27: How to Assess Your Metabolic Health (Part 1)

00:06 - Michael Kummer (Host)

You're listening to the Primal Shift podcast. I'm your host, michael Kummer, and my goal is to help you achieve optimal health by bridging the gap between ancestral living and the demands of modern society. Get ready to unlock the transformative power of nature as the ultimate biohack, revolutionizing your health and reconnecting you with your Primal Self. Stop wasting time and money on an annual physical exam and a blood panel that goes with it. It's not going to help you find out if you're metabolically healthy or not and I know this might sound strange to you because you know we all are used to our annual exams to figure out if there is something wrong with us. But here's the thing Chances are, you're not metabolically healthy, because only 12% of Americans are metabolically healthy. Yet Everyone I talk to and that includes a lot of family and friends and people who reach out to me when they go to the doctor what they hear is one of a few things. Number one everything is fine. But how can everything be fine with everyone if only 12% of Americans are metabolically healthy? Number two you know, don't worry about it, that's just part of getting older. No, it's not. Getting older doesn't mean getting sicker. Or? Number three you know, don't worry about it. A lot of my patients have that also not very good. Just because everyone has it, or a lot of people have it, it doesn't mean it's normal and you should be having it to whatever that condition might be. And then the classic one that I've heard a lot especially I mean I have heard it myself really is everything looks good but your cholesterol is a little high. So let's maybe discuss that. 

01:41

And you know, the thing is, you know annual physicals they're not bad. They're mostly good to find out if you're currently dying. Because if something is off, significantly off, as part of a regular, traditional annual physical, then you're already in very bad shape. If you're a faster, sugar is high, you're already pre-diabetic or diabetic. So it's very often way too late in the game to figure out. You know if something is wrong that you can avoid, you know. But it's not even an annual physical doesn't even guarantee you that everything is fine, that you're not currently dying. And I give you one example One of our previous neighbors. She died of lung cancer two weeks after her last annual physical. I'm like how on earth did the doctor not discover that she had terminal cancer during the physical exam? And there are a couple of reasons for that, why stuff usually never gets discovered during a regular physical unless it's very late or too late already. 

02:39

And number one is most of the tests, especially the blood work, does not include some of the most critical blood markers that I test for every single time that can give you a true indication of how your metabolic health is. They're not part of the blood work for reasons I don't understand. Number two is that many doctors don't understand or appreciate the difference between a normal range and an optimal range, because our normal range is deteriorated so much over the last few years and decades. Just to give you one simple example, the normal testosterone levels in man are somewhere between 300 to 1,000 or to 1,100 nanograms per deciliter, I think, is the unit. So it's a very wide spread and an indication that either we don't really know what the normal range should be or B that we have gotten so low in our testosterone levels that now suddenly our normal range starts at 300, whereas it used to be much higher in the past. In fact, over the last couple of years we've seen the normal range to go down, down, down, simply because the average levels have gone down. That's not a good thing. It doesn't mean it's normal just because everyone, or many males, suffer from low testosterone levels. 

03:48

And then the third factor is that doctors often interpret the findings based on outdated information they learned in med school 20 years ago and many, unfortunately, don't keep up with the latest scientific evidence and just apply common sense and think outside of the box. For reasons we don't have to go into, the medical system is broken and it's always the doctors fault, of course, but that's beyond the scope of this episode. But here's the thing and I'm not a medical doctor but considering what the feedback I've gotten information I've gotten from the doctors I talk to, and secondhand feedback from friends and family who talk to doctors I feel like I need to fill in the blanks and give you maybe a different perspective and equip you with information that you can take to your next physical exam and ask the doctor what you want to have checked, so you get a really good understanding of how your metabolic health is. So in this episode we'll cover what are the health markers you should be asking your doctor to include as part of your blood panel. That are usually not how to better interpret the findings, and so you don't have to rely only on the opinion of your doctor, which might be misleading, outdated or simply wrong why you should get your blood work done more than once a year? Because establishing trends is more important in some cases than snapshots. And there are certain issues with there are certain blood markers we'll talk about that can be negatively impacted by, maybe, exercise or by some other lifestyle factors that don't necessarily indicate an issue. But if you only get it once a year, you might not really know what your true values are, and that's why it's important to get your blood work done more than once. 

