Understanding Metabolic Health and Its Impact
For those who join my online coaching, I always recommend starting with a blood draw. This serves as a baseline, giving us valuable insights into your current health status. One exciting development in recent years is the rise of direct-to-consumer labs, making these essential tests more accessible than ever.
I believe that taking control of your health starts with understanding your metabolic markers. By regularly tracking these markers, you can ensure your cells are functioning properly. Regularly tracking these markers can provide insights into cellular function, helping you and your healthcare provider monitor your health."
Conversely, if you're metabolically unhealthy, various other health problems can arise. Most chronic symptoms and diseases share a common root cause: cellular malfunction. Research suggests that metabolic dysfunction can contribute to cellular issues that may lead to various symptoms
Chronic Conditions Exist on a Spectrum - Mild Symptoms Are Important Clues
Chronic conditions related to poor metabolic health exist on a spectrum—from non-life-threatening issues like erectile dysfunction, IBS, chronic fatigue, acne, and anxiety to more severe conditions like stroke, cancer, and heart disease.
It's crucial to recognize that even mild symptoms today are important clues. These early signs often indicate that more serious health issues could develop if left unaddressed.
“We’ve been taught that disease is often random (or hereditary), and my definitive claim—
that preventing some of the country’s largest killers is within your control—probably sounds surprising.
But when you dig into the scientific literature, you can see a phenomenal picture: People with Good Energy have a drastically lower risk of heart disease (#1 cause of death in the United States), many leading forms of cancer (#2 cause of death), stroke (#5 cause of death), Alzheimer’s disease (#7 cause of death), type 2 diabetes (#8 cause of death), and liver disease (#10 cause of death).
People with Good Energy will be much more likely to recover from pneumonia (#9 cause of death), COVID-19 (#3 cause of death), and chronic lower respiratory diseases (#6 cause of death). Studies show that 70 percent of people with heart disease and 80 percent of those with Alzheimer’s have dysfunctional blood glucose levels.
Poor energy metabolism, which is in part represented by elevated glucose levels, is a target on your back for a slow and painful journey toward death, a shorter life, innumerable brain and body symptoms, and significantly higher costs.”
- Casey Means, MD, Good Energy
By focusing on metabolic health and addressing underlying dysfunctions, we can take proactive steps to improve cellular health and prevent chronic conditions from progressing.
Fortunately, there are specific lab tests are available to help detect these invisible malfunctions within us.
The 11 Key Blood Biomarkers to Access Our Metabolic Health
1. Triglycerides
When we consume more sugar and refined carbs than our liver mitochnodria can handle, the excess is converted into fat and stored in our tissues. This process, known as de novo lipogenesis, was beneficial in our evolutionary past when food was scarce, providing energy during fasting. However, in today's world of constant eating and low physical activity, these fats accumulate in the bloodstream, leading to high triglyceride levels.
High triglycerides are a warning sign that you're consuming too much sugar and refined carbs (like soda, sugary beverages, juices, products with added sugar, candy, refined grains such as bread, crackers, tortillas, chips, cookies, pastries, cakes, cereals) and alchohol while not getting enough physical activity.
Excess alcohol raises triglycerides by impairing liver function and disrupting fat metabolism. When combined with fatty meals, alcohol can worsen post-meal triglyceride levels and deplete antioxidants, further harming metabolic health.
High levels can increase the risk of heart disease, especially when combined with low HDL or high LDL cholesterol.
Normal range: <150 mg/dL
Optimal range: <80 mg/dL
Note: Health experts often suggest that keeping triglyceride levels well below 150 mg/dL may reduce the risk of cardiovascular issues .Studies show that people with triglyceride levels below 81 mg/dL have a 50% lower risk of cardiovascular events compared to those with levels between 110-153 mg/dL.
2. HDL-Cholesterol
Often called 'good' cholesterol, HDL helps remove other forms of cholesterol from your bloodstream and transports it back to the liver for elimination, reducing the risk of plaque buildup, heart disease, and stroke.
