Part 4 of 4 (Part 1, Part 2, Part 3)
By Ron Rosedale, M.D.
Presented at Designs for Health
Institute's BoulderFest August 1999 Seminar
The receptors self-regulate.
If you want to know if insulin sensitivity can
be restored to its original state, well, perhaps not to its original
state, but you can restore it to the state of about a ten year
old.
One of my first experiences with this, I had a patient who literally
had sugars over 300. He was taking 200+ units of insulin, he was
a bad cardiovascular patient, and it only made sense to me that
you don't want to feed these people carbohydrates, so I put him
on a low carbohydrate diet.
He was an exceptional case, after a month to six weeks he was
totally off of insulin. He had been on 200 some units of insulin
for twenty-five years. He was so insulin resistant, one thing
good about it is that when you lower that insulin, that insulin
is having such little effect on him that you can massively lower
the insulin and its not going to have much of an effect on his
blood sugar either. 200 units of insulin is not going to lower
your sugar any more that 300 mg/deciliter.
You know that the insulin is not doing much. So we could rapidly
take him off the insulin and he was actually cured of his diabetes
in a matter of weeks. So he became sensitive enough, he was still
producing a lot of insulin on his own, then we were able to measure
his own insulin and it was still elevated, and then it took a
long time, maybe six months or longer to bring that insulin down.
It will probably never get to the point of the sensitivity of
a ten year old, but yes, your number of insulin receptors increases,
and the activity of the receptors, the chemical reactions that
occur beyond the receptor occur more efficiently.
You can increase sensitivity by diet, that is one of the major
reasons you want to take Omega 3 oils. We think of circulation
as that which flows through arteries and veins, and that is not
a minor part of our circulation, but it might not even be the
major part. The major part of circulation is what goes in and
out of the cell.
The cell membrane is a fluid mosaic. The major part of our circulation
is determined by what goes in and out. It doesn't make any difference
what gets to that cell if it can't get into the cell. We know
that one of the major ways that you can affect cellular circulation
is by modulating the kinds of fatty acids that you eat. So you
can increase receptor sensitivity by increasing the fluidity of
the cell membrane, which means increasing the omega 3 content,
because most people are very deficient.
They say that you are what you eat and that mostly pertains to
fat because the fatty acids that you eat are the ones that will
generally get incorporated into the cell membrane. The cell membranes
are going to be a reflection of your dietary fat and that will
determine the fluidity of your cell membrane. You can actually
make them over fluid.
If you eat too much and you incorporate too many omega 3 oils
then they will become highly oxidizable (so you have to eat Vitamin
E as well and monounsaturates as well) There was an interesting
article pertaining to this where they had a breed of rat that
was genetically susceptible to cancer.
What they did was they fed them a high omega 3 diet, plus iron,
without any extra Vitamin E and they were able to almost shrink
down the tumors to nothing, because tumors are rapidly dividing.
This is like a form of chemotherapy, and the membranes that were
being formed in these tumor cells were very high in omega three
oils, the iron acted as a catalyst for that oxidation, and the
cells were exploding from getting oxidized so rapidly. So omega
3 oils can be a double edged sword.
Most food is a double
edged sword.
Like oxygen and glucose, they keep us alive and
they kill us, eating is the biggest stress we put on our body
and that is why in caloric restriction experiments you can extend
life as long as you maintain nutrition. This is the only proven
way of actually reducing the rate of aging, not just the mortality
rate, but the actual rate of aging, because eating is a big stress.
It has actually been shown by quite a number of papers that resistance
training for insulin resistance is better than aerobic training.
There are a variety of other reasons too. Resistance training
is referring to muscular exercises. If you just do a bicep curl,
you immediately increase the insulin sensitivity of your bicep.
Just by exercising, and what you are doing is you are increasing
the blood flow to that muscle. That is one of the factors that
determines insulin sensitivity is how much can get there. It has
been shown conclusively that resistance training will increase
insulin sensitivity.
Back to the macronutrients because that is real simple, you don't
want very much in the way of non-fiber carbs, fiber carbs are
great, you are going to get some non-fiber carbs. Even if you
just eat broccoli you are going to get some non-fiber carbs. That
is OK since at least for the most part you are getting something
that is really pretty good for you. Protein is an essential nutrient.
