metabolic syndrome - june 2014
TRANSCRIPT
Metabolic Syndrome
June 2014
Metabolic Syndrome
Syndrome X
Identified less than 20 years ago
Increasingly common
Runs in families
The risk of it increases with age
Sufferers are overweight or obese
A risk factor for:
Cardiovascular diseases and type 2 diabetes
Certain cancers, liver disease and Alzheimer’s
What is Metabolic Syndrome?
It is a cluster of metabolic disorders:
Insulin Resistance
High Blood Pressure
An increased risk of blood clotting
High blood sugar
Low HDL (good) cholesterol level
High blood triglyceride (fat) level
Excess abdominal fat
Any three of these clinches the diagnosis
What causes Metabolic Syndrome?
The causes are complex
Poor lifestyle choices play a major role:
Eating too much sugar and other refined carbohydrates
Lack of exercise
Insufficient sleep
High stress levels
What causes Metabolic Syndrome?
However,
of all the influencing factors,
poor food choices,
in the form of sugar
and refined carbohydrate,
contribute between 80% and 90%
of the total effect.
How does Sugar causeMetabolic Syndrome?
Excess sugar makes us fat, and people with metabolic syndrome are all overweight or obese
There are two mechanisms:
Excess sugar is stored as fat
Leptin, produced in fatty tissue, is a hormone that regulates appetite. But fructose causes leptin resistance
Fructose Also Increases
Blood fat levels:
Triglycerides
Total blood cholesterol
LDL (bad) cholesterol
The prevalence of:
Type 2 diabetes
High blood pressure
Abnormal blood clotting
Heart disease
The very conditions that constitute
metabolic syndrome!
Positive energy balance
DoH ’98, USDA ’02, NIH ’03, NCHS ‘04
1940 50 60 70 80
What we eat
What we need
Obesity
A modern problem - statistics for it did not exist 50 years ago
A major factor in the development of Metabolic Syndrome
Your BMI is your weight in kilograms, divided by your height in metres, divided again by your height in metres
Healthy - a BMI between 18.5 and 24.9
Overweight - a BMI between 25 and 30
Obese - a BMI over 30
e.g. Weight 80kg, height 1.60m, BMI is 80 / 1.6 / 1.6 = 31.25 = obese
Scary Global Statistics
Obesity prevalence has doubled worldwide in the past 25 years
In 2005, 1.6 billion adults were overweight and 400 million of them were obese
By 2015, WHO predicts there will be 2.3 billion overweight adults and 700 million of them will be obese
Scary UK Statistics
By 2011, the proportion of adults with a healthy BMI (18.5 - 24.9) had fallen to 34% (men) and 39% (women)
There had been a marked increase in obesity rates over the previous 18 years:
In 1993, 13% (men) and 16% (women) were obese
By 2011, this had risen to 24% (men) and 26% (women)
For children attending reception classes (aged 4-5) during 2011-12, 9.5% were obese
Consequences
2011 - 11,736 hospital admissions for obesity - an 11-fold increase in 10 years
2011 - 53% of obese men and 44% of obese women had high blood pressure
Type 2 diabetes
Occurs where there is insulin resistance - the common factor in metabolic syndrome
Currently afflicts 4 million people
Expected to rise to 6 million by 2020
‘Management’ will then account for 25% of the health budget
A Typical Scenario
Weight gain - The GP suggests a ‘balanced diet’
‘Isn’t it my glands, doctor?’ - The GP prescribes thyroid hormone - further weight gain
High blood pressure and diabetes. The BP is treated with pills which often make the diabetes worse – further weight gain
The diabetes cannot be controlled without diet and weight loss, but medication is prescribed anyway
High blood cholesterol – a statin is prescribed
The Saga Continues
Obesity causes low back and knee pain - anti-inflammatories are prescribed
These cause indigestion and acid reflux, which makes sleeping difficult - a proton pump inhibitor and sleeping tablets are prescribed
The patient is now so unhappy that the GP prescribes an anti-depressant
Our patient is now incapacitated by increasing pain, and eats even more for consolation
Further weight gain
The Denouement
Our patient is taking up to twelve different medications, often with unpleasant side effects
A stroke, or a heart attack, is imminent
They may be using an inhaler for angina and a positive pressure ventilator for sleep apnoea
The joint pains worsen – the consultant confirms that nothing surgical can be done
Ever stronger pain killers are prescribed, to which tolerance quickly develops
Drug dependency, loss of job and loss of self esteem are added to our patient’s woes
Some Observations
It is interesting that such patients frequently claim to eat very little
They are in denial
They should be furious with a health service that has not served them well
The cost of their treatment is astronomical and would be unaffordable if it had to come out of their pocket
People in Africa used to know how to feed themselves:
Millet, sorghum and – more recently -maize, grown and milled at home
Ground nuts, sweet potato, pumpkin, cabbage
Gathering herbs, roots, shoots, fruits and wild spinach
Moderate intake of fresh, free range meat, eggs and milk
Hidden Hunger
In Southern Africa, today, the staples are
Refined maize meal (empty calories)
Bread (mostly refined)
White sugar (empty calories)
Soft drinks
Sweets
Most processed foods
Traditional margarine (trans fats)
Cooking oil
A Strategy of Empowerment
We challenged the denial, the addictive behaviour and any claim to victimhood, using cognitive behavioural therapy (CBT)
We educated our patients so that they could fully understand their condition
We set targets
We empowered them to heal themselves
We started a support group, and called it Waist Disposal
My physiotherapist wife opened a gym and ran exercise classes
An Alternative Scenario
Patients are seldom capable of making minor lifestyle adjustments, but they can make major ones
Patients with metabolic syndrome are challenged to adopt a fat-free, wholefood, vegan diet
No meat, no fish, no eggs, no dairy, no fat, no oil, no sugar, no refined carbohydrate, no fruit juices and no alcohol
Weight loss is sufficiently rapid to encourage continued compliance
The Result
Once a healthy weight is reached, most patients require no medication at all
High blood pressure, type 2 diabetes and raised blood cholesterol all disappear or greatly improve
Nor do patients need to stay vegan or teetotal
They have discovered the wisdom of moderation in all things
And there is nothing more empowering than the realisation that you can, and should be, responsible for your own health
Challenging Myths
This is no fad diet - there are millions of healthy vegans in the world
It is not difficult to change eating habits -ask McDonald’s, KFC and Pizza Hut
Radical lifestyle change is easier than minor adjustments
Fasting is the key to controlling IGF-1, which is linked to the development of disease and the ageing process. This is the basis of the 5:2 diet
The Pharmaceutical ModelIs it still relevant?
100 years of research has generated a wide range of potent & specific drugs
Anti-microbials
Pathogens allow differential metabolic targeting – ‘weak link’
Wide therapeutic index, curative
But resistance is now widespread
The Pharmaceutical ModelIs it still relevant?
Almost all drugs for CDDs are designed to suppress symptoms, and do not treat the underlying disease
Narrow therapeutic index, palliative
Iatrogenic illness is now a major cause of morbidity and mortality
The CDDs still have no cures … They are increasing in frequency
The age of onset is falling
Thank You for Your Interest
Health Empowerment Through Nutrition is a
UK Registered Charity concerned with the
alleviation of Hidden Hunger
www.hetn.org