Where will you be at 94?

Aside

Ok, bringing up Dal Richards feels a bit like cheating.  Here is Vancouver’s own Big Band Leader extraordinaire, in this video just 2 months short of his 94th birthday, proving that, at least for some people of his generation, it has been possible to maintain high health while not following a low carb diet!

If I tried to eat a typical “general mixed diet”, my health would be down the tubes in no time.

If you want to know a bit more, see the TV segment on his 94th birthday YouTube Link

Where will you be at age 94?  This summer, you can join Dal Richards as he performs on a cruise ship going up the BC coast.

 

Weight Health, Satiety and Carb Control – A Framework

I have added somewhat to my page previously called “About” and now called “Overview”.  Because this is meant to communicate the heart and soul of what the blog is about and why it exits, I post here the page content in full:

                        “over the past decade, everything has changed…. “

This is a blog dedicated to weight health and to the discussion of satiety as the guiding light and principal most likely to result in success for most individuals.

“Satiety”  (sa-TY-i-tee)  – as I will use it here, is the sense of having satisfied one’s appetite for food; one’s appetite has been satisfied by the food consumed.

“Weight Health” – refers to the fact that there is a lot more involved in a person’s health and well-being than simply how much body fat they may be carrying. The amount of body fat must not be such a dominant concern that other aspects of health and well-being are neglected, discounted or put in jeopardy.  A better term would be “body composition health” since it is now understood that many of the people who are slim or have a  body weight in the “normal” range are suffering harm from relatively small amounts of body fat, but tucked hidden within their bellies.

Why bother?

Because over the past decade everything has changed. Excitement and hope are the realistic, practical outcome.

We used to think we knew what we were doing when it came to weight (fat) loss.  If only people could be disciplined and follow the medical advice, all would be solved.  Just eat less and move more.  Go hungry, if need be. Even if you get very hungry, tough it out and above all “don’t break your diet”.  “Diet” always referred to a limit on the total calories consumed in a day. (The limit being a calorie number given or being a set limit on total food servings, which is just a less obvious way of setting a calorie limit.)

There is a growing chorus of voices suggesting/demanding a total re-thinking of the approach to weight control, from the basic concepts on up.

Why?

Calorie-restricted dieting has not saved us.  For the population as a whole, the message has not stopped a growing crisis of obesity.  For people who are individually prescribed such diets as part of their medical care, the long-term results are stunningly disappointing.  This reality is now just so obvious to everyone that it cannot be ignored or brushed aside any longer.  Yes, some people do well and we need to learn from them, but over-all we are getting further behind.

Calorie-restricted dieting may have unexpectedly and quietly caused long-term harm. There is a growing movement of rejection of calorie-restricted dieting for various reasons, suggesting that this practice might increase the risk of dis-ordered eating patterns, eating disorders, food addiction, depression, lowered metabolism, etc.  There is an urgent need for research to answer these concerns.

The past decade has brought us new information and understandings that profoundly change our options and demand a re-working of our concepts.

Such as:

Obesity itself is not a major cause of death or illness.  The amount of body fat is generally not the major factor in obesity-associated death and illness, other than at very high levels of body fat. Some people can be quite obese and not have much health impact (excluding effects related to physical size, such as stress on joints.)  The type of medical harms that we usually associate with obesity can show up also in those who are in the normal body weight category, but are “metabolically obese”.

Metabolic syndrome (basically intolerance of carbohydrates, with insulin resistance and a gradual worsening of blood sugar control) and inflammation are the major “toxic factors” in both obesity and those who are normal weight but with deep belly fat. The increase in health problems that show up in studies on obese people are mostly from metabolic syndrome and inflammation – such as increased hypertension, diabetes, heart attack and stroke (among other impacts).  Diabetes then brings its own set of consequences such as kidney disease, eye disease, nerve damage and even further increase in risk for heart attack and stroke.  Researchers also feel that the inflammation and the carbohydrate intolerance increase the risk for cognitive dysfunction, dementia and cancer.  Most, but not all, people, who struggle with their weight have metabolic syndrome (or show evidence of being headed that way).  Most, but not all, people who have normal body weight do not (or not yet) have metabolic syndrome.

