Treating the lipid abnormalities. The lipid abnormalities seen with Metabolic Syndrome (low HDL, high LDL, and high triglycerides) respond nicely to weight loss and exercise. Treatment should be aimed primarily at reducing LDL and triglyceride levels, and raising HDL levels. Successful drug treatment usually requires treatment with a statin or one of the fibrate drugs, or a combination of a statin with either niacin or a fibrate. It should also be noted that the use of statin drugs is not without its problems.

Treating the clotting disorder. Patients with Metabolic Syndrome have several disorders of coagulation that make it easier to form blood clots within blood vessels. These blood clots are often a precipitating factor in developing heart attacks. Patients with metabolic Metabolic Syndrome should generally be placed on daily aspirin therapy to help prevent such clotting events.

Treating the hypertension. High blood pressure is present in more than half the people with Metabolic Syndrome, and in the setting of insulin resistance, high blood pressure is especially important as a risk factor. Recent studies have suggested that successfully treating hypertension in patients with diabetes can reduce the risk of death and heart disease substantially. Low dose diuretics should be used according to Dr. Reaven. No more than 12.5 mg of hydrochlorothiazide should be prescribed. People with Metabolic Syndrome should not be prescribed the anti-hypertensive dosages of thiazides that have been recommended in the past. Difficult cases should be controlled with ACE inhibitors. ACE inhibitors increase levels of nitrous oxide (a potent endothelium generated vasodilator), resulting in vasodilatation and blood pressure reduction. ACE inhibitors also have been shown to improve endothelial function, and so have HMG-CoA reductase inhibitors (such as lovastatin and pravastatin), and to a lesser degree, calcium channel blockers (such as verapamil and nifedipine).

Treating High Blood Sugar. High blood sugar must be normalized. Traditionally there are four points of intervention to reduce blood sugar:
   · Pancreas. Two major classes of drugs are the sulfonylurea  and the meglitinides.  Sulfonylurea used for more than 4 decades. Their primary goal is to increase the level of endogenous insulin by stimulating the pancreatic secretion. These agents have no direct effect on insulin resistance. They may decrease the resistance slightly by reducing plasma glucose level. The meglitinide class, of which repaglinide is approved in the U.S., also stimulates insulin release from the pancreas. Clearly, these should be avoided among those with Metabolic Syndrome who already have a high insulin level. Further insulin will only worsen the problem.
   · Intestines. Alpha-glucosidase inhibitors are currently represented by acabose. The primary mechanism of action of these agents is to inhibit specific enzymes that break down carbohydrates in the small intestine. Absorption of carbohydrates is delayed, resulting in a reduction of postprandial hyperglycemia. No specific action on insulin resistance has been reported.
   · Liver. The biguanides, of which metformin is the agent used in the U.S., mainly decrease hepatic glucose production, They also increase peripheral insulin sensitivity, leading to reduced plasma glucose level. They also have some effect in reducing intestinal glucose absorption. Clearly this is a better drug to use than the previous two.
  · Muscle. This class of oral agents is known as the thiazolidinediones, of which troglitazone is approved for use in the U.S. It reduces insulin resistance by increasing the uptake of glucose by peripheral tissues such as skeletal tissue.  It is therefore uniquely designed to attack insulin resistance.

A diet high in protein is suitable for those with normal insulin sensitivity, but inappropriate for those with Metabolic Syndrome. It is important to note that there are good fats and there are bad fats. The fats recommended by Dr. Reaven are mostly heart-friendly unsaturated fats from plant and vegetable sources such as olive oil and nuts, not from the artery-clogging saturated fats present in steaks.

Dr  Reaven suggests replacing saturated fats with and mono- and poly -unsaturated fats will equally benefit LDL cholesterol lowering as compared to replacing saturated fats with carbohydrates. This is confirmed in multiple studies. Mono- and poly-unsaturated fats do not raise insulin levels, so you get the benefit of both LDL cholesterol and Metabolic Syndrome control. Unsaturated fats are found in foods such as vegetable oils (olive oil in particular is high in mono-unsaturated fats) nuts, and avocados, whereas saturated fats are abundant in fatty cuts of meat and whole milk dairy products.

