Part 2: What the doctor orders: Based on the book “Metabolical”
There are a few branches of Modern Medicine that have recognized both the problems and the importance of nutritional therapy; for instance, integrative and functional medicine and psychiatry. Their charge is to treat the upstream causes of disease, not the downstream symptoms. Many of these doctors and healthcare professionals eschew medications, rather opting to use food as medicine. And this makes sense the cellular pathways that lead to chronic disease are not druggable, but they are foodable. Unfortunately, such doctors are still few and far between. There are a few courageous practitioners who’ve spoken up, but most of them have been marginalized by the medical establishment for all the reasons stated above. However, this new wave of physicians has some guiding lights and the data to make inroads into the medical debacle we find ourselves in. Decades ago, the ability to dispense nutritional advice was “claimed” by dietitians. The field of modern dietetics was borne out of two concepts, both of which turned out to be false. The first is the idea that a “calorie is a calorie,” which was espoused by the Atwater system, developed by agriculturist Wilbur Olin Atwater in 1916. His claim to fame was that he standardized how much heat energy (i.e., how many kilocalories, or kcal) three specific macronutrients would liberate when burned in a bomb calorimeter (a device that measures heat release of organic substances), and he calculated the ratios, which computes the number of kcal in a given food by its protein (4 kcal/gm), carbohydrate (4 kcal/gm), and fat (9 kcal/gm) content. As fat was the most calorie-dense, Atwater thought it was the most egregious in terms of weight gain. Since then, dieticians have clung to the idea that a patient’s food plate can be calculated using this arithmetic. The problem is that our bodies are a bit more complicated. The Atwater equation neglected to account for the intestinal microbiome and its inherent metabolism of approximately 25 to 30 percent of everything you eat, as well as the role of fiber in altering that percentage. Since fiber doesn’t contribute any calories to your total but alters the percentage of the total that you absorb, the number of calories you eat versus how many you metabolize are completely disparate. Nowhere is this more true than for nuts such as almonds, where the amount of calories absorbed is a full 30 percent less than those generated from a bomb calorimeter; in fact, some manufacturers are now ratcheting down the labeling of caloric content of their products specifically to reflect this fact. Corporate dietitians have continued to exonerate processed food over the decades, as has the American Nutrition and Dietetics Department (AND). They do this for three reasons. The first is that they espouse calories, and virtually all food has calories, so what makes an individual food a problem? The Atwater system was, is, and always will be defective. Where those food calories come from determines where they go. It’s not physics, it’s nutritional biochemistry. My hope is that you will see past this fallacy. They also claim it’s what’s in the food that matters—this is clear from their support of the Nutrition Facts label. Except that it’s not what’s in the food, it’s what’s been done to the food, which doesn’t appear on the food label. They’ve missed the mark on both counts. And, last, 90 percent of their operating budget comes from Big Food, as documented by public health lawyer Michele Simon. They exonerate dietary sugar even to this day because they can’t possibly kill the goose that lays the golden eggs. Calories are the industry’s shield; it’s how they hide from culpability. What can you do to advocate for yourself? Get the proper testing! Here’s the list of the tests you need to make sure your doctor orders: lipid profile (LDL-C, HDL-C, TG), homocysteine (Hcy) level, alanine aminotransferase and aspartate aminotransferase (ALT and AST), uric acid, fasting insulin, fasting glucose, and hemoglobin A1c. Once you have these results, take a look at the HDL. If it’s over 60, it almost doesn’t matter what the other fractions are, as this is a sign of good cardiovascular health. If the HDL is under 40 (men) or under 50 (women), then your predisposition for heart disease is much higher. Then look at LDL-cholesterol. If it’s below 100, the small dense fraction can’t be high enough to be harmful. If it’s between 100 and 300, then you need to look at the TG level. If the TG level is above 150, that’s metabolic syndrome until proven otherwise. You need to assess diet and liver function. The liver enzyme alanine aminotransferase (ALT) is easy to assess and reasonably sensitive and specific for measuring the degree of liver fat. If it’s over 25, you definitely should investigate further. If the AST is elevated, you can assume your liver is either under acute (infectious, alcohol-, or toxin-related) assault, and if your ALT is elevated, then it’s likely under chronic metabolic assault (e.g., liver fat). If both are elevated, you then want to know whether there’s been any liver damage. Uric acid is a by-product of liver carbohydrate metabolism, especially when it metabolizes sugar. This prevents the mitochondria from metabolizing pyruvic acid to carbon dioxide, which forces the liver to turn excess energy into liver fat. Levels above 5.5 indicate mitochondrial dysfunction and insulin resistance. Fatty liver disease: ALT >25 in Caucasians, >20 in African Americans, >30 in Latinos, GGT >35, Uric acid > 5.5. Glucose intolerance: Fasting glucose > 100 or 2-hour, glucose > 140; HbA1c > 6.0 percent. Type 2 diabetes mellitus: Fasting glucose > 125 or 2-hour glucose > 200; HbA1c > 6.5 percent. Dyslipidemia and heart disease Lipid profile: TG > 150, HDL < 40, TG:HDL > 2.5, LDL-C >300, LDL-P >1000 Homocysteine > 15. Insulin resistance: Fasting insulin > 15, Insulin hypersecretion 3-hour OGTT with insulin levels; measure insulin secretion and resistance indices. Signs of poor mitochondrial function are high uric acid and high homocysteine. Signs of liver fat are high ALT and high fasting insulin. Signs of poor peripheral clearance of fat are a high triglyceride and a low HDL. This pattern would argue for reducing your refined carbohydrate and sugar consumption. Conversely, signs of poor liver clearance of fat include a high LDL without a concomitant high triglyceride, as well as a normal fasting insulin levels.
