Tag Archives: Metabolic syndrome

A Herald of Diabetes

The young woman who walked in for a consultation had a scarf wound around her neck. “I came to show you this,” she said, taking it off. There was a dark patch on the back of her neck with ridges and bumps, the skin raised and velvety. “I have already tried fairness creams,” she said. “They only make it worse.”
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The diagnosis was easy. She had a peculiar skin lesion known as acanthosis nigricans.

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The cosmetically disfiguring and aesthetically displeasing lesions usually occur on the neck (where they are clearly visible), armpit, groin, knees or elbows, in short areas with skin folds. Very rarely, it can be found on the fingers or around the lips or in the nipple area. It can occur at any age and in both men and women. It is seen in children and even in babies. The lesions appear gradually and do not itch or pain. This means that they remain unnoticed until they have spread over a large area. Initially it looks like dirt so people try to scrub it off, damaging the skin in the process. Others try to camouflage it unsuccessfully with talcum powder and make up.

Nearly 20 per cent of the population has acanthosis nigricans and the numbers are rising rapidly because obesity is the commonest risk factor. More and more people are becoming overweight in India and the world.

An inactive lifestyle causes weight gain and these two factors together cause relative insulin resistance, which results in elevated glucose levels, an abnormal lipid profile and high blood pressure. These changes are grouped together as the “metabolic syndrome X”. Acanthosis nigricans is one of the early markers of this syndrome. The American diabetic association classified it as a risk factor for the development of diabetes in 2000. In children and adolescents, symptoms of syndrome X or frank diabetes begin to appear within two years of the appearance of acanthosis nigricans.

The disease can also be hereditary and in typical inherited acanthosis nigricans, skin lesions are confined to one half of the body. They spread and increase till a certain age and then remain stationery or regress. In other families the lesions, though present in almost all family members, are not really hereditary. The biggest difference is that they are present on both sides of the body. The family usually has an inactive lifestyle, members are obese and go on to develop diabetes.

Medications can also cause these skin changes as a side effect. The most common offenders are hormones — like oral contraceptive pills (OCP), hormone replacement therapy (HRT), insulin, pituitary extract, growth hormone or systemic corticosteroids. Unfortunately, pituitary extract or steroids may be added to unregulated “natural herbal supplements” or “tonics” so the person may not even know that he or she is ingesting such substances. Sulpha drugs (antibiotic)and nicotinic acid (for high cholesterol) can also cause these.

Certain types of acanthosis nigricans are peculiar to women. It is associated with the polycystic ovary syndrome and appears at adolescence. Such girls are obese and have irregular periods and facial hair.

If you develop acanthosis nigricans, it is worthwhile consulting a physician. Although you may be obese, and that is the commonest cause of these skin changes, some investigations and tests need to be done. This is because the skin changes can (though this is rare) be associated with cancer, particularly in the abdomen. It can appear before any other obvious sign of a tumour. It can also be a part of the spectrum of autoimmune diseases like systemic lupus erythematosus, scleroderma, Sjögren syndrome, or Hashimoto thyroiditis.

There really is no specific treatment for the skin changes in acanthosis nigricans. The disease itself is harmless. The main danger lies in the complications associated with obesity and insulin resistance. Tackling the underlying problem makes the skin lesions fade. Here is what you can do to tackle it:

• If it is due to medication or health supplements, stop taking them.

• Reduce your weight with diet and exercise. Try to reach your ideal body weight (height in meter squared multiplied by 23).

• Eat more protein, fresh fruits and vegetables. Starches and sugars provide empty calories and aggravate insulin resistance.

• Sweat trapped in the folds can make the lesions malodorous. Bathe twice a day with a medicated soap like Neko if that is the case.

Evening primrose oil or fish oil supplements may help.

• Some prescription creams or lotions help lighten the affected areas. These contain modified vitamin A products and are often prescribed for acne.

• Fairness creams do not help.

• Surgical dermal abrasion can be done.

