Biomarkers Are a Useful Tool in Managing Diabetes
A ketone research professional who counts ketone ester and ketone supplementation among his areas of expertise, Dominic D’Agostino shares information through this website KetoNutrition.org. An associate professor at the University of South Florida and a scientist at the Institute for Human and Machine Cognition, Dominic D’Agostino’s research incorporates continuous glucose monitoring use for biomarkers.
Briefly defined, biomarkers are measurable bodily substances that can indicate physiological dysfunction as well as general health status. Biomarker substances are generally molecules that occur in tissues or fluids of the body.
For example, doctors have long used blood glucose as a reliable indication of diabetes as well as the severity of diabetes. Beyond helping to diagnose patients who already have diabetes, measuring glucose levels can help identify prediabetes and assess overall risk in otherwise healthy patients. As a biomarker, the glucose molecule is also incredibly helpful in diabetes management, indicating how well a patient is responding to a particular course of treatment.
From 2009 to 2016, data from the National Health and Nutrition Examination Survey (NHANES) collected from nearly 9,000 people revealed that only 12% of, or 1 in 8, Americans were considered “metabolically healthy,” a statistic circulating the media ever since.
Metabolic health is often defined as the absence of metabolic syndrome, which isn’t exactly how we would define it. For reference, metabolic syndrome is diagnosed when a patient has 3 out of 5 of the following: (1) waist circumference greater than 40 inches in men and 35 inches in women (I.e., abdominal obesity), (2) triglycerides at or above 150 mg/dL (3) HDL cholesterol of less than 50 mg/dL in women and 40 mg/dL in men (4) systolic blood pressure of 130 mmHg or greater or diastolic blood pressure of 85 mmHg or greater without medication (5) fasting blood sugar levels of 100 mg/dL or more. That means in some studies, the criteria for metabolic health is a far cry from what we think should be considered optimal. The absence of a disease doesn’t inherently imply “health,” and having less than three of these components does not mean being metabolically healthy. Needless to say, it is necessary to apply a bit more rigor to the definition of metabolic health and expand past the components of metabolic syndrome.
We view metabolic health as a spectrum of metabolic flexibility, glycemic control, insulin sensitivity, and inflammation, all of which are not mutually exclusive and common amongst metabolic diseases, including diabetes, cardiovascular disease, certain cancers, and dementia, among others. Thus, maintaining or striving to achieve metabolic health is incredibly important for long-term health and longevity. The good news is that our daily lifestyles strongly influence our metabolism and, consequently, our metabolic health — this includes how much we eat (eg. CICO), what we eat, macronutrient composition, how often we exercise, type of exercise, our sleep, stress, circadian rhythms, etc., which means that metabolic health is an actionable variable we can optimize, or at least vastly improve.
Without active inputs, maintaining metabolic health appears to be difficult, as both normal weight and obese individuals who are metabolically healthy at baseline transition to a metabolically unhealthy phenotype over time. It is important to identify biomarkers that can help determine the progression of metabolic decline before disease onset. These underlying symptoms (e.g., metabolic inflexibility, glycemic variability, insulin resistance, and inflammation) often occur years before clinical signs of metabolic disorders. However, doctors don’t routinely screen for the markers that may be at the root cause of poor metabolic health. The trend towards poor metabolic health is often correlated with weight gain, but not always. Thus, it is critical that medical professionals and researchers alike agree on a concise definition and specific determinants of optimal metabolic health in order to monitor, prevent, and course-correct poor and/or declining metabolic health.
After a lot of research and Dr. D’Agostino’s experimentation, he has identified five biomarkers beyond the five components of metabolic syndrome previously mentioned, which can provide considerable insight into the state of your metabolic health. These include real time continuous blood glucose monitoring (CGM), blood ketones, breath ketones, fasting insulin, and high sensitivity C-reactive protein (hs-CRP).
