Reducing dietary saturated fats does not reduce cardiovascular events and death. Improvements in cardiovascular outcomes are independent of direct cholesterol lowering.
Dietary trials that provide abundant natural fats such as α-linoleic acid, polyphenols and Ω-3 fatty acids found in nuts, olive oil, oily fish, and vegetables exert a positive health effect, likely by reducing inflammation, atherosclerosis, and thrombosis.
A meta-analysis including almost 10,000 patients confirmed that high intake of Ω-6 oils (from vegetable oils/margarines) increases the risk of death and heart disease compared to saturated fat plus trans-fat. Human research data suggest that we should remove these vegetable oils from our food supply for optimal health.
Total and LDL cholesterol are a poor marker of cardiovascular health. The cholesterol profile of elevated triglycerides and low HDL is a more predictive marker of cardiac risk and a reliable marker of insulin resistance. In fact, the QRISK calculator, used to estimate the 10-year risk of CVD does NOT use LDL cholesterol but uses a total cholesterol/HDL ratio instead.
Preventing insulin resistance in young men would prevent 42% of myocardial infarctions, a larger reduction than correcting hypertension (36%), low high-density lipoprotein cholesterol (31%), body mass index (21%), or low-density lipoprotein cholesterol (16%).
Treating the root cause of the disease, instead of the symptom is the key. Eliminate all refined carbohydrates to reverse obesity, prediabetes, and type 2 diabetes.
Refined carbohydrates are known to increase blood glucose levels, increase requirements for medications and result in weight gain. It is disturbing that dietary guidelines prioritize the consumption of starchy carbohydrates for type 2 diabetics, to nearly 55% of their daily macronutrient consumption.
Older data was confounded by the inclusion of Ω-3 polyunsaturated fatty acid intake. This misrepresented the health benefits of Ω–6. Other studies, such as the Anti-Coronary Club trial confirm that Ω–6 PUFA increases death and coronary heart disease compared to animal fat.
Important Points:
- Fibromyalgia
- Chronic pain
- hemoglobin A1c
- insulin resistance
Insulin Resistance and Chronic Pain
An estimated 10 million adults in the United States live with fibromyalgia — a condition that causes pain throughout the body often to the point where it’s difficult to function. Could the key to understanding and treating fibromyalgia and other chronic pain involve insulin resistance? We will shed some light on current research on this topic.
So, what is Fibromyalgia?
Characterized by chronic and widespread pain, increased sensitivity to pain, and heightened feelings of fatigue, brain fog, etc., fibromyalgia remains poorly understood. The condition is also hard to diagnose, difficult to manage, and diminishes the quality of life for those struggling with it. It is reported that there’s an estimated global prevalence of 2.7%, with females outnumbering males nearly three to one. In addition, a couple of studies have noted that fibromyalgia seems to be more prevalent among individuals with Type 2 diabetes (T2d) suggesting a link between the two conditions that is worthy of further study. While experts agree that genetics and environmental factors are at play with fibromyalgia, little is known regarding how and why the syndrome develops.
Diagnostic criteria for fibromyalgia comes from the American College of Rheumatology (ACR) guidelines. The Widespread Pain Index measures pain or tenderness felt in the week prior to the appointment in 19 different body regions. The Severity Scale is deduced by the patient’s reporting the severity of symptoms like fatigue and brain fog on a scale from 0 to 3. ACR guidelines combine these two measurements using a rating scale from 0 to 31, and according to them, a score of 13 or higher corresponds to a diagnosis of fibromyalgia.
The global economic impact of FM is enormous. In the United States alone, the healthcare cost is around $100 billion/year and is comparable to reports in European countries. Due to lower pain thresholds, patients with FM also have a higher incidence of symptomatic musculoskeletal and spinal disorders which in themselves contribute to the financial burden of managing this disorder.
Many hypotheses have been advanced to explain the extensive array of symptoms including inherited abnormalities, dysfunction of neurotransmitter pathways such as substance P, immune dysregulation, and several others. Unfortunately, none of these propositions has led to practical advances beyond symptomatic treatment. In fact, recent reviews of FM published in 2016 and 2017 have concluded that there have been no substantive advances in our understanding of this disease.
2. What are the Similarities Between Fibromyalgia and Insulin Resistance?
Although more recent reviews of fibromyalgia research do not make mention of the purported link between the syndrome and insulin resistance or diabetes, the two conditions affect brain vasculature in strikingly similar ways.
