Dr. Doron Sher - 'Carbs, Insulin and Fat'

Thanks look it's wonderful that you've given up your day to join us here can I just get a feel for actually who's in the audience if you're a doctor or medical practitioner would you mind just putting your hand up Wow so that's an enormous number of people that's absolutely fantastic dietician nutritionally trained anybody like that fantastic and just you know somebody without any specific training but you know interested in this lifestyle all right so that's still the majority of our audience well look welcome to to all of you and you know please do grab us in between sessions to ask us questions and it's real it's a real pleasure to to have you here so the question is why would an orthopedic surgeon know anything about nutrition well it started off that that I had a whole lot of patients that were coming to see me that were young and overweight and you say them seyton look I'd like you to go and lose some weight because every time you take a step three times your body weight goes through your knee and if you lose weight your knee will hurt you less but the problem is that current weight loss paradigm is that these people have to exercise to lose weight and they all say my knees hurt I can't exercise now don't get me wrong I love exercise is fantastic it's got lots of benefits just weight loss isn't actually one of them so here we see a normal knee and here we see an arthritic knee with bone on bone and what do i do as a surgeon I take one of these metal components and I put it inside the knee so a lot of these patients had been through the whole treadmill of Jenny Craig what weight weight watchers seeing you know GPS and nutritionists and coming back to me and saying look I just can't lose weight I'm not eating very much I just can't lose weight so I was looking at this stage for an option for them where I could give them some sort of anti-inflammatory type of diet help them lose weight and delay their surgery because we know that patients that are obese when they have their surgery have a higher infection rate their wounds break down more they have a higher likelihood of redu orthopedic surgery and medically they're more likely to have kin failure heart attack and just break the bone around the prosthesis so generally speaking it's a bad idea to do this sort of surgery in people that are significantly overweight so as a simple orthopedic surgeon I needed to try and figure out a way in my own head to understand what was happening and why my patients couldn't lose weight with some poetic license I'm going to take you through that now and and understand this is a gross oversimplification initially so I understood that to survive is an organism we needed certain things we needed the basic building blocks and to me like these Lego blocks it's a bit like protein now I don't I understand this is a gross oversimplification that's a little bit unusual it's a bit different to protein protein are the building blocks and we can't do without them fat has lots of functions it can act as a building block but it also has to do with hormones vitamins and energy production so fat as well is an essential ingredient so we've got two essential ingredients which are protein and fat so that's clear in my head now so we've got the building blocks sorted out now we need some sort of instructions of where these buildings block need to go and there's a huge number of factors they get involved with that but today I'm really only going to talk to you about one which is insulin and this is again a big over simplification so we've got our building blocks we've got our general instructions now how do we move the building blocks to where we need them to go and that's the body produces energy how do we get this energy well we have two major energy sources let's call them glucose and fat just to keep things simple now if our energies pre produced by glucose we need to burn less fat to keep the fire stoked this makes perfect sense if you're burning one you burn less of the other now what happens if we give the body more glucose than what it can actually use well you can see here the glucose builds up the body starts getting alarm signals because it can't burn the glucose anymore so very quickly the body says okay this is dangerous for me I'm going to stop burning the fats I can burn it a bit more glucose and what I need to do is accumulate some of that fat that I can't burn and now it says well how am I going to get rid of this glucose and that's where insulin comes into it so insulin gets rid of the glucose but where does it store it it stores it somewhere where there's lots of room wherever we've got lots of room in our fat so while we started with too much glucose we've ended up with too much fat so it's logical that if we want to burn the fat we need to burn less glucose and have less glucose available so that'll stop the glucose being stored as fat and then it starts to burn the fat and then your fat stores get smaller and smaller until you reach a good balance between what you eat and what you burn now I agree this is a very big oversimplification but it'll just help you think about what I'm going to present so foods made up of protein fat carbohydrates and smaller entities as I said protein and fat are essential because they can't be produced by our body but glucose can be made or synthesized