Metabolic Health: The 5 Markers and How to Improve Them

Metabolism is how your body turns food into energy and then stores or uses it. “Metabolic health” is not a formal diagnosis. It is shorthand for five measurements, all tied to your heart and your blood sugar, sitting in a healthy range.

When several of them drift out of range together, doctors call it metabolic syndrome. The National Heart, Lung, and Blood Institute (NHLBI) defines it as a group of conditions that together raise your risk of coronary heart disease, diabetes and stroke, and says you may have it if you have three or more of the five.

Most of these markers cause no symptoms. A growing waistline is visible, but the NHLBI says high blood pressure, high triglycerides and low HDL usually do not cause any symptoms. Mildly high blood sugar often goes unnoticed too: according to the CDC, you can have prediabetes for years with no clear symptoms. Higher blood sugar can cause thirst, urinating more often, blurred vision and tiredness. That is why the only reliable way to know where you stand is to measure them.

Even so, tiredness, thirst and weight gain have many possible causes, so they cannot tell you on their own what is going on. If they worry you, bring them to your doctor along with your numbers.

According to the NHLBI, about a third of US adults have metabolic syndrome.

Flip the question to who has all five markers at optimal levels without medication, and the group is small. An analysis of the national NHANES survey for 2009-2016 (Araújo and colleagues, Metabolic Syndrome and Related Disorders, 2019) estimated that only 12.2% of American adults met that bar using the newer, stricter cut-offs. Under the older cut-offs it was 19.9%. Even among adults at a normal weight, fewer than a third met it.

The useful reading of those figures: having a marker out of range is very common, it is not a personal failing, and there is almost always something specific to work on.

We did not find a recent official metabolic syndrome figure for Puerto Rico, so we will not invent one. Here is what has been measured:

• Diabetes. According to the CDC, 14.4% of adults in Puerto Rico had diagnosed diabetes in 2021, the highest figure among US states and territories.
• Obesity. According to BRFSS data published by the Puerto Rico Institute of Statistics, adult obesity rose from 26.3% in 2011 to 36.2% in 2024.

Both conditions are closely tied to the five markers. The island’s heat matters too: walk early or near sunset, and drink water before you feel thirsty.

No single habit fixes all five markers, but several move them in the right direction. This is what the NHLBI and the CDC recommend:

• Move. The CDC recommends that adults get 150 minutes of moderate-intensity activity a week, such as brisk walking, plus muscle-strengthening activity on 2 or more days.
• Follow an eating pattern, not a fad diet. The NHLBI recommends heart-healthy eating such as the DASH plan: fruits, vegetables and whole grains, with less saturated fat, sodium and added sugar.
• Sleep. The NHLBI gives 7 to 9 hours a day as the recommended amount for adults.
• Limit alcohol and do not smoke or vape. Both are part of the NHLBI’s recommendations.
• Manage stress with tools you can keep up, such as walking, slow breathing or talking to someone.
• Modest weight change helps. If you are overweight, the NHLBI says losing just 3% to 5% of your current weight can help manage risk factors such as high blood cholesterol and diabetes.

The most-cited trial is the Diabetes Prevention Program. According to the NIDDK, high-risk adults in a structured lifestyle change program (goals: lose 7% of body weight and exercise 150 minutes a week) lowered their chance of developing type 2 diabetes by 58% over about 3 years, compared with placebo.

For some people, markers can return to the normal range with these changes; for others they improve but medicine is still needed. The results come from structured programs with follow-up, and they are not a promise for every person.

There is no such thing as a metabolic reset. No short diet, juice, tea or supplement resets your metabolism, and it is not a medical term. What changes your markers is the list above, kept up for months. If a plan promises a fast reset, ask which numbers it claims to move and what evidence backs that.

A slow metabolism is rarely the explanation. A study of more than 6,000 people published in Science (Pontzer and colleagues, 2021) measured energy expenditure across the lifespan. After adjusting for body size and composition, daily energy expenditure stayed stable from about age 20 to 60 and then declined gradually. In other words, your metabolism does not break at 30 or 40.

The same study found that energy expenditure tracks fat-free mass, which includes muscle. That is a good reason to do strength training, although it does not turn any workout into a metabolism booster.

Some conditions and medicines do affect weight and energy. If you notice changes you cannot explain, that is something to evaluate with a doctor, not with a supplement.

You can measure two of the five markers at home: your waist, with a tape measure, and your blood pressure, with an upper-arm monitor. The other three (fasting glucose, triglycerides and HDL) come from a blood sample ordered by a doctor. According to the American Diabetes Association, a fasting glucose under 100 mg/dL is normal; your doctor may also order an A1C.

If you are in Puerto Rico, you can book an online visit with Dr. Diana Nieves Castro, a general practice physician licensed in Puerto Rico. She evaluates you and, when clinically appropriate, gives you a lab order for a lab near you. Online visits are only for people who are physically in Puerto Rico.

Once you have results, our guide helps you read your lab results. And if a number comes back out of range, each one has its own page: prediabetes, high blood pressure, high cholesterol and fatty liver.

To see how these habits are practised at the retreat, read the guide to the metabolic health retreat.

These guides cover, with the same evidence and no promises, three topics that usually come up next to metabolic health: