Staggering rise in metabolic syndrome case in NorthAmerica

Metabolic syndrome

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Metabolic syndrome is a cluster of five related health conditions, including abdominal obesity, high blood pressure, high blood sugar, high triglycerides and low HDL or good cholesterol.

Metabolic syndrome is a cluster of five related health conditions, including abdominal obesity, high blood pressure, high blood sugar, high triglycerides and low HDL or good cholesterol.

The rates of metabolic syndrome in the North American population are staggering. It is estimated that one in three Americans has metabolic syndrome. It is further estimated one in four Canadians, or more, may also have this condition.

The consequence of having this condition is catastrophic to human health. It believed to be related to 43% of all deaths in Canada. As the incidence and degree of metabolic syndrome increases, there is direct and proportional decrease in longevity and increase in fatality.

Having metabolic syndrome significantly increases your risk of developing atherosclerosis, cardiovascular disease, heart disease, stroke, Alzheimer’s disease or dementia, diabetes, insulin resistance, liver disease especially NAFLD of non-alcoholic fatty liver disease and kidney disease.

Being overweight is the major risk factor for metabolic syndrome. Having a pear-shaped accumulation of fat around the abdominal or midsection is called truncal obesity. It is a hallmark sign of this condition.

Body mass index or BMI is a measurement of total body fat expressed as a percentage of total body weight. A BMI greater than 30 or 30% total fat content, puts you at high risk for developing this syndrome.

Having three or more of these signs is diagnostic of metabolic syndrome: a waist circumference greater than 40 inches for men or 35 inches for women, blood pressure greater than 130/85 millimetres of pressure units, fasting glycerides greater than 150 mg/dl, fasting blood sugar greater than 100 mg/dl, HDL or good cholesterol reading less than 40 mg/dl.

Eating too much, especially refined sugars and processed carbohydrate foods, is a direct cause of the development of metabolic syndrome in adults. Sugary drinks like pop, fruit juices and alcohol contribute to weight gain and metabolic dysfunction. Also, sugary snacks like candy bars, donuts and refined pastries, ice cream, white bread and snack foods like potato chips contribute to the development of metabolic syndrome.

Other factors that contribute to the development of this condition may include genetics, sedentary lifestyle or lack of daily exercise or movement, cigarette smoking, advancing age or just getting older, thyroid disease, COPD or chronic obstructive pulmonary disease or other lung disease, advanced rheumatic diseases and use of prescription medicines that contribute to weight gain including anti-depressants and other mood stabilizing medicines.

High fasting insulin levels occur with this syndrome. Insulin is a hormone produced in the pancreas that helps the body utilize sugar obtained from dietary sources. Insulin increases cellular absorption of sugar from the blood stream. The amount of insulin released from the pancreas is directly proportional to the amount of sugar the body obtains from food. The higher the sugar content of the food consumed the more insulin is released.

Insulin resistance is the term used to describe the lack of sensitivity to insulin at the receptor on the cell wall. Insulin normally binds to a protein receptor in the wall of the body’s cells. The binding of insulin increases glucose transport across the cell wall membrane into the interior of the cell where it can be broken down to create energy.

Consuming a high content of refined sugar initially increases the amount of insulin released from the pancreas. Over time the body’s cells become sensitized to the higher level of insulin. As a result, the amount of insulin receptors in the cell wall may decrease to accommodate for the unusually high levels of insulin. This may result in a decrease of the number of insulin receptors or a further decrease in a cellular biochemical pathway involving the uptake of sugar.

High intake of sugars can lead to the development of pre-diabetes and diabetes. High blood sugar levels as measured by fasting blood sugar or hemoglobin A1C. Hemoglobin is an iron containing protein in red blood cells that functions to carry inhaled oxygen in the blood stream. The percentage of sugar stuck to the hemoglobin reflects a longer-term snapshot of sustained blood sugar levels over the last 3 months.

Since I have been practicing naturopathic medicine, I have seen the diagnostic limits of hemoglobin a1c dramatically lower. Now a hemoglobin a1C between 5.7 to 5.9% is considered high whereas years ago it was higher. This has led to an increase in the diagnosis of diabetes and the relatively newer term called pre-diabetes.

Diet and lifestyle changes are tantamount to treating metabolic syndrome. Stop eating added sugary foods. Stop or reduce ultra-refined and processed foods. Eat whole foods including fresh fruits and vegetables, whole grains and cereals, nuts and seeds and high-quality protein foods. Get moving and start exercising. Make exercise a daily routine. Take steps to break the vicious cycle that leads to metabolic syndrome.

The information provided in this article does not, and is not intended to, constitute medical advice. All information and content are for general information purposes only.

This article is written by or on behalf of an outsourced columnist and does not necessarily reflect the views of Castanet.

