Metabolic syndrome is a collection of risk factors that increase a person’s chance of developing heart disease, stroke, and diabetes.
The condition is also known by other names, including syndrome X, insulin resistance syndrome, hypertriglyceridemic waist, obesity syndrome, and dysmetabolic syndrome. According to a national health survey, nearly 1 in 4 Americans is experiencing this condition.1 The prevalence of metabolic syndrome increases with age, affecting more than 40 percent of people who are over 60 years of age.
According to the new International Diabetes Federation (IDF) definition, for a person to be diagnosed as having metabolic syndrome, the following clinical criteria must be met:
Central obesity (a primary factor defined as waist circumference with ethnicity-specific values in the U.S. as greater than 35 inches for women and greater than 40 inches for men), including any two of the following four secondary factors:
- Elevated blood pressure (>130/85 mg/dL)
- Increased fasting blood sugar (>100 mg/dL)
- Increased triglycerides (>150 mg/dL)
- Decreased HDL cholesterol (<50 mg/dL women, <40 mg/dL men)
Metabolic syndrome can lead to harmful changes to the body, such as:
- Damage to the lining of coronary and other arteries. This is a key step toward the development of heart disease or stroke;
- Changes in the kidneys’ ability to remove salt, leading to high blood pressure, heart disease, and stroke;
- Increase in triglyceride levels resulting in an increased risk of developing cardiovascular disease;
- Increased risk of blood clot formation, which can block arteries and cause heart attack and stroke;
- Slowing of insulin production, which can signal the start of type 2 diabetes, a disease associated with an increased risk for a heart attack or stroke.
Uncontrolled diabetes is also associated with complications of the eyes, nerves, and kidneys.
Approaching metabolic syndrome
There are three key ways to help treat metabolic syndrome:
- Achieve weight loss
- Treat comorbidities (hypertension, hyperlipidemia, overt diabetes)
- Administer pharmaceutical prophylaxis
As a chiropractor, your first focus should be on weight loss. Weight loss includes dietary habits, physical activity, and an often-overlooked aspect: the gut microbiota. As with any approach, you will only be successful if the patient is compliant with your treatment plan. The formula for success involves the right person, prescription, and time.
Education is the first step in helping patients to understand the overall disease and the increased risk for other diseases and morbidities. Engaging patients as active participants in their care greatly improves the potential of reversing metabolic syndrome and achieving a healthier, happier life.
Instructing patients on dietary changes should include reducing their consumption of the following: sucrose, fructose, processed foods, refined carbohydrates (such white-flour breads and pasta), fast foods, saturated animal fats, overcooked foods, food or drink in plastic containers, large meals, eggs, and fruit juices.
On the other hand, foods to increase in the daily diet include: extra-virgin olive oil, cinnamon, green tea, mixed nuts (unsalted), omega-3 fat sources and supplements, and fiber sources such as whole grains and legumes.
As a clinician you know physical activity is a vital component of weight loss. Edward Stanley, the Earl of Derby, once said, “Those who think they have not time for bodily exercise will sooner or later have to find time for illness.”
High intensity interval training (HIIT) has gained a lot of interest over the last few years for several reasons: Exercising in multiple short bouts per day improves adherence to exercise.2 HIIT training increases both aerobic and anaerobic capacity, and it induces a more pronounced reduction in subcutaneous adiposity compared to endurance training.3,4 A simple way to start HIIT is to use a seven-minute workout available online or through videos.
Exercise appears to improve both hepatic triglyceride content and visceral adipose triglyceride stores, independent of the changes wrought by weight loss or effect on insulin levels or sensitivity. Therefore, encourage patients to continue exercising regularly, even if they are not losing weight.5,6
But do nutrient-gut-microbiota inter- actions play a role in human obesity, insulin resistance, and type 2 diabetes?
The current obesity and type 2 diabetes pandemics have multiple causes beyond changes in eating and exercise habits as well as a susceptible genetic background. Gut bacteria seem to contribute to observed differences in body weight, fat distribution, insulin sensitivity, and glucose and lipid metabolism. Data mostly derived from preclinical studies suggest gut microbiota play an important role in conditions such as obesity, diabetes, metabolic syndrome, and non- alcoholic fatty liver disease.7
Martin J. Blaser, MD, said, “It is reasonable to propose that the composition of the microbiome and its activities are involved in most, if not all, of the biological processes that constitute human health and disease.”8
Rebalancing the gut microbiome can be accomplished by eating prebiotics, fermented foods, specific carbohydrates, and soluble fiber. Supplementing probiotics should also be considered with dosages varying from 1 billion CFUs to the trillions.
Metformin is a common prescription for elevated glucose. Like many prescrip- tions, metformin does have side effects including vitamin B12 deficiency. A recent study even concluded that metformin treatment is significantly associated with vitamin B12 deficiency and reduced serum B12 levels.9
There are multiple supplements that can be used instead to treat metabolic syndrome, one of which is N- acetylcysteine (NAC). NAC has been found to improve lipid profiles and fasting blood sugars as well as fasting blood insulin better then metformin.10 In one study, for example, following 24 weeks of treatment, participants in the NAC group demonstrated a greater reduction in BMI, fasting blood sugar, fasting insulin, and low-density lipoprotein.
Overall, patient engagement and education is the first step in managing metabolic syndrome, followed by dietary changes, exercise, and supplementation. If signs and symptoms are not addressed adequately with lifestyle changes, co- management with a medical provider is warranted.
Wayne H. Carr, DC, CCSP, DCARB, guides chiropractors through wellbeing care models for patient conditions. In practice since 1980, Carr has professionally excelled in human performance and functional medicine through the Institute for Functional Medicine. He is a graduate of the National College of Chiropractic, holds a diplomate in chiropractic rehabilitation, and is certified as a chiropractic sports physician. He can be contacted through bestpracticesacademy.com.
1 Ford ES, Giles WH, Dietz WH. Prevalence of the metabolic syndrome among US adults: findings from the Third National Health and Nutrition Examination Survey. JAMA. 2002;287:356-359.
2 Jakicic JM, Wing RR. Prescribing exercise in multiple short bouts versus one continuous bout: effects on adherence cardiorespiratory fitness and weight loss in overweight women. Int J Obes Metab Disord. 1995;19(12):893-901.
3 Tabata I, Nishimura K. Effects of moderate- intensity endurance and high-intensity intermittent training on anaerobic capacity and VO2max. Med Sci Sports Exerc. 1996;28(10):1327-30.
4 Tremblay A, Simoneau JA. Impact of exercise intensity on body fatness and skeletal muscle metabolism. Metabolism. 1994;43(7):814-8.
5 Johnson NA. Aerobic exercise training reduces hepatic and visceral lipids in obese individuals without weight loss. Hepatology. 2009;50:1105- 12.
6 Sreenivasa, BC. Effect of exercise and dietary modification on serum aminotransferase levels in patients with nonalcoholic steatohepatitis. J Gastro Hep. 2006;21:191-8.
7 Diamant, et al. Do nutrient-gut-microbiota interactions play a role in human obesity, insulin resistance and type 2 diabetes? Obes Rev. 2011;12(4):272-81.
8 Blaser M. The microbiome revolution. J Clin Invest. 2014;124(10):4162-4165.
9 Niafar M, Hai F. The role of metaformin on vitamin B12 deficiency. Intern Emerg Med. 2015;10(1):93-102.
10 Maged AM, et al. The adjuvant effect of metformin and N-acetylcysteine to clomiphene citrate in induction of ovulation in patients with Polycystic Ovary Syndrome. Gynecol Endocrinol. 2015;10:1-5.