Did you know that all tissues in your body can synthesize cholesterol from acetate? However, most of the cholesterol in your body is synthesised by your liver and then your intestine. The enzyme involved in the process is called HMG-CoA reductase.

The activity of HMG-CoA reductase can be powerfully lowered by well-known cholesterol lowering drug – Lipitor as well as a hormone in the body called glucagon. Conversely, HMG-CoA reductase can be powerfully stimulated by a hormone produced by your pancreas called insulin.
Metabolic syndrome is associated with insulin resistance or the ineffective use of insulin. This is linked to low grade inflammation in the body. Insulin resistance has a lot to answer for in the presentation of high serum cholesterol level.
High cholesterol levels can be powerfully reduced by adopting the following lifestyle changes:
1) losing excess body weight
2) choosing a low glycaemic index diet
3) increasing the percentage of lean body mass or muscles through exercise – specifically resistance training (this leads to reduction in HMG-CoA activity)
4) increasing consumption of omega-3 rich foods from fatty fishes and flaxseed
5) reducing intake of saturated fats from animal foods
6) increasing consumption of fruits and vegetables rich in polyphenols which are powerful anti-inflammatory agents
7) increasing consumption of nuts, seeds and legumes rich in micronutrients, fibre and vitamin E
increase consumption of plant sterols (plant sterols out compete dietary cholesterol for absorption and powerfully reduce overall cholesterol absorption)
9) increase fibre intake to 35-40g per day

Surprisingly, having a high cholesterol diet is not as deleterious to serum cholesterol levels as previously believed as high dietary cholesterol has the interesting effect of suppressing cholesterol synthesis by the liver. Also, assimilation or uptake of dietary cholesterol is relatively low as approximately 50% of dietary and biliary cholesterol is not absorbed from the intestine and excreted. This is good news indeed!
I hope the above highlights how a multi-prong approach can be adopted to powerfully reduce your cholesterol levels.
In conclusion, there is no single magic bullet for the reduction of serum cholesterol (the most commonly prescribed drug – Lipitor or statin, comes closest to the definition of a magic bullet but even this has its draw backs and significant side effects, a discussion fit for another article). For now, there does not appear to be one on the near future.

Low glycaemic index diets are more effective than other conventional weight loss diets possibly because low glycaemic index diets keep you feeling fuller for longer. That way the tendency to snack between meals is less.

Another explanation for this phenomenon is that eating low GI foods elicit less insulin production from your pancreas. With less circulating insulin, less sugar storage and fat production takes place. In essence, what you are doing is powerfully shifting the hormonal balance within your body toward less storage of fat. This results in the reduction in the percentage of body fat, thus facilitating weight loss!

Take the simple rice for instance; did you know that their glycaemic indexes vary considerably? Who would have guessed that the carbohydrate from your unsuspecting Jasmine rice (GI – 109) hits your blood stream faster than your table sugar (GI – 100)!

Check out the table below:

Glycaemic index of various types of rice

For further information, click one of the following links: Glycaemic Index and also How To Stop Your Sugar Cravings.

Not all fatness indicates disease risk. Not all leanness indicates lack of disease risk. So what is the one factor that is a potent indicator of disease risk? It is an inflammatory process called metaflammation, para-flammation or smouldering inflammation. This condition appears to be inextricably linked with individual lifestyle behaviours like:

1. poor diet
2. inactivity
3. excessive exercise (modern endurance events)
4. inadequate sleep (due to deprivation, insomnia or sleep disorders like sleep apnoea)
5. mental states like anxiety or depression
6. environmental stressors
7. excessive alcohol
8. smoking

