August 2008

metabolic syndrome, obesity and diabetes.

By: Lionel Perez Valenzuela.

The disease diabetes is increasing:

In the United States 10% of adults suffer from type II diabetes. Diagnosed one and half million new cases each year. For 2010, we expect 200 million cases of this serious disease in the world.

In the Argentina , some sites report that a 10% of the population have diabetes, about 3, 6 million (about 40% of these people know that a diabetic). According to INDEC, the rate for 2005 was 8.4% of the total population.

Diabetes in Mexico is one of the most important health year recorded 40 000 deaths caused by diabetes. In 1995, with 4 million patients, ranked tenth worldwide and it is estimated that by 2025, was seventh with 12 million.

Brief initial idea about insulin and diabetes.

Insulin is a hormone, a messenger molecule, which is carried by the bloodstream. Like many other hormones, insulin is protein in nature, ie consists of amino acids linked by peptide bonds.

Insulin is the hormone "anabolic" par excellence, ie, makes available the necessary input cells of glucose (cellular fuel), then by glycolysis and cellular respiration we provide the chemical energy in the form of ATP (energy currency) needed for cellular functions.

Its action is activated when the glucose level is elevated in the blood, with the insulin released from pancreatic beta cells. Its function is to promote the cellular uptake of glucose, so insulin is a hypoglycemic hormone (causes decreased glucose concentration in the blood).

Insulin also has other important functions, for example, stimulates the synthesis of protein and DNA synthesis. Therefore also acts as a growth factor to cells throughout the body.

Since antiquity physicians from all civilizations have left no record of the disease now called diabetes.

The first reference to diabetes is found in the Ebers papyrus found in 1862 in Thebes (now Luxor). In the papyrus contains a síntomalogia reminiscent of diabetes and the treatment prescribed.

The early literature Hindu Vedas describe the urine sticky, honey-flavored and strongly attracts ants diabetics. Susruta, the father of Hindu medicine described the diabetes mellitus and even managed to differentiate diabetes that occurred in young people that led to death and others that occurred in people of a certain age.

Demetrius of Apamea refined the diagnosis of diabetes mellitus Apollonius of Memphis coined the term diabetes (from dia "through" and Betes "pass") to refer to a disease characterized by removal of large amounts of urine (polyuria), weakness general and intense thirst. Apollonius thought it was a form of dropsy. Later he added the Latin term mellitus (honey, candy) to refer to the sweet taste of urine of patients.

now know that diabetes is a disorder characterized by high blood glucose (hyperglycemia). Our body works better with some level of blood glucose. If glucose levels rise or fall too low, we feel bad. say that a person is consistently diabetic if their blood glucose levels are high. Diabetes is the most common endocrine disorder.

High levels of glucose in the blood damage the small blood vessels, such as kidney, heart and eye. There are two typical forms of diabetes, diabetes type 1 and type 2 diabetes. The two forms of diabetes kill about 250,000 Americans per year and cause more expenses 130,000,000 million dollars.

Diabetes is the leading cause of kidney failure, amputation and loss of vision in adult Americans. Diabetes also doubles the risk of heart disease.

The pandemic of diabetes and its growth largely to the type 2 diabetes (often called adult onset diabetes, but it also affects some children). Type 2 diabetes appears suddenly (as if you can do the type 1), but it seems to be the end of a process that begins with a condition we now call " metabolic syndrome."

In other words, type 2 diabetes is the culmination of a group of related conditions including:

- high blood pressure

- abdominal obesity

- high concentration of certain blood lipids

So people who have these symptoms or signs, we can say that suffer from "metabolic syndrome " and are more likely of developing diabetes.

Under these conditions as the body stops responding to insulin, pancreatic beta cells are forced to release more thyroid hormone (this process is called insulin resistance ).

Type 2 diabetes do not appear until the beta cells the pancreas are exhausted. As Professor of Medicine, Endocrinology and Diabetes Richard Bergmann of the University of Southern California .

