Key Dietary Changes to Prevent and Treat Metabolic Syndrome
By Kelsey Costa, MS, RDN on January 24, 2023 — Medically Reviewed by Eliza Whitaker, MS, RDN
Learn how plant-based diets, intermittent fasting, and other key dietary strategies can prevent or reverse metabolic syndrome and promote cardiometabolic health.
Photo by Miniseries/Unsplash
Summary
Adopting targeted diet modifications can reduce the risk of metabolic syndrome and enhance the management of chronic diseases.
Plant-based diets, intermittent fasting, and intuitive eating are beneficial dietary practices for promoting a healthier relationship with food and improving cardiometabolic health.
Registered dietitians and other qualified health professionals can help individuals develop sustainable lifestyle changes for long-term success.
As we navigate 2024, a health concern demanding our immediate attention is metabolic syndrome (MetS).
MetS, also known as cardiometabolic syndrome, is a cluster of conditions that occur together, including increased blood pressure, high blood sugar, excess body fat around the waist, and abnormal cholesterol or triglyceride levels.
This syndrome is prevalent amongst roughly one-third of adults in the United States, impacting a significant portion of the population.
MetS directly affects cardiometabolic health, as the conditions that define MetS significantly escalate the risk of chronic diseases like heart disease, stroke, and type 2 diabetes.
These largely preventable diseases are among the top causes of death in the US, based on CDC data.
Prevention is the most effective approach to combat MetS and the resulting health conditions, but it's never too late to make positive changes that can significantly impact health outcomes.
This guide outlines fundamental shifts in diet and lifestyle choices that can help you mitigate the risk of developing MetS or help reverse its course — putting you on the path to optimal cardiometabolic health.
What contributes to metabolic syndrome (MetS)?
MetS is heavily influenced by lifestyle choices, particularly sedentary behaviors and unhealthy dietary habits.
This combination precipitates obesity, elevates hypertension risk, and leads to disorders related to carbohydrate and lipid metabolism. Left untreated, this can progress to cardiovascular diseases and type 2 diabetes mellitus (T2DM).
MetS is defined by the American Heart Association, the International Diabetes Federation, and the National Heart, Lung, and Blood Institute as having at least three of these risk factors:
Waist circumference greater than 94 cm in men or 80 cm in women
Plasma triglyceride levels of 150 mg/dL or higher
Plasma high-density lipoprotein cholesterol (HDL-C) levels less than 40 mg/dL in men or less than 50 mg/dL in women
Fasting plasma glucose levels of 100 mg/dL or higher
Systolic blood pressure (SBP) of 130 mmHg or greater and/or diastolic blood pressure (DBP) of 85 mmHg or greater.
Because these are interconnected cardiometabolic health issues, even managing one more effectively can lead to better overall health.
Still, early detection and treatment of MetS are vital to mitigating its progression and impact. Lifestyle modifications, such as adopting a nutritious diet, play a significant role in both preventing and managing this health concern.
1. Shift toward plant-based eating
Countless studies highlight the potential benefits of plant-based diets (PBDs), particularly those that exclude meat, fish, and seafood, such as vegan and vegetarian diets, on the components of MetS.
Research published in Nutrients in 2024 suggests that more restrictive forms of PBDs, mainly consisting of fruits, vegetables, grains, nuts, and seeds, are most effective in lowering the risk and managing the conditions of MetS, implying a better patient prognosis.
On the other hand, less restrictive PBDs, such as pescatarian or semi-vegetarian (flexitarian) diets, which allow moderate consumption of animal products, offer flexibility and are still associated with improved health outcomes.
So, while more restrictive types have shown superior outcomes, less restrictive types may provide a more practical approach to achieving better cardiometabolic health for the average individual.
Healthy versus unhealthy plant-based diets
With our growing knowledge of the power of plant-based compounds, it is increasingly evident that a shift towards more plant-based diets can be a transformative tool for managing and preventing cardiometabolic conditions.
However, it's crucial to distinguish between healthy and unhealthy plant-based diets. Not all plant-based diets yield the same health benefits, particularly when managing health markers.
According to a 2023 UK cohort study, a wholesome plant-based diet low in animal products, sugary beverages, snacks, desserts, refined grains, potatoes, and fruit juices correlates with a decreased mortality risk and significant chronic diseases among the adult population.
While a diet rich in whole foods like fruits, vegetables, legumes, nuts, and seeds can significantly reduce the risk of MetS, a plant-based diet full of processed foods, sugars, and unhealthy fats may not provide the same health benefits and can contribute to the development of MetS and resulting chronic health conditions.
