What is "Metabolic Health"? - #2

What does the term "metabolic health" even mean?

Why does it matter?

How do we check our own?

How do we get it fixed?

Dr. O addresses these questions in this episode.

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Learn more:

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• Take Dr. Ovadia's metabolic health quiz: iFixHearts
• Dr. Ovadia's website: Ovadia Heart Health
• Jack Heald's website: CultYourBrand.com

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Transcript

S1E02 - What is Metabolic Health

SUMMARY KEYWORDS 

metabolic, measurement, metabolically, food, body, carbohydrates, health, eat, healthy, unhealthy, insulin, fat, turns, sugar, measure, hormones, metabolism, blood pressure, blood, number 

SPEAKERS 

Jack Heald, Dr. Philip Ovadia 

Jack Heald  00:01 

Welcome back to Stay Off My Operating Table. I'm here with heart surgeon Dr. Philip Ovadia. I'm your host, Jack Heald, and today, we're talking about metabolic health. I've heard that word metabolism my whole life, Phil. But to be frank, I really don't think I know what it means. What is metabolic health? 

Dr. Philip Ovadia  00:26 

That's a great question jack. And it's one that I get often. And the first thing is, the first thing that I think everyone should understand is that metabolism and metabolic health aren't quite the same thing. So metabolism simply refers to our body's utilization of energy. So we eat primarily, and that's how we get our energy. And the body can do a couple of different things with whatever inputs, whatever energy, we're giving it, whatever, whatever food we eat, whatever food we eat, essentially, it gives it you know, it can use that energy to just kind of get us through our day to day activities, it can use the building blocks that are in that food, to build and rebuild our tissues. Realize that almost all the tissues, all the cells in our body are constantly turning over. And then it can put a certain amount into storage. And what metabolic health ultimately comes down to is the body correctly partitioning the energy and to each of those categories. 

Jack Heald  01:48 

Okay, so when we're eating, where we're bringing in energy, that's got to go to different functions. All right, so how does the body make that decision? And how does what we eat affect that decision? 

Dr. Philip Ovadia  02:06 

Yeah, so ultimately the main thing that helps the body make that decision is a bunch of chemicals that kind of go around in our body, what we call hormones. And those hormones instruct our organs. You know, things like the liver, and the gas, the stomach and the intestines, that all kind of play a part in all this, as well as our fat cells, which are actually an organ in and of themselves. In terms of what we're going to do with all of this food that's coming in all of this energy that's coming in. And it turns out that depending on what types of food you eat, different levels of these hormones are going to be made, and therefore that's going to direct control what happens with the energy coming from that food to a large part. 

Jack Heald  03:04 

Okay, I want to make sure I understand what you just said, the food you eat, affects which hormones your body produces. Correct? Correct. So that was not what that I didn't know that. Okay, so give us some examples. 

Dr. Philip Ovadia  03:24 

Well, the most important example is a hormone called insulin. And many people have heard about insulin. You know, anyone who is diabetic certainly knows all about insulin. But insulin, it turns out is probably you know, the most or at least one of the most important hormones controlling our metabolism and our metabolic health. And when we eat certain foods, in particular, carbohydrates, those are starches. Those are sugar. You know, things like wheat and flour, and cereals, and even a lot of vegetables, which have carbohydrates in them, that is going to cause insulin to be produced in higher amounts than, say, foods that are only protein or protein and fat kind of mixed. Essentially, fat causes no insulin to be produced, and protein causes a little bit of insulin to be produced. Ultimately, insulin tells our body primarily to store energy, though to take the food that we've just eaten, and primarily turn it into body fat for storage purposes. 

Jack Heald  04:47 

So when we're eating carbs, our body is triggered to store those store that food store those calories for future use instead of instead of energy now or rebuilding ourselves rebuilding our tissues. I got that, right. Correct. Correct. So why did carbs do that, rather than protein or fat?  

