Whole Foods magazine

March 2000


Syndrome X: An Epidemic In Hiding

An Interview with Jack Challem, Burt Berkson, M.D. Ph.D., and Melissa Diane Smith


By Richard A. Passwater


To me, the best reasons for attending trade shows are to see old friends. While we make new friends. While we can keep in touch throughout the year with brief and to-the-point telephone calls, trade shows often provide the opportunity to enjoy a meal together or have a leisurely visit. Recently, I was chatting with my longtime friend Jack Challem. Many readers know Jack from his more than 25 years of writing articles in various health and nutrition :magazines. He currently is writing for many publications, including Let's Live, Country Living's Healthy Living, Natural Health and A Modern Maturity. Challem is more than a reporter, "but he is best known as a reporter. In fact, the trademark, 'The Nutrition Reporter™ belongs to Jack Challem primarily because he publishes the Nutrition Reporter newsletter.

Challem also is a "journalist-expert@ that he uses' his vast experience in formulating nutritional hypotheses and writing review articles in scientific journals. His scientific articles have appeared in Free Radical Biology & Medicine, Journal of Orthomolecular Medicine, Medical Hypotheses and other journals. He also is the co-author of The Natural the Supergerms (Pocket Books 1997 ) our discussion of "supergerms" in this discussed where supergerms come supplements can protect you from supergerms.

During our recent chat, I mentioned to Jack that I was planning to do an interview with Dr. Burt Berkson, M.D., Ph.D., practices nutritional and integrative medicine in Las Cruces, NM, and is an adjunct professor of applied biology at New Mexico State University. He has worked as a lecturer, researcher and professor including the Max Planck Institute, University of Illinois, Rutgers University in New Brunswick, NJ. In addition to acquiring an M.D. and M.S. degree the teaching of biology, he earned a Ph.D. in the cell biology of fungi. Recognized as one of the leading experts on alpha lipoic acid, Dr Berkson is an active writer and speaker with numerous published works in scientific, medical, and popular journals. He is the author of The Alpha Lipoic Acid Breakthrough (Prima Publishing, 1998).

Dr. Berkson has a keen wit and tells some wonderful stories of how he has saved the lives of liver patients with lipoic acid. He also recounts amusing tales about his efforts to get other physicians to incorporate lipoic acid into their treatment protocols. Jack agreed that this would make a worthwhile column and then confided that he was writing a book about Syndrome X with Dr. Berkson and nutritionist Melissa Diane Smith: That gave me the idea for this column, in which I interview all three of these interesting people.

Physicians have used and understood the term Syndrome X for some time, but only recently have most other people begun to learn about it. Syndrome X refers to the grouping of glucose tolerance/insulin resistance, high blood pressure, overweight, high cholesterol, and high triglycerides. It sets the stage for adult - onset diabetes and degenerative heart disease, and likely other degenerative diseases as well. As I mentioned, Syndrome X: The Complete Nutritional Program to Prevent and Reverse Insulin Resistance is the new book about this subject. It was written by health writer Jack Challem, Burt Berkson, M.D., Ph.D., and nutritionist Melissa Diane Smith, and it was published in January by John Wiley & Sons ($24.95). The book goes into the dietary causes of Syndrome X and puts forth two A Anti-X@ diet plans, as well as listing supplements and physical activity needed to prevent and reverse the condition.

I haven't described Melissa Diane Smith so far, so let me introduce her now. She is a health journalist and nutrition counselor who specializes in customized diet plans and consumer education. Smith maintains a private practice in Tucson, AZ, and is the co-author of All about Vitamin E ( Avery, 1999), and why Am I Always So Tired? ( Harper, San Francisco, 1999). She also writes extensively on nutrition topics for a variety of health magazines, including Let's live, Delicious! And Great Life. She holds a journalism degree from the University of Arizona and a diploma in comprehensive nutrition from the American Academy of Nutrition.

Passwater: Jack, let ask the first and most obvious question; what is Syndrome X?

Challem: Syndrome X is the term used to define a cluster of two or more of the following traits: abdominal obesity ( paunch or beer belly), high blood pressure. High cholesterol, high triglycerides, and insulin resistance, Insulin resistance- a form of glucose intolerance that prevents the body from efficiently using insulin- is the cornerstone of Syndrome X, and it leads to all of these other problems. So, another way to look at this is to say, AIf you're overweight, you're not just over weight. You have Syndrome X. If you've got high blood pressure, you're not just hypertensive. You have Syndrome X.@ And so forth.

