I Wish I Were Far From the Madding Crowd

April 3, 2010

Obesity, HFCS, and fatty liver disease in children (as well as increased heart disease risk)

I personally am very interested in this topic because just over three years ago I had gone in to see my doctor because of abdominal pain.  My triglycerides and LDL were high.  He thought it might be my gallbladder so I went in for an ultrasound, which revealed that I had a fatty liver.

Fatty liver disease has not been considered a children’s disease, so it’s disturbing to read that children and adolescents are developing it, especially since there are usually few symptoms until the disease has progressed to a more advanced stage of steatohepatitis (aka hepatosteatosis) and scarring has already occurred.

According to the American Heart Association, more than 6 million children in the United States are affected.

High Fructose Corn Syrup Linked to Liver Scarring (HealthDay, March 19, 2010)

Reports on a study, “Increased fructose consumption is associated with fibrosis severity in patients with nonalcoholic fatty liver disease,” which found that increased consumption of HFCS led to increased fibrosis (scarring) in patients suffering from NAFLD.

Fatty Liver Disease May Raise Heart Disease Risk in Overweight, Obese Kids (American Heart Association, April 3, 2010)

A fatty liver disease that is not well-known in overweight and obese children may be a precursor of cardiovascular disease, researchers reported in Circulation: Journal of the American Heart Association.

The overweight children with NAFLD had significant cardiovascular risk including higher levels of fasting glucose, insulin, total cholesterol, low-density lipoprotein (LDL, “bad” cholesterol), triglycerides and higher systolic and diastolic blood pressure than the control group.

NAFLD is the most common cause of liver disease in children and is associated with metabolic syndrome, a clustering of risk factors for the development of cardiovascular disease and type 2 diabetes. NAFLD is characterized by the presence of oily droplets of triglycerides in liver cells. More than 6 million children in the United States are affected.

NAFLD in overweight children is strongly associated with metabolic syndrome. The association is independent of both body mass index and insulin sensitivity.

Fatty liver disease often has no outward symptoms, which contributes to it going undetected. Although some children will have symptoms such as abdominal pain or fatigue, the majority remain symptom-free until the disease is in very advanced stages.

American Heart Association Scientific Statement on Metabolic Syndrome in Children and Adolescents (2009)

Since 2003, substantial new information has emerged in children on the clustering of obesity, insulin resistance, inflammation, and other risk factors and their collective role in conveying heightened risk for cardiovascular disease and type 2 diabetes. A constellation of these interrelated cardiovascular risk factors in adults has come to be known as the metabolic syndrome.

The scientific statement covers the following topics:

Selected References

Steinberger J, Daniels SR. Obesity, insulin resistance, diabetes and cardiovascular risk in children: an American Heart Association scientific statement from the Atherosclerosis, Hypertension, and Obesity in the Young Committee (Council on Cardiovascular Disease in the Young) and the Diabetes Committee (Council on Nutrition, Physical Activity, and Metabolism). Circulation. 2003; 107: 1448–1453.[Free Full Text]

Grundy SM, Cleeman JI, Daniels SR, Donato KA, Eckel RH, Franklin BA, Gordon DJ, Krauss RM, Savage PJ, Smith SC, Spertus JA, Costa F. Diagnosis and management of the metabolic syndrome: an American Heart Association/National Heart, Lung, and Blood Institute Scientific Statement [published corrections appear in Circulation. 2005;112:e297 and 2005;112:e298]. Circulation. 2005; 112: 2735–2752.[Free Full Text]

Non-alcoholic fatty liver disease (NAFLD)

Once considered an illness of adults over 40, more and more children are being diagnosed with non-alcoholic fatty liver disease (NAFLD) and non-alcoholic steatohepatitis (NASH).  NAFLD can be a precursor to NASH, which can progress to cirrhosis.

According to Children’s Memorial Hospital in 2005 an estimated 1.6 million children were affected with fatty liver disease

But the American Heart Association now says that 6 million children have NAFLD (see above).

Note: The Children’s Memorial Hospital’s NASH program is a member of the NASH clinical research network.  In 2005, the NASH clinical research network launched a trial for treatment of liver disease in children. The NASH CRN website contains links to related information for patients.  Most of the website, however, is technical and requires an account to access.)

When complications such as cirrhosis cannot be controlled with treatment or when the liver becomes so damaged from scarring that it completely stops functioning, a liver transplant is necessary.

