How to Reverse Metabolic Syndrome and Insulin Resistance

Metabolic syndrome is a cluster of cardiometabolic abnormalities that increase the risk of diabetes, heart disease, and stroke. People with metabolic syndrome are five times more likely to develop type 2 diabetes and two times likelier to experience conditions related to atherosclerosis, such as heart attack or heart failure.¹Swarup S, Ahmed I, Grigorova Y, Zeltser R. Metabolic syndrome. In: StatPearls. Treasure Island (FL): StatPearls Publishing; March 7, 2024. https://www.ncbi.nlm.nih.gov/books/NBK459248

Early intervention is the most effective way to reverse metabolic syndrome and reduce the risk of other serious heart problems.²Rus M, Crisan S, Andronie-Cioara FL, et al. Prevalence and risk factors of metabolic syndrome: a prospective study on cardiovascular health. Medicina (Kaunas). 2023;59(10):1711. https://doi.org/10.3390/medicina59101711

Causes of metabolic syndrome

There isn’t a single cause of metabolic syndrome; a combination of lifestyle, environmental, and family factors increases risk. Some are modifiable, like diet, physical activity, sleep hygiene, alcohol consumption, and tobacco use. Others, like genetics, are hard coded.¹Swarup S, Ahmed I, Grigorova Y, Zeltser R. Metabolic syndrome. In: StatPearls. Treasure Island (FL): StatPearls Publishing; March 7, 2024. https://www.ncbi.nlm.nih.gov/books/NBK459248

“Socioeconomic status can play a role in [metabolic syndrome], partly due to lack of nutrition education and limited options in food deserts, or from social pressures in families where whole-food meals are not prioritized,” says Rachael O’Connell, ND, of Ohio Naturopathic and Suzelis Holistic Health. “Additionally, high-stress lifestyles without coping strategies or stress-relief practices increase poor behavior patterns and contribute significantly to hypertension.” 

Problematic behavior patterns may include frequently consuming excessive calories from carbohydrates, alcohol, and processed foods, and eating too often or “grazing” throughout the day. Physical inactivity, not tracking food intake, emotional eating, food addiction, and vulnerability to social pressures around eating also come into play.

“It is so important to reverse metabolic disease,” explains Dr. O’Connell, “because it is the primary driver of all-cause mortality. Diabetes, heart disease, artery disease, hypertension, obesity, amputation, many types of cancer, autoimmune diseases, pain syndromes, mental health [conditions], and untold other debilitating health problems are included in the complications of unmitigated metabolic disease.”

10 symptoms of insulin resistance

Although metabolic syndrome may not cause noticeable symptoms, there are 10 common signs of insulin resistance and related metabolic dysfunction:

1. Fatigue
2. Depression or anxiety
3. Brain fog
4. Afternoon energy crashes
5. Insatiable hunger and thirst
6. Frequent urination, especially at night
7. Edema or puffiness in the face and ankles
8. Headaches
9. Joint pain
10. Rashes or slow-healing wounds

When hormonal systems are affected, other symptoms may also be present. “Men may have sexual dysfunction,” Dr. O’Connell says, “and women may have period problems or more difficult perimenopause. For menstruating women with period problems, I give the option to test estradiol, progesterone, testosterone, and DHEA–s to see if they are developing PCOS, which is essentially a type of insulin-mediated syndrome or metabolic disease. Men sometimes want to see their testosterone, though it doesn’t often correlate for them as well as with PCOS patients.”

How is metabolic syndrome diagnosed?

