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Reducing Your Risk for the Deadly Metabolic Syndrome

by , | Last updated Feb 14, 2024 | Diabetes & Endocrine Health, Obesity & Weight Loss

Metabolic syndrome (MetS) deserves serious attention, for about one in three American population has MetS. Between 20 to 30% of the worldwide population has the metabolic syndrome. This condition pushes millions down the slippery slope to heart attacks, stroke, diabetes, and early death. Do you have MetsS? How do you reduce your risk?  Can you reverse metabolic syndrome if you 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 (a fasting blood glucose equal to or greater than 100 mg/dL)
  • Obesity (BMI 30 or above) or a waist circumference of more than 35 inches for women and more than 40 inches for men. An increased waist circumference is the form of obesity most strongly tied to metabolic syndrome.
  • High cholesterol  or low HDL (beneficial cholesterol). An HDL less than 40 mg/dL for men and less than 50 mg/dL for women is considered low.
  • Hypertension (high blood pressure) 130/80 or higher
  • Elevated triglycerides (greater than 150 mg/dL)

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.

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 all of 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 significantly increases the risk for liver cancer.  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.

MetS contributes to ovarian or erectile dysfunction. In older individuals it predicts cognitive decline and increases the risk of falling.

Insulin Resistance

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. This condition is known at “insulin resistance.” 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.

Obesity

A review study found that 61.6% in the obese group, 33.2% in the overweight group, and 8.6% in the normal-weight group had metabolic syndrome. Obesity is an chronic, multi-faceted, complex metabolic disease characterized by having too much body fat, usually a body mass index  (BMI) of 30 or greater, inflammation, and dysfunctional adipose tissue.

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 and inflammatory substances that interfere with cellular ability to metabolize glucose and damage the insulin-producing cells in the pancreas.

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

Excessive abdominal fat is an arsenal of many pro-inflammatory and pro-atherogenic agents that fuel chronic disease. Inflammation contributes to insulin resistance. Insulin resistance can  also trigger inflammation into a vicious cycle.

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 obesity 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?3

Cholesterol

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.

As useful as these numbers are, they do not tell everything. Not all LDL cholesterol is created equally. Small dense LDL’s are the most atherogenic. Oxidized cholesterol pushes inflammation inside the arteries and encourages the development of atherosclerosis. Many experts believe that  your LDLs level should be less than 100 mg/dL.

Above 60 is ideal for HDL (“good cholesterol”). 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, prediabetes, and diabetes. When HDL becomes oxidized, it becomes dysfunctional and cannot remove cholesterol from the arteries.4 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 antioxidants 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. If your systolic (top) number reads 120 to 129 or if the diastolic (lower) number is greater than 80 your blood pressure is elevated. Any figures above those are considered high blood pressure or hypertension.

Unavoidable Risk Factors

Some risk factors for MetS are uncontrollable, including a family history of type 2 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.5

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.”6

How to Reduce Your Risk

1. Eat a Largely Whole Food Vegetarian Diet

Extensiave studies have linked vegetarian diets to a lower risk of metabolic syndrome.7 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.8 Vegetarians have been found to have lower blood pressure and lower cardiovascular mortality. Vegetarians have lower inflammatory markers than omnivores and, consequently, lower risk of diabetes, cancer, and cardiovascular diseases because chronic inflammation fuels these conditions.9

Plant foods are rich in fiber and antioxidant, anti-inflammatory phytochemicals. Higher fiber intakes from whole plant foods increase satiety and promote less energy consumption. Higher fiber consumption improves the likelihood of weight loss in obese persons. High fiber intake from whole plant foods are linked to decreased risks of diabetes, cancer, and heart disease.10

If you are risk or already have Mets, severely limit your intake (or better yet eliminate sugar, high-corn fructose, simple carbs, and ultra processed foods and refined grains. Limit starchy carbohydrates to 1/2 cup a meal or one slice of bread. Reduce sodium intake. Enjoy colorful whole fruits and vegetables as they help boost the antioxidants and reduce inflammatory compounds common in Mets S. Emphasize plant foods that score low and moderate on the glycemic index.

Caveats: Consuming a well-balanced, largely whole plant food diet helps to reduce elevated cholesterol. However, replacing the meat with refined carbohydrates will not reduce elevated cholesterol levels.  A plant-based diet high in refined carbohydrate, sugar, salty vegetables, low in fiber-rich plant foods increases one’s risk for the metabolic syndrome.11  Vegetarians can develop vitamin D and B12 deficiencies. So be sure to keep your levels in good range. Our medical staff encourages vegans and vegetarians to get their B12, MMA (methylmalonic acid), and vitamin D levels checked annually.

