Metabolic Syndrome/
Impaired Glucose Tolerance

IGTMetabolic syndrome is a collection of findings (blood pressure, blood sugar and cholesterol) related to insulin resistance. Insulin resistance occurs when excess body fat cells impede insulin from working correctly (see below). This same mechanism causes type 2 diabetes, and is an independent risk factor for coronary heart disease, diabetes, neuropathy, obstructive sleep apnea, psoriasis, cognitive aging, fatty liver, and some cancers. It is associated with decreased bone fracture risk [1]. Two thirds of the American population is overweight or obese, and more than a quarter of the population meets the diagnostic criteria for metabolic syndrome. [10]

The collection of findings that comprise metabolic syndrome are hypertension (high blood pressure), hyperglycemia (increased blood sugar), hypertriglyceridemia (increased triglycerides, type of fat, in the blood), low HDL-C (low “good cholesterol”), abdominal obesity, and, in some definitions, chest pain, shortness of breath, and dark patches in skin fold regions. Risk factors for metabolic syndrome include family history, poor diet and inadequate exercise.

The National Heart, Lung and Blood Institute and the American Heart Association define Metabolic Syndrome as 3 of the following 5 criteria:

  • Abdominal Obesity: waist greater than 40″ in men, 35″ in women (Asian American: 35” men, 32” women)
  • Triglycerides: greater than 150mg/dL or on medication for increased triglycerides
  • HDL-C “good cholesterol”: less than 40 mg/dL in men, 50 mg/dL in women; or on medication for increased cholesterol
  • Blood pressure: greater than 130/85 (some sources say 135/85) or on medication for BP
  • Fasting blood glucose (sugar): greater than 100 mg/dL (some sources say 110) or on medication for increased blood sugar

The American Diabetes Association defines pre-diabetes when blood sugars are high, but not high enough to meet diabetes criteria. The World Health Organization defines impaired glucose tolerance as fasting blood sugar of greater than 140mg/dL and/or 140 – 200mg/dL 2 hours after ingesting 75g of glucose liquid.

Evaluation/treatment for shortness of breath and obstructive sleep apnea may play important roles in managing metabolic syndrome. At least one study demonstrated metabolic syndrome improvement in sleep apnea patients treated with breathing support (CPAP) for 3 months: they showed decreased blood pressure, LDL-C, triglycerides and glycated hemoglobin (HbA1c – used to monitor diabetes).[12]

In current research, Western diets strongly correlate with an increased risk of developing metabolic syndrome.[8]  Mediterranean-style diets confer a much lower risk of developing metabolic syndrome, and may resolve it when combined with exercise.[13] Interestingly, a 2007 literature review suggests that emotions including anger/hostility and some depression [9] may track with metabolic syndrome/insulin resistance.

Each factor comprising metabolic syndrome (cholesterol, blood pressure, pre-diabetes) is caused or exacerbated by insulin resistance. Insulin is a naturally occurring chemical (or hormone) in the body that allows glucose from the food you eat to enter the body’s cells. When food breaks down, one of its smallest components is the simple sugar glucose. All cells, the building blocks of your body, need glucose as fuel to keep going. However, glucose cannot pass through cell walls by itself. Glucose requires insulin accompaniment to enter cells. It is as though a cell is a car, and glucose is gas. Gas can’t enter a car without a nozzle/gas pump; insulin is like the nozzle through which glucose enters cells.

Insulin resistance, the basis of both metabolic syndrome and type 2 diabetes, occurs when the “nozzle is clogged”: insulin doesn’t function properly resulting in decreased glucose entry into cells. Certain fatty tissues (surrounding organs and lining the abdomen, containing enlarged fat cells and inflammation) prevent the insulin from working correctly, producing the “clogged nozzle”/insulin resistance effect: more and more insulin hormone is needed to send glucose into cells. When glucose does not enter cells, it remains in the bloodstream, producing the high blood glucose seen in metabolic syndrome and diabetes. High blood glucose, over time, damages healthy body tissues.

