Understanding Metabolic Health Beyond Diabetes (Part 2). Metabolic flexibility.

In Part 1 of this metabolic series we delved into what insulin resistance is and why it is important to pay attention to your blood sugar. High blood sugar over the years increases inflammation and eventially can lead to developing pre-diabetes and diabetes, if not adressed in time.

In this article we will take a deep dive into the specifics of subtle metabolic changes that start 10-15 years before diabetes is diagnosed. Currently one third of Americans have insulin resistance and 81% of them don't know about it! Read this again. This is statistics from CDC.

What is happening "under the hood" prior to the diagnosis is a gradual decline of metabolic flexibility. Diabetes and insulin resistance are end products of the loss of metabolic flexibility.

Let's explore metabolic flexibility and learn why it is the foundation of good health and the best prevention strategy against chronic disease.

What is Metabolic Flexibility?

Every single cell in our body needs energy to survive. Energy comes from the food we eat. Food is transformed into usable energy in our bodies inside the cells, in the tiny organelles called mitochondria. One meal can typically fuel us for several hours. If we go beyond that without eating, our bodies start to tap into the energy stores. Glycogen is one of the forms of stored energy in the body. Glycogen has a structure resembling a string of beads, where beads are sugar molecules. This string of beads is broken down by the enzymes to release energy, a process known as glycogenolysis. Located primarily in the liver and the skeletal muscle, glycogen serves as a readily available source of glucose that can be converted to energy when we need it. Glycogen can supply us with energy for 12-24 hours . When nutrients are scarce, or when we go for longer periods without food, fat cells in our bodies are used as an additional energy source. Stored body fat can provide energy for days and even weeks. Metabolic flexibility is the body's capability to switch between using glucose or fat as fuel sources. Generally speaking, metabolic flexibility is how well an organism can adapt and respond to fluctuations in energy supply and demand. [1]

When we have good metabolic flexibility, we burn mostly fat for energy when we are at rest. When we engage in more intense exercise, the body will switch to burning more glucose from glycogen. When our bodies can easily access our fat reserves we feel less hungry and more energetic. We can go for several hours without food and blood sugar dips or "hangry" spells, and we don't feel the need to snack between meals. Metabolic flexibility rewards us with steady levels of energy throughout the day, clear mind, and positive mood.

Metabolic Inflexibility as a Primary Driver of Metabolic Disease.

We are well adapted to use various sources of energy that come from fats, carbohydrates, and proteins. Humans have evolved during times of dramatic fluctuations in energy supply and demand. Periods of feasts and fasts ensured greater ability of the body to adapt to these changes by storing the energy surplus when nutrients are in abundance, and using the stored energy when nutrients are scarce. In our modern times, however, for most of us, food is available all the time. This near continuous intake of food creates competition between different sources of energy. Glucose becomes the preferred energy source, and as a result, nutrients' sensing and switching between them becomes more rigid and inefficient. This is a state of metabolic inflexibility. In metabolically inflexible state glucose is used for energy even at rest.

Metabolically inflexible body uses mostly glucose as the main source of fuel and has difficulty using body fat for energy. This means that the glycogen stores are depleted quickly, the blood sugar drops, and we feel tired, anxious, and hungry. This leads to a desire to eat more carbohydrates to get a quick energy boost. In metabolic inflexibility, blood sugar levels spike and drop, and resembles a coaster ride. In such state we experience more hunger, fatigue, brain fog, inability to go without food for several hours and the need to snack.

Are you metabolically flexible?

Ask yourself these questions:

• Am I often tired, particularly in the afternoons? That infamous "afternoon slump"?

• Do I keep snacks around like granola bars, candy, or need to have coffee just to make it through the day?

• Do I feel hungry frequently and become nauseous or weak if I go more than three hours without food?

• Do I have intense cravings for sweets even after meals?

  
  

These signs suggest that the body is less adaptable to burn fat for energy and runs primarily on glucose.

Metabolic Inflexibility and High Insulin

Insulin resistance is the main contributor of metabolic inflexibility. Chronically high insulin prevents fat burning thus making it harder to use it for energy. Consistently high blood sugar and high insulin are toxic to the cells, driving oxidative stress and inflammation. Generally, if insulin is consistently higher than 8 on the blood test, it may indicate insulin resistance.

It is important to keep in mind that normal fasting blood sugar levels does not rule out insulin resistance. It is possible to be insulin resistant with normal blood sugar levels and HbA1c. This is because insulin resistance is primarily a condition when insulin is elevated and the body uses it to cope with the high influx of glucose. Keeping blood sugar levels in normal range is always a priority for the body. This is why insulin resistance can go unnoticed for a very long time.

Other signs and symptoms of metabolic inflexibility and insulin resistance include:

• High waist circumference=more visceral fat=more inflammation=higher risk of disease

• Multiple skin tags especially around the neck or armpits.

