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      Metabolic Syndrome

      Your latest book is titled Syndrome S, is that the same thing as Syndrome X? If not, can you explain to me what Syndrome X is? 


      Syndrome X, in itself, is not a disease but a way to describe a situation in which a number of symptoms appear simultaneously or almost simultaneously in an individual. It is called a syndrome because these symptoms often affect different body parts.

      This syndrome has different names, such as metabolic syndrome, cardiometabolic syndrome or, as the Australians call it, CHAOS (Coronary artery disease, Hypertension, Adult-onset diabetes, Obesity, and Stroke)1.  

      The name Syndrome X was first given by Reaven in the late 1980's. According to various sources, the letter "X" was attributed to this syndrome either because it mostly affects Generation X (those born between 1960 and 1980) or because the cause is unknown. In any case, the number of instances of this syndrome is increasing among our fellow citizens. For the rest of this article, I will use either the term syndrome X or the term metabolic syndrome to refer to this state.


      According to Statistics Canada, about 21% of adults between the ages of 18 to 79 suffer from metabolic syndrome.2 According to the American College of Preventative Medicine, at least one third of the population, or 33%, is affected.3 What’s more, statistics show that the percentage of individuals affected by the syndrome increases with age. According to other North American statistics, about 50% of people aged 60 and over are affected.4


      Several symptoms are associated with this syndrome. The major symptoms include: insulin resistance, type 2 diabetes, high triglyceride levels, high blood pressure, low HDL cholesterol and abdominal obesity. To be diagnosed with metabolic syndrome or syndrome X, you must have at least 3 of the symptoms mentioned above.5 To these "classic" symptoms, more and more clinicians are adding glycation and inflammation.6 It is important to note that metabolic syndrome can develop gradually so that though blood parameters are still normal, show an upward trend.

      Interestingly, insulin resistance is associated with metabolic syndrome. Insulin resistance can also cause hypoglycemia. Indeed, in my private practice I have often met people with metabolic syndrome whose symptoms were of the hypo glycemic kind (hypoglycemia) rather than hyper glycemic kind (hyperglycemia or diabetes). Let's take this opportunity to review what we know about hypoglycemia:

      Hypoglycemia can be defined as: hypo = low; glycemia = sugar; an imbalance in carbohydrate metabolism causes an abnormally low level of blood or cellular glucose (sugar) levels.

      Since blood and cellular glucose levels affect the nervous system and energy levels, hypoglycemia symptoms are primarily of a nervous and energetic nature.

      Anxiety, irritability, fatigue, depression, allergies, tremors, dizziness, difficulty concentrating, cravings for starches or sugars, morning fatigue, hyperactivity, palpitations, cold sweats, etc.

      This list is not exhaustive. In addition, not all hypoglycemia patients suffer from all symptoms. Interestingly, some symptoms are episodic, usually occurring within an hour or two before or after a meal. 


      This is the typical profile. Either the average blood sugar levels start to rise or the person begins to show signs of hypoglycemia (see previous section). He or she starts to gain weight for no apparent reason. In addition, the weight gain initially seems to be mainly and disproportionately in the abdominal area. Blood pressure and triglycerides start to rise and the "good" cholesterol, HDL, is reduced.

      Your waist circumference and metabolic syndrome 

      A number of studies suggest that waist circumference is a good indicator of whether metabolic syndrome is present. The circumference of the waist becomes a simple initial indicator to assess the appropriateness of further investigation with your healthcare professional. 

      So, if your waist circumference is equal to or greater than what is indicated here, it would be prudent to check your blood pressure and the blood parameters mentioned above. 

      Below you will find two measurements: those established through consensus by the International Diabetes Federation7 and those established by the Mayo Clinic for Americans.8 It is worth noting that these measurements are based on medium-sized individuals. A person’s height must also be taken into consideration when it comes to assessing the waistline.

      International Diabetes FederationUSA/Mayo Clinic

      Women: less than 80 cm/31,5 inches

      Men: less than 94 cm/37 inches

      Women: less than 88 cm/35 inches

      Men: less than102 cm/40 inches


      Metabolic syndrome significantly increases the risk of heart disease, diabetes and stroke. Some suggest that very soon metabolic syndrome could overtake smoking as a risk factor for cardiovascular disease.9 In addition, researchers found that metabolic syndrome increases the risk of death from cardiovascular disease even in the absence of diabetes or other factors normally associated with a stroke.10 


      The causes of metabolic syndrome are many and readers of my articles will not be surprised to learn that they are basically the same as those for cancer.