in the body for the cells so we don't actually need to eat it but even if we could we can't get rid of carbohydrates and glucose from the food because every food is a combination of these different entities they just have different ratios of them so when you think you can't think of a macro tracking apps how much protein or fat have I eaten today you've got to think about real foods that you're eating because it contains more than one structure now the hormone that acts as a cellular at a cellular level to control of this all of this is insulin different foods will create different insulin responses within our body now if you're healthy and you've got normal blood glucose and a normal insulin level then insulins one of insulins main roles is to help you store your protein store your glycogen and help you build your body and stay healthy the problem is a big percentage of our population is metabolically unwell and in these people the insulin response is different and the more insulin you get the more fat storage you're going to have if you've got too much of the glucose on board so remember that food is a combination of these different items so we have to be careful which ones we eat so for those interested in the science here's a pretty picture of of insulin which is two amino acids basically two chains of amino acid linked by disulphide bonds and it's important to remember historically before insulin was discovered what happened to you if you develop type 1 diabetes you basically wasted away because in those people the insulin wasn't there to help them with the protein and fat storage to keep the body healthy so at any given moment we have about 5 grams of glucose floating around our blood and that's for a 70 kilogram person when we eat the sugar or the carbohydrate it gets absorbed into our blood and our blood sugar Rises so all carbohydrates regardless of how they start off end up as glucose in the blood now the body knows that glucose is very damaging so alarm bells start going and it tries to drop us back to that 5 grand baseline as quickly as possible and insulins the hormone that gets it done so why is glucose damaging well we've got these things called advanced glycated and price so you get glucose in the blood it binds to a protein it doesn't actually take any energy to bind to the protein after that you get what are called early glycation products and at this stage it's still a reversible process and we can measure this using something called an hba1c which I'll come back to when it gets more advanced the protein binding is irreversible and that tissue is now damaged forever until it's replaced or dies and there's no reversing the process once you get to this a GE stage so whether we like it or not this process is taking place in our bodies it's part of Aging but we can either have it happen slowly as it should be or accelerate it by having lots of glucose in our blood now since the blood there are red blood cells are bathed in glucose all the time some of that binding happens to the red blood cells and that's why in diabetics we can track the hba1c because that measures how much glucose has bound to the red blood cell over the last three months or so so a GU slowly built up in tissue but eventually the damage becomes obvious this is seen is in the eye as glaucoma loss of the elasticity of the walls of the blood vessels hypertension you're going to see it as disc degenerative diseases or other joint diseases Alzheimer's dementia brain diseases and eventually kidney and pancreas failure so you can think of us as very low temperature ovens cooking ourselves at about 37 degrees over our entire lives and we can either cook ourselves really slowly or we can rapidly increase that cooking rate by putting up our glucose so the main main main hormone we're talking about is insulin and insulin is released from the pancreas when there's blood in the bloodstream so we eat the sugar it goes into our blood the blood causes a pancreas response and the insulin gets into the blood as you see here and then the insulin drives the glucose out of the blood into liver muscle and fat and in a healthy person this is very important for muscle building so you mustn't think of insulin as evil necessarily now cell membranes effete are very complex they're a bit like the wall of a fort to keep things in and out but if you're the same as the cell wall you can pass through it whereas if you're not you can't get through now glucose is different than the cell wall and can't get through it so it needs a door opened in the cell wall to get in and insulin opens the door for glucose using something called a glute 4 transporter it drives the glucose out of the blood into the cell and this is mainly in skeletal muscle liver and fat cells now the storage form of glucose is glycogen which I'm sure all of you have heard of this is a bit like the stores in your kitchen cupboard if you're hungry open kitchen cupboard and you eat something it's a fantastic as long as everything's in balance but what happens now if we eat too much and we try to store too much glycogen well the kitchen cupboards overflow there's no room in the kitchen the body has to take that glycogen and put it somewhere where is it where does it put it it puts it in the fat cells that's de novo lipogenesis so this slide looks a little bit complex but don't worry we're