tag:blogger.com,1999:blog-27743857844461282102024-03-13T23:49:00.448-07:00Arizona Sun Family MedicineRakesh C. Patel, M.D.http://www.blogger.com/profile/16966778816944175639noreply@blogger.comBlogger9125tag:blogger.com,1999:blog-2774385784446128210.post-47633840230916843482012-11-14T09:16:00.000-08:002013-12-13T18:00:55.160-08:00On Being Metabolically and Psychologically Flexible<!--[if gte mso 9]><xml>
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<div class="MsoNormal">
As a doctor that focuses on the early detection of diabetes
and heart attack risk, I see risk where a lot of other doctors might not. It
comes back to that “ounce of prevention pound of cure” thing. It amazes me to
see how many patients come through my door that have been in a state of insulin
resistance for such a long time without knowing it and more importantly without
an action plan. See<span style="color: red;"> <span style="color: red;"><a href="http://www.ncbi.nlm.nih.gov/pubmed?term=Minimal%20Contribution%20of%20Fasting%20Hyperglycemia%20to%20the%20Incidence%20of%20Type%202%20Diabetes%20in%20Subjects%20With%20Normal%202-h%20Plasma%20Glucose" target="_blank">this study</a></span></span> and <span style="color: red;"><a href="http://www.ncbi.nlm.nih.gov/pubmed/20639452" target="_blank">this one</a></span> if you don’t believe me.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Patients need to have something tangible they can leave my
office to change their lives (and get inspired). Unfortunately there is no “one
size fits all” solution. We can talk about metabolic flexibility in regards of
how the body uses energy; well how about diet flexibility for patients. </div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
I offer an array of options for patients, like <a href="http://robbwolf.com/" target="_blank">Robb Wolf"s Paleo Solution</a>, <a href="http://www.drgundry.com/" target="_blank">Steven Gundry's Diet Evolution</a>, or <a href="http://www.bulletproofexec.com/the-complete-illustrated-one-page-bulletproof-diet/" target="_blank">Dave Asprey's Bulletproof Diet</a>. (can you tell I was an Anthropology-Zoology major in undergrad?)</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Those struggling with their weight have to be in it for the
long haul or else it is just a set up for failure, both metabolically and
psychologically. This is something I see over and over again in the low
calorie, “Weight Watchers” mentality. Short term weight loss with long term
rebound weight gain.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
For my patients with “metabolic risk”, a lower carbohydrate
approach is the starting point. Some are more eager than others to get on their
way. For those patients that want to grab the bull by the horns, my go to is
Kiefer’s plan/book: <span style="color: red;"><a href="http://carbnite.com/" target="_blank">The Carb Nite Solution (CNS)</a></span>.<span style="mso-spacerun: yes;"> </span>It is the plan I
recommend to most of my diabetics who are looking for a way to improve how they
feel and get off that wheelbarrow full of medicine they are on.<span style="mso-spacerun: yes;"> </span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
One of the reasons I like the plan is that it offers
flexibility for patients. Knowing they can have one Carb Nite (CN) a week,
makes it easier for them to plan for that work party, family get together, or
special event.<span style="mso-spacerun: yes;"> </span>I believe also that psychologically,
there is not that constant denial of food you get with most standard low
calorie plans, not to mention it adds a little fun to making lifestyle changes.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
I would like to share 2 patient stories, both are women (I
have their permission) who have struggled with diabetes for the last 7-10
years. One is on oral medications and the other is on oral medication plus
insulin. They both had hemoglobin A1C’s that were elevated (8.3 and 10.1
respectively) and have always struggled with there weight. Both went on CNS and
have now successfully have lost weight (15 lbs and 20 lbs respectively) and
have lowered their hemoglobin A1C at or under 7.0. That is as good as or better
than any multimillion dollar drug.<span style="mso-spacerun: yes;"> </span>Their
cost: about $20 investing in a book. </div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
They are both a work in progress, but these changes have had a
big impact, both metabolically and psychologically for both women. Both
patients had improvement in markers of inflammation (i.e. hs-CRP, PLAC2). They
also now exude a bit of confidence in moving forward instead of previous desperation.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
I have had many other patient success stories, but these two
stick out the most to me because it made such a large impact on both of their
lives.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
There is a lot of “psychology” that goes along with making
changes, you know that little voice in your head that you have that constant
dialogue with (common, it’s not just me). So the following is what I talk to my
patients about:</div>
<div class="MsoNormal">
<br /></div>
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<div class="MsoListParagraphCxSpFirst" style="mso-list: l0 level1 lfo1; text-indent: -.25in;">
<span style="mso-bidi-font-family: Cambria; mso-bidi-theme-font: minor-latin;"><span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Throw your scale away, you don’t need it,
really.</div>
<div class="MsoListParagraphCxSpMiddle" style="mso-list: l0 level1 lfo1; text-indent: -.25in;">
<span style="mso-bidi-font-family: Cambria; mso-bidi-theme-font: minor-latin;"><span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Relax, do not stress, especially when you fall
off the wagon (yes it is going to happen), just get back on. High cortisol is
bad, ummmkay (in the voice from the teacher on South Park)</div>
<div class="MsoListParagraphCxSpMiddle" style="mso-list: l0 level1 lfo1; text-indent: -.25in;">
<span style="mso-bidi-font-family: Cambria; mso-bidi-theme-font: minor-latin;"><span style="mso-list: Ignore;">3.<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Go with the flow and do not over analyze things.
