The Prediabetic Epidemic This section is compiled by Frank M. Painter, D.C.
Send all comments or additions to: Frankp@chiro.org
From March 2001 issue of Nutrition Science News
by Jack ChallemSyndrome X is a relatively new diagnosis, but it is a condition as old as the typical American diet
The person with a "fat tire" carries an unmistakable clue to his health right around the waist: He either has or is at serious risk of developing Syndrome X. The condition isn't a household word quite yet, but it's getting there. An estimated 60 to 70 million Americans—about one of every four people—have some degree of Syndrome X, which sets the stage for adult-onset diabetes and coronary artery disease.
The good news is that, like many other health problems, Syndrome X can be prevented and reversed through a combination of diet, supplementation, and moderate physical activity.
The term Syndrome X was coined in 1988 by a Stanford University endocrinologist, although the cluster of signs and symptoms that distinguish it had previously been referred to as metabolic syndrome or insulin-resistance syndrome. Originally, Syndrome X was defined by four characteristics: (1) abdominal obesity, (2) elevated levels of triglycerides and low levels of high-density lipoproteins (HDL, or the "good" cholesterol), (3) hypertension, and (4) insulin resistance. Insulin resistance, the hallmark of adult-onset diabetes, also lies at the core of Syndrome X. This hormone imbalance alters blood-fat ratios, raises blood pressure, and increases fat storage.
In the past 13 years, several other signs and symptoms have been associated with Syndrome X: low-density lipoprotein (LDL) cholesterol oxidized by free radicals, low levels of antioxidant vitamins, elevated C-reactive protein (C-RP, a marker of inflammation), [1] low dehydroepiandrosterone (DHEA) levels, high cortisol levels, and sometimes androgen-dependent baldness. [2] The current definition of Syndrome X is used flexibly in that some experts refer to a combination of just two or more of the characteristics as Syndrome X.
By itself, each characteristic of Syndrome X increases the risk of diabetes and coronary artery disease. A combination of characteristics, such as abdominal obesity and hypertension, further increases the risk of these conditions. Furthermore, diabetics carry an increased risk of cardiovascular disease. [3]
To assess your clients' risk of developing Syndrome X, pose the following key questions. Each yes answer suggests the possibility of glucose intolerance, insulin resistance, or diabetes. The more of them, the greater the risk.
Do you have or are you developing a pot belly?
Do you crave carbohydrates, or eat a lot of pasta, pizza, bread, or cereal?
Do you have a fasting glucose level greater than 100 mg/dL?
Do you take medications to lower blood sugar, reduce weight, lower blood pressure, or improve glucose sensitivity?
The Glucose/Insulin Seesaw
If elevated insulin levels are the most direct cause of Syndrome X, the obvious question is: What causes such a rise in insulin levels?
Although researchers are investigating genetic predispositions to insulin resistance and Syndrome X, the major influence appears to be dietary. For example, Native Americans and Hawaiians have a relatively high risk of developing insulin resistance and diabetes. However, these conditions did not occur within those cultures until they started eating foods rich in refined sugars and carbohydrates. In contrast, people of European descent may often take longer to develop insulin resistance, Syndrome X, and diabetes, but they are by no means invulnerable. To wit: A recent study in Diabetes Care found that the incidence of diabetes in the United States grew by 33 percent during the 1990s, and the incidence of diabetes among people in their 30s grew by 70 percent. [4] Such enormous increases in the rate of occurrence of any disease had been previously unheard of in medicine, making it epidemic in proportions.
Syndrome X embodies a host of signs and symptoms that suggest a person is at risk of developing adult-onset diabetes. Indicators include obesity, low HDL cholesterol levels, high triglyceride levels, high blood pressure, oxidized low-density lipoprotein (LDL) cholesterol, low levels of antioxidant vitamins and dehydroepiandrosterone (DHEA), and high cortisol levels. A combination of just two or more of these means a person has Syndrome X.
To understand the role of diet in the genesis of insulin resistance and Syndrome X, it is essential to understand the evolution of diet. Our genes evolved in tandem with our diet, with certain nutrients turning on or off our genes and providing the body's biochemical building blocks. From 55 million to 2.5 million years ago, most of our primate ancestors ate a high-plant diet with small amounts of meat. This diverse array of plant foods were uncultivated, and many resembled today's kale or rose hips. During the last major ice age, from 2.5 million to 10,000 years ago, meat and fat played a much more significant role in the diet. Therefore, humans' evolutionary heritage is based on people gathering and hunting their foods, a mix of vegetables and low-fat animal protein—game meat is lean, lower in saturated fat, and higher in omega-3 fatty acids.
About 10,000 years ago, humans began developing agriculture and, in particular, cultivating grains. However, human teeth are not designed to properly chew grains. To be consumed and digested, grains have to be crushed, a process that immediately refines them and makes large amounts of carbohydrates available for digestion.
