126. How to Fix Your Metabolic Health at Any Age

Most people think they're doing "enough" for their health, yet nearly 90% of Americans are metabolically unhealthy and don't know it. In this episode, I challenge outdated metrics like BMI, explain why sleep quality matters more than hours slept, and break down what actually moves the needle when it comes to long-term health. In this solo episode of EXTEND, I outline my five core health frameworks for 2026. I also walk through what it means to become the CEO of your own health, how to use simple biomarkers instead of guesswork, how to run personal N-of-1 experiments, and why muscle, sleep, and toxic exposure play a far bigger role in health than most people realize. What's Discussed: (00:00) How to Take Control of Your Health in 2026 (01:41) Becoming the CEO of Your Own Health Using Your Data (02:50) Why 90% of Americans Are Metabolically Unhealthy (07:41) Why Weight and BMI Are Misleading Health Metrics (11:40) The Key Biomarkers That Actually Matter (13:01) Why Sleep Quality Matters More Than Sleep Duration (16:09) How N-of-1 Experiments Remove Health Guesswork (18:09) The Hidden Health Impact of Everyday Toxic Exposure Sleep Optimization Workbook: https://www.drshah.com/sleep Thank You for Our Sponsors: Timeline: Go to timeline.com/drshah http://timeline.com/drshah to get 20% off your order. Learn more about Dr. Shah: Website: https://www.drshah.com/ Clinic: https://www.next-health.com/ Instagram:@darshanshahmd https://www.instagram.com/darshanshahmd/

Speaker names marked ? are inferred from speaking time and the show’s known hosts — they are not voice-verified.

• 0:03Dr. Darshan Shah?

  Welcome to Extend with me, Dr. Darshan Shah, a podcast dedicated to cutting-edge science, research, tools, and protocols designed to help you extend your health span. Having become one of the youngest doctors in the country at the age of 21, and trained and board-certified at the Mayo Clinic, I've accumulated three decades of practice as a board-certified surgeon and longevity expert. Over that time, I've discovered that a mere 20% of health knowledge yields 80% of the results when it comes to your health span. We're living in a new era where we are creating a new healthcare system, no longer focused on disease management, but achieving optimal health and vitality. Join me as I interview world-renowned experts, offering you a step-by-step guide to proactively avoid disease, and most importantly, extend your health span.

• 0:49Dr. Darshan Shah?

  Hello, everyone, and welcome to 2026. This is Dr. Shah here, and I'm so excited to launch another year of the Extend Podcast with all of you. Firstly, I just want to say thank you so much for listening to this podcast. I can't tell you the number of comments and feedback I get on this podcast that are super positive, and I'm really happy to be putting out incredibly usable information for all of you. This year, we're going to be changing up the format a little bit to make the podcast even more useful for all of you listeners based on your feedback. I know you guys all love the solo-sode episodes. We're going to be doing a lot more of those. The top five takeaways I have, we're going to continue that as well. And just bringing back some of the best guests that we've had and finding new guests to bring new information to you

• 1:34Dr. Darshan Shah?

  every single week is my goal. Once again, I just want to thank you all so much for joining this podcast, and I'm really happy to start off 2026 with all of you. On that note, I thought a lot about how we should all start off 2026, and I would really love to focus on five main content pillars over the course of this year. So we can really dive in deeper on some topics that I think are fundamental to all of our health journey. These five big-picture topics will really serve as frameworks for our discussion this year about what you can To really move the needle of your health and longevity. And I believe these are fundamental to all of our longevity journey. So let's go over what they are.

• 2:18Dr. Darshan Shah?

  Framework number one is becoming the CEO of your own health. This is where I really want to empower you with how to utilize the data that you have available to you to understand what is the current status of your biology. And secondly, how to do small N of one experiments on yourself that you can really figure out what works for you. As you know, I'm a big believer in the Pareto principle that states that you need to put 20% effort in to get 80% of the results on the back end. What does that mean? It really means focusing on the big rocks that are really going to move the needle before you go too far into the rabbit hole. Framework number two is going to be about metabolic health being the foundation of all health and wellness journeys.

• 3:01Dr. Darshan Shah?

