Reducing Metabolic Syndrome Risk

Metabolic syndrome is a compository condition that does not have a well-accepted definition or criteria. The American Heart Association (AHA) and the National Heart, Lung and Blood Institute (NHLBI) identified metabolic syndrome as the presence of three or more of the following components: An elevated waist circumference (men > 40 inches, women > 35 inches); elevated triglycerides > 150 mg/dL; reduced high-density lipoprotein (HDL) cholesterol (men < 40 mg/DL, women < 50 mg/dL; elevated blood pressure; and elevating fasting glucose. In order to prevent metabolic syndrome, the risk of cardiovascular disease (CVD) and type 2 diabetes must be abated. Diet and exercise have a positive impact on these risk factors in addition to quitting smoking and lowering low-density lipoprotein (LDL) cholesterol and taking steps to address high blood pressure. Lowering consumption of sugar-sweetened soft drinks and fruit drinks may also decrease diabetic risk factors, according to a recent study published in the Archives of Internal Medicine.¹

A review published in Applied Physiology, Nutrition and Metabolism noted, The components of diet currently recommended as healthy are likely also protective against metabolic syndrome, including low saturated and trans fat (rather than low total fat) and balanced carbohydrate intake rich in dietary fiber, as well as high fruit and vegetable intake (rather than low total carbohydrate); and the inclusion of low-fat dairy foods.²

Along with diet and exercise, nutritional ingredients can positively affect metabolic syndrome and lower the risk of CVD and diabetes. A 2007 study found hydroxycitric acid (HCA-SX), extracted from the dried fruit rind of the plant Garcinia cambogia, may be used as an intervention to overcome obesity-related complications.³ Five-week-old developing obese, male Zucker rats were supplemented with vehicle (control) and HCA-SX (as Super CitriMax®, from InterHealth Nutraceuticals) in drinking water for seven weeks. HCA-SX supplementation reduced food-intake and body weight gain, and reduced the increases in inflammation, oxidative stress and insulin resistance observed in untreated animals. Levels of fasting plasma insulin, glucose and triglycerides were also lower in the HCA-SX-treated group.

A separate study supplemented diabetic Zucker fatty rats (70 to 75 weeks old) with niacin-bound chromium (NBC; as ChromeMate®, from InterHealth Nutraceuticals), fraction SX of Maitake mushroom (MSX) and 60 percent HCA-SX (as Super CitriMax) alone or in combination to determine its effect on certain aspects of metabolic syndrome.⁴ Four groups of eight rats were fed through a tube daily with different ingredient combinations. For the initial three weeks, the control group received only water. The other groups received either 40 mcg/d of NBC, 100 mg/d of MSX or 200 mg/d of HCA-SX. During weeks four to six, the doses of each treatment were doubled. The control animals lost approximately 50 g of body weight (BW) per rat. In contrast, the NBC-treated rats lost approximately 9 g of BW per rat, the MSX-treated rats lost 16 g of BW per rat, and the HCA-SX-treated rats lost approximately 46 g of BW per rat. However, 75 percent of the rats in the control group lost more than 50 g of BW over the six-week duration, whereas none of the NBC-treated rats, 25 percent of the MSX- treated rats and 57 percent of the HCA-SX-treated rats lost more than 50 g of BW over the six weeks of the study. Rats in all three treatment groups showed significantly lower blood. Treatment of animals with a combination of the three supplements resulted in a lower systolic blood pressure (SBP) and maintenance of BW compared to control animals.

A study published in 2002 supplemented 55 overweight human subjects with a combination of 1,500 mg/d of the calcium salt of HCA (750 mg of pure HCA) (as Citrin®, from Sabinsa) and 300 mcg/d of elemental chromium for eight weeks.⁵ Patients lost an average of less than five pounds after four weeks and less than 10 pounds after eight weeks. Triglycerides and LDL in men over 60 years-old were significantly lowered during the course of treatment (P<0.05). HDL was significantly increased in all patients (P<0.01) and after eight weeks, the Coronary Heart Disease risk index was lowered significantly (P<0.01).

Research on the health benefits of omega-3 essential fatty acids (EFAs) is popping up all over. Omega-3s, in addition to other health advances, have been shown to decrease the risk of CVD and other obesity-related diseases. One review published in the Asian Pacific Journal of Clinical Nutrition said: Omega 3- phosphatidylcholine from salmon roe prevented the development of obesity-related diseases through the suppression of lipogenic gene expressions and the enhancement of lypolytic gene expressions in the liver of obese rats.⁶ A Canadian, semi-randomized, single-blind, four-period, crossover study found an olive oil (OO)-based diet with fish-oil fatty acid esters of plant sterols (FO-PS) may reduce CVD risk.⁷ Twenty-one moderately overweight, healthy hypercholesterolemic subjects were fed an OObased diet, including four experimental isoenergetic diets of four weeks each and four-week intervening washout periods. Diets contained 30 percent of energy as fat, of which 70 percent was from extra-virgin OO, and differed only in the supplement oil: OO, fish oil, FO-PS (as CardiaBeat, from Enzymotec LTD) or sunflower oil esters of plant sterols (SU-PS). Both fish oil and FO-PS provided 5.4 g/d total eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). FO-PS, SU-PS and OO provided the equivalent of 1.7, 1.7, and 0.02 g/d free plant sterols, respectively. Fish oil and FO-PS resulted in fasting and postprandial plasma triacylglycerol concentrations that were markedly lower than those observed with OO and SU-PS (P=0.0001), but to a different extent. LDL cholesterol was significantly lower after supplementation with FO-PS and SU-PS than at the end of the control OO diet (P=0.0031 and 0.0407, respectively). HDL cholesterol was not affected. FO-PS and SU-PS resulted in a lower ratio of total to HDL cholesterol and lower apolipoprotein (apo) B concentrations than did OO and fish oil. The ratio of apoB to apoA was significantly lower after SU-PS consumption than after consumption of OO (P=0.0126) and fish oil (P=0.0292). FO-PS and SU-PS resulted in similar ratios of apoB to apoA. HDL2 and the ratio of HDL2 to HDL3 were significantly higher at the end of the FO-PS treatment than at the end of the OO (P=0.0006), fish oil (P=0.0036), and SU-PS (P=0.0016) treatments.

