What is metabolic syndrome?

DEAR DOCTOR K:

My doctor says I have metabolic syndrome. He said it’s “like diabetes but not diabetes,” which I don’t understand. Can you explain what it is, and how I can fix it?

DEAR READER:

Metabolic syndrome is quite common, but not very well known. Many of my patients have it; nearly 50 million Americans have it — and many of them don’t know it.

Metabolic syndrome is dangerous. If you have it, you have a much higher risk of several major health conditions. Recent studies find that your risk of developing diabetes is four to five times higher. I guess that’s what your doctor meant when he said it was “like diabetes but not diabetes.” Your risk of stroke or a heart attack is about double. Your risk of dying prematurely is 30 to 60 percent higher.

Most important, you can cure it with changes in your lifestyle before you develop health problems.

You have metabolic syndrome if you have three or more of the following:

  • High blood pressure (hypertension).
  • Excess belly fat. This is measured as a waist size of 40 inches or more for men or 35 inches or more for women.
  • High triglycerides. This blood fat is often checked when you have a blood test for cholesterol.
  • Low levels of high-density lipoprotein (HDL). This is often called “good cholesterol.”
  • High fasting blood sugar.

By the way, if you just determined that you have only one or two, but not three, of these factors, don’t feel entirely relieved. You’re still at higher risk of heart attack and stroke than people without any of these risk factors.

Fortunately, you can take many steps to prevent or avoid metabolic syndrome:

  • Maintain a healthy body weight.
  • Get regular exercise.
  • Choose a healthy diet. It should be low in salt, in saturated and trans fats, and in highly processed foods such as white bread and sugary sodas. It should be high in omega-3 fats (as found in salmon and tuna, for example), in whole grains and fiber, and in vegetables and fruit.
  • Drink only moderate amounts of alcohol (one drink per day for women, one to two for men).
  • Don’t smoke.

Talk to your doctor about whether you need medicines to lower blood pressure or triglycerides if they are high, and to raise HDL if it is low and is not raised just by exercising.

Also talk to your doctor about whether you need medicines to lower blood sugar if you have diabetes or “pre-diabetes.” People with this condition have blood sugar that is above normal but not at diabetic levels.

Metabolic syndrome is a condition that doesn’t always cause symptoms but does put your health at risk. This is especially true if you have other risk factors for heart disease, such as smoking or having other close relatives with heart disease.

If you have metabolic syndrome, you may be able to eliminate it completely without medicines — just with changes in diet and exercise.

(This column is an update of one that ran originally in August 2012.)