Metabolic Health: Your Best Defense
Most people with COVID-19 have co-morbidities, the most prevalent of which are diabetes, cardiovascular disease, and hypertension.
— The Lancet, April 23, 2020
Obesity and chronic metabolic disease are killing COVID-19 patients.
— Dr Aseem Malhotra, UK Cardiologist, May 2020
… poor metabolic health was the immunity-impairing factor underlying cardiovascular disease, type 2 diabetes and obesity-related cancers that left so many nutritionally-compromised Americans vulnerable to the lethal coronavirus…
— Dr Dariush Mozaffarian, Tufts University
Metabolic disease. Metabolic health.
What do these terms mean for you?
Have you heard these terms and wondered vaguely what they mean? You’ll be hearing them a lot in the future, I suspect, as they’re about to become watch-words in the fight against COVID-19 and future viral epidemics.
As our experience with COVID-19 enters its fourth month, and reports of mad efforts to develop vaccines and treatments headlines our news feeds, you may have also seen articles detailing the equally-alarming epidemic of poor diet, sedentary lifesyle, vitamin D deficiency, and metabolic disease, and it’s relationship to those who succumbed to the virus.
You may be wondering if perhaps YOU have metabolic disease, as this crisis has engendered fear in many people. Do you feel vulnerable? Or, are you confident in the strength of your immune system (metabolic health) to protect you from infectious diseases?
COVID-19 has exposed just how unwell the general population is, and it’s not just people over 50 or 60. It’s becoming obvious that people of any age who are even mildly overweight are at higher risk for type 2 diabetes, cholesterol disorders, and heart disease. Some of these folks fell victim to COVID-19 infection, and made the news as fatalities that were “young and healthy.” But were they?
As more information slowly comes to the surface about the characteristics of those who were critically ill or died from/with COVID-19, the term metabolic disease is coming up often as one of those characteristics, and - as you’ll see below - it may not have been diagnosed before the patient came down with symptoms of the virus.
The elephant in the room is that the baseline general health in many western populations [was] already in a horrendous state to begin with. In the UK and USA, more than 60% of adults are overweight or obese.” - Dr Aseem Malhotra
Because we’re over 50 now and in the age group that’s considered at higher risk for infections (of any kind), as well as the major chronic diseases (cancer, heart disease, arthritis and dementia), the onus is on each of us to understand what metabolic health is, to learn about the risk factors, and also all of the opportunities we have to keep ourselves vibrant and healthy.
What is metabolic disease?
Metabolic disease means that the chemical reactions (metabolism) occurring in our cells as nutrients from food are broken down, then stored or used for energy, are altered, abnormal.
It can happen with an overload of nutrients, a back-up due to waste products, or prolonged exposure to toxic chemicals. Or all three! It is closely linked to overweight and obesity, and thought to be caused by overconsumption of sugars, highly processed carbohydrates and industrial seed oils. Our standard western diet, in other words.
Metabolic disease presents as elevated blood glucose levels, high blood pressure, low good cholesterol (HDL), high triglycerides, and increased waist circumference (belly fat). These are the tests done by doctors to determine whether patients are at risk for diabetes and/or heart disease. If a patient is found to have three or more of those five criteria, they are said to have Metabolic Syndrome.
In medical practice, when we diagnose Metabolic Syndrome, we begin by counselling patients about diet and lifestyle practices to lose weight and improve their blood pressure, blood glucose and cholesterol numbers. Very often, we also turn to the patient’s chart and type up a prescription for medications to help metabolize glucose and/or lower cholesterol.
I’m sure you’ve heard politicians and health care pundits talking about COVID-19 testing, tracing, vaccines and treatments, all as ways to control the transmission of the virus so we can get our lives back to normal. None of those approaches, in my view, will be as effective as a self-care plan focussed on a clean diet of whole foods, regular outdoor exercise in fresh air and sunlight, stress management, and restful sleep. A plan to become metabolically healthy, in other words!
Here’s the good news! For most people, this condition is 100% reversible with the diet and lifestyle hacks you’ll learn below.
What is metabolic health?
