High-Protein Diet Worse For Insulin Sensitivity Compared To High-Cereal-Fiber Diet

High-protein and high-fat diets have been shown to increase insulin resistance, setting the stage for diabetes. These diets are typically low-carb. Yet supporters of low-carb diets claim the converse, that they lower diabetes risk. Which is true?

If you take two overweight people with metabolic syndrome (at increased risk for diabetes), give them the same number of calories, except one eats a high-protein diet, the other eats a lower-protein diet with more carbs and fiber, which one will experience better insulin sensitivity?

This new study out of Germany did just that and found:¹

"Insulin sensitivity was 25% higher* after 6 weeks of the high-cereal-fiber diet than after 6 weeks of the high-protein diet."

* Measured by euglycemic-hyperinsulinemic clamp

Group assignment:

• The high-protein group was eating 28% protein, 43% carbohydrate, and 13 g cereal fiber.
  
• The lower-protein, higher-carb, higher-fiber group was eating 17% protein, 52% carbohydrate, 43 g cereal fiber.

For a 2000 calorie diet:

• This high-protein diet provided about 140 g protein and 215 g carb.
  
• This lower-protein/higher-fiber diet provided about 85 g protein, 260 g carb.

Not only did the cereal-fiber group eat less protein, but they absorbed less of the protein they did eat owing to interference from increased fiber. This lower protein may have contributed to improved insulin sensitivity:

"High-protein intake was associated with a tendency to increased protein expression in adipose tissue of the translation initiation factor serine-kinase-6-1, which is known to mediate amino acid–induced insulin resistance."

Anecdotally, I've noticed that people who eat more meat, and so more protein and fat, have a harder time clearing glucose from their blood.

This isn't the first time fiber was found to improve insulin sensitivity. This study found:²

"Increased insoluble dietary fiber intake* for 3 days significantly improved whole-body insulin sensitivity. These data suggest a potential mechanism linking cereal fiber intake and reduced risk of type 2 diabetes."

* 31 grams insoluble fiber daily. (Wheat bran is about 90% insoluble, where as oat bran is only about 50-60% insoluble)

A take-away message for me ... keep fiber intake up; watch protein/meat intake.________¹ Effects Of Supplemented Isoenergetic Diets Differing In Cereal Fiber And Protein Content On Insulin Sensitivity In Overweight Humans, American Journal of Clinical Nutrition, August, 2011
² Cereal Fiber Improves Whole-Body Insulin Sensitivity In Overweight And Obese Women, Diabetes Care, 2006

You See Green, I See Grey

How we perceive the world is largely up to us, that is, to how our brain interprets sensory input.

In his book, The Tell-Tale Brain: A Neuroscientist’s Quest For What Makes Us Human, V.S. Ramachandran says:

“Sensation is inherently subjective and ineffable: You know what it “feels” like to experience the vibrant redness of a ladybug’s shell, for instance, but you could never describe that redness to a blind person, or even to a color-blind person who cannot distinguish red from green. And for that matter, you can never truly know whether other people’s inner mental experience of redness is the same as yours.”

________I've been playing around with WordPress: Bix Weber. I may double-post for a while. I may choose one over the other in the future. Who knows.

Oslo Bomb Blast - Where Are The Emergency Personnel?

This is a video of the bomb blast in Oslo last Friday, including right before it happened.

Something unusual I noticed... the blast occurred in the middle of a big city (the capital of the country no less), in a developed country, in the middle of the day, and targeted government offices including that of the Prime Minister. And yet, during the course of this 11-minute video, although I heard sirens, I saw not one emergency vehicle or ambulance, police car, or other security patrol. In center city Philadelphia that absence of medical and security personnel would be unimaginable.


________

Former Labor Secretary: "Allow Anyone To Join Medicare"

A while back I said it would be better to lower the eligibility age for Medicare, not raise it as Obama suggested (from age 65 to 67). Lowering the age is better, in my opinion, because it would administer preventative and maintenance services to a population struggling with chronic conditions ... staving off critical interventions down the road. It costs less to help someone manage their blood glucose than it does to amputate a limb or administer kidney dialysis.

