The scientific community is still in disagreement as to whether or not obesity is a disease. While some still consider obesity a self-inflicted disease caused by poor eating habits and lack of exercise, there is growing evidence to support the claim that obesity is a disease.
According to Pi-Sunyer (2002), not only is obesity a disease but within the United States it is considered to be a condition of epidemic proportions. Statistics show that, in our country, over 20% of adults are diagnosed as clinically obese (Pi-Sunyer, 2002). The rationale that obesity is a disease is due to the fact that it causes many different comorbidities such as high blood pressure, diabetes, heart disease, etc.
Has Obseity Reached Epidemic Proportions In Western Countries?
I agree with Conway and Rene (2004) who believe that obesity is not only a condition that has reached epidemic proportions, but it is a disabling, multifaceted disease that causes changes in organ function and can come with a host of comorbidities. The excess body weight puts a strain on the heart, leading to changes in anatomical structure and the function of the organ. Obesity has also repercussions on the immune system (de Heredia et al., 2012), endocrine system (Poddar et al., 2017), and pulmonary system (Dixon & Peters, 2018). These repercussions are caused by both mechanical and functional alteration of tissues and organs.
Data Suggests That Obseity Is Associated With Several Very Serious Health Concerns
Research studies show that obesity is associated with an increased risk of developing cancer in at least 13 different organs (Avgerinos et al., 2019). Obesity is also linked to type-2 diabetes (Maggio & Pi-Sunyer, 2003), arthritis (Moroni et al., 2020). At the same time, a systematic review of scientific data that was published in 2017 shows that weight-loss interventions in the obese adult population decrease all-cause mortality (Ma et al., 2017). The same review shows that weight loss has a positive impact on cardiovascular mortality and cancer mortality (Ma et al., 2017).
Lastly, obesity’s status and acceptance as a disease are pivotal in determining its treatment, reimbursement for treatment, and the development of widespread interventions. For these reasons, I believe that obesity should be recognized as a disease.
References
Avgerinos, K. I., Spyrou, N., Mantzoros, C. S., & Dalamaga, M. (2019). Obesity and cancer risk: Emerging biological mechanisms and perspectives. Metabolism: clinical and experimental, 92, 121–135. https://doi.org/10.1016/j.metabol.2018.11.001
de Heredia, F. P., Gómez-Martínez, S., & Marcos, A. (2012). Obesity, inflammation and the immune system. The Proceedings of the Nutrition Society, 71(2), 332–338. https://doi.org/10.1017/S0029665112000092
Ma, C., Avenell, A., Bolland, M., Hudson, J., Stewart, F., Robertson, C., Sharma, P., Fraser, C., & MacLennan, G. (2017). Effects of weight loss interventions for adults who are obese on mortality, cardiovascular disease, and cancer: systematic review and meta-analysis. BMJ (Clinical research ed.), 359, j4849. https://doi.org/10.1136/bmj.j4849
Maggio, C. A., & Pi-Sunyer, F. X. (2003). Obesity and type 2 diabetes. Endocrinology and metabolism clinics of North America, 32(4), 805–viii. https://doi.org/10.1016/s0889-8529(03)00071-9
Moroni, L., Farina, N., & Dagna, L. (2020). Obesity and its role in the management of rheumatoid and psoriatic arthritis. Clinical rheumatology, 39(4), 1039–1047. https://doi.org/10.1007/s10067-020-04963-2
Pi-Sunyer, F. X. (2002). The obesity epidemic: Pathophysiology and consequences of obesity. Obesity Research, 10(S12), 97S-104S. https://doi.org/10.1038/oby.2002.202
Poddar, M., Chetty, Y., & Chetty, V. T. (2017). How does obesity affect the endocrine system? A narrative review. Clinical obesity, 7(3), 136–144. https://doi.org/10.1111/cob.12184
According to Dr. O’Neil-Smith, more than 20% of the population suffers from food allergies and intolerances. Elimination diets and IgG food antibody testing can be successfully used in clinical practice to address symptoms like bloating, constipation and diarrhea, fatigue, anxiety, asthma, joint pain, sleep disturbance, and headaches. As practitioners, we must relate this information to clients and patients in an easy-to-understand manner. When I introduce an elimination diet to my clients, I explain that eliminations diets are a great tool to identify food allergies and sensitivities. I would like the client to keep a food/symptom log for five days to see if there are patterns that can point to specific foods causing symptoms. The only downside is that not all reactions are immediate. Some foods can cause delayed reactions, meaning that an offending food can cause a reaction from several hours to several days after it has been ingested. This can make keeping a food/symptom log frustrating and confusing.
