6 Markers Of Metabolic Health You Should Keep In Mind, From Functional MDs

The cliché sentiment "you can't judge a book by its cover" certainly rings true when it comes to metabolic health. 

While historically, many experts saw weight and obesity as the main issue, it's now clear that's far from the truth. "Obesity is just another marker of metabolic health; it's not the cause," says neuroendocrinologist Robert Lustig, M.D., and author of the upcoming book Metabolical: The Lure and the Lies of Processed Food, Nutrition, and Modern Medicine. "It's downstream of the metabolic problem; it's not the metabolic problem itself."

The reality is, despite any external appearances, most people aren't optimally functioning internally. According to data from the National Health and Nutrition Examination Survey, only one in eight Americans are metabolically healthy. 

That's a pretty big issue considering metabolic dysfunction increases your risk of complications down the road, like heart disease, stroke, heart attack, diabetes, and more, Julie Foucher-Urcuyo, M.D., M.S., says in a recent mindbodygreen podcast episode. What's more, in our current pandemic, "People who are metabolically unhealthy seem to be more at risk of getting severely ill when they do get infected with the virus," she says. 

"Your waist circumference is very important, more important than your weight," says Lustig.

For men, a waist circumference greater than 40 inches would be considered a risk factor of metabolic disease, and for women it's 35 inches. "That's measured at your waist, right above your hip bones, usually at the most narrow part of the waist," says Foucher-Urcuyo. "As metabolic syndrome takes its toll, gaining weight in that abdominal region can add a lot of risk."

"One of the most important markers to me is blood sugar levels before and after eating," says Jeffrey Bland, Ph.D., the father of functional medicine and founder of Big Bold Health.

While your pre- and post-eating blood sugar levels may be a bit harder to test in a regular medical setting, the comprehensive metabolic panel (CMP) does cover your fasting blood glucose. As for proper levels? "A fasting blood glucose of less than 100 mg/dL is considered 'normal,' but most functional doctors prefer for that number to be at around 70 or 80 mg/dL," integrative doctor Kristann Heinz, M.D., R.D., previously told mbg.

Another thing to consider when measuring metabolic health is triglycerides, which are the end product of digesting and breaking down fats in food. Bland says that knowing blood triglyceride levels is crucial for the evaluation of fat metabolism.

While triglyceride measurement can be a bit complex, generally speaking, "a triglyceride level over 100 is questionable, a level over 150 is usually metabolic disease," says Lustig. You can check these numbers with a standard lipid panel, which is a measure of your HDL ("good") cholesterol, LDL ("bad") cholesterol, and triglycerides.

On that same standard lipid panel, you'll also get a reading of your LDL, or "bad" cholesterol levels.

To promote metabolic health, pediatrician and former commissioner of the FDA David A. Kessler, M.D., recommends keeping those LDL levels low. "You have to keep an eye on that LDL because it varies for people," he says in a mindbodygreen podcast episode.

To take that one step further, Lustig says that in his work, he's found it's not enough to know if you have high LDL—you need to know the type of LDL in question. "Eighty percent of the LDL in your bloodstream is irrelevant, it's buoyant LDL or type A. The 20% that matters is slow dense LDL, or type B," he says.

You've likely considered blood pressure an important health standard all your life, considering the signature cuff is commonplace at most doctors' visits—and it certainly plays a role in metabolic health, as well.

While there isn't an exact standard, Foucher-Urcuyo specifies that a reading of 135/80 is a risk factor for metabolic syndrome.

One marker that may be less familiar is uric acid—which is a waste product found in the blood, created when the body breaks down chemicals called purines. High levels of uric acid are commonly associated with gout—a form of arthritis, but that's not the only thing they may indicate, says Lustig.