Metabolic Syndrome

You will have most probably heard a lot about “metabolic syndrome”, or “syndrome X”. In 1988, a man called Gerald Reaven noted that several risk factors such as high cholesterol, high blood pressure and high blood sugar are commonly clustered together in overweight individuals. This clustering he called Syndrome X, and he recognised it as a high risk factor for cardio vascular disease.

The most common symptoms of metabolic syndrome include high cortisol levels, high blood pressure, high blood sugar, fatigue, and a “spare tyre” of weight around the middle. Metabolic syndrome often causes a fairly rapid fat gain, especially around the tummy, and left unchecked, predisposes a person to diabetes and heart disease. Recent surveys estimate that 32% of Maori, 39% of Pacific People and 16 to 40+ % of New Zealanders of European descent suffer from the metabolic syndrome.

The BMI Index

A good way to determine whether you have a weight issue, leading to metabolic syndrome is to determine your BMI. The BMI is simply height over weight squared, and all you need is a cloth measuring tape and some scales. To determine the BMI first determine the person’s height in metres, then divide the weight (kg) over height (m2) which would give you the BMI.

A BMI of more than 25 means you are overweight; a BMI of more than 30 would mean you are obese. If you are of Asian descent, you have a weight problem if your BMI is above 21. Many studies indicate that actual waist circumference may well be a better predictor of metabolic syndrome, cardiovascular risk factor and death from heart disease than body-mass index (BMI) alone. And by using waist circumference, along with the level of triglycerides in the blood, may predict metabolic syndrome to an even higher degree.

Signs & Symptoms

Some of the typical signs and symptoms of metabolic syndrome:

• Fatigue, sleepiness almost immediately after a high carbohydrate meal. (hypoglycemia)
• High blood sugar and cortisol levels
• Hypertension (high blood-pressure)
• Dyslipidemia (high cholesterol)
• Pro-thrombotic state – more prone to having a stroke and heart disease
• Microalbuminurea. A microalbumin urine test determines the presence of the albumin (protein) in the urine. In a properly functioning body, albumin is not normally present in urine because it is retained in the bloodstream by your kidneys.
• Inflammation (elevated CRP and/or ESR)
• Brain fogginess & inability to focus
• Visceral obesity, fat around the tummy, a “spare tyre”. Does your stomach precede you? Do you have an apple-shaped body type? and do you have your own personal spare tire? Insulin resistance is now well known to be associated with intra-abdominal fat as opposed to total fat distribution
• Intestinal bloating, flatulence, constipation and/or diarrhoea
• Depression independent of depressive events
• Erectile dysfunction (ED)

I call this condition metabolic “sin”drome, and if left unchecked will progress. Metabolic syndrome is again one of those “diseases of modern civilisation” and not a condition that drops into your lap from nowhere. You create it with your own way of living, thinking and eating in particular — you guessed it: refined carbohydrates, fizzy drinks, white bread, fatty takeaway, the good old Kiwi way of life.

My concern is that there are many children in NZ who will end up developing metabolic syndrome because of their sedentary lifestyle. When I was a kid we used to walk everywhere. Many children today eat too much of the wrong foods and do too little; they get stressed out with those crazy fast paced computer games which help to stimulate their cortisol levels.

Whatever happened to playing outside? Sedentary lifestyles create rising cortisol levels which lead to all sorts of internal problems, increasing fat deposition and creating insulin resistance. I found a study revealing that Australian kids are amongst the fattest in world. America may lead the world with adult obesity, but Australia leads the world in childhood obesity. I presume that the statistics of NZ and Australian children would be similar, and a quick drive around South Auckland and many other parts of this country will show you exactly what I mean.

Here is the progression, and this is how metabolic syndrome slowly develops as the years roll by:

The Progression of Metabolic Syndrome

Insulin Resistance – develops in childhood

Cholesterol problems – between 15 – 35 years of age

High blood pressure – between 35 – 50 years of age

Impaired Fasting Glucose – between 40 – 55 years of age

Diabetes – 50 – 55 years of age

Cardiovascular disease – above 55 years

Research reveals that stress affects your waistline

In my clinical experience, I believe that most Kiwis falsely blame their weight gain on junk foods, carbohydrates and a lack of exercise rather than their fatigued, stressed and hurried lifestyle. This is how the weight-loss clinics like to think too, and a whole industry has been built around diet foods and exercise to promote weight loss without addressing the real underlying issues.

We need to focus on health and wellness and forget about hopping on scales and calorie reduction, and this means looking at the behaviours, eating habits and the stresses in our lives. It is very important to point out a recent two-year New Zealand study of 225 overweight or obese Kiwi women involving non-dieting but including relaxation techniques.

