Metabolic Syndrome or Syndrome X

The term metabolic syndrome has been thrown about for some time. Other names associated with the syndrome are insulin resistance syndrome, syndrome x, or the deadly quartet. The syndrome relates to 4 risk factors that put a person at greater risk of developing type 2 diabetes and CVD. The term "syndrome" usually refers to a type of disease process. It is in question whether this syndrome is indeed a disease. So more research will need to be done to answer this. Doctors generally should refrain from actually diagnosing an individual with the syndrome until it is clear that it is a disease process rather than a collection of risk factors beyond it's individual components. The elements that I am eluding to are abdominal obesity, high blood sugar (hyperglycemia), abnormal cholesterol (dyslipidemia) and hypertension.

Obesity or more specific abdominal obesity refers to fat around the midriff and greater than 42 inches in circumference. The extra fat promotes the body to resist the effects of insulin and the ability of the body to use fats. Which leads to type 2 diabetes. This resistance of insulin may lead to inflammation of veins and arteries, lining of the arteries and veins will start to break down and develop high blood pressure. The events may lead an individual to develop CVD.

In the Framingham heart study, a study following a group of people and their families since the 1950's, showed that obese people with the syndrome had a 10 fold risk of developing diabetes and a 2 fold increase in developing CVD as compared to obese people without the syndrome. Normal weight individuals with the syndrome had a 4 fold increase for developing diabetes and a 3 fold increase for developing CVD as compared to their normal counterparts with out the syndrome.

The metabolic syndrome has also been associated with the following disorders/diseases:

Fatty liver with fibrosis,cirrhosis
Liver cancer
Chronic kidney disease
Polycystic ovary syndrome (multiple benign cysts on the ovaries) benign meaning noncancerous.
Obstructive sleep apnea
Gout

Therapy

There are 2 ways to treat metabolic syndrome
1. Treat underlying causes by intensifying weight management and increasing physical activity
2. Treat CVD risk factors with lifestyle modifications Change the diet

Studies have shown that the Mediterranean diet (high in nuts, fruits, vegetables, whole grains and olive oil) have had greater weight loss, lower blood pressure, improved cholesterol, improved insulin resistance and lower levels of vein and artery inflammation. Choose foods with a low glycemic index (whole grains, fruits and vegetables) and eliminating high sugar drinks may be particular beneficial with people with the syndrome. The diet solution targets the glycemic index and shows how to lose weight just by making different food choices.

The American diabetes association and European association for the study of diabetes published a joint statement raising arguments that the syndrome:

1. Lacks clarity of definition

2. Multiple different ways to treat metabolic syndrome for different people, for example, a person with a large waist circumference, high blood fat and high fasting blood sugar would need to be managed differently than someone with high blood pressure, low HDL cholesterol and high blood fat

3. Lack of consistent evidence base for various components in the definitions

4. Having patients already with CVD and diabetes may skew the results and cause bias.

5. Having an unclear path of the disease process in that some people have some elements while others have another set, but not everyone has all the same pieces 6. Other risk factors for CVD that are not apart of the syndrome such as inflammatory markers may have equal or greater value in evaluating risk.

It is up for debate whether this syndrome is actually a disease. What is clear, is taking into consideration each individual element, by lowering each element individually by lifestyle modification and medication regime, the person can effectively reduce their risk of developing CVD. It is advisable to consult your doctor before making any major changes and have a frank discussion about the syndrome.

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