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  #1   ^
Old Thu, May-22-08, 08:07
ReginaW's Avatar
ReginaW ReginaW is offline
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Default Diabetes, Heart Disease Risks Can't Be Grouped, Researchers Say

Diabetes, Heart Disease Risks Can't Be Grouped, Researchers Say

By Chantal Britt

May 22 (Bloomberg) -- Doctors should look at risks for diabetes and heart disease individually instead of trying to find criteria that predict a patient's potential for developing both, raising questions about the treatment of 50 million Americans.

Since the 1970s, physicians have used so-called metabolic syndrome to assess the risk of patients with decreased levels of good cholesterol, fatter waists, and high blood pressure as well as raised blood sugar and fat levels of developing diabetes and heart disease.

Although metabolic syndrome and its components are associated with type 2 diabetes, they have weak or no association with vascular dangers in the elderly, Scottish researchers writing today in the Lancet medical journal said. Physicians developed the criteria to better understand the links between the pre-diabetes state and heart disease. It requires individuals to have three of five medical disorders that were thought to identify individuals at risk of either condition.

``Attempts to define criteria that simultaneously predict risk for both cardiovascular disease and diabetes are unhelpful,'' said Naveed Sattar from the University of Glasgow.

The metabolic syndrome combines health issues such as raised blood sugar levels, decreased levels of good HDL cholesterol, and elevated levels of triglycerides in the blood to predict risk for heart disease and diabetes. It doesn't include known factors such as age, cholesterol and smoking.

50 Million Americans

The term metabolic syndrome has been commonly used since the late 1970s. It affects about 50 million Americans, according to the American Heart Association. Sattar's study was funded by Diabetes UK and the British Heart Foundation.

Sattar analyzed data from two studies with more than 7,500 non-diabetic people between 60 and 82 years old to investigate to what extent metabolic syndrome and its individual components were related to the risks of these two diseases in elderly populations.

In people without heart disease, metabolic syndrome wasn't linked to an increased risk of cardiovascular disorders, but to a more-than-four-fold risk of diabetes, Sattar found.

In patients with cardiovascular problems, it was associated with a 27 percent increased risk of heart disease and a more than seven-fold risk of diabetes. Body mass index or waist circumference, blood fat triglyceride levels, and blood sugar cutoff points didn't predict a higher risk for heart disease, but were associated with risk of new-onset diabetes.

``Both actions would better serve the health of those at risk of diabetes and cardiovascular disease than seeking a diagnosis of the metabolic syndrome,'' Richard Khan from the American Diabetes Association said in a comment. ``Diagnosis of the metabolic syndrome has no apparent clinical value. Naveed Sattar and co-workers put yet another nail in the coffin of the metabolic syndrome.''

http://www.bloomberg.com/apps/news?...7bCxFQ&refer=us
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  #2   ^
Old Thu, May-22-08, 08:43
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rightnow rightnow is offline
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Maybe this is a tiny step along the way to ditching the old "fat kills" mentality and opening up to the "disease kills" mentality and recognizing that while there may be some correlation, it's not causation.
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  #3   ^
Old Thu, May-22-08, 09:34
eryalen eryalen is offline
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I'd better save these for my next quarterly follow-up.
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  #4   ^
Old Sun, May-25-08, 21:12
Feinman Feinman is offline
 
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Default Carbohydrate Restriction and Causation in Metabolic Syndrome

Quote:
Originally Posted by rightnow
Maybe this is a tiny step along the way to ditching the old "fat kills" mentality and opening up to the "disease kills" mentality and recognizing that while there may be some correlation, it's not causation.


We have made the point that causation is in the underlying mechanism of insulin resistance. In fact, many people, including Reaven who is generally credited with inventing the idea, now insists on calling it Insulin Resistance Syndrome. The features of the syndrome, overweight, hyperglycemia, high triglycerides, low HDL, small dense LDL, high blood pressure are precisely those that are improved by carbohydrate restriction.

