What is metabolic syndrome?

Metabolic syndrome isn’t an illness, but rather a group of conditions and risk factors that increase your likelihood of developing the following:
 

• Cardiovascular disease – health problems that affect your heart and blood vessels such as heart attacks and stroke

• Type 2 diabetes

 
You may have come across one of its other names such as syndrome X or insulin resistance syndrome. In fact syndrome X and insulin resistance syndrome were the first names given to metabolic syndrome when it was first described in 1988 by Gerald Reaven, a professor of medicine at Stanford University in the USA.
 
Back then the idea of a cluster syndrome that was linked with diabetes and cardiovascular disease was controversial. These days, however, many health professionals acknowledge metabolic syndrome as an important tool for predicting diabetes and cardiovascular disease risk – though some have more recently questioned its relevance, since it doesn’t take into account other significant risk factors such as gender, age, family history and smoking status.
 

How many people have metabolic syndrome?

If you’re not that familiar with metabolic syndrome, you may be surprised to find out how common it is. According to Patient UK, a quarter of all adults in the UK have metabolic syndrome, with 10 - 50 per cent of adults affected worldwide (i).
 
It’s also thought that the older you are, the more likely you are to develop metabolic syndrome: 40 per cent of adults aged 50 or older in the USA and nearly 30 per cent of those in Europe are believed to be affected (ii). But it can develop in the young too, particularly in children who are obese.
 

What are the five signs or risk factors for metabolic syndrome?

So, what exactly are the risk factors and conditions involved in metabolic syndrome? Several different combinations have been proposed, but the following (iv) are widely felt to be the main ones:
 

• Raised fasting blood sugar (glucose) caused by insulin resistance: 5.6mmol/L or higher

• Being overweight or obese (in particular, having a lot of fat around your middle)

• Increased waist size: for men this is 94cm/37in or higher, and for women 80cm/32in or higher; a separate figure applies to men of South Asian heritage (90cm/36in or higher). An alternative risk factor is having a body mass index (BMI) of 30 or higher (increased waist size is assumed at this level of BMI) 

• Raised blood pressure: 130/85mmHg or higher

• Raised triglyceride levels (triglycerides are a type of fat found in the blood): 1.7Mmol/L or higher

• Reduced levels of (high-density lipoprotein (HDL) cholesterol (also known as ‘good’ cholesterol): 1.03mmol/L or lower in men and 1.29mmol/L or lower in women

 
Having any one of these conditions/risk factors could increase your risk of health problems. However, iIf you have three or more your risk is raised considerably, and you’ll usually be diagnosed as having metabolic syndrome. One source, for instance, suggests that having a combination of the above conditions/risk factors doubles your risk of heart attacks and strokes and increases your risk of diabetes by five times (iii).
 

Insulin resistance

Insulin is a hormone made by your pancreas that controls the level of sugar in your blood. When your pancreas cannot make any insulin at all, it means you have type 1 diabetes. With type 2 diabetes, your pancreas may make some insulin but not enough to keep your blood sugar level healthy.
 
Find out more about both types of diabetes in our diabetes guide.

Insulin resistance can also cause type 2 diabetes – this is when your body’s cells cannot absorb and use the insulin effectively that your pancreas makes. However, having insulin resistance doesn’t always mean you have type 2 diabetes, since your blood sugar levels may be raised but still within the normal range. But the longer you have insulin resistance, the more likely you’ll become prediabetic. And over time, your pancreas could lose its ability to make the amount of insulin your body needs, and you may be diagnosed with type 2 diabetes.
 
Having high levels of blood sugar can damage your blood vessels, iIndeed insulin resistance is a major metabolic syndrome risk factor. It’s also more common in people who are obese, especially those who have central obesity. According to Heart UK, that’s because excess fat from the abdominal area can enter the pancreas, where it can cause problems with insulin production (v).
 

Obesity/waist size

Being obese is also a major metabolic syndrome risk factor. In fact, it’s thought that the rising obesity rates in many countries around the world may explain why metabolic syndrome has become so widespread. However even if your weight is otherwise normal you may still be at risk of developing metabolic syndrome if you have a large waist size (this is also called central obesity or abdominal obesity). This may be because having a lot of fat around your middle can affect your blood fats, with experts suggesting it may also more than double your type 2 diabetes risk (vi).
 
