Metabolic Syndrome (Holistic)

Metabolic Syndrome (Holistic)

About This Condition

Reduce your metabolic syndrome risk by focusing on diet and lifestyle. According to research or other evidence, the following self-care steps may be helpful.
  • Try chromium

    Improve the action of insulin by supplementing with 200 to 1,000 mcg of this mineral

  • Fight back with fiber

    Improve blood cholesterol and blood sugar by taking 8 to13 grams a day of a glucomannan fiber supplement; dive into two or three doses and take with meals

  • Control your carbs

    Prevent excessive insulin production by saying no to foods with a high glycemic index

  • Choose a heart-healthy diet

    Reduce your risk by eating plenty of fruits, vegetables, legumes, whole grains, and fish; at the same time avoid fats from meat, dairy, and processed foods high in hydrogenated oils

About

About This Condition

Metabolic syndrome is a group of health risk factors that often occur together and increase the likelihood of heart disease and type 2 diabetes. The risk factors that make up metabolic syndrome include high blood glucose levels, high blood pressure, high waist circumference or waist-to-hip ratio, low HDL-cholesterol levels, and high triglyceride levels. A diagnosis of metabolic syndrome is made if a person has three or more of these conditions, and the more aspects of metabolic syndrome a person has, the greater their risk of type 2 diabetes, atherosclerosis, heart attack, and stroke.1, 2 In addition, metabolic syndrome is associated with increased risks of fatty liver disease, chronic kidney disease, Alzheimer's disease and other forms of dementia, and cancer.3, 4, 5, 6 Women with polycystic ovary syndrome (PCOS) frequently develop a similar group of metabolic disturbances.7

It is now widely accepted that the interrelationship between insulin resistance and malfunctioning fat tissue underlies metabolic syndrome. Insulin resistance occurs when insulin is no longer effective at getting cells to respond to rising glucose levels. Over time, insulin resistance causes impaired functioning of fat cells, which play a critical role in regulating metabolism. Expansion of malfunctioning fat tissue, particularly in the abdomen, further reduces sensitivity to insulin signaling. Together, these conditions lead to chronically increased production of tissue-damaging inflammatory chemicals. This chronic inflammatory state is linked to progressive injury to the inner lining of the blood vessels and to organs and tissues throughout the body.8, 9, 10

In addition to the recommendations discussed below, people with metabolic syndrome may benefit from some of the recommendations given for type 2 diabetes and cardiovascular disease, as well as obesity, high cholesterol and triglyceride levels, and hypertension.

Healthy Lifestyle Tips

Most people with obesity have or will develop metabolic syndrome.11 Excess fat tissue, especially when it accumulates in the abdominal region, increases the likelihood and severity of insulin resistance and is an independent risk factor for cardiovascular disease and diabetes.12, 13 Abdominal obesity is the most common component of metabolic syndrome.14 Weight loss, even when modest, has been shown to improve all components of metabolic syndrome, as well as other aspects of health.15 Therefore, an achievable weight loss goal, such as 5%–10% of body weight, is an important part of metabolic syndrome treatment.

Physical activity is associated with decreased risks of metabolic syndrome, type 2 diabetes, cardiovascular disease, and most other chronic diseases.16, 17 Exercise interventions have been shown to improve metabolic signs such as waist circumference, blood pressure, and HDL-cholesterol levels in people with metabolic syndrome, and physical activity in general improves fitness and positively impacts health outcomes associated with metabolic syndrome.18, 19 Although more research is needed to identify the optimal type, intensity, and duration of exercise necessary for metabolic benefits, an exercise program that includes both aerobic exercise and strength training may have some advantages over aerobic exercise alone.20, 21

Chronic psychological stress has been linked to the development and progression of metabolic syndrome in multiple observational studies.22, 23 Stress-related changes in immune function, insulin sensitivity, glucose metabolism, and eating patterns may all play a role, and may also underlie the observed relationship between metabolic syndrome and major depression.24, 25, 26 Mindfulness training interventions have been found to moderate the stress response and improve eating patterns and some metabolic signs in people with metabolic syndrome.27, 28

Although the mechanism is not completely understood, a growing body of research suggests tobacco smoking is independently associated with insulin resistance and abdominal obesity, and may compound the negative impact of metabolic syndrome on vascular health.29, 30 Smoking has also been linked to high blood pressure and high glucose levels.31 Smoking cessation has been found to improve blood pressure and levels of triglycerides, glucose, and HDL-cholesterol in the short term in individuals with metabolic syndrome, despite modest weight gain.32 The possibility that nicotine replacement therapy, such as using nicotine gums or patches, may contribute to metabolic disturbance needs further exploration.33, 34

