Metabolic Syndrome Revisited 

Antoaneta Sawyer, PhD 

 

Metabolic syndrome (MetS) is highly prevalent in the today’s Western World, and the number of people who struggle with it or its deadly consequences continues to rise. The reason for the increased incidence of MetS in the highly industrialized countries is mainly due to the high level of stress, malnutrition, use of over processed food, and physical inactivity. It includes cardiovascular disease, diabetes 2, abdominal obesity (increased waist circumference), hypertension, high triglycerides, low levels of high density lipoprotein (good cholesterol), and high levels of low density lipoprotein (bad cholesterol) combined with high fasting glucose levels (insulin resistance).

There is also a debate as to whether it is obesity or insulin resistance that causes metabolic syndrome, or if the syndrome is a result of a greater metabolic cause.  It is a cluster of conditions that occur together in one and the same person. It is increasing the risk of heart disease, stroke and diabetes. Having just one of these conditions- increased blood pressure, elevated insulin levels, excess body fat around the waist or abnormal cholesterol levels- is not a guarantee that you have metabolic syndrome, but it does contribute to the risk of it. If more than one of these conditions occurs in combination, the risk is even greater.

Having already metabolic syndrome or any of the components of the syndrome, one should have the opportunity to make aggressive lifestyle changes. Making these changes can delay or derail the development of those serious diseases that may result from metabolic syndrome.  Metabolic syndrome is worth caring about because it is a condition that can pave the way to both diabetes and heart disease, two of the most common and important chronic diseases of 21^st century. It can increase the risk of type 2 diabetes (the most common type of diabetes) anywhere from 9-30 times that of the normal population and despite clinical studies vary the risk of heart disease increases 2-4 times over the normal population. There are other concerns as well as fat accumulation in the liver (fatty liver), resulting in chronic inflammation and the potential for degenerative 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 apnea, polycystic ovary syndrome (POOS), increased risk of dementia with aging, and rapid cognitive decline in the elderly.   

Excess of insulin can cause fat storage. When excess insulin is secreted in response to excess sugar consumption, the blood sugar (glucose) is stored in fat cells. Normally, the glucose is used by the cells of the body and mostly stored in the muscles and the liver. But when there is more than the body can use, insulin forces fat cells to take in blood lipids called triglycerides and fat cells grow. Our daily energy is very dependent upon our blood sugar balance. If our blood sugar is too low we can become mentally and physically fatigued. Low blood sugar can come from either skipping meals or making unhealthy food choices like sweets, pastries, or any refined and processed flour product (such as breads, pastas, cookies, chips, and crackers that are not 100% whole grain). So now that we have discussed some of the common causes of a lack of energy, let’s talk about ways to get healthy energy levels that will truly keep you going all day long with no jittery feelings or the inevitable crash

Metabolic syndrome can remain latent for years, masquerading as other diseases like: Chronic Fatigue Syndrome (CFS), attention deficit disorder (ADD), obesity, kidney failure with edema (fluid retention), bipolar disorder, etc. Despite the serious cardiovascular risk posed by metabolic syndrome, there is currently no standard, accepted interventional treatment regimen to prevent the disorder. However, for those at greatest risk for metabolic syndrome, phenotypic nutrition allows nutritionists to tailor a nutrient and supplement strategy to amplify beneficial biochemical pathways as well as gene expression. After experiencing the modern scientific, technological and materialistic civilization, it has become clear that the very existence of life on this planet may be endangered by the rapid degeneration of human health in the modern world, and that the life sciences, including the modern approach, have been inadequate to preserve human well-being from such universal decline. Not only internal treatments and external surgical applications, but also the techniques of modern diagnosis itself are frequently harmful to human health. In view of these circumstances, the renaissance of traditional wisdom based on a more total comprehension of cosmology, including the arts of health and diagnosis has become absolutely essential to recover humanity, individuality and collectivity (Michio Kushi 1980; 115).