Metabolic health is the term used to describe the status of people who DON’T meet the criteria for Metabolic Syndrome.
Most of these people have normal blood pressure, lipid values, and a low normal BMI (body mass index). Specifically, it’s a blood pressure below 130/85, HDL (good) cholesterol above 50 mg/dL (women), waist circumference less than 35 inches (women), and fasting blood glucose levels below 100mg/dL (I prefer values closer to 90).
If you know your numbers (or can get them from your doctor) and you’re currently metabolically healthy, congratulations! You’re at lower risk for serious COVID-19 illness, as well as the chronic diseases mentioned above, regardless of your age.
But, don’t be fooled by how a person looks. Metabolic disease can affect people of ‘normal weight’. Less than one-third of normal weight people in the US fall into the category of metabolic health.
This means there are many people who have an unhealthy lifestyle and/or early signs of metabolic dysfunction on testing, even if they look thin and appear to be fit. It means that they have fat deposited centrally, around their abdominal organs, and are likely to have insulin resistance and generalized inflammation - the very early signs of metabolic syndrome.
As mentioned above, we’ve all heard alarming news reports about the ‘young, fit and healthy person’ who died of COVID-19. Chances are this patient was not metabolically healthy, however. Chances are he or she was mildly overweight, had elevated fasting insulin and low vitamin D levels, ate a diet of mostly processed foods and led a sedentary life - but, looked fit and healthy to the average onlooker. These folks are actually at 3 times higher risk of heart attacks, stroke, and death from all causes than those who are normal weight and metabolically healthy. Turns out, they are also at higher risk for serious illness from COVID-19.
According to Dr Cate Shanahan, MD and nutrition expert, the ultra-processed carbohydrates and polyunsaturated fats in the standard western diet create generalized inflammation in the body, which in some cases overreacts to the virus with the devastating “cytokine storm” that often results in death.
There’s no such thing as a healthy weight, only a healthy person. - Dr Aseem Malhotra
How is metabolic health established? How do you know?
Generally, in mainstream health care, we measure metabolic health by using the above diagnostic criteria for ‘metabolic syndrome’ as well as an interview to discuss dietary habits, exercise routines, work-life balance, and family history.
So, most of my patients have annual blood work that measures fasting blood glucose, hemoglobin A1C (a three month average of glucose values), a cholesterol panel, as well as a complete blood count and thyroid assessment. At their annual physical exam, we look at blood pressure and biometrics - weight, waist circumference and BMI. And we chat about their life.
I believe that metabolic health is determined by vibrant health as well as normal lab values. If I know my patient is active, happy, has good energy and very few medical complaints, is rarely ill with colds or flus, is fit and of normal weight, AND has normal blood pressure and blood tests - I will consider that person truly metabolically healthy.
I have a number of patients who fall into normal weight ranges but, they have abnormal cholesterol values, elevated blood pressure, and high normal fasting glucose levels. They look average, but on closer examination may be stressed or not sleeping, have a family history of cholesterol problems or diabetes, and/or are self-admitted sedentary couch potatoes. These patients, the lean metabolically unhealthy, are at increased risk for chronic disease, and require counselling and ongoing monitoring.
Then, there are obese individuals who test metabolically healthy by these standards. A recent review reported up to 35% of obese persons are metabolically healthy. Whether these folks have an absolute risk of type 2 diabetes and/or cardiovascular disease remains controversial. They too need to be counselled about diet, lifestyle, and the importance of regular follow up.
Want to know if you’re metabolically healthy? Ask your doctor to test your fasting blood glucose, hemoglobin A1C, fasting lipid panel (cholesterol), and Vitamin D3 level (and a fasting insulin, if possible), and measure your waist circumference, height and weight (BMI), and blood pressure. Then have a discussion about your results and what they mean for your metabolic health.
Metabolic health is really about what’s going on at the cellular level.
Metabolic malfunctioning is “subclinical” long before it’s picked up and diagnosed. That means the unhealthy, disruptive changes have already started happening at the cellular level before there is any change in blood work values or blood pressure. It may even be happening before we feel fatigued or notice the upward creep on the bathroom scale.
