How your diet can help prevent type 2 diabetes
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What is metabolic syndrome?
Metabolic syndrome is a group of health issues and risk factors that put you at high risk of developing type 2 diabetes and cardiovascular disease. Metabolic syndrome can lead to a number of serious health complications, but you may be able to delay or prevent these if you adapt your lifestyle.
What is metabolic syndrome?
You may not be familiar with the term, but metabolic syndrome is a very common diagnosis affecting a quarter of adults in the UK and 10-50% of adults worldwide. Metabolic syndrome can also occur in children who are obese. In recent years, its prevalence in adults and children has been increasing in epidemic proportions.
Metabolic syndrome refers to a cluster of risk factors or conditions relating to central obesity (excess weight around the waist) and different metabolic disorders (disturbances to the processes by which your body gets or makes energy).
These conditions put you at higher risk of type 2 diabetes as well as cardiovascular disease (CVD), which includes diseases affecting the heart and blood vessels such as heart disease and stroke.
The five characteristics of metabolic syndrome
It is widely felt that any combination of three or more of the following means that you have metabolic syndrome:
- High blood pressure.
- Being overweight or obese (especially around the waist).
- High levels of triglyceride (a type of blood fat).
- Low HDL cholesterol levels (HDL is known as the 'good' cholesterol).
- High blood sugar (glucose) caused by insulin resistance (which may result in type 2 diabetes).
Meeting one or two of these criteria may not result in a metabolic syndrome diagnosis. However, it's important to note that having any of the above puts you at greater risk of developing health complications. The more of these characteristics you have, the greater your risk becomes.
Is metabolic syndrome serious?
Metabolic syndrome has been recognised by professionals since the late 1980s. The combination of linked risk factors is used to identify those who have a high risk of developing CVD and type 2 diabetes.
The concept of metabolic syndrome also helps professionals to identify and better understand:
- The shared abnormalities in the body's metabolism that link the five clustered findings with each other and with the increased risk of CVD.
- Shared preventative treatments such as lifestyle changes.
The defining feature is being at high risk for type 2 diabetes and CVD, but there are several other health conditions, ranging in severity, associated with metabolic syndrome.
- Kidney disease.
- Some common cancers (such as liver, colorectal, endometrial, bladder, pancreatic, and breast cancer).
- Sleep apnoea.
- Inflammatory skin conditions (such as psoriasis, lichen planus, and hidradenitis suppurativa).
Type 2 diabetes (and insulin resistance)
"Metabolic syndrome is a sign that a person may have insulin resistance; if this insulin resistance progresses, a diagnosis of type 2 diabetes may follow," says Rachel Ball, registered British Dietetic Association (BDA) freelance dietician.
Insulin is a hormone that helps to control the amount of sugar (glucose) in your blood. If you have insulin resistance, your body can't respond properly to insulin and the build-up of blood sugar (glucose) is harder to control. Your pancreas has to produce more insulin in order to address this, which places it under pressure and can result in it not making enough to keep you blood sugar (glucose) stable. This in turn results in high blood sugar (glucose) and type 2 diabetes.
Until recently, experts believed that the underlying problem of metabolic syndrome was insulin resistance. As a result, metabolic syndrome diagnosis involved the presence of high blood sugar (glucose) and insulin resistance along with any combination (two or more) of the other characteristics.
However, now there is uncertainty as to whether all those with metabolic syndrome are indeed insulin-resistant. In 2005, the International Diabetes Federation (IDF) published new criteria requiring that obesity - but not necessarily insulin resistance - be present. The understanding is that excess fat deep inside the stomach cavity actively drives the other issues - insulin resistance, raised blood pressure, lipid changes. Thus insulin resistance is now widely considered a common risk factor of metabolic syndrome rather than the cause.
In any case, if you have insulin resistance you have a very high risk of developing type 2 diabetes. There are a number of serious health conditions associated with having diabetes, including eye problems, nerve and kidney damage, heart attacks, and strokes.
