Summary: The prevalence of obesity in children and young adults has risen in the US and even globally. It will have long-term consequences like an increase in diabetes, hypertension, and other related disorders. It has been an ongoing trend for the last few decades. Even worse, a new study by CDC indicates that covid-19 doubled the rate of weight gain in children. Weight gain has been highest among children aged 5 to 11 years. Moreover, these changes happened in a very short time. If steps are not taken to reduce obesity in children, it will have long-term consequences that would be felt even decades after the pandemic is over.

Keywords: obesity in children, weight gain, covid-19 pandemic

Non-communicable diseases like diabetes, cardiovascular ailments, arthritis, respiratory disorders are a huge burden for healthcare in the US. Early studies show that grounds for these health issues are laid down in wrong lifestyle choices in childhood. At present, close to 20% of children in the US are living with obesity1.

But that is not all. Data clearly shows that even before the covid-19 epidemic, the rate of obesity was continually rising among children aged 2 to 19 years2. Obesity has various impacts on the physical and mental health of children. Though diseases like diabetes or heart disorder occur much later in life, psychological issues related to obesity start much earlier3.

In 2020, the covid-19 pandemic caused a considerable change in the lifestyle of young and old. It resulted in many restrictions. It meant that children did not go out as often and were physically less active. It also meant consuming more calories. Increased use of gadgets, computer gaming also rose considerably.

One of the largest studies has been published by the US Centers for Disease Control (CDC), indicating a sharp rise in obesity amount children. As per the report, the rate of weight gain doubled in less than nine-months4.

Impact of covid-19 pandemics on obesity in children

The study used the medical record data of 432,302 children aged 2 to 19 years to see how pandemic affected their body weight or BMI. BMI is a more accurate way to understand obesity as it shows weight relative to height.

The study found that almost all children gained weight, except a small number who were underweight. Moreover, the study found that gain in body weight was more remarkable in younger children. Thus, preschool and school-aged children were affected more than adolescents.

It is evident why these young adults were more affected than adolescents. It appears to be the result of closed childcare centers and schools. As a result, most children did not engage in much physical activity at home.

And they spent more time in front of screens.

Some data is truly alarming, like 5.3 times increase in proportions of weight gain. Thus, obesity in 2-19 years rose from 19.3% in August 2019 to 22.4% in August 2020. It is worth noticing that such a severe increase occurred in just about 6-months of the pandemic. The study found that the rate of weight gain was 6.1 and 7.6 pounds, compared to 2.7 pounds in those with a healthy weight. This study also found the greatest increase in body weight among children aged 6-11, with 2.5 times greater change than the pre-pandemic rate4.

These findings should raise the alarm for all the caretakers. Since such an increase in weight gain may have severe long-term health consequences. It may cause a considerable increase in type 2 diabetes, heart diseases, and depression in this population group. Needless to say, that the impact of this pandemic will be felt even after decades.

Simple measures may help reverse these health issues

Thus, most professional organizations recommend the need for raising awareness. There are many ways in which this weight gain can be countered. It is vital to encourage children to do more physical exercise, spendmore time in the sun, and start moving.

It may also mean making dietary changes, reducing total calorie intake, less frequent snacking, or switching to healthy snacks. It is also vital to reduce portion sizes. Limiting the use of processed foods is an absolute must.

Finally, limiting screen time may also help. So many children these days are tied to gadgets, screens. Thus, a need to limit the time children are viewing TV, playing on gaming consoles.

References

1. Childhood Obesity Facts | Overweight & Obesity | CDC. Published April 5, 2021. Accessed October 8, 2021. https://www.cdc.gov/obesity/data/childhood.html

2. Skinner AC, Ravanbakht SN, Skelton JA, Perrin EM, Armstrong SC. Prevalence of Obesity and Severe Obesity in US Children, 1999–2016. Pediatrics. 2018;141(3). doi:10.1542/peds.2017-3459

3. G V, Mr L, M M, et al. [Health consequences of obesity in children and adolescents]. Minerva Pediatr. 2014;66(5):381-414.

4. Lange SJ. Longitudinal Trends in Body Mass Index Before and During the COVID-19 Pandemic Among Persons Aged 2–19 Years — the United States, 2018–2020. MMWR Morb Mortal Wkly Rep. 2021;70. doi:10.15585/mmwr.mm7037a3

Summary: Reducing total fat consumption did not considerably help reduce the prevalence of abdominal fat accumulation, and obesity has increased. Studies suggest that this rise is more due to higher consumption of linoleic acid (LA) rich omega-6 fatty acids. It occurred as humans switched to greater consumption of vegetable oils from animal fat consumption. It also resulted in lower omega-3 in the diet. Experimental studies confirm that reducing the dietary intake of LA may considerably help lower the risk of obesity. Additionally, adding omega-3 to the diet may have additional benefits of countering LA’s adverse effects, thus helping lower obesity prevalence.

Keywords: linoleic acid (LA), omega-6 fatty acids, omega-3 fatty acids, eicosapentaenoic acid (EPA), docosahexaenoic acid (DHA), endocannabinoid system

Introduction

New experimental data indicate that high dietary intake of omega-6 and relatively low omega-3 intake has more to do with obesity, accumulation of visceral fat, and insulin resistance than total fat intake to fulfil energy needs. Correction of omega-6: omega-3 ratio in diet may be the key to countering obesity.

