Understanding Metabolic Disorders: Symptoms, Causes, and Treatment

Metabolic disorders have traditionally been called ‘Aristocrats disease’ because they mostly affected Kings and Queens. But in the past 50-60 years, they have become commonplace and strike even the poorest of the poor, young and old, unsparingly.

But what are metabolic disorders?

A metabolic disease or metabolic defect occurs when the body’s metabolic process is disrupted as the body has too many or too few of the necessary components and the natural metabolism of the body is impacted by abnormal chemical processes.  

There are a variety of metabolic illnesses. Some of them are inherited, while most of them develop due to lifestyle, poor nutrition and other factors. Metabolic disorders are usually attributed to the malfunctioning of an organ involved in the process of metabolism and they can be resolved effectively by treating the underlying problem.

Modern science has been able to identify over 500 different metabolic disorders, many of them rooted in uncommon genetics. But thanks to the advancement in modern medicine, several diseases that were once a potential threat can now be treated and cured with relative ease. 

Improvements in diagnostics have also made it easier for doctors to comprehensively understand the biology of diseases. This understanding is helping them to decide the most effective treatment plan conclusively, thereby facilitating more effective intervention.   

Causes of Metabolic Disorders

The metabolic pathway is intricate and made up of numerous biochemicals, tissues, and organs. There is therefore a very high probability that something will go haywire and cause metabolic disease. 

According to some estimates, treatment of chronic diseases (diabetes, hypertension, heart disease, strokes, fatty liver disease, PCOS and infertility, dementia and cancer) accounts for 75% of healthcare expenses. Moreover, these diseases are treated symptomatically, usually with the prescription of drugs to ‘manage’ the disease for life and not to cure it altogether. 

Available data also suggests that insulin resistance affects at least 75% of the general population. Shockingly, despite being the root of several diseases, insulin resistance is commonly misdiagnosed, undervalued, and handled poorly due to ignorance and scientific misinformation. 

None of these chronic diseases are terminal. Thousands of research investigations over the past few decades have demonstrated that metabolic anomalies are neither persistent nor permanent. And yet intriguingly, the standards and procedures of the contemporary global health sector do not propagate this information or its clinical application.   

How to tackle metabolic disorders?

Understanding the trio of metabolic disorders / syndrome (insulin, cholesterol and blood glucose) and the interaction of their metabolic colonies is quintessential to tackling the complexity of the problem and arriving at a simple solution. 

The four essential parts that contribute to maintaining metabolic health are the liver, muscle, adipose tissue and pancreas. Each of these organs experiences systemic lipotoxicity leading onto  the progression of chronic illnesses in a set order. Therefore, it would be very helpful to be aware of how well each of these organ systems is operating so that rapid action may be taken to treat chronic illnesses as well as avoid and reverse these problems.

What are the markers for Liver metabolic disorders?

The following are significant markers of the liver’s metabolic state:

1. Lipid profile analysis:

The amount of total cholesterol is a poor predictor of metabolic health. Low-density lipoprotein (LDL) and high-density lipoprotein (HDL) both carry cholesterol. However, the terms “bad” and “good” cholesterol are misleading in a big way. In fact, the lipid profile test merely reflects insulin resistance and the kinetics in the lipid energy model. Both saturated fats and daily cholesterol consumption indeed have a positive effect on metabolic health. The diet-heart hypothesis that had declared cholesterol as the culprit now stands falsified.  

Triglyceride / HDL-C ratio: The most accurate indication of metabolic health and hepatic insulin sensitivity is the triglyceride/HDL-C ratio. Greater triglycerides in the blood aren’t caused by increased fat consumption, but by fat that is produced far in excess by the liver and eventually gets spilled over in the circulation. It denotes improved insulin sensitivity and de novo lipogenesis (DNL), which is the process of turning simple carbohydrates into fat. De novo lipogenesis (DNL) is increased primarily as a result of hyperinsulinemia and the ingestion of excess sugars, refined carbohydrates and alcohol consumption. Steatohepatitis and a rise in liver enzymes are brought on by the ingestion of refined oils (PUFA, a high-inflammatory omega-6).

