Teenagers think they know it all, think they can do it all, and think they’re going to live forever. But what good is immortality if you’re achy, breaky and breathless?
Unfortunately, it’s a question too many teens have to face, as the triple threat of diabetes, obesity, and asthma increasingly compromises the wellbeing of our nation’s adolescents.
A recent cross-sectional study to be published in the Journal of Allergy and Clinical Immunology, shows a strong link between insulin resistance and poor pulmonary function in a large cohort of adolescents. The correlation held for kids with asthma and, alarmingly, also in those without the disease.
Erick Forno, MD, MPH, and colleagues at the Children's Hospital of Pittsburgh quantified lung function in 1,429 adolescents with and without asthma who were enrolled in the 2007 to 2010 National Health and Nutrition Examination Survey. Ninety-five of the kids, who ranged in age 12 to 17 years, had asthma.
Investigators sought to assess the association between obesity, insulin sensitivity, metabolic syndrome and pulmonary function. The study did not control for diet or family history of diabetes.
The data showed a strong correlation between insulin resistance/metabolic syndrome and worsened lung function, particularly among the obese adolescents. The effect of metabolic syndrome was worse among those with asthma.
Dr. Forno notes that, “among adolescents with and without asthma, we found that insulin resistance is associated with decreased FEV1 and FVC values and that [metabolic syndrome] is associated with lower FEV1/FVC ratios.”
Researchers found that lung function (2% to 10% decrease in FEV1/FVC) was significantly worse among adolescents with insulin resistance and metabolic syndrome.
In particular, metabolic syndrome was associated with a 2% decrease in FEV1/FVC. Asthma alone was linked to a 6% reduction in lung function, and the combination of metabolic syndrome and asthma was associated with a 10% decrease. The correlation between metabolic syndrome and compromised respiratory function remained significant after controlling for other factors, including BMI and waist circumference.
Limitations of the study include the number of participants with asthma and how metabolic syndrome was defined. “The definition we used had less stringent criteria and thus allowed us to classify more subjects as having metabolic syndrome,” the authors note.
Teens were classified as having metabolic syndrome if they met three of five criteria: fasting glucose levels of 110 mg/dL or higher; waist circumference in the 75th percentile or higher; fasting triglyceride levels of 100 mg/dL or higher; high-density lipoprotein levels of 50 mg/dL or lower; and systolic blood pressure in the 90th percentile or higher. (Forno E, et al. J Allergy Clin Immunol. 2015: Mar 3, epub ahead of print).
Arguments about inclusion criteria aside, the main point here is that insulin resistance, obesity, and asthma are “kissing cousins” from a pathophysiologic point of view.
Deadly Kissing Cousins
Unfortunately, they can spell the kiss of premature death and a lifetime of morbidity for all too many teenagers.
Over the past 30 years, obesity has more than doubled among children and quadrupled among adolescents, according to the Centers for Disease Control and Prevention. Asthma has shown a similar surge in incidence. While they are often treated as distinct disease entities, they are clearly related, as the Forno study illustrates.
A number of factors are responsible for the rapidly rising number of obese youngsters, including poor food quality, too much time spent indoors, increased screen exposure and intense stress.
Conventional medicine can treat the symptoms of this epidemic, but as holistic practitioners we have a responsibility to delve deeper.
Asthma appears to be aggravated by metabolic syndrome and insulin resistance, and the presence of asthma—especially if not properly treated—predisposes already sedentary kids to avoid exercise and exertion, which only exacerbates the metabolic dysregulation.
It’s a classic vicious cycle!
The common factor here is systemic inflammation. In all three of these conditions—insulin resistance, obesity and asthma—patients show a generalized proinflammatory state. Insulin resistance and the concomitant elevated blood glucose levels create a feed-forward cycle of further inflammation.
Hyperinsulinemia shifts cells toward a TH2-type inflammatory response, which directly affects the lung. Insulin and insulin-like growth factor are linked to lung development and function.
Insulin is a fat-storage hormone responsible for weight gain. Fat cells produce highly inflammatory cytokines called adipocytokines (or adipokines) which include leptin, adiponectin, resistin, visfatin, as well as cytokines like IL-1, IL-6, and tumor necrosis factor alpha). The released adipokines lead to an inflammatory cascade, which drives insulin resistance, obesity-associated cardiovascular disease, and Type 2 diabetes.
These inflammatory signals also aggravate many other chronic diseases, including asthma.
People with obesity-associated asthma show abnormalities in proinflammatory mediators marked by neutrophilic airway inflammation, corticosteroid resistance and increased morbidity, all of which make the asthma more difficult to control and treat.
Leptin levels have been linked to the development and severity of asthma regardless of a person’s body mass index, and to increased systemic inflammation, even among non-obese patients. Insulin resistance may affect lung function through insulin growth factor 1, adiponectin or leptin. (Wood LG, et al. Am J Resp Crit Care Med. 2012;186: 1-2).
All of this leads to rapid and premature aging (so much for that infamous teenage immortality!), and opens the door to heart disease, stroke, dementia and cancer. In light of all these physiological realities, Forno’s findings are not entirely surprising, though they are no less disturbing for being predictable.
The Answer? Education
What can we, as concerned practitoners, do to help reverse the deadly tide threatening so many of our young peope?
Educate, educate, educate! Parents are not actively sabotaging their children’s health, and most kids don’t realize how their lifestyle choices and bad habits are setting them up for a lifetime of dependence on doctors and drugs. Yet the vast majority of the risk factors driving the epidemics of insulin resistance, obesity and asthma are related to diet and lifestyle choices---things over which people really do have some control.
- Let’s monitor nutrient and vitamin levels. Deficiencies play a large role in the irresistible cravings for precisely the kinds of foods that boost inflammation. It’s important to monitor patients’ nutrient levels, especially vitamin D and omega 3 fats, which help control insulin function.
- Let’s emphasize the importance of a healthy diet that: Limits and/or eliminates foods that cause an increase in insulin response, such as processed carbohydrates, starchy and sugary foods; Increases the amount of vegetables, healthy fats and protein at each meal, which is great at regulating blood sugar levels, insulin balance and hunger control; Avoids any food within three hours of bedtime, since a boost in insulin before sleep leads to belly fatLimits food allergens—especially gluten and dairy-- that lead to inflammation and chronic disease.
- Let’s teach our patients how to effectively manage stress, which is extremely important in disease prevention and treatment. Some recommendations include:Daily relaxation practices like deep-breathing exercises, meditation and other relaxation techniques;Getting seven to eight hours of sleep, as insomnia affects appetite hormones and drives up sugar and carbohydrate cravings.
- Let’s coach them on getting out and moving around. Exercise is super- important at all ages, but is especially crucial for growing bodies. It increases oxygen uptake and blood flow to all areas of the body, and helps regulate appetite.
Addressing the obesity and asthma epidemics will require step-by-step lifestyle changes. But the simple techniques above are powerful in preventing mortality, morbidity and improving quality of life.
It may not give immortality (sorry, kids), but will give something so much more — joie de vivre!
Madiha Saeed, MD, is a holistic family medicine physician in Aurora, IL. She received her MD from National University of Science and Technology and completed her residency in 2010 at St. Joseph Regional Medical Center. She is currently board certified in Family Medicine and is board certified in Integrative Holistic Medicine. The Society of Teachers of Family Medicine awarded her the Resident Teacher Award in June, 2010. Dr. Saeed also has a diploma in clinical homeopathy.