Metabolic syndrome
By * Dr Rita MONSIEUR and Dr Van Snick
The frequency of overweight is in constant increase in societies who have adopted a western lifestyle. The understanding and the treatment of the secondary affections in this phenomenon became a real medical challenge, probably the most important in the coming years. We consider that approximately 25 % of the population over age 55 present a metabolic syndrome.
The metabolic syndrome, also called belly syndrome, is a combination of cardiovascular risk factors, closely linked to obesity and specifically abdominal obesity. This condition is the result of an unbalanced lifestyle.
The metabolic syndrome is defined by an abdominal obesity and waist circumference increased (mandatory criterion) equal to or upper than 94 cm for men and 80 cm for women, plus two of the four following criteria :
• High triglycerides (> 1,5 g/l)
• Low HDL cholesterol bas < 0,5 g/l for women or < 0,4g/l for men
• Arterial high blood pressure with numbers equal or superior to 135/85 mm Hg
• Fasting blood glucose equal or superior to 1,00 g/.
These criteria are those corresponding to standards of the IDF (International Diabetes Federation) in 1995, and were revised downwards since the standards of 2001.
Obesity is rarely isolated. It is often accompanied by insulin resistance, hypertension, dyslipidemia and haemostasis disorders.
Metabolic syndrome with hyperglycemia, hyperlipidemia and hypertension, causes lesions in blood vessels and kidneys. Patients with metabolic syndrome have therefore a higher incidence of myocardial infarction, renal failure, stroke, retinopathy and coronary heart disease.
Finally, an optimal treatment of metabolic syndrome should lead to an effective reduction of cardiovascular risk complications.
The increased risk of coronary accident exceeds 20% in metabolic syndrome.
The biggest culprit is the fat tissue, by definition more abundant in obese than in people with normal BMI, it is a real endocrine gland with multiple secretions. The adipocytes release different hormones, like adiponectin, which affects the structural integrity of the cardiovascular system. Adiponectin is involved in lipid and carbohydrate metabolism. Its plasma concentration is decreased in obesity. The weight loss is accompanied by cons with a significant increase in its blood rate.
The visceral adipose tissue is directly involved in the pathophysiology of MS (Metabolic Syndrome) and cardiovascular diseases linked to obesity through adipocytokines such as leptin, TNF-alpha (tumor necrosis factor alpha), PAI-1 (plasminogen-activator inhibitor type-1) which the most abundant adiponectin is only expressed by the adipose tissue.
Certain sequences of adiponectin are similar to collagen X and VIII and in the C1q complement factor and exists in multimer complex.
Surprisingly, the obese patients have a lower concentration plasma levels of this adiponectin.
Especially their visceral adipose tissue is the site of inflammation.
There is an inverse relationship between the rates of adiponectin and at once the insulin resistance and inflammation.
The adiponectin regulates the expression of CRP (C-reactive protein) in adipose tissue and thus influences the plasma CRP.
Clinical studies suggest that adiponectin plays a key regulatory and anti-inflammatory in the development of atherosclerosis.
The adiponectin stimulates production of NO important mediator of endothelial function such as angiogenesis and vasodilation.
It restored the sensitivity to insulin by stimulating glucose utilization and fatty acid oxidation via phosphorylation and activation of AMPK (AMP activated protein kinase) in muscle and liver.
This adipocytokine has thus an anti-atherogenic activity, anti-inflammatory and anti-diabetic.
The C-reactive protein, an inflammatory condition indicator is also increased in blood.
At the type 2 diabetics, the plasma concentration of the protein is also decreased, as well as in coronary patients. In vitro studies have shown that adiponectin inhibits a number of processes leading to the installation of atherosclerosis. It goes of the adhesion of monocytes to the endothelium to the production of cytokines, by way of capture of modified LDL, lipid accumulation with frothy cell formation, migration and proliferation of smooth muscle cells of the arterial wall. There is a sexual dimorphism : women have higher levels of adiponectin than men, which could explain the increased cardiovascular risk in males.
Weight loss lowers blood pressure, increases the insulin sensitivity.
Weight loss causes a decrease in triglycerides rates and LDL and increased HDL cholesterol and decreased risk of cardiac and stroke
Many other substances from adipose tissue contribute to cardiovascular risk. We know for some years the role of leptin and that of angiotensinogen, a protein at the base of the renin-angiotensin-aldosterone (RAA).
