Diet and Lifestyle

According to information from the American Heart Association, almost 50 million Americans can be diagnosed as having Metabolic Syndrome.

What is Metabolic Syndrome?
Metabolic Syndrome is an umbrella term to describe someone suffering from a combination of the following conditions:
1. Abdominal obesity
2. High triglycerides
3. Low HDL (good) cholesterol
4. High LDL (bad) cholesterol
5. High Blood Pressure
6. Insulin resistance

Who is at danger for developing Metabolic Syndrome?
Typically middle age people who are eating more and exercising less.

Abdominal Obesity
Abdominal obesity is obesity centralized to the abdominal area that is out of proportion with fat stores in the rest of the body. A disproportionately large “waist circumference,” is considered a high risk factor for many diseases including type 2 diabetes, hypertension, cardiovascular disease, and osteoarthritis that affects mostly the knees, but also the hips and back.

How much fat Is considered abdominal obesity?
Body scans and MRIs can determine with great accuracy the degree of abdominal obesity someone may have, but these tests are very costly and inconvenient and to be truthful are not needed to reveal the obvious. Someone who a big belly has abdominal obesity.

Still needing science to prove to patients that they are indeed abdominally obese, many clinicians rely on the Body Mass Index (BMI) measurement. The BMI is determined by computing a number based on the height and weight of an individual.

Using the formula above, let’s say you are a woman who weights 140 pounds and is 5 foot-5 inches tall (65 inches). Let’s see how you would do.

Your body weight = 140
Divided by your height in inches squared
65 x 65 = 4225 (140/4225=0.033)
0.033 x 703 = 23.3 Your Body Mass Index and you would be normal.

BODY MASS INDEX RESULTS
-Below 18.5 Underweight
-18.5 – 24.9 Normal Range
-25.0 – 29.9 Overweight
-30.0 and Above Obese

But what if you were a man with some muscle? Say 6 feet tall and a muscle packed 210 pounds. You would have a Body Mass Index of 28.4 and you would be considered overweight!

You can probably see why this method of determining abdominal obesity and general obesity is often criticized. Critics point out that it fails to differentiate between body mass from fat and body mass from muscle. Recently using the BMI formula, researchers took the published weights of professional athletes in the National Football League and the National Basketball Association and determined that nearly all the footballers were overweight and half of them obese.

In addition, many of those tall, muscular and somewhat thin NBA stars were graded as overweight and a handful, including Shaquille O’Neal, arguably the best player in the league, were considered obese. At the time “SHAQ” at 7 foot 1 inch, weighed 320 pounds; few though, would consider him obese.

The BMI should never be used by itself as a diagnostic tool in determining health risks from obesity, but only one of many tools in guiding the patients towards a more healthy lifestyle.

The apples and pears
Some researchers have suggested that the WHR or Waist-Hip Ratio measurement is a more accurate measure of health risks based on being obese. They prefer this test because it takes into account the distribution of fat through the waist and hip area, where we store the majority of our fat.

Fat can be stored as abdominal fat (an “apple” body shape) or around the hips (a “pear” body shape). People who carry their excess fat in their hips are considered to have less of a risk factor than the abdominal obesity people.

To calculate your Waist-Hip Ratio

1. Measure your waist circumference at the belly button. Hold the tape measure straight.

2. Measure your hips at their widest part, that is where your buttocks peak.

3. Divide your waist by your hip measurement.

For women, ideal is a WTR of 0.8 or less. For example a women with a 29 inch waist and 36 inch hips just makes the cutoff.

For men, ideal is a WTR of 0.95 or less. A man with a 34 inch waist would be “ideal” with a 36 inch hip measurement.

In Waist-Hip Ratio, risk is rated by how high the ratio numbers are. For women, the higher the number past 0.8 the greater risk of obesity related disorders. For men, anything over .95, the higher it goes, the highest the risk.

High triglycerides
Triglycerides are fats that are chemically altered in the body so that they can be stored and then used later to meet our body’s energy needs. When we need to burn that fat, we release hormones that free the triglycerides from the fat cells. Too much stored fat or triglycerides in the blood is called hypertriglyceridemia and is linked to coronary artery disease and diabetes.

LOW HDL
Cholesterol does many wonderful things in our body which is why we need it. What we especially need to have is normal levels of the “good” cholesterol, HDL (high-density lipoprotein), because the HDL cholesterol seems to protect against heart attack and stroke by carrying away or preventing the bad cholesterol “LDL” from building up plaque on arterial walls. Low HDL, low protection.

