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Home > Living Well > Health Library > Metabolic Syndrome (Holistic)
Improve the action of insulin by supplementing with 200 to 1,000 mcg of this mineral
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
Prevent excessive insulin production by saying no to foods with a high glycemic index
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
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.
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
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.
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.
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.
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For over a decade, our team has combed through thousands of research articles published in reputable journals. To help you make educated decisions, and to better understand controversial or confusing supplements, our medical experts have digested the science into these three easy-to-follow ratings. We hope this provides you with a helpful resource to make informed decisions towards your health and well-being.
3 StarsReliable and relatively consistent scientific data showing a substantial health benefit.
2 StarsContradictory, insufficient, or preliminary studies suggesting a health benefit or minimal health benefit.
1 StarFor an herb, supported by traditional use but minimal or no scientific evidence. For a supplement, little scientific support.
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.
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.
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.
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.
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.
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Last Review: 06-08-2015
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