Metabolic Syndrome

Frequently Asked Questions

• 1

  What is Metabolic syndrome/Insulin resistance?

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  Metabolic syndrome is a combination of the medical disorders that, when occurring together, increase the risk of developing cardiovascular disease and diabetes. Some studies have shown the prevalence in the USA to be an estimated 25% of the population, and prevalence increases with age.

  Metabolic syndrome is also known as metabolic syndrome X, cardiometabolic syndrome, syndrome X, insulin resistance syndrome, Reaven's syndrome (named for Gerald Reaven), and CHAOS (in Australia).

• 2

  How is Metabolic Syndrome/Insulin Resistance defined?

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  The World Health Organization`s criteria in 1999 require the presence of any ONE of the following:

  • Diabetes mellitus
  • Impaired glucose tolerance
  • Impaired fasting glucose or insulin resistance
  • High blood sugar level, with a fasting blood glucose test of 5.6 millimoles per litre (mmol/L), or more AND two of the following:
  • Blood pressure: ≥ 130/85 mmHg
  • A triglyceride level of 1.7mmol/L or higher, or you're receiving treatment for high triglycerides.
  • Reduced HDL cholesterol("good" cholesterol)–less than 1.04 mmol/L in men or less than 1.3 mmol/L in women, or you're receiving treatment for low HDL
  • Central obesity-waist: hip ratio > 0.90(male); > 0.85 (female), or body mass index > 30 kg/m2 or having a waist circumference of 102 centimetres for men and 89cm or more for women, although waist circumference cut-off points can vary by race.
  • Microalbuminuria: urinary albumin excretion ratio ≥ 20 μg/min or albumin: creatinine ratio ≥ 30 mg/g.
  • High-sensitivity C-reactive protein has been developed and used as a marker to predict coronary vascular diseases in metabolic syndrome, and it was recently used as a predictor for non-alcoholic fatty liver disease in correlation with serum markers that indicated lipid and glucose metabolism.

  Having one component of metabolic syndrome means you're more likely to have others and the more components you have, the greater are the risks to your health.

  Associated diseases and signs are increased uric acid levels, fatty liver (especially in concurrent obesity), progressing to NAFLD (non-alcoholic fatty liver disease), polycystic ovarian syndrome (in women), and acanthosis nigricans (dark patches of leathery pigmentation on the skin).

• 3

  What causes Metabolic Syndrome?

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  The exact mechanisms of the complex pathways of metabolic syndrome are not yet completely known. The pathophysiology is very complex and has been only partially explained. Most patients are:

  • older,
  • obese,
  • Inactive
  • Stressed

  There continues to be a debate as to whether obesity or insulin resistance is the cause of the metabolic syndrome or if they are consequences of a more far-reaching metabolic imbalance.

  A number of markers of systemic inflammation, including C-reactive protein, are often increased, as are fibrinogen, interleukin 6, tumour necrosis factor-alpha (TNFα), and others.

  Some of the above have pointed to a variety of causes, including increased uric acid levels caused by dietary fructose.

• 4

  How is it managed at Health Renewal?

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  Your Doctor at Health Renewal will ask you to complete a short questionnaire, will perform a physical examination, which will include height and weight measurements, and request a fasting blood analysis at your local pathology laboratory. These results will be analysed by your Health Renewal Doctor who will determine whether metabolic syndrome/insulin resistance exists and advise you on your treatment options.

  By simply taking a tablet or tablets will not assist in the management of metabolic syndrome. While the tablets may assist in lowering blood pressure or blood glucose, it will not fix or diagnose the cause of the problem. At Health Renewal we look at each patient as a whole and assess ALL the possible causes, AS WELL AS, the damage Metabolic Syndrome may have already caused.

  Metabolic Syndrome tends to spend time in the company of obesity, hypertension, cholesterol issues and sugar/insulin malfunction. Our Health Renewal Doctors will develop a tailor- made programme for the individual using Nutraceuticals and medication if needed.

  If the problem is caused by obesity, we will manage this in order effectively address all underlying issues. Obesity is the disease of this millennium and requires proper treatment and long-term management. Our Body Renewal Medical Weight loss program is offered at Body Renewal. If the program is strictly adhered to patients lose between 8 and 15 kilogrammes of fat a month, generally find it quite easy to follow the program and feel good with increased levels energy. Many of our patients have tried numerous other well-known diets in the past but find Body Renewal Medical Weight loss program to be one that actually works with long-term results.

