The disconnect between matter, energy and chronic disease management, By Mukaila Kareem

Here comes the big disconnect. In clinical settings, the regimen of controlling blood sugar with medications or insulin shots primarily converts glucose to fat synthesis, which in the context of more substrates secondarily leads to the formation of cholesterol. In other words, a 6-carbon glucose, a simple sugar, is transformed to at least 16-carbon palmitic acid (fat) and then to a more complex 27-carbon cholesterol compound… Sadly, unlike a typical engineer, a modern healthcare practitioner does not address energy flow within the context of metabolic syndrome.

I was recently in Canada for the annual conference of the International Association of Nigerian Physical Therapists living in North America. I am certain I will have a lot of explanations to make by the time my relatives who live in Calgary find out that I was in their hometown without stopping by. My itinerary was to arrive at 12 p.m. local time and make a brief surprise visit to my relatives before the welcome and informal gathering of the association members in the evening. However, it turned out that my second flight was canceled and I had to stay overnight in Atlanta due to computer glitches that affected the airlines that weekend. I missed the scientific session on Friday and barely met the dinner gathering in the night. You may be wondering what this has got to do with metabolic energy and chronic disease management but bear with me, as the one hour fourteen minutes bus ride for the planned picnic from Calgary to Drumheller, the dinosaur capital of the world, inspired the writing of this article.

Suffice it to note that I have been to Calgary before but never ventured into the countryside and, as with all places, experiences inside the big cities never represent the real-life experiences of most people. The landscape from Calgary to Drumheller is no different from driving anywhere in the flat plains of Midwest United States, but instead of corn and soybean fields, there are wheat and beautiful yellowish canola plantations. My biggest shock was the oil fields that occasionally dotted the canola and wheat plantations. There are unmanned pulley systems, called jack pumps, drilling oil in real time on the farms! Alberta’s so-called oil sand was formed from the decomposition of plants and marine life about 200 million years ago, when the western part of Canada was believed to be mostly underwater.

This experience made me wonder why petroleum engineers do not engage in debates about kerosene, gasoline, diesel, or engine oil. These are constituents of petroleum or “crude oil” and each of them has different lengths of carbon chains attached to hydrogen atoms. They are combustible under various conditions, but these conditions are basic facts in all engineering fields, perhaps because the core training of engineering is about different kinds of energy masked in complex mathematical formulae (I hate math!). For example, you can drive your car at 70 miles per hour on a full or half tank and the purpose of keeping your car in motion remains the same until you run out of gas.

This is not how metabolism works: How the body processes your pizza, or my favourite West African pounded yam, is different when we are hungry than when we are full. In other words, the flow of energy when foods are broken down could be linear, circular or bifurcated for the purpose of building, burning or both. While the engineers are taught to follow the energy flow in a closed system, the modern health practice seems to be chasing the shadow by focusing on the nature of macronutrients that can be distilled to the confusing high fat, low carb and low carb, high fat diets.

Be it engineering or medicine, there is a world of difference between matter, a tangible substance that occupies space and energy, a property that does not have mass or volume. However, while energy cannot be separated from my favourite West African pounded yam or the gasoline, matter has been described as “a frozen light.” Energy has also been described as “not itself stuff (but) something that all stuff has.” As it turns out, photosynthesis is the primary storage that provides the energy that powers life. It initially stores intangible photons or sunlight energy in transient energy carrying molecules called ATP and NADPH, in what is often called light reaction.

As a son of an African farmer, I am familiar with making barns to store harvested corn or yams. In the same vein, the plants trap atmospheric carbon dioxide as the storage molecule, in what is called carbon fixation, but no different from making barns or my mom buying a bunch of baskets to store her kola nuts before selling them off-season, when the glut is over. A plant enzyme called Rubisco hitches a molecule of atmospheric carbon dioxide molecule on a 5-carbon compound to make two molecules of 3-carbon sugar.

