DO YOU HAVE THE METABOLIC SYNDROME?

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DO YOU HAVE THE METABOLIC SYNDROME?

• You're never too young to have it
• Jacqueline A. Eberstein, R.N.

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What is it?

• AKA Syndrome X or Insulin Resistance Syndrome
• A cluster of signs that indicate blood
  sugar/insulin imbalance
• Can lead to type 2 diabetes and cardiovascular
  disease.
• Incidence increases with age
• Is found in children who are overweight
• Responds to carb restriction.

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Who is at risk for insulin resistance?

• Overweight or obese individuals
• People with hypertension
• Those with a sedentary lifestyle
• People with a genetic predisposition
• Smokers
• Can occur in people who are normal weight but
  metabolically obese.

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Incidence of Metabolic Syndrome

• In the year 2000 it is reported that 47 million
  U.S. residents have metabolic syndrome.
• Among obese kids more than 25 have MS.
• More than 50 of severely obese kids have ms
• Latest stats indicate that 43 million people in
  the U.S .have prediabetes.

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Definition of MS

• If you have 3 or more of the following signs you
  have the metabolic syndrome
• Abdominal obesity- a high waist to hip
  ratio.
• High triglycerides
• Low HDL cholesterol
• High blood pressure
• High fasting blood sugar
• The WHO uses a somewhat different definition than
  that used in the US.

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Abdominal Obesity

• A waist circumference in men of more than 40
  inches.
• A waist circumference in women of more then 35
  inches.
• Deposition of fat around the middle is more
  dangerous than fat around the hips and thighs.
• Visceral fat increases inflammation markers that
  lead to vascular disease.
• More than 50 of adults in the U.S. over age 60
  are abdominally obese.

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Important predictor

• A recent study in men indicated that waist size
  predicted death from heart attack or stroke
  better than any other traditional risk factors
  including LDL or smoking.
• Every 2 inch increase in waist size increased the
  risk of dying of CV disease by up to 17 in the
  next 10 years.
• This study indicates the guidelines of 35 inches
  and 40 inches may be too high.

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Waist to Hip Ratio

• Compute your waist to hip ratio-measure waist
  around the navel, measure hips. Divide the waist
  number by the hip number.
• The higher your waist to hip ratio the more
  apple shaped.
• The lower the more pear shaped.

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High triglycerides

• Fasting triglycerides of 150mg/dL or higher.
• High triglycerides are a marker for insulin
  resistance. This is especially true if the HDL is
  low.
• They are an independent risk factor for CV
  disease.
• Triglycerides are known to increase when eating a
  low fat, high carb diet as is recommended by the
  ADA and the AHA.

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Low HDL cholesterol

• Men an HDL cholesterol below 40mg/dL.
• Women an HDL cholesterol below 50 mg/dL.
• HDL cholesterol AKA the good cholesterol,
  carries cholesterol back to the liver for
  disposal or recycling.
• As triglycerides go up the HDL often goes down.
  This increases CV risk.
• Low carb plans are very effective at elevating
  HDL cholesterol provided it is not too low in
  fat.
• Low fat diets often elevate TG and lower HDL.

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Hypertension

• A blood pressure reading of 135/85 or higher is
  a sign of MS.
• A new definition- prehypertension- 120/80 to
  139/89.

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Blood sugar by the numbers

• A fasting blood sugar of 100mg/dL or higher is a
  sign of MS.
• A fasting blood sugar of 100 to 125mg/dL is now
  called prediabetes or impaired fasting glucose.
• A 2 hour postprandial blood sugar between 140 and
  199 mg/dL is also prediabetes or impaired glucose
  tolerance.

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Other characteristics of MS

• Smaller and denser LDL and VLDL cholesterol
  levels.
• Increased risk of blood clotting.
• Increased inflammation markers-hsCRP
• Endothelial dysfunction.
• Carbohydrate cravings.
• Family history of diabetes.
• High uric acid levels

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Solution

• Recognize the cluster of symptoms.
• Accept the necessity for a permanent lifestyle
  change to diminish risks for diabetes, CV disease
  and other health concerns.
• Regular exercise to improve insulin sensitivity,
  HDL and increase muscle mass.
• Normalize weight.

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Low carb vs. low fat

• Best strategy if you have high BMI and high
  Triglycerideslow carb.
• If more than 2 symptoms of MS or high
  triglycerides and low HDL-- low carb is the first
  strategy.
• Low carb is superior to low fat/low calorie diets
  even in the absence of weight loss.

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• Carbohydrate restriction is one of several
  strategies for reducing body mass but even in the
  absence of weight loss or in comparison with low
  fat alternatives, CHO restriction is effective at
  ameliorating high fasting glucose and insulin,
  high plasma triglycerides, low HDL and high blood
  pressure. In addition, low fat, high CHO diets
  have long been know to raise TAG, lower HDL, and
  , in the absence of weight loss, may worsen
  glycemic control.
• Carbohydrate restriction improves the
  features of metabolic syndrome. Volek, J.,
  Feinman, R.
• Nutrition and Metabolism, 2005