Category Archives: carbohydrate

Obesity Epidemic Requires a Paradigm Shift

The obesity epidemic requires a paradigm shift. Several medical myths stand in the way of taking the most effective steps to safely help patients lose weight. The most important myth relates to saturated fat. Saturated fat consumption does not contribute to cardiovascular disease. This must be understood and accepted by the medical community so that sound advice can be given.

A meta-analysis of prospective epidemiologic studies showed that there is no significant evidence for concluding that dietary saturated fat is associated with an increased risk of CHD or CVD.( Am J Clin Nutr. 2010 Mar;91(3):497-9. )

In fact, as early as 2004, Mozaffarian et. al. investigated the influence of diet on atherosclerotic progression in postmenopausal women with quantitative angiography and found that:

In multivariate analyses, a higher saturated fat intake was associated with a smaller decline in mean minimal coronary diameter (P = 0.001) and less progression of coronary stenosis (P = 0.002) during follow-up. (Am J Clin Nutr. 2004 Nov;80(5):1175-84)

In addition, they further found that:

Carbohydrate intake was positively associated with atherosclerotic progression (P = 0.001), particularly when the glycemic index was high.

            Polyunsaturated fat intake was positively associated with progression when replacing other fats (P = 0.04)

These findings should come as no surprise given the basic science of atherosclerosis. Oxidized and glycated LDL stimulate macrophages to become foam cells initiating the creation of plaque. Cellular receptors that allow macrophages to ingest oxidized LDL are specific for oxidized LDL. These receptors do not recognize normal LDL to a significant degree.

Holovet et. al. studied the ability of oxidized LDL versus the Global Risk Factor Assessment Score (GRAS) to detect coronary artery disease. GRAS identified coronary artery disease 49% of the time, while oxidized LDL was correct 82% of the time.

In a large prospective study, Meisinger et al found that plasma oxidized LDL was the strongest predictor of CHD events when compared to conventional lipoprotein risk assessment and other risk factors for CHD.

Polyunsaturated fats are easily oxidized, saturated fats are not. It is the polyunsaturated fatty acids (PUFA) in the membrane of LDL particles that become oxidized and then initiate the cascade of inflammatory events leading to atherosclerosis. The major source of these PUFA in the American diet are “vegetable oils” (corn oil, soy oil etc.)  rich in the omega-6 PUFA, linoleic acid.

So why is this important to understand relative to the obesity epidemic? Because the most effective weight loss “diet” is arguably a low carbohydrate/high fat (LCHF) diet. This approach does not require calorie counting. This approach has been demonstrated to spontaneously reduce caloric intake whereas low fat diets require calorie counting and result in persistent hunger.

When compared to low fat calorie restricted diets  the LCHF approach has been equal or superior with respect to weight loss, insulin sensitivity, blood pressure reduction, and lipid profiles whenever these parameters have been measured.

But LCHF has not been embraced by the medical community due to the perceived dangers of saturated fat consumption and a low-fat ideology that lacks legitimate scientific evidence.

Once we dispel the mythology of saturated fat, the safety and efficacy of LCHF will be more readily accepted by physicians, the media and the lay public.

The nutritional villains in our society are highly refined and easily oxidized “vegetable oils” filled with pro-inflammatory omega-6 PUFA (linoleic acid), added sugar (especially HFCS) so prevalent in most processed foods and soft drinks, and the nutrient poor wasted calories of processed flour foods. These three culprits are responsible for our epidemics of obesity, insulin resistance and metabolic syndrome. These three conspire together to generate fatty liver disease, atherosclerotic plaque, and chronic inflammation.

When a LCHF approach is combined with  eating only fresh whole foods and avoiding added sugar, refined flour, and unhealthy  “vegetable oils”, we have the perfect recipe for our obesity epidemic.

The following references provide examples of studies that have demonstrated the efficacy, safety and  usual superiority of the LCHF  approach to weight loss.

Dig Dis Sci. 2007 Feb;52(2):589-93. Epub 2007 Jan 12. The effect of a low-carbohydrate, ketogenic diet on nonalcoholic fatty liver disease: a pilot study. Tendler D, Lin S, Yancy WS Jr, Mavropoulos J, Sylvestre P, Rockey DC Westman EC.

Interview with Dr. Ede about preventing Alzheimer’s

My friend and colleague, Dr. Georgia Ede, was recently interviewed concerning dietary interventions to prevent Alzheimer’s Dementia. Great interview, lots of information, references provided at the bottom of the transcript.

Here is the link.

Are You On The Road To Alzheimer’s? Interview With Dr. Georgia Ede – Choc & Juice

Another reason to eat a clean Paleo diet.