Jeff Volek and I have summarized these points in
Volek JS, Feinman RD: Carbohydrate restriction improves the features of Metabolic Syndrome. Metabolic Syndrome may be defined by the response to carbohydrate restriction. Nutr Metab (Lond) 2005, 2:31.

available without subscription at
http://www.nutritionandmetabolism.c...3-7075-2-31.pdf

This may have something to do with why some people want to say the syndrome doesn't exist.
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  #5   ^
Old Mon, May-26-08, 01:20
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Quote:
Originally Posted by Feinman
In fact, many people, including Reaven who is generally credited with inventing the idea, now insists on calling it Insulin Resistance Syndrome.

Wouldn't you know.

I finally find out what's killing me and it turns out it's the IRS.

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  #6   ^
Old Mon, May-26-08, 06:03
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PlaneCrazy PlaneCrazy is offline
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Quote:
Originally Posted by Feinman
We have made the point that causation is in the underlying mechanism of insulin resistance. In fact, many people, including Reaven who is generally credited with inventing the idea, now insists on calling it Insulin Resistance Syndrome. The features of the syndrome, overweight, hyperglycemia, high triglycerides, low HDL, small dense LDL, high blood pressure are precisely those that are improved by carbohydrate restriction.



Dr. Feinman, it's an honor, and real pleasure, to see you here and participating. I'm a patient of Dr. Westman's and have been telling him how important it is to have someone of y'all's caliber posting on these forums.

Welcome, and I look forward to reading more.

Plane,
Who had four-and-a-half markers for Insulin Resistance Syndrome before beginning low-carb last September. Now I'm down to one, low HDL numbers which don't seem to make sense except insofar as I'm still in the middle of weight loss.
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  #7   ^
Old Mon, May-26-08, 10:05
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rightnow rightnow is offline
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Quote:
Originally Posted by Feinman
We have made the point that causation is in the underlying mechanism of insulin resistance. In fact, many people, including Reaven who is generally credited with inventing the idea, now insists on calling it Insulin Resistance Syndrome. The features of the syndrome, overweight, hyperglycemia, high triglycerides, low HDL, small dense LDL, high blood pressure are precisely those that are improved by carbohydrate restriction.

Jeff Volek and I have summarized these points in
Volek JS, Feinman RD: Carbohydrate restriction improves the features of Metabolic Syndrome. Metabolic Syndrome may be defined by the response to carbohydrate restriction. Nutr Metab (Lond) 2005, 2:31.

available without subscription at
http://www.nutritionandmetabolism.c...3-7075-2-31.pdf

This may have something to do with why some people want to say the syndrome doesn't exist.

(I apologize for being flippant above. It's nice to see you here.)

Are you suggesting with the above, that part of the 'resistance' to low carbohydrate approaches, is not merely because it contradicts the 'popular' view of obesity's cause but because it threatens the entire establishment of opinion--and phenomenol income$ numbers--of so many actual diseases? That would make sense to me.

The content of the title of the article is interesting. (...Metabolic Syndrome may be defined by the response to carbohydrate restriction.) Does that imply that you are not using a person's presenting symptoms to define whether they have 'metabolic syndrome', but rather, that you are using 'their body reaction when treated with a low carbohydrate approach' as the definition of whether they 'have' IRS? So the 'test' of whether someone qualified for the label would be in the "do this for 3 weeks/months and we'll see how the numbers change", and not inherently or assumedly in everybody with those symptoms?

The reason I ask is that I am wondering how those symptoms would exist in someone who did NOT actually have the 'syndrome'; if they would not, then it makes me wonder why the definition is based on 'response to treatment' rather than the collective symptom-group itself.

This is trivia and probably not worth your valuable time, I'm just meandering on a discussion board here.
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  #8   ^
Old Mon, May-26-08, 10:45
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Nancy LC Nancy LC is offline
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Quote:
Originally Posted by rightnow
Wouldn't you know.

I finally find out what's killing me and it turns out it's the IRS.


I was going to say it's an unfortunate acronym... Oh well, more reason to dislike those three letters arranged in that particular order.
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  #9   ^
Old Mon, May-26-08, 13:24
Feinman Feinman is offline
 
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Quote:
Originally Posted by rightnow
... I am wondering how those symptoms would exist in someone who did NOT actually have the 'syndrome'; if they would not, then it makes me wonder why the definition is based on 'response to treatment' rather than the collective symptom-group itself.

