What is metabolic syndrome?

Metabolic syndrome is a collection of heart disease risk factors that increase your chance of developing heart disease, stroke, and diabetes. The condition is also known by other names including Syndrome X, insulin resistance syndrome, and dysmetabolic syndrome. According to a national health survey, more than 1 in 5 Americans has metabolic syndrome. The number of people with metabolic syndrome increases with age, affecting more than 40% of people in their 60s and 70s.

Who typically has metabolic syndrome?

• People with central obesity (increased fat in the abdomen/waist).
• People with diabetes mellitus or a strong family history of diabetes mellitus.
• People with other clinical features of "insulin resistance" including skin changes of acanthosis nigricans ("darkened skin" on the back of the neck or underarms) or skin tags (usually on the neck).
• Certain ethnic backgrounds are at a higher risk of developing metabolic syndrome.

As you grow older, your risk of developing metabolic syndrome increases.

What causes metabolic syndrome?

The exact cause of metabolic syndrome is not known. Many features of the metabolic syndrome are associated with "insulin resistance." Insulin resistance means that the body does not use insulin efficiently to lower glucose and triglyceride levels. A combination of genetic and lifestyle factors may result in insulin resistance. Lifestyle factors include dietary habits, activity and perhaps interrupted sleep patterns (such as sleep apnea).

What are the symptoms of metabolic syndrome?

Usually, there are no immediate physical symptoms. Medical problems associated with the metabolic syndrome develop over time. If you are unsure if you have metabolic syndrome, see your healthcare provider. He or she will be able to make the diagnosis by obtaining the necessary tests, including blood pressure, lipid profile (triglycerides and HDL) and blood glucose.

How is metabolic syndrome diagnosed?

You are diagnosed with metabolic syndrome if you have three or more of the following:

• A waistline of 40 inches or more for men and 35 inches or more for women (measured across the belly)
• A blood pressure of 130/85 mm Hg or higher or are taking blood pressure medications
• A triglyceride level above 150 mg/dl
• A fasting blood glucose (sugar) level greater than 100 mg/dl or are taking glucose-lowering medications
• A high density lipoprotein level (HDL) less than 40 mg/dl (men) or under 50 mg/dl (women)

How do I prevent or reverse metabolic syndrome?

Since physical inactivity and excess weight are the main underlying contributors to the development of metabolic syndrome, exercising, eating healthy and, if you have overweight or obesity, working toward a weight that's healthy for you can help reduce or prevent the complications associated with this condition. Your doctor may also prescribe medications to manage some aspects of your problems associated with metabolic syndrome. Some of the ways to reduce your risk:

• Healthy eating and achieving a weight that's healthy for you if you have overweight or obesity: Healthy eating and moderate weight loss, in the range of 5% to 10% of body weight, can help restore your body’s ability to recognize insulin and greatly reduce the chance that the syndrome will become a more serious illness. This can be done through diet, exercise, or even with help from weight-loss medications if recommended by your doctor.
• Exercise: Increased activity alone can improve your insulin sensitivity. Aerobic exercise such as a brisk 30-minute daily walk can promote weight loss, improved blood pressure and triglycerides 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 without accompanying weight loss. Any increase in physical activity is helpful, even for those unable to perform 150 minutes of activity per week.
• Dietary changes: Maintain a diet that keeps carbohydrates to no more than 50% of total calories. The source of carbohydrates should be whole grains (complex carbohydrates), such as whole grain bread (instead of white) and brown rice (instead of white). Whole grain products along with legumes (for example, beans), fruits and vegetables allow you to have a higher dietary fiber. Eat less red meats and poultry. Instead, eat more fish (without the skin and not fried). Thirty percent of your daily calories should come from fat. Consume healthy fats such as those in canola oil, olive oil, flaxseed oil and tree nuts.

If I have metabolic syndrome, what health problems might develop?

Consistently high levels of insulin and glucose are linked to many harmful changes to the body, including:

• Damage to the lining of coronary and other arteries, a key step toward the development of heart disease or stroke.
• Changes in your kidneys' ability to remove salt, leading to high blood pressure, heart disease and stroke.
• An increase in triglyceride levels, resulting in an increased risk of developing cardiovascular disease.
• An increased risk of blood clot formation, which can block arteries and cause heart attacks and strokes.
• A slowing of insulin production, which can signal the start of type 2 diabetes, a disease that is in itself associated with an increased risk for a heart attack or stroke. Uncontrolled diabetes is also associated with complications of the eyes, nerves, and kidneys.
• Fatty liver, which is sometimes associated with inflammation of the liver (non-alcohol related seatohepatitis or NASH). If untreated, NASH could lead to cirrhosis and liver failure.