As a follow up to my previous post, this is worth a look.
As a follow up to my previous post, this is worth a look.
There is a brief discussion of Roundup (Glyphosate) on Medscape.
The discussion covers several important issues. To Pique your interest in reading further here are a few salient quotes.
Glyphosate is the most used herbicide in the world, the pride and joy (as well as a great cash cow) of mega-giant chemical manufacturer Monsanto. Although ubiquitous as Roundup® and generally presented for many decades as safe for humans and animals, in 2015 The International Agency for Research on Cancer (IARC) of the World Health Organization labeled glyphosate as “probably carcinogenic to humans.”
The European Union (EU) is trying to determine whether Monsanto should have its license to sell Roundup renewed this year. With that renewal in mind, in the spring of 2016, 48 members of the EU Parliament, representing 13 nations, volunteered to have their urine tested for glyphosate. All were found positive by a German lab. In May 2016, a University of California, San Francisco, lab working for The Detox Project, funded by concerned individuals, reported positive urine tests for glyphosate in 93% of 131 urine samples from across the United States.
Is this widespread presence of glyphosate in humans incidental and harmless or are we all in danger of being poisoned by this Monsanto product? That is a very good question.
Remember the gut microbiome? We are learning a great deal about how it influences so much of human health. There is a project called Qmulus, at the Computer Science and Artificial Intelligence Laboratory at the Massachusetts Institute of Technology and funded in part by Quanta Computers of Taiwan. Under its auspices, authors Anthony Samsel and Stephanie Seneff, in a 40-plus-page review with 286 references, paint a very troubling picture of glyphosate’s inhibition of cytochrome P450 enzymes. For example, one role of this enzyme is to detoxify xenobiotics. The authors propose that the consequences of this inhibition, when coupled with other synergistic disruptions, may insidiously induce many diseases associated with a Western diet, including diabetes, obesity, cancer, autism, Alzheimer’s, and others.
A 2015 paper by the same authors takes these and new findings and deductions even further to manganese deficiency in cows fed genetically modified Roundup Ready feed. This update is 55 pages long with 328 supporting references. Both are in open access; peruse them if you choose. [Editor’s note: Links to the full text of these papers are included with the references.]
If you want to learn more about Roundup, GMOs, and the worsening global threat to our food safety (no exaggeration) you can learn more by visiting www.CenterForFoodSafety.org.
I learned about this organization while watching the film The Future of Food. Although this hit the screens in 2004 it is still worth watching. If you think ROUNDUP is safe or that GMO foods are OK, think again. At least give this movie and website a look before you settle back into contentment with Monsanto and all the other bad actors in the food-seed-pesticide industry making decisions that WILL destroy the ability of farmers in the US and possibly world-wide to use their own seeds.
Monsanto has genetically engineered and patented a suicide gene and placed it into all of it’s seeds (cotton, soy, corn) so that farmers must buy seeds EVERY YEAR. This seed produces crops whose seeds are sterile. If this seed is carried by wind, animals, or other common mechanisms, from Monsanto’s’ crops to non-GMO fields, the gene will hybridize with natural seed crops and after several generations render a majority of crops infertile.
Monsanto produces not just pesticides but pesticide resistant seeds that produce sterile crops. Monsanto is playing monopoly and quickly eliminating independent seed producers and destroying family farms that have every year used their own seeds which have been bred to thrive in the local environment of the family farm.
Other issues abound. Roundup resistant crops, eaten by American consumers, have high levels of ROUNDUP and other pesticides that have been demonstrated to cause tumors in > 50% of animals within 1 year. Monsanto only tested ROUNDUP for 3 months in animal studies and declared it safe. The USDA did not test it. The FDA did not test it. Government scientists and university scientists who expressed concerns were silenced by the economic power of this massive multi-national corporation.
When independent scientists published their alarming results (carcinogenesis), Monsanto used it’s financial resources to shut those scientists down. You can learn about this by watching The Future of Food or visiting www.CenterForFoodSafety.org.
