Instead of putting carbs in the doghouse and protein on a pedestal, make moderation the key for a healthy diet

With the explosion of many “new” diets designed to lower intake of carbohydrates and increase protein consumption, it would be natural to think that carbohydrates are evil and contribute to all diseases known to mankind. One could also assume that the key to losing weight and living forever is to cut out all the carbohydrates possible in the diet.

The Skinny on Diets
There are several problems and concerns with this assumption. First, these diet plans are not new—they have been around for decades. If they were so truly wonderful and life saving, why did they vanish into obscurity? And, after nearly 3 decades, why have not clinical studies been done to demonstrate the effectiveness and safety of these diets? Dean Ornish, MD, the cardiovascular diet guru, immediately saw the importance of researching his lifestyle plan and has since demonstrated its effectiveness and safety in clinical studies for reducing cardiovascular disease in heart patients.¹

How and why did the recent high protein diet craze come about? It started with the low fat diets, because someone promoted the concept that fats are not good for you. Saturated and trans fat are unhealthy, but mono and polyunsaturated fats are tremendously important to our health. The reasoning for the diets was that, since fats have a high energy density and are cut out of the diet, then weight loss will occur. Unfortunately it did not work out that way. The fat in these diets was replaced with high fructose corn syrup—processed sugar—which has other detrimental effects on human health. Therefore, since cutting out fat did not work, carbohydrate cutting must be the answer. Hence, the concept of the high protein diet was born. And yes, people are losing weight. But at what cost?

Many people on high protein diets have switched to high animal protein diets. Numerous nutrition talk show hosts claim that we are meant to be carnivores and will do better with that lifestyle. Unfortunately, they are remiss in their study of physiology—humans, along with a handful of other mammals, have lost the ability to make intrinsic vitamin C.² Apes will forage for berries in the wild and typically consume several thousand grams of vitamin C daily this way. True carnivores still retain intrinsic vitamin C production in the liver. Study after study have consistently shown that higher intakes of animal proteins increase our risk of cancer, osteoporosis, heart disease, and many other diseases.³,⁴ To add insult to injury, these people cut out the fruits, vegetables, and whole grains that protect against these same diseases. Patients on high protein diets are trading short-term weight loss for long-term health.

Not Created Equally
As for carbohydrates, not all are processed equally. Start with the whole grain; loaded with nutrients, fiber, and other healthy ingredients that nature gave us, but science cannot even identify. Then all that is natural and good is stripped, and a small portion is added back (mainly because of FDA regulations), which is then called “enriched.” It is not enriched—rather, it is stripped down, nutrient-poor, diabetes-causing, weight-gaining flour.

For example, some studies have demonstrated unequivocally that whole grains lower the risk of most major diseases and health conditions.⁵ On the other hand, refined grains (ie, processed) increases the risk of almost all major cancers, diabetes, and heart disease. When many diet plans remove the fat, it is replaced with refined carbohydrates—the best example is enriched wheat flour—which stimulates high insulin production. And insulin is not always a friendly hormone. As everything else in life, in normal physiological levels, it serves us well, but in states of excess, it becomes damaging to our health.

Most refined carbs have a high glycemic index—the rate at which glucose shows up in the bloodstream after ingesting a substance.⁶ There are some exceptions of refined carbs with a low glycemic index, but in general it causes glucose to hit the bloodstream in a rush. The body’s reaction to glucose in the bloodstream is to secrete insulin—the higher the glucose, the stronger the insulin response. In a certain percentage of patients, some estimates as high as 20% of the US population,⁷ the cycle of high glucose levels and repeated high insulin responses produces a condition known as hyperinsulinemia.

Glycosylation of proteins has long been implicated as one of the hallmarks of aging.⁸ In this theory, irreversible damage to cellular proteins by glycosylation ultimately leads to cell death. The higher the glucose levels in the bloodstream, the greater the amount of glycosylation that occurs. The hyperinsulinemia experienced in this syndrome has been linked with a constellation of adverse health effects: impaired vascular reactivity,⁹ polycystic ovary syndrome,¹⁰ hyperandrogenism,¹¹ increased cardiovascular risk and hypercholesterolemia,¹² and many types of cancer.¹³

This constellation of symptoms that include hypercholesterolemia, hyperinsulinemia, hypertriglyceridemia, abdominal obesity, and hypertension are referred to as the metabolic syndrome X, which is a term coined by Gerald Reaven, MD, several decades ago. This altered insulin resistance has the potential to contribute to many of the chronic diseases of a Western lifestyle. Fortunately, management of insulin resistance can be done effectively from a natural perspective.

