Medical Files
The specter of the insulin resistance syndrome
By Rafael Castillo, MD
Philippine Daily Inquirer
First Posted 22:12:00 05/02/2008
MANILA, Philippines—Remember insulin resistance which we’ve discussed in our previous columns as a major culprit increasing the risk for cardiovascular disease or CVD? Emerging data indicate it’s much more complex and vicious than just a CVD-risk elevator. It is the unseen specter that we should try to banish from our lives the earliest possible.
New and important evidence shows that Insulin Resistance Syndrome (IRS) can also increase the risk for breathing and sleep disorders, liver disease, Polycystic Ovarian Syndrome, type 2 diabetes, some types of cancers, Alzheimer’s disease and a list of medical conditions.
The list seems to be getting longer and longer each year with scientists and researchers worldwide working double time to try to unravel the mystery behind IRS and offer answers to the many questions about the syndrome.
A dedicated congress
Scientific evidence is accumulating so fast that it requires a dedicated congress to present new scientific evidence. This is the annual World Congress on the Insulin Resistance Syndrome (WCIRS). The 5th congress was held several months ago in Boston, Massachusetts and the 6th one later this year in Los Angeles, California. It is organized by the Metabolic Endocrine Education Foundation, a nonprofit organization dedicated to educating physicians and the public on IRS and other metabolic diseases. It also helps facilitate research in the field.
The WCIRS is a must-attend event for those who are really interested to get to the bottom of this complex problem. It gathers the world’s foremost medical authorities who all have informative lectures to give regarding the wide-reaching complications of the IRS. The various causative factors are discussed thoroughly, and practical pointers on prevention and treatment are offered.
Epidemic proportions
According to Dr. Gerald Reaven, professor of medicine at Stanford School of Medicine, the IRS has reached epidemic proportions. It runs parallel to the obesity epidemic that dramatically increases the risk of developing type 2 diabetes, coronary heart disease, stroke and various cancers. In the United States, it is estimated that IRS affects at least one in three adults. Here in the Philippines, the National Nutrition and Health Survey (NNHeS) showed that one out of five Filipinos may have this dreaded syndrome.
The IRS is called by so many names among which are Metabolic Syndrome, Syndrome X and Reaven Syndrome. Dr. Reaven is credited as the first health expert to sound the alarm in 1988 about this looming and unrecognized peril. Since then, it has received worldwide attention and the research focus it has been appropriately accorded.
Insulin resistance
What causes insulin resistance? It tends to run in families, so genes are partly responsible. Excess calories and fats in the diet lead to increased weight which contributes to insulin resistance because too much fat interferes with the muscles’ ability to use insulin. A sedentary life with practically no exercise further reduces the muscles’ ability to use insulin.
Many people with insulin resistance and high blood glucose have excess weight around the waist, known as abdominal or visceral obesity. Males with a waist circumference or WC more than 36 inches (for Asians) or 40 inches (for Caucasians), and females with WC more than 32 inches (for Asians) and 36 inches (for Caucasians) may be at risk for developing diabetes and the IRS.
There is a lower WC cutoff for Asians because together with African Americans, American Indians, Hispanic Americans or Latinos, and Asian Americans or Pacific islanders, they have a higher risk than Caucasians with WC measurements above these cut-off values.
The earlier one is conscious about the risk of developing the IRS with a gradually increasing belly size, the better for him or her to prevent the dreaded complications of the syndrome.
Except for the abdominal obesity, people who have insulin resistance have no telltale signs or symptoms. According to some experts on IRS, afflicted patients may get dark patches of skin, usually on the back of the neck, and sometimes on the elbows, knees, knuckles and armpits. This condition is called acanthosis nigricans which has also been associated with IRS in some reports.
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