How would you act today if you knew you were going to be completely successful? Go ahead and act that way, and the success will come.  Ralph Marston

   My son-in-law, Jarod, who recently turned thirty has been having some medical issues which are a concern because type II diabetes is part of his family of origin history.   After looking at his lab blood results and the doctor’s recommendations, the topic of metabolic syndrome and insulin resistance came to the forefront. Going back through my notes and transcripts, I came across the following paper which was submitted as part of my graduate studies in Nutrition and it is based on a real consultation which was conducted while I was in private practice. The client name and identifying information have been changed to insure privacy, but it could be any one of millions of people with these issues. 

The following is a consultation  I had with a client, Jack James.  Jack  recently celebrated his 60th birthday and has lived alone for the past three years since the death of his wife of thirty years.  Jack lives an extremely active life traveling extensively and seldom prepares food at home.    Upon completing a medical physical which included a lab blood analysis, Jack’s Doctor prescribed blood pressure medication, cholesterol medication, and another medication for his elevated sugar levels which he diagnosed as borderline type II diabetes in combination with a low-fat diet. 

After following his doctor’s recommendations for three months, Jack noticed that he has gained twelve pounds around his middle area and is experiencing extreme fatigue with mental confusion which is affecting his ability to work as a film editor.   When Jack talked with his Medical Doctor about these concerns, he was told this is just a normal part of aging and was offered a prescription for depression.  Rather than giving up and traveling down the prescription drug path, Jack made the decision to take personal responsibility of his own health and consult with a Certified Lifestyle Educator and Nutritionist.

Joa:  Jack, first let me thank you for bringing in all the Lab test results which I have entered into your chart.   Please remember that I do not diagnose, treat or cure any medical condition and any decisions which you make concerning the recommendations of your medical doctor are personal decisions which I will not discuss with you.   As a Nutritionist and Certified Lifestyle Educator, I will give you information on changes which can enhance your overall health.  Whether you decide to incorporate all or some of these suggestions is entirely up to you.

Jack:  I understand completely and that is why I came to see you on the recommendation of friends that you have worked with. 

 Joa:  From looking at your chart, I see that you have a cluster of related symptoms or disorders which include elevated total cholesterol, elevated triglycerides, hypertension, insulin resistance,  borderline type II diabetes, and high waist to hip ratio.  When these symptoms appear in a cluster they are commonly referred to as metabolic syndrome.  Are  you familiar with this term?

Jack:  No, are you saying that all of my health problems are really one problem and related to each other?  What causes metabolic syndrome?

 Joa:  Metabolic syndrome is primarily a nutritional disease caused by eating the wrong type of foods.   All systems of the human body are connected and any nutritional damage that affects one system affects the entire body.   The key disorder in metabolic syndrome is insulin resistance which is elevated insulin production and inefficient glucose metabolism.  Metabolic syndrome is caused primarily by a diet high in refined carbohydrates which not only raise glucose and insulin to unhealthy levels but also fail to supply the many vitamins, minerals, and other nutrients which your body needs to properly utilize these foods.

Jack:  Does that mean that you are going to put me on a diet and how long am I going to have to follow the diet?

 Joa:  No, diets do not work and any short term change really does more harm than good in regard to over-all health.  Most low-carb diets focus on the fact that eating high-carbohydrate foods raises blood sugar levels  which is risky for diabetes and heart disease and there is evidence suggesting that elevated blood sugar and insulin levels—from eating a lot of refined carbohydrate-rich foods—may contribute to obesity. 

All carbohydrates, whether from a slice of whole-wheat bread, a teaspoon of sugar or a serving of white rice, provide the same four calories per gram. But there are important differences in the foods that supply those calories.   While whole-grain bread provides fiber, vitamins, minerals and a healthy collection of disease-preventing phytonutrients, sugar provides nothing more than calories.  White rice provides carbohydrates in the form of starch rather than sugar, but because it’s refined, most of the nutrients have been lost. Sugar and high fructose corn syrup is often eaten alone as a soft drink, as candy, or in coffee or tea. Or it’s the major ingredient in low-fiber, low-nutrient, high-fat desserts or snacks.  If you boil down the effects of carbohydrates on blood sugar to a basic level, it’s not simply sugar that’s the problem. It’s mostly added sugars. Sucrose—table sugar—is present in foods almost totally as added sugar in desserts and snacks.