HDL is not only a predictor of cardiovascular risk but also has anti-inflammatory and antioxidant properties that protect against artery damage. While research continues to explore HDL's complexities, higher levels of this 'good' cholesterol are generally associated with better metabolic health.
If it’s over 60, it almost doesn’t matter what the other fractions are, as this is a sign of good cardiovascular health. If the HDL is under 40 (men) or under 50 (women), then your predisposition for heart disease is much higher.
- Robert Lustig, MD, Metabolical
Normal range: >40 mg/dL for men and >50 mg/dL for women
Optimal range: 50-90 mg/dL
Note: High levels of HDL (High-Density Lipoprotein) are associated with better metabolic health.
Side Note: Triglyceride to HDL Ratio
Once you have those two biomarkers you can calculate your Triglyceride to HDL Ratio, which according to Dr. Lustig "the best biomarker of cardiovascular disease, and the best surrogate marker of insulin resistance and metabolic syndrome".
“The serum triglyceride (TG), when unloaded of its fat at the adipose tissue, becomes the small dense LDL. Therefore, the TG:HDL (high-density lipoprotein) ratio—the real ratio of bad to good cholesterol—is the best biomarker of small dense LDL, the best biomarker of cardiovascular disease, and the best surrogate marker of insulin resistance and metabolic syndrome.
The reason TGs were ignored until now is that we had statins as treatment for high LDL-C, but until about fifteen years ago, we didn’t have treatment for high TG levels other than diet, which doctors didn’t employ.”
- Robert Lustig, MD, Metabolical
Normal range: Anything about a ratio 2.5 in Caucasian or 1.5 in African Americans is strongly suggestive of insulin resistance.
Optimal range: Less than 1.5, with a target of less than 1 being even better.
Note: This ratio is an important biomarker for cardiovascular disease and insulin resistance.
3. LDL-Cholesterol
Known as 'bad' cholesterol, LDL-Cholesterol can accumulate in your arteries, increasing the risk of heart disease and stroke. Lower levels are considered better for heart health.
However, LDL particle number (LDL-P) is considered a more detailed measure of cardiovascular risk than just looking at LDL cholesterol levels. It reflects the number of LDL particles, including smaller, denser ones that may contribute more to artery clogging.
However, LDL-P testing is less common, often considered a research test, and frequently not covered by insurance, making it more challenging to determine the type of LDL particles (large buoyant vs. small dense) without specialized testing.
“If it’s below 100, the small dense fraction can’t be high enough to be harmful. If it’s over 300, you might have the rare genetic disease familial hypercholesterolemia (FH) and you can’t clear your LDL, in which case a low-fat diet, and likely a statin added, will be essential to prevent a future heart attack. If it’s between 100 and 300, then you need to look at the TG level. If the TG level is above 150, that’s metabolic syndrome until proven otherwise."
- Robert Lustig MD, Metabolical
Normal range: 100-129 mg/dL
Optimal range: <100 mg/dL (for those at risk of heart disease)
Note: Lower LDL levels are associated with reduced risk of heart disease, but LDL particle number (LDL-P) offers a more precise risk assessment, particularly regarding the presence of small dense LDL particles, which are more atherogenic.
4. Fasting Glucose
A high fasting glucose level is a key indicator of insulin resistance, where glucose struggles to enter cells due to blocked insulin signals. Initially, the body compensates by producing more insulin, temporarily keeping glucose levels normal and masking the underlying issue. Unfortunately, insulin resistance can develop unnoticed for years because fasting insulin is not a standard lab test in the U.S., despite being affordable and easy to perform.
