Insulin resistance is the key feature in the Metabolic Syndrome estimated to affect 40% of the adult population in the U.S. It is defined by 3 out of 5 of the following: waist circumference greater than 35 inches in women and over 40 inches in men, blood sugar over 100 mg/dl, blood pressure greater than 130/85, HDL lower than 40 in men and lower than 50 in women and triglycerides over 150 in both sexes. Metabolic Syndrome is not a disease but a constellation of the above factors directly related to insulin resistance that can lead to diabetes heart disease and stroke and possibly cancer. Sedentary lifestyle and a diet high in refined starches and sugar (frequent celebration or holiday foods and deserts) are considered to be the prime causes with less than 30% due to genetics.

The good news is that the middle age spread and Metabolic Syndrome can be successfully decreased by dietary and lifestyle changes. After age 50 the average person will loose gain one pound of fat per year and loose ½ pound of muscle. By age 70 this adds up to 20 lbs fat gain and 10 lbs muscle loss.

The study group consisted of sedentary, overweight, postmenopausal women 50-75 years of age. In the study, one group of women was assigned to an aerobic exercise plan of 60-75% of maximum heart rate for 45 minutes a day, 5 days a week. Another group was assigned to do one day a week of stretching. Blood tests were taken at the start, 3 months and 12 months. CRP decreased by 10% in the aerobic group but increased by 12% in the stretching group. Women whose body mass index was greater than 30 (considered obese) or whose waist was greater than 34.5 inches (over 33 inches considered obese) had the greatest decrease of CRP. The reductions in this study were achieved only through exercise and no dietary changes were involved.
The visceral abdominal fat cells that surround the internal organs are the primary source of the CRP as well as other inflammatory chemicals. During an infection the CRP will rise and then fall after the infection is resolved. So if there is no infection and CRP is elevated, then it is coming from the deep abdominal fat cells. Elevations in CRP are also associated with greater generalized body pains, and pre-diabetes. An hsCRP of less than 1g/l is considered low cardiovascular risk, 1-3 moderate risk and 3.1-10 high risk.

The good news is that the CRP if highly modifiable through lifestyle changes such as exercise and diet. Other studies have shown that CRP can be reduced even more through the combined lifestyle changes of exercise and the Mediterranean diet. Just because the study mentioned above focused on women doesn’t mean its findings aren’t relevant to men. Abdominal fat works the same way in women and men. If a man’s waist is greater than 40 inches, he is at major risk for heart disease and diabetes and most likely will have an elevated CRP. Lifestyle changes appear to work equally well in men and women.

Previous medical studies showed that lifestyle and dietary changes could provide long lasting protection against Type II or Adult Onset Diabetes but doctors weren’t sure for how long. Now a new just published in the journal Lancet, the longest follow up of patients from the Diabetes Prevention Program Research Group provides the answer. This study followed 3,234 non-diabetic patients with elevated fasting glucose and impaired glucose tolerance. The rate of new diabetes fell by 58% with intensive lifestyle intervention and by only 31% in those patients taking metformin (a common drug for diabetes) compared to placebo over 2.8 years. Over the next 5.7 years the original lifestyle intervention group maintained their low diabetes onset rate. When researchers combines the two time periods to cover 10 years, the rate of new diabetes fell by 34% in the lifestyle intervention group and by 18% in the metformin group. The authors concluded, “a carefully followed diet-exercise combination seemed to be superior in preventing or delaying the development of diabetes compared to the effect of anti-hyperglycemic drugs (metformin)…”

For those who would prefer to rely on medicine such as metformin, Avandia or Actos to treat their diabetes there is bad news. In 2008 in the New England Journal of Medicine, a study of 10,000 people showed that people who took medicines only to lower their blood sugar had a higher risk of death. YES, A HIGHER RISK OF DEATH. Why, because the medicines don’t treat the underlying cause of the diabetes which in insulin resistance when the cells of the body don’t respond to the insulin signal to lower blood sugar. The drugs make the problem worse by elevating insulin levels.

