The royal dining table of the Joseon Dynasty is often regarded as a symbol of splendor and abundance. The *surasang*, with its twelve side dishes served at every meal, was a culinary feast crafted with the finest ingredients and cooking methods of its era. Yet, ironically, within this very abundance, many Joseon kings suffered from a cluster of diseases now termed 'metabolic syndrome' in modern medicine, often leading to premature deaths. Delving into Joseon royal records through the eyes of an endocrinologist reveals chilling insights into how their diet and lifestyle habits threatened their health.

The diet of Joseon kings was remarkably high in carbohydrates and fats. Staple foods included rice, as well as flour-based noodles and rice cakes (*tteok*), pan-fried dishes (*jeon*) cooked in oil, and high-calorie confections like *yumil-gwa* made with honey and grains. While meat was a precious commodity, it is presumed that the royal family consumed it relatively abundantly. Conversely, fresh vegetables and fruits were likely difficult to consume in sufficient quantities due to limitations in storage and supply. The *Joseon Wangjo Sillok* (Annals of the Joseon Dynasty) occasionally mentions foods favored by the kings; for instance, King Sejong was said to be exceptionally fond of meat, to the point where his officials expressed concern. This unbalanced, high-calorie diet was more than enough to induce insulin resistance, a primary cause of obesity, hypertension, and diabetes in modern individuals.

A king's life was a continuous cycle of extreme stress and restricted physical activity. Records of the kings' daily routines in the *Seungjeongwon Ilgi* (Diaries of the Royal Secretariat) and *Ilseongnok* (Diaries of Self-reflection) show that they endured intense mental labor, from managing state affairs from dawn till late night to attending *gyeongyeon* (royal lectures) and engaging in academic debates. In contrast, their physical activity was significantly less than that of commoners or military officials. They traveled by palanquin, and exercises like hunting or archery were limited. This sedentary lifestyle coupled with chronic stress increased cortisol secretion, elevating blood sugar and promoting abdominal obesity, which are key factors in metabolic syndrome. Political pressures such as strengthening royal authority, succession issues, and factional strife were critical elements that exacerbated the kings' stress.

Throughout the *Joseon Wangjo Sillok*, records of the kings' health conditions are scattered. 'Sogalbyeong' (消渴病), a disease exhibiting symptoms similar to modern diabetes, is recorded as afflicting several kings, including Sejong, Sukjong, and Yeongjo. King Sejong, in particular, suffered from 'sogalbyeong' and 'boils' throughout his reign, and symptoms of obesity and edema frequently appeared. These can be interpreted as typical manifestations of metabolic syndrome, accompanied by hyperglycemia, dyslipidemia, and hypertension. Furthermore, frequent records of 'jungpung' (stroke) indicate the prevalence of cardiovascular diseases such as hypertension and arteriosclerosis. At the time, royal physicians (*eoui*) treated these conditions with acupuncture, moxibustion, and herbal medicines, but there were clear limitations in addressing the fundamental causes of metabolic syndrome, namely diet and lifestyle habits.

The tragic short lifespans of Joseon kings were not solely due to a lack of medical technology. The abundant royal table and the heavy burden of power that governed their lives paradoxically acted as a poison, eroding their health. The fact that even kings, who enjoyed the highest power and resources of their era, were not immune to modern chronic diseases offers profound introspection for us today. In an age overflowing with information and rich dining tables, are we truly making wise choices to protect our health? Or are we, within the unseen shadow of metabolic syndrome, repeating another 'king's short lifespan'? Standing before the Joseon royal table of centuries past, we look into the mirror of history to reflect upon our own health and lives.