Thus, it's vital to focus on the quality of plant-based foods and aim for a well-balanced diet rich in whole and low-processed plant foods.
Dietitian's choice: Green Mediterranean Diet
A progeny of the traditional Mediterranean diet, the Green Mediterranean Diet could be practiced as a fully plant-based diet with no animal products or a plant-forward diet with limited animal products.
It emphasizes an increased intake of plant-based foods such as whole grains, fruits, vegetables, legumes, nuts, and healthy fats (e.g., avocados, olive oil).
Along with its core components, the Green Mediterranean Diet is supplemented with nutrient-dense foods like walnuts, green tea, and Mankai (a type of duckweed with high protein content).
This diet advocates for a lower intake of meats and poultry, further minimizing saturated fat consumption.
Physical activity is another cornerstone of the original Mediterranean and Green Mediterranean diets.
Ultimately, opting for the updated, more plant-forward version may amplify the traditional Mediterranean diet's beneficial cardiometabolic effects, offering a potentially superior dietary strategy for preventing and managing MetS and related conditions.
2. Reduce sodium, saturated fat, and sugar
Reducing the “Three S's” — sodium, saturated fat, and sugar — is equally important as including nutrient-dense plant-based foods for managing MetS.
These substances, often found in excessive quantities in unhealthy types of processed foods, are known contributors to various health issues, including obesity, hypertension, and diabetes, that are associated with MetS.
Sodium
Sodium is an essential mineral in small amounts, but its overconsumption can increase the risk of heart disease, stroke, and type 2 diabetes. The ideal daily sodium intake should not exceed 1,500 mg for most adults.
Some strategies to reduce dietary sodium involve cooking at home with fresh ingredients, choosing low-sodium options when available, and avoiding notoriously high-sodium foods like chips, condensed soups, and pizza.
It is also important to pay attention to the Nutrition Facts label on food products and aim for items with less than 5% of the Daily Value (DV) for sodium.
Saturated Fat
Saturated fat, predominantly found in animal products, is a dietary component that should be limited due to its potential to raise levels of low-density lipoprotein (LDL), or "bad cholesterol," increasing the risk of MetS and heart disease.
The American Heart Association recommends that saturated fat should compose only 5-6% of total caloric intake, which, for a 2,000-calorie diet, equates to approximately 13 grams.
To lower saturated fat intake, some action steps include reducing meat consumption, choosing low-fat or non-dairy alternatives, and opting for more plant-based protein sources.
Sugar
Excessive consumption of added sugars, particularly from sugar-sweetened beverages and processed foods, contributes significantly to insulin resistance and MetS.
This leads to subsequent health complications, such as endocrine/metabolic diseases, cardiovascular conditions, and various other adverse outcomes.
Adults should limit their intake of added and "free" sugars to below 25 g, approximately 6 teaspoons, per day. Furthermore, consumption of sugar-sweetened beverages should be restricted to less than one serving per week.
To promote cardiometabolic health, it is essential to choose nutrient-dense foods and minimize the consumption of packaged snacks such as cookies and candies, choose whole fruits over fruit juices, and select products with less added sugar or choose unsweetened versions when available.
Bonus “S” — Artificial Sweeteners
Artificial sweeteners, such as erythritol, sucralose, and aspartame, found in diet and low-calorie foods, may have potential health implications, including MetS, weight gain, and cardiovascular events.
Potential changes in gut microbiota induced by these sweeteners could influence metabolism and potentially promote obesity and metabolic disorders.
The current research reveals varying effects of artificial sweeteners on health. Given these inconsistencies, and considering the diverse metabolic responses these substances may induce, more extensive human research is needed.
Rather than relying on artificial sweeteners, as a precaution, our dietitians recommend minimizing their consumption.
3. Practice other proven strategies for success
In addition to following a healthy plant-based diet and reducing the intake of sodium, saturated fat, added sugars, and artificial sweeteners, other dietary practices have been linked to improved health outcomes.
Broadly, aim to consume a variety of whole and low-processed foods such as fruits, vegetables, whole grains, lean proteins, and healthy fats while limiting unhealthy types of processed and ultra-processed foods.
Beyond consuming healthy foods, considering meal timing and frequency, as well as your overall psychological approach to food and eating, are integral parts of healthy dietary practices.
Intermittent fasting (IF) or time-restricted eating (TRE)
Understanding the role of meal timing and frequency in cardiometabolic health is crucial. So, it’s no surprise that the concept of intermittent fasting or time-restricted eating has gained significant attention in recent years.
