What is metabolic syndrome & how can employers stop this health crisis in its tracks?

What is Metabolic Syndrome?

“It's not only a disease for the old or overweight”

Metabolic Syndrome is a cluster of conditions that together heighten the risk of chronic conditions like heart disease (4x increased risk), stroke (5x), and diabetes (7x). It also causes an overall increased mortality risk of 1.5x, and has been linked with an increased risk of multiple cancers, dementia, and poor mental health, which underscores how it affects all body systems. Qured’s test data shows that younger people are just as at risk as older people.

Of the 5 underlying conditions, you only need to have three to have metabolic syndrome. High blood pressure and being overweight, obese, or with a large waist circumference are the factors most commonly measured or observed, but you don’t have to be overweight to have metabolic syndrome. Both Natalie and Kish see people in their clinics who have a normal weight, normal blood pressure, but with borderline cholesterol, pre-diabetes (or insulin resistance) and abnormal liver enzymes. The patient thinks that’s fine, maybe they need to watch their cholesterol - but really they have metabolic syndrome and have a significantly higher risk of chronic disease. This is one of the reasons why Dr Kish has designed Qured’s health screening to test for all of these invisible factors together.

Here are some of the these more insidious factors, along with the signs, symptoms and risks: 

1. Lipid imbalance: It's not only high cholesterol that is an issue, an imbalance between the good (HDL) and bad (LDL) cholesterol is a problem too as HDL helps to stop the inflammatory response and has a real benefit by preventing the narrowing of blood vessels that cause heart attacks and strokes. 
2. High blood sugar: We typically associate high blood sugar with diabetes, but there are processes that happen well before you develop diabetes that indicate poor metabolic flexibility and impaired glucose tolerance. If you have something to eat, your body reacts to get rid of that glucose and get it to the right place - your muscles, and your liver to process any excess, which led us to… 
3. Abnormal liver enzymes: This is a sign of fatty liver (and typically seen as non-alcoholic fatty liver disease - NAFLD), which is caused from a build up of visceral fat. Visceral fat is fat being deposited on your organs, rather than under the skin, and causes major damage down the line. 

The medical system has historically looked at each of these conditions in isolation, and yet what we’re increasingly understanding is that it's not just one problem but a combination that creates a severe health risk. All of these are linked to inflammation - like when you have an illness or infection. Your body is reacting as if you have an infection and goes into sympathetic overdrive - your body’s fight or flight response - which raises cortisol, blood sugar and mobilises energy you don’t really need at the time, which causes more damage down the line again. 

Recognising the symptoms

“I’m exhausted when I wake up in the morning even though I’ve had a good night’s sleep” 

In her practice, Natalie sees a lot of clients who come in talking about everyday complaints that actually are the ‘quiet’ outward signs of metabolic syndrome. She walked us through some of these, and how she helps clients manage and even reverse the symptoms and underlying condition. 

1. Fatigue and cravings: Insulin resistance causes energy spikes and dips, leading to constant tiredness and sugar cravings. A client may feel tired despite having slept hours, and say they need to eat something every few hours. Poor metabolic health means you can’t effectively produce energy from the food you eat - you can’t flexibly access the glucose in your blood vs. stored fat for fuel. These spikes in glucose and underlying insulin resistance can lead to fatigue and cravings as you’re not responding to the insulin hormone as you should be. You then reach for easy, often unhealthy snacks, and that starts the cycle again. 
2. Immune system issues: The underlying inflammatory process can make you feel under the weather continuously, but constantly being in overdrive runs down your immune system itself, impacts how you're producing white blood cells and others that fight infection. High blood sugar can also feed bacteria and viruses, making you more prone to infections. So you may feel like you’re constantly coming down with coughs, colds and infections, and find it hard to recover. 
3. Low mood and mental health links: We can't underestimate the impact of metabolic syndrome on mental health. Low mood, anxiety and feeling depressed are really common and there's a lot of evidence and research that links together the fluctuations in your blood glucose levels and the impact that has on how you’re feeling mentally and how you're managing day-to-day stresses. About 40% of people with depression are found to have insulin resistance, but since the focus was on depression, the metabolic dysfunction diagnosis was hidden. We can’t disconnect the mind from the body. 
4. Stubborn weight:  Stubborn weight is linked to fat being stored on your organs, making it hard to shift. Hormone imbalances also make it hard to lose weight, and excess weight increases hormone imbalances, creating another negative cycle. 
5. Sexual health problems: Loss of libido and erectile dysfunction are really common symptoms. Dr. Kish shared that when people come into his clinic for sexual health dysfunction the first things he checks are diabetes and high cholesterol as they damage the blood vessels that enable someone to perform sexually. 

