Metabolic Syndrome

What is metabolic syndrome?

Metabolic syndrome is the name for a group of risk factors for heart disease, diabetes, and other health problems. You can have just one risk factor, but people often have several of them together. When you have at least three of them, it is called metabolic syndrome. These risk factors include:

• A large waistline, also called abdominal obesity or "having an apple shape." Too much fat around the stomach is a greater risk factor for heart disease than too much fat in other parts of the body.
• Having a high triglyceride level. Triglycerides are a type of fat found in the blood.
• Having a low HDL cholesterol level. HDL is sometimes called the "good" cholesterol because it helps remove cholesterol from your arteries.
• Having high blood pressure. If your blood pressure stays high over time, it can damage your heart and lead to other health problems.
• Having a high fasting blood sugar. Mildly high blood sugar may be an early sign of diabetes.

The more factors you have, the higher your risk for heart disease, diabetes, and stroke is.

What causes metabolic syndrome?

Metabolic syndrome has several causes that act together:

• Overweight and obesity
• An inactive lifestyle
• Insulin resistance, a condition in which the body can't use insulin properly. Insulin is a hormone that helps move blood sugar into your cells to give them energy. Insulin resistance can lead to high blood sugar levels.
• Age - your risk goes up as get older
• Genetics - ethnicity and family history

People who have metabolic syndrome often also have excessive blood clotting and inflammation throughout the body. Researchers don't know whether these conditions cause metabolic syndrome or worsen it.

Who is at risk for metabolic syndrome?

The most important risk factors for metabolic syndrome are:

• Abdominal obesity (a large waistline)
• An inactive lifestyle
• Insulin resistance

There are certain groups of people who have an increased risk of metabolic syndrome:

• Some racial and ethnic groups. Mexican Americans have the highest rate of metabolic syndrome, followed by White and Black people.
• People who have diabetes
• People who have a sibling or parent who has diabetes
• Women with polycystic ovary syndrome (PCOS)
• People who take medicines that cause weight gain or changes in blood pressure, blood cholesterol, and blood sugar levels

What are the symptoms of metabolic syndrome?

Most of the metabolic risk factors have no obvious signs or symptoms, except for a large waistline.

How is metabolic syndrome diagnosed?

Your health care provider will diagnose metabolic syndrome based on the results of a physical exam and blood tests. You must have at least three of the risk factors to be diagnosed with metabolic syndrome:

• A large waistline, which means a waist measurement of
  • 35 inches or more for women
  • 40 inches or more for men
• A high triglyceride level, which is 150 mg/dL or higher
• A low HDL cholesterol level, which is
  • Less than 50 mg/dL for women
  • Less than 40 mg/dL for men
• High blood pressure, which is a reading of 130/85 mmHg or higher.
• A high fasting blood sugar, which is 100 mg/dL or higher

What are the treatments for metabolic syndrome?

The most important treatment for metabolic syndrome is a heart-healthy lifestyle, which includes:

• A heart-healthy eating plan, which limits the amount of saturated and trans fats that you eat. It encourages you to choose a variety of nutritious foods, including fruits, vegetables, whole grains, and lean meats.
• Aiming for a healthy weight
• Managing stress
• Getting regular physical activity
• Quitting smoking (or not starting if you don't already smoke)

If making lifestyle changes is not enough, you may need to take medicines. For example, you may need medicines to lower cholesterol or blood pressure.

Can metabolic syndrome be prevented?

The best way to prevent metabolic syndrome is through the heart-healthy lifestyle changes.

NIH: National Heart, Lung, and Blood Institute

Obesity

What is obesity?

Obesity is a disease that means having too much body fat. It is different from being overweight, which means weighing too much. Both terms mean that your weight is greater than what's considered healthy for your height.

Body Mass Index (BMI) measures how much you weigh compared to how tall you are. An adult who has a BMI of 30 or more is considered to have obesity. Severe obesity is having a BMI of 40 or higher. Obesity increases your risk for many other diseases and health problems, especially if the extra body fat is carried around the waist.

What raises your risk of obesity?

Obesity happens over time from taking in more calories (through food and drinks) than used up from physical activity and daily living. Your body stores the extra calories as fat. The right balance between calories and activity is different for everyone.

There are many different factors that can affect your body weight. Certain medicines or medical conditions may affect your weight. Other factors include your:

• Genetic makeup
• Eating habits
• Sex
• Race or ethnicity
• Physical activity level

How is obesity diagnosed?

To find out if you have obesity, your health care provider may:

• Ask about your health history, which may include reviewing your weight history, weight-loss efforts, and how physically active you are.
• Do a physical exam, which may include checking your height, weight, and vital signs, as well as listening to your heart and lungs.
• Order blood tests or other imaging tests, which may include checking any known health problems, as well as for other weight-related diseases and health conditions.
• Calculate your BMI, to check your risk for certain diseases. The higher your BMI, the higher your risk. BMI does not distinguish between fat, muscle, and bone mass. It may also overestimate body fat in athletes or those with a muscular build, or underestimate body fat in older persons, or others who have lost muscle.
• Check your waist size, since a large waistline, with more body fat around your abdomen (belly) rather than your hips, increases your risk for weight-related health problems.