Source:  The Telegraph ( Kolkata, India)

 

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Metabolic Syndrome

Alternative Names: metabolic syndrome X, cardiometabolic syndrome, syndrome X, insulin resistance syndrome, Reaven’s syndrome (named for Gerald Reaven), and CHAOS (in Australia).

Definition:
Suddenly, it’s a health condition that everyone’s talking about. While it was only identified less than 20 years ago, metabolic syndrome is as widespread as pimples and the common cold. According to the American Heart Association, 47 million Americans have it. That’s almost a staggering one out of every six people.

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Indeed, metabolic syndrome seems to be a condition that many people have, but no one knows very much about. It’s also debated by the experts — not all doctors agree that metabolic syndrome should be viewed as a distinct condition.

So what is this mysterious syndrome — which also goes by the scary-sounding name Syndrome X — and should you be worried about it?

Understanding Metabolic Syndrome
Metabolic syndrome is not a disease in itself. Instead, it’s a group of risk factors — high blood pressure, high blood sugar, unhealthy cholesterol levels, and abdominal fat.

Obviously, having any one of these risk factors isn’t good. But when they’re combined, they set the stage for grave problems. These risk factors double your risk of blood vessel and heart disease, which can lead to heart attacks and strokes. They increase your risk of diabetes by five times.

Many people who have either diabetes, high blood pressure or obesity also have one or more of the other conditions, although it may have gone unrecognised.

Individually, each of these conditions can lead to damage to the blood vessels, but together they’re far more likely to do harm. People with these conditions in combination become much more likely to experience heart disease, stroke and other conditions related to problems with the blood vessels.

When a person has such a combination, they’re said to have metabolic syndrome. This is also sometimes called insulin-resistance syndrome (because one of the features is a very high level of the hormone insulin in the blood, which the body doesn’t react to or is ‘resistant’ to) or syndrome X.

There are currently two major definitions for metabolic syndrome provided by the International Diabetes Federation  and the revised National Cholesterol Education Program, respectively. The revised NCEP and IDF definitions of metabolic syndrome are very similar and it can be expected that they will identify many of the same individuals as having metabolic syndrome. The two differences are that IDF state that if BMI > 30 kg/m2, central obesity can be assumed, and waist circumference does not need to be measured. However, this potentially excludes any subject without increased waist circumference if BMI < 30, whereas, in the NCEP definition, metabolic syndrome can be diagnosed based on other criteria, and the IDF uses geography-specific cut points for waist circumference, while NCEP uses only one set of cut points for waist circumference, regardless of geography. These two definitions are much closer to each other than the original NCEP and WHO definitions.

Metabolic syndrome is also becoming more common. But the good news is that it can be controlled, largely with changes to your lifestyle.

Symptoms:
The problems found in metabolic syndrome include:


•Central obesity – fat is laid down around the abdomen rather than spread evenly around the body

•Abnormal fat levels in the blood – specifically, high levels of triglycerides and low levels of HDL (or ‘good’) cholesterol, which can lead to arteriosclerosis (fatty plaques) on the walls of blood vessels

•High blood pressure

•Insulin resistance or glucose intolerance – an inability to use insulin properly or control blood sugar levels very well, which is a very important factor in metabolic syndrome

Prothrombotic state – an increased tendency to make tiny clots in the blood

Proinflammatory state – an increased tendency to inflammation

Having one component of metabolic syndrome means you’re more likely to have others. And the more components you have, the greater are the risks to your health.

Causes:
Experts aren’t sure why metabolic syndrome develops. It’s a collection of risk factors, not a single disease. So it probably has many different causes. Some risk factors are:

*Insulin resistance. Insulin is a hormone that helps your body use glucose — a simple sugar made from the food you eat — as energy. In people with insulin resistance, the insulin doesn’t work as well so your body keeps making more and more of it to cope with the rising level of glucose. Eventually, this can lead to diabetes. Insulin resistance is closely connected to having excess weight in the belly.

