Syndrome X- The mystery syndrome

Antoaneta Sawyer, PhD

Syndrome X — a term, coined by Gerald Reaven (1988), describes a cluster or group of symptoms and abnormalities including high blood pressure, abdominal (visceral) obesity, insulin resistance, dyslipidemia [elevated blood triglycerides, increased bad cholesterol (LDL), and decreased levels of good cholesterol (HDL)].

In 1988, at the end of his Banting Memorial lecture (Stanford University) Reaven states: "At first blush it appears outlandish to suggest an association between hypertension, hypertriglyceridemia and hyperinsulinemia."
The terms 'metabolic syndrome,' 'insulin resistance syndrome' (IRS), 'dysmetabolic syndrome,' 'Syndrome X,' 'Raven’s syndrome,' 'plurimetabolic syndrome,' 'hypertriglyceridemia waist syndrome' 'visceral fat syndrome,' 'cardiometabolic syndrome,' 'general cardiovascular syndrome,' and CHAOS (in Australia) are all synonyms that define a cluster of conditions or abnormalities that occur together in a person, and increase the risk for development of type 2 diabetes, atherosclerotic vascular disease (AVD), coronary artery disease (CAD), and stroke.
Metabolic syndrome is also named the “Deadly Quartet” (1989) by Norman Kaplan, MD (professor of internal medicine at the University of Texas) as it can include upper-body obesity, glucose intolerance, hypertriglyceridemia, and hypertension. Kaplan believes that underlying the "Deadly Quartet" is the excessive blood-insulin levels often associated with insulin resistance.(Women'sHeartAdvantage)
Gale (2002) identifies the acronym CHAOS as an abbreviation for coronary artery disease, hypertension, atherosclerosis, obesity, and stroke. Actually, the metabolic syndrome is a cluster of disorders, all of which are affected by genetics, diet, and other environmental and lifestyle (intrinsic and extrinsic) factors (Grundy et al., 2005).
Five metabolic risk factors (dyslipidemia, hyperglycemia, hypertonia, and a general prothrombotic state with a proinflammatory state) are blamed for its appearance. (Source, Wiki and WD) Above all, they are commonly clustered together. As the cluster of abnormalities is frequently observed in allopathic clinical practice, it has been well documented in prospective studies by several cluster-analytical trials (Grundy, 2007; Hanley et al., 2002).
Experimental evidence suggests that it is the exact nature of the cluster which appears to bring additional risk, over and above that which would be expected from each one of the components separately and together. Stern et al. (2004) conclude that people with metabolic syndrome have five fold greater risk of developing Type 2 diabetes, if not already presenting with this disorder.
There are statistic expectations that up to 80% of the almost 200 million adults worldwide will die of CVD, according to the International Diabetes Federation (IDF, 2003). Hence, people suffering from metabolic syndrome are also at increased risk of mortality, as they are three times as likely to die from stroke or heart attack, and twice as likely to die from a coronary event, compared to people without metabolic syndrome. More than 300 million worldwide are now classified as obese, according to the World Health Organization (WHO, 2009), while another billion of people are considered overweight. The European health report (2005) places metabolic syndrome far ahead of HIV/AIDS in morbidity and mortality.
Jean-Pierre Després, PhD, FAHA (director of the lipid research center at Laval University Hospital in St. Foy, Quebec) claims, "Syndrome X is the most important public health problem in North America. Having this syndrome is as high a cardiovascular risk as having high cholesterol, yet most of the people who have it have normal or close-to-normal cholesterol they think they're fine."
Finally, the syndrome has been identified as an actual disease state with the code ICD9. "Nothing helped metabolic syndrome more than the establishment of the ICD9 code." - Yehuda Handelsman, MD (co-chair of the International Committee for Insulin Resistance and medical director of the Metabolic Institute of America).
Joanna Breitstein (2004) states,” The science is beginning to understand the role of insulin resistance,” and proceeds, “A new disease is being born. Unlike a new pathogen bursting from the jungle like Ebola or mutating from something familiar like each year's "new" strain of influenza, metabolic syndrome must be both socially and scientifically constructed. Well-known medical facts have been reorganized into a new understanding. And with that knowledge comes the need and opportunity for new research, new modalities of treatment, and, on the pharma side, new market risks, demands, and opportunities."
Author's final prediction is that “By 2025y - 86 million Americans will have the metabolic syndrome.” Some of the clinical syndromes and diseases, following the metabolic syndrome appearance are: (a) type 2 diabetes mellitus; (b) cardiovascular disease (CVD); (c) essential hypertension; (d) polycystic ovary syndrome (PCOS); (e) nonalcoholic fatty liver disease; (f) certain forms of cancer; (g) sleep apnea; (h) gout; (i) kidney failure, and (j) Alzheimer's disease (Annual Rev. Nutr. 2005).
The American College of Cardiology (ACC) and the American Diabetes Association (ADA) recently launched "Make the Link," campaign informing physicians and consumers that people with metabolic syndrome are undeniably linked to type 2 diabetes what can increase risk of heart disease and stroke. At the same time a new society called the "International Society of Diabetes and Vascular Research" launched its own journal-"Diabetes & Vascular Disease Research" (May, 2004)

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New Update on Qnexa®

Antoaneta Sawyer, PhD

The FDA Endocrinologic and Metabolic Drug Advisory Committee (July 15, 2010) failed to endorse the new obesity drug Qnexa® (Phentermine/ Topiramate) of Vivus Inc. for a final approval, due to concerns of its safety. In a final 10-6 vote, the FDA Advisory Panel concluded that they were concerned that Qnexa was too experimental. (Source, FDA and ChicagoTribune)
Most, if not all members agreed that Qnexa® is very effective drug- a combination of two separate drugs working in obvious synergism in inducing sensible weight loss. The drug alters the taste of food and boosts human metabolism, by cutting a person's body weight up to 15 percent. (Source, Vivus)
Despite their agreement on the efficacy of the drug, a number of side effects (e.g. depression, anxiety, insomnia, attention deficit/ hyperactivity disorder,metabolic acidosis, tachycardia, language and cognitive disorders, suicidal thoughts and teratogenicity) postponed the final Advisory Committee approval. It is obvious that the benefits of Qnexa® did not outweigh its potential risks.
Abraham Thomas, MD, MPH (Whitehouse Chair of Endocrinology at Henry Ford Hospital, Detroit, MI) agreed, "Qnexa® is far superior to anything else on the market. But our concerns are with safety. These have to be addressed, and I think it's best if these are addressed before approval." He especially was concerned about the metabolic acidosis that may occur with its use, reflecting young individuals bone health.
Some of the members proposed further pharmacodynamic studies and longer period of a follow-up (five years), while emphasizing on the increasing necessity of new anti-obesity drugs, due to the pandemic rate of obesity in U.S. The short follow-up of one year, was the major reason for casting a negative vote, for some of the panel members.
Michael Rogawski, MD, PhD (Chair of Neurology at the UC,Davis, Sacramento, CA) agreed, "Clearly we need more information about this medication, but the type of information we need, particularly with respect to teratogenicity, cannot be gained in a clinical trial setting, it can only be gained once the drug is on the market and large numbers of individuals are exposed to it."
Michael Proschan, PhD (Statistician from the National Institutes of Health, Bethesda, MD), explained his negative vote with the following statement, "A lot of these potential problems are brain related — depression, anxiety, memory, cognitive, and that always makes me worry a little more than with other kinds of problems. I don't think we have enough data to be able to say whether they are serious issues or not. I think if we had had longer follow-up I probably would have voted the other way but I just don't feel comfortable with 1-year follow-up."
Jessica Henderson, PhD (Acting Consumer Representative on the panel) voted in favor of Qnexa® approval, although she agreed that long-term safety data are missing. She concluded, "As a consumer representative, I put a lot of credence into quality of life and the pursuit of life, liberty, and happiness and a patient's right to those things."
Kenneth Burman, MD – (Acting Chair and endocrinologyst at Washington Hospital Center in Washington, DC) finally concluded, "We know that obesity is a major health problem and all efforts to address this issue should be lauded. Qnexa® does meet or exceed the agency's requirement for efficacy. On the other hand the medication has serious potential adverse effects, including potential teratogenicity, increased suicidal ideation, cognitive issues, tachycardia, and possible renal stones. Some of these side effects are serious and could be life threatening, and they have to be weighed against the potential of a relatively modest weight loss and its long-term health benefits."

