In this interview, JJ Virgin asks a clinician (Speaker B) to identify the most important markers for assessing metabolic health and the ideal values for each. The clinician cites a pre‑pandemic UNC study showing only about 7% of people meet optimal metabolic health criteria, noting that conventional reference ranges are too broad. He proposes tighter, optimal targets: fasting glucose < 90 mg/dL, HDL > 59 mg/dL, triglycerides < 100 mg/dL, A1c ≈ 5.4–5.6 %, hs‑CRP < 1 mg/L, homocysteine < 7 µmol/L, LDL particle size in the large buoyant “Pattern A” range with NMR‑derived LDL‑P < 950 nm, low insulin‑resistance scores, and favorable ApoB and Lp(a) levels. He also recommends checking magnesium (RBC) and vitamin D, noting insurance barriers. The conversation expands to functional fitness assessments—grip strength, VO2 max, balance, DEXA, jump tests—as complementary standards that could guide longevity and health‑span interventions. Overall, the dialogue emphasizes that current lab ranges are permissive, that tighter targets and broader testing can catch dysregulation years before disease manifests, and that integrating functional performance metrics would create a more comprehensive health picture.
Chapters
So looking at metabolic health, again, 'cause you do a lot of labs at your clinic, if someone wanted to go just look at the most important markers for metabolic health, which would they be and which numbers are the ideal ranges that you love?
So you and I were talking about this before, but there, a lot of this is pre-pandemic data, but I think it's a UNC report study that's cited around only 93% of participants— let me say it this other way— only 7% of participants hit the criteria for optimal metabolic health. 93% of the sort of— 93% of people don't have good metabolic health. And I think when you look at the conventional standards, they're a little bit loose. They're looking at statistical bell curve averages of just general population. So they're not even the functional ranges, the optimal, they're just average ranges. So I would have even tighter, more optimal ranges.
So it's probably— you'd have like 3%.
Yeah, probably 3% of people would check all the boxes for optimal metabolic health. So this is where I want the numbers to be. Uh, glucose, your fasting blood sugar to be under 90. HDL, or good cholesterol, to be above 59. Triglycerides are—
men and women, doesn't matter?
Doesn't matter.
Why do they always have the men and women different on that?
Yeah, I don't know. I want it to be the 60s and 70s for both men and women. Yeah, so there probably— there could be different reasons between men and women, but as long as we're above 59, I see great outcomes and people feel great. Yeah, so I don't have to have it significantly different. So HDL above 59, triglycerides under 100, um, The A1c to be under 5.6, you could say 5.7, that's your 3-month average of your blood sugar.
Where would you really love that to be?
5.4 would be beautiful. That'd be beautiful. I mean, you could run— we do this, but when it's needed, wearing like a continuous glucose monitor for a month and looking at their glucose spikes and dips throughout the month and seeing how food, stress, and sleep impact their blood sugar, but having optimal blood balance throughout the— blood sugar balance throughout the month, and inflammation markers, high sensitivity C-reactive protein to be under 1, homocysteine to be under 7. We would run what's called a nuclear magnetic resonance test, NMR test. We'd want small dense LDL particles, which are specific— they're the particles that carry LDL around, the oxidized sort of inflamed particles that carry cholesterol around. We want this to be under 950. We want to be in pattern A, which is the fluffy buoyant, large buoyant LDL particles. And yeah, so those are— when you look at that, the NMR test, the cardiometabolic testing, and the comprehensive metabolic test, LabCorp will also assess insulin resistance score. So if I can get that test, with LabCorp, if they're not going through Quest, I could look at their IR score as well. I want that to be as low as possible. So when you're looking at just metabolic health, those are what I would pick. There'd be a few other ones. ApoB would be one. Lp would be another one. And these are all conventional tests. Like none of these are like, right, functional medicine fringe tests. They're just not typically all ran. Some of them are ran, obviously, but not altogether. And if I could be super picky, like looking at magnesium, vitamin D would be super helpful for metabolic health.
Still blows my mind that we do not regularly do vitamin D.
Yeah, it's difficult for coverage for some people with their insurance. Yeah, it shouldn't stop them. I mean, we'll find a way to get it for them because this should be paramount that everybody's running a magnesium RBC and a vitamin D.
And the critical thing here is those numbers you just said, like if you look at the labs, the ranges are not that. And so that's the biggest challenge with this whole metabolic health thing is the ranges are too high. And so if you get to this, because it's a process over time, like you don't wake up with poor metabolic health, right? It's a process.
Yeah, by the time somebody's diagnosed, it's about 4 to 10 years prior to that diagnosis that things are brewing on that sort of disregulation continuum.
If I was benevolent dictator—
Yeah, what would you do? I want to know.
I would add in a grip strength test and a VO2 max test and a balance test. Like, I would look like, you know, if a VO2— exercise fixes a lot of stuff. They used to always say you can't out-exercise a bad diet. I go, well, it can actually make a big dent.
Well, yeah, and food is not going to be directly correlated to grip strength. I mean, there's going to be some things that exercise is going to move the needle for longevity and healthspan.
So, I mean, it would be fabulous if you went to your healthcare provider, they did a DEXA scan, they did a grip strength, they did like a jump test, they did a VO2 max, then they did all of those ones as well. Then you'd really have some direction to go.
Should be standard. I mean, hey, you should be part of these, um, incoming initiatives.
