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Living with Diabetes

Get healthy through the Holiday Season

The Holiday Season – Thanksgiving, Advent and Hanukkah – is just around the corner. Supermarkets have already been selling gingerbread, cinnamon stars, and other sweet allurements for weeks, and the Christmas markets with their aroma of freshly roasted almonds and mulled wine are nearing. Sweet, fatty and carbohydrate-rich foods tempt us everywhere and are supposed to get us through the cold, dark season with pleasure – a great challenge for those who want to keep their body shape or do not want to overstress it, but also especially for those people who should not mindlessly feast for health reasons.

Every Holiday Season diabetics, who should keep an eye on their blood sugar and insulin levels, face this challenge.

With a few tricks and a bit of planning, however, the Holiday Season can be fully enjoyed even with a diagnosis of “diabetes”.

Enjoyment is welcome – it’s the quantity that matters

For everyone – but for diabetics especially – the following is true: “The dose makes the poison.“

When snacking on sweets such as special holiday cake or pie, cookies and the like, enjoying the holiday menu and alcohol, it is important to watch the quantity or switch to tasty, healthier alternatives from the start.

When baking cakes or cookies, it is easy to reduce the amount of sugar and fat without forfeit the taste.

Carbohydrate-rich side dishes such as pasta, dumplings, rice, etc. are also a must on festive days. However, it is worth using these sparingly and preferring a larger portion of vegetables such as red cabbage, root vegetables, or lettuce. Gravy and sauces for roasts can also be thickened excellently with pureed vegetables or rye bread – therefore we can forgo processed starch as well as fatty sauces can be skipped.

In order to maintain a healthy body and metabolism, it is worthwhile to rely on light meals such as protein with vegetables or salad in the evening and to avoid a dessert. This keeps the rise in blood sugar moderate and allows the body to rest adequately overnight.

Alternative enjoyment

For example, instead of a cake, you can prepare a baked apple with raisins and cinnamon. You can easily avoid sugar and fat in this way, and at the same time increase the intake of fiber. Sautéed pears with goat cheese, for example, are also a perfect low-sugar dessert.

Instead of the usual Holiday Treats made with white flour, you can bake cookies made from oatmeal and sweeten them with pureed apple. Pralines made from nuts, dates and cocoa powder also offer wonderful alternatives without fat, white flour and refined sugar. 

Sugarcoated, roasted almonds for example can be wonderfully replaced by roasted chestnuts, which bring their very own sweetness.

Exercise lowers blood sugar

Even if the dark, cold season invites you to cuddle up on the sofa and so many suitable excuses against physical activities are quickly found, you should still incorporate exercise into your everyday life and especially during the holidays. A long walk with friends and family should definitely be a valuable activity following feasting or sitting for long periods of time. This not only burns more calories, but also lowers blood sugar.

Caution with alcohol

For most people, alcoholic beverages such as mulled wine, hot caipirinha as well as (sparkling) wine are part of a felicitous and, cozy Holiday Season. But alcohol also affects blood sugar levels. The extent to which it causes blood sugar to rise however cannot be said in general terms and varies greatly from person to person. Therefore, it is advisable to use alcoholic beverages as sparingly as possible and to measure blood sugar levels more often.

With this in mind, we wish you a joyous and healthy Holiday Season!

Protein – not only for Building Muscle

http://www.metabolic-balance.com

Protein is “THE” building block in the body. It consists of up to 50,000 protein compounds with vital functions. From muscles, skin, connective tissue, blood vessels, internal organs to hormones and enzymes – proteins are needed everywhere. Vital protein compounds are also needed for many biologically active substances, which provide, e.g., for the transport of iron or oxygen in the blood, for the immune system or bone metabolism. Protein makes up the largest proportion of human body mass in adults, at about 10 kg (about 22 lbs). The dry weight of many body cells consists of more than 50% protein.

Although protein is one of the energy-providing macronutrients along with fats and carbohydrates, it occupies a special position because it is never primarily stored in the body as energy. Unlike fats, which are stored in adipose tissue, and carbohydrates, which are stored as glycogen in the liver and muscle, proteins always have a specific function.

That is why protein is also an indispensable part of our nutrition. Whether vegetable or animal protein – in the stomach and intestines, the digestive juices break down the food protein into its smallest components, the amino acids.

To keep all vital processes running, amino acids must be available in sufficient quantities at all times. This is because thousands of repair processes take place in every cell every day, during which complex proteins are broken down into their individual components and are renewed.

Recommended daily protein requirement

If protein is lacking, it quickly becomes noticeable. Nails, hair and skin suffer, they become brittle, dull and wrinkled. Physical strength is also diminishing. We get tired quickly and are often exhausted for no reason.

How much protein is healthy for the individual cannot be answered in general terms. The German Nutrition Society (DGE) as well as the WHO recommend eating at least 0.8 g of protein per kg of body weight daily (0.36 grams per lbs).