It has been postulated that use of low glycemic-index carbohydrates will avoid worsening the manifestations of Metabolic Syndrome due to its slow glucose release and absorption rate. There is little doubt that low glycemic-index carbohydrates such as fruits and vegetables are superior when compared to high glycemic-index carbohydrates such as white flour and white bread. Dr Reaven studied this by increasing the fiber intake to the level recommended by the ADA for diabetics, and it had almost no effect. In a recent paper, substantial increases in the fiber level (exceeding the ADA recommendation) resulted in improved metabolic characteristics, as compared to a high carbohydrate/low fat diet. No comparison was made between the very high fiber diet vs. a diet low in carbohydrates and high in unsaturated fats.

The simplest and most effective approach is to replace the carbohydrates with poly- and mono-unsaturated fats and restrict saturated fat intake, to achieve both lower LDL cholesterol and improve Metabolic Syndrome.


2. Nutritional Supplementation.

A variety of natural non-toxic food based compounds can be used. The goals are to normalize blood sugar, and increase insulin sensitivity.

Normalizing  the lipid abnormalities. For dyslipidemia, the following can be considered: pantethine (300 -1,200 mg), panthothenic acid (300-1,300 mg), guccolipid (30-150 mg), polycosinol (5-10 mg), mineral ascobates (2-5 grams), lysine (2-5 grams), proline (1-2 grams), beta sitosterol ( 300 to 1,000 mg) ,chromium polynicotinate (400 -1200 mcg), oat brain powder (375 - 2,000 mg), gymnema sylvestre ( 50-250 mg), dry mustard powder (10 - 100 mg), and fish oils (1,000 to 4,000 mg).

Normalizing  the clotting disorder. To reduce the blood clot risk, natural compounds such as vitamin E (300 to 1200 I.U.), borage oil (200 - 1,000 mg),  and gingko biloba extracts (30 to 150 mg), L-carnitine (100 - 500 mg) has blood thinning properties and help promote circulation. Antioxidant therapy with optimum doses of Vitamin A, C, and E helps to stabilize plaques, improve vascular tone, and reduce thrombus.

Normalizing  the hypertension. To lower blood pressure, antioxidant therapy helps to stabilize plaques and improve vascular tone by inhibiting oxidation of LDL cholesterol. L-taurine ( 200 - 2,000 mg) ,  N-acetyl-cysteine (150 - 1,000 mg), quercetin (100-500 mg), Lipoic Acid (75 - 300 mg) should be considered

Normalizing high blood sugar. For glucose normalization and to increase insulin sensitivity, natural non-toxic compounds that have sugar modulation effects include chromium polynicotinate (400 -1200 mcg), vanadyl sulfate (25 -100 mg), lipoic acid (100-300 mg), cinnamon (500 - 2000 mg), L-glutamine (500 mg - 5,000 mg), phasoleium vulgaris (150 -600 mg),  can be considered.

For rebalancing the internal terrain to enhance digestive balance and efficiency, digestive enzymes, green foods such as chlorella, spirulina, algae, soluble fiber, and probiotics should be considered

For antioxidant deficiency: a strong multi-vitamin with at least 10,000 I.U. of beta carotene, 500 mg of vitamin C, 200mg of selenium, 100 mg of grape seed extract, 30 mg of co-enzyme Q10.

For normalization of adrenal function, pantethine 300-900 mg, licorice root, panthothenic acid 400-1,200 mg should be considered.

Other synergistic nutrients include: Coenzyme Q10   together with peperine extract to help enhance cardiac function,  wheat germ powder, horsetail/shavegrass herb powder, bioflavonoids that synergistically enhance the effects of other anti-oxidants, amaranth flour, apple pectin powder,  papaya fruit powder, bromelain to help reduce inflammation, milk thistle extract to help the liver detoxification, and lipase to help digest fat.

© 1999-2009  Michael Lam, M.D. All Rights Reserved.

References