2. Move to Live!

In general, moderate and vigorous exercise boosts antioxidant content and glucose disposal. It exerts anti-inflammatory actions and improves the sensitivity of the baroreceptors to regulate blood pressure in individuals who have metabolic syndrome.(( Golbidi S, Mesdaghinia A, Laher I. Exercise in the metabolic syndrome: A review found that just 2 to 5 minutes of light walking after a meal can improve blood sugar levels.12

Persistent, regular exercise increases the number of mitochondria in the muscle cells. Additionally, exercise also increases the metabolically beneficial hormone irisin that helps to reverse muscle insulin resistance and reduces fat production in the liver. 13

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.14 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 Your Vitamin D Level

Why? Mounting evidence suggests vitamin D inadequacy or deficiency may be a risk factor for the metabolic syndrome,  especially in the elderly.15 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 are vitamin D deficient and an additional 35% have inadequate amounts of vitamin D necessary for optimal health.16 Adequate amounts of vitamin D may 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. 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 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.17

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. 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 in itself may substantially reduce one’s risk of diabetes and help decrease elevated blood sugar. Modest weight loss (5 to 10%) is also linked to improvement in systolic and diastolic blood pressure and HDL cholesterol. As well, it has been linked to reduced health care costs. Studies suggest that a 5% weight loss significantly decreased the plasma concentrations of some risk factors for cardiometabolic disease (glucose, insulin, triglyceride, alanine transaminase, and leptin), but did not affect other risk factors. After a 16% weight loss, plasma free fatty acid and CRP concentrations decrease and plasma adiponectin concentration increase significantly.18  CRP is a marker for inflammation. Adiponectin is a hormone that improves the cells’ ability to respond to insulin, exerts anti-inflammatory actions, and promotes fat-burning metabolism.

Limit your food intake to two or three meals without  snacking, with your last meal being your smallest. Do not drink your calories (unless you make a fresh vegetable juice). Aim for a 12 -14 hour fast at night, counting the time from the end of your last meal to breakfast the next morning.

In prediabetes and diabetes, the hormone glucagon stimulates the liver to produce and release extra glucose. Time-restricted eating (eating two or three meals within a 10-12 hour time frame and fasting for the remaining hours–except for water) helps to restrain the time when glucagon can increase your blood glucose and improves your fat-burning metabolism. Additionally, time-restricting eating makes healthy foods taste better and thwarts the desire for unhealthful foods.19

One of the most important steps is eliminating the consumption of high fructose corn syrup(HFCS) 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.20 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.21

7. Don’t Skip, Nor Go Skimpy on Breakfast

Metabolic syndrome prevalence was higher in those skipping breakfast for 4 or more days/week compared to non-skippers.22 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.23 A  systematic review and meta-analysis show that a regular daily breakfast habit significantly benefits the cardio-metabolism and decreases the risk of cardiovascular diseases, type 2 diabetes mellitus, obesity, hypertension, strokes, metabolic syndrome, cardiovascular mortality, and abdominal obesity.24

8. Take Frequent, Short Exercise Breaks

Yes, you do need to schedule a 20 to 30 minutes slot for exercise each day, but that is not enough if you are sedentary. MetS increases your risks of forming undesirable clots. In fact, sitting for 3 hours straight impairs the blood flow in a main artery (femoral artery) of a leg by 50%. Unfortunately, the ability of this artery to dilate starts to become impaired after just one hour of sitting. When people sit, slack muscles do not contract to pump blood to the heart effectively. Blood can pool in the legs and affect the ability of blood vessels to expand and increase the risk for clots! Even slow 5-10 minute walks around the office can reverse harm caused to leg arteries during three hours of prolonged sitting.25 Interrupting prolonged sitting with a 5 minutes self-paced walk every 30 minutes lowers glucose and insulin levels and improves the ability of the cells to respond to insulin. 26

9.  Practice Good Oral Hygiene

Chronic inflammation fuels atherosclerosis, obesity, diabetes, clots, and many other problems. Individuals that have MetS have increased odds of developing periodontal disease. On the other hand, periodontal disease itself increases the risk of metabolic syndrome. Bacteria that cause inflammation inside the mouth can also increase inflammatory mediators elsewhere in the body. As a result, a sustained infection with periodontal bacteria can increase body weight and encourage insulin resistance.27 These infections may kickstart damage to the heart valves, neurons, and other complications. Evidence suggests that adequate dental care and periodontal therapy can reduce the levels of inflammatory mediators in serum.28

