[INTERVIEW]
Ronda Nelson: Metabolic health is not just for weight loss, not just having to do with GLPs, and not just something to overlook. In fact, it is the foundation for everything that you deal with with patients every single day, including brain health, weight loss, gut, energy, emotions, all of the things. They’re all dependent on metabolic health. So if you have patients that are stuck, you don’t know where to go, I’m gonna suggest this is exactly where you start, and I’m gonna show you what you might be missing. Let’s go.
Well, hello and welcome back. We are gonna talk about metabolic health despite this head cold. So we often are looking down the wrong path when we’re not addressing metabolic health. We are doing what we always do, which is chase the symptoms. We can’t help it. We are like a dog with an itch. We’re gonna scratch the itch. We’re gonna find the symptom. We’re gonna chase the symptom. Fatigue? Oh, we’re thinking adrenals. Fair. Weight gain? Mm, must be your food and your diet. Let’s get that food under control and get that calorie restriction down. Let’s do that down to, like, 1,200 calories a day. Yeah, good idea. Or maybe GLPs. Brain fog? Let’s just do a little bit of, you know, bacopa or some lion’s mane. None of these things are wrong either, not making anything wrong. What if it’s hormones? Oh, well then, liver for sure. Liver, liver, liver if it’s hormones. Oh, mood? For sure, we need to do some St. John’s wort. We need to probably get a little mushrooms going on in there to get that mood lifted up, and yeah, we’re gonna get that, no problem.
But what if the underlying issue in all of that wasn’t any of that? What if it was metabolic dysfunction? That’s all. And all of those things could be tied together and related to one common cause, and that is metabolic foundation. The metabolic foundation is cracked, it’s leaking, it’s not working.
So let’s talk about metabolic health. You all know what this is, I know. But there’s five markers that we use to assess metabolic health. So you can’t determine whether somebody’s in metabolic distress without these five blood markers. They are, as you can imagine, glucose, triglycerides, HDL. You need to be looking at fasting insulin, and I would argue A1C as a measure of glucose. We need to be looking at their blood pressure and waist circumference as well, because that can help us see — I mean, how extensive the risk factor is or the dysfunction is within the metabolic system.
So about one in eight Americans meet all five of the criteria, meaning that their blood — well, there’s five blood markers, plus the waist circumference and the blood pressure — are all outside of normal ranges. One in eight. So that means that a pretty good chunk of your patients are gonna be metabolically dysfunctional. So we wanna look at these markers in context with one another, right? We gotta do ’em all together.
So how many of you are actually measuring waist circumference? I know, kind of awkward for the patient, but it doesn’t have to be. But you need to know it. How many of you are checking blood pressure? You functional medicine doctors, are you checking blood pressure? Are you asking them about their blood pressure? I mean, you don’t have to necessarily check it in the office, but you can ask them. Some people take it, some people don’t take it, but it’s a good thing to know. You should have a cuff that you’re actually looking. If you really wanna get serious about metabolic health, my friend, this is how you do it right here.
So I wanna introduce you to a term you may know, but it’s called metabolic flexibility. And basically what it means is that a healthy person with a healthy metabolism, they’re able to easily switch between burning glucose and burning fat depending on what’s most available. We see that especially at night during the fasting period. If there’s no available glucose, the body might go after some fat, if there’s no glycogen stored or gluconeogenesis is impaired for some reason. But the body can switch. It’s called metabolic flexibility.
But a compromised metabolic patient has lost that flexibility, and she gets locked into glucose dependency. So she’s only reliant on glucose for fuel, so her body hoards the fat because it can’t efficiently — it can’t access it for fuel, so it’s just gonna hang onto it. So she can cut calories, she can exercise all day, she can do all the right things, and the weight’s not gonna come off for this particular individual, and she crashes mid-morning. She’s got all the signs of metabolic dysfunction. And then we say, “Oh, no, it must be adrenals. You must just be tired. Maybe add a little more protein to your meal.” Listen, I’ve been guilty of saying the same stuff, but I’m more now aware of the fact that there are metabolic issues with almost every patient. I would argue that it’s more than one in eight.
