL value when your total cholesterol and HDL go up and your triglycerides go lower, IS THAT THE LDL GOES HIGHER BECAUSE OF THE WAY IT IS CALCULATED! We want the HDL to go higher. We want the fats in your blood to be lower. When this happens it will oftentimes raise the LDL. No, it does not happen in everyone, but it happens in just about everyone and it is solely due to the way the LDL is calculated.
Now guess what happens when you walk into your doc's office after spending three months eating the way you should. Your HDL will be higher, which is great, but this may make the total cholesterol increase. Your triglycerides will be lower, which is awesome because that is what you want. But your LDL will be higher. Again, based on the formula the lab uses to calculate the LDL, the LDL will be higher when your HDL is higher and your TGs are lower.
When your doctor reads your lab report do you really think that she or he is going to say, "Wow, great, everything's fantastic!" Not a chance. All your doc sees is an elevated total cholesterol and an elevated LDL. They panic, your doctor that is, and immediately want to place you on cholesterol lowering meds. But wait a minute; if they are so interested in lowering the calculated LDL we can do this by raising your TGs or lowering your HDL: exactly what we do not want to do.
Just to bring everyone up to date. I think the latest guidelines say to keep the LDL below seventy if you have risk factors for heart disease. I have difficulty with this concept because we are using the calculated LDL and we are not measuring it directly. Sure, the cholesterol lowering meds work, but all too often I see well trained cardiologists freaking out because they cannot get the calculated LDL below seventy, or even one-hundred for that matter. And they will just keep pushing the dose higher and higher and higher. If they just stopped and thought the process through they would realize that in the vast majority of people this approach will not work.
Why?
Because their patient’s TGs may be low and their HDLs may be where they should be, so based on the calculation, the LDL will never get below 70.
But one cannot really harp on these docs for what they are doing. They are simply doing what they were trained to do. They apply the guidelines, do not think for themselves and they push the accepted medications for the treatment of cholesterol. But this would still be defined as ignorance, would it not? And whom do we blame for the millions of people who die each year because of this?
The lipid profile numbers that we should be paying attention to are the HDL and TGs only. What I like to use is the TG to HDL ratio. Keep this ration at or under two and you are sitting pretty. If it rises above two, be careful, because now not only are you looking at an increased risk of heart disease, but also diabetes and cancer. Two other diseases we will be discussing shortly.
Now on to chapter six.
Men occasionally stumble over the truth, but most of them pick themselves up and hurry off as if nothing had happened
-Winston Churchill
Comments, anyone :-)
Dr. James E. Carlson B.S.,D.O.,M.B.A.,J.D.
Please go to Amazon.com to order my book or go to DrJamesCarlson.com and request a digital copy of my book for only $11.99!
There is a show out now called, 'Are You Smarter Than A 5th Grader?'
For most docs when it comes to understanding math, I mean really basic math, the overwhelming answer will be no. Let's face it, when most people hear the word math, they cringe, their bellies tighten up and some of us may even vomit. But I am not talking about calculus or even algebra. What I am referring to here is simple addition, subtraction and division. You do not even need to multiply (thank goodness).
Let me explain what this equation is and why it is important you understand it.
So what exactly is this Friedewald Equation anyway? In the US when you go to the lab to have your lipid profile checked there are only three things measured. These are the Total Cholesterol, the HDL and the triglycerides. These three values are then used to calculate the LDL. It is important to realize that the LDL is not measured directly from the blood. This has profound implications when one is trying to interpret the lipid profile.
The equation states that the LDL is equal to the Total Cholesterol minus the HDL and subtracted from this is the triglycerides divided by 5 (see below).
LDL (calculated) = Total Cholesterol - HDL - TG/5
So when you give your blood the numbers of the total cholesterol, the HDL and TGs are placed into the equation and voila, out comes your LDL. Now look very carefully at how simple this equation is. It is simple, is it not? What do you notice? There is a lot of subtraction going on and one fraction. This fraction is important because as you divide the same number into a lower number what do you think happens? For instance, divide one hundred by five. You get twenty of course. Now divide fifty, a lower number, by five. Now we get ten. So dividing a lower number by the same number results in a LOWER number.
