What is metabolic syndrome? To define this somewhat nebulous but increasingly relevant term, let's split it in half. First, metabolic, meaning it has to do with metabolism and the metabolic system. Second, syndrome, which in a medical context, refers to conditions that include a number of sometimes disparate-seeming symptoms that all result from the same underlying cause. When left untreated, metabolic syndrome can escalate, leading to heart attacks and other potentially fatal outcomes. That's why it's essential that everyone be aware of key metabolic syndrome risk factors so they can take early action to prevent and treat this serious condition.
Metabolic Syndrome: An Expanded Definition
Rates of metabolic syndrome, also called Syndrome X, insulin resistance syndrome, and dysmetabolic syndrome, are on the rise, making it important to increase public knowledge of this condition.
According to the National Heart, Lung, and Blood Institute (NHLBI), a division of the National Institutes of Health (NIH), the term metabolic syndrome describes a collection of risk factors that elevate your chances of developing cardiovascular disease, diabetes, and other health problems. To be diagnosed with metabolic syndrome, you must present with at least three of these five indicators:
- High blood pressure: Blood pressure numbers measure the force of the blood pushing against the walls of your arteries as your heart pumps. Continued elevated blood pressure can cause damage to the heart and result in plaque buildup on the arterial walls.
- Low levels of high-density lipoprotein (HDL) cholesterol: Sometimes called "good" cholesterol, HDL cholesterol helps to remove buildup from your artery walls. Therefore, having low HDL levels puts you at higher risk of developing heart problems.
- High triglyceride levels: This is a type of fat found in the blood. Having too many circulating on an ongoing basis can make you more likely to develop heart disease.
- High fasting blood glucose levels: Even mildly high glucose (blood sugar) levels can be an early warning sign for type 2 diabetes.
- Disproportionately large waistline: Studies have shown abdominal obesity, meaning the presence of excess fat in the stomach area, is more predictive of heart disease than deposits of fat elsewhere in the body, such as on the hips or thighs.
The more of these criteria an individual meets, the higher their risk of diabetes, stroke, and coronary heart disease. The NIH predicts that metabolic syndrome one day will bypass smoking as the leading predictor of future heart disease.
A Growing Epidemic
At this time in the United States, metabolic syndrome could be considered an epidemic. According to a 2015 research letter that appeared in the Journal of the American Medical Association (JAMA), data drawn from the National Health and Nutrition Examination Survey (NHANES) shows that more than one in three Americans meets the diagnostic criteria for metabolic syndrome.
“Increasing metabolic syndrome prevalence was seen with increasing age in all groups,” the researchers wrote. “Prevalence of the metabolic syndrome was 18.3% among those aged 20 to 39 years and increased to 46.7% among those aged 60 years or older. Among patients aged 60 years or older, more than 50% of women and Hispanics had the metabolic syndrome.”
To clarify, the authors of the letter did not officially diagnose anyone with metabolic syndrome in the way that a primary care provider who can order a bevy of tests for each patient would. Instead, the researchers based their findings on markers of metabolic syndrome that are easy to collect and measure. The indicators they looked for in the NHANES data were as follows:
- Blood pressure of 130/85 mmHg or higher, or the use of medications to lower blood pressure
- HDL cholesterol levels of less than 40 mg/DL in men or less than 50 mg/DL in women
- Triglyceride levels of 150 mg/dl or higher
- Fasting glucose level of 100 mg/DL or greater, or the use of medications to control blood sugar
- Waist circumference of more than 40 inches in men, or more than 34.6 inches in women
5 Key Metabolic Syndrome Risk Factors
Given the complexity of metabolic syndrome, it should come as no surprise that it stems from the collision of several underlying causes. Some of those causes lie within an individual's control (to some extent, at least), such as an inactive lifestyle and insulin resistance. Other causes that contribute to the development of metabolic syndrome, however, cannot be controlled. This second category includes circumstances like growing older as well as genetic factors such as ethnicity and a family history of certain health conditions.
