Metabolic Syndrome is a threat to heart health

At our centre, we regularly come across individuals with multiple health problems, particularly those related to heart disease. Very often, they need robust prevention and rehabilitation programs to help improve their physical, physiological and psychosocial wellbeing.

One such condition which we encounter commonly these days is “Metabolic Syndrome”. As the name suggests it is a combination of multiple risk factors of heart disease such as abdominal obesity, high blood pressure, increased blood sugar level and abnormal cholesterol level. This condition is growing in number day by day in India and expected to grow exponentially across the globe. The fact that several risk factors are present in the same individuals puts them at a very high risk of heart attack and stroke.

Based on multiple research findings, the rise in the incidence of obesity and diabetes was found to be the main reason behind the increase in metabolic syndrome. Also, the younger population, that is individuals between 25 and 35 years of age, are most affected suggesting that it is high time the youngsters take note of it!

The criteria for diagnosing Metabolic Syndrome as per the International Diabetes Federation guidelines in 2006 are:

  • Higher waist circumference – more than 102cm for men; more than 88 cm for women & higher BMI
  • Increased blood sugar level – more than 100 mg/dL
  • Abnormal cholesterol levels – increased triglycerides and decreased High-Density Lipoprotein
  • Increased blood pressure – more than 130/85 mmHg
Obesity
Diabetes
Unhealthy Diet

The unhealthy lifestyle choices of our people such as

  • Physical inactivity
  • Unhealthy diet
  • Chronic stress
  • Disturbed sleep pattern
  • Increase in tobacco and alcohol consumption

are the culprits causing this sudden surge in metabolic syndrome.

One important fact to be highlighted here is that all the above risk factors are interrelated which means that the occurrence of any one of the risk factors could pave way for the others as well.

If an individual has been diagnosed with metabolic syndrome, the following management should be initiated at the earliest:

1. Intensive lifestyle modification

An intensive lifestyle modification program is the first and only step in fighting metabolic syndrome, especially in individuals who are young, whose blood pressure, blood sugar and cholesterol levels are borderline elevated and who are free of organ damage. The program typically consists of health education about the condition and its effect on the body, tailor-made exercise training which focuses on controlling blood pressure, lowering blood sugar and cholesterol levels and education about the importance of exercise, along with personalized dietary guidance. Psychosocial counselling to help individuals cope better with their mental stress and emotional problems is also included in the program.

Importance of Exercise Training in Metabolic Syndrome

Exercise training is the cornerstone in the lifestyle program because of its multiple benefits:

Aerobic Training

  • Helps to improve endurance and stamina
  • Results in fat and carbs being used up as calories
  • Lowers blood sugar, normalises cholesterol level and also controls blood pressure
  • Aids in weight loss

If you are wondering how much aerobic exercise is adequate, here is my recommendation:

Frequency Intensity Duration Type
5-7 days/week Mild to moderate Intensity 30-60 minutes/day walking, jogging, cycling, swimming, hiking, treadmill,
EFX

Strength Training

  • Helps to improve muscle strength and power
  • Aids in calorie expenditure and weight loss
  • Increases muscle mass and reduces fat mass
  • Can be done with the help of equipment or use of bodyweight too

Guidelines for strength training:

Frequency Intensity Duration   Type
2-3 days/week Mild to moderate Intensity 20-30 minutes/day Bodyweight (push-ups, pull-ups, squats), dumbbells, barbells,
machine-based

Other types of exercise training such as flexibility training, interval training and circuit training can be incorporated in the exercise program as per the individuals’ needs and health goals.

2. Medications

In individuals with advanced metabolic syndrome, that is high levels of blood sugar, abnormal cholesterol and uncontrolled blood pressure, medications such as anti-diabetic drugs, anti-hypertensive drugs and cholesterol-lowering drugs should be initiated along with the lifestyle intervention.

3. Surgery

Fat-reduction surgery or bariatric surgery is sometimes needed to address severe obesity especially if it does not respond to lifestyle changes and medications.

As metabolic syndrome is on the rise and so is the incidence of heart attack and stroke, we need to adopt a healthy lifestyle that includes regular exercise, balanced diet, well-managed stress and adequate sleep, along with regular medical checks. It is never too early and never too late to make a change that will improve your health and your overall wellbeing.

The 9 cardiovascular risk factors we should watch out for

As a Preventive Cardiologist, the question I get asked most often is this:

“I (or someone I know) have no bad habits and have not had any health problems in the past, but ended up with a heart attack. How come doctor?”

My immediate response is that there are 9 risk factors for serious heart and blood vessel disorders like heart attack and stroke. In fact, each of these 9 are independent risk factors which can cause disease by itself and when present in combination poses a very high risk of fatal heart disease.

The 9 cardiovascular risk factors: The Framingham (1) and the INTERHEART (2) studies are both landmark research works that have clearly identified the cardiovascular risk factors in all populations. The image below depicts the 9 risk factors that we should all be aware of and should watch out for.

A questionnaire-based survey was conducted this World Heart Day by Cardiac Wellness Institute to study the presence of behavioural risk factors for heart disease among college-going women in Chennai. Of the 554 students aged 15-30 years who responded to this survey, almost 40% reported to be chronically stressed. We have also noted a similar trend of staggeringly high rates of chronic mental stress among young corporate employees. Intensive lifestyle modification supervised by medical professionals has proven effective in changing dietary, exercise, sleep and stress-related risk factors in all age groups including young adults.

