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See the Seminar at http://www.youtube.com/watch?v=xrsHqIKtXNw A comprehensive analysis of the Metabolic Syndrome, Diabetes and Obesity Epidemic, exploring causal factors of appetite control derangement and descent into obesity, diabetes and coronary heart disease.
Citation preview
The Metabolic SydromeEngineering Root Cause…. and
Solution?(Is it the Sugar/Carb or the Fat…..?)
Ivor Cummins BE (Chem)October 11th 2013
2013 Ivor Cummins BE(Chem) MIEI
IS IS NOT
My personal analysis of broad root cause An aligned view in the orthodoxy…
An Engineering Analysis based on Data A Medical Study or medical guidance
A study of the Biochemistry of Life A study of Nutrition Stuff and latest fads
A personal experiment with N = 1 A Prospective Clinical Trial(!)
Leveraging a vast canon of expert’s work My own experiments and trials (bar 1)
Based on established science and literature Based on any of the BS books out there
IntroductionMyself: UCD, BE Chemical Engineering (Biochemical Stream) 5 Years Medical Device Manufacturing / R&D (hemodialysis & perfusion) 1 Year Precision Machine Design (Coronary Stent Manufacture) 16 Years here (Process, Product, Development…. Complex Problem-Solving focus) Currently R&D Manager (Gen I)
This Body of Work:
2013 Ivor Cummins BE(Chem) MIEI
Dr Peter Attia: mechanical engineering and applied mathematics at Queen’s University. Graduate Stanford Medical School; two years as a post-doctoral fellow at NIH in the National Cancer Institute as a surgical oncology fellow, followed by surgical residency
Robert H. Lustig: M.D. Professor of Pediatrics in the Division of Endocrinology at University of California, San FranciscoDr. Lustig is a Neuroendocrinologist, with basic and clinical training relative to hypothalamic development, anatomy, and function
Kimber Stanhope: M.S. in Nutrition Science and a Ph.D. in Nutritional Biology from the University of California at Davis. Project Scientist in the Department of Molecular Biosciences.20 years of nutrition research experience working on over 150 projects
Jeff S. Volek Ph.D., R.D.: associate professor in The Human Performance Laboratory at The University of Connecticut, Storrs, CT. He is an R.D. and has a Ph.D. in Kinesiology (Pennsylvania State University). He has published over 200 scientific articles and chapters.
A Selection of Experts from My Journey…Dr. Neville Wilson M.D. University of Cape Town Medical School, The College of Medicine, S.A.After stints of service as Doctor and Surgeon all over the world, he is currently in charge of Medical Services at Leinster Clinic Health Services Maynooth.
Andreas Eenfeldt M.D. Swedish medical doctor specializing in family medicine; his particular strength is in comparing and contrasting carbohydrate and fat metabolism in their respective ability to drive the diseases of modernity…he runs DietDoctor.com
2013 Ivor Cummins BE(Chem) MIEI
General / Other DisciplinesOur Engineering Practice
Root Cause Methodology
Problem Definition
Comparative Analysis (IS / IS NOT)•What, When, Where, Extent + Trends
Root Cause Analysis•Cause Effect chain – Root Cause Diagram•Physics based mechanism for all Linkages
Hypothesis Generation•For / Against Analysis•Generate Targeted Experiments
Problem Definition
Correlation Analysis• Epidemiological Studies•Loose application of Is / Is Not
Mechanistic Evidence•Explore mechanisms•Focus on suspected factors
Experimentation•Prospective Studies•Statistical Inference
Design & Analysis Of Experiments•Screening Experiments, then fractional•Statistical Inference informs next steps
2013 Ivor Cummins BE(Chem) MIEI
General / Other DisciplinesOur Engineering Practice
Root Cause Methodology
Problem Definition
Comparative Analysis (IS / IS NOT)•What, When, Where, Extent + Trends
Root Cause Analysis•Cause Effect chain – Root Cause Diagram•Physics based mechanism for all Linkages
Hypothesis Generation•For / Against Analysis•Generate Targeted Experiments
Problem Definition
Correlation Analysis• Epidemiological Studies•Loose application of Is / Is Not
Mechanistic Evidence•Explore mechanisms•Focus on suspected factors
Experimentation•Prospective Studies•Statistical Inference
Design & Analysis Of Experiments•Screening Experiments, then fractional•Statistical Inference informs next steps
A
B
C
2013 Ivor Cummins BE(Chem) MIEI
The Trends – Linear for Weight….
(OECD Data)
2013 Ivor Cummins BE(Chem) MIEI
Australia
Pro
po
rtio
n O
verw
eig
ht
USA
England
France
Korea
…and Exponential for Diabetes
Percent with Diabetes
Number with Diabetes
Per
cen
t w
ith
Dia
bet
es
Nu
mb
er w
ith
Dia
bet
es
2013 Ivor Cummins BE(Chem) MIEI
So is it Simply the Calories?Why are we consuming so much?
2013 Ivor Cummins BE(Chem) MIEI
% Obese
kCal/d
To understand the drivers of both, is the key to recovery…..
2013 Ivor Cummins BE(Chem) MIEI
Weight Control / Obesity is largely a subset of
The Metabolic Syndrome
Metabolic Syndrome Cost Impact?
2013 Ivor Cummins BE(Chem) MIEI
My back-of-the-envelope calculation suggests somewhere in the region of $1 Trillion + per annum in the coming decade for the top 20 GDP countries….
2013 Ivor Cummins BE(Chem) MIEI
Metabolic Syndrome Cost Impact?
