Your patient is exhausted, gaining weight, and crashing by 2 PM. You’ve worked up her adrenals, checked her hormones, done the liver support. Nothing seems to be working. Here’s what I want you to consider: the problem might not be any of those things.

 

Metabolic health for practitioners is one of the most overlooked starting points in clinical practice, and I’m not just talking about weight loss or using GLPs. I’m talking about the underlying issue beneath every complaint she has. Brain fog. Mood swings. Stubborn weight. Fatigue that doesn’t improve no matter what you do. When the metabolic foundation is cracked, nothing you build on top of it is going to hold.

 

In this episode, I walk through the five markers I use to assess metabolic dysfunction, the clinical signs most practitioners miss during the intake process, and where to start when everything else has stopped working. This is the conversation I wish somebody had told me about much earlier in my practice.

 

 

TIMESTAMPS

 

00:00 Why Metabolic Health Is the Foundation for Everything

00:45 How We Chase Symptoms and Miss the Real Problem

02:00 The Five Markers of Metabolic Health

03:45 What Metabolic Flexibility Is and Why It Matters

05:15 How Insulin Resistance Disrupts the Entire Endocrine Axis

07:15 Metabolic Dysfunction and Brain Health

08:30 Clinical Signs You Might Be Missing in Intake

10:00 The Labs That Actually Tell You What’s Going On

11:30 What Not to Do First (And What to Do Instead)

13:45 The Three Foundational Steps to Start With

16:15 Supplements Worth Considering

18:30 What Changes When You Fix the Foundation First

19:00 The Five Clinical Non-Negotiables

 

Why Do My Patients Keep Plateauing Even When I’m Doing Everything Right?

Metabolic dysfunction sits upstream from almost every complaint we deal with clinically. Hormones, energy, mood, inflammation, stubborn weight: they all have a metabolic component that, if ignored, will undermine your results. Insulin resistance alone will disrupt the entire endocrine axis. It drives estrogen dominance, suppresses progesterone, and tanks testosterone. You can’t treat a hormone problem on top of a broken metabolic foundation and expect it to work.

 

What Labs Should I Actually Be Running to Assess Metabolic Health?

Five markers tell you what you need to know: fasting glucose, fasting insulin, triglycerides, HDL, and blood pressure, with waist circumference added for a complete picture. Most practitioners neglect to order fasting insulin, but you need it to calculate HOMA-IR, which is the most sensitive early indicator of insulin resistance you have. Here’s the calculation: fasting glucose times fasting insulin divided by 405. A score under 1.5 indicates early resistance – and levels above 2.5 are significant. And don’t ignore the triglyceride-to-HDL ratio: divide triglycerides by HDL – anything over 2.0 is a red flag even when glucose looks completely normal.

 

Where Do I Start When a Patient Has Multiple Issues That All Need Attention?

Start with blood sugar. Address the diet, ensure good sleep, add in movement. Protein should be included with every meal, no naked carbohydrates, and eating within an hour of waking. A short walk after meals is more metabolically powerful than 45 minutes of fasted cardio. I know it’s not sexy and definitely not the most interesting protocol. But fixing the metabolic foundation first means everything you do after that will actually work. 

 

CTA

Watch the episode: If your patients are stuck and the protocols aren’t landing the way they should, this is probably exactly what’s missing. Watch it here.

 

Download the free guide: The Five Clinical Non-Negotiables walks through the five foundational pillars I start with in every patient case. Grab it here.

 

If you’re ready to go deeper and have a clear clinical framework for exactly this kind of thinking, Clinical Academy is where we do this work.