*Obesity — especially abdominal obesity. Experts say that metabolic syndrome is becoming more common because of rising obesity rates. In addition, having extra fat in the belly — as opposed to elsewhere in the body — seems to increase your risk.

*Unhealthy lifestyle. Eating a diet high in fats and not getting enough physical activity can play a role.

*Hormonal imbalance. Hormones may play a role. For instance, polycystic ovary syndrome (PCOS) — a condition that affects fertility — is related to hormonal imbalance and metabolic syndrome.

If you’ve just been diagnosed with metabolic syndrome, you might be anxious. But think of it as a wake-up call. It’s time to get serious about improving your health. Making simple changes to your habits now can prevent serious illness in the future.

Risk Factors:
The following factors increase your chances of having metabolic syndrome:

*Age. The risk of metabolic syndrome increases with age, affecting less than 10 percent of people in their 20s and 40 percent of people in their 60s. However, warning signs of metabolic syndrome can appear in childhood.

*Race. Hispanics and Asians seem to be at greater risk of metabolic syndrome than other races are.

*Obesity. A body mass index (BMI) — a measure of your percentage of body fat based on height and weight — greater than 25 increases your risk of metabolic syndrome. So does abdominal obesity — having an apple shape rather than a pear shape.

*History of diabetes. You’re more likely to have metabolic syndrome if you have a family history of type 2 diabetes or a history of diabetes during pregnancy (gestational diabetes).

*Other diseases.A diagnosis of high blood pressure, cardiovascular disease or polycystic ovary syndrome — a similar type of metabolic problem that affects a woman’s hormones and reproductive system — also increases your risk of metabolic syndrome.

Complications:
Having metabolic syndrome can increase your risk of developing these conditions:

*Diabetes. If you don’t make lifestyle changes to control your insulin resistance, your glucose levels will continue to increase. You may develop diabetes as a result of metabolic syndrome.

*Cardiovascular disease.High cholesterol and high blood pressure can contribute to the buildup of plaques in your arteries. These plaques can cause your arteries to narrow and harden, which can lead to a heart attack or stroke.

Diagnosis:
Although  doctor does not typically look  for metabolic syndrome, the label may apply if you have three or more of the traits associated with this condition.

Several organizations have criteria for diagnosing metabolic syndrome. These guidelines were created by the National Cholesterol Education Program (NCEP) with modifications by the American Heart Association. According to these guidelines, you have metabolic syndrome if you have three or more of these traits:

*Large waist circumference, greater than 35 inches (89 centimeters, or cm) for women and 40 inches (102 cm) for men. Certain genetic risk factors, such as having a family history of diabetes or being of Asian descent — which increases your risk of insulin resistance — lower the waist circumference limit. If you have one of these genetic risk factors, waist circumference limits are 31 to 35 inches (79 to 89 cm) for women and 37 to 39 inches (94 to 99 cm) for men.

*A triglyceride level higher than 150 milligrams per deciliter (mg/dL), or 1.7 millimoles per liter (mmol/L), or you’re receiving treatment for high triglycerides.

*Reduced HDL (“good”) cholesterol — less than 40 mg/dL (1 mmol/L) in men or less than 50 mg/dL (1.3 mmol/L) in women — or you’re receiving treatment for low HDL.

*Blood pressure higher than 120 millimeters of mercury (mm Hg) systolic or higher than 80 mm Hg diastolic, or you’re receiving treatment for high blood pressure.

*Elevated fasting blood sugar (blood glucose) of 100 mg/dL (5.6 mmol/L) or higher, or you’re receiving treatment for high blood sugar.

Treatment:
The first line treatment is change of lifestyle (e.g., Dietary Guidelines for Americans and physical activity). However, if in three to six months of efforts at remedying risk factors prove insufficient, then drug treatment is frequently required. Generally, the individual disorders that comprise the metabolic syndrome are treated separately. Diuretics and ACE inhibitors may be used to treat hypertension. Cholesterol drugs may be used to lower LDL cholesterol and triglyceride levels, if they are elevated, and to raise HDL levels if they are low. Use of drugs that decrease insulin resistance, e.g., metformin and thiazolidinediones, is controversial; this treatment is not approved by the U.S. Food and Drug Administration.

