Metabolic Syndrome

Statistics:

Demonstrating the essential need and urgency to define and address this prevalent health challenge

Statistics released during 2010: 150 million people diagnosed with Metabolic Syndrome! This is expected to rise to 300 million by 2030. This serious health risk can result in many other diseases, such as depression, heart disease, colon and breast cancer, diabetes, etc.

A study published in the South African Medical Journal, vol. 99, no. 5, May 2009, where the frequency of metabolic syndrome, overweight, obesity and risk of developing metabolic syndrome in workers at Kanye Seventh-day Adventist Hospital, Kanye, Botswana, were examined, and it was found that 34% of the hospital\’s workers had metabolic syndrome, the same percentage were at high risk of developing metabolic syndrome, 28.7% were obese, and 27.3% were overweight. Female gender was found to be strongly associated with obesity and metabolic syndrome. The age group of 35 – 54 years was most affected.

Another study by J Ker et al, published in the Cardiovascular Journal of SA in 2007, where the frequency of the metabolic syndrome in screened South African corporate executives were measured using the ATP III criteria, has recognised the importance of the metabolic syndrome as a clinical entity. A group of 1 410 corporate executives, belonging to a specialist health and fitness company in South Africa were tested, using three criteria as specified by the ATP III panel. Results showed that 31% of this group of corporate executives fulfilled the criteria for the diagnosis of metabolic syndrome. In a small subset of black executives, a similar finding was obtained. Another third of the executives had two criteria of the metabolic syndrome.

Background

The metabolic syndrome has existed in various forms and definitions, as a cluster of metabolic abnormalities with insulin resistance as the underlying major characteristic, has been known by several names since 1923.

Metabolic syndrome (Syndrome X; insulin-resistance syndrome) consists of a constellation of metabolic abnormalities that confer increased risk of cardiovascular disease and diabetes mellitus.

During the last five years, there has been controversy surrounding the definition of metabolic syndrome and the significance of the syndrome. This controversy has led to a lack of clarity about its role and value in clinical practice as opposed to its role in research.

Does metabolic syndrome predict cardiovascular disease risk better than the individual components? The relative value of metabolic syndrome in predicting type 2 diabetes mellitus remains uncertain. This controversy drove the need for a universally accepted single definition.

Problem with the definition

There are approximately six different definitions of metabolic syndrome, with the difference being the addition of one or more different components. Even the waist circumference as an obligatory component or just one of the criteria of the syndrome has added to the confusion.

Definition

A unified definition was finalised after a collaboration between the International Diabetes Federation, American Heart Association/National Heart, Lung and Blood Institute, the World Heart Federation, International Atherosclerosis Society and the International Association for the Study of Obesity. This new published definition involves the following factors:

• Increased waist circumference: abdominal circumference > 102 cm in men, > 88 cm in women  
• Increased triglycerides: > 1.7 mmol/1 
• Reduced HDL : < 1.0 mmol/l for men; < 1.3 mmol/l for women
• High blood pressure: >130 mmHg systolic; > 85 mmHg diastolic
• Increased fasting glucose: WHO – 6.1-6.9 mmol/l
• Increased fasting insulin (values differ according to different laboratories)

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Comments

The challenge is that the definition for an expanded waist circumference remains unsettled. Insulin resistance explains most of the symptoms of metabolic syndrome. Evidence now indicates that metabolic syndrome begins with excess central adiposity, but genetic predisposition is a contributing factor. Recently a polymorphism in the multi-PDZ domain-containing adaptor protein (PDZ-K1) regulating HDL receptor scavenger receptor type B Class 1 was found to be associated with metabolic syndrome.

Shift work, sleep deprivation and bright light exposure at night also relate to increased adiposity and metabolic syndrome. Recently, vitamin D deficiency was linked to the risk of cardiovascular disease and low vitamin D was strongly associated with overweight and metabolic syndrome, according to Prof James Ker, Dean Dept Medicine UP.

In conclusion, the inclusion of glucose intolerance and/or insulin resistance as obligatory criteria in the definition of metabolic syndrome, seems to be important for the ability to predict all-cause mortality and cardiovascular morbidity.

Summary based on following articles:

• Ingrid Larsson, Annakarin Lindroos, Theodore C. Lystig, Ingmar Näslund and Dr. Lars Sjöström. Metabolic Syndrome and Related Disorders. Summer 2005, 3(2): 102-112.
• SA Medical Chronicle, April 2010, based on an article published in the Cardiovascular Journal of SA in 2007.  

