When Americans are asked if they are metabolically healthy, 75% of them will answer yes; however, a recent study (2022) done at the University of North Carolina Chapel Hill Gillings School of Global Public Health showed that the metabolic health of Americans is “alarmingly low”.
In fact, in the study of over 8700 individuals, the researchers found that only 12% of Americans were metabolically healthy. That means over 1 in 8 or 88% have some degree of cardiometabolic dysfunction. Cardiometabolic dysfunction is based on elevations of blood sugar and insulin, triglycerides, lipids, or blood pressure. The study researchers claimed several reasons for the findings, but one of the most remarkable was that less than 37% were aware of their personal findings despite having regular care.
Many patients feel they are fine because their annual bloodwork was considered normal, but a deeper look can often uncover dysfunctions years before a diagnosis.
If detailed testing is not done, patients usually do not know there is a problem brewing until they develop symptoms or are ultimately diagnosed with a disease when levels exceed thresholds. For example, when a patient goes to their annual exam and gets bloodwork, they usually get a biometric panel. This panel is a basic screening tool, and normal ranges are based on the average American population, which, for the most part, does not define health. If indices on the biometric panel are out of range, a diagnosis of disease is made. At that point, interventions are harder to manage, and medication is offered.
When we look deeper into metabolic health and consider more in-depth screening interventions can be made before the diagnosis of disease. For example, checking a fasting insulin level, which only costs a few dollars, is rarely done in conventional offices, but when abnormal, it can diagnose pre-diabetes or metabolic disturbances up to 10 years prior to a diabetes diagnosis. It seems obvious to be doing these tests sooner than later.
Markers of metabolic dysfunction include excess body weight, especially centrally located, blood pressures higher than 130/80, elevated lipids or elevated fasting glucose over 90. Early symptoms of metabolic dysfunction may include malaise, weight gain, erectile dysfunction, irregular periods, brain fog, and even anxiety and depression. Patients often do not consider looking at metabolic health when presented with these symptoms.
Assessment for metabolic health includes some of the following tests:
- An InBody Scan looks for body fat percentage and percentage of visceral body fat. For men, the healthy range is between 10-20%. For women, the healthy range is between 18-28%. The cost of the InBody Scan is $35 dollars or $25 with your annual exam at Thrive.
- InBody calculates the recommended Body Fat Percentage ranges for men and women based on ACSM and ACE guidelines.
- Visceral fat refers to the amount of fat hidden and stored around your internal organs. The visceral fat level is measured between a score of 1-20 with 1-9 being the optimal healthy range. Of course, the lower, the better. There is a greater risk of developing hypertension, diabetes, and cardiovascular disease.
- Blood Pressure measurement
- As a general guide, ideal blood pressure is between 90/60mmHg and 120/80mmHg. high blood pressure is 140/90mmHg or higher.
- Fasting Insulin level between 2-5 for optimal health.
- Normal lab ranges can be much higher, but normal does not necessarily mean *optimal* for good health or weight. If you have prediabetes, the cells in your body don’t respond normally to insulin. Your pancreas makes more insulin to try to get cells to respond. Eventually, your pancreas can’t keep up, and your blood sugar rises, setting the stage for prediabetes— and type 2 diabetes down the road.
- Fasting blood glucose levels are optimal when less than 85. Fasting glucose levels of 100 to 125 mg/dL indicate prediabetes and 126 mg/dL or higher indicates diabetes. HBA1C can give you an average of glucose levels over the past 3 months. Optimal HBA1C levels should be less than 5.5%. Hemoglobin A1c levels in the range of 5.6%-6.4% mean you have prediabetes and a higher chance of getting diabetes. Levels of 6.5% or higher mean you have diabetes.
- Cholesterol/Lipid levels. The optimal assessment of lipids is an NMR and ApoB. Total cholesterol levels should be less than 200, however a more detailed assessment with the NMR can look at size and number of particles. Optimal smaller density LDL particles are associated with metabolic health. The goal is to get these smaller particle types to be less than 200 and lower if possible.
- Triglycerides are also a good indicator of metabolic health. These should be less than 85. HDL cholesterol is considered our beneficial cholesterol. Generally, low levels are associated with metabolic dysfunction. Optimally, we want to see the HDL in a 60 mg/dl range. If an NMR is not available, looking at the Triglyceride/HDL ratio may be helpful. A TG/HDL ratio of less than 2 is considered good, but a ratio less than 1 is optimal and suggests less atherosclerotic types of lipid particles.
- The ApoB is a newer assessment of cardiovascular risk. Optimally, we want ApoB to be less than 90. Apolipoprotein B (apo B), a key atherogenic lipoprotein, is a more sensitive measure of lipid-based risk than LDL-C. or total LDL measurement. The apo B level reflects the total number of atherogenic apo B–containing lipoproteins and provides information on LDL particle size, which is difficult to measure directly. High ApoB levels indicate decreased clearance of cholesterol from the blood. ApoB is highly influenced by genetics and is associated with heart disease, stroke, and overall lifespan. ApoB is modifiable, meaning dietary changes and supplement intake can help improve your ApoB levels.
Cardiometabolic assessment helps individuals look deeper into their metabolic health by looking at markers that are precursors to dysfunction and, ultimately, disease.
Since many individuals are unaware of these root causes, they consider themselves free of risk or future disease. Unfortunately, the statistics show this is not true. Addressing metabolic dysfunction early and reversing the abnormalities can change the course of disease development.
A prevention program would include an in-depth look at the markers, which, unfortunately, is not always done in traditional offices. With these results, patients are educated on how to address any abnormalities, specifically through diet and lifestyle interventions, supplements, and education.