obesity

What If We Are Wrong? Medication, Medical Science and Infallibility

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What if we are wrong? Such a simple question, but one that seems all but absent in modern medicine. Patients, particularly women, routinely present with chronic, treatment refractory, undiagnosed or misdiagnosed conditions. More often than not, the persistence of the symptoms is disregarded as being somehow caused by the patient herself. If the tests come back negative and the symptoms persist, then it is not the tests that are insensitive or incorrect but the patient. If the medication prescribed does not work or elicits ill-understood side effects, then somehow the patient is at fault. If the patient stops taking the medication because of said side-effects, then they are labeled non-compliant and difficult. The patient is always at fault. It is never the test, the disease model, or the treatment.

What if we are wrong? What if the tests to diagnose a particular condition are based on incorrect or incomplete disease models? What if a medication universally prescribed for a given condition doesn’t work or creates adverse reactions in certain populations of people? What if the side-effects listed are incomplete? Is it so difficult to admit that gold standards evolve or that medical science is fluid? Certainly, if a patient is presenting with a constellation of symptoms that create suffering and those symptoms do not remit with a given medication or medications and/or do not appear on the available diagnostic tests, why is it so difficult to consider that either the medication doesn’t work, the diagnostic was insufficient, or the diagnosis itself was incorrect? Why is it that we assume it must be a mental health issue or somehow the patient is causing the symptoms herself?

Here, one doctor tells how he learned that he was wrong about diabetes and metabolic disorder. He gleaned this not from a book or from his training and not from listening to his patients, but when he, a previously healthy young man, developed a metabolic syndrome that led to obesity and type 2 diabetes. It was by his own personal crisis that he began to question the model of diabetes and its relationship with obesity. Dr. Peter Attia asks:

What if we are wrong?

What if we are wrong, indeed. There are so many areas of medicine where we may be wrong; where we are likely wrong, but where no one is asking the question.

We congratulate Dr. Attia for his discovery, but why does it take a personal crisis for a physician to question the status quo? Why is there such fealty to particular disease classifications or disease models even when there is evidence to the contrary? Is it the nature of modern medicine to lay down guidelines and be done or is it simply human nature to resist the notion that we can be wrong? Maybe a combination of both; I don’t know the answer, but I do know that if one is certain of everything there can be no room for learning or discovery.

On the other hand, if we begin with the notion that humans, and thus, the structures humans create are fallible – that we do not know or understand everything – and if we add to that humility a dose empathy, perhaps then we can begin healing patients rather than managing them.

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More people than ever are reading Hormones Matter, a testament to the need for independent voices in health and medicine. We are not funded and accept limited advertising. Unlike many health sites, we don’t force you to purchase a subscription. We believe health information should be open to all. If you read Hormones Matter, like it, please help support it. Contribute now.

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This post was published originally on Hormones Matter in July 2013.

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Why Are We So Scared of Salt?

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Over the past several decades, the general consensus of health professionals has been to recommend that all people lower their salt intake. Without the recognition of the effects of lifestyle and dietary choice differences, this avalanche of low salt advice hit the general public and as a direct result many became ill. Differences in individual genetic, lifestyle, and dietary factors have completely been ignored in the broad-brush campaign for lowering salt intake. Today, it is unmistakably obvious that a large segment of the population followed the low salt regimen with disastrous consequences.

The professionals who first introduced and propagated the low salt diets had good intentions. They did not know any better. Now we do know better and there is no excuse for not revising a failed treatment regimen in the face of new countervailing evidence. The process of correction needs to begin on a large scale. My work is part of this very much needed correction.

Why Are We Scared of Salt?

In the 1960’s, scientific studies linked salt consumption to hypertension and obesity. I am not quite sure why it was salt they picked on as “enemy number one.” I suspect the reason was the proliferation of precooked and canned food, all of which were salt preserved. To me, it was not logical that only salt was picked on. There were many other dangerous food items that could have been singled out: sugar, margarine, preservatives, pesticides, etc. The American Heart Association still has some of these salt reduction articles on their website. Even today, when waiting for an appointment at my medical institution, the forever-on TV was showing how to cut salt out of kids’ daily lunch to be “healthy.” Indeed, once something is ingrained in our brains, it is habit forming. Habits are very hard to break, particularly when the medical research relied upon showed that salt is something dangerous that may kill you.

Is Salt or Sugar the Enemy?

The problem is that hypertension and obesity are not and have never ever been caused by salt! They are caused by sugar—I am saving the sugar discussion for my next article.

Why not salt? Consider: human fetuses are floating in salt water and are typically not born with heart attack or hypertension. Our bodies are made of over 7% salt, our brains, heart, and all of our cells use salt to function. Humans have always consumed salt. Do they all have hypertension and heart attacks? No, they don’t. In fact, for some time now, studies have been surfacing suggesting that reduced salt does not eliminate the chances for hypertension and heart attack but may even contribute to the problem.

It is scientifically irresponsible to analyze biological processes in the human body involving salt without accounting for the effects of sugar and sugar substitutes and the amount of water consumed.

Probably not many of you have the handbook “Harrison’s Manual of Medicine” (18th edition McGraw Hill Medical by Longo et al.,) but I do. Page 4

…serum Na+ [sodium] falls by 1.4 mM for every 100-mg.dL increase in glucose, due to glucose-induced H2O efflux from cells.

Let me explain this sentence for you: Sodium is part of salt. Salt is Sodium (Na+) and Chloride (Cl-) where the + and – represent the ionic state in which there is either one extra or one fewer electron (electrons have negative charge) and so the atom is looking for another atom it can attach to and form a bond creating a molecule. According to the medical handbook, Na+ drops if glucose, which is blood sugar, increases. If you eat glucose, it causes “H2O efflux from cells” which means that sugar attracts water to the point that it pulls it out of the cells, thereby emptying the cells of sodium, and thus, the cells are dehydrated.

Sugar causes a very serious problem that can result in hypertension and heart attack. The volume of blood inside the cells reduces by dehydration of the sugar and higher pressure is required to pass the dehydrated blood to traverse the same route and be able to oxygenate organs at the same rate as hydrated blood cells. Think of a water hose when suddenly the pressure drops (unfortunately we cannot replicate reduced water molecule size the same way dehydrated cells become smaller). You instinctively squeeze the hose end to increase pressure so the water can continue to reach to the same distance. You have just given a hypertension to your water hose!

