Metabolic Syndrome = Insulin Resistance

What Is Known About Metabolic Syndrome
Healthy Steps: Metabolic Syndrome—First Steps
Healthy Steps: Metabolic Syndrome—Full Program
Preventing Metabolic Syndrome
From Dr. Deborah's Desk

“You’re telling me I have a condition I’ve never heard of, but it’s dangerous because now I’m likely to get diabetes, or heart disease…or cancer?”

I'd hoped to raise the subject more delicately, but it was hard to avoid my concern about the metabolic problems in her recent tests. Marilyn had been teetering on the edge of diabetes for years, and already had high blood pressure. On some level she always thought that if she really had to she could fix that diabetic problem—if  it ever happened. And now I’m telling her she has two problems: insulin resistance, which sounds a lot like diabetes, and “metabolic syndrome,” neither of which cause her to feel sick today but both of which are likely to cause problems…some day. Sounds confusing, so let's try to make sense of it all.

As with many of us, Marilyn's weight had steadily crept up over the years, despite a diet of organic foods, all in moderation, and a constant level of exercise. She walked a lot and occasionally took some more vigorous dance classes. Happily married and enjoying her grandchildren, well ensconced in her community with good friends, so she answered my question about stress with a laugh and a smile: "Distant past!" Nevertheless, something else was amiss that brought us to this conversation, something harder to put your finger on, but no less worrisome for its vague name.

Metabolic syndrome (MS) as a diagnosis has been around for decades, though it lacks a precise and consistent definition. As a syndrome, it is described by a list of several key features, several of which are required to make the diagnosis. The key features include some easily measured ones (body fat distribution, individual lipid levels, high blood pressure) and some that we are still sorting out, like insulin resistance. I’ll go in greater detail into each of the criteria, but first let’s talk about why we should care: what’s the problem with having this metabolic syndrome?

Having metabolic syndrome (MS) is worrisome, and affects about one-quarter of the world’s adults. MS doubles your risk of dying from a heart attack or stroke, increases your risk of getting diabetes by a factor of 5-7, and also increases your risk of breast, prostate, and colon cancers, as well as dementia, chronic liver disease, and non-alcoholic fatty liver disease. MS also appears to be associated with atrial fibrillation, the most common heart rhythm irregularity, which itself poses a separate increased risk for heart disease. Let’s add in kidney failure and blindness, and I’m sure there are more. That’s the bad health news. There’s bad financial news as well—how much MS costs our health care system and work force each year. Hundreds of billions of dollars each year is a reasonable estimate, up to 825 billion with the diagnosis of diabetes 

The good news is that MS and particularly insulin resistance (IR) are completely reversible by making lifestyle changes. No medication required, though some medications might be helpful. If you know you have MS, you can skip down to the Full Program below for just how that is done. 

What Is Known About Metabolic Syndrome

It starts with what we eat. Insulin is normally released by the pancreas when we eat something that breaks down to sugars or proteins which also can become sugars. Insulin’s job is to escort sugar (glucose) out of the bloodstream when its level goes over one teaspoon for the whole body! The insulin unlocks the door to the cells of the body, allowing glucose to enter the cell and leave the bloodstream. Over time, with repeated elevations of blood sugar, the insulin receptors lose their sensitivity, develop resistance—in essence acquire a certain deafness and stop transporting the glucose into the cells, so the blood sugar goes up higher.  Higher sugar summon a response of higher insulin, but the insulin works less and less well, resulting in higher levels of sugar and progressively higher levels of insulin.

Diabetes results when the insulin isn’t strong enough to keep down the level of glucose in the bloodstream. But even before that point, the high insulin itself has become a problem equally if not more troublesome than the high sugar. Turns out that insulin, like so many other things in the body, has a sweet spot: we definitely need some insulin, and can work with a fairly wide range of insulin in our bood, but when levels go high and stay too high, insulin promotes inflammation and other health problems all on its own. The key to reversing the whole problem—of high sugar, high insulin, and resulting inflammation—is changing the fuel supply that sent our pancreas into overdrive.

