Home » Blog » Diabetes

Tag: Diabetes

Coconut Oil – Duct Tape for the Broken Metabolism

Coconut oil can be found in just about every grocery store, health food store and coffee shop near you.  It was made popular in the last few years by the highly advertised Bullet Proof Coffee claims of health and taste over the last few years.  But in the last few days, the news outlets through video and print have made it clear that the American Heart Association (AHA) isn’t happy with our use of this “duct tape for one’s metabolism.” The AHA has long been a proponent of education against activities increasing the risk of heart disease.  Since 1961 the AHA has decried the use of saturated fat, based on their support of Ansel Key’s diet heart hypothesis, and leading to over 60 years of preaching against the use of saturated fats from the pulpits of science.  The claim is that 85% of coconut oil is saturated fat (this is the fat deemed “evil” by those “disciples of the low-fat cloth”).   Yes, coconut oil is predominantly a saturated fat.  And approximately 75% of that is medium chain triglycerides, the form that converts most efficiently into ketones, for those of us using ketogenic nutritional approaches to health.  But is coconut oil really bad for your heart health?

Those of us using ketogenic diets know that LDL-C will commonly rise with increased saturated fat intake.  And, we’ve know this for over twenty years. This is to be expected, because LDL-C is really comprised of three different LDL sub-particles (big fluffy, medium, and small dense).  We’ve known for the last twenty years that increased saturated fat actually causes a shift in these particles to bigger “fluffier” particles.  We also know that it’s the small dense LDL particles are the atherogenic/inflammatory particles participating in the formation of vascular disease (arterial blockage) and their presence in the blood is directly correlated with the level of triglyceride, and that the big “fluffy” particles actually reduce the risk of vascular disease. Those of us following ketogenic lifestyles and treating disease with these protocols also know that triglycerides levels are increased directly by increasing levels of insulin.

The 2015 British Medical Journal published a study reviewing the relevant 19 peer reviewed medical articles that included over 68,000 participants.  This review showed that there is no association of high LDL-C (a calculated value of all the LDL sub-particles) with mortality (meaning that an elevated LDL-C does not lead to an increased risk of death from heart disease).  In stark contrast to this landmark review, The American Heart Association’s Presidential Advisory published this week in the June 20, 2017 issue of Circulation states that saturated fat is the cause of increased LDL-C and elevated LDL-C is associated with an increase in death by cardiovascular disease.  This boldfaced claim is based on a single small 4 year (2009-2013) literature review completed by the World Health Organization with a whopping 2353 participants, most of these studies only lasting 3-5 weeks (not nearly long enough to see fully effective cholesterol changes) and none of which had any focus on carbohydrate intake, insulin levels or LDL sub-particle measurement.  From this singular study, the AHA concludes that elevated LDL-C is an indicator of increased cardiovascular mortality.  That’s the equivalent of saying, “you know cars drive on the roads and cause pot holes, so we should all STOP driving cars because it is causing our freeway system to have increased pot holes.”

You can’t extrapolate mortality risk based on a single small study that doesn’t actually identify correlation or causation.  But the AHA did exactly that in 1961, and they are trying to do it again today.   The MR-FIT study, largest study ever completed, is incessantly quoted as the study that demonstrates reduction in cholesterol leads to reduction in cardiovascular disease, but this trial was actually a failure and did not demonstrate improved risk by lowering cholesterol.  In fact, the Director of the study, Dr. William Castelli actually stated, “. . . the more saturated fat one ate, the more cholesterol one ate, the more calories one ate, the lower people’s serum cholesterol…”

“We found that the people who ate the most cholesterol, ate the most saturated fat, ate the most calories weighed the least and were the most physically active,” he said.

Isn’t that interesting?

So, is coconut oil, or any other food high in saturated fat to blame?  Absolutely not!  There is no solid evidence to support these facts and there hasn’t been in over 65 years.   In fact, clinically, I find that the addition of coconut oil lowers triglycerides, decreases appetite, improves energy, improves skin tone, and plays a huge role in shifting the Omega 3/6 ratios to a more normal 2:1 level.

