The next epidemic (Syndrome X)

The dramatic rise in obesity, heart disease, diabetes and other conditions of prosperous nations are increasingly pegged as epigenetic in nature, and may well claim their origins in faulty embryonic development. We are, quite literally, what we eat as well as what our parents and even grandparents ate.

Metabolic syndrome X is a constellation of metabolic disorders that all result from the primary disorder of insulin resistance. All the metabolic abnormalities associated with syndrome X can lead to cardiovascular disorders – when present as a group, the risk for cardiovascular disease and premature death are very high.

The characteristic disorders present in metabolic syndrome X include:

• insulin resistance
• hypertension
• abnormalities of blood clotting
• low HDL and high LDL cholesterol levels
• high triglyceride levels

The chief abnormality present in syndrome X is insulin resistance. That is, the body’s tissues do not respond normally to insulin. As a result, insulin levels become elevated in the body’s attempt to overcome the resistance to insulin. The elevated insulin levels lead, directly or indirectly, to the other metabolic abnormalities seen in these patients.

Very often, the insulin resistance is severe enough that these patients eventually develop frank type 2 diabetes. When diabetes occurs, the high risk of cardiovascular complications goes even higher.

This condition is thought to run in families. The same families who have a history of type 2 diabetes are at risk for metabolic syndrome X. The family members at risk who actually go on to develop syndrome X are those who adopt sedentary lifestyles, and who become obese. In fact, metabolic syndrome X (like type 2 diabetes) can most often be prevented with exercise and weight loss.

Anyone with a family history of type 2 diabetes who is also overweight and who gets little exercise should be evaluated for the glucose, lipid and blood pressure abnormalities associated with syndrome X.

Treatment of syndrome X:

Treating the insulin resistance While there is no drug treatment that directly reverses the insulin resistance that causes syndrome X, there is, in fact, a way to reverse the insulin resistance – diet and exercise. Patients should make every attempt to reduce their body weight to within 20% of the “ideal” body weight calculated for age and height. (The ideal diet for this condition is a low calorie, low-cholesterol diet with plenty of fruits, vegetables, and fiber.) And patients should incorporate aerobic exercise (at least 20 minutes) into their daily lifestyle. If both of these can be accomplished, most of the metabolic abnormalities seen in syndrome X substantially improve.

However, human nature (and human metabolism) being what it is, the majority of patients with syndrome X cannot accomplish these goals. In these cases, each metabolic disorder associated with syndrome X needs to be treated individually, and aggressively.

Treating the lipid abnormalities The lipid abnormalities seen with syndrome X (low HDL, high LDL, and high triglycerides) respond nicely to weight loss and exercise.

Treating the hypertension High blood pressure is present in more than half the people with metabolic syndrome X, and in the setting of insulin resistance, high blood pressure is especially important as a risk factor. Recent studies have suggested that successfully treating hypertension in patients with diabetes can reduce the risk of death and heart disease by a substantial amount.

What you can do:

• Change in lifestyle, with specific avoidance of substance abuse, smoking cessation, and reduced intake of caffeine and simple sugars.
• Behavior modification, including a change in eating patterns and amounts of various foodstuffs eaten. A modified low carbohydrate lifestyle with exclusion of simple sugar is valuable. Food that does not deliver a high glucose load is preferred (low glycemic index foods).
• Exercise matched to the level of the subject’s aerobic fitness, with medical advice or advice from professional trainers, recommended before beginning an exercise program and periodically thereafter.
• A diet with a reduced intake of simple sugars, salt, and saturated fat; a controlled protein intake; and an increased intake of healthy fats, such as essential fatty acids in fish oil.
• Use of nutritional factors specifically designed for managing metabolic syndrome, including oat beta-glucan; antioxidants from berries; alpha-lipoic acid (ALA); chromium; biotin; vanadium; phaseolamin (Phase 2); vitamins that will reduce blood homocysteine levels.

In South Asia, undernutrition in one generation is followed by fat-laden fast foods the next. Children are set up in utero to experience an environment of low nutrition and find themselves in the land of plenty. The epigenetic software is programmed for one scenario but encounters another, often with disastrous results. Seismic shifts in food sources, geographic locations, chemical exposures and even weather patterns can alter gene expression through epigenetic changes.

Be well

Dr Sundardas