It is quite simple.
This lower number is particularly important because it is being subtracted from another part of the equation. So what happens if you subtract a lower number from something? Unless you are dealing with negative integers you will get a HIGHER number. As an example, subtract five from ten. The result is five. Now subtract two, a lower number from ten and eight is the result. Eight is higher than five. Still not so tricky.
Now let us digress a little and talk about what the total cholesterol really means. We have not done this yet and it really is quite simple. The total cholesterol is just that, the total cholesterol. We arrive at the total cholesterol by adding together the HDL, LDL (remember the LDL is calculated here, not measured) and the VLDL (for some reason the IDL does not even get honorable mention). So the equation looks like this:
Total Cholesterol = HDL + LDL + VLDL; where VLDL = TG/5
Now, what do you think happens to the total cholesterol if you increase, say, the LDL? That is correct, the total goes up. What about if the VLDL increases? Uh huh, the total goes up. Wait a minute. What if the HDL goes up? Bingo, so too will the total cholesterol.
As a very, very important side note, this is why when one begins to lower their carbs and to eat more fat and cholesterol the total cholesterol may increase. So it is very important NOT to panic. A very common scenario is the following; a patient figures out that the correct way to eat is to eat less carbs and to eat more fat, protein, and cholesterol. They go for their lab work and their doc notices that while the HDL went up dramatically the total cholesterol went up too. Then the patient is admonished against what they did. They are told those diets are bad for you. Then they are told to start a low fat, low cholesterol diet and guess what; when they check their numbers out in a few months they are so bad they wind up on cholesterol lowering medications.
This is an absolute tragedy. The physician who advises their patient to abandon a low carb, more fat, more cholesterol, more protein diet because the total cholesterol went up, but so, too, did the HDL, is demonstrating extreme ignorance of what total cholesterol is all about. This should never happen, but yet it happens every day. Every single day in almost all physician’s offices all over the world. But wait, it gets even worse.
Remember I said it is important to know that LDL is calculated, not measured. The reason this is important is because when the HDL goes up the total cholesterol may go up. And when the TGs go down you wind up subtracting a smaller number from the rest of the equation. Well, look at the equation. What will happen to your total cholesterol when you raise your HDL? That is correct, it will go up. Again, look at the equation. What do you think you will get when you subtract a higher HDL from a higher total cholesterol? And remember, the total cholesterol is higher because the HDL is higher. Let us do some math together to figure it out.
Subtract thirty-five, a common HDL to see, from a total cholesterol of two hundred thirty. You get one hundred ninety five. Now subtract fifty, a pretty common rise to see when you are eating the correct way, from a total cholesterol of two hundred sixty five. We now get two hundred fifteen. Do some more to prove it to yourself. The point, to say it again, is that when we subtract a higher number from a higher number we wind up with a higher number. Now when we subtract a smaller number from this higher number the result will be a higher number. The smaller number we are subtracting results from the TGs being lower when we lower our carb intake and eat more fat and cholesterol. And from the above discussion we have seen that when we divide a lower number by the same number the result is a lower number. It is this lower number we are subtracting form the higher number we arrived at above.
So the end result to the calculated LDL value when your total cholesterol and HDL go up and your triglycerides go lower, IS THAT THE LDL GOES HIGHER BECAUSE OF THE WAY IT IS CALCULATED! We want the HDL to go higher. We want the fats in your blood to be lower. When this happens it will oftentimes raise the LDL. No, it does not happen in everyone, but it happens in just about everyone and it is solely due to the way the LDL is calculated.