10. Take Good Care of Your Gut

MetS is often accompanied by an imbalance of the gut microbiota, inducing a low-grade inflammatory response in the body by destroying the gut barrier. Eventually, this change in gut microflora produces insulin resistance through metabolites that affect host metabolism and hormone release forming a vicious circle that promotes the continuous progress of MetS. 29A typical Western diet (high in saturated fats, refined foods, animal products, but low in fiber) or a plant-based diet low in fiber but high in sugars and refined carbs encourage the growth of unfriendly gut microbes that produce pro-inflammatory compounds.. So emphasize whole plant foods and include multiple servings of raw fruits and vegetables to improve your gut health. Sleep deprivation and an irregular schedule encourages the proliferation of pro-inflammatory gut microbes.

11. Improve Your Sleeping Habits

Sleep deficiencies from insufficient sleep schedules, insomnia with short sleep duration, sleep apnea, circadian misalignment, shift work, and night eating syndrome may all contribute to metabolic dysregulation and increase the risk for obesity, insulin resistance, and type 2 diabetes.30 Short sleep increases the the risk of coronary artery disease and stroke.31 Adiponectin is an important hormone generated from fat cells. This hormones improves the ability of the cells to respond to insulin and burn fat. There is often an inverse relationship between adiponectin levels and metabolic diseases. Short or fragmented sleep generally decreases adiponectin levels.

To improve sleep, retire and rise on a regular schedule. Sleep in total darkness. Avoid exposure to blue light and bright lights two hours prior to retiring. A fiber-rich diet improves sleep. In contrast, sugar and saturated fats reduce the quality of deep sleep. A lukewarm tub bath may help to promote sleep.

Conclusions

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. Wildwood Lifestyle Center and Wildwood Lifestyle Outpatient Clinic specialize in reversing prediabetes and type 2 diabetes, lowering insulin requirements for type 1 diabetes, natural weight loss, reversing metabolic syndrome, non-alcoholic fatty liver diseases, early stage chronic kidney disease, and so much more.

Our outpatient clinic serves Chattanooga and northwest Georgia. Telemedicine consults are available to Georgian residents once they have been seen by one of our health providers.

Additional Information:

See this link https://wildwoodhealth.com/category/hypertension/  for articles on natural remedies for hypertension.

Visit the link https://wildwoodhealth.com/category/obesity-weight-loss/  for articles on obesity and weight loss.

For diabetes, visit the link https://wildwoodhealth.com/category/diabetes-endocrine-health/ for helpful strategies on reversing prediabetes and type 2 diabetes.

Works Cited.

Hirode G. Trends in the Prevalence of Metabolic Syndrome in the United States, 2011-2016.JAMA. 2020;323(24):2526-2528. https://jamanetwork.com/journals/jama/fullarticle/2767313

Saklayen MG. The Global Epidemic of the Metabolic Syndrome. Curr Hypertens Rep. 2018;20(2):12. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5866840/

 

 

 

© 2024, Wildwood Sanitarium. All rights reserved.

Disclaimer: The information in this article is educational and general in nature. Neither Wildwood Lifestyle Center, its entities, nor author intend this article as a substitute for medical diagnosis, counsel, or treatment by a qualified health professional.