Abdominal obesity has grown at an alarming rate in the last 40-50 years in the US. Historical data shows that in men, it rose from 12.7% to 38.3%. Whereas, in women, it grew from 19.4% to almost 60% between 1960 -2000. This tripling of abdominal obesity is difficult to explain solely based on the total fat content of the diet1.

Researchers think that increase in abdominal obesity has more to do with the quality of fats consumed. Some researchers suggest that humans have evolved to consume omega-6 and omega-3 fatty acids almost in equal ratios. However, in the modern diet, its proportions are from ~10:1 to 25:1. That’s a severe disbalance2.

If that is the case, correcting the omega-6 to the omega-3 ratio by consuming more omega-3 and less omega-6 may solve the problems of obesity to a great extent. However, before making any firm recommendation, there has to be strong evidence supporting the theory.

Researchers think that some evidence comes from watching the historical changes in dietary patterns. For example, data shows that consumption of omega-6 fatty acids rose considerably from 1900 onwards, when people in the western world switched from butter or lard to consuming more vegetable oils, like soybean oil. This resulted in a two-fold increase of linoleic acid (LA), the primary omega-6 fatty acid in vegetable oils, and it makes now 8 to 10% of total calorie intake3.

These assumptions are further supported by a systemic review of studies indicating that LA content in subcutaneous tissues in the US has increased by 2.5 times.

Experiments confirm that reducing LA intake or increasing omega-3 intake may help counter obesity

Researchers carried out lab experiments in mice to understand the effect of LA on obesity and further understand the role of a high-fat diet4.

Firstly, they divided mice into two groups, one to be fed with a medium-fat diet (35% of total calorie intake) and another on a high-fat diet (65% of the total calorie intake). They further divided mice into two groups, with one fed with diet having 1% LA and another with 8% LA diet (meaning 1% and 8% of energy from LA, respectively).

Interestingly enough, they found that higher fat consumption was not much related to obesity, as there is not much difference in the group a and d.

However, there is a clear and high association between obesity and high LA consumption irrespective of total fat intake; thus, both group b and e mice developed severe abdominal obesity.

 

Next, they wanted to understand the role of omega-3 fatty acids in the diet. Thus, they added omega-3 (eicosapentaenoic acid (EPA) + docosahexaenoic acid (DHA) to the diet of the mice on the 8% LA group.

They found that omega-3 enriched diet may help prevent obesity and thus metabolic disorders. To their surprise, omega-3 could help control obesity in mice on an 8% LA diet, and total fat in the diet had not much impact on it. Thus omega-3 fatty acids prevented fat accumulation in the 8% LA and medium fat diet group (Figure 2 C) and 8% LA and high-fat diet group (Figure 2 F)

 

It confirmed the following things:

• LA is the primary cause of abdominal obesity, be it low fat or a high-fat diet. Thus, a need to limit LA consumption.

• Consuming a diet rich in omega-3 fatty acids (EPA+DHA) may help counter obesity-causing effects of LA.

Understanding the underlying mechanism

 

Researchers think that this ability of LA to cause obesity can be explained by changes that happened at the cellular level due to high LA consumption. It primarily stimulates the endocannabinoid system leading to impaired fat storage, altered behavior, appetite, and thus greater risk of obesity.

Although total calorie intake counts, perhaps how many calories a body gets from fats is less relevant. Even a high-fat diet will not cause obesity if it is low in LA containing fats. Further, adding omega-3 fatty acids rich in EPA and DHA may help counter these obesity-causing effects of LA.

References

1. Okosun IS, Chandra KMD, Boev A, et al. Abdominal adiposity in US adults: prevalence and trends, 1960–2000. Preventive Medicine. 2004;39(1):197-206. doi:10.1016/j.ypmed.2004.01.023

2. Simopoulos AP. Evolutionary Aspects of the Dietary Omega-6/Omega-3 Fatty Acid Ratio: Medical Implications. In: Alvergne A, Jenkinson C, Faurie C, eds. Evolutionary Thinking in Medicine: From Research to Policy and Practice. Advances in the Evolutionary Analysis of Human Behaviour. Springer International Publishing; 2016:119-134. doi:10.1007/978-3-319-29716-3_9

3. DiNicolantonio JJ, O’Keefe JH. Omega-6 vegetable oils as a driver of coronary heart disease: the oxidized linoleic acid hypothesis. Open Heart. 2018;5(2):e000898. doi:10.1136/openhrt-2018-000898

4. Alvheim AR, Malde MK, Osei-Hyiaman D, et al. Dietary Linoleic Acid Elevates Endogenous 2-AG and Anandamide and Induces Obesity. Obesity (Silver Spring). 2012;20(10):1984-1994. doi:10.1038/oby.2012.38

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Important Points:

• Obesity
• Malnourished
• Nutrient intake
• Vitamin deficiency
• Starvation

Malnutrition is Both Obesity and Starvation

Malnutrition is a word we usually associate with the tragically thin figures from TV news reports of third world famines. In fact, it’s a shockingly common problem the world over. Though not at starvation level, there are millions of patients who aren’t getting sufficient calories, protein, vitamins, and minerals.

Doctors say our growing reliance on fast food coupled with mounting rates of binge-drinking means many people lack the vitamins and minerals essential for health. The result, in the most extreme cases, is pot-bellies, wasted limbs and emaciated bodies – all conditions more often associated with famine victims in the developing world. While malnutrition can be fatal, in more mild forms it can cause a host of symptoms that impact our everyday life, from hair loss and muscle wastage to food cravings and lethargy.  It is possible to be obese and still be malnourished.

