Lonjevity - Superfood Fusion Cafe

Metabolic Syndrome

Written by Dr. Gerry Davies, owner of Lonjevity.

Obesity & The Metabolic Syndrome:

Now the Disease of the Average American

Do we really have a Problem

The “inconvenient truth” is not just that global warming is a distant threat but more immediately a huge mountain of disease and suffering is building in every population on the planet that has adapted a western diet and the trend has been accelerating. This is becoming a public health catastrophe not just for the human cost in pain and suffering but the unsustainable economic burden of the added health care costs of chronic diseases. [1]

We are talking about heart attacks, strokes, hypertension, diabetes, premature aging and all manner of associated diseases. There are three Lifestyle issues causing over 80% of medical problems these days: they are diet, smoking and exercise. Poor nutrition is taking over as the major risk factor and that is not meant to minimize the additional harmful effects of smoking and lack of exercise. [1-9]

The metabolic syndrome now affects the majority of people over age 50. It is a pre-diabetic state characterized by a waist measurement greater than 39 inches, a high blood glucose, high blood pressure, and high triglyceride levels. The International Obesity Taskforce [2] states that interventions on a sociopolitical level are required to reduce development of the metabolic syndrome in populations. [1, 10]

The problem is even more serious for America’s minority ethnic groups where African’s and Hispanics have a 40% and 30% higher incidence of diabetes than Caucasians and even though a minority in the population, black Americans make up the majority of patients on renal dialysis because of kidney failure from the complications of high blood pressure and diabetes. [1]

Understanding Glucose Intolerance and the Metabolic Syndrome:

Between 1970 and 2000 the incidence of type 2 diabetes tripled, [2] at the same time childhood type 2 diabetes increased tenfold. Now perhaps the majority of the adult population is experiencing a pre-diabetic state called the metabolic syndrome which along with glucose intolerance, type 2 diabetes, hypertension, vascular diseases and inflammation are all manifestations of the same disease process.

The skyrocketing incidence of insulin resistant diabetes really started to accelerate after 1980 when 493,000 new cases appeared each year. By 2005 1.4 million new cases appeared each year. In 2002 18 million Americans had type 2 diabetes and 41 million were estimated to have glucose intolerance, and in 2008 estimates put this at over 60 million. [3]

The common thread in metabolic syndrome is insulin resistant high blood glucose, inflammation and disordered blood lipids (elevation of LDL triglycerides with a decrease in HDL). Other aspects of the metabolic syndrome are abdominal obesity and high blood pressure but the hyperglycemia and insulin resistance is always present and the recognition of this will help understand the underlying cause. [5]

The dietary Cause of Metabolic Syndrome

Data from the US FDA show that over the same time frame as diabetes has been increasing the per capita food consumption has been increasing as well and particularly high glycemic index (HGI) foods. [11]

· One of the most significant is the consumption of high calorie sweeteners. High Fructose Corn Syrup (HFCS) was only introduced in 1970 and now is consumed at a rate of 80 lbs per capita per year. Consumption of all caloric sweeteners, HFCS and sugar, by 1998, was 150 lbs per capita per year.

· Flour of which 98% was white increased from 135 lbs/cap/year in 1970 to 197 lbs in 1998.

· Potatoes increased from 121 lbs in 1970 to 138 lbs in 2000.

· The combined per capita consumption of just high caloric sweeteners, white flour and potatoes combined in 1998 was 423 lbs per year, 526 grams a day amounting to 2106 Calories. Remember also that if 15% of the population has already heeded the warning the remaining 85% is consuming an even higher share of high glycemic index foods. White rice is another high glycemic staple with increasing consumption.

· There was an increase in total food available for consumption from 2,234 calories per person per day in 1970 to 2,757 calories in 2003. But 2106 calories, 76% of the total calories consumed per capita was in the form of refined HGI foods.

Incidentally as far as the damaging effect on health is concerned I’m not solely blaming HFCS, I don’t see much difference between HFCS (which is 45%glucose and 55% fructose) and regular cane sugar (which is sucrose, a disaccharide molecule consisting of 50% glucose and 50% fructose). Both cause a rapid increase in blood glucose and fructose levels and result in the production of fat and inflammatory substances.

Human bodies were not designed to cope with Large amounts of Glucose and Fructose

Sedentary individuals consume around 2000 calories per day or 80 calories per hour (80 calories would be produced from the metabolism of 20 gm glucose). The amount of glucose in blood and extracellular fluid is only 10 gm and it would not be uncommon eating HGI foods to absorb 250 gm (1000 calories) glucose at each meal.