Now guess what happens when you walk into your doc's office after spending three months eating the way you should. Your HDL will be higher, which is great, but this may make the total cholesterol increase. Your triglycerides will be lower, which is awesome because that is what you want. But your LDL will be higher. Again, based on the formula the lab uses to calculate the LDL, the LDL will be higher when your HDL is higher and your TGs are lower.
When your doctor reads your lab report do you really think that she or he is going to say, "Wow, great, everything's fantastic!" Not a chance. All your doc sees is an elevated total cholesterol and an elevated LDL. They panic, your doctor that is, and immediately want to place you on cholesterol lowering meds. But wait a minute; if they are so interested in lowering the calculated LDL we can do this by raising your TGs or lowering your HDL: exactly what we do not want to do.
Just to bring everyone up to date. I think the latest guidelines say to keep the LDL below seventy if you have risk factors for heart disease. I have difficulty with this concept because we are using the calculated LDL and we are not measuring it directly. Sure, the cholesterol lowering meds work, but all too often I see well trained cardiologists freaking out because they cannot get the calculated LDL below seventy, or even one-hundred for that matter. And they will just keep pushing the dose higher and higher and higher. If they just stopped and thought the process through they would realize that in the vast majority of people this approach will not work.
Why?
Because their patient’s TGs may be low and their HDLs may be where they should be, so based on the calculation, the LDL will never get below 70.
But one cannot really harp on these docs for what they are doing. They are simply doing what they were trained to do. They apply the guidelines, do not think for themselves and they push the accepted medications for the treatment of cholesterol. But this would still be defined as ignorance, would it not? And whom do we blame for the millions of people who die each year because of this?
The lipid profile numbers that we should be paying attention to are the HDL and TGs only. What I like to use is the TG to HDL ratio. Keep this ration at or under two and you are sitting pretty. If it rises above two, be careful, because now not only are you looking at an increased risk of heart disease, but also diabetes and cancer. Two other diseases we will be discussing shortly.
Now on to chapter six.
Men occasionally stumble over the truth, but most of them pick themselves up and hurry off as if nothing had happened
-Winston Churchill
Comments, anyone :-)
Dr. James E. Carlson B.S.,D.O.,M.B.A.,J.D.
Please go to Amazon.com to order my book or go to DrJamesCarlson.com and request a digital copy of my book for only $11.99!
Thursday, May 21, 2009
Chapter 4 of Genocide:How Your Doctor's Dietary Ignorance Will Kill You
CHAPTER FOUR-HDL: The Good Cholesterol
HDL is a type of cholesterol. HDL stands for High Density Lipoprotein. It is often referred to as the good cholesterol. There are tricks to remember this, such as let the H in HDL, stand for Healthy or High. So when one sees HDL they will hopefully remember either healthy or high and this should remind you that it is the healthy kind and we want this number to be high.
When one goes for the classic lipid profile the HDL will be reported as a number. If one's HDL is less than forty one is said to have a higher risk of heart disease. Values greater than fifty-nine are viewed as giving one a lower risk of heart disease. Values between forty and fifty-eight are a middle ground where risk could be high or low depending on other risk factors. These risk factors could be obesity, smoking, high blood pressure or being male. So if having an elevated HDL protects us from CAD the question should now become; how does one elevate HDL and what exactly is an HDL molecule?
As an extremely important side note male patients greater than forty-five years of age and especially patients male or female at or greater than fifty years of age who have any underlying medical problems absolutely need nuclear stress tests. A nuclear stress test is where a nuclear isotope is injected into the bloodstream. The patient runs on a treadmill, the heart is monitored while on the treadmill and then monitored again after the running is complete. This is an indirect assessment of potential blockages in the coronary arteries. It needs to be mentioned that even a nuclear stress test can miss coronary artery occlusions and even a negative stress test, that is, a stress test that does not reveal any blockages could be falsely negative. What this means is that there are blockages in the coronary arteries, but the nuclear stress test missed it. The only way around this is to perform cardiac catheterizations on everyone and to just stop performing nuclear stress tests since they can sometimes be misleading.