• 5

  What medications are used in the improvement of the Insulin Resistance component of Metabolic Syndrome?

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  If insulin resistance or early type 2 Diabetes is diagnosed, the following protocol will be followed by the Health Renewal Doctor:

  Program for Early Diabetics-

  There are acute differences between early and advanced stages of diabetes. Therefore those diagnosed with type 2 diabetes cannot and should not all be treated the same. In the early stages of the disease, people suffer from both hyperglycemia and hyperinsulinemia. Rather than take drugs that further increase the level of insulin in the blood, people with type 2 diabetes would do better to pursue therapies that increase the sensitivity of insulin receptors on the cell membranes.

  One of the best defences against mild to moderate type 2 diabetes and hyperinsulinemia is improved diet and exercise. Although the disease has a genetic component, many studies have shown that diet and exercise can reduce the need to go onto medication. One study also showed that while some medications delay the development of diabetes, diet and exercise are more effective. Just 30 minutes a day of moderate physical activity, coupled with a 5% to 10% reduction in body weight, produces a 58% reduction in the incidence of diabetes among people at risk.

  Prescribing Metformin: Increasing Insulin Sensitivity-

  In addition to diet and exercise mentioned above, the prescription drug Metformin has been proven to increase insulin sensitivity in people with mild to moderate hyperglycemia. Metformin is now the most commonly prescribed oral antidiabetic drug worldwide. It works by increasing insulin sensitivity in the liver. It also has a number of other beneficial effects including aids weight loss, reduces cholesterol-triglyceride levels, helps prevent cardiovascular complications of diabetes and improves endothelial function.

  In addition to Metformin, many nutrients have been shown to increase insulin sensitivity, protect vulnerable cell membranes and reduce the damaging effects of elevated glucose. A combination of improved diet, exercise, supplementation and insulin-sensitizing prescription drugs can reverse mild to moderate hyperglycemia before stronger drugs are required and permanent damage is done. See below under Nutraceuticals for lists of nutrients.

  Drug Therapy For Advanced Diabetics-

  Some people, however, will not have the benefit of the above knowledge before their type 2 diabetes advances to a more dangerous stage. In severe hyperglycemia, the pancreas becomes burned out after producing high levels of insulin for a long time. Insulin levels drop as a result of decreased production and blood glucose levels are allowed to rise to very high, toxic levels. Although diet and exercise, along with supplementation, are still strongly recommended, prescription drugs might also be necessary.

• 6

  What is recommended for the other components of Metabolic Syndrome?

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  Lifestyle modifications such as diet, weight loss, exercise and blood pressure medications will all help improve the signs and symptoms associated with Metabolic Syndrome.

• 7

  What Nutraceuticals/Integrative Supplements are recommended for metabolic syndrome?

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  Under no circumstances should people suddenly stop taking diabetic drugs, especially an Insulin type 1 diabetic who will never be able to stop taking insulin. With metabolic syndrome, the supplements are individually tailored and it is inadvisable to self-medicate. Self- medicating refers to a person who takes prescription medication or nutraceuticals on their own without a doctor's advice, supervision and/or consent. There is no single supplement given to all clients with Metabolic Syndrome. The doctor will decide, based on your examination, history and blood tests, what would be the best for you and your specific needs and/or deficiencies. However, it is possible to improve glucose metabolism, control, and tolerance of diabetes with the following supplements:

  Alpha Lipoic Acid, L-Carnitine, Chromium, CoQ10 (in the form of ubiquinol), DHEA, EPA/DHA (Omega 3), Green coffee bean extract, Vitamin D3 and Magnesium amongst others. Pycnogenol, taken daily, may help reduce health risk factors associated with metabolic syndrome such as type 2 Diabetes, blood pressure and cholesterol levels thus improving cardiovascular health.

• 8

  What in-office treatments are available at Body/Health Renewal for Metabolic Syndrome?

