Why we need to do more to fight metabolic syndrome

Your apple shape could be a symptom of a serious underlying health condition that is on the rise in Sub-Saharan Africa. Metabolic syndrome is a cluster condition where patients are diagnosed with high blood pressure, high blood sugar, excess body fat, especially around the waist, and high cholesterol.

According to Dr Dhesan Moodley, a specialist physician at the Integrative Medical Centre in Bryanston, Johannesburg, many patients do not know they have metabolic syndrome, they just feel tired and demotivated.

“As weight gain has become endemic in our a country, people do not realise that they are medically overweight and come to accept it as normal. As such, if they are not consulting with their doctors, they may not realise that they have asymptomatic underlying conditions.”

Having metabolic syndrome increases your risk of heart disease, stroke and type 2 diabetes. According to the US’s Mayo Clinic, about a third of US adults have it. Ethnicity plays a role, and in the US, Hispanic women are at the greatest risk of developing the condition. The exact reasons are not known, but genetics play a role in all the conditions in the cluster.

SA is among the countries with the highest rate of metabolic syndrome, and similarly, certain racial and socioeconomic groups are more susceptible. Wits researchers Philippe Jean-Luc Gradidge and Nigel Crowther in 2017 published a study “Metabolic syndrome in black SA women” in the journal Ethnicity & Disease.

The prevalence of metabolic syndrome is increasing in African populations, and is particularly high in black SA women (42%) versus women in the UK (23%) and the US (36%), the researchers found. This population group is also known to have the highest prevalence of obesity in the sub-Saharan African region (42%), and consequently, a high risk of non-communicable diseases.

They concluded that the growing incidence of metabolic syndrome represented a challenge to the transitioning primary healthcare system in SA. “A more holistic approach to management of the disease needs to be developed in the midst of persistent social disparities.”

Another study published in 2017 — by Eyitayo Omolara Owolabi of the University of Fort Hare and academics from Walter Sisulu University — was done among adults in Buffalo City, East London. “Urbanisation and westernisation have greatly influenced the metabolic health of individuals in SA, with a resultant increase in metabolic syndrome components,” they found.

The prevalence of metabolic syndrome was 21.8%; 15.6% and 24.8% among males and females, respectively. The prevalence was higher among participants who were aged 56 years and above, with low level of education (grade 1—7), married and retired. This predisposed the participants to cardiovascular diseases, a leading cause of premature morbidity and mortality.

Adding to the insidiousness of the condition is that one can be asymptomatic for years before it is becomes clear you have it. “Most of the disorders associated with metabolic syndrome do not have obvious signs or symptoms. One sign that is visible is a large waist circumference. And if your blood sugar is high, you might notice the signs and symptoms of diabetes — such as increased thirst and urination, fatigue and blurred vision,” says the Mayo Clinic.

“Your risk of metabolic syndrome is higher if you’ve ever had nonalcoholic fatty liver disease, polycystic ovary syndrome or sleep apnoea,” it says. Sleeping less than seven hours a night appears to worsen the condition.

Another risk is heart and blood vessel disease. “High cholesterol and high blood pressure can contribute to the build-up of plaques in your arteries. These plaques can narrow and harden your arteries, which can lead to a heart attack or stroke.”

The condition varies in the length of onset. “While most cases of metabolic syndrome take decades to advance to severe illness, some patients who neglect their health, diet and lifestyle can progress rapidly in a few years to severe illness,” says Moodley.

Similarly, the symptoms vary with individuals. In the initial stages, these patients are often asymptomatic other than exhibiting weight gain. Later, they could present with these symptoms:

• Diabetic symptoms (thirst, excessive urination most noticeably at night, frequent infections such as urinary tract and skin infections);
• High blood pressure (persistent headaches and nose bleeds); and
• In the advanced stages they could present with symptoms of heart disease (gripping chest pain, difficulty breathing, swelling of feet and excessive tiredness) and stroke (loss of consciousness, body numbness and weakness).