  Now metabolic health, this involves, as we all know, nutrition and how your body regulates energy and sugar levels. However, it's not just about nutrition. There's so much more tied up in metabolic health. Metabolic health is affected by your muscle mass, your sleep, your stress levels. So how do all of these individual factors really plug into the equation of your metabolic health? And how you can make major changes in how metabolically healthy you are? And I feel this is such an important topic right now because as we know, 90% of Americans have some degree of metabolic health abnormality at this moment in time. And I really want my listeners should not be in that 90% category.

• 3:44Dr. Darshan Shah?

  Framework number three is about root cause medicine being the missing puzzle piece that we've been searching for in reversal of chronic disease. Root cause medicine, also known as functional medicine, is really the foundation of all disease. Now metabolic health is one piece of that, but it also includes hormone deficiencies and imbalances, gut dysbiosis, toxic exposure, the toxins that we're exposed to in our day to day life, and chronic stress and emotional dysregulation and dealing with traumas. All of these are root causes of disease. And if we can address these root Causes as Dr. Mark Hyman and Jeffrey Bland tell us, we can truly, truly prevent disease in the future.

• 4:26Dr. Darshan Shah?

  Framework number four is going to be about hyper preventative medicine. So we all know about preventative medicine. We all want to prevent diseases like cardiovascular disease leading to heart attacks and strokes. We want to prevent cancer, obviously, and we want to prevent Alzheimer's disease and other neurodegenerative diseases. And for years, we've talked about preventative medicine. And I really believe preventative medicine is really stuck in the 1980s. And I want to bring all of you up to date to what is truly preventative in 2025. Now you can use advanced diagnostics that are available now, that are available for you today, to truly diagnose disease decades before it happens and then giving you the tools and how to prevent these diseases.

• 5:09Dr. Darshan Shah?

  And lastly, framework number five is how longevity medicine is the future of medicine. And if you truly understand the power of the latest science that we can utilize now and understand the basics of the new technology that's available to us in various modalities, things like stem cell reprogramming, peptide therapy, regenerative medicine, plasma exchange. There's so many new technologies that are available, that are safe, that are effective, that we can talk about and really keep our finger on the pulse of what's coming in the future. There's a revolution coming in the next 10 years utilizing artificial intelligence, technology, advanced testing, all together to truly empower your health journey.

• 5:53Dr. Darshan Shah?

  And I want to give you real world tools on how to make that happen. So along those lines, I'd like to give you some tools that you can use right now to truly accelerate your understanding of what is the current state of your health and wellness along all five of those pathways, all five of those frameworks. And tool number one is going to be a guide that I have on my website. If you just go to drshah.com/biomarkers to understand what are the core biomarkers that you need to know about your health. And so, you know, you all know that there's thousands of different blood Tests that you can do that are out there. And it's really easy to go down a rabbit hole along all of these blood tests.

• 6:36Dr. Darshan Shah?

  But I believe there's about 10 or 15 blood tests that everyone needs to get. So they understand the big picture of where their health is at this moment in time. And these blood tests go along some of the frameworks that I talked to you about metabolic health, inflammatory markers, cardiovascular markers, hormone health markers and nutritional biomarkers. Now, these biomarkers, we've talked about them many times in our podcast in the past. But basically you either need to ask your doctor to order them because your insurance should pay for them. And if your doctor won't order them, there's different ways that you can get them. One is that all the blood work laboratories, if you go and walk into them,

• 7:18Dr. Darshan Shah?

  they do have packages and cash pricing available for these biomarkers. So you can just go to a laboratory and get them done. There are online services like Function Health that you can use to get these biomarkers done, where you can sign up online and then go to the laboratory and get them done. There's also at home kits that you can buy that we can send you a kit to your home. You wear a little device on your shoulder, it collects about a cc of blood and you mail it in. You can't get as many biomarkers as you can get with some of the larger kits and going to a laboratory, but you get the critical ones. If you go to biokit.drshah.com, I have one of these kits available on my website. And then finally, it goes beyond blood testing. There are other markers that you can use that give you a day to day

• 8:02Dr. Darshan Shah?

  or month to month view into what's going on with your health. And you can get these markers with a bio impedance scale. This is a special scale that puts a little electrical current through your body. And it tells you two really important markers. One is your skeletal muscle mass and the other one is your fat mass. I always tell all of my patients, I don't care what your weight is. I think weight and BMI, they're kind of garbage measurements that don't really mean much to me. What really matters to me is that you're adequately muscled. Because I know if you're adequately muscled, that's going to be a great benefit to your metabolic health, which is then going to translate into fat loss.