You want to use it as a building block because your body requires
protein to repair damage and replenish enzymes. All of the encoded
instructions from your DNA are to encode for proteins. That is
all the DNA encodes for. You need protein, but you want to use
it as a building block, but I don't believe in going over and
above the protein that you need to use for maintenance, repair
and building blocks.
I don't think you should be using protein as a primary fuel source.
Your body can use protein very well as a fuel source. It is good
to lose weight while using it a s a fuel source because it is
an inefficient fuel source. Protein is very thermogenic, it produces
a lot of heat, which means that less of it is going into stored
energy, more is being dissipated. Just like throwing a log into
a fireplace.
Your primary fuel should
be coming from fat.
So you can calculate the amount of protein a person
requires, or at least estimate it by their activity level. The
book Protein Power actually went very well in to this. You have
to calculate how much protein is required by their activity level
and their lean body mass. There is still some gray area as to
how many grams per kilogram of lean body mass, depending on the
activity that person requires.
Anywhere perhaps one to two grams of protein per kilogram of lean
body mass, maybe even a little bit higher if someone is really
active.
You don't want to go under that for very long. I'd say that it
is better to go over than to go under that amount for very long.
But I especially don't want my diabetic patients, which means
all of us, because in a very real sense we really all have diabetes,
it is just a matter of degree, we all have a certain degree of
insulin resistance.
If you can cure a diabetic of diabetes, you can do the same thing
to a so-called non-diabetic person and still improve that person.
I want to improve my insulin sensitivity just as much as I do
my diabetics because insulin sensitivity is going to determine
for the most part how long you are going to live and how healthy
you are going to be. It determines the rate of aging more so than
anything else we know right now.
What about supplements
such as Chromium for example?
Chromium, it depends on whom you are dealing with,
but are we talking about a diabetic patient, who is supposed to
be the topic of this talk, yes, all my diabetics go on 1,000 mcg.
of chromium, some a little bit more if they are really big people.
Usually 500 mcg for a non-diabetic. It depends on their insulin
levels.
I don't care so much what their sugar levels are, I care what
their insulin levels are, which is a reflection of their insulin
sensitivity. We are talking about hyperinsulinemia or non-hyper-insulinemia.
Its insulin we should be concerned about.
I use a lot of supplements. What you really want to do, and my
purpose mostly is to try to convert that person back into being
an efficient burner of fat. We talked about when you are very
insulin resistant and you are waking up in the morning with an
insulin that is elevated, you cannot burn fat, you are burning
sugar.
They don't know how to burn fat anymore and that is your best
fuel.
One of the reasons that sugar goes up so high
is because that is what your cell is needing to burn, but if it
is so insulin resistant it requires a blood sugar of 300 so that
just by mass action some can get in to the cell and be used as
fuel. If you eliminate that need to burn sugar, you don't need
such high levels of sugar even if you are insulin resistant.
So you want to increase
the ability of the cells in the body to burn fat.
You want to make that glucose burner into a fat
burner. You want to make a gasoline burning car into a diesel
burning car. Did anyone ever look at the molecular structure of
diesel fuel in your spare time? It looks almost identical to a
fatty acid. There is a company right now that can tell you how
to alter vegetable oil to use in your Mercedes. It's just a matter
of thinning it out a little bit. It is a very efficient fuel.
You can look at other variables that will give you some idea too
such as triglycerides. If they are very sensitive to high levels
of insulin, they come in with insulin levels of 14 and they have
triglycerides of 1000, then you would treat them just as you would
if they had an insulin level of 50. It gives you some idea of
the effect of the hyperinsulinemia on the body.
You can use triglycerides as a gauge, which I often do. The objective
is to try to get the insulin level just as low as you possibly
can. There is no limit. They classify diabetes now as a fasting
blood sugar of 126 or higher. A few months ago it might have been
140. It is just an arbitrary number, does that mean that someone
with a blood sugar of 125 is non-diabetic and fine? If you have
a blood sugar of 125 you are worse than if you had a blood sugar
of 124. Same with insulin. If you have a fasting insulin of 10
you are worse off than if you had an insulin of 9. You want to
get it just as low as you can.