A “high-protein” nutrition is considered to be, when 30 percent of food energy is absorbed in the form of protein. According to scientific studies, a nutrition rich in proteins can prevent some diseases of civilization. For example, studies have concluded that high-protein food can improve the metabolic condition of type 2 diabetes mellitus, lower liver fat, reduce inflammatory processes and improve the overall lipid profile in the blood.

Although we actually consume plenty of protein-rich foods, the positive effect is lost. Scientific research brings it to light: it is primarily due to the combination of “a lot of protein paired with unhealthy nutrients.”. Our nutrition usually looks like this: lots of meat and sausages with plenty of additives. We neglect vegetables and fruits and absorb too little fiber and polyunsaturated fatty acids. This increases the risk of lipometabolic disorders, diabetes or cardiovascular diseases, despite a high-protein nutrition.

Protein quality – Biological Value

In addition to the appropriate protein intake, the quality of the protein is particularly important. The quality of the protein is defined by the eight essential amino acids. The dietary proteins have a different composition and the quality of the dietary proteins is calculated on the basis of the limiting essential amino acid in each case. In this case, it is not the highest possible protein content of the food that is decisive for the quality of the protein, but how much of this protein content can be converted into the body’s own protein.

In general, plant proteins have a lower value than animal proteins, which are more similar in composition to the human amino acid profile.

Higher biological values can be achieved by clever combinations of foods. If a food contains smaller amounts of certain amino acids, it can be supplemented with another food that has an excess of these amino acids. In general, it is recommended to combine animal with plant protein sources in order to achieve a higher biological value. However, it must always be taken into account that the individual protein components must be consumed in a certain proportion in order to utilize the optimum effect. For example, 35% potatoes combined with 65% cottage cheese results in a biological value of approx. 136, or 22% potatoes and 78% beef have a biological value of 114.

A supply of dietary proteins with a high biological value also has a positive overall effect on the acid-base balance, because most of the amino acids supplied can be utilized by the body. When eating foods with a low biological value, on the other hand, an excess of amino acids accumulates that are not needed by the body in the first place and have to be buffered or neutralized and excreted accordingly, which overtaxes the body and metabolism in the long run. An accumulation of acids blocks the metabolism. This has an effect on the well-being. Fatigue and lack of concentration can be acompanying symptoms. Inflammation, muscle and joint complaints often occur, and weight loss is also delayed.

Protein powder – Sense or nonsense?

Protein powders or protein shakes are no longer only popular among bodybuilders – recreational athletes are also increasingly using the diverse range of protein powders and ready-to-drinks (RTD) to build up muscles or lose weight. Nevertheless, there are always critics who refer to these additional protein portions as superfluous or even unhealthy.

Protein powders are available in concentrates, isolates or hydrolyzates. The first two forms differ only in their protein content (concentrate 80%, isolate 90%). In the hydrolyzate, the proteins have already been broken down into smaller amino acid chains and thus enter the blood more quickly. However, this leads to the fact that the amino acid concentration in the blood increases faster, with the consequence that the amino acids are increasingly used for energy production instead of protein synthesis, which are actually important for muscle building.

Protein shakes are also often used for weight reduction. Over a short period of time, this can be a useful meal replacement, especially if the shake replaces the evening meal. This additionally boosts the metabolism and at the same time achieves a long-lasting feeling of satiety. However, when choosing protein powders, the composition should be closely scrutinized. Often, the various protein shakes contain, in addition to high-quality protein, a variety of additives and also sugar, which block the metabolism and have a negative impact on weight loss.

Metabolic Balance and the macronutrient Protein

At Metabolic Balance, the macronutrient protein is also an important component in our nutrition plans. The targeted selection of high-quality animal and plant protein-rich foods, which are combined with vegetables and fruits, creates the basis for a balanced metabolism. The body is supplied with all the valuable protein building blocks and at the same time, excess acids produced during metabolism can be neutralized more easily by the vitamins and minerals from vegetables and fruit.

For a healthy nutrition, it also makes sense to consume different protein sources (e.g. fish, meat, eggs, cheese, sprouts, legumes, mushrooms, seeds or nuts) in a certain proportion throughout the day. In addition, it has proven to be particularly advantageous that only one type of protein per meal contributes to a rapid balancing of the acid-base balance, as hyperacidity can be largely avoided and at the same time the de-acidification of the body is supported.

In addition to the quality of the protein and the frequency of its consumption, the arrangement of the meals with protein is also an important pillar for Metabolic Balance. That means if you want to gently balance your metabolism and relieve the digestive organs, you always start your meal with one or two bites of the protein component. This way, the pancreas first produces the hormone glucagon, which is necessary for protein digestion, and the production of insulin is reduced. This, in combination with complex carbohydrates (vegetables, whole grains), forms a long-lasting fullness and the absence of cravings.

