On Metabolic Health

  • Recovering Metabolic Health – A Tarzan Story (With Apologies to Edgar Rice Burroughs)

    March 2nd, 2025

    by Ron Harrington

    As a young lad growing up in the 60’s I spent many rainy Saturday afternoons watching old movies, some of which featured Tarzan, the Ape Man. I developed a great admiration for Tarzan, with his lean, strong physique and rude animal health, and I hoped to emulate his life as nearly as possible. (I was thwarted in this effort chiefly by a lack of suitable vines in the local trees and a debilitating fear of quicksand.) Though my desire to swing through the trees has waned considerably, I would still like a portion of Tarzan’s health and vitality—as would we all.

    For we are a very un-Tarzan-like population. Recent reports on the health status of Americans are alarming. According to the CDC, over 35 million Americans have type II diabetes (and about 8 million of those don’t know they have it); almost 100 million Americans (including about half of those over 65) have prediabetes; three quarters of Americans are overweight or obese. And not all of those with diabetes or prediabetes are overweight—the lean can be afflicted as well. And it’s only getting worse.

    Type II diabetes among children and adolescents has almost doubled in just the last twenty years. Almost twenty percent of children and adolescents have prediabetes, and one quarter of young adults have it. It is clear that America has a burgeoning crisis in metabolic health.

    “Metabolic health” refers to how efficient our bodies are at breaking down the food we eat, getting it to the individual cells where it is needed, and producing the energy those cells need to function properly. It is foundational to every process in our bodies. When our metabolic processes become dysfunctional, our whole body suffers. Metabolic dysfunction leaves us feeling unwell, accelerates aging, and can contribute to the chronic diseases we all fear: diabetes, heart disease, cancer, Alzheimer’s, mental illness, and many others.

    Some years ago I was in terrible metabolic health. Over the course of forty years I had managed to pack on an extra 120 pounds. And I felt horrible. My lab numbers from a recent physical were awful, and I knew I was headed for major problems if I didn’t make some big changes.

    I had of course tried diets and exercise, and nothing much worked for long. I had been told that poor metabolic health was caused by being overweight, and the weight gain was caused by consuming more calories than I was expending. Being a curious fellow, I began to wonder why I was consuming more calories than I was expending. That curiosity led me to learn what elements of my diet and lifestyle led to metabolic dysfunction and what changes to make to recover from it. I learned that weight gain is just one of many possible unfortunate effects of metabolic dysfunction, and that weight loss is often one happy side effect of reversing it.

    Me, 1982 (age 22):

    Me, 2020 (age 60):

    Me, 2025 (age 65):

    I’ve lost a considerable amount of weight, but more important, I have greatly improved my metabolic health. My lab numbers are no longer in the tank, and my energy level and mental clarity have much improved. I am as yet unlikely to get invited to hang out with Derek Zoolander, but I have made a lot of progress. I’ve been reliably informed by my children that I now resemble a Goron, some creature from the Zelda video games; I don’t know what a Goron looks like, but I can only assume they are a handsome, well-proportioned species.

    [Editor’s note: This is a Goron:]

    The purpose of this story is to share with you some of what I have learned along the way in hopes you might find something useful in it. I am not selling anything, nor am I pushing a particular diet—what we learn from this story can apply to a lot of different ways of eating, from vegan to carnivore.

    Also, I am not going to tell you what you should eat or not eat. I will explain, as best I can, how our bodies process the different types of foods we eat, and the impact each has on our metabolic health, so that you can make informed choices about your own way of eating.

    There are a couple of ways we could approach this discussion. One would be to fully explore this chart detailing our metabolic pathways:

    The other way would be to talk about Tarzan, the Ape Man:

    I’m going with Tarzan.

    To help us understand metabolism and how it can go wrong, I’m going to tell a part of Tarzan’s story that the original author curiously omitted: Tarzan’s metabolic processes. Even though everything that follows is grossly oversimplified, it will still be necessary to get a little further into the scientific weeds than some of us might like, so gird your loins. (As Albert Einstein supposedly said, “Everything should be as simple as possible, but no simpler.”)

    Before I go on, I should point out that it would be madness for you to take what follows—the ravings of a random old man on the internet—at face value. You should do your own reading to figure out whether you think what I am saying is true. And I’m begging you, with tears in my eyes, don’t make any major changes to your diet or exercise routine without consulting a medical professional.

    After the story you’ll find other posts explaining some of the science behind all this, some ideas about how someone might go about following Tarzan’s path back to metabolic health, and links to references.

    Let us begin.

    Tarzan in the Jungle

    As Tarzan awoke from pleasant dreams he felt the sunlight on his face. He had fallen asleep in a clearing beside the fire where he and his friends from the village had spent a pleasant evening sharing stories. He cleared his throat and let loose with a few of his patented yells, just to let everyone know he was awake and on the job. He hopped into a tree, grabbed a vine, and made his rounds to check on his animal friends and the inhabitants of the nearby village. Assured that all was well and feeling a bit peckish, he set about to gather the makings of a good meal. He checked on a snare he had set up the evening before and found he had captured a nice, plump fowl. After gathering a few vegetables and some berries he built a fire to cook it all up. What is of particular interest to us in this story is what happens to the food that Tarzan eats. We know that various enzymes and chemicals in Tarzan’s digestive tract will break down the food into forms that his cells can make use of. But not all foods are dealt with in the same way.

    Tarzan, like the rest of us, has about 37 trillion cells in his body, all of which require a constant supply of fuel, or they die. The fuel the cells need comes from the food Tarzan eats, and by the time it gets to the cells it has been broken down to the molecular level so it can be processed by the mitochondria in his cells. (Mitochondria are tiny structures in the cells that turn the food molecules into energy. They are known as the “powerhouse” of the cells.)

    Mitochondrion (Artist’s rendering)

    As Tarzan digested the meal his body dealt with the different nutrients, each in its own way. The fat in the meal mostly got sent to the fat cells for temporary storage so Tarzan could use it for fuel between meals. The protein was used to build and repair muscle and other things his cells needed to thrive. The starch in the veggies turned to glucose as it was digested.  Since Tarzan’s body knew that high levels of glucose in his blood would wreak all sorts of havoc, his pancreas responded by releasing insulin to clean it up. The insulin told Tarzan’s fat cells to grab as much fat as they could and hold on to it so his other cells could focus on burning up the glucose. The insulin also told Tarzan’s liver to start converting excess glucose to fat. (I must pause here to point out that “Tarzan’s Liver” would be an excellent name for a rock band.) That fat was also sent on to the fat cells for storage. Some of the fructose in the berries (the kind of sugar that makes them sweet) was converted to glucose in his intestines; the rest got sent to his liver, where some of it was converted to glucose and stored in his liver and the rest converted to fat and forwarded on to his fat cells for storage. For a while after his meal, Tarzan’s cells were burning a lot of glucose.

    But as the glucose levels in his blood dropped, so did the insulin. As the insulin dropped, the fat cells started releasing fat so it could be burned.

    Between meals, Tarzan’s cells mostly burned fat.

    Tarzan spent the afternoon doing Tarzan-like things—stopping a rampaging elephant from destroying a village here, rescuing a toddler from a crocodile there. He took his responsibilities as King of the Jungle seriously. As the day wore on, Tarzan’s fat reserves had been dropping, and something deep in his brain became alarmed. It didn’t want Tarzan’s fat reserves to fall too low— they may be needed one day if food gets scarce. It caused hormones to be released that made Tarzan to start to feel hungry.

    As evening fell he encountered some friends from the village who were returning from a hunt. They had speared a nice fat boar and were planning a feast, which Tarzan was invited to join. They roasted the boar meat over an open fire and settled in to eat. Along with the boar, they had roasted some yams and had some berries they’d gathered for dessert.

    As Tarzan ate the meal his body dealt with the nutrients as before. The fat he ate was sent to fat cells for storage. Some of the fructose was converted to glucose, and the rest went to his liver where it was converted to glucose and stored and the rest converted to fat, which was then sent to the fat cells for storage. The starch in the meal was broken down into glucose, which caused his insulin levels to rise. The insulin told Tarzan’s fat cells to grab fat and hold on to it, his muscles to burn glucose for fuel, and his liver to convert glucose to fat.

    Since swinging on vines, running down elephants, and wrestling crocodiles had put a lot of stress on Tarzan’s muscles and his heart and lungs, his body responded by releasing hormones that triggered growth and repair, to ensure he would be prepared should such things happen again. The protein from the meal was used to repair and build muscle and other tissues.

    After the meal Tarzan sat by the fire with his friends, telling stories and relaxing. As the sun set, hormones were released that started preparing Tarzan for sleep. He watched the fire until he drifted off.

    Meanwhile, as his glucose levels dropped his insulin followed suit. As the insulin dropped, fat started to flow out of his fat cells to be used for fuel as he slept. During the night Tarzan’s liver released some of the stored glucose to keep the levels in his blood stable.

    That pattern repeated, day by day. He would eat a meal, glucose was burned with some converted to fat, fat was stored away until the glucose in Tarzan’s blood reached a safe level, and then the fat flowed out of his fat cells and was burned for energy until his next meal. His mitochondria were beavering away, turning the nutrients into the energy his cells needed. He was an active man, and that energy was being burned. His mitochondria were content. A complex interplay of hormones worked to ensure that he was taking in the same amount of energy he was burning. He didn’t have to count the calories he was eating, or track his activity to make sure he was active enough to burn off those calories. His hormones took care of that.

    And so Tarzan’s life went–and would likely have gone on for a long time had not something unexpected happened: Jane.

    Jane Porter was an American woman among a group of travelers who were marooned by a shipwreck on the coast near Tarzan’s home. Tarzan found her lovely and was determined to share his life with her. The details of their relationship and how Jane was ultimately rescued need not detain us, except to say that Jane ended up back in America, and Tarzan followed her there.

    Tarzan in America

    As Tarzan awoke from uneasy dreams he heard the sound of a jet airplane rattling the windows of his motel room. His flight to America had arrived late and he had checked into the first motel he found near the airport. Feeling hungry, he made his way down to the motel restaurant. After observing what a diner at a nearby table was eating, he asked for the same: eggs with bacon, hash browns, and a stack of pancakes. His metabolic system was entirely unprepared for what was about to happen.

    As he consumed the meal and began to digest it, his body went to work metabolizing the meal. The fat in the meal was broken down and sent to the fat cells for storage, as usual. The protein was used for growth and repair.

    The sugar in the syrup and the pancakes was split into fructose and glucose. Some of the fructose was converted to glucose, with the rest sent to Tarzan’s liver to be processed. There it was mostly converted to fat and sent to his fat cells for storage. Tarzan’s liver was overwhelmed. While it could easily handle the fructose in a serving of berries, it could not keep up with such an onslaught. Some of the fructose ended up being deposited as fat in his liver.

    The starch in the hash browns and pancakes—and there was a lot of starch— was immediately converted into glucose. That glucose, along with the glucose from the sugar, sent Tarzan’s pancreas into panic mode.  (“Tarzan’s Pancreas” would not be a particularly good name for a rock band.) They had never seen such a load of glucose. As Tarzan’s blood glucose levels rose, his levels of insulin rose with it.

    The insulin told the fat cells to start taking in fat and to hold onto it. It told the muscles and other tissues to burn glucose. It told his liver to convert all that excess glucose into fat, a process that Tarzan’s liver struggled to accomplish. Some of the fat ended up stored locally in his liver.

    It took a good deal longer for Tarzan’s insulin to drop low enough for his brain to get the signal that he had plenty of fat stored up, so his brain became concerned that he might be starving. The insulin kept the fat locked up in his fat cells so he couldn’t use it for energy. He felt strangely sluggish and was thinking of food throughout the morning, even though he was stuffed.

    Upon arrival in America Tarzan was in need of a job so he could support himself as he courted Jane. He quickly found one at a call center doing technical support for a software company. (And if you think his utter lack of technical knowledge would have made him an unlikely candidate for a job in technical support, then you haven’t called many technical support lines.)

    On the way to work his first day Tarzan stopped by Starbucks, as was the local custom, and selected a Café Mocha with Whipped Cream and a Cheese Danish.

    The fat in the meal was sent to the fat cells for storage. The small amount of protein in the meal was used for growth and repair. The added sugar was split into fructose and glucose. Some of the fructose was converted to glucose, with the rest sent to Tarzan’s liver where most was converted into fat and sent to the fat cells for storage. It was a much higher load of fructose than Tarzan’s liver was designed to handle, and so some fat ended up deposited locally in his liver. The starch in the Danish was converted to glucose, which, along with the glucose in the table sugar, prompted the pancreas to release insulin. It told the fat cells to grab fat and hold onto it, the muscles to burn glucose, and the liver to convert glucose to fat. It was a much higher glucose load than Tarzan’s liver was designed to handle, and some of the fat ended up being deposited locally in the liver.

    Once again Tarzan’s insulin spike went higher and lasted longer than it ever did back in the jungle. It took longer for his brain to get the signal that his fat reserves were adequate, so it kept him in energy storage mode for longer. Meanwhile, the elevated insulin and elevated blood glucose were doing damage throughout Tarzan’s body.

    Tarzan spent the morning feeling sluggish and thinking about food. He was supposed to be learning about the software he was going to support but he was in a bit of a mental fog. He did stir himself to ask a couple of pertinent questions, such as, “What is software?”