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Is Metabolic Syndrome Contagious?

Antoaneta Sawyer, PhD

The etiopathogenesis (the cause and development) of obesity, as part of the metabolic syndrome, remains problematic, questionable and still rather unknown. Insulin resistance (IR), which is often despite not always seen as a consequence of an increased obesity, is probably the cornerstone of metabolic syndrome and the main link to the metabolic cluster appearance.
Recent cascade of clinical trials is oriented to the viral etiology of the metabolic syndrome and obesity. Latest studies predict that a “Common Cold” virus may be the reason behind the metabolic syndrome and obesity appearance. (Source, Wiki) It is well known that common cold is an infection shown with symptoms like sniffles and sore throat for a period of one to three days, after the viral respiratory inhalation. In fact, common cold is a viral infection of the upper respiratory tract infection caused by several viruses, the most common of which is the human Rhinovirus, and several others known as Coronavirus, Adenovirus, and human Para influenza virus (HPIVs) might be involved in its pathogenesis.
A new clinical study published in Stem Cells (Pasarica et al. 2008) at Pennington Biomedical Research Center suggest that an adenovirus called “AD-36” may be the new adipogenic factor, involved in some cases of obesity. AD-36 it is proven to cause obesity in chickens, mice, rats, and monkeys. The human adenovirus 36 (AD-36) is one of the 52 types of adenoviruses known to infect humans. It was first shown to be associated with obesity in chickens by Dhundhar et al. (2000).
The authors speculate that the virus seems to show similar serotype as the one that causes sore throat, cough and common cold, but it may also contribute to weight gain. The same research claims that 33% of all obese adults have contracted AD-36 at some point in their lives, compared to just 11% of thin (lean) people.

According to the lead author, it seems quite likely that the virus triggers obesity by spreading to other parts of the human body. The team considers that when the virus goes to the fat tissue- it replicates, making more copies of itself increasing the number of new fat cells, which may explain why people get fat when they are infected with this virus. They concluded that a person exposed to AD-36 virus may recover from related viral ailments rather quickly, but he/she could gain weight for a period of 3 months. This is the period until the body will build up resistance to the same virus. Above all people infected with the virus could remain contagious for three months.
Further, it was found in several other studies that AD-36 could turn adult stem cells from fat tissue into fat cells. To recent date, AD-36 is the only human adenovirus that has been linked with human obesity, present in 30% of obese humans and 11% of non-obese humans (Albu, 2005; Augustus et al., 1967; Atkinson, 2007).
Another team of researchers led by Vangipuram (2007) infected ‘young’ fat cells with a variety of adenoviruses. The authors found that the adenovirus AD-36 suppresses the production of leptin by up to 51% and increases the reuptake of glucose in fat cells infected with this virus, leading to the secondary simulation of fat production. It was found that the fat accumulation is significantly higher than in cells that had not been infected. (Souce, Health24) Finally, the authors’ concluded that people could be fat for reasons other than viral infections so it's really pointless for fat people to try to avoid infection.

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FDA sets the day for a final Qnexa® approval

Antoaneta Sawyer, PhD

Vivus Inc. a biopharmaceutical company- producer of the new generation weight loss drug- Qnexa®, with encouraging weight loss results offering a great promise for a sensible weight loss in both, overweight and obese patients, is seeking for final FDA approval. (Source, Vivus)
Qnexa® is a drug combination of two drugs- Phentermine and Topiramate that are believed to work synergistically addressing satiety and appetite in patients who are overweight or obese. The expected effect of the drug is directed to address the metabolic syndrome cluster effects: hypertension, type 2 diabetes, dyslipidemia, central adiposity, including sexual health. (Source, Vivus)
Phentermine, known as the most widely prescribed weight loss pill in the U.S., was approved in 1959 for a short period of treatment in obesity. Caloric restriction, behavior modification and daily exercise are prescribed as an adjunct to the drug that must be used for a period of several weeks. Topiramate is an anticonvulsant drug FDA approved (1996) as antiepileptic drug and later on as a prophylactic drug for migraine. (Source, WebMD, Wiki, Answers)

Qnexa® is in its 3d clinical phase of approval, seeking final registration by the U.S. FDA, being evaluated in over 4,500 patients as a treatment for obesity, completed under a special protocol assessment (SPA) by the FDA. Despite its final stage Qnexa® is currently not approved. There were three separate studies performed at its first clinical phase. The first study (EQUATE) evaluated the drug in 756 obese patients over 28 weeks at 32 sites. The second (EQUIP) and the third (CONQUER) studied the drug for 56-weeks in 1,267 morbidly obese people (with or without co-morbid conditions) and 2,487 overweight and obese patients, (with at least two co-morbidities) respectively.
There were found the following encouraging results:
A. Weight loss of up to 14.7% (37 lbs) was achieved by patients treated with the drug across the 56 weeks in the EQUIP study.
B. During the two 56-week studies, the most commonly reported side effects were dry mouth, tingling and constipation.
C. There were found statistically significant results of improvement in all (cardiovascular, metabolic and inflammatory) metabolic risk factors among patients treated with the drug
D. The efficacy points of reference (benchmarks) for weight loss agents were exceeded at all three doses of the drug
E. The therapeutic results were significantly (69%) higher than the placebo results at all three doses of Qnexa®, showing good drug tolerability (Source, Vivus)
Tomorrow (July, 15) an FDA advisory committee meeting will be taking place to evaluate Qnexa® for obesity treatment. It is expected that upon the conclusion of the meeting, a panel of medical doctors is preparing to make a recommendation on the drug's approval. The FDA has set October 28, 2010 as the date by which the agency will make a formal decision on the approval of the drug.
FDA decided to publish the background material at the location of the advisory committee meeting (prior to the meeting), and the material is expected to be published on the FDA's web site (after the meeting). The Committee is supposed to discuss the safety and efficacy of new drug application (NDA, 22-580), with the trade name Qnexa® (Phentermine/Topiramate). FDA briefed in their online publications (this Thursday) that the review panel should take into account a number of potential side effects, despite acknowledging the drug’s effectiveness in helping patients losing weight. It is expected that FDA will announce its final decision in October, 28 (2010). (Source, FDA) Given two-thirds of adults in the United States are either overweight or obese, weight loss products, such as Qnexa®, may have widespread exposure, and the potential for associated safety issues must be considered," the FDA said, as the Associate Press reported. (Source, HealthNews)

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Metabolic syndrome and HGH connection