One of the ways to change that fuel supply involves macronutrients—how much protein, fat, and carbohydrates, and what type, become part of healing diet. The other way to change that fuel supply involves micronutrients—what you might think of as vitamins and minerals, but are also components of foods that can either help or hurt the process of making metabolism normal again.

Metabolic Syndrome diagnosis is based on a group of symptoms.

Metabolic syndrome has been described by a number of organizations, starting with the World Health Organization in 1998. Their criteria are still useful, although I modify them all slightly for practical application, and base my criteria on what I consider to be a consensus of the current working groups’ definitions of MS. 

I consider that a patient has metabolic syndrome when three or more of the following criteria are present:

1. waist circumference > 50% height
2. HDL cholesterol <40 mg/dL in men or <50 mg/dL in women
3. triglyceride level ≥150 mg/dL
4. systolic blood pressure >130 mm Hg or diastolic blood pressure >85 mm Hg
5. blood glucose level ≥110 mg/dL or HbA1c ≥5.6%
6. Insulin resistance as determined by lipoprotein particle size (LP-IR) and/or elevated insulin on a 3-hour glucose tolerance test.

The more criteria found in a given individual, the more risky the condition.

Some authors feel that insulin resistance, #6 in the list, is the key feature of metabolic syndrome. Insulin resistance occurs usually in the presence of abdominal obesity but can also occur in thin and fit people. It is determined partially by genetic risk and partially by lifestyle choices. I would say that it is always present with at least two of the other features, rarely exists on its own.

Diagnosing insulin resistance can happen in a number of ways.

Looking for insulin resistance (IR) can start with blood sugar: if fasting blood sugar is over 100 or Hemoglobin A1C (a measure of blood sugar over time) is over 5.6%, you have to start wondering. You also wonder about IR if a lipid panel shows high levels of triglycerides (over 150) and low levels of HDL. But I like to nail down the diagnosis with one of these two methods:

1. LP-IR Score. An NMR lipid panel includes, besides the standard measurements, the amounts of different sized lipid particles and a determination of insulin resistance called LP-IR. It turns out that one’s degree of insulin resistance determines how much of the many different sized particles one makes.
2. Glucose Tolerance Test (GTT). In a comprehensive GTT, a patient arrives at the lab first thing in the morning, fasting since the previous dinner. (If someone has been on a low-carb diet, I ask them to eat more carbs in the week before the test.) Blood is drawn for glucose and insulin levels, and then the patient drinks a solution containing 75 grams of glucose. Blood is repeatedly drawn at 1-hour intervals three times, each time measuring glucose and insulin.

Bringing it back to Marilyn, she had an abnormal LP-IR score as well as blood sugars that had hovered around pre-diabetic levels for years. I told her that she almost certainly had insulin resistance, and asked if she was ready to reverse it or if she wanted the more definitive 3 hour GTT. She was ready to find solutions, so that is what we looked at next.

When to ask your doctor for a test of insulin resistance

You know yourself better than anyone else: are you the type of person who wants to know ahead of time, before a problem becomes too serious (insulin resistance), so that it's easier to fix? Or would you rather wait til the sky is falling (type 2 diabetes), so you'll know you'll be more motivated to make the necessary life changes?

If you're someone who wants to take care of problems ahead of time, you may need to ask your doctor to check you for insulin resistance, using either or both of the above mentioned tests. These are the clues that you may very well have insulin resistance:

1. You're a woman whose waist measures greater than half her height. Even if you were born that way, having a larger waist puts you at increased risk for IR and type 2 diabetes.
2. You're a man with (sorry) "man boobs" or your waist hangs out significantly over your belt line.
3. Either sex: you don't overeat, but you can't seem to lose weight. You may not have enough "energy."
4. OR  you know you have significant stress and sleep issues that could be making your blood sugar issues worse.
5. You have a significant history of type 2 diabetes.
6. You have high blood pressure and you are overweight.
7. You have been diagnosed with breast, colon or prostate cancer.

There are probably other criteria for concern, but these are a good start.

Healthy Steps: Metabolic Syndrome—First Steps

For the greatest health improvement with the fewest steps, do the following:

• Choose a new eating plan: Look at the eating plans here (eating to reverse type 2 diabetes) and here (Low carb eating plan). They are very similar and either one will make a great change in your metabolism!

