Metabolic Syndrome: Diet and Exercise in the Treatment of the Metabolic Syndrome

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Host: Dr. Linda Austin - Associate Dean for Communication Development, Professor of Psychiatry.

Guest: Dr. Pamela B. Morris - CardiologistI am Linda Austin and I am Dr. Pamela B. Morris and this is Heart Sounds.

Dr. Linda Austin: Pam lots of people are getting the diagnosis of metabolic syndrome and it’s important to know that there is treatment for it. You are a cardiologist, once you have made that diagnosis or even if someone has a few of the signs or symptoms of it, how do you begin to think about treatment?

Dr. Pamela B. Morris: The exciting thing about the metabolic syndrome is that it is so readily manageable by lifestyle changes. For example, when you begin exercising, which is one of the most important treatments for the metabolic syndrome, your resistance to insulin the body’s sensitivity to your own insulin begins to improve immediately. Now, one of the things I think that scares people about exercise though is the amount of exercise that they think it requires. To treat the metabolic syndrome, it takes only moderate amounts of exercise.

Dr. Linda Austin: Like how much?

Dr. Pamela B. Morris: Well, if you are just trying to improve your sensitivity to insulin, it will only take about 30 minutes most days of the week.

Dr. Linda Austin: Does that have to be 30 minutes in one block or can you break it up in the day?

Dr. Pamela B. Morris: Breaking it up during the day is fine. For example, you may want to walk the dog for ten minutes in the morning before you leave for work, take a nice brisk walk for ten minutes during your lunch break, and then give the dog another walk break in the evening when you get home from work. So, what you have done is really to accumulate 30 minutes of exercise throughout the day.

Dr. Linda Austin: And does the walk have to be a brisk walk; do you have to get your heart rate going or what?

Dr. Pamela B. Morris: Well.

Dr. Linda Austin: What does it takes?

Dr. Pamela B. Morris: What I would suggest that it is difficult sometimes to monitor your pulse rate especially if you are on your lunch break or just walking the dog. What is really a better way to do it is to monitor how hard it feels to you and that is I tell my patients; I want them to walk at a brisk enough pace that they are proud of themselves. That you know that you are breathing a little bit more quickly and that you are getting your heart rate up a little bit, but it’s not necessary really to monitor the pulse rate specifically.

Dr. Linda Austin: So in other words if you have a sense of virtue about how you are walking.

Dr. Pamela B. Morris: That’s a good way to think about it.

Dr. Linda Austin: You feel mildly superior to people around you.

Dr. Pamela B. Morris (Laughing)

Dr. Linda Austin: So that’s exercise. Any other exercise tips that you have before we leave that, any other forms of exercise that your hear people really find helpful or useful?

Dr. Pamela B. Morris: Well, primarily for the metabolic syndrome it really does need to be aerobic exercise, the other types of exercise for example stretching or strength training are good for you in other ways, but it really must be aerobic exercise, such as walking, riding a bicycle, swimming, stair climbing or any of those types of aerobic exercise are fine.

Dr. Linda Austin: Okay, so the first tip then is that exercise. What’s the second thing you think about?

Dr. Pamela B. Morris: Nutrition; even as little as a 5 to 10 pound weight loss will improve symptoms or signs of the metabolic syndrome.

Dr. Linda Austin: Really.

Dr. Pamela B. Morris: It really doesn’t require a lot of weight loss. Now, you may need greater weight loss in terms of looking better in a bathing suit or achieving some of your other health goals, but even a modest amount of weight loss will improve the signs of the metabolic syndrome.

Dr. Linda Austin: But does that depend on how much over weight you are, I mean if you are a 100 pounds overweight surely that’s different than if you are 20 pounds overweight.

Dr. Pamela B. Morris: Well and also you are more likely to have gone even beyond the metabolic syndrome into more severe medical problems at that point, but generally just a few pounds if you are moderately overweight, if you are obese it may take a 5% to 7% of your body weight loss to achieve more significant gain.

Dr. Linda Austin: Any nutritional suggestions that you might have, for example fish oil or anything else?

Dr. Pamela B. Morris: Well let’s talk just for a moment also about the types of diet as you are talking about fish. The type of diet that’s most appropriate for someone with the metabolic syndrome might be a little different than for someone with other medical problems. These are the type of people we talked about in our diagnosis of the metabolic syndrome that these people with the metabolic syndrome tend to have a high blood sugar and high triglycerides; therefore, when you have the metabolic syndrome the type of diet would be one that is lower in carbohydrates and higher in lean protein. So, you would be the type of person for whom it would be better to have. If you are going to have carbohydrates, you want to have whole grains, so whole wheat bread, whole wheat pasta, or whole grain cereals. If you are having brown rice; if you are having rice it would be better to have brown rice than white rice. Also, you would want to have all your protein be lean, so still avoiding some of the fats choosing lean or cuts of meat, choosing fish at least 2 to 3 times per week would also be beneficial when you have the metabolic syndrome.

Dr. Linda Austin: Does it matter what kind of fish?

Dr. Pamela B. Morris: There are certain types of fish that are to be avoided, because of their mercury content.

Dr. Linda Austin: But they are my favorite ones

Dr. Pamela B. Morris: Well maybe not. They are those that are higher on the sea food chain, a food chain that is things like Mackerel. Any fish that’s carnivorous that eats lots of other fish and Mackerel, king Mackerel would be one of those that you would want to avoid. Though, ones that are most commonly seen would be the oilier fishes like herring, salmon would be great and you want to eat about three servings per week.

Dr. Linda Austin: Any dietary supplements?

Dr. Pamela B. Morris: Well, the dietary supplements that are recommended for reducing the risk of heart disease would be the fish oil supplement predominantly that would be a 1000 mg daily. If you have known heart disease, it would be appropriate to take a supplement. If you don’t have known heart disease really just increasing your intake of seafood would be fine.

Dr. Linda Austin: Pam I know also that in treating metabolic syndrome you treat the individual elements, but let’s talk about those in another Podcast.

Dr. Pamela B. Morris: Okay, that would be great. I love to come back.

Dr. Linda Austin: Thanks for chatting with us today.

Dr. Linda Austin: Thank you.

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