According to Caroline Horwath, senior lecturer in the University of Otago’s Department of Human Nutrition, the study revealed that the women lost an average of 2.5 kilograms and suffered “very substantial reductions” in depression, back pain, stomach upsets, insomnia and bowel problems like diarrhoea or constipation. Dr. Horwath said that stress and negative emotions can trigger women to overeat and consume high fat and high sugar foods. The study included relaxation techniques such as progressive muscle relaxation, abdominal breathing, and more effective tools to manage time, stress and negative emotions. Incredible, but the weight loss was achieved without focus on diet, which shows you that “diets don’t work”.

In the past ten years I have seen an explosion of weight-loss clinics, “fat-burning” shakes and supplements and internet based products designed to help an overweight person shed their spare tyre. But nothing has changed for Kiwis; we are fat and becoming fatter. It is time we got back to basics – eating good nutritious food, home cooked meals which are full of the nutrition our bodies crave. We also need to take a “chill pill” and relax more.

Stress linked to weight problems

Dr. James L. Wilson, an American expert on stress presented a seminar series entitled “Adrenal Fatigue and Its Relationship with Metabolic Syndrome & Hypothyroidism” in August 2009 in NZ to over 300 health-care professionals. Adrenal fatigue and metabolic syndrome are two different faces of a patient’s underlying stress disorder, according to Dr. James Wilson: “Both metabolic syndrome and adrenal fatigue are in epidemic proportions in the US and in most industrialised nations, including New Zealand. These conditions can arise as stress mal-adaptations and are intimately related, yet are often slow to be recognised, if at all, by conventional medicine,” said Dr. Wilson.

Recent figures ranking New Zealand as the third fattest nation in the OECD emphasise the need to understand why Kiwis are gaining so much weight. Stress tends to make people overeat to bolster their lagging energy levels and, Dr. Wilson explains, high cortisol levels caused by stress combined with high blood sugar and other related factors can lead to metabolic syndrome.

What many people don’t know is the link between depleted adrenal function (adrenal fatigue), hypothyroidism and metabolic syndrome. If the adrenal glands remain strong under stress, it leads to metabolic syndrome; if the adrenal glands become weak due to continued stress, it can lead to adrenal fatigue. Unlike metabolic syndrome, adrenal fatigue generally produces a person to having low cortisol levels, low blood pressure, low blood sugar, and fatigue that leaves people feeling chronically below par and “limping through life”. People experiencing adrenal fatigue often overeat because they try to drive themselves with salty or sweet foods.

Adrenal Fatigue vs Metabolic Syndrome

The main presenting differences between adrenal fatigue and metabolic syndrome

Metabolic syndrome

• High levels of the hormones cortisol, aldosterone and the mineral sodium
• Low levels of the mineral potassium
• High blood sugar levels
• Fluid retention
• Abdominal fat

Adrenal fatigue

• Low levels of the hormones cortisol, aldosterone and the mineral sodium
• High levels of the mineral potassium
• Low blood sugar levels
• Mild dehydration
• Any body shape

Poor Adrenal Function

Poor adrenal function may underpin hypo-thyroidism and is often linked to metabolic syndrome. Dr. Wilson also pointed out the interesting relationship between stress, fatigue, poor adrenal function and metabolic syndrome. I have learned over the past few years as a naturopath that it is of limited value in just treating a person’s thyroid gland when they present with hypothyroidism.

We know that many people suffer with hypothyroidism in NZ (approximately 40% of women have low thyroid function in NZ), and many of these patients who go to their medical doctor may well be disappointed to discover that their blood tests all come back normal, and reveal the patient to be euthyroid (“well-thyroid”).

Whilst some patients benefit from selenium, zinc or iodine supplementation to increase their thyroid function, by treating the adrenal glands and allowing them to function optimally the thyroid gland will be allowed to function much more efficiently, which in turn reduces the thyroid’s demand for several trace elements.

Do you have a problem with the adrenal glands or the thyroid gland, or both? It is common for those with adrenal fatigue to have some degree of thyroid involvement. And it is also common for those with thyroid problems to have adrenal involvement. Many practitioners will often focus on thyroid treatment, especially if the person is fatigued and overweight, yet neglect to treat the person’s adrenal glands, and if they do treat the adrenal gland, will just recommend an adrenal support product. But how do you know if you suffer more with a thyroid problem, or have an adrenal problem?

Dr. James Wilson spoke of the common but often overlooked connection between the thyroid gland and the adrenal gland. The adrenal glands main purpose is to produce and release certain regulatory hormones and chemical messengers, and the connection between thyroid and adrenal gland is a very important clinical consideration.

