What is metabolic syndrome?
This pattern, sometimes called syndrome X, insulin resistance syndrome or dysmetabolic syndrome, is a collection of conditions that when taken together dramatically increases the risk of heart disease, stroke and diabetes. A diagnosis of metabolic syndrome is made if a person has any three of the following risk factors:
- Waist circumference: at least 35 inches for women and at least 40 inches for men.
- Fasting blood glucose at least 100 mg/dL
- Serum triglycerides at least 150 mg/dL
- Blood pressure at least 135/85mmHg
- HDL ("good") cholesterol lower than 40 mg/dL for men or 50 mg/dL for women
Metabolic Syndrome appears to affect between 25 and 30 percent of the U.S. population according to various national health surveys. In fact, the number of people with metabolic syndrome seems to increase as we get older, affecting four in 10 Americans as they reach their 60s and 70s.
What are the symptoms?
Usually, there are no immediate physical symptoms. People with metabolic syndrome do have a tendency to be overweight, especially around the abdomen - having an "apple shape." Moreover, since this condition is associated with insulin resistance, individuals with metabolic syndrome may display some of the clinical features associated with an increase in the production of insulin. For instance, women may experience cysts on their ovaries (metabolic syndrome is associated with polycystic ovarian syndrome) and irregular periods. Individuals can have an increased incidence of skin tags, benign raised growths of skin that usually appear increases on the neck and back. In addition, they can exhibit acanthosis nigricans - a pigmentation of the skin, which appears discolored or dirty over the back of the neck and underarms.
Consistently high levels of insulin are associated with many harmful changes in the body prior to its manifesting as disease including chronic inflammation and damage to arterial walls, decreased excretion of salt by the kidneys, and thickening of the blood. People with metabolic syndrome also exhibit elevations in blood pressure and changes in their blood lipids, primarily with triglycerides (elevated) and good cholesterol or high density lipoprotein (HDL) (reduced). Problems associated with metabolic syndrome develop over time and usually worsen if left untreated.
What are the causes?
The exact cause of metabolic syndrome is unknown. It is frequently influenced by diet and lifestyle, but also seems to be genetically driven. As stated, many features of metabolic syndrome are associated with "insulin resistance," which causes cells to lose their sensitivity to insulin, the hormone needed to allow blood sugar to enter cells for use as fuel. As glucose levels in the blood increase, the pancreas tries to overcompensate and produce even more insulin, which ultimately leads to the characteristic symptoms of metabolic syndrome. When insulin levels spike, a stress response occurs that leads to elevations in cortisol, the body's long-acting stress hormone. This in turn creates an inflammatory reaction that if left unchecked begins to damage healthy tissue.
Interestingly enough, some data suggests that consumption of sodas (diet or regular) and other products containing high-fructose corn syrup (HFCS) like salad dressings and ketchup, jams, jellies, ice cream and many more foods may be linked to obesity, insulin resistance, and metabolic syndrome in both adults and children. Interrupted sleep patterns (such as sleep apnea) may also be a factor in increasing the incidence of insulin resistance and metabolic syndrome in the adult population.
What is the conventional treatment?
The primary goal of clinical management is to reduce cardiovascular risk factors and prevent type 2 diabetes. The major risk factors for cardiac disease include cigarette smoking, blood lipid abnormalities, elevated blood pressure and glucose, all of which should be reduced to recommended levels. Aggressive lifestyle changes, and in some cases medication, can improve most if not all components of metabolic syndrome.
Moderate weight loss, in the range of 5 to ten percent of body weight, can help restore the body's ability to recognize insulin and greatly reduce the chance of developing diabetes. It will also lower blood pressure and cholesterol. Aerobic exercise such as a brisk 30-minute daily walk can be highly effective in improving insulin levels, facilitating weight loss, and improving related symptoms. Most practitioners recommend 30-60 minutes daily of moderate intensity exercise on at least five days a week either divided throughout the day or all at once; the same benefit is achieved either way.
Most conventional practitioners recommend that patients follow a healthy eating plan like the American Dietary Association (ADA) diet, the Dietary Approaches to Stop Hypertension (DASH) diet or the Mediterranean Diet. All of these emphasize fruits, vegetables, and whole grains, while limiting unhealthy fats and promoting leaner protein foods like low-fat dairy and lean meats like chicken and fish.