Known risk factors for metabolic syndrome include high blood pressure, dyslipidemia (abnormal lipid levels), insulin resistance, and central (abdominal) obesity. Three or more of the following criteria must be present for a diagnosis¹Swarup S, Ahmed I, Grigorova Y, Zeltser R. Metabolic syndrome. In: StatPearls. Treasure Island (FL): StatPearls Publishing; March 7, 2024. https://www.ncbi.nlm.nih.gov/books/NBK459248^,2Rus M, Crisan S, Andronie-Cioara FL, et al. Prevalence and risk factors of metabolic syndrome: a prospective study on cardiovascular health. Medicina (Kaunas). 2023;59(10):1711. https://doi.org/10.3390/medicina59101711: 

• High triglycerides: Levels of or over 150 mg/dL
• Low HDL cholesterol: High-density lipoprotein (HDL) cholesterol less than 40 mg/dL for men and 50 mg/dL for women
• Abdominal obesity: Male waist circumference exceeding 40 inches, female waist circumference exceeding 35 inches
• Impaired fasting glucose: Fasting blood glucose levels of 100 mg/dL or higher
• High blood pressure: Systolic blood pressure of 130 mm Hg, or diastolic blood pressure of 85 mm Hg

“Diagnosis is done using clinical signs and symptoms, patient behavior patterns, and bloodwork,” says Dr. O’Connell. “The labs I run always include HbA1c to get an idea of average glucose over three months, and fasting insulin to determine insulin resistance.”

Other blood tests for confirming metabolic syndrome

Testing lipids, such as triglycerides, low-density lipoprotein (LDL) cholesterol, and HDL cholesterol (the “good” kind), is also used to confirm metabolic syndrome.¹Swarup S, Ahmed I, Grigorova Y, Zeltser R. Metabolic syndrome. In: StatPearls. Treasure Island (FL): StatPearls Publishing; March 7, 2024. https://www.ncbi.nlm.nih.gov/books/NBK459248

“Rather than a standard lipid panel,” notes Dr. O’Connell, “I run a fractionated lipoprotein Nuclear Magnetic Resonance (NMR), which breaks down the quality and quantity of LDL and HDL particles, giving a true picture of how inflamed the patient is and [helping to] stratify cardiovascular disease risk. I run triglycerides to see if they’re burning fat or packing it into their liver and viscera.”

Dr. O’Connell also orders a comprehensive metabolic panel to assess liver and kidney function, as results may indicate organ damage. “A complete blood count can help [determine] if there are any active problems like anemia or infection, which can hinder progress when we start therapies to reverse metabolic diseases,” she says.

Heart-protective diets support a healthier insulin response

Healthy lifestyle changes that address cardiometabolic risk factors, such as poor eating habits, can offset a genetic predisposition to metabolic syndrome.³Roberts CK, Hevener AL, Barnard RJ. Metabolic syndrome and insulin resistance: underlying causes and modification by exercise training. Compr Physiol. 2013;3(1):1-58. https://doi.org/10.1002/cphy.c110062^,4Patti AM, Al-Rasadi K, Giglio RV, et al. Natural approaches in metabolic syndrome management. Arch Med Sci. 2018;14(2):422-441. https://doi.org/10.5114/aoms.2017.68717

Plant-based vegetarian diets, particularly those rich in phytochemicals, are shown to reduce the risk of metabolic syndrome and improve overall health.⁵Nikparast A, Etesami E, Rahmani J, Rafiei N, Ghanavati M. The association between plant-based diet indices and metabolic syndrome: a systematic review and dose-response meta-analysis. Front Nutr. 2024;10:1305755. https://doi.org/10.3389/fnut.2023.1305755^,6Kim M, Park K. Association between phytochemical index and metabolic syndrome. Nutr Res Pract. 2020;14(3):252-261. https://doi.org/10.4162/nrp.2020.14.3.252^,7Cui X, Wang B, Wu Y, et al. Vegetarians have a lower fasting insulin level and higher insulin sensitivity than matched omnivores: a cross-sectional study. Nutr Metab Cardiovasc Dis. 2019;29(5):467-473. https://doi.org/10.1016/j.numecd.2019.01.012Phytochemical-rich foods include fresh fruits and vegetables, whole grains, legumes, tofu, nuts, seeds, olive oil, and seaweed. 

