Category Archives: metabolic syndrome

Insulin Resistance, the silent killer and root cause of modern chronic disease.

Insulin is much more than a blood sugar hormone. Produced by the pancreas primarily in response to carbohydrate and sugar consumption, insulin is a master anabolic signal that dictates how every cell in your body grows, uses energy, and repairs itself. When insulin levels are healthy, it keeps the body in a state of “build and store.” When insulin resistance (IR) develops, the body loses its ability to hear this signal, leading to systemic breakdown. Instead of “build and store” the body deteriorates, causing loss of muscle mass, strength, energy production, memory and cognitive function, bone strength, brain cells and connections, ability of blood vessels to relax, ability for the heart to pump blood, ability to achieve restorative sleep, ability of the liver and kidneys to clear toxins from the body, even the ability to reproduce resulting in infertility and erectile dysfunction. Visceral fat stores increase to destructive levels resulting in obesity and obesity-related complications including chronic inflammation which further drives IR to higher levels.

IR is a root cause of cardiovascular disease (heart attack, stroke, hypertension, heart failure), many kinds of cancer (directly linked to breast, prostate and colon cancer), kidney failure, heart failure, dementia, osteoporosis, osteoarthritis, and much more. IR is causally linked or a contributor to, every chronic non-communicable disease of modern civilization.

WHAT IS INSULIN RESISTANCE?

Insulin resistance is the inability of cells and organs to respond normally to insulin signaling. Every cell of every organ has insulin receptors that initiate action by the cell and organ.

WHAT CAUSES INSULIN RESISTANCE?

There are many causes of IR. Stress hormones (cortisol, adrenaline), inflammation, and high insulin levels themselves (response to dietary sugar and refined carbohydrates), each alone and in combination, cause immediate (within minutes to hours) insulin resistance. When these conditions persist over time insulin resistance becomes a chronic state. As fat cells grow in size, they reach a point where there is inadequate blood flow to the cells themselves and macrophages (immune cells that reside between the fat cells, most prominently in visceral fat) produce inflammatory chemicals called cytokines. Cytokines flow through the blood stream and effect every organ and every cell in the body creating a state of chronic inflammation which further worsens IR, creating a vicious cycle. As IR continues the pancreas produces increasingly higher amounts of insulin to maintain normal blood sugar levels but eventually IR becomes so great that blood sugar levels move into the “pre-diabetes” and eventually the diabetes range. IR builds for years to decades before blood sugar regulation fails. By the time blood sugar levels are “abnormal” insulin resistance has done great damage throughout the body.

Most doctors tragically do not order fasting insulin levels as routine blood tests. Fasting insulin levels rise long before fasting blood sugars and hemoglobin A1c start to rise. Meanwhile the damage progresses under the radar of routine testing.

1. Metabolic Engines: Muscle and Liver

Muscle

Normal Action: Insulin acts as a key that opens “doors” (GLUT4 receptors) to let glucose in for fuel. it also stimulates protein synthesis. Protein synthesis is essential to maintaining and increasing muscle mass and strength.
Insulin Resistance Effect: The “doors” stay locked. Glucose stays in the blood, and the muscle becomes “starched,” leading to sarcopenia (muscle wasting) and fatigue. The muscle can no longer utilize dietary protein to maintain or increase muscle mass.

Liver

Normal Action: Tells the liver to stop producing glucose and start storing it as glycogen or converting excess into fat.
Insulin Resistance Effect: The liver ignores the “stop” signal and keeps pumping out glucose while simultaneously ramping up fat production. This results in Non-Alcoholic Fatty Liver Disease (NAFLD).

2. Fat Cells (Adipose Tissue)

Visceral (Deep Fat) vs. Subcutaneous (Under Skin)

Normal Action: Insulin promotes fat storage and inhibits the breakdown of stored fat (lipolysis).
Insulin Resistance Effect: Fat cells—especially visceral ones—become “leaky.” They spill free fatty acids into the bloodstream and release inflammatory cytokines. This causes weight gain that is biologically difficult to lose because high insulin levels keep the “fat-burning” switch permanently off.

3. The Vital Organs: Heart, Kidneys, and Arteries

Heart and Arteries

Normal Action: Insulin stimulates the release of nitric oxide, which helps arteries relax and dilate.
Insulin Resistance Effect: Nitric oxide production drops, causing arteries to stiffen (hypertension). High insulin also damages the endothelial lining, leading to atherosclerosis (plaque buildup). This is the primary driver of heart failure, heart attacks and strokes.

Kidneys

Normal Action: Helps regulate sodium reabsorption.
Insulin Resistance Effect: The kidneys hold onto too much salt, increasing blood pressure. Over time, high blood sugar and inflammation damage the filtering units, leading to chronic kidney disease (CKD).

4. The Brain, Memory, and Sleep

Brain and Memory

Normal Action: Insulin crosses the blood-brain barrier to regulate appetite and support synaptic plasticity (the basis of learning).
Insulin Resistance Effect: Often called “Type 3 Diabetes,” brain IR starves neurons of energy and allows amyloid plaques and neurofibrillary tangles to build up. Worse, the brain is unable to utilize glucose to meet energy demands it starts to malfunction. This is a direct pathway to Alzheimer’s disease and dementia. As the small arteries in the brain become atherosclerotic and unable to deliver adequate oxygen and nourishment to brain cells small areas of the brain become permanently damaged eventually leading to vascular dementia.

Sleep

Insulin Resistance Effect: IR is heavily linked to Obstructive Sleep Apnea. (OSA) High insulin affects the central respiratory drive and increases fat deposits around the neck (a major contributor to obstructive sleep apnea), disrupting sleep cycles and creating periods of inadequate oxygen flow to the brain resulting in the acute stress response and awakening with each apneic event. Even without OSA, high insulin levels impair the production of melatonin which is essential to normal-restorative sleep. Throughout the day the brain accumulates metabolic toxins that must be cleared through the glymphatic system at night during sleep. As sleep is impaired this clearance system is disrupted, contributing to structural damage and functional loss. Sleep disruption and apneic episodes are stressful events, increasing stress hormones which then worsen IR, creating another vicious cycle. One night of sleep disruption causes acute IR. Chronic sleep disruption contributes to chronic IR.

5. Immunity and Structural Health

Immune System

Action: High insulin/glucose impairs white blood cell function.
Effect: Chronic inflammation (high CRP levels) and a weakened defense against infections. This is why diabetics often have poor wound healing. As normal immune regulation is impaired the immune system both over-reacts and under-reacts. Under-reaction increases risk of infection. Over-reaction produces cytokine storms seen with Covid-19 and other infections. Chronic inflammation worsens IR creating another vicious cycle. Chronic inflammation contributes to most chronic diseases.

Bone and Joints

Action: Insulin is bone-building.
Effect: IR leads to poor bone quality (despite high density) and osteoarthritis due to systemic inflammation and the “glycosylation” (sugar-coating) of joint cartilage, making it brittle.

6. The Pancreas: Beta and Alpha Cells

Normal Action: Beta cells produce insulin; Alpha cells produce glucagon (which raises sugar). They balance each other.
Insulin Resistance Effect:
- Beta Cells: Work overtime to produce massive amounts of insulin to compensate, eventually “burning out” and dying. This can produce per4manent irreversible damage to the pancreas.
- Alpha Cells: Become resistant to insulin’s “stop” signal and keep secreting glucagon, further raising blood sugar levels which in turn cause higher insulin secretion, both of which worsen IR, creating another vicious cycle.

