Syndrome X /
Metabolic Syndrome

Syndrome X / Metabolic Syndrome: Overview

Alternative names: Metabolic Syndrome X, Cardiometabolic Syndrome, Insulin Resistance Syndrome, Reaven's Syndrome, Dysmetabolic Syndrome, "Pre-Diabetes".

Syndrome X refers specifically to a group of health problems that can include insulin resistance (the inability to properly deal with dietary carbohydrates and sugars), abnormal blood fats (such as elevated cholesterol and triglycerides), overweight, and high blood pressure.

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Doctors have known for years that each of these health problems can increase the risk of other diseases, such as heart disease and diabetes.  For a long time, they failed to connect the dots and see these health problems as part of a syndrome.  We now know that eating large amounts of dietary carbohydrates (for example sweets, pastas, and breads) can raise cholesterol, triglyceride and insulin levels.  We know also that elevated insulin can promote obesity and high blood pressure.  Because these problems are related and tend to occur in clusters, they form a syndrome.

Many believe that Syndrome X is a disorder that most people are seriously at risk of developing by the time they reach middle age, if not before.  Syndrome X can remain effectively hidden for years, masquerading as symptoms of other conditions including fatigue, poor mental concentration, abdominal (apple-shaped) obesity, edema (fluid retention), nerve damage and an intense craving for sweets.

Syndrome X also generates high levels of cell-damaging free radicals and causes premature aging, setting the stage for catastrophic health problems such as heart disease, diabetes, Alzheimer's, cancer, and other age-related diseases.

The letter "X", of course, has always represented the unknown, whether it referred to hidden conspiracies in the X-Files television show or the unknown value in algebra.  Researchers added "X" when the syndrome was first identified, but still largely unproved and mysterious.  Today, many believe Syndrome X is a very common – and often ignored – disorder that can derail one's health.  The good news is that it does not have to be.

Causes and Development

The key to understanding Syndrome X is insulin resistance – a diet-caused hormonal problem that interferes with the body's ability to efficiently burn the food one eats.  Syndrome X occurs when insulin resistance is combined with high levels of blood fats (cholesterol and triglyceride), too much body fat, and high blood pressure.

Because of the foods now eaten across much of the world, levels of glucose and insulin have in many cases gone out of control.  Quite simply, we are overdosing on glucose and insulin – and both substances in high doses accelerate the aging of our bodies and encourage the development of disease.

Signs and Symptoms

The following symptoms may indicate whether you are in the 20% of people that have a genetic disposition to be less able to cope with a high glycemic diet.  This list is not intended for self-diagnosis.  If you are in any doubt, you should see a doctor who can carry out a proper evaluation of your health:

  • Excess body fat (often distributed around the middle, in the neck and the face
  • Craving for sweet foods and drinks ("sweet" can be deceptive, as many foods such as white bread, potatoes and white rice contain high levels of hidden sugars)
  • High blood pressure or hypertension
  • A chronic lack of energy and general lethargy
  • Mental fuzziness – the mind loses its sharpness and alertness
  • Skin tags in the neck, groin or armpit area
  • A bloated feeling after eating
  • Dry and flaky skin, splitting nails and dull hair
  • Diagonal creases in the lower ear lobe

Diagnosis and Tests

Anyone with a family history of type 2 diabetes who is also overweight and who gets little exercise should be evaluated for the glucose, lipid and blood pressure abnormalities associated with Syndrome X.

Treatment and Prevention

Syndrome X is primarily a nutritional disease caused by eating the wrong foods.  We all have the power to easily modify our lifestyles to protect ourselves against Syndrome X.

If your condition is serious, your doctor may need prescribe an aggressive course of medication aimed at reducing the impact of any life-threatening symptoms.

In addition to working with your doctor, you can of course help yourself in many ways.

Diet: Eliminate unhealthy foods that are known to contribute to Syndrome X: all types of alcoholic beverages, fried foods, sugar and artificial sugar substitutes, refined carbohydrate foods, and foods that contain hydrogenated and partially-hydrogenated fats (also known as trans fats).  Avoid processed and packaged foods and canned fruit juices, and limit consumption of fresh fruit juices because of naturally high sugar content.

Limit consumption of starchy foods such as bread products, pasta, and potatoes.  Research shows that the more carbohydrates one consumes, the greater the risk of developing Syndrome X. When choosing carbohydrate foods, emphasize whole grains and legumes and eat them in small portions.  Healthy carbohydrate foods include amaranth, barley, buckwheat, bulgur, brown rice, millet, and quinoa, along with legumes, yams, and whole grain breads.

