The Most Serious And Most Common Condition You Have Never Heard Of
By Dr. Barry Ramo, MD, FACC - Director New Heart Fitness and HealthMG is a 56-year-old Hispanic woman referred to the New Heart New You program at New Heart for weight management and heart disease prevention. She complains of severe fatigue and somnolence leading to dangerous episodes of spontaneously falling asleep i.e., at stop lights and while driving. She has a 10-year history of hypertension treated with medication. She had no cardiac history. She was obese with a BMI of 34 (Ideal 18-25). Her waist was 37 inches. A lipid profile showed high triglycerides and low HDL. A sleep study showed obstructive sleep apnea.
MG has constellation of findings defining the metabolic syndrome. At least 33% of Americans have findings consistent with this diagnosis. The major features are:
Abdominal obesity, defined as a waist circumference of >40 inches in men and 35 inches in women. This is the obesity due to huge deposits of fat around the abdominal organs differing from obesity from large hips. This obesity is malignant causing an increase in total body inflammation.
Fasting plasma glucose greater than or equal to 100mg/dL or drug treatment for elevated blood glucose. A HgA1c greater than 5.7-6.4 is called prediabetes. Obesity is present in 90% of individuals with these blood sugar findings. Weight loss can correct them.
Serum triglycerides greater than or equal to 150 mg/dL or drug treatment for elevated triglycerides.
Serum HDL cholesterol less than 40 mg/dL in men and less than 50 mg/dL in women or drug treatment for low HDL-C.
Blood pressure greater than or equal to 130/85 mmHg or drug treatment for elevated blood pressure.
Other common findings are commonly associated with the syndrome. These include evidence of increased inflammation in the body measured by the high sensitivity CRP. Obstructive sleep apnea that MG has is a common finding in people with the syndrome.
The abdominal obesity often referred to as an apple shape causes chronic inflammation. Inflammation is emerging as a major driving force for atherosclerosis and cancer. Most important, the obesity causes insulin resistance so that the body does not lower blood sugar in response to the insulin it produces. This elevates fasting blood sugar and predisposes to the diagnosis of type 2 diabetes.
The unique characteristics of the metabolic syndrome are increased triglycerides and low HDL or good cholesterol. When you go to get a lipid profile, you get total cholesterol, LDL cholesterol (low density lipoprotein), HDL cholesterol and triglycerides. The obesity leads to elevation of triglycerides and lowering of HDL cholesterol. The preferred treatment for this profile is a change in lifestyle. The triglycerides are reduced by diets low in rapidly absorbed starches, sugary drinks and baked goods. Weight loss is the most important way to correct these numbers as well as improving the blood glucose.
The management of the metabolic syndrome should be directed to each of the features. Overall, lifestyle changes will be the most effective in producing long range benefits. These include:
Weight loss in overweight or obese subjects.
Increased physical activity.
Modification of an atherogenic diet.
For MG, we focused on weight loss. The best diet is one you can follow long term. The keto, Adkins, and other high fat low carbohydrate diets will cause prompt weight loss, but the diets are inherently unhealthy. the diets are high in saturated fat predominantly from red meat and dairy. These diets re pro inflammatory and cause elevation in LDL cholesterol.
The scientific studies have shown, and I have found that the Mediterranean or Dash diets are the most effective way to manage weight. As a general rule a 10% drop in weight will bring the blood sugar into the normal range and reduce insulin resistance. In a previous column, I have outlined the components of the Mediterranean diets (November News). The Mediterranean diet is more than a diet, it is a lifestyle.
Studies comparing the Mediterranean diet to a low fat and prudent diet. The Mediterranean diet (high in fruits, vegetables, nuts, whole grains, and olive oil) resulted in greater weight loss, lower blood pressure, and improved lipid profile. Markers of inflammation that are elevated in the metabolic syndrome were reduced with this anti-inflammatory diet compared to the prudent low-fat diet. Importantly, insulin resistance was lowered with this diet.
Exercise plays an important role in reversing the elements of metabolic syndrome. the elements of the syndrome are favorably affected by regular exercise. the current recommendations that I have outlined in previous columns are 150 minutes/week of aerobic exercise and at least 20 minutes twice a week with resistance training.
The lipid abnormalities of the metabolic syndrome are high triglycerides and low HDL cholesterol. Although there is a strong correlation between heart disease risk and triglyceride levels, proof of a cause and effect has not been established. A class of drugs called fibrates and high dose of the vitamin niacin reduce triglycerides but did not reduce heart attack risk. A recent study of a synthesized fish oil reduced triglycerides and was associated with a reduced heart disease risk. This was surprising as previous studies with fish oil reduced triglyceride levels but had no impact on heart disease risk.
Now you have heard about an epidemic that is silent but long term deadly. So, do the looking at your feet test, and if you can’t see them, you may have the metabolic syndrome.