The UN-Wellness Epidemic

We often read and hear about the so-called wellness revolution, but where is it?

Childhood obesity is on the rise, and in 1999, researchers characterized adult obesity as an epidemic.¹ Then, in 2007, we were told that gestational diabetes is on the rise and this trend is likely related to obesity.² Also in 2007, researchers reported that pediatric hypertension is increasing in prevalence with the pediatric obesity epidemic.³ Where is this wellness revolution?

In a recent study that looked at 20,000 adults, 23.5 percent of whom were obese and 22.7 percent were smokers.⁴ The most recent report from the American Heart Association published at the end of 2007, indicates that 66 percent of adults are overweight, while 31.4 percent are obese. Seventeen percent of children and adolescents ages 12 to 19 are overweight, along with 17.5 percent of children ages 6 to 11, and 14 percent of children ages 2 to 5.5 Recently reported estimates indicated that the number of overweight and obese individuals is going to increase in the next 10 to 20 years to almost 75 percent of the population.

So again, if type 2 diabetes and childhood and adult obesity are on the rise, 23 percent of adults are smokers, and heart disease and cancer still are going strong, where is the wellness revolution? Seems like a very quiet revolution at best, with too few participants, which means there is no wellness revolution at the present time.

Most dictionaries provide a similar definition for wellness; it's a state of health achieved by healthy lifestyle choices and habits, such as regular exercise and proper nutrition.6 Experts state that if individuals partake in such "wellness activities," then disease expression can be reduced. Regarding heart disease, an expert panel made the following comments:

"According to a case-controlled study of 52 countries (INTER-HEART), optimization of 9 easily measured and potentially modifiable risk factors could result in a 90 percent reduction in risk of an initial acute myocardial infarction. The effect of these risk factors is consistent in men and women across different geographic regions by ethnic group, which makes study applicable worldwide. These 9 risk factors included cigarette smoking, abnormal blood lipid levels, hypertension, diabetes, abdominal obesity, a lack of physical activity, low daily fruit and vegetable consumption, alcohol over-consumption, and stress."⁵

With the above in mind, it should be clear that we are in desperate need of a wellness revolution, as UN-wellness is the norm.

The Metabolic Syndrome: A Wellness Marker?

Despite all the promotions about a wellness revolution, there presently is no way to measure wellness. That is, we have no wellness quotient that allows for an accurate prediction of future health or disease. What should we do?

Research does suggest the absence of the metabolic syndrome can function as a marker of one's wellness potential. The metabolic syndrome also is known as syndrome X and the insulin resistance syndrome.

A few years ago, researchers followed 208 apparently healthy, non-obese subjects for four to 11 years after baseline measurements of insulin resistance. The purpose was to correlate insulin resistance at baseline to the development of various clinical events including hypertension, coronary heart disease, stroke, cancer and type 2 diabetes.⁷ The subjects were divided into tertiles of insulin resistance at baseline: the most insulin-resistant tertile, intermediate insulin resistance, and no insulin resistance. During the follow-up period, 40 clinical events occurred among 37 subjects, including 12 hypertension, three hypertension and type 2 diabetes, nine cancer, seven coronary heart disease, four stroke, and two type 2 diabetes. Twenty-eight of the 40 diseases occurred in 25 individuals who were part of the most insulin-resistant tertile. The other 12 diseases developed the group with an intermediate insulin-resistant tertile. No diseases developed in the subjects with normal insulin sensitivity, which was (according to the authors) "seems to be truly remarkable."⁷

What exactly is syndrome X? It's characterized by several biochemical changes: insulin resistance, hyperinsulinemia (and hyperglycemia), increased triglycerides, decreased HDL cholesterol, increased LDL, hyperuricemia and reduced fibrinolysis.⁸ The outcome of these changes is an over-expression of inflammatory biochemistry, which likely is why so many diverse diseases are promoted by the presence of syndrome X.

In the clinical setting, there is a simple way to determine who is likely to have syndrome X. If three or more of the following are present, it's likely that the patient has syndrome X.⁵

• Fasting glucose of ³100 mg/dL
• Triglycerides of ³150 mg/dL
• HDL cholesterol <40 mg/dL for men and <50 mg/dL for women
• Blood pressure of ³130/85 mmHg
• Waist circumference of >40 inches for men and >35 inches for women

The percentage of your patient population that suffers with syndrome X depends on their age, weight and lifestyle. In general (and not surprisingly), syndrome X is more common in middle-aged and older individuals.⁹ In short, depending on whom you read, it's estimated that 40 million to 75 million Americans likely are suffering with syndrome X.

It's important for patients not to make the following mistake. Many people assume they are healthy because they are of normal weight. However, evidence suggests that syndrome X is quite prevalent in those with a body mass index (BMI) below 25, which many consider normal. Indeed, it's estimated that 11.1 percent to 21.3 percent of individuals with a BMI 23.0 to 26.9 have metabolic syndrome and would likely benefit from weight loss, improved dietary intakes and physical activity, all of which are classically accepted wellness strategies.¹⁰

Dietary Drivers of Syndrome X

Researchers indicate systemic inflammation promotes insulin resistance. Grimble states, "Evidence at present favors chronic inflammation as a trigger for chronic insulin insensitivity, rather than the reverse situation."¹¹

