David S. Klein, M.D.
Obesity - The Epidemic
BACKGROUND:
While beauty may be only skin deep, obesity is associated with a number of very serious health risks. If an individual is obese, life expectancy is decreased, arthritis is more likely to occur at a younger age. Approximately 80% of type II diabetics are obese.
At this time, almost 2/3 of the American public is overweight. The most eye-opening way to see this problem is to look at movies and television made before 1975, and the 'fat' person then would be the 'normal looking person' today.
There was one 'fat kid' in the class thattook some teasing. Now, it is hardly noticed.
DEFINITION:
The medical definition of obesity is based upon body mass index (BMI) which is weight in kilograms divided by surface area in meters squared. Currently, a BMI greater than 27.3 kg/m2 is considered obese.
If you carried a 10 pound bag of potatos for any length of time, you begin to tire of the weight. Imagine carrying several of these bags, or more, all of the time.
REASONS FOR CONCERN:
Obese individuals may experience abnormalities in hormone metabolism, such as increases in androgen production, the very common insulin-resistance, and rarely, increased cortisol production and clearance. There is a strong link between obesity and hypertension in patients who weigh greater than 20% of their ideal weight. Abnormalities in lipid metabolism may occur. Death from cardiovascular disease in the morbidly obese is twice as high as compared to those individuals with normal weight to height ratios (BMI.)
In addition to those obesity-relate health risks previously mentioned, other health problems must be considered. Excess weight places tremendous biomechanical stress upon the bony framework, muscles, and ligaments. Obese individuals suffer from many more pain-related problems than do non-obese individuals. Obesity is associated with arthritis of the hips, knees, feet, and spine. There is a dramatically increased likelihood of spinal nerve root impingement (pinch) which results in pain, weakness, and often requires surgical correction.
Backache in the obese is extremely common, and can be incapacitating. Surgical correction of spinal mechanical problems, such as herniated disk or nerve root pinch often fail if the patient receiving the surgery is markedly overweight. Further, long-term success is diminished in those patients who do well with surgery, due to the increased likelihood of arthritis developing in the spine, after surgery.
MEDICAL RISKS OF OBESITY 1:
- Diabetes is 2.9 times more prevalent in the obese than in the general public.
- High Blood Pressure is over 2 times more prevalent in the obese than in the general public.
- Cancer is far more common in the obese person than in the non-obese. Colon, rectal and prostate cancers are far more common in obese men, and endometrial, ovarian, breast and cervical cancers are more common in obese females than in non-obese persons, statistics corrected for age.
- Arthritis is more common in the obese.
- Respiratory diseases, including chronic bronchitis, pneumonia and sleep apnea are far more common in the obese population.
- Heart failure can occur as a direct result of obesity2.
Obesity and Pain - MECHANICS:
The bones of the spine move on each other (articulate) largely on joints known as spinal facets. Arthritis of these facet joints is associated commonly with trauma, degenerative disk disease and obesity. Arthritis leads to inflammation, and this inflammation leads to pain, spasm of the musculature over the joints, and can lead to spinal nerve root injury.
An individual with a large belly or large breasts must arch the back backwards (lordosis), in order to maintain balance. This lordosis produces increased stress on the facet joints, and increased rotational torque on the spinal disks, which leads to degeneration of the spinal disk, as well.
DIAGNOSTIC POSSIBILITIES:
There are many causes of obesity in the American population.
DISORDERS OF THE THYROID GLAND: Disorders of the thyroid (hypothyroidism) are more common than diabetes. Unfortunately, simple thyroid hormone blood levels are often misleading, and borderline hypothyroidism is extremely common, and is often associated with diabetes, disorders of menstruation, depression, and carpal tunnel syndrome.
Auto-immune thyroid disorders, such as sub-clinical thyroiditis, Hashimoto's Thyroiditis, and Grave's Disease often persist for years before properly diagnosed. Then, once diagnosed, they are often treated (poorly) with T-4 (Synthroid, levoxyl et al.) Consideration is given to following TSH (thyroid stimulating hormone), instead of monitoring basal metabolic rate as an end-point of thyroid replacement therapy. Subsequently, patients gain weight, experience low body temperatures, chronic infections, and develop clinical depression.
DISORDERS OF INSULIN-METABOLISM: Disorders of insulin sensitivity result in much of the obesity that we see today. As the population is becoming heavier, the incidence of frank diabetes is on the rise. Oddly, the obesity itself may not be causing the diabetes, but the diabetes is causing the obesity.
That is, if a person suffers from insulin insensitivity, insulin levels increase, just to keep glucose (blood sugar) levels constant. As the insensitivity to insulin worsens, the pancreas is unable to produce enough, and blood sugars rise, resulting in the diagnosis of 'diabetes.' The disorder may preclude the elevation of blood sugars by 10 years, or more.
Of the causes of insulin resistance, the most common causes involve mineral deficiencies. Vanadium and chromium deficiencies result in insulin resistance, and restoration of bio-available, balanced mineral mixtures can reverse the problem.
One of the approaches that we use to treat obesity involves the product Diatain,TM combined with a basic mineral chelate and B-complex vitamin.
The easiest approach is to use either "Daddy's Magic Minerals" 2 capsules, twice daily, combined with "Thyroid Friendly B," both of which are available in our catalog . The Diatain is taken one capsule with lunch and one with dinner.
Diatain is available at their website: Progressive Nutrient Solutions.
PSYCHIATRIC DISORDERS: Eating disorders are extremely common in patients with depressive disorders. Depression is one of the most common medical illnesses that plague our population. It has been estimated that over 20% of the population can be expected to suffer from clinically significant depression, at some time during a lifetime, and depression manifests primarily as an eating disorder mainly in women.
