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Metabolic Syndrome: What it is and what you can do about it? by Darwin Deen, MDMetabolic Syndrome (also known as Syndrome X) is a combination of risk factors that frequently occur together. Your physician will make this diagnosis if you are overweight and have higher than normal blood pressure with elevated levels of sugar or triglycerides in your blood. Many patients with adult onset diabetes also have metabolic syndrome. Why is it important?
The abnormalities that make up the Metabolic Syndrome each increase your risk for coronary heart disease. Taken together, the risk is increased up to 6 fold. Even if your cholesterol level is normal, you may be at risk for a heart attack or stroke. If you know that you have this increased risk, you can do something about it. Metabolic Syndrome reflects a diet that has too many calories, too much saturated fat, and a lifestyle without enough exercise. If your doctor has told you that you have Metabolic Syndrome, it is your wake-up call. Get busy changing your diet and exercise. Research shows that you can reduce your risk significantly with adjustments to your lifestyle and diet that produce small amounts of weight loss. Some suggestions are outlined below. Exercise Recommendations for Metabolic Syndrome:
How much and what kind of exercise you should do depends upon where you are starting from. Being Sedentary is the biggest risk factor for you heart that scientists have been able to identify (even a greater risk than cigarette smoking). If you smoke, quit! If you do not do any exercise, start walking for 5 minutes every day. It may be difficult at first, if so, go slowly. If you have a medical condition that influences your ability to exercise, discuss this with your doctor. If you are over the age of 45 and have not exercised in years, talk with your doctor about how to get started. If you do exercise, but not regularly, discuss your exercise regimen with your physician and make a plan for increasing your physical activity gradually. Once you are walking regularly, you can work on gradually increasing your pace or your distance. While 5 minutes a day is a great start, eventually you want to be walking for 30 minutes to an hour at least 5 days per week. If you already exercise this much then consider doing some resistance exercises to build muscle strength. Some people like going to the gym to work out in an environment where others are doing the same thing. Others prefer the privacy of their own home or yard. Whichever you prefer, remember to start slowly and increase gradually. There is no rush. Injuries are much more likely when you try to do too much too soon. Remember the tortoise and the hare, slow and steady wins the race. Overcoming Barriers to Exercise:
Many people find it difficult to begin an exercise regimen. Some of us start each new year with a resolution to get into shape but by spring, we have abandoned our plans. There are many great books, videos, and programs to help. Use whatever resources are available to you and your patients. Many people find that exercising with a friend can be very helpful to keep you on track. Identify someone who also wants to exercise more and share the experience of getting into shape together. Look for a local community center or YMCA with exercise classes (Yoga, etc.), or join a gym. Remember that a balanced exercise program includes three components: warm-up and stretching, aerobics, and strength training. You do not have to build bigger muscles, you only need to make the muscles you have stronger. This will help you to burn more calories all day long. Most of us do not think that we have the time to exercise. Yet those who do exercise have the same number of hours in the day as everyone else. They are just as productive at work and at home, maybe even more so. Many of us sit on the couch for hours in the evening watching TV. Get an exercise bike and park it in front of the TV. Make it a goal to bike for 30-60 minutes whenever you turn on the TV. Do not think that joining a gym will magically make the time appear in your day to go there. If you already have an hour a day to work out, that is a good time to join a gym. If you don’t have the time, try adding physical activities to your daily routine: sweep, dust, and vacuum for an hour; walk up stairs instead of taking an elevator or escalator; next time you need something from the store, walk there, or if it is too far, park at the far end of the parking lot instead of the closest spot you can find. If lifting weights in a gym doesn’t appeal to you, lift soup cans in your kitchen. Put on some music that you like and dance around your living room. Opportunities to burn calories are all around you, look for them. Three 10-minute sessions of activity per day is the same as 30 minutes all at once. Don’t miss any opportunities to do a little walking. As you get into better shape, you will look forward to these little bouts of exercise. Remember that you are saving your life with these activities. Dietary Goals for Metabolic Syndrome: 1) Reduce calories 2) Reduce saturated fat 3) Increase whole grains 4) Increase fruits and vegetables 5) Eat fish 1-2 times per week 6) Use monounsaturated or polyunsaturated oils such as Olive, Canola, Peanut, Safflower, Sunflower, Sesame seed, Corn, or Soy. How to Accomplish These Goals:
To reduce calories: eat less, skip dessert, snack on low calorie foods such as carrot sticks or rice cakes, avoid fried foods, when eating out, ask for gravy, sauce, or salad dressing on the side and use only what you need, reduce the fat added to your starches (eat that baked potato without sour cream), remove the skin from chicken after cooking. For most of us, eating less is very difficult. Behavioral strategies to help accomplish this goal include: 1) Do not skip meals. Hunger removes resolve as fast as alcohol does. 2) Put less on your plate to start with, take “seconds” if you need to. 3) Eat slower. It takes time for the satiety signals to get from your gut to your brain. 4) Use a smaller plate, then you can fill it up. 5) Leave a little behind at each meal. To Reduce Saturated Fat: Change gradually from full fat dairy products to reduced fat, then low fat (or skim), use butter sparingly or substitute a trans-fatty acid free margarine, eat smaller portions of red meat (3-6 oz instead of 6-8) and substitute leaner cuts of meat or chicken or fish, have one meatless dinner per week (do not substitute eggs or cheese for the meat in this meal). When eating fast food, try grilled chicken rather than a burger or fried chicken or fish and ask for no “special sauce” (use ketchup instead). Increase Whole Grains: If you use whole grains, congratulations. If you don't, look for whole grains when shopping and try them out once a week until you find some that you like and can use regularly. Whole wheat bread and brown rice are the easiest. Oatmeal and puffed grain cereals are readily available. Whole wheat pasta or pastas made from quinoa or other grains are harder to find but available in specialty shops, health food stores, and some supermarkets. Find whole grain crackers and side dishes like bulgur wheat. Increase Fruits and Vegetables: In my 20+ years of practice I have been consistently amazed at how few patients report fruit intake on their 24 hour dietary recall. Suggest that patients snack on fruit. Fruit spoils so those who shop every two weeks will need to consider canned or frozen fruits (use frozen strawberries as a topping on sorbet or ice milk, or mix them into a skim milk shake). Count fruit and vegetable servings and don’t be satisfied until they are at the “5-a-day” level (2 fruit and 3 vegetable). While you need to eat less meat and less fat (and avoid simple sugars), you can increase the size of your vegetable portions (cooked without fat). During the winter months, frozen vegetables provide an economical alternative to fresh. Trying new foods is the key to all dietary change. Adding fish to the diet provides a healthy alternative to the saturated fat in red meat and cheese. Tuna, salmon, whitefish and mackerel may be included for breakfast or lunch, and there are dozens of varieties of fish for them to try for the protein portion of their dinner. Baking, broiling, or poaching fish avoids the added calories from breading and frying, and allows the flavor of the fish to be appreciated. Minimize the use of lard, pork fat, or vegetable shortening for cooking and have patients experiment with substituting monounsaturated oils into their favorite recipes. The new foods do not taste the same, but as your palate adjusts, you get used to them. These are surely small sacrifices to make considering the large health benefits. Darwin Deen, MD