The American Heart Association lists five key metabolic syndrome risk factors that increase your likelihood of developing the condition.
1. Inactive Lifestyle
A person's risk of metabolic syndrome increases as their physical activity levels decrease. The results of a study published in PLoS One, a peer-reviewed, open-access journal, showed that the more time participants spent sitting, the greater the likelihood that they would develop metabolic syndrome. The authors found that individuals who spent more than 42 hours weekly sitting had a 4% to 12% attributable risk of metabolic syndrome. This held true across genders.
When determining participants' activity levels, the researchers categorized the following activities as sedentary behaviors:
- Lying down
- Using the computer and other forms of screen-based entertainment
- Watching TV
They considered any participants who engaged in at least 30 minutes of moderate-intensity activity per day on at least 5 days of the week, or at least 20 minutes of vigorous-intensity activity per day on at least 3 days of the week to be physically active, and those who did not meet either of those criteria to be physically inactive.
2. Insulin Resistance
Studies indicate that insulin resistance, a condition in which the cells do not respond properly to insulin, can elevate your risk of metabolic syndrome.
Some experts believe that insulin resistance is the driving force behind the development of metabolic syndrome. "Once acquired, those with a genetic predisposition would develop all the other aspects of the disorder," they claim. However, others believe that insulin resistance occurs in response to a sedentary lifestyle.
In any case, it's clear that both factors contribute significantly to the development of metabolic syndrome.
3. Abdominal Obesity
As touched on previously, abdominal obesity is a central component of metabolic syndrome. However, the connections between abdominal obesity and metabolic syndrome are quite complex. Researchers have yet to fully untangle whether one causes the other, or whether it's simply common for them to develop in tandem.
What is clear, however, is that a reduction in abdominal fat deposits does more to lower your risk of metabolic syndrome than a reduction in overall body weight or body mass index (BMI). The authors of a 2018 study suggest that this has to do with the role abdominal obesity plays in the development of a pro-inflammatory state, which has been linked to metabolic syndrome.
Population-based studies in the United States show that metabolic syndrome is more prevalent among certain racial and ethnic groups than others. Mexican Americans are more likely to develop metabolic syndrome than Caucasian Americans, who are more likely to develop the disorder than African Americans.
According the the American Heart Association, this remains true even when other factors such as BMI are accounted for.
While researchers agree that sex appears to influence a person's risk of developing metabolic syndrome, there's some disagreement over whether men or women are at higher risk.
Some sources, including the NIH, state that women are at higher risk than men. Yet the JAMA research letter seems to undermine that assertion: metabolic syndrome incidence among women was noted as trending down slightly, from 39.4% in 2007-2008 to 26.6 % in 2011-2012. This is more aligned with the stance of the American Heart Association, which holds that men have a higher risk than women.
What does appear to be inarguable is that sex-based differences influence the development and progression of the condition.
Other factors can cause, or contribute to, metabolic disease as well. People who develop diabetes in adulthood (type 2 diabetes) or who have a parent or sibling with the disease are at greater risk for developing metabolic disease. Those who have high triglycerides, gallstones, polycystic ovary syndrome (PCOS), or sleep apnea are also at greater risk, according to the NIH.
Studies also show that it's common for individuals with metabolic syndrome to have two other conditions as well: excessive blood clotting and chronic, low-grade inflammation. It's unclear whether those conditions influence the progression of metabolic syndrome or simply tend to develop under the same physiological circumstances.
Furthermore, researchers have found that certain medications appear to increase the likelihood that someone will develop the condition. Interestingly, antipsychotic drugs may predispose users to metabolic syndrome, perhaps due to side effects like weight gain and dyslipidemia. Other kinds of medication, including those used to treat allergies, inflammation, and HIV, can come with side effects such as weight gain and changes to blood pressure and blood sugar levels, which subsequently result in a higher risk of metabolic disease.
