Metabolic Syndrome X: Complementary and Alternative Medicine Treatment Essay (Article)

Objective

The objective of this paper is to review current published literature on using complementary and alternative medicine (CAM) to treat metabolic syndrome X (MetS).

Introduction

This paper will be aiming at reviewing current published literatures of using integrative and alternative medicine in treatment of metabolic syndrome X. the recommendations and findings of each literature will also be reviewed. At the end of the review, conclusion will be drawn depending on the reviewed papers.

Metabolic syndrome X is a group of cardiac risk factors caused by insulin resistance. Patients with MetS present with a cluster of characteristic which according to American Heart Association (2008) include ‘abdominal obesity (excessive fat tissue in and around the abdomen), atherogenic dyslipidemia (blood fat disorders — high triglycerides, low HDL cholesterol and high LDL cholesterol — that foster plaque buildups in artery walls), elevated blood pressure, insulin resistance or glucose intolerance (the body can’t properly use insulin or blood sugar), prothrombotic state (e.g., high fibrinogen or plasminogen activator inhibitor–1 in the blood), and proinflammatory state (e.g., elevated C-reactive protein in the blood)’. People with metabolic syndrome X are at high danger of developing cardiavascular diseases such as coronary heart disease and other complications such as stroke and peripheral vascular disease and non insulin dependent diabetes. Metabolic syndrome X is also known as insulin resistance syndrome due to the fact that the body totally fails to use the insulin it produces efficiently and effectively. The major risk factors for this syndrome are thought to be abdominal obesity and insulin resistance. Other factors which are associated with metabolic syndrome X are physical inactivity, aging, hormonal imbalance and genetic predisposition (AHA, 2009).

Diagnosis of metabolic syndrome X

Currently there are no well accepted diagnostic methods for metabolic syndrome X. the American Heart Association and the National Heart, Lung, and Blood Institute recommends that MSX be positively diagnosed when three or more of these components are present: Elevated waist circumference equal to or greater than 40 inches (102 cm) in men and equal to or greater than 35 inches (88 cm ) in women; Elevated triglycerides – equal to or greater than 150 mg/dL; reduced HDL (“good”) cholesterol – less than 40 mg/dL in men and less than 50 mg/dL in women; elevated blood pressure which is equal to or greater than 130/85 mm Hg ; and elevated fasting glucose which is equal to or greater than 100 mg/dL. The basic principle in management of metabolic syndrome X is to reduce the high risk of cardiovascular diseases and type II diabetes. This basically involves a first line therapy of quitting smoking and reducing LDL cholesterol, blood pressure and glucose levels to the recommended levels. Life style therapies come in handy in the management of short and long term risk. These include achieving desirable weight through weight loss (BMI less than 25 kg/m²), increased physical activity and healthy eating habits; reduced saturated fat, cholesterol and trans fat. Treatment of metabolic syndrome majorly involves treating the insulin resistance, treating the hypertension, treating the clotting disorder, and treating lipid abnormalities (AHA, 2009; NHLBI, 2009).

Use of Integrative and Alternative Medicine in Treatment of MSX

Acupuncture

Cabiolu and Ergene (2006) carried out a study titled “Changes in levels of serum insulin, C-Peptide and glucose after electroacupuncture and diet therapy in obese women” whose objective was to determine the role played by acupuncture in obese women who are suffering from syndrome X. The study showed that acupuncture combined with heat therapy (moxabustion) effectively lowers blood sugar and C-peptide levels and decreases fasting blood sugar levels, 24-hour urine glucose levels, glycosylated hemoglobin, triglycerides, LDL cholesterol, and increase good cholesterol (HDL). The study further showed that acupuncture works to balance blood sugar and promote weight loss by directly stimulating the pancreas, decreasing systemic inflammation, and regulating the digestive system. Depending on the symptoms present, acupuncture was shown to balance the organ system dysfunction that resulted in the blood sugar disregulation.

Exercise Techniques

In a study carried out by Elizabeth Peterson (nd) titled “exercise and weight loss effective in treating syndrome X” in which a total of 53 men and women with syndrome X were randomly assigned to one of three groups: exercise only, exercise plus a weight loss plan, or a control group. The exercise group exercised three to four time per week for 26 weeks. Exercise plus weight loss participants followed the same exercise program as the exercise only group and additional weight management program based on the LEARN manual. The control group was instructed not to make any changes into their normal exercise and dietary habits. The following parameters were measured were measured both before and after receiving treatment; blood pressure, cholesterol level, aerobic fitness, body composition, and glucose tolerance. The study found out that the participants in the exercise and weight management plan lost the most weight and reduced their level of hyperinsulinemia by as much as 47%. Those in the exercise group only lost less weight and reduced their level of hyperinsulinemia by only 27%. It is therefore evident that patients who showed greatest weight loss showed the greatest reduction in their level of hyperinsulinemia. This was also the same to blood pressure. From these results, we can therefore deduce that exercise plus weight loss is an effective treatment for hyperinsulinemia and high blood pressure in patients with syndrome X.

