Metabolic Syndrome – Not Just Apples vs Pears

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, which is also coined Syndrome X, is a common chronic condition that disables the body from being able to efficiently burn the food you eat.  People with Metabolic syndrome have some insulin resistance leading to high concentrations of glucose and insulin within their bodies.  Many people are not aware that they even have this condition and even fewer are aware of the implications and seriousness of the disease, but individuals with this condition have increased risk of:


Peripheral Vascular Disease

Nervous System Disorders

Eye Disease


Cardiovascular Disease

Premature Aging



In addition to increased risk of cardiovascular diseases, your risk of actually dying from a heart attack is 3 1/2 times greater.  The good news about Metabolic Syndrome is that it is treatable and preventable, since it is largely a product of lifestyle. 

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, but since it turns out that abdominal fat is much more of a health problem (the apples) as opposed to hips and butt fat (pears), it is necessary for diagnosing Metabolic Syndrome.  Recently the big “booty” has been in fashion, and interestingly butt fat poses no increased heart risk.  However, 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.

What are the Determining Factors for Metabolic Syndrome?  (You must meet 3 out of 5)?

Waist Circumference greater than 35 inches in women and 40 inches in men.

 Blood Pressure) must be greater than or equal to 130/80.  Only 1 of the 2 values needs to be elevated to be considered a risk.

Fasting Glucose greater than 100. 

Triglycerides greater than 150. 

Good Cholesterol (HDL) less than 50 in women and 40 in men.

You can measure your own waist circumference and blood pressure easily, but for the other values you must get a fasting blood test done.  This means no food or drink, other than water, at least 8 hours prior to testing.  These tests are simple and inexpensive and everyone should know where they stand, so if you have never had your labs done or have not had them within the past year, you should ask your doctor about having them done.  

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 atypical medications Clozaril and Zyprexa have a particularly significant risk of causing Metabolic Syndrome. Seroquel and Risperdal have a lesser risk and Geodon and Abilify have the lowest risk of all the atypicals.

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 should consider the benefits vs. risks of all the medications that we prescribe, and 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 useful for treating 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, but 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, it is important to point out the main cause of Metabolic Syndrome related to lifestyle and our world of fast food and sedentary lifestyles contributes to the problem.  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, and consider lifestyle intervention if you qualify.   

Our office now offers weight loss and health coaching by providing fitness and nutrition guidance.  For more information about lifestyle coaching, contact our office or go to the PATH link.  


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