Metabolic Syndrome: What You Need to Know and How to Take Action to Prevent Heart Disease, Diabetes and Stroke...

Metabolic syndrome is not a single condition, but rather a cluster of risk factors that significantly increase your chances of developing heart disease, stroke, and type 2 diabetes. Unfortunately, it is far more common than many realise. In the UK, it's estimated that around one in three adults over 50 have metabolic syndrome — and rates are rising (British Heart Foundation, 2024).

As a nutritional therapist, I see this all too often in clinic. The good news? With the right knowledge and support, it is absolutely possible to take control. Let's unpack it properly.

What Is Metabolic Syndrome?

Metabolic syndrome is diagnosed when you have at least three of the following:

• Elevated waist circumference

• High blood pressure

• Raised fasting blood glucose (or insulin resistance)

• High triglycerides

• Low HDL cholesterol

Each of these on their own increases risk, but together they multiply the danger.

Now, let’s go deeper into each, including the blood markers you should know, research-backed facts, typical medications (and their potential nutrient depletions), plus some top-level nutritional advice.

Waist Circumference and Waist-Height Ratio with Metabolic syndrome

Waist size is a major predictor of metabolic health, often more useful than BMI alone.

Waist circumference guidelines (NICE, 2024):

Men:

• Low risk: <94 cm

• Increased risk: 94–102 cm

• High risk: >102 cm

Women:

• Low risk: <80 cm

• Increased risk: 80–88 cm

• High risk: >88 cm

Waist-to-height ratio: Aim for less than 0.5. Your waist measurement divided by your height.

• Low risk: <0.5

• Moderate risk: 0.5–0.6

• High risk: >0.6

Why it matters: Excess visceral fat increases inflammatory markers and insulin resistance (Ashwell et al., BMJ Open, 2012).

Top tip: Track your waist size at home. Reduce intake of ultra-processed foods and prioritise movement daily. Walking is underrated!

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Blood Pressure

Blood pressure markers (NHS, 2024):

• Normal: <120/80 mmHg

• Elevated: 120–129 / <80 mmHg

• Hypertension Stage 1: 130–139 / 80–89 mmHg

• Hypertension Stage 2: ≥140 / ≥90 mmHg

Why it matters: High blood pressure damages arteries over time, increasing the risk of heart attacks and stroke.

Medications prescribed:

• ACE inhibitors

• Beta blockers

• Calcium channel blockers

• Diuretics

Watch for nutrient depletions:

• Diuretics can lower potassium, magnesium, zinc and B vitamins.

• Beta blockers may reduce CoQ10, essential for heart health.

Nutritional support:Increase potassium-rich foods like leafy greens and avocados. Magnesium from nuts and seeds can support blood pressure control. And always discuss medication and supplements with a qualified practitioner.

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Blood Glucose and Diabetes Risk

Blood glucose markers (NICE, 2023):

• Normal fasting glucose: 4.0–5.4 mmol/L

• Impaired fasting glucose (pre-diabetes): 5.5–6.9 mmol/L

• Diabetes: ≥7.0 mmol/L

HbA1c (average blood sugar over 2–3 months):

• Normal: <42 mmol/mol (<6.0%)

• Pre-diabetes: 42–47 mmol/mol (6.0–6.4%)

• Diabetes: ≥48 mmol/mol (6.5% or above)

Why it matters: Raised blood sugar damages blood vessels and nerves. Pre-diabetes is a key warning sign, yet often missed.

Medications prescribed:

• Metformin (first-line)

• Insulin (for advanced cases)

Watch for nutrient depletions:

• Metformin can deplete vitamin B12 and folate, which are vital for energy and nerve health (de Jager et al., Diabetes Care, 2010).

Nutritional support:

Focus on fibre-rich foods, balance carbohydrates with protein and healthy fats, and include magnesium for insulin sensitivity.

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Cholesterol and Lipid Profile

It is essential to look at all the numbers, not just total cholesterol.

Lipid panel markers (British Heart Foundation, 2024):

• Total cholesterol:

  • Optimal: <5 mmol/L

  • Borderline: 5–6.4 mmol/L

  • High: >6.5 mmol/L

• LDL (Low-Density Lipoprotein):

  • Optimal: <3 mmol/L

  • Borderline: 3–4.9 mmol/L

  • High: ≥5 mmol/L(LDL is often called “bad” cholesterol because it deposits cholesterol in the arteries.)

• HDL (High-Density Lipoprotein):

  • Optimal: >1.4 mmol/L (women), >1.0 mmol/L (men)(HDL is the “good” cholesterol, helping to clear cholesterol from the bloodstream.)

• Triglycerides:

  • Optimal: <1.7 mmol/L

  • Borderline: 1.7–2.2 mmol/L

  • High: >2.3 mmol/L

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Emerging research — particle size matters: Smaller, denser LDL particles are more harmful than larger, fluffy ones (Superko et al., American Journal of Cardiology, 2012). Unfortunately, NHS testing does not routinely check particle size, but private testing is available, please contact me to discuss.

Medications prescribed:

• Statins

• Ezetimibe

• PCSK9 inhibitors

Watch for nutrient depletions:

• Statins can deplete CoQ10, which supports energy production in cells and heart health.

Nutritional support: Increase soluble fibre (oats, flaxseed), add healthy fats (olive oil, avocados), and consider plant sterols to naturally manage cholesterol.

Triglycerides (In More Detail)

Triglycerides are a type of fat found in the blood, and elevated levels are a major risk factor for cardiovascular disease.

Triglyceride levels:

• Normal: <1.7 mmol/L

• Borderline high: 1.7–2.2 mmol/L

• High: >2.3 mmol/L

• Very high: >5.6 mmol/L (Seek medical advice immediately)

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Why it matters:High triglycerides are linked with insulin resistance and fatty liver disease (Nordestgaard et al., Circulation, 2016).

Nutritional support:

• Cut back on sugary foods and refined carbs.

• Include omega-3 fats from oily fish like salmon and mackerel.

• Moderate alcohol intake, as excess can spike triglyceride levels.

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Probiotics and Metabolic Syndrome

Gut health plays a crucial role across all metabolic markers. Research shows that targeted probiotics may reduce blood pressure, improve cholesterol levels, and support blood sugar balance (Ejtahed et al., Nutrition Reviews, 2020).

Probiotic strains to consider:

• Lactobacillus plantarum

• Bifidobacterium lactis

• Lactobacillus rhamnosus
  

I recommend choosing a high-quality supplement with clinically validated strains, ideally with CFU counts in the billions, and checking for low-histamine formulas if you are sensitive. As always, personalised advice makes all the difference.

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Final Thoughts

Metabolic syndrome can feel overwhelming, but it does not need to be. With personalised nutrition, targeted lifestyle changes, and the right testing, you can make meaningful improvements to your health markers and reduce your risks.

If you are unsure about your own numbers, or want to explore private, advanced testing beyond what the NHS offers, I can guide you through your options. Together, we can build a tailored plan to support your long-term health.

Ready to take control of your metabolic health?

Book a free 30-minute call today to discuss your personalised plan.

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