Let's Start at the Very Beginning

Wherever I go, people always want to talk with me about the blog.  Lately, I've heard a lot of this: "I went to your website and saw a lot of interesting stories, but I didn't know which ones to read first.  Where should I start?  What is the first thing you would want me to understand?"

So today we're going on a field trip.  We're going to step out the back door, and find a field of wheat.  Then we're going to pick a single grain, and take a careful look at it.  What do we see?  The grain contains 1) a bran fiber coat, 2) an endosperm, composed primarily of starch, and 3) the wheat germ, where the nutritious oils are.  Strip away the bran coat and wheat germ, like humans learned to do a couple hundred years ago, and all you have left is a pellet of white starch (also known as white flour).  Are you with me?

Now, if you could look at that pellet of white starch (or flour) under a microscope, you would see a long, simple chain of sugar molecules in a row.  It turns out that our bodies are so good at breaking the links between those sugar molecules that when you eat white flour, your blood sugar rises as fast as, if not faster than, when you eat sugar, like from a sugar bowl.  How do I know?  Well, one way I know is from my diabetic patients who check their blood sugars after they eat.  White flour and sugar spike blood sugars like crazy. 

White flour and sugar are called "refined carbohydrates."  "Refined" was picked by marketing folks to get customers thinking that whole grain flour was coarse, or unrefined.  For the most part, refined carbohydrates are not found in nature.  We make them that way.  In nature, carbohydrates are almost always found attached to fiber.  Think about dates and beets, for example.  Both of these are used by industry as raw material for refining sugar.  But in their original state, they are so rich in fiber that they get to be superfoods.

Okay, now what happens?  When you eat, your gut breaks down food into sugar, and it gets absorbed into your bloodstream.  If the food is easily broken down (like white flour and sugar), it gets absorbed quickly and your blood sugar rises rapidly.  If the food is broken down slowly (like produce, nuts, whole grains, beans, eggs, meats), it gets absorbed slowly and blood sugars remain more or less stable.  

After the broken-down food crosses the walls of your gut and enters your bloodstream, your body releases insulin to catch the incoming sugar and escort it to the cells of your body.  The insulin comes from your pancreas.  

Now, here comes THE MOST IMPORTANT PART of this discussion:  The faster you absorb the sugar, the more insulin you need to release to catch all the sugar and take it where it has to go.  The more slowly you absorb the sugar, the less insulin it takes to deal with the incoming sugar.

How does this work?  Like a valet service.  Let's say you were invited to a huge party, and the invitation said it started at 7 p.m.  Now let's say that at exactly 7 p.m., 1000 cars show up at the party center.  If this happens, there had better be a lot of valet staff there to park all those cars.  

BUT, your friends could have had an open house.  They could have said to show up any time between 3 p.m. and 9 p.m.  At the end of the day, the party center would still have parked 1000 cars.  But they would not have needed to hire nearly as many valet staff to do it.  Right?

So now imagine that the cars are the sugar, and the valet staff are the insulin.  If the sugar shows up all at once, you need a lot of insulin to deal with it.  If the sugar drips in bit by bit, you don't need to release nearly as much insulin. 

Which nutrients do we absorb slowly?  Fiber, protein and oil.  Like whole grains, dates, and beets.  Not to mention peanuts, eggs, beans, veggies, and the like.  Which ones do we absorb quickly?  Refined carbs: Cake. Sugar. Breakfast cereal. Doughnuts. Bagels. Cookies.  Is it starting to make sense?  If not, ask me questions!!

Next week:  Why it's important to use less insulin.

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  • 1/22/2012 2:11 PM Elizabeth Stern wrote:
    Dear Dr. Sukol:

    What do you think of the information in this NYT article about the risks of Vitamin D levels OVER 21??:http://www.nytimes.com/2012/01/17/health/research/risks-when-too-much-vitamin-d-is-too-much.html
    Reply to this
    1. 1/22/2012 9:26 PM Dr. Sukol wrote:
      You know, I am not sure.  I'll get the whole article and read it tomorrow.  This seems to be the first article reporting these kinds of findings.  There has certainly been a lot of controversy about whether optimum levels should be closer to 30 or to 40, and there are folks out there who are taking patients up into the 50's or higher, but I have not seen any recommending levels as low as 21.  
      Reply to this
    2. 1/25/2012 7:15 PM Dr. Sukol wrote:
      Here is what I found:  
      Since 2000, there has been a lot of dispute about the optimum dosing of Vitamin D. The Institute of Medicine (IOM) has studied the issue at length, and reports strong evidence to support using vitamin D with calcium for bone health only, and not for other conditions. This is not to say their findings are broadly accepted; they are not.  The IOM has come under a lot of criticism for their conservative recommendations.  Here they are, in any case: 600 international units (IU) daily for 1-70 years of age, 800 IU daily for those 71 years and older, 600 IU daily for pregnant and nursing women. For infants, the maximum recommended dose is 1,000 IU daily for 0-6 months old and 1,500 IU daily for babies ages 6-12 months.  They recommend a goal of 31, which is obviously well above the level recommended in the NYT article.  But it's lower than the goal levels of 40-50 that others are working toward.  This is the first research that's pointed toward such a comparatively low level, and I suppose we'll have to wait to see what additional studies show.

      Reply to this
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