A legitimate use for orlistat?

Cosmic pizza grease returns! But maybe this time to positive effect. The question is, are you willing to produce a little (maybe a lot) of cosmic pizza grease of your own to rid yourself of polychlorinated biphenyls, dioxins, dichlorodiphenyltrichloroethane and other organochlorine pollutants?

In my daily romp through the medical literature I came upon a paper in the Journal of Nutritional Biochemistry that answered a question I’ve been pondering on for a while? How can we get rid of the almost ungetridable pesticides and industrial pollutants that we all have stored in our tissues?

Organochlorine pesticides (DDT, lindane, etc), organochlorine and organobromine industrial pollutants, solvents, placticizers, and a host of other such substances are in the stored fat of all of us. Their use over the previous decades has so filled our environment with these chemicals that we can’t escape them. The are in the air, they fall in the rain, they are in the groundwater. Consequently, they are in our food. Whenever we eat, we get a load of these persistent organic pollutants (POPs) that make their way into our fat cells and cells in other tissues. And they build up because we can’t get rid of them.

Scientific evidence is mounting that these POPs accumulating in our fat cells might actually make us fat. POPs, especially the organochlorines, have been shown to cause weight gain and difficulty in losing weight in animals. It stands to reason that they should exert similar effects on humans, which could be one of the factors contributing to the worldwide obesity epidemic that has sprung up from nowhere over the last 25 years. No one is certain of the precise mechanism through which these chemicals work to promote weight gain, but more and more researchers are coming to believe that they do.

And no one knows if the levels contained in the average adult cause health problems. It is well known that large doses are extremely toxic, but low doses are a question mark right now. My take on it is that they’re probably not doing us a whole lot of good, and for my money I would just as soon get rid of mine.

Let’s take a look at how these substances accumulate in our fat.

First, the chemical structure of these compounds involves a chlorine-carbon bond that is very stable and lipophilic (fat loving). The stability is what keeps these chemicals around for decades without breaking down, and their lipophilic nature is what drives them into our fat.

When we eat foods that are contaminated with POPs (some foods are contaminated more than others, but virtually all foods contain some quantity of POPs), these foods make their way into our digestive tracts. The gall bladder squirts bile salts, cholesterol and phospholipids into the churned up mass of food as it travels through the first part of the small intestine. The POPs quickly find their way into the fat in this mass, which is then absorbed through the cells called enterocytes that line the small intestine. Once in the enterocytes, the fat – including the POPs – is repackaged and released into the lymph. The lymph containing the POP-laden fat makes its way to the blood, then to the fat cells, which remove most of the POPs and store them away.

Once they reach the fat cells, it becomes difficult to get rid of the POPs for a couple of reasons. First, they like fat, so they want to stay where the fat is. Second, if they do get released from the fat cells during weight loss they get reabsorbed by the enterohepatic circulation.

POPs that leave the fat cells go back into the blood and travel to the liver where they are released into gall bladder as bile. It is thought that these POPs are also released through the enterocytes back into the small intestine. Animal studies have shown both mechanisms to be at work. When the POPs reach the small intestine either through the bile or through the enterocytes, the process described a couple of paragraphs above repeats. The POPs mix with the fat and are absorbed and start their journey back to the fat cells once again. The process of releasing a substance (in this case POPs) by the liver into the intestine and having it picked back up again and recycled is called enterohepatic circulation.

If you are reducing food intake to lose weight these POPs traveling back into the blood make their way once again to the fat cells, but are released quickly as the fat cells give up their fat to provide the energy deficit created by the decreased food intake. What ends up happening is this flux of POPs from the intestine to the fat cells and back leads to increased POP levels in the blood and the uptake of POPs by other tissues such as the brain. I don’t know about you, but I would much prefer my POPs stay in my fat and away from my brain, kidneys, pancreas, etc. But what if I want to lose weight, what then? And is there a way to reduce the body’s load of POPs permanently?

We’ve got a situation that’s really a one way street. POPs can get in, but they can’t get out. All they can do is recirculate. And since they’re always coming in, we’re always going to have more and more of them accumulate. Which I have always found troubling because it seems that at some point they will begin to cause serious problems.

Hence my excitement when I came across and article titled “Enterohepatic circulation of organochlorine compounds: a site for nutritional intervention” in the above-mentioned journal.

