15. How to Reverse Metabolic Syndrome

Are you part of the 88% of people who are metabolically unhealthy—and don't even know it? Do you know what metabolic health really means? Or why is it the root cause of nearly every chronic disease? In this episode of Extend, I'm diving deep into the critical world of metabolic health—how it works, why it matters, and what you can do today to optimize it. With only 12% of Americans metabolically healthy, it's time to take charge. I'll break down the science of mitochondria, share the key biomarkers you need to track, and show you how tools like continuous glucose monitors (CGMs) can transform your health. Plus, I'll give you practical, everyday tips to flatten glucose spikes, stabilize your energy, and protect yourself from chronic disease. This episode isn't just about theory—it's about empowering you with tools and tips to optimize your metabolic health and live longer, healthier, and more energized. I Also Discuss: (00:03) Understanding Metabolic Health and Disease (02:05) The Role of Mitochondria in Energy and Metabolism (05:56) Key Biomarkers for Tracking Metabolic Health (09:35) How Continuous Glucose Monitors Can Transform Your Health (13:40) Mastering Metabolic Health and Vitality Learn more about Dr. Shah: Website: https://www.drshah.com/ Clinic: https://www.next-health.com/ Instagram: 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 back to the Extend Podcast, where we're going to explore the science behind living your healthiest and longest life. On today's solo sode, I'm going to talk about the incredibly important world of metabolic health, how it works, why it matters, and what you can do to optimize it. Metabolic health is a topic that everyone should become familiar with because it is one of the root causes of all chronic disease. Metabolic health was first described about 30 years ago when a doctor at Stanford described Syndrome X, now known as metabolic syndrome. This is a cluster of conditions that occur together due to insulin resistance that increases your risk of heart disease, stroke, type 2 diabetes, Alzheimer's, and even cancer. The syndrome was first described as a combination

• 1:32Dr. Darshan Shah?

  of five conditions, which include high blood pressure, elevated blood sugar, excess body fat around the waist, also known as visceral fat, and abnormal cholesterol and triglyceride levels. Having three of these conditions out of the five factors qualifies you as having metabolic syndrome. Today, we're going to touch upon the role of mitochondria, the key biomarkers you track for metabolic health, and how tools like continuous glucose monitors, also known as CGMs, can help you take control of your metabolic health and all the incredible benefits of doing so. We'll end the episode with practical, everyday tips that you can use today to flatten the glucose curve. And stabilize your energy levels. So let's get started. First is important that you have a clear definition of metabolic health in your head

• 2:16Dr. Darshan Shah?

  before we get started. Metabolic health at its very basic level refers to how efficiently your body processes and uses the food that you take in for energy. When your metabolism is running smoothly, you're much less likely to develop chronic disease. Sadly, only about 12% of people in the US are metabolically healthy as of 2018, according to a large study published in the journal Metabolic Syndrome and Related Disorders. That's incredibly alarming, and it's why it's critical for everyone to have an understanding of this topic. Your metabolism actually takes place within tiny structures inside almost every cell called mitochondria. Mitochondria are the batteries that power every cell in your body.

• 3:01Dr. Darshan Shah?

  They convert the food you eat, which has already been broken down into glucose, amino acids, fatty acids, and usable energy, into the form of energy called ATP. When they're working well, you feel energetic, your brain is sharp, and every function in your body functions optimally. But when your mitochondria are overworked or damaged, most often due to poor diet, chronic stress, or lack of exercise, they become less efficient, and you have less of them in every cell. This can lead to fatigue, inflammation, and different levels of metabolic disease, like prediabetes, fatty liver disease, and then obesity. To be clear, however, you do not have to be obese to have metabolic disease. As many people also have a condition called TOFI, an acronym for thin on the outside and fat on the inside.

• 3:45Dr. Darshan Shah?

  The key to supporting mitochondrial energy production is giving them the right inputs: nutrient-dense food, movement that challenges your body, good sleep, and avoiding toxins like excess sugar, processed oils, refined grains, and environmental toxins. To learn more about metabolic health, I highly suggest you read the book called Good Energy by my friend Dr. Casey Means. As we said earlier, it's incredibly important to know if you're developing metabolic disease because of the consequences of having it are disastrous. Metabolic syndrome significantly increases your risk of cardiovascular disease and heart attacks. Type 2 diabetes, non-alcoholic fatty liver disease, chronic kidney disease, sometimes leading to a kidney transplant, stroke, and even some cancers like colorectal and breast cancer.

• 4:30Dr. Darshan Shah?

