The Liver: Your Metabolic Gatekeeper

As I've been learning more about the different blood markers of metabolic dysfunction, something suddenly occurred to me. Most of them reflect liver function! Elevated fasting glucose, low HDL cholesterol, high LDL cholesterol, high triglycerides and high fasting insulin all reflect (at least in part) liver function. The liver is the "Grand Central Station" of cholesterol and fatty acid metabolism, to quote Philip A. Wood from How Fat Works. It's also critical for insulin and glucose control, as I'll explain shortly. When we look at our blood lipid profile, fasting glucose, or insulin, what we're seeing is largely a snapshot of our liver function. Does no one talk about this or am I just late to the party here?!

I read a paper today from the lab of C. Ronald Kahn that really drove home the point. They created a liver-specific insulin receptor knockout (LIRKO) mouse, which is a model of severe insulin resistance in the liver. The mouse ends up developing severe whole-body insulin resistance, dramatically elevated post-meal insulin levels (20-fold!), impaired glucose tolerance, and elevated post-meal and fasting glucose. Keep in mind that this all resulted from nothing more than an insulin resistant liver.

LIRKO mice had elevated post-meal blood glucose due to the liver's unresponsiveness to insulin's command to take up sugar. Apparently the liver can dispose of one third of the glucose from a meal, turning it into glycogen and triglycerides. The elevated fasting glucose was caused by insulin not suppressing gluconeogenesis (glucose synthesis) by the liver. In other words, the liver has no way to know that there's already enough glucose in the blood so it keeps on pumping it out. This is highly relevant to diabetics because fasting hyperglycemia comes mostly from increased glucose output by the liver. This can be due to liver insulin resistance or insufficient insulin production by the pancreas.

One of the interesting things about LIRKO mice is their dramatically elevated insulin level. Their pancreases are enlarged and swollen with insulin. It's as if the pancreas is screaming at the body to pick up the slack and take up the post-meal glucose the liver isn't disposing of. The elevated insulin isn't just due to increased output by the pancreas, however. It's also due to decreased disposal by the liver. According to the paper, the liver is responsible for 75% of insulin clearance from the blood in mice. The hyperinsulinemia they observed was both due to increased secretion and decreased clearance. Interestingly, they noted no decline in beta cell (the cells that secrete insulin) function even under such a high load.

Something that's interesting to note about these mice is they have very low blood triglyceride. It makes sense since insulin is what tells the liver to produce it. Could this have something to do with their lack of beta cell dysfunction?

The really strange thing about LIRKO mice is that their blood glucose becomes more normal with age. Strange until you see the reason: their livers are degenerating so they can't keep up glucose production!

LIRKO mice reproduce many of the characteristics of type II diabetes, without degenerating completely into beta cell death. So insulin resistance in the liver appears to reproduce some elements of diabetes and the metabolic syndrome, but the full-blown disorders require other tissues as well. As a side note, this group also has a skeletal muscle-specific insulin receptor knockout which is basically normal. Interesting considering muscle tissue seems to be one of the first tissues to become insulin resistant during diabetes onset.

So if you want to end up like your good pal LIRKO, remember to drink high-fructose corn syrup with every meal! You'll have fatty liver and insulin resistance in no time!

I have a lot more to say about the liver, but I'll continue it in another post.

Makanan Yang dipantang dan dianjurkan dikonsumsi oleh Penderita Kanker, khususnya Kanker Payudara.

Larangan atau Pantangan Penderita Kanker Payudara.
Jika kita sudah terserang kanker payudara, kita harus menghindari atau mengurangi asupan konsumsi beberapa jenis makanan. Karena ada kalanya makanan atau minuman tertentu akan memacu pertumbuhan sel abnormal, termasuk kanker payudara. Ada diantaranya yang mengandung zat tumbuh yang jika diasup akan merangsang pembesaran kanker. Ada pula yang mengandung karsinogenik akibat proses pengawetan. Dan ada pula yang jika dikonsumsi akan mengurangi efek kerja obat dalam tubuh.