According to Miguel Pappolla, MD, PhD, a professor of neurology at the University of Texas Medical Branch and medical director of St. Michael’s Pain and Spine Clinics in Houston, insulin resistance is known to impair brain microcirculation leading to slowed blood flow and oxygenation (hypo-perfusion) in certain brain regions. “What is very interesting,” he said, “is that patients with fibromyalgia also have hypo-perfusion in several brain areas.” The question remains, however, whether insulin resistance may be behind these similar decreases in blood flow experienced by those with fibromyalgia.
- Research into these Similarities
To investigate this question, Dr. Pappolla led a retrospective, cross-sectional study, reviewing medical records from 23 patients (21 females, 2 males; 11 White, 8 Hispanic, 4 African American; ages 35 to 60) at St. Michael’s Pain and Spine Clinics.7 All 23 patients met the ACR criteria for diagnosis with fibromyalgia.
As a measure of insulin resistance, the team selected the hemoglobin A1c, in which values between 5.7 and 6.4 define prediabetes and values of 6.5 or more constitute diabetes. They compared the A1cs on record for the 23 patients with fibromyalgia to those of two separate control groups: the non-diabetic subset (1,350 people) from the Framingham Offspring Study characterized by normal glucose tolerance (FOS NGT) and the non-diabetic subset (1,592 people) from the National Health and Nutrition Examination Survey (NHANES).
When the investigators compared the A1c test results of the people with fibromyalgia with those of age-matched controls, they found that the former group had significantly higher levels of hemoglobin A1c than the latter indicating a measure of insulin resistance.
“[People with prediabetes] with slightly elevated A1c values carry a higher risk of developing central (brain) pain, a hallmark of fibromyalgia and other chronic pain disorders,” notes Dr. Pappolla, pointing out that this link between insulin resistance and fibromyalgia has been around for a long time. Surprisingly, this link went unnoticed. “Considering the extensive research on fibromyalgia, we were puzzled that prior studies had overlooked this simple connection,” the first author says.
“The main reason for this oversight is that about half of fibromyalgia patients have A1c values currently considered within the normal range. However, this is the first study to analyze these levels normalized for the person’s age, as optimal A1c levels do vary throughout life,” the researcher continues.
“Adjustment for the patients’ age was critical in highlighting the differences between patients and control subjects,” he explains.
As part of the study, the researchers administered metformin — a drug that people typically take to treat insulin resistance — to the participants with fibromyalgia and muscular or connective tissue pain.
Metformin successfully reduced pain in this cohort, prompting the researchers to suggest that this common drug could be a viable and less expensive treatment option for some people with this chronic pain condition.
“In the [U.S.] alone, the healthcare cost is around $100 billion [per] year; comparable to reports in European countries,” the researchers write in the study paper.
“Earlier studies discovered that insulin resistance causes dysfunction within the brain’s small blood vessels. Since this issue is also present in fibromyalgia, we investigated whether insulin resistance is the missing link in this disorder.”
First author Dr. Miguel Pappolla
“We showed that most — if not all — patients with fibromyalgia can be identified by their A1c levels, which reflects average blood sugar levels over the past 2 to 3 months,” Dr. Pappolla adds.
The A1c test is a blood test that allows doctors to measure a person’s blood sugar levels by looking at “hemoglobin A1c,” a blood cell protein that binds to the simple sugar glucose. Doctors use this test to diagnose prediabetes and type 2 diabetes
In order to supplement this finding, the evolution of the pain scores of patients with FM who had had their Insulin Resistance treated pharmacologically was also reviewed. This subgroup of patients reported dramatic improvements of their myofascial pain after treatment with metformin.
- Do these findings offer hope for the future for Chronic Pain Treatment?
This evidence, although preliminary, suggests a pathogenetic relationship between Fibromyalgia and Insulin Resistance, which may lead to better treatment plans. Along with this, Metformin, a drug commonly used to treat diabetes patients by targeting insulin resistance, has shown promise with treating pain from fibromyalgia; it may translate not only into a radical paradigm shift for the management of [fibromyalgia] but may also save billions of dollars to healthcare systems around the world.
That said more research is needed to better understand the link between insulin resistance and fibromyalgia and other types of chronic pain.
