Sarasota Weight Loss

 

Weight Gain And Metabolic Syndrome

“The Health Crisis”

Metabolic Syndrome (aka Syndrome X) has four hallmark symptoms consisting of the following; obesity, hypertension, dyslipidemia, and hyperglycemia. In 2005 the National Institutes of Health and the New England Journal of Medicine published a paper stating, because of this epidemic, the current generation is projected to have a shorter life expectancy then the previous one… for the first time in recorded history! Since that publication, things have become much worse. In spite of medical advances, the baby boomer generation is in worse health than their parents were at the same stage of their lives. The American Medical Association reported that only 13 percent of baby boomers reported being in excellent health versus 32 percent of people being in excellent health from the previous generation. The West Virginia University School of Medicine used data from an ongoing national health survey to compare people who were 46 to 64 years old between 1988 and 1994 with baby boomers in the same age range between 2007 and 2010. Overall, 39 percent of the boomers were obese compared to 29 percent of the previous generation. About 16 percent of boomers had diabetes compared to 12 percent of the previous generation. Boomers were also more likely to have high cholesterol and high blood pressure. It was also reported that twice as many baby boomers walk with a cane or walker when compared to the previous generation. The fact that baby boomers are worse off than the previous generation in regard to obesity and disability in spite of medical advances, points to other factors. These other factors are primarily suspected to be stress, a toxic environment and processed, pesticide-laden food. The study revealed boomers smoked less, were less likely to have emphysema, and were less likely to have a heart attack. Our health has declined despite the fact that we have changed the USDA Food Pyramid, developed many new classes of pharmaceutical agents (especially ones for pre-diabetes and Type II Diabetes), have taken soda machines out of schools, and set the obesity epidemic as a top priority through the First Lady’s nation-wide plans. This syndrome, with all of its comorbidities (cardiovascular disease, stroke, many cancers, kidney failure, blindness, amputations, etc.), accounts for the majority of healthcare dollars spent. If the tide is not turned, Metabolic Syndrome will bankrupt our country.

What is Metabolic Syndrome?

In 1987 the late Gerald Reaven, MD, Professor of Medicine at Stanford University’s College of Medicine, first demonstrated that the four hallmark symptoms shared a commonality; hyperinsulinemia coupled with insulin resistance. He coined the term “Syndrome X” to illustrate the point. The four legs of the “X” represent the syndromes (hypertension, central obesity, hyperglycemia and dyslipidemia) and the center of the “X” represents the causal agent of too much insulin along with insulin resistance (the cells do not respond to the normal physiologic amounts of insulin). This is the accepted medical model of this disease.

The Failure of Treatments

We are being overtaken by this syndrome due to the simple fact that we have ignored the model! Instead of focusing our attention on the root cause we have decided to treat each of the symptoms as separate, unrelated diseases. Thus we have new dietary recommendations and “diets d’jour”, as well as a plethora of exercise regimens prescribed for obesity. There too are many prescription drugs to “control” the other three symptoms. If our attention is on “controlling symptoms” we have admitted, by default, that there is nothing we can do to reverse the syndrome. (i.e. “it will always be with us, we’ll just control it”) This attitude of acceptance is bad enough. If we understand this syndrome we can readily see why many of these treatments actually make the other symptoms much worse! Hyper-insulinemia means the patient’s pancreas is secreting an exaggerated amount of insulin in response to rises in blood glucose.

This can easily be tested by doing a fasting insulin level or the standard glucose challenge test and ordering insulin levels along with glucose levels at time zero, one hour, and two hour intervals post-challenge glucose administration. Unfortunately, the vast majority of practitioners do not even think about such an important marker. So we dwell on just the glucose level or Hemoglobin A 1 c (merely symptoms) and prescribe drugs such as the sulfonylurea (i.e. glyburide, glipizide, glimperide) which cause the pancreas to secrete more insulin, or we actually give them insulin in aggressive attempt to control a symptom. If the model is correct then this therapy should make the symptom worse….. and it does! This is the fundamental reason why we have failed to stem the tide (or actually reverse) this seemingly insidious illness.

Insulin Levels

If insulin just controlled/modulated glucose uptake by our cells and did nothing else, we probably would not have this problem. However, this is not the case, and when the amount of insulin remains consistently elevated it does other things…. Which are not good for your body/health. The body is an organism that strives to maintain a constant internal environment in the face of constantly changing, often hostile, external factors. Blood pressure, blood glucose, body temperature, acid/base balance, ect. must remain within a relatively narrow range in order to survive. It does so by means of the action/reaction, or mechanisms that exert opposite effects so that a balance may be archived. Examples are: vasodilation/vasoconctriction, oxidation/reduction, anabolism/catabolism, assimilation/elimination, ect. These systems are regulated primarily by the nervous system and the endocrine (hormonal) system. So if the environmental temperature is 125 degrees, our internal temperature remains 98.6.

Likewise if the temperature drops to 20 degrees, certain mechanisms are in place to make certain our internal temperature remains a constant 98.6. Glucose homeostasis is essential for life, as certain cells in the body can only use glucose as an energy source (certain brain cells, the adrenal medulla, red blood cells, etc.). Whether in times of feast or famine, blood glucose must remain in a certain range and insulin and glucagon are the master hormones that control this process (forget about ghrelin, liptin, incretins and all these “new mini-hormones” that are the master hormones that are in the literature today . . . these are subservient to the two masters). The body needs both of these “master hormones” to maintain balance (as they have exactly opposite physiological functions . . . if you know what insulin does, then you automatically know what glucagon does . . . the exact opposite!) and if an imbalance occurs, dysfunction or “disease” will arise.

