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CHAPTER ONE

Metabolic Syndrome: The Root Cause of Chronic Disease

I wish I had a better metabolism. But someone else probably wishes they could walk into a room and make friends with everyone like I can. You always want what someone else has.

— KELLY CLARKSON

Let’s start with some basic terminology.

Metabolism is a broad term that refers to the sum total of an organism’s energy-producing and energy-utilizing reactions.

Glucose is the primary fuel in the body that is utilized by your brain, heart, kidneys, muscles, liver, and all the vital organs. The goal is to have lots of energy by having the right amount of the right kind of fuel available at the right time. Glucose is the only fuel that red blood cells can use and is the preferred brain fuel under most conditions. Muscles are the largest glucose-burning tissue in the body. The amazing thing is that the entire bloodstream can only hold three to four teaspoons of glucose at a time. This means that blood-glucose levels need to be tightly regulated at all times.

Insulin acts as the fuel injector that pushes glucose to the vital tissues for use as fuel. The problem with insulin is that when it is too high for too long, it makes us voraciously hungry and shuts down fat burning.

All carbohydrates eventually break down into glucose, which is the simplest form of fuel. Sucrose is table sugar, fructose is fruit sugar, lactose is milk sugar, and the list goes on. You are hardwired to seek out sugar because it provides energy. The goal is to find ways to provide this energy from healthy fuel sources, the way nature intended. In nature, sugar comes prepackaged with fiber and water to provide a steady flow of fuel to the cells in the body. We interfere with this system at our peril.

Metabolic imbalances and diseases arise when there is a problem with fuel availability and utilization. This condition can be analogized to your car engine being flooded and then sputtering and producing soot and smog because fuel cannot be properly delivered and converted into energy.

So, metabolic disease is an energy-delivery problem at its core. To use another analogy, it’s like having plenty of money in the bank but still being broke because your accounts are “frozen” or you are locked out for not having the right password.

Turbo Metabolism

Turbo Metabolism means having a properly functioning energy-delivery system, so that fuel is delivered and utilized optimally, providing plenty of energy for fueling a vibrant life. The result is a long and energetic life free of the chronic diseases that plague modern urban society.

The underlying cause of much metabolic disease is metabolic syndrome — the name for a group of risk factors that triples your risk for heart disease, increases fivefold your risk for diabetes, and causes many other health problems, including stroke, liver damage, cancers, sleep apnea, high blood pressure, and even chronic pain.¹ (Risk factors are traits, conditions, or habits that increase your chances of developing a disease.)

In obesity, the storage capacity of fat (adipose) tissue can be exceeded. When this happens, the excess fat accumulates in other tissues, which can cause them to malfunction. When the pancreas, muscles, liver, and cells lining the blood vessels are saturated with fat, metabolic syndrome may result (see figure 1.1).²

Figure 1.1. The process by which caloric excess and obesity lead to belly fat and metabolic syndrome

A telltale sign of metabolic syndrome is belly fat: the ugly fat cells that engulf our vital organs and surround the loops of our intestines. This is not the fat under the skin that can be sucked out during liposuction. It is internal, and the only way to get rid of it is by adopting the Turbo Metabolism lifestyle. Belly fat is very evident in people with a “beer belly” and is the source of all metabolic diseases.

The proliferation of this “hungry fat” makes us crave even more of the wrong foods. Think about it: You don’t become overweight because you are hungry; you actually feel hungry because of this greedy belly fat, which keeps capturing and trapping energy, leaving you even hungrier! Thus, belly fat is the enemy of Turbo Metabolism: The more belly fat you accumulate, the hungrier (and fatter) you get!

Type 1 and Type 2 Diabetes

Diabetes is a group of diseases characterized by high blood-glucose levels that result from defects in the body’s ability to produce and/or use insulin. Insulin is a master chemical (hormone) produced by the pancreas, and it is responsible for moving glucose from the bloodstream to the organs where it is used for energy — principally the muscles, the heart, the brain, and the liver.

Symptoms of diabetes include increasing thirst and hunger, along with fatigue and blurry vision. Fatigue is a hallmark symptom because of the inability of glucose to be delivered to the cells to be used for energy. Diabetes is diagnosed by a fasting blood-glucose level of greater than 126 mg/dL (on two separate tests) or a blood-glucose level greater than 200 mg/dL at any time.

