In this educational video, board‑certified endocrinologist Dr. Luciano Coladni explains how various metabolic factors drive cardiovascular risk and how they can be assessed and modified. He begins by describing the most informative laboratory markers—fasting glucose, hemoglobin A1c, post‑prandial glucose, triglycerides, apolipoprotein B, HDL, waist circumference, and thyroid hormones—and explains what each reveals about insulin resistance, lipid dysfunction, and overall metabolic health. He then outlines the typical (often silent) clinical presentation of early diabetes and metabolic syndrome, noting fatigue, weight gain, and skin changes such as acanthosis nigricans. Dr. Coladni emphasizes lifestyle as the first line of defense, recommending at least 150 minutes of moderate aerobic activity or 75 minutes of vigorous activity per week, plus 2–3 sessions of strength training, and clarifies what counts as moderate exercise. He highlights sleep apnea as a major, under‑recognized driver of hypertension, cardiovascular events, and metabolic derangements, urging viewers to seek diagnosis and treatment. Finally, he provides a concrete “metabolic panel” of lab tests—LDL, apolipoprotein B, triglycerides, hemoglobin A1c, high‑sensitivity CRP, TSH/free T4, ALT/AST, serum creatinine/eGFR, and urine albumin‑to‑creatinine ratio—explaining the clinical value of each and referencing historical data linking albuminuria to cardiovascular mortality. The video concludes with a call for topic suggestions and a brief promotional plug for Clear Cardio assessments.
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Now the most common presentation is no presentation. When you have significant elevations, high glucose levels or uncontrolled diabetes, breathing and stopping to breathe 100, 200, 300 times a night. You wake up exhausted. Your blood pressure goes up. Your body feels that it's in danger. Apolipoprotein B is better than the LDL. They can give us very clear answers How to fix your metabolism after 40, an endocrinologist explains. I'm Luciano Coladni. I'm a board-certified endocrinologist and cardiometabolic health physician at Clear Cardio in Dallas, Texas. Blood glucose. Well, blood glucose can be very important in giving us a lot of information about how a person's metabolism is responding to stresses, responding to Food consumption, responding to fasting, responding to exercise. Now, which glucose level is the most important if we're trying to assess somebody's metabolism? The first one is the fasting glucose, along with a hemoglobin A1c. Hemoglobin A1c is a 90-day average of a person's glucose. In addition to that, sometimes postprandial glucose may also be very helpful. 2 hours postprandial glucose may also be very helpful. When I mention 2 hours postprandial, that means 2 hours after one starts eating. So when we have patients with diabetes, many times we talk about fasting— checking fasting glucose if they're still using the glucometer at home, and then checking postprandial glucose levels so that we can have an idea, particularly in patients on insulin, whether they are responding well to the treatment or they need adjustments. And perhaps some of the numbers that are important. Triglycerides are extremely important. Triglycerides, along with fasting glucose, and along with the hemoglobin A1c, will tell you a lot about somebody's insulin resistance. OK. Triglycerides are directly related to the consumption of calories, the consumption of different kinds of macronutrients, be it carbohydrates or others. And when you have significant elevations in triglycerides, you know that this person has some kind of dysfunction, be it overconsumption of calories, high glucose levels, or uncontrolled diabetes, or whether they have any kind of disease that will predispose them to significant consequences, including potentially pancreatitis. So if someone has triglycerides on average above 500 and probably even closer to 1,000 and beyond, they are at much higher risk of pancreatitis. But what triglycerides along with fasting glucose along with A1c will tell you is whether they have significant insulin resistance or not. How about HDL? HDL is— used to be considered very important, the so-called good cholesterol. In reality, the HDL is not as important as we used to think Waist circumference is perhaps the best measure. It's much more accurate than body mass index, and in particular, in men with a waist circumference above 38 puts you at a very significant risk of increase in cardiovascular disease. If we're talking specifically about diabetes, now the most common presentation is no presentation. It's just presenting to the lab and finding abnormalities from labs. If I had to say one thing that's very prevalent is that people who are newly diagnosed, even if they do not have the classical presentation of diabetes and the classical types of symptomatology, would be fatigue. Other early signs? Well, very significant weight gain, fatigue, sometimes signs of insulin resistance, which includes acanthosis nigricans, which are darkenings in folds that you can see in certain areas of the body, particularly around the elbows. Now we'll go on to the next topic. Can lifestyle changes reduce visceral fat and cardiovascular risk? Absolutely. So first and foremost, whenever we talk about cardiovascular risk and we talk about cardiovascular events, beyond— before we talk about any kind of pharmacological or surgical intervention of any kind, lifestyle can produce significant improvements in glucose levels, in blood pressure, can cause— can lead to significant reductions in the number of myocardial infarctions, cerebrovascular accidents. How much exercise? Well, you're talking about at least 150 minutes of moderate exercise per week. Or at least 75 minutes of intense exercise per week. What I tell people is, what is moderate exercise? People ask. And what I tell them, what is not. Walking your dog is not moderate exercise. Stop and go, stop and go, stop and go. Moderate exercise should be, you start walking and you go. Walking your dog would not be considered to be moderate exercise. I would, I guess it would be called mild exercise. The climbing stairs, really anything that will raise your heart rate would be considered to be moderate exercise. And you have to distinguish also between aerobic exercise, which are the kinds of things I'm talking about, and strength training, weight training, which is also extremely important.
