METABOLIC DYSFUNCTION

This week I will dive deeper into Dr. Attia’s research on the four horsemen of slow death and their root causes.? But before I do, I want to provide some context.? Why am I writing about this?? Why am I so concerned?

The most common symptom of heart disease isn’t chest pain, left arm pain, or shortness of breath.? It is sudden death.? You know a patient has heart disease because he or she has just died from it.

I have lost too many family members and friends to at least one of these horsemen.? My mother died a very painful death from cancer at age 57.? This led me to read and research and I changed my lifestyle—stopped eating meat and started running.? I have lost many friends in 2023 to heart attacks.? One minute they were here, alive, and apparently well, and the next they were gone.? Gone much too soon.

As Dr. Attia notes in Outlive:

“When I was in medical school, my first-year pathology professor liked to ask a trick question: What is the most common “presentation” (or symptom) of heart disease? ?It wasn’t chest pain, left arm pain, or shortness of breath, the most common answers; it was sudden death. ?You know the patient has heart disease because he or she has just died from it. ?This is why, he claimed, the only doctors who truly understand cardiovascular disease are pathologists. His point: by the time a pathologist sees your arterial tissue, you are dead.”

I am sure that many of you have lost friends and family to heart attacks, cancer, and dementia.? So where do we start?? Where do these disease processes begin?

METABOLISM

Metabolism is the process by which we take in nutrients and break them down for use in the body.

Dr. Attia believes that what we eat and how we digest it, how the body processes it, may be very important to how long we live and how well we live.? He believes that metabolic dysfunction vastly increases your risk for all the four horsemen of slow death: Type 2 diabetes, cardiovascular disease, cancer, and Alzheimer’s disease. So, as he says, you can’t fight the Horsemen without taking on metabolic dysfunction first.

So, what is metabolism?? This is what Dr. Attia says:

“Metabolism is the process by which we take in nutrients and break them down for use in the body. ?In someone who is metabolically healthy, those nutrients are processed and sent to their proper destinations. ?But when someone is metabolically unhealthy, many of the calories they consume end up where they are not needed, at best—or outright harmful, at worst."

GLYCOGEN

"If you eat a doughnut, for example, the body must decide what to do with the calories in that doughnut.? At the risk of oversimplifying a bit, the carbohydrate from our doughnut has two possible fates.? First, it can be converted into glycogen, the storage form of glucose, suitable for use in the near term.? About 75 percent of this glycogen ends up in skeletal muscle and the other 25 percent goes to the liver, although this ratio can vary.? An adult male can typically store a total of about 1,600 calories worth of glycogen between these two sites—enough energy for two hours of vigorous endurance exercise.

One of the liver’s many important jobs is to convert this stored glycogen back to glucose and then to release it as needed to maintain blood glucose levels at a steady state.? This is an incredibly delicate task: an average adult male will have about five grams of glucose circulating in his bloodstream at any given time, or about a teaspoon.? That teaspoon won’t last more than a few minutes, as glucose is taken up by the muscles and especially the brain, so the liver must continually feed in more, regulating it precisely to maintain a more or less constant level.? Consider that five grams of glucose, spread out across one’s entire circulatory system, is normal, while seven grams—a teaspoon and a half—means you have diabetes.”

SUBCUTANEOUS FAT

The second possible destination for the calories in that doughnut is to be stored as fat.? Even a relatively lean adult may carry 22 pounds of fat in their body, i.e., 90,000 calories of stored energy.

As Dr. Attia advises, and I quote extensively:

"The decision about where to put the energy from the doughnut is made via hormones, chief among them insulin, which is secreted by the pancreas when the body senses the presence of glucose, the final breakdown product of most carbohydrates.? Insulin helps shuttle the glucose to where it’s needed, while maintaining glucose homeostasis.? If you happen to be riding a stage of the Tour de France while you eat the doughnut, or are engaged in other intense exercise, those calories will be consumed almost instantly in the muscles.? But in a typical sedentary person, who is not depleting muscle glycogen rapidly, the excess energy from the doughnut will largely end up in fat cells (or more specifically, as triglycerides—the main constituents of natural fats and oils—contained within fat cells).

The twist here is that fat—that is, subcutaneous fat, the layer of fat just beneath our skin—is the safest place to store excess energy.? Fat in and of itself is not bad.? It’s where we should put surplus calories.? That’s how we evolved.? While fat might not be culturally or aesthetically desirable in our modern world, subcutaneous fat actually plays an important role in maintaining metabolic health.

Think of fat as acting like a kind of metabolic buffer zone, absorbing excess energy and storing it safely until it is needed. ?If we eat extra doughnuts, those calories are stored in our subcutaneous fat; when we go on, say, a long hike or swim, some of that fat is then released for use by the muscles.? This fat flux goes on continually, and as long as you haven’t exceeded your own fat storage capacity, things are pretty much fine.

But if you continue to consume energy in excess of your needs, those subcutaneous fat cells will slowly fill up, particularly if little of that stored energy is being utilized.

EXCESS FAT—VISCERAL FAT

When someone reaches the limit of their capacity to store energy in their subcutaneous fat, yet they continue to take on excess calories, all that energy must go somewhere.? The doughnuts or whatever they might be eating are probably still getting converted into fat, but now the body must find other places to store it. … As more calories flood into your subcutaneous fat tissue, it eventually reaches capacity and the surplus begins spilling over into other areas of your body: into your blood, as excess triglycerides; into your liver, contributing to non-alcoholic fatty liver disease (NAFLD); into your muscle tissue, contributing directly to insulin resistance in the muscle; and even around your heart and your pancreas.? None of these, obviously, are ideal places for fat to collect.

Fat also begins to infiltrate your abdomen, accumulating in between your organs.? Where subcutaneous fat is thought to be relatively harmless, this “visceral fat” is anything but.? These fat cells secrete inflammatory cytokines …, key markers and drivers of inflammation, near your most important bodily organs. This may be why visceral fat is linked to increased risk of both cancer and cardiovascular disease.

Next week I will dive deeper into Dr. Attia’s advice on metabolic disorder.? It is very important that you understand this foundation and begin to use the knowledge provided by Dr. Attia to begin to heal yourself.? I strongly urge you to read Outlive and I hope that these excerpts will help convince you to do so.

Have a disciplined week as you work to build your financial freedom and improve your longevity.? If you find this advice helpful, please share with your friends and colleagues.? As usual, I look forward to your questions and comments.? Be safe.? Take good care, and if you can, help someone in need.

Cheers, Nigel

Nigel Romano, Partner, Moore Trinidad & Tobago, Chartered Accountants

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