|
||||||
|
|
|
|
|||||||||||
|
|||||||||||||
| ||||||||||||||||||||||||||||||||||||
More than 2 decades ago, when I was a teaching nurse at the Joslin DiabetesCenter in Boston, there was a saying regarding type 2 diabetes:"Heredity loads the gun, but stress pulls thetrigger."
At that time, we thought stressors could be defined and recognized asoccurrences or entities—such as illness, trauma, obesity, or severepsychological stress—that created a turning point in glucose metabolism,reducing the ability of the body to adequately use or produce insulin. Today,this would be a simplistic approach to what we know is a complicated diseaseprocess.
There is still truth in the saying. Obesity does promote the onset of type2 diabetes, and illness or trauma can cause hyperglycemia in at-riskpopulations. However, as science moves forward, stressors may be much moredifficult to define and to recognize. They often appear innocuous or are somuch a part of our lives that we do not recognize them and the risks theyrepresent.
THE DEVIL'S IN THE TRANS FATS
An article in the April 13 issue of the New England Journal ofMedicine, "Trans Fatty Acids and Cardiovascular Disease,"reviews the effects that occur on the physiological and cellular levels withthe routine consumption of trans fattyacids.1 These fatscontribute to the growing epidemic of obesity in this country and, moreimportant, are directly linked to the increased risk of coronary heartdisease, sudden death from cardiac causes, and diabetes.
Trans fatty acids affect lipid control by raising the level of LDLcholesterol and reducing its particle size, lowering HDL cholesterol, andincreasing the total cholesterol-to-HDL ratio, a predictor of cardiac disease.Blood triglyceride levels increase more with trans fats than with any othertype of ingested fat. As if that is not enough, trans fats increase thesystemic inflammatory response.
Studies have shown that trans fats increase the activity of the tumornecrosis factor system and increase levels of interleukin-6 and C-reactiveprotein. Although not conclusive, initial studies have demonstrated thatimpairment of endothelial function and alterations in nitric oxide functionoccur in subjects who consume average amounts of trans fatty acids (2–3%of total calories consumed). All of these physiological alterations areharbingers of cardiac disease.
In the U.S., trans fats abound in fast foods such as french fries, bakedgoods, microwave popcorn, granola bars, margarine, crackers, peanut butter,and many other foods that the average American eats on a daily basis without agreat deal of thought. The super-sized portions of fast foods far surpass thedaily recommendation for consumption of dietary trans fats, which the DietaryGuidelines Advisory Committee suggests be kept below 1% of total energyintake.2 Add anextra-large high-fructose corn syrup soft drink to the fast food meal, and theresult is the American "to die for" dinner. Literally.
The Food and Drug Administration (FDA) has mandated that foods containing>500 mg of trans fats must list the total amount of trans fats on thelabel. If the food contains <500 mg, it can be listed as "0 g transfats." While this may be helpful to some consumers, most are not awareof the recommended limit on the daily consumption of trans fats. A secondconcern is that label-reading consumers who feel they are safe eating foodslabeled as having zero trans fats but actually falling just below the 500 mglimit will consume many more trans fats than they intend. The listing of transfats on the food label may be helpful in theory, but how it affectsconsumption remains to be seen.
INSIDIOUS INVISIBLE HEALTH STRESSORS
Dietary trans fat is only one example of the stressors faced in modernsociety—those practices that "pull the trigger" thatinitiates health deterioration. Unlike the visible stressors of illness,infection, and obesity, these are invisible stressors that contribute todisease in a stealth-like manner, one day, one meal at a time. The invisiblestressors can be part of the so-called conveniences of life that become moreingrained in our daily routine as workdays lengthen and time spent insedentary activity increases.
The presence of invisible stressors is reflected in the ever-increasingincidence of diabetes, obesity, and cardiovascular disease. The epidemic ofthese chronic diseases becomes more visible, particularly in the children ofthe nation, who are most vulnerable to the consequences. In many instances,health care providers narrow their focus to what seems to be a manageableapproach. Addressing individuals' disease-causing stressors and assisting themto adopt a healthier lifestyle certainly has far-reaching benefits. However,the societal support for maintaining healthy changes seems to be lacking. Thusfar, federal legislation and FDA mandates have not been able to make thechanges desperately needed to reduce the invisible stressors that prove sodeadly.
Denmark was able to pass laws that greatly reduce trans fatty acids byessentially eliminating the use of partially hydrogenated vegetable oils. Thiswas accomplished without substantially affecting the quality, cost, oravailability of food. This mandate extended to fast foods as well. Throughthis legislation, the Danes have nearly eliminated trans fatty acids in thesame fast foods that, in the U.S., have 5–10 g of trans fatty acids.Societal changes of this magnitude are possible when the risks to health andwell-being posed by these invisible stressors are taken seriously.
All health providers, particularly those involved in the care oflifestyle-related chronic diseases, must become public health advocates. Wemust make our agenda clear: widespread availability of heart-healthy foods,opportunities in all communities for physical activity, reforms that mandatephysical education in schools, and new nutritional regulations to reducesubstances known to increase cardiac health risks.
"Heredity loads the gun, and stress pulls the trigger."Although helping individuals dodge the bullet may be possible, wouldn't it bebetter to disarm the gun? 
Footnotes
|
References
2. Department of Agriculture Dietary Guidelines Advisory Committee:Nutrition and your health: Dietary guidelines for Americans: 2005 DietaryGuidelines Advisory Committee report. Available online atwww.health.gov/dietaryguidelines/dga2005/report/.Accessed May 2, 2006.
CiteULike 
Del.icio.us 
Digg 
Reddit 
Technorati What's this?
Read all eLetters
| ||||||||||||||||||||||||||||||||||||
|
||||||
|
| DOC News | Diabetes | Diabetes Care | Clinical Diabetes | Diabetes Spectrum |
