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
- Typical guidelines are less than 20
- We would like to see that less than eight, and maybe even closer to six
- 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 healthy. You 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.