• Darker areas of skin on the body (elbows, knuckles, neck)

• High blood pressure

• High VLDL cholesterol

• High triglycerides

• Elevated high-sensitivity C-reactive protein (a specific marker of inflammation)

• Elevated ALT >25 (alanine transaminase)

Eating for Metabolic Flexibility

Improving insulin sensitivity is critical for flexible metabolism. Moreover, better insulin sensitivity will reduce the stubborn belly fat, lower inflammation, and will help feel more energetic and balanced throughout the day without frequent sugary "pick-me-ups".

Here are my top 5 recommendations for a better blood sugar balance and metabolic flexibility.

• Include protein at every meal. For optimal protein intake for healthy individuals I recommend at least 1.2-1.6 grams per kilogram of ideal body weight. For example, if you weigh 65 kilograms (140 lbs) and that's your ideal weight, then you need at least 78 grams of protein per day, which equals to about 25 grams per meal of high quality protein. If you are engaged in resistance training, your protein needs are higher. For women, having about 25-30 grams of protein per meal is optimal. Protein is crucial for maintaining bone and muscle mass and the requirement for protein increases in menopause.

• Aim for 30 grams of fiber per day. Fiber is essential for proper metabolism of cholesterol, hormones, and toxins. Fiber is also a primary source of nourishment for the beneficial bacteria in the gut. High fiber foods are black beans, lentils, chickpeas, leafy greens, avocado, mushrooms, asparagus, Brussel sprouts, broccoli, cauliflower, berries, flax seeds, and chia seeds.

  
  

• Include a healthy fat at each meal. Good options are extra virgin olive oil, ghee, grass-fed butter, avocados, coconut oil, nuts and seeds. It is also important to include foods high Omega-3s like wild caught salmon, sardines, mackerel, trout.

  
  

• To protect against inflammation and oxidative stress, eat a large volume (several cups per day) of vegetables, diversifying them across colors with an emphasis on red, orange, yellow, purple, and green. Always include dark green vegetables in the daily mix. Green leafy vegetables are some of the best sources of folate, a nutrient critical for optimal cardiovascular health, and prevention of stroke, neurological diseases, and cancer. Vegetables give you a high nutrient-to-calorie ratio, allowing you to get far more nutrients into your diet without eating too much. The colors signify unique plant substances that have important health effects.

  
  

• Minimize ultra-processed foods. Frequent and long-term consumption of ultra-processed foods  that are often high in refined carbohydrates, sugar, salt, industrial fats, and artificial additives creates a perfect storm that stimulates the reward centers in the brain. Our brain is the the primary organ that regulates body weight. This is why these foods are highly addicting, causing us to overeat and gain weight.

  
  

• Avoid snacking between meals. Frequent snacking will keep your blood sugar high and in the glucose-burning mode, which is not great if you have insulin resistance. If you find yourself frequently snacking, reevaluate your main meals and make sure you eat adequate protein, healthy fats, and fiber at each meal. A balanced meal should carry you through until your next meal with only a slight sensation of hunger.

  
  

What I see quite often in my practice, especially among women, is that they do no adequately nourish themselves through out the day, snacking all day long and wait until dinner to have their biggest meal of the day, a strategy that always backfires with fatigue, weight gain, and erratic blood sugar.

If you feel overwhelmed and struggle to come up with ideas for nutritious, simple, balanced every-day meals that take less than thirty minutes to prepare, be sure to check out my my 7-day Metabolic Reset Meal Plan.

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More Ways to Improve Metabolic Flexibility

Exercise

Movement and exercise is critical to good metabolic heath. It is nearly impossible to improve any condition without frequent movement and exercise. Physical exercise creates new mitochondria inside the cells. Mitochondria are the energy factories. When we engage in physical activity such as running, cycling, or weightlifting, our body responds by increasing the production of mitochondria. This process, known as mitochondrial biogenesis, is essential for improving our ability to efficiently convert nutrients into energy. The more healthy mitochondria we have the greater our energy is.

Skeletal muscle is the largest organ system in the body and takes up 80% of glucose that we consume as food. [2] Lean muscle mass creates a greater demand for glucose and makes cells more sensitive to insulin which is critical for efficient and flexible metabolism.

This is why exercise that promotes muscle building is so important, especially as we age. Incorporating 2-3 weight lifting sessions per week is an excellent way to preserve and build muscle mass and improve metabolic flexibility.

Practice Intermittent Fasting

Intermittent fasting (IF) is one of the most effective strategies to improve insulin sensitivity and restore metabolic flexibility. IF is an eating pattern that involves fasting for varying periods of time, typically for 12 hours or longer. IF has been shown to dramatically improve cardio-metabolic markers, decrease visceral fat, reduce inflammation and even reduce pain in chronic conditions such as osteoarthritis. [3] These benefits are a direct result of the "flipping of the metabolic switch". It is the switch from using glucose and breaking down glycogen to using fatty acids and fatty-acid derived ketones to create energy. The additional benefit of IF is that it preserves lean muscle mass while reducing fat, a huge advantage over the traditional weight loss approach like calorie restriction. This metabolic switch occurs typically between 12 to 36 hours after the last meal. This is why the most popular and most sustainable form of IF for many people is Time Restricted Feeding (TRF), which involves restricting food intake to specific time periods of the day, typically between an 8 – 12 hours each day.

