In Diagnosing the Ultimate Disease of Civilization, we explored the diagnosis of metabolic syndrome, and now we are finally moving on to the treatment! The good news is that, since metabolic syndrome is primarily a lifestyle disease, the treatment starts with lifestyle modification, like diet, exercise, and other behavioral modifications like smoking cessation.
Diet is central to the treatment of metabolic syndrome. Because central obesity (fat around the waistline) is one of the core components of metabolic syndrome, the primary treatment approach consists of weight reduction, but is also key a key component of reducing cholesterol, hemoglobin A1c (a marker of diabetes), and cardiovascular disease. To address overweight and obesity, a reduction in caloric intake is recommended. Based on the fact that 3500 calories is roughly equal to 1 lb of fat, the current recommendation is to restrict caloric intake by 500 calories a day, which would translate into 1lb a week of weight loss on average. The ultimate goal being to decrease body weight by 7-10% over 6-12 months (CURRENT Practice Guidelines in Primary Care 2012). Although there is some evidence to suggest that the calorie restriction is more important than the type of diet, a Mediterranean diet consisting primarily of minimally processed fruits, vegetables, whole grains, legumes & seeds, poultry, and fish with olive oil as the main source of dietary lipids is encouraged and has been found to not only induce weight loss, but also reduce cholesterol and a1c levels, reduce inflammation, cardiovascular events and ones risk of dying from a heart attack (DynaMed, 2011. Mediterranean diet). In addition, recommendations include a decreased intake of dairy, red meat, eggs, saturated fats, trans fats, cholesterol, and simple sugars. Somehow I think permaculture can handle that.
First of all, reducing fossil fuel consumption will naturally reduce the amount of the “bad” foods we include in our diet, once we realize the amount of human energy required to replicate those processes involved in procuring them and weigh that against the benefit of that processing. Reducing processed foods will virtually eliminate the trans fats – primarily a product of food processing, including hydrogenation of vegetable oils, oil refining, meat irradiation, and food frying (SciELO, 2007). It will also go far to reduce the excessive intake of simple carbohydrates or sugars, the processed forms of which (e.g., high fructose corn syrup, etc.) are found in virtually everything nowadays. Simple carbs should be consumed only in their whole forms – fruits (fructose), vegetables (maltose), dairy products (lactose), etc. (University of Maryland Medical Center, 2013) – rather than extracted from certain foods and then added to others. Saturated fats are found in animal products (e.g., cream cheese, butter, etc.), and vegetable products (e.g., coconut oil, palm oil, etc.), but if you are eating from your permaculture food forest, you have control over the ingredients and their proportions. And because of the energy involved in producing these ingredients without fossil fuels, they may once again become the luxury that they are in nature, and consumed in the form of a whole food rather than going through energy-intensive processing. Finally, dietary cholesterol is actually not much of a problem at all, as it is esterified, which makes it difficult for the body to absorb (Lecerf & Lorgeril, 2011).
Then to increase the types of foods you want more of, no matter what zone you live in, a food forest could be designed to yield fruits and nuts, the latter of which have recently been found to prolong life and reduce cardiovascular mortality (Bao et al., 2013). An annual / perennial permaculture garden could be designed to provide most of your veggies, along with a medicinal herb garden containing plants that may help to treat metabolic syndrome. You may have to find alternatives to whole grains, as there is only a limited role for grain production in permaculture, but there are plenty of other plant sources of complex carbohydrates, protein, and fiber, which is the major advantage of whole grains over processed grains.
Chickens are integral to a permaculture design and a diet of food scraps and garden slugs would provide you manure for your garden, and eventually poultry meat, free of antibiotics and hormones. And, although more research needs to be done on people with diabetes, the good news is that there is a fragile link between eggs and high-cholesterol induced coronary heart disease (Husten, 2013), and the eggs of free range chickens are 2 times higher in heart-healthy omega-3 fatty acids, 3 times higher in the antioxidant vitamin E, and with half as much saturated fat, so there is yet another benefit of raising chickens on your permaculture homestead (Alterman, 2009).
There are a variety of aquaculture or aquaponic designs that can be integrated into a permaculture design. Most of the designs I am aware of focus on fish like tilapia and microgreens to consume the nitrogenous wastes products of the fish – the most well-known design comes from Will Allen’s Growing Power. Tilapia does contain omega-3 fatty acids, but also contains high amounts of omega-6 fatty acids, which despite cholesterol lowering effects, may be inflammatory and subject to oxidation, which contributes to metabolic syndrome (Nelson & Zeratsky, 2008). But if you are reducing your exposure to other sources of oxidative stress, it may still be a healthy choice of fish.
Unfortunately, many of the fish recommended for their high omega-3 to omega-6 ratio are forage fish (sardine, anchovy & herring) which are dangerously overfished. Salmon, a carnivorous fish, requires fish meal which contributes to the overfishing of other species, and is susceptible to sea lice in aquaculture settings, and can be “ranched” to better accommodate the natural behavior of salmon, but I still have not found any permaculturally designed salmon farms. And mackerel, another of the top five omega-3 rich fish is also now off the list of fish that an environmentally conscious person can ethically eat. But diet can only go so far and must be complemented by physical activity, which we will address next time. …