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Metabolic Syndrome : Risks and Modifications

By Mian A. Jan, MD, FACC, Cardiologist
The Chester County Hospital

Published: February 23, 2009

Metabolic Syndrome, also known as "Syndrome X" or "Insulin Resistance Syndrome," affects more than 50 million Americans, a number that could double in the next decade if we do not change our lifestyles and dietary habits.

This Syndrome is present when someone has at least three of the following five conditions:

  1. Fasting glucose level (blood sugar) over 110.
  2. Fasting triglyceride level (blood fats) over 150.
  3. HDL level (good cholesterol) less than 40 in men or under 50 in women.
  4. Blood pressure more than 130/85 or at any level requiring medication for high blood pressure.
  5. Waist size more than 40 inches for men or 35 inches for women, when measured around the belly button.

While each condition alone may or may not be particularly harmful, accumulating data shows that when combined they increase the risk of diabetes (up to three times the risk in some studies), cardiac events (such as heart attack) and stroke. A large waist size and obesity are obvious signs, but testing is needed to check for the rest.

The mechanism for the condition is complex. After absorbing food from the gut, the digestive system breaks down some portions into sugar-a major source of energy for the body. Absorbed sugar travels to tissues where cells convert it to energy for either immediate use (e.g., for brain or muscle work) or to store as fat for later use. Insulin secreted by the pancreas controls this.

Patients with Metabolic Syndrome have "insulin resistance" and so they are unable to transport sugar efficiently from the blood into the cells. In response, the body secretes more insulin, but since it is less effective at absorption, the blood sugar level rises. This vicious cycle of altered fat and sugar metabolism leads to increased fat storage (especially around the waist) and blood sugar, often causing apple-shaped obesity and later full-blown diabetes.

Metabolic Syndrome risk increases with age (45% of people over 60 have it), certain races (e.g., Hispanics and Asians), family history of diabetes and obesity, and the combination of lack of activity and a diet with too much saturated fat and carbohydrates rich in refined sugar. Simple fasting blood tests of sugar and lipids (cholesterol and triglycerides), along with increasing blood pressure and waist size determine the diagnosis.

The key to treating and preventing Metabolic Syndrome remains lifestyle modification with diet and exercise:

  1. Exercise: 30-60 minutes of moderate activity most days of the week.
  2. Weight loss: Even 5-10% will improve insulin resistance.
  3. Healthy diet: Cut trans fats, saturated fats and refined sugar. Eat more fruits, vegetables and whole grains to increase fiber content, substitute fish for meat and reduce salt.
  4. Stop smoking. Smoking increases insulin resistance among its other toxic effects.

Someone unable to reach lifestyle goals may need pharmacological therapy such as statins, fibrates, fish oil, and Metformin for sugar control. Consult your physician who should be monitoring your program.

Any person with strong family history of Metabolic Syndrome or Type II Diabetes should be encouraged to maintain a healthy lifestyle while still young.

This article was published as part of the Daily Local News Medical Column series which appears every Monday. It has been reprinted by permission of the Daily Local News.

Last Updated: 7/27/2009