Sources:

  1. http://www.deutsche-apotheker-zeitung.de/news/artikel/
  2. Bill Campbell, Richard B Kreider et.al: International Society of sports Nutrition position stand: protein and exercise; Journal of the International Society of Sports Nutrition (2007)
  3. Mag.rer.nat. Eddie Semler: Eiweiß unter Verdacht; UGB-Forum 3/2003, S.122-124
  4. Jiaqi Huang, Linda M Liao et.al.: Association Between Plant and Animal Protein Intake and Overall and Cause – Specific Mortality; JAMA Intern Med. 2020 Sep 1; 180(9) DOI: 10.1001/jamainternmed.2020.2790

Hypertension under Control

According to studies, 55% of all 35-64-year-old Germans suffer from arterial hypertension (high blood pressure). From the age of 65, the figure is as high as 60-80%. The number of unreported cases is estimated to be much higher, as about 50% of those affected have no knowledge of their disease.

High blood pressure does not initially cause pain or other symptoms and thus remains undetected for a long time. This is problematic because undetected high blood pressure can cause damage to organs such as the kidneys, eyes or heart over a period of years.

How blood pressure develops

In order for blood to flow through the blood vessels to all organs and tissues, force and pressure are required. The pumping of the heart and the elasticity of the vessel walls ensure that this pressure is created. With each beat, the heart powerfully pumps blood into the blood vessels. The blood transported in this way exerts pressure on the vessel walls, which resist this pressure. Together, these two factors account for the level of blood pressure.

When do we talk about hight blood pressure?

Blood pressure is considered to be increased if the first, systolic value exceeds 140 mmHg (millimeters of mercury) or the second diastolic value exceeds 90 mmHg – or both values are higher. Based on these reference values, specialists classify high blood pressure into different degrees of severity:

  • mild hypertension: 140-159 / 90-99 mmHg
  • moderately increased: 160-179 / 100-109 mmHg
  • severe: more than 180 / more than 110 mmHg

Risk of high blood pressure

In medicine, a distinction is made between two forms of hypertension – essential or primary hypertension and secondary hypertension.

Primary hypertension is present in 90% of hypertensive patients. Several factors can affect the regulation of blood pressure. In addition to age and hereditary predisposition, the main factors that increase blood pressure are obesity, a nutrition with too much salt, alcohol consumption, smoking, lack of exercise, stress or even medication.

In secondary hypertension, an underlying disease such as a circulatory disorder of the kidneys, narrowing of the renal artery, hormonal disorders or the so-called sleep apnea syndrome is the cause of the elevated blood pressure.

Permanently elevated blood pressure can damage blood vessels and cause hardening of the vessel walls. If, in addition, the cholesterol in the blood is elevated, this can lead to deposits and a narrowing of the vessels, which causes the blood pressure to rise further. High blood pressure always damages the kidneys. Due to the high pressure, the tiny filtering devices in the kidney die off. As a result, the kidneys are severely impaired in their filtering functions and the metabolic end products are not excreted by the organism at all or only insufficiently.

Hypertension and overweight

A major cause of high blood pressure is obesity. From an excess weight of about 10 kg, the blood pressure increases by about 2.3 mmHg diastolic and leads to a strain on the heart and the circulation, since a larger body mass must be supplied with blood. In addition, the abdominal fatty tissue produces increased angiotensinogen in the body. Angiotensinogen is a tissue hormone that docks to the receptors of the vascular muscles, stimulating the contraction of the vascular muscles, thus contributing to a narrowing of the blood vessels and increasing blood pressure.

In addition, overweight people often also produce too much insulin. Insulin not only regulates blood sugar levels alone, but also influences a special protein, ANP (atrial natriuretic peptide), which helps regulate blood pressure in the body by stimulating increased excretion of fluid via the kidneys when there is high pressure in the vessels. Scientists have found that insulin promotes the breakdown of ANP in adipose tissue, and as a result, overweight people have low levels of ANP, and so this pathway to blood pressure regulation is absent in them.

Hypertension and salt consumption

Sustained high salt consumption can lead to high blood pressure. This also increases the risk of developing cardiovascular diseases. The intake recommendations for table salt range from 3.75 g (American Heart Association) to 5 g/day (WHO) and 6 g/day (Deutsche Hochdruckliga – German Hypertension League) to 6.25 g/day (European Society of Cardiology). In fact, according to a DEGS study (Study on the Health of Adults in Germany), the daily intake of table salt in Germany is 8.4 g/day for women and 10 g/day for men.

Sodium chloride, the main component of salt, is essential for life and performs numerous tasks in the body. For example, it controls the water balance and coordinates the transmission of stimuli to muscle and nerve cells, participates in bone building and activates metabolic processes. In addition, chloride is an important component of gastric acid and therefore necessary for the digestion of protein in the stomach.

Every single cell in the body needs sodium and chloride to allow nutrients to enter the cells. This is because these two substances ensure a permanent exchange of water and nutrients at the cell membranes. The salt concentration before and in the cell is decisive for this. If there is a higher salt concentration outside the cell than inside the cell, water flows out of the cell to compensate for the difference. Conversely, water from the environment flows into the cell as soon as the salt concentration outside is lower than inside.