The very low-density lipoprotein (VLDL-C) is a blood marker for residual cholesterol.

It has a close link to triglyceride levels.

Very Low-Density Lipoprotein (VLDL) is a type of lipoprotein that is produced by the liver and transports triglycerides and cholesterol from the liver to the rest of the body. The relationship between VLDL and cholesterol is that VLDL contributes to total cholesterol levels in the blood. A high level of VLDL is considered a risk factor for cardiovascular disease as it can contribute to the accumulation of fat (from triglycerides) in the walls of arteries, leading to plaque formation and an increased risk of heart attacks and strokes. 

The ideal range for VLDL is below 15 mg/dL.

What Does a Health Metabolic Profile Look Like?

The optimum cholesterol level (VLDL-C) is below 15 mg% and TG/HDL ratio below 1.5. Simply put, any reading higher than these values indicates that you have insulin resistance.

2. LIVER ENZYMES:

GGT (gamma-glutamyl transferase) is a liver enzyme that is a marker for the following

• Oxidative stress in your body
• Metabolic or insulin resistance syndrome
• Fatty liver
• Risk of atherosclerosis (t co-localizes with oxidized LDL in atherosclerotic plaque)

GGT can be used to predict type 2 diabetes and heart disease. Elevated GGT is both the liver’s imperceptible cry for help and a sign that it needs more glutathione, the most powerful antioxidant, and free radical scavenger.

The binomial distribution of the enzyme level at the population level is skewed up to 40 IU/L because the majority of the population has fatty liver disease.

Even in cases of liver illness and bone health, it frequently results in an increase in alkaline phosphatase levels.

Liver function tests, in particular GGT, have taken center stage in the underwriting procedure for life insurance companies. GGT values are taken into consideration for premium payment and acceptance or rejection of policies because of their strong correlation with lifespan.

ALT (Alanine transaminase)

ALT is sensitive to drugs, alcohol, and too much sugar, which can all harm the liver. In stage 2 and subsequent stages of fatty liver disease, it is associated with increased steatohepatitis (inflammation) in both alcoholics (AFLD) and non-alcoholics (NAFLD). Hepatitis might cause an increase in it as well. The functional value is 25 IU/L. Unfortunately, there is a bias in that the highest upper limit of the reference range, which is based on the binomial distribution, has changed recently from 25 IU/L in the 1980s to 40 IU/L. Maintaining the upper limit at 40 IU/L provides a false sense of assurance regarding the health of the liver, and we are effectively omitting the liver’s silent cry.

Elevated liver enzyme levels and abnormal lipid profile ratios are the liver’s undetected pleas for assistance. The majority of the time, it goes unnoticed; you are reassured in the doctor’s office that it is benign and that you should reduce fat in your diet to lose weight. However, after 5–10 years you tend to manifest metabolic diseases. The “golden age” of identifying insulin resistance or pre “pre-diabetes” is missing because we measure blood glucose frequently and misinterpret the cholesterol profile by just glancing at the total numbers.

The Link between Metabolic Disorders and Insulin Resistance

The primary anabolic hormone, insulin, plays a role in keeping blood sugar levels within a normal range and distributing energy throughout the body. Food is more than just calories. It also carries environmental data that helps with metabolism and exerts epigenetic control over genes essential for existence. Before the discovery of insulin, Type-1 Diabetes was a death sentence for children. Since Banting and Best’s discovery of insulin more than a century ago, patients with Type-1 Diabetes have been able to save themselves but their lives are dependent on medications. 

Fasting levels of Insulin (mlU/ L)

          Ideal: <4 

          Normal: <6 

          Mild Elevation: 6 -10 

          Moderate Elevation: 11-15 

          Severely Elevated: > 15 

The fasting insulin level is the most crucial predictor of the onset of type 2 diabetes and all other metabolic disorders. Elevated insulin levels are associated with fatty liver disease, hepatic insulin resistance, subcutaneous adipose tissue-related unrestricted gluconeogenesis, and impaired lipolysis. In order to counteract insulin resistance, which starts in the liver and gradually extends to the muscles and pancreas, insulin levels are boosted. Because blood sugar levels will be normal during this pre-diabetes stage, we risk missing out on the opportunity to identify and treat it early, thereby preventing the development of all common metabolic disorders or illnesses.

