In his talk Lustig explains that all the reasons we think make us fat are just not true. No one chooses to be obese, especially children. It is not a matter of calories in and calories, not enough exercise, or just being lazy and gluttonous. It is a biochemical alteration that creates a toxic cycle of sugar, fat, more sugar, more fat. In fact, the metabolism of sugar is very similar to alcohol and can lead to fatty liver and hepatitis.

Bottom line: You can lose weight and control your appetite but you will never do it with the usual diet and exercise routine. You must get your sugar intake and your blood sugar hormones under control or you will continue to cycle and recycle the weight over and over.

Robert Lustig, MD on Sugar

What is it?           

Polycystic ovary disease (also known as Polycystic Ovary Syndrome or PCOS) is defined as a condition in which there is an imbalance in female sex hormones. This can lead to a number of changes including abnormal and irregular menses, acne and infertility. The typical woman with PCOS is thought of as being overweight, with acne, excess body hair and other signs of androgen excess such as male pattern baldness and even clitoral enlargement. However, as so frequently occurs in medicine, there are many varying degrees of PCOS and a woman may have PCOS without expressing the above typical symptoms. Many women with infertility may have underlying PCOS. One of the main issues with PCOS is insulin resistance which leads to obesity, infertility, and contributes to acne. A woman may have completely normal testosterone levels but still have evidence of androgen excess because in PCOS the problem is not simply testosterone excess, but a hypersensitivity of the androgen receptor. The symptoms may begin as a teenager but is usually diagnosed in the 20s and 30s. The majority of women probably go undiagnosed unless they have the typical symptoms. Many women out there with irregular or even fairly normal periods may have a form of PCOS and be at risk for infertility, diabetes and endometrial and breast cancer (because of progesterone deficiency). Cystic ovaries are not essential to the diagnosis of PCOS.

Could you be at risk for PCOS?

The point of this post is that PCOS is much more prevalent than generally known and is frequently not diagnosed leaving these women at risk for the complications (infertility, diabetes, endometrial and breast cancer) associated with PCOS. Diagnosis can be made with hormonal evaluation, analysis of insulin resistance and risk for diabetes, and attention to the clinical symptoms.

How is PCOS treated?

Treatment consists of aggressive management of abnormal blood sugar through diet (mostly low glycemic, low carbohydrate, high protein), lifestyle (regular exercise and nutrient support to help decrease abdominal fat and increase muscle mass) and medication (metformin) if needed. Studies have shown that having a fasting blood glucose above 86 leads to increased risk for cardiovascular disease (CVD). It is well known that diabetics have an increased risk for CVD, cancer, accelerated aging and dementia. It is likely that fasting blood sugars between 90-100 (prediabetes) carry similar risk. Balancing the hormones can be done with bio identical hormones to correct for progesterone deficiency instead of using oral contraceptives (especially if pregnancy is desired) and is frequently much better tolerated.

If you think you might be at risk for PCOS, it might be a good idea to get screened by a physician knowledgeable in this area. In addition to routine lab tests such as lipids and thyroid function, lab tests should include fasting glucose, fasting insulin, FSH, LH, estradiol, progesterone and possibly vaginal ultrasound. A program of diet, lifestyle, medication, and hormone balancing should be the initial treatment. With commitment, many women with PCOS are able to get pregnant and manage their glucose issues to prevent the well know sequelae of pre-diabetes and diabetes.

I have been plagued by insomnia for years and years. I have attributed it to many things and have been diagnosed with a variety of “disease states”. Depression is associated with insomnia, check. Too much stress from the loss of loved ones to the stresses of medical school and residency, check. The perils and pitfalls of perimenopause and menopause, check. But, I have discovered a new one that gets barely a mention and is thought to be inconsequential by most physicians, and I believe it may be contributing to the legions of people suffering from insomnia in our society. This is the complex biology of blood sugar regulation.

