An Overview of Metabolic Syndrome

Overweight man using a tape measure to measure his waist
MILATAS / Getty Images

Metabolic syndrome (also known as MetS or Syndrome X) is a constellation of risk factors that result from insulin resistance (when the body's tissues do not respond normally to insulin), overweight or obesity, and inactivity. Risk factors include high blood pressure, high blood sugar levels, abnormal lipid levels, and excess abdominal fat. A person with metabolic syndrome has a greatly increased risk of developing type 2 diabetes, stroke, cardiovascular disease, cancer, and premature death.

Symptoms

Because metabolic syndrome is a cluster of underlying conditions, symptoms may not seem connected. In fact, many of these conditions may not have obvious signs or symptoms.

Potential symptoms include:

  • Overweight or obesity
  • Large abdominal/waist circumference
  • Dizziness and fatigue
  • Signs commonly associated with diabetes, such as frequent thirst and urination

Metabolic syndrome is more effectively pinpointed by testing different blood markers. If you're unsure if you have MetS, your physician can request lab work that will help inform a true diagnosis.

Causes

The primary problems in metabolic syndrome are overweight and a sedentary lifestyle.

MetS is also linked to insulin resistance—a condition in which the body's cells aren't able to use insulin effectively to get blood sugar (glucose) into the cells, and so glucose builds up in the bloodstream. In the body's attempt to compensate for this insulin resistance, extra insulin is produced, leading to elevated insulin levels—in addition to high glucose levels. The elevated insulin levels can lead, directly or indirectly, to the characteristic metabolic abnormalities seen in these patients. Frequently, the insulin resistance will progress to overt type 2 diabetes, which further increases the risk of cardiovascular complications.

Risk Factors

MetS is highly widespread. According to the Third National Health and Nutrition Examination Survey (NHANES III), approximately 24 percent of the U.S. population is affected by metabolic syndrome. As age increases, the prevalence of MetS increases. In fact, around 44 percent of people over the age of 50 have MetS.

Ethnicity and family history also increases your risk of contracting the condition. Hispanics and especially Hispanic women tend to have the highest prevalence of MetS in the U.S.

Aside from age and ethnicity, there are several other risk factors that may be precursors for MetS:

  • Obesity: Having excess weight, especially around your abdominal organs, raises your risk.
  • Diabetes: Approximately 80 percent of people with type 2 diabetes concurrently have MetS.
  • Other conditions: Nonalcoholic fatty liver disease, polycystic ovary syndrome, sleep apnea are all marked by altered insulin/glucose utilization and chronic inflammation and can lead to MetS.

Metabolic syndrome tends to run in families, along with the propensity for type 2 diabetes. MetS will likely occur in susceptible people who become overweight and sedentary. This ultimately means that metabolic syndrome (like type 2 diabetes) can often be prevented with exercise and maintaining a healthy body weight.

Additionally, we now know that fat tissue surrounding the abdomen is metabolically active and proinflammatory, meaning it can excrete inflammatory markers known as adipokines, which are cell-signaling proteins that can affect insulin sensitivity.

Anyone who currently has type 2 diabetes and/or cardiovascular disease or has a family history of either of these conditions and is currently overweight and sedentary should be evaluated for metabolic syndrome.

Diagnosis

The criteria seen in metabolic syndrome include specific markers of insulin resistance, obesity (especially abdominal obesity), high blood pressure, and lipid abnormalities. Specifically, metabolic syndrome is diagnosed if any three of the following five markers are present:

  • Elevated waist circumference: 40 inches or more for men; 35 inches or more for women
  • Elevated triglycerides: 150 mg/dL or higher
  • Reduced high-density lipoprotein (HDL) levels (AKA “good” cholesterol): less than 40 mg/dL in men; less than 50 mg/dL in women
  • Elevated blood pressure: 130/85 mm Hg or higher or are already taking blood pressure medications
  • Elevated fasting glucose: 100 mg/dL or higher or are already taking glucose-lowering medications

It's important to note that meeting just one or two of these criteria doesn't mean you have MetS, but it does signify that your risk of more serious complications is elevated.

Treatment

While certain drugs may be used in the treatment of MetS (such as those used to combat insulin resistance and/or glucose uptake, reduce blood pressure or rebalance cholesterol), lifestyle changes are considered the best approach to combat MetS.

