Editor's Note: Due to nationwide interest in weight loss and fat, we have decided to print a copy of Dr. Brocato's outline of a talk he gave recently (April 8, 2004) at a meeting of the Golden Triangle Chapter of the Medical Transcriptionists' Association.

Introduction:

The U.S. is Big ... and getting bigger. In 2001, one in five U.S. adults were "obese." This extrapolates to approximately 45 million people. But twice as many fall in the next category, "overweight." The most active and trim segment of the population is now also too heavy -- some 15 percent of the children.

Fat is Toxic and obesity is now considered a major health problem. As people get fatter, they become more prone to a host of chronic diseases -- including

• diabetes,
• atherosclerosis, and
• cancer.

The problem is more than aesthetic, especially in U. S. residents under 60 years old. These people experience weight- fostered back injury, other musculoskeletal problems and diabetes. The largest rise in obesityþrelated disabling injuries and illnesses are people aged 30 to 49 years old. Lost wages and productivity further compound obesity's toll.

Mechanisms By Which Fat Makes People Sick.

Scientists are homing in on inflammation as a cause in diabetes, stroke, and cardiovascular disease. But what causes or triggers the tissue irritation that "plumping" up can damage the body?

Ongoing studies now suggest that getting fat increases the macrophages in abundance in fatty tissue. Macrophages are cells in the body's immune system and are not typically associated with fat. Macrophages appear to be a primary sources of chemicals sparking inflammation in fat and beyond. One inflammatory substance that fat or adipose tissue spews out when in excess is tumor necrosis factor-a (TNF-a). This inflammatory chemical can trigger insulin resistance.

These macrophages secrete chemicals that create an inflammatory response, and this causes an even bigger response by calling up an immune response, involving T- and B-cells. But herein lies the problem, there is no infection nor injury that should originally call up the macrophages. So, as one gets fatter, more and more macrophages actually are found in fat cells, a spot which scientists had originally thought didn't harbor macrophages, other than a few.

It appears that as animals get obese, macrophages move into fat tissue in larger and larger numbers and start spewing potentially dangerous amounts of inflammatory compounds. And as more individuals consume more foods or energy than they burn, that energy fattens them more. Their adipocytes or fat cells become gorged with fat and start leaking fat out through tears in the cell membrane, or the cells actually break open. When this happens, the macrophage clean-up crew swoops in to sop up the material released and thus begins the inflammatory response, generating the immune response with all the eventual chronic illness attached to the inflammation. That is the mechanism of "How Fat is Toxic to Your Health," but there is more to it. (Science News, "Inflammatory Fat"; February 28, 2004 Vol. 165; pp. 139-140.)

Pot Belly

"People with abdominal obesity appear to be at much greater risk of stroke or heart attack than people with peripheral fat deposits." This is the typical "Pot Belly" we see quite often in men; yet, a number of women have this type of fat distribution also. This is easily understood by comparing an APPLE to a PEAR. Generally, women who are overweight have the "pear" shape rather than the typical "apple" shape. The pear shape has fat distribution on the limbs and gluteal portions of the body -- peripheral fat deposits.

The easiest way to determine increased risk for myocardial infarction or stroke: (Measure the waist, then measurethe hips, and divide the waist measurement by the hip measurement. Example: if a woman's waist size = 32 inches, and her hip size = 42 inches, her waist-to-hip ratio would be 32/42 = 0.76.)

Waist-to-hip ratio: Ratios over 1.0 in men (3 to 5 fold increase risk)

Waist-to-hip ratio: Ratios over 0.8 in women (3 to 5 fold increase risk)

Also women have five-fold the risk for higher triglycerides, increased glucose levels, increased blood pressure, and increased prevalence of diabetes compared to other women with just peripheral fat deposits--limb fat (gluteal, arms and legs), the "pear" shaped woman. These measurements have a significant impact on prognosis. And even among patients who aren't clinically obese by standard measurements, linear increases in the Waist-to-Hip Ratio correlate with increased risk of stroke and heart attack. This was given in Medical World News, February 11, 1985. It took fourteen years before scientists knew why. In Science News, Vol. 155, #18, May 1, 1999, it was reported that obesity may trigger chronic inflammation.

