Shutting off Metabolic Syndrome
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Metabolic syndrome is by far the most common reason that people fail to gain control over coronary plaque. Learn how to beat this scourge.
Metabolic syndrome is known by a number of different names: insulin resistance, syndrome X, borderline diabetes. They're all the same and lead to the same common destination: more coronary plaque, three-fold or greater risk of heart attack, greater risk for stroke, and diabetes. The pre-diabetic status of the metabolic syndrome can go on for several years. At some point, you cross the line into full-blown diabetes, and turning back becomes near-impossible. That's why you should work to correct metabolic syndrome before you get to that point.
Metabolic syndrome can drive coronary plaque growth even when everything else, like LDL cholesterol or homocysteine, are corrected to perfect levels. Neglect of the metabolic syndrome is, without question, the most common reason your program can look perfect (excellent LDL cholesterol, for instance) yet your plaque continues to grow at an alarming rate.
You and your doctor will know that you have the metabolic syndrome if you have HDL <50 mg/dl, small LDL, triglycerides >150 mg/dl, high blood pressure, excess abdominal fat, blood sugar of >110 mg/dl. The likelihood of developing metabolic syndrome escalates sharply above a body mass index (BMI) of 27, though some people even show some of the features at an ideal weight and BMI (suggesting a powerful genetic predisposition). Having this syndrome is a matter of degree. Any one of the above abnormalities qualifies you as having metabolic syndrome (in our strict definition*); the more of these features you have, the more metabolic syndrome contributes to plaque ?growth. Contrary to popular opinion, blood sugar can be in the normal range while any of the other aspects of the metabolic syndrome are active.
Metabolic syndrome starts with resistance to insulin
A fundamental derangement in the metabolic syndrome, borderline diabetes, and (adult-onset or type II) diabetes is resistance to your own body's insulin, not a deficiency of insulin.
In fact, the metabolic syndrome means that you have too much insulin. Blood levels of insulin are high but your body's cells have become resistant to insulin. Blood sugars go up, since sugar is unable to enter cells. A cascade of effects develop in domino-like sequence: increased triglycerides leading to a reduction in HDL, small LDL, VLDL, increased inflammation, greater blood clotting, higher blood pressure, and fatigue even with day-to-day life demands.
A crucial step to take that may help you in this situation is to increase your "insulin sensitivity". Correct this fundamental defect and correction of the other phenomena will follow. Strategies that increase "insulin sensitivity" include:
* Exercise—with a focus on duration (at least 30 minutes per session, preferably 60 minutes), not intensity. Also, the more frequent your exercise efforts, the better.
* Strength training—Adding weights or resistance machines can help by increasing your basal metabolic rate and accelerates fat loss. Twenty minutes twice a week can accelerate your progress tremendously.
* Weight loss (if overweight)—a dramatic effect. Ideally, you should achieve a BMI of <25, or a body fat percentage of <24% for females, <18% for males, to fully erase the contribution of weight to metabolic syndrome. (See Five Strategies to Accelerate Weight Loss in this Manual.)
* Healthy foods— Choose foods with low glycemic index and avoid those with high glycemic index. (See Track Your Plaque, page 125: Foods Should Have a Low Glycemic Index or the Glycemic Load tables in the Nutrition Principles of the website.) The best choices among low glycemic index foods are raw nuts and seeds, oat bran, lean proteins, and healthy fats. These are foods that slow absorption of sugar into the blood, which over time lead to increased sensitivity to insulin.
* Fish oil —Omega-3 fatty acids in fish can help, though the effect is relatively modest. (Probably works by reducing release of fatty acids in the blood.)
* Chromium supplements—e.g., chromium picolinate 400-800 mcg per day has in some studies improved blood sugars by increasing insulin's effects. The effect is modest.
* Glucomannan—This sponge-like fiber provides a feeling of satiety when taken with water before meals, and is therefore a useful weight loss strategy. Average weight loss is 4 lb per month. The viscous nature of this fiber also slows sugar absorption, effectively lowering the glycemic index of foods. It can also lower cholesterol around 10 points. The dose is a minimum of 2000 mg prior to meals three times per day, and as high as 4000 mg for each dose. Be sure to drink plenty of water. (Discuss the advisability of increasing water intake with your doctor if you have kidney disease, liver disease, a history of water retention, or glandular disorders.)
* White bean extract—This supplement is a starch blocker, blocking around 30% of all sugars and carbohydrates ingested. Undigested starches make their way to the colon, where normal colonic bacteria convert it to gas. Excess gas is therefore an expected effect. Average weight loss is 4 lb per month on 1000 mg twice per day.
* DHEA—When taken at bedtime, this adrenal gland hormone enhances mobilization of abdominal fat (that contributes to metabolic syndrome and insulin resistance). Dose: 25 mg at bedtime for men and women ages 45–50; may increase to 50 mg over age 50. Do not increase beyond 50 mg unless directed by your doctor and safety verified by DHEA-S blood levels.
* Vitamin D—Recent observations suggest that this oft-overlooked nutrient can contribute to resistance to insulin and raise blood pressure (by increasing the blood pressure-raising hormone rennin.) Vitamin D deficiency is painfully common, particularly in northern climates. 1000–2000 units per day is the dose we use successfully. (Discuss with your doctor if you have kidney disease, kidney stones, or a history of high calcium levels.)
* Sleep—Chronic lack of a full night's sleep can block insulin's effects. This can be a powerful phenomenon and is very common. Surprisingly, catching up on lost sleep can require up to 3 weeks of sleeping 8-10 hours. Once you've caught up, do your best to consistently maintain 7 ½ to 8 hours of sleep per night.
Most people will need to follow more than one of these strategies to reverse all the phenomena of the metabolic syndrome. At the very least, everybody should adopt the habit of choosing low glycemic index foods, trying to get a full night's sleep consistently as possible, exercise, and take fish oil. Just how far you have to go depends a lot on genetic factors. Some people can completely eliminate the metabolic syndrome just by following these basic practices and losing 10 lbs. Others may need to work hard to achieve an ideal weight with a BMI of 25 or less.
If you're among those who've experienced plaque growth despite the appearance of favorable lipids or lipoproteins, you and your doctor should re-consider just how important the various aspects of the metabolic syndrome might be in your situation.
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