Metabolic Health Starts Here: 5 Essential Biomarkers to Track
Metabolic health is essentially your body’s ability to make energy from the food that you eat and support optimal organ function. Metabolic health starts with your metabolism, which is responsible for breaking down your foods and creating energy, in addition to influencing your body composition and numerous other functions. Now, more than ever, it’s critical to pay attention to how to support optimal body composition, given the alarming increase in weight gain in adults and kids throughout the pandemic. Medical costs associated with obesity are expected to exceed $1 trillion by 2025.
Generally speaking, your metabolic health measures your metabolism’s ability to maintain optimal levels of blood sugar/insulin sensitivity, blood cholesterol, and blood pressure. Due to our food supply & sedentary, stressful environment, metabolic health of the United States population is disturbingly low. Only 12% of Americans have optimal metabolic health biomarkers; 43% have pre-diabetes or diabetes; nearly 50% have high blood pressure and 38% have high cholesterol. And rather than working to improve the food and lifestyle choices driving this epidemic, the most common solutions are pharmaceutical interventions.
But you don’t have to have diabetes or be overweight to have poor metabolic health. You could be in your mid 30s and be a normal weight and still consistently experience blood sugar spikes throughout the day. One study showed that eating cereal led to blood sugar spikes in the pre-diabetes range (>140 mg/dL) for 80% of adults who did not have diabetes. Everyone benefits from paying attention to their food AND knowing their numbers.
There are a host of symptoms that can give you clues to let you know if you’re metabolically healthy or would benefit from making some changes to improve your health. Some symptoms that can be signs of poor metabolic health include:
- Low energy
- An erratic appetite
- An unstable mood
- Joint or muscle pain
- Poor sleep
The true clinical measures of metabolic health rely on five basic tests: blood glucose control & insulin sensitivity, triglycerides, HDL cholesterol, blood pressure, and waist circumference. Having optimal metabolic health means that you can maintain healthy ranges without the use of medication. See below for the key measurements of metabolic health and why they are important. Note that having numbers within the normal range does not always imply that they are optimal, so see below for both the normal and optimal ranges of each measure.
It is so important to work with a practitioner to get your metabolic health labs checked 1-2 times per year! In addition to routinely reviewing these labs with clients, we create specific nutrition and lifestyle goals together that help with achieving optimal levels and measuring progress. Poor metabolic health is a result of less optimal food and lifestyle habits overtime. While the common conventional medicine recommendation is to prescribe a drug to improve these biomarkers, you cannot medicate your way out of a highly processed diet and expect dramatic health improvements.
1. Blood Glucose Control: Fasting Blood Glucose, HgA1c, and Insulin
Normal Fasting Blood Glucose: 100 mg/dL, Optimal Fasting Blood Glucose: 70-90 mg/dL
Normal HgA1c: 5.7%, Optimal HgA1c: 4.6-5.5%
Normal Fasting Insulin: <12 uIU/mL, Optimal Fasting Insulin: <5 uIU/mL
All of the above are measures for how well your body is able to keep your blood glucose within a normal range. High fasting glucose implies that your body is not able to keep up with the demands that you are placing on it for a number of reasons. Common reasons include eating too much added sugar and not balancing meals with protein, fat and fiber. Other aspects outside of nutrition influence your blood sugar too like having poorly managed stress, having a sedentary routine, and not getting enough sleep.
While fasting blood glucose is more of a measure of short-term blood glucose management, HgA1c provides a measure of your average blood glucose management over the previous three months. A HgA1c between 5.7-6.4 indicates pre-diabetes and >6.0 is indicative of type 2 diabetes. The best way to improve your blood sugar levels, whether you fall in the pre-diabetes/diabetes range or not, is to invest in a continuous glucose monitor (CGM), a sensor that you wear on the back of your arm that reports your blood glucose levels 24/7. Different people have different blood sugar responses to the same meal which means seeing your personalized data helps with personalizing your nutrition needs. This helps you see your time spent in the optimal blood glucose range, which many experts believe to be a more valuable metric than HgA1c, especially for those with Type 1 or Type 2 Diabetes.