Interestingly, we all know eating properly and exercising regularly are healthy practices. However, we now know that each functions to reduce inflammation.¹² With respect to nutrition, over-eating is the first problem that must be addressed. It's now well-known that excess adipose tissue leads to a systemic pro-inflammatory cytokine imbalance that promotes insulin resistance.¹³ This situation is easily resolved, for we know the dietary source of our excess calories. The foods we tend to overeat are those high in calories and low in fiber, which tend to increase blood sugar and insulin levels, and increase body fat. The most notorious of such calorie sources are refined sugar, refined flour, and omega-6 and trans fatty acids. Unfortunately, these "foods" make up about 60 percent of calories consumed by the average American.¹⁴

Foods that should be consumed to fight syndrome X include vegetables, fruit, modest amounts of nuts, and healthy protein (lean meat, skinless chicken, and fresh fish). Franco, et al., use the term "polymeal" when describing a diet that consists of these foods, and they estimate about 65 percent to 85 percent reduction in the expression of heart disease if one adheres to this eating pattern.¹⁵ I simply refer to it as an anti-inflammatory diet or "deflaming" My website, www.deflame.com, provides anti-inflammatory nutritional information at no cost.

Supplements That May Help Reduce Insulin Resistance

Patients need to know that supplements cannot counteract the negative effects of diet. While most know this intuitively, many still look for loopholes. When considering supplements for diabetes and other conditions, I think it's important to adopt a mindset for supplementing consistent from condition to condition. And this is because we now know most degenerative diseases are caused by chronic inflammation, so our supplemental approach should be supportive of reducing inflammation.¹²

Interestingly, the supplements that have anti-inflammatory properties also are needed for proper insulin sensitivity. A multivitamin is a wise choice for all, and it appears we should all consider taking magnesium, omega-3 fatty acids and vitamin D as a foundational program of supplementation.^16-21

Foundations for Wellness

As stated earlier, wellness is defined as a healthy state achieved with proper lifestyle choices. Regular exercise, anti-inflammatory nutrition, mental fitness, and supportive relationships are the keys. At present, most Americans are pursuing disease, not wellness, and the epidemic proportions of the metabolic syndrome X is a strong example. Clearly, UN-wellness is the current norm and this needs to change.

References

1. Mokdad AH, Serdula MK, Dietz WH, et al. The spread of the obesity epidemic in the United States, 1991-1998. JAMA 1999;282:1519-22.
2. Ferrara A. Increasing prevalence of gestational diabetes mellitus: a public health perspective. Diabetes Care 2007;30:S141-6.
3. Hansen L, Gunn PW, Kaelber DC. Underdiagnosis of hypertension in children and adolescents. JAMA 2007 298:874-8.
4. Healton CG, Vallone D, McCausland KL, et al. Smoking, obesity, and their co-occurrence in the United States: cross sectional analysis. BMJ 2006;333:25-6.
5. Rosamond W, Flegal K, Furie K, et al. Heart disease and stroke statistics - 2008 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation 2008 Jan 29;117(4):e25-146.
6. http://dictionary.reference.com/browse/wellness. (Dictionary.com provides several definitions from various dictionaries and they agree on the cited definition)
7. Facchini FS, Hua N, Abbasi F, Reaven GM. Insulin resistance as a predictor of age-related disease. J Clin Endocrinol Metab 2001;86:3574-8.
8. Cordain L, Eades MR, Eades MD. Hyperinsulinemic diseases of civilization: more than just syndrome X. Compar Biochem Physiol 2003;136:95-112.
9. Ford ES, Giles WH, Dietz WH. Prevalence of the metabolic syndrome among US adults: findings from the Third National Health and Nutrition Examination Survey. JAMA 2002;287:356-9.
10. St. Onge MP, Janssen I, Heymsfield SB. Metabolic syndrome in normal-weight Americans; new definition of the metabolically obese, normal weight individual. Diabetes Care 2004;27:2222-8.
11. Grimble RF. Inflammatory status and insulin resistance. Currr Opin Clin NutrMetab Care 2002;5(5):551-9.
12. Nicklas BJ, You T, Pahor M. Behavioral treatments for chronic systemic inflammation: effects of dietary weight loss and exercise training. Can Med Assoc J 2005;172:1199-1209.
13. Axelsson J, Heimburger O, Lindholm B, Stenvinkel P. Adipose tissue and its relation to inflammation: the role of adipokines. J Ren Nutr 2005;15(1):131-6.
14. Cordain L, Eaton SB, Sebastian A, et al. Origins and evolution of the western diet: health implications for the 21st century. Am J Clin Nutr 2005;81:341-54.
15. Franco OH, Bonneux L, de Laet C, et al. The Polymeal: a more natural, safer, and probably tastier (than the Polypill) strategy to reduce cardiovascular disease by more than 75%. BMJ 2004;329:1447-50.
16. Fletcher RH, Fairfield KM. Vitamins for chronic disease prevention in adults: clinical applications. JAMA 2002;287(23):3127-9.
17. Lopez-Ridaura R, Willett WC, Rimm EB, et al. Magnesium intake and risk of type 2 diabetes in men and women. Diabetes Care. 2004;27:134-40.
18. King DE Mainous AG, Geesey ME, Woolson RF. Dietary magnesium and C-reactive protein levels. J Am Coll Nutr 2005;24(3):166-71.
19. Simopoulos AP. Essential fatty acids in health and chronic disease. Am J Clin Nutr 1999;70(3 Suppl):560S-9.
20. Chiu KC, Chu A, Go VL, Saad MF. Hypovitaminosis D is associated with insulin resistance and B-cell dysfunction. Am J Clin Nutr 2004;82:8205.
21. Cantorna MT. Vitamin D and autoimmunity: is vitamin D status an environmental factor affecting autoimmune disease prevalence? Proc Soc Exp Biol Med 2000;223:230-3.