How healthy is your metabolism?
It is clear that to have a healthy brain you need to have a healthy metabolism. The tragedy is the majority of the adult population is metabolically unhealthy. What can be done about it?
It is becoming increasingly clear that metabolic health is very important for maximising Brain Health. As a species man evolved in a very different food environment to one we live in now. Feast and famine was almost certainly the main driver of our metabolic evolution so that when we live in an era of over nutrition and poor nutrition the majority of the population has developed poor metabolic health.
The definition of poor metabolic health is debatable, but one of its consequences is metabolic syndrome, which is due to insulin resistance and hyperinsulinaemia. This leads to glucose intolerance or prediabetes, diabetes, hypertension, hyperlipidaemia and obesity. Many commentators would include non-alcoholic fatty liver and visceral obesity (TOFI - thin outside fat inside) as part of the syndrome.
The good news is that metabolic syndrome is responsive to dietary manipulation and can be reversed. This review article below in the BMJ reviews the evidence. What I learnt by reading this article is that visceral fat, which accumulates in the pancreas, causes pancreatic Beta-cell toxicity and hence may cause type 1 diabetes. This is why there seems to be a window of opportunity for reversing metabolic syndrome with diet, with the greatest effect within 10 years of disease onset.
The best dietary manipulation to reverse metabolic syndrome seems to be low carbohydrate diets combined with caloric restriction. The question is how low is low. I would argue that it needs to be low enough to at least result in intermittent ketosis. Other options proposed include intermittent fasting and caloric restriction. The problem with the latter two options is the hunger that accompanies these two diets and the behavioural responses to hunger make rebound weight gain or yo-yo-ing inevitable.
Let’s hope we will be able to take metabolic health forward as a potential research strategy to optimise brain health and its downstream effects on preventing or delaying the onset of neurodegenerative diseases. Although metabolic health is defined as having ideal levels of blood glucose, triglycerides, high-density lipoprotein (HDL) cholesterol, blood pressure, and waist circumference, without using medications, it misses the important fact that metabolism is a dynamic process. What we really need is a simple way of assessing metabolic health and its dynamics remotely so as to allow us to self-monitor what is happening.
If you have any suggestions about how to self-monitor metabolic health it would be much appreciated.
Taylor et al. Nutritional basis of type 2 diabetes remission. BMJ. 2021 Jul 7;374:n1449. doi: 10.1136/bmj.n1449.
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General Disclaimer: Please note that the opinions expressed here are those of Professor Giovannoni and do not necessarily reflect the positions of the Barts and The London School of Medicine and Dentistry nor Barts Health NHS Trust and are not meant to be interpreted as personal clinical advice.