One survey in 1990 found that 33.8% of Americans were using some form of alternative medicine and a later survey done by Dr. David Eisenberg (1997) found that the above use had increased to 42.1% in 1997. There is no currently available survey that thoroughly evaluates how many patients with diabetes are using complementary and alternative medicine. A recent survey of diabetes educators listed the following as the most recommended and used therapies - physical activity, self-help groups, lifestyle diets, laughter and humor, relaxation therapy, prayer, imagery/visualization, meditation, massage, and music therapy. An increasing number of people in the Western world are exploring alternative medicine as part of their medical care. In 1997, Americans made more than 629 million visits to alternative medicine practitioners, a 47% increase since 1990 (Eisenberg D.M. 1997). This number substantially exceeds the 386 million visits made to all primary care doctors in the same year. The conditions for which people are most likely to seek alternative medicine treatments include chronic pain, obesity, stress management, migraine headaches, arthritis, cancer, autoimmune disease, etc. Some people also seek alternative medicine treatment when conventional treatment offers little hope, especially at the end of life.

A recent Canadian survey indicated that approximately one third of over 500 persons surveyed used some sort of alternative treatment. The reasons people use these treatments have included the major belief that "alternative medicine" works without harm. Other reasons include prevention of illness, “wellness" beliefs in healing specific health problems, including back pain, headache, emotional problems, musculoskeletal problems, and infections. Another survey found that persons felt there were added benefits from alternative medicine use, lower cost, and perceived fewer side effects. Lesser used therapies taken in oral form included herbal medicine, multivitamin therapy, homeopathy, and Ayurveda. Other surveys of CAM use by diabetes patients include faith healing, macrobiosis (macrobiotic diet), membership in religious organizations, clinical ecology (using chromium and nicotinic acid treatment with resultant insulin dose decrease), astrotherapy (tying pieces of coral around the arms), reflexology (massage of foot areas said to represent internal organs), pearl therapy (oyster pearls boiled in milk and then drinking the liquid), herbal treatment, meditation, and homeopathy. (Feinstein, 2008) The use of complementary and alternative healing in metabolic syndrome is widespread with substantial number of patients deserting conventional metabolic syndrome management in favor of holistic methods.   

The main features of metabolic syndrome include insulin resistance, hypertension (high blood pressure), cholesterol abnormalities, and an increased risk for clotting and the patients are most often overweight or obese. Insulin resistance refers to the diminished ability of cells to respond to the action of insulin in promoting the transport of the sugar glucose, from blood into muscles and other tissues. Because of the main role that insulin resistance plays in the metabolic syndrome, a separate part of the study as devoted to insulin resistance. The literature research depicts that long with regular medical checkups few tests will help to diagnose and monitor the syndrome (Grundy et al 2005)

The terms "metabolic syndrome," "insulin resistance syndrome,” dysmetabolic syndrome”,  “syndrome X",  Raven’s syndrome, CHAOS (in Australia) are now used specifically to define a  constellation of conditions or abnormalities that is associated with increased risk for the development of type 2 diabetes and atherosclerotic vascular disease (e.g. heart disease, coronary artery disease and stroke). 

This constellation of conditions can be also named the “Deadly Quintet”, due to the fact that Metabolic Syndrome can include type 2 diabetes (the most common type of diabetes mellitus), high blood insulin levels, high blood pressure, obesity and poor lipid profile (dyslipidemia) - elevated LDL (“bad”) cholesterol,  low HDL (“good”) cholesterol, and elevated triglycerides, with increased risk for clotting.

Metabolic syndrome comprises an accumulation of different and mutually intensifying diseases and risk factors, which mostly share the same causes. Metabolic Syndrome is actually is a cluster of disorders, all of which are affected by both genetics and lifestyle intrinsic and extrinsic factors. It affects a large number of people in a clustered fashion. In some studies MS is calculated as being up to 25% of the population in USA. 

Metabolic Syndrome increases the risk of type 2 diabetes (the most common type of diabetes) anywhere from 9-30 times that of the normal population and despite studies vary the risk of heart disease increases 2-4 times over the normal population. There are also other concerns as well as fat accumulation in the liver (also known as fatty liver), resulting in chronic inflammation and the potential for degenerative 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 apnea, polycystic ovary syndrome (POOS), increased risk of dementia with aging, and rapid cognitive decline in the elderly.

What remains yet controversial is whether metabolic syndrome should be considered a coronary equivalent or not. The main features of metabolic syndrome include insulin resistance, obesity, hypertension (high blood pressure), cholesterol abnormalities, and an increased risk for clotting.

