1. DO YOU HAVE THE METABOLIC SYNDROME? You're never too young to have it Jacqueline A. Eberstein, R.N.

2. What is it? AKA Syndrome X or Insulin Resistance Syndrome AKA Syndrome X or Insulin Resistance Syndrome A cluster of signs that indicate blood sugar/insulin imbalance A cluster of signs that indicate blood sugar/insulin imbalance Can lead to type 2 diabetes and cardiovascular disease. Can lead to type 2 diabetes and cardiovascular disease. Incidence increases with age Incidence increases with age Is found in children who are overweight Is found in children who are overweight Responds to carb restriction. Responds to carb restriction.

3. Who is at risk for insulin resistance? Overweight or obese individuals Overweight or obese individuals People with hypertension People with hypertension Those with a sedentary lifestyle Those with a sedentary lifestyle People with a genetic predisposition People with a genetic predisposition Smokers Smokers Can occur in people who are normal weight but metabolically obese. Can occur in people who are normal weight but metabolically obese.

4. Incidence of Metabolic Syndrome In the year 2000 it is reported that 47 million U.S. residents have metabolic syndrome. In the year 2000 it is reported that 47 million U.S. residents have metabolic syndrome. Among obese kids more than 25% have MS. Among obese kids more than 25% have MS. More than 50% of severely obese kids have ms More than 50% of severely obese kids have ms Latest stats indicate that 43 million people in the U.S.have prediabetes. Latest stats indicate that 43 million people in the U.S.have prediabetes.

5. Definition of MS If you have 3 or more of the following signs you have the metabolic syndrome: If you have 3 or more of the following signs you have the metabolic syndrome: Abdominal obesity- a high waist to hip ratio. Abdominal obesity- a high waist to hip ratio. High triglycerides High triglycerides Low HDL cholesterol Low HDL cholesterol High blood pressure High blood pressure High fasting blood sugar High fasting blood sugar The WHO uses a somewhat different definition than that used in the US. The WHO uses a somewhat different definition than that used in the US.

6. Abdominal Obesity A waist circumference in men of more than 40 inches. A waist circumference in men of more than 40 inches. A waist circumference in women of more then 35 inches. A waist circumference in women of more then 35 inches. Deposition of fat around the middle is more dangerous than fat around the hips and thighs. Deposition of fat around the middle is more dangerous than fat around the hips and thighs. Visceral fat increases inflammation markers that lead to vascular disease. Visceral fat increases inflammation markers that lead to vascular disease. More than 50% of adults in the U.S. over age 60 are abdominally obese. More than 50% of adults in the U.S. over age 60 are abdominally obese.

7. Important predictor A recent study in men indicated that waist size predicted death from heart attack or stroke better than any other traditional risk factors including LDL or smoking. A recent study in men indicated that waist size predicted death from heart attack or stroke better than any other traditional risk factors including LDL or smoking. Every 2 inch increase in waist size increased the risk of dying of CV disease by up to 17% in the next 10 years. Every 2 inch increase in waist size increased the risk of dying of CV disease by up to 17% in the next 10 years. This study indicates the guidelines of 35 inches and 40 inches may be too high. This study indicates the guidelines of 35 inches and 40 inches may be too high.

8. Waist to Hip Ratio Compute your waist to hip ratio-measure waist around the navel, measure hips. Divide the waist number by the hip number. Compute your waist to hip ratio-measure waist around the navel, measure hips. Divide the waist number by the hip number. The higher your waist to hip ratio the more “apple” shaped. The higher your waist to hip ratio the more “apple” shaped. The lower the more “pear” shaped. The lower the more “pear” shaped.

9. High triglycerides Fasting triglycerides of 150mg/dL or higher. Fasting triglycerides of 150mg/dL or higher. High triglycerides are a marker for insulin resistance. This is especially true if the HDL is low. High triglycerides are a marker for insulin resistance. This is especially true if the HDL is low. They are an independent risk factor for CV disease. They are an independent risk factor for CV disease. Triglycerides are known to increase when eating a low fat, high carb diet as is recommended by the ADA and the AHA. Triglycerides are known to increase when eating a low fat, high carb diet as is recommended by the ADA and the AHA.