Type 1 diabetes, which accounts for only 10 percent of diabetes cases, is caused by a deficiency of insulin production by the beta cells of the pancreas. That is, type 1 diabetics lack insulin, and they tend to be very thin and have a hard time gaining weight. Type 2 diabetes accounts for 90 percent of all diabetes cases. It is caused by insulin resistance — the body produces sufficient insulin, but the insulin is unable to work properly. The result is higher-than-normal levels of blood glucose because the glucose is unable to be processed by the cells and used for energy, so it remains in the bloodstream. When we measure insulin levels in type 2 diabetics, we find their insulin levels are actually very high, meaning that the body is compensating for insulin resistance by producing even more insulin! One of the big problems with chronically elevated insulin levels is that they cause constant hunger, and fat cannot be used as a fuel as long as insulin levels are elevated. As a result, type 2 diabetics tend to be heavy. The goal of Turbo Metabolism is to improve insulin sensitivity so that these soaring insulin levels can drop down to normal.

Heart disease, cancer, lung disease, stroke, and diabetes are the leading killers of our time and account for two-thirds of all deaths. According to the Centers for Disease Control (CDC), the percentages of total deaths by the seven leading causes are as follows:

1. Heart disease: 24.1 percent

2. Cancer: 22.7 percent

3. Chronic lower-respiratory diseases: 5.9 percent

4. Accidents (unintentional injuries): 5.6 percent

5. Stroke (cerebrovascular diseases): 5.3 percent

6. Alzheimer’s disease: 4.9 percent

7. Diabetes: 3.0 percent³

If you are a nonsmoker over the age of forty, you can further narrow down the causes of death and disability to heart disease, strokes, cancer, and Alzheimer’s disease. These are all characterized by impaired metabolism (problematic energy delivery) at their core.

If you really think about it, the actual causes of death underlying these diseases can be boiled down to a handful of largely preventable lifestyle choices, such as tobacco use, poor diet, and physical inactivity, all translating to impaired energy transactions in the body (impaired metabolism). Many of these lifestyle choices or behaviors stem from unmanaged stress, lack of social support, and poor sleeping habits.

In fact, the manifestation of a disease such as diabetes is simply the tip of the iceberg. Many decades before disease becomes evident, sinister “conspiracies” are brewing. Insulin receptors are becoming blocked and inflammatory chemicals are poisoning our vital organs and metabolic processes as a result of our behavior and choices. Essentially, we are gradually overwhelming the balance of nature. Using our car analogy, we are “gunking up” the engine, slowly plugging our intricately designed valves and fuel injectors, through the choices we make with our forks, fingers, and feet. The channels of glucose transport — that is, fuel delivery to the cells — are quite literally blocked by fat! Eventually, we completely overwhelm the body’s capacity to cleanse itself; the scales are tipped and we are diagnosed with a disease.

The root cause underlying the problem is the excess of calorie-dense, nutrient-poor, toxic stuff masquerading as food, which essentially blocks the insulin receptors on the muscles and the liver and in the blood vessels. This causes serious difficulty with fuel delivery and utilization, incapacitating our energy-delivery system. These tissues essentially become “accessory fuel tanks” as we live in a constant state of feast without giving the system a chance to burn off the extra fuel.

Table 1.1 summarizes how physicians diagnose metabolic syndrome. Increased waist circumference plus any two of the criteria in the table results in the diagnosis. Metabolic syndrome is so dangerous because abdominal obesity (midsection or “belly” fat) produces harmful substances that cause inflammation and damage circulation and internal organs.

As stated above, your entire bloodstream can only handle three to four teaspoons of sugar at a time. Actually, the total amount of sugar you should consume in a day is zero teaspoons because refined sugar does not exist in nature. The body can extract all the sugar it needs from real unprocessed plant foods.

Table 1.1. Diagnosis of metabolic syndrome (a diagnosis includes increased waist circumference and any two other risk factors)

The Role of Insulin

Insulin is the glucose-disposal hormone that is designed to move sugar from your bloodstream to your muscles to be used as energy. In fact, muscle is the largest insulin-sensitive tissue in the body. So one way to increase insulin sensitivity is to activate your muscles! Using our car analogy, insulin acts as the fuel injectors, supplying glucose (fuel) to the engine (muscles, brain, and other vital organs). Our insulin level soars when we both consume a high-calorie, low-nutrient diet — a diet high in manufactured, processed food that is mostly refined carbohydrates (sugar, high-fructose corn syrup, and white flour) and unhealthy fat (feedlot meat, cheese, industrially prepared vegetable oils) and low in fiber and micronutrients — and couple it with a sedentary lifestyle, high stress, and lack of sleep. In response to constantly elevated insulin levels, the cells, tissues, and organs become insulin resistant or insensitive. This is like how we “tune out” and no longer hear a constant sound, like a fan or traffic outside our window.

