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By Todd Lemke, Pharm.D., Clinical Pharmacist, PAHCS
The clinical signs of Metabolic Syndrome have been known for years: high blood pressure, elevated cholesterol and triglycerides, obesity, and high fasting blood sugars. Scientists and health care providers have found links between the clinical signs and how each sign may, in fact, lead to the cause of the other signs.
Take your neighbor Bob, for example. He's fifty-one years old and has been working a good desk job for the past thirty years. Work is pretty busy so he doesn't have a lot of time to eat right during the day, sometimes only having time to buy a soda and a bag of chips. When he gets home, both he and his wife, Sue, are pretty tired so they either go out to eat or sit down in front of the TV and eat a microwave dinner. Bob seldom gets exercise since the winters are pretty bad and this spring has been so cold. He's put on a little weight over the years and his kids tease him once in a while about his growing waistline. Soon it'll be summer though, and he'll be able to get some exercise on his riding lawn mower and fishing out in the boat.
Bob seems pretty normal. In fact, he is among the 35 percent of the United States population in his age group that has Metabolic Syndrome. Lets see what may be happening in his body right now and how the clinical signs of Metabolic Syndrome are connected.
With Bob's sedentary lifestyle, he has put on those few extra pounds. The extra weight is primarily made up of fat. Fat, like other cells in the body, sends out chemical signals to the other cells of the body. In fat cells, one of these chemical signals makes other cells, such as muscle, resistant to taking up sugar from the blood stream. Bob might start to find his morning blood sugar a little higher than it had been ten years earlier. Bob's blood sugars may not be high enough to classify him as having diabetes, but if he has a family history of diabetes, he is well on his way to developing the disease.
When muscle cells aren't getting sugar to be used for energy, they signal the brain they need either more sugar or a second source of energy. One of the other readily available sources of energy in Bob is in his fat cells. The fat cells release fatty acid particles which can be used for energy by cells but are also taken up by the liver to be packaged into a form of cholesterol called VLDL (very low density lipoprotein). VLDL releases triglycerides into the blood stream to be used for energy by other cells. When Bob has a lot of VLDL it causes his HDL (high density lipoprotein, the good form of cholesterol) to become lower and his LDL (low density lipoprotein, the bad form of cholesterol) to become more compact and dense. When Bob has his check-up next year, his doctor might tell him his cholesterol tests are higher than they were at his last physical.
The extra weight Bob has put on and less-than-perfect diet have started to make his heart work a little harder. His blood pressure isn't too high, 142/90, at least not as high as a few of his co-workers. The elevated blood pressure is enough though, combined with the higher blood sugars and cholesterol, to cause some damage to his blood vessels. Over time, the damage to the blood vessels causes inflammation and plaque to form in the blood vessel wall. This damage leads to the blood vessels sending out signals that they need repair. The body sends platelets and proteins to repair the damage. Unfortunately, repairing the damage sometimes leads to a blockage in the blood vessel. This blockage could lead to a stroke or a heart attack. In Bob's case, if nothing is done, he may have a heart attack this summer as he is landing that big walleye on Lake Koronis.
The good thing about Metabolic Syndrome is that it is both preventable and treatable. Researchers have given us many tools to use in identifying people at risk and making modifications to their lifestyles and medications.
The most effective way to treat Metabolic Syndrome is through eating a healthy diet and getting regular exercise. Changes in diet and exercise can reduce your risk of developing Metabolic Syndrome by approximately sixty percent. Being fit can make you four times less likely to die from a stroke or heart attack. Bob's current exercise level and diet definitely need more work to reduce his risk. He doesn't have to become an olympic athlete however. By starting a walking program after work, he may be able to maintain a stable weight or even lose a few pounds. Working on his diet, he may be able to find better food choices at work and at home.
Important things to remember with diet and exercise are:
(Calories taken in as food)-(Calories burned during activity)=(Weight gained)
3500 calories will provide your body with an additional pound of weight.
Treating the clinical signs of Metabolic Syndrome with medications is sometimes necessary. In the past few years, many standards of care have been updated with the results of large clinical studies. Blood pressure, cholesterol, blood sugar, and other clinical goals have been adjusted to decrease the risk of both long and short-term complications. As Bob works with his health care providers, the right medication will be matched with his clinical signs. He may find himself on a medication used for diabetes that will help his cells take in sugar even though he has not been diagnosed with diabetes. He may find himself on a blood pressure medication or cholesterol medication that also helps to decrease the inflammation in his blood vessel walls. He may also find himself being put on aspirin to decrease the body's response to the blood vessel damage. His health care provider will then help monitor his health to make sure the changes in diet, exercise, and medications are having the desired effect.
PAHCS currently has the ability to assist you in finding out more about Metabolic Syndrome, evaluating your risk factors and creating an individualized treatment program. Our clinical dietitian is currently providing lifestyle education in Paynesville. Clinical pharmacists are also available for medication selection and monitoring to work with your primary care provider in treating Metabolic Syndrome in Paynesville, Belgrade, Watkins, Eden Valley, and Richmond. Contact your health care provider for further information or any of the clinical pharmacists.
Clinical Identification of Metabolic Syndrome
Any Three of the Following Risk Factors:
• Abdominal obesity
• Elevated triglycerides greater than 150 mg/dl
• HDL (High density lipoprotein,
the good cholesterol)
• Blood pressure greater than 130/85 mmHG
• Fasting blood glucose greater than 110 mg/dl
A free seminar will be held at PAHCS on Thursday, Sept. 26, at 7:30 p.m. at 700 Stearns Place. The seminar will include information from physicians, pharmacists, and dietitians.
Chart source NCEP ATP III, JAMA 2001; 285:2486
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Whether you call it Syndrome X, dysmetabolic syndrome, the deadly quartet or insulin resistance syndrome, Metabolic Syndrome sounds somewhat frightening. In fact, there are approximately 50 million people in the United States with Metabolic Syndrome, most of which don't know they have it. The term Metabolic Syndrome and the reason it has so many other names is that medical science is just beginning to link and better understand the clinical signs that make up the syndrome.