Metabolic Syndrome (Met S) affects nearly 47 million Americans. 1 The prevalence of arthritis is 52.5 million US adults between 2010-2012. This is estimated to rise to 78 million for Americans aged 18 years or older by 2040 per the Centers for Disease Control and Prevention. 2 These numbers are staggering in so much as it would seem lucky for you not to get either Met S or some form of arthritis. The question becomes whether or not having Met S may increase your risk of developing arthritis and how to avoid both problems.
What is Metabolic Syndrome (MetS)?
Metabolic Syndrome is a combination of medical conditions that places one at risk for cardiovascular diseases and type 2 diabetes 1, as well as cancer 1,3. It is synonymous with insulin resistance. The specific diagnostic criteria include 3 or more of the following conditions 1,4,5:
Met S is a combination of central obesity, elevated cholesterol and blood pressure and a dysregulation of blood sugar control. If left unchecked, this will develop into Type 2 Diabetes and heart disease, which brings along with it an increased risk of peripheral neuropathy, visual decline, the inability to heal from injury and possibly death.
In a nutshell, Met S is a measure of the body’s inability to regulate your metabolic needs safely, leaving the body riddled with systemic inflammation.
What is the etiology of Met S?
Unlike a fracture from an acute injury, Met S is considered a lifestyle disease. Meaning, it is a disease that is directly linked to the way a person lives their life. Many components of lifestyle that predict a lifestyle disease are eating a Standard American Diet high in refined sugars, refined grains, alcohol, trans fats (vegetable oils) along with sugary foods and drinks. This dietary habit promotes a rapid rise and fall of blood sugar, which is demanding, on the insulin system (insulin is produced by the pancreas and is used to pull glucose into the cell for energy or the liver for storage). Over time, this irregular blood sugar leads to the cells becoming insensitive to insulin. What results is the inability to get the glucose (energy) out of the blood and into the cell.
In addition, we also have an epidemic of being sedentary and getting poor quality sleep. All of the lifestyle factors feed into the condition of systemic inflammation leading to Met S and even arthritic conditions.
How does Met S play a role in pain from arthritic conditions?
Arthritis is a global term to describe painful inflammation and stiffness in the joints anywhere in the body. There are many different types from Rheumatoid Arthritis (RA) (affects multiple joints usually small joints in the hands and feet) to Osteoarthrits (OA)(can affect multiple joints but usually larger joints in a degenerative manner). Detecting these arthritic conditions usually begins with an xray to investigate the integrity of the joint surface along with a clinical exam.
It has been reported the arthritic conditions, although specific symptomology is found at the level of the joint, is in fact a “whole-organ” disease. 6 The evidence is accumulating to suggest that the health of the joint bone and tissues is a symptom of low-grade inflammation as a result of metabolic syndrome. A study demonstrated that symptoms of Carpal Tunnel Syndrome (pressure of soft tissue and nerves at the wrist joint) were greater in patients with Met S, even more than diabetes. 7 Another population study looking at the correlation of knee osteoarthritis and Met S found that central obesity (a precursor to Met S) was associated with knee OA in female subjects even without Met S. 8 Even patients diagnosed with RA were found to have a positive correlation between Met S and worsening functional status. 9 Obesity and Met S are considered a key risk factor for knee OA increasing the risk 3-fold. 10
Based on these few studies, of which there are many more relating Met S with many other disease processes, it is safe to confirm that arthritis or pain in the joint without specific mechanical injury is likely to be a symptom of a “whole-organ” disease. In fact, based on this association, it would be pertinent to evaluate your lifestyle even without the diagnosis of Met S or arthritis in order to reduce your risk and maybe even improve your current health and painful state.
What are functional medicine testing procedures to consider for Met S and arthritis?
Given the strong correlation of both disorders, Met S and painful arthritis, these additional tests may be useful 1:
What are the healing options for improving Met S and arthritis?
To answer this question, I will break it down into the four basic principles of the SOAR program:
As described earlier, Met S and arthritis are considered lifestyle diseases with a primary risk factor being the Standard American Diet. In order to improve either of these conditions, it is important to remove those items that are inflammatory foods, replace them with nutrient rich and low glycemic and low inflammatory foods in order to restore normal blood sugar levels and a normal inflammatory response.
A list of low glycemic foods to include adapted from Mateljan’s book is below 11. Remember this is not all inclusive, just a sample:
Remove. Replace. Restore.
Restore regular blood sugar levels and normalize your inflammatory response.
Remove refined sugars (including high fructose corn syrup), refined vegetable oils, alcohol, soda and refined carbohydrates (crackers, breads, cookies)
Replace with whole nutrient rich vegetables, fruits and proteins along with plenty of fresh water. Keeping your produce and meats organic will decrease the burden on the liver as your body regulates the inflammatory response.
Our bodies were designed to move. Movement will improve blood flow, strengthen muscles and bones, and even help burn fat. However, if you find yourself with Met S and painful arthritis, then it is a good idea to have a Physical Therapy evaluation to help guide you to safe and effective movement techniques to optimize the joint mobility to support and prevent further degradation of the arthritic joint. I often say, “A flexible joint is a healthy joint.” With the lifestyle of inflammation we have created for ourselves, it is hard to move while in pain. A movement assessment can teach you how to optimize your movement to minimize the pain. Inflammation is caused by systemic response but also mechanical inflammation. Understanding the mechanical piece to your joint pain will help guide you.