Eliminating sugar, flour foods, and fruit juices will also improve your gut flora and help to prevent dysbiosis.

Regards

Bob Hansen MD

The Obesity Code, a must read book by Dr. Jason Fung.

Doctor Jason Fung just published a terrific book titled The Obesity Code: Unlocking the Secrets of Weight Loss: 

Dr. Fung’s genius excels at simple, direct explanations with clarity and humor. His analogies are often hilarious and through his humor and logic he communicates simple but important truths. The major message is that obesity is a hormonal problem. Obesity is not a disease of excess caloric intake, nor is it a disease of sedentary lifestyle. Dr. Fung cites study after study in which obese patients (young and old alike) consumed less calories and exercised more with dismal results. He reviews the medical literature on the effects of refined carbohydrates and sugar on insulin and other hormones. He explains how sustained high insulin levels cause insulin resistance and weight gain. He clearly and decisively explains how 100 calories of sugar or flour effects the human body in a manner immensely different from 100 calories of broccoli.

“Have you ever seen anyone get fat from eating too much broccoli?”

Most importantly, Dr. Fung provides the solution that has helped hundreds of his patients. The solution is elimination of refined carbohydrates and sugar in combination with intermittent fasting. Intermittent fasting (consuming only water, coffee, tea, broth) for 24 -36 hours a few to several times per month helps to reset the brain’s set point for body weight. When combined with restriction of sugar and refined carbohydrate (foods made with flour) intermittent fasting presents a powerful tool to not only lose weight but to manage diabetes and prevent the many complications of obesity and diabetes.

Intermittent fasting increases the human metabolic rate, Your body actually burns more calories at rest per hour during fasting. The effects of intermittent fasting are distinctly different from what has been referred to as the “starvation response”. The “starvation response” ironically and confusingly refers to human studies that restricted (reduced) caloric intake but continued low calorie meals throughout the day.  It is unfortunate that those studies coined the term “starvation response” which is a decrease in resting metabolic rate. Caloric restriction diets reduce the human metabolic rate and therein lies the cause for the failure of all caloric restriction diets.

The confusion of these two approaches and their effects on human metabolism have clouded the discussion of obesity for decades.

Dr. Fung’s communication skills can be enjoyed by reading his book and viewing his many talks on YouTube.

His book and lectures should be mandatory for every medical student, physician, nutritionist and public health official. His book’s exhaustive medical references document the science that supports his theory and his clinical solution.

So take a leap, click on the link above for his book and the links below for some of his videos which are free on-line.

I think that Dr. Fung’s book is the most important book published on this topic in the 21st Century. His work will have profound influence during the next few decades. I encourage you to enjoy his genius.

Bob Hansen MD

The BigFatFix, a crowd funded film that explores the proper nutritional approach to diabetes epidemic

This new film created by a GP in UK, funded by small contributions, describes how elimination of added sugar and implementation of carbohydrate restriction can cure diabetes and result in weight loss. The film also covers how the low-fat craze, based on bad science (ignoring the full data) began with Ancel Keyes and evolved into arguably the worst public health disaster experienced by the modern world.

Nutrition Journals and the influence of the food industry

Ever wonder why the public is so confused about nutrition recommendations? Just follow the money and you will understand that most of the professional societies that publish nutrition articles are funded by big food companies that are trying to sell more sugar, refined carbs and junk food. I recently read an excellent post about this topic here:

The Vilest Villain: American Society of Nutrition

This theme is repeated by medical journals that are “The Official Journal of the Society of >>>>>>” Just fill in the blanks for just about any medical society. Funding comes from big pharmaceutical companies the same way that funding in the nutrition Journals comes from large (junk) “food” manufacturers.

Don’t get me wrong, there are plenty of very valuable, life-saving drugs out there.

But most chronic human disease in developed societies is generated by various combinations of poor nutrition, lack of exercise, disruption of circadian rhythm, inadequate restorative sleep, stress and lack of social support systems.

The obesity and diabetes epidemics continue to worsen yet the failed dietary advise of major health organizations is slow to respond to the data. Excess refined carbs (especially in the form of “food” made with flour) and added sugar (especially in the form of HFCS) are the major driving forces for obesity, diabetes and cardiovascular disease. Red meat is not the culprit, provided the meat is properly sourced (hormone and antibiotic free, grass fed) and cooked in a manner that does not create carcinogens and inflammatory mediators (cook with slow, low, moist heat, high temperature grilling and smoking cause problems, but that topic  is for another post).