Contrary to the television commercials saying, “when diet and exercise aren’t enough” medical studies now show diet and exercise are not only effective but long lasting for preventing diabetes. The low technology approaches of lifestyle changes are not advertised since there is no profit to be made. Yet the improved quality of life and prevention of the serious consequences of diabetes is priceless to those who want to take charge of their health. The Mediterranean diet is the one used in most of these studies ands is in fact the most widely studied diet in all of medical literature for heart disease, diabetes, high blood pressure and arthritis. It can also help to reverse the problem of insulin resistance.

Hunter Yost M.D. has a private practice in northwest Tucson. www.hunteryostmd.com

According to the American Journal of Clinical Nutrition, non-alcoholic fatty liver disease (NAFLD) affects about 70 million adults in the U.S. or 30% of the adult population. About 20 % of these individuals have the more severe form called non-alcoholic steatohepatitis or NASH. NAFLD is emerging as a major cause of chronic liver disease and is associated with the increasing prevalence of type II diabetes and obesity. It is the most common reason for the need for a liver transplant.

NAFLD is the most frequent explanation for abnormal liver test results and accounts for elevation of liver enzymes in up to 90 % of cases. Specific patterns of liver enzymes can be markers of insulin resistance, the primary cause of type II or adult diabetes.

Fatty liver is strongly associated with the Metabolic Syndrome. This is a pre-diabetic condition defined by 3 out of 5 of the following: blood pressure greater than 130/85, blood sugar greater than 100 mg/dl, triglycerides greater than 150 mg/dl, waist circumference greater than 40 inches for men and 35 inches for women and HDL (good cholesterol) less than 50 for women and 40 for men. People with Metabolic Syndrome have five times greater risked for diabetes, two times greater risk for heart disease, and significantly greater risk for stroke and gout. 64 million Americans are estimated to have Metabolic Syndrome.

The good news is that recently many studies show that the Mediterranean Diet can improve and prevent this fatty liver condition. This is the most researched diet in all of medical literature for heart disease, diabetes, cancer and arthritis. It consists of legumes, fruits and vegetables, nuts and seeds, fish, poultry, lamb, whole grains and minimal dairy. This diet decreases inflammation in all tissues of the body including the liver and improves insulin sensitivity so that adult diabetes can also be reversed. The standard American diet consisting of packaged and processed foods, soda drinks, fast foods, snack foods, refined sugars, and white flour based products is the primary cause of fatty liver, insulin resistance and expanding waistlines.

These dietary and lifestyle changes are a good example of effective low technology, low cost approaches to complex medical problems and are well documented in the medical literature.

Hunter Yost M.D. is in private practice in northwest Tucson. www.hunteryosymd.com

The American Journal of Cardiology in 2004 said “many patients with conventional risk factors for cardiovascular heart disease can experience lowered risk without medications within 12 weeks of starting a therapeutic lifestyle program, refuting the notion that lifestyle modification is not worth the effort.” These recommendations apply to high blood pressure, pre-diabetes, elevated triglycerides and low HDL (the “good cholesterol”). Many people with one or more of these factors also have elevated waist circumferences. Above 40 inches in men and 33 inches in women is considered to be a major risk factor for heart disease and diabetes.

In the 2008 Journal of the American College of Cardiology researchers found that eating a common American meal (e.g. steak, baked potato with sour cream or butter and desert) would immediatly elevate triglycerides, blood sugar, damaging free radicals. This causes a response in the body consisting of unnecessary stress chemicals triggering plaque deposition in arteries within hours after the meal. However a Mediterranean diet consisting of fish or poultry, vegetables, nuts and seeds, fruits and legumes has the opposite effect in the body. They called the Mediterranean diet an anti-inflammatory diet and should be considered for the primary (1st heart attack) and secondary (2nd heart attack) prevention of heart disease and diabetes.

“Ask your doctor if the Mediterranean diet is right for you”? Again, you probably didn’t hear this on TV. If these recommendations were actually followed the cost savings to our health care system would be tremendous through decreased medication usage and a decreased need for medical services for the most costly chronic illnesses.

