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Meet Dr. Su: Detective on the Trail of the Carbohydrate Killer!
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The provocative title of Dr. Robert Su’s recently-released book,

Carbohydrates Can Kill (,

couldn’t help but catch our attention.

At a time when we have added postprandial glucose checks to our panel of Track Your Plaque essential strategies, Dr. Su adds his own unique perspective as an anesthesiologist,

pharmacist, and victim of low-fat, high-carbohydrate conventional advice.

Dr. Su has graciously joined the discussions in the always-interesting Track Your Plaque Forum. Here is a chance to find out more about him in our exclusive interview.


TYP: Dr. Su, can you tell us something about your background - what type of medicine did you practice, where, for how long, etc.?

Dr. Su: First of all, I want to thank you for inviting me to join the “Track Your Plaque” discussions.

My father was a doctor and my mother was a midwife. Ever since childhood, I wanted to become a doctor when I grew up.

I attended Taipei Medical University, School of Pharmacy in Taipei, Taiwan, in 1961 and earned a bachelor degree in pharmacy in 1965. I left Taiwan for Japan to study medicine at Nagasaki University School of Medicine in 1967 and received my medical degree in 1971. I completed a rotating internship at Episcopal Hospital in Philadelphia, Pennsylvania in June 1972, and, in July 1972, I started a two-year anesthesiology residency at the Medical College of Virginia, in Richmond, Virginia, and completed it in June, 1974.

I joined a private anesthesiology group practice in Portsmouth, Virginia in July 1974. In 1981, I started a solo practice in anesthesiology and pain clinic at a time in which there were only a few pain clinics in the U.S. At the end of August 1997, I took an early retirement from surgical anesthesia, and continued to actively practice pain medicine with nerve blocks and acupuncture at my office. In early 2007, I entered semi-retirement and continued to see a few patients a couple of mornings a week.

TYP: I know that you've lost a substantial amount of weight by changing your diet, specifically reducing or eliminating carbohydrates. What prompted the change in your views on diet?

Dr. Su: Yes, indeed. I lost weight by giving up all carbohydrates including rice, which I had eaten for 60 years, flour products such as breads, noodles, bakery, and ice creams. But I have continued to eat green leafy vegetables.

I had been ill often from dysentery and frequent episodes of the common cold until I finished the sixth grade. Since then I had been healthy, including those years when I studied medicine and had to help my wife take care of my young children while having only a few hours of sleep every day. I had continued to be healthy (at least, so I thought) through the years of internship and residency, then private practice.

I had life insurance then, and had a nurse dispatched by the insurance company to check my blood pressure and perform blood tests annually. My blood pressure was always around 120/60 mmHg. My blood tests were normal every time.

After retiring from surgical anesthesia at the end of August, 1997, I spent most of the day at my office and continued my office paperwork at home in the evening. For that, I had to make lots of changes in my lifestyle. I did not have the time to work in the yard like I used to. I began to gain weight and lose physical stamina. Ironically, my relatives and friends complimented me on looking much healthier.

It perhaps was a mistake that I stopped my life insurance because the annual blood pressure checks and blood tests stopped. I continued to believe that I was healthy because I could eat anything I wanted without noticeably gaining weight, which in reality was going up. However, I began to notice discomfort in my left upper back each time I walked or was under stress. The discomfort worsened slowly over time to the point that I would become aware of the pain before I could finish walking 2 blocks. I suspected that I might have hypertension or angina. I did not want to let my wife or children know. Because the pain would disappear within 30 seconds to one minute as soon as I stopped walking, I thought I knew how to handle my stress and physical strain.

On a Saturday afternoon, June 9, 2002, I bought a new blood pressure monitor for my office. To test the new unit on myself, I accidentally discovered my blood pressure was 205/63 mmHg. I was shocked in disbelief. I continued to check my blood pressure repeatedly for the next 10 minutes. I finally stopped at 194/58 mmHg. With the symptoms I had experienced, I knew I had problems.

I am an advocate of “Physician Heal Thyself.” If a physician falls victim to the diseases from which he has tried to teach his patients to prevent, what would his patients think about his credibility?