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  Body Renewal Medical Weight loss program: Insulin resistance and diabetes can be dramatically improved if one can lose 5% to 10 % of body weight. The 5D Body Renewal Diet is offered at Body Renewal. If the program is strictly adhered to patients lose between 8 and 15 kilogrammes of fat a month, generally find it quite easy to follow the program and feel good with increased levels energy. Many of our patients have tried numerous other well-known diets in the past but find this program to be one that actually works with long- term results.

  I-Lipo, a low-level laser therapy (LLLT) is available at Body Renewal which will help with centimetre and weight loss. LLLT low-level laser therapy such as i-lipo has been proven to restore adipocytes to a lean, state without inducing cell apoptosis/ death. It is hypothesised that i-Lipo LLLT could serve as an adjunct to other dietary therapies to promote insulin sensitivity and reduce the risk of diabetes because a lean state is produced in the fat cell. Lean, state means improved insulin sensitivity, resulting in less insulin needed for glucose metabolism. Less insulin equates to less fat being deposited.

• 9

  How does i-Lipo - LLLT work?

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  An article published in the American Journal of Cosmetic Surgery in 2010 demonstrated a statistically significant reduction in both serum triglyceride and total cholesterol levels following a standard two-week, six treatment LLLT administration. LLLT based on histological evidence has proven to reduce fat mass stored on the waist, hips, and thighs while preventing fat cell death. The treatment causes the membrane of the fat cell to collapse allowing the triglyceride fat in form of free fatty acids and glycerol to be released and the cell returned to its lean state. These molecules can then easily pass through the pores in the cell wall to be taken up and transported by the body`s lymphatic system for metabolism into energy during the subsequently recommended post-treatment exercise. Reduced fat mass is associated with the synthesis of beneficial hormones like adiponectin, which promotes insulin sensitivity within numerous tissues. On-going clinical trials are evaluating the effectiveness of LLLT for potential acute and long-term medical benefits.

• 10

  What are the risks and complications of Metabolic Syndrome and its management?

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  Metabolic Syndrome is a combination of the medical disorders that, when occurring together, increase the risk of developing cardiovascular disease and diabetes. Some studies have shown the prevalence in the USA to be an estimated 25% of the population and prevalence increases with age. A new, innovative approach to Metabolic Syndrome recognition and treatment is needed since to date, conventional wisdom has failed us. South Africa is also in the midst of a diabetes epidemic. Over the past 20 years, the number of adults diagnosed with diabetes in South Africa has more than doubled, and children are being diagnosed with diabetes in alarming numbers. Diabetes has rapidly emerged as a leading culprit in the epidemic of heart disease, as well as being a leading cause of amputation and blindness among adults.

• 11

  How do I get started?

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  Make an appointment to consult with your Health Renewal Doctor and they will assist you in measuring your blood glucose, blood pressure and cholesterol levels amongst others. Your Doctor will then advise you of further preventative and supplement measures to take.

• 12

  How often should I see the integrative Doctor at Health Renewal?

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  Depending on your blood results, one could expect to follow up with your physician from anything between every 2 weeks, if it is advised and you undertake to do Body Renewal Medical Weight loss program, to once every 6 months.

• 13

  Can a wellness gene/genetic test be done at Health Renewal for Metabolic Syndrome?

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  Yes, a multi-gene DNA test can routinely be added to an assessment of:

  • blood cholesterol and
  • glucose levels,
  • blood pressure and
  • Body mass index (BMI) as part of Wellness Programs offered by healthcare practitioners.

  It includes analysis of variation in clinically useful genes that may contribute to:

  • abnormal cholesterol levels,
  • homocysteine accumulation,
  • blood clotting,
  • iron overload and
  • inflammation.

  Some of these abnormalities contribute to the development of type 2 diabetes, obesity and hypertension. Oxidative stress, detoxification of carcinogens and traditional oestrogen exposure are also important considerations in this context.

• 14

  Why should one not self-medicate?

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  For all health conditions, the nutraceuticals are individually tailored by the Health Renewal Doctor. The doctor will decide- based on your history, physical examination and blood tests what would be the best for you and your specific needs and/or deficiencies. Please do not self-medicate. Self-Medicating is done when a person takes prescription medication or nutraceuticals on their own without a doctor's supervision and/or consent. By not having a physical examination and blood testing done by a qualified medical practitioner, you could be missing vital deficiencies or conditions such as elevated blood pressure and high sugar levels. In addition, there is no single supplement given to clients as there is no magic bullet that can support all the essential nutrients that one's body needs.

