Better Nutrition, April 2004 http://www.betternutrition.com

Low carbs and syndrome X. (the low-carb continuum: expert analysis of the health applications: part 1) Stephen Holt.

Some soothsayers tell us that if the instance of obesity increases at its current level, almost every American will become overweight by the year 2050. But while many people tend to focus on the cosmetic aspects of their expanding waistlines, the real significance of obesity is the occurrence of many related diseases and associated, mounting death rates.



The prevention of obesity and related problems, such as Syndrome X and type 2 diabetes mellitus, constitutes a modern medical emergency. And there's no doubt that dietary intake of simple sugars--that is, simple carbohydrates--is a key miscreant. This makes carbohydrate restriction a logical approach to combat the rise of obesity, but even this basic approach can be facilitated to become more effective and healthful. Refined (simple) carbohydrates are pivotal in the cause of the modern epidemics of Syndrome X and type 2 diabetes, but they aren't the whole story.



Obesity Has Disease Companions



Taking obesity for granted can be a deadly habit. Table 1 (p. 38) highlights the risks and complications of obesity. Much research has attempted to predict the "forms" of obesity that create the greatest risks. In general, excess body fat located in and around the organs of the body presents an independent risk factor for cardiovascular disease and many other diseases.



Obesity, Syndrome X, Pre-Diabetes and Type 2 Diabetes



Currently, approximately 70 million Americans have a condition called the metabolic syndrome or Syndrome X. Syndrome X requires careful definition and description if the real advantages of a low-carb diet can be fully appreciated. First of all, Syndrome X is a combination of factors that are almost invariably associated with excess weight. The simplest definition of Syndrome X, then, is the variable combination of obesity, high blood pressure and high blood cholesterol, all linked by resistance to the hormone insulin. (Figure 1)



Insulin and Blood Glucose



While we all recognize the ability of insulin to help the body handle glucose, insulin resistance occurs when the body doesn't take proper command of insulin. As a result, the body reacts by making more insulin, so blood levels of the hormone begin to rise. Insulin gives prime signals to fat cells to store fat. Hence, obesity goes hand in hand with insulin resistance and its excess in many people. Indeed, insulin can tell the liver to make cholesterol, and it can tell tissues of the body to raise blood pressure. You can now see why obesity, high blood pressure and high blood cholesterol occur together under the umbrella term Syndrome X. Furthermore, insulin can tell the ovaries to secrete male-type hormones, tell the body to make inflammatory messenger molecules and even tell genetic material to express cancer growth. Thus, insulin resistance and its excess cause a diverse array of diseases. This extension of Syndrome X beyond its role in creating cardiovascular disease is what I have called Syndrome X, Y and Z.



The Concept of Syndrome X, Y and Z



As depicted in Figure 2 (p. 39), Syndrome X leads from primary obesity-related diseases, such as coronoary heart disease, to further complications that I characterize as Syndrome Y (immune impairment, blood clotting, etc.) and Syndrome Z (inflammation, cancer and liver disease).



Combating Insulin Resistance and Controlling Calories



Once we understand the role of insulin resistance in the development of obesity and related disease, we can begin to see how a low-carb diet is a step in the right direction--and how such diets may need to be modified or supplemented to become more effective in their desired outcomes of weight loss and health promotion. Many physicians are accepting the notion that there are carbohydrate-sensitive individuals who gain weight easily when sugar is a major component of their diets. This sensitivity has started to make physicians and scientists rethink the simple idea or equation of "energy in and energy out" of the body.



Energy is taken into the body in the form of calories delivered by food. This energy is utilized by the body for day-to-day living and to support physical activity. However, this equation of energy in and energy out doesn't fit perfectly with weight control tactics in humans.



There are some people who can consume large amounts of energy (calories in food) and not gain weight, even though their level of exercise isn't particularly high. That said, calorie control is generally a very important aspect of weight control, and anyone who proposes that calories do not count is seriously misguided.



An Overall Healthful Weight-Control Initiative



That's why "diets" cannot be eliminated as one of several important components of weight management. Excess dietary intake of simple sugars, together with a lack of physical exercise and poor lifestyle, contribute to poor function of insulin. This provides a powerful incentive to adopt a diet that is controlled in its simple carbohydrate content While low-carb diets have not been shown to correct insulin resistance, per se, they are a step in the right direction.



Diets Are Not "Stand Alone" Interventions for Many People



Low-carb diets are certainly effective for short-term weight loss in people wishing to lose 5-10 pounds, but this initiative is just the beginning in the elimination of the disability and premature death that results from obesity. National registers that keep information on people who have lost weight in a sustained manner imply that weight control occurs by means other than diet alone. Successful dieters undertake modification of eating behavior, make lifestyle changes and exercise. In other words, few people can achieve sustained weight loss by diet alone.



