NUTRITION AS A BASIS

FOR THE PREVENTION OF

DISEASE:
FOCUS ON SYNDROME X

Stephen Holt MD, LLD (Hon.) DSc, ChB., PhD, DNM,

FRCP (C), MRCP (UK), FACP, FACG, FACN,
FACAM, OSJ

Distinguished Professor of Medicine (Emeritus)

Scientific Advisor, Natural Clinician LLC
 NUTRITION AND DISEASE
•Malnutrition is a global problem which occurs in
two forms: UNDERNUTRITION and
OVERNUTRITION
•In industrialized communities the major form of
malnutrition is related to excess dietary intake of
the wrong type of food.
•In circumstances of poverty, malnutrition is
manifest as a consequence of insufficient intake of
food.
•There is a global epidemic of obesity.
•Emerging economies, such as India and Arab
countries, have seen a major increase in obesity.
•This presentation focuses on the worldwide
emergence of obesity and its health implications.
NUTRITION AND DISEASE

• Nutrition plays a major role in disease

prevalence and it is an important factor
that underlies many public health
initiatives.
• Disorders such as Metabolic Syndrome
X, Type II Diabetes, Osteoporosis,
Premature Aging, Cardiovascular
Disease and Cancer have direct links
with abnormal nutrition.
CHANGE IN DISEASE PROFILE
IN THE MIDDLE EAST
• Traditional eating habits have changed
with a move away from the healthy
Ramadan table.
• The world is a victim of fast food
colonialism.
• Recent studies show that 34% of middle
aged men and 45% of middle aged
women in Saudi Arabia are obese
(BMI>25). Obesity is rising in pre-school
children, causing a modern tragedy.
 SUPER-SIZING AMERICA AND
INDUSTRIALIZED SOCIETY
• Americans and other
nations exude
complacency about
their overweight status.
• Obesity is part of
Metabolic Syndrome X
• Syndrome X is under-
diagnosed, ignored
and often mistreated.
 FACT
• OBESE KIDS BECOME UNHAPPY,
UNHEALTHY OBESE ADULTS
THE UNKNOWN EPIDEMIC
REDEFINING SYNDROME X
• Classic Definition: Obesity,
Abnormal Blood Cholesterol, High
Blood Pressure, Linked by Insulin
Resistance.
• Syndrome X, Y and Z….., an
expanded definition incorporating a
novel unifying concept of common
diseases
Syn x slide
 THE PUBLIC HEALTH RISK

• Syndrome X increases risk for :

Type II Diabetes Mellitus
Cardiovascular Disease
Cardiovascular Deaths
Deaths from ALL CAUSES
Am.J.Epidemiol, 148, 958, 1998.
 INTEGRATIVE MEDICINE FOR
SYNDROME X

“While proper management of the

individual abnormalities of this
syndrome can reduce morbidity and
mortality, it seems unlikely that
management of the individual
abnormalities of this syndrome
provides better outcomes than a
more integrated strategy”
CDC, Atlanta, Ga., JAMA 2002
 BACKGROUND
• Studies imply that the physically active
person of normal body weight outlives
the overweight, inactive individual.
• Obesity related disease, most notably
Metabolic Syndrome X, presents
unifying concepts of premature aging.
• Retention of body functions and
survival are clearly associated with
calorie restriction.
LOOKING AT OBESITY AND RELATED
DISEASE FROM NEW SCIENTIFIC
PERSPECTIVES CREATES NEW
THERAPEUTICS
 A LITANY OF NEW PERSPECTIVES: 2010

• Greater understanding of epidemiology.

• Fat cells regulate energy balance.
• Neuro-hormonal control of appetite.
• Fuel sensing by the CNS.
• Obesitis
• Insulin Resistance: The Core of Syndrome X
• Cancer propagation (colon, prostate, pancreas)
• Evidence base for positive lifestyle change.
• Drug and nutraceutical approaches to treatment.
• The role of bariatric surgery
 NEW PERSPECTIVES ON
EPIDEMIOLOGY
• Global problem, 1.6b overweight
(BMI>25) 400m obese (>30)
• 32.9% of U.S. adults (age 20-74y) are
obese, 17% of teenagers (age 12-19)
are overweight. (Recent data in UAE
alarming)
• Obesity and Syndrome X increase
risk of death from all causes.
 OBESITIS
• Epidemiological links between obesity and
inflammation have been proposed for >40y.

• Glucose and fat intake induce inflammation by

oxidative stress or the activation of transcription
factors.

• Reductions in macronutrient intake in obese

subjects reduces oxidative stress and the
production of inflammatory mediators
(1000kcal/day, 4 weeks or 48 hr fast).

