Shaida Sina, ND

Metabolic syndrome is relatively new to the conventional world of medicine; many doctors are still unfamiliar with it. Conventional criteria for diagnosing metabolic syndrome differ from the naturopathic, preventive criteria. (See the accompanying story, “Criteria Comparison for Metabolic Syndrome,” for details.)

Recommended Screenings

Naturopathic physicians should include these screening tests when assessing for metabolic syndrome:

Body Mass Index: A calculation that looks at height and weight: >30% is indicative of metabolic syndrome. Consider 25%-30% as pre-metabolic. BMI calculators and tables are readily available online; for an example, visit nhlbisupport.com/bmi/bmicalc.htm.
Waist-hip ratio: <0.8 for females; <1.0 for males.

An additional measure for metabolic syndrome is Bioelectrical Impedance Analysis (BIA), which is a quick and painless way to assess body composition. This requires a special in-office instrument. Body composition will change during treatment; therefore, perform BIA testing intermittently throughout treatment to watch progress of patients’ loss of body fat and increase in lean muscle mass.

If these screenings indicate metabolic syndrome, I confirm the patient’s insulin resistance through blood work, using a modified glucose/insulin challenge test. I offer patients their choice: 1) The traditional test, which consists of drinking a 75g liquid sugar drink called glucola; or 2) my modified pancake challenge. The pancake challenge is a fasting blood test. Patients do not eat after 9 p.m. the evening prior to having blood drawn (drinking water is OK). In the morning, patients have their blood drawn, then eat a meal of up to three simple-flour pancakes (not whole wheat or multi-grain) and syrup; water and herbal tea is OK, too, but nothing else. Two hours after completion of the meal, blood should be re-drawn. Note: If you suspect a gluten issue, do the glucola test instead.

Blood work from a patient with insulin resistance should return these results:

Fasting glucose: >90
Fasting insulin: >5
Two-hour post-prandial glucose: >130mg/dl. A range of 130-199mg/dl indicates impaired glucose tolerance; >200mg/dl indicates diabetes
Two-hour post-prandial insulin: >50 mg/dl. A range of 30-50mg/dl indicates pre-insulin resistance.

In addition to the glucose challenge test, if I truly suspect insulin resistance, I will also order a hemoglobin A1C for a base line (A1C should be <5). Reassess the A1C in three to six months, to monitor progress. This test is much less expensive than the glucose challenge test. I seldom repeat the challenge test unless the patient needs to see the results to comply with therapy.

Criteria Comparison for Metabolic Syndrome

Conventional Criteria

Present history of mild hypertension; blood pressure: >135/85mmHg
Triglycerides: >150mg/dl
HDL: <35mg/dl
Fasting blood glucose: >110mg/dl
Uric acid: >6.0mg/dl
Waist line: >35 inches for females; >40 inches for males

Preventive Criteria

Family history of the following: diabetes, obesity, high blood sugar, thyroid, cardiac, stroke
Red flags: previous history of hypoglycemia, diabetes of pregnancy, weight gain, sedentary lifestyle, fatigue, allergies, thyroid symptoms, history of high blood pressure, history of kidney stones or gout, skin tags, adult acne, history of infertility, excessive stress, menstruation issues, alcohol intake and smoking
Blood pressure: >120/80mmHg
Triglycerides: >100mg/dl
HDL: <50mg/dl
Fasting blood glucose: >90mg/dl
Uric acid: >5.0mg/dl
Waist line: >32 inches for females; >36 inches for males

Next month’s article will address cardiovascular risk assessment for metabolic syndrome patients.

Shaida Sina, ND has been working in the field of medicine for more than 20 years. She received her BS from the University of Maryland, in the School of Medicine’s Department of Medical and Research Technology. During her first 10 years in health care, she worked in the field of laboratory medicine, where she ultimately became lead technologist of a reference infectious disease laboratory. Sina began her studies in natural medicine in 1995 at SCNM and was the first naturopathic physician to do a clinical rotation at Mayo Clinic, where she trained in reproductive endocrinology. Areas of clinical focus include women’s health care, pediatrics and general family practice.