David S. Klein, M.D.

Metabolic Syndrome X

Syndrome X, or metabolic syndrome X is probably a neuroendocrine disorder resulting from a combination of sub-clinical hypothyriodism, subclinical diabetes and adrenal fatigue. Leaky gut syndrome, however, may be an important but overlooked factorthat leads to symptoms of 'syndrome X.'

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.

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.

Leaky Gut Syndrome

The leaky gut (or LGS) is a poorly recognised but extremely common problem. It is rarely tested for. Essentially, it represents a hyperpermeable intestinal lining. In other words, large spaces develop between the cells of the gut wall, and bacteria, toxins and food leak in.

The official definition is an increase in permeability of the intestinal mucosa to luminal macromolecules, antigens and toxins associated with inflammatory degenerative and/or atrophic mucosal damage.

If the gut is not healthy, neither is the rest of the body. It is the point of fuel and nutrient entry. If healing is at a standstill look at the gut to see if this is the block. Chemical sensitivity, fibromyalgia and escalating food allergies are among the many problems caused by the leaky gut.

If gas, bloating, abdominal pain, indigestion, alternating constipation and diarrhoea are symptoms, irritable bowel syndrome may not be all that's going on.

The Mucosal Barrier

The barrier posed by the intestinal mucosa is, even in normal subjects, an incomplete one. Small quantities of molecules of different sizes and characteristics cross the intact epithelium by both active and passive mechanisms. The route by which such transfer occurs is, at least in part, dependent on molecular size. Molecules up to about 5000 Daltons in size cross the epithelial membrane of the microvilli. Larger molecules may utilise an intercellular pathway or depend on being taken up by endocytosis entering the cell at the base of the microvilli.

How Does The Gut Become Leaky?

Once the gut lining becomes inflamed or damaged, this disrupts the functioning of the system. The spaces open up and allow large food antigens, for example, to be absorbed into the body. Normally the body sees only tiny food antigens. When it sees these new, larger ones, they are foreign to the body's defence system. So the attack results in the production of antibodies against once harmless, innocuous foods.

Isn't Leakier Better?

It might sound good that the gut can become leaky, because it would seem that the body would be better able to absorb more amino acids, essential fatty acids, minerals and vitamins. For the body to absorb a mineral it does not just slowly diffuse across the gut membrane it must be attached to a carrier protein. This protein hooks onto the mineral and actually carries it across the gut wall into the bloodstream. However, when the intestinal lining is damaged through inflammation these carrier proteins get damaged as well, so now the victim is vulnerable to developing mineral and vitamin deficiencies.

The 7 stages of the 'inflamed’ gut:

1. When the gut is inflamed, it does not absorb nutrients and foods properly and so fatigue and bloating can occur.
2. As mentioned previously, when large food particles are absorbed there is the creation of food allergies and new symptoms with target organs, such as arthritis or fibromyalgia.
3. When the gut is inflamed the carrier proteins are damaged so nutrient deficiencies occur which can also cause any symptom, like magnesium deficiency induced muscle spasm or copper deficiency induced high cholesterol.
4. Likewise when the detox pathways that line the gut are compromised, chemical sensitivity can arise. Furthermore the leakage of toxins overburdens the liver so that the body is less able to handle everyday chemicals.
5. When the gut lining is inflamed the protective coating of lgA (immunoglobulin A) is adversely affected and the body is not able to ward off protozoa, bacteria, viruses and yeast’s like candida.
6. When the intestinal lining is inflamed, bacteria and yeast’s are able to translocate. This means that they are able to pass from the gut lumen or cavity, into the bloodstream and set up infection anywhere else in the body.
7. The worst symptom is the formation of antibodies. Sometimes these leak across and look similar to antigens on our own tissues. Consequently, when an antibody is made to attack it, it also attacks our tissue. This is probably how autoimmune disease s tart. Rheumatoid arthritis, lupus, multiple sclerosis, thyroiditis and many others are members of this ever-growing category of ‘incurable’ diseases.

