Stephen Holt MD-Syndrome x and Anti Aging (Webinar)

8/8/2019 Stephen Holt MD-Syndrome x and Anti Aging (Webinar)

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PREMATURE AGING IN THE DISEASEPREMATURE AGING IN THE DISEASE

CONSTELLATION OF METABOLICCONSTELLATION OF METABOLICSYNDROME XSYNDROME X

OR SYNDROME X,Y,ZOR SYNDROME X,Y,Z

Stephen Holt MD, LLD (Hon.) DSc, ChB., PhD, DNM, FRCP(C), MRCP (UK), FACP, FACG, FACN, FACAM, OSJ

Distinguished Professor of Medicine (Emeritus)

Scientific Advisor, Natural Clinician LLC


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SUPER-SIZING AMERICA

Americans exudecomplacency about theiroverweight status.

Obesity is part ofMetabolic Syndrome X

Syndrome X is underdiagnosed and often

mistreated by bothconventional andalternative medicine.


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FACT

OBESE KIDS BECOME UNHAPPY,UNHEALTHY OBESE ADULTS


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THE UNKNOWN EPIDEMIC


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REDEFINING SYNDROME X

Classic Definition: Obesity,Hypercholesterolemia, High BloodPressure, Linked by Insulin

Resistance. Syndrome X, Y and Z.., an

expanded definition incorporating a

novel unifying concept of commondiseases


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THE PUBLIC HEALTH RISK

Syndrome X increases risk for :

Type II Diabetes Mellitus

Cardiovascular Disease

Cardiovascular Deaths

Deaths from ALL CAUSESAm.J.Epidemiol, 148, 958, 1998.


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INTEGRATIVE MEDICINE FOR SYNDROME X

While proper management of theindividual abnormalities of thissyndrome can reduce morbidity and

mortality, it seems unlikely thatmanagement of the individualabnormalities of this syndrome provides

better outcomes than a more integratedstrategy CDC, Atlanta, Ga.,JAMA 2002


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FACTS

Obese people die young

Obese people develop premature

disability Obese people are modern, metabolic

dinosaurs

Obese people are generally mismanagedin clinical practice


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BACKGROUND

Studies imply that the physically activeperson of normal body weight outlivesthe overweight, inactive individual.

Obesity related disease, most notablyMetabolic Syndrome X, presents unifyingconcepts of premature aging.

Retention of body functions and survivalare clearly associated with calorierestriction.


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LOOKING AT OBESITY AND RELATED DISEASEFROM NEW SCIENTIFIC PERSPECTIVES

CREATES NEW THERAPEUTICS


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A LITANY OF NEW PERSPECTIVES: 2009

Greater understanding of the epidemiology of obesity.

The fat cell regulates energy balance and metabolism. Neuro-hormonal control of appetite.

Incretins: GLP-1 and GLP.

Fuel sensing by the CNS.

Obesitis

Insulin Resistance: The core of Syndrome X

Cancer propagation (colon, prostate, pancreas)

Evidence base for positive lifestyle change.

Drug and nutraceutical approaches to treatment. The role of bariatric surgery


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Global problem, 1.6b overweight (BMI>25)

400m obese (>30) 32.9% of U.S. adults (age 20-74y) are obese, 17%

of teenagers (age 12-19) are overweight. 70MUS citizens, Syndrome X.

Obesity and Syndrome X increase risk of deathfrom all causes.

The data support a gene-environmentinteraction where the genetically predisposedrespond to energy-dense foods, combined withreduction in energy expenditure. FarmyardScience

NEW PERSPECTIVES ON EPIDEMIOLOGY


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New discoveries of circulating factors that

signal energy reserves which also signal thebrain, adipose tissue, liver, muscle and theimmune system.

Research surrounding the discovery of leptin

led to the discovery of other chemical signals.

Signaling compounds: leptin, adiponectin,resistin, retinoid binding protein 4, visfatin,

etc. Appetite supression: Hoodia etc.

ENERGY BALANCE AND METABOLISM: REGULATED BY ADIPOCYTES


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GUT HORMONES AND APPETITE

Gut hormones influence eating behavior. Ghrelin: The Hunger Hormone increases

food intake and body weight (OREXIGENIC).

In contrast, all other peripheral factors that

regulate energy balance act to restraineating.

Ghrelin secretion is promoted by insomnia.T

he

Nocturnal Fridge Raiding Syndrome. The concept ofSleep Naturally.


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OBESITIS

Epidemiological links between obesity and

inflammation have been proposed for >40y.

Glucose and fat intake induce inflammation byoxidative stress or the activation of transcription

factors.

