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What is the Metabolic Syndrome$%:

The metabolic syndrome is a collection of high-risk symptoms including elevated lipids (cholesterol and triglycerides), hypertension and a proinflammatory state. Having the metabolic syndrome places the individual at high-risk for heart disease and diabetes. Men are more prone to developing the metabolic syndrome due to their natural tendency to deposit excess fat as VAT. Postmenopausal women are also at risk due to lower estrogen to androgen ratios. The shift from a pear shape to an apple shape displays this hormonal shift. In fact, the apple shape is primarily caused by VAT as opposed to subcutaneous (fat under the skin) fat.

The American Heart Association has established standards for diagnosing the metabolic syndrome. The patient must have 3 of the following conditions:

1. Waist circumference greater than 40 inches for men, 35 inches for women.
2. Triglycerides greater than 150 mg/dL.
3. HDL Cholesterol less than 40 mg/d for men, less than 50 mg/dl for women.
4. Blood pressure greater than 130/85 mm Hg.
5. Fasting glucose greater than 100 mg/dL.

The metabolic syndrome appears to be caused by insulin resistance and the associated accumulation of visceral adipose tissue (VAT), also called intra-abdominal fat. VAT releases inflammatory adipocytokines, which contribute to the proinflammatory state. Fatty liver is also strongly correlated with VAT, and is a likely cause of the elevated lipids.

VAT accumulation correlates with fasting insulin, total whole-body glucose disposal, glucose oxidation and nonoxidative whole-body glucose disposal. Also, factors associated with insulin resistance are also correlated with VAT accumulation, including triglycerides, hepatic lipase and HL/LPL ratio. Likewise, factors inversely associated with insulin resistance are also inversely correlated with VAT accumulation including HDL.

How can the Metabolic Syndrome be reversed$%:

Improving insulin sensitivity is of primary importance. This requires an improved diet along with exercise.

1. Lose weight. Weight loss greatly improves insulin sensitivity.
2. Upgrade your fat intake. Saturated fat significantly worsens insulin resistance, while monounsaturated and polyunsaturated fatty acids (especially omega-3) improve it.
3. Exercise. Even something as simple as daily walking reduces visceral adipose tissue areas and improves insulin resistance.
4. Minimize stress. Cortisol appears to be involved in VAT accumulation and insulin resistance.
5. Eat more fiber. Fiber improves insulin sensitivity and is associated with lower amounts of VAT. Pectin appears to be an especially effective fiber for reducing VAT.
6. Take supplements. Pantethine, taurine, calcium and tea all improve insulin sensitivity and reduce VAT.