Metabolic Syndrome Increases Risk of Health Problems

By: Michael (Mike) Shaw, PA-C, ABAAHP

Metabolic syndrome is a group of conditions that can increase the risk of health problems such as heart disease, stroke, and type 2 diabetes. [1]

Risk factors include high blood glucose, low levels of HDL (“good”) cholesterol, high levels of triglycerides, high blood pressure, and abdominal obesity. Each of these is independently a risk factor for heart disease. However, when a person has three or more, it is usually diagnosed as metabolic syndrome, which further increases the risk for additional health problems. [2]

For a diagnosis of metabolic syndrome, an individual typically has three of the following risk factors:

• Large waist: 35 inches or more for women and 40 inches or more for men
• High triglycerides: 150 mg/dL or higher
• Reduced HDL (“good”) cholesterol: Less than 40 mg/dL in men or less than 50 mg/dL for women
• Increased blood pressure: 130/85 or higher
• Elevated fasting blood sugar: 100 mg/dL or higher

A study by the University of North Carolina at Chapel Hill found only 1 in 8 Americans have optimal metabolic health, with more than 80% of Americans experiencing some symptoms of metabolic dysfunction. [3] Overall, the number of U.S. adults older than 18 with three or more of the risk factors is approximately 34%. [4]

Metabolic syndrome is closely linked to heart disease. High blood pressure against the vascular wall tends to reduce the elasticity of the arteries over time. [5] Calcium deposits will lead to plaque build-up, which is comprised of calcium, fat, iron, and dead red blood cells. Plaque build-up narrows the channel within the artery, which reduces blood flow and lessens the amount of oxygen and other nutrients reaching the body. [6]

Endothelial glycocalyx is a thin cell lining enveloping the arterial system. You can think of it as plastic wrap or Teflon for your cardiovascular system. Changes in the glycocalyx can promote an inflammatory response in blood vessels. [7] It can be like turning up the thermostat in the cardiovascular system, which creates an environment very supportive of plaque development on arterial walls. [8]

Of the metabolic syndrome risk factors, triglycerides can be both a symptom and a factor, and I focus on those levels as much or more than others. High triglycerides can signal that you are becoming insulin resistant or a signal for liver disease. [9] 

Normal triglyceride levels are less than 150 mg/dL. We see patients with triglycerides in the 300-600 mg/dL range. At the 500+ mg/dL level, when we draw a blood sample and put it in a centrifuge, the triglycerides – lipids in the blood – can look like butter. The only reason that it remains in a liquid form in a person’s body is because of body temperature.

In normal functioning, the body converts calories to glucose for energy. However, when an individual consumes too many calories, especially simple carbohydrates, the body can’t convert all of the calories to glucose, and it stores them in fat cells. [10] Fat cells are essentially empty containers that store excess calories as fat. This is beneficial for a bear that eats all it can before hibernating because it will need the stored energy. However, when humans eat too much and do not move or use the stored calories as fuel, it can result in obesity and metabolic dysfunction.

In addition to the five metabolic syndrome markers listed above, age and ethnicity are also factors in the risk of developing metabolic syndrome. As people age, the risk of metabolic syndrome increases. Ethnicity is also a risk factor for some. In the United States, Hispanics, especially women, seem to be at a greater risk for developing metabolic syndrome. [11] Additionally, black men were less likely than black women to have metabolic syndrome. [12]

Lifestyle Changes

Lifestyle changes can be some of the most effective ways of preventing or reversing metabolic syndrome. A healthy diet is key to reducing the impact of metabolic syndrome. A moderate weight loss of 5-10% of body weight can reduce insulin resistance and blood pressure and decrease the risk of diabetes. [11] I recommend whole grains, fresh produce, and healthy meats. 

Triglycerides can almost always be reduced with lifestyle changes. EverydayHealth.com lists eight things you can do to help reduce your triglyceride levels: [13]

• Avoid excess sugar
• Resist refined foods
• Add more fiber to your diet
• Choose healthy fats over saturated fats
• Know the dangers of trans fats
• Cut back on alcohol
• Exercise
• Control your weight

Omega-3 may also help in reducing cholesterol and triglycerides. [14] Exercise is another important factor in the prevention or improvement of metabolic syndrome. You don’t have to be Arnold Schwarzenegger or Jane Fonda. The American Heart Association recommends at least 150 minutes of moderate-intensity physical activity each week. [15] A 30-minute walk, five days each week will meet that goal.

Medication is often not necessary to decrease risk of metabolic syndrome and the associated conditions, including heart disease, type 2 diabetes, and stroke. However, a commitment to lifestyle changes is important in achieving those goals.