As shown in figure 1.2, constant and repeated spiking of blood glucose from a toxic diet of highly processed foods loaded with refined carbohydrates (such as from refined grain flours, sugar, and high-fructose corn syrup) leads to a constant elevation of insulin levels. With repeated glucose spikes, insulin levels have no chance to retreat to normal levels. This constant elevation of insulin makes us constantly hungry and leads to metabolic syndrome and type 2 diabetes. Thus, the formula is, repeated glucose spikes cause constant elevation in insulin levels, which leads to constant hunger and eventually disease. The key is to eat foods that release glucose slowly so that insulin levels stay low.

To summarize, in the presence of high levels of insulin, fat cannot be broken down into free fatty acids to be used for energy. This means that as long as you continue to consume a diet high in sugar and processed carbohydrates, your body will not be able to go to “fat-burning” mode. Thus, persistent elevation of insulin causes high levels of circulating blood glucose as well as fat accumulation. It also starts a perpetual cycle of hunger and cravings for sugar and high-glycemic foods (processed grains = fast carbohydrates = sugar releasing). The glycemic index is the degree to which food is processed to glucose in the body (for a chart of specific foods, see appendix 4). To hop off this cycle, your goal should be to follow a lifestyle that calms these raging insulin levels. Low insulin levels translate to less hunger, fewer weight problems, more fat burn, and less illness. When we provide the body with the right fuel, we begin to correct the hormone imbalances that wreak havoc on the entire system.

Figure 1.2. Blood glucose and insulin levels: With repeated glucose spikes, insulin levels have no chance to retreat to healthy levels

Insulin Resistance

You may wonder: How exactly does it happen that belly fat causes insulin resistance? Here’s how.

In a series of unfortunate events, our modern diet — typically high in sugar, refined starches, and “dirty fat,” such as trans fats and industrially produced oils — plugs the fuel injectors so that glucose can no longer enter the cells. Instead, glucose levels start to mount in the bloodstream. Muscle cells become insulin resistant, initially allowing energy to be stored as fat around the vital organs and in and around the liver. Eventually, these tissues also become insulin resistant. Thus starts the vicious cycle in which belly fat produces insulin resistance, and insulin resistance causes even more belly fat. As the liver and fat tissues also become insulin resistant, full-blown type 2 diabetes ensues with soaring levels of blood glucose.

Central obesity (excess weight in the midsection) produces hormones and other substances that are huge contributors to insulin resistance. Simply put, belly fat produces substances that act like a wad of bubble gum blocking a keyhole. Even though we have the right key (insulin), the door remains locked, and sugar is unable to enter the cells. It remains in the bloodstream, causing damage. Additionally, belly fat produces hormone messengers that make us tired, achy, and sick.

While diabetes is diagnosed by a fasting glucose of over 126 mg/dL, prediabetes is fasting glucose over 99 mg/dL, and insulin resistance starts at fasting glucose above 85 mg/dL.

Prediabetes and insulin resistance can precede type 2 diabetes by a decade. This is why I say that type 2 diabetes is just the tip of the iceberg. By the time we notice it, the main body of the iceberg has existed below our awareness for years. The result can be organ damage, such as eye and nerve damage, and its accompanying complications of full-blown heart disease and kidney disease.

Sugar Glazing, or the Importance of HbA1c

When we experience insulin resistance and too much blood sugar remains in the bloodstream, it causes “sugar glazing” of the hemoglobin in red blood cells. This is called glycation, and it results in glycosylated hemoglobin (also known as glycohemoglobin) or HbA1c. That is, a high level of circulating blood sugar makes the cells in the body, and the vessels through which they flow, “sticky.” Imagine blood cells as Ping-Pong balls flowing through a pipe. Now imagine that the balls and the pipes have been dipped in honey. As they try to flow through the pipes, they damage the lining.

This glycation or “sugar glazing” causes cellular dysfunction and tissue inflammation, leading to degenerative diseases from oxidative stress. In fact, type 2 diabetes is the perfect model for rapid aging.

Advanced glycation end products (aptly abbreviated as AGEs) make not only the red blood cells but all the proteins in the body sticky. They are like the sticky fingers of a toddler, affecting everything they touch. When proteins are sticky, they can no longer properly communicate with one another, leading to the onset of dysfunctions that we typically attribute to aging. In fact, this process of producing advanced glycation end products causes proteins to malfunction and accelerates the aging process.

