Metabolic syndrome.

The metabolic syndrome is present in someone when certain conditions are present. It is often associated with insulin resistance although it isn’t clear yet whether it is a cause or an effect or both. What is clear, is that patients who have metabolic syndrome  are at greatly increased risk of many medical problems including:

• diabetes
• coronary artery disease
• metabolic syndrome
• insulin resistance
• fatty liver disease
• dementia

The factors which make up the metabolic syndrome can be dramatically reduced through a low carbohydrate diet. While there is no simple test for insulin resistance, experts have shown that the successful dietary treatment of metabolic syndrome will reduce or eliminate a patient’s insulin resistance successfully.

Insulin Resistance

When sugar enters the body (either simple sugars or carbohydrates) the pancreas produces enough insulin to reduce blood sugar levels to normal. In folks with type 2 or non insulin dependent diabetes (NIDDM), the pancreas is unable to produce enough insulin to keep blood sugars normal because body’s cells have become resistant to the effect of insulin. The cells cannot take up the sugar as easily as they once could. The pancreas must make more and more insulin to try to bring down the blood sugar. Eventually the pancreas loses the ability to keep up with the blood sugars and the patient will need injections of insulin.

Vicious cycle: Insulin causes insulin resistance

Insulin has serious side effects, the most direct of which, is that it causes your fat cells to grow, multiply, and store increasing amounts of fat in the middle of the body and in the liver. These fat cells produce a hormone known as “resistin” which makes insulin resistance worse. A vicious cycle ensues building more and more fat which causes more resistance which leads to higher amounts of insulin being produced which generates even more fat.  More insulin generates more fat in the fat cells which then make more resistin leading to the need for ever increasing amounts of insulin.

Peter Attia, a founding member of the NuSi describes insulin resistance in a very moving video here.

INSULIN RESISTANCE SYNDROME 

The following information is taken directly from the Barnes-Jewish Hospital website.

BACKGROUND: Many patients with high levels of plasma triglycerides, low HDL cholesterol, high uric acid, Type 2 (mature onset) diabetes Mellitus, obesity, increased risk of clotting by virtue of high Plasminogen Activator Inhibitor Activity (PAI-Fx), and essential hypertension (aka Metabolic Syndrome) have an inherited resistance to the action of insulin. This causes the pancreas to overproduce insulin. To get the same amount of glucose (sugar) from the blood into cells, a normal person might require 1 unit of insulin for 10 mg of glucose (arbitrary numbers), while you might require 10 units of insulin for the same 10 mg of glucose. Thus, your cells are resistant to the action of your own insulin. This is INSULIN RESISTANCE.

DIAGNOSIS: A simple, inexpensive, shorthand way to diagnose insulin resistance and hyperinsulinemia is a fasting serum insulin. If serum insulin is high (L>20 uU/mL), or c-peptide is high (>4.6 ng/mL), insulin resistance may be present.

Consensus definition of Metabolic syndrome (incorporating IDF and AHA/NHLBI definitions)* (these are the folks most likely to have insulin resistance)

Any 3 of the following lead to a diagnosis of metabolic syndrome:

• Elevated waist circumference at the belly button. Waist circumference >102 cm (40 inches) in men, >88 cm (35 inches) in women
• Triglycerides 1.7 mmol/L (150 mg/dL) or greater
• HDL-cholesterol <1.04 mmol/L (<40 mg/dL) in men and <1.29 mmol/L (<50 mg/dL) in women
• BP 130/85 mmHg or greater without medication
• Fasting glucose 5.6 mmol/L (100 mg/dL) or greater.

*There are many definitions of metabolic syndrome/insulin resistance which are all a variation on the above basic parameters. This one is commonly used and easy to determine.

TREATMENT:

A low carbohydrate diet often reduces weight to the point of putting the insulin resistance in metabolic syndrome in remission.

The medication treatment of choice is Metformin, also the oral drug of choice in Type 2 diabetes, at a dose of 500 or 850 mg, three times/day with meals. By lowering insulin resistance and insulin, this will help to do the following: Lower triglycerides, Elevate HDL cholesterol; Treat Type 2 diabetes (if present); Prevent the eventual appearance of Type 2 diabetes Lower blood pressure; Lower PAI-Fx; Lower uric acid; Lower body weight.

Because Metformin does not lower blood glucose in normal subjects (non-diabetics), it can be given safely to people who are not diabetic.

To proceed to “treatment” with a low carbohydrate diet, click next
For the science minded, various definitions of metabolic syndrome are found here

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