Metabolic syndrome has burst on the scene in the past few years as an indicator of increased risk of atherosclerosis and diabetes. As rates of obesity and hypertension go up, it's estimated now that 30% of Americans have metabolic syndrome. Yet, following the rule that anything important is controversial, physicians and medical societies argue about how genuine it is. Does metabolic syndrome really increase the risk of illness, or is it just a collection of independent risk factors like obesity, abnormal blood fats, and elevated blood sugar and blood pressure? I'm convinced metabolic syndrome is for real. More importantly, it describes how toxic hormones produced by deep abdominal fat can damage the heart, kidneys, and blood vessels. So it's not just a risk factor, but a way of understanding -- and preventing -- disease.
What is metabolic syndrome?
Metabolic syndrome starts with a collection of five risk factors -- five physical problems. (The definition varies by the organization promoting it; I'll use the American version.) You need three of them to qualify. If you have three or more of any of the following, you have metabolic syndrome:
- Increased abdominal girth: your waist is 35" (89 cm) or greater in women or 40" (101 cm) or more in men. These numbers are somewhat arbitrary: subtract an inch or two if you're really short and add 1-2 inches if you're exceptionally tall. Most people with these measurements are at least somewhat obese.
- Fasting blood sugar of 110 or greater. (Many experts believe we should call abnormal a fasting blood sugar of greater than 100, but we'll stick with 110.) Keep in mind that you have diabetes when your fasting blood sugar consistently exceeds 125. Thus, a fasting blood sugar of 110-124 means you're on the brink of developing diabetes.
- Blood pressure of 130/85 or greater. You qualify if either number (systolic or diastolic) is elevated, so a blood pressure of 135/80 or 128/90 would count.
- HDL cholesterol of less than 40 in men and less than 50 in women.
- Fasting triglycerides of 150 or greater.
The majority of people with metabolic syndrome are obese (i.e., body mass index of 30 or more).
Why is the metabolic syndrome important?
It's becoming increasingly clear that excess deep abdominal fat can make you sick. I'm not talking about the "pinch an inch" fat between your skin and abdominal muscles, but the deep fat surrounding your intestines and other abdominal organs. Because hollow organs like intestines are also called "viscera", it's is also called "visceral fat." This fat is too deep to feel, but you can see it: it gives you a potbelly and increases your waist circumference.
Recent scientific studies show that people with metabolic syndrome die more frequently than they should. They have more heart disease than you'd expect just from the five risk factors by themselves (Clinical value of the metabolic syndrome for long term prediction of total and cardiovascular mortality, British Medical Journal 3/06).
Visceral fat infiltrates your liver. It surrounds your heart and pancreas. It can cause liver disease and cirrhosis. It increases insulin levels and makes your body less sensitive to insulin. Visceral fat emits toxic hormones that cause inflammation and tissue damage. It harms your heart and can damage your kidneys. So the risk to your health extends way beyond just heart disease and diabetes.
How did I get metabolic syndrome?
Research shows metabolic syndrome isn't an accident. It often results from chronic stress (Chronic stress at work and the metabolic syndrome, British Medical Journal 1/06). But just how this occurs is interesting: it's a kind of addiction.
If you become extremely stressed or upset (for example, a near-accident, an episode of road rage, or a bad argument), you'll find it takes half an hour or more to calm down. Until this occurs your entire metabolism is uncomfortably full on: you're trembling and sweating, and your heart pounds out of your chest. To turn off this stress, your brain tells your adrenal glands to make cortisone to counteract the ongoing adrenaline rush. Once the cortisone kicks in, you feel better.
So far, so good. But what happens if you're stressed all the time? Your body becomes immune to cortisone. To calm down now you need insulin.
That's right, insulin is a stress hormone. It doesn't just lower blood sugar.
How do you raise your insulin levels? Eat junk food-- "comfort food" -- like cookies, cake, candy, pizza, crackers, bread. You know, all the stuff you need to feel better after a bad day at the office.
Many women head for sweets, ice cream, and chocolate. The guy equivalent is salty or fast food: crackers, a couple of burgers, supersized fries, and a Coke.
So the bad news is you may be literally a junk food junkie. You eat not because you're hungry but to suppress painful emotions. That's an addiction.
Some alcoholics have told me that after they became diabetic, they didn't feel the need to drink. When their blood sugar gets high enough, they enter a kind of oblivion. Out-of-control diabetic patients often seem frankly out of it, spaced out but also kind of stupid. They recover once their blood sugar comes under control.
Of course, while junk food calms you down, it also makes you tired. Think "fat and lazy," or "I'm built for comfort, not for speed." It makes you much less likely to exercise or eat right. It sustains itself just like any other addiction.
The bottom line is that the stuff you eat to help you feel better isn't just causing the metabolic syndrome. While it tranquilizes you, it rots you from the inside out. And it robs you of the desire to stop.
Treating metabolic syndrome
I love talking with dedicated smokers about quitting. We get along fabulously while I discuss the horrible things smoking does to your health, how it ages you and wrinkles your skin, and how emphysema is like strangling to death over five years. We're in total agreement.
Then I talk to them about stopping, and they look at me like I just asked them to jump off the Vincent Thomas Bridge.
So too with most obese people. It's not that they don't want to lose weight, it's that they won't do anything about it. And when we discuss the simple, straightforward steps one can take to get healthy, they look at me like I'm crazy. They're way too polite to say so, but clearly the subtext is, "Doc, I'm just not that sort of person. I'm way too tired, stressed out, and set in my ways. Ask somebody else to change their lifestyle, not me."
Assuming you don't like what metabolic syndrome is doing to your health, here are some steps you can take to reverse the damage it's doing to you.
- Most of my patients would just like some sort of pill that would help them lose weight and fix the problem. In fact, several medications under development may do just that. But they're not FDA approved or on the market yet -- and you probably don't want to be the first person on your block to try out a new medication before more is known about its long-term safety.
- The most important single response is adequate exercise. Start with whatever you can do comfortably (for example, walking) and slowly increase to thirty minutes six times a week. You should exercise vigorously enough to feel warm for 15-20 minutes after stopping. Don't exercise in a way that makes you uncomfortable. If you're over 65, weigh over 200 lbs, or have heart or lung problems, see your doctor before beginning an exercise program.
- Losing weight can be hard, but it's easier to modify your diet. Cut back on sweets, snacks, junk food, animal fat, and simple starches like potatos, white bread, white rice, and pasta. Eat 8-10 helpings a day of fresh vegetables and fruit.
- Take medication to treat elevated blood pressure and cholesterol if present.
- Be sure to evaluate your risk of heart disease and get the treatment you need to lower this risk.
- Once you've figured out that you have no idea how to deal with the stress in your life, then we have something to work with. Exercise and improving your diet lowers stress levels and improves your energy. Yes, they require effort, but the result is you'll feel a lot better. If you're completely stressed out, lifestyle changes alone won't suffice: you need to learn some specific stress-reduction techniques..
Last updated Fri, Jun 19, 2015
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