Metabolic Syndrome

Metabolic syndrome is when you have 3 or more health problems that
put you at higher risk for diabetes, heart disease, and stroke. It is also known as
insulin resistance syndrome. It’s also called “syndrome X.” If you have metabolic
syndrome, it means you have 3 or more of these:

  • Abdominal
    This means having a waist size of more than 35 inches
    for women and more than 40 inches for men. A larger waist size is most strongly
    tied to metabolic syndrome.
  • High blood
    This means blood pressure of 130/80 mm Hg or higher. Normal blood pressure
    is less than 120/80 mm Hg. High blood pressure is strongly tied to obesity. It
    is often found in people with insulin resistance.

  • High
    fasting blood glucose.

    This means a level of 100 mg/dL or
    higher before treatment.
  • High
    triglyceride level.
    This means a level of more than 150 mg/dL before treatment. Triglycerides
    are a type of fat in the blood.
  • Low HDL
    (good) cholesterol.
    This means less than 40 mg/dL for men and
    less than 50 mg/dL for women.

Each of these still count as a risk factor, even if you are being
treated for it.

Experts don’t fully know what causes metabolic syndrome. Several
factors are connected. Obesity plus an inactive lifestyle adds to risk factors for
metabolic syndrome. These include high cholesterol, insulin resistance, and high
blood pressure. These risk factors may lead to cardiovascular disease and type 2

Metabolic syndrome is more likely the older you are. It may become
the main risk factor for cardiovascular disease, even more than cigarette smoking.
Higher rates of obesity may be related to higher rates of metabolic syndrome.

Insulin resistance may be a cause of metabolic syndrome. But
experts have not found a direct link between the 2 conditions. Hormone changes
caused by chronic stress may lead to abdominal obesity, insulin resistance, and
higher blood lipids (triglycerides and cholesterol).

Other factors that may lead to metabolic syndrome include:

  • Genetic changes in a person’s ability to break down fats
    (lipids) in the blood
  • Inflammation from substances released from fat cells
  • Older age
  • Problems in how fat is distributed in the body

Knowing your risk factors for any disease can help guide you to
take helpful actions. This includes changing habits and being checked by your
healthcare provider for the disease.

Risk factors most closely tied to metabolic syndrome include:

  • Older age
  • Being African American or Mexican American
  • Being African American and female
  • A body mass index (BMI) higher than 25
  • Diabetes during pregnancy (gestational diabetes) 
  • Having a family member with type 2 diabetes 
  • Smoking
  • History of heavy drinking
  • Stress
  • Being past menopause
  • High-fat diet
  • Inactive lifestyle

In general, people do not have symptoms. But high blood pressure,
high triglycerides, and being overweight may be signs of metabolic syndrome. People
with insulin resistance may have acanthosis nigricans. This is darkened skin areas
on the back of the neck, in the armpits, and under the breasts.

You may be diagnosed with metabolic syndrome if you have:

  • Abdominal obesity
  • BMI above 25
  • High triglycerides
  • Low HDL cholesterol
  • High blood pressure or are using medicine to lower blood
  • High fasting blood glucose
  • Increased blood clotting
  • Insulin resistance

Your healthcare provider will figure out the best treatment for
you based on:

  • How old you are
  • Your overall health and past health
  • How sick you are
  • How well you can handle specific medicines, procedures, and
  • Your opinion or preference

Below are the types of treatment for metabolic syndrome.

Weight loss

Losing weight increases HDL (“good”) cholesterol and lowers
LDL (“bad”) cholesterol and triglycerides. Losing weight can also reduce the
risk for type 2 diabetes.

Losing even a small amount of weight can lower blood pressure
and increase sensitivity to insulin. It can also reduce the amount of fat around
your middle. Diet, behavioral counseling, and exercise lower risk factors more
than diet alone.

Lifestyle changes

You will need to stop using tobacco and cut back on the amount
of alcohol you drink. Talk with your healthcare team about ways to get help for

Diet changes

Changes in diet are important in treating metabolic syndrome.
Treating insulin resistance is the key to changing other risk factors. The best
way to treat insulin resistance is by losing weight and getting more physical
activity. Here are healthy ways to change your diet:

  • Include a variety of foods in your diet.
  • Use healthy fats. Polyunsaturated and monounsaturated
    fats may help keep your heart healthy. These healthy fats are found in nuts,
    seeds, and some types of oils, such as olive, safflower, and canola.
  • Choose whole grains such as brown rice and whole-wheat
    bread instead of white rice and white bread. Whole-grain foods are rich in
    nutrients compared with more processed foods. Whole grains are higher in
    fiber, so the body absorbs them more slowly. They do not cause a rapid spike
    in insulin, which can trigger hunger and cravings.
  • Eat more fruits and vegetables. Eat 2.5 cups of
    vegetables and 2 cups of fruit a day. This amount will vary depending on how
    many calories you need. Be sure to choose a variety of fruits and
    vegetables. Different fruits and vegetables have different amounts and types
    of nutrients.
  • When eating out, take part of your restaurant meal home.
    Ask for a take-home box or avoid super-size selections when you order. Many
    restaurant portions are too large for 1 person, so consider sharing an
    entrée. Or order an appetizer instead of a main dish from the entrée
  • Read food labels carefully. Pay close attention to the
    number of servings in the product and the serving size. If the label says a
    serving is 150 calories but the number of servings per container is 3 and
    you eat the entire container, you are getting 450 calories. Choose foods
    that are low in added sugar.


Exercise helps people who are overweight or obese by helping
to keep and add muscle tissue, while burning fat. It also helps you lose weight
faster than just following a healthy diet. This is because muscle tissue burns
calories faster.

Exercise lowers blood pressure and can help prevent type 2
diabetes. Exercise also helps you feel better emotionally, reduces appetite,
improves sleep, improves flexibility, and lowers LDL cholesterol.

Talk with your healthcare provider before starting any
exercise program. Walking is a great exercise for just about anyone. Start
slowly by walking 30 minutes daily for a few days a week. Gradually add more
time so that you are walking for longer periods most days of the week.


People who have metabolic syndrome or are at risk for it may
need to take medicine as treatment. This is more likely if diet and other
lifestyle changes have not helped. Your healthcare provider may prescribe
medicine to:

  • Help lower blood pressure
  • Improve insulin metabolism
  • Lower LDL cholesterol and raise HDL cholesterol
  • Increase weight loss

Weight-loss surgery

Weight-loss surgery (bariatric surgery) is a treatment for
morbid obesity in people who have not been able to lose weight through diet,
exercise, or medicine. It may also help people who are less obese but who have
severe complications from their obesity.

Weight-loss surgery can be done in several ways. The types of
surgery are either malabsorptive, restrictive, or both. Malabsorptive procedures
change the way the digestive system works. Restrictive procedures greatly reduce
the size of the stomach. The stomach then holds less food.

Most people who have metabolic syndrome have insulin resistance.
The body makes insulin to move sugar (glucose) into cells for use as energy. Excess
body weight makes it harder for cells in the body to respond to insulin. If the body
can’t make enough insulin to override the resistance, the blood sugar level
increases. This is type 2 diabetes. Metabolic syndrome may be a start of type 2

Metabolic syndrome greatly raises your risk of:

  • Type 2 diabetes
  • Heart disease
  • Stroke
  • Polycystic ovarian syndrome (PCOS)
  • Fatty liver
  • Cholesterol gallstones
  • Asthma
  • Sleep problems
  • Some forms of cancer

The best way to prevent metabolic syndrome is to:

  • Keep a healthy weight
  • Eat a healthy diet
  • Be physically active

Your diet should be low in:

  • Salt
  • Sugar
  • Solid fats
  • Refined grains

Metabolic syndrome is a lifelong condition that will require
changes in your lifestyle. If you already have heart disease or diabetes, follow
your healthcare provider’s instructions for managing these.

Lifestyle changes for managing metabolic syndrome include:

  • A healthy diet
  • Physical activity
  • Stopping smoking if you’re a smoker or use other tobacco products
  • Losing weight if you are overweight or obese

  • Metabolic syndrome is when you have 3 or more health
    problems that put you at higher risk for diabetes, heart disease, and
  • Metabolic syndrome is more likely the older you are. It
    may become the main risk factor for cardiovascular disease, ahead of
    cigarette smoking. Higher rates of obesity may be related to higher rates of
    metabolic syndrome.
  • Knowing your risk factors for any disease can help guide
    you to take helpful actions.
  • Treatment may include weight loss, diet changes,
    exercise, and medicine.

Tips to help you get the most from a visit to your healthcare provider:

  • Know the reason for your visit and what you want to happen.
  • Before your visit, write down questions you want answered.
  • Bring someone with you to help you ask questions and remember what your provider
    tells you.
  • At the visit, write down the name of a new diagnosis, and any new medicines,
    treatments, or tests. Also write down any new instructions your provider gives
  • Know why a new medicine or treatment is prescribed, and how
    it will help you. Also know what the side effects are.
  • Ask if your condition can be treated in other ways.
  • Know why a test or procedure is recommended and what the results could
  • Know what to expect if you do not take the medicine or have the test or
  • If you have a follow-up appointment, write down the date, time, and purpose for
    that visit.
  • Know how you can contact your provider if you have questions.