Part 2.2 Fats - Triglycerides and Essential Fatty Acids

From the previous blog post, you're familiar with saturated and unsaturated fatty acids. Now we’ll look at how we obtain and use fats (synonyms: fatty acids, triglycerides. lipids), how much we need/don’t need, and why.

Triglycerides (TG): You’ve seen this term on every blood panel your doctor has ever ordered, but what does it mean and why should we care? Fasting blood-borne TG levels higher than 150 mg/dL correlate with increased risk for heart disease, fatty liver disorder, early onset type II diabetes, kidney disorders and pancreatitis (Article). Usually the effects are asymptomatic until something alarming happens and we find a doctor. TG blood screens are recommended yearly to identify high levels before they cause problems.

Triglyceride with 1) Palmitic acid, 2) Oleic acid and 3) Linoleic acids hitched on. Notice different saturation.

We get fats from two different sources: 1) our diet, 2) our liver synthesizes them from other molecules in our bodies including glucose. Yes, when you eat excess sugar, your liver uses it to make fat. (Bummer). In plants and animals, fatty acids tend to travel in threes hitched to a glycerol molecule. The glycerol carrier molecule isn’t choosy about who hooks into those three sites, so one glycerol ‘car’ can have three different fatty acid ‘riders’ varying in length or saturation-style (see image). If only one FA is hooked up, it’s a mono-glyceride, if two, a di-glyceride, and three, a tri-glyceride. This latter form is how fats mostly occur in our bodies. TGs are very large energy-dense molecules, and a lean adult has enough TG stored in them (about 15 kg or 33 pounds) to survive for more than 2 months.

For us to access the energy in dietary fats, our digestive process performs a multi-step process to break TGs down into molecules small enough to cross the intestinal lining.

Feasting: When we eat, 1) we break large fat particles into smaller ones by chewing and stomach churn. 2) most TG disassembly happens in the small intestine where enzymes rip two fatty acids off the glycerol triple-carrier to liberate free fatty acids and mono-glycerides. 3) These smaller molecules are emulsified further by the addition of bile, and are finally able to cross the microvilli membrane into the intestinal cells. 4) Once inside the intestinal cells, the TGs are reassembled into their prior triplet form, and packaged with other goodies like cholesterol and fat-soluble vitamins (A,D,E), into shipping containers called chylomicrons. 5) The chylomicron containers are shipped into the intestinal lymph system and thence into the bloodstream to deliver TGs, vitamins and cholesterol to the tissues. If cells don’t need the energy, excess TGs are instead delivered to our storage units - adipose tissue for later use. Chylomicrons decrease in size as they deliver their load to the periphery and then the empty containers return for recycling in the liver.

Fasting: When we are not eating, 1) “Need Fuel!” signals are released by cells when their energy supplies run low. These signals hit two targets. 2) Our storage units (adipose tissue) react by breaking stored TGs into free fatty acids (mono-glycerides). The mono-glycerides diffuse into the blood, and head off to the cells that need energy, for example, your leg muscle cells if you are going for a walk. 3) The liver responds by constructing new TG’s from the free fatty acids floating in the blood stream plus glucose (we use sugar to make fat!! Bummer again.) 4) The liver packages the TG and some cholesterol and protein into VLDL (very low density lipoprotein) shipping containers and sends them out in the blood. The name very low density means they contain more TG than the accompanying heavier protein and cholesterol. As the traveling VLDL shipping containers drop their TG cargo into energy-requiring cells, they become LDLs, (low density lipoproteins - relatively more protein and cholesterol-laden, see previous post on cholesterol), then IDLs (intermediate density lipoproteins), and then finally HDLs (high density lipoproteins) mostly empty protein vehicles which scavenge cholesterol and return to the liver for recycling and disposal.

TLDR-version: After a meal: blood TG levels spike because chylomicrons are clearing fat from the intestine. Fasting blood TG levels respond to energy requirements via free fatty acids from adipose tissue, and VLDLs from liver.

If the system is working well, TGs disappear into their destinations efficiently, and blood TG levels lower to normal. If the system is consistently overloaded with dietary fats, or confused by lots of sugar-induced insulin, TG blood levels respond by remained elevated and cause trouble in heart and blood vessels, liver, pancreas, kidney and more. How to decrease Triglycerides in your body to optimum levels (less than 150 mg/dL)? There are lots of ways, but the simplest and cheapest are lifestyle choices.

1) Exercise: This burns up extra TG’s floating around and decreases excess levels stored in your adipose tissue.