Cardiovascular disease (CVD) includes a number of life-threatening diseases involving the heart and blood vessels. Some of the most common diseases are coronary heart disease (CHD), congestive heart failure, and stroke.
CHD - the blockage of blood supply in the coronary arteries - is the most common type of heart disease and the most common cause of heart attacks. According to the British Heart Foundation, in 2019 it was the single biggest killer of men and women worldwide.
Heart failure is when your heart cannot cope with pumping the required amount of blood in each heartbeat. It is thought that over 900,000 people in the UK live with heart failure, which is a potentially fatal condition.
Strokes cause around 34,000 deaths in the UK every year. For survivors, it can cause severe disability. A stroke causes damage to the brain, usually due to a blood clot in the brain blood artery.
How your diet can help prevent type 2 diabetes
You've been given a prediabetes diagnosis, or have been identified as being at risk of type 2 d...
Can you fix metabolic syndrome?
"Metabolic syndrome and insulin resistance can be managed by lifestyle changes," says Ball.
These associated risks may be serious, but the good news is that they can be delayed and even prevented by altering your diet, increasing your physical activity, drinking less or no alcohol, and quitting smoking.
The NHS Diabetes Prevention Programme also provides support for people in England who have pre-diabetes, providing advice to help them to lower their risk of developing type 2 diabetes.
If you develop specific conditions associated with metabolic syndrome, your doctor will discuss other treatment options with you. These will vary depending on the disease and its severity.
Making changes to your diet can aid with weight loss and reduce excess waist circumference for those with abdominal obesity. Research also highlights the importance of following a nutrient-rich diet recommended for those living with type 2 diabetes. This includes consuming the right balance of fatty acids, antioxidants, carbohydrates, and fibre.
Ball's dietary tips
- Reducing refined carbohydrates could improve triglycerides and blood sugar (glucose) levels. Sources of refined carbohydrates are products with added sugar and white flour - for example, sweets, cakes, and white bread.
- Replacing refined carbohydrates with unrefined alternatives may have a beneficial effect on health markers. Suitable foods include granary bread, fruit, brown rice, new potatoes, and quinoa.
- The Mediterranean Diet, DASH diet, and plant-based diets have all been used to manage metabolic syndrome and type 2 diabetes risk. These have the common themes of; plenty of vegetables and fruit, whole grains, reduced processed foods, limited or no meat intake and low-fat dairy or dairy alternatives.
- Some research has found that processed meat is highly associated with developing metabolic syndrome (although evidence is limited and remains controversial).
- Fasting blood sugar (glucose) levels may be higher if you eat late at night. Some people choose an earlier time - for example, 6 pm - to stop eating which helps control those fasting readings.
"A lack of exercise may also worsen insulin resistance and make type 2 diabetes more likely," Ball warns. "Any type of activity that you enjoy is helpful. Increased activity may also help with weight loss, appetite regulation, mood, and blood sugar (glucose) levels."
- Regular physical activity and avoidance of prolonged periods of being still.
- Walking, cycling, swimming, and other aerobic physical daily activities can be performed at varying intensities to reach your weekly goal.
- Muscle-strengthening activities are performed on at least two occasions per week.
- Exercise training at a moderate to high intensity two to three times per week for 30-40 minutes each time.
- Meeting the 150 minutes per week of physical activity recommendation.
How useful is the concept of metabolic syndrome?
In recent years, some professionals have questioned how helpful it is to cluster these conditions under the umbrella term of metabolic syndrome. The diagnosis of metabolic syndrome does not take into account factors like age, gender, smoking, or family history. This may limit its usefulness in diagnosing the risk a person may have for CVD and type 2 diabetes.
However, the diagnosis of metabolic syndrome can help professionals to identify links between the associated conditions, develop a wider understanding of how they are connected, and deliver co-ordinated prevention and care advice.