I recently came across an important new study showing a strong association between obesity and poor overall health in adolescents. In this study obese adolescents had problems functioning in many settings including school, and the study also found that attention deficit/hyperactivity disorder, conduct disorder, depression, learning disability, developmental delay, bone/joint/muscle problems, asthma, allergies, headaches, and ear infections were all more common in obese children.
This study titled “Associations Between Obesity and Comorbid Mental Health, Developmental, and Physical Health Conditions in a Nationally Representative Sample of US Children Aged 10 to 17” was recently published in the journal Academic Pediatrics:
http://www.sciencedirect.com/science/article/pii/S1876285912002847
This was a cross-sectional study involving 43,297 children aged 10 to 17 from the 2007 National Survey of Children’s Health. This type of study is useful for showing what variables tend to run together in the population. For example a cross-sectional study might show that cigarette smoking is associated with lung cancer, but this type of study cannot tell us whether or not cigarette smoking causes lung cancer. Randomized controlled trials (RCT) are used to tease out cause and effect relationships.
The Obesity-Brain Connection.
It’s interesting to note that many of the problems found to be associated with obesity in this study have to do with abnormal brain function. For years I have noticed the same trends in the children and adults that I have treated. To state it simply, this suggests that in many cases obesity seems to change the brain for the worse. The authors of the study point out that they are not sure how obesity is tied to these disorders. Does obesity cause brain dysfunction? Does brain dysfunction cause obesity? Does some other factor cause both brain dysfunction and obesity?
My perspective is that both obesity and brain dysfunction are often caused by two dietary elements—the long-term consumption of excessive amounts fructose mainly from sugar and HFCS and high glycemic carbohydrates mainly from grains. Recent research has suggested that over time, these dietary elements can adversely affect brain function. I also suspect that a relative lack of omega 3 fatty acids relative to omega 6 fatty acids might also contribute to brain dysfunction. Research has also shown that these dietary elements are often associated with obesity. In science, when variables like obesity and brain dysfunction seem to be associated in some way, the next step is to develop a theoretical model that attempts to explain the connection between the variables. This theoretical model is then used to develop longitudinal studies and RCT to tease out possible cause and effect relationships.
The Definition of Obesity.
Remember that obesity is defined as excessive body fat—you have too much fat in your body relative to your lean body mass. This definition doesn’t include consideration of weight or Body Mass Index (BMI)—these are simply the parameters that the experts decided to use to measure obesity. In this study they used height and weight to calculate the BMI of each patient. If they had measured the body composition of all these children, I suspect that the relationship between excessive body fat and poor brain function would have been even stronger.
For decades I actually did measure the body composition of all my patients and I noticed some interesting trends. Some normal sized or even thin people have excessive body fat to a level that qualifies them as being obese. A thin obese person? That’s not something you hear about every day! That’s because the most commonly used measure for obesity is Body Mass Index (BMI) and BMI will always miss excessive fat in people who are normal size or thin. As was documented in this study, I noticed that people with excessive body fat, regardless of their size or weight, are much more likely to have brain dysfunction symptoms than those with a normal body composition. I also noticed that brain dysfunction symptoms often precede the accumulation of excessive body fat, suggesting that altered brain function might play a role in driving obesity.
CARB Syndrome: A New Disease Model.
Because I already suspected that excessive fructose and high glycemic carbohydrates might be playing a role in driving both obesity and brain dysfunction, I focused on reducing or eliminating these dietary elements for obese patients with brain dysfunction symptoms. I also worked with patients to increase their intake of omega 3 fatty acids and reduce their intake of omega 6 fatty acids. When patients complied, I noticed that their brain dysfunction symptoms improved followed by a slow loss of excessive body fat. To explain these observations I developed a new disease model call Carbohydrate Associated Reversible Brain syndrome or CARB syndrome.
This model assumes that these dietary elements increase fat storage through two likely mechanisms. Excessive fructose is now known to be the driving force behind insulin resistance where it takes more insulin to move glucose inside of cells. High glycemic carbohydrates cause abnormal glucose spikes and high levels of insulin in an environment of insulin resistance. This combination is associated with increased abdominal (central) obesity on a cellular level. Gary Taubes documents this very well in his book “Why We Get Fat: And What to Do About It”.