I have always been confident in my careful search for knowledge and my enthusiasm in research. I decided against seeking consultation from my colleagues in internal medicine or family practice because I was familiar with the medications they would prescribe. As a former pharmacist, I did not want the side-effects of medications. I wanted to find out why I fell victim to the diseases that I thought I understood.

So I went ahead with some self-experiments. I weighed 186 pounds on my bathroom scale and had a BMI at 27. I was overweight. To reduce my blood pressure without diuretic, I had carefully restricted fluid intake and been on a no-salt diet for four months, but no avail. On four occasions, my systolic blood pressure went up to 220 mmHg. I was very discouraged. I found salt was not the main reason why water was held inside our body. Rather, I suspected blood glucose played an important role in water and salt retention.

With my knowledge in metabolism, I decided to restrict carbohydrates and force my body to use fats. I also suspected that lowering my blood glucose would increase diuresis [fluid loss] and decrease my blood pressure. In the first 8 months, I lost 10 pounds. I also designed a “cardiac rehabilitation” program. Over the following three months in the summer of 2003, I lost 17 more pounds because I was able to work outside in my backyard.

Since the summer of 2002, I have continued to review both medical and nutritional literature. I found many studies that have been ignored by mainstream medicine. While continually reviewing literature, I have observed changes in my body and health that underscore the findings of the studies. I have also found changes that were not studied.

I have deliberately avoided using literature that is cross-referenced. Because I reviewed literature over a broad range but in-depth, I have found links between causes and results of diseases. I came to appreciate an interesting axis: carbohydrate consumption - postprandial hyperglycemia - postprandial inflammation - disease development. This axis provided me with an explanation why we face such a sharply rising trend in diseases.

Here I want to suggest how we should define postprandial hyperglycemia. Postprandial hyperglycemia should not only refer to an abnormal reading during a 2-hour glucose tolerance test. Rather, postprandial hyperglycemia is an increase of blood glucose over 120 mg/dl at any time. And it should be alarming when postprandial blood glucose exceeds 150 mg/dl at any time!

TYP: Dr. Su, can you tell us about the diet you advocate?

Dr. Su: Yes. When I decided to lose weight to lower my blood pressure, I did not follow any diet manual. (I got a chance to read one of Dr. Atkins’ books in July 2003, when I had already lost about 20 pounds.) Since I started to restrict carbohydrates in October, 2002, I have continued to explore different foods to help me lose weight and restore health, especially lowering blood pressure, easing the symptoms in exercise and stress, and increasing my physical strength. When I was writing my book, I did not want to publish another diet book because there were so many diet books out already. Rather, I would use the knowledge from my literature review and the findings of personal experimentation to help the reader of my book understand the principles of dieting for health.

As I wrote in my book, a healthy diet should restrict digestible carbohydrates and reduce glycemic index and glycemic load. Based on gender, build, and level of physical activities, the maximum of daily carbohydrates should be no more than 125-175 grams. I strongly suggest that keeping the daily amount of carbohydrates under 100 grams; 75 grams is even better. Although some studies suggest that diets rich in proteins do not harm the kidneys, I prefer keeping a daily amount of proteins no more than 35% of the total daily amount of calories, which should be no more than 235 grams for a large person who requires 2,800 Kcal a day. After restricting carbohydrates and proteins, the rest is fat, which I prefer to distribute among plant oils and saturated fats evenly. I do not have any problem with saturated fats. When we keep the level of inflammation low by restricting carbohydrates, neither saturated fats nor cholesterol should be a health hazard.

TYP: I am especially interested in the postprandial blood glucose experiences you show on your website homepage

in which you display the blood glucose responses to skim milk, sucrose, Cheerios, etc. Can you tell us what you conclude from the experience?

Dr. Su: I am glad that you are interested in the postprandial glucose experiences. While I stress the importance of postprandial hyperglycemia, I want my audience to learn first hand that different foods have a different impact on blood glucose levels which, in turn, affects the inflammatory level inside the vascular bed as well as the whole body.

