In short
- According to Dr. Casey Means, metabolism is the foundation of health. Poor metabolic health reaches into 9 of the 10 leading causes of death.
- Seven basic markers give an excellent first picture: glucose, triglycerides, HDL, HbA1c, the cholesterol:HDL ratio, waist circumference and blood pressure.
- For a deeper look, ApoB, hs-CRP and uric acid are added.
- Almost all values are changeable within ~2 months through habits.
- What counts most is the trend over time, not a single measurement.
Dr. Casey Means is a Stanford-trained physician and the author of the book Good Energy. In one of the most talked-about conversations on metabolic health, she explained a simple but powerful idea to Dr. Andrew Huberman: most modern diseases start with how our cells make energy. The good news: we can measure this with a few inexpensive blood tests. And we can often improve it faster than we think.
Why metabolism is the foundation of all health
Metabolism is how the body turns food into energy for every cell. When this process works well, we have energy, stable blood sugar, a clear head and healthy blood vessels. When it falters, the consequences reach far beyond body weight — into the heart, brain, hormones and mood.
Means cites worrying figures. An estimated up to 93 % of adults have suboptimal metabolism. Poor metabolic health lies behind 9 of the 10 leading causes of death. Her thesis is that medicine often treats symptoms instead of the cause.
The key point for anyone who wants to look after themselves: these disturbances run silently for a long time. Rising blood sugar, triglycerides or inflammation do not hurt. That is why a blood test is so powerful. It shows the direction while you can still turn things around with habits.
Mitochondria and “bad energy”
At the centre of Means's explanation are mitochondria. They are the tiny “power plants” in our cells that turn food into usable energy (ATP). When mitochondria weaken, the cell does not get enough energy. Means compares this to “power cuts”: too little power for normal function.
She describes the trio that leads to “bad energy”: mitochondrial dysfunction, inflammation and oxidative stress. Insulin resistance is when the cell starts resisting insulin. In her words, it is the cell's way of compensating for weakened mitochondria. That is why obesity, high blood sugar and high blood pressure are not separate diseases. They are often different faces of the same cause.
The practical consequence: if we strengthen the mitochondria (above all through exercise), we improve almost all markers at once.
7 key markers (with optimal values)
Means highlights seven measurements that you get in an ordinary check-up. Below are her target values, converted into the units used in Slovenia (mmol/L). Important: these are optimal targets, not just borderline “normal” values.
| Marker | Optimal target | What it tells you |
|---|---|---|
| Fasting glucose | below 5.6 mmol/L <100 mg/dL | Blood sugar after an overnight fast; an early sign of insulin resistance. |
| Triglycerides | below 1.7 mmol/L <150 mg/dL | The storage form of excess carbohydrates in the blood. |
| HDL cholesterol | >1.0 (M) / >1.3 (F) mmol/L | Protective (“good”) cholesterol; low levels often go with metabolic problems. |
| HbA1c | below 5.7 % | Average blood sugar over the last ~3 months — how much haemoglobin has sugar attached to it. |
| Cholesterol : HDL ratio | below 3.5 : 1 | A better indicator than total cholesterol alone. |
| Waist circumference | below ~102 cm (M) / ~88 cm (F) | An indirect sign of visceral (belly) fat. |
| Blood pressure | below 120/80 | Insulin resistance also raises blood pressure, so it belongs in the metabolic picture. |
Why these seven
Means stresses that none of these values tells the whole story on its own. The power is in the whole. Together they show fairly reliably what is happening at the level of the cell. She particularly highlights the triglycerides : HDL ratio. When triglycerides rise and HDL falls, this is often one of the earliest hints of insulin resistance, before glucose is clearly raised.
Advanced markers for a deeper look
The seven basic markers are an excellent foundation. For a deeper picture of the heart, inflammation and metabolism, these three are often added in practice. A doctor should guide the choice based on your risk:
| Marker | Why add it |
|---|---|
| ApoB | Counts the actual number of atherogenic particles — often a more precise predictor of heart risk than LDL alone. |
| hs-CRP | A sensitive indicator of silent, low-grade inflammation that speeds up the ageing of blood vessels. |
| Uric acid | Raised levels are linked to insulin resistance, high blood pressure and gout. |
Why “normal” is not the same as “optimal”
The big trap: a lab's “within normal limits” is often just the population average. And that population is largely metabolically unhealthy. Means warns that even the upper edge of normal is not a reason to relax. It is an invitation to look deeper, in the context of other markers and the trend. The goal is not “not being ill”, but being optimal.
That is why Blood Lab 360 always shows values against optimal ranges and explains them, rather than just ticking “normal”. More on this in the guide how to read a blood test report.
How to improve your values in ~2 months
The most empowering message is an optimistic one:
Means lists seven levers we hold in our own hands: food, sleep, emotional health, movement, toxin exposure, our relationship with light and our relationship with temperature. Food is the one most people get most wrong.
Exercise as medicine
Concretely: strength training 2–3× a week (all major muscle groups). Add 75 minutes of vigorous or 150 minutes of moderate activity a week and at least 7,000 steps a day. A movement break every 30 minutes also helps. So does a 10-minute walk after a meal, which smooths out the sugar spike.
Food that works for you
Five things to aim for at every meal: fibre, omega-3 fats, protein, probiotics and antioxidant-rich foods. In other words, as much real, unprocessed food as possible. You will find practical steps in the articles how to steady your blood sugar and how to lower cholesterol.
How often to measure
For most healthy adults, an annual check-up makes sense. When you are actively improving a marker, it is worth measuring more often, e.g. every 8–12 weeks. A follow-up test then confirms the plan is working. Means mentions that some people track key values up to 4 times a year.
The key is the trend, not a single measurement. One value is a snapshot. A series of measurements over months shows whether your habits are moving the needle. That is why it is worth saving and comparing your reports. This is the heart of our portal.
How Blood Lab 360 helps you
Upload your report and we explain your metabolic markers in plain language. We show each value against the optimum and prepare a concrete 90-day plan. Then we track the trend over time, so you can see that looking after yourself works. Already have a report? Upload it to Blood Lab 360 and get every value explained. Or read the sister article on habits for longevity.
Frequently asked questions
Which 7 markers show metabolic health?
Fasting glucose, triglycerides, HDL, HbA1c, the total cholesterol:HDL ratio, waist circumference and blood pressure. Together they give a good first picture.
How quickly can I improve metabolic markers?
According to Dr. Casey Means, they are changeable in about two months. The levers are habits: diet, exercise, sleep and stress management.
Why is the triglycerides:HDL ratio important?
A high ratio often points to insulin resistance and cardiovascular risk, even before glucose is clearly raised.
Which advanced markers make sense?
For a deeper look at the heart and inflammation, ApoB, hs-CRP and uric acid make sense. A doctor should guide the choice based on your risk.
