It is estimated that by 2020, two-thirds of the global burden of disease will be due to chronic non-communicable diseases, most of which are associated with diet. While hunger is a tremendous global health concern that cannot be minimized, overnutrition should similarly be given concentrated attention. Malnutrition affects up-to 1 billion people. Even though undernutrition is the main cause of malnutrition, people who are overweight could also be malnourished.
The “dual burden of malnutrition” is a term coined by the World Health Organization (WHO) to describe a situation which is characterized by “the coexistence of undernutrition along with overweight and obesity, or diet-related non-communicable diseases, within individuals, households and populations, and across the life course. Globally, the problem is not the availability of food resources, but the allocation and consumption of food.
Despite it being an essential response to infection and tissue injury, inflammation has also been associated with several pathological processes. Excessive acute inflammation causes tissue damage and non-resolving inflammation leads to chronic tissue malfunction, suggesting a delicate balance between the rapid and effective response to distresses in tissue homeostasis and the collateral damage on tissue function.
As a cluster, obesity, raised fasting plasma glucose, high cholesterol and hypertension comprise the metabolic syndrome.
Non-alcoholic Fatty Liver Disease is the main cause of liver disease. Its prevalence reaches 30% in the population and up to 75–100% in obesity.
Different degrees of severity characterize this disease. Although the great majority of patients are without symptoms, nearly 20% eventually progress to develop chronic hepatic inflammation which can lead to early hypertension, cirrhosis, cancer of the liver, and increased mortality.
NAFLD is the leading cause of liver transplantation in the United States.
Elevated GGT, a sentimental sign of liver function collapse, is triggered by metainflammation and liver insulin resistance.
Many patient’s who are identified early and achieve reversal of metainflammation by reducing omega 6, increasing omega 3, and eliminating carbohydrates get reversal of NAFLD.
Despite it being an essential response to infection and tissue injury, inflammation has also been associated with several pathological processes. Excessive acute inflammation causes tissue damage and non-resolving inflammation leads to chronic tissue malfunction, suggesting a delicate balance between the rapid and effective response to distresses in tissue homeostasis and the collateral damage on tissue function.
As a cluster, obesity, raised fasting plasma glucose, high cholesterol and hypertension comprise the metabolic syndrome.
Obesity is characterized by a low-grade chronic state of inflammation in which the level of pro-inflammatory cytokines such as TNF-α, IL-6, and CRP are increased. It is a state in which there is an over-accumulation of subcutaneous and/or abdominal adipose tissue.
This adipose tissue is no longer considered inert and mainly devoted to storing energy; it is emerging as an active tissue in the regulation of physiological and pathological processes, including immunity and inflammation. Adipose tissue is also implicated in the development of chronic metabolic diseases such as type 2 diabetes mellitus or cardiovascular disease.
Obesity can therefore be caused by inflammatory and metabolic diseases. Diet or dietary patterns as well play critical roles in obesity and other pathophysiological conditions. It is therefore recommended for one to have a healthy diet and other nutrients that are generally considered to be beneficial.
Overweight or obese physicians were less likely to discuss weight loss with heavy patients: only 18% of these doctors discussed losing weight with their patients while 30% of normal weight physicians did.
More interestingly, 93% of doctors diagnosed obesity in their patients only if they believed their own weight was equal to or less than that of their patients; only 7% of doctors believed their weight exceeded that of their patients diagnosed obesity.
You certainly wouldn’t go to a dentist with horrible teeth or a hairdresser with horrible hair, and you should avoid advice from an overweight healthcare provider.
When we reverse type 2 diabetes, hyperinsulinemia, and obesity, we are advocating for less medical intervention and more patient self-care.
Empowering the patient to manage a lifestyle disease with a lifestyle intervention does not result in a medical profit.
There is no financial incentive in the Business of Medicine, Big Pharma, or Big Food for this position.