Is coconut oil, or any other food high in saturated fat to blame? Absolutely not! There is no solid evidence to support these facts and there hasn't been in over 65 years. #docmusclesClick To Tweet

So, how does coconut oil help the broken metabolism?  The majority of people I see in my office have insulin resistance to some degree.  Insulin resistance is an over production of insulin in response to any form of carbohydrate or starch.  Increasing your saturated fat, does two things.  It provides a fantastic form of fuel, one your body can use very easily.  And second, it will decrease your craving for starches and carbohydrates, naturally decreasing production of insulin and helping to improve insulin resistance over time.

If you want to learn more about using fat and improving insulin resistance, see my previous blog post here.

You can learn more about how our acceptance of bad science has lead to an obesity and diabetes epidemic in our country over the last 65 years by reading these books below:

 

But I Said You're The Good Kind of Fat…

Good Fat

Can Healthy Fats Make You Fat?

Are Zero-Carb Diets OK?

And, Can You Heal A Damaged Metabolism With Keto?

Listen in to KetoTalk.com for Podcast #26.

The health podcast legend, Jimmy Moore, and I talk about how much fat is too much.  Or, is it?  What’s the deal with Zero-carb ketogenic diets?  We answer your questions and try to give you the most up-to-date knowlege regarding the ketogenic lifestyle and how it affects your metabolism. We zero in exclusively on all the questions people have about how being in a state of nutritional ketosis and the effects it has on your health.

There are a lot of myths about “keto” floating around out there and we shoot them down one at a time.

You can down-load it for free on iTunes or listen to KetoTalk.com on your computer. 

Enjoy!!

Adapt Bar Chocolate

 

OTG-Pack-and-Shaker

Ketogenic Diet Halts Tumor Growth

 

Prostate Cancer Cell Replication
Prostate Cancer Cell Replication

It has long been understood that tumor cells of any kind require high levels of glucose to grow and spread (1,2).  It is also recognized that higher levels of insulin, commonly found in patients with insulin resistance or type II diabetes, are 2.4 times more likely to stimulate the development of breast cancer (3). A diet low in glucose has thereby been theorized to be an adjunct to cancer treatment.

Ketogenic diets have been demonstrated to be therapeutically useful in the treatments of epilepsy and cardiovascular disease (4). A ketogenic diet is one in which carbohydrate levels are kept below 50 grams per day and fat intake is increased to the point that the body shifts its metabolism to use triglycerides, and the ketones derived from triglycerides, as the primary fuel source for the majority of the cells within the body.  With this understanding in mind, the application of a ketogenic diet, one high in fat and protein with limited carbohydrate or glucose has been suggested as a adjunct to cancer treatments (5).

KetoOS
KetoOS – Drinkable Exogenous Ketones

A recent study (6) in the Oncology Letters evaluated the benefits of a ketogenic diet in 78 cancer patients in clinical practice.  A novel marker measuring the tumor cells use of glucose called transketolase-like-1 (TKTL1) was closely monitored, as was each of the 78 patients adherence to a ketogenic diet.  Increased TKTL1 was noted in more aggressively active and growing tumors (7,8).

Among the 43 males and 35 females, 7 patients agree to and followed a fully ketogenic diet and 6 of them followed a partially ketogenic diet.  Ketogenic meals were provided by a German company called Tavarlin that would prepare and mail ketogenic meals including oil, fat, snacks, bread, protein and energy drinks.  Dietary journals were reviewed every three months over a period of about 10 months.

40 % of these patients experienced a halting of the tumor progression and 60% experienced improvement noted by normalization of TKTL1 or reduction in TKTL1, respectively.  Those on a ketogenic diet demonstrated an average reduction of TKTL1 by approximately 50%.