What Is The Difference Between An Allergy and A Sensitivity
I think that when we discuss elimination diets, it is important to understand the difference between a true allergy and a sensitivity. Food allergies can be life-threatening due to anaphylaxis. Food sensitivities can be caused by physiological and psychological issues. For example, leaky gut causes maldigested food particles to diffuse in the bloodstream, which causesimmune cells to mount an attack. Overgrowth of bacteria in the small intestine (SIBO) can cause severe reactions to fermentable foods, and it needs to be addressed with a very specific elimination diet called low-FODMAP. Enzyme deficiency and irritable bowel can also cause food intolerances. Stress and psychological factors can also be responsible for food reactions. To this day, there are foods I was forced to eat as a child that will literally make me sick, even though I do not have a true immune reaction to them. We can also be sensitive to “added” substances like food coloring, preservatives, and sulphites (Li, J. 2019).
Elimination Diets Need To Be Tailored To Individual Needs
For these reasons, the elimination diet needs to be tailored to the individual and their specific symptom burden. We must understand that an elimination diet does not merely remove foods, but it also prescribes that the client eats specific foods. For example, if leaky gut is the cause of food intolerances, we need to make sure that their diet includes plenty of gut healing foods. The same applies when we are dealing with food intolerances caused by imbalanced gut flora or irritable bowel. We can’t just refrain from eating offending foods; we must ensure that our diet is nutrient dense and health-promoting (Rinninella et al., 2019).
The good news is that food intolerances usually resolve themselves in a matter of 3 to 6 months, when the client avoids offending foods completely, and we address the root causes of the intolerances. While implementing an elimination diet, we monitor progress closely. This allows us to fine-tune the diet, and it also helps us to decide when the client is ready to reintroduce and to test the foods that were triggering a reaction. The reintroduction phase of the diet is as important as the elimination phase. We must not rush through the process. When symptoms have resolved, we will decide together which foods to reintroduce in the diet and in
which order. It is important that the client tests one food at a time every 4 to 5 days. This allows us to see if there are any delayed reactions to the food that we reintroduce. Keeping a detailed food/symptom log is going to be very useful during the reintroduction phase.
Reference
Li, J. (2019). Food allergy vs. food intolerance: What’s the difference? Mayo Clinic; https://www.mayoclinic.org/diseases-conditions/food-allergy/expert-answers/food-allergy/faq-20058538
Rinninella, E., Cintoni, M., Raoul, P., Lopetuso, L. R., Scaldaferri, F., Pulcini, G., Miggiano, G., Gasbarrini, A., & Mele, M. C. (2019). Food Components and Dietary Habits: Keys for a Healthy Gut Microbiota Composition. Nutrients, 11(10), 2393. https://doi.org/10.3390/nu11102393
What are the roles of lipoproteins and cholesterol in the body? Consider the interplay of insulin and cholesterol. How does a client’s insulin level impact his/her level of cholesterol? What is the current standard of care for someone who presents with elevated cholesterol? In what ways does this current standard of care affect insulin levels? Outline a nutritional protocol to help your client address his/her concerns of high cholesterol. Include labs might you request from your client’s primary care provider to assist you in designing this protocol. (600 words)
Lipids are hydrophobic: they are non-polar and insoluble in water. This means that they cannot dissolve in blood and rely on special particles for transport. These particles are called lipoproteins. Lipoproteins are a group of proteins synthesized in the small intestine and liver that transport hydrophobic lipids throughout the body. Lipoproteins are made up of lipids and proteins. The hydrophobic lipid portion of lipoproteins is placed in the core, while the hydrophilic protein portion is placed in the periphery of the particle. This particular structure is what allows lipoproteins to travel in the blood and transport lipids through the body.
Find Out What The Different Types of Lipoproteins and Their Names
There are different types of lipoproteins, and they are named according to the density of their content: chylomicron, chylomicron remnant, very low density lipoprotein (VLDL), intermediate density lipoprotein (IDL), low density lipoprotein (LDL), and high density lipoprotein (HDL). Chylomicrons are the least dense while HDL are the densest.
The lipids present in lipoproteins are triglycerides, phospholipids, free cholesterol, and cholesterol ester. Cholesterol is a high-molecular-weight alcohol, and it comes from two sources: exogenous (dietary cholesterol contained only in food from animals) and endogenous (manufactured by the liver). Cholesterol has several vital functions within the body. It gives our cells stability and stiffness. It is a precursor for the synthesis of steroid hormones, vitamin D, and bile, and it acts as an antioxidant. Cholesterol is needed for serotonin function, and low levels of cholesterol have been linked to aggressive behavior, violence, depression, and suicidal tendencies. Breast milk is rich in cholesterol, and infants and children need cholesterol-rich foods for proper development of the brain and nervous system. Cholesterol is also considered the “duct tape” of the body, used to repair damaged tissues.
