Poor metabolic health affects 1 in 3 people over 50 in the UK but what is it exactly and is there anything that can be done to prevent it? Poor metabolic health isn’t just a concern for older people, around 4.2% of children and young people and 28.7% of obese adolescents are thought to be affected by metabolic syndrome (see below).
Metabolic health affects the whole body and poor metabolic function increases the risk of serious chronic conditions including: type 2 diabetes, cardiovascular disease, hypertension, polycystic ovary syndrome, sleep apnoea, some types of cancer, erectile dysfunction, migraines, fatty liver and pancreas, Dementia, osteoarthritis and gout.
In this article, we explore metabolic health, ways you can support it and some common tests that can help identify how metabolically healthy you are, including how to spot signs of a fatty liver.
First, let’s look at some clues that your metabolic health could be out of balance:
What does it mean to be metabolically healthy?
To be metabolically healthy is primarily about having enough energy to do the things you like and that your body needs to do.
Metabolic health is all about obtaining energy (from the food we eat and sunlight) in order to provide our cells with the energy they need to carry out their functions.
A key part of metabolic health is the ability to use different food sources (carbohydrates, fats and proteins) efficiently and interchangeably, and being able go without food for limited periods of time, as in fasting or intermittent fasting. It’s known as metabolic flexibility.
Understanding metabolic health
Here, we outline the key organs involved in helping you stay metabolically healthy.
- Why is the liver important for metabolic health?
The liver is the primary site for processing (metabolising) carbohydrates, proteins, fats, vitamins and minerals coming from the food we eat. It receives blood from our abdominal organs – including the small and large intestines, stomach, pancreas, spleen and gallbladder, to be filtered and processed.
Once the liver has processed a food, the food origin becomes unrecognisable. For example sugar (technically glucose) can be converted to glycogen or a type of fat called triglyceride, for storage. Energy stores are converted back to glucose when the blood sugar levels fall. The liver can also create new glucose from other sources like protein.
Alongside muscle and fat tissue, the liver helps control metabolic flexibility – which as mentioned above is how efficiently our body adapts to maintain a constant supply of energy to our cells and tissues. This energy supply comes from what we eat or it can come from our energy stores. Our body turns to the latter when we stop eating for periods, such as during sleep or when fasting.
The health of the liver is therefore critical for metabolic health and energy levels.
An orchestrated cascade of hormones and signalling molecules work to ensure a continuous supply of nutrients to our cells and tissues. The release of glucose from the liver (and it’s storage) is under the control of insulin and glucagon, which act in opposing ways. Insulin is released in response to raised blood sugar and instructs the liver to store energy as fat (triglycerides) and glycogen. Insulin is a signal for “building up” processes and weight gain. On the other hand, when blood sugar levels fall, glucagon signals “breakdown processes” of energy stores to release glucose into the blood. In healthy individuals, insulin works to “switch off” glucagon.
Failure of the liver to respond to insulin and switch off glucagon, allows the constant production and release of glucose into the blood despite already raised glucose. This “deafness” to persistently high insulin is called “insulin resistance” and is a common feature of poor metabolic health.
Zinc helps support the regulation of glucagon and thus ensuring we have adequate zinc in our diets could help reduce risk of insulin resistance/diabetes.
As insulin instructs the liver to store energy as fat (triglycerides) it is often described as a fat storing hormone. So if insulin levels remain high it is much easier to gain body fat. Insulin levels rise when we eat carbohydrates, which is the rationale for a low carbohydrate diet for metabolic health.
What else does the liver do?
Overall the liver does an astonishingly large number of things – some 500 different chemical processes.
- Why is the gut microbiome important for metabolic health?
As human beings have evolved over time the trillions of microbes that live in our gut have taken on specific jobs to support our metabolism. This means to be metabolically healthy we need certain strains of microbes as well as a wide diversity of them. The more species we have in our gut the better – the goodies help keep the baddies in check!
Some of these “goodies” (beneficial bacteria) are able to digest some plant fibres that we humans cannot, and in doing so they produce some important elements for our body such as; vitamins (B vitamins and vitamin K) and short-chain fatty acids (SCFAs) which help to keep the gut healthy by feeding the gut lining and supporting its barriers which control what comes in and out.
Whilst the gut lining is designed to let some things through e.g., water and nutrients, it also needs to keep out what we don’t want. For this reason, an important arm of the immune system is located in and around the gut, which keeps pathogens and unwanted substances in check. It is estimated that 70-80% of our immune cells reside in the gut.
