Metabolic Syndrome

(Syndrome X, Insulin Resistance Syndrome)

The Facts

A person has metabolic syndrome when they have a combination of 3 or more certain health risks. These health risks include:

high blood pressure
high blood sugar levels
excess body weight around the waist
low levels of "good" cholesterol (HDL)
high levels of triglycerides (a type of fat found in the blood)

Each of these factors alone can increase a person's risk of developing diabetes, heart disease, and stroke. However, the risk is much higher when these factors are found in combination.

Approximately 1 in 5 Canadians have this condition, although the rate is higher for certain groups of people. For example, people of Indigenous and South Asian descent have higher rates of metabolic syndrome than Caucasians.

Other major risk factors that may lead to the development of metabolic syndrome include:

age (the risk of metabolic syndrome increases as you get older)
a family history of type 2 diabetes
a sedentary lifestyle
other medical conditions including high blood pressure, heart or blood vessel disease, and polycystic ovarian syndrome (a condition where a woman's body produces too much male hormones) and fatty liver disease
smoking

The Causes

Metabolic syndrome is believed to develop due to insulin resistance. Insulin is a hormone that is produced by the pancreas (an organ located near stomach). It helps blood sugar enter cells, where it is used for energy. With insulin resistance, the body fails to recognize the insulin that is produced, causing the sugar to accumulate in the blood instead of being absorbed into other cells. Because blood sugar levels remain high, the pancreas keeps producing more and more insulin, leading to high insulin levels. While blood sugar levels are not high enough to be classified as diabetes, they do increase the risk of developing serious health problems.

Scientists are not certain why insulin resistance develops but they believe it may be partly inherited. They do know, however, that being overweight and inactive contributes to the development of metabolic syndrome.

Symptoms And Complications

In general, few people have any noticeable signs or symptoms. However, the main characteristics of metabolic syndrome are:

excess body weight (usually around the stomach)
high blood pressure
low level of "good" cholesterol in the blood
high level of triglycerides (fats) in the blood
resistance to insulin (high blood sugar)

Although you may not notice any changes in the way you feel, having metabolic syndrome dramatically increases the risk of serious health problems including diabetes, heart disease, and stroke. In fact, the more health risks you have, the more likely you are to develop these conditions.

Making A Diagnosis

In order to diagnose your condition, your doctor will likely ask about your medical history, perform a physical examination, and analyze your blood.

If you have 3 out of 5 of the following health risks, it is likely that you have metabolic syndrome:

excess body weight (waist circumference greater than 102 cm (40 inches) for men and greater than 88 cm (35 inches) for women
high blood pressure - 130/85 mm Hg or higher
high levels of triglycerides (blood fats) - 1.7 mmol/L or higher
low levels of "good" cholesterol (HDL) - less than 1.0 mmol/L for men and less than 1.3 mmol/L for women
high levels of fasting blood sugar (glucose) - 5.6 mmol/L or higher

Treatment And Prevention

The goal of treating metabolic syndrome is to prevent the development of diabetes, heart disease, and stroke. Your doctor will first suggest lifestyle modifications such as exercising for 30 minutes most days of the week. One study showed that individuals who are physically active (30 minutes of activity at least once per week) have half the risk of developing metabolic syndrome than those who are inactive. Your doctor may also suggest eating a healthy diet to promote weight loss and normal blood cholesterol and fat levels. Smoking cessation is recommended for people who smoke.

If lifestyle modification alone does not improve your health risks, your doctor may prescribe one or more of the following medications:

weight loss medications (e.g., orlistat, liraglutide, semaglutide*)
insulin sensitizers (e.g., metformin, rosiglitazone) to help lower blood glucose and insulin levels
blood pressure-lowering medications
medications to decrease "bad" cholesterol (LDL) and increase "good" cholesterol (HDL)

Leading a healthy lifestyle now can reduce your risk of developing the health risks associated with metabolic syndrome as you get older. Effective prevention includes eating a healthy diet by following Canada's Food Guide and exercising for 150 minutes every week. Seeing your doctor for routine check-ups and checking your blood glucose levels, blood pressure, blood cholesterol, and weight will help you monitor your health.

*All medications have both common (generic) and brand names. The brand name is what a specific manufacturer calls the product (e.g., Tylenol®). The common name is the medical name for the medication (e.g., acetaminophen). A medication may have many brand names, but only one common name. This article lists medications by their common names. For information on a given medication, check our Drug Information database. For more information on brand names, speak with your doctor or pharmacist.