I also thought that Medicare could use their clout to negotiate lower prices for drugs and services. The larger the client pool, the more clout.

Lo and behold, Robert Reich, President Clinton's labor secretary, wrote last Friday:

"So what’s the answer? For starters, allow anyone at any age to join Medicare. Medicare’s administrative costs are in the range of 3 percent. That’s well below the 5 to 10 percent costs borne by large companies that self-insure. It’s even further below the administrative costs of companies in the small-group market (amounting to 25 to 27 percent of premiums). And it’s way, way lower than the administrative costs of individual insurance (40 percent). It’s even far below the 11 percent costs of private plans under Medicare Advantage, the current private-insurance option under Medicare.
...
In addition, allow Medicare – and its poor cousin Medicaid – to use their huge bargaining leverage to negotiate lower rates with hospitals, doctors, and pharmaceutical companies.
...
Estimates of how much would be saved by extending Medicare to cover the entire population range from $58 billion to $400 billion a year. More Americans would get quality health care, and the long-term budget crisis would be sharply reduced."
-Why Medicare Is The Solution — Not The Problem, Robert Reich, July 22, 2011

I didn't realize Medicare's administrative costs were so much lower.

He didn't mention the long-term reduction in health care costs wrought by preventative care. If you could somehow put a dollar figure on that and add it to his $400 billion savings estimate, the decision to extend Medicare to more people would make itself, no?
________

Variations On A Theme

The Arc theme.

I hadn't noticed this, but shaun's keen eye picked out similarities in the first two photos shown below that I posted recently on Google+. Oddly, my recent one, at the bottom, kept to the theme. I didn't do it purposely. Arcs on the brain.
________
Below is a photo of our chimney flue liner that we had installed last week. It reminds me of a scorpion tail. ... The house that swallowed the scorpion.



This is a photo of the space shuttle Atlantis' descent last week. From NASA:

"This unprecedented view of the space shuttle Atlantis, appearing like a bean sprout against clouds and city lights, on its way home, was photographed by the Expedition 28 crew of the International Space Station. Airglow over Earth can be seen in the background."

And here's a little critter I saw on the deck this morning. I don't know what he is. I've been calling him a tiger bug for the bold orange stripes on his back.



I love how shapes in nature repeat.
________

Do Carbs Make Us Fat? It's Hard To Conclude That From These Maps

In fact, from these maps, it looks like the more fat and protein people eat (protein is a useful gage for meat consumption), and the fewer carbohydrates they eat, the heavier they are.

Macronutrient maps from:
ChartsBin: Macronutrients, 2005 - 2007 (You can also see the trends for macronutrients from 1990 to 2007 for each country. In the US, the trend was for more fat and protein, and less carbohydrate, over the last ~17 years.)






________
Overweight and obesity maps from:
World Health Organization, Global Health Observatory

Body Mass Index (BMI), Mean, Ages 20+, Age Standardized, Male, 2008



Prevalence of Obesity (BMI > 30), Ages 20+, Age Standardized, Both Sexes, 2008


________
Low-carb advocate Gary Taubes, in his popular book, Good Calories, Bad Calories, said:

"Carbohydrates make us fat and ultimately cause obesity. The fewer carbohydrates we consume, the leaner we will be."

"Obesity is a disorder of excess fat accumulation, not overeating, and not sedentary behavior."

"Consuming excess calories does not cause [Taubes' emphasis] us to grow fatter, any more than it causes a child to grow taller. Expending more energy than we consume does not lead to long-term weight loss; it leads to hunger."

Taubes' views are shared by Dr. Atkins (New Diet Revolution) and Dr. Eades (Protein Power). I'm having difficulty reconciling this type of global data with their low-carb hypotheses, and their argument that calories don't count. Maps do not a study make, but there does seem to be a link between how many calories you eat and how much you weigh:


________

Poor Access To Healthcare = Lower Life Expectancy

I've been reading Dr. Allen Power's blog (part of the ChangingAging group of blogs). Here's his bio. I don't know Dr. Allen, but he has some compassionate things to say about the elderly that keeps me reading.

In his last post he mentioned this BBC article that describes the US' poor showing in life expectancy:

" "The researchers suggest that the relatively low life expectancies in the US cannot be explained by the size of the nation, racial diversity, or economics," says the document, which ranks the US 38th in the world for life expectancy overall."