Like big Pharma executives cycling between the pharmaceutical industry and the FDA, Monsanto executives and lawyers cycle in and out of the FDA and USDA. We have allowed the fox to guard the chicken pen and the stakes are high. Family farms have been put out of business by Monsanto’s unethical and predatory behavior, eliminating generations of private seed banks and wreaking havoc for family farms across America. Don’t believe it? Watch the movie. Many farmers have gone bankrupt fighting legal battles with Monsanto because the wind has blown Monsanto’s patented seeds onto their private lands and Monsanto successfully sued them for patent infringement. This predatory behavior has been going on below the radar for many years and it started when the Supreme Court ruled that Monsanto can patent seeds.
In fact, Monsanto has gone into the US national seed banks, collected samples of thousands of different seeds, and patented them! This outrageous and ridiculous scenario has allowed a private company to patent thousands of heritage crop seeds.
If this sounds incredible, you are right, but it is true.
In the meantime, support mandatory GMO labeling and support food retailers who have promised to carry only NON-GMO foods.
To your health.
BOB Hansen MD.
Doctor Jason Fung just published a terrific book titled The Obesity Code: Unlocking the Secrets of Weight Loss:
Dr. Fung’s genius excels at simple, direct explanations with clarity and humor. His analogies are often hilarious and through his humor and logic he communicates simple but important truths. The major message is that obesity is a hormonal problem. Obesity is not a disease of excess caloric intake, nor is it a disease of sedentary lifestyle. Dr. Fung cites study after study in which obese patients (young and old alike) consumed less calories and exercised more with dismal results. He reviews the medical literature on the effects of refined carbohydrates and sugar on insulin and other hormones. He explains how sustained high insulin levels cause insulin resistance and weight gain. He clearly and decisively explains how 100 calories of sugar or flour effects the human body in a manner immensely different from 100 calories of broccoli.
“Have you ever seen anyone get fat from eating too much broccoli?”
Most importantly, Dr. Fung provides the solution that has helped hundreds of his patients. The solution is elimination of refined carbohydrates and sugar in combination with intermittent fasting. Intermittent fasting (consuming only water, coffee, tea, broth) for 24 -36 hours a few to several times per month helps to reset the brain’s set point for body weight. When combined with restriction of sugar and refined carbohydrate (foods made with flour) intermittent fasting presents a powerful tool to not only lose weight but to manage diabetes and prevent the many complications of obesity and diabetes.
Intermittent fasting increases the human metabolic rate, Your body actually burns more calories at rest per hour during fasting. The effects of intermittent fasting are distinctly different from what has been referred to as the “starvation response”. The “starvation response” ironically and confusingly refers to human studies that restricted (reduced) caloric intake but continued low calorie meals throughout the day. It is unfortunate that those studies coined the term “starvation response” which is a decrease in resting metabolic rate. Caloric restriction diets reduce the human metabolic rate and therein lies the cause for the failure of all caloric restriction diets.
The confusion of these two approaches and their effects on human metabolism have clouded the discussion of obesity for decades.
Dr. Fung’s communication skills can be enjoyed by reading his book and viewing his many talks on YouTube.
His book and lectures should be mandatory for every medical student, physician, nutritionist and public health official. His book’s exhaustive medical references document the science that supports his theory and his clinical solution.
So take a leap, click on the link above for his book and the links below for some of his videos which are free on-line.
I think that Dr. Fung’s book is the most important book published on this topic in the 21st Century. His work will have profound influence during the next few decades. I encourage you to enjoy his genius.
Bob Hansen MD
This new film created by a GP in UK, funded by small contributions, describes how elimination of added sugar and implementation of carbohydrate restriction can cure diabetes and result in weight loss. The film also covers how the low-fat craze, based on bad science (ignoring the full data) began with Ancel Keyes and evolved into arguably the worst public health disaster experienced by the modern world.
There have been multiple studies comparing “lifestyle” interventions to bariatric surgery in treating obesity and diabetes. Repeatedly the authors conclude that bariatric surgery is superior to “lifestyle” interventions.
