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The diagnosis
of metabolic syndrome is a new way of looking at how
obesity, high blood pressure, high cholesterol, and
high glucose levels interact to produce serious diseases.
Most constellations,
such as Orion and the Big Dipper, are glorious wonders
of the nighttime sky. And then there’s metabolic
syndrome, a potent constellation of risk factors for
serious health problems that many adults should do more
than wonder about.
For years, physicians
have recognized that certain medical irregularities
are undesirable by themselves but extremely dangerous
when occurring at the same time. The condition, also
known as Syndrome X, is commonly referred to as metabolic
syndrome. The components of metabolic syndrome are:
obesity; elevated blood sugar levels, high blood pressure,
high triglyceride levels, and low levels of high-density
lipoprotein (HDL) cholesterol—the “good”
type—(See sidebar,
“Metabolic Syndrome: By the Numbers.”)
“When a person
meets even three of five of the criteria, it’s
a potentially serious situation that is unwise to ignore,”
says Dr.
David Bleich, associate professor at New Jersey
Medical School and chief of endocrinology at University
Hospital. “Metabolic syndrome greatly increases
a person’s likelihood of having a heart attack,
stroke, or developing diabetes.”
Endocrinologists believe
insulin resistance has a central role in metabolic syndrome.
In a healthy person, insulin, a hormone produced by
the pancreas, facilitates glucose transport into the
cell. Once inside, glucose is converted to energy or
is stored. When insulin resistance sets in, the pancreas
responds by producing more insulin. In time, as the
pancreas cannot compensate for the insulin resistance,
the blood sugar rises and diabetes ensues. The metabolic
syndrome and insulin resistance also lead to a state
of subclinical inflammation that damages the linings
of blood vessels and predisposes the individual to vascular
disease.
The number of people
with metabolic syndrome has gone sky high. An estimated
25 percent of all American adults and 40 percent of
adults over age 40 have the condition. That’s
about 60 percent more today than in the 1990s. What’s
behind the dramatic increase? Dr. Bleich believes it’s
no coincidence that rates of metabolic syndrome and
obesity are both on the rise. “Obesity, especially
when the weight is carried around the waist, has a direct
correlation to metabolic syndrome, and unfortunately,
there is an obesity epidemic in the U.S.,” he
says.
The diagnosis of metabolic
syndrome is based on more than results of blood tests
and blood pressure readings. “The patient’s
lifestyle and family history are also taken into account,”
says Dr. Bleich. “Someone who smokes or has an
immediate family member who had a heart attack at an
early age could be diagnosed with metabolic syndrome,
even if his numbers are slightly below the criteria.”
There’s no magical
cure for metabolic syndrome, but with lifestyle changes
and perhaps certain medications, it can be kept in check.
The lifestyle changes are the same recommended over
and over by physicians: lose weight, stop smoking, and
get more exercise. “We all know it’s important
to do these things, but it’s difficult,”
says Dr. Bleich. “How many employers do you know
give their employees time out of the work day to exercise?
Yes, that would cut into the bottom line, but the debt
we pay as a society due to obesity is far greater and
more serious.”
Depending on the patient,
there are some medications doctors can prescribe. For
people with an elevated risk of heart attack, baby aspirin
is a simple and relatively safe way to offset some of
the vascular effects of the metabolic syndrome. Statin
drugs are not only effective in lowering cholesterol,
says Dr. Bleich, but studies indicate they also have
potent anti-inflammatory effects. "Some, but not
all, people might be candidates for oral medications
given to people with diabetes", he says.
A
Delicate Balance
Metabolic syndrome is
an excellent example of how conditions of the endocrine
system can impact the entire body. Chances are, most
people don’t think twice about their endocrine
system. And yet, the system’s glands and the hormones
they release are the underpinnings of good health.
The major glands of the
endocrine system are, at first glance, an eclectic collection:
the pituitary gland (sometimes called ‘the master
gland’ because it regulates the other endocrine
glands) and the hypothalamus in the brain; the thyroid
gland in the neck; the adrenal glands above the kidneys;
the pancreas; and the ovaries and the testes. These
glands are in different areas of the body, but they
share a basic premise: an imbalance in the hormones
they release can cause significant problems.
Take the pituitary gland,
for example, which produces several hormones. Tumors
called pituitary adenomas can develop on the pituitary
gland. Certain types of pituitary adenomas produce unusually
high amounts of a hormone, causing symptoms that range
from abnormal growth to cessation of menstrual periods.
(The symptoms depend on which hormone is secreted.)
A pituitary adenoma is benign, but the symptoms it can
cause and its size and location in the brain are reasons
for treatment. At University Hospital, an interdisciplinary
team of physicians that include neurosurgeons, radiologists,
and endocrinologists develop a treatment plan for patients
who require surgery and subsequent monitoring.
Heed
the Warnings
The symptoms of some
endocrine conditions can be subtle, making it tempting
for the patient to “live with” the problem.
Betty Searvance, a 67-year-old Hudson County resident,
listened to her body instead. In the early1990s, she
began having trouble sleeping. “At first I thought
it was because I had recently lost my son, but I went
to my doctor, who found a goiter. He referred me to
the endocrinology department at University Hospital,”
says Mrs. Searvance. The goiter, an enlargement of the
thyroid gland, was a symptom of her underlying problem,
hyperthyroidism. With medicine to shrink the goiter
and treat her overactive thyroid, Mrs. Searvance began
feeling better.
