What’s Metabolic Syndrome? An Endocrinologist Answers

Metabolic syndrome, a group of factors associated with increased risk of heart disease and diabetes, used to be a term familiar only to endocrinologists, primary care doctors and cardiologists. Now, patients are hearing about the syndrome more and more. I talked to endocrinologist Jennifer Kirby, MD, to find out what it is and why we should know more about it.

A Collection of Factors

Heart disease depends on a number of factors, but metabolic syndrome refers to five measures that are commonly seen in patients who are likely to have a stroke, a heart attack or coronary artery disease. Doctors use these measures for diagnosis:

• Increased blood pressure: 130/85 or higher
• Elevated triglycerides: greater then 150 milligrams per deciliter of blood (mg/dL)
• Increased blood sugar: 100 mg/dL or higher
• Large waist circumference: at least 35 inches for women and 40 inches for men
• Reduced high-density lipoprotein cholesterol (“good cholesterol”)

Genetics also play a huge part in the development of both metabolic syndrome and heart disease. Your risk for heart disease increases if you exhibit several of the above measures and your family history includes:

• Heart disease
• Heart attack
• High blood pressure
• Overweight or obesity
• Type 2 diabetes

“You can’t control your genetics,” says Kirby. “But we can help you change the things that are modifiable.”

Are You at Risk for Metabolic Syndrome?

Make an appointment with your primary care doctor.

Diabetes and Metabolic Syndrome

Kirby usually first encounters her patients after a Type 2 diabetes diagnosis. “85 percent of patients with diabetes have metabolic syndrome,” says Kirby.

Patients can control or reduce their risk through weight loss, exercise, and behavioral modification. However, Kirby is careful to make the distinction between the popular conception of what successful weight loss looks like and the kind of progress she helps patients make to reduce their risk for heart disease.

“Your body will defend its weight,” she says, and she and other endocrinologists believe that the set point — the weight that your body can maintain with little effort — makes it difficult to lose weight and maintain weight loss. “We’re used to thinking that only dramatic weight loss impacts health,” says Kirby. “But a weight loss of 5-10 percent of body weight can have an impact in reducing metabolic syndrome factors.”

The same thing goes for exercise. Thirty minutes of brisk walking a day can make a dramatic improvement in her patients. “You can’t exercise your weight off, but exercise helps your body use insulin better,” she says.

Insulin Resistance

Insulin is the hormone that regulates blood sugar or glucose. When glucose levels rise, your body produces insulin to reduce glucose levels, but when you have insulin resistance, insulin doesn’t do its job effectively and the glucose levels remain high. Insulin resistance is linked to metabolic syndrome and both can be precursors to diabetes. “People with pre-diabetes have insulin resistance,” says Kirby.  Like metabolic syndrome, it’s often associated with high blood pressure, high LDL cholesterol and high triglycerides.

People with insulin resistance can show physical signs, such as skin tags and/or a darkening/thickening of the skin around the neck, which are due to high amounts of insulin in the blood. But, like metabolic syndrome, insulin resistance can be treated with lifestyle changes.

“Physical activity makes insulin work better,” Kirby says. “It’s key to making sure that insulin resistance doesn’t develop into diabetes and heart disease.”

Health Beyond the Scale

Kirby encourages her patients to lose weight, but she urges people to think about weight as a part of health, not as the only number that matters. “I have patients who do all the right things. They’ve changed their eating, they exercise, their triglycerides are down, their blood pressure is down, and their HDL is up, but their weight hasn’t changed,” she says. “This can make them discouraged even though they’ve substantially reduced their risk for heart disease.” Instead, Kirby wants patients to look at the whole picture.

The same goes for how we think about exercise. “It’s about movement — being active — as much as it is about formal exercise,” says Kirby. Things like getting up and walking around once an hour, taking the stairs, parking far away from the store entrance — these all factor into overall activity that improves health and reduces the indicators that she uses to measure heart disease risk. “If you have metabolic syndrome, focus on losing 5-10 percent of your body weight and getting adequate exercise and sleep!”

Kirby adds that most of us, even if we think of ourselves as active, get much less physical activity than we need. She points out that 86 million people in the United States are currently have pre-diabetes, most of whom don’t know it.