Metabolic syndrome: what it is, how it is diagnosed, and how to improve it

Glucose, triglycerides, blood pressure, weight… we often focus on these parameters separately, but metabolic health does not depend on a single value. What is often important is how they relate to each other and what happens when several alterations appear at the same time.

Metabolic syndrome is precisely the combination of different metabolic and cardiovascular risk factors. It does not always produce obvious symptoms and can appear even in people who are not obese.

In this article, we will look at what metabolic syndrome is, what its criteria are, why it can appear, and what strategies can help improve its different components. We will also look at what role supplementation can play and how far the evidence really goes.

What is metabolic syndrome?

Metabolic syndrome is not a single disease, but the joint appearance of several metabolic and cardiovascular risk factors.

To establish its presence, five components are assessed: waist circumference, triglycerides, HDL cholesterol, blood pressure, and fasting glucose.

The diagnosis is established when there are at least three of these five criteria.

Therefore, talking about metabolic syndrome does not simply mean being overweight, having high blood sugar, or having hypertension. What matters is the combination of different alterations.

What are the symptoms of metabolic syndrome?

One of the peculiarities of metabolic syndrome is that it may not produce obvious symptoms.

An elevated abdominal waist can be seen externally, but high blood pressure, elevated triglycerides, or low HDL can go completely unnoticed.

When glucose is sufficiently elevated, symptoms such as increased thirst, increased urination, fatigue, or blurred vision can appear.

Therefore, feeling well does not necessarily mean that metabolic health is in good condition.

The assessment must be carried out taking into account different measurements and analytical parameters, not just how we feel.

How is it diagnosed? The 5 criteria of metabolic syndrome

The diagnosis is based on the presence of at least three of the five established criteria.

The values commonly used are:

• Elevated waist circumference: the cut-off points depend on the population and the criteria used.

• Triglycerides: ≥150 mg/dL (1.7 mmol/L) or specific treatment.

• HDL: <40 mg/dL in men or <50 mg/dL in women, or treatment.

• Blood pressure: ≥130/85 mmHg or antihypertensive treatment.

• Fasting glucose: ≥100 mg/dL (5.6 mmol/L) or treatment.

In the case of waist circumference, there is a peculiarity: the cut-off points can vary according to the population and region. For people of European origin, for example, the International Diabetes Federation proposes ≥94 cm in men and ≥80 cm in women, although other criteria use different values.

Therefore, these data serve to understand how the diagnosis is established, but the assessment must be individualized based on each person's context.

What causes metabolic syndrome?

There is no single cause capable of explaining metabolic syndrome.

The abdominal adiposity and insulin resistance are closely related to its appearance, although the pathophysiology is more complex.

Insulin resistance has been studied for decades as one of the possible common elements. When cells respond worse to the action of insulin, the body needs to produce more to manage to keep glucose within adequate levels.

Over time, this alteration can be related to other metabolic changes, such as lipid alterations, increased abdominal fat, or changes in glucose control.

Therefore, when we talk about metabolic health, we should not focus only on blood sugar.

Glucose, lipids, blood pressure, and body composition are part of the same metabolic context.

Can you have metabolic syndrome without obesity?

Yes.

Elevated waist circumference is one of the five criteria, but it is not essential to establish the diagnosis.

A person may not have obesity and still meet three of the other criteria: for example, having elevated glucose, high triglycerides, and high blood pressure.

Similarly, a person with excess weight does not necessarily have to present all these alterations.

Therefore, body weight alone does not allow us to determine how metabolic health is.

It is necessary to assess the set of parameters and the individual context.

How can metabolic syndrome be improved?

Lifestyle changes constitute a fundamental part of the approach, especially when combining nutrition and physical activity.

A recent review that brought together 98 clinical trials and more than 12,800 participants with metabolic syndrome observed that interventions that combined nutritional components and physical activity had advantages over exercise alone for improving metabolic syndrome.

