Metabolic syndrome (syndrome X, insulin resistance syndrome) is characterized by a clustering of risk factors for cardiovascular disease and type 2 diabetes mellitus.
They commonly include excess intra-abdominal fat, insulin resistance, and ≥ 1 of the following: elevated serum triglyceride levels, decreased high-density lipoprotein (HDL) cholesterol level, and hypertension.
Medical tests that confirm a Diagnosis of Metabolic Syndrome:
- Large waist circumference, greater than 89 cm for women and 102 cm for men. Certain genetic risk factors, such as having a family history of diabetes or being of Asian descent – which increases your risk of insulin resistance – lower the waist circumference limit. If you have one of these genetic risk factors, waist circumference limits are 79 to 89 cm for women and 94 to 99 cm for men.
- A triglyceride level higher than 150 mg/dL (1.7 mmol/L); Indicates the risk of heart disease.
- Reduced HDL ('good') cholesterol. If HDL is less than 1.0 mmol/L, there is an increased risk of heart disease. The target is 1.5 mmol/L or more and is associated with a less than average risk of heart disease.
- Elevated LDL' ('bad) cholesterol of; 2.0 mmol/L. The target is 2.0mmol/l or less. This target level decreases the risk of heart disease.
- Increased blood pressure, meaning a systolic (top number) blood pressure measurement of 130 (mm Hg) or more or a diastolic (bottom number) blood pressure measurement of 85 mm Hg or more. Normal blood pressure is 120/80 mm Hg . A persistently high blood pressure over 140/90 is diagnosed as Hypertension. This indicates how much pressure is being placed on your blood vessels.
- Elevated fasting blood sugar (blood glucose) of 100 mg/dL (5.6 mmol/L) or higher, or you're receiving treatment for high blood sugar.
- hs-CRP A measure of low levels of inflammation that may be tested as part of an evaluation of cardiac risk.
- BMI (Body Mass Index) An alternative measure of obesity used by many doctors. It is calculated by taking weight (in kilograms) / height (in meters squared). For example 80kg / (1.7m x 1.7m) = a BMI of 27.7. An adult with a BMI greater than 30 is considered obese.
Treatment Objectives
- Achieve ideal glycemic control & reduce risk of further complications (diet, herbs and supplements)
- Establish optimal nutritional status
- Reduce postprandial glucose levels and LDL cholesterol/total cholesterol
- Improve insulin function and sensitivity
- Prevent nutritional and oxidative stress
- Support client psychologically (refer if necessary)
- Implement stress management techniques
- Implement regular exercise
Dietary Considerations
Specific Diet:
- Dietary recommendations are designed to control blood glucose levels (BGLs) and lipids to prevent complications associated with metabolic syndrome and to facilitate fat loss/ weight reduction if the patient is overweight
- The diet recommended for the treatment of metabolic syndrome is a diet low in total fat and cholesterol, relatively rich in monosaturated fats, and high in complex carbohydrates, particularly soluble fibre (up to 40g/day), with a low glycemic index (less than 55)
- A diet that comprises 30% carbohydrate: 30% protein: 40% fat ratio is recommended to control BSLs (as part of the metabolic syndrome profile) and total glycosylated-haemoglobin levels (HbA1c)
Food Inclusions
- A daily intake of 40g/day of fibre with a low-GI is recommended to improve insulin resistance long term 14 Water soluble fibre binds fats and lowers the absorption of glucose through delaying gastric emptying. 14 Good sources of water-soluble fibre are legumes, oat bran, nuts, seeds, Psyllium seed husks, pears, apples, and most vegetables.
- Eat foods high in omega 3 fatty acids which have been shown to lower cholesterol and triglyceride levels 16; Fish is a good source of omega-3, include: salmon, sardines, herring, mackerel and halibut and/or supplement with DHA/EPA. 15 Other sources of omega-3 include walnuts, flaxseed meal/oil and leafy green vegetables
- Eat onions, garlic and fenugreek in the diet, these have demonstrated blood-sugar-lowering action as well as lowering blood-cholesterol and blood pressure
- Eat bitter melon, the constituents in bitter melon (Charantin & Momordica) have been clinically proven to contain anti-diabetic properties to reduce blood sugar levels
- Include lean protein at every meal as it helps to reduce carbohydrate cravings
- Eat foods rich in flavonoids (quercetin, rutin, hesperidin, proanthocyanidina, and anthocyanosides), these have been found to protect against oxidative damage, increase intracellular levels of vitamin C and protect blood vessel integrity 20 Food sources include: onions, apples, citrus fruits, grapeseed extract, and black & green tea.
