Obesity is a chronic inflammatory disease: An evolving paradigm

The following is my first guest post.  Dr. Joseph Gentzel is a recent graduate from USD tDPT program that I do adjunct faculty work for.  He has done extensive study in the area of obesity and chronic diseases, especially related to diet and exercise (you can see why I thought he would have some great insights to share on this blog).  He graciously offered to do a post (after a little begging and pleading with him).  Here it is and you can follow more of his post at his blog Senior Physical Therapist's Blog.

Obesity is a chronic inflammatory disease:
An evolving paradigm

Dr. Joseph B. Gentzel, PT, DPT

With the most recent announcement that by 2030 forty-two percent of us will be obese¹ that translates to 9 out of ten ² of us being overweight or obese by 2030; it is imperative that we dismiss the information cascades that have failed so completely these past 40-50 years. There are many information cascades, but none bigger than the notion that obesity is caused by consuming too many calories in relation to the calories we burn; thus resulting in the deposition of fat stores in our body. Science has documented for us sufficiently that the weight reduction benefits of exercise is not restricted to calories burned³, but to other dramatic physiological changes made to the body’s physiology by a diet low in advanced glycation end products ( AGE poor diet)⁴  and exercise^5,6.

In 2001 Das asked the rhetorical question: Is obesity an inflammatory condition? ⁷ Ronca & Folco⁸ plus many others have indicated via their works how science supports obesity as an inflammatory condition. Calder et all⁴ describe many dietary factors associated with chronic disease inflammation that includes obesity. Roncal-Jimenez et all drive one of the many nails in coffin of the calories in calories out paradigm.⁹ May it rest in peace to never return again. By employing a model that fails so completely, we insure failure in addressing this mammoth public health problem. Failure, by any rational measure, has occurred in dramatic fashion with this paradigm.

Rayssiguier¹⁰ et all note that “studies have been published that implicate subclinical chronic inflammation as an important pathogenic factor in the development of metabolic syndrome”.  With multiple components comprising metabolic syndrome, this is an important point. Metabolic syndrome is comprised of combinations of visceral obesity, dyslipidaemia, hyperglycaemia, and hypertension.¹¹

So what? The clinical picture over these past 10 plus years seems to be clearing up to support that obesity is at least associated with and potentially caused by systemic inflammation. This is inflammation that we can measure with inflammatory markers such a C reactive protein, interleukin 6, possibly tumor necrosis factor, and many others. Being able to quantify the systemic inflammation offers objective measures of the condition and our interventions with same.¹²

This presents some novel approaches to addressing the disease that somehow we always knew worked but never understood how/why and too often got sidetracked by the clutter and noise that has bombarded the scene these past 40-50 years. The Centers for Disease Control and Prevention (CDC) appear to have little understanding of this and continue to apply invalid models. Nowhere is this more glaring that the USDA food pyramid that misses the point as illustrated by its continued advocacy of the toxin sugar¹³ and other nutritional areas that have ignored the science of the past 10 years.¹⁴ The Harvard School of Public Health agrees.¹⁵ The science is in and piling up to lead us away from the old information cascades. Information cascades that need to take their place alongside bloodletting and the like.

Sugar creates inflammation.⁴ Sugar causes injury to kidneys¹⁶, liver⁹, pancreas¹⁷, GI system^4,18,19, and virtually every system in the body. We should therefore not be surprised to find that obesity induced chronic inflammation damages the brain circuits that are involved with reward and feeding behaviors.²⁰

References

1.         Finkelstein EA, Khavjou OA, Thompson H, Trogdon JG, Pan L, Sherry B. Obesity and severe obesity forecasts through 2030. Am J Prev  Med. June 2012;42(6).

2.         Melville K. 9 out of 10 americans obese or overweight by 2030. [ONLINE]. 2008; 29 July, 2008:http://www.scienceagogo.com/news/20080629010344data_trunc_sys.shtml. Accessed May 7, 2012.

3.         Cannon B, Nedergaard J. Thermogenesis challenges the adipostat hypothesis for body-weight control. Proc Nutr Soc. Nov 2009;68(4):401-407.

4.         Calder P, Ahluwalia N, Brouns F, et al. Dietary factors and low-grade inflammation in relation to overweight and obesity. Br J Nutr. Dec 2011;106(Suppl 3):s5-s78.

5.         Kawanishi N, Yano H, Yokogawa Y, Suzuki K. Exercise training inhibits inflammation in adipose tissue via both suppression of macrophage infiltration and acceleration of phenotypic switching from M1 to M2 macrophages in high-fat -diet-induced obese mice. Exerc Immunol Rev. 2010;16:105-118.

6.         Petersen A, Pedersen B. The. anti-inflammatory effect of exercise. J Appl Physiol. Apr 2005;98(4):1154-1162.

7.         Das U. Is obesity an inflammatory condition? Nutrition. Nov-Dec 2001;17(11-12):953-966.

8.         Rocha V, Folco E. Inflammatory concepts of obesity. Int J Inflam. 2011 2011;2011:529061.

9.         Roncal-Jimenez C, Lanaspa M, Rivard C, et al. Sucrose induces fatty liver and pancreatic inflammation in male breeder rats independent of excess energy intake. Metabolism. Sep 2011;60(9):1259-1270.

10.       Rayssiguier Y, Gueux E, Nowacki W, Rock E, Mazur A. High fructose consumption combined iwth low dietary magnesium intake may increase the incidence of the metabolic syndrome by inducing inflammation. Magnes Res. Dec 2006;19(4):237-243.

11.       Alberti K, Zimmet P, Shaw J, IDF_Epidemiology_Task_Force-Consensus_Group. The metabolic syndrome--a new worldwide definition. Lancet. Sep 24-30 2005;366(9491):1059-1062.

12.       Ploeger H, Takken T, Greef Md, Timmons B. The effects of acute and chronic exercise on inflammatory markers in children and adults with a chronic inflammatory disease: a systematic review. Exerc Immunol Rev. 2009;15:6-41.

13.       Johnson R, Sanchez-Lozada L, Nakagawa T. The effect of fructose on renal biology and disease. J am Soc Nephrol. Dec 2010;21(12):2036-2039.

14.       Chiuve S, Willett W. The 2005 food Guide Pyramid: an opportunity lost? Nat Clin Pract Cardiovasc Med. Nov 2007;4(11):610-620.

15.       Willett W, McCullough M. Dietary pattern analysis for the evaluation of dietary guidelines. Asia Pac J Clin Nutr. 2008;17(Suppl 1):75-78.

16.       Nakayama T, Kosugi T, Gersch M, et al. Dietary fructose causes tubulointerstitial injury in the normal rat kidney. Am J Physiol Renal Physiol. Mar 2010;298(12-20).

17.       Ryu S, Ornoy A, Samuni A, Zangen S, Kohen R. Oxidative stress in Cohen diabetic rat model by high-sucrose, low copper diet: inducing pancreatic damage and diabetes. Metabolism. Sep 2008;57(9):1253-1261.

18.       Ding S, Lund P. Role of intestinal inflammation as an early event in obesity and insulin resistance. Curr Opin Clin nutr Metab Care. Jul 2011;14(4):328-333.

19.       Kawada M, Anihiro A, Mizpguchi E. Insights from advances in research of chemically induced experimental models of human inflammatory bowel disease. World J Gastroenterol. 2007;13(42):5581-5593.

20.       Cazettes F, Cohen J, Yau P, Talbot H, Convit A. Obesity-mediated inflammation may damage the brain circuit that regulates food intake. Brain Res. 2011;Feb 10(1373):101-109.