WHAT CAN A PERSON DO?
MEDICAL DIAGNOSIS: Before spending alot of hard-earned resource on diet-fads, a medical evaluation would be undertaken by a clinician with a proper understanding of the medical nature of obesity. This is not a trivial matter. Many physicians not well-educated in the diagnosis or treatment of obesity, and many individuals suffer the ravages of obesity, unnecessarily. It is important to find the best doctor around.
Only after endocrine (hormonal) problems have been eliminated as the physical causes of obesity, it is important to rule out depression as a contributing cause of the weight problem. Even mild depression can result in an eating disorder which can result in tremendous weight gain, if left untreated.
Hormonal imbalances may involve hormones, such as: Pregnenolone, Cortisol, DHEA, Testosterone, Progesterone, Estradiol, Estrone, Estriol, T-3, and T-4. The absolute value of the blood level is most often less important than the relative ratios between these hormones.
Further, simple dietary deficiencies can result in profound hormonal imbalanes. Treatment must be premised upon treatment of the underlying medical/dietary/hormonal problem.
TREATMENT
If a hormonal problem is found, it is often a simple matter to restore hormonal balance through the use of oral and transdermal medications. Bio-identical hormone replacement is premised on replacement of the missing or inadequate hormone with the precise chemical structure that was intended, not an engineered chemical that is not normally produced by the body.
Restoration of hormonal balance is the key to maintenance of health and vitality.
B-complex vitamins, insulin-acting minerals, Pregnenolone, DHEA, and CoQ-10, inositol, policosinoll are useful in the treatment of obesity.
These agents are readily available, but the buyer must be aware of quality differences that are evident with off-brand bottles. It is best to stick with reputable manufacturers, observing GMP standards that deliver pharmaceutical grade, assayed, high quality product.
Biological Basis for Weight Gain with Depression & Seasonality
Pinchasov BB, Grischin OV, Putilov AA: Rate of oxygen consumption in seasonal and non-seasonal depression. World J Biol Psychiatry. 2002 Apr;3(2):101-4.
Most depressives suffer from weight loss, anorexia and insomnia, while for winter depressives the typical symptoms are weight gain, carbohydrate craving, overeating, oversleeping and extreme lack of energy. It is important to know whether winter depressives differ from most other depressives on measures of energy regulation. In wintertime, we evaluated the rate of oxygen consumption in relationship to neuro-vegetative depressive symptoms in 92 Siberian women. The seated subjects underwent oxyspirography in the mid-morning (1.5 hours after a standard breakfast). It was found that the oxygen consumption rate was similar in non-depressed women (n = 25) and depressed women with non-seasonal depression (n = 27). The comparatively lower values were obtained in women with winter depression (n = 40).
This finding supports the suggestion that the behaviour disturbances typical for winter depression may represent a physiological feedback loop to energy conservation.
NUTRITION AND EXERCISE
It is essential to become educated in proper nutrition, and to understand the importance of exercise. There are many approaches to nutrition, and there are many useful, thought-provoking books available. These two books that may provide a start:
- Eat more, Weigh Less, by Dr. Dean Ornich
- Everyday Cooking
Diet is important, and there are many approaches. What works for one person, does not work for all. It is not uncommon for a person to try many diet protocols before finding the "right one."
What is important, is that caloric consumption must be decreased. Weight is gained over a period of years, and weight loss should be gradual, if it is to be safely undertaken. A target weight loss of 4-8 pounds per month is generally considered safe.
REFERENCES:
- Pi-Sunyer FX: Medical Hazards of Obesity. Ann Internal Med 119:655-660, 1993.
- Sharp JT, Barrocas M, Chokroverty S. The cardiorespiratory effects of obesity. Clin Chest Med. 1:103-118, 1980.
Inositol in Insulin Regulation
van der Heide LP, Kamal A, Artola A, Gispen WH, Ramakers GM: Insulin modulates hippocampal activity-dependent synaptic plasticity in a N-methyl-d-aspartate receptor and phosphatidyl-inositol-3-kinase-dependent manner. J Neurochem. 2005 Aug;94(4):1158-66.
Insulin and its receptor are both present in the central nervous system and are implicated in neuronal survival and hippocampal synaptic plasticity. Here we show that insulin activates phosphatidylinositol 3-kinase (PI3K) and protein kinase B (PKB), and results in an induction of long-term depression (LTD) in hippocampal CA1 neurones. Evaluation of the frequency-response curve of synaptic plasticity revealed that insulin induced LTD at 0.033 Hz and LTP at 10 Hz, whereas in the absence of insulin, 1 Hz induced LTD and 100 Hz induced LTP. LTD induction in the presence of insulin required low frequency synaptic stimulation (0.033 Hz) and blockade of GABAergic transmission. The LTD or LTP induced in the presence of insulin was N-methyl-d-aspartate (NMDA) receptor specific as it could be inhibited by alpha-amino-5-phosphonopentanoic acid (APV), a specific NMDA receptor antagonist. LTD induction was also facilitated by lowering the extracellular Mg(2+) concentration, indicating an involvement of NMDA receptors. Inhibition of PI3K signalling or discontinuing synaptic stimulation also prevented this LTD. These results show that insulin modulates activity-dependent synaptic plasticity, which requires activation of NMDA receptors and the PI3K pathway. The results obtained provide a mechanistic link between insulin and synaptic plasticity, and explain how insulin functions as a neuromodulator.
David S. Klein, MD, FACA, FACPM, FACMIMS
Director, Pain Center of Orlando
www.suffernomore.com