Metabolic Syndrome (or "Syndrome X")

What is Metabolic Syndrome?

The metabolic syndrome is a cluster of risk factors that increases the risk of coronary heart disease and type two diabetes. It is characterised by raised fasting plasma glucose, low HDL (protective/good) cholesterol, high LDL (poor) cholesterol, raised triglycerides, abdominal obesity and high blood pressure.

Current estimates suggest around 20-25% of the worlds population have the metabolic syndrome (1). Those who have the metabolic syndrome are twice as likely to die from and three times as likely to have a heart attack or stroke compared to non metabolic syndrome sufferers(1). Additionally those with metabolic syndrome are five times more likely to develop type two diabetes at some point in their life (1,3). Current Australian estimates produced by the 2005 AusDiab study state that 1.7 million Australians have diabetes, but nearly half of all cases of type two diabetes remain undiagnosed (2). Approximately 275 Australians develop diabetes every day (2). Diabetes is the fastest growing chronic disease in Australia and one of the most common world wide and is the fourth leading cause of death in the developed world 1,4).

This cluster of cardiovascular disease (CVD) risk factors that represents metabolic syndrome is expected to create a tsunami of heart disease and stroke cases creating a CVD epidemic of biblical proportions.

The Link: Diabetes and Metabolic Syndrome

Globally 3.2 million people die from complications associated with diabetes (1). Type two diabetes accounts for 90% of all cases of diabetes and has total financial cost of 10.3 billion dollars (2). Type two diabetes is a leading cause of premature death and illness due to it’s association with CVD, and is now responsible for up to 80% of all CVD deaths (1,2,3). 

The metabolic syndrome and its cluster of risk factors is most commonly experienced is those who are suffering from glucose intolerance or type two diabetes. This factor leads to substantial disease burden due to the additional cardiovascular disease risk of the metabolic syndrome, which has been suggested to be beyond the risk of each abnormality (1,3,4).

The metabolic syndrome is not however just limited to those suffering form diabetes and impaired glucose  tolerance. In fact many individuals experiencing the first signs of metabolic syndrome do so well before any formal diagnosis of type two diabetes has been made. These initial signs are represented by a elevated blood glucose (hyperglycemia) and triglyceride level and a decreased HDL (protective/good) cholesterol. These factors in there own right significantly increase an individuals risk of CVD. In fact those individuals with either or both type two diabetes or metabolic syndrome have the same CVD risk as a current cigarette smoker.

What Causes Metabolic Syndrome

What causes metabolic syndrome is a hotly debated topic amongst experts however most would agree that central obesity and insulin resistance are significant factors (1,3,4). Additional factors that may also have a casual effect include genetics, physical inactivity, poor nutritional status, ageing, a pro inflammatory state and hormonal changes (1). The role of these aspects do however appear to be greatly influenced by the ethnic origin of the individual (1).

1. Insulin Resistance

The pancreas's beta cells are responsible for the bodies production of the vital hormone insulin. Insulin is the key hormone responsible for driving glucose into the bodies cells to be utilised as a source of fuel. Insulin resistance occurs when cells in the liver, skeletal muscle and adipose/fat tissue become less sensitive and eventually resistant to insulin (1,3,4).  As a consequence glucose remains in the blood stream as it is no longer being taken up by the cells. This leads to further production of insulin (hyperinsulinlaemia)  in order to remove the high levels of blood glucose, which over time weakens the beta cells of the pancreas and eventually leads to beta cell failure (1). If the pancreas can no longer produce insulin then a person’s ability to control their blood sugar is lost which subsequently leads to a diagnosis of type two diabetes. Prior to this occurring the body is already in a pro inflammatory state and an accumulation of triglycerides has begun to occur. This leads to cellular damage and is characterized in it’s early stages by low HDL (good) cholesterol, high triglycerides,  high alanine transaminase (liver function test) , increased waist circumference and potentially raised serum uric acid levels.

2. Central Obesity

Many experts believe that central obesity is the catalyst to metabolic syndrome and insulin resistance (1,3,4,5). Obesity is an important independent CVD risk factor that is routinely associated with high cholesterol levels, high blood pressure, raised blood sugar and low HDL (good) cholesterol. Research indicates that obesity is associated not only with an increased risk CVD but also type two diabetes, some forms of cancer and osteoarthritis. Obesity is internationally recognized as a body mass index of equal to or greater than 30kg/m2. However, more indicative of metabolic syndrome is an individuals waist circumference or the accumulation of fat around the abdomen (1).  