Alcohol consumption increases the risk and severity of fatty liver disease in people with obesity and metabolic syndrome.35, 36 Even a low level of alcohol use increases progression of liver fibrosis and risk of liver cancer and other severe liver disease in those with fatty liver.37 Although light to moderate drinking, particularly of wine, has been correlated with reduced risks of metabolic syndrome, type 2 diabetes, and some cardiovascular outcomes, abstinence may nonetheless be more beneficial for those with obesity and metabolic syndrome.38, 39, 40, 41

Eating Right

The right diet is the key to managing many diseases and to improving general quality of life. For this condition, scientific research has found benefit in the following healthy eating tips.

Recommendation Why
Consider going Mediterranean
A Mediterranean dietary pattern has been shown in multiple studies to aid in the management of metabolic syndrome and prevention of type 2 diabetes and cardiovascular disease.

The Mediterranean diet emphasizes fruits, vegetables, whole grains, legumes, nuts, fish, and olive oil, and includes small amounts of dairy products, poultry, and red wine. Switching to a Mediterranean-type diet was found to improve the nutrient density of the diet in a trial with more than 5,700 participants affected by metabolic syndrome. Adherence to a Mediterranean dietary pattern has been found in multiple observational studies, clinical trials, and research reviews to improve health in people with metabolic syndrome and reduce the risk of metabolic disease in healthy individuals. Furthermore, comparison trials show it is more effective than standard diet recommendations and low-fat diet for reducing signs of metabolic syndrome.

While including foods that are part of the Mediterranean diet can improve metabolic health, there may be other aspects of food choice that also influence the diet's impact. For example, one interesting study that included a group of participants with strong adherence to Mediterranean diet found those who ate more locally sourced food were less likely to have metabolic syndrome compared to those who ate more food from farther away.
Get your protein
High-proteins diets may help people with metabolic syndrome achieve weight loss, and some evidence suggests plant protein may have more positive effects on metabolism than animal protein.
Research into the effects of high-protein diets on metabolic health has yielded inconsistent evidence. A study using data from over 3,000 middle-aged adults examined the relationship between protein intake and cardiac and metabolic risk factors. The analysis found those with higher protein intake, compared to those with lower protein intake, had better systolic (but not diastolic) blood pressure but worse blood glucose levels after 20 years of monitoring; no relationship was seen between protein intake and changes in body weight, waist circumference, cholesterol levels, or triglyceride levels. When protein source was considered, higher plant protein intake was associated with better blood glucose levels and waist circumference, but higher animal protein intake was associated with worsening of both of these aspects of metabolic syndrome. In a study in people with metabolic syndrome, eating a high-protein, reduced-calorie diet led to more weight loss than a standard reduced-calorie diet after six months; however, there were no other differences between the diets on aspects of metabolic syndrome. Another dietary intervention trial compared the effects of high-plant protein, high-animal protein, and normal-protein healthy diets in 62 overweight adults with metabolic syndrome during a 23-week weight loss program. All of the diet interventions led to similar weight loss and improvements in metabolic syndrome, with no significant differences between groups.
Keep an eye on the glycemic index
Avoiding high-glycemic index foods, which are most often refined starches and sugary foods, may help protect metabolic health, but is not sufficient to treat metabolic syndrome.
The glycemic index is a system that rates foods by their blood glucose-raising effect relative to an equal carbohydrate portion from a reference food, while the glycemic load takes into account the carbohydrate content of a typical serving (quantity) as well as the blood glucose-raising potential (quality). While a diet rich in high-glycemic index foods has been found to worsen blood glucose control, insulin sensitivity, lipid levels, and obesity, it is unclear whether low-glycemic index and low-glycemic load diet interventions are helpful in people with metabolic syndrome. A meta-analysis of studies found higher amounts of high-glycemic index foods in the diet corresponded with increased risk of metabolic syndrome, but a high-glycemic load diet was not correlated with risk. Another meta-analysis found low-glycemic index and load diets had no impact on cardiovascular or all-cause mortality in men, and only a low-glycemic index diet appeared to have a protective effect in women.
Explore options other than a low-fat diet
In general, a low-fat diet is not indicated for prevention or treatment of metabolic syndrome; instead, modest consumption of a variety of fats, with emphasis on polyunsaturated and monounsaturated fats, appears to improve metabolic health.