The Physiological Effects of Insulin

Insulin’s primary function is controlling glucose uptake to muscle cells, and in this way it helps regulate blood glucose homeostasis. However, insulin binds to many other receptors in the body and affects other physiological parameters. If insulin receptors on the muscle cells become resistant to insulin’s effect (and do not uptake glucose in an effective manner) the pancreas will produce more to ensure glucose uptake will occur. But if we increase insulin levels, what happens to all the receptors that are not “resistant” yet and modulate other bodily functions? This scenario becomes way more complicated, in that these receptors become “insulin resistant” at different times. So a “typical Syndrome Xer” presents to the physician with some central obesity, slightly elevated blood pressure, slightly elevated blood glucose and a less than stellar lipid panel. He is told to lose some weight by eating more fruits and vegetables, cutting down on fats and cholesterol (have oatmeal instead of bacon and eggs) and doing some light exercise. This is standard, first line therapy of lifestyle changes and sounds very reasonable. This compliant patient makes these changes and returns in two months, shocked and disappointed that his symptoms have become worse! Now he is given a low dose ACE inhibitor coupled with a diuretic for his hypertension and placed on metformin and glyburide to help control hyperglycemia.

The glyburide tells the pancreas to secrete even more insulin and he gains more weight. Insulin also “ramps up” the enzyme HMG-Co A reductase, which basically tells the body to produce even more cholesterol. Excess insulin also drives the kidneys to retain sodium and waste magnesium, which is an essential element for insulin receptor sensitivity. Hypertension and insulin resistance worsen. Usually at this point (if not sooner) a statin is added along with niacin and another oral hypoglycemic and we “start the march” to insulin therapy. This is why many of these patients will find themselves on six to nine prescription drugs and this if the current “standard of care” for this syndrome.

Food is your Best Medicine

Let us now suppose that the above patient visited Rx Weight Loss Sarasota first. Our physicians are skilled in the use of “muscle sparing” protein diet, not a hyper protein diet ala Atkins. Our diet plan is scientifically based and has years of successful outcomes with patients. This diet is also low in fat, particularly saturated fat and is very carbohydrate restrictive (providing about 20-40 grams of carbohydrate daily mainly from fibrous vegetables). The physician explains the “medical model” of syndrome X and relates how the overproduction of insulin can contribute to all his symptoms. Correcting hyperinsulinemia is very straightforward: all carbohydrates (with the exception of fiber) will eventually be turned into glucose…sometimes quickly, sometimes slowly. As the glucose is absorbed the pancreas begins to secrete insulin (in this case, too much insulin). By restricting the carbohydrates the production of insulin is immediately reduced.

The patient is interested but confides that he can be hypoglycemic at times and is afraid of such a restrictive protocol. The physician relates that hypoglycemia is usually the consequence of an overproduction of insulin, not a lack of carbohydrates. He further explains the body has “three tanks of energy” from which to draw. Glycogen (or our stored glucose), muscle, which can be broken down via gluconeogenesis to supply glucose and fat (triglycerides), which can be turned into glucose (from the glycerol) and ketonic bodies that most of the cells in the body can use for fuel. But the body draws on these compartments in a very specific order. It will always use the glycogen first and only when “that tank” is empty will it begin to simultaneously burn muscle and fat.

The physician tells the patient if he keeps “putting the fuel in the glycogen tank”, he will never be able to access his fat reserves, thus the restriction of carbohydrates. He also says that we never want to lose muscle, thus the inclusion of the adequate amount of protein to replenish what is lost to gluconeogenesis.

During the first three days of this protocol the patient may feel a little tired or weak (as the body depletes its glycogen) but once glycogen is gone and the body switches over to fat and muscle, you will have plenty of energy and your hypoglycemic episodes should stop.

Glucagon’s Effect on Weight

By balancing insulin and glucagon, you can loose weight and have more energy. Your blood work can be improved in as little as six weeks. This is because you have reset the pancreas, which no longer is pumping out too much insulin, so we can now start to put more carbohydrates and fat back in the diet.

After your glycogen reserves are depleted and carbohydrates continued to be restricted, the body had to maintain proper blood glucose levels. Under these conditions, the pancreas produces more glucagon (which raises blood sugar) and insulin (which lowers blood sugar) but there is more to glucagon than this primary function. Glucagon also stimulates two adipocyte (fat cell) enzymes (HSL and ATGL) and inhibits a third (lipoprotein lipase). The result is the release of triglycerides from fat cells (to be used as fuel) as opposed to insulin’s effect, which is to store fat. Glucagon enhances the entry of free fatty acids across the mitochondrial membranes so they can be used as fuel (insulin inhibits this). Glucagon also greatly inhibits the action of HMG-CoA reductase (along with the other enzymes necessary for cholesterol synthesis) and forces cells to pull cholesterol from the bloodstream via the stimulation of low-density lipoprotein receptors. This is why your lipid panel will improve. Finally the kidney, the retention of sodium caused by excess insulin has now been corrected and the hypertension is improved. The pathophysiology of metabolic syndrome is predictable. The reversal of the syndrome is also predictable and repeatable. Thousands of our patients have experienced the same benefits described above.

Boomers live longer than the earlier generations, but it’s a mixed blessing. Living longer, but being sick is far from an ideal life. The West Virginia School Of Medicine study can’t explain why boomers are in worse shape, but the study revealed they sit more and don’t exercise. Lack of exercise, combined with processed food and drive thru fast food is playing a huge role. Pollution, pesticides and food processing are playing a big role in our current public health picture.

What’s important for you, the reader, is to understand that it’s not to late to adopt new healthy lifestyles and make a big difference in how you feel.

Make your health and happiness a priority! You should do everything you can to be active and eat organic food. You will see the benefits in just several weeks.

 

 

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