What health problems can obesity cause?

Having a larger body size can make your heart work harder, put extra pressure on your joints, and may increase your risk for many health conditions, including:

• Type 2 diabetes.
• Heart disease.
• High blood pressure.
• Stroke.
• Metabolic syndrome.
• Osteoarthritis.
• Sleep apnea.
• Pregnancy problems.
• Fertility problems.
• Some cancers.

If you have obesity, losing even 5 to 10% of your weight can delay or prevent some of these diseases. For example, that means losing 10 to 20 pounds if you weigh 200 pounds.

What are the treatments for obesity?

Treatment plans for obesity may depend on your overall weight, other health conditions, and your willingness to participate in a weight-loss plan.

Your provider can tell you what a healthy weight is for you, help you set goals, and give you tips on how to lose weight. They may refer you to other providers that specialize in nutrition or weight loss to help you make realistic goals and provide support.

Possible treatments may include:

• Dietary changes and exercise goals to help you learn how to adopt healthy nutrition, exercise, and lifestyle changes to lose weight safely and keep it off long term.
• Counseling or support groups can give you encouragement and help you understand what's behind weight changes.
• Weight-loss medicines to treat obesity.
• Weight loss procedures or surgery if you have severe obesity or serious obesity-related health problems and have not been able to lose enough weight.

A healthy lifestyle that includes healthy eating patterns and regular physical activity can help you lose weight and lower your chance of developing complications related to obesity.

NIH: National Institute of Diabetes and Digestive and Kidney Diseases

Optic Nerve Disorders

The optic nerve is a bundle of more than 1 million nerve fibers that carry visual messages. You have one connecting the back of each eye (your retina) to your brain. Damage to an optic nerve can cause vision loss. The type of vision loss and how severe it is depends on where the damage occurs. It may affect one or both eyes.

There are many different types of optic nerve disorders, including:

• Glaucoma is a group of diseases that are the leading cause of blindness in the United States. Glaucoma usually happens when the fluid pressure inside the eyes slowly rises and damages the optic nerve.
• Optic neuritis is an inflammation of the optic nerve. Causes include infections and immune-related illnesses such as multiple sclerosis. Sometimes the cause is unknown.
• Optic nerve atrophy is damage to the optic nerve. Causes include poor blood flow to the eye, disease, trauma, or exposure to toxic substances.
• Optic nerve head drusen are pockets of protein and calcium salts that build up in the optic nerve over time

Contact your health care provider if you are having vision problems. Tests for optic nerve disorders may include eye exams, ophthalmoscopy (an examination of the back of your eye), and imaging tests. Treatment depends on which disorder that you have. With some optic nerve disorders, you may get your vision back. With others, there is no treatment, or treatment may only prevent further vision loss.

Pulmonary Embolism

What is a pulmonary embolism (PE)?

A pulmonary embolism (PE) is a sudden blockage in a lung artery. It usually happens when a blood clot breaks loose and travels through the bloodstream to the lungs. PE is a serious condition that can cause:

• Permanent damage to the lungs
• Low oxygen levels in your blood
• Damage to other organs in your body from not getting enough oxygen

PE can be life-threatening, especially if a clot is large, or if there are many clots.

What causes a pulmonary embolism (PE)?

The cause is usually a blood clot that breaks loose and travels through the bloodstream to the lungs. The clot is usually a deep vein thrombosis (DVT), a clot in the leg. In rare cases, material such as air bubbles, clumps of fat, or parts of a tumor can block the lung artery and cause PE.

Who is more likely to develop a pulmonary embolism (PE)?

Anyone can get a pulmonary embolism (PE), but certain things can raise your risk of PE:

• Having surgery, especially joint replacement surgery.
• Certain medical conditions, including
• Cancers
• Heart diseases
• Lung diseases
• A broken hip or leg bone or other trauma
• Hormone-based medicines, such as birth control pills or hormone replacement therapy.
• Pregnancy and childbirth. The risk is highest for about six weeks after childbirth.
• Not moving for long periods, such as being on bed rest, having a cast, or taking a long plane flight.
• Age. Your risk increases as you get older, especially after age 40.
• Family history and genetics. Certain genetic changes that can increase your risk of blood clots and PE.
• Obesity.

What are the symptoms of a pulmonary embolism (PE)?

Symptoms of PE include:

• Shortness of breath
• Rapid breathing
• Chest pain or discomfort, which usually gets worse when you cough or take a deep breath
• Increased heart rate
• Coughing up blood
• Very low blood pressure, lightheadedness, or fainting

Sometimes people with PE don't have any symptoms until they have serious complications, such as pulmonary hypertension (high blood pressure in the arteries to your lungs).

How is a pulmonary embolism (PE) diagnosed?

It can be difficult to diagnose PE. To find out if you have a PE, your health care provider will:

• Take your medical history, including asking about your symptoms and risk factors for PE
• Do a physical exam
• Likely order some tests, including various imaging and blood tests

What are the treatments for a pulmonary embolism (PE)?

