Introduction:
Q: Dr. Sawyer, why did you title your book "Metabolic Syndrome-the Deadliest Epidemic of 21st Century?"
Answer: After experiencing the modern scientific, technological and materialistic civilization, it has become quite clear that the very existence of life on this planet may be endangered by the rapid degeneration of human health in the modern world, and that the life sciences, including the modern approach, have been inadequate to preserve human well-being from such universal decline. Not only internal treatments and external surgical applications, but also the techniques of modern diagnosis per se are frequently harmful to human health. In view of these circumstances, the renaissance of traditional wisdom based on a more total comprehension of cosmology, including the arts of health and diagnosis has become absolutely essential to recover humanity, individuality and collectivity.
Answer: After experiencing the modern scientific, technological and materialistic civilization, it has become quite clear that the very existence of life on this planet may be endangered by the rapid degeneration of human health in the modern world, and that the life sciences, including the modern approach, have been inadequate to preserve human well-being from such universal decline. Not only internal treatments and external surgical applications, but also the techniques of modern diagnosis per se are frequently harmful to human health. In view of these circumstances, the renaissance of traditional wisdom based on a more total comprehension of cosmology, including the arts of health and diagnosis has become absolutely essential to recover humanity, individuality and collectivity.
Metabolic syndrome is highly prevalent in the today’s Western World, and the number of people who struggle with it or its deadly consequences continues to rise. The reason for the increased incidence of metabolic syndrome in the highly industrialized countries is mainly due to the high level of stress, malnutrition, use of over processed food, and physical inactivity. It includes cardiovascular disease, diabetes 2, abdominal obesity (increased waist circumference), hypertension, high triglycerides, low levels of high density lipoprotein (good cholesterol), and high levels of low density lipoprotein (bad cholesterol) combined with high fasting glucose levels (insulin resistance). Having just one of the above conditions- increased blood pressure, elevated insulin levels, excess body fat around the waist or abnormal cholesterol levels- is not a guarantee that a person has the syndrome, but it does contribute to the risk of it. If more than 2 of these conditions occur in combination, the risk is even greater. Having three or more of these factors means the person has metabolic syndrome with higher risk of diabetes 2 and cardiovascular disease (CVD).
Q: What did provoke your huge interest in the area of the metabolic syndrome phenomena?
Q: What did provoke your huge interest in the area of the metabolic syndrome phenomena?
Answer: One of the main focuses for quite number of years of mine was on obesity and insulin resistance, at the background of the "metabolic syndrome" phenomena. This was in the early 1980s when I finished my MD degree, and started to work as an endocrinologist in one of the main hospitals in the city where I was born. As a medical student, I have been always interested in understanding all hidden biochemical and molecular mechanisms behind obesity as a phase of metabolic syndrome appearance. Known as a quintessential nerd, I already knew enough about obesity, metabolic syndrome and Type 1 and Type 2 diabetes, as I have already cured allot of patients with the above disease and read most of the books on the syndrome. Thus, I started to specialize in endocrinology disorders. The medical team I worked for had made quite many efforts investigating what exactly where the causes of obesity and the main promoter for the future syndrome appearance or vice versa. The focus of ours was at first on identifying the bacterial and viral etiology of the obesity. At the same time most of the world famous researchers consider insulin resistance as the main cause behind obesity and started to look for auto-antibodies or mutations in genes and insulin receptors. It was extrapolated that these antibodies will bind to the insulin receptor and consequently will block them.
Q:What it is behind the Metabolic Syndrome paradigm?
Answer: “Syndrome X” — a term coined by Reaven (1988), describes a cluster or group of symptoms and abnormalities including high blood pressure, insulin resistance, elevated blood triglycerides and low levels of good cholesterol (HDL). The terms “metabolic syndrome,” “insulin resistance syndrome” (IRS), “dysmetabolic syndrome,” “Syndrome X,” “Raven’s syndrome,” “plurimetabolic syndrome,” “hypertriglyceridemia waist,” “cardiometabolic syndrome,” “general cardiovascular syndrome,” and CHAOS (in Australia) are all synonyms that define a cluster of conditions or abnormalities that occur together in a person, and increase the risk for development of Type 2 diabetes, atherosclerotic vascular disease (AVD), coronary artery disease (CAD), and stroke (Grundy et al., 2005).
Answer: “Syndrome X” — a term coined by Reaven (1988), describes a cluster or group of symptoms and abnormalities including high blood pressure, insulin resistance, elevated blood triglycerides and low levels of good cholesterol (HDL). The terms “metabolic syndrome,” “insulin resistance syndrome” (IRS), “dysmetabolic syndrome,” “Syndrome X,” “Raven’s syndrome,” “plurimetabolic syndrome,” “hypertriglyceridemia waist,” “cardiometabolic syndrome,” “general cardiovascular syndrome,” and CHAOS (in Australia) are all synonyms that define a cluster of conditions or abnormalities that occur together in a person, and increase the risk for development of Type 2 diabetes, atherosclerotic vascular disease (AVD), coronary artery disease (CAD), and stroke (Grundy et al., 2005).
Actually, the metabolic syndrome is a cluster of disorders, all of which are affected by genetics, diet, and other environmental and lifestyle (intrinsic and extrinsic) factors (Grundy et al., 2005). Five metabolic risk factors (dyslipidemia, hyperglycemia, hypertonia, and a general prothrombotic state with a proinflammatory state) are blamed for the metabolic syndrome appearance. Above all they are commonly clustered together. As the cluster of abnormalities is frequently observed in allopathic clinical practice, it has been well documented in prospective studies by several cluster analyses.
Popularly termed -- “the silent killer,” metabolic syndrome qualifies as the primary health problem faced by the modern Western world. An association between certain metabolic disorders аnd cardiovascular disease has been known since thе late 1950s, but comes into common usage in the 1970-1980s. The question of clustering cardiovascular risk factors has been discussed about for at least 35 years. The concept was developed by an Italian group in the late 1960s, while in the 1970s there were a variety of papers on the subject by a team in East Germany (Hanefeld et al., 1996). The authors offer a final statement on the metabolic syndrome cluster, its cardiovascular risk factors and insulin resistance.
Metabolic syndrome is a cluster of conditions that occur together, increasing the risk of heart disease, stroke and Type 2 diabetes. Having just one of these conditions —increased blood pressure, elevated insulin levels, excess body fat around the waist or abnormal cholesterol levels—is not a guarantee that one has metabolic syndrome, but it does contribute to the risk of it. If more than one of these conditions occur in a combination, the risk is even greater. It comprises an accumulation of different and mutually intensifying diseases and risk factors, which mostly share the same causes. It is actually is a cluster of disorders, all of which are affected by both genetics and lifestyle intrinsic and extrinsic factors. It affects a large number of people in a clustered fashion. In some studies Metabolic Syndrome is calculated as being up to 25% of the population in USA.
Metabolic Syndrome increases the risk of type 2 diabetes (the most common type of diabetes) anywhere from 9-30 times that of the normal population and despite studies vary the risk of heart disease increases 2-4 times over the normal population. There are also other concerns as well as fat accumulation in the liver (also known as fatty liver), resulting in chronic inflammation and the potential for degenerative cirrhosis. The kidneys can also be affected, as there is an association with microalbuminuria- the leaking of protein into the urine, a subtle but clear indication of kidney damage. Other problems associated with metabolic syndrome include obstructive sleep apnea, polycystic ovary syndrome (POOS), increased risk of dementia with aging, and rapid cognitive decline in the elderly. This constellation of conditions titled my book the “Metabolic Syndrome- the Deadly Epidemic of 21st century”, due to the fact that Metabolic Syndrome can include type 2 diabetes (the most common type of diabetes mellitus), hypertonia, obesity, dyslipidemia (poor lipid profile characterized by elevated LDL (“bad”) cholesterol, decreased HDL (“good”) cholesterol, and elevated triglycerides), with an increased risk for clotting and a bouquet of chronic degenerative diseases as a consequence- heart attack, stroke, gout, kidney failure, Alzheimer and even cancer.
Q: Can you describe for us what is exactly the Metabolic Syndrome Quintet? (I am using the term -title of one of your book chapters)
Answer: Metabolic Syndrome or the “Deadly Quintet” of 21 century is a cluster of:
1.Abdominal Obesity (waist circumference in men-greater than 40 inches and in women-greater than 35 inches).
2.Fasting glucose-greater than 110 mg/dl.
3.Dyslipidemia- Triglycerides-greater than 150 mg/dl and HDL (good) Cholesterol- less than 50 mg/dl in women, and less than 40 mg/dL in men
4.Blood Pressure-greater than 130/ 85 mm Hg
5.Increased risk of blood clothing as eventual precursor of heart disease and stroke
For a person to be defined as having metabolic syndrome, the new definition requires the presence of central obesity, plus two of the following four additional factors: raised triglycerides, reduced high-density lipoprotein cholesterol (HDL-C), raised blood pressure, or raised fasting plasma glucose level. Gender and, for the first time, ethnicity-specific cut-points for central obesity as measured by waist circumference are included.
Q: Is Metabolic Syndrome so common and prevalent that we must learn about it?
Answer: I consider metаbolic syndrome-the global epidemic of the 21st century. It is highly prevаlent in today’s Western world and the number of people afflicted by its deаdly consequences continues to rise. According to my book and my PhD research with more than 15 y of research on the “Allopathic and Holistic Approaches in Metabolic Syndrome Management”- metabolic syndrome is described as a chronic proinflammatory and highly reactive oxidative disease. Actually, oxidative stress is at the background of the pathophysiology of many other syndromes and diseases as atherosclerosis, cardiovascular disease (CVD), gout, dyslipidemia, diabetes 2, kidney failure, blindness, Alzheimer, nerve damage (neuropathy), obesity- all deadly consequences of metabolic syndrome. At each of these key points, insulin resistance and obesity, chronic inflammation, demographics, lifestyle, genetic factors, and environmental fetal programming result in metabolic syndrome’s final phenotypic expression. High prevalence of organ damage and poor prognosis has been demonstrated in a large number of the reviewed literature data. Defined as a constellation of risk factors including obesity, hypertension, dyslipidemia, and insulin resistance, metabolic syndrome is becoming a fairly common diagnosis in the Western industrialized world, and it is becoming one of the most pronounced 21st century pandemics. Metabolic syndrome (MetS) is so highly prevalent in the today’s Western world that the number of people who struggle with it or its deadly consequences continues geometrically to rise. The reason for the increased incidence of MetS in the highly industrialized countries is mainly due to the high level of stress, malnutrition, use of over processed food, and physical inactivity. It includes cardiovascular disease, diabetes 2, abdominal obesity (increased waist circumference), hypertension, high triglycerides, low levels of high density lipoprotein (good cholesterol), and high levels of low density lipoprotein (bad cholesterol) combined with high fasting glucose levels (insulin resistance).
Q: What are the metabolic syndrome causes or mechanism of appearance?
Answer: Although metabolic syndrome is not considered a disease but a syndrome (a group of different symptoms), its etiology (causes) and pathogenesis (mechanism of appearance) seem to be unifying. Obesity and insulin resistance, beside a constellation of independent factors, which include hepatic, vascular, and immunologic changes with strong pro-inflammatory properties, have been implicated in the pathogenesis. While the underlying etiology of metabolic syndrome is still the subject of intense debate, both abnormal abdominal fat distribution and insulin resistance have been identified as potential, interrelated pathogenesis causes. The flux of nonesterified fatty acids to the liver is tied into visceral fat accumulation as a contributing factor to the syndrome. General pro-inflammatory status is considered an obvious stage marker in the development and future propagation of the metabolic cluster of changes. There is also a debate as to whether it is obesity or insulin resistance that causes metabolic syndrome, or if the syndrome is a result of a greater metabolic cause. It is a cluster of conditions that occur together in one and the same person. It is increasing the risk of heart disease, stroke and diabetes. Having just one of these conditions- increased blood pressure, elevated insulin levels, excess body fat around the waist or abnormal cholesterol levels- is not a guarantee that you have metabolic syndrome, but it does contribute to the risk of it. If more than one of these conditions occurs in combination, the risk is even greater. Hence, future research is needed in clarifying the pathogenesis of the syndrome.
Q: What are the major clinical features of the metabolic syndrome?
Answer: One of the major clinical features of metabolic syndrome is the so called abdominal (or visceral) obesity. Learning on how to treat the syndrome is like to address obesity in a different way. Obesity sets the stage for the metabolic syndrome which then itself increases one's chances of diabetes, heart disease, stroke and other maladies. Therefore, everyone in our society should be concerned about obesity as well as our government must take care on developing preventive programs. Of course they are people and people. Those in whom the disorder is quite severe will accumulate fat extremely quickly, when those in whom it is moderate - will gradually increase in weight and those in whom it is mild- may be able to keep their excess weight stationary for long periods. Despite of the aggressiveness in weight loss programs and plans, based on restrictive diets, multiple drug treatment strategies, active exercise, sauna and massage techniques, the result seems temporary and very unsatisfactory. The pounds seem to come back immediately, after months and even years or as soon as the treatment programs are forgotten or relaxed. BMI is a measure of how much weight anyone carries for a given height. Basically a person is considered "overweight" when his/hers body mass index is greater than the upper range of the normal ranges. In order to meet the criterion for frank "obesity" one's BMI needs to be 30 or higher. The entity known as "morbid obesity" also known as clinically severe obesity, is defined as a BMI of greater than or equal to 40. However, one can also be labeled as morbidly obese if body mass index is 35 or higher and the individual has one or more "co morbid" conditions. The following co-morbid conditions can be formulated as metabolic syndrome (diabetes, high blood pressure, high cholesterol, stroke and cardiovascular disease). Being overweight is, alongside diabetes, a leading cause of increased cholesterol levels, high blood pressure and coronary artery disease. Hence, obesity increases chances of developing all the above risk factors.
Q: What is the main missing link in metabolic syndrome science?
Answer: Metabolic syndrome is converting in a serious problem due to the way American people eat: plenty of red and processed meat, and too much fried food. Forty-seven million Americans already have the syndrome. The authors advise people to select better protein sources: fish or white meats, beans, peas, lentils and nuts. The same study also concludes that dairy consumption decreased the risk of metabolic syndrome by 13%. People who consumed three servings of dairy per day had lower risk when compared with people who had it only twice a week (Lutsey et al., 2008). One of the missing links in the pathogenesis of metabolic syndrome is the long time unrecognized hepatic insulin resistance that appears to mediate the glucose intolerance, hyperglycemia, high level of triglyceride, and HDL-cholesterol abnormalities that contribute to the constellation of heart-disease risk factors called metabolic syndrome and it does represent a newly discovered pathophysiology link in CVD development (Biddinger et al., 2008). Kahn (2005) proved that insulin resistance is related to dyslipidemia, and insulin resistance- to glucose intolerance, while is not related to obesity.
Another important missing link underlying the syndrome is the understanding that dietary overindulgence can stimulate an excessive production of triglyceride-rich VLDL. While obesity creates insulin resistance, blood pressure is not linked to it and microalbuminuria is associated with glucose intolerance in diabetic subjects. Hence, obesity and glucose test results are strong predictors for diabetes development. The pandemic increase in the prevalence of obesity in the US is intimately associated with a 2.2-fold increased risk of development of impaired glucose intolerance.
An important feature is that metabolic syndrome can remain latent for years, masquerading as other diseases like: Chronic Fatigue Syndrome (CFS), attention deficit disorder (ADD), obesity, kidney failure with edema (fluid retention), bipolar disorder, etc. Despite the serious cardiovascular risk posed by metabolic syndrome, there is currently no standard, accepted interventional treatment regimen to prevent the disorder. However, for those at greatest risk for metabolic syndrome, phenotypic nutrition allows nutritionists to tailor a nutrient and supplement strategy to amplify beneficial biochemical pathways as well as gene expression.
Q: Is there any hormonal link hidden behind metabolic syndrome appearance?
Answer: Actually, it is already known that obesity causes insulin resistance, but is not related to high blood pressure. At the same time insulin resistance is known as the main culprit behind the metabolic syndrome. Except insulin there are few other hormones involved in the etiology and pathogenesis of metabolic syndrome. One of them is the hormone- leptin. Leptin is the hormone that works as natural appetite suppressant secreted by fat cells in the body. Its discovery in the 1990s helped researchers to start experimenting with leptin that caused mice to eat less and lose weight while this rarely happens in humans. Falling levels of this hormone, that helps the brain resist tempting foods, may explain why people who lose weight often have a hard time keeping it off. Restoring leptin to its “pre-diet” levels may reverse this problem, concluded Rosenbaum, offering a new way for dieters to finally win the weight battle. "When you lose weight you've created about the perfect storm for regaining weight," as per Rosenbaum et al. (2008) of Columbia University Medical Center in New York, whose research appears in the Journal of Clinical Investigation the same year. After a pronounced weight loss according to the author, "the metabolism not only becomes more efficient, so the body needs fewer calories, but the brain becomes more vulnerable to tasty-looking treats." Areas of the brain involved in telling not to eat seem to be less active. You are more responsive to food and you are less in control of it," as Rosenbaum stated. Since then researchers started to look for the best way to use the hormones to help treat obesity. In several earlier studies, researchers found out that when people lose weight, leptin levels decrease as the body tries to protect its proper stored energy. The team of Rosenbaum was interested to investigate the impact of this loss of leptin on the brains of people who had lost weight, and whether replacing the hormone might help them keep off the weight. They used an imaging technique known as functional magnetic resonance imaging that shows activity in the brain. The researchers studied six obese patients before and after going on a hospital-supervised diet that reduced their body weight by 10 percent. Patients were shown pictures of food and non-food items. The authors found that after weight loss, areas in the brain responsible for regulating food intake were less active when people were shown food images, while areas in the brain responsible for emotion were more active. When the researchers restored leptin to the levels before dieting, these changes were largely reversed. Similar results have been seen in people with a rare genetic condition in which their bodies do not make leptin. Rosenbaum et al. believe leptin could be useful tool in helping people maintain weight loss. According to the authors the idea to create a whole new class of therapies to help people with obesity may keep weight off after they have lost it. Making the situation worse, insulin also co-promotes the formations of an additional third type of adipose tissue. It seems that the more insulin the pancreas secretes, the more likely is the appearance of the “apple shape” around the waist.
