Keto and Metabolic Health

What percentage of Americans enjoy optimal metabolic health? According to the National Health and Nutrition Examination Survey, the figure is surprisingly low at just >12.2%.[*]

Maybe it’s not so surprising. When you combine the high sugar intake, ultra-processed foods, poor sleep, and lack of exercise that define modern living, you have a recipe for widespread metabolic dysregulation.

If you want to improve your metabolic health, start with diet and lifestyle factors. 

Can Keto improve metabolic health? The evidence is promising, and we’ll review it shortly.[*] First though, let’s define metabolic health. 

What is Metabolic Health?

Broadly speaking, metabolic health refers to how your body uses, stores, and partitions energy. For instance, your metabolic health dictates the management of fat, sugar, and other nutrients you consume through food. 

Blood sugar levels (blood glucose levels) are the chief clinical marker of metabolic health. If blood sugar stays too high for too long, it indicates that insulin (your blood sugar regulation hormone) isn’t working correctly. 

When someone is metabolically healthy, insulin effectively shuttles sugar out of the blood and into cells for safe storage. To simplify: you digest food, blood sugar rises, insulin shows up, blood sugar comes down again. 

That’s how it’s supposed to work. But when someone isn’t metabolically healthy, insulin doesn’t work properly, and blood sugar stays high. This condition (insulin resistance) underpins metabolic diseases like type 2 diabetes, polycystic ovarian syndrome, fatty liver disease, high triglycerides, and metabolic syndrome.[*] 

Beyond blood sugar levels and insulin function, clinicians also assess metabolic health based on blood pressure, waist circumference, triglycerides, and HDL cholesterol. We’ll spend more time on these metabolic markers in the next section. 

Signs and Symptoms of Poor Metabolic Health

Metabolic syndrome is a medical term for poor metabolic health. According to the International Diabetes Federation, a person has metabolic syndrome when they meet at least three of the following five criteria:[*]

• Fasting blood sugar levels greater than or equal to 100 mg/dL
• Elevated waist circumference (criteria differs based on country and population)
• Blood pressure greater than or equal to 130/85 mmHg
• Triglycerides greater than or equal to 150 mg/dL
• HDL-C less than 40 mg/dL (men) or less than 50 mg/dL (women)

When a person has metabolic syndrome, they’re considered to be at higher risk for many chronic diseases: heart disease, cancer, neurodegenerative disease, liver disease, etc. They’re also at higher risk for developing pre-diabetes and type 2 diabetes.[*] 

Type 2 diabetes is the climax of poor metabolic health. According to the American Diabetes Association, type 2 diabetes sets in when fasting blood glucose exceeds 125 mg/dL and HbA1c (a marker of average blood sugar) exceeds 6.4%. Pre-diabetes is defined by having an HbA1c of 5.7-6.4%.

The consequences of chronically elevated blood sugar levels include:[*]

• Blood vessel damage, which may increase your risk of a heart attack or stroke
• Increased oxidative stress and inflammation, which may worsen arthritis or increase your risk of certain cancers
• Increased fat storage, which is likely due to insulin resistance
• Increased risk for most chronic diseases, including diabetes and fatty liver disease

But what causes high blood sugar in the first place?

What Causes Poor Metabolic Health?

Most cases of poor metabolic health can be traced back to diet and lifestyle factors. Yes, genes affect metabolic health too, but genes can’t explain why US diabetes rates have increased sevenfold in the past 50 years.[*]

Genes haven’t changed in the past few decades. Diets and lifestyles have. 

The truth is, Americans are now eating more sugar and processed carbohydrates, exercising and sleeping less, and working more hours than ever before. All these factors are driving the diabesity (diabetes plus obesity) crisis afflicting about half the country.[*] Our cortisol (stress hormone) levels are elevated from chronic stress and anxiety, further worsening our metabolic dysregulation. 

