Research & Education

Metabolic Syndrome: The Deadly Quartet

The four horsemen of the apocalypse AKA the deadly quartet

In a moment I'm going to throw out a few rather depressing statistics about metabolic syndrome (MetS) and the state of health in the U.S. These stats need articulating. Over and over and over until we get it.

We also need to be very clear on the driving forces behind our rapid descent into a disease culture. I'll mention a couple in this blog. If we understand the root problems chances are much higher we'll be motivated and empowered to embrace solutions. (Perhaps only because we're angered by the extent to which -- yet again -- health is a distant runner up to profit.)

But there are do-able solutions which I'll also mention shortly. And what's particularly wonderful about the solutions is that they help not just you your family your neighbors your community but also the planet.

Doable solutions for all! 

Once called The Deadly Quartet MetS is comprised of elevated blood sugar blood fat (triglycerides) blood pressure and weight (abdominal adiposity).  We're not talking that elevated though.  Take blood sugar for instance. For a fasting blood sugar to be in the MetS range it need only hit 100 mg/dL. But 100 mg/dL is actually considered a normal result by many laboratories! (Laboratory reference ranges are based on the population as a whole. So if everyone goes up the reference range for normal will generally go up too. An interested future blog: Understanding Reference Ranges.  I tussled with the reference range conundrum in the B12 blog also.) The point is this: You won't always see fasting blood sugar flagged high on your lab report to draw attention to the number. And unfortunately a level of 100 mg/dL doesn't alert many doctors either.

Do you know your fasting blood sugar number? To be sure it's not the whole story but it's arguably more important than the vaunted total cholesterol number that gets far more P.R. High blood sugar is the third leading cause of death in the world!1

Dig into the research a little bit further -- scientists in Texas looked at blood sugar and heart disease and found that levels above 86 mg/dL were associated with increased risk for heart disease. That's quite a bit below 100.2

Note to self: A really good fasting blood sugar is around 86 mg/dL (or lower). Not a whole lot of folks actually clock in at 86.

We're a culture whose normal promotes disease.

How about weight? 70% of us are overweight. Along with elevated blood sugar it's part of the deadly quartet. And obesity is the number one risk factor for Type II diabetes.34  Obesity is the first leading cause of death in the world and hypertension is the fifth leading cause of death in the world. Along with elevated blood sugar that means three of the deadly quartet are leading causes of death.

With these stats we can't possibly be surprised that the incidence of type II diabetes increased in the U.S by a whopping 83% between 1995 and 2010 can we? (At 226% Oklahoma is the state with the dubious honor of highest increase in diabetes.)34

I'll say it again: We're a culture whose normal promotes disease.

While MetS is under-addressed by doctors it's well understood to be the gateway disease leading to increased risk of type II diabetes heart disease kidney disease cancers dementia autoimmune disease.  Pretty much every chronic disease to confront us is promoted by the inflammation-driven effects of MetS. A look at top causes of death in the U.S. -- most of them can be traced to the Deadly Quartet. Here's the Center for Disease Control's 2010 list.

Number of deaths for leading causes of death
1              *Heart disease: 597689
2              *Cancer: 574743
3              *Chronic lower respiratory diseases: 138080
4              *Stroke (cerebrovascular diseases): 129476
5              Accidents (unintentional injuries): 120859
6              *Alzheimer's disease: 83494
7              *Diabetes: 69071
8              *Nephritis nephrotic syndrome and nephrosis: 50476
9              *Influenza and Pneumonia: 50097
10            Intentional self-harm (suicide): 38364  
* Diseases directly or indirectly influenced by MetS. Even suicide which is often associated with depression could be driven by MetS via inflammation.5

A couple of driving forces behind our descent into a disease-centered culture.

Junk food.  Michael Moss's brilliant article from Sunday's New York Times Magazine called: The Extraordinary Science of Addictive Junk Food says it better and with greater depth than anything I could say.

The public and the food companies have known for decades now or at the very least since this meeting that sugary salty fatty foods are not good for us in the quantities that we consume them. So why are the diabetes and obesity and hypertension numbers still spiraling out of control? It's not just a matter of poor willpower on the part of the consumer and a give-the-people-what-they-want attitude on the part of the food manufacturers. What I found over four years of research and reporting was a conscious effort taking place in labs and marketing meetings and grocery-store aisles to get people hooked on foods that are convenient and inexpensive.