1.  What is Malnutrition?

Malnutrition is a serious condition that occurs when a person’s diet doesn’t contain the right amount of nutrients. Malnutrition means “poor nutrition” and can refer to:

• undernutrition – when you don’t get enough nutrients
• overnutrition – when you get more nutrients than you need

2.  Who is Affected by Malnutrition?

Malnutrition is a common health problem. There are an estimated 3 million malnourished people in the UK at any time, with many more at risk of becoming malnourished. Around one in three people admitted to hospital or care homes in the UK are found to be malnourished or at risk of malnourishment.

Malnutrition is caused by having an inadequate diet or a problem absorbing nutrients from food which can be caused by having reduced mobility, a long-term health condition, or a low income.

3.  What are the Signs of Malnutrition?

The most common symptom of undernutrition is unintentional weight loss (losing 5-10% or more of your body weight over three to six months), and other signs include weak muscles, fatigue, low mood, and an increase in illnesses or infections.

The main sign of overnutrition is being overweight or obese, however, people with undernutrition can also be overweight if they eat a diet high in energy (calories) but low in other nutrients.

4. Malnutrition of Excess: Obesity

The number of people who are malnourished despite being obese is shocking, a leading weight loss surgeon has said today. A recent study showed despite high levels of obesity in the U.S., many people are undernourished.

A diet of pizza, fries, crisps, pasta, rice, biscuits, cakes leaves many people consuming a lot of calories but few nutrients, says Dr Sally Norton, an NHS consultant specializing in weight loss and upper gastrointestinal surgery.

Drug companies push the sales of expensive drugs which treat the symptoms of the disease but not the cause. The multi-million-dollar drug industry encourages doctors to treat type 2 diabetes, high cholesterol, heart disease and other conditions related to poor nutrition with expensive drugs rather than healthier food.

Hippocrates, the father of medicine, was so right when he said, over 2,000 years ago: ‘let food be thy medicine’. And yet, fast-forward to the 21st century and a recent study of Americans shows that many Americans, despite their access to plenty of food, are undernourished.

5. Can obese people really be malnourished? 

Picture a malnourished hospital patient…..

The person you’re imagining probably doesn’t weigh 300 pounds, does she? Yet obese patients can develop malnutrition, before or during hospitalization and have worse outcomes as a result.

In fact, according to a recent study, malnutrition counteracts the “obesity paradox,” which holds that, among the critically ill, heavier patients do better than normal- or underweight patients. Researchers who looked specifically at malnourished obese patients showed that they had a higher risk of mortality than well-nourished patients of similar body mass index, according to results published in the January issue of Critical Care Medicine.

Yet these patients’ nutritional deficiencies often pass under hospital clinicians’ radar, according to experts. “We as physicians don’t necessarily have a great handle on who is malnourished,” said Kenneth B. Christopher, MD, co-author of the study. “You can always tell if someone’s profoundly malnourished, because they start appearing to be cachectic, but it’s less severe degrees of malnutrition that are actually harder to see.”

In addition to judgments based on appearance, a number of other factors can make it difficult to diagnose or prevent malnutrition in obese inpatients, including shortcomings in history taking, limitations of lab testing, and challenges in nutrition delivery. According to experts, hospitalists can help correct these deficits by raising their own index of suspicion and working with the health care team to focus on patients’ nutritional status.

While malnutrition can be fatal, in more mild forms it can cause a host of symptoms that impact our everyday life. How many nutrients do you get in biscuits, pieces of cake, crisps, fries, pizza, white rice, pasta and bread? Not a whole lot. So, if you are eating these ‘nutrient deficient’ foods regularly, you should make sure to get nutrients from real, fresh, whole foods, too.

6. Diagnosing Malnutrition

Accurate screening for malnutrition begins with the recognition that you can’t see it with your eyes or even a scale. “Nutritional status is not body mass index,” summarized Dr. Christopher, who is a nephrologist and critical care specialist at Brigham and Women’s Hospital in Boston. For one thing, excess weight may not represent body fat.

Obesity could also distract from recent weight loss, an important marker of malnutrition. “Somebody could be obese but have a gastrointestinal problem and have been losing weight. Even though they’ve lost a considerable amount of weight, they started off so obese that they’re still technically obese,” said Dr. Mechanick.

Because our society has so much stigma around overweight and obesity, when many obese people lose weight, however they lose it, they get more positive feedback,” said Charlene W. Compher, PhD, a professor of nutrition science at the University of Pennsylvania in Philadelphia. If a patient lost weight due to bariatric surgery, he is particularly at risk for malnutrition. “The odds of having vitamin deficiencies are very high with patients with gastric bypass, especially if they do not take all of the vitamin and mineral supplements that they are instructed to,” said Dr. Compher. And obese individual could be getting enough calories, but not enough protein or other nutrients due to an unhealthy diet.

7. How Can You Tell if You’re Malnourished?

“There’s no lab test for malnutrition,” said Dr. Kirkland. “People rely on albumin. It’s not helpful for malnutrition. Albumin just reflects the acuity of illness or the duration of malnutrition, but not the severity of it or the presence of it.”

Whatever your weight, ensure to always have well balanced healthy meals, with regular supplementation where necessary, as malnutrition could potentially lead to other chronic illnesses such as type 2 diabetes, heart issues and others.

