Metabolic syndrome in Asians

A few years ago, I started having trouble with high blood pressure and cholesterol.  The good cholesterol was low, the bad cholesterol was bad, and the triglycerides were going up.  My blood sugar was also a little bit worryingly high.  At the time, my doctor said I was doing everything right; diet, exercise and weight (I was obviously skinny – by American standards), and that my metabolism going all wrong was “just genetics.”  He said that at some point soon, I would have to start taking medication to control it.  Because my father has the same sort of problems, I figured that he was right.

That sort of statement – “Just genetics” is a tough thing to hear, because it suggests that there’s nothing you can do about it.  However, a few months later, I happened to read a scientific article [1] that said that some Asians start having trouble with their metabolism with a Body Mass Index (BMI) as low as 22.  At the time, my BMI was exactly 22, and it got me thinking.  What would happen if I lost a few pounds?  I recalled an uncle who suddenly lost 20 pounds after being hospitalized for a stroke, and among other surprises, his diabetes went away.  Was that just a fluke, or could it be a clue to something that might work for me?

I decided to lose three pounds to see what would happen.  I chose the number three because my weight varies about that much over the course of a given day.  I would normally weigh about 147 lbs in the morning, and about 150 lbs at the end of the day before going to bed.  If I lowered those limits to 144 lbs in the morning, and 147 lbs at night, then it would be about the smallest measurable weight loss I could accomplish, but it would put my BMI at 21.7.

It took about a month to lose the weight, and I was pretty unhappy about it the whole time. I held the same weight range for the rest of the year, and then I went and got all of the same tests done at my next annual checkup.  While there was no meaningful change in my blood sugar, the blood pressure and cholesterol were all great.  They were as good as they had ever been when I was younger and ridiculously athletic.

I had thought that maybe it was age.  Maybe it was not being physically able to tolerate the amount of cardiovascular exercise I used to do.  Then there’s the genetics.  But losing a little weight was a relatively simple, non-pharmaceutical and not-so-stressful way of achieving the same healthy blood pressure and cholesterol levels.

Subsequently, I decided to lose an additional 3 lbs. That’s just because it’s too easy to gain 3 lbs over the course of a vacation, and I wanted a little bit of wiggle room before having to worry about my blood pressure and cholesterol.

I suspect it would work well for the blood sugar if I were willing to put the weight loss in combination with a low carbohydrate diet, but as an Asian, I really like my rice and noodles.  It’s also possible that an even lower weight threshold might take care of the blood sugar.  It may be in the cards for me in the near future, and I will update if I decide to go low-carb or lose another three pounds.

I think the take home lesson is that if you are an Asian experiencing any sort of metabolic control problem, such as cholesterol, blood pressure or high blood sugar, one of the first things you should consider is getting your BMI under 22.  It seems that some of us might be genetically wired to be healthy at a lower weight than comparable non-Asians.  Also, it’s possible that 22 might not be a magic number, as more recent research suggests that Asians can get in trouble at an even lower BMI [2].

Maybe my doctor was right about it being genetics.  However, maybe it’s genetics and there’s still something you can do about it.

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