Six pillars of metabolic syndrome treatment include:

  • Maintaining a healthy weight
  • Incorporating regular exercise
  • Following a healthy diet
  • Managing stress
  • Getting quality sleep
  • Quitting smoking

The goal of treatment is to reduce or reverse the underlying risk factors one by one, and to use overall lifestyle changes to improve general outcome.

Anyone with metabolic syndrome should make every attempt to reduce their body weight by five to 10 percent (ideally through diet and exercise), as this has shown to actually increase your insulin sensitivity and to prevent the condition from progressing into something more serious.

It's also highly important to incorporate aerobic exercise into your overall lifestyle. Start slow, then work up to at least 20 minutes per day. Increased physical activity can improve insulin sensitivity, reduce blood pressure, and decrease triglycerides.

For most people, keeping your body mass index (BMI) under 25 can be very helpful in terms of prevention.

Diet for Metabolic Syndrome

While serving sizes will depend on your personal goals, a healthy diet for those combatting MetS should include:

  • Non-starchy vegetables, such as leafy greens, peppers, onions, mushrooms, tomatoes, etc.
  • Colorful fresh or frozen fruits, such as berries and citrus
  • Whole grains, such as brown rice, oats, and whole wheat bread
  • Lean protein, such as poultry, fish, beans and legumes
  • Plant-based fats, such as avocado, coconut, olives, and nuts and seeds
  • Low-fat dairy products
  • Very limited foods with added sugars (if any at all), such as yogurts, soft drinks, baked goods
  • Plenty of water—enough to meet your personal hydration goals

Work with your healthcare provider or a nutritionist/dietitian to create a customized meal plan that fits your needs and lifestyle.

With vigorous efforts to reduce weight and increase exercise, metabolic syndrome can be reversed, and the risk for cardiovascular complications can be substantially improved.

Treating Insulin Resistance

Approximately 80 percent of people with type 2 diabetes concurrently have MetS, which means it's highly likely that if you have a diagnosed glucose imbalance, you're already taking a glucose-lowering drug, such as metformin. While this type of drug may help with your glucose levels, it won't necessarily fix the underlying insulin resistance. (Remember, there is a way for people with metabolic syndrome to reverse their insulin resistance—diet and exercise.)

It's also well established that sleeping fewer than six hours per night regularly can send glucose levels out of whack and may contribute to insulin resistance, type 2 diabetes, and MetS. Keeping up with good sleep hygiene and prioritizing sleep is essential for health. If you never seem to wake up feeling rested—no matter how much you're sleeping—be sure to get assessed for sleep apnea, too.

Treating Lipid Abnormalities

While the lipid abnormalities seen with metabolic syndrome (low HDL, high LDL, and high triglycerides) respond nicely to weight loss and exercise, drug therapy is often required. Treatment should be aimed primarily at reducing LDL levels according to specific recommendations. Once reduced LDL targets are reached, efforts at reducing triglyceride levels and raising HDL levels should be made.

Successful drug treatment usually requires treatment with a statin, a fibrate drug, or a combination of a statin with either niacin or a fibrate, though increasing your fiber intake (as much as 35 to 40 grams per day from leafy greens, beans, and nuts, for example) can also help reduce your LDL and triglyceride levels, as fiber helps remove cholesterol from the body.

Treating Hypertension

High blood pressure is present in more than half the people with metabolic syndrome and, in the setting of insulin resistance, high blood pressure is especially important as a risk factor. Adequate blood pressure treatment in these individuals can substantially improve their outcome, usually through angiotensin-converting enzyme (ACE) inhibitors, beta-blockers, diuretics, and other medications, although regular exercise and stress reduction techniques such as yoga, meditation, and deep breathing can also work wonders in bringing down systolic and diastolic numbers.

A Word From Verywell

Metabolic syndrome is becoming more and more prevalent in our world, and while there's no singular cure, the key to prevention remains diet and exercise.

If you have a strong family history of metabolic syndrome or type 2 diabetes, you should be especially careful to maintain a healthy lifestyle, including getting plenty of vegetables, fruits, and whole grains, fitting in exercise, getting enough sleep, using stress reduction techniques, and quitting smoking.

Was this page helpful?

Article Sources