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How to achieve metabolic health – Diet Doctor

How to achieve metabolic health – Diet Doctor

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Metabolic health has become a popular topic among clinicians and the general public, and for good reason. Poor metabolic health — also called metabolic dysfunction — can increase the risk of diabetes, cancer, cardiovascular disease, dementia, and even Covid-19 complications.

A 2019 publication reported only 12% of Americans were metabolically healthy — defined as having no criteria of metabolic syndrome free of medications.

And the growing problem of metabolic dysfunction is not limited to the United States, but rather is a world-wide epidemic.

But the news isn’t all bad. Scientific evidence and growing clinical experience show that you can improve your metabolic health. And you don’t need expensive drugs or procedures to do it.

You can improve your metabolic health with lifestyle interventions like nutrition and exercise. You just need to find the right advice for you to start making improvements today. If that’s what you’re looking for, you came to the right place!

metabolic-health-cardio


Traditionally, metabolic health is defined as a lack of metabolic syndrome, meaning having no more than two of the following criteria:

  • Waist greater than or equal to 40 inches (102 cm) in men and 35 inches (88 cm) in women
  • Fasting glucose above 100 mg/dL (5.6 mmol/L) or HbA1c above 5.6% (38 mmol/mol)
  • Blood pressure above 120/80 mmHg
  • Triglycerides above 150 mg/dL (1.7 mmol/L)
  • High Density Lipoprotein (HDL) below 40mg/dL (1.04 mmol/L) for men and 50 mg/dL (1.3 mmol/L) for women

Different ethnicities may have different criteria for metabolic syndrome. For instance, South Asians have lower cut-offs for a healthy waist circumference of 35 inches (90 cm) for men and 31 inches (80 cm) for women. And Black Americans with insulin resistance frequently won’t have abnormal triglycerides and HDL, and therefore may not be identified as having metabolic syndrome.

But health is not the same as an absence of disease. So while not having metabolic syndrome is a good starting point, we feel you can do better.

We define metabolic health as not requiring medications for and having healthy levels of the following:

  • body fat, especially minimal abdominal or visceral fat
  • blood sugar, without signs of insulin resistance
  • blood pressure
  • blood lipids, including HDL and triglycerides
  • muscle mass and body composition
  • resting metabolic rate

And we believe you should achieve these goals with a lifestyle that you enjoy, can maintain, and that leaves you feeling energetic and vibrant.


How to achieve metabolic health

Does achieving metabolic health seem difficult or out of reach? Do you look at the list above and think, how am I going to improve so many different aspects of my health? 

The good news is that many people can improve their metabolic health, and can improve multiple aspects of their health all at the same time. 

But the solution doesn’t come in a pill. The solution comes from how you live your life — how you eat, exercise, sleep, and manage your stress. 

Below are the best ways to improve your metabolic health, backed by science.

Nutrition

metabolic-health-nutritious-food

There’s more than one way to eat to improve your metabolic health. However, the best diets all share a few common threads:

  • They are minimally processed. 
  • They contain very little sugar. 
  • They allow you to reduce calories without the need to count calories. 
  • They satisfy your hunger. 
  • They provide adequate nutrition.

You may be able to improve your metabolic health by practically any eating pattern that helps you lose weight.

The key to weight loss, however, is losing mostly fat mass without disproportionately losing muscle mass or reducing your resting metabolic rate.

This can be a tricky balance.

The key is finding a way of eating that you enjoy and can maintain long-term that positively impacts your metabolic health.

But that doesn’t mean you need to lose weight to improve your metabolic health. Some lifestyle interventions can improve metabolic health well before any meaningful weight loss.

Here are some dietary options from which you can choose.


Low carb for metabolic health

Eating a low-carb diet is an effective way to improve all aspects of metabolic health, including insulin sensitivity.

One observational study even suggested improved survival for those with prediabetes who ate a lower carbohydrate diet, and a non-randomized trial reported glucose normalization in over 50% of participants with prediabetes.

Although the data are not consistent, some studies suggest low-carb diets benefit metabolic health above and beyond their effect on weight loss. For instance, a 2006 study demonstrated lower insulin levels in people following a low-carb diet, despite equal weight loss compared to the control diet. And a 2019 randomized trial demonstrated following a low-carb diet improved metabolic syndrome better than a higher carb diet despite no difference in weight or fat mass loss.

Yet another trial showed that a low-carb diet was better than a low-fat diet plus a popular prescription weight loss drug for lowering blood pressure, and just as good at improving HDL and triglycerides. Again, both groups lost the same amount of weight, but the diet with the lower carbohydrate levels achieved better metabolic results.

Improving metabolic health despite equal weight loss suggests that another mechanism is responsible for the health benefits. While the studies don’t define what the mechanism is, they suggest that it could have to do with lower insulin levels caused by lower carbohydrate intake. Further trials are needed to prove this. 