In a study to titled “staying fit lowers C – reactive protein in people with metabolic syndrome by Doron Aronso et al (2004) found that physical fitness is associated with lower levels of an inflammation marker associated with heart disease, known as C-reactive protein. The researchers assessed the physical fitness levels of 1640 people and measured their C-reactive protein levels. This study was based on findings of previous studies that showed that C-reactive protein in blood increased the risk of heart attack and stroke in people with the metabolic syndrome. This effect of fitness on lowering C-reactive protein was particularly prominent in people with the metabolic syndrome. The study further showed that patients with metabolic syndrome who maintain a high fitness level do have markedly lower C-reactive protein concentrations compared to those with low fitness levels.

Chinese Herbs

Green Tea: Research studies have shown that Green Tea is effective in treatment of metabolic syndrome X. GT is made from the leaves of camellia sinensis, a small plant grown mainly in China and south East Asia. It contains caffeine and catechin polyphenols. In a randomized study by Dulloo et al (1999) where participants were subjected to green tea (50 mg caffeine, 90 mg epigallocatechin gallate), caffeine or placebo. This study showed that GT promoted fat oxidation and thermogenesis. In another uncontrolled study by Chantre and Lairon (2002) in which moderately obese subjects treated with a green tea extract (caffeine 150 mg/day and catechins 375 mg/day) showed that the participants’ body weight reduced by 4.6% and waist circumference by 4.5%. in 2005, Nagao et al randomizedhealthy Japanese men to 690 mg catechins or to 22 mg catechins (control). After a period of 12 weeks, the participants showed a decrease in body mass index, waist circumference, body fat mass, and subcutaneous fat significantly than in the control group. Kovac et al carried out another study that had a contrast to all the above studies. Their study demonstrated that GT (caffeine 104 mg and catechins 573 mg). This study showed that higher caffeine intake was associated with a significantly higher weight regain. This is an indication that chronic caffeine consumption blunts the weight loss effects of green tea.

Ma Huang (Ephedra): this is an herb derived from a shrub native to china and Mongolia with sympathomimetic properties. Although this drug was banned by the FDA, it has demonstrated modest short term weight loss in subjects treated with it. In a meta analysis conducted by Shekelle et al (2003), revealed that ephedra has numerous toxicities which include hypertension, palpitations, tachycardia, seizure, stroke, and death. This analysis also shows that it is very effective in weight loss. Haller et al (2000) showed that ephedra use in individuals without cardiovascular risk factors experienced severe adverse events which may even include disability and death.

Hoodia gordonii is a South African succulent that has been in use for centuries as an suppressant. In the United States, it is a ubiquitous weight-loss product. In one of the Hoodia prominent websites (2007), it is refered to as a miracle molecule. Although there are no published human studies on hoodia gordonii, it is widely used and effective. In one of the latest studies by Jun et al (2008) to evaluate the use of traditional Chinese medicine (TCM) in treatment of MetS found out that three herbs namely ginseng, rhizome coptidis and bitter lemon can be effectively used in treatomwent of MetS. These herbs were found to be effective in hyperglycemia, insulin sensitization, weight loss, and anti-oxidant. This study also reported that no large scale clinical trials have been conducted to evaluate the efficacy and safety of these herbal medicines.

Complementary Therapies

In a review of articles on complementary and alternative medicine and the management of the metabolic syndrome by Hollander, Jeffrey and Mechanick (2008) that aimed at covering definition, pathophysiology, epidemiology and population based consequences of MSDR, defines complementary and alternative medicine. This review applied evidence based principles to the discussion of a number of alternative therapies purported to treat aspects of MSDR.