What’s happening below the surface? Let’s take a trip back in time to high school biology - to cell biology and the parts of the cell.
Basically, human cells consist of a cell membrane, cytoplasm - the gel inside the cell that gives it substance, and a nucleus. The cell membrane is important for transport of nutrients in and out. The nucleus contains the cell’s DNA, as you’ll remember. Organelles (love that name), floating in the cytoplasm, are cellular ‘factories’ that perform vital functions, such as breaking down sugars and removing wastes (ie: metabolism).
bi·o·en·er·gy - renewable energy produced by living organisms.
One very important group of organelles, where glucose is basically broken down (metabolized) and energy is released, is the mitochondria. Our mitochondria are known as the “powerhouses of the cell.” They generate about 90 percent of all the energy molecules (adenosine triphosphate, or ATP) in the body. ATP is our bioenergy.
Mitochondria can be thought of as processing centers on a path that begins with sunlight and ends with ATP.
- Charles W. Schmidt, Environmental Health Writer
Facts about mitochondria:
They break down dietary sugars, created by plants from sunlight energy, to generate ATP energy for all human cells and bodily functions.
They activate the synthesis of important molecules such as heme (for hemoglobin) and steroid hormones.
Acting as ‘canaries in a coal mine,’ they are the first responders to toxic attacks on cellular DNA, sending out warning signals within the cell and to neighbouring cells to launch protective mechanisms.
They orchestrate immunity by monitoring and managing functions within immune cells. This is REALLY IMPORTANT and central to our discussion here of protection from novel viruses, such as COVID-19. They are seen as central hubs of the immune system that can dictate cell fate (life or death), and integrate cell functions and metabolism. There’s that word again!
They are exquisitely sensitive to environmental threats such as pesticides, mold, and heavy metals.
Some pharmaceutical drugs have been considered mitochondrial toxins, and are linked to an array of metabolic and age-related diseases including cancer, type 2 diabetes, neurodegenerative diseases such as Alzheimer’s and Parkinson’s, as well as cardiovascular disease.
When mitochondria are functioning normally, our cells are provided with the energy they need to perform optimally, our tissues and organs work the way they’re supposed to, and we feel great.
But, when mitochondria are damaged or toxic, energy production begins to slow down, waste backs up, and cellular function suffers. Gradually the disruption is felt in tissues and organs. We feel fatigued, listless, stiff and sore. OLD!
Importantly, our immune cells do not function properly when our mitochondria are damaged or decreased in number. So we’re less likely to be able to fight off serious infections, like novel viruses for example.
Mitochondrial dysfunction is one of the hallmarks of aging.
On the other hand, optimally functioning mitochondria can contribute to the extension of a healthy life!
Metabolic disease begins in the cell! It is an alteration in the function of the mitochondria, which results in a disruption in the amount of energy that can be produced from breaking apart the chemical bonds in nutrients.
This, in turn, affects the function of all of our cells, but particularly, immune cells. Mitochondria are much more than just energy-producing furnaces. They modulate immune function, inflammatory responses, aging and longevity.
To stay vibrant, our aim should be to improve our mitochondrial fitness - which means ramping up their efficacy in generating energy and supporting their capacity to avoid and repair damage to their delicate biochemical workings.
Mitochondria are factories of metabolic health! Read more about mitochondria.
How to boost your mitochondria (metabolic health) to beat viruses and stay vibrant!
Calorie restriction
Avoid overeating! Reducing overall calories consumed by intermittent fasting, for example, is the most successful approach to longevity, due to the increase in mitochondrial bioenergetic efficiency - ie they make more energy! Fasting acts as a mild stress signal that triggers mitochondrial action in a good way, otherwise known as hormesis. Read more.
Try intermittent fasting. One easy way is to limit your daily eating to a 10 hour window, say 9 am to 7 pm, or 10 am to 8 pm.
Certain nutrients
Feed your mitochondria! Along with a clean, whole foods diet, B vitamins, minerals, polyphenols and others nutrients such as L-carnitine, alpha lipoic acid, Coenzyme Q 10, and creatine help support mitochondrial health. They can be found in natural, unprocessed foods such as fruits and vegetables, nuts and seeds, seafood and pastured meat and poultry.
