How Metabolically healthy are you?
It is likely you have never really been asked this before and may not really know what it means? Or some readers may already identify as having a sluggish one, or wishing they had a better metabolism. Whatever camp you are in, we need to talk about metabolic health.
The metabolic problem:
Metabolic health is a big issue and it seems to be getting worse. And not just worse for Westerners, in fact metabolic health is becoming a very significant issue in countries such as India, Malaysia, South America and the Middle East. Some experts say that you are metabolically healthy if you don’t have metabolic syndrome, which is a collection of risk factors, including: central obesity, high triglycerides and cholesterol, high blood pressure, impaired glucose tolerance and fatty liver. Essentially, metabolic syndrome is a major risk factor for cardiovascular disease including stroke, obesity, heart attack, vascular dementia and type 2 diabetes.
Rates of this syndrome are alarmingly high and getting higher year upon year. About 2/3 of Adult Australians are in the over-weight or obese category with about 1/3 of Australians have fatty liver. There are over 500 million people world-wide with diabetes and another 500 million have impaired glucose tolerance. Metabolic syndrome affects about 35% of Australians and includes many who suffer from sleep apnoea and poly cystic ovarian syndrome. These numbers are not good, but the story may be much worse.
Health is more than the absence of disease and it is time we talk about metabolic health in terms of optimising health not only for the future but for how we feel today. The good news is, we are 100% in charge of our metabolic health and simply using, improving and optimising your lifestyle is the best medicine we know about. To put it another way: your life is your medicine.
A healthy metabolism means you digest foods and absorb nutrients well, without unhealthy blood glucose spikes, your liver detoxifies effectively, you manage cholesterol, blood sugars and fats well, and your fat tissue does not make excessive inflammatory chemicals. This in turn means that you can manage your weight, sleep, stress , hormones, brain neuro-transmitters and energy levels according to your needs.
Over the past few decades one of the major ways of checking your blood glucose is to use a test called Hb-A1c, this is an indirect way of getting an average blood glucose level over the preceding 3 months. Despite this being a good test, it doesn’t give you the full picture because it doesn’t pick up the high and lows of blood glucose levels and these highs and lows are associated with vascular tissue damage and an increased risk of cardiovascular disease. Another way of looking at it, is that high levels of blood glucose fluctuations put an additional stress on the body, such that it causes cellular damage and chronic low grade inflammation. The body is incredibly adaptable to short term stress, so much so, that we rarely feel any different: energetically, emotionally or metabolically in the short term. It is only after prolonged or severe stress, that the body gives off symptoms that we can pick up. Symptoms such as easy weight gain, fatigue, muscle tension, changes in bowel habits, headaches, hormonal dys-regulation and mood changes to name but a few.
Vively is an innovative and fast growing software company, that offers people a chance to look preventatively at their metabolic health. One way they do this, is to offer the user the opportunity to use a continuous glucose monitor, (CGM), which is a small device that you wear on the outside of your upper arm to measure your bodies blood glucose levels in real time. This means you can see the response of your lifestyle choices and see how they impact on of the key markers of homeostasis: ie what you eat, when you eat, how you eat, when you exercise, how you exercise and to see how other factors such as stress, sleep, illness etc impact your blood glucose levels. The results are often both surprising, illuminating and as a data set, they are starting to paint a very interesting picture indeed!
Given this new way of assessing metabolic health, might we see more of an issue than previously thought?
A CGM, as opposed to looking at the Hb A1c or a series of finger prick blood test, has the additional capability of picking up a more nuanced representation of a person’s glucose patterns; it has the capabilities of assessing glucose variability (how many highs and lows), how long someone spends in or out of the ideal target zone, how many spikes a person has and it gives an estimate of the HbA1c. It also offers the wearer, the opportunity to witness their blood glucose levels during times of stress, times of calm, times of insomnia, or how it responds to alcohol or caffeine, fasting, exercise and hormonal fluctuations. These patterns have not only been helpful for the individual, but as a data set, they are revealing a potentially alarming pattern, which needs further investigation.
Vively has been collecting this data for over 5 months, and we are seeing a higher-than-expected rate of potential metabolic dysfunction. With over 500,000 glucose readings to date in over 411 users, the average max blood glucose (post prandial) reading is 9.8 mmol/l. This places most people into the impaired glucose tolerance zone. ( need more data assessment for this section) Not only that the user can witness in real time the impact of simple lifestyle and dietary changes and see their impact on managing a more optimal glucose regulation pattern.
Note: post prandial means the 2 hours post eating.
Who is metabolically unhealthy?
In 2016, a group of researchers from the University of North Carolina published a paper that estimated that only 12.2% of adults in the United States are metabolically healthy.
In the study, waist circumference, fasting and long-term blood sugar, blood pressure, and blood fats and cholesterol were measured to evaluate metabolic health.
Interestingly the researchers commented that being a normal weight did not protect you from being metabolically unhealthy. In fact, less than 1/3 of normal weight adults were in fact metabolically healthy! Carrying excessive weight, was significantly associated with poor metabolic health, with 99.5% of obese people suffering metabolic dysfunction.
What happens when metabolic health is poor?
One of the largest nutritional studies came out of the UK, called PREDICT program. It involved assessing over 10,000 participants and it found that individuals respond differently to the foods that we eat.