Glucose cannot be stored and blood glucose concentration is under tight control by the action of insulin because excessive blood levels of glucose are toxic. 250 grams (9 oz) of glucose rapidly absorbed into the bloodstream is a relatively massive challenge for the body and must be rapidly transformed into something that can be stored. Insulin which is produced by the pancreas, signals the liver to convert glucose to either glycogen or triglycerides by the liver. However, sedentary individuals on a high glucose diet have constantly saturated body stores of glycogen and therefore most of the glucose must be converted to triglycerides in the liver. Insulin also directs fat deposition in adipose tissue particularly in the liver itself and other parts of the abdomen. Inflammatory fats (Low Density Lipoproteins, LDL) are produced and anti-inflammatory High Density Lipoproteins (HDL) are inhibited. Fructose, which makes up 55% of corn syrup and 50% of sugar can only be metabolized to triglycerides by the liver and appears to accelerate production of liver fat and inflammatory substances. [12,13,14]

The other unfortunate result of a rise in blood glucose followed by its rapid removal and storage as fat is that blood glucose will fall below normal before the body can switch off pancreatic insulin secretion and this results in uncomfortable hunger cravings 3 to 4 hours after the glucose load. Repeated frequent ingestion of HGI carbohydrates will never allow significant use of fat as an energy substrate leading to the familiar and intransigent ever increasing body fat with age. [20]

It cannot be surprising that HGI foods would have such a deleterious effect on human metabolism in light of the fact that all of the relevant organ systems and enzyme systems have evolved over at least 5 million years under the influence of a hunter gatherer diet containing virtually no HGI foods.

Little change in human biology has occurred since the appearance of “anatomically modern humans” 150,000 years ago. Our alimentary system is not equipped to deal with the drastic changes which have appeared with refining techniques of the past 100 years resulting in dangerously potent sugars and the virtual elimination of fiber from processed foods.

To illustrate this point even further Michael Pollen, in his book “The Omnivores Dilemma” claimed that cattle fed exclusively on corn rarely survive longer than one year after the withdrawal of grass in their diet. Although we as omnivores don’t have such severe problems it is apparent that radical changes in our diet that we are not equipped to deal with are taking a toll on our health.

Exercise and smoking have separate additive effects on inflammation and it is evident that inflammation is the common factor in the development of insulin resistant diabetes, atherosclerosis, endothelial stress and a host of disorders in multiple organs. It is well established that smoke inhalation is a huge cause of oxidative stress with lung damage and generalized inflammation. Exercise on the other hand has anti-inflammatory effects. In order to combat inflammatory influences the desired changes in diet need not only to eliminate HGI foods but at the same time to replace the junk food with high nutritional value foods containing anti-inflammatory substances and anti-oxidants.

There is much confusion regarding what are healthy foods because so much previously held information is now proving to be false. Take for instance the much maligned dairy industry: A 2007 study of 2,375 male subjects over 20 years suggested that daily intake of a pint of milk or equivalent dairy products more than halved the risk of metabolic syndrome. [15,16,17] The same can be said for beef and eggs previously unjustly stigmatized are wonderful sources of much needed protein and beneficial nutrients. After 40 years of study it is now apparent that cholesterol is not the cause of heart disease but merely a residue of the real cause, an inflammatory process but it will take a long time for the universal fear of cholesterol and fat in the diet to subside.

Because of the past campaigns against them consumption of fat, red meat, eggs and dairy in the US from 1970 to 2000 has not changed significantly at all and dairy consumption has actually declined [11]. Nevertheless there has been a relentless increase of obesity, metabolic syndrome and new cases of diabetes increasing 300% must surely be an indication that these foods were never the problem in the first place.

More and more evidence is accumulating to implicate high glucose producing carbohydrates (HGI foods) as the cause and the mechanisms of the disease process are becoming clearer too. Several recent studies have linked higher blood glucose levels even in non diabetics, to an increase in ischemic heart disease and all causes of death suggesting that everyone should attempt to keep their blood glucose levels as low as possible. This is difficult indeed where refined carbohydrates are ubiquitous in virtually all commercial foods and restaurant menus and in fact make up at least 75% of all foods consumed in the US.

To Summarize

1. Obesity, metabolic syndrome, diabetes and their deadly complications are caused by eating and drinking refined carbohydrates which have now become the staple diet of modern industrial societies and provide over 70% of the calories consumed in the US.

What to do?

1. Understand High Glycemic Foods and eliminate them as much as possible.

2. Consume essential nutrients found in whole plant foods as much as possible such as fruits, vegetables, legumes, whole grains, nuts, berries, and eat moderate portions of meat, fish, dairy etc.

