Metabolic Syndrome: the deadly epidemic you've probably never heard of

September 24, 2008

It’s a dangerous recipe. Take elevated blood pressure, add high triglycerides and a pinch of high blood sugar. Mix them with a generous helping of belly fat and you’ve got what some medical professionals call “metabolic syndrome.”

Experts disagree about whether metabolic syndrome is a condition in and of itself, vs. a collection of risk factors (see chart, p. 12) that also includes low HDL (“good”cholesterol).Most do agree that three or more of these risk factors together significantly increase the chance of heart disease, stroke and diabetes.An estimated 47 million U.S.adults — about 25 percent — have metabolic syndrome, also called “Syndrome X”and “Insulin Resistance Syndrome.” That number is expected to grow to 50 million to 75 million by 2010. While most common in people over 60, metabolic syndrome is increasing at an “alarming rate”in children and adolescents due to childhood obesity, says Michael Radin, M.D., of the Diabetes,Metabolic Disorder, Endocrinology Practice in Plainville. “It’s an epidemic, but not a lot of people know about it,”says Radin, also a physician with the Joslin Diabetes Center Affiliate at The Hospital of Central Connecticut.“A significant portion of people have metabolic syndrome but have no symptoms or choose to ignore symptoms.” It’s not hard to be oblivious.“If you have a rash, you’ll take care of it because it’s itchy or painful,”Radin says.“But you can walk around with a blood pressure of 180 and not feel a thing.”

One bad apple

One risk factor is obvious.“If someone comes into our office with a large belly, I’m probably going to test him or her for the other risk factors,”says Kathryn Tierney, M.S.N., A.P.R.N.-B.C., an advanced practice registered nurse with Radin’s practice. Tierney looks for an “apple” body type — mostly belly fat — vs. a “pear,”with mostly hip and thigh fat. For most men that’s a waist circumference of 40 inches or more;for women 35 inches or more.Excess weight anywhere can cause problems, but abdominal fat is more metabolically active, making hormones that cause inflammation and contribute to insulin resistance.

Insulin, a hormone made by the pancreas, helps control sugar levels in the bloodstream. After you eat,your digestive system breaks some foods down into sugar (glucose) that your cells use as fuel. Normally,insulin helps cells absorb glucose, but insulin resistance impairs the process.In response, your body creates more insulin, leaving you with more insulin and glucose in your blood.The resulting condition can lead to impaired fasting glucose or impaired glucose tolerance — also known as pre-diabetes.

The snowball effect

You can have insulin resistance and even type 2 diabetes without having metabolic syndrome, which illustrates a disturbing aspect of the syndrome.Each metabolic syndrome risk factor can, on its own, cause the same kinds of problems the risk factors cause together. Just being overweight puts you at risk for diabetes. Having high levels of triglycerides puts you at risk of cardiovascular disease.And each risk factor can exacerbate the others. Increased insulin raises your triglycerides and other blood fat levels. It also interferes with kidney function, leading to higher blood pressure.“These risk factors on their own are dangerous,”Tierney says.“Put them together and you can see how untreated metabolic syndrome is a potentially deadly condition.” The rate of cardiovascular disease among people with metabolic syndrome is two to four times higher than with the general population; the rate of diabetes, five to 30 times higher.Metabolic syndrome can also lead to infertility, cancer, arthritis, dementia,sleep apnea and liver damage. Death rates — due to cardiovascular and other conditions — are also higher for people with metabolic syndrome.

Hold the fries…and burger

The exact cause of metabolic syndrome is unknown, but contributing factors include:

• Age: Metabolic syndrome affects less than 10 percent of people in their 20s but more than 40 percent of people in their 60s.
• Genetics: A family history of type 2 diabetes or diabetes during pregnancy (gestational diabetes).
• Lifestyle: Low physical activity and excess caloric intake.

The typical Western diet, high in refined grains, processed meat and fried foods, is a particular problem,Radin says. He cites a study that followed 9,514 people ages 45-64 over nine years. It found eating a Western diet increased the risk of developing metabolic syndrome 18 percent. Two servings of meat a day vs. two a week increased the risk by 26 percent;and one serving of fried food daily (vs. none) increased risk by 25 percent. For reasons researchers don’tcompletely understand, consuming one diet soda daily led to a 34 percent increased risk, the study showed.While medications can treat high blood pressure, cholesterol and blood sugar,“you can substantially reduce or eliminate metabolic syndrome risk factors without medication or surgery,” Radin says.“Lose 7 to 10 percentof your body weight and you’ll see a drop in everything – blood pressure, triglycerides, insulin levels.”

“Unfortunately very few people make these changes. They’re looking for the quick fix,”Tierney adds.“But when they do, it’s dramatic.”

