Words: Dr Ryan N HARRISON
A ‘syndrome’ is a pattern, or collection, of symptoms that together indicates a disease. You don’t actually ‘catch’ a syndrome like you do a virus. Rather, the word ‘syndrome’ is used to describe a concurrence of symptoms that act as hallmarks for a disease, or health condition.
Metabolic syndrome — or, Syndrome X, Metabolic Syndrome X, or Insulin Resistance Syndrome — is a collection of symptoms of overall poor health, aside from risk factors of developing heart disease, stroke and diabetes. In fact, for the past 25 years+ more than a handful of physicians have judged metabolic syndrome to be a powerful, if not the most powerful, indicator of eventual heart attack.
According to a health survey, more than one in five Americans, for instance, has metabolic syndrome. It is also reported that a full quarter [25 per cent, or 1 in 4] of all American adults are estimated to have this syndrome. Besides, the likelihood of having metabolic syndrome rises with age — affecting more than 40 per cent of people in their 60s and 70s.
The primary symptoms of metabolic syndrome include:
- Insulin resistance
- Inability to fully metabolise carbohydrates
- Hypertension [high blood pressure]
- Cholesterol abnormalities
- Increased risk for clotting
- Overweight, or obesity.
You are clinically diagnosed with metabolic syndrome, if you have three or more of these symptoms. An interesting point is: a part of the earlobe crease appearing at a 45‐degree downward angle towards the shoulder and an elevated waist to hip circumference.
In a society in which 66 per cent of us are either overweight, or obese, it’s easy to understand how it’s possible that up to 25 per cent of the population has this syndrome. And, if current diet and lifestyle trends do not improve, the number will only climb, while increasingly affecting our children.
Insulin resistance is a particularly important part of the metabolic syndrome equation. As dietician Karlene Karst suggests — high insulin levels are actually the root cause of the syndrome. She also states that while it is possible to have insulin resistance without having metabolic syndrome, individuals who have metabolic syndrome always have insulin resistance. Insulin resistance refers to the diminished ability of cells to respond to the action of insulin in promoting the transport of blood sugar [glucose], from the blood into the muscles and other tissues.
Consistently high levels of insulin and glucose are linked to several harmful changes in the body, including —
- Damage to the lining of coronary and other arteries, a key step towards the development of heart disease, or stroke
- Changes in the kidneys’ ability to remove salt, leading to high blood pressure, heart disease and stroke
- Increased triglyceride levels, resulting in increased risk of developing cardiovascular disease
- Increased risk of blood clot formation, which can block the arteries and cause heart attack and stroke
- A slowing of insulin production, which can signal the start of type-2 diabetes, a disease that can increase your risk for heart attack, or stroke, and may damage your eyes, nerves, and kidneys.
There are other concerns that should be mentioned as well. Metabolic syndrome is associated with fat accumulation in the liver [fatty liver], resulting in inflammation and the potential for cirrhosis. The kidneys can also be affected, as there is an association with microalbuminuria, the leaking of protein into the urine, a subtle but clear indication of kidney damage.
Other problems associated with metabolic syndrome include obstructive sleep apnoea, polycystic ovary syndrome, increased risk of dementia with aging, and cognitive decline in the elderly.
Causes
As is true with several medical conditions, genetics and the environment both play important roles in the development of metabolic syndrome. Genetic factors influence each individual component of the syndrome, and the syndrome itself.
For example, a family history that includes type-2 diabetes, hypertension, and early heart disease greatly increases the chance for an individual to develop metabolic syndrome. Environmental issues, such as low activity level, sedentary lifestyle, and progressive weight gain also contribute significantly to the risk of developing metabolic syndrome.
While obesity is a strong risk factor, others factors of concern include:
- Women who are post‐menopausal
- Smoking
- Eating an excessively high carbohydrate diet
- Lack of activity [even without weight change]
- High intake of alcohol.
Environmental factors play an important part, but Karst maintains that metabolic syndrome is caused by a poor diet and lifestyle. She places insulin resistance, right at the centre of the equation.
Insulin Resistance
Insulin resistance means that the body does not use insulin efficiently to lower glucose and triglyceride levels. Insulin resistance is a combination of genetic and lifestyle factors. Lifestyle factors include diet, activity and, perhaps, interrupted sleep patterns, such as sleep apnoea.
Typically, insulin resistance develops as a result to a diet high in sugar, refined carbohydrates, and processed foods, especially when combined with a sedentary lifestyle. It certainly doesn’t help that over 70 per cent of the calories consumed by people in the US. and Canada, among others, come from foods that never existed in our ancestor’s diets: refined sugar, artificial sweeteners, white flour, high fructose corn syrup and transfats. Our bodies are not equipped to handle such ‘foods’ and the unnatural strain they put on our body’s various systems.
