DEFINITION
Metabolic Syndrome is the one which fulfills two or more of the following
criteria:
1. Central Obesity:
Waist circumference more than 102 cm (40 in.) in males
Waist circumference more than 88 cm (35 in.) in females
2. Dyslipidemia:
Serum Triglycerides more than 150 mg/dL
3. Dyslipidemia:
HDL levels less than 40 mg/dL in males
HDL levels less than 50 mg/dL in females
4. Blood Pressure:
greater than 130/85 mm of Hg or use of medication for Hypertension
5. Hyperglycaemia:
Elevated fasting plasma glucose levels equal or more than 110 mg/dL
or use of medication for hyperglycaemia
SYNONYMS OF METABOLIC SYNDROME
1. Insulin Resistance Syndrome
2. Syndrome X
3. Cardiometabolic Syndrome
4. Reavens Syndrome
5. CHAOS( in Australia)
Considering the above definition one can compare the metabolic syndrome
to Sthaulya pathogenesis as mentioned in ASTONINDITYA ADHYAYA.
Charak explained that on basis of sharir as ADHIKARAN SWAROOP eight
diseases are classified and among this eight ATISTHAULYA and ATIKRUSHA
are given utmost importance.
Being Atisthaulya has ASTHADOSHA as stated below:
1.
2.
3.
4.
5.
6.
7.
8.
AAYUSHYA HRASA
DAURBALYA
DAURGANDHYA
JAVOPARODHA
SWEDABADA
KSUDHA ATIMATRAM
ATI PIPASA
KRUCHA VYAVAYATA
PATHOGENESIS
The pathogenesis may be understood by the flow chart as given below
GURU, SNIGDHA, PISTANNA,
ABHISYANDHI, SANTARPANOTHA AAHAR
BIJA DOSHA
MEDA UTPADAK
BIJA AVAYAVA
DOSHA
CHOLESTEROL
ENRICHED
DIET
PRITHVI + AAP MAHABHUT PRADHAN
KAPHA
JATHARAGNI MANDYATA
BHUTAGNI MANDYATA
(PRITHVI + AAP BHUTAGNI)
MEDOVAHA
SROTO DUSTI
MEDAGNI
DUSTI
MEDOPOSHAK
RASABHAG DUSTI
DHATWAGNI MANDYATA
(MEDAGNI)
MEDASWITA
(CENTRAL OBESITY)
SUBSTRATE AVAILABILITY
INSULIN RESISTANCY
IL-6
TNF
ANTILYPOLYTIC EFFECT OF INSULIN
(VIKARA VIGHAT ABHAVA)
ABUNDANCE OF CIRCULATING FREE FATTY ACIDS (FFA)
(APACHITA MEDA/ SAMA MEDA)
INCREASED LIPOLYSIS
INCREASED FFA
EFFECT ON LIVER
EFFECT ON MUSCLE
TRIGLYCERIDES
VLDL, LDL,HDL
GLUCOSE
KLEDA MANSABHYAM
SANSARGA GACHATI
INSULIN MEDIATED
GLUCOSE INTAKE
END STAGE
LIVER DISEASE
HEPATO
CELLULAR
CARCINOMA
ACCUMULATION OF
TG IN SKELETAL &
CARDIAC MUSCLE
KLEDA MANSAYO
PRAMAN VRIDHI
MANSA DAURBALYA
GLUCOSE
JAVOPARODHA
CONCENTRATION
LIPOPROTEIN
LIPASE
(VIKAR VIGHAT ABHAVA)
MUTRAVAHA SROTAS
GLYCOSURIA
ALONGWITH
CYTOKINES
GURUNHI
MUKHANI AASADYA
(OSMOTIC DIURESIS)
PRABHUT AAVILA MUTRATA
(POLYUREA)
DIABETES MELLITES
(MADHUMEHA)
PANCREATIC
INSULIN
HEPATIC PRODUCTION
OF C-REACTIVE PROTEIN
INSULIN SENSITIZING
CYTOKINE ADIPONECTIN
ANTI INFLAMATORY
EFFECT
HEPATIC PRODUCTION
HYPERINSULINEMIA
OF FIBRINOGEN &
ADIPOCYTES PRODUCTION
OF PLASMINOGEN ACTIVATOR INHIBITOR 1
Na REABSORPTION
SYMPHATHETIC
NERVOUS ACTIVITY
PROTHROMBIC
STAGE
+ FFA
(PRATIGHAT)
HYPERTENSION
SAMA MEDA VATADINAM RODHAKAM
CONTRIBUTES
OBESITY+HTN +
CIRCULATINGCYTOKINES+
INSULIN RESISTANCE
ASYMMETRIC
DIMETHYLARGININE
(AN ENDOGENOUS
INHIBITOR OF NO)
PREVENTS VASODILATATION
OBSTRUCTIVE SLEEP APNEA
ALTERED RENAL
TUBULAR ABSORPTION
ALTERED ENDOTHELIAL
RENAL PATHOLOGY
OVARIES PRODUCE
EXCESSIVE AMOUNT OF
MALE HORMONES
(ANDROGENS IN PARTICULAR
TESTESTERONE)
HYPERANDROGENISM
MICROALBUMINURIA
REABSORPTION
OF URIC ACID
FROM
RENAL TUBULE
POLYCYSTIC OVARIAN
SYNDROME (PCOS)
HYPERURICEMIA
DIAGNOSIS CRITERIA:
1.