Intermittent fasting (IF) alternates between periods of eating and fasting to create a natural calorie deficit, while time-restricted eating similarly confines eating to a particular window of time each day.
IF aids in weight reduction, which in turn decreases fasting insulin levels, reduces cardiovascular risk factors, and suppresses inflammation.
This is achieved by modulating metabolic signaling pathways, including autophagy (the process of recycling damaged or unnecessary cells) and increasing lipolysis (the breakdown of fat).
Fasting also triggers a “metabolic switch,” potentially improving metabolic conditions, extending life expectancy, and simulating the effects of aerobic exercise.
How to practice IF and TRE
Common IF methods include the 16:8 method, where you fast for 16 hours and eat only during an 8-hour window, alternate-day fasting, and the 5:2 method, where you eat a normal, healthy diet for five days and limit calories to 500–600 on two non-consecutive days.
Fasting regimens that involve earlier eating windows, also known as early time-restricted eating, are the healthiest options. They align with our circadian rhythms, allowing for a longer overnight fast and providing additional health benefits.
However, fasting into the morning hours and enjoying meals at standard dinnertimes may be more feasible and socially desirable for many.
It's important to find an eating schedule that works best for your personal routines and preferences.
Regardless of your chosen eating window, avoid late-night eating, a risk factor for MetS and obesity.
Who shouldn't practice IF and TRE
Those who are pregnant or breastfeeding and people with a history of eating disorders or disordered eating should not practice fasting or time-restricted eating regimens.
Furthermore, individuals with certain medical conditions like type 2 diabetes may benefit from IF but should consult with a healthcare professional before starting to ensure safety, adjust medications, and monitor glucose levels to avoid hypoglycemia (low blood sugar).
Overall, incorporating intermittent fasting or time-restricted eating into your dietary practices can be a beneficial tool for improving cardiometabolic health.
However, if you have a medical condition or take medications, it is essential to consult with your doctor before implementing fasting into your dietary practices.
Intuitive and mindful eating
While meal timing and frequency play significant roles in healthy dietary practices, paying attention to our psychological approach to food and eating is equally essential.
Growing research suggests that difficulties in emotional regulation and an abundance of negative emotions can significantly contribute to the onset and persistence of obesity.
This is where interventions using intuitive and mindful eating techniques come into play.
Intuitive eating is a non-diet approach that focuses on honoring your body's internal cues for hunger, fullness, and satisfaction. It emphasizes making food choices based on how they make you feel rather than following rigid rules or restrictions.
As a complementary practice, mindful eating involves paying attention to the present moment while consuming food. It focuses on being fully present and engaged in eating rather than mindlessly or distractedly consuming food.
Due to their beneficial effects on emotional regulation, self-awareness of emotions, and adaptive emotional coping, these mindful eating interventions have proven successful in minimizing episodes of binge eating, alleviating depressive symptoms, and reducing emotional eating while promoting intuitive eating, particularly among adult women.
Mindfulness practices can lead to better portion control and weight management and may be especially effective for patients struggling with obesity.
How to start intuitive and mindful eating
Some actions you can take to incorporate intuitive and mindful eating into your daily life include paying attention to the sensory aspects of food (taste, texture, and smell), listening to your body's hunger and fullness cues before and during meals, and removing distractions such as TV and phone screens or reading material while eating.
Getting support
If you struggle to develop a healthy relationship with food, know you are not alone. Support from a mental health professional or registered dietitian specializing in this area can be helpful. They can provide personalized guidance and help you develop a healthier relationship with food and your body.
Key takeaways
A plant-based diet, especially one that is low in unhealthy processed foods and high in whole plant foods, can positively influence the components of MetS.
Diet modifications play a significant role in preventing and managing health concerns like MetS, with the adoption of practices like the Green Mediterranean Diet and the reduction of sodium, saturated fat, and sugar intake being crucial strategies.
Intermittent fasting and intuitive, mindful eating are beneficial dietary practices that improve cardiometabolic health and can promote a healthier relationship with food.
The most successful diet changes are those that align with individual needs and can be sustainably incorporated into your everyday life.
While this guide focuses on dietary practices, maintaining a healthy lifestyle involves more than just diet.
Daily physical activity and exercise, good sleep hygiene, and stress management are all essential components of a healthy lifestyle and can significantly impact cardiometabolic health.
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Dietitian Insights articles are authored by registered dietitians who utilize only high-quality sources, including peer-reviewed studies and reputable agencies, to provide the most up-to-date, evidence-based insights. Read our editorial process to learn more about how our content is medically reviewed and kept current and credible.
