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What is Metabolic Health and how can it impact me?

Introduction

Many consider health to have two distinct components: physical and mental. But there is a third seldom-appreciated dimension that is central to both physical and mental health: metabolic health. Metabolic is derived from the Greek “metabolikos”, meaning “changeable”, and metabolism too has a Greek derivation from “metabole” meaning “a change, a transition”. In health terms, psychiatrist Dr Georgia Ede sums it up neatly: “The word ‘metabolism’ refers to the complicated collection of chemical reactions our cells use to turn food into energy” (Ede, 2024).

Metabolic syndrome

Metabolic syndrome (MetS) is an important aspect of metabolic health and was given prominence by American endocrinologist Professor Gerald M Reaven in his 1988 Banting lecture (Reaven, 1988). Kajee (2023) notes that Reaven described “a syndrome comprising a constellation of cardiovascular risk factors characterised by hyperinsulinaemia [excess secretion of insulin], glucose intolerance, dyslipidaemia [unhealthy concentrations of certain lipids] and hypertension [high blood pressure]. These symptoms, which could all be present in a single individual, is now widely referred to as MetS.”

Metabolic health

According to the Diet Doctor website (Scher and Tamber, 2024), the traditional definition of metabolic health is a lack of MetS, meaning having no more than two of the following:

  • Waist greater than or equal to 40 inches (102 cm) in men and 35 inches (88 cm) in women
  • Fasting glucose above 100 mg/dL (5.6 mmol/L) or HbA1c [a measure of blood glucose concentration over the previous three months] above 5.6% (38 mmol/mol)
  • Blood pressure above 120/80 mmHg
  • Triglycerides above 150 mg/dL (1.7 mmol/L)
  • High Density Lipoprotein (HDL) below 40mg/dL (1.04 mmol/L) for men and 50 mg/dL (1.3 mmol/L) for women”

However, Scher and Tamber (2024) also helpfully define metabolic health in more accessible terms as not requiring medications for, and having healthy levels and measurements of:

  • body fat, especially minimal abdominal or visceral fat
  • blood sugar, without signs of insulin resistance [a reduced response to the hormone insulin]
  • blood pressure
  • blood lipids, including HDL and triglycerides
  • muscle mass and body composition
  • resting metabolic rate

Importantly, Scher and Tamber (2024) emphasise that metabolic health can be achieved by making lifestyle changes.

How widespread is MetS?

In a study of 34,821 subjects from ten European countries and one cohort from the United States, Scuteri et al (2015) reported that MetS “had in general a 24.3% prevalence (8468 subjects) that increased with advancing age (from 3.7% with age 20 – 29 years to over 30% with age 70 years …”.

And in a more recent study from Ireland, McCarthy et al (2022) analysed data from over 5000 participants aged 50 years or more. They concluded that MetS is highly prevalent in older adults in Ireland, affecting 40% of the 1.2 million population aged 50 years or more. Further, “[i]ncreasing age, male sex, lower educational attainment, and lower physical activity were all associated with an increased likelihood of MetS.”

Impact of poor metabolic health

Someone well placed to consider this aspect is Combe Grove’s Dr Campbell Murdoch, a GP with a special interest in metabolic health who works within the NHS in Somerset. Campbell finds that metabolic health is the most frustrating and hopeful part of his GP work: “Frustrating, because it is the cause for so much ill health; hopeful, because once recognised it can be improved rapidly, often within days to weeks.”

Interestingly, of all the patients Campbell sees in his busy NHS practice, around half experience health problems attributable to poor metabolic health: “Conditions are broad- ranging,” he explains, “ including high blood pressure, type 2 diabetes, arthritis, leg ulcers, skin conditions, infections, fertility problems, menopausal symptoms, prostate issues, cardiovascular disease (CVD), some cancers, mental health problems, kidney disease, liver disease, and even conditions such as dementia.”

