This syndrome also known as insulin resistance syndrome was hardly talked about just a few decades ago. Today, however this group of conditions or abnormalities are unfortunately quite commonplace worldwide. Metabolic Syndrome (MetSyn) as described by the image above puts an individual at an increased risk for atherosclerotic heart disease, diabetes, and stroke amongst other things. Risk factors can include being overweight, an overall lack of physical activity, aging, hormonal imbalances, family history and genetics. The official diagnosis comes when you have the co-existence of at least 3 of the following conditions:
Visceral (abdominal) obesity - waistline of > 40" (men), or > 35" (women) -- this is not the same as general obesity
Blood pressure of > 130/85
Fasting Blood sugar of > 100 mg/dl, which translates to an A1c value of > 5.0
Triglyceride level of > 150 mg/dl
HDL (good cholesterol) of <40 mg/dl (men), OR 50 mg/dl (women)
Recall that good cholesterol helps protect your heart/vessels by removing bad cholesterol from your periphery
Insulin resistance is one of the most important risk factors at play here. In a disease-free state insulin helps the cells take up glucose to use as a primary energy source. In insulin resistance the cell no longer recognizes insulin and therefore cannot use glucose. Think of insulin has the key that opens glucose channels. Over time the key no longer fits, and the door remains shut - the cell itself resists. Glucose then accumulates outside of the cell in the bloodstream, which in turn deprives the cell of nutrition. This resistance fails to suppress serum glucose normally and can be acquired, heredity, or a mixture of both.
The syndrome and its overall relevance are on the rise, and we know that it is more common among certain ethnic groups. Whether we like to acknowledge it - health disparities do exist and are important in this context too.
Treatment for this major public health challenge is aimed at keeping blood pressure, cholesterol, and fasting blood sugar levels in check. Ideally this is first accomplished by intrinsic lifestyle intervention changes such as consuming healthier foods, being consistent with some form of physical exercise routine, and appropriately managing weight and stress. If these are not effective, additional help from medications + pharmacological therapies may be warranted -- ACE inhibitors, beta blockers, oral diabetes and lipid lowering agents are at the top of the list.
In EMS we must be mindful of our personal health and lifestyle habits and be intentional around disease prevention. At your agency consider a wellness program or at minimum annual health assessments as a way to stay on top of your health. Our jobs and the schedules are tough, but we must take care of ourselves -- the community and our own homes are counting on us to live long and prosperous lives after retirement. On such study exposed metabolic syndrome in our industry as researchers found that the most significant single predictive factor of post-9/11 lung disease in first responders was, you guessed it -- metabolic syndrome.
Firefighters are by and large tactical athletes who work under the most severe environmental conditions while enduring heat stress and having to engage in physiologically taxing activities. Thus, fitness for duty is paramount to our mission success, personal safety and survival. Therefore, the fire service should consider severe obesity as an important marker of health risk and, at the very least, identify and provide rehabilitation (and perhaps transition out of active firefighting if not successful) to firefighters who reach unhealthy weights. Maybe the CPAT (candidate physical agility test) or their equivalents across the country should be required more frequently than just at the time of hire??
Finally, our health and well-being should matter just as much to us as the patients we serve on a daily basis. KEEP MOVING, EMBRACE MODERATION, and MAKE SMART CHOICES consistently - don't underestimate the power of these things.
August 12, 2024
Author: Joshua Ishmael, MBA, MLS(ASCP)CM, NRP
Pass with PASS, LLC
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