Super important! Avoid processed, sugary foods and polyunsaturated seed oils (soy, canola, corn, cottonseed, “vegetable oil”). Read more on how to eat to feed your mitochondria.
The best way to eat to support mitochondria is the Paleo/Primal diet, the one our cells evolved to thrive on. Work with your health care provider to get regular lab tests to prove that it’s working for you!
Exercise
The extra energy needed for physical exercise puts a positive kind of stress on the mitochondria of muscle cells, and the cells respond by producing more mitochondria and upgrading energy production. Here’s the lowdown on types of exercise and mitochondrial function.
Keep moving. Just do it.
Sleep
Good quality sleep helps the brain rest and detoxify. The mitochondria in our brain cells (neurons) power every brain function, and in so doing, accumulate toxic waste. During deep sleep, one of our sleep stages, brain cells are cleared of toxins, which is important to keep our neuron mitochondria healthy. Read more.
Aim for 7-9 hours of restful sleep every night. Consider investing in a sleep tracker so you’ll know you’re getting enough deep sleep.
Stress management and relaxation
Short blasts of stress stimulate mitochondria in a good way (through hormesis), BUT chronic and unrelenting stress is harmful to mitochondrial structure and function. Stress-induced mitochondrial dysfunction is particularly harmful to the nervous (brain), endocrine (hormones), and immune (infection-fighting and aging) systems. Regular relaxation practices such as meditation and yoga have been shown to turn on genes that promote healthy mitochondria.
Make a relaxation practice part of your daily routine.
Sunlight
The right amount of sun exposure is essential for our health. Sunlight triggers the production of vitamin D in our skin, and vitamin D is necessary for optimal mitochondrial activity. Spending time outdoors in the sun has many more benefits! From lowering blood pressure to improving brain function and sleep, getting at least some of our vitamin D from the sun is the way to go. Check out this APP so you’ll have and easy way to track your sun exposure and prevent burning. It’s also wise to supplement with Vitamin D3 during winter months.
Spend up to 20 minutes a day getting unprotected sun exposure (wear a hat and sun block to protect your face.)
Red or near infrared light therapy
Red and near-infrared light can penetrate the skin and act on mitochondria in a beneficial way, which enhances energy production. Natural daylight normally gives us these healthy wavelengths and is optimal, but we can’t always spend the time we need to outdoors due to work, weather or whatever! Using red light therapy or a near infrared home sauna may work as a way for you to get more healthy light. Read more about light therapy.
If you can’t be outdoors in natural daylight for a significant portion of your day, consider home red or near infrared light products.
Cold exposure/heat exposure
The mini shock of a cold shower alternating with the hot tap stimulates an increase in mitochondrial activity and production. Heat and cold both act as mild stress signals that have a positive effect on our mitochondria. Read more about cold and heat therapy.
Turn on the cold tap for 20 seconds to 1 minute at the end of your shower. Alternate with hot, if desired. Take a regular sauna if you can.
Reduce exposures to toxins from your food, water, air and personal products
Mitochondria are exquisitely sensitive to toxins. Working to reduce your exposures, by eating organic, drinking clean filtered water, going green with household products and cosmetics, and getting rid of any toxic mold in your environment is an essential part of a plan to support mitochondrial health. Read more about toxins and mitochondria.
Go green for your mitochondria. Reduce toxins and continue to support with diet and lifestyle metabolic health hacks!
What being metabolically healthy can mean for you:
feeling good every day
sleeping well
youthful appearance and energy
optimistic mood
robust immune system (protection from overreaction to mild viral infections)
enjoying life
glowing skin and silky hair
lean and fit
strong bones
rarely missing out due to illness
AND, normal blood tests and physical measurements!
If everyone was metabolically healthy, we’d all be resilient in the face of viral epidemics and other threats to our health. There would be no need for social distancing or lockdowns. And no need for anxiety, fear or feelings of vulnerability.
Something we can all be working toward to make a better future!