Older Bolder Life

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Metabolic Syndrome: Diagnostic Criteria and More

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Yesterday I shared a bit about the metabolic syndrome (scroll down to read), the constellation of risk factors that are deemed to represent a critical risk for developing other serious medical issues over time – including cardiovascular (heart) disease, cerebrovascular (i.e. strokes), diabetes, and several more.

Let’s take a more detailed look today at the diagnostic criteria for the metabolic syndrome and the most common symptoms it produces.

Diagnosing the Metabolic Syndrome

By the standard criteria in place today, you’re considered to have the metabolic syndrome if you have at least three of these five key criteria:

Waistline measurement of > 40 inches for men, > 35 inches for women.

Fasting triglyceride level above 150 mg/dl.

HDL (high density lipoprotein) level < 40 mg/dl for men, <  50 mg/dl for women.

Fasting blood glucose level > 100 mg/dl OR are taking glucose-lowering meds.

Blood pressure 130/85 or higher OR are taking meds to lower your blood pressure.

While not considered a diagnostic criteria, many people also have the skin changes of acanthosis nigricans (darkened skin under the arms or on the back of the neck) or skin tags.

Common Symptoms of the Metabolic Syndrome

Somewhat ironically, there aren’t any immediate symptoms associated with development of the metabolic syndrome; these changes develop over time, allowing our often over-developed sense of personal denial to strengthen as well.

An expanding waistline is surely a readily visible sign, particularly when it’s prominently deposited on the trunk and abdomen, though a person could be “skinny as a rail” and still have hypertension (high blood pressure), a high fasting blood sugar, high triglycerides, low HDL and be labeled as having the metabolic syndrome.

If in doubt, consult your physician, assess your risk factors with simple lab analysis, and chart your course for recovery.

Steps to take in dealing with a “diagnosis” of the metabolic syndrome will follow.

Metabolic Syndrome: What Is It?

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Yesterday I had the pleasure of sitting down with a delightful couple here in the DFW metro for coffee and a chat about their coaching needs.

The wife had recently been scolded by her physician and told “she was a walking metabolic syndrome disaster”, and left to an apparently under-equipped physician’s assistant to discuss it further, which consisted by report of being handed a three-page pamphlet and being told to “lose weight or you’ll need a (weight loss) surgery…”.

They were (quite reasonably) aghast at the interaction, and intimidated by what her “metabolic syndrome” implies. What follows here is meant to serve as a quick introduction to the issue, not an exhaustive discussion in critical detail.

So Just What is the Metabolic Syndrome?

At the most basic level, the metabolic syndrome is the name given a group of risk factors that increase an individual’s risk for a number of bad actors, for example, both cardiovascular (heart) and cerebrovascular (stroke) disease as well as diabetes.

The American Heart Association estimates that as many as 34% of American adults currently meet the criteria to have the metabolic syndrome, an astounding number when you think about. On the other hand, when you ponder how overweight and inactive a large portion of the population actually is, perhaps it shouldn’t be all that surprising.

While not part of the absolute diagnostic criteria for the metabolic syndrome, most authorities (correctly) implicate insulin resistance, a frustrating consequence of eating the Standard American Diet for many, in the development of the metabolic syndrome.

Not all physicians agree that the metabolic syndrome should be viewed as a distinct condition, and you might hear or read it described by other names, including the mysterious sounding Syndrome X, the insulin resistance syndrome, and the dysmetabolic syndrome.

Metabolic Syndrome Risk Factors

There are host of risk factors for developing the metabolic syndrome, here are some of the most common:

Overweight/Obese. Living above your ideal body weight, particularly with abdominal fat stores, is a major risk factor.

Age. Similar to many other health bugaboos, risk increases with age. Life choices in your 30’s really do matter; by age 60, the risk of developing a metabolic syndrome tops 40%.

Diabetes. Risk for developing metabolic syndrome goes up with a family history of T2 diabetes or having developed gestational diabetes during pregnancy for women.

Race. At least in the United States, Mexican-Americans, African-Americans, Asians, and Native Americans are considered to have higher risk.

Sex. Women have a slightly higher risk of developing metabolic syndrome than men.

Smoking. While perhaps not directly causal in the metabolic syndrome, tobacco use clearly worsens the health consequences.

Insulin resistance. A critical and expansive topic to be covered on its own; it must be included on any list of metabolic syndrome risk factors.

Other medical conditions: Non-alcoholic fatty live, polycystic ovary syndrome, cardiovascular disease, certain types of biliary disease (gallstones), lipodystrophy, and more.

Tomorrow we’ll take a quick look at the diagnostic criteria for the metabolic syndrome.

the Older Bolder Life Tuesday Veg 5 March: Ginger Pecan Cauliflower Rice Pilaf

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Our friend Chef Libby down in Austin has been playing around with cauliflower rice pilaf recipes over the past few weeks, working on something with a bit of Texas flair for some events on her spring calendar coming up.

In Texas, that means of course incorporating pecans instead of the classic pilaf sliced almonds, and to her palate ginger seems to play very well with the butter (or ghee) toasted pecans.

