Metabolic Syndrome: Research & Recommendations #Health #MaetabolicSyndrome #Nutrition

Joseph Albrecht
Nicholas Arma
Metabolic Syndrome
Introduction:

Metabolic syndrome is when one experiences a cluster of metabolic risk factors which

come together, causing problems.  These metabolic factors include insulin resistance,
hypertension, cholesterol abnormalities and increased risk of blood clotting.¹ Metabolic
syndrome is considered to be a risk factor for cardio vascular disease and type 2 diabetes
stemming from insulin-resistance and an abnormal function and pattern of body fat.¹
Approximately 32% of the general U.S. population and around 85% of Americans with diabetes have metabolic syndrome.  Out of all ethnic groups in the U.S., metabolic syndrome is highest among Mexican-Americans.  Prevalence also increases with age, affecting around 40% of people over 60.¹  To be diagnosed with metabolic syndrome, one must have at least 3 metabolic risk actors including: a large waistline, elevated triglycerides, low HDL levels, high blood pressure, and high fasting blood sugar.² One’s risk of heart disease, diabetes and stroke increases with the number of metabolic risk factors they have.  The rise of obesity in adults is also linked to increased prevalence of metabolic syndrome, with future projections claiming metabolic syndrome may overtake smoking as the leading risk factor for heart disease.² 

 Etiology/Background of Condition:

 The link between upper body obesity and diseases like atherosclerosis, diabetes, kidney

stones and gout was noted by French physician, Jean Vague in 1947.  Research following this would show how obese patients improved their diabetes, high blood cholesterol and high triglycerides by following a low-calorie, low-carbohydrate diet.  In 1977, Herman Haller used the term “metabolic syndrome” in reference to links between obesity, diabetes, high blood lipids, high uric acid levels, and fatty liver disease and how when all these factors joined together, they increased the risk of atherosclerosis developing.  In 1978, Gerald Phillips noted that a combination of risk factors for heart disease can also increase risk of obesity and other clinical states.  He proposed there were a “constellation of abnormalities”, including glucose intolerance, hyperinsulinemia, and elevated levels of glucose, triglycerides, cholesterol and insulin.  Phillips thought that the sex hormones could be a common factor that was related to all these conditions, and, supported research behind this.  In 1988, Gerald Reaven theorized that insulin resistance could be the underlying factor, creating the name “syndrome x”.³

 Pathophysiology:

 The individual diseases causing metabolic syndrome lead to adverse clinical conditions. 

Hypertension, for instance, can cause ventricular hypertrophy, progressive peripheral artery
disease and renal dysfunction.  Abdominal fat can produce potentially harmful levels of
cytokines such as tumor necrosis factor, adiponectin, leptin, resistin and plasminogen activator inhibitor.4 As a whole, it appears that metabolic syndrome causes microvascular dysfunction, further amplifying insulin resistance and promoting hypertension.  Metabolic syndrome also promotes coronary heart disease by raising the thrombogenicity of circulating blood, raising plasminogen activator type 1 and adipokine levels, it also causes endothelial dysfunction.  Oxidative stress and increased arterial stiffness are additional symptoms which link metabolic syndrome to heart disease.4 Although there are many factors behind metabolic syndrome which could lead to progressively worsening conditions, there are also numerous remedies which help healing take place.  Resveratrol, for instance, may help stimulate formation or mineralization of new bone after inflammation from metabolic syndrome causes bone loss.  Statins help control elevated LDLs, while niacin can help raise low HDL levels.  Niacin, fibrates and omega 3 fatty acids all help with elevated triglycerides.  If hyperglycemia is present, an insulin-sensitizing agent such as metformin can help.  Also a diet low in simple carbs and excess fat that’s rich in fiber can assist hyperglycemia. Common tests involved with metabolic syndrome include measuring fasting glucose, triglycerides, HDL and waist circumference.  If chest pain, dyspnea or claudication exist, tests such as: electrocardiography, ultrasonography, stress-single photon emission computed tomography or cardiac positron emission photography may be valuable.4 Testing frequency would likely depend on the severity of one’s conditions, used to measure treatment progress.

 Medical Treatment/Treatment Options

The major goal of treating metabolic syndrome is to reduce the risk of coronary heart disease.

Treatment is directed first at lowering LDL cholesterol and high blood pressure and managing diabetes (if these conditions are present).7 The second goal of treatment is to prevent the onset of type 2 diabetes, if it hasn’t already developed.7 Metabolic Syndrome is reversible through dedicated and committed lifestyle changes including consistent exercise, a heart healthy diet, stress management, quitting smoking if you’re a smoker and losing weight if overweight/obese. There are also drugs/medicines that may be taken if prescribed by healthcare professional/doctor such as statins, niacin, metformin and more.

