Chronic disease is crippling our country. Diabetes, heart disease, cancer, Alzheimer’s dementia and kidney disease have been in the top ten causes of death in the US for many years. Unfortunately, in 2020 the percentage of deaths from these diseases has risen dramatically. Many people don’t know that these diseases are related and that they are all associated with poor metabolic health. What many people don’t know is how these diseases are related. They are all associated with poor metabolic health. What’s frightening about this is that most people don’t know that they’re NOT metabolically healthy and only 12% of the US adult population meets the criteria to be considered metabolically healthy! That means 88% of us have a correctable condition that is associated with dying from heart disease, diabetes, cancer, Alzheimer’s disease or kidney disease. Read on to learn how to recognize if you are metabolically healthy and what to do about it if you are not!

Metabolic health is complex and definitions of health vary but measurement of a single hormone can give incredible insight. Sadly, this hormone is rarely tested by traditional practitioners. Insulin is the hormone responsible for getting blood glucose out of your blood and into your cells. When present it tells your body that abundant energy is available, that you have recently eaten and storage of the available nutrients is the primary goal. This means that fat cells (adipocytes), muscle cells and liver cells are all in storage mode. That’s great when you are metabolically healthy and have just eaten. However, like all hormones insulin levels are supposed to recede after the storage task is complete. When that happens the absence of insulin turns on fat burn capacity in the fat cells and glycogen (stored carbohydrate) burning in the liver and muscle cells. This is one way that we keep energy and blood sugar levels up when we are not eating. In 12% of us this is how we live and have done so for thousands of years. What’s happening in the rest of us?

The above labs are in a 28 year old female patient of mine with a family history of diabetes. She has been struggling with persistent weight gain and joint pain despite aggressive dieting and exercise. You can appreciate that her insulin levels are off the chart high. This is a fasting study which means that she hadn’t eaten in over 12 hours. Her insulin should be very low. However, her Hemoglobin A1C which is a marker for blood sugar commonly used to screen for diabetes is normal. A physician ordering typical labs would completely miss the elevated insulin and opportunity to correct the course of this patient who is on her way toward being diabetic!

The cause and mechanism of this leading indicator of metabolic disease are related but different. The mechanism has to do with a term called “resistance.” Resistance occurs in the body whenever an exposure is present for an extended period of time. For example when an annoying background noise like a fan gets “tuned out” by the ears and you don’t know it’s there until it’s turned off and you realize just now loud it was. In a similar manner when a hormone is chronically present the cells “tune it out” by making the receptor for the hormone less sensitive. This in turn results in the organ making the hormone, the pancreas in this example, secrete more of the hormone. As levels climb a cycle of increasing resistance ensues. With insulin the levels will continue to climb until the pancreas can’t keep up and blood sugar levels start to rise. This usually takes YEARS to develop and the opportunity to intervene early is lost when blood sugar is the only marker physicians look for in labs.

Unfortunately, this VERY common scenario occurs for many reasons. Environment, stress, toxins and genetics play a role but the first thing to address and in my experience is generally the primary cause is nutrition. Carbohydrate consumption in any form results in insulin secretion. Broccoli and Skittles both require insulin to be metabolized completely. However, Skittles requires much more due to the quantity of simple sugar and lack of fiber or dietary fat to slow absorption. Eating too many carbohydrates or eating them too frequently will lead to insulin resistance in a susceptible person.

The solution then seems simple. Reduce carbohydrate consumption and eat less frequently. Actually, that simplistic approach is true and does work but like ALL nutrition recommendations there is nuance in application and sustainability. Frequently, the metabolism is so damaged by the time the derangement is recognized that significant restriction even to the point of nutritional ketosis may be required. Fasting is another tool that will bring insulin levels down but again is nuanced in it’s application. If results are slow or a dramatic approach is required I recommend further testing to evaluate for toxicity from heavy metals, organic pollutants or mold in addition to an evaluation of gut, adrenal and immune function. When a root cause is identified the nutrition approach works much faster and with less restriction. Fortunately, metabolic health CAN be restored and carbohydrate tolerance can improve. The earlier we catch this problem the easier it is to correct it and live in optimal health!

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