Decoding Metabolic Health

A Wake-Up Call for the Next Generation

Aug 26, 2024

The cinema projector whirred to life, casting a bright beam across the darkened room. As the audience settled in, eagerly anticipating the film, a silhouette suddenly appeared, dancing erratically across the screen. It was my friend. I glanced down at the device he had handed me mere seconds before. "Oh sh**," I muttered, "his reading is 2.8." The blood glucose meter blinked its ominous message, its soft glow starkly contrasting the flickering images on the screen.

To my astonishment, he jumped from row to row down the seats toward the screen, his movements a bizarre spectacle in the shaft of light. Within seconds, he had bounded into the lobby, leaving a wake of confused murmurs behind him.

After I'd alerted my other friends about his reading, one of them rushed out to follow him. Moments later, they returned with news that sent a chill down my spine: our friend was on the floor in hysterical fits of laughter. Despite the seeming hilarity of the situation, we knew that this was a serious matter. His behaviour, a stark contrast to the gravity of the situation, was a clear sign of hypoglycemia.

It was the early 2000s, and like many teenagers, my weekends were a blur of trips to Affleck's Palace and cinema outings to catch the latest blockbusters. But this particular outing was etched into my memory for a different reason. It was one of my first hands-on encounters with metabolic health's real, immediate impact.

A Glimpse into the Future

Looking back on that moment in 2024, I can't help but feel a sense of suspicion. While my friend's Type 1 diabetes was bad luck, the metabolic health crisis we're facing today is largely of our own making. And it's affecting younger and younger people at an alarming rate.

A recent report by Diabetes UK revealed a shocking 40% increase in just five years in the number of people under 40 diagnosed with Type 2 diabetes in the UK. Globally, the prevalence of diabetes among people aged 20-39 years has jumped from 2.9% in 2013 to 3.8% in 2021. That's 260 million young adults grappling with a condition once considered a disease of middle and old age.

The Root of the Crisis

But why are we seeing this dramatic increase in diabetes cases, particularly among younger populations? The answer lies in a complex interplay of factors that have fundamentally altered our environment and lifestyle:

A Broken Food System: We're facing an environment that relies excessively on consuming highly palatable ultra-processed foods high in sugar, salt, and fats. These foods are often cheaper and more readily available than healthier alternatives, particularly in socially deprived areas. This environment contributes not only to metabolic disorders but also to the rising prevalence of obesity, which is both a result of and a contributing factor to metabolic dysfunction.
Sedentary Lifestyles: Increased screen time, reduced physical activity, and more sedentary jobs have all decreased overall energy expenditure. This shift in lifestyle patterns affects both metabolic health and body composition.
Socioeconomic Factors: Type 2 diabetes disproportionately impacts people from socially deprived areas and minority ethnic groups, with these inequalities being more pronounced at younger ages. In England and Wales in 2021–22, people from Asian and Black ethnic groups were over-represented among younger age groups with Type 2 diabetes. These disparities are often linked to reduced access to healthy foods, safe spaces for physical activity, and quality healthcare.
Political Inaction: Measures to tackle the root causes of metabolic health issues remain deprived of government. For instance, in the UK, bans on online advertisements, restrictions on unhealthy food deals, and a 9 PM watershed for junk food advertising have been postponed until October 2025. This lack of action allows the continuation of environments that promote metabolic dysfunction.
Corporate Influence: The food industry often prioritises profit over public health, driving innovation and marketing strategies that promote consumption patterns detrimental to metabolic health. This influence extends to shaping public perception and policy decisions.
Stress and Mental Health: Chronic stress and poor mental health can significantly impact metabolic health through various physiological pathways. These factors can also influence eating behaviours and physical activity levels, further affecting metabolic outcomes.
Environmental Factors: Emerging research suggests that environmental toxins, disrupted circadian rhythms due to light pollution, screen time, and even climate change may play roles in the increasing prevalence of metabolic disorders.

It's crucial to understand that these factors are interconnected and often reinforce each other. For example, socioeconomic factors can influence food choices and activity levels, affecting body composition and metabolic health. Similarly, political decisions (or lack thereof) can shape the food environment and impact socioeconomic disparities.

Obesity, which has increased dramatically over the past few decades, is both a result of many of these factors and a contributor to metabolic health issues. However, it's important to note that metabolic dysfunction can occur at any body size, and not all individuals with obesity will develop metabolic disorders. Have you ever heard of TOFI?

