Metabolic Syndrome 5 Part Deep Dive Part I

Part 1 - What is Metabolic Syndrome and Stats –

Metabolic Syndrome may be the most common and serious condition you’ve never heard of. And research shows that it’s on the rise! It is also been called syndrome X and insulin resistance syndrome

In this 5-part series of articles I will go through what it is, the stats, risk factors and what we can do to stay healthy and fight off this disorder which can lead to some of the deadliest diseases. Once we can understand what metabolic syndrome is, what causes it, and what we can actually do to reduce the risk factors that contribute, you become empowered that the control is in your hands and you don’t have to be a victim to it.

There can be genetic factors that play into Metabolic Syndrome, but this doesn’t’ have to mean you will get it. All your genetic factors are, are switches, and the way we flick the switch one way to go down the path or not, is based on your epigenetics which is the lifestyle you choose which will or won’t flick these switches. More on that later.

So, what is it? Let’s break it down, according to Merriam-Webster:

Metabolic: Relating to the chemical changes in living cells by which energy is provided for vital processes and activities and new material is assimilated.
Syndrome: A group of signs and symptoms that occur together and characterize a particular abnormality or condition.

Back in the 1980’s Gerald M Reaven, MD discovered from a lot of research, that if you had some specific measurements in the body together it meant something, and he called it metabolic syndrome. And he said if you have 3 or more on the list below you had metabolic syndrome:

1. Low HDL (good) cholesterol
2. High blood triglycerides
3. Large waist measurement
4. Elevated blood pressure
5. High blood sugars

While having any of the components of metabolic syndrome above can cause health problems on their own, having a combination of them powerfully increases the risk for most other modern-day chronic inflammatory diseases like:

• Obesity
• Gout
• Cancer
• Stroke
• Atherosclerosis
• Coronary Heart Disease
• Type 2 Diabetes
  • Alzheimer’s
  • Fatty Liver disease
  • Asthma

While there is a high correlation of being overweight and obese with metabolic syndrome, not everyone who has metabolic syndrome is overweight or obese. But there is a higher prediction of metabolic syndrome. Compared with men with BMI 18.5–20.9 kg/m², the odds of the metabolic syndrome were 2.97 (95% CI 1.24–7.15) for men with BMI 21–22.9 kg/m², 4.95 (2.13–11.54) for men with BMI 23–24.9 kg/m², and 9.88 (4.29–22.75) for men with BMI25–26.9 kg/m² .

Individuals in the upper normal-weight and slightly overweight BMI range have a relatively high prevalence and are at increased risk of having metabolic syndrome. (1)

-People with metabolic syndrome have 2 to 3 times the risk of having heart attack and stroke, type 2 diabetes or chronic kidney disease than people without the condition.
- Metabolic syndrome affects about 20% to 30% of adults in Australia but can also affect children and adolescents.
- About 25% of people globally have non-alcoholic fatty liver disease (NAFLD), and over 80 million Americans have NAFLD
- Over 100 million people have either pre-diabetes and diabetes (2017)

OK, hopefully by now I have your attention, Especially if we look at the risk factors that contribute to metabolic syndrome (MtS) and we can see how prevalent it is within our community.
For example: (2)

- Almost 2 in 3 Australian adults (63%) had abnormal blood lipids in 2011-12
- Almost 2 in 3 Australian adults (63%) were overweight or obese in 2014-15, similar to 2011-12
- 1 in 3 Australian adults (33%) have high levels of LDL cholesterol (LDL-C)
- Almost 1 in 4 (23%) have low levels of HDL-C
- 1 in 7 (14%) have high levels of Triglycerides
- It has been shown that the simple measurement of waist circumference is highly correlated with insulin resistance (IR) in a group of Caucasian, healthy adult men. which reflects underlying visceral adiposity (fat around the organs) and correlates with IR. (3)

Next time you’re out have a look and see how many people walking around have large bellies or better known as the beer belly. A lot of these people, and you see it more in men, might look lean enough in the rest of the body compared to the beer belly, this is a worrying sign of IR/MtS.