Note that if sodium (page 3 in same book) falls below 135 mmol/L, it is an electrolyte abnormality whose symptoms include “nausea, vomiting, confusion, lethargy, and disorientation”; if Na+ falls below 120 mmol/L it is a life threatening emergency that may cause “seizures, central herniation, coma, or death.” Not having enough salt (sodium) in the body is called hyponatremia and is “primarily a disorder of H2O homeostasis” meaning too much water and not enough salt. In common parlance, this is called water toxicity. Water toxicity can be caused by drinking too much water—e.g. drinking only water.

Interestingly, in the same book under the section of hypertension (page 834-835), the causes of hypertension are listed. Increased salt (or sodium) is not mentioned at all, but glucose intolerance is. However, under treatment, on page 836, it recommends lifestyle modifications that include lowering salt intake. So increased salt did not cause hypertension but lowering will cure it? I do not understand. Do you? Seems the authors of even this highly respected medical reference book could not escape the fallacy of the low salt campaign. Hypertension is clearly listed to be caused by sugar under the causes. So for heaven’s sake, if something is caused by sugar, treat it with removing sugar from our diet and not salt.

Confusion in the Ranks

In recent years a major fight started between the academic groups, not-for-profit organizations, and the government. Test after test shows that earlier hypotheses were all wrong about salt. Not only is added salt not hurting us, reduced salt does. Even the American Heart Association (AHA) and other heart organizations are in complete confusion. Next to the article of “lower your salt for health” are articles saying “that is all wrong and increase your salt.” I find this kind of funny. Here is an article from the AHA suggesting to increase salt. Here is another from the HealthAffairs organization; one from the American Journal of Hypertension, one from the Journal of the Association of American Medical Colleges, and there are now dozens more proving that indeed, reduced salt is actually bad for you.

How Bad is Reduced Salt on Health?

This particular article is my favorite because it shows how bad reduced salt diets really are on the heart. In detail, for a healthy individual reduced salt diet reduces BP by 1% (that means your systolic BP of 120 just dropped to oh my 118.5!!! gasp) and in patients with hypertension it reduced their BP by 3.5% (that is if it is say 160 systolic, which is high, it is reduced by a whopping 5.6 to 154.4! gasp again) but at the same time triglycerides, which contains the accurate measure of the sticky type of bad cholesterol in the LDL increased by 7% in people with hypertension (triglyceride should be less than 149). So if an individual with hypertension and triglyceride levels at 150 went on a low salt diet, that low salt diet would increase their triglycerides by 10.5 to 160.5, which is a significant jump for bad cholesterol. In a healthy individuals, the triglycerides jumped by 2.5%. Armed with such details, do you still believe that salt is bad for you?

Which Would You Rather Eat?

If I handed you 2 teaspoons: one was full of table sugar and the other full of table salt, which would you chose? For taste, we all would choose the sugar. What happens to our salt levels when we eat sugar? Refer back to the Harrison’s Medical Manual I mentioned earlier: eating glucose drops salt in our body because it sucks up all water and dehydrates. Eating a teaspoon of sugar will effectively dehydrate you and put you at risk of hyponatremia. By contrast, what will happen if you chose the teaspoon of salt? You will be thirsty, drink a couple of glasses of water and will feel like you are on top of the world.

My Recommendation

Stop being scared of salt and start being scared of sugar!

Sources

Longo et al., Harrison’s Manual of Medicine; 18th Edition, 2013; McGraw Hill Medicine

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More people than ever are reading Hormones Matter, a testament to the need for independent voices in health and medicine. We are not funded and accept limited advertising. Unlike many health sites, we don’t force you to purchase a subscription. We believe health information should be open to all. If you read Hormones Matter, like it, please help support it. Contribute now.

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This article was first published on June 13, 2015.

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A Rant About Diet and Responsibility

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The American diet is atrocious and largely responsible for the growing epidemics of diabetes, cardiovascular disease, and obesity, not just in America, but worldwide. The highly processed, high calorie, high fructose corn syrup and hydrogenated fat, and high chemical additive products that line grocery stores are products of American ingenuity; products that we have exported internationally, and sadly, products that are responsible for the declining metabolic health worldwide. This is a fact that many of us are reticent to accept. We are poisoning ourselves and everyone else around us by the products we make and consume.

A recent study found that fully 80% of metabolic disease can be attributed to lifestyle, e.g. poor diet and a lack exercise. Eighty percent. That is a staggering finding especially when one considers that 476 million people worldwide have diabetes, most of them Type 2 (T2). This represents a 129% increase since 1990, when the number stood 211.2 million. During the same time frame, the rates of cardiovascular disease have increased from 271 million to 523 million. Underlying a significant percentage of these conditions is the obesity epidemic, with 13% of the world’s population considered obese and 39% considered overweight and heading towards obesity.

In the US, the situation is quite dire, only 12-20% of the population, depending upon the criteria utilized, are considered metabolically healthy. Clearly, our approach to metabolic health is not working and yet, much of the focus in health research remains centered on either identifying that one medication or combination of medications that resolve all of our bad choices or an overly simplistic approach to health represented by balancing the calories in/calories out equation. As evidenced by the exploding numbers of metabolic disease, neither of these perspectives seems particularly useful.

While both personal choice and calories play a role in these epidemics, the problem is much broader. The food ecosystem has been decimated and in its place, we have non-nutritive chemical-toxicant food-like products that were designed to be highly addictive. When consumed, these products fundamentally change the metabolism of the individual who consumes them, and not for the better. Every bite of a chemically processed food is one step closer to metabolic disease. Beyond that however, the choice to allow industry to create, utilize, and ultimately dump these chemicals into food, other products, and into the environment, rests on us as well. Those are choices too; choices that affect the metabolic health of communities, and more broadly, the world.

We tend to think of industry and the pollution they create as amorphous, self-propelling and promoting agents of doom, forgetting of course, that each and every one of these organizations is made of people; people like you and me who make decisions to produce and promote these chemical poisons; people who choose to put poisons in foods under the auspices of the pathetically weak and ineffective GRAS guidelines. People make these choices. We do not get forever chemicals that fundamentally disrupt all aspects of metabolism without people who chose to create them, others who chose to use them in common products (and deny any and all risk), and all of us who relish in the novelty of these products. We do not get 80,000 synthetic chemical entities currently on the market without people putting them there. We do not get 1.8 billion pounds of glyphosate used every year, enough for every person on the planet to consume 4lbs annually without people that made choices to produce, use, and not regulate this chemical. We are the problem. We made these choices. We are the ones who are destroying our health and the health of others by the choices we make.

