Metabolic Syndrome and Stroke

Najarian RM, Sullivan LM, Kannel WB, Wilson PW, D’Agostino RB, Wolf PA.Metabolic Syndrome Compared With Type 2 Diabetes Mellitus as a Risk Factor for Stroke: The Framingham Offspring Study. Arch Intern Med. 2006 Jan 9;166(1):106-111.

Researchers writing in the Archives of Internal Medicine say that preventing and controlling Metabolic Syndrome is likely to reduce risk of stroke.

From the abstract: “Metabolic syndrome has been recognized as a prediabetic constellation of symptoms and an independent risk factor for cardiovascular disease.”

They concluded: “Metabolic syndrome is more prevalent than diabetes and a significant independent risk factor for stroke in people without diabetes. Prevention and control of (Metabolic Syndrome) and its components are likely to reduce stroke incidence.”

Read the abstract

Diet and Lifestyle

According to information from the American Heart Association, almost 50 million Americans can be diagnosed as having Metabolic Syndrome.

What is Metabolic Syndrome?
Metabolic Syndrome is an umbrella term to describe someone suffering from a combination of the following conditions:
1. Abdominal obesity
2. High triglycerides
3. Low HDL (good) cholesterol
4. High LDL (bad) cholesterol
5. High Blood Pressure
6. Insulin resistance

Who is at danger for developing Metabolic Syndrome?
Typically middle age people who are eating more and exercising less.

Abdominal Obesity
Abdominal obesity is obesity centralized to the abdominal area that is out of proportion with fat stores in the rest of the body. A disproportionately large “waist circumference,” is considered a high risk factor for many diseases including type 2 diabetes, hypertension, cardiovascular disease, and osteoarthritis that affects mostly the knees, but also the hips and back.

How much fat Is considered abdominal obesity?
Body scans and MRIs can determine with great accuracy the degree of abdominal obesity someone may have, but these tests are very costly and inconvenient and to be truthful are not needed to reveal the obvious. Someone who a big belly has abdominal obesity.

Still needing science to prove to patients that they are indeed abdominally obese, many clinicians rely on the Body Mass Index (BMI) measurement. The BMI is determined by computing a number based on the height and weight of an individual.

Using the formula above, let’s say you are a woman who weights 140 pounds and is 5 foot-5 inches tall (65 inches). Let’s see how you would do.

Your body weight = 140
Divided by your height in inches squared
65 x 65 = 4225 (140/4225=0.033)
0.033 x 703 = 23.3 Your Body Mass Index and you would be normal.

BODY MASS INDEX RESULTS
-Below 18.5 Underweight
-18.5 – 24.9 Normal Range
-25.0 – 29.9 Overweight
-30.0 and Above Obese

But what if you were a man with some muscle? Say 6 feet tall and a muscle packed 210 pounds. You would have a Body Mass Index of 28.4 and you would be considered overweight!

You can probably see why this method of determining abdominal obesity and general obesity is often criticized. Critics point out that it fails to differentiate between body mass from fat and body mass from muscle. Recently using the BMI formula, researchers took the published weights of professional athletes in the National Football League and the National Basketball Association and determined that nearly all the footballers were overweight and half of them obese.

In addition, many of those tall, muscular and somewhat thin NBA stars were graded as overweight and a handful, including Shaquille O’Neal, arguably the best player in the league, were considered obese. At the time “SHAQ” at 7 foot 1 inch, weighed 320 pounds; few though, would consider him obese.

The BMI should never be used by itself as a diagnostic tool in determining health risks from obesity, but only one of many tools in guiding the patients towards a more healthy lifestyle.

The apples and pears
Some researchers have suggested that the WHR or Waist-Hip Ratio measurement is a more accurate measure of health risks based on being obese. They prefer this test because it takes into account the distribution of fat through the waist and hip area, where we store the majority of our fat.

Fat can be stored as abdominal fat (an “apple” body shape) or around the hips (a “pear” body shape). People who carry their excess fat in their hips are considered to have less of a risk factor than the abdominal obesity people.

To calculate your Waist-Hip Ratio

1. Measure your waist circumference at the belly button. Hold the tape measure straight.

2. Measure your hips at their widest part, that is where your buttocks peak.

3. Divide your waist by your hip measurement.

For women, ideal is a WTR of 0.8 or less. For example a women with a 29 inch waist and 36 inch hips just makes the cutoff.

For men, ideal is a WTR of 0.95 or less. A man with a 34 inch waist would be “ideal” with a 36 inch hip measurement.

In Waist-Hip Ratio, risk is rated by how high the ratio numbers are. For women, the higher the number past 0.8 the greater risk of obesity related disorders. For men, anything over .95, the higher it goes, the highest the risk.

High triglycerides
Triglycerides are fats that are chemically altered in the body so that they can be stored and then used later to meet our body’s energy needs. When we need to burn that fat, we release hormones that free the triglycerides from the fat cells. Too much stored fat or triglycerides in the blood is called hypertriglyceridemia and is linked to coronary artery disease and diabetes.

