Metabolic Syndrome: Reducing Your Risk

  • In a segue from my last SharePost about coping with loss when you have schizophrenia, I wanted to talk about the alarming statistic that people with this diagnosis die 25 years earlier than the general population. You might wonder why that is and if it is under your control. I understand you could be justifiably worried because of the health risks associated with the medication you take. Armed with knowledge you have the power to make the changes that will benefit you. It will not be quick and it will not be easy yet it can be done.

    Most of the atypical medications used to treat schizophrenia and symptoms of other conditions like bipolar cause weight gain and as a result put people at risk for diabetes and heart disease. Metabolic syndrome is a cluster of risk factors for these and other diseases. People diagnosed with schizophrenia or other conditions who take atypicals often develop metabolic syndrome.

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    I'll talk here about what it is and what you can do to prevent it or halt it once it has started. This is one instance where making lifestyle changes like getting enough physical activity and exercise and eating heart-healthy food are the prime tactics for stopping the condition before it starts or managing it once you develop it.

    Metabolic syndrome is a cluster of risk factors linked to overweight and obesity. These factors elevate your risk of developing heart disease and diabetes and stroke. The five risk factors often occur together although any one can occur by itself. You are diagnosed with metabolic syndrome if you have at least three of the following:

    • A large waistline or abdominal obesity. This is the classic "apple" shape as opposed to pear shape body type where your excess fat is concentrated in the abdominal area instead of the hips. Women with a waist measurement of 35 inches or more and men with a measurement of 40 inches or more are at an increased risk of heart disease and these measurements are a metabolic risk factor.
    • A higher than normal triglyceride level. Or the use of medication to treat your triglycerides. This is a type of fat found in the body. A level of 150 mg/dL or higher puts you at risk.
    • A lower than normal HDL cholesterol level. This is the "good" kind of cholesterol that helps remove cholesterol from your arteries. It is also a risk factor if you're on medication to treat this. An HDL of less than 50 mg/dL for women and less than 40 mg/dL for men is a risk factor for heart disease and metabolic syndrome.
    • Higher than normal blood pressure. Or the treatment of your blood pressure with medication. This is indicated when your blood pressure is 130/85 mmHg or higher.
    • Higher than normal fasting blood sugar. Or the use of medication to treat your high blood sugar. A fasting blood sugar level less than 100 mg/dL is normal; between 100 and 125 mg/dL is prediabetes; 126 mg/dL or higher is diabetes. Above 100 mg/dL you have a metabolic risk factor.


    The most obvious sign of metabolic syndrome is a large waistline. Subtle signs like indicators of high blood sugar are increased thirst, increased urination (especially at night), fatigue and blurred vision. Another sign is that some people with a first elevation of high blood pressure experience dull headaches, dizzy spells or more nosebleeds than usual.


    You are twice as likely to develop heart disease and five times as likely to develop diabetes if you have metabolic syndrome compared to a person who doesn't have this cluster of risk factors. You are at the greatest risk for metabolic syndrome if you have a large waistline, an inactive lifestyle or insulin resistance.


    Heart disease is a condition that also can be caused by high LDL cholesterol (the "bad" kind) and smoking. You can assess your 10-year risk of developing heart disease with the NCEP online calculator. Even with a low risk the presence of metabolic syndrome over time will increase that risk. Having diabetes and metabolic syndrome together elevates your risk of heart disease as well.

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    This could all sound dire. How can you treat metabolic syndrome if you're diagnosed with it? The lifestyle approaches mentioned at the beginning of this SharePost are a good start: getting regular physical activity, losing weight, adopting a heart-healthy eating plan, and quitting smoking. Factors you can't control are treated with drugs. Your primary care doctor will use a physical exam and the results of blood work to diagnose you with metabolic syndrome. The first step in treatment is to lower your LDL cholesterol and high blood pressure and to manage diabetes if you have these conditions. The second step is to prevent type 2 diabetes if you don't already have it. When diabetes has already occurred, treatment is aimed at reducing the increased risk of heart disease. You can do this by controlling all your risk factors.


    The goal is to prevent metabolic syndrome in the first place, so start by measuring your waist with a tape measure placed around your middle, just above the hip bones. Remember to breathe out first. The tape should be snug yet not squeeze your flesh. Find your number.


    Calculate your Body Mass Index (BMI) too at the National Heart Lung and Blood Institute Web site. You are overweight if your BMI is between 25 and 29.9 and a reading of 30 or higher is technically obese.

    Please take heart if you're feeling overwhelmed or like you're ill-equipped to make drastic changes. Make one change at a time. I know a woman who lost 40 lbs over the course of two years. She treated her weight loss like it was a job and committed to doing one thing at a time to move towards her goal weight. Work with your treatment team to accomplish a healthy body just as you work with them to achieve a healthy mind.

    Two years ago I wrote a SharePost on healthful eating that you can review now to get an idea about what kinds of food to eat and their daily recommended servings. I suggest if you are concerned about your sugar to err on the side of eating more vegetables and fewer servings of fruit.

    Also remember: it is best to understand that a healthy weight might cover a range of weights not one single number on the scale. Weigh yourself once a week, in the morning, after you go to the bathroom and without any clothes on to get an accurate reading.

  • You can re-read my SharePost on improving your mental and physical health with exercise . Walking, treadmill walking or running, swimming, yoga, lifting free weights or using the machines, running, biking, and inline skating are just some activities that will benefit you.

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    The secret to getting in shape and staying fit is to do the things that you enjoy doing, to vary your routine and cross-train so that you don't get stuck in a rut, and to reward yourself for a job well done.

    Diet doesn't have to be a four-letter word, and indeed, adopting healthful eating habits is the goal, not starting and stopping and starting again an endless series of diets. If you slip up, forgive yourself and start over.

    I'd love to hear your stories about how you manage the risks associated with taking the schizophrenia medications, and any other helpful suggestions you have related to this topic.



Published On: March 21, 2010