But none of these studies have utilized very low carbohydrate diets or medically supervised fasting as a lifestyle intervention. Instead, the diets employed for the “lifestyle” intervention are typically an ADA calorie restricted low-fat diet. I find this very frustrating as a physician.
The science in this area has demonstrated that very low carbohydrate diets consistently out-perform the low fat calorie restricted diet in terms of weight loss, blood sugar control, blood pressure control and lipid profiles.
Bariatric surgery carries a mortality rate of up to 3% depending on the surgeon, hospital and other circumstances. As an anesthesiologist and pain management physician I have seen multiple complications of bariatric surgery including but not limited to multiple chronic nutritional deficiencies (malabsorption), hernias, sepsis, renal failure, rhabdomyalisis, respiratory failure requiring prolonged ventilation, multi-organ failure requiring prolonged ICU care, and death.
And although many patients have profound weight loss in the first year after bariatric surgery many patients ultimately gain back most of the weight initially lost.
We need studies that compare bariatric surgery to very low carbohydrate and paleo diets. We need studies that compare bariatric surgery to intermittent medically supervised fasting. Until those studies are performed we should not conclude that bariatric surgery is superior to lifestyle interventions, particularly given the high complication rates of this surgery and the proven effects of VLC diets and medically supervised fasting.
Here are links to videos that discuss this topic.
They are all worth watching.
I have previously discussed the issue of carbohydrate restriction, diabetes and obesity with multiple scientific references provided in previous posts.
Bob Hansen MD
Ever wonder why the public is so confused about nutrition recommendations? Just follow the money and you will understand that most of the professional societies that publish nutrition articles are funded by big food companies that are trying to sell more sugar, refined carbs and junk food. I recently read an excellent post about this topic here:
This theme is repeated by medical journals that are “The Official Journal of the Society of >>>>>>” Just fill in the blanks for just about any medical society. Funding comes from big pharmaceutical companies the same way that funding in the nutrition Journals comes from large (junk) “food” manufacturers.
Don’t get me wrong, there are plenty of very valuable, life-saving drugs out there.
But most chronic human disease in developed societies is generated by various combinations of poor nutrition, lack of exercise, disruption of circadian rhythm, inadequate restorative sleep, stress and lack of social support systems.
The obesity and diabetes epidemics continue to worsen yet the failed dietary advise of major health organizations is slow to respond to the data. Excess refined carbs (especially in the form of “food” made with flour) and added sugar (especially in the form of HFCS) are the major driving forces for obesity, diabetes and cardiovascular disease. Red meat is not the culprit, provided the meat is properly sourced (hormone and antibiotic free, grass fed) and cooked in a manner that does not create carcinogens and inflammatory mediators (cook with slow, low, moist heat, high temperature grilling and smoking cause problems, but that topic is for another post).
Americans consume an average 130 pounds per year of added sugar and 140 pounds per year of refined flour. Those are averages so there are many people who consume more. The added sugar is not the white stuff people put in their coffee. It comes in all sorts of forms but is found in energy drinks, soda, lattes and mochas, salad dressing, ketchup, canned soups, canned vegetables, white AND whole grain breads, pasta (even “whole grain”), crackers, breakfast cereal, just about any packaged food that has more than one ingredient on the label. These foods represent 70% of the American diet. The problems created by this situation are enormous and will bankrupt our “healthcare system”. This is a cultural and economic problem.
The solutions are simple but largely ignored in our society. We are creatures of habit and convenience.
Eat whole foods, nothing from a package that has more than one ingredient. Eat meat, seafood, poultry, fresh organic vegetables (6-9 servings per day), fresh organic fruits, and nuts. Meat should be hormone and antibiotic free (free range, grass fed). Seafood should be wild. Poultry should be free range and the eggs should come from free range chickens, ducks, geese.
Do not worry about eating fat as long as it comes from healthy animals and sources such as coconut oil, extra-virgin olive oil, avocado oil and clarified butter (ghee).
