Special Report Basic Nutrition & Weight Management
OBESITY & Longevity
by Stephen Holt, M.D.
Citizens of Western Nations
are tired of being told that
they are fat and idle, but physicians
and their patients are equally
fed up with the promises of a “quickweight-
loss strategy.” Combat against
the widespread epidemic of weight gain
and overweight status has proven to be a
monumental task for modern medicine,
especially in view of the recognition that
obesity is rapidly becoming the number
one preventable cause of premature
death and disability. The last thing that
modern healthcare, needs is another
“fast diet” or “magic pill” for weight
loss.
The global epidemic of obesity threatens
longevity. Considerable evidence
supports the notion that a physically
active person of normal body weight lives
longer than the overweight, inactive individual.
Obesity causes premature morbidity
and mortality as a consequence
of obesity related diseases are often
associated metabolic problems, such as
the Metabolic Syndrome X. Among the
commonest causes of premature death
and disability are heart disease, cancer,
stroke, lung disease, diabetes mellitus,
organic brain disease, accidents, infections
and side effects of drugs. These
diseases or disorders are often associated
with obesity or the Metabolic
Syndrome X. The many obesity related
diseases and diseases associated with
Syndrome X mirror common causes of
premature morbidity and mortality.
Obesity is caused by an interaction
of complex factors, including: genetic
predispositions, poor lifestyle, normal
reductions in lean body mass with age
and diet. Pivotal observations of the
effect of diet on aging are provided by
many animal studies, which show a
relationship between retention of body
functions or survival and partial food
restriction.
Weight Management Principles
Simple or single interventions for weight
control are universally unsuccessful.
There is not a documented, “stand-alone”
use of a diet, drug or dietary supplement
that has resulted consistently in sustained
weight loss or weight control. A combat
against obesity must involve a multifactorial
approach including: positive lifestyle change,
behavior modification, exercise and controlled
calorie diets.
Obesity has a series of “ugly disease
companions” and it has emerged as the
nation’s number one cause of premature
death, at least indirectly. This means that
weight control initiatives must address
the primary objective of overall health
and well-being. Excess dietary intake of
simple sugars, compounded by other
factors, drives the disordered regulation
of the functions of insulin (metabolic
dysglycemia). Insulin resistance leads to
excess insulin secretion which has many
negative effects on the body. In addition
to the inefficient “handling” of blood
glucose, insulin excess in the presence
of insulin resistance can promote cholesterol
synthesis in liver, raise blood pressure,
cause other hormonal aberrations
and result in cell proliferation.
The legacy of Metabolic Syndrome
X has not been fully experienced. Some
credible opinions imply that we may have
a current generation of adults who may
variably outlive their children. Syndrome
X may be precipitating a “human dinosaur”
phenomenon, as the metabolic
evolution of humankind cannot keep
pace with “advancing lifestyles.” Such
lifestyles are characterized often by excess
calorie intake combined with inactivity.
Metabolic Syndrome X, Insulin Resistance Syndrome
The phrase Syndrome X had been used
to describe the combination of obesity,
hypertension and hypercholesterolemia,
linked by underlying insulin resistance.
Approximately 70 million Americans have
Syndrome X, which is causally linked
with the development of cardiovascular
disease, female endocrine disorders,
polycystic ovaries (PCOS), non-alcoholic
fatty liver disease, gestational diabetes,
changes in eicosanoid status and cancer.
The pathophysiology of Metabolic
Syndrome X creates a platform for the
development of many diseases.
Effective prevention and treatment
of Syndrome X involves a multifaceted
approach to impact all cardinal
components of the disorder. Current
allopathic treatments may have been
too focused on individual components
of Syndrome X and they tend to form
a “back up plan” for management.
In contrast, natural approaches with
lifestyle modification and nutritional
and/or nutraceutical interventions may
provide versatile and powerful, firstline
management options.
The use of dietary supplements in the
adjunctive management of the Metabolic
Syndrome in the overweight individual
has led to the suggestion that there is
an array of nutraceuticals that can be
defined as Syndrome X nutritional factors.
These nutritional factors include a
variety of nutrients or botanicals or herbs
that may be used variably in a synergistic
manner to correct underlying metabolic
problems in Syndrome X.
These natural substances may help
reverse pathophysiology encountered in
the overweight person by addressing:
abnormal glucose metabolism, insulin
resistance, body status of inflammation,
diminished immune function, blood lipid
abnormalities, hypertension and other
issues that precipitate or contribute to
obesity related disease.
Obesitis: A Concept that Further Unifies Modern Disease Theories?
