A Disorder of Lifestyle

1. Metabolic Syndrome
June 2014

2. Metabolic Syndrome
 Syndrome X
 Identified less than 20 years ago
 Increasingly common
 Runs in families
 The risk of it increases with age
 Sufferers are overweight or obese
 A risk factor for:
 Cardiovascular diseases and type 2 diabetes
 Certain cancers, liver disease and Alzheimer’s

3. What is Metabolic Syndrome?
 It is a cluster of metabolic disorders:
 Insulin Resistance
 High Blood Pressure
 An increased risk of blood clotting
 High blood sugar
 Low HDL (good) cholesterol level
 High blood triglyceride (fat) level
 Excess abdominal fat
 Any three of these clinches the diagnosis

4. What causes Metabolic Syndrome?
 The causes are complex
 Poor lifestyle choices play a major role:
 Eating too much sugar and other refined
carbohydrates
 Lack of exercise
 Insufficient sleep
 High stress levels

5. What causes Metabolic Syndrome?
However,
of all the influencing factors,
poor food choices,
in the form of sugar
and refined carbohydrate,
contribute between 80% and 90%
of the total effect.

7. How does Sugar cause
Metabolic Syndrome?
 Excess sugar makes us fat, and people
with metabolic syndrome are all
overweight or obese
 There are two mechanisms:
 Excess sugar is stored as fat
 Leptin, produced in fatty tissue, is a
hormone that regulates appetite. But
fructose causes leptin resistance

8. Fructose Also Increases
 Blood fat levels:
 Triglycerides
 Total blood cholesterol
 LDL (bad) cholesterol
 The prevalence of:
 Type 2 diabetes
 High blood pressure
 Abnormal blood clotting
 Heart disease
The very conditions that constitute
metabolic syndrome!

9. Positive energy balance
DoH ’98, USDA ’02, NIH ’03, NCHS ‘04
1940 50 60 70 80
What we eat
What we need

10. Obesity
 A modern problem - statistics for it did not
exist 50 years ago
 A major factor in the development of Metabolic
Syndrome
 Your BMI is your weight in kilograms, divided
by your height in metres, divided again by your
height in metres
 Healthy - a BMI between 18.5 and 24.9
 Overweight - a BMI between 25 and 30
 Obese - a BMI over 30
 e.g. Weight 80kg, height 1.60m, BMI is 80 /
1.6 / 1.6 = 31.25 = obese

12. Scary Global Statistics
 Obesity prevalence has doubled worldwide
in the past 25 years
 In 2005, 1.6 billion adults were
overweight and 400 million of them were
obese
 By 2015, WHO predicts there will be 2.3
billion overweight adults and 700 million
of them will be obese

13. Scary UK Statistics
 By 2011, the proportion of adults with a
healthy BMI (18.5 - 24.9) had fallen to 34%
(men) and 39% (women)
 There had been a marked increase in obesity
rates over the previous 18 years:
 In 1993, 13% (men) and 16% (women) were
obese
 By 2011, this had risen to 24% (men) and
26% (women)
 For children attending reception classes (aged
4-5) during 2011-12, 9.5% were obese

14. Consequences
 2011 - 11,736 hospital admissions for obesity
- an 11-fold increase in 10 years
 2011 - 53% of obese men and 44% of obese
women had high blood pressure
 Type 2 diabetes
 Occurs where there is insulin resistance - the
common factor in metabolic syndrome
 Currently afflicts 4 million people
 Expected to rise to 6 million by 2020
 ‘Management’ will then account for 25% of the
health budget

16. A Typical Scenario
 Weight gain - The GP suggests a ‘balanced diet’
 ‘Isn’t it my glands, doctor?’ - The GP prescribes
thyroid hormone - further weight gain
 High blood pressure and diabetes. The BP is
treated with pills which often make the diabetes
worse – further weight gain
 The diabetes cannot be controlled without diet
and weight loss, but medication is prescribed
anyway
 High blood cholesterol – a statin is prescribed