• 8:40Dr. Darshan Shah?

  And weight loss. So getting a bio impedance scale, you can buy these on Amazon or online or in many pharmacies for just thirty to forty dollars. My favorite one is Renfo, R E N P H O. They make different modalities. There's also in-body scales, there's withings, lots of company makes make these. And I like the Renfo because it is lower cost and I found it to be more accurate for myself when I compare it to my DEXA scan. I really like the kind now that is a handlebar. And the handlebar allows you to put your thumbs on it as well, so it can run a separate electrical current through your trunk. And this can give us an indication of how much fat is in your upper body.

• 9:21Dr. Darshan Shah?

  And your upper body is where you hold your visceral fat, which is the more dangerous inflammatory fat. So getting a bio impedance scale can be very helpful. Secondly, I really like to have all my patients have a blood pressure cuff. A blood pressure cuff is also just twenty, thirty dollars online. And if you get one of the electronic ones, it'll do three measurements in a row. So why do you need your own blood pressure cuff versus just going to your doctor and getting one? Well, most people don't go to their doctor and get one more than once or twice a year. And usually the measure that you do at your doctor's office is thrown away because either you have white coat syndrome or the person doing the blood pressure measurement is not the most experienced person at the office.

• 10:01Dr. Darshan Shah?

  Really, you want to do this first thing in the morning, after relaxing for a little while, seated in a certain position. There's tons of YouTube videos about these. You want to measure three in a row and you want to average those blood pressure measurements. How often should you do this? I think at least quarterly you should do it. And how young is too young to be doing this? Well, really, I see people with high blood pressure as early as their twenties. So what I would recommend is you start, as soon as you hear this podcast, you start measuring your blood pressure on a quarterly basis. And lastly, I would get a special device called a grip dynamometer, especially if you're over the age of forty. A grip dynamometer is another fifteen, twenty dollar device that you can buy online.

• 10:43Dr. Darshan Shah?

  And you squeeze it and it tells you how many pounds or kilograms of pressure you can generate. With your grip and this is a proxy of your upper body strength. Now, half the people that we measure in our clinics, when they first come in to get this measured, they are, their strength level is too low for their age average. And this is alarming, right? Because you want to maintain strength. And unfortunately, when you're not working out enough at the gym, you're not picking up heavy things enough. And, or if you're going to the gym enough, but you're not working out close to failure, then you're just not building enough strength. So skeletal muscle mass is important and strength is important. The bio impedance scale tells you your muscle mass and the grip dynamometer gives you an indication of your strength.

• 11:28Dr. Darshan Shah?

  So these are all really important tools to empower yourself with. And I have all of this at drshah.com/biomarkers. You can download a guide which goes over these numbers in details. What are those key biomarkers? What is the optimal range for you, for someone of your sex and your age? And a great new year's resolution would be to download this guide, buy a few of these items and get these things measured first of this year. I think this is a great way to start the year, a great way to end the year and do some of these measurements quarterly.

• 12:03Dr. Darshan Shah?

  So I'm 52 right now, but I'm still pushing all of my limits. I'm running long distances. I travel across many time zones to support my work and I just want to live my life to the fullest. Staying active as I age isn't just about willpower. It's about supporting my mitochondria, the powerhouses of my cells, with the energy that they need to recharge my muscles and recharge my brain. Mitopure is a supplement that I take. It's backed by solid research showing that it can boost cellular energy, increase muscle strength and support overall healthy aging. Personally, I take Mitopure every single day. This helped me continue my active lifestyle, whether it's a high intensity workout or keeping up with my kids.

• 12:45Dr. Darshan Shah?

  So if you are looking to support your body and want to feel younger from the inside out, my friends at Timeline are offering you a 10% discount on your first order. Go to timeline.com/drsah to get started. That's timeline.com/drshah. Your future self will thank you.

• 13:08Dr. Darshan Shah?

