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Metabolic Syndrome is also sometimes called Metabolic Syndrome X or simply Syndrome X. It is also sometimes called insulin resistance syndrome because it is closely associated with a generalized metabolic disorder called insulin resistance. Gerald Reaven, MD, a researcher at Stanford University School of Medicine, coined the term “Syndrome X” in 1988. Syndrome X affects millions of people, many of which are unaware of this silent killer. A national survey said that one-out-of-five Americans have this syndrome. In people in their 60s and 70s, two-out-of-five have the syndrome. It is estimated that about 47 million people in the U.S. have Syndrome X.  A medical check-up that includes blood work is needed for diagnosis. Metabolic syndrome happens when you eat a diet with too many calories and too much saturated fat and do not get enough exercise.

Metabolic syndrome increases the risk for type 2 adult-onset diabetes, heart disease, stroke and possibly even cancer. As many as half of people with metabolic syndrome will develop diabetes. Several characteristics of metabolic syndrome are also factors for diabetes type 1 and 2 and heart disease. These include factors such as:

  • hyperinsulinemia
  • insulin resistance
  • glucose intolerance
  • hypertension
  • obesity
  • high triglycerides
  • low hdl cholesterol.

It is thought that Syndrome X runs in families. The same families who have a history of type 2 diabetes are at risk for metabolic syndrome X. For clinical diagnosis of this syndrome a person must have three or more risk factors. The National Cholesterol Education Program (NCEP) guidelines give the following guidelines for diagnosis of metabolic syndrome:

  • Abdominal obesity. Waist circumference exceeds 40 inches for men or 35 inches for women.

  • Fasting blood glucose is at least 110 mg./dl.

  • Triglycerides at least 150 mg./dl.

  • HDL-cholesterol no more than 40 mg./dl for men or 50 mg./dl. For women.

  • Blood pressure at least 130/85.

  • Blood fat disorders

Metabolic syndrome is not found in children. Lifestyle factors are just as important as genetics here. Two warning signs are inactivity and weight gain (especially around the abdomen). Two key ways of reducing one’s risk are exercise and weight loss. Other steps for managing the metabolic syndrome are also important for patients and their doctors. These include monitoring body weight routinely (especially the index for central obesity), routinely monitoring blood glucose, lipoproteins and blood pressure, treating individual risk factors according to established guidelines and carefully choosing anti-hypertensive drugs due to their different effects on insulin sensitivity.

The body of a person with metabolic syndrome has trouble with insulin resistance. Blood sugar rises in response to food and extra insulin needs to be made to absorb all of the sugar. The body can still make enough insulin to keep the blood sugar in the normal range but just barely. There is not any one diet that works for everyone with metabolic syndrome. Weight loss and exercise are what doctors recommend. Limiting alcohol and eliminating smoking are also advised. Sometimes medications to reduce high blood lipids and high blood pressure are also needed.

In people who have metabolic syndrome the ideal amount of dietary fat and carbohydrate for weight loss varies. Low-fat, high carbohydrate diets are probably not beneficial. This is because carbohydrates can raise blood insulin levels and triglycerides and reduce HDL-cholesterol. More fat and less carbohydrates are probably better for improving insulin sensitivity and blood lipids. This is especially true when the carbohydrates are mostly complex and the fat is mostly unsaturated. Diets like Atkins are not recommended because saturated fat raises triglycerides and LDL-cholesterol which increases risk for heart disease.

The amount and kind of exercise a person with metabolic syndrome does depends on their current fitness level. The biggest risk factor for heart disease is not being active. A good way to begin being active is by walking 5 minutes a day. Once a person is walking regularly they should slowly increase how far and how fast they walk, until they eventually walk for 30 to 60 minutes at least five days a week.

One way of reducing your risk is eating fewer calories. This can be done by eating less at each meal and skipping dessert. For snacks choose things like carrot sticks or rice cakes instead of candy bars or chips. When eating out ask that sauces and salad dressings be served on the side and use as little as possible of them. Instead of whole milk, cheese, yogurt, cottage cheese, etc. use reduced and then low-fat versions. Eat more whole grains, fruits, vegetables, and fish.

It is unfortunate that most people are not aware of the syndrome or their risk for developing it. Many experts are recommending an increased vigilance to identify patients at increased risk of this syndrome. They predict this syndrome could foster future epidemics of diabetes, strokes, and heart attacks. Health officials hope to address this serious public-health threat head-on by motivating patients to lose weight and exercise. Symptoms of metabolic syndrome can often be reversed through diet and exercise.

To understand the relationship between metabolic risk factors and the effectiveness of drug therapy in people who have metabolic syndrome more studies are needed. To gain the most benefit from modifying multiple metabolic risk factors, the underlying insulin resistant state must become a target of therapy. Once again, the best way is through exercise and weight loss.

I wrote this node because my dear friend suffers from metabolic syndrome. I worry about him and hope this write-up will remind him and others like him to watch what they eat and to be active.

FoodService Director, 2/15/2003, Vol. 16 Issue 2, p52, 1p
Medical Update, 2005, Vol. 30 Issue 10, p5, 1p

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