Her team has been using the organic pre-riced cauliflower in 5-cup bags from Costco for some of their experiments in her kitchen, and I’ve sized the following recipe down to fit that or a medium-sized cauliflower head you rice yourself.

Libby notes the fresh ginger really makes this recipe pop, though I made a recipe yesterday with powdered ginger (no fresh ginger in the house!) and it was delicious. You’ll want to try this one; it’s tasty, spot on in terms of macros, and presents very well for impressing the family or guests at the table.

1 medium head cauliflower, trimmed and riced, see notes above
5-6 green onions, green and white parts separated
3-4 tbsp butter or ghee
1/2 cup coarsely chopped pecans, walnuts, or almonds
1-2 tbsp finely chopped ginger (or 1/2 to 1 tsp ground ginger)
1/2-1 tsp crushed red pepper flakes
Good salt to taste

Optional
Alternative spices: Garlic, cinnamon, your call
3-4 tbsp chopped golden raisins OR
1-2 chopped medjool dates

Rice your cauliflower if using fresh. Prep the green onions: trim and clean, chop the white parts, then thinly slice the green stems on a steep angle and set aside.

Melt 2 tbsp of the butter/ghee over medium heat, and sauté (toast) the pecans until fragrant and golden brown. Remove from the heat, stir in the ginger and red pepper flakes, sprinkle with salt, then scrape into a large bowl.

Into the same skillet goes the remainder of the butter/ghee over medium-high heat, then the white parts of the onions; sauté for several minutes until just beginning to caramelize around the edges. Add the cauliflower, and raisins or dates if using, drop the heat down a notch, and cook for 4-5 minutes (longer if using frozen) until the cauliflower is just beginning to get tender.

Now scrape the cauliflower onion mixture into the bowl with the nuts, stir to mix, and adjust the salt to taste. Top artfully with the sliced onion greens and go to it.

Enjoy.

Telling My Own Story Here at Older Bolder

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Finishing a final bit of digital housekeeping on our sites, I’ve finally posted today a page of answers to the most common questions that come in about me, my personal health transformation, and my work as a physician (and later in the private sector).

While some might argue a bit lengthy for the web, I’ve taken the opportunity to share a little about my education, medical training, and work history, but probably more importantly about my own (fairly dramatic) health and life changes over the past three years, why healthy and wellness coaching is so critical to my family and I right now, and a few things in the health and wellness arena we value and appreciate.

For many of us, our hopes of becoming an Olympic sprinter, professional athlete, or highly-paid supermodel have past, though I’d argue to my last day that every one on the planet can pursue thoughtful, practical, and attainable steps to improve their health, and live happier, more active, and more functional lives today.

The challenge, of course, is customizing your approach to reclaiming your life to best fit your physiology (or metabolism if you’d prefer) and lifestyle as it is today, recognizing that as your health improves and your metabolism changes, your approach to nutrition, fitness, management of sleep and stress, and many other things will change over time.

Git ‘er done, and back to regular programming tomorrow.

Inquiring Minds Want to Know: Older Bolder Links, Reads, and More 2 March 2019

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Keto (Nutritional Ketosis) and Weight Loss

Nifty narrative review of keto-adaption and exercise tolerance, fatigue recovery, and organ damage prevention.
Tracking the food you eat helps in weight loss.
Another traditional medicine look at a 12-week ketogenic diet trial.
Canadian FP docs query if a ketogenic diet is effective for weight loss. It is.
Your cells thrive with fewer calories? For the most part, yes.

Exercise and Fitness

Interval training and sprints are good for you and your weight loss.
Fat cells release TGF-beta 2 post exercise – and it improves glucose tolerance.
Physical activity patterns and mortality.

Other Topics That Caught My Eye

Orthobiologics for knee osteoarthritis. (Need free Medscape account)
Another look at gut bacteria and dementia.
Gut microbiota varies by ethnicity.
Is yerba santa useful in dementia?

Food, Glorious Food

Short TED vid on the history of cheese.
How Benton’s, a famous Southern bacon purveyor, makes their famous bacon. (No nitrites)
Coconut Curry Braised Chicken Legs
Thai Inspired Celery Salad Update

the Older Bolder Friday Feast 1 March: Coconut Curry Braised Chicken Legs

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With much of the country is still hip deep in winter today, let’s talk about a warm, rich, tasty, and easy dinner to get on the table tonight – Coconut Curry Braised Chicken Legs.

Braised foods score big points on so many fronts. Braising allows one to take a humble cut of meat, one packed with tooth and connective tissue, and with the magical application of gentle heat, time, and liquid to convey both heat and flavor, turn that protein into a tender, moist, deeply flavored delight.

Probably my most remembered home dish from childhood was a beer-braised brisket; we have several great brisket recipes, but that’s the one we keep going back to. And how about those Thai-inspired Slow Roasted Short Ribs from a few weeks back? By the way, I just did a chuck roast using that recipe, and it was astoundingly good (post in the queue already).

My professional photographer daughter has been braising chicken legs in coconut milk and curry for years, and we’ve lately been using this amped up Coconut Curry Braised Chicken Leg recipe as later winter battles early spring here in North Texas.

