Annie Sawyer, Ph. D.
Metabolic syndrome, the epidemic of the 21st century, is highly prevalent in today’s Western world and the number of people afflicted by its deadly consequences continues to rise. One of the major clinical features of metabolic syndrome is the so called abdominal (or visceral) obesity. Learning on how to treat the syndrome is like to address obesity in a different way. Obesity sets the stage for the metabolic syndrome which then itself increases one's chances of diabetes, heart disease, stroke and other maladies. Therefore, everyone in our society should be concerned about obesity as well as our government must take care on developing preventive programs.
Of course they are people and people. Those in whom the disorder is quite severe will accumulate fat extremely quickly, when those in whom it is moderate - will gradually increase in weight and those in whom it is mild- may be able to keep their excess weight stationary for long periods. Despite of the aggressiveness in weight loss programs and plans, based on restrictive diets, multiple drug treatment strategies, active exercise, sauna and massage techniques, the result seems temporary and very unsatisfactory. The pounds seem to come back immediately, after months and even years or as soon as the treatment programs are forgotten or relaxed. BMI is a measure of how much weight anyone carries for a given height.
Basically one is considered "overweight" when his/hers body mass index is greater than the upper range of the normal ranges. In order to meet the criterion for frank "obesity" one's BMI needs to be 30 or higher. The entity known as "morbid obesity" also known as clinically severe obesity, is defined as a BMI of greater than or equal to 40. However, one can also be labeled as morbidly obese if body mass index is 35 or higher and the individual has one or more "co morbid" conditions. The following co-morbid conditions can be formulated as metabolic syndrome (diabetes, high blood pressure, high cholesterol, stroke and cardiovascular disease). Being overweight is, alongside diabetes, a leading cause of increased cholesterol levels, high blood pressure and coronary artery disease. Hence, obesity increases chances of developing all the above risk factors.
1. Genetics and Family History: A family history that includes diabetes or diabetes during pregnancy (gestational diabetes), hypertension, obesity, and an early heart disease greatly increases the chances that an individual will develop metabolic syndrome (Grundy et al., 2004). The obesity gene as the possible link to heart disease is studied by a team of researchers (Leyva, 1998; Hong et al., 1998; Song, Wang & Zafari, 2006).
2. Hormonal imbalances: Hormonal imbalances are usually not an isolated problem. Most of the time, they are related to stress response. Food cravings, fatigue, depression, digestive distress and many other health complaints are direct result of hormonal imbalance as a result of the daily stress (emotional, environmental, and dietary). Leptin is a hormone that works as natural appetite suppressant secreted by fat cells in the body. Its discovery in the 1990s helped researchers to start experimenting with leptin that caused mice to eat less and lose weight while this rarely happens in humans. Falling levels of this hormone, that helps the brain resist tempting foods, may explain why people who lose weight often have a hard time keeping it off. Restoring leptin to its “pre-diet” levels may reverse this problem, concluded Rosenbaum, offering a new way for dieters to finally win the weight battle. "When you lose weight you've created about the perfect storm for regaining weight," as per Rosenbaum et al. of Columbia University Medical Center in New York, whose research appears in the Journal of Clinical Investigation (2008). After a pronounced weight loss according to the author, "the metabolism not only becomes more efficient, so the body needs fewer calories, but the brain becomes more vulnerable to tasty-looking treats." Areas of the brain involved in telling not to eat seem to be less active. You are more responsive to food and you are less in control of it," as Rosenbaum stated. Recent study concludes that conditions associated with the syndrome termed “hyperandrogenism” (a medical condition characterized by excessive production and/or secretion of androgens). In young women it is often associated with glucose intoleranceand other features of the metabolic syndrome. The team proves the hypothesis that high levels of testosterone,
Dehydroepiandrosterone sulfate (DHEA-S), and cortisol, and lowlevels of sex hormone-binding globulin (SHBG) and IGF-I may be associated with metabolic syndrome in a representative cohort of olderwomen. The author’s final conclusion is that prevalenceof metabolic syndrome increases with age and although the problem seems to be multidimensional and multifactorial, age-related hormonal changes might contribute to its development in older women. From this study is becoming obvious that women who are postmenopausal face higher probabilities of developing metabolic syndrome comparatively with premenopausal women (Maggio et al., 2007; Giampapa, Pero & Zimmerman, 2004). The quality-of-life in women in postmenopausal age after receiving hormone therapy and the results from the heart and estrogen/progestin replacement are studied by another team (Hlatky, Boothroyd, Vittinghoff, Sharp & Woolley, 2002).