Markers of inflammation are expressed through a range of immune mediators such as cytokines, chemokines, adipokines, myokines and transcription factors. Recently, C-reactive protein has gained more attention than NFkB, TNF alpha and Il-6 but overall, these are common markers used to identify unhealthy inducers of metaflammation. It seems, the lifestyle-related inducers listed above are associated with oxidative stress, insulin resistance and eventual development of disease states.
Regularly consuming high glycaemic foods or large quantities of highly processed carbohydrate foods leads to inflammation and aging of cells. As Professor Jennie Brand Miller, world leading authority on the glycaemic index puts it very simply, “High GI foods lead to high inflammatory markers due to oxidative stress. What happens is that the high glucose load overwhelms the power-house (mitochondria) in the cell causing lots of free radicals to be generated. This leads to death of the mitochondria and eventual cell death.” In essence, aspire to eat like traditional natives and regularly choose low GI foods.
Regular moderate level physical activity, approximately ½ to 1 hour per day most days of the week is anti-inflammatory. Getting 8 hours of good quality sleep daily is also vital. It appears that the “stress-like’’ effects of sleep deprivation and the accompanying hormonal changes are associated with obesity.
In an advanced society like ours, mental states associated with stress, anxiety and depression seem to generate acute inflammatory responses accompanied by elevated levels of cytokines. Smoking also elicits a parallel reaction. Both of which are linked to degenerative diseases.
In a nutshell, the maintenance of a disease-free state lies squarely in our hands. Health is about consistently choosing pro-life behaviours through good nutrition, exercise, good quality sleep, relaxation and powerfully choosing joy-filled states. What are your views? Please post you comments below.

If you have any 2 of the following risk factors, you are at risk of developing metabolic syndrome:
1. central obesity (waist > 94cm for white males, > 80cm for white females)
2. high blood pressure
3. high cholesterol / lipids
4. high blood sugar
5. non-alcoholic fatty liver disease

High blood sugar levels in our body are correlated with insulin levels. When one factor rises sharply, the other spikes to help normalise blood sugar levels. These insulin spikes are associated with insulin resistance. One very effective way of preventing insulin spikes is to choose a low glycaemic index diet.

You may ask what is glycaemic index?  It is a way of grading carbohydrate foods depending on how fast they get digested. A number is assigned to each individual food item based on their ‘sugar potency’.
1. Low GI foods have GI <55
2. Intermediate GI foods have GI between 55 and 70
3. High GI foods have GI > 70

Research on glycaemic index has shown that by choosing fibre-rich low GI foods at every meal, we can reduce our blood glucose levels quite effectively and enhance insulin sensitivity.  This helps stall the progress of metabolic syndrome and enhance weight loss. Please note that not all low GI foods are suitable for regular consumption as many high fat, high sugar foods like chocolates, ice-cream and toasted muesli are inappropriate for weight loss and reducing insulin resistance.

I have compiled a list of common low GI foods below for your reference. Try to include at least two items at each main meal:

Please note that low GI does not mean license to over-dose.  It is best to aim for 45-50g of carbohydrate at each main meal and not more.  Too much carbohydrates and kilojoules will increase body weight and sabotage your weight loss endeavours.

Do you have any questions or comments?  If you do, I would love to hear from you.

In third world countries, eating in moderation is the only way to go as there is literally not a lot of food to go around. In places like Indonesia, Thailand or the Philippines, the staple food is rice.  When you examine their meals, you will realize that more than ¾ of what they eat will consist mainly of various types of organic vegetables and rice put together, mostly harvested from the land.  If they are lucky they might get a small amount of fish (perhaps 60-80g each at most) and a little egg to accompany the rest of the rice and vegetables. Egg is generally regarded as a cheap source of good quality protein so it is frequently served. This is the foundation of what people eat 3 times a day. Meat tends to be only served on special occasions. In some poorer areas of  Thailand, only two meals are served a day due to scarcity of food in certain regions. In Australia, we are fortunate; we do not have a problem with food scarcity, instead we get the privilege of dying from diseases caused by excessive food intake!

Studies have shown, without any shadow of doubt, that calorie restricted diets are associated with longer life expectancy. Now we know the reason why. This is because calorie restricted diets are anti-inflammatory and hence synonymous with good health.

This led some people to think that if calorie restriction is associated with longevity, then surely starvation or fasting occasionally must be better! Unfortunately (or fortunately), this was not found to be so.  Starvation is associated with inflammation.  Quite remarkably this is an adaptation that has evolved through human history to ensure survival during times of famine. Inflammation causes insulin resistance which is a state where the body is not sensitive to the hormone insulin.  Consequently, more and more insulin gets produced by the pancreas setting up a vicious cycle causing insulin resistance.  High circulating insulin helps conserve the body’s reserves sparing the breakdown of fat and protein!  This inbuilt metabolic miracle is hugely responsible for our survival in times of food scarcity.  And this is also precisely the reason why, punishing low calorie diets do not serve you!  They could make you more and more insulin resistant such that you are no longer able to break down fat at all!  In other words, when you ‘yo-yo’ diet you are destined to get fatter and fatter making each endeavour less and less effective.