Just as it is closely linked to overweight or obesity and inactivity, the disease is also linked to a condition called insulin resistance. According to the Mayo Clinic, normally, your digestive system breaks down the foods you eat into sugar. Insulin is a hormone made by your pancreas that helps sugar enter your cells to be used as fuel. In people with insulin resistance, cells do not respond normally to insulin and glucose cannot enter the cells as easily. As a result, your blood sugar levels rise even as your body churns out more and more insulin to try to lower your blood sugar, it says.

Insulin resistance leads to elevated blood glucose levels (hyperglycaemia), which, over time, leads to prediabetes and type 2 diabetes.

Moodley says by the time a patient presents with metabolic syndrome, “they have usually progressed beyond prediabetes to type 2 diabetes with its related symptoms, as outlined above”.

He adds that prediabetes can be identified and managed before it becomes type 2 diabetes. “The patient’s doctor should measure their fasting insulin levels, which are often elevated before their blood glucose and haemoglobin AIC test levels. (The haemoglobin AIC test is a simple blood test that measures your average blood sugar levels over the past three months.)”

Another reason to take steps to prevent metabolic syndrome, or manage it if you do develop it, is that it can affect mental health. There is a strong correlation between metabolic syndrome and depression, anxiety and stress, as these can often lead to lethargy, tiredness, low fitness levels, poor diets and neglecting to consult with a doctor, says Dr Moodley.

The condition can be prevented and/or managed with lifestyle changes as well as prescribed medicines and supplementation. Moodley says: “While patients need to see their doctors to manage their blood pressure, blood sugar and cholesterol levels, lifestyle plays an important part in controlling and, in some cases, reversing their condition. Such lifestyle changes include:

• Stress management: reducing avoidable stresses, and practising stress management techniques such as yoga and meditation.
• Regular exercise: at least 40 minutes of a mix of aerobic exercise (walking, jogging, swimming, cycling) and strength and toning exercises (gym circuits, weights);
• Diet: a daily 16-hour fast, low carbohydrate meals (especially processed carbs and sugars) and low saturated or trans fats (animal fats and deep-fried foods). These diets are usually high in fish, chicken, occasional meat, green leafy and cruciferous vegetables, and limited amounts of fruit. These foods should not be highly processed (such as cold meats) or deep-fried. Added salt should also be avoided.

In addition, meals should have liberal amounts of antioxidants such as chilli, ginger, garlic and turmeric.

Antioxidants are found in many spices and herbs, as well as in fruit, vegetables, and other plant-based, whole foods. These molecules fight free radicals in the body, which can cause harm if their levels become too high. Free radicals are linked to illnesses such as diabetes and heart disease. Therefore, including herbs and spices, as well as generous portions of fresh produce, is crucial to health, and combating metabolic syndrome.

Smoking should be avoided because it is linked with an increase in oxidation and free radicals, as well as high triglycerides, which cause a hardening of the arteries or a thickening of the artery walls (arteriosclerosis), increasing the risk of stroke, heart attack and heart disease.

Dr Moodley adds that, depending on the underlying conditions, the supplements that are usually beneficial for preventing and managing metabolic syndrome include omega 3, multivitamins, vitamins D3 and B12, alpha lipoic acid, chromium, magnesium and carnitine. Gut health supplements such as probiotics and glutamine are also helpful, he says.

Medications used to treat the individual conditions in the cluster, such as antidiabetic agents, statins and angiotensin-converting enzyme inhibitors to reduce blood pressure, need to be prescribed by a doctor. “The scripted medications are tailored to manage each of the underlying conditions. This is best discussed with their doctors and prescribed accordingly,” says Moodley.

The Buffalo City study emphasises the role of the government in treatment and education. “The district and provincial health policies should integrate preventive strategies towards addressing the cardiometabolic risk factors at the primary healthcare facilities and population level,” it says.

“Women, those in the older age group, individuals with low level of education and the unemployed should be targeted for interventions aimed at reducing [metabolic syndrome]. There is a need for educating patients on lifestyle changes to reduce the cardiometabolic risk factors, particularly among those with more than one risk factor.”

In addition, the study recommends that patients be screened for the disorder to ascertain the exact prevalence so as to inform public health policies.