Both NASH and NAFLD are becoming more common, possibly because of the greater number of Americans with obesity. In the past 10 years, the rate of obesity has doubled in adults and tripled in children. Obesity also contributes to diabetes and high blood cholesterol, which can further complicate the health of someone with NASH.  (From the NASH page on the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) website.)

From “Fatty Liver Disease is Common in the US

Source: Spare the exercise, spoil the liver

More information about fatty liver can be found on the American Liver Foundation’s Fatty Liver page and in their Fatty Liver Brochure.

In case you’re wondering what I did after my diagnosis…

At the ultrasound the technician had said, “Your gallbladder is fine, but you have a fatty liver.”  The way she said it made it sound like it was more than just a casual observation, so when I got home I did a quick search on the National Library of Medicine’s website, where I found a lot of information about NAFLD.  (I’m not a teetotaler, but I don’t drink much.)

The progression from NAFLD to NASH to cirrhosis to needing a liver transplant or you die got my attention. Even before I got the formal diagnosis from my doctor I changed my diet (I started eating fish, raisins, and nuts, as well as more fruit, nuts, raisins, whole grains, leafy green vegetables, and fiber (even tried quinoa); and fewer sugar-sweetened drinks) and lots more exercise.  I dropped about twenty pounds in four months and, more importantly, my triglyceride level dropped a lot.

I had relapsed a bit since then, but after viewing Dr. Lustig’s presentation on the effects of fructose (and having done some follow up reading on the topic) I have once again cut back on sugar consumption and have started working out more regularly once more.

If you’re been sort of blasé about fructose you might find yourself changing your mind if you look at the slides on the “Detrimental Effects of Fructose” from a presentation he gave at the National Institute of Environmental Health Sciences (NIEHS) (pp. 15-27, with final slides on p. 27 showing the end result) and look at how fructose metabolized by the liver ultimately results in the creation of lipid droplets (these are what create a “fatty liver”), FFA (free fatty acids) (which help trigger insulin resistance), and triglycerides (TG), resulting in higher blood pressure and inflammation (among other things).

March 21, 2010

Games, cortisol, epigenetics, and behavior

Haven’t really dealt with the digital lifestyle recently (see earlier posts The Virtual Frontier and Impact of technology on kids’ thinking abilities).

The following was thought-provoking:

The Children of Cyberspace: Old Fogies by Their 20s

Also came across the following that struck me as a nice summary of both positive and negative effects of video games (and, by extension, of online games as well).

How Video Games Affect Health (from fat food)

Notes that many negative effects aren’t directly caused by games, but by an excessive amount of time spent playing them.  (Of course, that’s true of many things.)

Still, given the possibility that outside stimulation might actually affect how the brain is wired (see below), I’m certainly going to be a little more cautious.

From Maternal Care Affects Adult Stress (a little dated—though I think I’ve seen something recently about maternal behavior can effect epigenetic changes):

The studies, presented at a [2003] conference on the fetal and infant origins of adult disease, found that baby rats who were licked by their mothers a lot turned out to be less anxious and fearful as adults and produced lower levels of stress hormones than those who were groomed less.

The scientists found that the mothers’ licking caused the baby’s brain to crank up a gene involved in soothing the body in stressful situations.

The rat research was led by Michael Meaney, a professor of medicine at McGill University in Montreal, Canada.

How the mothers’ grooming is thought to have affected their offspring’s behavior:

The brain contains receptors for stress hormones such as cortisol. The more receptors there are, the more sensitive the brain is to cortisol and the easier it is for the brain to tell the adrenal glands when to stop cranking out the hormones. The receptors set the tone for how the body responds to stress.

Meaney found that the rats who were reared with much licking had more cortisol receptors in their brains than the others and he determined why and how. He examined the DNA of about 50 rats who were licked a lot and another 50 who were not.

March 10, 2010

More on cortisol and stress

Came across a couple of blog posts about this topic and thought I’d share.  The author does a more complete job describing the role of cortisol in the body than I did in a previous post.

From Life and Body by Ben: Making the most of life and body
http://slicer30.wordpress.com

Ben’s focus is on the effect of cortisol on the storage of fat.  That’s necessary of course because our bodies need some fat reserves, but we all know that your body can also carry too much fat and that that can have very serious consequences for your health.  And cortisol does have other important functions that it carries out.

As I’ve noted in previous posts I’m very curious about the effects of environmental chemicals on the endocrine system in general and on hormones like cortisol in particular.

Reviewing The Endocrine Disruption Exchange‘s section on Prenatal Origins of Endocrine Disruption (links to each section are included here):

makes me wonder if there’s some sort of domino effect, some sort of cascade.