7. Reproductive Effects: Infertility

In Women: High insulin stimulates the ovaries to produce excess testosterone, which is the primary driver of Polycystic Ovary Syndrome (PCOS) and infertility.
In Men: IR is a leading cause of low testosterone and erectile dysfunction (due to the arterial damage mentioned above).

Summary of Systemic Effects

Condition	Primary Mechanism of Insulin Resistance
Atherosclerosis	Endothelial dysfunction, high triglycerides, low HDL, increased TG/HDL ratio, increased small dense LDL and remnant particles, increased endothelial permeability.
Dementia	Neuronal glucose starvation and plaque buildup, brain small vessel disease, disruption of blood brain barrier.
Chronic Inflammation	Release of cytokines from visceral fat.
Heart Failure	Stiffening of the heart muscle and high blood pressure.
Diabetes	Pancreatic beta cell and alpha cell damage

Insulin’s Role vs. Insulin Resistance (IR)

Organ/System	Normal Insulin Action	Effects of Insulin Resistance
Liver	Stops glucose production; stores glucose as glycogen.	The liver ignores the “stop” signal, pumping out sugar even when you haven’t eaten (fatty liver).Fatty liver disease is the greatest cause of liver failure in the US.
Muscle	Primary site for glucose uptake; promotes protein synthesis.	Muscles can’t take in fuel efficiently, leading to fatigue and muscle wasting (sarcopenia). Muscle cells cannot use amino acids from dietary protein to maintain or build muscle. Elderly lose muscle and strength, resulting in falls, fractures and head trauma. Loss of muscle (the major sink for blood sugar after a meal) further increases duration and degree of blood sugar and insulin rise after a meal, which in turn increases IR. (vicious cycle)
Fat (Adipose)	Stores fat; inhibits the breakdown of stored fat.	Fat cells leak fatty acids into the blood, leading to high triglycerides and visceral fat gain. Macrophages (immune cells) produce inflammatory cytokines which circulate through the body contributing to chronic inflammation which worsens IR, another vicious cycle.
Brain	Regulates appetite, memory, and cognitive function.	Linked to “Type 3 Diabetes”; impaired memory and increased risk of neurodegeneration. Brain loses ability to meet energy demands and clear toxins. Insulin resistance in the brain explains memory loss, cognitive impairment, loss of neurons and synapses, loss of neuroplasticity. BDNF (brain derived neurotrophic factor) production is decreased by IR.
Arteries	Stimulates nitric oxide for vasodilation (keeps vessels flexible).	Reduced nitric oxide causes vessels to stiffen, raising blood pressure and plaque buildup. This is called endothelial dysfunction, the precursor to heart attack, stroke, peripheral vascular disease and a root cause for neuropathy and amputations.
Heart	Regulates fuel use (switching between glucose and fats).	The heart becomes “metabolically inflexible,” increasing the risk of heart failure.
Kidney	Manages sodium reabsorption and filtration.	High insulin causes the kidneys to hold onto salt, driving up blood pressure and damaging filters. Oxidative stress leads to kidney failure.
Immune System	Modulates inflammation and helps T-cell function.	Creates a state of “chronic low-grade inflammation” and weakens the response to infections.
Bone	Stimulates bone-forming cells (osteoblasts).	Bone quality decreases; despite higher bone density in some cases, the bones are more brittle.
Joints	Maintains cartilage and reduces systemic inflammation.	High insulin promotes pro-inflammatory cytokines, accelerating osteoarthritis and gout.

A meal with sugar and refined carbohydrates causes excessive swings in blood sugar and insulin levels, creating insulin resistance and downstream damage. Alcohol consumption contributes to this process. Fat consumption does not cause a rise in blood sugar or insulin levels. Protein consumption produces a minimal rise in insulin levels in the absence of IR.

Fat storage can occur through hyperplasia (increase in number of fat cells) or hypertrophy (increase in size). Some ethnic groups are more prone to hypertrophy (south and east Asian). Hypertrophy in visceral fat (fat around the internal organs as opposed to fat under the skin) results in macrophage production of inflammatory cytokines. Eventually, the fat cells themselves can literally burst from too much volume.

In my next post, I will discuss what we can do to prevent and reverse IR.

REFERENCES

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https://pmc.ncbi.nlm.nih.gov/articles/PMC7462924/

Fujita S, Rasmussen BB, Cadenas JG, Grady JJ, Volpi E. Effect of insulin on human skeletal muscle protein synthesis is modulated by insulin-induced changes in muscle blood flow and amino acid availability. Am J Physiol Endocrinol Metab. 2006 Oct;291(4):E745-54. doi: 10.1152/ajpendo.00271.2005. Epub 2006 May 16. PMID: 16705054; PMCID: PMC2804964.

https://pmc.ncbi.nlm.nih.gov/articles/PMC2804964

Vargas E, Joy NV, Carrillo Sepulveda MA. Biochemistry, Insulin Metabolic Effects. [Updated 2022 Sep 26]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK525983/

https://www.ncbi.nlm.nih.gov/books/NBK525983/

Bugianesi E, Moscatiello S, Ciaravella MF, Marchesini G. Insulin resistance in nonalcoholic fatty liver disease. Curr Pharm Des. 2010 Jun;16(17):1941-51. doi: 10.2174/138161210791208875. PMID: 20370677.

https://pubmed.ncbi.nlm.nih.gov/20370677/

Cardillo C, Nambi SS, Kilcoyne CM, Choucair WK, Katz A, Quon MJ, Panza JA. Insulin stimulates both endothelin and nitric oxide activity in the human forearm. Circulation. 1999 Aug 24;100(8):820-5. doi: 10.1161/01.cir.100.8.820. PMID: 10458717.

https://pubmed.ncbi.nlm.nih.gov/10458717/

Ke JF, Wang JW, Zhang ZH, Chen MY, Lu JX, Li LX. Insulin Therapy Is Associated With an Increased Risk of Carotid Plaque in Type 2 Diabetes: A Real-World Study. Front Cardiovasc Med. 2021 Feb 1;8:599545. doi: 10.3389/fcvm.2021.599545. PMID: 33598483; PMCID: PMC7882504.

https://pubmed.ncbi.nlm.nih.gov/33598483/

Brosolo G, Da Porto A, Bulfone L, Vacca A, Bertin N, Scandolin L, Catena C, Sechi LA. Insulin Resistance and High Blood Pressure: Mechanistic Insight on the Role of the Kidney. Biomedicines. 2022 Sep 23;10(10):2374. doi: 10.3390/biomedicines10102374. PMID: 36289636; PMCID: PMC9598512.

https://pubmed.ncbi.nlm.nih.gov/36289636/

Kumar M, Dev S, Khalid MU, Siddenthi SM, Noman M, John C, Akubuiro C, Haider A, Rani R, Kashif M, Varrassi G, Khatri M, Kumar S, Mohamad T. The Bidirectional Link Between Diabetes and Kidney Disease: Mechanisms and Management. Cureus. 2023 Sep 20;15(9):e45615. doi: 10.7759/cureus.45615. PMID: 37868469; PMCID: PMC10588295.

https://pmc.ncbi.nlm.nih.gov/articles/PMC10588295/

Banks WA, Owen JB, Erickson MA. Insulin in the brain: there and back again. Pharmacol Ther. 2012 Oct;136(1):82-93. doi: 10.1016/j.pharmthera.2012.07.006. Epub 2012 Jul 17. PMID: 22820012; PMCID: PMC4134675.

