Metabolic Syndrome

Metabolic Syndrome (also called Syndrome X or Metabolic Syndrome X) is a complex syndrome, characterized by the clustering of insulin resistance and hyperinsulinemia. It is also associated with dyslipidemia (High levels of TG and LDL, low level of HDL), hypertension, abdominal (visceral) obesity, glucose intolerance (diabetes) and an increased risk of cardio vascular (heart) events.

Metabolic syndrome is more common in men than in women. This occurs usually later in life (after 50 years of age). The various risk factors are discussed individually in the section below, but it is also important to understand the interaction of these factors.

Insulin resistance or Hyperinsulinemia

When the glucuse levels in the blood rise (as they do after a meal), it stimulates the beta-cells in the pancreas in order for them to produce insulin. Hyperinsulinemia is the condition when the pancreas consistantly produce too much insulin for a given glucose response. The body attempts to correct this faulty state by making less and less insulin over a period of time. However, in this period the body also get used to having too much insulin available and becomes ineffective at using it. Hyperinsulinemia eventually turns into insulin resistance. Insulin resistance is a state in which a normal insulin concentration has a less than normal biological response. In other words your insulin no longer works as effectively as it should. This leads to impaired glucose tolerance and eventually overt diabetes mellitus.

Central obesity (apple shape) can also lead to insulin resistance due to the increased free fatty acid (FFA) production that lowers glucose uptake (causing hyperglycemia or high blood glucose levels) and in turn decreases insulin secretion.

  • See if you are apple or pear shaped : 
    apple or pear

Dyslipidemia

Dyslipidemia is characterized by increased levels of very low density lipoprotein (V-LDL) and Triglycerides (TG) as well as lower levels of High density lipoprotein (HDL). Insulin resistance impairs the normal suppression of free fatty acid (FFA) release from the fat cells. An increase in the release of FFAs in turn increases TG and V-LDL levels.

Hypertension

High insulin concentrations are associated with hypertension, independantly of glucose intolerance or obesity. Multiple mechanisms have been suggested to explain the relationship between hypertension and insulin resistance and hyperinsulinemia. For example : Hyperinsulinemia increases the renal (kidney) sodium and water re-absorption and this may lead to peripheral vasoconstriction and increase cardiac output. It can also lead to increased plasma noradrenaline concentrations, that will increase blood pressure. The relation between hypertension and hyperinsulinemia remains controvertial.

Impaired glucose tolerance (or Non-insulin dependant Diabetes Melitis)

Increased insulin resistance and chronic over stimulation of the Beta-cells in the pancreas, promotes hyperglycemia due to the impaired capacity to secrete insulin. This leads to constant high blood glucose levels and eventually diabetes.

Obesity

Metabolic Syndrome X occurs more frequently in people with central (visceral) fat distribution. The fat tissue produces increased amounts of free fatty acid (FFA), which in turn lowers your glucose uptake and also decreases pancreatic insulin secretion. This leaves the glucose unabsorbed in the bloodstream, causing hyperglycemia. This can also decrease the body's sensitivity to insulin and the person become insulin resistant.

Coronary artery disease (CAD) and Heart disease

The link between increased CAD risk and insulin resistance is multi-factorial. Both increased insulin concentrations and decreased insulin sensitivity have been shown to be strong independent risk factors in heart disease. The specific role of insulin in the development of heart disease remains poorly understood. Insulin resistance and hyperinsulinemia are common in NIDDM and are associated with hypertension, CAD and strokes.

Treatment

Goal: To prevent the progression or reverse the pathology of metabolic syndrome

  • Diet - Low GI, low fat. Concentrate on monounsaturated fats and Omega 3 fatty acids
  • Weight loss
  • Exercise
  • Medication - in the case of Insulin resistance and Dyslipidemia

Clinical markers for metabolic syndrome

Waist circumference over 102cm (40 inches) for men
. over 88cm (35 inches) for women.
Fasting blood glucose over 6mmol/l
Hypertension >=130/85 mmHg
Triglyceride >1.7mmol/l
HDL levels men < 1.0 mmol/l
. woman < 1.3 mmol/l

Contact

The practice:

21 Highland avenue
Bryanston, Johannesburg

 

Office  073 179 4907

 

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