• 15

  Health Renewal tip: How does one prevent Metabolic Syndrome?

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  Metabolic syndrome is a serious health condition associated with coronary heart attacks, diabetes, and even early death. You have it if you've got at least three of these five traits: excess abdominal fat, high blood triglycerides, low HDL (which is the good cholesterol), high blood pressure, and impaired glucose tolerance.

  Various strategies have been proposed to prevent the development of metabolic syndrome. These include:

  Lose weight- Shedding even 3 kilogrammes can significantly slash your risk. Even extremely overweight people are 70% less likely to develop diabetes when they lost just 5% of their weight even if they didn`t exercise. The Body Renewal Medical Weight loss program is offered at Body Renewal. If the program is strictly adhered to patients lose between 8 and 12 kilogrammes of fat a month, generally find it quite easy to follow the program and feel good with increased levels energy.

  Eat healthily 80% of the time and eat what you want 20% of the time, basically on the weekends. This can be done with intermittent fasting. Try to eat only 100% organic food which does not overtax your hypothalamus again. Obesity and weight gain are caused by the man-made ingredients, chemicals, hormones and food processing techniques in the growing, producing and manufacturing of every day, food.

  Turn off your Fat Switch by limiting your fructose intake. Limit your total fructose intake to less than 25g per day (which is equivalent to 2 low fructose fruits). Fructose can increase your hunger and lead to overeating by triggering changes in your brain. Fructose -containing sugars cause obesity by turning on your fat switch. Effective treatment of obesity requires turning off your fat switch (limiting fructose) and improving the function of your cells' mitochondria. Limit fructose from fruit to 15g a day. For example, 1 cup berries contain between 3g-4g of fructose, an orange 6.1g, a banana 7.1g, an apple 9.5g, 1 cup grapes 12.4 g & ½ mango 16.2g. Fructose is also metabolised to fat in your body far more rapidly than any other sugar. The metabolism of fructose by your liver creates a long list of waste products and toxins, including a large amount of uric acid, which drives up blood pressure and can cause gout.

  High fructose diets will lead to obesity, insulin resistance, fatty liver, and high triglycerides, signs of inflammation, vascular disease, and high blood pressure. Fruit juices are high in fructose, so strict avoidance is recommended. Likewise, honey is very high in fructose.

  Fructose can also raise your uric acid levels as it generates uric acid within minutes of ingestion. This can elevate your blood pressure, increase insulin and affect kidney function. The link between fructose and uric acid is so strong that you can actually use your uric acid levels as a marker for fructose toxicity. According to the latest research in this area, the safest range of uric acid appears to be between 3 and 5.5 milligrammes per deciliter (mg/dl). There appears to be a steady relationship between uric acid levels and blood pressure and cardiovascular risk, even down to the range of 3 to 4 mg/dl.

  Replace sweetened drinks- whether they`re sweetened with sugar, HFCS (high corn fructose sugar) or artificial sweeteners, with plenty of pure, clean water. Fructose/ fruit juice turn your fat switch on as indicated in point 3 above. A far safer alternative to fructose or sugar is to use pure glucose (dextrose) or Stevia or xylitol.

  Get your uric acid level checked to find out how sensitive you are to fructose. Research advocated an ideal uric acid level is probably around 4mg/dl for men and 3.5mg/dl for women. If you feel you are healthy and do not have signs of insulin resistance, and would like to consume more fruit then it is possible to have your doctor check your uric acid levels. This is a more powerful risk factor for heart disease than total cholesterol. If your level is over 5 then more than likely you would benefit from lowering your fructose intake as fructose tends to increase uric acid levels.

  Consume healthy fats, such as real butter, eggs, avocados and nuts (especially macadamia nuts) which are higher in fat and lower in protein. Unheated oils such as 1 T coconut oil, palm oil and olive oil are beneficial to the body.

  Eat plenty of raw food. Avoid all genetically engineered foods and processed foods. Avoid any product containing aspartame, which is derived from a genetically engineered organism.

