Gluttony, sloth and metabolic syndrome

There was a fabulous post by Peter at Hyperlipid today. I enjoyed his figures so much, I had to pass them on.

http://high-fat-nutrition.blogspot.com/2010/03/getting-fat-is-good-official.html

The issue here is correctly identifying cause and effect; something which I’ve noticed is a common problem in many aspects of modern society.

[[MORE]]Here's the diagram from the original paper Peter mentions, which claims that gluttony and sloth cause hyperinsulinemia, which in turn causes a host of additional maladies:



Here's Peter's alternative diagrams, which more accurately represent cause and effect:

Increased fasting blood glucose in low-carb diets

When you're relatively insulin resistant, even a slight rise in glucose production or intake can cause a blood glucose (BG) peak.

It goes something like this: low-carb intake reduces insulin; low insulin activates hormone-sensitive lipase (LIPE); LIPE breaks down triglycerides in the muscle or adipose tissue and releases non-essential fatty acids (NEFA); NEFA induces insulin resistance.

[[MORE]]In the morning, you normally have a growth hormone surge; that causes NEFAs to peak, and you have a spike in fasting BG (FBG).  When you eat a low-carb meal, the protein in it will cause insulin to be released -- although not nearly as much as if you ate carbs.  The insulin inhibits LIPE, so NEFAs decline; insulin sensitivity comes back; BG goes down.

However, if you have too much protein, BG can decline too far; then the body secretes catecholamines (adrenaline) to help bring BG back up again; that stimulates GNG (I'm not sure of the mechanism--it may be by stimulating glucagon release from the pancreas); you start to feel jittery; if it happens in the evening, it can contribute to insomnia.  Sometimes people mistake the jitteriness from low BG with what they feel from caffeine.  Also, you can become acclimated to the elevated catecholamine levels, which is why diabetics can be at severe risk for not recognizing low BG (a diabetic relative of mine passed out at the wheel and was killed as a result of this).

Caffeine and cocoa

One of the goals of the Paleo diet is to reduce the level of insulin in the body.  Insulin is a pro-aging hormone; it encourages excess energy to be stored as fat, and acts to inhibit lipolysis.  One of the side-effects of a low-carb diet is increased insulin resistance, which can lead to higher levels of insulin and larger peaks in blood glucose (BG) levels (high BG levels are worth avoiding because they can damage many internal systems, particularly nerves).

[[MORE]]Maintaining insulin sensitivity, or even increasing it, should be part of a comprehensive Paleo program.  There are many ways to do that, but I thought I would mention two that might be of interest: caffeine and cocoa.  In addition to improving insulin sensitivity, caffeine also decreases TNF-alpha, which lowers inflammation (which should, in theory, also be anti-cancer).  Cocoa contains not just caffeine, but also flavonoids, and cocoa consumption has been documented as having a strong inverse association with mortality from heart disease.

More details at Dr. T’s Nephropal blog:
http://nephropal.blogspot.com/2009/10/beans-coffe-and-cacao.html

Part of what this means to me is that drinks with coffee or tea or cocoa and cream, are acceptable on a Paleo diet not just for their low-carb, high-fat content, but because of the caffeine and flavonoids too.

Here's a link to a study that supports the idea that a low-carb diet increases insulin resistance:

http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=ShowDetailView&TermToSearch=7895958 

As it says in the abstract: "Studies in both humans and experimental animals indicate that the adaptive (phenotypic) response to low-carbohydrate intake is insulin resistance."

What happens with a low-carb diet is that with lower levels of BG, muscles adapt to burning fat as fuel.  Then, in order to conserve glucose for areas like the brain, the muscles become insulin resistant.

The often-neglected issue with the high-carb Kitavans is that they have a high sensitivity to insulin that's derived directly from their genetics; that's how they can get away with a diet like that and remain healthy.  Most people don't share those genes.

Here are links to a few more related papers:

http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=ShowDetailView&TermToSearch=9288547

http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=ShowDetailView&TermToSearch=10889799

Here are a few references for coffee and cocoa/chocolate (low adiponectin is associated with insulin resistance):

Williams, CJ, et al: Coffee consumption is associated with higher plasma adiponectin concentrations in women with or without type 2 diabetes: a prospective cohort study. Diabetes Care. 2008 Mar;31(3):504-7.

Janszky I, Mukamal KJ, Ljung R, Ahnve S, Ahlbom A, Hallqvist J: Chocolate consumption and mortality following a first acute myocardial infarction: the Stockholm Heart Epidemiology Program. J Intern Med. 2009 Sep;266(3):248-57.

Ding, E, et al: Chocolate and Prevention of Cardiovascular Disease: A Systematic Review. Nutrition and Metabolism. Jan 2006, 3(2):1743-707

Grassi D, et,al : Short-term administration of dark chocolate is followed by a significant increase in insulin sensitivity and a decrease in blood pressure in healthy persons. Am J Clin Nutr 2004;81:611– 4

I'm not trying to suggest that caffeine or flavonoid supplementation is a requirement; I'm confident that you can be perfectly healthy without them.  Rather, it seems like they could be an optimization, particularly for people who don't get enough vigorous exercise.

In addition to the Paleo diet, our evolutionary metabolic environment also included plenty of moving around, which decreases insulin resistance.  For those of us who are relatively sedentary, foods like caffeine and flavonoids may offset some of the negative effects of not getting enough exercise, by helping to maintain insulin sensitivity.

An approach to high blood pressure

The best approach to high blood pressure will of course depend on the cause.  Metabolic syndrome (chronic high levels of insulin with associated insulin resistance) is one well-documented cause of hypertension, as is diabetes.  The theory is that chronically high BG (even below levels considered diabetic) can damage nerves, including the autonomic nervous system, which is responsible for controlling blood pressure (among many other things).  In the long-term, the Paleo diet should help improve things by eliminating what may have been one aspect of the initial cause.

[[MORE]]There are many other causes too, though.  Calcium is required for muscles to contract, and magnesium is needed for them to relax – that includes the muscles in arterial walls, which, when they contract, raises your blood pressure.  Increasing your magnesium to the point of bowel tolerance for a few months helps some people.  Unfortunately, magnesium deficiency is wide-spread and often hard to correct.  Avoid magnesium oxide; amino acid chelates, such as magnesium orotate or aspartate are much more readily absorbed.  Time-release mag chloride (“Slow Mag”) is another option. Mag citrate (Natural Calm) is also OK, although you need to take more of it to get the same effect.

Another area that helps for some is nitric oxide (NO) releasers, such as arginine, ginkgo biloba, panax ginseng, resveratrol, green tea, garlic and quercitin.  NO is involved with blood vessel dilation.  Since NO is a strong oxidant, be sure to take extra antioxidants with NO releasers.