• Ruthlessly eliminate sugar for thirty days. After that you can enjoy small amounts of fruit and some dark chocolate (greater than 70% chocolate) up to one ounce daily. On special occasions (no more than twice a month), if it’s important to you, you can have a sweet treat with dinner—not instead of dinner, not before dinner, and not later in the evening. Right after you eat your dinner!

• Find a way to incorporate high intensity interval exercise into your lifestyle. You can do intervals walking, doing sit-ups or push-ups, cycling, rowing (machine or on the water), or even on a treadmill, although that’s a bit scary if you can’t get off and on easily. An interval is 20-30 seconds of all-out exertion, alternating with a rest period: 2-3 seconds of rest per year of your age, roughly. Repeat 4-8 times. That’s a full workout, or you can rest longer and repeat the cycle of 4-8 intervals. Do the workout two or three times per week, no more: it's important to recover fully between workouts. 

Healthy Steps: Metabolic Syndrome—Full Program

A comprehensive program involves many areas in which action steps can be taken, gradually or all at once. You will be your own most valuable health manager. Some of the suggestions below include flexibility: balance gentleness and honesty with yourself!

Start by following the basic nutrition and healthy lifestyle guidelines, with the following modifications:

Savor Helpful Foods

Reversing insulin resistance and metabolic syndrome depend on finding a low-carb eating plan that works for you.

• Protein: Every time you eat, every time!, choose a protein first, and eat it with a healthy fat to enhance nutrient absorption. Seafood should be wild-caught; meat should be free-range and grass-fed or wild; and poultry should be free-range or pastured.
  • Seafood: Emphasize omega-3-rich varieties such as wild Alaskan salmon and salmon roe (avoid farmed), herring, anchovies, sardines, and cooked or smoked oysters. To enhance nutrient absorption, add butter or cream sauce to fish and sour cream to roe.
  • Raw fish: To ensure safety, marinate for 7-24 hours in lemon or lime juice.
  • Lamb, beef, and pork: Consume with the fat and avoid overcooking to maintain tenderness.
  • Venison, elk, and bison: These meats may require marinating 3-24 hours for tenderness. Enjoy with butter or cream sauce.
  • Raw meat: Considered a delicacy in traditional cultures, raw meat should be frozen for 14 days to eliminate parasites.
  • Poultry: Enjoy chicken, duck, geese, quail, and Cornish game hens and consume with the skin and fat.
  • Eggs: Consume eggs from pastured hens whenever possible. Eat as many eggs as desired.
  • Organ meats: Organ meats are great sources of important nutrients such as vitamin A. (Yellow and orange vegetables are great for you, but they don't contain vitamin A, but a precursor known as beta carotene. Many people can't effectively turn beta carotene into vitamin A, so you need it somewhere in your diet.) If you don't have a leftover love of liver or other organ meats, consider one of three organ meat-eating options
    • Chicken liver pate! See our Recipe section.
    • Liverwurst! US Wellness Meats sells both liverwurst and braunschweiger in their online store, both delicious and great as a snack or protein in a meal
    • Hide the liver: chop it or blend it and add to soups and stews, or mixed with ground meat as meatloaf or meatballs. 
• Dairy: Dairy can be problematic because most dairy has a relatively high carbohydrate content. Butter and cream and sour cream are fine, up to 4 tablespoons daily, or cheese, up to 3-4 ounces. Occasional yogurt or half-and-half are probably fine, but avoid sweetened yogurts or coffee creamers.
• Fat: Essential for nutrient absorption, adequate fat also provides satiety in a carbohydrate-cautious diet. Restricting fat is hazardous causes fat-soluble vitamins to be lost and protein content to increase to dangerous levels for the kidneys.
  • Animal fats: Butter, fatty cuts of meat, poultry skin, and fat reserved from roasting meats provide valuable sources of fuel and fat-soluble vitamins. Use fats only from grass-fed meats. You can now buy duck fat from Thrive Market and have it delivered to your door. They also carry good lard!
  • Vegetable fats: Choose organic fats to avoid oil-soluble residues of chemicals or hormones. Healthy choices include coconut oil, coconut milk, extra virgin unrefined olive oil, and, for flavor, small amounts of sesame oil or other nut oils. For sautéing, maintain low temperatures and use fats that are solid at room temperature such as coconut oil, butter, ghee, and animal fat.
  • Avocado: Half an avocado daily provides a tasty fat and a valuable source of healthful fatty acids and nutrients.
  • Olives: Extra virgin olive oil and olives (up to 4 daily) contain important trace minerals. Olive oil should be raw and unheated and never used for cooking.
  • Nuts: The healthiest choices for diabetics are macadamia nuts. Almonds, pecans, and walnuts are acceptable in limited amounts. Buy the nuts raw, soak and dehydrate before eating (*see Recipe section: Crispy Nuts). If you have weight to lose, keep your daily nut serving within the size of your palm. (Peanuts are not nuts: they are actually legumes.)
  • Omega-3's and Omega-6's refer to two types of polyunsaturated fatty acids, each with a characteristic chemical configuration at either the 3 or the 6 position. We require a certain amount of each of those as we cannot make them internally. Ideally our body would like equal amounts, but the standard diet (which you probably ate at some point in your life) has a 6/3 ratio of 15-50/1. You may still be carrying those excess omega-6 fats in your body, and the best way to clean them up is to focus on omega-3's (diet and supplements) and to absolutely minimize omega-6's.
• Vegetables: Vegetables provide necessary minerals and phytonutrients. Eat vegetables lightly steamed with butter, cream, and sea salt; or raw in salads with olive oil and vinegar dressing. If you juice your vegetables, drink them with a meal, not instead of a meal. Butter and oils aid in nutrient absorption. Bitter greens are especially rich in nutrients. Limit root vegetables as described below.
• Fermented foods: Naturally fermented foods enhance digestion and immune function as well as providing valuable vitamin K2. Choose from sauerkraut, kimchi, fermented pickles, cultured vegetables, miso, yogurt, and kefir; eat at the beginning of meals two to three times a day.
• Celtic sea salt: This provides valuable trace minerals, and as insulin levels are lowered, you will excrete increasing levels of salt in your urine. Salt to taste.