Depression is the most common psychological disorder

Dealing with depression

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Depression is a common psychological disturbance that is characterized by loss of pleasure in life, lack of joy or happiness, melancholic outlook and generalized ill health.

It is the most common psychological disorder in the general population. Ten per cent to 20% of the general population suffer from this affliction at one time or another. Twenty per cent to 50% of patients in general practice are affected by depression to some degree. Thirty per cent to 60% of general hospital in-patients suffer from depression.

Signs and symptoms of this disorder include poor appetite with weight loss or increased appetite with weight gain, lack of sleep or insomnia, too much sleep or hypersomnia, agitation or depression of movement and muscle coordination, loss of interest or pleasure in usual activities, loss or decrease in sexual drive, feelings of worthlessness, self-reproach or inappropriate guilt, diminished ability to think and concentrate and recurrent thoughts of death or suicide.

There are two main categories of depression. Unipolar depression is characterized by one or more episodes of depression alone. Bipolar depression is characterized by episodes of depression alternating with periods of mania. Additionally, seasonal affective disorder (SAD) is another type of depression that occurs with decreased levels of sunshine experienced in the winter months.

Undiagnosed medical illness often presents as depression and should be considered in the evaluation of any sick patient. Hormone dysfunction, infectious disease, cancer, nutritional deficiencies and stress can present with signs and symptoms of depression.

Diagnosis of depression is based on symptoms presented to the clinician. Asking a direct and straight forward question of asking if the patient thinks they are depressed or not, is helpful.

Often referred to as a disease of exclusion, there is not a reliable blood or lab test that confirms the diagnosis of depression. Lab tests rule out other underlying conditions that may cause or contribute to depression.

Anemia, low iron, low Vitamin b12, other Vitamin B deficiencies, hypothyroidism, diabetes and blood sugar irregularities and other abnormalities may be diagnosed through proper blood tests.

Cortisol abnormalities have been suggested to be related to depressive episodes. Both low and high levels and abnormalities in daily rhythm of cortisol levels have been observed in depressed patients. Cortisol levels vary throughout the day and lab tests have a broad range. The clinical utility of measuring cortisol levels does little to change treatment.

Conventional medical treatment of depression is based on drug therapy. Tricyclic antidepressants were discovered in the 1950s and marketed later that decade. Amitriptyline, doxepin, imipramine, and nortriptyline are examples of tricycle antidepressants. While effective they are often not prescribed because of side effects including fatigue, weight gain and digestive disturbance.

Slow serotonin re-uptake inhibitors are a newer category of antidepressant that increases serotonin levels by decreasing its breakdown between adjacent nerves or neurons. Prozac or fluoxetine was the first SSRI drug marketed in the late 1980s for depression. Other SSRIs now include citalopram or Celexa, escitalopram or Lexapro, paroxetine of Paxil and sertraline or Zoloft. They all work by the same mechanism of increasing serotonin levels but have different affinities for different subtypes of serotonin receptors, different half life duration of activity and slightly different side effect profiles.

Atypical antidepressants drugs usually affect more than one type of neurotransmitter including adrenaline, dopamine and serotonin. These drugs include Bupropion or Wellbutrin, Effexor or venlafaxine, mirtazapine and trazadone.

Lifestyle habits are important in helping overcome depression. Daily exercise can be effective in improving moods. Moderate daily aerobic exercise between 30 and 60 minutes in the form of cycling, swimming, walking or other sport is recommended. Also, exercise in outdoor green space appears to be better than sterile, indoor exercise. Sleeping habits are also important in maintaining mood.

A lack of good quality sleep contributes to low mood and depression. Maintaining good sleep habits, such as avoiding stimulation before bedtime, going to bed at the same time and sleeping in a slightly cooler environment is important.

Diet is important in the treatment of depression. Neurotransmitters are made from specific amino acid precursors in our food. Specific amino acids for this purpose include gamma aminobutyric acid or GABA, phenylalanine, theanine, tryptophan and tyrosine. These amino acids are found in good quality protein foods. Highly processed foods are usually low in vitamin and mineral nutrient quality. Specifically, B-vitamins and trace minerals affect brain and neurological function and as cofactors in the manufacture of neurotransmitters. High sugar foods directly affect brain function, cause blood sugar fluctuations and contribute to irregularities in mood and behaviour. Good oils found in fish and vegetable oil such as olive oil help to nourish nerves or neurons in the brain.

Supplements such as B-complex vitamins, trace minerals like chromium, selenium and selenium are important for proper brain and neurotransmitter function. Amino acid supplements such as 5-hydroxytryptophan and tyrosine can improve specific neurotransmitter levels. Herbal medicines including Ashwagandha, Lion’s mane, saffron, Saint John’s wort and Siberian ginseng have also been reported to improve moods.

The information provided in this article does not, and is not intended to, constitute medical advice. All information and content are for general information purposes only.

