Are You Metabolically Healthy?
This is a pertinent question we should all be asking ourselves, in the light of the current COVID-19 Pandemic. As it appears that no matter what age you are, 40 or 80, if you’re ‘metabolically’ unhealthy or have signs of metabolic syndrome you’re more likely to suffer a fatality from being infected with COVID-19. Being metabolically healthy also reduces your risk of developing other more slow growing chronic diseases like heart disease, diabetes, cancer or dementia.
These are the 5 criteria for metabolic syndrome:
- Waist circumference over 40 inches (men) 35 inches (women).
- Blood pressure 130/85
- Fasting triglyceride levels over 150 mg/dL
- Fasting HDL below 40 mg/dL
- Fasting blood sugar over 100 mg/dL.
If a person has 3 of the 5 criteria met then they are classified as having metabolic syndrome. Metabolism covers many key elements in the body, but by honing in on glucose and lipid metabolism we can really get a feel for the likelihood of someone’s future risk of chronic diseases like cancer, heart disease and diabetes.
But from a functional medicine perspective there’s a real issue here, which is that most people if tested under those parameters would pass, giving a false sense of optimal health. In reality, these reference points are too lenient. Case in point, 150 mg/dL for Fasting Triglycerides is already way too high. Hyperlipidemia (or high blood fat levels) is where triglycerides are above normal. In healthy adults, fats are carried in small amounts in our blood from the food we eat to provide fuel for our cells. This is different from cholesterol, which is used to build cells and several hormones. Studies have shown that when your triglycerides are around 150mg/dL, signs of insulin resistance and other inflammatory markers increase. So we want to keep the triglycerides at optimal levels, i.e. below 100 mg/dL, to minimize the inflammatory and oxidizing affects on the blood stream.1
Next is HDL, levels are considered low when they are below 40 mg/dL. But levels as low as this are linked to the development of cardiovascular disease. This is especially true if your triglycerides and LDL cholesterol are also high. So the goal is to get to a much higher level around 60mg/dL or above to obtain the protective effects of HDL.2,3 These protective effects are directly due to HDL’s ability to remove LDL from the bloodstream and back to the liver, thus reducing the time spent by LDL cholesterol to oxidise or go awry. But these protective affects are only applicable if either your triglycerides or LDL are below 100mg/dL.
What is more productive and predictive is to look at ratios between HDL/TC (total cholesterol) and triglycerides/HDL. For HDL/TC ratio simply divide your HDL by your TC, and the magic number which should be reached is greater than 0.24 – generally speaking the higher the ratio the better.4 A more indicative ratio however is triglycerides/HDL. Studies have shown when people have higher triglycerides/HDL there is a higher level of clotting factors in the blood. A ratio of 2 or less is considered ideal and anything above 4 is high. This ratio is one of the most potent predictors of heart disease.5
Next is fasting glucose. The level of 100mg/dL again is too high, and on most occasions the test must be repeatedly high for doctors to intervene to suggest medical interventions. However, a study has shown that fasting blood sugar levels of 95mg/dL or more have three times the risk of developing future diabetes, compared to people with levels under 90mg/dL.6 Additional studies show that a normal Fasting Blood Glucose level in the mid 90’s predicts diabetes occurring a decade later. So, from a functional medicine perspective we need to aim for blood glucose fasting to be around 85 or less.7
When it comes to waist circumference levels, less than 40 inches for men and 35 inches for women are set as the benchmarks. Whilst these levels are indicative of metabolic risk, what is of more value is measuring the visceral fat levels inside the body, around the organs. Visceral fat is metabolically active and produces hormones which increase or decrease the risk of metabolic diseases like diabetes or heart disease. Two key hormones related to body fat levels, are adiponectin and leptin. You want your adiponectin levels high and your leptin levels to be low. Studies have shown high leptin levels to be associated with atherosclerosis and heart disease.
It is difficult to ascertain visceral fat unless you do CT or MRI scan, so best way to calculate it is as 10% of your total body fat. Visceral fat is also calculated with body fat analysers with ranges indicative of being healthy as less than 13. Anything above 13 is unhealthy and the individual is advice to make so healthy lifestyle choices.
In conclusion, when discussing your metabolic risk with a suitable health professional it is best to view it through the lens of the functional medicine parameters discussed to obtain a more sensitive and nuanced interpretation of your overall risk. A suitably qualified functional medicine professional can be identified from the institute of functional medicines website www.ifm.org where a more lifestyle intervention approach is given to improve your metabolic health.
- The role of triglycerides in atherosclerosis Beatriz G. Talayero, Frank M. Sacks Curr Cardiol Rep. 2011 Dec; 13(6): 544–552
- Kosmas CE, Martinez I, Sourlas A, et al. High-density lipoprotein (HDL) functionality and its relevance to atherosclerotic cardiovascular disease. Drugs Context. 2018;7:212525. Published 2018 Mar 28.
- Hage MP, Azar ST. Treating low high-density lipoprotein cholesterol: what is the evidence?. Ther Adv Endocrinol Metab. 2014;5(1):10–17.
- Millán J, Pintó X, Muñoz A, et al. Lipoprotein ratios: Physiological significance and clinical usefulness in cardiovascular prevention. Vasc Health Risk Manag. 2009;5:757–765.
- da Luz PL, Favarato D, Faria-Neto JR Jr, Lemos P, Chagas AC. High ratio of triglycerides to HDL-cholesterol predicts extensive coronary disease. Clinics (Sao Paulo). 2008;63(4):427–432.
- Park C, Guallar E, Linton JA, et al. Fasting glucose level and the risk of incident atherosclerotic cardiovascular diseases. Diabetes Care. 2013;36(7):1988–1993. doi:10.2337/dc12-1577
- Shaye K, Amir T, Shlomo S, Yechezkel S. Fasting glucose levels within the high normal range predict cardiovascular outcome. Am Heart J. 2012;164(1):111–116. doi:10.1016/j.ahj.2012.03.023
Guest blog by Miles Price
Functional medicine specialist, Clinical nutritionist
M.Sc. CFMP (FMU, IFM) BANT (UK)
Miles did his initial training at Hawthorn University with an M.Sc. Clinical Nutrition. He followed this up with a professional accreditation to practice with BANT (UK), the British Association of Applied Nutrition and Lifestyle Medicine in 2017. He subsequently obtained a Functional Medicine Diploma with Functional Medicine University in 2017. This was shortly followed by enrolling with the Institute of Functional Medicine on their practitioner program, which has now been completed in 2020. In 2018 he was a Four Seasons Advisor on their menu design, formulating the ‘Well-feeling’ menu creation for Four Seasons Hong Kong. He is also a wellness master for Four Seasons HK.
Miles has written for numerous publications in the SCMP, Asia Spa and Foodie Magazine. He has given numerous presentations at conferences on optimal health, customized medicine and cancer prevention and treatment.