Saturday, February 6, 2010

Hypertension and the X-Image

From the left: Mechad Brooks (from True Blood), Spanish tennis player Fernando Verdasco and Japanese soccer player Hidetoshi Nakata.




How is the X-Image and Hypertension Related?

[This is not a stretch... *wild wink*]

For men, this is the balanced, broad shoulders, narrow hips image. For women, strong symmetrical shoulders, narrow waist, wide child-bearing hips, long gams. The X-look was coined by Prof DeVany. Evolutionarily, secondary sex traits are associated with high fertility. For both genders, a narrow waist signifies high hormones -- testosterone (not hair-losing-DHT), estrogen, progesterone, DHEA, pregnenolone, etc. And... Low insulin, low insulin resistance and low inflammation and, thus, high immunity and resistance to lethal infections, the biggest killer of ancestral man besides predators and famine/drought.

Low insulin and low insulin resistance also corresponds (typically) to no visceral fat (intra-abdominal adiposity)... and narrower waists, precisely, the X-image.

Many genetic adaptations derive to push forward genetic material to the next generation and to provide for a stronger immune surveillance and protection system. Peter will soon be discussing the (protective) role of Lp(a) and the evolutionary disadvantages of vegetarianism. Bantu vegetarians not only have higher Lp(a) but also higher blood pressures.



Brain, Neuropeptides, and Hormones

The primary controller of fertility and sexual function is our... BRAIN.

I am not joking. Indeed, the brain is our biggest sex organ.

The pituitary-gonadal axis influence sex hormones and fertility by incorporating multilevel inputs from the intestines/GI, muscles, senses (eyes, ears, mouth/ philematology, smell/ pheromones), fat stores, liver, etc .

Scheider JE discusses the balance of energy and reproduction thoroughly. Two diagrams are from Energy Balance and Reproduction, click for PDF HERE.



Energy Balance and Reproduction
The physiological mechanisms that control energy balance are reciprocally linked to those that control reproduction, and together, these mechanisms optimize reproductive success under fluctuating metabolic conditions. Thus, it is difficult to understand the physiology of energy balance without understanding its link to reproductive success. The metabolic sensory stimuli, hormonal mediators and modulators, and central neuropeptides that control reproduction also influence energy balance. In general, those that increase ingestive behavior inhibit reproductive processes [e.g. excessive carbohydrates], with a few exceptions. Reproductive processes, including the hypothalamic–pituitary–gonadal (HPG) system and the mechanisms that control sex behavior are most proximally sensitive to the availability of oxidizable metabolic fuels. The role of hormones, such as insulin and leptin, are not understood, but there are two possible ways they might control food intake and reproduction. They either mediate the effects of energy metabolism on reproduction or they modulate the availability of metabolic fuels in the brain or periphery.

This review examines the neural pathways from fuel detectors
to the central effector system emphasizing the following points:

0 First, metabolic stimuli can directly influence the effector systems independently from the hormones that bind to these central effector systems. For example, in some cases, excess energy storage in adipose tissue causes deficits in the pool of oxidizable fuels available for the reproductive system. [Recall, insulin stores/locks in fat. We need 'some' insulin for muscle growth, but really not much. Hard-gainers have insulin resistance in the liver and elsewhere, I strongly suspect.] Thus, in such cases, reproduction is inhibited despite a high body fat content and high plasma concentrations of hormones that are thought to stimulate reproductive processes. The deficit in fuels [fatty acid fuel deficits caused by carb-pathways turned on] creates a primary sensory stimulus that is inhibitory to the reproductive system, despite high concentrations of hormones, such as insulin and leptin.

o Second, hormones might influence the central effector systems (including gonadotropin-releasing hormone (GnRH) secretion and sex behavior) indirectly by modulating the metabolic stimulus.

o Third, the critical neural circuitry involves extrahypothalamic sites, such as the caudal brain stem, and projections from the brain stem to the forebrain. Catecholamines [adrenaline, stress], neuropeptide Y (NPY) and corticotropin-releasing hormone (CRH) are probably involved.

o Fourth, the metabolic stimuli and chemical messengers affect the motivation to engage in ingestive and sex behaviors instead of, or in addition to, affecting the ability to perform these behaviors. Finally, it is important to study these metabolic events and chemical messengers in a wider variety of species under natural or seminatural circumstances.




