Posted on Tue, Jan. 21, 2003

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X marks a lot Syndrome boosts insulin, eating. Result: obesity

By Tracy Wheeler

Beacon Journal medical writer
Lana Koehler, who lost 55 pounds since being diagnosed, is starting a support group for those with Syndrome X.

Paul Tople, ABJ
Lana Koehler, who lost 55 pounds since being diagnosed, is starting a support group for those with Syndrome X.

If only they would just eat less. If only they would just exercise more. If only they would make an effort to do something, maybe Americans wouldn't be so fat.

But it's nowhere near that simple, Dr. Jeanette Moleski says. For about one-fourth of the overweight and obese, losing weight is essentially a losing battle, because they're fighting the wrong enemy.

The enemy isn't a box of Krispy Kreme donuts. The enemy isn't a bag of Cheetos. The enemy isn't even super-sized french fries.

The enemy is their own bodies, which unknown to them are producing far too much insulin, sending the wrong messages to their brains.

It's a condition called Syndrome X and it affects almost 70 million (one in four) Americans.

``The high insulin is telling them, `I have to eat, I have to eat, I have to eat to survive.' They're always hungry,'' said Moleski, of Hudson Family Health Center. ``They can eat a full Thanksgiving meal and an hour later be looking for leftovers. It's instinctual to eat.''

Problem missed

More often than not, though, Syndrome X goes undiagnosed. So their weight-loss fight is almost assured of ending unsuccessfully. It's like fighting a boxing match against the Invisible Man; you can swing all you want, but if you can't see your opponent, you're not going to land many punches. Worse yet, you may not even be aware there's an opponent in the ring who's swinging back.

For people with Syndrome X, the invisible opponent is insulin, a hormone manufactured by the pancreas that is supposed to regulate glucose (blood sugars) and help the body use the glucose as energy. In Syndrome X, though, the cells that normally respond to insulin are resistant. So the body makes more and more insulin in an effort to get those cells to respond.

The problem is that standard diabetes tests look only at glucose levels, not insulin levels. In Syndrome X patients, glucose levels are normal, while insulin levels can reach more than 15-times the normal level.

That's why Syndrome X often goes undiagnosed.

Just ask Lana Koehler.

Making the diagnosis

The 51-year-old Stow woman saw Moleski in April. As soon as Moleski walked into the examination room, she had Koehler pegged as a Syndrome X patient. Before offering the diagnosis, though, she told Koehler she needed to test her glucose and insulin levels.

``I told her I had had plenty of blood tests,'' Koehler remembers. ``Nothing had shown up before. I had been through glucose tolerance tests and they always came out negative. Dr. Moleski just said, `OK, but humor me.' ''

Sure enough, the doctor was right.

Koehler's glucose levels (at 104) didn't raise any red flags. ``Not at all,'' Moleski said, ``not even suspicious.''

Her insulin levels, though, were astronomical.

The first insulin reading came in at 43, about four times as high as it should be. One hour into the test, Koehler's insulin reading shot up to 180 ``which is way, way, way too high,'' Moleski said, ``but her glucose was still normal at 100... . . . So no one would have even picked this up without doing the insulin levels.''

Fighting problem

For the first time in her adult life, Koehler has hope.

``It was enlightening to me,'' she said of the test results. ``I actually have a disease. It wasn't that I didn't have willpower. I had lost and gained weight all my life. I had tried every diet imaginable.''

She would lose weight. In fact, she once lost 125 pounds on the Atkins Diet. But as soon as she started eating more normally, it all came back.

``I was ready to go on disability. I had accepted that I couldn't teach anymore. I was ready just to roll up in a hole and die. I didn't want to go on. It was too hard.''

Now, she said, ``I have a life.''

Koehler has lost 55 pounds since she was diagnosed in April and went on a high-protein, low-carbohydrate diet. She's now able to wake up at 7:30 or 8 each morning, instead of her old rising time of 10:30 or 11. She runs errands, instead of staying homebound. She can stay up until midnight, instead of collapsing after her last piano lesson at 8 or 9.

``What you have to understand is that I'm not doing this to lose weight, I'm doing this to have a life,'' she said.

Nutrition helps

Marianne Henry certainly understands.

``I spent the last year accepting that I'll be heavy the rest of my life,'' she said. ``That was very hard for me. I told myself, I'm going to have to love me for who I am. That's a terrible place to be. Terrible.''

In July, she was diagnosed with Syndrome X. Since then, the 42-year-old mother of three teens has lost 71 pounds, and now she can finally hike and bike again.

``I feel 20 years younger,'' she said. ``I'm getting my life back and that's the most important thing. I'm excited I feel like me again.''

Koehler and Henry suffered from myriad maladies, including high blood pressure, high cholesterol, irregular heart beats, fibromyalgia, fatigue and sleep apnea.

All those problems have decreased or completely disappeared.

Once diagnosed, Syndrome X patients are put on a high-protein, low-carbohydrate diet, along with medications -- metformin (Glucophage) to increase the body's sensitivity to insulin and wellbutrin (Zyban) to help curb carbohydrate cravings.

``Concentrated sweets'' (cookies, candies, pop) are eliminated and ``white foods'' (breads, pasta, potatoes) are restricted.

Limit carbohydrates

Don't confuse the diet with the Atkins diet, though. Unlike Atkins, this diet doesn't completely banish carbs. Instead, Moleski said, the goal is to limit carbs and make sure you're not eating ``unopposed'' carbs, meaning that any carbohydrate consumption is prefaced with some protein -- chicken, fish, lean beef, lean pork, eggs, tofu, cheese. Fruits and salads, to some degree, are allowed too.

The diet helps stabilize insulin production, stopping the outrageous spikes that tell them they have to eat.

Surprisingly, it's an easy diet to follow, Koehler said, if for no other reason than that stopping the diet is met with punishment. ``What's fortunate is when I deviate, I feel miserable,'' she said. ``If I eat the wrong foods, I feel tired, lethargic, I get headaches, I feel like I'm coming down with the flu. I'll get heart palpitations. It all comes back again. That keeps me pretty close to the straight and narrow.''

For Henry, it's simply an issue that she doesn't feel the need to eat like she used to.

``Over the last 10 years, I could sit down and eat a spaghetti dinner and an hour later it was like I never ate. I'd be so hungry I couldn't stand it. That's a hard thing to deal with,'' she said. ``That is completely gone now.''

Koehler is starting a support group for those who have been diagnosed with Syndrome X, or even for those who just suspect that they or a loved one might have it.

The first meeting is 7:30 p.m. Thursday at Stow City Hall in the boards and commissions room. Moleski will speak, offering information of symptoms and diagnosis.

``There are a lot of people out there like me,'' Koehler said. ``I'm on a mission. I want to tell as many people as possible that life doesn't have to be the way it is.''

Beacon Journal medical writer Tracy Wheeler can be reached at 330-996-3721 or at tawheeler~thebeaconjournal.com via e-mail.

http://www.ohio.com/mld/beaconjourn...cal/4994687.htm