Carbohydrate is the main killer in the average Western diet, not fat. Eskimos and other aboriginal people with very high fat levels in their diet do not suffer degenerative artery disease in the way we do in the civilized world. However misinformation and ignorance abounds. Whatever science you read extolling the supposed benefits of carbohydrates, this will always refer to complex carbohydrates (meaning whole grains). This also overlooks the fact that many people are intolerant to grains. Despite all the propaganda, even whole grains are not “natural” foods at all. Man evolved as a hunter gatherer and grains have only been in our diet for the last 10,000 years or so. Many people cannot digest grains but get unpleasant reactions.
Ironically, refined carbohydrates are better tolerated than whole grains by these individuals. But make no mistake, white flour, white sugar, corn syrup, white potato and other starch-rich foods are bad for you and will shorten your life. Yet these are the ingredients commonly used by the food manufacturing industry: bread, cakes, biscuits, pasta, pastries and other confectionary items, french fries, food thickeners, coffee whiteners, white rice and skimmed milk (milk with the fat reduced has proportionately more sugar!) – these are all stressful to your metabolism. Sooner or later the control mechanism which regulates the flood of such carbohydrates into your body will break down and serious, life-threatening consequences will result.
The four main resulting dangers are:
- Insulin resistance or hyperinsulinism
- Syndrome X or metabolic syndrome
The last three items are really 3 progressive stages of the same condition but all four are closely interwoven, as we shall see.
Obesity remains close to the top of conditions which will shorten your life. Insurance actuaries are very clear on how the percentage risk of death rises with every pound overweight; they are very exact about calculating the value of human life and the likelihood of an expensive payout. Pay attention to this cynicism!
Refined carbohydrates make you gain weight inexorably. Most people find losing weight easy when avoiding carbohydrate, without starving themselves or feeling hungry. This diet theme has been in circulation for over a century, from the original paper by William Banting, through the RAF diet, Scarsdale diet and various other incarnations. Atkins has been probably the most famous and successful low carbo plan of all time; the acclaim is simple – it works, despite everything the critics throw at it. Now the late Doctor Atkins has spawned a whole rash of “me too” plans, such as the South Beach Diet.
Low carbo eating is gentler and more successful than low calorie plans. World class health author Leslie Kenton has recently reworked the theme yet again, in a fine book called “The X Factor Diet” (Vermillion 2002) and Barry Sears “The Zone” is essentially that same life-saving information. Learn it and do it.
Anti-ageing doctors are increasingly concerned about the problem of insulin resistance as a causative factor in age degeneration. Carbohydrates of all types are digested to simple sugars, such as glucose, when they enter the gut. Eating large amounts of carbo results a great deal of digestion products or a “sugar rush”, which has to be dealt with safely.
One of the best-known hormones that regulates the metabolic processing of sugar is insulin (however don’t forget that other hormones from the adrenal glands are also involved in this process). Basically, insulin makes cells more receptive to glucose, so they can metabolize it, or turn it into glycogen, which is used as an energy store. This takes glucose out of circulation and lowers blood levels.
However, when this process has been abused for many decades, it is liable to break down. Suddenly the body ceases to adapt to glucose and, despite ever-increasing levels of insulin, glucose in the blood begins to rise. The cells can no longer utilize it properly. Cell receptors seem to have switched off and stopped listening to the signal from insulin, hence the term for this condition.
Insulin resistance is dangerous. Apart from the obvious risk of progression into the next two conditions, high insulin levels result in excess sympathetic nervous system activity, which keeps the individual tense and prone to fatigue. Sooner or later a complete system breakdown, or advanced ageing, will result.
Our understanding of disordered blood glucose control advanced considerably in 1988 when Dr Gerald Reaven of Stanford University published a paper describing what he called “Syndrome X”. A syndrome in medicine means a group of symptoms which appear together, as a characteristic pattern which is repeatedly encountered. In this case, the syndrome consists of five features: obesity, insulin resistance, high blood pressure, high serum triglyceride levels (bad fat) and low HDL (good cholesterol). Dr Reaven had no idea what caused this group of symptoms to occur together, so he named it “Syndrome X”.
Notice that patients with Syndrome X do not have the dangerously raised glucose levels of diabetes. But they do have insulin resistance and higher than normal levels of circulating glucose. The high level of insulin stimulates the kidneys to re-absorb sodium which in turn results in a tendency to hypertension. Dr Reaven believes that half of all hypertensives have insulin resistance. No-one needs to be told of the dangers of high blood pressure.
Raised triglycerides, along with raised LDL (bad cholesterol), combined with lowered HDL are disturbing. These changes in blood fats denote a major increase in the risk of arterial degenerative disease. Unfortunately, hyperinsulinism also reduces blood enzymes which prevent or dissolve blood clots. Thus, along with the undesirable changes in blood fats comes a sinister increase in the likelihood of thrombosis, making the risk of heart attack or stroke far greater than for healthy individuals.
The above conditions can be referred to as “pre-diabetic”. Sooner or later, left untreated, the condition is going to worsen and turn into full-blown diabetes. This disease has been likened to an overview on the process of ageing. Much of the degeneration in the arteries, heart, brain and eyes seen with diabetes is the same as that attributable to ageing. But it takes place much faster in a diabetic patient. The life expectancy of an individual with diabetes is therefore considerably below average.