https://pubmed.ncbi.nlm.nih.gov/22820012/

Rahman MS, Hossain KS, Das S, Kundu S, Adegoke EO, Rahman MA, Hannan MA, Uddin MJ, Pang MG. Role of Insulin in Health and Disease: An Update. Int J Mol Sci. 2021 Jun 15;22(12):6403. doi: 10.3390/ijms22126403. PMID: 34203830; PMCID: PMC8232639.

https://pmc.ncbi.nlm.nih.gov/articles/PMC8232639/

Scherrer U, Sartori C. Insulin as a vascular and sympathoexcitatory hormone: implications for blood pressure regulation, insulin sensitivity, and cardiovascular morbidity. Circulation. 1997 Dec 2;96(11):4104-13. doi: 10.1161/01.cir.96.11.4104. PMID: 9403636.

https://pubmed.ncbi.nlm.nih.gov/9403636/

Affuso F, Micillo F, Fazio S. Insulin Resistance, a Risk Factor for Alzheimer’s Disease: Pathological Mechanisms and a New Proposal for a Preventive Therapeutic Approach. Biomedicines. 2024 Aug 19;12(8):1888. doi: 10.3390/biomedicines12081888. PMID: 39200352; PMCID: PMC11351221.

https://pmc.ncbi.nlm.nih.gov/articles/PMC11351221/

Park MH, Kim DH, Lee EK, Kim ND, Im DS, Lee J, Yu BP, Chung HY. Age-related inflammation and insulin resistance: a review of their intricate interdependency. Arch Pharm Res. 2014 Dec;37(12):1507-14. doi: 10.1007/s12272-014-0474-6. Epub 2014 Sep 20. PMID: 25239110; PMCID: PMC4246128.

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Hardy OT, Czech MP, Corvera S. What causes the insulin resistance underlying obesity? Curr Opin Endocrinol Diabetes Obes. 2012 Apr;19(2):81-7. doi: 10.1097/MED.0b013e3283514e13. PMID: 22327367; PMCID: PMC4038351.

https://pmc.ncbi.nlm.nih.gov/articles/PMC4038351/

THIS WEBSITE PROVIDES INFORMATION FOR EDUCATIONAL PURPOSES ONLY. CONSULT YOUR HEALTH CARE PROVIDER FOR MEDICAL ADVICE.

Eat clean, drink filtered water, love, laugh, exercise outdoors in a greenspace, get some morning sunlight, block the blue light before bed, engage in meaningful work, find a sense of purpose, spend time with those you love, AND sleep well tonight.

Doctor Bob

4th International Evolutionary Health Conference

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Sorry for the confusion. The website for the International Evolutionary Health Conference changed when the venue changed from Boston to Virtual. Here is the correct website link which gives a list of speakers/topics and sign up information.

https://2023.evolutionaryhealthconference.com/

The previously published link will lead you to a site that says “canceled”. The conference is not cancelled, the venue has changed to virtual.

Dr. Bob

Fourth International Evolutionary Health Conference

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I’ve been asked to talk at the fourth International Evolutionary Health Conference on the topic of Cardiovascular Risk Assessment. This year the conference is virtual. Presenters include clinicians and researchers discussing many topics related to health. The underlying principle of this approach attributes modern degenerative and chronic diseases to mismatch between our evolutionary biology and present day life. You can sign up for this virtual event here.

https://2023.evolutionaryhealthconference.com/

Agenda

9:45 AM – 10:00 AM

Opening remarks

Prof. Lynda Frassetto

10:00 AM – 10:30 AM

Maladaptive cognitive/emotional processing as the cause of the stress response

Prof. Igor Mitrovic

Physiologic reserve is spare capacity activated when demand exceeds baseline, causing stress. If demand surpasses reserve, it damages the system and leads to death. The brain predicts the future to a…
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10:30 AM – 11:00 AM

How breathing patterns affect health

Dr. Michael Mew

11:00 AM – 11:15 AM

Round table with Q & A (Moderator: Darryl Edwards)

Dr. Michael Mew

Prof. Igor Mitrovic

11:15 AM – 11:45 AM

Break and Poster session

If you would like to submit a poster, please contact us at evolution.conference@nutriscience.pt

11:45 AM – 12:15 PM

Decoding The Truth: Cancer, Carbs and Cure

Darryl Edwards, MSc

1. We will delve into the extensive evidence showcasing how higher levels of physical activity can reduce the risk of various cancers. 2. While awareness of the importance of exercise exists, we will…
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12:15 PM – 12:45 PM

Influential factors on sun-induced vitamin D synthesis

Pedro Bastos, PhD candidate

Ultraviolet B radiation is absorbed in the epidermis by 7-dehydrocholesterol, giving rise to previtamin D3 and subsequently to vitamin D3. In the liver, vitamin D is converted to one of the various c…
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12:45 PM – 1:00 PM

Round table with Q & A (Moderator: Prof. Lynda Frassetto)

Darryl Edwards, MSc

Pedro Bastos, PhD candidate

1:00 PM – 2:15 PM

Lunch Break

2:15 PM – 2:45 PM

How nutrition can impact microbiome composition/permeability/immune response

Prof. Alessio Fasano

Improved hygiene and reduced microorganism exposure are linked to the ‘epidemic’ of chronic inflammatory diseases (CID) in developed nations. This hygiene hypothesis suggests that lifestyle and envir…
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2:45 PM – 3:15 PM

Comprehensive cardiovascular risk assessment

Dr. Robert Hansen

Assessing insulin resistance is central to predicting CV risk. LDL-C and standard lipid profile is extremely limited in predictive value. A systems engineering understanding of atherosclerosis and ev…
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3:15 PM – 3:30 PM

Round table with Q & A (Moderator: Pedro Bastos)

Prof. Alessio Fasano

Dr. Robert Hansen

3:30 PM – 3:45 PM

Short Break

3:45 PM – 4:15 PM

Environmental influences on cellular senescence and aging

Prof. Peter Stenvinkel

Planetary health recognizes that human well-being depends on the health of ecosystems. Neglecting this concept has led to an anthropocentric world, causing increased greenhouse gas emissions, heat st…
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4:15 PM – 4:45 PM

Fueling a Bright Future: The Role of Diet in Preventing Childhood Obesity

Dr. Polina Sayess

Childhood obesity is a global health issue. In my presentation, I’ll explore its origins, classifications, and mitigation strategies. I’ll discuss the definitions and distinctions between “overweight…
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4:45 PM – 5:00 PM

Round table with Q & A (Moderator: Prof. Lynda Frassetto)

Prof. Peter Stenvinkel

Dr. Polina Sayess

5:00 PM – 5:30 PM

Final discussion with all speakers and moderators

Establishing future research and intervention directions.

5:30 PM – 5:45 PM

Closing remarks

Prof. Lynda Frassetto

Please join us if you can.

Dr. Bob

AHS 2022 Lecture, Acute and Long Covid, Nutritional and Lifestyle Immunology

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I recently gave a talk at the AHS 2022 meeting held at UCLA. You can view the video here:

This first slide gives a good overview.

The presentation covers a quick review of my presentations given last year at the PAH 2021 annual meeting (virtual) with additional information on long Covid.

Multiple nutrients acting synergistically support a balanced response to viral infections, including SARS CoV-2. Here is a picture.

