Metabolic Optimization: Core Components Of Metabolic Health
The Journey to Metabolic Optimization:
Challenges and Opportunities
While a significant portion of the American population has diabetes (11.6% or around 38.4 million people) (CDC), an incredible 34.2% (more than 1 in 3) have Metabolic Syndrome (CDC). Even for those who wouldn’t be diagnosed with metabolic syndrome, many still have suboptimal metabolic function and may develop Metabolic Syndrome within a few years if corrective action isn’t taken quickly.
Creating a state of robust wellness is a fundamental human aspiration. To feel energetic, motivated, mentally clear, calm, focused, and grounded in one’s body are some of the most important aspects in life. Through a series of articles, a practical map of the metabolic wellness landscape will be presented, providing actionable steps to take along the journey to optimal wellness and increased healthspan. Metabolic optimization is a foundational and key component in this journey.
Not Normal – Optimal!
It’s vital to recognize that metabolic optimization is significantly more than not having diabetes, having a decent but not optimal body composition, having a reasonable lipid profile, or having a ‘normal’ but suboptimal blood pressure.
For robust wellness, goals for metabolic health include:
- A highly developed level of metabolic flexibility and fuel substrate utilization, refined glucose levels and insulin sensitivity, and mitochondrial optimization.
- Optimal body composition including muscle and fat mass, visceral fat (fat around organs), and bone density.
- Lipid and arterial plaque profiles that reduce the risk of a thrombotic (heart attack, stroke, or clot) event to as close to zero as possible.
- Blood pressure levels that significantly reduce stress on the cardiovascular system, kidneys, eyes, and brain.
Creating the above profile of metabolic wellness is a challenging goal and something that would serve almost everyone to strive for in achieving the longest possible healthspan. How deeply one wants to delve into optimization is an individual choice and an ongoing journey.
Metabolism and Healthspan
There are now up to 14 hallmarks of the aging process recognized by the scientific community and this is an area of intensive research and increasing funding. A fundamental component of the aging process is metabolic dysregulation and there is an intricately intertwined relationship between aging processes and metabolic health.
Optimizing metabolic health provides significant benefits in attenuating the hallmarks of aging. The main features of the “westernized” lifestyle, including hypercaloric nutrition and sedentariness, can accelerate aging as they have detrimental metabolic consequences (1). Conversely, lifespan-extending maneuvers including caloric restriction impose beneficial pleiotropic effects on metabolism. The introduction of strategies that promote metabolic fitness may extend healthspan in humans (2). A wide range of approaches to increasing metabolic fitness will be discussed in this series of articles in the light of the hallmarks of aging and healthspan optimization.
Challenges of Modern Society
Unfortunately, the modern environment not only doesn’t support metabolic optimization, it actively works to degrade it. Due to these factors, we aren’t set up for success on the journey to metabolic wellness.
Challenges include:
- Constant exposure to marketing of calorie dense and nutrient-poor foods
- 24/7 access to highly processed foods engineered to taste delicious that undermine our health
- Social structures that challenge good nutritional choices and our motivation
Gifts of Modern Society
Despite these confounding factors, there are many tools available to overcome challenges of the current social paradigms. Although modern society presents great challenges for our health, it simultaneously provides the greatest opportunities for wellness in human history.
Some of these tools include:
- Knowledge. Information is an extraordinarily powerful tool and this series of articles aims to equip you with knowledge aimed at your success on the path to wellness.
- Testing. This is an incredible tool we are fortunate to have at our disposal in the modern scientific era.
- Food access. Although we are surrounded by temptations of unhealthy foods, we also have amazing access to the widest variety of health-supporting foods in human history.
- Supplementation. Although it can feel overwhelming, the range of supplements at our disposal provides a wonderful opportunity to tailor and target metabolic optimization protocols to each individual’s needs based on nutrition profiling, genetics, and testing.
- Medications. Medications are potent tools in the kit of optimization. Although the goal is to use natural means and methods to the greatest extent possible, medications have an important role in the path to optimal metabolic health when used in an informed and target manner.
Being aware of these tools and establishing the mindset and support to utilize them provides incredible opportunities to achieve optimal health beyond what was possible throughout human history. If we choose to embrace the available potential, there is incredible reason for optimism and to feel blessed by the present state of knowledge and opportunity.
Fundamentals of Metabolism
Medicine with Heart is a clinic focused on integral human optimization and healthspan through a multifactorial approach. An essential and foundational aspect of establishing optimal health is generating a state of robust metabolic wellness.