      1. Changes in Lifestyle. We have adopted a way of life that is very different from that of our ancestors. Indeed, a growing number of studies suggest that despite the fact we have not changed genetically, we have changed the environment in which we live significantly.  The speed at which these changes took place means we have not been able to adapt to them physiologically.11 This is particularly true when it comes to nutrition and physical activity.

      2. Lack of Physical Activity. Humans have always needed to balance physical activity and diet. Unfortunately, in our industrialized society, that balance has generally ceased to exist. In North America, physical activity dropped significantly after World War II. Indeed, despite the fact that time spent playing sports or enjoying leisurely physical activities has risen  somewhat, physical activity associated with one’s job, household activities and transportation have fallen  dramatically.12

      3. Diet and Nutrition. Despite the fact that we are considerably less physically active than our ancestors, we consume significantly more calories than they did.13 This increase in the number of calories consumed - along with reduced physical activity - could contribute to the increase in the number of overweight or obese individuals. But the problem does not stop there. Indeed, the problem of a reduced nutrient density is added to that of excess calories. Not only do we consume more calories, but the food we eat today contains fewer nutrients (minerals, trace elements and vitamins) than before.14

      4. Organic Pollutants. More and more studies suggest that organic pollutants are involved both in cases of primary obesity and in that associated with metabolic syndrome.15 In order to reduce our caloric intake and still satisfy our sweet tooth, we replaced sugar with chemicals in the form of artificial sweeteners. But these chemicals, like many others, have been shown to increase the incidence of obesity.16 And there's more. Consuming drinks containing artificial sweeteners during pregnancy doubles the risk of obesity in children.17 Chemicals in the form of artificial sweeteners are never the solution!

      5. Stress. Stress plays a major role in the development of metabolic syndrome as it triggers insulin resistance. Indeed, continuous stress can cause insulin resistance which, in turn, will cause abdominal weight gain and increased blood sugar levels.18

      What to do?

      Metabolic syndrome can be prevented and even reversed. But, to succeed it is essential that one takes control of their health through a balanced management of their diet and level of activity.19


      The positive effects of exercise in the prevention and treatment of metabolic syndrome are well documented.20 In recent years, articles suggest the amount of physical activity required to maintain good health is about 2.5 hours per week. Unfortunately, more and more studies suggest that this level of physical activity is insufficient.21 

      Resistance exercise has an important effect on improved health in people with metabolic syndrome.22 In a study conducted among breast cancer survivors, resistance exercise combined with aerobics showed very positive effects and reduced certain parameters of metabolic syndrome.23

      Practice resistance exercises for at least ½ hour, 3 times a week. The exercise program should include exercises for all major muscle groups: legs, back, chest, shoulders, arms and trunk. These may include bodyweight exercises such as pushups, squats and chin-ups or use some sort of resistance such as elastic bands or dumbbells. You can also use resistance machines.  

      Various other forms of exercises have similar effects, such as swimming, Pilates or rowing. My clinical and personal experience - as well as a growing number of studies - strongly suggests that resistance exercise is more important than aerobic activity alone when it comes to managing metabolic syndrome.

      Aerobic activity should also be included in the exercise program. This can include walking (try to walk at least 10,000 steps a day), swimming or rowing (these have a resistance as well as aerobic effect). Zumba and dance are also excellent forms of aerobic exercise. Beware of long-distance running as it may, if it is intense and sustained, produce cardiovascular damage.24

      Ultimately, the important thing is to move and to move a lot - not only to burn calories, but, above all, to kickstart your metabolism. Also, it is important to move on a daily basis rather than have intense exercise sessions once a week. Refer to my article on exercise on this website.


      In terms of diet, several factors play a role in the prevention or elimination of various parameters associated with metabolic syndrome.25 Here are a few. 

      Reduce or eliminate simple sugars from your daily diet. Reserve your intake of simple sugars for special occasions (birthdays, holidays, etc.).

      Reduce your intake of alcohol to, on average, one beverage a day or less.

      Make sure you eat some type of protein (animal or vegetable) at every meal. 

      Eat vegetables at least twice a day.

      Make sure you have a significant amount of plant based  fiber in your daily diet. 


      Many supplements can help improve the parameters associated with metabolic syndrome. Those that help improve insulin resistance are particularly interesting because a lack of these nutrients seems to be the most important factor in the development of metabolic syndrome.26 Among these, I suggest the following:


      Chromium, as well as vitamin B3, is necessary for the formation of glucose tolerance factor (GTF) which increases the sensitivity of cell membranes to insulin. This increased cellular awareness counteracts or reverses insulin resistance.27 Studies have shown that increased chromium intake improves insulin resistance in obese subjects.28

      Taking 200-400 micrograms of chromium once or twice a day can be beneficial. When taking chromium, it's important for diabetics to check their blood sugar levels because by improving insulin resistance, chromium can lower blood sugar. 

