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 The UN-Wellness Epidemic Where is the Wellness? By David Seaman, MS, DC, DACBN We often read and hear about the so-called wellness revolution, but where is it? Childhood obesity is on the rise. In 1999, researchers characterized adult obesity as an epidemic.1 Then in 2007, we were told that gestational diabetes is on the rise and this trend is likely related to obesity.2 Also in 2007, researchers reported that pediatric hypertension is increasing in prevalence with the pediatric obesity epidemic.3 Where is this wellness revolution?In a recent study that looked at 20,000 adults, 23.5 percent were obese and 22.7 percent were smokers.4 The most recent report from the American Heart Association published at the end of 2007 indicates that 66 percent of adults are overweight, while 31.4 percent are obese. Seventeen percent of children and adolescents ages 12 to 19 are overweight, along with 17.5 percent of children ages 6 to 11, and 14 percent of children ages 2 to 5.5 Recently reported estimates indicated that the number of overweight and obese individuals is going to increase in the next 10 to 20 years to almost 75 percent of the population. So again, if childhood and adult obesity are on the rise, as is Type 2 diabetes, 23 percent of adults are smokers, and heart disease and cancer are still going strong, where is the wellness revolution? Seems like a very quiet revolution at best with too few participants, which means there is no wellness revolution at the present time. Most dictionaries provide a similar definition for wellness; it is a state of health achieved by lifestyle choices and habits, such as regular exercise and proper nutrition.6 Experts indicate if individuals partake in such "wellness activities," then disease expression can be reduced. Regarding heart disease, an expert panel made the following comments: According to a case-controlled study of 52 countries (INTER-HEART), optimization of 9 easily measured and potentially modifiable risk factors could result in a 90 percent reduction in risk of an initial acute myocardial infarction. The effect of these risk factors is consistent in men and women across different geographic regions by ethnic group, which makes study applicable worldwide. These 9 risk factors included cigarette smoking, abnormal blood lipid levels, hypertension, diabetes, abdominal obesity, a lack of physical activity, low daily fruit and vegetable consumption, alcohol over-consumption, and stress.5 With the above in mind, it should be clear that we are in desperate need of a wellness revolution, as UN-wellness is the norm. The Metabolic Syndrome: A Wellness Marker? Despite all the promotions about a wellness revolution, there is presently no way to measure wellness. That is, we have no wellness quotient that allows for an accurate prediction of future health or disease. What should we do? Research does suggest that the absence of the metabolic syndrome can function as a marker of one's wellness potential. The metabolic syndrome is also known as syndrome X and the insulin-resistance syndrome. A few years ago, researchers followed 208 apparently healthy, nonobese subjects for four to 11 years after baseline measurements of insulin resistance were made. The purpose was to correlate insulin resistance at baseline to the development of various clinical events including hypertension, coronary heart disease, stroke, cancer, and Type 2 diabetes.7 The subjects divided into tertiles of insulin resistance at baseline: the most insulin-resistant tertile, intermediate insulin-resistance, and no insulin resistance. During the follow-up period, 40 clinical events occurred among 37 subjects, including 12 hypertension, three hypertension and Type 2 diabetes together, nine cancer, seven coronary heart disease, four stroke, and two Type 2 diabetes. Twenty-eight of the 40 diseases occurred in 25 individuals who were part of the most insulin-resistant tertile. The other 12 diseases developed in the group with an intermediate insulin-resistant tertile. No diseases developed in the subjects with normal insulin sensitivity, which the authors noted "seems to be truly remarkable."7 What exactly is syndrome X? It is characterized by several biochemical changes.8 insulin resistance, hyperinsulinemia (and hyperglycemia), increased triglycerides, decreased HDL cholesterol, increased LDL, hyperuricemia and reduced fibrinolysis. The outcome of these changes is an over-expression of inflammatory biochemistry, which is likely why so many diverse diseases are promoted by the presence of syndrome X. In the clinical setting, there is a simple way to determine who is likely to have syndrome X. If three or more of the following are present, it is likely that the patient has syndrome X:5
The percentage of your patient population that suffers with syndrome X depends on their age, weight and lifestyle. Not surprisingly, syndrome X is more common in middle aged and older individuals.9 In short, depending on whom you read, it is estimated that 40 million to 75 million Americans are likely to be suffering with syndrome X. It is important for patients not to make the following mistake. Many people assume they are healthy because they are of normal weight. However, evidence suggests that syndrome X is quite prevalent in those with a body mass index (BMI) below 25, which many consider normal. Indeed, it estimated that 11.1 to 21.3 percent of individuals with a BMI 23.0 to 26.9 have the metabolic syndrome and would likely benefit from weight loss, improved dietary intakes, and physical activity programs, all of which are classically accepted wellness strategies.10 Dietary Drivers of Syndrome X Researchers indicate that systemic inflammation promotes insulin resistance. Grimble states: "Evidence at present favors chronic inflammation as a trigger for chronic insulin insensitivity, rather than the reverse situation."11 Interestingly, we all know that eating properly and exercising regularly are healthy practices; however, we now know that each functions to reduce inflammation.12 With respect to nutrition, over-eating is the first problem that must be addressed. It is now well-known that excess adipose tissue leads to a systemic pro-inflammatory cytokine imbalance that promotes insulin resistance.13 This situation is easily resolved, for we know the dietary source of our excess calories. The foods that we tend to over-eat are those high in calories and low in fiber, which increase blood sugar, insulin levels and increase body fat. The most notorious of such calorie sources are refined sugar, refined flour, and omega-6 and trans fatty acids. Unfortunately, these "foods" make up about 60 percent of calories consumed by the average American.14 Foods that should be consumed to fight syndrome X include: vegetables, fruit, modest amounts of nuts and healthy protein (lean meat, skinless chicken, and fresh fish). Franco et al. use the term "polymeal" when describing a diet that consists of these foods. They estimate about a 65 to 85 percent reduction in the expression of heart disease if one adheres to this eating pattern.15 I simply refer to it as an anti-inflammatory diet or "deflaming." My website, www.deflame.com provides free anti-inflammatory nutritional information. Supplements That May Help Reduce Insulin Resistance Patients need to know that supplements cannot counteract the negative effects of diet. While most know this intuitively, many still look for loopholes. When considering supplements for diabetes and other conditions, I think it is important to adopt a mindset for supplementing that is consistent from condition to condition. And this is because we now know that most degenerative diseases are caused by chronic inflammation, so our supplemental approach should be supportive of reducing inflammation.12 Interestingly, the supplements that have anti-inflammatory properties are also needed for proper insulin sensitivity. A multivitamin is a wise choice for all, and it appears that we should all consider taking magnesium, omega-3 fatty acids, and vitamin D as a foundational program of supplementation.16-21 Foundations for Wellness As stated earlier, wellness is defined as a healthy state achieved with proper lifestyle choices. The keys are regular exercise, anti-inflammatory nutrition, mental fitness and supportive relationships. At present, most Americans are pursuing disease, not wellness, and the epidemic proportions of the metabolic syndrome X is a strong example. Clearly, UN-wellness is the current norm and this needs to change. References
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All Rights Reserved, Naturopathy Digest, 2011.
Date Last Modified - Friday, 17-Oct-2008 12:11:17 PDT
About the Author: Dr. David Seaman is the author of Clinical Nutrition for Pain, Inflammation and Tissue Healing. He received his bachelor's degree in biology from Rutgers University, and then attended 