For example, some people find it harder to keep their blood glucose and insulin levels from spiking after food, while others blood fat levels remained high for long periods after eating and some experienced both.
Reasonable changes in blood glucose, insulin, and fat levels post prandially are considered normal, as they are part of the way the body digests food. In addition, the odd blood sugar spike or long raised blood fat level are not going to do a lot of instantaneous damage. However, over time, if these events are frequent and/or severe, they result in long term unhealthy metabolic response, with dire and wide ranging potential effects on the body. Effects such as inflammation, oxidative stress, mitochondrial dysfunction, immune dysregulation, and all the hallmark signs of metabolic syndrome, such as high blood pressure, abdominal weight gain, altered cholesterol levels, impaired liver function and more.
So, how can nutrition improve metabolic health?
Changing what you eat, when you eat and how you eat can have an impact on your metabolic health. Choosing well and seeing in real time the effects of your choices, can have a large impact on your blood glucose levels, and therefore your insulin and blood fat levels too. Over time this can improve your metabolic health and most importantly lower the production of inflammatory chemicals.
A healthy diet should include plenty of high fibre whole foods, including unprocessed and (ideally wild) animal proteins, plant foods like vegetables, fruit, legumes, seeds and nuts, and whole grains, as well as healthy fats, like olive oil, hemp and macadamia nut oil.
Most importantly too, cutting back on processed high sugar foods, such as sweetened drinks, refined grains, and ultra-processed foods, cakes, biscuits, and packaged foods and highly processed fats found in packaged chips, fried foods and more.
How you eat and when you eat can also play a role. Eating a high protein breakfast seems to be very important for setting the roadmap for the day, using apple cider vinegar can help balance blood glucose levels too, taking a walk within 60 minutes of eating, can help the body digest and process the glucose better, and getting a good night sleep is also a boon for stable blood sugars. Simple strategies to manipulate your common choices is a little like discovering some key life hacks!
The huge data pool that Vively is receiving will be a gold-mind for seeing the tendencies and patterns in their users, and also to lay witness to some of the clever and innovative ways people are supporting their own glucose stabilisation program.
Exercise’s impact metabolic health
Exercise is clearly important for maintaining healthy blood glucose levels and the reasons are multi-layers. Exercise releases blood glucose from the cells, into the blood for utilisation. The muscles and liver works collectively to help maintain a regular healthy blood sugar levels independent of meals, such that those who have good muscle bulk, tend to be able to support a healthy metabolism. Those who have a sustained resistance exercise program seem to have an additional way of managing the ups and downs of blood glucose, helping to add a stabilisation factor to their bodies and protecting them for the effects of poor choices. However you can’t exercise your way out of a bad diet, nutrition is as essential to good health as is sleep, sunshine and good relationships. So, despite some people’s seemingly healthy exercise programs, some may in fact be over-exercising and prompting further stress to their already stressed out metabolisms.
Exercise is a vital addition to every person’s health regime, and over 50% of Australians are not reaching the minimal set in the guidelines. The latest physical guidelines released by Harvard recommend at least 150minutes of exercise per week, with 2 sessions that are geared towards strengthening and toning the muscles. However more may be needed to support the reversal of a metabolic condition. Any physical activity is better than none and starting slowly and increasing incrementally is recommended. Exercising after a meal, such as going for a walk, can lower post-prandial glucose levels, where by recognising the transient nature of raised blood glucose with high intensity exercise, is deemed normal and expected and remains consistent with healthy metabolism
Sleep’s impact metabolic health
In addition to your food choices, there are other ways to improve your metabolic health. How much and how well you sleep can affect the way that your body responds to food.
In a recent study published in Diabetologia, which studied the blood glucose levels in 953 participants, showed that blood sugars levels remained high after a poor night sleep, which was made even worse by those who chose to eat a highly sugary breakfast, such as a processed cereal. What was interesting was that the research found that a bad night’s sleep made participants more likely to reach for the highly processed/carbs breakfast, which cause unhealthy spikes in blood sugar. In addition, the research showed that there was a greater impact on your blood sugar control if you went to sleep early as compared to how long you sleep in total.
Glucose, stress and mental health
Links have been found between metabolic health, stress and mood. Although stress is an expected part of life, it is seemingly increasing and we know that chronic stress is bad for metabolic health and it is well documented that stress in the workplace, increases the risk of developing metabolic syndrome. In addition people who suffer from mental health conditions are at greater risk of having issues with blood glucose control.
The likely mechanism may be found by looking at the underlying physiology of stress and the relationship between cortisol ( our stress hormone) and insulin ( our blood glucose control hormone). Chronic long term stress is not uncommon and when combined with a poor diet, poor sleep and minimal physical activity, it add a further burden on your metabolic health.
Metabolic health is critical for long term health: it underpins our day to day mood, energy, digestion, sleep and physical and mental health and productivity. Many of us run on the assumption that if we keep a healthy weight, there will be nothing awry with our metabolism, but research tells us this may not be true. At Vively we are laying witness to some surprising results, even in young adults, that indicate metabolic health may be more at risk than we previously thought, although further investigation is warranted, it may be time to ask yourself “how metabolically healthy am I”?