Insulin and Leptin 101 Basics

For more insulin and leptin 101 basics, please see Dr. A, my soul sister in science *BIG SMILE!*
--Mastering Leptin book report (but note her '????'s where I think she politely says wtf)





Stiffness. Caused by Insulin and ROS.

OK sometimes we want stiffness.

Er... But not forever...

Like a rubber tubing left outside to the elements, the vascular system in mammals (and fish) will stiffen and crack if it loses contractility and elasticity from oxidative damage. Rubber is resilient, yielding and flexible until it starts to break down from damaging factors such as UV, heat, cold, salt, oxidation, radiation, etc. In biologic systems, unlike rubber, there is respite and forgiving repair. Damage only occurs when the destructive factors outpace the rate of repair. The coronary arteries are most affected due to narrow relative diameters and high shearing forces as blood is pumped from the heart to the peripheral tissues. The higher the pressure, the more potential damage to the endothelium (lining of blood vessels). As the body tries to heal these tiny 'nicks' in the endothelium, scar tissue and calcifications form. If the immune system is on abnormal 'hyper-overdrive' or if the BP is abnormally high, then the scarring and calcifications can be more extensive, more keloidal, more thick with plaque. Those with Lp(a) (at any level, according to Dr. Harvey Hecht's research) tend to over-scar, it appears when the Lp(a) particles are small and oxidizable. Don't be dense. Saturated fat increases the size of LDL as well as Lp(a) (which is just LDL plus apo(a)), which improves the buoyancy and anti-atherogenic properties of LDL and HDL.





Insulin, Insulin Resistance Raise BP and Coronary Calcifications

High blood pressure is a 'gateway' condition to heavier, harder, stiffer conditions. BP greater than 110/70 is one of the first indicators that something is going on... See prior Nephropal post: Insulin.

BP is reflective of our inflammatory status and health of the endothelium. What causes BP to rise? Well. If you ask a cardiologist or any primary doc, they will tell you that essential hypertension has no known cause. WTF. With going paleo, BP, insulin, and insulin resistance are all lowered. Frasetto et al at UCSF showed this (as well as EVERYONE in the paleo community who was previously ill). Click HERE prior nephopal. With going low carb, Meckling et al has shown that BP, insulin and glucose were all also lowered (click HERE).

In the low-fat arm, of course, this was not the case. Low-fat is killing America by raising and maintaining high insulin levels which make us fat and STIFF.

Dr. Houston has discussed known causes of hypertension: ROS (reactive oxygen species), e.g. inflammation. Nephropal post: Nutrigenomics and Hypertension.

o Blood pressure and fasting plasma glucose rather than metabolic syndrome predict coronary artery calcium progression: the Rancho Bernardo Study.

o Insulin resistance independently predicts the progression of coronary artery calcification.

o Adiponectin, visceral fat, oxidative stress, and early macrovascular disease: the Coronary Artery Risk Development in Young Adults Study.

o Psychological stress, insulin resistance, inflammation and the assessment of heart disease risk. Time for a paradigm shift?

o Relationship of adiposity to subclinical atherosclerosis in obese patients with type 2 diabetes.




What Does NOT Raise Insulin?

Fat.

Pure unadulterated fat.

I aint talking olive oil honey.

See prior animal pharm: Insulin and Aging -- how low carb, high saturated fat works.


What Raises Insulin?

--Dietary carbohydrates (e.g. oatbran, grains, corn, legumes)
--(protein, mildly)
--Fructose
--Omega-6
--Gluten (via both the carb route and the endorphin system)
--Cortisol (stress, sleep deprivation, endurance training, etc)
--Hormone deficiencies (vitamin D, testosterone, estrogen, omega-3 fish flax, thyroid, etc)
--Drugs (steroids, birth control, Crestor/ rosuvastatin, Provera/ progestins, water pills, etc)
--Lack of ketones (MCT oil, coconut oil, periodicity of exercise or fasting)
--Sedentary atrophying lifestyle
(Last X-Image: Kellan Lutz, from Twilight series and 90210)



Dr. T's Winterization (good) v. Over-Summerization (bad)

Diagram from Schneider, modified.


