1 in 3 Suffer From This: 7 Early Warning Symptoms of Metabolic Syndrome

What is metabolic syndrome?

By definition, metabolic syndrome is characterized by a cluster of conditions including insulin resistance, obesity, dyslipidemia (abnormal lipid levels in the blood), and hypertension. (1)

People with metabolic syndrome, numerous studies show, are more likely to suffer from type 2 diabetes, coronary heart disease, strokes and even cancer.

This makes early identification of this problem and appropriate interventions a real life-or-death matter. (2) (3)

Before we start, two more important points to remember:

1) a given test result or the presence of a given symptom does not necessarily mean metabolic syndrome, but the more of them the worse.

2) If we expect metabolic syndrome in us, it should be confirmed with the cooperation of a professional.

Symptoms and lab results

Body composition

Metabolic syndrome (MetS) is associated with various body composition metrics, including waist circumference and Body Mass Index (BMI).

Waist circumference

Waist circumference can be considered a direct measure of central obesity and some indicator of MetS risk.

The International Diabetes Federation suggested cutoff points for waist circumference as ≥94 cm (37 inch) for men and ≥80 cm (31.5 inch) for women to identify individuals at increased risk for MetS.

Waist circumference reflects the amount of visceral fat, which is closely linked to metabolic disturbances and cardiovascular disease (4).

BMI

BMI is a commonly used measure to categorize people based on body fat, very easily calculated by dividing weight in kilograms by the square of height in meters (kg/m^2), or using one of hundreds of online BMI calculators. BMI of 25 kg/m^2 or higher is associated with an increased risk of MetS, indicating overweight or obesity status. (5)

Note: In people with high muscle mass (e.g., sportsmen), this indicator may skew.

Glucose control

Studies clearly show the relationship between metabolic syndrome and glucose control. (6, 7, 8, 9)

Tests that will tell us a little about our metabolic health will be fasting glucose, glycated hemoglobin HbA1c and glucose and insulin curve.

Fasting glucose

Regarding fasting glucose levels, the American Diabetes Association (ADA) provides us guidelines:

Normal: Less than 100 mg/dL (5.6 mmol/L).

Prediabetes: 100 to 125 mg/dL (5.6 to 6.9 mmol/L).

Diabetes: 126 mg/dL (7.0 mmol/L) or higher on two separate tests.

Note: Fasting glucose measurements can be easily skewed by, for example, exercise before the test (even mild exercise in the form of coming to the test on a bicycle) or various genetic predispositions.

HbA1c

HbA1c, or glycated hemoglobin, reflects average blood glucose levels over the past two to three months. The aforementioned ADA recommends the following HbA1c ranges:

Normal: Less than 5.7%

Prediabetes: 5.7% to 6.4%

Diabetes: 6.5% or higher on two separate tests (10).

OGTT

Although it requires a little more time and effort, it's also worth doing a 3-point glucose and insulin curve, which will give us a much better picture of our glucose tolerance (after we've consumed it and tested it at intervals).

Blood lipids

In the case of metabolic syndrome, we can expect some correlations regarding the levels of various lipids in our blood, cholesterol, lipoproteins, etc. Very often we can see elevated triglyceride levels with low HDL levels:

“These results indicate that low HDL-cholesterol is a component of the metabolic syndrome only in the presence of fasting hypertriglyceridemia in type 2 diabetic patients.” (11, 12)

This led to the development of a very good and simple marker reflecting metabolic health (or unhealth), namely the triglyceride to HDL ratio. We can read in different publications (13, 14, 15).

“Patients with carotid plaques also showed higher HDL-TG. In contrast to HDL-C, HDL-TG is directly associated with metabolism and arteriosclerotic vascular alterations. HDL-TG should be considered a biomarker of metabolic and cardiovascular risk and could be a marker of HDL dysfunction.”

“High TG/HDL-C ratio increases by 2.12 times the possibility of having MetS. “

“Increased plasma TG and decreased HDL-C levels have been associated with metabolic syndrome (MetS) and CVD, and their ratio, TG/HDL-C, has been proposed as a novel biomarker for predicting the risk of both clinical entities.”

Although it should be obvious to everyone the ratio of triglycerides to HDL is measured by dividing the value of triglycerides by the value of HDL.