Food Exclusions
- Foods that have a high glycaemic index must be avoided. The Glycaemic Index of a food can be calculated by multiplying the GI value of the food by the amount of carbohydrate in a serve and then dividing by 100
- Foods with a GI of 55 or less are called low GI foods; a GI of 55-69 is classified as moderate; and a GI of more than 70 is regarded as high.
Avoid the Following
- All simple sugars and refined carbohydrates such as white bread, white rice, corn, cornflakes, baked potato, cordials, soft drinks, biscuits, pastries, chips, and sugars (glucose, maltose, honey, sucrose, fructose)
- Avoid diet soft drinks/ energy drinks/ sodas
- Saturated fats, trans-saturated fats, deep fried foods
- All smoked and cured foods because of their ability to promote oxidation
- Reduce intake of sorbitol-rich foods such as cherries, pears, apples, plums and blackstrap molasses, due to the association with increased sorbitol accumulation and glycosylation of proteins that has been linked to many complications of diabetes, including eye and nerve damage.
Lifestyle modifications:
- Maintain a healthy body weight (BMI)
- Exercise 30mins daily or 1 hour 3-4 times per week of cardiac, or strength & resistance training. Strength training maximizes fat loss and minimizes the loss of lean body mass that frequently occurs with weight loss diets
- Implement techniques to promote relaxation, such as tai chi, yoga, mediation; stress increases cortisol which promotes visceral adiposity, insulin resistance and loss of glycemic control
Specific Nutrients
Chromium
- Supplementation with chromium of 400ug per day has been found to decrease fasting blood sugar levels, improve glucose tolerance, lower insulin levels, and decrease total cholesterol and triglyceride levels, whilst increasing HDL levels
- Chromium has a direct role in supporting glucose tolerance factor, it acts to mediate insulin’s effects and aid glucose transport across cell membranes
- Chromium increases insulin binding to cells and insulin receptor numbers and activates insulin receptor kinase, leading to increased insulin sensitivity.
- Food sources of chromium include brewer’s yeast, calf liver, wheat germ, sugar beets, seafood, eggs, meat and whole grains such as barley.
- The estimated safe and adequate daily dietary intake is 50 to 200ug for adults. The therapeutic dose range is 200 to 2000ug/day
Magnesium
- Intracellular magnesium plays a key role in regulating insulin action, insulin-mediated-glucose uptake and vascular tone. Magnesium deficiency has been proposed as a possible underlying common mechanism of the ‘insulin resistance’ of metabolic conditions (metabolic syndrome) and low magnesium intake in the diet has been linked to metabolic syndrome and type 2 diabetes.
- Food sources of magnesium include green leafy vegetables, nuts, peas, and whole grains.
- The recommended therapeutic dose for treatment of metabolic syndrome/ diabetes type 2 is around 500mg daily
Vitamin C
- In doses between 0.5-1.0g twice daily has been clinically shown to improve glycemic response
- Vitamin C prevents the breakdown of nitric oxide, decreases the oxidation of LDL, reduces platelet aggregation and has been found to help lower blood pressure
- Food sources of vitamin C include capsicums, black currants, citrus fruits (oranges, lemons, grapefruit), green vegetables, tomatoes and rosehips. Best eaten raw, as cooking destroys the active constituents.
B Complex
- As a combination, B vitamins play an important role in energy production, fat, cholesterol and carbohydrate metabolism.
- B3 is a component of the glucose tolerance factor, making it a key nutrient in prevention of diabetes. 28 Several studies have shown that supplementation with 100-200mg per day of vitamin B3 lowered insulin requirements, improved metabolic control, and increased beta cell function.
- B6 enhances the intracellular uptake of magnesium and protects against the development of nerve disease. B6 also inhibits glycosylation of proteins. Doses between 50-100mg are recommended
- B12 protects against diabetic neuropathy (a complication of metabolic syndrome if left unmanaged). Doses of 1-3000mcg per day are recommended.
- Food sources of B vitamins include: whole grains, fruits, vegetables, nuts, legumes, spirulina, meat sources (are the only B12 source)
Vitamin E
- Vitamin E has been clinically shown to improve glucose tolerance and insulin sensitivity in those with metabolic syndrome, which in turn leads to improved blood fasting glucose, and postprandial glucose 32 A 3-month trial of 800 IU/day supplementation of alpha-tocopherol was found to significantly improve plasma glucose levels, triglycerides, total cholesterol levels, LDL cholesterol and HbA1c status.
