A Beginner’s Guide to Metabolic Health

Are you in good metabolic health? If you’re an adult living in the United States, there’s an 88% chance that you have some form of metabolic dysfunction.[*] This article will serve as a beginners’ guide to understanding your own metabolic health and what steps you can take to improve it.

What is Metabolic Health? 

Metabolic health refers to how your body uses, stores, and partitions energy. When you eat, your body has to manage the fat, protein, and carbohydrates that you consume. These three categories of food are called “macronutrients.” The way your body manages these macronutrients is determined by your metabolic function. Blood sugar levels are an excellent marker of your metabolic health. If your blood glucose (sugar) remains elevated for too long after a meal, it’s likely because your insulin is not functioning properly. Insulin is a hormone produced in the pancreas that regulates blood sugar.[*]

In the 12% of Americans who are metabolically healthy, their insulin efficiently shuttles sugar out of the blood and into cells for storage. Metabolically unhealthy individuals become resistant to their own insulin, leading to chronically elevated insulin and blood glucose over time. This is a concept called insulin resistance, and it underpins many metabolic diseases, such as type 2 diabetes, polycystic ovarian syndrome (PCOS), fatty liver disease, elevated triglycerides, and metabolic syndrome.[*] Insulin resistance is a hormonal imbalance and a major contributor to the progressively worsening obesity epidemic in the United States.[*] 

What is Metabolic Syndrome vs. Metabolic Dysfunction? 

Metabolic health may be routinely assessed by your primary care physician, endocrinologist, or gynecologist. They may check your blood sugar levels, fasting insulin, blood pressure, waist circumference, triglyceride levels, and HDL cholesterol to determine your metabolic health status. These are common “markers” of your metabolic function. If your provider does not check these vital signs—simply ask!

According to the National Institute of Health (NIH), a person is formally diagnosed with metabolic syndrome if they have 3 or more of the following 5 criteria:[*] 

• Fasting blood sugar levels ≥100 mg/dL
• Triglycerides ≥150 mg/dL
• Serum HDL (“good” cholesterol) <40 mg/dL in men, <50 in women
• Waist circumference ≥40” for men and ≥35” for women (criteria differs based on country and population)
• Blood pressure ≥130/85 (or on BP-lowering medication)

If you have only 1 or 2 of the above criteria, you will have some degree of metabolic dysfunction or dysregulation without the formal diagnosis of metabolic syndrome. It would be wise to look at all five of these criteria as “goals” to achieve if any of them are out of range. Unfortunately, if you do have 3 or more of the above criteria, you’ve earned yourself a formal diagnosis of metabolic syndrome, which confers an increased risk of heart disease, stroke, and type 2 diabetes.[*]  

Are There Certain Signs and Symptoms of Poor Metabolic Health?

Depending on the progression of your metabolic dysfunction, you may have a range of symptoms from mild to severe. If you’ve developed type 2 diabetes, you may suffer from increased thirst, excessive urination, and blurred vision. If you’re at the beginning stages of compromised metabolic health, you may only suffer from mild fatigue or occasionally painful joints. Other physical attributes that might clue you into metabolic syndrome include:

* Acanthosis nigricans (a darkening of the skin on the back of your neck or under your arms)

* Skin tags

* Abnormal menstruation 

* Central obesity (excess weight around the abdomen)

All of these findings are often associated with insulin resistance and metabolic dysfunction.

What Conditions are Associated with Metabolic Syndrome? 

What happens when your blood sugar and insulin are chronically elevated? Your blood vessels are damaged, increasing your risk of stroke or heart attack. Your body becomes inflamed, worsening your risk of developing arthritis at a young age or even certain forms of cancer. Your body is more likely to store fat due to insulin resistance, increasing your body weight over time.[*] With metabolic syndrome, you’re more likely to develop fatty liver disease (which can actually lead to cirrhosis if unchecked), elevated cholesterol, chronic inflammation, central obesity, clotting disorders, hypertension, PCOS, neurological disorders, certain cancers, cardiovascular disease, and stroke. According to the American Institute for Cancer Research, metabolic syndrome confers a 20-60% increased risk of liver, colorectal, endometrial, and postmenopausal breast cancer.[*] 

You are also more likely to develop pre-diabetes, and type 2 diabetes. Per the American Diabetes Association, type 2 diabetes is defined by elevated blood sugars (≥126 mg/dL when fasting) and/or a HbA1c (average blood sugar over a 3-month period) of ≥6.5%. Pre-diabetes is defined by having an HbA1c of 5.7-6.4%.[*]

According to the CDC, about 96 million American adults (more than 1 in 3) have pre-diabetes.[*] 

What are the Risk Factors for Metabolic Dysfunction?

A number of environmental and lifestyle factors affect metabolic health. While genetics may play a role and do certainly load the gun, diet pulls the trigger. High sugar intake, ultra-processed foods, poor sleep, lack of exercise, and stress can all cause metabolic dysfunction. Assuring that all of these pillars of wellness are addressed may be key to improving your metabolic health. The rate of diabetes in the U.S. has increased sevenfold in the past 50 years.[*] Certainly there is more at play here than just genetics. Americans eat more sugar and processed foods than ever. We exercise less, sleep fewer hours, and work ourselves to death. Our metabolic health has not been a priority, but this dysfunction is slowly killing us, so we must take steps to address it. Other factors that contribute to metabolic dysfunction include age, ethnicity, and family history.

