Dr Dwight Lundell - Low Carb Cruise 2013, Endothelial Dysfunction

5200+ bypass ops

60,000 miles of blood vessels

everything goes thru endothelium to get to rest of cells in body

cells live for months or years

doesn't store glycogen or fat so needs constant supply of energy

this is why body keeps blood sugar in narrow range

pancreas generates insulin triggers glut4 transporter to move glucose into liver muscle and fat (resovoirs for glucose)

when glucose too low alpha cells of pancreas emits glucagon hormone which tells liver to release glucose into bloodstream and tells liver to produce sugar from protein or fat

normal blood sugar: 5litres blood, upper limit 100mg/dl, equals 5000mg or 5g of sugar (1 teaspoon) - very easy to overload with sugar

when over 150mg/dl bad things happen

endothelial cells at mercy of blood glucose levels, has a glut1 transporter, can't say no to sugar in blood

when we make energy it involves moving of electrons from one molecule to another (ADP->ATP), these molecules with extra electrons are known as free radicals which do damage if not neutralised

free radicals cause oxidative stress and damage cells, proteins, lipids and DNA

in presence of high glucose, endothelial cell changes shape, loses ability to selectively filter and eventually dies

injury of cell produces inflammatory response which attracts proteins and cholesterol to repair, but in presence of high glucose the LDL becomes oxidised (glycated)

LDL is now abnormal and macrophages engulf it, becoming foam cells and then fatty streaks

fatty streaks are found in everybody and seen in autopsies of young people

foam cells form a plaque which may eventually rupture

cholesterol wouldn't be there without the inflammatory response - elevated cholesterol DOES NOT cause heart disease

there is no such thing as an atherogenic lipid

elevated cholesterol is sign of over consumption of carbohydrates [normally!]

Fathead movie - insulin resistance === the cells are full

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