Eat good servings of fresh vegetables throughout the day, along with healthy protein-rich foods, such as lean meats, skinless poultry, egg whites, and wild caught fish.  It is also recommended that you eat foods with a low glycemic index.

Eating 4-6 small meals a day is better than three large meals each day.  Snacking on nuts between meals, and drink plenty of water.

Exercise: At least 30 minutes of exercise each day is very important.  Aerobic exercise is especially good, and includes activities such as walking, cycling, jogging, swimming, and Tai chi.

Lifestyle: Lose excess weight and if you smoke, seek help in stopping.

Nutritional Supplements: Some of the most useful supplements for managing and reversing Syndrome X are Omega-3 Essential Fatty Acids (EFAs), which trigger lipoprotein lipase activation, resulting in an immediate breakdown of triglycerides in the blood without drugs or side-effects.

Vitamin C and vitamin E can also be helpful, as can the minerals chromium, magnesium, and zinc.  Alpha-lipoic acid (ALA) and conjugated linoleic acid (CLA) can also help.

Prognosis; Complications

Recovering from Syndrome X does not happen overnight, but gradually over a several-month period, provided that there has been a commitment to a low glycemic diet, regular exercise and nutritional supplementation.  However, most individuals who commit to these changes do notice some weight-loss and a large increase in vitality in a much shorter period, often just a few weeks.

Both insulin resistance and Syndrome X increase one's risk of heart disease, diabetes and many other serious, life-threatening diseases because they impact – directly or indirectly – virtually every disease process.

Conditions that suggest Syndrome X / Metabolic Syndrome:


Lab Values

Laboratory Test Needed

Elevated Insulin Levels

Syndrome X (Metabolic Syndrome) is the variable combination of obesity (usually central in distribution), insulin resistance with elevated insulin levels, high blood cholesterol and hypertension.  Metabolic Syndrome causes Hyperinsulinemia. [Eckel RH, Grundy SM, Zimmet PZ (2005) The metabolic syndrome. Lancet 365: pp. 1415-1428]

Organ Health

Diabetes Type II

In advanced stages of Syndrome X, when the pancreas can no longer keep up, diabetes II may develop.

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Risk factors for Syndrome X / Metabolic Syndrome:


Menopausal Issues

An Australian study tracked the metabolic health of 265 women aged 46-57 for five years as many of them progressed through menopause.  The study found that a surprisingly high percentage of these women – nearly 1 out of 6 – developed impaired fasting glucose levels during this time.

During the menopause transition, more fat often starts to accumulate around the stomach and insulin levels begin to inch upwards.  This subtle change can trigger a drop in levels of sex-hormone-binding-globulin (SHBG), the substance that attaches to sex hormones in the bloodstream and makes them inert.  With reduced SHBG levels, greater amounts of bioactive "male" sex hormones – androgens such as testosterone and DHEA – begin to circulate inside a woman's body.

Over time, this oversupply of active androgens can make women more male-like in appearance, fuel more obesity in the stomach region, and disrupt glycemic control.  Left unchecked, these imbalances often become self-perpetuating, thus stimulating further weight gain and metabolic dysfunction that eventually increases the risk of syndrome X, diabetes, cardiovascular disease, and certain cancers. [Obes Relat Metab Disord. 2001;25(5): pp.646-51]

Researchers in the U.S. found that among 949 women followed for nearly a decade, the risk of developing metabolic syndrome increased during perimenopause. [Archives of Internal Medicine, July 28, 2008]

Lab Values - Chemistries


Andropause/Male Menopause

Testosterone levels in men generally begin to decline in the fourth decade of life during the period known as andropause or male menopause.  Testosterone is important for maintaining both physical and mental health, and deficiency is associated with many symptoms including insulin resistance and weight gain at the waist.

Most of the weight gained is visceral fat (between the internal organs), not subcutaneous fat (surface fat under the skin).  Visceral fat cells are the most insulin-resistant cells in the human body, and help to kickstart the vicious cycle known as Syndrome X that results in abdominal obesity, diabetes and high cholesterol levels.