"The metabolic syndrome leads to the need for more insulin secretion , but if the beta cells of the pancreas does not fail, you will not suffer diabetes"

us distinguish between type 1 diabetes and type 2

Type 1 Diabetes:

Characterized by insulin deficiency.

not produce enough insulin from the pancreatic beta cells.

Causes: autoimmune, genetic and environmental factors. In general, children and adolescents suffer. The little ones cry frequently and thoroughly wet diapers. Sometimes the diagnosis is through analysis casual showing high glucose in urine or blood.

requires daily insulin . Includes 5-10% of Americans diagnosed with diabetes.

Symptoms: increased thirst, urination and hunger increased, weight loss, blurred vision and extreme fatigue.

Type 2 Diabetes:

Characterized by insulin resistance.

beta cells produce insulin but the body's cells are resistant to its action. Resulting in a high concentration of glucose in the blood (because the glucose is not transported into the cells.) Therefore the cells that need insulin to get glucose suffer "hunger" (insulin-dependent tissues).

risk factors: age, obesity, family history, physical inactivity and certain ethnicities. Approximately 80% are overweight or obese.

Symptoms: fatigue, frequent urine, increased thirst and hunger, weight loss, blurred vision, wounds heal slowly. Some people show no symptoms.

"Obesity and overweight, illness of wealth?

Far from being a "disease of wealth ", obesity also affects greatly to developing countries. Although in Argentina there are no national nutrition data, according to several studies have estimated that some 20 million people are overweight or obese, and the number of deaths attributable to this disease is 30,000 per year.

At the same time, 1% of the obese than 150 kilos, a figure that translates to 200,000 disabled people with poor or no available medical . According to an estimate of the Centre for Research on Child Nutrition (CESNI), about 2,500,000 children and young Argentines are overweight or obese.

Regarding Latin America, according to WHO figures , Chile leads the statistics of obesity. An average of 21.9% of the Chilean population is overweight among people over 15 years. Thus, 19% of the male population is obese, while women reach an alarming 25% (1 / 4 of the female population). These statistics are similar to other Latin American countries like Mexico.

Worldwide WHO estimates that more than 1,000 million adults are overweight and 300 million obese worldwide, while that 2,000 million children and adolescents are overweight or obese (UNICEF).

We consider what are the social and economic causes of obesity and the epidemic of childhood obesity include:

- Increase food availability and reduced cost for those less healthy (fast food and others).

- Reduced demand for energy at work and home

- Less time and income on food preparation and healthy quality

- Less time for physical activity

- Poverty (barrier to access to quality food)

As childhood obesity:

- Both parents work at home for longer hours

- Changes in the school food (dietary changes in general)

- More food away from home (high-fat foods, soft drinks and juices)

- More leisure time watching television and videos

games

point out only some of the risks of childhood obesity:

-Hypertension-Dyslipidemia (changes in lipid metabolism)

- Asthma

- Joint problems

- Early puberty

- fatty liver

- Sleep Apnea

- Discrimination

What factors are involved in type 2 diabetes?

Professor Bergman explains that most of the genes involved in type 2 diabetes are associated with beta cell function, and this fact helps to explain the pattern of disease seen in the U.S. population: Some ethnic groups, particularly Asians, African Americans and Native Americans are not equipped to compensate for some degree of insulin resistance, as they become more obese, have have more visceral fat and increased risk of type 2 diabetes.

Other factors implicated in metabolic syndrome and diabetes include, as already noted, the epidemic of obesity, Fast-food premises that sell very high-fat foods, a sedentary lifestyle and the massive use of high-fructose syrup from corn during the past 30 years (The average U.S. consumption was 28.4 kg . Per person, mostly from soft drinks, juices and soft drinks). Then come back to the issue of high fructose syrup from corn and how it would affect our metabolism.

metabolic syndrome and cardiovascular disease.

Metabolic syndrome plays an important role in cardiovascular disease, comparing the danger to smoke two packs of cigarettes per day.

