Metabolic Syndrome & Obesity
What is Metabolic Syndrome and a brief look into Obesity and how the two are related. What causes Metabolic Syndrome? What are the risks from having one or both of these? What are the signs you have it? How can you prevent it? Can you cure it? If so How? These are some of the questions I will answer as I go on.
According to the American Heart Association a staggering 47 million Americans have it. That’s almost an unprecedented one out of every six Americans. Metabolic syndrome is not a disease in itself. Instead, it’s a group of risk factors — high blood pressure, high blood sugar, unhealthy cholesterol levels, and abdominal fat. These risk factors double your risk of blood vessel and heart disease, which can lead to heart attacks and strokes. They increase your risk for Cardiovascular Disease and of diabetes by five times. “For a diabetic, cardiovascular mortality per 10,000 patient-years at any level of blood pressure is a much higher risk than for somebody who is not diabetic. Research has confirmed a ‘multiplier effect’ for systolic blood pressure when several risky conditions are present.”[i] As you can imagine, if your systolic blood pressure is high, you’re at a much higher risk than it being low.
You also have Coronary Heart Disease which is associated with systolic blood pressure and is further influenced by other risk factors: “elevated cholesterol, low high-density lipoprotein cholesterol (HDL-C), smoking, and diabetes.”1 So, metabolic syndrome increases diabetes, coronary heart disease and Cardiovascular Disease risk. Another major contributor factor is obesity.
Obesity is a major problem, according to the Academy of Managed Care Pharmacy (AMCP.org) “5% of males aged 12 to 19 years have metabolic syndrome, doubling in prevalence to more than 10% in males aged 30 to 39 years and reaching 45% in males aged 60 to 69 years. Approximately one third of Americans between the ages of 50 and 59 years of both genders have metabolic syndrome.14,15”1. Excessive body weight consequently causes insulin resistance (difficulty using insulin in the periphery for metabolism). According to Mayo Clinic, one of three Americans are considered obese, and is becoming an increasingly health problem all around the world.
How do you know if you are obese? Well professionals have deemed the following percentages as a gage;
If the Body Mass Index Weight is below 18.5% – you’re considered underweight. If it’s between 18.5% — 24.9% it’s considered normal. If between 25.0% — 29.9% it’s considered overweight. Lastly, 30.0% and higher is considered obese.
I’ve briefly discussed already what causes metabolic syndrome, let’s dig a little deeper. According to the American Heart Association, metabolic syndrome is characterized by a group of metabolic risk factors in one person, think of these as symptoms, They include:
- “Abdominal obesity (excessive fat tissue in and around the abdomen)
- Atherogenic dyslipidemia (blood fat disorders — high triglycerides, low HDL cholesterol and high LDL cholesterol — that foster plaque buildups in artery walls)
- Elevated blood pressure
- Insulin resistance or glucose intolerance (the body can’t properly use insulin or blood sugar)
- Prothrombotic state (e.g., high fibrinogen or plasminogen activator inhibitor–1 in the blood)
- Proinflammatory state (e.g., elevated C-reactive protein in the blood)
The dominant underlying risk factors for this syndrome appear to be abdominal obesity and insulin resistance. Insulin resistance is a generalized metabolic disorder, in which the body can’t use insulin efficiently. This is why the metabolic syndrome is also called the insulin resistance syndrome.
Other conditions associated with the syndrome include physical inactivity, aging, hormonal imbalance and genetic predisposition. Some people are genetically predisposed to insulin resistance. Acquired factors, such as excess body fat and physical inactivity, can elicit insulin resistance and the metabolic syndrome in these people. Most people with insulin resistance have abdominal obesity.”[ii]
The American Heart Association and the National Heart, Lung, and Blood Institute recommend that the metabolic syndrome be identified as the presence of three or more of these components:
- “Elevated waist circumference:
Men — Equal to or greater than 40 inches (102 cm)
Women — Equal to or greater than 35 inches (88 cm)
- Elevated triglycerides:
Equal to or greater than 150 mg/dL
- Reduced HDL (“good”) cholesterol:
Men — Less than 40 mg/dL
Women — Less than 50 mg/dL
- Elevated blood pressure:
Equal to or greater than 130/85 mm Hg
- Elevated fasting glucose:
Equal to or greater than 100 mg/dL”[iii]
So far we have looked at what causes metabolic syndrome and what are the risks and signs/ symptoms for having it. Now I will discuss Prevention.
