It has been observed for a number of years that conditions such as adult onset diabetes, hypertension, elevated blood levels of cholesterol, elevated serum levels of low-density lipoproteins, obesity, and coronary heart disease are common disorders that often occur in one patient. In 1988 medical researcher and endocrinologist Gerald Reaven theorized that these metabolic and cardiovascular disorders are a multifaceted syndrome characterized by insulin resistance and the resultant elevation of insulin levels in the blood (called hyperinsulinemia). Subsequent studies have shown that increased insulin concentrations in the blood, as a marker of decreased insulin sensitivity, can be correlated with an increased risk of hypertension, hyperlipidemia and non-insulin dependent diabetes (NIDDM). These studies support Reaven's hypothesis, coined Syndrome X, that insulin resistance and hyperinsulinemia significantly increases the risk of developing cardiovascular disease, and in also appears to play an important role in other disease such as cancer. The importance of this finding cannot be understated considering that the clinical features of Syndrome X are found in a majority of patients, if only we consider the popular usage of often dangerous and questionable drug therapies to lower cholesterol and lower blood pressure without treating the cause.

The clinical manifestations of Syndrome X include:
•abdominal obesity, i.e. an "apple" shape, "love-handles," or a "beer gut"
•elevated blood triglycerides
•decreased HDL cholesterol (the "good" cholesterol) and elevated LDL cholesterol, (the "bad" cholesterol)
•hypertension (high blood pressure)
•atherosclerosis (hardening of the arteries)
•thrombotic diseases (e.g. deep vein leg thrombosis)
•blood sugar irregularities, including hypoglycemia
•non-insulin-dependent diabetes mellitus
but may also include:
•bone loss
•depression
•cognitive problems (e.g. poor memory and concentration)
•erectile dysfunction

All of these clinical manifestations are fundamentally related either to the failure of insulin to facilitate the entrance of nutrients into the cell, which disrupts cellular function, or the negative effects of elevated levels of insulin upon the vascular system and in tissues that have not yet become insulin resistant.

Insulin and Insulin resistance

Insulin is the body's primary anabolic or tissue-building hormone, and is secreted by the beta cells of the pancreas. Insulin promotes the uptake and storage of nutrients within the cell, including glucose, free fatty acids, and amino acids. The primary stimulus for insulin secretion is the ingestion of carbohydrates, whereas the consumption of a diet rich in proteins and fats tends to limit the secretion of insulin. When its activities predominate insulin prevents the breakdown of fat and protein.
When a cell does not respond to normal levels of insulin it is said to be insulin-resistant. Such a situation can develop from numerous factors:

•Consuming foods with high glycemic index. These are foods that contain a relatively large volume of simple sugars, which upon digestion, elevate blood glucose levels and stimulate the release of insulin.
•Low fat diets. Although widely marketed as being the basis of a healthy lifestyle, low fat diets are not necessarily beneficial. Significant portions of fat in a meal lowers the glycemic index by delaying stomach emptying.
•Deficiencies of chromium and magnesium. Deficiencies of these nutrients facilitate insulin resistance to create a vicious cycle pattern. Other common nutritional deficiencies include zinc, manganese, and the B-vitamins.
•Sedentary lifestyle and lack of exercise. Insulin resistance in the liver increases after five days of no exercise. Trained muscle does not require insulin for the uptake of blood glucose, whereas a lack of trained muscle mass in the body promotes systemic insulin resistance.
•Excess insulin secretion promotes insulin resistance in a vicious-cycle relationship. When a cell is exposed to elevated levels of insulin, it begins to 'down-regulate' its response to insulin and reduce the number of its insulin receptors.
•Obesity promotes insulin resistance. Insulin resistance, in turn, promotes elevated levels of insulin secretion, preventing the breakdown of fat and the promotion of obesity.

Effects of Insulin resistance

Not all tissues become insulin resistant at once. The liver, which is exposed to insulin-rich blood from the portal vein, becomes resistant first. Later, muscle and fat cells may become resistant, followed by platelets and other cells. Skin cells however do not become insulin resistant. Ultimately, the effects of insulin resistance depend on the which tissues are involved.

Hyperinsulinemia

As a tissue becomes insulin resistant, the uptake of blood glucose becomes more difficult, and as a result blood glucose levels begin to rise and continue to be elevated over an increasingly longer period of time. The pancreas, in turn, responds by secreting progressively higher levels of insulin until the glucose is effectively stored. In such a situation insulin secretion is not only elevated but prolonged, such that the total hours of insulin exposure in the body may become elevated by 50-100% beyond that of normal.