Do not use any “vegetable” oils (corn, soy, and other oils from grains or seeds) The vegetable oils are highly refined and inflammatory. They contain easily oxidized omega 6 fats that feed the production of inflammatory mediators in your body and create oxidized LDL leading to atherosclerosis.
Exercise daily, preferably outside in a green space. Twice per week spend 20-30 minutes doing resistance training (lift weights, work against the resistance of bands, use your own body weight doing pushups, pull-ups etc)
Reduce stress with mediation, yoga, tai chi, dancing, engaging in fun sports and social activities. Walk on the beach, by a lake, river or stream, in the woods, listen to music.
Get some sunshine regularly especially during the morning to get your circadian rhythm in order and to produce adequate amounts of vitamin D.
Spend time with family, friends and colleagues who are supportive and fun to be around.
Sleep in the dark.
Get at least 7 hours of sleep per night. Avoid TV, computer screens and other electronic devices for at least 2 hours before bedtime.
Unplug from the internet, email, etc on a regular basis.
We evolved as hunter-gatherers.
Bob Hansen MD
Jason Fung is a brilliant Canadian physician who has treated obesity and diabetes with a fasting protocol. Intermittent fasting produces physiologic changes similar to a low carbohydrate ketogenic diet (LCKD). Both approaches have been successfully used to treat diabetes, insulin resistance, obesity and metabolic syndrome. Learn why most medications that are used to treat diabetes do not address the underlying root cause by watching this video.
After watching that video consider the following discussion by Dr. Tim Noakes who cured his own “pre-diabetes” with a LCKD. Dr. Noakes was criticized by his less open-minded colleagues for employing a beneficial lifestyle change that allows most diabetics to reduce or eliminate their medications. Dr. Noakes had followed the “prudent diet” recommended by the USDA and AHA for decades. Despite following that “prudent diet” and exercising regularly by running long distances he had developed “pre-diabetes” (insulin resistance which often leads to type II diabetes). Then he stumbled upon an iconoclastic approach,
So he read more about it and decided to try it. The results were stunning to this physician who became an ardent proponent of carbohydrate restriction.
Now if you have not heard enough, listen to Eric C. Westman, MD, MHS who treats patients and teaches medical students and residents at the Duke University Lifestyle Medicine Clinic.
A paleo diet in combination with carbohydrate restriction is arguably the most beneficial nutritional approach to diabetes, pre-diabetes and obesity. The data that supports this statement grows on a daily basis.
You can read about why a LCKD should be the default diet for diabetes here.
Eat clean, live clean.
The findings of four articles recently published in the Journal of Clinical Endocrinology and Metabolism were presented on March 5 at a press briefing held at the Endocrine Society’s annual meeting, ENDO 2015, Despite the incredible public health implications of these four studies little has been reported in the popular press.
I have previously discussed the Environmental Working Group’s list of the Clean Fifteen and the Dirty Dozen toxic chemicals | Practical Evolutionary Health as well as the impact of environmental toxins on our epidemic of auto-immune disease Babies born with more than 200 toxic chemicals in their blood | Practical Evolutionary Health .
The press briefing and the findings of these four studies were reported on-line Endocrine Disruptors Cause Range of Diseases; Cost 157 Billion Euros
The estimated health effects of pesticides, chemicals used in personal care products, aluminum can liners, flame retardants in clothing, mattresses, furniture, etc., included the following
From Phtalates used in food wraps, cosmetics, shampoos, vinyl flooring
Flame retardants in electronics, furniture, mattresses:
Other estimates from endocrine disruptors included:
Here are some snippets from the on-line Medscape report.The economic costs are reported in Euros since this was a study of European data. Bear in mind that the European Union has more stringent environmental protection than the United States. As a result, a study using US data would likely show even greater damage.
The papers cover overall costs of selected disorders attributed to specific endocrine-disrupting chemicals, as well as more detailed analyses of costs related to endocrine-disrupter–linked obesity and diabetes, neurobehavioral deficits/disease, and male reproductive disorders/diseases.
