What is Metabolic Syndrome and why should you care?
If you have been paying some attention to the news on COVID in the past couple of years, you would have heard that the risk of becoming severely unwell or dying is closely associated with being obese, having high blood pressure, diabetes and heart disease; all the hallmarks of poor metabolic health. Unfortunately, the past 3 years of COVID isolation and lockdowns have done nothing to improve the metabolic health of most of the population in Australia and likely other parts of the western world. In general, people stayed inside more, exercised less, ate more processed food and drank more alcohol. All this has been compounded by the stress people have been under either due to job losses, the daily barrage of COVID related information or just spending too much time with family in lockdown! Even if COVID wasn’t around, the state of our metabolic health is still a huge concern. But what exactly is poor metabolic health and what is metabolic syndrome?
Our metabolism is our bodies ability to take the food that we eat/drink and efficiently digest and process it for energy production and storage, maintenance of necessary bodily functions and repair and defence mechanisms. When our metabolic health is poor we have troubles with these vital systems and this can start to show up with issues such as weight gain, elevated blood pressure, visceral fat, poor blood cholesterol/lipid levels and elevated blood sugars. These issues start gradually but over many years they can lead to heart attacks, strokes, diabetes, cancers, dementia, liver and kidney failure.
A recent study in the US showed that only 12% of Americans were metabolically healthy…12%! And for those over 60 that number was 2.1%! Don’t think that in Australia we are going to have much better figures. US data shows that 72% of the population is overweight of which 58% are obese! In Australia 67% are overweight of which 46% are obese, so we’re not that far behind. Sobering numbers….
Unfortunately metabolic ill health also affects people of normal weight, so just because you’re thinner doesn’t necessarily mean you’re not in danger… these thin metabolically unwell people are what we refer to as TOFI (Thin Outside, Fat Inside) or “skinny fat” and this is a large proportion of the population, particularly if you are of Asian or Indian/Sri Lankan background. Worryingly, children are now also being diagnosed with Metabolic Syndrome, setting them up for a lifetime of chronic medical issues, suffering and poor quality of life. To date the youngest child to be diagnosed with Type 2 Diabetes (the one associated with Metabolic Syndrome) is age 3!
So how do you know if you have metabolic ill health or what we call Metabolic Syndrome? There are slightly different variations on the criteria but this is a good start:
Waist circumference (Not your belt/hip measurement but the most protruding part of your stomach) in: men > 94cm or (>90cm for Asian and South American men) women > 80cm.
2. Blood pressure greater than 130 systolic and 85 diastolic
3. Reduced HDL cholesterol <1.0 in men and <1.3 women
4. Elevated Triglycerides greater than 1.7
5. Elevated fasting glucose >5.6 or a diagnosis of Type 2 Diabetes
In my opinion, the waist circumference numbers are very generous and don’t take into account a persons height, so a better way of calculating your risk, used by some agencies, is that if your waist in cm is more than about half your height you’re at risk. For example, if your height is 170 cm your waist should be no more than 85cm. You need three out of the five criteria for a diagnosis of Metabolic Syndrome but even one or two are signs of poor metabolic health and are something to be alarmed about. I wouldn’t wait to collect three before acting!
Apart from the waist measurement that you can do at home, the rest of the criteria require you to see a doctor for a blood pressure check and blood tests. But while you're testing for the ones listed above you should also get the following tested as well - fasting insulin and liver function - to see if you are on the road to developing Metabolic Syndrome as it can be picked up 10-15 years before people get diagnosed with it. That's correct… 10-15 years before…. now that’s called prevention! Picking it up earlier means you can reverse the likelihood of developing these illnesses and their complications… wouldn’t that be great? But unfortunately, and THIS IS THE IMPORTANT PART, many doctors do not do these earlier detection tests and if they do, they don’t know what to do with the results and how to advise you.
The condition that links all these criteria together is likely to be a high fasting insulin level. We all make insulin but some people make much more than others. I will get into insulin in more detail in the next post but an elevated insulin level at any age increases the risk of Metabolic Syndrome and the development of Type 2 Diabetes. So get a fasting insulin level done and while you’re at it get your doctor to check your liver function tests as well. Why? It's being discovered that non-alcoholic fatty liver disease (more on this later) is probably the underlying cause of high insulin levels which as I mentioned earlier is directly related to developing Metabolic Syndrome. So the effect of all this testing is to try to see if you're at risk of developing it years before you get it. Why? Because with some simple changes to your diet all of these conditions can be prevented and reversed in many cases.
So, in summary, Metabolic Syndrome is bad and can be diagnosed with blood tests and a visit to your doctor. It can be prevented if you know you’re at risk by checking early and given that we know so many people are likely to have it, we should be checking for it… even if you are thin. The good news is that many recent studies are showing that some or all this can be reversed and in some cases significant changes can occur in as little as a few weeks.
Ask your doctor to arrange the following tests for you:
Lipids/Cholesterol panel
Liver function tests
Kidney function
Fasting insulin
Fasting glucose
HbA1C: your average blood sugar level over the past 3 months
Inflammatory markers: hsCRP, Ferritin (I’ll go into why later)
Thyroid hormone
Vit D
In upcoming posts I’ll be talking more about why high insulin levels are so bad and what to look for on your blood tests even if your doctor doesn’t.
