The hard truth is that the food we eat to keep our metabolism running and us alive can, if we’re not careful, poison us. If we’re consuming too many carbs and not burning them off, glucose (sugar) builds up in the bloodstream which in turn drives up the hormone insulin required to get it out of the blood and into our cells for fuel. Unchecked, that sends us down the path of “insulin resistance” -- the pancreas can’t make enough insulin to do the job because the cells on the receiving end are becoming progressively less sensitive to it. Worst-case scenario: type 2 diabetes. The symptoms of advanced diabetes are life-threatening on their own and to top that off, diabetics suffer from a hugely increased risk of heart disease, heart attack and stroke. Sounds pretty grim, right? The good news? You don’t have to go there!

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The two way stations on the path from metabolic health to insulin resistance to metabolic disease are pre-diabetes and metabolic syndrome. If you’re diagnosed with either or both of these, consider it a wake-up a call, and a chance to reverse course before your health has suffered any irreversible damage. Here’s the top-line on how to recognize your metabolic issues and what you need to do to put them in your rearview mirror.

What is prediabetes?

OK, these numbers come back after a check-up with your primary care doc: a fasting blood sugar level in the range of 100 to 125 mg/dL, or a hemoglobin A1C level (a longer, 3-month window on those glucose levels) in the 5.7-6.4% range. That puts you in the prediabetic camp, and relax (for a minute anyway), you’ve got plenty of company. More than 1 in 3 adult Americans have it as well, and even more telling, the vast majority don’t know it. You do. What it should be telling you is that while you don’t have a disease per se, not as Western medicine defines it anyway, insulin resistance has got its hooks into you and if you don’t take steps to deal with that that, well, the Centers for Disease Control and Prevention estimates, within five years, 15-30% will cross the line into type 2.

What about metabolic syndrome?

Whereas prediabetes only takes into account blood sugar, this diagnosis looks at the big picture – how blood sugar, body fat and the cardiovascular system are all interconnected elements in a metabolic system that just isn’t working very well and, without some timely lifestyle upgrades, is likely to work worse and worse. The diagnosis encompasses five risk factors for chronic disease: a large waist circumference (over 35 inches for women; 40 inches for men); high triglycerides (over 150 mg/dl); low HDL or “good cholesterol” (under 50 mg/dl for women, under 40 for men); high blood pressure (130 systolic or greater); high fasting blood glucose (100 mg/dL or greater). Check off three of those boxes, you qualify, and once again, you’re not alone, about 1 in 3 Americans have it.

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While it’s not exactly good news, what I like about the metabolic syndrome diagnosis is that it puts us on notice. Even before any one of those numbers creeps high enough for a conventional MD to automatically prescribe a drug to address it (and, rest assured, that’s going to happen, probably sooner rather than later), metabolic syndrome is the flashing warning light that’s telling you to make the changes now to start moving all those numbers and all those risk factors moving in the right direction.

Turn the ship around with smart dietary choices.

If you’re familiar with my work at all, you should have a pretty good sense of what the solutions to these metabolic problems are. First up, diet. For metabolic health, and for health across the board, I can’t stress enough, lose or aggressively cut back on the low-fiber carbs like sugar, flour and all the crap they put in highly processed “convenience food.” Your digestive system breaks down those crappy carbs into glucose with lightning speed and dumps it into the bloodstream, exactly what you don’t want.

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What you do want, in addition to lean, clean proteins and some healthy fats, are lots of slow-digesting high-fiber “non-starchy” veggies, packed with disease-fighting nutrients. In metabolic terms, they do double-duty. Because they’re low-sugar, they’re perfect for “glycemic control,” and because they’re low in calories, they’re perfect for weight control.

Blood sugar and body fat: the terrible two-some.

As you may have figured out from the metabolic syndrome risk factors, high blood sugar and body fat, especially those extra pounds around the middle, conspire together to do a number on our metabolism. Sure, eating in such a way as to dump a ton of sugar in the bloodstream is bad news but, maybe not so obviously, that same lousy diet is likely to put the pounds on which can screw up your metabolism just as powerfully, in less direct ways. The extra fat you may be wearing acts as a giant hormone-secreting gland, pumping out inflammatory hormones that promote insulin resistance.

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As well, the beneath-the-surface abdominal fat, so-called visceral fat, coats the digestive organs and infiltrates the muscle cells, making the whole system less sensitive to insulin, meaning the pancreas has to produce more, meaning, you’re on the fast track to insulin resistance and metabolic disease. For those of us who are carrying an extra ten or twenty or more pounds, especially around the middle, quite possibly the single most impactful thing we can do  to reverse prediabetes and metabolic syndrome is to lose a chunk of that body fat.

Running away from metabolic disease.

Moving the body is crucial. Yes, we want to limit the amount of sugar circulating in the bloodstream but, as much as possible, we also want our muscle cells to burn blood sugar for energy. We can do that by building up the amount of physical activity we get in our everyday lives, for instance, by walking or climbing stairs rather than always defaulting to the car or public transportation or the elevator. Doing housework or cultivating a gardening hobby accomplishes the same end. And, for those of us who enjoy it, we can add more vigorous work-outs to our week, be it jogging, swimming, cycling, an exercise class, whatever. A higher-intensity work-out (so-called “HIIT”) eats up a lot of glucose in a relatively short amount of time, although it’s not for everyone. On the other end of the intensity spectrum, a simple 10-15 walk after dinner, when your system is having to process all those calories, has been shown to deliver impressive metabolic benefits.

De-stressing your way to metabolic health

Stress is the other big piece of the metabolic puzzle. When you’re under excessive stress, the levels of your primary stress hormone, cortisol, stay elevated which, once again, promotes insulin resistance and metabolic problems. High stress is one way to ensure you’ll be checking off those boxes on the metabolic syndrome check list: high blood sugar, high blood sugar, weight gain.

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So, find out what works for you to more effectively manage your stress. I’m a fan of a daily dose of sitting meditation and a regular yoga practice. Some of my patients swear by a walk in the park or the woods or a hot bath before bed. Mix and match. And never forget that a good night’s sleep, at least seven hours a night, is essential to keep stress, and cortisol levels under control. The proof? A 2021 meta-analysis of some 13 studies that found that people who slept under six hours a night were at significantly higher risk for metabolic syndrome. In fact, good sleep on the regular is even more important than you might think as even as little as a one night of substandard sleep can impair insulin sensitivity, so be sure to stay on top of your sleep game