Sources

  1. De Lorenso, A., et al., Normal-weight obese syndrome: early inflammation? Am J Clin Nutr, 85(1):40-5, 2007
  2. Sonnenberg, L., et al., Dietary Patterns and the Metabolic Syndrome in Obese and Non Obese Framingham Women. Obese Res, 13:153-62, 2005
  3. Sonnenberg, L., et al., Dietary Patterns and the Metabolic Syndrome in Obese and Non Obese Framingham Women. Obese Res, 13:153-62, 2005
  4. O’Riordan, Michael Oxidized, Dysfunctional HDL Evident in Atheroma, January 27, 2014 www.medscape.com/viewarticle/819773
  5. Loevinger, B.L., et al., Metabolic syndrome in women with chronic pain. Metabolism, 56(1):87-93, 2007
  6. Gill, Colleen, Medicine Net.com, Metabolic Syndrome, Denver and Health Sciences Center
  7. https://www.medicinenet.com/metabolic_syndrome_diet_foods_to_eat_and_avoid/article.htm
  8. 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
  9. https://lifestylemedicine.org/articles/benefits-plant-based-nutrition-cardiovascular-disease/
  10. Kahleova H, et al. A Plant-Based High-Carbohydrate, Low-Fat Diet in Overweight Individuals in a 16-Week Randomized Clinical Trial: The Role of Carbohydrates. Nutrients. 2018;10(9)
  11. Kim H., et at., Plant-based diets and incident metabolic syndrome: Results from a South Korean prospective cohort study. Plos Medicine. Nov. 2020. https://doi.org/10.1371/journal.pmed.1003371
  12. Buffey AJ., et. al. The Acute Effects of Interrupting Prolonged Sitting Time in Adults with Standing and Light-Intensity Walking on Biomarkers of Cardiometabolic Health in Adults: A Systematic Review and Meta-analysis. Sports Med 52, 1765–1787 (2022).https://doi.org/10.1007/s40279-022-01649-4
  13. Saklayen, Mohammad G. “The Global Epidemic of the Metabolic Syndrome.” Current hypertension reports vol. 20,2 12. 26 Feb. 2018, doi:10.1007/s11906-018-0812-z. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5866840/
  14. Wolters Kluwer Health. “Lifting weights protects against metabolic syndrome, study suggests.” ScienceDaily, 23 October 2012www.sciencedaily.com/releases/2012/10/121023124404.htm
  15. The Endocrine Society. “Low vitamin D linked to the metabolic syndrome in elderly people.” ScienceDaily, 6 July 2010
  16. Cui A. Prevalence, trend, and predictor analyses of vitamin D deficiency in the US population, 2001–2018. 2022; 9: 965376.
  17. Dunstan, W., et al., Lipids Online, Watching television risk factor for metabolic syndrome. Public Health,121: 83-91, 2007
  18. Magos F.Effects of Moderate and Subsequent Progressive Weight Loss on Metabolic Function and Adipose Tissue Biology in Humans with Obesity. Cell Metab. 2016  Apr 12;23(4):591-601. doi: 10.1016/j.cmet.2016.02.005.
  19. Panda, Satchin. The Circadian Code: Lose Weight, Supercharge Your Energy, and Transform Your Health from Morning to Midnight (p. 200 2005). Harmony/Rodale. Kindle Edition.
  20. Contaminants of Emerging Concern in Fish: Perfluorinated…water.epa.gov/scitech/cec/upload/cec_pfc.pdf
  21. Endocrine Society. “PFC exposure may spark metabolic changes in overweight children.” ScienceDaily. ScienceDaily, 25 February 2014. www.sciencedaily.com/releases/2014/02/140225134231.htm
  22. Kim, H.M., Kang, H.J., Lee, D.H. et al. Association between breakfast frequency and metabolic syndrome among young adults in South Korea. Sci Rep 13, 16826 (2023). https://doi.org/10.1038/s41598-023-43957-3
  23. Wennberg, Maria, et al., Poor breakfast habits in adolescence predict the metabolic syndrome in adulthood. Public Health Nutrition, 2014;1
  24. Li Z. Effects of regular breakfast habits on metabolic and cardiovascular diseases. 2021 Nov 5; 100(44): e27629. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8568444/
  25. University of Missouri-Columbia. “A walk around the office can reverse vascular dysfunction caused by hours at a computer.” ScienceDaily, 28 September 2015
  26. Yates, T. et al., Metabolic Effects of Breaking Prolonged Sitting With Standing or Light Walking in Older South Asians and White Europeans: A Randomized Acute Study. J Gerontol A Biol Sci Med Sci. 2020 Jan 1;75(1):139-146.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6909896/
  27. Watanabe K. et al., Porphyromonas gingivalis impairs glucose uptake in skeletal muscle associated with altering gut microbiota. The FASEB Journal, 2020; DOI: 10.1096/fj.202001158R
  28. Lamster IB, Pagan M. Periodontal disease and the metabolic syndrome. Int Dent J. 2017 Apr;67(2):67-77. https://pubmed.ncbi.nlm.nih.gov/27861820/
  29. Wang PX, Deng XR, Zhang CH, Yuan HJ. Gut microbiota and metabolic syndrome. Chin Med J (Engl). 2020;133(7):808-816. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7147654/
  30. Depner, C.M., Stothard, E.R. & Wright, K.P. Metabolic Consequences of Sleep and Circadian Disorders. Curr Diab Rep 14, 507, 2014 https://doi.org/10.1007/s11892-014-0507-z
  31. Wi Z. Sleep Disturbance and Metabolic Dysfunction: The Roles
    of Adipokines. 2022 Feb; 23(3): 1706.