HIGH LDL
High levels of LDL puts people at risk for heart disease as mentioned above because it builds plaque. You need to exercise and watch your diet in order to start bringing your LDL numbers down.

BLOOD PRESSURE
The well known remedies for reducing blood pressure without medication are to:
1. Lose weight, the more overweight you are, the greater the risk you will have for high-blood pressure.
2. Reduce salt intake. Most sodium comes from packaged and frozen foods.
This is yet another reason to eat your foods in their freshest and most natural form, go for vegetables.
3. Change your eating habits to reduce portions.
4. Exercise.

Insulin Resistance Syndrome
Our bodies DO need sugar (glucose) as a fuel for our cells to perform their daily cellular functions. When we eat sugar or foods that are broken down into glucose such as high-glycemic carbohydrates, our body’s digestive process puts that glucose into the blood stream for the cells to collect and utilize. The cells rely on the pancreas to monitor the blood levels and to alert them when glucose is abundant. The pancreas does this by secreting insulin which circulates through our bodies delivering the message to the cells of glucose’s presence.

In perfect balance, when we eat carbohydrates and produce glucose, the cells use it up as energy and there is little left over.

When our cells ignore insulin and become resistant
Over the course of years as we get older, become more sedentary, and our diets become “sugar loaded,” we process more glucose than our cells can use and the excess floats around in our blood, or is turned into fat in the cells.

Insulin Resistance also increases the symptoms and/or risk factors associated with metabolic syndrome, contributing to:

1. Accumulation of body fat
2. Obesity
3. Elevated triglycerides
4. High blood pressure.
5. Acceleration of the aging process.

DIET
It is commonly accepted that eating large amounts of simple carbohydrates (pastas, breads, and sugar filled foods) could lead to Insulin Resistance, elevated cholesterol, elevated triglycerides, and obesity. For this reason, as part of our program, we recommend that our patients change to a low-glycemic index diet.

The Glycemic Index is the rate that carbohydrates break down into sugar in the blood. The best source of low-glycemic carbohydrates are vegetables. Vegetables are slow burning carbohydrates and help keep insulin levels steady.

A diet rich in vegetables, proteins, good fats in the form of omega-3, and water is optimal for a long health span.

It is important to point out that a single diet will not work for everyone. To optimize your nutritional needs you should visit with an experienced health care professional well versed in the issues of metabolic syndrome and nutrition.

Insulin Resistance Syndrome and Metabolic Syndrome Research
Insulin Resistance Tied To Age-Related Muscle Loss
Writing in the medical journal Diabetes and Metabolism, researchers say: “…insulin resistance could be involved in age-related muscle protein loss, progressively leading to sarcopenia. Therefore in a more general concept, insulin resistance found in many clinical settings, could be considered as a contributor to muscle wasting.”

What is the Effect of Insulin Resistance and Loss of Lean Muscle (Sarcopenia) As We Age?
Researchers writing in the Journal of The Federation of American Societies for Experimental Biology say: “A reduced response of older skeletal muscle to anabolic stimuli (exercise & diet) may contribute to the development of sarcopenia. Skeletal muscle protein synthesis is resistant to the anabolic action of insulin in older subjects, which may be an important contributor to the development of sarcopenia.”

Metabolic Syndrome and Stroke
Researchers writing in the Archives of Internal Medicine say that preventing and controlling Metabolic Syndrome is likely to reduce risk of stroke.

Stress at Work and Metabolic Syndrome
Metabolic Syndrome is a combination of symptoms including high blood pressure, abdominal obesity, insulin resistance and others related to coronary heart disease.

Research and Recent News on Alzheimer’s Disease

How Many Animals You Can Name In One Minute, May Help Determine Risk of Alzheimer’s Disease
Researchers reporting this past Tuesday said that the names of animals (such as Zebra and Giraffe) maybe used to determine who could be in the earliest stages of Alzheimer’s disease.

A study says that common words learned later in life typically disappear from the vocabulary of people in the early stages of Alzheimer’s Disease. An example given is with the names of animals.

Because we typically learn “Dog” and “Cat” in our earliest years, people in the early stages of Alzheimer tend to remember the words, yet other animal names learned later in life, (after age 5) were forgotten, (i.e., words like zebra and giraffe).