It is a long-held assumption that a high-fat diet can induce obesity and metabolic dysregulation; however, a large body of evidence now shows that replacing carbohydrate calories with fat of any type can lower triglyceride levels and raise HDL-cholesterol levels, and consuming poly- and mono-unsaturated fats (but not saturated fats) may improve glucose metabolism. A study that included over 6,000 participants found those with the highest intakes of total fat, saturated fat, and monounsaturated fat had higher blood glucose levels than those with lower intakes. Unexpectedly, those with the highest saturated fat intake had lower triglyceride levels. Another study from Brasil with 9,835 participants found high intake of saturated fat from dairy products appeared to protect against metabolic syndrome, contributing to speculation that not all saturated fats are equal in their health effects.

Polyunsaturated omega-3 fats from fish have been suggested to have a protective role: a study compared diet to incidence of metabolic syndrome in 4,356 young adults during 25 years of observation and found high consumption of omega-3 fatty acids from fish reduced the likelihood of developing metabolic syndrome.
Low-Carbohydrate
Low- and very low-carbohydrate diets can help normalize metabolic parameters, but the long-term safety of a ketogenic diet is not known.

Increased carbohydrate intake, as a percentage of total calorie intake, has been clearly associated with higher risk of metabolic syndrome. However, one study that included 164 people with type 2 diabetes noted high carbohydrate intake was only related to metabolic syndrome, and in particular to high triglyceride and low HDL-cholesterol levels, in those with low fiber intake, suggesting carbohydrate quality, as much as quantity, impacts metabolic health. In a clinical trial in subjects with obesity and metabolic syndrome, a four-week, low-carbohydrate, high-fat, weight maintenance diet intervention was found to improve some features of metabolic syndrome (triglyceride and cholesterol levels) more than moderate- or high-carbohydrate weight maintenance diets.

A very low-carbohydrate diet, in which only 5%–10% of calorie intake is from carbohydrates, induces a physiologic state called ketosis, marked by high levels of ketones (products of fat metabolism). A therapeutic ketogenic diet includes 20–50 grams of carbohydrate per day, 1–1.5 grams of protein per kilogram of body weight, and unlimited fat. The ketogenic diet has been found to improve aspects of metabolic syndrome, including insulin resistance, blood glucose control, waist circumference, cholesterol and triglyceride levels, and blood pressure, as well as levels of inflammatory markers. One uncontrolled trial in 377 participants found a ketogenic diet reduced body weight, waist circumference, fat mass, and systolic blood pressure within 12 weeks and the benefits were maintained over one year of monitoring.

Little is known about the long-term effects of such a low-carbohydrate diet, which is notably low in prebiotic fibers needed to maintain a balanced gut microbiome, on health outcomes and mortality. A pooled analysis of clinical findings reported people eating low-carbohydrate diets have a substantially higher mortality rate. In addition, a study that followed more than 15,000 American adults for about 25 years found the lowest mortality rate occurred in those with moderate carbohydrate intake (50%–55% of calorie intake), while both low (<40%) and high (>70%) carbohydrate intakes were associated with higher mortality. This study further noted that, among those with low carbohydrate intake, only those who replaced carbohydrates with protein and fat from animal sources experienced an increase in mortality; instead, those who replaced carbohydrates with protein and fat from plant sources had a lower mortality compared to moderate carbohydrate consumers.

Supplements

What Are Star Ratings?
Supplement Why
3 Stars
Anthocyanins
> 400 mg daily
Taking anthocyanins may help people with metabolic syndrome achieve better blood glucose control and normalize triglyceride and cholesterol levels.
Anthocyanins are pigments found in many berries, as well as in other fruits and vegetables. Findings from a clinical trial in healthy and metabolic syndrome-affected subjects suggest anthocyanin supplementation may improve metabolic function in part by reducing inflammation. A meta-analysis of 32 randomized controlled trials, with a total of 1,491 participants with metabolic syndrome or its components, found anthocyanins can improve glucose and lipid metabolism, and may be more effective at doses exceeding 400 mg per day.
3 Stars
Berberine
500 mg three times daily
Clinical trials have shown berberine can benefit all aspects of metabolic syndrome.