Drug/Nutrient Interactions:

  Metformin is an oral medication that lowers blood glucose (sugar) by influencing the body's

sensitivity to insulin and is used for treating type 2 diabetes.5 In other words Metformin increases sensitivity to insulin in the liver, muscles, fat and other tissues thus allowing glucose to be transferred from the blood and into the cells so that the cells do not starve from lack of glucose thus, lowering the effects of hyperglycemia (because glucose has left the blood to enter the cells). Side effects include nausea, vomiting, upset stomach, diarrhea, and weakness. Low blood sugar can occur but this is usually when Metformin is combined with other anti-diabetic medications or from large quantities of alcohol consumed or unusually excessive exercise.6,9. Studies show that Niacin can decrease C-reactive protein meaning there is less inflammation within the body, increase HDL- cholesterol and lower LDL-cholesterol along with triglycerides9. Niacin technically helps circulation and has been shown to suppress inflammation. Symptoms of low Niacin levels include indigestion, fatigue, canker sores, vomiting, poor circulation and depression. Side effects of too much niacin include flushing of the skin, upset stomach, headache, blurred vision and an increased risk of liver damage. Statins are 3-hydroxy-3-methylglutaryl coenzyme A [HMG-CoA] reductase inhibitors. Long-term studies indicating that St-treatment has reduced the incidence of CVD by only 30% have placed an emphasis on increasing high-density lipoprotein (HDL-C) levels, which are protective against CVD2. By inhibiting HMG-CoA the synthesis of cholesterol is blocked as enzyme HMG-CoA is the rate limiting step of cholesterol synthesis in the human body. Side effects of statins include nosebleeds, sore-throats, runny or blocked nose, headache, muscle-joint pain.11

Diet Therapy:

A heart healthy diet is very important for treating metabolic syndrome along with control of

glucose levels so that pre-diabetic symptoms do not turn into full on type 2 diabetes. To control blood glucose it is recommended for diabetic patients to consumer 45-50% of their diet in carbohydrate as opposed to 45-65%, 30-35% in fats instead of 20-35% and 15-20% protein as opposed to 10-35%. Reducing sugars, refine grains and adding more whole grains and fiber to the diet will help keep blood glucose levels more consistent and will cause less spiking in ones glucose levels (a bigger spike leads to a bigger crash, so maintaining glucose balance is important). Less than 7% of fats consumed should be from saturated fats. The diet should also consist of less than 1% of fats come from trans fats and less than 200mg of cholesterol from foods. These strategies combined with the changes in macronutrient percentages will also help reduce the effects of Metabolic Syndrome. Reducing alcohol intake is also important as it can raise one’s blood pressure and triglyceride levels. No more than one drink of alcohol a day, and one drink is the equivalent of a 12 oz. beer, 5 oz. of wine, or 11/2 ounces of liquor. The DASH (dietary approaches to stop hypertension) diet eating plan would be very beneficial to a person with metabolic syndrome because of its reduced grain servings to help modify blood glucose levels whilst reducing hyperglycemia effects, it also promotes heart healthy foods to reduce hypertension as well as the fact it is a well-balanced diet in all food groups promotes well-being. Thus, reducing sodium is also important in prevention of hypertension and should consume less
than 2,300mg of sodium a day. Some sources of monounsaturated fats and polyunsaturated fats are salmon, trout, avocado, almonds, peanut butter, canola oil and olive oil.

The DASH diet eating plan guidelines is as follows:

Prevention:

 Prevention of metabolic syndrome is to lead a healthy lifestyle including some of the following procedures. Exercise is beneficial in reducing ones blood pressure, improving cholesterol levels and improving insulin resistance. GLUT-4 is a substrate that transports glucose into skeletal

muscle, cardiac muscle along with white and brown adipose tissue however it is insulin
dependent to go forth with its duty. Exercise allows for GLUT-4 to make its deliveries of glucose to its specific designations without insulin present. In other words exercise allows the substrate GLUT-4 to by-pass insulin to feed glucose to ones cells. For someone with insulin resistance, this is extremely important to the health and maintenance of ones cells (to emphasize the importance remember that all humans are made up of cells). Exercise can also help with weight reduction and reduction of triglycerides and LDL cholesterol. If one is overweight or obese, reducing BMI is beneficial to one’s blood pressure and heart health. The goal BMI would be to get to 18.5-24.9 kg/m2 in a healthy manner, dropping 20 pounds in one week for example would be excessive and an unhealthy manner. A healthy diet rich in omega-3 and omega 6 poly/mono-unsaturated fats, along with reduction of LDL cholesterol can improve one’s cholesterol and blood pressure. Saturated fats, trans fats and high cholesterol foods should be reduced and foods that are dense in monounsaturated fats, polyunsaturated fats should be included to improve heart cholesterol. If you are a smoker, quit smoking. If quitting completely in one day is unbearable and withdrawals are coming about then gradually decrease intake of nicotine and cigarettes with an end goal of stopping completely and ridding yourself of the addiction.

References:
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9) "Result Filters." National Center for Biotechnology Information. U.S. National Library of
Medicine, n.d. Web. 18 Nov. 2015.
10) "Vitamin B3 (Niacin)." University of Maryland Medical Center. N.p., n.d. Web. 18 Nov. 2015.
11) "Statins - Side Effects ." Statins. N.p., n.d. Web. 18 Nov. 2015.