I operate an interventional pain clinic in the urban core. More than 90% of my chronic pain patients have metabolic dysfunction and have always presumed that the Standard American Diet was to blame for their metabolic syndrome and subsequent metainflammation. Even the ones who do not have high waist circumference still had elevated fasting glucose and elevated HgBA1C.
I have noticed a pattern that seems unusual, and counterintuitive.
I assumed that a “clean” vegan diet would have “fewer toxins” and therefore patients would more quickly heal from chronic pain pathologies. The primary reason patients give me this dietary choice was a desire to improve health, lose weight, and avoid diabetes.
I have noticed that my male patient’s who are long-term vegan, for more than three years, seems to have more sarcopenia (muscle wasting) and have clinical and laboratory hypogonadism. Their LDL-C is typically low, as one would expect, but their Omega 6:3 ratios are very high (typically >20). The male long-term vegan patient seems to be clinically thin and yet metabolically obese, with multiple deficiencies in fat-soluble vitamins, specifically D and K.
I also find that this specific population has a harder time retaining muscle mass during strengthening, and almost all of them require testosterone supplementation. I don’t notice this in patients who are vegans for less than one year.
I recognize that “veganism is more than a diet; it is a philosophy and ethic.” Attempting to adequately supplement Omega 3, Vitamin D and K, and cholesterol for gonadal hormone formation is challenging in the strict vegan population.
I welcome any suggestions.
Dr. Gurpreet Padda
My clinic started as an interventional pain clinic, but I quickly realized that chronic pain was more than an isolated pathology of excessive pain. I have amazing tools that can relieve a patient’s symptoms, but I can’t reverse the course of the disease unless I treat the underlying cause, the metainflammation. Pain simply doesn’t become chronic in metabolically healthy people.
Unfortunately, less than 12.2% of the US population is metabolically healthy and more than 60% are overweight or obese.
Chronic diseases driven by obesity accounts for >$480 B direct costs. The total cost of chronic diseases due to obesity is > $1.7 T (about 9.3% of the US GDP or 47% of the total cost of chronic disease spending nationwide). These are MASSIVE costs, and overtime WILL BANKRUPT the US economy.
I believe that failing to treat the patient’s underlying pathology, the cause of the patient’s symptoms, is a disservice to the patient and to society.
Patients rarely seek preventative treatment, they most often wait for their symptoms to manifest, and pain is the cardinal symptom that drives them to seek care. Pain after all is the body signaling mechanism of impending tissue damage. Patients are also highly motivated and receptive to lifestyle changes when confronted with a lifetime of painful suffering.
I still have an interventional pain clinic, but now the interventions include lifestyle and chronic disease interventions that provide patients with tools and techniques to reverse metainflammation. We have gone from treating the patient in isolation to treating the community around the patient, to maintain adherence to lifestyle changes.
It’s not wise to use food labels of processed foods to determine actual protein content because food labeling information may be inaccurate. Food labeling information is based upon a food component calorie estimation, which is calculated by adding up the calories provided by the energy-containing nutrients: protein, carbohydrate, fat, and alcohol. The Atwater system uses the average values of 4 Kcal/g for protein, 4 Kcal/g for carbohydrates, 9 Kcal/g for fat, and 7 Kcal/g for alcohol.
The food labels measure nitrogen, which is presumed to be a protein source. According to Food and Agriculture Organization of the United Nations, “The protein content of foods has been determined on the basis of total nitrogen content… nitrogen content is then multiplied by a factor to arrive at protein content.”
But we have seen nefarious situations, where manufacturers simply increased the nitrogen content of food, adding toxins such as Formica or melamine. According to a 2008 article in Scientific American, “dairy products… contaminated with a chemical called melamine have sickened at least 54,000 babies and killed four… melamine is a nitrogen-based compound used in commercial and industrial plastics… An estimated 8,500 dogs and cats died of kidney failure after chowing down on melamine laced fare… food companies use the nitrogen-based compound in wheat flour and other products to make these products appear to have more protein. Normally, proteins are the only source of nitrogen in food, so by looking for that element in tests, one can figure out relative protein concentrations.” The amount of nitrogen, which represents a protein, does not mean that it is biologically available or that it is even protein.
If you eat whole real food, none of this matters. Get natural protein from natural sources. Avoid processed foods, vegetable oils, and refined carbohydrates and grains.
The prevalence of vending machines that stock soda in schools, particularly elementary schools, is concerning for the overall health and well-being of the country. Sodas are made largely with high fructose corn syrup. Fructose activates the dopaminergic reward system more than glucose, and high fructose corn syrup is spiked with extra fructose, far beyond what the labels suggest. Additionally, reinforced behavior, accentuated by the casino-like feel of vending machines, increases consumption in vulnerable populations, such as young children.
The ability of children, not adults, to make these choices, combined with the hedonic reward of dopamine, only increases consumption. Fructose preferentially is stored as fat through first-pass hepatic effects, leading to insulin resistance and potentially diabetes.