Dr. Philip Ovadia  05:23 

That probably comes down to our evolutionary history. And when you look prior to our recent history as human, so prior to about 10,000 years ago, realize that we've been humans evolving for millions of years. And the thought is, is that carbohydrates, and specifically that largely came in the form of fruits. You know, again, back before we were really processing food and making our own food, carbohydrates were a signal that it was a certain time of year what we would now call basically, summer, summer and spring. And food was more abundant, because we had the mostly animals that we ate at the time, protein and fat, and then these carbohydrates would come on every once in a while. But once they went away, there would now be less food available. So we would want to have storage, so that we could deal with those times that there was less food available. I mean, yes, that's, it makes perfect sense how it evolved. The problem is, in modern day times, for most people, in most environments, these days, food is always available. And carbohydrates in many different forms are available year round. And we have the fat and we have the protein that we've always had available to us. Even in more abundant amounts without having to put the effort in that we used to get it, we no longer have to go out and hunt for our food and grow our food and harvest our food. We just usually hop in our car and go get food. And so that has kind of hijacked that system. 

Jack Heald  07:21 

So metabolic health has to do with hormones, the most important hormone is insulin. What is it that causes us to not be metabolically healthy? I mean, obviously, as I as I think about what you just said, if we're over consuming carbs, and we're telling our body to store fat, and that's making us fat, is his being fat, just simply metabolically unhealthy? And to flip it around is, if you're metabolically unhealthy, are you also fat? 

Dr. Philip Ovadia  07:55 

No. So you can be not fat, you can be lean, or normal weight and be metabolically unhealthy. And you can also be obese and fat and still be metabolically healthy, although that is fairly unusual. But it is, it is very common. Actually, it turns out that people are not obese, but they are metabolically unhealthy. And that that comes down to a different aspect of our food supply in modern times, and that there are a few other specific things besides carbohydrates that can kind of damage the cellular mechanisms that control our metabolic health. 

Jack Heald  08:46 

Okay, so let's dig a little deeper. How do you go about assessing? How would one of us go about getting our metabolic the status of our metabolic health? evaluated? 

Dr. Philip Ovadia  09:00 

Yeah. So you know, there are it's a combination of measurements that can be taken either at home or at your doctor's office. And then there are some key blood markers, that we look at some blood tests that need to be done. So officially there are five measures of metabolic health. And these are kind of worldwide standards that are used. And those five measurements are your waist circumference. So this is a measurement you can take it home and basically just above the level of your bellybutton, you want to take a tape measure and you want to measure what the circumference is there, how far around it is. And for men, if that measurement is more than 40 inches, and for women if that is more than 35 inches, then you are considered to be metabolically unhealthy. 

Jack Heald  09:56 

Wow, just one measurement. It just one 

Dr. Philip Ovadia  09:59 

measure. It is. And it turns out that that measurement that you can, that anyone can do at home is probably the best single predictor of metabolic health. But there are four other measurements that we take into account for their numbers. So the second measurement is your blood pressure. And obviously, this is a very common measurement that everyone gets done every time you go and visit the doctor. And nowadays, you can go check it yourself every drugstore, every supermarket seems to have one of those automated blood pressure cuffs where you can even order them cheaply to have at home, but if your blood pressure, first of all, if you are have been diagnosed with high blood pressure, and you're taking medication to lower your blood pressure, you have already flunked this measurement. But if you're not, you want your top number to be less than 130. And the bottom number to be less than 

Jack Heald  11:00 

85 130 over 85 is the limit, okay, 

Dr. Philip Ovadia  11:06 

is the limit. So that's measurement number two. And now measurements, three, four, and five all come from blood work that you need to get checked. So measuring number three is your blood glucose, and that's going to be your fasting blood glucose. So when you haven't eaten for eight to 12 hours, if the your blood glucose is over 100, that that's another measurement of not being metabolically healthy. So you want it to be under 100. Lower is better 

Jack Heald  11:38 

talk, talk to me a little bit about what that fasting blood glucose is what's going on in your body. 

Dr. Philip Ovadia  11:44 

Again the body, glucose sugar is one of the primary energy sources for our body, our body actually turns sugar into the energy we need to run all the little cellular things that go on in our body. And so you know, a certain amount of the sugar is always going to be in our blood, okay. And then there are other places that sugar can go, it can get stored in the liver, it can get stored in the muscle, or it can get turned into fat. And you know, when we're metabolically healthy, we have enough of those storage places that even if we eat a good amount of sugar, it's not going to hang around in our blood. 

