Syndrome X: The Silent Killer

The summer months were hot, more than others I seemed to feel the oppressive heat -choosing to stay indoors in the air conditioning, feeling lethargy unheard of ever before. Towards the end of May I woke up one morning to an overcast sky and the “pitter patter” of rain drops on the window awning. Rejoicing at the respite from heat I got ready for working choosing to wear “quick dry” clothing. Emerging from my house onto the street I was immediately confronted with pandemonium-a huge crowd waited for the bus and there was no other public transportation in sight. Worse the rain stopped and the sun came out fiercer than before.

As I waited I found myself sweating, rivers running down my body, arms and face. It was a discomfort I had never experienced before -not even while doing “cardio” at the neighborhood gym. A bit concerned I returned home to collect my frightened wits together. One thing leading to the next saw me a few days later at the hospital for a “check up” -blood work ups, a cardiogram, and sonography. The reports were alarming high levels of cholesterol and T-wave changes! The subsequent stress test and echo cardiogram were both abnormal. And, the doctor showing great concern said, “considering that you weigh 90 kilograms and have high cholesterol levels -I am afraid we will have to conduct an angiography to check for blockages.” He had pressed the panic button -I do realize that today angiography is like a dental check up but somehow a “heart disease,” is frightening.

After a few hours of worrying, my practical side came to the fore, I decided to get down to the bottom of things-to educate myself.

Surfing the net I was amazed at the amount of information as well as its depth. I found that until that until the “awakening” moment, the sweating episode, I had been an “ostrich” my head buried deep in the sand. I had over the years become oblivious to my growing proportions assigning my bulk to “hereditary”-my mother and my maternal grandmother were both rotund figures.

As knowledge rubbed away my ignorance I realized that “fat was far from jolly.” In fact, the probability of my being a “Syndrome X” member/patient was quite high. My blood pressure hovered between 120/90 to 140/90, my waistline measured 42 inches across my belly — to top it all I was obese. Thus I was a prime target and a “high risk” candidate for succumbing to heart disease, stroke, and diabetes.

Research has shown, that most people world over are probably already in the “Syndrome X” category especially those that are middle aged and over. Symptoms that manifest themselves are: fatigue and fuzzy mindedness. It is a “life style” disease — an unbalanced diet rich in carbohydrates, lack of exercise, a couch potato life-style, and more.

Most of the factors are interrelated and the ‘X’ in Syndrome X at first represented unknown /not yet determined factors. The syndrome was first defined in 2001 and, today in 2004 the mystery has been unraveled — it is known to be extremely common, often unrecognized.

In America, 58 million adults are overweight and there is a 76% increase in Type II diabetes. In UK, obesity has tripled in the last 20 years. A WHO meeting in Geneva held at the end of May 2004 discussed in detail the new silent killer -obesity. Reports indicate that millions across Asia are succumbing to the disease. The new problem is attributed to an unprecedented rise in living standards -the result people can afford more and are getting fatter. Today what was at first envisaged to be an American problem has become a global one and governments in Asia are realizing the seriousness of “syndrome X” and are preparing to tackle the problem which is accelerating towards epidemic proportions. WHO estimates that all over the world at least one billion people are over weight and of this estimate at least 300 million are obese. Dr. Gauden Galea from the WHO headquarters in Manila indicated that since Obesity unlike SARS has no “panic triggering” impact it spreads silently unnoticed. He attributed obesity to sedentary life-styles, a stress filled existence, and one where fast and processed foods are a norm. Asia has seen that along with obesity there is a rise in both heart diseases and diabetes.

Today in 2004 governments all over the world are facing the staggering costs of treating “Syndrome X” – diabetes, obesity, and heart disease. The US based Center for Disease Control and Prevention has deduced that obesity costs the US 75 billion dollars in weight related medical treatments. A national study in Australia has indicated that the health burden due to diabetes and associated illnesses costs around three billion Australian dollars annually.