Background:
The per capita consumption of high fructose corn syrup — the mainstay of soft drinks and other sweetened beverages — has increased from 38.2 pounds in 1980 to 868 pounds in 1998 (Chou et al., 2004). In 1942, the annual U.S. production of soft drinks was 90 8 oz. servings per person; in 2000, it was 600 servings (Jacobson, 2005). Sodas and other sweetened beverages are readily available in our nation’s schools. Vending machines are placed in almost all of the nation’s middle and high schools (Weicha, Finkelstein, Troped, Fragala, & Peterson, 2006) and are in approximately 40 percent of our elementary schools (Fernandes, 2008). Both school vending machines and fast food restaurant use have been associated with increased intake of sugar-sweetened beverages by youth (Weicha et al, 2006). When vending machines are placed in elementary schools, black children are more likely to purchase a soft drink from these machines (39 percent) compared to white children (23 percent) (Fernandes, 2008). Could it be that these machines are becoming vendors of death?
Obesity doesn’t cause metabolic syndrome; obesity is a marker for metabolic syndrome.
In recent years, more megafarms have begun to use monocropping, which depletes the soil of beneficial microelements in order to maximize production. The role of Big Food in increasing food production depletes micronutrients and adds artificial flavors, increasing the likelihood of someone developing obesity.
By 1967, American corn farms were growing nearly three times as much corn as thirty years earlier. The mono-cropped surplus was shared with livestock to increase production. The average dairy cow now produces more than 70 pounds of milk per day, and the top-performing Holsteins produce 200 pounds per day, a 1,200 percent increase over the 1948 average. Similarly, a typical potato farmer produced about 63 sacks of potatoes for every acre in the 1930s, but by the mid-1960s, it was up to 200 sacks.
Eating is a behavior-driven by an expectation of pleasure; we crave flavors. However, mass production reduces micronutrients, which results in bland food. Maximizing food quantity came at the cost of nutrient density and food began to get blander. The solution to this bland food was adding flavors to stimulate taste. Flavor engineering combines organic chemistry with engineering, neuroscience, psychography, psychophysics, ethnography, demography, molecular biology, finance, botany, economics, and physiology to produce flavors that specifically increase cravings.
Hyperpalatable, highly processed foods are designed by food manufacturers to activate the reward system and increase food consumption. Unfortunately, the brain’s perception of the nutrient value is distorted by synthetic flavors. Subsequently, people end up overconsuming manufactured carbohydrates and manufactured fat in a combination that is likely to result in obesity.
Sugar addiction, especially glucose, leads to obesity because of how it is metabolized. Sucrose (table sugar) is a disaccharide made of 50% fructose and 50% glucose. Sucrose is metabolized primarily in the small intestine, releasing equal parts glucose and fructose. Glucose causes insulin release and is rapidly cleared from the bloodstream by insulin-dependent channels. Fructose is independent of insulin and is rapidly taken up by the liver by a first-pass effect and is preferentially stored as fat.
Further increasing obesity risks, glucose and fructose have different effects on the addiction centers in the brain. Although glucose does not directly activate the brain’s reward center, fructose does produce activation in the brain’s “reward circuit,” and increases the desire for food.
American College of Neuropsychopharmacology. “Fructose and glucose: Brain reward circuits respond differently to two kinds of sugar.” ScienceDaily. ScienceDaily, 10 December 2014. www.sciencedaily.com/releases/2014/12/141210080734.htm
When every species gets the same disease, is it an epidemic or a pandemic? Reversing the obesity, prediabetes, and type 2 diabetes epidemic is today’s most important public health challenge.
Every single species exposed to the standard American diet becomes overweight, pre-diabetic, or diabetic type 2. It takes a conscious effort to prevent and reverse this. Something in our nutritional intake is defeating our normal regulatory mechanisms.
Less than 12.2% of the population is metabolically healthy. If any other disease or impending catastrophe were going to injure nearly 88% of the US population, I guarantee that someone would have declared a true national emergency.
Our dietary intake will bankrupt the healthcare system.
Are only 1 in 8 adults considered healthy? According to data from the National Health and Nutrition Examination Survey 2009-2016, less than 12.2% of the US population is now considered metabolically healthy. This should give everyone pause.
We spend a ton of money on healthcare, yet the population seems to be getting sicker. Our entire healthcare system is incentivized to treat disease.
Maybe the problem is not the care of the patient after they are sick. Maybe the solution is to keep them from getting sick in the first place.
“Prevalence of Optimal Metabolic Health in American Adults: National Health and Nutrition Examination Survey 2009-2016,” was published online Nov. 28 in the journal Metabolic Syndrome and Related Disorders.
Low-fat food doesn’t always mean healthy, and looking at fat negatively can actually lead to insulin resistance and weight gain. Demonizing fat because it has more calories per gram ignores the information transmitted in food to your body and encourages consumption of ultra-processed foods.
If it says “low-fat” and you think it’s healthy, think again. You have fallen prey to Big Food and Ancel Keys.
Focusing simply on calories in and calories out produce an inherent bias against high-fat food, which may actually protect against obesity and related diseases. The simplistic calorie focus results in dietary guidelines that support replacing fat with starch and sugar, which promotes insulin resistance.
Malhotra A, DiNicolantonio JJ, Capewell S. It is time to stop counting calories, and time instead to promote dietary changes that substantially and rapidly reduce cardiovascular morbidity and mortality. Open Heart 2015;2(1) doi: 10.1136/opener-2015-000273 [published Online First: Epub Date|.