The mechanism by which this occurs involves cytokines, chemical messengers between immune cells. These cells produce IL-6 (interleukin-6), TNF-a, and others. However, fat-- especially, it appears, abdominal fat, produces IL-6, and we now know TNF-a. These chemical substances, along with interleukin-1B, get into the blood stream; travel to the liver, and there cause the liver to spew out C-Reactive Protein, an acute-phase protein generated by an acute-phase response of IL-1, IL-6, TNF-a. When these cytokines spill into the blood, the liver "may misread the message," thinking that infection is present somewhere. The liver begins generating CRP, because CRP binds to phosphorylcholine on bacterial surfaces, acts like an opsonin, and activates the classical complement pathway; in effect, the body thinks it is under chemical/biological warfare attack. The liver also generates more fibrinogen and serum amyloid A. (Innunology: A Short Course, 4th Ed., Pp. 24-26, 236; Life Extension, January, 2001, Pp. 11-14.)

CRP can rupture plaques in the body, causing clots or debris to block small blood vessels in the brain, heart and elsewhere. Substances to help lower CRP are omega 3 oil and nettle leaf extract. To lower IL-6, take vitamin K and DHEA. To lower fibrinogen, take aspirin, green tea, ginkgo, garlic, vitamin E (1200 iu) grape seed/skin extract, and niacin.

You can easily see, from what we have said now and at the beginning of this talk, that a "fat attack" can occur in anyone who is not just obese, but just overweight, and this can cause diabetes, cardiovascular problems, stroke, immune system disorders and arthritis. All these things and others are now known to be caused by an exaggerated inflammatory response.

As if to make matters worse, the diet that you have been told to eat is generating this "fat attack," as well as the polyunsaturated fatty acids you have also been told are "heart-healthy" to eat.

On this matter of high carbohydrate Diets as exemplified by the Pyramid Diet:

When the body over eats carbohydrates, even complex carbohydrates, those the body can't burn for energy or use immediately, is stored as sugar in the form of glycogen. However, the problem is that the liver can only store about 108 grams of glycogen; any excess, and the body reverses the fatty acid oxidation chain, stores excess starch as fat. This is why you see so many fat children as well as their parents because everyone has been told in America to eat more carbohydrates.

1970s Definition of Complex Carbohydrates Compared to Present Definition

Burkett gave a "layman's" definition by saying complex carbohydrates consisted of some starch, associated proteins and fats, and mostly fiber. This was like eating only 1/4 inch down of a potato and receiving the fiber and throwing the starchy part away. In other words, eat the peeling, and just a small portion of the starch.

The scientific definition of complex carbohydrate is sugar molecules in linear and branching fashion, forming starch which is complexed. This new definition suited the current appetites in 1992, when the USDA's Food Pyramid was introduced. "You could have your potatoes too, and eat it" -- starch and all.

The Pyramid's Future

The pyramid has been controversial since its debut, and the fact that it's undergoing an update points not only to new nutritional information that has emerged in the last decade, but also to fundamental miscalculations in the original design.

The amount of Starch You Are Told To Eat.

Critics argue that the plan is too carbohydrate heavy, with up to 11 servings of grain products a day. This is supposed to be 1/2 - cup servings of starch per day. The measures out to 11 x 1/2 = 5 cups of starch daily! Not only is this excessive, but the public demands super-sized servings, and they are getting it, at today's inflated portion sizes that far exceeds one's carbohydrate quota. (Muscle & FITNESS, March 2004; p. 214, 216)

And those on a low fat diet, in order to have satiety, often eat more starch than they should, but the starch doesn't last as long as fat does in digestion; thus, they are hungrier sooner, so they often eat more starch, thus generating a fat gaining cycle.

Therefore, it is to be understood with all the starch floating around out there, and you're given social permission to eat it, there is no way America is going to stay lean and trim, as well as healthy.

And What Else Does ALL That Starch Do?

It causes the body to generate excess insulin. Insulin is necessary to control blood sugar, but it also stimulates protein synthesis from amino acids, and causes fat storage, which means obesity. However, over time, "insulin thickens the artery walls. The smaller arteries that feed the heart are the first to clog, which over time can be fatal. Insulin also increases the blood's tendency to clot, adding to the problem. Thicker arterial walls mean less room for blood flow. This, coupled with increased clotting, spells high blood pressure. Insulin also increases the tension in the arterial walls making them stiffer and less able to expand. This results in even higher blood pressure." (MuscleMagazine, June 2004, p.168.)