The research at the root of these articles (Falling Behind: Life Expectancy In US Counties From 2000 To 2007 In An International Context, Population Health Metrics, 2011) claims that, besides smoking and obesity, disparities in access to basic healthcare contributes to Americans' low life expectancies. (The research also states that, for the period studied, "the US maintained its position as the country that spent the most per capita on health care.")

So, how do you improve access to basic healthcare? Dr. Power took a stab at that:

"Today’s local paper reports that our Blues want a rate increase of 9 – 19% for their various plans. So much for private health care being more cost effective! We can continue to stick our heads in the sand and protect our broken, privatized system, or we can take steps to seriously address the need for (1) universal health care, and (2) medical care that is driven by outcomes, not dollars."

I agree. Obama shouldn't be offering to raise Medicare eligibility age, he should be offering to lower it.
________

Watermelon, Why Not

For a food that's 92% water by weight, it's amazing it has any other benefit besides sweet hydration. But...

Effects Of Watermelon Supplementation On Aortic Blood Pressure And Wave Reflection In Individuals With Prehypertension: A Pilot Study, American Journal of Hypertension, 2011

In this study, participants (4 men/5 women, mid-fifties, with prehypertension: ~134/77 mmHg) had lower blood pressure* after 6 weeks of watermelon:

"To the best of our knowledge, this is the first study demonstrating beneficial effects of L-citrulline/L-arginine from watermelon supplementation in arterial function in humans."

Mechanism

Watermelon is rich in a substance called citrulline, which the body converts to the amino acid arginine, which can be used to make nitric oxide. (Another name for nitric oxide is nitrogen monoxide - like carbon monoxide except nitrogen instead of carbon.)

When blood vessels are exposed to nitric oxide, the muscles that make up the vessel relax, the vessel opening widens or dilates, and blood flow increases. (The drug Viagra uses this same nitric oxide mechanism to increase blood flow trough the penis causing erection. My mother, after her stroke, wore a nitroglycerin patch, thought to raise blood levels of nitric oxide to keep vessels flowing freely. She used to ask me if her arm would explode. I reassured her but I really had no idea.)

Not Just Better Blood Flow, But Better Blood Glucose, Less Body Fat, Better Serum Lipids

So finds this study:

Dietary Supplementation With Watermelon Pomace Juice Enhances Arginine Availability And Ameliorates The Metabolic Syndrome In Zucker Diabetic Fatty Rats, The Journal of Nutrition, 2007

Rats were fed watermelon juice for 4 weeks. Compared to the control (fed water), and to groups fed lycopene and pectin, the melon drinkers had:

• Increased serum arginine (citrulline was converted to arginine)
  
• Improved insulin sensitivity
  
• Decreased fat mass (better/higher ratio of brown fat to white fat)
  
• Lower serum glucose
  
• Lower serum free fatty acids
  
• Lower triglycerides
  
• Lower cholesterol
  
• Lower serum homocysteine
  
• Improved blood flow

Supplementing with arginine has been shown to produce many of these benefits in humans. (It's not a sure thing though because not all arginine gets converted to nitric oxide. The body has other uses for arginine, notably making urea to get rid of nitrogenous waste!) Supplementing with citrulline, however, is more likely to result in these benefits since the body breaks down up to half of oral arginine after we ingest it, then much of what's left intact goes straight to the liver, not the vessels. Not so with citrulline, which doesn't get degraded easily and bypasses the liver ending up in the blood stream. Gram-for-gram, less citrulline than arginine is needed for the same effect.

The gentleman holding the melon, Dr. Bhimu Patil from Texas A&M University, says:

"We’ve always known that watermelon is good for you, but the list of its very important healthful benefits grows longer with each study."

In watermelons, these include lycopene, beta carotene and the rising star among its phyto-nutrients – citrulline – whose beneficial functions are now being unraveled. Among them is the ability to relax blood vessels, much like Viagra does.