  Optimize your gut flora with fermented food such as fermented vegetables (which contain Vit K 2), which you can easily and inexpensively make at home. Alternatively take 1 x Vit K 2 supplement available from Health Renewal. Vitamin K2 is an important fat-soluble vitamin that plays critical roles in protecting your heart and brain, and building strong bones. It also plays an important role in cancer protection. The biological role of Vitamin K2 is to help move calcium into the proper areas in your body, such as your bones and teeth. It also helps remove calcium from areas where it shouldn`t be, such as in your arteries and soft tissues. Vitamin K2 is really critical for keeping your bones strong and your arteries clear. Its other main role is to activate proteins that control cell growth. That means K2 has a very important role to play in cancer protection.

  Eat the correct foods, phytochemicals and nutrients, to reduce Inflammation, oxidative stress and metabolic disorders resulting from obesity and metabolic syndrome.

  Aside from the more commonly known side effects such as heart disease and diabetes, risk factors lurking at a cellular level may also be negatively affecting the obese. Inflammation, oxidative stress and metabolic disorders may be present in an obese individual, taking their toll from the inside out. Certain phytochemicals and nutrients, such as nicotinamide riboside, lycopene, b-carotene, cyanidin-3-glucoside and pterostilbene have been shown to address these core dysfunctions. These can be found in milk, gac fruit, black rice and blueberries, respectively. This white paper presents some of the research surrounding these risk factors and why ingesting these nutrients should be considered to alleviate the ill-effects surrounding obesity.

  Unwind every day. Chronic stress can send blood sugar levels soaring. When you`re stressed, your body is primed to take action. This gearing up causes your heart to beat faster, your breath to quicken and your stomach to knot. It also triggers your blood sugar levels to skyrocket. Under stress, your body goes into fight-or-flight mode, raising blood sugar levels to prepare you for action. If your cells are insulin resistant, the sugar builds up in your blood, with nowhere to go – leading to chronically high levels.

  The good news is, simple relaxation exercises and other stress management movements can help you gain control over blood sugar levels, try these proven relaxers:

  • Start your day with yoga, meditation, or a walk.
  • Take three deep, slow breaths before answering the phone, starting the car, serving the kids lunch, or any other activity
  • Reclaim your Sundays as a day of rest or fun with your family, relaxing, worship, etc. Try to avoid spending the whole day on obligatory errands such as mowing the lawn, grocery shopping, or catching up on work.
  • Get a perfect night`s sleep of between 6 to 8 hours. When you sleep, too little – or too long because of sleep apnea – your nervous system stays on alert. This interferes with hormones that regulate blood sugar. Get plenty of sleep due to its effect on your metabolism and weight, as lack of sleep has been shown to affect levels of leptin and ghrelin – two of the hormones linked with appetite and eating behaviour. When you are sleep deprived, your body decreases the production of leptin, the hormone that tells your brain there is no need for more food, while increasing levels of ghrelin, a hormone that triggers hunger. For a good night`s rest, avoid caffeine after noon, leave work at the office, and skip late-night TV.
  • Do a blood test. Many diabetes and hypertensive symptoms are silent. A simple blood test can reveal whether sugar levels put you at risk for the condition. People with prediabetes,(slightly elevated blood sugar levels), often develop a full-blown case within 10 years. Knowing that your blood sugar levels are a little high can put you on a track to steadying them with simple diet and exercise changes before diabetes sets in and medications may be necessary. Everyone 45 years and older should have their blood sugar levels tested. Younger people who have risk factors such as being overweight, a family history, and high cholesterol and blood pressure should ask a doctor about getting tested sooner. If results are normal, get tested again within 3 years. If you have prediabetes, blood sugar should be tested again in 1 to 2 years.
  • Exercise regularly. Make sure to incorporate high-intensity interval training at least once or twice a week. Walk as much as you can every day- you`ll be healthier even if you don`t lose any weight. Why is walking so wonderful? Studies show that exercise helps your body utilise the hormone insulin more efficiently by increasing the number of insulin receptors on your cells. Insulin helps blood sugar move into cells, where it needs to go to provide energy and nutrition. Otherwise, it just moves around in your bloodstream, gumming up blood vessel walls and eventually causing serious health problems.