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Metabolic Syndrome

July 2006

By Steven V. Joyal, MD

A Program for Averting Metabolic Syndrome

The following step-by-step program can help you avert the potentially deadly consequences of metabolic syndrome. Taking these simple steps can help you lead a long, healthy life and avoid succumbing to a multitude of life-threatening diseases.

Step 1: Assess Your Body Composition.

The first step involves knowing and understanding your body composition and its importance in helping to prevent metabolic syndrome. Surprisingly, stepping on a scale and seeing what you weigh does not tell very much about your risk of developing metabolic disease.

Body mass index (BMI) is a standard measure of overweight and obesity. BMI is obtained by dividing your body weight in kilograms by your height in meters squared (kg/m2). However, BMI fails to account for body composition. Your body composition is a measure of how much lean body mass (muscle) and adipose tissue (body fat) you have.

Compare two 40-year-old men, both of whom stand six feet tall and weigh 200 pounds. One man is very muscular (about 7% body fat) and has a waist circumference of 32 inches. By contrast, the other man is out of shape (about 30% body fat) and has a waist circumference of 40 inches. The key point is, both men have the same BMI.

Does this mean that both men have the same risk of developing insulin resistance and metabolic syndrome? No!


To determine whether you have metabolic syndrome, ask your doctor to measure your waist circumference, blood pressure, fasting glucose, serum triglycerides, and HDL. By Adult Treatment Panel III criteria, you have metabolic syndrome if you have three or more of the following criteria:

  • Central obesity as measured by waist circumference: Men: > 40 inches. Women: > 35 inches.
  • Fasting blood triglycerides: > 150 mg/dL.
  • Blood HDL: Men: < 40 mg/dL. Women: < 50 mg/dL.
  • Blood pressure: > or = 130/85 mmHg.
  • Fasting glucose: > or = 100 mg/dL.

The man who has poor body composition (low level of lean body mass, high level of fat mass) and carries his body fat around his waist (central obesity) is at risk of developing insulin resistance and metabolic syndrome. The physically fit man with a low amount of body fat and a slim waist is at very, very low risk of insulin resistance and metabolic syndrome.

Unfortunately, many individuals pay more attention to body weight than to body composition. Scientists, however, know better.

The easiest surrogate assessment of body composition is central obesity, and the easiest way to determine central obesity is to measure waist circumference—if you have a big waist, your risk of metabolic disease is increased.

Step 2: Maintain Good Body Composition.

How do you obtain and maintain good body composition? Maintaining lean body mass and decreasing body fat is easier than you think.

First, do not fall for the latest fad diet. Maintaining a stable body weight is not magic. Ignore any diet “guru” who promises “magical” weight loss, vilifies “forbidden foods,” and promotes excluding certain food “types” based on the latest round of misunderstood and misinterpreted science. Do not buy into it!

Instead, simply eat more whole foods and fewer processed foods. Prioritize eating high-quality foods like salmon, vegetables, wild rice, berries, and citrus fruits. De-emphasize eating foods that are highly processed or of low nutritional value, such as cakes, cookies, bagels, fried chicken, and American cheese. In fact, studies show that diets that emphasize whole foods, such as the Mediterranean diet, help maintain lean body mass while also improving metabolic markers like insulin, cholesterol, fibrinogen, and uric acid.7 Other studies of people eating Mediterranean-type diets show a strong reduction in cholesterol levels, increased psychological and physical well-being, and a trend towards weight loss even without trying to diet.8

A great-tasting, healthy diet is abundant in whole foods, much like the traditional diets of Africa, Asia, and the Mediterranean. This style of eating is rich in whole grains, whole fruits, and green vegetables, incorporates low to modest amounts of protein, and is high in “good fats” from sources such as sesame seeds, walnuts, almonds, and olives. Moderate amounts of high-fiber carbohydrates and “good fats” predominate in traditional diets of the Mediterranean, Asia, and Africa.

Randomized clinical trials have shown that this type of diet may be best for people at risk for metabolic disease. For example, a trial in patients with type II diabetes mellitus showed better blood sugar control and cholesterol levels in people consuming a diet comprising 40% carbohydrates, 45% fat, and 15% protein compared to those who consumed a diet consisting of 55% carbohydrates, 30% fat, and 15% protein.9

In other studies, a diet moderate in carbohydrates and relatively high in monounsaturated fat from olive oil and polyunsaturated fat from fish—such as the Mediterranean diet—actually decreased insulin resistance and inflammation.10 Furthermore, this diet is better than the step I National Cholesterol Education Program (NCEP) diet in preventing heart disease and stroke.11

Second, if you are not physically active, start moving your body! Simply walking at a brisk pace three to five days each week for at least 20 minutes will help. If and when you get more ambitious, you can engage in more demanding physical activities at a higher level of exertion. In addition, consider weight training to build more muscle mass and to stimulate your metabolism.

Step 3: Improve Metabolic Function with Nutritional Supplements.

Smart supplementation can have a significant impact on metabolic health. A number of nutritional supplements hold great promise for normalizing blood sugar and metabolic control.

Chromium. Chromium is a critically essential cofactor for glucose control. Chromium helps insulin shuttle blood sugar (glucose) into cells. In fact, without chromium, insulin cannot work properly.

Unfortunately, most Americans are deficient in this critical nutrient. Some experts believe that Americans ingest less than half the recom-mended daily amount of chromium.12 This may be partly due to the nation’s over-reliance on processed foods, which are generally rich in calories but poor in nutrients.

Another factor contributing to widespread chromium deficiency is food grown in soil containing a low content of minerals such as chromium. In fact, the 1992 Earth Summit report showed that North American soils have been depleted of 85% of their mineral content in the past 100 years—the highest rate of mineral depletion in the world.13 Thus, it should come as no surprise that the foods we consume are deficient in trace minerals such as chromium. Some scientists have postulated that rising rates of metabolic syndrome and diabetes in the US may result in part from declining levels of chromium in American soil and diets.

Many clinical studies of patients with and without metabolic disease have shown metabolic benefits—including improved blood sugar control, cholesterol, and insulin—with supplemental chromium doses from 200 to 1000 mcg daily.14-17

Recently, a bioavailable and biologically safe form of chromium called chromium 454™ has attracted the attention of nutritional scientists seeking ways to promote metabolic health. Derived from plant and biological extracts, this distinct form of chromium is water soluble, allowing for outstanding absorption. Insulin-deficient diabetic rats that received chromium 454™ for three weeks demonstrated an impressive 38% reduction in blood glucose levels. These findings led scientists to suggest that chromium may provide metabolic support for individuals seeking to optimize their blood glucose levels.18

DHEA. In both middle-aged and older men and women, suboptimal hormone profiles are not unusual. Dehydroepiandrosterone (DHEA) is a critical hormone that is involved in many metabolic processes, both directly and indirectly (through its conversion to testosterone and estrogen).

Low levels of DHEA are associated with an increased risk of developing metabolic syndrome. For example, a cross-sectional study of 400 men, aged 40-80, showed that the lower the DHEA level, the greater the risk of insulin resistance and metabolic syndrome.19

DHEA dosing should be individualized based on blood testing. A simple blood test known as DHEA-sulfate (DHEA-S) will provide important information about your DHEA levels. However, even relatively low doses can provide benefit. A study of elderly men and women showed that a daily dose of as little as 50 mg of DHEA for six months was associated with significant fat loss and improvements in insulin sensitivity.20