3. Chronic elevated stress: The human body is well-designed to handle temporary spikes of physical and emotional stress, but how much and in what way stress affects human health varies from person to person. Chronic emotional stress can dramatically increase risk of heart attack, stroke, and even cancer, as when people are stressed, their cardiovascular, nervous, hormonal and endocrine systems work in partnership to cope, provoking quick narrowing of vessels, increasing the rate of blood coagulation, causing irregular heartbeats, and building up arterial plaque. Under stress, adrenal hormones induce the release of fat and sugar into the blood to be used for immediate energy supply (Bjorntorp, 2001; Bjorntorp & Rosmond, 2000). Stress disrupts normal hormonal levels, influencing immune system strength and eating habits (Innes, Vincent & Taylor, 2007). People who are not able to handle stress show high blood sugar and decreased release of insulin from the pancreas (Viner, Mc Grath & Trudinger, 1996). Extreme emotional stress (grief, anger, worry, fear) can cause the “broken heart syndrome “(BHS), also known as cardiomyopathy (Kim, 2009; Innes et al., 2007). Depression and metabolic syndrome connection is researched by (Dunbar et al., 2008). Clots may easily block an artery already narrowed by plaque, resulting in a heart attack, stroke, aneurysm, or aortic dissection. People who practice meditation and yoga are able to control and manage stress better than those who do not practice. It is noted that people who change their total lifestyle strategy and who use stress management relaxing techniques are able to control metabolic syndrome much better than those who only change their diets. Stress management techniques can improve long-term glycemic control in Type 2 diabetes (Surwit et al., 2002).
4. Too little sleep: Research also suggests that appetite-regulating hormones are affected by sleep and that sleep deprivation could lead to weight gain. In two separate well randomized studies, people who slept five hours or less had higher levels of ghrelin - a hormone that stimulates hunger - and lower levels of the appetite-suppressing hormone leptin than those who slept eight hours per night. Prof. Cappuccio of the University of WarwickMedical School (2006)has proved that short sleep duration may also lead to obesity, through an increase of appetite via hormonal changes. The study reviewed current evidence in over 28,000 children and 15,000 adults. For both groups the researcher found that shorter sleep duration is associated with almost a two-fold increased risk of being obese. The research also suggests that those who sleep less have a greater increase in body mass index and waist circumference over time and a greater chance of becoming obese over time. In his proper words: "The 'epidemic' of obesity is paralleled by a 'silent epidemic' of reduced sleep duration with short sleep duration linked to increased risk of obesity both in adults and in children. These trends are detectable in adults as well as in children as young as 5 years." Obviously lack of sleep produces excessive secretion of ghrelin, which stimulates appetite and creates less leptin, which suppresses appetite.
