Metabolic syndrome, which is also known as syndrome X, has become more common as the number of overweight and obese people rises. More than 300 million adults worldwide are obese, according to the World Health Organization. Metabolic syndrome refers to a cluster of conditions, including high blood pressure, high cholesterol and high blood sugar levels, and abdominal obesity, which raise a person's risk of heart disease, stroke and kidney damage. In the United States, an estimated 20-25 percent of adults have metabolic syndrome. A recent survey in Greece showed 2.3 million adults have the cluster of risk factors. A shift away from its Mediterranean-type diet is thought to be a factor. Inactivity, genetic factors and being overweight or obese are the underlying causes of metabolic syndrome. Each component of the syndrome raises the risk of developing one or more diseases. The more components people have, the greater the risk to their health.

Metabolic Syndrome symptoms
These include a large waistline, high blood pressure, raised insulin levels, excess body weight and abnormal cholesterol levels. If someone has three or more symptoms they have the syndrome and a higher risk of suffering from life-threatening illnesses.

Metabolic syndrome is a group of five risk factors that can increase your chance of developing heart disease, diabetes, and stroke. The five risk factors include:

Increased blood pressure
High blood sugar levels (insulin resistance)
Excess fat around the waist
High triglyceride levels
Low levels of good cholesterol, or HDL

Having one of these risk factors will increase your chances of developing heart disease.

Complications of Metabolic Syndrome X
People with metabolic syndrome x are three times as likely as healthy people to have a heart attack or stroke and twice as likely to die as a result. They also have a five-fold greater risk of developing type 2 diabetes. C-reactive protein is elevated in obese patients with the metabolic syndrome. Men with the metabolic syndrome are at increased risk of stroke even if they do not have diabetes or cardiovascular disease. S high rate of metabolic syndrome is found among patients with systemic lupus erythematosus.
   People with a constellation of diabetes and heart disease risk factors known as the metabolic syndrome are more likely to be depressed than people who are free from these risk factors.

Metabolic Syndrome Treatment
Increase physical activity, lose weight, give up smoking and lower blood cholesterol levels to reduce the risk of metabolic syndrome. A brisk 30-minute walk 6 days a week is enough to trim waistlines and cut the risk of metabolic syndrome.

ISRN Obes. 2012. Moderate weight loss decreases oxidative stress and increases antioxidant status in patients with metabolic syndrome.

Eur J Clin Nutr. 2015. A calorie-restriction diet supplemented with fish oil and high-protein powder is associated with reduced severity of metabolic syndrome in obese women.

Metabolic syndrome diet
Switching from white flour and sugar to whole grains reduces the risk. Some research has suggested that middle-age adults can lower their risk of metabolic syndrome by favoring a diet rich in whole grains such as bran, oats and brown rice over highly processed grain products like white bread.

Br J Nutr. 2015. High serum carotenoids associated with lower risk for the metabolic syndrome and its components among Japanese subjects: Mikkabi cohort study.

Food Funct. 2013. Pomegranate: a fruit that ameliorates metabolic syndrome. Department of Biotechnology, Christian-Doppler-Laboratory of Receptor Biotechnology, University of Natural Resources and Life Sciences Vienna, Muthgasse, Vienna, Austria. Pomegranate is an ancient fruit that is still part of the diet in the Mediterranean area, the Middle East, and India. Health-promoting effects have long been attributed to this fruit. Modern research corroborates the use of pomegranate as a folk remedy for diabetes and metabolic syndrome.

Dietary supplements
Pine bark extract in a product called Pycnogenol has been tested.

J Steroid Biochem Mol Biol. Jan 2014. Phytoestrogens and the metabolic syndrome. Extracts rich in phytoestrogens may be an alternative treatment or may complement conventional treatment for diseases linked with MS.

Diosgenin, 4-Hydroxyisoleucine, and Fiber from Fenugreek: Mechanisms of Actions and Potential Effects on Metabolic Syndrome.

Cause
Androgens and testosterone
As men age they are more likely to develop symptoms of metabolic syndrome, including increased belly size, high blood pressure, and cholesterol and blood sugar abnormalities. While levels of male hormones naturally decline with age, men who develop metabolic syndrome have lower androgen levels, specifically levels of sex hormone binding globulin and total testosterone. This could mean that androgen level decline leads to metabolic syndrome, or metabolic syndrome leads to low androgen or testosterone levels. My guess is the latter.

