Syndrome X patients face an increased risk of diabetes and cardiovascular Disease due to an abnormal response to insulin. The key to treatment lies in diet and exercise.

Syndrome X or sometimes known as the ‘Metabolic Syndrome’ is a grouping of cardiac risk factors that result from insulin resistance. This is when the body's tissues do not respond normally to insulin. In other words, the body’s receptors are “deaf” to insulin. You need to produce more and more insulin to get the same effects.

A person with Syndrome X has a greatly increased risk of Diabetes, cardiovascular disease and premature death.

The risk factors seen in Syndrome X include:

• insulin resistance
• obesity (especially abdominal obesity)
• high blood pressure
• abnormalities in blood clotting (the blood is more likely to clot leading to strokes and heart attacks)
• lipid abnormalities

Specifically, Syndrome X is diagnosed if any three of the following are present:

1. Elevated waist circumference: 40 inches or more for men; 35 inches or more for women
2. Elevated triglycerides (150 mg/dL or higher )
3. Reduced HDL (“good”) cholesterol (less than 40 mg/dL in men; less than 50mg/dL in women)
4. Elevated blood pressure (130/85 mm Hg or higher)
5. Elevated fasting glucose (100 mg/dL or higher)

The primary issue in Syndrome X is insulin resistance. In the body's attempt to compensate for insulin resistance, extra insulin is produced, leading to elevated insulin levels. The elevated insulin levels can lead, directly or indirectly, to the characteristic metabolic abnormalities seen in these patients. Frequently, the insulin resistance will progress to overt Type 2 Diabetes, which further increases the risk of cardiovascular complications. In fact, another name for Syndrome X is pre-diabetes.

Genetic
Syndrome X tends to run in families. Members of the family are more prone to Type 2 Diabetes. Syndrome X will occur in susceptible people who become overweight and sedentary. Syndrome X can be prevented with exercise and maintaining a healthy body weight.

Treatment of Metabolic Syndrome

Insulin Resistance:
To date there is no drug treatment that directly treats the underlying insulin resistance in Syndrome X.

However, diet and exercise can reverse the syndrome. Those with Syndrome X should make every attempt to reduce their body weight to within 20% of their "ideal" body weight (calculated for age and height) and incorporate aerobic exercise (at least 20 minutes) into their daily lifestyle.

With vigorous efforts to reduce weight and increase exercise, Syndrome X can be reversed and the risk for cardiovascular complications can be substantially improved.

Lipid Abnormalities:
While the lipid abnormalities seen with Syndrome X (low HDL (good cholesterol ), high LDL (bad cholesterol), and high triglycerides respond nicely to weight loss and exercise, drug therapy is often required.

Treatment should be aimed primarily at reducing LDLlevels. Once reduced LDL targets are reached, efforts at reducing triglyceride levels and raising HDL levels should be made. Successful drug treatment usually requires treatment with a statin, a fibrate drug, or a combination of a statin with either niacin or a fibrate.

Clotting Disorder:
Patients with Syndrome X can have several disorders of coagulation that make it easier for blood clots to form within blood vessels. These blood clots are often a precipitating factor in developing heart attacks.

Patients with Syndrome X should generally be placed on daily aspirin therapy to help prevent such clotting events. You should speak to a doctor, of course, before starting any new medication regiment. Fish oil has been shown to be very useful and safe for this condition.

Hypertension:
High blood pressure is present in more than half the people with Syndrome X and, in the setting of insulin resistance, high blood pressure is especially important as a risk factor. Adequate blood pressure treatment in these individuals can substantially improve their outcome.

The key to preventing Syndrome X, however, remains as diet (especially low that is low in carbohydrate ) and exercise. Any person with a strong family history of Syndrome X or Type 2 Diabetes should be especially careful to maintain a healthy lifestyle.

A new class of compounds recently discovered from garlic seems to be very effective in managing the lipid disturbance linked to Syndrome X. We have recently discovered new and unique compounds when certain species of garlic are extracted using supercritical extraction processes. This compounds, indentified by Belgian scientists are called vinyldithiins and sulfides can powerfully reverse and stall the effects of Syndrome X without known short or long term side effects. We shall discuss this in greater detail, next week.