The authors start off with some pretty frightening statements:

There is ample evidence that OCs [organochlorine compounds] are present in humans. Studies of breast milk composition have revealed the international presence of OCs. A memorable demonstration of the ubiquitous distribution of OCs in humans resulted from a meeting of 13 European Health ministers in June 2004. All of the ministers volunteered to have OCs measured in their blood, and most of the assayed OCs were found in all of the ministers.

There are also reports that the level of OCs in blood increases with age. This longitudinal increase results only if the rate of intake is greater than the rate of excretion. [My italics]

Since the presence of OCs in the human food chain will continue for decades, it is unlikely that cessation of production of OCs will contribute significantly to health in the foreseeable future. We therefore need to consider alternative approaches to potential health problems resulting from OCs. One approach is that of reducing the human body burden of OCs by nutritional means. We present here data that suggest that it is possible to reduce the rate of intake of dietary OCs and to increase the rate of excretion of OCs.

So we only accumulate if our intake is more than our excretion. But how do we excrete POPs? We excrete them in our stools. But unfortunately, only in minuscule amounts. These compounds are trapped in fat, and we absorb almost all the fat that gets into our GI tract. There is a tiny amount of fat that makes its way out in the stool, maybe 5 -7 grams per day, which is negligible in terms of shedding and meaningful amounts of POPs.

So, if we could figure out a way to reduce the absorption of fat back into the body, then more POP-laden fat would come out in our stools and be gone forever. And if we could figure out a way to lose weight, which increases the dumping of POPs into the small intestine AND decrease the reabsorption of it all, we could really make a substantial dent in our total body POP load.

Well, the good news is that we can! The bad news is that it comes at a price. The price? We have to become producers of cosmic pizza grease.

I posted a few weeks ago on the fact that orlistat, a drug that blocks fat absorption in the small intestine, had been approved for over the counter use. Orlistat can help you increase the fat in your stool and reduce your body load of POPs.

The authors of the study gave orlistat to rats that they had loaded up with human-sized amounts of POPs (rats don’t live as long, so don’t have the same tissue quantities of POPs as we and other longer-lived species do) and demonstrated that giving the rats orlistat markedly increased their fecal discharge of the chemicals. The researchers also put the rats on a diet and found that blood levels of POPs skyrocketed. When they gave the dieting rats orlistat they found that the drug caused a much greater excretion of POPs than when administered during the non-dieting state.

I trolled around and found another paper in the American Journal of Physiology (AJP) from a couple of years ago (click here to download a full text version) showing the same phenomenon when animals were fed olestra.

Olestra is a fat substitute made by Proctor & Gamble (P & G) that is not absorbed in the small intestine and makes its way on through. P & G thought they had a gold mine when they came up with olestra because it tastes like fat, cooks like fat, but doesn’t absorb. People could have chips and snacks and all kids of formerly high-fat foods, yet have no fat because olestra doesn’t absorb. The folks at P & G could hear the cash registers ching ching chinging–they were going to be rich, RICH, RICH.

But their plans were dashed because olestra, when consumed in large amounts, causes the same problems that orlistat does: cosmic pizza grease. So, people could only eat small amounts of the olestra-prepared chips and snacks, and who wants to eat only small amounts of these chips and snacks? I guess some people did, but only once.

The AJP article shows that the combination of caloric restriction and olestra brought about a 30-fold increase in excretion of POPs relative to an ad libitum diet, and that the uptake of POPs by the brain during the calorically-restricted diet was reduced by 50 percent.

Does it work the same in people? Probably. There are a couple of studies out there where victims of huge doses of POPs were treated by substances that bind fat in the small intestine, allowing it to continue on its course with its load of POPs.

If you want to reduce your load of POPs, here’s the program I would follow. In fact, I probably will do it at some point, I just haven’t decided when yet.

First, switch to organic foods as much as possible. Organic foods still have some contamination since it comes from the air, rain, and groundwater, but won’t have as much as conventionally grown produce.

Buy local as much as possible because the transport process can add POPs to the food.

Always, always, always wash produce before you eat it, preferably with a little soap, which will attract the POPs.

By following the above instructions, you can reduce as much as possible the POPs coming in.

To increase the amount going out, you’ve got to increase the fat content of your stool. You can do that a couple of ways. You can get orlistat when it is available. It will come in 60 mg capsules, which are half the dose of the prescription version. The standard prescription of the full bore stuff is 120 mg three times per day before meals. Based upon the chart below, you get the most bang for your orlistat buck at about 200 mg per day.

orlistat-jpeg.JPG

You could take four of the OTC capsules daily and pretty much get most of the benefit you’re going to get. I would take one before each meal and two before the meal containing the most fat.

