Tag Archives: atherosclerosis

Paxlovid is a winner, but lifestyle changes are essential to mitigate Covid risk.

Leave a reply

This discussion was originally posted before PAXLOVID WAS AVAILABLE. The title was originally Lifestyle More Effective than Drugs.

But now we have Paxlovid. Paxlovid is very effective in reducing morbidity and mortality associated with Covid-19 infection but also appears to reduce risk of Long Covid. 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. But do not let that discourage you from asking your provider to prescribe this drug for an acute Covid infection. This is a truly effective drug. It decreases morbidity and mortality as well as risk for Long Covid.

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

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.

More from Teicholz’s opinion piece:

“Other studies have found that dietary changes can rapidly and substantially improve cardiovascular risk factors, including conditions like hypertension that are major risk factors for worsened Covid-19 outcomes. A 2011 study in the journal Obesity on 300 clinic patients eating a very low-carbohydrate diet saw blood pressure quickly drop and remain low for years. And a 2014 trial on 148 subjects, funded by the National Institutes of Health, found a low-carb diet to be “more effective for weight loss and cardiovascular risk factor reduction” than a low-fat control diet at the end of the 1-year experiment.“

In a recent letter to the editor published in the journal METABOLISM, Dr. Casey Means points out:

A diagnosis of diabetes has been a key indicator of the severity of
COVID-19, and in this regard, the virus has relentlessly highlighted our
global Achilles heel of metabolic dysfunction, and points to a prime opportunity
to fight back.
That fight, however, is not going to be won with Clorox, Purell,
masks, or anti-IL-6 drugs. The fight will only be won through a serious
commitment to improving everyone’s foundational metabolic health,
starting with the lowest hanging evidence-based fruit: dietary and lifestyle
interventions.

Read the full letter here: https://www.metabolismjournal.com/article/S0026-0495(20)30118-9/pdf

In 2 pages the letter describes multiple benefits of better glucose control relative to COVID -19 infection and the immune system as well as reduction of factors that lead to cytokine storm (terminal event for many COVID-19 patients). The letter also discusses the benefit of reducing environmental toxins (discussed in previous posts about COVID-19 and other health problems) that would likely benefit COVID-19 patients.

Research published April 18th, 2020 found that patients exposed to
highest amount of environmental nitrogen dioxide (NO2) had increased
risk of death fromCOVID-19, and that long-term exposure to this pollutant
may be one of the most important contributors to fatality by
compounding lung inflammation [20].

Minimizing exposure to environmental
pollutants may serve a role in quelling the underlying pro-inflammatory
state that characterizes metabolic disease and COVID-19 associated
cytokine storms.

Other environmental toxins, including persistent organic pollutants
(POPs) found in air, water, and food generated from pesticides
and industrial chemicals, are also strongly implicated in the pathogenesis
of metabolic syndrome; promoting “clean living,” toxin-avoidant
strategies for patients as simple as emphasizing organic foods, home
air purification, and non-toxic home supplies could be considered, although
the clinical utility of these measures in the acute setting is unknown
[21].

In discussing the white elephant in the room he states:

What is starkly missing is the clear, simple, and strong recommendation for no added
sugar or ultra-refined carbohydrates, both of which are known drivers
of postprandial hyperglycemia and inflammation. As a medical community, we must not miss the opportunity to serve patients with straightforward, evidence-based nutritional and lifestyle strategies to assist in glycemic control.

I would encourage you to follow the link and read the 2 pages supported by multiple peer-reviewed references.

An ancestral (paleo) diet is also very effective for addressing insulin resistance, diabetes type 2 and obesity. Multiple studies have demonstrated this. Although an ancestral approach is typically low carb it is not typically ketogenic, but a ketogenic ancestral diet (high in non starchy vegetables to support the gut microbiome) can be implemented by restricting fruits to one serving of berries per day and limiting starchy vegetables.

Even without severe carbohydrate restriction, an ancestral anti-inflammatory diet will quickly address insulin resistance, type 2 diabetes, and obesity. In this study, insulin resistance was reversed in 10 days.

And another study compared an Ancestral (Paleo) diet to the Mediterranean diet in patients with ischemic heart disease AND insulin resistance (glucose intolerance or type 2 diabetes). Ancestral diet was superior to the Mediterranean diet in improving insulin sensitivity, blood sugar control and greater fat loss. Fasting blood sugars normalized in all patients on the Ancestral diet who had previously had abnormal blood sugars.

And here is a slide from one of my lectures with references on how an ancestral diet modulates immunity.

Leptin resistance, insulin resistance and obesity travel together. Here is yet another study demonstrating the effectiveness of an ancestral diet.

If you have obesity, diabetes or pre-diabetes the Very Low Carbohydrate version of the anti-inflammatory diet linked above would be the fastest and most effective intervention you can immediately employ to reduce your risk of succumbing to COVID-19. (Of course wear an N-95, follow good hygiene with hand-washing frequently, and use a HEPA filter or Corsi-Rosenthal box in your home, office, and enclosed work spaces)

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

  1. Avoid alcohol consumption (alcohol wreaks havoc with your immunity)
  2. Get plenty of sleep (without adequate sleep your immune system does not work well )
  3. Follow good sleep habits
  4. Exercise, especially out of doors in a green space, supports the immune system
  5. Get some sunshine and make sure you have adequate Vitamin D levels. Supplement with Vitamin D3 to get your levels above 30 ng/ml, >40ng/ml arguably better.
  6. Eat an anti-inflammatory diet rich in micronutrients.
  7. Practice stress reduction like meditation and yoga which improves the immune system
  8. Eliminate sugar-added foods and beverages from your diet. These increase inflammation, cause metabolic dysfunction, and suppress immunity.
  9. Eliminate refined-inflammatory “vegetable oils” from your diet, instead eat healthy fat.
  10. 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/)
  11. Drink water filtered through a high quality system that eliminates most environmental toxins.
  12. HEPA filters or the home-made version (Corsi-Rosenthal box) used in your home or workplace can reduce circulating viral load as discussed on this website.
  13. If you are eligible for vaccination, consider protecting yourself and your neighbor with a few jabs. Age > 50 and/or risk factors (Diabetes, pre-diabetes, insulin resistance, hypertension, obesity, heart disease, COPD, asthma, cancer treatment, immune suppression) suggests benefit from a booster. Risk for complications of boosters in adolescents, especially males, without risk factors, may equal benefit. Previous infection with Covid can be considered as protective as a booster. Discuss risk vs benefits with your doctor.