I do not recommend performing cardiac catheterizations instead of stress tests as the catheterizations are invasive and have higher complications associated with their performance. Getting a nuclear stress is still the preferred way to indirectly assess for the presence of coronary artery disease. If the stress test is positive then one will need a cardiac catheterization.
Before I leave this side-note, if you are someone with diabetes and you are a male or female at or greater than fifty years of age you absolutely need a nuclear stress test. This is because diabetics are notorious for having what is known as silent heart attacks and even blockages, which cause no symptoms whatsoever. You could be walking around with significant CAD and not even know it. And the only chance of knowing this is through a nuclear stress test. I cannot tell you how many times a diabetic patient over the age of fifty has come to see me for a regular check-up, has had no symptoms of chest pain, difficulty in breathing, or any other symptom which might have alerted me to the existence of coronary artery occlusion; has had normal looking EKGs and I perform a nuclear stress test and find significant coronary artery blockages. The scary thing is that some of these patients had actually been seeing other docs, including cardiologists, who failed to perform a routine nuclear stress test.
The bottom line is that if you have diabetes, or any other medical issue and you are at or greater than the age of fifty, you need a nuclear stress test. If you cannot walk for whatever reason there are other nuclear stress tests which can be performed to help assess for the presence of CAD. And lastly, if you are male or female at or greater than the age of sixty-YOU ABSOLUTELY NEED A NUCLEAR STRESS TEST NO MATTER WHAT!!!! This is because as we get older we can accrue plaques in our coronary arteries just from being on the planet longer.
Now, let us get back to our discussion as to what an HDL molecule is made up of.
First, we will look at what comprises an HDL molecule. Well, HDL stands for high-density lipoprotein. So, it has to have some protein in it, lipo means fat, so fats there too, and it is high density; but, still, what does that mean. It simply means it is a molecule, which contains cholesterol, fat, and protein. Since there is a lower amount of fat in an HDL molecule it is called high density because fat is less dense than protein and cholesterol. The more fat the lower the density, the less fat the higher the density.
OK, now here is something very interesting. Ask your typical internist, family doc, pediatrician, cardiologist, or just about anyone who thinks they know something about HDL how to increase the HDL in the bloodstream. We all see low HDLs and we see them a lot. Usually in men, but also in women. The answer they give is almost always the same; if you want to increase your HDL, lower your fat and cholesterol intake and increase your whole grains, fruits and vegetables. This, the above docs say, will increase your HDL.
From our discussion thus far you know immediately your body will have all the things necessary to make more fat and cholesterol. But what kind of fat and cholesterol will we make? The fat part is easy; we will make more triglycerides (you know what, I am getting tired of spelling out triglycerides so for now on I am calling them TGs). As far as cholesterol is concerned, again, what kind of cholesterol will we make when we eat a diet low in fat and cholesterol?
Well, cholesterol is cholesterol is cholesterol, so the short answer is; just plain ole cholesterol is formed. But is it HDL, LDL, VLDL or IDL, which I will now call the DLs? Guess what, if you focus on those three letter cholesterols you start to forget that they are simply carrier molecules of cholesterol. That is correct, all these DLs do is carry cholesterol around in the body and exchange it with other DLs. So viewing cholesterol as a good or bad type of cholesterol totally confuses the picture.
Another side note: HDL is known for carrying away cholesterol after a cell dies. After the HDL molecule picks this cholesterol up it shuttles it away and gives it to other DLs. But why is it considered the good cholesterol? Well, that is because HDL is also known to take cholesterol back to the liver for its removal from the bloodstream.
Now the confusing part begins. Exactly how do our bodies actually get rid of cholesterol? There are certain medications that are referred to as bile acid sequestrants. Bile is a substance the liver makes, it gets stored in the gallbladder and is released to help with the digestion of fats and cholesterol. Bile acid itself contains cholesterol so the drug companies developed a medication which binds with these bile acids, does not let them go and when you poop out comes the cholesterol. Pretty clever.
