The Lifestyle Disease - Home - Alabama Association of...
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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)