- What do you think are the three to five things that basically everybody, if they can, should know about what's circulating in their blood? I'm imagining LDL, HDL, this kind of thing. I guess ApoB is a big favorite of our friend Peter Attia. Fasting blood glucose, continuous blood glucose, post-meal, et cetera, just kind of evaluating how exercise, food, et cetera, impacts blood glucose.

And then I'll leave the other categories open 'cause my point here is not to answer the question. That's what comes to mind. - You've got the big ones. So this is key is that every single person listening, I hope after this episode will go to their health record or send their doctor a message and at least get the following test.

And the first seven that I'll mention are very basic and people might take umbrage to them because obviously there's a lot of debate about what's everyone's favorite lab test. But I think about it as what are the basics that everyone should know and then what's the next tier up that are easy to access and are cheap that'll give you a lot more richness, which you still might have to kind of fight your doctor for.

So the first few that you will not have to fight your doctor for and are often free on an annual physical and literally define metabolic syndrome are fasting glucose, fasting triglycerides, HDL cholesterol, hemoglobin A1C, total cholesterol, waist circumference and blood pressure. - Okay, sorry, I hate to interrupt and my audience hates it even more, but I'm gonna just, could you just explain what each of those is and what it corresponds to?

- Yes. - Great, thank you. - And I will say, first of all, the reason I'm choosing these, it's not even my own choice really, it's two reasons. One is that the two studies over the past five years that have shown us in large populations that the vast majority of American adults are metabolically dysfunctional use those biomarkers.

So I think because of that, it's important to know them. And the two studies that I'm referring to are one from UNC in 2018, which showed that based on those biomarkers, 88% of American adults have suboptimal metabolism. And then a follow-up study from the Journal of the American College of Cardiology from last year showed that that number has gone to 93.2% of American adults are suboptimal in their metabolism.

And these are the metrics that they use and they're very basic. If you had to pay out of pocket, they would be less than $100. So let's talk through them. Why they're great is because together, they give you kind of like a tapestry of what's actually happening inside the cell.

If you choose to look at them that way, if you read the tea leaves of them, the doctors often, if they see all these lab tests, it'll be in an electronic health record. We've all been through this experience. They'll come up on the screen and there'll either be like a green, orange, or red color next to it.

Like it's high, it's low, it's borderline. And the doctor will basically, it's very algorithmic. Oh, your LDL is high, we need to bring it down. Oh, your glucose is high, we need to bring it down. Oh, your blood pressure is high, we need to bring it down. But what I'm inviting people to do is understand a little bit about each test and then read the tea leaves of what it's telling us about our mitochondria.

So let's start with fasting glucose. So fasting glucose, when you look at these studies that I'm referring to, they call optimal less than 100. So to define whether you were in that 88 or 93%, you had to essentially be in their optimal range for all biomarkers, not on medication.

So I'll quickly run through what their ranges were. My ranges for optimal are tighter than these, but fasting glucose less than 100, triglycerides less than 150, HDL above 40 for men or 50 for women, hemoglobin A1C less than 5.7%, total cholesterol to HDL ratio less than 3.5 to one, waist circumference less than 35 inches for women or 40 inches for men, and blood pressure less than 120 over 80.

If those things were in those ranges and you weren't on medication for blood sugar or blood pressure or whatnot, you were considered optimally metabolically healthy. That's now 6.8% of Americans. All of these biomarkers are easy to change in one to two months, I would say, with simple lifestyle habits.

- Could you remind us what hemoglobin A1C is? I think most people are familiar with HDL cholesterol being the quote unquote good cholesterol and LDL being the bad cholesterol. And as I say that, I know I'm gonna get dogpiled. - Yeah, totally, yeah. - I'm not sure that I adhere to that.

I'm not sure I don't adhere to that. I'm not sure about a lot of things, but I am sure that most people think of them that way. - So just to stay functional here, we'll frame it that way for now with the caveat that that might not be the whole story, isn't the whole story.

But triglycerides, fat in the blood, fatty stuff. - What's so key to understand about the triglycerides, we don't wanna confuse triglycerides with eating more fat. Triglycerides are a storage form of excess carbohydrates in the blood. So this is why it can tell us something about, and I know you and Rob Lustig talked about this at length, but it's- - And Lane Norton.

- And Lane, yeah. - Yeah, I mean, one of the things that's really tricky, gosh, is that the language around nutrition and health is complicated because people hear the word fat, they think body fat, but then they also think the macronutrient fat. We just need more words to better parse the reality.

In biology, we call the two major groups of people, lumpers and splitters. Lumpers like to lump everything together. It oversimplifies and complicates. Splitters like to split everything, give a name for everything, individual name for everything. It complicates. And so there's a middle ground, right? There's a land of reasonable people and nomenclature.