References:
- NCBI (2016): A Correlative Relationship Between Chronic Pain and Insulin Resistance in Zucker Fatty Rats: Role of Downregulation of Insulin Receptors. Retrieved from
https://www.ncbi.nlm.nih.gov/pubmed/26705975
- Science Daily (2019): Does insulin resistance cause fibromyalgia? Retrieved from
https://www.sciencedaily.com/releases/2019/05/190507145523.htm
- MedicalNewsToday (2019): Fibromyalgia: Is insulin resistance ‘the missing link?’ Retrieved from
https://www.medicalnewstoday.com/articles/325155.php#1
- Plos One (2019): Is insulin resistance the cause of fibromyalgia? A preliminary report. Retrieved from
https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0216079
- Practical Pain Management (2019): Fibromyalgia and Insulin Resistance: Correlational or Causal Relationship? Retrieved from
- Healthline (2019): Drug Used to Treat Diabetes May Be Effective Against Fibromyalgia. Retrieved from
https://www.healthline.com/health-news/does-insulin-resistance-cause-fibromyalgia
A calorie is a calorie only if it is incinerated in a bomb calorimeter, and the heat given off measured. Biologically derived calories from different foods have entirely different metabolic effects on the human body. Equal calorie portions of sugar, alcohol, meat or olive oil have widely differing effects on hormonal systems such as insulin, and satiety signals such as cholecystokinin or peptide YY. It is irrelevant how many calories a portion of food on a plate contains.
Eat less doesn’t work. The current caloric reduction strategies promoted for weight loss are ineffective. Using the standard calorie reduction approach produces a probability of attaining a normal weight at 1 in 167, generating a greater 99% failure rate.
Important Points:
- Inflammation
- Tumor
- Cancer risk
- Immune reaction
Inflammation and Cancer
Our body’s immune system forms a defensive shield that would impress any fighting force. One of its most powerful weapons is inflammation, a carefully orchestrated maneuver designed to eliminate enemies such as bacteria, injured cells, and chemical irritants. We probably wouldn’t survive beyond infancy without it.
But inflammation has a split personality – besides the beneficial elimination, it can wreak havoc for those unfortunate enough to experience it. We now know that inflammation’s dark side is a powerful force in cancer development where it aids and abets tumor growth to spread it around the body.
- The History of Inflammation and Cancer
Experts have long suspected inflammation may play some role in cancer’s development, but researchers have only recently pinpointed chronic inflammation as a primary risk factor for cancer and other serious health conditions. In 1863, German scientist and physician Rudolf Virchow was the first to make the connection when observing that cancer often develops at sites of chronic inflammation. Because chronic inflammation causes few, if any, outward symptoms and because inflammation also benefits us at times, it’s taken quite a long time to see the relationship between inflammation and cancer.
Inflammation is a normal physiological response that causes injured tissue to heal. An inflammatory process starts when chemicals are released by the damaged tissue, and in response, white blood cells aid other cells to divide and grow in rebuilding tissue and repairing the injury. Once the wound is healed, the inflammatory process ends.
In chronic inflammation, the inflammatory process may begin even if there is no injury, and it does not end when it should. Why the inflammation continues is not always known. Chronic inflammation may be caused by infections that don’t go away, abnormal immune reactions to normal tissues, or conditions such as obesity. Over time, chronic inflammation can cause DNA damage and lead to cancer. For example, people with chronic inflammatory bowel diseases, such as ulcerative colitis and Crohn’s disease, have an increased risk of colon cancer.
- How Inflammation Can Lead to Cancer
When a tiny tumor starts growing from a few rogue cells, it can scavenge enough oxygen and nutrients from its surroundings. As it grows bigger, it’s demand starts to outstrip the supply, and cancer cells suffer. In their struggle to survive, they accumulate more and more genetic faults and release chemical signals that lure immune cells called macrophages and granulocytes to infiltrate the tumor.
Once inside the tumor’s inner sanctum, these cells secrete molecules called cytokines that kick-start the growth of blood vessels (angiogenesis) to ferry in much needed oxygen and nutrients. Other cytokines encourage growth of a sort of cellular ‘pillow’ called the stroma against which the tumor rests. Meanwhile, other inflammatory cells spritz the tumor with free radical molecules that further damage their DNA. Inflammation might also fire the starting gun for metastasis by producing chemicals that help tumor cells nibble through the molecules tethering them to their surroundings.
Taking all this together, it’s clear that fledgling tumors hijack inflammation and use it to accelerate the progression towards full-blown cancer.
