Quick answer: metabolic syndrome isn’t one disease. It is a cluster of risk factors, and you’re diagnosed when you have at least three of five: a large waist, high triglycerides, low HDL cholesterol, high blood pressure and high fasting blood sugar. It raises your risk of heart disease, stroke and type 2 diabetes, but lifestyle changes can improve every one of the five.
The five criteria
A common definition says you have metabolic syndrome if you meet three or more of these:
| Criterion | Cutoff |
|---|---|
| Waist size | Over 40 in (102 cm) for men, over 35 in (88 cm) for women |
| Triglycerides | 150 mg/dL or higher, or on treatment |
| HDL cholesterol | Below 40 mg/dL (men) or below 50 mg/dL (women), or on treatment |
| Blood pressure | 130/85 mmHg or higher, or on treatment |
| Fasting blood sugar | 100 mg/dL or higher, or on treatment |
Waist cutoffs are lower for many Asian populations, so ask your doctor which applies to you.
Symptoms
Metabolic syndrome usually causes no symptoms of its own. Most people notice:
- A growing waistline
- Tiredness
- Darker skin on the neck or armpits (a sign of insulin resistance)
- Signs of high blood sugar, if it has progressed, such as thirst and frequent urination
High blood pressure and high cholesterol are silent, so only a check-up shows them.
What causes it
Insulin resistance and excess belly fat are at the center. Other contributors include inactivity, a diet high in refined carbs and sugar, genetics, age, sleep apnea, PCOS and some medicines. Read more about signs of insulin resistance.
Why it matters
Having metabolic syndrome significantly raises the risk of heart attack, stroke, type 2 diabetes, fatty liver disease and chronic kidney disease. Each factor adds to the others, so tackling the cluster has a bigger effect than treating one number alone.
How it’s diagnosed
Your doctor will measure your waist and blood pressure and order a fasting glucose or A1C, and a lipid panel. Often a liver test is added.
Treatment starts with lifestyle
Food. A Mediterranean-style pattern, with vegetables, beans, whole grains, fish, nuts and olive oil, has the best evidence. Reduce sugary drinks, refined carbs and processed meats.
Activity. Aim for about 150 minutes of brisk activity a week, plus strength training twice a week.
Weight. Losing 5 to 10% of body weight improves blood pressure, blood sugar, triglycerides and waist size together.
Sleep. Treat sleep apnea if you have it, and aim for seven or more hours.
Quit smoking.
When medication is added
If lifestyle changes aren’t enough, your doctor may treat individual factors: blood pressure medication, a statin, or a diabetes medicine such as metformin. See our guides to lowering blood pressure naturally and how to lower cholesterol for the lifestyle side of those numbers.
When to get checked
Ask for a screening if you have a family history of diabetes or heart disease, extra weight around the waist, PCOS or a history of gestational diabetes. Get urgent help for chest pain, shortness of breath or stroke symptoms.
Frequently asked questions
Can metabolic syndrome be reversed?
Many people reduce or even lose the diagnosis with weight loss, healthier eating and regular exercise.
Is metabolic syndrome the same as diabetes?
No. It increases the risk of diabetes, but you can have it with normal blood sugar.
Does it only affect people who are overweight?
It’s most common with extra belly fat, but people with a normal weight can have it too.
Cura Editorial Team
Contributor at Cura Health Journal.