You may even be diagnosed with metabolic syndrome if you’re of normal weight and have normal blood sugar levels if you have the other three risk factors – read on to find out more about them.
 

High blood pressure

Having high blood pressure increases the risk of heart attack and stroke because it puts a strain on your heart making it work harder to pump blood around your body. A blood pressure reading, which is measured in millimetres of mercury (mmHg), consists of two numbers:
 

• The first number represents systolic pressure, a measurement of the pressure on your blood pressure walls when your heart beats.

• The second number represents diastolic pressure, which is a measurement of the pressure between beats.

 
A healthy blood pressure reading is between 90/60 and 120/80, while high blood pressure is 140/90 or higher. If your blood pressure is somewhere between the two it’s not considered high, but you may hear it referred to as pre-high blood pressure. This means your blood pressure may continue to get higher unless you take action to lower it (usually by addressing your diet and lifestyle).
 
Having a one-off or occasional reading of 140/80 or above doesn’t necessarily mean your blood pressure is high. However anyone with blood pressure readings that are consistently 140/80 or higher will usually be offered blood pressure-lowering medication.
 
Find out more about blood pressure and what you can do to keep yours within the healthy range, read our blood pressure guide.
 

Unhealthy blood fat levels

Triglycerides is the name for a type of fat that circulates in your blood. If your triglyceride levels are too high – that is, more than 1.7mmol/L – your heart disease risk may also be higher than it should be. Meanwhile people with high triglyceride levels also often have low levels of HDL cholesterol.
 
High triglycerides may be a factor in the development of atherosclerosis – thickening or hardening of the arteries – which increases the risk of cardiovascular disease. And as well as being one of the risk factors of metabolic syndrome, high triglycerides can be a sign of type 2 diabetes or prediabetes.
 
Insulin resistance can often lead to a combination of high triglycerides and low HDL cholesterol (the combination is often called dyslipidaemia). Meanwhile other things that can contribute to low HDL cholesterol levels include smoking – according to Heart UK giving up smoking can increase your HDL levels by up to 10 percent (vii) – and taking certain medicines including beta blockers (for lowering blood pressure) and anabolic steroids.
 

Other signs of metabolic syndrome to look out for

Besides the five main conditions and risk factors there are other things that may increase your susceptibility to developing metabolic syndrome too – your age is one of them, for instance. Others include:
 

• A family history of metabolic syndrome

• Lack of exercise

• Eating too many unhealthy processed foods

• Smoking  

• Polycystic ovary syndrome

• Obstructive sleep apnoea 

• Chronic kidney disease 

• Nonalcoholic fatty liver disease

 

Health conditions linked with metabolic syndrome

Metabolic syndrome is most strongly linked with an increased risk for cardiovascular disease and type 2 diabetes. However there are some other health conditions that are associated with it too – some of which are also risk factors for metabolic syndrome – including the following:
 

Kidney disease

If your kidneys aren’t working as well as they should – whether a result of disease, damage or simply ageing – it’s a sign that you may have chronic kidney disease. It is, in fact, quite common, with around one in 10 people affected by it to some degree or other (viii).
 
You can develop chronic kidney disease at any age, but it’s most common in older people (around half of people aged 75 or older are thought to be affected, thanks to the normal ageing of their kidneys (viii)). Kidney disease is also common in people who have diabetes, with around one in eight people with type 2 diabetes also having early-stage diabetic kidney disease when they’re first diagnosed with diabetes (ix).
 
Find out more by reading our guide to diabetes and kidney disease. 
 

Obstructive sleep apnoea

Often called OSA for short, this is the name for the condition when your breathing stops briefly while you’re asleep. If you have OSA you may feel tired rather than refreshed when you wake up in the morning, and you may also feel sleepy during the day.
 
OSA is caused by an airflow problem caused by the muscles in your throat relaxing too much. In fact they relax so much that they collapse completely, closing your throat and stopping you breathing. The problem is that you may experience so many episodes where your throat muscles collapse during the night that you don’t get a proper night’s sleep (it’s not unusual for someone to have more than 30 episodes a night where they stop breathing for a while before gasping for breath again).
 
The Sleep Apnoea Trust estimates that up to 10 million people in the UK have OSA, with excessive sleepiness during waking hours one of the most common symptoms (x). It’s also thought that half of people with OSA are overweight, with 40 percent of people living with obesity also affected by OSA (xi). You can read more about it in our guide to obstructive sleep apnoea. 
 