References:

• International Journal of Obesity (2019): Overfed but undernourished: recognizing nutritional inadequacies/deficiencies in patients with overweight or obesity. Retrieved from

https://www.nature.com/articles/s41366-018-0143-9

• NCBI (2012): The Malnutrition of Obesity: Micronutrient Deficiencies That Promote Diabetes. Retrieved from

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3313629/

• ACP Hospitalist (2015): Obesity and malnutrition are not mutually exclusive. Retrieved from

https://acphospitalist.org/archives/2015/02/nutrition.htm

• Critical Care Medicine (2015):  The True Obesity Paradox

Obese and Malnourished? Retrieved from

https://journals.lww.com/ccmjournal/Citation/2015/01000/The_True_Obesity_Paradox__Obese_and_Malnourished__.33.aspx

• NHS Inform (2019): Malnutrition. Retrieved from

https://www.nhsinform.scot/illnesses-and-conditions/nutritional/malnutrition

Important Points:

• whole grains
• refined grains
• Western dietary pattern
• diabetes
• obesity

Refined Grains: The Good, the Bad, the Ugly

Flour is all around us and a temptation at every meal. Breakfast toast, bagels, cereal, and pancakes fill our tables. Lunch revolves around sandwiches, wraps, pasta and pizza. Refined grains have been vilified as one of the leadings causes of ill health. Is there any truth to this? Should we toss all refined grain products off our tables? We will have an in-depth look at the good, the bad, and the ugly of refined flour to give you a better understanding of the goodies on your plate.

What are Refined Grains?

Refined grain is the term used to refer to grains that are not whole, because they are missing one or more of their three key parts (bran, germ, or endosperm). White flour and white rice are refined grains, for instance, because both have had their bran and germ removed, leaving only the endosperm. Refining a grain removes about a quarter of the protein in a grain and half to two thirds or more of a score of nutrients, leaving the grain a mere shadow of its original self.

Further refining includes mixing, bleaching, and brominating; additionally, thiamin, riboflavin, niacin, and iron are often added back in to nutritionally enrich the product. Because the added nutrients represent a fraction of the nutrients removed, refined grains are considered nutritionally inferior to whole grains. However, for some grains the removal of fiber coupled with fine grinding results in a slightly higher availability of grain energy for use by the body.

Grain refining led to disastrous and widespread nutritional problems, like the deficiency diseases pelagra and beri-beri. In response, many governments recommended or required that refined grains be “enriched.”

The Good

The federal government’s 2010 Dietary Guidelines for Americans recommend that half your daily grain intake be from high-fiber whole-grain sources, foods like brown rice, oatmeal and whole-wheat bread. Nutritionists often exhort people to choose whole grains over refined ones whenever they can.

But according to one leading nutrition researcher, Julie Miller Jones, a professor emeritus at St. Catherine University, we shouldn’t be so eager to throw out refined grains altogether. Refined grains do have some benefits — namely, nutrients added to refined flours.

Since folic acid was added to bread, cereal and other grains in 1999, the rate of newborns with neural tube defects — a known consequence of folic acid deficiency — has decreased 46%. Additionally, important nutrients like copper and iron are more easily absorbed when eaten with refined grains. Whole grains are healthy because they’re so high in fiber, which Americans don’t get enough of, but that fiber also fast-tracks food through the digestive system, absorbing nutrients along the way.

The Bad

As our national appetite for flour has inched up, so has the incidence of diet-related ills, such as obesity, heart disease and diabetes. Coincidence? Many nutrition experts don’t think so. When they weigh the evidence linking food choices and disease, they see the white, dusty fingerprints of flour everywhere.

Flour started out as an ingenious fix to a vexing problem. Grass seeds were plentiful, but the tough outer shell (the husk) made the seeds difficult to chew and digest. Early humans outsmarted the seeds by grinding them between stones, crushing the outer layers to get at the goodness inside. The result — a coarse powder — was the first whole-grain flour.

The downside was spoilage. Crushing the germ released its oils, which quickly turned rancid when exposed to air. With the advent of industrial milling in the late 1800s, machines began filtering out the germ and pulverized the remaining endosperm into a fine, white powder that lasted on the shelf for months. And so all-purpose white flour was born — along with a host of health problems.

Beneath their rigid architecture, whole-kernel grains conceal an array of vitamins, minerals, phytonutrients and fiber. But when machines pulverize kernels into flour, even whole-grain flour, what’s left behind is a starchy powder capable of wreaking havoc on the body.

The Ugly

Overconsuming flour can lead to a number of problems in the body, including:

• Food Allergies/Intolerances. Gluten intolerance is a term that has become synonymous with the current generation. Wheat is one of the biggest dietary triggers of food allergies and intolerances. While the exact reason is unclear, many experts blame the higher gluten content of modern wheat varieties
• Blood-Sugar Spikes. The difference between a whole-kernel grain and a processed grain all boils down to the glycemic index, which is how quickly the body turns food into fuel, or glucose. Foods made with wheat flour are particularly damaging. A carbohydrate in wheat, called amylopectin A, is more easily converted to blood sugar than just about any other carbohydrate. Two slices of bread made with whole-wheat flour raise blood sugar higher than six teaspoons of table sugar and higher than many candy bars.
• Food Cravings.  One of the biggest changes in modern wheat is that it contains a modified form of gliadin, a protein found in wheat gluten. Gliadin releases a feel-good effect in the brain by morphing into a substance that crosses the blood-brain barrier and binds onto the brain’s opiate receptors and makes you want to eat more.
• Caloric Overload. A refined grain packs more calories than a whole-kernel grain because it is more concentrated, and foods that are high in grains also tend to be high in sugar and industrialized fats. These foods contribute largely to obesity and the diabetes epidemic.
• Metabolic Slowdown. Research shows that the body may shift nutrients into fat storage and away from muscle burning in the presence of high-glycemic-index foods. In 2004, Ludwig and his colleagues at Harvard conducted a study, published in the journal Lancet, in which they fed rats diets with identical nutrients, except for the type of starch. By the end of the study, rats in both groups weighed roughly the same, but those eating a high-glycemic diet had 71 percent more fat than the low-glycemic-index group.
• Inflammation. A diet high in grains stokes inflammation. When blood sugar spikes, glucose builds up in the blood significantly. When glucose drifts in the blood, it attaches itself to nearby proteins resulting in a chemical reaction called glycation, a pro-inflammatory process that plays a role in a host of inflammatory diseases.
• GI Disorders. Studies show that the lectins in grains inflame the lining of the gut and create fissures between cells. Also, when whole-kernel grains are refined, 80 percent of the fiber is lost, and gut health suffers. Additionally, fiber helps sweep the gut of debris and supports the body’s critically important elimination and detoxification processes, which also play a role in keeping high cholesterol and inflammation at bay.
• Acid-Alkaline Imbalance. The body has an elaborate system of checks and balances to keep its pH level at a steady 7.4. A diet high in acidic foods, such as grains, forces the body to pull calcium from the bones to keep things on an even keel. When researchers looked at how the diets of more than 500 women affected their bone density, they found that a diet high in refined grains, among other nutrient-poor foods, was linked to bone loss. A highly acidic diet also chips away at our cellular vitality and immunity in ways that can make us vulnerable to chronic disease. Grains are the only plant foods that generate acidic byproducts. Wheat, in particular, is among the most potent sources of sulfuric acid, a powerful substance that quickly overcomes the neutralizing effects of alkaline bases.

The Bottom Line….

Grains are not essential, and there is no nutrient in there that you can’t get from other foods.

It is wrongly assumed that excessive caloric intake is the root cause of obesity. A calorie of food energy has different metabolic fates depending upon the hormonal stimulation. That same calorie may be used to generate body heat or stored as body fat.

Obesity is a disease of failed energy partitioning, not one of the total energy intake. The primary driver of this partitioning is the hormone insulin. Insulin is specifically a fat storage growth hormone.

Obesity, Prediabetes, and Diabetes Type 2 are associated with most of the diseases of modern society (cardiovascular/cerebrovascular disease, cancer, Alzheimer’s disease). These are all metabolic dysfunctions related to the malnutrition of overconsumption which leads to metabolic inflammation, or metal inflammation.

The best way to reverse diabetes is to not get diabetes in the first place because your chances of heart disease, cancer, and death are increased even as a prediabetic.

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Wheat is the key ingredient in the American diet. Unfortunately, after being milled, it is seldom utilized in its whole form with its components intact. The wheat we consume is in the form of bread, pies, cakes, cookies, biscuits, spaghetti, cream of wheat, cereals, and other forms that have been treated, heated, fractioned, and fragmented. Is consuming refined grains harmful? In this article, we expound on this.

1. What are refined grains?

Almost every nutrition expert agrees that refined carbs should be limited. However, they are still the main source of dietary carbs in many countries.

What Are Refined Carbs?

Refined carbs are also known as simple carbs or processed carbs.

There are two main types:

• Sugars: Refined and processed sugars, such as sucrose (table sugar), high fructose corn syrup, and agave syrup.
• Refined grains: These are grains that have had the fibrous and nutritious parts removed. The biggest source is white flour made from refined wheat.

Refined carbs have been stripped of almost all fiber, vitamins, and minerals. For this reason, they can be considered “empty” calories. They lead to rapid spikes in blood sugar and insulin levels.

They are also digested quickly and have a high glycemic index. This means they lead to rapid spikes in blood sugar and insulin levels after meals. Eating foods high on the glycemic index has been linked to overeating and increased risk of many diseases.

Sadly, sugars and refined grains are a very large part of the total carbohydrate intake in many countries. The main dietary sources of refined carbs are white flour, white bread, white rice, pastries, sodas, snacks, pasta, sweets, breakfast cereals, and added sugars. They are also added to all sorts of processed foods. Refined Grains Are Much Lower in Fiber and Micronutrients

How do grains get refined?

Whole grains consist of three main parts;

• Bran: The hard outer layer containing fiber, minerals, and antioxidants.
• Germ: The nutrient-rich core containing carbs, fat, protein, vitamins, minerals, antioxidants, and plant compounds.
• Endosperm: The middle layer contains mostly carbs and small amounts of protein.

The bran and germ are the most nutritious parts of whole grains. They contain high amounts of many nutrients, such as fiber, B vitamins, iron, magnesium, phosphorus, manganese, and selenium.

During the refining process, the bran and germ are removed, along with all the nutrients they contain. This leaves almost no fiber, vitamins, or minerals in the refined grains. The only thing left is rapidly digested starch with small amounts of protein. Whole grains are very high in dietary fiber.

That being said, some producers enrich their products with synthetic vitamins to make up for some of the loss in nutrients. Whether or not synthetic vitamins are as good as natural vitamins has long been debated. However, most people will agree that getting your nutrients from whole foods is always the best choice.

