What is metabolic syndrome – and do we really need to worry about it?

The Guardian

5 hours ago

Metabolic syndrome is trending online. On TikTok, thousands of videos dissect the subject, also referred to as metabolic dysfunction or disorder. These often come with claims that healing mitochondria, often called the 'powerhouses of cells', is key to restoring metabolic health.
The concept was popularized by Calley and Casey Means' bestselling book Good Energy. Some consider the Means siblings – Casey is Donald Trump's surgeon general pick, and Calley is an entrepreneur and lobbyist – architects of Make America Healthy Again.
Metabolic syndrome is a real and widespread health issue, and experts say people should be aware of it. Some content creators do relay accurate information about it, but messaging can take a turn toward scienceploitation, or the use of scientific language to sell untested products and diet plans, says Tim Caulfield, a professor and research director of the Health Law Institute at the University of Alberta. (Casey Means has received pushback for using her platform to advertise products like mitochondrial health supplements.)
Taking action to avoid metabolic syndrome could benefit many, but misinformation can lead to unwanted grief, distrust and dollars spent. Here's what doctors and scientists say about it.
Metabolic syndrome refers to having multiple conditions that increase the risk of health problems like diabetes, stroke and heart disease. These conditions include high blood pressure, high blood sugar, abdominal obesity, high blood triglycerides and low HDL cholesterol, also known as the 'good cholesterol.' According to the National Heart, Lung, and Blood Institute, having three or more of those conditions means you may have metabolic syndrome.
'When you combine these conditions, you develop metabolic syndrome,' explains Dr Blanca Lizaola-Mayo, a quadruple board-certified physician, the Medical Director of the Transplant Hepatology Center, and the co-founder of the Metabolic Liver Clinic at Mayo Clinic in Arizona.
Many people with metabolic syndrome also have insulin resistance, which makes it harder for cells to absorb glucose, raising blood sugar levels and increasing the risk of related health problems. Insulin is one of several hormones that help regulate metabolism. Factors like poor diet and chronic stress can dysregulate these hormones, contributing to metabolic syndrome, explains Lizaola-Mayo.
Sometimes, content creators use the phrase 'metabolic dysfunction' instead. These terms are being used online to describe a similar phenomenon, says Lizaola-May. But 'metabolic syndrome' refers to specific medical conditions, as described above. Meanwhile, there is no unified definition of 'metabolic dysfunction', but it refers more generally to the metabolism not functioning well.
According to the National Heart, Lung, and Blood Institute, one in three American adults has metabolic syndrome. In the UK, the estimate is one in four adults.
While the risk of metabolic syndrome increases with age, incidence is rising overall. This prevalence may be partly explained by increasing sedentary behavior among adults, along with the proliferation of highly processed foods and food additives that can trigger inflammation, says Lizaola-Mayo.
Mitochondria are cell parts that convert nutrients into adenosine triphosphate (ATP), which provides energy for cellular processes. To have good health, we need our mitochondria to produce energy efficiently and communicate well, says Martin Picard, an associate professor and doctor of the Mitochondrial Psychobiology Group at Columbia University Irving Medical Center.
People with metabolic syndrome may have some signs of reduced mitochondrial function, says Matt Rossman, an assistant research professor in integrative physiology at the University of Colorado, Boulder.
In this context, the term 'dysfunction' does not mean that mitochondria are broken or damaged, though that phrasing is sometimes misused online and in wellness spaces. 'You can have metabolic syndrome without having defective mitochondria,' Picard says.
The term 'mitochondrial dysfunction' doesn't necessarily mean something is wrong with the mitochondria, but suggests they aren't working as efficiently as they should, says Jerry Chipuk, a professor of oncological sciences and dermatology, as well as the founder and director of the Mitochondrial Analysis Facility, at the Icahn School of Medicine at Mount Sinai.