Insulin’s job is to ‘push’ glucose [blood sugar] into insulin receptor ‘doors’ on the surface of cells. When the body is continually blasted by foods containing high levels of simple sugars, the cells are bombarded with so much insulin that these ‘doors’ begin to malfunction and shut down. With fewer doors open, the body needs to produce even more insulin to push glucose into the cells. The pancreas is stimulated by sugar’s continued presence to produce more insulin, and a vicious cycle is in place, resulting in a condition called ‘insulin resistance.’
Blood insulin levels are chronically high — this inhibits fat cells from giving up their energy stores to help us lose weight. The more overweight we are, the more resistant to insulin we become, primarily because extra fat causes a hormone reaction that closes the cells’ doors to incoming glucose.
It’s a grim picture. The good thing is: as we lose body fat, insulin resistance improves.
Prevention
Since insulin resistance, physical inactivity and excess weight are the main underlying contributors to the development metabolic syndrome, all of them are preventable in stopping metabolic syndrome before it starts, is the best way to approaching it. Obviously, getting more exercise and losing weight can help reduce, or prevent, the complications associated with this condition. Preventing insulin resistance is important. It’s also probably more difficult, as it may require changes in long‐established patterns of eating and addiction.
Preventing Insulin Resistance
Naturally, the best way to prevent insulin resistance is to avoid the foods that promote it. This means staying away from refined sugar, white flour products, simple carbohydrates, etc. Maintaining a normal weight, eating a balanced diet, and keeping up a regular programme of aerobic exercise are the best preventive measures. Increasing fibre consumption is also helpful, as fibre slows the movement of sugar from food into the blood stream.
Losing Weight
Moderate weight loss, in the range of 5-10 per cent of body weight, can help restore the body’s ability to recognise insulin and greatly reduce the chance that the syndrome will evolve into a more serious illness.
Exercise
Increased activity alone can improve insulin levels. Aerobic exercise, such as a brisk 30‐minute daily walk can result in weight loss, improved blood pressure and cholesterol levels and a reduced risk of developing diabetes. Most healthcare providers recommend 150 minutes of aerobic exercise each week. Exercise may reduce the risk for heart disease, even when there is no accompanying weight loss.
Change The Diet
Metabolic syndrome is largely a nutritional disease that is manageable with dietary corrections — reducing carbohydrates, such as sweets, pastas and breads, and instating good fats [especially essential fatty acids] in carbohydrates’ place. A suitable, or appropriate, breakdown of the food groups should be about 45 per cent of calories from carbs, 40 per cent from fats and 15 per cent from protein.
Change The Fats
Finding the right balance of dietary fats is important as the wrong kinds of fats can contribute to insulin resistance by interfering with the burning of glucose and increasing insulin resistance. Eating cold‐water fish [such as wild salmon, tuna, mackerel, sardines or anchovies], two times/week, including flaxseed and nuts [such as walnuts, Brazil nuts, etc.] in the diet, and eating as much as dark green, and leafy vegetables as possible, will all help restore the omega‐3 to omega‐6 balance that is so important in preventing insulin resistance.
Omega‐3 fatty acids [fish oils] help maintain flexible cell membranes. This is important because only healthy membranes contain large numbers of insulin receptors, while increasing the surface areas available for insulin binding. Up to 2,000-4,000mg [4gm] of omega‐3s a day can be helpful to prevent metabolic syndrome.
Limit/Avoid Alcohol
While some recent studies suggest that drinking alcohol in strict moderation may help prevent metabolic syndrome, limiting its consumption is a better choice. Drinking too much alcohol can raise blood pressure and triglyceride levels and it can also harm the liver, brain and heart. In addition, alcohol is a source of empty calories, which inhibits weight loss, an important component of prevention.
Management
The major goals are to address both the underlying cause of the syndrome, and also the cardiovascular risk factors, if they persist. A majority of people with metabolic syndrome are overweight and lead a sedentary lifestyle. Therefore, lifestyle modification is the preferred treatment. Weight reduction usually requires a specifically tailored multifaceted programme that includes diet and exercise. Conventional medical care typically uses medications to aid in treatment, but we will explore suggestions for nutritional supplementation.
Diet
In general, a well‐balanced diet high in whole foods and low in sugars and saturated fats is a good start. A diet high in fibre helps to balance blood sugar. So, vegetables, nuts, seeds and whole grains should be encouraged. Protein also helps balance blood sugar, so viable sources of vegetable protein [or, lean animal protein] with each meal, or as snacks, is also a good suggestion. Several smaller meals throughout the day are better than three larger ones, as they will help keep the blood sugar and insulin levels steady. Sugars, white flour products, alcohol, caffeine and sources of saturated fat should be strictly avoided. They spike insulin and blood sugar levels, especially in the case of saturated fats, and increase the risk of diabetes and heart disease. Also, avoid artificial sweeteners, transfats and high‐glycaemic load foods.