A primary intervention for metabolic syndrome is to initiate smoking cessation programs. Smoking cigarettes increases insulin resistance and worsens the health consequences of metabolic syndrome.
Doctors may also prescribe medications to lower blood pressure, control cholesterol or help you lose weight. Insulin sensitizers like Glucophage (Metformin) may be prescribed to help your body use insulin more effectively. It lowers blood sugar, which also seems to help lower cholesterol and triglycerides as well as decreasing appetite. The side effects of Metformin (often temporary) include nausea, stomach pain, bloating and diarrhea. A more serious side effect, lactic acidosis, can affect those with kidney or liver disease, severe heart failure or a history of alcohol abuse and is potentially, though rarely, fatal. Aspirin therapy is often given to help reduce risk of heart attack and stroke.
What therapies does Dr. Weil recommend for metabolic syndrome?
- Dietary changes: The conventional medical recommendation of a low-fat, high-carbohydrate diet to lower triglycerides and bring down cholesterol is dead wrong in his opinion. Eating a diet high in the wrong kinds of carbohydrate and fat may actually elevate triglycerides and cholesterol. Instead, Dr. Weil recommends following an anti-inflammatory diet. This is a not a diet in the popular sense - it is not intended as a weight-loss program (although people can and do lose weight on it), nor is it an eating plan to stay on for a limited period of time. Rather, it is way of selecting and preparing foods based on scientific knowledge of how they can help your body remain optimally healthy. Along with influencing inflammation, this diet will provide steady energy and ample vitamins, minerals, essential fatty acids and dietary fiber. The following suggestions incorporate the principles of this way of eating:
- Eat small, frequent meals to keep blood sugar in a healthy range. Eating large meals can flood the bloodstream with glucose and insulin. Experiment until you find that you feel your best.
- Keep refined starches and sugars to a minimum, instead choosing those with a low glycemic index. (Sweet potatoes, winter squash and beans are examples of better carbohydrates.) You should also be aware of glycemic load in assessing dietary choices.
- Keep saturated fats and trans-fats to a minimum, but consume moderate amounts of monounsaturated oils, such as olive oil and some nut oils.
- Eat fish several times a week, emphasizing wild, cold-water fish high in omega-3 fatty acids, such as salmon and sardines. Or take omega-3 supplements.
- Eat generous amounts of non-starchy vegetables, like cucumbers, bell peppers, dark leafy greens, zucchini, eggplant, squash, asparagus, broccoli, cabbage, Brussels sprouts, beans, radishes and spinach.
- Eat foods high in magnesium, which research has linked to lowering the incidence of metabolic syndrome. One gets magnesium by eating plenty of whole grains, leafy green vegetables (spinach is a great source) as well as almonds, cashews and other nuts, avocados, beans, soybeans, and halibut.
- Cut back on alcohol, avoiding beer especially. (Even small amounts of alcohol can elevate triglyceride levels.)
- For more information on the anti-inflammatory diet, check out Dr. Weil's Anti-Inflammatory Food Pyramid.
- Exercise: Getting regular exercise is vital but too many people quit, become injured, or simply find the process less enjoyable than they should. Follow Dr. Weil's advice for making aerobic exercise an ongoing, safe and rewarding part of your life.
- Mind/Body: It is important to attend to stress in positive ways. Rather than using alcohol, tobacco, or television, try breathing exercises. They are simple, free, and right under your nose. Dr. Weil has compiled ten ways to reduce stress and promote relaxation, calm and peace within yourself. Some techniques take practice, and most require some commitment on your part to achieve results. However, the results are well worth the effort.
- An antioxidant supplement and multivitamin-mineral supplement.
- You can take additional magnesium if you do not think you're getting enough in the diet. Dr. Weil recommends magnesium citrate, chelate, or glycinate. Avoid magnesium oxide, which can be irritating, and take half the amount of magnesium as the calcium you take in supplemental form. If you do not take any supplemental calcium, watch out for taking large amounts of magnesium, which can cause diarrhea.
- If you are not eating oily fish at least twice a week, take supplemental fish oil, in capsule or liquid form, 1-2 grams a day. Look for molecularly distilled products certified to be free of heavy metals and other contaminants.
- Take alpha-lipoic acid, 100 to 400 milligrams a day. Note that this could potentially lower glucose levels too much if the person taking medication such as metformin - patients should work with their physicians so safe and proper dosages are employed.