    When lunchtime finally arrived Tarzan gratefully went to a nearby Wendy’s and secured a Dave’s Double combo, with fries and a Coke. The fat in the meal was broken down and sent along to fat cells for storage.

    The sugar in the bun and the Coke was split into fructose and glucose. Some of the fructose was converted to glucose, with the rest sent to the liver and was mostly converted to fat and sent to the fat cells for storage.  It was far more fructose than Tarzan’s liver was designed to handle and so some of the fat ended up deposited locally in the liver.

    The starch in the bun and the fries was immediately converted to glucose and released into Tarzan’s bloodstream. The pancreas sensed the increased glucose and released insulin to deal with it. The insulin told the fat cells to store fat, the muscles and other tissues to burn glucose, and the liver to convert glucose to fat. The barrage of glucose was more than his liver was designed to handle, and so some was left behind as fat in his liver.

    Tarzan’s glucose and insulin climbed much higher and took far longer to come down than had ever happened back in the jungle. It took a long time before the insulin dropped enough that his brain could get the message that it was okay to move around and to stop thinking about food.

    And so it went, meal after meal, day after day.

    Back in the jungle Tarzan would eat a meal, he would store the fat, then as insulin fell the fat was released and his mitochondria used it to make energy. He cycled freely back and forth between energy storage mode and energy burning mode.

    Now Tarzan was spending far more time in energy storage mode—and consuming more calories than he was burning—and it was starting to show. He had added a little softness around the middle, which got a little more pronounced with each passing year.

    Occasionally Tarzan would attempt to lose some weight and would sometimes succeed, for a time. He counted calories and practiced portion control. He would cut down on the sweets and soda, but he still thought about food all the time. His body chemistry was in energy storage mode for too much of the time, and though Tarzan was a man of strong will, he would eventually give in. He was no match for his hormones. He always gained the weight back, usually with a little extra.

    Every year Tarzan went in for his physical, and every year his doctor checked his fasting glucose. Every year it was fine. What Tarzan didn’t know was that each year it took more insulin to achieve that result. Back in the jungle it didn’t take much insulin to keep his glucose under control. Each year in America, while eating like an American, it took a little bit more. Due to the constantly elevated insulin and the fat in his liver, Tarzan was becoming insulin resistant.

    A few years on, at the yearly physical, Tarzan’s doctor pointed out a few concerning items (coincidentally, I used to dance under the name “Tarzan’s Doctor”). For one, his blood pressure was up, not super high but out of the normal range. His triglycerides were on the high side, and his HDL cholesterol was on the low side.

    The doctor told Tarzan that the lab numbers and extra weight around the belly showed that he was at risk for heart disease. He told Tarzan he needed to lose some weight and gave him a pamphlet detailing what a healthy diet looks like: plenty of whole grains, fruits, vegetables, lean meats, and not much saturated fat.

    What Tarzan didn’t know was that his insulin resistance had progressed to something called “metabolic syndrome.”

    Now Tarzan was concerned. He resolved to start eating healthy foods. He cleaned out the cupboard and went to the grocery store to stock up. The first day of his new healthy lifestyle he had a breakfast of Kellogg’s Total 100% whole grain cereal with skim milk, along with a glass of orange juice.

    As Tarzan ate this healthy meal, his body started to break it down.

    The fat in the meal was sent to the fat cells for storage. The protein in the milk was used to repair and grow tissues. The sugar in the cereal was split into fructose and glucose. There was a huge load of fructose in the orange juice, most of which went  to Tarzan’s liver (along with the fructose from the cereal), where much of it was converted into fat and sent to the fat cells for storage. It was far more fructose than his liver was designed to handle, and some of the fat ended up deposited in his liver. The starch in the cereal was broken down into glucose, and so stimulated the pancreas to secrete insulin to deal with it. Muscles and other tissues started burning the glucose, the liver started converting glucose to fat, and the fat cells were grabbing the fat and holding onto it. It was a much larger load of glucose than Tarzan’s liver was designed to handle and some of the fat was deposited there.

    Even though the fat cells were storing more fat, Tarzan’s brain wasn’t getting the signal that his fat reserves were full because of the elevated insulin. He felt sluggish and thought about food all morning.

    For his lunches, Tarzan had bought a variety of “Healthy Choice” frozen dinners. This day he had brought the chicken parmigiana. With over forty grams of carbohydrate (eleven of which was sugar), it had pretty much the same effect as his breakfast. The meal left Tarzan’s liver a little fatter and more insulin resistant than before.

    For his afternoon snack, Tarzan opted for a large “Acai Super Anti-Oxidant” smoothie from Jamba Juice. To Tarzan that sounded like about the healthiest thing he had ever heard of. Tarzan didn’t realize that he was getting eighty-eight grams of sugar, more than twice as much as in a twelve ounce can of Pepsi. His liver just whimpered and raised a white flag.

    For supper, Tarzan had some whole grain pasta, with some whole grain garlic bread and a side of asparagus. The fat in the meal was sent to his fat cells for storage. The protein from the meat in the spaghetti sauce was used for tissue growth and repair. The starch in the whole grain pasta and bread turned to glucose. His blood glucose spiked and remained high for much too long, and so it was a long time before his glucose and insulin dropped low enough that he could start burning fat again.

    Tarzan maintained this healthy eating pattern by scrupulously following the guidelines in the pamphlet. He had yet to learn that just because a food is advertised as healthy doesn’t mean it is.

    After three months of this supposedly healthy eating, Tarzan returned to his doctor for a follow-up. He was excited to see how much his lab numbers had improved. This proved a disappointment, to both Tarzan and his doctor. There was no detectable improvement. His doctor said he must simply be eating too much and advised him to cut back on his portion sizes. Tarzan was despondent.

    Though Tarzan loved America and loved being with Jane, his life was not without its dissatisfactions. In addition to feeling sluggish much of the time, he was under a great deal of stress at work. Every time he made a mistake on his TPS reports, five different bosses would come by his cubicle and let him know about it. And many of the callers to his technical support line would become inexplicably enraged. He wasn’t sleeping well. He had taken to staying up late, binging on Netflix and scrolling through his twitter feed. He would go to bed late and have difficulty falling asleep. When the alarm went off in the morning, he would hit snooze over and over and it would take a long time for him to stop feeling groggy. He had made friends in America, but he didn’t get to spend as much time with them as he would have liked. He would meet his friends for lunch or accompany Jane on a couples outing on occasion, but he missed those long hours rambling through the jungle or sitting around the fire with his buddies. Also, as Lord of the Jungle, Tarzan had felt a strong sense of purpose, something lacking in his life in America. And on top of all that he had become depressed. That had never happened in the jungle. He had experienced sadness, even grief, but never just this vague sense of despair.

    Then Tarzan had an epiphany.

    He remembered how happy he had been back in the jungle. He was healthy and full of energy. He wasn’t under constant stress; he had a strong sense of community and a strong sense of purpose. Leaving Jane to return to the jungle was out of the question, so Tarzan decided to try to replicate his jungle life as nearly as possible.

    He decided he was done with diets. They had only let him down. He remembered that in the jungle he just ate real food—stuff that came out of the ground and stuff that came from animals. He resolved to eat the same way in America. Once again he cleaned out the cupboards and brought in an entirely different set of groceries.

    The first morning of the new regime, Tarzan had eggs scrambled in butter, some blueberries, and a glass of whole milk. The fat in the eggs, butter, and milk was packed up and sent to the fat cells for storage.  The fructose in the blueberries was mostly converted to glucose in his intestines, with the remainder sent to the liver to be converted to fat and sent to the fat cells for storage. There wasn’t a great deal of fructose (and what there was bound up with fiber and so entered his bloodstream more slowly), so his liver was able to handle it with no problem. It breathed a sigh of relief. The sugar in the milk ended up as glucose, which, along with that in the blueberries, stimulated his pancreas to secrete insulin. Since there was less glucose resulting from this meal than Tarzan had grown accustomed to, a good deal less insulin was released. But it still did its job, telling the muscles to burn the glucose, the liver to convert it to fat, and the fat cells to store the fat. Since it was a smaller glucose load, the liver was able to handle the volume with no problem.

    At lunch Tarzan had a grilled chicken Caesar salad. His liver was ecstatic.

    For supper Tarzan grilled a nice ribeye steak, with some green beans and broccoli on the side. He had strawberries with cream and pecans for dessert. His body broke those down in the usual ways. The fructose and glucose loads were manageable. His liver, for the first time in a long while, was able to take the rest of the evening off and put its feet up.

    Tarzan continued to eat just real food, eating when hungry, and stopping when full. He didn’t realize it was happening, but his liver had been taking advantage of the lighter load and had started clearing out some of the fat. His liver was becoming more sensitive to insulin. Since his food wasn’t causing the high glucose spikes, his insulin levels were down. His other tissues were becoming more insulin sensitive.

     One afternoon a few weeks later Tarzan experienced something he hadn’t felt for a long time. He found himself fidgeting and wanting to move. When break time came, he got up and went for a walk instead of checking out the responses to his latest facebook posts. Tarzan didn’t realize it, but his insulin levels were now dropping low enough for his brain to get the signal that his fat stores were full. It now knew that Tarzan was not starving and started letting him know it was okay to move and to stop eating. Tarzan’s food cravings subsided considerably.

    He was feeling more energetic and started moving and exercising again. When he got home from work he no longer felt the desire to sit on the couch and reach for the remote. He could often be seen of an evening walking his monkey in the park. For the longest time exercise had been a chore and a duty; it was becoming a joy. He was gaining muscle mass and his heart and lungs were growing more efficient. And the activity and exercise helped to improve his insulin sensitivity even more.

    His newfound energy spurred him to make other changes. He deleted his Twitter and Instagram accounts and made sure to turn off all screens well before bedtime. He made sure he got out in the sun every morning. He found that the local zoo was in need of an assistant to the zookeeper (not an assistant zookeeper) and applied immediately. He won the job, and the zookeeper was impressed with the rapport Tarzan had with the animals. The job change not only removed the source of much of Tarzan’s stress, but looking after the animals gave him the sense of purpose he had been lacking. He deepened his relationships with his friends, spending more time together and inviting them over for long evenings around the firepit on his patio.

    Tarzan wasn’t aware of it, but because of his lowered fructose and starch intake his liver wasn’t converting nearly as much fructose and glucose to fat and so there was quite a bit less of it in his bloodstream to show up on his lab report as high triglycerides. He also didn’t know that his lowered insulin levels and increased insulin sensitivity were helping his blood pressure to normalize.

    A few months later he had another follow-up with the doctor. The doctor was surprised and pleased that Tarzan had lost some weight around the belly. He was even more pleased that Tarzan’s blood pressure and lab numbers were improved. In increasing his insulin sensitivity Tarzan had reversed his metabolic syndrome. He had gone a long way toward recovering his metabolic health.

    I’d like to say that Tarzan never strayed from his new path and continued to improve his metabolic health without stumbling. But that would be wrong. For one thing, the reward center in his brain never forgot those dopamine hits from his first taste of pancakes and syrup, and so was constantly prodding him to chase that dragon. And the whole world was conspiring to lead him astray. There were ads for sweets everywhere, and every social gathering featured a lot of foods that could throw him off track.

    After one annual physical his lab report was so good that he decided to celebrate with a cheat meal. He went to a diner and ordered an omelet, with hash browns and biscuits and gravy. It awakened something deep in his soul. After the meal he remembered how good Dr Pepper tastes and decided to have one before going back to eating just real food. Then it occurred to Tarzan that he hadn’t had pizza in a long time, and he could have that for supper and start eating right the next day. He did so, and followed it up with a slice of apple pie and ice cream for dessert. It was a few months before Tarzan came to his senses and started eating just real food again. He had gained back some of the weight, and was feeling sluggish and tired.

    Most of his setbacks were temporary. He attended a potluck with friends from church. Though he had resolved to not eat poorly at the potluck he found that when confronted with a skillet full of blackberry cobbler he was powerless to resist. He had a very small slice—it was only wafer thin—followed shortly thereafter by a much larger slice, which was followed by half a family-sized bag of Lay’s potato chips. He was back on track the next day, but paid for his excesses with a couple of days of feeling pretty crummy.

    Another time he had purchased a box of Total Whole Grain Cereal, just to see how his body responded to it. He found that it spiked his blood sugar to an unwelcome extent and resolved not to include it as part of his regular diet. But he neglected to throw away the box. The next evening he came home from work and found the box on the kitchen counter. He proceeded to eat three bowls of it in rapid succession—an act he came to bitterly regret for reasons upon which I shall not elaborate.

    But eventually Tarzan figured out the strategies to navigate this treacherous world. He also figured out which foods he could safely eat, and which would set him on a downward spiral. He learned strategies that would allow him to occasionally eat treats without triggering binges.

    He learned to identify natural fats, and came to understand how different kinds of fats affected his metabolic health.

    Tarzan also learned how to measure his metabolic health to ensure that he was eating an optimal diet.

    He learned to read labels on food packages so he could avoid metabolically damaging foods.

    Tarzan had figured out a metabolically healthy lifestyle. Tragically, Tarzan was hit by a bus and killed shortly before his fiftieth birthday.

    I’m kidding! Tarzan lived to an advanced age, dying at ninety-three in a fall while trying to rescue a neighbor’s cat from the upper branches of an oak tree. (The cat was never in any actual danger. He came down on his own when the ambulance arrived to see what all the fuss was about.)

