Metabolic Syndrome - Which Came First, the Chicken or the Egg?

At the annual meeting of the American College of Cardiology earlier this month, some startling figures were presented - there's an alarming rise in the number of people with the constellation of heart-disease risk factors known as the metabolic syndrome: the presence of at least three of the following risk factors: obesity, high blood pressure, high triglycerides, low HDL cholesterol, or high fasting blood sugar.

Additionally some clinicians also consider high LDL, high insulin, and waist-hip ratio or abdominal adiposity as risk factors. Some are also measuring inflammatory markers like C-Reative Protein (CRP).

The incidence of metabolic syndrome hasn't just increased - it is skyrocketing. As reported on WebMD - Metabolic Syndrome Skyrocketing - Despite the improvements seen in some heart disease risk factors, a survey of nearly 80,000 people showed that rates of the metabolic syndrome continued to rise both in the United States and in Europe.

The surge is driven mainly by the epidemic of obesity in the Western world, says researcher Benjamin A. Steinberg, a Sarnoff fellow at Brigham and Women's Hospital in Boston.

We're not doing much better with cardiovascular disease either. The survey estimates that in 1998, 61.4 million American adults were estimated to have cardiovascular disease or risk factors for coronary heart disease. That figure rose to 66.7 million in 2001 and to 67.2 million in 2004.

This is in light of the improvements seen with cholesterol levels across the board!

During the six-year period, some major gains were made in reducing the number of people with heart disease risk factors.

For example:

• The percentage of people with high triglyceride levels dropped from 46% to 40%.
• The number of people with low HDL cholesterol levels decreased from 35% to 33%.
• During this time frame the use of cholesterol-lowering statin drugs increased from 37% to 52%.

Yet despite these improvements, the rates of the metabolic syndrome rose from 36% to 44% during the same period.

So, what do the "experts" tell us is driving the alarming rate of metabolic syndrome?

Obesity.

That means the rise [in the metabolic syndrome] is primarily driven by the skyrocketing rates of obesity -- from 30% to 48% -- during the six-year period, says America Heart Association president Robert Eckel, MD, professor of medicine at the University of Colorado Health Sciences Center in Denver.

"Although several components of the metabolic syndrome are better off, people are still much more likely to be obese," he tells WebMD. "We have to continue to target obesity to reverse these trends."

Yes, I'm shaking my head here, wondering if they'll ever "get it."

Metabolic syndrome is one of those "chicken and egg" disorders - which came first, the metabolic dysfunction or the obesity, dyslipidemia, hypertension, insulin resistance, or high fasting blood sugars? The American Heart Association (AHA) apparently believes it is the obesity driving the disorder. Their recommendation - a low-fat diet to reduce weight coupled with increased physicial activity.

The problem with that recommendation? Data from numerous trials shows that a low-fat carbohydrate rich dietary pattern actually worsens the other risk factors for metabolic syndrome with increased triglycerides, decreased HDL. Without significant weight loss, such a diet may also increase insulin resistance and worsen fasting blood sugars due to the high carbohydrate intake required to achieve a fat intake less than 30% of total calories.

The AHA is fully aware of this, yet continues to ignore the data that clearly points to a low-carb diet as a better approach to tackle ALL the risk factors with dietary modification. The Nutrition & Metabolism Journal recently published the review, Carbohydrate restriction improves the features of Metabolic Syndrome. Metabolic Syndrome may be defined by the response to carbohydrate restriction, that included 112 references.

The bottom line? The review summary stated: Five symptoms common to most definitions of MetS are those that are reliably improved by CHO restriction. Carbohydrate restriction is one strategy for weight loss but, in addition, improves glycemic control, insulin levels, TAG and HDL levels even in the absence of weight loss. We suggest that response to CHO restriction may, in fact, be an operational definition of MetS. Its underlying basis would rest on the idea that the features of MetS are associated with a disruption in insulin metabolism which is strongly influenced by dietary CHO. The extent to which this definition is useful may depend on its application by individual practitioners. Experimental studies that follow its lead or conversely disprove its fundamental premise should advance our understanding of obesity, diabetes and CVD. Dismissing CHO restriction without evidence, or expressing "concerns" rather than offering data will probably be less productive.

Folks, obesity is indeed contributing to the increase in metabolic syndrome. However, the answer to reverse the trend is not as simple as losing weight. The only way to reverse the trend is to identify the driving factor behind our obesity AND metabolic dysfunction issues - resolve the underlying reason for our weight gain and identify what is disrupting our metabolic pathways so negatively.

The AHA takes the simplistic approach - eat less and exercise more - as the solution.

I'd like to know just how many people haven't already heard that advice and tried it only to fail again and again as their metabolic dysfunction worsens and their risk factors increase?

Until we move past the deeply rooted dogma that preaches the carbohydrate rich low-fat diet as the end-all-be-all and actually move instead toward an evidence-based approach, we're going to continue to see the alarming rate of metabolic syndrome rise higher and higher.

You don't have to wait for the "experts" to finally "get it" - your long-term health depends on educating yourself about what the science says, what the research data shows us and making an informed decision about taking control of your diet to improve your risk factors. A controlled-carb approach offers improvements in weight, HDL cholesterol, blood pressure, triglycerides, insulin senstivity and glycemic control.

If you're waiting for the leading organizations to suddenly accept and take the evidence-based approach any time soon and give you a greenlight to follow a controlled-carb diet - well, let's just say you might not want to hold your breath. There is way too much invested in the dogma and things will not change until the perspective is changed to focus on public health instead of the bottom-line dependent on the status quo.