Antoaneta Sawyer, PhD

Human Growth Hormone (HGH) is a hormone produced by the anterior pituitary gland in the brain. Humans begin producing HGH at birth and varying levels of HGH circulate in the bloodstream until death. HGH levels reach their peak during adolescence and begin to drop with each passing year. Unfortunately, as we age- beginning as early as age 25, our HGH levels decline to a fraction of the levels of our young age.
Many scientists link this decrease to multiple health threatening degenerative diseases and complications of advanced aging, which include loss of muscle (sarcopenia) and bone strength, an increase in body fat and decrease in metabolism and immune function along with multiple other problems.
Many anti-aging specialists name HGH--the old age “Performance Enhancer” and believe that supplementing our diets with HGH is an effective way to avoid the diseases and conditions associated with aging and improve vitality and appearance. HGH promotes tissue repair, cell regeneration, bones’ repair, muscles and vital organs rejuvenation, and supports immune system in combating infection and disease.
HGH facilitates the building of bone and muscle as well as production of cells that help organs and tissues grow and repair themselves. It also provides for the growth and repair of human muscles and tissue in advanced aging and has also show rejuvenating, regenerating effects on the human body that have been documented in multiple of scientific papers. In addition to all the above, HGH promotes an active metabolism and accelerates the way your body uses energy.
There are multiple symptoms and factors of aging that negatively affect quality of life, such as increased body fat, loss of lean muscle tissue, lower energy levels, decreased sexual function, common depressive symptoms, and weakened immune function or decreased skin turgor.
As explained in the HERS (2002) study, the low circulating level of hormones (HGH and testosterone) in particular promotes an increase in adipose tissue bulk. This leads to free fatty acids release, which are immediately transported to the liver, consequently stimulating the production of Apo-B, containing very low density lipoproteins (VLDL). At the same time insulin resistance leads to overproduction of triglyceride-rich lipoproteins and there is also a reduced activity of peripheral lipoprotein lipase which in turn supports the accumulation of triglyceride-rich lipoproteins in the circulation. Hlatky et al. (2002) teach that via the action of cholesterol ester transfer protein, triglycerides are transferred from these lipoproteins to high density lipoproteins in exchange for cholesterol esters. The enrichment of the triglyceride-rich remnant particles with cholesterol ester leads to formation of small dense LDL, known as VLDL. Moreover, because of this exchange, the level of high density lipoprotein (HDL) cholesterol simultaneously falls.
According to the New England Journal of Medicine study (1990) HGH helps with: restoring muscle mass; decreasing body fat; thickening the skin; reducing wrinkles; restoring lost hair; restoring hair color; increasing energy; improving cholesterol profile; restoring size of internal organs; improving vision; improving memory; elevating mood and improving sleep; increasing cardiac output and stamina; improving immune function; increasing mental function; increasing sex drive
http://www.ncbi.nlm.nih.gov/pubmed/19897679
An increasing prevalence of metabolic syndrome among U.S. adults is proved in a study published in J. Clin Endocrinol Metab (2010) by Attanasio et al. found metabolic syndrome age-adjusted prevalence in the United States was significantly higher than in Europe (51.8 and 28.6%, respectively). The metabolic syndrome prevalence in HGH deficient patients was higher than in the general population in the United States and higher in the United States than Europe. After HGH treatment significant changes were found in waist circumference, fasting glucose, and blood pressure measurements. Prevalence was unaffected by GH replacement, but baseline metabolic syndrome status and obesity were strong predictors of metabolic syndrome after HGH treatment.

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Obesity, recognized as the 21st century epidemic

Antoaneta Sawyer, PhD

Without doubt, obesity has reached epidemic proportions around the world and it is specifically reinforced in America. It is recognized as the most prevalent, recurrent, and relapsing pandemic disorder of the 21st century. (Source, ObesitySociety) Scientists are constantly defining obesity as the leading cause of chronic morbidity, disability and mortality, adding at around 112,000 excess deaths in the US. Latest study published in the New England Journal of medicine (Adams et al., 2006) showed an increased risk of mortality in overweight people (men and women). The excess body weight during midlife, including being overweight, was associated with an increased risk of death. (Source, NEJM). A potential decline in life expectancy in the US in the 21st Century is seen in a study done 2005, March 17, (Source, NEJM)
Obesity increases chances of developing all the co-morbid conditions that constitute the “deadly quartet” of the metabolic syndrome: abdominal obesity, type 2 diabetes, high blood pressure, and high cholesterol. In fact, obesity is considered the main feature of the metabolic syndrome cluster as it packs many negative health effects, including increased risk of stroke, heart disease, type 2 diabetes, hypertension and several common cancers and it has been also shown to reduce sexual activity (WHO, 2005). (Source, Third Age)
More than 300 million worldwide are now classified as obese, according to the World Health Organization (WHO, 2009). Another billion or people are considered now overweight in another study. The epidemic rate of morbid obesity in the US in the period (1986–2000) and (2000-2005) is studied by (Sturm, 2003; Sturm 2007).
Obesity is a disease that affects over one-third of the adult American population (approximately 72 million Americans). (Source, ObesitySociety) The U.S. Department of Health reports that each year, obesity causes at least 112,000 excess deaths in the US. Unfortunately, it doesn’t affect only adults as approximately 11 percent of all American children aged 6 to 17 are obese. (Source, ObesitySociety)
The rate of increased obesity is leading to major disability. The metabolic derangements, seen as part of metabolic syndrome can be outlined as a combination of: elevated Body Mass Index (BMI), an “apple shape,” visceral adiposity (belly fat), “nonalcoholic” type of liver cirrhosis, dyslipidemia (elevated LDL and triglycerides with decreased HDL), hypertension, glucose intolerance- all based on insulin resistance. Unfortunately this is one of the most mismanaged diseases in the clinical practice. (Source, NH-WC Beyond Holistic)
Obesity can shorten your life by 10 years, while extreme obesity - by 12 years, and put you at risk of developing a number of chronic conditions. Generally, obese people die young or develop premature morbidity and disability. (Source, About) The rate of morbidity and mortality is explained with maladies such as: type 2 diabetes, elevated cholesterol and triglycerides, hypertension, asthma, sleep apnea, cardiovascular diseases, gout, kidney failure, Alzheimer’s disease, degenerative (bone and joint) diseases, asthma, fatty liver, gallstones, infertility, miscarriages, birth defects, pancreatitis, irritable bower syndrome, heart failure, multiple cancers: hormonal (breast and prostate) cancers, colorectal, gallbladder, pancreatic, lung, uterine, cervical, ovarian, kidney, non-Hodgkin’s lymphoma, multiple myeloma, multiple myeloma, leukemia, and many others. (Source, Wiki)
Obesity is defined as excess adipose tissue, measured by the body mass index (BMI), defined as the weight in kilograms divided by the square of the height in meters. BMI is seen as an indicator of obesity. A person with BMI > 25 is defined as overweight and a BMI > 30 as obese. The main causes for obesity, according to the metabolic experts are: bad diet, including an increased reliance on highly processed foods, high level of stress, and increased immobility. (Source, ObesitySociety)
Fat tissue is recognized as an endocrine organ and as such, secretes a number of metabolites, cytokines, lipids, and coagulation factors, leading to chronic proinflammatory status and secondary insulin secretion, which can cause insulin resistance that leads to type 2 diabetes. (Axima, 2006)
Lately, obesity has increased across all age groups, reaching different ethnic groups and educational levels. Many features of modern life seem to promote weight gain. The combination of immobilization and stress, abundant and easily available calorically dense, nutritionally empty foods, in tandem with late social and economic influences are all likely contributors to the rising obesity pandemic. (Source, NHLBI)
It is well known fact that societies, which produce a steady stream of constant abundance tend to become overweight societies – especially when much of the diet consists of calorically dense but nutritionally empty foods. The human body has a natural system that helps prolong life when food becomes dangerously scarce. Although this is a helpful mechanism of survival, it does not adjust for a life lived in constant and perpetual plenty. All of these environmental and lifestyle factors lead many to overeat and get too little physical activity, with the result that many people are overweight or obese. (Source, NHLBI)
Authors strongly believe that current dietary recommendations to increase the consumption of carb-dense foods are counterproductive to weight management. Author’s hypothesis is that high-carbohydrate diets based on carbohydrate foods that promote high glycemic response (i.e., high-glycemic-index foods) alter appetite and energy partitioning in a way that is conducive to body fat gain. Thus, carbohydrate-dense foods that have strong impact and postprandial effects must be strongly limited in the case of metabolic syndrome (Holt et al, 1995; Holt et al., 2003).
As conclusion, being overweight, alongside diabetes, having elevated cholesterol levels, and an increased blood pressure, constitute the foundation of metabolic syndrome modern pandemic. In recent years, obesity and overweight are reaching epidemic proportions. Underlying reasons for this global obesity pandemic are complex and still not completely proven. Whereas genetic predisposition plays an obvious part, changes in genetic makeup cannot explain the dramatic rise in obesity rates over the past 10-15 years believe Flegal (1999) and Seidell (2000).
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The Canada Day celebration

Dr. Antoaneta Sawyer

This 1st of July, Canadians from all groups, races and ages are proudly celebrating their day of independence from Great Britain. The Canada Day is a holiday elegantly and widely celebrated by the whole Canadian population.

On this day, years ago (in 1867) Canada became an independent dominion from Great Britain officially established with the British North Americas Act. Canada became a federation of four provinces: Nova Scotia, New Brunswick, Ontario, and Quebec. Known as the Dominion Day, since 1983 the day was officially renamed as the "Canada Day"- the way how it is celebrated today. (Source, About)

The Canada Day is the largest annual holiday event in Thunder Bay - the neighboring city of the Twin Ports (WI). With estimates of over 20,000 the municipality is planning to organize a multitude of outdoor events. The symbol of national pride- the Canadian flag can be seen everywhere on the Canada Day. It consists of two vertical red rectangles separated by a white square, containing a red image of a maple leaf.