Diets high in refined carbs also tend to be low in fiber. Low-fiber diets have been linked with an increased risk of diseases like heart disease, obesity, type 2 diabetes, colon cancer, and various digestive problems.

2. The Effect of refined grains on your health

Abdominal Fat – Consuming mainly refined grains may increase your visceral adipose tissue, a type of fat found around your organs that may eventually lead to diabetes and heart disease; according to a study carried out, participants who consumed at least three servings of whole grains per day had approximately 10 percent less VAT than people who consumed only refined grains.

Overeating and Increase the Risk of Obesity- A large portion of the population is overweight or obese. Eating too many refined carbs may be one of the main culprits. Because they are low in fiber and digested quickly, eating refined carbs can cause major swings in blood sugar levels. This can contribute to overeating. This is because foods high on the glycemic index promote short-term fullness, lasting about one hour. On the other hand, foods that are low on the glycemic index promote a sustained feeling of fullness, which lasts about two to three hours.

Heart Health-Consuming refined grains instead of whole grains may result in atherosclerosis, or thickening of the arteries, which is a risk factor for heart disease. Another study found the bran component of whole grains, which is no longer present in refined grains, maybe the most protective against heart disease, as study participants who consumed the most added bran had the lowest risk for heart disease.

Diabetes-People who consume fewer whole grains and more refined grains have a higher risk for diabetes. Studies show that high consumption of refined carbs is linked with insulin resistance and high blood sugar levels. These are some of the main symptoms of type 2 diabetes. This may be in part due to the lower fiber, magnesium, and vitamin E content of refined-grain foods, as these nutrients are decreased when whole grains are refined.

Mortality-While fiber from whole grains may be protective against early mortality, the same is not true with fiber from refined grains. The fiber in refined grains comes from the endosperm of the grain, which doesn’t contain many nutrients, while the fiber in whole grains also includes fiber from the bran and germ of the grain, which have a higher nutrient content. The beneficial effects of whole grains may be due to more than the fiber contained in these grains.

3. Why are refined grain products harmful?

Refined grains and their food products are substandard foods for several reasons:

• They are excessively starchy and high in gluten.
• They are practically devoid of natural fiber.
• There can be up to approximately 25 different chemicals that are added to refined grains and bread products.
• Grains are fumigated.
• Bleaching chemicals are used.
• Artificial colorings and flavorings are used.
• They are nutritionally imbalanced.
• Because refined grain products are nutritionally imbalanced, they are responsible for contributing to several degenerative diseases. Calcium leaching from the bones and teeth occurs because of the altered phosphorous-calcium balance in these products. Sugar and refined grain products are primarily responsible for tooth decay in this country, as well as being the major cause of brittle bones in the elderly.

4. What are some Healthy Gluten-Free Whole Grain Alternatives?

• Amaranth
• Buckwheat
• Corn
• Millet
• Oats
• Quinoa
• Rice
• Wild Rice

5. To take, or not to take, refined grains?

In the US, the familiar white flour, which is the result of the modern refining process, is 72% extraction. This means that it has lost 28% of the bulk of the wheat, including half or more of many of the crucial nutrients. It would be prudent to cut down on refined flour products and instead opt for whole grains.

Eating a lot of refined carbs can have many negative health effects. However, not all carbs are bad. Some carbohydrate-rich, whole foods are extremely healthy. These are great sources of fiber, vitamins, minerals, and various beneficial plant compounds. Some healthy carb-rich foods include vegetables, fruit, legumes, root vegetables, and whole grains, such as oats and barley. Unless you are following a carb-restricted diet, there is absolutely NO reason to avoid these foods just because they contain carbs.

References

1. Healthline (2017): Refined Carbs Are Bad For You. Retrieved from https://www.healthline.com/nutrition/why-refined-carbs-are-bad#section1

2. SF Gate (2018): The Health Side Effects of Refined Grains. Retrieved from https://healthyeating.sfgate.com/health-side-effects-refined-grains-3064.html

3. NCBI (2019): Perspective: Refined Grains and Health: Genuine Risk, or Guilt by Association? Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6520038/

4. Food Matters (2011): Why Refined Grains Are Harmful + 8 Gluten-Free Whole Grain Alternatives. Retrieved from https://www.foodmatters.com/article/why-refined-grains-are-harmful

5. Sott (2019): Why Refined Grains Are Harmful. Retrieved from https://www.sott.net/article/226260-Why-Refined-Grains-Are-Harmful

If you are like most people, you are probably thinking that I have confused diabetes for diabesity, or you are probably wondering whether I intended to say obesity. You are not so far away from the truth as diabesity is a modern disease that links obesity with type 2 diabetes. Diabesity should be a concern for people with normal blood sugars who may be accustomed to unhealthy eating and lifestyle patterns. It is unfortunate that much is not mentioned about diabesity, which can predispose you to severe obesity, diabetes, and other fatal chronic conditions.

What Is Diabesity?

Diabesity is a sequence of events that starts with optimal blood sugar balance, to progressive insulin resistance, to being overweight, then becoming obese, and finally to full-blown Type-2 Diabetes. It comes in a spectrum that includes elevated blood sugar, elevated blood pressure, high cholesterol, and other health complications. These problems stem from diet, lifestyle, and environmental toxins interacting with our unique genetic susceptibilities. A study published in NCBI in 2013 concluded that “(diabesity) makes a strong call for utilizing indigenous, low-cost means of enhancing healthy dietary and physical activity habits.” Diabesity can also be described as the coexistence of obesity and type 2 diabetes.