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

Obesity Epidemic Requires a Paradigm Shift

1 Reply

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.

Fred Kummerow, PhD, fought the battle against Trans Fats for over 50 years.

Leave a reply

Professor Fred Kummerow passed away on May 31 at his home in Urbana, Ill at age 102. He ate butter, red meat and eggs cooked in butter, along with plenty of fruits and vegetables. He avoided margarine, french fries and other fried foods, along with cookies, cake and crackers which contained artificial trans-fats. He conducted research in his nutrition science laboratory at the University of Illinois up until his death. he authored the book Cholesterol Won’t Kill You, But Trans Fat Could: Separating Scientific Fact from Nutritional Fiction in What You Eat

Fred warned the American public and scientists in the 1950s about the dangers of artificial man-made trans fats. His research was largely ignored and criticized by the food industry and by scientists who were funded by the food industry for decades. Despite mounting evidence in both animals and humans that artificial trans fats dramatically increased the risk of heart attacks, strokes, peripheral vascular disease, diabetes, obesity, and probably several forms of cancer, the FDA ignored his pleas to address the issue. In 2009 Professor Kummerow filed a petition with the FDA to ban the use of trans fats. Although federal law required that the FDA respond within 180 days to such a petition, the FDA remained silent. In 2013, approaching the age of 99, Professor Kummerow sued the FDA. Two years latter in 2015 the FDA declared that artificial trans-fats were unsafe and should be eliminated from the US food supply by 2018.

Through his lifelong work, Professor Kummerow has produced a policy change that will likely save hundreds of thousands of lives.

What are trans fats and why have they been in our food for 7 decades?

Although there are some forms of natural trans fats which are safe for consumption when consumed in whole foods, artificial trans-fats are produced by placing unsaturated fat (such as corn oil, soy oil) under high pressure and high temperature conditions and adding hydrogen in the presence of a metal catalyst. These fats were introduced to many American foods because they dramatically extend the shelf life of foods and give a pleasant mouth texture to a variety of processed foods. They remain in many foods still on the shelves today. You cannot rely on labels such as “NO TRANS FATS” OR “TRANS FAT FREE” because food companies are allowed to make this statement as long as the amount of trans fats does not exceed 0.5 grams per serving. No amount is safe!

The Institute of Medicine, on July 10, 2002 declared manufactured trans fatty acid (TFA) a serious danger to the health of our nation with a: “tolerable upper intake level of zero.”  This means there is no safe level of consumption. Despite that strong statement in 2002, it has taken the efforts of an elderly professor, including a lawsuit, to bring the FDA around to finally address the issue.

But it is not over yet, you can bet that the food industry will try to delay the implementation of the ban or possibly even argue against the overwhelming science that supports such a ban.

In the meantime read labels. If any food item contains “partially hydrogenated” oil of any kind or “hydrogenated oil” of any kind it contains trans fats. These foods are typically foods you should not be eating any way because they usually also contain added sugar, refined flour and/or refined easily oxidized inflammatory “vegetable” oils. They are not whole foods and therefore should not be consumed for many reasons. But if you want to eat cake, cookies, crackers, bread, or any other processed foods, beware and read the ingredients so as to at least avoid trans-fats.

You can read about Fred Kummerow, his life and research at these sites:

Fred A. Kummerow, scientist who raised early warnings about trans fats, dies at 102 – The Washington Post

Fred A. Kummerow, an Early Opponent of Trans Fats, Dies at 102 – The New York Times

Fred Kummerow, U. of I. professor who fought against trans fats, dies at 102 – Chicago Tribune

Fred also studied the effects of a oxysterols and oxidized low-density lipoprotein (OxLDL) both of which contribute to atherosclerosis.  In a  2013 publication Professor Kummerow stated

“levels of oxysterols and OxLDL increase primarily as a result of three diet or lifestyle factors: the consumption of oxysterols from commercially fried foods such as fried chicken, fish and french fries; oxidation of cholesterol in vivo driven by the consumption of excess polyunsaturated fatty acids from vegetable oils; and cigarette smoking.”

Yet the American Heart Association continues to recommend increased consumption of polyunsaturated fats from the likes of corn oil, soy oil, cottonseed and similar oils. I have discussed the problems with that advice here and here.

So the next time you avoid trans fats by reading food labels, think of Professor Kummerow who brought light to some very dark areas in the history of nutrition and food in the US.

Eat clean, live clean, and enjoy.

Dr. Bob

Sugar Industry paid Harvard researchers to trash fat and exonerate sugar!

2 Replies

By now most of you have already heard about the study published in JAMA that reveals an unsavory historical scenario wherein the sugar industry  funded an academic review paper that diverted the medical community’s attention from sugar as a vector for disease and erroneously placed it on saturated fat and cholesterol consumption. You can read about it by clicking on the following link.

How the Sugar Industry Shifted Blame to Fat – The New York Times

Here is a quote from the above cited article in the NY times:

The internal sugar industry documents, recently discovered by a researcher at the University of California, San Francisco, and published Monday in JAMA Internal Medicine, suggest that five decades of research into the role of nutrition and heart disease, including many of today’s dietary recommendations, may have been largely shaped by the sugar industry.

Here is the abstract of the article published in JAMA (Journal of the American Medical Association).