Blood sugar and cortisol

For the last several years, I have suffered from that 2-3 AM awakening, and am unable to go back to sleep. In fact, it has actually gotten worse over the years, but is inconsistent with periods of severe insomnia, awakening with a pounding heart and a feeling of anxiety and sweating. My hormones are perfectly balanced, I eat an organic diet and I exercise, so why can’t I SLEEP?! I have asked my professors and colleagues and have gotten many theories and suggestions but nothing has worked. One night as I struggled with a sweaty attack and pounding heart, I got up to go the bathroom and decided to check my blood sugar – 75. I went back to bed (I confess after taking GABA supplement to try to get back to sleep), and the next morning, again took my blood sugar – 95. Hmmmm, why would my blood sugar go up in a fasting state? Well, this has to do with poorly functioning hypothalamic-pituitary-adrenal axis, and what we in functional medicine know as adrenal fatigue or adrenal dysfunction. This is thought to be a very common thing in our stressed, overworked, burned-out society. Cortisol, which is produced by the adrenal glands, is your stress hormone and one of its jobs is to maintain your glucose levels so that your brain, heart and muscles have a continuous supply of glucose to create energy for these vital organs. Cortisol is essential to life and your body will defer to making cortisol when stressed as evolutionarily, this can save your life. Your body does not know or care WHY you stressed. The flu, surgery, running a marathon, starvation, or a crummy, demanding job; it’s all the same to the body and it pours out cortisol for your survival.

Burnout

With excess demand over the years, your adrenals falter and misfire, the signals are erratic and along with many other symptoms (fatigue, apathy, depression), your blood sugar can get too low or too high because of erratic cortisol. During the night, when you are in a fasting state, the adrenals will slowly secrete cortisol to maintain your glucose, and the peak cortisol usually occurs shortly after arising in the morning. However, if your adrenals are a little off, or your blood sugar gets too low, the adrenals can overshoot and your cortisol will increase too early (2-3 am) to make sure your blood sugar is maintained. Thus, you get symptoms of hypoglycemia, followed by a cortisol surge accompanied by an increase in epinephrine and norepinephrine resulting in sweating, a pounding heart, and an anxious alertness. I might add that falling estradiol associated with menopause is a contributing factor and can make these symptoms even worse, but that is another post.

What can you do?

Our highly processed Standard American Diet (SAD) is very high in simple carbohydrates, which is contributing to our epidemic of insomnia.

I have discovered that if I carefully follow a low glycemic diet (nothing above 60 with a glycemic load <10), I sleep much better. No more ice cream, chocolate, or even fruit especially at night. A high protein breakfast (eggs and spinach) begins the day, with each meal containing at least 20-30 grams of protein. I avoid most grains. I am not

photo courtesy of PlanetChopStick under Creative Commons

saying that whole grains are not good for you, but if you have blood sugar issues, you probably want to make grains a rare treat. Avoid fruits with high sugar content and opt for those that are more tart and loaded with fiber like raspberries. At night, I have added a protein drink from Metagenics called Perfect Protein. It has 16 grams of whey protein and only 80 calories. This has become my nighttime desert. If I watch my sugar intake and take this at bedtime, I am much more likely to get a night of blissful, uninterrupted sleep. Maybe there is something to the old adage that a glass of milk will help you sleep. With a few modifications, it seems to be working for me. Happy snoozing! ZZZZZzzzzzzz

NB: At posting time, my favorite site to check glycemic load is down – for more information, try here.

Even a 2 year old can be scanned!

For more on the scanner, read on.

The patented Pharmanex BioPhotonic Scanner is the world’s first immediate, noninvasive method of measuring overall carotenoid antioxidant activity. The Pharmanex Antioxidant Laser Scanner is now a part of the services we offer to address your overall health care. The scanner was recently shown on Dr. Oz. It is becoming clear that oxidative stress plays a critical role in disease and knowing your antioxidant level is as important as knowing your cholesterol levels or your blood pressure. Current medical literature suggests that managing oxidative stress through adequate antioxidants can decrease your risk of cancer, heart disease, and complications related to diabetes. Antioxidants can boost your immune system and speed recovery times while decreasing pain and inflammation. Unless you eat 9-12 servings of fruits and vegetables daily, it is important that you take a vitamin supplement that can provide optimal nutritional support that can effectively raise your antioxidant level.