It’s clear that things like genetics, diet and nutrition, exercise and fitness, and even the stress of modern living all play a part in obesity and general health and well-being.  But having said that, the fact that those do have an effect does not preclude environmental chemicals from having an effect as well.

The problem for scientists and policymakers is that all of these factors are interwoven to some extent.  In The Optimistic Child (1995), a book about “immunizing” children from depression, Martin Seligman writes about an epidemic of depression that started in the late 50s and early 60s.  He notes that depression can have biochemical and genetic causes, then states quite matter of factly that “this epidemic is not biological.”   He states that no biochemical change has been identified that meets the time trends.

He specifically mentions fluoride in the water, ozone-layer breakdown, industrial pollution, and birth control pills as possible contributors to biochemical changes.  Instead, Seligman places the blame squarely on the “self-esteem” movement.  While I think he very well might be right about that having had a major impact, I also think that he was too quick to dismiss the effects of industrial pollution, many of which we weren’t aware of even in 1995.  For example, Our Stolen Future, which documented many of the effects of endocrine disruptors, wasn’t published until 1996.  (We also did not really take into account that children are not just smaller adults, but that childhood is a time when their bodies are growing and changing and that exposure that might not have an effect on an adult, whose body is already grown, might have subtle, yet still damaging consequences for a child.  And recent discoveries in neuroscience seem to indicate that adult brains can, surprise, surprise, still develop neurons.  Perhaps some chemicals are affecting adults’ brains, either directly or indirectly.  Perhaps many mental disorders from anxiety to depression to autism to Alzheimer’s are simply different endpoints on a multi-dimensional “spectrum” of the brain misfunctioning.)

In addition, we now know that drinking water can contain chemicals and byproducts from the drugs and pills people take, household cleaners and soaps (and other consumer products, etc., and we really have no idea how those interact with fluoride and chlorine in water.  (Well, actually, we do know that fluoride and chlorine can react with organic matter in wastewater to form toxic byproducts.)

So here’s are some hypotheses.  Could industrial chemicals have had neurological effects that directly caused an increase in depression (and other mental disorders)?  Could they have affected people’s bodies such that their endocrine systems got out of whack (that, I believe, is the technical term ;-)  )?

Could they have affected the production of cortisol, such that people’s bodies started storing more fat?  Did the resulting imbalance in the endocrine and immune systems start making people more susceptible to stress thereby compounding the problem?  Or are increased cortisol levels the byproduct of some of these processes?  And are some chemicals affecting the ability of the blood-brain barrier to keep certain chemicals out of our brains?

And, going back to Seligman, he argues fairly persuasively (I haven’t finished the book yet), that depression is caused by “learned helplessness.”  Learned helplessness is, according to Seligman, a strong predictor of depression.

Which makes me wonder, what were people’s reactions when Rachel Carson’s Silent Spring was first published in 1962?  You’ve just found out that the world in which you live is being contaminated by chemicals from industrial plants, pesticides, etc.  Wouldn’t you feel rather helpless?  This is not to say that such information should be kept from us.  Without knowing we can’t make informed choices.

Most people would, I think, agree that there’s some connection between mind and brain, between brain and body.

Aside: While looking for info on Silent Spring, I stumbled across the website for the Silent Spring Institute.  The institute’s mission is to identify and break the links between the environment and women’s health, especially breast cancer.

Interestingly, when I checked out the American Cancer Society’s site, there is no obvious link to anything about causes from exposure to chemicals in the environment.  It seems to be primarily about screening, diagnosis, and treatment.  This is not to say that screening and treatment aren’t important, but why not try to reduce or prevent the occurrence of cancer in the first place?  (The cynical answer is, there’s no profit in that.  More on that in another post.)

With respect to the difference between treatment and prevention (whether it be with respect to a disease or pollution), I am reminded of a story I heard—more of a parable really—many years ago.

A tribe that lived along a river.  One day they found a body floating down the river next to their village.  The tribe members were saddened and decided they would respectfully bury the body.  The next week another body floated down the river.  Again they buried the body.  A few days later, another.  And pretty soon they would sometimes find two or more bodies and hardly a day went by that they didn’t find at least one body.  The tribe became very good at building coffins and digging graves, but it never occurred to them that perhaps they should find out why bodies were floating down the river in the first place.

