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Metabolic Inflammation: What is it?

Important Points:

  • Inflammation
  • cytokines
  • homeostasis
  • metabolic syndrome

Metabolic Inflammation: What is it?

In the quest to understand the causes and early symptoms of diabetes and other chronic diseases, metabolic inflammation is often mentioned. What is it, and what is its role in the early onset of these diseases? This article delves into the definition of the term, its presentation, and likely effects.

1. What is the metabolic syndrome?

The occurrence of the metabolic syndrome has been on the rise in both developed and developing Countries. It can be described as a group of disorders including glucose intolerance, central obesity, hypertension, and lipid malfunctions present in various forms, depending upon the combination of the different components of the syndrome. Metabolic syndrome has been generally accepted to increase the risk for the development of Type 2 diabetes, cardiovascular disease, stroke, and cancer.

2. What is Inflammation?

Inflammation is part of the complex biological response of body tissues to harmful stimuli, such as pathogens, damaged cells, or irritants,and is a protective response involving immune cells, blood vessels, and molecular mediators. Immune signaling molecules called cytokines orchestrate inflammatory response when the harmful stimuli are detected. The inflammatory responses caused by both pathogens and wounding can cause damage to cells and tissue which in turn can induce further inflammatory responses.

The primary duty of inflammation is to isolate or rapidly destroy the underlying source of the disturbance, remove damaged tissue, and then restore tissue homeostasis. Excessive inflammation can have adverse effects, resulting in collateral damage and disease.

3. Inflammation and the metabolic syndrome

Metabolism can be described as the whole range of biochemical processes that occur within a living organism. Without a doubt, the relationship between inflammation and metabolism is complex. Several explanations have been proposed to explain the origin of the metabolic syndrome. Some consider an initial insulin resistant state progressing to the other components, while others view obesity as the main initiator of the syndrome.

More recently, the chronic low-grade inflammatory condition that often accompanies the metabolic syndrome has been implicated as a major factor both in the beginning of the metabolic syndrome and its associated pathophysiological consequences.

The inflammatory state that accompanies the metabolic syndrome does not completely fit into the classical definition of acute or chronic inflammation as it is not accompanied by infection; there is no massive tissue injury and the dimension of the inflammatory activation is also not large. It is therefore often called ‘low grade’ chronic inflammation or ‘meta-inflammation’, meaning metabolically-triggered inflammation or even ‘para-inflammation’ an intermediate state between basal and inflammatory states. Whatever the term used, the inflammatory process that characterizes the metabolic syndrome has its own unique features but its causes are far from being fully understood.

4. Inflammation and its outcomes

Despite it being an essential response to infection and tissue injury, inflammation has also been associated with several pathological processes. Excessive acute inflammation causes tissue damage and non-resolving inflammation leads to chronic tissue malfunction, suggesting a delicate balance between the rapid and effective response to distresses in tissue homeostasis and the collateral damage on tissue function.

As a cluster, obesity, raised fasting plasma glucose, high cholesterol and hypertension comprise the metabolic syndrome. We will have an in-depth discussion on some of these conditions in relation to metabolic inflammation:

            4.1 Obesity

Obesity is characterized by a low-grade chronic state of inflammation in which the level of pro-inflammatory cytokines such as TNF-α, IL-6 and CRP are increased. It is a state in which there is an over-accumulation of subcutaneous and/or abdominal fat (adipose tissue).

This adipose tissue is no longer considered inert and mainly devoted to storing energy; it is emerging as an active tissue in the regulation of physiological and pathological processes, including immunity and inflammation. Adipose tissue is also implicated in the development of chronic metabolic diseases such as type 2 diabetes mellitus or cardiovascular disease.

Obesity can therefore be caused by inflammatory and metabolic diseases. Diet or dietary patterns play critical roles in obesity and other pathophysiological conditions as well. It is therefore recommended for one to have a healthy diet and other nutrients that are generally considered to be beneficial.

              4.2 Type 2 Diabetes Mellitus

Type 2 Diabetes is a disease of insulin resistance, where people produce too much insulin and their receptors don’t work. They become insulin resistant and the inflammation arises from excessive insulin. 

It has been known for a while that there are higher levels of inflammation in the bodies of individuals with type 2 diabetes. The levels of certain inflammatory chemicals called cytokines are much higher in people with type 2 diabetes than in people who do not have diabetes.

The development of Type 2 diabetes is to a large extent driven by obesity and inactivity. Excess body fat, especially in the abdomen, leads to continuous (chronic), low levels of abnormal inflammation that alters insulin’s action and production. Chronic levels of free fatty acids and glucose as a result of insulin resistance induce further inflammation which results in increased cell death and impaired insulin secretion. This in turn prompts the progression from obesity and insulin resistance to full blown Type 2 Diabetes.

As type 2 diabetes starts to develop, the body becomes less sensitive to insulin and the resulting insulin resistance also leads to inflammation. A vicious cycle can result, with more inflammation causing more insulin resistance and vice versa. Blood sugar levels creep higher and higher, eventually resulting in hyperglycemia and other more serious effects of type 2 diabetes.

               4.3 Atherosclerosis

Heart disease is currently one of the major causes of disease and mortality facing humanity. Such a paradigm shift in disease pattern over the last century has been facilitated by the alarming global incidence of obesity and type 2 diabetes. Lately, there is an increasing focus on inflammation as one of the key factors in the pathophysiology of these disorders.

Early metabolic abnormalities that include weight gain, insulin resistance, and prehypertension and irregular blood lipid levels seem to have a complex relationship with diseases of the cardiovascular system.

Obesity increases the chances of diabetes, high blood pressure, pro-thrombotic state, and abnormal lipid presence. While inflammation and insulin resistance have direct antagonistic effects on the cardiac muscle, these metabolic irregularities as a whole lead to cardiovascular problems, warranting a multifaceted therapeutic and precautionary method of approach for the ‘Cardiovascular Metabolic Syndrome’ holistically.

              4.4 Non-alcoholic Fatty Liver Disease

Non-alcoholic Fatty Liver Disease is the predominant cause of liver disease. Its prevalence reaches 30% of the population and up to 75–100% in people with obesity.Different degrees of severity characterize this disease. A great majority of patients do not display any symptoms, however, nearly 20% eventually progress to develop chronic hepatic inflammation which can lead to early hypertension, cirrhosis, cancer of the liver, and increased mortality.

NAFLD is linked to overweight or obesity, Insulin resistance (in which your cells don’t take up sugar in response to the hormone insulin), high blood sugar (hyperglycemia, indicating prediabetes or type 2 diabetes) and high levels of fats, particularly triglycerides, in the blood.

Although this is one of the most prevalent metabolic anomalies in humans, what triggers the inflammation has remained elusive.

5. What then can be done?

The appearance of chronic diseases such as type 2 diabetes, atherosclerosis, non-alcoholic liver diseases, and gout seems to be fairly recent. Taking into account the generally late onset of these diseases in the life of an affected individual, the causes and effect of inflammation-induced metabolic disease needs to be looked at in-depth considering increased life expectancy and the Western lifestyle.

Understanding inflammation as a critical component of metabolic syndrome can shed some light on what metabolic inflammation is and how it very likely plays a significant role in the onset of these chronic diseases. In turn, care can be taken to prevent or even stop metabolic inflammation before it causes serious harm.

References

1.    NCBI ( 2007): Cardiovascular metabolic syndrome – an interplay of, obesity, inflammation, diabetes and coronary heart disease. Retrieved from.

 https://www.ncbi.nlm.nih.gov/pubmed/17391148

Current Research in Nutrition and Food Science (2015): Inflammation and Metabolic Syndrome- An Overview. Retrieved from http://www.foodandnutritionjournal.org/volume3number3/inflammation-and-metabolic-syndrome-an-overview/

3.    NCBI (2011): Inflammation and the Metabolic Syndrome. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3210244/

4.   NCBI (2013): Obesity, Inflammation and Diet. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3819692/

5.    WebMD: Diabetes and Inflammation. Retrieved from https://www.webmd.com/diabetes/type-2-diabetes-guide/inflammation-and-diabetes#1

6.    Wikipedia: Inflammation. Retrieved from https://en.wikipedia.org/wiki/Inflammation

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3 Reasons Trans Fats are Bad for You

Important Points:

  • Trans fats
  • Hydrogenated fats
  • Insulin resistance
  • Heart disease
  • Inflammation

3 Reasons Trans Fats are Bad for You

I remember a couple of years back when fast food Sunday treats was the norm for most families. Then slowly, as people became more health-conscious, families began switching to healthier dining options with less processed foods on the menu. So, for those gen Ys who found fast food banned from the family menu, I will give you the 3 reasons why we made the switch. This may also help those who have probably heard that “processed fats are not good for you” without knowing the reasons behind this. Then, next time you want to pick some fried or baked foods from a random store you will take the time to find out whether unhealthy Trans fats are on the ingredient list.