17. The Saga Continues
 Obesity causes low back and knee pain - anti-
inflammatories are prescribed
 These cause indigestion and acid reflux, which
makes sleeping difficult - a proton pump
inhibitor and sleeping tablets are prescribed
 The patient is now so unhappy that the GP
prescribes an anti-depressant
 Our patient is now incapacitated by increasing
pain, and eats even more for consolation
 Further weight gain

18. The Denouement
 Our patient is taking up to twelve different
medications, often with unpleasant side effects
 A stroke, or a heart attack, is imminent
 They may be using an inhaler for angina and a
positive pressure ventilator for sleep apnoea
 The joint pains worsen – the consultant
confirms that nothing surgical can be done
 Ever stronger pain killers are prescribed, to
which tolerance quickly develops
 Drug dependency, loss of job and loss of self
esteem are added to our patient’s woes

19. Some Observations
 It is interesting that such patients
frequently claim to eat very little
 They are in denial
 They should be furious with a health
service that has not served them well
 The cost of their treatment is astronomical
and would be unaffordable if it had to
come out of their pocket

21. People in Africa used to know how to
feed themselves:
 Millet, sorghum and – more recently -
maize, grown and milled at home
 Ground nuts, sweet potato, pumpkin,
cabbage
 Gathering herbs, roots, shoots, fruits and
wild spinach
 Moderate intake of fresh, free range meat,
eggs and milk

22. Hidden Hunger
 In Southern Africa, today, the
staples are
 Refined maize meal (empty calories)
 Bread (mostly refined)
 White sugar (empty calories)
 Soft drinks
 Sweets
 Most processed foods
 Traditional margarine (trans fats)
 Cooking oil

24. A Strategy of Empowerment
 We challenged the denial, the addictive
behaviour and any claim to victimhood, using
cognitive behavioural therapy (CBT)
 We educated our patients so that they could
fully understand their condition
 We set targets
 We empowered them to heal themselves
 We started a support group, and called it Waist
Disposal
 My physiotherapist wife opened a gym and ran
exercise classes

25. An Alternative Scenario
 Patients are seldom capable of making minor
lifestyle adjustments, but they can make major
ones
 Patients with metabolic syndrome are
challenged to adopt a fat-free, wholefood,
vegan diet
 No meat, no fish, no eggs, no dairy, no fat, no
oil, no sugar, no refined carbohydrate, no fruit
juices and no alcohol
 Weight loss is sufficiently rapid to encourage
continued compliance

27. The Result
 Once a healthy weight is reached, most
patients require no medication at all
 High blood pressure, type 2 diabetes and raised
blood cholesterol all disappear or greatly improve
 Nor do patients need to stay vegan or teetotal
 They have discovered the wisdom of
moderation in all things
 And there is nothing more empowering than
the realisation that you can, and should be,
responsible for your own health

28. Challenging Myths
 This is no fad diet - there are millions of
healthy vegans in the world
 It is not difficult to change eating habits -
ask McDonald’s, KFC and Pizza Hut
 Radical lifestyle change is easier than
minor adjustments
 Fasting is the key to controlling IGF-1,
which is linked to the development of
disease and the ageing process. This is
the basis of the 5:2 diet

29. The Pharmaceutical Model
Is it still relevant?
 100 years of research has generated a
wide range of potent & specific drugs
 Anti-microbials
 Pathogens allow differential metabolic
targeting – ‘weak link’
 Wide therapeutic index, curative
 But resistance is now widespread

30. The Pharmaceutical Model
Is it still relevant?
 Almost all drugs for CDDs are designed to
suppress symptoms, and do not treat the
underlying disease
 Narrow therapeutic index, palliative
 Iatrogenic illness is now a major cause of
morbidity and mortality
 The CDDs still have no cures …
 They are increasing in frequency
 The age of onset is falling

31. Thank You for Your Interest
Health Empowerment Through Nutrition is a
UK Registered Charity concerned with the
alleviation of Hidden Hunger
www.hetn.org