We like spicy, full-flavored food, of course you can ramp up or tone down the spices in this recipe, but remember the chicken legs are a mildly-flavored blank slate here. This recipe yields big results for about 10 minutes prep time before it slides into the oven…

1 can full-fat unsweetened coconut milk
2-4 tbsp prepared Thai curry paste
1-3 lemongrass stalks, outer layer peeled, crushed (see note above)
2-3 inch piece of fresh ginger, peeled, coarsely grated
4-6 garlic cloves, crushed
4 chicken legs (thigh+drumstick)
Good salt to taste

Optional
1-2 chopped serrano or jalapeno peppers
1-2 tsp fish sauce
1 tsp brown sugar

To serve
Chopped cilantro leaves and tender stems
Lime wedges and/or zest
Toasted unsweetened coconut flakes
Cauliflower rice

Prep the chicken, lightly season with salt and set aside. Preheat the oven to 400.

Stir the coconut milk, curry paste, and grated ginger together in a baking dish large enough to hold the 4 chicken legs. Add the lemongrass and garlic, then add the chicken legs and spoon the mixture over.

Bake for 60-75 minutes (depends on the size of the legs), basting with the cooking liquid/sauce every 15 minutes until the chicken is browned and cooked through (the joint will move fairly easily).

Plate, spoon some sauce over, and top with the cilantro, zest, and coconut flakes.

Enjoy.

Fascinating Supplement Read for the Week: Supplements and CVD

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Christopher Labos, a cardiologist practicing in Quebec penned an interesting piece on Medscape two weeks ago yesterday titled Supplements and CVD: Why Negative Data Don’t Dampen Sales. You’ll need a free Medscape account to read the article; if you don’t have access, I’d encourage you to register and read this one.

Any article that begins with the opening sentence “Vitamins and supplements do not prevent cardiovascular disease (CVD)” promises to cast supplements in a very negative light, and he paints with a very broad brush here appearing to lump “vitamins and supplements” into one ineffective heap.

The author does provide superficial summary data from several studies, though his interpretation of several is later challenged and corrected by multiple commenters, and he goes on to castigate the physicians and patients who persist in ignoring his cited data denigrating supplement use.

I don’t have time to delve into nitpicky particulars today, but three points come to mind about the article…

Three Quick Points About the Article

One, if you’re interested at all in the rational utilization of supplements, take 10 minutes, read the article AND the comments. You’ll note that opinions expressed by a number of health professionals in the comments vary widely (an understatement), and an impressive subset of physicians and allied health providers commenting disagree vehemently with the article’s premise.

Two, several commenters hit upon a key principal often neglected (or ignored) in the institutional practice of allopathic medicine today – the fact that supplement (or treatment) decisions need to be ultimately framed by an individual’s physiology (and metabolic state in this discussion of supplementation), and not necessarily by the sweeping generalizations of often very narrowly focused (i.e., looking a single vitamin, mineral, or cofactor) empirical studies.

Three, for those who face an uphill battle with their personal physician(s) with regard to supplement utilization, understand that you’re not alone. The reasons for the disconnect are multiple, and both the article and commentary suggest that physicians and the rest of us are heavily influenced by a number of biases we carry (including financial ones).

A Deeper Dive on Supplements Coming Shortly…

I have to admit, I’m fascinated by the supplement world, and come at it from the position of a longterm skeptic, no doubt due to my traditional medical training and practice, though personally use and recommend supplements routinely today. More to come…

Giving Back: Our 3% for 3 Pledge

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One more bit of ‘housekeeping’ before we get back to regularly scheduled programming here on the blog -please indulge me a moment to share about our 3% for 3 pledge.

To regularly partake of any form of news these days, even if briefly, will expose you to an avalanche of voices working very hard to convince you the world is going to hell in a hand-basket. To be fair, in many respects it probably is, and we all need to be very intentional and thoughtful about how we consume the news of the day, and more importantly, how we let it impact our daily lives.

Virtually absent from the news feeds of the day are stories of people and organizations quietly going about their missions of helping their fellow man, often at great sacrifice and with profound impact. And when’s the last time you heard or read a story from one of the big ‘news brokers’ about the powerful influences and even health benefits that gratitude, service, and thankfulness can have on your life?

Our Older Bolder 3% for 3 Pledge

We decided from the very beginning to donate 3% of our gross (pre-tax) business income here at Older Bolder Fitness to three different organizations a year who are working to do great things for people.

There are dozens and dozens of wonderful organizations working often in relative obscurity out there today, though I must admit our three organizations this year all have to do with something we’re crazy about – fly fishing.

Reel Recovery and Casting for Recovery help men and women battling cancer reconnect with the natural world through the healing power of fly fishing and the natural world, offering no-cost, immersive experiences with volunteers who teach, guide, and encourage along the way. Project Healing Waters Fly Fishing has a similar mission, though serves men and women veterans of all ages.

We’d encourage you to give a bit of yourself, and your resources, to a group (or groups) you’re inspired by. Gratitude is good for you.