Metabolic Syndrome Definition:
METABOLIC SYNDROME
(3 or more of the 5 factors)
Low HDL “Good Cholesterol” <1.0 mmol/L
High Blood Triglycerides >1.5 mmol/L
Waist >~38” Men
>~35” Women
High Blood Sugar
>5.6 mmol/L
Blood Pressure Elevated
>135/85 mmHg
Atheroschlorosis
Coronory Heart Disease
(Obesity)
Fatty Liver Disease
Gout
Arthritis
Type 2 Diabetes
Stroke
Alzheimers
Asthma
Metabolic Syndrome Definition:
METABOLIC SYNDROME
(3 or more of the 5 factors)
Low HDL “Good Cholesterol” <1.0 mmol/L
How many people have it then? It’s not too common, right?
High Blood Triglycerides >1.5 mmol/L
Waist >~38” Men
>~35” Women
High Blood Sugar
>5.6 mmol/L
Blood Pressure Elevated
>135/85 mmHg
Atheroschlorosis
Coronory Heart Disease
(Obesity)
Fatty Liver Disease
Gout
Arthritis
Type 2 Diabetes
Stroke
Alzheimers
Asthma
Metabolic Syndrome Definition:
METABOLIC SYNDROME
(3 or more of the 5 factors)
Low HDL “Good Cholesterol” <1.0 mmol/L
How many people have it then? It’s not too common, right?
How does >50% of US population strike you?
High Blood Triglycerides >1.5 mmol/L
Waist >~38” Men
>~35” Women
High Blood Sugar
>5.6 mmol/L
Blood Pressure Elevated
>135/85 mmHg
Atheroschlorosis
Coronory Heart Disease
(Obesity)
Fatty Liver Disease
Gout
Arthritis
Type 2 Diabetes
Stroke
Alzheimers
Asthma
20% of the “Fat” are “Fit”
40% of the “lean” are unhealthy
Metabolic Syndrome Definition:
METABOLIC SYNDROME
(3 or more of the 5 factors)
Low HDL “Good Cholesterol” <1.0 mmol/L
How many people have it then? It’s not too common, right?
How does >50% of US population strike you?
High Blood Triglycerides >1.5 mmol/L
Waist >~38” Men
>~35” Women
High Blood Sugar
>5.6 mmol/L
Blood Pressure Elevated
>135/85 mmHg
Atheroschlorosis
Coronory Heart Disease
(Obesity)
Fatty Liver Disease
Gout
Arthritis
Type 2 Diabetes
Stroke
Alzheimers
Asthma
Key Phenomenon: INSULIN
RESISTANCE
20% of the “Fat” are “Fit”
40% of the “lean” are unhealthy
A Crash Course in Endocrinology 1…..Insulin / Glucagon / Ghrelin /
Leptin – know your control system hormones!
sugar / simple carbohydrate
ingestion primarily
BMech
1. Insulin and
Glucagon
High Blood Sugar
2013 Ivor Cummins BE(Chem) MIEI
A Crash Course in Endocrinology 2
2013 Ivor Cummins BE(Chem) MIEI
BMech
• Ghrelin and
Leptin
And so, The KEY to the Cycle of DiseaseInsulin (The Master Hormone):• Gets glucose into Liver/Muscle AND FAT(!)• In healthy people, drives brain appetite drop but…• If driven too hard by Sugar and Carb in diet, leads to INSULIN RESISTANCE - “Body says NO!”• Brain Insulin Resistance: Appetite dysfunction results!
2013 Ivor Cummins BE(Chem) MIEI
The KEY to APPETITE CONTROLInsulin (The Master Hormone):• Gets glucose into Liver/Muscle AND FAT(!)• In healthy people, drives brain appetite drop but…• If driven too hard by Sugar and Carb in diet, leads to INSULIN RESISTANCE - “Body says NO!”• Brain Insulin Resistance: Appetite dysfunction results!
# 1: Insulin Resistance
2013 Ivor Cummins BE(Chem) MIEI
And so, The KEY to APPETITE CONTROLInsulin (The Master Hormone):• Gets glucose into Liver/Muscle AND FAT(!)• In healthy people, drives brain appetite drop but…• If driven too hard by Sugar and Carb in diet, leads to INSULIN RESISTANCE - “Body says NO!”• Brain Insulin Resistance: Appetite dysfunction results!
# 1: Insulin Resistance
2013 Ivor Cummins BE(Chem) MIEI
#2: Appetite Dysfunction
And so, The KEY to APPETITE CONTROLInsulin (The Master Hormone):• Gets glucose into Liver/Muscle AND FAT(!)• In healthy people, drives brain appetite drop but…• If driven too hard by Sugar and Carb in diet, leads to INSULIN RESISTANCE - “Body says NO!”• Brain Insulin Resistance: Appetite dysfunction results!
Leptin:• Is released by Fat Cells (Adipocytes)• Signals brain that fat stores are fine – STOP EATING• But Leptin Is Blocked by INSULIN RESISTANCE and…• If driven too hard (Excess Fat) then LEPTIN RESISTANCE
# 1: Insulin Resistance
2013 Ivor Cummins BE(Chem) MIEI
#2: Appetite Dysfunction
And so, The KEY to APPETITE CONTROLInsulin (The Master Hormone):• Gets glucose into Liver/Muscle AND FAT(!)• In healthy people, drives brain appetite drop but…• If driven too hard by Sugar and Carb in diet, leads to INSULIN RESISTANCE - “Body says NO!”• Brain Insulin Resistance: Appetite dysfunction results!
