Early Warnings of Chronic Disease

Most metabolic issues begin with an excess of calories from a Western diet, which a Continuous Glucose Monitor can track to identify spikes caused by specific meals.

A Continuous Glucose Monitor (CGM) can help individuals identify which specific meals cause dangerous glucose spikes, allowing for dietary adjustments. Dr. Chris Thompson suggested using a CGM for a month or two to understand and correct dietary habits.

"First it's calorie excess, right? So it's in the western diet, it's usually glucose, right? So you have too much glucose around."

"your glucose is shooting up to 200 with"

Clinicians could potentially detect and address metabolic issues 10 to 15 years before a clinical diagnosis, according to Dr. Thompson. However, these crucial warning signs are often missed because fasting insulin is not a routinely measured parameter in standard check-ups.

"They saw that if someone had high fasting insulin, they're more likely to get diabetes long term. It was like a 10 15 year time, they could detect this thing 15 years earlier."

The UNC NHANES study demonstrated that less than one-third of individuals categorized as lean are metabolically healthy, a finding Dr. Thompson described as surprising.

The study evaluated various parameters, including waist circumference, glucose levels, and blood pressure, to determine metabolic health.

Dr. Thompson emphasized the need to look beyond conventional body weight definitions and traditional markers to accurately assess an individual's metabolic state.

"What they found was that less than a third of people that are lean are are metabolically healthy. That's crazy. 12% of the whole population, less than a third of lean people are metabolically healthy."

Insulin's primary role is to clear glucose from the bloodstream, preventing cellular damage, but chronically elevated insulin levels are detrimental.

Frequent eating prevents insulin from returning to a baseline, keeping the body in a constant state of high insulin. Dr. Thompson noted that high glycemic index or high-load foods, especially those containing high-fructose corn syrup, exacerbate these insulin spikes.

Fat infiltrating the liver, muscle, or pancreas serves as an indicator of advanced dysregulation, as these organs are not designed to function as standard energy depots.

This accumulation marks a dangerous metabolic stage, following the initial dysregulation of insulin and glucose metabolism. Dr. Thompson highlighted that this type of fat is particularly problematic for organ function.

"The next thing that happens is ectopic fat... Ectopic fat is where you have fat in cells that it's not their job to store fat, like liver cells or muscle cells or pancreas cells."

Metabolic dysregulation often involves the storage of fat in muscle and liver tissues, with fatty liver identified as a significant health indicator.

Diagnostic tools for visceral fat include waist-to-height ratio, DEXA scans, CT scans, and MRIs, as mentioned by Dr. Thompson. Liver inflammation is frequently identified through elevated ALT levels in routine blood panels.

Insulin resistance can be identified using the Homeostatic Model Assessment for Insulin Resistance (HOMA-IR) formula.

This formula multiplies fasting blood glucose by fasting insulin levels and then divides the product by a constant. Dr. Thompson warned that an insulin resistance ratio exceeding two is clinically significant.

"It's a it's a a fasting blood glucose and a fasting insulin level. And you multiply those and divide it by a constant. And if it's greater than two, you have insulin resistance."

Metabolic flexibility refers to the body's capacity to efficiently switch between burning fat during fasting and carbohydrates after eating.

Metabolic inflexibility develops when the body struggles to access stored fat during fasting and inefficiently processes carbohydrates after meals. Dr. Thompson noted this leads to a higher likelihood of weight gain, obesity, and damage to pancreatic beta cells.

The destruction of pancreatic beta cells, which produce insulin, ultimately leads to further metabolic complications and disease progression.

"you can develop metabolic inflexibility as the next phase of this once you have insulin resistance where when you're fasting, you're not really accessing your fat anymore."

Breath analysis measures the respiratory exchange ratio, which is the ratio of carbon dioxide produced to oxygen consumed, offering insights into metabolic health.

A ratio near 0.7 suggests the body is primarily burning fat, while a ratio closer to 1.0 indicates carbohydrate usage, as explained by Dr. Thompson.

This testing helps assess metabolic flexibility by observing how the body utilizes fat and carbohydrates in both fasted and fed states. New portable devices are being developed for convenient at-home monitoring of these metabolic metrics.

"it's a ratio of a volume of carbon dioxide divided by a volume of oxygen... if that ratio is like 7... that means you're burning fats, right? And if it's one, you're burning carbs."