Under New Management
First and foremost in managing insulin is exercise, both aerobic and resistance. Aerobic exercise will help improve overall insulin sensitivity, while resistance exercise will build muscle; muscle mass is a major player in insulin mediated glucose uptake. This concept holds true whether the patient is 3 or 93 years old. We have typically considered our elderly as frail and avoided recommendations for resistance exercise. However, recent studies in elderly nursing home residents suggest that resistance training in this group of patients provides tremendous overall health benefits.¹⁴

The next approach is to examine the dietary patterns. Are they consuming refined carbohydrates and saturated fats? The soluble fibers found in whole grains and compounds in soy contain alpha-glucosidase inhibitors that slow down the digestion of glucose linkages. Ironically, one class of diabetic medications, the acarbose family, is alpha-glucosidase inhibitors. If more whole grains are consumed, then there would not be a need for the pharmaceutical form of the enzyme to slow processed sugar breakdown. Most patients need quite a bit of training on healthy lifestyle habits. Educating patients about going back to nature and avoiding processed foods is essential. If one needs to be a biochemist to read the label, then the food should not be ingested. Adjusting dietary patterns alone has an incredible impact on multiple diseases processes.

Supplement and Demand
Nutritional supplementation can play an important role in managing insulin resistance as well. Key nutrients vanadium and chromium act to help insulin do its job. Chromium is believed to act by amplifying the action of insulin on individual cells.¹⁵, ¹⁶ Vanadium’s action is not quite as clear. Most research points to several modes of action; to increase cellular sensitivity to low levels of insulin¹⁷ and also to act via an insulin-independent action to lower blood glucose levels.¹⁸ Conjugated linoleic acid (CLA) is a substance produced by bacterial action in ruminant animals and believed to act via the upregulation of the peroxisome poliferator activated receptor (PPAR)-alpha family of genes to affect insulin sensitivity.¹⁹ Alpha lipoic acid (ALA) has been used extensively in the past for its hydrophilic and hydrophobic antioxidant properties, and yet recently it has been identified as affecting glucose disposal. This effect is believed to be mediated through increased translocation of the GLUT-4 receptor to the cell surface of adipose cells—thereby increasing their glucose uptake ability.²⁰

Diagnosis of insulin resistance can be done with thorough patient history as well as some basic bloodwork. If there is a need to quantify the level of insulin resistance, several tests can be conducted. From a nonresearch perspective, I feel that the oral glucose tolerance test (OGGT) is one of the most effective. However, just measuring glucose levels, as is commonly done, is inadequate. Normal patterns of glucose appearance and clearance may be present, but what if high levels of insulin are needed to bring these glucose levels into the ideal range? Anytime an OGGT is done, both glucose and insulin levels have to be evaluated, which can give an early, clear indication of altered insulin resistance. Since the OGGT is a long and cumbersome test, many studies have tried to identify a single laboratory factor that is reflective of insulin sensitivity. Current contestants include fasting insulin to glucose ratio and fasting insulin with fasting triglyceride levels. A certain percentage of patients with impaired insulin resistance will go on to develop Type II diabetes, but this process can be identified and halted literally decades before glucose levels in blood and urine tip past the normal and into the diabetic range.

Overall, there is a shift in the belief of the general population that carbohydrates and fats are bad for us and that diets high in protein are the answer to all our woes. Rarely do the latest diet trends turn out to be based in solid scientific findings; most are ineffective in the long run and some are outright harmful. By educating your patients about the differences in beneficial fats and carbohydrates, we can help them understand that moderation is the key. If your patient has some evidence of insulin resistance, then steps need to be taken now to dramatically cut risk of many chronic diseases that impaired insulin resistance can adversely affect. CP

James Bogash, DC, is in private practice, Lifecare Chiropractic, Mesa, Ariz. He writes a weekly newsletter of research updates on topics related to natural medicine and wellness for his website: www.lifecarechiropractic.com. Bogash can be reached via email: info@lifecarechiropractic.com.

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