Leptin:• Is released by Fat Cells (Adipocytes)• Signals brain that fat stores are fine – STOP EATING• But Leptin Is Blocked by INSULIN RESISTANCE and…• If driven too hard (Excess Fat) then LEPTIN RESISTANCE
# 1: Insulin Resistance
2013 Ivor Cummins BE(Chem) MIEI
#2: Appetite Dysfunction
#3 Leptin Signal Block
And so, The KEY to APPETITE CONTROLInsulin (The Master Hormone):• Gets glucose into Liver/Muscle AND FAT(!)• In healthy people, drives brain appetite drop but…• If driven too hard by Sugar and Carb in diet, leads to INSULIN RESISTANCE - “Body says NO!”• Brain Insulin Resistance: Appetite dysfunction results!
Leptin:• Is released by Fat Cells (Adipocytes)• Signals brain that fat stores are fine – STOP EATING• But Leptin Is Blocked by INSULIN RESISTANCE and…• If driven too hard (Excess Fat) then LEPTIN RESISTANCE
# 1: Insulin Resistance
2013 Ivor Cummins BE(Chem) MIEI
#2: Appetite Dysfunction
#3 Leptin Signal Block
#4 Leptin Resistance
And so, The KEY to APPETITE CONTROLInsulin (The Master Hormone):• Gets glucose into Liver/Muscle AND FAT(!)• In healthy people, drives brain appetite drop but…• If driven too hard by Sugar and Carb in diet, leads to INSULIN RESISTANCE - “Body says NO!”• Brain Insulin Resistance: Appetite dysfunction results!
Leptin:• Is released by Fat Cells (Adipocytes)• Signals brain that fat stores are fine – STOP EATING• But Leptin Is Blocked by INSULIN RESISTANCE and…• If driven too hard (Excess Fat) then LEPTIN RESISTANCE
# 1: Insulin Resistance
2013 Ivor Cummins BE(Chem) MIEI
#2: Appetite Dysfunction
#3 Leptin Signal Block
#4 Leptin Resistance
Appetite
ObesityInflammationFatty Liver
“Bad Cholesterol”AtherosclerosisHeart Disease
DiabetesAlzheimersCancers etc
“The Diseases of Modernity”
Appetite
ObesityInflammationFatty Liver
“Bad Cholesterol”AtherosclerosisHeart Disease
DiabetesAlzheimersCancers etc
“The Diseases of Modernity”
Perhaps unsurprisingly, Insulin Resistance Leads to the Metabolic Maladies….
2013 Ivor Cummins BE(Chem) MIEI
BMech
Perhaps unsurprisingly, Insulin Resistance Leads to the Metabolic Maladies….
…..but, substantially, is it the chicken or the egg??
2013 Ivor Cummins BE(Chem) MIEI
BMech
Perhaps unsurprisingly, Insulin Resistance Leads to the Metabolic Maladies….
…..but, substantially, is it the chicken or the egg??
2013 Ivor Cummins BE(Chem) MIEI
BMech
Perhaps unsurprisingly, Insulin Resistance Leads to the Metabolic Maladies….
Excess Weight
…..but, substantially, is it the chicken or the egg??
2013 Ivor Cummins BE(Chem) MIEI
BMech
Perhaps unsurprisingly, Insulin Resistance Leads to the Metabolic Maladies….
Excess Weight
…..but, substantially, is it the chicken or the egg??
Self-Reinforce Loop Warning!
Self-Reinforce Loop Warning!
2013 Ivor Cummins BE(Chem) MIEI
BMech
So, time to fix 4 decades of “Hypothesis Resistance”, and move on…
Excessive Insulin Demand exhausts Pancreatic CellsIrrecoverable Cell Death
2013 Ivor Cummins BE(Chem) MIEI
BMech
So, time to fix 4 decades of “Hypothesis Resistance”, and move on…
Excessive Insulin Demand exhausts Pancreatic CellsIrrecoverable Cell Death
Greed +
2013 Ivor Cummins BE(Chem) MIEI
}
BMech
So, time to fix 4 decades of “Hypothesis Resistance”, and move on…
Excessive Insulin Demand exhausts Pancreatic CellsIrrecoverable Cell Death
+ appetite derangement
Greed +
2013 Ivor Cummins BE(Chem) MIEI
}
BMech
So, time to fix 4 decades of “Hypothesis Resistance”, and move on…
Excessive Insulin Demand exhausts Pancreatic CellsIrrecoverable Cell Death
+ appetite derangement
Greed +
2013 Ivor Cummins BE(Chem) MIEI
}Self-
Reinforce Loop
Warning!
Self-Reinforce
Loop Warning!
Self-Reinforce
Loop Warning!
BMech
Metabolic Syndrome / ObesityPOTENTIAL ROOT CAUSE #1:
SUGAR
2013 Ivor Cummins BE(Chem) MIEI
Glucose-glucose-glucose......chainsSo-called ”Simple Carb”, added sugar too though..
High Fructose Corn Syrup (HFCS): 55% fructose / 45% glucose
Sucrose (Table Sugar):50%glucose / 50% fructose
Fruit: 4% to 8% Fructose(but with lots of Fibre & Good Stuff!)
Fructose Vs Glucose Sources
Metabolic Syndrome / ObesityPOTENTIAL ROOT CAUSE #1:
SUGAR
2013 Ivor Cummins BE(Chem) MIEI
Fructose / HFCS “Mega Sources”:
* Soft Drinks / Sports Drinks *Most All Processed Food
Low Fat ProductsFruit Juices / SmoothiesMost Breakfast Cereals
Etc Etc Etc
From one of the best, 1957ACorr
DIET AND CORONARY THROMBOSISHYPOTHESIS AND FACT *
JOHN YUDKINM.A., Ph.D., M.D. Camb., M.R.C.P., F.R.I.C.
PROFESSOR OF NUTRITION IN THE UNIVERSITY OF LONDON ATQUEEN ELIZABETH COLLEGE
NO Significant Correlation for Fat and Heart Disease Rates
R2 = 0.1, P > 0.05
1. USA2. Australia3. Canada4. Finland5. New
Zealand6. UK7. Denmark8. Sweden9. Norway10. Netherlands11. Switzerland12. W. Germany13. France14. Italy15. Japan
Significant Correlation for Sugar and Heart Disease Rates
R2 = 0.41, P < 0.05
Let’s get up to date here….
Sugar g/day: Composite, multiple sourcesBMI/Diabetes Data: http://www.cdc.gov/nchs/data/hus/hus12.pdf#063
ACorr
2013 Ivor Cummins BE(Chem) MIEI
Sugar g/day
%BMI > 25Diabetes
Another Longer Term View…A
Corr
2013 Ivor Cummins BE(Chem) MIEI
Welcome, to The new age of Sugar
and Simple Carbs…
ACorr
Obesity Trend
Carb grams/day
Reminder first – Glucose Vs FructoseBMech
2013 Ivor Cummins BE(Chem) MIEI
And now, a Crash Course in Fructose Metabolism…..
Grateful thanks to Dr. Robert Lustig for the following slides which I have augmented somewhat for clarity
•Professor of Endocrinology / Pediatrics, UCSF•Director of Weight Assessment for Teen and Child Health
Please do see him professionally deliver this content more comprehensively in “Sugar, the Bitter Truth”
http://www.youtube.com/watch?v=dBnniua6-oM
BMech
60 kcal(+ 12 kcalglucose)
120 kcal Glucose24 kcal goes to liver
120 kcal Alcohol94 kcal goes to liver
120 kcal Sucrose (50:50 Fruc/Gluc)ALL Fructose must go to liver
The Mitochondria -Your Cellular Energy Production LineGlucose, Alcohol,
Fructose – One of these things is not like the others…..!
BMech
The Mitochondria -Your Cellular Energy Production Line
Into Your Liver goes the Fructose
BMech
The Mitochondria -Your Cellular Energy Production Line
Initial conversion and ATP depletion
BMech
Ramp Up the Uric Acid
Production
MS #1: Hypertension
The Mitochondria -Your Cellular Energy Production Line
BMech
Ramp Up Krebs Cycle and Citrate
Production
BMech
Kick Off unique Xylulose-S-P Production
BMech
Accelerate the Fat Production Line
BMech
Welcome to DNL: Elevated Blood
Triglyceride
MS #3: HDL Reduction
MS #4: Triglyceride
BMech
CExpt
Add Hepatic Lipid Production and
drive NAFLD
BMech
Add Blood FFA & Insulin Levels / IR
MS #2: Central Obesity
BMech
Add Blood FFA & Insulin Levels / IR
MS #2: Central Obesity
BMech
Self-Reinforce
Loop Warning!
Add Systemic Inflammation
BMech
Add Hepatic Insulin Resistance
MS #5: Sugar Control
BMech
Add Hepatic Insulin Resistance
MS #5: Sugar Control
BMech
Self-Reinforce
Loop Warning!
Add Hepatic Insulin Resistance
MS #5: Sugar Control
BMech
Self-Reinforce
Loop Warning!
Self-Reinforce
Loop Warning!
SREBP1 and increased Fat
Production
BMech
SREBP1 and increased Fat
Production
BMech
Self-Reinforce
Loop Warning!
Spiked Insulin Drives Fat Storage
MS #2: Central/General Obesity
BMech
Spiked Insulin Drives Fat Storage
MS #2: Central/General Obesity
BMech
Self-Reinforce
Loop Warning!
MS #2: Central/General Obesity
Appetite Dysfunction and Increased Consumption
BMech
Appetite Control
Leptinblocking
MS #2: Central/General Obesity
Appetite Dysfunction and Increased Consumption
BMech
Appetite Control
Leptinblocking
Self-Reinforce
Loop Warning!
MS #2: Central/General Obesity
Welcome to the Metabolic Syndrome
BMech
MS #5: Sugar Control
MS #3: HDL Reduction
MS #4: Triglyceride
MS #1: Hypertension
And Sugar’s effect on your “Bad” Cholesterol?
CExpt
2013 Ivor Cummins BE(Chem) MIEI
1965 – 1972, Excellent Engineering Style Studies – Not easy to find now
CExpt
No
rmal
Die
t
Hig
h S
ug
ar
Lo
w S
ug
ar
Hig
h S
ug
ar
Lo
w S
ug
ar
2013 Ivor Cummins BE(Chem) MIEI
Lower is Better in all plotlines here
1965 – 1972, Excellent Engineering Style Studies – Not easy to find now
CExpt
No
rmal
Die
t
2013 Ivor Cummins BE(Chem) MIEI
Lower is Better in all plotlines
Hig
h S
ug
ar
Lo
w S
ug
ar
Lo
w S
ug
ar
All Candidates Same Trend……
No
rmal
Die
t
Hig
h S
ug
ar
Lo
w S
ug
ar
2011: Fructose Drives Visceral ObesityCExpt
2013 Ivor Cummins BE(Chem) MIEI
Glucose:LOW
VisceralObesity
Fructose:HIGH
VisceralObesity
SAT = Subcutaneous
Or “Safe” Body Fat
SAT = Subcutaneous
Or “Safe” Body Fat Type
VAT =
VisceralOr “Toxic”
Body Fat Type
2011: Fructose Drives Post-Prandial TG C
Expt
2013 Ivor Cummins BE(Chem) MIEI
FructoseGlucose Sucrose
Trig
lyce
ride
(AU
C)
FructoseGlucose Sucrose
Trig
lyce
ride
22-2
4h
AreaUnder
Curve i.e.
