What is “Syndrome X”? Is it the same as Metabolic Syndrome?

The Metabolic Syndrome has also been referred to as “Syndrome X,” or the “insulin resistance-obesity syndrome.” Due to its rapidly increasing incidence, medical experts now refer to it as the “disease of the new millennium.” The Centers for Disease Control and Prevention estimates that one in five adults in the United States already has Metabolic Syndrome and that the numbers will continue to grow because of Americans’ sedentary lifestyle.

Metabolic Syndrome is usually recognized by a cascade of disorders encompassing Non-Insulin Dependent Diabetes (NIDD), high blood pressure, fatty build up around the arteries, centrally distributed (or abdominal) obesity, and high cholesterol.

The only symptom of Metabolic Syndrome that is readily noticeable is abdominal fat, which is defined among men as a waist size of 40 inches or greater and women as a minimum waist size of 35 inches. The other risk factors include high blood sugar, high triglycerides (the amount of fat in the blood), low HDL cholesterol (known as the “good” cholesterol) and high blood pressure (130/85 or higher). Those exhibiting a minimum of three of these five risk factors are classified as having Metabolic Syndrome.

Other diseases and conditions have been linked to Metabolic Syndrome, such as polycystic ovary disease, chest pain, and the presence of darkened skin under the arms known as “acanthosis nigricans.”

Only one of the risk factors is visible. Like diabetes, Metabolic Syndrome has insulin trouble at its core. But these two conditions—and heart disease—have so many things in common that researchers have been trying to figure out how the three are related. In fact, a recent study in the Journal of the American Medical Association found that men with at least three of the risk factors are three to four times more likely to die of a heart attack than those who did not have the condition. In addition, research shows that people with Metabolic Syndrome are more likely to develop blood clots and their bodies are more likely to produce plaque in the bloodstream that clogs their arteries thus making them more prone to a number of potentially deadly diseases.

A reduced sensitivity to insulin may be partly to blame. Insulin is the juice that greases human metabolism. It “knocks” on cells to get them to open their “doors” to glucose, the sugary fuel we make of our food. For people who have Metabolic Syndrome, cells may ignore, or become resistant, to insulin’s “knock,” so they don’t let glucose in. If you have insulin resistance, insulin levels in your blood will be higher than they should be. Unfortunately, measuring insulin levels is fraught with difficulty…the levels roller coaster up and down all day and it’s a relatively expensive test which doesn’t provide a lot of information.

Also, just because you have trouble with insulin doesn’t mean you’ll develop Metabolic Syndrome. Central obesity (abdominal fat) may be the switch that makes insulin troublesome and turns on the vicious metabolic circle that leads to Metabolic Syndrome. Here’s what happens: the abdominal fat that hides deep beneath waistlines is a lively fat-pushing machine. This isn’t the fat you can “pinch an inch” of. These fat pads lurk near vital organs beneath our abdominal muscles, not on top of them. They break down triglycerides and release a lot of fat into the circulation in the form of fatty acids—three for each molecule of triglyceride.

Excess fatty acids in the circulation are known for starting trouble. They make muscle cells less sensitive to insulin and, perhaps more important, infiltrate the liver and disturb it. Not only does the rattled liver get logy and slow at its normal job of breaking down insulin, but it also makes more glucose and more lipoproteins. The result? A bloodstream filled with too much insulin, sugar, and fatty lipids—three signposts for Metabolic Syndrome. What’s worse, those lipoproteins are then transformed into the mean, small, dense variety, which can muck up your arteries faster than LDL can. People who have high triglycerides and high insulin levels often have trouble dissolving blood clots, too. If clots aren’t broken up, there’s an increased chance that one might plug a narrowed artery and trigger a heart attack. Those clotting problems may be one of the reasons high blood pressure is a hallmark of Metabolic Syndrome, too.

Metabolic Syndrome can be prevented with weight management and appropriate levels of physical activity.

Treatment of Metabolic Syndrome includes the following:

• Reduce weight by decreasing your calorie content 500 calories per day with portion controlled foods and meal replacements (seek professional help, if necessary).

• Increase exercise level so that you’re engaging in moderately intensive aerobic activities such as brisk walking, bicycling and hiking six days each week for up to 60 cumulative minutes (four 15 minute regimens or two 30 minute regimens is acceptable). In addition, add two days of strength training to your routine.

• Know your numbers! (Obtain your waist size as well as your blood pressure, total cholesterol, HDL, blood sugar and triglyceride levels).

• Maintain a diary of your food intake, exercise regimen and “baseline” numbers so that you can monitor your progress.

(Nurse Pract 1996 Jun;21(6):74-5, 79-80, 83-6 Syndrome X. Recognition and management of this metabolic disorder in primary care. Minchoff LE, Grandin JA)