Elevated Visceral Fat: "Nobody Wants That"

The language that follows is the language of observational/epidemiological studies:

"among obese adults, visceral fat was associated with more than a twofold increased risk of developing incident diabetes (odds ratio 2.42, 95% CI 1.59 to 3.68).  In addition, developing either condition was also associated with markers of insulin resistance including elevated fructosamine levels (OR 1.95, 95% CI 1.43 to 2.67) and elevated fasting blood glucose (OR 1.88, 95% CI 1.38 to 2.56).

But there were no associations with general markers of obesity, including body mass index (BMI) or total body fat."

In other words, "these are interesting correlations."

Not that I would disagree with their conclusions:

"Our study may have implications for understanding differences between metabolically healthy and pathologic obesity."

This is interesting because not everyone that's fat is insulin resistant, and those who are develop illness as much higher rates than those who are not.

This is also interesting:

"In participants without diabetes at baseline, a number of factors were significantly and independently associated with incident diabetes in obese adults:

• Elevated visceral fat: OR 2.42, 95% CI 1.59 to 3.68 (P<0 .001=".001" li="li">
• Elevated systolic blood pressure: OR 1.26, 95% CI 1.07 to 1.48 (P=0.006)
• Elevated fructosamine levels: OR 1.95, 95% CI 1.43 to 2.67 (P<0 .001=".001" li="li">
• Elevated fasting blood glucose: OR 1.88, 95% CI 1.38 to 2.56 (P<0 .001=".001" li="li">
• Weight gain from baseline: OR 1.06, 95% CI 1.02 to 1.10 (P=0.002)
• Family history of diabetes: OR 2.32, 95% CI 1.25 to 4.29 (P=0.008)

"There were no associations for BMI, total body fat, or abdominal subcutaneous fat, they reported." 

Many of the same factors correlated with the development of insulin resistant in those not obese when the study began.

http://www.diabetesincontrol.com/index.phpoption=com_content&view=article&id=13578&cacatid=1&Itemid=17

All in all, this fits a well recognized pattern of illness - high fructosamine levels/high fructose intake, visceral fat, high blood pressure, elevated fasting glucose, weight gain, and family history of diabetes.  

Lucky for us, most of these symptoms are treatable through carb restriction - I recommend starting out at 25-50g/day to stop these symptoms, and after weight/fat/symptom normalization, many will be able to eat more carbs but maintain their wellness.  Eat meat, eggs, vegetables, nuts and seeds, little fruit or starch, no sugar/wheat.

Mercola On Fructose

What is the link between fructose and blood pressure? Fructose in your diet raises your blood pressure in three key ways:

1. When your liver breaks down fructose, uric acid is produced as a byproduct. Uric acid also drives up your blood pressure by inhibiting nitric oxide in your blood vessels. Nitric oxide helps your blood vessels maintain their elasticity. When you consume large amounts of fructose, increasing uric acid levels drive up your blood pressure. If your uric acid levels are chronically elevated, you have an increased risk for hypertension, kidney disease, metabolic syndrome and diabetes. Large amounts of fructose also place a great strain on your liver, which is responsible for most of the metabolic burden.
2. As metabolic physician and nutrition expert Dr. Ron Rosedale has explained, insulin stores magnesium. If your insulin receptors are blunted and your cells grow resistant to insulin, you can't store magnesium, so it passes out of your body through urination. Magnesium relaxes muscles; so, when your magnesium level is low, your blood vessels will constrict rather than relax, which further raises your blood pressure.
3. Insulin causes your body to retain sodium, which in turn causes fluid retention. Fluid retention results in elevated blood pressure and can ultimately lead to congestive heart failure.

I strongly advise keeping your TOTAL fructose consumption below 25 grams per day, or as low as 15 grams if you have high blood pressure, are overweight, or diabetic.

The fructose in whole fruits is generally healthy, unless you consume large amounts, and/or in the form of fruit juices or dried fruits. Still, if you have any of the health issues just mentioned and you're consuming large amounts of fruit, you would be wise to restrict your fruit intake to under 15 grams of fructose per day as well until your condition has normalized.

http://articles.mercola.com/sites/articles/archive/2012/09/23/broccoli-health-benefits.aspx?e_cid=20120923_SNL_Art_1

As always with Dr. Mercola's posts, you have to take the good with the bad.  This article starts out by hyping the benefits of broccoli consumption, but the citations indicate the research is mostly epidemiological, which means little to me.  Not that I would disagree with four servings of broccoli per week, but I doubt this would offer the mythical benefit for most of us in terms of improving blood pressure.  

