The Women’s Health Initiative (WHI) study

The WHI study is arguably the largest and most expensive state women’s health initiative which was an 8-year prospective study in postmenopausal women and essentially showed that a low fat diet has little to no effect on heart disease. This should have been the nail in the coffin, and we could have moved on, but the study had very little to no impact in changing policy.

The result is that most people in America are on course to become prediabetic, and when we look at these folks metabolically, the majority of these people have some degree of insulin resistance – to the tune of 150 million. This is an incredibly complex phenomenon and manifests in different ways to different degrees in different organs and different cell types – which is a rather simple way to look at it.

Carbohydrate intolerance is one of the key features of insulin resistance

When someone has problems metabolizing carbohydrates, it means that they don’t utilize carbohydrates in the cells very well and it accumulates to dangerous and damaging levels in the blood.  Basically, three fourths of the population should be consuming some level of carbs less than what they’re currently consuming. And yet nowhere does that recommendation appear in our dietary guidelines from any government or professional organizations and dietitians and other health professionals keep teaching the same dogma.

Digging down a little deeper

When you eat just a single carbohydrate meal, you should be processing the carbs in a healthy way; most of it should be taken up by skeletal muscle in an insulin mediated fashion and it gets oxidized or may be temporarily stored as glycogen. We now know that insulin resistant people have a greater proportion of the incoming carbohydrate converted to fat in the liver and that’s called the denovo lipogenesis. And fat production is the canary in the mine shaft, in that it signals the early stages of a lot of metabolic problems. Here’s a small part of the explanation.

When you convert carbs into fat, the initial product is a molecule composed of 16 carbons of saturated fat (C-16 palmitic acid), and a lot of palmitic acid gets desaturated to a 16-1 carbon (palmitoleic acid).

palmitic-acid-3d-balls

It is naturally present in meats, cheeses, dairy products, cocoa butter, and vegetable oils (soy and sunflower and canola).

Palmitoleic acid are inserted into triglycerides and cell membranes that are enriched in saturated fats. Which is a normal process.

Retinyl palmitate is an antioxidant and a source of vitamin A added to low fat milk to replace the vitamin content lost through the removal of milk fat. Palmitate is attached to the alcohol form of vitamin A, retinol, to make vitamin A stable in milk. Palmitic acid is naturally produced by a wide range of other plants and organisms, typically at low levels.

From a test called a fatty acid profile, we can see if the level of palmitoleic acid is high on a blood test. If it is, then this is a strong sign that a person is in an early stage problem of being insulin resistant. I recommend a test called Omega quant because it is the most reasonably priced of the tests.

It gets even more complicated than just carbohydrates turning into fat, but also how the dietary fat is handled; mainly by the liver cells. When we are insulin resistant, the liver cells will put triglycerides into the cells and cause something called steatosis, which is fat becoming stagnant in the cells. When this happens, the liver cells are so full of triglycerides, that the nucleus (where the DNA and RNA exist) is actually squished. The way a pathologist looks for fatty liver disease is by looking at the liver cell and quantifying how much triglyceride exists inside of the cell and whether or not the nucleus is smashed.

One nutrient needed to correct the steatosis is choline. Choline attaches to the triglycerides and forms things like phospholipids. A person deficient in choline will have a hard time correcting this problem. Egg yolks are a rich source of choline.

According to the World Health Organization, evidence is “convincing” that consumption of palmitic acid increases risk of developing cardiovascular disease. But realizing they are saying this without including the fix for the problem or that people who are not insulin resistant may not be affected the same by palmitic acid as compared to a person who is insulin resistant.

Realize this all exists on a continuum and is not an on-off switch. If you look at the population, there is an entire continuum of levels of insulin resistance or carb intolerance and it’s not just variable between people and it varies within a person over time and in response to different conditions. Even more, how much you exercise changes where you are on this continuum.

In general, as you get older, you become more “carb-intolerant.” I don’t like this word, but it gets to the point. You can view the whole nutrition and health paradigms through the lens of metabolism, the general premise is that we evolved to burn fat. And ancient humans were much healthier (in many ways) and performed better when we were burning primarily fat for fuel.

Scientifically speaking, exogenous carbohydrates are NOT an essential macronutrient for humans. From an evolutionary perspective humans developed physiological pathways to be able to utilize carbohydrates to take advantage of those sporadic events when carbohydrate sources were readily available.  So the take home is that, yes, we are able to consume carbohydrates, however, we were NEVER meant to consume them in the way that we are today.