Hypertension, Diabetes and Dyslipidemia are the three silent killers which can only be identified by routine health check up. All 3 conditions often co-exist in the same individual but do not cause any symptoms leading to a very high risk of sudden death. Simple tests like blood pressure measurement and blood sugar and lipid level analysis will throw light on your risk profile. Mild variations from normal and early stage of disease can be managed with lifestyle changes alone but more severe abnormalities will require medications in addition to lifestyle changes.

Unhealthy diet, Inadequate exercise, Obesity, Mental stress along with tobacco use and alcohol abuse are the risk factors that are soaring high in our population. Spreading awareness about the ill-effects of these lifestyle choices is the first step in curbing them. The second and most crucial step is providing the right tools to help people modify their risky behaviour. Exercise training, meal planning guidelines, stress management techniques, goal-setting to become fit, and professional help to quit smoking and drinking are some ways we help individuals succeed in making these difficult but salient changes that impact their health in a very positive way.

If you have a family history of cardiovascular disease, that is your parents or siblings have had a heart attack, stroke or other cardiac problems, you need to be even more vigilant about the 9 risk factors and take all steps to lead a heart-healthy lifestyle.

Action Point 1 If you are over 40 years old and have not had a medical check yet, it is time you saw your doctor for a cardiovascular risk assessment. If you have had a doctor check up more than 2 years ago, you need to repeat one now.

Action Point 2 If you are over 20 years old and think you have 1 or more of the above risk factors, you should get a doctor’s opinion and blood examination every 5 years.

Action Point 3 If you have been taking medicines for any of the above risk factors, you need to revisit the problem along with your doctor to understand the response to medications and the need for lifestyle modification to reduce and eventually even stop medicines if all parameters are well controlled.

Calories – Inside Out

We all know that there is a close link between body weight and heart health. In fact, obesity or excessive body weight in relation to height, is an independent risk factor for cardiovascular disease.

Regular exercise along with a healthy diet can help maintain physical, physiological and mental health. Many of us want to reduce weight; some of us wish to gain weight. An important thing to understand before making any weight management plan is the concept of calorie intake and calorie expenditure.

Calorie intake per day refers to the amount of calories that is being taken in the form of foods or supplements by an individual in a 24-hour period. Calorie expenditure refers to the amount of calories that is being burned out by an individual in the same time period. The overall working of our body relies on these two things, in short, on our body metabolism.

Now let us see what Positive calorie intake and Negative calorie intake are. Positive calorie intake refers to calorie intake being higher than calorie expenditure and negative refers to intake being lesser than expenditure.

Positive calorie intake = calorie intake > calorie expenditure = Weight Gain

Negative calorie intake = calorie intake < calorie expenditure = Weight Loss

In India, an average working individual consumes around 2100 – 2500 kcal in a normal day (weekday) and goes upto 3000 kcal during the weekends (outside food consumption). Our body at a resting state expends around 1200 – 1400 kcal for carrying out our basic functioning. Overall an individual has around 600 to 700 calories being left unused post consumption. This results in calorie overload, leading to weight gain.

Incorporation of physical activity and exercises can help in depleting the additional calories. Moreover, a minimal modification in the calorie intake with the help of a dietitian can help you shift from a positive calorie intake to a negative calorie intake resulting in weight loss.

Use of indoor equipments like treadmill, cycle ergometer, and cross trainer with adequate speed, inclination and resistance, burns around 300 – 400 kcal/hr. Outdoor activities such as jogging, swimming, brisk walking, hiking and cycling burns up-to 400 – 500 kcal/hr. Individuals involved in sports such as badminton, tennis, cricket, basketball, volleyball, football etc expend about 450 – 600 kcal/hr. Other activities like Zumba, Pilates, Yoga and Gymnasium can also help you loose your extra calories and attain an ideal body weight. If you are underweight and are planning to gain weight, it should be a healthy weight gain resulting from the intake of a healthy balanced diet and engaging in appropriate exercises rather than taking nutritional supplements, eating junk food and performing excessive exercises and succumbing to injuries.

Some important points to keep in mind with calories…

  1. 3,500 kcal = 0.45 kg of fat
  2. Adequate calorie expenditure = 200 – 400 kcal/day (or) 1000 – 1500 kcal/week
  3. Exercise 3-5 days/week for aerobic training, 2-3 days/week for resistance training and daily 15-20 minutes/day for abs and core training for more calorie expenditure
  4. Healthy weight loss = 1-2 kg/month
  5. Adequate calorie intake for weight loss =1600 – 1800 kcal/day
  6. Spend more time in outdoor activities and sports that you enjoy; it will help relieve your stress and expend those extra calories
  7. Incorporate a combination of workouts (rather than the same routine everyday) for better calorie expenditure
  8. High intensity interval training and resistance training burns calories even after the workout session.

Regular exercise and a good diet are sure to help you reach your health goals. Additionally, having an idea of your calorie intake and expenditure is important to maintain fitness and body weight. This is especially true for those of us who are diabetic, hypertensive, obese and diagnosed with heart problems. Better weight management is a sure-shot strategy to improved health metrics. Eat right, stay fit and always believe that you can!