Passwater: Why does Syndrome X pose a problem?

Challem: The standard medical view is that Syndrome X, and its underlying insulin resistance, are major risk factors for adult-onset diabetes and heart disease. However, the emerging research indicates that Syndrome X accelerates the whole aging process and the development of degenerative diseases, going way beyond diabetes and heart disease and including cancer and Alzheimer's disease.

Passwater: Where did the term originate?

Berkson: The term Syndrome X was coined in 1988 by a Stanford University researcher who recognized that the symptoms described by Jack Challem tended to occur in clusters. Because this was a new observation, it was called Syndrome X, with the "X" basically standing for the unknown. Syndrome X is well-understood today-virtually every physician knows the term-and some doctors refer to it as the insulin resistance syndrome or the metabolic syndrome.

Passwater: And what causes Syndrome X?

Smith: The cause is a diet high in refined carbohydrates. Basically, if you are eating the typical American diet, with all of its pastas, breads, cereals, and sweets, you're on the fast track to developing insulin resistance and Syndrome X.

What happens is this: large amounts of refined carbohydrates and sugar trigger a rapid increase in glucose, or blood sugar, levels. In response, the pancreas quickly releases large amounts of the hormone insulin, which normally moves glucose into cells, where it's to be burned for energy. But the insulin receptors on cells eventually get overwhelmed by the excess insulin, and cells become insulin resistant. In other words, cells cannot properly use insulin to burn sugar. As a result, more and more of the glucose is stored as fat, and some remains in the blood, leading eventually to adult-onset diabetes.

Baby boomers are ripe for developing Syndrome X. But overweight children have it too, as do many teenagers and seniors.

Passwater: All told, how many people have Syndrome X?

Challem: The majority of Americans. According to the latest surveys, 55% of American adults arc now overweight. To be overweight, you have to be producing excess insulin. So >% of Americans also have insulin resistance, and the combination of insulin resistance and obesity fits the definition of Syndrome X. Many of these people also have high blood pressure, high cholesterol, or high triglyceride levels, so they have other signs and symptoms of Syndrome X. In addition, an estimated 2 5% of thin Americans also have insulin resistance. Some of them may have no other symptoms, bemuse their bodies keep pumping out more insulin to deal with all the glucose from all the re fined carbohydrates they're eating. But some of them also have high blood pressure, high cholesterol, or high triglycerides. Basically, more than 65% of Americans have either insulin resistance of Syndrome X. These are notion wide health problems.

Berkson: Another way to look at this is to ask yourself how to induce diabetes. A diet high in refined carbohydrates and sugars is the best way. This is the diet most Americans eat. People are routinely eating prediabetic diets.

Smith: I might add that this is the diet that many so-called health experts have advised for years. There has been a fat phobia for 30 years, and dietitians and doctors have been recommending a low-fat diet to reduce the risk of heart disease. This was terrible advice: low-fat diets almost always translate into high-carbohydrate diets, which make insulin resistance and Syndrome X worse. To put this another way, the so-called experts have urged everyone to eat a diet that causes diabetes. Because diabetes is a principal cause of premature heart disease, high carbohydrate diets also lead to that.

Passwater: Isn't cholesterol a pretty poor indicator of coronary heart disease risk? After all, 80% of people who have heart attacks have normal cholesterol levels.

Berkson: By itself, elevated cholesterol is practically meaningless. In combination with other risk factors, however, it can be very important. In Syndrome X, the combination of elevated total cholesterol, high triglycerides, and low high-density lipoprotein (HDL, the "good" cholesterol) is a powerful indicator of trouble. In addition, as you well know and have preached for years, oxidized (or free-radical damaged) low-density lipoprotein (LDL, the "bad" cholesterol) is an excellent indicator of heart disease risk. Not surprisingly, people with insulin resistance and Syndrome X tend to have oxidized LDL.

In terms of the other risk factors, practically everyone knows that high blood pressure and excess weight increase the risk of heart disease. This is well-established. Each of these risk factors is very bad news, but the more of them that you have, the greater your risk of heart disease and diabetes.

Passwater: What are some of the other health risks associated with high glucose levels?

Challem: High glucose reduces the ability of white blood cells to track and engulf bacteria. In other words, high glucose puts white blood cells-and a big part of your immune system-to sleep. One study found that as sugar intake went up and protein intake went down, antibody production also went down. The bottom line is that sugar increases susceptibility to infection.

