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What is a Metabolic Health Doctor? Should You Have One?
Paul Kolodzik, MD, FACEP, FASAM
Board Certified by the American Board of Preventive Medicine Founding Member of the Society of Metabolic Health Physicians Medical Director, Metabolic MD
As the percentage of Americans who are overweight, prediabetic, and diabetic continues to rise, a new type of medical specialist is being increasingly recognized in the US and sought after by patients. This is the physician focused specifically on helping patients lose weight, lower blood sugar, and reverse the diseases that accompany excess weight, high blood sugar, or both. “Metabolic Health Specialists” are physicians who assist patients in preventing or reversing the condition known as “Metabolic Syndrome.” About one in three adults in the US, have Metabolic Syndrome, and most do not know they have this condition.
What is Metabolic Syndrome? Metabolic Syndrome is defined as a cluster of medical issues that occur together, increasing your risk of heart disease, stroke, diabetes, and other vascular and weight-related medical problems. These conditions include, among others: increased blood pressure, prediabetes, fatty liver disease, gastrointestinal reflux (GERD), abnormal cholesterol and/or triglyceride levels, extra body fat around the waist (excess visceral fat), and the arthritis that results from being overweight or obese.
The syndrome, and theses associated medical conditions are usually rooted in a problem called “insulin resistance.” Insulin resistance occurs when the body’s organs can no longer absorb all blood the sugar in a person’s vascular (blood vessel) system. This surplus blood sugar often results from the ingestion of too much sugar and carbohydrates.
The root of this problem of insulin resistance is straightforward. Insulin is released when a carbohydrate, or “carb,” is ingested, and it helps organs like our muscles absorb sugar to use as energy. Sugar (which is a “simple carbohydrate”) is absorbed directly into our blood; “complex carbohydrates” like starches, bread, and potatoes become blood sugar as soon as they are digested within the intestine. Moderate levels of blood sugar are good, serving as one of our body’s key energy sources. However, with persistently high blood sugar from excess sugar and other carbs, our organs become less sensitive to insulin. Blood sugar is then not absorbed as readily into, for example, our muscles. It then rises and remains at higher-than-normal levels. This extra blood sugar then goes to the liver and is converted to fat, which is then deposited in the midsection body. The result is extra fat around the middle portion of the body (visceral fat) and weight gain. As this process progresses, both weight and blood sugar go up further. Think about a bear in the fall fattening up on berries for the winter. But bears then hibernate (and do not eat) for six months. Many of us, unfortunately, tend to continually eat excess carbs, and put on more and more visceral fat, which becomes progressively more difficult to then get rid of.
The further insulin resistance progresses, the more difficult it is to reverse, and the more difficult it becomes to lose weight. Insulin resistance levels can be measured very accurately with appropriate testing. Metabolic Health Specialists are experts at assessing the level of insulin resistance in their patients. This allows them to then follow levels of insulin resistance and work with their patients through diet, medications, and other means to lower those levels.
If insulin resistance progressively rises, a vicious cycle causes it to become more difficult to reverse. Increasing insulin resistance leads to higher blood sugar, resulting in even more weight gain. Weight loss becomes more difficult in the face of insulin resistance and higher blood sugar. Prediabetes frequently sets in, and a majority of prediabetics, without intervention, then become diabetic. The other conditions of Metabolic Syndrome – hypertension, high cholesterol, elevated blood lipids, fatty liver, GERD, fatigue, and musculoskeletal issues, etc. are soon to follow. These may occur even before prediabetes is present, as insulin resistance has already progressed.
Metabolic Health Specialists are specially trained and focused on helping patients prevent and reverse Metabolic Syndrome through weight loss and the lowering of insulin resistance Prediabetes can be completely reversed in most patients, stopping the risk of progression to diabetes. In patients who have already become diabetic, blood sugar control can be improved, often even with a reduction in medication requirements such as insulin shots. With drops in weight and blood sugar, many of the conditions of Metabolic Syndrome are prevented and/or reversed.
For nearly all patients, the health issues are, or course, the most important. But with improvements in health, there is also the need for fewer regular doctor visits and fewer specialist visits. There are also fewer lost workdays, and less money spent on medications. Out of pocket costs related to health care are reduced.
