The most significant epidemic our country is currently facing is not caused by a virus or bacteria, but by our diets and lack of exercise. Metabolic syndrome, the combination of obesity (especially around the trunk and belly) and insulin resistance (the decreased ability to control blood sugar, including pre-diabetes and diabetes) increases the risk for heart disease, stroke, diabetes, and kidney disease. These four diseases are expensive to manage, cause a great deal of suffering and diminished quality of life, and are all in the top ten causes of death in this country.
Metabolic syndrome and its associated problems are the perfect example to support my naturalist point of view towards health. When I say I’m a naturalist, its not that I think herbs are better than pharmaceuticals, its that I think that people, if they make healthy choices and stay as close to their natural state as possible, will be healthy most of the time. Most diseases dealt with by modern medicine are caused by unhealthy behavior, be it drugs and alcohol, poor diets, lack of exercise or injury.
Eating too much causes metabolic syndrome. The excess calories consumed are stored as fat. Having such an excess of calories demands that the body over use insulin, the hormone that brings sugar from the blood stream into the cells for energy or storage as fat. As our cells get exposed to more and more insulin, it has less of an effect. This is called insulin resistance. After the insulin resistance gets bad enough, we call it diabetes. The exact way insulin resistance and diabetes happens is not yet understood but the weight gain and central obesity seems to play a role.
While we are struggling to discover the biology of metabolic syndrome, a study was recently released that found that patients with metabolic syndrome who underwent bariatric surgery, a group of procedures that surgically alter the stomach to make it much smaller, had significantly improved control of their blood sugar. These patients had poorly controlled blood sugar despite the best pharmaceutical treatments we have, many had even lost weight before the surgery, but cutting out or stapling their stomach allowed them better control of their blood sugar that before. These changes occur almost immediately, suggesting that the reason for this improvement is more complicated than just reducing the number of calories consumed.
The surgical solution for metabolic syndrome makes me feel somewhat uncomfortable. While this could improve and lengthen numerous lives in the United States, bariatric surgery can lengthen life by up to 40%, it is not without problems. The procedures are painful, have risks of complication and fundamentally change a person’s anatomy. People who have undergone bariatric surgery are more likely to have gallstones, scarring of the abdominal cavity, diarrhea, vomiting and vitamin deficiencies. Bariatric surgery, in many ways, is not a cure but merely exchanging one health problem for another one with a better life expectancy. It costs lots of money for each person to receive this surgery, so if all the people who would benefit from the surgery got it, the health system would have lots of spending to do.
As a naturalist, I would prefer we spent more energy in preventing metabolic syndrome, than treating it with a costly, profoundly altering surgery. I see the benefit in those who already have metabolic syndrome, but if we don’t change how we, as a people behave, our health will severely suffer. Bariatric surgery is the epitome of both what our health care system is good at and terrible at. We can administer a complicated, invasive procedure that demands tons of resources and skill, but we cannot convince people to practice healthy lifestyles. Staying in our natural states asks that we eat less and exercise more, not remove our stomachs. If we continue to live increasingly unnatural lives, we will have to go to increasingly unnatural therapies to try to stay alive.
Dr. Bruce Feinberg