Glucose also auto-oxidizes-that is, it starts its own chain reaction and starts producing large amounts of free radicals. These free radicals cause all sorts of mischief, and either cause or exacerbate virtually every disease. Some studies also have shown that high glucose-or high intake of sugars-increases the risk of some cancers.

As you've reported in this column in other issues, virtually every disease involves free radicals. Elevated glucose is a great way to generate lots of free radicals. This means that high glucose is likely an exacerbating factor, if not a causative factor, in a great many diseases.

Passwater: What are the risks associated with high insulin levels?

Challem: First, let me point out what people often forget: insulin is a very powerful hormone. It is, in fact, the only hormone you can boost to abnormal levels through diet alone. Think about this: you need a prescription to take testosterone, and DHEA you buy over the counter. However, to boost insulin levels, all you have to do is eat a lot of refined carbohydrates and sugars. Pretty amazing when you think about it: eating the typical American diet is a prescription for high insulin levels.

There is evidence that insulin may be the oldest hormone, or one of the oldest hormones found on Earth. As with other hormones, a little bit goes a long way. It can turn on genes, such as the fat-storage genes. Insulin also seems to accelerate the aging process, and it may express genes differently in older cells than in younger cells. There is some evidence suggesting that high insulin levels by themselves (even without high glucose levels) increase the risk of cancer and heart disease.

Passwater: How do you bring glucose and insulin levels back to normal?

Smith: The best way to treat a nutritional disease is through nutrition. We recommend a modern version of the paleolithic diet-that is, the type of diet people evolved on or, if you prefer, the type of diet God designed us for. Until 10,000 to 12,000 years ago, people ate no grains, at least no cultivated grains. There were no breads, cereals, donuts, or pastries. People were hunter-gatherers. They hunted big game for meat, and they gathered various vegetables, nuts, and some fruit. Our genes evolved on this type of diet.

In our book, we recommend two protein-rich diets that are different from other currently popular high-protein, low carbohydrate diets. One of our diets, for losing weight and reversing Syndrome X, is very low in carbohydrates. The other, for maintenance and preventing Syndrome X, has small amounts of carbohydrates, such as brown rice. We emphasize chicken, turkey, and fish-all good protein sources without the saturated fat of beef-and good fats-monounsaturated fats such as olive oil and omega-3 fats, like those present in cold-water fish. We also recommend that people eat a lot of non-starchy vegetables, such as broccoli and green beans. These vegetables provide the best types of carbohydrates those rich in fiber, nutrients and phytochemicals, yet without a lot of carbohydrates. This is the dietary profile most similar to that of our distant ancestors.

Passwater: Does the diet work?

Smith: Absolutely. My clients have had great success with it. I myself lost 30 pounds and cured myself of chronic fatigue syndrome eating this way. In the process of figuring out what diet was best, I discovered that the high-carbohydrate diets and the low-fat diets made me sicker. We weren't designed, genetically, to eat large amounts of grains or large amounts of carbohydrates.

Challem: I began following the Anti-X diet in February 1999, when we were writing the book.

I weighed 170 pounds and had a small paunch-a 38-inch waist. My fasting blood sugar was 111 mg/dl-just shy of the prediabetic range. In three months of eating mostly chicken, turkey, fish, and lots of salads, I lost 20 pounds and 4-1/2 inches from my waist. I wasn't even thinking about dieting. That's how easy it was! In addition, my fasting glucoses went from 111 to 85 mg/dl-from high normal to perfect normal.

Passwater: What are some of the basic principles of the diet?

Smith: Many of our dietary principles, which are explained in the book, make perfect sense to people who have been in the health-food and natural-foods industry. They're just good, basic nutrition. For example, the first principle is to avoid refined carbohydrates. Unfortunately, I've seen a lot of people pay lip service to this and then stuff their face with so-called "natural" refined carbohydrates and sugars. The second principle is to eat foods in as natural and fresh a state as possible. It's hard to criticize this as a radical or dangerous diet.

The basic Anti-X diet recommends quality, low-fat animal protein sources, such as eggs, chicken, turkey, and fish. Non-starchy vegetables, such as broccoli, cauliflower, and green beans, should form your main source of carbohydrates. The types of fats you take in also are important. Because excess omega-6s promote insulin resistance and are pro-inflammatory and carcinogenic, you should eliminate all cooking oils except olive oil. This includes corn, safflower and soybean oils, which are all high in omega-6 fatty acids. Trans-fatty acids-found in fried foods, most margarine and foods that contain partially hydrogenated oils-also promote insulin resistance, so they, too, should be avoided. The emphasis in the diet should be on the omega-3 and omega9 fatty acids, such as those in cold-water fish and olive oil.