Cholesterol and Heat Exposure
Cholesterol can become damaged upon exposure to heat and oxygen. Oxidized cholesterol is found in foods like fast foods, fried foods, margarines, baked goods, and foods that are deep fried in rancid vegetable oils.
Several studies reveal that prolonged exposure to insulin is linked to higher levels of lipid peroxidation markers in LDL. For this reason, we need to be aware that clients suffering from hyperinsulinemia will present higher levels of LDL compared to clients with normal blood sugar metabolism. The cholesterol guidelines from the American College of Cardiology and American Heart Association are as follows: patients with arterial plaques and otherwise healthy patients with LDL-C levels greater than or equal to 190 mg/dl are advised to drastically reduced intake of dietary cholesterol and are prescribed high-intensity statin therapy (or maximum tolerated statin therapy). Diabetic patients between the ages of 40 and 75 with LDL-C levels greater than or equal to 70 mg/ dl are prescribed moderate-intensity statin. It is disheartening to see such guidelines in place and to read that many expert physicians consider them not aggressive enough. Statins are dangerous medications linked to a host of side effects including memory loss and confusion, liver damage, muscle pain and damage. Statins also activate an immune response that prevents insulin from working correctly, causing an increase in blood sugar and, therefore, a higher incidence of diabetes. While as a nutritionist I cannot recommend against doctor’s orders, it is my duty to provide my clients with the latest research and information necessary to make informed decisions.
What Is High Cholesterol and How To Bring The Levels Down
When working with clients who are concerned about high cholesterol levels, some of the tests that I find helpful are the advanced lipid tests LDL particle number (LDL-P) and apolipoprotein B (apoB) as well as serum insulin test and c-reactive protein. These tests all measure biomarkers that can accurately predict risk of cardiovascular disease.
The nutritional protocol for such clients focuses on an anti-inflammatory diet that supplies high quality proteins, fats, and carbohydrates from low-glycemic vegetables and fruits. The diet removes added sugars, processed foods, fried foods, and vegetable oils. I also help them with stress management techniques and sleep hygiene. Supplements are an important part of nutritional therapy and, while there is no typical protocol, nutrients that are helpful in cases presenting high cholesterol are: chromium: 200-400 mcg with each meal; vitamin E: 200-600 IU d-alpha and d-gamma tocopherol; l-arginine: 700 mg two to three times a day with meals; magnesium orotate: starting with 400 mg and dosed to bowel tolerance; and curcumin: 15-60 mg three times a day. A formulation that I have used with success is Lipid-Sirt from Biotics Research.
References:
Naviglio D. Bad Cholesterol or “Bad” Science? Med chem [Internet]. 2016 [cited 2020 Oct 15];6(1). Available from: https://www.omicsonline.org/open-access/bad-cholesterol-or-bad-science-2161-0444-1000321.php?aid=66755
Shane Ellison — Life Saving Cholesterol Facts [Internet]. [cited 2020 Oct 15]. Available from: https://newswithviews.com/Ellison/shane13.htm
Kendrick M. The great cholesterol con: the truth about what really causes heart disease and how to avoid it. London: John Blake; 2008. 270 p.
Ross AC, editor. Modern nutrition in health and disease. 11th ed. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins; 2014. 1616 p.
Shils ME, Shike M, editors. Modern nutrition in health and disease. 10th ed. Philadelphia: Lippincott Williams & Wilkins; 2006. 2069 p.
Smith LL. Another cholesterol hypothesis: cholesterol as antioxidant. Free Radic Biol Med. 1991;11(1):47–61.
Mei S, Gu H, Yang X, Guo H, Liu Z, Cao W. Prolonged Exposure to Insulin Induces Mitochondrion-Derived Oxidative Stress through Increasing Mitochondrial Cholesterol Content in Hepatocytes. Endocrinology. 2012 May 1;153(5):2120–9.
Colas R, Pruneta-Deloche V, Guichardant M, Luquain-Costaz C, Cugnet-Anceau C, Moret M, et al. Increased lipid peroxidation in LDL from type-2 diabetic patients. Lipids. 2010 Aug;45(8):723–31.