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Thompson AS, Tresserra-Rimbau A, Karavasiloglou N, et al. Association of Healthful Plant-based Diet Adherence With Risk of Mortality and Major Chronic Diseases Among Adults in the UK. JAMA Netw Open. 2023;6(3):e234714. Published 2023 Mar 1. doi:10.1001/jamanetworkopen.2023.4714
Tsaban G, Yaskolka Meir A, Rinott E, et al. The effect of green Mediterranean diet on cardiometabolic risk; a randomised controlled trial. Heart. 2021;107(13):1054-1061. Published 2021 Jun 11. doi:10.1136/heartjnl-2020-317802
Huang Y, Chen Z, Chen B, et al. Dietary sugar consumption and health: umbrella review. BMJ. 2023;381:e071609. Published 2023 Apr 5. doi:10.1136/bmj-2022-071609
Singh, S., Kohli, A., Trivedi, S. et al. The contentious relationship between artificial sweeteners and cardiovascular health. Egypt J Intern Med 35, 43 (2023). https://doi.org/10.1186/s43162-023-00232-1
Song DK, Kim YW. Beneficial effects of intermittent fasting: a narrative review. J Yeungnam Med Sci. 2023;40(1):4-11. doi:10.12701/jyms.2022.00010
Anton SD, Moehl K, Donahoo WT, et al. Flipping the Metabolic Switch: Understanding and Applying the Health Benefits of Fasting. Obesity (Silver Spring). 2018;26(2):254-268. doi:10.1002/oby.22065
Charlot A, Hutt F, Sabatier E, Zoll J. Beneficial Effects of Early Time-Restricted Feeding on Metabolic Diseases: Importance of Aligning Food Habits with the Circadian Clock. Nutrients. 2021;13(5):1405. Published 2021 Apr 22. doi:10.3390/nu13051405
Yoshida J, Eguchi E, Nagaoka K, Ito T, Ogino K. Association of night eating habits with metabolic syndrome and its components: a longitudinal study. BMC Public Health. 2018;18(1):1366. Published 2018 Dec 11. doi:10.1186/s12889-018-6262-3
Czepczor-Bernat K, Brytek-Matera A, Gramaglia C, Zeppegno P. The moderating effects of mindful eating on the relationship between emotional functioning and eating styles in overweight and obese women. Eat Weight Disord. 2020;25(4):841-849. doi:10.1007/s40519-019-00740-6
Seeking professional help
Adopting healthy dietary and lifestyle practices is essential for preventing and managing MetS, but it may not always be easy or straightforward.
In some cases, professional guidance and support may be needed to implement and maintain lifestyle changes successfully.
Registered dietitians, personal trainers or exercise physiologists, and mental health professionals are valuable resources for personalized guidance and support in managing dietary needs, developing safe exercise plans, and addressing psychological factors affecting health behaviors respectively.
Additionally, online or in-person support groups offer a sense of community and encouragement, fostering an environment conducive to positive lifestyle transformations.
For more information on disordered eating, please visit EatRight.org.
If you or someone you know is struggling with an eating disorder, it's important to seek support and treatment. Here are some resources for finding help and information:
Association for Size Diversity and Health (ASDAH), provider listing
Practitioner applications
Based on the current literature, several dietary and lifestyle modifications can be incorporated into patient recommendations to prevent and manage the components of MetS.
A well-rounded approach involves adopting dietary practices such as the Green Mediterranean Diet, emphasizing healthy and low-processed foods while minimizing consumption of sodium, saturated fat, and sugar. Referral to a registered dietitian for patient-centered strategies that consider taste, culture, and food access is appropriate.
Intermittent fasting, once considered a passing trend, has proven benefits for cardiometabolic health. Patients interested in this method should be guided by a registered dietitian, especially if they have preexisting medical conditions.
Mental health professionals and dietitians can also support patients grappling with obesity and disordered eating through interventions based on intuitive and mindful eating.
Incorporating regular physical activity, sleep hygiene, and effective stress management are crucial for patients to lead healthy lifestyles and improve their cardiometabolic health. These efforts are best supported through a collaborative approach with various healthcare professionals, reducing reliance on unsustainable weight loss methods and medication use wherever possible.
Note: All information in this article is for educational purposes only and should not be interpreted as medical advice. The reader should consult with a healthcare provider before using any supplements or making any dietary or lifestyle changes. Read the full medical disclaimer.
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