The Canada Day will include a lot of ceremonies- city pancake breakfasts, concerts, official town's parade with evening firework display and many other official citizenship ceremonies for new Canadian citizens. The patriotic mood can be seen everywhere from the national flags in red and white displayed on cars and houses to the elegantly dressed Canadians with smiles on their faces.

The 1st of July is the day when the summer closes all school doors in Thunder Bay and all its students are proudly celebrating the beginning of summer vacation. Even the post office is closed. It is well known that only the public transport is still operating on that day, while most of the shops, small business offices, and little stores are closed. Only few pharmacies and gas stations may operate on this day.

For more info on the celebration of the Canada Day in Thunder Bay go to the article "Thunder bay to celebrate Canada day with a bang."

Obesity rates in America

Antoaneta Sawyer, PhD

Obesity in the United States is increasing at an alarming rate. We are all informed that obesity has been rising in the last 10-20 years. In fact people in the well developed and developing countries are increasing their waistline, with obesity reaching global epidemic proportions. Generally one is considered obese if is more than 20 percent overweight over his ideal body weight. Medical experts say a person who's about 30 pounds overweight must be considered obese.
The World Health Organization (WHO) is already labeling obesity with two terms- a "chronic disease" and "escalating global epidemic" and estimates that by 2025, the number of people with diabetes will reach 300 million- a staggering 122 percent increase in less than 30 years.
Obesity results when the person consumes more calories than the ones used by his daily activity. In the last decade, the conventional medicine changed its main concept that white adipose tissue works as a protective buffer or it is a "passive" energy warehouse. Now it is well known that white adipose tissue is highly dynamic hormonally involved tissue, engaged in multitude of hormonal, biochemical and metabolic reactions and with its proper memory.
In authors' proper words, "Our view of white adipose tissue (WAT) has changed over the last decade, from an inert triglyceride storage tissue to a highly active metabolic organ. Indeed, WAT secretes pro-inflammatory cytokines such TNF-a, interleukin-1 (IL-1), interleukin-1 receptor antagonist (IL-1Ra), and interleukin-6 (IL-6), and chemokines such as monocyte chemoattractant protein-1 (MCP-1), interferon gamma inducible protein 10 (IP-10), interleukin-8 (IL-8), RANTES, and peptides with hormone-like actions such as adiponectin, leptin and resistin" (Meier & Thalmann, 2007).
Lately, there is some more bad news on the "weight loss" horizon. Despite all the bold steps taken by government and state programs, the recent - 2010 Annual Obesity Report (June 29, 2010) showed data that obesity rates are still geometrically increasing. When in 1991, no state had an obesity rate above 20 percent, the new 2010report done by two separate public health groups concluded that the obesity rate in US is increasing in 28 states for 2009. (Source, Mayo Clinic, Healthy Americans and Medicine Net)
There is only one state, showing good results- the District of Columbia, while Alabama, Mississippi, Tennessee, and Weight Virginia scaled an increase of obesity rates over 30 percent comparatively to previous reports' data. What is unfortunate that four more states- Kentucky, Oklahoma, Arkansas and Louisiana have been added to the already well known list of "obese" American states. (Source, Medicine Net)
Currently, more than 12 million children and adolescents in the United States are considered also obese according to the report. "Obesity is one of the biggest public health challenges the country has ever faced, and troubling disparities exist based on race, ethnicity, region and income," concluded Jeffrey Levi, PhD, Executive Director of TFAH.
The report classifies Wisconsin right in the middle, scaling much better than 42 other U.S. States. The report says that 27 percent of Wisconsin adults are obese and nearly half of all black adults are obese. It is more than obvious that neither the increased awareness, nor the wealth of health knowledge offered by health organizations and government sponsored programs is translating yet in real results.
Additional Key findings of the Annual report are:
1. Adult obesity rates for Blacks topped 40 percent in nine states, 35 percent in 34 states, and 30 percent in 43 states and D.C.
2. Rates of adult obesity for Latinos were above 35 percent in two states (North Dakota and Tennessee) and at 30 percent and above in 19 states.
3. Ten of the 11 states with the highest rates of diabetes are in the South, as are the 10 states with the highest rates of hypertension.
4. No state had rates of adult obesity above 35 percent for Whites. Only one state - West Virginia - had an adult obesity rate for Whites greater than 30 percent.
5. The number of states where adult obesity rates exceed 30 percent doubled in the past year, from four to eight - Alabama, Arkansas, Kentucky, Louisiana, Mississippi, Oklahoma, Tennessee and West Virginia.
6. Northeastern and Western states had the lowest adult obesity rates; Colorado remained the lowest at 19.1 percent. (Source, Healthy Americans)
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Metabolic Syndrome-- Cancer link defined

Antoaneta Sawyer, PhD

Most scientists believe that metabolic syndrome is conglomeration of three or four diseases that together can portend a worse prognosis for certain illnesses, including number of cancers. What has not been well-defined until that moment— is the associated risk for colorectal cancer.
A national survey report presented at the 73rd Annual Scientific Meeting of the American College of Gastroenterology scientific meeting in Orlando, Florida (October, 6) concluded that patients coping with the metabolic syndrome have a 75% higher risk for developing colorectal cancer sometime in their lives (Garrow & Delegge, 2008). (Source, NH-WC"Beyond Holistic")
The authors’ purpose was to review and analyze data collected between 2000 and 2003 by the National Health Interview Survey (NHIS). Their survey was centralized on 1,200 survey participants with history of metabolic syndrome and 350 patients with a family history of colorectal cancer.
Cross-referencing disease data revealed that patients with metabolic syndrome do bear higher risk for colorectal cancer as the study showed a 75% increase. According to their opinion, this is one of the first—and certainly the largest—study to look specifically at colorectal cancer risk.
The National Survey Report read at the American College of Gastroenterology scientific meeting in Orlando, Florida concluded that there is indeed a higher (75%) risk for colorectal cancer in this population.
Similar results on the connection of metabolic syndrome, obesity and diabetes and cancer were gathered in studies of colon cancer (Cowey & Hardy, 2006) breast cancer (Goodwin et al., 2005), pancreatic cancer (Huxley et al., 2005), prostate cancer( (Hammarsten & Hogstedt, 2004), and endometrial cancer (Cust et al., 2007, T. Bjorge et al., 2010; and Lane, 2008).
In Cowey and Hardy's words, " Specifically, we examine the hypothesis that individual components of the metabolic syndrome contribute to the development of several processes, including insulin resistance, aromatase activity, adipokine production, angiogenesis, glucose utilization, and oxidative stress/DNA damage, which can work together to increase cancer risk beyond that of the individual components alone. We propose that the metabolic syndrome be considered as a high-risk state for certain types of cancer and that this relationship should be systematically explored across cancer types."
Metabolic syndrome and obesity are also associated with an increased risk for clear-cell renal carcinoma (RCC), according to results reported in the January issue of BJU International (2010; 105, 16-20). The goal of this study was to evaluate the association between body mass index (BMI) and histology of RCC in a cohort of 1640 patients with renal cortical tumors being surgically removed from January, 2000 to December, 2007. Of these tumors, 12% were benign and 88% were malignant, while 61% of the last ones were clear-cell RCCs.
The lead author William T. Lawrence, from Memorial Sloan-Kettering Cancer Center (MSKCC), New York, NY, stated, "This makes it more important than ever to identify those people who face an increased risk of developing this variant, which is on the rise in the USA." The association of BMI with RCC histological features was examined with multivariable logistic regression by the researchers. The lead researcher concluded, "The widespread use of abdominal imaging has definitely contributed to increased detection of RCC, but fails to account for it entirely." A number of studies have suggested that obesity could be a risk factor for RCC, but the exact reason is still unknown. Researchers speculated that it might be secondary to hormonal changes, decreased immune function, hypertension or diabetes in obese patients.
Obesity, defined as a BMI of equal or more than 30 kg/m2, was found in 38% of patients. BMI was associated with clear-cell renal carcinoma (RCC) histological features, after adjustment for tumor size, age, sex, American Society of Anesthesiologists (ASA) score, estimated glomerular filtration rate (GFR), hypertension, diabetes mellitus, and smoking. (Source, Wiki)
BMI was considered an independent predictor of clear-cell renal carcinoma histology in the subgroup of patients with RCC “We also looked at other health and lifestyle factors, like diabetes, hypertension and smoking. This showed that the only other factors that were independent predictors of clear-cell RCC were male gender and tumor size" concluded the author.
Finally the authors stated, "This study is useful as it provides individual predictors of the chance of developing this form of RCC cancer and obesity provides the strongest association." (Source, NH-WC "Beyond Holistic")

