Discover Exactly How Your Body Turns Carbs Into Energy!

Unlock the secrets of your body's energy powerhouse! Ever wondered how that sweet potato powers your gym session or how a doughnut fuels your morning? In this eye-opening video, Dr. Michael Lam dives deep into the fascinating journey of carbohydrates, from your plate to your cells. Discover the intricate biochemical processes that transform carbs into the energy that keeps you going.

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Transcript

Dr. Michael Lam: 0:00

This is a discussion for our providers on how to understand the body's carbohydrate metabolism. Okay? And this is important lecture as it relates to diabetes relates to lipid profile, and relates to how we can maintain our weight. Our body primarily uses carbohydrates as immediate fuel, energy. And the carbohydrates are generally divided into complex, which is like the vegetables they're called complex because they break down to sugar relatively slowly, compared to refined carbohydrates and starches, such as potato, noodles, and spaghetti, bread, refined bread that tend to break down very quickly into sugar. Now, this is the preferred way of energy delivery, as far as the body is concerned, it is fast it's immediate. And that's why when you have low blood sugar, you want to take a sugar pill to give you the instant glucose. Now, the body however, does not have a long store of carbohydrates. And carbohydrates in our body lasts, usually a max of between six to eight hours, after which the body will have to draw down energy from another source, primarily protein and fat. So if you constantly are feeding your body with carbohydrates and you're going to have a constant sugar load coming in. If you don't, then the body switches. In fact, 80% of the body's day to day energy is fed by fat is not fed by carbohydrates. Okay? So with that understanding, let us proceed a bit more. Now. So let's say now you take your bread and you take your sugar load, you take your doughnuts, and about six hours, eight hours later, you don't eat well what happens. And this is what happens in the low carbohydrate diet is that your body will kind of switch to fat. And so wheres the fat come from? The fat is stored in your peripheral tissue, such as your muscles, is also stored in your organs such as the liver, and the liver is one of the primary storage of fat in the form of triglyceride. When you take carbohydrates into your blood from your regular meal, the first thing that happens is that your blood sugar spikes up. And excess sugar is then pushed into the liver and stored in the form of a triglyceride. Of course, this is mediated by insulin, okay? So when you eat something, the blood sugar goes up, the insulin from the pancreas goes up, the insulin reaches the bloodstream, it pushes the sugar into the cells and also move the sugar that is excess that's in the bloodstream that's not going to the cells into the liver for So when you now fast, and you are more than six hours has storage. passed, what happens? The body then turns to the liver and start to take the triglyceride from the liver and then convert it back into sugar so that the sugar can go into the bloodstream and help out. So that's number one. So, the fatty acids are broken down from the triglycerides and enter the tissue. At the same time. Your body's primary concern is fuel to the brain. So the body at the liver level will also break down the triglycerides into first of all Acetyl CoA then it enters the mitochondria and then becomes HMG CoA and this particular compound then bifurcates. On one hand it kind of is converted into ketones. And ketones are important because the ketones can cross the blood-brain barrier into our brain and provide our brain the necessary energy source. And so that is very very critical because as far as the body is concerned brain is number one. Now, in addition to ketone production and this ketone you can detect in the urine. Then the body enter what we call a ketosis. If you are on a low carbohydrate, and the body is starving of carbohydrates, the body will go into ketosis. As the ketones are being made you produce energy. At the same time, the body also produce more cholesterol. Cholesterol is produced at the same time as the ketones so you're cholesterol level will rise. So if you do a blood cholesterol, measuring the LDL C level, the cholesterol, the number will go up. Okay? So when this happens, why is this happening is because the body wants to needs to make these LDL particles in order to contain the cholesterols and then have it excreted from the liver along with the triglycerides to go to the peripheral tissues, because oil and water don't mix in at the aqueous solution of the blood does not mix with fat. So in order for this to happen, that delivery to the cells, the body has to make these particles of lipoproteins and they are fed on the outside with a coating of protein. That's why it's called lipid protein. And inside it contains cholesterol as well as triglyceride. And these LDL particles at each step along the way, they unload the cholesterol, and then they become from one size, a bigger size to be a smaller size, okay? And as they become smaller size, they become more dense, they become HDL, so you go from VLDL to IDL to HDL, okay? So that's the progression. Now. So if you measure a LDL, or you measure total cholesterol, and if you are on a low carb diet, now the general people needs about 200 to 300, I would not say needed, they take about 200 to 300 grams of carbohydrates a day, okay? Low Carb diet is usually about, you know, 30 to 40 grams of carbohydrates a day a meal, I'm sorry. So this is what we're talking about. We're not about the kind of extreme low diet of 20 to 30 or 40 per day, okay? So the important concept to know is that as you reduce the reliance on carbohydrates for fuel, you're going to rely more on the fat from the liver. So your cholesterol is gonna go up, your ketone is gonna go up, your LDL is gonna go up. But the LDL is not universally bad, because there's a good LDL and there's not so good LDL, as the LDL is made by the liver its usually quite large is called fluffy, or large particle LDL. They are large because they contain cholesterol. And they float, and they are cardiac neutral. Meaning if you have a high count of good, fluffy LDL, you don't have cardiovascular risks increase. However, as