What you need to know about Metabolic Syndrome: America’s Silent Epidemic
Updated: Nov 9, 2018
This title expresses a grave concern to the healthcare community that Metabolic Syndrome truly is a “silent epidemic”. While America’s waistline keeps expanding, so does our national debt, making this epidemic not only detrimental to our patients but to our entire healthcare system. In this week’s post, I want to try to give you some insight on what Metabolic Syndrome is, what tests should be ordered to properly diagnose it, and alternative therapies that can help you from having to turn to pharmaceuticals, s well as share some suggestions on how to prevent this disease from even occurring.
“Metabolic syndrome is a cluster of metabolic abnormalities that includes abdominal obesity, atherogenic dyslipemia (elevated plasma triglycerides and reduced high-density lipoprotein [HDL] cholesterol), elevated blood pressure and insulin resistance, which can manifest as elevated fasting plasma glucose.” (1)
The National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III ) defines that metabolic syndrome as the presence of three or more of the following criteria: waist circumference > 40 inches (men) or 35 inches (women), blood pressure > 130/85, fasting triglyceride > 150, fasting good cholesterol (HDL) < 40 (men) or < 50 (women) and a fasting glucose > 100 (2)
In non-medical terminology, this means that metabolic syndrome is a combination of chronic medical issues including increased fat around the abdomen, high “bad” cholesterol, low “good” cholesterol, elevated blood pressure, and issues with sugar control- meaning your pancreas is not able to make enough insulin to control your sugars to stay within a normal range. Unfortunately, when these issues are grouped together in one’s body, larger problems such as type 2 diabetes, coronary artery disease (leading to heart attack and stroke), chronic pain/musculoskeletal issues, and mental health issues can develop.
A great majority of testing for metabolic syndrome occurs at your annual physical. Erin and I are big advocates in annual physicals as they are able to identify a potential problem and catch issues in such an earlier phase, including metabolic syndrome. Your healthcare provider will usually order a complete metabolic panel (CMP) at your annual physical. A CMP includes your fasting glucose and, if there is a concern of insulin resistance and/or a strong family history of diabetes, a hemoglobin A1C (HgbA1C) can be added as well. A lipid panel is also usually ordered and includes your triglyceride level and HDL. Your height and weight are also usually taken at your annual physical, along with additional vitals including temperature, pulse, and blood pressure. Now, one blood pressure reading being > 130/85 will NOT be a determining factor for a diagnosis. If it is elevated at your appointment, typically the practitioner will want you to monitor it for a certain length of time and see where your average reading lies.
Taking all of these readings into consideration along with possible symptoms (including weight gain or inability to lose weight, fatigue, dizziness (elevated sugars), headaches (high blood pressure), and digestive issues (bloating, reflux, bowel habit disruption from abdominal obesity)), you and your healthcare provider can discuss these findings and consider if metabolic syndrome might be a potential diagnosis.
Diagnosed with Metabolic Syndrome…now what?
A great majority of patients are able to reverse metabolic syndrome simply with dietary changes and lifestyle modifications. Granted, there is not ONE specific diet that is recommended as “gold standard” due to the complexity of metabolic syndrome. Think about it. There are A LOT of different issues going on at once, so selecting one specific diet for this diagnosis of a cluster of different disease processes is simply unrealistic. But, dietary changes is the primary focus.
What about the ketogenic diet?
Given that metabolic syndrome carries a substantial risk of type 2 diabetes, it is questioned by the healthcare community if the ketogenic diet is something that should be recommended. I am sure you have heard of the ketogenic diet, or keto-diet, as it is becoming a very popular diet in mainstream heath and wellness platforms. For those that may not know, a ketogenic diet primarily focuses on placing one’s body into “ketosis”(an elevation of ketones in the body that can be measured via urine sample) through a low carbohydrate intake and high fat intake, thus using fat as an energy source versus using carbohydrates. This diet has been, and continues to be, studied in patients with glucose intolerance/insulin resistance and/or type 2 diabetes.
In one study, they took 30 participants previously diagnosed by their primary care providers with metabolic syndrome and randomly prescribed them either “a sustained ketogenic diet with no exercise, standard American diet (SAD) with no exercise, or SAD with 3-5 days per week of exercise (30 min.)” (3). The results were significant enough for the authors to state in the conclusion that, based on “the results produced by the statistical data, the null hypotheses that a ketogenic diet has no effect on the five principle biomarkers of metabolic syndrome can be rejected” (3). In other words, the ketogenic diet with no exercise was found to cause a greater degree of positive change.