Unfortunately, the gut lining can become damaged. When this happens, things that we don’t want passing through from the gut to the bloodstream are suddenly able to, such as microbes, bacterial fragments (called endotoxins or lipopolysaccharides) and partially digested food. As something is happening that shouldn’t be, the body’s immune system responds to that. In defending the gut barrier inflammatory chemicals are released into the area, causing inflammation and the danger of serious infection. Inflammation is seen in most metabolic diseases, including obesity and insulin resistance.
We are learning that gut microbes can also influence our body fat. Studies done in mice transplanted with microbes from human faeces from obese or lean twins showed that mice who received obese twins microbes grew fat and therefore increased in weight, compared with mice who received microbes from lean twins. In these studies, researchers identified that obesity was seen together with an increased abundance of a family of microbes called firmicutes relative to the bacteroidetes family.
Although the gut microbiome is not completely understood, we do know that it’s influenced by what we eat – our food choices can feed “good bacteria” or “bad bacteria.” It can also be impacted by our stress levels, or by drugs such as proton pump inhibitors, and antibiotics (which kill bacteria, both the good and bad). You can read about more about how support your good bacteria here.
- Why is bile important for metabolic health?
Bile is the unsung, under-appreciated player in the metabolic health puzzle. Healthy bile secretion in the gut creates the right conditions to extract energy from food and prevents the build-up of harmful bacteria.
If bile fails to control the bacteria living in our gut, it is impossible to be metabolically healthy.
Bile is made in the liver from cholesterol, bile acids, phospholipids, electrolytes, water and the pigment bilirubin and its stored in the gallbladder. If we don’t make good quality bile, one of the downstream consequences, is raised cholesterol (because cholesterol is “used up” making bile).
Bile is released into the gut, when we eat, especially when we eat fats. Bile helps digest and absorb fats, including the essential omega 3 and 6 fatty acids and the fat soluble vitamins; K,A, D and E. Of the 750-1000 mL of bile that adults make a each day, we only lose around 50mL in faeces. The rest is recycled.
Bile not only acts on gut bacteria but also keeps our bowels moving. Its one of the reasons why when we drink coffee or other bitter compounds we might feel the urge to go to the loo.
Excreted bile escorts drugs, toxins, and other metabolic waste (such as ammonia from protein breakdown, bilirubin and biliverdin from red blood cells, and harmful oestrogens), out of the body in the stools.
Bile acids work as hormonal messengers influencing fat accumulation, the life span of our cells, inflammation, insulin and glucose uptake into the cells, cholesterol and energy levels and stimulates the release of glucagon-like peptide (GLP-1), which improves blood sugar control.
How to support healthy bile production
Healthy bile production needs the amino acids choline, taurine, glycine, methionine, cysteine all coming from protein in the diet.
| Amino acid | Food source |
|---|---|
| Choline | Seafood, liver, eggs, beef, fish, chicken, milk and certain plant foods such as broccoli, soya lecithin, shiitake mushrooms, beans, nuts (plant sources have lower amounts). |
| Taurine | High amounts in shellfish, mussels, scallops, clams, and in the dark meat of chicken and turkey. It’s lacking in most vegetables, nuts or seeds, fruits, and legumes but can be found in red gogi berries and some types of seaweed and algae. |
| Glycine | The amino acids needed to make glycine can be found in bone broth made with bones from fish, chicken or beef, chicken skin, also turkey, pork, lamb beef. Vegetarian sources: sesame seeds, spirulina, sunflower seeds, pumpkin seeds, nori, watercress, beans, and spinach. |
| Methionine | Turkey, beef, fish, pork, tofu, milk, cheese, nuts, beans, quinoa |
| Cysteine | Turkey, pork, , beef, chicken, fish, lentils, oatmeal, eggs, sunflower seeds, cheese, tofu |
Other ways to support bile production include:
- Bitter foods e.g., dandelion, mustard, coriander, radish, radicchio, ginger, artichoke, berberine (from barberries).
- Bile support supplements (Ox bile, Tudca)
Please discuss with a suitably qualified health care professional before taking any dietary supplement and about any concerns you might have regarding your bile health.
- Why is the pancreas important for metabolic health?
The pancreas is a vital organ for metabolic health because it is needed to digest carbohydrates, fats, and proteins in the diet and because it plays a central role in regulating blood sugar levels.
The pancreas produces all important proteins called enzymes which are needed to breakdown foods into more useable forms that can be used for energy. Different food types need different enzymes.
· Proteases breakdown proteins
· Amylases breakdown carbohydrates
· Lipases breakdown fats
The pancreas also releases essential hormones in response to certain situations for example:
· Insulin – in response to raised blood sugar
· Glucagon – in response to lowered blood sugar
· Gastrin – stimulates stomach acid production
Insulin and glucagon work together to keep blood sugar levels in our body within tight limits.