The signs of metabolic syndrome can be improved and often reliably and effectively treated by the use of an individually-adjusted carbohydrate-limiting food plan.  Also, and critically, most of the benefit of this treatment can be achieved with or without weight loss even close to “normal” range. “Carbohydrates” is the term used for any and all of the sugars and starches in foods.  There is carbohydrate intolerance, so lower the intake of total carbohydrates and change the foods eaten to lower the surge of glucose absorbed after a meal. For best benefit, also take other measures to improve carbohydrate tolerance, such as exercise.  When carefully applied and adjusted for the individual over time, experienced clinicians find that, almost universally, there is substantial improvement in blood pressure, blood fats and blood sugars and/or insulin levels (among other improvements).  (There is consistent clinical experience and some research showing this, more research would help.)

With effective relief from the burden of metabolic syndrome, with its accompanying elevated insulin levels, there is almost always a substantial reduction in excess body fat stores.  This is likely related mostly to reductions from previously elevated insulin levels.  When insulin levels are high, the body’s metabolic machinery favours turning the carbohydrate you eat into fat and storing it. High insulin levels also strongly resist the release of fat from stores to allow burning it off.

Relief from the damaging effects of metabolic syndrome/insulin resistance are much more important medically than whether there is substantial reduction in body weight. Studies into what is “the best” eating plan to achieve weight loss are off the mark on two counts (1) there will never be a best plan, it will depend on the individual metabolism and circumstances and goals and (2) it is vastly more important to find what are the best set of eating plans that, individually, allow the most protection from the harms associated with obesity, principally from metabolic syndrome and inflammation.

Control of body weight involves countless factors and very complex body systems, so no one intervention will ever be all that is needed.  Carbohydrate reduction/restriction is of major importance and benefit for those who have carbohydrate intolerance, but not all people who have high body fat have carbohydrate intolerance.  Unfortunately, low carb eating is not enough in itself to result in normal weight in all circumstances.  It is not magic.  Being on a low carb eating plan does not mean that you are living in a bubble, not affected by all the other factors that affect weight control such as high calories, poor sleep, food addictions, medications that promote weight gain, etc, etc.

If you have metabolic syndrome or a tendency to it, low carb eating can greatly improve your health and greatly improve your weight control while you work on finding the other things you need to do to further improve your weight control.

Nutritional ketosis is a powerful medical tool and can play an important role separate from any carbohydrate intolerance and separate from weight loss.

Low carb eating is actually four medical interventions confused together:

  • (1) as a means to protect the body from the various harmful effects of  carbohydrate intolerance/insulin resistance (metabolic syndrome), including lowering  blood insulin levels to allow a tipping of the balance from fat storage to fat release for burning and
  • (2) as a means to maintain abstinence for people who find that they have an addiction-like response to sweet or starchy foods or to fatty foods that are sweet or starchy (they can learn that they do not need to eat any sweet or starchy foods)
  • (3) as a means to improve the ability to maintain a stable blood sugar within the healthy range by dietary means with or without the help of medications (in the least dosages, thereby lessening medication adverse effects)
  • (4) as a means to be in the metabolic state known as “nutritional ketosis“.  Without going into the details here, nutritional ketosis is a normal physiological state that is part of your basic ancient metabolic flexibility.  In this state, you are burning fats and a fat-derived substance called “ketones” for almost all of your body needs.  In this state you need and burn a very small amount of glucose.  This small amount of glucose is critically needed, but your body can make it from protein and you don’t really need any from your food (if your body is working normally – this is not true in certain disease states and with certain medications, such as insulin and others that lower blood glucose).

Are there more than these four types of basic elements of the effects of carb control or low carb eating on health?  There is a lot of discussion on this topic, but its too early for conclusions.

By understanding the needs of each unique person in regards to what aspects of carbohydrate control are most important for them, a fully individualised eating plan can be worked out that allows the greatest flexibility and freedom, with the least amount of restriction that achieves their goals and is consistent with their circumstances and informed choices.

Nutritional ketosis is a medical intervention which helps control appetite – independent of whether the person is insulin resistance or not.

Because nutritional ketosis is a tool in itself, it can be targeted more specifically as a goal if the benefits are considered worthwhile in any given person’s situation.  This may involve avoiding high intake of protein, use of MCT oil (a coconut oil derivative that readily converts to ketones in the liver), use of metformin to reduce abnormally excessive production of glucose by the liver, and other strategies. (MCT oil is stripped of all other nutrients and could only be used sparingly and thoughtfully as a medical intervention.)

Research and clinical experience over decades have improved the understanding of fully individualised carb-controlled eating as a long-term, essentially permanent lifestyle option, so the medical benefits are available in a sustained way (essentially acting like a long-term medication).