Passwater: People often have trouble figuring out exactly what to do and what to use.

Smith: The book really helps here. It gives real practical information, including some very tasty and, I should add, very simple recipes. There also is a week-long menu plan. In addition, we devote a chapter to navigating through supermarkets and the menus of different types of restaurants-Italian, Japanese, Chinese, etc. and staying on a protein-rich diet without getting sabotaged by refined carbohydrates. Most restaurants are very accommodating to special requests. For example, you can order a chicken sandwich minus the bun, and most places are willing to substitute a salad or steamed broccoli for fries. I've found that many restaurants will allow these substitutions for free, but if you have to pay a dollar extra, that's a small investment for protecting yourself against a condition that accelerates aging and increases the risk of degenerative diseases.

Passwater: How is your diet different from Dr. Atkins' high-protein diet?

Smith: Let me restate your question more broadly: "How is our Anti-X diet different from the other popular high-protein, low-carbohydrate diets on the market?" I think our diet is much more balanced. I'm not sure a lot of people can thrive on all of the saturated fat found in the Atkins diet, at least not without balancing the saturated fat with heart healthy omega-3 fats. I'm certain people shouldn't be snacking on deep-fried pork rinds; they contain the worst types of fats! Some of the other diets recommend too many diary products, and most of us in the natural foods industry know that dairy allergies are very common. Some of the other diets impose practically religious rituals, e.g. don't eat this food until at least four hours after eating that food. The Anti-X diet is much less complicated and easier to follow.

Passwater: What happens when people go off the Anti-X diet? Do they gain their weight back?

Smith: This is a question I'm asked often, and I think there are some assumptions in that question that are off the mark. Should someone go on a healthy diet and lose weight and lower blood pressure-and then go back to eating an unhealthy, disease-promoting diet? Of course not! That would be like saying eat organically to reduce your risk of cancer, and when your risk goes down, then pig out with abandon on pesticide-laden food.

What all of us need to understand is that the Anti-X diet is the way we should be eating most of the time. Going off the Anti-X diet and back on the typical American diet sets you up for Syndrome X. While you can indulge in a high-carbohydrate food from time to time or on a special occasion-if you're not overweight or don't have any other indicators of Syndrome X-you shouldn't make a habit of eating this way or you'll be headed for disease.

I think the idea that the natural foods industry was founded on is that people should eat a healthy diet for life, not just for a few months. We have to remember the roots of our industry and that there are certain "foods" we should make a point of avoiding, at least nearly all the time. There's an enormous amount of junk masquerading as healthy and natural foods at the trade shows and in health food stores. Rice cakes are worse than sugar in terms of glucose control. There are too many highly refined cereals that are promoted because they are organic. Refined organic wheat is no better than refined nonorganic wheat in terms of what it does to blood sugar levels. There are also way too many sweets posing as natural sweets. The body doesn't care whether sweets are organic and all natural or not; it reacts to them the same way. 1 think, in many ways, too many people have forgotten about whole foods and the ideas that the natural foods industry is based on.

Passwater: How do the supplements fit in?

Challem: Supplements tend to be overlooked in the other popular diet books, but they are very important. Let me elaborate on my personal experience. I had been taking 50 mg of alpha-lipoic acid and many other supplements daily for years. After seeing my fasting glucose hit 111 mg/dl, I increased my alpha-lipoic acid to about 350 mg or so daily. I was following the Anti-X diet at the same time, so I don't know if the extra alpha-lipoic acid alone lowered my glucose-but the research certainly indicates that it can. My gut feeling is that the extra alpha-lipoic acid and the therapeutic diet probably worked synergistically to reverse the insulin resistance I had and cause a lowering of my blood glucose levels. This often is the case with supplements. They are terrific complements to a healthy diet because they provide raw materials the body needs to function more optimally.

Passwater: What other supplements do you recommend in the book?

Berkson: Alpha-lipoic acid is the key supplement recommended in the book. This vitamin-like nutrient plays crucial roles in the burning of glucose for energy and in liver function. Liver function may seem unrelated, but it is this organ and the pancreas that orchestrate how the body manages glucose and insulin. When the liver is diseased, glucose tolerance goes out the window. Alpha-lipoic acid improves liver function in a number of ways, such as by promoting the production of new, healthy liver cells and by boosting levels of the antioxidant glutathione, which is essential for liver function.