High sugar diets may be the most significant contributing factor. The average American consumes the equivalent of 15 teaspoons of added sugar per day. Chronically high sugar and ultra-processed food intake are well-documented to derail metabolic health.[*] 

With this in mind, let’s talk about solutions now.

How to Improve Metabolic Health

If you want to improve your metabolic health, focus on these areas:

#1: Diet

Diets high in refined sugars and processed carbohydrates increase the risk of developing metabolic syndrome and type 2 diabetes.[*] To reduce the risk, reduce your sugar intake and opt for whole foods that are not heavily processed (i.e. meats, seafood, vegetables, nuts, seeds, eggs, berries, etc.).

One way to do this? Replace sugar with noncaloric sweeteners like stevia, monk fruit, allulose, and erythritol. 

Along with limiting sugar, limiting overall carbs is a well-documented strategy for improving blood sugar regulation.[*] More on that soon. 

#2: Sleep  

Your metabolic health will thank you if you sleep 7 to 9 hours per night. Proper sleep is essential for insulin function, which in turn dictates blood sugar levels and fat-burning capacity.[*] 

Getting enough sleep also stabilizes hunger hormones, like ghrelin.[*] Short sleep often leads to overeating. Studies have shown that individuals with poor or disrupted sleep patterns have increased levels of ghrelin and a higher body fat percentage, particularly women.[*]

#3: Exercise

Along with sleep, exercise also enhances insulin function. Folks who exercise regularly have better blood sugar regulation.

Because of this, exercise is a useful metabolic therapy. It helps people with type 2 diabetes lose weight, reduce heart disease risk, and lower blood sugar.[*] 

#4: Stress management

Released during times of stress, the hormone cortisol puts you in “fight or flight” mode—a mode defined, in part, by elevated blood sugar levels.[*] Keep cortisol in check by managing stress as best you can. Potential ways to reduce stress include exercise, meditation, therapy, support groups, and yoga.

#5: Intermittent fasting

Intermittent fasting (taking regular breaks from calories) signals your body to make a metabolic switch. The switch is from burning sugar and carbohydrates to burning fat for energy. 

This is called developing metabolic flexibility, and it’s synonymous with good metabolic health. Fasting, however, isn’t the only way to enhance metabolic flexibility.

Keto for Metabolic Health: Can It Help?

The short answer is yes. A growing body of literature suggests that a Keto or low carbohydrate diet can improve blood sugar regulation, body weight, insulin function, blood pressure, cholesterol levels, triglycerides, and other markers of metabolic health in obese and diabetic populations.[*][*][*] 

In a 2018 study sponsored by Virta Health, one year of supervised Keto dieting reversed type 2 diabetes (as defined by HbA1c) in 60% of 218 participants.[*] Other highlights include:

• Average weight loss of 30.4 pounds
• Average triglycerides down 24%
• 94% of patients off (or reduced) insulin therapy

Why might Keto reverse metabolic problems? Because Keto restricts the macronutrient (macro) that raises blood sugar and insulin levels most: carbs. 

When you restrict carbs, it tells your body that sugar is scarce. This keeps insulin levels low, which in turn promotes the burning of fat for energy.  

This fat-burning state (called ketosis) also has hunger-suppressing effects.[*] Combine that with Keto’s suppression of insulin and you have a potential formula for weight loss, better energy, and grade-A metabolic health. 

If a ketogenic diet seems too difficult for you, studies also show possible metabolic benefits from moderately lower carbohydrate diets (i.e. <100g or <130g of total carbohydrates per day). The American Diabetes Association (ADA) recently endorsed low carbohydrate diets as a safe and effective way to improve blood sugar in individuals with pre-diabetes or diabetes.[*]

Seeking Metabolic Health

Of course, Keto isn’t the only way to improve your metabolic health. Cutting out sugar, sleeping more,  intermittent fasting, and exercising are also important. (Bonus points if you combine them) 

And remember: just because most people don’t enjoy optimal metabolic health, it doesn’t mean you can’t.