Wellness professional Miles Price poses some tough questions about our state of health in the face of the Covid-19 epidemic.
Are you healthy? I mean, metabolically healthy. This is a pertinent question we should all be asking ourselves in the light of the current COVID-19 pandemic. 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.
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Typically, metabolic health screening is picked up during an annual medical, whereby a doctor determines what is metabolically healthy based on fulfilling five criteria. The National Cholesterol Education Program Adult Treatment Panel, back in 2002, devised a definition for what is called metabolic syndrome. Those criteria are based around:
- Fasting triglyceride levels over 150 mg/dL
- Fasting HDL below 40 mg/dL
- Fasting blood sugar over 100 mg/dL
- Waist circumference over 40 inches (men) 35 inches (women).
- Blood pressure 130/85
If a person has three of the five criteria met, then they are classified as having metabolic syndrome, or in other words, they are ‘metabolically unhealthy’.
Metabolism covers many key elements in the body, but by zoning in on glucose and lipid metabolism we can really get a feel as to the likelihood of someone’s future risk of chronic diseases like cancer, heart disease, and diabetes.
However, from a functional medicine perspective, there’s a real issue here, and that is that most people, if tested under those parameters, would pass, giving a false sense of optimal health. In reality, these reference points are set too leniently.
Fasting Triglycerides
Case in point, Fasting Triglycerides is seen to be abnormal above 150 mg/dL – this is way too high. Hyperlipidemia (or high blood fat levels) is when triglycerides are above normal. In healthy adults, the fats are carried in our blood from the food we eat, in small amounts, to provide fuel for the cells. This is different to cholesterol, which is used to build cells and produce several hormones. Studies have shown that when your levels of triglycerides are around 150mg/dL, signs of insulin resistance and other inflammatory markers increase. So, we want to keep the triglycerides at optimal levels, like below 100 mg/dL, to minimize the inflammatory and oxidizing effects on the bloodstream.
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Fasting HDL
HDL levels are classified as low when they are less than 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. 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 oxidize or go awry. However, these protective effects are only applicable if either your triglycerides and LDL are below 100.
What is more productive and predictive is to look at ratios between HDL/TC (total cholesterol) and triglycerides/HDL. For the HDL/TC ratio simply divide your HDL by your TC; the magic number should be greater than 0.24 – generally speaking the higher the ratio the better. A more indicative ratio, however, is triglycerides/ HDL. Studies have shown when people have higher triglycerides to HDL there is a higher level of clotting factors in the blood. A ratio of two or less is considered ideal and anything above four is high. This ratio is one of the most potent predictors of heart disease. Studies have shown that ‘people with the highest ratio of triglycerides/HDL, had 16 times the risk of heart disease, then people with the lowest ratio’.
Fasting Blood Sugar
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 suggest medical intervention. However, a study has shown that fasting blood sugar levels of over above 95mg/dL or more have three times the risk of developing future diabetes, compared to people with levels under 90mg/dL. Additional studies are showing that having a normal FBG level of mid-90s 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.
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Waist Circumference
When it comes to waist circumference levels, less than 40 inches for men and 35 inches for women are set as 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 that 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.
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It is difficult to ascertain visceral fat unless you do CT or MRI scan, so the best way to calculate it as 10 percent from your total body fat. Visceral fat is also calculated with body fat analysers, with ranges indicative of being healthy as less than 13 percent. Anything above 13 percent is unhealthy and the individual is advised to make some 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 Medicine’s website, where a more lifestyle intervention approach is given to improve your metabolic health.
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