A range of studies confirms the diverse manifestations of poor metabolic health.  For example:

  • In a prospective cohort study of 476,986 participants with undiagnosed bladder cancer based on the UK Biobank, Fang et al (2022) found: “Bladder cancer risk increased with the number of MetS components.”
  • Using a weightadjusted waist circumference index (WWI) as an obesity metric, Tao et al (2024) investigated the association of WWI with CVD and mortality in 12,641 patients with MetS. They found: “As WWI values escalated, there was a proportional rise in the risk of CVD and mortality in MetS.”
  • In an American study of 1,015 participants, Limon et al (2020) found that “MetS was adversely associated with depressive symptoms and poor mental health-related quality of life. Our cross-sectional results suggest that depressive symptoms are higher among women with MetS.”
  • Salvi and Hajek (2019), reflecting on the relationship between MetS and severe mental disorders, state: “… that MetS, which is highly prevalent in patients with bipolar disorders and schizophrenia and tends to increase over time, contributes to cognitive decline and brain ageing in schizophrenia and even interferes with the efficacy of cognitive remediation therapy.”
  • In a recent narrative review of MetS and psoriatic arthritis (PsA), Williams et al (2024) note that “MetS is particularly prevalent in PsA compared to other inflammatory arthritides. Cohort studies indicate a higher risk of PsA in individuals with obesity … Weight loss interventions have been shown to reduce disease activity in PsA. Additionally, MetS negatively impacts the efficacy of tumour necrosis factor inhibitor drugs in treating PsA.”

Finally

Despite the foregoing it’s reassuring that help is available to maximise metabolic health. Adams et al (2023) comment: “Sustainable health improvements require persistent changes in thoughts and behaviour … There are techniques healthcare practitioners can employ to guide patients towards behaviour change, while encouraging them to take responsibility for their own health and achieve lasting improvements.” As Dr Campbell Murdoch observes: “Almost all these health and wellbeing problems are preventable, and too many people are unaware of how easy and enjoyable improving metabolic health can be. This is a solvable problem, and many people choose to make changes. As a GP, it’s rewarding to see patients gain new awareness of how their body works, and how metabolic health can be improved, then rapidly reap the benefits.”                      

References

Adams J, Unwin D, Unwin J, et al. Psychological, behavioural, and ethical considerations. In Ketogenic: the science of therapeutic carbohydrate restriction in human health. Ed. Nutrition Network. Elsevier: London; 2023

Ede G. Change Your Diet: Change Your Mind. Yellow Kite: London; 2024

Fang S, Liu Y, Dai H, et al. Association of metabolic syndrome and the risk of bladder cancer: A prospective cohort study. Front Oncol. 2022: 12:996440. https://doi.org/10.3389/fonc.2022.996440

Kajee H. Metabolic syndrome. In Ketogenic: the science of therapeutic carbohydrate restriction in human health. Ed. Nutrition Network. Elsevier: London; 2023

Limon VM, Lee M, Gonzalez B, et al. The impact of metabolic syndrome on mental healthrelated quality of life and depressive symptoms. Qual Life Res. 2020; 29:2063–2072. https://doi.org/10.1007/s11136-020-02479-5

McCarthy K, Laird E, O’Halloran AM, et al. An examination of the prevalence of metabolic syndrome in older adults in Ireland: Findings from The Irish Longitudinal Study on Ageing (TILDA). PLoS ONE. 2022;17(9): e0273948. https://doi.org/10.1371/journal.pone.0273948

Reaven GM. Banting Lecture 1988: Role of Insulin Resistance in Human Disease. Diabetes. 1988; 37: 1595–1607. https://doi.org/10.2337/diab.37.12.1595

Salvi V, Hajek T. Editorial: Brain-Metabolic Crossroads in Severe Mental Disorders—Focus on Metabolic Syndrome. Front Psychiatry. 2019; 10:492. https://doi.org/10.3389/fpsyt.2019.00492

Scher B, Tamber M. How to achieve metabolic health. Diet Doctor. 2024.  www.dietdoctor.com/science/metabolic-health

Scuteri A, Laurent S, Cucca F, et al. Metabolic syndrome across Europe: Different clusters of risk factors.  Angelo Scuteri1, Stephane Laurent2,3, Francesco Cucca et al. Eur J Prev Cardiol. 2015; 22(4): 486–491. https://doi.org/10.1177/2047487314525529

Tao Z, Zuo P, Ma G. Association of weightadjusted waist index with cardiovascular disease and mortality among metabolic syndrome population. Sci Rep. 2024; 14:18684. https://doi.org/10.1038/s41598-024-69486-1

Williams JC, Hum RM, Rogers K, et al. Metabolic syndrome and psoriatic arthritis: the role of weight loss as a disease-modifying therapy. Ther Adv Musculoskelet Dis. 2024; 16:1–15. https://doi.org/10.1177/1759720X241271886

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