Not Just Apples vs. Pears: Now It Is Metabolic Syndrome

Metabolic Syndrome was the headline issue at last week’s annual meeting of psychiatrists (APA). What is it? Do you fit the criteria? What can you do about it? What Is It? Metabolic Syndrome is common and it increases your risk of dying from a heart attack by 3 1/2 times. If you or a loved one meet the criteria you can do something about it. I’m sure I have been embarrassing people lately when I whip out my tape measure and measure their waist – at the level of the umbilicus. It turns out that abdominal fat is much more of a health problem (the apples) as opposed to hips and butt fat (pears) which has no increased heart risk. In fact, recently the big "booty" has been in fashion. But a waistline of 35" or more in women or 40" or more in men is one of the 5 criteria for Metabolic Syndrome. (If you have any 3 of the 5 criteria you get the diagnosis). The 2nd factor is increased blood pressure and the standard now is tougher, 130/80. If either systolic is >130 or diastolic is >80 you have elevated blood pressure. The other 3 criteria require a fasting blood test (8 hours with nothing but water). Fasting blood sugar should be 100 or less. Triglycerides should be less than 150 and good cholesterol (HDL) should be 40 or more in men and 50 or more in women. These tests are simple and inexpensive and everyone should know where they stand. A family history of any of these problems increases your risk. Metabolic Syndrome and Psychiatry Why are psychiatrists taking a lead role in expanding public awareness? It turns out that some of the medications we commonly use can increase the risk of any or all of these factors. Three commonly used antidepressants used long term can cause weight gain. Some antidepressants can increase blood pressure but most striking is the group of mood stabilizers called Atypicals. Some of these medications can seriously increase risk of weight gain, increase fasting sugar, increase triglycerides and increase bad cholesterol. A consensus panel including members from the American Psychiatric Association and Endocrinologists convened in November of 2004. They concluded that the medications Clozaril and Zyprexa have a significant risk of causing Metabolic Syndrome. Seroquel and Risperdal have a lesser risk and Geodon and Abilify have the lowest risk. But the FDA is cautioning doctors to screen for these problems and to monitor patients that are on any of the medications from this category. Doctors consider the benefits vs. risks of all the medications that we prescribe. Ironically the "Atypicals" are among our most useful medications. At higher doses they treat the most severe symptoms of mania and schizophrenia, but they are also used for refractory depression and anxiety disorders, including hair pulling and skin picking. In fact, they are the most versatile of any group of medications used for stress disorders. Although we can’t say with absolute certainty that some of these medications are a lot safer than others, the consensus panel and clinical experience strongly suggest that this is the case. It will take large comparison studies to prove it. What Can You Do About Metabolic Syndrome? If you meet criteria for Metabolic Syndrome and you are on one or more of these medications you shouldn’t just stop them. You may want to consider changing if you are on the higher risk medications. Or you may discuss with your physician some of the behavioral and medical options to help reduce your risk. Of course the main cause for the Metabolic Syndrome is our fast food, sedentary life style. Dieting is not the answer – I will address that issue in my next article. Heart disease is by far the most common cause of premature death in men and women. Even if it doesn’t kill you it will lower your quality of life. Don’t wait for your doctor to pull out his blood pressure cuff and measuring tape. Be proactive! Take action now to find out where you stand on all 5 criteria.


Metabolic Syndrome Criteria (If you answer “yes” to 3 or more of these questions you could be diagnosed with Metabolic Syndrome.) 1. Is your waistline 35" or more (for women) or 40" or more (for men)? (Measured at the belly button, not under the gut!) 2. Is your blood pressure above 130/80? (either systolic is >130 or diastolic is >80) 3. Is your fasting blood sugar above 100? 4. Are your triglycerides above 150? 5. Is your HDL cholesterol less than 40 (for men) or 50 (for women)?

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