"The citrulline-arginine relationship helps heart health, the immune system and may prove to be very helpful for those who suffer from obesity and type 2 diabetes. ... Arginine boosts nitric oxide, which relaxes blood vessels, the same basic effect that Viagra has, to treat erectile dysfunction and maybe even prevent it. Watermelon may not be as organ specific as Viagra, but it’s a great way to relax blood vessels without any drug side-effects.”

Almost 92 percent of watermelon is water, but the remaining 8 percent is loaded with lycopene, an anti-oxidant that protects the human heart, prostate and skin health.

“Lycopene, which is also found in red grapefruit, was historically thought to exist only in tomatoes,” he said. “But now we know that it’s found in higher concentrations in red watermelon varieties.”
- Watermelon May Have Viagra-Effect, ScienceDaily, 2008

Watermelon, why not?________* Lower brachial pulse pressure, aortic systolic blood pressure, aortic pulse pressure, and aortic pressure wave reflection.
That's our bowl of watermelon up there - thanks to RB for the idea!

Seal Meets Girl

At one point (4:44), the seal is laying completely across her. At 3:50 ... sheesh, that's flexibility. I'll admit, I worried the seal would take a bite.


________Thanks, Melinda!

Explore The Human Body In 3D

I've been having a great time playing with this. I wish we had this when I was in school! It's at biodigitalhuman.com


________Thanks Dave!

Revisiting Supplements, The Case Of Vitamin E

I've been reading about Dr. Bruce Ames. The gentleman has a distinguished career. He's currently Professor of Biochemistry at the University of California, Berkeley, and Senior Scientist at Children's Hospital Oakland Research Institute. He has published over 500 peer-reviewed articles (one of the most-cited scientists on record), is the recipient of numerous awards (In 1998, President Clinton awarded him the National Medal of Science for his "creativity, resolve, and a restless spirit of innovation to ensure continued US leadership across the frontiers of scientific knowledge."¹), and at 82 he's is still publishing.²

Dr. Ames' research focuses on aging, in particular, mitochondrial decay and degenerative diseases, e.g. cancer. Here's something he said about dietary supplements:

"Suboptimal consumption of micronutrients often accompanies caloric excess and may be the norm among the obese and contribute to the pathologies associated with obesity."
...
"Micronutrient inadequacies are widespread in the population, and a multivitamin-mineral (MVM) supplement is inexpensive. A solution is to encourage MVM supplementation, particularly in those groups with widespread deficiencies such as the poor, teenagers, the obese, African Americans, and the elderly, in addition to urging people to eat a more balanced diet."
- Low Micronutrient Intake May Accelerate The Degenerative Diseases Of Aging Through Allocation Of Scarce Micronutrients By Triage, Proceedings Of the National Academy of Sciences, 2006

I really like this triage theory of his. He has some other ideas, concerning pesticides for example or public health vs. personal responsility, that I'm not as enthusiastic about. Anyway...

Dr. Ames's research is prompting me to revisit my stance on supplementation. I've been thinking that for the majority of Americans most dietary supplements aren't necessary and may at times be harmful, that it's better to fix the food environment than to suggest a pill. Maybe that's idealistic. There are groups of people, in certain stages of life, with certain disabilities, that may do well to take a supplement. Given the state of food these days, those groups may make up a sizable portion of the population.


The Case Of Vitamin E

The rest of this post concerns one area of Dr. Ames' interest and research - vitamin E.

"Vitamin E" is actually a bucket term. There are at least 8 forms, 4 tocopherols (alpha, beta, gamma, and delta) and 4 tocotrienols (alpha, beta, gamma, and delta). Dr. Ames makes a convincing case that one of those forms, gamma-tocopherol (γT), is as important as, and in some cases more important than, the widely studied alpha-tocopherol (αT):

"γ-Tocopherol, the main form of vitamin E in the U.S. diet, unlike α-tocopherol, the main form of vitamin E in supplements, is an effective inhibitor of three different inflammatory pathways cyclooxygenase (COX), LTB4, and TNFα at physiological concentrations, both in human cells in culture and in rats.³ Previous work on γT had shown it is an effective nucleophile, unlike αT, and can inactivate lipid-soluble electrophilic mutagens such as nitrogen oxides. Epidemiological evidence supporting the importance of dietary γT has been reviewed.⁴ γT also is effective in inhibiting prostate and lung tumor cells by interrupting sphingolipid synthesis.⁵"

That forth reference was fairly comprehensive. It describes how gamma-tocopherol or its metabolite γ-CEHC, but not alpha-tocopherol:

• Has natriuretic activity (helps remove excess sodium from the body).
  
