Q: My doctor told me that I need to lower cholesterol, and she says I have something called “metabolic syndrome.” What is that? Do I need to do something about it?

A: Metabolic syndrome is defined as a group of conditions that commonly occur together in a person who has developed a “pear-shaped” body. Metabolic syndrome means the patient is at increased risk from high cholesterol symptoms, heart disease, stroke, artery disease, and type 2 diabetes. These conditions may include:

- Abdominal obesity with a waist measurement of 40 inches or more for men and 35 inches or more for women (for people of Asian descent, 35 inches for men and 31 inches for women)

- High triglycerides

- Low HDL (“good” cholesterol)

- Hypertension

- Elevated glucose, tested after a 12-hour fast

Though the precise designation of metabolic syndrome may vary among doctors, most agree that if you have three to five of these conditions, one of which is abdominal obesity, you have metabolic syndrome. And you definitely need to do something to lower cholesterol levels.

Q: I didn’t used to have a big waist. Can I just start skipping meals to lower cholesterol, or maybe go on the Atkins diet?

A: Gradual weight loss over a period of 6 to 12 months is recommended to lower high cholesterol symptoms, whereas skipping meals or adopting extreme diets is not recommended. High-protein diets, such as the Atkins diet, are not recommended because they raise phosphorus levels in the blood, which can worsen insulin resistance, a factor in metabolic syndrome.

The goal is to manage blood sugar and high cholesterol symptoms by eating several small low-fat, high-fiber meals throughout the day, and stop eating three hours before bedtime. Reducing alcohol intake helps manage blood sugar fluctuations and helps maintain general health.

A low-calorie diet that is low in saturated and trans fats (partially hydrogenated oils), cholesterol, sodium, refined flour and sugars is a commonly recommended treatment plan to lower cholesterol, as well as a treatment for metabolic syndrome. In addition, patients should consume fruits, vegetables, and whole grains. Consuming high fiber foods, such as all-bran cereal and whole-grain pasta, is an effective at reducing high cholesterol symptoms because fiber actually absorbs dietary cholesterol in the digestive tract, and these foods address insulin resistance. Fish, previously recommended for the treatment of high cholesterol symptoms, shouldn’t be eaten daily because of possible mercury content. The dietary goal is to lower cholesterol generally, and LDL (“bad” cholesterol) specifically.

Q: I’ve gotten out of the habit of exercising, and my doctor says have metabolic syndrome as well as high cholesterol. How many sit-ups do I need to shrink my waist?

A: While sit-ups seem to be addressing the problem of a larger waist, aerobic exercise is what doctors recommend most of the time for metabolic syndrome. Ask your doctor if you are ready to try brisk walking 30 to 60 minutes a day.

Q: Can I just take a pill for metabolic syndrome and make it go away?

A: Lifestyle changes, as well as quitting smoking, managing blood pressure, and lowering cholesterol will address metabolic syndrome more effectively. If they do not, there are a variety of prescription drug therapies as well as natural therapies to treat high cholesterol symptoms and effectively lower cholesterol. However, metabolic syndrome involves several conditions that are caused by sedentary lifestyle and poor diet. Addressing metabolic syndrome involves more than just popping a pill to lower cholesterol, which is why lifestyle changes are so important.