Hearts and Minds
Metabolic syndrome is a complex medical condition that involves multiple related diseases including obesity, elevated blood sugars, high blood pressure (hypertension) and high cholesterol (hyperlipidemia, hypercholesterolemia,hypertriglyceridemia). People with metabolic syndrome are at increased risk for developing many serious medical complications including type 2 diabetes, heart attack (myocardial infarction), stroke (cerebrovascular disease), and if not addressed, even early death. Unfortunately, people living with mental illness are at increased risk for developing metabolic syndrome. Due to the severity of this condition, early detection and intervention are critically important.
Who is at risk for developing metabolic syndrome?
People with mental illness are more likely than other individuals to develop this complex medical condition. Scientific research has shown that certain people are at an even greater risk of having metabolic syndrome:
- People with schizophrenia, bipolar disorder and depression. These illnesses carry an increased risk of metabolic syndrome and diabetes compared with many other medical conditions.
- African Americans, Latinos, Native Americans and Asian Americans. People from these ethnic groups are more likely to develop metabolic syndrome than people of Caucasian descent.
- People who smoke. Smokers tend to be have more difficulty managing many of their medical illnesses—including diabetes—and are more likely to have complications from their medical illnesses. Quitting smoking can very quickly reduce one’s risk of developing metabolic syndrome and diabetes. Chronic abuse of drugs and alcohol can also increase the risk of developing these conditions.
- People with a family history of diabetes and metabolic syndrome. Knowing their family history can help people to be well-informed of the risks and benefits of the decisions that they make, including choices about what medicines to take, how frequently they visit their doctor for check ups and how to make certain lifestyle choices to reduce their risk of developing serious medical illnesses.
- People who take second-generation (atypical) antipsychotic medications (SGAs). SGAs are now known to increase the risks of weight gain, diabetes and metabolic syndrome. Selecting a medication should involve careful review of these risks, as well as the benefits the medicines offer. Fortunately, many of these conditions can be prevented or detected with high quality medical care that includes good communication between primary care providers, psychiatrists and other members of the treatment team.
How can metabolic syndrome and diabetes be prevented?
As metabolic syndrome and diabetes are a complex combination of medical illnesses, there are multiple precautions that can be taken to prevent these severe conditions. In general, maintaining a healthy lifestyle is one of the best preventative measures against developing metabolic syndrome. A healthy lifestyle includes the following:
- Regular checkups with one’s primary care physician (PCP). In general, yearly checkups are the bare-minimum requirement for meeting with one’s PCP if a person is completely healthy. For people with medical conditions and mental illness, more regular follow up is often indicated. People at high risk for developing metabolic syndrome or diabetes will likely have their weight measured at each visit, along with a measurement of their waist circumference. Certain blood tests that evaluate the body’s ability to process sugars and fats may also be check regularly. These include fasting blood sugar (blood glucose), fasting cholesterol (lipid panel), and HbA1c (a measurement of one’s average blood sugar over the course of the preceding months).
- Eating a healthy diet. Many people have some understanding that a diet low in salt and fat can help to prevent obesity, high cholesterol, high blood pressure and diabetes. A healthy diet also includes regular servings of fruits and vegetables, limited saturated-fat intake, and can also include vitamin supplementation when appropriate.
- Regular exercise is helpful in the prevention of metabolic syndrome and can consist of daily walking, running or another form of aerobic exercise.
- Limited alcohol, drug and nicotine use is also critical in preventing metabolic syndrome and diabetes, as these substances can change the way that the body digests (and metabolizes) food.
Choosing appropriate medications with one’s physicians can be critical in preventing metabolic syndrome and diabetes. For example, a person with schizophrenia who is gaining a lot of weight with a particular SGA (including olanzapine [Zyprexa], clozapine [Clozaril] and quetiapine [Seroquel]) may be better treated with another similar medication that does not have the same risk of weight gain, metabolic syndrome and diabetes (e.g., certain first generation antipsychotics such as haloperidol [Haldol] or perphenazine [Trilafon]). Given the complexities of these decisions—specifically, weighing the risks of metabolic syndrome against the benefits of continuing a medication that appears to be working well—all medication management issues should be discussed with one’s family, psychiatrist and other treating physicians. Some people who are taking SGAs may also find that medications used in the treatment of diabetes (e.g., metformin) may be helpful in preventing metabolic syndrome. This is a possible treatment option that can be discussed with one’s psychiatrist and other physicians.
How are metabolic syndrome and diabetes treated?
Treating metabolic syndrome and diabetes involves many of the same strategies used for preventing these conditions. This includes regular doctor appointments, eating a healthy diet, exercising and avoiding smoking, alcohol and other drugs.In addition to these life-style modifications and regular medical follow up, there are medications that are helpful in treating metabolic syndrome and diabetes. These include medications to treat high blood pressure (antihypertensives), medications to treat high cholesterol (including statins such as simvastatin [Zocor] and atorvastatin [Lipitor]) and medications to treat diabetes (including insulin as well as other medications such as metformin). Most primary care physicians are well trained in diagnosing and managing metabolic syndrome and diabetes. However, some people with severe metabolic syndrome and diabetes may also seek a consultation or referral to an endocrinologist—a doctor who has specialized training in treating these conditions.
It is very troubling to know that many people living with mental illness and metabolic syndrome or diabetes are not getting good preventive medical care. Scientific studies have shown that a significant portion of people with schizophrenia are not even getting the basic screening tests for these conditions to try and prevent them. It is important to facilitate communication between one’s psychiatrists and other doctors. This can help to make sure that everyone receives appropriate medical and psychiatric care to prevent—and if necessary to treat—these serious conditions.
To learn more about becoming your own medical self-advocate by exploring the Medical Self Advocacy section of the NAMI Hearts & Minds website.Additionally, speaking with one’s doctors, local clubhouse, NAMI Chapter or community mental health program may help to find other forms of support. Many communities have walking groups, nutritional and fitness groups or other peer support programs that can be helpful in maintaining a healthy lifestyle. Below are some tools that might be helpful for some people. The use of websites like these should be done with the support and collaboration of one’s doctors:
- Peertrainer.com is a website devoted to helping people manage their weight, and this can directly contribute to improved management of pre-diabetic and diabetic conditions.
- Weight Watchers has some positive data about weight management and weight loss. It may be a good fit for some, and many individuals who live with mental illness have also succeeded at Weight Watchers. Finding a good fit for each person is the key.
- In Shape is a program that began at Monadnock Mental Health Center in Keene, N.H. and is currently being studied by Dartmouth University. The program offers personal training and nutritional support.
- The American Diabetes Association is a great place to find information about preventing and managing diabetes, from research to recipes.
Reviewed by Ken Duckworth, M.D., and Jacob L. Freedman, M.D., April 2013