AverageTrig
Impact
The Common Fasting Trigs test :Glucose > Fructose, but note
lower scale, ~0.18mmol/L
Fructose: HIGH (0.60 mmol/L)Post-Meal Trigs….
where damage is done…
2011: Fructose Drives ApoB Lipoprotein(“The real BAD Cholesterol”)
CExpt
Note: As can be seen, the sucrose (50% Fructose and 50% Glucose) seems synergistic in effect; my assumption is that the simultaneous Insulin response triggered by the Glucose exacerbates the issue – but this is TBD – the research team noted and deferred an explanation too…..
2013 Ivor Cummins BE(Chem) MIEI
Glucose:Low
ApoB
Fructose:HIGHApoB
Sucrose
FructoseGlucose Sucrose
ΔF
astin
g A
poB
(g/
L)
FructoseGlucose Sucrose
% A
poB
/Apo
A
Lots where this came from….
2013 Ivor Cummins BE(Chem) MIEI
CExpt
Soft Drinks boys and girls !
POTENTIAL ROOT CAUSE #2:
FAT
Triglyceride – 3 Fatty Acids with a Glycerol Backbone
2013 Ivor Cummins BE(Chem) MIEI Natural
Natural
Natural????
A Topic for another
Seminar(!)
Sugar g/day: Composite, multiple sourcesFat/BMI/Diabetes Data: http://www.cdc.gov/nchs/data/hus/hus12.pdf#063
Fat Versus Sugar: Correlative DataACorr
2013 Ivor Cummins BE(Chem) MIEI
FAT g/day
%BMI > 25Diabetes
Sugar g/day: Composite, multiple sourcesFat/BMI/Diabetes Data: http://www.cdc.gov/nchs/data/hus/hus12.pdf#063
Fat Versus Sugar: Correlative DataACorr
2013 Ivor Cummins BE(Chem) MIEI
SUGAR g/d
%BMI > 25Diabetes
FAT g/day
%BMI > 25Diabetes
A little bit of history…..Ancel KeysA
Corr
2013 Ivor Cummins BE(Chem) MIEI
And His BAD Science Punishment?
What Keys could have chosen…..A
Corr
2013 Ivor Cummins BE(Chem) MIEI
The Contemporaneous Controversy…ACorr
DIET AND CORONARY THROMBOSISHYPOTHESIS AND FACT *
JOHN YUDKINM.A., Ph.D., M.D. Camb., M.R.C.P., F.R.I.C.
PROFESSOR OF NUTRITION IN THE UNIVERSITY OF LONDON ATQUEEN ELIZABETH COLLEGE
NO Significant Correlation for Fat and Heart Disease Rates
R2 = 0.1, P > 0.05
1. USA2. Australia3. Canada4. Finland5. New
Zealand6. UK7. Denmark8. Sweden9. Norway10. Netherlands11. Switzerland12. W. Germany13. France14. Italy15. Japan
Significant Correlation for Sugar and Heart Disease Rates
R2 = 0.41, P < 0.052013 Ivor Cummins BE(Chem) MIEI
And the Dreadful SATURATED Fat?ACorr
OrthodoxView
TrendLineEh, excuse
me?
AnEngineer’sTrendLine
2013 Ivor Cummins BE(Chem) MIEI
Increasing Heart Disease with lower
fat
Decreasing Heart Disease with higher fat
Another Recommended PaperACorr
Dietary lipids and coronary heart desease: Old evidence, new perspective Review ArticleProgress in Lipid Research, Volume 31, Issue 3, 1992, Pages 195-243Michael I. Gurr, Professor in Food Science & Technology, University of Reading, UK.Professor in Human Nutrition, Oxford Brookes University, UK.
Michael Gurr, Ph.D., renowned expert on lipids and author of the authoritative textbook on lipid biochemistry, criticizes: ”…the degree of self delusion in research workers wedded to a particular hypothesis despite the contrary evidence”
Men from the studies
Who HAD Heart
Attacks
Men from studies who
had NO HeartAttacks
2013 Ivor Cummins BE(Chem) MIEI
2010: The Metastudy of all studiesA
Corr
Meta-analysis of 21 prospective cohort studies evaluating the association of saturated fat with cardiovascular disease
Conclusion: There is no significant evidence for concluding that dietary saturated fat is associated with an increased risk of CHD or CVD. More data are needed to elucidate whether CVD risks are likely to be influenced by the specific nutrients used to replace saturated fat….(Ivor note: like sugar or refined carb perhaps….)
2013 Ivor Cummins BE(Chem) MIEI
NO Effect of Dietary
Saturated Fat Seen Overall
• Let’s make up some time here and move on to experimental – go on, you know you want to!