The research on alpha-lipoic acid's role in glucose control goes back about 30 years. European researchers have found it very helpful in reducing glucose levels in diabetics-by as much as 30%--and by improving the efficiency of insulin. When insulin works efficiently, you need less of it. But alpha-lipoic acid does not cause hypoglycemia. It simply lowers and stabilizes glucose. However, people taking insulin or hypoglycemia drugs may have to lower the dose of these medications.

Challem: Vitamin E is another supplement we emphasize and, as you know, natural vitamin E is far superior to synthetic. We all know that vitamin E? is good for the heart. A recent Italian study found that vitamin E supplements reduce glucose levels and restore more normal insulin function. This is similar to what Evan Shute, M.D., noted 50 years ago-that vitamin E decreased insulin requirements because of improved glucose tolerance. Vitamin E, also quenches many of the free radicals that glucose generates.

Another important supplement is vitamin C, which is chemically similar to glucose and which competes against glucose. When the blood contains high levels of glucose, it's very hard for vitamin C to get a foothold. Various studies have shown that vitamin C improves glucose tolerance by lowering glucose and by normalizing insulin's response to glucose.

Chromium also is very important. People have known for years that chromium is essential for normal glucose metabolism. One recent study found that 1,000 mcg of chromium picolinate daily completely corrected diabetes in patients. I don't think it is, by itself, a cure-all, but it is one of the key micronutrients in managing glucose.

Smith: It's also very important for people with Syndrome X or insulin resistance to avoid taking iron and copper, unless tests indicate that they need these minerals. Iron and copper are essential, but men tend to get too much iron and women tend to get too much copper. Both of these minerals generate free radicals, which damage tissues and weaken glucose tolerance.

Passwater: Does exercise fit into your Anti-X program?

Smith: Physical activity is very important for preventing and reversing insulin resistance and Syndrome X. So we have a chapter devoted to it; it is a part of our Anti-X program. But we make a point of avoiding the "E" word in the book. Many people think that if they can't jog or do aerobics 30 minutes a day four times a week, they aren't going to get the benefits of exercise. This simply isn't true. The great news for many people is that you don't have to run miles every day or be an exercise fanatic to protect yourself from Syndrome X. Being moderately physically active throughout the day is actually all it takes. Quite a few studies have found that going for a daily walk greatly improves glucose tolerance. Dancing is another great form of physical activity. Even gardening in the great outdoors offers benefits. Our message is simple: stay active and do things you like to do so you keep doing them. The more you move your muscles, the better protected against Syndrome X you'll be.

Passwater: Do herbs have any effect on Syndrome X?

Berkson: Considerable research indicates that silymarin, the antioxidant extract of milk thistle, can have a dramatic improvement on glucose levels and insulin function. In one study, Italian researchers gave silymarin supplements to a group of diabetics for a year. Every indicator of their diabetes improved. Their glucose went down, the sugar in their urine decreased, and their insulin levels declined. Remember, these were full-blown diabetics. People who are not as sick are likely to recover faster.

There are many other beneficial herbs as well. Among them are bitter melon, fenugreek, garlic, and green tea. Even some culinary herbs, such as cinnamon, cloves, and bay leaves, have been shown to improve glucose function.

Passwater: Any final comments?

Challem: I'll get on my soapbox for a minute. The typical American is eating a diet designed for disaster. This diet is high in refined carbohydrates, such as breads, pastas, and various sweets, none of which provide any real nutritional value. People also are eating large quantities of refined oils, many of which are oxidized by heat, such as in the making of fries. Because of extensive refining, these foods shortchange people on vitamins, minerals, and various vitamin-like nutrients, such as carotenoids and flavonoids. These foods draw on the meager vitamin and mineral reserves people have, because vitamins and minerals are needed to metabolize these carbohydrates and fats. The typical diet is an absolute mess, and Syndrome X is the tip of the iceberg that results from this diet. There are a lot of devastating health conditions that can be developing underneath the surface of this iceberg.

And the diet, I fear, is going to get worse before it's going to get better for the majority of people. Genetic engineering is an abomination, the height of scientific arrogance in the name of financial avarice. Food technologists currently are working on the next generation of refined foods and cloaking their activities under the euphemism of functional foods. Natural, organic foods are the most functional foods ever created! We all need to get back to the basics of what the natural foods industry is all about-natural, organic, unpartitioned, unrefined foods. That's the real message of our Syndrome X book. Most diseases are nutritional IN ORIGIN, and most diseases should be prevented and treated with nutrition.

Passwater: Thank you all very much. WF


2000 Whole Foods Magazine and Richard A. Passwater, Ph.D.

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