THE TIMES

 

Health
April 14, 2003

A human time bomb
By Jerome Burne
A 35-40in waist means greater risk of diabetes and stroke

 

ANTONY WORRALL THOMPSON, the celebrity chef, has been worrying about his waist. It is a bit more than 40in (101cm), which means that he is at risk of a newly identified disorder that is causing concern among health experts. The condition already affects 25-30 per cent of the population and, if left untreated, can lead to diabetes, heart disease and stroke. It has also been linked with poor memory and a shrunken hippocampus — the area of the brain involved in memory formation.

Worrall Thompson is the face of a new campaign to “measure your mate”, which aims to raise awareness about the condition, known as insulin resistance syndrome (IRS). If your mate — or any male who lets you wrap a tape measure around them — measures more than 40in, they are at risk of IRS. The red-light figure for women is 35in.

IRS, which is also known as metabolic syndrome, glucose intolerance and Syndrome X, has been dubbed a “medical time bomb” because it could lead to an explosion of disease in years to come. And not only among those facing midlife spread. Derriford Hospital in Plymouth last month reported that 30 per cent of 300 children between the ages of 5 and 16 were showing signs of it. Diabetes now affects about 4 per cent of the population.

The key to all this is the way that your body handles glucose. Until recently this was considered a specialised medical problem reserved for diabetics. But this comforting division is an illusion; our sedentary lifestyle, coupled with a taste for sugar and refined carbohydrates, is playing havoc with the subtle balance between glucose and insulin in our bloodstreams.

Refined carbohydrates are dangerous in the long term because they are too easily digested. The body turns all carbohydrates into glucose, which is then released into the blood. But while wholefoods, such as pulses, fruit and most vegetables, are broken down over several hours, providing a steady trickle of glucose, a sugar-laden fizzy drink, for instance, produces a glucose spike — a sudden rise, followed by an equally dramatic fall. An occasional sugar spike is no big deal; but day after day, over many years, it can be deadly. As glucose levels rise, your body releases insulin to mop it up. After years of glucose peaks, the extra amounts of insulin have a diminishing effect. IRS then develops — a pre-diabetic state with high levels of both insulin and glucose circulating in your blood. The result, among other things, is that hard-to-shift spare tyre around the middle and damage to blood vessels and the heart.

In America the syndrome has been recognised as a medical condition, officially defined as having three or more of five conditions: abdominal obesity, high triglycerides (damaging fats) in the bloodstream, low levels of the good LDL cholesterol, high blood pressure and high glucose.

In sufferers, this can translate to feeling sluggish most of the time, nervousness, being in a low mood for no good reason, strong cravings for white bread and pastries, bingeing on chocolates or sweet snacks more than three times a week, using caffeinated drinks to stay alert and exercising fewer than three times a week.

We, too, need to recognise the condition, says Giancarlo Viberti, professor of diabetes and metabolic medicine at Guy’s Hospital. “At the moment someone who shows up in a doctor’s surgery with those symptoms probably would not be spotted as being at risk of heart disease and diabetes. By the time they are diagnosed as diabetic, 50 per cent of sufferers already have signs of damaged blood vessels.”

So what can be done? Experts such as Viberti agree that the best course of action is dieting to lose weight and taking 30 minutes of daily exercise, such as a brisk walk. But because diets are notoriously hard to stick to, the medical profession also favours a pharmaceutical approach, with weight-loss drugs such as Xenical (which prevents fats from being absorbed from your gut), and “early and intensive intervention with a combination of drugs” for diabetes. This means drugs to reduce insulin production (metformin), plus ones to increase insulin sensitivity (glitazones). Reducing hypertension with beta blockers is not advised since they make insulin resistance worse.

It is not an approach that finds favour with Sandra Lees, a former IRS suffer who “cured” herself with a change of diet and supplements. She has now become an energetic campaigner for the nutritional approach, working with Dr Ann de Wees Allen, the chief of biomedical research at the Glycemic Research Institute in Washington. “Just cutting calories or going on a low-fat diet is unlikely to do any good,” Lees says. “Most low-fat products are loaded with sugar, for a start.”

Instead Lees stuck to a low-glycaemic diet, ie, one made up of foods that don’t raise blood sugar levels. Broadly, that means going for foods such as sausages, beans, porridge and wholegrain pasta, and avoiding the likes of bagels, cornflakes, bananas and beetroot. One of the UK’s supermarkets already has a range of low-glycaemic foods in the pipeline.

This approach also involves the use of various supplements. High glucose and insulin levels, for instance, increase the amount of damaging free radicals in the bloodstream, which means that your body needs more antioxidants, such as vitamins C and E. Another antioxidant, alpha lipoic acid, has been found to lower glucose levels, while magnesium improves the way that the body handles excess glucose.

Such an approach is controversial and doesn’t have the backing of large-scale studies; but evidence for a nutritional approach to what is, after all, a nutritional problem, is coming in. A study published earlier this year in The Journal of Nutrition reported that adding an essential fatty acid called conjugated linoleic acid (CLA) to the diet of diabetics lowered their blood sugar levels by five time more than a placebo. Those on CLA also lost weight.

The danger signs