This is the first study of its kind and has significant potential.  Could dietary carbohydrate restriction be an effective cancer treatment or adjunct to cancer treatment?

Because the food diaries were based on reporting only, the sample study was very small, and patients treated in the outpatient setting have the possibility of variability in the standard oncologic treatments,  the results must be interpreted with caution.  However, the data is very promising.   This study is one in which I have great interest as I have seen similar results in my clinic on a case by case basis.

Based on the limitations noted above, rigorous randomized control studies are needed, but this is an exciting an promising first step.  Additionally, the presence of a marker for tumor growth that correlates with diet is remarkable.  And, it provides the ketogenic specialist a possible measurement tool that could be used clinically.

 

References: 

  1. Klement RJ and Kämmerer U: Is there a role for carbohydrate restriction in the treatment and prevention of cancer? Nutr Metab (Lond) 8: 75, 2011
  2. Vaughn AE and Deshmukh M: Glucose metabolism inhibits apoptosis in neurons and cancer cells by redox inactivation of cytochrome c. Nat Cell Biol 10: 1477-1483, 2008.
  3. Gunter MJ, Hoover DR, Yu H, Wassertheil-Smoller S, Rohan TE, Manson JE, Li J, Ho GY, Xue X, Anderson GL, et al: Insulin, insulin-like growth factor-I, and risk of breast cancer in postmenopausal women. J Natl Cancer Inst 101: 48-60, 2009.
  4. Paoli A, Rubini A, Volek JS and GrimaldiKA: Beyond weight loss: A review of the therapeutic uses of very-low-carbohydrate (ketogenic) diets. Eur J Clin Nutr 67: 789-796, 2013.
  5. Ruskin DN and Masino SA: The nervous system and metabolic dysregulation: Emerging evidence converges on ketogenic diet therapy. Front Neurosci 6: 33, 2012.
  6. Jansen, N., Walach, H.”The development of tumours under a ketogenic diet in association with the novel tumour marker TKTL1: A case series in general practice”. Oncology Letters 11.1 (2016): 584-592.
  7. . Schwaab J, Horisberger K, Ströbel P, Bohn B, Gencer D, Kähler G, Kienle P, Post S, Wenz F, Hofmann WK, et al: Expression of Transketolase like gene 1 (TKTL1) predicts disease-free survival in patients with locally advanced rectal cancer receiving neoadjuvant chemoradiotherapy. BMC Cancer 11: 363, 2011.
  8. Zhang S, Yang JH, Guo CK and Cai PC: Gene silencing of TKTL1 by RNAi inhibits cell proliferation in human hepatoma cells. Cancer Lett 253: 108-114, 2007

Thinking Outside of the Box

Nine dots

The image above has nine dots within a square.  Your task, using only four lines is to connect ALL nine dots WITHOUT ever raising your pen, pencil or finger (Please don’t use a sharpie on your computer screen . . . it doesn’t come off).

You may have seen this puzzle previously . . . it’s made its rounds in corporate training circles. But the underlying principle remains true.  The solution requires you to expand your thinking or to “think outside the box.”out-of-the-box

Whenever you find yourself on the side of the majority, it is time to pause and reflect. (Mark Twain)

Why should we limit ourselves to thinking outside the box.  Can’t we just get rid of the box?

True discovery consists in seeing what everyone has seen . . . then, thinking what no one has thought.

The answer can be found when those four lines are used beyond the box our mind creates:

Nine dots solution

What good has the box done us?  People were burned at the stake because they refused to believe the Earth was not the center of the universe. People were beheaded because they had a sneaking suspicion that the world was not flat.

Why is it so very hard to accept that our weight gain and diabetes are driven by a hormonal signal, and not by gluttony or caloric intake of fat?  The definition of insanity is doing the same thing repetitively and expecting a different outcome.  How long have you been restricting calories and fat with only minimal or no improvement in your weight, blood sugar, cholesterol or general feeling of health?diabetes global warming

The main problem with the current thought model, or dogma, on the obesity’s cause is that it does not account for metabolic syndrome.  Metabolic syndrome is insulin resistance.  It is an over production of insulin in the presence of ANY form of carbohydrate (sugar or starch).