    ***************

    Tarzan’s story is not at all unique. Millions of people around the world have gone through the same transition, from metabolic health to metabolic dysfunction. In the nineteenth century and into the twentieth, there were countless reports from explorers, colonial doctors, missionaries, and others detailing the remarkably good health of indigenous populations while eating their traditional diets. These reports came from across Africa, Asia, Australia, and the Americas. The reports were consistent: while the populations may have suffered from infectious diseases, parasites, and trauma, they were remarkably free of diabetes, heart disease, and cancer.

    This was true even of the very old.

    And these people groups were eating a wide variety of traditional diets: it included the Inuit, who ate almost exclusively meat with very high levels of fat consumption and almost no carbohydrates; it included the south sea islanders who ate a diet rich in unrefined carbohydrates along with a lot of fish and coconut; it included the Masai who consumed mostly meat, milk and blood.

    One thing these groups had in common was what they lacked: sugar and refined carbohydrates (e.g., flour).

    But another thing these cultures had in common was that when they started incorporating sugar and flour into their diets, they started experiencing what came to be called “diseases of civilization”: diabetes, cancer, heart disease, and dementia (among others).

    Sadly, most of those folks did not have the same opportunity to correct their diet and lifestyle that Tarzan had.

    Foods that raise the levels of fructose, glucose and insulin in our blood contribute to all manner of chronic disease. And these problems don’t just suddenly begin to develop the moment someone is diagnosed with type II diabetes. They have been developing all along as insulin resistance morphs into metabolic syndrome and on into diabetes.

    Those foods include, I am sorry to say, sweets, soft drinks, sports drinks, orange juice (and other fruit juices), fruit smoothies, and the million and one processed foods that have added sugar that we don’t even notice.

    They include bread, pasta, chips, crackers, breakfast cereals (even the “healthy“ ones), and the million and one processed foods that are loaded with refined carbohydrates.

    They include salad dressings, sauces and fried foods brimming with unnatural fats and oils.

    I fully realize that the lists above contain many of our favorite foods. I’m not one of those people who doesn’t understand why everyone doesn’t just eat kale. I didn’t pack on an extra 120 pounds by being indifferent to cookies, bread, and pasta. The thought that I can no longer eat biscuits and gravy occasions in me an emotion not unlike grief. But these are the very foods that are making us fat and sick.

    I am not saying you should never eat these foods again; rather that you might consider them treats for occasional indulgence instead of staples of your diet.

    There are unicorns among us who can eat lots of these foods and retain their metabolic health (just as there are people that live into their nineties while smoking three packs a day). And there is a great deal of variation among humans, and so likely there is not one diet that fits everyone. But it is likely that anyone would benefit from reducing or eliminating processed foods.

    If you would be interested in learning about the science behind Tarzan’s story, or would like to get some tips on how you can follow Tarzan’s path back to metabolic health, see the posts below. At the very end you will find links to references relating to the science discussed in the story.

    Contact: Should you wish to respond to all this, or just want to tell me I said something dumb, shoot me an email at ron_harrington@icloud.com.

    About me: I live near Tulsa, Oklahoma, where I am employed as an IT infrastructure engineer. I no longer dance professionally.

  • Macronutrient breakdown

    February 28th, 2025

    In the story I discuss how Tarzan’s body metabolizes the different kinds of foods he eats. Here is a little more detail on those processes (keep in mind that this is greatly simplified):

    Dietary Fat

    The fat we eat is first broken down into its constituent fatty acids and absorbed into the walls of the intestines. There the fatty acids are formed into “triglycerides” (three fatty acids attached to a glycerol backbone). The triglycerides are then packed up together and placed on these life rafts called “chylomicrons” which can move through the bloodstream and carry the triglycerides to fat cells for storage. Fats are also used to build structures, including cell membranes. When glucose is low, some fatty acids will be broken down by the liver and used to create something called “ketone bodies” (or “ketones”), which most tissues can burn for fuel in place of glucose.

    Protein

    Protein is broken down into its constituent amino acids. These amino acids are used to effect tissue repair and growth, and to build other structures needed by our cells. Amino acids can be burned as fuel by our cells if needed, and excess amino acids can be converted by the liver into glucose or fats.

    Carbohydrates

    Carbohydrates come in three main forms:

    Starch: Starch is a long string of glucose molecules bound together.

    When we eat starch it is broken down into individual glucose molecules. How quickly that happens is affected by how tightly the starch is bound up by fiber (starches bound up with fiber result in a slower and lower glucose rise in the blood).

    Fiber: Fiber comes in two forms, which work together to slow digestion of starch.

    • Insoluble fiber (does not absorb water): We do not digest insoluble fiber. It passes into the gut, and on out of the body.
    • Soluble fiber (does absorb water): It turns into a gel and helps to slow digestion of starches. The soluble fiber can be eaten by the microorganisms in our gut.

    Sugars:

    The sugars that concern us here are:

    Fructose:

    This is the sweetest sugar, which is found in fruits and in lesser amounts in vegetables. Some fructose is converted to glucose in our intestines, and the rest is sent to the liver. There it can be burned for fuel, converted to glucose and stored as glycogen (glycogen is a long string of glucose molecules that can be quickly broken down to glucose when needed), or converted to fat. The fat is formed into triglycerides, packed on life rafts called “Very Low-Density Lipoproteins” (VLDL) which can carry them to fat cells for storage. (The VLDL particles also carry cholesterol to cells. As the cargo is dropped off, the VLDL particles become LDL (Low-Density Lipoproteins).

    Glucose:

    This is the most common sugar. The starch in grains and vegetables is broken down into glucose molecules. Every cell in our bodies can burn glucose and there is a small subset of cells that can only burn glucose. Glucose can be burned for fuel, stored as glycogen, or converted to fat in the liver. This fat is also packaged into triglycerides and loaded onto VLDL particles for transport to the fat cells. Muscles also store glucose as glycogen for use in a pinch.

    NOTE: Table sugar is a combination of fructose and glucose known as “sucrose”; when we eat it, the fructose and glucose are separated and metabolized as described above. Our bodies handle high-fructose corn syrup the same way.

    Lactose:

    This is a sugar found in milk and is made of glucose and galactose. The glucose and galactose are separated, and then the galactose is converted to glucose.

    NOTE: The triglyceride number on your lab report is greatly affected by how much fructose and glucose your liver is converting to fat.

  • Glucose Metabolism:

    February 26th, 2025

    In the story I mention the role of insulin in fat storage and glucose metabolism. Here is a little more information on that (though still very much simplified).

    Glucose is a double-edged sword. It is vital, in that some cells in our bodies can burn only glucose, but it also can cause a lot of damage. Our bodies have a complex regulatory system to keep our glucose in a healthy range.

    In a metabolically healthy individual, glucose is usually found in a range between 70 and 100.

    If our glucose levels drop too low, we can grow light-headed, weak, and cranky. If they drop very low we can go into a coma, and if they drop lower still we can die. So if our glucose drops too low, our bodies release hormones that stimulate the liver to break down glycogen (the storage form of glucose) into glucose and release it into the bloodstream. If that is not enough, the liver will be stimulated to convert protein into glucose and release it into the bloodstream. It is normal for those processes to occur when we are fasting or if we do not eat starch or sugar.

    If glucose is elevated it can cause a lot of damage to our system (described in another post). When our glucose is elevated our pancreas releases insulin, which tells the muscles and other tissues to burn glucose, the fat cells to store fat, and the liver to convert glucose to fat.

  • Damage caused by elevated glucose and insulin levels

    February 24th, 2025

    In the story I mentioned that elevated glucose and insulin levels cause problems in the body; here are some of those problems:

    Glycation: When glucose or fructose molecules glom onto a protein (without being properly introduced by an enzyme) that is called “glycation.” It can contribute to many chronic diseases, including heart disease, cancer, diabetes, cataracts, Alzheimer’s disease, rheumatoid arthritis, premature aging, and more. Glycation of LDL particles in our blood can make them more likely to contribute to heart disease; glycated proteins are found in the amyloid plaques in the brain that are associated with Alzheimer’s. Glycated proteins in the lens of the eye contribute to cataracts. Glycation of proteins is a normal occurrence and is a big part of the aging process; but the more glucose and fructose in our blood, the more glycation happens (and the faster we age).

    Glycated protein:

    Increased oxidative stress: when glucose and fructose are burned for fuel in our mitochondria, something called “Reactive Oxygen Species” (ROS) are formed. Also known as “free radicals,” they can damage proteins, including our DNA. When a free radical steals an electron from another molecule it is called oxidation. Oxidized proteins become dysfunctional and cause inflammation. Free radicals contribute to many chronic diseases, including heart disease, cancer, diabetes, cataracts, Alzheimer’s disease, rheumatoid arthritis, premature aging, and more. Free radicals damage mitochondria, which in turn generate more free radicals in a classic vicious cycle. Although ROS generation is a normal part of metabolism and our cells have built-in defenses, if glucose and fructose levels rise too high those defenses are overwhelmed.

    Free radicals:

    Mitochondrial dysfunction: When our mitochondria get more glucose and fructose dumped on them than they can handle, they become dysfunctional. And since our cells rely on mitochondria to produce their fuel, dysfunctional mitochondria lead to dysfunctional cells; dysfunctional cells lead to dysfunctional organs. Mitochondrial dysfunction contributes to pretty much any chronic disease you can name. Mitochondrial dysfunction in the lining of our arteries can contribute to cardiovascular disease; mitochondrial dysfunction in the brain can contribute to depression, anxiety, bi-polar, and other mental health problems. And so on.

    Dysfunctional mitochondrion (Artist’s rendering)

    Damage to the lining of our blood vessels: Glucose in our bloodstream damages the protective lining of our blood vessels. This contributes not only to heart disease, but also, by damaging the very small blood vessels in our eyes, kidneys, and nerves it contributes to many of the complications associated with diabetes, such as neuropathy and retinopathy. Vascular damage can also contribute to dementia.

    High blood pressure: High levels of insulin can cause the kidneys to hold onto more water, leading to greater blood volume; it can also cause the arterial walls to thicken. Both contribute to high blood pressure. Sugar and starch intake can have a large impact on our blood pressure.

    Making us more vulnerable to some cancers: Most cancer cells undergo a mutation that renders them reliant on glucose fermentation to produce their energy (known as the Warburg effect). Those cancer cells require much more glucose than normal cells, and have more insulin receptors than normal cells. High levels of insulin and blood glucose create a hospitable environment for tumor growth. Lewis Cantley, discoverer of an enzyme called “PI3-kinase” and its role in the Warburg effect, is one of the world’s most respected and honored cancer researchers. (PI3-kinase helps cancer cells take in more glucose.) He had this to say about the link between insulin and cancer: “Our preclinical research suggests that if somewhere in your body you have one of these PI3K mutations and you eat a lot of rapid release carbohydrates, every time your insulin goes up, it will drive the growth of a tumor. The evidence really suggests that if you have cancer, the sugar you’re eating may be making it grow faster.’” (“Sugar” here being a reference to blood glucose.) (I am not here suggesting that sugar causes cancer, or that if we have cancer we can starve it out. But it certainly seems to create conditions for it to thrive.)

    Dysregulation of our gut bugs: We have 100 trillion microbes living in our gut; some are good guys and some are bad guys. Researchers are beginning the task of figuring out how these microbes affect our health. But one thing is becoming clear: high levels of sugar and starch feed the bad guys, with negative results for our health.

    This raises a question: If high levels of blood glucose cause damage, do normal levels of blood glucose do the same? Yes, they do. Nobody has an A1c score of zero, and everyone ages eventually. But our bodies have built-in mechanisms to repair most of that normal level of damage. But if the glucose levels are too high for too long those repair mechanisms fall behind and the damage increases over time.

    Consider this analogy. A town has a crew responsible for repairing potholes and other road damage. They are adequately staffed and have the necessary supplies on hand to effect the repairs for the normal and expected amount of damage. But traffic patterns change, and more heavy trucks start coming through town, increasing the damage. The road crew is not staffed to handle it, and they don’t have enough materials to do the repairs. Road damage builds up over time. Think of high loads of fructose, glucose, and insulin as heavy trucks rolling through town.

  • Energy Balance:

    February 22nd, 2025

    In the story, I mention that a complex interplay of hormones keeps Tarzan taking in the same amount of energy he is using. There are many hormones involved in that, but I’ll just mention a couple of them here.

    In a metabolically healthy individual, glucose is the primary fuel used after a meal that contains starch or glucose. As glucose drops, fat is released from the fat cells and becomes the primary fuel between meals. Here is how that happens:

    • Insulin is released in response to glucose; it tells the fat cells to hold onto their fat. As glucose levels drop back to baseline levels insulin levels do the same.
    • Leptin is a hormone that is released by our fat cells. It sends a signal to the hypothalamus (a structure in the brain) so that the hypothalamus knows that we have fat reserves.
    • When we eat a meal and fat is stored, our fat cells increase their leptin signal. But when insulin is elevated, the leptin signal is not as strongly received.

    So here is how that plays out:

    • We eat a meal that contains starch or sugar.
    • Glucose levels rise, and insulin rises in response, so we are primarily burning glucose for fuel.
    • As glucose and insulin levels drop, fat starts flowing out of the fat cells and becomes the primary fuel source.
    • At the same time, the hypothalamus is now getting the signal from the leptin that we have plenty of energy in our fat stores and causes hormones to be released to tell our body that we have enough energy stored, so we don’t need to keep eating, and we don’t need to conserve energy.

