By Helen Chow, ND, Dip Herb, UK-qualified Naturopath & Herbalist, Food Therapist
Have you ever come home from a health check carrying several little pieces of information that did not sound terribly alarming on their own?
Your blood pressure is “a little high”. Your blood sugar is “borderline”. Your waist seems to have expanded even though your weight has not changed dramatically.
Perhaps your triglycerides have crept upwards, while your HDL — the cholesterol we generally like to see higher — has slipped down.
Nothing sounds like an emergency. So it is very tempting to put the paperwork in a drawer and carry on.
But this is where you need to look at the pattern, rather than each number on its own. Because sometimes these apparently separate changes are travelling together in the same direction.
And when several of them occur at the same time, doctors have a name for the pattern: Metabolic Syndrome.
Don’t let the name frighten you. It doesn’t mean your body has suddenly developed some mysterious new disease. Think of it more like several warning lights appearing on the dashboard at once.
One little light may not mean very much. But when three or four begin flashing together, your body is asking for your attention.
So what exactly is metabolic syndrome?
Metabolic syndrome is a cluster of metabolic changes that tend to occur together and are associated with a higher future risk of type 2 diabetes, cardiovascular disease and stroke.
You will recognise many of them because we’ve already been talking about them throughout this Metabolic Health series.
The five commonly used markers are:
- A larger waist circumference, reflecting excess fat carried around the abdomen
- Raised triglycerides, a type of fat carried in your blood
- Low HDL cholesterol, the form of cholesterol commonly nicknamed “good” cholesterol
- Raised blood pressure
- Raised fasting blood glucose
Under commonly used criteria, having three or more of these five markers can lead to a diagnosis of metabolic syndrome.
That doesn’t mean having one or two is harmless. Nor does it mean that having three condemns you to diabetes or heart disease. It means the overall metabolic picture deserves attention.
And I think that’s a much more useful way to look at it.
Your body doesn’t divide itself into separate departments
Medicine has to separate things into categories. It helps doctors diagnose and treat disease.
But your body doesn’t know that your blood pressure belongs in one department, your blood glucose in another and your waist measurement somewhere else.
Everything talks to everything else. That’s why understanding your overall metabolic health can be far more useful than becoming obsessed with one number.
Take insulin, for example. When your cells become less responsive to insulin, your pancreas may compensate by producing more of it. For quite some time your blood glucose can therefore appear perfectly respectable even though your body is working increasingly hard behind the scenes.
We explored that in our discussion about insulin resistance and again when we looked at how your blood sugar can still look normal while insulin is doing overtime.
Over time, this metabolic strain may start showing itself elsewhere.
- Your waist expands.
- Triglycerides climb.
- Blood pressure changes.
- Glucose becomes harder to control.
And fat may begin accumulating where we certainly don’t want too much of it — around the abdominal organs and inside the liver.
Suddenly those apparently unrelated numbers start looking rather more like members of the same family.
Belly fat isn’t simply a dress-size problem
This is something women over 50 MUST understand. A thicker waist after menopause is not merely about whether your favourite trousers still fit. And no, I’m not suggesting that every woman needs a tiny waist.
We’re interested particularly in visceral fat — the deeper abdominal fat surrounding internal organs. This fat behaves differently from the soft fat just underneath your skin. Too much visceral fat tends to travel with insulin resistance, abnormal blood fats and other metabolic disturbances.
It’s also one reason I dislike reducing women’s health to the number on the bathroom scales. You can weigh exactly the same as you did five years ago and have a different body composition:
- Less muscle.
- More abdominal fat.
- A larger waist.
- And poorer metabolic health.
Conversely, you can improve your waist measurement, strength, glucose control and fitness without ever returning to whatever you weighed when you were 25. Healthy after 50 is not the same thing as skinny after 50.
Our aim is a metabolically healthier, stronger body.
How large is “a large waist”?
Here’s where it becomes confusing, because different organisations use different waist cut-offs.
For example, some widely used US metabolic-syndrome criteria use approximately 35 inches or 89 cm for women.
Other risk-assessment systems use lower thresholds, and ethnicity matters. Diabetes UK, for example, encourages women to aim for a waist below 80 cm or 31.5 inches when assessing type 2 diabetes risk.
So please don’t turn one tape-measure reading into a diagnosis.
Use your waist as one useful piece of information, alongside your blood pressure and blood tests. And measure change over time.
If your waist has been steadily increasing while your glucose, triglycerides or blood pressure are also drifting upwards, that story is far more interesting than one isolated measurement.
The 5 warning lights — in plain English
Let’s make those five metabolic-syndrome markers less clinical.
1. Your Waist
This gives us a rough clue about abdominal fat and where you are tending to store excess energy.
2. Your triglycerides
Triglycerides are fats circulating in your bloodstream.
A commonly used metabolic-syndrome threshold is 150 mg/dL or 1.7 mmol/L or higher. Triglycerides are particularly useful because they can respond to changes in diet, alcohol intake, insulin sensitivity, body fat and physical activity.