Fat Mechanistic DataB
Mech
2013 Ivor Cummins BE(Chem) MIEI
FAT – Experimental – Krauss et Al 2008
Trig Reduction
Experiment Design: 3 weeks isocalorific, remainder with -1000 calories per day (starve)
CExpt
2013 Ivor Cummins BE(Chem) MIEI
Serum Triglyceride –
Lower is Better
FAT – Experimental – Krauss et Al 2008
Trig Reduction
Experiment Design: 3 weeks isocalorific, remainder with -1000 calories per day (starve)
CExpt
HD
L “g
ood”
Cho
l
2013 Ivor Cummins BE(Chem) MIEI
Serum Triglyceride –
Lower is Better
HDL –
Higher is Better
FAT – Experimental – Krauss et Al 2008Experiment Design: 3 weeks isocalorific, remainder with -1000 calories per day (starve)
CExpt
Tot Chol/HD
L
2013 Ivor Cummins BE(Chem) MIEI
TOTAL CHOL / HDL
Lower is Better
FAT – Experimental – Krauss et Al 2008Experiment Design: 3 weeks isocalorific, remainder with -1000 calories per day (starve)
CExpt
Tot Chol/HD
L
Apo B / Apo A
2013 Ivor Cummins BE(Chem) MIEI
TOTAL CHOL / HDL
Lower is Better
ApoB / Apo A Lipoprotein
Lower is Better
FAT – Experimental – Krauss et Al 2008Experiment Design: 3 weeks isocalorific, remainder with -1000 calories per day (starve)
CExpt
LDL
Parti
cle
Dia
met
er
2013 Ivor Cummins BE(Chem) MIEI
LDL Particle Diameter
Higher is Better
FAT – Experimental – Krauss et Al 2008Experiment Design: 3 weeks isocalorific, remainder with -1000 calories per day (starve)
CExpt
LDL
Parti
cle
Dia
met
er
2013 Ivor Cummins BE(Chem) MIEI
LDL Particle Diameter
Higher is Better
Ivor Conclusion:• Low Sugar/Carb, high Fat diet dramatically improves Key MetS disease markers
FAT – Experimental – Krauss et Al 2008
Ivor Conclusion:• Low Sugar/Carb, high Fat diet dramatically improves Key MetS disease markers
Study Author’s Conclusion:• A LOW FAT diet with restricted calories sort of kinda gets within range of the High Fat diet in Key MetS disease markers….??? •Come again???•Are you Serious – call an engineer, please……..!
Experiment Design: 3 weeks isocalorific, remainder with -1000 calories per day (starve)
CExpt
LDL
Parti
cle
Dia
met
er
2013 Ivor Cummins BE(Chem) MIEI
LDL Particle Diameter
Higher is Better
Can do this again and again……
and again.
by Jeff S. Volek, Ph.D., R.D.
CExpt
2013 Ivor Cummins BE(Chem) MIEI
Obesity Trends over Several Decades
2013 Ivor Cummins BE(Chem) MIEI
Concluding Material
2013 Ivor Cummins BE(Chem) MIEI
Coup De Grace? 2013: The Rat Proxy…
Fiber-free white flour with fructose offers a better model of metabolic syndrome:Amin and Gilani Lipids in Health and Disease 2013 12:44 doi:10.1186/1476-511X-12-44
“…this study aims to develop a rat model which closely depicts MS in humans…”
“Replacing whole wheat with refined wheat flour in rat chow in 60% fructose-fed Sprague-Dawley rats resulted in:
2013 Ivor Cummins BE(Chem) MIEI
hypertension (p 0.01) hyperglycemia (p 0.03)
HDL Reduction (p 0.002)
hyper-triglyceridemia (p 0.001)In only
FOUR Weeks!
More Rat Tales….In results published online Feb. 26 2010 by the journal Pharmacology, Biochemistry and Behavior, the researchers from the Department of Psychology and the Princeton Neuroscience Institute reported on two experiments investigating the link between the consumption of high-fructose corn syrup and obesity.
"When rats are drinking high-fructose corn syrup at levels well below those in soda pop, they're becoming obese -- every single one, across the board. Even when rats are fed a high-fat diet, you don't see this; they don't all gain extra weight."
The second experiment -- the first long-term study of the effects of high-fructose corn syrup consumption on obesity in lab animals -- monitored weight gain, body fat and triglyceride levels in rats with access to high-fructose corn syrup over a period of six months. “Compared to animals eating only rat chow, rats on a diet rich in high-fructose corn syrup showed characteristic signs of a dangerous condition known in humans as the metabolic syndrome, including abnormal weight gain, significant increases in circulating triglycerides and augmented fat deposition, especially visceral fat around the belly. Male rats in particular ballooned in size: Animals with access to high-fructose corn syrup gained 48 percent more weight than those eating a normal diet.”
2013 Ivor Cummins BE(Chem) MIEI
25
X
Make your minds up guys…
Guidelines Schmidelines…..
Labelmania - What’s YOUR poison? Brown sugar, Fruit juice concentrate, Lactose ,Corn sweetener, Glucose, Malt syrup, Galactose, Corn syrup, High-fructose corn, Rice Syrup, Maltose, HFCS, Dextrose, Syrup, Honey, Molasses, Fructose, Invert Sugar, Maltodextrin, Raw sugar, etc, etc
Answer: All of it…welcome to “Synynom Shenanigans”
2013 Ivor Cummins BE(Chem) MIEI
% D
aily
Cal
orifi
c In
take
But I don’t eat that much Sugar…?
250 ml250 ml
Cereal OJ Smoothie Total Spoons
~4 ~6 ~8 ~19
80g
Over 2-3 times your daily AHA adult guidelines…..and more than a dozen times the estimated human evolutionary intake of ~1.5 teaspoons/day)…..
before you leave the breakfast table
Brekky
Time!
=2013 Ivor Cummins BE(Chem) MIEI
That means 6/9 teaspoons TOTAL INTAKE per day for a female/male human
- NOT 6/9 that you add yourself to existing food or drink, which is often loaded already!
And My N=1 Experiment?