Apparently hyperinsulinemia (too much insulin in the blood) can make anyone fat. And in fact insulin is the hormone that makes you fat and preliminary wrinkled or aged, despite we need it for energy delivery supply. An even more insidious reason for this is that the fat cells do not develop insulin resistance to the degree other body cells do. The final result is that, in insulin resistance, all muscles and organs are being starved while the fat cells are being fed. Already knowing that adipose tissue also produces increased levels of pro-inflammatory signaling factors (eicosanoids and interleukins) cellular substances – hormones and other bioactive substances referred to as adipocytokines (Hotamisligil, 2004), as a vicious circle of all of these factors insulin sensitivity in organs like muscle and liver is decreasing (Matsuzawa, 2004).
It is also highly hypothesized that secondary factors as for example: nonesterified fatty acid liberation and adipokine (e.g., adiponectin) production (Carr et al., 2004), independent of obesity and other risk factors may also play a significant role in the metabolic syndrome pathogenesis. Obviously the conglomeration or the convergence of these risk factors elevates the risk for this disease (Pladevall at al., 2006). As it is already cited in the literature- adipokines are a variety of proteins with signaling properties produced in body fat cells. While in the past white adipose tissue (one type of body fat) used to be regarded as a passive energy warehouse which is also used to provide a buffer and protection to all internal organs, lately this concept has been turned 180 degrees up and it is now understood that white adipose tissue is highly active and dynamic metabolic organ being involved in a multitude of physiological and metabolic biochemical reactions and processes.
Research also suggests that appetite-regulating hormones are affected by sleep and that sleep deprivation could lead to weight gain. In two separate well randomized studies, people who slept five hours or less had higher levels of ghrelin - a hormone that stimulates hunger - and lower levels of the appetite-suppressing hormone leptin than those who slept eight hours per night. Prof. Cappuccio of the Univesity of Warwick has proved that short sleep duration may also lead to obesity, through an increase of appetite via hormonal changes (Cappuccio, 2006). Lack of sleep produces secretion of ghrelin, which stimulates appetite and creates less leptin, which suppresses appetite. The hormonal relationship and obesity is shown also in the HERS study published in JAMA (2000). The hyperinsulinemia in women has been shown in this study to stimulate the release of testosterone from the ovaries. It is a well known fact that people who are obese are suffering from this disorder regardless of whether they eat normally, excessively, or less than normal. At the same moment it is quite obvious that there are people who are constantly overeating but are free of the above metabolic disorder. It is easy to conclude that obesity in all its multiple forms is due to an abnormal damage in the hypothalamic area of the brain- a center that is the main regulatory mechanism of a hunger, thirst and the sexual desire.
Q: What makes Metabolic Syndrome so important in order to be well known and easily recognized?
Answer: Metabolic syndrome is worth caring about because it is a condition that can pave the way to both diabetes and heart disease, two of the most common and important chronic diseases of 21st century. It can increase the risk of type 2 diabetes (the most common type of diabetes) anywhere from 9-30 times that of the normal population and despite clinical studies vary the risk of heart disease increases 2-4 times over the normal population. There are other concerns as well as fat accumulation in the liver (fatty liver), resulting in chronic inflammation and the potential for degenerative cirrhosis. The kidneys can also be affected, as there is an association with (microalbuminuria) - the leaking of protein into the urine, a subtle but clear indication of kidney damage. Other problems associated with metabolic syndrome include obstructive sleep apnea, polycystic ovary syndrome (PCOS), increased risk of dementia with aging, and rapid cognitive decline in the elderly. Nearly 47 million Americans have been officially diagnosed with metabolic syndrome, and nearly 1 million adolescents exhibit its abnormalities. The condition disproportionately affects minorities and low-income groups of the population. As the Western industrialized world is facing a large modern epidemic associated with a combination of multiple health risk factors, the need for future research, both theoretical and experimental, must be recognized. Statistically an increasing number of people in the Western industrialized world are exploring alternative medicine as part of their medical care.
Q: Is Metabolic Syndrome so dangerous?
Answer: Yes and I will summarize why. Metabolic syndrome is a precursor of the most dangerous risk factors (Eckel, Grundy & Zimmet, 2005)—heart attack, abdominal obesity, dyslipidemia, and high blood pressure. It is also defined as a “cluster of anthropometric, metabolic and hemodynamic abnormalities” that have been linked to increased risk for Type 2 diabetes (Grundy, Brewer, Cleeman, Smith & L’Enfant, 2004), cardiovascular morbidity (Isomaa et al., 2001), and all-cause mortality (Ford, Giles & Dietz, 2002; Isomaa et al., 2001; Sundström et al., 2006). There are statistic expectations that up to 80% of the almost 200 million adults worldwide will die of CVD, according to the International Diabetes Federation (IDF, 2003). Hence, people suffering from metabolic syndrome are also at increased risk of mortality, as they are three times as likely to die from stroke or heart attack, and twice as likely to die from a coronary event, compared to people without metabolic syndrome (Isomaa et al., 2001). More than 300 million worldwide are now classified as obese, according to the World Health Organization (WHO, 2009), while another billion of people are considered overweight. The European health report (2005) places metabolic syndrome far ahead of HIV/AIDS in morbidity and mortality.
Popularly termed -- “the silent killer,” metabolic syndrome qualifies as the primary health problem faced by the modern Western world. An association between certain metabolic disorders аnd cardiovascular disease has been known since thе late 1950s, but comes into common usage in the 1970-1980s. The question of clustering cardiovascular risk factors has been discussed about for at least 35 years. The concept was developed by an Italian group in the late 1960s, while in the 1970s there were a variety of papers on the subject by a team in East Germany (Hanefeld et al., 1996). The authors offer a final statement on the metabolic syndrome cluster, its cardiovascular risk factors and insulin resistance.
Metabolic syndrome is a cluster of conditions that occur together, increasing the risk of heart disease, stroke and Type 2 diabetes. Having just one of these conditions —increased blood pressure, elevated insulin levels, excess body fat around the waist or abnormal cholesterol levels—is not a guarantee that one has metabolic syndrome, but it does contribute to the risk of it. If more than one of these conditions occur in a combination, the risk is even greater. It comprises an accumulation of different and mutually intensifying diseases and risk factors, which mostly share the same causes. It is actually is a cluster of disorders, all of which are affected by both genetics and lifestyle intrinsic and extrinsic factors. It affects a large number of people in a clustered fashion. In some studies Metabolic Syndrome is calculated as being up to 25% of the population in USA.
Metabolic Syndrome increases the risk of type 2 diabetes (the most common type of diabetes) anywhere from 9-30 times that of the normal population and despite studies vary the risk of heart disease increases 2-4 times over the normal population. There are also other concerns as well as fat accumulation in the liver (also known as fatty liver), resulting in chronic inflammation and the potential for degenerative cirrhosis. The kidneys can also be affected, as there is an association with microalbuminuria- the leaking of protein into the urine, a subtle but clear indication of kidney damage. Other problems associated with metabolic syndrome include obstructive sleep apnea, polycystic ovary syndrome (POOS), increased risk of dementia with aging, and rapid cognitive decline in the elderly. This constellation of conditions titled my book the “Metabolic Syndrome- the Deadly Epidemic of 21st century”, due to the fact that Metabolic Syndrome can include type 2 diabetes (the most common type of diabetes mellitus), hypertonia, obesity, dyslipidemia (poor lipid profile characterized by elevated LDL (“bad”) cholesterol, decreased HDL (“good”) cholesterol, and elevated triglycerides), with an increased risk for clotting and a bouquet of chronic degenerative diseases as a consequence- heart attack, stroke, gout, kidney failure, Alzheimer and even cancer.
Q: Can you describe for us what is exactly the Metabolic Syndrome Quintet? (I am using the term -title of one of your book chapters)
Answer: Metabolic Syndrome or the “Deadly Quintet” of 21 century is a cluster of:
1.Abdominal Obesity (waist circumference in men-greater than 40 inches and in women-greater than 35 inches).
2.Fasting glucose-greater than 110 mg/dl.
3.Dyslipidemia- Triglycerides-greater than 150 mg/dl and HDL (good) Cholesterol- less than 50 mg/dl in women, and less than 40 mg/dL in men
4.Blood Pressure-greater than 130/ 85 mm Hg
5.Increased risk of blood clothing as eventual precursor of heart disease and stroke
For a person to be defined as having metabolic syndrome, the new definition requires the presence of central obesity, plus two of the following four additional factors: raised triglycerides, reduced high-density lipoprotein cholesterol (HDL-C), raised blood pressure, or raised fasting plasma glucose level. Gender and, for the first time, ethnicity-specific cut-points for central obesity as measured by waist circumference are included.
Q: Is Metabolic Syndrome so common and prevalent that we must learn about it?
Answer: I consider metаbolic syndrome-the global epidemic of the 21st century. It is highly prevаlent in today’s Western world and the number of people afflicted by its deаdly consequences continues to rise. According to my book and my PhD research with more than 15 y of research on the “Allopathic and Holistic Approaches in Metabolic Syndrome Management”- metabolic syndrome is described as a chronic proinflammatory and highly reactive oxidative disease. Actually, oxidative stress is at the background of the pathophysiology of many other syndromes and diseases as atherosclerosis, cardiovascular disease (CVD), gout, dyslipidemia, diabetes 2, kidney failure, blindness, Alzheimer, nerve damage (neuropathy), obesity- all deadly consequences of metabolic syndrome. At each of these key points, insulin resistance and obesity, chronic inflammation, demographics, lifestyle, genetic factors, and environmental fetal programming result in metabolic syndrome’s final phenotypic expression. High prevalence of organ damage and poor prognosis has been demonstrated in a large number of the reviewed literature data. Defined as a constellation of risk factors including obesity, hypertension, dyslipidemia, and insulin resistance, metabolic syndrome is becoming a fairly common diagnosis in the Western industrialized world, and it is becoming one of the most pronounced 21st century pandemics. Metabolic syndrome (MetS) is so highly prevalent in the today’s Western world that the number of people who struggle with it or its deadly consequences continues geometrically to rise. The reason for the increased incidence of MetS in the highly industrialized countries is mainly due to the high level of stress, malnutrition, use of over processed food, and physical inactivity. It includes cardiovascular disease, diabetes 2, abdominal obesity (increased waist circumference), hypertension, high triglycerides, low levels of high density lipoprotein (good cholesterol), and high levels of low density lipoprotein (bad cholesterol) combined with high fasting glucose levels (insulin resistance).
Q: What are the metabolic syndrome causes or mechanism of appearance?
Answer: Although metabolic syndrome is not considered a disease but a syndrome (a group of different symptoms), its etiology (causes) and pathogenesis (mechanism of appearance) seem to be unifying. Obesity and insulin resistance, beside a constellation of independent factors, which include hepatic, vascular, and immunologic changes with strong pro-inflammatory properties, have been implicated in the pathogenesis. While the underlying etiology of metabolic syndrome is still the subject of intense debate, both abnormal abdominal fat distribution and insulin resistance have been identified as potential, interrelated pathogenesis causes. The flux of nonesterified fatty acids to the liver is tied into visceral fat accumulation as a contributing factor to the syndrome. General pro-inflammatory status is considered an obvious stage marker in the development and future propagation of the metabolic cluster of changes. There is also a debate as to whether it is obesity or insulin resistance that causes metabolic syndrome, or if the syndrome is a result of a greater metabolic cause. It is a cluster of conditions that occur together in one and the same person. It is increasing the risk of heart disease, stroke and diabetes. Having just one of these conditions- increased blood pressure, elevated insulin levels, excess body fat around the waist or abnormal cholesterol levels- is not a guarantee that you have metabolic syndrome, but it does contribute to the risk of it. If more than one of these conditions occurs in combination, the risk is even greater. Hence, future research is needed in clarifying the pathogenesis of the syndrome.
Q: What are the major clinical features of the metabolic syndrome?
Answer: One of the major clinical features of metabolic syndrome is the so called abdominal (or visceral) obesity. Learning on how to treat the syndrome is like to address obesity in a different way. Obesity sets the stage for the metabolic syndrome which then itself increases one's chances of diabetes, heart disease, stroke and other maladies. Therefore, everyone in our society should be concerned about obesity as well as our government must take care on developing preventive programs. Of course they are people and people. Those in whom the disorder is quite severe will accumulate fat extremely quickly, when those in whom it is moderate - will gradually increase in weight and those in whom it is mild- may be able to keep their excess weight stationary for long periods. Despite of the aggressiveness in weight loss programs and plans, based on restrictive diets, multiple drug treatment strategies, active exercise, sauna and massage techniques, the result seems temporary and very unsatisfactory. The pounds seem to come back immediately, after months and even years or as soon as the treatment programs are forgotten or relaxed. BMI is a measure of how much weight anyone carries for a given height. Basically a person is considered "overweight" when his/hers body mass index is greater than the upper range of the normal ranges. In order to meet the criterion for frank "obesity" one's BMI needs to be 30 or higher. The entity known as "morbid obesity" also known as clinically severe obesity, is defined as a BMI of greater than or equal to 40. However, one can also be labeled as morbidly obese if body mass index is 35 or higher and the individual has one or more "co morbid" conditions. The following co-morbid conditions can be formulated as metabolic syndrome (diabetes, high blood pressure, high cholesterol, stroke and cardiovascular disease). Being overweight is, alongside diabetes, a leading cause of increased cholesterol levels, high blood pressure and coronary artery disease. Hence, obesity increases chances of developing all the above risk factors.
Q: What is the main missing link in metabolic syndrome science?
Answer: Metabolic syndrome is converting in a serious problem due to the way American people eat: plenty of red and processed meat, and too much fried food. Forty-seven million Americans already have the syndrome. The authors advise people to select better protein sources: fish or white meats, beans, peas, lentils and nuts. The same study also concludes that dairy consumption decreased the risk of metabolic syndrome by 13%. People who consumed three servings of dairy per day had lower risk when compared with people who had it only twice a week (Lutsey et al., 2008). One of the missing links in the pathogenesis of metabolic syndrome is the long time unrecognized hepatic insulin resistance that appears to mediate the glucose intolerance, hyperglycemia, high level of triglyceride, and HDL-cholesterol abnormalities that contribute to the constellation of heart-disease risk factors called metabolic syndrome and it does represent a newly discovered pathophysiology link in CVD development (Biddinger et al., 2008). Kahn (2005) proved that insulin resistance is related to dyslipidemia, and insulin resistance- to glucose intolerance, while is not related to obesity.
Another important missing link underlying the syndrome is the understanding that dietary overindulgence can stimulate an excessive production of triglyceride-rich VLDL. While obesity creates insulin resistance, blood pressure is not linked to it and microalbuminuria is associated with glucose intolerance in diabetic subjects. Hence, obesity and glucose test results are strong predictors for diabetes development. The pandemic increase in the prevalence of obesity in the US is intimately associated with a 2.2-fold increased risk of development of impaired glucose intolerance.
An important feature is that metabolic syndrome can remain latent for years, masquerading as other diseases like: Chronic Fatigue Syndrome (CFS), attention deficit disorder (ADD), obesity, kidney failure with edema (fluid retention), bipolar disorder, etc. Despite the serious cardiovascular risk posed by metabolic syndrome, there is currently no standard, accepted interventional treatment regimen to prevent the disorder. However, for those at greatest risk for metabolic syndrome, phenotypic nutrition allows nutritionists to tailor a nutrient and supplement strategy to amplify beneficial biochemical pathways as well as gene expression.
Q: Is there any hormonal link hidden behind metabolic syndrome appearance?
Answer: Actually, it is already known that obesity causes insulin resistance, but is not related to high blood pressure. At the same time insulin resistance is known as the main culprit behind the metabolic syndrome. Except insulin there are few other hormones involved in the etiology and pathogenesis of metabolic syndrome. One of them is the hormone- leptin. Leptin is the hormone that works as natural appetite suppressant secreted by fat cells in the body. Its discovery in the 1990s helped researchers to start experimenting with leptin that caused mice to eat less and lose weight while this rarely happens in humans. Falling levels of this hormone, that helps the brain resist tempting foods, may explain why people who lose weight often have a hard time keeping it off. Restoring leptin to its “pre-diet” levels may reverse this problem, concluded Rosenbaum, offering a new way for dieters to finally win the weight battle. "When you lose weight you've created about the perfect storm for regaining weight," as per Rosenbaum et al. (2008) of Columbia University Medical Center in New York, whose research appears in the Journal of Clinical Investigation the same year. After a pronounced weight loss according to the author, "the metabolism not only becomes more efficient, so the body needs fewer calories, but the brain becomes more vulnerable to tasty-looking treats." Areas of the brain involved in telling not to eat seem to be less active. You are more responsive to food and you are less in control of it," as Rosenbaum stated. Since then researchers started to look for the best way to use the hormones to help treat obesity. In several earlier studies, researchers found out that when people lose weight, leptin levels decrease as the body tries to protect its proper stored energy. The team of Rosenbaum was interested to investigate the impact of this loss of leptin on the brains of people who had lost weight, and whether replacing the hormone might help them keep off the weight. They used an imaging technique known as functional magnetic resonance imaging that shows activity in the brain. The researchers studied six obese patients before and after going on a hospital-supervised diet that reduced their body weight by 10 percent. Patients were shown pictures of food and non-food items. The authors found that after weight loss, areas in the brain responsible for regulating food intake were less active when people were shown food images, while areas in the brain responsible for emotion were more active. When the researchers restored leptin to the levels before dieting, these changes were largely reversed. Similar results have been seen in people with a rare genetic condition in which their bodies do not make leptin. Rosenbaum et al. believe leptin could be useful tool in helping people maintain weight loss. According to the authors the idea to create a whole new class of therapies to help people with obesity may keep weight off after they have lost it. Making the situation worse, insulin also co-promotes the formations of an additional third type of adipose tissue. It seems that the more insulin the pancreas secretes, the more likely is the appearance of the “apple shape” around the waist.
Apparently hyperinsulinemia (too much insulin in the blood) can make anyone fat. And in fact insulin is the hormone that makes you fat and preliminary wrinkled or aged, despite we need it for energy delivery supply. An even more insidious reason for this is that the fat cells do not develop insulin resistance to the degree other body cells do. The final result is that, in insulin resistance, all muscles and organs are being starved while the fat cells are being fed. Already knowing that adipose tissue also produces increased levels of pro-inflammatory signaling factors (eicosanoids and interleukins) cellular substances – hormones and other bioactive substances referred to as adipocytokines (Hotamisligil, 2004), as a vicious circle of all of these factors insulin sensitivity in organs like muscle and liver is decreasing (Matsuzawa, 2004).
