Day 033 - 10 Oct 94 - Page 42


     
     1
     2   Q.   You have talked about and suggested mechanisms for a link
     3        with saturated fats and diabetes.  "Saturated fat
     4        consumption may increase insulin secretion and lead to
     5        insulin insensitivity".  Do you want to just go into that?
     6          It is the Snowden study, I think?
     7        A.  Yes.  I regret to say I do not remember the details of
     8        the study and I would I have to refer to it again
     9        specifically.  But there are many studies that have shown
    10        that a high fat diet aggravates or reduces the capacity of
    11        insulin to do its job effectively, suggesting that higher
    12        and higher amounts of insulin are required simply to keep
    13        glucose under control.
    14
    15   Q.   What is the "fecal microbial enzyme activity" and
    16        "estrogen synthesis"?
    17        A.  It is believed and has been reported that -- by "fecal
    18        microbes" I simply mean the bacteria that are in the
    19        colon, the bacteria that normally inhabit the digestive
    20        track -- but, apparently, a diet that is high in saturated
    21        fat can alter the enzymatic activity of these bacteria.
    22        What that means is that these bacteria may be carrying on
    23        the synthesis of bacterial products in a different way,
    24        and also increasing the synthesis, the production of
    25        oestrogen, if you will, which in turn was believed by
    26        Snowden (and perhaps others) to impair insulin
    27        sensitivity.  This is apart from what I said earlier in
    28        relation to fat affecting insulin sensitivity.
    29
    30   Q.   If we can move on to the next point?  You mention
    31        gallbladder disease.  Do you want briefly to summarise the
    32        case on that?
    33        A.  Yes.  Here again gallbladder disease is known to be
    34        more common in individuals who are obese.  In studies of
    35        vegetarians, which again is a group remarkable for a very
    36        low consumption of cholesterol and typically a low
    37        consumption of fat, the incidence of gallbladder disease
    38        is markedly reduced.  In a study which I cite from 1985,
    39        there is a group of non-vegetarians compared to a group of
    40        vegetarians, and the difference -- and they were simply
    41        tracked for their history of having required gallbladder
    42        surgery -- the risk amongst the non-vegetarians was quite
    43        substantially higher than that of the vegetarians.
    44
    45        This probably relates to more than one aspect of the
    46        diet.  It probably relates to both cholesterol and to
    47        fat.  The bile acids that are produced in the liver sent
    48        down the bile ducts and take residence in the gallbladder
    49        where stones may form, are formed, from cholesterol.
    50 
    51        There have been suggestions that the same diet that is 
    52        high in fat and high in cholesterol that can produce high 
    53        serum cholesterol levels also makes it more likely that
    54        gallbladder stones will form.  Gallbladder surgery is
    55        extremely common in western countries, extremely rare in
    56        countries such as Africa or Asia where the populations
    57        adhere to a very low fat diet.
    58
    59        There is a role for fat and for fibre both because fibre
    60        helps to eliminate bile acids and to eliminate cholesterol

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