  Dr. Christopher Palmer, who I've also interviewed for this podcast, wrote an amazing book called Brain Energy, which discusses how metabolic disease leads to all form of mental health issues like anxiety, depression, OCD, PTSD, and even schizophrenia. So I hope you can see how it is critical to avoid metabolic disease so that you can avoid all forms of chronic disease and mental illness. And if you're suffering from any of these problems, treating your metabolic disease is foundational in treating both mental health and chronic disease issues. So how do you know if you have metabolic disease? Well, the situation with metabolic disease is actually a perfect example of why having your blood biomarkers checked early and frequently is critical.

• 5:14Dr. Darshan Shah?

  Metabolic health can vary by ethnicity and gender, activity level, family history and genetics, and your hormones, microbiome, and level of toxin exposure pale or. So it's incredibly important to recognize how personalized your risk is. Blood tests can tell you early in the disease process, sometimes 10 to 20 years before you have symptoms, that you have metabolic disease, when it's still early enough to reverse the damage that metabolic disease can do. It's a tragedy that many traditional yearly blood panels don't check these markers until it's too late. So you have to take this list to your doctor and insist that they check for them. I have the list in the show notes, as well as a link to where you can order an at-home finger stick blood test to get these markers tested easily at home.

• 5:58Dr. Darshan Shah?

  Here is my critical biomarker list that you should ask your doctor to obtain for you. Number one is fasting glucose. This measures your blood glucose levels after not eating for eight to 12 hours. Ideally, this should be below 90 mg per deciliter, and if it's over 120, this is an indication that metabolic disease is taking hold. Number two, hemoglobin A1C. This is a marker of your average blood sugar levels for the last two to three months. Aiming to keep these levels less than 5.5% is key, and even 5.2 or less is optimal. Western medicine actually uses hemoglobin A1C to make the diagnosis of diabetes when it's over 6.5 and prediabetes when it's over 5.7. Why would you want to wait for it to get there? Knowing early allows you to take action now.

• 6:48Dr. Darshan Shah?

  Timeline's Urolithin A is one of my favorite supplements for boosting mitochondrial health. I recently returned from a two-week international speaking engagement tour, and I can tell you that without my Timeline, I would not have made it. If you're looking for a boost in your energy at a cellular level, Timeline's Urolithin A is the secret to unlocking your mitochondria's full potential. It's backed by excellent science. Urolithin A is a compound that helps improve muscle strength and endurance, giving you that extra edge when you want to feel and perform your best. Whether you're pushing it in the gym or just want more energy throughout the day, Timeline has you covered. Try Urolithin A today and take your energy to the next level, because feeling good starts at the level of the mitochondria. Go to timeline.com to get some today.

• 7:36Dr. Darshan Shah?

  Number three, fasting insulin. This is another critical level, but it's often overlooked in standard biomarker panels. This level should be below 5 to indicate good metabolic function. A high fasting insulin level is often the first signs of metabolic disease. Number four is triglycerides. Elevated triglyceride levels are also a key sign of insulin resistance. Aim to keep this level under 100 mg/dL. Number five is actually not a blood test at all. It's getting a tape measure to measure your waist circumference at the level of your belly button. This is a strong, but simple and effective indicator of visceral fat, which can signal metabolic dysfunction. Visceral fat is the fat that is under the

• 8:19Dr. Darshan Shah?

  muscles of your abdomen, wrapped around your intestines, in your liver, and other organs. It's the fat that gives you a round, swollen appearing abdomen, sometimes referred to as a beer belly. Sadly, it's incredibly common, especially in men. Visceral fat actually secretes hormones and cytokines that create inflammation, so it's much worse than any other fat in your body. Number six is your skeletal muscle mass. You can get an indication of this with a bioimpedance scale, or more accurate measurement with a DEXA scan. How does that amount of skeletal muscle you have relate to your metabolic health? Well, your metabolism lives in your muscle. It's where most of your mitochondria are and approximately 50% of the mitochondria are in the muscle in your body.

• 9:02Dr. Darshan Shah?