Indeed, did you know that Alzheimer’s dementia is increasingly believed to be another manifestation of insulin resistance, one that affects the brain instead of other organs? Some investigators have even described it as “type 3 diabetes.”⁴ It should come as no surprise that the same metabolic conditions that cause heart attacks, strokes, erectile dysfunction, kidney failure, and amputations may also be poisonous to the brain! On the flip side, the lifestyle changes of Turbo Metabolism are also good for your brain.

The HbA1c Blood Test

In the HbA1c blood test, red blood cells are used because they can be extracted when we draw blood, and they have a life span of 90 to 120 days. Thus, the amount of sugar glazing or stickiness on them will depend on the blood sugar level for the last three months or so. Table 1.2 shows the correspondence between the HbA1c blood test and average blood glucose levels over the past ninety days.

Table 1.2. HbA1c test and blood glucose

We know from research that a 1 percent reduction in HbA1c corresponds to about a 20 percent reduction in the risk of heart attacks and strokes and close to a 40 percent reduction in the risk of kidney, nerve, and eye damage.⁵ Though most diabetes medications reduce HbA1c by about 1 percent, they do nothing for the underlying cause, so the disease progresses over time. When we start to understand the cause of diabetes, and act upon what we know, we not only stop the disease’s progression, we can reverse most of its harmful effects, improving the HbA1c blood test by a lot more than prescription drugs. Table 1.3 shows some HbA1c levels and corresponding glucose levels.

Table 1.3. HbA1c percentage and diabetes

CASE STUDY: JOHN

John, a sixty-six-year-old retired firefighter, was diagnosed as a type 2 diabetic with an HbA1c score of 9.5 percent. He was prescribed medications, but he avoided taking them. He had an aversion to testing procedures. Then, John joined the Turbo Metabolism program, and getting this information empowered him to take charge of his health. Now, John fully understands how his decisions directly affect his body, and he is much more mindful of what he eats. He also exercises regularly. His most recent HbA1c was 6.9 percent, and he feels much better. He recently returned from a hike to Machu Picchu in Peru, which is something he could not have imagined even a year before.

The Effects of Cortisol

Another hormone critical in insulin resistance is cortisol. Cortisol is a “stress hormone” secreted by the adrenal glands in response to a perceived threat. An integral part of our fight-or-flight stress response, cortisol provides a necessary bump in available blood glucose so that we have the energy needed to react quickly in an emergency.

Cortisol makes us hungrier, especially for calorie-dense, sugary, and fatty foods, and it increases insulin resistance, thereby increasing glucose levels in the bloodstream. It also contributes to belly fat. Cortisol is an example of a short-term survival mechanism kicking in to keep us alive in high-stress situations, but one that has harmful effects if it remains active — that is, if our cortisol levels remain elevated for a prolonged period of time in response to perceived stress.

The combination of high levels of cortisol and high levels of insulin is ideal for creating midsection or belly fat. Chapter 7 discusses the effect of stress as a contributor to metabolic diseases in more detail.

Inflammation

Another important concept is inflammation, which may be defined as the process of increased blood flow to an injured body part to deliver healing nutrients and infection-fighting white blood cells. Inflammation is characterized by swelling, heat, redness, and pain, and it typically occurs when we twist an ankle or stub our toe.

Many scientists and doctors accept chronic inflammation as the basis of most of our chronic disease and even of the aging process. The reality, however, is that short-term inflammation serves an important purpose in keeping us healthy. Have you ever bit your cheek eating dinner and woken up amazed the next morning because the cut has healed overnight? This is the miraculous, innate healing power of our bodies — our inflammatory response sends a SWAT team of infection-fighting white blood cells that secrete infection-fighting chemical signals to heal the wound.

This healing process goes haywire when we bombard the body with unrecognizable substances in the form of a diet rich in processed foods, sugar, fat, salt, high-fructose corn syrup, and synthetic compounds. The body activates the inflammation response, essentially sensing a five-alarm fire, and it continues this every day, so the inflammation response goes on and on. In other words, the body sends a SWAT team on an endless mission, so that it never leaves!

By the way, stress works the same way. An acute stressor followed by a short-term inflammation response is natural. But chronic, unmanaged stress leading to long-term inflammation can be harmful. For more on this, see chapter 7.