- Potential Causes of This Inflammation
The reason inflammation becomes chronic isn’t always apparent. It may be caused by infections that don’t go away, abnormal immune reactions to normal tissues, or certain conditions like obesity. Over time, chronic inflammation may damage DNA, leading to conditions like heart disease, type 2 diabetes, stroke and cancer. “Anything that causes inflammation will cause the DNA of a cell to replicate faster,” says Brad Mons, DO, Head and Neck Surgeon at our hospital in Tulsa. “The more your cells replicate, the higher chance you have of cancers developing.”
Sometimes, cancer-causing chronic inflammation stems from a disease characterized by inflammation; colitis, pancreatitis, and hepatitis, are linked to a greater risk of colon, pancreatic, and liver cancers, respectively. In these diseases, immune cells create highly reactive molecules containing oxygen and nitrogen that can damage DNA.
Chronic inflammation also may result from a chronic infection; H. pylori is often linked to stomach cancer, and hepatitis B and hepatitis C are often linked to liver cancer. HIV increases the risk of other viruses and very rare cancers, including Kaposi sarcoma, non-Hodgkin lymphoma, and invasive cervical cancer.
In other cases, environmental factors are the culprits. Asbestos exposure increases the risk for mesothelioma. In fact, many environmental carcinogens and risk factors are associated with some form of chronic inflammation.
- How to Reduce Your Risk
Today, researchers are exploring whether oxygen sensors in the body can be manipulated to reduce chronic inflammation. One study found that tricking immune cells into believing they’re lacking oxygen makes them retreat from the site of inflammation to conserve energy. Researchers are now studying whether medications could be developed to turn on certain proteins that, when activated, inhibit the body’s inflammatory response.
Evidence is also building that aspirin may help prevent chronic inflammation; the non-steroidal anti-inflammatory drug works by reducing the production of prostaglandins, chemicals that promote inflammation, pain, and fever. In a 2016 report published in the Journal of the American Medical Association, researchers who studied aspirin use in 135,000 patients concluded “long-term aspirin use was associated with a modest but significantly reduced risk for overall cancer, especially gastrointestinal tract tumors. Regular aspirin use may prevent a substantial proportion of colorectal cancers too.
- Using Diet to Combat Inflammation
- Add more plant foods to your diet: Plant foods are the only foods that contain anti-inflammatory phytonutrients, and they are high in the antioxidants and fiber your body needs to reduce your cancer risk.
- Limit processed foods: Choosing whole, fresh foods and doing your own prep maximizes nutrients and phytonutrients which keep us healthy in many ways, while reducing inflammation.
- Balance fatty acids: Eating the right dietary fats is important for reducing inflammation. Omega-3 fatty acids can help protect your body from chronic inflammation, but omega-6 fatty acids increase inflammation.
- Limit red meat: Eating too much red meat, like pork, beef, lamb, deer and buffalo, can increase your cancer risk, so try to limit red meat to 18 oz. or less a week.
- Eat more fermented foods: Fermented foods, also known as probiotics, can help reduce inflammation; to get the most health perks, eat at least one small serving of a fermented food each day.
Foods that help reduce your cancer risk also help reduce chronic inflammation and vice-versa. So, following these guidelines will ultimately reduce your risk of a variety of chronic diseases and improve your quality of life.
The bottom line
Better known to most of us by its brand name aspirin, acetylsalicyclic acid has been used for over a century to quell inflammation, and there’s now a body of evidence highlighting its potential in cancer prevention. While there’s still a ways to go to work out who should take aspirin, how much, and for how long, it’s becoming clear that blocking inflammation will play a big role in cancer prevention and treatment in the future.
References:
- NCBI (2010): Inflammation and cancer. Retrieved from
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2803035/
- National Cancer Institute (2015): Chronic Inflammation. Retrieved from
https://www.cancer.gov/about-cancer/causes-prevention/risk/chronic-inflammation
- Cancer Centre (2018): Inflammation linked to cancer, but lifestyle changes may help. Retrieved from
- Cancer Research UK (2018): Feeling the heat – the link between inflammation and cancer. Retrieved from
- MDAnderson Cancer centre (2014): Inflammation and cancer: Why your diet is important Retrieved from
https://www.mdanderson.org/publications/focused-on-health/inflamation-cancer-diet.h14-1589046.html