We need enough glucose for energy but not too much because it’s damaging in high concentrations. A surprisingly small amount of glucose (4g) should circulate in the bloodstream at any one time. That’s less than a teaspoon! When we consume more, it has to be used or stored and the liver and the pancreas are the first ports of call for the nutrient rich blood coming from the gut.
If the pancreas isn’t working well, nutrients cannot be properly processed. Consequently these nutrients can build up in the body resulting in raised blood glucose, abnormal blood lipids and a build-up of metabolic products such as uric acid (which can lead to gout).
In type 1 and late-stage type 2 diabetes, the part of the pancreas that secretes insulin, called the beta-cells, no longer works properly and the average size of the pancreas is reduced compared to people who don’t have diabetes. In type 1 and late stage type 2 diabetes the pancreas fails to produce insulin or enough insulin.
Type 2 diabetes on the other hand features insulin resistance (IR), a condition where our cells become deaf to insulin and so the pancreas responds by producing even more insulin (until it eventually becomes exhausted). Raised insulin in the blood is common in metabolic conditions and often occurs decades before raised blood glucose (15-24 years).
Some researchers have speculated that insulin resistance could in fact be a defence mechanism, to protect our cells from internal damage and metabolic stress. You can read more about insulin and insulin resistance here.
Persistently raised nutrients in the blood damage organs
The effects of uncontrolled high blood glucose (lipids and amino acids) in the blood over time damages blood vessels, the heart, eyes, kidneys, liver and nerve cells, and indirectly the gallbladder.
High glucose binds to proteins in areas such as the skin, arteries and joints which causes a stiffening and darkening – known as advanced glycation end products or AGEs. AGEs can be looked upon as a kind of caramelisation which can interfere with normal cell functioning. One example is glycated haemoglobin (HbA1c) which is used to measure raised blood glucose.
The damaging effects of high blood sugar also occurs inside the cells, where it may overpower anti-oxidant defence mechanisms and cause further damage to the cells internal machinery such as the mitochondria (the cells internal power-plants) and DNA (the genetic library).
Raised nutrients in the blood damage blood vessels, nerves, and organs
Bitter foods such dandelion leaves or chicory and spices such as cinnamon or berberine (from barberries), may be helpful. Berberine may increase insulin secretion by restoring damaged or exhausted pancreatic islet cells (the parts that secrete insulin), possibly because of it’s antioxidant and anti-lipid peroxidation properties.
Further examples of digestive bitters can be found in our article: How to improve your digestion.
- Why are the kidneys important for metabolic health?
The kidney’s main role is to filter blood, remove water soluble waste products from the body and to balance fluids, glucose and electrolytes. During the course of a day the kidneys filter an impressive 200 litres of fluid a day. If the kidneys aren’t working well, metabolic waste products from normal metabolic processes (urea, uric acid, and creatinine) and other environmental toxins that would normally be excreted in the urine, build up and cause damage.
The kidneys keep the balance of glucose and electrolytes in the blood (e.g., sodium, potassium and magnesium, bicarbonate) within carefully controlled limits and maintains the correct pH. The kidneys are important for keeping our cells properly hydrated.
People with poor metabolic health and raised blood sugar often have kidney impairment and vice versa.
- Hydration and metabolism
Metabolism is affected by the hydration status of our cells and tissues. Cellular dehydration may contribute to insulin resistance and increases our susceptibility to cellular damage.
Insulin also stimulates sodium retention and glycogen production (the short-term storage form of glucose). It has been understood since the 1930’s that glycogen is stored together with water and that large amounts of carbohydrate in the diet is linked to water retention. Raised insulin, as seen in obesity, is often accompanied by raised blood pressure. The underlying reasons for this association is thought to be multi factorial. One proposed contributing factor could be a direct effect of insulin stimulating sodium re-absorption in the kidneys or stimulation of the sympathetic nervous system in the heart, blood vessels, and kidney.
For tips and information on how to stay hydrated see our article here.
How to tell if you are metabolically healthy?
The following measurements are commonly used to provide a basic picture of metabolic health (for adults) – it’s an outline of where we as individuals might want to be.
| Waist circumference | Below 94cm for European men |
| Below 80cm for European women | |
| Other ethnicities see here – table 6 | |
| Blood pressure (NHS) | Below than 135 mmHg systolic (measured at home) |
| Below than 85 mmHg for diastolic (measured at home) | |
| Below 140 mmHg systolic (measured at the GP surgery) | |
| Below 90mmHg diastolic (measured at the GP surgery) | |
| Fasting blood glucose | Below 5.6mmol/L |
| Fasting triglycerides 1.7mmol/L | Below 1.7mmol/L |
| Fasting HDL-cholesterol | Above 1.03 for men |
| Above 1.29mmol/L for women. | |
If you have three or more of the above out of range, it’s called metabolic syndrome. | |
This cluster of metabolic abnormalities, doctors call “metabolic syndrome,” features sugar intolerance (technically glucose), abdominal obesity, low HDL cholesterol (HDL = high-density lipoprotein (the “good” sort)), raised triglycerides (a form fat in the blood), hypertension and insulin resistance.
