Over the last several few years, I find myself telling more and more patients about metabolic syndrome or insulin resistance after I review yearly labs. This constellation of medical issues has become more and more common in my practice. Metabolic syndrome is defined a number of ways, but it basically includes abdominal obesity with elevated blood sugar, low HDL (good cholesterol), high triglycerides, and high blood pressure (at least 130/80). Metabolic syndrome makes a person at increased risk for diabetes and coronary heart disease.

Metabolic syndrome or insulin resistance is something physicians screen for at wellness visits. Screening for this involves checking height, weight, and possibly waist circumference. Blood pressure is taken. Lastly, labs are ordered. I like to check a lipid panel, metabolic panel, hemoglobin A1C, and a fasting insulin level on my patients who are overweight or in their 40s or over at least once yearly. I may not see all the criteria for metabolic syndrome, but even seeing trends causes me concern. I try to address these issues at the visit and recommend changes that can delay the onset of diabetes or coronary heart disease.

Specifically, these are the labs values I generally use:

Glucose greater than 100

Triglycerides greater than 150

HDL less than 40 (men) or 50 (women)

Hemoglobin A1C greater than 5.6%

Insulin fasting greater than 20

I watch for a blood pressure greater than 130/80

BMI over 30

Waist over 38 inches in men or 32 inches in women

Criteria for actual diagnosis vary depending on which definition is used, but generally being obese with three other characteristics will qualify a patient for metabolic syndrome. Sadly, metabolic syndrome is on the rise and almost 25% of adults have metabolic syndrome. As we see more overweight children, we see metabolic syndrome there too.

Why does metabolic syndrome matter so much? More than the fact that it is a precursor to diabetes, it is REVERSIBLE! Unlike some medical conditions, there is treatment for metabolic syndrome that can further prevent heart disease and diabetes, which in turn decreases the risk for heart attack, stroke, kidney failure, and more that are associated with diabetes.  The treatment is usually initially aimed at lifestyle changes including weight loss, increased exercise, and smoking cessation. I usually recommend patients with metabolic syndrome to begin a low carbohydrate diet because these patients are specifically sensitive to sugar and simple carbohydrates. Any form of weight loss is helpful, but a diet that causes less insulin release will be most successful.  Exercise is often prescribed to help with weight loss as well as lowering blood pressure.

Aside from lifestyle changes, there are some medications which also help to treat metabolic syndrome.  I often use medications like metformin to help with insulin resistance. It lowers blood sugar and might help slightly with weight loss. I has been shown to prevent the development of diabetes. There are also a couple of other diabetes medications that can be helpful. Your doctor may start blood pressure medication, or medications to increase the good cholesterol or lower the triglycerides. While medication is great if needed, most of these changes can be obtained with lifestyle changes alone.

Who is at risk for metabolic syndrome? Honestly, everyone! Seriously though, people who are overweight, or smokers are at increased risk,  Also, people are at risk if they are sedentary, eat a high carbohydrate diet, or have a family history of diabetes. Lastly, aging also increases the chance of having metabolic syndrome. I like to have a very low threshold for discussing these issues with patients because I like to help them prevent bigger health concerns associated with diabetes and heart disease.

Metabolic syndrome is like a fork in the road where a person has to choose the pathway. One pathway is paved, with a fruitful future and health. The other pathway is one filled with multiple medications and comorbidities. It is never too late to change, and sooner is better than later, but even after diabetes has developed there is time for change and improvement. It is always important to remain vigilant and proactive about staying healthy!

Camryn Lee


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