Metabolic Syndrome: Part 1

(a.k.a. insulin resistance, pre-diabetes, hyperinsulinemia, Syndrome X)

I mentioned in the last blog the surprising statistic that 50% of all heart attacks occur in people with low LDL cholesterol, and that accumulating evidence indicates that cardiovascular disease is a multi-factorial disease which at its root is a problem of inflammation.  Among those “multi” factors are low HDL (“good”) cholesterol, high triglycerides, hyperinsulinemia, high blood pressure, the metabolic syndrome, C-reactive protein, homocysteine, lack of exercise, stress, and lack of a varied diet.  A good place to start discussing each risk factor individually is with the metabolic syndrome.

The metabolic syndrome is a constellation of risk factors which occur in response to “hyperinsulinemia” (a condition in which the pancreas pumps ever-increasing amounts of insulin in an effort to overcome the “insulin resistance” of the cells).  The symptoms that result in response to high insulin are high triglycerides, abdominal obesity, low HDL cholesterol, high blood pressure, and "high normal" blood glucose (fasting plasma glucose above 110 mg/dL, while the cutoff for diabetes is 126 mg/dL).  Having the symptoms of the metabolic syndrome significantly increases your chance of developing cardiovascular disease and/or diabetes, and the numbers of Americans afflicted is quickly rising.  The CDC recently estimated that 1 out of 3 American adults fits the criteria for the metabolic syndrome. . .

LDL Cholesterol is Not a Good Indicator of Heart Attack Risk

Half of all heart attacks occur in people with low, even optimal, LDL cholesterol as established by the National Cholesterol Education Program. 

Got your attention?

A not well-publicized fact that is becoming increasingly evident in cardiovascular disease research—by itself, LDL cholesterol is not a good indicator of heart disease risk.  So then why in the beegeebers is LDL the standard indicator that is consistently used by the medical profession across America, seemingly without question?  It follows that this one risk factor by which individuals and businesses measure their well-intentioned efforts to become healthy may not lead to the desired result, which I assume is to prevent heart attacks.  It’s not that LDL cholesterol should not be considered—it should.  What is debatable is if it should be the primary focus, often the only focus to the exclusion of other perhaps more important factors that lead people right to an unexpected heart attack. . .

Weight-loss is NOT necessarily healthy

A new scientific report on nearly 3 million people found that people with BMI's in the "overweight" category had less risk of dying than people of normal weight.  Furthermore, while obese people had a greater mortality risk overall, those with the lowest obesity level BMI (30 to 34.9) were not more likely to die than normal-weight people.

The report, although not the first to suggest this relationship between BMI and mortality, has caught the eye of the medical community and journalists, breaking through the virtually impenetrable resistance of the heretofore fat-obsessed (bias against fat) media culture.  

The report, Association of All-Cause Mortality With Overweight and Obesity Using Standard Body Mass Index Categories, was published in the Jan. 2, 2013 edition of the prestigious Journal of the American Medical Association.  The researchers published their results of a large and carefully done meta-analysis of nearly 100 studies.

Finally, someone has said it, and others have agreed to hear it (thanks to JAMA) and get it out into the public discourse to investigate it further.  This is NOT new information--I have been teaching that fat has never been proven to cause disease, and that fitness matters more than fatness for years in the N.E.W. LIFE program, though participants and dietitians alike have been skeptical and slow to convince.  Pick up Glenn Gaesser's excellent book on this topic Big Fat Lies, an even more convincing review of the overwhelming evidence that body fat, although often associated with lifestyle disease risk factors, cannot be implicated as causative in lifestyle diseases, no matter how much the medical profession and media have tried to blame fat.  In his book Dr. Gaesser retraces the information and faulty "conclusions" in all of the studies that we have been trained on as Registered Dietitians--an attentive read will raise the hairs on the back of a dietitian's neck.  Dr. Gaesser has been saying it for years, I have been saying it for years, and finally others have picked up the ball and are beginning to toss it around. Kudos to researchers Katherine M. Flegal, PhD; Brian K. Kit, MD; Heather Orpana, PhD; Barry I. Graubard, PhD, and JAMA.

What the newly released report (and the media's review of it) does not elaborate on (yet) is what I see as a the bigger two-fold problem:

1)  To the extent that health professionals of all types have led the public thinking that they must lose weight in order to reduce their risk of lifestyle disease, we leave them barking up the wrong tree.  Given how entrenched this thinking is, I wonder how much it is going to take to undo the trend.  It will mean honestly admitting where many strong and wrong recommendations have been given.  Already I have heard the skeptical minimization of this "one" report by a prestigious medical professional interviewed by the media. 

