Metabolic syndrome is an unhealthy metabolism that leads to fatal diseases such as heart attacks, diabetes, and cancer. Moreover, this condition affects more than a fifth of the US population and about a quarter of the European population. Even though its prevalence in South-east Asia is lower, it is still rapidly moving towards the rates of the western world even there. It should be understood that metabolic syndrome is a problem for not only overweight people. So, in 40 out of 70 percent of people with normal weight, doctors diagnose metabolic disorders. This is at least related to an increase in waist circumference or visceral obesity. So what is metabolic syndrome? How do you know if you are at risk? How can lifestyle help prevent this condition and what is the treatment aimed at?
This article was last reviewed by Svetlana Baloban, Healsens, on January 24, 2020. This article was last modified on 4 September 2021.
What is Metabolic Syndrome?
Essentially, metabolic syndrome is the simultaneous presence of several conditions, such as obesity, hyperlipidemia (abnormal levels of cholesterol and / or lipoproteins), diabetes and / or hypertension. This combination was first described back in the late 1960s. Nowadays, medical organizations say that even a few of the risk factors are sufficient. Let’s take a look at which conditions are referred to as metabolic syndrome and which of the factors are more influential.
Metabolic Syndrome Criteria
The NCEP ATP III1 panel identified 3 of 5 risks of the next metabolic syndrome criteria:
- increased waist circumference. In this case, the following values are named:
- ≥40 inches [≥102 cm] for men;
- ≥35 inches [≥88 cm] for women.
At the same time, the International Diabetes Federation names narrower ranges2:
- ≥37 inches [≥94 cm] for men;
- ≥30 inches [≥80cm] for women.
These are recommendations for the European race. For Chinese, Japanese and South Asians, a waist circumference of ≥90 cm for men is at risk. Note that weight is not taken into account, just the waist circumference. This is no accident. In the next chapter, we will review in detail why so much attention is paid to waist circumference.
Other risk factors include the following indicators:
2) elevated triglycerides (≥150 mg/dl);
3) low HDL cholesterol (<40 mg/dl in men, <50 mg/dl in women);
4) hypertension (≥130/≥85 mmHg); and
5) impaired fasting glucose (≥110 mg/dl). The American Heart Association reports a level of risk fasting glucose levels at ≥100 mg / dL.
At the same time, the pathophysiology of this syndrome remains a subject of continuing controversy. However, despite the lack of knowledge, researchers have identified visceral obesity and insulin resistance as the most important causative factors. Central obesity or visceral obesity is readily assessed at waist circumference and is independently associated with each of the other components of metabolic syndrome. The second significant factor in the development of this disease is an increase in glucose levels (hyperglycemia). However, even a small increase, both on an empty stomach and after a meal, increases the risk of cardiovascular disease and mortality.
In addition, a prospective Quebec study has found that even with no increase in blood sugar, elevated insulin levels (i.e., insulin resistance) are associated with a risk of coronary heart disease. In addition, insulin resistance also contributes to the development of hypertension due to the loss of the vasodilator effect of insulin and vasoconstriction3.
What causes metabolic syndrome?
The pathogenic mechanisms of MetS are complex and yet to be fully elucidated. However, the wide variation in geographic distribution of MetS emphasizes that the consumption of excess calories and lack of physical activity are the major contributors to the development of the disease. Moreover, visceral obesity is the key trigger for most pathways involved in metabolic syndrome.
It is worth saying here that visceral fat may not be visible to the naked eye, but it is the fat that envelops the heart, liver and other organs, representing a real threat. By itself, visceral fat behaves very differently from subcutaneous fat. For example, visceral fat deposits contribute to insulin resistance4. This is due to the fact that the visceral process of lipolysis leads to an increased supply of free fatty acids (FFAs) to the liver. This, in turn, increases synthesis of triglycerides and production of apolipoprotein B, the carrier of “bad cholesterol”. Ultimately, the “bad” particles become smaller, denser and much more numerous and easily penetrate the vascular endothelium, where they cause irreparable damage.
Very high levels of “bad” LDL cholesterol and low levels of “good” cholesterol are indirect effects of insulin resistance. If you add to this an increase in triglycerides (atherogenic dyslipidemia), then even at a normal weight, you will get central obesity with the same high risk of death as obesity5.
Thus, as you can see, visceral fat, elevated insulin levels, and an unhealthy lipid profile (unhealthy cholesterol levels) are linked to each other. And all this leads to problems with cardiovascular diseases, diabetes, hypertension. It is not a surprise why in Healsens, in addition to monitoring weight, we recommend monitoring waist circumference.
Metabolic Syndrome treatment
As previously described, MetS results from increased caloric intake out of proportion to metabolic requirements. That is why lifestyle changes are imperative to manage the main risk factors. The first step in reducing risk factors is maintaining ideal body weight. Accordingly, if BMI is increased, then weight loss is an important preventive and therapeutic strategy.
However, weight loss doesn’t have to be a goal by itself. As we wrote above, people whose weight within the normal range may have visceral obesity, which can be measured by checking the circumference of the waist. In this case disease prevention will imply reducing visceral fat without losing weight. The good news is that numerous studies show that it suffice to add physical activity to help the problem. In fact, physical exercise can reduce visceral adipose tissue by 6.1%. Moreover, exercise itself is effective in maintaining muscle mass and facilitating mobility.