going to go through it bit by bit the red stripe represents your blood and the yellow and part represents the fat cell so we've eaten the sugar it's in our body the blood sugar levels are high the body's got in emergency mode and it's sending out lots of insulin to try and get rid of it the liver and muscle glycogen stores are now full and so the sugar has to get driven somewhere it mainly gets driven into the fat cells around your abdominal organs and in the liver before going to the periphery so when insulin comes into contact with a cell it's sort of a scientific name for that is out of the site it has two powerful effects working together number one it prevents the cell from getting any smaller and number two it drives the glucose and the fatty acids into the cell that increases its size now it's almost impossible for the body to make new cells as an adult but what it can do is make those cells bigger and in a nutshell that's the reason for weight gain so now I'd like to take a couple of minutes to talk about complex carbohydrate a lot of people think complex carbohydrates are better for you than glucose or sugar but the reality is that when you eat a complex carbohydrate it's digested and split into individual glucose molecules and it enters the blood so the definition of a complex carbohydrate is just about 12 glucose molecules linked together so there's nothing fancy about a complex carbohydrate now it's important to understand how glucose actually becomes fat the storage form of fat is triglycerides so here we see a triglyceride with a glycerol and glycerol and three the acids and that's locked inside the cell so in its complete state with all of the the bits together that triglyceride can't pass through the cell wall if you remember what we were talking about having the that has to be the same as the cell wall so with a triglyceride trapped in there this the fat cell can't get bigger or smaller so we need to get the fat cells out or in how does that happen there's a there's a hormone called lipoprotein lipase and that splits the triglyceride into glycerol and fatty acids now the fatty acids are the same as the cell wall and they can just go straight through there but the glycerol needs to be split into glucose the glute for transporter takes it in there and then the glucose recombines with the glycerol to form a triglyceride again in order for the cell to get smaller the triglyceride needs to get broken down and that's what this hormone here does so let's look at the empath way the in pathway uses lipoprotein lipase to get stuff in and insulin makes this much more effective what does insulin do on the way out it blocks hormone-sensitive lipase and stops the breakdown of the fatty acids so the fat cell can't get smaller so in summary insulin increases the effect of lipoprotein lipase and blocks the effect of hormone and hormone-sensitive lipase effectively increasing the size of the cell so what does this mean for fat burning so you can either be in a fat-burning state if your insulin levels are very low or you can be in a fat storage state if your insulin levels are higher now here's very low insulin but even a very small rise in insulin level over here just moving from there to there will take away your fat burning' considerably and drive you into fat storage mode so we really have to be very careful with what happens with our insulin response now everyone's heard of insulin resistance in this audience I'm sure and what does it mean it's a bit like walking into a room where something smells bad initially it hits your nostrils quite hard but once you've been there for a while you get used to the smell another way of saying that is repeated exposure to the stimulus causes less of a response so you need more of this of that stimulus to make you notice it again so when you've been in the room for a while the smell goes away but if somebody brings something really stinky you'll notice it again otherwise you've gotten used to it so action of insulin as we discussed is to take glucose out of the cells now Paul's going to talk to us up in more detail about the insulin resistance and again I'm simplifying things for the sake of this talk but Paul will make it a little bit more complex unfortunately when insulin resistance develops it develops mainly in that muscle and fat cells unless so in the up muscle and liver and less so in the fat cells so the insulin is still there the liver and muscle don't accept the glucose as much so where does the glucose go with increased insulin into the fat cells so despite having the same diet the same exercise over a 25-year period as you develop some insulin resistance you might only put on one to two kilograms a year but if you start off at the age of 25 looking like this one to two kilograms a year later you end up looking like this without noticing much change now one to two kilograms a year if you divide it by 365 days is not very much weight to be putting on each day of the year so eventually as the pancreas is required to pump more and more insulin it burns out now remember we talked about that a G is how it causes permanent damage well the pancreas doesn't respond to insulin it's not insulin sensitive therefore it is damaged by the AG years and all those areas of the body that I showed you before that were damaged by AG is don't have insulin receptors in them eventually