What happens in a Syndrome-Laden society? Do we tend to “tune it out” when another one is named? Metabolic syndrome deserves serious attention, for one out of five adult Americans and one out of eight school-age children has it. This dangerous pandemic pushes millions down the slippery slope to heart attacks, stroke, diabetes, and early death. A quarter of the world’s population has it. If you don’t, you probably know someone who does have it.
Profile of Metabolic Syndrome
What’s involved in the complex mix of unhealthful conditions that make up metabolic syndrome (or MetS)?
- Insulin resistance/impaired glucose
- High cholesterol or triglycerides (blood fats) or low HDL (beneficial cholesterol)
- Hypertension (high blood pressure)
If an individual has any three of the above four unhealthful conditions, a doctor can confirm the diagnosis. Significance? Three of these conditions can double one’s risk of heart attack or stroke! And compared to those who have none of these conditions, the risk is tripled! Other physiologists would include a pro-inflammatory condition, a pro-coagulant state that encourages undesirable clotting, and a sympathetic nervous system overdrive. Obviously MetS warrants concern. Because understanding a disease is vital to preventing, curing, or managing it. Let’s begin by learning more about the nature and causes of MetS. Routine blood work would not necessarily indicate these. All persons with MetS should be evaluated on these parameters.
Complications? You Named It!
If left untreated, MetS will indeed prove deadly, for it affects virtually every system of the body. Not only does it increase the risk of developing and dying from cardiovascular disease, but it also is an independent risk factor in the development of deep vein thrombosis (undesirable clots). Heart, lung, kidney, and liver function decline.
For example, with MetS, the liver can become sick, as in non-alcoholic fatty liver disease. And unless lifestyle interventions are adopted to reverse the disease process, it can progress into nonalcoholic cirrhosis. MetS also increases significantly the risk for liver cancer. MetS contributes to ovarian or erectile dysfunction. In older individuals it predicts cognitive decline and increases the risk of falling. If obesity and elevated blood sugar are both present, the risk for colorectal cancer is increased. With MetS, the risk for prostate and recurrence of breast cancer also rises. Metabolic syndrome may increase one’s risk of dying from prostate cancer.
Insulin resistance is the most common of the four major risk factors. This condition results when more insulin than normal is required to do the job of glucose control in the body. Although more factors may be involved, this impairment of the body’s ability to properly manage blood glucose is the primary feature of insulin resistance.
A Closer Look at Insulin Resistance
When we eat carbohydrate foods, they are broken down either into glucose or another simple sugar that is converted into glucose, which then enters the blood. Glucose provides the fuel from which the cells, especially the brain cells, make energy. In order for this process to take place, the pancreas produces insulin, a hormone which facilitates the entry of glucose into the cells. Insulin must bind to receptor sites on the cells. To simplify, one could imagine insulin as a key which unlocks the cells’ doors (insulin receptors) so that the glucose can then enter the cell. Normal insulin sensitivity results when the insulin receptors are working optimally and glucose is delivered and utilized effectively.
Obesity and saturated fats from animal products damage insulin receptors by impairing their ability to respond to normal amounts of insulin. As a result, blood sugar levels remain high. If this continues, the pancreas is “tricked” into making more insulin in an effort to bring blood glucose within normal range. As long as the pancreas is able to produce enough extra insulin to overcome this problem, blood glucose levels can remain normal. This condition is known as “insulin resistance.”
If you are a lady, and your waist is over 35 inches, or if you are a man, and your waist is over 40 inches—watch out! Excess visceral fat which is stored over the abdominal organs, better known as “potbelly fat” or “apple-shaped fat,” is the most dangerous type. Adipocytes (fat cells) release extra free fatty acids which interfere with cellular ability to metabolize glucose and damage the insulin-producing cells in the pancreas.
Excessive abdominal fat is an arsenal of many pro-inflammatory and pro-atherogenic agents that fuel chronic disease inflammation and often contribute to insulin resistance. Insulin resistance can trigger inflammation in a vicious cycle. Please note that both weight and the percentage of body fat are important. Women who are within their normal weight range, but whose fat mass is greater than 30 percent of their total body weight, have elevated markers for inflammation. Weight alone isn’t enough; the fat percentage must be considered as well.1
Although many people who develop high blood pressure are not obese, the fact remains that obesity reduces the ability of the blood vessels to dilate and makes the arteries more subject to constriction.
Obesity and Poor Nutrition Contribute to MetS
Ninety five percent of individuals who have MetS are overweight or obese. The Framingham study showed that women who were obese and/or had the pattern of consuming empty calories were substantially at risk for developing MetS. It is interesting to note that both the dietary pattern of consuming empty calories and obesity increased the risk of developing MetS, whether or not cardiovascular risk factors were present.2
The Framingham authors concluded that, while the disease traits in MetS can exist independently of the metabolic syndrome, many of them are the result of it and would be nonexistent without it. Furthermore, suitable amounts of the right diet, especially a high-fiber diet emphasizing fruits, grains, nuts, and vegetables, would prevent the syndrome in most individuals. Might it not even render it essentially obsolete?