31 comments:

Byron said...

Dear Dr. BG,
you´re H*O*T!
What a great review. Thanks.
n-6 raises insulin? Even as pure oil? I didn´t know that. Do you think casein/casomorphines can do the same via opioid peptides with leaky gut or by someone really sensitive? And can you imagine such a thing of coconut oil? It gives me a carblike binge and I can´t find an explanation. Greetings.

theorytopractice said...

Great post. Prior to my Paleo conversion, I was one of those "really healthy" people who happened to have essential, low-grade hypertension. Drs had no clue what could be at fault, as I was in otherwise stellar health, and ate a pristine "food pyramid" diet. Damn, all those wasted years! I got the feeling (from some not-so-subtle hints) that some manner of sports enhancement help was involved (i.e., steroids, etc.). I mean, what else could it have been from their point of view, right? Sheesh.

James said...

good post. the ol' x image everyone is after. i would add (from trainer Todd Durkie), "stop working the mirror muscles" if you want an x image body. work the whole body, especially the lower body and back. the front takes care of itself!

Mike said...

Kick-ass post as usual, Dr. BG! I always like the sexy science twist! *grin*

What about insulin's connection to increased aldosterone? I was hoping you'd go into more detail on that; many folks still see sodium as the enemy, not excess carbohydrtaes(insulin)

Anonymous said...

On you, maybe.

Aaron Blaisdell said...

I finally have that X-image! Thank you Paleo! If only I could travel back in time to high school and kick some in-group/out-group butt. Xin Nian Kuai Le.

Dr. B G said...

Byron,

BABE! Yes n-6 increases insulin and insulin resistance. I dunno the mechanism but probably involves membrane signalling.

Absolutely -- I think casein/casomorphines have multiple routes of raising insulin/IR. Leaky gut has got the be the most (slowly) lethal. Painful for those with GI issues and IBS and fullblown celiac.

Coconut oil alone makes me hungry make because it smells so good and it's not a neutral tasting oil like MCT or light olive oil that Shangri La talks about (though others are repulsed/ allergic like kryptonite *haa*).

Dr. B G said...

Hey Keith,

You are lucky you didn't end up with full blown something like diabetes. There are so many people who try to do there best just like you were!!!! *sigh*

I'd like to blow up that st*pid pyramid.
-G

Dr. B G said...

James,

RIGHT ON! Functional full body!

-G

Dr. B G said...

Mike,

Hey hawwwtness you stumped me again. I have too that up -- I'm sure Kenny T. knowns b/c aldosterone is involved in our mineral secretion/retention and the kidneys. MMmmhhh...

-G

Dr. B G said...

Aaron,

Happy Tiger Year! *ROAR*

You DEFINITELY have your X-game on! No more vampire days for you.

-G

Dr.A said...

Ciao, BG!
Most excellent post!
Here is a quote from that leptin book I just checked out..
"When fat is eaten it stimulates the intestinal tract to release gastric inhibitory peptide that causes insulin to rise leading to insulin resistance.
Thus, high fat diets which are not supposed to cause insulin resistance are just as capable of inducing the same problem through a different mechanism."
Can you comment on that, cos I just don't know enough about all this stuff yet.. and I can't be arsed to look it up.
Is it all down to a clogged, congested and confused liver maybe???????????
Hah!
The one in the middle looks just like my husband, by the way, [when I'm not wearing my glasses :) ]
And the sexiest bit of a man is still the bit between his ears... doesn't matter how buff he is if he opens his mouth and he's got a squeaky voice or talks cr@p!

Dr. B G said...

Bella CIAO!

I still have not wrapped my head around insulin resistance and fat intake. Certainly it makes sense but the studies show no increase in insulin if the diet is paleo (frasetto's) or low carb or no carb (see Ai M's study) with oral glucose load tested against oral fat load.
http://drbganimalpharm.blogspot.com/2009/12/insulin-and-aging-how-paleo-works.html

Also probably gender, leptin and adiponectin and ghrelen differences exist.