With athletes, let's think about that. What is the effect of carbohydrate
loading before an event. What happens if you eat a bowl of pasta
before you have to run a marathon. What does that bowl of pasta
do? It raises your insulin. What is the instruction of insulin
to your body?
To store energy and not burn it. I see a fair amount of athletes
and this is what I tell them, you want everybody, athletes especially,
to be able to burn fat efficiently. So when they train, they are
on a very low carbohydrate diet. The night before their event,
they can stock up on sugar and load their glycogen if they would
like.
They are not going to become insulin resistant in one day. Just
enough to make sure, it has been shown that if you eat a big carbohydrate
meal that you will increase your glycogen stores, that is true
and that is what you want. But you don't want to train that way
because if you do you won't be able to burn fat, you can only
burn sugar, and if you are an athlete you want to be able to burn
both.
Few people have problems burning sugar if they are an athlete,
but they have lots of problems burning fat, so they hit the wall.
And for a certain event like sprinting it is less important, truthfully,
for their health it is very important to be able to burn fat,
but a sprinter will go right into burning sugar. If you are a
50 yard dash man, whether you can burn fat or not is not going
to make a huge difference in your final performance.
Beyond your athletic years if you don't want to become a diabetic,
and if you don't want to die of heart disease and if you don't
want to age quickly…It is certainly not going to do you any harm
to be able to burn fat efficiently in addition to sugar.
Vanadyl Sulfate is an insulin mimic, so that it can basically
do what insulin does by a different mechanism. If it went through
the same insulin receptors, then it wouldn't offer any benefit,
but it doesn't, it actually has been shown to go through a different
mechanism to lower blood sugar, so it spares insulin and then
it can help improve insulin sensitivity. On someone who I am trying
to really get their insulin down I go 25mg 3X/day temporarily.
I put people on glutamine powder. Glutamine can act really as
a brain fuel, so it helps eliminate carbohydrate cravings while
they are in that transition period. I like to give it to them
at night and I tell them to use it whenever they feel they are
craving carbohydrates. They can put several grams into a little
water and drink it and it helps eliminate carbohydrate cravings
between meals.
It is a high protein diet that will increase an acid load in the
body, but not necessarily a high fat diet. Vegetables and greens
are alkalinizing, so if you are eating a lot of vegetables along
with your protein it equalizes the acidifying effect of the protein.
I don't recommend a high protein diet. I recommend an adequate
protein diet.
I think you should be using fat as your primary energy source,
and fat is kind of neutral when it comes to acidifying or alkalinizing.
In general, over 50% of the calories should come from fat, but
not from saturated fat. When we get to fat, the carbohydrates
are clear cut, no scientist out there is really going to dispute
what I've said about carbohydrates.
There is the science behind it. You can't dispute it. There is
a little bit of a dispute as to how much protein a person requires.
When you get to fat, there is a big grey area within science as
to which fat a person requires. We just have one name for fat,
we call it fat or oil. Eskimos have dozens of names for snow and
east Indians have dozens of names for curry. We should have dozens
of names for fat because they do many different things. And how
much of which fat to take is still open to a lot of investigation
and controversy.
My take on fat is that if I am treating a patient who is generally
hyperinsulinemic or overweight, I want them on a low saturated
fat diet. Because most of the fat they are storing is saturated
fat. When their insulin goes down and they are able to start releasing
triglycerides to burn as fat, what they are going to be releasing
mostly is saturated fat. So you don't want to take anymore orally.
There is a ration of fatty acids that is desirable, if you took
them from the moment you were born, but we don't, we are dealing
with an imbalance here that we are trying to correct as rapidly
as we can.
You have plenty of saturated fat. Most of us here have enough
saturated fat to last the rest of our life. Truthfully. Your cell
membranes require a balance of saturated and poly-unsaturated
fat, and it is that balance that determines the fluidity. As I
mentioned, your cells can become over-fluid if they don't have
any saturated fat.
Saturated fat is a hard fat. We can get the fats from foods to
come mostly from nuts. Nuts are a great food because it is mostly
mono-unsaturated. Your primary energy source ideally would come
mostly from mono-unsaturated fat. It's a good compromise. It is
not an essential fat, but it is a more fluid fat. Your body can
utilize it very well as an energy source.
Animal proteins are
fine and are good for you, but not the ones
that are fed grains.
