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treatment metabolic syndrome
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  How is metabolic syndrome treated? The major goals are to treat both the underlying cause of the syndrome, andalso to treat the cardiovascular risk factors if they persist. As has beendiscussed, the majority of people with metabolic syndrome are overweightand lead a sedentary lifestyle.Lifestyle modification is the preferred treatment of metabolic syndrome.Weight reduction usually requires a specifically tailored multifaceted programthat includes diet and exercise. Sometimes medications may be useful. Diet   A detailed discussion of  diet therapies,pros and cons of various diets etc. is beyond the scope of this article. However, there is now a trend toward the useof a Mediterranean diet -- one that is rich in good fats (olive oil) and contains a reasonable amount of carbohydrates and proteins (such as from fish andchicken).The Mediterranean diet is palatable and easily sustained. In addition, recentstudies have shown that when compared to a low fat diet, people on theMediterranean diet have a greater decrease in body weight, and also hadgreater improvements in blood pressure, cholesterol levels, and other markersof heart disease -- all of which are important in evaluating and treatingmetabolic syndrome. Exercise   A sustainable exercise program,fore example 30 minutes five days a week is reasonable to start, providing there is no medical contraindication. (If youhave any special concerns in this regard, check with your doctor first.) Thereis a beneficial effect of exercise on blood pressure, cholesterol levels, andinsulin sensitivity, regardless of whether  weight loss is achieved or not. Thus, exercise in itself is a helpful tool in treating metabolic syndrome. Cosmetic surgery to remove fat  Some people may ask: Why not just have liposuction of the abdomen and remove the large amount abdominal fat, which is a big part of the problem?Data thus far shows no benefit in liposuction on insulin sensitivity, bloodpressure, or cholesterol. As the saying goes, If it's too good to be true, it  probably is. Diet and exercise are still the preferred primary treatment of metabolic syndrome. What if lifestyle changes are not enough to treat metabolic syndrome?  What if changes in lifestyle do not do the trick, what then? Drugs to controlcholesterol levels, lipids,and high blood pressure may be considered. If someone has already had a heart attack,their LDL ( bad ) cholesterol should be reduced below 100mg/dl. (Some experts now say it should beunder 70mg/dl.) A person who has diabetes has a heart attack risk equivalentto that of someone who has already one and so should be treated in the sameway. What remains controversial is whether metabolic syndrome should beconsidered a coronary equivalent or not. If you have metabolic syndrome, adetailed discussion about lipid therapy is needed between you and your doctor, as each individual is unique.Blood pressure goals are generally set lower than 130/80. Some bloodpressure medications offer more than simply lowering blood pressure. For example, a class of blood pressure drugs called  ACE inhibitors has been found to also reduce the levels of insulin resistance and actually deter thedevelopment of type 2 diabetes. This is an important consideration whendiscussing the choice blood pressure drugs in the metabolic syndrome.The discovery that a drug prescribed for one condition, and has other beneficial effects is not new. Drugs used to treat high blood sugar  and insulin resistance may have beneficial effects on blood pressure and cholesterolprofiles. A class of drugs called thiazolidinediones[pioglitazone( Actos) and rosiglitazone (Avandia)] also reduce the thickness of the walls of the carotidarteries.Metformin (Glucophage), usually used to treat type 2 diabetes, also has beenfound to help prevent the onset of diabetes in people with metabolicsyndrome. Indeed, in my practice, I routinely discuss metformin with mypatients who have metabolic syndrome. Many of my patients who have insulinresistance associated with metabolic syndrome opt for metformin therapy.However, there are currently no established guidelines on treating metabolicsyndrome patients with metformin if they do not have overt diabetes.   How Is Metabolic Syndrome Treated? Healthy lifestyle changes are the first line of treatment for metabolic  syndrome. Lifestyle changes include losing weight, doing physical activityregularly, following a heart healthy diet, and quitting smoking.If lifestyle changes aren't enough, your doctor may prescribe medicines.Medicines are used to treat and control risk factors such as high bloodpressure,high triglycerides, low HDL cholesterol, and high blood sugar.Blood-thinning medicines, such as aspirin, also may be used to reduce therisk of blood clots. Excessive blood clotting is a condition that often occurs with metabolic syndrome. Goals of Treatment The major goal of treating metabolic syndrome is to reduce the risk of heartdisease.Treatment is directed first at lowering LDL cholesterol and high bloodpressure and managing diabetes (if these conditions are present).The second goal of treatment is to prevent the onset of type 2 diabetes (if ithasn't already developed). Long-term complications of diabetes often includeheart and kidney disease, vision loss, and foot or leg amputation.If diabetes is present, the goal of treatment is to reduce the increased risk ofheart disease by controlling all of your risk factors.The main focus of treating metabolic syndrome is managing the risk factorsthat are within your control, such as overweight or obesity,an inactive lifestyle, and an unhealthy diet. Lifestyle Changes Losing Weight In general, people who have metabolic syndrome and are overweight orobese should try to reduce their weight by 7  – 10 percent during the first year oftreatment. For example, if you weigh 250 pounds, you should try to lose 18 to25 pounds. If you weigh 300 pounds, you should try to lose 21 to 30 pounds.After the first year, you're urged to continue to lose weight to the extentpossible, with a long-range target of lowering your body mass index (BMI) toless than 25. BMI measures your weight in relation to your height and givesan estimate of your total body fat.A BMI between 25 and 29.9 is considered overweight. A BMI of 30 or more isconsidered obese. A BMI of less than 25 is the goal for prevention andtreatment of metabolic syndrome.You can calculate your BMI using the National Heart, Lung, and Blood  Institute's (NHLBI's) online calculator,or your health care provider can calculate your BMI.For more information on losing weight or maintaining your weight, see theDiseases and Conditions Index article on Overweight and Obesity.  Following a Heart Healthy Diet A heart healthy diet is an important part of a healthy lifestyle. Choose a varietyof fruits, vegetables, and grains; half of your grains should come from whole-grain products.Choose foods that are low in saturated fat, trans fat, and cholesterol. Healthychoices include lean meats, poultry without skin, fish, beans, and fat-free orlow-fat milk and milk products.Try to limit foods that have a lot of sodium (salt). Too much salt can raise yourrisk of high blood pressure.Recent studies show that following the Dietary Approaches to Stop Hypertension (DASH) eating plan can lower bloodpressure.Choose foods and beverages that are low in added sugar. If you drinkalcoholic beverages, do so in moderation.Aim for a healthy weight by staying within your daily calorie needs. Balancethe calories you take in with the calories you use while doing physical activity.For more information on following a heart healthy diet, see the NHLBI's Aimfor a Healthy Weight Web site,  Your Guide to a Healthy Heart,   Your Guide to Lowering Your Blood Pressure With DASH,  and  Your Guide to Lowering Your Cholesterol With TLC.  All of these resources provide generalinformation about healthy eating. Doing Physical Activity Regularly Being physically active, along with following a healthy diet and not smoking, isone of the most important things you can do to keep your heart and lungshealthy.Many Americans are not active enough. The good news is that even modestamounts of physical activity are good for your health. The more active youare, the more you'll benefit.Before starting any kind of exercise program or new physical activity, talk withyour doctor about the types and amounts of physical activity that are safe foryou.
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