Compared with omnivores, vegans have higher insulin sensitivity and lower fasting insulin levels. However, not all vegan diets are created equal. Those high in processed foods, refined grains, and sugar-sweetened beverages are associated with a 27% increased risk of metabolic syndrome.⁵Nikparast A, Etesami E, Rahmani J, Rafiei N, Ghanavati M. The association between plant-based diet indices and metabolic syndrome: a systematic review and dose-response meta-analysis. Front Nutr. 2024;10:1305755. https://doi.org/10.3389/fnut.2023.1305755

Dietary plans that emphasize fresh, whole foods, like Dietary Approaches to Stop Hypertension (DASH) or the Mediterranean, may reduce the risk of heart disease, type 2 diabetes, and other conditions, especially when paired with an exercise plan.²Rus M, Crisan S, Andronie-Cioara FL, et al. Prevalence and risk factors of metabolic syndrome: a prospective study on cardiovascular health. Medicina (Kaunas). 2023;59(10):1711. https://doi.org/10.3390/medicina59101711 Studies show that DASH or a salt-restricted Mediterranean diet can significantly cut the risk of metabolic syndrome by managing blood pressure, blood sugar, cholesterol, and body weight.²Rus M, Crisan S, Andronie-Cioara FL, et al. Prevalence and risk factors of metabolic syndrome: a prospective study on cardiovascular health. Medicina (Kaunas). 2023;59(10):1711. https://doi.org/10.3390/medicina59101711^,8Filippou CD, Thomopoulos CG, Konstantinidis DG, et al. Effect of DASH vs. Mediterranean diet accompanied by a salt restriction on metabolic syndrome and cardiometabolic risk factors in adults with high normal blood pressure or grade 1 hypertension: secondary analyses of a randomized controlled trial. Hellenic J Cardiol. 2025;85:24-37. https://doi.org/10.1016/j.hjc.2024.05.006 Low-carbohydrate and Mediterranean-style diets have also been shown to improve insulin sensitivity.⁹Hyde PN, Sapper TN, Crabtree CD, et al. Dietary carbohydrate restriction improves metabolic syndrome independent of weight loss. JCI Insight. 2019 Jun 20;4(12):e128308. https://doi.org/10.1172/jci.insight.128308

Both diets incorporate heart-healthy foods such as olive oil, whole grains, fish, legumes, lean meats, and fruits and vegetables, while limiting sodium, saturated fats, and highly processed foods.¹⁰Castro-Barquero S, Ruiz-León AM, Sierra-Pérez M, Estruch R, Casas R. Dietary strategies for metabolic syndrome: a comprehensive review. Nutrients. 2020;12(10):2983. https://doi.org/10.3390/nu12102983

Treating metabolic syndrome with lifestyle modifications

Adopting a healthy diet, exercising, and losing excess weight may be enough to reverse metabolic syndrome.¹Swarup S, Ahmed I, Grigorova Y, Zeltser R. Metabolic syndrome. In: StatPearls. Treasure Island (FL): StatPearls Publishing; March 7, 2024. https://www.ncbi.nlm.nih.gov/books/NBK459248 Two and a half hours of moderate-intensity exercise or 70 minutes of high-intensity exercise each week can help reduce baseline body weight by up to 10% over a year, targeting a BMI of 25 kg/m2 or less. But even a daily walk can improve insulin sensitivity, especially after eating.¹¹Najafian J, Mohammadifard N, Naeini FF, Nouri F. Relation between usual daily walking time and metabolic syndrome. Niger Med J. 2014 Jan;55(1):29-33. https://doi.org/10.4103/0300-1652.128156 Exercise is also an effective way to manage stress, another risk factor for metabolic syndrome.³Roberts CK, Hevener AL, Barnard RJ. Metabolic syndrome and insulin resistance: underlying causes and modification by exercise training. Compr Physiol. 2013;3(1):1-58. https://doi.org/10.1002/cphy.c110062