The two primary adrenal hormones — adrenaline and cortisol — help control body fluid balance, blood pressure, blood sugar and other central metabolic functions. Low adrenal can actually cause someone’s thyroid problem to be much worse than it would be otherwise, and this occurs primarily due to the decreasing amount of circulating cortisol. Cortisol levels tend to decrease as the person moves into the “resistance” phase of continuing low-grade stress.

Cortisol

Cortisol (produced by your adrenal gland) affects your thyroid gland in three major ways:

• Cortisol facilitates the release of TSH (thyroid stimulating hormone) from the pituitary gland.
• Cortisol facilitates conversion of the inactive thyroid hormone (T4) to the active T3 form.
• Cortisol allows each T3 cell receptor to more readily accept T3.

Hypothyroid patients need to be aware of their adrenal hormone (cortisol) levels since many of the symptoms of adrenal problems are the same as hypothyroid symptoms. Many conventional medical doctors commonly overlook adrenal problems, except in extreme cases such as Addison’s disease (extreme decreased adrenal function). Conventional tests aren’t adequate for adrenal functions since they generally consist of a 24 hour urine test that does not take into account different levels of hormones in the urine at different times of the day.

A more accurate test would be to collect samples of saliva at 4 different times of the day, giving a more detailed picture of the patient’s daily cyclical adrenal function. Let’s now explore the different yet similar clinical presentations of adrenal fatigue and hypothyroidism.

Metabolic syndrome can be reversed

According to Dr. Wilson, many people going through adrenal fatigue experience some form of decreased thyroid function as well. Often when low thyroid is unresponsive to thyroid therapy, adrenal fatigue is a contributing factor. If this is the case, both the adrenals and the thyroid need support for optimal thyroid function. An expert on endocrine imbalances and their impact on health, including the effects of stress on adrenal function, Dr. Wilson reviewed and expanded upon the toll that stress takes on the body.

Dr. Wilson fully believes that metabolic syndrome can be reversed with a program of lifestyle changes including:

• a balanced diet
• stress management
• regular relaxation
• effective targeted nutritional adrenal support.

“There is a tremendous amount we can do to naturally balance the effects of stress on our bodies and compensate for stressful life events and stressful lifestyles. In the many years I’ve spent treating patients, and researching, writing and speaking, I’ve seen that if the physiological and biochemical mechanisms that deal with stress are properly supported, people can withstand quite a bit of stress – yet maintain their health, their ability to function, and their optimism,” Dr. Wilson said.

Tips to avoid Metabolic Syndrome & Adrenal Fatigue

According to Dr. Wilson, both adrenal fatigue and metabolic syndrome can be treated by a combination of lifestyle changes, proper nutrition, correct dietary supplements and exercise. Both conditions take time (1-2 years) and consistent treatment for a successful outcome. Both can be dramatically affected and even reversed by proper treatment, and healing is not only possible, but likely with proper treatment.

Here are a few hints and tips

• Eat foods “that grow in the ground, that grow out of the ground, that run around on the ground or food that is taken from the water”, i.e; eat natural whole foods which are prepared in your kitchen. These foods don’t come out of packets, bags, bottles or boxes. And please make the time to prepare and eat these foods, I simply don’t buy excuses like: “We don’t have the time anymore” or “I’m too tired to cook”, etc.
• Eat foods as natural and fresh as possible, keep carbohydrate-dense foods low, eat low glycemic index foods, concentrate on foods high in omega 3 foods, eat protein at every meal and snack, avoid trans-fatty acids, hydrogenated and partially hydrogenated oils (processed foods). Eliminate caffeine and “junk”, this is the big one! Junk in = junk out.
• With Metabolic Syndrome: Eat less, eat only when hungry, eat small regular meals, avoid food that stimulate insulin or blood sugar, avoid overeating, meals should emphasise low calorie, low glycemic. Eat foods not easily converted to glucose. Eat foods that do not stimulate cortisol production (caffeine containing, insulin stimulating).
• With Adrenal Fatigue: Eat before 10:00 am & again before noon, eat however balances body, avoid fruits in the morning (too much potassium, you need more sodium and less potassium in the morning), avoid missing meals, meals should emphasise protein, fat & unrefined CHOs together. Add salt according to taste, including water (prefer sea salt, Celtic salt, or sea salt with kelp powder)
• People who live more than 100 years are characterised by:
  • Less body fat than either 40 or 70 year olds
  • Lower fasting glucose
  • Lower free fatty acids (triglycerides and cholesterol)
  • Better insulin levels (better ability to remove insulin from blood) – levels superior to 70 year olds and on par with 40 year olds
  • Higher antioxidant levels (Vitamins C, E, selenium and glutathione).
  • Fewer free radicals in their lives (not smoking, not drinking, etc)
  • Eat 2 to 5 times more vegetables daily than those who die earlier
  • Much more relaxed and stress free lifestyle — to me this is the key.