Metabolic Syndrome Rehabilitation

What is metabolic syndrome?

Often viewed as individual diagnoses, metabolic syndrome is defined by a cluster of 3 of 4 problems of high blood sugars, abdominal obesity, abnormal cholesterol levels, and high blood pressure. These diagnoses are often the result of the same underlying problem that is insulin resistance. Insulin resistance, and in turn metabolic syndrome, greatly increase an individual’s 5-10 year risk for cardiovascular disease including coronary artery disease, stroke, kidney disease, blindness, and neuropathy. Unfortunately, insulin resistance is an insidious disease without early obvious signs and symptoms. Eventually, individuals may note frequent hunger, abdominal obesity, and nerve pains, though these are often later stage signs. The long term consequences of insulin resistance and metabolic syndrome ultimately result in significantly increased risk for complications with all cause morbidity and mortality.

The good news is that this risk can be mitigated with aggressive management. Ideally, metabolic syndrome can be reversed by improving or resolving an individual’s insulin resistance. Because people who have developed insulin resistance are at increased risk for developing it again in the future, some healthcare providers describe this reversal as insulin resistance remission. This is in part an appreciation of genetic risks, as well as appreciation that lifestyle changes can be difficult to sustain. Just ask anyone who has tried dieting in the past!

How is metabolic syndrome managed at Praxis?

Many Americans have become normalized to a diet high in simple carbohydrates and minimal activity levels. Achieving insulin resistance remission and improvement in metabolic syndrome requires a multimodal approach often including both sustainable lifestyle changes, and medication.

Praxis is uniquely suited to treat metabolic syndromes by creating 3-12 month intensive programs (The Praxis Tune Up) tailored to each individual’s needs and goals. In addition to diagnostic testing and medication management, our Nurse Practitioners work intimately with patients to improve their nutrition and activity levels. The Praxis Tune Up is broken into 3 month blocks during which time patients will receive a combination of nutritional education, and hands on physical activity and mobility coaching.

Nutrition education begins with a comprehensive assessment of an individual’s current eating habits, identification of easy changes, and pitfalls to avoid.
Clinicians typically then spend 30 minutes a week with patients learning about macro nutrients, meal planning, shopping, cooking, and ordering off a menu. Most patients will utilize a food diary to assist in mindfulness of eating patterns as well as to guide recommendations over time. After sustainably improved eating patterns (2-3 months), clinicians will examine caloric intake and/or need for proactive restrictions however many patients will already have experienced weight loss simply from improving the quality of their food and increasing their activity levels.

Physical activity and mobility needs are also assessed on an individual basis as patients present with varied underlying injuries and/or lifestyle barriers.
Utilizing multiple modalities including manual stretching, dry needling, ROM exercises, progressive resistance and interval training, we can help most patients overcome their obstacles to better activity tolerance. Physical activity schedules reflect each patient’s current activity tolerance, goals, and competing life interests. Resistance training promotes increased muscle mass that not only improves activity tolerance, but is also essential to increasing the basal metabolic rate (energy consumption). We utilize heart rate monitoring to guide exercise efforts during interval training work as well as to track improvements in cardiopulmonary health over time. Together, physical activities that combine resistance training and targeted heart rate zones intervals are the most efficient way to improve cardiovascular health, activity tolerance, and weight loss.

Many patients with metabolic syndrome and insulin resistance or Type 2 Diabetes benefit from medication use as well.
There are several types of insulin sensitizing medications that are considered first line treatments for Type 2 Diabetes including metformin, the 4th most commonly prescribed drug in North America. Metformin is relatively safe and does improve insulin sensitivity, but only improves blood sugars while it is being used. Interestingly, some patients with pre-diabetes are able to use metformin temporarily as an adjunctive to nutrition and exercise to improve their insulin resistance and avoid progressing to diabetes. Because many patients fail to improve their lifestyle influences through traditional care in the US, it is common for individuals with insulin resistance and diabetes to require escalating medications. Sulfonaureas are another class of insulin sensitizers that have long been used however new concerns that they increase the risk for cardiovascular disease raises concerns. Novel drugs such as bromocriptine-qr are emerging as interesting alternatives. Ultimately, some Type 2 Diabetics need to add insulin injections. While supplemental insulin can treat and/or prevent dangerously high blood sugars, high levels of insulin will perpetuate abdominal fat deposition. In other words, one of the criteria of metabolic syndrome, abdominal obesity, is likely to get worse with the addition of more insulin!

The good news is that improvements to nutrition and activity can have meaningful improvements on insulin sensitivity. With subsequent improvements in insulin sensitivity, the Nurse Practitioners at Praxis can modify patient’s medications in real time, or by making recommendations to a patient’s primary care provider. A number of factors will influence this decision and should be discussed on a case by case basis.

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