In addition to measuring your fasting glucose, it’s also important to measure fasting insulin. Higher insulin sensitivity equates to greater blood sugar regulation. Read more: What You Need to Know About Insulin Resistance
Normal Triglycerides: <150 mg/dL, Optimal Triglycerides: <100
Triglycerides are essentially a measurement of the fat that is circulating in your blood that is often elevated from eating too much sugar. As your body works to store excess calories as fat on your body, it must transport the fat throughout your blood to reach your tissues. Triglycerides are most often elevated when you over consume both calories and processed foods rich in refined carbohydrates and low-quality fats. Extra glucose gets shifted to the liver. Liver converts glucose to the stored form, glycogen. But when your liver is overloaded, it starts to expel triglycerides. Improving blood sugar regulation and improving insulin sensitivity are the best ways to lower triglyceride levels.
3. HDL Cholesterol
Normal HDL Cholesterol: 40 for men, >50 for women, Optimal HDL Cholesterol: 50 for men, >60 for women
The traditional cholesterol markers that are assessed are total cholesterol, high density lipoprotein (HDL) cholesterol and low density lipoprotein (LDL) cholesterol levels. HDL is lovingly referred to as the “good” cholesterol (think H for healthy) and LDL is labeled the “bad” cholesterol (think L for lousy). Cholesterol overall is beneficial for regulating hormones and optimizing cell functioning but may be problematic if it gets too high. For the most part, having high HDL cholesterol can help remove cholesterol from the blood vessels and carry it back to the liver for processing. Since it acts as a scavenger, it can be very beneficial in preventing plaque buildup in the arteries. In addition to wanting HDL levels to be higher, you want LDL levels to be below 100. Checking an NMR lipid profile adds additional value to determine your small LDL particle size and oxidized LDL levels.
4. Blood Pressure
Normal Blood Pressure <120 mmHg systolic and <80 mmHg diastolic
Blood pressure measures the pressure of your blood on your artery walls as the heart pumps blood throughout your body. Systolic blood pressure (the top number given in a blood pressure reading) measures the pressure as your heart pumps, whereas diastolic blood pressure (the bottom number) measures the pressure as your heart relaxes—this is why the systolic number is higher. These numbers typically rise and fall in unison, though there are cases where one may be dysregulated while the other is within a normal range. Too high of a blood pressure can signify that your heart has to work extra hard to pump blood throughout your body, often due to plaque buildup within the heart. It can thus cause undue strain on your heart and blood vessels to keep up with this force.
5. Waist Circumference
Normal Waist Circumference: <102 cm (40 in) for men, <88 cm (35 in) for women
Not all fat is created equal. In fact, fat found around your midsection, called visceral fat, has much worse implications for health than fat deposited around the rest of your body. It is more metabolically active than the other fat in your body (called subcutaneous fat), producing hormones and inflammatory proteins that are tied to an increased risk of developing metabolic conditions such as diabetes and heart disease. People rely so heavily on the scale that they forget the importance of waist circumference. You can have an optimal weight but have a high waist circumference, meaning more visceral fat. The scale is an easy first metric to quickly gauge how you’re doing but it’s incredibly valuable to use other important measurements of your overall health.
Simply having one of the above risk factors increases your odds of developing metabolic diseases like type 2 diabetes, heart disease, or stroke, and having more than one risk factor increases those odds even more. Additional metrics that can add further value include: Total Cholesterol, LDL Cholesterol (less optimal cholesterol), and an NMR Lipid Profile (including small LDL and oxidized LDL).
COVID and Metabolic Health
As we continue to deal with the pandemic, it is important to take control of your metabolic health to lessen your chances of getting severely ill from the virus. Metabolic health plays a crucial role in COVID outcomes, with 78% of ICU admissions and 94% of COVID deaths occurring in those who had at least one marker of metabolic dysregulation and 63.5% hospitalizations attributable to diabetes, obesity, hypertension and heart failure. Even more, the death rates were over 4 times higher in those that had markers of blood glucose dysregulation than those who did not. Multiple studies have documented the clear impact that metabolic dysregulation can have on COVID outcomes, with the most recent study documenting a 75% increased risk of death for each unit increase in markers of metabolic dysregulation.