Mechanism of appearance (Pathogenesis): An important pathogenic factor is the insulin-resistance which is often a consequence of increased obesity.  

Metabolic syndrome or the “Deadly Quartet” of 21 century is a cluster of: 

 

• Abdominal obesity (waist circumference( Men — waist greater than 40 inches; Women — waist greater than 35 inches

• Triglycerides — greater than 150 mg/dl

• HDL Cholesterol — less than 50 mg/dl in women, and less than 40mg/dl in men.

• Blood pressure — greater than 130/ 85 mm Hg

• Fasting glucose — greater than 110 mg/dl    

Tests you must request:

 

• Fasting blood sugar or three-hour glucose  tolerance test (diagnoses pre-diabetes)

• Hemoglobin A1c (measures the chronic blood sugar glycation control)

• Iron panel — includes ferritin, tranferrin,  iron-binding capacity and free iron level

• Cholesterol (with complete breakdown of  subtypes)-LDL, HDL, VLDL,

• Triglycerides

• Independent risk factors: homocysteine, Lp(a), fibrinogen and CRP

• Blood pressure frequent monitoring

• Waist measurement ( BMI)

• C-reactive protein test (CRP) and Homocysteine test. The above tests measure the rate of inflammation. 

• Total cholesterol, HDL, LDL and triglyceride test. The above tests measure the level of dyslipidemia.

• Urine test for microalbuminuria

• Hb (A1) or glycosilated (glycated) test. This HB is a form that is implicated in the diabetic nephropathy, retinopathy and neuropathy and diabetes 2

 To diagnose the Metabolic Syndrome one must present the following:  

• Central obesity (waist circumference) greater than 40 inches for men and greater than 35 inches for women

• Fasting blood triglycerides greater than or equal to 150 mg/dl

• Blood high-density lipoprotein (HDL) of less than 40 mg/dl for men and less than 50 mg/dl for women

• Blood pressure greater than or equal to 130/85 mmHg

• Fasting glucose greater than or equal to 110 mg/dL.

• Fasting plasma glucose test. This convenient test measures blood glucose after at least 8-12 hours of fasting. It is used to detect diabetes or pre-diabetes

• Oral glucose tolerance test. This highly sensitive test, which is used to diagnose diabetes or pre-diabetes, measures blood glucose after fasting for at least 8 hours and 2 hours after a glucose-containing beverage.

• Casual (random) plasma glucose test. This test measures blood glucose no matter when last meal was eaten. This test, along with other symptoms, is used to diagnose diabetes but not pre-diabetes.

Note * Test-results that come back positive for diabetes should be confirmed by repeating the fasting plasma glucose test or an oral glucose tolerance test on a different day. If one has been diagnosed with prediabetes or diabetes, there are a number of different ways to monitor it. Your MD will select the right drug, or procedure, while the ND- the correct diet, nutraceutical, herb or lifestyle changing approach.

Despite that there is no unified treatment or a disease cure, right diet, nutritional and herbal supplementation, lifestyle changes can help support healthy blood sugar levels and control metabolic syndrome. Several vitamins, minerals, herbs and antioxidants have been studied for their efficacy at promoting healthy blood sugar and protecting cells from the damage of elevated oxidation with favorable results.

The high cost of managing metabolic syndrome, together with the recent economical situation have led to a growing interest in potentially gentler modalities and methods presented as a strategy by the alternative medicine. CAM model is following correct and balanced nutrition, active lifestyle and exercise combined with behavior changes, relaxing techniques recognizing that all the above modalities can play important role in prevention and ameliorating the metabolic syndrome. Improving nutrition by eating more vegetables (50% of intake), by eating organic produce while increasing good fats (i.e. nuts, salmon, avocado, olive oil), eating fresh and avoiding preservatives, processed food, fructose corn syrup, artificial sweeteners, simple sugars and bad fats (fried food, hydrogenated oils). The AMA has lately recommended a growing consensus of additional multi-vitamin/ mineral to “prevent chronic disease”. This is the premise for supplementing nutrients through super foods (i.e. green foods, spirulina, chlorella, gogi berries, acai, mangosteen, noni, bee pollen) and other phytoproducts.

