What is Metabolic Syndrome?
The combination of obesity, abnormal cholesterol levels,
high blood pressure, and an inability to properly control glucose levels is
termed “metabolic syndrome” (also known as “insulin resistance syndrome”, or
What are the consequences of Metabolic Syndrome?
Having metabolic syndrome puts you at high risk of
developing type 2 diabetes and/or cardiovascular disease (heart disease,
stroke, heart attack etc.). It is
important to remember that cardiovascular disease is the number one killer in
the western world, and that the first symptom of cardiovascular disease is
often death! For this reason screening
and early intervention are very important.
Who gets it?
For most people, the root causes are poor diet, lack of
physical activity, and stressful lifestyle.
Currently about 1 in 4 Americans have the syndrome. In older segments of the population the
incidence is approaching 50%.
How is it diagnosed?
Individuals are considered to have metabolic syndrome if
they demonstrate any 3 of the following:
obesity (waist circumference >40” in men, >35” in women)
Triglycerides (a type of cholesterol) >/= 150 mg/dL
HDL-C (“good” cholesterol) < 40 mg/dL in men, < 50 mg/dL in women
blood pressure (>/= 130/85)
fasting glucose (IGT [blood sugar >/= 110 mg/dL and < 126 mg/dL]
What can be done about it?
First of all a diagnosis must be established. Metabolic syndrome is a “silent”
disorder—producing no symptoms until becoming manifest in diabetes or
cardiovascular disease. The disorder
must therefore be screened for. The
table below shows when you should be getting blood tests done to assess your risk.
It is wise to check glucose levels before age forty if
obesity, blood pressure, or cholesterol levels are abnormal (blood pressure
should be checked routinely). An
additional blood test called “CRP” is also appropriate for risk
assessment. This test evaluates the
predisposition of your blood vessels to inflammation. Recent research shows that CRP is a better indicator of heart
disease risk than is cholesterol. I
recommend having this test performed whenever your cholesterol is checked.
The core of treatment for metabolic syndrome should be a
nutritious diet, exercise, and stress reduction. It has been shown again and again that these simple changes can
reverse the metabolic syndrome and drastically reduce the risk of diabetes and
In addition to lifestyle changes supplements may be used
initially to normalize risk factors.
See my write-ups on “How to Control Your Cholesterol Without Drugs”,
“Supplements for High Blood Pressure”, and “Supplements for Glycemic
Control”. Ultimately, if risk factors
can be controlled with lifestyle changes supplements may be discontinued.
Here we will focus on diet and exercise.
Dr. Dean Ornish demonstrated that blood pressure and
cholesterol change dramatically with diet and exercise (he actually
demonstrated a reversal of heart disease!).
Goldhamer demonstrated the greatest effect of any study on blood
pressure using dietary changes alone.
Pritikin showed a reversal of diabetes in three quarters of diabetic
patients using diet and exercise.
All of the above authors have used a low-fat, low protein
diet. While this diet works extremely
well as a therapeutic diet for a short period, other, more maintainable diets
work well for metabolic syndrome. Using
“good fats” liberally exerts a positive effect on blood sugar control, blood
pressure, and obesity. Good fats
include omega-3’s from fish, flax seed, whole organic dairy products, and whole
grains. Monounsaturated fats from olive
oil, nuts, and avacado are health promoting.
Saturated fats found in coconut oil and free-range organic meats are
healthful. Use these “good fats” with
plenty of whole grains, fruits, and vegetables.
Conversely, diets high in “bad fats” (commercial meats,
hydrogenated oils, vegetable oils that are not cold pressed or are stored
improperly) and refined carbohydrates like sugar and white flour combined with
a lack of physical activity will make healthy individuals pre-diabetic. Diet has a powerful effect on human
metabolism, and I encourage you to follow these principles.
The following changes are enough in most people:
out refined grains: white flours
(white bread, semolina pasta, baked goods, sourdough bread, refined
cereals, etc). Substitute whole
grains, preferably sprouted (whole wheat flour, oat flour, rye, brown
rice, quinoa, spelt, etc.).
simple sugars: table sugar, other
forms of cane sugar, honey, maple syrup, etc. Substitute whole fruits.