Berberine is an alkaloid found in several medicinal plants, such as goldenseal (Hydrastis canadensis), barberry (Berberis vulgaris), Oregon grape (Mahonia aquifolium), and goldthread (Coptis chinensis). Results from laboratory research and clinical trials indicate berberine may have a positive impact on metabolic disorders including obesity, high cholesterol and triglyceride levels, insulin resistance, high blood glucose levels and type 2 diabetes, and high blood pressure. Some evidence suggests berberine may help people with metabolic syndrome by stimulating healthy function of adipose (fat) tissue.

One controlled trial included 80 participants with metabolic syndrome; specifically, all of the participants had high blood pressure, insulin resistance/type 2 diabetes, and high cholesterol and triglyceride levels. All participants were treated conventionally, and half also received berberine at a dose not specified in the published report. After one month, measures of blood glucose control, insulin sensitivity, lipid metabolism, and systemic inflammation had improved more in those given berberine. A double-blind, placebo-controlled trial with 24 participants affected by metabolic syndrome found 500 mg of berberine three times daily for three months led to decreased waist circumference, blood pressure, and triglyceride levels, and increased insulin sensitivity.
3 Stars
Cinnamon
1 to 3 grams daily
Cinnamon has been shown to improve all aspects of metabolic syndrome.
Because cinnamon and cinnamon extracts have demonstrated benefits in people with insulin resistance and type 2 diabetes, it has potential benefits in people with metabolic syndrome. A placebo-controlled trial that included 116 participants with metabolic syndrome found 3 grams of cinnamon per day for 16 weeks improved blood glucose, triglyceride, and cholesterol levels, as well as waist circumference, blood pressure, and blood glucose control. In a randomized controlled trial, cinnamon reduced signs of metabolic disease in people with type 2 diabetes: after eight weeks, study participants receiving 3 grams of cinnamon per day had lower blood glucose levels, triglyceride levels, body weight, and body fat, and improved blood glucose control. Similarly, in a placebo-controlled trial with 140 participants with diabetes, taking 1 gram of cinnamon daily for three months improved glucose and lipid metabolism and was associated with body fat and weight loss, with stronger effects in those with more severe obesity. Placebo-controlled trials in people with type 2 diabetes show cinnamon can reduce high blood pressure in people with metabolic disease. Furthermore, a meta-analysis of controlled trials showed cinnamon can also reduce high blood pressure, with greatest efficacy when used at a dose of 2 grams per day or less for at least 12 weeks.
3 Stars
Glucomannan
3 to 10 grams daily
Taking a glucomannan fiber supplement may improve metabolic syndrome.
Glucomannan, a type of water-soluble dietary fiber from the root of the konjac plant, may reduce risk factors in people with metabolic syndrome. A double-blind trial found that 8–13 grams per day of glucomannan improved cholesterol levels and blood glucose control in people with metabolic syndrome. It is thought to work in part by acting as a prebiotic fiber, enhancing colonies of beneficial gut bacteria that participate in regulating metabolism. Even in patients with type 2 diabetes, 3 grams of glucomannan per day for four weeks improved blood glucose control and lipid metabolism compared to placebo.
3 Stars
Green Tea
600 to 900 mg of tea catechins daily
Strong evidence indicates green tea and black tea extracts can help individuals with metabolic syndrome reduce body weight, lower blood glucose levels, and raise HDL-cholesterol levels.
Drinking tea has been associated with lower risk of metabolic syndrome, and both green and black tea extracts, as well as the green tea catechin epigallocatechin gallate (EGCG), have demonstrated positive effects in people with metabolic syndrome. One meta-analysis of six randomized controlled trials involving people with obesity and metabolic syndrome concluded consuming a green tea catechin-rich beverage reduces abdominal fat accumulation and improves metabolic status. A large meta-analysis of studies pooled findings from 16 controlled trials with a combined total of 1,090 participants with obesity and metabolic syndrome. The results showed that, while the evidence for green tea extract is stronger than that for black, both green and black tea extracts help lower blood glucose levels, raise HDL ("good")-cholesterol levels, and reduce body mass index, but have no impact on blood pressure, triglycerides, or other cholesterol levels. Most studies finding beneficial metabolic effects used 600–900 mg of tea catechins per day for at least 12 weeks. It is important to note liver toxicity has been associated with the use of very high doses of green tea extracts.
3 Stars
Guar Gum
3 to 10 grams daily
Taking a guar gum fiber supplement may improve metabolic syndrome.
Guar gum, another fiber supplement with similar properties to glucomannan, may also have metabolic benefits. A controlled trial in which subjects with type 2 diabetes and metabolic syndrome were given 10 grams per day of guar gum or placebo found those given guar gum had improved blood glucose control and reduced waist circumference after six weeks. Healthy men given the same dose of guar gum for six weeks were also reported to have experienced improvements in aspects of metabolic syndrome, including blood pressure and glucose, cholesterol, and triglyceride levels. Another preliminary trial noted taking 4 grams of guar flour twice daily reduced insulin resistance, decreased total and LDL-cholesterol levels, and increased HDL-cholesterol levels in men with type 2 diabetes.
2 Stars
Açaí
200 grams of berry pulp daily
Preliminary evidence suggests acai berry may improve metabolic health.
Açaí berries are high in polyphenols and therefore have a strong antioxidant action. In a pilot study, supplementing with 100 grams per day of açaí berry pulp for 30 days was found to lower blood glucose, insulin, and total and LDL-cholesterol levels in ten overweight adults with metabolic disease. However, in a placebo-controlled trial with 37 participants with metabolic syndrome, treatment with 325 mL of an açaí berry beverage (providing 370 mg of gallic acid) twice daily did not improve markers of glucose and lipid metabolism.
2 Stars
Chromium
200 to 500 mcg daily, or more under doctor supervision
Supplementing with chromium may be beneficial in people with type 2 diabetes and metabolic syndrome.

