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METABOLIC SYNDROME

Metabolic Syndrome: The Mother of All Diseases


Hospital consultants usually hold their meetings at lunchtime. Before coming to the meeting each of us rushes to the hospital canteen, grabs a sandwich, a can of diet coke, a bar of chocolate and a packet of crisps. The lunch menu stays the same even when a drug rep sponsors the meeting.

Looking back, I have no doubt that meal was a recipe for disease and disaster. The time pressure dictated the behaviour but not enough to justify future health consequences. Even diet coke is not healthy: it’s been found to increases your risk of metabolic syndrome by 36% and diabetes by 67%.

What Is Metabolic Syndrome?

Metabolic syndrome is a cluster of risk factors that include abdominal obesity, high blood pressure, high blood sugar, high triglyceride (TG) and low HDL. The last 2 are types of fat in your blood. You need 3 out of 5 factors to qualify for the full syndrome.

Each risk factor is serious but when combined together they set the stage for a health disaster. Just like a volcano ready to erupt at any moment to cause serious problems, such as heart attack or stroke. Complications do not follow the usual order: metabolic syndrome can progress straight to heart attack, while insulin resistance can manifest, for the first time, as cancer.

The concept of metabolism:

Metabolism is the cellular process that combines calories with oxygen to produce energy, necessary for your cells to run their vital activities. Your metabolism is normal when you are producing adequate energy to support your health and vitality. However abnormal metabolism is when calories are diverted away from your cells to be stored as fat.

Metabolic syndrome starts as insulin resistance

Insulin resistance is the hallmark of metabolic syndrome. This is when your cells become numb to the action of insulin. Since glucose can’t gain access to your cells it is deposited as fat in your liver (fatty liver) and around your internal organs (belly fat).

With increasing insulin resistance you blood glucose starts to rise and your lipid profile become altered. Raised insulin also result in high blood pressure (see my recent post on insulin resistance).

Fat Is Not Guilty: Sugar And Carbs Are!

Over the past three decades fat has been blamed for the obesity and heart disease epidemic. This has promoted the huge market of low fat diet and the multi-billion cholesterol pills (statin). The fat theory is now obsolete in view of wealth of evidence to suggest insulin resistance as the culprit.

Insulin resistance can explain all aspects of metabolic syndrome. Heavy consumption of simple sugars and refined starches are the real reasons behind the epidemic. The type of food we generally refer to as empty calories: fibre and nutrients are removed to prolong the shelf life.

Taking carbohydrates without fibre is going to put your insulin on the roof. This is a dangerous situation that can result in diabetes, heart disease, polycystic ovary syndrome or even cancer. Again food that lack nutrients is detrimental. Since you have to borrow nutrients from other part of your body to process these empty calories. This overtime taxes your systems and creates imbalance that can lead to serious diseases.

Risk of heart disease has shifted from smoking and hypertension in the 50s and 60s to obesity and diabetes, since 1980. Reports from the US relate increased use of High Fructose Corn Syrup (HFCS) to the increase in metabolic syndrome rates.

Are You Worried About Having Metabolic Syndrome?
Metabolic syndrome is a public health issue: it affects 32% of population in the US and 25% of population in Europe. Yet, it remains under diagnosed because some components are related to laboratory tests.

Check yourself against the following symptoms:
  • Symptoms of insulin resistance: tiredness, inability to focus (brain fogs), food craving and excessive hunger.
  • Symptoms of high blood sugar: fatigue, blurred vision, excessive thirst and increased urination.
  • High blood pressure is usually asymptomatic but can give symptoms of headache, dizzy spell and rarely nose bleeding.
Check your self against the following signs of metabolic disease:

Jean Vague, a French physician, was the first to link obesity with disease. She noticed in 1947 that men’s pattern of accumulation of fat in the abdomen (apple shape) is associated with diabetes and cardiovascular disease, while female distribution of fat around the hip (pear shape) is protective.

These were probably the bases of waist circumference (WC) and waist hip ratio (WHR), to reflect risk of disease in relation to fat in body mid-section. The disease risk goes exponentially high with WC of 100cm (40 inches) or above in men and 80cm (35 inches) or above in women.