2)  An overwhelming amount (underlined for emphasis below) of evidence shows that weight-loss can actually be harmful, sometimes very harmful.  Consider the following, summarized from Gaesser's excellent book Big Fat Lies (the rest of this blog is longer than the normal quick summary support, but that is precisely the point--the overwhelming amount of convincing evidence that people are not being made aware of):

• Fifteen studies published between 1983-1993 show that weight loss increases the risk of premature death by up to 260%.

• Dieters, especially yo-yo dieters (who make up about 90% of the dieters in this country), have a risk for Type II diabetes and for cardiovascular disease that is up to twice that of "overweight" people who remain fat.

• Weight loss was associated with 40-260% higher death rate when researchers devised 36 different ways of comparing causes of death and amount of body weight lost in a follow-up of the NHANES I study (1971-74) in 2,453 men and 2,739 women.

• In 20 of 29 groups weight loss increased the death rate from heart disease and stroke from 7-167% in 800,000 men and women tracked by the American Cancer Society.

• In 1995 the Centers for Disease Control and the American Cancer Society reexamined some of the data from the earlier ACS study focusing specifically on 43,457 women who had never smoked and who were overweight when the study began.  For the 2/3 of the women who were healthy to begin with who intentionally lost between 1-19 pounds, premature death rate from all causes was increased 40-70%. Unintentional weight gain, on the other hand, had no adverse effects on premature death.

• In a study of 12,000 men at high risk for heart disease men who lost weight actually had a greater risk of dying during the nearly 4 years of follow-up.

• In the Harvard Alumni study a subgroup of 11,700 men who had a weight loss of more than 11 pounds during 1962-1977 had a 75% greater risk of dying from heart disease by 1988.

• Dr. Steven Blair and his colleagues studied 10,500 men at high risk for heart disease enrolled in the Multiple Risk Factor Intervention Trial in 1973 and found that weight loss, even for a subgroup of men who would seem to be optimum beneficiaries of weight loss, resulted in 61-242% higher mortality rate from cardiovascular disease.  Weight gain did not significantly increase mortality from heart disease.

Health Care Crisis (Part 2)

Any employers out there reading this? 

Please see previous post and consider signing up for a free RSS feed of the Seed for your employees to receive a daily post (or sign up for a daily e-mail) written by yours truly, Registered Dietitian Diane Preves, M.S., R.D., owner/developer/instructor of the 10-week N.E.W. LIFE (Nutrition, Exercise, Wellness for LIFE) programs.   

For both employers and employees—heads up . . .

While recent health care reform law (the Affordable Care Act) is an attempt to avert the health care crisis referenced in the previous blog, the outcomes of such a late-entry strategy are yet to be seen, and unsure at best.  The need for individuals and companies of all sizes to take action to prevent disease has never been more important.  In August 2012 the National Business Group on Health, a non-profit association of 342 large employers including 66 Fortune 100 companies and providing health coverage for more than 50 million U.S. workers, retirees and their families reported that the cost of employer-provided health care benefits at large U.S. employers will increase an average of another 7% in 2013.  Employers will be asking workers to share the burden--60% of businesses in the survey plan to increase the percentage of the premium paid by employees in 2013, 40% plan to increase in-network deductibles while roughly one-third will increase out-of-network deductibles (33%) and out-of pocket maximums (32%).  The survey was based on responses from 82 of the nation's largest corporations and was conducted in June 2012 prior to the Supreme Court's announcement to uphold the health care reform law. 

But while many employers continue to adopt cost-sharing provisions, survey respondents now consider consumer-directed health plans (CDHP) and wellness initiatives to be more effective at stemming cost than shifting costs to employees.  Surveys are beginning to reveal that as the health care law begins to kick in some businesses will consider dropping health care for their employees altogether and paying the $2000 per employee fine.  While that may temporarily “solve” the financial conundrum businesses may find themselves in, that does not solve the problem.  Individuals still need to be healthy, and businesses still need healthy employees.  

