We asked two healthcare practitioners to explain exactly what metabolic syndrome is, what the risk factors are and most importantly, how to reverse it.

While different countries have different definitions of what a healthy waist circumference should be, both Drs van Dyk and Magan agree that the waist circumference for a male should be less than 102cm and less than 88 cm in a female

Dr Liana van Dyk, who practices as an integrative doctor in Centurion, Pretoria, explains that metabolic syndrome is a cluster of five risk factors which includes:

  • High blood pressure > 130/85
  • High blood sugar > 100mg/dl
  • High serum triglycerides > 150mg/dl
  • Abdominal obesity
  • Low HDL (high density lipo proteins): Less than 40mg/dl in men and 50mg/dl in women

Dr Alkesh Magan, a specialist Physician /Endocrinologist in the Division of Endocrinology Diabetology and Metabolism in Sandton Johannesburg, says that the presence of any three of these risk factors can lead to a diagnosis of metabolic syndrome.

The presence of abdominal obesity or “having an apple shape” may be an obvious and very visible risk factor. Excess fat around the stomach area is also a greater risk for heart disease than excess fat in other parts of the body, such as the hips for example.

While different countries have different definitions of what a healthy waist circumference should be, both Dr van Dyk and Dr Magan agree that the waist circumference for a male should be less than 102cm and less than 88 cm in a female.

Dr Magan says that other risk factors for metabolic syndrome include age, a family history of metabolic syndrome, leading a sedentary lifestyle as well as women who have been diagnosed with polycystic ovary syndrome. Insulin resistance is another risk factor, which makes it difficult for the body to use sugar.

The good news is that metabolic syndrome can be reversed. Dr Magan says that by maintaining a healthy waist circumference and normal blood pressure and cholesterol levels can reduce the risk of metabolic syndrome. “Exercise and weight loss can aid in these efforts and decrease insulin resistance,” he says.

In particular, he advises that we follow a healthy diet that includes fruits, vegetables and whole grains. Regular physical activity will reduce blood pressure, blood sugar, and cholesterol levels. The key is to maintain a healthy weight”.

Dr van Dyk agrees but stresses that metabolic syndrome needs an integrative approach in order to be reversed and strongly recommends 30-60 minutes of exercise six days a week which can positively influence the gene variation that contributes to insulin resistance and excessive inflammation in the blood vessels.

In terms of diet, Dr van Dyk gives the following valuable advice: “Eat to live, don’t live to eat. Every mouthful of food that your body doesn’t need is wasted.  The food you eat today builds the body of tomorrow. Choose wisely!”

She says that you should have regular lean protein in small portions and to consider the macro and micro nutrients in the food that you eat. “Ask yourself if this food choice will contribute to good health and if not, rather leave it. Include lots of salads and vegetables in different colours and eat fruit in moderation,” she says.

She also suggests including good plant oils in the diet and to only eat sugar and empty carbs as an occasional cheat.

Dr van Dyk says that water is a natural appetite suppressant and we should all be drinking at least 100ml of water for every hour of the day, and more in summer especially in a semi-desert country like South Africa. Water also alkalises and detoxifies the body.

Sleep is also an essential component to good health. “Sleep enough and practise good sleep hygiene. Lack of sleep contributes to weight gain and disruption of hormone balance,” she says.

Traditionally metabolic syndrome has been more pertinent in men but today men, women and even children are affected.

According to statistics released by the National Department of Health last year, obesity rates in South Africa are increasing rapidly, with almost 70% of women and 40% of men either overweight or obese. New research seems to also indicate that while metabolic syndrome affects both men and women, women are most at risk of cardiovascular disease. Ironically, obese individuals who do not predominantly store fat in the abdominal area, do not show the same type of problems as patients with metabolic syndrome.

Dr van Dyk says that while every person with metabolic syndrome has an increased waistline, not every individual with an increased waistline will qualify as having metabolic syndrome, reiterating the importance of being assessed by a healthcare practitioner.

Dr Magan says that this is a lifestyle management issue. His advice to people who want to reduce their risk of developing metabolic syndrome is to adopt a physically active lifestyle and good nutrition programme. This prevents complications and can reduce or eliminate the need for prescription medication to control some of the problems associated with metabolic syndrome.

Dr Magan suggests that after intensive lifestyle measures have been optimised, you as the healthcare practitioner should test whether your patient’s metabolic parameters are normal.

Dr van Dyk says that a person with metabolic syndrome should see their doctor as soon as they are mentally ready to make lifestyle changes. She suggests  a thorough blood work analysis with an integrative doctor that understands health and well-being as a whole. Hormones and the health of blood vessels should be evaluated while also considering genetic risk factors.

Prescription medication such as the appetite suppressant, Phentermine (Duromine) to assist with weight loss, together with lifestyle adjustments such as a healthy eating and exercise plan, can help to achieve a healthy waist circumference and overall health. Speak to your patients about options for weight loss management or go to www.ilivelite.co.za.