  On the second aspect, we want to know how are you doing from a metabolic health perspective? And some of these biomarkers will tell us, for example, one of them is hemoglobin A1C, another one is fasting insulin level. But we also want to measure what is your level of physical fitness? And I have another guide for you. This one is at drshah.com/fitness, which will give you a few simple tests that you can do either with a loved one or with your trainer at the gym to measure your mobility, your strength, and your cardiovascular fitness. And once again, you want to see where are your numbers compared to other people that are in your same age group and in your same sex group. And this guide will

• 13:50Dr. Darshan Shah?

  give you about a 30 minute testing sequence that you can do. Once again, it's always more fun and easier to do this with another person that's timing you, that's doing some of these movements with you, making sure you're doing them right, and getting a quarterly measurement of where you stand. And so the way I've set up this guide is that you can download the guide, you can do all of these measurements for free, record them, and it'll give you a score. And then what I really like to do is do these every quarter and write down my results and see if I'm going in the right direction, or at least maintaining if things are normal. So that's the second tool that you can use that I provided for you on my website. Next potential New Year's resolution that you can work on this year

• 14:32Dr. Darshan Shah?

  is fixing your sleep. An incredibly important aspect of health. I really believe that sleep more and more it rises to the top of the fundamentals of nutrition, exercise, because if you're not sleeping well, your nutrition the next day is going to be off, you're just going to eat whatever you see. I call that a seafood diet. And also, you're not going to want to exercise, or you at least won't exercise effectively. So getting your sleep in order is critical. Now, many of you might say, well, I sleep seven hours a night or eight hours a night. I think I'm fine. I have pretty good energy throughout the day. And I have a lot of patients that say that to me. But I still encourage them to track their sleep for at least six weeks. Why? Because once we get a good

• 15:16Dr. Darshan Shah?

  Of the sleep score average in six weeks, four to six weeks, then we truly understand how well they're really sleeping. I can't tell you the number of patients I see that think their sleep is fine. We track their sleep scores for a few weeks and their sleep score is fifty or sixty on the average, and that's not good. And there's many reasons for this that people don't realize. One is that they're waking up multiple times throughout the night, and that can be due to a condition known as sleep apnea. It can also be due to having to urinate. Another reason that people are not getting good sleep scores is that they don't get enough deep sleep. Even though they're spending the night in bed and they think they're asleep, their deep sleep is less than ten or fifteen minutes, when you want it to be close to an hour or more.

• 15:59Dr. Darshan Shah?

  And so you're not going to know any of this unless you're tracking your sleep. So how do you track your sleep? Well, wearables are a fantastic way to track your sleep. I have an Oura ring, I have a Whoop band, and even an Apple Watch. And I like all of them for different reasons. And if you're looking to get a wearable, I would try them all and just see which one works the best for you. And these devices can get kind of expensive. There are less expensive ones available online. Some of them are even twenty, thirty dollars now. Fitbit, I know, also makes a less expensive one as well. And I think these are incredibly valuable, not just for the sleep scoring, but also for activity scoring, for example. So doing six weeks of sleep scoring can be very beneficial. And then you can listen to the multitude of podcasts I have on Extend

• 16:43Dr. Darshan Shah?

  on how to start working on both your sleep routine and your sleep environment so that you can start optimizing your sleep score. And of course, if you have sleep apnea, you have to go see a specialist to get that treated. It's really dangerous to have sleep apnea, especially let it progress for years and years without getting it treated. So I have another tool for you on sleep as well. If you go to drshah.com/sleep, you can download my sleep guide. And the sleep guide gives you an explanation about sleep scores and little quizzes that you can take to assess your level of sleep that you can turn into a sleep specialist or just use to evaluate yourself. And there's also a list of things that you can do with your sleep environment.

• 17:26Dr. Darshan Shah?

  And your sleep routine to help you get better so that they can try on yourself. And improving your sleep is a great example of N of one science. So what do I mean by N of one science? This is where you find a metric to track for yourself. It could be your deep sleep minutes or even your sleep score. And you try a new intervention. Say you try something like mouth taping, for example, and you do it for a week and you see how that affected your sleep score without changing anything else. And if it positively affected your sleep score, then you want to continue doing it. And if it negatively affected your sleep core or didn't make a change, it might be something that you decide not to do. So small N of one experiments like this can really help you understand what works for you.