But even those trials that demonstrate greater weight loss with low-carb diets suggest it may be the type of weight loss that has beneficial effects. For instance, low-carb diets can help with fat loss better than other diets. Two randomized trials report significantly greater fat-mass loss with a low-carb diet compared to a low-fat diet.

Summary

A low-carb diet can help improve all aspects of metabolic health. Studies demonstrate low-carb diets are as good as, or in many cases, even better than other diets (such as low-fat diets) for improving metabolic health. Low-carb diets may improve metabolic health even without significant weight loss.


High protein

Eating an adequate amount, or even a high amount of protein is another effective way of improving your metabolic health.

Higher protein diets consistently demonstrate improved blood sugar control, including helping to achieve diabetes remission. As with low-carb diets, some trials report greater metabolic benefits from high-protein diets even without significant weight loss compared to control diets.

One small RCT even reported 100% prediabetes remission with a higher protein diet.

In addition, the data are fairly consistent that most people would improve their lean muscle mass by increasing their protein intake.

What’s a reasonable target amount of protein? As we describe in our protein guide, we define adequate protein as at least 1.2 grams per kilo of reference body weight per day. Increasing that to 1.6 grams per kilo may be even more beneficial for building muscle and improving metabolic health.

Furthermore, the majority of the RCTs demonstrating improved metabolic health with a low-carb diet also increase protein consumption. That leads us to believe that the best approach for metabolic health may be a low-carb, high-protein diet.

Summary

Higher protein intake can help with many aspects of metabolic health including losing weight, building muscle mass, and improving insulin sensitivity. 


Intermittent fasting

Intermittent fasting is a popular dietary trend that limits eating to certain time windows. Studies suggest intermittent fasting can improve insulin sensitivity and metabolic health.

Time-restricted eating is one type of intermittent fasting that involves eating meals in a set time-frame each day, such as between 11 am and 7 pm. A review of studies in healthy subjects showed that eating fewer meals during a shorter feeding window resulted in better glucose and insulin levels.

Another type of intermittent fasting is alternate day fasting. Healthy males who fasted for 20 hours every other day for 15 days showed greater glucose uptake with the same insulin levels, in essence improving their insulin sensitivity.

But not all studies agree. For instance, one RCT that did not control for how much or what the subjects ate didn’t demonstrate a benefit in lean mass for those fasting for 16 hours and restricting their meals to an eight-hour window. And another reported that alternate day fasting less effectively reduced fat mass than a matched degree of daily calorie restriction. There was also no evidence of fasting-specific effects on measured metabolic parameters.

One potential conclusion to draw from these studies is that your diet quality and total calorie intake are still important, even when engaging in intermittent fasting.

Summary

While the data are sparse and inconclusive, various forms of intermittent fasting have the potential to be beneficial for metabolic health. We believe intermittent fasting can be a more powerful intervention when it results in relatively effortless calorie reduction, and when it is combined with another metabolically healthy eating pattern such as a low-carb, higher protein diet.


Other diets for metabolic health

Other dietary approaches can also help improve metabolic health. 

In a review comparing different clinical trials in adults with type 2 diabetes, people who followed a Mediterranean diet for 12 months lost an average of 13.5 pounds (6.2 kilos). This resulted in improvements in blood sugar, cholesterol, and blood pressure.

Another review of Mediterranean diet trials in people with type 2 diabetes found that they are potentially more effective for lowering blood sugar levels than low-fat diets.

A low-carb or keto Mediterranean diet may be even better than a classic Mediterranean diet for lowering blood sugar.

Other studies suggest that Mediterranean diets can help people reduce body fat and their waist size, potentially contributing to metabolic improvements.

And a systematic review of Mediterranean diet studies suggest it is effective for most components of metabolic health.

Plant-based or vegan diets have also been shown to have a beneficial impact on metabolic health, although it’s not clear how much of the effect is due to weight loss vs other characteristics unique to plant-based diets. A systematic review of randomized trials found four out of eight trials demonstrated metabolic benefits with a plant-based diet, with some individual trials demonstrating greater weight loss and metabolic benefits over a “usual care” or the standard American diet. And other trials demonstrate beneficial effects on insulin sensitivity.

Some evidence also supports the beneficial metabolic effects from a lower carb plant-based diet.

Summary

Many different dietary approaches can improve the components of metabolic health. A low-carb, higher protein diet may be the most efficacious, but the key is finding an effective dietary pattern that you enjoy and can maintain long-term.


Exercise

Active senior man having strength exercise with barbell in a gym.

When you are first losing weight through your diet, you may not need to exercise much to maintain lean body mass. But as the weight continues to come off, then exercise becomes more important. And the good news is that exercise becomes more comfortable and more fun as you lose weight!

Studies suggest that high-intensity interval training (HIIT), resistance training, and cardio training all improve glucose utilization, blood pressure, and insulin sensitivity.

However, resistance training is superior when it comes to building muscle.

For maximal metabolic health benefits, it appears a mix of resistance training, cardio, and HIIT may be the best approach.