This is trivia and probably not worth your valuable time, I'm just meandering on a discussion board here.


Far from trivia, this is the heart of the matter. I’m impressed that you want an explanation: the idea was meant to be provocative although we probably didn’t develop it well. We thought our article was a break-through but it is rarely cited.

Anyway, the idea is that there is confusion about metabolic syndrome. So the article is not alone in thinking there is no value to defining a syndrome and quotes “Attempts to define criteria that simultaneously predict risk for both cardiovascular disease and diabetes are unhelpful.” The argument is that lumping things together does not change how you would clinically treat each individually.

Well, let’s go with that. There are numerous ways of treating obesity, one of which is carbohydrate restriction. Of the ways to treat obesity, which of these is good for reducing triglycerides? Well, the ability of carbohydrate restriction to improve triglycerides has been known since the fifties and this is certainly the most robust response to any dietary intervention and is generally better than most drugs. To raise HDL, you can use high levels of niacin but this frequently has side effects that are characterized as unpleasant or intolerable (seems to depend on whether you are prescribing it or taking it). For small, dense LDL the so-called pattern B, this is linearly improved by reducing carbohydrate. There are many drugs for improved glycemic response and insulin but, of dietary interventions, if you go with low-fat you generally have to be sure to lose weight. but carbohydrate reduction will be effective even if you don’t. And so on. In other words, there are, many treatments for the individual markers characterized as metabolic syndrome but carbohydrate restriction will improve all.

What you want from the designation of a syndrome is some common biological feature, the major candidate here is currently insulin resistance. The close connection between dietary carbohydrate and insulin makes the above treatments meaningful in a physiological way.

The bottom line is that each demonstration of the broad number of factors that are improved by carbohydrate restriction provides evidence that they are, in fact, tied together, as you say, by “the collective symptom-group itself.” The evidence however is in the “response to treatment.” Conversely, though, if it is truly a syndrome, each feature may appear at a different time or in response to different environmental stimuli, but your best bet will be to treat one marker with the methodology that has the potential to treat all. There are many causes of most of the feature included in the syndrome and, as you say, there is no guarantee that they are not isolated disease states but, until we know how to identify those, carbohydrate restriction may be the “default” approach.

Does this make sense?

We will try to send an article to Lancet in response to the cited article but we anticipate some resistance because “it threatens the entire establishment of opinion,” rather than the “phenomenal income$ numbers” which we see as a minor player here.
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  #10   ^
Old Mon, May-26-08, 14:10
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rightnow rightnow is offline
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The interesting thing to me is that if we did treat each of these as an isolated disease state, I haven't seen that anybody really has a clear idea what causes any of them.

I used to say it confused me that doctors acted like illness just fell out of the sky on people through sheer bad luck, or sheer "probability" based on family history. Like nothing the individual did had any part of it. That always bothered me since, being rather Type-A, I want to feel in control of what does or doesn't happen to me. When disease is attributed to chance or probability, it makes it seem like the disease-lottery. The whole philosophy it forces is more surreal than attributing it to the pattern of the stars.

Yet as long as diet is not considered as a provocative agent on a far greater level than it is now--and in a model that works, which the current popular model doesn't at all (since so many people following exactly the food pyramid and doctor's diets and ADA recommendations just get more fat, worse blood readings, degrading diabetes, rather than getting better)--then I don't see how literal-causation can be addressed--if we genuinely had a clue what caused a given one (in the current traditional model), we'd know how to make sure people never got it, which we don't (as the 30B diet industry attests to). And without trying to figure causation out, when it's just looked at like "the universe is too complex, so we just guess and do our best," we're back to the lottery-philosophy.

I do think that this is a rather powerful underlying concept when it's tied together in this way, because it indirectly implies something about possible causal factors ["whatever is opposite of the cure"] that might have a deeper (and more turbulent) impact in medicine.

