Importance of Metabolic Health and What You Can Do About It
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Importance of Metabolic Health and What You Can Do About It

Dr Peter Attia refers to the primary aging diseases as the “four horsemen”

  • Cardiovascular disease
  • Cancer
  • Neurodegenerative disease
  • Metabolic disease–a range of conditions from obesity all the way to type 2 diabetes

Today, we are going to focus on Metabolic disease:

What is Metabolic Disease?

The American Heart Association and the National Heart, Lung, and Blood Institute have agreed on the following criteria for Metabolic Syndrome:

  • Waist circumference of 40 inches or more for men, and 35 inches or more for women
  • Triglycerides 150 mg/dL or higher, or taking medication for elevated triglyceride levels, >100 preferred
  • HDL-C of less than 40 mg/dL in men or less than 50 mg/dL in women, or taking medication for low HDL-C levels
  • Blood pressure of 130/85 mmHg or higher, or taking medication for high blood pressure, >120/80 preferred 
  • Fasting glucose of 100 mg/dL or higher, or taking medication for elevated glucose levels

Having metabolic syndrome is defined as having three or more of these.

“I won’t suggest that this is the best way to evaluate metabolic health. I think there are many more nuances that we’re going to go into, but at a minimum, I think everybody should know where they stand on those things.” — Dr. Peter Attia

How does metabolic syndrome feed the other horsemen and those other diseases? If you look at all the analyses of all-cause mortality, cardiovascular mortality, cancer mortality, dementia incidence, all of these things all point in the same direction

Once you have metabolic syndrome, you’re at an increased risk of everything.”

Cardiovascular disease 

A systematic review and meta-analysis of 87 studies involving 951,083 patients found that Metabolic Syndrome is associated with a significant increase in the following: 

  • Risk of cardiovascular disease goes up by 135%
  • Risk of cardiovascular mortality goes up by 140%
  • Rick of all-cause mortality is up by 58%
  • Your MI risk is up by 99%
  • Stroke risk goes up 127%


A study looking at cancer risk found: 

  • A 56% increase in age adjusted risk of cancer mortality if you have met syn
  • In particular, there are a handful of cancers that seem especially impacted by this:
  • Endometrial cancer is seven times as likely
  • Esophageal cancer is almost five times as likely
  • Gastric cancer is about twice as likely
  • Liver and kidney is about twice as likely
  • So there are a handful of cancers that even appear to be especially exacerbated by metabolic syndrome, or by obesity and being overweight
  • Most people understand that smoking is an enormous driver of risk for cancer (it remains the number one environmental trigger of cancer) 
  • But obesity is number 2 
  • And if you look more closely at the data, it’s really Metabolic Syndrome, which obviously overlaps a lot with obesity


Neurodegenerative diseases

  • For Parkinson’s disease, the largest meta-analysis on this study suggests about a 24% higher risk of Parkinson’s disease in those with Metabolic Syndrome compared to those without
  • And just as we see in atherosclerosis, we see that having three of the risk factors for metabolic syndrome is a 31% higher risk of Parkinson’s disease, while having all five, 66% increase in risk.
  • When you look at all forms of dementia, (remember, Alzheimer’s disease is the most prevalent form of dementia, but there are many forms of dementia that are not Alzheimer’s, vascular dementia, Lewy body dementia, frontotemporal dementia) — So all comers, vascular dementia is about a 37% increase in risk. 

Regular/traditional biomarker tests


Guidelines and our ideal range

Triglyceride to HDL cholesterol ratio

  • Guidelines say that should be less than five to one
  • We believe that should be less than one to one, meaning, triglycerides should be less than HDL cholesterol.

Fasting glucose guidelines say less than 99, we strongly recommend Continuous Glucose Monitoring

Fasting insulin

  • Typical guidelines are less than 20
  • We would like to see that less than eight, and maybe even closer to six

Hemoglobin A1C 

  • Less than 5.7 is the cutoff for pre-diabetes, rely heavily on CGM here


Tests to measure Metabolic Health

Oral glucose tolerance test (OGTT) 

Background on OGTT

  • Today, that diagnosis is based on hemoglobin A1C because it is an easy test as opposed to OGTT that takes time and requires drinking glucose. The drawback of moving away from this is doctors are less familiar with the OGTT, and the truth of it is, it’s a far, far more important test because it is a functional test and it gives much more information, including canary in a coal mine information

How an OGTT works and why it is such an important metric for assessing metabolic health

  • 12 hour fast
  • Draw Blood
  • Drink glucola (pure glucose drink)
  • Take blood again in 30 minute intervals, for two hours
  • In each blood draw, they are measure both glucose and insulin levels

Important point: Doing this OGTT test, there are times when you can catch people who effectively have type 2 diabetes even though they aren’t there by hemoglobin A1C

Continuous Glucose Monitor (CGM) 

CGMs will provide a more accurate look at average blood glucose

  • Standard practice is to use hemoglobin A1C, which is measuring the amount of glucose on a hemoglobin molecule, and use that to estimate what the average blood glucose is
  • But CGM allows you to directly calculate the average blood glucose and bypass this idea of using hemoglobin A1C
  • There are a number of factors that can lead to a false implication of the A1C
  • If the red blood cells turn over too quickly or too slowly
  • If the red blood cells are too big or too small
  • If anything suspicious comes out of an OGTT, i.e., that glucose homeostasis is not being met, then use a CGM

What to look for in the CGM data:

  • Average blood glucose, number of peaks, how long it takes to recover from peaks, where the peaks occur in relation to meals versus stress, versus exercise, and the impact of sleep.

Diagnostic tools and tests can be used to help people understand their liver function, those tests can reveal non-alcoholic fatty liver disease, or NAFLD

  • The first telltale sign that somebody has NAFLD is a slight elevation in their transaminases. These are the enzymes, ALT and AST, with ALT being more of an indicator. The goal is to catch this when it’s just liver fat, because NAFLD is 100% reversible

NAFLD is the leading indication for liver transplants in the United States today

  • The majority of people that have failing livers today have it because of cirrhosis brought on by the fibrosis of accumulated liver fat. Historically, this is something we usually saw from alcohol, but now we’re seeing it more from non-alcohol sources, namely, excess adiposity

“This is a real silent epidemic…there are a lot of people walking around out there with NAFLD who are completely unaware.”

We see people walking around with transaminases in the 30s and we think, “well, that’s normal because it is consistent with the population”, that doesn’t mean it’s optimal and it doesn’t mean that it’s healthy. We want to see those transaminases typically in the 20s, not in the 30s




Metabolic Health is in our control, it is the most behavior and decision based

  • When it comes to cardiovascular disease, at the end of the day, if you want to eliminate it, you’re probably going to need medication at some point if your goal is to make sure you never get atherosclerosis.
  • When it comes to cancer, bad luck plays a role in many situations, and we have to rely on early and aggressive screening to make sure that we can catch these things early.
  • When it comes to Metabolic Health, if you’re exercising, sleeping, and having an optimal diet, you’re going to be metabolically healthyYou can control this!

                     The Keys to controlling your Metabolic Health

                      1)    Diet and Nutrition - Calorie restriction, time restricted eating, and whole foods

                      2)    Exercise - Get moving, lift weights, and cardio

                   3)    Sleep - Stay on schedule, remove all light, lower the temperature, supplement 


 Most of our Supplements help fight the "Four Horseman" here are a few that help with Metabolic Health.


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