stephen holt md-obesity pre diabetes and metabolic syndrome x

8/8/2019 Stephen Holt MD-Obesity Pre Diabetes and Metabolic Syndrome X

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OBESITY, PREDIABETES AND

METABOLIC SYNDROME X

An evidence-based part of a lifestyle program to

combat Syndrome X

Stephen Holt MD, Scientific Advisor to

Natural Clinician LLC


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THE UNKNOWN EPIDEMIC


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SUPER-SIZING AMERICA

Americans exude

complacency about

their overweight status Obesity is part of a

metabolic syndrome

Syndrome X is under

diagnosed and often

mistreated by

conventional medicine


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DEFINITION: SYNDROME X

Third Report of the NCEPExpert panel, on

Detection, Evaluation and Treatment ofHigh

Blood Cholesterol in Adults. JAMA, 3, 287,2002

Abdominal Obesity. Waist M > 100 , F > 88cm

Hypertriglyceridemia > 150mg/dL

Low

HD

L,M

< 40mg/dL, F < 50 mg/dL Hypertension > 130/85 mmHg

High fasting blood glucose > 110mg/dL


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SYNDROME X PREVALENCE US

ADULTSATP 111, JAMA, Jan 16, 2002

8814 Participants

Data 1988-1994 with 2000 census data 47 million US residents with Syndrome X

Forbes Magazine, August 6, 2001

70 million Americans with Syndrome X

Children 2% prevalence ?


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SYNDROME X PREVALENCE

Overall prevalence: 21.8 23.7%

Age range 20 29 years: 6.7%

Age range 60 69 years: 43.5 %

Ethnic Variation (approx)

Hispanic

M27 %, F 36 %

White M 24 %, F 22 %

African American M 17 %, F 25 %


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REDEFINING SYNDROME X

Classic Definition: Obesity,

Hypercholesterolemia, High Blood

Pressure, Linked by InsulinResistance.

Syndrome X, Y and Z.., an

expanded definition incorporating

a novel unifying concept of

common diseases


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SYNDROME X,Y AND Z

G.Reaven MD coined the phrase Syndrome X

S.Holt MD expanded Reavens concept to

Syndrome X,Y and Z to define the globalhealth threat of Syndrome X which causes :

CardiovascularDisease, Diabetes Mellitus,

Tendency to Thrombosis, Female Endocrine

Disorders, Acne, Infertility (PCOS), ImpairedImmunity, Eicosanoid Changes, Inflammation

and Cancer ?


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CAUSES OF SYNDROME X:

The Double Whopper Brain

Sedentary Lifestyle

Genetic TendencySubstance Abuse


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THE PUBLIC HEALTH RISK

Syndrome X increases risk for :

Maturity Onset Diabetes MellitusCardiovascularDisease

CardiovascularDeaths

Deaths from ALL CAUSESAm.J.Epidemiol, 148, 958, 1998.


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INTEGRATED MEDICINE FOR

SYNDROME X

While proper management of the

individual abnormalities of this

syndrome can reduce morbidity and

mortality, it seems unlikely that

management of the individual

abnormalities of this syndromeprovides better outcomes than a more

integrated strategy CDC, Atlanta, Ga.


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SYNDROME X CLINICAL INDEX

SYMPTOMS: glucose intolerance-thirst ,excess urination, mental clouding,

eyesight change, sensory loss, irregular

menstruation (PCOS), lifestyle issues.

SIGNS: obesity, skin change, Candida,hypertension, liver enlargement.

LAB TESTS: glucose, cholesterol, TG, LFT(AST: AAT < 1, normal AP), uric acid etc.


