| What does 'metabolic syndrome' mean? Metabolic syndrome is a condition in which a group of risk factors for cardiovascular disease (heart disease and stroke) and type 2 diabetes occur together. Although it doesn't have a universally accepted definition, most health professionals would include the following as the principal components: Abdominal obesity (i.e. excess body fat in the region of the stomach); High blood pressure (also known as 'hypertension'); Low blood levels of the 'good' cholesterol, HDL; High blood levels of the 'bad' cholesterol, LDL; High blood levels of triglycerides; and Insulin resistance (that is, an impaired ability of the body's insulin to handle blood glucose). People with three or more of the above symptoms can be considered to have the metabolic syndrome, greatly increasing their risk of cardiovascular disease and/or type 2 diabetes, two of the most pervasive diseases in Western populations. How common is the metabolic syndrome? Although its exact frequency isn't known, the condition is widespread among the adult population in developed nations, and increases in frequency with age. For example, a study in the United States found that about 7% of adults aged 20-29 years had metabolic syndrome, while 43% of those in the age group 60-69 were affected. So nearly half of the adults aged 60-69 had the syndrome. But this study was based on results obtained in the period 1988-1994, when the rate of obesity was much less than now. The rate of metabolic syndrome among American adults is almost certainly greater now than it was at the time of that study. It is also starting to appear in affluent adults who have adopted Western diets and lifestyles in developing nations. However, it isn't just adults who are affected - the condition is also afflicting an increasing number of children and adolescents as the worldwide epidemic of obesity spreads across the age groups. For example, a recent US study found that 20-25% of obese children and adolescents also exhibited insulin resistance, a key element of metabolic syndrome and the condition that can lead to type 2 diabetes What are the health implications of having metabolic syndrome? Each of the components of metabolic syndrome acts to significantly increase the risk of developing one or more diseases. As examples, excess abdominal fat is associated with increased risk of type 2 diabetes and heart disease; hypertension is the most important risk factor for stroke; high blood LDL and low HDL increase the risk of heart disease. Insulin resistance can be the first step on the road to type 2 diabetes. In brief, having type 2 diabetes significantly increases the risk of developing heart disease, kidney disease and blindness, and also of having to undergo limb amputations (due to gangrene). The rapid increase in incidence of metabolic syndrome, not only among adults but also in children and adolescents, represents a potential 'time bomb' for the future adult populations of developed nations. Effective preventive measures are needed for the entire population, and ways of reducing the incidence of metabolic syndrome among adults (mainly) are also urgently needed. What can be done to reduce my risk of developing metabolic syndrome, or to help overcome the syndrome if I already have it? First and foremost, if you are undergoing treatment for any of the components of metabolic syndrome (or for the actual diseases associated with it, such as diabetes or heart disease) it is essential that you take the advice of your professional health care provider. Your doctor and/or dietitian know your particular circumstances and can prescribe treatment that is tailored to best meet your requirements. The advice provided in the remainder of this article is of a general nature only. Although the incidence of metabolic syndrome is increasing, the situation is far from hopeless. Metabolic syndrome is a reasonably recent phenomenon and its causes, although not entirely understood, include environmental factors. This means that something has changed in the environment to promote obesity, hypertension, insulin resistance and so on. Examples of environmental changes that may have contributed to the metabolic syndrome include a marked reduction (by most people) in physical activity, and an increase in the number of meals eaten away from home (particularly foods that are rich in saturated fat and salt). Clearly, if the environment can be changed in one direction, those changes are reversible and the metabolic syndrome can be overcome. Steps you can take to reduce the risk (or severity) of metabolic syndrome include: 1. Increase activity level. The 'diabetes epidemic' that is sweeping the Western world, and is increasingly affecting affluent groups in developing nations, parallels the obesity epidemic that began a decade or so earlier. Although being obese is the single most important risk factor for type 2 diabetes, it is also true that being normal weight is not a guarantee of protection against diabetes. Some slim people also develop insulin resistance, and a small proportion of these will progress to diabetes. Physical activity can assist in reducing the risk (or severity) of metabolic syndrome independently of any effects of body weight. This also means that, even if you are having trouble losing weight, increasing physical activity will help to reduce your risk of developing heart disease or type 2 diabetes. This is the cornerstone of the 'health at any size' movement. You don't have to be extremely active to gain substantial benefit. By taking part in just 30 minutes of moderately-vigorous activity (such as brisk walking, cycling, swimming, light weight-training and so on) daily, you can substantially reduce the risk (or severity) of metabolic syndrome. 