Metabolic Syndrome And Obesity
Margaret E. Woltjer, Ph.D. & Chester J. Zelasko, Ph.D. | May 2005

What is metabolic syndrome?
The metabolic syndrome, also known as Syndrome X, is a group of metabolic abnormalities. When the abnormalities appear singly, each can lead to Type 2 Diabetes or cardiovascular disorders; when present as a group, the risk of cardiovascular disease rises dramatically along with the risk of premature death. The U.S. Centers for Disease Control & Prevention (CDC) estimated that almost 6 million hospitalizations and 950,000 deaths in the U.S. each year are due to cardiovascular disease.

Metabolic syndrome increases as obesity increases. With 31% of the adult population considered obese, metabolic syndrome is increasing (1). But that’s not the worst problem. The CDC recently reported that 16% of children ages 5-19 years old were considered overweight and that metabolic syndrome was already prevalent among these overweight youngsters (2). Those percentages translate to 69 million adults and over 10 million youngsters. The numbers are staggering.

What characterizes metabolic syndrome?
According to the American Heart Association (3), metabolic syndrome is characterized by:
  • Central obesity or excessive fat tissue in and around the abdomen.
  • Abnormalities in blood lipids that promote the buildup of plaque in artery walls, such as high triglycerides and low HDL cholesterol.
  • Insulin resistance, a condition characterized by the inability to utilize insulin effectively to lower blood glucose.
  • Elevated clotting factors in the blood such as high fibrinogen or plasminogen-activator inhibitor.
  • Borderline high blood pressure of 130/85 mmHg or higher.
  • High inflammatory markers, such as elevated high-sensitivity C-reactive protein or homocysteine in the blood.
Who is likely to get metabolic syndrome?
In the U.S. alone, it’s estimated that if you are 35 years old, there is a 25% probability that you have the syndrome; by age 60, the probability increases to 40%. Although the causes of the syndrome are not yet fully understood, it appears that some people are genetically predisposed. A recent study cited in Chemical & Engineering News has shown that a cluster of abnormalities similar to those of metabolic syndrome can be caused by a single mutation in a mitochondrial gene (4). Acquired factors, such as excess body fat and physical inactivity, can also elicit insulin resistance among those who are predisposed genetically. Physical inactivity and diets that produce high levels of fat in the blood correlate strongly to the syndrome.

Why does abdominal fat cause so many problems?
Much like setting up a business or selling a house, the answer is location, location, location. Fat stored between the abdominal wall and the organs in the abdomen, often referred to as visceral adipose tissue (VAT), is more active in producing and metabolizing hormones. It’s not the excess fat itself that’s the problem; it’s that VAT increases levels of hormones that result in hyperinsulinemia-insulin resistance and activation of the Hypothalamic-Pituitary-Adrenocortical axis (HPA) responsible for the stress response.

Insulin resistance indicates that the body is not responding efficiently to insulin’s signals to transport sugar from the blood into cells. The body compensates by producing more insulin, thereby overworking the pancreas to compensate for ineffective insulin receptors on cellular walls. Over time, this can lead to an increase in triglycerides because the blood sugar cannot be utilized.

The HPA axis stimulates the production of cortisol, a stress hormone. Research suggests that it’s the increased cortisol levels that perpetuate the metabolic syndrome cycle. However, what is still not clear is whether the visceral adiposity causes the increase in cortisol production, or whether increased stress of the 21st century causes the increased cortisol production which leads to the increased storage of visceral fat. However, in general, researchers agree that insulin resistance is central to the metabolic syndrome.

Metabolic syndrome can also be found in lean people when the fat lies in the visceral area; it is rare in people without visceral fat. But for most people, the problem arises primarily from lifestyle factors. The three most important factors found in most cases of metabolic syndrome are chronic stress, inadequate exercise, and excessive eating, especially of refined carbohydrates.

How do I know if I have metabolic syndrome?
Only your doctor can diagnose metabolic syndrome. However, Adult Treatment Panel III of the National Cholesterol Education Program has listed these markers that indicate you are at risk of metabolic syndrome (5).
  • Central obesity as measured by waist circumference:
    Men: Greater than 40 inches
    Women: Greater than 35 inches

  • Fasting blood triglycerides greater than or equal to 150 mg/dL (1.69 mMol/L)

  • Blood HDL cholesterol:
    Men: Less than 40 mg/dL (1.03 mMol/L)
    Women: Less than 50 mg/dL (2.93 mMol/L)

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

  • Fasting glucose greater than or equal to 110 mg/dL (6.1 mMol/L)
Can metabolic syndrome be managed or treated?
Yes. The solution lies in making healthy lifestyle changes before medications become necessary. Research shows that all risk factors can be improved through a combination of caloric restriction, regular exercise, and reducing the intake of saturated fats, trans fats, and cholesterol. It is further recommended that individuals who currently have metabolic syndrome or are genetically susceptible increase their intake of fruits, vegetables, and whole grains (6).

Some research suggests that smoking greatly worsens the health consequences of the metabolic syndrome. Because weight gain is often a problem for individuals who attempt to quit smoking, it’s recommended that you consult with a health professional to assist in developing a program that addresses both issues (6, 7).

Physical activity assures that calories consumed are expended. According to Osama Hamdy, director of the obesity clinical program at Harvard University’s Joslin Diabetes Center, reducing weight by as little as 7% significantly improves insulin sensitivity because when the body sheds fat, the first to go is the bad visceral fat (4).

Lifestyle Recommendations to manage or avoid metabolic syndrome
  • Eat smaller, more frequent meals that focus on quality protein, whole grains, vegetables, fruits, and quality oils such as olive oil.
  • Avoid refined carbohydrates, thus limiting the amount of insulin released at any given time during the day.
  • Eat more cold-water fish such as salmon or tuna to increase the intake of omega-3 fatty acids, or take a quality fish-oils supplement.
  • Exercise regularly including cardiovascular exercise, strength training, core training, and flexibility.
  • Reduce stress levels or develop coping mechanisms to reduce stress.
  • Chromium picolinate has been shown to help the body improve its ability to handle insulin. Discuss taking this supplement with your physician.
Metabolic syndrome is more than treatable if you work with your physician and you work at it--the key is changing your lifestyle. Lose weight. Exercise more. Eat your fruits and vegetables. That’s the better life way!

References
  1. Health e-Stat. Prevalence of Overweight and Obesity Among Adults: United States, 1999-2002. National Center for Health Statistics. 2005.
  2. Health e-Stat. Prevalence of Overweight Among Children and Adolescents: United States, 1999-2002. National Center for Health Statistics. 2005.
  3. American Heart Association. Metabolic Syndrome.
  4. A. Maureen Rouhi. Metabolic Syndrome. Chemical & Engineering News. 2004. 82 (47): 83-99.
  5. Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III): Final Report. Bethesda, MD: National Heart, Lung, and Blood Institute; 2002.
  6. Eckel RH, et al. The Metabolic Syndrome. Lancet. 2005; 365 (9468);1415-1428.
  7. The Metabolic Syndrome.
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