By Martha A. Simpson, D.O., M.B.A.
Associate Professor of Family Medicine
Ohio University College of Osteopathic Medicine

EXERCISE, WEIGHT LOSS, DIET -- BOTH TREAT AND PREVENT SYNDROME

Question: My doctor says that I might have metabolic syndrome and wants me to have a lot of tests. She says this can lead to diabetes. I am only 45 years old, but I am overweight and round in the middle. Can you tell me more about this syndrome and how I can get rid of it and how I caught it. Also, why is it important?

Answer: Metabolic syndrome is also called insulin resistance syndrome and syndrome X. By whatever name, it is a clustering together of a number of signs and symptoms that indicate an increased risk for coronary heart disease and type two diabetes. In addition, the person with metabolic syndrome has an increased risk of diseases related to plaque buildup in artery walls, such as stroke and peripheral vascular disease.

At least 47 million American adults have metabolic syndrome -- roughly 25 percent of the adult population. In addition, about 4 percent of teenagers have it.

According to the American Heart Association, there are no well-accepted criteria for diagnosing metabolic syndrome. However, among most of the sources that I checked, there appears to be a general consensus that if you have three or more of the following conditions, you have this syndrome:
• Central obesity -- waist circumference over 35 inches in women and 40 inches in men. This central obesity is due to excessive fat tissue in and around the abdomen.
• Hyperlipidemia -- Triglycerides, or blood fats, over 150 mg percent when measured after an overnight fast.
• Low HDL Cholesterol -- less than 40 mg/dl for men and 50 mg/dl for women of this so-called “good cholesterol.”
• Elevated Blood Pressure -- over 130/85 mmHg.
• Blood Sugar (glucose) over 110 mg percent, measured when fasting.

There are other criteria that not all sources agree are part of the syndrome. These are: proinflammatory state, as evidenced by high blood levels of C-reactive protein; prothrombotic state, indicated by high blood levels of fibrinogen; polycystic ovary syndrome, characterized by enlarged ovaries and fluid-filled cysts; and acanthosis nigricans, featuring patches of darkly pigmented skin.

Your physician is correct to ask for these initial lab tests. If she does diagnose you with metabolic syndrome, you can take positive steps to reduce your risk of heart disease and diabetes. The mainstay of treatment is weight loss through diet and exercise. Getting about 30 minutes of exercise daily is a minimum. If your blood glucose is elevated, your doctor may recommend medication to control your sugars as well as a diabetic diet. Elevated blood pressure may need to be controlled with medication, and excessive blood fats (lipids) may need to be controlled with diet and/or medication.

If it turns out that your only problem is weight, I can give you an additional word of encouragement. Starting a diet and exercise program under your doctor’s supervision may help you to actually fend off metabolic syndrome and its negative health consequences.

Family Medicine® is a weekly column. To submit questions, write to Martha A. Simpson, D.O., M.B.A., Ohio University College of Osteopathic Medicine, P.O. Box 110, Athens, Ohio 45701, or via e-mail to readerquestions@familymedicinenews.org. Medical information in this column is provided as an educational service only. It does not replace the judgment of your personal physician, who should be relied on to diagnose and recommend treatment for any medical conditions. Past columns are available online at www.familymedicinenews.org.