Sugar Industry and Coronary Heart Disease Research:  A Historical Analysis of Internal Industry Documents | JAMA Internal Medicine | JAMA Network

Early warning signals of the coronary heart disease (CHD) risk of sugar (sucrose) emerged in the 1950s. We examined Sugar Research Foundation (SRF) internal documents, historical reports, and statements relevant to early debates about the dietary causes of CHD and assembled findings chronologically into a narrative case study. The SRF sponsored its first CHD research project in 1965, a literature review published in the New England Journal of Medicine, which singled out fat and cholesterol as the dietary causes of CHD and downplayed evidence that sucrose consumption was also a risk factor. The SRF set the review’s objective, contributed articles for inclusion, and received drafts. The SRF’s funding and role was not disclosed. Together with other recent analyses of sugar industry documents, our findings suggest the industry sponsored a research program in the 1960s and 1970s that successfully cast doubt about the hazards of sucrose while promoting fat as the dietary culprit in CHD. Policymaking committees should consider giving less weight to food industry–funded studies and include mechanistic and animal studies as well as studies appraising the effect of added sugars on multiple CHD biomarkers and disease development.

This disturbing conspiracy reveals yet another industry sponsored distortion of science which had great impact on the health of our nation. The impact is accelerating today as the epidemics of obesity and diabetes rage out of control. But sugar consumption has not just been tied to obesity, diabetes, heart attacks and strokes. Sugar added foods and beverages have likely contributed to dementia,  many forms of cancer and other chronic debilitating diseases. Sugar and refined carbohydrates mediate these effects by increasing systemic inflammation and contributing to insulin resistance. Inflammation and insulin resistance are pathways to many disease processes. Metabolic syndrome (pre-diabetes) is the hallmark combination of multiple abnormalities with insulin resistance as the underlying root cause. Prolonged insulin resistance leads to type 2 diabetes and contributes to heart attacks, strokes,  cancer and dementia. In fact dementia is often referred to as type 3 diabetes, mediated in large part by insulin resistance in the brain.

Here are links to discussions and videos relevant to these topics.

Preventing Alzheimer’s Disease Is Easier Than You Think | Psychology Today

How to Diagnose, Prevent and Treat Insulin Resistance [Infographic] – Diagnosis:Diet

Reversing Type 2 diabetes starts with ignoring the guidelines | Sarah Hallberg | TEDxPurdueU – YouTube

I have previously provided links to the YouTube lectures given by the brilliant Dr. Jason Fung, These are worth mentioning again.

The Aetiology of Obesity Part 1 of 6: A New Hope

Insulin Toxicity and How to Cure Type 2 Diabetes

How to Reverse Type 2 Diabetes Naturally

Nina Teicholz is also worth a watch.

Nina Teicholz: The Big Fat Surprise – (08/07/2014)

And here is an important talk about sugar, refined carbohydrates and cancer.

Plenty to chew on.

We did not evolve to eat lots of sugar! It is dangerous stuff.

Bob Hansen MD

 

 

 

Berries, Dark Chocolate and Fruits-Vegetables improve blood vessels within 8 weeks

Leave a reply

A recently published study reveals that within 8 weeks of consuming a combination of 70% dark chocolate (50 grams per day), one serving of berries, and four servings of polyphenol rich  fruits-vegetables per day, measurable improvements occur in the functioning of arteries in humans with high blood pressure. Just eight weeks and improvement was observed.

So what did the researchers do?

First, they took 102 adults with high blood pressure and instructed them to consume no chocolate, no berries and only 2 portions of fruits-vegetables per day for four weeks. After four weeks on a “low polyphenol diet” they measured forearm blood-flow response to two different vasodilators (a vasodilator increases blood flow by relaxing the muscle in the wall of arteries). Blood and urine samples were also taken.

After the four week period on a low polyphenol diet, 51 patients continued on the same diet (control group).  51 subjects had fruits and vegetables of their own choice (from a list rich in polyphenols), one serving of berries/day and 50 grams/day of 70% dark chocolate delivered free of charge to their homes weekly (intervention group).

All participants kept food diaries, answered food questionnaires, had regular consultations with nutritionists.

After 8 weeks, blood and urine testing demonstrated higher levels of polyphenols in the “high-polyphenol” group, as expected.

Most importantly the subjects consuming dark chocolate, berries and more vegetables-fruits on a daily basis demonstrated measurable and significant improvements in “endothelial function” compared to the other group. Endothelial function reveals the ability of arteries to respond to changes in demand for increased blood flow. “Endothelial” refers to the cells that line the walls of arteries, directly in contact with flowing blood.  These cells are endothelial cells.

The maximum forearm blood flow response to the infusion of acetyl-choline (a vasodilator) was the test used to measure endothelial function. The maximum forearm blood flow in the high polyphenol group was TWICE that of the low polyphenol group. This large difference occurred with just eight weeks of a simple dietary intervention.

Before the dietary intervention there was no measurable difference between the two groups of subjects. After the dietary intervention there was a very large and meaningful difference.

Endothelial dysfunction is a major predictor of cardiovascular risk (heart attack and stroke). Endothelial dysfunction is BAD.

You can read about polyphenols here .

Epidemiologic studies demonstrate the health benefits of diets rich in colorful vegetables and fruits. Among the fruits berries appear to have the greatest density of important micro-nutrients on a per calorie basis.

Dark chocolate has a high content of polyphenols and multiple studies suggest significant cardiovascular benefit with just an ounce or two per day. You must be careful though about your source since the dutch method of preparation depletes the polyphenols and some brands have high amounts of cadmium or lead. The richest source of dark chocolate identified by ConsumerLab with the lowest amounts of heavy metal contaminants is 100% (bitter) Bakers Dark Chocolate. Dip it in honey or have it with sweet berries to offset the bitter taste. Avoid in the evenings or late afternoon (the caffeine content can interfere with sleep)

So eat those colorful vegetables, berries and indulge in some dark chocolate.