Food addiction-like responses, food triggering and brain sensitization have received increasing attention and come to be understood as key factors in weight control.  For people who have addiction responses to foods containing sugars and/or starches, the understanding that full abstinence is an option (there is no health requirement for intake of carbohydrates and they can be avoided except for those consumed daily in salads and non-starchy vegetables) can change their lives.

There is also improved understanding of dis-ordered eating patterns and the eating disorders.

This blog is my contribution towards putting into words the facts, concepts and options at play.

This blog is full of hope and enthusiasm that current new understandings and information, along with the networked communication of informed and determined people, can bring the needed tools into the grasp of many (possibly even most) people even with what we know and can share right now.

Let none be left behind – if you have a particularly difficult time achieving weight loss to your best healthy weight, then we all have something to learn from your journey.  I have had a personal life lesson in never, never, never, never, never, never, never, never, never give up and I encourage you (though some days you may need to pause from the striving) to put one try ahead of another. Given the massive research effort and the opportunity the internet gives us to put our heads together, hope is actually a very realistic attitude.

CONTEXT

My viewpoint is that all the researchers, clinicians, academics, policy makers and commentators are motivated from a true and honest heart.  Each one is striving for the goal of the best health and best fulfillment of life for individuals and for society as a whole.  Because there will not ever be one right best answer for weight health, and because not one of us knows yet the full collection of interventions/treatments that will bring access to weight health to all people, there are many different opinions.  Passionate discussion and rebuttal is the result.  But, “we fight because we care”.  Individuals who just want to collect their pay and go home would not waste time and energy on vigorous debate.  The more the crisis grows, the more testy the interactions can get.  We are all striving for the same goal.

This blog is written mostly from the point of view of the usefulness af low-carbohydrate nutrition  – as ONE OF the useful interventions to consider. There are countless factors that act together in determining an individual’s body weight at any particular time.  The vast majority of people who struggle with their weight will need to make use of a number of different interventions/treatments/lifestyle changes in their lives to achieve and maintain their desired healthy body composition.  Low-carb eating is not the sole intervention needed, nor is it important for all.

I’m not advocating for low-carb eating for all, I am advocating for the best health and fulfilling life for all, by whatever means prove to be best.  The proper stance of any physician, researcher, etc., is “let the truth win out”.  I write about low-carb nutrition because I think it is critically important that this option be more widely known and better understood.  There is a tremendous amount of confusion and mis-information about low-carb nutrition. This is hindering people from achieving what could be life-changing benefits.  What I am advocating, also, is that each person be aware that carbohydrate intolerance could be a factor in their health and that they receive knowledgable help, now and over the stages of their lives, in evaluating this impact and what it means for their health and for their food choices.

What I would like to see is carbohydrate awareness and carbohydrate literacy.

Each person’s body weight and composition is their own business. I would like to make a contribution towards improving the degree to which it is also their own free choice.

Short Link for this post http://wp.me/p2jTRh-9f

Talking with kids about sugar?

One resource you might find helpful when trying to communicate with kids about the problems with high intakes of sugars and starchy foods is the movie Fat Head, by Tom Naughton. Click to go to his web site and read more about this movie.

In an interview, Tom describes that he hears comments from parents that their kids have really been able to relate to the movie. The interview is also interesting as Tom relates his own experiences with low-carb living and how this has evolved over time for him.  The comments about kids and the Fat Head movie are in the last few minutes (24 min interview). Tom’s next project is a book for kids, with accompanying DVD. The interview is at NEquals1Health.com Link

Testing Blood Ketones

Testing Blood Ketones to Monitor Nutritional Ketosis

A number of people who follow a low-carb lifestyle have become interested in testing blood ketone levels.  The reason for this is that the amount of ketones that show up on urine testing tends to drop over time as your body adapts to burning ketones for fuel.  This makes following your urine ketone level (urine dip sticks for ketones) of limited value.

If you are eating low carb, you may be surprised to find that your level of blood ketones is much less that you expect.  The old “people are so different” game.  This matters if being in ketosis would be helpful to you personally for your fat burning and your appetite/satiety balance.  If your health is fine without dropping your carbs (actually total carbs plus some limit on protein) down far enough for ketosis, then going this extra mile isn’t something that you necessarily need to do to thrive.

It also matters if you are wanting to be in ketosis for some of its other known or proposed medical benefits (such as seizure control) or its benefits in athletic performance.

If you ketones are not in the range that you’d like, the first things to think of are (1) are you having more carbs than you thought and (2) should you cut back a bit on protein, though keeping in mind that adequate protein is essential?