Only thing is these specific types of meds can only lower the cholesterol number by a small amount. Anyone with a high cholesterol number will need another med, assuming the proper diet is not revealed to the patient to help lower the cholesterol number further. It may appear as if we have come off our topic of HDL, but we really have not.
You would think that if HDL was a good cholesterol it would somehow get rid of the cholesterol from the body so it could not bind to our arteries and kill us. But this does not happen. HDL quickly takes and gives its cholesterol to other DLs. One of which is the LDL transporter, which everyone mistakenly believes is the bad cholesterol. But if HDL is quickly giving its cholesterol to LDL, I am still confused. Would that not make HDL a bad cholesterol too, since it is aiding and abetting the LDL cholesterol? I will discuss more about LDL cholesterol below, but for now understand that LDL is considered the bad cholesterol.
OK, so let us get back to our typical internist, family doc, pediatrician, or cardiologist. When we ask them how to raise the HDL they will answer exercise, follow a low fat, low cholesterol diet, which means we need to eat more whole grains, fruits and veggies. After sixteen years of practicing medicine I can tell you that this does not work. Some docs will be thinking that, "Of course it works." And my reply is that in sixteen years of caring for patients I have rarely seen this diet/exercise approach work to significantly elevate the HDL.
Well what have I seen work you might ask? The only thing I have seen work to substantially increase HDL, doubling it, sometimes increasing the HDL by two and a half times its value; is increasing one's consumption of fat and cholesterol, coupled with a dramatic lowering of one’s carb intake.
That' is correct, as crazy as it sounds, increasing one's consumption of fat and cholesterol in the diet will substantially raise your HDL values. This process can take up to a year, but it works and it works every time. Every time! When patients of mine increase their fat and cholesterol consumption their HDLs oftentimes double. That’s right, double! The best the drug companies can offer is somewhere around a thirty-five percent increase in HDL, but if one increases their consumption of fats and cholesterol and lowers their carb intake, one can increase the HDL by 100%.
To put this in perspective, a thirty-five percent increase means that if your HDL is thirty, not an unusual number to see, the most you can expect as an increase if you are using meds will be from thirty to forty. Sounds impressive until you realize that you are still at increased risk of heart disease even with an HDL in the forty range. How about we take that HDL of thirty and change it into a sixty or seventy, this can be done if you follow the correct diet.
I really am not sure why the HDL doubles. I have read the books, but cannot figure it out. Only thing I can come up with is since the body is not making as much cholesterol, it chooses to make HDL and the good LDL preferentially over the others. So now one may wonder, what happens to the LDL thing, you know, that thing we doctors mistakenly call the bad cholesterol. I will show you in Chapter Six. Before we can talk intelligently about LDL we need to discuss some basic math and I mean really basic math, that is, the math used to calculate all the typical LDLs in our country.
Nothing is more difficult than competing with a myth
-Francoise Giroud
Hope everyone is enjoying the read!
Dr. James E. Carlson B.S.,D.O.,M.B.A.,J.D.
Please go to Amazon.com to order my book or go to DrJamesCarlson.com and request a digital copy of my book for only $11.99!
HDL is a type of cholesterol. HDL stands for High Density Lipoprotein. It is often referred to as the good cholesterol. There are tricks to remember this, such as let the H in HDL, stand for Healthy or High. So when one sees HDL they will hopefully remember either healthy or high and this should remind you that it is the healthy kind and we want this number to be high.
When one goes for the classic lipid profile the HDL will be reported as a number. If one's HDL is less than forty one is said to have a higher risk of heart disease. Values greater than fifty-nine are viewed as giving one a lower risk of heart disease. Values between forty and fifty-eight are a middle ground where risk could be high or low depending on other risk factors. These risk factors could be obesity, smoking, high blood pressure or being male. So if having an elevated HDL protects us from CAD the question should now become; how does one elevate HDL and what exactly is an HDL molecule?