Many employers also plan to increase financial rewards to workers for maintaining a healthy lifestyle or participating in a wellness program.  Employers that offer incentives report that the median amount employees can earn will jump 50% from $300 this year to $450 next year.  Whether you are an employer or an employee, I encourage you to research your choices of “wellness programs” wisely.  Many a company has considered diet programs like Weight Watchers to be used as a wellness program even though weight-loss is a poor indicator of improved health which does not often translate into disease prevention.  Instead, consider the very cost-affordable 10-week N.E.W. LIFE nutrition education/behavior modification program for proven health benefits and weight-loss.  The cost is only $20/session for a 10-week program.  The cost of not doing something to significantly improve the diet and health of your employees is most assuredly more than $200 per employee.

There have been excellent government initiatives at public education, but they have been relatively ineffective as compared to the scope of the problem.  The United States Department of Agriculture and other public health organizations have accomplished the herculean job of disseminating excellent nutrition information so that Americans are largely without excuse.  But government-funded public awareness campaigns have clearly not been enough.  While many Americans are making significant lifestyle changes, many more are not.  America’s health has continued to decline despite increased efforts and money designated to increasing public awareness.  For the most part, people are not going to “get healthy” because they realize they should, even though they understand that there are benefits to being healthy and dire consequences to staying unhealthy.  It would seem there is more needed in the approach.  Clearly the prevention efforts need to be more intensive, more personal, more helpful.  The Seed, delivered direct daily to your RSS feed reader or to individual e-mail inboxes, offers a more consistent message to heighten personal awareness. 

Health Care Crisis (Part 1)

America’s rapidly declining health and the simultaneous increasing cost of health care has been a wave steadily approaching the shores of our national well-being for over a decade.  Most of us knew the wave was out there somewhere, yet the majority behaved as if it really wasn’t a concern, at least not enough to make important changes in diet and exercise.  Maybe we were lulled into thinking that “insurance will cover it” in the last 20 years since 60% of the population began receiving health care coverage through their employers.  Well, the wave has hit the shore, like a tsunami, and change we must.  We are now in the midst of a “health care crisis” and now it’s sink or swim:

• The CDC reports that in 2005 more than 133 million Americans–almost 1 of every 2 adults–suffered with chronic illness.

• Nearly 26 million Americans have diabetes and an estimated 79 million Americans have “pre-diabetes”). Type 2 “adult-onset” diabetes is increasing in the adult population and has made a surprise appearance in children.

• In May 2009 the CDC published the results of a study in its National Health Statistics Report which found that 1 in 3 American adults in the U.S. meet the criteria for metabolic syndrome, a common but silent combination of metabolic symptoms including cholesterol, triglycerides, glucose, insulin, blood pressure and obesity that leads to heart attacks and diabetes (more on all of these in future blogs).  Hypoglycemia, a related disorder, plagues the lives of countless millions more.

• Cardiovascular diseases accounted for 1 in every 3 deaths in the United States in 2009, a year in which the direct and indirect cost of cardiovascular disease in the U.S. was an estimated $312.6 billion (American Heart Association’s “Heart Disease and Stroke Statistics--2013,” Circulation: Journal of the American Heart Association).  And lest we think these statistics are only of concern for retirees, the Framingham Heart Study revealed that 45% of all heart attacks occur in people under age 65.

• And of course we have all heard (or seen) by now that 67% percent of Americans--a whopping two-thirds of us--are either overweight or obese.

The facts are sobering, we are clearly in trouble.  But it really didn’t sneak up on us unawares--the ripples of the big wave have been hitting us for well over 2 decades.  While billions of dollars have been allotted to battling the trend, the overall health of America continued to decline.  As a nation the motivation to change just was not there.  Now, however, the exploding health care crisis is arguably the greatest threat to the well-being of individuals, families, businesses, and the American economy itself.  The escalating cost of insurance premiums and health care, coupled with sinking wages, and combined with escalating numbers of uninsured Americans, has become a recipe for disaster.  Recent health care reform law (the Affordable Care Act) is an attempt to avert that disaster, but the outcomes of such a late-entry strategy are yet to be seen, and unsure at best.  The need for individuals and companies of all sizes to take action to prevent disease has never been more important.

Signing up for a free RSS feed or daily e-mail update of the Seed to your inbox daily can support you in that effort.  The Seed is a short daily tip, education or encouragement to keep the vision of good health in the forefront of your mind.  The Seed will encourage you about just how doable a healthy lifestyle really is and help keep you motivated (anyone who has ever been on a diet or behavior change program realizes that being motivated to start is not difficult, it is staying motivated that is the more difficult key to real lifestyle change).  The Seed is like having a free Registered Dietitian to support you.