Performance Quest Fitness & Athletics: You Are Your Hormones - Endocrinology (Kaplan's Deadly Quartet)

WEDNESDAY, OCTOBER 26TH, 2011

Open Class 5:00pm
Foothill Boy's Varsity Basketball 7:30pm

ENDOCRINOLOGY
You Are Your Hormones

KAPLAN'S DEADLY QUARTET
From CrossFit Journal Issue 15

This article does a great job highlighting my previous post's message while introducing Dr. Kaplan's "Deadly Quartet".

Clinicians and researchers have long recognized the clustering of risk factors for heart disease. Physicians have known for decades that obesity (specifically abdominal adiposity - apple/pear shape), glucose intolerance (high circulating blood glucose that is a precursor and measure of diabetes), hypertension (high blood pressure), and hypertriglyceridemia (high blood fats) tended to coexist in the same person and are predictive of heart disease.

Furthermore, physicians had noticed that glucose intolerance, hypertension, and hypertriglyceridemia lie in store for patients who'd become overweight. The assumption was that because the obesity came first that it was the cause of the other risk factors. While this is a natural assumption it is nevertheless a classical logical fallacy - Post hoc, ergo propter hoc (After this, therefore because of this.)

This traditional view of obesity as the cause of glucose intolerance, hypertension, and hypertriglyceridemia was seriously challenged when Dr. Normal Kaplan, head of the Hypertension Division at the University of Texas Southwestern Medical Center at Dallas, published an article in the July 1989 Archives of Internal Medicine entitled "The Deadly Quartet". When Dr. Kaplan examined the research, he found that obesity is not the cause of glucose intolerance, hypertension, and hypertriglyceridemia but merely a correlate.

Dr. Kaplan went on to demonstrate that hyperinsulinemia, another correlate of each of the traditional risk factors, can be more realistically represented as the cause of glucose intolerance, hypertension, hypertriglyceridemia, AND obesity (upper body obesity specifically).

The importance of this work is hard to overstate. Treating glucose intolerance, hypertension, hypertriglyceridemia, and obesity as separate diseases had not yielded impressive results and all too often treatment for one of these diseases exacerbated the rest (e.g., Dean Ornish's diet worsens triglycerides while reducing obesity and hypertension).

What would be a legitimate test of Dr. Kaplan's hypothesis? Well, if hyperinsulinism is the root cause of glucose intolerance, hypertension, hypertriglyceridemia, and obesity then reducing hyperinsulinism should reduce the occurrence of the correlated risk factors and it does.

Dr. Kaplan suggested convincingly that hyperinsulinism was the cause of heart disease risk factors in 1989, but Dr. Robert Atkins had been making the same point since 1972 and had proven it in thousands, if not millions of persons who'd followed his book, Dr. Atkins' Diet Revolution. One of many lessons that can be garnered from this history is that the astute clinician will often trump the researcher by decades, which brings us to a final point - there are two serious problems with medical science today: first that correlation and causation are tragically confused by many researchers and second, that there is low regard and little interest among academics with the often highly successful protocols employed by clinicians.