Luke Curtis MD MS CIH
December 31, 2009
The US is now facing concerns about the H1N1 flu epidemic. In 2009, about 10,000 US citizens have died of this flu- including about 1,000 children. Much of the world has been severely affected by the AIDS/HIV epidemic over the past 29 years. However, 3 more prevalent epidemics facing the US and other developed nations include the interrelated problems of obesity, type 2 diabetes and mold related health problems.
The number of heavy people in the USA has grown rapidly in the past 20 years. For example, in 1990 only 13% of the adult USA population was considered to be obese, while by 2005 that number had doubled to about 26% (Source Centers for Disease Control 2009 available at www.cdc.nccdphp/dnpa/obesity/trend/maps/index.htm). Those with a body mass index (BMI) of over 30 are considered obese (please see below for explanation of BMI). About 6% of US adults are severely or morbidly obese (BMI of 40) and over 1% have a BMI of over 50. Obesity has also been growing in children and teenagers- with about 17% of children aged 6 to 19 years having a BMI of 30 or greater.
Obesity can be measured a number of ways. The most common way to determine obesity is the body mass index or BMI. Body mass in kilograms (1 kilogram= 2.2 pounds) is divided by the square of a person’s height in meters (1 meter= 39.3 inches). A “normal” BMI is from 18.5 to 25. A BMI of below 18.5 is considered underweight, a BMI between 25 and 30 is considered overweight, 30 to 35 is called mildly obese, 35 to 40 moderately obese and over 40 is considered seriously or morbidly obese. A BMI of 40 would be equivalent to 235 pounds in a person 5’4” tall and 280 pounds in a person 5’10”. To calculate BMI from height in pounds and height in feet and inches please see http://www.nhlbisupport.com/bmi/.
A more accurate way of determining obesity or excessive fat is to determine body fat percentage. Body fat can be determined in a number of ways including by measuring skin fat thickness and by weighing a person in water. Men should aim for 10-25% total body fat, women should be in the 15-30% range.
Muscular people can be in the overweight or mildly obese category and still be quite lean. In 2004, both candidates for US president, George Bush and John Kerry were in the overweight category, yet both were physically active and appeared quite lean, with low body fat percentages.
Obesity increases risk of many chronic diseases like heart disease, stroke, diabetes, eye problems, some forms of cancer, sleep apnea, depression and joint problems.
Why the recent rise in obesity in the USA? Genetic issues are believed to play some role in obesity. For example, some obese animals and humans have a genetic deficiency in the hormone leptin. Leptin is produced in the hypothalamus and signals the body to stop eating. A leptin deficiency can cause obesity.
While genetics plays some role in obesity- the biggest reason for the recent obesity surge is the current environment which discourages exercise and encourages consumption of diets rich in fat and refined sugars. The per person consumption of sugars (including cane/beet sugar and corn syrup) in the US is now over 142 pounds per year, up 19% since 1970 (Dietary Assessment of Major Trends in US Food Consumption, 1970-2005 by Hodan Wells & Jean Busby available at http://www.ers.usda.gov/Publications/EIB33/EIB33.pdf). Many of these added sugars are found in soft drinks, sports drinks, heavily sweetened coffee and other beverages. The size of bagels has increased from 2 to 3 ounces in the 1970’s to 4 to 6 ounces today. Restaurant meals are also getting larger. For example, the McDonald’s Value Meal of a Big Mac Hamburger, Large Fries and large Coke provides 1,350 calories, which is a lot of calories for a person who is not physically active. (Source http://nutrition.mcdonalds.com/nutritionexchange/nutrition_facts.html).
Physical activity has also been reduced in recent years as fewer people have physically demanding jobs and fewer people walk or bicycle to school/work/shopping/worship. The physical environment of many new towns and suburbs discourages walking and bicycling. Many new housing developments have no sidewalks or street lights, and funnel traffic into high speed, high traffic arterial roads which discourage walking and bicycling. Also, most children today are driven to school by their parents or a school bus. When I attended a Chicago kindergarten in 1964, I walked 1 mile each way to school and many of my rural contemporaries walked several miles each day to school.
The incidence of type 2 diabetes is also on the rise. The US incidence of type 2 diabetes is about 10% in adults and 0.5% in teens (2007 Diabetes Statistics- available at (http://diabetes.niddk.nih.gov/DM/PUBS/statistics/#allages). The incidence of diabetes was only about 6% in adults in the 1980’s. The development of type 2 diabetes is linked most strongly to obesity, lack of physical activity and consumption of a diet high in sugars and fats. Lack of fiber in the diet can also increase risk of diabetes. Although type 2 diabetes is typically seen in adults- more and more teenagers are developing type 2 diabetes- especially if they are overweight. The author has treated several teenagers with type 2 diabetes.
Uncontrolled diabetes can cause many health problems including increased risk for heart attacks and stroke, high blood pressure (hypertension), reducing immunity to infection, poorer wound healing, eye problems leading to blindness, depression, Candida (yeast) infections and male erectile dysfunction.