Dyslipidemia

n-3 polyunsaturated fatty acids, primarily eicosapentaenoic acid and docosahexaenoic acid which are found in cold water fish such as mackerel, salmon and cod have long been purported to have disease modifying potential inclusive of MetS. n-fatty acids appear to reduce triglyceride levels by regulating hepatic synthesis and secretion of very low density lipoprotein (VLDL) cholesterol. In a randomized study by Harris et al with a study population of 42 individuals with triglycerides levels between 500 and 2000 mg/dL to 4g concentrated n-3 fatty acid (Omacor) or placebo. The treatment arm showed 45% reduction in triglycerides, 32% reduction in VLDL cholesterol level, and total cholesterol level by 15%. In a similar study with a study population of 41showed that triglyceride levels fell by 38.9%, VLDL fell by 29.2% and total cholesterol levels fell by 9.9%. in both studies, there was an increase in levels of LDL cholesterol and HDL cholesterol levels. These results show that n-3 fatty acids can be used in regulating triglyceride levels. In another study by Durrington et al (2001) randomized 46 patients with coronary heart disease on simvastatin (10 to 40 mg) with triglyceride levels >200 mg/dL to either concentrated n-3 fatty acid or placebo. The results showed that there was a reduction in the levels of serum triglycerides by 20% to 30% and a 30% to 40% reduction in VLDL cholesterol levels. The study showed that fatty acids had no significant influence on LDL or HDL cholesterol level in individuals already receiving statin therapy. Other findings include showing of no major adverse effects with no drug to drug interaction.

Soy Protein has been shown to reduce LDL cholesterol level and elevation in HDL cholesterol level in clinical and observational studies although the mechanis is not well understood. In a meta-analysis review of 41 prospective randomized controlled trials ranging in size from 4 to 179 participants, representing a total of 1,756 subjects by Reynolds et al (2006) and another one with a total of 23 studioes composed of 1,381 subjects by Zhan et al (2005). These two meta-analysis reviews showed that soy protein reduced total cholesterol, LDL cholesterol, and triglyceride levels by significant levels. HDL l cholesterol levels increased, this was not significant.

Psyllium/dietary soluble fiber has also been shown to effectively lower LDL cholesterol levels. This is demonstrated by a study carried by Jenkins et al (2002) which aimed at evaluating the effect of high a high fiber diet (delivering at least 8 g/dL psyllium) vs a low fat, control diet in 68 subjects with hyperlipidemia. Compared with the control diet, the high fiber diet showed a reduction in total cholesterol levels, LDL cholesterol levels and triglyceride levels. In another multicenter prospective randomized control trial study by Anderson et al (2000) where 248 subjects with LDL cholesterol concentrations between 130 and 160 mg/dL cholesterol concentrations were randomized to 5.1 g psyllium or cellulose placebo. The results showed that after 24 weeks, total and LDL cholesterol levels reduced by to 4.7% and 6.7% lower respectively in the psyllium treated subjects compared to controls. In another similar study by Davidson (1998) showed that in participants on high dose psyllium diet, there was a great reduction in LDL cholesterol levels at 24 weeks. This study also showed no major side effects.

Insulin resistance

Theobroma cacao seeds are processed to produce Dark chocolate whose consumption (100 g/day) has been associated with improvement in insulin sensitivity. In a nut shell, three studies that were carried out differently (Grassi et al 2005a; 2005b; Brand-Miller, 2003) to evaluate the role of dark chocolate containing flavanols showed that this type of chocolate significantly improves the insulin sensitivity as measured by the homeostasis model of insulin resistance. These studies also show that food flavored with cocoa powder provoke a greater insulin response than when other flavors are used. Potential benefit may be derived from 100 g/day dark chocolate.

Multivitamins

In a transversal, observational study carried out by Botella-Carretero et al (2007) titled “Vitamin D deficiency is associated with the metabolic syndrome in morbid obesity” which included 73 consecutive morbid obese patients (body mass index 40Kg/m(2)) showed that vitamin D deficiency was present in 37 of the 73 patients (50.7%). Vitamin D deficiency was more prevalent in morbidly obese patients presenting with the metabolic syndrome, compared with those who did not achieve the criteria for this syndrome (60.9% vs. 33.3% respectively). In the study, when serum concentrations of 25-hydroxyvitamin D were categorized in tertiles, there was an association of the prevalence of the metabolic syndrome with the former with triglycerides levels being higher in the vitamin D deficiency group. The study concluded that vitamin D deficiency is associated with metabolic syndrome in morbidly obese patients. From these results, we can therefore conclude that Vitamin D supplementation in morbidly obese patients with syndrome X can be used to reverse effects of MetS.