3. Exercise 5 times a week for at least 30 minutes [19]

4. Stop smoking

REFERENCES

1. Rippe JM, Angelopoulos TJ, The American Journal of Lifestyle Medicine: A forum a vision and a mandate. AJLM: 2007.1.1.7

2. International Obesity Task Force. http://www.iotf.org/

3. US CDC: http://www.cdc.gov/diabetes/statistics/incidence/fig1.htm

4. Vega GL. Obesity, the metabolic syndrome, and cardiovascular disease. Am Heart J 2001;142:1108-16.

5. Reaven GM. Banting lecture 1988. Role of insulin resistance in human disease. Diabetes 1988;37:1595-607.

6. Alberti KG, Zimmet PZ. Definition, diagnosis and classification of diabetes mellitus and its complications. Part 1: diagnosis and classification of diabetes mellitus, provisional report of a WHO consultation. Diabet Med 1998;15:539-53.

7. Ford ES, Giles WH, Dietz WH. Prevalence of the metabolic syndrome among U.S. adults: findings from the Third National Health and Nutrition Examination Survey. JAMA 2002;287:356-9.

8. Liu S, Manson JE. Dietary carbohydrates, physical inactivity, obesity, and the 'metabolic syndrome' as predictors of coronary heart disease. Curr Opin Lipidol 2001;12:395-404.

9. Eckel RH, Krauss RM. American Heart Association call to action: obesity as a major risk factor for coronary heart disease. AHA Nutrition Committee. Circulation 1998;97:2099-100.

10. Pearson TA, Mensah GA, Alexander RW, Anderson JL, Cannon RO 3d, Criqui M, et al. Markers of inflammation and cardiovascular disease: application to clinical and public health practice. A statement for healthcare professionals from the Centers for Disease Control and Prevention and the American Heart Association. Circulation 2003;107:499-511.

11. USDA, Economic Research Service. http://www.ers.usda.gov/Data/FoodConsumption/

12. Hallfrisch J (1990). "Metabolic effects of dietary fructose". FASEB J 4 (9): 2652–2660. PMID 2189777.

13. Nakagawa T, Hu H, Zharikov S, Tuttle KR, Short RA, Glushakova O, Ouyang X, Feig DI, Block ER, Herrera-Acosta J, Patel JM, Johnson RJ (2006). "A causal role for uric acid in fructose-induced metabolic syndrome". Am J Phys Renal Phys 290 (3): F625–F631. doi:10.1152/ajprenal.00140.2005. PMID 16234313.

14. Reiser S, Powell AS, Scholfield DJ, Panda P, Ellwood KC, Canary JJ (1989). "Blood lipids, lipoproteins, apoproteins, and uric acid in men fed diets containing fructose or high-amylose cornstarch". Am J Clin Nutr 49 (5): 832–839. PMID 2497634.

15. Elwood, PC; Pickering JE, Fehily AM (2007). "Milk and dairy consumption, diabetes and the metabolic syndrome: the Caerphilly prospective study". J Epidemiol Community Health 61 (8): 695–698. doi:10.1136/jech.2006.053157. PMID 17630368. http://jech.bmj.com/cgi/content/abstract/61/8/695.

16. Snijder MB, van der Heijden AA, van Dam RM, et al (2007). "Is higher dairy consumption associated with lower body weight and fewer metabolic disturbances? The Hoorn Study". Am. J. Clin. Nutr. 85 (4): 989–95. PMID 17413097.

17. Pereira MA, Jacobs DR Jr, Van Horn L, Slattery ML, Kartashov AI, Ludwig DS. Dairy consumption, obesity, and the insulin resistance syndrome in young adults: the CARDIA Study. JAMA 2002; 287:2081-9.

18. Foster GD, Wyatt HR, Hill JO, McGuckin BG, Brill C, Mohammed BS, et al. A randomized trial of a low-carbohydrate diet for obesity. N Engl J Med 2003;348:2082-90.

19. Bell DS. Understanding the role of insulin resistance for the treatment of diabetes and the reduction of cardiovascular risks. J Gender-Specific Med 2002;5(suppl):1S-14S.

20. Taubes, G. Good Calories Bad Calories. Publisher: Alfred A Knopf New York 2007

21. Impaired Fasting Glucose Concentrations in Nondiabetic Patients With Ischemic Heart Disease: A Marker for a Worse Prognosis. from American Heart Journal Enrique Z. Fisman, MD,^aMichael Motro, MD,^aAlexander Tenenbaum, MD, PhD,^aValentina Boyko, MS,^bLori Mandelzweig, MPH,^b and Solomon Behar, MD http://www.medscape.com/viewarticle/409217

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