Prediabetes revisited

Antoaneta Sawyer, PhD


Syndrome X (Metabolic Syndrome) is a metabolic disease characterized by the presence of several of the following risk factors: glucose intolerance with hyperglycemia, hypertension, low high-density lipoprotein (HDL), elevated very low density lipoprotein (VLDL), high triglycerides, and abnormal body mass index (BMI), microalbuminuria, endothelial dysfunction, and general prothrombotic state– all at the background of chronic inflammation. (Source, Wiki and Wrong Diagnosis)
The main problem of our last century is that the syndrome is constantly escalating around the world, and especially here in U.S. It is estimated that over 22% of the adult U.S. population have the syndrome and its incidence is rapidly increasing each year. There are expectations that additional number of 12 million adults will likely develop the disease as a result of aging alone by 2022.
Metabolic syndrome is also known as a “prediabetic” phase or as a precursor to the development of type 2 diabetes. Prediabetes is recognized as the condition of having abnormal or elevated levels of glucose (sugar) in the blood. It is found in cases when blood glucose levels are elevated beyond normal but are not considered high enough to indicate true type 2 diabetes. There are 57 million people in the United States who have pre-diabetes. Recent research has shown that some long-term damage to the body, especially (Source, ADA)
Prediabetes is recognized as the condition of having abnormal or elevated levels of glucose, insulin, and triglycerides in the blood. In general, the ‘prediabetic’ phase should be defined as combination of insulin resistance, glucose intolerance, elevated insulin secretion, and inflammation - all seen as predictors of the metabolic syndrome. Even in non-diabetic subjects, people who are insulin resistant always have slightly elevated glucose levels. There are two different tests your doctor can use to determine whether you have pre-diabetes: the fasting plasma glucose test (FPG) or the oral glucose tolerance test (OGTT).
(Source, ADA and Wiki)
From multiple literature data is concluded that increased cardiovascular risk factors precede the onset of type 2 diabetes. An issue is whether it is glucose intolerance or insulin resistance that increases the cardio-vascular risk. As shown in the Framingham Heart Study (FHS) and the Insulin Resistance Atherosclerosis Study (IRAS) there is a beta-cell dysfunction (an increased insulin resistance and decreased insulin secretion) and chronic subclinical inflammation. The United Kingdom Prospective Diabetes Study (UKPDS) data suggest that the relationship between glucose concentrations, while clearly significant related to myocardial infarction (MI) is not as significant in its relationship to microvascular disease. Pyorala and co-authors also presented data from a 22-year follow-up of the Helsinki Policemen Study reported in Circulation (1998) that showed that nondiabetic men with the highest insulin resistance (IR) are at greatest risk for a major CHD event.
The "prediabetic" phase is seen by most of the researchers as an early attempt metabolic syndrome to be defined. Most adults who develop “prediabetes” have insulin resistance as its main culprit. Insulin resistance refers to the mechanism by which one develops prediabetes or metabolic syndrome. In fact they are not considered two different conditions. They are cause and effect — insulin resistance is a synonym for metabolic syndrome which is the preamble of the prediabetes state.
The recently completed Diabetes Prevention Program (DPP) study and the Wisconsin Diabetes Strategic Plan (WIDSP) 2004-2009 are showing to people with prediabetes the way how they can prevent the development of type 2 diabetes by making changes in their diet and increasing their level of physical activity. The American Diabetes Association (ADA) is offering allot of resources for people at risk for diabetes that can be used by people with prediabetes.
In conclusion, prediabetes and Type 2 diabetes are both intimately associated with insulin resistance, glucose intolerance, visceral (central) obesity, hypertension, and dyslipidemia. The metabolic syndrome describes the same constellation of abnormalities, with or without glucose intolerance. In conclusion, “prediabetes” is a term-synonym for metabolic syndrome. The prediabetic phase is found in case when blood glucose (sugar) levels are elevated beyond normal but are not considered high enough to indicate true Type 2 diabetes. (Source, Wiki and Emedicine)
Otherwise, prediabetes is diagnosed when the levels of glucose are abnormal but below the well known diabetic values: fasting values of 100-125 mg/dl, and 140-199 mg/dl (two hours after a glucose load). For true diabetes to be confirmed, the values must be 126 mg/dl (fasting levels) and 200 mg/dl (two hours after a glucose load).

The Science of Nutrition

Antoaneta Sawyer, PhD

Proper and balanced nutrition is absolutely necessary for proper metabolic health.(Source, NYTimes) The connection between nutrition and metabolic syndrome is studied by Stephen Holt, MD. He offers another metabolic syndrome term- Syndrome X, Y, Z... In his book "Combat Syndrome X Y & Z" by Stephen Holt MD and Julian Whitaker, the authors claim the metabolic syndrome may qualify as the number- one public health problem faced by the Western societies.
In author's proper words, "Metabolic diet tailored to specific weight control targets and objectives consists of: a) Short-term accelerated weight loss with low carbohydrate approach; b) Long-term maintenance with restricted simple sugar, trans-fatty acids and saturated fats, moderate protein intake (1g/Kg) with vegetable protein inclusion, moderate salt intake. (Source, NaturalClinician)
Isaacs and Vagnini (2005) offer a complete and comprehensive nutritional path to a complete metabolic syndrome healing in their book "Overcoming Metabolic Syndrome". Karst (2006) believes that what and how much one eats may provoke the metabolic syndrome appearance (The Metabolic Syndrome Program). According to Kushi & Kushi (1993) the "Macrobiotic diet" is the correct road to final cure of most of the chronic degenerative diseases, such as cancer and metabolic syndrome including. (Source, Amazon)
The right nutritional balance is an essential approach in the prevention and healing of the metabolic syndrome in its early and advanced stages. Consuming meals that include all ingredients is known to benefit the metabolic health, and could add years to people life, according to the U.S. Department of Health. The claim is that five or more daily portions of fruits and veggies may cut risk of heart disease, cancer and other diseases. The researchers used data from eight studies in Europe, Japan and the U. S. have identified nearly 40 vitamins and minerals that the body needs for various tasks, from shoring up bones to bolstering the immune system and repairing cellular damage. Instead of delivering predictable effects at particular doses, nutrients team up in complex synergistic ways. (Source, HHS)
On October 10, 2008, Wisconsin Governor Jim Doyle announced the Wisconsin Genomics Initiative (WGI), which is a collaborative research effort among Marshfield Clinic, Medical College of Wisconsin, University of Wisconsin School of Medicine and Public Health, and University of Wisconsin-Milwaukee. Their statement is, "The vision of WGI is to be able to predict for individual patients in a clinical setting the risks of disease susceptibility and treatment response using the combined power of cutting edge genetic, phenotypic, and environmental analyzes, thereby making the promise of personalized medicine a reality" (School of Medicine and Public Health, and University of Wisconsin, Milwaukee)
The amount, type, balance, and the pharmacokinetic marker "bioavailability" of nutrients are all important in nutrition. It is well known that insulin resistance, metabolic syndrome and diabetes are all intimately related to nutrition. By selecting nutrition from all four food groups, and by choosing fresh colorful vegetables and fruits, whole grains, rich sources of protein and good (healthy) fats, while avoiding heavily processed food is the way to go. The American Diabetes Association (ADA) published officially its nutrition recommendations and interventions for diabetes that are the same as the metabolic syndrome nutrition recommendations and interventions (ADA, 2007).
"Metabolic syndrome is a phenotypic expression of the genetic code as it interacts with the whole body environment and if someone has a genetic tendency to develop the metabolic syndrome phenotype, he/she will be far more likely to develop this phenotype if overweight, doesn't exercise, consumes a diet high in simple carbohydrates, saturated fats, and doesn't add specific nutrients" believes Steven Joyal MD (Source LEMagazine,2005). The author published a completely new ‘nutriphenotypic' approach, based on the individual phenotypic metabolic characteristic to weight management and obesity. His conclusions are that the ‘phenotypic nutritional approach' enables people to choose dietary strategies and nutrients that influence powerful biochemical and genetic factors to help control the expression of their genetic code to their benefit.
A new allopathic program for metabolic syndrome treatment proposed by Harvard University is already in use by the conventional medicine. A well-balanced diet combined with lifestyle changing approach and daily physical activity to prevention and treatment of metabolic syndrome management was established. (Source, Harvard) The Dietary Guidelines for Americans (2010) are the main cornerstone of the U.S. Federal nutrition policy and nutrition education activities. (Source, USDA)
Epidemiological data showed that metabolic syndrome is increasing in the State of Wisconsin. The 2nd Annual Diabetes Symposium of Wisconsin (2009) showed that better diagnosis, management, as well as institution of preventative measures can affect these outcomes positively. (Russell A. Wilke, MD, PhD "Obesity...Exploring Management Strategies for a Growing Epidemic") The future of nutrition will be based on the science of nutrigenomics - the study of the effects of foods and food constituents on gene expression. (Source, Wiki)