Alarming data is available world wide: In Vietnam 52% of the adult population consumes a high fat diet while 58% are physically inactive. In China a study indicates, 30% of children and young adults are overweight. Even in South Korea one third of people aged over 20 are obese /overweight.

Asian delegates at the WHO meeting in Geneva came to a consensus that the problem should be addressed on a war footing. Both governments as well as the industry would launch anti-obesity drives, and advise the populace to follow better diets -low in saturated fats, sugar and salt, and exercise regularly—at least 30 minutes of moderate exercise.

An action plan being formulated for Asia includes the International Association for the Study of Obesity forming a sub-committee for Asia -Pacific which has as members Malaysia, Japan, Korea, Indonesia, Thailand, Philippines, Australia and New Zealand. The association is in the process of including China, India, Singapore, and Hong Kong. AOSSO will study in depth the disease risk in Asian populations and indicate not just priorities but the public health concerns.

How does one determine obesity? The world wide practice is to use what is known as the BMI index -the body weight in kilograms divided by the square of the height in meters. The WHO recommendation is that a BMI of 25 should be the bench mark for over weight while 30 is indicative of obesity.

That the concerns regarding Syndrome X are being taken seriously is evident even in cyberspace. Many sites are devoted to the cause. Prevention of chronic aliments is a “mission.”

Whilst researching on different aspects of Syndrome X , I came across recommendations to use the ” Healthy Diet Food Pyramid -to challenge your life-style.” The suggestions by Mary Easaw, of the National Heart Institute in Kuala Lampur, and made accessible by AFIC, Asian Food Information Center, were not just practical they were “do able.” It was not alarming and saying — eat only boiled food.

The advice was to:

�Eat a wide variety of foods that will offer you the 40 vital nutrients you need.
�Eat in Moderation -it is a key to successful healthy eating.
�The five servings of fruits and vegetables should be a riot of colors-green, orange, yellow, browns, white -leafy vegetables, sprouts, and so on.
�Whole grains and cereals are beneficial.
âÂ?¢Use limited amounts of fats/oils -vary the cooking – – grill, steam, bake, roast.
�Use natural ingredients to flavor the food.
�Most important set realistic goals

The goals were:

* Fried foods should be consumed only twice a week.
* The use of spreads should be limited to small portions.
* Eat lean meat -fish and chicken without skin.
* Plan a “possible” diet with a nutritionist.
* A healthy diet is just one part the other is exercise. Exercise can be enjoyed-walk with your family, climb steps, walk to the neighborhood shops, wash the car yourself, you exercise as well as save money. Gardening, vegetable farming, active weekends, can all put you on the path to good health.
* Eat right, live right.

I was alarmed to learn that in 2004 diabetes has ceased to be a disease of old women and the rich. It is wide spread in Asian slums as well as mansions, and is affecting the young on a large scale. WHO estimates that 117 million people world wide have diabetes and the figure will exceed 300 million by 2025 – it is poised to become the biggest epidemic in human history. Further a worrying aspect is that it s increasingly becoming an Asian disease – 89 million Asians are diabetic and four of the five largest diabetic populations are in Asia-32.7 million in India, 22.6 million in China, 8.8 million in Pakistan and 7.1 million in Japan (IDL estimates). The spread is extremely rapid and by 2005 they expect 170 million victims with India and China alone having 100 million.

Popularly termed as a silent killer, it is hardly a benign condition. Excess sugar I learned causes not just thirst and frequent urination it affects the nerves causing numbness, clogs blood vessels, damages the eyes and kidneys as well as the heart. It could lead to strokes, heart disease, high blood pressure, kidney failure, blindness, gangrene, and more. WHO’s director of the diabetic unit Dr. Hilary King says, ” Mortality statistics seriously underestimate its impact.” Of the two kinds of diabetes its Type II that we need to fear. The epidemic (90-95%) is caused by this. It is caused by insufficient insulin production, resistance to insulin, improper carbohydrate loaded diets and an inactive life style. The causes are of concern and need immediate correction -see tables.