It is also highly hypothesized that secondary factors as for example: nonesterified fatty acid liberation and adipokine (e.g., adiponectin) production (Carr et al., 2004), independent of obesity and other risk factors may also play a significant role in the metabolic syndrome pathogenesis. Obviously the conglomeration or the convergence of these risk factors elevates the risk for this disease (Pladevall at al., 2006). As it is already cited in the literature- adipokines are a variety of proteins with signaling properties produced in body fat cells. While in the past white adipose tissue (one type of body fat) used to be regarded as a passive energy warehouse which is also used to provide a buffer and protection to all internal organs, lately this concept has been turned 180 degrees up and it is now understood that white adipose tissue is highly active and dynamic metabolic organ being involved in a multitude of physiological and metabolic biochemical reactions and processes.
Research also suggests that appetite-regulating hormones are affected by sleep and that sleep deprivation could lead to weight gain. In two separate well randomized studies, people who slept five hours or less had higher levels of ghrelin - a hormone that stimulates hunger - and lower levels of the appetite-suppressing hormone leptin than those who slept eight hours per night. Prof. Cappuccio of the Univesity of Warwick has proved that short sleep duration may also lead to obesity, through an increase of appetite via hormonal changes (Cappuccio, 2006). Lack of sleep produces secretion of ghrelin, which stimulates appetite and creates less leptin, which suppresses appetite. The hormonal relationship and obesity is shown also in the HERS study published in JAMA (2000). The hyperinsulinemia in women has been shown in this study to stimulate the release of testosterone from the ovaries. It is a well known fact that people who are obese are suffering from this disorder regardless of whether they eat normally, excessively, or less than normal. At the same moment it is quite obvious that there are people who are constantly overeating but are free of the above metabolic disorder. It is easy to conclude that obesity in all its multiple forms is due to an abnormal damage in the hypothalamic area of the brain- a center that is the main regulatory mechanism of a hunger, thirst and the sexual desire.
Q: What makes Metabolic Syndrome so important in order to be well known and easily recognized?
Answer: Metabolic syndrome is worth caring about because it is a condition that can pave the way to both diabetes and heart disease, two of the most common and important chronic diseases of 21st century. It can increase the risk of type 2 diabetes (the most common type of diabetes) anywhere from 9-30 times that of the normal population and despite clinical studies vary the risk of heart disease increases 2-4 times over the normal population. There are other concerns as well as fat accumulation in the liver (fatty liver), resulting in chronic inflammation and the potential for degenerative cirrhosis. The kidneys can also be affected, as there is an association with (microalbuminuria) - the leaking of protein into the urine, a subtle but clear indication of kidney damage. Other problems associated with metabolic syndrome include obstructive sleep apnea, polycystic ovary syndrome (PCOS), increased risk of dementia with aging, and rapid cognitive decline in the elderly. Nearly 47 million Americans have been officially diagnosed with metabolic syndrome, and nearly 1 million adolescents exhibit its abnormalities. The condition disproportionately affects minorities and low-income groups of the population. As the Western industrialized world is facing a large modern epidemic associated with a combination of multiple health risk factors, the need for future research, both theoretical and experimental, must be recognized. Statistically an increasing number of people in the Western industrialized world are exploring alternative medicine as part of their medical care.
Q: Is Metabolic Syndrome so dangerous?
Answer: Yes and I will summarize why. Metabolic syndrome is a precursor of the most dangerous risk factors (Eckel, Grundy & Zimmet, 2005)—heart attack, abdominal obesity, dyslipidemia, and high blood pressure. It is also defined as a “cluster of anthropometric, metabolic and hemodynamic abnormalities” that have been linked to increased risk for Type 2 diabetes (Grundy, Brewer, Cleeman, Smith & L’Enfant, 2004), cardiovascular morbidity (Isomaa et al., 2001), and all-cause mortality (Ford, Giles & Dietz, 2002; Isomaa et al., 2001; Sundström et al., 2006). There are statistic expectations that up to 80% of the almost 200 million adults worldwide will die of CVD, according to the International Diabetes Federation (IDF, 2003). Hence, people suffering from metabolic syndrome are also at increased risk of mortality, as they are three times as likely to die from stroke or heart attack, and twice as likely to die from a coronary event, compared to people without metabolic syndrome (Isomaa et al., 2001). More than 300 million worldwide are now classified as obese, according to the World Health Organization (WHO, 2009), while another billion of people are considered overweight. The European health report (2005) places metabolic syndrome far ahead of HIV/AIDS in morbidity and mortality.
Q: What is your opinion on the increasing rate of the American Obesity?
Answer: Obesity is an urgent and growing health problem in the United States. Many people have a constellation of major metabolic risk factors, wrong life-habit risk factors, and emerging risk factors that constitute the condition called – the metabolic syndrome. Factors characteristic of the metabolic syndrome (also known as dysmetabolic syndrome X) are abdominal obesity, atherogenic dyslipidemia (elevated triglyceride [TG] levels, small low-density lipoprotein [LDL] particles, and low high-density lipoprotein cholesterol [HDL-C] levels), raised blood pressure, insulin resistance (with or without glucose intolerance), and prothrombotic and proinflammatory states. Some of the clinical syndromes and diseases, following the metabolic syndrome appearance are: (a) Type 2 diabetes mellitus; (b) Cardiovascular disease (CVD); (c) Essential hypertension; (d) Polycystic ovary syndrome (PCOS); (e) Nonalcoholic fatty liver disease; (f) Certain forms of cancer; (g) Sleep apnea; (h) Gout; (i) Kidney failure, and (j) Alzheimer disease (Annual Rev. Nutr. 2005).
Multiple studies classify metabolic syndrome and diabetes far ahead of HIV/ AIDS in morbidity and mortality terms, yet the problem is not as well recognized or diagnosed. Metabolic syndrome considerably increases the risk of cardiovascular and renal events in case of hypertension. It has been associated with a wide range of classical cardiovascular risk factors as well as with early signs of organ damage leading to stroke, heart attack, gout, kidney failure, Alzheimer’s, and multiple cancers. Only heart disease kills one in five people in the US. According to the last statistics, more than one million Americans are diagnosed with Type 2 diabetes each year and more than one-third of the American population has metabolic syndrome. Traditionally, up to 80% of people with diabetes develop some form of cardiovascular disease, from heart attack and stroke to peripheral artery disease and heart failure.
Q: How to heal Metabolic Syndrome Naturally?
Answer: Despite that there is no unified treatment or a disease cure, right diet, nutritional and herbal supplementation, lifestyle changes can help support healthy blood sugar levels and control metabolic syndrome. Several vitamins, minerals, herbs and antioxidants have been studied for their efficacy at promoting healthy blood sugar and protecting cells from the damage of elevated oxidation with favorable results. The high cost of managing metabolic syndrome, together with the recent economical situation have led to a growing interest in potentially gentler modalities and methods presented as a strategy by the alternative medicine. Having already metabolic syndrome or any of the components of the syndrome, one should have the opportunity to make aggressive lifestyle changes. Making these changes can delay or derail the development of those serious diseases that may result from metabolic syndrome.
Diet. The primary treatment for metabolic syndrome is the diet. A diet high in protein is suitable for those with normal insulin sensitivity, but inappropriate for those with already established insulin resistance, prediabetes or metabolic syndrome. It is important to note that there are good fats and there are bad fats. The fats recommended by multiple clinical trials in care of already developed metabolic syndrome 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. Replacing saturated fats with and mono- and poly -unsaturated fats will equally benefit LDL cholesterol lowering as compared to replacing saturated fats with carbohydrates. 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 also postulated that the use of low glycemic-index (GI) 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.
Answer: Obesity is an urgent and growing health problem in the United States. Many people have a constellation of major metabolic risk factors, wrong life-habit risk factors, and emerging risk factors that constitute the condition called – the metabolic syndrome. Factors characteristic of the metabolic syndrome (also known as dysmetabolic syndrome X) are abdominal obesity, atherogenic dyslipidemia (elevated triglyceride [TG] levels, small low-density lipoprotein [LDL] particles, and low high-density lipoprotein cholesterol [HDL-C] levels), raised blood pressure, insulin resistance (with or without glucose intolerance), and prothrombotic and proinflammatory states. Some of the clinical syndromes and diseases, following the metabolic syndrome appearance are: (a) Type 2 diabetes mellitus; (b) Cardiovascular disease (CVD); (c) Essential hypertension; (d) Polycystic ovary syndrome (PCOS); (e) Nonalcoholic fatty liver disease; (f) Certain forms of cancer; (g) Sleep apnea; (h) Gout; (i) Kidney failure, and (j) Alzheimer disease (Annual Rev. Nutr. 2005).
Multiple studies classify metabolic syndrome and diabetes far ahead of HIV/ AIDS in morbidity and mortality terms, yet the problem is not as well recognized or diagnosed. Metabolic syndrome considerably increases the risk of cardiovascular and renal events in case of hypertension. It has been associated with a wide range of classical cardiovascular risk factors as well as with early signs of organ damage leading to stroke, heart attack, gout, kidney failure, Alzheimer’s, and multiple cancers. Only heart disease kills one in five people in the US. According to the last statistics, more than one million Americans are diagnosed with Type 2 diabetes each year and more than one-third of the American population has metabolic syndrome. Traditionally, up to 80% of people with diabetes develop some form of cardiovascular disease, from heart attack and stroke to peripheral artery disease and heart failure.
Q: How to heal Metabolic Syndrome Naturally?
Answer: Despite that there is no unified treatment or a disease cure, right diet, nutritional and herbal supplementation, lifestyle changes can help support healthy blood sugar levels and control metabolic syndrome. Several vitamins, minerals, herbs and antioxidants have been studied for their efficacy at promoting healthy blood sugar and protecting cells from the damage of elevated oxidation with favorable results. The high cost of managing metabolic syndrome, together with the recent economical situation have led to a growing interest in potentially gentler modalities and methods presented as a strategy by the alternative medicine. Having already metabolic syndrome or any of the components of the syndrome, one should have the opportunity to make aggressive lifestyle changes. Making these changes can delay or derail the development of those serious diseases that may result from metabolic syndrome.
Diet. The primary treatment for metabolic syndrome is the diet. A diet high in protein is suitable for those with normal insulin sensitivity, but inappropriate for those with already established insulin resistance, prediabetes or metabolic syndrome. It is important to note that there are good fats and there are bad fats. The fats recommended by multiple clinical trials in care of already developed metabolic syndrome 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. Replacing saturated fats with and mono- and poly -unsaturated fats will equally benefit LDL cholesterol lowering as compared to replacing saturated fats with carbohydrates. 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 also postulated that the use of low glycemic-index (GI) 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.
The most problematic type of carbohydrate for people with metabolic syndrome are the simple carbohydrates which are found in foods such as cakes, candies, pies, muffins, and ice cream. These foods contain large amounts of sugar, which go straight into the blood and quickly raise blood sugar, hence increasing the demand for insulin to bring the blood sugar levels back down. Even complex carbohydrates such as potatoes, bread, and pastas are fairly quickly digested and broken down into sugars. It is therefore very important that people with insulin resistance limit their intake of all complex carbohydrates. Proteins and most vegetables, on the other hand, do not have this effect on blood sugar. Proteins, in fact, will slow the absorption of the sugars that come from carbohydrates and decrease their impact on blood sugar and insulin levels.
Exercise. Epidemiological studies have shown that modest exercise is beneficial. However, unequivocal metabolic benefits from exercise will not be achieved from a casual walk a couple of nights a week. Significant, regular, chronic exercise is required to see improvements in insulin action, triglycerides, and HDL cholesterol. Exercise is as powerful a tool as weight loss.
Nutritional Supplementation. According to Murray a good multivitamin/ multimineral formula taken daily could be a good reassurance in case of malnourishment, aging or chronic degenerative disease. A variety of natural non-toxic food based compounds can be also used in metabolic syndrome healing. The goals are to normalize blood sugar, and increase insulin sensitivity. 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. There are different supplements, herbs and nutraceuticals formulas participating in the holistic metabolic syndrome healing. Between them are : Vitamin C, Vitamin E, vit D3, Folic Acid, Selenium, Chromium, Alpha Lipoic Acid (ALA), Coenzyme Q10 (CoQ10), Magnesium, L-arginine, Omega-3 fatty acids, Bioflavonoids, Vitamin B6, Vitamin B12, Betaine etc. There are many clinical trials (randomized, placebo controlled and cohort trials) on vitamin supplementation. Based on the detailed review of the medical literature in terms of 10 years recommendations are as follows:
Coenzyme Q10 (CoQ10) and Alpha Lipoic Acid (ALA) constitute the main part of metabolic syndrome healing.
Alpha-lipoic acid (ALA) approved for first in Germany as the king of the antioxidants and as a drug for treatment of diabetic polyneuropathies, is found to stimulate insulin and the glucose uptake in muscle and fat cells. If you have blood sugar issues, you’ll want an extra dose of the right antioxidants to combat free radical damage. Alpha Lipoic Acid is known as the “universal antioxidant” because it recycles other antioxidants, such as vitamins C and E, multiplying the benefit of both. It strongly protects the body from oxidative stress and the induced insulin resistance. It plays an important role in generating energy from food and oxygen in the mitochondria (the power plants inside the cells). ALA is both water- and fat-soluble, meaning it can easily cross cell membranes, and may provide both interior and exterior cellular free. There is good evidence that ALA improves high blood glucose in pre-diabetes or diabetes 2, by improving insulin sensitivity (Jacob et al., 1999). The author states: “Co Q10 and ALA quench free radicals and prevent the disruption caused by oxidative stress”. Holistic treatment with both antioxidants can increase glutathione levels, also an important antioxidant per se. They are also helping the regeneration of vitamin E, as it too free radical scavenger. ALA can ameliorate cataracts, neuropathy, blindness and vascular damage. Consuming spinach, broccoli, tomato, liver and kidney can deliver enough of the above antioxidants with food.
Coenzyme Q10 (CoQ10) is a potent antioxidant responsible for cellular energy throughout the body. Heart cells, in particular, have high energy demands, and therefore contain and require more CoQ10 than any other type of cell in the body. While the body produces CoQ10 on its own, levels naturally decline with age, making supplementation beneficial. There are literature data that CoQ10 can improve blood pressure, improve insulin resistance and endothelial dysfunction in diabetic patients (Hodgson et al, 2002). Adding Co Q10 (100-200mg) and ALA (600mg) is an important recommendation for metabolic syndrome sufferers. Above all statins may lower body's ability to produce CoQ10. This is because CoQ10 and cholesterol are both derived from mevalonate. The main role and purpose of statins is to inhibit the creation of bad cholesterol, thus statins suppress also the synthesis of CoQ10. Thus the addition of a high quality CoQ10 supplement to anyone’s daily regimen, in an absolute must in order to help maintaining optimal health.
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. The best way is to take the above nutrients in the form of a nutritional cocktail that contain most of the above mentioned nutrient. In a properly formed cocktail, the amount of each single nutrient is reduced, while the overall effect is still achieved.
Exercise. Epidemiological studies have shown that modest exercise is beneficial. However, unequivocal metabolic benefits from exercise will not be achieved from a casual walk a couple of nights a week. Significant, regular, chronic exercise is required to see improvements in insulin action, triglycerides, and HDL cholesterol. Exercise is as powerful a tool as weight loss.
Nutritional Supplementation. According to Murray a good multivitamin/ multimineral formula taken daily could be a good reassurance in case of malnourishment, aging or chronic degenerative disease. A variety of natural non-toxic food based compounds can be also used in metabolic syndrome healing. The goals are to normalize blood sugar, and increase insulin sensitivity. 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. There are different supplements, herbs and nutraceuticals formulas participating in the holistic metabolic syndrome healing. Between them are : Vitamin C, Vitamin E, vit D3, Folic Acid, Selenium, Chromium, Alpha Lipoic Acid (ALA), Coenzyme Q10 (CoQ10), Magnesium, L-arginine, Omega-3 fatty acids, Bioflavonoids, Vitamin B6, Vitamin B12, Betaine etc. There are many clinical trials (randomized, placebo controlled and cohort trials) on vitamin supplementation. Based on the detailed review of the medical literature in terms of 10 years recommendations are as follows:
Coenzyme Q10 (CoQ10) and Alpha Lipoic Acid (ALA) constitute the main part of metabolic syndrome healing.
Alpha-lipoic acid (ALA) approved for first in Germany as the king of the antioxidants and as a drug for treatment of diabetic polyneuropathies, is found to stimulate insulin and the glucose uptake in muscle and fat cells. If you have blood sugar issues, you’ll want an extra dose of the right antioxidants to combat free radical damage. Alpha Lipoic Acid is known as the “universal antioxidant” because it recycles other antioxidants, such as vitamins C and E, multiplying the benefit of both. It strongly protects the body from oxidative stress and the induced insulin resistance. It plays an important role in generating energy from food and oxygen in the mitochondria (the power plants inside the cells). ALA is both water- and fat-soluble, meaning it can easily cross cell membranes, and may provide both interior and exterior cellular free. There is good evidence that ALA improves high blood glucose in pre-diabetes or diabetes 2, by improving insulin sensitivity (Jacob et al., 1999). The author states: “Co Q10 and ALA quench free radicals and prevent the disruption caused by oxidative stress”. Holistic treatment with both antioxidants can increase glutathione levels, also an important antioxidant per se. They are also helping the regeneration of vitamin E, as it too free radical scavenger. ALA can ameliorate cataracts, neuropathy, blindness and vascular damage. Consuming spinach, broccoli, tomato, liver and kidney can deliver enough of the above antioxidants with food.
Coenzyme Q10 (CoQ10) is a potent antioxidant responsible for cellular energy throughout the body. Heart cells, in particular, have high energy demands, and therefore contain and require more CoQ10 than any other type of cell in the body. While the body produces CoQ10 on its own, levels naturally decline with age, making supplementation beneficial. There are literature data that CoQ10 can improve blood pressure, improve insulin resistance and endothelial dysfunction in diabetic patients (Hodgson et al, 2002). Adding Co Q10 (100-200mg) and ALA (600mg) is an important recommendation for metabolic syndrome sufferers. Above all statins may lower body's ability to produce CoQ10. This is because CoQ10 and cholesterol are both derived from mevalonate. The main role and purpose of statins is to inhibit the creation of bad cholesterol, thus statins suppress also the synthesis of CoQ10. Thus the addition of a high quality CoQ10 supplement to anyone’s daily regimen, in an absolute must in order to help maintaining optimal health.