That’s not the
end of Mrs. Searvance’s story, however, because
it can be difficult to achieve the normal level of hormone
production in the thyroid. “In 1992, I was diagnosed
with hypothyroidism, an underactive thyroid,”
she said. Dr.
Maya Raghuwanshi, an associate professor of medicine
at New Jersey Medical School and an endocrinologist
at University Hospital, prescribed a thyroid hormone
for her.
For insurance reasons,
Mrs. Searvance had to change physicians. Underscoring
the importance of knowing one’s body, she went
to her new doctor at a different hospital when she felt
a lump near her thyroid. “He told me I didn’t
have a lump. I said I did, and finally, a scan showed
a nodule on my thyroid,” says Mrs. Searvance,
who had the nodule (which was benign) removed in 2002.
Still, she said that she was so used to “the thorough
examinations of Dr. Raghuwanshi that I ’d go back
to her, even if I had to spend my own money.”
And Mrs. Searvance has
gone back to Dr. Raghuwanshi, not only for management
of her thyroid condition, but now, for her recent diagnosis
of another endocrine condition, Type II diabetes. She
is following a special diet plan and taking medication
to control her diabetes. Her experiences have taught
her, “Look out for the little things and know
your body.”
Help
for Older Bones
Increasingly, endocrinologists
are working alongside internists, cardiologists, and
other specialists to tackle the burgeoning health problems
of the day—namely, heart disease and obesity—and
the chronic conditions that affect an aging population,
such as osteoporosis.
About 10 million Americans
have osteoporosis, characterized by loss of bone mass.
Weakened, fragile bones are more prone to breaking,
and 1.3 million osteoporosis-related fractures occur
each year in the United States. Among the risk factors
for osteoporosis is a decrease in the amount of the
sex hormone estrogen.
“As a woman enters
menopause, her estrogen levels naturally go down,”
says Dr. Bleich. “In postmenopausal women, hormone
replacement therapy (HRT) is a standard treatment to
maintain estrogen levels and protect against bone loss,
but research has shown a correlation between HRT and
an increased risk of cardiovascular disease and breast
cancer.” Even with lower-dose HRT available, some
women are not good candidates for HRT or are concerned
about its possible complications. These women face another
risk: osteoporosis. “Fears over HRT might inadvertently
touch off an epidemic of osteoporosis,” says the
endocrinologist.
Dr. Bleich urges postmenopausal
women who do not take estrogen to talk to their physician
or consult an endocrinologist about strategies for preserving
bone mass. Dairy products and other calcium-rich foods,
such as broccoli and canned sardines, can be helpful,
but most women do not include sufficient amounts of
these foods in their diets. Weight-bearing exercise,
calcium supplements and Vitamin D (to help the body
absorb the calcium) are often recommended, and some
women are prescribed medicine that reduce the risk of
fracture by slowing the rate of bone breakdown or increasing
bone mineral density.
As with many other medical
conditions, the best defense against osteoporosis is
a good offense. “The prime years for building
bone mass are during adolescence,” says Dr. Bleich.
“Teenage girls, in particular, should be encouraged
to get adequate calcium in their diets.”
A
New Look at a Familiar Disease
Diabetes is an all-too-common
reason for people to visit an endocrinologist. Type
I diabetes and the more prevalent Type II diabetes,
in which the pancreas doesn’t produce enough insulin,
affects about 18 million people in the United States,
although 5 million are undiagnosed. Diabetes can be
well controlled by lifestyle changes, namely, diet and
exercise, and medicine, such as insulin injections for
Type I patients and oral tablets for Type 1 patients
and oral tablets for Type II patients. However, when
diabetes is not well controlled, it can wreak havoc
on the body, causing such complications as heart disease,
stroke, blindness, kidney failure, and nerve damage.
According to the American Diabetes Association, diabetes
was the sixth-leading cause of death in 2000.
Diabetes is a well-studied
disease, but it is complex and there is no cure, so
researchers continue to unlock the clues. Of special
interest, says Dr. Bleich, is a possible relationship
between the immune system and Type II diabetes. “There’s
evidence of a subclinical inflammatory response—not
the type people associate with a rash or a fever, but
one that occurs on the cellular level within the blood
vessels,” he says. “The cells’ function
becomes abnormal and damages the tiny blood vessels,
not unlike corrosive material in pipes.” Some
research indicates that elevated amounts of a substance
called c-reactive protein, a marker of inflammation
in the body, could be a predictor for diabetes.
Preventing diabetes remains
a major public health issue, and increasingly, physicians
are identifying patients with pre-diabetes. “People
with pre-diabetes have an elevated fasting blood glucose
level, but not as high as those with diabetes,”
says Dr. Bleich. Fasting blood glucose levels between
110 and 125 mg/dL are indicative of pre-diabetes; anything
higher is considered to be diabetes. Exercise and moderate
weight reduction—5 percent to 10 percent of body
weight—can help restore blood glucose levels to
within the normal range and prevent pre-diabetes from
progressing to Type II diabetes. Unlike Type II diabetes,
which can produce symptoms such as blurry vision, unusual
thirst, and frequent urination, pre-diabetes is symptomless.
That’s why it is important for people with pre-diabetes
to have glucose screening every one to two years.
To arrange
for a consultation with Dr. Bleich or Dr. Raguwanshi,
please call 973-972-2500.
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