References

1. Mayo Foundation for Medical Education and Research. (2021, May 6). Metabolic syndrome. Mayo Clinic. Retrieved October 6, 2022, from https://www.mayoclinic.org/diseases-conditions/metabolic-syndrome/symptoms-causes/syc-20351916
2. What is metabolic syndrome? www.heart.org. (2022, August 16). Retrieved October 6, 2022, from https://www.heart.org/en/health-topics/metabolic-syndrome/about-metabolic-syndrome
3.  Bwbieltz. (2018, November 29). Only 12 percent of American adults are metabolically healthy, Carolina study finds: UNC-chapel hill. The University of North Carolina at Chapel Hill. Retrieved October 6, 2022, from https://www.unc.edu/posts/2018/11/28/only-12-percent-of-american-adults-are-metabolically-healthy-carolina-study-finds/
4.  Centers for Disease Control and Prevention. (2017, September 20). Metabolic syndrome prevalence by race/ethnicity and sex in the United States, National Health and Nutrition Examination Survey, 1988–2012. Centers for Disease Control and Prevention. Retrieved October 6, 2022, from https://www.cdc.gov/pcd/issues/2017/16_0287.htm
5. Liao D;Arnett DK;Tyroler HA;Riley WA;Chambless LE;Szklo M;Heiss G; (n.d.). Arterial stiffness and the development of hypertension. The Aric Study. Hypertension (Dallas, Tex. : 1979). Retrieved October 6, 2022, from https://pubmed.ncbi.nlm.nih.gov/10454441/#:~:text=One%20standard%20deviation%20decrease%20in,to%20the%20development%20of%20hypertension
6. What is atherosclerosis? www.heart.org. (2022, July 20). Retrieved October 6, 2022, from https://www.heart.org/en/health-topics/cholesterol/about-cholesterol/atherosclerosis
7.  Reitsma, S., Slaaf, D. W., Vink, H., van Zandvoort, M. A. M. J., & oude Egbrink, M. G. A. (2007, June). The endothelial glycocalyx: Composition, functions, and visualization. Pflugers Archiv : European journal of physiology. Retrieved October 6, 2022, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1915585/
8.  Qu, J., Cheng, Y., Wu, W., Yuan, L., & Liu, X. (2021, September 13). Glycocalyx impairment in vascular disease: Focus on inflammation. Frontiers in cell and developmental biology. Retrieved October 6, 2022, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8473795/#:~:text=Changes%20in%20the%20structure%20and,hallmark%20of%20inflammation%2Drelated%20diseases
9. WebMD. (n.d.). What high triglycerides can do to you. WebMD. Retrieved October 6, 2022, from https://www.webmd.com/cholesterol-management/result#:~:text=If%20your%20triglyceride%20levels%20are,pain%2C%20which%20may%20be%20severe
10. Mayo Foundation for Medical Education and Research. (2022, September 3). Can triglycerides affect my heart health? Mayo Clinic. Retrieved October 6, 2022, from https://www.mayoclinic.org/diseases-conditions/high-blood-cholesterol/in-depth/triglycerides/art-20048186#:~:text=Triglycerides%20are%20a%20type%20of,triglycerides%20for%20energy%20between%20meals
11. Mayo Foundation for Medical Education and Research. (2021, May 6). Metabolic syndrome. Mayo Clinic. Retrieved October 6, 2022, from https://www.mayoclinic.org/diseases-conditions/metabolic-syndrome/symptoms-causes/syc-20351916
12. Centers for Disease Control and Prevention. (2017, March 30). Trends in metabolic syndrome prevalence by race/ethnicity and sex in the US: National Health and Nutrition Examination Survey, 1988–2012. Centers for Disease Control and Prevention. Retrieved October 6, 2022, from https://www.cdc.gov/pcd/issues/2017/testimplementationevalxml.htm
13.  Iliades, C. (n.d.). How to lower triglycerides with lifestyle changes. EverydayHealth.com. Retrieved October 6, 2022, from https://www.everydayhealth.com/heart-health-pictures/why-triglyceride-levels-matter.aspx
14. Mayo Foundation for Medical Education and Research. (2020, December 8). Fish oil. Mayo Clinic. Retrieved October 6, 2022, from https://www.mayoclinic.org/drugs-supplements-fish-oil/art-20364810#:~:text=There’s%20strong%20evidence%20that%20omega,%22)%20cholesterol%20also%20was%20observed

Prevention and treatment of metabolic syndrome. www.heart.org. (2022, June 29). Retrieved October 6, 2022, from https://www.heart.org/en/health-topics/metabolic-syndrome/prevention-and-treatment-of-metabolic-syndrome