Metabolic Syndrome: Criteria, Symptoms, Causes and How to Reverse It

What is metabolic syndrome?

Metabolic syndrome is a group of five risk factors that, together, raise your risk of heart disease, stroke and type 2 diabetes. It is not a single disease. It is a pattern that shows up on a waist measurement, a blood pressure check and routine blood work. Doctors also call it insulin resistance syndrome or syndrome X.

Each of the 5 risk factors is a concern on its own. Having 3 or more at once raises the risk more than any one alone. The good news is that the same lifestyle changes improve all of them.

What are the criteria for metabolic syndrome?

You have metabolic syndrome if you have three or more of these five risk factors:

• A large waist (abdominal obesity): 40 inches or more for men, 35 inches or more for women
• High triglycerides: 150 mg/dL or higher, or taking medicine for high triglycerides
• Low HDL cholesterol: below 40 mg/dL for men or below 50 mg/dL for women, or taking medicine for low HDL
• High blood pressure: 130/85 mm Hg or higher, or taking blood pressure medicine
• High fasting blood sugar: 100 mg/dL or higher, or taking medicine for high blood sugar

Lower waist cutoffs for people of Asian descent

People of Asian descent tend to develop insulin resistance and diabetes at a smaller waist size and lower weight. For Asian men and women, a large waist is 35 inches (90 cm) or more for men and 31.5 inches (80 cm) or more for women. This matters in Irvine, where many of our patients are Asian or South Asian. A person who looks slim can still meet the criteria.

How do you measure your waist?

Stand and place a tape measure around your bare belly just above your hip bones, at about the level of your belly button. Keep it snug but not pressing into the skin, breathe out normally, and read the number. Measure at the same spot every few months to track progress.

What are the 5 symptoms of metabolic syndrome?

Most people with metabolic syndrome have no symptoms. The 5 "signs" are really the five measurements above, which is why it is usually found at a routine checkup. Things you may notice include:

• Weight gain around the middle, an apple shape rather than a pear shape
• Dark, velvety patches of skin on the neck or in the armpits (acanthosis nigricans), a sign of insulin resistance
• Skin tags on the neck or underarms
• Thirst, frequent urination or tiredness if blood sugar is already high
• Snoring or daytime sleepiness, which can point to sleep apnea

Metabolic syndrome symptoms in women and men

In women, irregular periods, extra facial hair and acne can be signs of polycystic ovary syndrome (PCOS), which often comes with insulin resistance. Metabolic syndrome also becomes more common after menopause, which usually happens around age 50. In men, low testosterone and erectile problems can travel with metabolic syndrome and are worth mentioning to your doctor.

Read about PCOS and insulin resistance

What are the main causes of metabolic syndrome?

Insulin resistance and extra fat around the belly are the 2 main causes of metabolic syndrome. When cells stop responding well to insulin, the body makes more of it, blood sugar creeps up, the liver makes more triglycerides and HDL cholesterol falls. Belly fat makes this worse.

Read about the early signs of insulin resistance

Risk factors

• Age: the risk rises as you get older
• Excess weight or obesity, especially fat around the waist
• Low physical activity and long hours of sitting
• A diet high in sugar, refined starches and processed foods
• Family history of type 2 diabetes or early heart disease
• South Asian, East Asian, Hispanic or Native American background
• Diabetes during pregnancy (gestational diabetes) in the past
• PCOS, fatty liver disease or sleep apnea
• Some medicines, such as steroids and certain medicines for mental health conditions
• Smoking and poor sleep

Why does metabolic syndrome matter?

Metabolic syndrome raises the risk of serious health problems over time, including:

• Heart disease and heart attack
• Stroke
• Type 2 diabetes
• Fatty liver disease (MASLD), which can lead to liver scarring
• Kidney problems over time

The risk builds slowly and quietly. Finding it early gives you years to turn it around before damage is done.

How is metabolic syndrome diagnosed?