For years we thought that obesity was simply driven by an imbalance between food intake and exercise. We now know that this view is somewhat simplistic. All organisms evolved to store an “ideal” amount of fat for survival and these fat stores vary by the season of the year or pregnancy needs. Under a broad range of food intake, the brain plays a key role in maintaining appropriate fat stores for any given environmental situation. Although we don’t fully understand how the brain manages to do so, central control of total body fat stores certainly makes sense from an evolutionary standpoint.
Food Can Also Affect Your Brain.
Recent research has also suggested that excessive fructose and high glycemic carbohydrates can over time alter brain function. Lake of adequate amounts of omega 3 fatty acids also seems to adversely affect brain function. I call this altered state of functioning CARB syndrome when the brain is no longer able to properly auto-regulate fat stores. Throughout most of our evolutionary history, unstable glucose levels were associated with lack of regular food intake. When these unstable levels persist, the brain assumes that a famine may be on the horizon and it pushes the body into a metabolic state favoring increased total body fat storage regardless of the amount of food eaten.
In our modern world unstable glucose levels usually come from eating food loaded with sugar, HFCS and high glycemic carbohydrates, foods that were not present in our diet throughout most of our evolutionary history. When you eat this type of food on a regular basis, your brain responds by pushing your body to store extra fat, even as you lose lean body mass from dieting. That explains how some thin people become obese.
Take Care of Your Monoamines.
There is also a fair amount of evidence that the magnified glucose spikes and high insulin levels from eating this type of food can adversely affect brain function. Neurons communicate with one another using chemical neurotransmitters like dopamine, norepinephrine and serotonin. Over time people with CARB syndrome tend to develop predictable brain dysfunction symptoms reflecting low levels of these neurotransmitters. This alteration in the functioning of monoamine neurotransmitters could be caused by mitochondrial dysfunction from excessive glucose and insulin. The omega 3 fatty acid docosahexaenoic acid (DHA) also is critical for proper neuron functioning and communication between nerve cells. To date we have documented up to 22 brain dysfunction symptoms in patients who fit the CARB syndrome disease pattern.
What Kind of Depression Do You have?
Because CARB syndrome symptoms often overlap with traditional psychiatric disorders like major depression, this situation has created a great deal of confusion in clinical medicine. Up until about 50 years ago, all patients with depression lost their appetite and lost weight, a defining characteristic of the illness. Over the past few decades many patients with depression have an increased appetite, cravings for sweet and starchy foods and weight gain. In my opinion this is latter group is CARB syndrome, not true major depression. This is a critical distinction because high dose SSRI medication, the most effective treatment for true major depression, can actually make a person with CARB syndrome worse rather than better. The most effective treatment for CARB syndrome is removal of the dietary triggers of the disease and adding more omega 3 fatty acids to the diet, along with certain targeted supplements
Thus many of the children in this study likely have CARB syndrome—excessive body fat and brain dysfunction symptoms. Because the medical profession has missed this common disease, they seem surprised that so many obese children have associated brain problems. I am not surprised at all. Over the past few decades I have noticed that both children and adults with excessive body fat (obesity) tend to also have symptoms that qualify them for diseases such as depression, ADHD, PTSD, anxiety disorders, eating disorders, bipolar II, OCD, fibromyalgia and similar conditions. As I previously discussed, some of these individuals are normal size or even thin, but when you measure their body composition their excessive body fat becomes apparent.
Sumo Wrestler Obesity.
Based on my observations, not all obese people have CARB syndrome. It is possible to become obese by over-eating healthy food, but this type of obesity is not associated with metabolic problems like insulin resistance and type II diabetes. I call this less common form of obesity “Sumo wrestler obesity”. People with Sumo wrestler obesity don’t seem to have the brain dysfunction symptoms that are typical for people with CARB syndrome.
There also doesn’t seem to be any relationship between the amount of excessive fat stored and the severity of the brain dysfunction symptoms. A large person with CARB syndrome might have mild brain dysfunction symptoms whereas a thin person may have more severe symptoms. This is typical for many people with anorexia—they tend to have excessive body fat even though they are thin and they usually have significant brain dysfunction symptoms.
A Rationale For Considering Using Unproven Theories.