Avoid or Limit Problematic Foods

• Sugar: No sugar, honey, maple syrup, corn syrup, rice syrup, high-fructose corn sweeteners, agave, fruit juices or sodas. Juice and soda are equally powerful in markedly increasing your risk of diabetes. Avoid non-caloric sweeteners with the exception of stevia powder (the green powder only, not the white extract).
• Grains: All grain products (including whole and sprouted grains) are problematic, including wheat, rye, barley, spelt, corn, rice, kamut, oats, triticale, and beer. Highly processed quick-cooking grains such as instant rice and ready-to-eat breakfast cereals should be permanently avoided, but once your metabolism normalizes you can consider rice or other grains once or twice a week. Because of its tendency to promote inflammation, you might stay away from gluten on a permanent basis.
• Fruit: Fruits with low to moderate fructose content may then be consumed once daily (one piece of fruit or one cup of berries per day). Berries are ideal; other acceptable choices include lemons, limes, cantaloupe, cherries, tangerines, nectarines, and peaches. Eat fruit with meals to avoid blood sugar spikes. Fruit juices, dried fruit, bananas, and apples should be permanently avoided. Unless you have problems with heartburn or reflux, sparkling water with a pinch of salt and squeeze of lemon can be a refreshing alternative to fruit juice.
• Root vegetables:  You may occasionally (once or twice a week) eat half a red potato or a small serving of sweet potatoes or yams, always with lots of butter. Cooked carrots, white potatoes and beets behave like sugar if you tend to be diabetic, but raw carrots and beets are delicious grated on salads; potato salad (from cooked and cooled potatoes) offers a real benefit to digestion, but limit to once a week.
• Alcohol: Eliminate alcohol if you are overweight and diabetic. Beer is the most problematic alcohol for its grain and carbohydrate content. It is possible to reverse insulin resistance including a limited amount (3 ounces) of dry wine with dinner.
• Soy: The only acceptable soy products are fermented tempeh, miso, and tamari. Limit tempeh to one serving per week.
• Vegetable oils and GMO oils: Genetically modified oils include canola, corn, soy, and cottonseed. Also avoid sunflower and safflower oils, margarine, and all trans fats. Avoid flax oil as its value is negated by high insulin.  
• Make your own salad dressing! Every pre-made salad dressing, even "Your Favorite Brand Olive Oil Dressing" has too many omega-6 fatty acids swirled in with the olive oil flavoring.
• Restaurant and processed foods: As metabolic numbers improve, a wise eater may be able to find healthy meals at “slow-food” restaurants. Fast-food options should become a relic of the past. Even foods labeled “low-carb” often include excessive carbs and unhealthy fats.
• Low-fat, nonfat, or sweetened dairy products should be gone for good!
• "What about my upcoming ________________ (fill in with special event of your choice) ? On special occasions (no more than twice a month), if it’s important to you, you can have a sweet treat with dinner—not instead of dinner, not before dinner, and not later in the evening. Right after you eat your dinner! (OK, if it's a mid-day wedding, you can have it with lunch, but make it a smaller portion.)

