According to the National Institutes of Health, about a third of Americans live with metabolic syndrome. Despite how common it is, many of us are still very unclear about what metabolic syndrome really is.1
Simply put, metabolic syndrome is a cluster of conditions that skyrocket your risk of serious health issues, such as coronary heart disease, diabetes, stroke, and other health problems. Sounds serious—and it is—but it's also preventable.
Here's everything you need to know about metabolic syndrome, including the risk factors, common causes, and how to prevent and treat it.
Metabolic Syndrome 101
Metabolic syndrome goes by a few other names, including insulin resistance syndrome, syndrome X, and dysmetabolic syndrome. The term "syndrome" refers to a group of conditions present together, and metabolic syndrome includes a group of five different conditions.
You only need to have three of the following five to be given a diagnosis of metabolic syndrome:
- Excess abdominal fat: A waist circumference of more than 40 inches in men and 35 inches in women. Abdominal obesity (or excess belly fat) is the only visible sign of metabolic syndrome.
- High triglyceride levels: 150 milligrams per deciliter of blood (mg/dL) or greater
- Low HDL cholesterol: Less than 40 mg/dL in men and less than 50 mg/dL in women
- High fasting blood sugar levels: 100 mg/dL or higher (which signifies prediabetes)
- High blood pressure: 130/85 mmHg or higher
Regular routine testing—including a blood lipid panel, blood pressure tests, fasting glucose test, and basic metabolic panel—can help you and your healthcare provider pinpoint if you have metabolic syndrome or if you're at risk for it. You can get these medical and blood tests done at your primary care physician's office.
Getting diagnosed with just one of these conditions should serve as a warning sign to change your lifestyle habits and seek treatment, but having three or more significantly raises your risk of heart disease, which is the number one leading cause of early death in the U.S., as well as for stroke and type 2 diabetes. Research shows that metabolic syndrome can increase your risk for a heart attack and stroke by two-fold and raise your risk of getting type 2 diabetes by five-fold. 2,3
Think of metabolic syndrome as a warning sign that your metabolic health needs a tune-up. Your metabolism controls how your body processes calories into energy, and the metabolic markers, including waist circumference, blood pressure, triglycerides, HDL, and blood sugar levels, all give you a magnified look into how your metabolic health is humming along. If any of these biomarkers are out of whack, consider that your body's way of alerting you that it's time to take control of your lifestyle habits and overall health.
Causes and Risk Factors of Metabolic Syndrome
Because metabolic syndrome is a combination of different conditions, many different factors can contribute to developing it. However, health experts hypothesize that metabolic syndrome stems from insulin resistance.
Insulin is a hormone made by your pancreas that transports glucose (or sugar) from food into your cells to use as energy and keep your blood sugar levels stable. When you have insulin resistance, your body can't efficiently shuttle sugar to your cells, which causes the glucose to stick around in your bloodstream. This triggers your pancreas to produce even more insulin, leading to hyperinsulinemia, or high blood glucose levels, and it essentially causes your body to become desensitized to insulin. This cascade eventually can contribute to high blood sugar (hyperglycemia) and, if left untreated, type 2 diabetes.
The following can all potentially contribute to insulin resistance and metabolic syndrome:
- Overweight and obesity: Being overweight or obese is a huge risk factor for metabolic syndrome because it raises your risk of having all the other associated conditions. Overweight is defined as having a body mass index (BMI) between 25.0 and 29.9, and obesity is defined as possessing a BMI of 30 or higher. Excess body fat triggers inflammation in the body because adipose tissue releases proinflammatory cytokines, which also reduce the efficacy of insulin. Carrying extra fat in your midsection is way more dangerous than having extra fat in other parts of your body, like your hips and thighs, because excess visceral fat coats your internal organs and puts you at an increased risk for serious health conditions. But subcutaneous fat (fat under your skin) also plays a role.
- Sedentary lifestyle: Not moving enough can put you at risk for overweight and obesity, and some research shows that a sedentary lifestyle is linked to a poorer diet. Additionally, physical activity helps improve your insulin sensitivity by increasing your muscles' ability to absorb glucose from your bloodstream.
- Certain medications: Some blood pressure medications; psychiatric medications, including certain antidepressants, mood-stabilizers, anti-psychotics, corticosteroids, and certain HIV treatments are linked to insulin resistance. If you're on prescribed medications and live with metabolic syndrome, consider speaking to your doctor about how your meds might affect your health. 4, 5
Some people are more at risk for developing metabolic syndrome than others. While your risk mostly depends on your lifestyle and habits, some uncontrollable factors like genetics and age also play a role.
The following factors put you at a higher risk of metabolic syndrome:
- Age: Your risk of having metabolic syndrome increases with age because getting older usually goes hand in hand with a more sedentary lifestyle and living with a functional disability. People over 60 are more likely to get it; however, we've seen an uptick in prevalence in young adults in recent years.
- Ethnicity: Black and Hispanic people are more likely to get metabolic syndrome, and we currently don't know why. Black women are about 60 percent more likely to get it than Black men.
- History of diabetes: If diabetes runs in your family history or you had diabetes during pregnancy (gestational diabetes), you're at a greater risk for metabolic syndrome.
- Smoking status: Smoking increases triglyceride levels and lowers your HDL cholesterol levels, two major risk factors associated with metabolic syndrome.
- Excess alcohol intake: Reducing alcohol intake is linked to a lower prevalence of metabolic syndrome. Drinking too much alcohol is linked to reducing HDL cholesterol and interfering with your body's ability to metabolize carbs.6,7,8
How to Prevent and Treat Metabolic Syndrome
The protocol for preventing metabolic syndrome is the same as the treatment. As common as this complex web of conditions is, it's also preventable, and a diagnosis shouldn't deter you from making necessary lifestyle changes.