We still have identified another protein originating from adipose tissue : the resistin. Little is known at present on resistin in humans, but it is acquired that it is capable of inducing, as its name suggests, a resistance to insulin. It would thus indirectly increasing an insulin response and everyone knows that hyperinsulinemia is also harmful to the cardiovascular system and that the insulin resistance is a precursor of diabetes
The role of the orthosympathetic system or sympathetic is essential, we notice at the same time to the abdominal obesity, a hyperactivity of the autonomic nervous system.
This hyperactivity causes not only hypertension but also an insulin resistance, thus leading to the metabolic syndrome. At a BMI equal, an individual with abdominal obesity may have a basal muscle sympathetic activity until 55% higher.
The close relationship between increasing weight and sympathetic activity is observed in young hypertensive which present generally an increased cardiac output on normal peripheral resistance. Gradually, peripheral resistance increase and the cardiac output normalizes gradually.
A prolonged elevation of sympathetic tone also increases heart rate, systolic volume, peripheral resistance resulting in hypertension and ventricular hypertrophy. Catecholamines increase the risk of arrhythmias and also interfere with the renin-angiotensin-aldosterone and with platelet function (thrombosis).
Abdominal obesity is the result of a high calorie diet, but is often associated with predisposing factors such as deregulation of the hypothalamic-hypophyseal, activating the sympathetic system. The stress increases sympathetic tone, but also promotes abdominal obesity.
Even in the absence of visceral obesity, there is strong evidence that psychosocial stress may be responsible for an excess of mortality and of cardiovascular morbidity.
Objectives of treatment summary
A global care is necessary.
Decrease of the inflammatory state, specific and essential element in the metabolic syndrome. This is probably the start of the process, which the cue is the increase in CRP (C-reactive protein).
10 % loss of excess weight during the first year by behavioral modification, caloric restriction and adaptation of feeding behavior.
Practice of regular and moderate exercise thirty to sixty minutes per day.
Fight against atherogenesis by reducing trans fats and cholesterol. These should not exceed 7% of caloric intake.
Decrease in LDL cholesterol. The triglycerides seem to play an important role but not determined in detail, the restriction of dietary fat will lower them but the fight against triglycerides should not be specific.
Complete cessation of smoking.
Fight against hypertension is essential, figures should be down under 130 mmHg/80 mmHg.
Fight against the state of prediabetes
Decrease of hyperactivity of the sympathetic system
Fight against the stress
Tracks of treatment summary
The nutritional adaptation to the reduction of risk factors is simple: reduce the sugar, salt, soft drinks, fats (fatty meats, delicatessen, butter, fried) alcohol, and all excess to obtain a gradual weight loss.
The bases of the treatment of metabolic syndrome are weight loss, regular physical activity and smoking cessation. A reduction, even of low amplitude, already greatly improves insulin sensitivity and cardiovascular risk factors. It has been shown that a mean decrease of 7% weight reduced the risk of developing type 2 diabetes by 58%.
The treatment of hypertension and hyperlipidemia is of course crucial in preventing cardiovascular risk. Hyperglycemia and prothrombotic states should be corrected. It is interesting to use antilipemic plants that act on the parameters of lipid profile, some have an action of capture like the fibrates, while others act on the synthesis of cholesterol in the liver.
Some natural remedies summary
The Metaregul 1 gel/day for at least 6 months intended to therapeutic objectives because consisted of ...
The quercetin is a flavonoid, i.e one of the numerous pigments which give their color to fruits, vegetables and to medicinal plants. In nature, quercetin is often linked to vitamin C which improves the absorption by the body. Quercetin is considered to be the most active flavonoids. The quercetin is extracted from diverse vegetable sources, in particular from seeds and from pods of Dimorphandra mollis, a tree of the legumes family, native of South America, as well as the peel of onions. It has properties of antioxidants, anti-inflammatory and antihistaminic (anti-allergic) confirmed in animals. Quercetin has positive effects on the capillaries and cardiovascular system. The flavonoids are natural compounds of the family of polyphenols. Most of these compounds show interesting biological activities such as anti-oxidizing and anti-radical actions. Indeed, by complexing with specific enzymes, flavonoids are able to metabolize dioxygen.
The chromium normalizes insulin function and regulates sugar level. Il diminue la demande en insuline chez le diabétique. It reduces the demand of insulin in diabetics. As part of the metabolic syndrome, it decreases those of pre-diabetes of type two, the glucose intolerance and the insulinic resistance. It plays a cofactor role with insulin. Secondarily, it helps burn fats and increase muscle mass, lowers LDL cholesterol and increases HDL cholesterol.
