In recent years, gut and metabolic health has gained significant attention in medical research. Both play pivotal roles in regulating various aspects of our well-being, encompassing everything from energy levels and appetite to sleep quality and hormone balance for long-term health. It is my goal to discuss the fundamental concepts of the gut-metabolic health axis, uncover their intricate connection, and offer practical steps to improve their homeostasis & your overall wellbeing.
What is Gut Health? It’s essential to understand what constitutes “gut health.” This was discussed in detail in my last blog, titled “The Importance of Gut Health: A Guide to the Gut-Body Connection” I encourage you to read that first and learn how gut health can have direct and indirect impact on our systemic health.
What is Metabolic Health? Metabolic health is the efficient functioning of processes in our body that convert food into energy. In essence how well our body breaks down, processes, utilizes and stores excess energy from food we consume. This is crucial for powering every cell, supporting growth, repair, and various functions such as energy regulation, appetite, sleep, body weight, hormonal balance and mood. When these processes function optimally, we achieve peak metabolic health and overall wellness.
Optimal Metabolic Health
Being metabolically healthy means having optimal levels of the following markers, thereby reducing the risk of metabolic syndrome—a cluster of conditions that heighten the risk of heart disease, stroke, and type 2 diabetes.
- Blood Sugar Levels: Healthy fasting blood sugar levels and normal hemoglobin A1c values indicate that the body is effectively processing glucose. However, we must also monitor fasting insulin as this has been shown to be an important predictor of insulin sensitivity and risk for type 2 diabetes, as demonstrated in the Whitehall II Study (Tabák AG et al., 2009).
- Triglycerides: These are a type of fat found in the blood and correlated with blood glucose levels. Normal triglyceride levels suggest that the body is metabolizing fats properly.
- HDL Cholesterol Levels: HDL (high-density lipoprotein) cholesterol is often referred to as the “good” cholesterol because it helps remove other forms of cholesterol from the bloodstream. Higher levels of HDL cholesterol are generally considered beneficial for heart health.
- Blood Pressure: Normal blood pressure levels (typically below 120/80 mm Hg for adults) show that the heart and circulatory system are functioning well.
- Waist Circumference: Excessive abdominal fat is linked to metabolic problems and an increased risk of cardiovascular disease and type 2 diabetes.
**If you have family history of heart disease, elevated lipid levels with ratios that put you in a “high risk” category for developing heart disease, I recommend you ask your physician to run an expanded lipid panel which gives better insight (Labcorp NMR Lipo- profile or Quest labs Cardio IQ blood test).
Key Benefits of Optimizing Your Metabolic Health
Reduced Risk of Chronic Diseases
- Type 2 diabetes
- Cardiovascular diseases, such as heart disease and stroke
- Certain types of cancer
- Non-alcoholic fatty liver disease (NAFLD)
Optimized Hormonal Health
- Improves insulin sensitivity, reducing the risk of insulin resistance and diabetes
- Potentially improves reproductive hormonal balance, reducing symptoms of conditions like polycystic ovary syndrome (PCOS), irregular menstrual cycles, leading to an enhancement in overall reproductive health.
Weight Management
- Enhanced fat metabolism and reduced fat storage
- Reduced cravings and improved appetite regulation from better balanced hunger hormones
Improved Energy Levels
- Reduced fatigue and increased vitality
- Enhanced physical performance and endurance
Better Mental Health and Cognitive Function
- Reduced risk of neurodegenerative diseases such as Alzheimer’s
- Improved mood and reduced risk of depression
- Enhanced cognitive functions like memory, attention, and processing speed
Healthy Skin, Hair and Nails
- Improved skin health, with reduced acne and other skin conditions
- Healthier hair and nails
Optimized Digestive Health
- The interplay between metabolic health and gut health is bidirectional
- Improved metabolic health can foster a balanced gut microbiome, leading to reduced gastrointestinal issues like gastroparesis and a lower risk of conditions like IBS and IBD.
- A healthy gut can also reciprocally support and enhance metabolic functions, contributing to better glucose management, reduced inflammation, and effective energy utilization.
Strengthened Immune Function
- Reduced susceptibility to infectious diseases
Healthy Aging
- Enhanced quality of life in later years
- Delay in the onset of age-related conditions
Bone and Muscle Health
- Reduced risk of osteoporosis and fractures
- Enhanced muscle strength and mass
Poor Metabolic Health also Known as Metabolic Syndrome
Metabolic syndrome is comprehensively defined in the 2022 Stat Pearls article by Swarup S, Goyal A, Grigorova Y, et al.
The rising trend in Metabolic Syndrome is a global concern. Factors driving this increase include shifts in lifestyle, dietary habits, and various environmental factors that range from chronic stress to daily toxin exposures from pollutants in the air, water and food. This multifaceted impact on metabolic health highlights the interconnectedness of our well-being with the environment we live in.