    Here’s how that went wrong for Tarzan:

    • When he started eating meals with a lot of sugar and refined carbohydrates and became resistant to insulin, his insulin stayed elevated longer after meals.
    • That means it took longer for Tarzan’s hypothalamus to get the signal that he had enough fat reserves. (“Tarzan’s Hypothalamus” would be a dreadful name for a rock band.)
    • So even though Tarzan had just eaten a meal, his brain still thought he was starving.
    • Hormones were released that caused Tarzan to crave food, and to conserve energy.
    • Tarzan’s hormones were telling him to sit on the couch and eat potato chips.
    • When he was metabolically healthy his hormones were telling him between meals to stop eating and to get moving.

    Tarzan wasn’t metabolically unhealthy because he was eating more calories than he was burning; he was eating more than he was burning because he was metabolically unhealthy.

  • Insulin Resistance:

    February 21st, 2025

    Insulin resistance is a state where some tissues in the body become resistant to the effects of insulin and they require more of it to achieve the same effect.

    Insulin resistance is effectively the first step on the road to type 2 diabetes. When we are insulin resistant, glucose from the starch in our meals goes higher and lasts longer; more damage is done by the excess glucose and insulin. Fat spends more time locked up in our fat cells and less time being used for fuel.

    There is no scientific consensus on what causes insulin resistance. One theory is that it is caused by being overweight. But since there are a lot of normal weight people with insulin resistance and since our metabolic health can be improved before we lose much if any weight, there is likely more to the story.

    Some research suggests that insulin resistance starts with fat in our livers from excess consumption of sugar and starch, which leads to elevated insulin and blood glucose, which in turn causes other tissues to become resistant to insulin. (Overfeeding fat can also leave fat deposited in the liver, but we are far more likely to overdo it with sugar and starch than with fat.) It could also be caused by high intake of starches and sugars that lead to chronically elevated insulin. When tissues are constantly exposed to a hormone they can downregulate their receptors for it. Over 50 million American adults are estimated to have non-alcoholic fatty liver disease. Many more have at least some excess fat in their livers.

  • Metabolic Syndrome:

    February 19th, 2025

    Metabolic syndrome is a cluster of markers that tend to appear together, and is a harbinger of health problems to come.

    Low HDL and high triglycerides are associated with increased risk for heart disease. (That is not to say they cause heart disease; maybe they do, maybe they don’t. Some third thing may cause all three. We don’t really know.) The markers for metabolic syndrome are these:

    • Fat in the abdominal area
    • High Triglycerides (or on medicine to reduce triglycerides)
    • Low HDL (or on medication to raise HDL)
    • High Blood pressure (or taking medicine to lower blood pressure)
    • High A1c or fasting blood glucose (or taking medicine to lower blood glucose)

    (HDL is the name of one of the particles that transport cholesterol around our body; HDL carries cholesterol back to the liver to be processed. It is known as the “good cholesterol.”)

    Anyone with three or more of those markers is considered to have metabolic syndrome. The CDC estimates that about 100 million Americans have it. And the prevalence increases with age (over half of those over 60 have it).

    Those with metabolic syndrome are more likely to fall victim to serious chronic disease, including (but not limited to):

    • diabetes (type II)
    • cardiovascular disease
    • many types of cancer
    • Alzheimer’s and other neurological diseases
    • depression, anxiety, bi-polar, and other mental health problems
    • rheumatoid arthritis and other autoimmune disorders
    • fatty liver disease
    • polycystic ovarian syndrome
    • gout

    Insulin resistance and metabolic syndrome can be thought of as steps along the way towards type II diabetes. The progression looks something like this:

    • We eat too much processed food which results in too much glucose and fructose sent to our livers for processing.
    • We get excess fat deposited in our liver.
    • Our liver grows less sensitive to insulin.
    • Our baseline insulin grows higher, especially if we are eating a lot of foods that easily convert to glucose.
    • Other tissues grow resistant to insulin.
    • We start exhibiting the markers for metabolic syndrome
    • Higher insulin levels cause other tissues to become desensitized to insulin.
    • As our insulin resistance grows it becomes harder for our pancreas to pump out enough insulin to keep our blood glucose in a normal range.  
    • As our fasting glucose levels rise above 110 (or our A1c rises above 5.7) we are diagnosed with pre-diabetes.
    • Our pancreas falls further behind and our fasting glucose levels rise above 125 (or our A1c rises above 6.5) and we are diagnosed with diabetes (type II).
  • A Primer on Dietary Fat:

    February 17th, 2025

    The fats we eat are not only used as a reserve energy source and burned for fuel, they are also used to build structures in our bodies, such as cell membranes. It is important that we get the types of fats our bodies need to build those structures, and to understand the distinction between the natural fats our bodies expect and the unnatural fats so often provided in the processed foods we eat.

    Processed vs. Unprocessed

    The distinction between processed foods and unprocessed foods applies to fats. Some of the fats in our food supply come from natural, unprocessed or minimally processed sources and some from very unnatural processed sources. Processed fats and oils can lead to inflammation.

    Animal fats are natural, provided they haven’t been hydrogenated. If purchasing lard, beef tallow, butter, or other animal fats check the label to ensure that they haven’t been hydrogenated.

    Fats from plants can be natural or unnatural depending on how they are produced: refined vs. unrefined. Natural oils are extracted without using chemicals or heat. Unhealthy processed oils are produced with heat and/or chemicals. Unfortunately, the overwhelming majority of fats in processed foods and used for cooking in restaurants is the unhealthy processed kind.

    Some vegetable oils come from the fruit of the plant: olive, palm, coconut; and others from the seeds: soybean, peanut, corn, safflower, grapeseed, canola (from the rapeseed plant), etc.

    Natural oils are produced without heat and chemicals, and will say something like “cold pressed,” “expeller expressed,” or “unrefined” on the label. Natural, healthy, olive oil will be labeled “extra virgin” (“regular” olive oil is extracted using heat and/or chemicals).

    Most seed oils are created using an industrial process involving heat and solvents to extract the oil (the solvent generally used is hexane, a petroleum product; before processing is complete the hexane is evaporated away).

    Check food labels carefully. Vegetable oils found in processed foods (soybean oil, peanut oil, corn oil, canola oil, grape seed oil, etc.) are almost always the industrially produced kind.

    To sum up processed vs. unprocessed fats:

    Animal fats (lard, beef tallow, duck fat, butter) are natural if they haven’t been hydrogenated or otherwise processed.

    Vegetable oils from the fruit of the plant (olive, palm, coconut, avocado) are natural if they are unrefined.

    Vegetable oils from seeds (soybean, peanut, corn, grape seed, canola, safflower) are unnatural and inflammatory unless they are cold pressed (and most aren’t). A major problem with processed oils is that they are very prone to oxidation, especially when heated. The fry vat in a typical restaurant is reheated over and over. Anything cooked in it will be heavily oxidized and inflammatory.

    And note that margarine is made from these unnatural oils, and is often hydrogenated to boot.

    Be sure to check food labels carefully for these oils. The food industry puts them in just about everything.

    Types of Fats

    The three types of dietary fat are saturated, monounsaturated, and polyunsaturated. “Saturated” means all the carbon atoms in the fatty acid molecule have a hydrogen molecule bound to them, and so there is no gap where other atoms can interact with it. “Monounsaturated” means the fat molecule has one gap where other atoms can interact with it. “Polyunsaturated” means that the fat molecule has at least two gaps where other atoms can interact with it. Saturated fats are less prone to oxidation because they don’t have that gap; polyunsaturated fats are most prone to oxidation because they have multiple gaps.

    In choosing how much of which types of fats to include in our diets, it is important to know how the different kinds of fats can affect our health. Monounsaturated fat (MUFA):  Olive oil contains primarily MUFA, in the form of oleic acid. Some meats contain significant amounts as well (half of the fat in a ribeye steak is oleic acid). Oleic acid is not considered detrimental to health.

    Polyunsaturated fat (PUFA): An important distinction between types of PUFA is between omega-3 fats and omega-6 fats. Both are essential fatty acids (meaning our bodies need them, can’t make them, and so must get them from our food).

    Most of us get too much omega-6 and too little omega-3 fats. Pre-industrial populations tended to have rates of 4:1 or lower; Americans tend to have an omega-6/omega-3 ratio of around 16:1

    A high ratio is associated with inflammation and heart disease risk.

    Natural sources of Omega-6 PUFA include walnuts, sunflower seeds, avocado, eggs, and cashews. It is far better to get our omega-6 PUFA from those real food sources than from the unnatural oils found in processed foods. (The average American gets 10 percent of calories from soybean oil, a processed oil very high in omega-6 fats.)

    As to omega-3, according to Healthline, some health organizations recommend a minimum of 250–500 mg each day for healthy adults. This can be obtained from about 8 ounces of fatty fish per week. Wild-caught cold-water fish like salmon are the best sources. Eggs (especially pastured eggs) have significant omega-3 fats as well; but they aren’t as good a source as fish.

    Fish oil supplements are available for those wishing to increase their omega-3 intake. Choose a high-quality supplier to ensure the fats aren’t oxidized. Also, don’t take more than the recommended dose.

    If we get our required PUFA from real foods rather than from the industrial oils found in processed foods, it will be less likely to cause inflammation and contribute to chronic disease.

    Saturated fat: There is much controversy around saturated fat and its effect on our health. For many years the dietary guidelines have recommended sharp limits on saturated fat in the diet (though those recommendations no longer include a limit on overall fat or dietary cholesterol). But there are many researchers who do not believe the evidence against saturated fat is conclusive. In fact, the Journal of the American College of Cardiology published a review by top researchers that concluded that there was not sufficient evidence to support the recommendation to limit saturated fat. Other researchers dispute those findings. So far no large, randomized controlled trials have confirmed the hypothesis that saturated fats will shorten our lives. There are a number of large observational studies that show a small association between saturated fat and heart disease mortality, but those studies cannot prove causation.

  • A Word On Nutrition Studies

    February 15th, 2025

    News reports on the latest nutrition studies can be confusing. On Monday we read in the Post that drinking coffee will give us a thick, luxurious coat of fur. On Tuesday we read in the Times that drinking coffee will give us mange. What are we to make of it?

    An understanding of the types of studies we see discussed in the media and a bit of insight on how to interpret them can help make some sense of a very confusing field. Among the most common types of studies in the field of nutrition and health include:

    Observational studies – In these studies researchers collect data on dietary patterns from large groups of people (sometimes in the hundreds of thousands) and follow them over a period of years to observe health outcomes. Many of the studies you see talked about in the media are of this sort. These studies cannot show causation, only association. They can be an important step in getting reliable knowledge about human health and nutrition, but they should not be considered definitive.

    The way the science is supposed to work, is that when an association is found (between, say, red meat consumption and heart disease) the next step is to do an experiment to see if one of the things in the association causes the other. All too often in nutrition science that next step is not taken, and the association is trumpeted to the media, with the public assuming a causal relationship that has not been proven.

    Randomized controlled trials – In these studies researchers take their subjects, whether animals or people, and randomly assign them to groups—for example, they might put one group on one diet, another group on a different diet, and direct a third group to eat as they normally eat (this would be the control group). They then collect health outcome data on the subjects and compare the outcomes among the groups. These studies can show causation provided they are well designed and executed.

    Mechanistic studies – These are experimental studies in biochemistry and physiology showing how things work, such as what happens to the food we eat after it is broken down to the molecular level and enters our cells, and how different types of molecules interact with each other. These can be done in vivo (in a living person or animal) or in vitro (e.g., in a petri dish).

    Potential problems with nutrition studies – When we encounter reports about these health and nutrition studies, we should look upon them with a skeptical eye.  Health reporters typically pass on what they are told by researchers without any skepticism and often go further than the researchers in making claims for the study. Before we make a dietary or lifestyle change in response to a study we see in the media, we need make sure the study is valid. Here are some things to look for:

    Exaggerated effect – You may see a study saying, e.g., that by avoiding some type of food you can reduce your risk of a heart attack by fifty percent. That sounds huge. But if you look at the actual study results you may find that the effect is really very small. Let’s say that over the course of the study, one percent of the people eating the food have a heart attack, while only .5 percent of the people avoiding the food have one. Since .5 is fifty percent of one, that would often be reported as a fifty percent risk increase. The actual risk would be just .5 percent, or 1/2 of one percent. I don’t think many of us are going to make a big lifestyle change to avoid a half of one percent increase in risk. (In this case the relative risk was 50%; the absolute risk was .5 percent; absolute risk is what matters.)

    Uncontrolled variables – When comparing two elements of diet in a nutrition study it is critical that the two groups vary only in the element being studied.  In a study comparing the health effects of eating chicken versus eating red meat, for example, the researchers should strive to keep everything else in the diet as identical as possible. If the red meat group is eating a hamburger on a bun with a side of fries, while the chicken group is eating a grilled chicken salad, it is not a valid study. If the researchers don’t make very clear which variables they have controlled for, be skeptical of the study.

    Bad study inputs – In an observational study, researchers may base the entire study on one recall questionnaire asking people to estimate how much of different foods they ate over the past year. In some studies they don’t check to see if the subjects are eating the foods they claim they are. In a randomized controlled trial or mechanistic study, the diets they feed the subjects may not be relevant to the real world, or in animal studies may not be species appropriate. Or they may feed the subjects an amount of the food in the study far beyond what anyone would eat in the real world. As I seem to  recall, in one of the early studies on artificial sweeteners they used an amount of the sweetener in mice studies that, if the amount were used to bake a Twinkie and the Twinkie were scaled up accordingly, it would be a Twinkie 35 feet long and weighing approximately 600 pounds.

