Metabolic Syndrome (Syndrome X)

You may have heard of a dangerous cluster of health issues known as Metabolic Syndrome (formerly referred to as Syndrome X). This is a medical term for a group of conditions that, when occurring together, strongly indicate a predisposition to diabetes, hypertension, and heart disease. These conditions—which include high blood pressure, high triglycerides, decreased HDL, and abdominal obesity—tend to appear together in some individuals and drastically increase health risks. The term is also heavily linked with another term: insulin resistance.

Insulin is the hormone responsible for getting energy, in the form of glucose, or blood sugar, into our cells. A person who is insulin-resistant has cells that respond slowly to the action of insulin. Following a meal, this person will have elevated glucose circulating in the blood, signaling yet more insulin to be released from the pancreas until the glucose is taken up by the cells. Experts suggest that 10 to 25 percent of the adult population may be resistant to insulin to some degree.

People who are insulin-resistant often have elevated triglycerides. Elevated triglycerides usually coincide with low HDL. People who are overweight show signs of insulin resistance more often than people who are normal weight. Those with Metabolic Syndrome typically have borderline-high fasting blood sugar.

Studies have shown that Indians are at very high risk for Metabolic Syndrome. It is quite common in our city to see men who are quite thin, but are carrying a big belly. We call this the "apple" figure. Women tend to have more fat on their hips and thighs, and this is called the "pear" figure. In fact, the fat on the hips and thighs is protective against heart disease.

Ten to twenty people out of a hundred are resistant to insulin. So, what should you do if you suspect you're one of them? Because these conditions occur in a cluster, the steps you take to bring one of the conditions into a healthy range will likely improve the others. For example, if you're overweight, simply losing up to 10 or 15 percent of your current body weight can bring blood pressure down and increase your cells' sensitivity to insulin. Exercise is an important component of weight loss. It also raises HDL blood levels, even without weight loss.

You may have Metabolic Syndrome if you have at least 3 of the factors mentioned in the table below:

Risk Factor	Cut-off level
Obesity (Waist Circumference for Indians):
Men	> 90 cm (35.4 inches)
Women	> 80 cm (31.5 inches)
Triglycerides	≥ 150 mg/dl
HDL cholesterol:
Men	< 40 mg/dl
Women	< 50 mg/dl
Blood pressure	≥ 130/85 mmHg
Fasting blood sugar	≥ 100 mg/dl

Author: Dr. Aashish Contractor is India's pioneer in cardiac rehabilitation and the Founding Medical Director of the Mumbai Marathon. With over 25 years of experience, he has guided hundreds of heart patients to run safely.