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In the world of fitness and health, metabolic syndrome is the great unknown. Historically, metabolic syndrome was known as Syndrome X — largely because it was a multifaceted syndrome with an unclear treatment paradigm.  Today, health professionals define metabolic syndrome as a cluster of symptoms and conditions that generally indicate poor cardiovascular health and increased risk for type 2 diabetes.

So, with this in mind, the next question is: are you at risk?

This article will explain what you need to know about metabolic syndrome, including how to recognize the signs, prevention tips, and treatment options. By the end of this article, you should have a better understanding of this mysterious syndrome, and how it may impact your health, fitness, and wellbeing.  Let’s go!

What is the rare and mysterious Syndrome X?

The American Heart Association, in tandem with the National Heart, Lung, and Blood Institute, describes it as the condition that meets at least three out of the five following conditions :

Summary: Conditions for Clinical Diagnosis (AHA/NHLBI)

Condition Numerical Threshold
High blood pressure Greater than or equal to 130/85 mm HG
Glucose levels Greater than or equal to a blood sugar level of 100 mg/dL, at fasting (e.g. in the morning or in between meals)
Cholesterol levels HDL Cholesterol (also known as, the ‘good’ cholesterol) less than 50 mg/dL for females or 40 mg/dL for males

LDL Cholesterol (low-density lipoprotein or bad cholesterol) over 129mg/dL for females and males

Triglyceride levels Greater than or equal to 150 mg/dL
Obesity As measured by waist circumference, greater than 35 inches for females or 40 inches for males

The information above includes the standardized metrics, but of course remember that depending on your health history and lifestyle, these could differ.

This is a ton of data, most of which you won’t ever have to see unless you’re currently in conversations with your healthcare provider about these metrics. Blood tests that check your cholesterol and triglycerides levels should be ordered by a medical doctor. But, tests like waist circumference measurement is a simple enough for one to do at home using a tape measure, and based on your previous health history you may even have blood glucose monitors or other devices laying at home.

If you are experiencing one or two of the above symptoms, consider scheduling an appointment with your physician or healthcare provider to speak more about your risk for metabolic syndrome.

How common is metabolic syndrome?

Given the recent press coverage, it would be reasonable to assume that the prevalence of the syndrome is increasing. (Remember: prevalence means the percentage of the population that has a medical disease or syndrome, versus incidence is the number of new cases per year). Interestingly enough, this is not the case.

Currently, researchers estimate the number of Americans affected by metabolic syndrome to be around 50 million, a large number in its own right. This number is also consistent in the U.S. over time. Research from the Centers for Disease Control and Prevention (CDC) shows that the estimated prevalence of metabolic syndrome has actually remained constant in the United States population over the last 10 years or so, despite health interventions. Moreover, it is cited that patients reporting specific sub-components of the syndrome, such as high blood pressure and obesity, are increasing over time in the U.S., which gives cause for concern. In simpler terms, this essentially means that the clinical burden has the potential to increase dramatically in the coming years.

Since it’s a cluster of syndromes, is it really “caused” by one thing?

Yes, and no. This is a complicated answer, so let’s tackle this step by step. It is a syndrome, so pieces of the symptoms could be caused by a variety of things — from diet to exercise to sleep. But, at the fundamental level, there is research that provides evidence that metabolic syndrome is the result of disrupted metabolic homeostasis. That’s a long sentence, so let’s break this down.

Metabolic Homeostasis

Metabolic homeostasis refers to the cycles that lead to a fairly stable equilibrium in your body. Like many things in life, it is a give and take process, in which your body essentially self-regulates itself to make certain that there is a balance.

The Relationship Between Insulin and Glucose

The delicate relationship between insulin sensitivity and glucose is key for understanding your metabolism. Glucose is a simple sugar that is the building block of most carbohydrates. When you have high glucose levels in your blood, like right after you’ve eaten, your body will release insulin from the beta cells of your pancreas, which alerts your cells in the liver, fat, and muscle to absorb the glucose from your blood, returning you to a stable glucose level while also providing your body with energy.

The converse also happens. When you have low glucose levels in your blood, for example when you’ve just come back from an exercise class, or if you haven’t eaten in several hours, then the alpha cells in your pancreas will release glucagon, a hormone that signals the liver to go ahead and break down your stored glycogen to glucose so that your body can have energy.

Insulin is the main lever for balancing out glucose. When your glucose is too high, insulin can jumpstart the processes to lower it down. But, if your glucose level is consistently high — whether it is due to your diet, a genetic predisposition, or any other reason — your body can actually become insulin resistant. This means that the same amount of insulin has a weakened effect on your metabolic processes. Importantly, this is when the health problems begin, and when the risk for type 2 diabetes is on the line.