There are several possible effects of hyperinsulinemia:
•Hyperinsulinemia disrupts sodium metabolism and promotes water retention and hypertension.
•Hyperinsulinemia increases the oxidative load in some tissues, promoting oxidative damage and initiation of atherosclerosis and neoplasia (cancer).
•Hyperinsulinemia decreases the total daily secretion of growth hormone with negative effects throughout the body. One notable effect of this is to inhibit the conversion of the inactive thyroid hormone (T-4) to its active form (T-3). This creates a "functional hypothyroidism," which is difficult to detect because a routine thyroid blood test will display an otherwise normal level of circulating thyroid hormones. Chronic hyperinsulinemia may be accompanied by chronic compensatory hypercortisolemia (high blood cortisol levels), poor tolerance to stress, depressed immunity, and eventually, adrenal exhaustion.
•Chronic, high levels of insulin secretion will eventually exhaust the beta cells of the pancreas, increasing the likelihood of a functional deficit of these tissues, resulting in adult-onset diabetes.

Designation of Syndrome X

The designation of Syndrome X in a given person can be determined by measuring fasting insulin levels, or by measuring insulin changes to a glucose challenge. Unfortunately, most physicians and labs cannot run these tests as there are several practical and technical challenges that make this procedure difficult. Practitioners may determine Syndrome X with a fairly large degree of certainty however, based on patient history and physical examination. The most important physical feature that is indicative of Syndrome X is truncal-abdominal obesity, such that the circumference of the abdomen at the navel is greater than that of the hips. For men the ratio between these two measurements should be no greater than one, i.e. the abdominal girth should be equal to or less than the waist circumference. For women, the waist-hip ratio should be less than 0.8, i.e. the circumference of the waist should be less than 80% than the circumference of the hips. Another good indicator of Syndrome X are consistent readings of elevated triglycerides in routine blood tests, which tends to parallel insulin secretion.

Treatment of Syndrome X

The treatment of Syndrome X has three limbs, all of which must be done simultaneously:
1. Take supplements to counter the deficiencies that lead to insulin resistance;
2. Engage in a minimum of 15-20 minutes of resistance-type (anaerobic) exercise on a daily basis.
3. Consume a low carbohydrate diet.

Supplements

It has been widely suggested over the past few years that a high fat diet is a contributing factor in the development of cardiovascular disease. There are many low fat products on the market that claim to be "heart smart" or "heart friendly." Unfortunately, this is a huge misconception. We have already seen how a low fat diet will increase blood glucose levels and will result in abnormal insulin secretion. Further, certain kinds of fat have been shown to actually inhibit or reverse cardiovascular damage, and can even promote weight loss. The kind of fats that are beneficial to our health are the omega 3 fatty acids, found in marine-based foods such as cold-water fish and sea vegetables, as well as green vegetables and free-range grass-fed animal products. Researchers have shown that the consumption of omega 3 fatty acids (in contrast to the omega 6 and arachidonic fatty acids that make up the bulk of our dietary fat) can have a positive effect upon our health. In Syndrome X this "oil change" requires the restriction of most kinds of fat except those rich in omega 3 fatty acids, with neutral fats such as olive oil and butter. Important supplemental forms of omega 3 fatty acids include eicosapentanoic acid (EPA) and docosahexanoic acid (DHA), derived from cold water fish such as salmon and halibut.

Other important supplements in the Syndrome X pattern include:
•Zinc citrate, 50 mg daily
•Magnesium, 800 mg daily
•Chromium chelate, 600-800 mcg daily
•Vitamin B-100 complex, complete
•Antioxidants, e.g Vitamin C, Vitamin E, Selenium, and Alpha Lipoic acid, as well as herbs such as Rosemary, Hawthorn, Turmeric, Milk Thistle, Guggulipid, Reishi, Amla, and Astragalus

Exercise

Exercise is a very important factor in the treatment of Syndrome X, primarily anaerobic, muscle-building exercise that increases lean muscle mass to reverse systemic insulin resistance. Examples include military-style calisthenics (e.g. pushups, chin-ups, and lunges) and weight lifting, as well as walking, running or bicycling uphill. Despite the importance of exercise, many patients will find that weight loss isn't necessarily dependent upon it. In this way the moderate to severely obese can shed some of the excess weight before beginning an intensive exercise regimen.

Low Carbohydrate diet

There is a great diversity of fad diets nowadays that put an emphasis upon low carbohydrates and high proteins. Any one of these diets is often quite effective to mediate insulin secretion and promote weight loss, but in most cases do not correct the underlying nutrient deficiencies, and do not make important distinctions between the different kinds of animal products, such as feed-lot beef, pork, and farmed fish, in contrast to free range, grass-fed, and wild animal products. Just as important is an emphasis upon the consumption of low carbohydrate antioxidant-rich and high-fiber above-ground vegetables. These foods need to make up at least 40% of the total volume of food consumed on a daily basis. This includes vegetables such as broccoli and broccoli sprouts, Swiss and red chard, cauliflower, garlic, onions, beet greens, cabbage, brussel sprouts, and summer squash. Please refer to the Paleolithic diet sheet for more information on a suitable diet in the treatment of Syndrome X.

Resources - print
Syndrome X: Overcoming the Silent Killer That Can Give You a Heart Attack. By Gerald M. Reaven, et al.
Dr. Bernstein's Diabetes Solution. By Richard K. Bernstein
The Healing Power of Minerals. By Paul Bergner

Resources - WWW
Syndrome X, Stanford University
North American Institute of Medical Herbalism