Here is a suggested list of vegetables, Try to get 8-9 servings per day. I give this recommendation to my patients. I adopted this from the recommendations of Doctor Terry Wahls. (From a Wheelchair to Commuting on a Bicycle: How One Woman Naturally Reversed MS | Terry Wahls MD | Defeating Progressive Multiple Sclerosis without Drugs | MS Recovery | Food As Medicine)

9 SERVINGS  OF NON-STARCHY VEGETABLES PER DAY, 3 SERVINGS FROM EACH OF THREE CATEGORIES.

 

  1. DARK GREEN LEAFY VEGETABLES, 3 SERVINGS PER DAY EQUALS 3 CUPS MEASURED COOKED OR 6 CUPS MEASURED RAW
  • Arugula, Beet Greens, Bok Choy, Chard all colors, Chicory, Cilantro
  •  Dandelion Greens, Endive, Escarole, Kale-all kinds, Parsley, Radicchio
  • Radish leaves, Spinach, Turnip Greens, Watercress

 

  1. Colored vegetables, 3 cups daily:
  • GREEN: Artichoke, Asparagus, Avocado (FRUIT), Cabbage (red and green) Celery, Cucumber with skin, Okra, Olives, Peppers, Zucchini with skin
  • RED: Beets, red cabbage, red peppers, cooked tomatoes (fruit)
  • YELLOW: Carrots, Pumpkin, Squash-summer and winter, Sweet potato,

 

  1. SULFUR RICH VEGETABLES, 3 CUPS DAILY: Some leafy greens are also sulfur rich so there is overlap in these categories
  • Arugula, Asparagus, Bok Choy, Broccoli, Brussel sprouts, Cabbage, Cauliflower, Collard Greens, Garlic, Kale, Kholrabi, Leeks, Mushrooms, Onions red-yellow-white, Radishes, Scallions, Shallots, Turnip Greens, Watercress.

Eat the rainbow and enjoy good health.

You can read this study on Medscape but you must first establish a user name and password (free and open access)

Beneficial Effect of a Polyphenol-Rich Diet on CVD Risk

Bob Hansen MD.

Great lecture videos available on line

1 Reply

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

 

 

 

Why do our tax dollars continue to subsidize death, disability and disease?

1 Reply

Yesterday I posted a comment on Medscape after reading an article Longtime Dietary Fat Advice Unsupported by Data: Analysis . Medscape is a website with articles and news written for physicians and other health professionals. Anyone can access this information by creating a user name and password, there is no fee.

Here is my comment. It is long and technical. I will provide an explanation in lay terms after quoting myself.

Sugar, especially HFCS (high fructose corn syrup), used in so many foods is more inflammatory than saturated fat. Grass fed meat from ruminants has a fatty acid mix that is exactly the same as wild game, which we evolved to eat, along with tubers, green leafy vegetables, and fruit in season. Excess refined fructose intake AND use of modern refined “vegetable oils” along with non-healthy grains combine to cause excess caloric intake, NAFLD (non-alcoholic fatty liver disease), obesity, metabolic syndrome and CAD (coronary artery disease). N6 PUFA (omega six polyunsaturated fatty acids) are easily oxidized. N3 PUFA (omega 3 fatty acids) despite greater number of double bonds are protected from oxidation in cell and Lipoprotein membranes by plasmalogens as opposed to linoleic acid which is not easily  incorporated into plasmalogens. The PUFA in vegetable oils (linoleic acid) is the FA (fatty acid) that is oxidized on LDL particles and remnant particles, stimulating monocytes to transform to macrophages and then foam cells. The USDA, ADA and AHA have had it upside down for decades and they still fail to admit folly. We evolved for > 1 million years without grains and they have contributed to disease. Per calorie fresh vegetables have five times the amount of fiber compared to whole grains. We do not need grains and would be better without them. They contain anti-nutrients and wheat, hybridized in the 1980s to a storm resistant dwarf plant, now has 50 times more gluten/gliadin than the old wheat. This has generated more gluten intolerance and celiac. Our greatest nutritional threats to public health include refined sugar, carbohydrates predominantly from grains and refined vegetable oils. Vegetable oils are not healthy, we did not evolve to eat them. N3 FAs are anti-inflammatory but have been competing in our diets with a sea of inflammatory N6 PUFA from unnatural refined and easily oxidized “vegetable oils”. Even though PUFA can reduce LDL-C they wreak havoc by creating ox-LDL particles which initiate the cascade of atherosclerosis. Substituting SFA (saturated fatty acids) with PUFA results in increased levels of Lp(a) and oxLDL in humans, not a good thing. Close the feed lots, stop government subsidy of corn, wheat, dairy and soy, eat meat from grass fed ruminants, wild seafood, fresh organic vegetables and fruits in season. Nibble on tree nuts. Stop creating carcinogens with high dry heat cooking methods and we will watch obesity, insulin resistance, metabolic syndrome and atherosclerosis melt away.

That was my comment. Here is some explanation.

I have previously discussed the pro-inflammatory nature of refined “vegetable oils”. “Vegetable oils” are actually not from vegetables, they are from grains, seeds and legumes. The two major sources of excess omega six polyunsaturated fats in the American diet are corn oil and soy oil marketed by various brand names such as Wesson. They are major components of margarine and other butter substitutes and are present in most salad dressings. Most salad dressings sold in our supermarkets contain high levels of easily oxidized unhealthy refined “vegetable oils” and HFCS. The use of these salad dressings converts a healthy salad into a vector for disease.

The major source of caloric sweeteners in our food and beverages is high fructose corn syrup. Both corn (oil and sugar) and soy predominate our processed food supply because they are cheap. They are cheap because our tax dollars subsidize their production. This subsidy started during the Nixon administration. Once a food subsidy is put in place it is very difficult to eliminate, Big Agriculture provides a deep pocket for lobby money and our elected officials from the mid-west bread-basket respond to $$.

Another major source of disease causing elements in the standard American diet is highly refined flour from wheat. Doctors Davis and Perlmutter discuss the problems associated with wheat-flour foods in their books Wheat Belly and Grain Brain respectively. The production of wheat has also been subsidized since the Nixon administration.

Wheat is not what it used to be. A new dwarf hybrid wheat has predominated the US market since the 1980s. Bread and pasta are not what they used to be when great grand-mother made her own bread and pasta in the kitchen from coarsely ground whole flour. But even if we all went back to making our own whole-grain bread and pasta from locally ground pre-1980s wheat, bread, pasta and pastry would still present a health risk because of issues related to intestinal permeability, auto-immune disease (now epidemic in the USA), and the presence of nasty lectins and phytates (discussed in my manifesto and previous posts).

The Medscape comment quoted above describes  adverse consequences caused by replacing saturated fat in the diet with “vegetable oils”. This is a complex subject and I will try to be brief for now but promise to expand on this in a future post.