There is now a trend toward the use of a Mediterranean diet — one that is rich in ‘good’ fats [olive oil] and contains a reasonable amount of carbohydrates and proteins [from fish and chicken]. The Mediterranean diet is palatable and easily sustained. In addition, recent studies have shown that when compared to a low fat diet, people on the Mediterranean diet have a greater decrease in body weight, and also greater improvements in blood pressure, cholesterol levels, and other markers of heart disease — all of which are important in evaluating and treating metabolic syndrome.
Exercise
A sustainable exercise programme is a key component in addressing metabolic syndrome, provided there is no medical contraindication. There is a beneficial effect of exercise on blood pressure, cholesterol levels, and insulin sensitivity, regardless of whether weight loss is achieved, or not. Thus, exercise in and of itself is a helpful tool in treating metabolic syndrome. Conversely, research shows that there is no benefit in cosmetic surgery to remove fat where insulin sensitivity, blood pressure and cholesterol are concerned. Diet and exercise remain the best courses of action.
Supplements
Chromium. Improves glucose tolerance and balances blood‐sugar levels. Take a daily total of up to 1,000mcg.
Magnesium. Magnesium plays an important role in the prevention and treatment of metabolic syndrome and diabetes. It benefits the two conditions by increasing the number and sensitivity of insulin receptors. The dosage suggestion is 500‐1,000mg daily of magnesium bound to glycinate, succinate, citrate, or aspartate. Magnesium oxide, in larger dosages, can cause loose stool.
Gymnema sylvestre. This herb [meshashringi, in Ayurveda] is native to the tropical forests of southern and central India. It lowers blood sugar levels. Take 400mg of the herbal supplement, or 25 per cent of gymneic acid extract daily.
Alpha-lipoic acid. Some researchers credit alpha‐lipoic acid with being the principal supplement for preventing and reversing metabolic syndrome. The supplement earned the reputation by increasing the burning of glucose. The body needs alpha‐lipoic acid to produce energy; it plays a crucial role in the energy‐producing structures in cells [mitochondria]. The body actually makes enough alpha‐lipoic acid for this basic function. Alpha‐lipoic acid acts as an antioxidant, however, only when there is an excess of it and it is in the ‘free’ state in the cells. There is little free alpha‐lipoic acid circulating in your body, unless you consume supplements, or get it injected. Alpha‐lipoic acid is a versatile antioxidant — it helps deactivate an unusually wide array of cell‐damaging free radicals in several bodily systems and also improves insulin sensitivity. 100‐250mg/day, in concert with other antioxidants, may be sufficient to protect against metabolic syndrome. However, typical doses range from 300‐1,800mg daily.
Vanadyl sulphate. Vanadyl sulphate is the most popular and common form of vanadium, an element in the body that is found in foods such as pepper, dill, radish, eggs, vegetable oils, buckwheat, and oats. There has been some debate over whether, or not, it is an essential nutrient. Recently, a great deal of attention has been paid to vanadium because of its insulin‐mimicking activities. It improves glucose tolerance in people with insulin resistance. Take 100‐300mg daily; higher doses require the supervision of a physician.
Biotin. Biotin is involved with proper glucose metabolism. Take 9‐16mg daily.
High‐potency multivitamin/mineral supplement. This will supply most of the nutrients involved with blood sugar metabolism. Take as directed by your physician.
Essential fatty acids. EFAs — especially omega‐3s — are vital to health and proper insulin function. Flaxseed, or fish oil, combined with evening primrose oil, is a good idea. Take as directed and up to 9 gram [9,000mg] daily in divided doses.
Bitter melon. This can help balance blood‐sugar levels. Take 200mg, three times daily, or 5ml of the tincture, twice daily.
Garlic. This is an important herb for stabilising blood sugar and reducing the risk of heart disease and other circulatory disorders by improving blood flow, lowering elevated blood pressure, and reducing levels of ‘bad’ cholesterol. Take 300‐450mg, twice daily.
Fenugreek. This herb stabilises blood sugar. Take a product with an equivalent dosage of 15‐50gm daily.
Conclusion
The term ‘metabolic syndrome’ is a way of identifying individuals at high risk for the development of heart disease and diabetes. We all know that obesity, high cholesterol, and hypertension are bad omens. We also know that insulin resistance precedes type-2 diabetes, and can itself be an important condition meriting treatment. Each of us knows someone who is overweight, hypertensive, or has cholesterol levels that are ‘a little high.’ It may be a brother, sister, parent, neighbour, or even yourself.
While the actual definition of metabolic syndrome is subject to vary, the known clustering that occurs suggests that adults with any major cardiovascular risk should be evaluated for the presence of other risk factors. Individuals at risk should receive education and counselling on lifestyle modifications, and all risk factors for heart disease should be treated promptly and earnestly.
The fundamental point to understand is that it is important to treat risk factors as ‘bad things’ before ‘worse things’ happen. While such changes can be addressed in your office, the other 99 per cent of the time, they need to be addressed in the real world. This means we need to start having healthier food options readily available. We need to also have the time during the day to take a walk. We simply and basically need to restructure certain fundamentals in our society, because individuals having metabolic syndrome should be supported in making such, but often difficult, changes.
