What if a single killer was responsible for the health conditions you fear most, including heart attack and stroke, infertility and diabetes, even Alzheimer’s disease and cancer? What if you could easily fight back by dusting off your sneakers and grabbing an apple instead of a fast-food apple pie?
The disease is real. Metabolic syndrome—out-of-whack blood sugar and high insulin levels brought on by too little exercise and too much belly fat—affects at least 51 million adults and children in America, the Centers for Disease Control and Prevention estimates. But the number could be as high as 140 million adults and another 10 million kids—virtually every overweight grown-up and child—because metabolic syndrome is tied directly to excess body fat and inactivity (stress and lack of sleep make it even worse). As Americans grow heavier and even less active, rates of metabolic syndrome are expected to rise. “This condition underlies some of the deadliest, most costly diseases we face,” says Daniel Einhorn, MD, medical director of the Scripps Whittier Institute for Diabetes in La Jolla, California. “Genetics plays a role, but 90 percent is the result of too many pounds and not enough exercise.”
While experts call it one of the 21st century’s biggest health crises, few of us are hearing about it from our family doctors. Yet.
It’s a ticking time bomb, the toxic result of our crazy-busy, grab-a-snack, no-time-for-exercise, chained-to-the-computer lifestyles. “The health consequences may take 15 or 20 years to develop,” says metabolic syndrome researcher C. Ronald Kahn, MD, president of the Joslin Diabetes Center in Boston. “Once, metabolic syndrome was a disease of old age. Today, it’s starting at age 15 or 20 or 30 … and even in preteens. We’re setting ourselves up for some very dramatic, widespread health impacts for people in the prime of life.”
There’s a dangerous, double silence around metabolic syndrome. You can’t see or feel it, and unless you’re under the care of a cardiologist (heart doctors were among the first to realize its significance), an infertility specialist, or an especially astute family doctor, you may not hear about it from your physician anytime soon.
In the first place, there’s no simple blood test and no symptoms. You must piece together a string of early warning signs, including an increasingly snug waistband on your favorite jeans, slightly high blood pressure, and slightly low levels of “good” HDL cholesterol.
Second, there’s no drug to fix it. Pharmaceutical researchers are looking hard at several drugs with “magic bullet” potential—pills like the diabetes drugs rosiglitazone and metformin that might tame insulin levels early enough to prevent or at least significantly cut the risk for many major diseases at once. But for now, with no drug to tout, drugmakers seem unwilling to launch the kind of multi-million-dollar “health awareness campaign” for metabolic syndrome that’s raised public consciousness about high cholesterol, asthma, and arthritis.
Another reason most docs are in the dark: Insulin resistance—the core problem in metabolic syndrome—first became an official medical diagnosis with a code number doctors could enter on insurance forms in 2002. “Even with a diagnosis code, there aren’t any treatments yet that insurance companies will pay for; most don’t cover weight loss or exercise,” notes Yehuda Handelsman, medical director of the Metabolic Institute of America in Tarzana, California.
Metabolic syndrome is so new that experts can’t even agree on a good name. Nobody’s quite happy with the four in current use: metabolic syndrome, dysmetabolic syndrome, insulin resistance syndrome, and syndrome X.
For now, detecting metabolic syndrome requires looking for the right clues. “The important thing is that you or your doctor already have the information you need—your waist measurement, health history, family history, blood lipid test results. and blood pressure numbers—to figure out if you’ve got metabolic syndrome,” Dr. Einhorn says. “But you’ll probably have to ask your doctor to review them with you.”
Individually, the early warnings seem almost insignificant—something to worry about someday when you’re not so busy; maybe you hope they’ll go away on their own. But here’s why you should pay attention now: “If you’ve got the risk factors, you’re in the danger zone already,” Dr. Einhorn says. “Your insulin levels are already high, already doing damage.”
The fix? Another do-it-yourself project. So far, the only steps proven to help everyone overcome metabolic syndrome are weight loss and regular exercise. Stress reduction and a good night’s sleep will help, too.
There is no simple test for metabolic syndrome. Instead, experts look for a pattern of seemingly insignificant health problems that, when pieced together like a jigsaw puzzle, show that this killer condition is silently at work.
“These are all small signals that together can indicate a problem,” says researcher Marie-Pierre St-Onge, PhD, assistant professor in the Division of Physiology and Metabolism at the University of Alabama at Birmingham. “Start by taking your waist measurement. If it’s high, go to your doctor or to a blood pressure screening for a blood pressure check. If that’s even slightly elevated, go ahead and get your cholesterol and triglycerides checked.”
If you have three or more of these “little” health problems, you most likely have metabolic syndrome.