What are Trans Fats?

Trans fats are a form of unsaturated fat that can be found both from natural and artificial sources. Natural trans fats are found in meat from ruminant animals such as cattle, sheep, and goats and are created naturally through digestion in the ruminant’s stomach before being passed into dairy products as well as beef and lamb cuts. For the trans fats that occur naturally, there is not much to worry about. Science has shown that these trans fats have a decent safety profile when consumed in moderate amounts by humans. The most common trans fat that occurs naturally is conjugated linoleic acid (CLA) which is mostly found in dairy. It has been found to have some therapeutic benefits including helping in weight loss and bodybuilding. Consequently, CLA is usually marketed as a dietary supplement.

Artificial trans fats, on the other hand, may cause more harm than good. They are commonly referred to as industrial fats or partially hydrogenated fats. Artificial trans fats are derived from vegetable sources, and they are artificially altered to remain solid at room temperature so that they keep longer. Artificial trans fats can be found in fried foods such as doughnuts, and baked goods such as cakes, pie crusts, biscuits, frozen pizza, and cookies. Science has shown that artificial trans fats have serious health risks that should dissuade you from using them.

1.   Trans fats are bad for your heart health

Artificial trans fats may increase your risk of heart disease, as some clinical studies have shown. Examples of highly concentrated artificial trans fats are Vanaspati ghee and margarine. It’s been revealed that people who consume high amounts of artificial trans fats are likely to have increased bad cholesterol amounts without a corresponding increase in good cholesterol. Other fats, on the other hand, increase both bad and good cholesterol amounts. According to CDC reports 2019, high levels of low-density lipoprotein (bad cholesterol) may increase one’s risk for heart disease and stroke, and trans fats have also been shown to damage the inner lining of blood vessels known as the endothelium, which can lead to impairment in blood vessel function. In connection, a number of significant studies have shown that consumption of artificial trans fats are linked with the development of the cardiovascular disease.

2.   Trans Fats could Decrease Insulin Sensitivity and Predispose to Type 2 Diabetes

The relationship between Trans fats and insulin sensitivity is currently murky and further clinical research needs to be conducted to give clear direction. One study conducted by the University of Minnesota in 2006 concluded that “high intakes of trans fats may increase the risk for type 2 diabetes, inconsistencies across studies and methodological problems make it premature to draw definitive conclusions at this time. More experimental research in humans is needed to further address this question.”

Another large study showed that those who consumed the most trans fats had a 40% higher risk of diabetes. A number of animal studies have also shown a positive correlation between the consumption of artificial trans fats and insulin resistance which increases the likelihood of type 2 diabetes.

3.   Trans Fats Cause Inflammation

Inflammation is a necessary and useful response when injury or infection has occurred; however, chronic inflammation has been linked to the root cause of many chronic diseases such as heart disease, metabolic syndrome, diabetes, and arthritis. A study published in 2002 showed a positive correlation between the consumption of a diet high in hydrogenated fat and the production of inflammatory cytokines that have been associated with atherosclerosis. Other studies have also shown that trans fats increase inflammation especially in overweight or obese people.

In 2015, the Food and Drug Administration (FDA) banned the use of trans fats in food preparation. They “determined that PHOs, the major source of artificial trans fat in the food supply, are no longer ‘Generally Recognized as Safe’, or GRAS.” Too many processed foods still contained unhealthy trans fats as the ban has not been implemented to date, and processed foods that contain partially hydrogenated vegetable oil are the richest source of trans fats in the modern diet.

How to limit your intake of unhealthy trans fats

Although natural trans fats from animal products are considered safe when taken in moderate amounts, consuming artificial trans fats regularly could jeopardize your health.  Industrial seed oil, or the standard vegetable oil in your grocery store, may contain 5% trans fat.  I personally avoid all vegetable oils and stick to saturated natural fats whenever possible.

Limit your intake of processed foods made with vegetable oil such as doughnuts, cookies, crackers, muffins, pies, and cakes. When buying food, read labels carefully and check for any partially hydrogenated items on the ingredients list.

High consumption of artificial trans fats have been linked to long-term inflammation, insulin resistance, and cardiovascular disease. It’s unfortunate that most of Americans are hooked on fast food which is the biggest culprit for unhealthy trans fats.

References

1.   FDA (2018): Trans Fat. Retrieved from https://www.fda.gov/food/food-additives-petitions/trans-fat

2.   NCBI (2014): Trans fatty acids – A risk factor for cardiovascular disease. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3955571/

3.   CDC: Cholesterol myths and facts. Retrieved from https://www.cdc.gov/features/cholesterol-myths-facts/index.html

4.   NCBI (2007): A prospective study of trans fatty acids in erythrocytes and risk of coronary heart disease. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/17389261

5.   NCBI (2006): Trans fatty acids, insulin resistance, and type 2 diabetes. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/16958313

6.   NCBI (2002): Effect of hydrogenated and saturated, relative to polyunsaturated, fat on immune and inflammatory responses of adults with moderate hypercholesterolemia. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/11893781

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The Impact of sugar on Mental Health

Important Points:

  • Sugar
  • Mental Health
  • Dopamine
  • Inflammation
  • Brain

The Impact of sugar on Mental Health

When enjoying your tasty donut, the last thing on your mind is your long-term mental health. There is plenty of evidence to suggest that you should be thinking of just that. Most of us know the harm of too much sugar on our physical health in recognizing that it can cause obesity, wide-spread inflammation, and poor dental health and lead to diabetes, but few understand the significant impact of a high sugar diet on our mental health. In this article, we will at how a diet filled with too many sweeteners, such as sugar, honey, maple syrup, high-fructose corn syrup and molasses can have a detrimental impact on mental well-being.

Sugar and mental health: A toxic combination?

We all know how diet affects your physical health, but did you know that it can also have lasting effects on your mental health?  Regular consumption of meals high in sugar can affect your brain, increasing your risk of developing mental illnesses and mood disorders like depression.

The science of sugar

Sugars are simple, soluble carbohydrates essential for cell and organ functioning. Our bodies have the ability to break complex carbohydrate molecules into simple sugars so it is not necessary to take in sugar in its simple form.

Taking in excess sugar

Neurons are very sensitive cells and are not well prepared for sugar level spikes. A study by researchers from the Department of Neurobiology at Huazhong University of Science and Technology in Wuhan, China, performed on diabetic rats showed that high blood glucose, a simple sugar, led to inflammation and neuronal damage and death in the brain which suggests that people with diabetes are at risk for neuronal damage.

What is the link between sugar consumption and mental health?

1. Inflammation

Inflammation is a natural process which helps the body protect itself from damage and also aids in the healing process. Regular consumption of refined carbohydrates and added sugars triggers inflammatory responses that can cause inflammation in the brain and lead to depression.

2. Stress responses

After consumption of a high sugar meal, the hormone insulin is produced to regulate the high blood sugar level and in removing the excess sugar to the cell can actually lower the blood sugar level to below normal. This is called hypoglycemia. A lower than normal blood sugar level will trigger the hunger signal which sets one up for a cycle of sugar addiction. Hypoglycemia may show itself by triggering several stress responses including a feeling of instability (“having the shakes”) confusion, irritability, insomnia, anxiety, and depression.

High insulin levels can also cause an imbalance of hormone estrogen and progesterone, the balance of which is important in keeping us happy and calm.

3. Obesity and depression

High consumption of refined carbohydrates and sugar is associated with excess body weight and obesity. Overweight and obese people are more likely than people with a healthy weight to suffer depression as obesity can cause poor self-image, low self-esteem and social isolation, all known contributors of depression.

4. High release of dopamine

Due to the powerful impact sugar has on mesolimbic dopamine system — the brain’s reward system — sweet foods are highly desirable. Just like drugs, sugar can activate this reward system causing release of dopamine, a chemical that controls the brain’s reward and pleasure center making you crave for more sugar to keep you feeling good. Short term surges in dopamine can be pleasurable, but high concentrations can cause depression and attention deficit disorder.