As Metabolic Syndrome is a combination of factors there isn’t just 1 blood test or 1 sign that you have it. As it is still being understood and realising the prevalence of it, your doctor may miss seeing the pieces come together to create this disorder or might not get enough information to make a decision.

So, what should you look for to see if you have metabolic syndrome/insulin resistance?

   Usual Markers:

-Central or abdominal Obesity -

     -Men – greater than 101.6cm

     -Women – greater than 88.9cm

-Triglycerides - greater than or equal to 150 milligrams per
       decilitre of blood (mg/dL)

-HDL Cholesterol -
     -Men – Less than 40 mg/dL

     -Women – Less than 50 mg/dL

- blood pressure - greater than or equal to 130/85 millimetres of
    mercury (mmHg)

- Fasting glucose - greater than or equal to 100mg/dL

Some other really good markers to take into account as proxies for insulin resistance:

• Total Cholesterol/HDL cholesterol - 5:1 is considered good a
  higher ratio increases risk
• Triglycerides/HDL-C – this marker should be below 2
• LPIR - scores range from 0-100 and the higher the score indicates greater IR. According to new research, the recently developed lipoprotein insulin resistance (LPIR) score can identify type 2 diabetes (T2D) risk years before glycaemic abnormalities are clinically detected.
• GGT – in the range of 0 to 30 IU/L are normal. Anything above 30 IU/L could be a sign that your liver isn't working the way it should. (more on liver function and IR later) (3)
• Ferritin – The normal range is 25-155 microgram/L in menstruating adult females, and 40-260 microgram/L in adult males.
  Serum ferritin(SF) has been positively associated with insulin resistance and the metabolic syndrome in whites without diabetes (4)
• Fasted insulin – less than 25 mlU/L
• HOMA IR - HOMA-IR >3.80 as “high” having clear correlates of insulin resistance Homeostatic model assessment (HOMA) is a method for assessing β-cell function and insulin resistance (IR) from basal (fasting) glucose and insulin (5)
• OGTT – 54mg/dL – 138mg/dL is normal glucose levels at 2-hour point above 140mg/dL is considered prediabetic.
• OGTT (insulin) – Below 30 mlU/L is good, above 40 mlU/L is concerning. When you get an Oral glucose tolerance test (OGTT) also ask for your insulin level at the 2-hour point. (this isn’t normally done but will give you earlier detection that something may be going wrong, more on this to come)
• Leptin – For men with a BMI of 22, values need to be between 0.7 and 5.3 ng/mL and for women values need to be between 3.3 and 18.3 ng/mL. Higher readings can raise concerns. It is secreted by adipocytes (fat cells) and binds to the hypothalamic leptin receptor (Ob-R) to enhance metabolism and reduce appetite, thereby increasing energy expenditure and decreasing energy intake. Glucocorticoids and insulin act on adipocytes to increase leptin expression. It is associated with obesity, since a higher adipose tissue mass results in elevated leptin levels. It is also significantly associated with BMI Insulin and HOMA index. (6)
• Adiponectin- For men ranges are 2-26 ug/mL and for women ranges are 4-37 ug/mL. Lower scores are a sign for concern. Adiponectin level negatively correlates with cardiovascular and metabolic disorders. Adiponectin in the plasma correlate inversely with adiposity and directly with insulin sensitivity. (7)
  

As you can see metabolic syndrome/insulin resistance can affect a lot of different systems in the body, and when you can assess these areas through different blood tests you can see where on a scale you are. As eventually if untreated MtS/IR can transform into full blown type 2 diabetes, which then carries its own risk for other deadly diseases.

In the next article we will walk through some of the mechanisms of how insulin should work, and when it starts to get out of balance, the path that it takes, and the consequences that lead to MtS/IR.