I was talking with friends this past weekend and the topic of staving off Type II Diabetes was raised. I casually mentioned that the condition was self-inflicted and to some point self-controllable. This post will serve as a reference to those who care.
Metabolic Syndrome is a cluster of symptoms that lead to Type 2 Diabetes and heart disease. The “big two” causes of metabolic syndrome are overeating and a sedentary lifestyle. Most research and therapeutic effort has been focused on the control of food intake, the increment of energy expenditure, and improvement in insulin action. The failure of these efforts to slow the rate of the epidemic has led to the most authoritative researchers turning their attention to alternative hypotheses. I have a personal concern because there is a history of Metabolic Syndrome in my family.
In my job, I see and read more medical studies than is healthy. Because I’m concerned with developing Metabolic Syndrome, studies related to it attract my attention. I’m concerned because my family has a history of developing Diabetes, and because not one case of Type 2 Diabetes has been cured with insulin, nor has any coronary heart disease been cured with surgery. These treatments only act on the symptoms.
The medical literature seems to suggest that five factors play various roles in the control of the syndrome: diet, exercise, exposure to plastics, type and ratios of species of gut bacteria, and cold exposure. I’ll touch on each one individually and then bring things back together at the end. This is the state of affairs as I see them at this point in time.
1. Diet
It’s no surprise that diet is a large factor in the development of metabolic syndrome. However, beyond limits to total calories, diet recommendations are controversial. I think that this controversy comes from inferior sample design and analysis resulting in conflicting conclusions.
Sample design for diet studies always starts with the recognition that there will be a high degree of non-compliance. People are going to default to those practices that put them in their current category. This limits the range of the treatment variable. Researchers don’t feel that anyone is going to stick to a diet with only 5% of daily calories from fat—or less than 10% of calories from carbohydrates. So to increase compliance they narrow the range and call less than 30% of daily categories from fat—low fat, and less than 40% of calories from carbohydrates—low carb; which really doesn’t measure low anything. The same is true of other dietary factors such as protein.
A few retrospective studies have exampled populations with little to no incidence of metabolic syndrome and then catalogued what they ate. Those studies also have their problems, not the least of which is genetic diversity.
The Paleo-diet should be a prime fit for this. The diet is constructed to mimic that of pre-agricultural humans—a noble goal. The one thing it lacks is starvation. If you really want to mimic the diet of paleo humans you have to include frequent periods of no food. You aren’t on a Paleo-diet if you eat every day—and by the way not eating every day seems to be really good for you. And there is evidence that high-protein diets are not as good for you as low-protein diets. Be advised that genetically modern humans are genetically different from Paleolithic humans—for one thing, adult paleo-humans could not digest milk and modern humans have more starch processing genes.
The one thing that most, if not all, of the health sustaining diets have in common is they all recommend against processed food. However, that recommendation is made for a multitude of reasons ranging from avoidance of genetically modified ingredients to lowering intake of salt and sugar. I think of processed food as anything that requires an ingredients label; but that’s not necessarily the criterion used in published research—be careful with interpretation.
Any diet that reduces weight will show positive health benefits for most people less than 75 years of age—after that results are mixed. For younger adults, a diet high in starch, low in fat, protein, and simple sugars seems to be best at mitigating the effects of metabolic syndrome; by diet, I mean, what you eat, not as commonly used a plan for limiting calories.
2. Exercise
The application of exercise to the prevention of Metabolic Syndrome is at least as controversial as diet, and for many of the same reasons—too many studies with conflicting results. This is at least partially due to the dosage range being too low, uncertainty in compliance, and study length.
Exercise comes in four flavors; strength, balance, endurance, and flexibility. They are not interchangeable in the prevention/mitigation of Metabolic Syndrome as they have different physiological effects. Only two of these flavors affect the Metabolic Syndrome; strength and endurance. This is not to say that flexibility and balance are unimportant to a quality life—they most certainly are.
Strength exercises increase muscle and reduces insulin resistance. Endurance exercises can build muscle as strength improves, but after fitness is attained (i.e. the body has adapted) there is no further direct effect on the Metabolic Syndrome. Endurance exercise helps combat heart disease by improving heart strength, reducing weight and improving mood. Losing weight can reverse pre-diabetes and maybe even full on diabetes
The big positive effects of exercise in mitigating the Metabolic Syndrome are from increased strength. Dr. Sullivan does a much better job explaining this than I can. Here are two videos from his YouTube channel:
The take away from this is: get stronger, right now, today—you can never be too strong.