The take home message is that no single nutritional intervention is likely to have significant impact with an acute infection unless all but one nutritional component is optimal. Nevertheless, there is compelling evidence that Vitamin D deficiency is rampant in the developed world and if one nutritional intervention is likely to be of benefit, Vitamin D supplementation, particularly in high risk populations, presents the most likely candidate. As usual, preventive supplementation would be preferable to rescue high dose intervention.

In a study of frail elderly hospitalized patients, regular vitamin D supplementation was associated with decreased mortality as demonstrated here. Compared to no supplementation, regular supplementation was associated with a 93% reduction in risk of death.

A study from Spain with very high dose Vitamin D in the form of Calcifediol showed significant benefit in hospitalized patients, suggesting that Vitamin D deficiency was prevalent in that population and that such a treatment intervention should be widely considered.

Calcifediol Treatment and COVID-19-Related Outcomes

Click to access dgab405.pdf

The following graphic from another nutrition review article, with red additions added by myself, demonstrates the complex interaction between nutrition and the two main components of our immune system, innate immunity (immediate response) and adaptive immunity (based on immune memory). Again red highlights added by yours truely.

And here is a slide from my lecture with quotes from that article.

Yet most Americans are deficient in many of these essential nutrients as depicted here. The percentages represent the % of Americans that fall below the estimated amount required to prevent deficiency in HALF of adults (a very low standard).

The EAR is a very low bar to meet, yet many Americans fall below even that low standard.

The SARS CoV2 virus interferes with a crucial component of the the initial (innate) immune response, the production of interferon 1 and the signaling of interferon one to immune cell mediators as depicted in this graphic.

SARS CoV2 on the left is compared to Virus X on the right. On the left interferon 1 (IFN) production and signaling is blocked by the virus, interfering with an effective and controlled immune response, on the right IFN is not blocked. A cascade of events results in TOO LITTLE, TOO LATE, AND THEN TOO MUCH of an immune response, producing a cytokine storm.

Obesity, insulin and leptin resistance, also interfere with the production and signaling of interferon. The result is that people with insulin and leptin resistance (pre-diabetes, Type 2 Diabetes as well as sarcopenia) experience a double hit. First the virus itself disrupts the immune response and superimposed upon the viral effect is the effect of insulin and leptin resistance on the immune response.

SOCS: suppressor of cytokine signaling. Several recent viral studies have shown that viral genes can hijack SOCS1 to inhibit host antiviral pathways, as a strategy to evade host immunity

On the left Interferon production and signaling are normal and a successful immune response is mounted. On the right the presence of insulin and leptin resistance, associated with obesity results in an initial inadequate response and a late excessive response. TOO LITTLE, TOO LATE, THEN TOO MUCH.

Factors that can quickly impact insulin and leptin resistance include all the components of an ancestral lifestyle depicted in my website graphic. A paleolithic or ancestral diet that eliminates sugar added foods and beverages, replacing those empty calories with nutrient dense foods, exercise, adequate restorative sleep, stress reduction, avoidance of environmental toxins, social connection. All of these affect health in general, mitigate insulin and leptin resistance, and support a balanced immune response to viral infection. The circle of health depicted below is surrounded by the many deleterious aspects of modern living. Thus, a mismatch between our evolutionary biology and present day life.

Here is a slide from my lecture that lists many lifestyle factors that can impact infection with any virus, including SARS CoV-2

My lecture also included discussion of Long COVID, theories of etiology and pathophysiology which will be discussed in my next post.

For the full lecture which is about 34 minutes long, please follow the link above.

THIS WEBSITE PROVIDES INFORMATION FOR EDUCATIONAL PURPOSES ONLY. CONSULT YOUR HEALTH CARE PROVIDER FOR MEDICAL ADVICE.

Doctor Bob

Red Meat and Health, another round of nonsense

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Again, another biased article claims to demonstrate the dangers of red meat. There are so many problems with the author’s analysis and conclusions it is hard to know where to begin. Rather than go through the nitty gritty here, just head on over to this analysis to read another debunking of the same litany of bad science.

https://www.globalfoodjustice.org/nutrition/does-the-global-meat-trade-lead-to-poor-health

In the context of the COVID 19 pandemic I will close with the usual summary.

Avoid alcohol consumption (alcohol wreaks havoc with your immunity)
Get plenty of sleep (without adequate sleep your immune system does not work well )
Follow good sleep habits
Exercise, especially out of doors in a green space, supports the immune system
Get some sunshine and make sure you have adequate Vitamin D levels. Supplement with Vitamin D3 to get your levels above 30 ng/ml. (read this Open Letter)
Eat an anti-inflammatory diet rich in micronutrients.
Practice stress reduction like meditation and yoga which improves the immune system
Eliminate sugar-added foods and beverages from your diet. These increase inflammation, cause metabolic dysfunction, and suppress immunity.
Eliminate refined-inflammatory “vegetable oils” from your diet, instead eat healthy fat.
Clean up your home environment and minimize your family’s exposure to environmental toxins by following recommendations at EWG.org with regards to household products, personal care products, and organic foods. (https://www.ewg.org/)
If you are eligible for vaccination, consider protecting yourself and your neighbor with a few jabs.

THIS WEBSITE PROVIDES INFORMATION FOR EDUCATIONAL PURPOSES ONLY. CONSULT YOUR HEALTH CARE PROVIDER FOR MEDICAL ADVICE.

Doctor Bob

COVID 19 UPDATE: What have we learned?

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I was recently interviewed by a health blogger, Dmitri Konash, with specific questions about COVID 19. The podcast link is below.

Here are the questions and answer notes from the podcast.

QUESTION #1: It has been almost 4 months since Covid19 was declared a global pandemic. What are the main things which we have learned about the virus over these 4 months?

Very contagious, spread by droplet AND aerosol as well as fomites (CLOTHING, surfaces, pillows, blankets, etc). Aerosols are tiny particles suspended in the air for hours following a sneeze or cough or possibly yelling or singing. Droplets are larger particles that fall to the ground or onto surfaces. Depending on the surface the virus can remain infectious for up to 72 hours following droplet spread.

Individuals without symptoms can transmit disease (unlike most viruses) so this in combination with degree of contagion is very dangerous.

The average time from exposure to develop symptoms is 5 DAYS, 97.5% of people who develop symptoms do so within 11.5 days.

Some individuals never develop symptoms but can transmit disease for 2 or more weeks.

Infected individuals can carry the virus for up to 36 days (but we do not know how long an individual can transmit the disease) Average time to clear the virus is 14 days. (nasal PCR test)

Cough and sneeze can project 26 feet through the air, that is why masks can decrease risk but decreasing projection distance and viral load.

Masks Work, they decrease risk of disease transmission and probably decrease viral load, so if transmitted the recipient is probably less likely to develop severe complications (not proven but likely true).

Most infections are transmitted in closed spaces where many people are congregated and socializing such as parties, social gatherings, meetings, bars and restaurants.

Outdoor activity is safer.

The longer the contact between individuals the greater the risk.

The closer the contact the greater the risk.

Anyone can die from the virus but risk increases with age, diabetes, pre-diabetes, obesity, heart and lung disease, immune-compromise.

Any organ can be affected, lungs, brain, heart, kidneys, blood vessels.

Hyper-coaguable state can cause blood clots in the legs, lungs, heart and brain, any organ.

After recovering from infection individuals can suffer permanent damage to these organs.