Enjoy the foods that you get to eat on ultra low carb days (ie bacon) and on
carb nites (ie cherry turnovers ;-) ). </div>
<div class="MsoListParagraphCxSpMiddle" style="mso-list: l0 level1 lfo1; text-indent: -.25in;">
<span style="mso-bidi-font-family: Cambria; mso-bidi-theme-font: minor-latin;"><span style="mso-list: Ignore;">4.<span style="font: 7.0pt "Times New Roman";">
</span></span></span>If the CNS is not right for you, than be
flexible and modify the program (ie initially start with lesser carb
restriction)</div>
<div class="MsoListParagraphCxSpMiddle" style="mso-list: l0 level1 lfo1; text-indent: -.25in;">
<span style="mso-bidi-font-family: Cambria; mso-bidi-theme-font: minor-latin;"><span style="mso-list: Ignore;">5.<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Have a short and long term goal. Reward yourself
for every short-term goal you meet.</div>
<div class="MsoListParagraphCxSpMiddle" style="mso-list: l0 level1 lfo1; text-indent: -.25in;">
<span style="mso-bidi-font-family: Cambria; mso-bidi-theme-font: minor-latin;"><span style="mso-list: Ignore;">6.<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Be prepared. Have your food options planned out
ahead of time and have a back up “emergency” plan in place. </div>
<div class="MsoListParagraphCxSpMiddle" style="mso-list: l0 level1 lfo1; text-indent: -.25in;">
<span style="mso-bidi-font-family: Cambria; mso-bidi-theme-font: minor-latin;"><span style="mso-list: Ignore;">7.<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Don’t be afraid of eating fat</div>
<div class="MsoListParagraphCxSpMiddle" style="mso-list: l0 level1 lfo1; text-indent: -.25in;">
<span style="mso-bidi-font-family: Cambria; mso-bidi-theme-font: minor-latin;"><span style="mso-list: Ignore;">8.<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Did I say relax?</div>
<div class="MsoListParagraphCxSpMiddle" style="mso-list: l0 level1 lfo1; text-indent: -.25in;">
<span style="mso-bidi-font-family: Cambria; mso-bidi-theme-font: minor-latin;"><span style="mso-list: Ignore;">9.<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Manage your expectations. The weight did not
come on in 1 month and it will not all come off in 1 month.</div>
<div class="MsoListParagraphCxSpMiddle" style="mso-list: l0 level1 lfo1; text-indent: -.25in;">
<span style="mso-bidi-font-family: Cambria; mso-bidi-theme-font: minor-latin;"><span style="mso-list: Ignore;">10.<span style="font: 7.0pt "Times New Roman";"> </span></span></span>Eat
real food. Avoid or limit shakes and smoothies (or at least only keep them to
post resistance training time only)</div>
<div class="MsoListParagraphCxSpMiddle" style="mso-list: l0 level1 lfo1; text-indent: -.25in;">
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are in it for the long haul. If it is something that you do not think you can do,
then stop and let’s find something that will.</div>
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<span style="mso-bidi-font-family: Cambria; mso-bidi-theme-font: minor-latin;"><span style="mso-list: Ignore;">12.<span style="font: 7.0pt "Times New Roman";"> </span></span></span>When
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If you want to learn more about Kiefer, check out his
website at www.athlete.io</div>
Rakesh C. Patel, M.D.http://www.blogger.com/profile/16966778816944175639noreply@blogger.com15tag:blogger.com,1999:blog-2774385784446128210.post-71366627435448475532012-09-25T22:54:00.000-07:002012-09-26T06:31:13.410-07:00Does LDL-P Matter?<style>
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<div class="MsoNormal">
(<i style="mso-bidi-font-style: normal;">Note: Please consult
with your healthcare provider for any personal health issues</i>)</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Now that I have your attention, the question above is
certainly rhetorical and one could easily substitute ApoB or Non-HDL
cholesterol, so I am not singling out LDL-P (or picking on NMR technology).<span style="mso-spacerun: yes;"> </span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
It has been a several weeks since AHS 2012 occurred and
unfortunately I was unable to attend. From the twittersphere, I read about some
good presentations including Peter Attia’s discussion on cholesterol (if you
have not checked out <a href="http://eatingacademy.com/" target="_blank">The Eating Academy</a>, you really should). </div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
I fell down the low carb rabbit hole several years ago and
have never felt better, both physically and mentally. As that rabbit hole goes
deeper (read: greater carb restriction), there have been some inherent
“problems”. There are numerous reports of low carbers having their cholesterol
go thru the roof when they restrict their carbs (for definition let’s say less
than 50 grams a day). Food quality is good, exercise is good, they feel good,
but their lipids look horrible.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
I would like to share my story, my n=1 case. I started a
lower carb Paleolithic diet over 2 years ago after I had read <a href="http://www.amazon.com/Dr-Gundrys-Diet-Evolution-Waistline/dp/0307352129/ref=sr_1_sc_1?ie=UTF8&qid=1348637837&sr=8-1-spell&keywords=gundrydiet" target="_blank">Steven Gundry’s Diet Evolution</a> (also see books by <a href="http://www.amazon.com/The-Paleo-Diet-Healthy-Designed/dp/0470913029/ref=sr_1_1?ie=UTF8&qid=1348637890&sr=8-1&keywords=cordain" target="_blank">Cordain</a>, <a href="http://www.amazon.com/New-Evolution-Diet-Paleolithic-Ancestors/dp/B005X49PRC/ref=sr_1_1?s=books&ie=UTF8&qid=1348637912&sr=1-1&keywords=de+vany" target="_blank">DeVany</a>, <a href="http://www.amazon.com/Paleo-Solution-Original-Human-Diet/dp/0982565844/ref=sr_1_1?s=books&ie=UTF8&qid=1348637940&sr=1-1&keywords=robb+wolf" target="_blank">Wolf</a>, <a href="http://www.amazon.com/Good-Calories-Bad-Controversial-Science/dp/1400033462/ref=sr_1_1?s=books&ie=UTF8&qid=1348637963&sr=1-1&keywords=good+calories+bad+calories" target="_blank">Taubes</a>, among others).
I have progressed in my personal views and have progressed to where currently I
eat a form of a cyclic ketogenic diet (<a href="http://carbnite.com/" target="_blank">CarbNiteSolution</a> (CNS) by <a href="http://www.dangerouslyhardcore.com/" target="_blank">Kiefer</a>).
There are many reasons, but I am a fat kid at heart and it allows me some
flexibility with my “re-feeds”. </div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Last fall I had a <a href="http://www.theparticletest.com/" target="_blank">NMR LipoProfile</a> done which showed a LDL-P
of 2700 (less than 1000 is optimal). For a physician who focuses on heart attack prevention, this was quite
horrifying. What should I do? My initial thought was to slug down 20 mg of
Crestor daily. The only thing was that I was losing weight (more precisely, fat
via body composition testing) and I felt better than ever. My energy was
amazing. So I continued and eventually started Kiefer’s protocol described in
CNS earlier this year. There was one problem, my LDL-P was not changing and as
of this writing the last value was over 3000. </div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Well, as I do with my patients, I always want to know if a
patient has disease or not. That really is the question, not how high is the
cholesterol. I know from my practice that risk factor assessment means very
little without actually knowing if disease exists. <span style="mso-spacerun: yes;"> </span>Using standard risk assessment tools can miss
people who really are at risk (3). By looking at risk assessment models<span style="mso-spacerun: yes;"> </span>(like Framingham Risk Score) we can over- or
under-estimate risk greatly. My workhorse disease detection is Carotid Intima
Media Thickness (CIMT). This test simply put, measures the “lining” of the
carotid artery via ultrasound. The thicker the lining is, the greater the risk.
