Poor Nutrition: What’s It Costing You?
A few days ago I re-watched Food Inc, a documentary on the food industry. About halfway through, we meet a family of four ordering from the dollar menu at the fast food drive-thru.
During the interview we learn that the father has type 2 diabetes, takes about $200 in medication and may lose his job if his eyesight worsens from the diabetes. Meanwhile, the mother explains how the dollar menu is a better deal than a head of broccoli for 99 cents.
3 burgers a day for a month — $90.
Diabetes medication for a month — $200.
Your health – priceless.
Actually, even keeping good health out of the calculation, a $1 burger costs a lot more than $1!
Let’s say this gentleman ate burgers for breakfast, lunch and supper for a month – 90 meals that cost $90. Now let’s add in the medication, for a grand total of $290 a month or $3.22 a burger.
The cost of poor diet and little exercise
People with type 2 diabetes like the gentleman in Food Inc, usually also have metabolic syndrome — a bunch of metabolic problems that increases the risk for having cardiovascular disease.
About a quarter (20-25%) of the world’s adult population (!!) has metabolic syndrome. This makes them twice as likely to die from a heart attack or stroke compared to adults without the syndrome.
Hmm… that dollar burger is looking even more expensive [1].
What is metabolic syndrome?
Metabolic syndrome is a bit like the combo meal at your local fast food restaurant, because you can mix and match factors for metabolic syndrome.
Generally metabolic syndrome is a cluster of things.
- High BMI (often, but not always)
- Central deposition adiposity — a fancy way of saying fat around your middle, and deep in your abdominal cavity around your internal organs
- High circulating triglycerides — i.e. fat globs wandering around in your blood looking for a fight
- Too much “bad” LDL cholesterol; not enough “good” HDL cholesterol
- High blood glucose
- Poor sensitivity to insulin
- High blood pressure
- Hepatic steatosis, aka fatty liver — since the liver is the central warehouse of nutrient processing, it’s affected much earlier than the heart by a poor diet
If you have a BMI over 30 then you can go on to the next set of risk factors, but if your BMI is under 30 then you need to figure out if you have central obesity by measuring your waist girth (see Figure 1 on how to measure)[2-3].
Researchers measure waist girth a little differently than we do it at PN — instead of measuring at the belly button like the Precision Nutrition measurement guide (see PN V3) they measure half way between the bottom of the ribs (inferior margin of the ribs) and the top of the hip bone (superior border of the iliac crest) or about 2 cm above your belly button. (See Fig. 1 below)
Figure 1 – Measuring waist circumference (girth)
Depending on where you’re from you’ll have different cut-off girths:
| Men: | Women: |
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If you have central obesity or a BMI greater than 30 then having two of any of the following four risks classifies you as having metabolic syndrome:
- High blood triglycerides (or being treated for this risk):
- ≥1.7 mmol/L or 150 mg/dL (Note: this isn’t very high as Canadian guidelines have >2.0 mmol/L considered optimal)
- Not enough good (HDL) cholesterol (or being treated for this risk)
- For men <1.03 mmol/L or 40mg/dL
- For women <1.29 mmol/L or 50 mg/dL
- Too much blood glucose (being pre-diabetic or having type 2 diabetes)
- A fasting blood (plasma) glucose level ≥5.6mmol/L or 100 mg/dL
- High blood pressure (or treatment for this risk)
- Systolic blood pressure ≥130 mm Hg OR
- Diastolic blood pressure ≥85 mm Hg
Treating metabolic syndrome
That list of symptoms above is pretty daunting.
To date, many medical professionals have opted to treat metabolic syndrome with an expensive, and possibly risky, pharmaceutical cocktail that includes drugs like beta blockers, diuretics, vasodilators, calcium antagonists, ACE inhibitors, and statins.
$1 burger indeed!
This week’s review is on how to treat metabolic syndrome without drugs! Gee, what a novel idea.
Instead, the study looked at diet, exercise, and diet and exercise together to treat metabolic syndrome.
Camhi SM, Stefanick ML, Katzmarzyk PT, Young DR. “Metabolic Syndrome and Changes in Body Fat From a Low-fat Diet and/or Exercise Randomized Controlled Trial.” Obesity 2009 Oct 1. doi:10.1038/oby.2009.304
Methods
Scientists found 179 men and 149 postmenopausal women between the ages of 30-64 years that had low levels of good cholesterol (high density lipoprotein cholesterol; HDL-C), high levels of bad cholesterol (low density lipoprotein cholesterol; LDL-C) and a BMI of less than 34 (morbidly obese were exclude) to take part in the yearlong study.
These men and women were randomly put into one of four groups:
- control
- exercise only
- diet only
- diet and exercise
I’m not too fond of the exercise prescription — 1 hour of aerobics classes for 3 days a week at 60-85% of maximum heart rate — but the original study was done in 1992 and this study further analyzes the original data.
The diet is also a throwback to the 90s since the total fat was <30% of total calories, saturated fat was <7% of total calories and reduced cholesterol to <200 mg/day.
The scientists measured body fat, waist girth, triglycerides, HDL-C, LDL-C, blood pressure and fasting blood glucose.
Metabolic syndrome score is a calculation that combines these measures along with age to figure out the severity of the syndrome.
Results
Men
For men, diet + exercise was the most beneficial treatment. This combo improved body fat, waist girth, HDL and blood pressure.
Next most beneficial was diet, which improved waist girth and blood pressure.
Exercise on its own didn’t improve any measure.
Women
Women didn’t get as much of a benefit as men from any intervention.
This suggests that there are important sex-linked differences in metabolic syndrome, which require further research.
However, the women’s diet + exercise group had the most improvement in waist girth and body fat followed by the diet-only.
Overall
Interesting part of the whole study was that all three intervention groups (diet, exercise and diet plus exercise) had improved metabolic syndrome scores, and it all seemed to be linked to losing body fat.
The more body fat these folks lost, the more improvement on their metabolic syndrome scores — regardless of the group.
This tells us that that the metabolic syndrome is probably linked to lifestyle but also the metabolic effects of body fat itself.
Conclusion
This is another example of how diet and exercise is more beneficial than either one alone.
While I think there are more effective diet and exercise plans than the low fat diet and low intensity cardio, in this study it is impressive that they still worked.
As a society we prefer “easy yet complicated”, like discovering new drugs for disease.
But “difficult yet simple”, like diet and exercise, is probably the most valuable both in terms of money and well being.
Bottom line
Combining diet and exercise is more effective for losing body fat and improving your health than diet or exercise alone.
And this solution is a lot cheaper than drugs.
"I'll take the value meal with a side order of ridiculously expensive drugs, please. And supersize those pills."
References
- The metabolic syndrome booklet. International diabetes federation
- ATPIII Guidelines At-A-Glance Quick Desk Reference. National Cholesterol Education Program.
- Alberti KG, Zimmet P, Shaw J. Metabolic syndrome–a new world-wide definition. A Consensus Statement from the International Diabetes Federation. Diabet Med. 2006 May;23(5):469-80. Review
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