According to the same principle, sodium chloride can also have an effect on blood pressure: The more salt is absorbed through food and gets into the blood, the higher the fluid content must be there. Therefore, if a lot of salt is eaten, more water is extracted from the cells and incorporated into the blood – the blood volume increases. If the salt intake and thus also the blood volume are increased in the long term, the blood vessels subsequently react by contracting, i.e. they become narrower and the blood pressure rises.

However, how sensitively blood pressure responds to an increase in salt concentration seems to depend on various factors such as genetic predisposition, body weight and age, and is not the same for everyone. This is referred to as salt sensitivity.

The majority of the salt intake is generally through processed foods. However, these are not always just the classic ready-made products. Important sources of salt are primarily bread and bakery products, meat and sausage, dairy and salty snacks.

Metabolic Balance – Regulating hypertension without medication

With the Metabolic Balance nutrition program, we have a tool at hand with which we can have a positive influence on high blood pressure in a very short time and possibly even reduce blood pressure medication. Therefore, regular monitoring of blood pressure is urgently needed in hypertensive clients, especially in the first phase of the nutrition program. This is because during the preparation phase we at Metabolic Balance already start a detoxification program for the body by preparing it for the upcoming dietary change with light food based on vegetables, fruit, potatoes or whole grain rice and with sufficient fluid intake. At the beginning, plenty of water is washed out, which relieves the organs and blood pressure.

In the further course of the Metabolic Balance program, a moderate blood sugar and insulin level is achieved through the selection of foods, i.e. the ANP level in the body also gradually rises again, thus fulfilling its task of helping to regulate blood pressure. At the same time, fat cells produce less angiotensinogen with increasing weight loss.

Studies have shown that blood pressure can be reduced by about 2 mmHg per kilogram (about 2 lbs) of weight loss.

Similarly, salt consumption is greatly reduced in the Metabolic Balance nutrition program. This is not because Metabolic Balance explicitly recommends using less salt, but because there are no processed food products and foods with a high salt content on the menu. The salt from the typical household salt we add to our food ourselves is usually only a fraction of the amount we consume daily through processed foods.

Sources:

  1. Thomas Semlitsch, et.al.: “Long-term effects of weight-reducing diets in people with hypertension” -02/März/2016 https://pubmed.ncbi.nlm.nih.gov/26934541/
  2. https://www.zavamed.com/de/bluthochdruck-uebergewicht.html
  3. Institut für Qualität und Wirtschaftlichkeit im Gesundheitswesen (IQWiG) (2019): Den Blutdruck ohne Medikamente senken, https://www.gesundheitsinformation.de/den-blutdruck-ohne-medikamente-senken.2083.de.html?part=behandlung-ne#zh6a zuletzt aufgerufen am 12.01.2021.
  4. https://www.rki.de/DE/Content/Gesundheitsmonitoring/Gesundheitsberichterstattung/GBEDownloadsK/2015_4_bluthochdruck.pdf?__blob=publicationFile

The Intestine and its Inhabitants

The intestine is an important part of the digestive system – it transports the food bolus, absorbs nutrients and water, produces vitamins and short-chain fatty acids, and removes indigestible food components. With a length of about eight meters, a surface area of up to 400 square meters and a diameter of only a few centimeters, it is the main transport artery from the food supply in the supermarket to the bloodstream.

With our food, we not only absorb vital nutrients that enter the bloodstream via the intestine, but also many foreign substances and pathogens. A healthy intestine that is equipped with a good intestinal flora and whose intestinal wall barrier is intact can catch, destroy and excrete toxins and pathogenic germs in advance, so that they no longer pose a risk to the body.

Unfortunately, the “interior equipment” of the intestine is massively disturbed by today’s modern nutrition and lifestyle. Often the intestinal mucosa is damaged, e. g. by nutrition low in fiber and too much sugar or by abundant additives that are added in large quantities to many processed foods. It is estimated that about 8 kilograms (17.6 lbs) of preservatives pass through the intestine over the course of an adult life. This is unfavorable, since the preservatives do their job in the intestine just as they do as an additive in food: They destroy bacteria and do not distinguish between disease-causing or health-promoting intestinal bacteria.

The intestinal mucosa as a border post

Nutrients and water are supposed to reach the body from the intestine. However, this does not apply to undigested food components, toxins and pollutants. Therefore, the intestinal mucosa must form an effective barrier. Normally, the cells in the intestine are located close together and the intercellular spaces are sealed with a kind of “Velcro” tape, i. e. membrane protein complexes, the so-called „tight junctions“. In addition, the intestinal mucosa is supported by a variety of different intestinal bacteria, which settle on the intestinal mucosa like a “thick fluffy carpet”, creating an impermeable barrier to blood circulation.

The tight junctions can be opened to allow larger molecules and larger quantities of water to pass through.