• 18:07Dr. Darshan Shah?

  And I'm a big believer in understanding what works for you because people throw out so much advice out there. And a lot of it, a lot of people love, and they say they can't live without it. And a lot of people say that absolutely did not work. And so people have a lot of confusion and you get paralysis by over analysis of all of this information that's thrown out there on social media. And to truly understand why there's so much back and forth on information. It really comes down to one factor as certain interventions work for certain people. So if you have a metric that you can track either with a wearable or a blood test or even a bio impedance scale. And you can change one variable, maybe for a week or a month and see if it worked for you.

• 18:52Dr. Darshan Shah?

  This is what's really going to move the needle of your health. You do maybe one or two experiments like this every single month. And before you know it, at the end of the year, you've run 2024 experiments and you've really understood what works for you. And we're going to be focusing a lot on this topic over the course of this year. Empowering you with different experiments that you can do personally. And what are the markers that you can follow so that you know if you're really making a difference? Lastly, we're going to focus a lot on functional medicine. And this includes hormones, it includes your gut health, it includes exposure to toxins. And I want to give you another tool here because I really believe that our toxic exposure is truly detrimental to our health. To the same level as lack of sleep.

• 19:36Dr. Darshan Shah?

  Eating ultra-processed food and having poor metabolic health and being sedentary. These are all four legs of the stool that work against us to truly develop into chronic disease and become a huge detriment to our health. And so when I talk about toxic exposure, there's a lot of different aspects here, right? We have toxins in our environment that we've never had before that are being dumped into our environment over the course of the last 60 to 70 years by chemical factories, by air pollution, by even our cosmetics and our skin products. So how do you get your head wrapped around this? Well, I like to break it down once again with the Pareto Principle.

• 20:18Dr. Darshan Shah?

  So I'll give you my big picture advice and I'm going to give you another tool that you can use to really detoxify your life this year. So let's talk about first the Pareto Principle. What are the 20% of the actions that you can do to detoxify 80% of your life? Let's talk about these in four verticals. Vertical number one is air. Many of us know that air pollution is a huge risk factor for lung cancer, for chronic disease. But how do you avoid air pollution? Well, here's what most people don't know and they don't tell you. The air inside of buildings is actually more harmful to you for most people than it is in the air outside. And why is this?

• 20:59Dr. Darshan Shah?

  Well, it's because the air inside buildings is trapped because all the windows are closed and we're bringing in pollutants from the outside, either in our shoes, it's in the dust inside, it's being off-gassed from furniture that's been sprayed with certain chemicals. It comes from the cleaning products that we have inside of our homes and inside of our office buildings. And so what can you do to help this situation? Very simple, open your windows. If you check your phone and the air quality index outside is in the green, which it is in most places in the United States, you can just open your windows, open your windows as much as possible. What if you can't open your windows? Maybe you live in a place where the windows don't open, like a really high floor of an

• 21:39Dr. Darshan Shah?

  office building, for example, then you can get a really high-quality air purifier. The Pareto Principle. People here is where do you spend the most time? Most people spend it in their work environment and also their home, in their bedrooms where they spend the night where they're sleeping. And those two environments, if you buy a high-quality air purifier, you can truly detoxify the air inside if you can't open the windows. My good friend, Dr. Austin Perlmutter, started a company to create a high-quality air purifier. It's called the Lycan Air Purifier. Look it up. Next is your water. So huge believer that you should be always drinking water, either out of a glass cup or a glass water bottle.

• 22:22Dr. Darshan Shah?

  Please stop drinking water out of plastic. Even a metal can is much better than a plastic water bottle because of the microplastics. Most tap water is filled with contaminants, and so having a high-quality filtration system, both at home and in your office, works wonders. You can either get a filter that you can buy, that can be a countertop filter or even a pitcher. And my favorite type of filtration is actually using reverse osmosis filtration with a reminorizer. This can be a game changer. Reverse osmosis is the best type of filtration that there is. So consider putting one in at home. It could cost you about $400 or $500. And then ask your boss or whoever runs your office to put one in at your office sink.

• 23:07Dr. Darshan Shah?

