What is the metabolic syndrome?


Metabolic syndrome is a set of criteria used to identify a pathological state of metabolism. If you qualify as having metabolic syndrome, this means one or more aspects of your metabolism is out of whack such that your odds of suffering from heart disease, stroke, diabetes, obesity, cancer etc. are substantially increased.

Metabolic syndrome is identified by measuring five markers: waist circumference (WC), HDL cholesterol (HDLc), triglycerides (TG),  fasting plasma glucose (FPG) and both systolic (SBP) and diastolic blood pressure (DBP).

Each marker has a ‘cut-off’ value, whereby if you’re under it, you’re ‘low risk’ for metabolic syndrome and you’re above it, you’re at ‘high risk’.

To qualify for low or high risk of metabolic syndrome, you need to be above the cut-off value of at least three of these five markers. The cut-off values are

  1. WC 102 cm in men and 88 cm in women
  2. HDLC < 40 mg/dL in men and < 50 mg/dL in women
  3. TG 150 mg/dL
  4. SBP 130 mm Hg or DBP 85 mm Hg
  5. FPG 100 mg/dL

If one marker helps, won’t two be better?


By combining two of these five markers, namely TG/HDLc ratio and the TG x FPG index, researchers hoped to be better able to identify people at higher risk for a particular disease associating with the syndrome.

This index and ratio were selected, in large part, because they’re thought to be relatively good (indirect) measures of insulin sensitivity.

Insulin sensitivity is a fundamental biological mechanism that, when gone awry, is implicated in a number of like diseases such as Alzheimer’s , cancer and diabetes .

Just as an example, using the TG/HDLc ratio, the TG x FPG index or the metabolic syndrome criteria makes little difference in your ability to predict cardiovascular disease in someone. However, they’re still amongst the best measures we have to do such predictions .

Is there a treatment for metabolic syndrome?


A mix of lifestyle changes and a few select drugs are the current options for the treatment of metabolic syndrome.

However, the drugs and lifestyle advice (especially the dietary advice) given to those concerned haven’t made much of a dent in the incidence of the syndrome, affecting 33% of Americans as of 2012 .

As an aside, people with relatively rare genetic diseases such as familial hypercholesterolemia or with inborn errors of metabolism like phenylketonuria (PKA), are more vulnerable to metabolic syndrome .

There can be strong genetic factors at play for some people, but the growing incidence of the syndrome suggests that some things in our modern environment may be to blame.

Drugs as a treatment for metabolic syndrome


Drugs generally don’t do particularly well as a stand-alone treatment for the syndrome. Metformin is arguably the top drug candidate for the treatment of metabolic syndrome, probably because it targets multiple aspect of energy metabolism to a larger extent than others do.

In one study over three years, 18% of the placebo group, 23% of the metformin group and 38% of low-fat lifestyle group no longer qualified as having the syndrome .

Considering there was more improvement in the poorly advised lifestyle group than in the metformin group, metformin cannot be considered a suitable stand-alone treatment for metabolic syndrome.

The majority of other drugs target a particular marker amongst the five, like statins for cholesterol and anti-hypertensives for blood pressure.

Neither of these drugs fundamentally improve the syndrome, at best they are of limited use to manage symptoms or lower the value of their corresponding marker.

Lifestyle as a treatment for metabolic syndrome


Don’t smoke cigarettes. It may be obvious to you but many people still smoke them, so please don’t smoke cigarettes .



A low carbohydrate or ketogenic diet are the dietary interventions with the most evidence supporting their use as a first-line treatment for metabolic syndrome .

A diet which is more closely matched to our biology’s evolutionary history – also known as a ‘Paleo diet’ – also appears to impact metabolic syndrome in a positive manner .

For instance, it rightly emphasizes that we should pay attention to our balance of essential fatty acids, crucial for mitigating inflammatory states associated with the syndrome .

When making choices about what food to eat in order to improve this syndrome, think about

  • keeping your total carbohydrate load low whilst improving the quality of the carbohydrate sources you do eat (e.g. substituting bread for low-GI berries)
  • eating more micronutrient dense foods (meat, fish, nuts, green leafy vegetables…)
  • avoiding dietary approaches such as DASH (Dietary Approach to Avoid Hypertension) as a treatment for metabolic syndrome. When tested in controlled settings against other diets, DASH and DASH-like diets repeatedly fail to improve metabolic syndrome meaningfully



One amazing fact about sleep is that if you don’t have enough of it, even within a mere 24 hour period, your ability to handle glucose worsens substantially – so much so in fact that your blood sugar profile starts to look like that of a diabetic !

So sleep early, long and deep. Get enough natural sunlight in the morning, throughout the day too if possible, and keep the lights low at night – or just go camping !

If you’re willing to go a step further, filter the blue light from your electronic devices as this can disturb melatonin release, crucial to your sleep .

More and more research is suggesting that properly entraining your body’s internal clocks with external light cues (the sun) is an important lifestyle treatment for metabolic syndrome.



You cannot exercise down high triglycerides, exercise away your belly fat or resolve your blood pressure by sweating like mad on the treadmill every day.

What you can do is try to be generally non-sedentary. This means walking frequently, which entails not staying still in one spot (whether sitting or standing) for hours at a time. It is a good habit that will lower your odds of developing metabolic syndrome .

Occasional bouts of safe high-intensity exercise may help lower blood sugar . However, please understand that this is an ‘add-on’ and should not be used as a primary strategy to manage metabolic syndrome. Food and sleep are most likely much more important.

Takeaways for the treatment of metabolic syndrome

  1. First, do you ‘have it’ or not? Ask your doctor to run lab tests looking at the five metabolic syndrome markers
  2. Second, if you do have it, your first-line treatment for metabolic syndrome should involve lifestyle changes (diet, sleep and light entrainment as well as being non-sedentary)
  3. Be very conservative with any drug-centric approach that your doctor may offer
  4. It’s smart to focus on improving your metabolic syndrome markers to the extent that these can affect your odds of suffering from many other diseases


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