It is quite obvious that there is no single magic bullet that can overcome this condition. Fortunately, Metabolic Syndrome can be reversed with dietary, lifestyle, and nutritional supplements. Dr Reaven, the acknowledged father of this syndrome, advocates a diet high in unsaturated fat (45%), low in protein (15%), and moderate in carbohydrate (40%). Exercise, weight management, and optimum nutritional supplements such as chromium polynicotinate, vitamin C, proline, lysine, and other antioxidants help to normalize sugar and increase insulin sensitivity. Every attempt should be made to reduce total body weight to within 20% of the "ideal" body weight calculated for age and height. If this is done Metabolic Syndrome will improve significantly.

 There are several steps that must be followed:

         1. Diet: The primary treatment for metabolic syndrome is the correct “metabolic” diet. A diet high in protein is suitable for those with normal insulin sensitivity, but inappropriate for those with metabolic syndrome. It is important to note that there are good fats and there are bad fats. The fats recommended by Dr. Reaven are mostly heart-friendly unsaturated fats from plant and vegetable sources such as olive oil and nuts, not from the artery-clogging saturated fats present in steaks. Dr Reaven suggests replacing saturated fats with and mono- and poly -unsaturated fats will equally benefit LDL cholesterol lowering as compared to replacing saturated fats with carbohydrates. Mono- and poly-unsaturated fats do not raise insulin levels, so you get the benefit of both LDL cholesterol and Metabolic Syndrome control. Unsaturated fats are found in foods such as vegetable oils (olive oil in particular is high in mono-unsaturated fats) nuts, and avocados, whereas saturated fats are abundant in fatty cuts of meat and whole milk dairy products. It has been postulated that use of low glycemic-index carbohydrates will avoid worsening the manifestations of Metabolic Syndrome due to its slow glucose release and absorption rate. There is little doubt that low glycemic-index carbohydrates such as fruits and vegetables are superior when compared to high glycemic-index carbohydrates such as white flour and white bread. Dr Reaven studied this by increasing the fiber intake to the level recommended by the ADA for diabetics, and it had almost no effect. In a recent paper, substantial increases in the fiber level (exceeding the ADA recommendation) resulted in improved metabolic characteristics, as compared to a high carbohydrate/low fat diet. The most problematic type of carbohydrate for people with metabolic syndrome are the simple carbohydrates which are found in foods such as cakes, candies, pies, muffins, and ice cream. These foods contain large amounts of sugar, which go straight into the blood and quickly raise blood sugar, hence increasing the demand for insulin to bring the blood sugar levels back down. Even complex carbohydrates such as potatoes, bread, and pastas are fairly quickly digested and broken down into sugars. It is therefore very important that people with insulin resistance limit their intake of all complex carbohydrates. Proteins and most vegetables, on the other hand, do not have this effect on blood sugar. Proteins, in fact, will slow the absorption of the sugars that come from carbohydrates and decrease their impact on blood sugar and insulin levels.

            2. Nutritional Supplementation: A variety of natural non-toxic food based compounds can be used. The goals are to normalize blood sugar, and increase insulin sensitivity. For antioxidant deficiency: a strong multi-vitamin with at least 10,000 I.U. of beta carotene, 500 mg of vitamin C, 200mg of selenium, 100 mg of grape seed extract, 30 mg of co-enzyme Q10. For normalization of adrenal function, pantethine 300-900 mg, licorice root, panthothenic acid 400-1,200 mg should be considered. Other synergistic nutrients include: Coenzyme Q10   together with peperine extract to help enhance cardiac function, wheat germ powder, horsetail/ shavegrass herb powder, bioflavonoids that synergistically enhance the effects of other anti-oxidants, amaranth flour, apple pectin powder,  papaya fruit powder, bromelain to help reduce inflammation, milk thistle extract to help the liver detoxification, and lipase to help digest fat. The best way is to take the above nutrients in the form of a nutritional cocktail that contain most of the above mentioned nutrient. In a properly formed cocktail, the amount of each single nutrient is reduced, while the overall effect is still achieved. Because of biochemical and metabolic individual variation, the use of nutritional supplements should therefore be personalized for your body. One person’s nutrient can be another person’s toxin.