Inflammatory skin conditions

Skin complaints such as psoriasis and lichen planus may also be associated with metabolic syndrome:
 
Psoriasis – which affects around two percent of people in the UK (xii) – is caused by overactive immune system cells speeding up the turnover of skin cells. The result is dead skin cells forming silvery white scales that can accumulate and form large, raised, itchy patches, with the most common type of psoriasis found on the elbows, knees, lower back and scalp (though it can develop almost anywhere).
 
For more details, read our guide to psoriasis causes.

Lichen planus is an itchy skin rash that affects around one in 5,000 people, usually in those aged 45 and older (xiii). It can also affect other parts of the body, including the mouth, hair, nails and genitals, and can last for 18 months or longer (though most cases clear up within six to 12 months).
 
What we know about lichen planus is that inflammation triggers the rash, though what causes the inflammation isn’t clear. Treatments are available to help relieve itching and improve the appearance of the rash, but mild cases may not need any treatment and often eventually clear up on their own.
 

Common cancers

According to a review of studies, an increased risk for some common cancers have been linked with metabolic syndrome, including breast, liver, bladder, pancreatic, colon and endometrial cancers (xiv). The mechanisms that link metabolic syndrome and cancer risk aren’t fully known, say the researchers. But they concluded that metabolic syndrome may be a surrogate marker for other cancer risk factors such as low levels of physical activity, intake of high calorie-dense foods, high fat and low fibre intake, with obesity and high blood sugar also possible linking factors.
 

Gout

Between one and two in every 100 people in the UK are thought to be affected by gout (xv), a type of arthritis that causes extremely painful and swollen joints (often those in the toes, ankles, knees and fingers). Gout is caused by high levels of a substance called uric acid in the blood, which is also called hyperuricaemia. However hyperuricaemia has also more recently been associated with conditions and risk factors for metabolic syndrome, including insulin resistance and high blood pressure.
 
You can find out more about gout and how it’s treated by reading our guide.
 

How can you prevent metabolic syndrome?

Some of the risk factors and conditions of metabolic syndrome can be treated with prescription medicines: blood pressure-lowering medicines, insulin-regulating medicines or triglyceride-lowering medicines, for instance. However doctors offer most people diagnosed with metabolic syndrome advice about lifestyle changes that can reverse it and help reduce their risk of developing type 2 diabetes, cardiovascular disease and other related health complications.
 
The same lifestyle advice can also help prevent metabolic syndrome in those who haven’t already developed it. Some of the things you can do include the following:
 

Eat healthily

Having a nutritious, balanced diet can help keep your blood pressure, cholesterol and blood sugar levels at a healthy level. Aim to eat plenty of fruit and veg (at least five portions a day) as well as wholegrains and other fibre-rich foods. At the same time try to reduce your intake of saturated fat and refined carbs (foods with added sugar and white flour). Try to cut back on salt too, as eating too much can increase your blood pressure (aim to limit yourself to 6g of salt a day). 
 
It may also be worth trying a way of eating called time-restricted eating – which is a type of intermittent fasting – as a study has shown it may help with weight loss and blood sugar and blood pressure management in people with metabolic syndrome (xvi). Time-restricted eating means limiting your eating to a set number of hours within the day and fasting for the rest of the time. This particular study involved participants with metabolic syndrome having all their normal meals within a 10-hour period (8am to 6pm, for instance).
 

Be more active

A lack of exercise may contribute to insulin resistance, weight gain and raised blood sugar, so try to be more active in general (avoid sitting for long periods, for instance). In addition to making sure you move more often in your normal daily life, health experts recommend the following (xvii):
 

• If you’re an adult aged 19 - 64 you should aim to do at least 150 minutes of moderate activity a week spread evenly over four to five days or every day, as well as strengthening activities that work all the major muscle groups on at least two days each week.

• Older adults should also aim for the same level of activity, but are advised to do activities that improve their flexibility too (xviii).

 
However if you’re not very active, aim to increase the amount of exercise you do very gradually until you reach the recommended level. Also talk to your GP if you have a medical condition before starting a new exercise regime.
 

Achieve a healthy weight

Not everyone with or at risk of metabolic syndrome is overweight or obese, but those who are and are carrying too many excess pounds can help themselves by losing some weight.

