It is estimated that one in every four South Africans suffers from Metabolic Syndrome. In this introductory post, I briefly explore this growing pandemic: what is it; something on the causes and its prevalence; how to identify it and a bit on the resources available to manage this condition more effectively. 

What is Metabolic Syndrome?

Identified about 20 years ago, the Metabolic Syndrome (‘Met-S’) has become an increasingly common condition around the world.  First known as Syndrome X, the condition is often found to be present in families and the risk of developing it increases with age. People with Met-S tend to be overweight or obese and the syndrome is considered to be a major risk factor for cardiovascular diseases and type 2 -diabetes. Additional research also indicates that Met-S substantially ups the risk of developing certain cancers, liver disease and Alzheimer’s disease.

It is important to note that this syndrome is not a disease in itself, but rather a cluster of disorders related to a particular type of metabolic dysfunctional known as insulin resistance. Other associated disorders include high blood pressure, high blood sugar, low ‘good’ cholesterol levels, elevated levels of triglycerides (or blood fat) and excessive abdominal fat. One would have to have at least three of these disorders to be officially diagnosed with Met-S.

Causes of the Condition

While experts aren’t completely sure why Met-S develops, obesity, unhealthy lifestyle choices, hormonal imbalances, as well as genetics, in addition to insulin resistance, all influence the development of the syndrome. In people with insulin resistance, insulin (the hormone that helps the body utilise glucose as energy) doesn’t work as efficiently as it should. The body thus secretes more insulin than it should (hyperinsulinaemia) in an attempt to cope with the rising level of blood sugar (glucose) and this, in turn, can lead to a person developing diabetes, as well as the other conditions associated with Met-S. Insulin resistance is particularly associated with excessive tummy fat, which substantially increases the risk of developing Met- S. Research shows that approximately 80% of obese adults are likely to have Met-S. But the risk does not end there as approximately 40% of normal weight adults may also have, or be at risk, for Met-S.

As obesity in a major factor in the development of the Met-S, experts point to the world’s rising prevalence of obesity as proof of a similar increase in the prevalence of Met-S. A healthy body mass index (BMI), as defined by the World Health Organization, is generally accepted to be around 18.5 to 24.9 kg/m 2 , while being overweight is in the range of 25.9 to 29.9 kg/m 2 and obesity is any BMI over 30 kg/m 2 . BMI may, however, not be an ideal method of determining the weight-related risk status of an individual. A measure known as the Weight-to- Height-Ratio (WtHR) may be a more accurate measure of disease risk, with any ratio above 50% indicating risk and above 58% signalling significant risk for the diseases of the Met-S.

Poor lifestyle choices especially consuming sugar and other refined carbohydrate, not exercising, insufficient sleep and high levels of psychological stress all play a role in the development of Met-S. However, of all the influencing factors , poor food choices, especially with regard to the over consumption of vegetable oils, sugar and refined carbohydrate contributes between 80% and 90% of the total effect.

Prevalence of Met-S

World Health Organization (WHO) data that reveals that the prevalence of obesity has nearly doubled worldwide since the 1980’s. As alarming is research published in 2013 that showed that more than 45% of rural adult female South Africans are obese. A 2010 survey by the pharmaceutical company GlaxoSmithKline indicated that a hefty 61% of South Africans were overweight or obese. Yet 84 % of the survey’s respondents considered themselves to be healthy or moderately healthy. A more recent study published in the prestigious medical journal, Lancet, confirms that about 70% of women and 40% of men in South Africa are overweight or obese. The World Health Organization’s prediction of a whopping 90.5% increase in the prevalence of Type 2 diabetes in Africa by the year 2030 is probably the most significant statement to emanate from the WHO research data on diabetes prevalence. It is without doubt a statement that none of us can afford to ignore!

Are You A Met-S Sufferer?

Having one component of Met-S means that you are more likely to have other disease risk factors and the more factors you have the greater the health risk. Having at least one Met-S risk factor – such as excessive belly fat, high blood pressure, low good cholesterol, high blood sugar, high insulin levels or high blood fat levels – may also mean the presence of undetected risk factors. A consultation with your doctor (together with the relevant tests) will help determine whether you have Met-S and what you can do to avoid the serious diseases associated with the syndrome.

Managing This Metabolic Malady

What scientists have discovered is that chronic diseases of lifestyle generally do travel alone but are often part of the more complex Met-S. If you’ve just been diagnosed with Met-S, lifestyle changes may offer the best option of preventing serious illness in the future. Both prevention and treatment is focused on holistically tackling each risk factor in turn. Firstly, weightloss is imperative as this can improve every aspect of Met-S. Begin by adopting a diet consisting of healthy fats, moderate amounts of protein, low in carbohydrate, especially refined carbohydrates and avoid processed goods or foods rich in sugar and hydrogenated vegetable oils. A healthy eating plan will not only help you lose weight, but should also improve your blood lipid picture, help to normalise blood pressure and blood sugar levels, as well as increase the likelihood of reversing any underlying insulin resistance.

It is also important to engage in regular physical activity. Exercise improves insulin resistance, lowers blood pressure and improves cholesterol levels. Walking is an excellent way to get moving but always aim to find an exercise that suits your lifestyle and that you will enjoy. This way you will be more likely to stick with a regular activity regime. If you smoke, give some thought to joining a smoking cessation programme. Not only does smoking increase your risk of blood vessel and heart disease, but it is also a major risk factor for respiratory diseases, dementia, and a number of cancers.

On average, we need about 7- 8 hours of quality sleep per night in order to maintain energy, mental alertness and a properly functioning immune system. Sufficient sleep also helps keep your weight in check and this effect has much to do with the hormones ghrelin and leptin.  Ghrelin controls hunger and there is an increase in this hormone when one is sleep deprived.  Leptin tells you when to stop eating, and less of this key hormone is produced in sleep deprived people. An imbalance in either of these hormones, invariably lead to weight gain. Too little sleep can also slow your metabolism and cause you to reach for high-energy comfort foods in an effort to counteract fatigue. Thus, it is imperative that you get sufficient rest in order to support your whole-person efforts of avoiding becoming a victim of the Met-S.

While there are a number of medications and supplements which may help in the management of Met-S, the key to both prevention and treatment is effective self- care rather than only relying on medical care. Very few people with chronic conditions are empowered, i.e. trained, taught and encouraged, to adequately care for themselves. Sadly, most of the time we simply rely on a combination of prescription medication, a diet sheet and a few words of instruction or advice from a healthcare professional to do the job.

Losing weight, reducing blood pressure, blood fats, insulin or blood sugar levels, all help in preventing the complications associated with the serious chronic conditions of the Met-S. If you would like more information on the Met-S and suggestions on what you can do to combat this growing pandemic; or it you would like to be given some tools to help you be able to help others who may be at risk, then please email me at askdrhill@upforit.co.za.

I’m Dr Peter Hill for UpForIt.