The second thing you could do if you don’t like the orlistat option is to go to the grocery store and get some Lay’s Light potato chips or some other snack made with olestra (trade name: Olean), figure out how much you would have to eat to get about 15-20 grams of the stuff and have at it.

Both of these methods should reward you with the production of plenty of cosmic pizza grease, but, unfortunately, maybe not at the specific times you might want to welcome it. So, this detox regimen would be best carried out over a weekend when you can stay around the house and close to the john.

To really make the program work better, you should go on a low-cal diet starting a day or so before you start either the orlistat or the olestra to mobilize the POPs for better elimination. During your detox, you should keep the calories down but eat some fat at each meal so that the gall bladder contracts and squirts out the POP-laden bile so that the chemicals can be removed and carried away in the fat or in the faux fat (olestra).

I haven’t found any studies on humans checking for the amounts of POPs removed using this method, but I would figure it would be a fair amount. If you keep large quantities from going in and periodically sacrificing a weekend to hugely increase the quantities going out, you should get rid of most of your accumulation of PCPs over time. Will you feel better? Will you lose more weight? Will you live longer? I haven’t a clue, but I can’t imagine that you would be worse for it. I would think that the less POPs you have on board the better.

The orlistat/olestra detox maneuver is certain to remove POPs. But are there other ways that are less cosmic?

Serendipitously, in the same issue of the Journal of Nutrirional Biochemistry containing the orlistat detox article there is another about the use of green tea and its catechins to prevent the absorption of fat in the intestine.

Based on the information available thus far, it is evident that green tea and its catechins effectively lower the intestinal absorption of lipids. Among the green tea catechins, EGCG is the most potent inhibitor of lipid absorption. The potent inhibitory effect of EGCG appears to be associated with its ability to form complexes with lipids and lipolytic enzymes, thereby interfering with the luminal processes of emulsification, hydrolysis, micellar solubilization, and subsequent uptake of lipids. EGCG appears to be more effective in lowering the absorption of lipids of extreme hydrophobicity, such as cholesterol and α-tocopherol, with little or a moderate effect on less hydrophobic lipids such as retinol and fatty acid. It is probable that green tea or it constituents lower the absorption of other lipophilic compounds such as POPs. Further studies are warranted to define the mechanisms underlying the inhibition of lipid absorption by green tea and its catechins.

A search on PubMed indicates that calcium is also pretty good at binding intestinal fat and preventing its uptake. There is some controversy over whether calcium supplements will prevent the absorption or if it is only calcium as a component of dairy products that works. See if you can guess which side the dairy industry came down on.

You can probably do a mini-detox with the green tea (or green tea extracts containing the catechins) and calcium without the appearance of cosmic pizza grease, but I don’t know how effective the mini-detox would be as compared to the full thing. If you do try a mini detox, I would make sure to take some magnesium along with the calcium.

Once again, let me hasten to repeat, I have never tried this method of detox myself and have never used it on patients. The science underlying it appears sound, and I don’t think it should cause problems if pursued over a couple of days now and again, but I’m not recommending or advocating it. I’m merely putting it up because I think it will be of as much interest to the people reading this blog as it is to me.

If and when I do try it myself (or more likely, try to talk MD into doing it), I will blog on my (her) experiences post haste.

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19 thoughts on “A legitimate use for orlistat?

  1. Hi, Mike,

    I have used Orlistat (Xenical) in patients a few years ago, when I followed the party line and believed in “eating fat makes you fat” but luckily I saw the light and changed. My limited experience was that patients tried it and very soon gave up because of the cosmic pizza grease problems and never came back for more, and because they never lost weight.

    This sounds a much better use for orlistat. Do you think it may help to reduce heavy metal load as well especially mercury? Thanks.

    Best regards,

    Tahir.

    Hi Tahir–

    I don’t think it would work for heavy metals, but I don’t know for sure. I don’t think heavy metals are nearly as lipophilic as POPs.  I know mercury and others end up stored in fat, but mainly are treated by chelation, a process whereby they are made water soluble and gotten rid of via the kidneys. 

    Cheers–

    MRE 

  2. Did they mention any concentration amounts for the green tea? Do you know if the green tea studies use regular, name brand types of green tea or are they using green tea leaves bought from an herbal store? Thanks for the info.

