… also referred to as Insulin Resistance
What is it?
If you have metabolic syndrome you will usually have one of the following disorders:
- Hyperinsulinaemia – too much insulin in the blood stream or
- Type 2 diabetes – diagnosed by blood sugar testing
And two or more of the following:
Women with a history of hirsutism (excessive body hair), oligomenorrhoea (scanty periods), infertility, or polycystic ovarian syndrome often have an underlying insulin/blood sugar control problem.
- Central (Abdominal) obesity. A disproportionate amount of body fat in the abdominal region. Determined by having a waist circumference of 100cm or more in men and 87.5cm or more in women
- High Cholesterol
- Hypertension (High Blood Pressure) over 130/80
- Elevated levels of blood factors that promote blood clotting, such as plasminogen activator inhibitor – 1 (PAI-1) and fibrinogen (but these are not routinely checked)
- Hyperuricaemia. High levels of uric acid in the blood
- Microalbuminuria. Small amounts of the protein albumin, found on urine tests.
Part of the Syndrome X profile includes an earlobe crease appearing at a 45-degree downward angle toward the shoulder and an elevated waist to hip circumference.
Episodes of low blood sugar levels (experienced as feeling faint or weak, rectified by eating), carbohydrate intolerance, sugar cravings, sleepiness after meals, insomnia (relieved by snacking), adult acne, and central abdominal obesity are all indicators of insulin excess. Abnormalities on a blood test and a slightly raised blood pressure are commonly observed in adults with high insulin, elevated insulin levels may start in childhood, particularly in the overweight youngster with abnormally high cholesterol
Who Gets It?
A recent study in New Zealand (2002-2003) revealed that Metabolic syndrome affects 32% of Māori, 39% of Pacific people and 16% of the rest of the population.
Studies have suggested that genetic factors may determine how insulin is handled in the pancreas and liver of some people. This, in turn, may influence the risk of developing insulin resistance and diabetes, especially in ethnic groups. There is also a higher risk in postmenopausal versus premenopausal women. It is felt that one or two risk factors exert an effect in a particular group, thus influencing the course of metabolic syndrome.
The prevalence of the metabolic syndrome in children increases with the severity of obesity and reaches 50 percent in severely obese youngsters.
What Causes It?
Key factors include obesity, stress and lack of physical activity as well as insulin resistance – which usually is the direct result of obesity. Your emotional health may influence the onset and ongoing symptoms associated with metabolic syndrome. Hostility, aggression, anger, etc. have been shown to correlate with other unhealthy lifestyle habits, such as poor diet and lack of exercise.
The risk of insulin resistance also increases during pregnancy, and is thought to have a cumulative effect with subsequent pregnancies.
Family history: if includes heart attacks, hypertension, and Type II diabetes, the likelihood of being insulin resistant increases. It appears about 50% of the variability of insulin may be due to genetic propensities; the other half seems related to lifestyle. Some researchers speculate that the genetic link may also be strongly influenced by mimicry. Offspring may (in fact) be mimicking the poor eating habits of parents, producing another generation plagued by obesity, insulin insensitivity, and diabetes.
Stage of Life: A recent Australian study tracked the metabolic health of 265 women aged 46-57 for five years as many of them progressed through menopause. The study found that a surprisingly high percentage of these women – nearly 1 out of 6 – developed impaired fasting glucose levels during this time.
During the menopause transition, more fat often starts to accumulate around the stomach and insulin levels begin to inch upwards. This subtle change can trigger a drop in levels of sex-hormone-binding-globulin, (normally attaches to sex hormones and makes them inert). With reduced SHBG levels, greater amounts of bioactive “male” sex hormones – androgens such as testosterone – begin to circulate inside a woman’s body.
Over time, this oversupply of active androgens can make women more male-like in appearance, fuel more obesity in the stomach region, and disrupt glycaemic control. Left unchecked, these imbalances often become self-perpetuating, thus stimulating further weight gain and metabolic dysfunction that eventually increases the risk of syndrome X, diabetes, cardiovascular disease, and certain cancers.
All of the factors associated with metabolic syndrome are interrelated.
Insulin resistance has a negative effect on lipid production, increasing VLDL (very low-density lipoprotein), LDL, and triglyceride levels in the bloodstream and decreasing HDL. This can lead to atherosclerosis which, over time, can lead to cardiovascular disease, blood clots, and strokes.
Insulin resistance also leads to increased insulin and glucose levels in the blood. Excess insulin increases sodium retention by the kidneys, which increases blood pressure and can lead to hypertension.
Excess serum glucose is converted to fat and stored, thus increasing obesity.
Chronically elevated glucose levels in turn damage blood vessels and organs, such as the kidneys, and may lead to diabetes.
How is it Diagnosed?
Presence of two or more features as outlined above. In addition, the following tests are usually done:
Glucose, insulin, cholesterol, uric acid
Blood pressure, weight and waist measurements.
Can it be Prevented?