How Can I Improve My Metabolic Health? 

There are several ways to minimize your chances of developing metabolic syndrome and the co-morbidities that come with it. If you try all of these interventions—you may even be able to reverse certain metabolic conditions, like type 2 diabetes.

Choose Your Diet Wisely:

• The average American eats the equivalent of 15 tbsp of added sugar in their diet every day.[*] One of the best dietary improvements you can make is minimizing your intake of processed carbohydrates and refined sugars. The World Health Organization gives a recommended limit of 25g of added sugar per day. This isn’t a goal to strive for! I advise my patients to consume 0g of sugar daily.
• There are a number of diets to follow that may improve your metabolic health. As a general rule, reducing sugar intake and prioritizing whole, unprocessed foods is key. Sticking to meats, seafood, vegetables, nuts, seeds, eggs, and berries is a wise way to improve metabolic function. Replace refined sugars with natural sugars from low carbohydrate fruits. If sweetener is needed, stick to stevia, monk fruit, allulose, or erythritol. Limiting overall carbohydrates can be a helpful tactic as well.[*]  
• Virta Health conducted a study in patients with type 2 diabetes who followed a ketogenic, low carbohydrate diet. They found an average weight loss of 30.4 lbs with a 60% reversal rate of their type 2 diabetes, and 94% of participants reduced or eliminated their insulin therapy![*] These are very promising results and 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.[*] 
• Diets that have shown some evidence of success in helping improve metabolic health include Keto[*], Low Carb[*], Paleo[*], Carnivore[*], Atkins[*], Mediterranean[*], and other healthy, whole food diets. 

The common thread? All these diets reduce or eliminate sugar intake. 

Remember: The most appropriate diet is the one that works best with your preferences and lifestyle.

Work on Your Mental Health: 

• Many of us are overworked and underpaid. We are so used to prioritizing everybody else in our lives before ourselves. 
• Released during times of stress, the hormone cortisol puts your body into “fight or flight” mode. Cortisol elevates your blood sugar and is almost guaranteed to worsen your metabolic health.[*] 
• Try your best to manage your stress with relaxation techniques, happiness training, gratitude journals, meditation, exercise, therapy, support groups, and/or yoga. 

Get Adequate Sleep:

• This is always easier said than done, but the healthiest people get an average of 7-9 hours of sleep per night. 
• Proper sleep is essential for insulin function, which in turn dictates your blood sugar levels and fat-burning capacity.[*] 
• People who are sleep-deprived or work third shift often have elevated ghrelin (the hunger hormone) levels.[*] Ghrelin will worsen your food-seeking behavior, making you choose unhealthy options for your meals or snacks. Many studies have shown that individuals with poor or disrupted sleep patterns have increased levels of ghrelin and a higher body fat percentage, particularly women.[*]

Exercise Regularly: 

• Exercise enhances insulin function, making your body more sensitive to the hormone. People who exercise routinely tend to have better blood sugar regulation, lower rates of heart disease, and improved metabolic markers.[*]
• Try to find a way to fit 150 minutes of moderate-intensity aerobic exercise into your week. According to the American Heart Association (AHA) and the Centers for Disease Control (CDC), 150 minutes per week of moderate-intensity activities like biking, jogging, hiking, or swimming will keep your metabolic health optimized.[*]
• Two days per week of strength training is also advised. 
• If regular exercise seems like an insurmountable task—start easy! Simply take the stairs instead of the elevator or walk around your block once per day. 

Other Interventions: 

• Intermittent Fasting: Some studies on I.F. (i.e. fasting for 16 or 18 hours per 24-hour period) show promising results in helping to improve metabolic function.[*] For example, eating between the hours of 12pm-8pm and fasting overnight may help your body burn fat for energy. These hours can easily be shifted to 10am-6pm—whatever works with your schedule. I.F. may help with developing your metabolic flexibility and can be combined with any of the aforementioned diets for improved success.

Note: Intermittent fasting is not appropriate for everybody. Young individuals may find it very easy to skip a meal, but older people on multiple medications may need to consult with a doctor first. I.F. is also not a great fit for people who are pregnant, breast feeding, or have a history of disordered eating.

• Medications: There are a range of FDA-approved medications available that may help decrease body fat, lower HbA1c, increase metabolism, and improve insulin sensitivity. These medications may be prescribed by your family doctor alongside certain lifestyle interventions to help improve your metabolic health.
• Weight loss: A modest 5-10% body weight reduction (i.e., a 10lbs weight loss in a 200lbs individual) may reduce insulin resistance, improve blood pressure, lower triglycerides, and decrease your risk of diabetes.[*]

If you’re in the 88% of individuals with metabolic dysfunction, or if you have a genetic background that predisposes you to metabolic syndrome—don’t fret. You can improve your metabolic health by getting adequate sleep, reducing stress, eating right, and exercising. You may even want to try intermittent fasting - if your schedule allows it! There’s no reason why you can’t be in the 12% of Americans who are metabolically healthy. Start taking steps to optimize your metabolic health today!