An integrative approach to effectively manage metabolic syndrome

Written by the Dr Arien van der Merwe MBChB FRSPH MISMA

Addressing metabolic syndrome in an integrative medicine approach, that can be applied to private practice, local clinics, community primary care facilities and in the workplace, has to become a top priority to address the burden of this disease (health challenge) in South Africa. By 2010, 150 million people have been diagnosed with metabolic syndrome, using the diagnostic criteria as per the previous article summary. We know that only about 20% are actually diagnosed, hence the utmost importance of regular health and wellness screenings, one of the main reason for promoting workplace wellness interventions. It is predicted that this figure will increase to 300 million by the year 2030. Compare this figure to the 35 million positive HIV people globally, with 22 million of those in Africa, and it is clear that metabolic syndrome is an even bigger health challenge to for which to find integrative medical and wellness solutions.

An integrative medicine approach, including the use of functional medicine, nutriceuticals (nutri- from nutrition and –ceutical from pharmaceutical), the usual lifestyle options, a realistic exercise program combined with nutritional guidance, advice on dealing with carbohydrate addiction, stress management and relaxation training, combined with a support network, will go a long way in providing solutions to address this most prevalent health challenge. Add to this the search for cause, by looking at the deeper mental-emotional blocks, the psycho-spiritual connection, where physical disease is regarded as a manifestation of a deeper subconscious pattern that has to become conscious, and the journey into healing can begin. Regarding dis-ease as a teacher rather than a curse or punishment, gives patients hope and many tools to use in managing their illness. This allows for an attitude of self responsibility and learning, rather than becoming a victim of the disease.

To summarise:

• Behaviour modification, including a change in eating patterns to a healthy, varied and tasty diet that includes a variety of seasonally available fruit and vegetables, nuts, seeds, low glycemic index carbohydrates, healthy fats (essential fatty acids as in extra virgin olive oil, grapeseed and avocado oils) and portion controlled protein from fish, poultry and lean meat, with increased intake of fibre rich food.
• Regular, gentle, enjoyable exercise matched to the individual fitness level
• The use of specific nutriceuticals and nutritional factors specifically designed for managing metabolic syndrome: e.g. beta-glucan from oats, antioxidants from berries, alpha-lipoic acid (ALA), chromium, biotin, vanadium, phaseolamin (Phase 2) and the vitamins that will reduce blood homocysteine levels, such as folic acid and vitamins E and B12.
• Addressing insulin resistance: betaglucan in oat soluble fiber may lower blood glucose levels after sugar intake, chromium polynicotinate, vanadium, molibdenum  and alpha lipoic may assist insulin function through improved performance of glucose tolerance factor. Gymnema sylvestre, fenugreek and cinnamon are herbs that increase insulin receptor sensitivity and glucose metabolism.
• Beta-glucan and Omega 3 fatty acids as found in cold water fish oil may reduce blood levels of low-density lipoprotein (LDL) cholesterol, and triglycerides, and may variably increase high-density lipoprotein (HDL) cholesterol.
• Antioxidants and chromium with biotin may exert positive effects on blood cholesterol.
• Beta-glucan may produce a sensation of satiety when taken before meals, and thereby assist in controlling calorie intake.
• Reduction in blood pressure result from weight control and lifestyle changes.
• The oxidative stress and advanced glycation end products may be reduced by bioflavonoids, proanthocyanidins, alpha lipoic acid and other antioxidants. High dosages of B-complex vitamins improve glucose metabolism.
• Of the utmost importance: address subconscious emotional blockages and long forgotten memories that play an important role as causal factor in the specific symptoms of metabolic syndrome. In short, struggling with metabolic syndrome is not due to lack of will power – there are more factors involved in this health challenge found in more than one third of the general population!