A 2003 study indicated that cardiovascular exercise was therapeutic in approximately 31% of cases. The most probable benefit was to triglyceride levels, with 43% showing improvement; but fasting plasma glucose and insulin resistance of 91% of test subjects did not improve.   Many other studies have supported the value of increased physical activity and restricted caloric intake (exercise and diet) to treat metabolic syndrome.

Restricting the overall dietary carbohydrate intake is more effective in reducing the most common symptoms of metabolic syndrome than the more commonly prescribed reduction in dietary fat intake

Controversy:
The clinical value of using “metabolic syndrome” as a diagnosis has recently come under fire. It is asserted that different sets of conflicting and incomplete diagnostic criteria are in existence, and that when confounding factors such as obesity are accounted for, diagnosis of the metabolic syndrome has a negligible association with the risk of heart disease.

These concerns have led to the American Diabetes Association and the European Association for the Study of Diabetes to issue a joint statement identifying eight major concerns on the clinical utility of the metabolic syndrome.

It is not contested that cardiovascular risk factors tend to cluster together, but what is contested is the assertion that the metabolic syndrome is anything more than the sum of its constituent parts.

Lifestyle and home remedies:
You can do something about your risk of metabolic syndrome and its complications — diabetes, stroke and heart disease. Start by making these lifestyle changes:

Lose weight. Losing as little as 5 to 10 percent of your body weight can reduce insulin levels and blood pressure, and decrease your risk of diabetes.

Exercise. Doctors recommend getting 30 to 60 minutes of moderate-intensity exercise, such as brisk walking, every day.

Doing Yoga :Doing Yoga exercise, meditation etc. under the guideline of a good yoga teacher

Stop smoking.Smoking cigarettes increases insulin resistance and worsens the health consequences of metabolic syndrome. Talk to your doctor if you need help kicking the cigarette habit.

Eat fiber-rich foods. Make sure you include whole grains, beans, fruits and vegetables in your grocery cart. These items are packed with dietary fiber, which can lower your insulin levels.

Prevention:
Various strategies have been proposed to prevent the development of metabolic syndrome. These include increased physical activity (such as walking 30 minutes every day),   and a healthy, reduced calorie diet.   There are many studies that support the value of a healthy lifestyle as above. However, one study stated that these potentially beneficial measures are effective in only a minority of people, primarily due to a lack of compliance with lifestyle and diet changes.   The International Obesity Taskforce states that interventions on a sociopolitical level are required to reduce development of the metabolic syndrome in populations.

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Although much more research has to be done to work out the relationship between different factors in metabolic syndrome, and how drug treatments might be used to help people, there are steps you can take to reduce your risk.

Lifestyle changes can make a big difference, preventing or delaying the development of serious disease. Losing weight and getting active are the top priority. But make sure you get proper advice and support – research has shown that people who join a weight-loss group, for example, are more likely to lose weight and keep it off.

In terms of getting fit, join a gym or find a sport you enjoy. You’re more likely to stick at it if you like what you’re doing.

Some preventive treatments are also available from your GP. It’s important to keep your blood pressure under control, and blood fat (cholesterol) and blood sugar (glucose) at healthy levels. But some blood pressure treatments, such as diuretics and beta blockers, can actually make metabolic syndrome worse.

A 2007 study of 2,375 male subjects over 20 years suggested that daily intake of a pint (~568 ml) of milk or equivalent dairy products more than halved the risk of metabolic syndrome. Some subsequent studies support the authors’ findings, while others dispute them.

Check with your doctor if you’re concerned. Drugs to control blood fat and cholesterol levels, and blood glucose levels, are often needed.