      Vitamin B3

      Vitamin B3, like chromium, is necessary for cells to use insulin properly. So, it only makes sense that supplementation may help improve insulin resistance. Several studies have shown that vitamin B3 helps prevent type1 diabetes29 and can also act positively to mitigate several parameters of metabolic syndrome.30

      Taking 50 to 100 mg of vitamin B3 in the form of niacinamide or controlled-release niacin can greatly help to improve the symptoms associated with the metabolic syndrome.


      The oral administration of zinc has also shown very positive effects as regards to metabolic syndrome.31 


      Let me finish with magnesium, one of the most important minerals, yet one that is most deficient in our North American diet. A significant number of studies suggest that magnesium plays a key role in insulin sensitivity.33 Several studies have demonstrated that there is an inverse correlation between the intake of magnesium and metabolic syndrome.34 Some studies suggest that young adults with higher dietary magnesium levels are less likely to develop metabolic syndrome.35 Another study highlighted that there is an inverse correlation between magnesium consumption and systemic inflammation as well as the onset of metabolic syndrome in women over fifty.36

      Taking 125-150 mg of magnesium morning and evening can also be very useful in a program whose goal is to prevent or correct metabolic syndrome.


      Metabolic syndrome or Syndrome X poses a real threat. Fortunately, it is possible to avoid and even reverse. The only obstacle to the effective and sound management of this syndrome is our will. Yes, we must prioritize and take charge. But the same lifestyle adjustments that help control metabolic syndrome are also those that help reduce the risk of cancer. It's up to us.