So when we look at the skyrocketing numbers of diabetes, cardiovascular disease, and obesity, it is not enough to say ‘eat better and eat less’. We need to clean house, top to bottom. We need to stop producing the garbage food that pollutes our bodies and the environment. We need to take responsibility for all of the choices that lead us to the point where only 12-20% of the population can be considered metabolically healthy.

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More people than ever are reading Hormones Matter, a testament to the need for independent voices in health and medicine. We are not funded and accept limited advertising. Unlike many health sites, we don’t force you to purchase a subscription. We believe health information should be open to all. If you read Hormones Matter, like it, please help support it. Contribute now.

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Nutrigenomics, Diet and Human Health

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Perhaps for the first time in human history our children face a decline in life expectancy compared to previous generations. Much of the research suggests the increase in obesity and the co-morbid chronic health issues such as diabetes, heart disease, liver disease, and cancers are to blame. Pointing the finger at the modern diet is easy. A surface level examination suggests modern man eats little more than processed foods that are high in carbohydrates but not much else. Here caloric intake is high while nutrient intake is low. Presumably, flipping the ratio of calorie to nutrient would improve health outcomes tremendously. And in many cases it does, but for many other individuals obesity and the associated health problems persist. How is that possible?

Diminishing Biodiversity in the Modern Diet

The composition of one’s diet influences health radically. It is well known, though often ignored, that dietary nutrients provide the building blocks for cell functioning and survival in every tissue of the body. Without those nutrients a myriad of health problems arise. What we eat plays a huge role in human health. What we eat has changed radically in recent decades. Beyond simply evolving from hunter-gatherer type diets to more processed and carbohydrate dense diets, the biodiversity of the plants and animals we eat has diminished dramatically as well. Indeed, 70% of the world’s diet comes from only 15 crops (sugarcane, maize, wheat, rice, potatoes, sugar beet, soybeans, cassava, palm kernel, barley, sweet potatoes, tomatoes, watermelons, bananas, brassicas). That alone should give one pause, but when one considers that these crops have been domesticated significantly with much of the genetic diversity among the different types of plants bred out, we can begin to see how limited the modern diet really is.

Some research suggests that in only a  few generations, modern farming has cultivated out 95% of the genetic variation among staple crops. Sit with that for a while. We’ve cultivated out 95% of the genetic variation from the plant based foods we eat – genetic variation that took many millennia to evolve. With 95% of the over 200,000 plant metabolites that provide nutritional sustenance critical for human health (and animal health) removed from the food chain, human health is facing a serious crisis that will require more than just a return to fruits and vegetables. We need a wholesale change in modern agriculture.

Diet-Disease Relationships: Nutrigenomics and the Evolving Microbiome

What happens when the foods we eat have limited genetic diversity? We lose critical dietary nutrients and disease develops – a boon for the supplement industry, a bust for human health. From an evolutionary standpoint, shifts in human diet evoke changes in metabolic capacities emanating from gastrointestinal microbiota. Evolutionarily, the microbiome has evolved for optimal absorption and metabolism of essential nutrients. As diet has changed, gut microbiota have changed too. As the genetic variation in food sources declines (and as we increasingly overuse antibiotics and other medicines) parallel declines in microbiome diversity have been observed leading many to suggest a connection between gut health and overall health. What can we do?

Obesity and Illness Persist Despite Dietary Changes

When obesity and chronic illness persist despite dietary changes that include increased plant based foods, consider the possibility that those foods have been nutrient depleted through commercial farming practices. And while eating plant based whole foods is certainly better than eating highly processed carbohydrate dense foods, that may not be enough to restore gut microbiota and health. It is likely that we have to return to eating an organic, heirloom diet, that is highly diverse, more genetically variable and nutrient dense. It may also be necessary to include nutrient supplements when dietary diversity is not possible.

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More people than ever are reading Hormones Matter, a testament to the need for independent voices in health and medicine. We are not funded and accept limited advertising. Unlike many health sites, we don’t force you to purchase a subscription. We believe health information should be open to all. If you read Hormones Matter, like it, please help support it. Contribute now.

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Glyphosate Induced Obesity?

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Are you struggling with your weight? Are you eating well and exercising but still not losing weight? Well then, it might be time to consider what’s on or in what you are eating or what you are eating eats. Sound complicated? It’s not. An emerging body of evidence shows a strong link between eating foods sprayed with commercial herbicides and eating meats raised on commercial feedlots (that are born and bred on a cocktail of chemicals) and obesity.

After years of eating highly processed and chemically laden fruits, vegetables and meats, the bacteria in our guts shift radically towards a species that emit what are called endotoxins. These endotoxin releasing bacteria induce inflammation, which then shifts a series biochemical pathways that favor fat storage as a protective and compensatory reaction to the steady state of chemicals coming from our diet and the lack of nutrients contained within these foods. Indeed, what we now call autoimmune reactions, the continued elevation in inflammation and antibodies, may be a result of the food we eat (and the other pharmacological and environmental chemical exposures). It turns out, that the constant state of inflammation many of us find ourselves in is the body’s way of trying to clear those toxins.

With obesity in particular, there have been several interesting studies published over the last couple years providing clear links between chemical exposures and fat storage. Whether the body stores fat or uses fat depends upon the balance of good and bad bacteria in the gut and that balance is predicated heavily upon nutrient availability and toxic exposures. High calorie, low nutrient, chemically dosed foods, shift bacterial communities that increase fat storage and inflammation. Not only that, but since gut bacteria metabolize dietary vitamins and even synthesize vitamins from scratch on their own, the high fat, low nutrient, chemically laden diet downregulates the vitamin producing bacteria, in favor of the more pathogenic and opportunistic bacteria. This further depletes nutrient stores while enhancing inflammation. The cycle becomes very difficult to end, as anyone struggling to lose weight knows all too well. There is hope, however. New research from disparate sources demonstrates how reducing the toxic load and increasing nutrient availability can re-calibrate fat usage and storage parameters.

