“Metabolic health” can be defined with standard indicators such as those showing ideal levels of blood sugar, triglycerides, high-density lipoprotein (HDL) cholesterol, blood pressure, and waist circumference, without using medications. However, there are sub-cellular pathways that lead to metabolic disorders that we should pay attention to much earlier than when these medical markers manifest or are analyzed later in life (Dr. Lustig talks about glycation, oxidative stress, inflammation, mitochondrial dysfunction, insulin resistance, and membrane instability in his forthcoming book, Metabolical). Many metabolic factors comprise a person’s risk profile for developing a leading chronic disease.
Too many focus on obesity (body weight), but we don’t die of “obesity.” We die of the diseases that “travel” with it or drive us to it – metabolic derangements that cause obesity but that also underlie metabolic disorders affecting the non-obese, such as non-alcoholic fatty liver disease. Diabetes, hypertension, heart disease, cancer, liver disease, and dementia are the chronic diseases that kill us – but underneath most of these conditions is almost always some form of metabolic dis-ease, and the runway is long, sometimes going all the way back to the womb. Starting off life metabolically healthy, especially in the first five years, can have positive outcomes lasting a lifetime. Nonalcoholic fatty liver disease (NAFLD) is the most common liver disease in children in the United States, with an estimated prevalence of nearly 10% in the general population. We are literally turning out children’s livers into Foie gras.