• A waist measurement of more than 35 inches if you’re a woman, 40 inches if you’re a man
• Blood pressure of 130/85 millimeters of mercury (mmHg) or higher
• Triglyceride levels of 150 milligrams per deciliter (mg/dl) or higher
• Low HDL levels—less than 50 mg/ dl if you’re a woman, less than 40 mg/dl if you’re a man
• Fasting glucose level of 100 mg/dl or higher
• If you’re at higher-than-normal genetic risk for metabolic syndrome (because you have a parent, sibling, aunt, or uncle with diabetes or are of Asian descent), your risk rises with a waist measurement of 31 to 35 inches if you’re a woman, 35 to 37 inches if you’re a man, the American Heart Association announced in late 2005.
In prehistoric times, insulin resistance may have been a famine survival tool, a genetic trick that kept blood sugar from being absorbed too quickly by hungry muscle cells and made it available for the brain and reproductive system. But when ancient genes collide with 21st-century lifestyles, the trick becomes a killer.
Normally, tiny amounts of insulin are enough to prompt muscle and liver cells to absorb sugar, their preferred fuel, after a meal. Insulin activates receptors on the cell’s surface, sending a signal: “Hey, dinner’s here! Come and get it!” The cell dispatches molecular pickup trucks called GLUT4 transporters to the surface to haul in the glucose.
But if you’re overweight and inactive, as two out of three Americans now are, body fat interferes. “Fat is the culprit,” says Sonia Caprio, MD, associate professor of endocrinology and pediatrics at Yale University School of Medicine. “As you become obese, even in children, immune fighters called macrophages surround fat tissue and release inflammatory compounds—chemical messengers like interleukin-6 and C-reactive protein—into the bloodstream. These interfere with insulin receptors on muscle and liver cells. And the receptors cannot signal properly.”
The result: Insulin receptors are jammed, cells can’t absorb glucose, and blood sugar levels rise. In desperation (because muscle and liver cells need sugar), tiny islet cells in your pancreas churn out more and more insulin to force hungry cells to take up the sugar. “It works,” Dr. Einhorn says. “Lots of insulin forces cells to absorb the sugar. In fact, it works so well that your blood sugar levels can stay normal, or only slightly elevated, for decades.” But, unseen and unfelt, insulin levels will be at dangerous levels, round the clock, for years.
Sitting around makes things worse. “Muscle contractions from physical activity can make cells absorb blood sugar regardless of insulin levels or insulin resistance,” Caprio says. “If you don’t get exercise, you’re relying even more on insulin and insulin receptors to get sugar into cells.”
A sedentary life full of stress and late nights is even worse: New research from Harvard and Duke Universities suggests that both lack of sleep and high anxiety exacerbate metabolic syndrome, perhaps by upping levels of stress hormones.
Smoking can also raise risk. In a new study of 3,649 men, risk for metabolic syndrome was 17 percent higher for those who smoked up to 20 cigarettes daily and 66 percent higher for those with a pack-and-a-half-a-day habit.
The best prescription for avoiding, or taming, metabolic syndrome isn’t a drug at all—it’s a healthy lifestyle, Dr. Einhorn says. Here’s what works.
Trim a few pounds. Losing only 5 to 7 percent of your body weight is enough to boost insulin sensitivity. If you weigh 175 now, that’s a loss of just 9 to 12 pounds.
Eat smarter carbs. In one recent study, insulin-resistant volunteers lost 15 pounds apiece, but only those who ate a healthy diet became less insulin resistant. On their plates: fruit, veggies, and grains that rank at the bottom of the glycemic index (GI), a system that rates foods based on their effect on blood sugar levels. Low-GI items such as beans, whole grains, veggies, and most fruits digest slowly and release sugar steadily into the bloodstream. High-GI items, such as cake and sweetened drinks, boost blood sugar—and insulin—fast.
Add fish and walnuts. Omega-3 fatty acids in salmon, sardines, white albacore tuna, and other fatty cold-water fish (and in walnuts and flaxseed) can raise your HDL while lowering your LDL and triglycerides—protecting you from metabolic syndrome’s cardiovascular ravages.
Walk around the block. The benefits of exercise go beyond slimming: Activity quickly cuts blood sugar and insulin levels by forcing blood sugar into muscle cells. As little as 20 minutes of walking every day can help. “Anything is vastly better than nothing when it comes to exercise,” Dr. Einhorn says.
Add strength training. Take a class at your local gym or invest in hand weights or resistance bands. Strength training makes cells obey insulin more readily by increasing the number of receptors that ferry blood sugar inside.
Stop smoking. By boosting insulin resistance, smoking raises the risk for heart disease, diabetes, and cancer even higher.