In the video, a cup of plain Cheerios (about 100 Kcals) raised blood glucose more than 80 mg/dl in less than an hour. Also, both an 8-ounce cup of skim milk (about 100 kcals) and 25 grams sucrose (100 Kcals) in 8 oz water boosted blood glucose 33 mg/dl and 48 mg/dl, respectively. So, if the person had added fruits such as a banana or strawberries in a bowl of skim milk, the blood glucose level would rise even higher, likely beyond 200 mg/dl or more. Even worse, if he/she had a cup of coffee with a teaspoonful of table sugar, how high would postprandial blood glucose level go?

In contrast, the person who ate a boiled egg had no increase in her blood glucose level throughout the entire 60 minutes.

You might ask me about the point that I am trying to make. Is it not okay if all participants had blood glucose levels of 139 mg/dl 2 hours after the experiments started? Of course, it is not!

Studies have shown that patients who come to hospital for emergency care such as trauma, heart attack, and stroke, and whose blood glucose levels were at 150 mg/dl or higher, have poor outcomes. This observation is also true in organ transplantation. One study with kidney transplantation showed the rejection rate acutely jumped from 42% to 71% when the transplant recipients’ postoperative blood glucose level was 153.6 mg/dl or greater. This is why I mentioned earlier that “postprandial hyperglycemia” is an increase of blood glucose over 120 mg/dl at any time. It should be alarming when postprandial blood glucose exceeds 150 mg/dl at any time!

TYP: What is your approach to macronutrient diet content? Do you advocate restriction of any fat fraction, flavonoid content, fiber content, etc.?

Dr. Su: Based on my knowledge gained from an extensive literature review along with findings from my self-experimentation, I do not advocate restriction of any particular fat fraction. Of course, most of our colleagues are “lipophobic” and encourage their patients to restrict fats in general, or, at least, saturated fats, because of the melting points of the saturated fats.

Fats are not the primary cause for atherosclerosis; inflammation is. As discussed earlier, the axis: carbohydrate consumption - postprandial hyperglycemia - postprandial inflammation - disease development, suggests that atherosclerosis occurs only in the presence of hyperglycemia and inflammation. Because consuming fats with little or no carbohydrates does not produce hyperglycemia or inflammation, there is no atherosclerosis.

Another important point for consuming fats is to provide us with satiety. It is the physicians’ ill advice for patients to restrict calories for losing weight, because starving oneself is very difficult in the practical world. In fact, with carbohydrate-restricted diet helps individual reduce both the meal volume and calorie consumption without stress.

I do not particularly push for high dosages of flavonoids, although I do recommend regular doses of fish oil, multiple vitamins, and, perhaps, an extra 500 mg of Vitamin C. I understand that we are concerned about the harmful effects of oxidation and take antioxidants for health. When we realize that hyperglycemia promotes oxidation, we understand the most effective antioxidant is to restrict digestible carbohydrates.

I encourage my readers to consume a reasonable daily amount of fibers, especially from green leafy vegetables.

TYP: Do you have any specific issue or issues that you want share with us?

Dr. Su: Yes, I do. I am very concerned about the rising trend of diseases in the U.S. population and other countries. I am disappointed that the medical and nutritional professions have led us to believe that the low-fat, high-carbohydrate diet is the best for our health. The mistakes have not only unnecessarily shortened many lives, but have also contributed to skyrocketing health care costs.

Through my writings, presentations, and upcoming radio talk show, I am going to bring my message to as many people as I can. I hope more people like you will join me in the crusade for preventing and managing postprandial hyperglycemia, diabetes mellitus, and many diseases, by asking everyone to have a semiannual or annual series of blood glucose tests, started at fasting and continued for a period of two hours after, at an interval of 15 minutes between tests. These tests will help evaluate the impact of food on postprandial blood glucose levels and the function of pancreatic beta cells for early detection and prevention of postprandial hyperglycemia and diabetes mellitus.

TYP: Thank you, Dr. Su.

More about Dr. Robert Su can be found on his website, His book by the same name is available at his website. Dr. Su also blogs at the Carbohydrates Can Kill Blog:

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