In another prospective study carried out with the main objective of determining the role of Vitamin C diet in slashing diabetic risk carried out by (nd) in which 21,831 men and women were followed over a period of 12 years. The researchers analysed dietary patterns using a semi-quantitative food frequency (FFQ) amongst the participants of the European Prospective Investigation of Cancer-Norfolk. The men and women had an average age of 58.4 at the start of the study, and women made up two thirds of the study population. Over 12 years of follow up 735 incident cases of diabetes were diagnosed. The researchers found that men and women with the highest blood levels (at least 1.10 and 1,29 mg/dL, respectively) had a 62 percent reduction in their risk of developing type – 2 diabetes, compared to men and women with the lowest blood levels (less than 0.56 and 0.77 mg/dL, respectively). The study further showed that men and women who have high intake of fruits and vegetables (459 and 550 grams per day, respectively) had a 22% reduction in their risk of developing type 2 diabetes, compared to men and women with the lowest fruit and vegetable intake (289 and 382 grams per day, respectively).

In a san ancillary study of a 36 month, randomized, double-blind, controlled trial designed to assess the impact of supplementation with 500 microg/day phylloquinone on bone loss carried out by Yoshida et al (2008) to determine the effect of Vitamin K supplementation on insulin resistance in older men and women with the hypothesis that “vitamin K supplementation for 36 months will improve insulin resistance in older men and women.” The study population comprised of non diabetic men and women (n = 355; age 60-80 years; 60% women). The study concluded that Vitamin K supplementation for 36 months at doses attainable in the diet may reduce progression of insulin resistance in older men. Insulin resistance is one of the factors in metabolic syndrome X and suppressing its progression therefore helps in treatment of MetS.

Dietary interventions

In a study carried out by Shin et al (2009) titled “dietary intake, eating habits, and metabolic syndrome in Korean men published in the American dietary association with the main objective of evaluating the association between the intake frequencies of certain food groups, eating habits and the risk of metabolic syndrome.” This was a cross sectional study of Korean men. The study had a sample size of 7, 081 men aged 30 years and above who were recruited between august 2002 and may 2007. A frequency questionnaire was used to assess the association of metabolic syndrome and sociodemographic characteristics, food intake frequencies, and eating habits. The study showed that study participants with metabolic syndrome had significantly higher family history of type 2 diabetes mellitus and were more likely to be current smokers than their counterparts who were not suffering from metabolic syndrome X. participants with metabolic syndrome showed significantly higher intake of seaweed and oily foods than participants without metabolic syndrome. The study further showed that participants with metabolic syndrome were more likely to eat quickly and to overeat frequently. The study concluded that the intake of seaweed and oily foods, habits such as eating faster and frequent overeating are associated with the risk of metabolic syndrome while high fruit intake may be associated with a lower risk of metabolic syndrome. From this we can deduce that dietary interventions are very vital and form an integral part in treatment of syndrome X.

In another study by Dr. Van Sant-Crowle (2004) with the aim of evaluating the efficacy of low fat, high fiber, and exercise program for Metabolic syndrome X found out that mean cholesterol levels dropped by 32.5 mg/dL, decrease in systolic blood pressure by 18mg Hg, and diastolic blood pressure by 6.84 mm Hg, the triglyceride/HDL ratio also decreased by 1.33. In this study, patients attending the Pritikin Center for a variety of conditions, such as heart disease, diabetes, obesity and hypertension were recruited to take part in the study after a thorough physical examination. They received individual instructions on the diet and exercise program. This study was limited in that the participants were not restricted to a specific calorie intake. As part of the exercise program, the participants performed 45 to 60 minutes of aerobic activity daily. Strength training exercises were included in the workout about 3 times a week. At the end of then study, the results showed that of the five criteria used to describe the metabolic syndrome, 58% of the patients in the study no longer met three or more of those criteria.

In another study carried out by Sahyoun (2009) titled “Wholegrain ease metabolic syndrome in older people.” used a sample size of 535 healthy volunteers with an average age of 72 to complete three-day food records and undergo blood tests for metabolic risk factors. The study highlighted an important difference between whole grain and refined grain intake where by the researchers observed that higher intake of refined grains was associated with higher prevalence of the metabolic syndrome. This was not consistently found among younger populations in other studies. The explanation given by the researchers to this finding was that this was probably due to the fact that the volunteers were an older population and, therefore, more susceptible to impaired glucose tolerance.

Conclusion

Complementary and alternative therapies are effective and efficient in the management of metabolic syndrome x. These therapies need to be monitored in order to achieve maximum results. In some of the studies reviewed in this paper, there were a lot of loop holes that needs to be investigated more; more clinical studies to authenticate and evaluate their efficacy. This will create a wide base of literature on the role of CAM in the treatment and management of Metabolic Syndrome X, thus will ensure evidence based practice.

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