Vital Supplements

• Dr. Ron's Ultra Pure Liver: For those unwilling to eat liver, supplement with liver pills (6 daily).
• Pure Encapsulations Alpha Lipoic Acid (ALA): ALA increases insulin sensitivity. Eat organ meats or take 400 mg (1 capsule) twice daily.
• Integrative Therapeutics Chromium Forte: This supplement combines the ancient herb gymnema, bitter melon, vanadium, chromium, niacin, and more, all useful for balancing blood sugar and insulin. Take 1-2 tablets two to three times daily before meals.
• Probiotics: Bio-Immersion Original Formula is a great choice. Start with 1/8 tsp, increase to 1 tsp daily, between meals.
• Vitamin D: Obtain vitamin D from the sun with 20 minutes of full-body (not just hands and ankles) exposure to midday sun (May to September in northern latitudes). With direct UV exposure, the body can generate up to 20,000 units or more of vitamin D daily. Test your blood level of vitamin D3: the ideal range for healthy people is 40-65 ng/ml; those with health challenges may benefit from higher levels. If sun exposure is not giving you adequate vitamin D3 levels, take Pure Encapsulations Vitamin D3. Take as needed to normalize blood levels. For most adults that amount is approximately 4000 i.u., daily, or consult your health care professional for individual requirements. If you are taking more than 2000 i.u. daily, it would be prudent to also take vitamins A and K2. They can be obtained in a good multi-vitamin.
• Thorne Research Basic Nutrients III is an excellent multi-vitamin. The bottle recommends 6 daily, but for most people two capsules taken twice daily are completely adequate.
• Thorne Research Magnesium Citramate: Take 150-600 mg daily according to bowel tolerance of this or other healthy magnesium supplement. You can also find magnesium in green leafy vegetables, nuts, seeds, and fish. Your need for magnesium goes up as your insulin levels go down as part of the process of healing.

Lifestyle

• Interval training is incredibly helpful in reversing metabolic syndrome or insulin resistance. Short sessions of intense interval work help to normalize weight and metabolism by boosting growth hormone levels.
  • For example, perform a 5-minute warmup, then move into 4-8 sets of intervals: each set consists of 20-30 seconds of high intensity work alternating with 20-90 seconds of recovery: rest enough so that you work equally hard in all your intervals. Choose any strenuous activy you repeat safely: modified push-ups, sit-ups, Tabata squats or mountain climbers. You can also do intervals on the rowing machine, stationary bicycle or treadmill if you're adept at managing the machine. If it takes you 5 seconds to get up to high intensity, start your 20 seconds after that time. Conclude with 5 minutes of cool down.
  • Perform intervals two to three times a week, maximum! You must give your body time to recover to reap the benefit.

  Caution: Start slowly and build up to highest intensity over a matter of months. Injuries can occur if you exert full strength when you are just starting.