The lower the result, the better. In general, below 1 the result is ideal, below 2 is good, while above 3 and more it is already worrisome.

Liver enzymes

Also, commonly tested liver enzymes have been linked to metabolic syndrome in many publications.

For example, gamma-glutamyl transferase (GGT) and high-sensitivity C-reactive protein (suggesting inflammation) levels were higher in both male and female patients with MetS than in those without. (16).

This seems to be related to the fact that metabolic syndrome is strongly associated with liver steatosis (fatty liver).

Elevated alanine aminotransferase (ALAT) is also frequently observed in fatty liver and MetS. (17)

“Conclusions— Elevations of liver enzymes (including ALAT) are associated with higher CRP concentrations. Hepatic inflammation secondary to liver steatosis is a potential contributor to the low-grade inflammation associated with the metabolic syndrome.”

Liver fattening, thus metabolic problems and MetS can be suggested by an ASAT to ALAT ratio aboves 1 and higher (below 1 we have an ideal result). (18, 19)

“A normal AST:ALT ratio should be <1. In patients with alcoholic liver disease, the AST:ALT ratio is >1 in 92% of patients, and >2 in 70%.13 AST:ALT scores >2 are, therefore, strongly suggestive of alcoholic liver disease and scores <1 more suggestive of NAFLD/NASH.”

Hormones

Reduced as well as elevated hormone levels can indicate metabolic syndrome. The situation is different for men and women. In men, for example, lower testosterone levels have been observed. (19)

“Low serum SHBG, low total testosterone, and clinical AD are associated with increased risk of developing MetS over time, particularly in nonoverweight, middle-aged men (BMI, <25).”

In women, in turn, it can lead to hyperandrogenism (androgens = “male” hormones like testosterone etc.), involving, as mentioned at the beginning, high glucose and insulin levels. (20)

“Higher FAI (free androgen index) was associated with the hyperinsulinemia and hyperglycemia components of the metabolic syndrome.”

“Compared with women in the lowest FAI quartile, those in the highest quartile had a fivefold greater odds of having the metabolic syndrome”

Hunger

A constant sense of hunger often accompanies people with metabolic syndrome.

This is associated, among other things, with so-called leptin resistance. Leptin, secreted by adipose tissue, plays a crucial role in suppressing appetite.

As it turns out, leptin levels, insulin resistance and obesity are closely intertwined and often occur together.

“However, studies have shown that high levels of leptin are usually observed in obese patients. The possible mechanisms include decreased sensitivity to elevated leptin levels, which is called leptin resistance, caused by defects at or downstream of the leptin receptor, induction of inhibitors of leptin signaling, and alterations in the transport of leptin across the blood–brain barrier [2,4,17]. “ (21)

Thus, the association between MetS and leptin resistance (resistance = higher leptin levels) were found many times:

“Leptin levels were also predictive of metabolic syndrome in both sexes, which is similar to other studies. For example, in adult males participating in the Olivetti Prospective Heart Study, leptin levels were predictor of developing metabolic syndrome at 8-year follow-up [29]. In addition, Franks et al. [30] reported that leptin levels predict worsening of metabolic syndrome over time.” (22)

However, poor metabolic health and associated chronic inflammation can also affect other hormones responsible for satiety, energy expenditure or food intake:

“An increase in proinflammatory cytokines, a decrease in endothelial nitric oxide and adiponectin levels and an alteration in hypothalamic peptides and gastrointestinal hormones that regulate satiety, hunger and food intake all occur in metabolic syndrome.“ (23)

Hormones likely affected include also glucagon-like peptide 1, glucose-dependent insulinotropic polypeptide, pancreatic polypeptide, peptide YY, oxyntomodulin, cholecystokinin and ghrelin. (24)

Among other things, due to the problem of maintaining satiety, people with metabolic syndrome may be more irritable, in a poor mood or have less energy and be more tired, which can be added as another symptom to our list.

Bottom line

There are many confirmed symptoms and laboratory tests that can indicate that things are not as they should be with our metabolic health.

Importantly, many of these can be checked at home with simple instruments (scales, measuring tape) or common laboratory tests (like glucose testing, lipidogram, etc.).

The more of these symptoms we have, the sooner we should consult professionals.

24.02.2024