      1. Sawyer, Antoaneta Syndrome-X the mystery syndrome, The Examiner 19 août 2010
      2. Syndrome métabolique chez les adultes, 2012 à 2013,
      3. Bailony, Rami Metabolic syndrome: what is it and why should we care?, 6 août 2015
      4. Maria Aguilar; Taft Bhuket; Sharon Torres; Benny Liu; Robert J. Wong Prevalence of the Metabolic Syndrome in the United States, 2003-2012 JAMA. 2015;313(19).
      5. Crisafi, Daniel and Vera Tweed Metabolic Syndrome, Better Nutrition (2012)
      6. Junie, Claudine; Catherine Gallou-Kabani; Alexandre Vigé et Marie-Sylvie Gross Épigénomique nutritionnelle du syndrome métabolique, Médecine Sciences,  Volume 21, numéro 4, avril 2005, p. 396-404
      7. The IDF consensus worldwide definition of the  metabolic syndrome, International Diabetes Federation (2005)
      8. Metabolic Syndrome,
      9. What Is Metabolic Syndrome? National Heart, Lung and Blood Institute November 6, 2015
      10. Hanna-Maaria Lakka; David E. Laaksonen; Timo A. Lakka; Leo K. Niskanen; Esko Kumpusalo; Jaakko Tuomilehto; Jukka T. Salonen The Metabolic Syndrome and Total and Cardiovascular Disease Mortality in Middle-aged Men JAMA December 4, 2002, Vol 288, No. 21
      11. Junie, Claudine; Catherine Gallou-Kabani; Alexandre Vigé et Marie-Sylvie Gross Épigénomique nutritionnelle du syndrome métabolique, Médecine Sciences,  Volume 21, numéro 4, avril 2005, p. 396-404
      12. Brownson RC, Boehmer TK, Luke DA. Declining rates of physical activity in the United States: what are the contributors? Annu Rev Public Health. 2005; 26:421-43.
      13. Gibbons, Anne The evolution of diet, National Geographic Février 2016
      14. Z. X. Tan R. Lal K. D. Wiebe Global Soil Nutrient Depletion and Yield Reduction Journal of Sustainable Agriculture, Vol. 26(1) 2005
      15. Ariane Ambolet-Camoita, Min Ji Kima, Alix Leblanca,Martine Aggerbecka, Les polluants organiques persistants : implication dans l’obésité et le syndrome métabolique Cahiers de Nutrition et de Diététique Volume 47, Issue 4, September 2012, Pages 183–192
      16. Les édulcorants aggraveraient le risque de diabète et d'obésité L’Express 19/09/2014
      17. Les édulcorants artificiels doublent le risque de surpoids infantile, selon une étude Radio Canada lundi 9 mai 2016
      18. Crisafi, Daniel Syndrome S, Chat (2014)
      19. Churilla, James  THE METABOLIC SYNDROME: The Crucial Role of Exercise Prescription and Diet ACSM'S Health & Fitness Journal January/February 2009 - Volume 13 - Issue 1 - pp 20-26
      20. Gomes Ciolac, Emmanuel and Guilherme Veiga Guimarães Physical exercise and metabolic syndrome Rev Bras Med Esporte _ Vol. 10, No 4 – Jul/Ago, 2004
      21. Harvard School of Public Health Physical Activity
      22. CM Dieli-Conwright, JE Mortimer, D Spicer, D Tripathy, T Buchanan, W Demark-Wahenfried, and L Bernstein Effects of a 16-week Resistance and Aerobic Exercise Intervention on Metabolic Syndrome in Overweight/Obese Latina Breast Cancer Survivors Cancer Epidemiol Biomarkers Prev April 2015 24; 763
      23. Strasser, Barbara; Uwe Siebert, Wolfgang Schobersberge Resistance Training in the Treatment of the Metabolic Syndrome May 2010, Volume 40, Issue 5, pp 397-415
      24. James H. O’KeefeHarshal R. Patil; Carl J. Lavie, Anthony Magalski; Robert A. Vogel; and Peter A. McCullough Potential Adverse Cardiovascular Effects From Excessive Endurance Exercise MayoClinProc. June 2012;87(6):587-595
      25. Elisabet Wirfält, Bo Hedblad, Bo Gullberg, Irene Mattisson Food Patterns and Components of the Metabolic Syndrome in Men and Women: A Cross-sectional Study within the Malmö Diet and Cancer Cohort, Am. J. Epidemiol. (2001) 154 (12): 1150-1159.
      26. Lann, Danielle and Derek LeRoith Insulin Resistance as the Underlying Cause for the Metabolic Syndrome Medical Clinics of North America, 2007-11-01, Volume 91, Issue 6, Pages 1063-1077
      27. Yinan Hua, Suzanne Clark, Jun Ren, Nair Sreejayan Molecular mechanisms of chromium in alleviating insulin resistance Journal of Nutritional Biochemistry 23 (2012) 313–319
      28. Nair Sreejayan, Feng Dong, Machender R. Kandadi, Xiaoping Yang andJun Ren Chromium Alleviates Glucose Intolerance, Insulin Resistance, and Hepatic ER Stress in Obese Volume 16, Issue 6, pages 1331–1337, June 2008
      29. Elliott RB, Pilcher CC, Stewart A, et al. The use of nicotinamide in the prevention of type 1 diabetes. Ann N Y Acad Sci 1993;696:333-341.
      30. Vaccari CS, Nagamia S, Thoenes M, Oguchi A, Hammoud R, Khan BV.
      31. Efficacy of controlled-release niacin in treatment of metabolic syndrome: Correlation to surrogate markers of atherosclerosis, vascular reactivity, and inflammation. J Clin Lipidol. 2007 Dec;1(6):605-13
      32. Yusuke Adachi, Jiro Yoshida, Yukihiro Kodera, , Tamas Kiss , Tamas Jakusch, Eva A. Enyedy, Yutaka Yoshikawa, Hiromu Sakurai Oral administration of a zinc complex improves type 2 diabetes and metabolic syndromes Biochemical and Biophysical Research Communications Volume 351, Issue 1, 8 December 2006, Pages 165–170
      33. Mario Barbagallo,, Ligia J. Dominguez, Antonio Galioto, Anna Ferlisi, Calogero Cani, Loriano Malfa, Antonella Pineo, Adele Busardo, Giuseppe Paolisso Role of magnesium in insulin action, diabetes and cardio-metabolic syndrome X Molecular Aspects of Medicine Volume 24, Issues 1–3, 6 February 2003, Pages 39–52
      34. Nicola M. McKeown , Paul F. Jacques, Xinli L. Zhang, Wenyen Juan, Nadine R. Sahyoun Dietary magnesium intake is related to metabolic syndrome in older Americans European Journal of Nutrition June 2008, Volume 47, Issue 4, pp 210-216
      35. Ka He; Kiang Liu; Martha L. Daviglus; Steven J. Morris; Catherine M. Loria; Linda Van Horn; David R. Jacobs Jr; Peter J. SavageMagnesium Intake and Incidence of Metabolic Syndrome Among Young Adults Circulation. 2006; 113: 1675-1682
      36. Yiqing Song, Paul M. Ridker, JoAnn E. Manson, Nancy R. Cook, Julie E. Buring, and Simin Liu, Magnesium Intake, C-Reactive Protein, and the Prevalence of Metabolic Syndrome in Middle-Aged and Older U.S. Women Diabetes Care 2005 Jun; 28(6): 1438-1444.