• The paradox of obesity and malnutrition

    by Brian Flyer, MD
    on Dec 6th, 2016

When we think of malnutrition, images of starving children in third world countries come to mind.  As physicians, the term cachexia is used to represent patients with a wasted appearance; for example, sunken eyes, loss of temporal muscles on the sides of the face, and overall poor muscle mass.  We are used to seeing this appearance in many advanced cancer patients or those with certain chronic diseases.  But, it turns out that a high percentage of obese patients are actually malnourished. 

The level of malnutrition among obesity is typically missed, because they don't reveal outward signs of wasting, but rather plethora.  Physicians may not appreciate malnutrition, given the stigma of being obese.  Blood lab tests may provide clues and many obese patients, without specific disease states, will have low serum albumen levels or mild anemia.  Furthermore, when obese patients lose weight, this may be mistrued as an improvement, when in reality, it could represent more severe stages of malnutrition.

Obesity in this country is epidemic and largely contributed by low-cost, high-calorie, nutrient-poor foods.  Specific foods consumed typically include high fructose corn syrup (eg soda, candy), refined flour (eg milled rice), and trans fats (eg chips, cookie, crackers).  Yet, such foods are often very deficient in proper nutrients.  Some nutrients, like thiamine, a B vitamin, are critical as a cofactor in the metabolism of sugars in the body.  Therefore, it is logical that the consumption of simple carbohydrates without thiamine will add to the burden of glucose metabolism and actually contribute to the development of diabetes.  Thiamine is readily found in meats, eggs, fish, and legumes.  Severe deficiencies can lead to diseases like Beri-beri or Wernicke's encephalopathy, but moderate deficiencies may contribute to diabetes.

Obesity increases the risk of developing diabetes by 400%.  The usual mechanisms involve insulin resistance, pancreatic beta-cell dysfunction, genetics, and incretin (gut) hormone resistance, but specific nutrient deficiencies may contribute, as well.  Many of these nutrients function as cofactors in glucose metabolism pathways.  Although there is less compelling research to prove their exact role in diabetes, it appears that Vitamin D, Vitamin C, Chromium (found in meats, yeast, and wheat germ), Biotin (a B vitamin found in eggs, almonds and other nuts, and legumes), and Thiamine (also known as Vitamin B1) may be very instrumental in the prevention of diabetes.

I have always considered nutritional counseling to be a relevant part of my medical practice and find it rewarding and enlightening to assist my patients in this regard.


Author Brian Flyer, MD Dr. Brian Flyer is an internist located in Beverly Hills, CA.

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