10. Low HDL cholesterol Men: an HDL cholesterol below 40mg/dL. Men: an HDL cholesterol below 40mg/dL. Women: an HDL cholesterol below 50 mg/dL. Women: an HDL cholesterol below 50 mg/dL. HDL cholesterol AKA the “good cholesterol”, carries cholesterol back to the liver for disposal or recycling. HDL cholesterol AKA the “good cholesterol”, carries cholesterol back to the liver for disposal or recycling. As triglycerides go up the HDL often goes down. This increases CV risk. As triglycerides go up the HDL often goes down. This increases CV risk. Low carb plans are very effective at elevating HDL cholesterol provided it is not too low in fat. Low carb plans are very effective at elevating HDL cholesterol provided it is not too low in fat. Low fat diets often elevate TG and lower HDL. Low fat diets often elevate TG and lower HDL.

11. Hypertension A blood pressure reading of 135/85 or higher is a sign of MS. A blood pressure reading of 135/85 or higher is a sign of MS. A new definition- prehypertension- 120/80 to 139/89. A new definition- prehypertension- 120/80 to 139/89.

12. Blood sugar by the numbers A fasting blood sugar of 100mg/dL or higher is a sign of MS. A fasting blood sugar of 100mg/dL or higher is a sign of MS. A fasting blood sugar of 100 to 125mg/dL is now called prediabetes or impaired fasting glucose. A fasting blood sugar of 100 to 125mg/dL is now called prediabetes or impaired fasting glucose. A 2 hour postprandial blood sugar between 140 and 199 mg/dL is also prediabetes or impaired glucose tolerance. A 2 hour postprandial blood sugar between 140 and 199 mg/dL is also prediabetes or impaired glucose tolerance.

13. Other characteristics of MS Smaller and denser LDL and VLDL cholesterol levels. Smaller and denser LDL and VLDL cholesterol levels. Increased risk of blood clotting. Increased risk of blood clotting. Increased inflammation markers-hsCRP Increased inflammation markers-hsCRP Endothelial dysfunction. Endothelial dysfunction. Carbohydrate cravings. Carbohydrate cravings. Family history of diabetes. Family history of diabetes. High uric acid levels High uric acid levels

14. Solution Recognize the cluster of symptoms. Recognize the cluster of symptoms. Accept the necessity for a permanent lifestyle change to diminish risks for diabetes, CV disease and other health concerns. Accept the necessity for a permanent lifestyle change to diminish risks for diabetes, CV disease and other health concerns. Regular exercise to improve insulin sensitivity, HDL and increase muscle mass. Regular exercise to improve insulin sensitivity, HDL and increase muscle mass. Normalize weight. Normalize weight.

15. Low carb vs. low fat Best strategy if you have high BMI and high Triglycerides=low carb. Best strategy if you have high BMI and high Triglycerides=low carb. If more than 2 symptoms of MS or high triglycerides and low HDL-- low carb is the first strategy. If more than 2 symptoms of MS or high triglycerides and low HDL-- low carb is the first strategy. Low carb is superior to low fat/low calorie diets even in the absence of weight loss. Low carb is superior to low fat/low calorie diets even in the absence of weight loss.

16. “Carbohydrate restriction is one of several strategies for reducing body mass but even in the absence of weight loss or in comparison with low fat alternatives, CHO restriction is effective at ameliorating high fasting glucose and insulin, high plasma triglycerides, low HDL and high blood pressure. In addition, low fat, high CHO diets have long been know to raise TAG, lower HDL, and, in the absence of weight loss, may worsen glycemic control.” “Carbohydrate restriction is one of several strategies for reducing body mass but even in the absence of weight loss or in comparison with low fat alternatives, CHO restriction is effective at ameliorating high fasting glucose and insulin, high plasma triglycerides, low HDL and high blood pressure. In addition, low fat, high CHO diets have long been know to raise TAG, lower HDL, and, in the absence of weight loss, may worsen glycemic control.” Carbohydrate restriction improves the features of metabolic syndrome. Volek, J., Feinman, R. Carbohydrate restriction improves the features of metabolic syndrome. Volek, J., Feinman, R. Nutrition and Metabolism, 2005 Nutrition and Metabolism, 2005