“Limiting our exposure to the most widely used and potentially hazardous endocrine-disrupting chemicals is likely to produce substantial economic benefit,” lead author of the overview study, Leonardo Trasande, MD, from New York University, said at the briefing.
The European Union defines an endocrine-disrupting chemical as an “exogenous substance that causes adverse health effects in an intact organism or its progeny, secondary to changes in endocrine function.”
With exposures occurring via pharmaceuticals, industrial solvents, personal-care products, aluminum-can linings, plasticizers, pesticides, and environmental pollutants, chemicals known to be endocrine disrupting include diethylstilbestrol, polychlorinated biphenyls (PCBs) , dioxins, perfluoroalkyl compounds, solvents, phthalates, bisphenol A (BPA), dichlorodiphenyldichloroethylene organophosphate/organochlorine pesticides, and polybrominated diphenyl.
Affected hormones include estrogen, androgen, thyroid, retinol, aryl hydrocarbon, and the peroxisome proliferator-activated receptor (PPAR) pathway. In all, 13 chronic conditions have strong scientific evidence for causation by endocrine-disrupting chemicals, Dr Trasande said.
“There are safe and simple steps that families can take to limit their exposure to endocrine-disruptive chemicals. They can avoid microwaving plastic. They can avoid eating from aluminum cans or drinking fluids from aluminum cans. They can eat organic. Or even simply air out their homes every couple of days to remove some of the chemical dust…that can disrupt hormones in their bodies.”
Using estimates based on the literature and established statistical methods adapted from those used by the Intergovernmental Panel on Climate Change, Dr Trasande led a 12-member scientific steering committee, which determined that there was probable causation of endocrine-disrupting chemicals for IQ loss and associated intellectual disability, autism, attention-deficit/hyperactivity disorder (ADHD), childhood obesity, adult obesity, adult diabetes, cryptorchidism, male infertility, and mortality associated with reduced testosterone.
Using mid-point estimates for probability of causation, the panel calculated a median cost of €157 billion, or 1.23% of the EU gross domestic product, with a lower median range of €119 billion and a high end estimate of €270 billion.
Dr Trasande summarized results from the four papers at the briefing, including these data points:
Dr Trasande said that a similar analysis for the United States would be “the logical next step” and that he would anticipate analogous findings, although there are some differences. Brominated flame retardants are more stringently limited in Europe, for example, but levels of phthalates have decreased 17% to 37% in the United States between 2001 and 2010.
Keep in mind that these studies were published in the peer-reviewed Journal of Clinical Endocrinology and Metabolism. They do not represent a governmental agency report, which is frequently tainted by the influence of lobbyists and scientists with conflicts of interest. Whether the European governments respond to this data in a meaningful way remains to be seen. Given the Republican majority in both the US Congress and US Senate as well as the sad state of journalism in the US it is likely that this scientific data will fall on deaf ears.
Nevertheless, we all have the opportunity to educate ourselves about these dangers to the health of our families and make changes in our daily lives that might limit the damage to our personal health and the health of those we love.
Do not drink water from plastic bottles. Do not drink soda or fruit juices from plastic or aluminum containers. Do not microwave food in plastic containers or store warm food in plastic containers. Eat organic vegetables and fruits whenever possible and avoid especially non-organic produce from the Dirty Dozen
Despite the manufacturers claims to the contrary, BPA used to line aluminum cans is not safe, same for BPA used in thermal paper receipts. “BPA free” hard plastic containers and metal containers lined with BPA replacements will likely prove to be unsafe in the future.
That “new-car” smell and “new-furniture” smell may contain endocrine disrupting flame retardants off-gassing. So open your windows and get rid of those odors, use HEPA air-filters at home. Consider having your old furniture reupholstered instead of buying new furniture. Apply only safe personal care products to your body (visit the EWG website for more information)Consumer Products | Environmental Working Group
Live clean, eat clean.
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.
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.
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.
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.
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.
And here is a picture that shows the phospholipids that contain the linoleic acid.
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.
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.”
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.
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.
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.
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.