As an extremely important side note male patients greater than forty-five years of age and especially patients male or female at or greater than fifty years of age who have any underlying medical problems absolutely need nuclear stress tests. A nuclear stress test is where a nuclear isotope is injected into the bloodstream. The patient runs on a treadmill, the heart is monitored while on the treadmill and then monitored again after the running is complete. This is an indirect assessment of potential blockages in the coronary arteries. It needs to be mentioned that even a nuclear stress test can miss coronary artery occlusions and even a negative stress test, that is, a stress test that does not reveal any blockages could be falsely negative. What this means is that there are blockages in the coronary arteries, but the nuclear stress test missed it. The only way around this is to perform cardiac catheterizations on everyone and to just stop performing nuclear stress tests since they can sometimes be misleading.
I do not recommend performing cardiac catheterizations instead of stress tests as the catheterizations are invasive and have higher complications associated with their performance. Getting a nuclear stress is still the preferred way to indirectly assess for the presence of coronary artery disease. If the stress test is positive then one will need a cardiac catheterization.
Before I leave this side-note, if you are someone with diabetes and you are a male or female at or greater than fifty years of age you absolutely need a nuclear stress test. This is because diabetics are notorious for having what is known as silent heart attacks and even blockages, which cause no symptoms whatsoever. You could be walking around with significant CAD and not even know it. And the only chance of knowing this is through a nuclear stress test. I cannot tell you how many times a diabetic patient over the age of fifty has come to see me for a regular check-up, has had no symptoms of chest pain, difficulty in breathing, or any other symptom which might have alerted me to the existence of coronary artery occlusion; has had normal looking EKGs and I perform a nuclear stress test and find significant coronary artery blockages. The scary thing is that some of these patients had actually been seeing other docs, including cardiologists, who failed to perform a routine nuclear stress test.
The bottom line is that if you have diabetes, or any other medical issue and you are at or greater than the age of fifty, you need a nuclear stress test. If you cannot walk for whatever reason there are other nuclear stress tests which can be performed to help assess for the presence of CAD. And lastly, if you are male or female at or greater than the age of sixty-YOU ABSOLUTELY NEED A NUCLEAR STRESS TEST NO MATTER WHAT!!!! This is because as we get older we can accrue plaques in our coronary arteries just from being on the planet longer.
Now, let us get back to our discussion as to what an HDL molecule is made up of.
First, we will look at what comprises an HDL molecule. Well, HDL stands for high-density lipoprotein. So, it has to have some protein in it, lipo means fat, so fats there too, and it is high density; but, still, what does that mean. It simply means it is a molecule, which contains cholesterol, fat, and protein. Since there is a lower amount of fat in an HDL molecule it is called high density because fat is less dense than protein and cholesterol. The more fat the lower the density, the less fat the higher the density.
OK, now here is something very interesting. Ask your typical internist, family doc, pediatrician, cardiologist, or just about anyone who thinks they know something about HDL how to increase the HDL in the bloodstream. We all see low HDLs and we see them a lot. Usually in men, but also in women. The answer they give is almost always the same; if you want to increase your HDL, lower your fat and cholesterol intake and increase your whole grains, fruits and vegetables. This, the above docs say, will increase your HDL.
From our discussion thus far you know immediately your body will have all the things necessary to make more fat and cholesterol. But what kind of fat and cholesterol will we make? The fat part is easy; we will make more triglycerides (you know what, I am getting tired of spelling out triglycerides so for now on I am calling them TGs). As far as cholesterol is concerned, again, what kind of cholesterol will we make when we eat a diet low in fat and cholesterol?
Well, cholesterol is cholesterol is cholesterol, so the short answer is; just plain ole cholesterol is formed. But is it HDL, LDL, VLDL or IDL, which I will now call the DLs? Guess what, if you focus on those three letter cholesterols you start to forget that they are simply carrier molecules of cholesterol. That is correct, all these DLs do is carry cholesterol around in the body and exchange it with other DLs. So viewing cholesterol as a good or bad type of cholesterol totally confuses the picture.
