The Metabolic Syndrome
Jerry BrainumIs This Sneaky Insulin Resistance Ruining Your Workouts and Your Health?
Although he had 25 years of bodybuilding-training experience, Louis B. had been slacking off lately. Personal and job pressures caused him to miss workouts with increasing frequency. That was apparent in his widening waistline, since he hadnít reduced his food intake to match his reduced training. But the biggest shock came at his annual medical exam. His blood tests showed a low level of protective high-density-lipoprotein cholesterol (HDL), coupled with high blood triglycerides, or fat.
Even worse, his blood pressure was high, and so was his fasting glucose level. That put Louis among the 27 percent of Americans who have the metabolic syndrome.
The metabolic syndrome has had various names over the years, such as Syndrome X, Reavan Syndrome, insulin resistance syndrome and the deadly quartet. While scientists continue to debate the full diagnostic criteria for the metabolic syndrome, most agree that having three out of the following five features puts you in the club:
- A waist size greater than 40 inches in men, 35 inches in women.
- Low fasting high-density-lipoprotein cholesterol levels, below 40 in men and below 50 in women.
- An elevated fasting blood triglyceride level of 150 or more.
- A fasting blood glucose level above 115 milligrams per deciliter of blood.
- A blood pressure reading higher than 130/85.
The primary components of the metabolic syndrome are having a lot of abdominal fat, particularly deep-lying, or visceral, fat; poor blood lipid levels; high blood pressure; and insulin resistance with or without glucose intolerance. It is also characterized by a systemic chronic inflammation that is directly related to increased visceral fat stores, as we shall see. Aggravating the inflammation is an increased tendency to form blood clots, which is directly linked to heart attack and stroke.
The metabolic syndrome is more common among African-Americans, Hispanics, Asians and Native Americans, though it can affect anybody. In fact, the syndrome is now increasingly showing up in children and teenagers, likely the result of poor diets combined with lack of exercise.1,2 Surveys show that 6.4 percent of Americans aged 12 to 19 have it, and risk increases with age. By 2040 an estimated 40 percent of Americans will be afflicted with the syndrome, and it will supersede cardiovascular disease as the leading cause of death.
The metabolic syndromeís constellation of symptoms predisposes you to various diseases: cardiovascular disease, diabetes, chronic kidney disease, elevated uric acid, gout, kidney stones, fatty liver, gallstones and mental decline. The good news is that it is completely preventable, via diet and exercise, though in some cases certain drugs may also help.3
To understand the dangers that lie beneath the metabolic syndrome, you need to know about bodyfat.
Bodyfat: Much More Than Meets the Eye
In years past bodyfat, which consists of triglycerides, a form of saturated fat, was thought to be nothing more than a storage depot for excess energy. You ate too much, didnít do enough exercise to burn excess calories, and those calories took an express route to fat cells. While obesity was considered unattractive, the health concerns about it were limited to its adverse effects on cardiovascular function, blood pressure and risk of diabetes.
More recently, however, scientific findings have made it clear that bodyfat releases numerous chemicals that have potent effects on health.4 Collectively referred to as adipokines, the chemicals are released in greatest quantity from visceral fat. Many promote inflammatory conditions throughout the body; medicine now recognizes inflammation as the underlying cause of most degenerative health conditions.
Excess visceral fat is the basis of the metabolic syndrome, although hormones also come into play. Even those who are only moderately fat show increased incidence of coronary artery disease.
A roll call of adipokines tells a cautionary tale:
- Adiponectin. One of few good guys among adipokines, adiponectin is an anti-inflammatory agent against insulin resistance, the cornerstone of the metabolic syndrome.5.6 When adiponectin is elevated, most other inflammatory adipokines, including C-reactive protein (CRP) and fibrinogen, are decreased. Decreased adiponectin levels are linked to higher bodyfat levels, decreased insulin sensitivity, poor blood lipid levels and increased cardiovascular disease risk. Lack of adiponectin may be the basis for most of the inflammatory symptoms of the metabolic syndrome.