Ideally, for optimal health your triglycerides should be below 100. The level at which total cholesterol is considered normal has been dropping for years. First, it was 240 then—oops!—it was 220, 200, and then 180. So… average is not normal! Two hundred is too high. According to the Mayo Clinic your “good” cholesterol (HDL) should be 40 to 49 mg/dL if you are a man and 50 to 59 mg/dL if you are a woman. Above 60 is ideal for HDL.
As useful as these numbers are, they do not tell everything. Oxidized cholesterol pushes inflammation inside the arteries and encourages the development of atherosclerosis. While HDL is considered protective against atherosclerosis, HDL itself can become oxidized from smoking, a deficient diet, or a pro-inflammatory condition such as obesity, pre-diabetes, and diabetes. When HDL becomes oxidized, it becomes dysfunctional and cannot remove cholesterol from arteries.3 In other words, a person’s diet and medical history should be carefully evaluated even when the numbers are within normal levels. One caveat here: No vitamin pill can replace the thousands of anti-oxidants and anti-inflammatory compounds found in plant foods!
High Blood Pressure
Though high blood pressure is not always a pillar of metabolic syndrome, it is still significantly dangerous. Again, what was considered “normal” 10 years ago is no longer normal. According to the latest consensus, if your systolic reading is 130, you have early hypertension. If your systolic (top) number reads 120 to 139 or if the diastolic (lower) number is above 80 to 89, don’t be lulled into false security. You actually have pre-hypertension. The human body begins to pay a physiologic price with a systolic reading of 125. Normal blood pressure is below 120/80.
Unavoidable Risk Factors
Some risk factors for MetS are uncontrollable, including a family history of type II diabetes, hypertension, heart disease, bipolar disorders, and aging. Hispanics and Asians seem to be at greater risk than other ethnic groups. Women with fibromyalgia are 5.56 times more likely than healthy controls to have metabolic syndrome.4
A pregnant woman’s metabolic state has a powerful influence on whether her child (either male or female) will develop obesity, hyperinsulinemia (elevated insulin), and related conditions. Early studies suggest that children of parents with MetS have higher levels of inflammatory markers making the children more susceptible to developing atherosclerosis later.
Modifiable Risk Factors
Lifestyle factors that contribute to MetS include obesity, overeating, snacking, consumption of refined and sugary carbohydrates, and sedentary lifestyle. “The metabolic syndrome is present in about 5 percent of people with normal body weight, 22 percent of those who are overweight, and 60 percent of those considered obese. Adults who continue to gain five or more pounds per year raise their risk of developing metabolic syndrome up to 45 percent.”5
How to Reduce Your Risk
1. Eat a Largely Vegetarian Diet
In a study of 700 participants, researchers at Loma Linda University found that vegetarians experience a 36 percent lower prevalence of metabolic syndrome than non-vegetarians, even after researchers adjusted for factors such as age, gender, race, physical activity, calories consumed, smoking, and alcohol intake.6 Plants foods are rich in fiber and anti-oxidant, anti-inflammatory phytochemicals.
2. Include Weight Lifting in Your Exercise Routine
Exercise improves the ability of cells to respond to insulin. Greater muscle strength and muscle mass have been linked to a lower risk for metabolic syndrome. A large study found that weight lifters have approximately 13% lower risk for developing MetS than non-weight lifters.7 If you are not used to weight lifting, start out with stretches first, then lift soup cans and gradually increase weight. Learn how to do weight lifting properly.
3. Check Vitamin D Level
Why? Mounting evidence suggests vitamin D inadequacy may be a risk factor for the metabolic syndrome especially in the elderly.8 Vitamin D deficiency increases one’s risk for diabetes, inflammatory problems, and possibly atherosclerosis. Nutrition epidemiologists estimate that 50 percent of the populations in North America and Europe are vitamin D deficient! Adequate amounts of vitamin D can reduce complications of MetS, such as reducing the risks for colon cancer and inflammatory processes.
It should be noted that exposure to sunlight increases vitamin D-2 synthesis, and both obesity and kidney disease compromise the ability of the body to convert vitamin D-2 into its active hormone form. Therefore, a select group of individuals with vitamin D deficiency and chronic kidney disease require vitamin D-3 supplementation.