Grundy Scott M., Stone Neil J., Bailey Alison L., Beam Craig, Birtcher Kim K., Blumenthal Roger S., et al. 2018
Grundy SM, Stone NJ, Bailey AL, Beam C, Birtcher KK, Blumenthal RS, et al. 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Blood Cholesterol: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation [Internet]. 2019 Jun 18 [cited 2020 Oct 16];139(25). Available from: https://www.ahajournals.org/doi/10.1161/CIR.0000000000000625
Carbohydrates are an important macronutrient and a significant source of energy in the diets of multiple populations across the globe.
Carbohydrate intake over the past 75-100 years has varied greatly from region to region, and there is huge disparity in data between developed and developing countries. In the western world carbohydrate processing and consumption has drastically changed during the past 100 years. During this time, there has been an overwhelming increase in chronic disease and diseases of lifestyle.
According to the FAO, in the past century, starch consumption has declined in western countries while it has been steady or increasing in developing countries. In the United States, 42% of energy is provided by low-quality carbohydrates coming from refined grains, sugar (especially high fructose corn syrup), and some starchy vegetables. Unhealthy diet and lack of exercise are the primary causes of obesity, which in our country has gone from 14.5% to 30.9% during 1971-2000.
What Is The History Behind Our Current Cultural Consumption Of Carbohydrates?
But how did we get to this? The answer is in the changes in farming and food processing that have taken place in approximately the past 80 years. We have switched from natural farming, which was based on crop rotation and soil fertilization that depended on the use of crop leftovers and manure to industrial and scientific farming. This change has grossly depleted our land, yielding impoverished crops. The past century has also seen changes in food processing with the advent of the food revolution that followed World War II. And while the food revolution “liberated 1950s housewives”, it has brought about a decrease in quality carbohydrates associated with the rise of many chronic and degenerative disease.
Carbohydrate consumption seems to have increased in the past few years, with bread and breakfast cereals forming a large part of modern western diets. The percentage of carbohydrates consumed is high, but the nutrient content of our diet has gone down due to impoverished soil, modern farming techniques and food processing.
Available data shows that carbohydrate consumption in developing countries contributes to 60-70 percent total energy (Shan et al., 2019). There is increasing evidence that carbohydrate consumption patterns in western countries are also growing, and it is believed that percentages will soon be close to that of developing countries. Despite this trend, many North Americans have an increasingly negative perception of carbohydrates. This is particularly shown by the low carb diets that have been popular in the past few decades, starting with the Atkins Diet. Dr. Atkins published his first book, “Dr. Atkins’ Diet Revolution”, in 1972, and since then, several dietary approached have focused on limiting, or at least controlling, carbohydrate intake: from the Zone diet, to South Beach, to the ketogenic, the primal and the paleo diet.
Childhood Obesity and Consumption Of Carbohydrates
As far as childhood nutrition is concerned, the past 70 years has seen a reduction in caloric intake, but an increase in body weight and childhood obesity. According to the data, there has been a 19% reduction in calorie intake in 50 years for boys, and 29% reduction for girls, but sugar consumption has increased. Fewer overall calories paired with increasing consumption of sugars means that the diet of our children is very low in nutrient-dense food. Food quality in school diets all over the country has also declined over the past 40 years. We should not be surprised to see that iron deficiency is the most common deficiency in our kids. It should not surprise us to learn that nutrient deficiency in our children is rampant and that our country ranks #39 in the world on the “child flourishing index”.
References:
Cassidy, C.M., “Nutrition and Health in Agriculturalists and Hunter-Gatherers,” Nutrtional Anthropology, Jerome, Norge W., Randy F. Kandel and Frettel H. Pelto, editors, Pleasantville, New York, pp. 117-179, (1980).
Food Agricultural Organization (2020). Global trends in production and consumption of carbohydrate foods. Retrieved 27 October 2020, from http://www.fao.org/3/W8079E/w8079e0g.htm.
Shan, Z., Rehm, C. D., Rogers, G., Ruan, M., Wang, D. D., Hu, F. B., … & Bhupathiraju, S. N. (2019). Trends in dietary carbohydrate, protein, and fat intake and diet quality among US adults, 1999-2016. Jama, 322(12), 1178-1187.
Trends in Intake of Energy and Macronutrients — United States, 1971–2000 [Internet]. [cited 2020 Oct 23]. Available from: https://www.cdc.gov/mmwr/preview/mmwrhtml/mm5304a3.htm
30 Interesting Facts About The Green Revolution, A New Age For Agriculture [Internet]. Facts.net. 2020 [cited 2020 Oct 28]. Available from: https://facts.net/science/technology/green-revolution-facts
How Highly Processed Foods Liberated 1950s Housewives [Internet]. National Women’s History Museum. [cited 2020 Oct 28]. Available from: https://www.womenshistory.org/articles/how-highly-processed-foods-liberated-1950s-housewives
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