Likewise, high-fructose corn syrup, a chemically altered form of the natural sugar fructose, is added to soft drinks and sweets that have little or no redeeming nutritional value.   Sugar and high fructose corn syrup increase free-radical production, boost blood levels of cholesterol and triglycerides and stimulate the production of insulin which promotes insulin resistance.  Rather than suggesting a temporary diet we are going start with some simple therapeutic lifestyle changes that will last a life-time. 

The first issue that we will confront is how you feel about your body.  When you realize that your body is the only possession that you will really ever own and that most people take much better care of their temporary material possessions such as their house or car than they do their bodies, it is much easier to make these therapeutic lifestyle changes.  

Jack:  For the last three months, I have been eating low-fat chicken or fish and avoiding red meat.  That is the reason that I am shocked to be gaining weight rather than losing.

 Joa:   Jack, you just made a very interesting statement about gaining weight which is a scale measurement…how does your body feel with the changes that you have made? 

The first step in making therapeutic lifestyle changes is doing a morning check-in with your body.  This is a simple relaxation technique where you will learn to feel what is happening in your body each morning and work with controlling hormones which have an effect on the symptoms of metabolic syndrome. 

 Two stress hormones, corticotrophin and cortisol, are very sensitive to physical and mental stresses.  Feelings of physical fatigue, mental exhaustion, and anger are strongly associated with unbalanced levels of  these hormones and with metabolic syndrome. 

Cortisol is a stress hormone that constricts blood vessels and is strongly associated with heart disease and other degenerative diseases.  High levels of cortisol are also associated with low levels of dehydroepiandrosterone (DHEA), a hormone that is commonly depressed in insulin resistance. 

DHEA is the hormone necessary for production of testosterone, estrogen, and other steroid hormones with optimum levels having been reported to have an anti-aging effect and lessen erectile dysfunction in older men.  

We will practice this relaxation technique in the office and I will give you a CD to use each morning before you start your day.

 Jack:  Okay, at this point I am ready to make these changes and take personal responsibility over my health.  What is the next step?

 Joa:  The next area that we are going to discuss is the effects of a low fat diet on metabolic syndrome.  In recent years, large numbers of people have adopted low-fat diets and regularly eat low-fat or zero-fat foods, in the belief that such diets are healthy and can help  them to reduce weight and lower their risk of heart disease. 

Low-fat diets as with vegetarian diets typically translate to high-carbohydrate and often high-calorie diets, and their popularity has greatly  increased the prevalence of obesity in recent years.  Diets high in refined carbohydrates promote insulin resistance and obesity. 

In addition, there is compelling  evidence that people eating low-fat diets have greater feelings of anger, hostility and depression.  These mood changes appear to be biological consequences of inadequate dietary fat in the central nervous system.  Omega-6 fatty acids and omega-3 fatty acids are essential  nutrients and  without them we cannot achieve  and maintain health.  The healthy ratio lies between 1:1 and 4:1.    The current ratio of omega-6 to omega-3 fatty acids  in the U.S. diet ranges from 20:1 to 40:1.  Corn, soybean, safflower, sunflower, and cottonseed  oil are all high in omega-6 fatty acids and these are  the oils which I am suggesting you avoid.  In addition to reducing your intake of omega-6 fatty acids, there are two ways to  balance your fatty acids intake.  One is to use unrefined or cold-pressed extra-virgin olive oil as your primary oil in salads and cooking.  Olive oil is low in omega-6 fatty acids and rich in omega-9 monounsaturated fatty acids, which do not compete  with omega-3 fatty acids. 