Although still being debated the significance and exact definition of the metabolic syndrome, Dr. Francisco Lopez-Jimenez of the Mayo Clinic in Rochester, Minnesota, believes that this concept is useful. "It is controversial as a new diagnosis ... because each individual component has a name: hypertension, obesity, abnormal cholesterol levels"

Skeptics, made an obvious question that he admits: "What is the importance of creating a new diagnosis, when all the symptoms and are identified as separate diseases and the treatment I'm still the same? "Lopez-Jimenez replied: "Unifying measures, which may be trivial separately, metabolic syndrome makes a major difference for patients. If blood glucose is a bit high, the circumference of the waist is slightly abnormal, it is very likely diagnose metabolic syndrome, but that term patient left the office without a sense of risk for diabetes or cardiovascular disease may suffer. If the patient only sees his analysis are only slightly abnormal, will not have sufficient motivation to change their behavior "

As a preventive cardiologist Lopez-Jimenez remarked that metabolic syndrome is a risk factor for heart attacks and strokes , not just diabetes. "Each component of metabolic syndrome has been linked to with cardiovascular disease. Although some people without diabetes develop cardiovascular disease, in many cases, diabetes is the midpoint between metabolic syndrome and heart disease "

The strong correlations between metabolic syndrome, cardiovascular disease and diabetes is not completely understood, Lopez-Jimenez said. "The approach to these problems has been that high sugar levels are harmful, but it is likely that beyond this there are other factors involved, because several studies have failed to show significant reductions in cardiovascular events by controlling only blood glucose. People with diabetes have a constellation of abnormalities. Patients with type 2 diabetes have high levels of insulin, which by themselves can affect the cardiovascular system, causing the diabetic to reabsorb more salt, causing blood pressure to rise and changing the metabolism of cholesterol. Elevated insulin itself may be related to various arterial abnormalities such as arteriosclerosis ¨

We summarize the main features of the metabolic syndrome (also called syndrome of insulin resistance, metabolic syndrome X or obesidadiabética )

- abdominal obesity, circumference of the waist above 88.9 cm (35 inches ) in women or 101.6 cm (40 inches ) in man (one inch = 2.54 cm )

- Low levels of high density lipoprotein (HDL, HDL or "good cholesterol")

- Test high fasting glucose (or fasting glucose test)

- Insulin resistance (the body does not respond properly to the hormone )

- High blood pressure (above 130/80).

Does the diet: a strong response to diabetes and metabolic syndrome or a false hope?

Being overweight or obese are two of the most important factors in metabolic syndrome and diabetes Type 2, diet and exercise are two traditional locations on the prevention of diabetes, but losing weight is easier said than done, as presented by Richard Bergman the University of Southern California. "We have heard many times on the approach to a lifestyle leading to weight loss, but only for a short period of time, 97% of people who lose weight by diet and exercise back to recovery in a period three to five years is very difficult to have an improvement in the long term "

Some research has found that weight loss can be maintained with enough effort. As Bergman says: "In Finland, monitoring groups have been formed and studied people for five years, used a long time and many hours of monitoring and advice, and this reduced the risk of diabetes significantly, but this is generally ineffective in a real life situation. Thin people think it is very simple, but it is almost impossible to lose weight for people in this way. An obese person who has lost weight, not like a thin person. Because their rate of energy use are very low, and gain weight again even with a reduced calorie diet "

The doctor, lose weight or

Nevertheless, research on metabolic syndrome continues to show how much difference can a change in lifestyle, for better or worse, in the progression to diabetes.

This has been demonstrated by studies conducted by the Diabetes Prevention Program, which has studied 3,234 overweight and with impaired glucose tolerance (two key elements of the metabolic syndrome). A combination of diet and exercise reduced diabetes risk by 41%, much better than the drug metformin (used in diabetic patients overweight), which only reduced the risk of diabetes by 17%.

The diabetes prevention program was so effective that was completed a year earlier, to allow the control group received appropriate advice on the combination of diet and exercise, to the cardiologist López-Jiménez results were compelling. "Patients lost only 4 pounds (about two kilos), but those who became more physically active and tried to eat better, the chances of developing diabetes decreased. It's hard to find someone with metabolic syndrome is very active, exercise and have a good diet. Anyone with metabolic syndrome needs a change of behavior "

The benefits of exercise, combined with some weight loss, has led some physicians to change their focus of attention so far always focused on the scale. López-Jiménez points "We try to stay away from the point of view that our goal is to reduce weight. Especially not say, get some exercise, right diet and then we will see. We prescribe the quality and quantity of exercise and work with patients to overcome any physical or also in our case with the horrible winter of Minnesota "

Eat less, exercise more.

