Metabolic syndrome: signs, symptoms and treatment

Published August 2024 | 4 min read 
Expert contributors Professor Diane Fatkin, molecular cardiologist at the Victor Chang Cardiac Research Institute; Dr Rebekah Hoffman, chair of the NSW and ACT Faculty of the Royal Australian College of General Practitioners 
Words by Sabrina Rogers-Anderson 

Metabolic syndrome affects more than one-third of the Australian population and carries serious health risks – yet most of us have never heard of it. Here’s what you need to know about this condition and how to prevent it. 

With cardiovascular disease responsible for one in four deaths in Australia, medical experts are calling for better awareness of a medical condition that increases the risk of heart attack and stroke by two to three times.

Metabolic syndrome – also known as syndrome X or insulin-resistance syndrome – affects around 30% of Aussie adults as well as some children and adolescents. But the good news is that you can help prevent it by following a healthy lifestyle.

What is metabolic syndrome?

Metabolic syndrome is a cluster of health conditions that occur together and can lead to heart attack, stroke, type 2 diabetes and chronic kidney disease.

New research even shows that metabolic syndrome increases the risk of all types of cancer.

You may be diagnosed with metabolic syndrome if you have at least three of these conditions:

• central obesity (also known as high waist circumference)
• high blood pressure
• high blood triglycerides (a type of fat in your blood)
• low levels of HDL (‘good’) cholesterol
• insulin resistance or type 2 diabetes.
  

“The combined effect of all these factors is not good as far as the heart is concerned and leads to an increased risk of coronary artery disease, heart rhythm abnormalities like atrial fibrillation, heart failure and stroke,” says Professor Diane Fatkin, molecular cardiologist at the Victor Chang Cardiac Research Institute.

Conditions associated with metabolic syndrome

Central obesity

Central obesity refers to excess fat around the abdomen. The general rule is that you have central obesity and are at increased risk of metabolic syndrome if your waist measures more than 94cm for men or 80cm for women.

But the definition of central obesity varies depending on your ethnic background. For example, Chinese, South Asian and Asian-Indian men should keep their waist circumference below 90cm to avoid the risk of central obesity.

High blood pressure

When your systolic blood pressure is over 140 and/or diastolic blood pressure is over 90 – expressed as 140/90mmHg – you have high blood pressure. This alone increases your risk of heart attack and stroke.

People with health conditions including heart disease, diabetes and kidney disease should keep their blood pressure below 130/80mmHg.

High blood triglycerides

Triglycerides are a type of fat that’s created and stored in your fat cells when you consume more kilojoules than you use. Being overweight or insulin resistant, drinking too much alcohol and eating foods that are high in sugar and fat can lead to high levels of triglycerides in your blood.

High triglycerides can put you at risk of stroke, heart attack and heart disease.

Low HDL cholesterol

Low levels of HDL cholesterol – the ‘good’ or protective type – often go hand in hand with high triglycerides. The combination of these two conditions can lead to atherosclerosis (hardening of the arteries), which is a risk factor for heart disease.

Insulin resistance or type 2 diabetes

Insulin resistance happens when your cells don’t respond normally to insulin, a hormone that regulates your blood sugar levels. If insulin resistance becomes chronic, it can lead to high blood sugar, pre-diabetes and type 2 diabetes.

Both insulin resistance and type 2 diabetes are associated with atherosclerosis, high blood pressure and heart disease.

Thyroid function and metabolic syndrome

While thyroid dysfunction is not a formal component of metabolic syndrome, there is significant evidence to suggest that it can influence the development of metabolic syndrome. 

“Thyroid hormones play a role in regulating metabolism, energy balance, and lipid levels. Hypothyroidism, characterised by low levels of thyroid hormones, can lead to weight gain, elevated cholesterol levels, and insulin resistance - all components of metabolic syndrome,” says Dr Hoffman.

Conversely, she adds, hyperthyroidism can affect glucose metabolism and lipid profiles, although its impact on metabolic syndrome is less clearly defined.

Treating thyroid dysfunction, particularly hypothyroidism, may help improve components of metabolic syndrome, including lipid profiles and insulin sensitivity.

Symptoms of metabolic syndrome

The most obvious sign of metabolic syndrome is a waist circumference that exceeds the recommended guidelines. High blood pressure, high triglycerides and low HDL cholesterol generally don’t cause any obvious signs or symptoms so can go unnoticed.