Many factors contribute to atherosclerosis, heart attack and stroke. Sedentary lifestyle, stress, inadequate restorative sleep, smoking and poor dietary choices top the list. These factors also contribute to obesity, diabetes, metabolic syndrome, insulin resistance and many cancers.

DIETARY FACTORS:

The combination of sugared foods and beverages (predominantly sweetened with HFCS), refined flour foods, and excess consumption of the PUFA in “vegetable oils” TOGETHER  contribute to the formation of plaque in the walls of our arteries (atherosclerosis).

How does this happen?

LDL (low density lipoprotein) is a particle that transports cholesterol and triglycerides through our blood to our organs. This particle is comprised of a core and a surrounding membrane.  Here is a picture.

LDL 2

The core contains cholesterol in a storage form (esters) and triglycerides. The outer membrane includes a large protein called apoprotein B-100, “free” cholesterol molecules and phospholipids. The phospholipids contain fatty acids, including PUFA.

LDL has been demonized as “the bad cholesterol” and that demonization has mislead the public.

hdl_ldl good guy bad guy

LDL is the major lipoprotein in our blood but there are others that have different names.

Cholesterol is cholesterol, whether it is carried in LDL or HDL. When carried in the core of a lipoprotein it is carried as a cholesterol ester. 80% of the cholesterol in an LDL particle is carried as an ester in the core. 20% is carried as “free” cholesterol on the outer surface or membrane.

LDLand cholesterol molecule

HDL (high density lipoprotein) is smaller and denser. HDL has been called “the good cholesterol”, another misnomer.

HDL particles, when they are functioning correctly can protect us from atherosclerosis but in patients with diabetes, obesity, and insulin resistance, HDL particles do not function well and in fact probably contribute to disease. (More about that in a future post)

But back to LDL.

Although the risk of cardiovascular disease is correlated with the amount of cholesterol carried by LDL in our blood (referred to as LDL-C), the total amount of cholesterol shuttled by LDL particles is much less relevant than one would be led to believe given the great use of statin drugs to lower LDL-C.

The short version is as follows.

Compared to LDL-C, a much better predictor of cardiovascular disease is the amount of “modified” LDL particles circulating in the blood. Oxidized LDL particles are one form of “modified LDL”. LDL can also  be modified by excess blood sugar levels (especially from HFCS). This modification is referred to as glycosylated or glycated LDL. In this latter form of modification, the major protein on the outer membrane of the LDL particle (apo B 100 in the picture above) becomes attached to a sugar and the result is an LDL particle that is not easily cleared by normal processes. The modified LDL is not “recognized” by the LDL receptors that act as entry points into our cells for proper processing. The result is that the glycated LDL particles circulate longer and are more likely to use up their anti-oxidants (Vitamin E and  Co-enzyme Q 10).

As a result glycated LDL are more likely to become oxidized. That is not good because oxidized LDL sets up a cascade of unhealthy events.

The portion of the LDL particle that becomes oxidized is the fat (fatty acid) from “vegetable oil”, specifically the fatty acid called linoleic acid. This fatty acid has two double bonds making it more likely to be oxidized than for example oleic acid, the major fatty acid in extra virgin olive oil which has only one double bond.

The double bonds between the carbons in the fatty acids are unstable and easily oxidized. The single bonds in saturated fat do not get oxidized.

All other things being equal (and you will see that they are not), the more double bonds in a fatty acid the greater chance for oxidation.

Here is a picture showing the linoleic acid, also called linoleate, on the outer membrane of the LDL particle.

LDL with linoleate

And here is a picture that shows the phospholipids that contain the linoleic acid.

LDL 3

Let’s say it again. The fatty acid found in “vegetable” oil, linoleic acid, is easily oxidized because it has two double bonds.

Saturated fats are not oxidized because they contain no double bonds.

The part of the LDL particle that becomes oxidized is the fatty acid that comes from “vegetable oils”.

A particular kind of immune cell (white blood cells called monocytes) have  special receptors for oxidized LDL particles. When ox-LDL are “seen” by these monocytes, the monocytes become transformed into macrophages. Macrophages are designed to destroy bacteria that invade our bodies. The oxidized LDL particles resemble the structures of invading bacteria. The macrophages, with very specialized receptors for oxidized LDL, “swallow” the LDL particles and release toxic chemicals to destroy “the invader”.  The macrophages then become “foam cells” in the walls of our arteries, initiating the creation of plaque. Here is a picture.

ldl_mechanisms oxidation in vessel wall

This picture depicts the oxidation occurring in the wall of the artery after LDL particles have penetrated the wall. However LDL particles can and do become oxidized while still circulating in the blood and these oxidized particles can stimulate monocytes to transform into macrophages and gobble up the oxidized or modified LDL while these particles are still circulating in the blood.

How and whether unmodified LDL particles cross the wall of arteries into the “sub-endothelial” area remains an unsolved complex issue. The picture above implies that LDL particles simply move across the endothelial cells that line the wall of the artery but that is a presumption.

Clearly, macrophages that have “swallowed” modified LDL particles have mechanisms to work their way between the junctions formed by adjacent endothelial cells.

This is an important distinction because many cardiologists believe that what drives atherosclerosis is a mass effect. The greater the number of LDL particles, the more likely they are to cross the endothelial barrier, get oxidized and retained and start the process of plaque formation. However the process is much more complex and not clearly understood.

We do not yet know or understand completely the factors that influence the permeability of the endothelium to Lipoprotein particles. We do know that modified (oxidized and glycated LDL) disrupt the protective surface of endothelial cells which is called the glyocalyx. Other factors that disrupt the glyocalyx include high blood sugars, dramatic fluctuations in blood pressure (too high or too low), oxidative stress, infections, and circulating endotoxin (which is governed by intestinal permeability).

It is clear from several studies that modified (oxidized) LDL as a single variable predicts cardiovascular disease and heart attacks with much greater accuracy than LDL-C (total cholesterol content of LDL particles). It is also clear that monocyte receptors are specific for modified LDL and that the  process that initiates the cascade of events that leads to plaque formation involves the interaction between modified lipoprotein particles and the immune system (monocytes).

Now here is another twist.