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. The best way is to take the above nutrients in the form of a nutritional cocktail that contain most of the above mentioned nutrient. In a properly formed cocktail, the amount of each single nutrient is reduced, while the overall effect is still achieved.
Q: So should eceryone take the above cited formulas?
Answer: Of course not. We can not generalize or globalize the nutritional intake pattern portfolio. Due to biochemical and metabolic individual variation, the use of nutritional supplements should therefore be personalized for your body. One person’s nutrient can be another person’s toxin. I am just listing the available dietary, homeopathic or herbal formulas that could help coping with the syndrome.
Q: Go ahead and sorry for interrupting you........
Answer: Acetyl L-carnitine (ALC) is the acetyl ester of the amino acid L-carnitine and is similar in form to the amino acid L-carnitine. It's absorbed into the bloodstream more efficiently than L-carnitine and passes more easily through cell membranes and is utilized more efficiently in the mitochondria of the cell. ALC assists in the transport of fat through the cell membrane and into the mitochondria of the cell, where fats are oxidized to produce the cellular energy ATP. ALC also promotes a healthy nervous system and supports memory.
L-carnitine is helpful in the treatment of dyslipidemia and particularly in case of elevation of bad cholesterol- LP (a). This lipid molecule can increase the risk of CVD. In a study by Derosa et al. (2003) was demonstrated that L-carnitine is effective in diabetics 2 with elevated LP (a) and has cardio protective effects while improving contractility of the heart in patients with heart problems. There is a study showing that L-carnitine may improve glucose control (Mingrone et al., 1999).
L-arginine works as a precursor amino acid to the formation of nitric oxide (chemical messenger that causes vessel’s relaxation). Hence L-arginine can improve endothelial dysfunction while working as an antioxidant scavenger for free radicals (Chowienczyk et al., 1997).
Q: Any other vitamins or minerals?
Answer: Acetyl L-carnitine (ALC) is the acetyl ester of the amino acid L-carnitine and is similar in form to the amino acid L-carnitine. It's absorbed into the bloodstream more efficiently than L-carnitine and passes more easily through cell membranes and is utilized more efficiently in the mitochondria of the cell. ALC assists in the transport of fat through the cell membrane and into the mitochondria of the cell, where fats are oxidized to produce the cellular energy ATP. ALC also promotes a healthy nervous system and supports memory.
L-carnitine is helpful in the treatment of dyslipidemia and particularly in case of elevation of bad cholesterol- LP (a). This lipid molecule can increase the risk of CVD. In a study by Derosa et al. (2003) was demonstrated that L-carnitine is effective in diabetics 2 with elevated LP (a) and has cardio protective effects while improving contractility of the heart in patients with heart problems. There is a study showing that L-carnitine may improve glucose control (Mingrone et al., 1999).
L-arginine works as a precursor amino acid to the formation of nitric oxide (chemical messenger that causes vessel’s relaxation). Hence L-arginine can improve endothelial dysfunction while working as an antioxidant scavenger for free radicals (Chowienczyk et al., 1997).
Q: Any other vitamins or minerals?
Answer: Minerals: Chromium is an essential nutrient with benefits in the holistic healing of metabolic syndrome and type 2 diabetes. Chromium is necessary for proper insulin function and blood glucose regulation because it helps facilitate the uptake of glucose for energy production, and it increases the efficacy of insulin, reducing the amounts the body must produce. It can be found in various foods, including whole-grain cereals, prunes, nuts and seafood. It is quite common for diabetics to be deficient in this vital trace mineral, but there are a number of chromium forms available in the dietary supplement market; many studies have been conducted and are ongoing in the management of blood glucose. Chromium carnosinate is a water-soluble, bio-available and biologically safe dipeptide-nutrient compound. And chromium picolinate, another biologically active form of chromium, has been tested on animals and humans.
Chromium is а critically essential cofactor for glucose control. Chromium helps insulin shuttle blood sugar (glucose) into cells. In fact, without chromium, insulin cannot work properly. Unfortunately, most Аmericаns аre deficient in this critical nutrient. Some experts believe thаt Аmericаns ingest less thаn half of the recommended dаily аmount of chromium. This mаy be pаrtly due to the nаtion’s over-reliаnce on processed foods, which аre generаlly rich in cаlories but poor in nutrients. Аnother fаctor contributing to widespreаd chromium deficiency is food grown in soil contаining а low content of minerаls such аs chromium. In fаct, the 1992 Eаrth Summit report showed thаt North Аmericаn soils hаve been depleted of 85% of their minerаl content in the pаst 100 yeаrs—the highest rаte of minerаl depletion in the world.13 Thus, it should come аs no surprise thаt most of the foods consumed аre deficient in trаce minerаls such аs chromium. It also helps cells respond well to insulin, the hormone produced within the pancreas that makes blood sugar available as energy.
Chromium stands out as a natural way to improve the insulin sensitivity of your cells by increasing the number of insulin “binding sites” on each cell. Taking Chromium can speed up the achievement of healthy, even blood sugar levels. Bulgarian researchers (Vladeva at al., 2005) conclude in their study that chromium supplementation can improve the glycemic control of type 2 diabetics possibly due to an increase in insulin action rather than stimulation of insulin secretion. Researchers added chromium levels appeared to be higher in the general Bulgarian population when compared to many Western countries (Vladeva at al., 2005).
Vanadium is also important in the metabolic syndrome improvement. It is enhancing the metabolism of glucose and improves and reverses the insulin resistance. The recommended dose is 100 mg vanadyl sulfate daily. (Cohen et al., 1995) Vanadium is another “insulin helper” and an extremely potent insulin-like agent. Canadian researchers state that vanadium has been shown to enhance glucose transport, glycogen and lipid synthesis, and inhibits gluconeogenesis and lipolysis in isolated cells. (Mehdi, 2006) It is proven that Vanadium can improve insulin sensitivity, and to enhance glucose transport, glycogen and lipid synthesis on molecular level significantly.
Magnesium deficiency can worsen insulin resistance a common phenomenon in metabolic syndrome and diabetic patients. The mineral can help glucose transportation into the cell to be utilized for energy in the mitochondria. The recommended dose is 500 mg of Magnesium (Paulisso, 1992). Magnesium is a mineral needed by every cell of your body. It helps maintain normal muscle and nerve function, keeps heart rhythm steady, and bones strong. In addition it is often called an anti-stress mineral as it has a calming effect and can assist in inducing restful sleep.
Calcium. Several reviews and mega-studies have concluded that calcium can help lower elevated blood pressure. A meta-analytical study analyzed results of 42 randomized clinical trials and found that calcium reduces systolic blood pressure by 1.44 mm/Hg and diastolic blood pressure by 0.84 mm/Hg. The conclusion of this study was that calcium supplementation leads to a small reduction in BP in hypertonic patients (Griffith, Guyatt, Cook, Bucher & Cook, 1999).
Potassium. Research has shown that potassium may help lower elevated blood pressure. It also helps lowering risk of stroke, maintaining muscle balance and preventing muscle cramping. Potassium helps to reduce the amount of sodium in the body and is essential for normal growth development and lifespan. A team of authors proved that potassium is beneficial for high blood pressure, cardiac arrhythmia, congestive heart failure, myasthenia gravis, muscle weakness, premenstrual syndrome and stroke prevention in a recommended daily dose of about 4,700 milligrams per day (Whelton et al., 1997).
Nickel. Nickel is a trace mineral, present in multiple cell types. Small amounts of nickel are useful in certain bodily functions; for example, minute amounts of nickel are important in DNA and RNA stabilization and may play a role in the metabolism of glucose and hormonal balancing functions. A new Spanish research (at the Hospital Príncipe de Asturias) showed the connection between several minerals: magnesium, copper, zinc, chromium, and nickel in a population of 92 diabetic individuals, some suffering from metabolic syndrome, proving that alterations in their levels may have important roles in its appearance and future healing (Aguilar et al., 2007).
Zinc. Zinc orotate is used to treat symptoms of proven zinc deficiency: osteoporosis, cardiovascular disease, diabetes, and lowered immunity. The relationship between obesity and zinc has been studied by author’s team (Chen, Lin & Lin, 1991). Zinc deficiency is known to be associated with an increased prevalence of coronary artery disease as well as Type 2 diabetes, with several other metabolic syndrome associated risk factors: hypertension, hypertriglyceridemia, and insulin resistance (Singh et al., 1998).
Vitamins and Co-factors:
Vit E -Vit E refers to a family of eight related, lipid-soluble, antioxidant compounds widely distributed in plants known as “tocopherol” and “tocotrienols”. The tocopherol and tocotrienol subfamilies are each composed of alpha, beta, gamma and delta, and all possess unique biological effects. Different ratios of these compounds are found in anatomically different parts of a plant. For example, the green parts of a plant contain mostly alpha tocopherol and the seed germ and bran contain mostly tocotrienols. Vit E has been clinically proven to promote healthy cholesterol levels also. They help inhibit the production of cholesterol in the liver and may actually be able to reverse arterial blockage, promoting efficient blood flow supply to the heart muscle. Research suggests that supplementing with 100 mg to 600 mg of CoQ10 daily may help maintain healthy cholesterol and blood pressure levels, contributing to overall cardiovascular health. In addition, it is a powerful antioxidant that helps protect heart cells from the damaging effects of free radicals, unstable molecules in the body produced by normal body processes (such exercise and digestion) and environmental factors (such as pollution and the sun's UV rays The natural blend of vitamin E is more effective as an antioxidant, when compared to the synthetic form. It is an essential vitamin which supports the immune system, and promotes healthy cardiovascular function. It may also help maintain healthy brain cells, and most aspects of a healthy body. It is a fat-soluble vitamin and one of the main antioxidants.
Vitamin C is a water-soluble vitamin that is essential for the overall normal growth and development of the body. It is required for the maintenance of healthy cartilage, bones, teeth and gums. Vitamin C is also important to the formation and maintenance of collagen, which in turn is significant to the health of skin, ligaments, tendons and blood vessels. Vitamin C also supports the health of your immune system, vision and cardiovascular system. It is the most important water-soluble antioxidant in the body, fighting the damaging effects of free radicals. As vital as this nutrient is, it is not stored in the body and therefore must be replaced regularly. Smoking, stress and certain illnesses can contribute to reduced levels. Since the body cannot make vitamin C on its own, it must be acquired through either diet or supplementation.
The family of vitamins Bs is required for the formation of cellular energy, hormones and proteins. The term "vitamin B-complex" refers to all essential water-soluble vitamins that include vitamin B1 (thiamine), vitamin B2 (riboflavin), vitamin B3 (niacin), vitamin B5 (pantothenic acid), vitamin B6 (pyridoxine), and vitamin B12 (cobalamine), as well as biotin and folic acid. These nutrients are vital for stress relief and nerve function. They are required for the formation of cellular energy, as well as for hormones and proteins. Plus, they serve to transform fats into other necessary products. B vitamins support the nervous system general health and maintenance, mental and emotional health, and stress defense. B vitamin deficiencies may contribute to stress-related symptoms, such as depression, irritability, and insomnia, and may even deplete certain chemicals vital to the body's natural stress response.
Vitamin B1 helps nerve cells to function properly and provides energy, while metabolisms may be energized by vitamin B2. Vitamin B1 is essential for every cell, and processes carbohydrates, proteins, and fats.
Vitamin B2 can serve as an antioxidant, is also essential for activating folic acid and vitamin B6, and for processing fats and amino acids.
Vitamin B3 is important for maintaining energy, and helps create healthy brain and nerve cells. It assists in transforming carbohydrates into fats, and also processes alcohol.
Vitamin B5 helps reduce stress and manage stress hormones. It is needed to maintain proper communication between the brain and nervous system. It is also vital for the activation of the adrenal glands, which help to combat stress. Besides its role in energy production, vitamin B5 is required for forming lipids (fats), steroids and neurotransmitters. One B5 by-product- pantethine, may help lower cholesterol and triglyceride blood levels.
Vitamin B6 helps to form various neurotransmitters, making it instrumental for proper mental and possibly mood, function. Vitamin B6 helps the processing of amino acids (the basic building blocks of all proteins), and hormones as melatonin, serotonin, and dopamine.
Vitamin B12 (methylcobalamin) provides crucial neurological benefits. It is essential for carbohydrate metabolism, and may contribute to cardiovascular health. It also helps to produce the nutrient S-Adenosyl-L-methionine (SAM-e), which holds joint and mood benefits.
Vitamin B12, Vitamin B6 and Folic acid in combination can help elevated homocysteine levels. It is recommended a dose of Folic acid-1-2mg; Vitamin B6-100-200mg; Vitamin B12- 500-1000 mcg.
Niacin (vit B3) is responsible for cholesterol regulation. Recently it has been proved superior in decreasing the bad cholesterol and increasing the good (HDL) cholesterol than Zetia and Vytorin (the highly prescribed pharmaceuticals for cholesterol control).
Biotin is essential for fat and carbohydrate metabolism, supporting cell and nerve tissue growth and development.
Choline Bitartrate. Choline prevents fats from accumulating in the liver, and is essential for the health of nerves, kidneys and liver. It aids in emulsifying cholesterol so it doesn't settle on the arterial walls. Most people with metabolic syndrome, hypertonia, heart abnormalities (heart palpitation), liver steatosis, and even liver cirrhosis are discovered to show choline deficiency. It is an important lipotropic (fat emulsifier) involved in the biosynthesis of lecithin and the formation of the amino acid methionine (Mindell, 1999).
Inositol. Inositol is not considered a vitamin per se because it can be synthesized by the body. It is beneficial in case of diabetic neuropathy, metabolic syndrome, panic disorder, high cholesterol, insomnia, cancer, depression, schizophrenia, Alzheimer's disease, attention deficit-hyperactivity disorder (ADHD), polycystic ovarian syndrome, hypertension, high triglycerides, high LDL cholesterol, peripheral vascular disease and Raynaud's disease (Goodman, Rall, Nies & Taylor, 1996).
Folic acid is required for cell replication and growth, and the production of DNA, RNA, and red blood cells. It also assists in digesting and utilizing proteins, and forms new proteins. It aids in tissue growth and cell function, and assists digestion. Also, folic acid is crucial for pregnant women's health, as it may hinder the formation of neural tube defects.
Vitamin A. Vit A is described as necessary for insulin production in a study that shows that decreased vitamin A intake decreases insulin production by the pancreas beta-cells, emphasizing the importance of adequate vitamin A intake (Matthews, Rhoten, Driscoll & Chertow, 2004). Another separate study suggests the threshold for vitamin consumption in terms of metabolic syndrome benefits in humans. The authors concluded that an intake of 10,000 IU can lower blood sugar and insulin in healthy people (Facchini, Abbasi & Reaven, 2001). The conclusion from both studies is that vitamin A could be beneficial in preventing the metabolic syndrome.
Vitamin D3. Over the past five years, researchers have established tentative links between vit D deficiency and metabolic syndrome. I consider vit D3 the new Hollywood Star in healing the metabolic syndrome the natural way. A new study from Spain provides new evidence that the two are closely associated. It looked at a group of morbidly obese individuals and found that 63 percent of them had metabolic syndrome. A little more than half of the group also had too little vitamin D in their bodies. Replacement of vit D3 to healthy levels yields: higher HDL, lower triglycerides, lower blood sugar, reduced C-reactive protein, reduced blood pressure, reduced VLDL, enhanced sensitivity to insulin. Replacement of vit D3 to healthy levels enhances insulin sensitivity and reverses insulin resistance to the healthy levels.
Another study (2004) published in the American Journal of Clinical Nutrition found that raising a person’s blood levels of vitamin D (from 25 to 75 nmol/l) could improve insulin sensitivity by a whopping 60 percent. Compare that to metformin, one of our pharmaceutical gold-standards, which can dispose of blood sugar by a meager 13 percent according to the New England Journal of Medicine. Many studies have concluded that D is good for people, especially those who have high insulin, prediabetes, diabetes, metabolic syndrome, pancreatitis, breast or prostate cancer and heart disease.
Vitamin K-2 (Menaquinone). The Rotterdam Study (a prospective, population-based study) was derived to investigate the risk of incidental CHD, all-cause mortality, and aortic dissection mortality in a cohort of 7,083 men and women aged 55 and over. The analysis included 4,807 individuals with dietary data and no history of previous myocardial infarction or other heart incident. The cohort was followed until January 1, 2000. After accessing all factors--age, gender, MBI, smoking habits, education and dietary factors--vitamin K was added to the subject’s diet. The author’s final conclusions were that a dietary intake of K2 is significantly associated with reduced risk of CHD. It can also help to provide major protection from osteoporosis, cardiovascular disease and heart and vessel calcification (Geleijnse et al., 2004).
Enzymes:
Bromelain. Bromelain is a digestive enzyme found in the stem and fruit of the pineapple plant Ananas comosus. It is best known as a digestive aid and for its anti-inflammatory effects while used in between meals. It is used successfully to help treat a number of disorders including heart disease, arthritis, and upper respiratory tract infection (Kelly, 1996). Bromelain was proven to inhibit the aggregation of platelets, and to help prevention of heart disease caused by plaque formation that could lead to a future heart attack (Werbach, 1993; Werbach & Murray, 1993; Whitaker, 1997).
Papain. Papain represents an enzyme found in the papaya fruit. It is best known for its digestive and anti-inflammatory effects, used between meals. It can be proven helpful in heart disease treatment and prevention (Werbach, 1993).