The WHR is more accurate to detect disease risk: alarm rings with measurement above 0.90 in men and 0.85 in women.




A normal body weight and a normal BMI should not stop you checking your WC. A condition known as TOFI (Thin from Outside Fat from Inside): means too much belly fat but normal body weight, increases your risk of metabolic syndrome.

Medical research shows that 40% of normal weight people have abnormal metabolism, while 20% of the obese have normal metabolism. The latter group are probably healthy obese.

Are you at greater risk of metabolic syndrome if you are over 50?

Incidence of metabolic syndrome among the over 50 is even higher. Reported at 40% in the US and 30% in Europe. These are related to middle age change in body composition. Characterised by loss in muscle mass and a gain in fat together with significant hormonal changes. The changes could be related to inactivity and can be reversed by regular exercises.

Tests To Diagnose Metabolic Syndrome

Below I outline some of the tests that are available both here in the UK and also through US labs. If you are not familiar with the medical terminology used and would like an explanation in ‘layman’s’ terms, please contact me. I would be happy to talk you through your options.

Tests to diagnose insulin resistance, discussed in my previous blog post, are a first step. These include fasting blood glucose, Haemoglobin A1C and fasting insulin. Unfortunately, fasting insulin (the earliest sign of insulin resistance) is not available in the NHS.

You also need to find out if you are at risk of an acute vascular event such as heart attack or stroke. The conventional lipid profile is not reliable as 90% of those who had a heart attack got the same lipid profile of those who hadn’t.

Instead, your best bet is to go for highly specialised tests offered by giant labs in the US such as Genova diagnostics. They test for chronic inflammation along your arteries (homocysteine and hs-CRP). They also look at your LDL (bad cholesterol) from different perspectives: check both LDL particles size and numbers.

There are two types of LDL particles. Type A – large fluffy (beach ball) rise with fat intake but have no health risk. Type B – small dense (golf ball) rises with simple sugar and refined starches. These easily stick together to form blood clots resulting in cardiovascular catastrophe, such as heart attack or stroke.

Having been diagnosed with metabolic syndrome it would be worthwhile to arrange genetic tests. These could reveal subtle genetic defects (SNP) that can result in jams along your cellular metabolic pathways. Despite being genetic they are easily treatable with active nutrients that bypass defects and open up the metabolic pathways. You do not have to live with your genes anymore.

Testing your vitamin D is also important, as deficiency is common among people living in the western world. Research showed that vitamin D improves gut flora and metabolic syndrome in mice by restoring the good bacteria in their gut.

Does metabolic syndrome result in any complications?
Common complications include: fatty liver, gallstones and sleep apnoea.

Patients can also develop complications in relation to individual disease component:
  • High blood pressure damages the heart and can cause chronic kidney disease, often requiring dialysis or kidney transplant.
  • Diabetes can damage the eyes: the commonest cause of blindness. It also damages the kidneys and can result in limb amputation.
Research also indicated that 50% of diabetics present to the hospital for the first time with complications such as stroke or heart attack.

Being diagnosed with metabolic syndrome you have the following options of treatments:

You can either tap into the mainstream medicine that will help you to live with your disease. You need to take many pills to control various conditions such as high glucose, high blood pressure and abnormal cholesterol. Medications could slow down disease and may delay complications. However this take place at a high cost of side effects and the need to stay on pills for the rest of your life.

Otherwise you might want to tap into the high tech personalised medicine that may help to reduce your dependency on medications.

Put simply, you do not have to live with your disease if you can reduce your waistline, research says:

Reducing your body weight by 5% would lower your triglyceride (TG) and reduce your risk of type 2 diabetes.
If you can shift more weight this will improve your blood pressure, lower your LDL (bad cholesterol) and increase HDL (good cholesterol).

And the management is simple: more fibre and regular exercises. You also need to reduce your inflammation level and risk of clot, bypass your genetics defects and grease the metabolic machine. 

Dr Sharief Ibrahim FRCP
Metabolic Syndrome
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