However, I like the model he's proposing above with regards to how we are such a sick, diabetic, hypertensive culture.  And with this issue, we don't have to rely on goofy science to know if it helps.  With carb restriction generally and fructose specifically, most of us will see blood pressure normalization.

I found that after carb restriction, potassium supplementation further normalized my BP, and recently met someone who's doctor recommended potassium for that purpose also, which I thought was good news.

The big takeaway - all these symptoms (high blood pressure, dis-lipidemia, visceral fat, gout, insulin resistance/diabetes) are not discrete illnesses, but representative of excess consumption of carbs in general and sugars (which almost always are about 50% fructose) specifically.

Gout from Taubes

Ever had gout or known someone that did?  Ever heard the line about excess purines being the cause?  Consider this:
Because uric acid itself is a breakdown product of protein compounds known as purines – the building blocks of amino acids – and because purines are at their highest concentration in meat, it has been assumed for the past 130-odd years that the primary dietary means of elevating uric acid levels in the blood, and so causing first hyperuricemia and then gout, is an excess of meat consumption.
The actual evidence, however, has always been less-than-compelling: Just as low cholesterol diets have only a trivial effect on serum cholesterol levels, for instance, and low-salt diets have a clinically insignificant effect on blood pressure, low-purine diets have a negligible effect on uric acid levels.
http://www.fourhourworkweek.com/blog/2009/10/05/gout/

That's right - eating foods with less purine content does not help with gout.  How can that be true, you may wonder.  The answer is that eating foods lower in purine content does not reduce the intake of purines enough to matter; even vegetarians can have relatively high rates of gout.  What matters is why your body stops clearing the purine fueled uric acid, which, at high blood concentrations, results in accumulation of destructive crystals in (most commonly) the joints.
About that, Taubes comments:
... there’s the repeated observation that eating more protein increases the excretion of uric acid from the kidney and, by doing so, decreases the level of uric acid in the blood.(7) This implies that the meat-gout hypothesis is at best debatable; the high protein content of meats should be beneficial, even if the purines are not.
The alternative hypothesis is suggested by the association between gout and the entire spectrum of diseases of civilization, and between hyperuricemia and the metabolic abnormalities of Syndrome X.
In other words, there's really no reason to think that gout is "caused" by anything other than what causes all of the clusters of diseases known as the diseases of civilization.  In fact, the treatment that works best for gout is carbohydrate restriction, generally, with particular attention paid to fructose consumption. 

Uric acid is cleared from the body via the kidney, but with the metabolic derrangement that results from high carbohydrate diets, the kidney becomes overloaded and uric acid clearance becomes secondary. 
... a series of studies in the 1960s, as clinical investigators first linked hyperuricemia to glucose intolerance and high triglycerides, and then later to high insulin levels and insulin resistance.(14) By the 1990s, Gerald Reaven, among others, was reporting that insulin resistance and hyperinsulinemia raised uric acid levels, apparently by decreasing uric acid excretion by the kidney, just as they raised blood pressure by decreasing sodium excretion. “It appears that modulation of serum uric concentration by insulin resistance is exerted at the level of the kidney,” Reaven wrote, “the more insulin-resistant an individual, the higher the serum uric acid concentration.” (15)

Second, fructose directly raises uric acid levels. 

Third, fructose, which is broken down in the liver in a manner similar to that of alcohol, can over task the liver and contribute to accelerated insulin resistance, which exacerbates all of the symptoms of metabolic syndrome. 

In other words, just like statins and blood pressure medications treat symptoms of metabolic syndrome, but don't cure it, gout medications treat the symptoms of gout but don't deal with the cause.

I recommend you read the article linked above, but for treatment, all you need do is eat meat, vegetables, nuts and seeds, little fruit or starch, and no sugar or wheat as you pursue vigorous health vice relief of symptoms.

I'll include more on why fructose consumption should be moderate in following posts.