In one study, participants were asked to name as many animals as they could in one minute, “healthy” people could list 20-25. Alzheimer sufferer’s could only list 10-15, a significant drop in vocabulary.

You can read more at BBC

What Some Researchers Say You Can Do To Fight Off Memory Loss
Other researchers reporting Wednesday said that the tools to fight off memory loss associated with aging is to:

– Be physically fit
– avoid stress
– be socially active
– learn new things
– and “think young”

They also said that omega-3 (a fish oil) “may reduce the cell inflammation that triggers a decline in memory.”

Read More 

More On Insulin and Aging
A new study, to be published, says that high insulin levels, among both diabetics and non-diabetics, may contribute to Alzheimer’s disease.

To quote the authors of the study “Although this model has obvious relevance for diabetes mellitus, hyperinsulinemia and insulin resistance are widespread conditions that affect many nondiabetic adults with obesity, impaired glucose tolerance, cardiovascular disease, and hypertension. Our results provide a cautionary note for the current epidemic of such conditions, which, in the context of an aging population, may provoke a dramatic increase in the prevalence of AD (Alzheimer’s).”

You can read the entire article at the
Journal of Neurology

Obesity, High blood Pressure, High Cholesterol and Alzheimers Risk
Study published in October 10, 2005 issue of the Archives of Neurology

Midlife obesity puts you at a higher risk for dementia and Alzheimer’s disease than being at normal weight. The researchers noted: “Midlife obesity, high total cholesterol level, and high systolic blood pressure were all significant risk factors for dementia….”

Read the abstract

Examination of the effects of testosterone deficiency on Alzheimer’s Disease
Gouras GK, Hauxi X, Gross R, et al. Testosterone reduces neuronal secretion of Alzheimer’s -amyloid peptides Proc Natl Acad Sci U S A. 2000;3:1202-5.

Interpretation: Examination of the effects of testosterone deficiency on Alzheimer’s Disease

The researchers noted: “Increasing evidence indicates that testosterone, especially bioavailable testosterone, decreases with age in older men and in postmenopausal women….These results raise the possibility that testosterone supplementation in elderly men may be protective in the treatment of Alzheimer’s Disease

Melatonin Research

Blood Pressure
Scheer FA, Van Montfrans GA, van Someren EJ, et al. Daily nighttime melatonin reduces blood pressure in male patients with essential hypertension. Hypertension 2004;43:192-7.

Study: Researchers sought to examine whether hypertension could be lowered by better sleep.

The researchers stated: “In patients with essential hypertension, repeated bedtime melatonin intake significantly reduced nocturnal blood pressure. Future studies in larger patient group should be performed to define the characteristics of the patients who would benefit most from melatonin intake. The present study suggests that support of circadian pacemaker function may provide a new strategy in the treatment of essential hypertension.”

Melatonin’s Beneficial Effects on Night-Time Blood Pressure and Women Aged 47 to 63
Researchers writing in the American Journal of Hypertension examined the question: “The nocturnal decline of blood pressure (BP) is almost coincident with the elevation of melatonin, which may exert vasodilatating and hypotensive effects. In this study we investigated whether prolonged nocturnal administration of melatonin could influence the daily rhythm of BP in women.”

How was the study conducted?
“In a randomized double-blind study, 18 women, 47 to 63 years of age (nine with normal blood pressure and nine being treated treated for essential hypertension) received a 3-week course of a slow-release melatonin pill (3 mg) or placebo 1 hour before going to bed. They were then crossed over to the other treatment for another 3 weeks.”

What did they conclude?
“In comparison with placebo, melatonin administration did not influence (daytime) BP but did significantly decrease nocturnal systolic, diastolic, and mean BP without modifying heart rate. The effect was inversely related to the day–night difference in BP…These data indicate that prolonged administration of melatonin may improve the day–night rhythm of BP, particularly in women with a blunted nocturnal decline.”

Cagnaccia A, Cannolettaa M, Renzia A, Baldassaria F, Aranginob S, Volpea A. Prolonged Melatonin Administration Decreases Nocturnal Blood Pressure in Women. American Journal of Hypertension. Volume 18, Issue 12, Pages 1614-1618

Immune Stimulation
Poon AM, Liu ZM, Pang CS, et al. Evidence for a direct action of melatonin on the immune system. Biol Signals. 1994 Mar-Apr;3(2):107-17.