5. Increased risk of mental illnesses

Brain derived neurotrophic factor is a protein that promotes survival of nerve cells and cognitive function. A diet rich in fats and refined sugar is associated with a low brain derived neurotrophic factor increasing the risk of psychiatric disorders and depression.

6. Starving the Brain

When you consume excessive sugar, a lot of insulin is produced to push this sugar into cells for energy production. The resultant dip in blood sugar can alarm the body and the adrenal glands, making them work over time.  These glands are charged with producing cortisol and fight or flight chemicals that can get your heart racing, and rev up anxiety, and cortisol can promote insulin resistance.  This will make you consume more sugar, which will inflict more suffering on your brain and potentially even putting you at risk for Alzheimer’s dementia down the line.

7. Disrupting Hormones

When cortisol is in demand for its blood-sugar balancing effects, or because of other psychological or bodily stressors, the body “shunts” the production of progesterone to support further cortisol output. This makes evolutionary sense because if we are under stressful circumstances, preserving progesterone, our “pro-gestational” reproductive hormone, becomes secondary. Insulin can also stimulate production of DHEA and sex hormones including testosterone, which can drive the pathology we see with polycystic ovarian syndrome. Sugars have also been demonstrated to reduce liver production of sex hormone binding globulin, freeing up testosterone and estrogen in ways that may promote symptoms of estrogen dominance including premenstrual moodiness and irritability.

What effect does sugar have on mental conditions?

  • Depression & Schizophrenia: The rapid fluctuation of blood sugar can worsen mood disorders. Research has shown that high sugar can lead to an increased risk of depression and even worse outcomes in patients with schizophrenia. Interestingly, countries with high sugar intake also have correspondingly high rates of depression.
  • Anxiety: Although sugar does not increase your risk of anxiety, it can worsen your symptoms and weaken the body’s ability to respond to stress. By minimizing sugar, you can lessen the severity of anxiety symptoms, improve mood and improve the body’s ability to cope with stress.
  • Addiction: There’s a growing evidence of sugar’s addictive potential. Drugs and sugar both flood the brain with the “feel-good” chemical dopamine. In studies, rats have been shown to prefer sugar-water over cocaine, and they also display classic signs of addiction including tolerance and withdrawal when the sugary products are removed.
  • Learning & Memory: Sugar can affect how and how much we learn and remember. After six weeks of drinking a fructose solution, much like soda, rats “forgot” how to find their way out of a maze. Insulin resistance from a high sugar diet can damage communications between brain cells involved in learning and memory formation.

How do we avoid the pitfalls of sugar?

How easy is it to avoid sugar? We are bombarded with advertisements for convenience foods and tasty treats. But even seemingly healthful foods can have high levels of hidden sugars. Breakfast cereals, sauces (including ketchup and pasta sauce), flavored milks, whole-meal bread, and many products labeled as low fat, such as fruit yogurts are such culprits.

Smoothies and fruit juices for children were in the spotlight last year in an article published in BMJ Open. It was noted that over 40 percent of products surveyed contained at least 19 grams of sugar – a child’s entire maximum daily amount of free sugars. High sugar levels have also been reported in baby and toddler food products.

Always remember to check the nutritional labels. While the list of ingredients might claim no added sugars, the nutrition facts panel will show the amount of carbohydrates and sugars in the product.

What is the evidence that cutting down on sugars will have health benefits? Studies have shown that individuals who experience depression benefit from eating a healthful diet. The next time a low mood threatens to spoil your day, remember where sugar is hidden in plain sight and look to other tasty treats to lift you out of the doldrums.

Do we need to limit our sugar?      

Our bodies and minds were not designed to take in such immense amounts of sugar that has become the norm in American society. Thanks to ongoing research, we are more and more aware of the intricate link between diet and wellness. It has a significant role to play in both physical and mental health. Grappling with mental illness is difficult enough without having additional obstacles in your way. Make sure sugar isn’t making your situation harder than it needs to be.

Additionally, choosing foods that are low in refined ingredients, such as sugar, but high in omega-3 fatty acids, vitamins, and minerals can relieve the symptoms of depression. Scientists think that the power of these foods lies in promoting good brain health.

References:

  1. Everhealth (2012): The Impact of Sugar on Mental Health. Retrieved from

http://everhealth.net/patient-education/the-impact-of-sugar-on-mental-health

  • Medical News Today (2017):Sugar and mental health: A toxic combination? Retrieved from

https://www.medicalnewstoday.com/articles/318818.php

  • Kelly Brogan:3 Ways Sugar Is Ruining Your Mental Health. Retrieved from
https://kellybroganmd.com/3-ways-sugar-ruining-mental-health/
  • Neuroscience (2017):Sugar is Not So Sweet For Mental Health. Retrieved from

https://neurosciencenews.com/sugar-mental-health-7194/

  • Standard Media (2018):The link between sugar and mental illnesses. Retrieved from

https://www.standardmedia.co.ke/article/2001282656/link-between-sugar-and-mental-illnesses

  • NCBI (2014):Nod-like receptor protein 1 inflammasome mediates neuron injury under high glucose. Retrieved from

https://www.ncbi.nlm.nih.gov/pubmed/24014157

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Sugar, Inflammation, and Health

Important Points:

  • Inflammation
  • Fructose
  • Natural sugar
  • Added sugar
  • Lifestyle change

Sugar, Inflammation, and Health

It’s no secret that sugar is bad for you. It spoils your teeth, packs on pounds around your belly, and provides zero nutrition. Unfortunately, these are the least of sugars crimes. The biggest reason why you should stop eating sugar is that it is one of the most pro-inflammatory foods, and current research suggests that chronic, body-wide inflammation is associated with many modern diseases like obesity, diabetes, and heart disease. So what role does a high-sugar diet play in chronic inflammation? In this article, we’ll delve into this and much more.

What is inflammation?

Inflammation is part of the body’s natural healing process.

Acute inflammation develops rapidly in response to an injury or infection. This type of inflammation tends to be good: It’s your body’s way of trying to fight off further damage while jump starting healing. It usually lasts a few days to a few weeks.

Chronic inflammation is long-term inflammation that occurs over months or years, and can increase your risk for serious diseases. It’s usually caused by unhealthy lifestyle factors like diet.

Some foods, like sugar can also cause inflammation in the body, which in small amounts is not too detrimental, but eating too many inflammatory foods or too much of any one such food may cause chronic low-grade inflammation which can lead to serious health problems such as heart disease, diabetes, and cancer. 

How does added sugar affect your body?

People who take diets rich in refined sugar may be increasing their risk of chronic inflammation. Research suggests that when people eat and drink less sugar, inflammatory markers in their blood decrease.

A high sugar diet can have harmful effects on health, such as increasing the risk of chronic diseases, weight gain, and tooth decay, and it can also result in chronic inflammation causing the body’s immune system to activate resulting in damage to healthy cells. Inflammation as a result of lifestyle factors such as obesity, smoking, and a sedentary existence can contribute to a range of diseases including heart disease, diabetes, rheumatoid arthritis, and Alzheimer’s.

When you consume excess added sugar and refined carbohydrates there will be a few changes in your body which help explain why a diet high in sugar can lead to chronic, low-grade inflammation.

  • Excess production of AGEs: Advanced glycation end products (AGEs) are harmful compounds that form when protein or fat combine with sugar in the bloodstream. Too many AGEs lead to oxidative stress and inflammation.
  • Increased gut permeability: Bacteria, toxins, and undigested food particles can more easily move out of the gut and into the bloodstream, potentially leading to inflammation.
  • Higher “bad” LDL cholesterol: Excess LDL cholesterol has been associated with higher levels of C-reactive protein (CRP), a marker of inflammation.
  • Weight gain: A diet rich in added sugar and refined carbohydrates can lead to weight gain. Excess body fat has been linked to inflammation especially when exacerbated by insulin resistance.

It is important to note that inflammation is unlikely to be caused by sugar alone, so other factors like stress, medication, smoking, and excess fat intake need to be monitored or mitigated too.

Is added sugar linked to inflammation?

A lot of research has been carried out to determine how sugar causes inflammation.  Diets high in added sugar are thought to signal the production of pro-inflammatory molecules in the body which, over time can create an environment of chronic, low-grade inflammation and lead to trouble in the future. Sugar also stimulates the production of free fatty acids in the liver. When the body digests these free fatty acids, the resulting compounds can trigger inflammatory processes.

Different kinds of sugar may contribute more or less to inflammation. For instance, some research has suggested that fructose may cause more inflammation than glucose. However, a systematic review found no difference in inflammation from fructose and glucose, so more research is needed.