We do not know how many people who recover will be immune or how long immunity could last. Already one case of re-infection has been reported.

The infection fatality rate (IFR) for COVID-19 IS 25 times greater than the H1N1 FLU pandemic.

A recent analysis comparing the 2009 H1N1 influenza A pandemic to COVID 19 suggested this:

	Case Fatality Rate	Infection Fatality Rate
2009 H1N1 Virus (flu)	0.1% to 0.2%	0.02%
COVID-19 New York	8%	0.50%

CFR is # deaths/#cases identified by nasal PCR, IFR is # deaths/actual # cases in a given population, estimated by antibody testing of a large population

For a discussion on the difference between CFR (case fatality rate) and IFR (infection fatality rate) see my previous post.

https://practical-evolutionary-health.com/2020/04/25/stanford-study-on-santa-clara-county-very-questionable-conclusions/

QUESTION #2: We reached the new high of newly diagnosed cases on June 28th. It looks like the virus is not subsiding. What is the status re drug and vaccine development?

Vaccine will likely take at least a year to develop, test, then manufacture and distribute.

Initially most vulnerable will probably take priority for vaccination. Massive vaccination will take longer.

THERE HAS NEVER BEEN A SUCCESSFUL CORONA VIRUS Vaccine. There are many corona viruses. They mutate quickly and a vaccine that works initially may become ineffective if/when new strains emerge.

Decadron (dexamethasone) IV decreases mortality rates in very sick patients.

Remdesivir shortens illness and might decrease mortality rate (the reduction compared to placebo fell short of statistical significance, p=0.059, cut-off for statistical significance is usually P=0.050)

Hydroxychloroquine and chloroquine have failed to show any benefit. A prevention trial remains underway.

There is no “cure”, just risk reduction.

QUESTION #3: What are the latest recommendations on prevention?

Social distance

Mask

Frequent hand washing

Get adequate sleep, sleep deprivation impairs immunity

Avoid alcohol which suppresses the immune system.

Get sunshine (vitamin D)

Develop a social “bubble”, limit contacts to close, reliable (responsible behavior) individuals

Exercise out of doors.

If overweight or obese, LOSE WEIGHT (Low Carb High Fat diet is MOST EFFECTIVE in combination with time restricted eating)

IF diabetes or pre-diabetes, carbohydrate restriction can rapidly achieve better blood sugar control, which is linked to risk reduction. Regular exercise can also improve insulin sensitivity, as can improved sleep habits.

QUESTION #4: There was some information recently about potential long-term impact on vital body organs for patients who had only mild symptoms. What actions do people who were tested positive for COVID19 should take to minimize long term impact to their health?

Follow general principles of healthy living (visit my website)

Sleep

Nutrition-anti-inflammatory diet

Exercise

Sunshine

Stress reduction

Social-community support

Minimize environmental toxin exposure (organic foods, safe personal and home-care products, visit EWG.org)

QUESTION #5: What actions should be taken by people who have been tested negative for COVID19 ?

Same answer as question #4 above, lifestyle changes to enhance immune function and reduce systemic inflammation.

On July 10, a review article on COVID 19 was published in JAMA.

Pathophysiology, Transmission, Diagnosis, and Treatment
of Coronavirus Disease 2019 (COVID-19)

Here is the link.

https://jamanetwork.com/journals/jama/fullarticle/2768391

The case-fatality rate for COVID-19 varies markedly by age, ranging from 0.3 deaths per 1000 cases among patients aged 5 to 17 years to 304.9 deaths per 1000 cases among patients aged 85 years or older in the US. Among patients hospitalized in the intensive care unit, the case fatality is up to 40%

And here is a link to the JAMA patient information page for COVID 19.

https://jamanetwork.com/journals/jama/fullarticle/2768390

In the context of the COVID 19 pandemic I will close with the usual summary.

Avoid alcohol consumption (alcohol wreaks havoc with your immunity)
Get plenty of sleep (without adequate sleep your immune system does not work well )
Follow good sleep habits
Exercise, especially out of doors in a green space, supports the immune system
Get some sunshine and make sure you have adequate Vitamin D levels.
Eat an anti-inflammatory diet rich in micronutrients.
Practice stress reduction like meditation and yoga which improves the immune system
Eliminate sugar-added foods and beverages from your diet. These increase inflammation, cause metabolic dysfunction, and suppress immunity.
Eliminate refined-inflammatory “vegetable oils” from your diet, instead eat healthy fat.
Clean up your home environment and minimize your family’s exposure to environmental toxins by following recommendations at EWG.org with regards to household products, personal care products, and organic foods. (https://www.ewg.org/)

THIS WEBSITE PROVIDES INFORMATION FOR EDUCATIONAL PURPOSES ONLY. CONSULT YOUR HEALTH CARE PROVIDER FOR MEDICAL ADVICE.

Doctor Bob

Fat Fiction: this movie could save your life

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The USDA Dietary Guidelines are about to be published again with an update. Unfortunately, despite much input from the scientific community requesting that the dietary guidelines address the epidemics of obesity and diabetes, it looks like nothing will change. More than 50 scientific papers that support a Very Low Carbohydrate approach to address obesity, diabetes and pre-diabetes will be ignored.

But if you want a more scientific perspective I suggest you watch this movie. You can watch it free on Amazon Prime.

If you have read Good Calories Bad Calories by Gary Taubes or Big Fat Surprise by Nina Teicholtz. then you have already been exposed to the sad history of dietary recommendations in the United States and the tragic results.

Both books are well researched and present accurate science. The movie Fat Fiction reviews the sad history of dietary advice in the US. It presents many examples of patients whose lives were changed and improved by following the advice of nutritionists and physicians who have instead, followed the science and abandoned the ideological-unscientific USDA dietary guidelines.

The American Diabetes Association has finally recognized a VLC ketogenic diet as a valid approach to treating type 2 diabetes. In fact, a ketogenic diet is the only diet that has ever been documented in controlled clinical trials to reverse diabetes type 2 and get patients off insulin and oral medications used to treat diabetes.

Unfortunately, the USDA guidelines and the American Heart Association recommendations continue to recommend unhealthy inflammatory refined “vegetable oils” (processed/refined oils from corn, soy, safflower, peanuts, cottonseed, etc.) and high carbohydrate/low fat meals. The high carb/low fat approach to cardiovascular disease, obesity, and diabetes has been an absolute failure, increasing rather than decreasing the risk of heart attack and stroke as well as contributing to the explosive epidemics of obesity and DM2. The low fat dogma has fostered the obesity and diabetes epidemics since this dogma was first introduced in the mid 20th century. The low-fat ideology remains fully supported by financial contributions from the processed-food industry, creating a financial conflict of interest for the AHA and similar organizations.

In the context of the COVID 19 pandemic, where obesity, insulin resistance, pre-diabetes and diabetes type II are major risk factors for death from the infection, it is even more imperative that individuals suffering from these risk factors stop using medications to treat problems created by food and instead clean up their diet.

“You can’t throw drugs at a nutritional disease and expect it to work” (Dr. Sarah Hallberg, TEDtalk)

You can fight systemic inflammation with the anti-inflammatory diet I present on this website, but if you have obesity, diabetes or pre-diabetes, the very low-carb version is the most effective and sustainable nutritional approach. Full fat dairy is optional (although technically not part of our evolutionary nutrition) and if you are obese, overweight, diabetic or pre-diabetic and full fat dairy is necessary for you to achieve a ketogenic diet, then go for it. But make sure you include an abundance of non-starchy vegetables which are an important component of a healthy ketogenic diet.