So these metabolic issues influence almost everything that we deal with. Hormones — insulin resistance disrupts the entire endocrine axis. Let me say that again. Insulin resistance disrupts the entire endocrine axis, because that right there drives estrogen dominance. It suppresses progesterone. It tanks testosterone. Hello, do we even need — what is this, you know, low T situation? What if all it is is a metabolic disorder? Has anyone ever asked that question? If this rampant supposed low testosterone thing has anything to do with metabolic health, it’s a good question to ask. I think we’re gonna be surprised, and you probably already know the answer. Also, insulin upregulates the aromatase enzyme, which then causes even more estrogen dominance and down the wrong pathway for women in menopause. We also know you can’t treat a hormone problem on top of a broken metabolic foundation. So if you have a hormone patient and you’re not addressing her blood sugar, her metabolic health — the hormones, the liver, all the support that you’re giving, it’s not gonna work.
The other thing is energy and fatigue. Again, we kind of default to what we know, and that is to use adaptogens, but we forget that the mitochondria run on metabolic currency. That’s their money. That’s the language that they speak. So when we have very poor blood sugar regulation, we’re gonna have unstable cellular energy. I mean, the mitochondria are like the battery, so it’d be like having a battery that’s shorting out all the time. You know, it’s like glitching out all the time because there’s so much dysfunction and irregularity in the way that the metabolic health and blood sugar is that the poor mitochondria, they can’t even charge their own battery, much less power the city. So if the patient is exhausted, no matter how much he or she sleeps, they hit the wall by 2:00 PM every day, that is likely a mitochondrial issue, could be caused by metabolic health.
Also, brain and mood. Blood sugar dysregulation — one of the top drivers of anxiety, irritability, and mood swings. So the brain consumes more glucose than any other organ, so it’s very, very sensitive to metabolic instability. So when she’s anxious for no reason, when she’s got mood issues — “I’m fine one minute and I’m not fine the next minute” — think metabolic, think blood sugar. I had a teacher one time and she said, you know, “Mood and energy always follow blood sugar. When blood sugar drops, mood’s gonna go down and energy’s gonna go down.”
So inflammation. Metabolic dysfunction is very, very pro-inflammatory at the cellular level, and every single inflammatory complaint, no matter whether it’s joint pain, skin inflammation, gut inflammation, doesn’t matter — it’s worse when there is poor metabolic flexibility. And then stubborn weight. Although it’s probably not caused necessarily by this, but it’s certainly regulated by, and that’s the weight that doesn’t respond to dietary effort. They do everything, everything, everything. It’s just a metabolic problem.
So here’s what I want you to watch for, and you’re gonna know all these things, and I’m just telling you because sometimes we just need to go back to basics and do a little bit of remembering. When they energy crash mid-morning or mid-afternoon, that’s a sign that there’s metabolic issue. Sweet or carb craving after the meals — so they eat, and then they need something sweet. It’s like the blood glucose is like, “Yeah, that wasn’t enough. I need more.” Waking at 2:00 to 4:00 AM — we see that. That is a cortisol/blood sugar rebound issue in the middle of the night. We see it a lot in menopausal women. But ask them, “What time do you wake up?” If they say, “Between 2:00 and 4:00, and I’m up for two hours,” eh, there you go. Don’t even bother with the other stuff. Get the metabolic foundation fixed, ’cause if you don’t get that fixed, you’re not gonna make any progress.
Belly fat that won’t shift. Brain fog after eating — not before they eat, after they eat. You eat and then all of a sudden you’re getting sleepy. “I can’t think. My mind doesn’t work.” Mood that tracks with meals — so I said mood and energy follows blood sugar. So when you start to see patterns, or the patient sees patterns, where mood is changing based on meals or what they’ve eaten or meal timing, that is a sign that we’ve got metabolic dysfunction. And then the patient that gets real hangry after a couple hours — you know, they have to eat every few hours. Also the patterns and the sign that you need to look at that could be signaling a metabolic problem.