It is obvious that big pharma and big food will not likely be supporting studies that reduce the utilization of their products over non-compensable lifestyle changes. Evidence-based academic research is also unlikely to be performed by academicians who are funded by these same interests. The entire health delivery industry seems to be geared towards medicalization of treatment rather than lifestyle improvement, which would radically disrupt the status quo. “doctors who got money from drug and device makers—even just a meal—prescribed a higher percentage of brand-name drugs overall than doctors who didn’t” and “the more money doctors receive…the more brand-name drugs they tend to prescribe.” Ornstein C, Jones RG, Tigas M. Now there’s proof: docs who get company cash tend to prescribe more brand-name meds. ProPublica. https://www.propublica.org/article/doctors-who-take-company-cash-tend-to-prescribe-more-brand-name-drugs. Published March 17, 2016. Accessed May 1, 2016.
The effects of pharmaceutical firm enticements on physician prescribing patterns. There’s no such thing as a free lunch. J P Orlowski and L Wateska. Chest 1992;102; 270-273 DOI 10.1378/chest.102.1.270
So this is where we are headed… while I applaud the attention we must all place on this urgent issue, as a species we have gone from food scarcity and malnutrition to food excess and the malnutrition of overconsumption, in less than 30 years out of a 2-3 million year history. Maybe it’s not an app we need. Maybe it’s an issue of food quality (vegetable oil, refined grains, acellular carbohydrates).
https://www.cnbc.com/2019/08/17/weight-watchers-new-childrens-app-kurbo-faces-backlash.html
Once the body is in nutritional ketosis, reduced insulin shifts the metabolic pathways to preferentially burn fat stores instead of storing fat stores. This leads to weight loss and can reverse the symptoms of diseases like Type 2 diabetes.
Impaired glucose tolerance and type 2 diabetes mellitus are associated with increased risk of cardiovascular disease.
Postprandial hyperglycemia, with resultant hyperinsulinemia and excessive inflammatory cascade, leading to endothelial dysfunction.
A ‘cheat day’ is often embraced on ketogenic diets, as a reward, presumably activating the dopaminergic hedonic response system, akin to activating the nucleus acumens with a tap of cocaine.
Unfortunately, even one 75 gram dose of glucose while on a “keto” (high fat, low carbohydrate) diet can lead to damaged blood vessels, using a measure of flow-mediated dilation (FMD), arterial stiffness, and diameter, velocity, and flow of the common and internal carotid, and vertebral arteries were assessed in the fasting state and 1 h post glucose consumption.
A “temporary lapse in adherence with consumption of a food causing a glucose spike might lead to acute endothelial damage.” What this suggests?
1. Even low dose infrequent cheat days, once you are on keto, may not be good for your blood vessels.
2. Your blood vessels become more sensitive to glucose after you are on keto?
3. Even an infrequent binge of cocaine once you are clean is probably not a good idea?
4. Metabolic flexibility is diminished as a particular dietary pattern becomes established?
Short-Term Low-Carbohydrate High-Fat Diet in Healthy Young Males Renders the Endothelium Susceptible to Hyperglycemia-Induced Damage. Nutrients, 2019; 11 (3): 489
According to a “NEW” study published in Obesity, “lifestyle interventions focused on altering dietary and physical activity habits using behavioral strategies can produce sustained weight loss among African Americans and Hispanics who have type 2 diabetes (T2D)” Which ivory tower have they been living in or is this new information to their sources of funding?
Maybe some of these researchers could come to visit outpatient clinics that have been successfully doing this for 20 plus years.
Pharmaceuticals have only a short-term role in a long-term lifestyle and behavioral issue.
Bariatric surgery is an induced dietary restriction and malabsorption syndrome, patients often overheat the restriction with liquid calories or develop such significant malabsorption that they develop secondary complications .
I treat obesity, exactly the same as I treat addiction.
The only intervention I have ever found to be successful in the long term was providing the patient with behavioral management tools in altering habits (using substitution and harm reduction), and then a re-education of what was truly “healthy” (and that didn’t include starting the day with a bowl of cereal and skim milk.
In a busy clinical practice, a brief direct interaction, providing just in time information that is “doable” is the only thing that I have found useful. The more esoteric the information or the more complicated the protocol, the worse the adherence.
Download our entire protocol for free on the profile page.
Weight Loss Experiences of African American, Hispanic, and Non‐Hispanic White Men and Women with Type 2 Diabetes: The Look AHEAD Trial. Obesity, 2019; 27 (8): 1275