Syndrome X

Question:
"My Health Coach thinks I might have Syndrome X. I am 20 lbs overweight and have a sedentary job. What is Syndrome X and can it be reversed?"

our Health Coach Answer:
Before explaining what Syndrome X is, I first want to recommend that you actually be tested to see whether or not you actually have it. Given the fact that you are overweight and lead a sedentary lifestyle, chances are that you do, but it's best to be sure. Also note that in my clinical experience, it is very, very common to see 30 and 40 year-old men and women who have, or are developing Syndrome X.

There are five parameters, or risk factors, that define Syndrome X, which is also known as Metabolic Syndrome, Reaves Syndrome, Insulin Resistance Syndrome, Dysmetabolic Syndrome, and "pre-diabetes." You must have three out of the five risk factors to be accurately diagnosed with Syndrome X.

The risk factors are:

1. abdominal obesity (a waistline that is 40 inches or more in men,
   and 35 inches or more in women
2. elevated triglycerides (150 mg/dl or higher)
3. low HDL ("good") cholesterol levels (40 mg/dl or lower in men,
   50 mg/dl or lower in women)
4. elevated blood pressure (130/85 or higher)
5. impaired fasting glucose (greater than110 mg/dl)

All of these risk factors can be easily measured by your physician.

In my opinion, speaking as a physician who regularly treats Syndrome X, one of the additional key points to make is that abdominal obesity, or intra-abdominal fat, is the literal metabolic driving force behind the disease.

The metabolic chain of events goes something like this.

Visceral obesity (read intra-abdominal fat) results in a steady release of Free Fatty Acids into the blood stream (FFA's). FFA's trigger the overproduction of triglycerides in the liver resulting in a dramatic decrease in HDL cholesterol.

The same visceral obesity is responsible for insulin resistance, resulting in elevated fasting blood sugar and hypertension. (Insulin is a type of human growth factor resulting in the migration of smooth muscle cells into the walls of blood vessels, ultimately causing high blood pressure.)

There is one other important point I wish to make. If you define the illness - in this case, Syndrome X - you also define the treatment! However, though targeting intra-abdominal obesity is the correct treatment approach for reversing Syndrome X, this is a topic that is seldom broached by physicians and patients alike because of the emotional issues that are related to it. Or, all too often, patients misinterpret the treatment regimen to mean little more than doing sit-ups or stomach crunches, thinking this will reduce their waist size. Nothing could be further from the truth. This additional fat is NOT in the abdominal wall and thus is not amenable to such exercises or even to more drastic measures, such as liposuction. Rather, the fat is packed around internal organs and therefore MUST be carefully exercised and "dieted" away. This calls for a therapeutic lifestyle change, in other words.

In addition to working with your Health Coach, there are a number self-care steps you can take to reverse Syndrome X. They are very similar to those I previously discussed [Note: Bryan, link the underlined text with the Ask the Health Coach piece on triglycerides] for lowering high triglyceride levels. Namely:

Diet: The first step you should take when it comes to your diet is to eliminate unhealthy foods that are known to contribute to Syndrome X. These include all types of alcoholic beverages, fried foods, sugar and artificial sugar substitutes, refined carbohydrate foods, and foods that contain hydrogenated and partially-hydrogenated fats (also known as trans fats - this means avoiding processed and packaged foods, which usually contain trans fats). Also avoid canned fruit juices and limit your consumption of fresh fruit juices, as well, because of their naturally high sugar content.

You will also want to limit your consumption of starchy foods, such as bagels, bread, pasta, and potatoes. The research shows that the more carbohydrates that are consumed in one's diet, the greater the risk of developing Syndrome X. When choosing carbohydrate foods, try to emphasize whole grains and legumes and eat them in small portions.

Instead of the food choices above, be sure to eat plentiful servings of fresh vegetables throughout the day, along with healthy protein rich foods, such as lean meats, skinless poultry, egg whites, and wild caught fish, such as salmon, sardines, mackerel, and tilapia.

Healthy carbohydrate foods include amaranth, barley, buckwheat, bulgur, brown rice, millet, and quinoa, along with legumes, yams, and whole grain breads. I also recommend that you eat foods that have a low glycemic index rating. A ranking of foods by their glycemic index can be found here: www.topfitonline.com/chartglycemic.htm.

In addition, instead of eating three large meals each day, try eating four to six smaller meals, and snacking on nuts between meals. Also be sure to drink plenty of pure, filtered water throughout the day.

Exercise: A regular exercise program is also an essential step. Ideally, you should try to get at least 30 minutes of exercise each and every day. Aerobic exercise is especially good, and includes activities such as walking, cycling, jogging, and swimming. I also recommend Tai chi, due to the many benefits I've personally received from my many years of practicing it.

If you are unused to exercising, be sure to consult with your Health Coach so that the two of you can work together to create an exercise program that is most appropriate to your specific needs.

Lifestyle: Since you mentioned that you are overweight I recommend that you work with your Health Coach, who can help you devise a program for losing excess weight. Also, if you smoke, seek help so that you can quit.

Nutritional Supplements: Some of the most useful supplements for managing and reversing Syndrome X are omega-3 essential fatty acids. Omega-3 fatty acids trigger lipoprotein lipase activation, resulting in an immediate breakdown of triglycerides in the blood without drug or side effects.

Vitamin C and vitamin E can also be helpful, as can the minerals chromium, magnesium, and zinc. Alpha-lipoic acid (ALA) and conjugated linoleic acid (CLA) can also help.

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