- Food sources of vitamin E include: wheat germ oil, vegetable oils or their seeds (sunflower, avocados, sweet almond) and nuts (hazelnuts, almonds, peanuts, walnuts)
- Doses between 500-1,200 IU are recommended to improve insulin actions in those with metabolic syndrome disorder.
Omega-3 essentials fatty acids
- Omega-3 EFAs have anti-inflammatory and immuno-modulating effects, they decrease insulin resistance and help to prevent cardiovascular and neurological complications related to metabolic syndrome.
- They have also been shown to provide antithrombotic and anti-platelet activity as well as lowering triglycerides, improving endothelial function, reducing blood pressure and preventing atherosclerotic development
- Daily supplementation of 4g of omega-3 has been shown to reduce triglyceride and total cholesterol concentrations and to increase high-density lipoprotein (HDL) cholesterol concentrations.
- Food sources of omega-3 fatty acids include: fish (salmon, mackerel, herring, sardines, cod) and flaxseed oil and meal, spinach and walnuts are sources of a-linolenic acid, which can be converted after ingestion, to EPA. 15 A dose of 1-2 tablespoons of flaxseed oil contains 2.5g of omega-3 fatty acids. 2 The therapeutic dose ranges from 1-10g daily; 19 A number of clinical trials have used 4g/day.
N-acetyl-Carnitine:
- Carnitine helps to liberate fat from cells into energy (known as beta-oxidation) and has been clinically shown to decrease total serum lipid levels as well as increase HDL levels in those with metabolic syndrome as well as diabetic patients
- In addition, acetyl-carnitine has been found to enhance glucose uptake, storage and utilization. The daily recommended therapeutic dose is at least 3g or higher per day in order to achieve these effects
Co Enzyme Q10:
- Has been found to reduce blood glucose, increase insulin sensitivity, reduce high blood pressure, reduce triglycerides and lipid peroxidation. 36 The therapeutic dose range is 30-150mg/ day
- CoQ10 is specifically important for those patients on statin drugs as it has been found that these drugs naturally deplete CoQ10 levels within the heart tissue
Alpha Lipoic acid:
- Improves glucose metabolism, improves blood flow to peripheral nerves, and increases insulin sensitivity
- Lipoic acid has a powerful ROS-scavenging activity and is involved in the regeneration of other antioxidants such as glutathione, vitamins C and E
- Randomised clinical trials investigating daily supplementation of 600mg reported improved insulin sensitivity in those with metabolic disorders
Dietary Guidelines
- Avoid foods high in sugar as they will increase BSLs. Be aware of ‘hidden’ sugars such as glucose, maltose, honey, sucrose, fructose, corn syrup and molasses that may be added to food products.
- Eat complex-carbohydrate foods (with a GI of 55 or less) and choose foods high in fibre such as whole grains, dense grainy breads, bran cereals, barley, buckwheat and quinoa. Avoid starch vegetables such as potatoes, sweet potatoes, cooked carrot, parsnips, and corn
- Eat frequent, small meals spread throughout the day
- Opt for low-fat dairy products and limit intake to 2-3 serves per day.
- Reduce intake of saturated fats and cholesterol to assist with management of cholesterol and triglyceride levels.
- Eat small, lean portions of meat; Eat red meat 1-2 per week only
- Eat fish, at least 2-3 times a week.
- Include beneficial fats such as olive and flaxseed oil, nuts, nut butters
- Steam vegetables/ fish or bake instead of frying.
- Remove skin from poultry and fat from meat before cooking. Meat fat is saturated fat that adds weight and promotes heart disease.
- Limit alcohol consumption
- Limit salt intake
- Increase consumption of low GI vegetables. Eat 3-5 serves per day (1/2 to 1 cup)
- Maintain a healthy body weight, fat loss can improve blood glucose levels and reduce the need for diabetic medications
- Drink plenty of water to maintain hydration and assist with the movement of fibre through the bowels
Some Extra Guidelines Include
- Enjoy your food. Sit and eat, don’t eat and run. Use it as necessary down time to de-stress. This will help you digest and get the most nutrition from it.
- Have plenty of variety. Eating the same thing every day leaves you open to nutrient deficiencies if your diet is lacking.
- Use plenty of fresh herbs, extra virgin olive oil, and look for products that do not contain GM substances (which are poorly tested for side effects).
- Cook with a little olive oil. Olive oil remains more stable at high temperatures than polyunsaturated (vegetable) oils. Never heat oil to the max.
- Cook using stainless steel or pyrex glass. Don’t use aluminium, or teflon pans.
- Keep your salt intake controlled. High salt consumption leads to hypertension.
- Buy organic whenever you can afford it. More nutritious and no pesticides