    Hi Javier–

    No mention of brand names or amounts.  The paper wasn’t an original study, but a review of the literature on the subject.  You might want to check it out on PubMed (PubMed lists all the references) and look at the individual papers cited for the info you’re seeking.

    Cheers–

    MRE 

  3. Dr. Mike:

    What if you don’t have a gall bladder? How does this affect the release of POP’s?

    Hi Hellistile–

    It doesn’t really affect it.  The liver continues to produce and release bile into the duct going to the small intestine.  This duct actually enlarge and almost becomes another gall bladder.

    Cheers–

    MRE 

  4. What do you think of saunas as a method of detoxifying? The claim is that you can sweat out all of the bad stuff over a period of regular sauna use, although I have no idea of the mechanism by which this is supposed to work. It does sound much more pleasant than the orlistat weekend cleansing routine.

    Hi Sue–

    I don’t think the sauna will work for POPs because sweat doesn’t contain fat and these substances travel in fat.  The only real way you have to get rid of substances that stick in the fat is to move them out through the GI tract.

    Sorry.

    MRE 

  5. I’ve often wondered about the value of the various ‘detox’ regimens (Chlorella is another one that springs to mind). I know even if we’re super picky about our food (which I’m not), we can’t avoid many of the substances that are all around us, in the water that we drink and bathe in, air we breathe, soaps, detergents, deoderants, etc.

    I’ve previously ignored much of the ‘detox’ craze (Isn’t there even a ‘detox diet’ or something like that?) as more people just trying to sell you stuff that a decent diet, a little exercise, and drinking plenty of water would do just as easily. Is there more to it?

    Hi Bob–

    Despite a “decent diet, a little exercise, and drinking plenty of water”  you still get loaded up with POPs because they are in almost all food to one degree or another and in much of the water we drink.  The question is: does it hurt you?  No one really knows.  Toxic doses certainly cause serious problems, but do the amounts we routinely have in our fat cells do us any damage?  I suspect we would probably function better without them, which is why I put up the post.

    Best–

    MRE 

  6. Are these (or any other toxins) found in meat? I would suspect that meat would at least contain lower concentrations.

    Hi Freddy–

    Yep, they’re contained in meat.  They concentrate in the fat.  Grass fed will have much less than lot fed, so you can reduce your intake by sticking with grass fed animals.  Even organic will have some because the pollutants are everywhere.  We have these pollutants in our fat and the animals we eat do to.  They can’t he avoided completely, only minimized.

    Cheers–

    MRE 

  7. If you don’t have a gall bladder, isn’t the bile constantly dripping into the small intestine? If that’s true, then couldn’t someone without a gallbladder just go on a no-fat diet for a weekend and all of the POP’s would pass through because there wouldn’t be any fat for them to bind to.

    Love your blog!

    Hi Kevin–

    It would seem like it would work that way, but it really doesn’t.  Maybe for a short time after gall bladder removal the system works as you describe, but not for long.  The duct that goes from the liver to the small intestine ends up becoming sac like and takes over the job of the gall bladder, which is what allows people without gall bladders to function pretty normally.  Plus, if you aren’t sending fat to the small intestine, the POPs won’t go their either.  Istead they will travel in the blood and end up in other organs and tissues.  That’s why the orlistat would work: it keeps the POP-laden fat from being reabsorbed and moves it on through.  The olestra acts like a fat that isn’t absorbed, and it moves on through.

    Hope this explaination makes sense. 

    Cheers–

    MRE 

  8. I have a question that may be related to this.

    On several low carb forums right now, there is a debate going on about what happens to the extra fat calories if carbs are kept extra low so that insulin is kept low. Some say it will be stored as fat anyway, others say it will be burned as heat and still others say it will be excreted. One member even did near-zero carbs and very high fat for a week (4500 calories instead of a normal 2500, with an average of about 80-90 g of protein). He lost a pound off of his already lean physique.

    So, where does that extra fat go? Is it excreted? The detractors say that fat is completely digested before reaching the colon but I am not sure. If it is excreted, could you go ultra high fat, zero carb for a week or so and get the same detox results as the cosmic pizza grease?

    Hi Ryan–

    Your comment raises an interesting question.  Where does all the excess energy go?