    Poor study design – Sometimes studies are conducted in a way that the results aren’t clear. You may see a report showing that the subjects lost weight or had certain health improvements on a certain diet, but that the subjects gained back some of the weight and lost some of the improvements after a year. You look at the study and find that they were including people that stopped eating the diet half-way through the study. You can’t tell from the study what the outcome is for people that stick to the diet, which is what you really want to know.

    Healthy user bias – This is common in observational studies. If people have been told by the health authorities to avoid a certain food for decades, it should not be surprising to find that health-conscious people avoid that food. Since health-conscious people do all sorts of things that might improve their health there is no way to know whether avoiding the food has anything with their improvement. Health-conscious people and non-health-conscious people can differ in many ways. A yoga instructor who wheels her Prius into the drive-through lane at Salad and Go for a grilled chicken salad, and the contractor who pulls his Super Duty F250 into Carl’s Jr. for a Double Western Bacon Cheeseburger combo likely differ in ways other than the type of meat found in their lunch.

    Evaluating nutrition studies – Here are some tips for evaluating the studies you see reported on in the media:

    • Assume any study is fatally flawed unless confirmed otherwise. Find the actual study and read the abstract, methods, and conclusion. If those are not written in clear, understandable language or aren’t available for inspection, be skeptical of the study.
    • Look for the actual effect size. The media probably reported the relative risk. You need to find the absolute risk, which is the relevant value.
    • Look at the data. If it is a diet study, look at what the people or animals in the study were actually eating, and make sure that it makes sense. If that information is not available, be skeptical of the study.
    • If the researchers (or those reporting on the research) are claiming a causal effect from an observational study, be more than skeptical of the study.

    A note about the word “significance”: In statistics, the word “significance” is a term describing whether a result has passed a mathematical test showing that an outcome is likely not the result of chance. It may not be a large enough effect to be considered significant in the common use of the word.

  • Real Food:

    February 13th, 2025

    Of all the changes Tarzan made to recover his metabolic health, switching to a real food diet was the most important.

    • Real food is meat, eggs, dairy, fish, seafood, vegetables, fruit, grains, nuts, seeds, spices, oils and fats in as close to their natural form as possible. If they are processed in a way that reduces their nutritional value, they are not real foods.
    • Real foods generally do not have ingredient labels, because they have only one ingredient. If they do have ingredients, they are small in number and are themselves all real foods.

    Here are few examples of what I mean:

    Fruit – A piece of fruit is real food. Fruit juice is not (it contains way too much sugar). Fruit smoothies are worse. Fruit juice concentrate (used as a sweetener) is basically just sugar.

    Vegetables – A vegetable is a real food, but processing can render them metabolically problematic. For example, a tomato is obviously a real food. Canned tomatoes can be, as can tomato sauce and tomato paste. When we get to tomato-based sauces, things can go downhill fast. Many pasta sauces contain sugar and artificial oils. When buying pasta sauce look for those that are made up of real foods (e.g., tomatoes, olive oil, and spices).

    Dairy – Whole milk, butter, ghee, cheese, full-fat yoghurt, kefir (fermented milk) are real foods. Margarine is not. Low-fat yoghurt (usually containing a lot of sugar) is not.

    Meat – A piece of meat is a real food. Problems come in with packaged meats, which can vary greatly in their processing. Often sugar and chemical additives are found in packaged meats.

    Nuts and Seeds – Nuts and seeds are real foods. A nut butter (or seed butter) can be pretty much a real food provided it is just the nuts or seeds, mashed up and put in a jar; but often sugar and artificial oils are added to the mix.

    Grains – We are advised to include a lot of whole grains in our diet, but we are not given much guidance on how to know what is the best choice in the bread, cereal and pasta aisles. For a product to be labeled “Whole grain” it must contain the entire kernel of the grain; but that can mean a product that contains the whole, intact grain kernel, or it could mean a product in which the grain kernel has been ground into a fine flour, causing the loss of much of the benefit of the whole kernel. It will be digested quickly and will lead to an increase in blood glucose and insulin.

    Also, a product can be labeled “whole grain” if the grain in a product has at least 51% whole grain content by weight. The rest can be regular flour. (In products labeled “100% whole grain,” all the grain in the package must include the entire kernel.)

    Most of the whole grain products at the supermarket will be of the finely-ground flour variety. That is true of bread, cereal and pasta. It is marginally better than regular flour, but it is not a healthy option.

    Bread is so ingrained (see what I did there) in our culture it’s hard to believe that it could be part of what’s making us sick. But it is. The bread we find today at the local Piggly-Wiggly is far different than that eaten by our ancestors. In biblical times the grain was ground between a couple of rocks and the resulting bread would have been very heavy and coarse. Such bread would have taken longer to digest, and the glucose would have entered the bloodstream more slowly, making it less metabolically damaging. Starting with the industrial revolution, industry has produced ever-finer and easier to digest flour. Modern breads are lighter than ever, and much more intensely processed. Those changes have continued into the 21st century. Bread, cereal and pasta made from this flour is a threat to our metabolic health.

    If we want to find “real food” bread, we could perhaps procure it from an artisan baker who uses ancient techniques to bake bread. Or we could turn to something like “Ezekiel Bread,” which is made from grains that are sprouted and then mashed into dough before baking. Not only do these types of bread produce a much lower glucose spike, we are also much less likely to overeat them. (I could eat a dozen dinner rolls without breaking a sweat; no way would I eat a dozen slices of Ezekiel bread.)

    As for other grains: brown rice and steel-cut oats are unprocessed and don’t cause as much of a glucose rise as would minute rice and instant oatmeal, but they still cause a significant rise and could be a problem for many of us (same with corn). As with any food, different people respond differently. How much we must limit these grains will vary based on how we as individuals respond to them. Grains are not essential nutrients; it is not necessary to include them in our diets.

    One other note about real food: There is much emphasis these days on “plant-based” diets in the media. Some people appear to thrive on properly formulated plant-based diets, and realize better health outcomes than when eating a typical American diet; but it is also true that many people thrive on real-food diets that include quite a lot of meat and other animal products.

    A review published in the Annals of Internal Medicine concluded that the evidence on the effects of eating red meat does not support the recommendation to limit red meat consumption. Other researchers dispute that conclusion. There are no randomized controlled studies comparing people eating red meat with those who don’t (and holding everything else constant) that show that red meat is harmful. There is no reason to assume that plant foods are better for us than animal products.

    And one point about sugar:

    Sugar is one area where natural vs. processed doesn’t make as much difference as one might hope. High-fructose corn syrup is without doubt a highly processed food, and the fructose and glucose enter the bloodstream a little more quickly than table sugar; but once there they have exactly the same effect. Molecules of fructose and glucose are molecules of fructose and glucose, whether they come from pure cane sugar, high-fructose corn syrup, honey, a date, fruit-juice concentrate or any of the other sixty-some sources of sugar we see on food labels. Some sugar sources may carry with them additional nutrients along with the sugar, but if we eat more fructose and glucose than our bodies were designed to handle our health will suffer.

  • How much protein should I eat?

    February 11th, 2025

    There is much confusion and controversy around protein.  This partly stems from the Recommended Dietary Allowance (RDA) for protein, which is just 0.8 grams per pound of body weight. Many people take that to mean that is all we need. But that amount is just what we need to avoid a deficiency. It says nothing about what is optimal.

    Dr. Don Layman of the University of Illinois has been studying protein metabolism since 1972 and has become one of the world’s foremost experts in the field. Most of what follows is based on the findings from his lab.

    Dr. Layman recommends between 1.2 grams of protein per kilogram of ideal body weight for a moderately active person, up to 1.8 grams per kilogram of ideal body weight for someone doing more vigorous exercise (including resistance training). That translates to roughly .54 grams per pound of ideal body weight for a moderately active person up to .82 grams of protein per pound of ideal body weight for someone doing more vigorous exercise. (He doesn’t see a problem with going higher than that but doesn’t see much benefit either.)

    To determine daily protein needs, estimate where you are on the spectrum from moderately active to vigorously active and estimate your daily protein needs from that. (As we age our ability to properly process protein decreases, so we need more as we reach our sixties and beyond.)

    Dr. Layman suggests that everyone should get at least 100 grams of protein per day. So the values below start at least 100 grams for everyone.

    Ideal Body WeightModerate ExerciseVigorous Exercise
    115(100)(100)
    130(100)106
    170(100)139
    200109164
    225123185

    It is important to note that “protein” is just a word for a package of amino acids. There are 20 different amino acids, and 9 of those are considered essential (meaning that our bodies cannot make them so we must get them in our diet). We also must get them in the proper proportion.

    Dr. Layman stresses that we need to get our protein in large enough servings to stimulate muscle synthesis. Our muscles, organs, bones and other components are not static. Our metabolic system is constantly breaking them down and rebuilding them. We turn over 250-300 grams of protein a day. Since our organs get first dibs on essential amino acids, if we don’t get enough essential amino acids and in the proper proportion, our metabolic system will not use the amino acids to rebuild muscle, and it will gradually diminish (starting in our 30’s, we lose about 3-5 percent of our muscle mass per decade, and that accelerates as we age). Our bodies have sensors that let our metabolic system know that we have more essential amino acids than our organs need and that it is okay to use some of them for muscle. That sensor is looking for one particular amino acid: leucine. If our metabolic system detects 2.5-3 grams of leucine, it assumes the other essential amino acids are there and gives the go-ahead to start building muscle.

    The best sources of leucine are in animal protein, but some plant protein sources have varying amounts (I got these values from Microsoft Copilot AI; it wouldn’t lie):

    Protein SourceGrams of protein needed to get 2.5 grams of leucine
    whey25 grams
    bean28 grams (but does not contain enough of the other essential amino acids)
    beef31 grams
    chicken32 grams
    pea32 grams (but is a little lower in the amino acid methionine)
    soy36 grams

    If using bean or pea protein you may want to add other plant protein sources to ensure you get enough of everything

    To get 2.5 grams of leucine, you’d need at least 25 grams whey protein, slightly more for beef, 32 grams of protein from chicken, 32 grams from pea protein, or 36 grams of soy protein. It takes five eggs to get 2.5 grams of leucine, so unless you want five eggs you’ll probably want a side of sausage or bacon. Keep in mind that 2.5 is the minimum; as we age we need more.

    We know that the protein from animal products comes with all the essential amino acids in the proper proportion. If we are getting our protein from plant foods we need to do the necessary research to know what sources (or combinations of sources) will get us the essential amino acids we need in proper proportion. And according to Dr. Layman if we are getting our protein primarily from plant sources we should try to get 30% more to account for the lower quality of the protein.

    As to protein distribution, Dr. Layman stresses the importance of getting a big chunk of protein with our first meal. He suggests getting 40-55 grams of protein at the first meal of the day, and something similar at the last meal, then getting the remainder of our daily protein needs at midday. He said adding a fourth meal can be beneficial if that is necessary to get enough protein.

    To see Dr. Layman discussing these matters, check out this interview: https://www.youtube.com/watch?v=-8Logf5zdEU

  • Movement:

    February 9th, 2025

    The second most important change Tarzan made was increasing his movement.

    Movement comes in two forms, activity and exercise.

    Activity: Activity is simply not sitting still. The more we move the better as far as our metabolic health is concerned. Sedentary behavior is associated with all the chronic conditions we have been discussing. “Activity” encompasses things like going for a walk, gardening, housework, walking the dog, going for a bike ride, mowing the yard, playing golf.

    Some of those things can rise to the level of exercise if done with enough intensity—like that competitive speed gardening I’ve been hearing so much about.

    Sitting still too much leads to mitochondrial dysfunction. Our mitochondria are working around the clock turning the foods we eat into ATP to power our cells. When we don’t burn that ATP it will gum up the works.

    Exercise. Activity by itself is not enough—we also need exercise. Exercise is a key component of recovering and maintaining our metabolic health. Exercise helps to improve our insulin sensitivity, and the right kind of exercise can help us maintain or increase our heart and lung capacity as well as our muscle mass and bone density.

    Exercise was critical to Tarzan’s metabolic improvement. It helped Tarzan become more insulin sensitive; it caused his body to create more and better mitochondria. It helped Tarzan maintain bone density and muscle mass as he aged—it was exercise that enabled Tarzan to still be able to climb a tall oak tree at the age of ninety-three.

    Note first of all the distinction between activity and exercise. Exercise is when we push our body to an extent that it triggers an adaptive response, meaning that we put our body under enough stress that our body says, “I don’t know what just happened, but I’ve to get ready in case it happens again.” The body then responds by releasing hormones that trigger growth and repair. More muscle is created; the infrastructure to get oxygen and nutrients to those muscles improves—new capillaries are created; mitochondria get the signal to divide. Our muscles get stronger and improve their metabolic function; our heart and lungs get stronger and more efficient.

    There are two types of exercise that can help us recover and maintain our metabolic health: resistance training and endurance training.

    Resistance training is putting enough load on your muscles to cause your body to respond by creating more muscle. Most of us lose 3%-5% of our muscle mass per decade starting in our 30’s, and that loss accelerates when we reach our 60’s – unless we take steps to avoid it. (This loss of muscle mass is called “sarcopenia.”)

    Resistance training can be done with body weight (requiring no equipment), dumbbells, resistance bands (all of which can be done at home) or with barbells and machines down at the gym. The benefits of resistance training include more muscle mass, which means more mitochondria, and which will result in more energy being burned.

