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Diet and Inflammation
Whatever happened to our diet – It is not working!
“Let food be your medicine and medicine be your food” – Hippocrates
- According to the CDC, More than one-third of adults (35.7%) are obese defined as a body mass index(BMI) of 30 or more. Another third of all Americans are in the overweight category defined as those with a body mass index between 25-30 taking the total number of Obese and Overweight Americans to about 68% percent of the population. Almost 17% of youth were also obese.
- Obesity-related conditions include heart disease, stroke, type 2 diabetes and certain types of cancer, some of the leading causes of preventable death.
- In 2008, medical costs associated with obesity were estimated at $147 billion; the medical costs for people who are obese were $1,429 higher than those of normal weight.
Let us examine the factors that led to this epidemic of Obesity in this country that is affecting our health, well being and even our longevity. In order to understand what led to this phenomenon, we first have to take a look at how we evolved. Human race has evolved as hunters and gatherers adapted to a diet of meat, eggs, nuts, fruits and vegetables. This diet, had relatively high quantities of protein, fat with unrefined carbohydrates along with antioxidants that come from coloured fruits and vegetables. Agriculture is a relatively recent development having been in existence for only about 10,000 years considered small in evolutionary perspective. As a result, humans have not fully adapted to eating a diet rich in grain based carbohydrate rich foods.
Three things that happened to the modern diet contribute significantly to the obesity epidemic.
Insulin Resistance or Metabolic Syndrome
The first and the most important factor is insulin resistance or metabolic syndrome. Affecting one in three Americans, Insulin Resistance is common and is believed to be a direct result of the erroneous message advocated by the food pyramid that a grain based diet. The now withdrawn food pyramid assumed that fat is the primary reason we were gaining weight and reducing the fat from 40 percent to about 30 percent is going to reduce the obesity epidemic. While our dietary fat did go down significantly, the obesity epidemic went the opposite. As can be seen from the obesity trends over the past 30 years available on CDC’s website, despite reductions in our overall fat intake, our weight went. The reason this happened is because of insulin resistance. Let us understand what insulin is and the effects of insulin resistance.
Insulin is the key hormone for glucose metabolism, fat gain and loss. After you eat carbohydrates, your blood sugar levels will increase. It is the insulin’s job to push the glucose into the cells where it is used for energy or stored for future needs as fat. Insulin also helps muscles, fat and liver cells store sugar that can be released when it is needed. Each cell surface has insulin receptors which act like little doors that open and close to regulate the amount of blood sugar allowed to flow in.
If the body takes in too much simple sugars found in carbohydrates (like white breads, potatoes, sugary drinks etc), the cells are bombarded with so much insulin that the “doors” begin to malfunction and shut down. If the doors aren’t open, the pancreas feels the need to produce even more insulin to push into the cells because it cannot perform its function to lower sugar levels tending to leave the insulin floating in the blood stream. A vicious cycle is now in place resulting in a condition called Insulin resistance which inhibits our fat cells from giving up their stores of energy to let you lose weight. This is called metabolic starvation” as your own fat stores are “locked” due to insulin resistance and unable to give the fat back when you need it despite having the stores.
More insulin resistant you are, more insulin the pancreas has to produce to keep the blood sugars under control. Most people are able to compensate well to insulin resistance by increasing the production of insulin so that their blood sugars are kept under control. Unfortunately, Insulin is an anabolic(body building) hormone. Therefore, more insulin resistant one is, the more body building happens. Insulin also builds the body in the wrong areas such as intra-abdominal fat and upper body fat, two areas of fat accumulation that are associated with metabolic syndrome. Studies have shown that belly fat leads to increased inflammation in the body thereby increasing the risk of cardiovascular disease, diabetes and other conditions. In fact, waist circumference of over 40 inches in men and 36 inches in women(lower in Asian Populations), is one of the five criteria for metabolic syndrome. As the metabolic syndrome increases production of harmful chemicals such as cytokines thereby increasing the body’s inflammation levels increasing the risk of disease.
Lack of Antioxidants
Second thing that happened to our diet that increases inflammation is lack of polyphenols and other antioxidants in the diet. Before the modern food processing era, our diet used to have more than 50 percent unprocessed and uncooked food items such as coloured fruits, vegetables, and other natural ingredients that are high in antioxidants such as polyphenols. Studies have shown that lack of polyphenols leads to increased inflammation in the body. Read this article on an overview of oxidative stress to gain an insight in this important paradigm.
Omega 3 to Omega 6 Ratio
Third thing that leads to increased inflammation is the ratio of Omega 3 to Omega 6 fatty acids used to be 1:1 but is now at 1:16 which also increases inflammation. Learn more. With the above 3 factors, the inflammation levels rise significantly thereby increasing the risk of many health problems including cardiovascular diseases, diabetes and even increased risk of certain types of cancers! in this context, it is important to remember that most human diseases start with inflammation.
Physicians should play a more proactive role in taking care of this often ignored but all too important medical condition. Unfortunately, about 94% of the nation’s physicians receive little to no education in Nutrition as per research.
With so much misinformation, physicians should get the tools, training and education so that they can play a pro-active role in understanding the factors that lead to weight gain in their patients rather than “blaming the patient” and tell them to “lose weight”. This strategy of blaming the victim does not work and can potentially alienate patients as they need specific guidance, advice and a program that they can follow under physician supervision.
About the Author – Prab R Tumpati MD