Others studies (4, 5, 6) have continued to show its positive effects on reversing type 2 diabetes, positively improving one’s cardiovascular system, and potentially preventing or lessening the effects of Alzheimer’s disease. These are very exciting times in healthcare in regards to the ketogenic diet and its effect on metabolic syndrome.
Now there always is the concern about the ketogenic diet not being safe for certain subtypes. There is the concern that it may worsen cholesterol and/or obesity, but studies have shown that ketogenic diet actually can aid in reducing the chronic inflammatory effects of obesity, help raise good cholesterol, and improve glycemic control. In regards to possible negative effects of the ketogenic diet on obesity, one study concluded that “a period of low carbohydrate ketogenic diet may help to control hunger and may improve fat oxidative metabolism and therefore reduce body weight.” (7) They did suggest paying close attention to kidney function as the ketogenic diet is high in protein and could be harmful to those who already have problems with their kidney function. Also, the duration of the ketogenic diet should be between a minimum of 2-3 weeks to a maximum of 6-12 months and this is completely dependent on the patient’s health status. Overall though, the ketogenic diet may be effective, as long it is under the direct supervision of a healthcare provider. Always discuss with your healthcare provider before starting any drastic changes in your diet and remember that the ketogenic diet is NOT for everyone.
Along with the suggested dietary changes, lifestyle modifications should also be utilized. According to the American Heart Association, “to improve overall cardiovascular health, we suggest at least 150 minutes per week of moderate exercise or 75 minutes per week of vigorous exercise (or a combination of moderate and vigorous activity).” 8).
This could be anywhere from brisk walking, running, elliptical, stair master, etc. along with 2 days a week of strength training, either with weights or plyometric exercises (using your own body weight). Erin and I typically recommend being active at least 30 minutes every day, with Sunday being more of a “rest” type of exercise day. Ultimately, if you get your body to a certain cardiovascular performance level being moderately active every day will not harm you, only help you.
In addition to helping with weight loss efforts. being active every day will improve your cardiovascular system, support joint and muscle health, and improve mental health status. There are so many great benefits of being active daily and, in regards to metabolic syndrome, it can help drastically reverse it and/or even prevent it from developing in the first place.
Typically, Erin and I really don’t suggest or even talk about starting any medications when it comes to chronic diseases such as metabolic syndrome as we are firm believers that the body can heal itself, if given the chance to. But I would be remised if I did not mention one medication that we both tend to use in practice; metfomin or glucophage.
Metformin is a first-line medication in the treatment for type 2 diabetes, but also can be used (in conjunction with diet and lifestyle modifications) for metabolic syndrome. We always strongly educate our patients that this is NOT magic pill to make everything go away, but rather an additional tool we can use in treatment, and possible reversal of, this disease process. Depending on the patient and their lab results, we typically will prescribe 500mg twice a day- that’s if our patient is able to tolerate the potential gastrointestinal (GI) side effects. Metformin is infamous for its GI side effects (diarrhea, nausea, vomiting, abdominal pain), so if this does occur we take a slower approach and titrate our patients to the ideal 500mg twice a day dosing. Patients tend to have positive results with the use of Metformin in conjunction with dietary modifications and daily physical activity, and are usually able to stop it after a short period of time. That being said, if the patient has a genetic predisposition for type 2 diabetes (their family tree is strong with it!) we will just keep them on it to help prevent type 2 diabetes from occurring.
Like I said, we don’t typically go right to pharmaceuticals, but if needed Metformin is a great tool in our bag of tricks. There are other medications we can use as well, but we don’t really want to go that route as that simply means that our patient is traveling down the path of becoming a type 2 diabetic.
Other medications that are considered with metabolic syndrome are cholesterol medications (statins), blood pressure medications, and weight loss medications. These types of medications need to be discussed with your primary healthcare provider as each patient/provider preference is different.
Metabolic syndrome, unfortunately, is becoming a “norm” in Americans due to our poor dietary habits (fast food does NOT mean better food!), lack of exercise, and overall laxity in taking care of ourselves. Whenever I diagnose a patient with metabolic syndrome (and its regrettably becoming a daily occurrence) I always end our appointment by saying, “You have this one vessel and have the potential to turn this around before other permanent events can occur. Why not make it the best it can possibly be?” Always remember to make your health and wellness a priority and if you feel that you might fall under the criteria listed above, talk with your healthcare provider about ways to treat and prevent the longterm effects from occurring.
Hope you have an amazing week and always remember to FollowYourGut