Sunday, July 10, 2016

Type 2 Diabetes, a Dietary Disease #336, Noakes: “It’s the fatty liver disease, stupid.”

Continuing my theft of Dr. Tim Noakes' excellent post on South African blogger Marika Sboros’s FOODMED.NET, Dr. Noakes relates how “more support for Gerald Reaven’s unifying hypothesis of chronic disease has come from an unexpected source – from those doctors, hepatologists, who specialize in…diseases of the liver.”
Dr. Noakes continues, “It has been known for some time that the added risks associated with obesity depend, in part, on where that extra fat is stored in the body.  Thus fat that accumulates under the skin – subcutaneous fat – is far less unhealthy than is fat that accumulates within and between the organs in the abdomen, so-called visceral obesity.
“The hepatologists have now gone one step further to show that the real killer in visceral obesity is the fat that accumulates within the liver causing NAFLD, a disease that is now reaching epidemic proportions.
“Their work shows that it is NAFLD and not obesity per se that produces the abnormal metabolic state – the atherogenic dyslipidemia (Table 2) – that causes heart disease in those with insulin resistance and the metabolic syndrome.
“Table 2: The metabolic features of atherogenic dyslipidemia present in those with NAFLD and insulin resistance
    Elevated blood glycated hemoglobin (HbA1c) levels
    Elevated fasting blood insulin levels
    Elevated fasting blood glucose levels
    Hyperinsulinemia and hyperglycemia (elevated blood glucose levels) in response to carbohydrate ingestion
    Low blood HDL-cholesterol concentrations
    High blood triglyceride concentrations
    Elevated numbers of small dense LDL-particles
    Elevated blood Apo lipoprotein B concentrations
“The absolutely key point is that dietary carbohydrates and not dietary fat cause NAFLD. For when the insulin resistant eat excess carbohydrates including fructose found in sugar and fruits, they must convert into fat any extra carbohydrate they cannot either use as a fuel or store immediately as carbohydrate in liver or muscles.
“Note that all these options are severely reduced in those with insulin resistance.  Instead under the action of insulin – the fat-building hormone – that fat is stored, initially as fat in the liver.  But as NAFLD develops, insulin resistance worsens, hyperinsulinemia increases, atherogenic dyslipidemia deteriorates and the seeds for the chronic diseases of obesity, diabetes, heart disease, NAFLD and perhaps cancer and dementia are sown.
“Thus it is that dietary carbohydrates and not dietary fat are the direct cause of this group of chronic diseases in those with insulin resistance.
    The work of Dr Gerald Reaven is as revolutionary to the understanding of medicine as were the works of Newton, Galileo and Darwin to their disciplines.
    By producing a unifying theory for perhaps six chronic diseases and by presenting the initial evidence that these conditions are initiated by high carbohydrate diets in those with insulin resistance, he has fundamentally changed our understanding of how these conditions develop and how best they should be treated.  And also how they might be prevented.
Our challenge is to incorporate this new understanding into our teaching and practice of medicine.

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