Gut Bacteria and Obesity

Just a few years ago, researchers from Shanghai, China identified one of the gut bacterial over growths associated with obesity and published their results in a paper entitled: An opportunistic pathogen isolated from the gut of an obese human causes obesity in germfree mice. Called enterobacter clocae, the endotoxin producing bacteria was found overpopulated in the gut of a severely obese patient who was also insulin resistant, hypertensive and suffered from the array of obesity related health issues. The enterobacter clocae pathogens made up 35% of the total bacterial content in this patient’s gut; a huge bacterial load. Knowing that enterobacter emitted endotoxins and that endotoxins were associated with inflammation and insulin dysregulation, the researchers speculated that a reduction in the enterobacter population would correspond with a reduction in weight and the other health issues. They were correct. With a special diet and traditional Chinese herbs, weight loss and health parameters changed along with the reduction in toxic load. After 9 weeks, enterobacter represented only 1.7% of the total gut bacteria and at 23 weeks, .32%. The total weight loss during that period was 50kg or 110lbs.

Could something as simple as reducing the opportunistic enterobacter via diet be the solution to obesity? To answer this question, the researchers went back to lab and designed an experiment to test the hypothesis, only they did it in the reverse. They asked if enterobacter was a causative factor in obesity, could they induce obesity in mice bred specifically to resist excessive weight gain simply by increasing the bacterial load?

From the fecal matter of the obese patient, the researchers isolated the particular strain of enterobacter clocae called B29. They took the B29 and inoculated four groups of seven, germ-free mice; B29 inoculated plus normal diet or high fat diet and non-inoculated normal or high fat diet. Germ-free mice are a strain of mice that are microorganisms free and raised in isolates. They are resistant to obesity even when fed a high fat diet.

One mouse from each of the inoculated groups died immediately after the inoculation indicating the toxic nature of this bacteria. Remember, this strain of bacteria represented 35% of the original patient’s gut bacteria, likely acquired gradually over the course of lifetime. During the first week, all of the inoculated mice lost weight, again indicating the mounting immune response. Anorexia, is often a sign of illness as the body reallocates resources towards fighting an infection.

Subsequently, and after the immediate anorexic responses, both groups of inoculated mice gained excessive weight, whereas the non-inoculated mice did not. The inoculated plus high fat diet group not only gained significantly more weight but expressed higher levels of enterobacter inflammatory markers and insulin resistance showing an interaction between diet and bacterial growth. The researchers speculate that the high fat diet facilitates the transfer of this bacteria to the bloodstream and increases the systemic inflammatory reaction. The inflammation then shifts the body towards fat storage via a range biochemical cascades meant to fight the infection but that also induces other reactions along the way; reactions we consider hallmarks of metabolic disease including high cholesterol, insulin resistance, liver damage, decreased adiponectin (satiety hormone – low adiponection means one is always hungry) and even increased amyloid A proteins associated with Alzheimer’s. This study, albeit small and in need of replication, shows us that when the balance of good to bad bacteria shifts, obesity is induced. It doesn’t tell us, however, how environmental chemicals in and on food impact this bacterial shift. For that we have to go to a couple other reports.

Nutritional Perils of the Western Diet

The Western diet has become a synonymous with highly processed foods that barely resemble actual food in nutrient and DNA composition. Indeed, in our efforts to produce the largest and prettiest produce, we’ve cultivated out 95% of the genetic variation from food crops; reducing to almost nothing the ~200,000 plant metabolites that provide nutrition. To make matters worse, we have substituted nutritionally rich and diverse crops with ones that originate from plant seeds engineered with bacterial RNA and DNA and are laced with glyphosate, adjuvants and other chemicals. In addition, all commercial meat production relies heavily on genetically modified, glyphosate-doused feed to grow the cattle, combined with prophylactic antibiotics, growth hormones and a cocktail of other chemicals that compensate for the deplorable conditions under which Western foods are produced. The genetically modified, chemically laden food stuffs are then sold to the consumer as fruits, vegetables, meats and dairy or processed even further into other food-like products. From beginning to end of the food chain are exposures to chemicals and foreign bacterial DNA that our bodies cannot accommodate and that provide only limited nutrients.

So, in addition to the direct exposure to chemical toxicants, conventionally grown Western foodstuffs also impair health by reducing vital nutrient content required for even the most basic cell functioning. By disrupting the balance between good gut bacteria and bad or pathogenic bacteria conventionally grown further disrupts nutrient availability while increasing inflammation and the cascade of ill-health is set in motion.

Metabolic Starvation in the Face of Obesity

As we’ve covered previously, every cell in the body requires energy to exist and function. That energy comes in the form of mitochondrial adenosine triphosphate or (ATP). The production of ATP requires nutrients as co-factors and for enzyme functioning. Many of these nutrients come from diet and others are produced de novo or from scratch by the bacteria in our gut. Glyphosate grown foods attack both. Glyphosate reduces the nutrient availability of foodstuffs, even in the less processed, presumed healthy fruits and vegetables, while simultaneously killing the good bacteria in our guts. Glyphosate is a potent bactericide that in a perverse twist of design preferentially targets the beneficial bacteria while leaving untouched the opportunistic and pathogenic bacteria, like enterobacter clocae. So while eating a healthy diet might lead to weight loss and improved health outcomes under normal circumstances, when that diet consists of conventionally grown foods, with genetically engineered seeds capable of withstanding the toxic insults of glyphosate and its adjuvants, neither the diet nor the disrupted intestinal flora can produce the nutrients required to enable healthy cellular metabolism. The GM-glyphosate combo induces a state of metabolic starvation and through a number of survival pathways and shifts towards fat storage rather than fat loss as a secondary source of energy.

Critical to this entire equation is the fact that the bactericidal properties of glyphosate disrupt normal gut microflora.  Glyphosate directly shifts the balance of power away from the healthy, vitamin and mineral factories that feed the body’s enzymes and mitochondria, towards more pathogenic bacteria that are resistant to glyphosate and may even feed on it, further evoking metabolic starvation. As the bacterial balance continues to shift, disease appears and inflammation ensues. Those diseases are then treated pharmacologically with drugs that also disrupt gut bacteria, deplete nutrient stores and damage mitochondria. The cascade of ill-health becomes more and more difficult to end using traditional approaches. Moreover, where and how disease appears is as much based upon individual predispositions as it is on nutrition and other exposures, making the complexity of modern illness something modern medicine is not accustomed too. In other words, these diseases do not fit neatly into the one disease, one medication model, and thus, very rarely respond favorably to treatment.