LOW HDL
Cholesterol does many wonderful things in our body which is why we need it. What we especially need to have is normal levels of the “good” cholesterol, HDL (high-density lipoprotein), because the HDL cholesterol seems to protect against heart attack and stroke by carrying away or preventing the bad cholesterol “LDL” from building up plaque on arterial walls. Low HDL, low protection.

HIGH LDL
High levels of LDL puts people at risk for heart disease as mentioned above because it builds plaque. You need to exercise and watch your diet in order to start bringing your LDL numbers down.

BLOOD PRESSURE
The well known remedies for reducing blood pressure without medication are to:
1. Lose weight, the more overweight you are, the greater the risk you will have for high-blood pressure.
2. Reduce salt intake. Most sodium comes from packaged and frozen foods.
This is yet another reason to eat your foods in their freshest and most natural form, go for vegetables.
3. Change your eating habits to reduce portions.
4. Exercise.

Insulin Resistance Syndrome
Our bodies DO need sugar (glucose) as a fuel for our cells to perform their daily cellular functions. When we eat sugar or foods that are broken down into glucose such as high-glycemic carbohydrates, our body’s digestive process puts that glucose into the blood stream for the cells to collect and utilize. The cells rely on the pancreas to monitor the blood levels and to alert them when glucose is abundant. The pancreas does this by secreting insulin which circulates through our bodies delivering the message to the cells of glucose’s presence.

In perfect balance, when we eat carbohydrates and produce glucose, the cells use it up as energy and there is little left over.

When our cells ignore insulin and become resistant
Over the course of years as we get older, become more sedentary, and our diets become “sugar loaded,” we process more glucose than our cells can use and the excess floats around in our blood, or is turned into fat in the cells.

Insulin Resistance also increases the symptoms and/or risk factors associated with metabolic syndrome, contributing to:

1. Accumulation of body fat
2. Obesity
3. Elevated triglycerides
4. High blood pressure.
5. Acceleration of the aging process.

DIET
It is commonly accepted that eating large amounts of simple carbohydrates (pastas, breads, and sugar filled foods) could lead to Insulin Resistance, elevated cholesterol, elevated triglycerides, and obesity. For this reason, as part of our program, we recommend that our patients change to a low-glycemic index diet.

The Glycemic Index is the rate that carbohydrates break down into sugar in the blood. The best source of low-glycemic carbohydrates are vegetables. Vegetables are slow burning carbohydrates and help keep insulin levels steady.

A diet rich in vegetables, proteins, good fats in the form of omega-3, and water is optimal for a long health span.

It is important to point out that a single diet will not work for everyone. To optimize your nutritional needs you should visit with an experienced health care professional well versed in the issues of metabolic syndrome and nutrition.

Insulin Resistance Syndrome and Metabolic Syndrome Research
Insulin Resistance Tied To Age-Related Muscle Loss
Writing in the medical journal Diabetes and Metabolism, researchers say: “…insulin resistance could be involved in age-related muscle protein loss, progressively leading to sarcopenia. Therefore in a more general concept, insulin resistance found in many clinical settings, could be considered as a contributor to muscle wasting.”

What is the Effect of Insulin Resistance and Loss of Lean Muscle (Sarcopenia) As We Age?
Researchers writing in the Journal of The Federation of American Societies for Experimental Biology say: “A reduced response of older skeletal muscle to anabolic stimuli (exercise & diet) may contribute to the development of sarcopenia. Skeletal muscle protein synthesis is resistant to the anabolic action of insulin in older subjects, which may be an important contributor to the development of sarcopenia.”

Metabolic Syndrome and Stroke
Researchers writing in the Archives of Internal Medicine say that preventing and controlling Metabolic Syndrome is likely to reduce risk of stroke.

Stress at Work and Metabolic Syndrome
Metabolic Syndrome is a combination of symptoms including high blood pressure, abdominal obesity, insulin resistance and others related to coronary heart disease.

Risk of Stroke and Hormone Replacement Therapy

Researchers writing in the medical journal Maturitas say that there is no significant association between hormone therapy and risk of total stroke in women during 10.5 years follow-up.

Lia C, Engströma G, Hedblada B, Berglundb G, Janzona L. Risk of stroke and hormone replacement therapy. Maturitas Volume 54, Issue 1 , 20 April 2006.

From the abstract:
Objective
The purpose of this study was to examine the risk of first-ever stroke in relation to use of hormone replacement therapy (HRT) among middle-aged and older Swedish women.

Materials
A total of 16,906 women, 45–73 years old, from the ‘Diet and Cancer’ study in Malmö, Sweden were examined. Women were considered as HRT users if they took systemic hormone therapy regularly. Incidence of stroke was followed for a mean period of 10.5 years.

Results
In all, 2148 (12.7%) women used HRT. A total of 461 stroke cases occurred during follow-up, 48 of them in HRT users. Incidence of total stroke and ischemic subtype had no significant relation to HRT use. However, an increased risk of hemorrhagic stroke was found in women taking unopposed estrogen or un-native estrogen regimens. Although not significantly, the risk of stroke was 33% lower in women who started their treatment before menopause. Among HRT users, the risk of stroke was associated with advancing age, smoking, excess body weight and hypertension.

Conclusions
There is no significant association between hormone therapy and risk of total stroke in women during 10.5