Syndrome X

Syndrome X is not some illness taken from Star Trek, or the X Files, or even a virus from an experiment gone wrong. In fact, you may already have the disease and not even know it. Consider that one in three adults have succumbed to it in countries with a well-fed population, and it’s estimated that 60 million Americans– one in four adults over the age of 35– are afflicted as well. The worst part is that you figure it can’t be you; you watch what you eat, you’re not over weight, and you don’t smoke. Nevertheless, you might still be a victim of the dreaded Metabolic Syndrome X.

Behind The Mystery

The name “Syndrome X” was first coined by Gerry Reaven of Stanford University, author of Syndrome X: Overcoming the Silent Killer That can Give You a Heart Attack. It was first used to designate a patient group that, while not actually having diabetes, were developing the metabolic illness that could lead to diabetes or heart disease. Also known as “borderline diabetes,” “creeping diabetes,” “pre-diabetes,” or “impaired glucose tolerance,” it’s still further referred to as “insulin resistance syndrome,” “the deadly quartet,” and “central obesity syndrome.” It was formerly recognized by the medical community only a few short years ago, but still remains relatively controversial. The distinguishing factor between Metabolic Syndrome X and diabetes is this: With diabetes, insufficient insulin or virtually no insulin at all is produced in the pancreas, whereas with Syndrome X, insulin is being produced but not used properly by the body.

While the dangers of the disease are serious in adults, the prevalence is increasing in children as the trend in child obesity rises. Research reported in the International Journal of Pediatric Obesity states that nearly half of the children in North and South America will be overweight by 2010, up from what recent studies originally projected to be about one-third. In addition, the same article predicts that more than a million children will show signs of high blood pressure, raised cholesterol levels and/or other early indicators of cardiovascular disease – the very conditions that define Syndrome X.

A Deeper Layer

Think of Syndrome X as a cluster of abnormal conditions rather than a single disease. Included are insulin resistance, “dyslipedemia” (blood fat abnormalities like high triglycerides, high levels of LDL, or the “bad” cholesterol and low levels of HDL, the “good” cholesterol), as well as high blood pressure (hypertension).

What happens when we eat a meal is that carbohydrates and complex sugars are broken down into basic sugar molecules (glucose) that then enter the blood stream. The body reacts to the increase in blood glucose levels by stimulating the production of a pancreatic hormone called insulin. Insulin’s job is to promote cells into the body – particularly muscle cells – to take up the glucose and use it for cellular energy. At the same time, insulin signals the liver to stop releasing fats, a secondary source of energy, into the blood.

So far so good. Now here is where the problem comes in. With our usual high sugar and high carbohydrate diets (touted just a few years back as the best way to lose weight and have a healthy heart), overwhelming high amounts of glucose are dumped into the blood stream. While it’s still not known exactly why, over time the cells in the body begin to respond less and less to the insulin. As a result, glucose is not transported out of the bloodstream as efficiently and cells have less of it to use for energy, leading to a vicious cycle whereby the body attempts to compensate by releasing even more insulin–the hallmark of Syndrome X.

What’s more, the increased insulin levels begin to have an opposite effect on the liver, causing a flood of triglycerides into the bloodstream. These are the very fats that settle onto the arteries and cause atherosclerotic “plaques” — narrowing the artery walls — which is the beginning of cardiovascular disease (CVD). If the arteries get too narrow, say in the heart, for example, the result is a heart attack. If they narrow in the brain, it can lead to a stroke. In fact, it is thought by many that Syndrome X may account for as much as 50 percent of all heart attacks.

But that’s not all. Left to go its course, all the excess insulin and lipids in the bloodstream create certain biochemical changes that lead to the destruction of pancreas cells. The net result is full-blown diabetes.

Part of the reason the cells become insulin resistant may be due not only to what we eat but the way in which we eat. Victor Zammit, of the Hannah Research Institute in Ayr, Scotland, has proposed that high-energy snacks and drinks, and continually eating small amounts of food throughout the day, may actually contribute to high levels of glucose in the blood. Our cells, particularly muscle cells, become accustomed to the higher levels and fail to respond to insulin over time. Add to that eating pattern the craze for “low-fat” foods loaded with sugar instead, and you’ve set the stage for Syndrome X.

There is even research suggesting that Syndrome X can increase the risk of prostate, colon and breast cancers, and women with Polycystic Ovarian Syndrome (PCOS) are at greater risk of developing Metabolic Syndrome X.

Of course, this all doesn’t happen overnight. It takes time, but without dietary and lifestyle changes, it’s virtually inevitable and can lead to many diseases and a shortened lifespan.

