The Metabolic Syndrome is a common yet under-diagnosed condition of dysmetabolism and increases the risk for cardiovascular disease. Main features of the syndrome are insulin-resistance or risk thereof and abdominal obesity. Below is an overview of how Metabolic Syndrome is diagnosed, what insulin-resistance is, the cardiovascular disease link, and how to eat to treat or prevent the Metabolic Syndrome.
How is the Metabolic Syndrome diagnosed?
The presence of abnormalities in any 3 of these 5 measures meets the criteria for a metabolic syndrome diagnosis. For the International Diabetes Federation, waist circumference is a required criterion to diagnose metabolic syndrome (Grundy, et al, 2004). The following describes all 5 measures:
A waist circumference for males of 40" or more and for females of 35" or more. Abdominal obesity is a risk factor for metabolic syndrome and also increases risk of a fatty liver. You can measure your waist circumference by using a measuring tape around your midsection with tape right above the belly button and tape parallel to the floor. Click here for an easy-to-use and inexpensive measuring tape on amazon.
Elevated triglycerides: >150 mg/dL OR on triglyceride-lowering medication Ask your doctor if you have high triglycerides or ask for a printout of your lab report. Medications that may be prescribed include omega 3 supplementation, fibric acid derivative, niacin, or statins.
Low HDL cholesterol in males is <40 mg/dL and females is <50 mg/dL OR if on medication for cholesterol The role of HDL is to clear out fatty deposits in the artery (reducing risk of blood clot or heart attack). Ask your doctor if you have low HDL or ask your clinic for the lab report of your lipid panel. Medications may include a statin. A healthy dietary pattern can increase HDL and addresses the root cause of a low HDL.
High blood pressure at >130/80 OR taking medication for blood pressure High blood pressure can be an elevation of either number of >130/80. A common medication for high blood pressure is lisinopril. Obesity is one of the driving factors of hypertension. Frequent and varied fruit and vegetable consumption can help normalize high blood pressure. Chronic high blood pressure can be dangerous for your health, so if your doctor recommends medication - it is a good idea to remain compliant with it until you reach a healthier weight, include plants at every meal, and are reassessed by your doctor.
High fasting blood glucose at more than 100 mg/dL OR diagnosed with type II diabetes or prediabetes OR on medication You can ask your doctor to measure your blood glucose or A1c. If you have high blood glucose on a fasting test, on medication to normalize blood glucose (i.e. metformin, insulin), or have been diagnosed with type II diabetes, then you are at increased risk for metabolic syndrome. Pre-diabetes is also a risk factor.
What is Insulin Resistance?
To understand insulin-resistance, one must first understand blood glucose and insulin.
Blood glucose is a molecule that is broken down from consuming carbohydrates and sugars.
Insulin is the hormone that is needed to process blood glucose - or to uptake glucose into the cells to use for energy. Insulin is great hormone for growing children or active individuals.
When blood glucose is continually high or the demand to process glucose with insulin is continually high, insulin-resistance can happen. That is, when the body is producing insulin but the body is losing its sensitivity to it. This can often be seen in the Metabolic Syndrome or with Type II Diabetes. Obesity is also associated with insulin-resistance.
Take Caution with Insulin Shots
Now, if you have type II diabetes, have abdominal obesity, AND are taking insulin shots - remember in 2 paragraphs prior I mention that insulin is a great hormone for growing children or active individuals. If you are not in these categories yet THEN you give yourself an insulin shot, you are prompting your high blood glucose to be converted straight to fat - exacerbating your obesity. You may find you have gained weight after you first began insulin shots. If your blood glucose and A1c are high, then you need to intervene somehow and insulin will do the job to normalize these values. But it is more effective to prevent high blood glucose spikes all together as able by avoiding added sugars like soda, sweet tea, white bread, desserts, huge bowls of popcorn/chips. It's not worth it! If you don't limit them and do your best to not over indulge on processed carbohydrates, then you are asking for high blood glucose or obesity or both. Keep reading for what TO eat.