What recent studies can show the old advice to the mothers to eat well and exercise, and the effects associated with the metabolic syndrome and diabetes?

Weight training can help: In a new study, progressive resistance training, benefit three key points of the metabolic syndrome: insulin resistance, blood triglycerides (Lipids dangerous) and basal glucose testing or fasting glucose.

Exercise helps even without weight loss: a study on 115 adults in the Johns Hopkins Medical Institute, found that exercise improves blood pressure, total cholesterol and insulin sensitivity. The cause of these results was no improvement in fitness and weight loss, but the reduction of total body fat and abdominal fat.

Being active can have their dividends as we age : Studies in Norway, showed that men who perform physical activity in their free time, had a 40% reduction in the development of metabolic syndrome.

targeted programs can help: A Montreal study focused on people who had already developed type 2 diabetes showed that those who had completed the DiabetAction program, which helps select the optimal exercise trends to reduce diabetic showed a significant reduction in body weight, blood pressure, waist circumference, basal heart rate and prevalence of metabolic syndrome after six months. Even

interventions "moderate" may have better results than simple advice family doctor, as shown by a study of 335 people whose characteristics made them susceptible to diabetes who received professional advice which led them to do more exercise and improve most of the markers of metabolic syndrome. This group had a 31% reduction in the risk of developing diabetes, but "the usual treatment of the family doctor was ineffective in modify the progressive metabolic deterioration."

Sitting too long can be harmful: A recent look at the role of sedentary behavior in the death, cardiovascular disease, Type 2 diabetes and metabolic syndrome concluded that the growing trend towards inactivity suggests that "people who do not exercise can become even more metabolically ineffective in the coming years if they sit too much"

" combination of ingredients?

No one questions the metabolic benefits of weight loss. But Edward Weiss University in St. Louis, says that exercise confers a number of perks. "Studies show as if a person matching starting an exercise program and not lose weight can still expect a substantial reduction in risk of diabetes "

If exercise alone is beneficial and weight loss alone is beneficial, should not produce weight loss through exercise even more benefits? That's what Edward Weiss expected when I compare two groups, one who lost weight due to caloric restriction and another who lost weight due to an exercise program. However, both groups showed similar improvements in body weight, glucose tolerance and insulin sensitivity. "It's clearly a result surprising because the assumption was that if it was beneficial weight loss and exercise was beneficial, each separately, should be expected in May benefit by combining both, but the results showed that "

Benefits year focus on insulin action. As Weiss says, "The muscle adapts to exercise, so any release of insulin or insulin application, have a greater hypoglycemic effect, bringing more glucose into the cell or intercellular space. Therefore improves glucose clearance , muscle is more sensitive to exercise "

"Caloric restriction seems to work differently, decreasing oxidative stress (metabolic changes) and even inflammatory bowel may be adaptations"

Since exercise and caloric restriction works by mechanisms different, normally should provide greater benefits by combining both treatments, doing so separately. But Weiss thinks that more research is needed and that in certain conditions the combination of exercise and calorie restriction should be more effective against metabolic syndrome.

A conversation with a specialist in metabolism and biochemistry.

In a conversation with Stephen Brietzke endocrinologist and diabetologist in University of Missouri-Columbia, asked about some topics that help us understand the labyrinthine relationship between metabolic syndrome, diabetes and cardiovascular disease .

Some people think that talking about metabolic syndrome is not useful because doctors and addressing each of the components of all forms. What do you think?