To Lose Weight, Feed the Body What it Needs: Nutrients.

Despite the complexity of the interactions that come together and create the chronic health issues we face today, there is one variable that can be controlled that will mitigate obesity and ill-health directly: eating, or more specifically, what is eaten. The simple act of cleaning up one’s diet, of moving away from processed foods and away from conventionally grown foods towards organics, can have a tremendous effect on reducing the body’s toxic load and subsequent inflammation, weight gain, and disease. Similarly, replacing needed micronutrients so that bacterial and mitochondrial functioning can come back online and switch from fat storage to fat/energy burning will be critical. This will take time, however, and the transition towards health may be slow. Obesity and ill-health did not emerge overnight and they will not disappear overnight. Finally, we have to recognize that there is no one-size-fits-all, silver bullet, diet vitamin or diet pill. Each of us adapts to chemical exposures and the lack of nutrition individually and uniquely. So each of us requires a different cocktail of nutrients to move forward. Which nutrients and at what doses should be determined individually and may involve some degree of trial and error. As the Western diet is devoid of critical vitamins, minerals and amino acids, it is likely many individuals are suffering from broad based deficiencies. It is also likely, that restoring what has been absent chronically will go a long way towards health and healing, regardless of one’s particular health issues. So if you are struggling with obesity and other health issues, feed your body what it needs to function – nutrients.

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More people than ever are reading Hormones Matter, a testament to the need for independent voices in health and medicine. We are not funded and accept limited advertising. Unlike many health sites, we don’t force you to purchase a subscription. We believe health information should be open to all. If you read Hormones Matter, like it, please help support it. Contribute now.

Yes, I would like to support Hormones Matter. 

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This post was published originally on Hormones Matter on July 28, 2014. 

 

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Weight Loss Versus Healthy Living

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If you’ve ever glanced at yourself in a reflection and thought, “I can stand to lose a few pounds,” you are in the company of many people around the world who spend a substantial amount of time and effort to shed the fat. Also, you may share the disappointment of those who lost, but did not maintain the desired weight loss.

In 2014, I faced such a dilemma that resulted in several diagnoses attributed to weight- related chronic metabolic dysfunction. Obesity and metabolic conditions have become so commonplace that rationalizations and public acceptance of taking maintenance prescriptions have become rites of passage in adulthood. Conventional doctors with less than 10 minutes of face-to-face time, offer cryptic instructions to drop the weight and then prescribe the medications advertised on television during the big game or the latest TV drama. Many of us do not question our primary physician’s wisdom and accept the prescription(s) without an exit strategy to correct the decline of health.  As a result, we remain attached to a synthetic substance that exchanges the suppression of one symptom with the initiation of a new one.  How do we begin to right this slippery slope of inevitability?

Is Weight Loss the Solution?

The great minds of health and fitness have spoken!  The cure for weight related diseases is calorie restriction coupled with calorie expenditure – weight loss.  The weight loss industry is a $60-billion-dollar cash cow. Prior to the 1950s, there weren’t any health clubs to be found. In modern day American cities, you cannot drive 10 miles in any direction without running into a health club franchise. Weight loss programs are well represented on television commercials and fat loss over-the-counter supplementation remedies can be found in any drug store chain across the country. Despite the weight-loss landscape of proposed opportunities of success, more than two – thirds (68.8 percent) of adults are considered to be overweight or obese. The estimated annual medical cost of obesity in the US was $147 billion in 2008. Somehow, the cure doesn’t appear to lessen the trend of obesity and the growing numbers of weight related chronic conditions.

Weight Loss Equals Energy Reduction + Energy Expenditure, Or Does It?

The concept of weight loss by conventional wisdom is essentially, Eat Less and Exercise More. As a middle aged overweight American, I spent many days feeling quite hungry while eating the Standard American Diet (SAD) that included the occasional drive thru run for breakfast, lunch and/or dinner. In my daily life, there wasn’t much movement outside of walking from my home to my vehicle to go to work and vice versa. Perhaps, these experts had a point. The problems that can materialize from this approach is the driving purpose of losing weight by all means necessary with a limited understanding of long term health and sustainability. There is also a perception from the layman standpoint that weight loss automatically equates to good health. Most weight loss programs call for reducing a person’s daily caloric intake from 3,000 – 4,000 calories daily to 1,200 – 1,500 calories along with an increase in daily activity.  If it were only that easy, we’d all be thin and healthy.

Very few people find weight loss success with this method and often end up gaining the original weight back and more (keeping the weight loss industry happy). Why would this happen? Adipose tissue (visceral fat) is an endocrine organ that excretes hormones (leptin) to regulate satiety. It also slows metabolism and increases inflammation in the body in order to create homeostasis by extending hunger to gain the fat back to its previous state.

When insulin is high, brown fat begins to mimic white (visceral) fat to halt the thermogenic response of using energy (food) and begin fat storage. Was this approach supposed to be permanent? Did this approach correct the opiate receptors and dopamine response to the sugar and reset taste receptors that are hardwired from natural selection to be predisposed to quick energy in the form of sweets? Does the dietary intake sustain the weight loss if activity wanes because of injury or illness? Were the nutrient deficiencies on the SAD Diet corrected or did the new dietary intake create new deficiencies? Was the hit to hormone production previously corrected and can hunger and satiety be trusted now? Lastly, was this dietary/exercise solution adopted as a lifestyle change or a plug-in to an imbalanced way of living? Typically the answer to these questions is no, and that is why this approach fails. We cannot diet our way out of a lifetime of bad habits – habits that have negatively altered our chemistry. We have to correct the chemistry.

But Wait, Can’t I Just Detox?

The new trendy “ace in the hole” to sustain such an unsustainable “fix it” dietary change is called DETOX.  Fall off the wagon as many times as you like, just plug in a device designed to flush the gut with nutrients to circumvent the pizza binge or sugar attack as a result of derailing.  Detox programs can tend to be vegetable or fruit based or both to reset/replenish the body with all the essentials to get one back on track. Interestingly enough, one has to consider that the dietary change and the detox individually are presented as high in nutrition but cannot be sustained long term individually or collectively to reach and maintain the desired weight. The rub is that the health, fitness and diet industry do not own these failures to meet and exceed customer benchmarks. The fallout and blame is often times put on the “will power” of the individual.