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Childhood obesity pandemic

Antoaneta Sawyer, PhD

Obesity in the United States has reached epidemic proportions. The Americans are slowly but steadily expanding their waistline. As per recent statistics 33 percent of the adult population is considered obese. Almost a third of all American children are considered either overweight or obese.
Generally one is considered obese if is more than 20 percent overweight over his ideal body weight. In fact that is the most commonly used definition of obesity. According recent statistics about 200,000 Americans will have weight loss surgery this year only. Obesity accounts for nearly 300,000 deaths in the United States each year, and is associated with numerous chronic health issues.
The main cause of obesity in humans is the constantly increasing caloric intake and the rate of physical inactivity. Generally, obesity results when the person consumes more calories than he uses in his daily activity. Chronic consumption of an excessive amount of calories will result in a steady weight gain.
Obesity sets the stage for metabolic syndrome which itself increases your child chances of diabetes, heart disease, stroke, gout, Alzheimer’s disease and other chronic disturbances. While the metabolic syndrome is becoming more common in elderly (above 40 y), now children as young as 15 are being diagnosed with the syndrome leading to diabetes, stroke, heart attack, Alzheimer’s disease, macular degeneration, gout, kidney failure, eye problems or peripheral neuropathy later in life.
Constantly increasing rates of metabolic syndrome are influencing type 2 diabetes cases. The World Health Organization (WHO, 1998) estimations are that by 2025, the number of people with diabetes will reach 300 million—a staggering 122% increase in less than 30 years. Prevalence of obesity among children and adolescents: United States, Trends 1963–1965 Through 2007–2008 is reported by CDC. According to the Centers for Disease Control and Prevention (CDC) between 1990 and 1998, obesity fueled a 33 percent jump in adult diabetes and 70 percent for those between the ages of 30 to 39.
Childhood obesity pandemic rates represent one of the WI top health priorities. Since 1960, the number of children who are obese has doubled in the United States. The U.S. government estimates that some six million children are now overweight enough to endanger their health. According to the National Center for Health Statistics (NCFHS), 14 percent of the children between the ages of six and 11 are overweight (1988 to 1994)- a six percent increase over the 1976 to 1980 period. The percentage of teenagers who are overweight increase by six percent (1976 to 1980) to 11 percent (1988 to 1994). (Source, Univ Iowa)
There is a new project funded by the Wisconsin Partnership Program with a team led by Aaron Carrel, MD (medical director of the UW Health Pediatric Fitness Clinic) aimed to address childhood obesity rates among Latino children in Milwaukee. The purpose of the project is to examine how different factors will affect health, nutrition and lifestyle of these children. The program is focused on helping the child, and the whole family, to create and maintain healthy eating behaviors. It will be introduced in Milwaukee- (Bruce-Guadalupe School). Individual nutritional choices and fitness programs will be documented by technology. (Source, UWSMPH)

The new obesity hypothesis

Antoaneta Sawyer, PhD

The bacteria in our bowel, also known as residents (normal inhabitants) are between 10- 100 trillion. In order the human body to be healthy, they must function in a constant equilibrium, being intimately connected with immunity and metabolism. The gut bacteria are not just passive microorganisms, they provide us with many benefits but on times they may compromise our health. In a new study was proved that they may not only influence our metabolism but to determine how much calories we absorb from food. They may be the new hypothetical reason behind metabolic syndrome and obesity.

Until now the science shows data that every person has 160 different kinds of gut bacteria, which belong to two main families: the family of Bacteroidetes and the family of Firmicutes. These bacteria are found not only in humans and in animals, but they are also isolated from water and soil samples. Normally they are beneficial but when they overpopulate- they may cause a disease. (Source, Wiki)

“On the whole, our gut bacteria are beneficial as they prevent disease-causing bacteria from taking hold in our body simply by filling up all the available space. And they help us digest foods, such as some starches that we cannot break down ourselves, producing vitamins and energy sources we can use,” states Ruth Ley, a microbial ecologist at Cornell University in Ithaca, N.Y.(Source, Los AngelesTimes)

A comparative study done by the same team (2005) at the Washington University School of Medicine in St. Louis, studied the gut bacteria in mice, and compared lean mice with genetically obese ones. The genetically obese mice had a mutation in the hormone leptin, which normally controls appetite and metabolism. Similarly to mice, the two main gut inhabitants in humans were Bacteroidetes and Firmicutes. The researchers were surprised to find out that obese and lean mice had different proportions of each. In particular, fat mice tended to have more Firmicutes, and fewer Bacteroidetes, just the opposite to lean mice who had more Bacteroidetes than Firmicutes.

In a separate study, the same team worked with sterile (bacteria-free) mice that have no gut bacteria. Generally, these mice eat a lot, but do never get fat, presumably because they don't have Firmicutes bacteria to absorb all the calories from the food. For their surprise, when the researchers implanted the same bacteria from fat mice to their sterile counterparts, the recipients mice gained weight. This result, reported in Nature (2006), directly suggests that intestinal bacteria are directly connected with obesity and weight gain.

In another study also published in Nature (2006), the team tried to compare the results in mice with people, and studied the proportion of Firmicutes and Bacteroidetes in 12 people. They examined the bacteria in obese people in one year of follow up diet program. Before the diet started, the subjects had more Firmicutes and fewer Bacteroidetes, but as the diet progressed, the Bacteroidetes went up, while the Firmicutes numbers went down. Despite the conclusions in 12 people are far from being statistically significant, the question behind the new obesity hypothesis is still open for a future research.

Generally, babies are born “bacteria-free” (sterile), but start collecting bacteria from their mothers and their family. It is obvious that there is also an inheritance from family members. If the gut-obesity theory proved correct, that would suggest obesity risk could be over passed with correct diet, selected foods and drinks which regulate the kind of bacteria that are not beneficial.

A study found that ‘a "high-fat, high-sugar" diet changes the composition of bacteria in the gut, making it easier to gain weight and harder to lose it. ’According to the study published in the new Journal of Translational Medicine, ‘the changeover can happen in as little as 24 hours." Researchers led by Andrew Gewirtz at Emory University found that bacteria in human gut may play an important role in whether the body will use fat for energy or will store fat for future occasion. " If a person has changes in their gut bacteria — and that could be due to anything, to diet, to illness or antibiotic use and if that person has kids, then they can transfer those gut bacteria and maybe transfer the problem," Gewirtz stated. (Source, Time)

Otherwise, Firmicutes are seen as bacteria that absorb maximum calories from food by fighting for each available calorie from food and drinks, while signaling the body to either to store fat, slowing down metabolism. In fact the more Firmicutes one individual has the more obese he (she) is.