05:19

And then I'm going to share with you a couple of things, a couple of health metrics. You can assess yourself every day, really right now, without requiring a blood panel, and I use those. I go through them every so often to see, okay, how am I really doing without knowing how my blood is looking? I do my blood work every three to six months, but beyond that, there are many things you can do to also assess how healthy you are or not. And then, last but not least, I'm going to cover some of the blood testing options that you can leverage if you don't have insurance. You know this is mostly an issue, I guess, in the United States. In most other countries the blood work is covered by the insurance and everyone has insurance or most people at least but here I've seen that's the case all the time. Sometimes what the insurance charges is ridiculous for a blood work, especially if you want to get some of those fancier blood markers. That should be really part of a regular exam. So I'm going to share with you what I'm doing, because I'm not using my insurance either, but with that we're going to jump right into the blood markers that I think you should be having tested several times a year as part of your blood panel, and number one is your C-reactive protein, or CRP. 

06:23

There are a couple of other inflammatory markers you can test for. I'm going to have a dedicated blog post that goes into more details so you can check that out. But the CRP is really one that often doesn't get checked for, and I don't know why, even though it should. Crp, or C-reactive protein, gives an indication whether or not there is an inflammatory response in your body, whether or not there is inflammation. Now, crp doesn't tell you what caused the inflammation, where it's located or what it is, but it's a general idea or a general indication that your body deals with some sort of inflammation and the normal range, or where you should be, is below three. 

07:03

Ideally, you want to be below one. Typically, my CRP is lower than 0.3. And I think 0.3 is just the threshold that the lab can test for it doesn't? The lab cannot test, at least the one I use. They cannot tell me if it's 0.1, 0.2, or 0.3. All I know is it's below that 0.3 threshold and so that's good. That means no inflammation or very little. That is usually not a concern. If it's above three, or if it's constantly above one, there is likely something in your lifestyle that might be causing a low-grade, chronic inflammation. It could be that your immune system is over-responding, it could be an autoimmune issue, it could be the beginning of a metabolic issue, etc. So you want to check your CRP and make sure it's below one, ideally. 

07:52

Now there are a couple of things that can skew the results, which is one of the reasons why you want to retest or test more often, and one is intensive exercise. Few times in the past, when I didn't know any better, I went to do my blood work right after working out, right after doing CrossFit. That was because the lab was right next to my CrossFit box and I just walked over and got my blood panel done because it was faster at the time. What I didn't know was that intense exercise can temporarily cause an increase in CRP, and that's because exercise is a stressor that causes your immune system to respond, and so you likely see temporary inflammation after an intense workout. That's perfectly normal, it's nothing to worry about, but it might lead to elevated CRP levels, and if you just see that without knowing what caused it meaning the exercise you might think that there is something going on, whereas it's not so. That's why I usually try to avoid intense exercise at least 24 hours before getting my blood work done. Sometimes I try even have two days of no workouts before I get my blood work done to really make sure that anything my body is dealing with to try to recover and recuperate from that workout is out of the system and I'm back to baseline. The other thing I've noticed that sometimes my liver enzymes are also elevated in response to very high intense workouts. So, again, try to not make exercise scooter results, but get your CRP checked as often as you can. 

09:18

The second one is hemoglobin A1C or HA1C. That's your long-term blood sugar. That gives an indication of how your blood sugar levels were over the past 90 or so days, and usually as part of a blood work you get your fasting glucose, and that's really a very poor indication of your body's blood sugar response, because if that is high already, then you're already in bad shape. You're already pre-diabetic or even diabetic if you have elevated fast at glucose levels without having done anything. Now again, exercise can temporarily raise your blood sugar levels. So don't exercise right before getting a test similar to the CRP. But the way better metric that you should ask your doctors to include is your HA1C. You can tell how we're blood sugar levels over the past three months or so, and that's a fairly good indication of whether or not they are too high on average. Now there are again a couple of things that can influence those levels, and one is exercise, sauna bathing, stress of any sort really because exercise and sauna bathing are stressors too can increase your blood sugar levels or can cause temporary spikes in blood sugar. 

10:25

I've noticed that when I exercise, sometimes my blood sugar levels spike dramatically. I've seen it with my continuous glucose monitor that I wear every so often, and so the more you exercise, the more you deplete or release blood sugar or sugar into your bloodstream or glucose into your bloodstream from your liver or muscle stores. The higher the average blood sugar is going to be, the higher the HA1C is going to be. But here is the thing If it's somewhat close to five maybe 5.1, 5.2, 5.3, whatever that's perfectly fine. I've seen people who have HA1C below five, but I could probably get there if it didn't work out, if it didn't sauna bath. So keep my blood sugar artificially lower. But I don't think I'd be any healthier by not exercising and by not sauna bathing and by not doing some of those things that can cause temporary spikes in blood sugar. So again, make it sure it's reasonably low, it's not too high, but don't freak out if it's maybe higher than someone else just because you work out a lot, you sauna bath a lot, et cetera. 