Fig 1. Impact of poor metabolic health on our overall health and wellbeing
Consequences of Poor Metabolic Health
Suboptimal metabolic health, when paired with an individual’s genetic predisposition and environmental stressors can lead to a range of adverse effects. This includes and not limited to, PCOS, erectile dysfunction, fatigue, brain fog, cholesterol imbalance, thyroid function, hypertension, obesity, and nonalcoholic fatty liver disease (NAFLD), with broad effects on ocular, renal, and vascular systems. The diagram in Fig 1 above illustrates these far-reaching effects.
Exploring the Connection Between Gut Health and Metabolic Health
This was briefly discussed in the article titled “The Importance of Gut Health: A Guide to the Gut-Body Connection.” Now lets explore this a little further:
Fig 2. Illustrates the bidirectional link between our metabolic and gut health
The human gut, often referred to as the “second brain”, houses trillions of microorganisms that play a crucial role in our overall health. These microorganisms, collectively known as the gut microbiome, are instrumental in various metabolic processes, ranging from glucose metabolism to lipid storage and appetite regulation. As research progresses, it’s becoming increasingly clear that the state of our gut microbiome directly influences our metabolic health, which includes conditions like type 2 diabetes, obesity, and cardiovascular diseases.
Gut Microbiome Patterns in Type 2 Diabetes (T2DM)
A study by Tilg H and Moschen AR, 2014, examined the gut microbiome patterns in individuals with T2DM. Their findings are summarized below:
- There was a noticeable alteration in the microbiome patterns among individuals with T2DM.
- This alteration manifested in the form of lower microbial diversity and significant depletion in beneficial bacteria, particularly butyrate-producing bacteria, which is a product of gut bacteria fermenting dietary fiber. Butyrate acts as a signaling molecule that aids in repairing the intestinal lining and enables colonic cells to regenerate.
- There was a marked depletion of Akkermansia muciniphila and mucin-producing goblet cells, which are vital for maintaining a barrier between the gut & our bloodstream.
- These microbial changes are linked to inflammation, insulin resistance, leading to impaired glucose metabolism, and increased intestinal permeability (leaky gut). This allows harmful substances to crossover into the bloodstream, causing both local and systemic inflammation.
**Please note that our goal is to achieve the right “balance” of these organisms!
Microbiome and Cardiometabolic Risk
A study by Cuevas-Sierra et al., 2019 showed:
- A distinct link between the gut microbiota and cardiometabolic risks, which include conditions like obesity and cardiovascular diseases.
- Dysbiosis, an imbalance in the gut microbiota, is a potential precursor to metabolic inflammation, which can heighten the risk of cardiovascular diseases.
- Fig 3, below illustrates the genetic and epigenetic (environmental) influences on health & gut microbiome. Dysbiosis signals food cravings & impacts food preferences which drives obesity, insulin resistance, elevated cholesterol, metabolic associated fatty liver disease (also known non-alcoholic fatty liver disease).
Fig 3. Cuevas-Sierra et al 2019 – illustrates the Gut microbiome and Cardiometabolic Risk
Oral Health Connection: What’s often overlooked is the importance of oral health. Bacteria entering blood vessels from oral and gut cavities trigger local and then systemic inflammation, contributing to atherosclerosis and disrupted lipid and carbohydrate metabolism.
It is interesting to note that species found in atherosclerotic plaques include c pneumoniae, H- pylori, gingivitis (ASCVD: atherosclerotic cardiovascular disease). Czerniuk MR et al 2022.
Dietary Influence and its Repercussions
Work done by Garcia-Montero C et al, 2021, reveals that the “Western” dietary pattern, characterized by high consumption of red meat, sugar, salt, and low fiber, shows a pronounced correlation with the T2DM microbiome signature.
- This type of diet leads to the proliferation of harmful bacteria like E. coli, which in turn ramps up the production of endotoxins
- Decreased microbial diversity with a significant shift toward elevation in harmful bacteria and byproducts
- Drop in butyrate-producing species, leading to aggravated inflammation and metabolic dysregulation as also shown in study by Tilg H and Moschen AR, 2014
These points emphasize that a diet abundant in processed foods and sugars has the potential to disrupt the balance of the gut microbiome. This disruption could potentially lead to the development of metabolic disorders.
Recognizing these detrimental effects reinforces the need to prioritize dietary and lifestyle interventions for our health. Numerous studies consistently highlight the benefits of a Mediterranean diet in promoting a healthy microbiota and preventing chronic diseases, including metabolic syndrome.
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To be continued:
Stay tuned for Part 2, where we will explore biological mechanisms linking gut and metabolic health. Discover what my approach to assessing and addressing your individual needs looks like, followed by some simple strategies you can use right away to start your healing journey.
References can be found at the end of blog – Part 2