WHAT IT MEANS TO BE METABOLICALLY HEALTHY (PART 1)
Definition of Health
By definition, health is the absence of disease. In other words, if you’re not sick, you ought to be healthy. While that’s a very straightforward explanation, it relies on a common understanding of what the term “disease” means.
For example, most men wouldn’t consider themselves to be sick just because they have a bit of a dad pouch. In fact, I bet few primary care physicians would classify a person as sick just because they have a few extra pounds around their hips. At least, that’s been my experience with friends and family who fall into that category; they were told by their doctors that they’re in perfect health.
The problem is that fat accumulation around the midsection, and specifically around the organs, is often a sign of metabolic dysfunction. If left untreated, it significantly increases your risk of developing a chronic illnesses.
My point is that there are no consensus definitions — among the general population or even among healthcare professionals — of the terms “health” and “disease.”
That’s the primary reason why I decided to write this article. I hope it helps you both better judge how healthy you are and identify ways to improve your metabolic health.
The latter is crucial if you want to reduce your risk factors for developing an avoidable disease, such as the ones mentioned in the beginning of this article.
Definition of Metabolic Health
I’ll be using the term “metabolic health” a lot throughout this article, because it’s arguably the most important indicator of how much you’re at risk for developing a largely preventable chronic disease.
Metabolic health is an indication of how well your metabolism is functioning.
In other words, if you’re metabolically healthy, your body does an excellent job of converting carbohydrates into glucose, fatty acids into ketone bodies, and proteins into amino acids. The former two can then be used for energy, and the latter are turned into the building blocks of muscle tissue or the signaling molecules that help cells communicate.
Additionally, a metabolically healthy body is able to efficiently eliminate waste products via the liver and kidneys.
As you can imagine, if your metabolism isn’t working optimally, then your body won’t be able to properly extract energy and nutrients from the food you eat. This can lead to weight gain, inflammation, an impaired immune system and a host of other issues. In the long run, metabolic dysfunction can significantly increase your risk of developing a metabolic disease, and can make you more susceptible to viral infections.
Unfortunately, many of us are metabolically unhealthy. Dr. Perlmutter — a board-certified neurologist, fellow of the American College of Nutrition, and five-time New York Times bestselling author — estimates that only 12% of Americans are metabolically healthy.
That’s a shockingly low number, but it aligns with the proportion of individuals who are overweight or obese, and the skyrocketing rates of cardiovascular disease, cancer and other metabolic issues.
Now that we’ve established the basics, let’s talk about how you can determine whether or not you’re truly (metabolically) healthy.
Top 12 Factors to Determine How Healthy You Are
Determining how healthy you are isn’t easy because it involves the assessment of several factors, as listed below.
The problem is that some of these factors can be misleading if they’re looked at in isolation. For example, I’ve known several bodybuilders who were fit and as strong as tanks, but who still were not (metabolically) healthy. A person’s appearance alone isn’t always a great indicator of health.
Let’s look at each of these factors and how you can use them together to judge your own health.
If you’re healthy, you should feel great on most days. The problem is that unless you’re in-tune with your body, you might not know what it means to feel good.
For most of my life, I thought I felt good. That was until I started making key lifestyle changes.
In other words, for most of my adult life, I was feeling 60% but thought that was the best I could do. I didn’t know that I wasn’t hitting my peak potential.
On the other hand, if you truly know what it means to feel 100%, then any deviation from that norm can be a clear signal that something is off.
Over the past few years, I’ve become relatively sensitive to any factors that impact the way I feel. Examples include stress, certain foods that reduce my mental clarity, and getting as little as 30 minutes less sleep during a given a night. If any of those things happen, I immediately feel worse.
Of course, “worse” is still worlds better than I used to feel.
As I said previously, the way someone looks isn’t always a great indicator of their health.
For example, if you’ve been following the news, you’ve probably heard anecdotes of “perfectly healthy” people (including marathon runners) who contracted COVID and died.
That’s because a person’s cardiovascular fitness (endurance) and body composition aren’t reliable indicators of their metabolic health.
In my early 20s, I was a professional athlete and worked out up to 13 times per week. So I was in pretty good shape and had excellent cardiovascular markers. That’s one of the reasons why I didn’t pay much attention to sleep or nutrition. In fact, I had an awful diet consisting of fast food, highly processed carbs and sugary soft drinks.
Needless to say, I wasn’t metabolically healthy. But I didn’t recognize the signs, including irritable bowel syndrome (IBS), frequently being sick and injured (caused by a dysfunctioning immune system and chronic inflammation) and the inability to reach my full potential.
The latter I only realized when, in my mid and late 30s, I started lifting heavier weights and surpassing the cardio performance I had 20 years earlier.
The key takeaway here is that someone’s physical appearance, strength and endurance aren’t necessarily indicators of metabolic health. However, if someone is completely out of shape and huffs and puffs after walking up a flight of stairs, chances are that their cardiovascular system isn’t working optimally. And that often goes hand-in-hand with a disturbed metabolism.
More importantly, if someone is overweight or shows signs of central obesity or visceral fat, there is a good chance that their fat and glucose metabolism is severely impaired. Said differently, I don’t know of any mechanism by which someone could be overweight and metabolically healthy at the same time.
The skin is an excellent reflection of someone’s health and diet. Severe skin issues — such as acne, eczema and chronic rashes — are usually solid indications of a dysbiosis in the gut, poor dietary choices or inflammation.
So if you suffer from any of these conditions, I can virtually guarantee you that you have metabolic issues that can likely be fixed by making the proper lifestyle changes (as we’ll discuss further down).
4. Metabolic Flexibility
Metabolic flexibility is your body’s ability to efficiently switch back and forth between using glucose (from carbs) and ketone bodies (from fat) as fuel. Most people don’t have that metabolic flexibility, resulting in low energy levels and dizziness (caused by plummeting blood sugar levels and the inability to access body fat for fuel) if they have to skip a meal or fast for extended periods.
When was the last time you fasted for 20 hours and felt great while doing it?
If you’re metabolically healthy, your body automatically starts burning (body) fat for energy without causing hypoglycemia (low blood sugar) anytime the need arises. That way, you don’t feel crappy when you have to skip a meal or when you miss a snack between meals.
Dr. Cohen's Comment: And vice versa, those on a lower carbohydrate diet need to be able to use carbohydrates effectively for higher performance fuel. More on that in the future.
If you suffer from a dysbiosis of your gut’s microbiome, chances are that your metabolic health is severely impaired.
Signs of issues with your gut microbiota may include constant bloating after meals, frequent diarrhea, irritable bowel syndrome (IBS), Crohn’s disease, ulcers, frequent heartburn and others.
I suffered from IBS for most of my life, as did my father. In fact, he still does. Unfortunately, he hasn’t accepted the connection between his lifestyle and gut issues, despite the fact that I’ve shared everything I know about the topic.
When I first realized that constant bloating and pressure in my abdominal area wasn’t normal, I was told that it’s likely hereditary because my dad had it too (and so did his dad). After all, my paternal grandfather died of stomach cancer before I was born.
But I didn’t realize, until a few years ago, that none of these symptoms are normal and that they could be completely avoided by adopting a healthy diet.
6. Immune System
I used to be sick with viral and bacterial infections several times a year. But I figured it was entirely normal to be sick that often.
The truth is that being sick frequently is a sign of a compromised immune system that often goes back to metabolic dysfunction. On the flip side, a well-functioning metabolism goes hand-in-hand with a healthy immune system.
I noticed a dramatic difference in how often I get sick after I changed my dietary habits and became more protective of my sleep. In fact, I went three years without being sick (until I contracted COVID-19). And even then I had only minor symptoms, such as a mild cough and a loss of smell that lasted two or three days.
The bottom line is that if you’re sick a lot, your immune system and metabolism are likely not functioning as they’re supposed to.
7. Blood Markers and Other Tests
There are several blood markers that I get checked every three months, because they provide an excellent indication of metabolic health. Unfortunately, some of them aren’t even part of the regular blood panel your physician might order during your annual checkup.
While I recommend getting a comprehensive blood panel every few months (below is the entire list of checks my doctor orders), I’ll point out the checks that are most critical (in my opinion) right after the bulleted list: Dr Cohen's Comment: I edited this based on my medical experience. We offer panels such as this at very low pricing and for VIP members at a little bit above costs.
Complete blood count (CBC) with differential
Metabolic panel comprehensive
Hemoglobin A1c (HgA1c)
C-reactive protein (CRP)
Erythrocyte Sedimentation Rate (ESR)
Omega 3 index
Thyroid hormones (TSH, free T3, free T4)
And for men add these:
Testosterone (free and total)
Luteinizing hormone (LH)
CRP is a protein produced by the liver in response to inflammation. Your CRP usually goes up when you’re sick. I’ve also experienced transient increases in CRP right after intense workouts. Neither of these cases are cause for concern.