The hormonal relationship and obesity is shown also in the HERS study published in JAMA(2000). The hyperinsulinemia in women has been shown in this study to stimulate the release of testosterone from the ovaries. It is a well known fact that people who are obese are suffering from this disorder regardless of whether they eat normally, excessively, or less than normal. At the same moment it is quite obvious that there are people who are constantly overeating but are free of the above disorder. It is easy to conclude that obesity in all its multiple forms is due to an abnormal damage in the hypothalamic area of the brain- a center that is the main regulatory mechanism of a hunger, thirst and the sexual desire. If your hormones are in balance, you likely sleep well, have lots of energy and a strong sex drive, and your immune system and digestive system should be functioning smoothly. However, it’s relatively easy to push your hormones off kilter, leading to an array of varied symptoms and hormone disorders including:
5. Side effects of certain drugs: The notion that metabolic syndrome can also be a result of certain drugs (corticosteroids, antidepressants, antipsychotics, protease inhibitors and antihistamines) is based on the metabolic side effects of the above drugs (Hilgers & Mann, 2008; Aronson, 2006). Two separate studies (Elliot & Meyer, 2007; Messerli, Grossman & Leonetti, 2004) provide independent results, verifying that antihypertensive therapy may lead to an increase in diabetic onset. The authors conclude thatthi?zides and beta-blockersmay significantly increase blood lipids and glucose while ACE inhibitors (ACEI) and Ca channel blockers (CCB) do less harm. Beta-blockers may promote weight gain, andthi?zides and beta-blockers are associated with an increasedincidence of diabetes, compared to CCB and ACEI. The ALLHAT study opposes previous findings that Thiazide-type diuretics are superior and more economic in preventingCVD. Thus, they shouldbe preferred as the “first-line” antihypertensive therapy despite of the diabetes onset (Wright et al., 2008).
Drug –to- drug interactions in metabolic syndrome treatment can be another reason for the “vicious” nature of the syndrome (Iacobellis, 2006). Authors of a third study disagree with the ALLHAT study conclusions, proving for a second time that diuretics are related with significant onset of metabolic syndrome and diabetes (Hilgers & Mann, 2008). Another team reportsthat their SHEP study participants are developing Type 2 diabetes,while being on treatment with chlorthalidone - a drug used to treat hypertension (Kostis et al., 2005). Thus, authors conclude that ACE inhibitors should be the first choice in case of hypertonia treatment, followed by the CCB and beta-blockers and Thiazide diuretics as last choice.
Metabolic syndrome, the epidemic of the 21st century, is highly prevalent in today’s Western world and the number of people afflicted by its deadly consequences continues to rise. One of the major clinical features of metabolic syndrome is the so called abdominal (or visceral) obesity. Learning on how to treat the syndrome is like to address obesity in a different way. Obesity sets the stage for the metabolic syndrome which then itself increases one's chances of diabetes, heart disease, stroke and other maladies. Therefore, everyone in our society should be concerned about obesity as well as our government must take care on developing preventive programs.
Of course they are people and people. Those in whom the disorder is quite severe will accumulate fat extremely quickly, when those in whom it is moderate - will gradually increase in weight and those in whom it is mild- may be able to keep their excess weight stationary for long periods. Despite of the aggressiveness in weight loss programs and plans, based on restrictive diets, multiple drug treatment strategies, active exercise, sauna and massage techniques, the result seems temporary and very unsatisfactory. The pounds seem to come back immediately, after months and even years or as soon as the treatment programs are forgotten or relaxed. BMI is a measure of how much weight anyone carries for a given height.
Basically one is considered "overweight" when his/hers body mass index is greater than the upper range of the normal ranges. In order to meet the criterion for frank "obesity" one's BMI needs to be 30 or higher. The entity known as "morbid obesity" also known as clinically severe obesity, is defined as a BMI of greater than or equal to 40. However, one can also be labeled as morbidly obese if body mass index is 35 or higher and the individual has one or more "co morbid" conditions. The following co-morbid conditions can be formulated as metabolic syndrome (diabetes, high blood pressure, high cholesterol, stroke and cardiovascular disease). Being overweight is, alongside diabetes, a leading cause of increased cholesterol levels, high blood pressure and coronary artery disease. Hence, obesity increases chances of developing all the above risk factors.
1. Genetics and Family History: A family history that includes diabetes or diabetes during pregnancy (gestational diabetes), hypertension, obesity, and an early heart disease greatly increases the chances that an individual will develop metabolic syndrome (Grundy et al., 2004). The obesity gene as the possible link to heart disease is studied by a team of researchers (Leyva, 1998; Hong et al., 1998; Song, Wang & Zafari, 2006).
