Keep fat away
Forty odd years ago, when I started practicing medicine, we seldom checked if people under 45 years of age had elevated blood sugars or an abnormal lipid profile. We made cursory enquiries about “family history of diabetes” and that was it. This was before the era of health insurance and master health check ups. So most people were not even aware whether their family members actually did have diabetes. The processed food industry was also in its infancy, and packaged foods with unhealthily high levels of trans fats, salt, chemicals, fructose and sugar were either not available or prohibitively expensive.
Times have changed. We are now a prosperous nation, and most of us consume calories in excess of our physical requirement. We also have a sedentary lifestyle. The emphasis is on long hours of study or work with physical activity an unwelcome intruder. Mechanised transport has replaced walking, and even the bicycle is not as popular as it used to be.
Now, many people over 25 are obese. They have a BMI higher than 30 (obese), and definitely above 23 (overweight). Many have deranged lipid profiles. Some have blood sugar values which are in the “higher normal” range. Women are more affected than men by these changes in lifestyle; 60-70 per cent have menstrual irregularities. When they try (often unsuccessfully) to conceive, they are told that they have PCOS (polycystic ovarian syndrome.)
All these patients have the cardio-metabolic syndrome, a disorder of energy utilisation and storage. It is diagnosed if at least three out of the following five conditions are present.
• Central abdominal obesity is present if the waist:hip ratio > 0.90 (male) or > 0.85 (female). The waist circumference alone can be used and should be less than 94cm or 37in (male), or 80cm or 32in (female).
• The blood pressure is 130/90 or more on three or more occasions.
• High blood sugar levels, with a fasting blood glucose test result of 100 milligrams per deciliter (mg/dL), or 5.6 millimoles per litre (mmol/L), or more.
• High cholesterol, with a level of the blood fat called triglycerides of 150 mg/dL (1.7 mmol/L) or more and the level of high-density lipoprotein (HDL) cholesterol — the 'good' cholesterol —less than 40 mg/dL (1.04 mmol/L) for men or less than 50 mg/dL (1.3 mmol/L) for women.
• A BMI of 30 or more.
• Additional findings which should raise suspicions of metabolic syndrome are fatty liver, gall stones and high CRP (C Reactive Protein).
As we age, we are more prone to develop the cardio-metabolic syndrome. Normally, the food we eat is broken down into simple sugars, which are absorbed, utilised for energy or stored in tissues. In order for the glucose to be broken down, adequate amounts of insulin need to be produced by the pancreas. Metabolic syndrome is due to a type of insulin resistance where more and more insulin needs to be produced to keep the sugars under control. This insulin resistance leads to abdominal obesity, high uric acid levels, abnormal lipid profile and eventually (when supply fails to keep pace with demand) frank diabetes. In women it is one of the causes of PCOS. Metabolic syndrome X results in a 20 per cent higher risk for stroke and heart attacks.
The risk factors for developing metabolic syndrome should be tackled in childhood. Despite heavy academic schedules, 30 minutes of non-stop active exercise is essential from the age of five. This should be maintained all through life.
Keep a watch on the waist circumference, weight and BMI. Losing as little as 15 per cent of the additional body weight can reverse many of the changes responsible for the metabolic syndrome.
Eat a sensible high fibre diet, low in fat and processed food with at least 4-6 helpings of fruits and vegetables. Try to use only half litre of oil a month per family member. Avoid ghee, vanaspathi and palm oil.
Smoking or being around smokers increases the risk of insulin resistance.
After 3-6 months of dieting, walking and other lifestyle changes, if the abnormal biochemical values do not return to normal, your doctor can help you with medications to help your body fight the insulin resistance.
Metformin helps the body to efficiently utilise glucose and reverses some of the insulin resistance. The statin group of drugs corrects the lipid profile. Blood pressure can usually be brought to normal with medication. Since no particular group of drugs has been proved to be superior to another, your physician will be able to prescribe what is best for you. Prevention of heart attacks and strokes may require a nightly dose of (75mg) aspirin.
Dr Gita Mathai is a paediatrician with a family practice at Vellore. Questions on health issues may be emailed to her at firstname.lastname@example.org