When things go wrong
Now that you've been introduced to the most important actors of metabolic health in the previous article, let's look at how things can start to break. The hallmark disease of metabolism is diabetes mellitus. In type 1 and 2 diabetes, blood glucose levels are elevated (even in a fasted state), which is not good for the human body, but the cause is different. Individuals with type 1 diabetes do not produce (enough) insulin in their pancreas. Type 2 diabetes starts differently, insulin production is intact but the cellular sensitivity to the effect of insulin is reduced. This means that more insulin is required to bring down blood glucose levels.
A person in good metabolic health eats just enough to resplenish their glycogen and triglyceride storage, and has some periods of fasting in-between eating during which these storages are utilized.
However, many of us eat too much, too calorie-rich and too often. Especially if these meals are carbohydrate rich, the limits of our glycogen storage capacity in our body are eventually exceeded. It gets harder and harder to get the excessive blood glucose into cells. Cells become less insulin sensitive. With abnormal amounts of insulin, glucose can still be forced inside the already packed cells. Simultaneously, glucose is increasingly converted to triglycerides and those are stored in places where we are not supposed to store fat: inside our organs (especially our liver) and in white-adipose-tissue in-between our organs.
We now have two huge problems that can push the body into developing all sorts of diseases. The first problem is the long periods of elevated insulin (hyperinsulinemia) that the body is exposed to under circumstances of reduced insulin sensitivity/insulin resistance. The second problem is that the fat stored inside and in-between organs is a source of inflammation. Together these problems are major drivers for the development of cardio- and neuro-vascular disease, kidney disease, cancer and neurodegenerative diseases.
Different stages of the same problem
Poor metabolic health essentially progresses in the following order:
- Prolonged hyperinsulinemia
- Reduced insulin sensitivity - insulin resistance
- Metabolic-dysregulation Associated Steatotic Liver Disease (MASLD)
- Type 2 Diabetes Mellitus
Stages 1-3 are asymptomatic and, unfortunately, go unnoticed in most people. Since fasting glucose tends to still be normal and people rarely wear a continuous glucose measurement device or undergo a glucose tolerance test, these metabolic derangements are not picked up by physicians either. However, if you are obese, you are likely to fall somewhere in this spectrum. Even a substantial proportion of non-obese people have insulin resistance and/or MASLD, especially those with a relatively sedentary lifestyle. If MASLD progresses to steatohepatitis (inflammation of the liver due to fat deposition) it can also become a serious threat to liver health, with some people eventually developing liver cirrhosis or a hepatocellular carcinoma - primary liver cancer.
It might take several years of stage 1-3 before fasting glucose becomes elevated and type 2 Diabetes is diagnosed. At this point, a lot of damage has already been done, which promotes the development of other diseases. Fortunately, that damage can be undone and even type 2 diabetes can be cured, if you take control of your metabolic health.