In the context of our present pandemic I will repeatedly say:

Avoid alcohol consumption (alcohol wreaks havoc with your immunity)
Get plenty of sleep (without adequate sleep your immune system does not work well )
Follow good sleep habits
Exercise, especially out of doors in a green space, supports the immune system
Get some sunshine and make sure you have adequate Vitamin D levels.
Eat an anti-inflammatory diet rich in micronutrients.
Practice stress reduction like meditation and yoga which improves the immune system
Eliminate sugar-added foods and beverages from your diet. These increase inflammation, cause metabolic dysfunction, and suppress immunity.
Eliminate refined-inflammatory vegetable oils from your diet, instead eat healthy fat.
Clean up your home environment and minimize your family’s exposure to environmental toxins by following recommendations at EWG.org with regards to household products, personal care products, and organic foods. (https://www.ewg.org/)

THIS WEBSITE PROVIDES INFORMATION FOR EDUCATIONAL PURPOSES ONLY. CONSULT YOUR HEALTH CARE PROVIDER FOR MEDICAL ADVICE.

Doctor Bob

Chronic Inflammation, the silent killer

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I was recently interviewed by a health blogger for his podcast. The topic was chronic inflammation. Here it is.

I prepared some notes for the interview. Here are the questions and answers.

What made you so interested in the topic of chronic inflammation?

Interest in chronic inflammation:

Emerging evidence, source of most chronic disease including mental health (depression, etc.) is inflammation
family health issues experience personally
health care policy interest since graduate school
First started to question USDA dietary advice after reading GOOD CALORIES, BAD CALORIES, by Gary Taubes,
Experienced Statin myopathy, researched statin drugs, bad data, financial conflicts of interest. Sought alternative approaches to Coronary Artery Disease prevention.
In USA, Profit driven health care system evolved from more benign not-for-profit earlier system in medical insurance and hospital system. Drug and surgery oriented. Corporate ownership of multiple hospitals, concentration of wealth and power in the industry and in society in general
Saw this every day: growing obesity, Metabolic Syndrome, DMII, auto-immune disease. Root causes NOT ADDRESSED.
While recovering from surgery attended on line functional medicine conference on auto-immune disease, covering diet, sleep, exercise, sunshine, Vitamin D, environmental toxins, gut dysbiosis, intestinal permeability (THE GATEWAY TO AUTOIMMUNITY IS THROUGH THE GUT).
Introduced to EVOLUTIONARY BIOLOGY and Paleo Diet by my son

What diseases does chronic inflammation typically lead to?

Cancer
Diabetes
Obesity epidemic, DIABESITY
Hypertension
Metabolic Syndrome (3/5: HTN, insulin resistance/high blood sugar, abdominal obesity, high TGs, low HDL),
Autoimmune diseases
Degenerative arthritis
Neurodegenerative disorders (dementia, Parkinson’s, neuropathy, multiple sclerosis)
Works of Dale Bredesen (dementia, “The End of Alzheimer’s”), Ron Perlmutter (Grain Brain), Terry Wahls (The Wahls protocol for MS), all FUNCTIONAL MEDICINE looking at root cause of illness, common-overlapping threads.
Interplay between sleep, circadian rhythm, exercise, sunlight, stress, environmental toxins, diet, processed foods, nutritional deficiency, gut microbiome, endocrine disruptors, intestinal permeability, oral and skin microbiome, social disruptors, GUT BRAIN AXIS. These are all part of one large ECOSYSTEM.
Positive and negative feedback systems requiring a SYSTEMS ENGINEERING approach to understanding root causes.
Butyrate is the preferred substrate for colonocytes, providing 60-70% of the energy requirements for colonic epithelial cells^1,2. Butyrate suppresses colonic inflammation,³ is immunoregulatory in the gut,⁴ and improves gut barrier permeability by accelerating assembly of tight junction proteins.^5,6
Improves insulin sensitivity, increase energy expenditure, reduce adiposity, increases satiety hormones,
HDAC activity inhibitor, PROTECTS GENES from removal of necessary acetyl groups.
Butyrate also influences the mucus layer. A healthy colonic epithelium is coated in a double layer of mucus. The thick, inner layer is dense and largely devoid of microbes, protecting the epithelium from contact with commensals and pathogens alike. The loose, outer layer of mucus is home to many bacteria, some of which feed on the glycoproteins of the outer mucus layer itself. Both of these mucus layers are organized by the MUC2 mucin protein, which is secreted by goblet cells in the epithelium. Supplementation of physiological concentrations of butyrate has been shown to increase MUC2 gene expression and MUC2 secretion in a human goblet cell line.^7,8

What are the population groups which have higher risk of chronic inflammation?

Obese
Sedentary
Poor-urban-polluted environment dwelling (air, water, noise, crowding, violence, racism, oppression)
Divergence from ancestral evolutionary biology
Working environment: indoors, polluted, oppressive supervisors, no sunlight, noise pollution, air pollution, toxic social situations, repetitive motion, bad ergonomics,
night shift, disruption of circadian rhythm
both parents working, no time for real food and family interaction, supervision of children.
screen time- sedentary behavior, lack of outdoor activity
Stress of social inequality, food insecurity, violent neighborhoods, nutritional deserts

What are the “danger signs” or typical symptoms which may signal a chronic inflammation?

DANGER SIGNS:

Waistline (waist to height ratio, BMI)
Sarcopenia (muscle as an endocrine organ)
Sleep disturbance
Pain
Headaches
Depression
Lack of joy.
Brain fog, fatigue

What are the typical biomarkers of chronic inflammation?

METABOLIC SYNDROME (3 or more of the following: high blood pressure, elevated blood sugar, elevated Triglycerides, low HDL, obesity)
CRP predictive of cardiovascular events,
ESR associated with arthritis
Stress hormones (morning cortisol levels)
Resting Heart Rate and Heart Rate Variability

What are the typical sources of systemic chronic inflammation?

Sources of Chronic Inflammation:

Diet

N6/N3 FA ratio determined by too much Refined Easily Oxidized Vegetable Oils, not enough marine sources of N3 FA, grain fed vs grass fed/finished ruminant meat. Loren Cordain research wild game FA composition = grass fed. Margarine vs Butter. Fried foods using Vegetable oils. Oxidized fats/oils, oxy-sterols in diet.
Sugar excess leading to insulin resistance
Refined carbs leading to insulin resistance (dense acellular….)
Disturbance of gut microbiome from poor nutrition (sugar, refined carbs and vegetable oils all disrupt the microbiome)
Gut brain axis.
Food ADDITIVES AND PRESERVATIVES
Trans Fats (finally banned)

Endocrine disruptors/ BIOACCUMULATION

Plastics (microparticles in our fish, food and bottled water)
Plastic breakdown products
Phthalates added to plastics to increase flexibility ( also pill coatings, binders, dispersants, film formers, personal care products, perfumes, detergents, surfactants, packaging, children’s toys, shower curtains, floor tiles, vinyl upholstery, it is everywhere) 8.4 million tons of plasticizers produced annually. EWG.org
Pesticides, herbicides, glyphosate (Monsanto), DIRTY DOZEN, CLEAN FIFTEEN EWG.org
Medications
ABSORBED skin, eat, drink, breath,
BPS is as bad as the BPA it replaced
Polychlorinated biphenyls used in INDUSTRIAL COOLANTS AND LUBRICANTS
Flame retardants (PBDEs, polybrominated dipheyl ethers) are ubiquitous in furniture and children’s clothing. Also linked to autoimmune disease
Dioxins
PAHs (polycyclic aromatic hydrocarbons
Sunblock
CUMULATIVE BURDEN, INTERACTIONS, SYNERGY?

