Ruchi Mathur, MD, FRCP(C) is an Attending Physician with the Division of Endocrinology, Diabetes and Metabolism and Associate Director of Clinical Research, Recruitment and Phenotyping with the Center for Androgen Related Disorders, Department of Obstetrics and Gynecology at Cedars-Sinai Medical Center.
Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
Metabolic syndrome is worth caring about because it is a
condition that can pave the way to both diabetes and heart disease, two of the
most common and important chronic diseases today.
Metabolic syndrome increases the risk of type 2 diabetes (the common type of
diabetes) anywhere from 9-30 times over the normal population. That's a huge
increase. As to the risk of heart disease, studies vary, but the metabolic
syndrome appears to increase the risk 2-4 times that of the normal population.
There are other concerns as well that should be
mentioned. Metabolic syndrome is associated with fat accumulation in the liver
(fatty liver), resulting in inflammation and
the potential for cirrhosis. The kidneys can also be affected, as there is an
association with microalbuminuria -- the leaking of
protein into the urine, a subtle but clear indication of kidney damage.
Other problems associated with metabolic syndrome
include obstructive sleep apnea, polycystic ovary syndrome , increased risk of
dementia with aging, and cognitive decline in the elderly.
How is metabolic syndrome treated?
The major goals are to treat both the underlying cause
of the syndrome, and also to treat the cardiovascular risk factors if they persist. As has been
discussed, the majority of people with metabolic syndrome are overweight and
lead a sedentary lifestyle.
Lifestyle modification is the preferred treatment of metabolic syndrome.
Weight reduction usually requires a specifically tailored multifaceted program
that includes diet and exercise. Sometimes medications may be useful.
Diet
A detailed discussion of diet therapies, pros and cons of various diets etc.
is beyond the scope of this article. However, there is now a trend toward the
use of a Mediterranean diet -- one that is rich in
"good" fats (olive oil) and contains a
reasonable amount of carbohydrates and proteins (such as from fish
and chicken).
The Mediterranean diet is palatable and easily sustained. In addition, recent
studies have shown that when compared to a low fat diet, people on the
Mediterranean diet have a greater decrease in body weight, and also had greater
improvements in blood pressure, cholesterol levels, and other markers of heart
disease -- all of which are important in evaluating and treating metabolic
syndrome.
Exercise
A sustainable exercise program, fore example 30 minutes
five days a week is reasonable to start, providing there is no medical
contraindication. (If you have any special concerns in this regard, check with
your doctor first.) There is a beneficial effect of exercise on blood pressure,
cholesterol levels, and insulin sensitivity, regardless of whether weight loss is achieved or not. Thus,
exercise in itself is a helpful tool in treating metabolic syndrome.
Cosmetic surgery to remove fat
Some people may ask: Why not just have liposuction of
the abdomen and remove the large amount abdominal fat, which is a big part of the
problem? Data thus far shows no benefit in liposuction on insulin sensitivity,
blood pressure, or cholesterol. As the saying goes, "If it's too good to be
true, it probably is." Diet and exercise are still the preferred primary
treatment of metabolic
syndrome.
What if lifestyle changes are not enough to treat metabolic syndrome?
What if changes in lifestyle do not do the trick, what
then? Drugs to control
cholesterol levels, lipids, and high blood pressure may be considered.
If someone has already had a heart attack, their LDL
("bad") cholesterol should be reduced below 100mg/dl. (Some experts now say it
should be under 70mg/dl.) A person who has diabetes has a heart attack risk
equivalent to that of someone who has already one and so should be treated in
the same way. What remains controversial is whether metabolic syndrome should be
considered a coronary equivalent or not. If you have metabolic syndrome, a
detailed discussion about lipid therapy is needed between you and your doctor, as each individual is
unique.
Blood pressure goals are generally set lower than 130/80. Some blood pressure
medications offer more than simply lowering blood pressure. For example, a class
of blood pressure drugs called ACE inhibitors has been found to also reduce the
levels of insulin resistance and actually deter the development of type 2
diabetes. This is an important consideration when discussing the choice blood
pressure drugs in the metabolic syndrome.
The discovery that a drug prescribed for one condition, and has other
beneficial effects is not new. Drugs used to treat high blood sugar
and insulin resistance may have beneficial effects on blood pressure and
cholesterol profiles. A class of drugs called thiazolidinediones (pioglitazone [Actos] and
rosiglitazone [Avandia])
also reduce the thickness of the walls of the carotid arteries; although restrictions have been placed by the US FDA on the use of
rosiglitazone (Avandia) due to a reported increase in heart attack and other cardiovascular events in patients taking this drug.
Metformin (Glucophage), usually used to treat type 2
diabetes, also has been found to help prevent the onset of diabetes in people with metabolic syndrome.
Indeed, in my practice, I routinely discuss metformin with my patients who have
metabolic syndrome. Many of my patients who have insulin resistance associated
with metabolic syndrome opt for metformin therapy. However, there are currently
no established guidelines on treating metabolic syndrome patients with metformin
if they do not have overt diabetes.
High blood pressure, also known as hypertension, is a repeatedly
elevated blood pressure exceeding 140 over 90 mmHg -- a systolic pressure above
140 with a diastolic pressure above 90. There are two causes of high blood pressure, primary and secondary. Primary high blood pressure is much more common that secondary and its basic causes or underlying defects are not always known. It is known that a diet high in salt increases the risk for high blood pressure, as well as high cholesterol. Genetic factors are also a primary cause. Secondary high blood pressure is generally caused by another condition such as renal hypertension, tumors, and other conditions. Treatment for high blood pressure is generally lifestyle changes and if necessary, diet.