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose

Resources:
http://www.bbc.co.uk/health/physical_health/conditions/metabolicsyndrome1.shtml
http://www.webmd.com/heart/metabolic-syndrome/metabolic-syndrome-what-is-it
http://www.mayoclinic.com/health/metabolic%20syndrome/DS00522
http://en.wikipedia.org/wiki/Metabolic_syndrome
http://www.healthfocus.net.au/what-is-metabolic-syndrome/

http://www.myoptumhealth.com/portal/ADAM/item/Weight+control+and+diet

Mediterranean Diet Improves Heart Risk Factors

Eating a “Mediterranean diet” could prevent or even reverse metabolic syndrome, a cluster of risk factors for heart disease and diabetes. Scientists believe that a Mediterranean-style diet has antioxidant and anti-inflammatory effects on your body.

A review of 35 clinical trials found that faithfully eating a Mediterranean diet can improve traits such as belly fat, high blood pressure, low levels of “good” HDL cholesterol, elevated blood fat levels, and high blood sugar.

Reuters reports:
“For instance, those who stuck with the Mediterranean diet as compared to eating their regular foods or a low-fat diet trimmed their waistlines by about 0.43 cm (0.16 inches) on average.  They also showed slashed their blood pressure by 2.35 points on the top reading, and their fasting blood sugar by 3.89 milligrams per deciliter.”

Resources:
Reuters March 7, 2011
Journal of the American College of Cardiology March 15, 2011;57(11):1299-313

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Sweet Danger

“I cannot have diabetes,” exclaimed the middle-aged gentleman. “The laboratory results are wrong. My parents did not have diabetes, I am a vegetarian, and I do not even eat sweets.”

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Well, this man is living in a soap bubble that is about to burst. None of the reasons cited protects from the onset of diabetes. As far as family history is concerned, awareness and routine laboratory tests for metabolic diseases are a relatively new phenomenon. His parents may have had diabetes and may have died quietly of an undiagnosed complication like a heart attack.

India has 30 million known diabetics, the largest number in the world. The figure is mounting daily and is slated to escalate by 200 per cent. Most of the affected will be in the economically productive age group of 30-60. We have to find out ways to combat this epidemic, halt it and prevent our children from falling prey to it.
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Studies have shown that the possibility of developing diabetes depends on one’s genes, which are inherited from both parents, and the nurturing environment provided first in the womb and later by the mother.

To begin with, women should have the correct BMI (body mass index — weight divided by height in metre squared) of 23 before they become pregnant. Some women are undernourished and eat poorly. Their calorie intake is only 70 per cent of the required amount (2,000-2,200 calories for an active adult female). The protein content may be less than the recommended 075-1gm/kg. Both these situations result in poor foetal growth and an SFD (small for dates) baby.

Compensatory mechanisms come into play in SFD babies and they develop relative insulin resistance so as to maintain normal blood glucose concentrations. Vital organs like the brain and heart receive sufficient nutrition, but it is diverted away from the muscles.

These small babies exhibit a phenomenon called “catch up growth”. If fed adequately after birth, they attain normal weight for age and height within three years. In the process, they can develop impaired glucose tolerance as early as seven years of age.

Today’s teens have a different story. They are becoming obese on a diet of fast food and “time pass” television. Many girls are overweight when they get married. Pregnancy and well meaning advice to “rest and eat for two” do not help matters. Those who are obese (BMI more than 29) or diabetic during pregnancy can produce large babies (LFD or large for dates). These babies are exposed to excess nutrition in the womb. They secrete excess insulin, can develop insulin resistance and eventually diabetes. The problem is compounded if they are growing up in a family with faulty eating habits and little or no regular exercise.

Since we now know that the majority of us carries a gene which predisposes us to develop diabetes, it makes sense to thwart the march to disease.