Chromium is a mineral needed in trace amounts by the body. It has been widely studied for its potential benefits in people with insulin resistance and type 2 diabetes. A 23-year observational study found those with poorer baseline chromium status were more likely to develop metabolic syndrome than those with better chromium status. However, clinical trials examining the effects of chromium supplementation in people with metabolic syndrome have been mixed.

In one placebo-controlled trial with 70 subjects affected by metabolic syndrome, those receiving 300 micrograms of chromium (in the form of chromium-enriched yeast) per day had no changes in measures of glucose and lipid metabolism but had a decrease in resting heart rate. While high heart rate is not typically considered part of metabolic syndrome, it is linked to heart disease. In a placebo-controlled trial that enrolled 59 subjects diagnosed with high glucose levels, insulin resistance, or metabolic syndrome, taking either 500 micrograms or 1,000 micrograms of chromium (as chromium picolinate) daily for six months did not change any of the measured metabolic parameters. Chromium picolinate, at a dose of 1,000 micrograms per day, was also ineffective for improving metabolic markers in a placebo-controlled trial with 63 participants with obesity and metabolic syndrome. Nevertheless, a meta-analysis of 28 randomized controlled trials in people with type 2 diabetes concluded chromium not only improves markers of glucose regulation and insulin sensitivity, but also decreases triglyceride levels and increases HDL-cholesterol levels. The evidence therefore indicates chromium may specifically benefit those with metabolic syndrome co-occurring with type 2 diabetes.
2 Stars
Coenzyme Q10
30 to 200 mg daily
A small body of clinical evidence suggests coenzyme Q10 may improve insulin sensitivity, glucose and lipid metabolism, and blood pressure in those with metabolic syndrome.
Coenzyme Q10 (CoQ10) has well known cardiovascular benefits. In people with metabolic syndrome, 100 mg of CoQ10 per day for eight weeks improved markers of insulin resistance, but had no impact on glucose, lipid, and inflammatory marker levels compared to placebo. A controlled trial that included 104 participants with metabolic syndrome compared the effects of a dietary intervention alone to diet plus 30 mg of CoQ10 and red yeast rice providing 10 mg of monacolin K (a cholesterol-lowering compound) per day. After two months, those taking the supplements had greater improvements in blood pressure, cholesterol levels, and glucose levels. Although CoQ10 has been reported to lower blood pressure in clinical trials in uncomplicated hypertensive subjects, a placebo-controlled trial in 30 patients with high blood pressure and metabolic syndrome found 200 mg of CoQ10 twice daily did not lower blood pressure after 12 weeks of treatment. CoQ10 may be helpful in treating metabolic syndrome associated with polycystic ovary syndrome: in one trial, 100 mg of CoQ10 per day for 12 weeks was more effective than placebo for improving glucose and lipid metabolism.
2 Stars
L-Carnitine
2 to 3 grams daily
L-carnitine supplementation may reduce cardiovascular risk by improving metabolic parameters such as body weight, blood glucose control, insulin sensitivity, and lipid levels.
The amino acid L-carnitine has been shown in clinical trials and meta-analyses to improve blood glucose control, insulin sensitivity, weight loss, and lipid metabolism, indicating its potential usefulness in treating metabolic syndrome and reducing cardiovascular risk. In one placebo-controlled trial, women with obesity and type 2 diabetes participated in a low-calorie diet program and received 2 grams of L-carnitine per day or placebo for about eight weeks. At the end of the trial, those receiving L-carnitine had greater improvements in blood glucose control, insulin sensitivity, cholesterol and triglyceride levels. In an uncontrolled trial, taking 3 grams of L-carnitine daily for three months led to decreased insulin resistance, LDL-cholesterol levels, and body-mass index (BMI), and increased HDL-cholesterol levels in 80 women with polycystic ovary syndrome, a condition associated with metabolic syndrome.