Risk factors and what’s within your control

“People are much more aware of their health, fed up with not feeling top form and being able to perform their best, taking longer to recover from illness, and they want to make a change” 

Both Dr Kish and Natalie explored what puts you at risk for metabolic disease, and what you can change. While you can’t change your age, genetics, or ethnicity (“non-modifiable risk factors”), which all do play a part, there are lifestyle factors that are within our control and fundamentally the dramatic increase we are seeing today is due to lifestyle. Metabolic syndrome affects 30% of the population in developed countries and 14% worldwide; and in 2023, almost 2000 children under 19 are diagnosed with type 2 diabetes - that number was 0 as recently as 2000. Some lifestyle changes you can make include: 

1. Diet: Choose whole foods. Ultra-processed foods (the topic of another Qured webinar) hide sugar and lack fibre. You should aim for 30 grams of fibre in your diet, but the average person in the UK gets only 18 - and that’s declining. 
2. Moderation and portion sizes. Plate sizes in the UK have increased from an average 22cm to 28cm, and portion sizes have increased commensurately. Moderate your alcohol consumption - new studies are showing there really is no ‘ideal’ or suggested level of alcohol but Natalie suggests trying for 5 alcohol-free days in a week. 
3. Hydration. Getting enough water and reducing caffeine intake can help partially because if you’re dehydrated then the concentration of sugar in your blood is higher, so hydrating can help with glucose regulation and high blood pressure.  
4. Eat enough protein. Protein doesn’t disrupt blood sugars in the same way that other macronutrients do, and can help with satiety. Natalie recommends aiming for 30g of protein at breakfast. A quick, easy high protein breakfast could be a bowl of greek yoghurt with 2 tablespoons of nut butter and berries.
5. Slow down when you eat! Chewing properly helps you digest and get the most nutrients from your food and reduces bloating. 
6. Increase your muscle mass. We store extra glucose in muscle - with ideally 80% in muscle and only 20% in the liver, so if there’s more than the body can store, it ends up overpacking the liver. More muscle can help improve the metabolic processes and also lose weight as muscle burns more calories at rest than fat. 
7. Move during the day. If you sit 6 hours a day at your desk or job site, that’s defined as sedentary - and that covers a major part of the workforce. Most of us spend almost half our waking hours at work, so that environment matters and this is where employers can help to enable more activity during the day. 
8. Sleep. There can be up to a 30% difference in blood sugar and hunger levels after a poor night’s sleep. There is a massive impact on your metabolic health if you get less than 6 hours of sleep, with the ideal being 7-9, even if you think you’re doing ok on less, your body is not. 
9. Vaping and smoking: We used to see vaping as better than smoking but now we’re seeing really big impacts on insulin resistance. 
10. Try to manage and navigate stress. Hard to do, but work on setting boundaries and making make time for "me time".

Practical steps for employers

“Employees lose nearly a day a week from both mental and physical health issues” 

We discussed the steps employers can take to improve employee health. There's a lot within your control as an employer, from the baseline of encouraging employees to move more during the day, to innovative ideas like a recent client who revamped their on-site canteen menu to include healthier options based on blood testing outcomes. 

