I recently attend a seminar held by Designs for Health on the topic of the functional endocrinological approach to the diabesity epidemic. I had the pleasure of hearing from two incredible speakers, Rebecca Murray and Dr Alan Weiss, who gave fantastic presentations and I gleaned numerous clinical pearls that my future patients are going to benefit from tremendously. In this two part series, I’ll break down the factors that are underlying this epidemic and offer some solutions.
What is Diabesity ?
Diabesity (diabetes + obesity) is a multifactorial disease that refers to an epidemic of overlapping systemic and metabolic dysfunctions including obesity, insulin resistance, metabolic syndrome, and Type II Diabetes.
Signs of Diabesity and Metabolic Syndrome
Any 3 of the 5 following criteria indicate diabesity or metabolic syndrome:
- Abdominal obesity
- Men with a waist circumference greater than 102 cm / 40 in
- Women with a waist circumference greater than 88 cm / 35 in
- High triglycerides above 150 mg/dL
- Low HDL cholesterol
- Men < 40 mg/dL
- Women < 50 mg/dL
- High blood pressure
- Systolic < 130 mmHg and diastolic > 85 mmHg
- Elevated fasting blood sugar above 100 mg/dL and Hemoglobin A1c above 5.5
- Also includes systemic inflammation from chronically elevated cortisol and insulin levels and a tendency to form blood clots
Causes of Diabesity and Metabolic Syndrome
There are several factors that influence and cause insulin resistance which leads to metabolic syndrome and diabesity. Certain cultures are more prone to disorders of metabolism such as American Indians, African Americans, Hispanics, and Asians. This genetic predisposition is due to what researchers term the “thrifty” or “survival” gene in these populations. When these cultures are exposed to industrially processed foods like refined flour and sugar, diabetes, obesity and metabolic syndrome becomes rampant.
Environmental influences also have a significant impact on raising insulin and cortisol levels including:
- Dietary toxins like high fructose corn syrup, trans fats, refined carbohydrates (especially wheat), and refined vegetable oils
- Environmental toxins such as BPA, pesticides, phthalates, and heavy metals
- Deficiencies in vitamins, minerals, nutrients, and essential fatty acids
- Chronic stress from emotional, psychological, and physiological factors
- Abnormal gut flora or intestinal dysbiosis due to excessive use of antibiotics, overgrowth of pathogenic bacteria, poor diet, lack of dietary fiber, lack of breast feeding during infancy and being born by c-section
- Lack of physical activity and sedentary lifestyles
- Disrupted sleep patterns
- Use of steroid medications
Signs of elevated insulin levels from insulin resistance
One of insulin’s main jobs is to deliver sugar to our cells where it can be used to produce energy. When insulin is chronically elevated from the influences mentioned above, eventually our cells become deaf to the message insulin is trying to deliver. We end up with high levels of insulin and blood sugar circulating in our blood stream because the sugar can no longer get into our cells. Here are some common signs of insulin resistance:
- Impaired glucose metabolism with elevated fasting and post-prandial blood sugar measurements
- High blood pressure due to insulin promoting retention of sodium and water
- Abnormal cholesterol levels with low HDL and elevated triglycerides, which predisposes us for cardiac disease. Elevated insulin lowers our protective HDL cholesterol production in the liver.
- Abdominal obesity
- Abnormal blood clotting
- Elevated liver function tests due to elevated insulin causes fatty acids to accumulate in the liver causing inflammation and potentially leading to cirrhosis and the need for a liver transplant.
- Hormonal imbalances
- Acanthosis nigrans , which are hyperpigmented patches of skin especially found in the armpits and neck folds
Symptoms of Diabesity and Metabolic Syndrome
- Sugar cravings, especially after meals
- Eating sweets does not relieve cravings for sugar
- Fatigue after meals
- Frequent urination
- Increased thirst and appetite
- Difficulty losing weight
- Slowed stomach emptying
- Sexual dysfunction
- Visual problems
- Numbness and tingling in the extremities
- Excess abdominal fat
Ultimately, chronically elevated insulin levels can lead to the progression to Type II diabetes and is associated with increased incidence of stroke, coronary heart disease, high blood pressure, dementia, and cancer. Diabesity is a disease of the modern lifestyle and is completely preventable and reversible. The entire spectrum of diabesity — from mild to severe increases in blood pressure, cholesterol, and blood sugar, are really just the end effects of poor diet and lifestyle, environmental toxins, and lack of exercise interacting with a genetic pre-disposition. In the next part, I’ll discuss the solutions.