Below are a few ideas to include more movement through your day but they are not intended to be specific to your joint pain that requires further evaluation.
Remove. Replace. Restore.
Replace with simple movements like:
Restore normal joint movement and reduce pain as a result of arthritis.
Although this is not specifically outlined as a lifestyle factor that results in Met S, it is known that sleep is an important physiological step for repair and clean up from metabolic processes. So in the case of Met S and arthritis it is important to get regular restorative sleep. The hours of sleep are less important as is the quality of sleep. But as a general rule, 7-9 hours is recommended. If you are sleep deprived, this number may be higher than you think. More specific recommendations can be found in Soar into Health. A better marker of whether or not you are getting enough sleep is feeling rested when you wake up naturally. You may find this naturally improves with changes in the first two steps.
Remove. Replace. Restore.
Remove excessive screen time and lights, especially in the bedroom.
Replace with a regular bedtime and stick to it. Keep your bedroom cool and dark. Allow yourself to wake naturally to the morning light whenever possible. If your line of work requires irregular hours, work with a professional to find a good supplement to support your body.
Restore the ability to repair your body while you recover from metabolic syndrome and painful joints.
This part of the program is open ended and flexible. Given the likelihood that you may find these lifestyle changes difficult and even isolating, this is the part where you find your way to connecting to the people and your environment. It is important, if not critical, to have a support network of people that want to see you succeed in caring for your health. This may be a friend, a partner, a pet or even church. Ask for what you need, and be sure to make it clear. Finding the supportive resource does you no good if you don’t use it. It is important to have guidance from a professional if you get stuck, but developing a system to keep you accountable for your goals will allow you the greatest gains.
Remove. Replace. Restore.
Remove passive strategies.
Replace with connections to your family, partner, friend or even a pet. Use the connections you have to find the network of people to hold you accountable. Self-driven motivators are also useful like journaling, inspiring quotes or even meditation.
Restore connection to your life.
It may be necessary based on the above tests and your progress with these simple strategies to include supportive supplements. Taking a professional probiotic supplement containing bifidobacteria and lactobacilli would be beneficial to re-inoculate with healthy bacteria. If leaky gut is suspected then digestive enzymes and L-glutamine may be helpful. Reducing inflammatory foods and including anti-inflammatory fats like those containing Omega 3 or taking a fish oil supplement will aid in healing.
Touch on each one of these every…. Single… day. We are human and perfection is not attainable. Doing your best is NOT synonymous with perfection. Make it habit to eat well, move well, sleep well and soar on daily and the overall impact on your health may surprise you.
Despite the severity of Met S impact on health and even pain, at this stage, it is still manageable if not reversible if you make simple lifestyle changes. The goal here is sustainability to support recovery and improve your health. It has taken your body years of abuse to develop this problem, so results won’t be immediate. Should you sustain this lifestyle long term, improvement would continue to be expected.
Eat Well. Move Well. Sleep Well. Soar On.
1. Lipski, Elizabeth PhD CCn CHN. Digestive wellness. 4th Edition ed. United States of America: Mc GRaw Hill; 2012.
2. Athritis related statistics. http://www.cdc.gov/arthritis/data_statistics/arthritis-related-stats.htm.
3. Kohlstadt I, ed. Advancing medicine with food and nutrients. Second ed. Voca Raton, FL: Taylor and Francis Group, LLC; 2013.
4. Aguilar M, Bhuket T, Torres S, Liu B, Wong RJ. Prevalence of the metabolic syndrome in the united states, 2003-2012. JAMA. 2015;313(19):1973-1974.
5. Higdon JP, Drake VP, eds. An evidence-based approach to vitamins and minerals; health benefits and intake reccomendations. 2nd edition ed. New York: Thieme Stuttgart; 2012.
6. Mobasheri A, Henrotin Y. Biomarkers of (osteo)arthritis. Biomarkers. 2015;20(8):513-518.
7. Gul Yurdakul F, Bodur H, Oztop Cakmak O, et al. On the severity of carpal tunnel syndrome: Diabetes or metabolic syndrome. J Clin Neurol. 2015;11(3):234-240.
8. Han CD, Yang IH, Lee WS, Park YJ, Park KK. Correlation between metabolic syndrome and knee osteoarthritis: Data from the korean national health and nutrition examination survey (KNHANES). BMC Public Health. 2013;13:603-2458-13-603.
9. Cojocaru M, Cojocaru IM, Silosi I, Vrabie CD. Metabolic syndrome in rheumatoid arthritis. Maedica (Buchar). 2012;7(2):148-152.
10. Allen KD, Golightly YM. State of the evidence. Curr Opin Rheumatol. 2015;27(3):276-283.
11. Mateljan G. The world's healthiest foods. First ed. Seattle, Washington: George Mateljan Foundation; 2007.
Dr Carolyn Dolan DPT, Cert MDT, MSHN
Where physical therapy, nutrition and lifestyle meet, because how you live your life determines whether or not you soar. Inspiring action with information so you can reduce pain, optimize healing and improve function naturally during recovery from injury, surgery or painful condition. This is a website for the open-minded; obstinate need not apply.