Root Causes of Cardiometabolic Disease

There are a lot of wellness articles this time of year focusing on how to achieve weight loss. While you might desire a quick fix and fast weight loss, most programs, pills, cleanses, and crash solutions don’t deliver long-term results. When you lose weight with unsustainable methods (like starving yourself), you often end up at a higher weight than when you started just a year or two later. That’s if you can even stick to the plan in the first place.

Finding a healthy weight is important for your health, but it’s not as simple as fitting into a BMI category. The number on the scale only tells a fraction of the story regarding your cardiometabolic health and risk for chronic disease.

If you want to lose weight in the New Year, you’ll want to keep reading this article! We’ll cover:

• Cardiometabolic disease and the relationship to weight
• Insulin resistance and causes
• The threshold theory
• Why some people are thin and diabetic, and others are overweight and healthy
• How to support cardiometabolic health

This article covers the background information about the relationship between weight and health. Spoiler: Body fat isn’t inherently bad!

To dive into integrative approaches for weight loss, stay tuned for my next article on the topic. Let’s dive in!

The Relationship Between Obesity and Cardiometabolic Diseases

Cardiometabolic diseases are chronic conditions mainly considered lifestyle-related and preventable. They include:

• Heart disease
• Stroke
• Prediabetes and type 2 diabetes
• Hyperlipidemia (high cholesterol)
• Hypertension (high blood pressure

Chronic conditions affecting metabolic and heart health are on the rise, contributing to a more significant number of deaths each year. Heart disease is the leading cause of death for women.

Obesity is also on the rise. In 2017, 41.9% of U.S. adults were obese, which is up from 30.5% in 2000. While obesity is a risk factor for cardiometabolic disease, weight doesn’t tell the whole story.

The obesity category is based solely on body mass index (BMI), a height-to-weight ratio. The BMI was developed based on data from white men; the scale was not designed for women and people of color.

Everyone with a BMI over 30 is considered obese, but the measurement doesn’t distinguish between fat mass vs. muscle mass. It’s possible to be “obese” with a lot of muscle mass and be fit, just as you can have a normal BMI but be at risk for cardiometabolic disease.

There is a link between obesity and cardiometabolic disease, but it is only part of the picture. While almost 42% of us are obese, 93% of Americans are metabolically unhealthy, regardless of their BMI or body size. Poor cardiometabolic health is a problem for us all, something even thin people need to pay attention to. It may be even more critical for thinner people because they are less likely to be screened for cardiometabolic disease.

Understanding Insulin Resistance

Insulin resistance is the root of cardiometabolic disease and is why most of the population is metabolically unhealthy. Understanding insulin resistance and its drivers helps us catch and reverse the process earlier, which is completely possible with an integrative approach!

Insulin resistance exists on a spectrum, with severe insulin resistance as type 2 diabetes. Type 2 diabetes occurs when excess fat accumulates in the liver and pancreas, promoting elevated glucose (blood sugar) and insulin. Insulin is the hormone that helps move glucose from the bloodstream into cells, where it’s used to make energy.

Elevated glucose leads to complications of diabetes, including heart disease, kidney disease, blindness, neuropathy, and dementia. But it begins with fat accumulation in the liver and pancreas, often decades prior.

Causes of insulin resistance include:

• Genetic factors – insulin resistance was likely evolutionary advantageous in hunter-gather times
• Low physical activity – movement counteracts insulin resistance
• The modern food environment with highly palatable processed food around every corner

The Threshold Theory

Dr. Roy Taylor is the researcher who discovered the mechanism of excess fat accumulation in the liver and pancreas, causing insulin resistance and diabetes. He proposes that we each have an individual fat threshold, an amount of body fat our body tolerates. When we exceed our personal threshold for fat, the process of insulin resistance begins. The process is independent of BMI and explains why so many people in non-obese categories are metabolically unhealthy.

This theory demonstrates that moving below one’s fat threshold is the key to reversing insulin resistance and diabetes. In studies, weight loss and decreased calorie intake reverses diabetes, regardless of obesity status. It also explains why bariatric surgery can reverse diabetes.

The key is maintaining a healthy weight (and body fat level) for you.