While we do know the causes of many cancers (and for those for which we do know some of the causes doesn’t mean we know all of the causes), we know a lt more than we did just fifteen years ago.  But we just don’t know enough yet to pinpoint the exact causes of all cancers or diseases or disorders.  Well, scientists are researching that, but that’s not something most of us can do.  Do what can we do?  I guess I’d say the take-away lesson of all of this is, do what you can now to get in shape and to reduce stress.

One of the examples of small steps that Robert Maurer describes in One Small Step Can Change Your Life is of a woman who knew she needed to get more exercise and to eat better, but found the idea of committing to half an hour several times a week too overwhelming.  The step he suggested to her that finally got her started on the way to being in shape was that she simply march in front of the television one minute a day.

February 28, 2010

Your brain (and body) and overstimulation

Went skating with my kids yesterday.  This time went much better than the last time I had been skating since I was wearing skates that weren’t too large.  (Actually made it around the rink several times without falling.)

The skating rink we went to has a pinball machine and a couple of old arcade games, which my kids naturally wanted to play.  Being more aware of the possible effects of too much stimulation on the mind (and having at times been sucked into playing such games in my youth), I tend to be somewhat cautious about letting my kids spend too much time playing such things.  Of course, pinball for example shows you that such games have been around a lot longer than the Web.

Games do vary a lot in terms of how intense they are, and there are positive aspects to them (puzzle-solving, developing quick reflexes and better hand-eye coordination), but many games are designed the way they are to be stimulating (and for some people overstimulating).  I don’t know whether this has anything to do with an adrenaline rush, endorphins, or dopamine, but it’s clear that something is going on inside some people’s heads.

As I noted in a previous post, all of us are being exposed to chemicals in the environment.  The Highly Sensitive Person‘s discussion of cortisol got me thinking about the effects of stress on the body and whether or not the stress created by exposure to chemicals could trigger that.  So I decided to look into it and related hormones.

There has been quite a bit in the news over the last several years about “endocrine disruptors.”  Our Stolen Future, a book by Dr. Theo Colborn, Dianne Dumanoski, and John Peterson Myers, was one of the first to bring attention to endocrine disruption and the fact that common contaminants can interfere with the natural signals controlling development of the fetus.  It highlights the fact that modern medical advances are enabling scientists to determine what effect some common contaminants can have on your body’s endocrine system.  A good, basic explanation of the endocrine system can be found on KidsHealth.org and The Hormone Foundation’s website.

The Endocrine Disruption Exchange (TEDX), founded by Dr. Colborn, offers some good background information on endocrine disruptors.  It also contains information on the effects that prenatal exposure to endocrine disruptors can have.

TEDX’s Critical Windows of Development describes how prenatal exposure to certain chemicals could in part cause cancer and other disorders like infertility and diabetes later in life.  The site includes a timeline of how the human body develops in the womb, with animal research showing when low-dose exposure to endocrine disrupting chemicals during development results in altered health outcomes.

If you’re a doubter about all of this, you can also check out the a website maintained by the American Association of Clinical Chemistry.  A table there lists the various endocrine glands, the hormones they produce, and the conditions and diseases associated with their improper function.

The Hormone Foundation lists environmental endocrine disruptors among external factors that can affect the endocrine system, and notes that such chemicals they can affect people and animals in several ways:

  • disrupted sexual development
  • decreased fertility
  • birth defects
  • decreased hatching in animals
  • reduced immune response
  • neurological and behavioral changes, including reduced stress tolerance

Cortisol is a marker for stress, but appears to have many positive effects and is in fact necessary.  It apparently helps the body respond appropriately to stress.  What’s not clear is whether constant production from chronic stress might in turn cause some additional effects.  And what happens when you combine the stress of daily life with the stress of exposure to chemicals?

Some would say there’s no proof that these chemicals cause particular effects, though The Endocrine Society recently came out with a scientific statement on endocrine disruptors.  (They want you to pay $20 for the statement itself, but you can get the basic details from the press release.)

As the president of The Endocrine Society noted:

[W]e present evidence that shows endocrine disruptors have effects on male and female reproduction, breast development and cancer, prostate cancer, neuroendocrinology, thyroid disease, metabolism and obesity, and cardiovascular endocrinology.”

And if you look through the scientific literature you’ll discover that many (if not most) scientists will admit there’s a lot going on with the brain and the endocrine system (and glands like the hypothalamus and pituitary gland that interact with both) that we don’t know much about.  And given how complex the human body is, it’s not surprising that exposure to so many chemicals could cause problems, some obvious, others much more subtle.

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