Good fats:
Omega-3 fatty acid. The holistic practice recognizes that there is an over-supply of omegа-6 fаtty аcids in the Western diets. Thus, correcting the rаtio of omegа-6 to omegа-3 fаtty аcids, аs close to 1-to-1 аs possible, is extremely importаnt to correct the widespreаd deficiency of omegа-3 fаtty аcids in the diet. Fish oil is found to enhаnce and even reverse insulin sensitivity--hence, enteric-coated fish oils аre to be preferred for enhаnced compliаnce аnd bioаctivity becаuse therаpeutic dosаges of fish oil аre meаsured in grаm amounts. From a holistic point of view, a low fаt/ low cholesterol diet with correct proportion between 3:6 omegas EFA, a restriction in saturated fats аnd daily exercise аre essentiаl in helping to lower cholesterol or to mаintаin low cholesterol levels. There are many clinical studies that prove that regular consumption of fish oil (omega-3) can lower the risk of sudden cardiac death and to protect against heart disease. Working as anti-inflammatory substances, they can reduce significantly inflammation as a byproduct of degenerative disease (obesity, metabolic syndrome, Alzheimer, gout, kidney disease, diabetes). Except their anti-inflammatory properties they can be used for their anti-clotting ones. UCLA scientists have confirmed that fish oil is the missing link to Alzheimer (recently known also as ‘diabetes of the brain’). Reporting in the current issue of the J. of Neuroscience Prof. Greg Cole reports that the omega-3-fatty acid docosahexaenoic acid (DHA) increases the production of LR11, a protein found in Alzheimer’s patients.
Plant stanols/ sterols. Plant stanols/sterols containing Phytosterols have cholesterol-lowering properties (reducing cholesterol absorption in intestines in forms that are sufficiently bioavailable for therapeutic effect) should be a key element of maximal dietary therapy. The above principle has been already recognized by the National Cholesterol Education Program (NCEP) Adult Treatment Panel III (ATP III) and has been amply confirmed by experimental studies in humans. High LDL cholesterol can be also influenced by niacin, tocotrienol, red yeast rice, psyllium, oats, soy, policosanol, Garcinia cambogia, plant sterols/stanols, gugulipid, and coenzyme Q10. Elevated triglycerides can be decreased by a strong restriction of simple carbohydrates, and the addition of omega 3 EFA in a form of flax seed oil, borage oil, evening primrose oil, and cod liver oil. Heart health can be maintained by coenzyme Q10, B 12, B6, folic Acid, hawthorn leaf and flower, garlic; ALA, ALC.
Rutin. Rutin is a bioflavonoid, related to quercetin and hesperidin that mainly helps cholesterol normalization. It is found normally in plants and plays a role in detoxification processes in the body. It also facilitates absorption and proper use of vitamin C by the body. One of its main roles is to bind and flush out iron ions. Rutin may help strengthening capillaries, by improving elasticity of arterial walls while promoting greater blood flow to the heart, while diminishing risk of heart disease. Shils et al. (1994) proved that rutin may be beneficial in metabolic syndrome and diseases associated with it: chronic venous insufficiency, capillary fragility, hypertension, infections, heart attack, atherosclerosis, and dyslipidemia with stroke prevention. Rutin was also proved as a potent antioxidant that defends against free radical damage in case of obesity, metabolic syndrome, and dyslipidemia.
Hesperidin. Hesperidin is a compound found in citrus fruit peel, also known as a citrus bioflavonoid. It has a general anti-inflammatory and pain relieving effect and is closely related to other citrus bioflavonoids such as quercetin, rutin and diosmin. Alone or in combination with other bioflavonoids, it is used for vascular conditions: Type 2 diabetes, hemorrhoids, endometriosis, premenstrual problems, and diabetic gangrene with or without heart problems. Diabetic gangrene can be influenced as well as hemorrhoids and varicose veins, as proved by a team of researchers (Allegra, Bartolo & Carioti, 1995; Shils et al., 1994).
Quercetin. Quercetin is a bioflavonoid that supports cellular health and function. In human cells is known to have anti-inflammatory properties. It is a naturally occurring phytochemical recognized by several holistic practitioners as a powerful agent for promoting healing of inflammation, preventing cancer and reducing cholesterol levels (Comalada et al., 2005). Recent Spanish study found that quercetin can reduce obesity, high blood pressure, plasma VLDL, and to reverse insulin resistance--all fragments of the metabolic syndrome. The study also proved that quercetin leads to an increased secretion of an enzyme--nitric oxide synthase—an eukaryoptic enzyme that catalyzes nitric oxide (NO) production from L-arginine. NO is an important cellular signaling molecule having a significant role in many biological processes such as vasodilatation in case of CVD and atherosclerosis (Rivera, Moron, Sanchez, Zarzuelo & Galisteo, 2008). Chinese medicine has long used quercetin-rich plant called Euonymus allatus (Fang, Gao & Zhu, 2008).
Phosphatidyl Choline. Phosphatidyl choline is a phospholipid and a main constituent of lecithin. As such, it is essential to form acetylcholine, one of the main neurotransmitters in the central nervous system. It demonstrates an inhibitory effect on cholesterol absorption and is used in metabolic syndrome with dyslipidemia. It may be beneficial in cases of high C-reactive protein and homocysteine blood levels (associated with inflammation), heart disease, metabolic syndrome, obesity, Type 2 diabetes with peripheral vascular disorders, liver steatosis and cirrhosis, elevated triglycerides, memory loss, and in advanced aging in case of Alzheimer's disease (Murray, 1994).
Q: What about Botanicals?
Answer: Generally speaking, herbs are employed on the basis of their symptom specific effects. However, the desired symptom-specific effects are not always seen as a result. It is interesting to note that for any specific condition, there is always more than one herb available that can be employed. What is necessary for the achievement of the desired result is to match the appropriate herb to the appropriate constitution (metabolically and biochemically). In the case of metabolic syndrome herbal healing---the use of Terminalia Arjuna as a cardiac tonic and for blood pressure regulation, Guggul herb for a cholesterol control, Bitter melon- for glycemic and diabetes control, Garcinia cambogia for lipids control, Gymnema sylvestre must be matched to one’s metabolic syndrome management, so too must the nature and qualities of herbs or nutraceuticals be matched for predictable, reliable and desired effects to be achieved. It is resulted from the model that some people who are not obese by traditional measures nevertheless are insulin resistant and have abnormal levels of metabolic risk factors. Examples are seen in individuals with 2 diabetic parents or 1 parent and a first- or second-degree relative; the same is true for many individuals of Mexican or African ethnicity.
Gingko biloba. Gingko biloba is an herbal extract that has been double-blind tested many times for its ability to increase the oxygen content to the brain and other bodily tissues, including the heart. It has been shown to give cardiac protection against stroke and atherosclerosis, beling effective for hearing disorders and dizziness where blood flow is poor. It may offer significant protective action against strokes, and it protects arterial walls (Mashour, Lin & Frishman, 1998).
Hawthorn Berry. Hawthorn Berry works as a cardiac tonic, and may be used for cardiovascular conditions such as congestive heart failure (CHF), coronary circulation problems and arrhythmias. It is also used to increase cardiac output reduced by hypertension or pulmonary disease, to treat hypotension (low blood pressure) and hypertension (high blood pressure), atherosclerosis, and hyperlipidemia (Mashour, Lin & Frishman, 1998).
Grape seed extract (GSE). GSE is also used for diabetes complications such as neuropathy or retinopathy, improving wound healing, preventing dental caries, cancer prevention, age-related macular degeneration (ARMD), poor night vision, liver cirrhosis, allergic rhinitis, and prevention of collagen breakdown. GSE contains oligomeric proanthocyanidins (OPCs) or procyanidins which are responsible for these (antioxidant) actions. GSE is often used for preventing cardiovascular disease, varicose veins, hemorrhoids, atherosclerosis, and hypertension, and peripheral vascular disease, edema associated with injury or surgery, and myocardial or cerebral infarction.
A team of researchers (Moreno et al., 2003) found that GSE strongly inhibit pancreatic lipase in a “dose-dependent” manner. These findings implied that human adipocytes might absorb GSE from the circulation comparatively to Orlistat, which works only in the intestine. Thus, GSE could potentially reduce the levels of circulating free fatty acids and help prevent insulin resistance in obese people (Moreno et al., 2003).
Spanish experts analyzed the effect of grape seed proanthocyanidins on healthy male rats with normal blood lipid levels. GSE extract improves plasma lipid profile; it lowers triglycerides by 50% and apolipoproteins-B by 40%. It also significantly lowers free fatty acids and LDL (“bad cholesterol”) while slightly increasing HDL (“good cholesterol”) while the total cholesterol levels are not changed. Hence, a single dose may improve lipid profile and improve atherosclerotic risk index in rats (DelBas et al., 2005).
Another team of researchers summarized their results by suggesting that a combination of GSE and chromium polynicotinate (also known as niacin-bound chromium) can be more effective than either one alone in helping to protect humans against metabolic syndrome. The extract is used as an antioxidant and as an insulin-sensitivity enhancer (Preuss, Montamarry, Echard, Scheckenbach & Bagchi, 2000; Preuss, Bagchi & Bagchi, 2002).
Kava (kava-kava). Kava is a name or a term used for both the plant and the beverage made from it. The beverage is prepared from the root of the herb, found in Polynesia, Melanesia, and Micronesia. Kava is approved in European Union (EU) for treatment of anxiety. In the US is used mainly for its relaxing and calming effects, and for a weight loss. The use in a low dose is recommended, as in higher doses can be harmful for the liver. Herbalists are careful while prescribing Kava due to its liver toxicity. Several drugs as statins and acetaminophen (Tylenol) must be also avoided together with kava-kava, due to the cumulative liver toxicity of all the above (Volz & Kieser, 1997).
Garcinia cambogia. Garcinia is an herb that contains a biologically active compound—hydroxycitric acid, which is known to inhibit the synthesis of lipids and fatty acids and to lower the formation of LDL and triglycerides. Significant amounts of vitamin C and Garcinia have been used as a heart tonic in a study. Researchers have found that in an in vivo model in diabetic Zuker fatty rats (an equivalent to metabolic syndrome model in humans), the rats experienced a significant reduction in their symptoms when treated with niacin-bound chromium, Maitake mushroom and Garcinia cambogia (Heymsfield et al., 1998). The team confirmed that this combination can significantly ameliorate hypertension and diabetes mellitus, reduce high cholesterol, and may also inhibit the conversion of excess calories to body fat by inhibiting appetite substantially. The above results prove the herb as an effective herbal medicine for controlling metabolic syndrome. In conclusion Garcinia is well-established “fat-burning agent” all over the world and is currently becoming the primary herb in America, EU and Japan, for obesity and metabolic syndrome treatment (Heymsfield et al., 1998).
Gymnema Sylvestre. The primary use for this botanical is as an antidiabetic agent. The leaf extracts contain gymnemic acid which inhibits elevated blood sugar and acts as a cardiovascular stimulant. This use has been the subject of considerable research since the 1930s, with promising results for Type 1 and Type 2 diabetes. Gymnema is also known as Gurmar or Meshashringi, what literally means “sugar destroyer.” It has been used in Ayurvedic medicine for centuries to regulate sugar metabolism and to reverse insulin resistance. It was proven to prevent adrenaline from stimulating the liver to produce glucose, thereby reducing blood sugar levels and reversing insulin resistance (Sugihara et al., 2000).
Gymnema contains gymnemic acid (GA), quercitol, lupeol, ß-amyrin and stigmasterol, which have glucose lowering properties. The hypoglycemic (blood sugar-lowering) action of gymnema leaves was first documented in the late 1920s. The leaves of the herb increase secretion of insulin by the beta cells in the pancreas and improve uptake of glucose into the cells, by significantly stimulating the activity of the glucose-utilizing enzymes (Persaud, Al-Majed, Raman & Jones et al., 1999). In a study conducted by Diabetes Educators, Gymnema was found to lower HbA1c from 10.1% to 9.3%. The leaves are also known to lower serum cholesterol and triglycerides and abolish the taste of sugar, which neutralizes carbohydrate cravings (Bishayee & Chatterjee, 1994).
Mahonia grape (Oregon grape). Mahonia plant is used for ulcers, heartburn, stomach problems, and to treat infections. In low doses it is a cardiac and respiratory stimulant, while in high doses-it is a depressant. The American Indians used it for centuries as an appetite stimulant due to its bitter taste. The main herbal parts that are used are the rhizome and the root. The root contains 2.4 - 4.5% of isoquinoline alkaloid constituents including berberine, berbamine and oxyacanthine. Berberine has sedative, hypotensive, antifibrillatory, bile-stimulating and anti-inflammatory effects. Studies indicated that the constituent berbamine might have antiarrhythmic, hypotensive, spasmolytic and immunostimulating activity (Galle et al., 1994). Berberine (the most active ingredient) had a powerful antioxidant, anti-inflammatory and anti-mutagenic effect and its primary mode of action is the inhibition of lipid peroxidation in another study (Rackova, Oblozinsky, Kostalova, Kettmann & Bezakova, 2007).
Salacia reticulata/oblonga. Salacia is an Ayurvedic plant that has been grown and used for centuries in India. Studies proved that the herb helps support healthy blood sugar, insulin and blood lipid levels, reduces triglycerides and has LDL-lowering ability which aids in weight loss. Salacia is a powerful antioxidant also and contains mangiferin, a polyphenol that enhances the body's sensitivity to insulin, and participates in sugar digestion and absorption (Yoshikawa, Morikawa, Matsuda, Tanabe & Muraoka, 2002). Another study showed saponins positive effects on lowering LDL and triglycerides and hepatoprotective and antioxidant properties in vivo experimental studies in mice. In Japan the herb is generally used as a supplementary food in order to help against metabolic syndrome, diabetes as an antioxidant and for hepatoprotection (Yoshikawa, Ninomiya, Shimoda, Nishida & Matsuda, 2002). The largest dose ever offered experimentally to humans was 1,000 mg. The study concluded that this dose is decreasing insulin and blood glucose levels by 23% to 29% and that it has hepatoprotective effect (Yoshikawa et al., 2002).
Red Clover. Red clover is an herb rich in isoflavones (a class of phytoestrogens which are structurally similar to estrogens). Hence, the herb is very useful for hormonal disturbances in premenopausal and menopausal women. It may also help protect against heart disease due to its isoflavones that have been associated with elevation in "good" high-density lipoprotein (HDL). One study found that menopausal women taking red clover had better arterial compliance (stronger arteries), which can help prevent heart disease. Red clover was also proven to have blood-thinning properties, which keeps blood clots from forming (James, 1997).
Terminalia Arjuna. Terminalia bark contains several active constituents, including gallic acid, ethyl gallate, the flavone luteolin, and it is reported to be beneficial in cardiovascular conditions. It was also reported to lower serum cholesterol and is used for cardiovascular conditions, including heart disease, angina, hypertension, to lower the cholesterol in cases of hyperlipidemia, and to prevent necrosis of cardiac tissue. Terminalia Arjuna was also used orally as a mild diuretic (Vaidya, 1994; Vaidya, 1997).
Red yeast rice (Monascus purpureus). Red yeast rice is a byproduct of the yeast (Monascus purpureus). It contains fiber, starch and fatty acids, as well as monacolin and mevinolin that are proven to provide natural benefits for cholesterol health. Red yeast is proven to effectively inhibit cholesterol production in the liver similarly to statins. At the same time red yeast may lower Coenzyme Q 10 levels thus, recommendation on daily supplementation with Co Q 10 must be advised. Lately they were contraindications mentioned in the literature for its side effects, reminding to those of the statins family (Bartram, 2002).
Banaba Leaf (Lagerstroemia speciosa). Banaba leaf is a traditional folk remedy from Southeast Asia: India, Bangladesh, Malaysia, Thailand, Philippines, Indonesia, and Japan. At the beginning it was used for memory improvement. Secondarily the leaf extract was shown to have powerful effect in metabolic syndrome and Type 2 diabetes sufferers. Its main mechanism is to help maintaining healthy blood sugar levels with its active ingredient—corosolic acid. Several “in vivo” animal and human studies showed that corosolic acid helps to support optimal glucose metabolism and to reverse insulin resistance. A well randomized trial showed that banaba leaf can benefit adults with Type 2 diabetes, when taken for a period of two weeks. The study concluded those patients’ blood glucose levels decreased by 20-30% in total. In conclusion standardized banaba leaf extract may benefit people who suffer of metabolic syndrome and Type 2 diabetes, by maintaining optimal blood sugar concentrations and normalizing the function of insulin in the cells (Judy et al., 2003).
Jujube (Zizyphus Mauritania). Jujube is a small Indian tree used also in the Chinese medicine with its fruits – the main applicable part. Chinese medicine is using the fruits for its anti-anxiety and anti-depressive properties. The herb is also known as blood detoxified and purifier. Its main use was proven in cases of hypertension, appetite, anemia, for improving muscular strength, nephritis, for preventing liver steatosis, and in case of general inflammation. New research has shown that Indian jujube increases immune-system resistance, and it can be used in treatment of fevers (Arndt & Kayser, 2001).
Linseed oil (Ocimum sanctum). Linseed oil was always known for its antihyperlipidaemic and antioxidant effects. Its oil (OSSO) was investigated in alloxan diabetic rabbits (Gupta, Mediratta, Singh, Sharma & Shukla, 2006). The results of the study show hypocholesterolaemic and antioxidant effects despite they did not show any antidiabetic effect. Despite the authors believed that OSSO should be used for its good antioxidant properties, especially in cases of elevated lipid peroxidation like metabolic syndrome and diabetes. It was also found that linseed oil is increasing the reduced glutathione levels in blood (Narendhirakannan, Subramanian & Kandaswamy, 2006).
American ginseng (Panax quinquefolius). There are several small “in vivo” studies in the literature on the “thermogenic” and sugar lowering properties of the American ginseng in which 3g/d of a standardized ginseng extract is used. In one of the studies, ginseng was proven to reduce peak postprandial glucose by 1.0 mmol/L and insulin IAUC by 23.8% comparatively with the control group. A Canadian study proved that there is no significant difference across different ginseng types of treatments (Dascalu et al., 2007). A separate study studied the effects of American ginseng on blood glucose levels in mice (Xie et al., 2002) and showed that glucose tolerance improved significantly, and in addition, a significant reduction in body weight was observed after 12 days, due to its “thermogenic” effect. Two other small studies results support the antihyperglycemic (Xie, Wang, Wu, Basila & Yuan, 2005) and antiobese effects of American ginseng (Xie et al., 2002). In conclusion American ginseng can be a significant addition for prevention and treatment of metabolic syndrome with and without diabetes (Xie et al., 2002).