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THE X FACTORS

Insulin resistance

Obesity High blood LDL

Low blood HDL

Slow clearance of

fats from blood

Cholesterol synthesis

in the liver

Blood clotting

Adverse lifestyle

Serum uric acid

Homocysteine


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SYNDROME X : NUTRITION WATCH MACRONUTRIENTS

CHO, FAT, PROTEIN HEALTHY FAT (EPA)

SALT RESTRICTION

FIBER INTAKE


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SYNDROME X : THERAPEUTICS

Soluble fiber eg oat beta glucan hydrocolloid

Soy Protein 25 g/day

Omega 3 fatty acids (EPA)

Chromium

Alpha lipoic acid

Vanadium

Antioxidants eg ellagic acid, bioflavonoids

Starch blockers

Cinnamon

Maitake


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SYNDROME X NUTRITIONAL FACTORS


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THE GLYCEMIC INDEX

Calculations of the glycemic index of

food is probably a waste of time.

Understanding factors that controlgastric emptying rate can result in

inference about the glycemic index.

Slowing gastric emptying slows

glucose absorption relevance in

acute dosing


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GLUCOSETOLERANCEWITH SOLUBLE FIBER

Holt S, et al

Effect ofGel Fiber

Lancet,

March 24th, 1979.


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Holt S, et al

Effect ofGel Fiber

Lancet,

March 24th, 1979.


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Holt S, et al Effect ofGel Fiber Lancet,March 24th, 1979.


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Holt S, et al

Effect ofGel Fiber

Lancet,

March 24th, 1979.


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LOWERING CHOLESTEROL

WHEN THE TREATMENT IS

WORSE THAN THE DISEASE

DIET

EXERCISE

Soluble Fiber, Soy Protein, Omega 3fatty acids, Garlic, and others


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EFFECT OF FIBER Satiety

Slowing stomach

emptying

Altered

absorption in the

small intestine

Lowering of blood

lipids

Beneficial effects on

the Lower bowel

Intrinsic Metabolic

Effects of short

Soluble Fiber (IMEF)

Reductase

Reductase Inhibitor


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HOW FIBER LOWERS

CHOLESTEROL Inhibits digestive enzymes

Inhibits mixing of digestive fats,

starch and protein with a

reduction in energy transfer

(calorie intake) Colonic fermentation of soluble

fiber ( beta glucan) SCFA-statin


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ALPHA LIPOIC ACID

Antioxidant (AGES) Lipo-Hydro

Cataracts

Neuronal damage

Hepatic support

Glucose and insulin regulation


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KEY ENVIRONMENTALHAZARDS


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SYNDROME X : TYPE 2

DIABETES

Insulin Resistance

Compensatory Hyperinsulinism Pancreatic Endocrine Failure

Diabetes Mellitus

Not Inevitable Progression

Cellular ? Metabolic defects?


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ONEDIET FORHEALTH AND WEIGHT

LOSS DOES NOT EXISTHolt S. 1987


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DIETS: DISADVANTAGES

AND LIMITATIONS MASQUERADING LOW CARB

LIFESTYLE

ATKINS DIET (BANTING 1860)

SEARS ZONE

VARIATIONS ON A THEME

ANTI-SYNDROME X DIET (REAVENS) TAILORING NUTRITION WITH BACK

TO BASICS, POSITIVE LIFESTYLE


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WEIGHT CONTROL NOT ONLY A FUNCTION

DIET CALORIE CONTROL

BEHAVIOR MODIFICATION EXERCISE


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SYNDROME X

HYPOGLYCEMIA

TODAY, DIABETES

TOMORROW.Seale Harris, 1924


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Combat Syndrome X

Public

Education

Lifestyle Change

Nutritional Interventions (Clinical Syndrome

X: Nutritional Factors)

Current Allopathic Approaches form back-up

Parental Guidance

Warnings on Food? Litigation?

Forget Fad Diets eg. Atkins, Zone etc.

Special Focus on Specific Populations at risk


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ACTION SYNDROME X

NUTRITIONAL FACTORS

HYPERLIPIDEMIA Beta glucan effect

Chromium

Antioxidant

SUGAR BLOCKER

GLYCEMIC INDEX

Slows glucose

absorption Reduces insulin

surges

ANTIOXIDANT

INSULIN RESISTANCE

alpha lipoic acid

Chromium

WEIGHT CONTROL

Satiety promotion

Appetite supression

HOMOCYSTEINE

B6, B12, Folate

BLOOD PRESSURE

stephen holt md-obesity pre diabetes and metabolic syndrome x

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