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.
