~ Syndrome X -- What It Is and How to Approach It

Syndrome X (Metabolic Syndrome, i.e., insulin resistance and hyperinsulinemia)

Eclectic physicians have, for the past 20 years, judged hyperinsulinism, or Syndrome X, a powerful indicator of an eventual heart attack. For clarity, let it be understood that a syndrome represents clusters of symptoms; in Syndrome X the symptoms are an inability to fully metabolize carbohydrates, hypertriglyceridemia, reduced HDL, smaller, denser LDL particles, increased blood pressure, visceral adiposity, disrupted coagulation factors, insulin resistance, hyperinsulinemia, and, often, increased levels of uric acid.

For years, high uric acid levels have been associated with cardiovascular disease, but the relationship was poorly understood. Dr. Gerald Reaven unraveled the link when he determined that elevations in uric acid are, often, promulgated by Syndrome X; Syndrome X, in turn, is a forerunner to heart disease. (Fang et al., 2000)

Until hyperinsulinemia is diagnosed and a therapeutic course charted, the arteries are under severe attack and the risk of a blood clot increases. Lesions, i.e., wounds and injuries, damage the arteries; attempts at vascular repair corrode the vasculature with atheromatous material, blockading and closing off vital circulatory routes. The population of sticky platelets increases, as well as the production of free radicals. Lipogenesis (the production and accumulation of fat in arterial tissue) encourages smooth muscles in the vasculature to proliferate. Along with excessive amounts of fibrinogen (a plasma protein that encourages the clotting of blood), PAI-1 (an inhibitor of the fibrinolytic process) becomes more active, further increasing the likelihood of a blood clot. HMG-CoA reductase, the rate-limiting enzyme involved in hepatic cholesterol production, appears simulated in both diabetic and non-diabetic animal studies amidst high levels of insulin. (Dietsschy et al., 1974)

Syndrome X interferes with glucose delivery, a consequence initiated by insulin's nonresponsiveness at the receptor site on the cell. Normally, ordinary levels of insulin will escort glucose into the cell, leaving a bloodstream favoring neither hyper or hypoglycemia. In Syndrome X, the receptor turns a cold shoulder to the hormone and insulin is no longer able to deposit its cargo; as a result glucose loads up in the bloodstream. The pancreas is aware of the problem and attempts to resolve it by discharging more and more insulin. The logic appears to be: since normal levels of insulin cannot get the job done, perhaps greater and greater amounts of circulating insulin will be able to drive glucose, the principal metabolic fuel, into our 60 trillion cells.

In most cases of type 2-diabetes the problem is insulin resistance and inadequate compensatory insulin; in Syndrome X, insulin resistance and excessive amounts of insulin are the hallmarks. The vast difference between the two conditions is that in Syndrome X, the pancreas does not falter in its effort to pump out insulin. It sounds as if the host has won but the following reasons discredit this logic.
  1. The pancreas can tire in its endless effort to supply compensatory insulin and insulin-dependent diabetes will result.
  2. Hormones are powerful substances with equally meaningful purpose. When insulin is not used for its intended functions, insulin builds up in the blood stream, and, from various perspectives, the risk of heart disease increases.
For example, hyperinsulinemia increases the risk of hypertension (twofold), hypertriglyceridemia (three to fourfold), type 2-diabetes (five to sixfold), and reduces HDL cholesterol levels. The Quebec Cardiovascular Study found that individuals with elevated levels of triglycerides and LDL cholesterol, plus low HDL cholesterol had 4.4 times the risk of heart disease compared to men with none of the risk factors. But, the risk soars to twenty fold in men with similar cardiovascular profiles who are also hyperinsulinemic. The Quebec study showed that with each 30% elevation in insulin levels, there was a 70% increase in the risk of heart disease over a five-year period. (Despres et al., 1996)

Many physicians fail to consider insulin resistance as a forerunner to both type 2 diabetes and cardiovascular disease. A fasting blood glucose above 115 mg dL, triglycerides above 160 mg/dL, HDL cholesterol (one fourth of total cholesterol), blood pressure persistently over 140/90 mmHg, total cholesterol above 240 mg/dL, and 10-15 pounds of extra weight usually gives a fair indication as to whether or not the patient has some degree of insulin resistance. (Challem et al., 2000) If fasting or two-hour postprandial (after meal) insulin levels are measured, a normal range is 6-35 mcIU/mL; a normal two-hour postprandial glucose is generally between 70-139 mg/dL. (Fasting and two-hour postprandial insulin levels are not standardized; subsequently variances in reference ranges occur.) Even if these tests are run, physicians, often, err in properly assessing the cumulative values of multiple irregularities. The signs are all there, but failure to connect the dots can lead to a treatment that never addresses the source of the ill health.

Syndrome X is, largely, a nutritional disease that is manageable with dietary corrections, i.e., reducing carbohydrates as sweets, pastas, and breads and instating "good fats" in carbohydrates place.

It has been determined that the quantity of food consumed, as well as the type of food selected, determines how much insulin must be supplied. The Harvard University School of Public Health announced that women between the ages of 38-63 increased their risk of heart attack by 40% if their diet contained quantities of carbohydrates, particularly of refined nature. Though refined carbohydrates are the most maligned, even starchy vegetables, as potatoes, corn, yams, carrots, peas, and most beans can be troublesome to some.

Dr. Gerald Reaven, renowned authority on Syndrome X believes an appropriate breakdown of the food groups should be about 45% of calories from carbohydrate, 40% from fat, and 15% from protein. Substituting fats for carbohydrates quiets an insulin release from the pancreas, and a primary step in Syndrome X has been aborted.

Dr. Reaven cautions that current dietary recommendations, i.e., replacing fats with carbohydrates may be fine for some individuals but a grievous, even fatal, suggestion for those insulin resistant.

Supplemental recommendations to assist in controlling Syndrome X include alpha-lipoic acid, conjugated linoleic acid, DHEA, essential fatty acids, magnesium, thiamine, vitamin A, and vitamin C, as well as those listed below.


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