Check your blood sugars once a year after the age of 25, even if you are asymptomatic, to be sure you don’t fall in the “prediabetic” category. Those who are prediabetic have a fasting blood sugar between 100 and 126mg/dl and a two-hour post prandial or oral glucose tolerance test value between 140 and 200mg/dl. Abnormal values may occur 15 years before the onset of overt diabetes. Without active intervention eventually 35 per cent go on to develop the disease. With effort and a change in lifestyle, 45 per cent can revert to normal.

Medical complications — which cause heart disease, stroke, peripheral vascular diseases, and eye and kidney problems – begin to set in during the prediabetic stage. Early identification and treatment can reduce the damage.

The BMI should be maintained at 23. This can be done by keeping the caloric intake between 1,500-2,000 calories a day. The diet should be low in fat, and contain four to six helpings of fruit and vegetables. But dieting alone will not help, as weight loss through starvation cannot be sustained. Food restriction should be combined with physical activity for 60 minutes every day. A brisk walk (five kilometres), or one hour of swimming or cycling will do the trick.

Blood pressure should be maintained at 130/80 or less. Salt restriction and weight loss alone may be sufficient to achieve this. If not, medication may be needed.

Lipid levels also need to be monitored in prediabetes as dyslpidaemia and altered glucose tolerance go hand in hand. Elevated lipid levels predispose to a stroke and heart attack. LDL should be below 100 mg/dl, HDL above 40mg/dl (above 50 mg/dl for women), and triglycerides below 150mg/dl. Reducing the total oil intake to 500 ml a month, checking labels for hidden fats in processed foods, and eating more soluble fibre (beans and oats) will help. If levels remain high the statin group of medications can be started.

If parents adopt a healthy lifestyle, children will soon follow suit. Perhaps this way we can reduce the impact of this devastating disease in the next generation.

Source
:The Telegraph (Kolkata, India)

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Sitting All Day as Bad as Little Exercise

Sitting all day may significantly boost the risk of lifestyle-related disease even if one adds a regular dose of moderate or vigorous exercise, Is too much sitting as bad as too little exercise?
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The health benefits of pulse-quickening physical activity are beyond dispute — it helps ward off cardiovascular disease, diabetes and obesity, among other problems.

But recent scientific findings also suggest that prolonged bouts of immobility while resting on one’s rear end may be independently linked to these same conditions.

“Sedentary time should be defined as muscular inactivity rather than the absence of exercise,” concluded a team of Swedish researchers. “We need to consider that we are dealing with two distinct behaviours and their effects,” they reported in the British Journal of Sports Medicine .

Led by Elin Ekblom-Bak of the Karolinska Institute in Stockholm, the scientists proposed a new “paradigm of inactivity physiology,” and urged fellow researchers to rethink the definition of a sedentary lifestyle.

They point to a recent study of Australian adults showing that each daily one-hour increase in sitting time while watching television upped the rate of metabolic syndrome in women by 26 percent — regardless of the amount of moderate-to-intensive exercise performed.

Thirty minutes of daily physical exercise decreased the risk by about the same percentage, suggesting that being a couch potato can cancel out the benefits of hitting treadmill or biking, for example. Metabolic syndrome is defined as the presence of three or more factors including high blood pressure, abdominal obesity, high cholesterol or insulin resistance. New research is required to see if there is a causal link between being sedentary and these conditions and, if so, how it works, the researchers said.

One candidate is lipoprotein lipase, or LPL, an enzyme that plays a crucial role in breaking down fat within the body into useable forms. Recent research has shown that LPL activity was significantly lower in rats with restrained muscle activity — as low as one tenth of the levels of rats allowed to walk about.

The LPL level during such activity “was not significantly different from that of rats exposed to higher levels of exercise,” the scientists reported. “This stresses the importance of local muscle contraction per se, rather than the intensity of the contraction.”

These studies suggest that people should not only exercise frequently, but avoid sitting in one place for too long, they said.

Climbing stairs rather than using an elevator, taking five-minute breaks from a desk job, and walking when possible to do errands rather than driving were all recommended.

Source: The Times Of India

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