An increasing number of people are experiencing metabolic dysfunction that can contribute to various chronic diseases. High blood pressure, elevated blood sugar levels, raised triglycerides in the blood, extra fat around the waistline, and low high-density (HDL) cholesterol are all factors that increase the risk of cardiometabolic diseases like type 2 diabetes, coronary heart disease, and stroke. When someone has at least three of those conditions, they are diagnosed with metabolic syndrome.
The metabolic dysfunctions characterizing metabolic syndrome are becoming increasingly common. Around one in three adults in the U.S. have metabolic syndrome. Increased high-calorie, low-fiber processed foods, increased sedentary lifestyles and decreased physical activity have all contributed to the rising incidence of metabolic syndrome.
Fortunately, lifestyle changes like a balanced individualized diet, stress management, and focusing on the microbiome's health can help reverse these metabolic issues and prevent serious health problems.
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What is Metabolic Syndrome?
Metabolic syndrome refers to a group of metabolic imbalances, that meet the metabolic syndrome criteria including:
- increased blood pressure (130/85 millimeters of mercury (mm Hg) or higher)
- high blood sugar (100 mg/dL (5.6 mmol/L) or higher) or insulin resistance
- excess body fat around the waist (more than 35-inch waist circumference for women and more than 40 inches for men)
- elevated triglyceride levels in the blood (150 milligrams per deciliter (mg/dL), or 1.7 millimoles per liter (mmol/L), or higher) and
- abnormal cholesterol balance in the blood, such as low HDL cholesterol (less than 40 mg/dL (1.04 mmol/L) in men or less than 50 mg/dL (1.3 mmol/L) in women)
When someone has at least three of those conditions, they are diagnosed with metabolic syndrome. Each of those conditions increases the risk of cardiometabolic diseases, including type 2 diabetes, coronary heart disease, and stroke. For example, someone with metabolic syndrome is five times more likely to develop type 2 diabetes.
These characteristics are interrelated with intertwined consequences. For example, being overweight, especially around the abdomen, is a bigger risk factor for heart disease than extra fat in other parts of your body, such as subcutaneous fat. This is because "having an apple shape" or carrying excess weight around the body's midline indicates visceral fat around the abdominal organs. Research shows that increased visceral fat is a major risk factor for inflammation throughout the body, imbalanced cholesterol, insulin resistance, and cardiovascular disease.
Obesity and a lack of physical activity contribute to the development of insulin resistance which leads to
- elevated blood sugar and insulin levels that can lead to type 2 diabetes
- excess retention of sodium by the kidneys, which elevates blood pressure
- increased triglycerides and low-density lipoprotein cholesterol levels along with decreased HDL cholesterol, metabolic factors which favor the formation of atherosclerotic plaques that contribute to coronary heart and cerebrovascular disease
Metabolic Symptoms
The signs and symptoms of metabolic syndrome depend on which metabolic imbalances occur. Many of these conditions may not be obvious, especially in the beginning stages, like elevated blood pressure and imbalanced cholesterol. Others are more obvious, like central obesity or an increased waist circumference giving someone an "apple" shape.
When insulin resistance occurs and leads to elevated blood sugars, noticeable symptoms may occur. These include
- increased thirst
- increased urination, especially at night
- blurry vision or vision changes
- fatigue
- shakiness or lightheadedness
- mood swings or irritability
- headaches
- cravings for sweets or carbohydrates
What Causes Metabolic Syndrome
Many factors can contribute to the metabolic imbalances that define metabolic syndrome. While some risk factors for metabolic syndrome, like an increased age, lower economic status, family history, and genetics, are not controllable, other risk factors can be influenced by lifestyle habits and approaches.
Some key lifestyle factors that can contribute to the development of metabolic syndrome include
- a lack of physical activity and a sedentary lifestyle
- an imbalanced diet with high-calorie, low-fiber, and processed foods
- not getting enough good quality sleep or circumstances that throw off circadian rhythms like shift work
- smoking
- excessive and unmanaged stress
In addition to these lifestyle factors, the health of the gut and microbiome play a role in metabolic imbalances characteristic of metabolic syndrome. Certain types of imbalances in the microbes in the gut (dysbiosis) can contribute to a leaky gut barrier that allows food particles and microbes to get into the bloodstream and contribute to inflammation and dysregulated immune responses throughout the body. Certain types of bacteria can also extract more energy from the diet, contributing to obesity and its metabolic consequences. For example, lower levels of bacterial families Firmicutes and higher levels of Bacteroidetes are correlated with higher body mass index independent of genetics, age, and gender.
Metabolic syndrome is also more common in people with certain conditions, such as polycystic ovary syndrome (PCOS) and nonalcoholic fatty liver disease (NAFLD), which involve dysregulated inflammation, microbiome balance, and insulin and blood sugar levels.
How to Test Your Patients for Metabolic Syndrome
A functional medicine approach evaluates the underlying metabolic dysfunction and the root causes contributing to them. Blood work can detect abnormalities in insulin, blood glucose processing, and cholesterol. Testing can also evaluate imbalances in the gut microbiome and any resulting detrimental metabolic changes, such as increased inflammatory markers, insulin, and glucose levels.
Physical exam:
During a physical examination, your provider can screen for several components of metabolic syndrome.
- waist circumference or waist-to-hip ratio, which can screen for an increased risk of diabetes, heart disease, and other complications
- weight
- blood pressure
Blood Sugar and Metabolism Markers
Several tests can evaluate blood sugar balance and insulin function.