    To help understand the benefits of resistance training, consider these two case studies:

    Here we have a frail elderly man with a marked degradation in his ability to hop:

    Here we have a robust elderly man punching a guy in the face:

    What is the difference between the gentleman who has lost the ability to hop and the gentleman who has retained the ability to punch a guy in the face?

    Muscle mass.

    Though much can happen that is beyond our control, whether we find ourselves in old age frail and unable to effectively hop, or robust and able punch a guy in the face, depends largely on how well we build and maintain muscle mass. And that requires resistance training (along with getting enough protein).

    Endurance training means putting enough stress on our system that it stimulates our body to increase the capacity of our heart and lungs to get oxygen and nutrients to the muscles that need them.

    There are a couple of ways to go about this. One is through what is commonly called “cardio”: doing some physical activity that gets our heart into a target range and keeps it there for a period of time. (As conditioning improves, both the duration and intensity can increase.) Depending on your level of conditioning, that could be anything from walking around the block to running a 15K. It can be done on a bike, treadmill, elliptical machine, stair-climbing machine—anything that gets your heart into the target range and keeps it there. (Information from the National Academy of Sports Medicine on how to identify the proper level of intensity for you can be found here.)

    Another way to build endurance is through high intensity interval training.

    (HIIT). In HIIT, we alternate between intense all-out effort and moving at a more leisurely pace. This can be done with pretty much any form of exercise: running, bicycling, stationary bike, elliptical, floor exercise. Some forms require no equipment whatsoever. And it doesn’t have to take much time. You can get a good workout that triggers an adaptive response in 12-15 minutes. (I need to reiterate here: Please do not start doing intense workouts without consulting your doctor to ensure it’s okay. If you start doing this and flop over dead, I don’t want you blaming me.) The benefits of HIIT include increased insulin sensitivity, improved cardiovascular function, and better mood. Information from the National Academy of Sports Medicine on how to implement HIIT can be found here. NOTE: If you have not been exercising regularly you may not want to jump right into HIIT. You might do regular cardio for a while until you are better conditioned.

  • Beyond Diet and Movement:

    February 7th, 2025

    Tarzan made other lifestyle changes that helped improve his metabolic and overall health.

    The more of these changes we can make, the better our health will be.

    • Reduce stress. Our stress response is an important part of our body’s tool kit for keeping us alive. Let’s say, for example, you make an ill-advised remark that inflames the populace and you find yourself having to flee an angry mob—as happens to all of us from time to time. You will need to mobilize all your body’s resources to stay a step ahead. That is equally true should you stop and pick up a length of pipe to make a stand, as I have found such situations to sometimes require. Hormones, including cortisol and adrenaline, will be released to prepare your body to flee or fight, as the situation warrants. But that is meant to be a temporary condition. Ideally you will either escape or repel the mob in short order and your hormonal milieu can return to normal. But if our stress is ongoing, those same hormones will lead to inflammation and mitochondrial dysfunction. So take what steps you can to reduce the stress in your life; if you can’t remove the stress, learn to reduce your stress response. (Here is link to some articles on dealing with stress at the National Academy of Sports Medicine website: link.)
    • Get some Sunshine. Get out in the sun every day—ideally in the early morning, at midday, and late in the evening. We weren’t designed to be indoors all the time. Our bodies expect sunshine and malfunction when they don’t get it. Sunlight is known to improve mood and mitochondrial function.
    • Get some Sleep. Take the necessary steps to improve your sleep. Sleep is important for our mood, and the proper functioning of our brains—our brains do maintenance and repair while we slumber.
    • Avoid toxins. That includes toxins we voluntarily ingest–like tobacco smoke, e-vapors, and alcohol—but also environmental toxins like chemicals and air pollution. (Alcohol can be very damaging to our metabolic health; anyone striving to improve metabolic health should avoid it. Those who are metabolically healthy can perhaps get away with a small amount.)
    • Connect socially. Having strong social bonds is critically important for our health.
    • Find a sense of purpose. Having a strong sense of purpose is associated with better overall health. We not only need to know how to live a healthier life, we need a reason to live it. I get my sense of purpose in living out my faith and through my family.

    In addition to the lifestyle factors we’ve discussed, a small percentage of people can have metabolic dysfunction for unrelated reasons. There are genetic conditions that can cause metabolic dysfunction, as can exposure to toxins such as mercury and mold. For those dealing with such issues, it is even more important to get the lifestyle factors right.

  • Measuring Our Progress

    February 5th, 2025

    To know if we are improving our metabolic health, we must measure it.  Fortunately, we have some targets we can measure to see how well we are progressing. These are of course not the only important markers of good health–your doctor will request many more at your annual physical—but if these are off, we know we have improvements to make.

    Before listing these recommended labs, a word about the “normal” ranges is in order. The ranges for most lab tests are determined by testing random samplings of supposedly healthy adults. But there are a great many American adults who haven’t been diagnosed with a disease that nevertheless can’t be said to be metabolically healthy.

    In short, “average,” in most cases, is not good.

    For example, the range for triglycerides is 50 to 150 (lower is better).

    That doesn’t mean that if you have a triglyceride level of 149 you are fine and at 151 you are in trouble. Given the state of metabolic health among American adults, we don’t want to be average. We should try to get to the good side of average (e.g., below average for triglycerides; above average for HDL).

    NOTE: Most lab ranges are determined this way, but there are exceptions. Total and LDL cholesterol ranges have been adjusted down to what the health authorities think they should be.

    For the measurements below, our targets should be not just in the normal range, but at least in the “good” category. These measurements and lab tests should be taken periodically to track our progress toward metabolic health.

    Waist circumference: A waist circumference greater than 40 inches for men or 35 inches for women is a marker for metabolic syndrome. Those needing to lose weight and improve body composition should measure the waist regularly.

    Triglycerides: Lower is better; normal range is 50-150. Above 150 is a marker for metabolic syndrome. Good would be under 100; ideal would be under 70. This test is part of the lipid panel in your yearly physical.

    You can also get a lipid panel test at walkinlab.com for $28 dollars.

    HDL cholesterol (HDL-C): Higher is better. Normal range is 40-72. Below 40 is considered a marker for metabolic syndrome. Above 60 would be considered good; ideal would be above 70 (for HDL, being above the normal range is a good thing). This test is also part of a standard lipid panel.

    Triglycerides/HDL ratio: Lower is better. This is HDL divided by triglycerides. (e.g., TG=140; HDL=45; 140/45=3.11). Anything under 4.0 is considered normal, but again, much lower is better. Around 1 is considered ideal. This ratio is considered by many researchers the best lab marker for heart disease risk.

    A1c: This test measures how much of your hemoglobin (a blood protein) has been glycated over the previous three months, which correlates to your average blood glucose level. Normal is below 5.7 (above that is prediabetes; 6.5 and above is type 2 diabetes). Ideal would be 5 or below. This test costs $28 at Walkinlab.com. (Some doctors order this as part of the physical; some do not).

    Blood pressure: 120 over 80 is considered normal; 130 over 90 is considered elevated; anything over that is considered high. Elevated blood pressure is a marker for metabolic syndrome. It is a good idea to purchase your own blood pressure monitor at the drugstore so you can track it. Instructions for properly taking your blood pressure can be found here.

    Fasting insulin: This measures the insulin levels in your blood after fasting overnight. It is key in identifying insulin resistance. Anything over 15 (in microunits/mL) is likely insulin resistance; under 10 is considered good, and under 6 is ideal. This is a very important metric that is not generally tested as part of our annual physical. Our A1c and fasting glucose may be fine, but if it takes a lot of insulin to keep it fine that means we are insulin resistant. By checking fasting insulin, we could identify insulin resistance years or decades before it progresses to type 2 diabetes. This test costs $28 at walkinlab.com.

  • Some Practical Steps

    February 3rd, 2025

    Recovering our metabolic health is going to require some changes, along with feedback to tell us if those changes are having the desired effect. Below you will find some suggested steps that can help along the way.

    1. Get baseline measurements on your markers of metabolic health:
    • Waist circumference (measure your waist at the navel)
    • Weight (keep a running five-day average)
    • Blood pressure (check multiple times; it can drop quite a bit if you sit still for a few minutes: target is below 120 over 80). (You can buy a blood pressure monitor at the drugstore.)
    • Fasting blood glucose (You can buy a glucose monitor at the drugstore; even better, you can get a continuous glucose monitor that lasts two weeks for $49 at HelloLingo.com )
    • Fasting insulin level. (You can purchase the test at Walkinlab.com, and take the test at LabCorp or Quest.) You need to fast for at least 12 hours before taking the test.
    • Lipid panel to get your triglyceride and HDL-C levels (You can purchase the test at Walkinlab.com, and take the test at LabCorp or Quest.) You need to fast for at least 12 hours before taking the test.
    • Check your body fat percentage. You can use the Precision Nutrition Body Fat Calculator to get a ballpark estimate, which should be good enough for our purposes. If you want a more accurate measurement, many gyms have bioelectrical impedance scanners that give a reasonably accurate report on body composition. Or you could pay substantial dollars and get a DEXA scan.

    2. Start eating real food. Though it may be tempting to try to change things all at once, an incremental approach is probably better for most of us. Making a couple of changes at time allows us to see progress and adapt to each stage. Here is a suggested path to changing your diet:

    • Start with a real food breakfast. That would mean ditching things like cereal, instant oatmeal, toast, fruit juice, fruit smoothies, and low-fat yogurt and replacing them with things like eggs, sausage, berries, whole milk and plain Greek yogurt. (Toast can pass muster if it’s made from something like Ezekiel Bread.) Remember that protein is especially important in the first meal of the day.
    • After acclimating to your breakfast changes, make the same changes at lunch. Eliminate sugar-sweetened beverages and eat only real foods. That means ditching things like French fries, chips, hamburger buns, and crackers and eating meat, cheese, vegetables and fruit.
    • After acclimating to your lunch changes, make the same change at dinner. Remember that protein is also important in the last meal of the day.
    • Eliminate snacking between meals. If you are genuinely hungry, eat a protein snack (e.g., boiled egg).
    • Treat bread, pasta, dessert and other processed foods as special treats and occasional indulgences.
    • Eat when you are hungry, eat enough to feel satisfied, and stop eating. Don’t eat when not hungry.

    3. Structure your meals properly:

    • Build your meals around protein. Determine how much protein you need in the meal and ensure you get it. (See the post on protein here.)
    • Choose foods with a carbohydrate content that you can properly metabolize (and that varies greatly by individual; see steps 11 and 12 below on how to determine whether you are eating too many carbs). Remember that carbohydrates are not essential in the diet, and if you are needing to shed some weight limiting carbs is an effective way to do that.
    • The remainder of the calories in your meal will come from fat. Here we have a lot of flexibility. If you are concerned about saturated fat and/or wish to eat a more Mediterranean-style diet, you can choose leaner cuts of meat and use more olive oil and eat more fish. If you need to adjust your calories up or down you can do that by adjusting the amount of fats in your meals (ensuring they come from natural sources). If needing to reduce calories it is best to start with carbohydrates, then move on to fat. Getting adequate protein should be non-negotiable. If we find ourselves getting hungry between meals, reducing carbohydrates and increasing natural fats is a good strategy to make our meals more satisfying.

    4. Track your food intake (at least for a while)

    • Keep a food diary of exactly what you eat, either on paper or using an app like “My Fitness Pal.” Do this long enough to get a good sense of what your dietary pattern looks like and how much of each nutrient you are eating.
    • Get a food scale and weigh your food enough times that you have a good feel for how many ounces (or grams) a serving size is for you for the foods you commonly eat.

    5. Find out how the foods you eat affect your blood sugar and avoid any that spike your glucose too high or for too long. You can do this a couple of ways:

    • Use a glucose meter (the kind where you prick your finger). These can be had at any drug store. (You don’t need to do this all the time, just enough to get a good idea of how the foods you commonly eat affect your blood glucose.) Test about 60-75 minutes after eating to get the peak response, and test again at two hours. Ideally you glucose level will be back at baseline after two hours. ( I personally try not to eat anything which spikes my glucose over 120 and that takes over an hour to return to baseline, but that is not a recommendation for anyone else to follow.)
    • Use a continuous glucose monitor. You can get one that lasts two weeks for $49 at https://www.hellolingo.com; I cannot emphasize enough how helpful this can be. You can see in real time how different foods affect your blood sugar, as well as how things like movement, sleep and exercise affect it. Two weeks is plenty of time to get an idea of what foods you can safely eat and which to avoid.

    6. Increase your activity level: Spend less time sitting around and more time up and about. This will become easier as your metabolic health improves from your changes in diet.

    7. Exercise more: Implement resistance training and endurance training. Start small if you haven’t been exercising. It can be beneficial to wait until you get some momentum on your weight loss before beginning an exercise program.

    8. Get out in the sun every day, preferably soon after sunrise, at midday, and in the evening.

    9. Improve your social connections.

    10. Reduce stress if possible; if not, work on reducing your response to that stress.

    11. Track your progress to see how the changes you are making affect your metabolic health markers. Use the values in the “Measuring Progress” post as your standard.