Also, the researchers saw no differences in inflammatory factors between the groups that consumed high fructose corn syrup versus table sugar (sucrose). The sample sizes were small, and the quality of the studies was low, so more research is necessary to confirm these findings too.

Below are some of the common signs and symptoms of chronic inflammation:

People with chronic inflammation may have an increased risk of diabetes, depression, and dementia, and in older adults, chronic inflammation may also be linked to a higher risk of death. Doctors are working on how to reduce chronic inflammation.

Is natural sugar linked to inflammation?

It’s important to note that there is a difference between added sugar and natural sugar. Added sugar is removed from its original source and added to foods and drinks to serve as a sweetener or increase shelf life. Added sugar comes from high-fructose corn syrup (HFCS), sucrose or “table sugar”, fructose, glucose and corn sugar and is found mostly in processed foods and drinks.

Among US adults, around 13% of total calories come from added sugar. This is high, considering that government guidelines advise that no more than 5% to 15% of calories should come from both solid fats and added sugar.

Sugar found naturally in food, such as fructose in fruit and lactose in milk and dairy products, has not been linked to inflammation. In fact, foods with natural sugars, such as fruits and vegetables, may be anti-inflammatory, but adding processing to them is the equivalent of drinking sugar sweetened beverages, such as soda. For example, experts caution against processing fruit into juices because it removes the fiber and concentrates the sugar to a higher level per serving.

Does sugar cause inflammation?

Inflammation is a critical component of metabolic syndrome and can lead to diseases like type 2 diabetes, atherosclerosis, non-alcoholic liver diseases and gout. Research suggests that eating excess sugar can lead to chronic inflammation.

In the United States, the amount of high fructose corn syrup people consume increased from 1978 to 1998 and then stabilized according to the  Nationwide Food Consumption Surveys . With greater awareness of the risks of added sugar, sugar intake in the U.S. has been declining; nonetheless, people are still consuming too much sugar.

There are definitely changes you can make to minimize your inflammation risk which would include reducing your sugar intake. Here is our list to guide you to a healthier lifestyle.

Lifestyle Changes Can Reduce Inflammation

  • Adopt a low glycemic diet: High sugar intake links to chronic inflammation, stroke risk, coronary heart disease risk, and type 2 diabetes risk, and examples of these are soda, refined carbohydrates, and foods containing high fructose corn syrup.
  • Read food labels: If you are unsure about certain products, get into the habit of reading food labels; look out for ingredients like sucrose, glucose, high-fructose corn syrup, maltose and dextrose.
  • Choose whole-grain carbs: These include oats, whole-grain pasta, brown rice, quinoa and barley which have a lot of fiber and antioxidants that your body uses to help control blood sugar and protect against inflammation.
  • Eat more vegetables: Vegetables contain antioxidants, vitamins and minerals which can protect against and reduce inflammation in the body.  (Fruits are not included here because modern fruits contain tremendous amounts of carbohydrates).
  • Eat lots of antioxidant-rich foods: Fill your plate with foods rich in antioxidants to naturally help counteract inflammation; some examples include nuts, seeds, avocados, oily fish and olive oil.
  • Keep active: Regular physical activity, including both aerobic and resistance exercise can help protect against weight gain and inflammation.
  • Manage stress levels: Learning to manage stress levels through relaxation techniques and even exercise can help reduce inflammation.
  • Add curcumin to food:A component in turmeric called curcumin improves several inflammatory diseases.
  • Get enough fiber:Researchers have shown an association between high fiber diets and lower inflammatory factors, such as TNF-alpha and interleukin-6.
  • Drink green and black teas:Scientists have associated compounds found in green and black teas with lower C-reactive protein in the blood.
  • Eat more nuts: Almonds and other nuts may help to lower the risk of pro-inflammatory states (cardiovascular diseases such as atherosclerosis) and chronic inflammatory diseases (diabetes).
  • Add fish oil to the diet: Omega-3 fatty acids positively affect lower levels of inflammatory factors in the blood, such as C-reactive protein, interleukin-6, and TNF-alpha.

References

  1. Medical News Today (2017):Everything you need to know about inflammation. Retrieved from

https://www.medicalnewstoday.com/articles/248423.php

  • Healthline (2017): Does Sugar Cause Inflammation in the Body? Retrieved from

https://www.healthline.com/nutrition/sugar-and-inflammation

  • Medical News Today (2019): Does sugar cause inflammation in the body? Retrieved from

https://www.medicalnewstoday.com/articles/326386.php

  • Mindbodygreene (2019): The Real Reason You Should Quit Sugar + How To Cut It Out Of Your Life For Good. Retrieved from

https://www.mindbodygreen.com/0-24763/the-real-reason-you-should-quit-sugar-how-to-cut-it-out-of-your-life-for-good.html

  • NCBI (2014):Chronic inflammatory disorders and risk of type 2 diabetes mellitus, coronary heart disease, and stroke: a population-based cohort study. Retrieved from

https://www.ncbi.nlm.nih.gov/pubmed/24970784

  • NCBI (2019): Chronic Inflammation. Retrieved from

https://www.ncbi.nlm.nih.gov/books/NBK493173/

  • Greatist (2019):Does Sugar Actually Cause Inflammation? Retrieved from

https://greatist.com/health/sugar-and-inflammation

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Does chronic overnutrition play a role in metabolic inflammation?

Important Points:

  • Inflammation
  • overnutrition
  • obesity
  • carbohydrates
  • fatty acids

Does chronic overnutrition play a role in metabolic inflammation?

We have been looking at metabolic inflammation and its role in the development of obesity, diabetes, and other chronic diseases. Does overnutrition contribute to metabolic inflammation? How?

Background on Overnutrition

It is estimated that by 2020[b1] , two-thirds of the global burden of disease will be due to chronic non-communicable diseases, most of which are associated with an unhealthy diet. While hunger is a tremendous global health concern that cannot be minimized, overnutrition should similarly be given concentrated attention. Malnutrition affects up to 1 billion people and doesn’t just affect those who are thin due to food shortages; people who are overweight could also be malnourished.

The “double burden of malnutrition” is a term coined by the World Health Organization (WHO) to describe a situation which is characterized by “the coexistence of undernutrition along with overweight and obesity, or diet-related non-communicable diseases, within individuals, households, and populations, and across the life course. Globally, the problem is not the availability of food resources but the allocation and consumption of food.

1. What  is overnutrition?

Overnutrition is defined as the overconsumption of nutrients and food to the point at which health is adversely affected. Overnutrition can develop into obesity which increases the risk of serious health conditions including cardiovascular disease, hypertension, cancer, and type-2 diabetes.

Until recently, overnutrition had been viewed as a problem that only affected developed nations. However, this has been reviewed to affect most populations. The prevalence of obesity is increasing in developing countries with the introduction of fast food and refined sugars.

While once considered the disease of the rich, low-income groups in richer countries are also being affected by this condition.

2. What is overnutrition-induced inflammation?

Inflammation is a biological response launched by the immune system against dangerous assaults which threaten the integrity and normal physiology of an organism. Chronic nutrient overload causes an increase in fat tissue (adipose) irregularities in that, if adipose tissue expandability is low, there will be an increased presence of thickened tissue. This would lead to a proinflammatory state that can trigger insulin resistance, release of macrophage chemoattractant proteins, and in chronic inflammation, even the death of the thickened adipose tissue itself. This creates cyclic action that extends the insulin resistance to all adipose tissue.

An important characteristic of overnutrition-induced diseases is chronic low-grade inflammation caused by nutritional excess. Overnutrition-induced inflammation is thought to occur in the brain and thus plays an extensive and steering role in overnutrition-induced diseases.

3. Overnutrition and the Metabolic Syndrome

The metabolic syndrome is a constellation of metabolic risk factors including high cholesterol, elevated blood pressure, insulin resistance and elevated serum glucose, a pro-inflammatory state, and a prothrombotic state.

Most persons with metabolic syndrome are obese and usually have abdominal obesity. Generally, obesity is a reflection of overnutrition. A current view is that when adipose tissue fails to store all excess nutrients as triglycerides, lipids (fats) begin to accumulate in various tissues (e.g., muscle, liver, pancreas, and heart). The foundation of the metabolic syndrome thus appears to be overnutrition – more nutrient intake than can be safely disposed by lipid oxidation.

When obesity is present, adipose tissue becomes inflamed. This inflammation may result in a pro-inflammatory state which could contribute to both cardiovascular disease and diabetes.