If you have PE, you need medical treatment right away. The goal of treatment is to break up clots and help keep other clots from forming. Treatment options include medicines and procedures.

Medicines:

• Anticoagulants, or blood thinners, keep blood clots from getting larger and stop new clots from forming. You might get them as an injection, a pill, or through an I.V. (intravenous). They can cause bleeding, especially if you are taking other medicines that also thin your blood, such as aspirin.
• Thrombolytics are medicines to dissolve blood clots. You may get them if you have large clots that cause severe symptoms or other serious complications. Thrombolytics can cause sudden bleeding, so they are used if your PE is serious and may be life-threatening.

Procedures:

• Catheter-assisted thrombus removal uses a flexible tube to reach a blood clot in your lung. Your health care provider can insert a tool in the tube to break up the clot or to deliver medicine through the tube. Usually you will get medicine to put you to sleep for this procedure.
• A vena cava filter may be used in some people who cannot take blood thinners. Your health care provider inserts a filter inside a large vein called the vena cava. The filter catches blood clots before they travel to the lungs, which prevents pulmonary embolism. But the filter does not stop new blood clots from forming.

Can pulmonary embolism (PE) be prevented?

Preventing new blood clots can prevent PE. Prevention may include:

• Continuing to take blood thinners. It's also important to get regular checkups with your provider, to make sure that the dosage of your medicines is working to prevent blood clots but not causing bleeding.
• Heart-healthy lifestyle changes, such as heart-healthy eating, exercise, and, if you smoke, quitting smoking.
Using compression stockings to prevent deep vein thrombosis (DVT).
• Moving your legs when sitting for long periods of time (such as on long trips).
• Moving around as soon as possible after surgery or being confined to a bed.

NIH: National Heart, Lung, and Blood Institute

Stress

What is stress?

Stress is how your brain and body respond to a challenge or demand. When you are stressed, your body releases certain hormones. Hormones are chemicals that travel in your bloodstream and control how different parts of your body work. The hormones that are released when you are stressed make you alert and ready to act. They can raise your blood pressure, heart rate, and blood glucose (blood sugar) levels. This response is sometimes called a "fight or flight" response.

Everyone gets stressed from time to time. There are different types of stress. It can be short-term or long-term. It can be caused by something that happens once or something that keeps happening.

Not all stress is bad. In fact, it can help you survive in a dangerous situation. For example, one kind of stress is the jolt you may feel when a car pulls out in front of you while you are driving. This jolt of hormones helps you quickly hit the brakes to avoid an accident. A little short-term stress can sometimes be helpful. For example, the stress of having a deadline for school or your job may push you to get your work done on time. Once you finish it, that stress goes away.

But stress that lasts a long time can harm your health.

What causes long-term stress?

Long-term stress, or chronic stress, lasts for weeks, months, or longer. As you go about your life, your body is acting as if you're being threatened.

Causes of long-term stress include:

• Routine stress from the demands of work, school, family needs, money problems, and other daily pressures that don't stop.
• Stress from sudden, difficult changes in your life, such as divorce, illness, losing your job, or other unhappy life events that often have a long impact.
• Traumatic stress, which may happen when you're in danger of serious harm or death. Examples include being in a bad accident, a war, a flood, earthquake, or other frightening event. This type of stress can cause a long-lasting problem called post-traumatic stress disorder (PTSD).

How can long term-stress harm my health?

People respond to stress in different ways. If you're stressed for a long time you may notice that you are:

• Getting sick more often than usual because stress weakens your body's ability to fight germs
• Having stomach problems or trouble digesting food
• Having trouble sleeping
• Having headaches
• Feeling sad, angry, or easily upset

When stress keeps going, your body acts as if you're always in danger. That's a lot of strain that may play a part in developing serious health problems, including:

• Depression
• Anxiety
• Heart disease
• High blood pressure
• Diabetes

It's possible to get used to the symptoms of stress and not even realize there's a problem. So when there's a lot of stress in your life, it's important to pay attention to how it affects you so you can do something about it.

How can I manage long-term stress?

Simple things that improve your mental health may be helpful in managing long-term stress, such as:

• Get regular exercise. A 30-minute daily walk can help you feel better and help keep your immune system strong, so you don't get sick.
• Try relaxing activities. You could look for an app or wellness program that uses breathing, meditation, or muscle relaxation exercises.
• Get enough sleep every night.
• Avoid too much caffeine.
• Decide what you need to do now and what can wait. And focus on what you got done each day, not on what you weren't able to do.
• Ask your family or friends for support.

When should I ask my health care provider for help with stress?

Get help if you're having severe symptoms for 2 weeks or more, including:

• Trouble sleeping
• Changes in your eating that cause unwanted changes in your weight
• Troubles getting out of bed because of your mood
• Difficulty focusing your thoughts
• Losing interest in things you usually enjoy
• Not being able to do your usual daily activities

Always get help right away if stress is causing you to:

• Have thoughts of suicide
• Feel you can't cope
• Use drugs or alcohol more often than usual

Your health care provider may refer you to a mental health professional such as a psychologist or social worker.

NIH: National Institute of Mental Health