Metabolic syndrome is a cluster of risk factors for cardiovascular diseases and DM2 which was first defined by the WHO (World Health Organization) in 1998. “The WHO definition was the first to tie together the key components of insulin resistance, obesity, dyslipidemia and hypertension. The definition mandates that insulin resistance be present; without it, even if all the other criteria were met, the patient would not have metabolic syndrome. The WHO definition also allows patients with T2D to be diagnosed with metabolic syndrome if they meet the other criteria.” (PMID: 19407331)
The Food and Drug Administration (FDA) has approved five major weight loss medications available for weight management, which are orlistat, phentermine, phentermine/topiramate extended-release, naltrexone/bupropion sustained-release, and liraglutide (PMID: 34815532). All of these drugs are known to have side effects, so patients will ask us what formulas they can take to minimize the consequences of CV and DM2.
Along with counseling someone on dietary and lifestyle changes that they can make to improve their insulin resistance, I would look at what signs and symptoms the patient is presenting with. From there, I could determine which TCM pattern(s) that overall fits the presentation. I also look at recent research to see what would benefit the patient most in regards to formula modifications and/or additional supplementation.
For example, a recent real-world comparative cohort study demonstrated that “Chinese herbal medicine is associated with higher body weight reduction than liraglutide among the obese population” (PMID: 36160410). Berberine, an alkaloid from Huang Lian (Coptidis rhizoma), has been compared in efficacy to metformin (PMID: 29515798) and Ozempic, although the research on this is still pending.
Several studies have shown that Shan Zha (Fr. Crataegus pinnatifida) can have beneficial effects on controlling and treating high blood sugar, dyslipidemia, obesity and atherosclerosis. “Its leaves, fruits and seeds have various active substances such as flavonoids, triterpenic acids and sesquiterpenes, which through different mechanisms can be beneficial in metabolic syndrome.
Flavonoids found in the leaves of hawthorn can significantly reduce atherosclerotic lesion areas, the fruit extracts contain two triterpenic acids (oleanolic acid and ursolic acid), that have the ability to inhibit the acyl-coA-cholesterol acyltransferase (ACAT) enzyme and as a result reduce very low-density lipoprotein (VLDL) and low-density lipoprotein (LDL) cholesterol levels.” (PMID: 31217924). Chinese hawthorne berries may be used as a single herb tea daily (with contraindications considered), as well as Jiaogulan tea, Gynostemma pentaphyllum. (PMID: 23431428)
Huang P. L. (2009). A comprehensive definition for metabolic syndrome. Disease models & mechanisms, 2(5-6), 231–237. https://doi.org/10.1242/dmm.001180
Müller, T. D., Blüher, M., Tschöp, M. H., & DiMarchi, R. D. (2022). Anti-obesity drug discovery: advances and challenges. Nature reviews. Drug discovery, 21(3), 201–223. https://doi.org/10.1038/s41573-021-00337-8
Liao, Y. N., Chen, H. Y., Yang, C. W., Lee, P. W., Hsu, C. Y., Huang, Y. T., & Yang, T. H. (2022). Chinese herbal medicine is associated with higher body weight reduction than liraglutide among the obese population: A real-world comparative cohort study. Frontiers in pharmacology, 13, 978814. https://doi.org/10.3389/fphar.2022.978814
Dehghani, S., Mehri, S., & Hosseinzadeh, H. (2019). The effects of Crataegus pinnatifida (Chinese hawthorn) on metabolic syndrome: A review. Iranian journal of basic medical sciences, 22(5), 460–468. https://doi.org/10.22038/IJBMS.2019.31964.7678
Huyen, V. T., Phan, D. V., Thang, P., Hoa, N. K., & Ostenson, C. G. (2013). Gynostemma
Fan, Q., Xu, F., Liang, B., & Zou, X. (2021). The Anti-Obesity Effect of Traditional Chinese Medicine on Lipid Metabolism. 12. https://doi.org/10.3389/fphar.2021.696603
pentaphyllum Tea Improves Insulin Sensitivity in Type 2 Diabetic Patients. Journal of nutrition and metabolism, 2013, 765383. https://doi.org/10.1155/2013/765383