Syndrome X
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Syndrome X
Dr Bob Lister, a consultant in clinical nutrition and Chair of the Institute of Brain Chemistry & Human Nutrition at the London Metropolitan University, investigates Syndrome X, a condition which is closely linked to the epidemic of obesity that is overtaking developed societies worldwide.
He explains the mechanisms of Syndrome X – and the simple dietary and lifestyle measures that can be used to combat it.
The X Threat
What is Syndrome-X
What Causes Syndrome-X
Symptoms of Syndrome-X
Management of Syndrome-X
Obesity
Dietary Control
Exercise
Micro-Nutrition: Chromium
Micro-Nutrition: Lipoic Acid
Conclusion
The X Threat
The X-Threat has nothing to do with the X-Files but none the less it is a condition that represents a very real threat to the health of the population of the UK and many other countries.
I refer to the metabolic disorder colloquially known as Syndrome-X, or more correctly as Metabolic Syndrome-X – to distinguish it from Cardiac Syndrome-X and Fragile-X Syndrome, two very different conditions. Why, you ask, is this such a threat? And if it is so, why have many of us not heard of it before?
What is Syndrome-X
Syndrome-X is a condition characterised by impaired glucose tolerance and is closely related to Insulin Resistance Syndrome. Indeed the two may be the same condition but may present slightly differently in different individuals.
The name Insulin Resistance Syndrome is a clue to the nature of this metabolic disorder that was first identified in the late 1960s by Professor Reaven in the USA. It is primarily a disorder of glucose metabolism and insulin activity that may affect as many as 1 in 5 of the population. It is estimated that as many as 16 million people in the UK may be affected and 60 million in the USA. As with cancer and heart disease Syndrome-X is a product of life style, nutrition and genetic susceptibility. As with these two diseases there is no simple test to detect the condition but it can be diagnosed by the clinical signs and symptoms characteristic of the disorder. There are biochemical tests such as the measurement of blood insulin levels and a prolonged glucose tolerance test that can be used to support a clinical diagnosis but they are not in themselves sufficiently specific for an accurate diagnosis.
What Causes Syndrome-X
The primary cause of Syndrome-X is an inability of insulin to transport glucose into cells in the normal way. This impairment of glucose transport has given the condition its alternative and descriptive name of Insulin Resistance Syndrome. As blood glucose levels rise following a meal, insulin is released from the pancreas to move glucose from the blood into cells, particularly muscle cells, to be converted into
energy. If this transport system is faulty, leading to a persistent rise in blood glucose, more insulin is released in an attempt to force the glucose into the cells. If the increased insulin levels cannot force all the glucose into muscle, the insulin will cause the excess blood glucose to be converted into fat which is deposited in fat stores and on the walls of blood vessels.
If Syndrome-X is left untreated, many patients with the condition may go on to develop Type2 diabetes formerly known as Non-Insulin Dependent Diabetes (NIDD) or, less accurately, Maturity Onset Diabetes. This latter term has become obsolete since children and young people, among whom lack of exercise and over consumption of high sugar foods are common, started to develop the condition.
Although it is believed that Type-2 diabetes does have a genetic component by far the largest factor in its development is the modern lifestyle where inactivity and a poor diet with a preponderance of high calorific foods are common. It has been estimated that 2.1 million people in the UK have impaired glucose tolerance with major symptoms of Syndrome-X and are at serious risk of developing Type2 diabetes with all the associated adverse conditions that this brings.
Symptoms of Syndrome-X Include:
• Insulin resistance which is characterised by:
Hyperglycemia and Hyperinsulinemia
• Atherosclerosis especially coronary artery disease.
• Hypertension
• Obesity
• Dyslipidemia (disorders of blood fats) e.g.Elevated levels of LDL cholesterol (Bad) & reduced levels of HDL cholesterol (Good); VLDL (a risk factor for heart disease); Slow clearance of fat from blood after a meal.
• Increased thrombotic tendency i.e. increased likelihood of blood clots due to a reduction in clot dissolution.
Consequences of Untreated Syndrome X
Failure to treat Syndrome-X with appropriate changes in lifestyle may result in a range of serious clinical disorders as a consequence of the above pathological changes. These include:
• Type 2 diabetes that may require lifelong treatment with injected insulin or drugs.
• Cardiovascular diseases which include:
Ischaemic Heart Disease (coronary) that may be responsible for 50% of heart attacks; peripheral vascular disease that can lead to amputation of the affected limb; stroke.
• Peripheral neuropathy – nerve damage, particularly of the lower limbs.
• Retinopathy leading to blindness.
• Nephropathy resulting in kidney failure.
• Obesity
• Poor skin and hair quality
• Depression leading to relationship breakdown and possible eventual suicide…
Management of Syndrome-X
It is clear from this catalogue of potentially disabling conditions that Syndrome-X poses a very real threat to the health of the individual. It also has major cost implications for society both in the increasing medical costs involved in its long-term treatment and the social costs resulting from the ensuing disabilities.