Some of the high-impact steps employers can take include: 

1. Early health screening & identification. Blood testing is the best way to identify the non-visible signs of metabolic syndrome and catch it early, when changes are easier to make and the more severe negative health impacts can be avoided. 
2. Targeted exercise & health support. This needs to fit around an individuals’ job role and capabilities. Create a supportive environment for physical activity - standing desks, walking meetings, regular breaks and encouraging employees to eat away from their desks.
3. Provide healthier food & drink choices in the workplace. If your employees’ work site means that there are no healthy choices available to them at all, consider your role in helping improve that as an employer. 
4. Stress management, flexibility, and mental health support: Stress is such a major factor in physical and mental health that it’s an employer’s role to help reduce work-related stress and support stress management. Consider resources for stress management, flexible working hours or mental health support programs. 

Questions asked during the webinar

Q: Can supplements help? Natalie emphasised the importance of seeking personalised advice from a registered nutritionist, as the right supplements can vary widely depending on individual health conditions and current medications. She also reminded us that supplements should support, not replace, a healthy diet and lifestyle.

Q: Why doesn’t the NHS check for metabolic syndrome? 

The NHS recommends a health check when you turn 40, which helps identify some components of metabolic syndrome. However, there isn't a specific drive to diagnose metabolic syndrome as a whole. Metabolic syndrome consists of multiple conditions that need to be identified and addressed together.

Given the current strain on NHS resources, care is often reactive, focusing on the most immediate health issue. Comprehensive testing for all components of metabolic syndrome allows for a holistic and preventative approach, but it can be time-consuming and resource-intensive. As a result, the opportunity to diagnose metabolic syndrome may sometimes be missed. Identifying the underlying causes at an individual level requires significant time and resources, which are often limited within the NHS.

Q: What age should someone get tested?

There is no specific age limit for when you should start monitoring your metabolic health. Evidence shows that metabolic syndrome can begin at a young age, even in children. At Qured, we have observed that younger individuals are showing signs of metabolic syndrome just as frequently as older individuals.

Addressing metabolic syndrome is easier in its early stages before significant damage that leads to chronic diseases, such as heart attacks and strokes, occurs. However, it's also never too late to start making changes. Many studies have shown that lifestyle changes can delay or prevent serious health conditions, providing substantial benefits at any age.

Q: I’m of slim build and think my diet is fairly healthy. Does that mean I’m not at risk?

Unfortunately, being slim and having a seemingly healthy diet doesn't necessarily eliminate the risk of developing metabolic syndrome. Many individuals in this category are diagnosed with serious chronic conditions related to metabolic syndrome.

This can be due to factors such as sedentary lifestyles, stress, consumption of ultra-processed foods and alcohol, pre-existing medical conditions, and genetics. Even if you are of slim build, you may still have visceral fat (fat around your organs), which increases your risk. Therefore, it's important to monitor your overall health and lifestyle, not just your weight.

Q: How much of an impact does stress have?

Stress can have a significant impact on your metabolic health. Both physical and mental stress trigger the "fight or flight" response, a short-term survival mechanism. However, when stress persists, it can activate inflammatory responses that damage blood vessels, increase blood pressure, and elevate hormones like cortisol. Elevated cortisol levels can lead to insulin resistance and high blood glucose levels.

From a behavioural perspective, stress often results in unhealthy lifestyle choices and poor sleep, both of which can cause weight gain and raise cholesterol levels. All of these factors are direct contributors to the hallmarks of metabolic syndrome. Thus, managing stress is crucial for maintaining metabolic health and preventing metabolic syndrome.

Final Thoughts

At Qured, we believe that tackling metabolic health isn’t just about addressing individual health issues, but also creating a culture of wellness. By prioritising early screening, promoting healthy lifestyles, and managing stress, employers can make a significant impact. Not only will this improve employee health and wellbeing, but it will also boost productivity, reduce days lost to sickness, and reduce healthcare costs.

We’re here to help you make these changes so please get in touch if you have any questions or would like more information on our tests. Let’s stop the metabolic health crisis together, one workplace at a time.