Americans consume an average 130 pounds per year of added sugar and 140 pounds per year of refined flour. Those are averages so there are many people who consume more. The added sugar is not the white stuff people put in their coffee. It comes in all sorts of forms but is found in energy drinks, soda, lattes and mochas, salad dressing,  ketchup, canned soups, canned vegetables, white AND whole grain breads, pasta (even “whole grain”), crackers, breakfast cereal,  just about any packaged food that has more than one ingredient on the label. These foods represent 70% of the American diet. The problems created by this situation are enormous and will bankrupt our “healthcare system”. This is a cultural and economic problem.

The solutions are simple but largely ignored in our society. We are creatures of habit and convenience.

Eat whole foods, nothing from a package that has more than one ingredient. Eat meat, seafood, poultry, fresh organic vegetables (6-9 servings per day), fresh organic fruits, and nuts. Meat should be hormone and antibiotic free (free range, grass fed). Seafood should be wild. Poultry should be free range and the eggs should come from free range chickens, ducks, geese.

Do not worry about eating fat as long as it comes from healthy animals and sources such as coconut oil, extra-virgin olive oil, avocado oil and clarified butter (ghee).

Do not use any “vegetable” oils (corn, soy, and other oils from grains or seeds) The vegetable oils are highly refined and inflammatory. They contain easily oxidized omega 6 fats that feed the production of inflammatory mediators in your body and create oxidized LDL leading to atherosclerosis.

Exercise daily, preferably outside in a green space. Twice per week spend 20-30 minutes  doing resistance training (lift weights, work against the resistance of bands, use your own body weight doing pushups, pull-ups etc)

Reduce stress with mediation, yoga, tai chi, dancing, engaging in fun sports and social activities. Walk on the beach, by a lake, river or stream, in the woods, listen to music.

Get some sunshine regularly especially during the morning to get your circadian rhythm in order and to produce adequate amounts of vitamin D.

Spend time with family, friends and colleagues who are supportive and fun to be around.

Sleep in the dark.

Get at least 7 hours of sleep per night. Avoid TV, computer screens and other electronic devices for at least 2 hours before bedtime.

Unplug from the internet, email, etc on a regular basis.

We evolved as hunter-gatherers.

Peace

Bob Hansen MD

 

 

Great lecture videos available on line

In January I attended the annual meeting of Physicians for Ancestral Health. There were great presentations on many topics related to lifestyle and health. Take a look at the website linked below to learn about many topics relating nutrition, exercise, and lifestyle to health.

Open Video Archives | Physicians for Ancestral Health

I presented a lecture titled “The Lipoprotein Retention Model, What’s Missing?” This discusses many factors (root causes) that contribute to the formation of plaque in arteries and what can be done to prevent this insidious process by adopting a “Paleo Lifestyle“.

Other videos include:

Paleopathology and the Origins of the Paleo Diet. Keynote speaker Michael Eades MD, author of several books and a well known website.

Medicine Without Evolution is like Engineering Without Physics– Randolph M Neese, MD Director of the Arizona State University Center for Evolution.

The Roles of Intermittent Fasting and Carbohydrates in Cancer Therapy– Dawn Lemanne, MD, MPH, integrative oncologist.

 23 and Me: Practical First Steps-Deborah Gordon MD, discusses a practical approach to utilizing information from this genetic test.

Histamine Intolerance-Why (food) Freshness Matters– Georgia Ede MD.

 

Mood and Memory: How Sugar Affects Brain Chemistry-Georgia Ede, MD.

Systems Analysis and Multiple Sclerosis– Tommy Wood MD, author, blogger and lecturer, frequently interviewed on topics related to exercise and nutrition.

Cholesterol OMG– Jeffry Gerber, MD “The Diet Doctor” in Denver Colorado

Bob Hansen MD

 

 

 

Still want a doughnut or cereal for breakfast?

A recent study has demonstrated that brain deterioration detected by MRI scan seems to be linked to higher blood sugar levels even within the “normal range”.

Here are some important quotes from a Medscape discussion:

“Previous studies have shown that T2D (type 2 diabetes) is associated with brain atrophy, cognitive deficits, and increased risk for dementia. Elevated plasma glucose levels still within the normal range increase the risk for T2D.”

“Studies showed that in apparently healthy individuals, atrophy of the amygdala and hippocampus increased as FPG (fasting plasma glucose) within the normal range increased.”

“You start having abnormalities in the brain even at levels that are within the normal range. This is important because, should we be defining normal glucose levels for different purposes?”

Bottom line, as discussed by neurologist David Perlmutter in his book Grain Brain, even “normal” blood sugars as defined by measurements in our society many not be healthy. If a whole modern culture has higher blood sugars, higher blood pressures, fatter waistlines compared to our healthy hunter gatherer ancestors, then the “normal range” may not really be “normal”. If we define “normal” as individuals within 1 or 2 standard deviations of the mean, but a large portion of the population is unhealthy, is normal healthy?