Weight Loss and Management are More than Calories In, Calories Out

Looking into the concept of weight management, the term in of itself provides a connotation of an ongoing process. Weight management incorporates an integrative approach that does not begin and end with what you put into your mouth or the intensity in which you move. There are vital aspects of life that directly and indirectly affect weight such as:

  • sleep quality
  • adherence to circadian rhythms
  • stress/anxiety management (reduction of sympathetic system responses to only acute life or death situations)
  • emotion management
  • physical activity (all throughout the day and not only with a designated workout period)
  • prioritization of personal and professional time
  • spiritual connectivity /connectivity with the world around you
  • financial designations (putting financial matters into perspective with proper balance)
  • personal development (neuroplasticity – creating new neuro pathways built for new knowledge, experience and challenges keeps the brain vibrant and young)
  • nutritional balance (nourishment of the microbiome alleviating gut flora dysbiosis, cultivating cellular health, optimally functioning mitochondria for ATP production/recycling, adherence to common nutrient deficiencies and overall wellness

Ultimately, the long-term solution is a culture/lifestyle change. What does that mean and how does that differ from the current offerings? When times are tough and difficulties in life occur, resorting to the behavior that contributes to poor health is not advantageous. Those who live within a given culture or lifestyle do not simply follow principles or rules, they actually embody the culture and the lifestyle –which is their identity. When times are difficult, there isn’t any other way to live or to revert. Weight management provides the framework to give your life back and offer a long, active life with weight loss as a consequence of clean living. In that regard, clean living and total health should be both the beginning and endpoints of healthy living. Live healthy and embrace body composition over an arbitrary number on a scale.

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This article was published originally in April 2017. 

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Popping the Obesity Balloon

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It is well known that obesity in the United States is in epidemic proportions. It is also well known that it presents a risk for metabolic disease, the most common being diabetes. Books have been written about various diets and appetite curbing pills are legion. It is, of course, obvious that the type of diet consumed by so many people is responsible. What has not been understood is the exact mechanism.

Obesity and the Brain

Fat is stored in cells called adipocytes (from Latin adep, fat) these cells are capable of producing a hormone called leptin. This circulates in the blood until it comes to the part of the brain known as the hypothalamus. The message that leptin delivers to this organ tells it that the fat stores in the body are full and food intake should be curtailed. It is an important mechanism of appetite control. It is not generally appreciated that it is the brain, not the stomach, that is responsible for the sensations of hunger and satiety, thus controlling appetite.

As usual in basic science research, leptin was discovered in mice. By injecting it into fat mice that were made to be leptin deficient experimentally, appetite control resulted in reduction in body weight to normal proportions. It was concluded that this would be the obvious treatment for obese humans. Clinical trials with leptin treatment in obese humans failed to make any difference. It was then found that these humans already had plenty of circulating leptin but the hypothalamus was insensitive to its message. Adipocytes were doing their part but the hypothalamus was unresponsive. The question then was why the hypothalamus was insensitive and not responding to this important mechanism. The next phase of research was published in a scientific journal called Cell. This is read only by a group of scientists that are studying the properties of the cells that make up the body. It will be a long time before this research reaches clinicians and it also has the disadvantage of having been performed in mice. The message is so transparent, I undertook to report it here because we can use it now.

Of Mice and Men

When mice were fed on a high-fat diet, a mechanism was found in the hypothalamus. A “master switch” that controls inflammation in the body was turned on. This switch normally remains inactive throughout life in healthy animals. However, with it turned on, the mice gained weight and became resistant to insulin and leptin. By using genetic engineering, the researchers were able to turn off the master switch and they were then protected from becoming obese, even on a high-fat diet. It has been known for a long time that obese people develop inflammatory disease. The mechanisms involved are extremely complex but the simple message is one that is timeless “don’t overeat, particularly high calorie junk foods”. It has also been long known that calorie restriction in experimental animals is the only way to extend their longevity. Hungry animals fed this way not only live longer than those fed with enough food to give satiety, they also remain much more active into old age. We are obviously not required to remain permanently hungry, only to reach satiety with the right food. It is therefore not surprising that “junk food” eaters are always hungry.

Diet Basics: Eat Real Food

If this research is true for humans, it may be that it is actually a protective factor as long as we obey the rules of diet that have been with us for thousands of years. It is only recently that we drive a two ton machine to a store to buy food in a variety of boxes packaged by a food industry that depends entirely on their products being purchased. We would not require anti-inflammatory drugs or even a special diet. All we would need is self discipline and a full recognition that the only food we should ingest is the natural food that I used to tell all my patients is “made by God”. The high calorie man-made foods, many of which are simple carbohydrates, should be rejected completely. This is, of course, advice that is bound to be ignored by the majority because our sense of sweet taste that provides so much pleasure is perceived by our brains. Also, natural food is expensive. Taste buds on the tongue send a sensory input signal to the brain where it is interpreted. Reducing it to first principles, so much of our diet is hedonistic. As the old saying goes, we live to eat rather than eating to live.

Sugar on the Brain

Sugar extracted from its natural source is more of a drug than a food. This is because censors on the tongue send an input message to the brain where the sensation of sweet taste is perceived and interpreted. I remember that several physicians wrote letters to medical journals to state that the sweetener, aspartame, was responsible for a number of symptoms in their patients identical to those induced by sugar, including migraine headaches. The manufacturers responded by performing a study in which aspartame was given to experimental subjects in the form of capsules that they swallowed, thus bypassing the sweet taste mechanism. The study showed that there was no evidence for migraine or any other symptoms as a result of administration of this chemical sweetener by this method, suggesting that its effects are produced by the sensory input from tongue to brain. I am personally highly sensitive to sugar. The ingestion of one cookie gives me whole-night insomnia. Since I am not unique, I wonder how many people are taking sleeping pills because of chronic insomnia induced by their innocent consumption of sugar.

Artificial Sweeteners: Chemical Cocktails

Aspartame breaks down in the body to formaldehyde (used to pickle bodies), formic acid (used by bees to sting) and wood alcohol (that makes people go blind). Irrespective of the chemical content of artificial sweeteners, however, they are no substitute for sugar since they are likely to do the same thing. The only escape is to break the sweet taste craving by “cold turkey” withdrawal. I have seen many people get well by doing this. Sometimes it only takes a very small intake of sweet taste to cause relapse and reappearance of the previous symptoms. To back up my conclusion that this is a drug effect, I have seen many people that cannot resist sugar, even though they know perfectly well that they will suffer for it. In fact, animal studies have shown that sugar is more addictive than cocaine.