Clearly, diet and lifestyle modifications are the foundation of treating metabolic syndrome, with or without pharmacological treatment. There is evidence that combined diet, exercise and pharmacological interventions may prevent evolution to diabetes [11]. Even without weight loss, exercise improves insulin resistance. General information about the treatment of each of these conditions is reviewed elsewhere (see hypertension, diabetes, or hypercholesterolemia). Even those who do not have diabetes should take diabetes-class medications (metformin).[1]

TCM, Traditional Chinese Medicine, has long recognized metabolic syndrome’s associated conditions. In TCM, metabolic syndrome results from years of imbalances between the “Liver, Kidney and Spleen Systems.” These TCM “Organ Systems” refer not only physical organs, but also expanded spheres of influence that include categories of physiologic processes (like digestion, elimination, etc.) and emotional associations. As mentioned above, Western medical research now notes certain emotional states (anger/hostility and depression) possibly correlate with metabolic syndrome. In TCM, anger/hostility, some forms of depression, and hypertension are directly related to “Liver Qi Stagnation with or without Liver Qi Depression.” The “Liver System” provides negative feedback/control over the “Spleen System.” When the “Liver System” hyperfunctions (as is common with anger and hypertension), it suppresses “Spleen System” functioning.

The “Spleen System” includes digestive functions. As a result of suppressed/diminished “Spleen Qi/Stomach Yang” (diminished digestive ability/strength), “Fluids” are not properly eliminated, and increased “Dampness and Phlegm” accumulate in the gut wall and blood stream. The “Fluids” (loosely correlating to cholesterol and the substrate for fat deposition in fat cells) then migrate and accumulate in blood vessels and body tissues (correlating with plaque formation and fat deposition). Later on, weak “Spleen Qi/Stomach Yang and Kidney Qi Deficiencies” fail to produce “Wei Qi” (defensive energy), which loosely correlates to dysregulated immune function/inflammation: the ultimate culprit in insulin resistance.

Thus, Chinese Medical physiology and pathophysiology anticipates the association of hypertension, diabetes and increased cholesterol. According to TCM, it does not follow that all people with hypertension or depression develop metabolic syndrome, as there are other “Organ Systems” at play. However, TCM theory is robust enough to find metabolic syndrome’s associated conditions common and predictable, despite lack of objective blood pressure and laboratory measurements at TCM’s inception.

Treating Metabolic Syndrome with TCM requires “Moving and Draining Dampness”, “Mobilizing/Relaxing Liver Qi”, “Strengthening Spleen Qi” and possibly “Tonfiying Liver Blood and Kidney Qi”. While acupuncture is helpful to start the process, Chinese Herbal Medicine forms the foundation of trying to address this condition. With time and lifestyle modification, early metabolic syndrome can be addressed. Ayurveda, medicine from India, can prove invaluable in addressing the diet and exercise modifications needed to address metabolic syndrome. Ayurvedic diets are very satisfying and naturally low in fat and glycemic index. Yoga exercises can help even the very sedentary start using large muscle groups, which improves insulin resistance.[2, 3]

Learn more about Metabolic Syndrome here and here 


These brief overviews of conditions represent distillations of basic and current medical reviews from the following sources:

[1]Conventional Medical Sources

“Harrison’s Principles of Internal Medicine: Volumes 1 and 2, 18th Edition”. Dan Longo Anthony Fauci, Dennis Kasper, Stephen Hauser, J. Jameson, Joseph Loscalzo. McGraw-Hill Professional; (July, 2011)

Medscape eMedicine Physician’s online resource. Various review articles accessed March 2014

Elena Citkowitz, MD, PhD, FACP Clinical Professor of Medicine, Yale University School of Medicine; Director, Cholesterol Management Center, Yale-New Haven Hospital, St Raphael Campus

Polygenic Hypercholesterolemia

Metabolic Syndrome

Stanley S Wang, MD, JD, MPH  Clinical Cardiologist, Austin Heart South; Director of Legislative Affairs, Austin Heart; Director, Sleep Disorders Center at Heart Hospital of Austin; Assistant Professor of Medicine (Adjunct), University of North Carolina School of Medicine

