MetabolicSyndromeTheLifestyleDisease

RobertDawkins,PhD,MPHPracticalHealthStrategies.com

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“MetabolicSyndrome”

• Aclusterofsigns&symptomsassociatedwithcardiovascularandcancerrisk

• Thetermdatesfromthe1950’sbuttheclusteringhasbeenknownsincethe1930’s

• ThecontemporaryinterestbeganwithDr GeraldReaven’s 1988BantingLecture

• Doctorshavedebatedwhetheritisa“disease”practicalhealthstrategies.co

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Metabolicsyndromeisalsoknownas:• metabolicsyndromeX• cardiometabolic syndrome• deadlyquartet• syndromeX• insulinresistancesyndrome• Reaven's syndrome (namedforDr.GeraldReaven)• CHAOS (inAustralia):Coronaryarterydisease,Hypertension,Adultonsetdiabetes,Obesity,andStroke

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TimelineofMetabolicSyndromeCriteria:

• WorldHealthOrganization(1998)#*

• EuropeanGroupfortheStudyofInsulinResistance(1999)#

• NationalCholesterolEducationProgram(2001)#

• AmericanAssociationofClinicalEndocrinologists(2003)• InternationalDiabetesFederation(2005)#*

• AmericanHeartAssociation&NHLBI(2005)#

• “Harmonized”definition(2009)#

#Measure of obesity included *BMI included (nonexclusively)

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Metabolicsyndrome:“Harmonized”definition(2009)

Parameter:•WaistCircumference• Triglycerides(mg/dL)•HDL-c(mg/dL)•Bloodpressure• Fastingglucose(mg/dL)

LimitValues:•Populationspecific• > 150•Men:<40;Women:<50• >130/>85• > 100

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MetabolicSyndromeincreasesriskof:

• Diabetes• Cardiovascular:CAD,CHF,MI,AF• Cancer:colorectal,liver,breast,pancreatic,endometrial

• Neurological:Stroke,Alzheimers disease,depression

• Allcausemortality

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Andisalsoassociatedwith:

SleepApneaSystemicinflammationElevatedUricAcidlevels

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Someimportantfactorsarebeyondcontrol:

• Gender• Race/Ethnicity• Genetics(other)• Age• Otherdiseases

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BUT,

Youcanmanagesomeveryimportantfactors:

• Diet:whatandhow• Sedentarybehaviorand/orlowphysicalactivity• Disruptedchronobiologyand/orsleep• Excessivealcoholuse• Stress

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Syndrome(n): agroupofsigns/symptomsthatconsistentlyoccurtogether

Disease(n): Agroupofdeleterioussigns/symptomswithasharedpathologyandetiologywhichmayormaynotbeknown

IsMetabolicSyndromeadisease?practicalhealthstrategies.comWellnessPlansyoucanLiveWith!

MetabolicSyndrome:theLifestyleDisease

Theetiologyislivinginthe21st Centurywithanantiquephysiology&genome.

Thefinalcommonpathwayiscaloricimbalance

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Mechanism:

• Plentifulandeasilyaccessiblemixeddiet,inthecontextofmoderntechnologyandcircadiandesynchrony,leadsto

• Excessivecaloricintakerelativetocaloricexpenditureleadsto• A“trafficjam”atthemitochondrialeadsto• Oxidativedamageandinflammationleadsto• Insulinresistanceleadsto• Furtheroxidativefuelimbalance

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MetabolicSyndrome

TheLifestyleDisease

Calories

DietMix Low

Activity

SleepRestriction

SleepApnea

CircadianDisruption

Sedentary

Alcohol

TheSleepConnection

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Metabolicsyndrome:“Harmonized”definition(2009)

Parameter:•WaistCircumference• Triglycerides(mg/dL)•HDL-c(mg/dL)•Bloodpressure• Fastingglucose(mg/dL)

LimitValues:•Populationspecific• > 150•Men:<40;Women:<50• >130/>85• > 100

Note:WaistCircumferenceistheonlyobservableparameterpracticalhealthstrategies.comWellnessPlansyoucanLiveWith!

US Obesity trends1990-2010

Remember:ObesityistheonlyobservableMetS parameter

Source:cdc.gov practicalhealthstrategies.comWellnessPlansyoucanLiveWith!

Whatdoessleeplossdo?• Totalsleepdeprivation(rats):increasedfoodintakebutweightloss;heatloss;death

• Sleeprestriction(human):decreasedleptin,increasedghrelin,increasedhunger

• Epidemiology:shortsleepassociatedwithhigherBMI

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From:Rechtschaffen,etal

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From:Rechtschaffen,etal.

Adaptedby:ReinaPaulien Barfpracticalhealthstrategies.comWellnessPlansyoucanLiveWith!

Shiftwork

Whatdoesirregularsleepdo?• Shiftwork:obesity,elevatedtriglycerides,lowerHDL,diabetes,cardiovascularabnormalities

• Shiftwork:changingS/Wpattern,lesssleep(?);alteredcircadianrhythmicity;disturbedmelatoninpatterns

• Chronicandrepeatedshort-termcircadianmisalignment:metabolicchangessimilartoMetS

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Clocksexistineveryorgan&cell

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Circadiandesynchronizationtriggersprematurecellularaging.

FASEBJournal29(12),4790-4803(2017)

Whydoeslightmatter?• Animalsarephysiologicallydependentuponstablelight/darkcycles

• Light,evenabriefexposure,suppressesmelatonin

• Melatoninisthe“alarm”forthebiologicalclock(SCN)

• Peopleinmodernsocietyareonlyindarknesswhileasleep

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From: Mol Vis 22,61-72 (2016)

Differencesinartificial“white”light:

Whatdoeslightdo?

