The Non-Medicated Life:
Natural Cure for the Metabolic Syndrome
by Dr. Paul E. Lemanski
Editor's Note: This is the seventh in a
series on optimal diet and lifestyle to help prevent and treat heart
disease. Any planned change in diet, exercise or treatment should
be discussed with and approved by your personal physician before
implementation. The help of a registered dietitian in the implementation
of dietary changes is strongly recommended.
Medicines are a mainstay of American life and
the healthcare system not only because they are perceived to work
by the individual taking them, but also because they can be shown
to work by the objective assessment of scientific study. Clinical
research trials have shown that some of the medicines of Western
science may reduce heart attacks, strokes and cardiovascular death.
In the first six installments of The Non-Medicated
Life, informed diet and lifestyle has been shown to accomplish naturally
for the majority of individuals, many, if not most, of the benefits
of medications. For the condition known as metabolic syndrome, however,
such a diet and lifestyle approach may be shown to be significantly
safer and more effective in reversing the condition than the multiple
medications, which could be required.
The metabolic syndrome is a serious, newly recognized
risk to cardiovascular health caused by multiple, and many times
minor, derangements in metabolic function, any one of which would
not be of inordinate concern. The National Cholesterol Education
Program identifies the full syndrome as a target for assessment
and treatment because the cardiovascular risk is substantial, but
underestimated by the level of LDL or the bad cholesterol. Indeed,
even in those with normal LDL, metabolic syndrome doubles the risk
for a heart attack and stroke and triples the risk for diabetes.
This begs the question: other than asking one's physician, how can
an individual determine if they have the metabolic syndrome?
The metabolic syndrome is based on assessing
five aspects of metabolic function:
1) Abdominal fat distribution
2) Blood pressure
3) HDL or the good cholesterol level
4) Blood sugar
5) Triglyceride level
The full syndrome is defined as having derangements
in any three of these five aspects. Derangements for each are quite
specific. With regard to abdominal fat distribution, an abdominal
circumference at the level of the belly button exceeding 40 inches
for a male or 35 for a female is considered a derangement. With
regard to blood pressure, a systolic or top number exceeding 130
or a diastolic or bottom number exceeding 85 or the current use
of blood pressure medications indicate a derangement. With regard
to HDL, a value less than 40 for a male or 50 for a female is considered
a derangement. With regard to blood sugar, a fasting value greater
than 100 milligrams per deciliter (mg/dl) is considered abnormal.
Finally, with regard to triglycerides a fasting value greater than
150 is considered abnormal.
".Metabolic syndrome doubles
the risk for a heart attack and stroke and triples the risk for
Pharmacological treatment of the metabolic syndrome
may be directed at any one of the five aspects of metabolic function
exceeding the established targets. When values are significantly
outside of the established range pharmacological treatment would
be one appropriate approach. Thus a patient with an elevated blood
pressure of 140/95 on at least two separate occasions may be treated
with blood pressure lowering medications consistent with established
medical practice. A female patient with an HDL cholesterol of 30
mg/dl may appropriately be a candidate for cholesterol altering
medications. But the criteria for each aspect of metabolic function
used to make a diagnosis of this condition as part of the full syndrome
are more stringent than when considered separately.
Herein lies a dilemma for the clinician. If
a patient's blood pressure is consistently 135/90, this would be
significant from the perspective of contributing to the metabolic
syndrome. Yet, a blood pressure of 135/90 is not felt high enough
by most clinicians to justify beginning a medication. In like manner,
if a female patient's HDL is 45mg/dl this would contribute to the
metabolic syndrome despite the fact that by itself such an HDL usually
would not raise concern. Indeed, by itself such an HDL from the
perspective of the national cholesterol guidelines, most practicing
clinicians, and the normal ranges for HDL established by national
laboratories would be considered acceptable and thus not require
any pharmacological treatment.
While medications may be used to treat the metabolic
syndrome, a much safer and more natural approach using diet and
lifestyle change should be considered by those with the syndrome.
Such an approach recognizes a biochemical and physiological link
among the different metabolic derangements that make up the metabolic
syndrome. Indeed, the separate derangements, which contribute to
metabolic syndrome may be seen as sharing a common underlying cause:
excess body weight, especially when it is distributed around the
belly rather than the hips. Such excess body weight raises blood
pressure, raises triglycerides, raises blood glucose by making insulin
work less effectively (insulin resistance) and lowers HDL. The metabolic
derangements of excess body weight contribute to metabolic syndrome
in the same manner they contribute to diabetes. Indeed, metabolic
syndrome should be thought of as pre-diabetes.
Weight loss is a function of the consumption
of fewer calories each day than one uses each day in activity. While
it is difficult to generalize, a caloric restriction for most individuals
to approximately 1,200 calories per day especially when combined
with daily exercise such as walking will usually result in a medically
significant weight loss over two to three months or less. Twenty
pounds even for individuals 60 or more pounds overweight can reap
huge health rewards and many times may reverse metabolic syndrome.
As little as five pounds of weight loss may normalize blood pressure.
Exercise such as walking daily even in the absence
of significant weight loss may normalize triglycerides. For those
with elevated blood glucose weight loss may not only return the
sugar to normal levels, but in the Diabetes Prevention Study in
individuals with slight elevations of blood sugar and a family history
of diabetes, 20 pounds of weight loss decreased the risk for developing
diabetes by 60 percent. In summary, metabolic syndrome is a newly
recognized risk for cardiovascular disease for individuals not previously
recognized to be at risk. The syndrome doubles the risk for stroke
and heart attack and triples the risk for diabetes. Utilizing diet
and lifestyle and emphasizing modest weight loss, many times the
metabolic syndrome may be reversed, helping the individual to employ
a more natural non-medicated approach and avoid the proverbial bottle
of pills to solve this very significant health problem.
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