Disruptive factors such as stress, medications, alcohol, pathogenic germs and various additives can alter the intestinal flora and damage the intestinal mucosa. The pathogenic bacteria primarily benefit from a changed intestinal flora, because they can adapt very quickly to the changed environment and multiply accordingly quickly. As a result, inflammation of the intestinal mucosa may occur and the intestinal epithelium gradually becomes permeable (leaky gut syndrome) to allergens, pollutants and pathogens that harm the body. Allergies, diabetes mellitus type 2, skin diseases and fungal infections are also associated with a damaged and altered intestinal flora.

Food for the intestinal cells

Lactobacilli (lactic acid bacteria) and bifidobacteria, which settle sufficiently in the intestine, can protect and strengthen the intestinal mucosa. Studies have impressively demonstrated that lactobacilli can repair defects caused by harmful bacteria.

The broadest possible bacterial colonization in the intestine is therefore more than desirable. This ensures that the intestine is well supplied and the intestinal cells are optimally nourished. The intestinal cells receive all vital nutrients directly from the intestinal content. The intestinal content can be partially metabolized by some intestinal bacteria from the group of lactobacilli and bifidobacteria, forming short-chain fatty acids. Short-chain fatty acids provide energy, stimulate intestinal peristalsis and the circulation of the intestinal wall. Particular attention is paid to butyric acid, which promotes the metabolism of the intestinal mucosa and the growth of blood vessels in the intestinal wall. It also has anti-inflammatory and anticancerogenic effects.

Propionic acid and acetic acid play an important role in gluco- and lipogenesis. Furthermore, propionic acid supports the glucose balance in addition to building up the intestinal flora. It throttles the release of glucose and stimulates the pancreas to produce insulin. At the same time, the sensitivity of the body cells to insulin is increased.

It is therefore beneficial if sufficient lactobacilli and bifidobacteria colonize the intestine. With a nutrition rich in fiber, especially vegetables, legumes, whole grains and fruits, the bacterial population can be increased. But just as important are foods that provide probiotic bacterial strains, which are mainly found in fermented foods such as sauerkraut, yoghurt, kefir, buttermilk and many more.

Intestinal bacteria against obesity

Obesity is still mostly induced by high calorie food intake and lack of exercise. However, numerous studies have shown now that there is also a significant difference between normal and obese people with regard to the composition of the intestinal microbiome. Thus, the two bacterial strains Bacteroidetes and Firmicutes occur in different populations – in normal-weight individuals, in the majority, Bacteroidetes strains were detected, while Firmicutes predominated in overweight individuals. The higher the percentage of Bacteroidetes, the lower the body weight was.

Currently, scientists are increasingly interested in the significance of the bacterial species Prevotella and Bacteroides in connection with the clinical picture of obesity and the corresponding nutritional recommendations. In studies, subjects were divided into different enterotypes depending on which bacterial species dominated – Prevotella or Bacteroides. They were able to show that this classification had a decisive influence on dietary success. If Prevotella dominated, the subjects responded successfully to a nutrition characterized by abundant dietary fiber, especially fiber from whole grain products. If the bacterial strain Bacteroides had the upper hand, then this nutrition was less successful. Instead, a nutrition that promoted bifidobacteria, i.e. foods rich in inulin (parsnips, Jerusalem artichokes, leeks, salsify, and many others), was better able to positively influence metabolism and support weight loss.

Conclusion

Our intestine and its functionality has an immense influence on our health and well-being. For this reason, it is important to do everything possible to maintain intestinal health and take good care of the intestinal inhabitants. This is best achieved with a nutrition that is above all varied and rich in fiber and vital substances (vegetables, herbs, whole grains, legumes) and largely avoids processed foods and products. With a colorful mixture of these foods, as they are also compiled in the Metabolic Balance nutrition plan, the health-promoting intestinal bacteria receive plenty of nourishment and the opportunity to settle diligently in the intestine. In addition, high-quality fats (cold-pressed vegetable oils) and proteins (sea fish, nuts, dairy products, eggs) should not be missing. While fats support the energy production of intestinal cells, proteins (amino acids) are important components for building and repairing damaged intestinal cells.

The Metabolic Balance nutrition plan takes all these criteria into account. Nevertheless, it may well be that participants with long-standing intestinal problems need support at the beginning of the nutritional change due to a very weakened intestinal flora. In this case, pre- and probiotics can be very useful and good.  But – “Keep your eyes open when shopping” – many of these pre- and probiotics contain, in addition to a variety of bacterial strains, plenty of additives, which in turn cancel out the positive effect of the bacterial strains and have an unfavorable effect on the intestinal flora.

For example, Metabolic Basics Probiotics B.26 is recommended. With 26 bacterial strains (100 billion germs) and 24 herbal, spice and fruit extracts, it offers a high concentration and bacterial diversity. At the same time, the herbal and spice extracts have an anti-inflammatory effect on the intestine and facilitate the settlement of important intestinal bacteria in the intestine.

