Metabolic Syndrome Overview
Metabolic syndrome is not a disease in itself, but a group of risk factors that occur together, increasing the likelihood of serious health issues. A person is diagnosed with metabolic syndrome when they have at least three of the following five conditions:
- Increased waist circumference (Women ≥ 35 inches, Men ≥ 40 inches)
- High blood pressure (Systolic ≥ 130 mmHg and/or diastolic ≥ 85 mmHg)
- High triglyceride levels (≥ 150 mg/dL (1.7 mmol/L))
- Low HDL (“good”) cholesterol (Women < 50 mg/dL, Men <40 mg/dL)
- High fasting blood glucose (≥100 mg/dL )
Cortisol Overview
Cortisol is a steroid hormone produced by the adrenal glands, often referred to as the "stress hormone" because it helps regulate the body’s response to stress. However, it also plays roles in: Blood sugar regulation, fat, protein, and carbohydrate metabolism, immune system function, blood pressure regulation and sleep-wake cycles.
Cortisol levels follow a well-defined diurnal rhythm, typically peaking in the early morning and gradually declining throughout the day. However, throughout the day, there can be various surges of cortisol when the body becomes under stress.
The HPA axis (hypothalamic-pituitary-adrenal axis) regulates cortisol production and is a major part of the body’s stress response system.
How does the HPA axis work?
The brain senses a stressor — this could be physical (like illness or injury), emotional (like anxiety), or environmental (like lack of sleep or poor nutrition). Next, the hypothalamus responds by releasing a hormone called CRH (Corticotropin-Releasing Hormone). CRH travels a short distance to the pituitary gland, which then releases ACTH (Adrenocorticotropic Hormone). ACTH travels through the bloodstream to the adrenal glands, located above the kidneys. The adrenal glands respond by releasing cortisol into the bloodstream.
The Cortisol and Metabolic Syndrome Connection
Cortisol’s Role in Glucose Balance & Insulin Resistance:
Cortisol plays an important role in glucose metabolism by stimulating gluconeogenesis in the liver to ensure there is glucose available during times of stress. When cortisol levels remain high due to chronic stress, disruption occurs leading to both hyperglycemia and insulin resistance.
Insulin resistance means that the body’s tissues — like muscle and fat — stop responding properly to insulin, the hormone that helps glucose enter cells. Instead of being used for energy, glucose stays in the bloodstream, leading to higher blood sugar levels. This situation forces the pancreas to work overtime and produce more insulin. Over time, this strain can burn out the beta cells in the pancreas, worsening blood sugar control and potentially leading to type 2 diabetes.
HPA Dysregulation
When the HPA axis is dysregulated due to chronic stress levels, the system becomes out of balance and results in cortisol rhythms becoming flattened. This means that instead of being high in the morning and low at night (which is healthy), cortisol levels stay elevated throughout the day or spike in the evening. This dysregulation is strongly linked to: Lower insulin sensitivity, higher blood sugar levels, increased risk of developing type 2 diabetes, insomnia, difficulty falling asleep, or feeling unrefreshed after sleep, weakened immune response, brain fog and memory problems, anxiety, depression, and mood swings
Central Obesity
Cortisol promotes fat storage, especially in visceral (deep abdominal) fat rather than subcutaneous fat (fat under the skin). This is due to higher expression of cortisol receptors in abdominal fat tissue and increased activity of the enzyme 11β-HSD1, which converts inactive cortisone into active cortisol locally in visceral fat. Cortisol also increases the drive to eat and can blunt signals from leptin (the “fullness” hormone) and elevates ghrelin (the “hunger” hormone).
Management/ Prevention of Metabolic Disorders and Elevated Cortisol
- Evaluating Cortisol Levels: We can assess cortisol’s pattern through various collection methods, including saliva, blood, and urine. Salivary cortisol is commonly used due to its non-invasive nature and its ability to reflect biologically active free cortisol levels. Blood cortisol measurements provide total cortisol concentrations, encompassing both free and protein-bound fractions. Urinary cortisol offers an integrated measure of cortisol excretion over 24 h. Each method has distinct advantages and limitations, and the method of collection should be determined on an individualized basis
- Routine Screenings: Regular screening for abdominal circumference, blood pressure, fasting glucose, insulin, lipids, liver function, and muscle mass.
- Stress management: Mindfulness, therapy, yoga, and relaxation techniques
- Better sleep: Consistent sleep schedules and good sleep hygiene
- Healthy Diet: Emphasize whole grains, fruits, vegetables, lean proteins, and healthy fats. Avoid processed foods and added sugars.
- Regular Physical Activity: Aim for at least 150 minutes of moderate aerobic exercise per week. Combine cardio and strength training to manage central fat, boost insulin function, and preserve muscle.
As a practitioner, ensure you guide patients through a personalized evaluation to determine the right balance of therapeutic and lifestyle interventions.
Resources
- Andreadi, A., et al. (2025). International Journal of Molecular Sciences, 26(5), 2090.
- Chang, E., & Patel, B. (2024). Advances in Human Physiology Research, 5(1).
- Mazgelytė, E., & Karčiauskaitė, D. (2024). Advances in Clinical Chemistry, 123, 129-156.
- Paredes, S., & Ribeiro, L. (2014). Revista da Associação Médica Brasileira, 60, 84-92.