Omega 3 fatty acids in fish oil are considered “heart healthy”. They help prevent heart attacks and strokes. They also decrease inflammation throughout the body thereby producing many health benefits.

BUT OMEGA 3 FAT HAS MORE DOUBLE BONDS THAN OMEGA 6 FAT (LINOLEIC ACID) YET THEY HELP PROTECT THE HEART. HOW CAN THAT BE?

How do they avoid contributing to atherosclerosis? Are they not even more readily oxidized than linoleic acid?

The simple answer is no.

The major reason is that the omega three fatty acids are protected by “plasmalogens” which are important components of our LDL particle outer membranes. Plasmalogens are found in the membranes of lipoprotein particles and in the membranes of human cells. Because of their chemical structures, omega three fats are easily incorporated into plasmalogens which protect the double bonds of omega three fats from oxidation. Linoleic acid, the predominant component of “vegetable oils” is not easily incorporated into the protective arms of plasmalogens.

This selective protection is well described on pages 141-142 of  “The Fats of Life”, written by Dr. Glen Lawrence and published in paperback in 2013. (link below)

I asked Dr. Lawrence about this issue in an email and here was his response.

“The omega-3 fatty acids are preferentially incorporated into plasmalogens, which act as antioxidants due to the double bond adjacent to the ether linkage of these phospholipids. This structure would tend to scavenge free radicals or reactive oxygen species near the surface of the membrane, rather than allowing them to penetrate deeper in the membrane where the double bonds of PUFA are located. This makes any polyunsaturated fatty acids attached to the plasmalogens more resistant to oxidation than they would be in a regular phospholipid. See pp 141-142 of The Fats of Life. The shorter chain and less unsaturated linoleic acid does not tend to be incorporated into plasmalogens.”

In summary:

  1. “Vegetable oil” is actually not oil from vegetables but rather a highly processed and refined oil. This oil contains primarily the easily oxidized omega 6 PUFA (polyunsaturated fatty acid) linoleic acid. Oxidation can occur during manufacture,  before consumption while sitting in the bottle, but especially during high heat cooking (fried foods). Oxidation can also in your body as this fat circulates in your blood on the membrane of lipoprotein particles.
  2.  LDL particles are the major lipoprotein particles that shuttle cholesterol and fatty acids (in in the form of triglycerides) through our bodies in our bloodstream.
  3. Modified LDL particles (glycated and/or oxidized LDL) stimulate monocytes (immune cells) to transform into macrophages and gobble up the modified LDL. In addition, glycated LDL particles are more easily oxidized because they circulate longer in our blood.
  4. Macrophages become filled with modified LDL. These are called foam cells. Foam cells  initiate a cascade of events that lead to the formation of plaque in the walls of our arteries.
  5. The part of the LDL particle membrane that becomes oxidized is the phospholipid that contains linoleic acid which comes from “vegetable oils”
  6. High amounts of sugar, especially HFCS, and highly refined flour foods in our diets cause larger blood sugar fluctuations than whole foods and therefore contribute to the glycation of LDL particles. This glycation leads to more oxidation of LDL. In this manner HFCS and refined flour foods contribute to the process of atherosclerosis.
  7. High amounts of sugar, HFCS and refined flour foods also contribute to obesity, insulin resistance and diabetes which then increase the risk of heart attack and stroke.
  8. Several factors contribute to the disruption of the glycocalyx which is the protective surface of the endothelial cells that line our arteries. These include but are not limited to modified LDL, inflammation, high blood sugars, abnormal fluctuations in blood pressure, circulating endotoxin (associated with increased intestinal permeability), infections. Disruption of the glycocalyx contributes to the formation of plaque (atherosclerosis).
  9. Modified LDL particles might also migrate through the junctions that connect adjacent endothelial cells either inside macrophages or on their own. Many factors, known and unknown likely determine the susceptibility or permeability of these junctions to this migration.

These are the major points, but there is allot more to discuss. Substituting “vegetable oils” for saturated fat in our diets not only increases the amount of oxidized LDL but also increases a dangerous lipoprotein called Lp(a). On third of Americans have an amount of Lp(a) that is considered “high risk” for heart attack and stroke. More about that in a future post.

Then there is the process of an actual heart attack or stroke which involves disruption of plaque and the creation of a blood clot that ultimately disrupts the flow of blood and the death of heart or brain tissue. The susceptibility of plaque to disruption is a huge topic that involves high blood pressure, diabetes, insulin resistance, oxidative stress, inadequate sleep, and stress to name a few. So much more to discuss.

But getting back to the title of this post, why don’t you ask your elected representatives why our tax dollars continue to subsidize nutritional root causes of death, disability and disease?

Here are some links to papers and books that support the discussion above.

Circulating Oxidized LDL Is a Useful Marker for Identifying Patients With Coronary Artery Disease

Cholesterol deposition in macrophages: foam cell formation mediated by cholesterol-enriched oxidized low density lipoprotein.

Erythrocyte fatty acid profiles can predict acute non-fatal myocard… – PubMed – NCBI

Changes in Dietary Fat Intake Alter Plasma Levels of Oxidized Low-Density Lipoprotein and Lipoprotein(a)

Low-density lipoprotein subclass patterns and risk of myocardial in… – PubMed – NCBI

Subendothelial Lipoprotein Retention as the Initiating Process in Atherosclerosis

Oxidative susceptibility of low density lipoprotein subfractions is… – PubMed – NCBI

Effects of linoleate-enriched and oleate-enriched diets in combinat… – PubMed – NCBI

Enhanced oxidative susceptibility and reduced antioxidant content o… – PubMed – NCBI

Susceptibility of small, dense, low-density lipoproteins to oxidati… – PubMed – NCBI

Modulation of Endothelial Glycocalyx Structure under Inflammatory Conditions

Oxidized Lipoproteins Degrade the Endothelial Surface Layer

S1P Control of Endothelial Integrity

Mechanical control of the endothelial barrier. – PubMed – NCBI

Therole of actin-binding proteins in the control of endothelial bar… – PubMed – NCBI

The Fats of Life, Dr. Glen Lawrence

Functions of plasmalogen lipids in health and disease

Grain Brain: The Surprising Truth about Wheat, Carbs, and Sugar–Your Brain’s Silent Killers: David Perlmutter, Kristin Loberg: 9780316234801: Amazon.com: Books

Finally a quote from the Dali Lama (thanks to my cousin Diane for bringing this to my attention).