So let’s talk about these labs. First, you wanna get fasting insulin. This is not often added to a regular normal panel, so it’s an add-on. You also need it in order to calculate HOMA-IR, and if you’re not familiar with that, that is the best early indicator of insulin resistance. But you need fasting glucose and fasting insulin. That’s all. And it is just two numbers. Fasting glucose times fasting insulin divided by 405. That’s the calculation, and a score less than 1.5 indicates early insulin resistance, and if it’s above 2.5, you have significant insulin resistance. So it’s a very, very, very sensitive marker to what’s going on with their metabolic health.
Triglyceride to HDL — that’s another calculation that you could consider. Divide fasting triglycerides by HDL. Anything over 2.0 is a red flag. If it’s above 3.0, it’s significant insulin resistance, regardless of what the glucose looks like. You could see this be off and glucose could look pretty normal. It could be like 92, which is still within the normal lab range, but there’s still metabolic dysfunction brewing underneath.
So here’s what I don’t want you to do. You ready for this? Please do not spend a ton of money on a bunch of hormone panels, Dutch tests — don’t get me started — thyroid testing, big fat adrenal protocols, a lot of liver, liver, liver detoxification. You can’t go jump ahead to all that stuff. Start with the basics. I will always say upper digestion is essential, so when I’m having this metabolic conversation with you, it’s paired with ensuring upper digestion works. Because we’re trying to stabilize something that we’re depending on the stomach, the bile, and the pancreas to deliver the right nutrients in a form that the body can use. It doesn’t do any good to any metabolic conversation that we’re having to have food that’s poorly broken down in the stomach, or fats that aren’t fully emulsified with adequate amount of bile, or an insufficient amount, I mean, of pancreatic enzymes to break the food down. If we can’t break the food down, then what are you fixing here? ‘Cause we have, like, half-digested food. That’s not gonna fix anything. So upper digestion support goes without saying, but this metabolic issue has to start, has to be the first.
Also, don’t keep chasing numbers. Sometimes I’ve had practitioners that say to me in a consultation, they’ll say, “Well, you know, I did the blood test and then we waited 60 days, 90 days. We retested, but then the number was this, so then I decided to change a protocol on that.” No, no, no. Just like I said with the triglyceride HDL ratio — glucose could look normal, but if you’re not checking the ratio, you’re not looking at the other signs that the patient may be exhibiting, you may absolutely miss it. You’ll end up adding supplements that have good intention, but they don’t have a good foundation to work from. That’s the difference. Your patients will plateau and they’re gonna say, “Well, this isn’t working,” and you’re gonna be like, “Yeah, well, kind of it’s not,” because you skipped all over the place. You did all the things. I’m not saying you shouldn’t address them. I’m saying make metabolic health first.
So blood sugar and insulin and food timing — all of this is super basic. It’s not sophisticated and it’s not fancy, and we like to reach for the fancy tests and the fancy protocols. It’s just not. It’s not sexy. Not at all. But it is absolutely foundational. It’s like prepping a house for paint. You put the tape down. You have to put the paper down. You have to do all the things. And as you’re prepping the house for paint, you’re thinking, “Ugh, this is so tedious. I really do not wanna have to do this right now.” But when you’re done, the finished product is amazing and it works. You have less mess, less disaster. All the things are so much better when you take the time to do the prep. That’s what we’re doing.
So here is where I want you to start. Number one, get their blood sugar stable. Eat protein at every meal. No naked carbohydrates — so carbs have to always be paired with a fat and a protein. Eat within an hour of waking up. No more than four to five hours between meals. This is not a diet. We’re not trying to lose weight. We’re trying to get blood sugar back in order.
