The five stages of Metabolic Syndrome and what you can do to protect your long-term health.

What is metabolic syndrome?

Metabolic syndrome is a collection of risk factors that, combined with excess weight or obesity, can increase your likelihood of developing heart disease, stroke, and diabetes.

The risk factors are:

  • High blood sugar levels (insulin resistance, prediabetes and diabetes)
  • High blood pressure
  • High triglycerides (a kind of fat found in the blood)
  • Low HDL (good cholesterol)
  • And often, a fatty liver too.

If you have excess abdominal weight, a BMI above 26, and are developing a prediabetic state (HbA1C over 5.6), the chances are high that you have metabolic syndrome.

This can often lead to non-alcoholic fatty liver disease (NAFLD). Left untreated, fatty liver can accelerate your risk of cardiovascular conditions like high blood pressure, and bad cholesterol.

What causes metabolic syndrome?

You may be genetically predisposed to metabolic syndrome. However for the majority, metabolic syndrome is directly linked to excess weight, often caused by eating too much unhealthy food and not exercising enough.

Here’s why:

Poor diet, excess antibiotics, stress, a lack of fibre can cause gut dysbiosis – an imbalance of good and bad bacteria in your digestive system. In contrast, a nutrient rich diet and more physical activity is also linked to a healthier and more diverse gut microbiome. [1]

When the bad bacteria outweighs the good, it increases inflammation, which in turn raises levels of proinflammatory cytokines (the molecular messengers between your cells).

This results in insulin resistance, which inhibits your body’s ability to take out the sugar in your blood.

This is the most significant cause of metabolic syndrome. It also causes other pro-inflammatory processes that accelerate liver and blood vessel damage, which can contribute to coronary artery disease.

Add abdominal obesity to the mix and the pro-inflammatory cycle is further increased, leading to non-alcoholic fatty liver and metabolic syndrome.

The 5 stages of metabolic syndrome

Stage 1: Too many calories often leads to an elevated production of insulin and increased insulin resistance. This in turn eventually raises your fasting blood level of insulin. Insulin resistance can be measured directly, and is worked out by measuring HbA1c – the average amount of blood sugar over the prior three months.

The ideal adult reading is under 5%. Between 5-5.5% indicates the glucose average is rising; at 5.5% and above is the warning zone; over 5.7% is prediabetic, and HbA1c over 6.5% is generally considered the point at which diabetes is diagnosed.

Stage 2: When the insulin receptors in your body’s cells become resistant, your organs – the liver, muscles and adipose cells – can no longer effectively uptake the blood glucose. This leads to elevated blood sugar, particularly during or after a meal.

As more and more insulin is required to attempt to keep your blood sugar down, the fasting insulin rises.

Insulin resistance is indicated by a higher than average spike in insulin, which can be measured by an insulin and glucose tolerance test. Diabetes is diagnosed when the blood sugar becomes dangerously high and the body can no longer maintain the balance.

Stage 3: Triglycerides – a type of fat (lipid) found in your blood – also rise with this process.

When you eat, your body converts any calories it doesn’t immediately need to use into triglycerides and stores them in your fat cells and liver. Later, your hormones release these triglycerides for energy between meals.

If you regularly eat more calories than you burn, particularly from high-carbohydrate foods, you develop high triglycerides (hypertriglyceridemia), which is a sign of excess fat storage in the liver and fat stores. Metabolic syndrome can be diagnosed at this stage.

Stage 4: After elevated Insulin and Triglycerides levels, your HDL Cholesterol falls (the protective kind) falls. This slows down the transport of LDL cholesterol safely back from your blood vessels, so your LDL cholesterol (the bad one) eventually rises.

The LDL particles get smaller and more oxidised, your blood vessels become damaged, and the arteries thicken. This can lead to heart disease and blood pressure problems, eventually risking a stroke or heart attack.

Stage 5: Under the effects of inflammation and oxidation which accompany these processes, your kidneys, eyes and nerves essentially age faster. Uncontrolled, the high blood sugars and lipids cause toxic damage to your cells.

Fatty liver (NAFLD) may become more rancid, gradually scarring the liver and causing nonalcoholic steatohepatitis (NASH). This process is accelerated if you are diabetic or happen to have a high burden of pollutants – which is guaranteed if you live in Hong Kong or any major city.

Don’t guess, test.

The consequences of metabolic syndrome are major – making testing essential. If you’re overweight, we recommend you test for the risk factors that make up metabolic syndrome.

At IMI, we can test for the risk factors – from blood sugar levels, to cholesterol, blood pressure and whether you have a fatty liver. We can also assess your gut health for dysbiosis.

[1] T Koutouratsas et al, Role of exercise in preventing and restoring gut dysbiosis, 2021

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