If that’s not the answer, perhaps your liver is just pumping out too much glucose.  This happens when the liver becomes “insulin resistant”.  Yes, your liver can become insulin resistant just like your muscles can.  This effect is noticed most in the mornings. If you are not yet diabetic or heading into pre-diabetes, this may be happening without necessarily showing up as a notable rise in blood sugar (glucose) level if you still have enough insulin effect to clear the glucose from the blood.

If you are eating low carb, you also will have more ketones with greater activity or exercise levels.  There are also medications and medical conditions that could be a factor.  This area of science has not received enough research attention to say that we understand it very well, yet.

If you consume a significant amount of medium chain triglycerides (MCT), such as tablespoon amounts of coconut oil, you will have some ketones in your blood that are produced directly from those medium chain triglycerides that you have just eaten, whether you are truly “in a ketogenic state” or not. This is too much to explain properly in this post, so I’ll write on this topic another day.

If you are at all interested in doing this yourself, you will need to put some time and effort into learning about this topic.  You would need to thoroughly understand the safe and effective use of low carb dieting and the ins and outs of nutritional ketosis.

If you are considering low-carb eating for yourself, especially at the level of going into ketosis, you must discuss this first with your doctor as (1) there may be reasons for you that this might be a bad idea or a bad idea at this particular time, (2) you may need some testing before and during and (3) you may be on medications that could have very dangerous and potentially lethal effects if the medications are not or cannot be adjusted or changed before and during the transition.  You may need frequent medical follow-up in the first days and weeks for adjustment of medications and medication dosages.  This is an interesting problem, when you think about it.  Your health may improve so quickly that you could actually be killed by the medications you take because those medications are to help you with problems you no longer have.

The book to read that is most informative about nutritional ketosis is The Art and Science of Low Carbohydrate Performance by Jeff S. Volek, PhD, RD and Stephen D. Phinney, MD, PhD.  The price is more than reasonable ($8.95 on amazon and no I have absolutely no commercial ties or links).

One of the speakers at the Nutrition and Metabolism Society meeting in 2011 was Dr. Adam Hartman, who is an expert in the use of ketogenic for the control of epilepsy in children.  He made an interesting comment on the timing of testing for ketones.  When eating the typical mixture of foods that people normally consume in our society (a mix of proteins, carbohydrates and fats), ketones are highest in the morning.  This makes sense because the least flow of carbohydrates in from the digestive tract is overnight, so the body burns some fat in the night.  When eating a ketogenic diet, on the other hand, the most exposure to carbohydrates is overnight especially towards morning as the liver produces glucose to keep your brain fueled and to prepare you for getting up.  Therefore, if you are eating a very ketogenic diet, the blood ketones go up during the day as you burn more fat for fuel.

Regarding testing blood ketones, the following refers to the blood ketone test strips for the Abbott Precision Xtra (Medisense).  These come in a box of 10 strips.

Please note that the shelf life of these strips is not long (I don’t know the details) so please be aware of this before ordering a large number of testing strips or before buying from a source you don’t have confidence in.  An expiry date will be on each box and a lot number.

For people in Canada, the first place to turn to is your local pharmacy.  I bought mine at London Drugs (a major chain) over the counter for $20.00 per box of 10 strips.  I checked their on-line ordering site, and they do not offer these strips for on-line sale.  I didn’t shop around to compare price, so I am not advocating London Drugs over any other store.

People in the US face prices for these testing strips that can be quite high and also people in smaller towns may have difficulty getting testing strips locally.  I did some looking around on-line.

Also, of course I can’t vouch for any company on-line or not.  You have to look into any company or on-line seller and make a decision for yourself.

I am just reporting what I have found on-line. I have no idea whether these are good companies (or even real companies) or not.  Exercise caution.

A significant factor in cost could be the shipping fees, so you might want to take that into consideration, not just the price per box.

Well.ca offers at this link a box for $24.29 USD ($2.43 per test strip)

CanadaDrugs.com lists, at this link

  • $32.42 USD (May 28/12) for box of 10 ($3.24 per test strip)
  • for 3 boxes or more (30 test strips or more) this drops to $2.49 per test strip

Universal Drug Store offers at this link a box of 10 for $19.99 USD ($2.00 per test strip)

There may be other sites that are as good or better, this is just what I found with about 20 minutes of checking.

I am not advocating that you purchase from any of these sites or that these sites will link you to a reputable business.  Buyer beware.

