“Am I going to get diabetes — like my father — and die of a heart attack?” asked the 53-year-old high school math teacher, a patient of Marvin M. Lipman, Consumer Reports’ chief medical adviser. “I’ve looked this up online, and the outlook isn’t good.”
He was referring to the metabolic syndrome, a diagnosis made a week earlier after a physical exam showed that he was overweight (with a waistline well over 40 inches) and hypertensive (with a systolic blood pressure over 160 and a diastolic over 90). When the patient’s lab results confirmed the diagnosis, Lipman knew they were dealing with a serious situation: The patient’s serum triglycerides (a blood fat) were extremely high and his “good” HDL cholesterol very low — an ominous combination. On top of that, his fasting blood sugar was in the pre-diabetes range.
That combination of signs and symptoms, if left untreated, could result in a considerably shortened life span. Almost a third of American adults have the syndrome, research suggests, though most don’t realize it.
His hard question: “Will I live to see my grandchildren?”
The metabolic syndrome is a combination of risk factors for Type 2 diabetes, coronary heart disease and stroke. Although definitions vary on the precise mix of signs and symptoms that make up the syndrome, the patient had what Lipman thinks are the most characteristic.
Most notable: abdominal obesity, or a waist circumference of at least 40 inches in men and 35 inches in women. That’s worrisome because abdominal fat is more metabolically active than fat in the rest of the body, which means it’s more likely to cause heart attacks and strokes.
In addition, that type of fat is associated with resistance to the blood-sugar-lowering action of insulin, the hormone responsible for escorting glucose from our blood into our cells, where it is used as fuel for energy. In fact, a former name for the metabolic syndrome was insulin resistance, and the condition is often a prelude to Type 2 diabetes.
The specs for the remaining components of the syndrome include triglycerides over 150 mg/dl, HDL cholesterol less than 40 mg/dl in men and 50 in women, blood pressure levels over 135 and 85, and a fasting blood sugar over 100 mg/dl.
The patient had all five warning signs, and as a math teacher, he knew how that multiplied his risks. In one meta-analysis, his chances for developing Type 2 diabetes were up to more than five times the normal rate, and his risk for cardiovascular disease was doubled. People with the syndrome face an increased chance of such other health problems as gout, sleep apnea, fatty liver disease, kidney failure, polycystic ovary disease and even liver cancer. Overall, his odds of dying prematurely were about 150 percent higher than someone without the syndrome.
Some risk factors for the syndrome are beyond a person’s control. For example, it is more common among women, African Americans, Hispanics, Asians and Native Americans. But there are a number of steps you can take, and the patient knew what he had to do before Lipman told him.
The doctor and patient discussed diet. The patient’s choice was to switch to the Mediterranean-style diet (high in nuts, whole grains, fruits, veggies, olive oil and fish). In one study this popular — and tasty — diet resulted in greater weight loss and improvement in insulin resistance and blood lipids compared with a control diet. He decided to cut out pasta, rice and potatoes, and he restricted breads to whole-wheat versions. He limited his alcohol intake to one glass of wine per day. In addition (after a normal exercise stress test), he took advantage of a gym in the high school where he taught. Each morning before classes, he undertook a 45-minute workout, alternating aerobics with strength training.
In the course of a year, he lost 15 percent of his body weight and brought his blood sugar, triglycerides and HDL cholesterol levels back to normal. His new waistline now measures 39 inches, down from 44, and his blood pressure is under control, thanks in part to the blood pressure drug he now takes every day.
And he has kept his enthusiasm for his new exercise and diet regimen — especially after he learned that he was about to become a grandfather.
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