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So if I had a recommendation, and certainly no exercise physiologist or personal trainer, but I would say walk at least 3 days a week, And then do strength training 2 or 3 days a week. 30 minutes at a time, 30 minutes of strength training 2 or 3 times a week. Walking at a moderate pace that will raise your heart rate at least 30 minutes, 3 times a week. Blood pressure, uncontrolled blood pressure in particular. Sleep health, the presence or not of sleep apnea. That is incredibly important and many times something that no one pays attention to, but that becomes very important in terms of metabolic consequences. Patients with sleep apnea Have higher blood pressure, significantly higher rates of cardiovascular events, significantly higher rates of diabetes, significantly higher rates of hypogonadism or lack of testosterone, particularly in men. Well, imagine yourself breathing and stopping to breathe 100, 200, 300 times a night. So even though you may think you've gotten 5, 6, 7 hours of sleep, in reality, when we talk about REM sleep, Maybe you've had an hour or 2. So you wake up exhausted. Every time you have an apneic episode, an episode where you stop breathing, your blood pressure goes up. You have a lot of the stress hormones being released to compensate for that significantly stressful event to your body. But what I'm talking about is stress where your body feels that it's in danger. And so when you stop breathing, your body feels you're in danger. So You have a lot of stress hormones being released, your blood pressure goes up, and imagine that happening on and off 100, 200 times every night. Number one problem. Number 2, you wake up even though you thought perhaps that you slept for 7 hours, maybe you slept for 2 or 3 in reality with REM sleep, and then you're as if you are walking around exhausted. And so what do you need to overcome that sense of exhaustion? You need energy. And what does— what kind of energy? Well, you're going to get calorie-rich foods that are going to give you a sense that you're getting more energy. So paying attention on sleep is also extremely important, and there are now a number of ways, in addition to the usual in-house, in-hospital, in-clinic sleep studies, to provide that answer of, do I have sleep apnea or not? If you do have sleep apnea, please make sure you address it. Perhaps this will be the most compelling part of this conversation here, is to ensure that you compel you to please address your sleep apnea. Your health will be overall greatly improved for it. Going back to laboratory studies, there are a number of different laboratory studies that can point out to you whether you are in danger metabolically and in terms of cardiovascular disease. And these include an apolipoprotein B. Apolipoprotein B is the best marker of the most disease-producing particles in circulation that are cholesterol particles, so apolipoprotein B is better than the LDL, the so-called bad cholesterol. So what kind of test would you need to tell you? An LDL, an apolipoprotein B, a fasting glucose, a hemoglobin A1c, a highly sensitive CRP. So CRP is C-reactive protein. So LDL, apolipoprotein B, hemoglobin A1c, highly sensitive CRP, a TSH and a free T4, so some thyroid hormones that are easy to check and they can give us very clear answers where your metabolism stands. Liver enzymes, in particular ALT and AST, a renal function, so a serum creatinine and an eGFR, a urine test for albumin to creatinine ratio. This is one of the most underlooked and predictive tests that one can obtain. If we go back to the 1950s and '60s, we already had inkling that this information was important. Why do I say that? Because the life insurance industry started looking into albumin-to-creatinine ratio in the 1950s, and they tested that hypothesis with policemen in New York City. And they observed that policemen who had higher albumin excretion rates in the urine had a much higher cardiovascular mortality. So this is a very important test. So in summary, what are some of the tests that you should look when you're trying to assess your overall metabolic status? LDL, apolipoprotein B— I forgot to mention triglycerides, we discussed that in our previous segment, but I forgot to mention this segment— hemoglobin A1c, A TSH, a free T4, highly sensitive CRP, albumin-to-creatinine ratio. Those are some of the key tests that we should consider when trying to ascertain a certain individual's metabolic status. And now we go on to the next topic. So we're going to finish here for today. If you send us suggestions of topics that may be of interest to you, we'll discuss that further in other episodes. Certainly things that we should consider discussing metabolic Liver disease, metabolic kidney disease, sleep apnea, hypogonadism in males and females. So there are a number of opportunities for us to discuss this further in other segments. Please send us your suggestions, we'd love to hear from you. Thank you.
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