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1670 ROUTE 34 N. 3R FLOOR SUITE 3C WALL • NJ 07727

Michael Rothman MD Articles

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Fatal Four

The “fatal four” are a group of conditions/diseases, which when present, represent major risk factors for catastrophic health outcomes. The fatal four are high blood pressure, diabetes, obesity, and dyslipidemia (abnormal blood lipids). Together, this deadly quartet is known as “metabolic syndrome” or “syndrome X” and is a major cause of heart disease.

What is the cause of “metabolic syndrome”? If you go to your conventional medical doctor, he/she will tell you that it is a combination of genetics and a poor quality diet.

If you indeed have this constellation of conditions, he/she will then advise you to follow a low fat diet. The American Heart Association, the National Cholesterol Education Program and a long list of other mainstream medical groups recommend the low fat diet.

If this dietary intervention fails (and most of the time it does), your doctor will prescribe medications to treat your high blood pressure, medications to treat your abnormal blood lipids, and medications to treat your elevated blood sugars. You may be referred to a cardiologist (for the dyslipidemia and hypertension) and an endocrinologist (for the diabetes). You will also be advised to increase your attention to yourdiet, making sure to carefully omit the “deadly dietary fat”.

Why does the low fat diet fail so often and so miserably? Poor patient compliance? Terrible genetics?

NO! The low fat diet does exactly what all the scientific evidence indicates that it is supposed to do. The low fat diet is also known as the high carbohydrate diet. (There are only three macronutrients available to eat, protein, fat and carbohydrates. So, a low fat diet is a high carbohydrate diet.)

High carbohydrate diets have the following effects; they lead to high blood pressure, they lead to diabetes, they lead to obesity and they lead to dyslipidemia. One of the underlying reasons that high carbohydrate intakes lead to all these problems is that high carbohydrate diets lead to high insulin levels. Patients will invariably end up with a condition known as “insulin resistance”

Now some of you may be asking, what about the good carbs? (Like complex carbohydrates) Surely, they can’t be bad. Well, actually complex carbs (while not as bad as processed carbs, because they contain more fiber, minerals and vitamins) in excess cause the same metabolic imbalances as processed carbohydrates.

What about fruit? Surely, that’s a “good” carb. The facts about fruit sugar are as follows; firstly, fruit sugar is fructose. Fructose has different properties than sucrose (table sugar). Your liver must first process fructose before it can be utilized. Therefore, the initial blood sugar does not rise as rapidly after a high fructose meal (as it does after a high sucrose meal). This was the basis for food corporations to tout fructose as “the good sugar”.

However, fructose causes severe damage above and beyond rising blood sugars. It causes biochemical injuries known as advanced glycosylated end products (AGE’s). AGE’s lead to kidney damage, wrinkles, cardiovascular disease, dementia… (In fact just about any problem will be magnified by AGE’s) and of course high blood pressure, diabetes, obesity and hyperlipidemia.

So, beware of the fatal four. Eat meals that have balanced ratios of protein carbohydrates and fats. Avoid meals that are over filled with carbohydrates.

There are no “good sugars”, only lesser or greater degrees of “bad sugars”.

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