This does not mean that there is a single diet or a single type of exercise that works for everyone.

Each of the alterations present may also require a specific approach.

Therefore, improving metabolic health is not about looking for a quick fix, but about working on the different factors that are altered.

What role does fiber have in metabolic health?

Within nutrition, soluble fiber can be especially interesting.

A review of 181 clinical trials with more than 14,500 participants observed overall reductions in total cholesterol, LDL, and triglycerides with soluble fiber supplementation.

However, the effect varied depending on the type of fiber, the dose used, and the characteristics of the people studied.

This is important because we cannot assume that all fibers produce exactly the same effect or that a certain dose will have the same result in all people.

One of the fibers that has specific research is partially hydrolyzed guar gum or PHGG.

In a trial conducted on people with type 2 diabetes and metabolic syndrome, the administration of 10 g daily of PHGG for six weeks was associated with a reduction in waist circumference and HbA1c compared to the start of the study.

However, no changes were observed in other parameters such as fasting glucose, triglycerides, HDL, LDL, or blood pressure.

This allows us to better understand where fiber can be of interest: as part of a global strategy, not as an intervention capable of correcting metabolic syndrome on its own.

Can fiber supplementation be useful?

When it is difficult to achieve a sufficient intake of fiber through diet, a supplement can help complete the intake.

FiberTotal provides 6 g of soluble fiber per serving, of which 3 g comes from PHGG Sunfiber®.

This fiber stands out for its digestive tolerance and for being certified as low FODMAP.

However, it is important to maintain the context: the amount of PHGG in FiberTotal does not reproduce the dose used in the clinical trial mentioned above.

Therefore, we should not automatically transfer the results of a study conducted with a specific dose to any product that contains the same ingredient.

Supplementation should be understood as a tool to complement nutrition when it makes sense, not as a substitute for an adequate diet.

Can supplements help with metabolic syndrome?

Supplements do not replace nutrition, physical activity, or medical treatment when it is necessary.

That said, some ingredients have been studied for their possible influence on parameters related to glucose and lipid metabolism.

Here it is important to differentiate between the evidence available on a specific ingredient and the evidence of a complete formula.

Just because an ingredient has demonstrated certain effects in a study does not automatically mean that a combination that contains it will produce exactly the same result.

Berberine and metabolic syndrome

The berberine is one of the ingredients that has the most clinical research within this context.

A recent review of randomized, placebo-controlled trials found favorable effects on different parameters: triglycerides, LDL, total cholesterol, fasting glucose, two-hour glucose, body mass index, and waist circumference.

In contrast, it did not find a significant overall effect on HDL or blood pressure.

These results are interesting, but they must be interpreted correctly.

The available evidence does not allow us to state that berberine alone reverses metabolic syndrome.

In addition, the review evaluated high-purity berberine administered without other ingredients. Therefore, its results cannot be directly transferred to any formulation that contains berberine.

Why does the formulation of berberine matter?

One of the aspects that have been studied in relation to berberine is its limited oral absorption.

For this reason, different formulations have been developed aimed at improving its bioavailability.

Metabolic-Max uses Berbevis®, a formulation of berberine associated with a matrix with phospholipids and other components.

In a pharmacokinetic study conducted on 12 healthy volunteers, the formulation of berberine associated with phospholipids produced a plasma exposure superior to that of non-formulated berberine.

The total exposure was approximately 9.76 times higher after taking into account the different effective amount of berberine administered.

But there is an important difference between bioavailability and clinical effect.

Just because a formulation produces greater exposure to berberine does not mean that it has a clinical effect nine or ten times greater.

What do we know about silymarin?

The silymarin, from milk thistle, has also been studied in different contexts related to metabolic health.

A meta-analysis of 33 trials and 1,943 participants found reductions in fasting glucose, insulin, HbA1c, total cholesterol, triglycerides, and LDL.

However, the included studies presented important differences in terms of population, dose, and duration.

In addition, the majority presented low methodological quality or a high risk of bias.

