Aug
01
2004

Too Much Fat Fuels Metabolic Syndrome

By | Heart Disease, High Blood Pressure, Hormones, Nutrition, Obesity

In a review article for physicians from the St. Michael’s Hospital of the University of Toronto (see reference below) Dr. Monge outlined some of the newer human research where links were found between the lining of the blood vessels and the hormones produced by fat cells that lead to the complications of the metabolic syndrome. In obese people there is a cluster of conditions such as high blood pressure, high blood sugar, high cholesterol, lipid abnormalities and high insulin levels, which is known as “metabolic syndrome”. Another name that was used for this condition in the 1990’s was “syndrome of insulin resistance”.

Dr. Monge pointed out that blood vessel health depends on the fine balance between two opposing forces. On the one hand there is a system that leads to blood vessel spasm, blood clotting, growth promoting, inflammation causing and oxidizing. On the other hand there is a system that is responsible for blood vessel relaxation, growth inhibition, blood clot dissolving, inhibiting inflammation and antioxidant activity. Complex changes occur in our metabolism when we put on pounds and accumulate too much fat. It is important to realize that fat is not just sitting there, but is composed of highly active fat cells that respond to insulin and growth factors and in turn produce a number of hormones and factors that affect the cells that are lining the blood vessels. Inflammatory cytokines are produced by fat cells that attack the blood vessels by producing atheromatous plaques, causing them to accumulate fat again and help in the processes that lead to rupture of the plaques.

Too Much Fat Fuels Metabolic Syndrome

Too Much Fat Fuels Metabolic Syndrome

The end result is that the deadly interplay between the fat cells and the endothelial cells lining the blood vessels tips the balance between the two systems mentioned above to the point where heart attacks and strokes suddenly occur.

There are two complex pathways that are involved in this process and that are linked to what was stated above. One crucial aspect of this involves nitric oxide, a small molecule that is normally produced by the endothelial lining cells and that is needed for normal circulation of the heart muscle, skeletal muscles and internal organs. This protective system is where much of the derangement of normal metabolism occurs with regard to the metabolic syndrome.

Dr. Monge pointed out that with these newer insights into the complex metabolic changes associated with the metabolic syndrome in obese people, there will be very practical results in the near future. Anti-inflammatory medications are already being utilized and some of the anti-diabetic medications have been shown to reduce the risk of heart attacks. It is hoped that sensitive tests will be developed to measure the hidden endothelial dysfunction at a time when preventative steps are still effective or early intervention can be done.

More info on the metabolic syndrome: http://nethealthbook.com/hormones/metabolic-syndrome/

Reference: Metabolic Syndrome Rounds (April 2004): J.C. Monge “Endothelial Dysfunction and the metabolic syndrome”

Last edited Oct. 26, 2014

May
01
2004

Chronic Inflammation Causes Cancer, Heart Attacks And More

By | Anti-aging medicine, Arthritis, Cancer, Heart Disease, Obesity

When the Time Magazine devotes 7 full pages in the March 22, 2004 issue to the topic of inflammation as the source of most of the diseases of the Western World, you know that something important is happening in medicine. Christine Gorman and Alice Park have summarized some of the groundbreaking research of the past few years in this article. I will report about this article here, but also include direct links regarding some of the relevant research the authors have mentioned including some of the key links regarding the metabolic syndrome, which was not mentioned in the article.

Since the beginning of the obesity wave in North America it has become obvious that a cluster of diseases such as heart attacks, strokes, Alzheimer disease, cancer of the colon, multiple sclerosis, arthritis and others have also become more frequent. Dr. Paul Ridker, a cardiologist at Brigham and Women’s Hospital, was one of the pioneers of investigating inflammation as a possible cause and the common denominator of these diverse illnesses. He noticed that certain patients got heart attacks although their blood LDL cholesterol levels (the “bad” cholesterol) were normal. The theory at that time was that all patients who would develop heart attacks would come from a high-risk group of patients with elevated LDL cholesterol. The problem was that 50% of patients with heart attacks had normal LDL cholesterol levels. Dr. Ridker suspected that the C-reactive protein (CRP), which is found to be elevated in the blood of rheumatoid patients, would be somehow involved in the disease process of hardening of the arteries before a heart attack would occur. CRP is produced by the liver cells and by the lining cells of arteries in response to a general inflammatory reaction in the body. Examples of this would be rheumatoid arthritis patients and patients with autoimmune diseases, where CRP levels can be readily measured with a blood test. Dr. Ridker found that there was a very good correlation between the CRP level and the degree of inflammation as well as the risk for developing heart attacks and strokes. Further investigation by others confirmed that CRP levels were perhaps more important than LDL levels in predicting impending heart attacks. This is so, because CRP is the body’s substance in the blood stream that would be responsible for breaking up LDL containing deposits (plaques) in the walls of the arteries, which leads to heart attacks in the heart and to strokes in the brain.