The vitamin B6 is a water-soluble vitamin. It is involved in over sixty enzymatic systems participating in protein metabolism. Vitamin B6 participates in the synthesis of amino acids and is essential for the synthesis of niacin from tryptophan. This vitamin also regulates the release of hepatic glycogen from the muscles needs. It participates in the production of insulin, hemoglobin and antibodies.
The vitamine B12, also called cobalamin contains a metallic ion (cobalt). This vitamin can be only synthetized by bacteria and, so, is mainly present in products of animal origin. Vitamin B12 contributes to the formation of blood cells and the marrow, the metabolism of carbohydrates, fats and proteins and to the production of genetic material. It also assists the nervous and cardiovascular mechanisms and plays a role in the synthesis of DNA. Vitamin B12 plays a role in preventing accumulation of homocysteine, reducing the risk of cardiovascular disease. The medical inhibitors of gastric acid may decrease the absorption of vitamin B12 in the diet, as well as antilipemic medicines. Vitamin B12 intervenes in many enzymatic processes, as well as in the metabolism of lipids and carbohydrates, phosphorus and glutathione which exercises in the body the role of hydrogen carrier.
The spirulina contains 3 times more vitamin B12 than raw calf liver. It should be noted that a variable proportion (but strong) of this B12 is in fact composed of B12 analogues, non-assimilated by the human.
The acerola is rich in vitamin C (1800mg/100g) : it contains 20-30 times more than oranges. It has an anti-inflammatory action. It increases resistance to stress through its action on the adrenal glands.
The Ribes nigrum The leaves contain a little essential oil, numerous flavonoids and prodelphinidins. The anthocyanosides of fruit have a vasculoprotective and anti-edematous activities as well by oral way as by parenteral way in animals. Biological tests indicate that these substances decrease capillary permeability and increase their resistance. They are also free radical scavengers. The prodelphinidins of the leaves show an anti-inflammatory activity by increasing adrenocortical activity.
Vitis vinifera The vine rich in flavonoids (more than 4%) is responsible for the famous French paradox, which shows a lower rate of cardiovascular disease in wine regions despite similar cholesterol levels or even higher than in other regions. The most plausible explanation is an antioxidant role due to these flavonoids and among others the kaempferol-3-O-glucosides, quercetin-3-O-glucosides and especially to the richness of the wine tannins. Along with this antioxidant effect, the anti-inflammatory role and vascular protective of the flavonoid of the vine leaf has long been known. Flavonoids act on the cardiovascular system. They increase the peripheral circulation, dilate the coronary vessels, influence the hemostasis and reduce blood pressure. Flavonoids protect the tissular cells from damage of the radiation and they interfere in the release by the cells, "mast" of mediators playing a role in allergic reactions and inflammatory. They also have inhibitory properties of platelet aggregation. Anti-inflammatory effects of flavonoids have been demonstrated. The flavonoids have an inhibitory effect on the biosynthesis of prostaglandins. The prostaglandins (formed by the way of the cyclooxygenase) and leukotrienes (formed through the lipoxygenase) are metabolic Biologically active of the arachidonic acid which play an important role in the complex inflammatory process.
Allium cepa Présesents hypoglycemic properties. Clinical trials are few on its hypoglycemic action. A preliminary study (20 diabetic subjects) published in 1983 suggests that consumption of allium, can significantly lower the blood glucose. The results of a study led on diabetic rats indicate that compounds in garlic and onion may have insulin-like action. It is the amino-sulfoxides compounds which can protect the circulating insulin against the degradation and also stimulate its production by the pancreas. Its antisludge platelet actions and antihypertensives are added to the hypoglycaemic potential. The onion contains fructans, flavonoids and sulphurated compounds. he antisludge platelet action and fibrinolytic is linked to its sulphurated compounds (dimethyl and the diphenylthiosulfinate are both inhibitors of cyclo-oxygenase and lipoxygenase).
Melissa officinalis, Melissa by its action on stress and especially spasmolytic (sympathicolytic), complete the anti-stress actions of the other plants. Rich in polyphenols and flavonoids, the Melissa adds to this soothing and neurovegetative action, an antiinflammatory and antioxidant effect. The Melissa binds to muscarinic and nicotinic acid to act on muscarinic receptors. This mechanism suggests a positive action in Alzheimer's disease.
Metabolic syndrome is probably now the deadliest disease in industrialized countries.
The treatment begins with the treatment of the syndrome and then each of its risk factors.
The association of inflammatory phenomena in the various risk factors aggravates the prognosis.
In the early stages of this syndrome, a specific treatment of this one associated with a weight loss will be enough to return to a favorable situation.
The treatment begins with the treatment of the syndrome and then each of its risk factors.
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