It is also a way to assess for plaque (atherosclerosis) of the artery. Having
plaque means you have atherosclerosis. I believe it is a significantly better
way of looking at risk because we are looking for the actual pathology (1,2). </div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
I had my CIMT done in 2006 on the Standard American “heart
healthy diet” eating low fat, higher carb. You know those espoused by the ADA
and AHA. My lipids were “normal” at this time. My thickness was 0.6 mm (about
the 50<sup>th</sup> percentile). I also had two small “road bumps “ (minimal
plaques) at my left carotid bulb both measuring 1.2 mm. I was not happy. I also
had similar findings on a study in 1/2010. </div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Flash-forward to June 2012, about 4 months into CNS, my CIMT
showed a thickness of 0.445 mm (13<sup>th</sup> percentile) and I had the
vascular age of a 16 year old! And oh by the way, the “road bumps” were gone. All
the while carrying an LDL-P of over 2500 consistently for over a year. I have
also had a CT Coronary Calcium score that was zero.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Epidemiology tells us that high LDL-P is associated with
greater CVD risk (4,5). Where is mine? </div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Lets address the high LDL-P issue on low carb diets first.
Unfortunately, I do not have the complete answer. The literature does not
reveal much. The work of Paul Jaminet/Chris Masterjohn proves interesting (6).
To sum, high cholesterol on a low carb diet could be due to:</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="mso-tab-count: 1;"> </span>1. Thyroid
dysfunction (my TSH, T4, T3, rT3 were normal)</div>
<div class="MsoNormal">
<span style="mso-tab-count: 1;"> </span>2.
Micronutrient deficiency (none noted via testing)</div>
<div class="MsoNormal">
<span style="mso-tab-count: 1;"> </span>3.
Toxin/Infectious exposure (no periodontal disease or other sources of
infection)</div>
<div class="MsoNormal">
<span style="mso-tab-count: 1;"> </span>4. Active
weight loss (check, but does not explain why others with active weight loss
have better/normal lipids)</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Let’s take a 50000 ft. view. My hypothesis is that insulin
signaling is playing a huge role. We know that the root cause of
atherosclerosis in 80% of people is due to insulin resistance (7).<span style="mso-spacerun: yes;"> </span>Insulin is an anabolic hormone (ask
bodybuilders). Unfortunately it is not very discriminatory. Meaning: subcutaneous
areas, the liver and the arteries can be storage depots for fat in the setting of
insulin resistance. I see insulin resistance as “loading the gun” for initial
heart attack risk/event. </div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Inflammation is the second part. If insulin resistance loads
the gun, then inflammation pulls the trigger. Inflammation has a role in the
development and progression of atherosclerosis AND in the
rupture/destabilization of plaques (8). In addition, to complicate matters, the majority of plaque rupture/erosions do not cause events.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
So what does one due to mitigate all of this disease? Well,
that would be to minimize the effects of insulin. That can be done by a
carbohydrate-restricted diet. In the largest extreme that would be a ketogenic diet.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
What does a ketogenic diet do? Well simply put, it minimizes
the effect of insulin from the dietary component. This mitigation can be a reason for fat efflux (ala LPL and HSL activity). Could one also hypothesize
that fat is being effluxed not only from the subcutaneous tissue, but also the
liver, hence a potential treatment of nonalcoholic hepatitis (NASH)? By this
same thought process, could this be a mechanism to efflux “fat” out of arteries,
which may be one mechanism of action which may account for disease in patients
with high HDL-C cholesterol in the presence of insulin resistance?</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Although not widely studied, Ketogenic diets (which remove
agents of Neolithic disease) can minimize inflammation. I have seen this
clinically in my practice and in myself. My hs-CRP is not detectable (all my
other markers of inflammation are normal as well, Lp-PLA2 and Myeloperoxidase).
Inflammation IS the key component to events (ie plaque rupture) as stated above.
</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
So if LDL-P is high but inflammation is very low and there
is no insulin resistance, does it matter? This, of course, does not preclude
the possibility of atherosclerosis to progress in the setting of insulin
resistance and no/low inflammation (think the 78 yr old that needs a stent but
never had the event). <span style="mso-spacerun: yes;"> </span>So if one is
eating low carb, one would think these metabolic issues should take care of
themselves.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
I definitely think in the Standard American Diet (SAD), high
LDL-P is a huge problem. Primarily due to the significant insulin resistance
associated with the discordance of LDL-C to LDL-P in the setting of
inflammation. It is a recipe for disaster. It also represents nearly 80% of
patients coming thru my door. <span style="mso-spacerun: yes;"> </span>Yes, 80%,
it is that high! (9,10)</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
I propose diet DOES matter (shocking, I know). In
particular, those that minimize carbohydrate exposure and thus insulin
signaling; will have difficulty developing atherosclerosis, inflammation and
thus events and potentially reverse it. What are the diets that do this? A
ketogenic diet, <span style="mso-spacerun: yes;"> </span>low carb/LC Paleo diet AND
as much as it pains me to say, the plant based diet. </div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
This is a very complex issue and one that warrants further
investigation and for now most of my answers are “it depends”. But we must
always remember to treat the patient/disease and not the number. </div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
References:</div>
<div class="MsoListParagraphCxSpFirst" style="mso-list: l0 level1 lfo1; text-indent: -.25in;">
<span style="mso-bidi-font-family: Cambria; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: Cambria; mso-fareast-theme-font: minor-latin;"><span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><a href="http://www.ncbi.nlm.nih.gov/pubmed?term=CAFES-CAVE%20study">http://www.ncbi.nlm.nih.gov/pubmed?term=CAFES-CAVE%20study</a></div>