However, if your CRP is elevated without an apparent reason (e.g., an acute infection), it’s likely due to chronic inflammation caused by a dysfunctional metabolism.
My CRP is usually below 0.3. That indicates the absence of inflammation, which is what you want to see when you’re metabolically healthy.
Unlike your fasting glucose, which offers only a snapshot of your blood sugar levels at a given point in time, your A1c tracks your average blood sugar levels over the past 90 days.
An elevated HgA1c is a sign of blood sugar and insulin sensitivity issues.
For reference, if your HgA1c is above 5.6%, you already have an increased risk of diabetes. Values of 6.5% or higher are consistent with diabetes.
As the name implies, a CGM continuously monitors your blood sugar levels. In combination with a mobile app, the device helps you easily correlate spikes in blood sugar with the food you’ve eaten. More importantly, you can visualize how long your blood sugar stays elevated after a meal.
For example, I’ve noticed that consuming fruits or raw honey causes a rapid spike in blood sugar that recovers quickly, and that I don’t think negatively impact your metabolic health.
On the other hand, if I consume refined grains, I see multiple spikes over the course of several hours, thus taxing my pancreas more than necessary.
Dr. Cohen's Comment: Wearing a CGM periodically is a MUST assessment for everyone!! Perhaps the most important assessment available. Direct feedback to allow you to gauge metabolic health. We have special access to the SuperSapiens app and FreeStyle Libre Sport sensor here.
Your fasting insulin levels are perhaps even more important than your blood sugar markers, because they give you an indication of how sensitive your cells are to insulin.
In the morning (while in a fasted state) your insulin levels should be below 16 ulU/mL, and ideally below 3 ulU/mL.
I didn’t start testing for insulin until 2020. Since then, my levels have consistently been below 3 ulU/mL.
Besides using a high-quality supplement, regular sun exposure before noon without sunscreen is the best solution to improve your levels. During the warmer months of the year, I expose my entire upper body to the sun for 15-20 minutes on a daily basis. Additionally, I supplement with a product from Designs for Health that my doctor prescribes — especially in winter when the sun is less strong here in Georgia.
Dr Cohen's Comment: An optimal level is 50 to 65 ng/dl. Make sure to combine with vitamin K2, omega 3 and magnesium to active vitamin D3. All these are available in our updated DAILY DOSE supplement packets.
The two blood lipid markers I pay close attention to are my high-density lipoprotein (HDL) and my triglycerides. I largely ignore total cholesterol and low-density lipoprotein (LDL) because they’re meaningless for someone who is already metabolically healthy, like I am.
As a rule of thumb, you want your HDL to be as high as possible and your triglycerides to be as low as possible.
My HDL usually hovers between 45 and 55 mg/dL and my triglycerides between 50 and 80 mg/dL, depending on how many carbs I eat.
A huge gap between HDL and triglycerides (with low HDL and high triglycerides) is usually an indication of metabolic issues. The best way to fix that is by removing industrial seed and vegetable oils, as well as highly-processed carbs from your diet.
Dr Cohen's Comment: Ideal is HDL higher than triglycerides.
Considering that the thyroid’s job is to control your metabolism, it shouldn’t come as a surprise that out-of-range thyroid hormone levels are a potential indicator of metabolic dysfunction.
Note that being on a very low carb or ketogenic diet — which is considered healthy by many people — can also negatively impact your thyroid function.
I experienced that first-hand after having been on a strict keto diet for over two years. As soon as I re-introduced clean carbohydrates from raw honey and seasonal fruits, my thyroid levels normalized.
Over the past 100 years, testosterone levels in men (but also women) have been on the decline. While it’s normal to see minor declines of certain sex hormones as you age, the drops we’re seeing across the population are anything but normal.
Very often, the decline in testosterone goes hand-in-hand with a species-inappropriate diet consisting of processed carbs and seed oils, as well as metabolic conditions such as obesity.
As a result, if you suffer from low testosterone levels, chances are there’s something wrong with your metabolism.
Note that when I say “low,” I don’t mean levels below the “normal” range. I’m referring to levels that are in the lower half of the “normal” range. That’s because the “normal” range merely reflects an average across the entire population. As the population’s levels go down, so does the normal range. In other words, if you’re in the lower half, your levels are already too low.