Entrenched in this process are many steps that could potentially lead to metabolic syndrome.

Metabolic syndrome is characterized by the clustering of several conditions, many of which are intrinsically linked to insulin resistance (see: glucose levels, triglyceride levels, obesity). Researchers in this field hypothesize that insulin resistance, in combination with disrupted regulation of glucose, leads to cardiovascular pathology in line with metabolic syndrome. In more layman terms? Like many other cardiovascular diseases, diet, genetics, and lifestyle are the main causes of the components of metabolic syndrome, although at the core level, the syndrome is the manifestation of metabolic dysfunction in your body.

Risky Business

Risk Factors

Many risk factors for metabolic syndrome have been identified, including insulin resistance, triglyceride levels, abdominal obesity, sedentary lifestyle, age, and diet. On the individual level, if you have a family history of type 2 diabetes, polycystic ovary syndrome (PCOS), or non-alcoholic fatty liver disease, this could increase your risk down the road.

What is the biggest risk factor?  Although it differs for each individual,  a readout from the longitudinal NHLBI Family Heart Study suggests that central obesity, as measured by waist circumference, was the most significant driver of risk over time. With this in mind, body composition is a useful tool for understanding your personal risk by assessing your fat and muscle.

Visceral Fat

It isn’t only your waist number though — it’s what makes that up. Separate studies have found that the proportion of visceral, or deep abdominal fat, is a key indicator for risk of metabolic syndrome. That is, among individuals of varying body sizes and backgrounds, visceral fat was found to be directly correlated to the onset of metabolic syndrome. This is likely related to the relationship between fat cells and the metabolic cycle, as described earlier in this article, in that the high presence of visceral fat is associated with insulin resistance, inflammation, and endothelial dysfunction. Remember that triglyceride levels are a clinical diagnostic indicator of metabolic syndrome and other complications like type 2 diabetes, so this makes sense! In short, fat around your abs is abs-olutely an important risk factor!

Lean Mass

Another area to focus on is your lean mass, which we’ve written on previously. In brief, there is a decent cadre of research to support the idea that increased muscle mass reduces insulin resistance, and serves as a protective effect for avoiding both metabolic syndrome and type 2 diabetes. Gains on gains, right?

Prevention and Treatment

To further prevent the onset of metabolic syndrome in your life, here are a couple of high-level tips.

In general, diet and exercise are high-yield ways of controlling your glucose and triglyceride levels, which are directly influential on insulin resistance and the other conditions relating to metabolic syndrome. In terms of diet, a plate that is high in fiber and low on sugar is beneficial. There is growing research that a high-fat, high-saturated diet may decrease insulin sensitivity.

Experts also recommend staying hydrated to combat high glucose levels. Not only will increased water intake benefit your cardiovascular health, but also has downstream positive effects on your wakefulness and energy throughout the day.

Incorporating regular aerobic or cardio exercises, such as walking, running, or calisthenics, into your routine also has significant effects on your glucose levels and weight loss. For more specific recommendations, consult with your healthcare provider to receive advice tailored to your lifestyle.

If you are diagnosed with metabolic syndrome, or you think that you may be experiencing some of the symptoms, there are some treatments that are on the pipeline. Specialized and personalized nutrition regimens that emphasize the Mediterranean diet could address your symptoms by affecting gene-diet interactions. For example, introducing more HDL Cholesterol, also known as your “good cholesterol” good be beneficial.

In addition, pentacyclic triterpenes may be a promising target for future treatment of metabolic syndrome, if lifestyle changes aren’t having any effect. Future research will continue to explore potential treatments, but lifestyle changes, with an emphasis on diet and increased physical activity, are the first place to start.

In Summary

To recap, metabolic syndrome is a name for a set of symptoms and conditions, revolved around cardiovascular health. Obesity and a high amount of visceral fat is a large risk factor for being diagnosed with metabolic syndrome. There are certain things you can do to prevent metabolic syndrome in your life, from focusing on minimizing your visceral fat to maximizing your lean mass which may lead to weight loss. A diet that boosts your HDL is also important, as well as hydration. If these aren’t successful, future treatments are on the horizon. Remember that Body composition analysis can be an essential tool for understanding your approach to preventing the onset of metabolic syndrome. Knowledge about how to identify your risk for metabolic syndrome based on your body composition, as well as understanding the syndrome itself, can support you in making informed decisions throughout your healthcare journey.


Jahnavi Curlin is a graduate of Harvard College and a physician-in-training. She currently writes on health and wellness for national and global publications.

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