Wednesday, February 10, 2010

Someone You Know Has Metabolic Syndrome - And It's Killing Them

The world at large - but especially America - is under siege from an insidious assailant:  the metabolic syndrome.  Known also as Syndrome X or Insulin Resistance Syndrome, and several other names, this term was coined in 1977 by German scientist Haller H.  Metabolic syndrome has been around as long as agriculture, but until the 1940's it was more an affliction of nobility and the well-to-do; fast forward to today - in the United States, it plagues people of all walks of life, with an emphasis on the poor and down-trodden.

It frustrates me to no end that many of my friends and family, so many of the people walking down the street living with this syndrome and associated diseases - especially those who do not have the means to afford higher quality foodstuffs or, even worse, that feed their children, who can only know what we teach them, what essentially amounts to toxic garbage.

What is metabolic syndrome?

Metabolic syndrome is, as Michael Pollan and others call it, a "disease of civilization".   There are no obese children where wild humans roam.  It arises when you combine a sedentary lifestyle with a diet rich in carbohydrates, especially the sugar fructose (HFCS anyone?)

A syndrome is a combination of medical disorders or pattern of symptoms that may indicate the presence of other symptoms/disorders (for example, the correlation between CHD and diabetes).   This can allow us to look for and, perhaps, find other issues that may not have been as readily apparent, signs that are part and parcel to a greater overall problem/disease - progeny of the same beast, so to speak.

The Wiki Gods give us some signs and symptoms of Metabolic Disorder, which are:
  • Diabetes mellitus type 2
  • High blood pressure
  • Central obesity - visceral or abdominal fatty deposits
  • Decrease in HDL (this does not necessarily have anything to do with levels of LDL)
  • Elevated blood triglycerides (fat in the blood)
Risk factors associated with the Metabolic Syndrome include:
  • Obesity - greatly increases the chance of having Metabolic Syndrome, but skinny people can develop insulin resistance too
  • Stress - chronic stress disrupts proper hormone function
  • Age - 44% of US citizens over the age of 50 are affected
  • Sedentary lifestyle - being active increases insulin sensitivity - the opposite fosters resistance
  • Coronary Heart Disease - 50% of patients with CHD also have metabolic syndrome.  Correlation does not imply causation, but all the same, this is a STRONG trend
Metabolic Syndrome - or MetS - is an issue of insulin sensitivity.  

An eye-opening paper (read this) mentions
It is at least plausible that obesity and the features of MetS arise in parallel from disruptions of insulin metabolism (possibly a consequence of high insulin due to chronic high dietary CHO). Also a high prevalence of so called metabolically obese-normal-weight individuals with MetS has long been known [18].
CHO in this context means dietary carbohydrate.  What this, and the rest of the paper, is saying - as well as the greater body of responsibly conducted research into insulin sensitivity, low carb diets, etc. - is that excess blood sugar (from CHO) can put your body's insulin system all out of whack.  Insulin desensitization and the resulting blood chemistry has been shown to lead to all of the above signs and symptoms of MetS.

MetS is, in the end, the effect the Standard American Diet has on our bodies.  (You can thank corn for this, largely.)

Who has it?

A 2002 study shows that
The unadjusted and age-adjusted prevalences of the metabolic syndrome were 21.8% and 23.7%, respectively. The prevalence increased from 6.7% among participants aged 20 through 29 years to 43.5% and 42.0% for participants aged 60 through 69 years and aged at least 70 years, respectively. Mexican Americans had the highest age-adjusted prevalence of the metabolic syndrome (31.9%). The age-adjusted prevalence was similar for men (24.0%) and women (23.4%).  However, among African Americans, women had about a 57% higher prevalence than men did and among Mexican Americans, women had about a 26% higher prevalence than men did. Using 2000 census data, about 47 million US residents have the metabolic syndrome. 
So, roughly 1/4 of the population of the United States.  Yikes.

As the risk factors mentioned above would indicate, this is a lot more prevalent in older populations (just 6.7% in 20-somethings to a whopping 43% in the 60-70 year range).   As people get older, generally, they become more sedentary - perhaps less health conscious in general?  I'm not sure, but going from ~7% to 43% would suggest so.