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Mediterranean diet prescription for healthy living

Antoaneta Sawyer, PhD


Mediterranean diet is built on high-quality food with basic ingredients that include fresh fruits and vegetables, whole grains, nuts and seeds, legumes, seafood, yogurt, olive oil, and small amount of wine. This diet has the reputation for being a "true model of preventive eating" for patients with chronic degenerative disease and is known to contribute for better quality of life. (Source, AHA and NH-WC "Beyond Holistic)
The Mediterranean-style diet which is mainly a "low-carb" diet is quite more effective than low-fat- low-calorie diet for prediabetics and aged people with a cognitive decline. It is also rich in olive oil, nuts, and fish, but low in red meat, dairy products and alcohol. Whole food should be seasonal, fresh, strictly portioned, appropriately cooked, and organically grown. (Source, Wiki)
"This diet emphasizes organic vegetables, fruits, fish, olive oil, lower meat consumption, and moderate wine and non-refined grain intake," concludes lead author Tangney (Rush University Medical Center in Chicago), in a news release from the American Society for Nutrition (ASN). In a completely new and ongoing prospective study called the Chicago Health and Aging Project (CHAP, 2010), a team led by Tangney, have found that adherence to the Mediterranean diet may reduce the risk of cognitive decline with older age. (Source, Rush Univ)
A traditional nut-enriched Mediterranean Diet helps reverse metabolic syndrome, and appears to be useful for managing metabolic abnormalities in older adults, as well as provides substantial protection against diabetes, heart disease and stroke. (Source, MedPage Today) One of the first major studies on the Mediterranean diet use as preventive nutritional strategy in metabolic syndrome was performed in 2004 by a team of Italian scientists. Researchers randomized 180 men and women with metabolic syndrome to compare the effect of two diets-- "Mediterranean diet" and the so called "prudent diet." The nutrient ratio composition of both diets was identical consisting in 50%-60% carbohydrates, 15% protein, and <30%>It was concluded that after 2 years on both diets, metabolic syndrome patients on Mediterranean diet lost more weight, had lower plasma C- reactive protein (CRP) and interleukin 6 (IL-6) levels (a guarantee of reduced inflammation), and less insulin resistance, comparatively to the control group. Their total cholesterol and triglycerides fell, while the good cholesterol (HDL) rose significantly comparatively to the participants on the prudent diet. The main and maybe most important feature from the whole study was the endothelial function improvement in the Mediterranean diet group, while it remained unchanged in the control group. That was the first proof ever in the scientific literature (JAMA) that a Mediterranean diet works in people with obesity and metabolic syndrome, including people with diabetes and cardiovascular diseases. (Esposito et al., 2004) (Source, Wiki and PubMed)
The Mediterranean-style diet is more effective than a typical "low-fat" and "calorie-restricted" diet in case of metabolic syndrome prevention. According to a new study released last Monday, not only did the Mediterranean diet lead to a greater weight loss, but it also resulted in better glucose tolerance, and improved some of the serious metabolic effects (cardiovascular risk factors). The study, presented at the Experimental Biology 2010 meeting in Anaheim California experimented with testing the diet of 4,000 adults aged 65 and older. Final conclusions from the above study were that, "Adults over age 65 should look to include more olive oil, legumes, fiber, nuts, and seeds in their diet in order to improve their recall times and other cognitive skills, such as identifying symbols and numbers." Tangney, lead author of the above study, added to the above equation the necessity of a daily physical activity as an important part of maintaining cognitive skills. (Source, ASIP)
Authors (Cloutier & Adamson, 2004) claim that the Mediterranean diet is more than just a diet- it is a lifestyle. They believe that by finding fulfillment in exercise, the outdoors lifestyle, and relationships-- all fundamental part of the Mediterranean life style--would help prevent anyone falling back into unhealthy habits. The authors found that a compound in olive oil named "oleocanthal" (whose pungency induces a stinging sensation in the throat) m?y help reduce inflammation, and may prevent conditions like he?rt disease, metabolic syndrome, Type 2 diabetes, arthritis, Alzheimer's disease, autoimmune disease, and certain cancers. (Source, NH-WC "Beyond Holistic and ElementsForHealth)
Needes separately concludes that in order to lessen gout and kidney damage, protein levels had to be kept low and should not be above 15- 20% of the total diet calories (Needes, 2002). Based on the results of a 20 year mega-nutritional study two authors scientifically illustrated that a "plant-based- oil-free diet" can not only prevent and stop the progression of heart disease but it can also reverse its effects (Caldwell & Esselstyne Jr, 2008). Mediterranean diet is connected with less risk of mild cognitive impairment, according to another report (Scarmeas, 2009). (Source, NH-WC Beyond Holistic")
Another Italian team or researchers (Sofi, Cesari, Abbate, Gensini & Casini, 2008) assessed and analyzed 12 international studies, which collectively included more than 1.5 million participants whose dietary habits and health were tracked for follow-up periods ranging from three to 18 years. A score based on the strict adherence to the Mediterranean diet could be used as an effective preventive tool for reducing the risk of premature death in general population. It was examined the concept of using a numerical score to estimate how much people stick to the diet, known in the literature as an "adherence score." The researchers found that people who stayed strictly on the Mediterranean diet had significant improvements in their health, including a 9% drop in overall mortality, a 9% drop in mortality from cardiovascular disease, a 13% reduction in incidence of Parkinson and Alzheimer's disease, and a 6% reduction in cancer. (Source, BMJ)
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The DASH diet

Antoaneta Sawyer, PhD

Another "metabolic syndrome friendly" diet is the Dietary Approaches to Stop Hypertension diet also known as the " DASH diet." This is maybe one of the most rigorously researched diets than anyone else in the scientific literature. (Source, DASH diet) The influence of a diet on blood pressure monitoring results is studied by Djousse et al., 2006 ( Source, AHA)
The National Heart, Lung, and Blood Institute (NHLBI) started in a joint venture manner a huge multi-centered, well randomized, outpatient version of a study across the US nation, involving Harvard School of Public Health, Johns Hopkins University, Duke University, Kaiser Permanente Center for Health Research, and Pennington Biomedical Research Center (1993- 1997). As a result of this research the diet (DASH) approach was officially recommended by the NHLBI, as part of the National Institutes of Health (NIH) to control blood pressure and to help maintaining stable weight. (Source, Wiki)
One of the main and most specific DASH diet features is to limit the intake of sodium in the general diet. The diet is proven to help lower hypertension (elevated blood pressure) what name it- Dietary Approaches to Stop Hypertension (DASH). The diet is proven to reduce systolic blood pressure by 11mm Hg and diastolic blood pressure by 6 mm HG in hypertensive patients and systolic blood pressure by 6 mm Hg and diastolic blood pressure by 3 mm Hg in patients with normal blood pressure. (Source, Wiki and EHow)
DASH diet was also found to reduce and stabilize blood glucose and to reduce blood lipids, what makes her good and reliable choice of a diet in case of metabolic syndrome and obesity. The emphasis is on good eating habits, by encouraging the consumption of nuts, whole grains, fish, poultry, fruits and vegetables, while lowering the consumption of red meats, sweets, and sugary foods and beverages. Generally, the diet is focused on the replacement of "junk food" and highly processed food pattern (a typical western diet) with home cooked healthy alternatives. So this is in fact another option for someone who is overweight or obese and has metabolic syndrome.
DASH diet is highly abundant in lean protein, fruits and vegetables, whole grains and low-fat dairy option. It is also rich in potassium, magnesium, and calcium, as well as protein and fiber. DASH diet consists of lean protein, 8-10 fruits and vegetables, low-fat dairy, whole grains, and about 25 percent of the total daily calories come from good fats, like olive and canola oil. In general the diet recommends nine servings of fruits and vegetables per day, two to three servings of low-fat dairy and protein, and five to six servings of whole grains.
Actually, DASH diet is a good prototype-example of a low GI diet and also one of the best diets for prediabetes, obesity with hypertension and metabolic syndrome as it has been tested and proven to significantly lower blood pressure and lipid levels, and to improve glucose intolerance. It can be compared also with the Mediterranean diet as it requires 8-10 fruits, vegetables and fiber in the diet. (Source, ADA)
What can compare DASH to the Low GI diet is that all the fruits and vegetables must be with low glycemic index. It is high in fruits and vegetables and whole grains - plus, it recommends a certain amount of low-fat dairy and lean protein pretty much alike the Mediterranean diet. You may learn more about the DASH diet specifics by reading the NIH guidebook (2009) termed "Your Guide to lowering your Blood Pressure with DASH." The manual offers healthy food alternatives and their nutritional value, as well as meal plans and exact proportions of macronutrients.
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The ‘Fat Resistance’ diet

