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How to Create a Plan for Metabolic Health

Posted by Dr. Armen Nikogosian on Feb 15, 2019 11:24:30 AM

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 Dr. Armen Nikogosian, MD

Only 12% of Americans have ideal metabolic health—an alarmingly low number.

Statistic source: Joana Araújo, Jianwen Cai, and June Stevens. Metabolic Syndrome and Related Disorders. Feb 2019. http://doi.org/10.1089/met.2018.0105

Recent calculations showed that just one in eight Americans had good metabolic health. But on the bright side, more people than ever are aware of the effects that the metabolism has on their overall vitality. Patients now seek out functional medical practitioners in higher numbers to help guide them along the path towards a better quality of life through improved metabolic health.

This means that though people are eager to improve their metabolic health, many of them will have an uphill battle. Your challenge is creating a metabolic health plan for your patients that works for different individuals and their specific needs. This post outlines the steps a functional medical practitioner can take to develop holistic metabolic health plans for individuals.


Out with the Bad, in with the Good

Some people are looking for the healthy aging benefits that come with better metabolic health, while others are trying to lower their risk for certain conditions. It doesn’t matter what the patient’s motivation is; out with the bad and in with the good is a simple concept and should be the starting point.

The beginning of a working metabolic plan is to make sure that the patient is getting plenty of the ‘good stuff’ and less of the ‘bad stuff.’ You can get a pretty good idea of whether the patient has unmet nutritional needs with a thorough history, physical examination and food diary. You’ll also need to perform some testing to fully determine the patient’s levels.


Functional Nutrient Testing

Standard nutrient serum testing can be helpful in determining potential unmet nutrient needs, but they do not give much insight into how well the patient’s cells are actually utilizing those nutrients.  To determine this key piece of the metabolic puzzle you will need functional nutrient testing.

All nutrients have upstream and downstream metabolites.  These are compounds in the body which either need a specific nutrient to become activated (upstream) or are produced as a result of the action of a specific nutrient (downstream).  By measuring these metabolites, we can go far beyond simply measuring nutrient levels to see how well the nutrients are utilized by the cells of the body.

There are many categories of metabolic health to look at but two of the most important are methylation and mitochondria.  Both functions are critical to metabolic health. Methylation facilitates scores of diverse processes throughout our bodies. It relies heavily on various nutrients, most notably the B vitamins and DMG.  Mitochondria produce the energy which fuels our metabolism it also uses a plethora of nutrients, most notably CoQ10, alpha lipoic acid, and carnitine.  Another way to view this is that methylation functions like the economy of our body, ensuring a smooth, seamless flow of the metabolism, while mitochondria functions like the utilities producing the basic resources needed for everyday survival.

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The environment modern human beings live in now is different than the one from which they evolved. Diesel exhaust, sulfur dioxide, and lead are all around us in the air. Normal tap water can contain aluminum, ammonia, arsenic, and other contaminants. Processed foods often introduce ‘bad’ additives.

Detoxification goes beyond just figuring out whether a patient has an excess of heavy metals like mercury. There’s a baseline level of natural, daily detox that happens just by being alive. There’s also a certain level of regular toxicant—even when we are living clean—which can vary greatly across individuals. Functional medical practitioners need to determine if toxification/detoxification levels are balanced and occurring adequately or if it is imbalanced and the patient’s body is struggling with it. Certain nutrients assist with detoxification, so this doubles back to ‘out with the bad, in with the good.’

Balancing the Immune System

Gut health is a critical foundation for metabolic health because the immune system lives there. The state of the gut has substantial effects on inflammation in the body.  Unchecked inflammation requires scores of nutrients to maintain and is metabolically “expensive”. We can’t turn off inflammation completely, but it should be turned off and on appropriately and for the right reasons.

Review gut health with your patients and look for unchecked activation of inflammation. By balancing the immune system—starting with the gut, we can make sure inflammation is regulated.

Lifestyle Movement

Evaluating the patient’s lifestyle continues the ‘out with the bad, in with the good’ approach. Start with the basics. First, are they eating clean, whole foods and minimizing their processed food intake? Second, do they have any food sensitivities? Asking the patient if they feel bad after eating certain foods can yield a lot of information. If necessary, implement food sensitivity testing or food allergy testing to narrow things down further.

Now onto the movement part. The pillars of good health come down to four kinds of movement:

  • Moving the body (exercise)

  • Moving the bowels (gut health)

  • Moving the mind (cognitive) stimulation

  • Movement of hormones (cortisol and melatonin)

Exercise is self-explanatory, and we just went over how the gut is the base for the immune system. It is essential that the patient is ‘moving’ their brain by engaging in daily cognitive activities; this too is a simple concept. But what about hormones? We don’t have much control over most of the hormones in our bodies, but cortisol and melatonin are different. They’re like dance partners, and we can make sure they’re moving in sync by controlling the way we respond to our environment. Most patients think stress is something that happens to them. However, stress isn’t what happens to a person in their life—it’s how they react to their environment.

People can have minimal stress response to the most atrocious and intense occurrences once they learn how to mitigate it. Getting enough sleep each night is something the patient can do to enhance their lifestyle and reduce stress. Melatonin and cortisol are tied together; stress will impact sleep, and lack of sleep can affect stress response. So, creating whatever kind of environment is necessary to get the right amount of sleep is crucial for controlling cortisol, the stress hormone.

Fight One Battle at a Time

When a patient has a particularly unhealthy lifestyle, it’s important to start addressing metabolic health at a pace which they are comfortable with. Some doctors will tear down a patient’s lifestyle after evaluating them and put them on intensive programs after the first visit. But this can be counterproductive. Yes, the doctor is correct. The patient has unhealthy habits and should change. But making multiple significant life changes all at once can be daunting and difficult. In addition to that, some lifestyle changes won’t yield results for quite some time. If the patient is making sacrifices and not getting tangible returns, they’re likely to lose motivation.

The best approach to promote compliance is to get the patient some solid results as quickly as possible. It will help them build faith in your process and motivate them to follow through on other changes. Initially focusing on supplementation and gut health tends to work well. If they’re nutrient deficient, have unmet needs, have gut dysbiosis or other gut-related issues, you can have the patient feeling noticeably better within a few weeks.  From there, tackle one problem at a time, so your patients don’t get overwhelmed and stay motivated.


Humans are designed to be in balance. But our environment and age are the two main things working against us. Creating a plan for metabolic health is about rebalancing your patient as much as possible. By evaluating the patient to determine which ‘bad’ things need to be eliminated or reduced and which  ‘good’ things they need more of, we can create a plan that puts the patient on track towards optimal metabolic health.

Armen Nikogosian, MD practices functional and integrative medicine in Henderson, Nevada.  He is Board Certified in Internal Medicine and a member of the Institute for Functional Medicine (IFM) and the Medical Academy of Pediatric Special Needs (MAPS).  

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