This article is written by or on behalf of an outsourced columnist and does not necessarily reflect the views of Castanet.

Diabetes drug Ozempic now popular as a weight-loss drug

Double duty drug

Photo: Novo Nordisk

Ozempic and related GLP-1 drugs have taken Europe and North America by storm and have quickly become the darling of the weight loss world.

Since its approval as a weight loss drug, demand for Ozempic and related drugs has skyrocketed. And, as demand has increased, frequent shortages have occurred.

Ozempic was first released as a new drug in the U.S. in December 2017 and shortly thereafter in Canada, in January 2018. Worldwide sales of of it and related drugs quadrupled between 2020 to 2024. The annual sales of the drugsis estimated to be close to $50 billion per year with sales projected to continue to increase exponentially.

Novo Nordisk, the Danish company that makes Ozempic and Wegovy has a current valuation more than $500 billion.

Ozempic, Rybelsus, Wegovy and other related compounds are drugs approved for the treatment of Type 2 diabetes and weight loss in Canada and the U.S. These drugs are related to a group of hormones naturally produced in the human digestive system called incretins. Incretins suppress appetite and stimulate insulin production. GLP-1, or glucagon like peptide, is the classification of these specific drugs that mimic the action of incretins.

Incretin is the name given to a group of metabolic hormones produced in the digestive system after consuming food. The two main incretins are GLP-1 and GIP or gastric inhibitory peptide. They collectively increase the release of insulin and decrease the release of glucagon in the pancreas.

Insulin is a hormone produced in the beta cells of the pancreas located in the upper abdomen. The purpose of insulin is to increase absorption of glucose and sugar from foods consumed by cells throughout the body. That will result in a decrease of blood sugar levels and increase in cellular glucose levels.

Glucagon is a hormone produced in the alpha cells of the pancreas. The purpose of glucagon is to increase blood sugar levels by decreasing glucose and sugar absorption by cells. It also increases the production of sugar in the liver and other organs throughout the body. Glucagon basically counteracts the effects of insulin to help maintain proper blood sugar levels.

The mechanism of action of GLP-1 drugs includes decreased appetite, an increased sense of fullness, a slowing of digestion, a decrease in stomach emptying, a decrease in glucagon production and an increase in insulin production. They also decrease gluconeogenesis, or sugar production, in the liver and other organs.

GLP-1 medications are usually administered as a once-per-week subcutaneous injection. An oral daily tablet and a twice-per-week injection routine are also available. The injection should be given at the same date and time to areas of the abdomen, thigh or upper arm.

With Ozempic and other related drugs, the average weight loss is around 15% of body mass over six to 12 months. Within the first month of use, the average weight loss is five pounds, or 2.4 kilograms. Within three months of use the average weight loss is 15 pounds, or 7.2 kilograms. The average duration of use to see if the drug works for you is three to six months.

The side effects of GLP-1 drugs include nausea, vomiting, constipation, diarrhea, dizziness, gerd, heartburn, gastric paralysis, dizziness, headache, low blood sugar, indigestion, gas and bloating and jaundice. Occasional allergic reactions and skin rashes have been reported. Rare occurrences of pancreatitis, kidney disease, thyroid cancer and bowel obstruction have also been reported, as have emerging adverse effects to mood and increased suicide risk. Other reported side effects include heart palpitations, swollen lymph nodes and trouble breathing. Cases of rare sudden death by heart attack and gastrointestinal complications have been reported and the long-term side effects of these drugs are not fully known yet.

Contrary to popular opinion on the Internet, there is no natural GLP-1-like compounds, such as a vitamin, herb or supplement.

Natural supplements touted for weight loss include bitter melon, bitter orange, caffeine, cayenne pepper, chromium, chitosan, conjugated linoleic acid, fenugreek, fibre supplements like glucomannan, guar gum and psyllium, ginseng, green coffee bean extract, green tea extract, gymnema and red raspberry ketone. These supplements have little benefit in promoting weight loss and have shown inconsistent results.

Berberine obtained from the herbs Barberry, Goldenseal and Oregon grape root is promoted as a natural Ozempic alternative. Some preliminary studies show it has mild GLP-1-like activity. Weight loss is mild in comparison to other GLP-1 drugs. More studies are needed to show its effectiveness.

Ephedra and its related compound, pseudo-ephedrine, have demonstrated weight loss benefit. However, due to the side effect profile of increasing blood pressure, heart attack risk and strokes, it is not recommended.

Eating a whole food, unprocessed diet rich in fresh fruits, vegetables, whole grains and cereals, beans and legumes, nuts and seeds and high quality protein can promote weight loss. Elimination of added sugar products and refined ultra-processed foods eliminates extra calories. Increasing aerobic activity levels can also improve metabolism and aid in weight loss.

The information provided in this article does not, and is not intended to, constitute medical advice. All information and content are for general information purposes only.