Tucson Arizona

Your bathroom scale cannot give you this information. How do you know if your weight gain is due to gaining fat or muscle? How do you know if your weight loss is due to loosing fat or loosing muscle? Anyone can go on a diet and loose 20-30 pounds but unless they were following a specific program to build muscle through diet and exercise, much of that weight loss would be due to loosing muscle and they would be likely to gain back most of the weight. It is quite encouraging for people to learn that their muscle mass has increased even by a few tenths of a point while their fat mass has decreased by a few tenths of a point or more. Some healthcare practitioners are beginning to use the bioimpedance analyzer in their practices for individuals who want to know more than what their scales can tell them.

Tucson Arizona

Body composition can be measured through a simple, non-invasive device called a bioimpedance analyzer. A mild current, which cannot be felt, is passed through electrodes attached to the foot and hand. The current passes through the different body compartments: intracellular water, extracellular water, fat mass, and free fat mass (everything other than fat). If the current passes slowly, there is more fat mass and extracellular water. If it passes through more quickly, there is more intracellular water and muscle tissue. The analyzer is also programmed to calculate the amount of stored energy in the cells and cell membranes, called phase angle and body capacitance. Not surprisingly, healthy people have more stored energy than unhealthy people. Bioimpedance correlates quite well with the DEXA scan, which is considered the gold standard for measuring fat, muscle, and bone mass, but uses radiation so it cannot be used for regular assessment of body composition.

Traditional markers of total body weight, body mass index (BMI), and waist circumference are helpful for baseline information but cannot tell whether a person is gaining or losing muscle mass, or shifting from unhealthy extracellular water to healthier intracellular water. By measuring these latter biomarkers, along with the phase angle marker, we can track nutritional and lifestyle changes, and minimize the otherwise inevitable consequences of aging and disease.

A new term called ‘sarcopenic obesity’ is appearing in the medical literature. Simply put, it means loss of muscle mass while fat mass increases. Reduction in muscle mass can be caused by previous bouts of crash dieting, inadequate protein intake and inactivity. Sarcopenic obese people may even have a normal or low BMI measurement and look thin, but have a relatively high fat ratio – lending the term “skinny fat people”. Research from UCLA Center for Human Nutrition showing bioelectrical impedance measurements made of young women at increased risk of breast cancer demonstrated sarcopenic obesity in 38 out of 40 women. In these women, body fat is best reduced by encouraging heavy resistance exercise rather than simply restricting calories. Increasing their muscle mass will help increase their basal metabolic rates and burn more fat.

Incorporated into a comprehensive therapeutic lifestyle management program, bioimpedance analysis, performed every few weeks, can be a powerful tool to monitor body composition changes. It is also a great motivator as people see the results of the lifestyle and dietary changes they have made. With weight loss, slower is healthier, and energy usually improves quickly. Medical studies agree that maintaining muscle mass and minimizing fat mass is one of the best indicators of healthy aging.

Tucson, Arizona

How many people today are turning to homegrown vegetables to cope with the current downturn? Hardly anyone I know. Why, because coinciding with the post-war economic boom was the rise of the fast food industry and the introduction of convenience foods (remember Swanson’s TV dinners) that did not exist in the 1930’s, providing inexpensive, high fat, high salt and sugar, low nutrition foods. In fact, the fast food industry is doing quite well right now with McDonald’s Corp. announced a first-quarter profit of $980 million, up 4% from last year and Burger King 1st quarter profits up 1.6% over last year. So this time instead of a decrease in heart disease and related problems there may be an increase. People’s waistlines are expanding as their wallets have been shrinking.

Our relatives of not so long ago had it right. They switched by necessity to healthier foods. Fresh produce, beans and legumes and poultry are relatively inexpensive today. Spending about one hour a week making a bean and vegetable soup can provide leftovers to last the rest of the week for a lot less money than eating out. Our parents, grandparents and great-grandparents also walked a lot more by necessity in those days than we do now. Unless we learn these important lessons from them, we may emerge from this recession much less healthy than they did when economic times were even worse.

Tucson, Arizona