Beberapa makanan dan minuman yang dianjurkan untuk menghindari atau dikurangi konsumsinya:
1. Tauge
2. Vetsin
3. Tape
4. Es
5. Cabai
6. Kurangi garam
7. Lengkeng
8. Alkohol
9. Nenas
10. Sawi putih
11. Daging merah
12. Rokok
13. Nangka
14. Durian
15. Soft drink
16. Kangkung
17. Ikan asin

Anjuran dalam Masa Pengobatan Kanker Payudara.
Terdapat beberapa bahan makanan yang dianjurkan untuk dikonsumsi secara rutin. Konsumsinya boleh hanya satu jenis bahan saja atau campuran dari beberapa bahan. Jika kita sedang terserang kanker payudara, dianjurkan untuk meminum jus bahan-bahan makanan berikut, lakukan dua kali satu gelas setiap hari.
1. Wortel
2. Lobak
3. Pisang raja
4. Belimbing manis
5. Seledri
6. Brokoli
7. Kubis
8. Apel
9. Bawang putih

Minum juga susu kedelai setengah gelas, lakukan dua kali sehari, atau konsumsi selalu 100 gram tempe setiap hari.
Aneka Sayuran Hijau Pencegah Kanker:
1. Buncis
2. Daun singkong
3. Kacang panjang
4. Daun pepaya
Menurut Dr. Vivi K. Tjahjadi, dari Karyasari, obot untuk kanker payudara adalah rebusan sambiloto, kunir putih, rumput mutiara dan keladi tikus, diminum pagi siang dan sore. Ramuan ini jika diminum 12 hari, lambat laun rasa nyeri akan berangsur hilang dan benjolan juga hilang. Payudara akan kembali seperti semula tanpa rasa sakit. Dengan minum ramuan ini kanker payudara berpeluang benar-benar sembuh.
(Sumber :http://bima.ipb.ac.id/~anita/kanker_payudara.html)

Book Review: Blood Sugar 101

I just finished reading "Blood Sugar 101" by Jenny Ruhl. It's a quick read, and very informative. Ruhl is a diabetic who has taken treatment into her own hands, using the scientific literature and her blood glucose monitor to understand blood sugar control and its relationship to health. The book challenges some commonly held ideas about diabetes, such as the notion that diabetics always deteriorate.

She begins by explaining in detail how blood glucose is controlled by the body. The pancreas releases basal amounts of insulin to make glucose available to tissues between meals. It also releases insulin in response to carbohydrate intake (primarily) in two bursts, phase I and phase II. Phase I is a rapid response that causes tissues to absorb most of the glucose from a meal, and is released in proportion to the amount of carbohydrate in preceding meals. Phase II cleans up what's left.

In a person with a healthy pancreas, insulin secretion will keep blood glucose under about 130 mg/dL even under a heavy carbohydrate load. The implications of this are really interesting. Namely, that blood glucose levels will not be very different between a person who eats little carbohydrate, and one who eats a lot, as long as the latter has a burly pancreas and insulin-sensitive tissues.

Most Americans don't have such good control however, hence the usefulness of low-carbohydrate diets. This begs the question of why we lose blood sugar control. Insulin resistance seems like a good candidate, maybe preceded by leptin resistance. As you may have noticed, I'm starting to think the carbohydrate per se is not the primary insult. It's probably something else about the diet or lifestyle that causes carbohydrate insensitivity. Grain lectins are a good candidate in my opinion, as well as inactivity.

Diabetics can have blood glucose up to 500 mg/dL, that remains elevated long after it would have returned to baseline in a healthy person. Ruhl asserts that elevated blood sugar is toxic, and causes not only diabetic complications but perhaps also cancer and heart disease.