4. What is Carbohydrate Overnutrition?

Most evidence supports the concept that fatty acids represent the final common pathway to tissue nutrient overload. Less attention has been given to the possible negative effects of excessive intake of carbohydrates.

Chronic overstimulation of insulin secretion induced by dietary carbohydrates could have the following adverse effects:

  • β-cell function may be impaired by chronic glucotoxicity
  • carbohydrate-induced hyperinsulinemia may suppress muscle insulin sensitivity.

Furthermore, high-carbohydrate intakes can prompt the formation of fatty acids in the liver by way of lipogenesis; fatty acids produced in this way can feed into the final common pathway of ectopic lipid accumulation. There is thus need to look further into the role of carbohydrate overnutrition in the development of the metabolic syndrome.

5. What Factors Contribute to Overnutrition?

Obesity in the United States has reached startling heights. The National Center for Health Statistics at the Centers for Disease Control and Prevention (CDC) estimated that in 2015-2016, the prevalence of obesity in the United States was 39.8% in adults and 18.5% in youth. 

While obvious factors including genetics, drugs, and other medical conditions may contribute to obesity, behavior is perhaps the most common contributor. Healthy weight on an individual level is associated with a healthy diet and regular physical activity. Restaurants serve incredibly caloric meals, with some meals containing as much as 2,000 calories. The sedentary lifestyle practiced by most adds to the epidemic.

Unfortunately, this obesity trend has spread to other nations, including many developing countries. China, for example, now has more than 5,000 Kentucky Fried Chicken (KFC) restaurants in 1,100 cities. Similarly, McDonald’s expects to have 4,500 restaurants in China by 2022, up from 2,500 in 2017. A growing number of Chinese households also own television sets, personal vehicles, and other technologies that reduce physical activity and facilitate weight gain.

It is of note that economic inequality in developing nations is a primary cause of both overnutrition and undernutrition. Studies conducted in India show that income inequality had the same effect on the risk of being overweight as it did on the risk of being underweight; specifically, for each standard deviation increase in income inequality, the odds of being underweight increased by 19% and the odds of being obese increased by 21%. 

While some people have the resources to purchase amounts of food beyond their daily caloric requirements, others cannot meet their recommended caloric intake. However, increasing numbers of poor people are becoming overweight in more nations, as these individuals consume affordable, yet highly caloric meals, such as fast food and processed foods.

6. What Should Be Done to Avoid Overnutrition?

An approach to understanding the effects of overnutrition on the metabolic profile is through overfeeding studies. These indicate that overnutrition produces a deterioration of metabolic status. Variability in individual response is however to be expected. Such investigations are potentially useful for identifying those who are particularly susceptible to the development of metabolic risk factors.

The host of genetic factors likely act at tissue levels to influence the response to nutrient excess. Different people may react differently to accumulation of fat, but overnutrition is generally considered to trigger metabolic disorders and predispose one to chronic conditions like Type 2 Diabetes. When choosing what to eat, one should be careful to ensure they choose balanced meals rich in fiber and nutrients and avoid the modern day fast food craze, as the cost of bad eating is too high.

References

  1. Unite for sight (2018): Module 4: Overnutrition. Retrieved from http://www.uniteforsight.org/hunger/module4
  2. NCBI (2009): From chronic overnutrition to insulin resistance: the role of fat-storing capacity and inflammation. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/19171470
  3. NCBI(2013): Neuroinflammation in Overnutrition-induced Diseases. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4389772/
  4. American Federation for Medical Research (2016): Overnutrition, ectopic lipid and the metabolic syndrome. Retrieved from https://jim.bmj.com/content/jim/64/6/1082.full.pdf
  5. NCBI (2009): From chronic overnutrition to insulin resistance: the role of fat-storing capacity and inflammation. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/19171470

 

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Metabolic signals and innate immune activation in obesity

Important Points:

  • Obesity
  • Inflammation
  • Innate immune activation
  • Non-alcoholic fatty liver disease
  • Infection

Metabolic signals and innate immune activation in obesity

The interplay between immunity, inflammation, and metabolic changes is a growing field of research. Exciting new evidence is emerging with regard to their role in the regulation of metabolism and the activation of inflammatory pathways during the progression of metabolic disorders such as Type 2 Diabetes and Atherosclerosis.

 1. The innate immune system

The innate immune system was made to sense and defend against infection and irritation. It sends signals creating a cascade of action from recognizing a threat of infection or irritation to the right cells which respond with the proper countermeasures. As the front line of defense, the innate immune system must be swift in recognizing these threats in order to establish a barrier that will keep the rest of the body healthy and disease free, and then it must provide a way to release that barrier once the threat has dissipated. When it sends many signals to set up barriers and not enough signals to remove the barriers, chronic inflammation is established. Long-lasting and low-grade chronic inflammation can often lead to Type 2 Diabetes and cardiovascular diseases.

2. How does the innate immune system work?

The innate immune system guards against all threats of infection and irritation even ones it hasn’t seen before including bacterial, viral, and fungal infections or a break in the protective barrier of any organ, especially skin, which causes irritation. Its response is swift, within about four hours, and coordinates the following components:

  • T-cells and B-cells bind antibodies to antigens that have invaded the body
  • Phagocytes essentially “eat” infectious organisms to get rid of them
  • Cytokines kick in with the inflammatory response which may include pain, tenderness, redness and warmth due to increased blood flow, or fever

Once the infection or irritation is contained, the innate immune system will work on its resolution including tissue repair and activation of the process by which antibodies are made; these antibodies will prevent an infection by the same organism later. While much of our understanding of this system comes from what we know about our responses to infection, it is thought that immune responses can also be triggered by internal problems such as inflammation.

3. The Innate Immune Response to Obesity

The increased prevalence of obesity and overweight in adults continues to rise and contributes to disease and death that is estimated to cost $147 billion dollars a year in the U.S. (Finkelstein et al., 2009) and up to 0.6% of the gross domestic product of European countries (Muller-Riemenschneider et al., 2008). More ominous is the high rates of childhood obesity which is a strong predictor of adult obesity (Lee et al., 2009). This has also shifted the prevalence of adult diseases such as type 2 diabetes and pre-diabetes into childhood and has generated new treatment and prevention challenges (Lee, 2006Lee et al., 2006). One study (Skinner et al., 2010) showed an increase in inflammatory bio-markers in obese children as young as 3 years of age. This indicates that many of the origins of obesity-induced inflammation may actually be initiated during childhood. Therefore, many people will face a lifetime threat to health from obesity.

Because the innate immune system is supposed to be relatively short acting, the response to obesity-induced inflammation is hard to compare. Applying the same models may be inaccurate and insufficient to fully explain how the body is affected. Furthermore, it is clear that the inflammation generated by obesity does not require as swift and dedicated a response as those seen in acute infectious settings (Hotamisligil, 2006). These unique challenges have led to the coining of the term “metainflammation” to describe the chronic low-grade inflammatory events that occur in obesity and its associated diseases.

A frequently asked question is why would obesity trigger an immune response? For the most part, this question remains unanswered, but one answer to this may lie in the fact that many of the key regulators of metabolism also play critical roles in regulating inflammatory responses.

4. Inflammation as a link between obesity and disease

The interest in obesity-induced inflammation relates to the understanding that inflammatory mechanisms are aid in the development of diseases found more often in those who are obese such as heart disease.

It is impossible to cover the scope of all of these diseases so we will focus our attention on the inflammatory mechanisms of fatty liver disease and Type 2 Diabetes. This will set the stage for future discussion of the innate immune components activated in obesity. I will highlight both clinical and pre-clinical studies in animal models of obesity that have built our understanding of the mechanisms that drive obesity-associated diseases.

4.1 Non-alcoholic Fatty Liver Disease (NAFLD)

The liver plays a critical role in the regulation of glucose and lipids levels in the blood. Obesity generates changes in the function of the body; glucose production and the breakdown (oxidation) and storage of fats specifically in the liver. Unusual fat accumulation in the liver is connected to many obesity-associated illnesses that include non-alcoholic fatty liver disease (NAFLD) and metabolic syndrome. The metabolic changes that occur with this fat accumulation include insulin resistance propagated by the liver which is related to inflammatory cytokine signals.

4.2 Type 2 Diabetes (T2D)

The regulation of glucose metabolism is securely coordinated from the hypothalamus between nutrients regulated by the liver and gut, the use of these nutrients and storage in muscle and fat, and insulin secreted by the pancreas. The dysregulation of almost all of these processes with obesity is now known to be associated with the activation of innate pro-inflammatory pathways. The net result of this is the rise of systemic insulin resistance and hyperglycemia.