3. Your HDL cholesterol
For women, HDL below approximately 50 mg/dL or 1.3 mmol/L is one of the commonly used metabolic-syndrome markers.
Incidentally, LDL cholesterol — important though it is in an overall cardiovascular assessment — is not one of the classic five metabolic-syndrome criteria.
That sometimes surprises people.
4. Your blood pressure
A commonly used metabolic-syndrome threshold is 130/85 mmHg or above, or receiving treatment for raised blood pressure.
Again, don’t diagnose yourself from one reading after you’ve run upstairs, argued with somebody or drunk three coffees. Blood pressure is much more useful as a properly measured pattern.
5. Your fasting blood glucose
A fasting glucose of 100 mg/dL or 5.6 mmol/L or above is commonly used as another metabolic-syndrome marker.
Your clinician may also look at HbA1c, which gives a broader picture of your recent glucose exposure.
If those numbers still feel confusing, go back to my explanation of HbA1c and blood sugar. They make much more sense once you understand what each test is actually measuring.
“But I really feel perfectly well”
You might. That is one of the frustrating things about metabolic syndrome. You can feel absolutely normal while your blood pressure, triglycerides, glucose and waist measurement are gradually moving in the wrong direction.
- There may be no pain.
- No dramatic symptom.
- No great moment when you suddenly “become metabolic”.
It develops quietly. But there’s a rather encouraging flip side to that. If we catch those changes while they’re still warning lights rather than major breakdowns, we have something to work with.
Why does this become particularly relevant after 50?
Midlife can create a rather perfect metabolic storm:
- Hormonal changes around menopause can influence where body fat is stored.
- Muscle mass can decline if we don’t actively preserve it.
- Sleep may become worse.
- Stress may increase.
- Activity can decrease.
- Years of rushed meals
- Caring responsibilities
- Putting everybody else first, and ourselves last
These can all catch up with us. None of that means menopause automatically causes metabolic syndrome. And don’t you start blaming your hormones for everything that happens after 50!
But research does suggest metabolic syndrome becomes more common after menopause, which is another good reason to start paying attention to your metabolic markers rather than waiting until something crosses a disease threshold.
This is also why muscle matters so much. Muscle isn’t merely decorative tissue hanging off your skeleton. It is a large metabolically active tissue that helps dispose of glucose.
That’s why I keep bringing you back to strength training. We’re not trying to turn you into a bodybuilder. We’re trying to keep as much useful, metabolically active tissue as possible for your next 20 years.
Your liver may be part of the same conversation
Here’s another connection that often gets missed: The liver plays a central role in regulating glucose and fats.
When excess fat begins building up inside it, what we now call metabolic dysfunction-associated steatotic liver disease — MASLD — can sit right alongside insulin resistance, abdominal fat and metabolic syndrome.
And you absolutely don’t need to be a heavy drinker for this to happen. If this is new to you, read my explanation of fatty liver after 50.
Again, we’re not discovering five unrelated diseases. We’re seeing different expressions of a metabolic system under strain.
You can even have metabolic trouble without looking “overweight”
This matters, really matters. A woman can have a perfectly respectable BMI and still carry more visceral fat than is healthy, have low muscle mass or develop abnormal glucose, blood pressure or triglycerides.
That’s particularly relevant across different ethnic backgrounds because metabolic risk doesn’t always appear at the same body size.
So please don’t allow somebody — including yourself — to say: “But I can’t have metabolic problems. I’m not fat.”
Look at the evidence from your own body. Not somebody else’s body. Not an Instagram body — yours.
What I’d want you to know about your own metabolic dashboard
At your next routine check, I’d want you to understand rather than merely collect your results. Know your:
- waist measurement
- blood pressure
- fasting glucose and/or HbA1c
- triglycerides
- HDL cholesterol
Your doctor may quite appropriately look at other things as well, including LDL and non-HDL cholesterol, kidney function, liver markers and overall cardiovascular risk.
You don’t need to become your own laboratory technician. You simply need enough understanding to ask intelligent questions:
- “Is this number moving in the right direction?”
- “Is there a pattern here?”
- “Should we be looking at my other metabolic markers?”
That’s a very different conversation from waiting passively until somebody tells you that you now have a disease.
The lovely thing is that many of these markers respond to the same habits

This is probably my favourite part. You don’t need five entirely separate programmes for five separate warning lights. Several basic habits can influence several metabolic markers at once.
Regular movement and exercise can improve glucose handling, insulin sensitivity, fitness, blood pressure and body composition.
Resistance exercise helps preserve and build muscle.
Reducing sugary drinks and heavily refined, ultra-processed carbohydrates may help glucose, appetite and triglycerides in many women.
Building meals around adequate protein can make it easier to preserve muscle and feel satisfied.
Choosing predominantly real, minimally processed food rather than living on snacks, biscuits and convenience foods is still one of the most boringly effective pieces of advice I can give you. My older guide to healthy dietary habits gives you somewhere practical to start.
- Sleep matters.
- Stress matters.
- Smoking matters.