  Next, let's talk about your food. So most toxins come in food in two places. One is in packaged food. So this is all the food that's in the center. The supermarket is wrapped in plastics. That's microplastics. And usually packaged food is ultra-processed, has a lot of chemicals in it, as we know. So avoiding ultra-processed food and food wrapped in plastic is a good idea, in my opinion. And secondly, you want to watch out for glyphosate and other chemicals sprayed on your produce. So buying organic is great, but also washing your food and baking soda has proven to be the best way to remove some of these pesticides and other chemicals that are on your produce. And lastly, your skin. So we don't realize it,

• 23:50Dr. Darshan Shah?

  but every single day we are lathering chemicals that affect our health. On our skin when we're using cosmetic products such as soaps, perfumes, shaving cream, shampoo, et cetera. And these chemicals are both endocrine disrupting chemicals, meaning that they mess with your hormones, and also immune disrupting chemicals. They mess with your immune system. And this is a big reason why younger and younger people are having hormone disruptions like low testosterone levels and early puberty. And so how do you avoid this? Well, there's a solution. There are apps out there such as Yuka, that's spelled Y U K A, Think Dirty, and Skin Deep. Those are three apps that

• 24:31Dr. Darshan Shah?

  you can use to scan product barcodes and it'll tell you how toxic your products are that you're using. And what you can do then is it'll also suggest alternatives and you can buy a non-toxic version. And now more and more, the non-toxic version of a product can actually be the same price or even less expensive than some of the more expensive brands out there for more toxic products. And so this is a really good way to eliminate toxins on your skin. Finally, there's a great company called Branch Basics that I love to use for my own home. They make non-toxic chemicals that you can wash your clothes in and also clean your home with. And this is another replacement that you can use

• 25:12Dr. Darshan Shah?

  for detoxifying some of the products that we put on our clothes that then absorb through our skin. So with that, you probably guessed it, I have another guide for you. I call it your 52 week guide to reducing your toxic burden personally and for your family. And you can download this at drshah.com/Toxins. And the way I've set this up is 52 pieces of advice that you can use to reduce your toxins in your air, water, food, and home environment or work environment. And you can just print this out and paste it up on your refrigerator. And every week, you and your significant other, or you and your family can pick something to do that will reduce your toxic burden. And there are some of the things that, you know, do require more time and energy. So if you have a week

• 25:57Dr. Darshan Shah?

  where you don't have a lot going on, you can do some of the things that require more time. And then there's certain things that are super easy to do, like open your windows that don't require a lot of time. So the idea here is over the course of the year, you can very significantly reduce your toxic burden and truly improve your health because of it by going through this process over the course of the year. And it's a learning process, just like everything else that we talked about today on this podcast can become. And with your own data and with having guys like this on how to do N of one experiments, you can truly start moving the needle of your health this year. So my goal for you and for everyone listening to this podcast is to pick maybe one of these things,

• 26:42Dr. Darshan Shah?

  two, or even all four of these guides and implement them into your life. Start with one and maybe try another one in another quarter and then do another one in another quarter after that. But I really think these four items, these four guides that I mentioned here today, and then I will link in the show notes, will make the most difference for you and your health journey this year. And then, of course, listen to my podcast, Extend on any podcast channel and on YouTube to fill in the gaps and go deeper down the rabbit hole of how to improve your health. Like I said, I'm going to be empowering all of you every single week with another episode or two on how to run N of one experiments and give you the Pareto Principle. What are the 20% items that you can do to really make 80% of the difference?

• 27:26Dr. Darshan Shah?

  And then find the best guests in all of the topics that we mentioned, along with five pillars of health that we're going to be talking about this year. Thank you so much for joining this journey with me. And I look forward to interacting with many of you or all of you through email and through the comments at my social media this year as we truly move the needle of our health. Thank you once again for listening to Extend Podcast.

• 27:52Dr. Darshan Shah?

  Thank you so much for listening to the podcast today. Please remember to subscribe if you liked this episode and give us a good review and share a link with your friends. It really helps to support all of our efforts. I also want to remind you that the information shared on this podcast is for educational purposes only and is not intended to replace professional medical advice, diagnosis, or treatment. Please consult with your healthcare provider or physician. Before making any decisions or taking any action based on what you hear today, especially if you have any underlying health conditions or on any medications. Your doctor knows your personal health situation the best, and it's always important to seek their guidance.