5. Why obesity affects the innate immune system

The blend of a sedentary lifestyle and surplus energy intake has led to an increased occurrence of obesity which constitutes a major risk factor for several diseases including type 2 diabetes and cardiovascular diseases. Intensive research during the last two decades has revealed that one main feature of obesity linking it to insulin resistance is the presence of chronic low-grade inflammation, a result of the innate immune system being activated.

Recent evidence suggests that activation of the innate immune system in the course of obesity starts with an elevation in metabolic signals which sets up a pattern of recognition receptors and leads to stimulation of critical inflammatory signaling cascades which interfere with insulin signaling.

Exercise is one of the main prescribed interventions in obesity management because it helps improve insulin sensitivity and reduce obesity-induced chronic inflammation. A deeper understanding of the effects of exercise on inflammatory signaling pathways in obesity is useful to optimize preventive and therapeutic strategies to combat the increasing incidence of obesity and its related diseases.

References:

  1. Journal of Biological Chemistry (2013): How Metabolism Generates Signals during Innate Immunity and Inflammation. Retrieved fromhttp://www.jbc.org/content/288/32/22893.full.html
  2. Physiological reviews (2018): Innate Immune Signaling and Its Role in Metabolic and Cardiovascular Diseases. Retrieved fromhttps://www.physiology.org/doi/abs/10.1152/physrev.00065.2017
  3. NCBI (2012): Innate Immune Activation in Obesity. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3888776/
  4. NCBI (2015): Metabolic signals and innate immune activation in obesity and exercise. Retrieved from

https://www.ncbi.nlm.nih.gov/pubmed/25825956

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Understanding the role metabolic inflammation plays in obesity and diabesity

Important Points:

  • Inflammation
  • Obesity
  • Diabesity
  • Insulin resistance
  • Adipose tissue

Understanding the role metabolic inflammation plays in obesity and diabesity

Obesity is a disease that has plagued the modern day man in recent time. Access to highly processed foods and decrease in physical activity are key contributors to this ailment. Researchers are hard at work looking into what other underlying factors lead to obesity, especially given its relationship with the onset of Type 2 Diabetes, Cardiovascular diseases, and liver disease. We will take an in-depth look at metabolic inflammation and its role in the onset of obesity. Let’s dive in.

1. What is Obesity?

Obesity is a state in which there is an over-accumulation of subcutaneous and/or abdominal fat (adipose tissue) characterized by a low grade chronic state of inflammation in which the level of pro inflammatory cytokines are increased.  This adipose tissue is no longer considered inert and mainly devoted to storing energy; it is emerging as an active tissue in the regulation of physiological and pathological processes including immunity and inflammation.

  Weight (Pounds) x 703       OR         Weight (Kilograms) 

 
Height (Inches) x Height (Inches)      Height (Meters) x Height (Meters)  

Obesity is diagnosed when your body mass index (BMI) is 30 or higher. To determine your body mass index, use one of these formulas:

BMI =  

BMI Weight status
Below 18.5 Underweight
18.5-24.9 Normal
25.0-29.9 Overweight
30.0 and higher Obesity

For most people, BMI provides a reasonable estimate of body fat. Because BMI doesn’t directly measure body fat, some people such as muscular athletes may have a BMI in the obesity category even though they don’t have excess body fat.

2. What is Diabesity?

‘Diabesity’ is the term for diabetes occurring in the context of obesity. This form of obesity-dependent diabetes has emerged as a major public health problem in recent times. Though it is basically explained by insulin resistance and pancreatic beta cell dysfunction, new patterns have evolved to explain these modifications in the context of the modern rates of obesity and diabetes.

3. Is Obesity an Inflammatory Condition?

The connection between obesity and inflammation has been in debate in the recent past. Unbeknownst to many, the link between these conditions was made decades ago. Over a century ago, high doses of a class of anti-inflammatory compounds including aspirin (salicylates) were used to treat Type 2 diabetes. In some cases, the symptoms of diabetes totally disappeared. Unfortunately, this treatment was discontinued due to the serious side effects caused by the high doses of salicylates.

We will now look at the questions of our topic today in-depth; does obesity cause inflammation, or is inflammation caused by something secondary to obesity such as high blood sugar or triglycerides levels? How about diabesity? Does diabesity cause inflammation, or does inflammation cause diabesity? How and why does the body initiate an inflammatory response to diabesity? Let us tackle each item separately.

4. How Does Inflammation Cause Diabesity?

Listed are some lines of evidence that show inflammation directly causes obesity and diabesity.

  • The development of diabesity has been shown to follow inflammation. Raised levels of inflammatory cytokines predict impending weight gain. In a study, infusion of inflammatory cytokines into healthy, normal weight mice caused insulin resistance. This concept is also illustrated by the fact that people with other chronic inflammatory conditions are at higher risk of developing Type2 Diabetes; for example, about one-third of chronic Hepatitis C patients develop Type 2 diabetes, and those with rheumatoid arthritis are also at higher risk.
  • In obesity, inflammation has been noted to start in the fat cells themselves. As fat mass expands, inflammation increases. One explanation may be that dysfunction of the mitochondria (the “power plant” of our cells) caused by obesity puts increased stress on cellular function. Another mechanism may be oxidative stress. As more glucose is delivered to the fat cells, they produce an excess of reactive oxygen species (ROS) which in turn starts an inflammatory cascade within the cell.
  • Inflammation of the fat tissue causes insulin resistance, which is the primary feature of Type 2 diabetes. TNF-α, a cytokine (small protein) released during the inflammatory response and several other proteins involved with inflammation, such as MCP-1 and C-Reactive protein have been repeatedly shown to cause insulin resistance.
  • Inflammation of the brain (specifically the hypothalamus) causes leptin resistance, which often precedes and accompanies insulin resistance and Type 2 diabetes. Leptin is a hormone that regulates appetite and metabolism this through its effect on the hypothalamus. When the hypothalamus becomes resistant to leptin, glucose and fat metabolisms are impaired and weight gain and insulin resistance result.
  • When there is inflammation of the gut, there arises leptin and insulin resistance. This may occur via an increase in lipopolysaccharide (LPS), an endotoxin produced by Gram-negative bacteria in the gut. LPS has been shown to cause inflammation, insulin resistance in the liver, and weight gain.

5. How  does Diabesity Cause Inflammation?

In the past, fat was considered an inactive tissue with no biological action. It wasn’t considered for much other than storing energy. It has now emerged that fat tissue is a metabolically active endocrine organ that secretes hormones and inflammatory cytokines such as IL-6 and TNF-α. This metabolic activity of fat is the key to understanding its role in diabesity.

6. Why would obesity cause inflammation?

The first theory is that obesity-induced inflammation is a protective mechanism that prevents the body from losing mobility or fitness. Fat storage is an anabolic process, which means it builds up the organs and tissues. Inflammation, on the other hand, is a catabolic process which breaks down organs and tissues. It’s possible that the activation of catabolism via inflammation is the body’s attempt to keep weight within acceptable bounds. Evidence that experimentally induced local inflammation in fat tissue improves insulin resistance and causes weight loss supports this theory.

The second theory is that, obesity-induced inflammation is simply a malfunction that was never selected against in human evolution. Obesity and its related disorders have been extremely rare throughout human history, and have only become common in the past 40 years. The surplus of modern, processed foods that accompanies diabesity is also a relatively new phenomenon. It’s possible that the stresses of obesity are similar enough to the stresses of an infection that the body reacts to obesity in the same way it would to an infection: via inflammation. Supporting this theory is evidence that the same intracellular, inflammatory stress pathways are activated in both obesity and infection.

7. Tackling Inflammation in the control of diabesity

We can therefore conclude that inflammation is both the cause and the result of diabesity. Once obesity and/or insulin resistance have been established, each can further stimulate the production of inflammatory cytokines, forming a vicious cycle of inflammation and diabesity.  

Reduction of inflammation is a major key in preventing and treating diabesity. Focusing exclusively on regulating blood sugar and fat hormones without addressing other potential causes of inflammation is bound to produce inferior results.

 

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Metabolic inflammation as a cause of insulin resistance

Important Points:

Metabolic inflammation as a cause of insulin resistance

In previous articles, I have discussed the role of metabolic Inflammation in obesity and diabetes. Today, we will narrow down to the specifics of what insulin resistance is, its effects, and how metabolic inflammation increases the chances of one developing it.  