2) Cooking and eating: Many flavor molecules are fat-soluble which are lost in “fat-free” foods. To makeup for the lack of flavor, processed fat-free foods have sugar added to them to make them more palatable. It’s best to avoid these processed hidden-sugar-laden foods, because type 2 diabetes is risky. Instead, get more creative in the kitchen. Select recipes that are more veggie-forward, discover more pungent and umami-rich ingredients like fermented foods, spices, herbs, mushrooms etc. Instead of frying foods, roast, bake or slow-cook. It’s definitely a life-style change, but one that will benefit your health-span.

3) Drinking and smoking; Decrease alcohol intake and eliminate smoking - both are correlated with increased TGs, metabolic syndrome and morbidity from many causes.

4) Medication or supplementation: Fibrates, Niacin (prescriptions needed) and Essential Fatty Acids somewhat decrease levels of blood TGs.

Essential Fatty Acids (EFA’s) Also called Omega-3s and 6s, these are fats that we get from our diet, most notably fish oils from fish that need insulation in cold water, salmon, sardines, mackerel, steel head trout, cod, (yes, there was a reason for cod liver oil...) as well as flax, walnuts, and leafy green vegetables. The omega nomenclature (biblical reference here, science is not without a sense of humor) tells you how far from the end of the molecule the unsaturated kink is (see the final fatty acid ‘rider’ in the image above). We cannot make these EFA’s in our body and we’ll die without them, hence: essential. They are an important part of cardiac health, vision, inflammation regulation and other important functions. This is why nutritionists are always all over you to eat fatty fish like salmon. If you take the skin off your salmon before you eat it, you are losing much of the oil, so eat the skin! (Salmon skin hint: Grilling makes it even more delicious.) Include these foods in your weekly intake; walnuts, flax, chia seeds, salmon, herring, sardines, oysters, dark leafy greens, pine nuts, Brazil nuts, sunflower seeds/oil, pecans.

Overall takeaway: Balance your fat (triglyeride) intake with lots of healthy food choices, move around to burn off excess energy, eat fish and other delicious foods with EFA’s, and you’ll have solved the fat conundrum, plus you’ll enjoy the wonderful benefits of a healthy heart, liver, pancreas, kidneys and long healthspan.

What Are You Eating?! Part 1: Macromolecules and micromolecules

A healthy diet includes the appropriate amounts of 6 things:

Carbohydrates, fats, proteins, vitamins, minerals and water. A teenage athlete, a pregnant woman, and a sedentary senior all require exactly the same nutrients, but in different proportions based on their activity level and stage of life.

Macromolecules (fats, carbs, proteins) are called such because they are big polymeric (chains of repeating units) molecules, and we need a large quantity of them, usually daily. They supply energy for all activities and building material for tissue repair. We require constant bodily housekeeping to stay healthy. Micromolecules (vitamins and minerals) are small molecules and we don’t require a large quantity, but they are absolutely essential to our existence. For example, sailors who didn’t get enough vitamin C on ocean voyages suffered from scurvy. Vitamin D insufficiency causes bone fragility, Vitamin E deficiency is associated with neurologic issues, and so on.

Nutrition is a complex scientific field involving molecular biology, physiology, neurology, and chemistry, but still bumps up against the mundane everyday need of preparing and eating food. This interface of ever-evolving science vs shopping for groceries can cause consternation among regular folks who don’t have PhDs in the aforementioned subjects. And it opens the door for money-grabs by those taking advantage of the confusion with fad diets and false supplements. Add in factors like health problems caused by psychological issues, Big-Ag pesticides and pharmaceuticals, food inequity due to social injustice and climate change, dearth of scientific education… and the whole thing starts to get overwhelming. One just starts to flounder with the simple question of “What am I eating?!”

Let’s zoom out a little. The reason for much of the confusion is because nutrition is basically biology, so a lot of answers start with “It depends…”. New discoveries are being made all the time. It seems like the federal nutrition guidelines change every few years. They have to because they are based on ever-new research uncovering more facts. Can you imagine that doctors once told their patients to eat margarine??? Now, the dangers of trans-hydrogenated fats to the cardiac system are well-documented.

An aside: During a recent visit to a health professional, a dear friend with cholesterol issues was asked if they were willing to switch from butter to margarine. I almost fell off my snowshoes when he told me this story. After about 60 seconds of apoplectic sputtering and almost having a cardiac event myself, I regained coherence and wondered aloud about the nutrition education of health professionals. Alas, nutrition is quite neglected in most physician’s education.