Miceexposedtolightpulseduringthenight:

§ Disruptedtimingoffoodintake

§ Nochangeintotalfoodintake

§ Gainedmoreweightthanunexposedmice

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Whatdoesmelatonindo?• Adolescentrats:gainedlessweightandfat;samefoodintake

• Adultrats:lostweight,fat,loweredleptin&insulin;foodintakeunchanged

• Obeserats:lostweight,reducedLDL&triglycerides,increasedHDL

• Adult(human)dxMetS:reducedLDL&BPwithin2months

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SomeQuestions:

Isit:

Sleepandsleeploss?

Chronobiologyandcircadiandesynchrony?

Melatonindose,duration,and/ortiming?

"Thedoctorofthefuturewillgivenomedicine,butwillinteresthispatientsinthecareofthehumanbody,indiet,andinthecauseandpreventionofdisease."

....ThomasEdison

So,whatcanyoudo?

TheLifestyleDisease

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“Theonlywaytokeepyourhealthistoeatwhatyoudon’twant,drinkwhatyoudon’tlike,anddowhatyou’ddruthernot.”

.....MarkTwain

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“Earlytobedandearlytorise,Makesamanhealthy,wealthy,andwise.”

BenjaminFranklinPoorRichard’sAlmanac,1757

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WelosttheRhythmofLife!practicalhealthstrategies.comWellnessPlansyoucanLiveWith!

'Damnthatboy,'....'he'salwaysasleep.….andsnoresashewaitsattable.'

CharlesDickens,ThePosthumousPapersofthePickwickClub,1836-1837

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SleepApnea:SystemicinflammationSympatheticactivationRepetitivedesaturation

EdgarAllanPoeEleonora,1841

“Theywhodreambydayarecognizantofmanythingswhichescapethosewhodreamonlybynight.”

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Narcolepsy:DiabetesObesity

Sleep 36(6), 835-840 (2013)

Sleepwell:• KnowTwo+ProcessModel

• Circadiandrive• Homeostaticdrive• Allostaticdrive

• Stabilizechronobiology• Considerlightexposure/melatonin

• Bewareof“sleephygiene”• Shiftworkisachallenge• Evaluatesleepdisorders

• Sleepapnea• CBTforInsomniacomplaints

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Eatwell:• Two+ProcessModel

• Circadiandrive• Homeostaticdrive• Allostaticdrive

• Caloriesdocount• Nutritionalsomatters• Substratemixture

• Carbohydrates• Fat• Alcohol

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Substratemixturematters:

Obesity 19(4), 676–686 (2011)

“...thesubstratemixtureoxidizedmustbeequivalent,onaverage,tothecompositionofthenutrientmixconsumed.”

Thatmeans:

Ifoneconsumesadiethigherinfat,onemustalsometabolizefatatahigherrate.

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Substrateselection:Physiologicallevel

• Insulin/glucagon

Biochemicallevel• RandleCycle

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Threewaysfatmetabolismcanbestimulated:

• Depletionofthebody’sglycogen(carbohydrate)stores• Increaseinthebody’sfatstores• Exercise&Activity

Takeawaymessage:theproblemwith“fastfood”isthe“fast”notsomuchthe“food”

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Eatwell:EatregularlyandSnackingisOKbut:

• Don’teatconstantly• Do“mindful”eating

Don’t“overdo”fatsMakeyour“carbs”complexandgetenoughfiber

• Minimizesugarsandsimple“carbs”

Limitalcohol

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BeActive:

• Caloriesdocount

• Metaboliceffectscountmore

• Neurologicaleffectsaregood

• Psychologicaleffectsaretheicing

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EvenalittleHelps

Am J Public Health 102(4), 698–704 (2012)

Aslittleasonehourofmoderateactivityperweekreducedriskofdeathbyone-third

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ExercisetotreatSleepApnea?

Sleep 34(12), 1631-1640 (2011)

Exercisegrouphadreducedapneaevenwithnoweightloss

Reportedimprovedsleepqualityandlesssnoring

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BeingInactiveisWorsethanbeingOverweight

Med Sci Sports Exer, 44(4), 625-636 (2012)

Overweightandinactivitybothleadtodiminishedqualityoflife…butinactivityhadthestrongereffect

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Exerciseholdsimmediatebenefitsforaffectandcognitioninyoungerandolderadults Psychol Aging 28(2), 587–594 (2013)

Lowerlevelsofphysicalactivityariskfactorforreducedcognitivefunctioninmiddleage

Am J Public Health 95(12), 2252–2258 (2005)

PhysicalActivityevenhelpsYourBrain!

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DecreasedActivitydecreasesInsulinSensitivity

Med Sci Sports Exer 44(2), 225-231 (2012)

Increasedpost-mealglucoselevelsandmorevariabilityin24-hourlevelsfromlowesttohighestconcentrations

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Areyouan“ActiveCouchPotato”?

Exer Sport Sci Rev 38(3), 105–113 (2010)

Prolongedsittingisadistincthealthriskfactorfromtoolittleexercise

Action:breakupsedentarytimetogainhealthbenefits.

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BeActive:• Parkawayfromthestore• Walkthedog• Playwiththekids• Standupoccasionallytowork• Recreation:hunt,fish,golf,cycle,sail,ski,etc.

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“God,grantmetheserenitytoacceptthethingsIcannotchange,ThecouragetochangethethingsIcan,Andthewisdomtoknowthedifference.”

ManageStress:

ReinholdNiebuhr(1892-1971)

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“...goodhealthismorethanjustexerciseanddiet.It’sreallyapointofviewandamentalattitudeyouhaveaboutyourself.”

....AlbertSchweitzer

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“HealthyLivingIstheBestRevenge”ArchInternMed,169(15),1355-1362(2009)