11:29

Somewhat related to your long-term blood sugar is your fasting insulin. That's also arguably one of the most important metrics that I would include in every single blood test, because insulin sensitivity is one of the key factors that determine your metabolic health and your risk for developing a metabolic or chronic disease in the long run, and so a good range of fasting insulin is below three micro-international units per milliliter. Sometimes they use different units. You can convert between those, but on my blood panel it's always UIU per ml per milliliter and so usually my fasting insulin is actually below the low cutoff. For the most part I've had it at 1.8 UIU per milliliter, which is below the two UIU per milliliter cutoff. So that means I'm more sensitive to the hormone insulin than even the lowest average. That's a good thing. 

12:26

You want to have your fasting insulin as low as possible, because that means your cells are hyper sensitive to insulin. It only requires a little bit of insulin to remove glucose from your bloodstream. That means your pancreas is working less and your cells are more receptive and more responsive to insulin. That's a good thing, because the opposite insensitivity or resistance, insulin resistance is one of the hallmark factors or markers of metabolic disease in the long run. That's something you definitely want to check. Also, vitamin D is something that I would check, maybe not with every blood work, but at least once a year. I would test my vitamin C levels, in particular during the cold months of the year to see if it makes sense to maybe supplement with a high quality vitamin D3 supplement. Then also, of course, sunlight is really the major source of vitamin D production. That's why I'm so much in the sun without wearing sunscreen or wearing sunglasses to make sure my levels are high, because studies have shown, especially over the last couple of years, that those with the lowest levels have the highest susceptibility of adverse outcomes when it comes to certain viral infections. 

13:32

So very important Blood lipids. One of my favorite topics and one of the most misunderstood topics, I think, because there is still this misconception among most medical professionals, unfortunately, and also, of course, the regular population, is that high cholesterol and high LDL is bad. It's an indication of that. You might get arterial or already have arterial plaque or the risk of heart disease and stroke and whatnot. That's complete BS. There might be some very loose correlation, but there is definitely no causation of high cholesterol or high LDL and cardiovascular disease. So high total cholesterol or high LDL are mostly benign. Chances are they're completely irrelevant. Now again, depending on the state of health, if you already know that you're unhealthy, then high cholesterol or high LDL might be an indication that there is something else going on that needs to be addressed, but those two are never the causes of cardiovascular disease. 

14:36

My total cholesterol is usually somewhere between 220 and 280, and my LDL is typically somewhere between 180 if it's very low, and up to 260 when it was on the higher end. And, of course, the more fat I consume, the higher those levels are. But here is one thing that most people don't understand 80% of the cholesterol in your body is made by your body, because it's so important. 25% of our brain is made up of cholesterol. It's incredibly important, has so many important functions, and trying to lower those levels is just poor advice. In fact, a lot of people with cardiovascular disease have very low LDL levels, and I would never, ever recommend anyone to use statins to lower their levels. Now there might be some ridiculously high levels that might indicate something is going on. 

15:21

I've seen this once or twice before, but, generally speaking, if your doctor tells you your cholesterol is too high, you need to stop consuming salt and reduce the saturated fat intake, etc. It's BS. There is no other way to say it. Now, here is the thing, though, with LDL. There are different types of LDL molecules, and the problems can arise when those molecules oxidize, when they become inflammatory. Now, it's not the LDL that's the problem, or it's not the LDL that just mysteriously oxidizes. It's a lifestyle problem that can cause LDL to oxidize and then cause problems, and a good way to find out if you have problems caused by oxidized LDL is to get a calcium score scan. So it's basically almost kind of like a CT. You get into a tube and you get your heart up to your brain basically or at least this part scanned, and it looks for a terial plaque, and I've done this in the past and I had sero-aterial plaque, despite having had very high cholesterol and LDL levels for several years. Now, apparently, it does not cost any arterial plaque, and so if that's something you want to be sure of, you can do a calcium score scan. It's also not very expensive, even if you don't insurance. I think I paid 100 or 200 bucks and that was it. So that's something you want to test Now. 

