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Tuesday, September 8, 2009

The Metabolic Syndrome, Do You Have it?

Rarely mentioned by physicians to their patients, the Metabolic Syndrome is an astonishingly common and dangerous disorder that now affects more than 30% of adult Americans, and more than 51% of people over the age of 60, but what is it?*

The term Metabolic Syndrome refers to a cluster of metabolic abnormalities which, when taken together, are a major risk indicator for the development of heart disease, peripheral artery disease, stroke and diabetes.

The central metabolic abnormality of this syndrome is insulin resistance. The hormone insulin is produced by the Islets of Langerhans within the pancreas. Its main function is to regulate the metabolism of the body’s main fuel, glucose, which derives from commonly ingested sugars and carbohydrates. It affects how glucose is ultimately stored in the liver, and how it is utilized by muscles. It also plays an important role in the control of body fat, and in cell growth.

The problem begins when cells throughout the body, mainly muscle cells, lose some of their responsiveness to insulin. When this happens, blood sugar levels increase, and the pancreas, in an attempt to keep sugar levels controlled, gradually goes into an overdrive mode, producing more insulin, and creating the background for additional metabolic derangements.

Do you have the metabolic syndrome? There is no universally accepted way to diagnose it, but, depending on the guidelines used by your physician, the diagnosis will be made on the basis of a physical examination (including blood pressure, height, weight, and waistline measurement), and laboratory tests, some of which are common (e.g., fasting blood glucose and a simple cholesterol profile), and more sophisticated tests (e.g., fasting insulin, and indicators of blood vessel inflammation and clot formation tendency, cardiac CRP and Fibrinogen, respectively).

A particularly useful, inclusive diagnostic and informative blood test is the one offered by Berkeley Heart Lab, Inc., available through some medical practices, and widely used in our practice (despite the great value of this test, many insurance companies are still balking about reimbursement does this make any sense to you?).

Some risks include: A waistline of 40 inches or more for men or 35 inches or more for women, blood pressure of 130/85 mm Hg or higher, triglyceride level above 150 mg/dl, fasting blood glucose level greater than 100 mg/dl, high density lipoprotein level (HDL) less than 40 mg/dl (men) or under 50 mg/dl (women), BMI** (body mass index) of 40 or more (morbid obesity), high fasting insulin level, high prothrombin level, or a high specific indicator of blood vessel inflammation.

Most people with the metabolic syndrome are obese and sedentary, with genetics playing a significant role. There are no specific symptoms; it’s frequently a silent, neglected killer.

The most dreaded complications of the metabolic syndrome, heart attack and stroke, may be delayed or decreased with lifestyle changes including weight loss, exercise, and diet changes (mainly reducing carbohydrates). But medications are necessary in a large percentage of cases.
So, if you suspect that you have the Metabolic Syndrome, don’t waste time, seek medical advice and make the necessary changes to make it a longer, healthier life.

*Statistics based on the National Health and Nutrition Examination Survey (NHANES) 2003–2006.
**A BMI calculator is available on the left column of this page.

Igal Staw, Ph.D., M.D.

Twitter / Dr. Staw