The 21st centurys silent pandemic
Susan Biali, MD
Have you ever heard of metabolic syndrome, otherwise known as syndrome X? Although most of us have long lost count of the number of times we’ve heard about diabetes and coronary artery disease, many have never heard of this closely related and potentially devastating health situation.
Even doctors don’t talk about it often, though it’s all around us: at least one in four Australian adults meet the diagnostic criteria for metabolic syndrome and the numbers are climbing steadily.
Risk factors and diagnosis
Health research organisations around the world point to the ballooning rates of obesity as the root of this new pandemic. Whether or not a doctor diagnoses you with metabolic syndrome depends on whether you have three or more of the following five risk factors, all of which are closely related to obesity and being overweight.
Large waist circumference
A predominance of abdominal fat, also known as an apple body shape, significantly increases your risk of developing coronary artery disease, high cholesterol and diabetes. Women who have a waist bigger than 35 in (90 cm) and men who have more than a 40 in (100 cm) waist are at particularly high risk. If you have a strong family history of diabetes, high cholesterol or early coronary artery disease, your at-risk waist circumference may be even lower than these numbers.
Elevated fasting blood sugar
With the prevalence of type 2 diabetes skyrocketing and even appearing now in overweight children, it’s important for every adult to get their fasting blood sugar checked at some point.
Discuss with your doctor how often you’ll need to get tested, based on your age, general health and other risk factors. If you have a strong family history of diabetes, have high blood pressure, are overweight or have any other risk factors for cardiovascular disease, you’ll need to be screened more regularly.
A fasting blood sugar higher than 5.6 mmol/L is one of the major risk factors for metabolic syndrome. Although high blood sugar is obviously a problem in itself and causes all sorts of problems for the body, the key underlying issue in metabolic syndrome is insulin resistance.
Normally if your blood sugar goes up, for example, when you drink a sugary drink, your pancreas responds by producing insulin. The insulin drives sugar from your blood into your cells, which in turn metabolise it.
People with metabolic syndrome typically have high levels of insulin resistance, which means that the insulin produced in response to high blood sugar no longer drives sugar into cells as effectively. This results in both elevated insulin and chronically high blood sugar levels, ultimately developing into diabetes.
Increased blood pressure
Most doctors will diagnose you as having high blood pressure if your readings regularly read at or above 140 millimetres of mercury (mmHg) over 90 mmHg. However, an average reading of 130/85 or more qualifies as a risk for metabolic syndrome.
Reduced HDL cholesterol
You’ve probably heard HDL cholesterol referred to as “good” cholesterol. It’s protective against cardiovascular disease and we doctors like to see a number higher than 1 mmol/L. With respect to metabolic syndrome, an HDL level lower than 1.04 mmol/L in men or 1.3 mmol/L in women will put you at risk.
Increased triglyceride levels
Your doctor will normally test your triglyceride levels alongside the other standard cholesterol tests. These fats circulate in our blood and our body makes use of them for energy. If your triglyceride levels are higher than 1.7 mmol/L, that’s another key risk factor. The higher your triglyceride levels, the higher the risk of insulin resistance as well.
Complications of metabolic syndrome
When we think of high blood sugar, elevated blood pressure and increased fat and cholesterol in our blood, we may justifiably worry about heart disease, but may not even be aware of the dangers of metabolic syndrome. Yet this cluster of risk factors that lead to metabolic syndrome can have a powerfully negative impact on our life and health.
According to the International Diabetes Federation, people who qualify as having metabolic syndrome have five times the risk of developing diabetes and are twice as likely to die from it. They also have three times the risk of heart attack or stroke and have double the risk of dying from one of these, compared to people who don’t have the syndrome.
These statistics put metabolic syndrome far ahead of HIV and AIDS in terms of illness and mortality, yet far fewer people have ever heard of it.
Although the prevalence and impact of metabolic syndrome make for some pretty depressing statistics, there’s a very bright side to all of this. Lifestyle factors play a huge role in the development of this condition, making it highly preventable and treatable with lifestyle modification and the adoption of healthier habits.
Whether you already have metabolic syndrome, are on your way to developing it or would simply like to minimise your risk, there are several key things that you can do.
There’s good news here as well: you probably don’t need to lose as much weight as you think to significantly improve your future health. Losing as little as 10 per cent of your weight can lower insulin levels, decrease blood pressure and reduce the probability of developing diabetes.
Small changes in weight can make a big difference. There are few things more satisfying to a doctor (and a patient) than seeing weight, blood pressure, blood sugar and bad cholesterol all come down simultaneously. And it’s a life-saver too.
A study published in the Journal of Gerontology noted that the prevalence of metabolic syndrome is approaching a staggering 50 per cent in post-menopausal women. Thankfully, the same study found that lifestyle modification such as weight loss and low-intensity exercise significantly lowered the risk factors for metabolic syndrome.
Daily walks are a good start towards avoiding this syndrome. Go at a moderate pace that requires a bit of effort and work up to at least 30 minutes, five to seven days a week.
Smoking dramatically increases the damage to the body caused by high blood sugar, high blood pressure and increased cholesterol, and it immensely amplifies your risk of dying from cardiovascular disease.
Although this one should be a no-brainer, smoking is such a powerfully addictive habit that sometimes the only thing that will make someone quit is a major health scare, such as being diagnosed with this very serious syndrome.
Eat a wholefood-based Mediterranean-style diet
Make it a habit when you grocery shop to stick to the outer perimeter where the real food is; stay out of those aisles full of processed foods your grandmother wouldn’t recognise. A diet based on wholefoods, especially the wholegrains, fresh fruits and vegetables, fish and olive oil characteristic of the Mediterranean diet, can be a powerful weapon against metabolic syndrome.
There are numerous reasons for this, including the powerful anti-inflammatory effect of healthy fats and the ability of fibre to reduce high blood sugar and cholesterol.
The role of supplements
Since metabolic syndrome by definition is multi-factorial, any supplement that has been proven to lower blood sugar or cholesterol or benefits the cardiovascular system should have a positive impact.
Fish oil containing high levels of the long-chain omega-3 fatty acids EPA and DHA provides a broad spectrum of benefits, from boosting mood to preventing heart disease. More specific attributes of fish oil related to metabolic syndrome include improving glucose metabolism and decreasing triglycerides.
The ability of the mineral chromium to lower blood sugar has been studied for many years, with varying results. One well-designed study showed that chromium picolinate did improve short-and long-term blood sugar control more than a placebo in type 2 diabetes.
Whether you increase fibre by choosing fibre-rich foods or by taking a high-fibre supplement, virtually any type of fibre will have a positive impact on metabolic syndrome. Some well-studied supplemental forms include guar gum and glucomannan, which can lower cholesterol and blood sugar and promote weight loss, as well as psyllium, which lowers blood sugar.
The active ingredient in green tea extract, epigallocatechin gallate (EGCG), is truly astonishing in its ability to benefit the human body. In addition to boosting metabolism, green tea has been shown to enhance insulin action and promote optimal blood sugar levels, as well as reducing fat cell creation and triglyceride and cholesterol levels.
Be sure to check with your doctor or licensed health practitioner before trying these and any other supplements or treatments.