Chronic Inflammation Causes Cancer, Heart Attacks And More

Chronic Inflammation Causes Cancer, Heart Attacks And More

Other investigators found that CRP was only one link in a complex chain of events that includes inflammatory substances (cytokines) from the fat cells as well as insulin and insulin-like growth factors from the metabolic syndrome. Leptins are also a factor as has been discussed under this link.
Dr. Steve Shoelsen from the Joslin Diabetes Center in Boston has developed a mouse model for the metabolic syndrome. These mice will produce huge amounts of inflammatory substances in their fatty tissue in response to any inflammatory process that is started in them. Anti-inflammatory drugs such as the statins or metformin, it is hoped, will be shown conclusively to dampen the inflammatory process and prevent heart attacks, strokes and diabetes as well as cancer, Alzheimers disease and arthritis. Heart disease has already been shown to be improved by anti-inflammatory drugs. Asthma is an inflammatory disease of the small bronchial tubes, which can be stabilized with the anti-inflammatory drug Avastin.

What can we do as consumers to prevent some of those life-threatening diseases? By reducing our weight through calorie restriction on a low-glycemic diet we can help to reduce the insulin-like hormone substances of the fatty tissue. Regular exercise of at least 30 minutes of a brisk walk daily or the equivalent of other sports activities will half our risk for colon cancer and many other cancers. A diet rich in fruits and vegetables as well as fish and fish oils will reduce the amount of free radicals in our system cutting down on the circulating inflammatory substances. This prolongs life, prevents all of the major diseases of modern civilization and leads to longevity as the study of the Okinawa diet has shown.

Based on an article in the Time Magazine, March 22, 2004 edition, page 54 to 60.

Here is a chapter on arteriosclerosis from the Net Health Book, which explains inflammatory changes of the arterial wall:

http://nethealthbook.com/cardiovascular-disease/heart-disease/atherosclerosis-the-missing-link-between-strokes-and-heart-attacks/

Last edited October 26, 2014

Feb
01
2004

Kidney Disease, Another Complication Of Metabolic Syndrome

By | Hormones, Nutrition, Obesity, Prevention

The metabolic syndrome is a new disease entity that is known to be associated with obesity. In order to make the diagnosis of metabolic syndrome at least 3 of the 5 components listed in the table under this link (hypertension, hypertriglyceridemia, low high-density lipoprotein cholesterol level or LDL cholesterol, high glucose level, abdominal obesity) have to be present.

Dr. Jing Chen and colleagues of Tulane University School of Medicine in New Orleans, La., published an analysis of the Third National Health and Nutrition Examination Survey in the Feb.3, 2004 edition of the Annals of Medicine. Patients with chronic kidney disease were identified in this study where 3, 4 or 5 of the metabolic syndrome criteria were positive. Two criteria for chronic kidney disease were measured:

1. if there was a significant reduction of the filtration capacity of the kidney.

2. if there was critical leakage of blood protein into the urine.

Kidney Disease, Another Complication Of Metabolic Syndrome

Kidney Disease, Another Complication Of Metabolic Syndrome

Depending on how advanced the metabolic syndrome was (all 5 criteria of metabolic syndrome positive versus only 3 or 4) there was a higher or lower risk of developing chronic kidney disease.

I have depicted the results of this study in bar graph form here. It shows clearly that chronic kidney damage occurs in a dose-response curve pattern depending on how severe the degree of the metabolic syndrome is.

Risk of developing kidney disease with various degrees of severity of the metabolic syndrome
 Kidney Disease, Another Complication Of Metabolic Syndrome1

With 5 factors of the metabolic syndrome present the risk to develop reduction in filtration capacity of the kidneys is almost 6-fold. This is 3-fold higher than in a person with a milder degree of metabolic syndrome where only two factors are present. Such a person would only have a 2-fold risk for developing chronic kidney damage (dark blue shaded bars in graph). A dipstick urine test can measure protein in urine, which is an alternative way to measure kidney damage due to the metabolic syndrome. These values followed a very similar dose-response curve (light blue shaded bars in graph). The authors of this study believe that the kidney damage inflicted by the metabolic syndrome is different from that caused by high blood pressure or by diabetes. Future studies will have to establish whether this type of kidney damage can be repaired by treating the metabolic syndrome with a low glycemic, calorie restricted diet coupled with exercise.

Based on an article published in: Ann Intern Med 2004:140:167-174.

Last edited December 8, 2012