Metabolic Syndrome

By Stephen Holt, MD, PhD, FACP

• What is Metabolic Syndrome?
• Who is at Risk?
• Causes
• Symptoms
• Treatment
• Alternative Treatment Options
• Long Term Prognosis
• Suggested Articles

What is Metabolic Syndrome?

Metabolic syndrome is actually multiple conditions, that when existing together, increase one’s risk of heart disease and other serious health issues such as diabetes, stroke, liver disease and cancer. The term “metabolic” refers to the complex of physical and chemical processes occurring within a living cell or organism that are necessary for the maintenance of life. The term “syndrome” refers to a group of factors or conditions that consistently occur together.

Metabolic Syndrome is also known as dysmetabolic syndrome, Syndrome X and insulin resistance syndrome.

Discovered 20 years ago, metabolic syndrome is a serious health issue which is becoming more and more common in the United States, reportedly affects a staggering 70 million American adults. Due to most people not knowing what it is or that it even exists and the fact it affects so many, it has been termed the “silent killer”, and the “unknown epidemic”.

Who is at Risk?

According to the American Heart Association and the National Heart, Lung, and Blood Institute, there are five risk factors that make up metabolic syndrome.

The five risk factors for metabolic syndrome are:

1. A large waistline (abdominal obesity) – Known as the “apple” shape, a waist measurement of 40 inches or larger for men and a waist measurement of 35 inches or larger for women.
2. High blood pressure – Blood pressure reading 130/85 or greater or being on medication for high blood pressure.
3. High blood sugar (insulin resistance) – Or being on medication for high blood sugar. Insulin is needed to help control the amount of sugar in the body. Insulin resistance causes the body to produce too much insulin. A reading of equal to or higher than 100mg/dL signifies insulin resistance.
4. Low HDL cholesterol level (High Density Lipoprotein) – HDL cholesterol levels of 40 mg/dL or lower in men and 50mg/dL or lower in women. Or being on medication to increase HDL cholesterol levels. HDL is called the “good” cholesterol because it helps remove cholesterol from the arteries.
5. High triglyceride level (a type of fat in the blood) – Triglyceride level of 150mg/dL or greater.

When at least three of the above five risk factors co-exist, one is said to be diagnosed with metabolic syndrome.

Causes

Researchers have yet to definitively pinpoint a single cause for metabolic syndrome but one thing appears to be clear – all of the syndrome’s risk factors point inextricably to adverse lifestyle.

The term “metabolic” refers to the complex of physical and chemical processes occurring within a living cell or organism that are necessary for the maintenance of life. When at least three of five risk factors co-exist, metabolic syndrome is present. Having just one risk factor does not mean a diagnosis of metabolic syndrome.

Symptoms

Metabolic syndrome needs to be assessed by a medical professional through physical examination and laboratory tests in order to make the diagnosis. Since most of the metabolic syndrome risk factors don’t have symptoms, the only outward sign is an increasing waistline. Elevated blood pressure and high cholesterol don’t always exhibit symptoms.

One must have three of the five following risk factors to be diagnosed:

• A large waistline
• High blood pressure
• High blood sugar (insulin resistance)
• A low HDL cholesterol level (the good cholesterol)
• A high Triglyceride level (a type of fat in the blood)

Tests that may be done to diagnose metabolic syndrome are:

• Waist measurement – Using a tape measure, the waist will be measured to determine risk factor. A large waistline indicates high risk.
• Blood pressure measurement – Blood pressure is measured by wrapping a blood pressure cuff snugly around the arm and using a stethoscope to detect the sound of the pulse in the large artery of the inside of the arm.
• Blood glucose test (fasting or normal) – Using a needle, a sample of blood is removed from the arm and then tested to measure the amount of glucose (sugar) in the blood. A diagnosis of diabetes is made when the fasting glucose level is high (126 mg/dL or higher).
• HDL cholesterol level – Using a needle, a sample of blood is collected from a vein in the arm and then tested in a lab for the amount of high density lipoprotein (HDL) in the blood (good cholesterol).
• LDL cholesterol level – Using a needle, a sample of blood is collected from a vein in the arm and then tested in a lab for the amount of low density lipoprotein (LDL) in the blood (bad cholesterol).
• Total cholesterol level – Using a needle, a sample of blood is collected from a vein in the arm and then tested in a lab for the amount of all the cholesterol in the blood. It is important to note that the body needs a small amount of cholesterol to work properly; however, too much cholesterol can block the arteries and cause a heart attack.

Treatment

Metabolic syndrome is a serious condition that can be treated or prevented by actively making changes to one’s lifestyle and overall health habits. If one already has metabolic syndrome and a change in lifestyle isn’t enough, medication may be necessary to reduce blood pressure, LDL cholesterol and blood sugar.

Recommendations for treating or preventing metabolic syndrome include:

• Weight loss – The long-range target is to lower body mass index (BMI) to less than 25. BMI measures weight in relation to height and gives an estimate of total body fat. A BMI between 25 and 29.9 is considered overweight. A BMI of 30 or more is considered obese. A BMI of less than 25 is the goal for prevention and treatment of metabolic syndrome.
• Exercise – The more physical activity one gets, the more beneficial it is to one’s health, but studies show that even small amounts of physical activity are beneficial. Staying active aids in maintaining a healthy weight as well as maintaining healthy blood pressure, cholesterol levels and mood. For individuals with metabolic syndrome, at least a moderate amount of activity as opposed to light activity is most effective. Getting 30 minutes of moderate exercise 5 to 7 days per week is recommended. Before beginning a new exercise regimen, consultation with one’s doctor is suggested.
• Healthy diet – Eating a variety of foods rich in fruits, vegetables, whole-grains and fish (preferably oily fish), along with lowering consumption of salt (sodium), sugar and unhealthy fats is all part of living a healthy lifestyle. Alcohol consumption should be kept to a moderate level or cut out altogether as consuming large quantities of alcohol is known to adversely affect the heart and the liver. Following a healthy diet plan affects weight, blood pressure, cholesterol levels and blood glucose levels.
• Stop smoking – Smoking raises the risk for heart attack and stroke. Products are available to help the process of quitting smoking. If necessary, seek the assistance of a doctor or a support group for help in quitting.
• Medication – If lifestyle habits aren’t enough, it may be necessary to take medication to control symptoms of metabolic syndrome. A physician can prescribe blood pressure medication, cholesterol lowering medication and high blood sugar medication. Working closely with one’s doctor to safely treat any or all of these symptoms can prevent the syndrome from worsening.
• Clinical Trials -Clinical trials are research studies that explore whether a medical strategy, treatment, or device is safe and effective for humans. These studies are a key research tool for advancing medical knowledge and patient care. For individuals with metabolic syndrome who are interested in volunteering to take part in research, there are clinical trials currently under way

Alternative Treatment Options

As recommended by the American Heart Association and the American Diabetes Association, the first line of treatment for metabolic syndrome is lifestyle changes, including a healthy diet, weight loss, plenty of moderately strenuous exercise and no smoking.

Scientific studies have shown huge health benefits when small but positive lifestyle changes are implemented where risk factors related to metabolic syndrome exist. In fact, by implementing a natural approach in treating metabolic syndrome, some of the side effects and long term adverse effects of prescribed medications can be avoided.

