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 Syndrome X”).
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:
- Abdominal obesity (waist circumference >40” in men, >35” in women)
- High Triglycerides (a type of cholesterol) >/= 150 mg/dL
- Low HDL-C (“good” cholesterol) < 40 mg/dL in men, < 50 mg/dL in women
- High blood pressure (>/= 130/85)
- High fasting glucose (IGT [blood sugar >/= 110 mg/dL and < 126 mg/dL] without diabetes)
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.
Age First Tested
Coronary Artery Disease
Every 5 years
Every 3 years
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 cardiovascular disease.
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:
- Cut 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.).
- Limit simple sugars: table sugar, other forms of cane sugar, honey, maple syrup, etc. Substitute whole fruits. Applesauce makes an excellent sweetener.
- Limit 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.
- Cut 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.
- Lots 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.
- Cut 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 fish.
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 “good fats”.
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:
- Cardiovascular fitness
- Increased insulin sensitivity (so your body can regulate glucose better)
- Lower “bad” cholesterol
- Higher “good” cholesterol
- Elevated mood (depression is a risk factor for both cardiovascular disease and type 2 diabetes)
- Weight control
- Increased strength—the single greatest predictor of disability as we age is lack of muscle mass
- Increased bone density—osteoporosis currently affects 10 million Americans
- Lower 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 per week.
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:
· Martial arts
· 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 ideas:
- Join a gym and commit to going at least 3 times per week.
- Find like-minded friends to support you by forming an exercise group that meets regularly.
- Clean 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.
- Choose a style of stress reduction that resonates with you. Sign up for a meditation or Tai Chi class
- Weight 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.