The Metabolic Syndrome
There is no official definition for “the metabolic syndrome,” and different health groups and agencies offer different version of their own criteria for it. All versions, however, recognize that obesity–especially abdominal obesity–is associated with insulin resistance. Even worse, the very concept of the metabolic syndrome came about because of the proven relationship among the following conditions:
Insulin resistance means that one’s tissues resist the effects of insulin, creating a relative deficiency called Type 2 Diabetes Mellitus (DM). Ineffective insulin stimulates the release of even more ineffective insulin while allowing hyperglycemia.
Complications of Insulin Resistance
Insulin resistance leads to inflammation and damage to blood vessels, abnormal lipids (“dyslipidemia”), and hypertension, all of which increase the likelihood of suffering a cardiovascular disease (CVD) event–that is, a heart attack or a stroke. It is felt that these conditions that increase CVD risk are not complications per se, but comorbidities intimately part of the syndrome.
Risks for Type 2 DM, heart attack (myocardial infarction), angina, and cerebrovascular accidents (stroke) rise for those with the metabolic syndrome.
Relationship with Diabetes
Whether the metabolic syndrome insulin resistance contributes to chronic hyperglycemia or whether actual diabetes started processes that make the metabolic syndrome more likely, the end result for both scenarios is increased risk for a CVD event.
How Is Metabolic Syndrome Diagnosed?
The obesity, hyperglycemia, dyslipidemia, and hypertension that make the diagnosis of the metabolic syndrome can be explored with blood work and cardiovascular testing to evaluate the status of the entire cardiovascular system.
Obesity is an end-result of a very complex assortment of predisposing conditions–nutritional, genetic, physiologic, and even psychiatric. The diagnosis of obesity requires much more than a scale or the tabulation of a BMI index. It requires insight into the misleading motivations to overeat, poor choices of diet, and the lack of physical exercise that partners with the overeating.
Consultation with a dietitian/nutritionist and possibly a therapist (psychologist, social worker, or psychiatrist) is helpful.
Diabetics already experience hyperglycemia–a defining part of their disease. Type 2 DM patients may be in denial since they had lived most of their lives before diagnosis as “non-diabetics.” Education into the reality of hyperglycemia from any cause goes hand-in-hand with testing that documents specific glucose levels and/or the snapshot of generalized glycemic control from a hemoglobin A1c blood test.
Elevations in blood pressure are most commonly from unknown causes, but when it is part of the metabolic syndrome, it adds CVD risk regardless. Blood work to test for identifiable causes of hypertension can be done, and–as typically happens–when they don’t pinpoint an exact cause, treatment is indicated when diet and exercise fail to achieve blood pressure goals.
Elevations in LDL cholesterol (LDL-C) and triglycerides, and/or a lower than normal level of HDL cholesterol (HDL-C) increase CVD risk. Blood tests to determine these levels are referred to as a “lipid profile.” The components of a lipid profile and their respective ideal (normal) values are the following:
- Total cholesterol (normal <200)
- LDL-C (normal <130)
- HDL-C (normal >60)
- “Non-HDL,” the total cholesterol minus the HDL-C (normal <160)
How Is Metabolic Syndrome Managed?
Management of the metabolic syndrome centers on its four cardinal features:
The abdominal obesity that is characteristic of the metabolic syndrome is due to a mixture of genetics, diet, and physical inactivity. Most diets fail due to a lack of education into the risk of obesity and implementation of unreasonable expectations. A diet that is not “designed to fail” should be designed by a dietitian/nutritionist that is individualized for the patient. Any exercise program that is part of weight reduction will also favorably impact hyperglycemia, hypertension, and dyslipidemia.
Diabetics live with the prospect of hyperglycemia continuously. Reinforcing glycemic goals is part of the educations and management for Type 1 DM patients, but Type 2 DM required strong reinforcement and relentless education due to their tendency to be in denial.
Hypertension, like obesity, is best managed with diet and exercise. When these fail, either due to compliance or an uncooperative physiology, treatment with anti-hypertensive drugs is indicated. There are a wide variety of these available so that successfully tailoring a regimen specific to a patient is likely. Medication(s) can be chosen based on side effects, compliance, and efficacy.
Management and treatment of dyslipidemia is based on a goal of correcting abnormal levels of HDL-C, LDL-C, and triglycerides. Diet, exercise, and the use of statins are the classic approach to treating dyslipidemia.
Prevention of Metabolic Syndrome
The four classic elements of the metabolic syndrome–obesity, hyperglycemia, hypertension, and dyslipidemia–don’t “strike” a patient suddenly. They increase to unacceptable levels insidiously, even over years. Therefore, the best strategy to treat the metabolic syndrome is to prevent it.
Obesity is often a life-long problem for a person. The entire concept of an “ideal body weight” may be an unreasonable goal that makes one give up, only to reengage toward a commitment later, followed by repeated failure. Such loss-and-gain tactics make successive attempts even more difficult.
When the amount of weight one carries is unhealthy, the best prevention is to make efforts to attack it correctly in the beginning, via consultation with a dietitian/nutritionist. Setting reasonable goals will best ensure the success of any diet.
Physical exercise is a crucial co-star in the approach to losing weight. Fitness is important, even when one reaches an deal body weight. Physical exercise also is important in discouraging the mental setbacks to diet, such as depression and anxiety.
For Type 1 diabetics, prevention of hyperglycemia is a full-time obligation. For those with Type 2 DM, hyperglycemia begins insidiously, which can damage blood vessels even before the diagnosis is made. Because of this, persons should consider their family history associated with all of the components of the metabolic syndrome and begin preventative measures before becoming afflicted likewise.
Again, the classic diet-exercise approach, important in obesity, hyperglycemia, and dyslipidemia, is the approach to non-invasive prevention of hypertension. Genetics may deem anti-hypertensive medications necessary eventually, but that can be pushed back considerably by diet and exercise before hypertension actually develops.
Prevention requires a sensibility of one’s own risk, which can be assessed simply by looking to family. Over half of dyslipidemia is genetic, so recognizing one’s risk by appreciating one’s family history can prompt a diet and exercise program before obesity or hyperglycemia develop. Not only is this the best approach to preventing dyslipidemia, but it should be the life-long approach for all persons.