Research published in The Lancet reveals that insulin resistance can be detected over a decade before fasting glucose reaches diabetic levels, highlighting a missed opportunity for early intervention. If your glucose levels are rising, it's a significant warning sign of cellular dysfunction, including mitochondrial issues, oxidative stress, and chronic inflammation, all of which disrupt normal insulin signaling
"Every practitioner gets a fasting glucose on all their adult patients, looking for type 2 diabetes. Yet this is the single worst parameter to measure, because it’s the last thing to change. Once the fasting glucose rises over 100 mg/dl (signifying glucose intolerance; 126 means diabetes), metabolic syndrome is in full force, and there are no options for prevention anymore; now you’re in full-fledged treatment mode. But in fact, a fasting blood glucose of 90 is already questionable."
- Robert Lustig, MD, Metabolic
Normal range: <100 mg/dL
Optimal range: 70-85 mg/dL
Note: A blood glucose level above 100 mg/dL is a serious indicator of problems with cellular functioning.
5. Liver Enzymes: AST, ALT, GGT
AST and ALT are liver enzymes that enter the bloodstream when liver cells are damaged, often due to insulin resistance. Elevated levels of AST and ALT are linked to a higher risk of fatty liver and metabolic disease. If ALT exceeds 25, further investigation with your doctor may be needed, as it could indicate liver fat accumulation.
Aspartate aminotransferase (AST) reflects mitochondrial function and can rise due to alcohol use, paracetamol, or hepatitis.
Elevated AST suggests acute liver stress, while elevated ALT indicates chronic metabolic issues, such as liver fat.
GGT, another liver-related enzyme, is a marker for oxidative stress, a key factor in metabolic dysfunction. High GGT levels are strongly associated with an increased risk of type 2 diabetes, cardiovascular disease, cancer, liver disease, and premature death. A GGT level over 35 suggests significant liver issues, warranting further evaluation, such as a liver ultrasound. In such cases, it's crucial to reconsider your sugar and alcohol intake.
Fatty Liver Disease Indicators:
- ALT >25 in Caucasians
- ALT >20 in African Americans
- ALT >30 in Latinos
- GGT >35 U/L
The liver plays a crucial role in metabolism, regulating blood sugar, processing fats, and producing bile for nutrient absorption. When overburdened, the liver can develop fatty liver disease, which now affects nearly 50% of U.S. adults. Insulin resistance in the liver can trigger a harmful cycle of increased insulin production, further worsening metabolic health.
Maintaining good liver function is important for overall health and may impact factors like heart disease risk and hormone balance.
Normal Ranges:
ALT: 7–55 U/L
AST: 8–48 U/L
GGT: 8–61 U/L
Optimal Ranges:
ALT and AST: <17 U/L
GGT: <25 U/L (men), <14–20 U/L (women)
Research suggests that all-cause mortality starkly increases when AST and ALT levels rise above about 17 U/L. For GGT, lowest risk for men is about <25 U/L and women <14 to 20 U/L. Some sources recommend <8 U/L. Sources vary, but these are good targets to aim for.
- Casey Means, MD, Good Energy
6. Uric Acid
Uric acid is a by-product of breaking down fructose and purine-rich foods like red meat, seafood, and alcohol. Rapid consumption of fructose, especially from high-fructose corn syrup in sodas, can spike uric acid levels, leading to various health issues. Excess uric acid causes oxidative stress, disrupts mitochondrial function, and diverts energy production toward fat storage, particularly in the liver, worsening insulin resistance.
Additionally, uric acid triggers systemic inflammation by releasing inflammatory chemicals and increases blood pressure by blocking nitric oxide, which normally relaxes blood vessels. High uric acid levels can crystallize in joints, leading to gout—a painful condition associated with higher risks of type 2 diabetes, kidney disease, depression, sleep apnea, and heart attacks.
Normal Ranges:
Women: 1.5–6 mg/dL
Men: 2.5–6 mg/dL
Optimal Ranges:
Men: <5 mg/dL
Women: 2–4 mg/dL
Note: Levels above 5.5 mg/dL may indicate mitochondrial dysfunction and insulin resistance.