Metabolism encapsulates the chemical processes that take nutrients and transform them into energy to fuel physiological processes. Though the basic definition is simple, the details of this overarching concept is incredibly complex and the outcomes of either metabolic wellness or disorders incredibly profound. Although various aspects of the underlying mechanisms of metabolism will be presented, the primary focus of this blog series regarding metabolic health and optimization will be on the pragmatic aspects of what metabolic wellness looks like and how it can be achieved. To accomplish this, the four primary areas of metabolic health will be reviewed along with potential steps to actualize metabolic optimization. The current article is presented as an overview of core components of metabolic wellness and future articles will delve into details and actionable steps such as testing and various practices and protocols used to provide insight and methods for achieving metabolic optimization.
Core Components of Metabolic Health
There are four core components of metabolic health that together provide a framework for the metabolic state of each individual, each an essential component of foundational wellness. Through an in-depth analysis of the current state of these factors, various action steps involving a multifactorial approach can be taken.
Core aspects of metabolic health include:
- Nutrition and metabolic processing
- Body composition
- Lipid profile
- Blood pressure
By rigorously quantifying and creating protocols to ensure each area of metabolic health is on a path to optimal health, Medicine with Heart establishes a precise and individualized approach for each patient. Lifestyle factors and supplementation are generally the first-line therapies and protocols utilized to establish each person’s baseline of metabolic health. Once it is clear that lifestyle approaches have been well established, further treatments may be added if optimal metabolic health hasn’t been achieved.
Each component may have overlapping and/or separate approaches and protocols, ensuring each person is viewed as unique. Through this method, optimal outcomes can be achieved.
There are various intertwining aspects to integrate through innovative protocols with each component impacting all aspects of metabolic health. By seeing this as a holistic framework, the most significant results can be actualized. Each of these will be covered in depth in future articles and the mechanisms through which they impact the four components of metabolic health presented. These aspects include:
- Mindset
- Nutrition:
- Food
- Supplementation
- Fasting
- Medications
- Sleep
- Exercise
- Stress optimization
- Circadian biology
- Hormetic (beneficial stress) exposure
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Nutrition and Metabolic Processing
The body generally utilizes two fuel sources to generate energy: glucose and fatty acids/ketones. Most people are in a state of utilizing glucose as the primary fuel due to dietary intake predominating in carbohydrates. Glucose is a reasonable fuel source to generate ATP although an optimal physiological state is one of metabolic flexibility where the body is able to easily generate ATP through either glucose or fatty acid involvement in the Krebs Cycle. The capacity to switch rapidly between fatty acid oxidation and glucose oxidation is a key marker of metabolic flexibility.
Metabolic flexibility is the natural state of metabolism as it promotes the ability of an organism to respond or adapt according to changes in metabolic or energy demand as well as the prevailing conditions or activity (1). Changes that impact fuel source can include rest vs. activity, fasting vs. feeding, and predominant fuel source (glucose vs. fatty acids)
A primary goal in the journey to metabolic optimization is to develop a robust state of metabolic flexibility so the body is able to easily adapt to changing demands. This is a state of metabolic health with various ways to test for and establish.
Foundational Components of Nutritional Optimization
Components for optimizing metabolic utilization of our nutrition consists of an integrative framework with the intention of bringing various testable markers to the most desirable levels.
These aspects include:
- Nutritional intake and patterns:
- Nutrition and fasting
- Food
- Supplements
- Nutrition and fasting
- Circadian biology of eating patterns
- Medications (if/as needed)
Nutrition, Metabolic Processing, and Fasting
What we eat is the primary driver of our metabolic state. The aim of the Medicine with Heart Metabolic Optimization Journey is to establish a state of metabolic optimization where the body (that is, the mitochondria through the Krebs Cycle) is able to burn either glucose or fatty acids for fuel efficiently and switch between these substrates easily. This flexibility is a key component to achieving metabolic health in the other three areas: body composition, lipid profile, and blood pressure.
Metabolic flexibility is the natural state of the body and is often lost as we age as a result of frequent and excessive food consumption with minimal fasting windows along with diets emphasizing higher carbohydrate loads. Through various phases of nutritional strategy, such as the foods we eat, how much we eat, and when we eat (including fasting periods and circadian biology), this state of flexibility can be re-established so we can enjoy a more natural physiological state of health.
Body composition
Body composition is the percentages of fat, bone, and muscle that make up our bodies. By establishing ideal and individualized quantities of these components through a variety of lifestyle factors and protocols, we are able to both create and maintain healthy metabolism.
Either a healthy or vicious cycle can develop as fat, muscle, and bone are metabolically active organs with potentially beneficial or detrimental effects. Skeletal muscle, for example, is the major organ in which insulin-mediated glucose uptake by glucose transporter 4 (GLUT4) takes place (2). This means that muscle absorbs glucose from the bloodstream and into muscle tissue, a vital mechanism that assists in health blood sugar regulation. In a future article, we’ll delve deeply into the role body composition plays in achieving optimal health and healthspan.