Grainfed animals are going to make saturated fat
out of the grains. Saturated fat in nature occurs to a very tiny
degree. Not in the wild there is very little saturated fat out
there. If you talk about the Paleolithic diet, we didn't eat a
saturated fat diet. Saturated fat diets are new to mankind. We
manufactured a saturated fat diet by feeding animals grains. You
can consider saturated fat to be second generation carbohydrates.
We eat the saturated fats that other animals produce from carbohydrates.
Zone was a good diet compared to the American diet it was unusual.
Is it an optimal diet? No. Is it optimal for what is known today
about nutrition, it is not. He is stuck in this mold he can't
get out of but now he is trying to get out of it through the back
door. Initially the author spoke about how it made no difference
if you got your carbohydrate from candy or vegetables.
The Volkswagen was a good car, but eventually they had to change
it to keep up with modern technology. What he is doing now is
changing his recipes so that the 40% carbohydrates are coming
primarily from vegetables, and the carbohydrates are going way
down because he knows that if he doesn't it's not as good a diet.
I would go 20% of calories from carbs. Depending on the size of
the person, 25 to 30% of calories from protein, and 60-65% from
fat. You can get non-grain fed beef.
Insulin is not the only
cause of disease.
There are other considerations such as iron. We
know that high iron levels are bad for you. If a person's ferritin
is high, red meat is out for a while, till we get their iron down.
SO there are other things involved about if we are going to allow
a person to eat red meat or not.
There is a great deal of difference between a non-grain fed cow
and a grain fed cow.
Non-grain fed will have only 10% or less saturated fat. Grain
fed can have over 50%.
There is a big difference. A non-grain fed cow will actually be
high in Omega 3 oils. Plants have a pretty high percentage of
Omega 3, and if you accumulate it by eating it all day, every
day for most of your life, your fat gets a pretty high proportion
of Omega 3. I would try for 50% oleic fat, and the others would
depend on the individual, but about 25% of the other two.
In a fat diabetic I would probably go down on the saturated fat
and go 60% oleic. I would go 1 to 1 on the omega 6 to 3, that
would be therapeutic. The maintenance ratio would be about 2.5
to 1 omega 6 to 3. Arachadonic acid, DHA, to EFA. Therapeutic,
I would go lesser on the saturated fats. I would try to do most
of this through diet. There are some practicalities involved.
I would ask the person if they like fish and if they practically
puke in front of me they are going on a tablespoon of cod liver
oil, the best brand is made by Carlson which doesn't taste fishy
at all.
There are probably some others too that are okay. Most people
end up going on a supplement of Omega 3 oils because most of them
are not going to eat enough fish to get it, which would be about
four days a week, and it can't be overcooked etc., it is a little
hard to get that much entirely from diet.
I like sardines if they will eat them. Sardines are a very good
therapeutic food. They are baby fish so they haven't had time
to accumulate a bunch of metal. They are smoked so they are not
cooked and the oil is not spoiled in them. You have to eat the
whole thing. Not the boneless and skinless. You need to eat all
the organs and they are high in vitamins and magnesium.
DNA glycates.
So if people are worried about chromosomal damage
from chromium, what they should really be worried about instead
is high blood sugar. DNA repair enzymes glycate as well. Insulin
is by far your biggest poison. They disproved that study that
was against chromium many times. They showed that it only happens
if you put cells in a petrie dish with chromium but in vivo studies
prove otherwise. The lowering of insulin is going to be better
than any possible detriment of any of the therapies you are using.
Insulin is associated with cancer, everything.Insulin should be
tested on everybody repeatedly, and why it is not is only strictly
because there hasn't been drugs till recently that could effect
insulin, so there is no way to make money off of it. Fasting insulin
is one way to look at it, not necessarily the best way. But it
is the way that everybody could do it. Any family doctor can measure
a fasting insulin. There are other ways to measure insulin sensitivity
that are more complex that we do sometimes.
We use intravenous insulin and watch how rapidly their blood sugar
crashes in a fasting state in 15 minutes and that assesses insulin
sensitivity, then you give them dextrose to make sure they don't
crash any further. There are other ways that are utilized to directly
assess insulin sensitivity, but you can get a pretty good idea
just by doing a fasting insulin.
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