Asian ginseng (Panax ginseng). The root of Panax ginseng is well known as it has been used for centuries in China. The active substances in ginseng are similarly named--ginsenosides (steroidal saponines). Their sugar-lowering effect was also observed in a dose of 3g/d extract of Panax ginseng by Attele et al. (2002). Later study showed that treatment with the extract significantly reduces plasma cholesterol levels in mice. The study demonstrated that ginsenosides in Asian ginseng play a role in antihyperglycemic action (Xie et al., 2005). The study was programmed to study the antidiabetic effect of ginsenosides that was not associated with body weight changes. From the study became obvious that other constituents in the extract have antiobesity effect. Final conclusions of the above studies were that Asian ginseng berry extract may have therapeutic value in treating diabetics and obese patients as well as metabolic syndrome patients (Xie et al., 2002).
Fenugreek (Trigonella foenum graceum). Fenugreek is a well-known Mediterranean legume, with sugar-lowering potential. The herb has properties in improving glucose tolerance, decreasing sugar absorption, reducing insulin resistance, and improving and reversing insulin resistance by increasing insulin secretion from the pancreas. A comparative study on the activity of fenugreek and several other Indian medicinal plants in alloxan diabetic rats has been done by a team of researchers (Kar, Choudhary & Bandyopadhyay, 2003).
Hoodiа gordonii. Hoodia gordonii is a plant growing in the Kalahari Desert of South Africa. It has been used by African tribes for centuries to help keep off hunger while on long hunting expeditions in the desert. Researchers believed that a molecule found in Hoodia gordonii (known as P57) is the responsible active mechanism behind its ability to work as appetite inhibitor. At the same time the herb was proven to help support increased energy levels without any side effects. The properties of Hoodia gordonii in metabolic syndrome with obesity were studied by Holt (2005). Actually, Hoodia gordonii is under constant clinical trials in the last few years and is an herb with obvious clinical metabolic interest for the authorities.
Ashwagandha (Withania somnifera). Ashwagandha holds one of the main places in the Ayurvedic medicine. The herb is recognized from centuries as a powerful adaptogen that helps memory, and assists in times of elevated stress as calming botanical. In addition to its anti-stress properties it has expressed anti-inflammatory, energetic and rejuvenating properties. Researchers discovered that the herb is also a potent antioxidant with anti-cancer effect, and weight-loss boosting properties (Karst, 2006). The author described Ashwagandha as an adaptogen of first choice in metabolic syndrome treatment. The antioxidant activity of the glycowithanolides—the active part of Ashwagandha was studied separately by another team of researchers (Bhattacharya, Satyan & Ghosal, 1997).
Ivy Gourd (Coccinia indica and Coccinia cordifolia). Coccinia is an Ayurvedic herb used in India for centuries. Its main use is in obesity, metabolic syndrome and Type 2 diabetes management (prevention and healing). Coccinia indica protective effect on changes in the fatty acid composition in ѕtreptozotocin induced diabetic rats is studied by (Pari & Venkateswaran, 2003). Coccinia cordifolia and Coccinia indica are compared for their glycemic control in experimental model in rats (Kuriyan, Petracchi, Ferro-Luzzi, Shetty & Kurpad, 2008).
German chamomile (Matricaria recutita). The review of the medical literature reported a number of beneficial effects of chamomile in both, in vitro and in vivo animal tests. A recent study in Tokyo published in Nat Med Tokyo (2008) proved that chamomile is showing good antihyperglycemic and antioxidant properties in vivo animal models of diabetes. The study showed anti-proliferative and apoptotic effects in various human cancer cells and concluded that drinking chamomile tea daily with meals may help prevent the complications of diabetes, which include loss of vision, nerve damage, and kidney damage (Srivastava & Gupta, 2007).
Antioxidants:
There is abundant evidence that antioxidants in the diet can protect human cells from negative radicals. Although Melton (2006; p.42) calls them–“an antioxidant myth” and a "fairy tale,” they are helpful in metabolic syndrome prevention as well as to reduce chances of Type 2 diabetes and CVD appearance. The significance of flavonoids and other plant sterols in the diet were shown in a study done by a team (Miller & Larrea, 2002). The authors proved that antioxidants can slow hardening of the arteries and prevent coronary disease, all consequences of the metabolic syndrome. Consuming a variety of fruits and vegetables rich in antioxidants is a good approach in metabolic syndrome prevention and healing.
Adaptogens:
Adaptogens are a relatively new class of botanicals that are known to balance body metabolism and to increase the body’s resistance to physical and mental stress by modulating stress response mediated by levels of adrenal hormones- corticosteroids and adrenocorticotropic hormone (ACTH). Thus, they can improve digestive function and correct utilization of nutraceuticals absorbed with food. The concept of an adaptogen dates back centuries ago back to ancient India and China, while modern studies did not begin until the late 1940s. In 1947, Lazarev defined adaptogen as agents that allow the body to counter adverse physical, chemical, or biological stressors by raising nonspecific resistance toward such stress, thus allowing the organism to ‘adapt’ to the stressful circumstance. His definition for an adaptogen is still correct, but nowadays also may include an ability to balance endocrine hormones and the immune system. An overview with particular reference to adaptogen efficacy is offered by Pannosian and Wagner (2005). It is known from clinical experience that certain adaptogenic herbs and other traditional botanicals decrease symptoms of fatigue, stress, anxiety, neuralgia, depression, and other ailments. They are known to increase stamina and enhance physical performance. The ones that are used in metabolic syndrome prevention and healing are: Panax ginseng, Ashwagandha, Rhodiola rosea, Curcuma, Maca, Eleutherococcus senticosus, Cordyceps and Tribulus terrestris.
Super Foods:
Due to the fact that metabolic syndrome is intimately associated with oxidative stress, herbs, super foods and spices, with their rich arrays of antioxidants, can help reduce the impact of free radical damage by reducing the oxidation of fats in these patients (Pratt & Matthews, 2003). Some of the super foods that may be used, to cope with the metabolic syndrome are the following:
Green tea. Green tea may improve cognitive performance as well as treat stomach disorders, vomiting, diarrhea and headaches. It is used as a diuretic and in combination products for weight loss (Luo, Kannar, Wahlqvist & O'Brien, 1997). It may be beneficial to in prevention of heart disease, glucose abnormalities and kidney stones. Preliminary studies show that flavonoids found in green tea might reduce lipoprotein oxidation. In vitro tests indicate that catechins in green tea reduce proliferation of vascular smooth muscle that occurs with high concentrations of low-density lipoproteins (LDL). There is some evidence that an unidentified compound in green tea and caffeine suppresses thromboxane formation during blood clotting by inhibiting the release of arachidonic acid from platelets. A study indicated that a green tea extract rich in EGCG can increase calorie and fat metabolism (Luo et al., 1997). Polyphenols such as gallic acid and catechins such as epigallocatechin gallate (EGCG), epigallocatechin (EGC), epicatechin gallate (ECG) and epicatechin (EC) are abundant in green tea and were found to be responsible for many of its proposed benefits.
Garlic (Allium sativa).Scott (2006) emphasized the effects of spices in metabolic syndrome management. Garlic reduces both cholesterol and triglyceride levels, thereby reducing the risk of atherosclerosis, reversing atherosclerosis, by inhibiting and even reversing the deposition of cholesterol in the arterial endothelial layer, reducing the platelet stickiness by preventing the excessive aggregation of platelets, thus reducing the risk of heart attacks and thrombotic strokes (Scott, 2006). The author stated that garlic lowers blood pressure by stimulating the synthesis of nitric oxide which is an important chemical involved in vascular dilatation. Garlic, capers and coriander mimic the effects of insulin on the cell receptors while coriander enhances insulin secretion by the pancreas while ginger and caper counter insulin resistance by increasing sensitivity to insulin (Scott, 2006).
Spices:
Spices show a strong potency and range of effects in the fight against metabolic syndrome. In conjunction with vital lifestyle changes they can help to reverse the progress of this disease and its associated conditions. Capers, coriander and garlic mimic the effects of insulin on the cell receptors while coriander enhances insulin secretion by the pancreas while ginger and caper counter insulin resistance by increasing sensitivity to insulin.
As proved in the literature, cinnamon is one of the most potent inducer of insulin sensitivity and the addition of one gram of cinnamon a day to the diet can reduce abnormal blood glucose levels by 30%. Cinnamon enhances enzymes that increase insulin receptor sensitivity and inhibits those with opposite action. Cinnamon has the added benefit of lowering the abnormal lipid levels commonly found in metabolic syndrome and reducing the oxidative stress caused by lipid oxidation in these patients.
Turmeric (curcuma) comes from the ginger family and it has been extensively used in Ayurvedic medicine for centuries. Turmeric is a strong antioxidant and anti-inflammatory, known mainly by its mechanism to address cardiovascular issues, obesity, diabetes, and dyslipidemia (all metabolic syndrome abnormalities). It has antibacterial effect against some bacteria and it may be beneficial in atherosclerosis, as well as many other inflammatory diseases. A research indicates that curcumin is helpful for preventing heart failure and for repairing atherosclerotic oxidative damage. Vaidya (1997) believed that curcumin may turn off genes that enlarge the heart and cause fibrotic scarring.
Chromium is а critically essential cofactor for glucose control. Chromium helps insulin shuttle blood sugar (glucose) into cells. In fact, without chromium, insulin cannot work properly. Unfortunately, most Аmericаns аre deficient in this critical nutrient. Some experts believe thаt Аmericаns ingest less thаn half of the recommended dаily аmount of chromium. This mаy be pаrtly due to the nаtion’s over-reliаnce on processed foods, which аre generаlly rich in cаlories but poor in nutrients. Аnother fаctor contributing to widespreаd chromium deficiency is food grown in soil contаining а low content of minerаls such аs chromium. In fаct, the 1992 Eаrth Summit report showed thаt North Аmericаn soils hаve been depleted of 85% of their minerаl content in the pаst 100 yeаrs—the highest rаte of minerаl depletion in the world.13 Thus, it should come аs no surprise thаt most of the foods consumed аre deficient in trаce minerаls such аs chromium. It also helps cells respond well to insulin, the hormone produced within the pancreas that makes blood sugar available as energy.
Chromium stands out as a natural way to improve the insulin sensitivity of your cells by increasing the number of insulin “binding sites” on each cell. Taking Chromium can speed up the achievement of healthy, even blood sugar levels. Bulgarian researchers (Vladeva at al., 2005) conclude in their study that chromium supplementation can improve the glycemic control of type 2 diabetics possibly due to an increase in insulin action rather than stimulation of insulin secretion. Researchers added chromium levels appeared to be higher in the general Bulgarian population when compared to many Western countries (Vladeva at al., 2005).
Vanadium is also important in the metabolic syndrome improvement. It is enhancing the metabolism of glucose and improves and reverses the insulin resistance. The recommended dose is 100 mg vanadyl sulfate daily. (Cohen et al., 1995) Vanadium is another “insulin helper” and an extremely potent insulin-like agent. Canadian researchers state that vanadium has been shown to enhance glucose transport, glycogen and lipid synthesis, and inhibits gluconeogenesis and lipolysis in isolated cells. (Mehdi, 2006) It is proven that Vanadium can improve insulin sensitivity, and to enhance glucose transport, glycogen and lipid synthesis on molecular level significantly.
Magnesium deficiency can worsen insulin resistance a common phenomenon in metabolic syndrome and diabetic patients. The mineral can help glucose transportation into the cell to be utilized for energy in the mitochondria. The recommended dose is 500 mg of Magnesium (Paulisso, 1992). Magnesium is a mineral needed by every cell of your body. It helps maintain normal muscle and nerve function, keeps heart rhythm steady, and bones strong. In addition it is often called an anti-stress mineral as it has a calming effect and can assist in inducing restful sleep.
Calcium. Several reviews and mega-studies have concluded that calcium can help lower elevated blood pressure. A meta-analytical study analyzed results of 42 randomized clinical trials and found that calcium reduces systolic blood pressure by 1.44 mm/Hg and diastolic blood pressure by 0.84 mm/Hg. The conclusion of this study was that calcium supplementation leads to a small reduction in BP in hypertonic patients (Griffith, Guyatt, Cook, Bucher & Cook, 1999).
Potassium. Research has shown that potassium may help lower elevated blood pressure. It also helps lowering risk of stroke, maintaining muscle balance and preventing muscle cramping. Potassium helps to reduce the amount of sodium in the body and is essential for normal growth development and lifespan. A team of authors proved that potassium is beneficial for high blood pressure, cardiac arrhythmia, congestive heart failure, myasthenia gravis, muscle weakness, premenstrual syndrome and stroke prevention in a recommended daily dose of about 4,700 milligrams per day (Whelton et al., 1997).
Nickel. Nickel is a trace mineral, present in multiple cell types. Small amounts of nickel are useful in certain bodily functions; for example, minute amounts of nickel are important in DNA and RNA stabilization and may play a role in the metabolism of glucose and hormonal balancing functions. A new Spanish research (at the Hospital Príncipe de Asturias) showed the connection between several minerals: magnesium, copper, zinc, chromium, and nickel in a population of 92 diabetic individuals, some suffering from metabolic syndrome, proving that alterations in their levels may have important roles in its appearance and future healing (Aguilar et al., 2007).
Zinc. Zinc orotate is used to treat symptoms of proven zinc deficiency: osteoporosis, cardiovascular disease, diabetes, and lowered immunity. The relationship between obesity and zinc has been studied by author’s team (Chen, Lin & Lin, 1991). Zinc deficiency is known to be associated with an increased prevalence of coronary artery disease as well as Type 2 diabetes, with several other metabolic syndrome associated risk factors: hypertension, hypertriglyceridemia, and insulin resistance (Singh et al., 1998).
Vitamins and Co-factors:
Vit E -Vit E refers to a family of eight related, lipid-soluble, antioxidant compounds widely distributed in plants known as “tocopherol” and “tocotrienols”. The tocopherol and tocotrienol subfamilies are each composed of alpha, beta, gamma and delta, and all possess unique biological effects. Different ratios of these compounds are found in anatomically different parts of a plant. For example, the green parts of a plant contain mostly alpha tocopherol and the seed germ and bran contain mostly tocotrienols. Vit E has been clinically proven to promote healthy cholesterol levels also. They help inhibit the production of cholesterol in the liver and may actually be able to reverse arterial blockage, promoting efficient blood flow supply to the heart muscle. Research suggests that supplementing with 100 mg to 600 mg of CoQ10 daily may help maintain healthy cholesterol and blood pressure levels, contributing to overall cardiovascular health. In addition, it is a powerful antioxidant that helps protect heart cells from the damaging effects of free radicals, unstable molecules in the body produced by normal body processes (such exercise and digestion) and environmental factors (such as pollution and the sun's UV rays The natural blend of vitamin E is more effective as an antioxidant, when compared to the synthetic form. It is an essential vitamin which supports the immune system, and promotes healthy cardiovascular function. It may also help maintain healthy brain cells, and most aspects of a healthy body. It is a fat-soluble vitamin and one of the main antioxidants.
Vitamin C is a water-soluble vitamin that is essential for the overall normal growth and development of the body. It is required for the maintenance of healthy cartilage, bones, teeth and gums. Vitamin C is also important to the formation and maintenance of collagen, which in turn is significant to the health of skin, ligaments, tendons and blood vessels. Vitamin C also supports the health of your immune system, vision and cardiovascular system. It is the most important water-soluble antioxidant in the body, fighting the damaging effects of free radicals. As vital as this nutrient is, it is not stored in the body and therefore must be replaced regularly. Smoking, stress and certain illnesses can contribute to reduced levels. Since the body cannot make vitamin C on its own, it must be acquired through either diet or supplementation.
The family of vitamins Bs is required for the formation of cellular energy, hormones and proteins. The term "vitamin B-complex" refers to all essential water-soluble vitamins that include vitamin B1 (thiamine), vitamin B2 (riboflavin), vitamin B3 (niacin), vitamin B5 (pantothenic acid), vitamin B6 (pyridoxine), and vitamin B12 (cobalamine), as well as biotin and folic acid. These nutrients are vital for stress relief and nerve function. They are required for the formation of cellular energy, as well as for hormones and proteins. Plus, they serve to transform fats into other necessary products. B vitamins support the nervous system general health and maintenance, mental and emotional health, and stress defense. B vitamin deficiencies may contribute to stress-related symptoms, such as depression, irritability, and insomnia, and may even deplete certain chemicals vital to the body's natural stress response.
Vitamin B1 helps nerve cells to function properly and provides energy, while metabolisms may be energized by vitamin B2. Vitamin B1 is essential for every cell, and processes carbohydrates, proteins, and fats.
Vitamin B2 can serve as an antioxidant, is also essential for activating folic acid and vitamin B6, and for processing fats and amino acids.
Vitamin B3 is important for maintaining energy, and helps create healthy brain and nerve cells. It assists in transforming carbohydrates into fats, and also processes alcohol.
Vitamin B5 helps reduce stress and manage stress hormones. It is needed to maintain proper communication between the brain and nervous system. It is also vital for the activation of the adrenal glands, which help to combat stress. Besides its role in energy production, vitamin B5 is required for forming lipids (fats), steroids and neurotransmitters. One B5 by-product- pantethine, may help lower cholesterol and triglyceride blood levels.
Vitamin B6 helps to form various neurotransmitters, making it instrumental for proper mental and possibly mood, function. Vitamin B6 helps the processing of amino acids (the basic building blocks of all proteins), and hormones as melatonin, serotonin, and dopamine.
Vitamin B12 (methylcobalamin) provides crucial neurological benefits. It is essential for carbohydrate metabolism, and may contribute to cardiovascular health. It also helps to produce the nutrient S-Adenosyl-L-methionine (SAM-e), which holds joint and mood benefits.
Vitamin B12, Vitamin B6 and Folic acid in combination can help elevated homocysteine levels. It is recommended a dose of Folic acid-1-2mg; Vitamin B6-100-200mg; Vitamin B12- 500-1000 mcg.
Niacin (vit B3) is responsible for cholesterol regulation. Recently it has been proved superior in decreasing the bad cholesterol and increasing the good (HDL) cholesterol than Zetia and Vytorin (the highly prescribed pharmaceuticals for cholesterol control).
Biotin is essential for fat and carbohydrate metabolism, supporting cell and nerve tissue growth and development.
Choline Bitartrate. Choline prevents fats from accumulating in the liver, and is essential for the health of nerves, kidneys and liver. It aids in emulsifying cholesterol so it doesn't settle on the arterial walls. Most people with metabolic syndrome, hypertonia, heart abnormalities (heart palpitation), liver steatosis, and even liver cirrhosis are discovered to show choline deficiency. It is an important lipotropic (fat emulsifier) involved in the biosynthesis of lecithin and the formation of the amino acid methionine (Mindell, 1999).
