What is Syndrome X?

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Dear Dr. Mo: What is the Syndrome X? I have heard I may be having it – what to do if that’s so?

Dear reader: Syndrome X, more commonly known as the metabolic syndrome and also known as the insulin resistance syndrome is characterized by a clustering of several risk factors for cardiovascular disease and Type 2 diabetes.

This syndrome is among the very common ones in the modern times mostly due to our changed dietary and activity habits and yet, many people have never heard of it and many people (especially people over 50) have it – and, many live their lives without knowing it.

Metabolic syndrome is silent but dangerous

This syndrome presents a serious threat to health.

As I explained, it is a congregation of high-risk factors and if you have this syndrome, you have a much higher risk of a heart attack or stroke as well as of developing diabetes, liver and kidney disease.There’s also evidence that older adults with this syndrome could be more likely to have problems with their memory.

These risk factors most commonly include:

  • Excess intra-abdominal fat (belly fat – the apple shape). This excess is present if a waist size is 101.5 cm (40 inches) or more for men or 90 cm (35 inches) or more for women;
  • Insulin resistance (High fasting blood sugar measure);

And one or more of the following:

  • Elevated triglyceride levels in the blood;
  • Decreased levels of high-density lipoprotein (HDL – the “good” fat or good cholesterol)
  • High blood pressure (Hypertension)

So, you have a metabolic syndrome (the syndrome X) if you have three or more of the above-listed risk factors.

For your doctor to diagnose it, he or she will measure your waist circumference and blood pressure and will take your lipid profile and fasting plasma glucose (blood sugar) levels. In addition, your family history is also relevant – if anyone in your family has or had Type 2 diabetes.

If you are over 40 years of age, have a waist circumference greater than recommended (for race and sex), you should talk to your doctor about examinations to test for other risk factors, which could cause the metabolic syndrome.

Even if you and your doctor determine that you only have one or two of these factors but not all three or more, you are still not in the clear. You’re still at higher risk of heart attack and stroke than people without any of these risk factors so you should make an attempt at eliminating them.

There are many things you can do to prevent metabolic syndrome from occurring and to eliminate the risk factors that are causing it and this is good news.

Here is what you can do:

  • Aim for a healthy body weight – once you are there, make an effort to maintain it; weight loss of about 7% may be sufficient alone to reverse the syndrome! This is why achieving and maintaining a healthy weight is so important and cannot be overstated;
  • Start a healthy diet – It should be low in saturated and trans fats and low in salt (sodium); it should not contain processed foods such as sugary sodas, processed cheese, fast foods and white bread. It should be rich in omega-3 fats (i.e. go for salmon and similar fatty fish and olive and canola oils), in whole grains and fiber, and of course in vegetables and fruit;
  • Get regular exercise – at least 150 minutes per week (or minimum 30 minutes a day/5 days a week);
  • Drink only moderate amounts of alcohol (one drink per day for women, one to two for men) – or avoid it completely;
  • Don’t smoke – even if you have no risk factors for metabolic syndrome – smoking is still very bad for your health.

In addition to these lifestyle changes, there are some medications to assist in managing the syndrome and possibly reverting. Each feature of the syndrome should be managed to achieve recommended targets and available treatments are very effective:

Talk to your doctor about whether or not you require medicines to lower your blood pressure or triglycerides if these are high, and to raise the HDL if it is low (especially if all these parameters are not improved just by exercising and diet changes).

Talk to your doctor about whether or not you need medicines to lower your blood sugar – at the moment of diagnosis, you may already have developed Type 2 diabetes or if not, you may have “pre-diabetes”. In pre-diabetes, blood sugar is elevated but still not at diabetic levels.
An insulin sensitizer such as Metformin may be useful in this case.

Conclusion

Remember that metabolic syndrome is a condition that doesn’t necessarily cause (any) symptoms for a lengthy amount of time but still puts your health at high risk.
This is especially important to remember if you have other risk factors for heart disease – if you smoke,  or have a history of heart disease in your family.

Best is to be mindful of your health by maintaining a healthy diet and a regular exercise plan – with this alone you may be successful in eliminating this syndrome without any medicines.

Yours in health,

Dr. Mo