<div class="MsoListParagraphCxSpMiddle" style="mso-list: l0 level1 lfo1; text-indent: -.25in;">
<span style="mso-bidi-font-family: Cambria; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: Cambria; mso-fareast-theme-font: minor-latin;"><span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><a href="http://ht.ly/dQAo9">http://ht.ly/dQAo9</a></div>
<div class="MsoListParagraphCxSpMiddle" style="mso-list: l0 level1 lfo1; text-indent: -.25in;">
<span style="mso-bidi-font-family: Cambria; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: Cambria; mso-fareast-theme-font: minor-latin;"><span style="mso-list: Ignore;">3.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><a href="http://www.ncbi.nlm.nih.gov/pubmed/22399535">http://www.ncbi.nlm.nih.gov/pubmed/22399535</a></div>
<div class="MsoListParagraphCxSpMiddle" style="mso-list: l0 level1 lfo1; text-indent: -.25in;">
<span style="mso-bidi-font-family: Cambria; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: Cambria; mso-fareast-theme-font: minor-latin;"><span style="mso-list: Ignore;">4.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><a href="http://www.ncbi.nlm.nih.gov/pubmed/21392724">www.ncbi.nlm.nih.gov/pubmed/21392724</a></div>
<div class="MsoListParagraphCxSpMiddle" style="mso-list: l0 level1 lfo1; text-indent: -.25in;">
<span style="mso-bidi-font-family: Cambria; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: Cambria; mso-fareast-theme-font: minor-latin;"><span style="mso-list: Ignore;">5.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><a href="http://www.ncbi.nlm.nih.gov/pubmed/16765964">http://www.ncbi.nlm.nih.gov/pubmed/16765964</a></div>
<div class="MsoListParagraphCxSpMiddle" style="mso-list: l0 level1 lfo1; text-indent: -.25in;">
<span style="mso-bidi-font-family: Cambria; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: Cambria; mso-fareast-theme-font: minor-latin;"><span style="mso-list: Ignore;">6.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><a href="http://perfecthealthdiet.com/category/biomarkers/hdlldlcholesterol/">http://perfecthealthdiet.com/category/biomarkers/hdlldlcholesterol/</a></div>
<div class="MsoListParagraphCxSpMiddle" style="mso-list: l0 level1 lfo1; text-indent: -.25in;">
<span style="mso-bidi-font-family: Cambria; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: Cambria; mso-fareast-theme-font: minor-latin;"><span style="mso-list: Ignore;">7.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><a href="http://www.ncbi.nlm.nih.gov/pubmed/10466661">http://www.ncbi.nlm.nih.gov/pubmed/10466661</a></div>
<div class="MsoListParagraphCxSpMiddle" style="mso-list: l0 level1 lfo1; text-indent: -.25in;">
<span style="mso-bidi-font-family: Cambria; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: Cambria; mso-fareast-theme-font: minor-latin;"><span style="mso-list: Ignore;">8.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><a href="http://www.ncbi.nlm.nih.gov/pubmed?term=Arbab-Zadeh%20A%20et%20al.%20Circulation%203%2F6%2F2012%3B125%3A1147-1156">http://www.ncbi.nlm.nih.gov/pubmed?term=Arbab-Zadeh%20A%20et%20al.%20Circulation%203%2F6%2F2012%3B125%3A1147-1156</a></div>
<div class="MsoListParagraphCxSpMiddle" style="mso-list: l0 level1 lfo1; text-indent: -.25in;">
<span style="mso-bidi-font-family: Cambria; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: Cambria; mso-fareast-theme-font: minor-latin;"><span style="mso-list: Ignore;">9.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><a href="http://www.ncbi.nlm.nih.gov/pubmed/21788628">http://www.ncbi.nlm.nih.gov/pubmed/21788628</a></div>
<div class="MsoListParagraphCxSpMiddle" style="mso-list: l0 level1 lfo1; text-indent: -.25in;">
<span style="mso-bidi-font-family: Cambria; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: Cambria; mso-fareast-theme-font: minor-latin;"><span style="mso-list: Ignore;">10.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><a href="http://www.ncbi.nlm.nih.gov/pubmed/20007945">http://www.ncbi.nlm.nih.gov/pubmed/20007945</a></div>
<div class="MsoListParagraphCxSpMiddle" style="mso-list: l0 level1 lfo1; text-indent: -.25in;">
<span style="mso-bidi-font-family: Cambria; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: Cambria; mso-fareast-theme-font: minor-latin;"><span style="mso-list: Ignore;"><br /><span style="font: 7.0pt "Times New Roman";"></span></span></span></div>
<div class="MsoNormal" style="margin-left: .25in;">
<br /></div>
Rakesh C. Patel, M.D.http://www.blogger.com/profile/16966778816944175639noreply@blogger.com77tag:blogger.com,1999:blog-2774385784446128210.post-92097195076200071442012-04-13T13:23:00.001-07:002012-04-13T13:29:59.004-07:00Eating a Dangerously Bulletproof mealAs many people close to me know, I have struggled with my weight over the last decade. I have come a long way, losing over 85 lbs in my quest to be a healthier Dad and doctor. Lead by example. In my journey over the last year I have become a fan of several bloggers. Two of my favorites are Dave Asprey’s <a href="http://www.bulletproofexec.com/" style="color: red;" target="_blank">Bulletproofexec</a><span style="color: red;"> </span>and John Kiefer’s <a href="http://www.dangerouslyhardcore.com/" style="color: red;" target="_blank">Dangerously Hardcore</a><span style="color: red;">. </span><br />
<br />
I find it amazing when an internet geek and a physicist/bodybuilder can come to common ideas based on differing reasons. Anyways, I have coined a term I would like to take dibs on: “Dangerously Bulletproof”. Basically a mash of both mechanism’s to improve function, both physically and mentally. One of my office staff suggested I use the term “Pateleo” (Patel and Paleo), which I like, but Dangerously Bulletproof just sounds sexier. I plan to write more on this in a future blog posts. Today, I thought I would offer up a “Dangerously Bulletproof” meal. I know it’s not very original and I am sure @<a href="http://nomnompaleo.com/?81588080" style="color: red;" target="_blank">nomnompaleo</a> probably has this on her site somewhere (i just have not had time to look over there), but as for now I claim it.<br />
<br />
Pasta and spaghetti dinners with garlic bread are something I tend to miss, so here is a substitute I find satisfying: Pateleo “Spaghetti”<br />
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Ingredients:<br />
4-6 oz grassfed beef<br />
4 slices bacon (good source like from <a href="http://www.grasslandbeef.com/Detail.bok?no=580" style="color: red;" target="_blank">US Wellness</a> Meats)<br />
1 oz shredded spinach<br />
1-2 oz asparagus, chopped<br />
½ cup Lower carb tomato sauce (I used Tomato Basil Pasta Sauce from <a href="http://www.montebene.com/basil_marinara.html" style="color: red;" target="_blank">Monte Bene Farm Fresh</a>)<br />