The Consequences of the Metabolic Syndrome
The Metabolic Syndrome increases risk of heart disease. This is because the dietary habits paired with dysmetabolism (i.e. insulin-resistance, abdominal obesity, or high blood pressure) changes the composition of the blood. For example, high blood glucose or triglycerides. This creates an irritant to the arterial wall which causes an erosion of the inner most epithelial layer.
Next, cholesterol builds up in this weakened spot of the arterial wall. The body then sends an immune response, specifically white blood cell macrophages, in attempts to remove the cholesterol. This is a good short-term solution to a minor problem but with the ongoing irritants of a high-carbohydrate diet and the resulting consequences to blood lipids, this immune response becomes ineffective. The cholesterol and macrophages turn into a cholesterol plaque attached to the artery wall.
This plaque increases risk for a blockage of the artery, aneurysm, or stroke. The body tries to defend against this by growing a smooth muscle barrier around the cholesterol plaque which originates from the wall of the artery. This creates a weakened artery wall and increases risk for aneurysm (a busted artery that bleeds out).
Bottom line is, the Metabolic Syndrome increases your risk for cardiovascular disease, heart attack, and stroke.
THE GOOD NEWS
The Metabolic Syndrome is preventable and reversible!
Excessive carbohydrates is a leading cause of the syndrome. Many have found success on a low-carbohydrate diet which is a diet that promotes protein, fruits/vegetables, and limits carbohydrates to one serving per meal.
Carbohydrates to avoid are ones that break down to sugar (glucose) in the digestive system too readily making your blood glucose spike. They are: corn, potatoes, bread, pasta, juice, sugar, flour, chips, soda. Avoiding these foods or limiting portions can make a a big impact on your weight and health. Try to avoid packaged foods where the first ingredient listed is sugar, corn, potatoes, or flour. All these foods are high in carbohydrates. You want to choose foods that are lower in carbohydrates - importantly, they don't have to be void of all carbohydrates. Carbohydrates in moderation is really important for the Metabolic Syndrome.
But don't leave yourself hungry! Fill up with non-starchy vegetables to ensure you are getting adequate vitamins and minerals. Imagine your body is a machine, and vitamins and minerals are the high quality components that keep your machine running smoothly. Feeling fatigue? You may be low on a variety of nutrients. The traditional American diet is high in carbohydrates and low in micronutrients! Eat a variety of colorful fruits and vegetables to ensure a variety of vitamins and minerals! Spinach, sweet potatoes, blueberries, strawberries, and red cabbage are some examples of colorful fruits and vegetables.
Protein at every meal and snack will help you feel satisfied. Have you ever had a big bowl of popcorn or chips and you found yourself eating a whole bunch before you felt full? Carbohydrates don't fill you up very fast. Try protein foods: meats of all types, peanut butter, eggs, greek yogurt. Keep reading for more examples of a healthy meal!
Healthy Eating for the Metabolic Syndrome
The meals in these 2 pictures are examples of what a healthy meal looks like. The carbohydrates are whole grains (brown rice, whole grain bread) and there's only one portion. The meals also include 2 different colors of plants (fruit, vegetable), and a protein (beef, chicken). If you want seconds, then do not get more carbohydrates (milk, fruit, grains, potatoes, corn) but get non-starchy vegetables (broccoli, brussel sprouts, carrots) and protein (meat). Grilled, sauted, or baked foods are better than fried. Crock pots and pressure cookers are fine choices as well.
Milk or water are good choices for beverages. Water to stay hydrated, and milk with any level of dairy fat is acceptable (skim, 1%, 2%, whole). Milk is a good source of calcium which also can promote weight loss.
Caloric moderation can encourage weight loss if overweight or obese. To achieve weight loss, the Executive Summary Guidelines recommends 1200-1500 calories per day for women and 1500-1800 calories per day for men (Executive Summary Guidelines, 2014). The goal for Metabolic Syndrome is to achieve a waist circumference that is less than 40 inches for men and less than 35 inches for women. In obesity, an end goal of 7-10% weight loss compared to baseline is beneficial for health. But any loss is associated with improved health outcomes.
Many scientists debate if fat should be restricted in the diet. Some researchers such as with the American Heart Association believe saturated fat is associated with cardiovascular disease, but this hypothesis doesn't take into account the variety of types of saturated fat. Dairy, for example, has a high amount of saturated fat but dairy (i.e. whole milk) but has not been found to increase risk of cardiovascular disease. In fact, the opposite in some studies. Same with coconut oil. To read more about the diversity of saturated fat, I recommend the following article.