Though the mechanism is not fully understood, it is theorized that metabolic dysregulation worsens COVID outcomes by creating low levels of inflammation throughout the body through the production of inflammatory cytokines. This inflammation can weaken the immune response, priming the body to be susceptible to a virus. People with metabolic dysregulation also tend to have poorer vascular health and are prone to higher rates of clotting and blood coagulation during illness. There has never been a more important time to work towards achieving optimal metabolic health!
4 Tips for Improved Metabolic Health
While there are many things that you can do to improve your metabolic health, here are four easy and effective places to start:
1) Follow my Optimal Plate Method
Achieving optimal blood sugar levels and lower inflammation means eating non-starchy vegetables (fiber), protein, healthy fats and an optional serving of whole food carbohydrates with each meal. This way of eating helps you feel more satisfied from your meals, allowing you to feel less hungry. The fiber and healthy fats found in this style of eating are key to lowering cholesterol and blood pressure while increasing HDL cholesterol. If you are interested in diving deeper into this framework and how to personalize it for you, sign up for our My Food is Health waitlist.
2) Pre-game with 1-2 Tbsp Apple Cider Vinegar in Water
In our nutrition programs many of our clients wear continuous glucose monitors (CGMs). What our clients can see in their CGM reports is that drinking 1-2 tbsp of apple cider vinegar, mixed in 6-8 fl oz of water before a meal can significantly blunt a blood sugar spike after a meal. The benefits are likely attributed to the acetic acid in vinegar that may interfere with the breakdown of carbohydrates and increases the muscle’s ability to take up glucose. A 2013 study showed that adding vinegar to meals (1 tablespoon at mealtime twice daily), resulted in lower post-meal blood glucose levels. The reductions from the apple cider vinegar were greater than the effect of metformin (a drug used for type 2 diabetes).
3) Prioritize Stress Reduction
While it might seem crazy that stress can impact your health to such a degree, stress creates a host of physiological changes in your body that can lead to a dysregulated metabolism. First, stress activates the renin-angiotensin system, prompting your body to hold onto more water and salt which thus increases blood pressure. Second, stress increases the production of the hormone cortisol. When you’re stressed, the body wants to release rather than store glucose. The end result of these hormonal shifts is to allow more glucose into the bloodstream for energy. This happens even if you do not eat sugary foods!
4) Invest in a CGM
Consider investing in a continuous glucose monitor to understand your blood sugar levels throughout the day. The latest science demonstrates that glycemic variability, more than fasting blood sugar or HgA1c predicts the development of heart disease. Not to mention that glycemic variability (highs and lows) can increase fatigue, depressed thoughts, and more. Many of our clients use Levels Health to order and track their blood sugar levels.
With a continuous glucose monitor, you don’t need to guess how your activity levels and food choices are affecting your blood glucose. Since all foods affect everyone differently, this kind of measurement gives you the best data that can lead to personalized nutrition interventions. Metabolic health begins with maintaining blood glucose within a normal range since it prevents energy crashes, cravings, and stress that can all lead to worsening metabolic health.
Our mainstream culture has a massive blood sugar problem with so many people walking around oblivious to their poorly controlled blood sugar levels. Currently our reactive healthcare system will only grant a patient with uncontrolled type 2 diabetes a CGM that is covered by insurance. The current system is set up so that in order to understand your blood sugar level,you should already be struggling with Type 2 Diabetes in order to access information about your body’s response to meals and exercise. While the technology can be massively beneficial for people to reverse pre-diabetes or even just improve blood sugar levels in non-diabetics, you typically cannot get a doctor to write you a prescription.
One of our clients has pre-diabetes and recently asked her doctor for a CGM prescription, per our recommendations. Her doctor stated that you would not use a type 2 diabetes device for pre-diabetes just like you would not electively use chemo and radiation if you have pre-cancer (like a precancerous polyp), you would wait until full blown colon cancer. It’s difficult to understand how data about blood sugar levels is comparable to chemo and radiation but that is the reactive mentality of the sick care conventional medicine system. Fortunately you no longer need your doctor to write you a prescription thanks to startups like Levels Health that allow you to order a CGM online without begging your doctor for a prescription.
If you are looking to transform your health, start focusing on optimizing metabolic health.
Jamie Foti contributed to this article.