2. Improve health through better eating habits. Emphasis should be placed on eating foods with relatively low 'glycemic index' (GI). It is also important to eat only sparingly foods that are high in saturated fats (such as full-fat dairy products, fatty meats, biscuits, cakes, pastries, potato chips and most other fried takeaway foods). Suitable replacements are whole-grain cereal foods, fruits and vegetables, foods rich in monounsaturated and polyunsaturated fats, including those that provide high levels of 'omega-3' fats. Fish (especially those with dark-flesh) is an excellent source of omega-3 fats. It is now usually recommended that we eat two or three fish meals (preferably not fried or battered) per week. You can also increase your levels of these essential fatty acids (EFA) by taking a high quality Omega 3 supplement. Green leafy vegetables are also a good source. Other good sources of health-promoting fats include avocado, nuts, seeds (pumpkin, sunflower), canola oil, olive oil, sunflower oil, soybean oil, peanut oil, and margarine spreads. The increased risk of stroke and heart disease from high blood pressure means that careful attention should be paid to the dietary guideline on salt (sodium chloride): 'Choose foods low in salt'. Low salt foods are defined in the food regulations as having a sodium content not exceeding 120 mg/100 g. With the requirement to include sodium content in a 'nutrition information panel' on the label, reading the labels on supermarket foods will allow you to identify those processed foods that are 'low salt'. 3. Lose some weight (if overweight or obese).Weight loss should result from increasing physical activity and making appropriate alterations to diet, as recommended above. Weight loss has beneficial effects on several components of metabolic syndrome, including the risk of developing insulin resistance. Although only a relatively small percentage of those with insulin resistance do progress to type 2 diabetes, everyone who does develop type 2 diabetes did experience insulin resistance first, so it is an indicator that you are 'at risk' of developing diabetes. Because developing insulin resistance increases with increasing body fat levels, weight reduction should lower the risk of insulin resistance. It has been reported that carrying as little as 11 kg of excess body fat during early adulthood increases the risk of later onset of type 2 diabetes twenty-fold. Also with respect to weight, if you have recently undergone significant weight gain, despite attempting to use diet and physical activity to maintain normal weight, you would be well-advised to ask your doctor to check for insulin resistance. You might also like to ask if your doctor believes that a 'glucose tolerance test' would be appropriate, measuring both 'glucose response' and 'insulin response'. A reduction in body fat also almost invariably leads to improved blood pressure. So losing weight reduces the risk of stroke, because high blood pressure is the strongest individual risk factor for stroke, losing about 5-10% of your current weight (if you have substantial excess body fat) will have worthwhile effects on several aspects of metabolic syndrome. Although 5-10% may not seem a lot, it can actually be quite a high percentage of your initial body fat level. For example, if you weigh 165 pounds and have a body fat level of 33% (indicative of mild obesity), your body fat content is ~54 pounds. Losing 10% (7.5 kg) of your body weight as fat means that you have lost about 30% of your body fat. 4. Quit smoking (if you are a smoker). Smoking is associated with increased risk of heart disease (in addition to other conditions not directly related to metabolic syndrome, including lung cancer, bronchitis, emphysema and impotence). Quitting smoking is one of the healthiest lifestyle alterations that can be made by a person who smokes. 5. Reduce stress levels. Although not necessarily a direct cause of metabolic syndrome, our increasingly busy lifestyles and other sources of stress have profound influence on health outcome. Light physical activity, meditation, yoga, music and/or other relaxation techniques can all be used to reduce stress. Brought to you by; PROGRADE NUTRITION and Phil Bray's Health And Fitness programs. 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