you get type 1 diabetes and it's a type 2 diabetes I beg your pardon and it's a process that creeps up on us slowly so how can we tell if people are developing insulin resistance it can happen to people of normal weights as well as people that are significantly overweight but we know that it correlates very well with abdominal circumference and visceral fat levels luckily we are able to actually measure insulin resistance in a blood test this is called a glucose tolerance test but a standard glucose tolerance test isn't good enough you actually need to mention measured insulin at the one and two-hour mark as well you have a baseline sample drawn they give you this 75 grams of of sugary drink you sit there so you don't burn it up too much and then they measure you at one hour and two hours but that the test is not useful unless you measure insulin levels as well and I'll show you why now just for those of you that think my god how can I give me 70 grams 75 grams of sugar that's terrible well one or two quarter bottles of an up and go breakfast there drink about one point three cups of something like crunchy in that cornflakes or about four and a half slices of bread is the same as what they're giving you so if you test high on that glucose tolerance test and you're eating a reasonably standard Australian diet your sugar is up all of the time because that's just one meal that's giving you that glucose tolerance test and you're going to be eating more than that during the day so if we look over here on the right we see an insulin level and a blood glucose level and they fairly well matched and this person has a normal plasma glucose and normal insulin level today I'm just going to look at the two our values it's important to look at the one our values as well but it's really beyond the scope of today's talk so I'm not going to spend a significant amount of time doing that all right five to seven years later the person's still eating this high carbohydrate diet getting sugars and and and in their blood all of the time now the insulin is starting to have a bit more of a problem and you can see that your blood insulin level is starting to grow go up but thankfully the insulin still doing its work and so your blood glucose level stays low so here we are with a normal blood glucose level and if you just understand a glucose tolerance test without the insulin you're gonna be fantastic my blood glucose level still normal I've got nothing to worry about but now look what's happened to the insulin level it's gone up from 11 to 83 so our previous person had an insulin level of 10 this person now has an insulin level of 83 but the insulin still working well enough for their glucose to be controlled at a blood level results do not satisfy the diagnostic criteria for impaired fasting glycemia or impaired glucose tolerance and I would say to you that's not correct if you interpret them the right way so we now go to the next stage the person's sort of 12 or 15 years into their eating habits you can see their blood sugar level started to rise now and the insulin continues to rise so what's happened is the insulin kind of can't go much higher than this it's you know the pancreas is pumping out as much as it possibly can and that's not enough to control the blood glucose which is starting to rise so impaired glucose tolerance follow-up is recommended so this is basically the first time that people are starting to have some inkling that there's something wrong with them and this is the first point where most doctors would be saying to you look you know I'm worried about your diabetes but you can see that we're probably 10 years too late with this person they should have been addressed 10 years ago so what's the last thing that happens well the last thing that happens is that your insulin drops again well why would you insulin drop again the pancreas just burns out it can't produce enough of the insulin for you and so what happens to your blood glucose when your insulin isn't working well it's skyrockets so this is the last stage now even at this stage it is somewhat reversible by changing your diet so if you're in the situation don't give up all hope but it's a lot easier in the earlier stages for things to be improved now the main reason you've developed this insulin resistance is because of carbohydrates not because you weren't able to process or produce the insulin unfortunately a lot of the medical paradigm up to now has been to give people insulin to control their diabetes and again as a simple orthopedic surgeon if the glucose is causing the problem not the insulin it doesn't make a lot of sense to me that you would treat people with insulin when what you should be doing is taking away their glucose and so we've got to get people into a more balanced environment and this is what I'm going to talk to you about in my next talk is about balancing your fat and glucose and energy sources thank you

Channel: Low Carb Down Under

Views: 92,115

Keywords: Low Carb Down Under, LCDU, www.lowcarbdownunder.com.au, Low Carb Sydney 2017, Carbohydrate Restriction, Low Carb High Fat, LCHF, Metabolic Syndrome, Insulin Resistance, Doron Sher, Orthopaedic Surgery, Glucose, Diabetes, weight loss

Id: E16hfXmPGcA

Length: 23min 16sec (1396 seconds)

Published: Wed Apr 04 2018

Reddit Comments

[u/unibball]

Simple explanation well expressed.