In the practice of medicine over the last 15 years, I noticed that a very interesting pattern emerged.  There was always a spike in fasting and postprandial insulin levels 5-10 years prior to the first abnormal fasting and postprandial blood sugars.  These patients were exercising regularly and eating a diet low in fat.  But they saw continued weight gain and progressed down the path of metabolic syndrome.  10-15 years later, they fall into the classification of type II diabetes.  What I now lovingly refer to as stage IV insulin resistance.

The only thing that seems to halt this progressive process with any degree of success is carbohydrate restriction.  Fasting insulin levels return to normal, weight falls off, and the diseases of civilizations seem to disappear as insidiously as they arose.

So you tell me, is the world flat?  Is the Earth the center of the universe?

Low-carb is bad

What is a low carbohydrate or ketogenic diet?  15 years of practical in the trenches experience have helped me develop a very simple program to help you lose and maintain your weight.  Access to this program, video help and access to blog articles at your fingertips are offered through my online membership site.

You can also hear me each week a I discuss low carbohydrate, paleolithic and ketogenic diets with the Legendary Jimmy Moore on KetoTalk.com

Caffeine . . . Weight Loss Wonder Boy or Sneaky Scoundrel?

I’ve been looking for the answer for quite some time. . . what role does caffeine play in your and my weight management journey?  The answer gave me a headache. . . literally and figuratively.

As many of you, including my office staff, know, I love my Diet Dr. Pepper (and my bacon).  I found that being able to sip on a little soda throughout the day significantly helped the carbohydrate cravings and munchies during a busy and stressful day at the office.   Diet Dr. Pepper contains caffeine, however, I wasn’t really worried.  Caffeine has been well know to have a thermogenic effect which increases your metabolism and has been thought for many years to help with weight loss among the weight loss community.

Diet Dr. Pepper is, also, one of only four diet sodas on the grocery store shelves that doesn’t contain acesulfame potassium (click here to see why most artificial sweeteners cause weight gain).  The four diet sodas that I have been comfortable with my patients using are Diet Dr. Pepper, Diet Coke, Diet Mug Root-beer and Diet A&W Cream Soda.  These are the last four hold out diet sodas that still use NutraSweet (aspartame) as the sweetener.  Most of the soda companies have switched the sweetener in their diet sodas to the insulinogenic acesulfame potassium because it tastes more natural and aspartame has been given a media black eye of late.  However, NutraSweet (aspartame) is the only sweetener that doesn’t spike your insulin or raise blood sugar (click here to find out why that is important).

Yes, I know.  The ingestion of 600 times the approved amount of aspartame causes blindness in lab rats (but we’re not lab rats, and . . . have you ever met someone that drinks 600 Diet Dr. Peppers in a day?  The lethal dose of bananas, which are high in potassium that will stop your heart, is 400).  Aspartame can also exacerbate headaches in some (about 5% of people) and I’ve had a few patients with amplified fibromyalgia symptoms when they use aspartame.   But for most of us, its a useful sweetener that doesn’t spike your insulin response, halting or causing weight gain.

But, over the last few years, I’ve noticed that increased amounts of Diet Dr. Pepper & Diet Coke seem to cause plateauing of weight and decreasing the ability to shift into ketosis, especially mine.  I’ve also noticed (in my personal n=1 experimentation) that my ability to fast after using caffeine regularly seems to be less tolerable, causing headaches and fatigue 8-10 hours into the fast, symptoms that don’t seem to let up until eating. Through the process of elimination, caffeine seems to be the culprit.

