Metabolic Syndrome

According to Statistics Canada, results from the 2009 to 2011 Canadian Health Measures Survey (CHMS) indicate that 1 in 5 Canadian adults aged 18 to 79 had metabolic syndrome. Metabolic Syndrome, also known as Syndrome X, Insulin Resistance Syndrome, or Mets refers to a cluster of conditions that occur together. These conditions include high blood pressure, high blood sugar levels, excess body fat around the waist or mid-central obesity, and abnormal cholesterol levels. What exactly are the effects of metabolic syndrome and why should we care? Not only can it hinder an individual’s ability to effectively metabolize simple dietary carbohydrates such as sweets, pasta, and bread. Metabolic syndrome can predispose one to increased health risks of diabetes, heart disease, and stroke.

In addition to cardiovascular disease and type 2 diabetes, individuals with metabolic syndrome have been found to be susceptible to other conditions such as polycystic ovarian syndrome, fatty liver, cholesterol gallstones, asthma, sleep disturbances, and some forms of cancer.^[1] It seems only appropriate that with the aging population that we are currently facing, being informed and making the appropriate lifestyle changes can help prevent the progression to the more serious health conditions associated with metabolic syndrome. Conventional intervention for metabolic syndrome may include dietary changes along with insulin-sensitizing agents, lipid-lowering agents such as statins, and diuretics to help reduce blood pressure. Treatment of metabolic syndrome from a naturopathic approach involves an evaluation of risk factors, dietary and lifestyle changes to reduce weight, as well as safe and effective options to target the various components of metabolic syndrome. Modalities include botanical herbs that can increase insulin sensitivity/decrease blood glucose, reduce blood lipid levels, alleviate stress levels, and protect the heart, as well as modalities such as Traditional Chinese Medicine and acupuncture to reduce weight. In addition to appropriate intervention, early detection is essential in preventing the progression to more serious pathologies as mentioned above. This paper will discuss the components of metabolic syndrome, the diagnostic criteria and risk factors, and lastly, the naturopathic approaches to treating metabolic syndrome.

COMPONENTS OF METABOLIC SYNDROME

According to the National Cholesterol Education Program’s Adult Treatment Program Panel III (ATP III) report, the six components of metabolic syndrome are identified as:^[1]

• Abdominal obesity
• Atherogenic dyslipidemia
• Raised blood pressure
• Insulin resistance
• Pro-inflammatory state
• Pro-thrombotic state

Abdominal obesity refers to increased waist circumference. Atherogenic dyslipidemia essentially refers to a triad of increased blood concentrations of small, dense low-density lipoprotein (LDL) particles, decreased high-density lipoprotein (HDL) particles or good cholesterol, and increased triglycerides.^[2] It can also include other lipoprotein abnormalities. Raised blood pressure or hypertension is a common occurrence in individuals who are overweight and have insulin resistance, and is therefore inevitably a component of metabolic syndrome. A pro-inflammatory state is recognized by the increase of an inflammatory marker called C-reactive protein, which is commonly seen in individuals with metabolic syndrome. The cause of this can be attributed to obesity, as adipose tissue or fat tissue releases inflammatory cytokines that may produce higher levels of CRP.^[1] The final component, a pro-thrombotic state, is characterized by increased plasma plasminogen activator inhibitor (PAI)-1 and fibrinogen.^[1]

DIAGNOSTIC CRITERIA & RISK FACTORS

Although there has been much debate over the definition and diagnostic criteria for metabolic syndrome, the most commonly used diagnostic criteria is that of is that of The National Education Program’s Adult Treatment Panel III (NCEP/ATP III), which defines metabolic syndrome as the presence of at least 3 of the following clinical signs;^[3]

• Blood pressure over 130/80 mmHg
• Plasma triglycerides > 150 mg/dL
• HDL-cholesterol (HDL-C) <40 mg/dl in men and <50 mg/dL in women
• Waist circumference >40 inches in men and >35 inches in women
• Fasting blood glucose > 110 mg/dL

Diagnosis of metabolic syndrome is generally made based on repeated elevations of the same 3 out of 5 components listed above.^[3] In terms of risk factors for metabolic syndrome, it comes as no surprise that obesity has been recognized as the main risk factor. Obesity is a major risk factor for type 2 diabetes mellitus which has two common features; high blood glucose, and high blood lipids or hyperlipidemia.^[4] Physical inactivity, insulin resistance, advanced age, hormonal factors such as corticosteroids, and diets high in fats which increase abdominal obesity have also been identified as major risk factors for metabolic syndrome.^[5] Low-carbohydrate diets in particular appear to have beneficial lipoprotein effects in individuals with atherogenic dyslipidemia, compared to high-carbohydrate diets.^[2]

