METABOLIC SYNDROME: WHAT IT IS AND HOW TO MANAGE IT

It's currently estimated that around one in every three adults in the United States has a diagnosis of metabolic syndrome, which makes up about 33% of the adult population.[1]

Also referred to as "syndrome X," metabolic syndrome can be a bit confusing as this is not a disease in itself, but rather a cluster of conditions that can set the stage for metabolic diseases.

While the root of metabolic syndrome is often debated, what's clear is that the risk of metabolic syndrome is highly related to lifestyle factors such as diet and exercise.

What Is Metabolic Syndrome?

Metabolic syndrome isn't characterized by a single diagnosis but consists of a group of conditions that increase your risk for stroke, coronary heart disease, and diabetes. These conditions include:[1]

• Abdominal obesity – having a larger waistline puts you at higher risk for heart disease due to the metabolic activity of visceral adipose tissue (fat cells).
• Hypertension – when you experience high blood pressure for extended periods, it can damage your blood vessels and instigate plaque formation that puts you at risk for heart disease. 
• High blood glucose – Chronically high blood sugar levels can damage your blood vessels and increase your risk of blood clots. 
• High blood triglycerides and LDL cholesterol (low-density lipoproteins) – High blood triglycerides can increase your LDL "bad" cholesterol, which raises your risk of heart disease as this type of blood lipid can deposit in your blood vessels and create plaque buildup.
• Low HDL cholesterol (high-density lipoproteins)– the "good" cholesterol that helps to remove LDL cholesterol from your blood vessels.

Generally speaking, if you have three or more of the above conditions, you likely have metabolic syndrome. 

Symptoms of Metabolic Syndrome 

The conditions associated with metabolic syndrome don't necessarily present with symptoms right away. A large waistline is likely the most obvious symptom that something is happening internally, but it is possible to have excess weight around the middle without having metabolic syndrome. 

As time goes on, you may notice issues relating to insulin resistance, like increased thirst, fatigue, or excess urination. 

Causes, Risk Factors, And Complications 

Causes

While the exact cause of metabolic syndrome is unknown, obesity, inactivity, and insulin resistance all seem to play into developing the conditions that lead to metabolic syndrome. 

Insulin resistance, in particular, shares several traits of metabolic syndrome, which is why metabolic syndrome is sometimes referred to as "insulin resistance syndrome." Insulin is a hormone responsible for lowering glucose and triglycerides in your blood after meals. By signaling the presence of these energy-providing nutrients, insulin lets your cells know that fuel is present, and they are moved out of the blood and into your cells to be used for fuel or stored for later.[2]

When your cells are resistant to insulin signals, glucose and triglycerides build up in the blood and can cause a host of issues related to metabolic syndrome. 

What creates insulin resistance in the first place is up for debate and likely comes down to several factors. Below are the most well-understood risk factors that can contribute to metabolic syndrome. 

Risk Factors 

Risk factors for metabolic syndrome can be divided into two categories; modifiable and non-modifiable. Of course, if you keep an eye on your modifiable risk factors, it greatly reduces the impact of the non-modifiable ones. 

Some non-modifiable risk factors associated with metabolic syndrome include:[3]

• Age – as you age, the risk for metabolic conditions increases.
• Ethnicity – in the US, Hispanics tend to have a higher prevalence of metabolic syndrome, although the reasons for this aren't clear.
• Genetics – if you have a family history of type 2 diabetes or metabolic syndrome, it increases your risk.

In addition to the above, several modifiable risk factors can contribute to or help prevent metabolic syndrome. These risk factors come down to lifestyle choices, which is why taking your health into your own hands can be so empowering.

Modifiable risk factors:

• Obesity – being overweight, especially carrying excess abdominal weight, can increase your risk for metabolic syndrome, likely due to the metabolic activity of visceral fat tissue.[4] 
• Diabetes – if you already have diabetes (especially type 2 diabetes or gestational diabetes), it increases your risk for metabolic syndrome. 
• Poor Sleep – studies show that disrupted sleep (either short sleep duration or poor sleep quality) can significantly increase the risk for metabolic syndrome.[5,6]
• Stress – chronic stress can set the stage for several imbalances and diseases, and metabolic syndrome is no exception. In fact, research shows that in addition to metabolic syndrome, persistent stress is linked to obesity, cardiovascular disease, and diabetes.[7] 

Complications 

The two primary complications that can come with untreated metabolic syndrome are type 2 diabetes and cardiovascular disease. 