- fasting glucose
- hemoglobin A1c measures the average blood sugar level over the previous six weeks
- fasting insulin
- C-peptide, a marker that the body is producing insulin
Together, these can identify insulin resistance. When sugars remain in the blood, they can cause inflammation and damage blood vessels, leading to metabolic syndrome, heart disease, type 2 diabetes, and NAFLD.
The Metabolomic Profile is one test that looks at many of these metabolic markers of glucose balance and insulin function. It also measures several markers of adiposity, like leptin and adiponectin, which can be used to help assess the risk of metabolic syndrome.
The NutraEval FMV also provides insights into cellular health, toxin exposure, and how the body handles oxidative stress, which can all impact metabolism.
Lipids
A lipid profile including total cholesterol, HDL ("good" cholesterol), LDL ("bad" cholesterol), and triglycerides can be measured to evaluate the balance of fats in the blood. In addition, lipoprotein(a), LDL particle number, and ApoB-containing lipoproteins (ApoB) can provide a more specific risk assessment.
Inflammation Markers
High-sensitivity CRP is made by the liver in response to inflammation and can be used over time to track trends in inflammation within the body that contribute to and result from the metabolic imbalances involved in metabolic syndrome.
Gut Health
A comprehensive stool test like the GI Effects reflects the overall health and balance of the digestive tract by measuring a variety of microbes and intestinal health markers. It can help assess the microbiome's compensation and how well you break down and digest fats, proteins, and carbohydrates. This can guide an individualized approach to metabolic health and nutrition based on your unique needs.
Metabolic Syndrome Treatment
Treating metabolic syndrome requires a comprehensive approach that includes lifestyle changes, such as eating a healthy diet, exercising regularly, and quitting smoking. Additionally, medications may be needed to help manage high blood pressure, high cholesterol, and diabetes.
Eat a Balanced Whole Foods Diet
Dietary approaches are effective in helping to prevent or control metabolic syndrome. Diets rich in fiber, vegetables, legumes, and other high-quality proteins like wild fish and grass-fed meats are associated with more balanced weight and fat distribution, less insulin resistance, and improved markers of inflammation and fat and sugar metabolism. This approach focuses on high-fiber and complex carbohydrates and avoids processed and added sugars to keep blood sugars balanced.
For example, a Mediterranean diet, emphasizing citrus fruits, vegetables, legumes, and complex carbohydrates with moderate fish and olive oil, helps improve blood sugar, insulin, and cholesterol. Since this way of eating balances inflammation and promotes gut health, it has wide-reaching benefits throughout the body, including improving some of the risk factors for metabolic syndrome.
In particular, polyunsaturated omega-3 fatty acids in foods like salmon and walnuts positively impact blood pressure, insulin, and triglycerides.
A gluten-free diet may also improve many aspects of metabolic syndrome, such as reducing waist circumference, balancing blood sugar, and reducing triglyceride levels.
Balance the Microbiome
The microbiome is very responsive to changes in diet. A diverse plant-focused diet rich in dietary fiber supports balanced gut bacteria that promote a healthy gut lining and proper digestion, weight, and blood sugar balance. These types of diets are naturally rich in polyphenols and long-chain omega-3 polyunsaturated fatty acids, which significantly increase gut microbial diversity and the ratio of Firmicutes/Bacteroidetes to positively impact glucose and lipid metabolism, improving the management and prevention of metabolic syndrome.
Prebiotic foods like garlic, bananas, and asparagus feed healthy gut bacteria. Probiotics in naturally fermented foods like sauerkraut and miso promote microbial diversity to help regulate insulin sensitivity, cholesterol, and weight.
Move Regularly
Studies show a strong association between physical inactivity and obesity with metabolic dysfunction. Incorporate regular, consistent exercise to improve the body's ability to handle sugars and reduce abdominal obesity.
Maintain a Balanced Weight
Maintaining a weight that is balanced for your body can improve the metabolic factors involved in metabolic syndrome. For those above their ideal weight, studies suggest that losing 7% of body weight can reduce insulin resistance and blood pressure and decrease the risk of diabetes.
Manage Stress and Get Enough Sleep
Unmanaged chronic stress and inadequate or disrupted sleep are associated with metabolic syndrome, mainly through the impacts on inflammation and blood lipids. Finding a meaningful practice for managing stress and maintaining a regular sleep routine and consistently adequate sleep is critical for a balanced metabolism in the long term.
Avoid Smoking
Stopping smoking helps to improve the balance of lipids in the blood and reduce the risk of metabolic syndrome.
Summary
Metabolic syndrome is characterized by abdominal obesity, insulin resistance, high blood pressure, and imbalances in blood lipids or cholesterol. An imbalanced diet with too many processed foods and refined sugars, too little physical activity, chronic stress, and imbalances in the gut microbiome all contribute to metabolic dysfunction. People with metabolic syndrome are at an increased risk of developing cardiometabolic diseases like type 2 diabetes and coronary heart disease.
A physical exam can screen for many signs of metabolic syndrome, such as an increased waist circumference or waist-to-hip ratio and elevated blood pressure. Laboratory testing can further elucidate metabolic health by looking at blood sugar balance and insulin levels, evaluating gut health and the microbiome's composition, and measuring cholesterol levels in the blood.
Fortunately, lifestyle changes can improve the metabolic imbalances which characterize metabolic syndrome and prevent these related chronic conditions. Maintaining a balanced weight and healthy microbiome through regular physical activity and an anti-inflammatory whole foods-focused diet can improve metabolic measures like blood pressure, lipids, and blood sugar levels. In addition, implementing a meaningful stress management practice and regular sleep routine helps improve metabolic markers.
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