The NIH is supporting efforts by researchers to learn more about metabolic disease, including investing in studies of linked complications. For example, why is it that women with metabolic disease tend to have cysts on their ovaries? Or what's the connection between difficulty breathing and metabolic disease?
How to Lower Your Risk of Developing Metabolic Syndrome
If you have identified factors that make you prone to developing metabolic disease, the good news is that it's quite possible to use lifestyle changes to prevent or mitigate metabolic syndrome.
That said, a few factors that can aggravate metabolic syndrome cannot be helped or should not be changed. Obviously, a person with HIV should not stop taking their medication.
Successfully lowering your risk of metabolic syndrome, or controlling it, requires a long-term outlook, steady commitment, and collaboration with a team of knowledgable health care professionals. While expert guidance can ensure your efforts have the highest chance of success, the bulk of the work will come from you, not pharmaceuticals, if you're truly determined to improve your metabolic health.
6 Natural Ways to Combat Metabolic Syndrome Risk Factors
Taking steps to improve your health can feel daunting. Instead of trying to rapidly and drastically change your whole life, break your long-term goals down into smaller, actionable items. The following tips can serve as a guideline for you to develop your own personalized plan for lowering your risk of metabolic syndrome or minimizing the adverse health effects that can come with the condition.
1. Educate Yourself
It can be tough to understand what’s going on inside your body if the underlying cause remains mysterious to you. Understanding your disease and the science behind it is an important first step toward long-term, successful management.
The Internet provides plenty of information, but not all of it is accurate. It’s wise to check several reliable sources. Another option is to buy a book (electronic versions can be very inexpensive). Diet books to counter metabolic syndrome may not offer a plan you want to follow, but most will provide simplified background information to convey a better understanding of the symptoms.
Last but certainly not least, consider how your primary care provider can be your ally and support your efforts to take your health into your own hands.
2. Start Moving
If you have metabolic syndrome, you most likely are overweight. It can feel hopeless when you reach a certain point of obesity, especially since carrying excess weight can make physical activity uncomfortable. The key is to meet yourself where you are. Just 30 minutes of walking a day will get your triglycerides headed downward again. If that feels like too much, try walking for 10 minutes. Pick a goal that feels achievable and start there. Once you start walking and feel those little improvements, you may be surprised by how soon you're able to walk a little longer.
3. Stop Smoking
Smoking sends inflammation in the body through the roof—the last thing a person with metabolic disease needs. It’s like smoking a cigarette next to a gas pump. While you likely know that smoking undermines your health goals, it's easier to say you want to quit than to follow through on it. Resources like this one put together by the Centers for Disease Control and Prevention (CDC) can help you make the transition from current to former smoker.
4. Decrease Your Alcohol Intake
Alcohol may be touted as heart healthy thanks to its HDL-raising properties, but it also increases blood pressure. Plus, if you're working to lose weight, cutting out high-calorie alcoholic beverages can go a long way. Cocktails, in particular, can add up since they're often made with sugary mixers. If you do choose to drink, opt for a low-sugar, low-calorie option.
5. Use Supplements to Enhance Your Efforts
There are plenty of supplements that claim to help people with metabolic disease. Stick with ones that are backed by research. Balanced mixtures of essential amino acids (EAAs) are reliably shown to decrease triglycerides, as well as the amount of fat stored in the liver. EAAs also appear to help manage blood pressure and act as anti-inflammatories.
6. Eat a Nutrient-Dense Diet
A well-balanced diet focused on nutrient-dense foods is a must. There's plenty of room within that mandate to create a diet plan that suits your tastes.
Here are a few ideas to get you started. First, expand the range of fruits and vegetables you consume. Pomegranates, for example, are amazing and tasty treats that have been shown to lower cholesterol. Second, get some fish onto your plate. Eating cold-water fish caught in the wild helps lower your blood pressure and fight inflammation in the body. Third, prioritize antioxidants—these compounds help your body fight disease and inflammation.
If you're looking for an overall strategy to follow, the DASH diet provides a great model of an eating pattern to combat metabolic syndrome.