Red Bull in caffeineAfter mulling through the last 10 years of caffeine research, most of which were small studies, had mixed results, used coffee as the caffeine delivery system (coffee has over 50 trace minerals that has the potential to skew the results based on the brand) and never seemed to ask the right questions, the ink from a study in the August 2004 Diabetes Care Journal screamed for my attention.

It appears that caffeine actually stimulates a glucose and insulin response through a secondary mechanism.   The insulin surge and glucose response is dramatically amplified in patients who are insulin resistant.  Caffeine doesn’t effect glucose or insulin if taken while fasting; however, when taken with a meal, glucose responses are 21% higher than normal, and insulin responses are 48% higher in the insulin resistant patient. Caffeine seems to only effect the postprandial (2 hours after a meal) glucose and insulin levels.  The literature shows mixed responses in patients when caffeine is in coffee or tea, probably due to the effect of other organic compounds (1).

Caffeine Effect on glucose insulin
Caffeine effect on plasma glucose and plasma insulin compared to placebo (1).

Caffeine also diminishes insulin sensitivity and impairs glucose tolerance in normal and already insulin resistant and/or obese patients.  This is seen most prominently in patients with diabetes mellitus type II (stage IV insulin resistance).  Caffeine causes alterations in glucose homeostasis by decreasing glucose uptake into skeletal muscle, thereby causing elevations in blood glucose concentration and causing an insulin release (2-6).

Studies show that caffeine causes a five fold increase in epinephrine and a smaller, but significant, norepinephrine release.  The diminished insulin sensitivity and exaggerated insulin response appears to be mediated by a catacholamine (epinephrine, norepinephrine & dopamine)  induced stress response (5).  Caffeine has a half life of about 6 hours, that means the caffeine in your system could cause a catacholamine response for up to 72 hours depending upon the amount of caffeine you ingest (7).

The reason for my, and other patient’s, headaches and fatigue after a short fast was due to the exaggerated stress hormone response.  Increased levels of insulin were induced by a catacholamine cascade after caffeine ingestion with a meal, dramatically more amplified in a person like me with insulin resistance. The caffeine with the last meal cause hypoglycemia 5-7 hours into the fasting, leading to headaches and fatigue that are only alleviated by eating.

Even when not fasting, the caffeine induced catacholamine cascade causes up to 48% more insulin release with a meal, halting weight loss and in some cases, causing weight gain.

Caffeine is not the “Wonder-Boy” we thought it was.

How much caffeine will cause these symptoms? 50 mg or more per day can have these effects.

caffeine-content-of-popular-drinks

Ingestion of caffeine has the following effects:

  • 20-40 mg – increased mental clarity for 2-6 hours
  • 50-100 mg – decreased mental clarity, confusion, catacholamine response
  • 250-700 mg – anxiety, nervousness, hypertension & insomnia
  • 500 mg – relaxation of internal anal sphincter tone (yes . . . you begin to soil yourself)
  • 1000 mg – tachycardia, heart palpitations, insomnia, tinnitus, cognitive difficulty.
  • 10,000 mg (10 grams) – lethal dose (Yes, 25 cups of Starbucks Coffee can kill you)

The equivalent of 100 mg of in a human was given to a spider, you can see the very interesting effect on productivity.  How often does the productivity of the day feel like the image below?

Spider Normal
Normal Spider (9)
Spider Caffeine
Spider on caffeine (9)

Beware that caffeine is now being added to a number of skin care products including wrinkle creams and makeup.  Yes, caffeine is absorbed through the skin, so check the ingredients on your skin care products.

Diet Dr. Pepper, my caffeine delivery system of choice, has slightly less caffeine (39 mg per 12 oz can or 3.25 mg per oz) than regular Dr. Pepper.  I found myself drinking 2-3 liters of Diet Dr. Pepper per day (long 16-18 hour work days in the office).  After doing my research, I realized that my caffeine tolerance had built up to quite a significant level (230-350 grams per day).

So, a few weeks ago, I quit . . . cold turkey.