The other way to balance fatty acids is to increase your intake of omega fatty acids through  such foods as cold-water fish,  walnuts, omega-3 enriched eggs, free-range  meat, and organic green vegetables.  The other alternative to insure adequate amounts of omega-3 is  fish oil supplement of EPA-DHA.  Studies have shown that eating a diet high in omega-3 fatty acids can help reverse insulin resistance, reduce blood pressure, reduce fasting glucose, increase HDL cholesterol and reduce the risk of heart attack and stroke.

 Jack:  Are you saying that I do not need to avoid or watch my fats?

 Joa:  In addition to avoiding omega-6 rich vegetables oils, it is extremely important to avoid trans-fatty acids.  Trans-fatty acids promote insulin resistance and a variety of health problems in the body because they are shaped differently than the polyunsaturated fatty acids from which they are made.  These trans-fatty acids crowd out essential fats from the cell membranes and interfere with the conversion of shorter-chain fatty acids into longer ones.  This shortage of long-chain fatty acids make the cell membranes less fluid and reduce the number and sensitivity of insulin receptors.  Trans-fatty acids  promote not only insulin resistance, but also the health problems that define metabolic syndrome such as high triglycerides, low HDL cholesterol, and high total cholesterol, obesity, and heart disease.

 Jack:  What can I do to eliminate trans-fats from my diet?

 Joa:   Today,  trans-fatty acids are widespread in the typical diet such as yours.  They are found in margarine,  deep-fried foods, and foods that contain partially hydrogenated oils  which include a wide array of convenience foods including vegetable shortening, salad dressings, microwavable  and TV dinners, crackers, coffee creamers, breads, cookies and pastries.    The most valuable suggestion that I make in this area is read ingredient labels.  Please note that ingredients are different from nutritional information on labels.  The real ingredients are usually hidden in very small print.

 Jack:  What other changes would you recommend?

 Joa:  Walking may be the best form of regular recreational movement, but anything that promotes core body movement without excess stress such as dancing or swimming will be beneficial.   Increasing your intake of pure filtered water and replacing fruit juices and sodas with water.  Both fruit juice and soda elevate glucose and insulin to high levels very quickly.  Be aware of the sugar drinks that have flooded the market with claims of being healthy such as Vitamin Waters and Green Teas which have the same effect on glucose and insulin levels.

And last but not least, if you want to prevent or reverse metabolic syndrome, it is essential that you consume adequate amounts of protein and fiber throughout the day which is best consumed in three small meals and two snacks with breakfast being eaten within thirty minutes of rising each morning.

 Jack:  This visit has been extremely educational but how will I remember all this information?

 Joa:  In addition to the relaxation CD, I will give you a folder with additional information on all the therapeutic lifestyle changes which we have discussed and you can, of course, call me at any time with questions before our follow-up visit.

      The above consultation is very typical and briefly touches the subject of the cluster of related symptoms or disorders which include elevated cholesterol, elevated triglycerides, hypertension, insulin resistance,  borderline type II diabetes, and high waist to hip ratio which are commonly referred to as metabolic syndrome. 

       And to answer what you must be thinking…no my family does not allow this subject to be discussed at family dinners (or anywhere else).  Am I a health food fanatic…well maybe, but I live in the real world, eat out and make the best choices with the foods available.

     When Jarod and I were discussing lifestyle changes that he is making, my daughter was resisting.  Jenn said, “This is not fair…I don’t have health problems…I had to eat healthy while I was growing up and now I have to eat healthy again with you!” 

     Jenn’s statement pointed out the very core of Metabolic Syndrome.  It does not occur overnight…it is an accumulation of years of starving the body of the essential nutrients that it requires.  The body is very forgiving of the self-abuse of nutrient starvation…but the results are seen in the physical appearance and felt in the internal health issues.  Where insulin resistance used to show up later in life…it is now apparent in children who are beginning life  nutritionally starved by being fed a complete diet of artificial and chemically modified foods.

     Living Well with Nutrition is environmentally sustainable, socially just and spiritually fulfilling.

Love, Light & Lots of Laughter…Joa

www.joacarter.com