Another study published in the Journal of Cardiometabolic Syndrome noted, Long-chain omega-3 FAs, from fish and sea mammals, were associated with lower blood pressure, serum triglycerides and two-hour glucose, and higher HDL cholesterol, fasting insulin and homeostasis model assessment. Saturated fat consumption was associated with higher triglyceride levels and blood pressure. Trans fatty acid consumption was associated with higher blood pressure. Consumption of long-chain omega-3 FAs from marine sources may improve certain metabolic syndrome components, and thus may reduce risk for cardiovascular disease.⁸

Konjac-mannan (KJM), also known as glucomannan, is a soluble fiber. A study published in Diabetes Control, found KJM added to conventional treatment improved glycemic control, blood lipid profile and SBP in high-risk diabetic individuals.⁹ The study treated 11 hyperlipidemic and hypertensive type 2 diabetic patients conventionally with a low-fat diet and drug therapy. After an eight-week baseline, all were randomly assigned to take either KJM fiber-enriched test biscuits (as LuraLean, from AHD International) or a matched placebo wheat bran fiber biscuits during two three-week treatment phases separated by a two-week washout period. Compared with the placebo, KJM significantly reduced the metabolic control primary end points: serum fructosamine (P=0.007), total HDL cholesterol ratio (P=0.03), and systolic blood pressure (P=0.02). Secondary end points, including body weight, total, LDL, and HDL cholesterol, triglycerides, apolipoproteins A-1, B, and their ratio, glucose, insulin, and diastolic blood pressure, were not significant after adjustment. A separate study found KJM (as LuraLean) improved blood lipid levels and alleviated the elevated glucose levels in diabetic subjects.¹⁰

Another form of fiber from dehydrated leaves of the cactus Opuntia ficus-indica has shown an effect on blood lipid levels. The study was conducted in France on 68 females diagnosed with metabolic syndrome.¹¹ Half of the females consumed 1.6 g of NeOpuntia® (from Bio Serae) per meal and half a placebo. All volunteers followed well-balanced diets with controlled lipid input. The 42 females older than 45 years of age showed a significant increase in HDL levels with NeOpuntia and a tendency toward decreased triglyceride levels. At the same time, there was a decrease in HDL levels with the placebo. NeOpuntia reduced LDL in 42 women, especially after day 14. At the end of the study, 39 percent of the NeOpuntia group, and only 8 percent of the placebo group, were no longer diagnosed with metabolic syndrome.

References are on the next page.

References for Controlling Metabolic Syndrome Risk

1. Julie R Palmer et al. Sugar-Sweetened Beverages and Incidence of Type 2 Diabetes Mellitus in African American Women Arch Intern Med. 2008;168:1487-1492

2. Sabrina E. Feldeisen, Katherine L. Tucker Nutritional strategies in the prevention and treatment of metabolic syndrome Appl. Physiol. Nutr. Metab. 2007;32(1):46 DOI:10.1139/H06-101

3. Asghar M. et al. Super CitriMax (HCA-SX) attenuates increases in oxidative stress, inflammation, insulin resistance, and body weight in developing obese Zucker rats Mol Cell Biochem. 2007;304(1-2):93-9. Epub 2007 May 15

4. Talpur N et al. Effects of niacin-bound chromium, Maitake mushroom fraction SX and (-)-hydroxycitric acid on the metabolic syndrome in aged diabetic Zucker fatty rats Mol Cell Biochem. 2003;252(1-2):369-77

5. Vladimir Badmaev, Muhammed Majeed, Anthony A. Conte. Open field, physician controlled clinical evaluation of a botanical weight loss formula based on Garcinia cambogia derived (-)hydroxycitric acid NutraCos. January/February 2002; 10-14.

6. Yanagita T, Nagao K Functional lipids and the prevention of the metabolic syndrome Asia Pac J Clin Nutr. 2008;17(1):189-91

7.Isabelle Demonty et al. Fish-oil esters of plant sterols improve the lipid profile of dyslipidemic subjects more than do fish-oil or sunflower oil esters of plant sterols1,2,3 Am J Clin Nutr. 2006;84(6):1534-42

8. Ebbesson SO Fatty acid consumption and metabolic syndrome components: the GOCADAN study J Cardiometab Syndr. 2007;2(4):244-9

9. V Vuksan et al. Konjac-mannan (glucomannan) improves glycemia and other associated risk factors for coronary heart disease in type 2 diabetes. A randomized controlled metabolic trial Diabetes Care 1999;22(6):913-19

10. Hsiao-Ling Chen, RD, PhD et al. Konjac Supplement Alleviated hypercholesterolemia and Hyperglycemia in Type 2 Diabetic SubjectsA Randomized Double-Blind Trial J Am Col Nutr. 2003;22(1):36-42

11. Linarès E, Thimonier C, Degre M The effect of NeOpuntia on blood lipid parameters--risk factors for the metabolic syndrome (syndrome X) Adv Ther. 2007;24(5):1115-25