Another side note: HDL is known for carrying away cholesterol after a cell dies. After the HDL molecule picks this cholesterol up it shuttles it away and gives it to other DLs. But why is it considered the good cholesterol? Well, that is because HDL is also known to take cholesterol back to the liver for its removal from the bloodstream.
Now the confusing part begins. Exactly how do our bodies actually get rid of cholesterol? There are certain medications that are referred to as bile acid sequestrants. Bile is a substance the liver makes, it gets stored in the gallbladder and is released to help with the digestion of fats and cholesterol. Bile acid itself contains cholesterol so the drug companies developed a medication which binds with these bile acids, does not let them go and when you poop out comes the cholesterol. Pretty clever.
Only thing is these specific types of meds can only lower the cholesterol number by a small amount. Anyone with a high cholesterol number will need another med, assuming the proper diet is not revealed to the patient to help lower the cholesterol number further. It may appear as if we have come off our topic of HDL, but we really have not.
You would think that if HDL was a good cholesterol it would somehow get rid of the cholesterol from the body so it could not bind to our arteries and kill us. But this does not happen. HDL quickly takes and gives its cholesterol to other DLs. One of which is the LDL transporter, which everyone mistakenly believes is the bad cholesterol. But if HDL is quickly giving its cholesterol to LDL, I am still confused. Would that not make HDL a bad cholesterol too, since it is aiding and abetting the LDL cholesterol? I will discuss more about LDL cholesterol below, but for now understand that LDL is considered the bad cholesterol.
OK, so let us get back to our typical internist, family doc, pediatrician, or cardiologist. When we ask them how to raise the HDL they will answer exercise, follow a low fat, low cholesterol diet, which means we need to eat more whole grains, fruits and veggies. After sixteen years of practicing medicine I can tell you that this does not work. Some docs will be thinking that, "Of course it works." And my reply is that in sixteen years of caring for patients I have rarely seen this diet/exercise approach work to significantly elevate the HDL.
Well what have I seen work you might ask? The only thing I have seen work to substantially increase HDL, doubling it, sometimes increasing the HDL by two and a half times its value; is increasing one's consumption of fat and cholesterol, coupled with a dramatic lowering of one’s carb intake.
That' is correct, as crazy as it sounds, increasing one's consumption of fat and cholesterol in the diet will substantially raise your HDL values. This process can take up to a year, but it works and it works every time. Every time! When patients of mine increase their fat and cholesterol consumption their HDLs oftentimes double. That’s right, double! The best the drug companies can offer is somewhere around a thirty-five percent increase in HDL, but if one increases their consumption of fats and cholesterol and lowers their carb intake, one can increase the HDL by 100%.
To put this in perspective, a thirty-five percent increase means that if your HDL is thirty, not an unusual number to see, the most you can expect as an increase if you are using meds will be from thirty to forty. Sounds impressive until you realize that you are still at increased risk of heart disease even with an HDL in the forty range. How about we take that HDL of thirty and change it into a sixty or seventy, this can be done if you follow the correct diet.
I really am not sure why the HDL doubles. I have read the books, but cannot figure it out. Only thing I can come up with is since the body is not making as much cholesterol, it chooses to make HDL and the good LDL preferentially over the others. So now one may wonder, what happens to the LDL thing, you know, that thing we doctors mistakenly call the bad cholesterol. I will show you in Chapter Six. Before we can talk intelligently about LDL we need to discuss some basic math and I mean really basic math, that is, the math used to calculate all the typical LDLs in our country.
Nothing is more difficult than competing with a myth
-Francoise Giroud
Hope everyone is enjoying the read!
Dr. James E. Carlson B.S.,D.O.,M.B.A.,J.D.
Please go to Amazon.com to order my book or go to DrJamesCarlson.com and request a digital copy of my book for only $11.99!
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