As for exercise, if there is nAs for exercise, if there is no personal trainer to consult, 30-60 minutes of moderate-intensity exercise per week will bring good results. These activities include jogging, brisk walking, cycling, or swimming. Medium intensity refers to exercise where your heart rate rises up to 80% of your maximum heart rate. We wrote separately how to calculate your maximum heart rate. Such conscious efforts to make lifestyle changes will be highly beneficial in reducing the risk and treating metabolic syndrome.
Finally, research also shows that judicious use of bariatric surgery has benefits for treating obesity and MetS. This is due to the fact that weight loss helps improve all components of exercise. In turn, exercise increases your calorie intake, promotes weight loss, and reduces your overall risk of cardiovascular disease.
Bariatric surgery is a branch of surgery that deals with the treatment of obesity. Depending on the surgery, people often lose 30% to 50% of their excess weight within 6 months.
The second important step in the prevention and treatment of MetS is diet modification. For example, avoiding or significantly reducing the intake of saturated fat, trans fat, cholesterol, sodium and simple sugars helps with dyslipidemia, hyperglycemia and hypertension. We talked about this in detail when we looked at ways to lower cholesterol. In addition, we just note that diets with high or very low fat content exacerbate the problem, since 25-35% of our daily calories should come to us in the form of fat. By the way, a meta-analysis of studies showed that only with a diet, visceral adipose tissue decreases by 1.1%. Note that exercise reduced this rate by 6.1%.
So, central obesity is a serious risk factor, and the central factor is the increased sugar content in foods. In addition to home-made sugar, 66% of packaged foods and beverages contain added sugar. This triggers the release of insulin, which causes circulating lipids to be deposited as fat. And the increase in fat, in turn, causes insulin resistance. As these deposits become excessive, fat begins to be deposited in internal organs, appearing in the liver, omentum, skeletal muscles and peripheral organs. Therefore, limiting or avoiding foods containing added sugars is the mainstay of metabolic syndrome prevention.
What about medications? There is currently no single medicine therapy for metabolic syndrome. Accordingly, pharmaceutical therapy is aimed at treating its individual components. For example, your doctor may prescribe medications to treat dyslipidemia (unhealthy cholesterol levels) if tests results indicate this problem. If hypertension has been diagnosed, appropriate medications will be prescribed to control blood pressure. In addition, your doctor may prescribe antiplatelet medications to reduce your prothrombotic risk. The same principle will be used to reduce the risk of diabetes. So, medical intervention is aimed at stopping or treating certain components of metabolic syndrome.
Supplements or Nutraceuticals for Metabolic Syndrome
Before talking about additives, we should note that they are not recommended as replacement for pharmacotherapies. This is because the benefits of these nutraceuticals are still being researched. However, since they have shown some benefits, they can be used to supplement or reduce the risk of developing MetS.
The active ingredient in this spice has anti-inflammatory and antioxidative properties. Curcumin has been shown to suppress inflammation by a reduction in the expression of pro-inflammatory cytokines. Thus, studies of the effect of curcumin on the components of metabolic syndrome in humans have shown positive effects. For example, a significant improvement in fasting glucose, triglycerides, “good” HDL cholesterol. In addition, a decrease in diastolic blood pressure was observed. However, curcumin did not have any significant effect on waist circumference and systolic blood pressure levels6.
Garlic is known for its medicinal value due to its antioxidant and antithrombotic properties. Reinhart and colleagues, in a meta-analysis of 29 randomized placebo-controlled trials, showed that the garlic intake lowers total cholesterol and triglyceride levels7. Another study demonstrated the effects of aged garlic extract in people with metabolic syndrome8. In the study, patients took 1.2 grams of garlic supplements per day for 24 weeks. The anti-inflammatory effect of garlic is due to organosulfur compounds in their derivatives. These compounds have antioxidant effects that help fight inflammation. As a result, garlic is proven en to be a promising natural treatment for metabolic syndrome.
Resveratrol is a natural polyphenol found in edible plants. Clinical studies in patients with insulin resistance and non-alcoholic fatty liver disease have shown promising results. In fact, the use of resveratrol has been shown to improve insulin sensitivity, glucose tolerance, and overall weight and body mass index. In the study, patients took 2 150mg resveratrol capsules twice a day for three months9.
Cinnamon extracts have antithrombotic, insulin-sensitizing, lipid-lowering, anti-inflammatory, and antioxidant properties that are beneficial in MetS. In a randomized placebo-controlled trial, Ziegenfuss and colleagues demonstrated that the use of an aqueous extract of cinnamon was associated with improvement in fasting blood glucose, blood pressure, and body composition in people with MetS10.
Berberine is used in China for its antimicrobial properties and is known to have antidiabetic properties. Studies in humans with MetS have reported a reduction in waist circumference, triglyceride levels, and systolic blood pressure, especially in women11.
Furthermore, nutraceuticals such as omega fatty acids, quercetin, bergamot essential oil, neem extracts, and sulforaphane (extracted from Brassica vegetables such as broccoli) may be helpful in managing MetS. We will keep an eye on new research in this area. In the meantime, let’s summarize all of the above.
First, metabolic syndrome is a global epidemic. It is a chronic disease that is a risk factor for atherosclerotic and non-atherosclerotic CVD. Secondly, existing treatments target different components of metabolic syndrome. In addition, the choice of therapy is quite limited, as there are only a few drugs that have a convincing effect on long-term results. Third, the chronic nature of the components of the metabolic syndrome requires long-term and often indefinite use of various medicines. All this suggests that early diagnosis and preventive treatment of the disease aimed at changing the way of life play an important role.