Lipids and Metabolic Health
by Dr. Dan Kalish
A recent research study found that 88% of Americans had a damaged metabolism, meaning that only 12% of people in the US have maintained normal metabolic health. This sounds horrific and a little hard to believe until you walk around any US city, large or small, and look at the fitness level and body fat level of the average American. Obesity, high cholesterol, high triglycerides, poor blood sugar control, all the signs and symptoms of metabolic health in crisis now define the majority of us. And you don't have to look far back in time to see this is new.
I was struck by a photo album I saw in a bookstore years ago that had pictures of regular Americans, just plain working folk, from the 1930’s. Everyone was rail thin. In fact, most of them would be taken to have an eating disorder in our current culture that has normalized obesity. Even looking back at photos from the 1970’s you can see the difference. There just weren’t that many overweight people, and by our current standards, most looked painfully thin.
In studying this shattering of our collective metabolic health, I’ve focused this past year or two on looking at the role of lipids, or fatty acids, in the development of metabolic dysfunction. Lipids are complicated to say the least. We eat fat and a lot of it. Your liver makes fat in a process called de novo lipogenesis. We burn up fat for energy, it’s the body’s main fuel. And if you eat too much fat it’s bad, but if you eat too many carbs it can get even worse as excess carbohydrates are converted directly into – you guessed it – fat. So while eating fat can make you fat, eating excess carbs can cause the same problem, and a high fat and high sugar diet will damage your blood vessels. Interestingly, 121 million Americans suffer from some form of heart disease and heart disease treatments, while excellent in many respects, could be avoided entirely if we employed functional medicine treatments in a preventive fashion.
Poor lipid management leads to chronic fatigue, sleep disorders and insomnia, brain health and hormone health crises and a variety of other conditions. Why? Well, our primary energy source for mitochondrial energy production (up to 90% while at rest and after a meal) comes from fatty acids like palmitic, low omega 6 levels (a key type of fatty acid) results in lack of REM sleep, 60% of your brain is made from fat and brain cell connections and transmission of nervous system information relies upon the myelin sheath that covers your brain cells which is, yup, made out of fats. And crazy as this may sound, ALL of your steroid hormones are made from fatty acids, including testosterone, estrogen, progesterone, cortisol and DHEA. So lipid problems lead to low sex hormones, poor brain cell transmission, messed up mitochondrial energy production and on and on it goes. Treatment for fatigue, boosting brain and hormone health and getting better sleep often relies upon correcting low fatty acids.
We order a fatty acid profile on every patient I work with, and more often than not, find dramatic deficiencies on omega 3 or omega 6 fatty acids. Of course, many people suffering from metabolic syndrome, while low in omega 3 or omega 6 fats, can simultaneously be high in saturated fats. This is emblematic of metabolic dysfunction as the liver starts to make excess fatty acids and the fatty acids you eat and make are not broken down effectively. The pathway that breaks down fats for energy is called beta oxidation and the key nutrient that runs this pathway is carnitine. Carnitine deficiencies or poor diets with excess carbohydrates can each contribute to excess saturated fats, high cholesterol and at the end of a long process your liver accumulates excessive fat which will further exacerbate metabolic health.
In functional medicine, we can test all these various aspects of your metabolism and determine where the blocks to health are located. Fat burning, carb burning, the mitochondria themselves, oxidative stress that damages your LDL cholesterol, damage to lipids or fatty acids from oxidative stress can specifically be checked along with the major fat soluble antioxidants that are there to protect your heart and blood vessels from damage. You can even measure glutathione levels in a dozen different ways looking at the amino acids used to make glutathione along with functional assessments for glutathione levels. The depth of insight provided by functional medicine laboratory tests into metabolomics is profound. In addition, many practitioners also run genomic tests, looking for SNPs, which are small defects present in all of us, that can add up to cause significant metabolic issues.
This new era of functional medicine looking at metabolomics and genomics allows for the development of truly personalized nutrition and lifestyle programs that can restore metabolic health. In this next gen approach, heart disease treatment using conventional medical approaches such as statins (medications to lower your cholesterol) can be given side-by-side with personalized nutritional protocols that take into account your unique metabolic defects alongside any genetic issues your body may be struggling with. I see this as the future of medicine where we can combine the best of science and nature into programs that can make a difference in the lives of patients.