I believe that food and movement are the underpinnings of health, and these are some of the few things we can control for our entire lives.

SO. For the next few blogs, I will focus on one nutrient at a time and give a basic overview of what, why and how much we need according to recent research. The hope is to improve your ability to winnow bunk from truth, make better choices, and empower you to ask questions about food/supplements claims, whether they come from advertising, your friend’s friend, or your doctor.

Next week: FATS. Why we need them, what they do in our bodies, best sources, amounts, the bigger picture from the inner workings of the cells, to outer effects of our choices on the environment.

Hydration: When, Why, Amount? (Now, Because, Lots...)

We are mostly water (60-70%). Water lubricates our joints, makes up most of our blood and cells, regulates our pH, cushions our organs, and provides the aquatic medium in which we function. Going without water even for a half a day can be very uncomfortable, and longer will seriously affect our health. Clean drinking water is a human right, along with food and shelter.

Basic water requirements for adults is over 10 cups a day but that includes the water we get from food (usually about 20%). Our relationship with water can get complicated, and depends on age, size, climate and activity level, among other things. But before you start moaning about how much time during your day you might have to spend looking for a loo, let’s dig a little deeper.

1) If you rarely feel thirsty and your urine is a pale yellow color, you are adequately hydrated. Keep up the good work.

2) Caffeinated beverages count towards your daily water intake, if you are used to it. There is a mild increase in urination (diuresis) noted, but not enough for the average coffee or tea drinker to worry about.

3) If you exercise a lot and sweat, you’re going to need to drink more water to replace your loss. Electrolytes are an optional perk, but since most people don’t push themselves that hard during exercise, plain water is just fine. Prior to exercise pre-hydrate, then hydrate and re-hydrate.

4) Does drinking warmer water hydrate us more? Drinking water of any temperature will hydrate you. Drinking warm water before a meal will 1) pre-fill your stomach, leading to satiety faster. 2) dissolve and transport certain food stuffs along faster in the GI tract. Even hydrophobic things like fats (think peanut butter) will become more fluid. 3) The warm liquid acts as a vasodilator, widening blood vessels in the digestive system and helps increase blood flow and GI activity (A biomechanical description in the words of a gastroenterologist). Both Ayurvedically and in Chinese Medicine, warm water is advised to balance the body systems. Fine - whatever gets you to drink more water works. The idea that drinking hot water boosts metabolism is a myth, however.

5) Thirst can masquerade as hunger. If you have hunger pangs away from meal times, try drinking a glass of water and notice how you feel, it may do the trick. On the other hand, of you are truly hungry, it will be noticeable a few minutes later, so then you’ll know you need fuel. Sometimes drinking a glass of water allows true feelings such as anxiety or boredom to become recognizable. In which case, maybe drink another glass of water, take a breath, and plan to deal with the issues head on.

6) Environment: If you live in a drier climate, you’ll have to hydrate more. A lot more. We exhale 100% water-saturated air, and a low-humidity environment will not give it back when we breathe in. I really noticed this living in Boulder Colorado (mile-high and parched all the time) vs living in Portland Maine (sea level, much more humid). I had to carry a bottle of water with me all the time in Boulder, and my throat would dry out enough to signal me to drink. I still carry the bottle in Portland, and forget that it’s even there (to my hydration detriment).

7) Body constitution: Some people are simply drier (hair, skin). These are the folks who never had acne as a teen, but are now paying for it with dizzy spells and dry skin issues as adults. I’m one of those, and I’m not sure if the acne trade off was worth it, but I now MUST drink more water and use more skin protection. (This segues into…)

8) Aging: We dry out as we age. Our body composition changes to retain less water in our tissues. Our thirst triggers diminish as we age, and there can be competing effects of medications and illnesses (dry mouth, cramps, palpitations). Sometimes dizziness will alert us, sometimes a skin issue. Start drinking more water over the course of the daytime, and less after the sun goes down so you don’t pee all night.

So how to comfortably increase hydration in our lifestyle?

• Timing: Start drinking more water earlier in the day, and taper off after 7 pm so your sleep is not disturbed by trips to the bathroom. Sip smaller amounts during the day instead of plugging down a large amount at once. Set hourly alarms on your phone or computer to remind you to drink a glass of water. Associate a water intake habit to something you already do frequently.

• Keep a refilled water container (glass or bottle) out and visible in your home, for example on a frequently passed counter, and/or workplace, such as on your desk. The visual cue will be a helpful reminder.

