After Decades of Medical Heralding, Metabolic Syndrome Remains Unchecked – with Dire Consequences
I am privileged to work exclusively with those battling cancer. Frequently, to my chagrin, we diagnose type 2 diabetes in patients who are new to our facility, some of whom have been battling cancer for years. These patients typically present with large truncal obesity and hypertension—perfect set ups for the diagnosis of metabolic syndrome. I then find myself plagued with the uneasy sense that perhaps the cancer may have been prevented, truncated, or changed phenotypically if this person’s metabolic terrain had been addressed earlier in life.
Those with type 2 diabetes frequently have had the “metabolic syndrome” indices for years prior to their diagnosis of overt hyperglycemia, (hypertension, increased waist hip ratio, hypertriglyceridemia, reduced HDL, elevated fasting glucose). Epidemiologic studies conducted throughout the world speculate that colon, prostate, pancreatic, and post-menopausal breast cancer may in some way be linked to this state. In addition, there is evidence that many other cancers are influenced by obesity and hyperinsulinemia including endometrial, gall bladder, pancreatic, ovarian, non small lung cancer, as well as sarcoma and hematologic malignancies. Metabolic syndrome causes dysregulation of cellular activity. Hypertension may increase cancer risk by blocking apoptosis and modifying cell turnover, insulin excess may promote the development of cancers cells in the liver and pancreas. Obesity may cause dysregulation at multiple sites, including cancer cell proliferation and angiogenesis. An estimated 47 million Americans suffer from this common malady, with an estimated 43.5% > 60 years of age. One wonders again that such a common malady in the US continues to go unchecked despite a huge effort in education across every health care field from physicians, to naturopaths, to dietitians, to nurses.
The American Cancer Society has recently published their updated 2012 Nutrition and Physical Activity Guidelines (CA Cancer J Clin. 2012 Jan-Feb; 62(1):30-67). These reflect the need to address obesity and metabolic syndrome as the central focus of public health efforts to reduce cancer risk, improve cancer survival as well as improving cardiovascular health.
It seems as if the medical profession is not having the impact that it should in terms of checking this monster. A colleague of mine recently was hired by a very large 40,000 member church to help change the culture in terms of eating and health. Reports were incredibly positive. I think it’s time to take a very hard look at our systems for prevention as our current model of changing America is failing miserably. In addition we need to rethink the current “packaging” of our health message and continue to move from the white coat as first line to a much more accessible venue for the public.
The “culture” change my colleague designed has some interesting possibilities. Social behavior in a respective community is repeatedly reinforced by the peer support around an individual. In this setting, personal health becomes less of an isolated event and much more an item to be celebrated by those watching. The accountability for food behaviors in this paradigm may be just what we are reaching for.