Obesity and excess body fat can be
classified as inflammatory conditions
and inflammation is a key factor in the
pathophysiology of Metabolic Syndrome
X. Not only does obesity raise the level of
pro-inflammatory messenger molecules
in the body, it precipitates or contributes
to several disorders of inflammation,
including cardiovascular disease, cancer,
arthritis, liver disease and asthma. This
inflammatory disease “link” compounds
the undesirable effects of insulin resistance.
Many factors that link inflammation
and tissue damage have come from
recent studies of non-alcoholic, fatty liver
disease which is a common component
of Metabolic Syndrome X.
The final common pathway of tissue
damage often involves oxidated damage
due to the generation of free radicals,
perhaps exacerbated by a reduction in
antioxidant defenses in the body. Of
course, the progression of the complications
of obesity and diabetes mellitus is
related to oxidated tissue stress with the
development of advanced glycation and
products (AGES). Therefore, the treatment
of obesity related disease seems
quite incomplete without supporting
antioxidant activity in the obese clinical
management of the obese or overweight
person.
Circadian Biorhythms, Sleep, Obesity and Metabolic Syndrome X
Sleep deprivation, overweight status and
Metabolic Syndrome X appear to be inextricably
linked in many people. The mechanisms
of this association are not fully
understood. Reduction in sleep duration
in healthy young men is associated with
major changes in hormonal levels of substances
(ghrelin and leptin) that increase
hunger and appetite, thereby promoting
weight gain. An established association
between short sleep duration and obesity
has led to the proposition that more
sleep is necessary to prevent obesity.
Chronic lack of sleep may increase
susceptibility to the Metabolic Syndrome
X and it is known that forced sleep deprivation
in healthy young adults appears
to be “diabetogenic”, as evidenced by
detectable alterations of glucose metabolism.
The diabetogenic effects of sleep
deprivation may be hormonally mediated.
Sleeplessness has been associated
with decreases in the normal nocturnal
surge of thyrotropin or growth hormone
and increases in corticosteroid secretion.
These hormonal changes are often
present in the elderly, reinforcing the
notion of a potential causal relationship
between sleeplessness and/or obesity
and premature aging.
The restoration of sleep patterns of
optimum quality and duration can be
expected to improve the management of
obesity, but stress management appears
to be a very important additional factor
in obesity management, because of
its beneficial effect on sleep patterns
or body metabolism that favors weight
control.
Clearly, natural ways to healthy sleep
are preferred over pharmaceutical interventions
and comprehensive lifestyle
plans suggest that first-line options for
adjuncts to sleep involve increasingly
the use of dietary supplements. Sleeping
naturally has been described in programs
that involve lifestyle change and
the use of nutritional support for sleep
with dietary supplements.
Implications for Effective Management of Obesity
Integrative medicine can offer the optimal
pathway to the management of an
overweight status, if the modern science
of allopathic medicine is complemented
by holistic care. Many people can shed
a few pounds of body weight in the
short term, but sustained weight control
involves many management principles,
other than diet alone.
The last thing that is required in the
new millennium is another diet promise
for weight loss. That said, carbohydrate
restriction in the short term can result in
apparently safe and effective, accelerated
weight loss. However, long-term restriction
of carbohydrate intake is probably
neither safe nor effective. Low carbohydrate
diets result in rebound weight gain,
largely because of lack of compliance and
failure of carbohydrate restriction to overcome
insulin resistance. Without positive
lifestyle change there cannot be a health
benefit from any weight control program.
Drugs for weight control are often
undesirable because of side effects.
Nutritional approaches are often safe and
are assumed cost effective when used in
an appropriate manner. unfortunately,
many dietary supplements used for
weight control are purveyed often with
weak evidence of efficacy.
Recent studies with non-stimulant
appetite suppressants such as Hoodia
Gordonii and Caralluma Fimbriata wall
or extract are very promising because
controlled intake of calories is the key
initiative in weight control.
Diets to combat Syndrome X should
also have more liberal “healthy fat” recommendations
(omega-3 and -6 fatty
acids in the correct balance) with strict
control of refined carbohydrate intake,
restricted salt intake, enhanced fiber
intake and a move toward vegetable
sources of protein.
Currently, alternative and complementary
medicine may have more to offer the
prevention and treatment of Syndrome
X than many existing pharmaceuticals,
which are being scrutinized increasingly
in terms of their cost effectiveness and
safety.
For references send a SASE to totalhealth
magazine.
Stephen Holt M.D., LLD (Hon.), DNM,
FRCP (C), MRCP (UK), FACP, FACG, FACN,
FACAM, Distinguished Professor of
Medicine, Chairman, Department of
Integrative Medicine, NYCPM, NY
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