SLEEP DEPRIVATION CHRONIC IN OUR SOCIETY

Eating late vs time restricted eating

Gut Microbiome disrupted by

1/3 of prescribed medications disrupt the microbiome AND increase intestinal permeability
Stress
Sleep deprivation
Sugar
Refined carbs
Refined veg oils
Over exercise and Under exercise, both are bad.
Environmental toxins

Gut dysbiosis and infections include (often chronic, low grade, not diagnosed)

Pathogenic bacteria, infection or overgrowth/imbalance
SIBO
Parasites
Viruses
BAD bugs > good bugs
Good bugs make vitamins and SCFAs required for colonocyte energy
Gut-Brain axis huge topic, VAGUS NERVE COMMUNICATION both ways, SCFA in gut and in CIRCULATION (butyrate, propionate, acetate), NEUROTRANSMITTER PRODUCTION (SEROTONIN, OTHERS), enterochromaffin cells producing > 30 peptides.
Overuse of antibiotics in medicine
AND use of antibiotics in raising our food.
Vaginal delivery vs C-section
Breast feeding vs bottle feeding

INCREASED INTESTINAL PERMEABILITY:

Caused by all factors above
Leads to higher levels of circulating LPS-endotoxin, bacterial products that create an immune-inflammatory response.
Incompletely digested proteins with AA sequences overlapping our own tissue causing autoimmunity/inflammation through molecular mimicry

Heavy Metal toxicity

Lead
Mercury
Cadmium
Arsenic

MOLD TOXICITY (> 400 identified mycotoxins, can cause dementia, asthma, allergies, auto-immunity)

At home
At work

What are the most efficient natural (non-medication) ways to address chronic inflammation?

Anti-inflammatory Diet, real whole food that our ancestors ate through evolutionary history (grass fed/finished ruminant meat, free range poultry, antibiotic free, and pesticide free food, wild seafood (low mercury varieties), organic vegetables and fruit, nuts, fermented foods, eggs)
Low mercury fish and seafood for omega three fatty acids
Sleep hygiene
Exercise, not too much, not too little, rest days, out of doors, resistance training, walking, yoga, Pilates, tai chi, chi gong, dancing, PLAYING!!!!!!!!!!!!!
Stress reduction: meditation, mindful living, forest bathing, sunlight, Playing, music, praying, SOCIAL CONNECTION, laughter, comedy, quit the toxic job, quit the toxic relationship, SAUNA/SWEAT, heat shock proteins, exercise
Vitamin D, sunshine, check levels
PLAY, PLAY, PLAY, LAUGH, DANCE, ENJOY, LOVE
Be aware of potential dangers of EMF, WiFi, hand held devices, blue tooth headphones.
Address environmental justice
Address social inequality, food insecurity
Tobacco addiction
Ethanol
Other substance abuse
Agricultural subsidies in US distort the food supply
Loss of soil threatens food supply
Suppression of science (global warming, environment, etc.,) worsens environmental degradation, creating an EXISTENTIAL THREAT.

Avoid alcohol consumption (alcohol wreaks havoc with your immunity)
Get plenty of sleep (without adequate sleep your immune system does not work well )
Follow good sleep habits
Exercise, especially out of doors in a green space, supports the immune system
Get some sunshine and make sure you have adequate Vitamin D levels.
Eat an anti-inflammatory diet rich in micronutrients.
Practice stress reduction like meditation and yoga which improves the immune system
Eliminate sugar-added foods and beverages from your diet. These increase inflammation, cause metabolic dysfunction, and suppress immunity.
Clean up your home environment and minimize your family’s exposure to environmental toxins by following recommendations at EWG.org with regards to household products, personal care products, and organic foods. (https://www.ewg.org/)

THIS WEBSITE PROVIDES INFORMATION FOR EDUCATIONAL PURPOSES ONLY. CONSULT YOUR HEALTH CARE PROVIDER FOR MEDICAL ADVICE.

Doctor Bob

USDA Dietary Guidelines Flawed

2 Replies

The NUTRITION COALITION is a non-profit organization dedicated to bringing science to dietary recommendations in the US. The COALITION recently called upon the USDA to hold off on publishing it’s updated Dietary Guidelines for US Citizens because of reported improprieties in the process of scientific review.

https://www.nutritioncoalition.us/news/usda-members-blow-whistle-flaws-in-process

The guidelines since their inception have been biased and flawed, ignoring much of the dissenting scientific opinion in testimony before the committee and cherry picking studies without a balanced approach to the scientific literature.

The confluence of the Covid-19 pandemic with the epidemics of obesity and diabetes in the US have created a perfect public health storm, as discussed in my last post. The USDA Dietary Guidelines Committee chose to ignore more than 50 studies that confirm the benefits of a Very Low Carbohydrate nutritional approach to address obesity and diabetes.

Because of the importance of the guidelines influencing US dietary choices in the context of COVID-19 I have copied the informative letter from the NUTRITION COALITION below. There is a link in the letter that will allow you to send emails to your senators, congressman, and the Secretary of Agriculture, supporting the recommendations of the NUTRITION COALITION.

Here is the letter.

Dear Friends and Colleagues,

In a remarkable development, one or more member(s) of the Dietary Guidelines Advisory Committee recently came forth and blew the whistle, identifying serious flaws in the Dietary Guidelines process. I write to you today to ask that you contribute your voice to our effort to have these allegations taken seriously by the U.S. Departments of Agriculture and Health and Human Services (USDA-HHS). We are specifically asking these federal agencies to delay the Committee’s report, which is due out in just a matter of weeks, until the allegations can be investigated and addressed.

The Dietary Guidelines are considered the “gold standard” of science and are a powerful lever on government feeding programs, military rations, professional medical associations, and much more—including nutrition guidelines around the world. It is imperative that they be based on good science.

However, the current 2020 process is clearly flawed. We know, for instance, that almost all studies on weight loss have been excluded from consideration. We also know that virtually all studies on carbohydrate restriction have been excluded. Some USDA reviews of the science include the science only up to 2016, despite a Congressional mandate that the Dietary Guidelines include a comprehensive review of the science “that is current at the time.” It’s clear that the expert committee, in addition to excluding crucial science, has not been given enough time to do its work and has, essentially, had to cut corners.

Moreover, the Advisory Committee, in its draft conclusions, indicated that the cap on saturated fats is likely to stay firmly in place. The evidence linking saturated fats to heart disease was judged to be “strong,” not only for adults, but also, for the first time, children. Yet scientific justification for a continuation of these caps is lacking, and the Subcommittee presented weak evidence to make its case. The past decade has seen a thorough reconsideration of saturated fats, and now, there are close to 20 review papers reexamining the evidence—which have near-universally concluded that saturated fats have no effect on cardiovascular or total mortality.

Delaying the report will give time for a thorough investigation into these allegations.

By signing this letter, you are helping to push for Dietary Guidelines that are based on a comprehensive review of the science and are therefore more likely to help the public regain its health. Thank you for any contribution to this effort!

