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Harvard Commentaries
Harvard Commentaries
Reviewed by the Faculty of Harvard Medical School

Man to Man Man to Man

The Metabolic Syndrome: A Menace
to Men's Health

September 12, 2013

By Harvey B. Simon M.D.

Harvard Medical School

Metabolic syndrome isn't as well known as heart disease, diabetes, or cancer when it comes to health threats to American men. But if present trends continue, that's likely to change. Why? Because about 47 million Americans have the metabolic syndrome — although many don't know it. Metabolic syndrome doubles a man's risk of having a stroke or dying from heart disease. And new research suggests the syndrome also contributes to cognitive decline, kidney disease, and liver disease. If that's not bad enough, the metabolic syndrome nearly doubles a man's risk of prostate cancer.

Daily exercise not only helps prevent this menace, but it can reverse the metabolic syndrome should it develop. To keep it away, exercise needs to be part of your daily schedule.

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The Fearsome Five

The metabolic syndrome is a cluster of five closely-related cardiovascular risk factors. Each is dangerous in its own right, but having several of these at the same time creates an even greater health risk than any one does on its own.

To be diagnosed with the metabolic syndrome, a person has to have any three of the following five abnormalities. Having four or five of these conditions at the same time makes for an even more hazardous situation.

Risk Factor
Abdominal obesity
Waist circumference of 40 inches or more (35 inches or more for women)
Fasting triglyceride levels
150 mg/dL or higher
HDL cholesterol levels
Below 40 mg/dL HDL (below 50 mg/dL for women
Blood pressure
130/85 mmHg or higher
Fasting blood sugar
110 mg/dL or higher

Let's take a closer look at each one.

    1. Abdominal obesity — This is the fundamental factor in the metabolic syndrome. The increase in America's girth accounts for this rapidly growing syndrome. Unlike fat cells in the buttocks and thighs, fat around the abdominal organs resists the action of insulin, which can lead to diabetes. It also releases free fatty acids that are deposited in the liver, pancreas, and heart, where they can produce organ damage.
    2. Triglycerides — Doctors still don't know if a high triglyceride level alone increases the risk of heart disease. But it's now clear that high triglyceride levels are indeed risky when they're part of the metabolic syndrome.
    3. HDL cholesterol — This is the "good" cholesterol because it helps carry cholesterol molecules away from arteries. So the higher your HDL, the better. Normal values for men begin at 35 mg/dL, but even a "normal" level of 40 will increase your risk for heart attack and stroke when it's part of the metabolic syndrome.
    4. Blood pressure — Experts have been progressively lowering the cut-off for healthy blood pressure readings as they've learned more about elevated blood pressure and the risk of stroke, heart disease, and kidney failure. But although a pressure of 130/85 is only considered "prehypertension," it's enough to contribute to a diagnosis of the metabolic syndrome.
    5. Blood sugar — An elevated blood sugar level is the hallmark of diabetes. People with type 1 diabetes don't produce enough insulin, a hormone that helps regulate the amount of sugar that gets to your cells. People with the more common form of diabetes, type 2, produce insulin, but their tissues don't respond properly to the hormone, a condition called insulin resistance.


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Exercise: Half of the Dynamic Duo

Exercise is one of the two best ways to prevent the metabolic syndrome, and it's also the mainstay of therapy once the problem has developed. (Weight loss is the other.)

A study of 612 healthy men demonstrates just how powerful it is. Subjects were between the ages of 42 and 60 when the study began, and none had the metabolic syndrome. Over the next four years, though, 107 men developed the problem. But the men who exercised regularly were only about half as likely to develop the syndrome as the inactive men. And it didn't take heroic amounts of exercise to produce protection. Just three hours a week did the trick! Regular exercise:

  • Burns calories, which promotes weight loss. Nearly all people who win at the losing game attribute their success to exercise as much as diet. In addition, exercise seems to have a specific ability to reduce abdominal obesity, a big plus for health.


  • Reduces triglyceride levels more so than one would expect from weight loss alone.


  • Boosts HDL cholesterol. The more you do, the higher your HDL will be. As few as eight miles of walking a week will help.


  • Lowers blood pressure. Exercise is one of the most important lifestyle treatments for hypertension, and it is just as helpful for the prehypertensive levels recorded by many men with the metabolic syndrome. Walking only 30 minutes a day can reduce systolic blood pressure by 4 to9 mmHg.


  • Lower blood sugar and insulin levels. Exercise makes muscles and other body tissues more sensitive to insulin, which means that less insulin is needed to keep the blood sugar down. Exercise is an important way to prevent and treat diabetes, and its dual benefits are very helpful in the metabolic syndrome.

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Diet: The Other Half

Dietary changes can deal a big blow to the metabolic syndrome. A 2004 study found that a Mediterranean diet and moderate exercise corrected the metabolic syndrome in 55% of participants. Here are some guidelines to follow:

  • Restrict simple sugars and other rapidly-absorbed carbohydrates such as white rice, white bread, and potatoes. Instead, eat complex carbohydrates found in unrefined, high-fiber foods such as brown rice, whole grain breads, beans, and bran cereals.


  • Eliminate saturated and trans fats, which raise LDL ("bad") cholesterol. Substitute the monounsaturated and omega-3 fats found in olive oil, nuts, canola oil and fish. Calories still count even with heart-healthy fats so watch portion sizes.


  • Keep your sodium intake below 2,300 mg a day. Instead of snack foods, processed meats and other salty foods, choose fruits, vegetables, and low-fat dairy foods.


  • Avoid alcohol if you have high triglycerides and a stubborn inability to lose weight as part of the metabolic syndrome. But consider one or two drinks a day if you have low HDL ("good") cholesterol —and drink responsibly.

Harvey B. Simon, M.D. is an Associate Professor of Medicine at Harvard Medical School and a member of the Health Sciences Technology Faculty at Massachusetts Institute of Technology. He is the founding editor of the Harvard Men's Health Watch newsletter and author of six consumer health books, including The Harvard Medical School Guide to Men's Health (Simon and Schuster, 2002) and The No Sweat Exercise Plan, Lose Weight, Get Healthy and Live Longer (McGraw-Hill, 2006). Dr. Simon practices at the Massachusetts General Hospital; he received the London Prize for Excellence in Teaching from Harvard and MIT.

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