20 August 2010

An expanding waistline translates to an increased risk of degenerative lifestyle diseases such as diabetes and heart disease. IN my younger days, jeans were meant to look rugged, and fitted snugly. In the past decade, the fashion vogue was the hipster, with the waistline very much below the waist. That was the voice of the Y generation, boldly depicting the “y” cleft at the posterior. Some of us young-at-heart baby boomers wore these droopy pants with unflattering results. These pants created the “muffin top” as flabby tummies overflowed its edges.

A century ago, the human population was too busy battling infectious diseases. Heart diseases, hypertension, diabetes, stroke and obesity received scant attention.

Besides, life expectancy only hovered around 50, so these conditions were considered rare as people did not live long enough to get them.

However, today, the cause of mortality has shifted from bugs to degenerative lifestyle diseases. Just like a machine which rusts with time, these degenerative diseases typically accompany the process of ageing. What went wrong?

We certainly missed something here. In our medical curriculum, we are taught to compartmentalise diseases, hence many health professionals, including myself, have been conditioned to relate the different conditions as separate entities, not realising that there is a common link.

In 1988, Dr Gerald Reavens pieced the mystery together and coined the term “Syndrome X”. This is one of the most important discoveries in preventive medicine. The subsequent tussle over definitions by the various authoritative bodies created substantial confusion. Currently, Syndrome X is known as the Metabolic Syndrome, which encompasses the following criteria:

> A waistline more than 40 inches in men, 35 inches in women.

> Elevated triglycerides.

> Reduced HDL-cholesterol.

> Borderline blood pressure.

> Borderline blood sugar reading.

Having any three of the above qualifies for the diagnosis. In the United States, it is estimated that 25% of the population are afflicted with the Metabolic Syndrome and another 25% are going there.

Malaysian obesity rates are approaching those of the West and therefore we do not need to be Einsteins to realise that we are also facing a huge problem.

Why the big concern? The natural progression of this condition can lead to full-blown diabetes, prompting the understanding that it is indeed a pre-diabetic condition.

The Metabolic Syndrome offers us the insight that chronic diseases do not “just happen” overnight. Although there is certainly a genetic predisposition to these diseases, it is not all the parent’s fault. It is mainly the road that we choose to travel on.

Very often, the route becomes slippery and hazardous, but we have the choice to re-chart the course or remain on the road to chronic ill health.

The genesis of metabolic upheaval

The root of the problem is none other than one’s choice of food, in particular, carbohydrate intake, especially if they are highly processed. Fragrant rice, white rice, frosted cereals, white bread, noodles and potatoes are typical components of our meals and these carbohydrates are readily converted into glucose in the body. They are known as high glycaemic foods. Sugar is the ultimate source of the body’s fuel and is channelled to cells, particularly muscle cells, for energy production.

However, trouble brews when the blood sugar spikes repeatedly in a day. I personally know of some who have roti canai and teh tarik for breakfast, char kueh teow for lunch, and nasi kandar for dinner, with calory-dense snacks in between.

After a typical high glycaemic meal, the blood sugar goes through a roller-coaster ride. As it rises rapidly, the pancreas secretes too much of the hormone insulin due to hyperstimulation. This stage is known as “insulin abuse”. Insulin lowers the blood sugar by acting like a key that opens the locks on the muscle cells, thereby allowing the sugar to get into the cells to be burned as energy.

After this, the blood sugar crashes down, dipping below its baseline, leading to low blood sugar and hunger, feeding the craving for carbohydrate. The cycle repeats itself a few times a day, year after year.

Full-blown Metabolic Syndrome

Just like any lock which has been overused, there comes a stage when the cells refuse to open the door despite plenty of insulin, rendering the “keys” ineffective. This state is called insulin resistance and is synonymous with the onset of the Metabolic Syndrome, when the blood sugar now stays elevated,

As the blood sugar cannot get into cells to be used as energy, it switches to a different route to be stored as fat, which is concentrated around the middle. This fat is known as visceral fat, or aptly called, “killer fat”, as it is associated with fatty liver, heart disease, stroke, sleep apnoea and diabetes.

The Metabolic Syndrome is a stubborn guest and a silent harbinger of many maladies.

As time goes on, the pancreas finally wears itself out and this paves the way for type 2 diabetes.

As the pancreas throws in the towel, the insulin level drops. Now, as the blood sugar escalates out of control, there is further starvation of the cells as less and less glucose gain entry. The body’s fats and proteins start to break down, much like the body “eating itself”, leading to extreme fatigue, loss of weight due to wasting muscles, thirst and frequent urination. Diabetes has announced its arrival.

Much like a tug boat collecting junk, the Metabolic Syndrome pulls along a host of related chronic diseases, waiting in the wings to rear its ugly head. We now realise that diabetes, obesity, heart disease and stroke are rival siblings in the same family, with the same root cause, each trying to outdo the other.

Take action

The good news is there is a recipe for avoidance or reversal of the Metabolic Syndrome. The bad news is there is not a single drug that can do the trick. The worst news is that the action required is a triad of unpopular measures that include exercise, taking low glycaemic meals, and following a programme of optimal cellular nutrition.

These are the recommendations of Dr Ray Strand who wrote the bookHealthy For Life, which stresses the target of developing a healthy lifestyle with the permanent side effect of weight loss. The key here is to reverse insulin resistance. In a 12-week study of patients with the Metabolic Syndrome who followed the programme, parameters like blood pressure, blood sugar, lipids and insulin resistance were reduced.

Exercise for at least 30 minutes a day, combining stretching, muscle toning and light aerobics. The rationale behind exercise in reducing insulin resistance is the benefit provided by improved muscle capillary blood flow, which delivers insulin to the target tissues.

Concomitant with this is the increase in lean mass, thereby increasing metabolic rate and more efficient glucose utilisation.

Understanding the glycaemic index is paramount in the successful reversal of the Metabolic Syndrome. High rating carbohydrates are, needless to say, our usual favourites. Examples of low glycaemic index carbohydrates include the uninspiring rolled oats, whole bran, broccoli, vegetables and most fruits (except for bananas).

Just like there are good carbs and bad carbs, there are also good proteins and good fat. It makes no sense to practise healthy carbohydrate intake and yet gulp down pots of red meat curries and fatty foods.

The manner of eating is also important as small frequent meals cause less sugar spikes than hearty meals. An ideal concept is “graze”, not “gorge”.

Last but not least is the concept of optimal cellular nutrition, which means providing the cells with the ideal amount of micronutrients (essential cellular food) which meets the shortfall in our unbalanced modern diets.

With specific reference to insulin resistance, supplementation with a mineral called chromium has the promising effect of lowering blood sugar. Animal studies also suggest that chromium supplementation increases lean mass, thereby aiding the burning of fat.

Other minerals like vanadium and manganese may also play a pivotal role in improving blood sugar control.

In caramelising banana, the sugar coats on the fruit and browns with heat. In the body, the glucose also bonds to the red blood cells through a process known as “glycation” (measured by a blood test known as HBA1c). A similar process occurs with fats and proteins, leading to oxidation and inflammation of various tissues, yielding a bewildering array of complications.

A marker for blood vessel inflammation called C–reactive protein gives an indication of the state of the arteries. A broad spectrum antioxidant supplement together with potent doses of vitamin B complexes can offer some protection.

The threat of the Metabolic Syndrome often goes unnoticed by those afflicted as there are hardly any symptoms. However, it is a very real threat, and one in which we should eliminate before it irreversibly robs us of our well-being.

This article was published in www.thestar.com.my on 28 July 2010.