What is the Metabolic Syndrome? The metabolic syndrome is a collection of high-risk symptoms including elevated lipids (cholesterol and triglycerides), hypertension and a proinflammatory state. Having the metabolic syndrome places the individual at high-risk for heart disease and diabetes. Men are more prone to developing the metabolic syndrome due to their natural tendency to deposit excess fat as visceral adipose tissue (VAT) also called intra-abdominal fat. Postmenopausal women are also at risk due to lower estrogen to androgen ratios. The shift from a pear shape to an apple shape displays this hormonal shift. In fact, the apple shape is primarily caused by VAT as opposed to subcutaneous (fat under the skin) fat. The American Heart Association has established standards for diagnosing the metabolic syndrome. The patient must have 3 of the following conditions: 1. Waist circumference greater than 40 inches for men, 35 inches for women. 2. Triglycerides greater than 150 mg/dL. 3. HDL Cholesterol less than 40 mg/d for men, less than 50 mg/dl for women. 4. Blood pressure greater than 130/85 mm Hg. 5. Fasting glucose greater than 100 mg/dL. What causes the Metabolic Syndrome? The metabolic syndrome appears to be caused by insulin resistance and the associated accumulation of VAT. VAT releases inflammatory adipocytokines, which contribute to the proinflammatory state. Fatty liver is also strongly correlated with VAT [1], and is a likely cause of the elevated lipids. VAT accumulation correlates with fasting insulin, total whole-body glucose disposal, glucose oxidation and nonoxidative whole-body glucose disposal [2]. Also, factors associated with insulin resistance are also correlated with VAT accumulation, including triglycerides [3], hepatic lipase [4] and HL/LPL ratio [5]. Likewise, factors inversely associated with insulin resistance are also inversely correlated with VAT accumulation including HDL [3]. How can the Metabolic Syndrome be reversed? Improving insulin sensitivity is of primary importance. This requires an improved diet along with exercise. 1. Lose weight. Weight loss greatly improves insulin sensitivity. 2. Upgrade your fat intake. Saturated fat significantly worsens insulin resistance, while monounsaturated and polyunsaturated fatty acids (especially omega-3) improve it [6]. 3. Exercise. Even something as simple as daily walking reduces visceral adipose tissue areas and improves insulin resistance [7]. 4. Minimize stress. Cortisol appears to be involved in VAT accumulation and insulin resistance. 5. Eat more fiber. Fiber improves insulin sensitivity and is associated with lower amounts of VAT [9]. Pectin appears to be an especially effective fiber for reducing VAT [10]. 6. Take supplements. Pantethine [11], taurine [12], calcium [13] and tea [14] all improve insulin sensitivity and reduce VAT. David Spelts Fat Loss Nutrition [1] Kelley DE, McKolanis TM, Hegazi RA, Kuller LH, Kalhan SC. : Fatty liver in type 2 diabetes mellitus: relation to regional adiposity, fatty acids, and insulin resistance. Am J Physiol Endocrinol Metab. 10/2003. [2] Laakso, Markku: Insulin resistance, body fat distribution, and sex hormones in men. Diabetes, 2/1/1994. [3] R. B. Terry, P. D. Wood, W. L. Haskell, M. L. Stefanick and R. M. Krauss: Regional adiposity patterns in relation to lipids, lipoprotein cholesterol, and lipoprotein subfraction mass in men. Journal of Clinical Endocrinology and Metabolism, 1989. [4] C. E. Tan; L. Forster; M. J. Caslake; D. Bedford; T. D. G. Watson; M. McConnell; C. J. Packard; J. Shepherd: Relations Between Plasma Lipids and Postheparin Plasma Lipases and VLDL and LDL Subfraction Patterns in Normolipemic Men and Women. Arteriosclerosis, Thrombosis, and Vascular Biology, 1995. [5] Despres JP, Couillard C, Gagnon J, Bergeron J, Leon AS, Rao DC, Skinner JS, Wilmore JH, Bouchard C: Race, visceral adipose tissue, plasma lipids, and lipoprotein lipase activity in men and women: the Health, Risk Factors, Exercise Training, and Genetics (HERITAGE) family study. Arterioscler Thromb Vasc Biol, 2000. [6] Riccardi G, Giacco R, Rivellese AA.: Dietary fat, insulin sensitivity and the metabolic syndrome. Clin Nutr. 8/2004. [7] Miyatake N, Nishikawa H, Morishita A, Kunitomi M, Wada J, Suzuki H, Takahashi K, Makino H, Kira S, Fujii M.: Daily walking reduces visceral adipose tissue areas and improves insulin resistance in Japanese obese subjects. Diabetes Res Clin Pract. 11/2002. [8] Gluck ME, Geliebter A, Lorence M.; Cortisol stress response is positively correlated with central obesity in obese women with binge eating disorder (BED) before and after cognitive-behavioral treatment. Ann N Y Acad Sci. 12/2004. [9] DS Ludwig et al: Dietary fiber, weight gain, and cardiovascular disease risk factors in young adults. Journal of the American Medical Association 1999. [10] Hendricks KM et al. High-fiber diet in HIV-positive men is associated with lower risk of developing fat deposition. Am J Clin Nutr 78: 790-5, 2003. [11] Osono Y, Hirose N, Nakajima K, Hata Y: The effects of pantethine on fatty liver and fat distribution. J Atheroscler Thromb, 2000. [12] Nakaya Y, Minami A, Harada N, Sakamoto S, Niwa Y, Ohnaka M: Taurine improves insulin sensitivity in the Otsuka Long-Evans Tokushima Fatty rat, a model of spontaneous type 2 diabetes. Am J Clin Nutr, Jan 2000. [13] Soares MJ, Binns C, Lester L: Higher intakes of calcium are associated with lower BMI and waist circumference in Australian adults: an examination of the 1995 National Nutrition Survey. Asia Pac J Clin Nutrition, 2004. [14] C. Wu, et al: Relationship among Habitual Tea Consumption, Percent Body Fat, and Body Fat Distribution. Obesity Research, September, 2003.
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