Criteria of Metabolic Syndrome in Adults

The International Diabetes Federation Definition

International Diabetes Federation”: Worldwide Definition of the Metabolic Syndrome. www.idf.org/idf-worldwide-definition-metabolic-syndrome

Ethnic specific values for waist circumference

How is it diagnosed?

General investigation should include blood tests of cholesterol and lipids, blood sugar, liver function and kidney function (these tests require you have to have been fasting overnight). Analysis of the urine and a urine albumin to creatinine ratio (looking for protein in the urine as a sign of kidney damage).

Ways to reduce your risk.

Incorporate as many lifestyle changes as you can. Eating a healthy diet, exercising regularly, and losing weight will all dramatically reduce your risk of diseases associated with Metabolic syndrome.

Make dietary changes. Eat plenty of natural wholegrain foods, vegetables and fruit,  reduce portion sizes and limit foods high in sugar and fat. Reduce saturated foods such as meat, full cream dairy and many processed foods. This will help improve your cholesterol levels. Reducing alcohol consumption to less than 2 standards drinks a day may help lower triglyceride levels.

Increase your physical activity level- regular exercise raises the level of HDL (‘good’) cholesterol in the blood, which helps remove excess cholesterol from your body and protects against heart disease. Exercised muscle cells are also more sensitive to insulin.

Manage your weight– increasing physical activity and improving eating habits will help you lose excess body fat. As a result, your blood pressure will drop and your cells will be more sensitive to insulin.

Quit smoking– smoking increases your risk of heart disease, stroke, cancer and lung disease. Quitting will have many health benefits, especially if you have Metabolic syndrome.

Medication may be required– Lifestyle changes are extremely important but sometimes medication may be required to manage the condition. The most     important thing is to reduce your risk of heart disease, stroke and Type 2 diabetes.

How will it affect me?

Metabolic syndrome can present with a variety of symptoms depending on the associated medical  conditions. Some people with Metabolic Syndrome may not have any symptoms initially. You may experience the following symptoms:

· Tiredness and fatigue.

· Sleep apnoea (transient periods of breathing sensation and snoring during sleep) associated with obesity.

· Headache (due to high blood pressure)

· Frequent urination, thirst, weight loss or gain due to high blood sugars.

· Chest pain or shortness of breath on exertion  (i.e. poor blood supply to the heart).

· Collapse or other neurological symptoms due to blockage of the vessels that supply the brain with blood.

Where do I get help?

· Your doctor.

· An accredited practicing dietician (contact the dieticians Association of Australia: http://www.daa.asn.au)

· International Diabetes Institute. (03) 9258 5000.

· Diabetes Australia (www.diabetesqld.org.au) 1300 136 588

· Quitline (137 848) www.quit.org.au

References

1.)“International Diabetes Federation”: Worldwide Definition of the Metabolic Syndrome. www.idf.org/metabolic-syndrome

2)”Diabetes Australia”. www.diabetesaustralia.com.au.

3)“National Heart, Lung and Blood Institute”. www.nhlbi.nih.gov/health/dci/Diseases/ms/ms_whatis.html

4)“Mainstreaming the Metabolic Syndrome: a definitive definition”.www.mja.com.au/public/issues/183_04_150805/zim10442_fm.html

5)“Metabolic Syndrome”. www.heart.org/HEARTORG

For More Information

Wesley Corporate Health

Level 2 / 46 Edward Street

Brisbane  Qld  4000

Phone:  07 3234 2600

Email: wellness@weshealth.com.au

Disclaimer

This Fact Sheet is provided for your information only and does not replace qualified medical advice. The information provided may not apply to every person or all situations. A medical practitioner should be consulted for all treatment and medication.

All About Glucose!

What is Glucose?

Foods containing carbohydrate, such as potatoes, breads and cereals, are broken down for absorption and converted to glucose to supply energy to active muscles and the brain. 

Normally your blood glucose levels increase slightly after you eat, which triggers your pancreas to release insulin to control your glucose levels. This is an important process as an increased level of blood glucose over time can damage your eyes, kidneys, nerves and blood vessels.

What is an appropriate level?      

Ideal blood glucose (fasting) is less than 5.5mmol/L. It is important to maintain your blood glucose under this level as certain conditions can result from persistently high blood sugar levels (hyperglycaemia) or persistently low blood sugar levels (hypoglycaemia). The onset of diabetes is characterised by long-lasting hyperglycaemia and is the most prominent disease related to failure of blood sugar regulation.

Who should have their blood glucose checked?