“Selenium intake reduces serum C3, an early marker of metabolic syndrome manifestations, in healthy young adults. C3 seems to be related with selenium status and several anthropometrical and biochemical measurements linked to metabolic syndrome in apparently healthy young adults,” wrote (Puchau, Zulet, Gonzalez de Echavarria, Navarro-Blasco & Martinez, 2008) . These findings suggest a possible role for selenium intake in the modulation of C3, whose assessment may be an early marker of metabolic syndrome manifestations as per the conclusions of the researchers from the University of Navarra in Pamplona (European Journal of Clinical Nutrition, published online Nov 5 2008). According to their online report ‘Selenium status’ appears to be linked with serum complement factor 3 (C3), which has been reported to be a marker for increased risk of the metabolic syndrome. The researchers’ state: “We report here for the first time an association between circulating C3 and nail selenium concentrations.” Selenium levels have been falling in Europe since the EU imposed levies on wheat imports from the US, where soil selenium levels are high. As a result, average intake of selenium in the UK has fallen from 60 to 34 micrograms per day, leading to calls from some to enrich soil and fertilizers with selenium to boost public consumption. Selenium-enriched fertilizers are used in Finland. The European recommended daily intake (RDI) is 65 micrograms. The recommended EC Tolerable Upper Intake Level for selenium is 300 micrograms per day (EU pub) 

            3. Herbs: Generally speaking, herbs are employed on the basis of their symptom specific effects. However, the desired symptom-specific effects are not always seen as a result. It is interesting to note that for any specific condition, there is always more than one herb available that can be employed. What is necessary for the achievement of the desired result is to match the appropriate herb to the appropriate constitution (metabolically and biochemically). In the case of metabolic syndrome herbal healing---the use of Terminalia Arjuna as a cardiac tonic and for blood pressure regulation, Guggul herb for a cholesterol control, Bitter Melon- for glycemic and diabetes control, Gacinia for lipids control, Gymnema as a sugar destroyer must be underlined. Just as the natures, qualities, nutrient content, etc., of the various foods must be matched to one’s metabolic syndrome management, so too must the nature and qualities of herbs or nutraceuticals be matched for predictable, reliable and desired effects to be achieved. It is resulted from the model that some people who are not obese by traditional measures nevertheless are insulin resistant and have abnormal levels of metabolic risk factors. Examples are seen in individuals with 2 diabetic parents or 1 parent and a first- or second-degree relative; the same is true for many individuals of Mexican or African ethnicity. 

            4. Exercise: Epidemiological studies have shown that modest exercise is beneficial. However, unequivocal metabolic benefits from exercise will not be achieved from a casual walk a couple of nights a week. Significant, regular, chronic exercise is required to see improvements in insulin action, triglycerides, and HDL cholesterol. Exercise is as powerful a tool as weight loss. 

           5. Others: A. Alcohol. In few population-based studies, moderate drinkers are found to have lower insulin levels as compared to non-drinkers. Our small-scale studies have shown moderate drinkers to be more insulin sensitive. There have been no intervention studies to show that initiating alcohol consumption in individuals who are insulin resistant with low HDL is beneficial. So it is not reasonable to suggest that non-drinkers should start to drink 1-2 drinks per day. On the other hand, we do not have the evidence to recommend abstaining from alcohol. B. Smoking. Smoking is unequivocally bad for people prone or already diagnosed with the metabolic syndrome as it is associated with high triglycerides, low HDL cholesterol and insulin resistance.

 What are the vital steps to follow and what to avoid in case of MetS diagnosis? 

 

1. Exercise regularly may help you to lose the fat around your waist area

2. Eliminate high fructose corn syrup and all the other artificial sweeteners.

3. Cut MSG, Aspartame (NutraSweet), Sucralose (Splenda) off your diet 

4. Use an anti-inflammatory diet and supplements to reduce the free  radicals and the signs of chronic inflammation

5. Take at least 2 grams omega-3 capsules per day (fish oil, flaxseed oil, cod liver oil etc) 

6. Use aged garlic extract to lower bad cholesterol levels

7. Take advantage of natural antioxidants in fruits and vegetables

8. Lower your homocysteine levels

9. Use antioxidants/vitamins to prevent cholesterol oxidation and nerve damage

10. Add plenty of soluble fiber to your diet to lower your  blood sugar

11. Avoid eating foods high in absorbable iron (in red meat and others)