the LDL becomes more small or more dense, they become "the bad LDL", in which case a smaller particle, they can penetrate the any fissures or cracks in the endothelial wall of the blood vessel, leading to atherosclerosis triggering, okay? So just looking at the LDL itself doesn't tell the whole story, you have to look at a particle and the prevalence of these particles. So going one step further is important. So most people on low carb diet, what happens is that the triglyceride goes down, their total cholesterol goes down, their HDL goes up, and they lose weight. Most of them have a A1C hemoglobin as well as fasting blood sugar goes down because you're not eating as much carbs. And so this is wonderful. The only thing is the LDL will go up. And a lot of people are somewhat concerned and don't know what is really going on. So so what we now know is that the total cholesterol, remember is equal to HDL + LDL +(triglyceride/5). So if your triglyceride is lower, your total cholesterol is gonna go down your if your HDL goes up your cholesterol, your total cholesterol is gonna go up. If your LDL goes up, then the total cholesterol is gonna go up. So it's not uncommon to find that all the markers, weight, blood pressure, triglycerides, HDL all improve with the exception of LDL. So the lesson here is do not be overly concerned. A lot of people in this category actually have very healthy LDL provided that their large particle LDL, sufficient and a good ratio. So it's important to get the LDL large particle and small particle count as part of your regular workup in order to give your body a clear understanding of what your cardiac risk is, remember, the large particle LDL, are cardiac neutral. Its only the small particle size of the LDL, that's problematic because they are oxidized LDL. So that's what we need to focus our attention. With regards to Lipoprotein A, that's an LP with a small letter A, that is a oxidize lipo protein that carries a little tag of protein along with it. That's why it's called lipoproteins A. This is very similar in terms of clinical significance to the oxidized LDL. So because it's not commonly done, it is you can look at an LPA as like an advanced marker of oxidized LDL. Remember, we said you know when you have a collagen or endothelial wall that is broken or have fishers from stress, from excessive sugar, from excessive worrying, then the small particles tend to invade the endothelial more. So oxidized LDL becomes more problematic the small particle one. LP(a) is a advanced version of that. We used to think that LP(a) is genetic still is a genetic marker, but it does vary depends on time of the day as well as time of your stress. So it's not constant. To reduce LP(a), you need vitamin C, B5, which is Pantathene, and pantothenic acid, and of course, cholesterol. Why? its because these three items make collagen in the body. The collagen in the body, the infrastructure is cholesterol, plus vitamin C, and the Pantathene. Okay? So why is it important? So let's go back. So to reduce LP(a), you need to number one, reduce oxidized LDL formation. Okay? And because we know that oxidized LDL formation has a tendency to invade at endothelial wall and cause trigger atherosclerosis events. So if you don't have the fissures in the endothelial wall, or the cracks from stress, or excessive sugar, then there's no reason for the body to make oxidized LDL LP(a) its kind of a close cousin, so to say. So therefore, you want to have a body make collagen. Well, how do you make collagen? Collagen is made in the body by a combination of Citamin C, Lysine, which is an amino acid, and Prolene. So if you do these three things together, you know, your body will make collagen over time, okay? It will take about nine months to actually do it, right. And then during this period of time, as the collagen wall of the endothelial wall, which is made of collagen repairs, is smoothens out, there's no cracks or fissures, and there's no room for the LP(a) to deposit. And so you want to take Vitamin C, Prolene, Lysine, for that, okay? But coming back to the bigger picture, is that you can see now how low carb diet if you combine it with intermittent fasting, where you are eating two meals a day, usually about 11 o'clock, and 6pm. So from 6pm to 11am, you really have this fasting and you're pushing, you're pushing the body into a ketosis state, but it's not a true ketosis diet. Because you're not a ketogenic diet has to have very high fat sometimes up to 80%. So most people that you hear about ketogenic diet, are a modified ketogenic diet. Meaning it is low in carbohydrates, it is moderately high in protein, and it's also moderately high in fat. Okay? We do know that saturated fat is associated with the fluffy type of LDL, the cardiac neutral ones, while the fat that is generated from sugar generates more of the low particle size, LDL, which is the bad LDL. So if you look at the LDL alone number, without knowing whether it's large or small, you will be confused. So people say well, saturated fat is not so good. It is not necessary. So, comparatively speaking, you're better off with saturated fat versus carbohydrates as a generation of LDL particles. Of course, you need a balance in life, you know, nothing. Nothing is perfect. So, the lesson learned is that yes, when you go on low carbohydrate diet, you're going to have a rise in LDL, all the markets are improved. If you combine intermittent fasting, provided your weight is okay. You know, you don't get nausea, you don't get other feelings, your body will tell you, you know, you can lose weight up to a certain degree and the body will go into a catabolic state and you have no immune, you get sick quite frequently. So ketogenic diet, in the pure form, you know, really low low carb 30, 40 grams of carbs a day is very hard to sustain and most people fail, in fact, more than 90%. So most of us have to be sustained, will need to go on to a modified ketogenic diet, whether it's low carb, moderate protein, and moderate fat, but the key is to reduce refined carbs, focus on the complex carbs, and reduce the noodles and spaghetti and things like that. And to expect the LDL to go up and if you're not sure whether the LDL is good or not, then get the LDL particle size to further examine and you should be quite comfortable. And of course, your provider will be able to analyze and explain this to you. Okay?