1. What is Insulin resistance?

Approximately 30% of Americans, and up to 50% in the 60 years and over bracket, have a silent blood sugar problem known as insulin resistance. It begins when cells in your muscles, body fat, and liver repel or ignore the signal sent out by the hormone insulin to take glucose from bloodstream into our cells for breakdown or storage. Glucose, commonly called blood sugar and is the body’s main source of fuel.

Insulin resistance increases the risk for prediabetes, Type 2 diabetes, and a host of other serious health problems, including heart attacks, strokes and cancer.

2. How does Insulin Resistance Develop?

Some factors that determine insulin resistance are aging and ethnicity, but the driving forces seems to be excess body weight, too much belly fat, a lack of exercise, smoking, and even sleep depravity.

As the insulin resistance develops, more insulin is produced by your body as it tries to fight back. After an accumulated period of time, several years even, the beta cells in your pancreas get worn out because of all the extra work and can no longer keep pace with the increased demand for insulin. Then – years after insulin resistance stealthily began – your blood sugar may spike and you may manifest prediabetes or type 2 diabetes. You are also at risk of developing non-alcoholic fatty liver disease (NAFLD), a condition that increases your risk for liver damage and heart disease.

3. What are the Signs and Symptoms of Insulin Resistance?

Insulin resistance does not always manifest to the naked eye but here are other possible signs that are visible:

  • A large waist. Experts say the best way to tell whether you’re at risk for insulin resistance involves a tape measure and moment of truth in front of the bathroom mirror. A waist that measures 35 inches or more for women, 40 or more for men (31.5 inches for women and 35.5 inches for men if you’re of Southeast Asian, Chinese or Japanese descent) increases the odds of insulin resistance and metabolic syndrome, which is also linked to insulin resistance.
  • Additional signs of metabolic syndrome. According to the National Institutes of Health, in addition to a large waist, if you have three or more of the following, you likely have metabolic syndrome, which creates insulin resistance.
  • High triglycerides. Levels of 150 or higher or taking medication to treat high levels of these blood fats.
  • Low HDLs. Low-density lipoprotein levels below 50 for women and 40 for men or taking medication to raise low high-density lipoprotein (HDL) levels.  
  • High blood pressure. Readings of 130/85 mmHg or higher or taking medication to control high blood pressure
  • High blood sugar. Levels of 100-125 mg/dl (the prediabetes range) or over 125 (diabetes).
  • High fasting blood sugar or you’re on medicine to treat high blood sugar. Mildly high blood sugar may be an early sign of diabetes.
  • Dark skin patches. If insulin resistance is severe, you may have visible skin changes including patches of darkened skin on the back of your neck or on your elbows, knees, knuckles or armpits. This discoloration is called acanthosis nigricans.

4. Chronic low-grade inflammation and the development of insulin resistance

As early as 1950’s, a connection between inflammation and insulin resistance seemed to present especially in the obese, but the mechanics of the link were unknown. Recently, this has become clearer. Research has shown an association between the body activating signal pathways for inflammation over and over and a decrease in insulin sensitivity which is a rise in insulin resistance. Elevated levels of many inflammation signaling molecules (cytokines) and the inflammatory marker C-reactive protein (CRP) were found in those with insulin resistance and its symptoms, especially those that were obese.

5. What Health Conditions are Related to Insulin Resistance?

An estimated 87 million American adults have prediabetes; 30-50% will go on to develop full-blown type 2 diabetes., and up to 80% of people with type 2 diabetes have NAFLD. But those aren’t the only threats posed by insulin resistance.

Thanks to years of high insulin levels followed by an onslaught of cell-damaging high blood sugar, people with insulin resistance, prediabetes, and type 2 diabetes are at high risk for cardiovascular disease. Insulin resistance doubles your risk for heart attack and stroke and triples the odds that your heart attack or ‘brain attack’ will be deadly, according to the International Diabetes Federation.

Meanwhile, insulin resistance and metabolic syndrome are also linked with higher risk for cancers of the bladder, breast, colon, cervix, pancreas, prostate and uterus. The connection: High insulin levels early in insulin resistance seem to fuel the growth of tumors and to suppress the body’s ability to protect itself by killing off malignant cells.

Research has also found a strong association between insulin resistance and memory function decline, increasing the risk for Alzheimer’s disease

Research has also found a strong association between insulin resistance and memory function decline, increasing the risk for Alzheimer’s disease.

6. Can understanding the causes of Insulin Resistance aid in future preventive approaches?

As obesity-associated chronic low-grade inflammation is responsible for the decrease of insulin sensitivity, so obesity is a major risk factor for insulin resistance and related diseases such as type 2 diabetes mellitus and metabolic syndromes. The state of low-grade inflammation is caused by over-nutrition which leads to lipid accumulation in adipocytes and interferes with insulin signaling and action. This interference only adds to the cascade of errors (pathogenesis) that leads to insulin resistance. It has been suggested that specific factors and signaling pathways are often correlated with each other; therefore, both the accumulation and the interference mentioned should be studied further to fully understand the connection between inflammation and insulin resistance.

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What is the relationship between metabolic Inflammation and type 2 diabetes?

Important Points:

  • Inflammation
  • Diabetes
  • Obesity
  • Metabolic syndrome
  • Beta cells

What is the relationship between metabolic Inflammation and type 2 diabetes?

A growing body of data shows that type 2 diabetes is at least in part rooted in inflammation. The higher a person’s body mass index, the more pro-inflammatory macrophages they have in their fat tissue and the higher their chances of developing Type 2 diabetes. In this article, we will highlight the emerging role of inflammation in the pathway that leads to diabetes. We will also analyze the implicated inflammatory pathways and biomarkers of inflammation in diabetes and metabolic diseases.

1. The Metabolic Syndrome and Metabolic Inflammation

Metabolic syndrome often precedes type 2 diabetes and cardiovascular disease and is characterized by high blood pressure, a large waist circumference, elevated fasting glucose and triglycerides, and low HDL cholesterol.

Metabolic inflammation (MI) is currently a hot research topic, wherein peculiarities in metabolic and inflammatory pathways are looked into for their possible contribution to atherosclerosis, Type 2 diabetes, and insulin resistance (IR). In MI, insulin signaling is hindered by obesity-related inflammation. Metabolically activated macrophages are key cells in the process believed to spike both pro- and anti-inflammatory pathways in reaction to excess fat.

Diabetes is a complex metabolic disorder affecting the glucose status of the human body. The main clinical diagnostic features are impaired glucose tolerance and hyperglycaemia which occur as the result of an absolute or relative insulin deficiency or resistance to its action. Chronic hyperglycaemia associated with diabetes can result in end organ dysfunction and failure and may involve the retina, kidneys, nerves, heart and blood vessels. There is a  clinical relationship between diabetes and atherosclerotic cardiovascular disease, with the risk for cardiovascular disease (CVD) being significantly elevated in patients with diabetes.

Typically, CVD occurs one to two decades earlier in people with diabetes, with more aggressive, severe and diffuse distribution.The first WHO global report on diabetes published in 2016 demonstrates that the number of adults living with diabetes has almost quadrupled since 1980 to 422 million adults and this is expected to rise to 552 million by 2030.Effective novel therapeutic approaches are needed for the treatment and/or prevention of diabetes and atherosclerotic disease.

Various proposals and hypotheses have been developed to describe the mechanisms involved in the propagation of diabetes, mainly focusing on Type 2. The increase in prevalence of the condition has been related to well-recognized risk factors, such as the adoption of a western lifestyle, lack of physical activity, and high sugar diet. 

Genetic predisposition, ethnicity, and aging are not modifiable risk factors for Type 2 diabetes, but other factors such as being overweight or obese, an unhealthy diet, insufficient physical activity, and smoking are modifiable through behavioral and environmental changes. However, increasing evidence has shown that inflammatory pathways are common in both the modifiable and non-modifiable factors.

 2. When was inflammation first thought to cause diabetes?

Observational studies provided the first evidence for the possible association between inflammation and diabetes. Over a century ago, the administration of high doses of salt led to decreased blood sugar in people with a suspected or definite diagnosis of diabetes.Later studies on the role of inflammation in diabetes revealed that this hypoglycaemic action was related to the inhibition of an enzyme which is one component in the insulin response pathway.

A landmark study to correlate inflammation with diabetes, conducted in animal models by Hotamisiligil et al. in 1993, revealed that tumor necrosis factor-alpha (TNF-alpha) played a role in obesity and particularly in insulin resistance and diabetes.Causal connections between inflammation and obesity or Type 2 diabetes were made because of these findings. 