7. HbA1c
Hemoglobin A1c (HbA1c) measures the percentage of glycated hemoglobin, reflecting the average blood glucose level over the past three months. Levels below 5.5% are considered normal, while levels above 6.5% indicate type 2 diabetes. Most adults fall into the gray zone between these numbers. The higher the HbA1c, the greater the fluctuations in blood sugar and the higher the risk for metabolic disease.
Normal Range: <5.7%
Optimal: 5.0-5.4%
8. hs-CRP
CRP is a protein produced by the liver and released into the bloodstream in response to inflammation. The 'high-sensitivity' CRP (hs-CRP) test can detect low levels of inflammation.
This test is a common and accessible way to measure inflammation and is often elevated in individuals with metabolic dysfunction, including obesity, heart disease, type 2 diabetes, leaky gut, Alzheimer's, and sleep disorders like obstructive sleep apnea. hs-CRP levels can also rise during infections.
Ranges:
Low risk: <1.0 mg/L
Moderate risk: 1.0–3.0 mg/L
High risk: >3.0 mg/L
Optimal: <0.3 mg/L
"A study of nearly thirty thousand individuals showed that very low hsCRP (<0.36 mg/L) was associated with the least risk of cardiovascular events, such as heart attack and strok, and the risk steadily increased from there. Even a range of 0.36 to 0.64 mg/L conferred higher risk than <0.36 mg/L, and by the time one reached 0.64-1.0 mg/"
- Casey Means, MD, Good Energy
9. Vitamin D3 (25-Hydroxyvitamin D):
Vitamin D3 (cholecalciferol) is a hormone produced when our skin is exposed to sunlight. It plays a crucial role in immune function, hormone synthesis from LDL cholesterol, and overall health. Low vitamin D levels can indicate systemic issues and are linked to various health problems, including osteoporosis, diabetes, autoimmune diseases, heart disease, and cancer.
Vitamin D is essential for immune system modulation, calcium absorption, and protecting against inflammation. Higher vitamin D levels are associated with better metabolic health, reduced inflammation, and even longer telomeres, which contribute to slower aging. Additionally, vitamin D supports liver function in metabolism, particularly in regulating HDL levels and protecting against endotoxin (toxic substances found in the outer membrane of certain bacteria) damage, crucial for heart and brain health.
Factors like age, skin color, and diet also impact vitamin D levels. As we age, our skin’s ability to produce vitamin D diminishes, making sun exposure or supplementation increasingly important. A protein-rich diet aids in storing vitamin D, which is vital for maintaining immune function, especially during winter months.
Normal Range: 20-50 ng/mL (according to NIH recommendations)
Optimal Range: 40-60 ng/mL (according to research)
10. Homocysteine
Homocysteine is an amino acid in the blood, a natural byproduct of protein metabolism. High levels of homocysteine can be a risk factor for heart disease, as they may promote plaque buildup in the arteries and increase blood clotting. Elevated homocysteine levels can also indicate deficiencies in B vitamins (B6, B12, and folate), which are crucial for its metabolism.
If you have a family history of heart disease, consider asking your doctor to check your serum homocysteine (Hcy) levels. Although not routinely ordered, this test provides valuable insights into how your diet, rather than genetics, influences heart disease risk. Hcy should be cleared from the bloodstream to prevent inflammation in blood vessels. The enzyme responsible for clearing Hcy relies on folic acid, so low folic acid intake, certain chemotherapy treatments, or genetic issues with this enzyme can raise Hcy levels and increase heart disease risk.
Normal Range: 5-15 mcmol/L
11. Fasting Insulin & HOMA-IR
A fasting insulin test determines how well cells respond to insulin. Elevated insulin levels may indicate the presence of toxic fat in cells or inflammation that interferes with normal insulin function.
The HOMA-IR (Homeostasis Model Assessment of Insulin Resistance) can be calculated using fasting insulin and glucose levels. While some doctors may argue that this test is unnecessary, understanding the degree of insulin resistance is important even for those without diabetes.
