METABOLIC SYNDROME

WHY IS MY HDL LOW? WHY IS MY BLOOD PRESSURE
HIGH? MY HIP HURTS.

Dan was a middle-aged Wall Street executive who was
working even more now that he had “retired.” A serious
limo accident had left him with chronic hip pain, and that,
coupled with pressure from two new ventures, made it all
too easy for him to gain weight. His annual physical showed
he had high triglycerides, a low HDL cholesterol, mildly
high blood sugar, high blood pressure (his systolic had always been more than 140 millimeters of mercury, but now his diastolic was 95 millimeters of mercury), and a waist offorty-four inches. He never skipped his twice weekly
handball game, but his hip pain was getting worse, and he
drank to relieve the pain. He weighed 251 pounds.
“Dr. John, I’ll level with you. I’m scared,” he said, handing me a six-page summary of his medical records over eighteen years, including current prescriptions for pain meds and Viagra, and recent lab values and test results.
Dan had metabolic syndrome. His low HDL, high blood
pressure, and large waist size greatly raised his heart attack risk. So did taking Viagra, which I advised him to stop. He ate like many people: a morning muffin, a sandwich at his desk at noon, chips around 4:00 p.m., and whatever he could manage for dinner (which was often take-out or a restaurant meal).
Dan started the Mediterranean diet to reduce the
inflammatory effects of metabolic syndrome and to help
with his impotence. He had no wine (alcohol is metabolized
first: its seven calories per gram go straight to the liver to be stored) or ice cream in the first twelve weeks. No steaks or full-fat cheese, either, except on four special occasions per year. I told him that high-fiber, whole-grain cereals lowered diabetes risk and insulin resistance, unlike most muffins, so he switched to cereal in the morning. And I said that learning to cook—even a little—would help. I showed him how to use a chef ‘s knife and how to sauté: he had never cooked before, but he quickly got the hang of it. I suggested he switch from espresso to herbal tea, as caffeine raises blood pressure, and unfiltered coffee raises LDL cholesterol. I persuaded him to play handball three days a week, and he eventually added two more sessions. He began a simple treadmill walking regimen, which he made easier by watching Hawaii Five-0 reruns. Executives like to compete, so he found 5Ks to walk with a buddy. After twelve weeks he had lost sixteen pounds, his systolic had dropped ten millimeters of mercury and diastolic five millimeters of mercury, his glucose fourteen milligrams per deciliter and triglycerides seventy-four milligrams per deciliter. I told Dan that these were all typical measurements for someone with metabolic syndrome who had lost about 6 percent of his weight, but Dan wanted to do better. And he did. After nine months, Dan’s waist was thirty-nine inches, his blood pressure was normal, and he had raised his HDL to forty-five. He had walked a 10K and lost forty-one pounds. His pain was reduced and quality of life had greatly improved—both in the kitchen and in the bedroom. “Dr. John, I just want to thank you. I didn’t believe you when you said the lentils, olive oil, and nuts would help my sex life. But they did, even without the Viagra!” WHAT IT IS: Metabolic syndrome means having three out of five risk factors—large waist size, low HDL, elevated blood sugar, blood pressure, and triglyceride level—for heart disease. Together they pose a greater risk than each one alone. The cause of metabolic syndrome is visceral (on the inside) belly fat and increased insulin resistance.

YOU ARE AT INCREASED RISK IF YOU
• are overweight, especially around the waist
• are obese
• are sedentary
• have elevated triglycerides
• have low HDL cholesterol
• have high blood pressure
• have a hormone imbalance
• have a family history of metabolic syndrome

CULINARY MEDICINE

FOODS TO INCREASE

• Milk, yogurt, cheese, and other dairy products. A study of more than ten thousand women over the age of forty-five showed that those who eat the most calcium-rich foods have a 36 percent reduced risk of metabolic syndrome compared with those who eat the least. A study of twenty four hundred middle-aged men showed that those who drank two cups of milk daily were 62 percent less likely to have metabolic syndrome than those who rarely drank milk.
• The Mediterranean diet. Eating a diet rich in whole-grain cereals, fish, legumes, fruits, and vegetables has been shown to reduce the risk of metabolic syndrome by 13 percent, and over two years it has improved sexual function in women with metabolic syndrome.
• Fruits and vegetables in general. An Iranian study found that people who ate the most fruit had a 34 percent reduced risk of metabolic syndrome, and people who ate the most vegetables had a 30 percent reduced risk of metabolic syndrome, compared with those who ate the fewest of these foods.
• High-fiber cereals and grains. People who eat the most cereal fiber have a 38 percent reduced risk of metabolic syndrome and people who eat the most whole grains have a 33 percent reduced risk of metabolic syndrome compared with people who eat few or none of these foods.
• Foods rich in magnesium such as halibut, almonds, cashews, soybeans, spinach, nuts, oatmeal, and peanuts. The current RDI for magnesium is 310–420 milligrams. People who get half or less are at a 75 percent increased risk of metabolic syndrome compared with those who get the full RDI. Magnesium may act as an anti-inflammatory.
• Soy nuts. When substituted for red meat for eight weeks among women with metabolic syndrome, soy nuts reduced blood sugar and LDL cholesterol; other soy foods did not.

FOODS TO AVOID

• Alcohol. It has been shown to increase the risk of metabolic syndrome by 26 percent.
• Red meat. In a seven-year study, men who ate the most meat had a 4.7 times greater chance of developing metabolic syndrome than men who ate the least, though this was attributed to the saturated fat content of the meat.
• Foods high in saturated fat. A Greek study showed that 35 percent of those who ate a diet high in saturated fat had metabolic syndrome compared with only 9 percent of those who ate a Mediterranean diet that was low in saturated fat.
• The Western diet. Women who eat a diet low in whole grains and high in saturated fat have up to a 68 percent increased risk of developing metabolic syndrome.
• High-fructose corn syrup (HFCS) for men. HFCS raises uric acid levels, which lowers nitric oxide levels, and increases insulin resistance. HFCS does not raise uric acid levels in women.

TOP CHEFMD-APPROVED RECIPES
• Parmigiano Caesar Salad with Shrimp
• Curried Turkey Tenderloin with Penne and Roasted Asparagus
• Tangy and Cool Buttermilk and Avocado Breakfast Smoothie

WATER-COOLER FACT: It is estimated that one in four or five adults in the United States—up to 25 percent—has metabolic syndrome.

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