16:39

The other thing that in the past the assumption was there are two factors or two metrics as part of your lipids that are more important than your total cholesterol in the LDL, and those are the triglycerides in your HDL. But even there there is now a lot of robust scientific evidence that even higher triglycerides might not necessarily be an issue and lower HDL might not necessarily be an issue. Now I still aim to have a somewhat even ratio of HDL to triglycerides. Typically in my case it's around one to one. Not that I do anything in particular other than just living a healthy life and eating a lot of fat and animal based protein, but that's something you might want to try shoot to. If those levels are completely out of whack, if your triglycerides are three times as high as your HDL, there is probably room for improvement and there might be something going on. But again, I've significantly decreased the priority of looking at my blood lipids and to make sure they are within the normal range, because the normal range is a BS. Nobody seems to exactly understand what those levels mean and where they should be. But higher doesn't necessarily mean it's bad. So don't stress out about them and certainly don't take a doctor's advice if the telly you need to go on statins because you have total cholesterol of 250. 

17:52

Sex hormones are another thing that some of them are part of a regular blood work, but most often they're not, in particular testosterone. I've mentioned it before. We don't really know what the optimal ranges are or what the normal ranges are. It's such a widespread, from 300 to 1000 nanograms per deciliter, depending on what lab you look at. But here's the thing you want to be in the upper range, most likely, even if you're getting older and 42 years old now, and you don't want to be in the 250 to 300 range. That's usually not normal and certainly not optimal. So you want to be above 500, the closer you can get to 1000, the better it is. 

18:29

Now there might be a lot of lifestyle things you can do to improve your testosterone levels. There are foods you can eat. There are foods to avoid, obviously, you know, like soy and stuff that has estrogen or estrogen mimicking chemicals in them. But there might also be genetic limitations on where you can get, and so in some cases, testosterone replacement therapy or hormone replacement therapy might be warranted. We talk about it in an upcoming episodes so I can share my experience with it and what works, what doesn't and why I wouldn't do certain things again. 

18:59

But there are other sex hormones you definitely want to test, you know, including your estrogen. Obviously that's both important for, in men and women, your DHA, your progesterone, your LH, etc. And there are certain ratios that I'm going to talk more about in my blog post. So you know, check that out. We don't have to go into all of that, but make sure your sex hormone levels are part of your blood work. 

19:19

Ferritin is also an important one, especially if you suffer from low energy levels or you feel like you might have, you know, low iron or iron absorption issues. You know, getting a ferritin levels check is a good indication. We have a lot of customers with MK supplements that have purchased heart and spleen in particular because they have low ferritin or low iron levels and spleen is obviously one of the best sources, most absorbable and bioavailable sources, of iron, of heme iron, and so that's something you definitely want to check. Prolactin is also something you would definitely want to be below 12, unless you're breastfeeding women. Very often that gets not checked and that can have significant issues if those levels are elevated. Thyroid hormones obviously those are typically part of you know the regular test at least in my case, the SAH and T3 and T4 are always part of my comprehensive metabolic panel. But if not, make sure you test your thyroid hormones. 

20:09

One more thing that's not related to blood work but that's a very important check you should be doing every so often At least I do it once a year is a DEXA scan, and a DEXA scan is kind of like a CT again, and it checks your bone density. It checks your fat deposits so you can see where you have your fat. You know if you have a lot of visceral fat around your organs, around your midsection and, again, important bone density. And the thing is, with certain blood markers, especially if you look at minerals and vitamins, often you cannot tell if you're deficient, because your body is so good at keeping stable blood levels For example, calcium clear example you will likely never find calcium deficiency in your blood. If there are low calcium levels in your blood, then you're already in very bad shape. But until that happens, your body just leaches the calcium from the bones to maintain healthy and or stable levels. And so by doing a dexa scan or a bone density scan, you can see how dense your bone material is, because that's again not only an indication if you're maybe not lifting enough weights, but also if you might have micronutrient issues, deficiencies or absorption issues, especially as far as calcium is concerned, vitamin K2 or vitamin D is concerned. All of those play a role in depositing minerals such as calcium into your bone and dental tissue. And so that's something I do every year. Typically when I go to a biohacking conference, I have those dexa scans there and I can get them. I pay I don't know what it is 25, 50, even if it's 75 bucks but once a year it's a very good investment to see how my bone density is. 