Not only does losing weight help you manage your blood sugar levels, it can help reduce your blood pressure and cholesterol levels too. Find out more about losing weight and how it can benefit you by reading our guide to the facts about weight loss.
 

Quit smoking

If you smoke, giving up is arguably the most important thing you can do to improve your health, whether you’re at risk of developing metabolic syndrome or not. Thankfully these days there are lots of stop smoking products that can help. Ask your GP for advice on quitting, including how stop smoking aids like patches, lozenges and gum could help you control cravings for nicotine. Read more about giving up smoking in our guide. 
 

Cut back on alcohol

Drinking alcohol in moderation can be helpful because having too much can affect your blood sugar levels and contribute to weight gain. As a general rule of thumb try to stick to the government’s recommendation of no more than 14 units of alcohol each week on a regular basis, spreading your intake evenly over at least three days instead of having them all together. If you’re watching your blood sugar, try avoiding low-alcohol wines as they can have more sugar than ordinary wines, plus low-sugar beers and ciders, as these may have less sugar but can contain more alcohol.
 
There are more tips on cutting down on alcohol in our guide to alcohol misuse. 
 

Keep stress in check

When you’re feeling stressed your blood pressure may also be affected, plus it’s not exactly good for your blood sugar either. Try to find ways of feeling calmer and more relaxed, then make time for them every day, or as often as you can. Taking a little time away from stress can be really helpful for your health in general, even if you can’t escape it altogether.
 
Discover ways of managing stress in our guide to stress symptoms and signs. 

 

How to improve insulin resistance naturally

If you’re one of many people who have insulin resistance, taking any medication your GP has prescribed and following their healthy lifestyle advice are considered the best ways to achieve better control over your blood sugar levels. You may also like to try nutritional supplements that have been shown to help with blood sugar control. However, talk to your GP beforehand if you’re considering taking these or any other supplements, as there’s always a slight risk that your blood sugar may drop too low. 
 

What supplements can you take for metabolic syndrome?

First of all, to make sure your body is getting all the nutrients it needs to stay healthy it may be a good idea to try a quality multivitamin and mineral supplement, especially if you don’t always eat as healthily as you should. To find out more about multivitamin supplements and the variety of different formulations available, take a look at our guide to multivitamins and daily requirements. 

You may also want to consider trying one or more of the following:
 

Cinnamon

A natural remedy that’s been used in traditional Chinese medicine for centuries, cinnamon is a spice that’s also often recommended by natural therapists for people with type 2 diabetes, as there’s some evidence it may help improve blood sugar levels (viii).
 

Alpha lipoic acid

There’s also evidence to suggest this fatty acid and powerful antioxidant could help reduce insulin resistance and fasting blood glucose levels (xx) as well as improve insulin sensitivity in people with type 2 diabetes (xxi). However, if you already have diabetes always consult your GP before taking alpha lipoic acid as it may enhance insulin activity.
 

Magnesium

Experts have found that insulin resistance may be linked with low magnesium levels, and that boosting magnesium levels may be particularly beneficial for people with insulin resistance who are also overweight or obese (xxii). Researcher elsewhere have also discovered magnesium may help with blood sugar control (xxiii).
 

Turmeric

The curry spice turmeric contains an active compound called curcumin that’s thought to have a number of potential health benefits, including the ability to reduce blood sugar levels (though to date most studies have been carried out in animals rather than humans, meaning the available evidence isn’t as strong as it could be). One review of more than 200 research papers has even concluded that curcumin may help improve insulin resistance (xxiv).
 

High-strength fish oils

Omega-3 fatty acids – particularly those found in oily fish such as salmon, trout, sardines and mackerel called EPA and DHA – are widely considered helpful for general health and wellbeing. According to the NHS, a healthy, balanced diet should include at least two portions of fish a week, including one of oily fish (xxv). A review of studies also suggests omega-3 fatty acids have potential as a means of preventing or treating insulin resistance (xxvi).
 
If you can’t or don’t like eating fish, a high-strength fish oil supplement may be a good alternative – or you could try an omega oil supplement derived from marine algae instead of fish if you’re a vegetarian or vegan.