Integrative Wellness Solutions in a Nutshell

• healthy eating habits with unre­fined, low glycemic index (GI) carbohydrates (e.g. wholewheat, oats, muesli, legumes, cold potatoes, legumes), high fibre intake, reduced saturated fat intake, fresh vegetables and limited fruit (three a day), enough high quality proteins (e.g. lean meat, fish, eggs), and limited amounts of unsaturated fats
• no alcohol, smoking cessation
• suitable food supplements and herbal remedies
• regular moderate exercise
• stress management and daily relaxation time
• digging for subconscious emotional issues

More information on the specific useful nutrients for metabolic syndrome

• Chromium is probably the most important mineral for maintaining constant blood sugar levels. It is used for the treatment of high (hyper-) and low blood sugar levels (hypoglycaemia). Chromium forms part of the glucose tolerance factor (GTF), an important molecule in the man­agement of carbohydrate metabolism, as it improves the functioning of insulin. GTF (and hence chromium) improves the absorption of glu­cose in the cells so that it can be used for generating energy. GTF binds to insulin and the cell receptors to improve the absorption of glucose, thereby reducing blood sugar levels. GTF consists of one chromium molecule, two niacin molecules (vitamin B3) and three amino acids (glycine, cysteine and glutamic acid).
• Vitamin E reduces cell damage and prevents the oxidative damage to endothelial tissue, associated with hypercholesterolaemia and high triglycerides. Vitamin E can also reduce the insulin requirements of insulin dependant diabet­ics. Type 1 diabetics must start with 80mg of vitamin E a day and their insulin dosage must be monitored carefully. The insulin can systemati­cally be reduced as the vitamin E dose is increased to 320mg a day, the recommended maintenance dosage for type 2 diabetics.
• Vitamin C improves glucose tolerance and liver function. The transport of vitamin C into the cells is facilitated by insulin. Those with insulin resistance, therefore often don’t have enough intracellular vitamin C.
• Co-enzyme QI0 is important in the metabolism of oxygen and the production of the energy molecule ATP (adenosine triphosphate). It improves oxygen consumption at cellular level.
• Manganese is an essential mineral involved in various enzyme systems which control the metabolism of glucose and proteins, bone formation, synthesis of L-dopamine (a neu­rotransmitter), cholesterol and mucopolysaccharides. Marginal defi­ciencies are common because of soil depletion, which leads to reduced manganese in nuts and wholegrain products.
• Flavonoids such as quercetin, proanthocyanidin (from the extract of grape seeds or pine bark and Ginkgo bilobaare strongly recommended. These pre­vent damage from the free radicals caused by abnormal glucose/energy metabolism, reduce the damage to peripheral blood vessels, prevent loss of sight and protect all the organs (such as the brain) from increased blood sugar levels. Alpha-lipoic acid exerts antioxidative effects and improves insulin resistance and blood glucose levels.
• Magnesium can stimulate insulin activity. Low magnesium levels are common in insulin resistance, hypertension and hypercholesterolaemia.
• Pyridoxine (vitamin B6) can improve the peripheral damage to the extremities caused by poor blood circulation. Vitamin B6 also improves the oxygen supply to tissue and helps to prevent atherosclerosis. As well as other B-group vitamins: B3, 5, I2; folic acid, biotin, inositol
• Zinc and vanadium to improve insulin sensitivity and as co-factor of glucose tolerance factor
• Medicinal herbs to produce favourable changes in insulin sensitivity and blood glucose levels:
• Gymnema sylvestre
• Cinnamon
• Ginkgo biloba
• Blueberry (bilberry or Vaccium myrtillus)
• Milk thistle (silymarine)
• Fenugreek (Greek hay or Trigonellafoenum-graecum)
• Garlic & onions

Finally, and probably most important of all, the subconscious emotional and psycho-spiritual issues have to be addressed for a return to the original state of perfect health.

As James Hillman said in his book ‘A Blue Fire’:
‘The right reaction to a symptom may as well be a welcoming rather than laments and demands for remedies, for the symptom is the first herald of an awakening psyche which will not tolerate any more abuse. Through the symptom the psyche demands attention. Attention means attending to, tending, a certain tender care of, as well as waiting, pausing, listening. It takes a span of time and a tension of patience. Precisely what each symptom needs is time and tender care and attention. Just this same attitude is what the soul needs in order to be felt and heard.’

Summary extract from book Diabetes and Metabolic Syndrome by Dr Arien van der Merwe, to be published September 2015, and article by Dr Arien van der Merwe published in Natural Medicine Journal SA, June 2010.

Summary of article ‘Effects of omega-3 Fatty Acids on Lipids and Glycemic Control in Type II Diabetes and the Metabolic Syndrome’, published by a task team in Evidence Report/Technology Assessment, Number 89, March 2004.

Summary of article ‘Natural treatments for Metabolic Syndrome using nutriceuticals to thwart a deadly trend’ by CD Meletis et al, published in Alternative and Complementary Therapies Dec. 2003, pg 289-293.