It is recommended that all adults have their blood glucose levels checked once a year. Those people at high risk of developing diabetes should have their blood glucose tested more frequently. This includes anyone with a family history of diabetes, is overweight or obese or is over the age of 45.

Untreated, high glucose levels can cause serious damage to many parts of the body and lead to stroke and heart disease. Symptoms are not easily recognised, thus regular glucose checks are suggested. Blood glucose testing can be used as an active tool in the prevention and maintenance of diabetes. A simple blood glucose test can:

· Screen for diabetes

· Determine if blood sugar levels are abnormally low

· Monitor treatment of diabetes

· Check for gestational diabetes

What is Diabetes?

Diabetes is the name given to a group of different conditions which result from an excess of blood glucose. This excess is caused by either little or no insulin being produced by the pancreas, resulting in the glucose passages being blocked off.

There are two main types of diabetes – type 1 and type 2; they are classified based on the presence or absence of insulin production.

Type 1 diabetes is the less common of the two, accounting for just 10-15% of all cases. It usually affects children and young adults, however, it can occur at any age. Type 1 diabetes results when the body’s immune system mistakenly destroys the cells of the pancreas where insulin is produced. As insulin can no longer be produced it needs to be replaced through daily injections.

Type 2 diabetes is the most common form of the disease and usually affects adults. It is a lifestyle disease which is strongly associated with high blood pressure, abnormal blood fats and excess weight around the waist.

People who develop Type 2 diabetes are usually insulin resistant, which means their pancreas produces insufficient amounts of insulin to maintain the correct glucose balance. While there is no single cause for developing Type 2 diabetes, there are well-known risk factors:

Modifiable Risks

· Excess weight

· High blood pressure

· Smoking

· High cholesterol

· Physical inactivity

· Poor nutrition

Non-Modifiable Risks

· Family history

· Age

· Aboriginal or Torres Strait Islander

· Ethnic background of either Melanesian, Polynesian, Chinese or Indian origin

What is Pre - Diabetes?

There are three common conditions which are linked to an increased likelihood of developing Type 2 diabetes: impaired fasting glucose (IFG), impaired glucose tolerance (IGT) and gestational diabetes.

IFG and IGT are conditions in which blood glucose levels are higher than normal, but not high enough to be diagnosed as Type 2 diabetes. The difference between the two conditions is determined by one’s fasting blood glucose response to sugar intake. If blood glucose level rises abnormally, this is classed as IGT. On the other hand, if the blood glucose level does not rise abnormally after the sugar intake, but is still higher than the normal (5.5mmol/L) or non-diabetic range, this is diagnosed as IFG.

Gestational diabetes typically develops between the 24th - 28th week of pregnancy and usually goes away after birth. This type of diabetes is due to an insulin resistance which develops as a result of hormones produced by the placenta. These hormones block the action of the mother’s insulin, causing a build up glucose. Gestational diabetes affects 3 - 8% of all pregnant women.

Symptoms of Diabetes

The symptoms indicative of Type 1 diabetes are often sudden and can be life-threatening, therefore it is  often diagnosed quite quickly. The symptoms of Type 2 diabetes are not quite as obvious and can often go unnoticed or even dismissed as a part of ‘getting older’.

Common symptoms of Type 2 diabetes include:

· Excessive thirst

· Feeling tired and lethargic

· More frequent than normal urination

· Mood swings

· Increased hunger

· Gradual increase in weight

· Blurred vision

How can I reduce my glucose level?

Regular exercise

Aim for at least 30 minutes of moderate intensity physical activity on all or most days of the week. Choose activities that are aerobic in nature such as walking, jogging or swimming. This helps to manage your weight and reduce blood glucose levels and can also improve your blood pressure and cholesterol.

Make healthy food choices

· Eat less foods containing saturated fats and more fruit and vegetables. This will help manage your weight and reduce your risk of heart disease

· Enjoy a diet based on high fibre and low glycemic index (GI) carbohydrate foods such as wholegrain breads and cereals, beans and lentils

· If you have a low blood glucose level, dietary changes such as eating small frequent meals, and choosing complex carbohydrates rather than simple sugars can help regulate your glucose level

Overweight

Lose excess weight by eating a healthy diet and participating in regular physical activity. This helps the body to become more sensitive to insulin and use glucose more effectively.

Medical treatment

Lifestyle changes are extremely important in reducing your glucose level, however, sometimes medication may be necessary to further manage your condition. You will need to consult your doctor for any advice on medication.