Any weight-loss plan, then, must involve positive lifestyle changes, with increased levels of exercise and modification of eating behavior, including but not limited to a selection of smaller meal-portion sizes. In other words, a diet with an altered ratio of macronutrient intake (for instance, a low-carb diet) and the consumption of low-carb foods isn't enough by itself to control weight with any degree of consistency.



Enhancing the effects of a low-carbohydrate diet must involve extended effort to combat or correct insulin resistance that is present in most, but not all, overweight people.



The current absence of a safe and effective pharmaceutical approach to combat insulin resistance and its associated diseases of high blood cholesterol, high blood pressure and so forth, together with the side effects of cholesterol-lowering drugs, makes dietary supplement and functional food interventions first line options in the fight against obesity and its disease companions.



Resources



Agatston A, The South Beach Diet, Rodale Press, Emmaus, Pennsylvania, 2003



Atkins RC, Dr. Atkins' New Diet Revolution, Avon, New York, New York, 1998



Bessesen DH and Kushner R, Evaluation and Management of Obesity, From the Centers for Obesity Research and Education, Hanley and Belfus, Philadelphia, Pennsylvania, 2002



Holt S, Combat Syndrome X, Y and Z ..., Wellness Publishing, Newark, New Jersey, 2002



Holt S, Enhancing Low Carb Diets, Wellness Publishing, Newark, New Jersey, 2004



Holt S, Wright JV, Nutritional Factors for Syndrome X, Wellness Publishing, Newark, New Jersey, 2004



Reaven G et al, Syndrome X: Overcoming the Silent Killer that can Give You a Heart Attack, Simon and Schuster, New York, New York, 2000



Sears B, Enter the Zone, HarperCollins, New York, New York, 1995



Taller H, Calories Don't Count, Simon and Schuster, New York, New York, 1961

Table 1: Risks for these diseases tend to increase by degrees of
obesity. Several of the factors in high risk column are related to
Syndrome X

Illnesses Associated with Being Overweight

High Risk Moderate Risk Lower Risk

Diabetes mellitus Heart disease Cancer of womb,
breast, colon

Insulin resistance Peripheral vascular Hormonal disorders,
disease especially sex
hormones

Hypertension Stroke Infertility

High blood fats Arthritis, both Congenital defects
osteoarthritis and gout in children of obese
mothers

Gallstones Polycystic Ovary Increased accident
Syndrome rates

Sleep apnea Low back pain Depression

Decreased aerobic Fibromyalgia, Social isolation
fitness potential medical risk in surgery

When Not to Use Low-Carb Diets




Low-carb diets are not recommended for serious aerobic enthusiasts. The primary fuel for all body movement is glucose. With exercise, stores of carbohydrates (glycogen) in muscles and the liver are used rapidly, and carbohydrates are necessary to maintain level of these body stores of readily utilizable fuel. The loss of glycogen from muscles is a big problem with routine exercise because this depletion will reduce physical performance and can cause premature fatigue. Potential interference between low-carb diets and exercise is a key issue to overcome, and it makes recommendations for obligatory, exercise with a low-carb diet difficult tot some people. Low-carb diets are not recommended during pregnancy or for some people with certain diseases that can be aggravated by changes in macronutrient intake in their diet (e.g., excessive protein intake in people with gout).



Recognized Causes of Obesity



* Social gluttons

* Familial predisposition

* Genetic obesity

* Diet composition

* Eating patterns

* Emotional factors

* Medical causes



1. Drugs 2. Surgery 3. Brain disease 4. Endocrine causes 5. Abnormal metabolism 6. INSULIN RESISTANCE/ EXCESS



Table 2: The most common form of obesity is "simple obesity," which is a lifestyle disorder. Insulin resistance is capitalized because it is a much more important and common cause of obesity than previously supposed.



Which Low-Carb Diet is Best?



The most popular, contemporary low-carbohydrate diet was described by Robert C. Atkins, MD, but his initial dietary recommendations were self-modified over a period of 30 years. Dr. Atkins' Diet was joined in recent years by other popular low- or lower-carb diets, including but not limited to The Zone, Carbohydrate Addict's Diet. Sugar Busters Diet and The South Beach Diet.

While arguments prevail that one low-carb diet is better than the other, there is no real evidence that such differences exist. Certainly, recent studies published in the New England Journal of Medicine in 2003 served as a wake-up call for conventional medicine, when the Atkins' Diet was shown to be effective and reasonably healthful, at least in the short term. In fact, every diet described in the history' of weight management has suffered from a lack of effectiveness for long-term weight control. These circumstances lead to the rational proposal that modifications can be made to low-carb diets that may make them more effective in the long term. There is a need to examine ways of enhancing all low-carb diets and the ideal carbohydrate-restricted diet remains a matter of debate.