If you come up with something better, please let me know.

UPDATE June 14, 2012

My Abbott Precision Xtra (Medisense) is my new BFF.  Turns out I really do need the ketosis (at least for now) to have a reasonable time with appetite and I was not reliably achieving that with my low carb eating.  Despite carbs total about 15 g most days (1-2 times a week up to perhaps 25 g) and protein most days about 90 g (some days about 100 g), I was not getting a good level of blood ketones.  My fasting ketones were 0.4 mmol/L to 0.6 mmol/L and late afternoon ketones 0.9 mmol/L to 1.1 mmol/L. I have cut back a bit on protein and added some MCT oil.  It will be a while to find my best balance, but I feel an effect on appetite with my ketones in the range from about 1.5 mmol/L to 3.2 mmol/L.  Above that I feel a bit tired and out of focus.

It will take some time before there is much collective understanding about the hows and the whys of using blood ketone testing for insight into low carb eating and its benefits.  People will have to put their heads and their experiences together.  Also, we have to avoid jumping to conclusions too soon, based on only a few people’s experiences.

Today, Jimmy Moore, of Livin’ La Vida Low Carb, has posted his very interesting report of the first 30 days of his trial of using blood ketone testing and I’m sure interest is going to rise quickly.

Short link for this post http://wp.me/p2jTRh-87

Overnight Fasting a Key?

From The Salk Institute comes an intriguing study relating to the timing of meals, snacking and the length of over-night fasting:

Scientists have long assumed that the cause of diet-induced obesity in mice is nutritional; however, the Salk findings suggest that the spreading of caloric intake through the day may contribute, as well, by perturbing metabolic pathways governed by the circadian clock and nutrient sensors.

The Salk study found the body stores fat while eating and starts to burn fat and breakdown cholesterol into beneficial bile acids only after a few hours of fasting. When eating frequently, the body continues to make and store fat, ballooning fat cells and liver cells, which can result in liver damage. Under such conditions the liver also continues to make glucose, which raises blood sugar levels. Time-restricted feeding, on the other hand, reduces production of free fat, glucose and cholesterol and makes better use of them. It cuts down fat storage and turns on fat burning mechanisms when the animals undergo daily fasting, thereby keeping the liver cells healthy and reducing overall body fat.

The daily feeding-fasting cycle activates liver enzymes that breakdown cholesterol into bile acids, spurring the metabolism of brown fat – a type of “good fat” in our body that converts extra calories to heat. Thus the body literally burns fat during fasting. The liver also shuts down glucose production for several hours, which helps lower blood glucose. The extra glucose that would have ended up in the blood – high blood sugar is a hallmark of diabetes – is instead used to build molecules that repair damaged cells and make new DNA. This helps prevent chronic inflammation, which has been implicated in the development of a number of diseases, including heart disease, cancer, stroke and Alzheimer’s. Under the time-restricted feeding schedule studied by Panda’s lab, such low-grade inflammation was also reduced.

“Implicit in our findings,” says Panda, “is that the control of energy metabolism is a finely-tuned process that involves an intricate network of signaling and genetic pathways, including nutrient sensing mechanisms and the circadian system. Time-restricted feeding acts on these interwoven networks and moves their state toward that of a normal feeding rhythm.”

The way this study has been presented in some media could be mis-leading. Have a look at the above link to understand what the study did and what it found.  The critical facts are that this was done in mice (human implications can only be guessed at), rodents respond to intermittent fasting much differently than humans do, mice normally eat at night and sleep in the day (which can get a little confusing as you read about the study) and they were fed a 60% fat diet, which probably means about 20% or more of carbs.  Any time a diet is studied that has a mix of fat with this much or more carbs, the results cannot be taken as showing what the results would have been with low-carb eating.

Still, I think this is a very important study.  It is also one that, BTW, contributes to the a-calorie-is-a-calorie food fight (but that is not likely to be acknowledged). This study does not actually demonstrate that these factors apply to humans, but it is certainly possible, at least even to some degree.

IF humans actually respond similarly to the way the mice responded in this study, what would that mean?  I think it is worth addressing that question, keeping in mind that this is just theory so far.

(1) It would suggest that it is generally best to have a relatively longer time between your last food of the evening and your first food the next day.  For example, having your dinner as early in the evening as works for you (that is, without setting up a situation where you are repeatedly or persistently hungry) and then avoiding snacking in the evening or night.

