Metabolic Syndrome and the Cholesterol/Insulin Connection

"Mr. Jones, your blood tests look pretty concerning, your cholesterol is high, your blood pressure is high at 140/90, your fasting blood sugar is high at 100, you're putting on weight.  The current recommendations are to advise "lifestyle" management, so I'm telling you to lose weight, cut out the fast food and exercise and I'll see you in 4 weeks.  If nothing improves your going to need some medications to control your blood pressure, cholesterol, and sugar."

Mr. Jones goes home worried, skips the McDonalds and Taco Bell for a few days, doesn't lose much weight, returns to his doctor in 4 weeks and gets...a statin drug for the cholesterol, a blood pressure drug, typically a thiazide diuretic for his blood pressure, and perhaps a drug like metformin for the high sugar.  If his doctor is particularly helpful he might get a referral to a nutritionist who will advise him to eat a balanced diet consisting of a mix of carbohydrates including USDA recommended 5-9 servings of grain per day, fruits and vegetables, and limited red meat and saturated fat, increasing the amount of fish and poultry vs. the Big Macs and quarter pounders.  Of course, Mr. Jones doesn't care for vegetables so he eats sugary fruit thinking it is good for him and does his best with the rest.  But, he has a stressful job, lacks time to prepare food, and finds himself resorting to fast food again.

What's wrong with this picture?

The problem here, as is typical of today's symptom-driven medicine is that nobody is addressing the real cause of Mr. Jone's various maladies.  Doctors are very willing to get out the prescription pad and write for the latest drug, but it would be better if they would learn the basic biochemistry behind these symptoms and investigate how to address this biochemical imbalance to really fix the problem.  Yes, there is a cause and that is not a lack of willpower, intelligence, or motivation on Mr. Jone's part.  The real culprit, the actual cause of his high cholesterol, high blood pressure, and his obesity is...HIGH INSULIN. That and a deficiency of certain steroid hormones-but that's another blog post...

Insulin is a hormone made in the pancreas gland that is vital for survival.  It has various jobs, the most commonly known one is to lower blood sugar by persuading the cells to import the sugar molecules from the bloodstream where they are either burned as an energy source or stored as fat or glycogen.  Insulin also does a few other things:  It causes the walls of your blood vessels to become thick and stiff, raising blood pressure; it causes cells all over the body to proliferate and grow, thereby increasing the rate of cancer; and, it turns out, it directly activates the genes responsible for the manufacture of cholesterol in the liver. This is an important point; even most physicians don't know this and it makes all the difference in the world to your health.

The real treatment for high blood pressure, obesity, and high cholesterol is the same: KEEP YOUR INSULIN VERY LOW.

A recent article in the Journal of Clinical Investigations,Article,explained it this way:

Eating carbohydrates(sugar, grain, starch)--->Body responds by raising insulin levels--->Insulin activates transcription factors, proteins called SREBPs , "sterol regulatory element–binding proteins"--->SREBPs travel to your DNA and turn on the more than 30 genes for cholesterol synthesis--->more cholesterol gets made---> clogged arteries/heart and blood vessel disease

 

How do you lower insulin, and thereby reduce cholesterol and blood pressure?  By consuming a very low carbohydrate, low glycemic-index diet.  The Paleolithic Diet, of which I am a fierce advocate is such a diet and the weight-loss program that I use in my clinic is another: Ideal Protein.  The first is a diet you can eat for the rest of your life; the second is a medically supervised program to take 3-7 pounds of fat off per week!

Here's a typical example:

Darren came to see me a few months ago.  He was overweight, fatigued, worried about low testosterone, and frightened by the thought that he might not live to see his young children grow up if his health continued to deteriorate.  At my initial consult I found a man who ran his own business, was stressed, lived on junk food and whatever was at hand (mostly high-fat and refined carbohydrate processed foods), had minimal exercise, and was hypertensive.  His blood work was frightening:  Total cholesterol of 238(optimal about 150), HDL, the good cholesterol, very low at 23(optimal over 40), LDL, the bad cholesterol, was too high to measure(optimal less than 100), and his triglycerides, also bad, were an astounding 856(optimal about 60).  His fasting blood sugar was 96 (optimal about 80) and his fasting insulin was 16 (optimal <2).  His vitamin D3 was very low at 23, and his body composition revealed that he was 26.9% fat (he needed to lose 40 pounds of fat to be at a healthy body composition of 10-12% body fat).  I must admit that while reviewing his history and labs before his first visit, I was deciding on what drugs to start him on if he didn't seem like the type of person who could change his lifestyle.  However Darren was super motivated, willing to do what it would take to turn this situation around, and approached it like the businessman he is: I gave him the facts and a plan and he agreed to implement it.  Well, Darren cleaned the house out of all the junk foods and refined carbohydrates that very day, started moderately exercising, and most importantly, adopted my Paleolithic diet plan to lower his insulin.

The result, two and 1/2 months later:

Darren has lost 38 pounds of fat, now weighing in at 201!  His cholesterol has dropped to a healthy 162 with HDL(good cholesterol) up to 40, his LDL(bad cholesterol) has dropped to 102, and his triglycerides are 99.  He feels great as well and is motivated to get to 180# in time for spring.  What wonder drug did he get?  He got some supplements to improve his insulin resistance, a multivitamin, fish oil, and supplemental testosterone, but most importantly he got a sane diet designed to fix the problem...high insulin.

Darren started out on my Paleolithic Diet and was losing about 1-2 pounds of fat per week; that wasn't enough for him, so I enrolled him in my weight loss program,Ideal Protein, and that accelerated his fat loss to 7 pounds per week.  But, while losing fat is good, the real benefit of these low carbohydrate diets was to drastically lower his insulin levels and then his body could stop making cholesterol, lower his blood pressure and resume normal operations.  It's as simple as that...If everyone would do this, we could mostly eliminate the use of toxic cholesterol and blood pressure drugs, prevent adult-onset type 2 diabetes and most hypertension, and people would feel and look great and live a lot longer.  Eat a Paleo Diet! Until next time,

In Health,

Dr. Kaye