Metabolic syndrome (MetS) is a cluster of signs and symptoms that are found in many patients. The standard of care determines that MetS diagnose should consider having three out of these five criteria: Increased waist circumference, high blood pressure, blood sugar that sits over the normal ranges, increased levels of triglycerides, and low HDL cholesterol. The Functional Medicine approach to treat metabolic syndrome also uses the standard of care diagnosis criteria but incorporates advanced tests to provide a personalized assessment and care.
However, MetS have always been difficult to define and diagnose. In fact, the last criteria may differ from one country to another due to the difference between the population. Instead of being a problem, this difference is an improvement to these criteria since it can be applied to a wider variety of patients.
Comparison of NCEP ATPII diagnosis and International Diabetes Federation
|NCEP ATP III||International Diabetes Federation|
|Increased waist circumference >35” women/>40” men||Central obesity (considering ethnicity-specific waist circumference) USA: >35” women/>40” men Euro, SS African, MidEast: >31” women/>37” men Asia/Hisp: >31” women/>35” men|
|High blood pressure (>135/>85 or on HTN meds)||Elevated blood pressure >135/>85 or on HTN meds|
|High fasting blood sugar >100mg/dL||High fasting blood sugar >100mg/dL or in treatment for high blood sugar|
|High triglycerides >150mg/dL||Elevated triglycerides <150 or drug treatment for hypertriglyceridemia.|
|Low HDL Cholesterol <50 women mg/dL and <40 men mg/dL||Low HDL-C: <50 women mg/dL and <40 men mg/dL|
While these two diagnosis systems may look alike, the International Diabetes Federation states that central obesity should always be present. Two out of four other complications should be present to diagnose MetS.
The Functional Medicine approach to treat metabolic syndrome
The diagnosis guideline is a useful resource to know where our patient is standing and their risk of developing a chronic condition. Besides, Functional Medicine and Conventional Medicine use these guidelines to diagnose and follow up with a treatment protocol. Pharmacological treatment is useful for patients with a high risk of cardiometabolic disease. Their journey looks difficult because their treatment may have a lot of changes to be done. This is where conventional medicine is useful, and the treatment protocol should be followed thoroughly. On the other hand, we may have a patient who chooses not to follow the pharmacologic approach and rather continue the process with lifestyle changes or even combine both approaches!
In an ecosystem approach, visceral adiposity and insulin resistance play an essential role, even if they are included in the endocrine or circulatory system. In fact, visceral adiposity and insulin resistance are the triggers that will develop metabolical dysregulations such as high blood glucose, hypertension, and dyslipidemia.
Primary prevention for metabolic syndrome
The main role of MetS risk assessment and diagnosis is to slow or inhibit the metabolic derangement process. In fact, the blood pressure cut off points are not as high as the hypertension criteria. However, a primary prevention setting allows us to identify the metabolic dysfunction associated with cardiovascular risk factors. Furthermore, this approach will allow the clinician to identify more patients with cardiometabolic risk and afterward provide a personalized treatment to treat the underlying causes of this condition.
|Cardiovascular factors||Metabolic factors|
|Elevated lipids||Elevated lipids|
|High BMI||Elevated BP|
|Elevated BP||High glucose levels|
|Family history, gender, and age|
Insulin Resistance and metabolic syndrome
Previously the conversation around insulin resistance would inevitably ends with the presentation of prediabetes, followed by type2 Diabetes, loss of b-cells function, and ending with insulin-dependent diabetes. Nowadays, we know that our genes and their interaction with the ecosystem determine our health or disease journey.
However, if our genes are not fixed in the diabetes development, but our patient is promoting an ecosystem of insulin dysfunction, our body would respond in different comorbidities. Furthermore, this explains why patients with high HOMA-IR levels do not develop T2DM but instead present non-alcoholic fatty liver disease (NAFLD).
|Insulin resistance- induced comorbidities|
|Type 3 DM-Alzheimer’s disease|
|Non-alcoholic fatty liver disease|
|Hormone dysregulation- cancer, PCOS, and osteoporosis|
Furthermore, the Functional Medicine approach is to treat upstream, and the only way this is possible is to look at the patient’s antecedents, what is triggering the condition, and the mediators that promote the symptomatology. Also, the causes may be linked directly to our patient’s lifestyle (the ecosystem) and linked them together to determine this combination’s effects.
The functional medicine evaluation process
Functional medicine aims to evaluate the metabolic risk factors by integrating the standard of care diagnosis system with in-depth questionnaire assessments. Besides, advanced anthropometric assessments are required to understand the root causes of inflammation fully. Furthermore, by using screening tests, such as genetic assessments or food sensitivity and microbiome tests, Functional medicine can promote early detection, provide a nutritional personalized treatment and elevate the patient’s treatment compliance.
In El Paso Functional Medicine, we use the best technology to assess anthropometric status. InBody 770 will show accurate and reproducible results on the percentage of body fat, body mass index, visceral adiposity, and much more.
Functional Medicine treatment:
By assessing the lifestyle factors that may trigger the effects and metabolic conditions, the functional medicine approach will determine:
· Personalized lifestyle changes, this may include personalized diet, exercise recommendations, and stress management.
· phytonutrient therapies
· When possible: reduction of pharmacotherapy/ surgery avoidance.
The healthcare system has an overload of work and with the growing incidence of chronic diseases, the work will get tougher. Conversely, the treatment and extra work that the patients have to go through need to change, if we want this incidence to drop. Overall, functional medicine’s main objective is to reduce the risk burden, slow disease progression, and reverse the condition through maintainable lifestyle changes tailored to your risk factors. By taking an ecosystem and changing those factors that might increase insulin resistance and visceral adiposity, we can provide personalized treatment, and comply with the standard of care. Ana Paola Rodríguez Arciniega, MS.
Ansell, B J et al. “An evidence-based assessment of the NCEP Adult Treatment Panel II guidelines. National Cholesterol Education Program.” JAMA vol. 282,21 (1999): 2051-7. doi:10.1001/jama.282.21.2051
Amato, Marco C et al. “Visceral Adiposity Index: a reliable indicator of visceral fat function associated with cardiometabolic risk.” Diabetes care vol. 33,4 (2010): 920-2. doi:10.2337/dc09-1825
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The information herein is not intended to replace a one-on-one relationship with a qualified health care professional, licensed physician, and is not medical advice. We encourage you to make your own health care decisions based on your research and partnership with a qualified health care professional. Our information scope is limited to chiropractic, musculoskeletal, physical medicines, wellness, sensitive health issues, functional medicine articles, topics, and discussions. We provide and present clinical collaboration with specialists from a wide array of disciplines. Each specialist is governed by their professional scope of practice and their jurisdiction of licensure. We use functional health & wellness protocols to treat and support care for the musculoskeletal system’s injuries or disorders. Our videos, posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate and support, directly or indirectly, our clinical scope of practice.* Our office has made a reasonable attempt to provide supportive citations and has identified the relevant research study or studies supporting our posts. We provide copies of supporting research studies available to regulatory boards and the public upon request. We understand that we cover matters that require an additional explanation of how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at 915-850-0900. Read More…
Dr. Alex Jimenez DC, MSACP, CCST, IFMCP*, CIFM*, CTG*
Licensed in Texas & New Mexico