This article is part of an ongoing series entitled, Beyond RX: OTC Corner, which will include topics such as OTC medications, dietary supplements, and other health care approaches that will help nurse practitioners and physician assistants provide patients with tools to manage their health.

Robert D. Sheeler, MD, is guest editor of the series. He is an associate professor of family medicine, Mayo Clinic, in Rochester, Minn. He is board certified in family medicine, integrative medicine, and holistic medicine.

More than one-third of adult patients who visit primary care clinicians meet the criteria for metabolic syndrome. Although definitions and criteria can vary, the prevailing characteristic is central obesity (Table 1). The prevalence of type 2 diabetes is six-fold higher in patients with metabolic syndrome, and the risk of cardiovascular disease and mortality is approximately double in patients with metabolic syndrome with hypertension compared to those without it.1

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TABLE 1. Metabolic syndrome criteria (any three of five traits required for diagnosis)

Abdominal obesity, defined as a waist circumference in men ≥102 cm (40 in) and in women ≥88 cm (35 in)
Serum triglycerides ≥150mg/dL or drug treatment for elevated triglycerides
Serum high-density lipoprotein (HDL) cholesterol <40 mg/dL in men and <50 mg/dL in women or drug treatment for low HDL cholesterol
Blood pressure ≥130/85 mm Hg or drug treatment for elevated blood pressure
Elevated fasting glucose >100 mg/dL


Lack of exercise is a major predictor of obesity. Thirty minutes of any type of daily exercise that specifically emphasizes weight/resistance training is advisable. The metabolic benefits of this training include increased muscle mass, decreased adipose tissue, decreased insulin resistance, and increased resting metabolic rate.

Weight loss and diet

Weight loss in patients with metabolic syndrome results in improved insulin sensitivity and decreased progression to diabetes. Diets that may be of specific benefit include:

The Mediterranean anti-inflammatory diet decreases refined carbohydrates and increases monounsaturated fats. It emphasizes fruits, vegetables, nuts, whole grains, and olive oil. Benefits include greater weight loss, lower systolic and diastolic blood pressure, decreased cholesterol level, decreased high-sensitivity C-reactive protein level, and decreased insulin levels.3

The DASH (Dietary Approaches to Stop Hypertension) diet emphasizes fruits and vegetables and low sodium intake. It allows low-fat dairy items, as well as fish, nuts, poultry, and whole grains. The standard diet allows for 2,300 mg of sodium, while the more restrictive lower-sodium DASH diet allows only 1,500 mg/day. Positive health outcomes include decreased diastolic blood pressure,4 decreased fasting glucose, and a reduction in serum triglycerides.

The paleo diet emphasizes higher protein content and a higher fat intake using monosaturated and polyunsaturated fats, while avoiding trans fats and omega-6 fats. Fewer carbohydrates are consumed, and higher fiber using nonstarchy fruits and vegetables is recommended. It excludes dairy products, grains (making it gluten free), processed oils, refined sugar, and salt. It also bans legumes, alcohol, and coffee. Although improvements in body composition and cardiac and respiratory fitness have been demonstrated with adherence to the paleo diet, unfavorable lipid changes have been reported.5