Dr. O’Connell says a three-pronged approach is best. “The fastest, safest, and most effective way I’ve helped patients reverse metabolic disease is prescribing a whole foods–based ketogenic diet,¹²Yuan X, Wang J, Yang S, et al. Effect of the ketogenic diet on glycemic control, insulin resistance, and lipid metabolism in patients with T2DM: a systematic review and meta-analysis. Nutr Diabetes. 2020;10(1):38. https://doi.org/10.1038/s41387-020-00142-z^,13Zaki HA, Iftikhar H, Bashir K, et al. A comparative study evaluating the effectiveness between ketogenic and low-carbohydrate diets on glycemic and weight control in patients with type 2 diabetes mellitus: a systematic review and meta-analysis. Cureus. 2022;14(5):e25528. https://doi.org/10.7759/cureus.25528 encouraging regular exercise (at least walking daily and some bodyweight exercises based on ability), and recommending counseling or therapy to aid in thenecessary behavior changes to stop self-sabotaging.”

Other lifestyle choices, such as not smoking, limiting alcohol, and getting enough quality sleep, will help improve overall metabolic health.¹Swarup S, Ahmed I, Grigorova Y, Zeltser R. Metabolic syndrome. In: StatPearls. Treasure Island (FL): StatPearls Publishing; March 7, 2024. https://www.ncbi.nlm.nih.gov/books/NBK459248 

Managing blood pressure, blood sugar, & cholesterol

Although positive lifestyle changes are the gold standard for treating metabolic syndrome, certain nutrients and supplements may help manage blood pressure, cholesterol, and blood sugar:

• Pomegranate juice, green tea, garlic, quercetin, omega–3 fatty acids, vitamin D, and phosphorus have blood pressure–lowering properties.⁴Patti AM, Al-Rasadi K, Giglio RV, et al. Natural approaches in metabolic syndrome management. Arch Med Sci. 2018;14(2):422-441. https://doi.org/10.5114/aoms.2017.68717
• Quercetin,¹⁴Tabrizi R, Tamtaji OR, Mirhosseini N, et al. The effects of quercetin supplementation on lipid profiles and inflammatory markers among patients with metabolic syndrome and related disorders: A systematic review and meta-analysis of randomized controlled trials. Crit Rev Food Sci Nutr. 2020;60(11):1855-1868. https://doi.org/10.1080/10408398.2019.1604491 chokeberry, citrus bergamia, curcumin, ginseng, green tea, mulberry, omega–3 fatty acids, calcium, zinc, and vitamins B3, B12, and D support healthy cholesterol levels.⁴Patti AM, Al-Rasadi K, Giglio RV, et al. Natural approaches in metabolic syndrome management. Arch Med Sci. 2018;14(2):422-441. https://doi.org/10.5114/aoms.2017.68717
• Chokeberry, citrus bergamia, green tea, mulberry, omega–3 fatty acids, vitamin B3, and zinc may lower triglycerides.⁴Patti AM, Al-Rasadi K, Giglio RV, et al. Natural approaches in metabolic syndrome management. Arch Med Sci. 2018;14(2):422-441. https://doi.org/10.5114/aoms.2017.68717 
• Calcium, curcumin, ginseng, vitamin D, and zinc support healthy blood sugar.⁴Patti AM, Al-Rasadi K, Giglio RV, et al. Natural approaches in metabolic syndrome management. Arch Med Sci. 2018;14(2):422-441. https://doi.org/10.5114/aoms.2017.68717
• Berberine has been shown to reduce fasting plasma glucose levels, two-hour oral glucose tolerance, total cholesterol, triglycerides, waist measurements, and BMI.¹⁵Liu D, Zhao H, Zhang Y, Hu J, Xu H. Efficacy and safety of berberine on the components of metabolic syndrome: a systematic review and meta-analysis of randomized placebo-controlled trials. Front Pharmacol. 2025;16:1572197. https://doi.org/10.3389/fphar.2025.1572197

