Silent Syndrome Raises The Risk Of Diabetes, Heart Disease, Maybe Cancer

Here’s a pop quiz: What’s it called when your bloodsugar is slightly elevated, your HDL’s (high-density lipoproteins, the”good” cholesterol) are kind of low and your blood pressure edges up?Diabetes? Atherosclerosis? Hypertension? None of the above.

When these otherwise unremarkable changes occur together,you have what doctors now call “metabolic syndrome” (also”insulin resistance syndrome” or more sinisterly “SyndromeX”). If you?re not familiar with it, chances are you soon will be.

A recent national health survey found that more than onein five Americans have it, putting them at increased risk of diabetes, heartdisease and stroke?maybe even cancer. The incidence increases with age,affecting more than 40% of people in their 60’s and 70’s.

Are You a Silent Sufferer?

You have metabolic syndrome if you have three ormore of the following:

  • Waist measurement of at least 40 inches (men) or at least 35 inches (women).
  • Fasting blood sugar > 110.
  • Triglyceride level > 150.
  • HDL < 40 (men) or < 50 (women).
  • Blood pressure > 135/80.
> = equal to or greater than; < = less than

Source: Third Report of the National Cholesterol EducationProgram Expert Panel, NIH, 2001.

Most people affected are unaware of this ticking timebomb. Recognition of the disorder is so new, even doctors may fail to realizethat when certain small changes in simple health measures occur in concert, thewhole is greater than the sum of the parts, and that it bodes ill for futurehealth if not dealt with now.

Making Sense of Metabolic Syndrome.While the diagnosis of metabolic syndrome may not always be obvious, there arewarning signs. It typically starts with weight gain, especially around themiddle (and especially among men) and inactivity, both common forerunners to”insulin resistance.” This often triggers a cascade of ominous eventsthat leads to metabolic syndrome.

Insulin is the hormone the body depends on to take sugarout of the bloodstream and into cells. But in overweight people, the cells oftenbecome inured to recognizing insulin, preventing the hormone from doing its job.That results in high blood sugar and high insulin levels, as thebody keeps trying to bring the rising blood sugar under control by pumping outever-increasing amounts of insulin. Excessive insulin in the blood can elevateblood pressure to the high end of normal and increase blood levels oftriglycerides and small, dense LDL’s (low-density lipoproteins, the”bad” cholesterol), as well as cause a slight drop in HDL’s. Puttogether, the changes spell metabolic syndrome.

Triple Health Threat.Metabolic syndrome is important to recognize because it puts you at higher riskfor several chronic diseases. The most obvious is type 2 diabetes. Metabolicsyndrome commonly precedes the onset of diabetes by several years, with aboutone-third to one-half of those with the syndrome eventually developing thedisease. Many people diagnosed with “pre-diabetes” (insulinresistance) may well have metabolic syndrome.

An even more immediate risk, however, is heart disease andstroke. Metabolic syndrome can lead to cardiovascular changes even before youget diabetes, because of changes in blood lipids (LDL’s and HDL’s) and bloodpressure, even if your total cholesterol level is normal, says Scott Grundy,M.D., Ph.D., director of the Center for Human Nutrition at the University ofTexas Southwestern Medical School in Dallas.

Finally, a possible long-term risk of allowing high levelsof insulin to course through your veins is cancer. Though it’s far from proventhat metabolic syndrome actually causes cancer, several population studies havefound a link between high insulin levels and cancers of the pancreas, breast andcolon.

Weight Loss is Key. Thesingle most effective way to fight insulin resistance’the apparent firstdomino in the cascade of events leading to metabolic syndrome?is to loseweight. Losing just a few pounds has been shown to restore the body’s abilityto recognize insulin.

Diet advice varies, but according to Gerald Reaven, M.D.,professor of medicine emeritus at Stanford University and the researcher whocoined the phrase “Syndrome X,” a diet slightly lower in carbohydratesthan what’s typically recommended works best. He recommends just 45% carbs(instead of 50% to 60%) and as much as 45% fat, arguing that although a high-carbdiet may be fine for other people, it could put those with metabolic syndrome atrisk for elevated insulin and triglyceride levels. Not everyone agrees.

Robert Eckel, M.D., of the University of Colorado HealthSciences Center in Denver and chair of the Council on Nutrition and PhysicalActivity and Metabolism for the American Heart Association, worries that ahigh-fat intake inevitably leads to a high-calorie intake?ergo, weight gain.The best solution, he says, is to keep carbs at about 50% of calories, buteliminate refined carbs and reduce fat intake to cut calories and lose weight.

“Simply losing weight and increasing activity willimprove metabolic syndrome risk,” says Eckel. Even increased activitywithout weight loss will improve insulin sensitivity, he admits, but quicklyadds, “Weight loss is a very important part of the equation.”

Other Dietary Solutions. Arecent study from Harvard Medical School found that a high intake of dairyproducts (about three servings a day) reduced the incidence of metabolicsyndrome by almost 70% in more than 3,000 young men and women. A high-fiber dietwas also protective.

According to Mark A. Pereira, Ph.D., a Harvardepidemiologist and one of the researchers, people who were overweight and hadthe lowest intakes of dairy and fiber were seven times more likely to developmetabolic syndrome over 10 years than those whose diets were high in fiber anddairy.

EN‘s Bottom Line.Whatever you call it, this collection of slightly askew, but seemingly benign,blood levels can actually be a harbinger of two of the nation’s biggestkillers, heart disease and diabetes?and maybe even a third, cancer.

What should you do? Measure your waist (don’t cheat?putthe tape measure across your belly), get a physical and have your doctor checkyour fasting blood glucose, HDL’s, triglycerides and blood pressure. If youhave three of the five markers for metabolic syndrome (see “Are You aSilent Sufferer?”), take action to reduce your risk. First andforemost, lose weight and get active. And follow the tips in “How to ReduceYour Risk,” above.

How to Reduce Your Risk

Proven Risk Reducers:

  • Lose weight.If you?ve got metabolic syndrome, chances are you?re overweight.
  • Exercise.Physical activity alone can improve insulin levels.
  • Don’toverindulge on carbs. Eat a diet with 45% to 50%carbohydrates, mostly as whole, unrefined foods.
  • Allow yourselfmore fat. Include as much as 30% to 45% of caloriesfrom fat, but stick to healthy fats, such as those in canola oil, olive oil,flaxseed oil and nuts.
  • Limit alcohol.No more than one drink a day for women, two for men.
  • Check your Rx.Ask your doctor or pharmacist if your blood pressure medication could aggravateinsulin resistance (e.g. diuretics, beta blockers) or improve it (e.g.angiotensin receptor blockers).

It Couldn’t Hurt:

  • Get plenty oflow-fat dairy products. Aim for three servings a day.Your bones will benefit too.
  • Eat high-fiberfoods. Aim for 20 to 35 grams of fiber a day.
  • Get plenty ofsleep. Aim for at least eight hours a night. A studyfrom the University of Chicago reports that not getting enough shut-eye candecrease insulin sensitivity by as much as 40%.

?D.W.

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