Historically, fasting has been used as both a religious practice for thousands of years. Fasting as a medicinal practice has been used since the time of ancient Chinese, Greek and Roman physicians. Fasting initiates a mechanism in the body called autophagy which is important for cell repair and identification and removal of diseased cells and cellular debris and pathogens.

Intermittent fasting is generally very safe and should not be confused with "therapeutic fasting" which is longer in length, and should be supervised by a qualified practitioner.

Try Cold Exposure

People living in northern climates, such as Scandinavian countries and Russia, have a long-standing tradition of embracing the cold through activities like ice water exposure. This practice, known for its health benefits, has been passed down through generations as a way to strengthen both the body and the mind. The act of immersing oneself in icy waters is believed to boost the immune system, increase circulation, and improve overall well-being. It is seen as a form of resilience training, teaching to endure discomfort and adapt to extreme conditions.

Recently, cold exposures like ice baths and cold showers have been starting to gain popularity in the US too, and for a good reason. Regular cold exposure has benefits of positively affecting metabolic health [4].

Why cold?

As you may already know, we have two kinds of fat based on where it is found in the body, visceral (abdominal fat) fat, and subcutaneous (under the skin) fat. Fat can also differ in its quality and can be classified as either "white fat" or "brown fat". White fat stores extra energy. Too much white fat is linked to poor metabolic health. Brown fat, on the other hand, due to its greater numbers of iron-rich mitochondria, has a very different metabolic behavior. Brown fat burns chemical energy to create heat and help maintain body temperature. Simply put, brown fat is much better at burning fat into energy.

It has been shown in research that in response to cold, white fat cells in both animals and humans take on characteristics of brown fat cells. Even mild cold, like the room temperature of 19 °C (66 °F) for a month can significantly increase brown fat percentage and fat metabolic activity (this makes me not feeling so bad about living in a cold climate). It can also improve insulin sensitivity, and balance leptin and adiponectin, two key hormones that regulate metabolism. Do not attempt ice baths if you have any underlying conditions like cardiovascular, neurological, autoimmune or advanced age.

Or Heat...

If the thought of a polar bear plunge sends chills down your spine, no worries. If you are like me, who would rather be warm than freezing, another great way to improve metabolic flexibility is regular sauna sessions. The tradition of sweating in sauna is very old and is very common in countries like Finland and Russia. Traditional sauna looks like a small room with wooden walls with an area with exposed heated rocks. The temperature is usually maintained between 150-190F and the humidity is controlled by pouring water on the hot rocks.

Besides traditional sauna, other types of saunas have gained popularity in recent years. One of the most widely used is infrared sauna where infrared radiation heats the body directly without the need for high temperatures. Infrared saunas operate at lower temperatures compared to traditional saunas, typically ranging from 120-135°F.

The reason sauna is so beneficial is that induces sweating. Sweating is a mechanism our body uses for body temperature regulation. Heat induced sweating can be compared to a mild to moderate cardio exercise session. One study from Binghamton University demonstrated that participates who had frequent and regular sauna sessions (3 times per week) lost 4% of body fat over the course of 16 weeks.

Regular sauna bathing have been found beneficial for people with chronic pain conditions, fibromyalgia, arthritis, cardiovascular and autoimmune conditions.

If you are new to sauna, start low and slow and gradually increase your time to avoid excessive heat stress. Drink plenty of water with added electrolytes after every sweaty session.

I find sauna sessions to be extremely relaxing. For me it is a form of self care, a way to unwind and disconnect from the busy rhythm of everyday life, and immerse in quiet warm comfort and stillness. It is a great way to switch from "fight-or-flight" to "rest-and digest" mode which results in balanced stress hormones and improved sleep.

My personal choice is Sunlighten infrared sauna. I use it regularly since moving into cold New Hampshire climate.

Functional Approach to Metabolic Health.

Metabolic health is the foundation of good health. It cannot be reduced to the simplistic "just lose weight" or "eat less and excerices more" approahes. Metabolic health is a reflection of diet, micronutrient status, exercise, stress, sleep and even light! A common mistake many people do when adressing metabolic health is jumping to "big guns" like restrictive diets and prescription medications. But there is no magic bullet and no shortcuts no matter what anyone may tell you. Healthy metabolism is a result of consistent and diligent work on all fronts: diet, exercise, sleep, stress, and living in sync with nature's cycles, and that's what functional approach entails.

Only 12 % of people in America re metabolically healthy. Don't wait until you start seeing troubling numbers on your labs. Being pro-active and taking small steps each day will pave your way to better health and longevity for years to come. Reach out if you need guidance!

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