Another interesting figure from this study is the greater prevalence in Mexican-American's, and in women in the Mexican-American and African-American communities.   Leads me to wonder of the cultural and socio-economic reasons for this difference.  I'd like more data on the difference between the African-American population as a WHOLE and, say, the Anglo-Saxon population in the US.

I'd really like to point out that this paper was done in 2002.  Since then, rates of Type 2 Diabetes are on the rise - there is a strong correlation between Diabetes and MetS.  A study from the National Center for Chronic Disease Prevention and Health Promotion tracked rates of diabetes from 1996 to 2007.  The results?

Yikes again!  In 10 years incidence has, in most states, doubled.  In some tripled!  In none has it gone down.  Information on Metabolic Syndrome is much harder to find, as it is a relatively "new" issue (awareness-wise) and researchers are still struggling to properly define it.  Type II Diabetes, though, can help us track this monster - it is a symptom, after all.

More fun pictures:  a graph of obesity, in various age groups, and its rate of incidence over the past few decades. (Disclaimer:  Not everyone categorized as overweight/obese is actually so - this classification is determined by using Body Mass Index - as such, I am considered 'overweight' at roughly 10% bodyfat.  Ludicrous.  Unfortunately, people like me - higher than average muscle mass - make up a small portion of the 'overweight' category;  these numbers are statistically significant, especially when you look at the younger age ranges.  2-11 is especially telling, and saddening.)
As mentioned before, visceral and abdominal adiposity are strong indicators of metabolic syndrome.  With a significant rise in overweight and obese individuals, there will be a significant rise in the 'spare tire'.  What can be even more scary, though, is that visceral fat is MUCH harder to notice than subcutaneous adipose tissue - you can be relatively skinny, a far cry from overweight, and still have dangerous levels of visceral fat surrounding your organs and infesting your liver.

I've been looking long and hard - if anyone has decent information on current rates of Metabolic Syndrome, please let me know!

How do we avoid it?

In his article Metabolic Syndrome Defined, Dr. Michael Eades ruminates on the looseness of what "Metabolic Syndrome" means - is this really a syndrome, or are do these disorders merely 'happen' to manifest together:
A new paper published in Nutrition & Metabolism addresses the issue in an insightful manner. The authors first plucked from the vast scientific literature the five features of the Metabolic Syndrome than seem to be the common denominator of all the definitions in use: obesity (whether measured by weight, BMI, or waist circumference), elevated glucose and/or insulin levels, low HDL cholesterol, High triglycerides, and hypertension (high blood pressure). They then realized that all these disorders (or symptoms of the Metabolic Syndrome) were all reliably improved or eliminated by diets that restrict carbohydrate.
The authors conclude after examining the medical literature on carbohydrate restriction and the various components of the Metabolic Syndrome that the Metabolic Syndrome can be defined as a set of markers that respond to carbohydrate restriction. 
The paper he links is called, 'suprisingly', "Carbohydrate restriction improves the features of Metabolic Syndrome. Metabolic Syndrome may be defined by the response to carbohydrate restriction" (and is cited earlier in this post).  

In this paper is compiled data from another awesome low-carb study, shown below:

The diet used is the Atkins Diet, which starts you off at zero to Very-Low Carb (20g) and, after an initial weight-loss specific phase, gradually lets you introduce more (10g/week until weight-gain resumes);  the carbs in the Atkins diet are replaced with fat and protein, but an emphasis on the fat.   In the high CHO diet, triglyceride levels initially drop, but actually rise ABOVE baseline in the long-term.   Interestingly, HDL levels see a significant increase on the high-fat diet.  Hmmmm.

This data seems fairly conclusive: low-carb, high-fat diet promotes weight loss, insulin sensitivity, serum HDL and triglyceride levels - indicators of MetS - significantly more than the lipid-phobic, high-carb (high-profit) diet espoused by the USDA and certain medical "professionals".


If you or someone you know may (hint: someone you know DOES) have Metabolic Syndrome or a related condition, I urge you to learn more and/or inspire them to become more educated about the benefits of a low-carb lifestyle.  It could very well save their life.
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Man vs World by Aaron M Fraser is licensed under a Creative Commons Attribution-No Derivative Works 3.0 United States License.