The good news is that it can be both prevented and treated with relatively cheap and simple procedures. Although drug treatment can be effective in reducing the elevated blood glucose levels present in most Syndrome X patients, cheaper and simpler dietary/lifestyle strategies can also prove effective.
Obesity
Obesity is common in the majority of people with Syndrome-X, frequently accompanied by a elevated levels of blood glucose. Both can be attributed to chronic calorific intake in excess of that expended, particularly in the form of food with a high glycemic index (GI). This is food that, following ingestion, leads to a rapid rise in blood sugar due to the ease with which the food releases or is converted into glucose in the digestive tract. Typically foods with a high GI are those containing high levels of sugars, natural or added, and/or a high percentage of starches that are rapidly broken down to sugars in the gut. Details of the GIs of foods are outside the scope of this article but they may be found in many popular books on diet and health and on the Internet. (Foods Matter also has a basic GI table. Please send SAE to 5 Lawn Road, London NW3 2XS or request by email – info@foodsmatter.com)
Dietary Control
The first approach in the management of Syndrome-X should be to replace the daily intake of high GI foods with low GI foods. This has the immediate effect of reducing the blood sugar surge that follows the intake of a high GI food and the consequent outpouring of insulin from the pancreas. Low GI foods release their glucose more slowly which means that the pancreas also releases insulin more slowly, allowing the glucose to be absorbed into the cells rather than converted into fat to be deposited in fat stores or more dangerously, into fatty deposits on the arterial walls.
Although all patients with Syndrome-X are not obese and not all obese patients have Syndrome-X there is a substantial overlap. A primary objective in Syndrome-X management should be weight reduction in those with a body mass index greater than 25, with this figure as a target.
A reduction in the total daily intake of carbohydrates will also go some way to reducing elevated insulin level. This will reduce the total calorific intake and, providing it is not compensated for by an increase in calories from fat, should help weight loss.
Exercise
Lack of an adequate level of exercise is a major factor in the development of Syndrome-X. Exercise will reduce circulating blood sugar levels by driving glucose into the muscles to be utilised for generating energy. It will help to increase insulin sensitivity and maintain blood sugar levels within normal limits i.e. less than 9mmol/l. Increasing fitness by exercise has been shown to reduce insulin resistance and increase the efficiency by which glucose can enter muscle cells by as much as 25%.
Exercise should be regular and aerobic in order to help to control the excess insulin. The type of exercise is not important but the aim should be to exercise fairly vigorously for about 20 minutes every day. A brisk walk of about 45 minutes per day can also achieve the desired effects.
Micro-Nutrition: Chromium
Obesity is frequently a consequence of poor nutrition particularly where there is a reliance on high GI foods that result in energy intake exceeding energy expenditure. Ready-to-eat and processed foods frequently have a high GI index and may lack adequate levels of micronutrients. The mineral chromium in particular is important for the maintenance of normal blood sugar levels.There is some evidence that, in subjects with a low intake of chromium, supplementation with this mineral can increase the number of insulin receptors on the cell surface, overcome insulin resistance and facilitate the entry of glucose into the cell.
In order to maintain good health the recommended daily intake of chromium is 50µg (micrograms). Studies have shown that many populations do not reach this level and this is particularly noticeable in pregnant and lactating women and in individuals who consume high levels of processed foods or who are stressed. Many processed foods are not only chromium deficient but may actually increase its excretion. Studies have shown that patients with insulin resistance, impaired glucose to be chromium deficient. (Shils et al 1994). Supplemental chromium has been shown to be of benefit in patients with insulin resistance and those with early Type2 diabetes. (Gibson 1998).
A change to diet containing adequate levels of chromium can help to reduce blood sugar levels and minimise the symptoms of Syndrome-X. Good sources of chromium include whole wheat products, nuts and seeds and fresh vegetables; garlic and onions contain above average levels of chromium. (If the soil in which they grew had available Se. – Ed)
Micro-Nutrition: Lipoic Acid
Another nutrient that has been found to help with the management of Syndrome-X is lipoic acid. This molecule plays a number of roles in glucose metabolism; it can facilitate the uptake of glucose and reduce the level of blood glucose (Jacob). The mechanism of action of this molecule has not been finally established but in addition to its direct effect on insulin resistance it can also reduce some of the adverse effects of elevated blood glucose. These include lowering elevated blood lipids (fats) and improving cardiac function.
Conclusion
Syndrome-X is a powerful indicator of future disease trends, particularly cardiovascular disease and diabetes, in both the developed and developing world. If left unchecked it will lead to major and unsustainable costs to society and has the potential to inhibit growth and development in much the same way that AIDS has, and will have, in Africa. It is incumbent upon the governments of all countries to recognise the significance of Syndrome-X and to initiate measures to limit its spread.
R E Lister
References
Syndrome X, by Dr John Reynolds, Harley Street consultant in Rheumatology, Rehabilitation and Sports Medicine and Dr Ann Allen of the Glycemic Research Institute, Washington, DC. See www.syndrome-x.co.uk
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