I just don't know what they are...

*aaah ha* Let me know when you figure it out in your pretty head!!

What I know is that when I routine do 3-5 hrs cardio (low intensity) and my sprints/HIIT/xfit 1-2 hrs/wk, then I have no hunger.

my food/alcohol intake can be ANYTHING and I still lose weight or maintain. however when I stop the exercise or cut in half, all bets r off *sigh* BUGGERS. Can't have my cupcakes... *haaa* My husband feels like #1 [in the dark *wink* j/k]

-G

mary said...

re what byron said about coconut oil and a carb-like binge- i had the same thing with coconut milk. i put down a whole can of it, even though my stomach was uncomfortably full, like i used to do with a carb binge. this happened several times.

then what's weider is as soon as i got my period it was like a light switch going off. i had lost the craving, although i still put a little coconut milk in my coffee. there might be some hormone thing going on with the heavy saturated fat content???

anyway- we are having a discussion at paleonu.com, and i was wondering if anyone had anything to add. from that blog, me as 'v' talking to KGH, dr. harris:

over at paleonu.com we are discussing 'broken metabolism'. dr. harris thinks the liver is the principally damaged organ here. i told him that my liver panel was normal, but i felt that my metabolism was out of whack last year (pre-paleo). below is some of our conversation. 'KGH' is dr. harris, a radiologist. any thoughts?

from paleonu.com:

from a couple posts up:

v: if the liver is being metabolically damaged from food- the damage has to be already severe for it to be picked up by standard tests for liver function. would you agree with the preceding statement?

KGH: No AST and ALT are pretty sensitive. They can go up long before the damage is severe.

now v says:

i dug up my 5/09 lab results.

AST: 21 IU/L out of a normal range ( or "reference interval") of 0-40
ALT: 16 IU/L out of a normal range of 0-40

So from the liver everything is looking good, right?

My TSH was 2.464. High is >3, so TSH looks good

But then my Ferritin, Serum is flagged low at 6 ng/mL out of a reference interval of 10-291
During this time I had heavy periods, so I suppose all my iron was leaking out. I had cameras go down my throat and up my butt, but no leaking found. They thought maybe I wasn't absorbing iron well, and so tested for celiac: negative. Then they saw my h.pylori bacteria count was high, and knocked it out in January of that year with strong antibiotics. my ferritin had gone up to 25 with iron supplementation. i stopped taking it, and it went back down to 7. my vitamin d was 24 ng/mL, which is low. my Hemogloin A1c was 5.9- a healthy adult is supposed to be 4.8-5.9. my c-reactive protein was 1.48mg/L Average is 1.00 - 3.00. I don't know if any of this jumps out at anyone.

I just think it strange that my AST and ALT Liver panel numbers were good, yet my insulin was not stellar, i had an apple shape, and my ferritin level was low with heavy periods.

If, by your logic, the liver is the principal damaged organ with a damaged metabolism, and my liver numbers were good, that must mean that my apple shape, low ferritin, and high end of normal insulin are signs of a well-running metabolism, no? But that doesn't make sense. That's why I keep posting about this. Maybe the first organ system to show obvious signs of a damaged metabolism in women is the reproductive system.

Dr. B G said...

Hey Mary,

That liver test is not normal. But I have no evidence.

I've seen a couple of cases of NASH and the liver tests were better than yours (< 20).

I think 2 things can be going on --(a) intraabdominal visceral fat deposition without enzyme disruption
(b) intraabdominal visceral fat deposition with enzyme disruption

Sometimes an abdom ultrasound or CT will pick up. Sometimes they don't. (usually it can though but I don't know the specificity or sensitivity b/c liver biopsy is the gold standard for NASH at this time, I believe).

Who is predisposed to NASH which is basically insulin resistance at the liver level? Asians, Indo-Asians, Pacific Islanders and all those also predisposed to diabetes Type 2. E.g. 80% of the whole global world.