Heart attack incidence is strongly associated with A1C level, which is a rough measure of average blood sugar over the past couple of months. It makes sense, although most of the data she cites is correlative. They might have seen the same relationship if they had compared heart attack risk to fasting insulin level or insulin resistance. It's difficult to nail down blood sugar as the causative agent. More information from animal studies would have been helpful.

Probably the most important thing I took from the book is that the first thing to deteriorate is glucose tolerance, or the ability to pack post-meal glucose into the tissues. It's often a result of insulin resistance, although autoimmune processes seem to be a factor for some people. Doctors often use fasting glucose to diagnose diabetes and pre-diabetes, but typically you are far gone by the time your fasting glucose is elevated!

I like that she advocates a low-carbohydrate diet for diabetics, and lambasts the ADA for its continued support of high-carbohydrate diets.

Overall, a good book. I recommend it!

Atasi Nyeri Haid dengan Herbal Alami

Hampir seluruh perempuan di dunia pernah merasakan nyeri haid (Dismenorea), tentu saja dengan berbagai tingkatan mulai dari sekadar pegal-pegal di seputaran panggul dan sisi dalam hingga rasa nyeri yang luar biasa sakitnya. Namun, tak perlu khawatir karena nyeri haid itu bukanlah suatu penyakit, melainkan gejala yang timbul akibat adanya kelainan dalam organ panggul. Bila kelainan itu diobati, maka nyeri haid akan hilang dengan sendirinya.

Seperti dikemukakan dr Boy Abidin SpOG dari RS Mitra Keluarga Kelapa Gading dalam acara media workshop, di Jakarta, pekan lalu, nyeri yang terasa dibawah perut itu biasanya terjadi pada hari pertama dan kedua haid. Derajat nyeriberkurang setelah keluar darah yang cukup banyak.

Penyebabnya secara alamiah bermacam-macam, dari meningkatnya prostaglandin sampai dengan perubahan hormonal ketika mulai haid, dan bahkan kecemasan yang berlebihan. Bila ditilik dari faktor penyebabnya, dr Boy membagi dalam dua kategori nyeri haid, yaitu primer dan sekunder.

"Untuk yang primer, faktor penyebabnya sering tak diketahui dengan pasti. Tetapi untuk nyeri haid sekunder, hampir sebagian besar disebabkan oleh kelainan dalam organ panggul," kata dr Boy seraya menyebut kelainan panggul itu antara lain endometriosis, infeksi, kelainan rahim sampai dengan penggunaan alat kontrasepsi dalam rahim.

Angka kejadian nyeri haid di dunia sangat besar. Rata-rata lebih dari 50 persen perempuan di setiap negara mengalaminya. Di Amerika angka prosentasenya sekitar 60 persen dan di Swedia 72 persen.

"Sementara di Indonesia angkanya diperkirakan mencapai 55 persen perempuan usia produktif tersiksa oleh nyeri selama haid. Harap dicatat, sebagian dari perempuan yang terserang gejala nyeri haid yang berat bahkan tak mampu beraktifitas," katanya.

Untuk mengantisipasi nyeri haid, menurut dr Boy Abidin, ada beberapa terapi yang bisa dilakukan. Disebutkan, antara lain, terapi anti prostaglandin, terapi hormonal, terapi bahan alami, dan tentu saja menjalani pola hidup sehat.

"Dua terapi pertama jelas melibatkan seorang dokter. Tapi untuk terapi bahan alami dan pola hidup sehat bisa dilakukan sendiri. Seperti memperhatikan asupan gizi seimbang, istirahat cukup dan olahraga sesuai kebutuhan," ujar dr Boy Abidin menyodorkan terapi alternatif itu.

Tapi masalahnya, sekarang ini banyak perempuan yang berkarir di luar rumah yang seringkali kesulitan waktu untuk melakukan hal-hal sehat semacam itu?

Pilihan berikutnya adalah terapi bahan alami. Sudah semakin lazim tren kembali ke alam. Tak mengherankan jika semakin banyak asupan berbahan alami ataupun herbal ditawarkan sebagai "obat" atau minuman pengurang nyeri haid.

