Syndrome X: The Silent Killer

Syndrome X sounds so mysterious and sinister, I have appropriately nicknamed it the silent killer (I know hypertension has this moniker as well). There are well over 80 million North Americans afflicted with this condition and most of them aren’t aware of it. Yet having this condition may be the surest route to a heart attack or stroke, more so than elevated cholesterol alone.

In 1968, Dr. Gerald Reaven and his colleagues at Stanford University first started studying conditions of altered or defective insulin sensitivity. Insulin is the protein hormone that is secreted by the pancreas in order to move glucose from the bloodstream into the cells. Insulin sensitivity refers to how well the cells are listening to the message.

When one eats food, especially carbohydrates like fruits, vegetables, and all the grains, they are digested down into glucose. The glucose circulates in the bloodstream. Glucose cannot be simply absorbed into most cells of the body and used for energy. There are insulin receptors on the surface of the cells that are like locks on doors. Insulin is the key that fits in the locks; once the doors open, then the glucose can enter the cells.

Twenty years later, Dr. Reaven discovered that literally millions and millions of people suffer from a cluster of metabolic abnormalities collectively known as Syndrome X. At the core of this condition is a state known as insulin resistance, also know as metabolic syndrome.

Insulin Resistance and Metabolic Syndrome are at the core of Syndrome X

Insulin resistance is caused by the over-consumption of sugars and starches. When the blood stream is loaded with glucose, the liver and muscle cells, which are the primary storage areas for glucose, are quickly filled. If one’s diet is chronically high in carbohydrates and the cells are constantly full of glucose, the cells can actually deactivate some of the insulin receptors on their surface. Now the cells are not as sensitive to the hormone. In the future, after a meal, it takes a larger amount of insulin than normal to get the sugar into the cells and to bring the blood sugar blood back to normal.

If this process continues, in time the cells become so resistant to insulin that the pancreas can’t produce enough insulin to force the glucose into the cells. This is when the blood sugar starts getting higher and higher and eventually type 2 diabetes is diagnosed.

With insulin resistance, individuals cannot be diagnosed simply by looking at fasting blood sugar (FBS). Most times the FBS is normal or high normal. However, health symptoms and other lab values may already be starting to change.

Some symptoms that can appear with Syndrome X are: fatigue, brain fog, memory problems, anxiety or agitation, depression, weight gain and especially belly fat, blurred vision, skin tags, heart palpitations, and high blood pressure.

According to Dr. Barry Sears, author of the Zone books, chronic elevated insulin can also lead to constriction of the blood vessels, increased stickiness of the platelets, and inflammation which can all aggravate atherosclerosis and high blood pressure. It can also cause weakening of the immune system.

Lab values that may worsen in response to insulin resistance include increased triglycerides and/or LDLs, decreased HDLs, and elevated serum insulin.

So what is it about elevated insulin that causes so much harm?

Let me share with you one of Dr. Reaven’s analogies. Insulin acts like a shepherd, herding his precious flock into the cellular “corrals”. Unfortunately, in many people, glucose behaves like a group of errant sheep, stubbornly refusing to go where the shepherd directs. When that happens, the pancreas pumps out more and more insulin. That’s the biochemical equivalent of sending out more and more “shepherds” to get the “sheep” into the “corrals”. Imagine hundreds of shepherds chasing thousands of sheep across a pristine field covered with thick, beautiful green grass. Those hundreds of feet and thousands of hoofs will quickly tear up the field, ripping out and flattening down the grass. Soon, the field that once looked so green and lush will be trampled and scarred, brown, and dirty.

Something similar happens inside your body when glucose refuses to move into the storage cells at insulin’s command. The interior linings of your arteries, like the grassy field, are “ripped” and trampled” as the body attempts to overcome this problem.

Eventually, the insulin “shepherds” corral the glucose and order is restored in the body. But all is not well, for the “field” (lining of your arteries) is damaged and there’s other damage, as well. This damage sets the stage for heart disease or stroke.

