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Vexed by Syndrome X

Sufferers of this insulin-related disorder are at greater risk for heart disease and diabetes. But it often goes undiagnosed--and experts can't agree on the most effective treatment for it.


Joseph Dell'Alba says he wasn't looking for "eternal life." But the 76-year-old, semiretired businessman was looking for a better way to deal with his heart disease. For almost two decades he had been bouncing in and out of the hospital for bypass surgery, angioplasty and medication. Dell'Alba had gotten to the point where it was a struggle to walk the 200 feet to his mailbox in rural Pennsylvania.

Fed up and discouraged by conventional treatment, last May Dell'Alba tried a new nutrition-oriented doctor who told him that the root of his problems was his high insulin levels. With no history of diabetes in his family, Dell'Alba was shocked that he now had a new thing to worry about along with his elevated triglycerides, high blood pressure and blocked arteries.

But Dell'Alba religiously stayed away from pasta and fruit, loaded up on olive oil, cod liver oil, fish, lean meat and nonstarchy vegetables, and took lots of supplements. Less than a year into his regimen, Dell'Alba's insulin levels have plummeted along with his blood pressure, triglycerides and weight.

Dell'Alba suffers from the scary-sounding condition Syndrome X, also known by the more prosaic term insulin resistance syndrome, a well-documented metabolic disorder that some experts say is a too-often-forgotten key in the treatment of a range of disorders, especially heart disease and stroke.

When diabetics are diagnosed, they quickly learn about their bodies' glucose metabolism problems and that they are at greater risk for heart disease. But Stanford University's Dr. Gerald Reaven, author of the recent book "Syndrome X: Overcoming the Silent Killer That Can Give You a Heart Attack," estimates that 25% of the nondiabetic population in this country also has glucose metabolism problems, though most don't know it. They are, however, at risk for the panoply of conditions that characterize Syndrome X, including high triglycerides, high blood pressure and low levels of HDL ("good") cholesterol.

Doctors routinely screen and treat patients for those heart risk conditions. But they often do not recognize and treat these patients' faulty glucose metabolism. That is a mistake, says Boulder, Colo.-based Dr. Ron Rosedale, who is Dell'Alba's physician. When you treat the risk factors without dealing with the glucose metabolism problems underlying those symptoms, he says, "it's like pulling out the dandelions by the leaves and not by the roots. It'll come back."

The root of Syndrome X is insulin resistance--that is, difficulty utilizing insulin, and "hyperinsulinemia," or high levels of insulin. Type 2, or adult-onset, diabetics also suffer from insulin resistance, but they have lost the ability to regulate their blood sugar levels.

Those suffering from Syndrome X have workhorse pancreases that pump out extra insulin to compensate for the body's sluggish ability to process it. That extra insulin forces the blood sugar down, but at a price, says Reaven. "Excess insulin in the bloodstream prompts the damage associated with Syndrome X," Reaven says. In addition, Syndrome X sufferers are at risk for developing diabetes when their overworked pancreases give out. Yet they often fall through the diagnostic cracks because doctors typically screen for elevated glucose levels that characterize diabetes, but not for insulin resistance and the high insulin levels that characterize Syndrome X.

It was Reaven who in 1988 first identified the link between a number of heart disease risk factors and insulin resistance coupled with compensatory hyperinsulinemia. He suggested the name "Syndrome X" to stress the still unknown nature of the condition. The heart attack risk factors that he linked to insulin resistance at the time were high blood pressure, high triglycerides and low HDL cholesterol levels. Since then the list of risk factors linked to Syndrome X has grown to include abnormal (smaller and denser) LDL cholesterol particles, slow clearing of blood fats after meals and decreased ability to break up clots. Not all patients exhibit all of those abnormalities and the luckier ones, with milder cases, may exhibit only a few.


There are now a number of studies corroborating Reaven's work. The long-term Quebec Cardiovascular study, for example, found that men with the Syndrome X symptoms of high insulin levels, small dense LDL particles and another lipid abnormality, elevated apolipoprotein B, were 20 times more likely to develop heart disease than those without those conditions.

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