Source:

  1. Yu Q et al. Lactobacillus protects the integrity of intestinal epithelial barrier damaged by pathogenic bacteria. Front Cell Infect Mircobiol. 5:26.
    Doi: 103389/fcimb.2015.00026.
  2. Schumacher B. “Störungen im Darm machen krank“. Ärzte Zeitung 2014 Oct 10; 03:05.
  3. Wehkamp J, Götz M, Herrlinger K, Steurer W, Stange E „Chronisch entzündliche Darmerkrankungen“; Deutsches Ärzteblatt 2016 Feb 5; 113/5
  4. Fischer S. „Genom, Proteom und Mikrobiom – Ein mikrobiologischer Blick in den menschlichen Organismus. Die Naturheilkunde 5/2015
  5. Francesco Asnica et. Al: Microbiome connections with host metabolism and habitual diet from 1098 deeply phenotyped individuals; Nature Medicine (2021; DOI: 10.1038/s41591-020-01183-8)
  6. Christensen L., Roager H. m., astrup a., Hjorth m. f. (2018): microbial enterotypes in personalized nutri-tion and obesity management. am J Clin nutr 108 (4): 645–651
  7. Hjorth m. f., Roager H. m., Larsen T. m., Poulsen S. K.,Licht T. R. Bahl m. I., Zohar Y., astrup a. (2018): Pre-treatment microbial Prevotella-to-Bacteroides ratio, determines body fat loss success during a 6-month randomized controlled diet intervention. Int J Obes 42 (3): 580–583

Cholesterol – Facts and Myths

Many people cringe when “cholesterol” is mentioned as it is associated with unpleasant topics such as obesity and disease. But what actually is cholesterol and is it really as harmful as many fear? Who is affected by high cholesterol levels and is it enough to abstain from cholesterol-containing foods in order to protect oneself? You will find answers to all these questions in this short summary on cholesterol.

What is cholesterol and what does “LDL” and “HDL” mean?
Cholesterol is a fat-like substance and can be found in all animal foods. Like fat, it does not dissolve in water and must therefore bind to certain proteins (lipoprotein) in order to be transported in the body via the blood (90% of which consists of water) to the various organs.
The most important and best known lipoproteins in this context are HDL (high-density lipoprotein) and LDL (low-density lipoprotein).

LDL supplies the organs and tissues with cholesterol. Excess LDL cholesterol can bind with white blood cells and deposit on the inner walls, usually the arteries, of blood vessels, leading to arteriosclerosis. If these deposits thicken over time, the blood vessels become increasingly inelastic and constrict. In the worst case, this results in complete vascular occlusion, which can trigger coronary heart disease, stroke or heart attack. This is why there is often talk of “bad” or “evil” cholesterol.

HDL cholesterol has the property of binding excess LDL cholesterol from the blood and transporting it back to the liver, which is why it is also called “good” cholesterol.

Myth 1 Cholesterol is fundamentally harmful

WRONG

Cholesterol is not fundamentally harmful, in fact, it is essential to life. Cholesterol is a very important component of the human body and performs a variety of tasks in the organism. It is involved . . .

  • . . . in the construction of cell walls and tissues
  • . . . in the formation of vitamin D
  • . . . in the formation of bile acids for fat digestion
  • . . . in the production of various hormones (cortisone, estrogen, testosterone)

Myth 2 Only very overweight people have high cholesterol levels

WRONG

A high cholesterol level is not visible from the outside and does not necessarily depend on body weight. Most sufferers have no symptoms and do not notice their high cholesterol levels, so the disease often goes undetected and untreated. Both obese and normal-weight people may be affected by an increased level of LDL cholesterol.
In addition to body weight, other risk factors such as an unhealthy lifestyle with increased tobacco and alcohol consumption, lack of exercise and poor nutrition, as well as diseases such as high blood pressure or diabetes play a major role.
In addition, there is also a genetically-related metabolic disease known as familial hypercholesterolemia, in which the affected people often have a strongly elevated LDL cholesterol level already at a young age, which greatly increases the risk of developing cardiovascular disease. So even young people can have a heart attack at a very early age.

Myth 3 Eggs and cholesterol-containing foods are bad for cholesterol levels

WRONG

About two-thirds of the body’s cholesterol is produced in the liver by the body itself. Only one third is ingested through food, of which only about half is actually absorbed by the body.
In healthy people, dietary cholesterol intake has little effect on cholesterol levels because the body can adjust its own production of cholesterol accordingly. Thus, if there is a higher supply of dietary cholesterol, the body’s own production is inhibited.
However, about 20-25% of the population are unable to do so, so that no adjustment of the body’s own cholesterol production takes place, resulting in elevated cholesterol levels in the blood.
This adaptation mechanism can also fail to occur in the case of highly unbalanced nutrition with a high proportion of cholesterol, a lot of saturated fats, few long-chain carbohydrates, such as those found in fruit and highly processed foods, and little fiber. Therefore, it is much more important to develop a healthy and balanced nutrition pattern than to avoid eggs or other cholesterol-containing foods in general. Dietary fats with poor fat quality are considered a major health risk – especially in terms of elevated cholesterol levels.
Saturated fatty acids, such as those found in butter, lard, cream, sausages, meat and cheese, increase cholesterol levels more than the cholesterol in food.Trans fatty acids, which are mainly found in industrially produced foods such as fried foods, pastries, confectionery and convenience foods, also have a negative effect on cholesterol levels, as they increase the “bad” LDL cholesterol and lower the “good” HDL cholesterol.