And unfortunately that does not exist on the internet, nor does it exist in any one specific subfield of medicine or science. I mean, so much of the confusion out in the world is because of a lack of adequate language in order to explain. Okay, so the triglycerides are a reflection of excess carbohydrate intake.

- And how it's helping us with that tapestry of understanding the trifecta of bad energy is that if you think about it, let's just go back to that cell and that poor mitochondria that's being absolutely decimated by our environment and its capacity is low. Okay, so that mitochondria is like, I can't process glucose or fatty acids to ATP very well, so I'm gonna block their entry into the cell.

So now you've got glucose rising in the bloodstream. So, okay, fasting glucose, that was one of our biomarkers. If that's going up, that is a little bit of that tapestry of maybe something's going on inside the cell that's blocking the entry into the cell, so it's rising the bloodstream.

Okay, well, where's all that? The body does not want lots of glucose floating around in the bloodstream because it can literally independently cause endothelial dysfunction, which is basically blood vessel problems. It can cause oxidative stress in the bloodstream. It can cause glycation, which is sugar literally just sticking to things.

The body doesn't want that glucose high in the bloodstream, so it converts it to triglycerides to be stored in a storage form of energy. That's a key point that I think is helpful to understand is that the body, it's always trying to like kind of keep things in the right range, so it'll convert things.

So then triglycerides, a picture in your blood of glucose being high and triglycerides being high is very much should signal to everyone when they look at their labs that there's probably something going on inside the cell that's blocking the cell from being able to use and process. It's a sign of mitochondrial dysfunction and chronic overnutrition.

Too much substrate, not enough processing, glucose is gonna go up, triglycerides are gonna go up. And so then if you kind of squint and read the tea leaves, it's like, huh, I think metabolic dysfunction. And what's fascinating is that the travesty in our healthcare system is that a patient might go into the doctor and their fasting glucose is 99, one point under what we'd consider the normal range, and their triglycerides are 149, one point under what we'd consider the normal range from these things.

That doctor might say to that patient, you're totally fine. Both glucose and triglycerides are normal. But that's just really problematic because they're on the upper end of normal for both of those. And so really what that would say to me as someone thinking about the mitochondria is like this person is definitely metabolically dysfunctional.

They're on the highest end of normal for both triglycerides and glucose. There's something, there's definitely insulin resistance going on here. I would much rather see that glucose at 73 and that triglyceride at 50, which to me would say, oh, this cell's processing through energy, great, and things are moving through, and we're not backing up in the bloodstream, we're not converting to triglycerides.

So that's where really optimal ranges get in. But so that's glucose and triglycerides. Why, if those are starting to creep up, it's a sign that something is happening metabolically. And then when we look at some of the other biomarkers, so hemoglobin A1c is really, so that's a marker that's looking at how many of the hemoglobin molecules that are in the red blood cells that carry oxygen, how many of those hemoglobin molecules have sugar stuck to them?

And that's glycation. So you're looking at glycated hemoglobin, and you can imagine that if the concentration of glucose is higher over time, more glucose is gonna stick to red blood cells, and that's gonna create a higher percentage of glycated hemoglobin. So that's why that lab is represented as a percentage.

So less than 5.7 is what we want. - You want those cells nice and smooth and slippery. - Nice and smooth, no sugar stuck to them, causing dysfunction. And because blood cells last for about nine to 120 days, hemoglobin A1c is giving us a basically a snapshot of average blood sugar levels over nine to 120 days.

And if that average is higher, again, probably a sign that cells are rejecting glucose from the cell and it's causing a rise in the bloodstream. And then just talking about one other biomarker in that, that we talked about, which was blood pressure, people might say, well, how does blood pressure relate to like what's going on inside the cell, you know, in the mitochondria and whatnot?

And a really, the fascinating link is that when that cell becomes insulin resistance, which again is a compensatory mechanism for mitochondrial dysfunction, the insulin is gonna rise in the blood 'cause the body's insulin resistant. So the body's gonna churn out more insulin to try and overcome the insulin block to drive the sugar into the cells.

So insulin levels rise. Well, insulin is one of the key activators of nitric oxide, which is the molecule in the blood that dilates and relaxes blood vessels. And so when we become insulin resistant and we're not responding to that insulin signal, we end up getting less nitric oxide activity.

So this is how kind of looking at even these very basic, very cheap biomarkers through the lens of basic cellular physiology, we can start to see, man, my body might be like underpowered. I might have a mitochondrial issue here. So that's a few of those tests that we really wanna shoot for.

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