Therefore, it is more appropriate to consider silymarin as a supporting ingredient within a global strategy, and not turn it alone into the protagonist of the metabolic approach.

What do we know about Gymnema sylvestre?

With Gymnema sylvestre we must be somewhat more cautious.

The available clinical research is more limited and there are important differences between the extracts used, the doses, the duration of the studies, and their standardization.

In a small double-blind, placebo-controlled trial conducted on people with glucose intolerance, 600 mg daily were administered for 12 weeks.

Within the supplemented group, changes were observed in some parameters, including two-hour glucose, HbA1c, LDL, weight, body mass index, and insulin sensitivity.

However, at the end of the intervention, there were no significant differences between groups in the continuous variables analyzed.

A subsequent review also highlights the heterogeneity of the evidence and the need to conduct larger and longer-duration clinical studies.

Therefore, it can be considered a complementary ingredient of interest, but we still need more evidence to precisely define its clinical effect.

Where does Metabolic-Max fit in?

After reviewing each of these ingredients, we can better understand the logic of a formula oriented towards metabolic health.

Metabolic-Max should not be understood as a product intended to «accelerate» the metabolism.

Its approach is to bring together different ingredients related to some of the processes we have explained.

The daily dose of two capsules provides:

• 550 mg of Berbevis®, which provide 170.5 mg of berberine.

• 300 mg of Gymnema sylvestre, which provide 225 mg of gymnemic acids.

• 132 mg of milk thistle, which provide 105 mg of silymarin.

• 4.75 mg of piperine.

• 100 µg of chromium.

In addition to berberine, gymnema, and silymarin, the chromium contributes to normal macronutrient metabolism and the maintenance of normal blood glucose levels.

The formula, therefore, should be understood as a complementary tool within a broader metabolic care strategy, which starts with nutrition and physical activity and which must be adapted to the needs of each person.

Frequently asked questions about metabolic syndrome

Is metabolic syndrome the same as insulin resistance?

No.

Insulin resistance frequently appears associated with metabolic syndrome, but it does not constitute the diagnosis on its own.

To talk about metabolic syndrome, at least three of the five established criteria must be met: waist circumference, triglycerides, HDL, blood pressure, and fasting glucose.

Can metabolic syndrome be reversed?

Its different components can improve to the point that a person stops meeting the diagnostic criteria.

However, there is no single intervention valid for all cases.

The strategy will depend on which parameters are altered and may include changes in nutrition, physical activity, and, when necessary, specific treatment.

Do supplements accelerate the metabolism?

It is not an appropriate way to describe the function of the supplements we have reviewed.

Their possible interest is mainly related to parameters such as glucose, insulin, lipids, or body composition, not with demonstrating a general increase in energy expenditure.

Therefore, talking about «accelerating the metabolism» oversimplifies its possible function.

Is Metabolic-Max for losing weight?

It should not be considered as a product specifically intended for weight loss.

The available clinical evidence refers mainly to individual ingredients or specific combinations, not to Metabolic-Max as a complete formula.

Weight control must be addressed from a global strategy that takes into account nutrition, physical activity, rest, and the individual characteristics of each person.

Metabolic health is better understood when we stop looking at each piece of data separately

Metabolic syndrome reminds us of something important: metabolic health does not depend on a single parameter.

Glucose, lipids, blood pressure, and body composition are related to each other and must be interpreted within the context of each person.

Therefore, improving metabolic health is not about looking for a supplement that «accelerates» the metabolism or focusing only on losing weight.

The basis remains adequate nutrition, physical activity, and an individualized approach to the alterations that may exist.

Fiber and certain ingredients can have a complementary role when they are justified, but supplementation should accompany the strategy, not replace it.

Understanding what is happening in each case allows for better decisions and using each tool at the right time.

Know more to fear less and choose better.

Written by:

Sergio Guerrero

Dietitian | Master's in Sports Pharmacology

@sergioguerrero_dietista