From:
Guy R. Schenker, D.C.
March, 2000


Dear Doctor, 

With NUTRI-SPEC you have the power to protect your patients (and 
yourself and your family, of course) from ...

"THE DEADLY QUARTET."     

This is the name given by physiologists to the metabolic syndrome 
which includes:  

- obesity
- elevated triglycerides 
- elevated blood pressure
- diabetes

The name derives from the fact that if you have these four 
conditions simultaneously you don't have much life to look 
forward to.  Essentially, your two choices are to die much, 
much sooner than you would like, or, to suffer morbid symptoms 
for a long period of time and then die.                                                                                                  

You know from your study of NUTRI-SPEC that half of all 
Americans die of cardiovascular disease.  If you can do so 
without too much self- torment, ponder the dreary facts of 
death -- half of your patients, half of your friends, and half 
of your family are going to die of heart attacks and strokes.  
But -- if any of those patients, or friends, or family members 
have been hanging out with the deadly quartet, their chances 
of succumbing to cardiovascular disease are many, many times 
those of someone their age who has successfully avoided such 
company.  

On a cheerier note -- you can, with NUTRI-SPEC, push all four 
of those nasty rascals right out of anyone's life.  How?  Ask 
yourself what fundamental metabolic imbalance would be 
associated with this deadly quartet?  Electrolyte Stress you 
say?  You are correct in that everyone suffering from this 
metabolic syndrome would, upon NUTRI-SPEC testing show an 
electrolyte stress imbalance.  However, the electrolyte stress 
is secondary in this case to a more primary fundamental 
metabolic imbalance -- one that preceded it probably by several 
years at least.  Which NUTRI-SPEC imbalance would that be?  

Let me give you a clue.  My thought is that this metabolic 
syndrome should be re-named the "Deadly Quintet."  You see, 
there is a fifth shady character who is always lurking behind 
the scenes.  And though he gets not as much recognition, he 
is actually the one that started the gang and put the other 
four up to their dastardly deeds.  Who is this devil?  

INSULIN RESISTANCE.

Insulin resistance is the condition in which a person loses 
sensitivity to the hormone insulin.  Typically these people 
put out normal or even exaggerated quantities of insulin in 
reaction to dietary carbohydrate.  But, the insulin in these 
insensitive people does not do its job.  Instead of the insulin 
picking up the glucose in the blood and carrying it to the 
cells, the cells are refractory to the hormone's action.  Thus
the insulin levels in the blood remain high for many hours 
after a meal, all the while it takes much longer than it 
should for sugar to clear from the blood.   

Have you figured out which NUTRI-SPEC imbalance we are dealing 
with here?  We are talking about insufficient capacity to clear 
sugar from the blood and put it to metabolic use.  We are 
talking about a metabolic imbalance that eventually leads 
to diabetes.  Yes -- you've got it - we are talking about 
a ketogenic metabolic imbalance.  Every one of your patients 
who shows a ketogenic tendency is a prime candidate for adult 
onset diabetes, plus, elevated blood pressure,  elevated 
triglycerides and cardiovascular disease.  Every one of 
these patients -- under your care -- can be spared what 
inevitably would have been a gruesome future.   

If insulin resistance is the king pin of the deadly quintet, 
what created this monster in the first place?  Physiologists 
determined decades ago that insulin resistance was associated 
with high blood pressure, obesity, diabetes and elevated 
triglycerides.  However, it took years to sort out the cause 
and effect relationships.

Since obesity (and abdominal obesity in particular) was always
a factor -- many physiologists concluded that obesity was a 
cause of this metabolic syndrome.  This belief was reinforced 
by the fact that when obese patients with this metabolic 
syndrome lost weight the triglycerides, blood pressure, and 
blood sugar all improved as well.  Other physiologists 
discovered that the insulin resistance component of this 
metabolic syndrome occurred to some degree in almost everyone 
with age.  They attempted to claim, therefore, that aging was 
a cause of insulin resistance and thus the rest of the 
quintet, and that some people simply showed this aspect of 
aging sooner than others.  