It’s one of the best ways to determine the health of your blood vessels and your risks of developing atherosclerosis — a disease that has long been associated with the consumption of saturated fats and cholesterol.
In reality, bad dental health is likely only a symptom of underlying metabolic issues, nutritional deficiencies and systemic inflammation. In other words, improving your metabolism and reducing inflammation will lead to better dental health (not the other way around).
Anecdotally, I can tell you that I’ve had issues with cavities all of my life, despite brushing my teeth and flossing after every meal. It wasn’t until I changed my dietary lifestyle and fixed my metabolism that I stopped getting cavities. Additionally, the inflammation in my gums has dramatically improved (as measured by a gum score).
Every time I get my teeth cleaned by my dentist, the technician measures my gum score by poking my gums with a pick to see how much bleeding there is on a scale from 1 to 4 (1 being the best). I used to get a lot of 3s and even some 4s, but over the past two years, I’ve been consistently in the 1s and 2s.
A few months ago, my dentist asked me what I’m doing because he’s never seen scores that good. I told him that I changed my diet, but he was in disbelief.
The point is that if you suffer from bad dental health, it’s likely not because you’re doing a bad job brushing your teeth. It’s more likely due to nutritional deficiencies (i.e., a lack of vitamin K2) and inflammation caused by your diet. That’s why bad dental health is a good indicator of metabolic dysfunction. Dr. Cohen's Comment: There are a number of labs now offering oral bacterial health assessments. This is another must do assessment. We use Oral DNA Labs.
9. Chronic Pain
Chronic pain is a fairly obvious sign that something is wrong. I’m not referring to muscle pain due to an injury or accident, but to pain that doesn’t have an obvious root cause. Great examples are headaches, and especially migraines.
While tension headaches can be triggered by stress (see below), they’re often indicators of metabolic issues caused by the wrong dietary choices. Certain chemicals in food, such as the antinutrients found in many plants and the histamines found in aged foods, can cause headaches — a signal from your body to avoid those substances.
Joint pain is also a common response to the accumulation of oxalates (one type of antinutrients) found in such foods as leafy greens like kale and spinach.
Pain is an inflammatory response and while short-term inflammation is important for healing, chronic inflammation is the leading risk factor of metabolic diseases. As a result, if you suffer from chronic pain that’s not caused by an injury or accident, chances are your metabolism isn’t functioning optimally and you might be at an increased risk of developing a preventable disease.
The important message here is that if you suffer from chronic stress due to your lifestyle, you’re at risk of having a weakened immune system and metabolic dysfunction.
Dr. Cohen's Comment: Monitoring HRV (heart rate variability) as a gauge of physical and mental stress is something I do daily. I am excited about the new Hanu Health app which will allow for live HRV tracking and biofeedback breathing exercises to allow you to become more resilient, recover faster and develop a stronger mind-body connection.
Sleep is the foundation of a healthy lifestyle. You can’t be healthy if you don’t sleep well. Your body needs enough quality sleep to run through certain recovery and maintenance programs; if you cut your sleep short, or if the quality of your sleep isn’t where it should be, you prevent your body and mind from managing the stressors of the day.
But in a nutshell, if your bed and wake times are inconsistent, if you have trouble falling or staying asleep, if you don’t spend approximately 40% of your sleep in restorative phases (deep and REM sleep), or if you wake up frequently or feel exhausted every morning (despite sleeping more than 7-8 hours), chances are that your body isn’t functioning optimally and that you’re at a higher risk of developing a metabolic disease.
12. Menstrual Cycle
If you’re a person who menstruates, your cycle should be relatively consistent. The average mensural cycle is 28 days (source). If your cycle is significantly shorter or longer, if you frequently miss periods, if your menstrual flow often changes in volume (e.g., becomes much lighter or heavier) or if you bleed or spot in between periods, that could be an indication of an underlying issue.
If the cause of those issues isn’t hormonal contraceptives and if you’ve ruled out conditions such as uterine polyps or pelvic inflammatory disease (often caused by a bacterial infection), your lifestyle might be the reason why your menstrual cycle is off.
For example, stress, sudden changes in weight, or changes in exercise routine can temporarily impact your period.
Studies have also shown that people with polycyclic overly syndrome (PCOS) are often insulin resistant, suggesting a link between metabolic health and PCOS. The latter can also lead to menstrual issues.
As a result, menstrual problems can be another indicator of metabolic issues that you should take into consideration when assessing your health.