How then do plants handle useful excess energy? As a son of an African farmer, I am familiar with making barns to store harvested corn or yams. In the same vein, the plants trap atmospheric carbon dioxide as the storage molecule, in what is called carbon fixation, but no different from making barns or my mom buying a bunch of baskets to store her kola nuts before selling them off-season, when the glut is over. A plant enzyme called Rubisco hitches a molecule of atmospheric carbon dioxide molecule on a 5-carbon compound to make two molecules of 3-carbon sugar.

This sugar can be regarded as my mom’s kola nut “basket,” which is initially energised by ATP and then embedded with the sun derived high energy photosynthetic electrons from the transient NADPH, to form the basic nutrient called glyceraldehyde-3-phosphate. This simple sugar is the prime end-product of photosynthesis and can be metabolised as an immediate food nutrient by both plants and animals. Glyceraldehyde-3-phosphate is therefore the energy-rich simple sugar that connects photosynthesis with metabolism.

Beyond being the first nutrient compound, plants can combine and rearrange glyceraldehyde 3 phosphate to form simple sugars (glucose, fructose and galactose), starch (tubers and grains) and structural elements, such as cellulose found in trees and woods. Furthermore, the plants use this sugar as the building block to synthesise amino acids, proteins and fats. In other words, fats and proteins are offshoots of sugar! In physics, macronutrients are regarded as matter with “frozen light” or stored energy. During combustion, the energy in gasoline is used to produce motion in your car, while giving off water vapour and carbon dioxide.

In metabolism, glucose, a six-carbon molecule, is slowly and systematically broken down into two 3-carbon pyruvate molecules. Interestingly, breaking down pyruvate involves stripping off 3 carbon dioxide molecules, called decarboxylation, while harvesting the high energy hydrogen electrons to produce NADH. To prevent from blowing us apart, the hydrogen electrons are delicately guided to combine with oxygen to form water (H2O) and release the energy currency of all cells called ATP.

I have seen this movie for more than 30 years where patients with diabetes on the so-called hypoglycemic agents end up with increased weight gain and high levels of triglycerides and cholesterol in the blood, otherwise called hyperlipidemia. This is why most patients on the so-called intensive glucose control end up taking not just medications for lowering blood glucose but also cholesterol medications…

Here comes the big disconnect. In clinical settings, the regimen of controlling blood sugar with medications or insulin shots primarily converts glucose to fat synthesis, which in the context of more substrates secondarily leads to the formation of cholesterol. In other words, a 6-carbon glucose, a simple sugar, is transformed to at least 16-carbon palmitic acid (fat) and then to a more complex 27-carbon cholesterol compound. These are all anabolic pathways that build more matter and do not break the bond energy to form water and carbon dioxide. Sadly, unlike a typical engineer, a modern healthcare practitioner does not address energy flow within the context of metabolic syndrome.

I have seen this movie for more than 30 years where patients with diabetes on the so-called hypoglycemic agents end up with increased weight gain and high levels of triglycerides and cholesterol in the blood, otherwise called hyperlipidemia. This is why most patients on the so-called intensive glucose control end up taking not just medications for lowering blood glucose but also cholesterol medications, a case of creating more problems and then taking credit for seeming to solve them.

I had the opportunity to jaw-jaw about this unfortunate polypharmacy and chronic disease management with a new friend during the conference’s African Night’s Owambe party, the Nigerian style. I was led to the table where my mentor and teacher, Professor Balogun, was also seated. There were two gentlemen I did not recognise but I casually introduce myself by first name to the gentleman closer to me, but Professor Balogun did a more formal introduction over the loud Naija songs in the background. Lo and behold, Ema Gye is a University of Jos trained medical doctor who practices lifestyle medicine in Calgary and with that we talked like we’ve known each other forever.

It was another great gathering of Nigerian Physiotherapists living in the USA and Canada. Thank you, Prof. E. B. John and your exco team, and immense thanks to the local organising committee led by Mr Tunji Bello and Mrs Adejumo. I missed the scientific session, but the picnic to Drumheller, Alberta was like a scientific session on the road and I truly had a blast.

Mukaila Kareem, a doctor of physiotherapy, writes from the USA and can be reached via makkareem5@gmail.com