Number two, address sleep. Get them sleeping, because poor sleep directly impacts insulin resistance. If the patient has even one night of poor sleep, insulin resistance is measurably increased by morning. Measurably increased. So bedtime at the same time every night, wake up at the same time every day. But sleep is so essential.
And then number three is get them moving. We know that GLUT4 is what moves the glucose out into the muscles. We wanna get that glucose moving and doing its work in the muscles, so taking a short walk right after a meal is more metabolically powerful than a 45-minute fasted cardio session. No kidding. Research to back it up 100%. So strength training two to three times a week — doesn’t have to be big and heavy and hard, just needs to build muscle so we’ve got more muscle to move that glucose into, and the muscle then becomes insulin sensitive muscle. We don’t wanna do, like, hardcore punishing, you know, CrossFit-type cardio workouts, because that only makes the metabolic dysfunction worse. It spikes cortisol, and that’s working against us. So we wanna think about what are the exercises we can do that are gonna frame and support the body so that that metabolic flexibility can come back into play.
Now, if we were gonna boil this down into supplements, there’s a whole bunch to choose from, and I’m not gonna take the time to go through all of them here, because then we would be here for an hour or two. But there are a couple of them that are important. One is magnesium. This one is one that you probably should be considering if you have an insulin-resistant patient. Magnesium’s responsible for over 300 different enzymatic reactions. Magnesium deficiency, what it does is it impairs the insulin receptor function directly, so it makes the insulin receptors work less efficiently. So deficiency is very, very common and very widespread. We can get magnesium food-based. It’s very high in chlorophyll. It’s in all green plants. But how many people are eating plenty of greens? And what is plenty? You know, how do you define plenty? Is that a cup, two cups, five cups, a gallon, 10 pounds? I don’t know. But it’s real easy to address magnesium deficiency. Just give a good food-based magnesium.
The second thing I’ll say is berberine. I think we all know that berberine is such a powerful herb for all things having to do with metabolic function. It helps with improving insulin sensitivity. There’s research that compares it to metformin. It’s kind of in that category for helping to decrease blood glucose, and it has some support for the lipids as well — cholesterol, triglycerides. So berberine on social media, they’re talking about, “Oh, berberine is the natural Ozempic.” No, it’s not. It doesn’t work that way. That’s not what the pathway is. Don’t get sucked into all of that. But berberine is a good herb. You can always choose this and be safe when you’re working with metabolic-resistant patients.
And then I also really like AMPK. This particular one comes from Gaia. I love their AMPK activator product, and this one works also incredibly well and should be considered if you’re going to think about, you know, working with someone and getting their metabolic health up.
So there you go. Short and sweet today. I just want you to be thinking about this in the coming weeks when you’re working with your patients. Don’t forget about the essential role that metabolic health plays in all these other things. You’re gonna save yourself so much time. And what if you balance blood sugar, you get their metabolic health up and running, and then guess what? There’s not a lot left to deal with, right? The hormones start to regulate, their stress starts to go away, their brain fog lifts. Look, you just saved them a bunch of money. They don’t have to buy a bunch of supplements. They feel better, you look like a hero, and they’re healthier at the end of the day. So it’s the foundation for absolutely everything.
[CLOSING]
Ronda Nelson: If you haven’t yet, go download my free guide. It’s called “The Five Non-Negotiables,” and you can find it at rondanelson.com/nonnegotiables. What it will do is go over my five essential foundational aspects that every single practitioner needs. One of them, of course, is blood sugar or metabolic health. And if you wanna go deeper and you want more clinical information, you can also learn more about Clinical Academy. That is my training program for practitioners that wanna know exactly what to do when you’re sitting in front of a patient. You’ve got all the clinical knowledge. It teaches you the how. It teaches you what to do. So go to rondanelson.com/clinicalacademy, and you can join there. Thanks for watching. I’ll be back next week.
[END]