From a public health perspective, it is important not to lose sight of the forest for the trees. Metabolic syndrome can bring together people with a family history of disease, who had heart disease, or are slightly overweight, having blood pressure above normal and blood biochemistry slightly abnormal, but not candidates for a drug based therapy, since their analysis taken individually do not justify it. But we know that a healthier lifestyle, with 30 to 60 minutes of physical activity on most days a week and a small reduction in weight, are associated with profound benefits in metabolic syndrome, whether people are sufficiently motivated to make changes

Does the metabolic syndrome concept has helped to understand diabetes and cardiovascular disease?

The concept of a syndrome makes us think about underlying causes. There are two ways of looking at the concept of metabolic syndrome, first as a series of related phenomena: type 2 diabetes, disorders of blood lipids and coronary heart disease, all with a possible common cause, which could explain them all. Another way to look at it as a group of risk factors for multiple diseases, which is unrelated causes. I favor the first analysis. Evidence suggests that insulin resistance is key in metabolic syndrome, and studies treatments that benefit enjoyed by other insulin resistance syndrome components. There is also some evidence that ACE inhibitors (Angiotensin Converting Enzyme), which are used to treat high blood pressure diabetes also have beneficial effects on the effect of insulin and the incidence of diabetes.

For how metabolic syndrome, why people are so concerned with visceral adipose tissue (fat in the abdomen)?

suspect that the metabolic syndrome can result from disease or lack of balance in visceral adipose tissue. usually only think of fat as an energy storage simple, but in reality is much more complex than that. Visceral adipose tissue plays a ying-yang, good-bad. Produces beneficial compounds that increase insulin sensitivity (then delve into that topic), reduce the blood pressure and keep blood vessels healthy. But it also produces components that promote inflammation. When this tissue is "healthy" components occurs predominantly beneficial, when the tissue is "sick" change its production to the inflammatory components.

never heard anyone speak of adipose tissue as "sick" ...

Ten years ago nobody had said that adipose tissue might be sick he looked just like a store was metabolically inert and treatment for diabetes was to lose weight. We believe that some kind of "change" or "switch" occurs in adipose tissue by promoting the production of molecules that stimulate inflammation. There is also a concept that is emerging , people can be fat inside. If we look at type 2 diabetes patients in Japan, many do not appear to modern Western eyes as obese, but if we make a study of images and measure visceral fat, we see that there are a lot of fat inside .

We've always thought Diabetes is a disease related to the high amount of glucose in blood, but in reality we see that is much more complicated than that ...

complications of diabetes usually fall into two groups. The first one is damage to small blood vessels in the retina, kidney and nervous system, due to high blood glucose levels that bind to structural proteins, and gradually alter its function and damaging the blood vessels. A second complication is arteriosclerosis, hardening of the arteries, which probably has a different basis. Atherosclerosis, may be related to inflammatory changes in arterial walls thicken and lose elasticity. It also accelerates plaque formation (buildup of fatty substances and other) in the lining of the artery wall, these processes tend to block blood flow. In diabetes and metabolic syndrome, visceral adipose tissue tends to inflammatory components and the balance in the arterial walls changes from a healthy condition, rich in antioxidants and compounds that cause the relaxation to an inflammatory condition that leads to high blood pressure and plaque formation. Therefore cardiovascular disease and diabetes from the lack of balance in adipose tissue.

delve a little deeper into the relationship between obesity and diabetes, for that we need to know the functions of the hormone called leptin (from Greek leptos intestine), allowing us better understanding the links between these two diseases.

Leptin is a very important hormone, discovered about ten years ago, is encoded by the obese gene (ob). Its protein structure and consists of 167 amino acids including a signal peptide of 21 amino acids. Three-dimensional structure has four alpha helices and a disulfide bridge between cysteines at position 96 and 146, the latter being required for biological activity of the hormone.

Leptin is secreted by adipose tissue that informs the central nervous system of the body energy status. If we have enough stored energy, increased leptin levels and suppress the appetite, leptin also regulates other neuroendocrine functions. Then is well understood that mice with the mutated ob gene (no leptin), suffer from hyperphagia (feed constantly), obesity, endocrine dysfunction and predisposition to diabetes.