The Power of Insulin Sensitivity

Insulin sensitivity is a key indicator of overall metabolic health. It's not just about avoiding diabetes; it's about optimising the body's energy management system.

People with low insulin sensitivity, also called high insulin resistance, require larger amounts of insulin from their pancreas or injections to stabilise blood glucose. Insulin resistance indicates that your body has difficulty metabolising glucose, which can indicate wider health problems.

Why is insulin sensitivity important?

Low insulin sensitivity can lead to a variety of health problems. The body will try to compensate for low insulin sensitivity by producing more insulin. However, a high level of circulating insulin (hyperinsulinemia) is associated with a range of serious health issues:

Damage to blood vessels
High blood pressure
Heart disease and heart failure
Obesity
Osteoporosis
Increased cancer risk

It's worth noting that stress and illness can introduce short-term periods of reduced insulin sensitivity. In most cases, insulin sensitivity should recover once the stress or illness has passed. However, chronic stress or repeated illnesses can contribute to long-term insulin resistance.

For years, I've maintained a regular intermittent fasting habit, not as a weight loss strategy, but as a way to try to maintain and improve my insulin sensitivity. Fasting periods allow insulin levels to drop, which can help cells become more responsive to insulin when it is present. It's a bit like when you drink a lot of coffee - the effects of caffeine wear off over time. Yet, take a break from caffeine for a while, and you'll find it highly effective again. Similarly, giving your body a break from constant insulin exposure can help reset its sensitivity.

Beyond Insulin: The Interconnected Metabolic Network

But metabolic health is about more than just insulin sensitivity. Our bodies are vast, interconnected networks where a single aspect of metabolic dysfunction can ripple through the entire system. Remember when we said that chronic stress can impact insulin resistance? Well, that's just one example of how different aspects of our health and lifestyle can influence our metabolic well-being.

Sleep deprivation, for instance, can also significantly impact insulin sensitivity. Poor sleep can increase cortisol levels (a stress hormone), contributing to insulin resistance. Moreover, lack of sleep can affect the hormones that regulate appetite, potentially leading to overeating and weight gain - factors that further impact insulin sensitivity.

This interconnectedness extends to all aspects of metabolic health. Let's look at some key players in this metabolic network:

Insulin: Your body's glucose management system is crucial for energy regulation.
Glucose: Your body's primary energy currency, managed by insulin.
Lipids: Essential for many bodily functions, but problematic in the wrong balance. Insulin resistance can lead to dyslipidemia, a condition characterised by abnormal levels of lipids in the blood.
Inflammation Markers: Your body's alarm system is often elevated in metabolic dysfunction. Chronic inflammation can contribute to insulin resistance, and insulin resistance can, in turn, promote inflammation.
Hormones: The messengers in your metabolic network, including stress hormones that can affect insulin sensitivity. Hormonal imbalances can both result from and contribute to metabolic dysfunction.
Microbiome: The hidden workforce influencing everything from food processing to insulin sensitivity. The gut microbiome can influence how we metabolise and produce compounds that affect insulin sensitivity.

Understanding this interconnectedness is crucial. It means that when we work to improve one aspect of our metabolic health, we're likely benefiting other areas as well. Conversely, it also means that neglecting one area can have far-reaching consequences.

The High Stakes of Metabolic Health

The consequences of this metabolic health crisis are severe. Young-onset Type 2 diabetes is associated with greater insulin resistance, faster decline in β cell function, and earlier, more severe complications than late-onset Type 2 diabetes. A recent study showed that individuals diagnosed with Type 2 diabetes at age 30 died, on average, 14 years earlier than those without diabetes.

A Call to Action

It's clear that we need a multi-faceted approach to address this crisis:

Individual Action: While systemic changes are necessary, individual choices still matter. Understanding and optimising our metabolic health is a crucial first step.
Education: We need widespread education about metabolic health, starting from a young age.
Policy Changes: Governments must prioritise health over short-term political gains and corporate interests. This includes implementing strategies to improve food environments and promote physical activity.
Corporate Responsibility: The food industry must be held accountable for its choices to consumers and incentivised to prioritise our health and profit.
Healthcare Focus: A shift towards preventive care and early intervention in metabolic health issues is crucial.

Because here's the truth: the actions we take today will determine the next generation's health. Just as my friend's struggle with Type 1 diabetes opened my eyes to the importance of metabolic health, let the current crisis be our wake-up call.

Paul Clegg