Research shows that insulin resistance can develop up to 15 years before the diagnosis of type 2 diabetes. Fasting insulin of greater than 15 microunits/ml usually means significant insulin resistance, and risk for metabolic disease. From the glucose and insulin levels together, you can calculate an index called the homeostatic model assessment of insulin resistance (HOMA-IR = glucose x insulin ÷ 405), which assesses your risk for diabetes.
"However, many academic societies (including the American Diabetes Association) don’t advocate getting a fasting insulin level. They have several arguments against it such as cost (about $15), reproducibility, and the fact that fasting insulin doesn’t correlate with BMI—which is exactly the point. It’s not about obesity; it’s about metabolic health. If you don’t measure fasting insulin, you’re missing all the TOFIs—the normal-weight metabolically ill people."
- Robert Lustig, MD, Metabolical
A fasting insulin test measures how well your cells respond to insulin. Elevated insulin levels may indicate the presence of toxic fat in cells or inflammation that interferes with normal insulin function.
The HOMA-IR (Homeostasis Model Assessment of Insulin Resistance) can be calculated using fasting insulin and glucose levels. While some doctors may argue that this test is unnecessary, understanding the degree of insulin resistance is important, even for those without diabetes.
Research shows that insulin resistance can develop up to 15 years before the diagnosis of type 2 diabetes. A fasting insulin level greater than 15 microunits/ml typically indicates significant insulin resistance and an increased risk of metabolic disease. You can calculate HOMA-IR using the formula: HOMA-IR = (glucose x insulin) ÷ 405. This index assesses your risk for diabetes.
Fasting Insulin Ranges:
- Optimal: 2-5 mIU/L
- Concerning: >10 mIU/L
- Significantly Elevated: >15 mIU/L
HOMA-IR Ranges:
- Less than 2.8: Excellent
- 4.3: Average
- Above 4.3: Elevated risk
12. Blood Pressure
While not blood tests, blood pressure and waist circumference are crucial biomarkers to assess yearly. High blood pressure is the most common preventable risk factor for cardiovascular diseases, including heart disease, stroke, and kidney disease. It contributes to vessel damage, causing blockages that restrict blood flow over time.
Blood pressure is closely linked to insulin resistance. Normally, insulin stimulates the release of nitric oxide, which dilates blood vessels. However, in insulin-resistant individuals, this process is impaired, leading to reduced vessel dilation and increased blood pressure.
Normal Range: 120/80 mmHg
13. Waist Circumference
Waist circumference is an important indicator of fat around your abdominal organs, signaling excess energy stored where it shouldn't be. Fat can be stored in three main compartments, each with different risks:
- Subcutaneous fat: The fat under your skin that you can pinch. It's not considered dangerous and isn't linked to increased mortality.
- Visceral fat: Coats the abdominal organs like the liver and intestines. This fat is harmful, promotes chronic inflammation, and raises the risk of disease and early death.
- Ectopic fat: Accumulates inside the cells of organs like the liver, heart, and muscles. It's extremely dangerous, interferes with insulin signaling, and significantly increases disease risk and early death.
Both visceral and ectopic fats are strongly linked to insulin resistance and metabolic disorders. Visceral fat acts like a hormone-secreting organ, releasing pro-inflammatory chemicals that worsen insulin resistance. Ectopic fat disrupts normal cellular functions, particularly insulin signaling.
Normal Waist Circumference:
- Men: <102 cm
- Women: <88 cm
International Diabetes Federation Recommendations:
- Men of South Asian, Chinese, Japanese, and South/Central American descent: <90 cm
- Women of the same groups: <80 cm
- Men of European, Sub-Saharan African, Middle Eastern, and Eastern Mediterranean origin: <94 cm
- Women of the same groups: <80 cm
Bottom Line
Taking control of your health starts with understanding and regularly monitoring your metabolic markers. By identifying and addressing early signs of metabolic dysfunction, you can take proactive steps to improve cellular health, prevent chronic conditions from developing, and optimize your overall well-being.
Thank you,
Ed