This article is written by or on behalf of an outsourced columnist and does not necessarily reflect the views of Castanet.

This article is written by or on behalf of an outsourced columnist and does not necessarily reflect the views of Castanet.

Learn to treat your liver right

A healthy liver is critical

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“Liver disease” is the term used to describe a host of diseases that affect the liver.

The main diseases that affect the liver include hepatitis, fatty degeneration, cirrhosis and liver cancer.

An estimated 25% of the adult population are believed to suffer from some form of liver disease. Non-alcoholic fatty liver disease is by the most common affliction of this vital organ. Viral hepatitis, cirrhosis and liver cancer occur in less than 2% of the adult North American population.

Men and women are equally affected. Individuals who consume large quantities of alcohol, consume excessive amounts of sugars and refined carbohydrates or excessive amounts of fats or consume drugs like acetaminophen in a large amount daily, are exposed to toxic chemicals that, over a time or exposed to certain viruses can develop liver disease.

The liver is a large, dark red organ located in the upper right portion of the abdomen, beneath the diaphragm.

The liver is the largest and most metabolically active organ in the human body. It has more than 500 different functions. Those functions include such broad categories as intermediate metabolism of carbohydrates, fats and proteins, production of many different types of proteins and enzymes including albumen and globulin that help to regulate fluid volume in the blood stream and initiate blood clotting, production of bile that aids in the digestion and absorption of fats, detoxification and removal of foreign material and toxins such as bacteria, drugs, alcohol and other noxious chemicals, storage of fats, proteins, sugar and various vitamins and minerals, helps to maintain the balance of hormones and breaks down older worn out red blood cells and disposes of them through bile.

The liver is one of the most frequently damaged organs in the body. Fortunately, it has an incredible regeneration capacity. It has been experimentally shown that only 10% of liver mass is required to maintain normal liver function.

Jaundice is the yellowish discolouration of the skin, the whites of eyes and other tissues due to excess circulating bilirubin in the blood. Jaundice is not a disease but is usually a sign of underlying liver dysfunction. Bilirubin is a yellow or orange pigment produced by the breakdown of red blood cells and hemoglobin in the liver. Cholestasis results when bile flow through the liver is impaired. Gilbert’s disease is a genetic condition that predisposes to elevated bilirubin levels in the blood. Five percent of the population are believed to have this genetic condition.

Hepatitis is an inflammatory process that causes damage to liver cells. The major causes of hepatitis are viruses A, B, C, alcohol and drugs. Hepatitis A is spread by fecal oral contamination and causes a flu-like illness. Hepatitis B is associated with a wide spectrum of liver disease from a sub-clinical carrier state to acute hepatitis, cirrhosis or liver scarring and liver cancer. It also causes flu-like symptoms but can progress and lead to liver failure.

Chronic hepatitis is an inflammation of the liver that lasts longer than six months.

Ascites is the term used to describe excess fluid in the abdomen and is usually due to chronic diseases, such as cirrhosis of the liver from alcoholism or liver cancer.

A fatty liver is the abnormal accumulation of fat in liver cells. The liver can store up to 20% of its weight in glycogen or a storage form of sugar and up to 40% of its weight in fat, mainly as triglycerides. It occurs when there is a chronic exposure to environmental toxins, excess consumption of alcohol, excessive consumption or genetic predisposition to high dietary fats or a diet high in sugars and other associated refined ultra-processed foods.

Signs and symptoms of liver disease are numerous. Early signs may include fatigue, poor appetite, nausea, vomiting and fever or chills. Distaste for certain foods or cigarettes is an early characteristic sign of hepatitis. Poor digestion, gas, bloating and heartburn can also occur. Hives and joint pains can occur. Jaundice or a yellowish discolouration of the skin can occur. Blood tests to check liver enzymes and bilirubin, and imaging tests such as an ultrasound are the main tests to diagnose liver disease.

Avoiding excess exposure to toxins is important in improving liver function. Avoid, or decrease, alcohol use and drug use, such as acetaminophen or other potentially toxic drugs.

Diet and lifestyle changes are most important when treating liver disease. Decreasing excessive consumption of fructose, glucose, sucrose, honey and other forms of added sugar is important. Limiting refined carbohydrates, such as ice cream, candy bars, pop, baked goods and white bread can be helpful to improve liver function.

Losing weight, especially abdominal girth, with a healthy whole foods diet, can be helpful in reversing fat accumulation in the liver.

Coffee and other natural bitters can help the liver work better. Supplements, such as digestive enzymes, lecithin, berberine, artichoke, beets, dandelion and milk thistle, can also help improve liver function.

The information provided in this article does not, and is not intended to, constitute medical advice. All information and content are for general information purposes only.

This article is written by or on behalf of an outsourced columnist and does not necessarily reflect the views of Castanet.