When insulin resistance is left uncontrolled it can lead to diabetes, which results in chronically high blood sugar levels and triglycerides that can damage blood vessels and set the stage for cardiovascular disease.[8]

Furthermore, high cholesterol levels and hypertension can contribute to the buildup of plaque in your arteries, setting the stage for a heart attack or stroke.[9]

How To Prevent or Manage Metabolic Syndrome

Metabolic syndrome is largely a result of lifestyle choices, which means that when you know how to incorporate the right lifestyle modifications, it can make a significant difference in your health outcomes. 

Since metabolic syndrome is strongly linked to obesity and insulin resistance, targeting these two conditions is an excellent place to start. However, stress and sleep should also be taken into consideration. Below are some lifestyle guidelines that can help you prevent or manage metabolic syndrome.

Weight loss

Weight loss will not only help you to shed extra pounds around your middle (abdominal obesity), but it can also help to resensitize your cells to insulin. In fact, research shows that even relatively small amounts of weight loss (5-12%) can start to reverse insulin resistance[10,11].

Of course, weight loss is not as simple as "deciding to lose weight," and there are many factors that contribute to why your body is holding weight in the first place. With that being said, two lifestyle factors that can significantly affect how your body stores and utilizes energy are diet and physical activity.  

Dietary Changes

At the root of almost all metabolic issues is the dysregulation of how your body uses energy from the food you eat. Studies show that switching to a low-carb diet can help to resensitize your cells to insulin, not only in the short term but in a way that may reverse insulin resistance altogether.[12]

Low-carb diets may also reverse diabetes, diminish fatty liver, and improve your overall lipid profile (triglycerides and cholesterol).[12] 

However, just because a food is low in carbohydrates does not mean it's a healthy food, so discretion among your food choices must also come into play. Ideally, you'll follow a diet that consists primarily of whole foods that are also low-carb. This will ensure that your body is still receiving the nutrients it needs to function optimally while also mitigating the impact that high levels of carbohydrates can have on insulin and blood sugar. 

Physical Activity

Another excellent way to improve insulin sensitivity is through physical activity. Moving your body sends a message to your cells that it's time to ramp up fuel usage, which in turn helps them perk up their 'ears" to insulin's signals. As a result, your cells allow more fat and glucose in, reducing their buildup in your blood. Studies show that exercise improves insulin sensitivity in both insulin-resistant individuals and non-insulin resistant.[13]

Exercise also helps to improve blood pressure, cholesterol, and triglycerides, supporting heart health. And, of course, it also promotes weight loss.[14]

Furthermore, physical activity can enhance levels of feel-good hormones while decreasing stress hormones, making it a natural stress reliever.[15]

Physical activity can include anything from a brisk 30-minute walk to a high-intensity cardio workout and everything in between. How you move your body is much less important than making sure that you move it at all. Find activities you love which will make your exercise much more enjoyable. This will help you stay motivated to keep returning to it.  

Sleep

As mentioned, disrupted sleep correlates with an increased metabolic syndrome risk. When you don't get the rest your body needs, it makes it much more challenging to deal with life's stressors, and it can promote poor dietary choices and weight gain – all factors that may contribute to metabolic syndrome and its associated conditions.[16]

Poor sleep may also result in higher cortisol levels, which is known to promote abdominal obesity.[17]

Sleep issues can be hard to tackle, but many people find that once they start making other lifestyle changes (such as cleaning up their diet and increasing physical activity), sleep becomes much easier. Of course, stress also plays a crucial role in your sleep quality as well. 

Stress Reduction

By now, you're probably picking up on the fact that all of these lifestyle factors play into each other, and stress works itself right into the mix. 

Chronic stress is associated with weight gain (especially around the middle), poor sleep, and all kinds of metabolic dysfunction.[18,19]

As the prevalence of chronic stress has become more widespread, research into how we can manage our stress levels has also increased. Some of the most well-established stress-reduction techniques include:[20,21,22,23]   

• Physical activity
• Meditation
• Journaling
• Connection with loved ones
• Deep diaphragmatic breathing 

Takeaway  

If you've been diagnosed with metabolic syndrome, or want to get ahead of a future diagnosis, following a healthy lifestyle is the most important step you can take to mitigate your risk.

This includes plenty of physical movement, a healthy diet, stress reduction, and a focus on quality sleep. All of these factors combined promote a healthy body weight and can reduce markers for metabolic syndrome like irregular blood lipids, hypertension, larger waist circumference, and high blood glucose levels.

Having metabolic syndrome does not mean that you're destined for diabetes or heart disease; it's simply a warning sign that you're headed in that direction.

To learn more about metabolic disease, healthy lifestyle options, and how you can mitigate your risk or even turn things around, check out the BioCoach App for information, guidance, and much more.