During the past 50 years, dietary changes have accelerated, pushing us even further from our evolutionary baseline diet. Refined carbohydrates—pastas, breads, cereals, and breakfast bars—now dominate the diet. Many foods are breaded and fried, merging refined grains with refined and often oxidized oils. People did not consume pressed oils until relatively recently. In addition, many foods also contain large amounts of varying forms of sugar, along with partially hydrogenated oils (vegetable oils processed to have some of the characteristics of saturated fats). These foods, even with fortification, contain relatively few micronutrients such as vitamins, minerals, carotenoids, and flavonoids.
Such a diet wreaks havoc on glucose and insulin levels. For example, refined sugars and carbohydrates rapidly boost glucose levels. To reduce high glucose levels (and to prevent kidney damage), the pancreas then secretes large amounts of insulin, which helps transport glucose into cells where it is burned for energy (chiefly in muscle cells) or stored as glycogen (in the liver) or fat (in adipose cells).
Over time, elevated insulin levels overwhelm a finite number of insulin cell receptors. As a consequence, these cells become "resistant" (or insensitive) to insulin, and blood levels of glucose and insulin increase—hyperinsulinemia—setting the stage for Syndrome X, diabetes, heart disease, and other disorders. High glucose levels also generate large numbers of cell-damaging free radicals, which appear to cause or exacerbate many of the complications of diabetes such as eye and nerve diseases, and also increase antioxidant requirements. [5]
A Modern Stone-Age Diet
An "anti-X" diet—one that prevents the Syndrome X cascade—is rich in animal proteins and nonstarchy vegetables. The guiding dietary principles are straightforward and easy for your at-risk clients to put into practice. Among these principles are:
Avoid refined carbohydrates such as white breads, pizzas, pastas, cereals, candy or food bars and sweet bakery products. Instead, emphasize low-starch fresh vegetables such as broccoli, cauliflower and mixed-green salads.
Eat some heart-healthy protein at each meal. Such protein sources include bison, chicken, fish and turkey. They can judge the portion size by what fills them comfortably. For between-meal snacks, eat some nuts.
Eat fresh, natural foods. Fresh foods should be selected over canned, boxed or frozen.
Limit intake of carbohydrate-rich foods. Even whole-grain breads are high in carbohydrates compared to vegetables.
Avoid soft drinks and juices because they are sources of concentrated sugars. Avoid alcohol because it stresses the liver, an organ crucial to blood-sugar control.
Avoid the omega-6 fatty acids found in soy, safflower, and corn oils; these oils are highly refined products, and the omega-6 fatty acids drain the body's vitamin E stores. Foods fried in these oils increase the oxidization of LDL. Extra virgin olive oil is the only cooking oil your customers need.
Avoid foods containing trans-fatty acids and partially hydrogenated oils, which are found in many packaged foods such as margarine, salad dressings and baked goods. Trans-fatty acids and partially hydrogenated oils are refined food products that are known to increase the risk of heart disease. [6]
Increase consumption of omega-3 fatty acids, found in salmon and mackerel, or take omega-3 fish oil supplements. These fats have anti-inflammatory properties and reduce the risk of heart disease. [7]
In practice, these anti-X dietary principles are easy to follow because of the simplicity of meal preparation. For example, breakfast might consist of scrambled eggs with spinach. Lunch at a restaurant might be a turkey burger minus the bun and broccoli substituted for fries. For dinner, have customers try baked chicken (pull back the skin and sprinkle on Italian seasoning) with steamed vegetables. A healthy beverage is sparkling mineral water with a slice of lemon or lime.
Can such a diet be adapted to vegetarians? It is possible, though not easy. Legumes are relatively high in carbohydrates, and a recent study found that canned baked beans were almost as bad as jelly beans in triggering intense glucose and insulin responses, though this likely resulted from the large amount of sugar in canned baked beans. [8] If a vegetarian develops Syndrome X, it is a sign that he, too, should adjust his diet. Any diet that makes a person sicker instead of healthier is the wrong diet.
Supplements to Regulate Glucose and Insulin
Several dietary supplements play key roles in fine-tuning the body's ability to deal with excess glucose and insulin. Supranormal dosages are often required to offset damage caused by a history of eating refined foods. These supplements are safe, particularly when compared with glucose-sensitizing medications. (There is no single medication for treating Syndrome X, and a combination of drugs for this purpose poses serious side effects.) As these supplements improve glucose control and insulin function, medication requirements will likely decrease.Alpha-Lipoic Acid, a sulfur-containing fatty acid found in spinach and animal protein, has been prescribed for years in Germany to treat diabetic nerve disease. Only recently have researchers understood its antioxidant actions quench free radicals responsible for many diabetic complications. It also lowers glucose levels—by 10 to 30 percent—and improves insulin function. [9] Supplement tips: German physicians recommend 600 mg of alpha-lipoic acid daily to treat diabetic complications. For general use as an antioxidant, 50-100 mg/day is ideal. To help correct insulin resistance and Syndrome X, 200-400 mg/day may be required. [10]
Vitamin E has been used by physicians since the 1940s to help prevent and reverse heart disease. During the past five years, medical acceptance of vitamin E supplements has grown substantially. A British study of 2,000 subjects with carefully diagnosed heart disease found that people taking 400-800 IU natural vitamin E daily for an average of 18 months had a 77 percent lower prevalence of heart attacks, compared with people taking placebos. [11]
Supplement tips: Recent studies have shown that natural vitamin E (identified as "d-alpha" on the label) raises blood levels of the vitamin twice as high as the synthetic form (indicated by "dl-alpha"). [12] An ideal dose may be 400 IU daily.