Doctors and Self-Discipline

Doctors therefore have the responsibility to educate patients about how their God-given health can be maintained. We know now that our genes are drastically changed by poor diet and lifestyle and we therefore can produce diseases in ourselves. The choice is ours to make.

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The Misguided Battle Against Dietary Fat and Cholesterol

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I was at my medical provider the other day waiting for my turn for an MRI test. I shared the lobby with over 100 people. As I looked around, for the first time I noticed something odd. About 80% of the people in the lobby were overweight. I found a seat, the only seat. It was a single small seat. Most of the seats now are double sized to allow the obese to sit. I am claustrophobic and was concerned about this on my way to the MRI machine. The nurse gave me a wink and smile and we walked into the room. I was nailed to the floor. I have never seen anything like this though I have been in MRIs many times before.

I recall having been pushed into a narrow tube many times before where I could not lift a hand, usually dimly lit with some wind blowing in my face and a terribly loud echoing hammering as the image slices were taken. Yet here I was, glided silently into an MRI machine that was almost big enough for me to sit up in. “Ah the benefits of having obese people” I thought as I entered this brightly lit giant tube that was so wide that even the noise was reduced, lacking the echo we all are familiar with and hate. The radiologist told me that all MRI scanners are being replaced. As I was scanned for 45 minutes, I had no claustrophobia at all and not too much noise to block my thinking. The time gave me a chance to pause about the obesity epidemic: how did we get here? Why are entire new industries created to cater to our new weight rather than help us become healthy? Why are so many of us overweight to begin with? What has gone wrong?

Coincidentally, for unrelated reasons, I was already researching the nutritional recommendations of the USDA for the past several months; reading all of the books and academic research papers available to me. The USDA recommendations sparked my interest because I run a migraine group full of glucose intolerant migraineurs. I merely wanted an answer to why migraineurs (like me) are glucose intolerant, when I came across the huge nutritional boxing ring with major academic fights in this arena. The real science was hid, even by the NIH, unpublished.

The obesity epidemic starts with the theory of Ancel Keys who in the mid 20th Century US decided that coronary heart disease (CHD) was the most important thing to focus on (Eisenhower just had a heart attack). He found support for his hypothesis that high cholesterol is caused by high dietary fat—in particular saturated animal fats—and those with high cholesterol will most certainly have CHD, will flip and die very soon. His findings were dubious at best, but still garnered support (Ancel Keys – Seven Countries Study)

Researchers all over the world presented conflicting evidence but they were not only not able to publish these data in reputable academic journals, they were ostracized for even trying. Eventually so many scientists lost their reputation as a result of trying to fight Keys’ hypothesis that many left academia or changed fields of research and gave up (1-3).

Nina Teicholz spent eight years digging up files never published and hidden in the archives of the NIH (3). The reason for not publishing? The findings did not support Keys’ theories. It was assumed that the results had to have been wrong and therefore could not be published. In scientific research the role of science is to try to refute the theory by proving it wrong. In the case of Keys’ theory, the law of science changed: a theory was accepted as truth and no one could publish anything unless they found supporting evidence to THAT theory. Thus, science moved backwards and has effectively stalled for decades where cholesterol and fat are concerned.

When nutrition research began in the early 20th Century, we did not have the all of the tools available that we have today. Today we know that cholesterol is not made from fat at all but from Acetyl CoA and Acetoacetyl CoA (source). So if cholesterol is not made from fat, what is the connection of eating saturated fat to CHD? Nothing actually—today we know but shhhhh… this still cannot be said loud!

Cholesterol Is Made from Acetyl CoA and Acetoacetyl CoA, Not Fat

Cholesterol is made from two molecules in a total of about 39 hard steps by our liver (or we can eat it like egg yolks). Would our body go through such hard work of creating something if it ended up causing our death? It is not even plausible that human evolution would have supported such counter mechanism.

A Primer on Metabolism

Acetyl CoA is

“an important biochemical molecule in cellular respiration. It is produced in the second step of aerobic respiration after glycolysis [the breakdown of glucose (think carbohydrates) by enzymes, releasing energy and pyruvic acid] and carries the carbon atoms of the acetyl group to the TCA cycle [Krebs cycle which is a chemical reaction used by all aerobic organisms] to be oxidized for energy production” (source)

and Acetoacetyl CoA is

“intermediate in the oxidation of fatty acids [fats] and in the formation of ketone bodies [fat burning energy bodies]” (source).

Note that neither is a fat but they together form fat (cholesterol) by oxidation. Cholesterol is a lipid (a naturally occurring molecule like fats, waxes, steroids, fat-soluble vitamins like vitamins A, D, E, and K, and also triglycerides). Triglycerides are ester derived from glycerol and three fatty acids – body fat, phospholipids (a major component of all cell membranes), and many other types of lipids. The main biological functions of lipids (such as cholesterol) are storing energy, signaling, and acting as structural components of cell membranes.

It is not the matter of eating fat and oops we now have cholesterol; rather it is a matter of “we must have cholesterol to survive.”

Where do these elements come from in the body to create cholesterol?

As noted above: carbohydrates (glucose is a carbohydrate) and an element that is an intermediate step in oxidizing fatty acid combined create cholesterol, which “then enters the citric acid cycle in the mitochondria…” (source) Note the key word here: carbohydrates. This is important because the “health-heart” movement of Ancel Keys’ “fat causes high cholesterol” is clearly not true if cholesterol is made from carbohydrates and not a fat. How did we end up thinking that cholesterol is made from fat? It certainly is fat but clearly is not made from fat.

Why do we need cholesterol?

Cholesterol is used by our mitochondria (not what we eat but what our mitochondria needs to create energy ATP). (source)

How much cholesterol is needed and what happens when we reduce cholesterol?