From the abstract: “Pineal melatonin modulates the mammalian immune system. In vivo studies showed that melatonin enhanced the natural and acquired immunity while in vitro studies demonstrated its inhibitory influence.”

Melatonin, Immune Function and Aging
Researchers writing in the medical Journal Immunity & Aging say: (From the abstract) “Aging is associated with a decline in immune function (immunosenescence), a situation (sp) known to correlate with increased incidence of cancer, infections and degenerative diseases….Melatonin has the potential therapeutic value to enhance immune function in aged individuals and in patients in an immunocompromised state.”

Venkatramanujam Srinivasan, Georges J.M. Maestroni, Daniel P. Cardinali, Ana I. Esquifino, S. R. Pandi-Perumal and Sandra C. Miller. Melatonin, Immune Function and Aging. Immunity & Ageing 2005, 2:17

Read the abstract

Melatonin Randomized Trial for Insomnia in the Elderly
Nalaka S. Gooneratne, MD,MSc, Principal Investigator, University of Pennsylvania
Study start: October 2004; Expected completion: July 2007

From the study details “Melatonin is a hormone secreted predominantly during the sleep period, suspected to have a strong link to the circadian sleep-wake cycle. Melatonin is also available in a pill form and, when administered during the day, tends to have a sedative effect. Clinical trials that have examined the nocturnal effects of melatonin have focused on patients of any age who have insomnia, regardless of their endogenous melatonin levels. Data indicate, however, that individuals with low endogenous melatonin levels may be more responsive to exogenous melatonin. Generally, melatonin levels decrease with age; therefore, older individuals with insomnia represent an ideal population in which to study the effects of exogenous melatonin on sleep. This study will provide older adults with insomnia melatonin tablets to determine whether the tablets will increase their sleep.”

Read more about this current research

Melatonin and Alzheimer-like Neurodegeneration
Writing in the medical journal Acta Pharmacologica Sinica, researchers studied the effect of melatonin and cognitive impairment. They wrote: “Alzheimer disease (AD), an age-related neurodegenerative disorder with progressive loss of memory and deterioration of comprehensive cognition, is characterized by extracellular senile plaques of aggregated beta-amyloid (Abeta), and intracellular neurofibrillary tangles that contain hyperphosphorylated tau protein. Recent studies showed that melatonin, an indoleamine secreted by the pineal gland, may play an important role in aging and AD as an antioxidant and neuroprotector. Melatonin decreases during aging and patients with AD have a more profound reduction in this hormone. Data from clinical trials indicate that melatonin supplementation improves sleep, ameliorates sundowning, and slows down the progression of cognitive impairment in Alzheimer patients.” Wang JZ, Wang ZF. Acta Pharmacol Sin. 2006 Jan;27(1):41-9.

Read the abstract here

Does Melatonin Protect Vision As We Age?
Researchers writing in the Journal of Pineal Research say that Melatonin maybe beneficial in preserving visual functions.

Excerpts from the study abstract:
“Current evidence suggests that melatonin may act as a protective agent in ocular conditions such as photo-keratitis, cataract, glaucoma, retinopathy of prematurity and ischemia/reperfusion injury.

These diseases are sight-threatening and they currently remain, for the most part, untreatable. The pathogenesis of these conditions is not entirely clear but oxidative stress has been proposed as one of the causative factors.

Oxidative damage in the eye leads to apoptotic degeneration of retinal neurons and fluid accumulation. Retinal degeneration decreases visual sensitivity and even a small change in the fluid content of the cornea and crystalline lens is sufficient to disrupt ocular transparency. In the eye, melatonin is produced in the retina and in the ciliary body. Continuous regeneration of melatonin in the eye offers a frontier antioxidative defense for both the anterior and posterior eye.

However, melatonin production is minimal in newborns and its production gradually wanes in aging individuals as indicated by the large drop in circulating blood concentrations of (Melatonin).

These individuals are possibly at risk of contracting degenerative eye diseases that are free radical-based. Supplementation with melatonin, a potent antioxidant, in especially the aged population should be considered as a prophylaxis to preserve visual functions.”

Siu AW, Maldonado M, Sanchez-Hidalgo M, Tan DX, Reiter RJ. Protective effects of melatonin in experimental free radical-related ocular diseases. J Pineal Res. 2006 Mar;40(2):101-9.