Understanding the Metabolic Syndrome


Dr. Brown is an assistant professor of pharmacy practice at Palm Beach Atlantic University, Lloyd L. Gregory School of Pharmacy,West Palm Beach, Fla.

The metabolic syndrome, also known as Syndrome X or insulin resistance syndrome, is a group of risk factors that increase a person's chance of developing heart disease, stroke, and type 2 diabetes. It is estimated that 47 million American adults have the metabolic syndrome, and it appears that men and women are at equal risk. Although the condition is more common in later life, an estimated 4.2% of adolescents 12 to 19 years of age have the metabolic syndrome.

What Are the Core Risk Factors?

The core risk factors that make up the metabolic syndrome have remained consistent. A few changes have been made, however, as experts have learned more and more about heart disease and diabetes. The most recently updated list of risk factors is as follows:

  • A lot of fat around the abdomen (called central obesity; a waist circumference of more than 40 inches in men and more than 35 inches in women)
  • A high level of triglycerides (150 mg/dL or more) or if you are taking medication to lower your triglycerides
  • Reduced high-density lipoprotein (HDL—the good cholesterol; less than 40 mg/dL in men and less than 50 mg/dL in women) or if you are taking medication to raise your HDL
  • High blood pressure (130/85 mL of mercury or higher) or if you are taking medication to lower your blood pressure
  • High fasting blood sugar level (100 mg/dL or more without having any food for the past 8 hours) or if you are taking medication to lower your blood sugar

It is important to note that your waist measurement is not necessarily the same as the waist size you use to purchase clothing. Instead, a properly trained health care provider should take the measurement of your waist to determine whether you are classified as having central obesity. As already stated, metabolic syndrome also is known as insulin resistance syndrome. This condition is related to the fact that the body cannot use insulin very well and will make too much insulin. Too much body fat and not enough exercise also contribute to this risk. Also, some people have genes that increase their risk for developing insulin resistance. Patients with insulin resistance commonly go on to develop type 2 diabetes.

How Is the Metabolic Syndrome Diagnosed?

There is no absolute way to diagnose this condition. However, having at least 3 of the 5 risk factors listed above generally means that you have the metabolic syndrome. If you have any of these risk factors or are unsure whether you do, you should see your doctor.

How Is the Metabolic Syndrome Treated?

Weight loss and increased physical activity are extremely important in reducing the risk for heart disease and diabetes.

Weight Loss

Diets low in saturated fats, cholesterol, and carbohydrates as well as high in fiber are recommended to help you lose weight. Dietary changes you make should not be looked on as "going on a diet." Instead, they should be lifestyle changes that you maintain throughout your life. Generally, weight loss of about 10% over a 6-month period is recommended. However, your physician can help you determine how much weight you need to lose.


Moderate exercise (for example, brisk walking) for 30 minutes most days of the week is recommended. The time you spend exercising may be broken up into smaller time periods to fit your daily schedule if needed. It is recommended that you start slow (such as walking for 5 minutes every day) and gradually increase the amount of time you spend exercising. Exercise is good for improving your cholesterol level and burning off calories. Before you begin exercising, it is important that you talk with your doctor to be sure that your body can handle the increased physical activity.

Reaching Your Goals

Some patients with the metabolic syndrome may need medications to reduce their risk factors for heart disease and diabetes. If you have high blood pressure, your primary care physician may ask you to start exercising and/or to reduce the amount of salt in your diet. Losing weight also will lower your blood pressure. If you still have not reached your goal blood pressure with these lifestyle changes, you may need one or more medications. Treating high blood pressure is a very important way to help lower your chances of developing heart disease. If you have a low HDL level or a high triglyceride level, reducing your alcohol intake (no more than 2 drinks per day for men or 1 drink per day for women) can help improve your cholesterol level. Also, diets low in cholesterol and saturated fats but rich in foods from plant sources, as well as physical activity, help to lower cholesterol in your body. Smoking cessation is another way to help you reach your cholesterol and blood pressure goals. Despite these changes, medications may still be needed. Some patients with the metabolic syndrome have a high fasting blood sugar level. Reducing carbohydrates, losing weight, and increasing physical activity are helpful to improve your blood sugar level. Sometimes medications may be required to help lower your chance of developing type 2 diabetes.


If you have any of the risk factors mentioned above for the metabolic syndrome, you should see your physician. Take control of your life, and help lower your chances of developing heart disease and diabetes!

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