2. Hormonal imbalances: Hormonal imbalances are usually not an isolated problem. Most of the time, they are related to stress response. Food cravings, fatigue, depression, digestive distress and many other health complaints are direct result of hormonal imbalance as a result of the daily stress (emotional, environmental, and dietary). Leptin is a hormone that works as natural appetite suppressant secreted by fat cells in the body. Its discovery in the 1990s helped researchers to start experimenting with leptin that caused mice to eat less and lose weight while this rarely happens in humans. Falling levels of this hormone, that helps the brain resist tempting foods, may explain why people who lose weight often have a hard time keeping it off. Restoring leptin to its “pre-diet” levels may reverse this problem, concluded Rosenbaum, offering a new way for dieters to finally win the weight battle. "When you lose weight you've created about the perfect storm for regaining weight," as per Rosenbaum et al. of Columbia University Medical Center in New York, whose research appears in the Journal of Clinical Investigation (2008). After a pronounced weight loss according to the author, "the metabolism not only becomes more efficient, so the body needs fewer calories, but the brain becomes more vulnerable to tasty-looking treats." Areas of the brain involved in telling not to eat seem to be less active. You are more responsive to food and you are less in control of it," as Rosenbaum stated. Recent study concludes that conditions associated with the syndrome termed “hyperandrogenism” (a medical condition characterized by excessive production and/or secretion of androgens). In young women it is often associated with glucose intoleranceand other features of the metabolic syndrome. The team proves the hypothesis that high levels of testosterone,
Dehydroepiandrosterone sulfate (DHEA-S), and cortisol, and lowlevels of sex hormone-binding globulin (SHBG) and IGF-I may be associated with metabolic syndrome in a representative cohort of olderwomen. The author’s final conclusion is that prevalenceof metabolic syndrome increases with age and although the problem seems to be multidimensional and multifactorial, age-related hormonal changes might contribute to its development in older women. From this study is becoming obvious that women who are postmenopausal face higher probabilities of developing metabolic syndrome comparatively with premenopausal women (Maggio et al., 2007; Giampapa, Pero & Zimmerman, 2004). The quality-of-life in women in postmenopausal age after receiving hormone therapy and the results from the heart and estrogen/progestin replacement are studied by another team (Hlatky, Boothroyd, Vittinghoff, Sharp & Woolley, 2002).
3. Chronic elevated stress: The human body is well-designed to handle temporary spikes of physical and emotional stress, but how much and in what way stress affects human health varies from person to person. Chronic emotional stress can dramatically increase risk of heart attack, stroke, and even cancer, as when people are stressed, their cardiovascular, nervous, hormonal and endocrine systems work in partnership to cope, provoking quick narrowing of vessels, increasing the rate of blood coagulation, causing irregular heartbeats, and building up arterial plaque. Under stress, adrenal hormones induce the release of fat and sugar into the blood to be used for immediate energy supply (Bjorntorp, 2001; Bjorntorp & Rosmond, 2000). Stress disrupts normal hormonal levels, influencing immune system strength and eating habits (Innes, Vincent & Taylor, 2007). People who are not able to handle stress show high blood sugar and decreased release of insulin from the pancreas (Viner, Mc Grath & Trudinger, 1996). Extreme emotional stress (grief, anger, worry, fear) can cause the “broken heart syndrome “(BHS), also known as cardiomyopathy (Kim, 2009; Innes et al., 2007). Depression and metabolic syndrome connection is researched by (Dunbar et al., 2008). Clots may easily block an artery already narrowed by plaque, resulting in a heart attack, stroke, aneurysm, or aortic dissection. People who practice meditation and yoga are able to control and manage stress better than those who do not practice. It is noted that people who change their total lifestyle strategy and who use stress management relaxing techniques are able to control metabolic syndrome much better than those who only change their diets. Stress management techniques can improve long-term glycemic control in Type 2 diabetes (Surwit et al., 2002).