But there's more: "insulin ... increases the activity of the enzymes that convert linoleic acid (Omega-6, found mostly in vegetable oils) into the more highly unsaturated fatty acids. Excess insulin [is] involved in many degenerative diseases." (Ray Peats Newsletter, November 2003; p. 5)

"Several studies suggest that a high degree of unsaturation in the fats is fundamentally related to the aging process, since long lived species have a lower degree of unsaturation in their fats. Caloric restriction decreases the age-related accumulation of the fatty acids with 4 and 5 double bonds." (Ray Peat's Newsletter, March 2004; p. 5)

Polyunsaturated Fats/Polyunsaturated Fatty Acids (PUFA)

Generally associated with starch is greater ingestion of unsaturated fats. The reason is that those "trying to avoid saturated fats and cholesterol will probably eat more TRANS fatty acids, because these are used in foods promoted as low in saturated fat and cholesterol." Trans fats are everywhere; fast foods, baked goods, chips and crackers, mixes, sauces, spreads, breakfast bars, tortillas, breakfast cereals, fish sticks and many convenience foods such as some puddings and peanut butters.

The Pyramid Diet, low in saturated fat and cholesterol, may have promoted accelerated degeneration and decrepitude in the American population, especially the elderly

.

What Do PUFAs Do to Our Body That You Have Not Been Told?

PUFAs from vegetable oils, whether Omega-3 or Omega-6, when extracted with heat, become oxidized, which is another way of saying "rancid." This is usually masked by deodorizing the oils. Udo Erasmus, author of Fats That Heal, Fats That Kill, says this about Canola oil: "Canola is like the rest of the vegetable oils that are treated with Draino, window washing acid, bleach and fried before they go into the bottle. It has some n-3 (Omega- 3). Sometimes they partially hydrogenate to prevent flavor reversion. I don't recommend it." (Ironman Magazine, January 2004, pp. 163-174).

Others have said that Canola oil with its high Omega-3s becomes rancid when extracted and must be deodorized. When this process is performed, the Omega-3s go down to very little present and by ratio, the Omega-6 go up in quantity. The excess n-6 is what you want to avoid.

Many polyunsaturated oils were tested by a university from supermarkets and health food stores. A number were found to be partially hydrogenated, and this process was not listed on the bottle.

What happens when vegetables oils are partially hydrogenated? You form "trans" fatty acids. These generate free radicals in the body that can cause heart attacks, stroke, cancer, and other diseases, researchers have illustrated (The Oiling Of America, p. 14.). Oils are partially hydrogenated so that they act more like shortening, lard, or other solid fats in cooking. Also, when added to processed foods, they increase the shelf life -- and this means greater profits for food companies (Ironman Magazine, April 2004; p. 128.).

Another problem with "trans" fatty acids in the diet is that they generate or increase levels of Lipoprotein [a] or Lp[a]. This is nothing more than "an LDL particle with an additional adhesive protein surrounding it. This biological 'adhesive tape' is named apoprotein (a) or, apo (a). The letter (a) could, in fact stand for 'adhesive.' The adhesive apo (a) makes the lipoprotein (a) fat globule one of the stickiest particles in our bodies." Some researchers out of Germany are now saying it is the Lipoprotein [a] that is the main culprit in heart disease. Not so much the cholesterol -- as you've probably heard by now -- nor LDL, but this very sticky protein surrounding LDL that increases our risk value for cardiovascular accident. (Why Animals Don't Get Heart Attacks...But People Do! Rath, Matthias, M.D.; pp. 89-92, 72-77.)

How Do We Lower this Lp[a]?

"Lp[a] is thought to be mostly under genetic control, but "trans" fatty acids in the diet increase its levels and saturated fatty acids in the diet decrease its levels." ---Know Your Fats, Enig, Mary G; p. 257.

"Nobel laureate Linus Pauling and his colleague Mathias (sp) Rath proposed that our bodies produce Lp(a) to compensate for low levels of vitamin C. They caused atherosclerosis in guinea pigs by depleting their bodies of vitamin C. Vitamin C depletion caused Lp(a) to appear in the plaque. A high level of Lp(a) is a risk factor for heart disease. That does not mean the Lp(a) is the cause. The cause may be vitamin C deficiency in association with other factors, such as low levels of vitamin B-3 (niacin) which also lowers Lp(a). Consumption of 'trans' fatty acids causes levels of Lp(a) to rise while consumption of saturated fats lowers blood levels of Lp(a)." (Wise Traditions, Spring 2001, p. 22.)