People with high blood sugar levels caused by insulin resistance or type 2 diabetes may experience symptoms including fatigue, excessive thirst and urination, and blurred vision.

Causes of metabolic syndrome

Pinpointing which factor initiates metabolic syndrome is challenging, given the different conditions involved. “But lifestyle factors play a significant role,” says Dr Rebekah Hoffman, chair of the NSW and ACT Faculty of the Royal Australian College of General Practitioners.

“A diet lacking in a range of vegetables, proteins and nutrients, and physical inactivity, are well-documented contributors to the development of metabolic syndrome. A diet high in sugars and unhealthy fats and low in fibre, combined with a less active lifestyle, can lead to insulin resistance and metabolic syndrome.”

There’s also substantial evidence suggesting a genetic component to metabolic syndrome, notes Dr Hoffman.

“Family history of type 2 diabetes, hypertension and cardiovascular diseases can predispose individuals to metabolic syndrome,” she explains. “Certain genetic variations can also affect how the body processes lipids and glucose, influencing the likelihood of developing the syndrome.”

How metabolic syndrome is diagnosed

If your GP suspects you may have metabolic syndrome, they’ll measure your waist circumference, check your blood pressure and order blood tests to measure your triglycerides, cholesterol and blood sugar levels.

But metabolic syndrome can sometimes fly under the radar and go undiagnosed.

“Patients often see different specialists for various components of metabolic syndrome, such as a cardiologist for hypertension and an endocrinologist for diabetes,” explains Dr Hoffman. “This fragmentation can lead to the interconnected nature of these conditions being overlooked.”

Having a regular GP will enable a long-term overview of your whole health, says Dr Hoffman.

“Having a GP will ensure that an integrated, multidisciplinary approach is taken with GP-led care,” she says. “Your GP will also ensure that regular check-ups are done to review insulin levels, cholesterol and blood pressure.”

Need a second medical expert to weigh in on your diagnosis? Our free Second Opinion service for eligible HCF members^* gives you peace of mind and helps you make confident decisions about your health at no extra cost.

Metabolic syndrome treatment

If you think you have metabolic syndrome, it's important to see your GP. They may prescribe medications to manage metabolic syndrome such as high blood pressure or high triglycerides. 

Another effective way to treat metabolic syndrome is to make healthy lifestyle changes to reduce the various risk factors.  

“There is no doubt that adopting a heart-healthy lifestyle is beneficial,” says Prof Fatkin. “This includes a balanced diet, regular moderate exercise, getting plenty of sleep and reducing stress.

Manage your weight

Bringing your weight down to within the healthy range and reducing your waist circumference should help improve your insulin resistance, blood pressure, triglycerides and cholesterol. Losing weight and keeping it off can be challenging though, which is why we’re helping eligible members save on the evidence-based CSIRO Total Wellbeing Diet. Created by Australia’s national science agency, the program combines a higher-protein, low-GI eating plan with proven weight loss tools to help improve habits and create lifelong positive behaviours.

Exercise regularly

Aim for at least 30 minutes of moderate exercise five days a week. Ideally, you should exercise for 30 to 60 minutes on most days of the week. If you keep this up, you’ll soon see improvements in your weight and other health markers.

Eat a healthy diet

Limit the amount of saturated fat, sugar and salt in your diet, and increase your intake of whole grains, vegetables, fruit and healthy unsaturated fats like those found in olive oil and fish.

Quit smoking and reduce drinking

Smoking and drinking alcohol have a range of negative health effects. Limit your alcohol consumption to a maximum of 10 standard drinks per week. The less you drink, the better.

Preventing metabolic syndrome

Embracing a healthy lifestyle is the best way to keep metabolic syndrome at bay. Improving one of your health conditions should have a positive flow-on effect on the others. For example, losing weight should improve your insulin resistance. Then, once your blood sugar levels are under control, your blood pressure and triglyceride readings should come down, says Dr Hoffman.

“Visiting your GP to examine a multifaceted approach, including lifestyle modifications and genetic counselling where appropriate, is essential in managing and preventing metabolic syndrome,” says Dr Hoffman.

While it’s difficult to pinpoint which health condition triggers the others, research suggests that obesity is one of the most common contributing factors to metabolic syndrome. So, managing your weight could be the best place to start.

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