Small changes, dramatic results

“It’s difficult for people to change how they eat,”says Patricia O’Connell,R.D.,M.S., a registered dietitian and certified diabetes educator with the Joslin Diabetes Center Affiliate at The Hospital of Central Connecticut.“Even if they’ve seen a family member suffer from complications of diabetes,that does not always translate into appropriate lifestyle changes.”

“Knowledge doesn’t always lead to behavior change,” agrees Karen McAvoy, M.S.N., R.N., Joslin’s diabetes education coordinator. They acknowledge that the advice “eat less and exercise more” sounds simple, but is difficult for many to follow. That’s why metabolic syndrome patients are often referred to Joslin and other hospital programs, including the Weigh Your Options clinical weight loss center and Elliot and Marsha Cohen Good Life Center. Program staff provide education, supervised exercise and nutrition plans, counseling and other tools to help people make long-term,lifestyle changes.One of the first steps is helping people understand the difference between “going on a diet” and changing eating habits. Determining what you should and shouldn’t eat can be enormously confusing. “What foods are ‘bad?’ There really are no ‘bad’ foods, just better choices. There is research that backs a low carbohydrate approach and research that backs low fat,” O’Connell says.

Actually it depends on the types of carbohydrates and fats. Certain calorie-dense, nutrient-poor carbohydrates are problematic for people with metabolic syndrome (and many other conditions) because they worsen insulin resistance and promote weight gain. These include highly processed carbohydrates (sugars and starches) like those found in white rice, white bread,sugary baked goods and sodas.Better carbohydrates are whole grains, fruits, vegetables and beans,which also include fiber, vitamins and minerals.Trans fats and saturated fats – found in foods like whole-milk dairy products, some margarines, fatty meats, egg yolks and partially hydrogenated vegetable oils – should also be avoided. Better choices are monoand polyunsaturated fats, found in olive oil, almonds, avocadoes and other sources, and omega-3 fats,found in fish.

In general, a healthy diet should include lots of fruits and vegetables;whole grains; some lean protein like fish and chicken (minus the skin);and smaller amounts of mono- and poly-unsaturated fats.To help people ease into new eating habits, Radin offers these tips:

• Include a fruit or vegetable with each meal or snack
• Eliminate soft drinks and juice
• Eat smaller portions (When eating out, order the smallest portion size; share entrees; and take home a doggy bag.)

When cooking:

• • Make lower-fat versions of recipes; use low-fat dressings and mayonnaise, and skim or 1 percent milk. (Check labels — some low-fat foods have as many calories as their full-fat counterparts).
• Bake, broil or grill vs. frying.
• Use non-stick pans and cooking sprays vs. butter and oil.

The other half of the weight-loss equation is exercise. Experts recommend 30 to 60 minutes daily — which can seem overwhelming to someone who’s never exercised, or hasn’t in awhile. “We tell people to start slowly,” McAvoy says. “Start with two minutes, go to five minutes, 10 minutes and so on.You don’t have to run — walking has been found to help most with central obesity.” She also suggests people schedule exercise, just as they would meetings or other appointments.Adds O’Connell, “People need to think of exercise more as medicine, vs. something you have to do. You don’t look outside and say, ‘It’s cloudy — I’m not going to take my pills today.’The same holds true for exercise.”

She and other experts offer these exercise tips (check with your doctor before starting an exercise program):

• Find an activity you enjoy — walk, swim, bike, dance — anything that gets you moving
• Play a backyard game with your kids or grandkids
• Get an exercise partner
• Take stairs vs. the elevator
• When you go to the store, etc., park your car farther from your destination
• Walk around when talking on the phone
• Join a gym. Some insurance companies offer discounts on supervised exercise programs or gym memberships.

Making even small changes to your food intake and activity level can make a difference. The Diabetes Prevention Program research study found that the prevalence of metabolic syndrome decreased 43 percent to 51 percent among study participants who lost 7 percent of body weight and exercised at least 150 minutes weekly. “If you catch metabolic syndrome early and make lifestyle changes,you can not only eliminate the risk factors, you can in some cases prevent diabetes and cardiovascular disease,”Radin says.“It’s an example of how much control we really have over our health.”

Metabolic syndrome risk factors

According to the American Heart Association and National Heart, Lung, and Blood Institute, three or more of these components together may indicate metabolic syndrome:

Elevated waist circumference:

• Men—40 inches or larger
• Women—35 inches or larger

Elevated triglycerides: 150 mg/dL or higher
Reduced HDL (“good”) cholesterol:

• Men—Less than 40 mg/dL
• Women—Less than 50 mg/dL

Elevated blood pressure: 130/85 mm Hg or greater
Elevated fasting glucose: 100 mg/dL or greater