Advice Column, Health, Lifestyle, Parenting

The monster around your middle

  • Paarl Dietitians
  • Category Advice Column, Health, Lifestyle, Parenting

Metabolic syndrome is a health condition that everyone’s talking about. Although it was only identified less than 20 years ago, metabolic syndrome is as widespread as pimples and the common cold. It is estimated that around 20-25 per cent of the world’s adult population have metabolic syndrome.

Indeed, metabolic syndrome seems to be a condition that many people have, but no one knows very much about. So what is this mysterious syndrome — which also goes by the scary-sounding name Syndrome X — and should you be worried about it? Keep reading for some insight.


Metabolic syndrome is not a disease in itself. Instead, it’s a collection of the most dangerous risk factors: high blood sugar, pre-diabetes, diabetes, high cholesterol levels, high blood pressure and abdominal (tummy) fat. 

Obviously, having any one of these risk factors isn’t good. But when they’re combined, they set the stage for serious problems.

People with metabolic syndrome are twice as likely to die from and three times as likely to have a heart attack or stroke compared with people without the syndrome. They have a fivefold greater risk of developing type 2 diabetes!!

The underlying cause of metabolic syndrome continues to challenge the experts but insulin resistance and central obesity (excess tummy fat) are considered the most significant factors responsible for this syndrome.

What comes first, the chicken or the egg?

Insulin resistance is very often the starting point of metabolic syndrome. Insulin is a hormone that helps your body convert food into glucose and enter your cells to be used as fuel. Insulin resistance occurs when cells in the body (e.g. muscle cells) become less sensitive and eventually resistant to insulin. Glucose can no longer be effectively absorbed by the body cells and therefore remains in the blood, so your body keeps making more and more insulin to cope with the rising level of glucose in an attempt to process the glucose. Eventually, this can lead to diabetes.

Even long before diabetes happens, excessive amounts of insulin is causing damage to the body. The dangerous part of this syndrome is the long term effects of raised insulin levels to your blood vessels often leading to premature heart attacks, strokes and type II diabetes.


To identify if you have metabolic syndrome it is necessary to take a few basic measurements.

There are five risk factors that make up metabolic syndrome. To be diagnosed with metabolic syndrome, you would have at least three of these risk factors.

Body Mass Index (BMI)

BMI of 30kgm/m2and higher

Waist circumference

For men: 102cm or larger
For women: 88cm or larger

Cholesterol: High Triglycerides


1.7mmol/L or higher


Using a cholesterol medicine

Cholesterol: Low Good Cholesterol (HDL)


For men: Less than 1.03mmol/L
For women: Less than 1.3mmol/L


Using a cholesterol medicine

High Blood Pressure


Having blood pressure of 135/85mm Hg or greater


Using a high blood pressure medicine

Blood Sugar: High Fasting Glucose Level

5.6mmol/L or higher

Even if you don`t have these measurements available it`s possible for you to know if you are at risk by asking yourself a few basic questions. The American College of Endocrinologist has identified that if you have 2 of the following risk factors you are at risk for developing metabolic syndrome, or may have insulin resistance already:

  • You have ever been diagnosed with coronary heart disease, high blood pressure, polycystic ovarian syndrome, non-alcoholic fatty liver disease.
  • You have a family history of type II diabetes, high blood pressure or coronary heart disease.
  • For women: you have a history of pregnancy-related diabetes or impaired glucose tolerance in pregnancy.
  • You have a sedentary lifestyle and do not engage in regular exercise.
  • You are overweight with a Body Mass Index (BMI) of greater than 25kg/m2 OR if you have a waist circumference measurement greater than 102cm (male) or greater than 88 cm (female).
  • You are older than 40 years of age.


YES!! Controlling and normalising insulin levels is key to improving metabolic syndrome.

Physical activity, weight loss and healthy food choices help the body respond better to insulin. Studies showed by losing weight (through cutting carbohydrates, fat, calorie intake) and being more physically active, people with metabolic syndrome may avoid or delay developing type 2 diabetes or suffering a stroke or heart attack.


Weight loss 

Research confirmed that people with metabolic syndrome can significantly improve their health by losing 5 to 10 percent of their body weight. Weight loss is often a difficult task when you are insulin resistant and have metabolic syndrome. Not only will you have cravings for carbohydrates most of the time, your body is resistant to fat breakdown due to the high amounts of circulating insulin. Normal weight loss diets and quick fixes are ineffective to aid weight loss seeing that the raised insulin levels are not treated. Not only do we need to decrease the calorie content of the diet, one need to look at what your diet consist of. Certain foods are known to worsen insulin resistance and others to improve insulin resistance.

Rethink refined carbs and sugar

Carbohydrates and sugar in your diet is known for increasing the amount of insulin in your blood. It is therefore necessary to exclude sugar as much as possible. The other concern lies with the amount of carbohydrates that is consumed per meal as well as during the whole day. Insulin levels can be dramatically increased by the amount of carbohydrate as well as the type of carbohydrate consumed.

It is crucial to eat only carbohydrates which are low in Glycaemic index (GI). The Glycaemic Index is a ranking of foods based on their immediate effect on blood glucose levels. It is a physiological measure of how fast, and to what extent, a carbohydrate food (starch containing food) affects blood glucose levels. If the glucose reaches the blood stream quickly, your insulin levels will rise dramatically. Low GI foods will result in a smaller insulin response and help with losing weight and preventing insulin resistance related complications.

Be Smart about Fats 

It is a well-known fact that too much fat in the diet will increase body weight and body fat percentage – therefore the body`s need to produce more insulin. Research indicates that the type of fats we consume may also play a role. It is thought that saturated fat reduces the body’s ability to use insulin where mono-unsaturated and omega-3-fats improve the body’s ability to use insulin.

Mono-unsaturated fats are found in avocados and avocado oil, olives and olive oils, olive based margarines, canola margarines and oils.

Omega-3 fats are found in oily fish e.g. pilchards, mackeral, sardines, salmon and fresh tuna, seeds and canola oil. Should you dislike fish or have difficulty eating adequate amounts of other omega-3 containing foods, you can make use of an omega 3 supplement. If you’re unsure what to take, ask Paarl Dietitians to recommend a supplement for you.


Exercise is an integral part of any healthy lifestyle and we all know we should be doing more. Aim to exercise four to five days a week for 30 minutes.


If aggressive lifestyle changes such as diet and exercise aren’t enough, your doctor might suggest medications to help control your blood pressure, cholesterol levels and blood glucose.

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