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Diet: The Metabolic Syndrome  Previous Next

The Metabolic Syndrome

by: John D Zelem, MD


Consider these questions:

• Having trouble losing weight?
• Are you slowly gaining weight
• Is your blood pressure elevated?
• Is your cholesterol going up?
• Are your triglycerides going up?
• Is your HDL going down?
• Do you get sleepy after eating?
• Have you developed a pattern of nighttime eating?
• Is your blood sugar rising?

If you have answered three or more of these with a “yes” answer you may have the Metabolic Syndrome.

Do you find yourself having trouble losing weight even with exercise and, for all intents and purposes, watching what you eat? I suspect that you have been told to eat a low fat, high carbohydrate diet and you have done that. So why is there still a problem? You probably have thought of every possible reason for your lack of success. You may have thought that your thyroid gland is not working properly or your metabolism has slowed down: probably not. Possibly your hormone levels are off or maybe you need to step up your exercise program, or maybe you need one of these more dramatic diets to go on: not likely. That sounded like me and how I was thinking.

Normal Energy Production And Storage
You may or may not have been aware of something called “The Metabolic Syndrome.” What is it, you may ask? Allow me to give you a little background of basic information before I define this syndrome.
Our bodies need fuel for energy just like any machine. Sugar is that source. We need to get down to the cellular level where this energy production actually occurs. Glucose is the sugar utilized by the cell for the production of energy in the furnaces of our cells, which are called mitochondria. The entry of glucose into the cells is facilitated by the hormone insulin, which is produced in the pancreas. This hormone also will drive glucose into muscle and the liver for storage in a more complex form called glycogen. This will be used as a source of energy at other times such as periods of starvation and exercise. Any amounts over and above normal usage for immediate energy and storage in liver and muscle are sent to fat cells for greater storage of energy sources.
There is an opposing hormone, glucagon, which is also produced in the pancreas and is responsible for releasing fat for energy when stimulated by the intake of protein. The intake of carbohydrates and excessive levels of insulin suppress it.
Normally these hormones work in conjunction with each other maintaining a balanced situation of energy substrates utilization and storage. Situations such as dieting, starvation, exercise and the Metabolic Syndrome will alter this balance.

Glycemic Index
Whenever we ingest sugar or carbohydrates our bodies react with a rise in the blood sugar inducing the secretion of insulin to get the sugar into our cells and produce energy and store the excess in muscle, the liver, and eventually, fat. The Glycemic Index is a measurement of the rate of the rise of blood sugar following the ingestion of a particular test food relative to that of a standard food such as glucose. The measurement for glucose is 100. This index will quantitate the rate of secretion of insulin. Under 55 is generally considered to be a low-glycemic food and over 70 is high-glycemic.

Low GI = 55 or less
Medium GI = 56 - 69
High GI = 70 or more

Our diet today is mainly composed of over-processed carbohydrates in the form of our modern-day flour. This flour is the result of removing all of its complex components, leaving us with a pure, super-fine white powder that, when ingested, causes our blood sugar to rise rapidly to higher than normal levels. This leads to an exaggerated insulin response. This rapid rise in insulin will cause blood sugar levels to drop precipitously to relatively low levels, lower than normal, causing drowsiness, and fatigue. The subsequent rebound also results in a desire to eat again to restore blood sugar levels. Long term this becomes an uncontrollable craving for carbohydrates. This roller coaster effect occurring over and over, leads to carbohydrate addiction, carbohydrate craving, nighttime eating, insulin resistance, and the beginning of the Metabolic Syndrome. These high insulin levels also shut off the glucagon response and leave no way that fat can be utilized as a source of energy. This is when weight gain occurs and weight loss becomes almost impossible.
Eventually, this syndrome will cause inflammation and narrowing of the small arteries going to the muscles of your body causing them to constrict. This leads to a decreased ability of insulin to deliver glucose to the muscles for use and storage. Insulin levels will then increase significantly to try and accomplish this task but, eventually, most of the glucose will be diverted to fat cells causing what is called “insulin resistance.” Glucagon is totally shut off at this point.
Some of the other effects of the Metabolic Syndrome are high blood pressure, increased triglyceride and cholesterol levels, and decreased HDL, all leading to an increased risk of cardiovascular disease. This Syndrome has been said to occur in about 20-25% of the population. A significant portion of this group will go from insulin resistance to full blown Diabetes as the Metabolic Syndrome causes a “burn-out” of the insulin-producing cells of the pancreas. This is also one of the reasons why we are seeing a lot more obesity and diabetes, especially in our young. It is getting to epidemic proportions.