Nutrition tips:

In order to control cholesterol levels through nutrition, the most suitable diet is one that uses a lot of

  • fiber-rich foods such as oats, pulses, apples and vegetables and that inhibits cholesterol intake.
  • vegetable oils with high omega-3 fatty acid content such as linseed oil, walnut oil and hemp oil and thus supports the cardiovascular system. However, nuts and seeds are also an ideal supplement.
  • green tea. It is rich in cell-protecting antioxidants, but also saponins, which can bind cholesterol and inhibit fat absorption from food.

Conclusion:

With the Metabolic Balance nutrition concept and the individual selection of foods, the basis for a healthy cholesterol level is laid. In addition,   

  • exercise in everyday life
  • limiting alcohol and tobacco consumption and
  • reducing stress

can have a positive effect on cholesterol levels.
You want to go deeper into the topic? Then read the article written by Silvia Bürkle, nutritionist and co-founder of Metabolic Balance here.

Cholesterol under control!

Cholesterol is essential for human life. It is not only a necessary component of cell membranes, but also an important starting material for the production of sex hormones in the adrenal grands, ovaries and testicles. In addition, vitamin D, which is so important for our metabolism, is formed from cholesterol under the skin. Most cholesterol is needed for the production of bile acid in the liver. Due to the many functions of cholesterol in the body, it is also able to produce cholesterol itself. This means that 90% of the daily amount of cholesterol needed is produced by the liver. In contrast, only 10% of total cholesterol is absorbed with food.

Cholesterol is a fat-like substance and, like triglycerides and long-chain fatty acids, is insoluble in water, i. e. it cannot circulate freely in the blood (blood consists of 70% water). Therefore, the fats are transferred to a water-soluble form, the so-called lipoproteins.

The exogenous metabolic pathway
Dietary fats absorbed through the intestine – cholesterol, triglycerides and long-chain fatty acids – are packed in lipoprotein shells in the intestinal wall and thus enter the vascular system via the lymph channels. From there they are distributed throughout the body. With the help of enzymes, triglycerides and individual fatty acids are broken down, which are needed for energy production and various metabolic processes. The remaining residual particles are absorbed by the liver.

The endogenous metabolic pathway
The liver produces various lipoproteins from the residual particles, among other things LDL cholesterol. The LDL is absorbed into the cells via special LDL receptors found on almost all cell types and thus removed from the bloodstream. Unfortunately, the absorption of LDL cholesterol into cells is not unlimited. If the supply of cholesterol from the blood exceeds the needs of the cells, the LDL receptors on the cell surface are reduced and the cells absorb less and less LDL cholesterol from the blood.
As a result, a large part of the LDL cholesterol present in the blood oxidizes and is absorbed by the immune system’s scavenger cells (macrophages). So-called “foam cells” are formed, which contain large amounts of cholesterol. Over time, these cells die off and release cholesterol crystals, which promote the deposition of plaques in damaged vessels – arteriosclerosis develops.

HDL cholesterol is formed in the intestine and liver as well as in the blood while metabolizing other lipoproteins. These can – and this distinguishes them from other lipoproteins present in the blood – absorb oxidized LDL cholesterol and transport it back to the liver, where it is then used to produce bile acids.

Primary and secondary lipometabolic disorders
Approximately 30 percent of diagnosed hypercholesterolaemia are primary or familial hypercholesterolaemia. Primary or familial hypercholesterol anaemia is attributed to a gene defect. This gene defect causes fewer LDL receptors to be formed on the cells and thus reduces the absorption of cholesterol into the cells – with the result that the LDL concentration in the blood rises rapidly. 
Often, however, an elevated cholesterol level is secondary. The reason for this may be, for example, a nutrition that is too rich in fats, which in particular contains too many saturated fatty acids and trans fatty acids. But a nutrition high in carbohydrates and low in fiber also contributes to this. Diseases such as hypothyroidism, diabetes or renal dysfunction can also cause elevated cholesterol levels. Furthermore, medication such as cortisone, antihypertensives or beta-blockers are suspected of having a negative effect on cholesterol levels.

What role does nutrition play?
Dietary and lifestyle changes are core elements of prevention and treatment of dyslipidemia.
In general, a nutrition that is simply low in cholesterol is not recommended. The cholesterol in food usually has only a small effect on blood levels. It is much more important to have a balanced nutrition in which, besides high-quality vegetable omega-3 oils, sea fish, lots of fresh vegetables, herbs, fruits, as well as high-fiber foods are on the menu.