    I’ve had a number of patients and countless letters from readers who have had the same experience.  They consume a ton of fat, but don’t gain weight…or even, as with the guy you described, lose a little.  Mostly the letters we get are from people who complain that they are following our diet to the letter, yet not losing weight.  When we investigate, we find that in virtually every case these people are consuming huge numbers of calories as primarily fat.  We always ask them if it doesn’t strike them as strange that they’re eating as much as they are, yet not gaining.

    In order to lose weight, one must create a caloric deficit.  This can be done in a number of ways.  People can burn more calories by increasing exercise; they can eat fewer calories; or they can increase their metabolic rate.  Or they can do any combination of the above.

    Most people going on a low-carb diet decrease their caloric intake.  A low-carb diet is satiating, so most people eat much less than they think they are eating even though the foods they’re consuming are pretty high in fat.  Some people, however, can eat a whole lot on a low-carb diet, and, can in fact, eat so much that they don’t create the caloric deficit and don’t lose weight.  But the interesting thing is that they don’t gain weight either.  They pretty much stay the same.  They are eating huge numbers of calories and not gaining, so where do the calories go?

    First, I don’t think they go out in the bowel.  If they did, people would have cosmic pizza grease stools whenever they ate a lot of fat over a period of time, and they don’t. And a number of studies have shown that increasing fat in the diet doesn’t increase fat in the stool.

    Eating a very-low-carbohydrate diet ensures that insulin levels stay low.  Unless insulin levels are up, it’s almost impossible to store fat in the fat cells.  With high insulin levels fat travels into the fat cell; with low insulin levels fat travels out.  So, it’s pretty safe to say that the fat isn’t stored.  So what happens to it?

    The body requires about 200 grams of glucose per day to function properly.  About 70 grams of this glucose can be replaced by ketone bodies, leaving around 130 grams that the body has to come up with, which it does by converting protein to glucose and by using some of the glycerol backbone of the triglyceride molecule (the form in which fat is stored) for glucose.  If one eats carbs, the carbs are absorbed as glucose and it doesn’t take much energy for the body to come up with its 200 gram requirement; if, however, one isn’t eating any carbohydrates, the body has to spend energy to convert the protein and trigylceride to glucose.  That’s one reason that the caloric requirements go up on a low-carb diet.

    The other reason is that the body increases futile cycling.  What are futile cycles?  Futile cycles are what give us our body temperature of 98.6 degrees.  Futile cycles are just what the name implies: a cycle that requires energy yet accomplishes nothing.  It operates much like you would if you took rocks from one pile and piled them in another, then took them from that pile and piled them back where they were to start with.  A lot of work would have been expended with no net end result.

    The body has many systems that can cycle this way, and all of them require energy.  Look up the malate-aspartate shuttle; that’s one that often cycles futilely.

    Another way the body dumps calories is through the inner mitochondrial membrane.  This gets a little complicated, but I’ll try to simplify it as much as possible.  The body doesn’t use fat or glucose directly as fuel.  These substances can be thought of as crude oil.  You can’t burn crude oil in your car, but you can burn gasoline.  The crude oil is converted via the refining process into the gasoline you can burn.  It’s the same with fat, protein and glucose–they must be converted into the ‘gasoline’ for the body, which is a substance called adenosine triphosphate (ATP).  How does this conversion take place?  That’s the complicated part.

    ATP is made from adenosine diphosphate (ADP) in an enzymatic structure called ATP synthase, which is a sort of turbine-like structure that is driven by the electromotive force created by the osmotic and electrical difference between the two sides of the inner mitochondrial membrane.  One one side of the membrane are many more protons than on the other side.  The turbine-like ATP synthase spans the membrane, and as the protons rush through from the high proton side to the low proton side (much like water rushing through a turbine in a dam from the high-water side to the low-water side) the turbine converts ADP to ATP.

    The energy required to get the protons heavily concentrated on one side so that they will rush through the turbine comes from the food we eat.  Food is ultimately broken down to high-energy electrons.  These electrons are released into a series of complex molecules along the inner mitochondrial membrane.  Each complex passes the electrons to the next in line (much like a bucket brigade), and at each pass along the way, the electrons give off energy.  This energy is used to pump protons across the membrane to create the membrane electromotive force that drives the turbines.  The electrons are handed off from one complex to the other until at the end of the chain they are attached to oxygen to form water.  (If one of these electrons being passed along the chain of complexes somehow escapes before it reaches the end, it becomes a free radical.  This is where most free radicals come from.)