• Inhibits cyclooxygenase activity (acts as an antiinflammatory, like an NSAID).

Also, the gamma version has been linked to:

• Lower incidence of cataracts
  
• Lower risk of death from cardiovascular disease ("In a 7-y follow-up study of 34,486 postmenopausal women, Kushi et al concluded that the intake of dietary vitamin E (mainly γ-tocopherol), but not of supplemental vitamin E (mainly α-tocopherol), was significantly inversely associated with increased risk of death by CVD.")
  
• Lower risk of certain cancers, e.g. digestive tract, lung, and prostate ("The most striking finding was that men in the highest quintile of plasma γ-tocopherol concentrations had a 5-fold reduction in the risk of prostate cancer compared with those in the lowest quintile.")

Most supplements contain alpha-tocopherol, not gamma tocopherol. That's unfortunate because "high doses of alpha-tocopherol deplete plasma and tissue gamma-tocopherol."

Vitamin E is an essential nutrient. That means we need it, our bodies don't make it, we have to eat it. It's made only by plants, and because it's a fat-soluble nutrient, it's found in higher quantities in plant oils.

The gamma form of tocopherol (γT) is the dominant form in plants; the alpha form (αT) is thought to be the dominant form in most animal/human tissue (including blood plasma) - which is why αT has been more rigorously studied than γT. However, research is discovering that we have a lot of γT in skin, muscle, vein, and fat tissue. (αT may dominate in human tissue, even though we eat more γT, and even though they're absorbed and transported almost identically, because γT is degraded in the liver more readily. However, the water-soluble compound that's produced from γT, γ-CEHC, has its own biological activity, as Ames' research describes.)

So, if your supplement says "alpha-tocopherol" under vitamin E, it may not be as healthful as something that says "mixed tocopherols." If it's mixed, it may not reveal how much of the blend is alphaT and gammaT. And then, how much of each is best to take? Knowing that the alpha depletes the gamma?

You could always go the food route:⁴

"Vegetable oils such as corn, soybean, and sesame, and nuts such as walnuts, pecans, and peanuts are rich sources of γ-tocopherol."

From NutritionData:

• Walnuts, 1 ounce, 8.0 mg gamma-tocopherol, 0.5 alpha-tocopherol
  
• Pecans, 1 ounce, 6.8 mg gamma-tocopherol, 0.4 alpha-tocopherol
  
• Peanut Butter, 2 tablespoons, 2.7 mg gamma-tocopherol, 1.9 alpha-tocopherol
  
• Almonds, 1 ounce, 0.2 mg gamma-tocopherol, 7.3 alpha-tocopherol

So, almonds are a poor source for gamma-tocopherol, relative to alpha-tocopherol. How about that.
________¹ Cellular Nutrition / The Hunt To Fix Hidden Hunger / Biochemist Bruce Ames Thinks A Simple Multivitamin May Fight Obesity, San Francisco Chronicle, 2006
² Adaptive Dysfunction Of Selenoproteins From The Perspective Of The Triage Theory: Why Modest Selenium Deficiency May Increase Risk Of Diseases Of Aging, FASEB Journal, 2011
³ γ-Tocopherol, But Not α-tocopherol, Decreases Proinflammatory Eicosanoids And Inflammation Damage In Rats, FASEB Journal, 2003
⁴ γ-Tocopherol, The Major Form Of Vitamin E In The Us Diet, Deserves More Attention, The American Journal of Clinical Nutrition, 2001
⁵ γ-Tocopherol Or Combinations Of Vitamin E Forms Induce Cell Death In Human Prostate Cancer Cells By Interrupting Sphingolipid Synthesis, PNAS, 2004

Curiosity

As soon as we think we know something -- almost anything, curiosity begins to wither.

The less we know the more curious we become.
- Dr. Dan Gottlieb
________Virginia, thanks for the memory.