Fast Food done better

Doesn’t it seem like we have less time in a day then when we were younger. Well obviously there is still 24 hours in a day now as there was 30-40 years ago, but how much we try to pack into that time seems to increase as we get older. With more and more responsibilities, obligations and demands onto our day, cooking a healthy meal at home is often not high on the old priority list. Welcome the time saver for this problem – Mr. McDonald’s or Miss Wendy’s or what ever fast food chain we want to throw into the mix to become a staple of many of our diets.

Let’s be honest about the truth of the fast food diet. They are not as healthy or nutritious as the home cooked meal. They have more salt, more calories and are made up of more processed foods with added preservative and flavor enhancers. None of that is good. We all know that it is not the best for us, but what to do when we have the stress of everything else bearing down on us and we need something fast. Well here are some ideas. 

Try to preplan your meals. You know what nights you have a meeting and when the kids have to be at soccer practice or dance. So prepare a home cooked meal ahead of time at home that you can grab and go from home; instead of grabbing and going through the fast food drive-through. Make your own sack meal not one from the fast food joint. When to do this? How about the night before instead of watching “The Biggest Loser” on TV, help yourself to become a biggest loser and make your meals (maybe even with your family help to create some family time together) the night before.

Another thought is just because you are having to drive through to get the meal, doesn’t mean you have to pick the worst item on the board and then supersize it. We can make wise choices; most restaurants have a nutritional guide to help you know how to make the better choice. You might be a little surprised at how many calories and what is in some of your choices. Also some fast food restaurants will be better then others when it comes to nutritional value of what you are taking in.

Another thing, just because the super extra large soda is only a dollar, doesn’t mean that it is the best value for your health. Save the dollar, get some water and add some better nutritional value to your life. And if you just have to have that Coke, maybe you can survive with only a medium size.

Enjoy the sun without the burn

A new study published by the US Centers for Disease Control and Prevention (CDC’s) in the May 11 issue of Morbidity and Mortality Weekly Report, shows sun protective behavior is on the rise, which is good news. Unfortunately sunburns are still prevalent and are most common among those between 18 and 29 years of age.

Sunburns can be a predisposing factor for skin cancer. Basal cell carcinoma and squamous cell carcinoma, two forms of skin cancer, are the 2 most common cancers in the United States. Melanoma, another form of skin cancer, has increase mortality associated with it. It is important to prevent sunburns because the increase in the number of sunburns you have will increase your risk to get skin cancer.

While the good news is that more and more people are becoming aware of utilizing tips to reduce sunburns and sun exposure, many people (50.1% of all adults and 65.6% of those in the 18-29 year age group) are still experiencing at least one sunburn in the previous year according to this report. This report demonstrates there is still more work to be done in getting people to avoid sunburns to help reduce skin cancer.

Best preventative measures are wearing sun screen (women are better then men at this), protective clothing such as long clothing and/or wide-brimmed hat (men did better then women with this measure) and utilizing shade (both men and women were similar with this measure).

Here are a few tips on picking the right sunscreen. Look for ingredients such as zinc, titanium dioxide and avobenzone or mexoryl SX. Avoid added ingredients such as oxybenzone, Vitamin A (retinyl palmitate) and added insect repellent; as these have been found to decrease the effectiveness of the sun screen. Don’t think that increase price means improved performance, many lower or medium cost sunscreen options compare to higher end options. Creams are better then sprays or powders and look for products with broad spectrum protection and water resistant for beach, pool or exercise activities. SPF above 50+ is over kill, look for SPF 15-50+ which is enough. Make sure you reapply as needed based on activity and never go longer then 2 hours without reapplying.

Enjoy the summer, but just do it in a way that avoids sunburns to reduce your skin cancer risks.

Disease and Illness

I recently read an excellent post by Tony Ingram who is a fellow Physical Therapist that this post was generated from.  I would encourage you to go to his site and read his post, Disease vs. Illness.