At the present time the CARB syndrome disease model is an unproven theory. Is it wise to use an unproven theory to manage patients? In science there is no such thing as a fully proven theory. Controlled clinical trials can provide support for a theory, but regardless of how much support there is, there is always a chance that the theory will be proven wrong in the future. In other words disproving a theory is much easier than proving one. Given this state of affairs, which theories should we use to guide us when managing patients? One of the most important elements to consider is the possible risks involved in using treatments generated by the disease model.
The current most commonly used disease model for major depression is the “monoamine model” where for unclear reasons, levels of dopamine, norepinephrine and serotonin seem to be too low. Hereditary factors seem to play a role in true major depression. Using the monoamine model, it certainly makes sense to use drugs that boost the effects of these neurotransmitters in the brain, even if we don’t know exactly why these levels are low. It’s also important to understand that using these types of psychotropic drugs involves some risk because the medications can have serious side effects. Because true major depression is a potentially dangerous disease, the decision is often made to use medications because the benefits seem to outweigh the risks, an important consideration in any treatment decision.
If you have the CARB syndrome form of depression, this benefits versus risks discussion is completely different. Although medications can temporarily relieve some of the brain dysfunction symptoms of CARB syndrome, they do not get at the root cause of the disease—a diet loaded with excessive fructose and high glycemic carbohydrates that also lacks adequate amounts of omega 3 fatty acids. The CARB syndrome disease model suggests that removing excessive fructose and high glycemic carbohydrates from the diet and increasing omega 3 fatty acids should be the most effective way to manage the disease and this is certainly what I have seen in my clinical practice.
Because most physicians are unaware of the CARB syndrome disease model, they manage patients with CARB syndrome the same way they manage patients with classical psychiatric disorders—with medications. Because the most prominent symptom of CARB syndrome is craving sweet and starchy food, patients who are managed with medications typically continue to consume this type of food driven by their cravings, making a successful recovery from the illness almost impossible. To make matters worse, some commonly used psychotropic medications actually stimulate cravings for sweet and starchy foods.
Take Control of Your Own Health.
Thus even though the CARB syndrome disease model has yet to be supported by large controlled trials, the treatments for CARB syndrome are extremely low risk. There is clearly very little risk in reducing your intake of sugar, HFCS and high glycemic carbohydrates and consuming more omega 3 fatty acids. Many other physicians already make these recommendations because too much sugar, HFCS and high glycemic carbohydrates and lack of omega 3 fatty acids have been associated with many other diseases.
By spending some time on this site, you are in a good position to tell whether you or yoiur family members fit the CARB syndrome disease model. If the disease model fits, you can institute simple dietary changes even if your own physician has no knowledge of this disease. Make the changes and see what happens. There is very little risk in doing so and as this study points out, there are substantial health risks if you choose to do nothing.
Supplement Your Way to Health.
There are also several supplements that seem to effective in helping people with CARB syndrome recover. The simple amino acid L-glutamine is effective at suppressing those pesky cravings for sweet and starchy foods. I recommend taking a minimum of 1,000 mg three times daily on an empty stomach. I also use a combination supplement called CARB-22 that contains the precursor amino acids that your brain needs to maintain healthy levels of monoamine neurotransmitters. Four capsules twice a day can be a very effective way of reversing CARB syndrome as long as you are also following a healthy diet. I also strongly recommend taking a high quality omega 3 fatty acid supplement, especially on days when you don’t eat fish.
Learn More From the Pros.
To learn more about the adverse effects of excessive fructose, I recommend reading Richard Johnson’s book “The Sugar Fix” or his new book “The Fat Switch”. I also favor a Paleo-style diet because it removes the triggers of CARB syndrome and increases the intake of healthy fats. For more information about a Paleo-style diet, I recommend reading Loren Cordain’s book “The Paleo Answer” or Robb Wolf’s book “The Paleo Solution”. I also recommend spending some time on low-carb blogger Jimmy Moore’s site at:
http://livinlavidalowcarb.com/blog/
This study clearly demonstrates that our current obesity epidemic is not only associated with well-documented metabolic problems like insulin resistance and obesity, it is also associated with poor functioning in multiple settings and many common brain dysfunction disorders. When faced with such a serious situation, we need to move as quickly as possible from documenting the pathology to effectively treating it. In my opinion the CARB syndrome disease model gives us a very effective way to do so.
Dr. Bill Wilson
