Metabolic syndrome care measures

It takes long-term lifestyle intervention as the primary cornerstone, individualized control of blood sugar, blood pressure, blood lipids, and waist circumference indicators as the core goal, and dynamic follow-up program adjustments as long-term support. There is no need to pursue any "miracle cure", nor do you need to be overly anxious because several indicators are abnormal at the same time. Most patients can bring their indicators back to a safe range as long as they find the right rhythm that suits them.

I just received a 42-year-old business salesperson last week. The physical examination revealed that fasting blood sugar was 6.3mmol/L, triglyceride was 3.8mmol/L, blood pressure was 138/88mmHg, and waist circumference was 94cm. He just stepped on the diagnostic line of metabolic syndrome. His hands were shaking while holding the report, wondering whether he was about to suffer from diabetes or stroke. When I was formulating a plan for him, I didn’t prescribe a lot of medicine. I first asked him to change two small habits that would not affect his work at all: First, reduce the amount of liquor from half a catty to two taels when socializing. Always keep a glass of warm boiled water next to the wine glass, and drink a sip of wine with two ounces of water. ； The second is to take the subway instead of driving to and from work, and get off the bus two stops early and walk home. He adhered to these two requirements for a month. He came for a review last week and found that his waist circumference had decreased by 2cm, his triglycerides dropped directly to 2.1mmol/L, and his blood pressure was stable at around 130/80mmHg.

When it comes to dietary adjustments, there is really a lot of controversy in the industry. As soon as they are diagnosed with metabolic syndrome, many people call for a carbon cut, saying that a low-carb diet can reduce weight and triglycerides quickly. Indeed, I have seen patients who followed a strict low-carb diet for 3 months and lost 15 pounds, and their blood lipids returned to normal. However, there was also a patient with weak kidney function. After half a year of low-carb diet, his weight did not drop much, but his creatinine increased. He later adjusted to the Mediterranean diet recommended by the guidelines, eating more deep-sea fish, whole grains, and less refined sugar. Although the weight loss was slow, and he only lost 4 pounds in 3 months, his blood sugar stabilized and his uric acid also dropped. Do you really want to say which plan is better? In fact, there is no standard answer. If you usually have a lot of entertainment and don't have the conditions to cook by yourself, don't force yourself to eat boiled vegetables every day. Every time you eat, take two bites of vegetables first, then meat, and finally the staple food. Cut off one-third of the rice. That's better than anything else. ； If you usually have enough time and can arrange three meals by yourself, then it is definitely safer to try the Mediterranean diet, and the long-term compliance will be high.

Don’t get confused when you hear about exercise, thinking that you have to go to the gym for an hour every day to be effective. I used to have a retired aunt who danced square dance for two hours every day. After dancing for half a year, her fasting blood sugar still fluctuated around 6.2mmol/L, and the swimming ring on her waist did not get smaller at all. Later, after she finished dancing, I asked her to do arm exercises at home with two 500ml bottles of mineral water for 10 minutes each time. When she had nothing to do, she would do a few sets of silent squats against the wall when she was standing and watching TV. She just added a little bit of resistance exercise. When she checked back two months later, her waist circumference had dropped by 3cm and her fasting blood sugar had dropped directly to 5.4mmol/L. There is another question that has been debated for several years: Should we exercise on an empty stomach? In fact, it really depends on the person. If you don’t take anti-diabetic drugs and have no history of hypoglycemia, if you get up in the morning and walk briskly for half an hour on an empty stomach, your fat burning efficiency will indeed be higher. ； But if you are already taking anti-diabetic drugs or taking insulin, exercising on an empty stomach can easily induce hypoglycemia, which is actually dangerous. It is better to rest for half an hour after eating and then go downstairs for a 20-minute walk, which can also help suppress post-meal blood sugar.

There are a lot of misunderstandings about medication. Many people hold the belief that "drugs are responsible for three parts of the poison". Even though their triglycerides have exceeded 5.7mmol/L, they insist on not taking medicine, saying that they need to rely on diet and exercise. I met such a patient two years ago. His triglycerides were found to be 6.2mmol/L, but he refused to take fibrate drugs. As a result, he was hospitalized with acute pancreatitis three months later, and almost had a serious accident. Some people are just the opposite, thinking that everything will be fine after taking medicine, so they continue to eat and drink and stay up late. The dosage of medicine is getting larger and larger, but the indicators are still unstable. In fact, the use of medication is inherently flexible. If your indicators are just off the mark and you have no other underlying diseases, you can rely on 3 months of lifestyle intervention to adjust them first. If you cannot adjust them, you can then consider medication. ； If you already have a family history of high blood pressure or diabetes, or if your indicators are high enough to pose a clear risk, then take the medicine you should. There is really no need to take it hard.

Many people ignore the impact of mood and sleep on metabolism. Last year I met a 28-year-old Internet programmer. After he was diagnosed with metabolic syndrome, he tested his blood sugar 8 times a day and counted calories for every bite of food. He was so stressed that he had insomnia every day. As a result, his blood sugar measured fluctuated high and low, and was actually higher than when he was first diagnosed. Later, I asked him to put away his blood glucose meter and only measure his fasting blood sugar twice a week. On weekends, he should not stare at the calorie meter at home and go out hiking and playing basketball. He did not need to deliberately control his diet, as long as he did not drink milk tea and eat fried chicken every other day. After adjusting like this for a month, he came back for a check-up and found that his blood sugar was back to normal and his sleep was much better. Would you say it's magical? Cortisol rises when you are stressed, which itself will disrupt glucose and lipid metabolism. The more anxious you are, the harder it will be to lower your indicators. It is better to relax and take your time.

To be honest, metabolic syndrome is simply a problem caused by long-term bad living habits. It is not a terminal disease that cannot be cured, and there is no one-size-fits-all care plan: some people are suitable to start with exercise, some people are suitable to adjust their diet first, and some people really need to take medication. As long as you don’t think about it in one step, force yourself to implement a strict plan that you can’t stick to, and slowly find a rhythm that suits you, you can bring your body back to a good state.