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respective specialist physicians.\u00a0 I remember well the subject-by-subject advancement through each unit, with the pathophysiology being coordinated with the supporting pathology and pharmacology relevant to the topic at hand.\u00a0 For example, we would spend several days on a topic like Hypertension (elevated blood pressure), learning a plethora of details relevant to that diagnosis, then hard-stop and move on to the next topic, e.g. Ischemic Heart Disease.\u00a0 Each \u201cdisease\u201d was treated as an island, or a silo, effectively a unique disease process that had its own risk factors and unique treatments.<\/p>\nRedundant Diagnoses<\/h3>\n
Fast forward to 8-9 years ago when I finally recognized that our modern convention of labeling diseases was misleading.\u00a0 Working in the hospital setting, I recognized a pattern among the majority of my patients carrying largely the same diagnoses, to the point almost of being able to \u201crubber stamp\u201d charts with a cluster of diagnoses from among the following:<\/p>\n
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<\/p>\n
- \n
- Obesity<\/li>\n
- Hypertension<\/li>\n
- Type 2 diabetes<\/li>\n
- Dyslipidemia (abnormal lipids)<\/li>\n
- Obstructive Sleep Apnea<\/li>\n
- Fatty Liver<\/li>\n
- Coronary Artery Disease (CAD)<\/li>\n
- Peripheral Arterial Disease (PAD)<\/li>\n
- Stroke (cerebrovascular disease)<\/li>\n
- Anxiety\/Depression<\/li>\n
- Erectile Dysfunction<\/li>\n<\/ul>\n
<\/p>\n
Why is it that nearly every patient with diabetes and obesity also has hypertension?\u00a0 And fatty liver . . . and dyslipidemia.\u00a0 And why does every patient with heart disease, stroke, or erectile dysfunction also have hypertension?<\/p>\n
Do these patients really have 10+ different diseases?\u00a0 Of course not.<\/p>\n
A Unifying Disease Process<\/h3>\n
The reason for the grouping of these conditions is that all of these diagnoses are driven by the same disease process \u2013 Insulin Resistance. \u00a0We are so fixated on each individual medical problem existing on its own as a separate entity that we struggle to see that they\u2019re just different symptoms of the same metabolic disease.<\/p>\n
In fact, the diagnosis of Metabolic Syndrome<\/a> is, by definition, a combination of these conditions \u2013 elevated blood pressure, elevated fasting glucose, abdominal obesity, and abnormal lipids.\u00a0 As of 2014, the incidence of Metabolic Syndrome<\/a> was 32.3% (and increasing) among adults in the United States.\u00a0 Thus, nearly 1\/3 of US adults have at least 3 of these conditions.\u00a0 Why, then, would we think that each one is a different disease process?!?<\/p>\n
The common thread among these conditions is that they are all driven by Insulin Resistance, and addressing the Insulin Resistance results in improvement in all of these manifestations.\u00a0 Occam\u2019s Razor<\/a> states that the simpler explanation is likely the correct one \u2013 also stated as \u201cEntities are not to be multiplied beyond necessity.\u201d\u00a0 Thus, if one disease process explains the presence of multiple conditions in the same individual, then that is far more likely than if there were multiple different disease processes all occurring simultaneously.\u00a0 This principle is cited endlessly in medicine, but seems to be ignored in this most obvious example of metabolic disease.<\/p>\n
Risk Factors?<\/h3>\n