Here we refer to type II diabetes or “late onset” diabetes. As its name suggests, this is mainly what affects older individuals. It is a direct result of collapsed carbohydrate regulation. Whereas type I diabetes is caused by the failure of the pancreas to secrete adequate insulin, in type II there is too much insulin. The two conditions are fundamentally different. In the type II condition the body has become refractory to insulin, simply not responding to regulation as it should. Thus, despite high levels of insulin, glucose increases to unacceptable levels in the blood. Be sure you understand: untreated diabetes is a fatal disease process.
The many complications of diabetes can be summed up as follows: arteriosclerosis (leading to increased risk of heart disease, stroke and gangrene of the lower limbs), early dementia, impotence, eye damage leading to blindness, poor kidney performance, nerve damage, resulting in numbness and paralysis of the limbs, skin sores, carbuncles, ulcers and poor wound healing.
Be aware then: you do not want to develop diabetes at any stage of life. Beware what you eat!
In the old days the main test was tasting the urine to see if sugar is detectable: hence the term diabetes mellitus (sweet tasting)! Fortunately things are more scientific these days!
Doctors will insist on measuring isolated blood glucose levels, though these can be very misleading, even when fasting, and random samples are worse than useless. More helpful is the glucose tolerance test. The patient fasts overnight and then, after a loading drink of 50 grammes of glucose, blood samples are taken hourly. Usually this is continued for 2- 3 hours but far better is to go 4 hours. The diagnostic sign is that the glucose level goes high (over 180) and stays high or is very sluggish at returning to pre-test levels. This means the cells are not utilizing the glucose properly, either through frank lack of insulin, or due to insulin resistance.
Guidance values are as follows:
|Fasting||30 minutes||1 hour||2 hours||3 hours|
At least two of the recordings must be abnormal (high) to diagnose diabetes.
Hyperinsulinaemia is mainly diagnosed by sophisticated blood tests, showing abnormally high insulin levels without proportionately raised glucose levels. Blood insulin levels are difficult to measure and so not done routinely. The GTT is much more valuable if insulin is measured concurrent with the glucose levels.
The so-called insulin tolerance test means giving an injection of insulin to a fasting patient (one unit per kilogram of body weight) and taking repeated blood glucose samples every three minutes for a quarter of an hour. Insulin resistance is diagnosed if the blood glucose falls by less than 50% of the fasting level in that 15 minutes. The test is not safe to perform if the fasting glucose is less than 120 mg/dL.
Hospital doctors and internists will also measure blood haemoglobin AIC or glycosylated haemoglobin. That tells them much more accurately what long-term changes in blood levels of glucose have been like. Normal levels range up to 7%. Above 7% is bad, above 10% very bad and above 12% is dangerous and means very poor glucose control. Experts recommend repeating this test every 3- 6 months once diabetes has been established.
What You Can Do
By the time you have developed diabetes, you need help from a qualified and skilled doctor. But the only aim of the ordinary physician is to control the disease by keeping the blood glucose levels within normal limits. You will be offered drugs which increase insulin secretion (such as the sulphonyl ureas) or a different kind of drug metformin which increases the body’s sensitivity to its own insulin. This simplistic approach does not go nearly far enough for you. It is far better to tackle the causes.
You can do a great deal to avoid disordered carbohydrate metabolism, or help yourself towards a recovery, if you have understood the origins of the problem. First and most obvious is to drastically curtail the amount of carbohydrate in your diet. Avoid all sugar, flour and “white foods”. What carbo you do eat, take only as whole-grain products.
Exercise and weight control are vital at all stages of life but particularly if you are in the high risk zone (50 plus). All knowledgeable practitioners agree these two decrease insulin resistance significantly. Both also help in reducing hypertension. Do not even consider medication for blood pressure, unless all lifestyle changes fail – drugs will merely mask the problem and not eliminate the cause.
Dr Reaven restricts carbohydrate and replaces it with mono and polyunsaturated fats, such as olive oil and fish oils. These increase insulin sensitivity and help reduce triglycerides and LDL. However some care is required, omega-3 fats (fish and flax oil) are known to potentially impair insulin levels and increase blood glucose. This adverse effect may be avoided by adding vitamin E (400 IU daily) to the regime. The omega-6 fatty acids (evening primrose oil, star flower, borage) has insulin-like properties and also increases sensitivity to insulin but without affecting bad blood fats.
Top of the list is chromium, aka “glucose tolerance factor”! Take at least 400 mcg daily.
Next comes DHEA which lowers insulin levels and also, vitally, protects organs, particularly the kidneys, against damage due to high blood glucose levels. Men need about 25 mgms daily but women should not take more than 10 mgms daily, or it will cause greasy spotty skin.
Next comes magnesium. A consensus panel of doctors in the America Diabetes Association agreed magnesium deficiency may play a role in developing insulin resistance, carbohydrate intolerance and hypertension. Pay attention: it is not often that conventional doctors recommend nutrient solutions! Take 350 mgm a day or more.
Vitamins B3, B6 and C are also vital. Deficiencies have shown up as insulin resistance. Take 100- 1,000 mgm of B3, 50- 100 mgm of B6 and 2 grammes of vitamin C daily, alone or as part of your health formula.
Alpha lipoic acid, a star-quality supplement steadily climbing to the top of the anti-ageing league table, apart from being a powerful antioxidant has also been shown to improve insulin action. You need 200- 400 mgms daily.