Type 2 Diabetes, Type 1 Diabetes

Romesh Khardori, MD, PhD, FACP  Professor of Endocrinology, Director of Training Program, Division of Endocrinology, Diabetes and Metabolism, Strelitz Diabetes and Endocrine Disorders Institute, Department of Internal Medicine, Eastern Virginia Medical School


Meena S Madhur, MD, PhD  Assistant Professor, Department of Medicine, Divisions of Clinical Pharmacology and Cardiology, Vanderbilt University School of Medicine

 [2], [3]

  • “Acupuncture Energetics: A Clinical Approach for Physicians”. Joseph M. Helms. Medical Acupuncture Publishers; 1st Edition. (1995)
  • “Foundations of Chinese Medicine: A Comprehensive Text for Acupuncturists and Herbalists”. Giovanni Maciocia. Churchill Livingstone; 2 Edition (July, 2005).
  • “Diagnosis in Chinese Medicine: A Comprehensive Guide”. Giovanni Maciocia. Churchill Livingstone; 1st Edition (January, 2004).

4. “Chinese Scalp Acupuncture”. Jason Ji-shun Hao, Linda Ling-zhi Hao and Honora Lee Wolfe. Blue Poppy Press; 1st Edition. (November, 2011)

5. Griffin BP. Statins in aortic stenosis: new data from a prospective clinical trial. J Am Coll Cardiol. Feb 6 2007;49(5):562-4. [Medline].

6. Lewington S, Whitlock G, Clarke R, Sherliker P, Emberson J, Halsey J, et al. Blood cholesterol and vascular mortality by age, sex, and blood pressure: a meta-analysis of individual data from 61 prospective studies with 55,000 vascular deaths. Lancet. Dec 1 2007;370(9602):1829-39. [Medline].

7. Becker DJ, Gordon RY, Halbert SC, et al. Red yeast rice for dyslipidemia in statin-intolerant patients: a randomized trial. Ann Intern Med. Jun 16 2009;150(12):830-9, W147-9. [Medline].

8. Yoneda M, Yamane K, Jitsuiki K, et al. Prevalence of metabolic syndrome compared between native Japanese and Japanese-Americans. Diabetes Res Clin Pract. Mar 2008;79(3):518-22. [Medline].

9. Goldbacher EM, Matthews KA. Are psychological characteristics related to risk of the metabolic syndrome? A review of the literature. Ann Behav Med. Nov-Dec 2007;34(3):240-52. [Medline].

10. Grundy SM. Metabolic syndrome pandemic. Arterioscler Thromb Vasc Biol. Apr 2008;28(4):629-36. [Medline].

11. Tupper T, Gopalakrishnan G. Prevention of diabetes development in those with the metabolic syndrome. Med Clin North Am. Nov 2007;91(6):1091-105, viii-ix. [Medline].

12. Drager LF, Togeiro SM, Polotsky VY, Lorenzi-Filho G. Obstructive sleep apnea: a cardiometabolic risk in obesity and the metabolic syndrome. J Am Coll Cardiol. Aug 13 2013;62(7):569-76. [Medline].

13. Esposito K, Ciotola M, Giugliano D. Mediterranean diet and the metabolic syndrome. Mol Nutr Food Res. Oct 2007;51(10):1268-74. [Medline].

14. Pan A, Lucas M, Sun Q, van Dam RM, Franco OH, Manson JE, et al. Bidirectional association between depression and type 2 diabetes mellitus in women. Arch Intern Med. Nov 22 2010;170(21):1884-91. [Medline]. [Full Text].

15. “Decoded Science” website.

Author: Leslie Cohen, M.A. and B.A

18 Chinese herbal formulas for treating hypertension in traditional Chinese medicine: perspective of modern science Xingjiang Xiong1,3, Xiaochen Yang1, Yongmei Liu1, Yun Zhang1, Pengqian Wang2,3 and Jie Wang1 Hypertension Research (2013) 36, 570–579 & 2013 The Japanese Society of Hypertension All rights reserved 0916-9636/13