No matter what your preferred form of movement or exercise, one thing is clear: inactivity can lead to insulin resistance and worsen metabolic health. And regular movement improves metabolic health. But if you stop moving regularly, your metabolic health may worsen. (Move it or lose it!)

You can learn more about the health impacts of exercise in our dedicated exercise guide and the section on exercise in our body composition guide.


Other lifestyle factors

Sleep

Studies show that short-term sleep deprivation raises glucose levels and blood pressure, and worsens insulin resistance and metabolic health.

A chronic sleep disturbance, such as from obstructive sleep apnea, is also associated with worsening metabolic health.

It’s unclear how much sleep is too little, just enough, or too much. Is there a difference in metabolic health in someone who gets six hours of sleep per night instead of eight? Is there a certain amount of lost sleep, or a frequency of bad nights that triggers metabolic dysfunction? We don’t know.

However, scientific studies support that there is an association between metabolic health and sleep. And treating sleep problems may improve metabolic health.


Stress

Short term physiological and psychological stress, such as a sudden illness or sudden threat may induce temporary insulin resistance.This type of insulin resistance reverses when the sudden stress is over. Such a response to short-term stress likely has no long-term negative consequences for metabolic health.

However, it appears that chronic stress and chronic activation of the body’s fight or flight response will potentially lead to persistent insulin resistance and worsening of metabolic health. Since this chronic stress is longer-term, without a sudden onset and quick resolution of the trigger, it may lead to longer-term negative consequences.

The good news is that you can reverse the negative effects. Two small controlled studies demonstrate that meditation alone helped reduce blood sugar and metabolic syndrome in patients with heart disease. Since mindfulness training, yoga, meditation, dancing, singing, and walking in nature can be effective ways to reduce stress, increase well-being and improve overall physical health, they may also help with metabolic health.


Medications and supplements

Old man taking pills

While some medications and supplements may help with individual components of metabolic health, few, if any, truly reverse the underlying problem and meaningfully impact all aspects of metabolic health. Only lifestyle interventions can do that.

Many doctors prescribe metformin for patients with prediabetes and/or insulin resistance. It works by decreasing glucose production by the liver and increasing the insulin sensitivity of cells.

Pioglitazone is another medication that lowers blood sugar by enhancing the body’s sensitivity to insulin. This drug tends to not be as popular as metformin, however, in part due to the potential side effect of weight gain.

Blood pressure medications can improve blood pressure, but many may worsen other components of metabolic health. For instance, beta-blockers can lead to weight gain, potentially worsening other aspects of metabolic health.

Weight loss drugs, such as liraglutide, a GLP-1 agonist medication, can help people lose weight; this may be enough to improve most aspects of metabolic health. However, these drugs come with a cost and potential side effects, and they only benefit you while you are taking them. Once you stop, studies show the weight tends to come back and the metabolic improvements disappear.

Niacin can raise HDL and lower triglycerides, but again, it doesn’t impact the underlying cause of metabolic disease. In fact, it can worsen insulin resistance and raise blood sugar, thereby potentially worsening overall metabolic health.

Berberine has a similar effect to metformin and may improve insulin sensitivity and triglycerides.
However, it has little effect on other aspects of metabolic health.

Green tea may have modest metabolic benefits helping with weight loss and reducing both waist size and blood pressure.

Summary

Multiple medications may improve individual components of metabolic dysfunction, but none address all components of metabolic health or effectively reverse the underlying causes of poor health.


Bodyweight is an incomplete metric to follow for metabolic health. As we mentioned previously, some data demonstrate that you can significantly improve your metabolic health without meaningful weight loss. And if you are losing weight, the type of weight loss may be more important than the absolute amount.

Tracking your body composition — your fat mass, muscle mass, and overall lean mass — gives much better insight into your metabolic health. You can learn more about testing your body composition in our dedicated guide. 

Measuring your waist circumference is the easiest metric for metabolic health. A DEXA scan is likely the most accurate and informative, and a bioimpedance scale bridges the gap between accuracy and availability/affordability.

But metabolic health also involves blood pressure, blood sugar, lipids, and metabolic rate.  

Home blood pressure cuffs are widely available and fairly easy to use. You can learn more in our guide on blood pressure.

Your doctor may order blood tests for your fasting blood sugar or a hemoglobin A1c . But a continuous glucose monitor, a small device that gives you a running reading of your blood glucose level, may be an even more helpful way to monitor your blood sugar. You can learn more about CGMs in our detailed guide

Another helpful metric is your resting metabolic rate (RMR). Your RMR is roughly the amount of energy, or calories, you burn naturally, without exercise, during the day. You can hear a detailed discussion about RMR and how knowing your results may impact your health in our podcast interview with Kirsty Woods, Ph.D


More information on metabolic health 

Are you looking for more information about the individual components of metabolic health? You’re in luck. We have guides on just about every aspect of metabolic health. Here are some of the best places to look for more information.


Get started today to improve your metabolic health

If you want to get started improving your metabolic health today, you may want to explore our low-carb or keto diet guides. You can also sign up for our free 2-week keto low-carb challenge!

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