Before the discovery of leptin , adipose tissue was seen only as an energy storage tissue, a tissue that most people tried to get rid of. Following the discovery of leptin and other hormones produced by adipose tissue, completely changed the vision we had of it. Currently

adipose tissue, is seen as a major endocrine gland, which secretes a large number of mediators, a peptide hormone (cytokine) called Adipokines whole being secreted by adipose tissue (adipokines in English) with great influence on metabolism and other organs, particularly the brain. Adipose tissue is one that tells the brain about two of the most important vital functions: food and reproduction.

Despite the important role of leptin, many obese people have high serum leptin concentrations, indicating that the organism also can become resistant to leptin (ie, leptin is unable to exercise its action.)

As adipose tissue synthesizes more leptin (because your body becomes resistant), inflammatory levels increase, because high levels of leptin are highly pro-inflammatory. As we have seen a crucial aspect of metabolic syndrome was the change that occurred in adipose tissue from a state of "healthy" antioxidant, protector of the arteries to a "sick" pro-inflammatory, with increased arterial plaque formation, increased blood pressure, cardiovascular disease and diabetes. Another important lipokines

is ADIPONECTIN that raises levels of insulin sensitivity. An interesting relationship is that the hormone decreases with increasing our levels of body fat. Therefore, overweight and obesity contribute to lower levels of circulating adiponectin contribute to the loss of insulin sensitivity.

Adiponectin is one of the most abundant plasma proteins, and their concentrations sexual dimorphism, as women in the circulating levels are higher than those reported in males.

Finally back on the syrup, high fructose corn, which many researchers think it is related to the epidemic of obesity and type 2 diabetes.

high fructosaa syrup is made from corn starch. After the starch is completely hydrolyzed to glucose. Then by an enzyme glucose isomerase (a aldohexose) is isomerized to fructose (a cetohexosa). Syrup, high fructose corn may have a concentration of 55% fructose.

According to some studies fructose does not cause the same effect that glucose, among others, does not cause the same release of insulin and leptin than glucose (ie that these hormones are maintained at relatively low levels despite the intake drinks or foods sweetened with syrup corn), which is counterproductive because it does not produce the same level of satiety.

Another important question is that fructose, not create a feeling of satiety, increases the release of hormone ghrelin (Ghrelin in English), the appetite-stimulating hormone (produced in the stomach and pancreas) . Therefore high levels of fructose would produce a hormonal imbalance, first low insulin and leptin and ghrelin concentrations increased, resulting in increased appetite. This also demonstrated that fructose consumption increases the level of blood triglycerides in a long, contributing to cardiovascular risk.

Conclusions:

certainly can not present the great depth of investigations carried out, and many have yet to confirm or reject deepened, but at least we can draw some conclusions for immediate implementation:

- The fat tissue is not only a reserve of energy, is also an endocrine tissue which releases a large number of important Lipokines, including leptin and adiponectin.

- Lipokines secreted by adipose tissue regulate pro-inflammatory state, largely responsible for vascular complications (atherosclerosis) seen in metabolic syndrome and type 2 diabetes.

- The concept of metabolic syndrome should be of general application to health policy level.

- We are facing a global epidemic of overweight, obesity and type 2 diabetes.

- we get a significant improvement in quality of life, with changes in behavior:

1 - stop feeding high-fat meals (usually fast food and sweets), stop drinking sweetened with corn syrup (soft drinks and juices in general)

2 - Becoming more active, and in our spare time, walking, exercising or playing sports. Even losing weight very slightly benefits are long term and lower risk of diabetes or cardiovascular complications.

- Changes will not happen by themselves, we need health policies, a shift to community and individual level too deep, to improve our quality of life.

Some important links:

This article is a translation and expansion of following article:

http://whyfiles.org/276metabolic_syndrome/index.php?g=1.txt

To learn more about diabetes:

http://www.msd.com.ar/msdar/corporate/press/diabetes/noticia1.html

To learn more about diabetes, with articles and information important nutritional level:

http://www.drcormillot.com/articulos/100277.htm # A279

http://www.drcormillot.com/articulos/articulos.php?id=3

Diabetes in Latin America and the Caribbean:

http:// www.msd.com.ar/msdar/corporate/press/diabetes/noticia2.html