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Metabolic Syndrome
A cardiovascular time bomb
Too much fat around the waist – should you be concerned? Yes, if your waist size is more than 88 centimetres (35 inches) for a woman, or more than 102 centimetres (40 inches) for a man. The measurement may indicate that you have metabolic syndrome. It is quite common and occurs in one in five Canadian adults. It is also a growing epidemic.
What is metabolic syndrome?
You may have heard of this condition. In the past, it has been called syndrome X and insulin resistance syndrome. Metabolic syndrome is a collection of medical conditions that increase the risk of diabetes and heart disease. These conditions are excess abdominal fat, insulin resistance, and one or more of the following: elevated triglycerides, low HDL (good) cholesterol, and high blood pressure.
Having this group of symptoms greatly increases your risk of diabetes or a heart event, compared to having each symptom alone. Metabolic syndrome has been referred to as a cardiovascular time bomb.
As mentioned, in Canada one in five adults has metabolic syndrome. Children and teenagers can also have the condition. However, no definition of metabolic syndrome has been established for children less than ten years of age. The Canadian Health Measures Survey shows that 17 per cent of people aged eighteen to 39 years have metabolic syndrome, compared to 39 per cent of people between the ages of 70 to 79. This means that as we age, we are at higher risk of developing metabolic syndrome.
What causes the syndrome?
It is still uncertain exactly what causes metabolic syndrome. It is very complicated. The problem is linked to the body’s metabolism. It is believed insulin resistance, where the body cannot use insulin properly, is the main reason. There are also problems with the way some of the fat tissue functions.
Insulin is a hormone made by the pancreas. It helps control the amount of glucose in the blood stream. Insulin is needed to bring the glucose from the blood into the body’s muscle, fat, and liver cells so they can use the glucose for energy. It is the key that opens the door and signals this reaction. It can also affect the breakdown of fat and production of glucose in liver cells.
Common Measures Used to Diagnose Metabolic Syndrome |
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Waist circumference |
Greater than 102 cm (40 inches) for a man or 88 cm (35 inches) for a woman |
High fasting blood glucose levels |
5.6 mmol/L or higher |
High blood pressure |
130/85 mm Hg or higher |
High triglycerides (bad fat in the blood) |
1.7 mmol/L or higher |
Low HDL (good fat in the blood) |
Lower than 1.0 mmol/L in men |
Usually after eating food, levels of insulin increase, and help cells absorb the blood glucose. In metabolic syndrome, the cells are not able to follow orders from insulin, and so glucose cannot enter the cells easily. There is abnormal insulin secretion and signalling. Chemicals called cytokines (immune messengers), which promote inflammation, are released. These abnormalities also affect where insulin is distributed, so insulin may gather in the fat. This problem with insulin metabolism is caused by a combination of genetic and lifestyle factors.
The location of fat tissue has a role in metabolic syndrome. Fat cells in the abdominal area are linked with low levels of inflammation throughout the body. (Fat under the skin, which protects the organs, does not cause this inflammation.) Chronic inflammation contributes to greater risk of high blood pressure, diabetes, and fats and other substances building up on the artery walls.
As the fat cells around the waist release cytokines into the blood stream, the signal for insulin to let glucose into the cells is blocked. The cells have no fuel and blood glucose is stuck and builds up in the bloodstream. After eating, blood glucose stays higher than normal.
The pancreas then works harder and harder to make more insulin to deal with the blood glucose. It eventually overtakes the cytokines. Cells are finally able to get blood glucose. More and more insulin pushes excess glucose into fat cells for storage. More fat is stored in the body. At the same time, more body fat is broken down, leading to high levels of bad cholesterol and lowering good cholesterol.
This is a vicious cycle. As the waistline keeps getting larger and larger, cells become less sensitive to insulin, and insulin and glucose levels continue to rise. People with metabolic syndrome often have insulin levels two to three times higher than usual.
Treating Metabolic Syndrome |
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Exercise |
30 to 60 minutes daily of moderate intensity exercise like brisk walking |
Weight loss |
A five to 10 per cent decrease in body weight decreases insulin levels and blood pressure |
Healthy eating |
follow Canada’s Food Guide, reduce calories eaten, and increase vegetable intake www.healthcanada.gc.ca/foodguide |
| * Recommendations from the Diabetes Pregention Program Research Group | |
Who is at risk for metabolic syndrome?
Factors to consider for metabolic syndrome risk include age, race, obesity, family history, poor diet, and not enough exercise.
- Age: The risk of metabolic syndrome increases with age. It affects less than 10 per cent of people in their twenties, but 40 per cent in their sixties.
- Race: Aboriginal North Americans, Hispanics, South Asians, and African Americans are at greater risk of metabolic syndrome than other races.
- Obesity: Body mass index (BMI) is a reflection of total body fat, which considers weight in relation to height. A BMI greater than 25 is a risk for developing metabolic syndrome.
- Family history of diabetes: Having others in the family with type 2 diabetes, or diabetes during pregnancy, increases risk.
- Poor diet: A diet lacking in vegetables, and high in processed foods and salt, adds to the risk.
- Not enough exercise is a risk factor.
What are the complications of metabolic syndrome?
Having metabolic syndrome can increase the risk of developing:
- diabetes
- cardiovascular (heart) disease, which, for example, increases the risk of stroke
- and obstructive sleep apnea.
How is metabolic syndrome treated?
Treating metabolic syndrome is very similar to treating obesity. Weight loss through diet and exercise is the starting point. If necessary, the medication metformin may be used if the person has diabetes. Metformin is an insulin sensitizer, meaning it increases the body’s response to insulin.
The Diabetes Prevention Program Research Group suggests that obese people with glucose levels that are higher than normal (but not at a diabetes level) can reduce their risk of diabetes. Losing five to seven per cent of their weight along with physical activity of 150 minutes per week lowers the risk. Exercise helps the body use blood glucose more efficiently, and often helps lower blood glucose levels.
To help prevent metabolic syndrome, eat a healthy diet with lots of vegetables and fruits, and choose lean cuts of white meat and fish over red meat. Also, when possible, avoid processed and fast food. Eat correct portion sizes.
Keep a food journal to help you evaluate your habits and eating patterns. It can serve as a reference when making changes to your diet. You may need to work with a dietitian to achieve eating goals. There are a great many food choices on the market, and choosing healthy food consciously and understanding options takes education and time.
To treat metabolic syndrome requires changing your diet, exercise and lifestyle, and this may require a team of health care professionals to assist you. A number of family practice clinics include dietitians, pharmacists, nurses, and psychologists in the office. You may want to ask your doctor if other team members can provide advice on making lifestyle changes.
FAMILY HEALTH is written with the assistance of |
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FAMILY HEALTH is written with the assistance of |
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