We are giving away a copy of The Decision Tree: How to Make Better Choices and Take Control of You Health by Thomas Goetz! Read this excerpt and comment for your chance to win the book!
No Such Thing as Normal
Carol Nelson knew she wasn’t in great health. Years ago, she’d gained 60 pounds during a pregnancy. Now, Carol (her name has been change, but the details of her story are true) found herself stuck at more than 220 pounds. And the weight was just the start of it. She always felt fatigued, and her hands and feet were often swollen. She wasn’t sick so much as just unwell.
Over the years, various specialists (rheumatologists, endocrinologists, internists) had offered various diagnoses (high blood pressure, hypothyroidism, osteoarthritis) and prescribed various medications (levothyroxine, celecoxib). But nothing worked. “I was really at the end of my rope, really thought whatever I had was going to kill me,” she says. “And it would have, had I not found out what the problem was. You can’t fight an enemy when you don’t know who he is.”
The breakthrough came when a new endocrinologist diagnosed her with something called metabolic syndrome. She’d never heard of it. But as she Googled and learned more, her chronic ailments — the weight, the high blood pressure, the lack of energy — started to make sense. They even seemed treatable. Carol went on metformin and rosiglitazone (both of which regulate blood sugar), and she lost 20 pounds by cutting out carbohydrates. And she started to feel less sick. She started to feel better. “Getting a diagnosis was a relief,” she says. “I have hope now, whereas I didn’t have any before.”
Carol Nelson is among the first wave of people to be diagnosed with metabolic syndrome, a condition that, though concretely defined only 8 years ago, is now said to afflict about 25 perfect of American adults. The disease is rife worldwide: In Ireland, 20 percent of adults meet the disease criteria, and in India, an incredible 40 percent of adults could be diagnosed with the syndrome. We sit, indeed, amid an epidemic of metabolic syndrome, a fact all the more remarkable because so few people are familiar with it. For this is no virus on the loose, no plague that has spread unchecked. Rather, metabolic syndrome is just a new way to think about a cluster of well-known and increasingly prevalent conditions. Metabolic syndrome is characterized by five risk factors: high blood pressure, high blood sugar, high triglycerides (fatty acids in the bloodstream), low HDL (“good)) cholesterol, and obesity. Of the five, obesity is the most important, because the rise in the numbers of the morbidly over-weight is directly driving the rise in the syndrome. Metabolic syndrome is, in fact, almost indistinguishable from obesity — at least 85 percent of those who have the syndrome are obese or overweight.
But is it real? In some ways, no. Since it’s a checklist of risk factors rather than symptoms, it stretches the way we think of disease. It’s very much a human invention, a “syndrome” — the term researchers assign to things they don’t quite understand. But in other ways, it’s absolutely real. Though championed by drug companies, it’s also been defined and recognized by legitimate health organizations. And having it is definitely unhealthy. You can’t die of metabolic syndrome, but you can die of what it leads to: diabetes and heart disease.
The ambiguity surrounding metabolic syndrome has made it a controversial diagnosis in the medical community. Critics say that metabolic syndrome lumps together risks we already recognize and monitor. Worse, some say that it’s just a fancy way to describe obesity. By accepting it, they say, we turn a lifestyle problem into a medical problem. After all, the treatment for metabolic syndrome is the same as that for obesity and many other poor-lifestyle conditions: diet and exercise.
The debate surrounding metabolic syndrome is, in many respects, a consequence of the increase in risk-based diagnoses in medicine. These conditions exist not because they are themselves deadly, but because they’re harbingers of worse conditions likely to come later. For people like Carol Nelson, getting a diagnosis of metabolic syndrome might be a useful way to engage with their health, to get serious about it. Doing so is quite clearly based on the principles of using data and acting early. On the other hand, the “emergence” of metabolic syndrome is symptomatic of how disease-centric our health care has become. If we don’t engage with our health until we get sick, well then, maybe it’s best if anybody can be classified as sick. And in that sense, the syndrome assigning seems like a cop-out, a way of giving people a diagnosis simply because their lifestyles have gotten away from them.
Metabolic syndrome, in other words, could be the great disease of our age. Or it could be a sign of how diseased our age is, a demonstration of how certain we are that there is always a scientific explanation, a diagnosis, and perhaps a pill for what ails us. Either way, metabolic syndrome is a disease whose time has come.
Excerpted from The Decision Tree: How to Make Better Choices and Take Control of You Health by Thomas Goetz. Published by Rodale.
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