The metabolic syndrome

Metabolic syndrome, which is also called Syndrome X, is becoming more and more prevalent in the western world.

It is estimated that one in five American adults already suffer from this syndrome and it is very plausible that more or less the same figures will apply in all population groups in South Africa who follow a western lifestyle.

What is the metabolic syndrome?

The metabolic syndrome is a cluster of important risk factors that include:

• raised blood fat levels - low-density lipoprotein cholesterol (LDL-C), which is also called 'bad cholesterol', triglycerides and other fat fractions;
• decreased high-density lipoprotein cholesterol (HDL-C), which is also referred to as 'good cholesterol';
• hypertension or high blood pressure;
• high glucose and insulin levels or insulin resistance;
• obesity which is defined as a BMI of 30 or more.

A patient is defined as suffering from the metabolic syndrome if he, or she, has three or more of the above-mentioned conditions.

Metabolic syndrome is also linked to conditions such as polycystic ovarian syndrome (PCOS)  , the menopause and advancing age.

American research

An American study conducted among more than 12 000 Americans aged 20 or older, of both sexes and different ethnic origins at Columbia University in New York, found the following in relation to the metabolic syndrome:

• nearly 23% of both the male and female subjects were classified as suffering from the metabolic syndrome;
• Hispanic and white men were more prone to the metabolic syndrome than black men;
• Hispanic women were more prone to developing the metabolic syndrome than white or black women;
• the incidence of metabolic syndrome increased with advancing age;
• additional risk factors for developing the metabolic syndrome included smoking, high refined carbohydrate intake and physical inactivity in men, as well as smoking, non-drinking, low household income and postmenopausal status in women;
• the predominant risk factors associated with the metabolic syndrome predispose adults to developing heart disease, stroke and type 2 diabetes;
• 'central adiposity' or abdominal fat increases the risk of metabolic syndrome, i.e. individuals with a typical 'beer boep' are more likely to develop this syndrome than individuals with other fat distributions (e.g. on the hips and breasts);
• the menopause is associated with a shift in body fat from the hips and breast to the abdominal area and an increase in metabolic syndrome.

How to counteract the metabolic syndrome

Research has shown that the most potent lifestyle change anyone can make to counteract the metabolic syndrome is to do more exercise. The next best thing to increasing physical activity is to lose weight.

Researchers have found that even a modest loss of 5% or more of body weight (e.g. an obese women weighing 70kg would only have to lose 3.5kg) will improve many of the risk factors associated with the metabolic syndrome.

Patients who have been diagnosed with the metabolic syndrome should, therefore, strive to do two things:

• Increase their physical activity by doing 30 minutes of exercise a day. The simplest way to achieve this, is to go for a brisk walk for half an hour every day of the week. Most people should be able to fit this type of exercise into their schedules and the beauty of such a solution is that one does not need complicated equipment or to pay expensive gym fees to get active. Other inexpensive options are to cycle or swim. However, if you are a person who needs encouragement to get active, then it may be an idea to join Walk for Life or a good gym so that the instructors can keep you motivated and monitor your progress. Always check with your medical doctor if you are allowed to do exercise and if walking is indicated. Don't start off with 10 km a day – ease into exercise slowly and listen to your body while you gradually increase the intensity and duration of your exercise.
   
• Lose five percent or more of their weight. There are many ways in which you can achieve weight loss, but the most sensible way is to consult a clinical dietician. You will need a diet that is low in total fat, saturated fat and cholesterol (to lower 'bad cholesterol') and high in foods with a low glycaemic index (GI). Such a diet is not easy to compile and you may find it difficult to apply - this is where the dietician will come in useful. He or she will firstly work out a diet that is tailored to your unique set of circumstances (e.g. obesity, raised blood glucose and insulin levels, high blood pressure and raised blood fats). Then the dietician will assist you with correct food choices and steer you through the problems you may encounter with purchasing the right foods and working out portion sizes and distribution of certain foods over the day (e.g. intake of carbohydrates with a low GI at each meal in combination with other foods that lower your blood glucose and insulin levels). Such a diet will also decrease your blood fat levels and help you to lose weight.

Your doctor may also prescribe certain medications (blood pressure pills, or statins to lower cholesterol, or diabetic medicines), which you would use in combination with exercise and diet.

If you have been diagnosed with metabolic syndrome there is no need to panic, follow your doctor's instructions, get active and consult a dietician. Once you have got into the habit of exercising on a daily basis, eating correctly and taking the correct medications, your symptoms will improve dramatically.