None of this at all changes my opinions and concerns expressed on the page “Restrict/Rebound” or in my writings about “Satiety-Focused Weight Health“.  So, from my perspective, this would mean working with your body to establish daily eating habits and routines that allow you to meet these goals without putting up with ongoing hunger.  Of course, sometimes when you are changing your eating patterns or metabolism there may be some extra hunger for a few days or a week or so as your body adjusts.  For example, if you are in the habit of getting up in the night to eat, it may be a useful strategy to just stop this and tough it out for a few nights while your body adapts (unless, of course you have a specific medical need, such as being a diabetic who can have hypoglycemia overnight).

Many people who adopt a low-carb or at least a controlled-carb lifestyle find that they are much less interested in snacking.  This is probably for different reasons for different people, due to the various ways that eating low-carb promotes satiety.

(2) Even further, it might suggest that it is best to avoid having food still in the early part of the digestive process as you go into the later evening (when your digestive system would be starting to slow down) and on going to bed (your digestive system slows overnight).  This would be influenced by the timing of your evening meal relative to your circadian rhythm, the mix and amount of food eaten and also the functioning of your digestive system.

I could imagine a perfect storm for this would be a diabetic, who has delayed stomach emptying from nerve damage, on a medication that slows stomach emptying eating a large meal containing fat (slows stomach emptying) and protein (slows stomach emptying) and lots of very slowly-digesting starchy food (e.g. legumes, “al dente” pasta) who eats from 8 pm to 9 pm and goes to bed at 11:30.  That person’s digestive system just isn’t going to get any rest.

(3) What about creating a longer fast by skipping or delaying breakfast?  Sorry, I’m still a “Nope, I don’t think so” on that one.  I’m not an anthropologist, but I think the wisdom of the ages in human culture has pointed to a regular intake of meals, including breakfast.  Young, metabolically healthy people can get away with it for a while, but I don’t think it’s a strategy that holds up as the decades start to pass or if you are metabolically unwell or you are under chronic stress.  (See Restrict/Rebound page and comments.)

(4) In the day, moving away from snacking may be beneficial (again, working with your appetite/satiety system on this).

On the subject of meal timing, as I recall other studies have shown that your digestive tract and your appetite/satiety system work best when you have a regular, predictable circadian pattern (wake, sleep and activity) and also when you have regular meals of a generally similar make-up.  That is, your body functions best when it can get into the habit of digesting, for example, a lunch eaten at about the same time each day and containing a similar amount of food and mix of types of food day to day.  Your body wants to anticipate a certain job it has to do with your breakfast, and a certain job it generally has to do at lunch time and also a certain general job you expect from it at supper time.

When I was growing up, we rarely ever snacked in the evening.  There was always tasty stuff in the fridge and always cookies or other baking on the counter.  We ate dinner at about 6 pm, had a small dessert and the simple fact was that none of us thought about food again until the morning.  On the other hand, none of us would be happy with being up long at all in the morning before eating breakfast and none of us would ever have been happy skipping lunch.

This study from the Salk Institute does not provide solid information about human biology, but still I would suspect that the human body functions best when the digestive tract and metabolism can rest at night.

Addendum: another take on the same study, from Sweat Science http://t.co/ABOAeQg5

Short link for this post Overnight Fasting a Key?   http://wp.me/p2jTRh-7d

Sugar Damage and Related Research

For anyone interested in looking “behind the scenes” at the research that goes into development of medical knowledge, this is a link to what I have been doing this morning. (Note: it is not obvious, but there are 4 pages, you click at the top right.)

http://www.ncbi.nlm.nih.gov/sites/myncbi/collections/public/18SLu9dl8FbUgixFr7tzWyi/

I have spent the past couple of hours looking at research related to damage from high blood sugars and from molecules that have been damaged by sugar (glycation). Some of these molecules are called AGEs, which is Advanced Glycation End Products. In the body, these attach to receptors, which are thus called RAGEs, or Receptors for Advanced Glycation End Products. It gets confusing as AGEs aren’t the only damaging molecules from high blood sugars. On top of that, it is now known that RAGEs react to many other molecules that occur within the body, not just those related to sugar damage.

AGEs are produced in your body and they are also present in foods. The AGEs present in foods (bacon is, sadly, the source of the greatest amount of AGEs in the typical North American diet) have been shown in research to have damaging effects.