SSRI antidepressant drugs and their role
Obesity, dyslipidemia, and diabetes with selective serotonin reuptake inhibitors: the Hordaland Health Study.
J Clin Psychiatry. 2006. Raeder MB, Bjelland I, Emil Vollset S, Steen VM. Einar Martens' Research Group for Biological Psychiatry, Center for Medical Genetics and Molecular Medicine, Helse Bergen HF, Norway.
This study aimed to examine whether subjects taking selective serotonin reuptake inhibitors SSRI drugs are more likely to have elements of the metabolic syndrome compared with those taking no psychotropic drugs. For comparison, we also studied subjects taking antipsychotic drugs. We used data from The Hordaland Health Study '97-'99, a general community cross-sectional health survey including 25,315 subjects aged 40 to 49 and 70 to 74 years. For the groups studied, we estimated prevalence and odds ratios for obesity, hypercholesterolemia, low high-density lipoprotein cholesterol, hyper-triglyceridemia, and diabetes. We have shown that use of at least some SSRIs is associated with clinical and biochemical elements of the metabolic syndrome. Our data indicate differences in the metabolic side effect profile among various SSRI drugs, although treatment bias might have influenced these results. We suggest that patients taking SSRIs be carefully monitored for obesity and dyslipidemia.

Metabolic Syndrome in Children?
Overweight children and adolescents often show signs of it -- a cluster of risk factors that raise the risk of heart disease and diabetes. These include, in addition to excess body weight, high blood pressure, high blood sugar and high cholesterol levels. The good news is that diet and exercise can have a positive effect on reducing these risk factors in overweight youth

More than half a million children in Europe may be suffering from a cluster of obesity-related risk factors that will increase their odds of developing diabetes, heart disease and stroke. Youngsters in Europe are catching up with their counterparts in the United States, where 2 million children are affected by metabolic syndrome.
     Exposure to tobacco smoke -- either through active smoking or secondhand smoke -- increases the likelihood that adolescents will develop metabolic syndrome. The association is even stronger among teens who are overweight or at risk of being overweight.

Eat Less for Better Sex? In a new study, 100 men with metabolic syndrome were compared with matched male controls who did not have the syndrome (they are called the controls). Patients with metabolic syndrome had an increased prevalence of erectile dysfunction at 26% versus 13% for the control group. The syndrome X group also had a higher level of C-reactive protein, an marker of inflammation. Erectile dysfunction, which occurs in up to 30 million men in the United States and approximately 100 million men worldwide, affects up to 50% of males between 40 and 70 years of age. This study showed a linear increment in the prevalence of erectile dysfunction that is associated with a linear increase in C-reactive protein level. As the C reactive protein level rises, it starts affecting the endothelium, the lining in blood vessels responsible for maintaining healthy dilation of blood vessels. Many patients with erectile dysfunction seem to have a vascular mechanism that is similar to that seen in atherosclerosis, which includes endothelial dysfunction. “High Proportions of Erectile Dysfunction in Men With Metabolic Syndrome,” Esposito K, Giugliano F, et al, Diabetes Care, May 2005.

New data from ALLHAT (Antihypertensive and Lipid-lowering Treatment to Prevent Heart Attack Trial) fail to support a preference for either angiotensin-converting enzyme (ACE) inhibitors or calcium channel blockers over diuretics in nondiabetic hypertensive patients with or without the metabolic syndrome. The findings are especially true in African-American hypertensives.

Metabolic Syndrome, Inflammation, and Fatty Acids
The metabolic syndrome consists of hypertension, insulin resistance, central adiposity, hypertriglyceridemia, and low HDL cholesterol concentrations. Overweight preteen adolescents have higher plasma concentrations of C-reactive protein and interleukin 6 than do normal-weight control subjects. Fatty acid composition analysis of the subjects' plasma phospholipid and cholesteryl ester (CE) fractions also uncovered differences between normal-weight and overweight groups, including higher saturated fatty acids and lower n–3 polyunsaturated fatty acids in the overweight group, particularly in the phospholipid fraction. These distortions in the phospholipid fatty acid composition were even more pronounced in the subgroup of overweight subjects who met the criteria for the metabolic syndrome. The increased saturated fatty acid concentrations and reduced n–3 fatty acid concentrations in the overweight subjects are most likely due to poor diet. Furthermore, because n–3 fatty acids have antiinflammatory properties, a reduced intake of fish and leafy greens might also explain the higher concentrations of plasma interleukin 6 and C-reactive protein.

Metabolic Symptom Blood Markers
Patients with high levels of skin sterol (STC) in combination with high levels of C-reactive protein (CRP) are at almost twice the risk even after adjustment for age and gender/

Questions
Q. Is choline helpful for metabolic syndrome X? What about resveratrol or plant products?
   A. Choline may help lower homocysteine levels, but I have not seen any research regarding its effect on metabolic syndrome x. Anyway, this syndrome is best treated by diet and supplements are secondary although resveratrol has had a positive study in rodents. Many plant extracts can be of help, there are too many to mention, but opuntia is one.

Q. I have symptoms of metabolic syndrome x and would like to know which SSRIs are most likely to cause or make this syndrome worse.
   A. We have not seen any studies comparing different SSRIs and their effect on metabolic syndrome x.

Q. How do I know if I have metabolic syndrome x?
   A. A person is considered to have metabolic syndrome when they have three or more of the five following conditions: abdominal obesity, high triglyceride levels, low levels (HDL cholesterol, high blood pressure and high blood sugar. Having metabolic syndrome increases a person's risk of heart disease and type 2 diabetes.