I agree with you -- hormones like estrogen that peak at ovoluation -- shut off insulin resistance (IR) like a 'switch'. Us grrrls can have more IR for no apparent reason other than our bodies think they are preparing for a BABY. *haaa*

My only conclusion is that hormones can be very complicated and that the best situation for IR and longevity are optimal 'youthful' levels.

-G

Dr. B G said...

btw what I see is when people go low carb and/or semi-paleo, the ALT AST goes to lower levels within 4wks. Abnormal normalizes to < 40 and 'normal' 20s 30s will go to < 15. Those to me are signs of an uncongested, visceral fat-free liver organ. At one time mine was as high as 27 when I was getting over some hormone madness (the Levonorgestrel IUD). WTF. A lotta things can cause IR. See Stephan's latest post too. Caffeine, fructose, Mg++ deficiency. I'd add excessive alcohol, n-6 (too many nuts/seeds, especially if unsoaked), dairy (immunogenic effect, all except ghee where proteins are removed).

mary said...

i really appreciate your detailed response. you are the star of the paleo blogs, and i'm not being facetious. i want to have blood work done in april. i lost a lot of tummy fat on paleo since i had that blood work i mentioned, so i will be on the look out for hopefully better liver panel numbers. you're the best!! ni shi zui hao de!! -mary/ aka 'v'

Dr. B G said...

mary aka 'V'

Bu ke qi!
holymoly u crack me up GRRRLL...

dui bu qi, ni bu dui -- wo shi wang ba DAN. *haaa*

-G

Neonomide said...

Bootylicious!

I was just warming up my own paleo post on fasting insulin and wondered the link with hypertension. Thank You again so much for so many steaming hot references on the subject!

I was "diagnosed" with elevated BP as a child (no reason given), so hypertension discussion is always of interest to me. No white coat syndrome, I'm afraid. Seems that I'm a Vitamin D hyper responder on hypertension like I told before, yet I agree that many other things also come to play. Other than sodium restriction and exercise, I'm sure. It seems we're having a telepathic connection!

Paleo Lifestyle­™ sure covers a wide range of strategies! ^^

Vitamin D guru James Dowd seems to like magn, Vit D and potassium combo a lot with fresh produce and fish and I'm all into that. Close to DASH in some respects, excluding Whole Grain sh** I' more and more unfond of. (2 months STRAIGHT total avoidance now and I feel great!)

A Vit D Council president John Cannell collaborator naturopath Alex Vasquez has a nice list of his take on about Hypertension treatment without drugs, if you are interested:

http://www.naturopathydigest.com/archives/2006/nov/vasquez.php


PS: Bad News from Finland part deux: the same bloke who has told us that "carbohydrates are more natural food than fat" is the new Professor of Nutrigenomics and Nutrigenetics in our university. He's owned by Nordic Sugar bureau Danesco. I'm a bit afraid we're not getting raunchy stuff like FUNGENUT anytime soon on air. There is always hope.

Peter said...

G,

Just catching up here. Some great links. Fantastic stuff!

Peter

Dr. B G said...

Neomide!

I'll ck out the Vasquez link -- thanks!

We ARE telepathic :) *ahaa*

Sorry about the Finland news -- I guess fats will remain controversial everywhere for another oh... what? 50 yrs? Or is it time soon?! *heee*

-G

Dr. B G said...

Peter,

JE Schneider is amazing -- I thought you might appreciate her inter-species discussions. Especially the bipedal, big cranium, small gut animal species.

-G

lightcan said...

Happy Year of the Tiger, our special tigress!!

Dr. B G said...

lightcan!

Happy Lunar Chinese New Year to YOU my gal (and all the other sexxxxxy HOT animals out there)!

May it be a truly blessed year *wink*

XOXOXO,
G

mary said...

gongxi facai!!

oh no! i just had douhua with the syrup and i have a yucky feeling in my chest!!! my daughter warned me. anyway tea lunch was yummy and we saw some good dragon dancers and kung fu artists, after which my husband and the douhua lady informed me they were affiliated with with the local chinatown mafia who collect about $100 a month from stores for 'protection' (zai bingzhou, feicheng). rule of law isn't always the general rule.

gongxi yisheng yao zanjia 2011 nian paleo/ancenstral eating da hui. hen guangrong o!