“Man. Because he sacrifices his health in order to make money. Then he sacrifices money to recuperate his health. And then he is so anxious about the future that he does not enjoy the present, the result being that he does not live in the present or the future, he lives as if he is never going to die, and dies having never really lived.”

Eat clean, live clean, sleep well, exercise wisely, rest often, enjoy the company of loved ones, spend time outdoors and live in the present.

BOB

Paleolithic Diet Reversed Osteoporosis and Fatty Liver in an 82 year old man

Leave a reply

Joe (not his real name) is an 82 year old man who presented to me in 2009 with severe degenerative arthritis of the spine, debilitating chronic pain,  osteoporosis, coronary artery disease, congestive heart failure and fatty liver. When I first met him in 2009 he weighed 265 pounds (6 foot), had just undergone multi-vessel coronary artery bypass surgery. He could not walk more than 30 feet without feeling short of breath and severe low back pain. He was referred to me for interventional pain management. At that time the only way he could sleep was in a hospital bed with his head elevated to a 90 degree angle. Otherwise he experienced “orthopnea” (shortness of breath lying flat caused by congestive heart failure). His osteoporosis (demineralization of bone) was so bad it was difficult to do pain blocks using X-RAY because the bone did not show up well on X-Ray due to the osteoporosis. He had also suffered compression fractures in the lumbar spine. Compression fractures are caused by weak bones where just the weight of the body can cause one or more vertebrae to partially collapse.

I recommended a paleolithic-carbohydrate restricted diet. He lost 90 pounds and on the paleo diet was able to get off some of his medication for congestive heart failure.

I saw Joe yesterday for an interventional pain management procedure (radio-frequency ablation of nerves to his painful arthritic lower lumbar facet joints). He gets these about every 6 months to treat chronic pain.

I recalled the first time I did this procedure. It was a struggle because his bones were so demineralized. But yesterday it was a breeze, his bones looked 30 years younger and had enough calcium and other minerals to provide beautiful fluoroscopic (live X-ray) images.

Joe is now sleeping with just 10 degrees elevation at the head of his bed (previously 90 degrees). His fatty liver disease is gone.

The Paleo diet allowed this elderly gentleman to lose 90 pounds, improve his exercise tolerance dramatically (he just won a metal detecting contest competing against young adults) and significantly improve his bone strength. It also cured his fatty liver disease.

Not bad for just limiting food to fresh vegetables, fresh fruits, meat, seafood, nuts and eggs.

Joe’s improvement is not a surprise. A study done at UCSF on the metabolic ward demonstrated improved calcium metabolism (reduced urinary excretion of calcium)  within 2 weeks of placing young “couch potato” adults on a paleolithic diet. It also demonstrated improvements in blood pressure, glucose tolerance, decreased insulin secretion, increased insulin sensitivity and improved lipid profiles in just a few weeks. This occurred without an exercise program (exercise will enhance bone strength, reduce blood pressure, improve insulin sensitivity and improve lipid profiles) and without weight loss. The subjects were “force fed” to avoid weight loss so the beneficial effects of the dietary change alone could be analyzed without the con-founder of weight loss. You can read the abstract of this study here.

The improvements in calcium metabolism are not mentioned in the abstract but appear in the full article in Table 1.

Joe is very grateful for the tremendous improvement in his quality of life, primarily achieved by adopting a Paleo-diet.

Until next time.

BOB Hansen MD

Amputations, Gangrene and Carbohydrates

5 Replies

As an anesthesiologist I have spent more than 60,000 hours in the operating room and cared for over 30,000 patients. I often observe the end-results of bad dietary advice. I am referring to the liberal carbohydrate allowance that the American Diabetes Association and other agencies offer diabetics.

Today was a particularly poignant day as I cared for two diabetics who required amputations for complications of diabetes type II. These complications could have likely been avoided if our supermarkets were not stocked with high carb nutritionally deplete “food” AND if the ADA, physicians and nutritionists counseled diabetics to significantly reduce their carbohydrate intake. Instead, the low fat narrative has so predominated our culture, that we have taken our eyes off of the major dietary threats during the past 40 years, excessive carbohydrates and especially refined carbohydrates.

The leading cause of amputations in modern society are the complications of diabetes including peripheral arterial disease (atherosclerosis in the arteries to our limbs) and peripheral neuropathy (loss of sensation in the feet and hands). The combination of these two, or just one alone can lead to non-healing wounds and ulcers in the feet, then chronic infections and ultimately gangrene. Futile efforts to restore circulation to the legs with vascular bypass surgeries or arterial stents usually just briefly delay the inevitable series of amputations that start in the toes and progress up the leg, step by step until only a stump is left above the level once occupied by the knee.

Gangrene is an ugly thing. During the Civil War the major cause was trauma. Today the major cause is diabetes and indirectly, excess carbohydrate consumption.

The visual experience of gangrene results in a visceral reaction, even after more than 30 years of observation. The knowledge that most of these complications could be avoided by simply eating whole fresh foods instead of crap in a bag or crap in a box is frustrating. The human suffering and economic costs (lost wages, disability, medical expenses) are staggering. Diabetes type II is largely a disease of lifestyle. The lifestyle elements involved include poor dietary habits, lack of exercise, inadequate sleep, and stress. All of these contribute and all are modifiable and avoidable.

Type II diabetes is arguably reversible early in the disease process. As it progresses a patient reaches an irreversible point of no return where the pancreas has been exhausted and the insulin producing cells are no longer efficient and effective. Equally important,  the cells in the rest of the body do not respond in a normal fashion to what little insulin is produced. But even at this stage carbohydrate restriction can mitigate complications if only healthy fresh whole-foods are consumed and modest exercise is practiced on a daily basis.

Other complications of diabetes including blindness, painful neuropathy, kidney failure requiring dialysis, heart attack and stroke all are arguably avoidable with a whole foods paleolithic carbohydrate restricted diet and modest amounts of regular exercise.

What a pity, what a shame, what a waste.

