Chapters 8 and 9

Pg. 123 "In fact, there are really only two processes that handle energy properly--growing or burning. And there are two proper outcomes--living or dying. Every cell has to grow at one time in its life versus burn at another time--but never both at the same time."

Pg. 130 "As you might expect, mTOR is highly sensitive to diet. A high-protein composition of your diet activates mTOR, thereby promoting cell division, development of lean body mass, insulin sensitivity, and bone and cardiovascular health. Conversely, caloric deprivation leads to lowering ATP levels, which reduces mTOR, making growth an impossibility. Also, activating AMP-kinase can shut down mTOR in its tracks because now you're burning, not growing."

Pg. 130 "These three enzyme checkpoints together explain how the cell metabolizes energy: PI3-kinase imports glucose into the cell; AMP-kinase directs the energy to mitochondria for burning; and mTOR determines whether a cell lives or dies. While cell metabolism has everything to do with energy, it has nothing to do with calories."

Pg. 137 "When I entered medical school in 1976, the upper limit of normal (two standard deviations from the mean) for liver enzyme alanine aminotransferase (ALT) was 25. Now the cutoff on the lab slip says 40. How come? Did the ALT assay change? The name changed (back then it used to be called SGPT), but the assay is the same. So why is the cutoff 15 points higher--maybe because humans changed? Yes, because 45 percent of the general population now has some modicum of fatty liver disease, and the entire "normal" distribution has shifted to the right."

Pg. 145 "A fasting insulin of greater than 15 microunits/ml usually means significant insulin resistance, and risk for metabolic disease. From the glucose and insulin levels together, you can calculate an index called the homeostatic model assessment of insulin resistance (HOMA-IR = glucose x insulin / 405), which assesses your risk for diabetes. A HOMA-IR less than 2.8 is excellent, 4.3 is average, and anything higher means trouble." For the record, based on my lab results from 6/2/21, my HOMA-IR score is 5.59.

Pg. 146 Lab criteria for diagnosis

Fatty liver disease: ALT > 25 in Caucasians, > 20 in African Americans, > 30 in Latinos; GGT > 35; Urice acid > 5.5

Glucose intolerance: Fasting glucose > 100 or 2-hour glucose > 140; HbA1c > 6.0 percent

Type 2 diabetes: Fasting glucose > 126 or 2-hour  glucose > 200; HbA1c > 6.5 percent

Dyslipidemia and heart disease: Lipid profile TG > 150, HDL < 40, TG:HDL > 2.5, LDL-C > 300, LDL-P > 1000; Homocysteine > 15

Insulin resistance: Fasting insulin > 15

Insulin hypersecretion:
3-hour OGTT with insulin levels; measure insulin secretion and resistance indices.


Any chance you would be willing to share your entire lab results?
2021-06-24 14:58:18
I will be exploring that topic in a future newsletter.
2021-06-24 18:23:47
WHAT??? Is this how the ranges in the lab reports are created? 


So why is the cutoff 15 points higher--maybe because humans changed? Yes, because 45 percent of the general population now has some modicum of fatty liver disease, and the entire "normal" distribution has shifted to the right."


This makes me feel like I have been over reacting to certain things and definitely under reacting to some. How can I trust the bloodwork after this? 

Anyway - thank you for sharing this. 
2021-06-26 00:11:29
I've had several conversations with my doctor in which he's stated that even though the report says I'm in the "normal" range, the result is still not optimum. You can trust your actual numbers, but you cannot trust the ranges or what the report reflects as "low" or "high." 
2021-06-26 14:25:24

Metabolical - Book Darts