NATUROPATHIC TREATMENT
Omega-3-fatty acids

Omega-3 –fatty acids are considered essential fatty acids or EFA since they cannot be produced in the body. Not only are omega-3-fatty acids good for the brain; they can help prevent cardiovascular disease, which as discussed previously is a complication of metabolic syndrome. High dietary intake of omega-3 fatty acid over a period of 6 years has been found to reduce the risk of a first myocardial infarction (MI) or heart attack by as much as 59% in both men and women.^[6] When it comes to the components of metabolic syndrome in particular, eating a diet high in omega-3 fatty acid seems to reduce risk of hypertension by about a third.^[7] Another study found that substituting polyunsaturated fat for saturated fat resulted in significantly lower plasma cholesterol levels.^[8] Food sources of omega-3 fatty acids include anchovies, sardines, mackerel, and atlantic salmon, to name a few.

Chromium Picolinate

Chromium picolinate is an essential trace nutrient known for its function in carbohydrate and lipid metabolism. Studies have found that supplemental chromium given to individuals with impaired glucose tolerance or diabetes can normalize blood sugar levels, improve blood sugar utilization, and decrease insulin requirements.^[9] One particular study found that chromium may improve insulin sensitivity by enhancing intracellular insulin receptors.^[10] Other clinical evidence suggests that taking chromium chloride 250 mcg daily for 7-16 months decreases triglycerides and very-low-density lipoprotein (VLDL) cholesterol, as well as increases high-density lipoprotein (HDL) cholesterol, in patients with atherosclerotic disease compared to placebo.^[11] It is also used orally for weight loss, to increase muscle mass and fat-free mass, and decrease body fat.

Vitamin C

Vitamin C, also known as Ascorbic acid, is a well-known anti-oxidant and as most of us know, is important to immune function. In addition to these benefits, Vitamin C is essential for the synthesis of carnitine, which has been found to be useful in preventing and treating heart disease and whose function will be discussed more in detail in this paper.^[12] Food sources of vitamin C include citrus fruits, cantaloupe, broccoli, Brussels sprouts, cauliflower, and potatoes. It is important to note that significant amounts of vitamin C in food can be lost when cooking with high temperatures or during prolonged warming of food.^[12]

CoQ10

Coenzyme Q10, or CoQ10 is a fat-soluble compound that is synthesized in our bodies. Like vitamin C, coQ10 has anti-oxidant activity and supports immune function. In addition, coQ10 has been found to be useful in preventing and treating cardiovascular conditions such as angina, hypertension, and congestive heart failure which as discussed previously, may be complications of metabolic syndrome.^[12]

Carnitine

Carnitine is a low-molecular weight compound that is obtained from the diet and is also biosynthesized in the liver, kidney, and brain from the essential amino acids lysine and methionine.^[13] It is a compound that is involved in the metabolism of certain xenobiotic compounds or foreign chemical substances in the body. Disorders of fatty acid oxidation (which essentially refers to the break down and release of energy from fatty acids), and metabolism have been found to be associated with primary and secondary forms of carnitine deficiency.^[13] There is also some clinical evidence that suggests that taking L-carnitine in conjuction with isoflavones or pantothenic acid, also known as vitamin B5, might reduce body weight and waist circumference in overweight people.^[14]

L-theanine

Since ancient times, it has been known that green tea brings relaxation.^[15] L-theanine is an amino acid contained in green tea leaves and constitutes between 1-2% of the dry weight of tea leaves. ^[15]One double-blind placebo-controlled study found that L-theanine intake in the experimental group resulted in a reduction in the heart rate and salivary immunoglobulin A (s-IgA) responses to acute stress in comparison to the placebo controlled group.^[16] This is particularly helpful in reducing stress levels, which thereby helps reduce the risk of hypertension associated with metabolic syndrome.

Conclusion

Metabolic syndrome is a chronic lifestyle disease that is becoming more prevalent with the increased rate of obesity in our society. Therefore, diet and regular exercise lie at the forefront of treating this syndrome. If left untreated, metabolic syndrome can lead to more serious pathologies such as diabetes or cardiovascular disease. The aforementioned natural interventions are not comprehensive in the treatment of metabolic syndrome. An ideal treatment plan would begin with the necessary dietary and lifestyle counselling, as well as an evaluation of risk factors and medication that the individual may be taking, in order to determine which herbs or supplements would interact and/or be most appropriate. Always consult with a Naturopathic Doctor to determine what treatment is appropriate for you.