treating metabolic disease, diabetes, hypertension, high blood pressure

Andy’s Story – Part 1: A Familiar Story Of Escalating Health Problems

In this post I share the real life story of ‘Andy’ who came to me seeking help and answers following the serious deterioration of his health. Andy is not unique, I see many other men in their mid 40s, 50s and 60s who come to me with very similar health problems.

Generally these problems are preventable, all can be diagnosed with the right tests and therefore prevent an escalation of disease, and in many cases these medical conditions can be reversed. Unfortunately for reasons I will go into later, in most cases this doesn’t happen.

Here’s Andy’s story…

A Tale Of 3 Diseases: Diabetes, High Blood Pressure and Acid Reflux

Andy, 52 years old, came to see me as a last resort. He was devastated to have been diagnosed with three medical conditions within just a few months. These were diabetes, high blood pressure and stomach acid disease.

Over the last 7 years Andy had been attending the GP surgery on regular basis. Unlike many people who delay going to the doctor, he presented early with vague symptoms of general tiredness, brain fogs (lack of concentration) and persistent hunger. His doctor kept reassuring him that everything was OK with normal routine blood tests.

However, Andy’s condition progressed over time and he also started to suffer with symptoms of indigestion and heartburn. His GP referred him to the local hospital gastroenterologist who diagnosed acid reflux disease after a camera examination. Andy started on anti-acid pills, with little relief.

A couple of months down the line Andy began to visit the toilet frequently to pass water, and was drinking too much fluid. His fasting blood sugar had been hovering around 6.5 to 6.9 for long time but the very last record came back over 7.0, a level diagnostic of diabetes. He was referred to see the diabetes specialist in the local hospital who started diabetes pills.

Andy kept attending the surgery for blood sugar monitoring, to adjust his medications. His blood pressure was observed running high and therefore he was stared on blood pressure pills and referred to see the specialist in hospital for further action.

Andy was very angry about the rapid deterioration in his health. He couldn’t understand why he should suffer with 3 serious medical conditions while he religiously attended his GP follow up. He is now enrolled as a patient but not sure if there is any hope for disease cure. His biggest fear if he is going to take these pills for the rest of his life.

3 Crucial Questions

Andy attended my clinic to find answers for three genuine questions:

  1. Did his GP miss an opportunity to prevent these diseases happening?
  2. Is there any hint to relate these conditions to a common cause?
  3. Is there any hope for a treatment that could reverse these conditions and reinstate his health?

I thought Andy’s questions were very interesting, and the answers hold the key for preventing this escalation in disease. Hopefully the following information may prevent someone else experiencing Andy’s agony in the future.

The answer in a nutshell:

  • Andy’s early symptoms were due to insulin resistance, this progressed over the years to metabolic syndrome.
  • This explains Andy’s high blood pressure and stomach acid reflux.
  • The metabolic syndrome advanced to full-blown diabetes.

So did Andy’s GP miss something?

I have a lot sympathy with Andy’s GP. I think Andy had received a 5 star service. His GP continued to monitor progress and routine blood tests could not reveal any positive results for the GP to act on. He was also immediately referred to see the specialist in the local hospital when he started to have some serious symptoms.

And this is what the GP surgery is all about! GPs can only use the tests they have at their disposal and they should follow the guidelines set out by the NHS.

Andy’s GP kept monitoring the results of the right test advised on the guidelines, but the wrong test to address Andy’s ambitions!

Testing blood glucose is always going to be normal in a case of insulin resistance (see the recent blog). As your cells become numb to the action of insulin, your pancreas compensates by producing more insulin. Therefore raised insulin would be the first marker of the disease and the right test if you intend to prevent high blood pressure and diabetes.

Unfortunately insulin testing is not available within the NHS and even if the GP were told of a high insulin level, their guidelines do not give information on what to do to resolve the issue. The GP system is focused on treating symptoms – for example, prescribe pills to lower high blood pressure or high blood sugar – but not to deal with underlying causes or to prevent diseases.

GPs are very dedicated to treat diseases but are not trained to offer prevention. Short consultation times simply do not allow enough time for a detailed and holistic approach required for prevention.

You might wonder if there were any clinical signs that would have helped the GP diagnose Andy’s condition earlier?

The answer is ‘yes’ but unfortunately doctors are just not taught or encouraged to look for them.

Metabolic syndrome is the underlying problem, the core problem, but have you ever heard of anyone being given a diagnosis of metabolic syndrome? Whilst this serious condition gives birth to most other chronic diseases including cancer, it is seriously under diagnosed.

Metabolic syndrome affects 40% of adults in the US and 30% in Europe!

With an early diagnosis of metabolic syndrome, Andy would have been the perfect candidate for prevention. In fact metabolic syndrome itself could have been prevented if the signs of insulin resistance had been identified.

Have You Got Metabolic Syndrome?

It is easy to know if you have metabolic syndrome, just from your general appearance. A potbelly or accumulation of fat in your tummy is the first sign. This gives you an “apple shape” in comparison to fat accumulation around the hip that gives a “pear shape”.

A French physician known Jane Vague made this simple observation in 1947. She found that accumulation of fat around the internal organs is associated with diabetes and heart disease while around the hips it protects against disease.

Andy’s records were very interesting: his body weight was 72 kg and his height was 176cm, this gave him a normal BMI (body mass index) of 23. If you stop at this level you would say Andy is normal. You have to take it one step further to discover the abnormality.

Andy is a TOFI (Thin from Outside, Fat from Inside) since his WC (Waist Circumference) was 42 inches – any record above 40 inches is associated with disease – and his WH (Waist Hip) ratio was 1.0: 0.9 is the upper limit for men.

A potbelly is not enough to label Andy as having metabolic syndrome: a cluster of risk factors that also include high blood pressure, blood sugar and LDL but low HDL (the last 2 are types of fats in your blood). You need 3 factors out of 5 to qualify for the full syndrome.

So was there a common cause linking Andy’s health problems?

Andy’s disease started with insulin resistance: glucose not gaining access to his cells and hence being diverted to be stored as fat. This put too much pressure on Andy’s liver to work overtime to handle excess fat excreted as bile. The gall bladder pushes a huge amount of bile as sludge into the small intestine. This refluxed backwards to burn his stomach and duodenum

So reflux of bile into stomach was the cause of Andy’s indigestion and heartburn is part of the metabolic syndrome. Andy was started on anti-acid pills despite having a normal camera test.

The sequence of events confirms that Andy’s early symptoms were a genuine warning sign and a call for urgent prevention. Unfortunately this did not happen and Andy was left to suffer three serious medical conditions: hypertension, diabetes and stomach acid disease.

As I said earlier, Andy’s story is not unique. This is a common scenario of early signs not sounding the alarm bells because of lack of awareness and appropriate testing. Like many others, Andy was on a daily routine of monitoring his blood sugar with a finger prick, and taking 5 pills a day for his conditions.

But this is not the end of the story.

Andy’s second question to me was how to find the core problem we will cover in Part 2. We will look at how to resolve the problem and reverse Andy’s medical conditions to reclaim his health? I will cover this part of the story in Part 3.

 

For more on metabolic syndrome click here.

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