Reductions in macronutrient intake in obesesubjects reduces oxidative stress and theproduction of inflammatory mediators

(1000kcal/day, 4 weeks or 48 hr fast).

Managing weight control must include antiinflammatory tactics


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INSULIN RESISTANCE

New concepts of inflammation-induced insulinresistance.

Two pathways: the NF-kB pathway and the c-JunNH2-terminal kinase (JNK) pathway which aretranscription-factor-signaling-pathways that are

linked to the pro-inflammatory effects of obesityand insulin resistance.

Pathways are activated by pro-inflammatory stimulie.g. cytokines (TNF-alpha).

Potential mediators of insulin resistance include IL-6, IL-10, TNF-alpha, CRP, IL-8, PAI-1 etc.


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POTENTIAL MECHANISMS OF OBESITIS


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OBESITIS


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CANCER: OBESITY AND SYNDROME X

Obesity and Syndrome X increase

mortality from several cancers e.g. colon,prostate, breast and pancreas.

Consistent risk factors for colon cancer (or

adenoma) include obesity, inactivity, pot-belly, hyperglycemia andhyperinsulinemia (Syndrome X)

Obesity linked to fatal prostate cancer.

Type II diabetes increases risk ofpancreatic cancer by approximately 50%.


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LIFESTYLE CHANGE AND NUTRITION:

FIRST LINE OPTION

Face to face lifestyle advice performsabout 50% better than comprehensiveinternet-based programs for weight loss.(inference: the same applies to books?)

Continued patient-practitioner contactwith compliance promotes sustainedweight control.

Managing weight loss without managingSyndrome X is nihilistic.


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DRUGS AND NUTRACEUTICALS


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WEIGHT MANAGEMENT

Not only a function of diet

Calorie Control

Behavior Modification Exercise

Management of Syndrome X

Treatment of obesity related disease

Obesitis

Detoxification


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UNREALISTIC WEIGHT

LOSS EXPECTATION


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COMMON CAUSES OF OBESITY

The Double Whopper Brain

Sedentary Lifestyle Genetic Tendency

Social Gluttony (Appetite)

Sleeplessness

Body Toxicity


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THE GLYCEMIC INDEX

Calculations of the glycemic index of foodis probably a waste of time.

Understanding factors that control gastricemptying rate can result in inferenceabout the glycemic index.

Slowing gastric emptying slows glucoseabsorption relevance in acute dosing


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GLUCOSE TOLERANCE WITH SOLUBLE FIBER

Holt S, et al

Effect of Gel

Fiber

Lancet,

March 24th,

1979.


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DIETARY PRINCIPALS

Calories Count

Watch Macronutrients CHO, Fat,

Protein Healthy Fat (EPA)

Salt Restriction

Fiber Intake

Nutrient Density


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SYNDROME X NUTRITIONAL FACTORS

OBESITY: Hoodia, fiber, green coffee bean extract,

starch blocker, chromium, fat blockers

HYPERTENSION: fiber, botanicals unpredictable

OXIDATIVE STRESS: alpha lipoic acid, AGES, redox

balanced, hydrophilic and lipophilic

HOMOCYSTEINE: B6, B12, folate, TMG

INSULIN RESISTANCE: fish oil (EPA), alpha lipoic acid,

vitamin and mineral supportBLOOD LIPID: soy, fish oil, guggul, garlic etc.

INFLAMMATION: EPA, curcumin, C etc.


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SYNDROME X NUTRITIONAL FACTORS

A healthy blood glucose level

A healthy blood cholesterol level

A healthy blood homocysteine level

Healthy immune function

Healthy digestive function

Antioxidant functionCalorie control by induction of satiety

Inhibition of fat and sugar absorption


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SYNDROME X PROTOCOLSYNDROME X PROTOCOL

Lifestyle change: diet, exercise,

limitation of substance abuse,

behavior modification

Nutritional insurance: mixtures of

fruit, vegetable, berries and greens

powders with full RDI of vitamins,

mineral enrichment.


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CONCLUSIONS Weight management involves holistic medicine and

education on new perspectives. There is no successful, sustainable stand alone

intervention for weight control

Failing to manage Metabolic Syndrome X and its

complex pathophysiology is a common mistake. Sleep, inflammation, nutrition etc. must be

addressed.

Nutraceuticals are preferred first line adjunctive

options: the concept ofSyndrome X NutritionalFactors, Clinical EPA/DHA.

The Integrative Approach must be favored.

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Stephen Holt MD-Syndrome x and Anti Aging (Webinar)