Metabolic Syndrome – Criteria, Causes, Diet, Exercise, Reverse, Treatment

Metabolic syndrome has been widely publicized in recent years due to its association with heart disease, stroke and diabetes. With all three conditions being among the top ten killers in developed nations, preventing and reversing metabolic syndrome is an important strategy to save lives. However, the approach to achieving this goal largely lies in the hands of the individual through concerted and continuous dietary and lifestyle changes.

What is metabolic syndrome?

Metabolic syndrome is a group of risk factors which increases the chances of developing heart disease, stroke and/or diabetes. Risk factors in this context simply means that certain conditions may make heart disease, strokes and diabetes more likely to occur. Therefore people with metabolic syndrome should be regularly screened, undertake dietary and lifestyle changes, and possibly use medication to reduce these risks.

Prevention and reversal of metabolic syndrome is possible with significant dietary and lifestyle changes. It may help to minimize the risk or even completely avoid the complications of metabolic syndrome which can be life threatening. Losing weight, maintaining a healthy diet and becoming more active are the cornerstones of metabolic syndrome prevention and reversal. Drug therapy can also assist to some degree.

Metabolic syndrome affects over 1 in 5 American adults with men being at a slightly higher risk than women. It is more liky to occur with advancing age and it affects about 2 in 5 American adults over the age of 60 years. However, metabolic syndrome is a global problem. About 1 in 4 adults in Europe and Latin America and approximately 1 in 10 adults in East Asia have metabolic syndrome.

Criteria for Metabolic Syndrome

The definition of metabolic syndrome includes the following group of conditions:

  1. High blood pressure (BP equal to or greater than 130/85 mmHg)
  2. High blood glucose (fasting glucose equal  to or greater than 100 mg/dL)
  3. High blood triglycerides (equal to or greater than 150 mg/dL)
  4. Low “good” cholesterol (HDL cholesterol less than 40 mg/dL in men or 50 mg/dL in women)
  5. Large waistline (waist circumference equal to or greater than 102 cm / 40 in in men or 88 cm / 35 in in women but due to racial differences a BMI over 30 may be considered in place of waist circumference)

Metabolic syndrome is defined as having 3 or more of these 5 criteria.

Causes of Metabolic Syndrome

The cause and mechanism behind metabolic syndrome appears to be complex and associated with a multitude of factors. Metabolic syndrome is believed to be caused by a dysfunction of fat (adipose) tissue and insulin resistance. Poor dietary habits, a sedentary lifestyle and family history play an important role in the development of metabolic syndrome.

When the fat cells enlarge and immune cells known as macrophages enter into the adipose tissue, it may cause the release of chemicals (cytokines) that promote inflammation. This contributes to insulin resistance although insulin resistance may arise without adipose tissue dysfunction.

The location of the adipose tissue also plays a role – it is visceral fat and not subcutaneous (superficial) fat that is responsible for inflammation. Abdominal fat is more likely to release high levels of pro-inflammatory cytokines which can be harmful.

Insulin resistance, as the name suggests, is where the cells of the body become less responsive to insulin. The pancreas secretes the hormone insulin when the body’s blood glucose levels rise. This hormone then stimulates cells to take up more glucose from the blood stream and also stimulates the liver to store more glucose as glycogen.

Collectively these effects of insulin lower the blood glucose levels to a normal range.  However, with insulin resistance the blood glucose levels remain elevated. Even increased insulin secretion by the pancreas is not always able to return the blood glucose levels to a normal range.

Read more on insulin resistance.

The various conditions that occur in metabolic syndrome can then cause organ damage and failure in different ways. For example, the high blood pressure and abnormal blood lipid levels may lead to atherosclerosis which narrows the arteries carrying blood to the heart and brain which could culminate in a heart attack or stroke, respectively.

Metabolic syndrome has also been associated with the following conditions:

  • Polycystic ovarian syndrome (PCOS)
  • Fatty liver disease
  • Gallstones
  • Sleep apnea

How to Reverse Metabolic Syndrome?

Dietary and lifestyle changes are essential. It can help to control, prevent and even reverse metabolic syndrome. These dietary and lifestyle changes are not a short term solution for reversing metabolic syndrome as the risk of developing metabolic syndrome persists. Therefore these dietary and lifestyle measures should be continued lifelong as it also has a host of health benefits, beyond just preventing or reversing metabolic syndrome.


The DASH diet and Mediterranean diet are often advised as the dietary approach to controlling, preventing or reversing metabolic syndrome.

  • Limit daily calorie intake to help with weight loss and prevent future weight gain.
  • Increase the intake of fruit, vegetables and wholegrains.
  • Reduce the intake of trans and saturated fats and opt for mono- or polyunsaturated fats.
  • Replace red meat and poultry with fish.

Read more on the DASH diet.


  • A combination of aerobic and resistance training is advisable.
  • Moderate to intense physical activity for 120 to 150 minutes weekly is suggested.
  • 30 minute sessions at least 5 days in a week but preferably exercising 7 days in a week.
  • Being more active during daily activities is also helpful beyond dedicated periods of exercise.
  • Excessive sitting and other sedentary positions need to be minimized.

Treatment of Metabolic Syndrome

Although diet and lifestyle are effective and should be maintained, sometimes drug therapy may be necessary.It is important that drug therapy only be commenced when prescribed by a doctor.

  • Metformin can help to control blood glucose levels and reverse insulin resistance to some degree.
  • Statins and other lipid-lowering agents are useful for abnormal blood lipid levels.
  • Antihypertensive drugs like ACE inhibitors help to reduce blood pressure levels.
  • Anticlotting drugs like aspirin can reduce the risk of cardiovascular events such as strokes.

Apart from its role in developing heart disease, stroke and diabetes, metabolic syndrome is also associated with the development of obstructive sleep apnea and cancers of the breast, colon, gallbladder, kidney and prostate.

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