Pesticides.  Other potent and often overlooked drivers of MetS and obesity are the pesticides on our foods. 

A little-acknowledged study by Lee that was released in 2006 (using National Institute of Health data) noted that exposure to six pesticides (called POPs -- persistent organic pollutants) resulted in up to a 38-fold risk for developing type II diabetes in certain individuals (Where's the publicity on this study?)  By comparison a study looking at women smokers with a 40-year history found a mere 27-fold increased risk for developing lung cancer.7

Obese people were particularly vulnerable to the effects of POPs. POPs are known to accumulate in adipose and cause massive metabolic disruption.
It's not just about eating JUNK. It's the TOXIC JUNK that's particularly horrific.
The do-able solutions? Here's a few. Pick a couple:

     Plant a garden and don't use pesticides. (even a little garden pot on the porch with a few basils and tomatoes- you'll love it!)
     Buy local food. Where is your farmers market?
     Exercise. (My goal: Commuting by bike to work 3 days a week).
     Stop most sugar and especially the processed stuff
     Buy food from the perimeter of the grocery store- fresh veggies and fruits; lean clean proteins
    Don't buy food with chemical names in the ingredient list
     Eat more greens beans lean poultry.
     Read Mark Hyman's Blood Sugar Solution.
When I was in medical school a professor told us that sugar was a drug and should be regulated as such. Her statement was an awakening for me. It was a radical idea at the time but the time has come hasn't it?    

by Dr. Kara Fitzgerald



Dr. Fitzgerald received her doctorate of naturopathic medicine from National College of Natural Medicine in Portland Oregon. She completed the first CNME-accredited post-doctorate position in nutritional biochemistry and laboratory science at Metametrix Clinical Laboratory under the direction of Richard Lord Ph.D. Her residency was completed at Progressive Medical Center a large integrative medical practice in Atlanta Georgia. Dr. Fitzgerald is lead author and editor with J. Alexander Bralley Ph.D. of The Metametrix Institute's Case Studies in Integrative and Functional Medicine. She is a contributing author to Laboratory Evaluations for Integrative and Functional Medicine and the Institute for Functional Medicine's updated Textbook for Functional Medicine. She has also published in a number of peer reviewed journals. Dr. Fitzgerald is on faculty and a Curriculum Advisory Committee member at Institute for Functional Medicine. She is an adjunct faculty member at University of Bridgeport in the school of Human Nutrition and a member of The Institute for Therapeutic Discovery. Dr. Fitzgerald regularly lectures internationally for several organizations. Formerly at Advanced Diagnostic Pain Treatment Center at Yale-New Haven she is now in private practice in Sandy Hook Connecticut. She may be reached at or


1.  Gray LJ Khunti K Williams S et al. Let's prevent diabetes: study protocol for a cluster randomised controlled trial of an educational intervention in a multi-ethnic UK population with screen detected impaired glucose regulation. Cardiovasc Diabetol. 2012;11:56.
2.  Hoogwerf BJ Sprecher DL Pearce GL et al. Blood glucose concentrations  or 125 mg/dl and coronary heart disease risk. Am J Cardiol. Mar 1 2002;89(5):596-599.
3.  Centers for Disease Control and Prevention.  Atlanta GUSDoHaHS Centers for Disease Control and Prevention 2011. National diabetes fact sheet: national estimates and general information on diabetes and prediabetes in the United States 2011. 2011.
4.  MMWR. Increasing Prevalence of Diagnosed Diabetes - United States and Puerto Rico 1995-2010. November 16 2012 / 61(45);918-921.
5.  Silic A Karlovic D Serretti A. Increased inflammation and lower platelet 5-HT in depression with metabolic syndrome. J Affect Disord. Dec 1 2012;141(1):72-78.
6. Lee DH Lee IK Song K et al. A strong dose-response relation between serum concentrations of persistent organic pollutants and diabetes: results from the National Health and Examination Survey 1999-2002. Diabetes Care. Jul 2006;29(7):1638-1644.
7.  Kligerman S White C. Epidemiology of lung cancer in women: risk factors survival and screening. AJR Am J Roentgenol. Feb 2011;196(2):287-295. 

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