What Are The Triggers For Diabesity?

Diabesity occurs following the development of insulin resistance and obesity. When your diet is full of empty calories: quickly absorbed sugars, liquid calories (soda, juice, sports drinks), and refined carbohydrates, you are likely to develop a resistance to insulin. Insulin (produced by beta cells in the pancreas) is the hormone that is responsible for grabbing glucose out of the bloodstream and storing it in cells. This ensures that blood sugar remains even in the blood. When the body starts ignoring the signal sent out by insulin, we call this insulin resistance. A high insulin level is one of the first signs because beta cells will keep releasing more and more insulin to try to remedy the situation. Unfortunately, the higher your insulin levels are, the worse your insulin resistance becomes.  High insulin levels will also cause a spike in appetite which leads to overeating. Very soon, you develop weight gain around the belly, more inflammation and oxidative stress, and other effects such as high blood pressure, high cholesterol, low HDL, atherosclerosis, and increased risk of cancer, Alzheimer’s, and depression.

It is important t note here that the root cause of the problem is insulin resistance and not elevated blood sugar. Fortunately, insulin resistance can be reversed since it is strongly linked to a poor diet and an unhealthy lifestyle.

Most people can save themselves from diabesity by eliminating the factors that send their biology out of balance and replacing them with what’s needed to help the body re-balance itself.

Diabesity and Genetics

Many people believe that insulin resistance and diabesity are genetic conditions that cannot be extraneously controlled. True enough, our genetic predisposition plays a role in how we choose what to eat and how to live. It also plays a role in the development of insulin resistance. However, insulin resistance and diabesity are greatly influenced by diet and lifestyle. By controlling these factors, you can greatly minimize your chances of developing the conditions.

How To Reverse Diabesity

Before reversing diabesity, there are a few things you can do to keep safe. They include:

1. Know the signs of insulin resistance.

One of the first tell-tale signs of insulin resistance is uncontrollable weight gain. You might also experience increased blood pressure and skin discoloration (acanthosis nigricans) on rare occasions. Unfortunately, insulin resistance may go unnoticed for years. Hence, you may be better off having some tests done.

2. Get the right tests done

You should get tested if you have a positive family history of type 2 diabetes and are affected by a poor diet as well as a sedentary lifestyle. An insulin response test is the best test to tease out the condition.

If you have already been diagnosed with diabesity, here are three things you can do to start your reversal journey.

Make healthy diet choices

This may involve the input of your physician, nutritionist/ dietician, and yourself to come up with the right meal plan. A healthy diet will start with the elimination of sugary and processed foods. Opt for wholesome grains, fresh vegetables and fruits, nuts, white meat, and unsaturated fats. You can read more about this type of diet here. (hyperlink to foods that improve insulin sensitivity).

Get adequate rest

Stress is a major contributor to insulin resistance and blood sugar imbalance.  Stress also contributes to making unhealthy food choices and overeating. You need to make a conscious effort to distress frequently by:

• Sleeping for at least 7 hours daily
• Practicing relaxation techniques such as yoga
• Taking breaks in between work, like every two hours
• Taking sabbaticals and vacationing periodically

Quit a sedentary lifestyle

Modern jobs involve sitting at an office desk and hitting the keypad for hours on end. In a world where work is compensated by the hour, it can be difficult to make time for exercise. However, when you consider the negative long-term effects of a sedentary lifestyle, you will be forced to reconsider the value of the extra money. What is the point if it’s going to cost your health in the long run? Quitting a sedentary lifestyle involves making deliberate choices about exercise and fitness. This may mean walking at least 30 minutes every day or engaging in more vigorous aerobic exercise 4-6 times a week.

References

1.   Science Daily (2012): Genetic variants are linked to obesity and insulin resistance. Retrieved from https://www.sciencedaily.com/releases/2012/06/120626151107.htm

2.   NCBI (2011): Is fast food addictive? Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/21999689

3.   NCBI (2013): Diabesity. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/23905459

4.   NCBI (2008): High-fat diets cause insulin resistance despite an increase in muscle mitochondria. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2409421/

In the quest to understand the causes and early symptoms of diabetes and other chronic diseases, metabolic inflammation often comes up. What is it, and what is its role in the early onset of these diseases? This article delves into the definition of the term, its presentation, and likely effects.

1. What is metabolic syndrome?

The occurrence of metabolic syndrome has been on the rise in both developed and developing countries. It can be described as a group of disorders including glucose intolerance, central obesity, hypertension and lipid malfunctions present in various forms, depending upon the combination of the different components of the syndrome. Metabolic syndrome has been generally accepted to increase the risk for the development of Type 2 diabetes, cardiovascular disease, stroke, and cancer.

2. What is Inflammation?

Inflammation is part of the complex biological response of body tissues to harmful stimuli, such as pathogens, damaged cells, or irritants, and is a protective response involving immune cells, blood vessels, and molecular mediators. Immune signaling molecules called cytokines orchestrate inflammatory response when the harmful stimuli are detected. The inflammatory responses caused by both pathogens and wounding can cause damage to cells and tissue which in turn can induce further inflammatory responses.

The primary duty of inflammation is to isolate or rapidly destroy the underlying source of the disturbance, remove damaged tissue and then restore tissue homeostasis. Excessive inflammation can have adverse effects, resulting in collateral damage and disease.

