America’s True Epidemic: Metabolic Syndrome

     The American healthcare system is fighting a war against chronic disease and there is an endless supply of casualties. The three main diseases, that will kill almost every American living today, fall within three broad categories: neurodegeneration, cancer, and cardiovascular disease. A forth disease subset, Type 2 Diabetes, should be thought of as the ultimate chronic disease accelerator. Type 2 Diabetes is the mother-load of metabolic illnesses, a result of years of mismanaged nutrition, usually due to the Standard American Diet (SAD). The SAD is not really a diet at all, but a complete lack of any dietary considerations. When following the SAD, you can eat whatever you want,  whenever you want, and in whatever quantity you want. This style of eating is directly related to the onset of Type 2 Diabetes, which accelerates that onset of the three chronic diseases mentioned above. 

     The question is, might there be a way to determine your risk factor for developing a chronic diseases? Perhaps decades earlier than you should? Recent research is pointing toward Metabolic Syndrome as a tool that can be used to indicate the risk of developing a chronic disease. According to a paper written by Grundy et al (2005), Metabolic Syndrome is a clustering of interrelated, diagnostic risk factors of metabolic origin (comes from deregulation of one's metabolism), that directly promote the develop of atherosclerotic cardiovascular disease and Type 2 Diabetes. 

     In simpler terms, metabolic syndrome is a grouping of medical findings that  strongly predict the onset of several life threatening diseases. Those with metabolic syndrome have two times (2X) the increased risk of developing cardiovascular disease and are five times (5x) more likely to contract Type 2 Diabetes. Metabolic syndrome is diagnosed when a patient is diagnosed with three out of five hallmark medical findings. It is important to remember that even if someone has one of the five findings associated with Metabolic Syndrome, their health is still at risk.

     Below is an overview of the Five Hallmarks of Metabolic Syndrome and how they are diagnosed clinically. If, after reading this article, you think you might be at risk for metabolic syndrome, the best course of action is to contact your doctor for a full metabolic evaluation. 

The Five Traits of Metabolic Syndrome

     The presence of abnormal findings in 3 out of the 5 Criteria Constitutes a Positive Diagnosis of Metabolic Syndrome

     (Note, someone is automatically considered positive for a finding if they are taking any form of medication to counter a major positive diagnostic finding. For example, if someone is taking blood pressure medication, they would automatically be counted as positive for elevated blood pressure)

1. Elevated Waist Circumference 

     Waist Circumference is the diameter of someone's waist, which is in part due to the level of adipose tissue around the waist. Increased adipose tissue in the waist line indicates over-feeding of nutrients. Below are the guidelines for waist circumference and instructions on how to measure. 

Men	>40 inches (102cm)  in Men
Women	>35 inches (88cm) in Women

 

How to Measure Your Waist Circumference:

     Locate the top of the right iliac crest. Place a measuring tape in a horizontal plane around the abdomen at level of the iliac crest. Before reading the tape measure, ensure that it is snug, but does not compress the skin and is parallel to the floor. Measure is made at the end of normal expiration. (Grundy, 2005) 

 

     An elevated waist circumference is an indication of an elevation total body fat, or adipose tissue. 

2. Elevated Triglycerides: 

     Triglycerides are the level of fat circulating within someone's blood. Elevated fat levels are not necessarily an indicator that too much fat is being eaten. De Novo lipogenesis (making fat molecules) is a topic for another blog. For now, realize that increased levels of fat in the blood is a dangerous sign and an important level to track. Regardless of where the triglycerides originated from, an increased presence of triglycerides in the blood is an indicator of metabolic issues. 