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1. Place Bacon in fry pan and cook until crispy but not burnt, at the same time place beef in sauce pan or skillet and brown.<br />
2. While bacon/beef are cooking, shred spinach and chop up asparagus in 1/2 to 3/4 inch pieces<br />
3. Once bacon is cooked, set aside and add the veggies to the left over bacon grease and cook until spinach wilts slightly. Pour this on a plate and this will be your “spaghetti”. <br />
4. Mix the sauce with the ground beef and pour on top of the veggies. <br />
5. Add bacon to the side, and this will be your substitute for garlic bread. A nice salty alternative, besides bacon makes it better!.<br />
6. Enjoy with a bottle of San Pellegrino!<br />
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<div class="separator" style="clear: both; text-align: center;"><a href="http://4.bp.blogspot.com/-1zm-lO2nRB4/T4iI9_03aaI/AAAAAAAAAEE/MBMs6It1nVk/s1600/photo.JPG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="320" src="http://4.bp.blogspot.com/-1zm-lO2nRB4/T4iI9_03aaI/AAAAAAAAAEE/MBMs6It1nVk/s320/photo.JPG" width="240" /></a></div><br />
“Vital Signs”: Total Calories 459; Fat grams 32; Total Carbs 14grams;Dietary Fiber 6 grams; Total “usable” Carbs 8 grams; Total Protein 30. 62%of cals from Fat, 25% cals from protein, and 12% cals from carbs<br />
If you want more fiber, add a tbsp of chia seeds over the top.Rakesh C. Patel, M.D.http://www.blogger.com/profile/16966778816944175639noreply@blogger.com7tag:blogger.com,1999:blog-2774385784446128210.post-28981740845680383922011-08-26T19:18:00.000-07:002011-08-26T19:19:00.216-07:00Weight loss, Fat Loss, and Voodoo<div class="MsoNormal">It has been awhile since my last post. When I started this blog, it was my intention to post monthly. But such are things with life. I post today after my workout. But before I get to that, let me tell a little story.</div><div class="MsoNormal"><o:p></o:p></div><div class="MsoNormal"><br />
</div><div class="MsoNormal">Over the last 2 ½ years I have changed my diet. I was changed forever after reading Dr. Gundry’s Diet Evolution. Since then I have read many other books/blogs. Those include <a href="http://thepaleodiet.com/">The Paleo Diet</a>, <a href="http://www.amazon.com/Good-Calories-Bad-Challenging-Conventional/dp/1400040787">Good Calories Bad Calories</a>, <a href="http://perfecthealthdiet.com/">The Perfect Health Diet</a>, <a href="http://www.bulletproofexec.com/">Bulletproofexec</a>, and <a href="http://www.fourhourbody.com/">The 4 Hour Body</a> among others. I have also been collecting journal articles reading about as much of the research that I can. <o:p></o:p></div><div class="MsoNormal"><br />
</div><div class="MsoNormal">The main thing I surmised is that it is key to keep insulin levels even (mostly by controlling carbohydrate intake in both quantity AND quality), adequate fiber intake when eating carbohydrates to buffer the insulin response, and fat can be your friend and has been wrongly demonized. <o:p></o:p></div><div class="MsoNormal"><br />
</div><div class="MsoNormal">Back to my “story”. The problem recently has been that I had reached a plateau in my weight loss efforts. In addition I just got back from vacation and was about 5 lbs above the baseline I had been over the previous six months. So what did I do? Like every other person does, I hit the gym. So for two months I did cardio 4-5 x a week with some weights, mixed in with some hot yoga. But results were not forthcoming and I was getting frustrated. I had actually gained 2 pounds (not sure if this was fat or muscle or both).<o:p></o:p></div><div class="MsoNormal"><br />
</div><div class="MsoNormal"> Then my gym started a 90 day challenge. So I thought to myself, what the heck, I know it was pretty much a scam to get me to by more services (which of course I did), but I thought that a challenge is what I needed. Recommit! I hooked up with a trainer, 2 x a week. He asked what my main goal was, and I obviously pointed to my gut and said “I want to get rid of this”. He said not a problem, but you are not going to like me very much. What ensued was a brutal high intensity workout 2 days a week with cardio/spinnning or hot yoga on off days. 90 days later I was down about 5 lbs and had lost about 2% body fat. Not quite the results I was looking for, but it was a start. I thought my nutrition was good, but I know it was not perfect. About 1 month ago, I had come across a blog called the <a href="http://whole9life.com/">Whole9</a>. On their site, they mentioned something called the <a href="http://whole9life.com/category/whole-30/">Whole30 </a>challenge. Basically you eat whole, unprocessed foods for 30 days, including no alcohol and processed carbohydrates. Again, I was up for the challenge. Re-recommit! Well, my 30 days are almost up and I must say I have been impressed. After 3 weeks I had lost 9 lbs and decreased body fat by about 3-5%, all with only working out 2-3 x a week (very little cardio).<o:p></o:p></div><div class="MsoNormal"><br />
</div><div class="MsoNormal">Here are my observations. They are specific for me and are not intended to be extrapolated to other individuals (see #9). <o:p></o:p></div><div class="MsoNormal"><br />
</div><div class="MsoNormal">1. I must stay under 100 grams of carbohydrates in order to continue my weight loss. On days I go over 100 grams I either stay even or gain weight, no matter my calorie count! <o:p></o:p></div><div class="MsoNormal">2. During the 30 days I did not actively “count” calories (although I did log them along with wearing my Fitbit). My daily calorie intake ranged from 1400-2500 calories a day. <o:p></o:p></div><div class="MsoNormal">3. Eggs are my friend. <o:p></o:p></div><div class="MsoNormal">4. I LOVE the grass fed beef I purchased locally (I went in on 1/3 of a cow). <o:p></o:p></div><div class="MsoNormal">5. I need to eat this way for the rest of my life, not just 30 days, Duh! <o:p></o:p></div><div class="MsoNormal">6. Post prandial blood glucose never went above 125 at the 1 hour mark or 2 hour mark. <o:p></o:p></div><div class="MsoNormal">7. Counting calories is imperfect because food labels are imperfect. <o:p></o:p></div><div class="MsoNormal">8. If I “carb crave” in the evening then I have not eaten enough fat during the day. <o:p></o:p></div><div class="MsoNormal">9. Self-quantification is important. Collect data about your body then make changes from the data you obtain. The definition of insanity is doing the same thing over and over again and expecting different results. <a href="http://www.withings.com/">Weigh daily</a>, check blood sugar and blood pressure regularly, track activity (Fitbit or Bodybugg), track your sleep (<a href="http://www.fitbit.com/">Fitbit</a> or <a href="http://www.myzeo.com/">Zeo Sleep Coach</a>). <o:p></o:p></div><div class="MsoNormal"><br />