Low-Glycemic Response
There is hope! There is an answer. It is called a low glycemic diet. This must be considered a lifestyle change, not a temporary eating habit. Traditional diets do not work because they are designed to be an acute solution to a chronic problem. Also the faster one loses weight, generally, the faster it comes back. The chances of losing up to 10% of your total body weight and keeping it off for 5 years is the same as the 5 year survival rate for cancer of the lung, 5%. This is a very sobering statistic. You will find that it may, and should, take 18-24 months for you to achieve your end results. You should set short-term goals along the way. I have actually chosen to let my body decide what its end-point will be and take as long as it needs to get there since my program also involves exercising, which yours should too.
You need to understand that this syndrome is reversible with time while the alternative of not making this change is diabetes, which is never reversible. Remember, if you continue to do what you have always done, you will continue to get what you have always gotten.
When an individual eats a low-glycemic meal there is a totally different metabolic response. Eating foods such as fruits, vegetables, good carbs that do not cause a rapid rise of your blood sugar, good protein and fat is the answer. The “whites” are out: the white breads, the white potato, and the white rice. Even most whole wheat bread is not our friend. It cannot be enriched wheat flour; it must be stone ground.
These types of carbs will allow a slow rise of blood sugar, leading to a more modest release of insulin balanced with a proper release of glucagon. The insulin encourages the muscle to take up the sugar and the rest goes to the liver and fat. On the other hand, glucagon is also present in normal levels and will break down the fat, at about the same rate it is created, initially at a greater rate. The result of this equation is no weight gain or possible weight loss. Even if you have the Metabolic Syndrome, the start of a low glycemic lifestyle, not diet, may allow a reversal of all of the bad effects of this syndrome. Eventually, exercise must become a part of this healthy lifestyle.

So how do we summarize this complex bit of information and put it into a useful tool that is easy to follow. First of all, how badly do you want the results, the goals that you set? If the goal is important enough the work will follow and you will accomplish it. Remember that the Metabolic Syndrome is reversible with time, and Diabetes is never reversible.
Here are some general guidelines to follow. Low glycemic food will not raise your blood sugar as high and as rapidly as high glycemic foods will and, at the same time, will start to increase your body’s sensitivity to insulin. Low glycemic diets will help you to lose weight, help those who already have diabetes maintain better control of their blood sugar. Low glycemic foods will help you to stay full longer. Finally, high glycemic foods may replenish carbohydrate stores after exercise but low glycemic foods will improve physical endurance.
Foods that have a low glycemic index generally had a low glycemic load. Eliminate foods with both high glycemic indexes and high glycemic loads. Optimize your insulin levels by eating fruits and vegetables and whole grains. The fiber in these foods will both be healthy and release sugar into your bloodstream slowly.
I want to reiterate for you that I have changed my lifestyle to low-glycemic index, low glycemic load and have seen a significant change in myself. I am not hungry all the time anymore. I am free of carbohydrate addiction and cravings. I can actually sit in front of the TV at night or read a book and not have a high-glycemic snack next to me. I have not been doing it long enough to get off all of my meds but I see that in the near future and I recently was able to reduce my high blood pressure medication. Remember, getting healthy is a process and this is just one of the steps. It is not about what has happened to me, but I do know this can work for you.
I am not saying that this is the lifestyle change that you have to make, but if you see yourself in a similar situation, take a good look. Obviously you will need to discuss this with your doctor and see if it is a fit for you. You should also work out a program with your personal physician to regularly check your labs, weight, and blood pressure. Remember, if you continue doing what you are doing, you will continue to have what you have. If you want to make some changes in your life, you must make some changes in your life. I wish you success and good health.

Dr Zelem is a practicing General Surgeon with a passion for health & wellness. For more information you can visit: Dr Zelem is also available for seminars and lectures on this topic.

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