There is nothing short of an epidemic silently sweeping the United States. According to the American Medical Association, 34% (more than one in three) adults now fits the criteria for the condition known as Metabolic Syndrome, which vastly increases risk of both cardiovascular disease and diabetes. For adults over the age of 50, the rate is 44% – nearly one in two. Despite the high incidence of this condition, it is not infectious in nature. You can’t catch it from your neighbor, and you can’t pass it along to your children. Nor is it something that can be simply treated with an antibiotic or other drugs. Taking many years to develop, the best news is that the treatment (and prevention) of this condition is entirely within your control, in accordance with many actions and decisions made on a daily basis. Here we will discuss what this ailment is, how it may affect you, the latest research regarding treatment and prevention, and how you can work with your doctor to avoid it.
In 1940, nutritionist Victor Lindlahr published a book entitled You Are What You Eat, describing how to achieve and maintain health with diet, the connection between the foods put in one’s body, and overall health. Interestingly, Victor was the son of Dr. Henry Lindlahr, a physician who is considered to be the founder of naturopathy in the United States, bringing the study and application of “Nature Cure” from Germany. As you will see, in no aspect of health is the expression, “you are what you eat” more applicable than in Metabolic Syndrome. Regular exercise and activity, proper sleep, and adequate stress coping mechanisms are vitally important in the management of this condition.
So what exactly is Metabolic Syndrome? It is the specific collection of a number of medical conditions – raised blood pressure, elevated levels of blood sugar, excess body fat around the waist and abnormal cholesterol levels. Each of these conditions brings particular health hazards, but when they are all present there is significant risk of developing more severe medical issues, including heart attack, stroke, diabetes, and even neurologic and rheumatologic conditions. According to the American Heart Association, the exact guidelines for Metabolic Syndrome are as follows:
- Elevated waist circumference:
- Men — greater than 40 inches
- Women — greater than 35 inches
- Elevated triglycerides: greater than 150 mg/dL
- Reduced HDL cholesterol:
- Men — less than 40 mg/dL
- Women — less than 50 mg/dL
- Elevated blood pressure: above 130/85 mm Hg (or use of medication for hypertension)
- Elevated fasting glucose: above 100 mg/dL (or use of medication for hyperglycemia)
Since testing is required, it is necessary to see your doctor to determine whether or not you fit the criteria for Metabolic Syndrome. Whether you fit all these parameters or just a few of them, it is in your best interest to consider some positive changes that will reduce your risk and possibly eliminate the condition all together. As previously stated, most all of the factors that contribute to Metabolic Syndrome are directly related to lifestyle, diet, and activity. This means that avoiding this condition is entirely in your control! Anyone interested in taking their health into their own hands has all the power to avoid Metabolic Syndrome. Of course, prevention is always easier than treatment, but if you do already fit the criteria, know that you can often reverse the process by making these same changes and sticking to them.
Perhaps the most important component related to risk for Metabolic Syndrome is diet. Remember, you are what you eat! Many experts suggest that the significant increase in Metabolic Syndrome in recent years has much to do with the rising American addiction to refined carbohydrates. This trend can be traced back to the vast promotion of the low fat diet, beginning in the 1960s and taking strong root by the 1980s. We were told that intake of fat, especially saturated fat, is bad and should be significantly curtailed to reduce risk of heart attack and stroke. Low fat and nonfat foods began to line the grocery store shelves. The trouble is, over this same period of time, obesity in America has gotten out of control. Currently, 35% of American adults are obese and a staggering 68% are overweight. This is not a genetic condition, and yet rates among children are 16% obese and 31% overweight. One major reason for this is that when fat went out the window, it was overwhelmingly replaced with refined sugars and carbohydrates. When these are combined with sedentary behavior (not enough activity or exercise), they lead to increased weight gain. We are passing our bad habits on to our children, and the full extents of the consequences are unclear.
Let’s talk details of prevention and treatment by examining some of the latest research in Metabolic Syndrome. Specifically, we’ll look at how Metabolic Syndrome relates to diet, exercise, sleep, and overall stress management.
Beyond reducing dietary carbohydrates and sugars, there is exciting research regarding the role of a healthy gut microbiome in regards to Metabolic Syndrome. What we are talking about here is probiotics! Researchers at Washington University School of Medicine in St. Louis are doing cutting edge work in this field. Perhaps the most fascinating information from the past few years is a study that compared the gut microbiome of obese vs. lean mice. With no other changes in diet or activity, lean mice were made to gain weight and show molecular changes consistent with Metabolic Syndrome simply by transferring the bacteria from obese mice into their own guts.
In addition, studies in humans have shown a relationship between low diversity of gastrointestinal (GI) bacteria species and increased rates of both obesity and Metabolic Syndrome. What does this mean for you? Optimally, every individual should include an array of fermented foods into their diet. This might include yogurt, kefir, sauerkraut, kombucha, miso, tempeh, and many others. If you aren’t eating these regularly, consider a broad-spectrum probiotic supplement.