21:42

My mom last year broke her ankle twice. I think it was different ankles, but still very suspicious that she would break a bone twice within a year. So she went to get a dexa scan and they said, no, everything is good. And I'm like well, can I see the test? And I looked at the test again. Based on the interpretation of the doctor, her levels, her bone density levels, are significantly lower than mine. I'm like mom, you might be within the normal range in the 50th percentile, but those are not ideal levels. And second of all, most importantly, they didn't check her entire body. They only checked her parts of your spine and her hip, nothing else. So she might have bone density issues in her ankles and they didn't even check for that. The dexa scan I do every year is a whole body scan, so I can see everywhere how my bone density is in the various parts of my body. So see if I need to do something to improve it, either by increasing my micronutrient intake or by lifting more weights to make my bone, my bone, stronger. 

22:40

Now, speaking of which, how often to get your checks or your lab blood work and your tests done? There are some things you can do once a year, like bone density it typically doesn't change very much within a year but blood panels I would recommend you do at least twice a year, ideally every quarter, for a couple of reasons. One is you might get this good result if your CRP might be high because you have a cold or you worked out too close to the blood work, or whatever the case might be. Sometimes, even if the sample is too long in transit, the sample might deteriorate and so you get less than ideal or accurate findings in the report. So that's why I recommend doing it more often and really looking at trends. How are you trending? Much like with HRV spot measurements are good, but trends are ultimately what's important. If you're on a journey towards better health, you want to see that you're improving over time, and so that's why I recommend doing those more than once a year. 

23:38

Now, if you have insurance and they pay for it, great. If you don't have insurance, there are a couple of options you have. There is on-demand services like Quest, hasem and Lab Corp. That's the one I typically use because they can do it. I think it's CVS so Walgreens. You just walk in there, well, you go to the webpage, you pay for the tests you want to have and then you go to Walgreens or CVS I don't remember which one and they do the blood draw right there and you get the results a couple of days later. The problem with that is they only have very select tests. They don't have everything that I want to cover, but at least some of the things that I want to cover. Maybe more often, if I get a poor result or an unusual result like my CRP or my testosterone, maybe then I can get that at Lab Corp. 

24:16

The other thing that I do most of the time is I have an anti-aging doctor I work with. His name is Dr Randy Smith. I'm going to include the contact information, the show notes, and he actually sends someone to my home to get my blood drawn. I get a very comprehensive panel and do this every three to six months. The blood panel costs me I think it's between 350 and 400, where someone comes to my house. Just to put this in perspective, when I used my insurance in the past and I would go to Quest. Quest would charge my insurance $3,000 for the very same test that I get for $400 with someone coming to my home. I don't even have to go anywhere. That might be an option as well If you don't have insurance. I know it's not super inexpensive, but doing this at least twice a year, I think, is an excellent investment in your health. Now let's talk about some of the things you can do without even getting a blood work, things you can use to assess your health. 

25:09

Number one is how do you feel? This is a tricky one, because you have to be fairly in tune with your body to understand when you're feeling good, great or maybe not so good. I'm saying this because in the past, when someone would ask me how do you feel, I would say good. If I would think about how did I feel? I'm like. Well, at the time I thought I felt good. It took me actually until I changed my diet and my lifestyle to really understand what it means to feel really, really good. Then I understood that well, how I felt before wasn't good. It was actually pretty crappy, but I didn't have a better baseline and I had nothing better to compare it against. Again, it's important or you can assess how you feel. If you have a fairly good baseline, you can do this every day. How do you feel? Do you feel arrested? Do you feel energetic? Do you feel tired, etc. If you feel great, chances are you're doing a lot of things right and nothing major might be going on. 

26:02

Number two is your fitness level. Now, being fit doesn't necessarily mean being metabolically healthy. I know this because in the past, when I was a pro athlete, I was very, very fit, but I was not metabolically healthy. I didn't know at the time, but now I know. Being fit doesn't mean you're metabolically healthy. But not being fit means you're metabolically certainly not metabolically healthy. In the worst case scenario, if you're overweight or obese, you are by definition not metabolically healthy. If you're out of breath because you have to walk up a flight of stairs, there is something going on. 