Vitamin C and glucose are similar chemically, and researchers have long believed the two compounds compete with each other. Increasing vitamin C intake seems to edge out some of the glucose or improve its disposal, perhaps by encouraging cells to burn more of it. Some research has found that 2,000 mg/day vitamin C daily lowers both glucose and glycosylated hemoglobin levels, the latter a standard marker of diabetic control. [13]
Supplement tips: Vitamin C is easily absorbed, and a combination of the vitamin with some type of flavonoid (e.g., pine bark extract, grape seed extract, or citrus bioflavonoids) may enhance the benefits of vitamin C in preventing insulin resistance. [14] A daily dosage of 1,000-2,000 mg/day vitamin C may be helpful, along with 25-500 mg/day of flavonoids.
Chromium plays a key role in enhancing insulin function, which leads to more efficient glucose metabolism. In a study of Chinese adult-onset diabetics, 200 mcg chromium picolinate daily led to improvements in fasting glucose and postprandial insulin levels after four months. However, subjects taking 1,000 mcg daily also had "spectacular" decreases in glucose and insulin levels to near-normal levels. [15]
Supplement tips: It's often difficult to discern which chromium supplement is best. However, more research has been published on chromium picolinate than on other common supplemental forms of the nutrient. A daily dosage between 500-1,000 mcg should help reduce blood-sugar levels.
EDITOR's NOTE: The most recent research suggests that Chromium Nicotinate is much better absorbed, AND is much more effective than Chromium Picolinate.
Silymarin is an antioxidant extract of the herb milk thistle (Silybum marianum). It has been shown to reduce all of the major indicators of diabetes, including blood sugar, insulin, glycosuria, and glycosylated hemoglobin. [16] Researchers achieved these results with 800 mg daily of a standardized silymarin extract given for one year. The benefits appeared consistently after about 60 days, and all diabetic signs improved further over the course of a year. However, lower doses are probably sufficient in combination with other supplements.
Supplement tips: With other supplements, 200-400 mg/day of a standardized extract of silymarin should help maintain normal glucose levels.
Take the Extra Step
Eating foods that normalize glucose and insulin function and taking supplements that fine-tune metabolism are crucial steps in preventing and reversing Syndrome X. However, taking a third step—engaging in regular physical activity—increases the number of muscle cells needed to burn excess glucose. Several studies show that simply going for a daily walk improves glucose and insulin function. Walking and many other physical activities, such as dancing, can be fun as well as therapeutic.
The major risk factor for Syndrome X—abdominal obesity—can be assessed visually. A blood-pressure cuff can identify hypertension, a second characteristic of Syndrome X. Another major clue is the medications a person takes, such as those that lower blood pressure, reduce cholesterol or lower blood sugar. Yet none of these medications actually addresses the underlying cause of Syndrome X. Only a revamped diet, supplements, and moderate physical activity can prevent and reverse Syndrome X.
Jack Challem, known as The Nutrition Reporter™, is lead author of "Syndrome X: The Complete Nutritional Program to Prevent and Reverse Insulin Resistance" (John Wiley & Sons, 2000).
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9. Jacob S, et al. The radical scavenger a-lipoic acid enhances insulin sensitivity in patients with NIDDM: a placebo-controlled trial. Presented at Oxidants and Antioxidants in Biology, Santa Barbara, Calif., 1997 Feb 26-Mar 1.
10. Rett K. Alpha-lipoic acid (thioctic acid) increases the insulin resistence in overweight patients with type II diabetes. Diabetes Metab 1996;5:59-62.
11. Stephens NG, et al. Randomized controlled trial of vitamin E in patients with coronary disease: Cambridge Heart Antioxidant Study (CHAOS). Lancet 1996;347:781-6.
12. Burton GW, et al. Human plasma and tissue a-tocopherol concentrations in response to supplementation with deuterated natural and synthetic vitamin E. Am J Clin Nutr 1998;67;669-84.
13. Eriksson J, Kohvakka A. Magnesium and ascorbic acid supplementation in diabetes mellitus. Ann Nutr Metab 1995;39:217-23.
14. Clementson CA. Ascorbic acid and diabetes mellitus. Med Hypothesis 1976 Sep-Oct;2(5):193-4.
15. Anderson RA, et al. Elevated intakes of supplemental chromium improve glucose and insulin variables in individuals with type 2 diabetes. Diabetes 1997;46:1786-91.
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