Any one of the following can cause Leaky Gut Syndrome:

• Antibiotics because they lead to the overgrowth of abnormal flora in the gastrointestinal tract (bacteria, parasites, candida, fungi)
• Alcohol and caffeine (strong gut irritants)
• Foods and beverages contaminated by parasites like Giardia lamblia, cryptosporidium, blastocystis hominis and others
• Foods and beverages contaminated by bacteria like helicobacter pylori, klebsiella, citrobacter, pseudomonas and others
• Chemicals in fermented and processed food (dyes, preservatives, peroxidized fats)
• Enzyme deficiencies (e.g. celiac disease, lactase deficiency causing lactose intolerance)
• NSAIDS (non-steroidal anti-inflammatory drugs) like ASA, ibuprofen, indomethacin, etc.
• Prescription corticosteroids (e.g. prednisone, hydrocortisone, DepoMedrol, etc.)
• High refined carbohydrate diet (e.g. candy bars, cookies, cake, soft drinks, white bread)
• Prescription hormones like the birth control pill
• Mold and fungal mycotoxins in stored grains, fruit and refined carbohydrates

If the filtering and/or detoxification systems within the liver are overloaded or inefficient, this will cause toxins, dead cells and microorganisms to build up in the blood stream. This will then increase the workload of the immune system, which will become overloaded and irritated. The immune system will then produce excessive inflammatory chemicals, and in some cases, auto antibodies, because it is in a hyperstimulated state. This may lead to symptoms of immune dysfunction such as allergies, inflammatory states, swollen glands, recurrent infections, chronic fatigue syndrome, fibromyalgia or autoimmune diseases. Some of the more common autoimmune diseases are systemic lupus erythematosus (SLE), sclerosing cholangitis, primary biliary cirrhosis, Hashimoto’s thyroiditis, vasculitis and rheumatoid arthritis.

Immune dysfunction is common in the chemically overloaded environment we live in today, and is exacerbated by nutritional deficiencies inherent in processed and high fat diets. Suppressive drugs are often used to treat symptoms of immune dysfunction.

Simply put, the digestive tract consists of a long tube, which connects the mouth to the anus. After food is swallowed it passes through the oesophagus to the stomach, where it is churned up with acid and stomach enzymes into small particles. This then passes into the small intestine, which is around 20 feet long. The most important function of the small intestine is to digest and absorb nutrients from the food particles that arrive from the stomach. In the upper part of the small intestine, secretions from the liver and gallbladder (bile), and the pancreas (enzymes), are inserted through a small tube (duct), situated near the pancreas gland. Another vital function is to act as a barrier to prevent the re absorption into the blood circulation, of toxins and macromolecules.

When the digestive tract (also known as the intestinal mucosa) is inflamed, you can develop what is called a "leaky gut". This means that large food molecules, endotoxins and xenobiotics can pass straight into the bloodstream and be presented to the liver for detoxification. They should not be in the blood - so the immune system reacts to them, immune complexes are formed and these complexes travel to the liver where they are broken down. This places an enormous burden on the liver, stressing its detoxification capability. As a result these substances may be partially processed and accumulate in the liver and fatty (adipose) tissue. Research in recent years has uncovered the important connection between the health of the human body and the integrity of the gut wall. It is now well established that inflammation of the intestines and a resultant increased permeability of the intestinal mucosal wall has a connection with conditions such as infection, food allergy, Crohn’s disease, coeliac disease, dermatological conditions, colitis, or auto-immune diseases (such as rheumatoid arthritis, ankylosing spondylitis, Reiter’s syndrome, eczema and other ‘allergic’ disorders).

It has also been speculated that the combination of leaky gut and dysfunctional liver detoxification can lead to increased fatty tissue stores of toxic compounds and depressed immune system function.

Causes of leaky Gut

Some of the most common causes of a leaky gut are: Nonsteroidal anti-inflammatory drugs (NSAID) usage, intestinal infection, dysbiosis, parasites, maldigestion, deficient immunoglobulins, ingestion of allergenic foods, alcoholism, ingestion of toxic chemicals, trauma and endotoxaemia.

Decreased permeability may be caused by chemotherapy, gastroenteritis, irritable bowel syndrome, food allergy, ulcerative colitis, etc. Identifying the cause is an important first step in reversing altered permeability.

David S. Klein, MD, FACA, FACPM, FACMIMS
Director, Pain Center of Orlando
www.suffernomore.com