“Disease, then, is something an organ has; illness is something a man has.” - Eric J. Cassell, 1978

Disease and injury are things we all experience at different times and in different forms, they are apart of a normal consequence of life as we move through this world we live in. How that disease or injury affects us is sometimes part of the illness we experience. Let’s look at the difference between the two to help clarify how we cope and return to a more normal way of life after they occur and two important take home points.

Disease or injury is an abnormal condition affecting an organism. You get a virus, cancer, break a bone, twist your ankle, etc. Fortunately with the advancements of medical science and use of our immune system most diseases are treatable and often with complete healing. Likewise most injuries will heal themselves. We are wonderfully equipped to heal our tissues whether a broken bone, sprained ligament, pulled muscle or others through our immune system and our bodies healing mechanisms.

Illness is the feelings that most often go along with the disease or injury; such as pain, weakness, discomfort, distress, fatigue, dysfunction, etc. These feelings can be significantly affected by non-disease factors for example: beliefs, expectations, fears, and anxiety to name a few.

Most often a disease or injury will cause illness to follow and typically the feelings of illness will decrease as part of the recovery process as the disease or injury heals. But, and this can be a big but, they can each occur on their own.

For example you can have a disease and feel no illness. Many people walk around with high blood pressure and are unaware of it till a stroke or heart attack makes them aware of it. Others may have a cancer that is not detected early on. Take home point number one, is why regular physician visits and screenings are so important to help detect a disease that might be present even though you are not experiencing any illness.

The other end of spectrum can also happen when someone has illness, but no disease or injury has occurred often referred to as Somatoform Disorder. This does not mean that person is faking it; it is part of a complex psychological process with some sort of neurological or neuro-immune disorder in play that we don’t fully understand yet.

But lastly I want to point to the fact that illness can affect disease. The extra stress, anxiety and fear that we allow from the illness can increase our body’s production of hormones and sensitization of our nervous system that actually make the disease or injury worse or slows the healing process. This in turn can lead to greater feeling of illness and a horrible illness/disease cycle has begun. Take home point number two, is the importance of using relaxation techniques and other stress reducing skills (understanding the disease and injury process to reduce fear and clarify beliefs and expectations) can actually help you recover faster and improve your healing from an injury or disease process to break you out of the illness/disease cycle.

If you sit at work, exercise at home

You probably have heard about some research reports about the unhealthy effects of sitting to much. Studies have shown that the more hours you sit each day the increase risk of dying prematurely there is. A research study showed that those that sit more then 8 hours each day (which is typical for many Americans) had a 15% increase in dying during the 3 year follow-up compared to those who sat less then 4 hours a day. The initial report with this study stated that even if you exercised in your non-sitting time, this did not defeat the deleterious effects of inactivity with sitting.

This prompted panic in some to instantly design a stand-up work station or think they were doomed either way since their job required them to sit, so they gave up exercising. Some new research out of Finland, may allow you get back in your chair and ditch the stand-up station (unless you really like it) and encourage you to get back to exercising if you have a sit down job.

The original study done just used self-reported questionnaires to determine activity levels; these often have some problems with accuracy of self reporting. The new study by the group in Finland actually put sensors on people to actually record their activity level and muscle contractions. They followed people that exercised and sat for nine (9) hours a day and also checked them on days they didn’t exercise and sat for nine (9) hours. What they found was on the days they exercised that they had significant increase in muscle activity over the day, compared to the days they did no exercise. Other studies have shown that when we are able to get muscles to work at a moderate to vigorous level we can produce significant health benefits.

So while adding exercise to your lifestyle may not change your sitting time, it will add significant health benefits. If you have a sedentary sitting job, make sure you are adding exercise to your routine to reduce the ill effects of sedentary lifestyle and do not go home and add to the sedentary habits by sitting in front of the TV the rest of the night. Also try to create some mobility to your sedentary sitting job by trying to get up and move around the office a little more. Make an extra trip or two to the copy machine or printer. The added activity might add some years to your life.