Table 1

The causes of Diabetes are attributed to :
âÂ?¢The changing life-styles -unhealthy food and sugar drinks being a way of life. Some in Asia even term the disease as “western-type diabetes,” and place the blame on food available at Macdonald’s and KFC as well as aerated colas.
�That life today is spent on the couch or behind a desk -a sedentary existence that does not allow burn up of calories.
âÂ?¢Evolution namely what is known as the “thrifty gene” that keeps expecting times of drought and encourages the body to store food during seasons of plentiful for seasons of famine. As the world today more is available there are more people who are overweight than ever before.
�Ethnicity -some specific groups are more prone to diabetes than others. Studies have shown that Indians, the Chinese, and Malays are more susceptible than others especially when they abandon traditional diets and life styles.

Table 2

The acknowledged risk factors of diabetes are:
�Existing cases of diabetes in the family.
�Being obese.
�Being of Asian, native Australian, or Pacific Islands origin.
�Older than 45 years in age.
�Having impaired glucose tolerance.
�High blood pressure.
�Low HDL cholesterol.
�Raised triglyceride levels.
�Birthing babies that weigh nine pounds or more.
�Being inactive/ a couch potato.

Similarly there is an established connection between diabetes Type II and Obesity. Today this is a world-wide challenge figures indicate that over 60% of the adult population in the USA and Australia is either overweight (BMI 25-29.9) or obese (BMI>30). The Center for Disease Control and Prevention indicates that as many as 47 million Americans have a “metabolic syndrome” known as Syndrome X which involves insulin resistance, obesity, abdominal fat, high blood sugar levels, high triglycerides, high cholesterol and high blood pressure. Most of the group belonged due to poor diet, insufficient physical activity, and obesity. The high prevalence world wide has necessitated a need for urgent action and damage control.

The profile of Syndrome X is:

a.A abdomen that measures 40 inches or more in men and 35 inches or more in women -apple shaped persons.
b.Hypertension of 130/85 mm or higher.
c.Trigycerides of 150mg/dl and more.
d.Fasting sugar levels of higher than 100mg/dl.
e.HDL of less than 40mg/dl for men and less than 50mg/dl for women.

The primary factor in Syndrome X is insulin resistance. This leads to elevated levels of insulin in the body which in turn directly or indirectly causes other disturbances/abnormalities. The insulin resistance is so severe that the person becomes a type 2 diabetic. This puts the individual on the “fast track” of developing cardio vascular diseases.

The factors that contribute to insulin resistance are:

�A diet that is rich in carbohydrates.
�Eating processed foods.
�A leaning towards fast foods.
�Consumption of foods with preservatives.
�Consumption of foods grown in mineral depleted soil.
�A genetically inherited resistance.
�A sedentary life style.
�Extreme psychological stress.

When considering treatment options, it is well recognized that there are no “drugs” yet developed that reverse insulin resistance. The only established and successful treatment method is diet and exercise. The individuals should systematically reduce their body weight to 20% of the “ideal body weight.”

The reasons why insulin resistance leads to weight gain are:
�Due to non usage of insulin, less glucose in the blood is consumed, that is converted into energy. As a result the glucose is deposited in the tissues as fat.
�Since the body is not able to obtain the energy it needs for daily activities, it induces cravings for food leading to excessive intake.
âÂ?¢As the metabolic disorder continues the body loses even further its ability to break down foods to produce energy leading to “huge” weight gains.

In case a reversal is not achieved each of the components of the syndrome are treated individually. The lipid profile of syndrome X , low HDL and high LDL is to be corrected by reducing LDL levels . The next step is to correct the triglyceride levels; the third is to raise HDL cholesterol levels. The doctor will prescribe either a statin or a fibrate drug or a combination of statin with niacin or a fibrate. The decision on which drug is to be taken depends on the health profile of each individual case. The coagulation problems faced by Syndrome X patients often leads to heart attacks. Syndrome X patients are normally placed on a daily dose of aspirin to prevent clotting and subsequent heart attacks. Another grave risk factor is hypertension or high blood pressure. This needs to be controlled to reduce the risks of heart diseases leading to death. Medications are however not the “answer” prevention it is felt is better than cure.