How to Sustain and Improve Metabolic Health

The discussion shows us that body fatness isn’t inherently bad or unhealthy, although our society has made it a moral issue. The real issue (for all bodies) is when you exceed your personal fat threshold and insulin resistance ensues. The tricky piece here is that we each have our own unique threshold and what’s hard is that we can’t compare ourselves to others. You might have a low threshold than your friend Jane which means Jane might be a little thicker than you but still metabolically healthier.  So, as always with nutrition it’s about nuance.

So, as we enter the New Year, consider more than the number on the scale; consider your cardiometabolic health. Here are some initial action steps:

• Test your cardiometabolic health, no matter your weight. At TārāMD, we provide a comprehensive cardiometabolic panel that takes a deep and wide look at cardiovascular and metabolic health markers, including hemoglobin A1C, fasting insulin, advanced lipid panel, and advanced functional testing. We can detect insulin resistance in the early stages and help you correct your course.

• Dial in your nutrition. Insulin resistance doesn’t happen in a vacuum; it has everything to do with the food environment in which we live. As a first step, focus on eating whole, unprocessed food and up-leveling food quality at every turn. Because you have a personal fat threshold, nutrition requires a personalized approach. Schedule an appointment with a TārāMD nutritionist (Robin Kaiden, RD and Francesca Alfano, MS, CDN, CNS, IFNCP) today to learn about long-term weight loss and metabolic health solutions. Your first step is figuring out what your threshold is and we can help you figure that out with a strategy so you’re not guessing.

• Balance blood sugar. If you are on the path to insulin resistance, balancing blood sugar will help you get off. Eating enough protein, fiber, and healthy fats is essential, but again, you may need a more personalized strategy. Some patients benefit from using a continuous glucose monitor to optimize nutrition but it’s not for everyone nor does it need to be. We tend to think blood sugar is all about food, but movement, stress management, and sleep also play a significant role.

For many with poor cardiometabolic health, weight loss can help restore health, but how do you lose weight? It can be incredibly challenging and isn’t as simple as eating less and moving more like diet culture tells us. Our beliefs, hormones, habits, and much more add complexity.

In my next article, I will dive into integrative and functional medicine approaches to weight loss and provide action steps to consider as part of your journey. Of course, working with an expert at TārāMD can help you achieve your health goals and home in on the strategies that will work for you.

Improving your metabolic health is crucial to preventing cardiometabolic disease down the road, but it doesn’t have to do with your BMI. It’s time to take the discussion of January weight loss and turn it on its head. Let the scale take a backseat and instead find the sweet spot where your body is at its peak of metabolic health. You’ll love how you feel there.

References

1. National Academies of Sciences, Engineering, and Medicine; Division of Behavioral and Social Sciences and Education; Committee on National Statistics; Committee on Population; Committee on Rising Midlife Mortality Rates and Socioeconomic Disparities; Becker T, Majmundar MK, Harris KM, editors. High and Rising Mortality Rates Among Working-Age Adults. Washington (DC): National Academies Press (US); 2021 Mar 2. 9, Cardiometabolic Diseases.Available from: https://www.ncbi.nlm.nih.gov/books/NBK571925/
2. Centers for Disease Control and Prevention. Adult Obesity Facts. Accessed 12/2/23 from https://www.cdc.gov/obesity/data/adult.html
3. O'Hearn, M., Lauren, B. N., Wong, J. B., Kim, D. D., & Mozaffarian, D. (2022). Trends and Disparities in Cardiometabolic Health Among U.S. Adults, 1999-2018.Journal of the American College of Cardiology, 80(2), 138–151.
4. Taylor, R., Al-Mrabeh, A., & Sattar, N. (2019). Understanding the mechanisms of reversal of type 2 diabetes.The lancet. Diabetes & endocrinology, 7(9), 726–736.
5. Taylor R. (2021). Type 2 diabetes and remission: practical management guided by pathophysiology.Journal of internal medicine, 289(6), 754–770.
6. Taylor, R., Ramachandran, A., Yancy, W. S., Jr, & Forouhi, N. G. (2021). Nutritional basis of type 2 diabetes remission.BMJ (Clinical research ed.), 374, n1449.