- Alcohol can matter.
- If you’re carrying excess abdominal fat, reducing some of that fat — without starving yourself or sacrificing muscle — can improve several pieces of this metabolic puzzle simultaneously.
There’s no requirement to become painfully thin. There’s no prize for living on lettuce.
And please… don’t regard medication as failure
If your doctor recommends treatment for high blood pressure, diabetes or significant lipid abnormalities, taking appropriate medication doesn’t mean you’ve “failed” at natural health.
- Lifestyle and medical treatment aren’t rival football teams.
- Sometimes lifestyle change is enough.
- Sometimes medication is also needed.
- Sometimes medication buys you protection while you work on the underlying lifestyle factors you can influence.
The smart approach is to use the tools appropriate to your actual level of risk.
The same principle applies if type 2 diabetes has already developed. Remission is possible for some people, but remission has a specific medical meaning and requires proper monitoring. I explain that distinction in my article on type 2 diabetes remission.
Don’t try to fix everything by Monday 🙂
This is where enthusiasm gets people into trouble. They discover that several markers need improvement and suddenly decide that from tomorrow morning they will:
- fast for 20 hours
- give up every carbohydrate
- run five miles
- lose two stone
- sleep eight hours
- stop drinking coffee
- meditate twice a day
- become a completely different person before Thursday…
You know how that story usually ends…
Choose the changes that give you the biggest return:
- Walk regularly.
- Build muscle.
- Eat real food.
- Prioritise protein.
- Reduce the foods and drinks that are obviously working against you.
- Protect your sleep.
- Measure again after enough time has passed to see a meaningful trend.
- Then adjust where necessary
That is much more HealthSifu.
The label isn’t your destiny
If somebody tells you that you’ve metabolic syndrome, don’t you go walking away thinking: “Well, that’s it then. I’m ill now.”
I’d rather you hear: “Several of my metabolic warning lights are on. Now I know where to focus.”
That’s useful information.
- Because blood pressure can change.
- Glucose control can change.
- Triglycerides can change.
- Muscle can be built.
- Fitness can improve.
- Visceral fat can be reduced.
And metabolic health is not something that belongs only to young women. Your body is still responding to the instructions you give it every day. That gives us plenty to work with.
A Health Sifu Note
Metabolic syndrome sounds rather grand and frightening for something that’s really a collection of warning signs. So don’t become hypnotised by the label. Look at the pattern.
One number rarely tells the story of your health, just as your body weight alone doesn’t tell me whether you are strong, insulin-sensitive, well nourished or carrying too much visceral fat.
What matters is where your metabolic health is heading. And if several markers are drifting in the wrong direction, don’t wait for them to become diseases before giving your body better instructions.
Start with the basics that influence several systems at once: muscle, movement, nourishing real food, good sleep, sensible waist management and appropriate medical monitoring.
Small course corrections made now can become very large differences ten or twenty years from now. That’s exactly why we are having this conversation.
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Scientific References & Further Reading
American Heart Association — Symptoms and Diagnosis of Metabolic Syndrome
A clear explanation of the five commonly used metabolic-syndrome markers and the “three out of five” diagnostic approach, including blood pressure, fasting glucose, triglycerides, HDL and waist circumference.
Read the American Heart Association guide
NHLBI — Metabolic Syndrome Diagnosis
The US National Heart, Lung, and Blood Institute provides an approachable explanation of how clinicians assess waist measurement, blood pressure, glucose, HDL cholesterol and triglycerides. It also notes that waist thresholds can vary according to race and ethnicity.
Read the NHLBI guide
Alberti et al. — Harmonising the Metabolic Syndrome
This major international consensus statement helped bring different definitions together. Importantly, it concluded that no single marker must be present: three abnormal findings from the five can qualify, while waist thresholds should take population and regional differences into account.
Read the PubMed record
Mayo Clinic — Metabolic Syndrome
Good “yummy” background reading if you want a straightforward explanation rather than a research paper. Mayo Clinic explains how abdominal fat, blood pressure, glucose and blood fats can cluster together and why insulin resistance often sits underneath the pattern.
Read the Mayo Clinic overview
Diabetes UK — Waist Measurement and Diabetes Risk
A particularly useful practical guide showing why waist measurement adds information beyond BMI. Diabetes UK recommends that women aim for a waist below 80 cm when considering type 2 diabetes risk and explains why ethnicity also matters.
Read the Diabetes UK guide
Raman et al. — Metabolic Syndrome in Post-Menopausal Women, 2023
This scoping review found metabolic syndrome was reported more commonly in post-menopausal than pre-menopausal women across the studies reviewed. It supports paying closer attention to metabolic markers during the post-menopausal years without suggesting menopause is the sole cause.
Read the PubMed abstract
Park et al. — Lifestyle Modification for Metabolic Syndrome, 2024
This systematic review and meta-analysis examined comprehensive lifestyle interventions. Programmes combining diet and exercise improved health behaviours and were associated with improvements including lower glucose and systolic blood pressure.
Read the PubMed abstract
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