This list of published papers is in no way an attempt to be complete, just some interesting ones I have set aside in a list, published in the past few months, to pursue in more depth later. To be more complete, I would do other searches on PubMed  using related search terms or following the work of specific researchers. For example, the older citations on the list are because I followed backwards Dr. Ceriello’s work, for example:

Vascul Pharmacol. 2012 May 16. [Epub ahead of print]

The emerging challenge in diabetes: The “metabolic memory”

Ceriello A.

Abstract

Large randomized studies have established that early intensive glycemic control reduces the risk of diabetic complications, both micro and macrovascular. However, epidemiological and prospective data support a long-term influence of early metabolic control on clinical outcomes. This phenomenon has recently been defined as “metabolic memory.” Potential mechanisms for propagating this “memory” may be the production of reactive species unrelated to the presence of hyperglycemia, depending on the previous production of AGEs which can maintain RAGE over-expression, on the level of glycation of mitochondrial proteins and on the amount of mtDNA produced, all conditions able to induce an altered gene expression which may be persistent even when glycemia is normalized. Clinically, the emergence of this “metabolic memory” suggests the need for a very early aggressive treatment aiming to “normalize” the metabolic control and the addition of agents which reduce cellular reactive species and glycation in addition to normalizing glucose levels in diabetic patients in order to minimize long-term diabetic complications.

Copyright © 2012. Published by Elsevier Inc.  PMID:22609133

I generally will look at a thousand or so of these “abstracts” of published papers in a typical week, on many different health-related topics, but mostly regarding diet and nutrition.

The place to go online for information about AGEs is to the website The AGE-less Way, where you can learn about this subject and the very important work of Dr. Jaime Uribarri MD and Dr. Helen Vlassara MD.  There is much useful info on their site and they also have a book out, The AGE-less Way, available in print and on Kindle.  Dr. Uribarri was interviewed by Jimmy Moore in January 2012. http://www.thelivinlowcarbshow.com/shownotes/5670/532-dr-jaime-uribarri-warns-of-disease-making-advanced-glycation-end-products-ages/

Short Link for this post http://wp.me/p2jTRh-7F

Normal Weight but At Risk

High Blood Sugar, Diabetes and High Blood Pressure in People of Normal Weight

Dr. Mark Hyman has written well on this topic in his new post “Skinny Fat People: Why Being Skinny Doesn’t Protect Us Against Diabetes and Death”.

In this article, he incorporates findings from the research paper below.  I had re-tweeted (from Emily Deans MD) about this study a few days ago and was just about to write a post on it, but Dr. Hyman has this covered.  This is the link to the free full text of the research paper.

Pediatrics. 2012 May 21. [Epub ahead of print]

Prevalence of Cardiovascular Disease Risk Factors Among US Adolescents, 1999-2008.

Source

aDivisions of Nutrition, Physical Activity and Obesity and.

Abstract

OBJECTIVE:

Overweight and obesity during adolescence are associated with an increased risk for cardiovascular disease (CVD) risk factors. The objective of this study was to examine the recent trends in the prevalence of selected biological CVD risk factors and the prevalence of these risk factors by overweight/obesity status among US adolescents.

METHODS:

The NHANES is a cross-sectional, stratified, multistage probability sample survey of the US civilian, noninstitutionalized population. The study sample included 3383 participants aged 12 to 19 years from the 1999 through 2008 NHANES.

RESULTS:

Among the US adolescents aged 12 to 19 years, the overall prevalence was 14% for prehypertension/hypertension, 22% for borderline-high/high low-density lipoprotein cholesterol, 6% for low high-density lipoprotein cholesterol (<35 mg/dL), and 15% for prediabetes/diabetes during the survey period from 1999 to 2008. No significant change in the prevalence of prehypertension/hypertension (17% and 13%) and borderline-high/high low-density lipoprotein cholesterol (23% and 19%) was observed from 1999-2000 to 2007-2008, but the prevalence of prediabetes/diabetes increased from 9% to 23%. A consistent dose-response increase in the prevalence of each of these CVD risk factors was observed by weight categories: the estimated 37%, 49%, and 61% of the overweight, obese, and normal-weight adolescents, respectively, had at least 1 of these CVD risk factors during the 1999 through 2008 study period.

CONCLUSIONS:

The results of this national study indicate that US adolescents carry a substantial burden of CVD risk factors, especially those youth who are overweight or obese.   PMID: 22614778  (added emphasis mine)

It is very telling to read the full report.  In there you will find a chart of the results.  This chart includes important results that are not clearly expressed anywhere in the written report. That is, some of the numbers are only reported in visual form on the chart.