I frequently recommend various vitamin supplements, and now I have a tool to measure the effectiveness of my regimens. Unfortunately, poor GI health and poorly absorbed products may result in failure to produce the oxidative stress protection that is desired. Pharmanex has a product called Lifepak Nano that is guaranteed to raise your antioxidant levels. The product is specially formulated to maximize absorption and efficacy. Pharmanex conducts in-depth research, uses the most advanced science, and uses the highest quality ingredients that are available for its products. Safety and scientifically-backed recommendations are of utmost importance and will parallel the standard of care you have come to know from me.

The scans are offered for $20 and may be done before any appointment.  If you would like a scan before your next scheduled appointment, come by as it only takes a few minutes. We will show you how to increase your antioxidant defenses simply, effectively, measurably, and guaranteed. Call 415.440.2200 to make an appointment.

Everybody knows the saying, “You are what you eat” and now there is more scientific truth proving that statement. In today’s society, most understand that the fat and grease in a burger are not as good for the body as fruits and vegetables; but try getting your man to practice that on Football Sunday. I’m sure more would choose hot dogs, chips, and chicken wings before they nibbled off a veggie platter. But now researchers and doctors are coming down hard on men to clean up their diet to improve prostate health.

A recent study at the UCLA’S Jonsson Comprehensive Cancer Center evaluated blood samples before and after the low-fat diet began and examined tissue from removed prostates of the study-group. Researchers noticed a slowed cancer-cell growth in men that ate a low-fat diet coupled with fish oil supplements. They also saw a change in the composition of cell membranes in both healthy and cancerous cells in the prostates of men who ate a healthier diet. The membranes contained higher levels of omega-3 fatty acids from the fish oil, and less omega-6 from corn oil. Researchers suspect that this could be the reasoning for the change in cell biology.

The finding of the hindered cancer-growth due to diet is important because the rate of cell division can be predictive for future cancer progression. Now since doctors and scientists can help slow cell-division, they can reduce the rate of the cancer spreading outside the prostate.

Since it is hard to evaluate the findings of diet-controlled studies, the UCLA research had chefs prepare the meals so the diets were controlled precisely. This made them confident to say that the diet was the deciding factor in the experiment. The change in the cell membrane omega-3 composition determined that the change in diet not only affected the biology of the body but also of the cancer tissue.

The findings of this study are more proof that diet and natural therapies can aid in healing and cancer treatment. Many diet-studies have been conducted on aggressive cancers, like non-Hodgkin lymphoma and mesothelioma, to see if there is an effective way to reverse the growth of cancerous cells. Though this new information is proof that a healthier diet aids the body in a multitude of different scenarios, more studies are being conducted to make the thesis a theory.

Allison Brooks holds a degree in biomedical anthropology from the University of Mississippi.  She is currently finishing an ethnography on the effects of bio medicalization on Bolivian cultures.

This change in the way people feel should not be surprising. We now have “functional brain scans” that can show us what is happening in the brain with changes in thought. Studies show that your thoughts create brain activity. These thought patterns, if repetitive, can actually perpetuate negative behavior because the brain creates a “pattern” that becomes hardwired. Don’t forget that your thoughts cause a chemical release in your brain and have an impact on how you feel. The chemicals released depend on the thoughts you have, and affect your mood and behavior. “Automatic Negative Thoughts,” as described by Dr. Daniel Amen in Change Your Brain, Change Your Life, can lead to moodiness, depression, and irritability. Changing the thought patterns and getting rid of toxic negative thoughts, however, can change this. (See Dr. Amen’s books that outline ways to banish and replace these negative thoughts.) To further complicate things and to learn more about your thoughts and where they come from (where do your thoughts reside and originate anyway?), watch “The Living Matrix”.  You will come away with even more awe and respect for life and your miraculous body.