According to the New England Journal of Medicine, an individual’s level of physical fitness is directly relative to rate of mortality, and diseases, most specifically chronic disease such as Metabolic Syndrome, Obesity and Cardiovascular Disease. “Although it seems obvious to conclude that healthier persons, who by their nature have higher levels of fitness, will live longer, a wealth of emerging data provides new and exciting insights into this relation. Encouraging data from patients with9,10 and without11,12 cardiovascular disease demonstrate that less fit or less active persons can improve their survival if they increase their level of fitness or physical activity. A program of regular exercise can improve fitness by 15 to 30 percent within three to six months.13”[iv]
This same article goes on to say that, “positive effects of exercise on vascular function, autonomic tone, blood coagulation,3 and inflammation14 are likely to contribute to improved cardiovascular health and survival. Accordingly, the Centers for Disease Control and Prevention,15 the American Heart Association,16 and the American College of Sports Medicine15 recommend that all people adopt a physically active lifestyle and, specifically, that all adults engage in moderately intense physical activity for at least 30 minutes on most — and preferably all — days of the week.”[v]
They are specifically talking about aerobic activities. Sustained aerobic activity for a minimum of 30 minutes or more is the only way to develop Mitochondria. “Mitochondria are self-replicating organelles that occur in various numbers, shapes, and sizes in the cytoplasm of all eukaryotic cells. Mitochondria play a critical role in generating energy in the eukaryotic cell. Mitochondria generate the cell’s energy by oxidative phosphorylation, using oxygen to release energy stored in cellular nutrients (typically pertaining to glucose) to generate ATP. Mitochondria multiply by splitting in two. Respiration occurs in the cell mitochondria.”[vi]
Mitochondria play a HUGE role in the human genome. Their nick name is the “Powerhouse, they do all the work, to make the body work! They are found in high concentrations in the muscle cells that require more energy. Though the primary function of mitochondria is to produce energy, they also play an important role in the metabolism and synthesis of certain other substances in the body. Mitochondria has many functions, from energy conversion, to heat production, they play a HUGE role in metabolic system and perform many other metabolic tasks, such as: Steroid synthesis, regulation of cellular metabolism etc.
Some mitochondrial functions are performed only in specific types of cells. For example, mitochondria in liver cells contain enzymes that allow them to detoxify ammonia, a waste product of protein metabolism.
The development of mitochondria is dependent to each individual. When the energy needs of a cell are high, mitochondria grow and divide. When the energy use is low, mitochondria are destroyed or become inactive. Genetics also play a role mitochondria, some people are born with more than others, which is directly relative to people who are born with a high metabolism. Through prescriptive training you can physiologically change your body. In doing so, you can increase the number of mitochondria one has.
Since the mitochondria are responsible for processing oxygen and converting substances from the foods we eat into energy for essential cellular functions, if there are problems with the mitochondria, it can lead to many defects for adults. These include Type 2 diabetes, Parkinson’s disease, atherosclerotic heart disease, stroke, Alzheimer’s disease, and cancer. Many medicines can also injure the mitochondria. As you may have noticed, these chronic diseases listed here, correlate to the same diseases that are attributed to obesity and metabolic syndrome.
The New England Journal of Medicine, American Heart Association, Cooper Institute (aka Aerobics Institute) have done thousands of studies on these very topics and have published all of their findings. A Metabolic Equivalency Test (MET) is a way to measure a person’s aerobic capacity. Scientifically speaking, it “is a physiological concept expressing the energy cost of physical activities  as multiples of resting metabolic rate (RMR- The amount of calories your body metabolizes/burns in a complete state of rest) and is defined as the ratio of metabolic rate (and therefore the rate of energy consumption) during a specific physical activity to a reference rate of metabolic rate at rest, set by convention to 3.5 ml O2·kg-1·min-1 or equivalently 1 kcal·kg-1· h-1 or 4.184 J·kg-1· h-1.”[vii]
“More specifically, MET is used as a practical means of expressing the intensity and energy expenditure of physical activities in a way comparable among persons of different weight. Actual energy expenditure (e.g., in calories or joules) during a physical activity depends on the person’s body mass, therefore the energy cost of the same physical activity will be different for persons of different weight. However, since the RMR is also dependent on body mass in a similar way, it is assumed that the ratio of this energy cost to the RMR of each person will remain more or less stable for the specific physical activity and thus independent of each person’s weight.”[viii] MET results have found that an individual’s MET score is the strongest predictor of the risk of death among both normal subjects and those with cardiovascular disease. Each 1-MET increase in exercise capacity conferred a 12 percent improvement in survival.[ix]
For managing both long- and short-term risk, lifestyle therapies are the first-line interventions to reduce the metabolic risk factors. These lifestyle interventions include:
- Weight loss to achieve a desirable weight (BMI less than 25 kg/m2)
- Increased physical activity, with a goal of at least 30 minutes of moderate-intensity activity on most days of the week
- Healthy eating habits that include reduced intake of saturated fat, trans fat and cholesterol
In Conclusion, I adhere and prescribe to what Dr. Kenneth Cooper[x], aka “The Father of Aerobics” has spent 40+ years studying and doing research on. Physical Fitness is the a key component to a long and healthy life. Along with history, his research has showed us that in doing 30 sustained minutes of intense aerobic workout 5-7 days a week will help prevent people from getting chronic illnesses, diseases and syndromes. My question is, why isn’t this being taught and even implemented in our school systems? Why is the United States so great a disease and illness management, rather than prevention? Why do 90% of health clubs and gyms and even physicians, why do they NOT teach and implement RMR, MET testing?
ALOT of the stuff I have learned is from my trainer, gym owner Mike Craven; check him out!
[i]http://www.amcp.org/data/jmcp/pages 3-5.pdf: Pg2, Academy of Managed Care Pharmacy.
[ii] http://www.americanheart.org/presenter.jhtml?identifier=4756: American Heart Association
[iii] http://www.americanheart.org/presenter.jhtml?identifier=4756: American Heart Association
[iv] http://content.nejm.org/cgi/content/full/346/11/852: NEJM ,Survival of the Fittest – More Evidence.
[v] http://content.nejm.org/cgi/content/full/346/11/852: NEJM ,Survival of the Fittest – More Evidence.
[ix] http://content.nejm.org/cgi/content/full/346/11/793: NEJM, Exercise Capacity and Mortality among Men Referred for Exercise Testing