2 Stars
Magnesium
300 mg daily
People with metabolic syndrome often have low magnesium status and benefit from magnesium supplementation.
Low magnesium levels have been associated with increased risk of metabolic syndrome, as well as type 2 diabetes and cardiovascular disease, in multiple observational studies. A review of randomized controlled trials investigating the use of magnesium supplements in people with components of metabolic syndrome concluded magnesium has metabolic benefits in individuals with low magnesium levels. In one placebo-controlled trial that included 198 participants with metabolic syndrome and low magnesium status, taking 382 mg of elemental magnesium daily for 16 weeks reduced blood pressure, blood glucose levels, and triglyceride levels. However, 300 mg of magnesium along with 600 micrograms of chromium and 36 mg of zinc daily for 24 weeks did not impact aspects of metabolic syndrome in a placebo-controlled trial that included people with metabolic syndrome whose baseline magnesium status was not measured.
2 Stars
Myoinositol
1.1 to 4 grams daily; in combination supplements, the ratio of myoinositol to d-chiro-inositol is generally 40:1
Myoinositol, alone or in combination with d-chiro-inositol, may improve some aspects of metabolic syndrome in women with polycystic ovary syndrome.
Myoinositol is best known for its therapeutic effects in women with polycystic ovary syndrome (PCOS). Myoinositol alone and in combination with another inositol isomer, d-chiro-inositol, has been reported to improve not only the hormonal aspects of PCOS but also some of the metabolic disturbances associated with the condition, including insulin resistance, high blood pressure, obesity, and lipid levels. One controlled trial found myoinositol was more effective than metformin (a medication frequently used to treat type 2 diabetes) for improving blood glucose control and triglyceride levels in women with PCOS after 12 weeks of treatment, but a similar trial did not note any metabolic advantages of myoinositol over metformin.
2 Stars
Omega-3 Fatty Acids
1 to 2 grams of fish oil, or ~300 mg of combined EPA plus DHA, daily
Fish oil and its omega-3 fatty acids have positive metabolic effects and are especially effective for lowering high triglyceride levels in people with metabolic syndrome.

Polyunsaturated omega-3 fatty acids from fish, particularly eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), have anti-inflammatory properties that benefit metabolic and cardiovascular health. A meta-analysis of results from 27 studies found a relationship between higher blood levels of omega-3 fats and lower risk of metabolic syndrome.

Other reviews of the research indicate omega-3 fatty acid supplementation can improve insulin sensitivity and blood vessel function in people with metabolic disorders. A controlled trial with 89 participants with metabolic syndrome found those who received 1 gram of fish oil, providing 180 mg of EPA and 120 mg of DHA, daily had improvement in metabolic parameters at the end of six months; specifically, reductions in body weight, blood pressure, LDL- and total-cholesterol levels, and triglyceride levels were noted. However, a twelve-week placebo-controlled trial with 417 subjects with metabolic syndrome found supplementing with 1.2 grams of polyunsaturated omega-3 fatty acids daily reduced triglyceride levels but had no impact on insulin sensitivity, blood pressure, cholesterol levels, or levels of inflammatory markers. Likewise, in a twelve-week trial involving men with metabolic syndrome, a reduced-calorie diet was found to improve metabolic signs, but adding a fish oil supplement provided no additional benefit except triglyceride lowering. A meta-analysis of five controlled trials in which overweight subjects with metabolic syndrome were treated with omega-3 fatty acids plus vitamin E found this supplement regime lowered triglyceride and LDL-cholesterol levels but otherwise did not alter metabolic parameters.
2 Stars
Probiotics
= 6.5 billion colony forming units (CFUs) daily
Early research indicates probiotics have likely, though small, benefits on metabolic and cardiovascular health.