Inositol. Inositol is not considered a vitamin per se because it can be synthesized by the body. It is beneficial in case of diabetic neuropathy, metabolic syndrome, panic disorder, high cholesterol, insomnia, cancer, depression, schizophrenia, Alzheimer's disease, attention deficit-hyperactivity disorder (ADHD), polycystic ovarian syndrome, hypertension, high triglycerides, high LDL cholesterol, peripheral vascular disease and Raynaud's disease (Goodman, Rall, Nies & Taylor, 1996).
Folic acid is required for cell replication and growth, and the production of DNA, RNA, and red blood cells. It also assists in digesting and utilizing proteins, and forms new proteins. It aids in tissue growth and cell function, and assists digestion. Also, folic acid is crucial for pregnant women's health, as it may hinder the formation of neural tube defects.
Vitamin A. Vit A is described as necessary for insulin production in a study that shows that decreased vitamin A intake decreases insulin production by the pancreas beta-cells, emphasizing the importance of adequate vitamin A intake (Matthews, Rhoten, Driscoll & Chertow, 2004). Another separate study suggests the threshold for vitamin consumption in terms of metabolic syndrome benefits in humans. The authors concluded that an intake of 10,000 IU can lower blood sugar and insulin in healthy people (Facchini, Abbasi & Reaven, 2001). The conclusion from both studies is that vitamin A could be beneficial in preventing the metabolic syndrome.
Vitamin D3. Over the past five years, researchers have established tentative links between vit D deficiency and metabolic syndrome. I consider vit D3 the new Hollywood Star in healing the metabolic syndrome the natural way. A new study from Spain provides new evidence that the two are closely associated. It looked at a group of morbidly obese individuals and found that 63 percent of them had metabolic syndrome. A little more than half of the group also had too little vitamin D in their bodies. Replacement of vit D3 to healthy levels yields: higher HDL, lower triglycerides, lower blood sugar, reduced C-reactive protein, reduced blood pressure, reduced VLDL, enhanced sensitivity to insulin. Replacement of vit D3 to healthy levels enhances insulin sensitivity and reverses insulin resistance to the healthy levels.
Another study (2004) published in the American Journal of Clinical Nutrition found that raising a person’s blood levels of vitamin D (from 25 to 75 nmol/l) could improve insulin sensitivity by a whopping 60 percent. Compare that to metformin, one of our pharmaceutical gold-standards, which can dispose of blood sugar by a meager 13 percent according to the New England Journal of Medicine. Many studies have concluded that D is good for people, especially those who have high insulin, prediabetes, diabetes, metabolic syndrome, pancreatitis, breast or prostate cancer and heart disease.
Vitamin K-2 (Menaquinone). The Rotterdam Study (a prospective, population-based study) was derived to investigate the risk of incidental CHD, all-cause mortality, and aortic dissection mortality in a cohort of 7,083 men and women aged 55 and over. The analysis included 4,807 individuals with dietary data and no history of previous myocardial infarction or other heart incident. The cohort was followed until January 1, 2000. After accessing all factors--age, gender, MBI, smoking habits, education and dietary factors--vitamin K was added to the subject’s diet. The author’s final conclusions were that a dietary intake of K2 is significantly associated with reduced risk of CHD. It can also help to provide major protection from osteoporosis, cardiovascular disease and heart and vessel calcification (Geleijnse et al., 2004).
Enzymes:
Bromelain. Bromelain is a digestive enzyme found in the stem and fruit of the pineapple plant Ananas comosus. It is best known as a digestive aid and for its anti-inflammatory effects while used in between meals. It is used successfully to help treat a number of disorders including heart disease, arthritis, and upper respiratory tract infection (Kelly, 1996). Bromelain was proven to inhibit the aggregation of platelets, and to help prevention of heart disease caused by plaque formation that could lead to a future heart attack (Werbach, 1993; Werbach & Murray, 1993; Whitaker, 1997).
Papain. Papain represents an enzyme found in the papaya fruit. It is best known for its digestive and anti-inflammatory effects, used between meals. It can be proven helpful in heart disease treatment and prevention (Werbach, 1993).
Good fats:
Omega-3 fatty acid. The holistic practice recognizes that there is an over-supply of omegа-6 fаtty аcids in the Western diets. Thus, correcting the rаtio of omegа-6 to omegа-3 fаtty аcids, аs close to 1-to-1 аs possible, is extremely importаnt to correct the widespreаd deficiency of omegа-3 fаtty аcids in the diet. Fish oil is found to enhаnce and even reverse insulin sensitivity--hence, enteric-coated fish oils аre to be preferred for enhаnced compliаnce аnd bioаctivity becаuse therаpeutic dosаges of fish oil аre meаsured in grаm amounts. From a holistic point of view, a low fаt/ low cholesterol diet with correct proportion between 3:6 omegas EFA, a restriction in saturated fats аnd daily exercise аre essentiаl in helping to lower cholesterol or to mаintаin low cholesterol levels. There are many clinical studies that prove that regular consumption of fish oil (omega-3) can lower the risk of sudden cardiac death and to protect against heart disease. Working as anti-inflammatory substances, they can reduce significantly inflammation as a byproduct of degenerative disease (obesity, metabolic syndrome, Alzheimer, gout, kidney disease, diabetes). Except their anti-inflammatory properties they can be used for their anti-clotting ones. UCLA scientists have confirmed that fish oil is the missing link to Alzheimer (recently known also as ‘diabetes of the brain’). Reporting in the current issue of the J. of Neuroscience Prof. Greg Cole reports that the omega-3-fatty acid docosahexaenoic acid (DHA) increases the production of LR11, a protein found in Alzheimer’s patients.
Plant stanols/ sterols. Plant stanols/sterols containing Phytosterols have cholesterol-lowering properties (reducing cholesterol absorption in intestines in forms that are sufficiently bioavailable for therapeutic effect) should be a key element of maximal dietary therapy. The above principle has been already recognized by the National Cholesterol Education Program (NCEP) Adult Treatment Panel III (ATP III) and has been amply confirmed by experimental studies in humans. High LDL cholesterol can be also influenced by niacin, tocotrienol, red yeast rice, psyllium, oats, soy, policosanol, Garcinia cambogia, plant sterols/stanols, gugulipid, and coenzyme Q10. Elevated triglycerides can be decreased by a strong restriction of simple carbohydrates, and the addition of omega 3 EFA in a form of flax seed oil, borage oil, evening primrose oil, and cod liver oil. Heart health can be maintained by coenzyme Q10, B 12, B6, folic Acid, hawthorn leaf and flower, garlic; ALA, ALC.
Rutin. Rutin is a bioflavonoid, related to quercetin and hesperidin that mainly helps cholesterol normalization. It is found normally in plants and plays a role in detoxification processes in the body. It also facilitates absorption and proper use of vitamin C by the body. One of its main roles is to bind and flush out iron ions. Rutin may help strengthening capillaries, by improving elasticity of arterial walls while promoting greater blood flow to the heart, while diminishing risk of heart disease. Shils et al. (1994) proved that rutin may be beneficial in metabolic syndrome and diseases associated with it: chronic venous insufficiency, capillary fragility, hypertension, infections, heart attack, atherosclerosis, and dyslipidemia with stroke prevention. Rutin was also proved as a potent antioxidant that defends against free radical damage in case of obesity, metabolic syndrome, and dyslipidemia.
Hesperidin. Hesperidin is a compound found in citrus fruit peel, also known as a citrus bioflavonoid. It has a general anti-inflammatory and pain relieving effect and is closely related to other citrus bioflavonoids such as quercetin, rutin and diosmin. Alone or in combination with other bioflavonoids, it is used for vascular conditions: Type 2 diabetes, hemorrhoids, endometriosis, premenstrual problems, and diabetic gangrene with or without heart problems. Diabetic gangrene can be influenced as well as hemorrhoids and varicose veins, as proved by a team of researchers (Allegra, Bartolo & Carioti, 1995; Shils et al., 1994).
Quercetin. Quercetin is a bioflavonoid that supports cellular health and function. In human cells is known to have anti-inflammatory properties. It is a naturally occurring phytochemical recognized by several holistic practitioners as a powerful agent for promoting healing of inflammation, preventing cancer and reducing cholesterol levels (Comalada et al., 2005). Recent Spanish study found that quercetin can reduce obesity, high blood pressure, plasma VLDL, and to reverse insulin resistance--all fragments of the metabolic syndrome. The study also proved that quercetin leads to an increased secretion of an enzyme--nitric oxide synthase—an eukaryoptic enzyme that catalyzes nitric oxide (NO) production from L-arginine. NO is an important cellular signaling molecule having a significant role in many biological processes such as vasodilatation in case of CVD and atherosclerosis (Rivera, Moron, Sanchez, Zarzuelo & Galisteo, 2008). Chinese medicine has long used quercetin-rich plant called Euonymus allatus (Fang, Gao & Zhu, 2008).
Phosphatidyl Choline. Phosphatidyl choline is a phospholipid and a main constituent of lecithin. As such, it is essential to form acetylcholine, one of the main neurotransmitters in the central nervous system. It demonstrates an inhibitory effect on cholesterol absorption and is used in metabolic syndrome with dyslipidemia. It may be beneficial in cases of high C-reactive protein and homocysteine blood levels (associated with inflammation), heart disease, metabolic syndrome, obesity, Type 2 diabetes with peripheral vascular disorders, liver steatosis and cirrhosis, elevated triglycerides, memory loss, and in advanced aging in case of Alzheimer's disease (Murray, 1994).
Q: What about Botanicals?
Answer: Generally speaking, herbs are employed on the basis of their symptom specific effects. However, the desired symptom-specific effects are not always seen as a result. It is interesting to note that for any specific condition, there is always more than one herb available that can be employed. What is necessary for the achievement of the desired result is to match the appropriate herb to the appropriate constitution (metabolically and biochemically). In the case of metabolic syndrome herbal healing---the use of Terminalia Arjuna as a cardiac tonic and for blood pressure regulation, Guggul herb for a cholesterol control, Bitter melon- for glycemic and diabetes control, Garcinia cambogia for lipids control, Gymnema sylvestre must be matched to one’s metabolic syndrome management, so too must the nature and qualities of herbs or nutraceuticals be matched for predictable, reliable and desired effects to be achieved. It is resulted from the model that some people who are not obese by traditional measures nevertheless are insulin resistant and have abnormal levels of metabolic risk factors. Examples are seen in individuals with 2 diabetic parents or 1 parent and a first- or second-degree relative; the same is true for many individuals of Mexican or African ethnicity.
Gingko biloba. Gingko biloba is an herbal extract that has been double-blind tested many times for its ability to increase the oxygen content to the brain and other bodily tissues, including the heart. It has been shown to give cardiac protection against stroke and atherosclerosis, beling effective for hearing disorders and dizziness where blood flow is poor. It may offer significant protective action against strokes, and it protects arterial walls (Mashour, Lin & Frishman, 1998).
Hawthorn Berry. Hawthorn Berry works as a cardiac tonic, and may be used for cardiovascular conditions such as congestive heart failure (CHF), coronary circulation problems and arrhythmias. It is also used to increase cardiac output reduced by hypertension or pulmonary disease, to treat hypotension (low blood pressure) and hypertension (high blood pressure), atherosclerosis, and hyperlipidemia (Mashour, Lin & Frishman, 1998).
Grape seed extract (GSE). GSE is also used for diabetes complications such as neuropathy or retinopathy, improving wound healing, preventing dental caries, cancer prevention, age-related macular degeneration (ARMD), poor night vision, liver cirrhosis, allergic rhinitis, and prevention of collagen breakdown. GSE contains oligomeric proanthocyanidins (OPCs) or procyanidins which are responsible for these (antioxidant) actions. GSE is often used for preventing cardiovascular disease, varicose veins, hemorrhoids, atherosclerosis, and hypertension, and peripheral vascular disease, edema associated with injury or surgery, and myocardial or cerebral infarction.
A team of researchers (Moreno et al., 2003) found that GSE strongly inhibit pancreatic lipase in a “dose-dependent” manner. These findings implied that human adipocytes might absorb GSE from the circulation comparatively to Orlistat, which works only in the intestine. Thus, GSE could potentially reduce the levels of circulating free fatty acids and help prevent insulin resistance in obese people (Moreno et al., 2003).
Spanish experts analyzed the effect of grape seed proanthocyanidins on healthy male rats with normal blood lipid levels. GSE extract improves plasma lipid profile; it lowers triglycerides by 50% and apolipoproteins-B by 40%. It also significantly lowers free fatty acids and LDL (“bad cholesterol”) while slightly increasing HDL (“good cholesterol”) while the total cholesterol levels are not changed. Hence, a single dose may improve lipid profile and improve atherosclerotic risk index in rats (DelBas et al., 2005).
Another team of researchers summarized their results by suggesting that a combination of GSE and chromium polynicotinate (also known as niacin-bound chromium) can be more effective than either one alone in helping to protect humans against metabolic syndrome. The extract is used as an antioxidant and as an insulin-sensitivity enhancer (Preuss, Montamarry, Echard, Scheckenbach & Bagchi, 2000; Preuss, Bagchi & Bagchi, 2002).
Kava (kava-kava). Kava is a name or a term used for both the plant and the beverage made from it. The beverage is prepared from the root of the herb, found in Polynesia, Melanesia, and Micronesia. Kava is approved in European Union (EU) for treatment of anxiety. In the US is used mainly for its relaxing and calming effects, and for a weight loss. The use in a low dose is recommended, as in higher doses can be harmful for the liver. Herbalists are careful while prescribing Kava due to its liver toxicity. Several drugs as statins and acetaminophen (Tylenol) must be also avoided together with kava-kava, due to the cumulative liver toxicity of all the above (Volz & Kieser, 1997).
Garcinia cambogia. Garcinia is an herb that contains a biologically active compound—hydroxycitric acid, which is known to inhibit the synthesis of lipids and fatty acids and to lower the formation of LDL and triglycerides. Significant amounts of vitamin C and Garcinia have been used as a heart tonic in a study. Researchers have found that in an in vivo model in diabetic Zuker fatty rats (an equivalent to metabolic syndrome model in humans), the rats experienced a significant reduction in their symptoms when treated with niacin-bound chromium, Maitake mushroom and Garcinia cambogia (Heymsfield et al., 1998). The team confirmed that this combination can significantly ameliorate hypertension and diabetes mellitus, reduce high cholesterol, and may also inhibit the conversion of excess calories to body fat by inhibiting appetite substantially. The above results prove the herb as an effective herbal medicine for controlling metabolic syndrome. In conclusion Garcinia is well-established “fat-burning agent” all over the world and is currently becoming the primary herb in America, EU and Japan, for obesity and metabolic syndrome treatment (Heymsfield et al., 1998).
Gymnema Sylvestre. The primary use for this botanical is as an antidiabetic agent. The leaf extracts contain gymnemic acid which inhibits elevated blood sugar and acts as a cardiovascular stimulant. This use has been the subject of considerable research since the 1930s, with promising results for Type 1 and Type 2 diabetes. Gymnema is also known as Gurmar or Meshashringi, what literally means “sugar destroyer.” It has been used in Ayurvedic medicine for centuries to regulate sugar metabolism and to reverse insulin resistance. It was proven to prevent adrenaline from stimulating the liver to produce glucose, thereby reducing blood sugar levels and reversing insulin resistance (Sugihara et al., 2000).
Gymnema contains gymnemic acid (GA), quercitol, lupeol, ß-amyrin and stigmasterol, which have glucose lowering properties. The hypoglycemic (blood sugar-lowering) action of gymnema leaves was first documented in the late 1920s. The leaves of the herb increase secretion of insulin by the beta cells in the pancreas and improve uptake of glucose into the cells, by significantly stimulating the activity of the glucose-utilizing enzymes (Persaud, Al-Majed, Raman & Jones et al., 1999). In a study conducted by Diabetes Educators, Gymnema was found to lower HbA1c from 10.1% to 9.3%. The leaves are also known to lower serum cholesterol and triglycerides and abolish the taste of sugar, which neutralizes carbohydrate cravings (Bishayee & Chatterjee, 1994).
Mahonia grape (Oregon grape). Mahonia plant is used for ulcers, heartburn, stomach problems, and to treat infections. In low doses it is a cardiac and respiratory stimulant, while in high doses-it is a depressant. The American Indians used it for centuries as an appetite stimulant due to its bitter taste. The main herbal parts that are used are the rhizome and the root. The root contains 2.4 - 4.5% of isoquinoline alkaloid constituents including berberine, berbamine and oxyacanthine. Berberine has sedative, hypotensive, antifibrillatory, bile-stimulating and anti-inflammatory effects. Studies indicated that the constituent berbamine might have antiarrhythmic, hypotensive, spasmolytic and immunostimulating activity (Galle et al., 1994). Berberine (the most active ingredient) had a powerful antioxidant, anti-inflammatory and anti-mutagenic effect and its primary mode of action is the inhibition of lipid peroxidation in another study (Rackova, Oblozinsky, Kostalova, Kettmann & Bezakova, 2007).
Salacia reticulata/oblonga. Salacia is an Ayurvedic plant that has been grown and used for centuries in India. Studies proved that the herb helps support healthy blood sugar, insulin and blood lipid levels, reduces triglycerides and has LDL-lowering ability which aids in weight loss. Salacia is a powerful antioxidant also and contains mangiferin, a polyphenol that enhances the body's sensitivity to insulin, and participates in sugar digestion and absorption (Yoshikawa, Morikawa, Matsuda, Tanabe & Muraoka, 2002). Another study showed saponins positive effects on lowering LDL and triglycerides and hepatoprotective and antioxidant properties in vivo experimental studies in mice. In Japan the herb is generally used as a supplementary food in order to help against metabolic syndrome, diabetes as an antioxidant and for hepatoprotection (Yoshikawa, Ninomiya, Shimoda, Nishida & Matsuda, 2002). The largest dose ever offered experimentally to humans was 1,000 mg. The study concluded that this dose is decreasing insulin and blood glucose levels by 23% to 29% and that it has hepatoprotective effect (Yoshikawa et al., 2002).
