Metabolic syndrome – #1 public health Issue in Canada
One out of every four Canadians is speculated to be in the early stages of developing metabolic syndrome, pre-diabetes, or type 2 diabetes.
The conventional approach is diagnosis-driven and until a precise diagnostic code is given to the patient, there is no treatment plan.
In the functional medicine or naturopathic medicine approach, the “underlying dysfunction” or ‘tolle causum” (causes) are identified and a multi-pronged treatment approach is initiated.
Metabolic syndrome was first termed “Syndrome X” by Dr. Gerald Reaven, MD, a Stanford University endocrinologist more than 30 years ago.
Simply put, it is a disorder of human physiology that if untreated, eventually leads to type 2 diabetes, cardiovascular disease and atherosclerosis.
In 2002 (JAMA vol; 287:356-359), the definition was further clarified that for a person to be diagnosed with metabolic syndrome, they had to meet three of the following criteria: triglycerides greater than 1.7, HDL cholesterol less than 1.03 in men and less than 1.3 in women, waist to hip ratio greater than 1, fasting blood sugar greater than 6.1 and blood pressure greater than 130/85.
Then in 2004 a follow up article in JAMA (vol; 292:2823-2824) added two more criteria: increased clotting tendency and low magnesium.
Normal insulin metabolism regulates the production and storage of sugar (glycogen) in the liver, it is anti-inflammatory and stimulates the production of nitric oxide which relaxes blood vessels and lowers blood pressure.
The mechanism of metabolic syndrome starts with insulin resistance when normal insulin pathways are disrupted and more fat gets stored inside the cell instead of being stored as glycogen.
As fat builds up inside the cell, the mitochondria (the energy producer of all cells) becomes less efficient. This results in the activation of inflammatory pathways and free radical production and increased insulin resistance.
This now becomes a vicious cycle.
The long term consequences of metabolic syndrome and type 2 diabetes are significant and include among others: chronic infection, poor wound healing, neuropathy, non-alcoholic fatty liver disease, kidney disease, cataracts, retinopathy, sleep apnea and autoimmune disorders.
For this reason it is important to prevent and treat the earliest signs and symptoms of this metabolic syndrome.
Most are aware that dietary polyunsaturated fats are prone to becoming rancid as a result of oxidation. It is also important to understand that glucose itself oxidizes during some cooking processes creating clumps with proteins called AGE’s (advanced glycosylation end-byproducts).
For example cooking foods with carbohydrate and/or protein will develop AGE’s when cooked at high temperatures.
Barbecuing meat with sugary sauces at high temperatures, flaming a crème brulée and sticky buns are all sources of AGE’s.
When these are consumed, even by a person with normal blood sugar, inflammatory pathways are up-regulated causing insulin to become more resistant and you have the beginnings of metabolic syndrome.
Similarly, a diet high in refined carbohydrates activates the same pathways.
Clearly, the conventional approach of prescription drugs is simply not effective enough, or we wouldn’t have such an escalating problem.
The good news is that lifestyle, dietary, and nutraceutical support strategies offer many advantages for the prevention and treatment of metabolic syndrome and type 2 diabetes.
A study in JAMA 2004; 292:2823–2824, it was shown than lifestyle intervention reduced the incidence of type 2 diabetes by 58 per cent whereas Metformin reduced the incidence by 31 per cent.
This means that if a patient, average age 51, has a HgA1c (average blood sugar over 3 months) of 6.8 (not diabetic yet) and is prescribed Metformin, that same patient has the choice to exercise 150 minutes per week,(or 21 minutes per day) in order to increase muscle mass and lose seven per cent of their weight over 2.8 years and have a 27 per cent better outcome than if they had just taken the Metformin alone.
There is certainly a place for the use of Metformin as a stop gap measure or in the lowest dosage possible to control blood sugars.
The goal is to avoid prescription medications if at all possible.
In a future article I will review a naturopathic treatment program used with a patient to lower the risk factors for metabolic syndrome.
Dr. Ingrid Pincott, naturopathic physician, has been practicing since 1985 and can be reached at 250-286-3655 or www.DrPincott.com