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Metabolic Syndrome 

Metabolic syndrome refers to the co-occurrence of a set of factors that contribute to the increased risk of diabetes and cardiovascular disease (CVD).  These risk factors include obesity (specifically abdominal obesity), elevated blood glucose levels, elevated blood pressure, elevated triglycerides and reduced high-density lipoprotein (HDL, “good”) cholesterol. Aggressive lifestyle modifications that address the main contributors to the metabolic syndrome – insulin resistance, abdominal obesity, and physical inactivity - are crucial to reducing the risk of serious complications.

Risk Factors


Majority of patients do not experience any symptoms. It is thus important to identify factors that increase your risk of developing metabolic syndrome:


  • Unhealthy diet  

  • Excess body weight, especially abdominal obesity

  • Physical Inactivity

  • Diabetes or family history of type 2 diabetes

  • Increasing age

  • Ethnic Background (in the U.S., metabolic syndrome is most prevalent in Mexican American women)

  • Postmenopausal status

  • Smoking


Prediabetes risk factors



The reasons for the clustering of the metabolic risk factors are largely unknown. Insulin resistance is widely accepted as the major contributor to metabolic syndrome.


Insulin resistance. In the body, digestible carbohydrates from food such as sugars and starches break down to glucose. The presence of glucose in the blood triggers the secretion of insulin, a very important hormone produced by the pancreas. Insulin enables cells (muscle, heart, liver) to take up glucose so that they can utilize it for energy or store it for future use. Insulin resistance is a condition in which cells become insensitive to insulin and do not absorb glucose properly. At first, this leads to transiently higher levels of glucose in the blood (since cells cannot absorb it, glucose builds up in the blood), which, in turn, causes increased production of insulin. If not addressed by lifestyle modifications, insulin insensitivity will lead to permanently high blood glucose levels years later. Insulin resistance has been associated with many disorders: obesity, diabetes, heart disease, dyslipidemia (abnormal lipid blood levels), and hypertension.  Unfortunately, because of the lack of symptoms, in an overwhelming majority of cases insulin resistance does not get diagnosed until it has already led to complications, such as increased blood glucose levels or diabetes. However, although they are not used frequently, there do exist tests that can detect increasing blood insulin levels before it develops into an overt disorder.  Glucose tolerance/insulin resistance test (sometimes also called the 2-hour post-glucose insulin test) determines the fasting levels of insulin and glucose, as well as their levels at one and two hours after the consumption of a specified amount of glucose.

Insulin resistance is most commonly present (and thus suspected) in people who consume unhealthy diets (excess sugar and saturated fat), have abdominal obesity and are physically inactive. If you have one or more of the aforementioned risk factors, ask your doctor for the glucose tolerance/insulin resistance test. 

Early detection of insulin resistance will allow a timely intervention and could lead to prevention of many complications.

Insulin Resistance



Diagnosis is based on the physical examination and results of the blood tests.  There are several definitions of metabolic syndrome. The most widely used is the one that characterizes metabolic syndrome as the presence of 3 or more of the following risk factors:


Waist Circumference. Larger than 35 inches for women and 40 inches for men.


Hyperglycemia (elevated blood glucose levels). Fasting blood glucose levels higher or equal to 100 mg/L (5.6 mmol/L) (or taking medications for elevated blood glucose)


Dyslipidemia (abnormal lipid panel). Triglycerides higher or equal to 150 mg/dL (1.7 mmol/L) (or taking medications for elevated triglycerides); High-density lipoprotein (HDL) cholesterol lower than 40 mg/dL (1 mmol/L) in men and lower than 50 mg/dL (1.3 mmol/L) in women (or taking medication for low HDL cholesterol). 


Hypertension (elevated blood pressure). Blood pressure higher or equal to 130/85 mmHg (or taking medication for elevated blood pressure)



Treatment for the metabolic syndrome does not differ from the treatment of its individual components (this is the primary reason why some experts question the value of diagnosing metabolic syndrome in the first place). The first line of treatment are lifestyle modifications that address the most common underlying causes – excess weight and physical inactivity. Pharmacological therapy (medications for elevated blood glucose, triglycerides, hypertension and low HDL)  is introduced when risk factors persist even after the lifestyle changes have been introduced.​

Lifestyle Medicine

Healthy Diet for Weightloss


Proper eating habits are not only important for prevention of metabolic syndrome, but for achieving and maintaining optimal overall health. While it is important to focus on weight loss in case you are overweight, you must not neglect proper nutrition. There are too many diets that promise dramatic and quick weight loss but also result in a dangerous exclusion of essential nutrients. Your goal has to be a healthy weight loss. 

