Metabolic Syndrome

Metabolic syndrome is the NHS name for a group of health problems that put you at risk of type 2 diabetes and of conditions that affect your heart or blood vessels. HEART UK lists the group as insulin resistance, high blood pressure, overweight carried around the waist, and unhealthy levels of blood fats. The NHS says it is very common, that its cause is not known, and that it is linked to insulin resistance and may also be linked to too much fat around the tummy.

It is different from metabolic disorders, which are rare genetic conditions. The NHS says metabolic syndrome increases your chances of cardiovascular disease and type 2 diabetes, and may also raise the chances of non-alcoholic fatty liver disease, osteoarthritis and gout. Each part can be measured, which is what makes it something you can act on.

Metabolic syndrome is recognised from a cluster of measurements: waist size, blood pressure, blood sugar and two blood fats, triglycerides and HDL cholesterol. The NHS says a GP or specialist who suspects it will:

• ask about medical conditions you or your family have
• check your BMI and waist measurement
• check your blood pressure
• ask about any symptoms you have
• arrange blood tests for blood glucose and the fats in your blood, such as cholesterol

You may be asked to have nothing but water for up to 12 hours before the blood test. HEART UK describes the blood fat pattern as high triglycerides with low HDL cholesterol. Some thresholds differ by background, and HEART UK, for example, sets a lower waist threshold for Asian men, so your clinician explains which of your results sit outside the healthy range for you.

Metabolic syndrome may cause no symptoms at all, and the NHS says you usually find out after a blood test or check-up. The signs are in your numbers:

• a waist that is more than half your height
• raised blood pressure
• an HbA1c in the prediabetes range or above
• high triglycerides or low HDL cholesterol on a lipid profile

The NHS lists these risk factors:

• living with obesity
• a diet high in saturated fat
• doing little exercise
• a Hispanic or South Asian background
• smoking
• drinking a lot of alcohol
• getting older

An NHS Health Check, offered every 5 years to people aged 40 to 74 without an existing condition, measures your waist, blood pressure and cholesterol, and sometimes blood sugar.

Metabolic health describes how well your body handles sugar and fat, and a clinician measures it with the same numbers used for metabolic syndrome. Those are your waist against your height, blood pressure, HbA1c or fasting glucose, and a lipid profile, often with liver function because the NHS links metabolic syndrome to fatty liver disease. NICE advises keeping your waist to less than half your height, which is the simplest check you can do at home.

A test sold as a metabolic test is sometimes something else. A resting metabolic rate test measures how much energy you burn at rest, which can help set a calorie target, and it tells you nothing about blood sugar or blood fats. Ask which one you are being offered, and what the result will change about your plan.

Metabolic syndrome is treated mainly with lifestyle changes, and the NHS puts losing weight, if you are overweight, first. Its advice is to:

• try to lose weight if you are overweight
• eat less saturated fat, meat and dairy, and more fruit, vegetables and whole grains
• do at least 150 minutes of moderate to intense exercise a week, spread over at least 4 or 5 days
• cut down or stop smoking
• avoid sitting for long periods

Your GP looks after any part of it that needs care beyond these changes, such as high blood pressure. Because every part of the syndrome is measurable, a review can show whether your waist, blood pressure, HbA1c and lipids are moving. A medical weight loss programme is built around those reviews.

The medical cause of a slow metabolism that a clinician tests for is an underactive thyroid. The NHS lists its symptoms as extreme tiredness, feeling cold, putting on weight, constipation, low mood, dry skin or hair, and irregular or heavy periods, and it is found with a blood test for TSH and T4. Treatment for an underactive thyroid restores normal levels.

Two other changes are normal. The British Heart Foundation explains that as you lose weight, your body needs less energy to maintain a smaller body, which is one reason weight loss slows. Muscle is also lost with age unless you train it. Some home scales report a metabolic age: it is an estimate calculated by the scale, useful as a trend on the same scale and no basis for a diagnosis.

See a GP if you think you are at risk of metabolic syndrome, which is the NHS advice, and see them promptly if you have symptoms that can mean type 2 diabetes:

• feeling very tired
• peeing more than usual
• feeling thirsty all the time
• losing weight without trying to

The NHS adds that not everyone with type 2 diabetes has symptoms, so a blood test matters. Symptoms of an underactive thyroid, such as extreme tiredness and feeling cold, also need a GP before any weight programme starts. If eating or your weight is causing you distress, speak to your GP or contact Beat.

A first assessment arranged by Medical Weight Loss London at UNTIL Soho, 111 Charing Cross Road, covers every part of metabolic syndrome. It measures your waist, weight and blood pressure, and arranges HbA1c, a lipid profile and liver function tests, with thyroid function and a full blood count. First assessments at London clinics cost about £150 to £310, with tests on top (what a programme costs).

The terms are explained in the weight management glossary. Ask what to get checked and UNTIL Health Concierge arranges the appointment with a registered clinician.