    Check these weekly:

    • Waist circumference
    • Blood pressure
    • Weight (or keep a running weekly average)

    Check these every few months:

    • Fasting insulin
    • HDL (part of lipid panel)
    • Triglycerides (part of lipid panel)
    • A1c

    12. If your markers are unsatisfactory, you can adjust your carbohydrate intake by removing the following foods:

    • Grains, such as rice, oatmeal, and corn
    • Starchy vegetables, such as potatoes, carrots, and sweet potatoes
    • Milk
    • High-sugar fruits, such as mangoes, bananas, apples, pears, and oranges (restrict fruit intake to berries, which are lower in sugar).

    NOTE: If you take this step and you are taking medications to lower your blood sugar or blood pressure, be sure to let your doctor know; they may want to monitor and adjust your medications. You should never attempt to adjust your medications yourself.

    If your metabolic health markers are still unsatisfactory after a few more months, you might engage a medical practitioner with the knowledge to guide you in implementing a ketogenic diet. You may need to go very low carb in order to improve your insulin sensitivity.

    The Society of Metabolic Health Professionals website (https://thesmhp.org) has a provider directory. Many providers offer remote services.

  • Do I have to eat the same foods Tarzan ate?

    February 1st, 2025

    Not necessarily. There are people using all kinds of diets to recover their metabolic health. What successful diets all have in common is that they avoid sugar and highly processed foods.

    A vegan would substitute plant protein and oil sources for the eggs, chicken, beef and butter. A carnivore dieter would forego the fruits and vegetables.

    Someone eating a Mediterranean diet would eat more olive oil and fish. Someone practicing intuitive eating would stay within the bounds of real food (If your intuition is telling you to eat a bag of Twizzlers, it might be best to ignore it.) Those who feel it important to eat grains would eat sprouted grain bread (e.g., Ezekiel Bread) instead of bread made from flour. And so on. (Those choosing to embark on a vegan diet should consult an expert to ensure that they are getting all the essential nutrients their bodies need.)

  • How Restrictive Do I Need To Be?

    January 30th, 2025

    How we as individuals respond to foods will determine how restrictive we have to be. That depends largely on how insulin sensitive we are—that is, how well our bodies process the carbohydrates in our diets . And our insulin sensitivity can vary based on how much we’ve been sitting around, how intensely we have exercised, and how much sleep we have gotten, along with other factors.

    By “how we as individuals respond to foods,” I mean this:

    • How it affects our blood sugar
    • Does it trigger cravings and cause us to eat things we shouldn’t (or more than we need to feel full).
    • Does it cause our waistlines to expand (or prevent weight loss if that is our goal)
    • Does it make our key lab markers worse (HDL, triglycerides,A1C, fasting insulin)
    • Does it make us feel worse

    Based on those responses, these are the ways we may need to restrict our diets in order to maintain our metabolic health:

    • Very insulin sensitive people may be able to maintain their metabolic health by simply cutting back on these processed foods. (By processed foods I mean those containing added sugar, refined carbohydrates such as flour or cornmeal, and those containing unnatural oils and fats.)
    • Others may need to eliminate processed foods entirely, but have no need for further restrictions and can eat real foods with substantial starch (e.g., potatoes, oatmeal).
    • Some among us will need to go further and eliminate starchy vegetables and grains (e.g., potatoes, oatmeal).
    • Others will need to eliminate high-sugar fruits like apples and bananas.
    • Some will need to eliminate virtually all carbohydrates from the diet to attain metabolic health (known as a ketogenic diet, or “keto” for short).
  • What’s up with all this talk about ketogenic diets?

    January 28th, 2025

    The word “ketogenic” comes from a process in our body that occurs when we have low levels of glucose and our liver is breaking down fat for use as energy. Part of the process of breaking down fat creates “ketone bodies” (“ketones” for short). Our organs (including our hearts and brains) can use ketones as fuel.

     If someone has low enough glucose and they begin producing higher levels of ketones, they are said to be in “ketosis.” (A level of 0.5 is considered to be the threshold for nutritional ketosis, but higher levels may be necessary for different therapeutic purposes.)

    (This is not to be confused with “ketoacidosis,” a dangerous pathological state that can occur when people with type 1 diabetes have poorly controlled blood sugar.)

    There are different levels of what people call ketogenic diets:

    • “Doing keto”: For some it has simply become a synonym for a low-carb diet, and those following may or may not be in actual ketosis
    • Nutritional ketosis: This level of ketosis is appropriate for weight loss and reversing insulin resistance and metabolic syndrome.
    • Therapeutic ketosis: This is a higher level of ketosis used to treat or reverse a whole host of chronic conditions and diseases that have a metabolic component. These should only be done under the direct supervision of a doctor or other medical practitioner.

    Here is a partial list of conditions for which a therapeutic ketogenic diet has either been confirmed to be helpful or has shown promise as a treatment:

    • Epileptic seizures. Ketogenic diets have been used for over one hundred years to effectively reduce or eliminate epileptic seizures.
    • Diabetes (Type 2). Ketogenic diets have been used to treat diabetes, and many have seen their diabetes go into complete remission and have gotten off all their medications.
    • Mental health: The medical schools at both Harvard and Standard have launched departments of metabolic psychiatry, where they use metabolic treatments to improve mental health, including the use of ketogenic diets. They have seen remarkable improvements in patients with severe mental health conditions, up to and including complete remission.
    • Studies testing whether ketogenic diets improve Alzheimer’s symptoms are ongoing.
    • Heart failure: There is emerging evidence that heart function can improve on ketogenic diets.
    • Cancer: Ketogenic diets are being used in conjunction with other treatments; in some cases it has been found to reduce the side effects of chemo and other therapies and to make those therapies more effective.
    • Migraines: Multiple studies have shown ketogenic dietary therapies can reduce the frequency and intensity of migraines.

    I would like to reiterate here that you should not do substantial carbohydrate restriction without letting your doctor know. That is especially true if you are on medications for blood pressure, blood sugar control, or mental health.

    One other note: Some people adopting a very low carbohydrate diet find that their LDL cholesterol rises significantly (some others see it go down). Should you find that concerning you can add some carbs back in to bring it down.

    If you or someone you know would like to investigate how a therapeutic ketogenic diet can help with a chronic condition, a good place to start is the Charlie Foundation. It began as a resource for parents of children with seizure disorders, and has expanded to include information about how ketogenic diets are being used to treat other chronic conditions, including neurodegenerative diseases and mental health disorders. https://charliefoundation.org.

  • How do I know which foods are likely to spike my blood sugar?

    January 26th, 2025

    A helpful tool is the glycemic index. It is a measure of how much 100 grams of a given food increases blood glucose in comparison to how much 100 grams of pure glucose affects it. The score ranges from 0-100. The glycemic index gives useful information but has its limitations. For one thing, the glycemic index of a food is based on an average; our personal response may be different. Also, the food we are interested in may come in servings above or below 100 grams. The food may have a low glycemic index, but if our serving size is greater than 100 grams, it may still send our blood sugar soaring. With that in mind, the concept of the glycemic load was developed. That is an estimate of how much a particular serving size of a food will affect blood sugar (on average). It is pretty easy to find the glycemic index of foods. You can just use your favorite search engine to look for the GI of particular brands of food. Once you have the glycemic index a glycemic load calculator can find the GL for you. Here is one: https://www.omnicalculator.com/health/glycemic-load.

    You enter the glycemic index of the food in question along with the number of grams of carbohydrates, and it spits out the glycemic load. Anything above 20 is considered high; anything below 10 is considered low. According to the MyFitnessPal app on my phone a 6.1 ounce baked potato has 37 grams of carbs. The glycemic index is 95. When I punch that into the calculator it gives a glycemic load of 35.

    We need to keep in mind that just because something has a low glycemic load, that doesn’t mean it’s healthy. Fructose doesn’t affect our blood glucose levels much, so it will have a lowish glycemic load, depending on how much is consumed. That doesn’t make it healthy.

    We should also remember that the glycemic index values are based on population averages, and that as individuals our responses to various foods can vary greatly. Also, as individuals our responses can vary based on things like whether we have exercised recently, how much sleep we go the night before, how stressed out we are, and the order in which we eat our food.

  • What is an acceptable level of blood sugar after a meal?

    January 24th, 2025

    Nobody knows. The kind of randomized controlled experiments that would tell us have not been done. According to the people at the “Very Well Health” website, we know that having blood sugar higher than 140 two hours after eating is out of the normal range. This is a case where we don’t want to be just normal. We know that blood glucose does damage; what we don’t know is what level exceeds our body’s ability to recover from it. We know we need to spend time between meals in fat burning mode, which requires that glucose and insulin drop to baseline, preferably far more quickly than after two hours.

  • Can our need of carbohydrate restriction change over time?

    January 22nd, 2025

    Yes, it can. One way to look at it is that carbs are earned: if we work to increase our insulin sensitivity we may be able to increase our carbohydrate intake. (But we must carefully monitor our metabolic health markers to ensure that we are not doing damage.)

    A year or so ago I did a test involving potatoes. I am something of a gourmand, and one of my great joys in life is to have a meal in a fine dining establishment, prepared by a top chef in peak form. One of my favorite such meals is the Santa Fe Skillet from Denny’s. It is a delightful concoction, with fried eggs sitting upon a bed of roasted potatoes, chorizo sausage, and cheese, along with peppers and onions cooked to perfection—perfection here meaning “beyond recognition.” I was testing the proposition that if I ate potatoes as part of a meal with plenty of protein and fat, that they might be digested slowly enough that they wouldn’t have a large effect on my blood sugar. My hopes were dashed. It still spiked my blood sugar to an unwelcome extent.

    I recently tested potatoes again as part of a meal and was pleasantly surprised to find it did not have a large effect on my blood sugar. I have greatly improved my insulin sensitivity over the past year.

    That doesn’t mean I eat potatoes very often, but I will occasionally have a baked potato when I go out for a steak dinner.

  • Is there anything I can do to reduce glucose spikes when I do eat carbohydrates?

    January 20th, 2025

    Yes, there is. Here are a few suggestions:

    • Take a walk after the meal. A 10-20 minute walk after a meal can significantly reduce blood sugar spikes by burning off glucose so your body doesn’t have to store it.
    • Eat the protein first. If eating, say steak and a baked potato, eat the steak first, then the potato. Avoid eating carbohydrates alone; eat them only as part of a meal with protein and fat.
    • Work out before eating. A sufficiently intense workout can deplete some of the glycogen stored in our muscles, so some of the glucose from the meal will go towards replenishing it.
    • Get a good night’s sleep. Sleep deprivation makes us less sensitive to insulin.
    • Reduce stress, or do something to reduce your stress response. Stress hormones make us less sensitive to insulin.
  • Is it okay to cheat?

    January 18th, 2025

    It depends. Maintaining metabolic health over the long haul requires that the way we eat be sustainable. For people who think they can’t live without certain foods, that may mean they cheat on occasion (perhaps a weekly sweet treat). For someone else, being sustainable may mean no cheats ever, in the same way someone trying to quit smoking can’t cheat. For some of us, sweets and processed carbs are like cigarettes. We must go cold turkey.

    We also need to keep in mind that when we cheat we are shifting our biochemistry in the direction of fat storage, at least for a while. That should motivate us to keep any cheats to a minimum.

    If you do decide to have an occasional cheat, here are some guidelines:

    • Buy just one serving. Don’t buy a carton of ice cream thinking you’ll have a scoop on occasion. Go to the ice cream shop and buy one scoop in a cup. Don’t buy a box of cookies; buy just one cookie.
    • Avoid the thought process, “I’ve blown it for today, so I might as well wait until tomorrow to start eating right again.” The sooner you are back on the wagon the sooner your biochemistry gets back into energy-burning mode, and the sooner your reward center stops clamoring for more.
    • Get a small portion. Most of the pleasure comes in the first few bites.
    • Make yourself accountable to someone else. If you find yourself at a social event with a lot of bad food around, let someone know you don’t plan to eat it. That helps stiffen will power.
    • At social events bring something for yourself that is tasty and satisfying so you won’t be as tempted to eat the other foods on offer.
    • Don’t cheat with something that will trigger cravings. I know that if right now I were to eat a single Oreo cookie, someone would likely find me, hours later, passed out in some back alley surrounded by Little Debbie brownie wrappers, a half-eaten Twinkie clutched in my Dorito-stained fingers. So, I don’t eat Oreos.
    • Watch out for carb creep, where we gradually increase our carb intake until it starts to affect our metabolic health. Set definite boundaries and have someone hold you accountable.
  • What about snacks?

    January 16th, 2025

    Once again, it depends. What are you snacking on? Are you trying to recover metabolic health or maintain it? Are you trying to lose weight or maintain your weight. Are you snacking because you are hungry, bored, or just want the flavor?

    It matters very much of course what we are snacking on. We know that if the snack raises our blood sugar that it will take us out of energy burn mode and put us into energy storage mode. If it is a high fat snack it may not raise our blood glucose, but it does cause us to burn the fat we are eating instead of the fat from our fat cells, so we want to avoid snacking if we are trying to lose weight. Of course, if we are hungry we should eat something; but if we get hungry between meals that is probably a sign that we need to eat more filling and satisfying meals. The state we want to get to is where we fill our fat stores during meals, then between meals we burn that fat as it’s released. Snacking short-circuits that process. If we want to snack out of boredom, that is our reward center wanting a dopamine hit. Give it a different reward: call a friend, do a puzzle, read something interesting—whatever positive thing that you find rewarding.

  • What about low-carb substitutes?

    January 14th, 2025

    I see “low carb” this and “keto-friendly” that at the store. Are those okay?