In a small study of people with obesity, a gastrointestinal microbiome modulator of inulin, beta–glucan, and blueberry polyphenols improved glucose tolerance after four weeks of supplementation.⁴Patti AM, Al-Rasadi K, Giglio RV, et al. Natural approaches in metabolic syndrome management. Arch Med Sci. 2018;14(2):422-441. https://doi.org/10.5114/aoms.2017.68717 Blueberry supplementation has additional health benefits, including improved lipid levels and diastolic blood pressure.¹⁶Carvalho MF, Lucca ABA, Ribeiro E Silva VR, Macedo LR, Silva M. Blueberry intervention improves metabolic syndrome risk factors: systematic review and meta-analysis. Nutr Res. 2021;91:67-80. https://doi.org/10.1016/j.nutres.2021.04.006

Seaweed could also benefit people with metabolic syndrome. A small 2009 study found consuming four to six grams of wakame (brown seaweed) daily reduced high blood pressure. Women in the study also saw smaller waist measurements.¹⁷Teas J, Baldeón ME, Chiriboga DE, Davis JR, Sarriés AJ, Braverman LE. Could dietary seaweed reverse the metabolic syndrome?. Asia Pac J Clin Nutr. 2009;18(2):145-154. https://pubmed.ncbi.nlm.nih.gov/19713172

Along with regular exercise and a whole-foods diet, some supplements may help support weight loss. These include berberine;¹⁸Asbaghi O, Ghanbari N, Shekari M, et al. The effect of berberine supplementation on obesity parameters, inflammation and liver function enzymes: A systematic review and meta-analysis of randomized controlled trials. Clin Nutr ESPEN. 2020;38:43-49. https://doi.org/10.1016/j.clnesp.2020.04.010 green tea, curcumin, vitamin D, and ginseng.⁴Patti AM, Al-Rasadi K, Giglio RV, et al. Natural approaches in metabolic syndrome management. Arch Med Sci. 2018;14(2):422-441. https://doi.org/10.5114/aoms.2017.68717; and a combination of plant extracts such as curcuma longa, silymarin, guggul, chlorogenic acid, and inulin.¹⁹Patti AM, Al-Rasadi K, Katsiki N, et al. Effect of a natural supplement containing curcuma longa, guggul, and chlorogenic acid in patients with metabolic syndrome. Angiology. 2015;66(9):856-861. https://doi.org/10.1177/0003319714568792