How can obesity and type 2 diabetes be prevented and treated? The cornerstone of prevention of obesity and type 2 diabetes is a well balanced diet. The daily diet should provide at least 5 half cup servings of fruits and vegetables, preferably prepared without added fats and sugars. Alcohol and refined sugars, such as cane sugar, corn syrup and honey, should be avoided. Refined grains, like white flour and white rice, should also be avoided.
A number of studies have reported that taking 200 micrograms daily of supplemental chromium is useful for controlling diabetes (Canadian Family Physician 2009;55(6):591-6). Chromium is often deficient in diets and is needed to make a protein called glucose tolerance factor which helps to control diabetes. Some, but not all, studies have reported that diets high in fiber are useful for controlling both excess weight and diabetes (Canadian Family Physician 2009;55(6):591-6).
Doug Kaufmann’s Phase diets are excellent for battling both obesity and diabetes. The diet plans suggested by the late William Crook M.D. (The Yeast Connection) are also very good for battling both obesity and diabetes. A well balanced vitamin/mineral supplement containing calcium, magnesium, zinc, chromium and b-vitamins is also a good idea for diabetics.
Exercise is useful for battling both obesity and type 2 diabetes. Be sure to pick an activity you enjoy such as walking/jogging, bicycling, swimming, dancing, exercise class, weight lifting, golf, tennis, gardening/yard work or even vigorous play with children/grandchildren/dogs. Having an exercise partner or joining a walking, biking, dance or exercise group is often helpful for people needing to lose weight. Many people exercise regularly with a dog, spouse, boyfriend/girlfriend, sibling, parent, child, neighbor or coworker.
To lose weight, try to exercise at least 1 hour at a time at least 3-5 times per week. To burn the maximum number of calories, it is better to exercise longer at a moderate pace that exercise intensively for short periods. For example, it is best to walk, jog, bike, stationary bike, or swim at a moderate pace for a half hour to hour or so than to run, bike or swim all out for a few minutes at a time and then become quickly exhausted.
Slow weight loss is best, it is best not lose more than 1 or 2 pounds of weight per week. Faster weight loss often leads to health problems such as chronic fatigue, weakness, depression, constipation and increase susceptibility to illness. Near starvation diets lower a person’s metabolic rate as the body tries to save energy and go into a famine mode. Following a starvation diet, persons tend to regain weight quickly since their metabolism has been lowered by a too low calorie diet (Sports Medicine 1990;10(2):72-87).
People should aim for a reasonable weight. Many people are healthy in the “overweight” BMI range of 25-30 kg/meter2. Some studies with the elderly have reported that the longest life spans and lowest infection and death rates occur in seniors in the “overweight” BMI range of 25 to 30 (Journal of Nutrition in Health and Aging 2008;12(7):487-91).
Mold related health problems have also been increasing in recent years. Problems with indoor mold or moisture growth have triggered recent increases in mold related asthma and sinus problems. Keeping homes with relative humidity below 60% (with air conditioners and dehumidifiers) and immediately fixing any mold or water damage in the house can do much to prevent the development of mold related asthma and sinus problems.
Although research data is rather sparse, many medical researchers also believe Candida related health problems are on the rise in the USA . Candida is a yeast (fungus) which commonly grows in the intestines of humans. The use of a high sugar diet, obesity, diabetes, frequent antibiotics and the use of steroids and birth control pills all encourage overgrowth of Candida. Intestinal Candida overgrowth can also spread to the skin, mouth and sexual/urinary organs like the vagina, penis and bladder.
As with obesity and diabetes, a well balanced diet such as with plenty of lean protein foods/vegetables and low in sugar, yeast and refined grains is helpful in fighting yeast problems. Many people have found Doug Kaufmann’s phase diets helpful in battling yeast problems. Use of probiotic bacteria from yogurt or capsules containing Lactobacillus or Acidophilus are also useful in battling yeast problems (Journal of Antimicrobial Chemotherapy 2006;58(2):266-72). The use of antibiotics should be avoided unless absolutely necessary. Those with severe Candida problems may need medical attention and anti-fungal drugs, like Diflucan (fluconazole), to get their Candida overgrowth under control.
Infections of such molds (fungi) as Candida, Aspergillus, Fusarium and many other molds can cause life-threatening infections in many people with immunocompromised immune systems. Such infections have been increasing greatly in recent years (Transplantation and Infectious Diseases 2000;2:22-28.). As many as 5 to 15% of all bone marrow transplant patients die of infections from Aspergillus and other molds.
Immunocompromised patients include those with HIV/AIDS, on immune suppressing drugs following bone or organ transplants, or those with certain forms of cancer like lymphoma or leukemia. Immunocompromised patients need to be kept in a clean and dry indoor environment with air filtration from a HEPA (High Efficiency Particulate Air) or similar filter to remove most airborne bacterial and mold spores. Several studies have reported that use of HEPA filters can reduce mold infection and death rates in those undergoing bone or organ transplants (Journal of Infectious Diseases 2006;193:1408-18). Immunocompromised people should also not live/work in buildings with water damage, wet carpets or obvious mold growth.
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