Dr. Toshi Is In! "Metabolic Syndrome"

Dear Dr. Toshi,

I just heard of a condition called "Metabolic Syndrome." What's that?

"Metabolic syndrome" is a problem related to abdominal fat, blood pressure, blood glucose, and lipids (cholesterol and fats) that affects our health in significant ways. I talked about hypertension and cholesterol in previous articles, and also discussed BMI and waist circumference for screening obesity. I'll talk about diabetes and how blood sugar and insulin work in a later article. Please remember that there always are exceptions to the rule because of an individual's genetics and so on, so this will be about things that apply to most people. (There's another interesting topic related to everyone's unique genetics called "Individualized Medicine," which I'll cover in the future.)

There are a few definitions of "metabolic syndrome," but according to the one that's most widely used in the US, someone has metabolic syndrome if they have at least three of the five conditions below:

• Abdominal obesity (a waist measurement greater than 40 inches for men, or greater than 35 inches for women)
• A triglyceride level of 150 or greater
• An HDL cholesterol (the good kind of cholesterol) level that's less than 40 for men or less than 50 for women
• A systolic blood pressure (the top number in your blood pressure) of 130 or greater, or a diastolic blood pressure (the bottom number) of 85 or greater OR they're on a medication for high blood pressure
• A fasting glucose level of 100 or higher OR they're on a medication to control their blood sugar level

Metabolic syndrome is bad because it means that a person is at higher risk of developing Type 2 Diabetes and cardiovascular disease such as a heart attack or stroke. It also means the person has a higher risk for getting other conditions such as liver failure like nonalcoholic fatty liver disease and some kinds of cancer.

In the Framingham Heart Study population, obese people who have metabolic syndrome have a 10 times higher risk of getting diabetes, and the two times higher risk of developing cardiovascular disease than people with a normal weight who don't have metabolic syndrome. People with a normal weight who have metabolic syndrome have four times the normal risk of getting diabetes, and three times the normal risk of getting cardiovascular disease.

By the way, the Framingham Heart Study is one of the most famous, ongoing, large-scale research studies involving over 14,000 people from three generations since 1948, and it has resulted in many important discoveries about how cardiovascular health affects other parts of the body. It's how we learned that high blood cholesterol and high blood pressure are major risk factors for developing cardiovascular diseases like heart attacks and stroke.

Abdominal obesity is fat around the tummy, which is shown in a person's waist measurement (waist circumference). A high body weight, especially with abdominal fat, is a major risk factor for metabolic syndrome for most people. In one study, only 5% of people with a normal weight had metabolic syndrome, but 82% of overweight or obese people had metabolic syndrome. As you may know, diabetes, hypertension (high blood pressure), high cholesterol, and obesity are all related. Please check the CDC website or my previous article about BMI and waist circumference to find out the proper way to measure your waist.

The first step of the recommended treatment for metabolic syndrome is weight loss and exercise, which only you can do. As they say, "You can't pay somebody to do your pushups for you!" It's important to remind ourselves that we gained weight very slowly over many years as we get older, so it will also take a long time to lose the weight. Expect a long-term commitment. In the end, we'll enjoy longer, healthier lives! You can start today, and it's a lot easier if you do it with your friends or family members so you can encourage each other. If you're still young in your teens or twenties, start good habits now because even a 10-year-old can have metabolic syndrome. Now is the time to start having a healthy life!

Dr. Toshiko ("Toshi") Luckow, MD, is a Family Physician at the West River Health Services Hospital and Clinics.