• Walking: Discover forms of exercise you love - and do these activities regularly. Brisk walking is sufficient for most people. For even greater benefits, consider adding strength and interval training to a program of daily walking. Use common sense to avoid overly stressful exercise, which can trigger the release of cortisol and thus raise glucose levels. After a workout, eat enough to replenish energy but to maintain the low-carbohydrate directions in the diet plan.
• Strength exercises: Working out with weights or even your own body weight (such as performing push-ups), requires intense muscle effort. This dramatically increases your muscles' ability to use insulin, and therefore lower insulin resistance. Engage in strength training two to three times a week.
• Treat stress naturally: Sustained stress can raise internal cortisol levels which can aggravate a tendency to insulin resistance.  Look for relief in exercise, meditation, hobbies, or counseling. If you consider yourself depressed, be cautious: prescription antidepressants are associated with an increased risk of type 2 diabetes. Instead, treat depression naturally as you would other forms of emotional stress.
• Avoid endocrine disruptors: Steer clear of BPA and other sources of endocrine disruptors, which may aggravate diabetes. BPA is found in plastic water bottles and the linings of food and beverage cans and take-out containers. Many cosmetics and pesticides and other types of plastic also contain pseudo-estrogen endocrine disruptors.
• Relax and have fun: Both simple laughter and sitting in a hot tub can lower blood sugar.

Hormone Treatment

Many people ask if boosting their thyroid hormone can help with weight loss and reversal of metabolic syndrome, which usually includes some degree of excess body fat and weight. The short answer is that if your thyroid hormone status is actually abnormal, it will help significantly to normalize your hormones. Besides simple hormone levels, it is also important to normalize or optimize the interplay between thyroid hormone and the adrenal hormones: cortisol and adrenaline primarily. Elevated cortisol definitely aggravates metabolic syndrome and insulin resistance: stress management can be helpful. If serious abnormality is suspected, it's best to investigate adrenal function with a DUTCH (dried urine test for complete hormones) test, working with a knowledgeable practitioner who can help to sort out the results. 

Sex hormones can also be important. As estrogen levels fall precipitously for women and testosterone falls more gradually for men, lowered sex hormone levels make us all less able to handle dietary carbohydrates gracefully. That expanding waistline comes naturally with additional birthdays! Replacing low hormones can be helpful for both women and men in their efforts to reverse metabolic syndrome and insulin resistance.

Homeopathic Treatment

Metabolic syndrome and insulin resistance are most effectively managed with the lifestyle interventions described here. Any additional benefit from homeopathic treatment would be with the help of a professional homeopath.

Prevention

There is no doubt that making changes in diet and lifestyle can prevent and and reverse metabolic syndrome. To balance your blood glucose and prevent the insulin spikes that lead to insulin resistance, you must eat no more than the small amount of sugar present in vegetables and minimal fruit. Say goodbye to refined carbohydrates. Create a balanced, healthful diet rich in proteins, healthful fats (including saturated fats), and low-glycemic vegetables. Integrate moderate portions of low-glycemic fruits, root vegetables, and whole grains after you've reached your desired weight and your blood sugar has stabilized.

Regular exercise is another important factor in preventing and overcoming diabetes. Exercise helps with blood glucose control by making cells more sensitive to insulin. Studies show that even a few days of sedentary living causes the metabolic changes associated with diabetes. Establish the habit of a brisk half-hour daily walk. For even greater benefits, include a moderate program of strength-building exercises and interval training, both of which can dramatically improve your body's ability to use glucose.

 From Dr. Deborah's Desk

Marilyn was reluctant to take away her favorite foods—breakfast of fruit and toast, alternating with muesli—but eventually developed a real creativity and love of breakfast options. She reminded me that much of the world thinks breakfast means meat and vegetables or some form of broth with meat or eggs! And avocado made any meal better. 

She made her exercise-dance class a regular feature of her week, rather than introducing any new kind of intervals exercise.

While we were both most happy that her metabolic numbers normalized, it was a nice side effect that her body fat was slowly redistributed into more compact muscle. Her weight stayed about the same, but clothes felt better and her body moved more easily. 

This information is provided for educational purposes only, and any individual diagnosis or treatment should be determined by you and your doctor. See Additional Information.