CExpt
July 2013 Singapore
Ivor the Laboratory Rat
HDL
1.47
GGT
112
Trig
0.92
Trig/HDL
1.44
Tot Chol /HDL
4.5
CExpt
530
Ferritin
>1.00mmol
/L
< 200approx
<4.0
<35approx
< 1.5mmol
/L
< 2.0
Note: converted from mmol/L to mg/dL to get ratio guidelines
2013 Ivor Cummins BE(Chem) MIEI
Ivor the Laboratory Rat
HDL
1.47
GGT
112
Trig
0.92
Trig/HDL
1.44
Tot Chol /HDL
4.5
CExpt
530
Ferritin
>1.00mmol
/L
< 200approx
<4.0
<35approx
< 1.5mmol
/L
< 2.0
Note: converted from mmol/L to mg/dL to get ratio guidelines
2013 Ivor Cummins BE(Chem) MIEI
42
35
Ivor the Laboratory Rat
HDL
1.47
GGT
112
Trig
0.92
Trig/HDL
1.44
Tot Chol /HDL
4.5
CExpt
530
Ferritin
>1.00mmol
/L
< 200approx
<4.0
<35approx
< 1.5mmol
/L
< 2.0
Note: converted from mmol/L to mg/dL to get ratio guidelines
2013 Ivor Cummins BE(Chem) MIEI
42
35
230
Ivor the Laboratory Rat
HDL
1.47
GGT
112
Trig
0.92
Trig/HDL
1.44
Tot Chol /HDL
4.5
CExpt
530
Ferritin
>1.00mmol
/L
< 200approx
<4.0
<35approx
< 1.5mmol
/L
< 2.0
Note: converted from mmol/L to mg/dL to get ratio guidelines
2013 Ivor Cummins BE(Chem) MIEI
42
35
230
1.73
Ivor the Laboratory Rat
HDL
1.47
GGT
112
Trig
0.92
Trig/HDL
1.44
Tot Chol /HDL
4.5
CExpt
530
Ferritin
>1.00mmol
/L
< 200approx
<4.0
<35approx
< 1.5mmol
/L
< 2.0
Note: converted from mmol/L to mg/dL to get ratio guidelines
2013 Ivor Cummins BE(Chem) MIEI
42
35
230
1.73
0.78
Ivor the Laboratory Rat
HDL
1.47
GGT
112
Trig
0.92
Trig/HDL
1.44
Tot Chol /HDL
4.5
CExpt
530
Ferritin
>1.00mmol
/L
< 200approx
<4.0
<35approx
< 1.5mmol
/L
< 2.0
Note: converted from mmol/L to mg/dL to get ratio guidelines
2013 Ivor Cummins BE(Chem) MIEI
42
35
230
1.73
0.78
Ivor the Laboratory Rat
HDL
1.47
GGT
112
Trig
0.92
Trig/HDL
1.44
Tot Chol /HDL
4.5
CExpt
530
Ferritin
>1.00mmol
/L
< 200approx
<4.0
<35approx
< 1.5mmol
/L
< 2.0
Note: converted from mmol/L to mg/dL to get ratio guidelines
2013 Ivor Cummins BE(Chem) MIEI
42
35
230
1.73
0.781.03
Ivor the Laboratory Rat
HDL
1.47
1.73
GGT
112
42
Trig
0.78
0.92
Trig/HDL
1.03
1.44
Tot Chol /HDL
3.5
4.5
CExpt
35
530
230
Ferritin
>1.00mmol
/L
< 200approx
<4.0
<35approx
< 1.5mmol
/L
< 2.0
Note: converted from mmol/L to mg/dL to get ratio guidelines
2013 Ivor Cummins BE(Chem) MIEI
Continued….
Weight
95
5k run time
28
Waist
35
Sys BP
145
Dia BP
95
CExpt
Ideal ~82Kg
Ideal 32”
<85mmHg
<135mmHg
Avg of 20+ readings from same Equipment2013 Ivor Cummins BE(Chem) MIEI
Continued….
Weight
95
5k run time
28
Waist
35
Sys BP
130
145
Dia BP
80
95
CExpt
Ideal ~82Kg
Ideal 32”
<85mmHg
<135mmHg
Avg of 20+ readings from same Equipment2013 Ivor Cummins BE(Chem) MIEI
Continued….
Weight
95
5k run time
28
Waist
35
Sys BP
130
145
Dia BP
80
95
CExpt
Ideal ~82Kg
Ideal 32”
<85mmHg
<135mmHg
Avg of 20+ readings from same Equipment2013 Ivor Cummins BE(Chem) MIEI
82
Continued….
Weight
95
5k run time
28
Waist
35
Sys BP
130
145
Dia BP
80
95
CExpt
Ideal ~82Kg
Ideal 32”
<85mmHg
<135mmHg
Avg of 20+ readings from same Equipment2013 Ivor Cummins BE(Chem) MIEI
82
24.5
Continued….
Weight
82
95
5k run time
24.5
28
Waist
32
35
Sys BP
130
145
Dia BP
80
95
CExpt
Ideal ~82Kg
Ideal 32”
<85mmHg
<135mmHg
Avg of 20+ readings from same Equipment2013 Ivor Cummins BE(Chem) MIEI
B’fast
Lunch
Snack
Dinner
Supper
MINIMISE2013 Ivor Cummins BE(Chem) MIEI
+or
oror etc
+
or
or
85% !!
IDEAL
B’fast
Lunch
Snack
Dinner
Supper
MINIMISE2013 Ivor Cummins BE(Chem) MIEI
+or
oror etc
+
or
or
85% !!
