lundi 25 novembre 2013

METABOLIC SYNDROME: THE GOOD THE BAD THE UGLY AND THE DEADLY

METABOLIC SYNDROME
A DISEASE IS BORN WHEN YOU CONVERT SOCIAL INEQUALITIES INTO MEDICAL MEASUREMENTS
It is interesting to observe the metabolic changes among the Native Americans over a short period of time in their history.
Metabolic changes that account for Metabolic Syndrome, a creation of the Epidemiologists who do not see patients or look after them, were once considered rare among the Indians.
Even recently published articles tout that Metabolic syndrome is less common among the South Western USA Indians and South East Alaska Natives, even though it is increasing in its prevalence.
At the same time it is interesting to note that Metabolic syndrome is at a low level of prevalence among the Western Inuit in Aleut Islands and also the Inuit in Canada
Metabolic syndrome is a medical Frankenstein created by Dracula of Diagrams, the epidemiologists. Instead of paying attention and asking WHY
Waist Circumference is increasing?
Why the Fats in the blood are increasing?
Why the Blood pressure is increasing among people, who never had it before,

They formulated tables that would categorize people who have at least three of the measurements of the monsters, is given a new “Disease” Metabolic Syndrome. And warn the poor souls that they are now susceptible to Diabetes and Cardiovascular disease,
It is interesting to follow the history of Metabolic Syndrome, even though lately in the Endocrinology circles the professors are a little mute about it.
The Metabolic syndrome is very quantitative, if you have three of the five criteria, then you have Metabolic syndrome.
Different groups may have different criteria predominating or differing social changes, but in the end they all would be dumped at the doors of their General Practitioners awaiting treatment.
Visitors to the USA do not need any guidelines to see that majority of that population has “Metabolic Syndrome”, 2/3 of American adults and children are overweight or obese, only recently knocked out of the Obesity chart by Mexico!
This is the best example of OBJECTIFICATION. Take some common pertubances in the body metabolism in responses to societal changes and also socio economic and psychological pressures and call it a disease or syndrome. While a syndrome is not a disease, most people will be horrified being designated the recipients of a Syndrome, the most common syndromes in public imagination being Downs Syndrome, Fibromyalgia and Irritable Bowel Syndrome. Not very pleasant associations.
In the above study of American Native Indians and Inuit, there were gender and geographic differences in the prevalence of Metabolic Syndrome. Canadian Inuit did well with a very low prevalence of 13.5 % compared to the 45 % of the South Western Natives.
That a social factor is present is evident in a study published in 2002, by the same group of troubadours who later went on to trumpet that the Pima had the highest rates of Diabetes in the world.
Over a four-year period, aged 45-74, Pima Indians, HDL-C the good cholesterol decreased and the bad cholesterol LDL-C increased.
People who don't pay attention to history tend to make the same errors over again, we learn from our books. In 1979, when Lipoprotein measurements were available commonly, it was found that
LDL was lower in Native Americans and HDL was higher in them compared to their European American counterparts! This was used to explain the lower rate of heart disease among the American Indians, just thirty years ago! Can any of the providers now working with the American Indians believe that Cholesterol levels among the Pima Indians were 50-60 mg/dl LOWER than the whites. (Bennett 1979).  Even with a high rate of Diabetes, they still had a lower CVD rate!
In a study comparing tribes from various geographical regions, they were astounded to find the rates of CVD Cardiovascular Disease were lower among the Indians, and the differences in death rates could be explained by just Smoking alone! Those who smoked died earlier!
It has been postulated, once again by the number crunching geeks, that Cardiovascular risk in many populations rise at around 25 kg/m2 BMI or higher. For Asians, Body Mass Index of 22 or 23 is considered normal and obesity is pegged at BMI of 26 or 27 kg/m2.
These are all calculations but what does it say?
This is where MEDICINE and ANTHROPOLOGY differ.

Asians differ widely in the illness and disease characteristics of Heart Diseases. The Japanese have a lower Coronary Artery Disease, in fact, the lowest in the world. Of course one can attribute that to Lots of Fish and Soy Protein, Green Tea and lack of salt and cooking oils.
The Chinese whether in China or overseas tend to have lower heart disease rates, even though the new changes in society and body girth may alter that in Mainland China.  I am acquainted with the eating habits of the Chinese in Malaysia and Indonesia; their illness burdens are much lower than their fellow countrymen of other races, Malays in Indonesia and Malaysia and Asian Indians in India.
(one day of dining in Bogor in Indonesia with my Chinese Indonesian friends)
I was invited to give a lecture at the Endocrine Society of India at Cochin in 2008 and the audience was surprised when I told them that a sure way to shorten their lifespan was to migrate to the USA! Asian Indian Physicians in the USA have a four fold higher prevalence of coronary artery disease compared to Americans (who already have a higher rate). Vegetarianism does not protect Asian Indians from Heart Disease, and the normal risk factors do not predict the incidence of Heart Disease among the Asian Indians in India or migrants to other country.
They are the poster boys for
The Good                    HDL
The Bad                       LDL
The Ugly                      Triglycerides
The Deadly                 Lipoprotein LPa
The Deadly Lp a is elevated among Asian Indians, and studies have shown that it is present when they emigrate to US, UK, Singapore, Canada.
What is interesting is that, while in India their Metabolic syndrome rate is 25 per cent, which is the average of European countries (taking into consideration their normal BMI to be 22-23 kg/m2), it jumps to a whopping 42% when they migrate to the USA!
All these talks about Metabolic Syndrome has had at least two important outcomes:
The people working with Minority and Immigrant groups realize the social and cultural impact of the lifestyles and their association with Metabolic Syndrome and secondly, a desire by groups to do something to prevent it in a culturally sensitive fashion. Group specific community action committees are trying to bring the news of Ill Health and Illness associated with Immigration and Social Factors to the consciousness of those who suffer.