26:33

Lack of fitness usually goes hand in hand with poor metabolic health as well. You can use this On the one side of the spectrum, maybe not so much on the other side, so don't confuse your fitness with metabolic health. But your lack of fitness can very well be an indication of not being metabolically healthy either. Your skin health is a great way to see, to visualize your metabolic health. If you have chronic skin issues like acne or eczema or rashes that don't go away, that's usually an indication there is something metabolically going on in your body, because the skin is often a reflection, a direct reflection, of your metabolic health. And again, if your skin should look clear, it doesn't have to be perfect, it doesn't have to look like you're wearing makeup. But if you have red spots, a lot of pimples, acne, eczema, those are all signs of an underlying metabolic condition Metabolic flexibility, another thing I talked about in the past. 

27:27

If you fall apart because you have to skip a meal, something is wrong. If you're not metabolically flexible, meaning that if your body cannot switch between burning carbs and burning fat for energy, then you're metabolically inflexible and that's a metabolic issue. If you're metabolically healthy, you can easily skip a meal or two meals or three meals without falling apart. Yes, you might get hungry, you might feel like I really want to eat, but if you're falling apart, getting hungry, you fall asleep at the wheel because your energy levels are completely out of way. That's not normal and the sign of metabolic issues. 

28:01

Gut health is another thing If you upload it and constipate it with diarrhea or whatever after every meal or very often, that's again a sign of a metabolic issue, because if your gut is not healthy, your metabolism isn't either. So there is a very clear correlation. Very closely related to that is your immune health, which starts in the gut. But if you're sick a lot with viral infections and what have you and it doesn't really matter if it's winter or summer or somewhere in between if you're sick a lot, that means your immune system isn't working optimally and that also means your metabolism is negatively impacted by something you're doing. So if you're sick a lot, chances are your metabolic health is in the drain as well and you need to do something about it. 

28:42

Dental health is similar to skin health. Dental health is another very good indicator because there is a microbiome in your mouth. If there is inflammation going on, if there is anything going on that leads to poor dental health, that's again very much an indication of a negatively impacted metabolism, a sick metabolism, potentially gut issues to close the loop here gut, skin, teeth, metabolic health overall. So all very closely related. But dental health is not related to half of your brush, what type of toothbrush you use or toothpaste, or if you rinse or not, or if you floss or not, your gums and your teeth ought to be healthy, even if you don't brush a lot. Based on the microbiome and the lack of inflammation in your mouth, that goes back to your metabolic health. 

29:30

Chronic pain if you have arthritis or pain all the time in certain areas, unless it's something acute caused by an accident or an injury or whatever. But chronic pain is a sign of chronic inflammation and that often goes down or is directly related then with your metabolism. If you have chronic inflammation in your body, and even if you only recognize it by joint pain, chances are something else with your metabolism is not going right. So you can always use that to assess your metabolic health or lack thereof. Stress is not a good example. If you're not very good at dealing with stress and if you have a poor stress resilience, that often leads to metabolic issues because stress weakens your immune system. With a weak immune system or over reactive immune system, you open the gates for metabolic issues, and so there is usually, if you see one meaning a lot of stress and not of unmanaged stress, metabolic issues are typically right there as well. 

30:25

Same goes with sleep If you don't sleep well, if you don't get a lot of quality sleep every single night, your metabolism is likely negatively impacted because all of that goes together. And last but not least and that applies mostly to menstruating women you should have a fairly regular and pain free menstrual cycle. If it's either irregular and or very painful, chances are something is going on either with your endocrine system or with some other metabolic process that needs to be addressed and fixed by making the right lifestyle choices. Of course and when I have a next episode, I talk about some of the things you can do to figure out or to fix your metabolism. If, going through that list and looking at your latest blood work, you figure out, okay, something is not quite right. With that, we're going to wrap it almost up. 

31:14

I want to point to the show notes. 

31:16

There is a lot of more information. 

31:17

There's a link to a blog post that goes into all of those details, with even more blood markers that I typically test for and the optimal ranges I would recommend, and a couple of extra links that I would recommend as far as wearing a continuous blood glucose monitor or et cetera, that can help you assess some of those or make sense of some of those blood markers and how your body responds to certain lifestyle changes like food, like exercise, like stress, et cetera. 

31:41

I hope you liked this episode. I hope it was useful so you can take some of this information back to your doctor for your next physical exam and make sure you get all the tests done that can give you really a good idea of how metabolically healthy you are and don't just accept, oh, you're fine, or you know, don't worry about it, that's just a normal part of aging. It is not, and chances are you might not be fine, considering that only one or 12% of Americans are metabolically healthy. And with that we're going to wrap it up and I hope I'll see and hear you in the next episode. Thank you.