• Carry a water bottle with you. Stash them in your vehicle, at your desk, in your workout gear bag. I have water bottles everywhere so I have no excuses.

• Mix it up: try different sorts of teas in the winter, and sparkling waters with light flavors in the summer. I also maintain a large jar of water with mint in the fridge during the summer for a cool drink.

• Be careful of alcohol consumption - definitely dehydrating. You’ll have to drink more water to make up for the loss. That, plus the diuresis caused by the alcohol will keep you up at night!

• Drink a glass of water with meals. Avoid juices, or dilute them. They are mostly sugary water, and the calories are not helpful.

• ‘Empty the bucket’ before you leave the house, or whenever an opportunity presents itself during the day. Even if you don’t need to. (You’ll always need to).

Garlic – get a press.

Garlic is good for you right? It’s even better if you crush it and let it sit for 10 minutes. Like a cold pack with two compartments that have to be crushed and mixed to get an endothermic (cold) reaction, garlic has compartments with 1) Alliin (precursor) and 2) Alliinase (enzyme). They have to be mashed together for a while (10 min at room temperature is long enough) for the Aliinase enzyme to change the Aliien to Allicin – the much touted sulphur-containing organomolecule with all the health-protective properties. Cooking heat destroys the enzyme Alliinase, thus ending the reaction. To maximize it’s full potential, crush the garlic first and let it sit a bit while you finish chopping the veggies and other prep work. For more reading, try here and here.

Farmers Markets - why shop there?

There are many different reasons.

1) Freshness of food. Likely the food you buy at the Farmers market was picked within 24 hrs. Certain nutrients are light and heat vulnerable and start to decay within a day or so. The 3-week old apple from Chile no longer has the vitamin C, folate or thiamin it started out with.

2) Local is defined as within 100 miles; so within a day to transport. Choosing local means choosing food that has a lower fossil fuel footprint to bring it to you. The apple from Chile was driven, flown and then trucked to the North American grocery store, spending thousands of calories in fossil fuel for the 50 or so calories that it actually provides to the eater.

3) Quality assurance. If you can visit a farm and it has an open and welcoming policy, you can see how they run their business with your own eyes. You can develop a relationship with your farmer and be reassured of the quality of the food you are buying.

4) Economics. A small local Farmer takes home 95% of what you pay them at the Farmers Market, vs 5-15% from the supermarket. Local farmers mostly source their supplies and equipment locally, almost 90% in one study, and create close to 3 times as many jobs per $1M in income. Local farmers spend their money locally too, perhaps even supporting your business. What goes around locally, comes back locally.

In Portland, the Farmers market is Saturdays in Deering Oaks Park and Monument Square from 7-1 until Nov 27th. Then it moves inside to the Girls School on Stevens Avenue near Walton st. for the winter on Saturday mornings only, 9-1.

Probiotics vs Prebiotics

Probiotics are the microorganisms that live in our intestines. They help us digest our food and maintain our health by preventing pathogen attachment, and secreting important molecules such as vitamin K and some B’s. “Prebiotics” is a fancy-schmancy name for dietary fiber that our microorganisms eat to stay viable. Don’t let anyone sell you “pre-biotics”. AIGHHHH! You can eat an apple, vegetables, legumes, nuts or a bowl of oatmeal and be just fine.

Count ingredients, not calories

This is a way of simplifying how to think about healthy food, and ending up with the healthiest body composition and weight possible. How? Eat the healthiest food possible.

The more ingredients an edible item contains, the more likely it is to be processed and further from the original local whole food. Think of the progression from a freshly picked apple to an apple shipped from Chile, to applesauce, to apple pie, to a weird apple turnover-thing wrapped in cellophane that will never decay.

The fewer additions, subtractions, chemical and mechanical processes to which a food is subject, the greater retention of nutrients, vitamins, fiber, freshness and palatability. Instead of reading the caloric value on a package, notice the ingredient list. If it’s really long, have suspicions about it’s quality, flavor and nutrient value. Peanut butter should have peanuts and salt and maybe some extra oil, not peanuts, sugar, salt, hydrogenated cottonseed oil and unpronounceable stabilizers. Here are some comparisons of labels.

Quality of food is the aim here, not quantity of calories. Your body is valuable - feed it amazingly healthy things. If you wouldn’t feed it to a 5 year old (that you like), you shouldn’t eat it either. Aim for foods with very short ingredient lists or those without labels. Foods that have only one ingredient are the ones that will give you the biggest health bang for the buck. And you will probably never have to count calories again.

Apple vs “apple snack pie”