In the UK, an estimated one in five adults has metabolic syndrome – a condition that has been described as a cardiovascular time bomb. Could you be at risk?

Before reading any further, find a tapemeasure and check the size of your waist in centimetres. If it’s greater than 80cm and you are female, or if it’s larger than 94cm and you are male, then the chances are you may have metabolic syndrome. The good news is, if you do, there are lots of things you can do to improve your health before it deteriorates any further. The bad news is, if you ignore the warning signs and carry on with your current diet and lifestyle, you are at increased risk of developing diabetes and of having a heart attack or stroke. In fact, 80% of people with metabolic syndrome will develop type 2 diabetes if they don’t take steps to avoid it.

WHAT IS METABOLIC SYNDROME?

It is associated with several abnormal findings, but the most easily identified is central obesity – in other words, having a large waist or ‘beer belly’. Compared with fat cells elsewhere in your body, those packed around your internal organs are unusually active. They ‘leak’ fatty acids into the circulation and produce a number of hormones that are associated with insulin resistance. Once cells lose their sensitivity to insulin hormone, your blood-glucose levels stay higher than normal after eating carbohydrates. Your pancreas tries to overcome this by making more and more insulin to help push excess glucose into fat cells for storage. This sets the scene for a vicious circle in which your waistline gets bigger and bigger, your cells become less and less sensitive to insulin and your insulin and glucose levels keep rising. Eventually, your glucose levels may rise enough for your doctor to diagnose type 2 diabetes. Paradoxically, this form of obesity-related diabetes is often associated with high insulin levels, although eventually your pancreas may become fatigued, so that insulin production stops and type 1 diabetes (associated with lack of insulin) develops.

SYMPTOMS AND SIGNS

As well as having central obesity, high insulin levels and glucose intolerance, people with metabolic syndrome can develop high blood pressure, abnormal blood-fat levels (raised triglycerides but low levels of beneficial HDL-cholesterol), increased blood stickiness and even liver problems as a result of their increasingly abnormal metabolism.

“Metabolic syndrome may well prove a helpful signpost to identify those who can make dietary and lifestyle changes that can potentially prolong their life.”

You are also likely to have difficulty losing weight on low-fat diets, to feel tired all the time and to develop sugar cravings. Although metabolic syndrome has been described as a ‘cardiovascular time bomb’ it may well prove a helpful signpost to identify those most at risk of developing type 2 diabetes, heart attack and stroke and who can make dietary and lifestyle changes that can potentially prolong their life.

DEFINITION

As it represents a cluster of symptoms and signs, metabolic syndrome is diagnosed when three or more risk factors are present. Although there is no firm consensus on diagnosis, the European Group for the Study of Insulin Resistance suggest the following definition:

• fasting blood-insulin levels in the highest 25% for the population.

PLUS any two of the following:

• glucose levels great than or equal to 6.1 mmol/l (but less than 7.0mmol).
• high blood pressure greater than, or equal to 140/90mmHg.
• abnormal blood-fat levels (high fasting triglyceride levels of greater than 2.0mmol/l or HDL-cholesterol of less than 1.0mmol/l).
• central obesity: waist circumference greater than or equal to 94cm in men and 80cm in women.

Because insulin levels are not routinely measured, a simpler definition that uses just two factors – waist circumference (greater than 90cm) and elevated blood triglyceride level (greater than 2mmol/l) – has also been suggested.

SELF-HELP

If you are overweight with a big waist, it is important to see your doctor, who can screen you for raised blood pressure and check your blood-fat and glucose levels. He or she may need to prescribe a number of drugs to improve your health and it is important to take these as prescribed. There are also things you can do yourself that have the potential to reverse metabolic syndrome altogether. Although the tendency towards insulin resistance may be inherited, it is usually acquired due to lifestyle factors such as obesity, lack of exercise and eating excessive amounts of refined carbohydrates.

People with metabolic syndrome need to lose excess weight, exercise regularly (which in itself can lower glucose levels, blood pressure and blood-fat levels) and switch to a diet that does not cause spikes in blood-sugar levels. This means eating foods with a low rather than a high glycaemic index. Research shows that following a controlled-carbohydrate diet can reverse ALL the clinical findings associated with metabolic syndrome, helping you lose weight, lower a raised blood pressure, lower triglyceride levels and increase beneficial HDL-cholesterol. Some people may prefer to follow a very low-calorie diet, under the supervision of a trained counsellor. While the traditional low-fat, calorie-controlled diet is also an option, people with metabolic syndrome tend to find it very difficult to lose weight following this approach which encourages a high carbohydrate intake – the very macronutrient that triggers insulin release in the body.

SUPPLEMENTS

A number of supplements can help people with metabolic syndrome. As a basic rule, most people benefit from taking a multivitamin and mineral supplement because magnesium, selenium, copper, zinc, vitamin C and vitamin E are all important for improving glucose tolerance. Depending on how well your blood glucose levels are controlled, you may wish to add in a supplement such as:

• Chromium, which helps to regulate bloodsugar levels by improving insulin resistance in muscle cells. It may help only people who are chromium deficient but, as this is relatively common, there is little harm in trying a chromium supplement at a dose of 200-400mcg daily (don’t forget to factor in any chromium included in your multivitamin and mineral supplement) for a few months to see if it helps.
• Alpha-lipoic acid, which helps to improve insulin sensitivity and glucose uptake into muscle cells.
• Conjugated linoleic acid, which helps to improve insulin resistance in fat cells.
• Co-enzyme Q10, which may improve the function of insulin-producing cells in the pancreas.
• Pycnogenol which can significantly improve glucose tolerance through a mechanism that is not yet fully understood.

Interestingly, drinking green tea can also improve glucose control and you may wish to enjoy this regularly or, if you don’t like it, take green tea supplements.

Garlic extracts have a number of beneficial actions that help to maintain a healthy heart and circulation.

Taking omega-3 fish oils will provide an additional useful protective effect on the heart and circulation and help to reduce the inflammation associated with metabolic syndrome.

NB: Supplements should always be used to complement the medical treatment your doctor has recommended and should never be chosen instead of normal medical care. Never stop taking any prescribed medications except under the advice of your doctor.

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