Listed below are common behaviours and dietary practices that either promote or reduce inflammation:

Which camp do you belong to?  Make changes to get into the anti-inflammation camp right away.  Studies have shown you could be saving yourself 7-10 very good years.

PCOS can occur at any age. Insulin resistance tends to rise naturally at puberty. Symptoms of PCOS vary tremendously from individual to individual. Examples of symptoms are: irregular / infrequent menstrual cycles, infertility,  acne, acanthosis nigricans (rough dark-coloured skin around neck and armpits), heavy body- hair, hirsutism, stubborn body fat, inexplicable tiredness with acute drop in blood pressure on standing up or with exercise, post-meal low blood sugar levels, sleep apnoea and general reduced stress threshold.  Do you have any combination of these symptoms?  If you do, make an appointment to see your doctor.

Diet, exercise and medication are prime tools for successful management of PCOS. It is imperative that a good structure involving adequate exercise, low glycaemic index eating plan and right medication be put in place to assist PCOS sufferers to rebalance hormones (insulin, luteinizing hormone, testosterone), improve insulin sensitivity and significantly reduce symptoms of PCOS.

What are low glycaemic index foods? They are fundamentally foods containing carbohydrate that breakdown slowly to release sugar (glucose) into the bloodstream gradually. Choosing low glycaemic index (GI) foods will lower your insulin levels. And lowering insulin levels will enhance fat burning and reduce fat storage. Naturally this will assist weight loss! Examples of low GI common foods are:

Glycaemic Load = (GI x carbohydrate per serve) / 100

Food items with high carbohydrate content have high glycaemic load.  Large scale studies from Harvard University indicate that frequent consumption of high GL and high GI foods appear to be synonymous with adverse health outcomes.  

Drugs, metformin and thiazolidinediones, are commonly prescribed for enhancing insulin sensitivity in the treatment of PCOS. Please note that metformin may interfere with vitamin B12 absorption, so it may be necessary to have regular blood tests to ensure vitamin B12 levels are good.  In B12 deficiency of this nature, consuming B12-rich foods like meat, dairy products, fish, shellfish and poultry may not be sufficient to correct the problem.  Monthly injections of vitamin B12 subcutaneously or intramuscularly should be considered.  In severe cases of hirsutism, drugs that block the effect of male hormone – testosterone, like spiranolactone and finasteride are also prescribed.  Oral contraceptive pills (i.e. Dianette) are also often prescribed to increase circulating oestrogen levels and suppress ovarian function. 

In summary, medical management of PCOS lies in lifestyle modification with low GI diet, exercise and pharmacological treatment. In most cases, this lifestyle change has to be life long.

Footnote: For more information on glycaemic index go to http://www.glycemicindex.com/

Couscous Salad

In 2001, an anticancer drug hailed ‘a miracle’ was approved by the Food and Drug Administration Department (FDA). This drug is called Gleevec.

Gleevec seems to be able to arrest the formation of new blood vessels (angiogenesis) needed for cancer cell growth. Did you know that herbs and spices rich in fatty acids of the terpene family also act along the same lines as Gleevec?
Terpenes seem to stimulate cancer cell death (apoptosis) thereby limiting cancer cell growth, containing tumours. Armed with this knowledge, lets look at preparing a dish that is low in glycaemic index and rich in herbs.

