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The Turf Battle Over Metabolic Syndrome

Some Say It Doesn't Exist, But the Real Issue Is Lost in the Sniping

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Updated October 15, 2013

Written or reviewed by a board-certified physician. See About.com's Medical Review Board.

Lately, segments of the medical community have become entangled in a debate over metabolic syndrome - specifically, over whether it even exists. I think this debate is unnecessary, and since it promises to confuse non-physicians about the importance of metabolic syndrome, it may be harmful.

Metabolic syndrome is a grouping of cardiac risk factors that include insulin resistance, obesity (especially abdominal obesity), high blood pressure, abnormalities in blood clotting, elevated LDL cholesterol and triglycerides, and reduced HDL cholesterol. Each of these factors increase the risk of heart disease, and when they are seen together, the risk becomes even higher. This explains metabolic syndrome in depth.

Background on Origins of 'Metabolic Syndrome'

Metabolic syndrome was first recognized by a diabetes specialist, and for several years was a key focus of the American Diabetes Association (ADA). In the late 1990s, the American Heart Association (AHA) jumped on the bandwagon, and enlisted their impressive public relations arm to massively publicize metabolic syndrome, and to promulgate their own guidelines for diagnosing and managing it.

Then in 2005, the ADA released a statement announcing that, after all, there is no such thing as metabolic syndrome. Today, if you go to the ADA website, which used to be loaded with information on metabolic syndrome, all you'll find is their opinion that it doesn't actually exist. People who formerly had metabolic syndrome are now considered by the ADA to have "pre-diabetes."

And most recently, the ADA and the European Association for the Study of Diabetes engineered an "expert consultation" from the World Health Organization declaring that metabolic syndrome is, after all, not a useful concept.

Meanwhile, the AHA website still contains detailed guidelines on the diagnosis and management of metabolic syndrome, and the AHA public relations arm is still busily informing doctors and patients of its importance. And Dr. Scott Grundy, a well-known cardiologist, in reply to the attempted stifling of metabolic syndrome by the diabetes specialists, told theHeart.org, "That the metabolic syndrome exists. . . is a fact. This constant return to risk prediction makes me believe that the critics either do not understand the potential utility of the metabolic-syndrome concept or they have some other agenda."

DrRich Comments:

The sniping between heart specialists and diabetes specialists over the metabolic syndrome is entertaining, but not especially helpful. Indeed, as I see it, it seems difficult to understand why this debate is even going on except in the context of a "turf battle."

The ADA came up with a useful clinical syndrome whose primary abnormality is insulin resistance, and which clearly resides in the domain of the diabetes specialists. But then the much larger and much more powerful AHA came along and usurped "ownership" of metabolic syndrome (since the chief significance of metabolic syndrome is that it increases the risk of heart disease). It seems apparent that this is why the ADA started fighting back, trying to redefine this condition as pre-diabetes - which certainly sounds like a condition that they ought to control rather a bunch of heart doctors. The fight, in other words, is over who gets to "control" this medical condition.

The increasingly unseemly public squabble over metabolic syndrome, by previously dignified professional organizations, starkly demonstrates just how important it is for such interest groups to "own" specific medical disorders. This ownership largely determines who gets funding for research, education, and public relations.

The fact is, the "metabolic syndrome" terminology has taken firm root, and at this point it will be difficult for the ADA to dislodge it from the medical lexicon. Furthermore, metabolic syndrome does have important clinical significance, and people who are predisposed to this condition need to pay attention to it.

Here's What You Really Need to Know:

Metabolic syndrome occurs in people who have a genetic predisposition to insulin resistance and then allow themselves to become sedentary and overweight. In these individuals, lack of exercise and obesity can lead first to insulin resistance, which then can lead to the other features of metabolic syndrome. And the risk factors that accumulate in metabolic syndrome greatly increase the risk of heart disease.

How do you know if you are predisposed to insulin resistance? One cannot always tell, but often these people have a family history of type 2 diabetes or metabolic syndrome. Those who do have such a family history need to take special pains to maintain a healthy weight, and get plenty of exercise. Keeping a normal weight and getting exercise is important in everyone, of course, but in those prone to metabolic syndrome it is critically important. Whatever you call this condition and whichever medical organization ends up championing it, that's what you need to know.

Sources:

The ADA on metabolic syndrome: http://www.diabetes.org/diabetes-research/summaries/ada-easd-metabolic-syndrome.jsp

The AHA on metabolic syndrome: http://www.americanheart.org/presenter.jhtml?identifier=4756

Kahn R. Metabolic syndrome-what is the clinical usefulness? Lancet 2008; DOI: 10.1016/S0140-6736 (08) 60731-X.

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