What is driving the increase in cardiometabolic disorder in the US? Are the weight loss drugs (Mounjaro, Ozempic, Zepbound etc.) the solution?
February is Heart Health Month and it is a great time to assess one’s risk for developing heart disease and other related conditions. Cardiometabolic Disorders and heart-related conditions account for 75% of the entire US healthcare expenditures. And one silent disease that is emerging as an epidemic far worse than Covid is a condition called nonalcoholic fatty liver disease. The current estimates are that 45% of adults and 25% of children in the US has this condition. It develops as a consequence to the underlying cause for ALL cardiometabolic diseases. These diseases all share a common pathophysiologic mechanism and are all related. These include: heart attacks, stroke, Type 2 diabetes, high blood pressure, Alzheimer’s (“Type 3 Diabetes”), elevated cholesterol, weight gain around the midsection, some kidney diseases and nonalcoholic fatty liver disease.
So what is driving this sharp increase in all of the diseases? It is multifactorial but far and away the largest contributor to this worldwide epidemic is sugar and fructose (AKA: high fructose corn syrup). Most people know where their sources of table sugar consumption comes from (i.e.: adding sugar to your food/tea/coffee), but high fructose corn syrup is found not just in sodas but in many processed foods on the grocery store shelves and consumers may be unaware of the quantity of fructose they are consuming. Beware: Fructose is also found in fruit. Some mammals prepare for the long winter food shortage by consuming large amounts of ripe fruit in order to store energy for the long winter. This is precisely why one’s cholesterol and triglycerides naturally increase in the fall and winter. We become more insulin resistant in the fall to store energy for the impending food shortage-which does not happen for many Americans. This physiologic process provided a survival advantage for our ancestors!
Fructose is an energy thief and dysregulates energy production in the mitochondria (cell battery pack) especially in the liver. It also causes an increase in a compound in the blood called uric acid. Increased levels of uric acid cause the body to become more insulin resistant, which leads to higher blood sugar levels, weight gain, high blood pressure, inflammation, elevated cholesterol and deposition of fat in the liver. All of these factors contribute to heart disease.
Fructose is the silent killer that we need to address from a public health perspective to truly impact health in the 21st century.
Some additional markers that the physicians at The Logan Institute order to assess cardiometabolic risk include: oxidized LDL, uric acid levels, insulin, micro albumin/creatinine and the liver fibrosis panel through Cleveland Heart Lab. The liver fibrosis test is a relatively new addition to this lab and will provide information as to the possibility of fibrosis (scarring) and risk for liver cirrhosis. Untreated fatty liver disease can lead to cirrhosis of the liver. The good news is that all of these conditions are all treatable and reversible. But one must know their risk factors!
Researchers have been working on pharmaceutical options to address the epidemic of obesity. So then the question we must ask is: does this new class of weight loss drugs offer the solution to the cause of weight gain and cardiometabolic diseases? The short answer is NO. At first glance the mechanism of these drugs seems promising as they increase insulin secretion, improve insulin sensitivity, slow emptying of the stomach and reduce fasting and after meals blood sugar levels. There is insufficient long-term safety studies to recommend it at this time. Also, if an individual using this drug is not actively working on maintaining muscle mass through proper conditioning, they may in fact begin to catabolize (break down) muscle which will ultimately lead to slower metabolism and energy loss.
Lifestyle medicine is the BEST solution to combat this trending epidemic which includes diet, exercise, sleep, stress management and much more. Let The Logan Institute help you navigate this complex physiologic condition with a variety of services including the newly developed weight management program with Dr Litty (Certified Lifestyle Medicine Doc) and Georgia Duke (Certified Health and Nutrition Coach) or with individual counseling and proper and comprehensive testing.
TLI has been a longtime leader in lifestyle and nutrition management as a method to reverse chronic conditions. Nutrition has always been the foundation of all of our prescribed treatment plans and home plans. It takes more effort than getting a weekly injection, but in the end by incorporating life-long habits that will foster a stronger body, mind and spirit will pay dividends in the future. Let TLI and our trusted practitioners work with you and your family to build these strong foundations.
-Dr. Logan
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