"Note: Research has shown that saturated fat in the diet is needed by the body to enable it to adequately convert the essential omega-fatty acid (a-linolenic acid to the elongated omega-3 fatty acids EPA and DHA. These latter fatty acids are necessary for prostaglandin formation and visual function, respectively. (Gerster 1998)"---Know Your Fats, Enig, Mary G. Ph.D.; p. 107.

Writing in Life Extension Magazine, March 2004, pp 73-76, William Davis, MD, FACC, cardiologist, author, and lecturer who specializes in coronary disease regression and strategies to improve human performance, recommends the following:

L-carnitine - 1000mg twice a day; lowers Lp(a) 7-8 %

Flaxseed - 2 tbsp per day, ground; lowers Lp(a) 7%

Raw almonds - 1/4-1/2 cup per day; lowers Lp(a) 7-10%

He also recommends fish oil capsules and 3000 mg of niacin daily with a 325 mg aspirin to limit flushing. Dr. Davis practices in Milwaukee, WI. Contact him at trackyourplaque.com.

Matthias Rath, MD, in his book, Why Animals Don't Get Heart Attacks...But People Do!, further suggests vitamin E, Beta-carotene and selenium, as well as vitamin C. Additionally he suggests "'Teflon' protection of the artery wall and reversal of fatty deposits in the artery wall" by taking the natural amino acids lysine and proline to form a 'Teflon' layer around the "lipoproteins which prevents further fat deposits in the artery walls. Moreover, fat molecules are detached from their anchor sites inside the artery walls." He has documented proof that his regime works. (pp. 72-77; 89-92.)

These polyunsaturated oils (vegetable oils) decrease thyroid function, which implies weight gain. And if you decrease thyroid function, either by PUFAs or thyroid dysfunction, you will have difficulty in converting carotenes in plant foods into true vitamin A.---Wise Traditions, Winter, 2001, pp. 28-39

Another problem is that you need fat in the diet to convert beta-carotene to true vitamin A.

It works this way: "Under optimal conditions humans can indeed convert carotenes to vitamin A. This occurs in the upper intestinal tract by the action of bile salts and fat-splitting enzymes. Of the entire family of carotenes, beta-carotene is the most easily converted to vitamin A." If you have optimal pro-vitamin A conversion to true vitamin A, "you would have to eat an awful lot of vegetables and fruits to obtain even the daily minimal requirements of vitamin A." This is because the ratio is 6 units of beta-carotene is needed to produce one unit of vitamin A.----Wise Traditions, Winter, 2001, pp. 28-39

"But the transformation of carotene to retinol (vitamin A) is rarely optimal. Diabetics and those with poor thyroid function, a group that could well include at least half the adult US population, cannot make the conversion. Children make the conversion very poorly and infants not at all - - they must obtain their precious stores of vitamin A from animals fats -- yet the low-fat diet is often recommended for children. Strenuous physical exercise, excessive consumption of alcohol, excessive consumption of iron (especially from 'fortified' white flour and breakfast cereal), use of a number of popular drugs, excessive consumption of polyunsaturated fatty acids, zinc deficiency and even cold weather can hinder the conversion of carotenes to vitamin A, as does the low-fat diet."---Wise Traditions, Winter, 2001, pp. 28-39

Now get this. "Carotenes are converted by the action of bile salts, and very little bile reaches the intestine when a meal is low in fat. Butterfat stimulates the secretion of bile needed to convert carotenes from vegetables into vitamin A, and at the same time supplies very easily absorbed true vitamin A. Polyunsaturated oils also stimulate the secretion of bile salts but can cause rapid destruction of carotene unless antioxidants are present."---Wise Traditions, Winter, 2001, pp. 28-39

Vitamin A, as well as vitamin D, act principally as catalysts for protein and mineral assimilation. Both nutrients support endocrine function and protect against inflammation. "Vitamin A is needed for the conversion of cholesterol into steroid hormones and, in fact, is rapidly depleted by stress. When you have done everything else and your cholesterol still resists coming down, try true vitamin A." Note this: "Cholesterol-lowering drugs increase the body's need for vitamin A." (Wise Traditions, Spring 2001, p. 18.) Years ago people ate butter, egg yolks, liver, organ meats and shellfish, and cream. Heart disease was practically unheard of 60 years ago. A doctor had to write his medical school to find out the symptoms, since he saw very few with heart disease. After the 1950s, heart disease erupted on the scene as vegetable oils took hold after WWII.