Syndrome X Diagnosed

While there are no carved-in-stone criteria for the diagnosis of metabolic Syndrome X, it’s generally held that the presence of three or more of the following confirms its diagnosis:

Male obesity — 40 inches plus (waist circumference)

Female obesity — 35 inches plus (waist circumference) Blood pressure of 130/85 mmHg or above Fasting glucose of 110 mg /dL or greater Fasting blood triglycerides of 150 mg/dL or greater

Male HDL cholesterol — less than 40 mg/dL
Female HDL cholesterol — less than 50 mg/dL

Who’s Most at Risk?

Most sufferers of Syndrome X lead sedentary lifestyles, with little, if any exercise, and eat a poor diet often high in sugar and carbohydrates. As a result, they’re typically also overweight. Believe it or not, there’s a genetic predisposition too, as it will often be seen running in families. Therefore, a strong knowledge of your family medical history is important. Syndrome X generally starts out with insulin resistance, the result of excessive insulin secreted by the pancreas (hyperinsulinemia) in an attempt to deal with increased amounts of sugar (hyperglycemia) from our diets. After a period of time, body tissues do not respond normally to insulin and as the body tries to compensate, insulin levels rise. Also known as “insulin overload,” this can lead to other metabolic abnormalities like elevated blood fats, blood pressure and obesity, all of which herald cardiovascular disease and type 2 “adult onset” diabetes. Increased glucose, as well as high levels of insulin, is also a major source of free radicals, which have been shown to be a major factor in the development of cardiovascular disease.

What Can You Do?

The conventional method of treatment is to address each metabolic disorder separately, with the underlying insulin resistance as the primary target. However, there’s currently no drug that directly reverses insulin resistance. After the onset of insulin resistance, elevated lipids (high LDL and high triglycerides) commonly seen in Syndrome X are treated with statins and/or fibrate drugs. Premature clotting problems (due to an increase in fibrinogen production) are often treated with aspirin or blood-thinning agents like Warfarin. And, of course, antihypertensive medications are deployed for high blood pressure (being careful to use only those that don’t negatively affect glucose levels).

While all of this is great for the pharmaceutical companies, there’s really a better approach. The safest, most effective way to reduce insulin resistance and high triglyceride levels, particularly in the overweight and obese, is through weight-loss and increased physical activity. Believe it or not, most of the metabolic abnormalities associated with Syndrome X will significantly improve with changes in diet and exercise. Syndrome X is completely reversible by just losing weight, watching out for what you eat (and how often) and engaging in regular aerobic exercise. In fact, a 2001 study by the American Diabetes Association, showed that a weight-loss of as little as 5 percent can reduce the incidence of type 2 diabetes by more than 50 percent.

So how can we treat Metabolic Syndrome X without drugs? Well, start with your diet:

- Reduce carbohydrate intake, particularly processed carbs

- Eliminate foods high in fructose (a complex sugar)

- Avoid the plague of trans-fatty acids (margarine and foods containing partially hydrogenated oils)

- Increase your intake of low-glycemic index carbohydrates — non-starch vegetables, leafy greens, broccoli, asparagus, cauliflower, cabbage and tomatoes — while reducing intake of the starchy ones (potatoes, yams, beans).

- Also, note that fiber is an important regulator of insulin. Furthermore, watch out for high protein diets, like Atkins, since high-protein meats can often be a source of saturated fat, which will have a negative effect on Syndrome X sufferers. Look more toward fish, eggs, cheese, poultry and game meats as protein selections. Beware of too much soy and legumes, especially for vegetarians who rely on them solely as meat/protein substitutes. Soy can affect the thyroid, slowing down the body’s metabolic rate and making it harder to lose weight, while many legumes (beans) are high in starch. Omega-3 fatty acids have been shown to be very effective in controlling insulin resistance. They’re found in many seeds (flax, pumpkin, hemp) and nuts — particularly walnuts, eggs, wheat germ, fish, and fish oil.

Finally, a 2005 British study suggested a link between drinking milk and developing Syndrome X, but results are too preliminary to make any final conclusions. Also, successfully treating hypertension can significantly reduce the risk of death and heart disease in diabetes and Syndrome X according to recent studies. Other steps for managing potential Metabolic Syndrome X include: routinely monitoring body weight (particularly the index for central obesity), blood glucose, lipoproteins and blood pressure. And if you’re a smoker, quit (or at the very least cut back significantly). The worst thing you can do is nothing at all. Since you don’t “feel sick” the prevailing symptoms of increased blood sugar levels, increased blood fats, and hypertension continue and ultimately lead to severe disease and illness.

Metabolic Syndrome X — a common, poorly recognized, potentially deadly, yet highly treatable disease — is most effectively prevented by weight-loss, diet, and exercise. It’s been said so many times before, but in the case of Syndrome X, it’s especially true — your health really is in your own hands.