Diagnosing Metabolic Syndrome

Our metabolism, the process by which we take in nutrients and break them down to be used in the body, plays a huge role in our overall health.

Insulin resistance, a hallmark of poor metabolic health, is associated with massive increases in disease risk:

• Cancer risk increases up to twelvefold.

• Alzheimer’s disease risk increases fivefold.

• Death from cardiovascular disease increases almost sixfold.

Although the final destination of poor metabolic health is likely heart disease, cancer, or Alzheimer’s, those with metabolic syndrome may encounter a variety of metabolic disorders such as pre-diabetes, non-alcoholic fatty liver disease (NAFLD), nonalcoholic steatohepatitis (NASH), hyperinsulinemia, and eventually type 2 diabetes (T2D) on their yellow brick road to premature death.

The golden takeaway is this:

You can’t fight heart disease, cancer, or Alzheimer’s without tackling metabolic function first.

In other words, the first step to delaying death is getting your metabolic health in order.

How? Exercise. Nutrition. Sleep. Stress management. 

The practices that drive strong metabolic health are nothing new.

Nonetheless, it is still critically important to understand how metabolic dysfunction is assessed so you can ensure that the practices you deploy are actually effective. 

Metabolic syndrome is defined by five criteria:

1. High blood pressure (> 130/80)

2. High triglycerides (> 150 mg/dL)

3. Elevated fasting glucose (> 110 mg/dL)

4. Waist circumference (> 40 inches in men or > 35 inches in women)

5. Low HDL cholesterol (< 40 mg/dL in men or < 50 mg/dL in women)

If you meet three or more of these criteria, you have metabolic syndrome.

To maximize your well-being and increase your lifespan, it is recommended to steer clear of these criteria.

So, if you want to live a long life filled with healthy years and avoid a slow, agonizing death (cancer or Alzheimer’s) or a quick, tragic death (heart attack or stroke), then it is extremely important to prevent metabolic syndrome.

All Fat is Not Created Equal: Subcutaneous vs. Visceral Fat

Remember, metabolism is the process by which we take in nutrients and break them down for use in the body.

In metabolically healthy individuals, nutrients are processed and sent to their proper destinations. 

In metabolically unhealthy individuals, many calories end up in places where they are either not needed or downright harmful.

The end-of-the-line stop for those with poor metabolic health is Type 2 diabetes which is essentially a carbohydrate tolerance disorder—your body can no longer effectively process and store glucose on its own.

But to arrive at full-blown Type 2 diabetes, which kicks open the door for a bounty of deadly diseases, your body generally has to go through years of sedentary lifestyle habits and poor nutrition.

The carbohydrates we consume are shuttled to one of two places as determined by hormones, mainly insulin.

1. Carbs can be converted into glycogen (the stored form of glucose) and stored in muscles or the liver for use in the near term.

2. Or they can be stored as fat for future energy use when other sources run dry.

However, not all fat stores are created equal.

Subcutaneous fat (sub-kyoo-tay-nee-uhs), the layer of fat just beneath your skin, is the safest place to store excess energy until it is needed for future use. As long as you don’t surpass your own fat storage capacity, you’re in good shape. 

However, if you consume excess calories beyond your nutritional needs for a long enough period of time, those subcutaneous fat cells will eventually reach their capacity. 

If they fill up but the body remains in a positive energy balance, meaning it receives more calories than it burns, the surplus will spill over into other, more harmful areas of your body: 

• into your blood, as excess triglycerides;

• into your liver, contributing to nonalcoholic fatty liver disease (NAFLD); and 

• into your muscle tissue, contributing to insulin resistance in the muscle. 

Fat will also start accumulating in between your organs, such as around your heart and pancreas.

Visceral fat wraps around your organs and, unlike relatively harmless subcutaneous fat, leads to inflammation and increased risk of cardiovascular disease, cancer, and more.

Subcutaneous fat storage capacity differs widely between individuals which explains why someone who appears thin could have a metabolic disorder whereas someone who carries a bit of fat could be metabolically healthy.

Although waist circumference is easy to assess and the most widely discussed in the media with headlines pointing to an obesity epidemic, it is only one facet of assessing metabolic health.

Surely, it is critically important and you should strive to maintain a healthy body composition—visceral fat can have deadly repercussions.

But you can not rely only on your waist circumference to assess metabolic health.

It is paramount to measure all five criteria (listed above) to gather a comprehensive picture of your metabolic health.

That’s all, folks. Thank you for reading!

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Much love to you and yours,

Jack

Other indicators worth monitoring to detect metabolic issues early:

• Elevated uric acid

• Chronic inflammation

• Elevated homocysteine 

• Overproduction of very low-density lipoprotein (VLDL)

• Elevated insulin, especially elevated postprandial (after eating) insulin, is a sign of a potential metabolic disorder.

• Lipoproteins and triglycerides—The ratio of triglycerides to HDL-C should be less than 2:1 but ideally less than 1:1.

• Mildly elevated ALT liver enzymes (30 IU/L for men or 19 IU/L for women or higher).

  • Note: Elevated ALT could also be a symptom of something else such as a viral infection or a reaction to medication.

• Rising HbA1c—This blood test measures your average blood sugar levels over the past three months and is used to diagnose Type 2 diabetes, where:

  • Normal = 5.1%

  • Pre-diabetic = 5.7-6.4%

  • Diabetic = +6.5%