Some alternative approaches in the treatment and prevention of metabolic syndrome are as follows:

• Soluble fibers (beta glucan extract) – Recent research shows certain fractions of specific types of soluble fiber (beta glucans) may be extremely effective in lowering blood cholesterol, balancing blood glucose and helping to promote weight loss. Beta glucans are sugars that are found in the cell walls of bacteria, fungi, yeasts, algae, lichens, and plants, such as oats and barley. They are sometimes used as medicine.
• Soluble fibers from food – Sources of soluble fiber from food are oatmeal, oat cereal, lentils, apples, oranges, pears, oat bran, strawberries, nuts, flaxseeds, beans, dried peas, blueberries, psyllium, cucumbers, celery, and carrots.
• Omega-3 Fatty Acids (especially EPA (Eicosapentaenoic acid) ) – The American Heart Association recommends eating fish (particularly fatty fish such as mackerel, lake trout, herring, sardines, albacore tuna, and salmon) at least 2 times a week. However, supplementation with a high quality fish oil capsule can be an effective source of omega-3 fatty acids as well.
• Antioxidants – Antioxidants, also known as free radical scavengers, are molecules that fight free radicals from building up in the body. Free radicals are a type of unstable molecule that is made during normal cell metabolism such as food digestion and energy production, or as a consequence of some external influence such as toxins. Free radicals, when allowed to build up in the system, can cause damage to cell membranes that may cause cardiovascular disease, cancer, and premature aging. Examples of antioxidants include alpha lipoic acid, lycopene, selenium, beta-carotene, vitamin C, E, and A, and coenzyme-Q10.
• Herbs/Botanicals – Plants have been a source of therapeutic agents for more than 5000 years. Approximately 25% of the modern medications are developed from plants. Herbs and botanicals are supplements that contain extracts or active ingredients from the roots, berries, seeds, stems, leaves, buds or flowers of plants. Some herbs and botanicals have been studied and tested to be effective as potentially beneficial in the management of metabolic syndrome. Examples include cinnamonum tamala (cinnamon), milk thistle and Korean ginseng.
• Functional Foods – Functional foods are foods that promote health by providing an additional physiological benefit beyond that of meeting basic nutritional needs. Health Agencies of the Federal Government in the U.S. have recently acknowledged the ability of natural supplements (or functional foods) to contribute to the prevention of disease, in particular the prevention of cardiovascular disease. It was Hippocrates, the father of modern medicine that said “food is medicine”. Eating functional foods in combination with other healthy lifestyle changes can prevent or slow the progression of metabolic syndrome. Soy, oats, fruits, vegetables, flaxseed, tomatoes, and tea are just a few examples of functional foods. Orange juice fortified with calcium, and margarines fortified with calcium are additional examples.

Long Term Prognosis

Long term prognosis is good, if the syndrome is treated. Because it’s is a cluster of conditions that occur together, by making aggressive lifestyle changes and working with one’s physician, heart disease, stroke and diabetes is preventable.

If heart disease, diabetes, high blood pressure or fatty liver disease has already been diagnosed, maintaining a healthy lifestyle which includes eating healthy foods, not smoking and exercising can prevent the diseases from worsening.

It is important to keep in mind that safety is a serious issue when dealing with all methods of treatment for any medical condition. Natural doesn’t always mean “safe”. Vitamins and nutritional supplements in high doses must be monitored for safety; therefore, seeking advice from a trusted medical source is advised.

A healthy lifestyle is a lifelong commitment. By safely using an integrated medical approach of treatment – combining natural and conventional medicine together, metabolic syndrome can be managed or prevented altogether.

Suggested Articles

• Metabolic Syndrome Linked to Memory Loss
• Nonalcoholic Fatty Liver Disease
• Metabolic Syndrome May Increase Risk for Liver Cancer

About the Author

Stephen Holt, MD, PhD, FACP

Stephen Holt, M.D. is a Distinguished Professor of Medicine NYCPM (Emerite) and a medical practitioner in New York State. He has published many peer-review papers in medicine and he is a best-selling author with more than twenty books in national and international distribution. He has received many awards for teaching and research. Dr. Holt is a frequent lecturer at scientific meetings and healthcare facilities throughout the world. He is a best selling author and the founder of the Holt Institute of Medicine.