Achieve and maintain a healthy weight (click here to see how) and exercise regularly
In children and teenagers part of the increased risk is due to:
- Decreased periods of exercise, activity
- More time in front of the computer and television
- Unhealthy super-size meals
- Sugared drinks
- High-fat, high-calorie meals at fast-food restaurants
Parents need to guide children to develop healthy eating habits, moderate computer or “screen” time and make sure that they get outside and play!
Successful management of the metabolic syndrome involves strategies that address each of the individual components of the condition (e.g., high blood pressure, high cholesterol and obesity).
The goal is to improve indicators without worsening another aspect condition. For example, some anti-hypertensive drugs (e.g., diuretics and beta blockers) increase the risk of elevated blood glucose and insulin resistance.
Medical drugs may include:
- Glibenclazide or Metformin– increases cell sensitivity to insulin
- Statins (Atorvostatin & Simvastatin [Lipex]) – to lower cholesterol
- Reductil – designed to decrease the absorption of fat by approximately 30 percent
- Decrease the amount of animal fats and damaged oils in the diet,
- Avoid sweets, and refined grains
- Stop smoking
- Avoid excessive alcohol use.
- Basic strategies such as having a nutritious breakfast that includes a protein and fibre may help control one’s appetite and, therefore, curb snacking and binge eating later on.
- Weight loss: Losing weight increases levels of HDL cholesterol and decreases levels of triglycerides and LDL cholesterol. Even a modest reduction (5 to 10 percent of total weight) can increase the body’s sensitivity to insulin, lower blood pressure and decrease the impact of central obesity.
- Exercise: has a beneficial effect on all the factors in metabolic syndrome.
Advantages & Disadvantages of this approach
Main goals are reduction in markers of the disorder. However in practice (from my observation) doctors are generally not very pro-active in supporting their patients to do the single most important thing – lose weight. Thus the treatment is a long-term maintenance regime. Along the way, the cocktail of medications increases, with more being added to control side effects that arise. One big risk of statin therapy would appear to be the negative effect it has on the body’s CoQ10.
Statins block enzyme pathways involved in the production of cholesterol, thereby lowering cholesterol levels.The same enzymes that are involved in the production of cholesterol are also required for the production coenzyme Q10 the levels of which are lower in those taking statins. Coenzyme Q10 (ubiquinone) is important in the manufacture of ATP. Present in every cell, it is especially concentrated in the very active cells of the heart. Low levels of CoQ10 are implicated in virtually all cardiovascular diseases, including angina, hypertension, cardiomyopathy and congestive heart failure.
- looks beyond the presenting symptoms – sees the patient as a whole rather than a collection of symptoms
- includes support for other organs – adrenal glands, liver, thyroid if indicated
- provides psychological and nervous system support where self esteem, stress, anxiety are big factors.
- requires the patient to be an active participator in their treatment regime.
- Treatment may take longer to reduce the main markers (such as elevated cholesterol)
- Compliance may be more difficult to achieve due to the nature of some of the remedies (eg Herbal tinctures)
- ultimate result could see the patient returned to a “normal” level of functioning, without the side-effects commonly experienced with medication.
- places stronger emphasis on dietary changes and weight loss – these areas often receive more focus with a view to educating the patient than the medical approach.
Diet, herbs and nutritional supplements are carefully matched to the individual. Specific nutrients that may be indicated to help improve insulin and glucose metabolism, provide antioxidants, manage blood pressure, support healthy cholesterol levels, reduce stress and to counteract depletions and side effects of prescription medication. Managed weight loss is central to treatment as well as implementation of an exercise regime to enhance the body’s ability to utilise glucose more effectively.
Take the following quick quiz to assess your risk for insulin resistance.
- Do you eat snack bars, pretzels, potato chips, corn chips or other “junk food” more than five times per week?
- Do you have high blood pressure?
- Do you have a difficult time losing weight despite exercising regularly?
- Do you carry more weight in the upper abdominal area of your torso? (ie: is your waist larger than your hips? )
- Do you have a close relative who has had heart disease, high blood pressure, adult onset diabetes, PCOS or obesity?
- Do you have difficulty concentrating, feel irritable, or get headaches between meals?
- Do you have (or have you had) high cholesterol?
- Do you experience frequent cravings for sugars or other high carbohydrate foods?
- Are you 5 kilos or more over what you would call your ‘ideal’ weight?
- Do you often feel tired after eating a meal?
- Do your meals emphasise pasta, rice, pastry, potatoes, or corn more than 3 times per week?
- Do you experience hypoglycaemia (low blood sugar) – you may get weak or shaky when you’ve not eaten for a while. These symptoms are often accompanied by sugar cravings and usually disappear with eating something.
- Do you exercise less than 2 times per week?
- Does your energy fluctuate markedly throughout the day?
If three or more of these statements apply to you, then you might have insulin resistance. We strongly recommend an appointment with one of our naturopaths as soon as possible to get you back on the path of good health. Prevention of full-blown Metabolic Syndrome is the best strategy, and it’s never to late to start to turn back this potentially life-threatening condition.