Hormone Imbalances from Excess Belly Fat

As I’ve said, insulin resistance, cortisol, inflammation, and belly fat are a direct result of our modern, unhealthy diet. In addition, lack of regular physical activity, chronic stress, and lack of sleep are also major contributors.

Yet there is another serious issue with belly fat: It is an active hormone-signaling system that wreaks havoc on our appetite, our cravings, and even our endocrine system — the network of hormone signals that allows our body organs to act in harmony.

In men, belly fat contains aromatase, an enzyme that converts testosterone to estrogen, which is bad news for men because men need testosterone for energy, vitality, maintaining healthy metabolism, erections, and libido.⁶

In women, excess belly fat signals the ovaries to produce more testosterone, which contributes to acne, hair loss, cysts on the ovaries, and lack of ovulation (also known as polycystic ovary syndrome, to use fancy doctor words). This is an important factor behind infertility and menstrual irregularity in women. It is in fact very common for supposedly infertile women to be able to conceive after losing some of their excess weight.⁷

Yet another problem with a diet loaded with processed foods full of carbohydrates and fats is that it triggers resistance to leptin, a satiety hormone. This resistance to leptin helps create the perception that we are starving, even as we are being overloaded with calorie-dense fake foods.

The Difference between Real Hunger and Craving

Your goal should be to maintain satiety or satisfaction, to start thinking about food as a source of energy and wisdom from nature. However, to understand satiety, you must first understand hunger. What does hunger mean to you? Craving sugar, chocolate, cheese, or meat is less likely real hunger and more likely an addiction reaction, arising from the effect of these substances on the reward center of the brain. The same sensations of craving — jitteriness, headaches, fatigue, irritability — are present in drug withdrawal. True hunger is a mouth or throat sensation similar to thirst. We often mistake thirst, boredom, nutritional deficiency, or a low blood sugar for hunger.

Have you ever been truly hungry?

A good gauge of whether a meal is truly nourishing is the degree to which it keeps you satiated. A meal that is biochemically suited to your needs should keep you satisfied for three to five hours.

In the following chapters, we will come up with a “zero-belly strategy” to turbocharge your metabolism, by exploiting the healing power that each of us is blessed with the day we are born.

Shedding ugly belly fat can be the key to reversing diabetes, improving heart health and memory, increasing energy and vitality, improving erectile dysfunction, preventing cancer, and getting rid of sleep apnea and fatty liver disease, in addition to injecting you with more energy and zest for life.

When your body is given the right fuel, you gain energy and vitality, and there is no need for it to be hoarded as fat in places where it can cause harm.

Every time you eat or drink, you are either nourishing your body or feeding disease. You have two choices: You can either “try” — that is, make excuses and then fail — or you can succeed no matter what obstacles come your way.

In the words of Yoda in Star Wars: “Do or do not. . . .There is no try.”

Facts and Fallacies

• Fat is just inert excess energy.

We know now that fat is actually metabolically and normally active tissue that produces insulin resistance, inflammation, and cravings for unhealthy foods.

• You cannot grow new fat cells as an adult.

The reality is that you can grow new fat cells (and new muscle cells and brain cells) as an adult. New cell formation is called hyperplasia. Enlargement of existing cells is called hypertrophy.

• Being hungry all the time makes you fat.

It’s almost the reverse: Carrying unhealthy belly fat makes you hungry. Belly fat hoards energy (rather than releasing it for burning), leaving you feeling hungry all the time.

CASE STUDY: MARY

Mary, a fifty-three-year-old schoolteacher, had a long history of excessive weight gain. She had tried several weight-loss programs with little success. Entering the Turbo Metabolism program was a game changer for her. She began to think about food as energy and information. I emphasized that physical activity and emotional well-being were also very important, and so she incorporated strategies for both aspects in her daily routines.

In the process Mary dropped twelve pounds and three inches of fat from her waist in two months. She feels that these results are just the beginning, and she continues to feel better every day. By taking better care of herself, Mary has already had a positive impact on her students and colleagues.

RULES TO LIVE BY

Time for a reality check: Do you have extra pounds around your belly? Has your doctor advised you to lose weight, but you avoid tests, ignore test results, or prefer to pretend that you are not at risk?

Embrace a zero-belly strategy with these rules to live by:

• The battle is won or lost hand to mouth. What and how much you eat matters.

• Food is not the enemy. Substances disguised as food are the land mines to avoid.

• You can win this war. Once you recognize the problem, you can begin the fight against metabolic syndrome.

• The stakes are high. The food you put in your mouth today will determine the quality of the rest of your life.