3. Limit exposure to plastics
A PubMed search for “bisphenol A” (BPA) returned more than 13000 results—not all are negative, some are cautionary. Research on BPA ingestion has connected it to everything from low sperm counts, to hearing loss, and impaired memory function. Yet, at this time the US government thinks it safe. So much so that BPA content is not required to be listed on plastic products. However, in 2015 California listed BPA as a reproductive health hazard and required a warning on labels of products with BPA content.
A daily dose of 50 µg/ kg/day is considered “safe” for human consumption. This exposure does not account for differences in metabolism related to age, sex, liver function, and physiological status. One study found bioactive BPA in half of studied women. This doesn’t, of course, mean that the BPA is harming them; just that it is there.
BPA is a known to interfere with endocrine system function. The endocrine system is a network of glands in your body that make the hormones that help cells talk to each other. The pancreas is part of the endocrine system and it talks to cells with insulin and other hormones. The inhibition of the pancreatic hormones is one way BPA is thought to affect Metabolic Syndrome. BPA exposure may also promote obesity and thus affect the Metabolic Syndrome indirectly.
There are many gaps in the knowledge of the relationship between BPA exposure and cardiometabolic risk. There are also uncertainties in the mechanisms of exposure, all of which prevent sound judgments concerning the risks to human health.
It’s worthy of note that few prospective studies have found any relationship between BPA exposure and adverse health effects. This has been attributed to small sample sizes and the difficulty in measuring BPA exposure. However, several retrospective studies have indicated a relationship.
It doesn’t hurt to minimize the use of plastics, especially in the microwave. However the persistence oif BPA seems to be short so
4. The right gut bacteria in the right numbers
Another factor in the prevention of Metabolic Syndrome that has recently come to light is the importance of the mixture in species and abundance of gut bacteria—the micro-biome. It seems that having the right kind of bacteria in the right numbers provides just the right absorption to improve insulin resistance.
Since gut bacteria are affected by the foods you eat they aren’t really independent from the first factor. It may be argued that the role of diet is not only to provide nutrients but to regulate the micro-biome. If so, then the typical western diet is not doing us any favors.
To correct this, the recommendation is to favor single ingredient foods over processed food, eliminate simple sugars, and consume probiotics. More extreme cases may require a fecal transplant. Take care of your gut populations.
5. Cold exposure
The last factor I’ve found in the literature is a program of cold exposure promoting the growth of brown fat (AKA brown adipose tissue). In this Dutch study, researchers found that exposing people to temperatures of 57F for ten days promoted the growth of brown fat and increased insulin sensitivity. They were really excited because the results were better than those resulting from changes in diet and exercise.
Medical Cryotherapy is also used to reduce weight, improve circulation, and grow brown fat thus mitigating the effects of Metabolic Syndrome. This is based on the finding that cryotherapy produces brown fat and that increased brown fat may directly protect against Diabetes.
Wim Hof has popularized this issue world-wide. The success of his method has sparked a great deal of scientific interest. He uses both cold exposure and breathing exercises to accomplish reversal of metabolic syndrome as well as other ailments.
I’m having trouble maintaining the cold therapy through the summer, but winter is on the way and I’ll get back to it then.
Synthesis
I’m absolutely positive that living organisms are much more complicated than this simple model would lead you to believe. Sun exposure may be important to good health—but not too much. Life is complicated and we haven’t much history in figuring things out.
The best way to protect yourself against Metabolic Syndrome is to maintain a weight at the low end of the BMI scale for your age and sex, get strong, increase endurance, cultivate a strong micro-biome, and increase your brown fat. This can be accomplished by eating a diet based on starch and fresh vegetables, lifting heavy weights two to three times per week, walking a couple miles per day, and getting cold. It may also help to fast regularly (or irregularly, but often) and to avoid BPA. But it isn’t yet clear if there are positive effects from fasting after an ideal weight has been attained, and while there is strong evidence of a harmful association, the jury is still out on BPA.
In case you wonder why you should do this, aggressive treatments for Metabolic Syndrome are dangerous and should only be used as a last resort. But really, why should you take action?
You should take action because these things will allow you to enjoy your world for a larger fraction of your life. You have the power to reduce the length of your dying, but only if you take action. Yes, your genes have an effect. Some folks will have an easier time with this, than will others; no excuse. Humans have evolved to survive on starch based diets combined with motion in cold environments, get at it.