Still not convinced? Large bodies of evidence show that eating a nutritious diet and exercising regularly can reverse metabolic syndrome. Here's what you can do to lower your risk of metabolic syndrome as you age and help treat it if you already live with this syndrome:
- Lose weight if you need to: A staggering 69% of American adults are overweight or obese, and, specifically, 36% have obesity. People with overweight and obesity are recommended to focus on weight loss to help manage their metabolic health. Reducing your weight by 5 to 10% if you are overweight is shown to substantially benefit all metabolic risk factors, per a JRSM Cardiovascular Disease study. In other words, losing weight if you are overweight or obese can help improve your cholesterol levels, blood pressure, insulin resistance, fasting blood sugar, and triglycerides.
- Get active: About 25% of adults do not meet the global recommended levels of physical activity. The World Health Organization recommends 2.5 to 5 hours of moderate-intensity aerobic physical activity per week or at least an hour and 15 minutes of vigorous-intensity aerobic physical activity, in addition to strength training twice a week. Making exercise part of your routine—especially if you have a desk job or sit for most of the day—can help improve your biomarkers significantly.
- Eat a nutritious diet: Our increasingly busy lifestyles and the convenience of ultra-processed foods have made it easier than ever to neglect our nutrition. However, our diet is the foundation of our overall health, and eating whole, nutritious foods goes a long way in preventing disease. Avoiding refined carbs such as sugar and white flour as well as processed meats, restaurant foods, and ultra-processed foods while focusing on a diet rich in fruits, vegetables, whole grains, beans and legumes, healthy fats (such as omega-3s) and lean proteins can help you optimize your health so that your body can start fighting back against metabolic syndrome.
- Quit smoking and reduce your alcohol intake: No one wants to be told to quit their vices, but doing so may be your golden ticket. The current body of evidence clearly shows that the risk of metabolic syndrome is higher in people who smoke and drink too much alcohol.
- Manage stress levels: Chronically high levels of the stress hormone cortisol means your body is constantly stressed—and chronically high cortisol levels can eventually raise your triglycerides, blood sugar, and blood pressure. Some of the best ways to manage your stress include getting quality sleep, exercising regularly, practicing yoga and breathing techniques, and seeking therapy. 9, 10, 11, 12
The Bottom Line
Metabolic syndrome comprises five risk factors: abdominal obesity, high blood pressure, high triglycerides, high fasting blood sugar, and low HDL cholesterol. They put you at risk for chronic diseases such as heart disease, stroke, and type 2 diabetes. Having just three of the five risk factors means you have metabolic syndrome, but this condition is preventable and reversible. Eating a more nutritious diet, exercising more, quitting smoking, and reducing your intake of alcohol, as well as maintaining a healthy weight, can all help get your metabolic health back on track.
Topics discussed in this article:
- National Heart, Lung, and Blood Institute. (2022, May 18). What is metabolic syndrome? https://www.nhlbi.nih.gov/health/metabolic-syndrome
- Cleaveland Clinic. (2023, September 13). Metabolic syndrome. https://my.clevelandclinic.org/health/diseases/10783-metabolic-syndrome
- Guentert, D., Valdez, A., and Yang, S. (2014, August 19). Is it clinically useful to identify metabolic syndrome as a real syndrome? American College of Cardiology. https://www.acc.org/latest-in-cardiology/articles/2014/08/25/15/46/is-it-clinically-useful-to-identify-metabolic-syndrome-as-a-real-syndrome
- Edwardson, C. L., Gorely, T., Davies, M. J., Gray, L. J., Khunti, K., Wilmot, E. G., Yates, T., & Biddle, S. J. (2012). Association of sedentary behaviour with metabolic syndrome: a meta-analysis. PloS one, 7(4), e34916. https://doi.org/10.1371/journal.pone.0034916
- National Alliance on Mental Illness. (2023, April). Metabolic side effects of psychiatric medications. https://www.nami.org/About-Mental-Illness/Treatment/Mental-Health-Medications/Metabolic-Side-Effects-of-Psychiatric-Medications
- Hirode, G., & Wong, R. J. (2020). Trends in the Prevalence of Metabolic Syndrome in the United States, 2011-2016. JAMA, 323(24), 2526–2528. https://doi.org/10.1001/jama.2020.4501
- Kim, S. W., Kim, H. J., Min, K., Lee, H., Lee, S. H., Kim, S., Kim, J. S., & Oh, B. H. (2021). The relationship between smoking cigarettes and metabolic syndrome: A cross-sectional study with non-single residents of Seoul under 40 years old. PloS one, 16(8), e0256257. https://doi.org/10.1371/journal.pone.0256257
- Kim, S. K., Hong, S. H., Chung, J. H., & Cho, K. B. (2017). Association Between Alcohol Consumption and Metabolic Syndrome in a Community-Based Cohort of Korean Adults. Medical science monitor: international medical journal of experimental and clinical research, 23, 2104–2110. https://doi.org/10.12659/msm.901309
- Harvard T.H. Chan School of Public Health. (n.d.). Adult obesity. https://www.hsph.harvard.edu/obesity-prevention-source/obesity-trends-original/obesity-rates-worldwide/
- Han, T. S., & Lean, M. E. (2016). A clinical perspective of obesity, metabolic syndrome and cardiovascular disease. JRSM cardiovascular disease, 5, 2048004016633371. https://doi.org/10.1177/2048004016633371
- World Health Organization. (2022, October 5). Physical activity. https://www.who.int/news-room/fact-sheets/detail/physical-activity
- Cleveland Clinic. (2021, July 14). Metabolic syndrome diet: What to eat and what to avoid. https://health.clevelandclinic.org/metabolic-syndrome-diet/