Once known as an obscure condition termed Syndrome X, metabolic syndrome has now hit the main stream media outlets as cause for concern. In recent years, we have learned that drinking as little as one soda per day, no matter if it was regular or diet, can increase the risk of heart disease through metabolic syndrome. Unfortunately, most people are unaware of the term “metabolic syndrome”, much less its consequences.
Metabolic syndrome is diagnosed using specific criteria (Table 1), but essentially patients are experiencing problems with insulin metabolism. Insulin is a hormone secreted from the pancreas in response to glucose consumption. Insulin binds insulin receptors on cells, allowing glucose to be cleared from the bloodstream and enter cells through special transporters in the cell membrane. When people eat too many refined sugars and grain products, cells stop responding to insulin. This is termed insulin resistance. Approximately 90 million Americans now have insulin resistance.
What factors or conditions place people at risk for developing metabolic syndrome?
1. Being overweight or having a waist circumference of >40 for men and >35 for women
2. Having elevated blood pressure, blood glucose or lipids
3. Sedentary lifestyle
4. Family history of type 2 diabetes, hypertension or cardiovascular disease
5. History of glucose intolerance or gestational diabetes
6. Sleep apnea
7. Polycystic ovarian syndrome
Health officials have done a great job getting out the word on the obesity epidemic, but effective approaches to deal with it are still lacking. The key to effective treatments is to understand the metabolic cascades and lifestyle factors that result in obesity. Fat cells, also called adipocytes, were once thought to be only store houses for fat. In the last 10 years, research has emerged showing that fat cells are actually active metabolic tissue secreting chemical mediators for inflammation. Obesity can actually be viewed as a low grade systemic inflammatory disease. Inflammation accounts for most chronic diseases including atherosclerosis, osteoarthritis and chronic pain.
Obesity and metabolic syndrome are closely linked. In children who are severely obese, the overall prevalence of metabolic syndrome is nearly 50%. The outcry over childhood obesity has been heard, and schools in our area are making attempts at changing school menus to reflect better choices that may impact the health of our future generation. Unfortunately, if we don’t address what children are eating at home, the schools’ efforts will be undermined.
Treatment for metabolic syndrome falls in the category of Therapeutic Lifestyle Changes, or TLC. The National Institutes of Health (NIH) and the American College of Cardiology (ACC) recommend therapeutic lifestyle changes as the standard of care for management of cardiovascular risk factors, like elevated cholesterol and metabolic syndrome. Unfortunately, in actual practice TLC is often discounted by physicians and insurance companies who instead turn to pharmaceutical agents. In fact, the 53rd Scientific Session of the ACC indicated that patients can achieve risk reduction of cardiovascular disease in only 3 months of initiating therapeutic lifestyle changes.
Instituting lifestyle changes is not as simple as giving a patient a handout on diet and exercise. In our practice, we are using a revolutionary program called FirstLine Therapy which is a TLC program. FirstLine Therapy is a clinically effective program that dramatically reduces total cholesterol, triglycerides, homocysteine and apolipoproteinB (risk factors for heart disease) in as little as 12 weeks. A clinical trial in patients with metabolic syndrome was published last year, demonstrating the effectiveness of FirstLine Therapy.
Correcting the underlying cause of disease is always of utmost importance. By using lifestyle changes including diet, exercise and stress reduction, metabolic problems resulting from years of unhealthy habits can be reversed. Research is demonstrating the cells can switch the signals of inflammation and insulin resistance and promote proper sugar metabolism. The old adage “it’s never too late” is certainly applicable to obesity and metabolic syndrome. For so many Americans who have struggled with weight problems and lipid and blood sugar abnormalities, there is a solution.
Diagnostic Criteria for Metabolic Syndrome
Patients must meet 3/5 of the following:
1. Elevated waist circumference
2. Elevated triglycerides
3. Reduced HDL
4. Elevated blood pressure
5. Elevated fasting glucose