</div><div class="MsoNormal">I am most interested in my lipid, metabolic, and inflammatory markers. My hs-CRP, Lp-PLA2 and MPO were already low, but several markers of insulin resistance (IR) were elevated. I performed a baseline in April and will have them re-drawn next week. I will post results. <o:p></o:p></div><div class="MsoNormal"><br />
</div><div class="MsoNormal">Nutrition, weight loss, and muscle gain are a complex machinery and it is even trickier in the setting of IR. About 70% of patients I treat have some form of IR, along with some form of lipoprotein abnormality. IR is really the source of most people’s issues that I treat. Until this is addressed, pathology (cardiovascular disease) will continue to ensue. I see this in patients day in and day out. I firmly believe carbohydrate restriction is a major piece of the puzzle and continue to recommend this for my patients with IR.<o:p></o:p></div><div class="MsoNormal"><br />
</div><div class="MsoNormal">In the meantime, I will continue my low carb, moderate fat ways as it is working for me as it has for countless others.<o:p></o:p></div>Rakesh C. Patel, M.D.http://www.blogger.com/profile/16966778816944175639noreply@blogger.com11tag:blogger.com,1999:blog-2774385784446128210.post-78208978965134175382011-04-21T20:18:00.000-07:002011-04-21T20:18:44.804-07:00Use of Artificial Sweeteners Increases Body Fat<span class="Apple-style-span" style="font-family: 'times new roman', times, serif; font-size: medium; line-height: 21px;">There has been conflicting stories about the use of arti</span><span class="Apple-style-span" style="font-family: 'times new roman', times, serif; font-size: medium; line-height: 21px;">ficial sweeteners, especially diet sodas. A recent article suggest drinking diet soda does not increase the risk of diabetes (</span><span class="Apple-style-span" style="-webkit-border-horizontal-spacing: 2px; -webkit-border-vertical-spacing: 2px; font-family: Verdana, Geneva, Arial, Helvetica, sans-serif; font-size: 13px;"><b><a href="http://tinyurl.com/43j3dck">http://tinyurl.com/43j3dck</a>). </b></span><span class="Apple-style-span" style="font-family: 'times new roman', times, serif; font-size: medium; line-height: 21px;">Well here is some research to suggest that artificial sweeteners can actually increase body fat, which can be a risk factor for Type 2 Diabetes and the Insulin Resistant Syndrome. This is from the Colgan Institute (<a href="http://colganinstitute.com/index.php?main_page">http://colganinstitute.com/index.php?main_page</a>). So maybe think twice before you decide to guzzle down that next diet soda.</span><br />
<span class="Apple-style-span" style="font-family: 'times new roman', times, serif; font-size: medium; line-height: 21px;"><br />
</span><br />
<span class="Apple-style-span" style="font-family: 'times new roman', times, serif; font-size: medium; line-height: 21px;">The main</span><span class="Apple-style-span" style="font-family: 'times new roman', times, serif; font-size: medium; line-height: 21px;"> </span><span class="Apple-style-span" style="font-family: 'times new roman', times, serif; font-size: medium; line-height: 21px;"><span class="yshortcuts" id="lw_1303441448_1" style="line-height: 1.2em; outline-color: initial; outline-style: none; outline-width: initial;">sugar substitutes</span></span><span class="Apple-style-span" style="font-family: 'times new roman', times, serif; font-size: medium; line-height: 21px;"> </span><span class="Apple-style-span" style="font-family: 'times new roman', times, serif; font-size: medium; line-height: 21px;">are saccarin (Sweet'N Low), aspartame (Equal,</span><span class="Apple-style-span" style="font-family: 'times new roman', times, serif; font-size: medium; line-height: 21px;"><span class="yshortcuts" id="lw_1303441448_2" style="background-attachment: initial; background-clip: initial; background-color: transparent; background-image: initial; background-origin: initial; background-position: initial initial; background-repeat: initial initial; border-bottom-color: rgb(54, 99, 136); border-bottom-style: dotted; border-bottom-width: 2px; cursor: pointer; line-height: 1.2em; outline-color: initial; outline-style: none; outline-width: initial;">NutraSweet</span></span><span class="Apple-style-span" style="font-family: 'times new roman', times, serif; font-size: medium; line-height: 21px;">), sucralose (Splenda, Altern) and acesulfame potassium. Sorbital and maltitol are used in "no sugar " ice cream and candy. </span><span class="Apple-style-span" style="font-family: 'times new roman', times, serif; font-size: medium; line-height: 21px;"><span class="yshortcuts" id="lw_1303441448_3" style="background-attachment: initial; background-clip: initial; background-color: transparent; background-image: initial; background-origin: initial; background-position: initial initial; background-repeat: initial initial; border-bottom-color: rgb(54, 99, 136); border-bottom-style: dotted; border-bottom-width: 2px; cursor: pointer; line-height: 1.2em; outline-color: initial; outline-style: none; outline-width: initial;">Erythritol</span></span><span class="Apple-style-span" style="font-family: 'times new roman', times, serif; font-size: medium; line-height: 21px;"> </span><span class="Apple-style-span" style="font-family: 'times new roman', times, serif; font-size: medium; line-height: 21px;">is the most recent, xylitol, cyclamate, and stevia are common. Despite their minimal to zero calories, they all make you put on body fat.</span><br />