Over the next decades, many studies provided more supporting evidence for the role of inflammation in the initiation and progression of diabetes.Accumulative evidence suggests that chronic inflammation in target cells of insulin action may contribute to obesity, insulin resistance, and related metabolic disorders including Type 2 diabetes. 

What is the relationship between Metabolic Disorders and Inflammation in Type 2 Diabetes?

In several studies, our understanding of insulin resistance and insulin secretion in the onset of Type 2 diabetes and its progression has been expanded.Subjects at risk of T2D display an initial state of insulin resistance compensated by hypersecretion of insulin in the beta cells. As it progresses, this shift in pancreatic function is eventually unable to cope with the required insulin secretion, and by the time diabetes is diagnosed, beta cells are no longer able to secrete enough insulin. 

Although the relative contribution of beta cell dysfunction and insulin resistance can vary in people with Type 2 diabetes, it is generally accepted that abnormal insulin sensitivity precedes the clinical diagnosis of diabetes by up to 15 years.Therefore, along with looking into the mechanism of insulin resistance, studies have investigated the pathways leading to beta cell failure.

3. Is there evidence of Inflammation in Other Organs in People with Type 2 Diabetes?

The evidence is inconclusive whether the inflammatory state in Type 2 diabetes can spread to other organs such as the liver, the neural system, and possibly skeletal muscle. More research is needed to determine this.

4. What are the Future Perspectives for the Treatment of Diabetes?

Below are some of the approaches currently being investigated.

  1. Gauging anti-inflammatory diets in streamlining an individual’s microbiome through innovative approaches for Type 2 diabetes
  2. Examining the effects of vitamin D supplementation on serum levels of inflammatory markers through clinical trials; results so far are inconsistent
  3. investigating whether antagonists of leukotriene production enzymes or receptor binding BLT1 have benefits for metabolic and cardiovascular health; results have not been reported yet

5. What is the future of understanding metabolic inflammation as a cause for diabetes?

Given the increasing prevalence of diabetes, it is crucial that research focuses on its prevention as well as its treatment. Heart disease, the metabolic syndrome and type 2 diabetes (T2D) all have a high level of circulatory cytokines as a result of inflammation. Inflammatory cytokines are produced by different cell types and secreted into the circulation, where they regulate different tissues through their local, central, and peripheral action.

An improved understanding of the mechanisms linking inflammation to diabetes and related complications has stimulated interest in targeting inflammatory pathways as part of the strategy to prevent or control diabetes and its complications.

Type 1 diabetes is considered to be more of an immunological response rather than a metabolic disorder and the preliminary results of trials using anti-inflammatory and immunomodulatory medication are promising. These treatments in combination with possible use of stem cells to regenerate pancreatic beta cells could potentially be the key to permanent treatment of Type 1 diabetes. Therefore, after a holistic review of the possible mechanisms that lead to Type 1 and Type 2 diabetes and the numerous already described inflammation pathways that are involved, it becomes more and more clear that future research should focus on simultaneous suppression of various inflammatory response pathways rather than focusing on one pathway at a time.

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Lifestyle Induced Inflammation

Important Points:

  • Inflammation
  • Lifestyle change
  • Healthy diet
  • Refined carbohydrates
  • Trans fats

Lifestyle Induced Inflammation

Inflammation is not entirely a bad thing. When it happens over extended periods, it can trigger diseases such as diabetes, heart disease, and obesity. A number of foods that we eat have been linked to chronic low-grade inflammation, so being aware of them and eliminating them from your diet can help to improve your health and prevent disease.

5 Foods that Trigger Inflammation

1. Artificial Sugars

There are two main types of artificial sugars:

  • Table sugar – sucrose composed of 50% glucose and 50% fructose
  • High-fructose corn syrup (HFCS) – 45% glucose and 55% fructose.

One reason artificial sugars are harmful is that they can increase inflammation which can lead to disease. In one study, mice fed high-sucrose diets developed breast cancer that spread to their lungs, in part due to the inflammatory response to sugar. In another study, the anti-inflammatory impact of omega-3 fatty acids was impaired in mice fed a high-sugar diet.

In yet another study, people were given regular soda, diet soda, milk, or water. Of these, only those in the regular soda group had increased levels of uric acid which causes inflammation and insulin resistance. While the small amounts of fructose in fruits and vegetables are fine, getting large amounts from added sugars is a bad idea. Eating a lot of fructose has been linked to obesity, insulin resistance, diabetes, fatty liver disease, cancer, and chronic kidney disease. Food high in artificial sugar includes candy, soft drinks, cakes, sweet pastries, and certain cereals.

2. Artificial Trans Fats

Artificial trans fats are made by adding hydrogen to unsaturated fats, which are liquid, in order to make them solid. In a solid state they have a longer shelf life. Consequently, manufacturers often use trans fats to extend the shelf life of processed foods such as French fries and other fried fast food, margarine and vegetable shortening, packaged cakes and cookies, pastries, and all processed food with “partially hydrogenated” oils as part of the ingredients.

Artificial trans fats have been shown to cause chronic low-grade inflammation. They lower “good” HDL cholesterol levels and may cause damage to endothelial cells lining arteries which is a risk factor for heart disease.

3. Refined Carbohydrates

Carbohydrates are the source of energy for our cells. However, refined carbohydrates, which have most of the fiber removed, may cause inflammation by creating an environment for the growth of inflammatory microbiota. They may also cause leptin resistance and obesity.

Fiber is essential for promoting satiety and improving blood sugar control. Refined carbs have a higher glycemic index (GI) than unrefined carbs, and foods with a high glycemic index elevate blood sugar rapidly. White bread is an example of refined carbohydrates. In one study, subjects who ate 50 grams of white bread experienced higher blood sugar levels and a spike in inflammatory markers. Refined carbohydrates are found in white bread, pasta, white rice, carbonated drinks, cakes and all processed food that contains added sugar or white flour.

4. Excessive Alcohol

Moderate consumption of alcohol has been associated with cardiovascular benefits, however excessive consumption is likely to cause inflammation and trigger disease. Heavy drinking can also trigger leaky gut syndrome which is a precursor for inflammation and organ damage. Moderate alcohol consumption should not exceed two standard bottles for men and one standard bottle for women.

5. Processed Meat

Excessively processed meats have added compounds such as advanced glycation end products which are harmful to the body. They have been linked with heart disease, diabetes, stomach cancer, and colon cancer. Common types of processed meat include some sausages, bacon, ham, smoked meat, and beef jerky. Advanced glycation products are created by exposing meats to high temperatures during preparation. These products are known to increase oxidant stress and inflammation, and cause inflammation through other mechanisms as well. As a result, it is wise to minimize the consumption of processed meat.

The Bottom Line for Inflammation and Disease

Chronic low-grade inflammation is linked to a number of chronic diseases including cancer, obesity, heart disease, and diabetes. These conditions further contribute to inflammation making it a vicious cycle. It is also evident that lifestyle contributes to this kind of toxic inflammation, and by altering diet and making a few lifestyle changes one can greatly minimize their chances of getting these diseases. It is not enough to just drop these unhealthy foods, but you need to replace them with healthier alternatives. Here is an article about foods that reduce inflammation (hyperlink to the article on managing inflammation with diet).

What happens if you have already been diagnosed with an inflammation-related disease? Do not panic as hope is not lost. By altering your diet, you can claim your health back. Foods that promote insulin sensitivity can help to reverse diabetes and cure obesity. You can also read our article on how to reverse diabetes with diet.

If you are at high risk for lifestyle-related disease there is no shortcut to health and longevity; you just have to take drastic measures to change your diet and lifestyle. A good place to start is by eliminating these toxic foods from your diet.

References

1.   NCBI (2010): The global diabetes epidemic as a consequence of lifestyle-induced low-grade inflammation. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/19890624

2.   NCBI (2015): Differences and similarities in hepatic lipogenesis, gluconeogenesis and oxidative imbalance in mice fed diets rich in fructose or sucrose. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/25905791

3.   NCBI (2014): Trans fatty acids: are its cardiovascular risks fully appreciated? Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/24636816

4.   NCBI (2005): Consumption of trans fatty acids is related to plasma biomarkers of inflammation and endothelial dysfunction. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/15735094

5.   NCBI (2008): High-glycemic index carbohydrate increases nuclear factor-kappaB activation in mononuclear cells of young, lean healthy subjects. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/18469238