 

Fenugreek

Fenugreek seeds have a long tradition of use in some parts of the world, including in Ayurvedic medicine. These days herbal practitioners often recommend fenugreek seeds to people with insulin resistance, as they may help the body to produce insulin. There’s also some evidence fenugreek seeds may be helpful in reducing insulin resistance and controlling type 2 diabetes, though supporting studies to date are small in scale (xxvii). However, don’t take fenugreek if you’re pregnant or breastfeeding.
 

Vitamin D

Vitamin D is probably best known for helping the body to absorb calcium. However, a growing number of experts also believe having low levels of vitamin D may be linked with insulin resistance as well as diabetes (xxviii).
 
Unfortunately vitamin D deficiency is common, including in the UK. Public Health England advises adults and children over the age of one year old to consider taking a daily supplement containing 10mcg of vitamin D, particularly during autumn and winter (xxix).
 
However if your skin is rarely exposed to the sun – if you spend most of your time indoors, for instance, or if your skin is always covered when you’re out and about – you may need to take vitamin D throughout the year. People with dark skin from African, Afro-Caribbean and South Asian backgrounds should consider taking vitamin D all year round too, PHE advises.

The recommended form of vitamin D is vitamin D3 or cholecalciferol, as it’s the natural form of vitamin D that the body makes when it’s exposed to sunlight. Vitamin D3 supplements are available in tablet form, and now you can get them in veggie-friendly drops too. However most vitamin D3 supplements are made from the fat of lamb’s wool, which means they’re unsuitable for vegans. The good news is that vegan vitamin D3 supplements sourced from lichen are now more widely available.
 

High-strength anthocyanidins

Having consistently high blood sugar levels can damage your blood vessels. However, supplements that contain plant substances called anthocyanidins are thought to help support blood vessel health. That’s because anthocyanidins – which are found in dark-skinned fruits such as blueberries, cranberries, raspberries, blackberries and red grapes as well as vegetables such as red cabbage, red onions and aubergines – protect collagen in the body (collagen is a structural protein that gives blood vessels their strength).
 
If you want to try an anthocyanidins supplement, look for one that also contains vitamin C, as vitamin C supports the body’s ability to produce collagen.
 

Find out more

Being diagnosed with metabolic syndrome may be alarming, despite the fact that it is becoming increasingly common. Another way to look at it, however, is that it’s an opportunity to make healthier choices and limit your risk of developing diabetes or cardiovascular disease. There are plenty of things you can do to help yourself – this guide aims to show you some of the ways you can do just that. Meanwhile, we have lots more information and advice for you about a variety of health conditions in our pharmacy health library. 

 

References:

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(ii) Available online: https://patient.info/doctor/metabolic-syndrome
 
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(xxiii) Song. Y, He. K, Levitan. EB. Effects of oral magnesium supplementation on glycaemic control in Type 2 diabetes: a meta-analysis of randomized double-blind controlled trials. Diabet Med. 2006;23:1050-1056. Available online: https://onlinelibrary.wiley.com/doi/10.1111/j.1464-5491.2006.01852.x
 
(xxiv) Dong-wei Zhang et al. Curcumin and Diabetes: A Systematic Review. Evid Based Complement Alternat Med. 2013; 2013: 636053. Available online: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3857752/
 
(xxv) Available online: https://www.nhs.uk/live-well/eat-well/food-types/fish-and-shellfish-nutrition/
 
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Kassaian N et al. Effect of fenugreek seeds on blood glucose and lipid profiles in type 2 diabetic patients. Int J Vitam Nutr Res 2009 Jan;79(1):34-9. Available online: https://econtent.hogrefe.com/doi/10.1024/0300-9831.79.1.34 .

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(xxviii) Al-Shoumer KAS, Al-Essa T M. Is there a relationship between vitamin D with insulin resistance and diabetes mellitus? World J Diabetes. 2015 Jul 25; 6(8): 1057–1064. Available online: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4515445/
 
(xxix) Available online: https://www.gov.uk/government/news/phe-publishes-new-advice-on-vitamin-d
 

 

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Disclaimer: The information presented by Nature's Best is for informational purposes only. It is based on scientific studies (human, animal, or in vitro), clinical experience, or traditional usage as cited in each article. The results reported may not necessarily occur in all individuals. Self-treatment is not recommended for life-threatening conditions that require medical treatment under a doctor's care. For many of the conditions discussed, treatment with prescription or over the counter medication is also available. Consult your doctor, practitioner, and/or pharmacist for any health problem and before using any supplements or before making any changes in prescribed medications.

 

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