IDEAL
•Effectively NO Sugar•Effectively NO Wheat•Minimal Simple Carbs•NO “Diet” Foods (sugar!)•NO “Low Fat” stuff (sugar!)•Olive not Vegetable Oils•Butter not Margerine•Plenty Healthy Meat and Fish, leave the skin on!•Loads of Veg with dinner•Lots of eggs/cheese•Moderate Nuts•Moderate Fruit•85% Choc, NO Milk Choc•Olives, Avocados•Tomatoes and salad veg
SUMMARY FINDINGS•Excessive Dietary Sugar and simple carbs are the primary root cause of the Metabolic Syndrome and associated “Diabesity” Epidemic (i.e No Sugar, and stick to Vegetables only for your carb input)
•Excessive Sugar and simple carbs promote insulin response and appetite dysfunction, creating multiple self-reinforcing loops•Sugar / simple carbs are the primary development agent of Insulin Resistance Syndrome through proven mechanisms, and are a primary driver of Lipid Generation (“Bad Cholesterol”) and eventual dyslipidemia•The driven weight gain consists of adipose tissue (esp. Visceral) which exacerbates Insulin Resistence, drives Leptin Resistance and reinforces the disease process •Natural Dietary Fat is NOT a core root cause of the metabolic syndrome and associated disease/obesity – and it does NOT cause “Bad Cholesterol” !!!! Time to end 40 years of Bad Science….
2013 Ivor Cummins BE(Chem) MIEI
• “Sugar, The Bitter Truth” Professor Robert Lustig– http://www.youtube.com/watch?v=dBnniua6-oM
• “The Skinny on Obesity” (8 parts)– http://www.youtube.com/watch?v=nOl5promItc
• “High Sugar Diets and Disease” Dr. Kimber Stanhope– http://www.youtube.com/watch?v=_AJka21yfyE
• “Wheat Belly” Dr. William Davis– http://www.youtube.com/watch?v=UbBURnqYVzw
• “The Straight Dope on Cholesterol” Dr. Peter Attia– http://www.youtube.com/watch?v=dAWdHYSrh7M
• “How Bad Science and Big Business created the Obesity Epidemic” David Diamond PhD
– http://www.youtube.com/watch?v=3vr-c8GeT34
• “The Blog of Dr. Neville Wilson”– http://drnevillewilson.com/
A Sample of Approachable Science
B’fast
Lunch
Snack
Dinner
Supper
MINIMISE2013 Ivor Cummins BE(Chem) MIEI
+or
oror etc
+
or
or
85% !!
IDEAL
•Effectively NO Sugar•Effectively NO Wheat•Minimal Simple Carbs•NO “Diet” Foods (sugar!)•NO “Low Fat” stuff (sugar!)•Olive not Vegetable Oils•Butter not Margerine•Plenty Healthy Meat and Fish, leave the skin on!•Loads of Veg with dinner•Lots of eggs/cheese•Moderate Nuts•Moderate Fruit•85% Choc, NO Milk Choc•Olives, Avocados•Tomatoes and salad veg
Current Working Thesis:1. Excessive Dietary Sugar (directly ingested or in as found in most processed
food/drinks) is the 1st order primary root cause of the Metabolic Syndrome and associated “Diabesity” Epidemic through the following elements:
1.1 Insulin Resistance is the driving force of appetite dysfunction, excessive fat storage and the constellation of metabolic disease.
1.2 Sugar is the primary aggravator of Insulin Resistance through proven mechanisms, and is a direct driver of Lipid Generation and eventual dyslipidemia (Serum Triglyceride, VLDL etc)
1.3 An elevated proportion of simple, high-glycemic carbohydrate in the diet (Glucose rapidly released by Amylase, no fibre to attenuate), works in tandem with the simple sugars to promote Insulin Resistance.
1.3 Fructose is particularly pathogenic thru many pathways – lack of satiety signalling, promotion of Hepatic fat generation and hepatic IR, lack of Ghrelin suppression, impact to Leptin levels, etc
1.4 The driven weight gain consists of adipose tissue (esp. Visceral) which is itself an organ, releasing body toxic cytokines and hormones, exacerbating Insulin Resistence and accelerating the disease process
2. The disproportionate / non-linear rise of disease relative to the increase in sugar consumption can be attributed to amongst other things:
2.1 Gestational Insulin Resistance and predisposition towards obesity in the next generation (2nd order effect)
2.2 Co-incident lowered level of physical activity in society exacerbates the high sugar / simple carb damage
3. Dietary Fat is NOT a core root cause of the metabolic syndrome, but excess sugar / simple carbs through the action of the insulin elevation will drive dietary fat into storage (obesity) and further negative pathways will result as seen
2013 Ivor Cummins BE(Chem) MIEI
BACKUP
2013 Ivor Cummins BE(Chem) MIEI
The Wisdom of the Past?
"Diabetic Cookery; Recipes and Menus" by Rebecca W Oppenheimer, 1917
Aw, c’mon now!}
2013 Ivor Cummins BE(Chem) MIEI
2013 Ivor Cummins BE(Chem) MIEI
The So-Called “Cholesterol”http://www.slideshare.net/ancestralhealth/attia-ahs-talk-pc-
friendly
2013 Ivor Cummins BE(Chem) MIEI
"High triglycerides alone increased the risk of heart attack nearly three-fold. And people with the highest ratio of triglycerides to HDL -- the "good" cholesterol -- had 16 times the risk of heart attack as those with the lowest ratio of triglycerides to HDL in the study of 340 heart attack patients and 340 of their healthy, same age counterparts. The ratio of triglycerides to HDL was the strongest predictor of a heart attack, even more accurate than the LDL/HDL ratio. (Harvard-lead study - Circulation 1997;96:2520-2525)."
Polyunsaturated Fun
2013 Ivor Cummins BE(Chem) MIEI
2013 Ivor Cummins BE(Chem) MIEI
The Super Healthy PUFA
2013 Ivor Cummins BE(Chem) MIEI
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