Do you want to spend your last day in diapers drooling in a nursing home or do you want to go out hiking in the woods and enjoying grandchildren?

The choice is yours, but the next time you have a doughnut or cereal for breakfast, consider the long term consequences.

Live clean and prosper.

Bob Hansen MD

Here is the whole Medscape article for those interested in the nitty-gritty details.

White Matter Lesions Linked to Rising Plasma Glucose

SANTIAGO, Chile — Higher fasting plasma glucose (FPG) levels are associated with a higher burden of brain white matter hyperintensities (WMH), particularly in the frontal lobes.

The association is especially strong in individuals with type 2 diabetes (T2D), a new study shows.

Lead author Nicolas Cherbuin, PhD, and colleagues in the Centre for Research on Ageing, Health and Wellbeing of the Australian National University in Canberra used data from the Personality and Total Health (PATH) Through Life Project, a large, longitudinal, population-based study investigating the time course and determinants of cognitive aging and mental health.

The study findings were presented here at the XXII World Congress of Neurology (WCN).

The PATH Through Life Project aims to follow approximately 7500 randomly selected adults in the greater Australian capital area over 20 years.

From an older age cohort (60 to 64 years; n = 2551), 401 community-living individuals were available for analysis. All were free of neurologic disorders, stroke, and gross brain abnormalities and had a Mini-Mental State Examination (MMSE) score of 27 or greater.

Using linear regression analysis, the researchers tested the association between FPG and WMH volumes, controlling for covariates of age, sex, intracranial volume, education, smoking, hypertension, body mass index (BMI), diabetes, and interactions of diabetes and sex.

Plasma glucose was measured after an overnight fast and was categorized as normal, defined as less than 5.6 mmol/L (<100.8 mg/dL), impaired (5.6 to 7 mmol/L [100.8 to 126 mg/dL]), or T2D (≥7 mmol/L [≥126 mg/dL] or self-report of T2D).

Patient groups with normal FPG (n = 276), impaired FPG (n = 86), or T2D (n = 39) were similar in age (approximately 63 years), education (14 years), and MMSE scores (29.26 to 29.45). BMI was higher in the impaired FPG and T2D groups than in the normal FPG group. There was also more hypertension in the T2D group.

WMH Mostly in Frontal and Temporal Lobes

Dr Cherbuin reported that among the entire cohort, higher FPG was associated with a higher burden of WMH in the right hemisphere (P = .02) but not in the left hemisphere. The effect was most prominent in the frontal and temporal lobes.

These findings were largely attributable to participants with impaired FPG or T2D, and the effect was most pronounced for participants with T2D.

Table. WMH Volumes per FPG Level

Location Normal FPG (n = 276) Impaired FPG (n = 86) T2D (n = 39)
Left hemisphere WMH (mm3) 2343.68 ± 2311.72 2331.07 ± 2528.34 2800.62 ± 2152.87
Right hemisphere WMH (mm3) 2379.59 ± 2645.19 2414.98 ± 2609.72 3199.79 ± 4031.47
Values are expressed as mean ± standard deviation.

 

Previous studies have shown that T2D is associated with brain atrophy, cognitive deficits, and increased risk for dementia. Elevated plasma glucose levels still within the normal range increase the risk for T2D.

Studies showed that in apparently healthy individuals, atrophy of the amygdala and hippocampus increased as FPG within the normal range increased. Striatum volumes decreased several years later in line with higher FPG or occult T2D. Functionally, poorer performance of fine motor skills is evident with higher FPG.

Session chairman Samuel Wiebe, MD, professor of neurology at the University of Calgary, Alberta, Canada, commented to Medscape Medical News that the present study intrigued him because it addresses the fact that the definition of normal glucose “maybe doesn’t apply to everything…. You start having abnormalities in the brain even at levels that are within the normal range. This is important because, should we be defining normal glucose levels for different purposes?”

Higher levels of glucose even within the normal range may affect facets that are just beginning to be understood, such as white matter changes. “That’s just one aspect. There could be other areas,” he said. “So I think that that’s an intriguing finding that deserves further study.”

Dr Wiebe said the greater effect of elevated glucose seen in the frontal lobes may be related to some degree to their sheer size or to blood flow. “I think that the truth is that it is a spectrum. It begins to have an impact at a range of values that are lower than the cutoff” for traditional interventions, he said.

He feels it would be interesting to follow up this study with assessments that go beyond WMH volume measurements, such as tractography or connectivity studies that look at brain function.

There was no commercial funding for the study. Dr Cherbuin and Dr Wiebe have disclosed no relevant financial relationships.

XXII World Congress of Neurology (WCN). Abstract 434. Presented November, 2, 2015.