Weightloss diet to prevent diabetes

Be Physically Active


A large body of data shows that active people have a significantly lower risk for a host of conditions: type 2 diabetes, heart disease, stroke, some cancers (breast and colon), osteoarthritis, depression, dementia. What is especially interesting and appealing about the physical activity as a preventive tool, is its efficacy - very little goes a long way! One study showed that only 15 minutes a day increased life expectancy by 3 years!

Physical activity to prevent diabetes

Normalize Blood Pressure 


Although it is most often without any symptoms, high blood pressure can damage the blood vessels and, if left uncontrolled, lead to serious and life-threatening conditions such as heart attack or stroke (thus its name “the silent killer”). High blood pressure is a public health problem of enormous proportions - nearly a quarter of the world's adult population had been diagnosed with hypertension. Healthy lifestyle plays a crucial role in prevention and treatment of hypertension.

How to use glycemic index and load

Improve your Blood Lipids 


Lipids have important and varied physiological functions. They serve as an integral part of cell membranes, as an energy source, as enzyme helpers or co-factors and as signaling molecules that affect vital cellular processes, such as growth or survival. However, when present in excess in blood, some lipids, namely triglycerides and cholesterol, can lead to serious cardiovascular complications such as heart disease, heart attack or stroke.

How to use glycemic index and load


Omega-3 to Lower Triglycerides


One of the first indications that some fats might be healthier than others came from the studies on Inuit nutrition.  It is now well established that fatty acids from fish (primary food of Inuit) - the long-chain omega-3 polyunsaturated fatty acids (PUFAs), eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) - lower the level of triglycerides in the blood and are considered to be heart healthy. Unfortunately, a typical Western diet is deficient in omega-3 PUFAs.

Red Rice to Lower Cholesterol


Red yeast rice is rice fermented using Monascus purpureus, a type of mold that gives the rice a distinct red-purplish color.  The mold used in the production of red yeast rice is from the same family as the mold that was used to isolate lovastatin, a drug that revolutionized the treatment of high blood cholesterol.  It is thus not surprising that red yeast rice contains a compound, monacolin K, that is chemically identical to lovastatin.

Fiber to Address Multiple Risk Factors 


Dietary fiber is a diverse group of plant materials that cannot be broken down (digested) by human enzymes or absorbed in the small intestine. High-fiber diets have a multitude of health benefits. Fiber helps with weight loss, contributes to cardiovascular and gastrointestinal health, normalizes cholesterol and blood glucose. Many of these health gains are a result of the effect that dietary fiber has on enriching and maintaining good bacteria in the gut.

Psyllium for treatment of prediabetes

Fenugreek for Glycemic and Lipid Control


Fenugreek (Trigonella foenum-graecum), an aromatic annual plant with clusters of small yellow flowers, has been appreciated as a medicinal herb since ancient Egyptian times. The medicinal part of the plant, its dried seeds, are the staple spice in Indian, Middle Eastern and Ethiopian cuisines. Of all medicinal properties ascribed to fenugreek, it is its ability to lower the levels of blood glucose and lipids that has received the most scientific attention.

Fenugreek for treatment of prediabetes and prevention of diabetes

Alpha-lipoic acid 


Dubbed a “universal antioxidant” for its solubility in both fat and water and its wide range of action, alpha-lipoic acid also acts as a cofactor (enzyme helper) for various enzymes involved in energy production, and carbohydrate and protein metabolism. In food, it is found in small amounts in kidney, heart, spinach, broccoli and potatoes. Alpha-lipoic acid has been used for many years to help control neuropathy associated with diabetes. 



A popular spice, cinnamon has been widely used since ancient times. Clinical trials that investigated the use of cinnamon for glycemic and lipid control have been rather small in size and provided conflicting results. The most recent review study suggested cinnamon's efficacy in lowering blood glucose and triglyceride levels in patients with type 2 diabetes.   However, very little is known about the optimal dose or duration of the cinnamon therapy.​

Cinnamon for glycemic control

Last updated: October 23, 2017

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