<span class="Apple-style-span" style="font-family: 'times new roman', times, serif; font-size: medium; line-height: 21px;">They pile on the pudge for simple physiological reasons. Sweet tastes in the mouth, and in the gut, induce an appetitive response by the brain, and an insulin response by the pancreas.(1-3) Because the artificial sweeteners are much sweeter than sugar, the response is larger than if you use sugar. Insulin is a prime storage hormone. The extra insulin will store as fat all the extra calories you eat because of the appetitive response induced but not satisfied by the chemical sweetener. Studies show definitively that both rats and people fed artificial sweeteners, put on more weight than if they used the equivalent amount of sugar.(1-3)</span><span class="Apple-style-span" style="font-family: 'times new roman', times, serif; font-size: medium; line-height: 21px;"> </span><span class="Apple-style-span" style="font-family: 'times new roman', times, serif; font-size: medium; line-height: 21px;"><br style="line-height: 1.2em; outline-color: initial; outline-style: none; outline-width: initial;" /></span><span class="Apple-style-span" style="font-family: 'times new roman', times, serif; font-size: medium; line-height: 21px;">The</span><span class="Apple-style-span" style="font-family: 'times new roman', times, serif; font-size: medium; line-height: 21px;"> </span><span class="Apple-style-span" style="font-family: 'times new roman', times, serif; font-size: medium; line-height: 21px;"><span class="yshortcuts" id="lw_1303441448_4" style="background-attachment: initial; background-clip: initial; background-color: transparent; background-image: initial; background-origin: initial; background-position: initial initial; background-repeat: initial initial; border-bottom-color: initial; border-bottom-style: none; border-bottom-width: initial; cursor: pointer; line-height: 1.2em; outline-color: initial; outline-style: none; outline-width: initial;">artificial sweetener industry</span></span><span class="Apple-style-span" style="font-family: 'times new roman', times, serif; font-size: medium; line-height: 21px;"> </span><span class="Apple-style-span" style="font-family: 'times new roman', times, serif; font-size: medium; line-height: 21px;">does not like being told that they are contributing to the rampant</span><span class="Apple-style-span" style="font-family: 'times new roman', times, serif; font-size: medium; line-height: 21px;"> </span><span class="Apple-style-span" style="font-family: 'times new roman', times, serif; font-size: medium; line-height: 21px;"><span class="yshortcuts" id="lw_1303441448_5" style="border-bottom-color: rgb(54, 99, 136); border-bottom-style: dotted; border-bottom-width: 2px; cursor: pointer; line-height: 1.2em; outline-color: initial; outline-style: none; outline-width: initial;">adult-onset diabetes</span></span><span class="Apple-style-span" style="font-family: 'times new roman', times, serif; font-size: medium; line-height: 21px;"> </span><span class="Apple-style-span" style="font-family: 'times new roman', times, serif; font-size: medium; line-height: 21px;">and obesity in the US and Canada. And their ads claim the opposite. But if you examine the science, you will never use an</span><span class="Apple-style-span" style="font-family: 'times new roman', times, serif; font-size: medium; line-height: 21px;"> </span><span class="Apple-style-span" style="font-family: 'times new roman', times, serif; font-size: medium; line-height: 21px;"><span class="yshortcuts" id="lw_1303441448_6" style="background-attachment: initial; background-clip: initial; background-color: transparent; background-image: initial; background-origin: initial; background-position: initial initial; background-repeat: initial initial; border-bottom-color: initial; border-bottom-style: none; border-bottom-width: initial; cursor: pointer; line-height: 1.2em; outline-color: initial; outline-style: none; outline-width: initial;">artificial sweetener</span></span><span class="Apple-style-span" style="font-family: 'times new roman', times, serif; font-size: medium; line-height: 21px;"> </span><span class="Apple-style-span" style="font-family: 'times new roman', times, serif; font-size: medium; line-height: 21px;">again.</span><br />
<span class="Apple-style-span" style="font-family: 'times new roman', times, serif; font-size: medium; line-height: 21px;"> </span><span class="Apple-style-span" style="font-family: 'times new roman', times, serif; font-size: medium; line-height: 21px;"> </span><span class="Apple-style-span" style="font-family: 'times new roman', times, serif; font-size: medium; line-height: 21px;"><br style="line-height: 1.2em; outline-color: initial; outline-style: none; outline-width: initial;" /></span><span class="Apple-style-span" style="font-family: 'times new roman', times, serif; font-size: medium; line-height: 21px;">1. Yang Q.Gain weight by "going diet?" Artificial sweeteners and the neurobiology of sugar cravings: Neuroscience 2010. Yale J Biol Med. 2010 Jun;83(2):101-8.</span><span class="Apple-style-span" style="font-family: 'times new roman', times, serif; font-size: medium; line-height: 21px;"><br style="line-height: 1.2em; outline-color: initial; outline-style: none; outline-width: initial;" /></span><span class="Apple-style-span" style="font-family: 'times new roman', times, serif; font-size: medium; line-height: 21px;">2. Brown RJ, de Banate MA, Rother KI.Artificial sweeteners: a systematic review of metabolic effects in youth. Int J Pediatr Obes. 2010 Aug;5(4):305-12.</span><span class="Apple-style-span" style="font-family: 'times new roman', times, serif; font-size: medium; line-height: 21px;"><br style="line-height: 1.2em; outline-color: initial; outline-style: none; outline-width: initial;" /></span><span class="Apple-style-span" style="font-family: 'times new roman', times, serif; font-size: medium; line-height: 21px;">3. Margolskee,R, et al. T1R3 and gustducin in gut sense sugars to regulate expression of Na+-glucose cotransporter 1 PNAS 2007 104: 15075-15080</span>Rakesh C. Patel, M.D.http://www.blogger.com/profile/16966778816944175639noreply@blogger.com2tag:blogger.com,1999:blog-2774385784446128210.post-49264091828794547392011-02-06T19:34:00.000-08:002011-02-06T19:34:44.761-08:00Yeaaa! We're number one again!!!Unfortunately, this number 1 ranking is something that we should not be proud about. Congratulations to the US for being the fattest nation in the world. Latest statistics show that our average body mass index is over 28 (25-29.9 is overweight and over 30 is obese).<br />
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I am always amazed at the charts on obesity on the CDC website over the last 20 years (<a href="http://www.cdc.gov/obesity/data/trends.html#State">http://www.cdc.gov/obesity/data/trends.html#State</a>) . It is shocking.<br />
<br />
This article has charts from the World Health Organization:<br />
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<a href="http://www.dailymail.co.uk/news/article-1353761/U-S-home-fattest-men-women-Western-World.html">http://www.dailymail.co.uk/news/article-1353761/U-S-home-fattest-men-women-Western-World.html</a><br />
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Yet, the "Food-Industrial Complex", continues to dupe the masses with fancy marketing and deceptive food labels.<br />
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I just saw this ad on the TV yesterday regarding high fructose corn syrup:<br />
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http://www.youtube.com/watch?v=EEbRxTOyGf0<br />