Influence of carbohydrates on cholesterol levels
A low-carbohydrate nutrition has a positive effect on blood lipid levels and cholesterol. This was observed by scientists in a study of nearly 180 overweight middle-aged men. In the subjects who only met their energy requirements with carbohydrates for a quarter instead of a half, the harmful triglyceride levels and unhealthy LDL cholesterol in the blood already showed a decrease after three weeks. This effect was also observed if the participants did not lose weight.
The explanation for this is provided by the metabolic intermediate product acetyl-CoA. It is produced during the breakdown of carbohydrates, fats and proteins, is needed for energy production and at the same time is also the starting substance for the body’s own cholesterol synthesis. With a high consumption of carbohydrates, especially those with a high glycemic load, more acetyl-CoA molecules are formed, which then stimulate cholesterol formation when no energy is needed, for example in the form of exercise and activity.

Vegetables – cholesterol-lowering
Fiber-rich foods, which are mainly rich in soluble fiber, such as apples, pulses and oats, have a positive influence on LDL levels. Their direct effectiveness is mainly based on their ability to bind bile acids in the intestine and excrete them. The more bile acids are bound and disposed of in the intestine by the soluble fiber, the less cholesterol is reabsorbed into the bloodstream. As a result, the liver removes more cholesterol from the bloodstream for the production of bile acid – the level of LDL cholesterol in the blood drops.

In addition to soluble fiber, plant foods also offer a special group of bioactive substances, the so-called plant sterols (phytosterols). These are particularly useful in reducing the absorption of cholesterol from the intestines into the bloodstream.
Plant sterols compete on the micelles in the small intestine with the absorption of cholesterol, so that cholesterol in the presence of plant sterols is increasingly excreted in the stool. This also means that less cholesterol is absorbed into the body, whether it is food cholesterol or the cholesterol that enters the intestines with bile acid. Plant sterols are found naturally in vegetable oils, pumpkin seeds, sunflower seeds or pine nuts and other nuts.

In addition to abundant fiber and phytosterols, vegetable foods also provide a high proportion of other secondary plant substances (carotenoids, polyphenols, sulfides, etc. ), which may protect LDL cholesterol from oxidation. The free radicals that accumulate in the body during the metabolic process or also due to stress are absorbed by the antioxidants and thus prevent them from joining with the cholesterol-containing fat particles.

Avoid hidden fats
The quality of dietary fats also has a major influence on the concentration of lipoproteins. Neither cholesterol nor fats are “dangerous” substances, but essential to life. The problem is usually that too many fats with an unfavorable fatty acid composition are consumed. A scientific study shows that on average 70 % of the daily amount of fat is absorbed as hidden fat (e. g. in sausage, cheese, chocolate, sweet pastries, snacks etc. ). However, it is now known that the fatty acid pattern in nutrition influences the composition, size and oxidation tendency of LDL cholesterol.
Therefore, the focus should be on monounsaturated and polyunsaturated fatty acids. A wide variety of studies have shown that replacing saturated fatty acids and trans fatty acids with omega-3 fatty acids (sea fish, cold-pressed vegetable oils, walnuts, seedlings) helps to activate the LDL receptors on the cells to absorb more LDL cholesterol.

Conclusion:
With a balanced nutrition rich in vital substances, as well as by avoiding industrially processed foods and a healthy lifestyle, which means integrating exercise into everyday life and reducing stress, a secondary lipometabolic disorder can be kept in check. At the same time, other risk factors for cardiovascular diseases such as high blood pressure or blood sugar as well as obesity can be reduced.
In the Metabolic Balance metabolic program, analysis of blood values can determine whether the problem is primary or secondary hypercholesterolemia. Not only values such as total cholesterol, HDL or LDL cholesterol are decisive, but also glucose and triglyceride values must be taken into account in order to be able to make the appropriate nutrition recommendations. Simply avoiding foods high in fat and cholesterol can only reduce elevated cholesterol levels to a limited extent.

Sources:

  1. Scholz R: Medizinische Biochemie, Band 9/10 „Cholesterin, Lipoproteine und Steroidhormone“, Zuckschwerdt-Verlag
  2. Deutsche Gesellschaft für Ernährung e.V. Evidenzbasierte Leitlinie: Fettkonsum und Prävention ausgewählter ernährungsbedingter Krankheiten. Version 2015; http://www.dge.de
  3. Deutsche Gesellschaft für Ernährung e.V. Evidenzbasierte Leitlinie: Kohlenhydratzufuhr und Prävention ausgewählter ernährungsbedingter Krankheiten. Version 2011; http://www.dge.de
  4. Worm,N., Mehr Fett. Warum die etablierten Ernährungsempfehlungen nicht haltbar und potenziell gefährlich sind. Ernährung & Medizin 27 (2012)57-63
  5. Bantal, Ganapathi; George, Belinda (2012): Low density Lipoprotein cholesterol target. Changing goal posts. In: India journal of endocrinology and metabolism 16 (suppl 2), S233-5. DOI:10.4103/2230-8210.104047

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