Red Clover. Red clover is an herb rich in isoflavones (a class of phytoestrogens which are structurally similar to estrogens). Hence, the herb is very useful for hormonal disturbances in premenopausal and menopausal women. It may also help protect against heart disease due to its isoflavones that have been associated with elevation in "good" high-density lipoprotein (HDL). One study found that menopausal women taking red clover had better arterial compliance (stronger arteries), which can help prevent heart disease. Red clover was also proven to have blood-thinning properties, which keeps blood clots from forming (James, 1997).
Terminalia Arjuna. Terminalia bark contains several active constituents, including gallic acid, ethyl gallate, the flavone luteolin, and it is reported to be beneficial in cardiovascular conditions. It was also reported to lower serum cholesterol and is used for cardiovascular conditions, including heart disease, angina, hypertension, to lower the cholesterol in cases of hyperlipidemia, and to prevent necrosis of cardiac tissue. Terminalia Arjuna was also used orally as a mild diuretic (Vaidya, 1994; Vaidya, 1997).
Red yeast rice (Monascus purpureus). Red yeast rice is a byproduct of the yeast (Monascus purpureus). It contains fiber, starch and fatty acids, as well as monacolin and mevinolin that are proven to provide natural benefits for cholesterol health. Red yeast is proven to effectively inhibit cholesterol production in the liver similarly to statins. At the same time red yeast may lower Coenzyme Q 10 levels thus, recommendation on daily supplementation with Co Q 10 must be advised. Lately they were contraindications mentioned in the literature for its side effects, reminding to those of the statins family (Bartram, 2002).
Banaba Leaf (Lagerstroemia speciosa). Banaba leaf is a traditional folk remedy from Southeast Asia: India, Bangladesh, Malaysia, Thailand, Philippines, Indonesia, and Japan. At the beginning it was used for memory improvement. Secondarily the leaf extract was shown to have powerful effect in metabolic syndrome and Type 2 diabetes sufferers. Its main mechanism is to help maintaining healthy blood sugar levels with its active ingredient—corosolic acid. Several “in vivo” animal and human studies showed that corosolic acid helps to support optimal glucose metabolism and to reverse insulin resistance. A well randomized trial showed that banaba leaf can benefit adults with Type 2 diabetes, when taken for a period of two weeks. The study concluded those patients’ blood glucose levels decreased by 20-30% in total. In conclusion standardized banaba leaf extract may benefit people who suffer of metabolic syndrome and Type 2 diabetes, by maintaining optimal blood sugar concentrations and normalizing the function of insulin in the cells (Judy et al., 2003).
Jujube (Zizyphus Mauritania). Jujube is a small Indian tree used also in the Chinese medicine with its fruits – the main applicable part. Chinese medicine is using the fruits for its anti-anxiety and anti-depressive properties. The herb is also known as blood detoxified and purifier. Its main use was proven in cases of hypertension, appetite, anemia, for improving muscular strength, nephritis, for preventing liver steatosis, and in case of general inflammation. New research has shown that Indian jujube increases immune-system resistance, and it can be used in treatment of fevers (Arndt & Kayser, 2001).
Linseed oil (Ocimum sanctum). Linseed oil was always known for its antihyperlipidaemic and antioxidant effects. Its oil (OSSO) was investigated in alloxan diabetic rabbits (Gupta, Mediratta, Singh, Sharma & Shukla, 2006). The results of the study show hypocholesterolaemic and antioxidant effects despite they did not show any antidiabetic effect. Despite the authors believed that OSSO should be used for its good antioxidant properties, especially in cases of elevated lipid peroxidation like metabolic syndrome and diabetes. It was also found that linseed oil is increasing the reduced glutathione levels in blood (Narendhirakannan, Subramanian & Kandaswamy, 2006).
American ginseng (Panax quinquefolius). There are several small “in vivo” studies in the literature on the “thermogenic” and sugar lowering properties of the American ginseng in which 3g/d of a standardized ginseng extract is used. In one of the studies, ginseng was proven to reduce peak postprandial glucose by 1.0 mmol/L and insulin IAUC by 23.8% comparatively with the control group. A Canadian study proved that there is no significant difference across different ginseng types of treatments (Dascalu et al., 2007). A separate study studied the effects of American ginseng on blood glucose levels in mice (Xie et al., 2002) and showed that glucose tolerance improved significantly, and in addition, a significant reduction in body weight was observed after 12 days, due to its “thermogenic” effect. Two other small studies results support the antihyperglycemic (Xie, Wang, Wu, Basila & Yuan, 2005) and antiobese effects of American ginseng (Xie et al., 2002). In conclusion American ginseng can be a significant addition for prevention and treatment of metabolic syndrome with and without diabetes (Xie et al., 2002).
Asian ginseng (Panax ginseng). The root of Panax ginseng is well known as it has been used for centuries in China. The active substances in ginseng are similarly named--ginsenosides (steroidal saponines). Their sugar-lowering effect was also observed in a dose of 3g/d extract of Panax ginseng by Attele et al. (2002). Later study showed that treatment with the extract significantly reduces plasma cholesterol levels in mice. The study demonstrated that ginsenosides in Asian ginseng play a role in antihyperglycemic action (Xie et al., 2005). The study was programmed to study the antidiabetic effect of ginsenosides that was not associated with body weight changes. From the study became obvious that other constituents in the extract have antiobesity effect. Final conclusions of the above studies were that Asian ginseng berry extract may have therapeutic value in treating diabetics and obese patients as well as metabolic syndrome patients (Xie et al., 2002).
Fenugreek (Trigonella foenum graceum). Fenugreek is a well-known Mediterranean legume, with sugar-lowering potential. The herb has properties in improving glucose tolerance, decreasing sugar absorption, reducing insulin resistance, and improving and reversing insulin resistance by increasing insulin secretion from the pancreas. A comparative study on the activity of fenugreek and several other Indian medicinal plants in alloxan diabetic rats has been done by a team of researchers (Kar, Choudhary & Bandyopadhyay, 2003).
Hoodiа gordonii. Hoodia gordonii is a plant growing in the Kalahari Desert of South Africa. It has been used by African tribes for centuries to help keep off hunger while on long hunting expeditions in the desert. Researchers believed that a molecule found in Hoodia gordonii (known as P57) is the responsible active mechanism behind its ability to work as appetite inhibitor. At the same time the herb was proven to help support increased energy levels without any side effects. The properties of Hoodia gordonii in metabolic syndrome with obesity were studied by Holt (2005). Actually, Hoodia gordonii is under constant clinical trials in the last few years and is an herb with obvious clinical metabolic interest for the authorities.
Ashwagandha (Withania somnifera). Ashwagandha holds one of the main places in the Ayurvedic medicine. The herb is recognized from centuries as a powerful adaptogen that helps memory, and assists in times of elevated stress as calming botanical. In addition to its anti-stress properties it has expressed anti-inflammatory, energetic and rejuvenating properties. Researchers discovered that the herb is also a potent antioxidant with anti-cancer effect, and weight-loss boosting properties (Karst, 2006). The author described Ashwagandha as an adaptogen of first choice in metabolic syndrome treatment. The antioxidant activity of the glycowithanolides—the active part of Ashwagandha was studied separately by another team of researchers (Bhattacharya, Satyan & Ghosal, 1997).
Ivy Gourd (Coccinia indica and Coccinia cordifolia). Coccinia is an Ayurvedic herb used in India for centuries. Its main use is in obesity, metabolic syndrome and Type 2 diabetes management (prevention and healing). Coccinia indica protective effect on changes in the fatty acid composition in ѕtreptozotocin induced diabetic rats is studied by (Pari & Venkateswaran, 2003). Coccinia cordifolia and Coccinia indica are compared for their glycemic control in experimental model in rats (Kuriyan, Petracchi, Ferro-Luzzi, Shetty & Kurpad, 2008).
German chamomile (Matricaria recutita). The review of the medical literature reported a number of beneficial effects of chamomile in both, in vitro and in vivo animal tests. A recent study in Tokyo published in Nat Med Tokyo (2008) proved that chamomile is showing good antihyperglycemic and antioxidant properties in vivo animal models of diabetes. The study showed anti-proliferative and apoptotic effects in various human cancer cells and concluded that drinking chamomile tea daily with meals may help prevent the complications of diabetes, which include loss of vision, nerve damage, and kidney damage (Srivastava & Gupta, 2007).
Antioxidants:
There is abundant evidence that antioxidants in the diet can protect human cells from negative radicals. Although Melton (2006; p.42) calls them–“an antioxidant myth” and a "fairy tale,” they are helpful in metabolic syndrome prevention as well as to reduce chances of Type 2 diabetes and CVD appearance. The significance of flavonoids and other plant sterols in the diet were shown in a study done by a team (Miller & Larrea, 2002). The authors proved that antioxidants can slow hardening of the arteries and prevent coronary disease, all consequences of the metabolic syndrome. Consuming a variety of fruits and vegetables rich in antioxidants is a good approach in metabolic syndrome prevention and healing.
Adaptogens:
Adaptogens are a relatively new class of botanicals that are known to balance body metabolism and to increase the body’s resistance to physical and mental stress by modulating stress response mediated by levels of adrenal hormones- corticosteroids and adrenocorticotropic hormone (ACTH). Thus, they can improve digestive function and correct utilization of nutraceuticals absorbed with food. The concept of an adaptogen dates back centuries ago back to ancient India and China, while modern studies did not begin until the late 1940s. In 1947, Lazarev defined adaptogen as agents that allow the body to counter adverse physical, chemical, or biological stressors by raising nonspecific resistance toward such stress, thus allowing the organism to ‘adapt’ to the stressful circumstance. His definition for an adaptogen is still correct, but nowadays also may include an ability to balance endocrine hormones and the immune system. An overview with particular reference to adaptogen efficacy is offered by Pannosian and Wagner (2005). It is known from clinical experience that certain adaptogenic herbs and other traditional botanicals decrease symptoms of fatigue, stress, anxiety, neuralgia, depression, and other ailments. They are known to increase stamina and enhance physical performance. The ones that are used in metabolic syndrome prevention and healing are: Panax ginseng, Ashwagandha, Rhodiola rosea, Curcuma, Maca, Eleutherococcus senticosus, Cordyceps and Tribulus terrestris.
Super Foods:
Due to the fact that metabolic syndrome is intimately associated with oxidative stress, herbs, super foods and spices, with their rich arrays of antioxidants, can help reduce the impact of free radical damage by reducing the oxidation of fats in these patients (Pratt & Matthews, 2003). Some of the super foods that may be used, to cope with the metabolic syndrome are the following:
Green tea. Green tea may improve cognitive performance as well as treat stomach disorders, vomiting, diarrhea and headaches. It is used as a diuretic and in combination products for weight loss (Luo, Kannar, Wahlqvist & O'Brien, 1997). It may be beneficial to in prevention of heart disease, glucose abnormalities and kidney stones. Preliminary studies show that flavonoids found in green tea might reduce lipoprotein oxidation. In vitro tests indicate that catechins in green tea reduce proliferation of vascular smooth muscle that occurs with high concentrations of low-density lipoproteins (LDL). There is some evidence that an unidentified compound in green tea and caffeine suppresses thromboxane formation during blood clotting by inhibiting the release of arachidonic acid from platelets. A study indicated that a green tea extract rich in EGCG can increase calorie and fat metabolism (Luo et al., 1997). Polyphenols such as gallic acid and catechins such as epigallocatechin gallate (EGCG), epigallocatechin (EGC), epicatechin gallate (ECG) and epicatechin (EC) are abundant in green tea and were found to be responsible for many of its proposed benefits.
Garlic (Allium sativa).Scott (2006) emphasized the effects of spices in metabolic syndrome management. Garlic reduces both cholesterol and triglyceride levels, thereby reducing the risk of atherosclerosis, reversing atherosclerosis, by inhibiting and even reversing the deposition of cholesterol in the arterial endothelial layer, reducing the platelet stickiness by preventing the excessive aggregation of platelets, thus reducing the risk of heart attacks and thrombotic strokes (Scott, 2006). The author stated that garlic lowers blood pressure by stimulating the synthesis of nitric oxide which is an important chemical involved in vascular dilatation. Garlic, capers and coriander mimic the effects of insulin on the cell receptors while coriander enhances insulin secretion by the pancreas while ginger and caper counter insulin resistance by increasing sensitivity to insulin (Scott, 2006).
Spices:
Spices show a strong potency and range of effects in the fight against metabolic syndrome. In conjunction with vital lifestyle changes they can help to reverse the progress of this disease and its associated conditions. Capers, coriander and garlic mimic the effects of insulin on the cell receptors while coriander enhances insulin secretion by the pancreas while ginger and caper counter insulin resistance by increasing sensitivity to insulin.
As proved in the literature, cinnamon is one of the most potent inducer of insulin sensitivity and the addition of one gram of cinnamon a day to the diet can reduce abnormal blood glucose levels by 30%. Cinnamon enhances enzymes that increase insulin receptor sensitivity and inhibits those with opposite action. Cinnamon has the added benefit of lowering the abnormal lipid levels commonly found in metabolic syndrome and reducing the oxidative stress caused by lipid oxidation in these patients.
Turmeric (curcuma) comes from the ginger family and it has been extensively used in Ayurvedic medicine for centuries. Turmeric is a strong antioxidant and anti-inflammatory, known mainly by its mechanism to address cardiovascular issues, obesity, diabetes, and dyslipidemia (all metabolic syndrome abnormalities). It has antibacterial effect against some bacteria and it may be beneficial in atherosclerosis, as well as many other inflammatory diseases. A research indicates that curcumin is helpful for preventing heart failure and for repairing atherosclerotic oxidative damage. Vaidya (1997) believed that curcumin may turn off genes that enlarge the heart and cause fibrotic scarring.
Q: Why Fiber?
Answer: These important micronutrients are needed to keep the body in a good balance. Fiber can fight cancer, diabetes, obesity and many other diseases. Vegetables, especially non-starchy vegetables, contain fiber and important micronutrients such as vitamins and minerals. Daily fiber may help metabolic syndrome patients to regulate blood sugar levels. The ability of oаt betа-glucаn to reduce blood choleѕterol in hypercholeѕterolemic ѕubjectѕ it is shown in a study by Brааten, Wood and Ѕcott (1994). Oats, spelt, corn, barley, peas, beans, fruits and vegetables are rich in fiber and complex carbohydrates. The connection between soluble fiber and serum lipids is shown in a literature review published by the team of researchers (Glore, Vаn Treeck & Knehаnѕ, 1994).
Glucomannan is another natural plant-based fiber that benefits digestive health. It is a calorie-free nutrient, what may promote healthy blood sugar levels and a significant decrease of elevated cholesterol. Derived from the konjac root, it is a water-soluble dietary fiber that acts as a bulk-forming laxative (Anderson, Algood & Turner, 1999). Another team of researchers (Anderson, Kendall & Jenkins, 2004) offered carbohydrate and fiber recommendations for individuals with diabetes. The lipid-and glucose-lowering efficacy of Plantago psyllium in Type 2 diabetes are studied by another team (Rodrigers-Moran, Guerrero-Romero & Lazcano-Burciaga, 1998).
Glucomannan is another natural plant-based fiber that benefits digestive health. It is a calorie-free nutrient, what may promote healthy blood sugar levels and a significant decrease of elevated cholesterol. Derived from the konjac root, it is a water-soluble dietary fiber that acts as a bulk-forming laxative (Anderson, Algood & Turner, 1999). Another team of researchers (Anderson, Kendall & Jenkins, 2004) offered carbohydrate and fiber recommendations for individuals with diabetes. The lipid-and glucose-lowering efficacy of Plantago psyllium in Type 2 diabetes are studied by another team (Rodrigers-Moran, Guerrero-Romero & Lazcano-Burciaga, 1998).
Others. a. Alcohol. In population-based studies, moderate drinkers are found to have lower insulin levels as compared to non-drinkers. Our small-scale studies have shown moderate drinkers to be more insulin sensitive. There have been no intervention studies to show that initiating alcohol consumption in individuals who are insulin resistant with low HDL is beneficial. So it is not reasonable to suggest that non-drinkers should start to drink 1-2 drinks per day. On the other hand, scientists do not have the evidence to recommend abstaining from alcohol. b. Smoking. Smoking is unequivocally bad, associated with high triglycerides, low HDL cholesterol and insulin resistance.
Q: Any final words?
Q: Any final words?
Answer: Metabolic Syndrome is a vicious circle and as such each one of its main symptoms must be adressed immediately and agressively. Keeping normal levels of blood sugar is N #1 factor for prevention of metabolic syndrome. Maintaining chronic high levels of blood sugar is a guarantee to develop not only Type 2 diabetes, but also obesity, dyslipidemia and high blood pressure (all abnormalities of the metabolic syndrome cluster). Glucose levels below the threshold for diabetes-126 mg/dl-used to be admitted as normal in past. Nowadays, even a level of 100-125 mg/dl can raise a significant risk of developing type 2 diabetes, heart attack, stroke, Alzheimer, and certain cancers. The government now refers to minimal elevations of glucose, known as “pre-diabetes” (impaired fasting glucose). “Thus anyone at a high risk with a sibling or a parent with diabetes, excess weight, and abdominal obesity should be tested annually for a fasting glucose” (Ford et al 2002 & Grundy et al 2005). The authors believe that what most people do not know or recognize is the rapid “aging” effect of sugar and the bottom line is that blood sugar frequent spikes can make anyone prematurely older than his generation. When excess blood sugar reacts with proteins in the blood, advanced glycosylation end-products (AGEs) are formed what is leading to rapid glycation. As a dangerous process, glycation impairs bimolecular, cellular, organ and tissue functions leading not only to premature aging but also to rapid degenerative decline. The authors make final conclusion that “blood sugar control is of paramount importance”.
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These statements have not been evaluated by the Food and Drug Administration. The material in this newsletter is provided for informational purposes only. Thus our intentions are not to diagnose, cure, mitigate, treat or prevent any disease. If you use the information in this newsletter without the approval of your health professional, the authors of this letter do not assume any responsibility. Copyright @ 2009, Natural Health-Wellness LLC. All rights reserved.
These statements have not been evaluated by the Food and Drug Administration. The material in this newsletter is provided for informational purposes only. Thus our intentions are not to diagnose, cure, mitigate, treat or prevent any disease. If you use the information in this newsletter without the approval of your health professional, the authors of this letter do not assume any responsibility. Copyright @ 2009, Natural Health-Wellness LLC. All rights reserved.
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