• Managing weight control without managing

inflammation is an incomplete approach.
: Fat tissue, normal weight mouse

:Fat tissue, from fat mouse (ob/ob)

POTENTIAL MECHANISMS OF OBESITIS
OBESITIS
 CANCER: OBESITY AND SYNDROME X
• Obesity and Syndrome X increase mortality from
several cancers e.g. colon, prostate, breast and
pancreas.

• Consistent risk factors for colon cancer (or adenoma)

include obesity, inactivity, pot-belly, hyperglycemia and
hyperinsulinemia (Syndrome X)

• Obesity linked to fatal prostate cancer.

• Type II diabetes increases risk of pancreatic cancer by

approximately 50%.

• Hyperinsulinemia or oxidative stress initiated by

hyperglycemia appear to be the mechanism.
 LIFESTYLE CHANGE AND NUTRITION:
FIRST LINE OPTION

• Randomized controlled trials on the use of lifestyle or

diet changes for inducing and maintaining weight loss
are few and far between.
• Face to face lifestyle advice performs about 50% better
than comprehensive internet-based programs for
weight loss. (inference: the same applies to books?)
• Continued patient-practitioner contact, high levels of
physical activity and the long term use of drugs
(supplements?) with positive lifestyle change promote
sustained weight control.
• Managing weight loss without managing Syndrome X is
nihilistic.
DRUGS AND NUTRACEUTICALS
 WEIGHT MANAGEMENT
• Not only a function of diet
• Calorie Control
• Behavior Modification
• Exercise
• Management of Syndrome X
• Treatment of obesity related disease
• Obesitis
UNREALISTIC
WEIGHT LOSS
EXPECTATIONS
 COMMON CAUSES OF
OBESITY
• The Double Whopper Brain
• Sedentary Lifestyle
• Genetic Tendency
• Social Gluttony (Appetite)
• Sleeplessness
 THE GLYCEMIC INDEX
• Calculations of the glycemic index of
food is probably a waste of time.

• Understanding factors that control

gastric emptying rate can result in
inference about the glycemic index.

• Slowing gastric emptying slows glucose

absorption – relevance in acute dosing
GLUCOSE TOLERANCE WITH
SOLUBLE FIBER

Holt S, et al
Effect of
Gel Fiber…
Lancet,
March 24th,
1979.
 DIETARY PRINCIPALS
• Calories Count
• Watch Macronutrients CHO, Fat
Protein
• Healthy Fat (EPA)
• Salt Restriction
• Fiber Intake
SYNDROME X NUTRITIONAL FACTORS

•OBESITY: Hoodia, fiber, green coffee bean

extract, starch blocker, chromium, fat blockers
•HYPERTENSION: fiber, botanicals unpredictable
•OXIDATIVE STRESS: alpha lipoic acid, AGES,
redox balanced, hydrophilic and lipophilic
•HOMOCYSTEINE: B6, B12, folate, TMG
•INSULIN RESISTANCE: fish oil (EPA), alpha
lipoic acid, vitamin and mineral support
•BLOOD LIPID: soy, fish oil, guggul, garlic etc.
•INFLAMMATION: EPA, curcumin, C etc.
 CITRUS BERGAMOT

Demonstrated ability to treat dyslipidemia, improve blood

glucose and induce weight loss with antioxidant activity.
A multi-functional botanical supplement for CVS health.
 Bergamot extract reduces blood levels of
triglycerides, cholesterol and glucose in 238
dyslipidemic patients after 30 days
  Total- HDL-C LDL-C Tryglycer Blood
Chol ides glucose
Placebo 0.14% +1.2% -1.1% +0.1% +0.5%
Bergamonte -20.69% +22.9% -24.1% -29.9% -18.8%
(500mg/Day)
Bergamonte -26.53% +40.1% -36.00% -38.8% -22.3%
(1000mg/Day)
Statin Group -24.61% -27.6%
(1500mg/day)

Data is polled from 238 patients:

(1) 82 patients with isolated hypercholesterolemia (LDL>130)
(2) 76 patients with mixed dyslipedemia (hypercholesterolemia and hypertryglyceridemia)
(3) 48 patients with mixed hyperlipemia and glycemia)
(4) 32 patients previously on statin, 60 days wash out period
Clinical Benefits: Citrus bergamot

• Reduction in total cholesterol

• Reduction in LDL-C
• Reduction in triglycerides
• Increase in HDL-C
• Significantly lowered glucose levels
• Improve measures of Vasodilatation
• Weight management adjunctive
properties
 CONCLUSIONS
• Nutritional interventions for disease prevention and
management are major targets for political decisions
that must shape healthcare in the future.
• The modern epidemic of obesity, and the related
condition of Metabolic Syndrome X, represent major
challenges to humankind.
• There can be no widespread longevity without calorie
restriction in industrialized societies.
• Social, economic, medical and political influences on
the global spread of obesity in emerging economies
have been quite inadequate.