Metabolic Syndrome — When the Sum is Greater than the ‘Parts’

May 11, 2013

Everyone knows that keeping their weight under control is important to good health, but now the “location” of fat on a person’s frame, along with other factors, matters too. Physicians understand that all fat is not created equal — especially as it relates to the dangers of developing metabolic syndrome.

This syndrome is a group of abnormal findings all related to the body’s metabolism. It’s closely linked to a specific metabolic problem called “insulin resistance.” Insulin resistance develops when the body’s ability to use insulin to control the amount of sugar in the blood is impaired.

Experts agree that it’s not just about telling overweight people to lose weight, it’s about identifying people with insulin resistance. When people develop insulin resistance, their insulin level goes up and their glucose goes up, too. Both glucose and insulin are dangerous when too high.

Those diagnosed with metabolic syndrome are actually dealing with several disorders with their metabolism at the same time, including obesity (especially around the waist), high blood pressure, abnormal cholesterol levels and a resistance to insulin.

Those with metabolic syndrome are at much greater risk for having a heart attack or stroke. They have a higher risk than a diabetic person, a heavy smoker or someone who only has hypertension. This combination of disorders can lead to serious trouble down the road.

There are five telltale signs or markers indicating high insulin or insulin resistance. It’s important to identify and screen people who have abdominal obesity which gives them a round, ‘apple-shaped’ appearance (as opposed to a pear shape). Men with a waist over 40 inches and women with a waist over 35 inches are at increased risk. They may not have metabolic syndrome, but they should be checked carefully for other signs of the condition.

Metabolic syndrome is typically diagnosed when a person has at least three of five specific signs (in addition to abdominal obesity):
• hypertension (greater than 135/85)
• glucose intolerance (fasting glucose greater than 110)
• high triglycerides (greater than 150)
• low HDL (good) cholesterol (men less than 40, women less than 50).

Known risk factors for metabolic syndrome include:
• age (the chances increase as you get older – about 40% of people in their 60s are impacted)
• obesity and poor nutrition (the risk of developing metabolic syndrome increases if you have a body mass index greater than 25)
• having other diseases (high blood pressure, heart and blood vessel disease)
• having a family history of type 2 diabetes or diabetes during pregnancy
• race (African Americans and Mexican Americans are more susceptible than whites)

Before reaching a diagnosis of metabolic syndrome, a physician will complete a physical exam, including a complete medical history and blood tests.

Weight loss and increased physical activity are the first-line approaches in treating this condition and can help reduce the risk of developing metabolic syndrome in the first place. Increased physical activity has been shown to lower blood pressure, reduce insulin resistance, improve heart function and will help those trying to shed extra weight. If these strategies alone are not successful, a physician may recommend medication.

However, the key to effective treatment with medications is to treat this constellation of problems and the patient as a “whole.” In other words, therapy must be directed at the insulin resistance and not just the individual parts of the syndrome.

If addressed singly, treating one component may actually interfere with the treatment of another. For example, certain blood pressure medicines may make insulin resistance and glucose intolerance worse…and some make it better. Some medications for obesity raise the blood pressure, and some weight loss strategies are less effective if a person has high insulin.

Because this syndrome is really a combination of conditions, working closely with a trusted health care provider is crucial. The goal is to identify those at risk, educate them and steer them into appropriate testing and care. This will save lives — so it’s much more than just telling overweight people to lose weight.

Dr. Rajeev Jain is an endocrinologist with Aurora Advanced Healthcare. He can be reached at the Aurora Advanced Healthcare clinics in Milwaukee (414 352-3100), Menomonee Falls (262 251-7500), or West Bend (262 338-1123).

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