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Well, if you have 1 1/2 hour to kill, I HIGHLY recommend spending the time watching this presentation "Sugar: The Bitter Truth" by Robert H. Lustig MD. He is a Endocrinologist at UCSF. I think he does an elegant job of talking about sugar in the diet and particularly fructose.<br />
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Sorry to be a downer on Super Bowl Sunday, but as I tell my patients, "it is, what it is".Rakesh C. Patel, M.D.http://www.blogger.com/profile/16966778816944175639noreply@blogger.com2tag:blogger.com,1999:blog-2774385784446128210.post-64519102067587591222011-02-04T21:29:00.000-08:002011-02-04T21:29:01.601-08:00Metabolic Syndrome and Cognitive Function<div class="enrichLocation"> <b>Bordeaux, France</b> - People with the metabolic syndrome were significantly more likely than others to experience a decline in cognitive function, independent of previous cardiovascular disease, depression, or <i>APOE</i> genotype, in a study of generally healthy adults aged 65 and older who were followed for four years [<a href="http://www.theheart.org/article/1181423.do#bib_1"><b>1</b></a>]. In particular, hypertriglyceridemia and low HDL-cholesterol levels were associated with declines in global cognitive function, and diabetes was associated with deteriorating memory. </div><div class="enrichLocation">"Our study sheds new light on how metabolic syndrome and the individual factors of the disease may affect cognitive health," first author <b>Dr </b><b>Christelle Raf</b><b>faitin</b> (French National Institute of Health Research, Bordeaux, France) noted in a statement on the study from the <b>American Academy of Neurology</b>. The report was published online February 2, 2011 in <i>Neurology</i>. </div>"Our results suggest that management of metabolic syndrome may help slow down age-related memory loss or delay the onset of dementia." <b><u>to read more click the link</u></b><br />
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<a href="http://www.theheart.org/article/1181423.do">http://www.theheart.org/article/1181423.do</a><br />
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My comments:<br />
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The data keeps coming in how detrimental the metabolic syndrome and insulin resistant cholesterol pattern is in terms of risk for disease beyond the heart. I feel it is very important to look for insulin resistance. The key is identifying it early and educating my patients of the risk to their health. This way a plan of action can be formulated.<br />
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Those markers of insulin resistance can include acanthosis nigricans on physical exam (unfortunately commonly seen in my practice in adults as well as in teens!), abnormal lab values like elevated uric acid, GGT, high TG/HDL ratio, elevated blood glucose, low testosterone, low vitamin D.<br />
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A word on blood glucose. I feel it is very important to make use of the 2 hour glucose tolerance test (fasting, 1 hour and 2 hour post 70 gram carbohydrate challenge). Based on this article in Diabetes care last March (<a href="http://care.diabetesjournals.org/content/33/3/557.full">http://care.diabetesjournals.org/content/33/3/557.full</a>), a lot of information can be obtained and education points for patients. The scary realization from the study is that if the 1 hour blood glucose is over 150 mg/dl, you have a 13 times increased risk of becoming diabetic in the next 8 years (even with normal fasting and 2 hour blood glucose)! Worse yet, the risk starts to increase with the 1 hour sugar staring at 120 mg/dl!<br />
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So be on the look out and be vigilant, you never know when insulin resistance can rear it's ugly head. Unfortunately, these days it is more common than not.Rakesh C. Patel, M.D.http://www.blogger.com/profile/16966778816944175639noreply@blogger.com1tag:blogger.com,1999:blog-2774385784446128210.post-60331647964313929192011-01-25T19:50:00.000-08:002011-01-25T19:50:11.808-08:00Eating A Rainbow Counts!We always encourage patients to focus on vegetables and fruits (in that order). The main message is variety, especially when looking at colors. We know these natural forms of nutrients and anti-oxidants (as opposed to pills, powders, and magic potions) play an important role in preventing illness and disease.<br />
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When you are looking at fruits, try to pick fruits that have skin (ie fiber) like hard apples/pears and any type of berry. Try avoiding fruits that are higher in glycemic index such as melons and pineapple (this means the sugars in these fruits get into the body very quickly causing higher levels of blood glucose).<br />
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With veggies, avoid the starchy ones like potatoes, corn, and peas. Target the green leafy veggies like spinach, collards, and kale. Then add the colors like yellow or red bell peppers. Mushroom and onions are good to go as well. Going to a local farmers market can also help in trying variety as you will usually find the in season produce.<br />
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Here is a link to one I attend regularly:<br />
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<a href="http://www.arizonafarmersmarkets.com/pageAhwatukee/ahwatukee.htm">http://www.arizonafarmersmarkets.com/pageAhwatukee/ahwatukee.htm</a><br />
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A new study has shown eating veggies and fruits with a variety of color can help prevent hypertension (high blood pressure).<br />
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Please click on the article below:<br />
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<a href="http://www.theheart.org/article/1174585.do">http://www.theheart.org/article/1174585.do</a>Rakesh C. Patel, M.D.http://www.blogger.com/profile/16966778816944175639noreply@blogger.com2tag:blogger.com,1999:blog-2774385784446128210.post-35951102816158970942011-01-25T19:32:00.000-08:002011-01-25T19:32:14.233-08:00Welcome!My name is Rakesh Patel. I am a Family Physician in Gilbert, Arizona. Welcome to my blog. My main goal in treating patients is helping prevent heart attacks and strokes. We look at many risk factors to determine the best path for prevention. I hope you find my posts intriguing and insightful on your road to prevention!Rakesh C. Patel, M.D.http://www.blogger.com/profile/16966778816944175639noreply@blogger.com0