Tag Archives: metabolic syndrome

Metabolic Syndrome and Cancer

Metabolic syndrome, the combination of risk factors that 1 in 5 Americans share, may be implicated in the development of cancer in the digestive system.

Known by several different names, such as syndrome X, insulin resistance syndrome, Reaven’s syndrome, and even CHAOS in Australia, metabolic syndrome (MetS) is usually diagnosed if the patient has three or more of the following: obesity (measured by BMI greater than 29 or a waist to hip ratio), triglyceride levels above 150 mg/dL, HDL cholesterol below 40 mg/dL, high blood pressure (diastolic greater than 130), and fasting blood sugar over 100. Other factors, such as insulin resistance, may be used to determine the diagnosis.

The Cooper Clinic in Dallas, TX provided 33,230 men for the study on digestive system cancers. The men were followed for over 14 years. Adjustments were made for cardiorespiratory fitness to remove a common difference between the physically fit and those with MetS. The study concluded that having MetS did correlate strongly with cancer of the digestive system. In particular, two of the common MetS factors, obesity and high blood sugar, were associated with cancer:

Our results support the hypothesis that metabolic syndrome is positively associated with mortality from cancers of the digestive system. Interventions that reduce abnormalities associated with the syndrome could reduce risk of premature death from these cancers.

Treatment for MetS is varied; many doctors try a reduced calorie, low fat diet to reduce one or more of the risk factors (usually, weight and blood pressure). A high failure rate is seen, usually attributed to “lack of compliance” by the participants. Drugs for blood pressure control, cholesterol, and triglycerides are often used. In my case, those attempts failed to achieve a good result. But a low carbohydrate diet combined with niacin (to help reduce triglyceride levels which did not respond to diet alone) removed all of the risk factors.

Low carbohydrate diets seem to work better for most people. Many, myself included, are not inclined to cheat on the diet because they never feel hunger. One study in the journal Nutrition & Metabolism noted:

Carbohydrate (CHO) restriction is one of several strategies for reducing body mass but even in the absence of weight loss or in comparison with low fat alternatives, CHO restriction is effective at ameliorating high fasting glucose and insulin, high plasma triglycerides (TAG), low HDL and high blood pressure.

The Glycemic Index Fraud

People are often alarmed at my low carb diet, predicting all sorts of dire consequences for my future health. Often, the well meaning recommendations come in the form of platitudes like “eat a balanced diet”, yet the people can rarely tell me what that means. Would a balanced diet be one exactly equal in the percentage of calories from the three macronutrients? If so, that would be a relatively low carb diet, with about half the carbohydrates the low fat devotees recommend. Usually people use this term interchangeably with “normal diet”, another meaningless term.

But the more informed about nutrition will prescribe specific foods they think are appropriate. The new favorite is to recommend “low glycemic index” foods. The idea is that you need carbohydrates so you eat the good ones, not the bad ones. And that might work for some people, even though you don’t really “need” carbohydrates.

People consuming the standard American diet of 400 or so grams of carbohydrates might benefit from thinking about the type of carbs they are consuming. But it isn’t an appropriate substitute for reducing total carbohydrates. Especially for someone overweight, with metabolic syndrome, high triglycerides or blood sugar issues.

The reason is the very nature of how the glycemic index is created. As Dr. Eades explains:

Young, healthy subjects consume a test dose of glucose (or sometimes 50 grams of carb from white bread, which is also a common standard) and have their blood sugar curves measured. They then come in on subsequent days and consume the test foods (the potato, beans, tomatoes, whatever) and have their blood sugar checked over the next two hours to create the blood sugar curves driven by the carbs in these foods. These curves are compared to the pure glucose curves and a glycemic index is created.

I am no longer a “young healthy subject”, so the glycemic index isn’t appropriate for me. Not only that, but even if you are a “young healthy subject” (or think you are), it might not apply to you either. The index itself is an average of hundreds of people, and in every study and trial you always have “outliers”, those who fall out of the average range of responses. Humans are complex beings, and we react differently to foods. Starches like potato might send your blood sugar into the stratosphere, as could be expected, but so might oatmeal. Diabetics, who test their blood sugar regularly, can tell you the foods that trigger an increase in blood sugar in them, but may not in others.

A study published in the American Journal of Clinical Nutrition noted that the glycemic index was not useful in improving the markers for metabolic syndrome. The following is a slightly edited conclusion from the report (the original is at the link, and includes the exact lab values of each marker mentioned in the quote):

At the end of the 11-wk intervention periods, the decreased GL test foods did not change fasting plasma glucose … or insulin concentrations compared with increased GL test foods. Serum total cholesterol, LDL-cholesterol, HDL-cholesterol, and triacylglycerol concentrations were also not significantly different for decreased and increased GL test foods, respectively. Finally, proinflammatory (high-sensitivity C-reactive protein, interleukin-6, tumor necrosis factor-{alpha}, monocyte chemoattractant protein 1) and prothrombotic (plasminogen activator inhibitor 1) markers were not affected. Glucose and lipids were also analyzed after 1 and 5 wk of intervention and were not affected by the intervention.

What does work to reduce these markers? Total carbohydrate restriction:

The results support the use of dietary carbohydrate restriction as an effective approach to improve features of MetS [metabolic syndrome] and cardiovascular risk.

The glycemic index may have its uses, but it is no substitute for carbohydrate reduction in those trying to improve weight, metabolic syndrome or blood sugar issues.

15 Months Later

15 months ago I weighed 247 pounds, took hydrochlorothiazide (HCZT) for high blood pressure, Prilosec OTC for GURD, and had triglycerides of 344. My BP was 140/96, my waist size was creeping up on 42″, my HDL cholesterol was 20 and my fasting glucose level was 103. I had more than three of the indicators of “metabolic syndrome” — in fact, I had them all — increasing my risk for heart disease, stroke and diabetes:

According to the American Heart Association and the National Heart, Lung, and Blood Institute, metabolic syndrome is present if you have three or more of the following signs:

  • Blood pressure equal to or higher than 130/85 mmHg
  • Fasting blood sugar (glucose) equal to or higher than 100 mg/dL
  • Large waist circumference (length around the waist):
    o Men – 40 inches or more
    o Women – 35 inches or more
  • Low HDL cholesterol:
    o Men – under 40 mg/dL
    o Women – under 50 mg/dL
  • Triglycerides equal to or higher than 150 mg/dL

I wanted to avoid taking statins, a class of drug that has some side effects for some people. In my About page I have the course of action taken over a few years to try and get the situation under control. But nothing seemed to work until my doctor suggested I try reducing carbohydrates to see if I respond. I picked up Protein Power from the local bookstore, started the diet, and responded, very quickly. I then bought The Protein Power Lifeplan, the updated book, and found it a great help. (If you are only going to buy one, get Protein Power Life Plan).

Now, 15 months later, I have lost 44 pounds down to 203 (still 10 – 15 pounds overweight, but progress nonetheless). My size 36 pants are just starting to get a little loose, and I long ago abandoned the size 42, 40 and 38 size pants I wore over the past year and a half. I haven’t taken the HCZT for high blood pressure in over a year … today, it was 122 / 62 … and I stopped taking Prilosec OTC right after starting the diet. My triglycerides dropped first to 103 (from 344), then rose back to 143 as I have transitioned into the maintenance phase of the diet. My fasting glucose is now under 100, at 98. My HDL cholesterol, once at 20, is now 34, just 6 points shy of the desired 40.

My doctor is pleased, I am pleased, but more importantly, I feel great. The low carb way of eating is one I can tolerate long term, and plan to continue on this diet for the rest of my life.