Applesauce makes an excellent sweetener.
animal products: Use only
free-range, organic meat.
Commercial meats are higher in inflammatory fats and contain
hormones, pesticides, and other harmful man-made farming implements.
out coffee. A cup or two of tea
per day is ok. The levels of
caffeine in coffee interfere with glucose metabolism. Coffee also causes long-term low-level
inflammation—a risk for heart disease and cancer.
of fruits and veggies: only about
25% of Americans consume the recommended 5 or more servings of fruits and
vegetables per day! These foods
are high in vitamins and minerals that are essential to good health and
contain plenty of fiber, which has a beneficial effect on both blood sugar
levels and cholesterol.
hydrogenated oils (i.e. margarine and many prepackages cookies, crackers,
and baked goods—hydrogenated oils are the worst fat you can put into
your body). Substitute
monounsaturated and omega-3 fats: olive oil, avocado, nuts, flax, fatty
To put it simply, eat a diet rich in fruits, vegetables, and
whole grains. Check out books by
McDougal, Ornish, and Goldhamer for recipes and other diet information on low
fat diets. Check out Nourishing
Traditions by Sally Fallon and Mary Enig for information on a diet rich in
Exercise is crucial to normal metabolism. Throughout the evolution of mankind exercise
has been necessary to regulate blood flow, hormonal secretions, nervous system
activity, metabolism, mood, etc. In our
modern age many of us have no need of exercise for survival. We must actively court exercise.
The benefits of exercise include:
insulin sensitivity (so your body can regulate glucose better)
mood (depression is a risk factor for both cardiovascular disease and type
strength—the single greatest predictor of disability as we age is lack of
bone density—osteoporosis currently affects 10 million Americans
CRP: this protein is the best
predictor of cardiovascular disease known.
With all of these benefits you cannot afford not to
exercise. Exercise should include
at least 30 minutes of moderate physical activity on most days of the week
including three days of strength training.
If you have metabolic syndrome you should begin by focusing on
cardiovascular fitness. Schedule
yourself for 30 minutes of aerobic activity per day. Once this becomes routine add 30 minutes strength training 3 days
Chronic stress leads to insulin resistance. Our mood is intimately related to our
health. In fact, depression is a risk
factor for both type 2 diabetes and cardiovascular disease. High levels of stress increase inflammation
within the body and stimulate the adrenal glands to higher-than-normal levels,
which contributes to insulin resistance.
There are many methods of stress reduction, and the best method is the
one that you enjoy the most.
Here are a few methods that you may want to look into:
Progressive muscle relaxation
When lifestyle modifications aren’t enough
In some cases people are unable to make changes fast enough
to use lifestyle changes alone. In
these cases it may be necessary to use supplements to accelerate healing. Most cases can be managed without drugs.
Supplements can be used to control cholesterol, glucose
levels, and blood pressure when needed.
Ideally these supplements should be discontinued when lifestyle changes
successfully control these risk factors.
How do I begin this process?
Each of us has our own unique style of implementing
change. Some of us do better by making
a complete change overnight and sticking to it. Others of us do better by creating a plan by which we make small
changes over a period of time.
For all of us one thing is certain, we must begin by
changing something. Below are a few
- Join a
gym and commit to going at least 3 times per week.
like-minded friends to support you by forming an exercise group that meets
out your cupboards—throw away anything with sugar, white flour, or
hydrogenated oils in it. Make a
trip to Briar Patch or Earth Song and replace the foods you threw away
with appetizing, health-promoting foods.
a style of stress reduction that resonates with you. Sign up for a meditation or Tai Chi
Watchers offers a program through which you can learn portion control-a
key to weight loss. In addition,
the program provides you with a support network. If you are overweight set an initial goal of 7% weight loss.
Remember that beginning a change is the hardest part, after
that the momentum begins to take over and good habits begin to take hold. Please feel free to contact me at my office
with any questions.