The bottom line about developing metabolic syndrome is that you’re becoming progressively less able to process carbohydrates in food. In order to improve your quality of life and to prevent things from getting worse, some changes are likely needed. Clues that your metabolic health needs attention can be found in our graphic further above in this article.
What is fatty liver (fatty pancreas) and what causes it?
When the liver is storing too much fat (as triglycerides) the liver is described as fatty. Fatty liver is a common condition that many people have without realising. Fatty changes in the liver and pancreas increase the risk of developing diabetes.
People with type 2 diabetes usually have excess fat in their liver and pancreas, two key organs in the maintenance of the normal level of blood sugar.
Fatty liver and pancreas
There are two types of fatty liver; one linked to excess alcohol consumption and the other unrelated to alcohol. They’re hard to distinguish and look very similar. Non-alcoholic fatty liver disease (NAFLD) affects up to 20-30% of people in the West. Fatty pancreas on the other hand is estimated to impact around 16% of the global population.
It’s essential to recognise that triglycerides, the type of fat stored in the liver and pancreas, comes not only from dietary fat but also from carbohydrates and alcohol in the diet (and occasionally excess protein).
Accumulated fat can impair the vital functions of the liver and pancreas, though the exact causation or relationship is unclear.
A small study indicated that restricting dietary energy alone improved pancreatic B cell function and insulin response in the liver in a group of people with type 2 diabetes. Fat stores in the pancreas and the liver decreased, which suggests that whatever is going wrong in type 2 diabetes can be reversed by reduced dietary energy intake. The idea of “resting” an overstretched pancreas and liver, to allow time for the organs to recover, is not new.
Do you have a fatty liver?
If you have a “beer belly” or a high waist:hip ratio, it’s likely you have some degree of fatty liver.
| Waist:hip ratio |
| For men above 1 is too high. Aim for below 0.95 to reduce risk of disease. |
| For women over 0.85 is too high. Below 0.8 puts you at a lower risk of disease. |
What causes poor metabolic health?
There are many contributors to poor metabolic health including a poor diet, shortages of key amino acids, nutrient and trace mineral deficiencies; thiamine and B6 deficiency are common in T2 diabetes. Smoking guns include excess alcohol, excess sugar and processed starch consumption, exposure to environmental toxins or a build-up of metabolic wastes and imbalances in the gut microbiome.
Whilst all of the underlying causes of suboptimal metabolic health aren’t fully understood, chronic inflammation and obesity are very common in people with poor metabolic health and both increase your vulnerability to serious infections such as COVID-19.
The immune system and metabolism work hand in hand. It is known that immature fat cells can morph into a type of immune cell called a macrophage whose job it is to eliminate foreign substances and harmful microbes by engulfing them and releasing inflammatory chemicals to destroy them. Macrophage infiltration of fat tissue is seen in people who are abdominally obese. Other research has shown that our immune cells use body fat stores to fight infection.
In obesity fat cells become enlarged and inflamed and they are infiltrated with immune cells and release inflammatory chemicals. Inflammation is known to be triggered by things such as stress, cigarette smoke, viruses, bacteria, parasites, free radicals, allergens and environmental chemicals.
According to now retired professor Caroline Pond, author of the book The Fats of Life the body stores fat where the immune system is busy e.g, surrounding lymph nodes.
How to support metabolic health
If you know or suspect your metabolic health needs attention a good place to start is with diet and a low carb diet designed to take the pressure off insulin can be helpful. If you eat carbs several times during the day and each time insulin is released that means there are long periods of the day when insulin levels are high which means your body is in “energy storage” mode. During that time it is much more difficult to burn fat for energy.
For more information see our article on A low-carb diet for metabolic health.
Things to embrace for good metabolic health include:
Things to avoid for good metabolic health:
For more support on living a healthy lifestyle, which can help prevent a range of conditions, why not try the free Evergreen Life?
Reviewed by:
Anna Keeble MA BA Head of Content and Wellbeing Expert
Dr Claire Marie Thomas MRCGP DFSRH DTMH DipNLP MBChB BMedSci Medical Expert
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