What is metabolic syndrome?

Firstly, let’s break down what metabolic syndrome means by breaking it down into its two constituent parts. We’ll start off with syndrome which is the easy part. In medicine, a syndrome is a combination of conditions or medical signs (things that a doctor would identify in a patient) and symptoms (things that a patient would complain about) that correlate with one another and are associated with a particular disease.

The metabolic part relates to metabolism or the chemical processes in the body that utilise food and manage how it is converted into energy for us to function and grow. Diabetes is one example of a metabolic condition because it affects how the body breaks down glucose from food (carbohydrates) and our energy stores and converts it into energy for our cells to use. However, because this is a syndrome, diabetes (or more accurately type 2 diabetes) is just one part of it. Metabolic syndrome is a combination of diabetes, hypertension and dyslipidaemia (an abnormality with the fats in the blood, namely cholesterol and triglycerides).

Internal medicine specialist and diabetologist Dr Yohan Samarasinghe tells us more about insulin resistance, which lies at the heart of metabolic syndrome and what we can do to help prevent it.

Insulin resistance – the heart of the matter

At the heart of metabolic syndrome is something called insulin resistance, which happens to be the central problem behind type 2 diabetes. People who are insulin resistant require more insulin compared to people who don’t have insulin resistance or who are insulin sensitive. Their cells don’t respond to insulin in a normal way. As insulin is the hormone that helps transport glucose into cells, if the cells are not responding to insulin, glucose cannot get into the cells and remains in the blood circulation, resulting in many of the symptoms that one gets with poor diabetes control, notably feeling tired, thirsty, passing a lot of urine and having blurred vision.

Drugs that address type 2 diabetes largely work in five different ways:

• They address the insulin resistance problem.
• Encourage the pancreas to produce more insulin to overcome insulin resistance.
• Discourage patients from eating.
• Remove excess sugar either in the urine or via the bowel.
• Usually the last resort is the supplementation of insulin via injections through the skin.

The underbelly of insulin resistance

Insulin resistance is very much associated with central adiposity, which is the accumulation of fat in the abdomen. This is often why healthcare professionals will be more interested in measuring your waist circumference rather than working out your body mass index (BMI). Although BMI is the method by which we define obesity, the measure is crude and doesn’t take into account body composition. For instance, Danny DeVito and Arnold Schwarzenegger may have a similar BMI, but very different physiques and compositions. One is far more likely than the other to have the metabolic syndrome!

The fat that accumulates in the abdomen has a different metabolic potential compared to fat elsewhere in the body. It produces fat hormones that encourage insulin resistance and create the typical dyslipidaemia that one sees in patients with the syndrome. Patients will have a high fasting triglyceride level with a low (good) HDL cholesterol level.

Poor diabetes control will also often result in high (bad) LDL cholesterol. Individuals with the metabolic syndrome get this disruption in their lipids because some of the enzymes involved in lipid metabolism are controlled by insulin. If insulin cannot work in a normal way on these enzymes, then a disruption of these metabolic processes occurs.

Why should we worry about the metabolic syndrome?

Well, the combination of conditions that form this syndrome are all cardiovascular risk factors. These conditions increase your chances of getting a heart attack or stroke. Having all three of the conditions; diabetes, hypertension and high cholesterol not only amalgamates your risk of cardiovascular disease, but exponentially increases it.

It is therefore vital to strike at the heart of the syndrome, which is the central adiposity or abdominal fat and tackle the insulin resistance, whilst at the same time aiming for good blood pressure and cholesterol control.

Can we prevent metabolic syndrome?

There are certain risk factors that make us more likely to develop the metabolic syndrome that we can’t do much about, such as:

• Genetics, those with a family history of metabolic syndrome are at greater risk.
• Age, insulin resistance increases with age.
• Race. Certain ethnicities such as south Asians and Hispanics are more prone to it.

However, factors such as gaining weight from overeating and doing less exercise is something that we can all target.

By far the best way to prevent the syndrome or to manage it is to improve one’s diet and increase exercise. There is no one diet that will fix the problem, but calorie restriction and particularly reducing carbohydrates seems to be highly beneficial. Again, there is no particular type of exercise that is more beneficial than another, but increasing physical activity levels will have a positive effect in making the body more insulin sensitive and thus reducing blood glucose levels.

There are many licensed medications that can be used for all the individual conditions within the syndrome (diabetes, hypertension, high cholesterol and obesity). The trick and art of counteracting the syndrome is finding the right therapeutic combination for each individual patient. No one patient is alike, and individuals will respond to drugs in different ways. Finding the most effective combination to reduce the risk of metabolic syndrome, with the least side effects is what specialists aim for. Ultimately, we want to prevent the primary cause of death from the metabolic syndrome, which is cardiovascular disease.

To check yourself for metabolic syndrome and the conditions that play a role in it such as diabetes and hypertension, visit a specialist for assessment.