    It depends. Some low-carb or “keto friendly” foods are created by companies led by people who really want to provide metabolically healthy options for us. They are minimally processed, using real food as their ingredients. Other companies are just trying to cash in on a growing trend and don’t seem to care much about what they put in their food (I am here thinking of Mission, purveyor of delicious yet nutritionally dubious low-carb tortillas).

    A low-carb substitute (for bread, tortillas, cookies, crackers, desserts) may or may not be okay for us, depending on what is in it and how our bodies react to it.

    On a low-carb substitute’s package you will typically see a reference to “net carbs.” The idea is that some forms of carbohydrate—fiber and alcohol sugars —are not digested and pass into our gut where some of it is digested by the microbes there, and so don’t affect our blood sugar. That is partially true. The alcohol sugars erythritol and xylitol do not have much effect on our blood sugar, but maltitol and sorbitol do (though not as much as glucose). So read the label carefully. (Some recent research suggests that erythritol can increase blood clotting in unhealthy ways. It may be best to avoid that until the research is in on that.)

    Low-carb breads and tortillas typically substitute fiber for starch. Substitute desserts usually substitute alcohol sugars for sucrose.

    Some alcohol sugars do provide sweetness without spiking blood sugar, but there isn’t really enough data to know about the health impacts of consuming them (particularly their effect on the microbes in our gut). One observation I have made is that consuming more than a small amount of alcohol sugar sweeteners can have untoward effects. (For a demonstration of the possible effects of overconsuming alcohol sugars, see Daniels, J. (1994); Dumb and Dumber; “Toilet Scene.” [film])

    Other non-caloric sweeteners include stevia, which is an extract from a plant; aspartame, created from amino acids; and sucralose, a chemically modified form of a sucrose molecule that we taste the sweetness of but do not metabolize. A newer non-caloric sweetener that is gaining popularity is allulose. It occurs naturally but scientists have learned to synthesize it. There is some evidence that allulose can have positive effects on our microbiome and blood sugar, but it is too early to say for sure.

    Eating these substitutes can cause cravings of their own, and if one isn’t careful they can become a larger and larger part of the diet. It is probably best to reserve them for special circumstances rather than using them as staples of your diet.

    On the plus side, these substitutes may help some people avoid refined carbs and added sugar, and so can help them to maintain their metabolic health. One might compare it to a cigarette smoker who turns to vaping when unable to quit tobacco. It would be better to do neither, but vaping is (perhaps) less harmful than smoking cigarettes.

    In deciding whether to eat one of these substitutes, it is crucial to look past the health claims on the package and pay attention to the nutrition and ingredient labels. To calculate the starch and sugar intake, subtract the fiber and alcohol sugar from the total carbohydrate to get the net carbs. For example, on this package of Mission “Carb Balance” tortillas, we see that it has 12 grams of carbohydrates, 9 grams of which are fiber. Since the fiber is not converted to glucose but passes on into our gut, there are only three grams left to convert to glucose. So far so good.

    But then we come to the ingredient label, which is something of a horror show. Interesterified and hydrogenated soybean oils? That sounds like something one might use to refinish a coffee table.

    Or how about this SlimFast “Keto Nutty Caramel & Nougat” bar. It has 21 grams of carbohydrate, but after you subtract out the 13 grams of fiber and 5 grams of sugar alcohol, you are left with only 3 grams of net carbs. Seems like a reasonable option.

    Until we get to the ingredient label. Egad! Unless you happen to hold a PhD in chemistry, you will likely not know what most of those things are, much less be able to gauge their possible impact on your health.

    We should never forget that the food that comes out of the ground or from animals is going to be better for us than that which comes out of a box.

  • So what do I buy at the grocery store?

    January 12th, 2025

    The key distinction is between unprocessed or minimally-processed food and processed food. Unprocessed food would be meat, fish, dairy, eggs, vegetables, and fruit (fresh and frozen), along with herbs and spices. Unprocessed foods don’t have ingredient lists. They come from plants or animals, not things that came out of a lab.

    Any packaged foods should be minimally processed (meaning the ingredients are real food). They should be low in sugar (especially added sugar) and low in refined carbohydrate (e.g flour). They should not have industrial vegetable oils (soybean oil, corn oil, etc.).

    Most meat should be unprocessed—just meat, though if you are a careful shopper you can find some brands of packaged meats that are minimally processed.

    When considering a packaged food, it is important to closely scrutinize the label. For example, here is the label for Kellogg’s Raisin Bran Crunch. The name makes it sound vaguely healthy. Note first of all that it has 68 grams of carbohydrate, of which 28 grams are sugar. That will not only dump a lot of fructose on your liver, it will spike your blood glucose. This is pretty much the epitome of a highly processed food.

    And note the ingredient list. There are five different kinds of sugar. (For a listing of the other names for sugar found on food labels, go here.)

    Here is the label for Thousand Island salad dressing. Note that ingredient list. It’s off to a bad start with soybean oil, and it has a lot of stuff in it that looks like it came out of a lab rather than a plant or animal. That is a highly processed food.

    A minimally processed food might look like this, Rao’s Homemade Marinara sauce. Notice that all of the ingredients are real food: tomatoes, olive oil, and spices.

    And here is the nutrition label for the same product. Note that it has no added sugar (the sugar present is that from the tomatoes).

    Be aware that similar products can have very different levels of processing.

    Here are three different labels for bacon:

    Great Value Hickory Smoked Bacon:

    Yikes!

    Applegate, Organic Hickory Smoked No Sugar Uncured Bacon:

    Getting better. But they are being a little sneaky here. One of the criticisms of bacon is that many brands contain nitrates. But do you know what else has a lot of nitrates? Celery powder.

    Wellshire Farms, Thick Sliced Dry-Rubbed Bacon:

    Not too bad. Here we have just pork, salt, and minimal sugar.

    Don’t assume that just because a food makes a health claim on the label or because it has a healthy reputation that it’s good for you. Likewise, don’t assume a food with a bad reputation is harmful. Always read the label.

  • Other Resources

    January 3rd, 2025

    Should you find it necessary to adopt a low carb diet to improve your metabolic health, here is a book you might find useful (or look for interviews with the author on YouTube):

    End Your Carb Confusion: A Simple Guide to Customize Your Carb Intake for Optimal Health, by Dr. Eric Westman. Dr. Westman is a researcher at Duke University where he also manages the weight loss clinic . He has been researching low carbohydrate and ketogenic diets for over twenty years.

    If you are interested in new information on how improving metabolic health can improve mental health, see this book (or look for interviews with the author on YouTube):

    Brain Energy: A Revolutionary Breakthrough in Understanding Mental Health– and Improving Treatment for Anxiety, Depression, OCD, PTSD, and More by Dr. Christopher Palmer. Dr. Palmer is an assistant professor of psychiatry at Harvard Medical School and does research on metabolic therapy for mental illness. He is also a clinician who treats patients using metabolic therapy.

    If you’d like to go deeper into the science of metabolic health, see the books below by Gary Taubes (or look for interviews with the him on YouTube). Mr. Taubes is an award-winning investigative science journalist who studied physics at Harvard, aerospace engineering at Stanford, and journalism at Columbia. He has been researching and writing about nutrition science for over twenty-five years.

    • Rethinking Diabetes
    • The Case for Keto: Rethinking Weight Control and the Science and Practice of Low-Carb/High-Fat Eating
    • The Case Against Sugar
    • Why We Get Fat: And What to Do About It
    • Good Calories, Bad Calories

  • References

    January 1st, 2025

    Diabetes stats:  https://www.cdc.gov/diabetes/php/data–research/index.html

    https://archive.cdc.gov/www_cdc_gov/media/releases/2019/p1202diabetes.html

    https://diabetesjournals.org/care/article/46/3/490/148482/Youth-OnsetType-2-Diabetes-The-Epidemiology-of-an

    Overweight stats: https://www.cdc.gov/nchs/fastats/obesity–overweight.htm

    Diseases associated with mitochondrial dysfunction: https://en.wikipedia.org/wiki/Mitochondrial_disease

    Mental illness associated with mitochondrial dysfunction: https://www.psychologytoday.com/us/blog/the–therapycenter/202405/mitochondria–ground–zero–for–psychiatric–illness

    Number of cells in the human body: https://biologydictionary.net/how-many-cells-are-in-thehuman-body/

    fat metabolism: https://en.wikipedia.org/wiki/Lipid_metabolism protein metabolism: https://en.wikipedia.org/wiki/Protein_metabolism carb metabolism: https://en.wikipedia.org/wiki/Carbohydrate_metabolism Lipogenesis (conversion to fat): https://en.wikipedia.org/wiki/Lipogenesis

    glucose conversion to fat: https://healthcare.utah.edu/the–scope/healthlibrary/all/2018/08/how–sugar–converts–fat

    hormones keep weight stable https://www.modernendocrine.com/hormones–and–weight–understanding–the–connection/

    vascular damage from glucose: https://vascular.org/news–advocacy/articlespress–releases/why–diabetes–can–damage–your–blood–vessels–and–how–knowif

    Glycation: https://en.wikipedia.org/wiki/Glycation

    elevatd glucose increases ROS:

    https://diabetesjournals.org/diabetes/article/49/11/1939/10490/Highglucose-level-and-free-fatty-acid-stimulate

    ROS diseases: https://www.mdpi.com/2227–9059/11/11/2925

    Elevated glucose and insulin and blood pressure: https://www.healthcentral.com/condition/diabetes/can–blood–sugar–affectblood–pressure

    Elevated glucose and insulin and increased cancer risk:

    https://www.mcgill.ca/pollak-lab/files/pollak-

    lab/insulin_glucose_and_the_increased_risk_of_cancer_in_patients_with_type_2_diabetes

    Elevated glucose negatively affects gut microbiome: https://pmc.ncbi.nlm.nih.gov/articles/PMC7284805/ Fat in liver as a cause of insulin resistance: https://www.sciencedirect.com/science/article/pii/S0925443914002579

    Elevated glucose as a cause of insulin resistance: https://en.wikipedia.org/wiki/Downregulation_and_upregulation Metabolic syndrome: https://en.wikipedia.org/wiki/Metabolic_syndrome

    Diseases associated with metabolic syndrome: https://my.clevelandclinic.org/health/diseases/10783–metabolic–syndrome

    https://www.heart.org/en/health-topics/metabolic-syndrome/aboutmetabolic-syndrome

    https://www.mayoclinic.org/diseases-conditions/metabolicsyndrome/symptoms-causes/syc-20351916

    Metabolic syndrome and mental illness: https://archivesbiologicalpsychiatry.org/metabolic–syndrome–in–psychiatricdisorders/

    Metabolic syndrome and autoimmune disorders: https://www.jrheum.org/content/51/4/360

    Metabolic syndrome and Alzheimer’s: https://link.springer.com/article/10.1007/s00018–011–0840–1

    Metabolic syndrome and gout: https://www.medicalnewstoday.com/articles/is–metabolic–syndrome–amodifiable–risk–factor–for–gout

    Avoiding nutrient deficiencies on a plant-based diet:

    https://www.mindbodygreen.com/articles/vegan-diet-nutrient-deficiencies

    Review of studies on red meat: Annals of Internal Medicine

    NASM protein recommendations: https://blog.nasm.org/nutrition/power-protein

    Loss of muscle mass as we age: https://www.webmd.com/healthyaging/sarcopenia–with–aging

    Endurance training: https://www.verywellfit.com/is–hiit–training–or–steadystate–cardio–better–4126506

    Effect of sleep on mitochondrial function: https://www.mdpi.com/2076–

    3921/12/3/674

    Lifestyle factors influencing mitochondrial function:

    https://www.drwendyquijadahansenpharmd.com/post/unraveling-themysteries-of-mitochondrial-dysfunction-symptoms-influencing-factorsstrategies-f

    Health effects of having a sense of purpose:

    https://www.mayoclinichealthsystem.org/hometown-health/speaking-ofhealth/purpose-and-mental-health

    Omega-6/Omega-3 ratio: https://www.healthline.com/nutrition/optimizeomega–6–omega–3–ratio#TOC_TITLE_HDR_4

    Benefits of Omega-3 fatty acids: https://nutritionsource.hsph.harvard.edu/what–should–you–eat/fats–andcholesterol/types–of–fat/omega–3–fats/

    Review of studies on saturated fat: Journal of the American College of

    Cardiology

    Ketogenic diets: https://www.healthline.com/nutrition/ketogenic–diet–

    101#diet–types

    Potential benefits of ketogenic diets: https://www.healthline.com/nutrition/15–conditions–benefit–ketogenicdiet#TOC_TITLE_HDR_17

    Ketogenic diet for mental illness: https://med.stanford.edu/news/allnews/2024/04/keto–diet–mental–illness.html

    Ketogenic diet for heart failure: https://cardiovascularbusiness.com/topics/clinical/heart–health/keto–dietheart–failure–questions–cleveland–clinic

    NASM protein recommendations: https://blog.nasm.org/nutrition/powerprotein

    Optimal lab values for triglycerides, HDL, and fasting insulin: https://www.levels.com/podcasts/the–top–lab–tests–to–determine–whether–ornot–youre–actually–healthy–with–dr–casey–means

    Studies on ketogenic diets as treatment for migraines: https://www.frontiersin.org/journals/nutrition/articles/10.3389/fnut.2023.1204700/ful https://www.news–medical.net/news/20231012/Ketogenic–diets–found–toslash–migraine–frequency–and–fatigue–in–new–study.aspx

Proudly powered by WordPress