Metabolic Health

August 1, 2023
Dr. Mary Knudsen ND

Are you Metabolically Healthy?

Metabolic Dysfunction is an exciting new term that we are using to describe your metabolic health which can be seen through body composition (the ratio of muscle to fat), early blood markers detecting imbalances and waist circumference.

The Difference Between Subcutaneous Fat and Visceral Fat

Subcutaneous body fat, or the body fat you can pinch, under the skin can actually be metabolically healthy. This is the storage spot for extra carbohydrates and calories that we might eat. The amount of storage we have in our subcutaneous fat varies from individual to individual.

What happens when we eat too many calories, specifically too many carbohydrates? Our body converts excess carbohydrates into fats, which circulate in the blood stream as triglycerides. Then, they will go to fill up subcutaneous fat cells. Once these cells fill up is when we run into problems.

Excess fat starts to spill over into MUSCLES, which is the beginning of insulin resistance. Also into the LIVER which is the start of fatty liver and into the organs around our abdomen which is called VISCERAL (meaning around organs) FAT or VISCERAL ADIPOSE TISSUE (VAT).

VAT is extremely inflammatory and can interfere with the function of many organs including the pancreas which is the boss organ of your blood sugar.

Sometimes, people with less subcutaneous fat, can be at a higher risk for metabolic dysfunction because they have less space for excess fat to go. These otherwise “skinny” individuals with an increased waist-line might be at higher risk for metabolic dysfunction, and should pro-actively get tested.

The Start of Metabolic Dysfunction

Metabolic Dysfunction begins when there is an accumulation of VAT and fatty tissue in muscles which promote insulin resistance.

Remember, insulin tells the cells of our body to uptake glucose or sugar, removing it from our blood stream. When the cells listen to insulin’s message and respond by lowering our blood sugar, they are working well. Sugar moves out of our bloodstream into our cells. This is insulin sensitivity. This is what we want!

Eating too many refined carbohydrates causes too much insulin release and over time, the cells down-regulate their receptors for insulin or “ignore” the message. Imagine the cells getting a bit bratty and saying “this message again!? I’m tired of it, I’m not going to listen.” They stop doing their job of taking glucose out of the blood stream and into the cells. This results in chronic high blood sugar.

This is insulin resistance.

It’s a state where the body is overfed but the cells are starving. Excess blood sugar can damage our tissues – our cells, our blood vessels, our nerves, even our brain!

There is one particular carbohydrate that triggers our body to store more fat – fructose. Fructose breaks down into uric acid (yes, the one that causes gout), which pushes the body to store calories more easily as fat. The worst sources of fructose are pop (which contains high-fructose corn-syrup) and fruit juice. But let’s not be too quick to blame fruit! Eating whole, lower-glycemic fruit such as apples with the peel on and berries, are unlikely to cause metabolic dysfunction. Sucrose, which is table sugar, is about 50/50 glucose and fructose. All sugar has fructose! Let’s get the sugar out of our diets for good! (think sweetened yogurt, sauces with sugar, salad dressings and sugary snacks).

Liquid fructose can cause fatty liver in someone who has never touched a drop of alcohol. This is a shocking discovery!

Metabolic Dysfunction at it’s Worst

When Metabolic Dysfunction and Insulin Resistance progress, the cells are no longer able to burn fat through a process called beta oxidation, when the body burns fat for fuel. This no longer becomes an option, and now the individuals who may need to lose body fat the most, can no longer do it, no matter what they do. We hear your frustration… this is not your fault!

Waist Circumference

A high waist circumference or a waist to hip ratio of greater than 1:1 can be an indication of accumulation of VAT.

Body composition

As Naturopathic Doctors, we are less concerned about the number on the scale and more interested in your body composition, the ratio of muscle to fat in the body, and specifically if that fat is subcutaneous or visceral (around organs).

Symptoms of Metabolic Dysfunction

Elevated blood sugar and blood insulin
Insulin Resistance
Abdominal Weight Gain
Non-alcoholic Fatty Liver
The inability to lose body fat no matter how hard you try

Testing for Metabolic Dysfunction

There are several easy and very inexpensive tests that your naturopath or family doctor can order to assess your blood sugar balance and insulin sensitivity. The goal is to detect imbalances early so that we can be proactive about prevention!

Urate – is a blood test, often used to detect gout, that can be an early indicator of metabolic dysfunction (incidentally, so can gout!). It is a sign that you might be consuming too much sugar.

Triglycerides – is a test that is done on your standard lipid panel. Though it is a test for blood fats, remember it is a reflection of eating too many calories from carbohydrates.

Liver Enzymes – your Naturopathic Doctor will look at OPTIMAL levels of liver enzymes as a way to predict and prevent non-alcoholic fatty liver disease (NAFLD), or a further inflammatory progression of the disease, non-alcoholic steatohepatits (NASH).

Liver Ultrasound – if your liver enzymes and other markers are sub-optimal, your naturopathic doctor may recommend that you ask your MD for an abdominal ultrasound to rule out fatty liver.

Insulin Resistance – You can also request your fasting insulin and fasting glucose and have your naturopathic doctor calculate your HOMA-IR. HOMA-IR stands for Homeostatic Model Assessment of Insulin Resistance, and can determine the presence and extent of any insulin resistance that you might currently have. It is a powerful tool that can detect early insulin resistance when dietary and lifestyle factors are still incredibly effective in the prevention of metabolic dysfunction. I sometimes call a diagnosis of early insulin resistance pre-pre-pre diabetes (yes, I made that up) but patients get really excited to be empowered with information that they can act on NOW.

Symptoms of Metabolic Dysfunction

Cardio-Vascular disease and Type 2 Diabetes

Neuro-Degenerative diseases such as dementia, as increased blood sugar can harm the brain

Increased risk for fatty liver disease that can lead to cirrhosis of the liver. Cirrhosis is when the liver becomes severely scarred and the liver tissue no longer functions. It is the main cause of liver transplants.

Nutrition for Metabolic Dysfunction

There is sound evidence about the benefits of intermittent fasting. Chose an 8-12 hour eating window and fast for 12-16 hours per day. To break the fast, always chose a food with fat and/or protein. Avoid breaking your fast with a carbohydrate such as a piece of fruit which will send your blood sugar soaring.

Your naturopathic doctor may also recommend a low-glycemic program and supplements that have been clinically shown to restore insulin sensitivity. The sooner we get started, the better!