Reducing the cholesterol from food is unnecessary to achieve health. This is because most cholesterol is produced within the body. "Bad" cholesterol has been a myth in the medical community for a long time. Cholesterol in the diet (i.e. eggs) will not increase blood cholesterol.
MyPlate education (appropriate calorie distribution, increase in non-starchy vegetables, moderation of carbohydrate sources).
Encourage quality carbohydrates (whole foods: grains, fruit) in place of simple sugars (juice, sucrose, soda).
Prediabetes or diabetes diet education.
Pair protein when consuming carbohydrates.
Recommend 500 kcal deficit/day; portion-control, balanced meals rather than grazing.
Promote protein as necessary/if relevant.
Heart health is of upmost importance with the Metabolic Syndrome to prevent the associated cardiovascular disease. Limit sodium intake to under 2000 mg per day (1500 mg per day is even better), aim to have a protein source (i.e. eggs, nuts) and a plant (i.e. whole fruit, vegetable, beans) at every meal and snack. Omega 3 is a healthy polyunsaturated fat. All cell membranes in the body are comprised of cholesterol and fat. Omega 3 can help cell membranes have healthy cell membranes. This includes the epithelial lining of the arterial wall to help prevent cholesterol plaque build up and blood clots. Salmon, tuna, walnuts, and olive oil are great sources of omega 3. Fiber from whole foods (i.e. whole fruit, vegetables, beans) can also support healthy glucose and triglyceride levels.
A Great Method to Track Your Weight Loss
Now that you have some ideas about how to eat to treat or prevent the Metabolic Syndrome, and you have also formed an ongoing relationship with your doctor and registered dietitian nutritionist, losing weight will likely be part of the overall treatment goal for Metabolic Syndrome. If obese with a waist circumference of more than 40" for men and 35" for women or with a BMI more than 30 (google "BMI calculation" to find out your BMI), here is an effective way to track your progress of losing some of that abdominal obesity!
To track weight loss progress, use a measuring tape and a pen and paper. Measuring the circumferences of the arm (midpoint of bicep), the middle of the thigh, the neck, and the waist. (When measuring the waist, be sure your measuring tape is perpendicular to the floor and just above your belly button.) Add all these numbers up and this is your total and record on paper or journal. Each week, do it again. Your total number will change and this the number of inches you have lost. Be SURE to bring this information and share with your doctor and registered dietitian nutritionist. They will be glad you did!
Weight loss tip! Many are surprised by how much cutting out soda alone can improve lab values and waist circumference. Soda consumption increases risk for the Metabolic Syndrome as well as a high consumption of processed foods in general.
What labs and measurements will your doctor or registered dietitian nutritionist want to know and track for the Metabolic Syndrome?
A1c
Glucose
Blood pressure
BMI
Triglycerides
Total cholesterol
HDL
Waist circumference
You can keep track of these too by asking your doctor to provide you with your lab print out and compare it to the information towards the top of this article for diagnostic Metabolic Syndrome criteria. One thing I believe whole-heartedly, is you the patient need to also understand your own medical condition and what to do about it after you leave the doctor's office.
This article is meant to provide general information on the Metabolic Syndrome. Even though I have an education and background in nutrition science, I have not personally reviewed your labs nor assessed your nutrition status. Therefore, I am unable to individualize a diet plan for you. I urge you to see a medical doctor or registered dietitian nutritionist for individualized nutrition diagnoses and recommendations.
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References
Executive Summary: Guidelines (2013) for the Management of Overweight and Obesity in Adults. (2014). Obesity, 22(July 2014), S5–S39.
Grundy, S. M., Hansen, B., Smith, S. C., Cleeman, J. I., & Kahn, R. a. (2004). Clinical Management of Metabolic Syndrome: Report of the American Heart Association/National Heart, Lung, and Blood Institute/American Diabetes Association Conference on Scientific Issues Related to Management. Circulation, 109(4), 551-556. doi:10.1161/01.CIR.0000112379.88385.67