Cirrhosis of the liver refers to a disease in which normal liver cells are replaced by scar tissue caused by alcohol and viral hepatitis B and C. This disease leads to abnormalities in the liver's ability to handle toxins and blood flow, causing internal bleeding, kidney failure, mental confusion, coma, body fluid accumulation, and frequent infections. Symptoms include yellowing of the skin, itching, and fatigue.
Diabetes mellitus is a chronic condition characterized by high levels of sugar (glucose) in the blood. The two types of diabetes are referred to as type 1 (insulin dependent) and type 2 (non-insulin dependent). Symptoms of diabetes include increased urine output, thirst, hunger, and fatigue. Treatment of diabetes depends on the type.
Cholesterol is naturally produced by the body, and is a building block for cell membranes and hormones. Low-density lipoprotein (LDL) cholesterol is the "bad" cholesterol, conversely, high-density lipoprotein (HDL) cholesterol is the "good" cholesterol. High cholesterol treatment includes lifestyle changes (diet and exercise), and medications such as statins, bile acid resins, and fibric acid derivatives.
Menopause is the time in a woman's life when menstrual periods permanently stop, also called the “change of life." Menopause symptoms include hot flashes, night sweats, irregular vaginal bleeding, vaginal dryness, painful intercourse, urinary incontinence, weight gain, and emotional symptoms such as mood swings. Treatment of menopausal symptoms varies, and should be discussed with your physician.
Sleep apnea is defined as a reduction or cessation of breathing during sleep. The three types of sleep apnea are central apnea, obstructive apnea (OSA), and a mixture of central and obstructive apnea. Central sleep apnea is caused by a failure of the brain to activate the muscles of breathing during sleep. OSA is caused by the collapse of the airway during sleep. OSA is diagnosed and evaluated through patient history, physical examination and polysomnography. There are many complications related to obstructive sleep apnea. Treatments are surgical and non-surgical.
Polycystic ovarian syndrome (PCOS), also known by the name Stein-Leventhal syndrome, is a hormonal problem that causes women to have a variety of symptoms including irregular or no menstrual periods, acne, obesity, and excess hair growth. Treatment of PCOS depends partially on the woman's stage of life and the symptoms of PCOS.
Nonalcoholic fatty liver disease (NAFLD) refers to a wide spectrum of liver disease ranging from simple fatty liver (steatosis), to nonalcoholic steatohepatitis (NASH), to cirrhosis (irreversible, advanced scarring of the liver). All of the stages of NAFLD have in common the accumulation of fat (fatty infiltration) in the liver cells (hepatocytes).
Insulin resistance is the diminished ability of cells to respond to the action of insulin in transporting glucose (sugar) from the bloodstream into muscle and other tissues. Causes of insulin can include conditions such as stress, obesity, metabolic syndrome, and steroid use. Some of the risk factors for insulin resistance include fatty liver, heart disease, strokes, peripheral vascular disease, high cholesterol, and smoking. Treatment for insulin resistance are lifestyle changes and if necessary, medication.
Cushing's syndrome, sometimes referred to as hypercortisolism, is a hormonal disorder caused by prolonged exposure to high levels of the hormone cortisol. Symptoms may include obesity, thinning arms and legs, a rounded face, and increased fat around the neck. Some causes of Cushing's syndrome is from taking glucocorticoid hormones such as prednisone for inflammatory diseases. Treatment for Cushing's syndrome depends on the cause.
Heart disease (coronary artery disease) is caused by a buildup of cholesterol deposits in the coronary arteries. Risk factors for heart disease include smoking, high blood pressure, heredity, diabetes, peripheral artery disease, and obesity. Symptoms include chest pain and shortness of breath. There are a variety of tests used to diagnose coronary artery disease. Treatment includes life-style changes, medications, procedures, or surgery.
Obesity is the state of being well above one's normal weight. A person has traditionally been
considered to be obese if they are more than 20 percent over their ideal weight.
That ideal weight must take into account the person's height, age, sex, and
build.
Smoking is an addiction. More than 430,000 deaths occur each year in the U.S. from smoking related illnesses. Secondhand smoke or "passive smoke" also harm family members, coworkers, and others around smokers. There are a number of techniques available to assist people who want to quit smoking.
Diffuse idiopathic skeletal hyperostosis (DISH or Forestier's disease) is a form of degenerative arthritis. It is characterized by calcification along the sides of the vertebrae of the spine. Symptoms include stiffness and pain in the upper and lower back. Anti-inflammatory medications are used to treat DISH.
A diabetic diet, or diabetes diet helps keep blood glucose levels in the target range for patients. Exercise and medication may also help stabilize blood glucose levels. Keeping track of when you take your diabetic medicine, keeping track of food choices, eating the proper amount of fruits, vegetables, carbohydrates, and fats will also help maintain proper blood glucose levels.
The risks for developing type 2 diabetes include family history, ethnicity, birth weight, metabolic syndrome, and obesity. Warning signs pointing to an increased risk for developing type 2 diabetes include irregular menstruation, impaired fasting glucose, inflammatory markers, and other risks. Gestational diabetes is also a risk factor for developing type 2 diabetes later in life. Prevention of type 2 diabetes can be achieved through a healthy diet (Mediterranean diet), exercise, weight control, not smoking, and medication.
Regular physical activity can reduce the risk of disease. Regular exercise can also reduce the symptoms of stress and anxiety. There are fitness programs that fit any age or lifestyle.
Cholesterol occurs naturally in the body. High blood cholesterol levels increase a person's risk of developing heart disease, heart attacks, strokes, TIAs, and more. In addition to medication (fibrates, statins, bile acid sequestrants, and niacin), lifestyle changes can be made to lower blood cholesterol levels
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