4. Limit Television and Sitting Time
Research shows a strong inverse association between physical activity and MetS. Low cardiovascular status is an important risk factor for metabolic syndrome. In Australia, researchers studied 6,241 adults aged 35 years or older who were free from diagnosed diabetes mellitus, and self-reported ischemic heart disease. These participants were not taking any lipid-lowering or anti-hypertensive drugs. In women who watched more than 14 hours of TV a week, MetS was twice as prevalent compared to women who watched 7 hours of TV or less. The incidence of MetS increased 48 percent for men who watched TV more than 14 hours per week compared with those who watched it less than 7 hours per week. Women, who were active 2.5 hours or more per week, had 28 percent less risk of developing MetS. Men who were as active dropped their risk for MetS by 45 percent.[note
]Dunstan, W., et al., Lipids Online, Watching television risk factor for metabolic syndrome. Public Health,121: 83-91, 2007))
Physical inactivity causes the muscle cells to become less sensitive to insulin, and damages the glucose transport in the cells. The number of power plants (mitochondria) in muscle cells also declines; as a result, glucose and fats are not burned as efficiently. An encouraging bit of news is that those who are physically fit, even if overweight, have less risk of developing metabolic syndrome than those who are not fit.
Only one hour of sitting causes blood pools in the leg, decreases blood flow in the thigh, and increases blood viscosity.(1)0 All these provide a dangerous milieu that encourages atherosclerosis and undesirable clots. If you are going to watch T.V, exercise while doing so!
5. If Obese, Work on Losing 10% of Your Body Weight
That itself may substantially reduces one’s risk for diabetes and help elevated blood sugar. Limit your food intake to three meals, with your last meal being your smallest. Do not drink your calories (unless you make a fresh vegetable juice). One of the most important steps is eliminating the consumption of high fructose corn syrup so common in soft drinks, many packaged cereals, and baked goodies. HFCS elevates triglycerides and over a period of time can increase one’s risk for liver and kidney damage. If you fill up with wholesome foods such as whole fruits, salads, vegetables, and legumes, you will be able to control your appetite more easily.
6. Skip the Fish
Omega-3 fats are vital to the health, but fish is not a safe source. Why? Perfluorinated compounds (PFCs) are a class of synthetic compounds containing thousands of chemicals formed from carbon chains with fluorine attached to these chains. According to the Environmental Protection Agency, PFCs have been associated with immunotoxicity, thyroid disease, endocrine disruption, and cancer in animals. They also can damage the liver and the kidneys. The EPA estimates that PFC contamination in food may account for more than 90% of human exposure to PFOS (one type of PFC). Studies indicate that fish from contaminated waters may be the primary source of exposure to PFOS.9 Flaxseed, chia, walnuts, spinach, and organic soybeans are the best sources of omega-3 fats for most people.
We should mention that PFC’s are also found in fast food wrappers, popcorn bags, non-stick cookware such as Teflon, stain-resistant carpet and scotch-guard products. Overweight children who were exposed to higher levels of perfluorinated chemicals tended to show early signs of developing the metabolic syndrome such as higher concentrations of insulin and triglycerides in their blood.10
7. Don’t Skip, Nor go Skimpy on Breakfast
Adolescents who either neglected to eat breakfast or who ate a poor breakfast had a 68% higher incidence of metabolic syndrome than adults who ate a substantial breakfast.11
Metabolic Syndrome is a perilous condition and often proves deadly. The good news is that lifestyle strategies can substantially reduce one’s risk for MetS. In a future article, we will discuss lifestyle solutions to reversing this serious condition. It is important to work with one’s health care team if one does have Metabolic Syndrome.
- De Lorenso, A., et al., Normal-weight obese syndrome: early inflammation? Am J Clin Nutr, 85(1):40-5, 2007
- Sonnenberg, L., et al., Dietary Patterns and the Metabolic Syndrome in Obese and Non Obese Framingham Women. Obese Res, 13:153-62, 2005
- O’Riordan, Michael Oxidized, Dysfunctional HDL Evident in Atheroma, January 27, 2014 www.medscape.com/viewarticle/819773
- Loevinger, B.L., et al., Metabolic syndrome in women with chronic pain. Metabolism, 56(1):87-93, 2007
- Gill, Colleen, Medicine Net.com, Metabolic Syndrome, Denver and Health Sciences Center
- Rizzo, N, Sabate, et al., Vegetarian Dietary Patterns Are Associated With a Lower Risk of Metabolic Syndrome: The Adventist Health Study 2. Diabetes Care, 2011
- Wolters Kluwer Health. “Lifting weights protects against metabolic syndrome, study suggests.” ScienceDaily, 23 October 2012www.sciencedaily.com/releases/2012/10/121023124404.htm
- The Endocrine Society. “Low vitamin D linked to the metabolic syndrome in elderly people.”. ScienceDaily, 6 July 2010
- Contaminants of Emerging Concern in Fish: Perfluorinated…water.epa.gov/scitech/cec/upload/cec_pfc.pdf
- Endocrine Society. “PFC exposure may spark metabolic changes in overweight children.” ScienceDaily. ScienceDaily, 25 February 2014. www.sciencedaily.com/releases/2014/02/140225134231.htm
- Wennberg, Maria, et al., Poor breakfast habits in adolescence predict the metabolic syndrome in adulthood. Public Health Nutrition, 2014; 1