Are You Metabolically Healthy?

This is a pertinent question we should all be asking ourselves. As it appears that no matter what age you are, 40 or 80, if you’re ‘metabolically’ unhealthy or have signs of metabolic syndrome you’re more likely to suffer from illness. Being metabolically healthy also reduces your risk of developing other more slow-growing chronic diseases like heart disease, diabetes, cancer or dementia.

Typically, metabolic health screening is picked up during an annual medical, whereby a doctor determines what is metabolically healthy based on fulfilling 5 criteria. The National Cholesterol Education Program Adult Treatment Panel (NCEP ATPIII) back in 2002, devised a definition for what is called metabolic syndrome. Those criteria are based around:

  • Fasting triglyceride levels over 150 mg/dL
  • Fasting HDL below 40 mg/dL
  • Fasting blood sugar over 100 mg/dL
  • Waist circumference over 40 inches (men) 35 inches (women).
  • Blood pressure 130/85


If a person has 3 of the 5 criteria met then you are classified as having metabolic syndrome, or in other words, you are ‘metabolically unhealthy’. Metabolism covers many key elements in the body, but by zoning in on glucose and lipid metabolism we can really get a feel as to the likelihood of someone’s future risk of chronic diseases like cancer, heart disease and diabetes. But from a functional medicine perspective there’s a real issue here, and that is that most people if tested under those parameters would pass, giving a false sense of optimal health, but in reality, these reference points are set too leniently.


Fasting Triglycerides

Case in point, Fasting Triglycerides is seen to be abnormal above 150 mg/dL, this is way too high. Hyperlipidemia (or high blood fat levels) is where triglycerides are above normal. In healthy adults, the fats are carried in our blood from the food we eat, in small amounts, to provide fuel for the cells. This is different to cholesterol which is used to build cells and several hormones. Studies have shown that when your levels of triglycerides are around 150mg/dL signs of insulin resistance and other inflammatory markers increase. So, we want to keep the triglycerides at optimal levels like below 100 mg/dL to minimize the inflammatory and oxidizing effects on the bloodstream.


Fasting HDL

HDL levels are classified as low when they are less than 40 mg/dL. But levels as low as this are linked to the development of Cardiovascular disease. This is especially true if your triglycerides and LDL cholesterol are also high. So the goal is to get to a much higher level around 60mg/dL or above to obtain the protective effects of HDL. These protective effects are directly due to HDL’s ability to remove LDL from the bloodstream and back to the liver, thus reducing the time spent by LDL cholesterol to oxidise or go awry. But these protective effects are only applicable if either your triglycerides and LDL are below 100.


What is more productive and predictive is to look at ratios between HDL/TC (total cholesterol) and triglycerides/HDL. For HDL/TC ratio simply divide your HDL by your TC, the magic number should be greater than 0.24 – generally speaking the higher the ratio the better. A more indicative ratio however is triglycerides/ HDL. Studies have shown when people have higher triglycerides to HDL there is a higher level of clotting factors in the blood. A ratio of 2 or less is considered ideal and anything above 4 is high. This ratio is one of the most potent predictors of heart disease. A study particularly pointed out ‘people with the highest ratio of triglycerides/HDL, had 16 times the risk of heart disease, then people with the lowest ratio’.


Fasting Blood Sugar

Next is fasting glucose. The level of 100mg/dL again is too high, and on most occasions the test must be repeatedly high for doctors to intervene to suggest medical interventions. However, a study has shown that fasting blood sugar levels of over above 95mg/dL or more have three times the risk of developing future diabetes, compared to people with levels under 90mg/dL. Additional studies are showing that having normal FBG level of mid 90’s predicts diabetes occurring a decade later. So, from a functional medicine perspective we need to aim for blood glucose fasting to be around 85 or less.


Waist Circumference

When it comes to waist circumference levels, less than 40 inches for men and 35 inches for women are set as the benchmarks. Whilst these levels are indicative of metabolic risk, what is of more value is measuring the visceral fat levels inside the body, around the organs. Visceral fat is metabolically active and produces hormones that increase or decrease the risk of metabolic diseases like diabetes or heart disease. Two key hormones related to body fat levels, are adiponectin and leptin. You want your adiponectin levels high and your leptin levels to be low. Studies have shown high leptin levels to be associated with atherosclerosis and heart disease.


It is difficult to ascertain visceral fat unless you do CT or MRI scan, so the best way to calculate it as 10% from your total body fat. Visceral fat is also calculated with body fat analysers with ranges indicative of being healthy as less than 13%. Anything above 13% is unhealthy and the individual is advice to make so healthy lifestyle choices.


In conclusion, when discussing your metabolic risk with a suitable health professional it is best to view it through the lens of the functional medicine parameters discussed to obtain a more sensitive and nuanced interpretation of your overall risk. For more information regarding metabolic health and testing, please contact us.



  1. The role of triglycerides in atherosclerosis Beatriz G. Talayero, Frank M. Sacks Curr Cardiol Rep. 2011 Dec; 13(6): 544–552
  2. Kosmas CE, Martinez I, Sourlas A, et al. High-density lipoprotein (HDL) functionality and its relevance to atherosclerotic cardiovascular disease. Drugs Context. 2018;7:212525. Published 2018 Mar 28.
  3. Hage MP, Azar ST. Treating low high-density lipoprotein cholesterol: what is the evidence? Ther Adv Endocrinol Metab. 2014;5(1):10–17.
  4. Millán J, Pintó X, Muñoz A, et al. Lipoprotein ratios: Physiological significance and clinical usefulness in cardiovascular prevention. Vasc Health Risk Manag. 2009;5:757–765.
  5. da Luz PL, Favarato D, Faria-Neto JR Jr, Lemos P, Chagas AC. High ratio of triglycerides to HDL-cholesterol predicts extensive coronary disease. Clinics (Sao Paulo). 2008;63(4):427–432.
  6. Park C, Guallar E, Linton JA, et al. Fasting glucose level and the risk of incident atherosclerotic cardiovascular diseases. Diabetes Care. 2013;36(7):1988–1993. doi:10.2337/dc12-1577
  7. Shaye K, Amir T, Shlomo S, Yechezkel S. Fasting glucose levels within the high normal range predict cardiovascular outcome. Am Heart J. 2012;164(1):111–116. doi:10.1016/j.ahj. 2012.03.023
Open chat
Hello from LifeClinic!
How can we help you today?