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Metabolic Syndrome


RISK FACTORS
physical inactivity
overweight
high glycemic diet
high fructose intake
too much Kapha (Ayurveda)
being poor in America but still having a car
knowing that there's a drug to fix it so you don't have to get out of your recliner

COMPONENTS of Syndrome
dyslipidemia
abdominal obesity
hypertension
impaired blood sugar metabolism
insulin resistance

COMPLICATIONS
diabetes and CVD
alzheimer's, osteoarthritis and other conditions of chronic inflammation
thrombosis, stroke
liver disease
low testosterone, ED, and infertility
low T mbdt combo of suppression of HPA axis, aromatization of T-->Est, and oxidative stress

PATHOPHYSIOLOGY
inactivity & high glycemic diet-->insulin resistance
-->hyperglycemia and hyperinsulinemic at same time

elevated insulin-->inhibits production of lipase (burns fat)-->can't break down fat
so can't get sugar into cells and can't burn fat-->must break down carbs and proteins for energy
dieting then leads to muscle loss, must reverse high insulin condition before dieting

fructose metabolized in liver:
fructose-->phosphorylated requiring ATP-->fructose-1-phosphate
ADP formed-->AMP-->inosine 5'-phosphate-->uric acid
high levels of uric acid may-->CV dz by reducing NO (cause of HTN?)

SIGNS AND SYMPTOMS
mb ASx
if SX, variable and nonspecific
cravings, inappropriate hunger (belly full and still hungry)
fatigue, depression, insomnia
sleep apnea, low libido
infections, onychomycosis, skin tags
LABS: high TGs, chol, LDL, VLDL, low HDL

DIAGNOSIS
(Three of the following five criteria are necessary for diagnosis)
1) Elevated Waist Circumference/Abdominal Obesity >102cm
2) Elevated Triglycerides >150 mg/dL
3) Reduced HDL <40 mg/dL
4) Hypertension; Systolic ≥ 130 or Diastolic ≥ 85
5) Elevated Fasting Glucose ≥ 100 mg/dL
6) Drug Treatment for any of these is considered as having met the criteria

TREATMENT
goals: to reduce atherosclerosis and DM risk
conventional tx: prescription meds to lower lipids, elevate HDL, tx HTN, and daily aspirin to decrease prothrombotic state
diet/lifestyle: works better than meds in nondiabetics
diet and exercise work better in combo than either alone
goal: clinically relevant weight loss
goal: normalize physical and lab criteria of the syndrome
supps: good omega 3 source for HDL and TG's
supps: vit C, E, flavonoids, flax, GLA 240-480mg, Mg+, B12,
exercise: first thing in the am and again in the evening, corrects insulin resistance
diet: low glycemic, high fiber, and reasonable calorie intake will add up to weight loss over time
LPI on glycemic index vs load: http://lpi.oregonstate.edu/infocenter/foods/grains/gigl.html
diet: eat more veggies, berries, raw nuts, less potatoes, rice, bread

AYURVEDIC HERBS FOR GLYCEMIC REGULATION
Guduchi stem (Tinospora cordifolia)
Amalaki fruit (Emblica officinalis)
Shardurika leaf (Gymnema selvestre)
Tumeric roof (Curcuma longa)
Kutki root (Picrorhiza kurroa)
Neem leaf (Azadirachta indica)

SOURCES
Dr Mercola's site
Dr Nicolai's grand rounds 2010
Encyclopedia of Natural Medicine 2nd ed
Medscape on fructose http://www.medscape.com/viewarticle/575891?src=mp&spon=34

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