I put a post out last week where I highlighted the connection between neck pain and abdominal obesity. This made me think more about the topic as I see the expanding waistlines of many of my friends and most of my family.

This trend scares me….literally…I recently had a friend come and stay with me who I hadn’t seen for 15 years. Part of the reason we spent time with each other after so long was that he wanted to address his weight gain. We ended up playing a game of pickleball, like miniature tennis, and he struggled with his fitness, and I genuinely thought he could have a heart attack.

Images of me calling his wife flashed through my head, and I felt stupid for pushing him during the game. Luckily my fears weren’t realized, but this problem will only worsen.

In the US, the number of obese people is expected to rise to just under 50% by 2030 (1). This public and personal health crisis must be addressed on an individual and, where possible, at a general level.

There are different types of obesity, and the one I mentioned above, central obesity, is more serious regarding related increases in many health problems and early death. (2)

Some forms of obesity can come from hormonal changes, but the percentage of cases of hypothyroidism, Cushing, and Hypogonadism don’t explain the rapid increase in patients over the last 30 years.

However, we are learning now through research that excess body fat changes hormones which can make it hard to lose weight, but these hormonal changes are a consequence, not a cause, as they tend to normalize with weight loss (4).

Doctors aren’t equipped or trained well in advising patients on how to lose weight, and most tend to ignore it, pushing the problem, increased risk of diabetes, heart attacks, strokes, and some cancers further down the line.

Some people might think it’s easy for me to talk about obesity because I’m slim and have some sort of genetic ability to stay thin. Well, genetics play a small role in obesity but as everyone who has ever spent time with me says…” You don’t eat enough .” My usual reply is that I eat the right amount, considering I’m about the same weight I was 20 years ago.

Yet, when I spend time in Canada or the UK on holiday, I put on weight, usually about 5-10lbs in a month. That’s mainly because I’m eating out or people are cooking for me, and I’m not in complete control of what I’m eating as I am at home. If I stayed a year with no change in those eating habits, I might just put on 30 lbs, and that’s what I see with my peer group once skinny athletic men are now walking around with their rotund waistlines as a source of pride, maybe even status.

The question for me is how do I bring up the topic of weight gain or loss without being accused of fat shaming?
When patients come to me for advice, it’s easy I use a lifestyle medicine approach which allows me to help patients and clients see the connection between things that are not commonly discussed as causes of obesity, namely,
Disrupted sleep pattern (5)
Timing of food eaten (6)
Stress levels and how to manage them (7)
Environment (3)

But when it’s my friends, do I stand by and ignore the fact that some support and encouragement may be the key to preventing stroke, heart attack, and some cancers?

You see, the environment is a particular concern of mine. As mentioned, I’ve seen how obesity can spread through social networks. I’ve seen certain groups of people collectively become obese over the years. The study quoted here highlights this very well,
“The study found that when an individual becomes obese, the chances that a friend of theirs will become obese increase by 57 percent. Their siblings have a 40 percent increased risk of obesity, and their spouse a 37 percent increased risk”.

Obesity is a multifactorial problem that needs to be addressed in a multifactorial way.
Hormones play a small role in the current epidemic. Still, solid support from healthcare practitioners can help people tackle this problem and save lives, unnecessary suffering, and money.

Sources:

(1) https://www.nejm.org/doi/full/10.1056/NEJMsa1909301?query=featured_home

(2) https://www.hsph.harvard.edu/obesity-prevention-source/obesity-causes/

(3) https://www.endocrine.org/patient-engagement/endocrine-library/obesity

(4) https://www.ncbi.nlm.nih.gov/books/NBK279053/

https://www.endocrine.org/patient-engagement/endocrine-library/obesity

(5) https://www.hsph.harvard.edu/nutritionsource/sleep/

(6) https://www.hsph.harvard.edu/nutritionsource/healthy-weight/diet-reviews/intermittent-fasting/

(7) https://www.amymyersmd.com/article/cortisol-and-weight-gain/

(8) https://hms.harvard.edu/news/obesity-spreads-through-social-networks

Have you ever heard about Metabolic Syndrome?   

In simple terms, someone can be diagnosed as having metabolic syndrome if they have 3 or more of the following signs and symptoms:

• Central obesity 
• Reduced high-density lipoprotein
• Elevated triglycerides
• Elevated blood pressure 
• Elevated fasting blood glucose

Also, people who do have this cluster of signs and symptoms often have chronic diseases such as cardiovascular disease, arthritis, chronic kidney disease, schizophrenia, and several types of cancer. Just in the United States, there are over 3,000,000 new cases alone, with 47 million existing cases.  

This “syndrome” is generally considered chronic and lifelong, but what are the criteria for all five risk factors? 

Let’s dig down a little and find out a bit more about those markers.
The National Institutes of Health guidelines define metabolic syndrome as having three or more of the following traits, including traits for which you may be taking medication to control: 

• Large waist: A waistline that measures at least 35 inches (89 centimeters) for women and 40 inches (102 centimeters) for me. 
• High triglyceride level: 150 milligrams per deciliter (mg/dL), or 1.7 millimoles per liter (mmol/L), or higher of this type of fat found in the blood. 
• Reduced “good” or HDL cholesterol: Less than 40 mg/dL (1.04 mmol/L) in men or less than 50 mg/dL (1.3 mmol/L) in women of high-density lipoprotein (HDL) cholesterol 
• Increased blood pressure: 130/85 millimeters of mercury (mm Hg) or higher.
• Elevated fasting blood sugar: 100 mg/dL (5.6 mmol/L) or higher (pre-diabetic or type 2 diabetic). 