     Below is the criteria for elevated triglycerides

> 150mg/dl (1.7 mmol/L)

Taking a Drug to Lower Triglycerides

(Note: for longevity purposes, anything over 100 mg/dl may be problematic)
  

3. Reduced HDL-C

     HDL cholesterol (HDL-C) is considered to be the "healthy" and "protective" cholesterol molecule, but it is not actually a cholesterol molecule at all. Instead, HDL is an important cholesterol molecule transporter that shuttles cholesterol through the bloodstream. One of the key functions of HDL-C is to carry damaged cholesterol molecules from the body's arterial walls into the liver, a process known as reverse transport. Since atherosclerosis can form from LDL cholesterol molecules embedding themselves into the walls of arteries, this reverse transport processes carried out by HDL-C ensures arteries remain safe from unwanted cholesterol accumulation. Reducing the level of HDL in the blood means less reverse transport and higher levels of cholesterol available to cause atherosclerosis.

Men:  Reduce HDL < 40 mg/dl (1.03 mmol/L)

Women: Reduce HDL < 50 mg/dl (1.03 mmol/L)

In either men or women, taking any medication to raise HDL indicates a positive finding

 

(Reverse Transport of Cholesterol from Arterial Walls is carried out by HDL-C)

4. Elevated Blood Pressure

     Blood pressure is calculated using two numbers, systolic blood pressure and diastolic. Systolic blood pressure is the highest pressure recorded during the contraction and ejection phase of blood from the heart. Diastolic blood pressure is the lowest pressure recorded while the heart is relaxed and filling. Elevations in either systolic or diastolic are an indication that someone's cardiovascular system is working harder than it should. There are numerous reason for blood pressure to increase, either through arterial wall stiffening or an increase in blood volume. Regardless, elevations in blood pressure should be taken very seriously as they are a symptom of a serious problem. 

Systolic	>130 mm Hg SBP or on medication to lower hypertension
Diastolic	> 85 mm Hg DBP or on medication to lower hypertension

5. Elevated Fasting Glucose

     Fasted glucose refers to the level of blood glucose recorded in the blood during a fast from food. 

Men and Women	Fast Blood Glucose >100 mg/dl
Men and Women	On medication to lower blood sugar (Insulin, Sulfonylurea, Metformin, etc)

     Any steady increase in blood sugar is an indication that the body is unable to maintain an optimal level of blood sugar homeostasis. Increased blood glucose is an indication of the onset of insulin resistance, which is the body's inability to respond to insulin levels and clear glucose from the blood. Insulin resistance is the first step toward Type 2 Diabetes, which could be thought of as a complete insulin resistance. 

Summary

     Metabolic Syndrome is a grouping of diagnostic criteria that strongly indicates someone's chances of developing heart disease or Type 2 Diabetes. The five hallmarks include:

• evaluated waist circumference
• elevated triglycerides
• depressed HDL cholesterol
• elevated blood pressure
• elevated fasted blood glucose. 

     Over the next few months, I plan to create a series of blog posts, YouTube videos, and client documents breaking down how to identify metabolic syndrome and methods to reverse the condition. My hope is to create a baseline of information that anyone can use to improve their long term health. Future articles on this blog will break down each of the Metabolic Syndrome Hallmarks individually to explain interventions and prevention.  

 

By: Chris Baldasano, Founder, Redox LLC

M.S., Masters of Biomedical Science 

 

Work Cited:

1. Healthy Learning (Producer), & . (2010). Obesity and the Metabolic Syndrome: Approaches for Prevention. [Video/DVD] Healthy Learning. https://video.alexanderstreet.com/watch/obesity-and-the-metabolic-syndrome-approaches-for-prevention
2. Grundy, S. M., Cleeman, J. I., Daniels, S. R., Donato, K. A., Eckel, R. H., Franklin, B. A., Gordon, D. J., Krauss, R. M., Savage, P. J., Smith, J., Spertus, J. A., & Costa, F. (2005). Diagnosis and management of the metabolic syndrome. An American Heart Association/National Heart, Lung, and Blood Institute Scientific Statement. Executive summary. Cardiology in Review, 13(6), 322–327. https://doi.org/10.1161/CIRCULATIONAHA.105.169405