Menurut Dr Dyah Iswantini, MAgr dari Pusat Studi BioFarmaka IPB, ada sejumlah herbal alami yang digunakan untuk menjaga kesehatan perempuan seperti licorice, damiana, tabat barito, dong quai, chaste tree berry, black cohos, labisia pumila dan kunyit.

Berdasarkan Artikel pada Majalah Herba Edisi Januari 2005, Tanaman Baru Cina, Daun Ungu, Myana dan Kunyit Putih juga sangat efektif mengatasi nyeri haid. Dosis yang dianjurkan untuk terapi ini adalah sebesar 3x1 kaps/hari dengan dosis perkapsul adalah 500 mg. Sedangkan produk Herbal import yang cukup efektif untuk mengatasi gangguan saat haid adalah tumbuhan Primerose.

Namun produk/tanaman herba ini tidak dianjurkan Untuk wanita yang sedang hamil dan menyusui karena dapat membahayakan kandungan dan pertumbuhan bayinya. (T-1)

Sumber : - Suara Merdeka Online

- Majalah Herba Edisi Januari 2005

Olive Oil Buyer's Guide

Olive oil is one of the few good vegetable oils. It is about 10% omega-6 (n-6) fatty acids, compared to 50% for soybean oil, 52% for cottonseed oil and 54% for corn oil. Omega-6 fatty acids made up a smaller proportion of calories before modern times, due to their scarcity in animal fats. Beef suet is 2% n-6, butter is 3% and lard is 10%. Many people believe that excess n-6 fat is a contributing factor to chronic disease, due to its effect on inflammatory prostaglandins. I'm reserving my opinion on n-6 fats until I see more data, but I do think it's worth noting the association of increased vegetable oil consumption with declining health in the US.

Olive oil is also one of the few oils that require no harsh processing to extract. As a matter of fact, all you have to do is squeeze the olives and collect the oil. Other oils that can be extracted with minimal processing are red palm oil (9% n-6), hazelnut oil (10% n-6) and coconut oil (2% n-6). These are also the oils I consider to be healthy. Due to the mild processing these oils undergo, they retain their natural vitamin and antioxidant content.

You've eaten corn, so you know it's not an oily seed. Same with soybeans. So how to they get the oil out of them? They use a combination of heat and petroleum solvents. Then, they chemically bleach and deodorize the oil, and sometimes partially hydrogenate it to make it more shelf-stable. Hungry yet? This is true of all the common colorless oils, and anything labeled "vegetable oil".

Olive oil is great, but don't run out and buy it just yet! There are different grades, and it's important to know the difference between them. The highest grade is extra-virgin olive oil, and it's the only one I recommend. It's the only grade that's not heated or chemically refined in any way. Virgin olive oil, "light" olive oil (refers to the flavor, not calories), "pure" olive oil, or simply olive oil all involve different degrees of chemical extraction and/or processing. This applies primarily to Europe. Unfortunately, the US is not part of the International Olive Oil Council (IOOC), which regulates oil quality and labeling.

The olive oil market is plagued by corruption. Much of the oil exported from Italy is cut with cheaper oils such as colza. Most "Italian olive oil" is actually produced in North Africa and bottled in Italy, and may be of inferior quality. The USDA has refused to regulate the market so they get away with it. If you find a deal on olive oil that looks too good to be true, it probably is.

Only buy from reputable sources. Look for the IOOC seal, which guarantees purity, provenance and freshness. IOOC olive oil must contain less than 0.8% acidity. Acidity refers to the percentage of free fatty acids (as opposed to those bound in triglycerides), a measure of damage to the oil. Fortunately, the US has a private equivalent to the IOOC, the California Olive Oil Council (COOC). The COOC seal ensures provenance, purity and freshness just like the IOOC seal. It has outdone the IOOC in requiring less than 0.5% acidity. COOC-certified oils are more expensive, but you know exactly what you're getting.

Thanks to funadium for the CC photo