Lipid Profile
Although there has been significant controversy surrounding the importance of lipid levels in maintaining cardiometabolic health, the current state of science suggests that maintaining healthy levels of Apolipoprotein B-100 (Apo B) is an important component of preventing thrombotic events (heart attack and stroke). An initial goal for Apo B levels is below 70 mg/dL with optimal levels being as low as 30 mg/dL based on individual circumstances and testing. Apo B is a powerful tool for assessment of atherogenic lipid status (3) – the levels of potentially atherosclerotic lipids that could aggregate in vascular walls, increasing cardiovascular disease risk. We are fortunate to have tools available for optimizing Apo B levels including:
- Nutritional strategies
- Supplementation
- Medications
Testing Apo B levels is easy and can be done with a simple blood test. Determining an individual’s target level can be refined through advanced testing, such as:
- A coronary computed tomography angiography (CCTA) scan
- The information gathered by this test can now be run through an advanced AI platform called cleerly
- This innovative test is now available to Medicine with Heart patients
- The information gathered by this test can now be run through an advanced AI platform called cleerly
Based on testing, levels of cardiometabolic risk can be stratified and innovative protocols implemented to halt and potentially even reverse the risk of a thrombotic event. In a future article, we’ll delve into the latest science around mechanisms of cardiometabolic health, leading-edge testing, and state-of-the-art protocols for optimizing lipid levels to minimize the probability of vascular events.
Blood Pressure
The crucial importance of healthy blood pressure levels is often forgotten when considering the spectrum of metabolic health and normal levels are considered to be 120/80. These numbers represent systolic pressure (the pressure in your arteries when your heart pumps) and diastolic pressure (the pressure in your arteries when your heart relaxes).
The American College of Cardiology and American Heart Association define healthy and unhealthy levels of blood pressure as follows:
Although hypertension is a potentially devastating disease, it is usually without symptoms. It is easy and essential to monitor blood pressure to ensure it is kept in the normal range as elevated blood pressure can contribute to numerous serious diseases, including:
- Heart attack
- Atherosclerosis
- Heart failure (a weakened heart muscle)
- Stroke
- Kidney failure
- Vision loss
- Sexual dysfunction
In a future article, we’ll dive deeply into the causes, impacts, testing, and treatment of high blood pressure. For example, you may be surprised to learn that blood pressure is almost always taken incorrectly and we’ll cover how to ensure your readings are accurate.
Conclusion
In this article, we’ve reviewed the crucial importance of seeking metabolic optimization, including:
- The significant impact of disordered metabolism on society
- How social structures lead to poor health decisions
- The hope and tools available to empower us to optimal wellness
- That an optimized metabolism is crucial for healthspan
- The four foundational aspects of metabolic health
- Basic parameters of metabolic health
- The basics of metabolic processing and metabolic flexibility
- Some of the diseases that can be caused by disordered metabolism
In future articles, we’ll dive deeply into each aspect of metabolic health and how to test for and optimize the spectrum of metabolism to actualize a state of robust wellness and healthspan.
References
- Carlos López-Otín, Lorenzo Galluzzi, José M.P. Freije, Frank Madeo, Guido Kroemer, Metabolic Control of Longevity, Cell, Volume 166, Issue 4, 2016, Pages 802-821, ISSN 0092-8674, https://doi.org/10.1016/j.cell.2016.07.031.
- Carlos López-Otín, Lorenzo Galluzzi, José M.P. Freije, Frank Madeo, Guido Kroemer, Metabolic Control of Longevity, Cell, Volume 166, Issue 4, 2016, Pages 802-821, ISSN 0092-8674, https://doi.org/10.1016/j.cell.2016.07.031.
- Goodpaster, B. H., & Sparks, L. M. (2017). Metabolic Flexibility in Health and Disease. Cell metabolism, 25(5), 1027–1036. https://doi.org/10.1016/j.cmet.2017.04.015
- Kim, G., & Kim, J. H. (2020). Impact of Skeletal Muscle Mass on Metabolic Health. Endocrinology and metabolism (Seoul, Korea), 35(1), 1–6. https://doi.org/10.3803/EnM.2020.35.1.1
- Behbodikhah, J., Ahmed, S., Elyasi, A., Kasselman, L. J., De Leon, J., Glass, A. D., & Reiss, A. B. (2021). Apolipoprotein B and Cardiovascular Disease: Biomarker and Potential Therapeutic Target. Metabolites, 11(10), 690. https://doi.org/10.3390/metabo11100690