References

www.diabetesaustralia.com.au

www.dhhs.tas.gov.au/healthyliving/diabetes

For more Information

Wesley Corporate Health

Level 2 / 46 Edward Street

Brisbane  Qld  4000

Phone:  07 3234 2600

Email: info@weshealth.com.au

Disclaimer

This Fact Sheet is provided for your information only and does not replace qualified medical advice. The information provided may not apply to every person or all situations. A medical practitioner should be consulted for all treatment and medication.

SLEEP More, WEIGH Less

Did you know that under-sleeping can lead to poor performance and impaired judgement and has also been linked to depression, obesity, diabetes and hypertension. A new study of 1,200 people showed that the average Australian adult gets less than seven hours sleep a night, below the seven to eight hours recommended by sleep experts.

A study by Columbia University, found people who slept four hours or less per night were 73% more likely to be overweight or obese. Also, people who habitually slept for five hours had 15% more ghrelin, a hormone which increases feelings of hunger, than those who slept for eight hours. Those who slept for less time were also found to have 15% less leptin, a hormone which suppresses appetite. "These differences are likely to increase appetite, and therefore contribute to obesity" Dr Taheri states. The subjects in the study also tended to eat more sweet and starchy foods when sleep was cut short.

While research continues, sleep still remains one of the body's most mysterious processes. We do know that sleep is absolutely necessary for survival and even occasional sleeping problems can make daily life feel more stressful or cause you to be less productive. Sleep loss also affects growth hormone secretion that is linked to obesity and impairs the body's ability to use insulin, which can lead to the onset of diabetes. It is paramount that we discover more about this activity where we spend a third of our lives - sleeping.

There are prescriptions and non-prescription drugs, herbs, remedies, technologies, etc that may help you get a good night's sleep. Some work for some and not for others.

Here are some tips you can try at home tonight. These tips are intended for the average adult, but not necessarily for children or persons experiencing medical problems:

• Imagining - Think of a hammock - you're up off the ground, wrapped in a cocoon of comfort, swaying gently in the open air. The sun is warm on your face and there's a cool breeze blowing you back and forth. This visualisation helps you "see" what the reward for sleeping will be, getting you more in the mood to sleep. Visualisation has proved helpful in developing the appropriate brain wave patterns for sleep.
• Magnesium - Has a calming effect on the nervous system. It is part of bones and cells, especially the smooth cells of arteries, and assists in the absorption of calcium and potassium. Over 300 enzymes in our body need magnesium to function properly. It is so important, that the brain stores a "safety supply" to have in the event of a drop in the magnesium reserves.
• Nutmeg - Grind fresh nutmeg and serve it with warm low fat milk and a touch of honey. Milk is naturally high in calcium and rich in tryptophan; together they can be a powerful tranquilizer (and very delicious).
• Hot foot baths - In the Eastern World, a hot foot bath is a traditional remedy; it draws blood from the brain to calm a racing mind. Try soaking your feet in a hot bath with a cupful of Epsom salts and a few drops of lavender essential oil, which will soothe you. Your feet absorb the magnesium from the Epsom salts and relax you further.
• Stomach rub - Soothes down the digestive system and helps bring about deeper relaxation. Lie on your back and place your hand on your belly button. Begin to make small circles in a clockwise direction as you gently glide your hand over your stomach. Let your circles gradually become bigger and bigger. When your circles reach the outside of your stomach, gradually reduce their size until you are back at your belly button again. Reverse the direction; repeat the whole series with your other hand and do this several times. Doing this with lavender oil can create an even more relaxing experience.
• Listening to an audio book - The brain works like a tape player - with one main auditory loop that processes words. If you fill that loop with an interesting book, there's no room for your own worrisome internal narrative. Especially helpful for those who have continuous thoughts running through their heads.
• Deep breathing - Take a deep breath in then slowly release out - focussing on your breathing causes your mind to get distracted from your worries and focussed on your breathing. Doing this for a few minutes can relax your mind and help you get a more peaceful sleep.
• Turn it off - Sleep experts suggest refraining from doing work, watching television, or being on the computer at least an hour before bed time. This allows your brain to start to 'wind down'.

References

1. Gangwisch. D, Malaspina. D, Boden-Albala. B, (2005) Inadequate Sleep as a Risk Factor for Obesity: Analyses of the NHANES I; COlumbia University, College of Physicians and Surgeons, New York, NY.
2. Taheri. S, Lin. L, Austin. D, Young. T, Mignot. E, (2004) Short Sleep Duration is Associated with Reduced Leptin, Elevated Ghrelin, and Increased Body Mass Index. PLos Med 1(3): e62. doi:10.1371/journal.pmed.0010062.