Somewhere very early along this research path it had been 
discovered that the deadly quintet could be created in lab 
animals (and in people) with a diet that was high in fat and 
high in sugar.  Countless experiments were done feeding 
animals and humans a high fat plus high sugar diet and observing 
the horrible consequences.  Still, the actual sequence of cause 
and effect was not determined.  Did you have to be already 
obese before a high fat plus high sugar diet would cause 
insulin resistance?  Did you have to reach a certain 
physiological age before high fat plus high sugar would do 
its damage?  Did you have to become diabetic first before the 
triglycerides and blood pressure would go up?  Did the 
diabetic condition make you sensitive to a high fat and high 
sugar diet, or did the high fat plus high sugar diet cause 
the diabetes?  

Fortunately, a few physiologists think analytically.  A series 
of experiments was designed that demonstrated the exact 
sequence of events, and, exactly what causes what.  Here is the 
sequence:  
              
Step One

         - High Fat + High Sugar Diet. 
     
Step Two

         - Insulin Resistance
         - Decreased Glucose Transport               
	     - Elevated Serum Insulin	
               
Step Three
 
         - Elevated Serum Triglycerides
         - Increased Size of Abdominal Fat Cells

Step Four

         - Elevated Blood Pressure        
         - Increased Clotting Tendency of Blood  
         - (Serum Cholesterol Normal to Somewhat Elevated (but never    
                nearly as elevated as Triglycerides))


Step Five

         - Obesity
 
Step Six

         - Type II Diabetes Mellitus 

In other words, it is diet that pushes over the first domino 
that leads to crashing health.  This is important.  It shows 
that anyone who tries to intervene therapeutically in this 
metabolic syndrome is going to have very limited success 
unless they address the primary issue -- the garbage this 
person has been cramming in their mouth for years and years 
and years.                                                             

 The cardiovascular disease from which this person will 
 ultimately expire is not caused by obesity per se; it is 
 not primarily caused by diabetes; it is not caused by aging; 
 and it is not caused primarily by elevated triglycerides.  
 It is the insulin resistance that  always happens first; 
 none of the rest can happen unless preceded by insulin 
 resistance.  Furthermore, insulin resistance has one and only
  one cause ...            

THE HIGH FAT PLUS HIGH SUGAR DIET.  

Predictably, this important information is slow to have an 
impact on the medical establishment.  Patients with high 
triglycerides are treated with medications to pull the blood 
fats down.  People with high blood pressure are treated with 
an assortment of anti-hypertensive drugs; people who are 
obese are given a low calorie diet; and people with diabetes 
are given drugs to control their sugar (and often are given 
insulin (horrors!) when their insulin levels are already sky 
high).  (Insulin is itself a very damaging hormone by mechanisms 
other than those at work in the insulin resistance syndrome.)  
Not nearly enough emphasis is put on the fact that a rotten 
diet is the ultimate cause, and that correcting the diet has 
to be part of the cure.  

If you happened to have your brain plugged in as you read these 
last few pages, there is an obvious question that popped into 
your mind.  A question that is so obvious that you must be 
wondering (as I did for years) why so few physiologists had 
enough analytical thinking capacity  to ask the same question.  
If a high fat plus high sugar diet sets off this whole chain 
reaction of insulin resistance with all its ramifications, 
exactly what is it about this diet that causes problems?  
Is it the fat?  Is it the sugar?  Or is it that the fat and 
sugar have to be combined?  

As it turns out, these questions and more have been answered 
conclusively.  And while these important issues have been 
resolved in the scientific literature, the medical establishment 
has reacted to the truth with a yawn.  After all, why bother 
to get excited about the truth,  why bother to get excited 
about cause and effect, why bother to get excited about 
prevention, when one has Calan, Lipitor, and Rezulin, and an 
amazing arsenal of (not so wondrous) wonder drugs to play with?  

Since we NUTRI-SPEC Doctors think a little differently, we are 
thrilled to discover the truth and find ways to use that 
knowledge to help our patients.  Some excellent studies have 
been done which really zero in on the dietary culprit in this 
metabolic syndrome.  Care to guess what it is?  Is it the fat?  
Is it the sugar?  Is it the combination of the two?  One of 
the best studies I have seen looked at every conceivable 
combination of dietary factors, plus exercise, to see just what 
did and did not cause insulin resistance.  The study looked at
a high fat plus high sugar diet, and a high fat plus low sugar 
diet, and a low fat plus high sugar diet, and a low fat plus 
low sugar diet, plus each of those diets with  or without 
supplemental dietary fiber, plus each of those diets with and
without exercise.  