  And you have direct control over how much muscle you have and therefore how many mitochondria you have. So what you can actually do if you're one of the 90% plus of people that have some degree of metabolic health abnormality? The good news is it's not a death sentence. In fact, we see people every day that reverse metabolic disease in just months. Getting 8,000 steps a day, strength training, optimizing your sleep, avoiding ultra-processed food, and having stress reduction techniques can help you lower your risk of metabolic disease. Also, new trends like sauna therapy, intermittent fasting, or even cold exposure can impact metabolic health. One of the best tools for improving metabolic health, which in my opinion is a modern medical

• 9:47Dr. Darshan Shah?

  miracle, is a continuous glucose monitor, also known as CGM. This small device tracks your blood sugar levels in real time, showing how your body responds to different foods, exercise, stress, and sleep. It's a tiny filament of a needle that goes into your arm and stays there for a couple of weeks while it transmits your current blood glucose level every five minutes to your phone. It used to be that you had to have a doctor's prescription to get one, but now you can get them over the counter or even online. It's important to pair this device with a smart app to help you dissect the results. My favorite one of these apps is called Levels Health, and I have a discount code for you in the show notes. This app actually uses AI to recognize pictures of food and tie those into how it is affecting

• 10:32Dr. Darshan Shah?

  your metabolic health. When you get the data back from the app, you will see that you will actually get a curve for what your glucose is doing over the course of the day. What you're looking for is a flat and narrow glucose curve. That means your blood sugar stays relatively stable throughout the day without too many dramatic spikes and crashes. If you get a spike, you want it to last not a long time. It should return down to baseline within the next two hours. Prolonged spikes can lead to inflammation, oxidative stress, and insulin resistance over time. Using a continuous glucose monitor, Helps you identify your personal triggers for glucose spikes, whether it's a certain food or eating late at night. It's like having a personalized metabolic coach in your pocket all the time.

• 11:15Dr. Darshan Shah?

  The CGM is also a great example of the concept of N of one. Every one of us has different reactions to different foods, different food preparations, and even different microbiomes. And genetics actually play a role as well. When you get a CGM, what I usually recommend is for at least a six-week trial, do daily micro experiments with different foods and eating patterns to see what works for you. I actually personally found that eating bananas was really bad for my own glucose curve, as well as going to bed within three hours of my last meal. Here are some of my top 10 strategies to manage glucose spikes and support better metabolic health overall that I empower many of my patients with

• 11:57Dr. Darshan Shah?

  when they start their own mini experiments on their own CGM at home. Number one, start your meal with fiber. Vegetables or a salad before your main course slow down glucose absorption. Number two, pair starchy carbs with protein and fiber. This combination helps prevent sharp glucose spikes. Try to never eat starchy carbs or sugar alone. Number three, eat smaller portions of refined carbs. Things like bread, pasta, and sugary desserts are better considered for after-dinner treats rather than at the beginning of a meal or the main dish of a meal. Number four, go for a walk after your meal. Even a 10 to 15-minute walk can lower your post-meal glucose levels,

• 12:42Dr. Darshan Shah?

  and this is especially important after dinner. Number five, avoid sugary drinks. Liquid sugar, like in sodas or juice, hits your bloodstream fast. Number six, try time-restricted eating. Limiting your eating window to eight to 10 hours improves your insulin sensitivity, particularly if you only eat when the sun is out. Number seven, get quality sleep. Poor sleep can spike glucose levels and increase insulin resistance. Number eight, manage your stress. High cortisol levels from stress can elevate your blood Sugar. Number nine, stay hydrated. Dehydration can impair glucose control, so drink plenty of water. And finally, number 10, experimenting with vinegar.

• 13:25Dr. Darshan Shah?

  Although it doesn't work for everyone, a tablespoon of apple cider vinegar diluted in water before meals can blunt glucose spikes. A really great book that is an easy read that I have every patient get when they're going through their CGM journey is called Glucose Revolution by Jesse and Shupe. It's a great read and a great primer on how to control glucose spikes. Lastly, there are some new medical therapies that you should talk to your doctor about and consider if you have metabolic health issues, particularly if you've tried everything else and you're still struggling. GLP-1 medication like semaglutide or tazepatide can be a game changer if paired with all of the above techniques as mentioned earlier. A new class of oral medications called SGLT2 inhibitors are also very effective.

• 14:09Dr. Darshan Shah?

  Lastly, metformin is tried and true in the medicine category to help treat metabolic disease. There are also supplements that can help you manage your metabolism, like omega-3s, vitamin D, magnesium, and special probiotic strains like the ones found in a supplement called Pendulum. Metabolic health is one of the most powerful levers that you can pull for long-term health, energy, and vitality. By focusing on your mitochondria, tracking key biomarkers, and using tools like the CGM, you can make targeted changes and really move the needle. And by using strategies like flattening your glucose curve, you're setting yourself up for a longer and healthier life. If you want a quick guide to assessing your own metabolic health,

• 14:50Dr. Darshan Shah?

  go to my website at www.drshah.com/metabolism to download a PDF guide. Thank you, and please share this episode with a friend or family member that might be interested in improving their own metabolic health.

• 15:08Dr. 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.