4. Too little sleep: Research also suggests that appetite-regulating hormones are affected by sleep and that sleep deprivation could lead to weight gain. In two separate well randomized studies, people who slept five hours or less had higher levels of ghrelin - a hormone that stimulates hunger - and lower levels of the appetite-suppressing hormone leptin than those who slept eight hours per night. Prof. Cappuccio of the University of WarwickMedical School (2006)has proved that short sleep duration may also lead to obesity, through an increase of appetite via hormonal changes. The study reviewed current evidence in over 28,000 children and 15,000 adults. For both groups the researcher found that shorter sleep duration is associated with almost a two-fold increased risk of being obese. The research also suggests that those who sleep less have a greater increase in body mass index and waist circumference over time and a greater chance of becoming obese over time. In his proper words: "The 'epidemic' of obesity is paralleled by a 'silent epidemic' of reduced sleep duration with short sleep duration linked to increased risk of obesity both in adults and in children. These trends are detectable in adults as well as in children as young as 5 years." Obviously lack of sleep produces excessive secretion of ghrelin, which stimulates appetite and creates less leptin, which suppresses appetite.
The hormonal relationship and obesity is shown also in the HERS study published in JAMA(2000). The hyperinsulinemia in women has been shown in this study to stimulate the release of testosterone from the ovaries. It is a well known fact that people who are obese are suffering from this disorder regardless of whether they eat normally, excessively, or less than normal. At the same moment it is quite obvious that there are people who are constantly overeating but are free of the above disorder. It is easy to conclude that obesity in all its multiple forms is due to an abnormal damage in the hypothalamic area of the brain- a center that is the main regulatory mechanism of a hunger, thirst and the sexual desire. If your hormones are in balance, you likely sleep well, have lots of energy and a strong sex drive, and your immune system and digestive system should be functioning smoothly. However, it’s relatively easy to push your hormones off kilter, leading to an array of varied symptoms and hormone disorders including:
5. Side effects of certain drugs: The notion that metabolic syndrome can also be a result of certain drugs (corticosteroids, antidepressants, antipsychotics, protease inhibitors and antihistamines) is based on the metabolic side effects of the above drugs (Hilgers & Mann, 2008; Aronson, 2006). Two separate studies (Elliot & Meyer, 2007; Messerli, Grossman & Leonetti, 2004) provide independent results, verifying that antihypertensive therapy may lead to an increase in diabetic onset. The authors conclude thatthi?zides and beta-blockersmay significantly increase blood lipids and glucose while ACE inhibitors (ACEI) and Ca channel blockers (CCB) do less harm. Beta-blockers may promote weight gain, andthi?zides and beta-blockers are associated with an increasedincidence of diabetes, compared to CCB and ACEI. The ALLHAT study opposes previous findings that Thiazide-type diuretics are superior and more economic in preventingCVD. Thus, they shouldbe preferred as the “first-line” antihypertensive therapy despite of the diabetes onset (Wright et al., 2008).
Drug –to- drug interactions in metabolic syndrome treatment can be another reason for the “vicious” nature of the syndrome (Iacobellis, 2006). Authors of a third study disagree with the ALLHAT study conclusions, proving for a second time that diuretics are related with significant onset of metabolic syndrome and diabetes (Hilgers & Mann, 2008). Another team reportsthat their SHEP study participants are developing Type 2 diabetes,while being on treatment with chlorthalidone - a drug used to treat hypertension (Kostis et al., 2005). Thus, authors conclude that ACE inhibitors should be the first choice in case of hypertonia treatment, followed by the CCB and beta-blockers and Thiazide diuretics as last choice.
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These statements have not been evaluated by the Food and Drug Administration. The material in this newsletter is provided for informational purposes only. Thus our intentions are not to diagnose, cure, mitigate, treat or prevent any disease. If you use the information in this newsletter without the approval of your health professional, the authors of this letter do not assume any responsibility. Copyright @ 2009, Natural Health-Wellness LLC. All rights reserved.
These statements have not been evaluated by the Food and Drug Administration. The material in this newsletter is provided for informational purposes only. Thus our intentions are not to diagnose, cure, mitigate, treat or prevent any disease. If you use the information in this newsletter without the approval of your health professional, the authors of this letter do not assume any responsibility. Copyright @ 2009, Natural Health-Wellness LLC. All rights reserved.
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