So, it’s not really a disease; it’s just a group of conditions that go together. Doctors commonly say there is no definitive cause. However, if we analyze each risk factor, we can start to unpick some of the underlying causes that are ‘pretty well known’.

The first fact is that carbohydrates raise blood glucose and are composed of different forms of sugar. They’re quickly absorbed and raise blood sugar. Also, foods that do this can be said to have a high glycemic index. Foods that raise blood sugar also trigger higher insulin responses; if insulin levels are high for a long time, the body develops insulin resistance. 

Once you have insulin resistance, the cells don’t respond the same way to sugar, so the glucose rises, and we have a vicious cycle that eventually leads to type 2 diabetes. 

 

When this cycle starts, the second fact comes into the picture. Insulin stimulates the conversion of blood glucose to fat, lipogenesis, and the fat that travels in the blood is called triglycerides; too much of that is the second criterion for diagnosing metabolic syndrome. The third fact is that insulin also slows down the body’s ability to use fat as a fuel source (lipolysis), so insulin promotes the growth of fat and prevents fat burning; hence, it is stored waistlines increase. 

The last fact is that cortisol is a stress hormone that raises blood sugar, leads to insulin resistance, and is very closely associated with belly fat. For example, if a person has too much cortisol, a condition known as Cushing syndrome, they will develop insulin resistance, belly fat, and typical body shapes, as shown in the diagram.  

 If we correlate the five risk factors with carbs, insulin, and cortisol, we can establish that:  

1. Cortisol and insulin resistance causes abdominal obesity.  
2. Raised triglycerides are the result of insulin resistance and high blood sugar. 
3. High blood pressure is primarily a function of stress and, combined with cortisol, becomes a component of metabolic syndrome by increasing blood pressure. 
4. Elevated blood glucose results from carbohydrate consumption and high insulin, just like we see in the “vicious cycle” when consuming carbs.  
5. Reduced HDL and increased LDL are a result of inflammation. 

To me, it’s evident that the underlying cause of the metabolic syndrome is insulin, inflammation, and stress. You need to focus on these three things to reverse or prevent getting any of the five risk factors for metabolic syndrome. 

How can we treat metabolic syndrome? 

Well, let’s look at the standard treatment for metabolic syndrome. 

1. For abdominal obesity, doctors tell you to lose weight and suggest a “healthy diet” that is high in grains and carbohydrates, rich in fruits, and low-fat dairy or non-fat dairy. However, now you know that all these things have a high glycemic index that will promote insulin resistance. 
2. They also give you statin drugs for the triglycerides to decrease LDL and consequently help to increase HDL. However, statin drugs interfere with the liver’s cholesterol production, an essential nutrient and one of the building blocks of your brain. They also interfere with the body’s production of coenzyme Q10, the critical enzyme inside the mitochondria that helps the body produce energy. The statins will shut down energy production in the brain, heart, and liver because they’re the most metabolically active. I personally wouldn’t recommend taking statin drugs, but I’m not a medical doctor. So only you and your doctor can make that decision, and if you take any statin drugs, you must supplement with high doses of coenzyme Q10.
3. For high blood pressure, doctors can prescribe many drugs, including prescribe beta-blockers, and for type 2 diabetes and high blood sugar, they’ll prescribe insulin or insulin-promoting medication. 

You now see why metabolic syndrome is considered chronic and can’t be cured; this problem starts with insulin, insulin resistance, and blood glucose. Yet most treatments promote insulin resistance, and eating a diet high in carbohydrates encourages insulin resistance, and even worse, the same happens with type 2 diabetes. When you take insulin or an insulin-mimicking drug, you trick yourself into becoming more insulin-resistant.

The problem with metabolic syndrome is treating each risk factor (symptom) separately; this happens when we ignore the root cause- and focus strictly on treating symptoms.

So how can you treat the root cause? 

The first step is reversing insulin resistance, reducing the intake of foods that stimulate the most insulin and the frequency of meals that promote insulin. This means eating less sugar, fewer carbs, and, for the majority of people with metabolic syndrome, eating fewer calories. 

Some options are low-carb keto and intermittent fasting.  I’ve tried everything, not because I have metabolic syndrome but because I like to experience any lifestyle modifications firsthand.  Personally, I think the easiest intervention most people can do is limit the time window in which they eat. This can lead to weight loss and usually means people don’t snack as much. 

Next is reducing inflammation; in general, sugar, gluten in some grains, and insulin cause inflammation. Most people are sensitive or allergic to foods like grains and processed dairy, and in other cases, people are also susceptible to specific foods like strawberries, fish, nuts, or nightshades. 

The third, and probably the most impactful thing, is stress because stress contributes to the rise in insulin and inflammation and produces cortisol. Which we now know are the 3 big underlying facts of metabolic syndrome.

I hope people with metabolic syndrome see how a slow, sustainable change in their lifestyle, which focuses on reversing the things that trigger their insulin levels, inflammation, and cortisol level, can lead to better results with metabolic syndrome than just taking drugs for each symptom. 

Sources:  

https://www.cdc.gov/pcd/issues/2017/16_0287.htm  

https://www.mayoclinic.org/diseases-conditions/metabolic-syndrome/symptoms-causes/syc-20351916