You would think that these questions were asked over the 80+ years but no reputable scientist dared asking. The moment such question was asked, the sticker “black sheep” went up the forehead so researchers just let it go. Thus we have no idea how much cholesterol we actually need. Everyone needs a different level: the thought that a 30-year old 7-foot-tall male Marathon runner needs the same cholesterol level as a little old lady, aged 95, in a wheelchair is just preposterous. Clearly each person needs a different level based on mitochondrial respiration intensity and frequency, which is age, gender, and activity related. A cookie-cutter approach just cannot work. What happens when we reduce cholesterol? As noted above, cholesterol stores energy, it is a signaling agent, and acts as structural components of cell membranes among other things. If we reduce cholesterol, we effectively reduce our body functions.

The Combustible Vegetable Oils

Since it was decided that fat creates cholesterol and thus saturated fats had to be removed from everyone’s diet, the research was about how to make vegetable oils, unsaturated or polyunsaturated, edible and digestible (the kind flies won’t eat in your garage). Hydrogenation could only produce dangerous fats, such as hydrogenated vegetable oils (trans fats) or partially hydrogenated vegetable oils, both of which were said to have randomly combusted in delivery trucks while being taken for cleaning and also while taken back to the restaurants after cleaning. Apparently the fumes vegetable oils create settle in the clothing (and the lungs of the chefs) and even after professional cleaning are still capable to burst into flame without any provocation (3). These vegetable oils have polyunsaturated fats that have the unfortunate “poly” (multiple) bonds. These bonds break easily, transforming fats into ugly sticky goo and free radicals. This goo replaces animal fats in human mitochondria, blocking the mitochondria from creating energy.

This makes a lot of sense: fats in vegetable oils are not the same chemical components as fats in animal bodies. There is a huge difference in how they work and to what they bond. Animal fats become energized by thermal heat referred to as internal combustion whereas vegetables use external energy (the sun) and in heat they disintegrate, oxidize, and become goo. They chemically change from being fats to something that cannot be used by the human body as fats (4). Olive oil does not combust but at higher temperatures oxidize, creating free radicals.

Fat provides a lot of energy, 9 Calories per gram as opposed to carbohydrates and proteins, each producing only 4 Calories per gram. This implies that by removing fat calories from our diet, a very large part of the daily calories needed to be made up by something other than fat. Since protein also contained fat (saturated fat in particular), the Food Pyramid and later “My Plate” both reduced the protein amount as well. Thus, what we were left with was increased carbohydrates in our diets. However, as noted above, carbohydrates are part of cholesterol creation. This has become a catch 22 that no one in the “heart-health” supporter group accepted or did not see or decided to ignore because it was too complex or decided to ignore because then they too would become black sheep.

The Catch 22

Perhaps most the most striking aspect of this misunderstanding, is that if we follow the steps, we inadvertently increase the very diseases that we would like to avoid. By increasing carbohydrate intake, we’re increasing cholesterol and inducing metabolic disorders.

reduce cholesterol ==> reduce fats ==> increase carbohydrates ==> increase cholesterol

So here we are today, 80+ years later. Today the Western Diet world has a nightmare of metabolic disorders to fight. Where do metabolic disorder lead to? CHD of course, the very thing Ancel Keys wanted to rid the society from. However, there is more to it than that.

Carbohydrates have some nasty properties—both simple and complex carbohydrates do:

  1. They are addictive; eight times more than cocaine or heroin (5, 6)
  2. Grains (complex carbohydrates we eat the most of) release morphine (7), another drug
  3. Carbohydrates spike insulin and create insulin resistance (8-10)
  4. Insulin in the blood makes us hungry
  5. The more carbohydrates we eat, the more insulin we release and the hungrier we get
  6. Insulin resistance turns into type 2 diabetes
  7. People with type 2 diabetes are at an increased risk of CHD
  8. Carbohydrates create triglycerides, the type of cholesterol that is know to cause CHD (11)

And so now not only are we back at trying to prevent CHD, where we started 80+ years ago, but we also have massive metabolic disorder epidemic and new diseases, such as cancer, that also appear to be connected to high carbohydrate consumption.

Yet, to this day, the nutrition guideline of the USDA for the American population, now called My Plate, does not even include dietary fat! I challenge you to find a baby food with more than 1% fat in it; babies are only eating carbohydrates.

Luckily there is a new movement toward a healthy diet that goes under a couple of different names: Low Carbohydrate High Fat (LCHF) or ketogenic diet. These types of diets are used now therapeutically for many health conditions; health conditions we could probably prevent if we simply added saturated animal fats back into our diet and dumped all that sugar and grain.

Sources

  1. Taubes G (2008) Good Calories, Bad Calories: Fats, Carbs, and the Controversial Science of Diet and Health (Anchor).
  2. Taubes G (2011) Why We Get Fat: And What to Do About It (Anchor) Reprint edition December 27, 2011 Ed p 288.
  3. Teicholz N (2015) The Big Fat Surprise: Why Butter, Meat and Cheese Belong in a Healthy Diet (Simon & Schuster; Reprint edition, New York) p 496.
  4. Browner WS, Westenhouse J, & Tice JA (1991) What if americans ate less fat?: A quantitative estimate of the effect on mortality. JAMA 265(24):3285-3291.
  5. Ahmed SH, Guillem K, & Vandaele Y (2013) Sugar addiction: pushing the drug-sugar analogy to the limit. Current Opinion in Clinical Nutrition & Metabolic Care 16(4):434-439.
  6. Lenoir M, Serre F, Cantin L, & Ahmed SH (2007) Intense Sweetness Surpasses Cocaine Reward. PLoS ONE 2(8):e698.
  7. Perlmutter D & Loberg K (2014) Grain Brain: The Surprising Truth About Wheat, Carbs, and Sugar – Your Brain’s Silent Killers (Hodder & Stoughton).
  8. DiNicolantonio JJ & Lucan SC (2014) The wrong white crystals: not salt but sugar as aetiological in hypertension and cardiometabolic disease. Open Heart 1(1):e000167.
  9. Schaefer EJ, Gleason JA, & Dansinger ML (2009) Dietary Fructose and Glucose Differentially Affect Lipid and Glucose Homeostasis. The Journal of Nutrition 139(6):1257S-1262S.
  10. Stanhope KL (2015) Sugar consumption, metabolic disease and obesity: The state of the controversy. Critical Reviews in Clinical Laboratory Sciences:1-16.
  11. Gandotra P & Miller M (2008) The role of triglycerides in cardiovascular risk. Current Cardiology Reports 10(6):505-511.

Graphic credit: You shall be obese (picture ©Angela A. Stanton, Ph.D.)

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