Below are some links and research articles to back up my statements.

Peace, health, and harmony.

BOB

1. Type 2 Diabetes

2. American Diabetes Association Embraces Low-Carbohydrate Diets. Can You Believe It? | Richard David Feinman

3. Nutrition Science on Pinterest

4. Low-Carb for You: Low-Carb versus Low-Fat

And Many More:

Jenkins DJ, Kendall CW, McKeown-Eyssen G, Josse RG, Silverberg J, Booth GL, Vidgen E, Josse AR, Nguyen TH, Corrigan S et al: Effect of a low-glycemic index or a high-cereal fiber diet on type 2 diabetes: a randomized trial. JAMA 2008, 300(23):2742-2753.

Westman EC, Yancy WS, Mavropoulos JC, Marquart M, McDuffie JR: The Effect of a Low-Carbohydrate, Ketogenic Diet Versus a Low-Glycemic Index Diet on Glycemic Control in Type 2 Diabetes Mellitus. Nutr Metab (Lond) 2008, 5(36).

Gannon MC, Hoover H, Nuttall FQ: Further decrease in glycated hemoglobin following ingestion of a LoBAG30 diet for 10 weeks compared to 5 weeks in people with untreated type 2 diabetes. Nutr Metab (Lond) 2010, 7:64.

Gannon MC, Nuttall FQ: Control of blood glucose in type 2 diabetes without weight loss by modification of diet composition. Nutr Metab (Lond) 2006, 3:16.

Gannon MC, Nuttall FQ: Effect of a high-protein, low-carbohydrate diet on blood glucose control in people with type 2 diabetes. Diabetes 2004, 53(9):2375-2382.

Forsythe CE, Phinney SD, Feinman RD, Volk BM, Freidenreich D, Quann E, Ballard K, Puglisi MJ, Maresh CM, Kraemer WJ et al: Limited effect of dietary saturated fat on plasma saturated fat in the context of a low carbohydrate diet. Lipids 2010, 45(10):947-962.

Jakobsen MU, Overvad K, Dyerberg J, Schroll M, Heitmann BL: Dietary fat and risk of coronary heart disease: possible effect modification by gender and age. Am J Epidemiol 2004, 160(2):141-149.

Siri-Tarino PW, Sun Q, Hu FB, Krauss RM: Saturated fat, carbohydrate, and cardiovascular disease. Am J Clin Nutr 2010, 91(3):502-509.

Int J Cardiol. 2006 Jun 16;110(2):212-6. Epub 2005 Nov 16. Effect of a low-carbohydrate, ketogenic diet program compared to a low-fat diet on fasting lipoprotein subclasses. Westman EC, Yancy WS Jr, Olsen MK, Dudley T, Guyton JR.

Mol Cell Biochem. 2007 Aug;302(1-2):249-56. Epub 2007 Apr 20.Beneficial effects of ketogenic diet in obese diabetic subjects. Dashti HM, Mathew TC, Khadada M, Al-Mousawi M, Talib H, Asfar SK, Behbahani AI, Al-Zaid NS.

 

 

Weight Gain, Another Reason to Avoid Statins

2 Replies

Published on line two days ago in advance of print publication, a new study demonstrates an association between statin use and increased caloric intake resulting in weight gain. (1)

A brief editorial (Written by Dr. Rita Redberg, on faculty at UCSF and editor of JAMA: INTERNAL MEDICINE). is worth quoting in entirety as it succinctly reviews many criticisms of statin overuse that I have discussed in previous posts here and here.

“There remains much controversy over the risks and benefits of statins for primary prevention. Besides the risks of muscle aches, diabetes, and cognitive dysfunction, I have observed over the years that for many patients, statins provide a false reassurance, as people seem to believe that statins can compensate for poor dietary choices and a sedentary life. In an elegantly performed analysis of NHANES data from 1999 to 2010, Sugiyama and colleagues have documented exactly such behavior. They found that compared with statin nonusers, statin users significantly increased their fat intake and calorie consumption, along with their BMI, in the last decade. This article raises concerns of a potential moral hazard of statin use, in addition to the already known adverse effects. Focusing on cholesterol levels can be distracting from the more beneficial focus on healthy lifestyle to reduce heart disease risk.” (2)

Of course association does not imply causation, but the editorial above suggests a plausible explanation for the relationship.

I have previously discussed how a carbohydrate restricted whole foods diet (here and here) results in superior weight loss, improved glucose control, reduced blood pressure, reduced triglycerides and improved HDL when compared to a low fat American Heart Association type diet. The former results in spontaneous reduction of caloric intake (improved satiety-no calorie counting required), the latter requires calorie counting in order to reduce caloric intake. The carbohydrate restricted approach does NOT result in increased net fat intake but because carbohydrates are reduced, fat as a % of total calories is increased. On average most studies in adults report a spontaneous reduction of about 400-600 calories per day when carbohydrates are significantly restricted.

A paleolithic diet that eliminates all processed foods, refined vegetable oils, grains, legumes and dairy but includes pastured grass-fed meat, wild seafood, free range poultry and eggs, organic fresh vegetables, fruit and nuts is typically low carbohydrate compared to the standard American diet (SAD). A paleolithic nutritional approach produces similar metabolic improvement within a few weeks. (3)

(1) Sugiyama T, Tsugawa Y, Tseng C-H, Kobayashi Y, Shapiro MF. Different time trends of caloric and fat intake between statin users and nonusers among US adults: gluttony in the time of statins? [published online April 24, 2014]. JAMA Intern Med. doi:10.1001/jamainternmed.2014.1927. PubMed

(2) Statins and Weight Gain: Redberg RF. JAMA Intern Med. 2014 Apr 24. doi: 10.1001/jamainternmed.2014.1994. [Epub ahead of print]  PubMed

(3) Metabolic and physiologic improvements from consuming a paleolithic, hunter-gatherer type diet L A Frassetto1, M Schloetter, M Mietus-Synder, R C Morris Jr1 and A Sebastian European Journal of Clinical Nutrition (2009) 63, 947–955; doi:10.1038/ejcn.2009.4; published online 11 February 2009 PubMed

Go in peace

Bob Hansen MD