From this chart, one can see that 13% of the children who were classed as normal body weight had pre-diabetes or diabetes! (That is about 1 in every 8.)

OK, let me repeat that 10 times! (Or, I can just hope you might pretend I did.)

Imagine how many kids this would have been if Jenny Ruhl’s criteria for non-damaging blood sugar levels had been used (not a snowball’s chance on that).

Mark Hyman goes on to report:

A surgeon friend of mine recently told me that even in people of normal weight, he found belly’s full of fat – caked around their colon, liver, kidneys, and draped over all their organs.  This is caused by our industrial diet full of high fructose corn syrup, added sugars, trans-fats, flour and processed food.

Dr. Hyman’s full post includes much more than this and is well worth the read.

Short link for this post http://wp.me/p2jTRh-7o

A gluten-free low-carb bar in a pinch

Aside

On my recent trip to Denver for the obesity conference, I was so very glad to have found a gluten-free low-carb snack bar that I can use in a pinch.

I keep pretty much to real foods and eat quite simply.  Personally, I don’t fill my life with low-carb baking or with a lot of artificial sweeteners or sugar alcohols as sweeteners.  (For some people, though, this can be an important part of their long-term strategy that works for them.)

When travelling while eating gluten-free and low-carb, things can get difficult even when all goes according to plan.  I was glad that I planned ahead for this and had ordered from the US a box of snack bars and packed some for the trip.

I have absolutely no ties to any companies, so I’ll go ahead and mention the name Quest Bars, which I learned of through listening to Jimmy Moore’s LLVLC podcasts.  Having some of these with me really came in handy and saved me from having to go hungry on more than one occasion.

These bars are not sold in Canada.  You can, however, order them from the US for personal use (not to bring them in and sell them) as long as you stick to an amount that a Custom’s Agent would consider reasonable for personal use for a couple of months.  I ordered them from a major on-line supplement retailer that I have ordered from many times in the past 5 years or more.

To me, this is something I would only turn to for uncommon situations, such as a long flight.  If I started to think that I “needed” to have one every week or every few days, I would start to wonder about myself and to understand that I was just making up excuses.  Having the option of a gluten-free low-carb snack bar is great to know about, but if they start to call your name from the cupboard, perhaps they aren’t for you.

Gluten awareness even for low-carbers

There has been a fair amount of interest in my article on the need for gluten awareness even in the world of low-carb nutrition or grain-free eating, such as a Paleo lifestyle.

The topic is much larger than can be contained in any one blog post.  I tried to explain my thoughts a bit more in the comments section under the article, including:

With the immune system, the dose causing impact is orders of magnitude less than for the blood-sugar control system.

With the immune-system, the price to pay for small intakes is out of all proportion.

The Canadian Celiac Association is one place to look for info, such as this article on the new food labelling laws coming into effect in Canada in August.

Canada is in a transition period between the old labelling regulations and new regulations that take effect on August 4, 2012. By that date, labels for all food products sold in Canada will have to carry clear identification of the priority allergens, gluten, and added sulphites at a level greater than 10 ppm.

In Canada, gluten means “any gluten protein or modified protein, including any protein fraction derived from the grains of the following cereals: barley, oats, rye, triticale, wheat, kamut or spelt”. The definition also applies to the grains of hybridized strains of the cereals listed above.

And this article on cross-contamination:

People who need to eat gluten free need to check both the ingredients in food and any cross-contamination with gluten-containing ingredients that might happen when the food is manufactured, packaged and prepared for eating.

When you think about avoiding cross-contamination, you need to realize that crumbs matter. Look around your kitchen to see where there are crumbs – on the counter top, in the microwave, on the cutting board or in the corners of your metal baking dishes? Anywhere you see crumbs is a potential place for cross-contamination.

The Celiac Disease Foundation at celiac.org has an article on gluten in medications, along with extensive other info.

Celiac.com offers a mind-boggling list to keep in mind when reading food labels Unsafe Gluten-Free Food List (Unsafe Ingredients), along with extensive other info.

You might enjoy a “Wheat is Murder, Go Paleo” t-shirt from Tom Naughton’s site Fat Head.

I know, I know. Just eat non-processed real foods and you don’t have to worry about labels.  Yeah, that’s what I do.  But life ain’t perfect and neither are people and the penalty for small “sins” should not be so large.

When the 8 percent of us who need to avoid even tiny intakes of gluten (this is a rough estimate, true incidence not known and likely rising) are aware, knowledgable and active, life will get easier as the world adapts to our presence.