It's pretty common to study something for treatment. But treatment today seems to be designed to deliberately not cure/heal but to 'treat' (expensively) for the rest of your life. What you guys are talking about is a 'treatment' that (a) makes nobody any real money, (b) treats a whole group of disease states not just one thing, and (c) points to a causal factor which if 'treatment' were applied before the condition existed, could prevent the disease states in the first place. That's a bit of real Science research, as opposed to the more common targeted-treatment Technical research. A very big deal.

I wouldn't be surprised if it were difficult to get 'through' the established thought/ previous 'experts', or 'entrenched industry' it'd be called if it weren't science. But I think you guys may have some of the most important work at a critical time in the whole medical industry. So good luck with that.

PJ

Last edited by rightnow : Mon, May-26-08 at 14:19.
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  #11   ^
Old Mon, May-26-08, 14:36
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LessLiz LessLiz is offline
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Quote:
What you want from the designation of a syndrome is some common biological feature, the major candidate here is currently insulin resistance.
I now recognize another instance of my ignorance. I had thought that insulin resistance == metabolic syndrome and that metabolic syndrome == insulin resistance. Everything I have read about metabolic syndrome seemed to me to be a result of insulin resistance. Without having read a definition of metabolic syndrome I just assumed they were two terms with essentially the same definition but that the usage metabolic syndrome implied recognition of 2nd and 3rd order consequences of insulin resistance.
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  #12   ^
Old Mon, May-26-08, 14:56
LC FP LC FP is offline
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The ADA and the European Diabetes Society has been "concerned" with metabolic syndrome for a long time, and even got into a tiff with the AHA about it's utility. In 2005 they issued a joint statement listing their issues with the diagnosis, and their fear that patients may be harmed by wasted efforts by their doctors to counteract the syndrome. Got this from Medscape cardiology 2005. They listed the criteria for the various definitions for MetS then:

Quote:
The ADA/EASD statement says that the fact that these definitions conflict implies that there is no clear evidence base for what should or should not be included. It says that the criteria for the syndrome are ambiguous and incomplete and that the rationale for thresholds are ill-defined; the value of including diabetes in the definition is questionable; insulin resistance as the unifying etiology is uncertain, and there is no clear basis for including/excluding other cardiovascular disease risk factors.

The cardiovascular risk associated with the "syndrome" appears no greater than the sum of its parts, according to the statement. Treatment of the "syndrome" is no different from treatments for each of its components and in patients with diabetes or known vascular disease, and inordinate attention to the "syndrome" can impede appropriate care, the authors believe. People should not be diagnosed with the "metabolic syndrome," as doing so will mislead the patient into believing that he or she has a unique disease, instead of well-known cardiovascular risk factors, the authors state.

The authors of the statement believe that "the metabolic syndrome requires much more study before its designation as a 'syndrome' is truly warranted and before its clinical utility is adequately defined." They recommend that doctors continue to evaluate patients for the presence of other cardiovascular risk factors when one is discovered; aggressively treat individual cardiovascular risk factors; avoid labeling patients with the term "metabolic syndrome;" and not attempt to prescribe a treatment for this "syndrome" until new, solid evidence is obtained.

The metabolic syndrome has also recently been declared "dead" by the man who originated the concept (as "Syndrome X"), Gerald Reaven, MD (Stanford University School of Medicine; Stanford, California).[19,20] Dr. Reaven has declared himself "unimpressed" by both the WHO and ATP III forms of the metabolic syndrome. He believes that physicians should focus on individual cardiovascular disease risk factors instead of whether or not individuals are obese or whether they meet a certain number of criteria for making a diagnosis of the metabolic syndrome. However, Scott M. Grundy, MD (University of Southwest Medical Center; Dallas, Texas), who was a member of the team that issued the ATP III criteria as well as a consultant to the group that developed the IDF definition, replied that he see still sees "signs of life" in the concept, which "represents a powerful hypothesis that unifies the metabolic factors underlying the development of both atherosclerotic cardiovascular disease and diabetes" and "a useful clinical tool."[21]

So just treat the symptoms. Pretty much what rightnow said. Unfortunately many or most of the designer molecule treatments for diabetes, hypertension and lipids make other aspects of the syndrome, or insulin resistance, worse.
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