The complete list of heart disease risk factors for people with Syndrome X are: impaired glucose tolerance, high insulin levels, elevated triglycerides, low HDLs, slow clearance of fat from the blood after a meal (hence fat stays in the blood stream longer and more likely to stick to the walls of the arteries), smaller, more dense LDL particles (more likely to pack tightly in the blood vessesls), increased propensity of the blood to form clots (more likely to have blockages in the vessels), decreased ability to dissolve blood clots, and elevated blood pressure.

Lifestyle factors that worsen Syndrome X: obesity, lack of physical activity, cigarette smoking,

excess alcohol, and the wrong diet.

Just how important are the Syndrome X risk factors? Men with elevated triglycerides and LDLs, plus low HDL, had 4.4 times the risk of heart disease. But the risks jumps to 20 fold in men with high blood triglycerides plus small, dense LDL particles and elevated fasting insulin seen in Syndrome X. Nearly 70% of the people with heart disease in the Quebec Cardiovascular Study had full-fledged Syndrome X, complete with elevated insulin and triglycerides, smaller and denser LDL particles and low HDL cholesterol. The study also found that for each 30% elevation of insulin levels, there was a 70% increase in the risk of heart disease over a 5-year period. Knowing all this about elevated insulin, it is important to ask your family doctor to test your serum insulin level to rule out Syndrome X. You will be happy to know that nutrition, lifestyle, and some supplements can successfully treat this condition. In the area of nutrition, the key is to limit sugars and starchy carbohydrates. I suggest a diet with a ratio of 15% protein, 40% fat (30 – 35% polyunsaturated fat and 5 – 10% saturated fat), and 45 % carbohydrates. This diet is simple and effective because it reduces carbohydrates and increases fats. Protein also has a mild affect on insulin secretion so that food group must be limited as well. Fat, whether saturated or unsaturated, has no affect on insulin levels. The more daily calories that come from fat and the fewer that come from carbohydrates, allows better control over blood sugar and insulin. If the bulk of the fat is coming from healthy foods like avocado, nuts, seeds, fish, olive oil, flaxseed oil, canola oil, and so on, both insulin and LDL cholesterol levels are both decreased, lowering the risk of cardiovascular disease. Carbohydrates should be obtained primarily from low starch vegetables, and then smaller amounts of whole grain products, starchy vegetables, and fruits. Choices of protein can include fish, organic, grass-fed meats and dairy products, omega 3 rich eggs, beans, lentils, nuts, and seeds. This style of diet is tasty (most people enjoy the taste of fat), simple, effective, and most people have no trouble sticking to it for long periods of time. Aside from increasing the protein intake once the Syndrome X symptoms are controlled, it really is a diet that one can maintain for life. Second to diet, exercise is next best way to control Syndrome X. Regular aerobic will increase sensitivity to insulin and burns up glucose during exercise, thus reducing the amount of insulin needed to get glucose into the cells. With regular aerobic exercise, as one gets fitter, the efficiency with which glucose moves into the cells can improve by as much as 25%. Aerobic exercise, which gets the blood moving more rapidly and the breath rate up can include brisk walking, running, cycling, dancing, swimming, or other sports. It should be done for 30 minutes for most days of the week. But any exercise is better than none. A single exercise session can increase insulin efficiency both during that session and for as much as two days afterwards.

The better shape you are in and more you exercise regularly, the better the results.

The combination of improved diet and regular exercise usually has a positive consequence. That is weight loss. Studies have shown that weight loss has a tremendous affect on insulin resistance. In one study with a group of 36 overweight individuals ages 24 to 69 years of age, when they lost an average of 20 pounds over 5 months, their insulin efficiency improved by approximately 40%. Another positive bonus was that their triglyceride levels dropped dramatically as well.

Some negative lifestyle habits that aggravate Syndrome X are things like smoking, alcohol, and caffeine. All three of these vices have the effect of increasing blood sugar. As we know, this in turn increases insulin production.

I hope this information is useful in helping you gain some insight on a condition that is not well addressed by the conventional medical system. The impact to the healthcare system and to individuals’ quality of life could be devastating. If you are unsure how to proceed with controlling Syndrome X, consult your naturopathic physician.