Expert Health Articles

What is insulin resistance? What is metabolic syndrome?

Chelsea Haselman

Registered Dietician/Certified Diabetes Educator at Bluffton Women’s Care

Metabolic syndrome and insulin resistance are public-health concerns that are on the rise.  The increase in energy intake, obesity and sedentary lifestyle are a few of the contributing factors.  A diagnosis of metabolic syndrome is consistent with a five-fold increase in the risk of Type 2 diabetes mellitus and a two-fold risk of developing cardiovascular disease over the next five to 10 years.  

Metabolic syndrome is defined as being interconnected by physiological, biochemical, clinical and metabolic factors that directly increase the risk of atherosclerotic cardiovascular disease and Type 2 diabetes mellitus.  Diagnostic criteria according to the world health organization is as follows:  A patient with the diagnosis of insulin resistance or impaired glucose metabolism combined with any of the two following diagnoses: obesity, increased waist circumference (abdominal obesity), elevated blood pressure, high cholesterol or elevated glucose levels. An insulin resistance diagnosis is demonstrated as impaired glucose metabolism or tolerance by an abnormal response to a glucose challenge test with an elevated corresponding insulin level.  It is defined as a condition in which a normal insulin concentration does not adequately produce a normal insulin response. 

The susceptibility of developing metabolic syndrome or insulin resistance has a large variation in age and other genetic and environmental factors that can play a role.  It is also recognized that some people who are not obese by traditional measures can be insulin resistant and have abnormal levels of metabolic risk factors.   

Effective preventative approaches include lifestyle changes such as weight loss, diet and exercise and medication treatment when deemed appropriate.    

  • Life style modification: Treatment should not only be addressed by a physician but also by other health care professionals, such as a dietitian or health education professional.
    • Weight reduction: There are four main therapies that can be used to achieve weight reduction; calories restriction, increased physical activity, behavioral modification and in appropriate patients, FDA approved weight reduction drugs. A recommended weight loss goal of 10% reduction in body weight is recommended in the first six months to a year and continued weight loss thereafter until BMI is less than 25. While weight loss can be difficult to achieve, exercise and dietary changes alone can lower blood pressure and improve lipid and insulin levels even in the absence of weight loss. A weight loss as small as five to 10% of body weight can significantly reduce risk factors associated with insulin resistance and metabolic syndrome. 
    • Diet: There are many diet options on the market and while all can produce weight loss results in the short term, many can be extremely restrictive and unrealistic for long-term behavioral change. The most effective and healthful methods for long-term weight loss are reduced-energy diets, which consist of a 500-800 calorie a day reduction of overall current calorie intake. Sustained dietary changes may require a referral to a registered dietitian to help implement and offer suggestions to ensure an adequate nutrient intake while reducing overall calorie intake. The Mediterranean diet and DASH diets have both been supported scientifically and by professional organizations to be beneficial for patients with these conditions.     
  • The Mediterranean Diet:
    • High in consumption of fruits, vegetables, legumes and whole grains. 
    • Low consumption of alcohol, dairy products and meat products that have high saturated fat content.  
  • DASH diet
    • High in fruits, vegetables and low-fat dairy products. 
    • Low in saturated fat and total fat intake and recommends low glycemic index foods such as unrefined and complex carbohydrates. 
  • Exercise:  Daily, moderately intense activity for a minimum of 30 minutes, five days a week or a goal of >10,000 steps a day. 

Metabolic syndrome and insulin resistance syndrome are conditions that vary in the risk factors present in each patient.  It should be treated on an individualized basis and have a treatment plan that involves a multidisciplinary approach involving multiple medical professionals that can help to facilitate behavior change.