Problems Caused By Being Overweight

The International Diabetes Federation consensus worldwide definition of Metabolic Syndrome (Syndrome X) is as follows:

Central obesity (or a BMI index of over 30) AND any two of the following:

  • Raised triglycerides: > 150 mg/dL (1.7 mmol/L), or specific treatment for this lipid abnormality.
  • Reduced HDL cholesterol: < 40 mg/dL (1.03 mmol/L) in males, < 50 mg/dL (1.29 mmol/L) in females, or specific treatment for this lipid abnormality
  • Raised blood pressure: systolic BP > 130 or diastolic BP > 85, or treatment of previously diagnosed hypertension
  • Raised Fasting Plasma Glucose (FPG): previously diagnosed Type 2 Diabetes, or FPG > 100 mg/dL (5.6 mmol/L).  If FPG is above this value, an OGTT Glucose tolerance test is strongly recommended but is not necessary to define presence of the syndrome.

Symptoms - Metabolic

Syndrome X / Metabolic Syndrome suggests the following may be present:


Problems Associated With A Sedentary Lifestyle

Many components of metabolic syndrome are associated with a sedentary lifestyle, including increased adipose tissue, reduced HDL cholesterol, and a trend toward increased triglycerides, blood pressure, and glucose in the genetically susceptible.  Compared with individuals who watched television or videos or used their computer for less than one hour daily, those that carried out these behaviors for greater than four hours daily have a twofold increased risk of metabolic syndrome. [Fauci, Anthony S. (2008). Harrison's principles of internal medicine. McGraw-Hill Medical]

Recommendations for Syndrome X / Metabolic Syndrome:


Weight Loss

One of the first lines of approach is to lose excess weight.  A good way to do this is to cut down on the amount of sugary snacks and drinks consumed and to eat three well balanced meals a day containing complex carbohydrates and "good" fats which are found in fish, olive oil and nut oils.  If you are overweight, losing weight will make the body more insulin sensitive, i.e. less insulin will be required to move sugar from the bloodstream and into various tissues.

Low/Decreased Carbohydrate Diet

Insulin resistance and Syndrome X are caused primarily by a diet high in refined carbohydrates, which include many people's favorite and most frequently eaten foods, such as cereals, muffins, breads and rolls, pastas, cookies, donuts and soft drinks.  These refined carbohydrates not only raise glucose and insulin to unhealthy levels, but they also are devoid of the many vitamins, minerals, and vitamin-like nutrients our bodies need to properly utilize these foods.

High/Increased Fiber Diet

Any fiber choice is useful for Syndrome X sufferers, but psyllium, pectin or guar gum would offer the additional benefit of lowering cholesterol.  The amount of pectin in approximately two servings of pectin rich fruit such as pears, apples, grapefruit, and oranges is 15 grams.  Psyllium or guar gum are obtained by supplement.  The RDA of total fiber is 20-30 grams.


Aerobic Exercise

Exercise is an important aid in the treatment both of insulin sensitivity and Syndrome X. Exercise not only helps with losing weight but also makes muscle more insulin-sensitive, which in turn improves the sensitivity of the whole body.



This trace mineral is instrumental in glucose regulation, the proper function of insulin and weight control.  Also helps regulate appetite and metabolism.


Magnesium has been shown to improve glucose handling.  Low quantities in the diet (caused by modern methods of food production) increase the risk of insulin resistance.


This trace mineral is needed for various enzymes to work, and is essential for nerve health and normal insulin function.


Selenium is a mineral that works alongside vitamin E as part of the antioxidant protection against free radical damage caused by high insulin levels.  It may also help prevent heart disease.


This is an essential trace element for fat and carbohydrate metabolism.  It also helps to regulate glucose levels and reduces sugar cravings.


Alpha Lipoic Acid

Numerous additional studies have indicated that alpha lipoic acid (ALA) is useful for the treatment of diabetes mellitus which follows syndrome X. ALA stimulates increased glucose utilization in muscle cells and significantly reduces human insulin resistance/sensitivity.  This process may occur via an insulin signaling pathway.  ALA also helps to prevent free radical cellular damage caused by elevated insulin levels.


Vitamin E

Vitamin E is an important antioxidant that protects against free radical damage caused by high glucose and insulin levels in the blood.  It is also known to reduce the risk of heart disease and cancer.

Vitamin C (Ascorbic Acid)

Vitamin C is a powerful antioxidant that protects against infection and boosts the immune system.  It also helps maintain normal insulin function and may decrease bad cholesterol levels.

Vitamin A

Vitamin A has been shown to increase the efficiency of glucose disposal by insulin.  It is therefore an essential vitamin for those with Syndrome X.

Vitamin B-Complex

Vitamin B complex (B1, B2, B3, B6 and B12) helps the body to maintain good energy levels and healthy cells.

Folic Acid

Folic acid helps break down protein and may reduce the risk of heart disease.

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