One symptom is bad but two or more flashes danger signals – it puts one in the “high risk category” and surely and certainly it signifies that disaster is lurking around the corner.

At a personal level my angiography did not show any blockages-imagine I was a hair’s breath away from trouble. Heaving a sigh of relief and thanking all the gods I have decided no more “Syndrome X” – believe me we can turn things around and prevent the downward spiral in our lives and health. We need DDDE:

* Discipline
* Dedication
* Diet
* Exercise

The diet should be planned according to your specific needs – it should be low in fats and carbohydrates and high in fiber and proteins. Please do not leave out fats and carbohydrates completely that is disastrous. What one needs to do is find out what works for you at a personal level. Plenty of fresh vegetables, fruits, and nuts are beneficial, as also fish and white meat. Red meat intake, binging at fast food outlets such as MacDonald’s, KFC, or pizza is not recommended, aerated drinks like colas, excessive alcohol, and excess sugar is not advised.

Studies world wide have established that to better our future:

1.A change to a healthy lifestyle reduces significantly blood sugar levels.
2.Exercise and diet result in a decrease of abdominal fat which in turn improves glucose assimilation and tolerance.
3.Cardio-respiratory fitness improves glucose tolerance.
4.Weight loss medications do not improve blood sugar levels.

What is recommended is:

a.A low calorie diet ( a decrease of 500-1000 calories per day is recommended ).
b.Physical activity – one should exercise at moderate levels for 30-45 minutes daily.
c.Behavioral therapy – a change in patterns and reduced stress levels are extremely beneficial. Type A personalities should transform into Type B. Meditation, deep breathing, chanting, listening to soothing music, watching a fish tank are all beneficial. Communing with nature -sitting by the sea side, or beneath a tree glancing at green fields or a lake is supposed to have a calming effect.

On a personal level, I have prepared a program with the help of my cardiac care physician. To help me focus I maintain a diary where I jot down my day -food, mood, and exercise wise. The aim is to lose 3 kilos a month – nothing drastic. Now after three weeks-I find my complexion is glowing, I am more active the lethargy seems to be ebbing away and I am hoping that when I have my blood test at the end of next week I will have some improvements.

By sharing my personal experience I am hoping to pass the message along ” Good Health is our birth right and it is in our hands.”

It is important for the governments, health departments as well as each one of us as individuals to spread the message ” Fight the X-syndrome Globally” prevent an epidemic.

Defeat Syndrome X by:

1.Prudent eating – limit the kinds of food as well as quantity. Limit foods that are high in fat such as pizzas, chips, fried noodles, and so on to once or twice a week. All food is healthy there is no such thing a taboo foods – eat wisely and in moderation.
2.Sweat it out – adopt a vigorous work out that helps your heart function better. Running, dancing or swimming are good choices. Be regular at least a 30 minute work out per day is required.
3.Eat Breakfast – it is the most important meal. It helps control body weight Cereal, a fruit or a roll is quick and easy.
4.Include iron rich foods in your diet. Orange and lime juice promote absorption of iron while tea and coffee prevent it.
5.Drink fluids 8 glasses a day will help you to be hydrated and also flush toxins out of the body.
6.Be physically active take a 10 minute activity break every hour while you work at the computer, your desk at work, while you watch television or do house work. Climb the stairs instead of taking the elevator. Activity reduces disease risk.
7.Between meal snacks help prevent fatigue. Choose right –milk, crackers, or a apple not biscuits, chips, or chocolates. The last three should eaten only occasionally and not as meals.
8.Include plenty of fruits, vegetables and calcium rich foods. They prevent disasters and provide a large portion of the essential nutrients a body needs.
9.Plan your calorie intake.
10.Live wisely.

These 10 steps assure a bright future and a disease free existence.