As this Thanksgiving rolls around and you are spending it with friends and family, take some time to express your gratitude and think loving thoughts about yourself. It will likely make the holiday a much better experience even in the most trying of families or situations.

I am grateful for my family in all its diversity.

I am grateful for a new puppy that brings laughter and joy to our house.

I am grateful for my morning walks and beautiful sunrise in Sausalito.

I am grateful for Jack.

I am grateful for a good night’s sleep.

Now make your gratitude list and write it down every day. Remember, “Your thoughts create your life.”

Kudos to the person who took the time to put together this illustration – if you see this post, please contact me so I can give credit where credit is due.

Don’t forget – there is a difference between natural sugars found in fruit and processed sugars in soda and candy.  However, for people with blood sugar issues, fructose can cause spikes.

What are the numbers?

So, what IS a normal glucose?  Well, the range for blood sugar or glucose is 70-125mg/dl with 126 being a diagnosis of diabetes. 100-125mg/dl is now considered pre diabetes. A glucose greater than 90 is cause for concern.  Hemoglobin A1C is a measure of your average glucose over the last 3 months and should be less than 5.6 and ideally 4.4-5.0.  In my medical career, I have seen the numbers for diabetes adjusted downward as we realized that the damage of elevated glucose begins much earlier.  Diabetes used to be diagnosed at 140 mg/dl for glucose and 6.5 for HemoglobinA1C.

The Blood Sugar Rollercoaster so many of us are on...and don't even know it.

Diabetes does not happen overnight but likely begins on a continuum over 10 or more years.  We now know that metabolic changes and damage from high glucose begins years before diagnosis and the ongoing damage is largely silent with no symptoms.  A glucose level above 90 shows impairment in the metabolism and utilization of blood sugar. The damage to blood vessels, neurons, and the microvasculature begins and slowly progresses to full-blown diabetes resulting in the ravages of this disease including blindness, renal failure, and cardiovascular disease and death.

Why are we developing diabetes?

Your blood sugar is affected by a number of things including hormones, toxic exposures, and genetics.  Mostly though, your blood sugar is a result of what you eat.  Far and away, we eat too much sugar found in processed and packaged foods full of sugar and chemical preservatives, and sugary drinks; and we simply eat too much.  Our appetites are fueled by hormonal imbalances in cortisol, thyroid hormones, and insulin, making us pack on the pounds.  The increasing fat, particularly abdominal fat, sets up its own metabolism and alters the internal environment to favor continued fat deposition making it very difficult to lose the weight.  Our stressful lives and polluted environment trick our body into thinking that we are in danger, and it turns up your stress fighting hormones, which slows your metabolism. Your body stores fat preparing for the long winter of food scarcity that never comes.  The high levels of glucose and insulin begin doing their damage well before the diagnosis of diabetes.

Type I and Type II Diabetes

Two types of diabetes occur.  Type I Diabetes is a result of destruction of the islet cells in the pancreas that make insulin and is a very different disease than Type II Diabetes, which is not due to pancreatic islet cell failure but to an inability of the body to utilize glucose due to insulin resistance and too much glucose and insulin. The etiology of Type I diabetes is not clear and is not included here.  It is Type II diabetes that is becoming epidemic in our nation due mostly to our ballooning waistlines.

The Good News

The good news is that Type II diabetes is completely preventable.  Once you are in the prediabetic stage of diabetes, you already have impaired glucose tolerance and weight loss becomes increasingly difficult.  Just decreasing calories won’t do it.  But we now better understand the mechanisms behind the metabolic derangements that occur with high blood sugar.  We can track progress with new tools and biomarkers. With nutritional support, discipline, commitment, and a clear determined mind, diabetes can be prevented and perhaps even cured.