The following recipe is prepared with couscous as the principal ingredient. Couscous has a glycaemic index of 61 and glycaemic load of 8.7. The glycaemic index of a food item measures how it affects your blood glucose level (low glycaemic index <55, 56<moderate glycaemic index<69, high glycaemic index >70). You can think of this as a number which represents the glycaemic/glucose ‘potency’.
In this instant, couscous is considered a moderately high glycaemic index food. Adding lemon and lime to couscous will reduce the glycaemic index of the meal as the acidity of these citrus will reduce the rate at which food goes into the small intestine from the stomach, thus lowering the rate of rise of blood sugar level even more. Achieving a flatter blood sugar response long term is the mainstay for management of insulin resistance. Studies have shown that frequently choosing low glycaemic index and glycaemic load food items in one’s diet will enhance insulin sensitivity and even prevent some cancers (preliminary studies seem to indicate that high insulin levels are associated with some tumours)!
Turmeric has powerful anti-inflammatory properties. Its absorption increases a thousand fold by adding olive oil and pepper in the recipe. The following is a low glycaemic index, ‘anti-inflammatory’ and terpene-rich meal. Enjoy!

Ingredients

Couscous, 1cup
Cherry tomatoes, ½ punnet
Chickpeas, 1cup (soaked, boiled and drained)
Cold pressed olive oil, 1 tablespoon
Mint, ½ a bunch
Parsley, ½ a bunch
Coriander, ½ a bunch
Lemon, ½ whole
Lime, ½ whole
Sugar, 1 teaspoon
Turmeric, 1 teaspoon
Water
Pepper
Chicken stock

Preparation

Put couscous in a bowl, pour boiling water and then add chicken stock and turmeric and set aside for 10 minutes. When liquid has been absorbed, separate couscous grains with a folk.
Add chick peas, tomatoes, mint, parsley, coriander, lemon, lime, sugar, pepper and cold pressed olive oil. Mix well and serve.

References

J. McMillan-Price, P. Petocz, F. Atkinson, et al., ‘Comparison of 4 diet of varying glycaemic load on weight loss and cardiovascular risk reduction in overweight and obese young adults; a randomised controlled trial’ Archives of Internal Medicine, 166(14), 2006: 1466 – 75.

G. A. Santisteban, J. T. Ely, E. E. Hamel, et al., ‘Glycaemic modulation of tumour tolerance in a mouse model of breast cancer’ Biochemical and Biophysical Research Communications, 132(3), 1985: 1174-9.

E. Weiderpass, G. Gridley, I. Persson, O. Nyren, A. Ekbom, H. O. Adami, ‘Risk of endometrial and breast cancer in patients with diabetes mellitus’ International Journal of Cancer, 71(3), 1997: 360-63.

C. A. Plouzek, H.P. Ciolino, R. Clarke, G. C. Yeh, ‘Inhibition of P-glycoprotein activity and reversal of multidrug resistance in vitro by rosemary extract’ European Journal of Cancer, 35(10), 1999:1541-5.

Many diabetics erroneously think that they should avoid tropical fruits as they will raise their blood sugar levels. Well this is not true.

No doubt some of these fruits may be high in Glycaemic Index (i.e. GI>70) such as watermelon. But watermelons are actually quite low in carbohydrate content so consuming one cup of chopped watermelon is unlikely to raise your blood sugar level too much.
Whole fruits are nutrient-rich, low in kilojoule, high in fibre, rich in antioxidants and a great source of carbohydrates. Fruits contain many vitamins and minerals, in particular vitamin C, folate and potassium. Australians are encouraged to eat at least two serves of fruit a day.
Listed below are some common fruits, their Glycaemic Indexes and their corresponding Glycaemic Loads. Carbohydrates that break down quickly during digestion have high GI (i.e. GI>77) as the glucose from the digestion of these carbohydrates enters the blood stream quickly resulting in high blood sugar response. Conversely, carbohydrates that break down slowly enter the bloodstream gradually, leading to a low GI value (i.e. GI<55). Foods that are low in Glycaemic Index show much flatter blood sugar response when eaten and this has the effect of increasing insulin sensitivity when regularly consumed. Diabetics are encouraged to include these foods frequently in their diet for better blood sugar control.
Glycaemic Load = carbohydrate content * Glycaemic Index / 100 (the lower the Glycaemic load the lower the blood sugar level rises).

Following is a list of common fruits and their Glycaemic Indexes -

Rhubarb, grapefruit, lemon, lime, passion fruits, strawberries, blueberries, mulberries, black berries, boysenberries and gooseberries contain little or no carbohydrate and do not impact on blood sugar levels. Hence, they can be freely consumed in large quantities without any adverse effects.

So in conclusion, to be healthy, eat a wide variety of fruits!