    There are two parts to the whole process.  The process of converting ADP to ATP is called phosphorylation and the process of the electrons ultimately attaching to oxygen is called oxidation.  The combined process is called oxidative phosphorylation.   It is referred to as ‘uncoupling’ when, for whatever reason, the oxidation process doesn’t lead to the phosphorylation process.  Anything that causes this uncoupling is called an ‘uncoupling agent.’

    You can see that the whole process requires some means of regulation.  If not, then the electromotive force (called the protonmotive force, since it’s an unequal concentration of protons causing the force) can build up to too great a level.  If one overconsumes food and doesn’t need the ATP, then the protonmotive force would build up and not be discharged through the turbines because the body doesn’t need the ATP.  The body has accounted for this problem with pores through the inner mitochondrial membrane where protons can drift through as the concentration builds too high and by proteins called uncoupling proteins that actually pump the protons back across.  So we expend food energy to pump protons one way, then more energy to pump them back.

    One of the things that happens on a high fat diet is that the body makes more uncoupling proteins.  So, with carbs low and fat high, the body compensates, not by ditching fat in the stool, but by increasing futile cycling and by increasing the numbers of uncoupling proteins and even increasing the porosity of the inner mitochondrial membrane so that the protons that required energy to be moved across the membrane are then moved back.  So, ultimately, just like the rocks in my example above, the protons are taken from one pile and moved to another then moved back to the original pile, requiring a lot of energy expenditure with nothing really accomplished.

    This is probably all as clear as mud, but it is what happens to the excess calories on a low-carb, high-fat diet.

    Cheers–

    MRE   

  9. Okay,
    I have question, just who are the insulin sensitive overweight people that J.O. Hill studies? Have you ever encountered people who don’t do well on a low carb diet?

    Hi Mmmm–

    I have found insulin sensitive obese people, typically women, but they still do fine on low-carb diets.

    Cheers–

    MRE

  10. Trying to get my head round all this!!

    Where does the fat we consume go whilst futile cycling takes place. If I drank a pint of double cream, it would all be absorbed into the bloodstream, rather than going down the pan, correct? As I understood it (from Malcolm Kendrick) the newly absorbed fat is mostly transported as triglycerides in chylomicrons direct to fat cells, bypassing the liver.
    Now I read that with low insulin levels, the fat/triglycerides cannot enter fat cells.

    So, where does my newly absorbed pint of cream spend the next couple of hours? Does it remain in the bloodstream? I must confess to getting more than a liitle confused, Dr Eades.

    Hi Neil–

    The newly absorbed fat is transported in the lymphatic system and dumped through the thoracic duct into a large central vein near the heart.  This fat is then in the bloodstream and does go to the cells, but it goes through the liver as well.  The triclycerides probably do go into the fat cells, but then comes right back out if insulin is low.  As the fat goes through the liver in a low-insulin situation it gets partially broken down into ketone bodies.  These ketone bodies are fat that is soluble in blood and are transported to the various tissues that use them.  The tissues extract the ketones they need and break them down to the high energy electrons that enter the electron transport chain (the oxidative part of oxidative phosphorylation) that are then used to pump protons across the membrane in one direction, which then get pumped back causing a dissipation of energy without any real work being done.  Some ketone bodies are released into the breath, others into the urine, and some into the stool, getting rid of even more calories.

    Hope this helps.

    Cheers–

    MRE 

  11. Wow Dr. Mike, MD musta switched from decaf to high test w/o tellin ya! That was some puritan work ethic there. Great article and reply about fat calories!

    Hi Robert–

    Thanks.  Somehow I’ve never considered myself imbued with the puritan work ethic.  Who knows why I was inspired on this one.

    Cheers–

    MRE 

  12. Another question related to very low carb, if you have the time. You wrote “if, however, one isn’t eating any carbohydrates, the body has to spend energy to convert the protein and trigylceride to glucose”.

    I have read that this process is fairly inefficient. Does that mean that your protein requirements will go up if you eat very low carb since more of the protein will be converted to glucose (with some wasted in the process)? It seems that if you don’t eat enough protein, your body will cannibalize muscle to get the glucose it needs.

    On the flip side though, if you eat extra protein, will all of the excess protein be converted to glucose and will this raise your insulin levels, causing you to store those extra calories taken in as fat, even with no carbs taken in?

    Thanks again for your time.

