Presently, no specific drugs are available to manage the metabolic
Lifestyle changes are the best options to prevent the metabolic syndrome
or to manage a person diagnosed as having the metabolic syndrome.
Thus, lifestyle changes not only offer the best universal beneficial options
for the metabolic syndrome, but they also go a long way in managing and
/or reducing the long term consequences of the presence of major risk
factors which predispose a person to ASCVD. Although the presence of some
of these risk factors may need additional specific drug therapies, lifestyle
changes still continue to be central to their treatment.
In order to ensure compliance, the prescribed diet should be individualised.
It must be realistic, flexible, and take into consideration the patient's
likes and dislikes, to as large an extent as possible, and must suit the
patient's life style. It is important to educate the patient about the
basic requirements of the diet and judge compliance at regular intervals.
BASIC DIET ADVICE
The aim is to attain acceptable body weight with a special emphasis on
attaining the desired waist measurement. Other specific changes would
be necessary depending on the presence of associated risk factors such
as impaired glycemia or diabetes, hypertension, dyslipidemias etc.
Aim initially at slow reduction of 7% to 10% from baseline weight over
one year of management. Even small amounts of weight loss are associated
with significant health benefits. Continue weight loss thereafter to extent
possible with goal to ultimately achieve desirable weight
Effective weight loss requires a combination of caloric restriction, physical
activity, and motivation; effective lifelong maintenance of weight loss
essentially requires a balance between caloric intake and physical activity
and the maintenance of sufficient skeletal muscle mass/quality.
After 6 months, the rate of weight loss usually declines and weight plateaus
because of a lesser energy expenditure at the lower weight and the lifestyle
prescription may need to be revised.
Experience reveals that lost weight usually will be regained unless a
weight maintenance program consisting of dietary therapy, physical activity,
and behavior therapy is continued indefinitely.
The widespread misconception that carbohydrates (in any form) should
not be eaten by people with diabetes should be removed. Carbohydrates
in the form of simple sugars need restriction. The carbohydrates should
be in the form of complex polysaccharides (starch) and contain adequate
amount of digestible fibers.
Carbohydrates should constitute around 60-70% of the total calories which
is usually found in traditional diets eaten in various parts of India.
Very high carbohydrate intakes and/or high glycaemic index foods can exacerbate
the dyslipidemia, including hypertriglyceridemia, of the metabolic syndrome,
especially if the overall calory intake is very high.
In addition, there should be ample intakes of fresh fruits and vegetables,
and whole grains; fruits and vegetables are recommended to provide fiber,
vitamins, minerals and hydration, and to increase satiety through the
volume of food ingested, in order to avoid feelings of deprivation and
Protein intake should be approx. 0.8 gms/kg ideal body weight; this usually
comprises around 12-18% of the calorie intake.
The requirements for proteins may be increased in catabolic states, pregnancy,
lactation and in some elderly patients. This should be preferably taken
from natural sources rather than commercially available protein supplements
as far as is possible.
Protein intake may need to be restricted in patients with nephropathy.
Fats should be restricted to around 20-25% of the total calories. If
the fat content exceeds 35%, it is difficult to sustain the low intakes
of saturated fat required to maintain a low LDL-C. On the other hand,
if the total fat content falls below 25%, triglycerides can rise and HDL-C
levels can decline; thus, very-low-fat diets may paradoxically exacerbate
It is recommended that the saturated fat be <7% of total calories;
reduce trans fat (< 1% based on WHO recommendations); dietary cholesterol
<200 mg/dL; total fat 25% to 35% of total calories. Most dietary fat
should be unsaturated; simple sugars should be limited. These goals can
be achieved by (1) choosing lean meats and vegetable alternatives; (2)
selecting fat-free (skim), 1%-fat, and low-fat dairy products; (3) minimizing
intake of partially hydrogenated fats i.e. bakery products to decrease
trans fatty acids; (4) avoid repeated reusing of the oil for cooking purposes
(frying) purposes as this leads to a significant increase in the trans
fatty content of the diet.
Many foods contains fats; this "invisible fat" should be taken
into account when estimating the total fat intake. On an average 40% of
the fat intake is contributed by the invisible fat in a typical Indian
It is advisable to restrict the total intake of cooking fats to less than
6% of the total energy intake; in simple terms, food should be cooked
in the least amount of oil or ghee; if feasible, food should be preferably
be grilled, steamed or broiled, microwaved, rather than fried.
The total intake of cholesterol should be restricted to around 300 mg
per day. Egg yolks, organ meats, marine invertebrates (including molluscs,
crab, shrimps and lobster) have a very high cholesterol content.
The fat intake may need to be further modified if associated dyslipidemia
Recent evidence suggests that attention must be paid to the intake of
essential fatty acids (EFAs) such as omega-6 (w6) and omega-3 (w3) fatty
These EFAs must be derived from food as they cannot be synthesised in
the body. Not only must they be eaten in adequate amounts, but the relative
ratio (w6/w3) is around
Indian diets usually contain too much of w6 fatty acids and little, if
any, of w3 fatty acids. Indian diets usually give a ratio of around 40:1.
The disproportionate ratio is made worse by the use of the so called "safe"
cooking oils such as safflower oil and sunflower oil, in which the ratio
is around 150:1!
Traditional cooking media like mustard oil, coconut oil and ghee have
a poor content of w6 fatty acids allows a more optimal w6/w3 intake, but
this has to be balanced with the relatively high saturated fat content.
The other alternative is home scale blending of traditional cooking media
with oils rich in w6 to lower the ratios, eg. simple blending of sunflower
and mustard oil in 1:1 at home would bring down the ratio to approximately
7 as against 163 for sunflower alone
The Omega-6 and Omega-3 content of the commonly used edible oils:
||Omega - 6
||Omega - 3
||W6 / W3
|Mustard / Rape
Salt restriction is necessary in patients with associated hypertension,
cardiac failure and fluid overload. Reduce sodium intake to no more than
100 meq/day (2.4 g of sodium or 6 g of sodium chloride / one teaspoon
These can be eaten by people with diabetes in moderate amounts. Ripe
and very sweet fruits are better avoided. Raw and partially ripe fruits
and citrus fruits are preferable.
If consumed, alcohol should be used in moderation.
Limit alcohol intake to no more than 1 oz (30 ml) of ethanol (eg, 24 oz
[720 ml] of beer, 10 oz [300 ml] of wine, or 2 oz [60 ml] of 100-proof
whiskey) per day or 0.5 oz (15 ml) of ethanol per day for women and lighter-weight
It should be avoided in all diabetics who are severely obese and on a
significantly hypocaloric diet, in those who have high triglyceride levels.
All other contraindications to alcohol intake also apply to diabetics.
INTERESTINGLY, OUR TRADITIONAL INDIAN DIETS, WITH SLIGHT MODIFICATION,
ARE CLOSE TO WHAT IS NOW CONSIDERED IDEAL DIETS!
|PATIENTS DO NOT HAVE TO MAKE ANY "MAJOR
CHANGES TO THEIR USUAL DIETARY HABITS, WITH THE EXCEPTION OF AVOIDING
SIMPLE SUGARS, CUTTING DOWN ON THE SALT AND ADJUSTING THE FAT INTAKE.
THIS ALLOWS INCREASING COMPLIANCE WITH THE DIET ADVISE!