Footnotes

• 1
  Swarup S, Ahmed I, Grigorova Y, Zeltser R. Metabolic syndrome. In: StatPearls. Treasure Island (FL): StatPearls Publishing; March 7, 2024. https://www.ncbi.nlm.nih.gov/books/NBK459248
• 2
  Rus M, Crisan S, Andronie-Cioara FL, et al. Prevalence and risk factors of metabolic syndrome: a prospective study on cardiovascular health. Medicina (Kaunas). 2023;59(10):1711. https://doi.org/10.3390/medicina59101711
• 3
  Roberts CK, Hevener AL, Barnard RJ. Metabolic syndrome and insulin resistance: underlying causes and modification by exercise training. Compr Physiol. 2013;3(1):1-58. https://doi.org/10.1002/cphy.c110062
• 4
  Patti AM, Al-Rasadi K, Giglio RV, et al. Natural approaches in metabolic syndrome management. Arch Med Sci. 2018;14(2):422-441. https://doi.org/10.5114/aoms.2017.68717
• 5
  Nikparast A, Etesami E, Rahmani J, Rafiei N, Ghanavati M. The association between plant-based diet indices and metabolic syndrome: a systematic review and dose-response meta-analysis. Front Nutr. 2024;10:1305755. https://doi.org/10.3389/fnut.2023.1305755
• 6
  Kim M, Park K. Association between phytochemical index and metabolic syndrome. Nutr Res Pract. 2020;14(3):252-261. https://doi.org/10.4162/nrp.2020.14.3.252
• 7
  Cui X, Wang B, Wu Y, et al. Vegetarians have a lower fasting insulin level and higher insulin sensitivity than matched omnivores: a cross-sectional study. Nutr Metab Cardiovasc Dis. 2019;29(5):467-473. https://doi.org/10.1016/j.numecd.2019.01.012
• 8
  Filippou CD, Thomopoulos CG, Konstantinidis DG, et al. Effect of DASH vs. Mediterranean diet accompanied by a salt restriction on metabolic syndrome and cardiometabolic risk factors in adults with high normal blood pressure or grade 1 hypertension: secondary analyses of a randomized controlled trial. Hellenic J Cardiol. 2025;85:24-37. https://doi.org/10.1016/j.hjc.2024.05.006
• 9
  Hyde PN, Sapper TN, Crabtree CD, et al. Dietary carbohydrate restriction improves metabolic syndrome independent of weight loss. JCI Insight. 2019 Jun 20;4(12):e128308. https://doi.org/10.1172/jci.insight.128308
• 10
  Castro-Barquero S, Ruiz-León AM, Sierra-Pérez M, Estruch R, Casas R. Dietary strategies for metabolic syndrome: a comprehensive review. Nutrients. 2020;12(10):2983. https://doi.org/10.3390/nu12102983
• 11
  Najafian J, Mohammadifard N, Naeini FF, Nouri F. Relation between usual daily walking time and metabolic syndrome. Niger Med J. 2014 Jan;55(1):29-33. https://doi.org/10.4103/0300-1652.128156
• 12
  Yuan X, Wang J, Yang S, et al. Effect of the ketogenic diet on glycemic control, insulin resistance, and lipid metabolism in patients with T2DM: a systematic review and meta-analysis. Nutr Diabetes. 2020;10(1):38. https://doi.org/10.1038/s41387-020-00142-z
• 13
  Zaki HA, Iftikhar H, Bashir K, et al. A comparative study evaluating the effectiveness between ketogenic and low-carbohydrate diets on glycemic and weight control in patients with type 2 diabetes mellitus: a systematic review and meta-analysis. Cureus. 2022;14(5):e25528. https://doi.org/10.7759/cureus.25528
• 14
  Tabrizi R, Tamtaji OR, Mirhosseini N, et al. The effects of quercetin supplementation on lipid profiles and inflammatory markers among patients with metabolic syndrome and related disorders: A systematic review and meta-analysis of randomized controlled trials. Crit Rev Food Sci Nutr. 2020;60(11):1855-1868. https://doi.org/10.1080/10408398.2019.1604491
• 15
  Liu D, Zhao H, Zhang Y, Hu J, Xu H. Efficacy and safety of berberine on the components of metabolic syndrome: a systematic review and meta-analysis of randomized placebo-controlled trials. Front Pharmacol. 2025;16:1572197. https://doi.org/10.3389/fphar.2025.1572197
• 16
  Carvalho MF, Lucca ABA, Ribeiro E Silva VR, Macedo LR, Silva M. Blueberry intervention improves metabolic syndrome risk factors: systematic review and meta-analysis. Nutr Res. 2021;91:67-80. https://doi.org/10.1016/j.nutres.2021.04.006
• 17
  Teas J, Baldeón ME, Chiriboga DE, Davis JR, Sarriés AJ, Braverman LE. Could dietary seaweed reverse the metabolic syndrome?. Asia Pac J Clin Nutr. 2009;18(2):145-154. https://pubmed.ncbi.nlm.nih.gov/19713172
• 18
  Asbaghi O, Ghanbari N, Shekari M, et al. The effect of berberine supplementation on obesity parameters, inflammation and liver function enzymes: A systematic review and meta-analysis of randomized controlled trials. Clin Nutr ESPEN. 2020;38:43-49. https://doi.org/10.1016/j.clnesp.2020.04.010
• 19
  Patti AM, Al-Rasadi K, Katsiki N, et al. Effect of a natural supplement containing curcuma longa, guggul, and chlorogenic acid in patients with metabolic syndrome. Angiology. 2015;66(9):856-861. https://doi.org/10.1177/0003319714568792