A Functional Medicine Treatment Protocol for Metabolic Syndrome: Testing, Nutrition, and Supplements

Metabolic syndrome is a rising condition among US adults, from 32.5% in 2011 to nearly 37% in 2016. This condition significantly increases your risk for other health problems. People with metabolic syndrome have a two-fold higher risk of dying and a three-fold higher risk of stroke or heart attack than those without metabolic syndrome. People with metabolic syndrome are also five times more likely to develop type 2 diabetes.

Lifestyle factors such as physical inactivity and eating poor-quality processed foods are major contributors to the rising incidence of metabolic syndrome. This article will cover what metabolic syndrome is, what causes it, symptoms to look for, lab tests that can help individualize treatment, and a functional medicine treatment protocol for metabolic syndrome.

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What is Metabolic Syndrome?

Metabolic syndrome, sometimes called insulin resistance syndrome or syndrome X, is characterized by abdominal obesity, insulin resistance (impaired blood sugar regulation), high blood pressure, and abnormal cholesterol levels. Having metabolic syndrome increases your risk of developing type 2 diabetes and cardiovascular disease.

To be diagnosed with metabolic syndrome, three or more of the following must be present: a waist circumference greater than 35 inches for women or 40 inches for men, fasting blood sugar higher than 100 mg/dl, fasting triglyceride levels higher than 150 mg/dl, fasting high-density lipoprotein (HDL) cholesterol <50 mg/dl for women or <40 mg/dl for men, and blood pressure higher than 130/85 mmHg.

Metabolic syndrome is a condition primarily brought on by a Western lifestyle, characterized by a lack of physical activity and unhealthy eating patterns. While it originated in Western nations and is more prevalent in urban populations, it has become a global problem.

What Causes Metabolic Syndrome?

Several factors contribute to the metabolic imbalances that are characteristic of metabolic syndrome. While lifestyle factors are pivotal in this condition, there are uncontrollable factors associated with this it, such as genetics, family history, older age, and lower socioeconomic status.

Thankfully, modifiable factors make up the majority of the causes of metabolic syndrome—the most significant being nutrition. We have become reliant on low-fiber fast food, and our health is being adversely affected by it. A Western diet, high in refined carbs, sugar, trans fats, and processed foods, contributes greatly to abdominal obesity, insulin resistance, and an unhealthy cholesterol pattern, which are hallmarks of metabolic syndrome. In addition to a Western diet, micronutrient deficiencies, such as vitamin D, can cause insulin resistance and impaired glucose control, increasing the risk for this condition.

A sedentary lifetsyle isn't doing our body's any favors either. Physical inactivity is significantly linked to the metabolic imbalances associated with metabolic syndrome. A study examining physical activity and the prevalence of metabolic syndrome in over 1600 individuals found that those who did not engage in moderate or vigorous physical activity had almost double the risk for developing metabolic syndrome than those who had 150 minutes per week or more of physical activity.

Gut health imbalances are implicated in so many health conditions, and metabolic syndrome is no exception. Alterations in the gut microbiome (the microorganisms that live in the gut) are identified in people with metabolic disorders. Evidence also links gut dysbiosis (imbalances in the microorganisms that live in the gut) with obesity, insulin resistance, and unhealthy cholesterol patterns. Disruptions in the gut barrier function and inflammation play critical roles in the metabolic consequences of compromised gut health.

Getting adequate deep, restorative sleep every night is vital to optimal health. Not getting enough sleep every night (at least 7 hours) has been associated with an increased risk for metabolic syndrome in both men and women. It may be more than sleep duration that impacts metabolism, as circadian misalignment also increases the risk for factors associated with metabolic syndrome.

Circadian rhythm is representative of the physical, mental, and behavioral patterns our bodies follow during a 24-hour cycle. These behaviors respond to light-dark cycles, such as sleeping at night when it’s dark and eating during the day when it’s light. Evidence indicates that eating and sleeping outside of these light-dark cycles results in circadian misalignment. When this occurs we increase our risk of developing metabolic syndrom due to it's impact on blood sugar control.

Stress is another lifestyle factor that has far-reaching effects, including impacting metabolic disease. A systematic review and meta-analysis examined the link between psychological stress and metabolic syndrome and found that adults with high stress had a 45% higher chance of developing metabolic syndrome.

Exposure to toxins and impaired detoxification can lead to an increased toxic load in the body. Toxins negatively impact body processes, such as mitochondrial function and the gut microbiome, which can lead to insulin resistance and metabolic dysfunction.