WEIGHT
2.
WAIST CIRCUMFERENCE
3.
BMI
4.
BLOOD PRESSURE
5.
LIPID PROFILE
6.
FASTING BLOOD GLUCOSE LEVEL
7.
GLUCOSE TOLERANCE TESTING
8.
FASTING INSULIN LEVELS
9.
HORMONAL ASSAY IN PCOS
10. MEDICAL HISTORY FOR OBSTRUCTIVE SLEEP APNEA
11. FAMILY HISTORY FOR CVD & DM
TREATMENT:
A. NIDAN PARIVARJAN
Metabolic Syndrome is a lifestyle disorder which needs to be changed
on priority basis.
Obesity being main cause reduction of body weight is essential.
Gramya Aahar, fast food, trans fatty food, saturated fatty food should
be strictly avoided, with low sugar intake and regular exercise.
concentrations
of
Garlic
Garlic reduces LDL cholesterol.
Prevents a rise of blood pressure
Avoids the deposition of plaque on the walls of arteries, reducing chances of
heart attack and stroke.
Garlic contains sulphurous compounds that act as antioxidants and also help
with expansion of the blood vessels, keeping blood pressure at a normal
level.
Onions
Onion contains a constituent called quercetin that is known to be a strong
antioxidant; this means it can prevent the damaging effects of free radicals
on human tissues.
Researchers have linked quercetin of onions with increased levels of HDL
cholesterol as well as low levels of LDL cholesterol.
Nuts
the
primary
lipoprotein
of
LDL
and
also
reduces
taila
(Ricinus
communis)
Ricinoleic
acid
exerts
anti-
inflammatory effects.
Draksha (Vitis vinifera) - study shows it relieves symptoms of chronic
venous insufficiency, arteriosclerosis and high blood pressure, alleviate
inflammatory conditions and is cardioprotective. They reduce fragility of
blood vessel.
Oats and Beans
Oats are a rich source of fiber and a compound called beta glucan; these act
together to bring about a reduction in the levels of LDL cholesterol.
Beans also contain a large amount of fiber and can help to reduce the
quantity as well as the rate of cholesterol absorption from the diet.
Diet should be such that it must be guru but should have apatarpan
effect. Oats, flakes, honey, butter milk have such role.
VIHARATMAK (PHYSICAL ACTIVITY)
-
Avoid Smoking
Prevent stress
Follow aachar rasayan
Triphala
11.
Amruta
12.
Musta
13.
Pippali
14.
Kutki
15.
Patola
12.
Kutki
13.
Vidanga
14.
Laksha
8. Pushkarmoola
9. Deodaru
10.
Mirigashringa
11.
Nagbala
Gokshur
11.
Chitrak
12.
Shilajeet
Drugs having mutrala effect so reducing the HTN & Renal Pathology
1. Punarnava
2. Gokshur
3. Musta
4. Ushir
5. Dashmula
6. Varun
7. Pashan bheda
8. Brahmi
9. Padmak
10.
Pundarik
11.
Madhuk