Jack Heald  12:36 

They wait because we have places for it to go, is that right? 

Dr. Philip Ovadia  12:42 

Correct, because we have places for it to go. And because our the signals going on in our body is telling it to go to the correct places. When our metabolic health breaks, when we become metabolically unhealthy we have no more places to put it, if we keep bringing it in. And we also don't have the proper signaling that even if we're bringing in lower amounts of it it's still not going to the right places, and too much of it is hanging around in our blood, and then it'll show up in the blood, okay, it will show up in the blood. And then it also turns out that we know that that is damaging to many of the different organs in our body having too much sugar in the blood. So that's why it's a warning sign having too much sugar in your blood. Okay, so 

Jack Heald  13:37 

that's the first of the blood tests. 

Dr. Philip Ovadia  13:39 

That's number three. And the other two blood tests both come from the cholesterol panel that is very commonly checked these days. And there are two measurements on that that we're interested in. for these purposes, the HDL cholesterol, oftentimes called your good cholesterol, and you want that to be higher, the higher your HDL cholesterol is the better, which a lot of people kind of find confusing as well. So the cutoff for that in numbers is if you are a woman, you want that measurement to be above 50. And if you are a man, you want it to be above 40. And those are the units that are used in the United States. If you're listening to this overseas, sometimes it's a different system that's used, but above 40 for a woman about or excuse me above 40 for a man above 50. For a woman that means you're metabolically healthy, that's your HDL, okay, and the final measurement, which also comes off of that cholesterol panel is called your triglycerides. And this one, you want to be lower. And it's the same for men and women you want it to be under 150. And again, those are the standard American units that were referring to. So you look at those five measurements. And officially, if three of those aren't in the good category, three of them are in the bad category, you have what we call metabolic syndrome. And basically, that means that you are not metabolically healthy. But even having one or two of those measurements abnormal predicts that you are on your way to poor metabolic health. And that it's highly likely if you have even one of those abnormal that within 10 years, you'll get to the point where you have three of them at normal and you're you have over metabolic syndrome. So you know, the goal, everyone's goal should be to have zero of those abnormal. 

Jack Heald  15:49 

Do you have any idea what percentage of American adults fall into the category where they've got zero of five? In other words, they are metabolically healthy? 

Dr. Philip Ovadia  15:59 

Yeah. So the latest data we have on that shows that 12% are metabolically healthy meet all five criteria of good metabolic health. So the flip of that, and this is a shocking number to most people is that 88% of the adults in the United States are not metabolically healthy. 

Jack Heald  16:25 

Because this is 2021. And this is a pertinent question. Does poor metabolic health contribute to a poor outcome? If you catch COVID? 

Dr. Philip Ovadia  16:37 

Yes, very clearly, as a matter of fact, poor metabolic health is probably the number one risk factor for a poor outcome if you catch COVID. And even quite honestly, the data would suggest that it makes you being metabolically unhealthy makes you more likely to catch COVID. And then once you catch COVID, to get sick with COVID, the less metabolically healthy you are. 

Jack Heald  17:06 

So in other words, this is a really good time to be metabolically healthy and a really bad time not to be. 

Dr. Philip Ovadia  17:14 

And yes, this in particular, but the reality is, is that that's always been the case. Because even if we go back to let's say, 2018, or 2019, prior to COVID, and we've looked at the top 10 causes of death in the United States, seven out of the 10 Top 10 causes of death can be related to poor metabolic health. 

Jack Heald  17:37 

Wow. All right. Well, I think that's a great place to end. You have given me a ton to think about. I'm going to go measure my middle and I want to be under 40 inches. It sounds like 

Dr. Philip Ovadia  17:56 

Yes, you do. Hope. All right. I would encourage everyone to do the same and to get those other measurements checked as well. 

Jack Heald  18:04 

Very good. Well, this has been the stay off my table podcast with Dr. Philip Ovadia. If you want more information, we will link that in the notes to the podcast. You can follow Dr. Ovadia at on twitter at Isaac's hearts and we'll talk to you next time.