    Hi Ryan–

    It takes about a gram of protein to make 0.7 grams of glucose, so if your only source of glucose was protein, you would have to eat 100 grams or protein to make 70 grams of glucose.  But you don’t get all of your glucose from protein.  Some comes from the glycerol backbone of the triglyceride molecule.  When dietary fat or your own stored fat is broken down, the glycerol backbone holding the three fatty acids is released and can be used to make glucose.  So, you do need extra protein on a low-carb diet to help keep the blood glucose stable without having to cannibalize your own lean tissue.

    The body only converts the protein needed to keep glucose in the normal range, so you don’t have to worry about glucose levels going up and a resultant insulin rise.  Doesn’t happen.

    Cheers–

    MRE 

  13. Dr. Mike,

    This is in follow up to your answer to Ryan #8

    You stated that in a low insulin situation fat can be disposed of three ways, “People can burn more calories by increasing exercise; they can eat fewer calories; or they can increase their metabolic rate. Or they can do any combination of the above.” In the explanation of futile cycles which have to do with the metabolic rate you further state that, “Futile cycles are what give us our body temperature of 98.6 degrees. Futile cycles are just what the name implies: a cycle that requires energy yet accomplishes nothing.” Would this mean that in some people on a high fat, high calorie diet in a low insulin situation that their body temperature would go up, though I imagine to a small and perhaps not measurable degree?

    Porter

    Hi Porter–

    That is indeed what happens.  The increased cycling runs the temp up a little.

    Cheers–

    MRE 

  14. Hi Mike,

    Just read all the comments on this article. I would agree with most of what is being said. Occasionally I come across a patient who just refuses to lose weight, and by taking them on a high fat very low to no carb diet they do begin to lose weight.

    One question which has always puzzled me is this, given that the conversion of proteins and fats to glucose is inefficient, and given that if you do consume large quantities of calories as fat, which are processed through futile cycles, do you generate a lot more free radicals and ultimately do cellular damage? I tend to visualize it as leaving a car engine running while it is stationary. No real function, but the engine still wears out.

    Should low carb practitioners increase their relative intake of antioxidants, if they are not consuming significant amounts of organic vegetables. Thank you once again for a great blog.

    Hi Tahir–

    I don’t think that low-carbers need more antioxidants, and here’s why.

    First, they are eating more fat and more saturated fat, so the mitochondrial membrane fats will become more saturated (i.e. have a lower desaturation index) making them less prone to free radical damage.

    Second, the greater number of uncoupling proteins and the increased proton leak across the membrane tend to dissipate the energy across the membrane and decrease the likelihood of as many free radicals being produced.  It’s kind of difficult to explain, but imagine with much higher pressure on one side than the other.  As the electrons move down from one complex to the next along the membrane they are releasing energy to increase the pressure differential.  Since the pressure differential is already high, there is more resistance and the electrons are more likely to break out of the system and become free radicals.  If the pressure is constantly being reduced on the higher-pressure side, then there is not nearly as much resistance to the release of energy from the electrons and, hence, the electrons are more likely to continue their course and not bolt from the system and become free radicals.   Hope this helps.

    Best–

    MRE 

  15. Hi Dr. Mike,
    I have a few questions. You said one option for the POPs detox is to go to the “…grocery store and get some Lay’s Light potato chips or some other snack made with olestra…” But wouldn’t the carbs in the potato chips prevent (or limit) the stored fat from being mobilized by the action of insulin? You recommended a low calorie diet during the detox; shouldn’t it also be low carb? Also, this was a post from several months ago, have you tried this detox yourself yet? TIA! I really enjoy the blog!
    -Brenda

    The carbs will prevent some of the fat from being mobilized, but the olestra will carry out the pesticides that are already in the circulation as they’re dumped into the GI tract instead of letting them be reabsorbed with the fat.

    Best–

    MRE

  16. Hi, nice post. But I was thinking, don’t we get the same result with green tea, soluble fiber and normal fat? As I understand, bile salts will bind with soluble fiber and will be excreted. And bile salts are released whenever we eat any type of fat. So for example, drinking green tea and eating olive oil and avocado in each meal together with some other fiber rich veggies while on a diet should yield the same results. Am I right? What do you think?

    • Hard to day without doing a real study to see. Most fat is reabsorbed from the bowel through the entero-hepatic pathway. Orlistat, olestra (no longer available – I think) and escolar ( a fish) all bind with fat in the bowel and carry it out. Nothing, that I know of anyway, has the capacity to inhibit fat resorption other than these.