The young man was 23 years old.  He had finished high school and gone to work as an electrician’s apprentice.  He did not describe his work as overly physically taxing.  He was substantially overweight as is 60% of the population of the United States.  He took no medication and he had never sought medical attention for more than a cold.  He was recently married and came to the clinic at his wife’s insistence.  The basic problem appeared to be fatigue to the point that he wasn’t getting anything done around the house when he came home from work.  He described being so tired that he just couldn’t go fishing and didn’t even want to go to a movie.  Instead he wanted to sit in front of the TV set and often fell asleep in the early evening hours before waking up to go to bed about 10:00 o’clock.  When basic blood tests were done, it was found that his blood sugar was 380 mg% (normal less than 110 mg%).  The young man obviously had diabetes mellitus.

     On further examination, he was also found to have high blood pressure with a value of 150/94 mm of mercury.  A lipid panel was checked and it was seen that his cholesterol was 280 mg% (normal up to 200 mg%) with the “good cholesterol” quite low at only 28 mg% (normal more than 35 mg%).  His triglycerides were very high at 380 mg% (normal less than 150 mg%).  Triglyceride level in the blood can be roughly thought of as a measure of carbohydrates that were eaten in the previous week but not burned.  These sugar-containing carbohydrates are then changed into triglycerides and stored as the fat deposits around the body.  As a general rule, a high triglyceride level can be thought of as a state of over-nutrition from carbohydrates.

     Thus at the tender young age of only 23 years, this young man had developed the “metabolic syndrome”, something we used to think of as occurring in 50 year olds. The metabolic syndrome is a group of clinical findings that mark a person for progressive development of arterial disease that eventuates in heart attacks and strokes.  The 5 components of the metabolic syndrome are:

 1.  Insulin resistance manifest as high blood sugars and often leading to obvious diabetes mellitus.
 2.  A high blood cholesterol.
 3.  A waist size greater than 40 inches in men or 35 inches in women.
 4.  Hypertension.
 5.  A high triglyceride level.

     The importance of making the diagnosis of the metabolic syndrome rests upon it being a marker for premature development of strokes and heart attacks.  If a person has any three of the above five parameters, that person qualifies for being diagnosed as having the metabolic syndrome and has double the normal risk for developing strokes and heart attacks.  For whatever reason, the diagnosis of metabolic syndrome is being made much more frequently in much younger individuals than what was done in the past.  Classically, the metabolic syndrome was diagnosed in men in their 50’s at the time that they had their first heart attack.  Now we are seeing the components of the metabolic syndrome with increasing frequency in very young individuals such as this young man.

     I have received some feedback regarding these columns that I write.  Very commonly readers will state that I spend a lot of time preaching and warning in a threatening manner.  With the readers understanding, that’s what preventive medicine is all about.  The healthcare professionals at your local clinics endeavor to teach someone how to better take care of themselves thus avoiding future disease.  Medical services are much, much cheaper and much more effective when they prevent disease rather than try to treat it.

     So here I go again. This young man needed to eat less and exercise more.  Believe it or not, all of the abnormalities in his blood tests, blood pressure and stamina can be reversed with a calorie-controlled diet and adequate exercise.  Studies have been done and described in these columns before (please see “Lifestyle Change, Cheaper Than Medicine” column for 27 Feb 2002 at www.macpierre. com, Central South Dakota Medical News) showing that diet and exercise alone works better than medicine to prevent the future development of frank diabetes in individuals at risk.  And so the specific advice for this young man is to get a very substantial change in lifestyle.  He needs to exercise on a regular basis and get his weight back into the appropriate range.  He needs to cut down the amount of carbohydrates in his diet, avoiding the sweets and the breads and the pastas that are so easy to obtain and taste so good.  Whether he can really achieve this is going to be up to him.  The consequence of the metabolic syndrome is the development of strokes and heart attacks 10-15 years after the problem first develops.  In the past, this meant men and women would get their problems in their 50’s and 60’s.  This young man will encounter his problems in his 30’s if he does not change his ways.

     The healthcare professionals at your local clinics can be very helpful in providing advice and counseling on how to deal with the metabolic syndrome.  Not all of the people who develop this syndrome become patently diabetic at an early age such as the young man above did.  Many of them won’t come to medical attention until the problem is far advanced. Dealing with the overweight, sedentary young individual can prevent an epidemic of early heart attacks that our computer age and over-nutrition are bringing on.