Metabolic syndrome is diagnosed with a simple exam and blood tests. A visit usually includes:

• Waist measurement, weight and BMI
• Blood pressure, often checked more than once
• A lipid panel for triglycerides and cholesterol
• A1C or a fasting glucose test to check for prediabetes or diabetes

Your doctor may also check liver tests, kidney function and a urine test, and ask about sleep, periods and whether diabetes runs in your family. Results usually come back within a few days. If one part of the picture is abnormal, it is worth checking the others.

See what your cholesterol numbers mean

How can I fix metabolic syndrome?

Lifestyle changes are the first treatment for metabolic syndrome, and they can bring several numbers back to normal. Triglycerides and blood pressure can start to improve within weeks of steady changes to diet, activity and weight.

Lose a modest amount of weight

If you carry extra weight, losing 5% to 10% of your body weight can lower blood pressure, blood sugar and triglycerides and raise good cholesterol. For someone who weighs 180 pounds, that is 9 to 18 pounds.

Move more

• Aim for at least 150 minutes a week of moderate physical activity, such as brisk walking or cycling
• Add strength exercises two days a week
• Break up long periods of sitting with short walks

Sleep, stress and smoking

• Aim for 7 to 9 hours of sleep and get snoring checked
• Quit smoking
• Limit alcohol, which raises triglycerides and blood pressure

What is a good diet for metabolic syndrome?

A Mediterranean-style or DASH-style eating pattern works well for metabolic syndrome. Both focus on whole foods and limit sugar, salt and processed food.

Foods to eat more of

• Vegetables, fruit, beans and lentils
• Whole grains such as oats, brown rice and whole wheat
• Fish, chicken, tofu and eggs for protein
• Olive oil, nuts, seeds and avocado
• Plain yogurt and low-fat dairy

Foods to avoid with metabolic syndrome

• Sugary drinks, including soda, juice and sweet coffee drinks
• White bread, white rice, pastries and chips
• Processed meats and fried food
• Salty packaged and restaurant foods
• Large portions and late-night snacking

For breakfast, choose protein and fiber over sweet cereal or pastries: eggs with vegetables, plain Greek yogurt with berries and nuts, or oatmeal topped with 1 small handful of nuts. There is no single superfood. The overall pattern of eating is what changes the numbers.

Get help with a nutrition and weight management plan at The Pur Health

Is medicine used to treat metabolic syndrome?

There is no single pill for metabolic syndrome, but medicine may be used to treat its parts when 3 to 6 months of lifestyle changes are not enough or risk is high. Options Dr. Munib may discuss include:

• Blood pressure medicine when blood pressure stays high
• A statin for high LDL cholesterol or high overall heart risk
• Metformin for selected people with prediabetes or diabetes
• A prescription weight-loss medicine, such as Wegovy or Zepbound, for adults who meet the label criteria. Ozempic and Mounjaro are used for type 2 diabetes
• Treatment for linked conditions, such as snoring and poor sleep

Which medicine fits depends on your numbers, your other health conditions and the medicines you already take. Labs are usually rechecked 4 to 12 weeks after starting a medicine. Medicine works alongside diet and activity, not in place of them.

How Dr. Munib approaches metabolic syndrome

Dr. Munib looks at the whole picture rather than one number at a time. At a visit she may:

• Measure your waist, weight and blood pressure
• Order a lipid panel, A1C or fasting glucose, and liver and kidney tests
• Ask about sleep, periods, family history and the medicines you take
• Look for linked conditions such as PCOS, fatty liver or sleep apnea

The plan depends on what she finds at your visit and on your lab results. For many people it starts with food, activity and sleep changes and a recheck in about 3 months. For others it may include treating blood pressure, cholesterol or blood sugar, or a weight-loss medicine discussion. Progress is tracked with the same five measurements.

Learn how Dr. Munib manages blood pressure, cholesterol, diabetes and other chronic conditions

Get checked for metabolic syndrome in Irvine

If your waist, blood pressure, triglycerides, HDL or blood sugar are out of range, Dr. Munib can review your results and build a plan with you at our office at 114 Pacifica, Suite 280, Irvine. We are in-network with most PPO plans. Cash-pay visits are $190 for new patients and $150 for returning patients, and labs are billed separately. Call (949) 647-5234 or book online.