Sanna Darvish, a PhD student candidate at CU Boulder, says 'mitochondrial dysfunction' can be a vague term, but in her and Rossman's research, it's related to a process that results in oxidative stress. This is linked to ageing and health issues, like metabolic syndrome.
Although a person with metabolic syndrome may have less efficient mitochondria, this is distinct from a mitochondrial disease, which is a very rare condition.
The signs of metabolic syndrome are the underlying conditions mentioned above, like high blood sugar and high blood pressure.
But it can also be a 'silent disease', explains Lizaola-Mayo. For example, metabolic syndrome increases the risk of type 2 diabetes, and many diagnosed individuals 'have been diabetic for years without realizing it', she says.
Some subtle changes may indicate a decline in metabolic health, she says, including frequent headaches, blurry vision, excessive thirst and increased urination. Unusual tiredness and weakness can also indicate an issue. Medical providers use blood pressure and blood tests to diagnose metabolic syndrome.
Genetic and environmental factors influence the development of metabolic syndrome. The latter is what we can control, says Lizaola-Mayo, but it can be challenging to eat well and exercise consistently. Time and costs are significant obstacles, and marketing can trick consumers into thinking some food products are healthier than they are.
Sign up to Well Actually
Practical advice, expert insights and answers to your questions about how to live a good life
after newsletter promotion
Still, metabolic syndrome is preventable and reversible through a balanced diet and regular exercise, even without significant weight loss.
It's essential to adopt healthy habits, rather than crash diets and exercise spurts, Lizaola-Mayo says. The best meal plans and exercise routines are the ones you enjoy, she says, because those are the ones you'll stick with.
'The reality is that we don't need to diet,' she says. 'We need to change our nutrition for good.'
GLP-1 medications can help patients whose metabolic syndrome has progressed to type 2 diabetes. Still, these medications need to be used in conjunction with lifestyle modifications to achieve long-term benefits, says Lizaola-Mayo.
Preventive care, including blood work and routine screenings, is one of the best ways to avoid future illnesses. If you're concerned about metabolic syndrome, seek a regular checkup with your primary care physician.
Mitochondria rely on various nutrients to make ATP, Chipuk explains, so a balanced diet is ideal, he says. But a very carbohydrate-heavy or high-sugar diet can erode mitochondrial function.
Exercise has a 'profound effect' on mitochondria, says Rossman, increasing the number of mitochondria and supporting their ability to consume oxygen and produce ATP.
While animal studies suggest obesity can make mitochondria less effective, Chipuk cautions that not all forms of weight loss are healthy. He emphasizes it's 'more about strengthening the body than simply eliminating extra pounds'.
Activities like chronic smoking and drinking alcohol can contribute to mitochondrial dysfunction. Stress also impedes mitochondria, Chipuk says. Meanwhile, positive life experiences seem to be associated with healthier mitochondria, says Picard.
Research on mitochondrial health supplements is ongoing. But in most cases, there's not enough valid medical information to support the use of supplements for metabolic syndrome, says Lizaola-Mayo. More large randomized controlled trials are needed to determine if they can provide clinically meaningful benefits, says Rossman.
'It's essential to be very careful with supplements,' says Lizaola-Mayo. 'You can achieve more with exercise and a simple, healthy diet.'
Picard also finds supplements 'overrated' and doesn't see them as the way forward for mitochondrial health, instead emphasizing the medical benefits of exercise and nutrition. Lizaola-Mayo cautions that research has shown some supplements contain additives that damage the liver.
Navigating health decisions is challenging, even when you're feeling well, says Caufield.
'The conventional healthcare system does not treat people well, especially women and people of color,' he says. 'On top of that, resource constraints can make it even more complicated.'
So it's understandable that people turn to the internet for guidance. But beware 'grifters exploiting genuine problems with the health care system and using scientific language to sell their products', says Caufield. Red flags include offering overly simple solutions to complex issues, or relying on a single study, he says: 'If something sounds too good to be true, it probably is.'