Glucose is the last parameter to be raised in the Metabolic Syndrome after years of futile attempts by hyperinsulinemia to counteract insulin resistance. Diabetes is defined as blood glucose levels greater than 126- mg/dL while fasting and over 200 mg/dL after eating, while pre-diabetes is defined as blood glucose levels between 100 and 126 mg/dL while fasting and 140 to 200 mg/dL after eating. The HbA1c, which provides an approximation of the average blood glucose levels in the previous three months, is more intriguing to the general public.

What approaches should you take to treat diabetes?

Treat diabetes with a holistic approach that includes a balanced diet, regular exercise and movement, prescribed medications, stress management, exposure to natural elements, structured water, and a supportive network among others. Work with a healthcare provider to develop a personalized treatment plan to effectively regulate blood sugar levels and prevent long-term complications. 

Do we need to monitor our insulin levels to see if we are insulin-resistant or not?

If you have diabetes, we often monitor blood glucose levels to keep it within normal limits but  we generally never measure the insulin levels. Using a continuous glucose monitor (CGM) is an option for blood glucose levels, but constantly measuring your blood sugar levels can create more stress than calm. 

The question to ask is whether blood sugar levels alone can help you manage your condition and avoid complications. But is monitoring through an instrument the only way?

Not always. 

There are surrogate indicators of insulin resistance. For instance, our skin is a good indicator of internal metabolism. You may notice blackish discoloration and velvety or leathery appearance of skin patches around the neck, underarms, and over the face which occurs because the layer of skin that produces melanin is rapidly proliferating. This phenomenon is called Acanthosis Nigricans.

It is quite depressing to frequently witness young individuals and even youngsters struggle with insulin resistance. You will be shocked to realize how common it is in our population if you simply observe this sign the next time you visit a mall or at a large gathering. Abdominal fat, particularly visceral fat, is an indicator of increased aromatase expression. High estrogen in men is due to increased aromatase expression in abdominal fat, particularly visceral fat. 

You are not necessarily healthy just because you are slim. Since obesity is an issue everywhere, we are not ignoring it. It is only one manifestation of the metabolic syndrome’s symptoms. Liver fat (not the subcutaneous fat that causes love handles) is associated with insulin resistance in MRI fat fraction studies (it is never a problematic syndrome’s symptoms. Body mass index (BMI), which is based on weight, is a poor indicator of metabolic health.

Do women confer advantages over men?

Females of reproductive age are naturally protected. The number of males being affected by diabetes, heart disease, hypertension, strokes, dementia, gout, and fatty liver disease is three times more than females even when food habits and sedentarism are the same. This indicates that hormones have an influence on metabolism.

Androgens (male sex hormones) do not stimulate adiposity (fat deposition in adipose tissue).  Therefore, the personal fat threshold is reached quickly in males, resulting in subcutaneous fat cell hypertrophy (growth in size) and insulin resistance. Chronic inflammation caused by hypertrophic fat cells results in the production of cytokines and proinflammatory mediators. All bodily cells, particularly the muscles, and liver, eventually develop insulin resistance as a result of this chain of events.

Female sex hormones such as estrogen promote the growth of young fat cells or hyperplasia. This allows a  large amount of fat to be stored in the subcutaneous adipose tissue without the fat cells becoming large and developing insulin resistance. The Female personal fat threshold (PFT) is higher than in males and so is their metabolic buffer.  

Is liposuction a good option?

Liposuction is actually harmful. It reduces  the subcutaneous adipose tissue fat cells drastically that keep your personal fat threshold (PFT) in check. Thus, making you more likely to develop metabolic diseases at an early age.

Conclusion:

The only hope for treating, reversing, and protecting future generations from these chronic disorders is the widespread adoption of a balanced diet which could positively impact and improve the health condition. The first line of defense against metabolic syndrome is adopting heart-healthy lifestyle changes. To help you develop a nutrition, exercise and overall lifestyle regimen that is effective for you, you might need to consult a holistic integrative practitioner. With the right treatment and lifestyle habits, metabolic disorders can be eradicated efficiently.