3. Inflammation and metabolic syndrome

Metabolism can be described as the whole range of biochemical processes that occur within a living organism. Without a doubt, the relationship between inflammation and metabolism is complex. Several explanations have been proposed to explain the origin of the metabolic syndrome. Some consider an initial insulin-resistant state progressing to the other components, while others view obesity as the main initiator of the syndrome.

More recently, the chronic low-grade inflammatory condition that often accompanies the metabolic syndrome has been implicated as a major factor both at the beginning of the metabolic syndrome and its associated pathophysiological consequences.

The inflammatory state that accompanies the metabolic syndrome does not completely fit into the classical definition of acute or chronic inflammation as it is not accompanied by infection; there is no massive tissue injury and the dimension of the inflammatory activation is also not large. It is therefore often called ‘low grade’ chronic inflammation or ‘meta-inflammation’, meaning metabolically-triggered inflammation or even ‘para-inflammation’ an intermediate state between basal and inflammatory states. Whatever the term used, the inflammatory process that characterizes the metabolic syndrome has its own unique features but its causes are far from being fully understood.

4. Inflammation and its outcomes

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. We will have an in-depth discussion on some of these conditions in relation to metabolic inflammation:

            4.1 Obesity

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 as 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.

              4.2 Type 2 Diabetes Mellitus

Diabetes Type 2 is a disease of insulin resistance, where people produce too much insulin and their receptors don’t work. They become insulin resistant and the inflammation arises from excessive insulin.

It has been known for a while that there are higher levels of inflammation in the bodies of individuals with type 2 diabetes. The levels of certain inflammatory chemicals called cytokines are much higher in people with type 2 diabetes than in people who do not have diabetes.

The development of Type 2 diabetes is to a large extent driven by obesity and inactivity. Excess body fat, especially in the abdomen, leads to continuous (chronic), low levels of abnormal inflammation that alters insulin’s action and production. Chronic levels of free fatty acids and glucose as a result of insulin resistance induce further inflammation, which results in increased cell death and impaired insulin secretion. This, in turn, prompts the progression from obesity and insulin resistance to full-blown Type 2 Diabetes.

As type 2 diabetes starts to develop, the body becomes less sensitive to insulin and the resulting insulin resistance also leads to inflammation. A vicious cycle can result, with more inflammation causing more insulin resistance and vice versa. Blood sugar levels creep higher and higher, eventually resulting in hyperglycemia and other more serious effects of T2DM.

               4.3 Atherosclerosis

Heart disease is currently one of the major causes of morbidity and mortality facing humanity. Such a paradigm shift in disease patterns over the last century has been facilitated by the alarming global incidence of obesity and type 2 diabetes. Lately, there is an increasing focus on inflammation as one of the key factors in the pathophysiology of these disorders.

Early metabolic abnormalities that include weight gain, insulin resistance, and prehypertension and irregular blood lipid levels seem to have a complex relationship with diseases of the cardiovascular system.

Obesity increases the chances of diabetes, high blood pressure, pro-thrombotic state, and abnormal lipid presence. While inflammation and insulin resistance have direct antagonistic effects on the cardiac muscle, these metabolic irregularities as a whole lead to cardiovascular problems; warranting a multifaceted therapeutic and precautionary method of approach for the ‘Cardiovascular Metabolic Syndrome’ holistically.

              4.4  Non-alcoholic Fatty Liver Disease

Non-alcoholic Fatty Liver Disease is the predominant cause of liver disease. Its prevalence reaches 30% of the population and up to 75–100% in people with obesity. Different degrees of severity characterize this disease. A great majority of patients do not display any symptoms. However, 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 linked to overweight or obesity, Insulin resistance ( in which your cells don’t take up sugar in response to the hormone insulin), high blood sugar (hyperglycemia, indicating prediabetes or type 2 diabetes) and high levels of fats, particularly triglycerides, in the blood.

Although this is one of the most prevalent metabolic anomalies in humans, what triggers the inflammation has remained elusive.

5. What then can be done?

The appearance of chronic diseases such as type 2 diabetes, atherosclerosis, non- alcoholic liver diseases, and gout seems to be fairly recent. Taking into account the generally late onset of these diseases in the life of an affected individual, the causes and effects of the inflammation-induced metabolic disease need to be looked at in-depth considering increased life expectancy and the Western lifestyle.

Understanding inflammation as a critical component of metabolic syndrome can shed some light on what metabolic inflammation is and how it very likely plays a significant role in the onset of these chronic diseases. In turn, care can be taken to prevent or arrest metabolic inflammation before it causes serious harm.

References

1.   NCBI ( 2007): Cardiovascular metabolic syndrome – an interplay of, obesity, inflammation, diabetes, and coronary heart disease. Retrieved from. https://www.ncbi.nlm.nih.gov/pubmed/17391148

2.   Current Research in Nutrition and Food Science (2015): Inflammation and Metabolic Syndrome- An Overview. Retrieved from http://www.foodandnutritionjournal.org/volume3number3/inflammation-and-metabolic-syndrome-an-overview/

3.    NCBI (2011): Inflammation and the Metabolic Syndrome. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3210244/

4.    NCBI (2013): Obesity, Inflammation, and Diet. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3819692/

5.    WebMD: Diabetes and Inflammation. Retrieved from https://www.webmd.com/diabetes/type-2-diabetes-guide/inflammation-and-diabetes#1

6.   Wikipedia: Inflammation. Retrieved from https://en.wikipedia.org/wiki/Inflammation