We must also consider the role of antibiotic treatment in the alteration of the gut microbiome. Numerous studies have linked repeated exposure to antibiotics in the first two years of life to an increased propensity of obesity in early childhood. The exact mechanism is not clear, but given all we know about GI bacteria, this is likely a significant factor. Overweight children all too often become overweight adults, leading to increased risk for Metabolic Syndrome. Very recent research also suggests a link between frequent antibiotic use in adults and development of type II diabetes up to 15 years later. Certainly antibiotics are a lifesaving medicine, but doctors and patients, should look to more judicious use of these therapies in light of better-understood risks that may be associated with them.
In one more piece of dietary information, it’s no surprise to anyone that soda isn’t particularly good for you. Recent research shows that individuals who consume at least one soft drink per day have a higher incidence of Metabolic Syndrome. Even more interestingly, those who drank diet soda had an even higher prevalence compared to those who drank regular soda. Diet soda drinkers had larger waistlines and higher levels of fasting blood sugar. So while all that sugar isn’t very healthy, the artificial sugar is even worse.
Exercise and Activity
So how about exercise? Certainly an individual’s level of regular activity is related to Metabolic Syndrome, and this is reflected in the literature. On the most basic of levels, we are creatures intended for physical activity. Our modern culture makes it all too easy to lead remarkably sedentary lives, moving only from home to car to office with the occasional expedition to the shopping mall or grocery store. There are numerous studies correlating this low level of activity with increased weight gain and rise of Metabolic Syndrome, but no one really needs a study to point out this obvious fact. More interesting is the data regarding what types of activity might be best.
Indeed, some activity is better than no activity at all. In this regard, it doesn’t really matter what it is. I tell my patients trying to introduce the first bit of exercise into their lives that the best kind is whatever you enjoy the most. This will maintain motivation and keep you moving! There are so many options beyond just going to the gym. If the thought of “exercise” makes you wince, consider ways to sneak extra movement into your daily routine – from using the stairs, to parking on the far side of the grocery store parking lot, or even walking or bicycling.
For those looking to be more aggressive about exercise, the latest research suggests that a combination of cardiovascular activity and interval training leads in the greatest reduction of symptoms correlated to Metabolic Syndrome. High intensity interval training (HIIT) has been shown make for the most dramatic improvement, but you should speak to your physician to ensure cardiovascular stability prior to engaging in such vigorous activity.
Everyone knows the importance of a good night’s sleep, but how about its effect beyond simply feeling rested in the morning? A number of recent studies have specifically looked at the importance of adequate sleep and its relationship to a number of components of Metabolic Syndrome. One such study shows that short sleep duration was associated with excess body mass among both adolescents and young adults. In another, individuals who slept less than five hours per night were 88% more likely to suffer from abdominal obesity than those who slept seven to eight hours. With increased body mass comes increased risk of sleep apnea, and numerous studies link sleep apnea to higher incidence of both elevated blood pressure and diabetes. Indeed, when considered all together, insomnia and insufficient sleep has been shown to be an independent predictor of Metabolic Syndrome, entirely distinct from patterns of diet and exercise.
How about stress? Research in the past number of years has elucidated a connection between elevated psychological stress and a vast array of medical conditions, from irritable bowel syndrome to asthma to headaches. Recent data suggests that stress also has a direct impact on Metabolic Syndrome. Individuals that reported more frequent stressful life events had significantly increased risk for developing Metabolic Syndrome in the 6.5 year follow up period. Along a similar vein, Metabolic Syndrome was shown to be highly prevalent among those people with a history of post-traumatic stress disorder (PTSD). Higher reported levels of anxiety were also shown to increase risk.
As the risk factors for developing Metabolic Syndrome can begin to develop in childhood, an interesting study of adolescents showed lower risk of developing these symptoms among those children with more positive emotions and attitudes, including increased optimism and higher self-esteem. It’s nice to have some scientific evidence showing that a positive outlook on life is positively healthy! Of course, we understand that stress is a ubiquitous part of life. In that regard, it is perhaps more helpful to talk about stress management. There are many resources available for those who are interested in delving deeper into this issue. One of the more interesting ones is a free online course available through University of California – Berkeley, entitled The Science of Happiness, which explores the field of positive psychology, exploring “the roots of a happy and meaningful life.”
The important take-home message here is that whether you already have the constellation of symptoms that constitutes Metabolic Syndrome, you are moving in that direction, or you want to take early steps to prevent it in the future, each and every individual has the power and the tools necessary to improve their health. It is vital to work alongside a well-versed physician in order to regularly monitor lab values and design a treatment protocol that is individualized for you. Fortunately, despite being so prevalent, Metabolic Syndrome is entirely preventable and treatable. I encourage everyone to make a step toward taking control of your health today!
Dr. Craig T. Fasullo has a family practice in Manchester, CT at Connecticut Natural Health Specialists. All of the physicians at the clinic are in network providers for most insurance companies and are accepting new patients. For more information or questions, please call (860) 533-0179 or visit ctnaturalhealth.com