Did I mention the 15 withdrawal symptoms of caffeine? (8)

  • Headache – behind the eyes to the back of the head
  • Sleepiness – can’t keep your eyes open kind of sleepiness
  • Irritability – everyone around you thinks you’ve become a bear
  • Lethargy – feels like your wearing a 70 lb lead vest
  • Constipation – do I really need to explain this one?
  • Depression – you may actually feel like giving up on life
  • Muscle Pain, Stiffness, Cramping – feel like you were run over by a train
  • Lack of Concentration – don’t plan on studying, doing your taxes or performing brain surgery during this period
  • Flu Like Illness – sinus pressure and stuffiness that just won’t clear
  • Insomnia – you feel sleepy, but you can’t sleep
  • Nausea & Vomiting – You may loose your appetite
  • Anxiety – amplified panic attacks or feeling like the sky is falling
  • Brain Fog – can’t hold coherent thoughts or difficulty with common tasks
  • Dizziness – your sense of equilibrium may be off
  • Low Blood Pressure & Heart Palpitations – low pressure and abnormal heart rhythm

I experienced 13 of the 15 that lasted for 4 days.   I do not recommend quitting cold turkey unless you have a week off and someone to hold your hand, cook your meals and dose your Tylenol or Motrin.  My wife thought I was dying. . . I thought I was dying on day two.  I actually had a nightmare about buying and getting into my own coffin.  It can take up to three weeks to completely recover from caffeine withdrawal.

The other way to quit is to decrease your caffeine intake by 50 mg every two days.   That means decrease caffeine by:

  • 1 can of soda every two days
  • 1/4 cup of coffee every day
  • 1/2 can of Energy Drinks every two days
  • 1 cup of tea every two days

The benefit of this method is that withdrawal symptoms are much less severe without the caffeine headache and the ability to remain productive.  It will take longer, but quitting cold turkey is not a pretty picture.  Been there . . . done that, . . . and I’m not going back. I actually lost another half inch off my waistline by day 5 of caffeine discontinuation.

What is the take home message here?  If you have any degree of insulin resistance, caffeine makes it worse and will amplify your weight gain as well as decrease the productivity of your day.

References:

  1. Lane JD, Barkauskas CE Surwit RS, Feinglos MN, Caffeine Impairs Glucose Metabolism in Type II Diabetes, Diabetes Care August 2004 vol. 27 no. 8 2047-2048; doi:10.2337/diacare.27.8.204
  2. Jankelson OM, Beaser SB, Howard FM, Mayer J: Effect of coffee on glucose tolerance and circulating insulin in men with maturity-onset diabetes. Lancet 1527–529, 1967
  3. Graham TE, Sathasivam P, Rowland M, Marko N, Greer F, Battram D: Caffeine ingestion elevates plasma insulin response in humans during an oral glucose tolerance test. Can J Physiol Pharmacol 79:559–565, 2001
  4. Greer F, Hudson R, Ross R, Graham T: Caffeine ingestion decreases glucose disposal during a hyperinsulinemic-euglycemic clamp in sedentary humans.Diabetes 50:2349–2354, 2001
  5. Keijzers GB, De Galan BE, Tack CJ, Smits P: Caffeine can decrease insulin sensitivity in humans. Diabetes Care 25:364–369, 2002
  6. Petrie HJ, et al. Caffeine ingestion increases the insulin response to an oral-glucose-tolerance test in obese men before and after weight loss. American Society for Clinical Nutrition. 80:22-28, 2004
  7. Evans SM, Griffiths RR, Caffeine Withdrawal: A Parametric Analysis of Caffeine Dosing Conditions, JPET April 1, 1999 vol. 289no. 1 285-294
  8. Noever R, Cronise J, Relwani RA. Using spider-web patterns to determine toxicity. NASA Tech Briefs April 29,1995. 19(4):82. Published in New Scientist magazine, 29 April 1995