The bottom line was that ...                                                        

SUGAR, AND SUGAR ALONE                                                                      
IS THE CAUSE OF INSULIN REISITANCE.                                                 

Furthermore, the effect of sugar is so powerful that no amount 
of exercise and no amount of dietary fiber reduces its damage 
in the least.  No amount of fat restriction reduces its damage 
either.  Furthermore, no quantity of fat intake would cause 
insulin resistance, unless that high fat diet was accompanied 
by high sugar intake.  

So now our case appears to be complete.  We began discussing 
the deadly quartet and resolved to re-name it the deadly 
quintet because insulin resistance was the key.  We then 
carried our analysis a step further to find that insulin 
resistance had one and only one cause and that was an improper 
diet.  Now we see that the qualities which  constitute an 
improper diet can be reduced to one single factor -- the 
intake of sugar.  

Is our case complete?  Not quite.  We have two more giant steps 
to take.  First, we must ask ourselves just what is meant by 
"sugar?" The sugar used in all of these studies to create this 
vicious metabolic syndrome was sucrose.  What do we know about 
sucrose?  We know that it is a di-saccharide comprised of 
glucose plus fructose.  We at NUTRI-SPEC also know (review 
Chapter 10 of your Manual) that glucose is capable of causing 
only a fraction of the metabolic damage (glycation, hypoglycemia, 
hormone imbalances, etc.) that fructose causes.  What this means 
is that the real villain revealed by our detective work is none 
other than the single molecule -- fructose -- fruit sugar.  
(Go back to page 3 and change Step One to read, "High Sucrose 
(Fructose) Diet.") 

Now that we have solved the mystery of the cause and cure of 
ne of the most virulent pathologies to afflict human kind, 
we must take the one final giant step and ask what does this 
mean clinically?  As we have already stated, this entire 
metabolic syndrome is a perfect description of what is going 
in your NUTRI-SPEC patients who test as ketogenic.  It is 
your ketogenic patients who tend to react to the common high 
fructose diet with the clinical picture we have been discussing.                 

Contrast this to your glucogenic types who eat equally high 
quantities of the devastating sugar fructose, yet who respond 
in an entirely different fashion.  Your ketogenic patients 
will show elevated blood sugar while your glucogenic patients 
are reactive hypoglycemics.  Your ketogenic patients will 
have high triglycerides far in excess of any tendency to 
high cholesterol.  Your glucogenic patients will frequently 
have cholesterol problems that far exceed their triglyceride 
problems.  Your ketogenic patients tend to gain weight above 
the waist and particularly in their abdomen, while your 
glucogenic patients tend to gain weight below the waist as 
much or more than above the waist.  Your ketogenic patients 
have a much higher tendency to develop cardiovascular disease 
than your glucogenic patients do.  

Another way to say this is that most Americans eat disgusting 
and devastating quantities of fructose.  On an individual 
basis, if one has a ketogenic tendency, one is going to die 
from eating fructose; if one has a glucogenic tendency,  
one will live a long life during which one feels half dead 
from eating fructose.  In either case you can, with NUTRI-SPEC, 
restore metabolic balance and add tremendously to the quantity 
and quality of each individual's life.   

Sincerely,


Guy R. Schenker, D.C.

Barnard R.J., Youngren J.F., Martin D.A.  Diet, not aging, 
causes skeletal muscle insulin resistance.  Gerontology.  
1995;42,205-11. 

Barnard RJ, Roberts CK, Varon SM, Berger JJ.  Diet induced 
insulin resistance precedes other aspects of the metabolic 
syndrome.  J Appl Physiol. 1998 Apr; 84(4)1311-5.  

Grimditch GK, Barnard RJ, Hendriks L, Weitzman D.  Peripheral 
insulin sensitivity as modified by diet and exercise training.  
Am J Clin Nutr. 1988 Jul;48(1):38-43. 
				 

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