There is increasing awareness of the importance of gut bacteria in regulating metabolism and inflammatory immune function, and growing evidence indicates a role for probiotics, as well as prebiotics (fibers that enhance growth of beneficial bacteria) and synbiotics (combinations of pro- and prebiotics) in preventing and treating metabolic syndrome.

One placebo-controlled trial compared the effects of a multi-strain probiotic supplement and an inulin-based synbiotic supplement to placebo in 120 participants with pre-diabetes. Both the probiotic and synbiotic supplements reduced the prevalence of metabolic syndrome more effectively than placebo. A meta-analysis was performed using data from nine randomized controlled trials investigating the use of probiotics in subjects with metabolic syndrome. The trials used different species of lactobacilli and bifidobacteria, at doses ≥ 6.5 billion colony forming units (CFUs), and lasted three to 12 weeks. Five of the trials reported small but statistically significant positive findings with regard to metabolic syndrome parameters such as body-mass index (BMI), blood glucose levels, and lipid metabolism. In addition, certain probiotic strains appear to improve gut microbiome composition and reduce blood levels of inflammatory markers in people with metabolic syndrome. More research is needed to identify specific strains, optimal doses, and duration of treatment needed for probiotics to improve metabolic health.
2 Stars
Vitamin D
3 to 4,000 IU of vitamin D3 daily
Vitamin D deficiency increases the risk of metabolic disorders.
Vitamin D has multiple actions that affect metabolic syndrome. It has been shown to lower blood glucose levels, reduce insulin resistance, regulate blood pressure, promote body weight management, improve fat tissue function, reduce inflammation, and normalize triglyceride and cholesterol levels. A number of studies have linked vitamin D deficiency to increased risks of insulin resistance, type 2 diabetes, and metabolic syndrome. Supplementation appears to be helpful in those with metabolic syndrome who have poor vitamin D status. Until more is known about vitamin D and metabolic syndrome, it is important to maintain sufficient vitamin D levels.
1 Star
Calcium
Refer to label instructions
One study found that supplementing with calcium improved insulin sensitivity in people with hypertension.

Caution: Calcium supplements should be avoided by prostate cancer patients.

One double blind trial found that 1,500 mg per day of calcium improved insulin sensitivity in people with hypertension. No research on the effects of calcium in people with metabolic syndrome has been done.

1 Star
Vitamin E
Refer to label instructions
Vitamin E supplements, particularly tocotrienols, have been found to be beneficial in treating the conditions that make up metabolic syndrome.
Two clinical trials have examined the effects of vitamin E in subjects with metabolic syndrome. In the first trial, 80 participants received either 800 mg of alpha-tocopherol, 800 mg of gamma-tocopherol, 800 mg of each alpha- and gamma-tocopherol, or placebo daily; after six weeks, those receiving both forms of vitamin E had reductions in markers of oxidative stress, nitrogen-related stress, and inflammation, suggesting vitamin E may reduce tissue damage associated with metabolic syndrome. In the second trial, which included 57 participants, taking 400 mg per day of mixed tocotrienols (other forms of vitamin E) for 16 weeks reduced inflammatory marker levels and improved lipid profiles. In addition, vitamin E supplements, particularly tocotrienols, have been found to be beneficial in treating the conditions that make up metabolic syndrome, including obesity, high blood pressure, high glucose levels, and abnormal lipid profiles.
1 Star
Zinc
15 to 50 mg daily
Zinc is important for metabolic health, but there are risks associated with both too little and too much zinc.
Studies examining the relationship between zinc status and metabolic syndrome have yielded mixed findings. A study based on data from 1,088 participants in the National Health and Nutrition Examination Study (NHANES) from 2011–2014 found a correlation between high zinc levels and increased risk of metabolic syndrome. However, according to a meta-analysis of 20 controlled trials, zinc supplementation appears to have metabolic benefits such as improving blood glucose control and triglyceride and cholesterol levels. Another research review noted zinc supplements have a positive impact on blood glucose control in those with type 2 diabetes who have zinc deficiency. Taken together, the research suggests the importance of avoiding zinc deficiency and excess for preventing cardiovascular disease and type 2 diabetes.

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