The tools Metabolic Health Specialists use to reverse Metabolic Syndrome include dietary, medication, and activity interventions, but in a very focused way, and often with a technological bent. It is not the traditional approach of physicians telling their patients to “just eat less and exercise more.” These specialists carefully assess patient’s level of insulin resistance (an approach very rarely used by most primary care providers) and use this information to construct a dietary, weight loss, medication, and blood glucose moderation plan. Other hormonal parameters, like thyroid function, are also carefully evaluated. Detailed guidance regarding a low carbohydrate diet is provided, often accompanied by the use of a Continuous Glucose Monitor or CGM. (Blood sugar is also termed blood glucose.) CGMs mentor blood glucose 24/7, with remote reporting provided to the prescribing physician. CGMs are prescribed not just for diabetics, but also for nondiabetics and prediabetics to guide weight loss and blood sugar reduction. Reasonable intermittent fasting goals are sometimes collaboratively set. Newer FDA approved weight loss medications are also often utilized (Wygovey, Semaglutide, Plenity, Contrave, Qysemia). With reductions in blood sugar, fat is burned for energy instead of sugar, so weight is lost. The other issues associated with Metabolic Syndrome, for example fatty liver, high cholesterol, hypertension, joint pain, even fatigue, then also recede.
Metabolic Health Physicians also have a focus on their patients’ muscle mass, and for a very good reason. This is because these specialists understand that if muscle mass can be slightly increased, the quality and efficiency of insulin receptors on the muscles is improved. Insulin resistance is then further lowered. So Metabolic Health Physicians provide guidance related to resistance and strength training as well. They often take middle aged overweight men and women, often with no strength training experience, and gently, but progressively move them forward to gain muscle and help reverse Metabolic Syndrome. A bonus of slightly increased muscle mass is an increase in basal metabolic rate (BMR). With this increase in BMR (a direct result of a larger muscle mass) increased energy expenditure occurs even during periods of inactivity (such as even when a person is merely sleeping or sitting at a desk). This further assists with weight loss.
Can a primary care physician provide Metabolic Health guidance? Certainly, they can. But it is difficult for them to do so consistently and in an in a comprehensive manner. This is because the primary care doctor’s depth of knowledge related to Metabolic Health, and his or her office visit time constraints often make patient progress challenging.
Primary care doctors do an excellent job on the front lines of American medical care but are more focused on issues such as the routine medication management of high blood pressure, high cholesterol, or diabetes. Primary care doctors are also busy seeing patients with acute medical conditions – bronchitis, gastrointestinal conditions, back and joint pain, etc. They do not always have the time to emphasize the approaches necessary to reverse or prevent Metabolic Syndrome and the associated diseases. In a nutshell, primary care in this country has become largely reactive to disease, not proactive in preventing or reversing disease.
Primary care providers are also not usually versed in the nuances of insulin resistance, low carb diets, and the newer FDA approved weight loss medications (such as Wygovy, Semaglutide, Contrave Plenity, Qysemia). They only very, very rarely will prescribe a CGM to a nondiabetic or prediabetic patient.
It takes a provider with a focused knowledge base on these subjects be consistently successful in helping their patients reverse Metabolic Syndrome. Ask yourself - when was the last time your doctor had more than a few minutes talk with you about your need for weight loss and how to achieve it? What about discussing your diet (for example how many grams of protein and carbohydrates you should shoot for daily). Should you try intermittent fasting to help with weight loss? What about your exercise regimen? The importance of muscle mass in reducing insulin resistance? If you are overweight, has your physician discussed with you your level of insulin resistance or your possible need (really urgency) to reverse prediabetes before it becomes diabetes? Has he or she discussed with you the possible use of the newer FDA weight loss medications like Wygovy? Have you had a discussion with your physician about your risk of Metabolic Syndrome and the associated risks of related vascular or weight-related disease?
Metabolic Health Specialists serve as consultants to your primary care provider, like a cardiologist, or a gastrointestinal specialist, but with a preventative, metabolic heath, and weight management focus. They complement your primary care physician’s medical management efforts by addressing health issues proactively to preempt the development of more serious medical conditions.
Metabolic Health Physicians have both the office visit time with their patients and the expertise to address all these very important questions. Most also have health coaches and nutritionists on their staff to provide weekly ongoing monitoring, education, support, and motivation.
The goal of Metabolic Health Specialists is to recognize health issues and work proactively with patients before they progress to potentially life changing serious health conditions, such as heart disease, stroke, and other vascular issues. An additional goal is wight loss and heading off health problems associated with excess weight such as back and joint pain. With this focus patients also routinely achieve an improved sense of wellness and well-being, improved energy, and even better personal confidence and a brighter outlook on life. Optimal Metabolic Health replaces Metabolic Syndrome. Patient then, literally, live happier, healthier, and longer lives.