Click here to sign a physicians’ letter of support. In addition, it would be extremely helpful if you could also take time here to contact your representatives in Congress and let them know the importance of getting the Guidelines right. As an expert in the field, your voice will be able to resonate more than most, I hope you will take some time to try to help generate change to our far-reaching nutrition policy.

Thank you,

Nina Teicholz

Executive Director

The Nutrition Coalition

Read more about the allegations in our press release and letter to USDA-HHS.

THIS WEBSITE PROVIDES INFORMATION FOR EDUCATIONAL PURPOSES ONLY. CONSULT YOUR HEALTH CARE PROVIDER FOR MEDICAL ADVICE.

Doctor Bob

COVID-19, Lifestyle interventions more effective than most drugs. (But Paxlovid is a winner)

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This discussion was originally posted before PAXLOVID WAS AVAILABLE. Paxlovid is very effective in reducing morbidity and mortality associated with Covid-19 infection. Standard dosing: PAXLOVID two 150-mg tablets of nirmatrelvir, one 100-mg tablet of ritonavir twice daily for 5 days.

Dose adjustments are necessary for certain medical conditions and there are many drug interactions that should be considered.

The results of a randomized placebo controlled clinical trial in high risk individuals has been published in the NEJM. The study was done just when Omicron hit. The study demonstrated an 89% reduction of hospitalizations and deaths by day 28 (absolute reduction of 6.2/100) with ZERO deaths in the Paxlovid group (7 in the placebo group). Paxlovid also had LESS side effects than placebo.

Another study from Israel demonstrated equally impressive results as shown here.

In addition, a study from the VA has looked at longer term effects (pre-print publication, still waiting for peer review.)

The study included 9000 Paxlovid patients treated within 5 days of symptom onset during the Omicron and subvariant waves and compared the treated patients with approximately 47,000 matched controls.

There was a 26% reduction in Long Covid.

Here is a breakdown of the Long Covid Symptoms

The VA study also showed a 48% reduction of death and 30% reduction in hospitalization after the acute phase (acute phase = first 30 days) as demonstrated here.

Many drug intervention trials for treating COVID-19 early in the pandemic have been disappointing. No studies have shown benefit for hydroxychloroquine, with or without azithromycin. This topic has been covered in previous posts. Remdesivir was FDA approved based upon one study that showed reduction in duration of symptoms. The mortality rate with Remdesivir, however, did not demonstrate a statistically significant difference when compared to “usual care”. https://www.niaid.nih.gov/news-events/nih-clinical-trial-shows-remdesivir-accelerates-recovery-advanced-covid-19

Another study published in Lancet failed to show any clinical benefit from Remdesivir.

“No statistically significant benefits were observed for remdesivir treatment beyond those of standard of care treatment. Our trial did not attain the predetermined sample size because the outbreak of COVID-19 was brought under control in China. Future studies of remdesivir, including earlier treatment in patients with COVID-19 and higher-dose regimens or in combination with other antivirals or SARS-CoV-2 neutralising antibodies in those with severe COVID-19 are needed to better understand its potential effectiveness.”

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31022-9/fulltext

Likewise well designed studies of Ivermectin have shown no clinical benefit.

Monoclonal antibodies effective against early variants are no longer effective against the newer variants. So in terms of drug therapies for acute Covid infections we have Paxlovid for out patient care and dexamethasone for critically ill patients.

But we do know that certain underlying conditions such as obesity, diabetes, pre-diabetes (insulin resistance) and hypertension significantly increase risk of DEATH AND COMPLICATIONS with COVID-19. Since there are lifestyle interventions that can quickly and effectively mitigate these problems (diet, exercise, sleep, stress reduction….) now would seem like a good time to take our epidemics of obesity and diabetes in hand with aggressive lifestyle interventions to decrease the mortality rate of COVID-19 infection.

Such measures do not require expensive drugs or expensive drug trials, they simply require knowledge, guidelines and the will to implement change in our daily habits. Yet there has been little discussion about this in the media or on the part of public health officials.

Lets look at obesity in the US.

From 1999–2000 through 2017–2018, the age-adjusted prevalence of obesity increased from

30.5% to 42.4%, and the prevalence of severe obesity increased from 4.7% to 9.2%.

Click to access db360-h.pdf

Percent of adults aged 20 and over with obesity: 39.8% (2015-2016)
Percent of adults aged 20 and over with overweight, including obesity: 71.6% (2015-2016)
https://www.cdc.gov/nchs/fastats/obesity-overweight.htm

The most effective tool for addressing obesity and diabetes is a very low carbohydrate diet.

Effects of the Low Carbohydrate, High Fat Diet on Glycemic Control and Body Weight in Patients With Type 2 Diabetes: Experience From a Community-Based Cohort

https://pubmed.ncbi.nlm.nih.gov/32193200/

This study was a done in a community-based program, not an academic practice setting. That is significant since it demonstrates feasibility outside of academic centers with standard community resources. The results of this study confirmed the results of many previous studies done in academic settings including better blood sugar control, reduction or elimination of diabetic medications, and significant weight loss.

“All patients following the LCHF diet who initially took
insulin had either a reduction or discontinuation of
this therapy by their healthcare provider when clinically
indicated, compared with less than a quarter of
those receiving usual care.“

In another study done in Italy, significant weight reduction (7 kg), waistline reduction (7 cm.), fat mass reduction (3.8%) and systolic blood pressure reduction (10.5 mmHg) were achieved in 3 months with a Very Low Carbohydrate diet.

Middle and Long-Term Impact of a Very Low-Carbohydrate Ketogenic Diet on Cardiometabolic Factors: A Multi-Center, Cross-Sectional, Clinical Study (https://pubmed.ncbi.nlm.nih.gov/25986079/

Nina Teicholz had an opinion piece published in the Wall Street Journal on May 30, discussing the USDA dietary guidelines that have largely ignored a massive body of evidence supporting a Very Low Carbohydrate Diet for obesity and diabetes. She cites many studies that have been ignored by the USDA dietary guidelines committee. Here is here opening statement.

“Americans with obesity, diabetes, heart disease and other diet-related diseases are about three times more likely to suffer worsened outcomes from Covid-19, including death. Had we flattened the still-rising curves of these conditions, it’s quite possible that our fight against the virus would today look very different.”

You can read the full article here:

https://www.wsj.com/articles/a-low-carb-strategy-for-fighting-the-pandemics-toll-11590811260

But think about that simple statement, THREE TIMES MORE LIKELY TO SUFFER WORSENED OUTCOMES FROM COVID-19. Yet these conditions are highly responsive to lifestyle interventions that not only mitigate obesity, insulin resistance and high blood pressure, but also enhance immune function.

Practical Evolutionary Health

How food, exercise, sleep and stress affect your health, longevity, and happiness. How have we deviated from our evolutionary makeup?

Category Archives: metabolic syndrome

Insulin Resistance, the silent killer and root cause of modern chronic disease.

4th International Evolutionary Health Conference

Fourth International Evolutionary Health Conference

Agenda

AHS 2022 Lecture, Acute and Long Covid, Nutritional and Lifestyle Immunology

Red Meat and Health, another round of nonsense

COVID 19 UPDATE: What have we learned?

Fat Fiction: this movie could save your life

Chronic Inflammation, the silent killer

USDA Dietary Guidelines Flawed

COVID-19, Lifestyle interventions more effective than most drugs. (But Paxlovid is a winner)

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