Metabolic Syndrome Symptoms

The signs and symptoms of metabolic syndrome may include:

• abdominal obesity
• high fasting triglycerides
• low HDL cholesterol
• hypertension
• insulin resistance
• high fasting blood glucose

Symptoms that are often associated with insulin resistance include:

• increased thirst and hunger
• frequent urination, especially at night
• headaches
• blurry vision
• slow wound healing
• vaginal and skin infections

Functional Medicine Labs to Test That Can Help Individualize Treatment of Metabolic Syndrome

When assessing for metabolic syndrome, basic blood testing would include a comprehensive metabolic panel (CMP), hemoglobin A1c (HbA1c), insulin, and a lipid panel (which includes triglyceride and HDL cholesterol levels) to assess for insulin resistance, high blood glucose, and abnormal cholesterol levels characteristic of this condition. In addition to basic blood testing, the following functional medicine lab tests can help identify root causes for metabolic syndrome to individualize your treatment plan.

Metabolomic Profile

The Metabolomic Profile assesses an at-risk patient's likelihood of developing metabolic syndrome and includes the following markers:

1,5-AG, Cystatin C, C-Reactive Protein, Leptin/Adiponectin Ratio, Fasting Insulin, eGFR, Creatinine, Fasting Glucose, BMI

Genetic Test

The 3X4 Genetics Test + Blueprint Report from 3X4 Genetics assesses over 134 genes influencing metabolism, detoxification, inflammation, weight, hormones, and how the body will respond to diet and supplements. This test provides valuable insight that can help target which lifestyle factors to focus on in treating metabolic syndrome.

Micronutrient Panel

Evaluating micronutrient status with a Micronutrient Test provides insight into what nutritional imbalances may be contributing to metabolic syndrome and allows you to provide a highly individualized nutritional treatment plan.

Vitamin D can also be tested separately in a regular comprehensive blood workup.

Comprehensive Stool Test

A comprehensive stool test, like the GI-MAP test by Diagnostic Solutions, provides valuable information about the gut microbiome, digestion, absorption, inflammation, and immune function to assess overall gut health. Additionally, this stool test by Diagnositic Solutions includes zonulin to provide information about gut permeability, which can impact metabolic dysfunction.

DUTCH Test

The DUTCH Plus™ test is a urine test that evaluates stress hormones and the Cortisol Awakening Response (CAR), an indicator of the impact of stress on the body. It also includes an insomnia cortisol sample if sleep dysfunction is present.

Inflammation Test

Various factors associated with metabolic syndrome, such as impaired gut health and insulin resistance, cause increased inflammation in the body. Markers to evaluate for inflammation, such as C-Reactive Protein (CRP), can help manage treatment for this condition.

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Functional Medicine Treatment Protocol for Metabolic Syndrome

A functional medicine treatment protocol for metabolic syndrome takes a patient-centered approach and addresses all environmental and lifestyle factors that may be contributing.

Physical Activity

Physical activity lowers your risk of developing metabolic syndrome. Exercise has been proven effective in reducing abdominal obesity, regulating blood pressure, improving HDL cholesterol and triglyceride levels, and regulating blood glucose and insulin levels. Getting 150–300 minutes of moderate-intensity aerobic activity or 75–150 minutes of vigorous aerobic activity each week is recommended.

Stress & Sleep

Stress management and sleep optimization are other vital aspects of a functional medicine treatment protocol for metabolic syndrome. By reducing the impact of stress with mind-body therapies, like with meditation, you can improve glucose control, reduce inflammation, and improve cortisol levels. Additionally, getting adequate sleep (7 hours per night) is essential for optimal health and is associated with a lower risk for metabolic syndrome.

Detoxification

If toxin testing indicates high levels of toxins are present, it’s crucial to identify the source of the exposure so it can be reduced or eliminated. In addition to certain supplements, staying hydrated and eating a high-fiber healthy diet are key factors supporting the body’s natural detoxification processes. Activities like dry brushing, using a sauna, and exercising also enhance the body’s detoxification processes.

Nutrition Considerations for Patients With Metabolic Syndrome

Nutritional support plays a significant role in the treatment of metabolic syndrome. Focusing on anti-inflammatory, high-fiber, nutrient-dense foods is the best way to support overall health. A Mediterranean diet does just that; evidence shows this eating style is linked to a lower risk of metabolic syndrome.

A Mediterranean diet emphasizes whole grains, seasonal fruits and vegetables, herbs, legumes, and healthy fats like olive oil. The core of this eating style is high-fiber plant-based foods, although it also includes fish, poultry, dairy, eggs, and red wine in moderation.

A Mediterranean diet can enhance blood sugar control, reduce inflammation, support gut health, improve HDL cholesterol and triglyceride levels, and regulate the HPA axis (which modulates the stress response).

Supplements Protocol for Metabolic Syndrome

A functional medicine supplements protocol for metabolic syndrome considers your individual lifestyle, environmental factors, and laboratory test results to create a tailored treatment plan unique to your needs. The following supplements are commonly prescribed for metabolic syndrome; however, it's crucial to follow your doctor's advice to ensure you're taking supplements appropriate for you.

Multivitamin Multimineral Supplement

A high-quality multivitamin multimineral supplement can provide a broad base of vitamins and minerals to support optimal metabolic health. The Designs for Health DFH Complete Multi™ with Copper is an example of a high-quality multivitamin multimineral supplement that contains essential micronutrients for optimal metabolic health and proper blood glucose control.

Multivitamin Multimineral Prescription

The following is the DFH Complete Multi™ with Copper recommendation; however, always follow the guidance of your healthcare practitioner.

Dose: 2 capsules with lunch and 2 capsules with dinner

Duration: Ongoing

Probiotics

Probiotics are beneficial strains of bacteria that improve health. Probiotic supplements support a healthy gut microbiome, improve gut barrier function, modulate inflammation, reduce insulin resistance, and improve blood glucose control, making them a valuable consideration in a metabolic syndrome treatment plan.

Probiotics Prescription

Ortho Molecular Products Ortho Biotic is a prime example of a quality probiotic. It contains six beneficial bacteria strains and one health-promoting yeast strain, supplying each capsule with 23 billion colony-forming units (CFU) of probiotic support.

Dose: 1 capsule per day, with meals

Duration: Ongoing

Omega-3

Omega-3 fatty acids have many benefits for optimal health. Omega-3 supplements reduce inflammation, support cardiovascular health, reduce triglyceride levels, increase HDL cholesterol, and improve insulin sensitivity in people with metabolic disorders.

Omega-3 Prescription

Dose: 2,000 mg per day

Duration: Minimum of 3 months

Berberine

Berberine is the active compound in an ancient Chinese herb, Coptis chinensis French, used for thousands of years to treat diabetes. Evidence shows berberine supplementation reduces triglycerides, insulin, HbA1c, and blood glucose levels. Berberine has anti-inflammatory and antioxidant properties, making it a valuable addition to a metabolic syndrome treatment protocol.

Berberine Prescription

Dose: 500 mg, two to three times per day

Duration: Minimum of 3 months

Milk Thistle

Milk thistle is a well-known herb used for its liver-protective benefits. The liver is one of our major detoxification organs, so when the body’s toxic load is high, it’s helpful to protect the liver from damage from toxins and support the liver in eliminating toxins from the body. The active compounds in milk thistle are called silymarin and are known to have liver protective effects and support detoxification. Studies have shown that when milk thistle and berberine are used in combination, they promote cardiometabolic health by improving blood glucose control and lipid profiles.

Milk Thistle Prescription

Dose: 200 mg, three times per day

Duration: 4 months

Vitamin D

Vitamin D is important for overall health, with benefits ranging from reducing inflammation to regulating glucose control. Deficiencies in vitamin D are associated with an increased risk of many chronic diseases, including metabolic syndrome, diabetes, and cardiovascular disease.

Vitamin D Prescription

A “loading dose” is usually required to increase blood levels of Vitamin D to normal ranges.

Loading Dose: 50,000 IU, 3 times per week

Duration: 1 month

Once normal blood levels are reached, a maintenance dose of Vitamin D is needed to maintain optimal levels.

Maintenance Dose: 800 to 2,000 IU of Vitamin D3 per day

Duration: Ongoing

Any protocol must consider the total nutritional intake from all supplemental sources. For instance, this multivitamin contains 1,000 IU of vitamin D3 and may meet the daily need for vitamin D3 once the loading dose raises Vitamin D levels to normal ranges. Monitor blood levels of vitamin D through laboratory testing to determine whether the multivitamin is sufficient to maintain normal blood levels of this micronutrient.

When to Retest Labs

When utilizing fish oil and berberine to improve blood glucose control and triglyceride and HDL cholesterol levels, it can take 12 weeks to see results. Based on this data, it’s best to wait at least 3 months before retesting cholesterol and markers of blood glucose control to determine treatment effectiveness.  

After starting a vitamin D supplement, waiting 3 to 6 months before retesting your vitamin D levels is advised.

Retesting in 3 to 6 months is also ideal for a comprehensive stool analysis, micronutrient panel, DUTCH  Plus™, toxins, and basic blood work to provide enough time for the treatment protocol to improve the nutrient status, stress hormones, toxic load, inflammation, blood glucose control, and gut health.

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Summary

Metabolic syndrome is a prevalent and rising problem, with lifestyle factors, such as physical inactivity and unhealthy dietary choices, as significant drivers of this condition. Tuning into healthy lifestyle practices, such as exercise, healthy food choices, stress management, getting quality sleep, and avoiding toxin exposure, are simple ways to reduce your risk for metabolic syndrome while promoting optimal health and well-being.

In addition to a healthy lifestyle, various supplements prove helpful in the treatment of metabolic syndrome. Consult your integrative healthcare practitioner to find out what lab tests and supplements may be beneficial in creating a treatment plan tailored for individualized needs.