Antoaneta Sawyer, PhD

Dr. Leo Galland, wrote his book ‘The Fat Resistance Diet: Unlock the Secret of the Hormone Leptin to: Eliminate Cravings, Supercharge Your Metabolism, Fight Inflammation, Lose Weight & Reprogram Your Body to Stay Thin' ( 2006), based on the concept that hormones such as leptin, insulin, ghrelin, glucagon and adiponectin control appetite and closely monitor body fat levels.
The diet is built with the idea of possible biochemical and metabolic changes, following a recovery from the effects of 'bad eating' habits. (Source, Amazon; Fatresistancediet) As an internist, the author recognizes that obesity, metabolic syndrome and type 2 diabetes are modern pandemics of our American society. While separating myths from facts, Galland is completely sure that 'leptin resistance' is the phenomena that drives obesity and metabolic syndrome up. The critical relationship between inflammation, incorrect diet habits, and obesity is well explained in the initial chapters of the book. (Source, Answers)
According to the author, when the body lipids elevate, that causes chronic but steady proinflammatory background, which subsequently alters the whole body biochemistry and creates hormonal imbalances. The book is built on healthy eating guidelines, so you can reverse your metabolic problem by designing your proper menu. The Wall Street Journal termed it: "The new thing in dieting." (Source, Random House)
By offering a variety of more than 100 different recipes, the author is introducing the reader to his version of an "anti-metabolic syndrome" diet plan to the road of success in combating ‘leptin resistance' timely and steadily with the help of hormone-balancing and anti-inflammatory nutrients.
As most of the well known diets, the Galland's diet is built on three-phase (stage) approach:
Stage 1. Consisting in a radical and quick weight loss
Stage 2. Directed to a moderate but steady weight loss
Stage 3. Geared to a long term "lifestyle" maintenance
Galland claimed that it is possible for dieters to achieve their ideal weight by inhibiting inflammation and to restore body biochemistry in terms to reduce cravings, and to increase metabolism and fat burning. In addition, his nutritional approach is based on detoxification and the addition of several super foods, what has been associated with weight loss and significant decline in cholesterol levels and blood pressure- all recognized as metabolic syndrome effects. (Source, Wiki)
The author's purpose is to transform the human body into a "fat-fighting" lean machine with the help of correct nutrition. The foundation of the "Fat resistance diet" is based on the abundant intake of fresh fruits and vegetables rich in antioxidants and phytonutrients such as carotenoids and flavonoids that have proven their anti-inflammatory effect. The author's idea is simple, but reasonable: eat plenty of veggies, fruits, and lean meats (fish and chicken), never overeat, maintain an active lifestyle, and get your daily exercise.
Foods high in carotenoids include carrots, spinach, tomatoes, broccoli, grean leafy vegetables, pumpkins and papaya, already recognized as powerful natural anti-inflammatory key weapons. The diet also emphasizes an increased intake of foods that are high in good fats, such as the omega 3 fatty acids found in fish, walnuts, and flax seeds.
Despite there is no any guarantee that the ‘Fat Resistance’ Diet will work exactly in your individual metabolic syndrome case, as there is no ‘one-size-fits-all’ diet out there on the American market, you can still educate yourself on several rules for healthy and preventive nutrition.
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Role of Probiotics and Prebiotics in the modern diet

Antoaneta Sawyer, PhD

Recent USDA statistics show that since 1970, the average daily caloric intake in the U.S. has increased by nearly 25 percent. Researchers at the Cornell University examined 52 paintings of the well known 15th century painting created by Leonardo da Vinci the “ Last Supper” and digitally compared the size of food and plate for a period of time of 1000 years with the most modern one.

Their report, published in The International Journal of Obesity (April, 2010), showed that the plate, as well as the entrée size enlarged by about two-thirds over the millennium while bread size increased by nearly 25 percent. (Wansink, B & Wansink, C.S.)
The World Health Organization (WHO) estimations are that by 2015, there will be more than 1.5 billion overweight consumers, with an incurring health cost beyond $117 billion per year in the US alone. (NH-WC "Beyond Holistic) Thus, the need of future research in the science of metabolomics for obesity control is strongly substantiated. (Source, Wiki, and PMV)
The new science of metabolomics is constantly discovering new mechanisms to control morbid obesity as part of the metabolic syndrome. Recently it was found a new connection between obesity as part of the metabolic syndrome disorder related to the use of probiotics and prebiotics, as regulators of the gut microflora (Source, Wiki)
Results from recent research suggested that there is a significant decrease in body mass index (BMI), linked to a modulation of gut peptides and appetite modulation that have been observed upon long term treatment of overweight and obese patients with probiotics and prebiotics. The study published in the Curr Opin Clin Nutr Metab Care (2005). also noted that the concept may be also applicable to humans, “Moreover, the metabolomic analysis will allow to select the potential new microbial targets related to obesity and related disorders in the future” (Delzenne & Cani, 2005).
Gut microorganisms, also termed “microbiota” are the trillions of bacteria that normally reside in the human GI tract, and affect nutrient absorption, energy and immunity regulation. Margaret Furtado MS, RD, LDN claims in her article"Probiotics, prebiotics, gut microbiota, and obesity" that ingestion of probiotics and their synbiotic use with prebiotics is highly recommended as preventative approach to the road of health and well-being (Source, BariatricTimes)
The rule that early gut microbiota composition can guide weight development throughout early childhood was established. Ingestion of probiotics is recommended as preventative approach to maintaining the balance of the intestinal microflora and thereby enhancing health and well-being (Furtado, 2009). The role of the gut microflora in affecting the caloric intake control and satiety is gradually being unraveled” are the statements of Prof. Glenn Gibson (University of Reading).
New science breakthrough study published in Nature (Ley, Turnbaugh, Klein & Gordon, 2006) reported that microbial gut flora is different between obese and lean people and that obese people are losing weight when probiotics are added. Two main divisions of beneficial bacteria—Bacteroides and Firmicutes—are recognized as normal residents in the gut, and the equilibrium between the two species is very important in determining an individual’s chance for obesity. This breakthrough is based on the finding that the obese people microflora reverted back to the one of the lean people, suggesting that obesity may have a microbial pathogenesis component.
Thus, the obesity phenomena is induced not so much by overeating, but as to the different metabolic activities of already modified gut flora facilitating the extraction of calories from ingested dietary substances that is storing calories in the adipose tissue for later use. It is obvious that there is an elevated rate of food ingestion in obese patients. Therefore, the attempt to modulate the equilibrium or gut microflora may have a role in the future prevention and treatment of obesity.
Probiotics are nonpathogenic live microorganisms that are believed to confer health benefits to the host when ingested (WHO). (Source, USProbiotics.com) As Gibson (2010) stated “The role of the gut microflora in affecting calorie control and satiety is gradually being unraveled.” The author’s conclusion is that prebiotics may beneficially modify bacterial populations in the guts and aid weight management, with “promising effects also shown in humans.” Larsen, Vogensen, Van den Berg & Anderson proved that "Gut microflora in human adults with type 2 diabetes differs from non-diabetic adults” (2010)
Prebiotics are non-digestible oligosaccharides believed to act as “fertilizers” of the colonic microflora, enhancing growth of beneficial residential organisms (e.g. Bifidobacterium, and Lactobacillus) (Reuter, 2001). Despite known as “non-digestible” the prebiotics are between the food fibers or ingredients that have a beneficial effect through their selective metabolism in the intestinal tract” (Gibson et al., 2004). Prebiotics are believed to offer health benefits on the host, explained with the activation or modulation of lipid metabolism most likely via the process of fermentation. (Source, NutritionNews)
The combination of prebiotics and probiotics, known as "synbiotic", is believed to show enhanced health benefits acting as a “functional food.” (Source, Invista.com) Recent studies reviewed the synergistic role of prebiotics and probiotics on obesity and suggested that individuals with obesity may have differing amounts of particular microflora (e.g. Firmicutes). (Source, Wiki) The combination of probiotics and prebiotics has been proposed to be used in food due to its health-enhancing, and anti-obesity properties to modify the gut flora to its beneficial ratio.
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