Dr. B G said...

Gongxi Facai Mary!

I love the ginger syrup w/douha too but it makes my heart race from the sweetness(!). Mafia have a way of surviving don't they?

Gan xia! Ni ti ke qi!! Da jihui. It is an truly exciting opportunity to evolve healthcare.

Peace and prosperity,
G

lightcan said...

Uh, this has been the funniest thing I've seen in ages: Dr. Davis on Clinton and his stent. 'Lp(a) tends to be the province of people with greater than average intelligence.' ergo my super high Lp(a) means I am very intelligent? I wouldn't say so myself, (not much more than 120 I guess), but dr. Harris definitely is.

What is the take home message from Peter's posts? Have you changed your position, re. your assertion than any lp(a) is bad (Hecht)?

Dr. B G said...

Hey lightcan,

It is true -- I think Lp(a) carriers are amazing survivors and have uncanncy intelligence. See lightcan -- you ARE a PRIME example *wink* and I wish I had some!

Even if Clinton's Lp(a) was ~10 mg/dl -- that would be uncontrolled on the low saturated fat SAD (which is probably what he was following lately). Honestly the saturated fat from McDonald's and midwestern cooking is probably what protected the coronary vessels from not blocking up in his younger 40s-50s, I would conjecture.

Mainly only saturated fat, omega-3s, and low carb control Lp(a).

Saturated fatty acids also control infections -- they are vital to our immunity along with omega-3 fatty acids. Lp(a) is an 'arm' of the immune system just like HDLs and LDLs.

I think Peter's series on Lp(a) is ASTOUNDING and nothing he writes on cardiovascular disease is short of pure BRILLIANCE.

His latest is great:
http://high-fat-nutrition.blogspot.com/2010/02/ok-ascorbate-and-lpa.html

We all have more to learn... I am not so into heart disease anymore b/c it is TOTALLY reversible and simple to do:
--low carb Paleo
--fix vitamin/hormone deficiencies
--exercise
--EAT SATURATED FAT D*MN IT TO INCR HDL2b, immunity AND CONTROL Lp(a)


Dr. Harris? Do you mean the omega-3 index guy?
-G

lightcan said...

Dr. Harris from PaNu

Yes, Peter is brilliant and cool, but I am not sure I understood everything. I need 'Lp(a) for dummies'!

Oh, re. Clinton, that was a joke and a propositional fallacy. Just because I have high lp(a) doesn't mean I am very intelligent.

Dr. B G said...

lightcan,

I need Lp(a) for dummies after Peter's post too! It is nice to understand the putative mechanisms underlying this factor (as is sdLDL) and how evolution plays in.

Like many out there in the blogosphere, nothing makes sense unless it is in 'light of evolution'... that is what Billy E and Dr. Tourgeman and I purport.

Don't worry I knew you were being facetious... I think Lp(a) is a big challenge at TYP and with Heart Hawk (at any Lp(a) level 2-200+ mg/dl) but I don't think Davis was implying for himself (although course he is quite intelligent for being a recovering vegetarian; I give him a lot of credit for accepting change).

Lightcan -- you don't give yourself enough credit!!

Do you have a baseline Lp(a) prior to paleo? Has it improved? I have seen easy improvements from mid-100s to 200s with 50-70% drops in just 4wks with dietary changes (and pounding some fish oil)...

I think the goal is nice fluffy particles, not dense st*pid stuff. Like LDL, if Lp(a)/oxLDL is high accompanied by high insulin, high insulin resistance, low HDLs, high Tgs, high sdLDL, then the Lp(a)/oxLDL is all likely to be the dense stuff as well. Studies show that soft plaque may have a core interior of oxLDL (e.g. Lp(a)) whcih is not calcified yet -- but HIGHLY unstable and likely to rupture/clot and thus be more likely to cause imminent infarctions (strokes/heart attacks).

But of course controllable! :) Within 2-4wks of low carb, high sat fat paleo (and some vit D/omega-3 and thyroid improvements)

-G

trinkwasser said...

Old age: when things that used to be flexible get stiff, and things that used to be stiff get flexible :(

From that POV insulin resistance = ageing