PUFAs weaken the cells' mitochondria -- the powerhouses of the body. This in turn greatly intensifies loss of energy production. (Ray Peat's Newsletter, November 2003, p. 5.) Ray Peat, Ph.D. contends that "the promotion of cancer, heart disease, mitochondrial damage, hypothyroidism and immunosuppression [is] caused by the polyunsaturated fats as their most important feature ...." (Ray Peat's Newsletter, March 2004, p. 3.)

Loma Linda University in California points out that trans fats produced from partially hydrogenated vegetable oils (PUFAs), may actually cause muscle loss. The trans fats interfere with absorption and utilization of amino acids. (Muscle & Fitness, February, 2004, p. 180.) This means that if you're a body builder or a strength athlete, needing more muscle mass and bone mass for your sport, then avoid these oils. Also, as we age, we want to maintain muscle mass and bone mass, get up and go and feel good, but aging itself causes a loss in these qualities. And if you're being told by your dietician, for heart health, to increase your polyunsaturated fatty acids, you may well be losing the very muscle mass and bone mass that will keep you out of a wheelchair.

Final Note:

    Many people avoid saturated fat, such as whole milk, butter, whole eggs, liver, etc. because they are under the impression that saturated fat will raise their cholesterol. Guyton & Hall, writing in Textbook of Medical Physiology, Ninth Edition, p. 873, say that your diet has to be high in saturated fat in order to raise your cholesterol. They say it this way: "A Highly Saturated fat diet increases blood cholesterol concentration 15 to 25 percent. This results from increased fat deposition in the liver, which then provides increased quantities of acetyl-CoA in the liver cells for production of cholesterol."

    They further say that it is not known why a diet high in unsaturated fatty acids depresses the blood cholesterol a slight to moderate amount. We now know the answer. When PUFAs are placed into the diet, they invade the membranes of cells, this disruption causes cholesterol to come out of the blood stream and help stiffen up the membranes again, thus lowering blood stream cholesterol. (Wise Traditions, Spring 2001; p. 16.)

    Another problem is surfacing that most physicians do not know of. It is my estimation from my studies that about only 3000 physicians world wide have linked estrogen, particularly estradiol (E2) to heart disease in men especially.

    It works like this: Testosterone is changed to estradiol by aromatase, especially if they are fat--another example of toxic fat. Many men have high aromatization of Testosterone to estradiol. Excess E2 causes tissue abnormalities, fibrosis ("the formation of fibrous tissue as a result of injury or inflammation of a part, or of interference with its blood supply"), and inflammation.

    This is probably a major factor in heart disease as well as all the endocrine disrupters now present in our environment. A male approaching 40 should have his E2 checked yearly. If it is 10 to 30 pg/ml, he is considered to be in the safe range; however, if E2 is greater than 30 pg/ml, he should immediately start on an aromatase inhibitor, such as the prescription drug Arimidex by AstraZeneca or the natural herb, Chrysin with bioperine.

    It's suggested that 0.5 mg twice per week, say on a Tuesday and then again on a Friday or Saturday the Arimidex can be taken. If your reading is around 33 pg/ml to 38 pg/ml, you may try just the Chrysin with bioperine, several times daily and/or T-Bomb II--both can be found at your natural foods store.

    Reviews On systemic Enzymes, Vol. 2, Issue 2, April, 2004, p. 1, says

..."inflammation is now considered the major factor in heart health and disease, consistent not only with clinical but also epidemiological data. Increasing numbers of people who suffer a cardiac event -- especially women and those in younger age groups -- tend to have normal cholesterol profiles, have an active lifestyle, and are generally not overweight."

    And these women are in their forties!

    Centers for Disease Control in Atlanta says the lives of 500,000 women are claimed each year by heart disease -- this includes young women under the age of 45, more so than any other disease, including cancer of the breast. For heart health tips, a free booklet on heart health for women can be obtained by calling 1-888-217-3147 or www.naturally.com.