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Engineering a High-Performance Metabolism: Insights from Healthspan's Dr. Richard Cohen

In this Research Review, the focus is placed on understanding human metabolism, presented as the engine responsible for converting fuel into energy, essential for optimal bodily function. Dr. Richard Cohen, a physician with extensive experience in performance medicine, provides a detailed examination of metabolic dysfunction. By comparing the efficiency of a well-functioning metabolism to that of a high-performance vehicle, this article highlights the importance of maintaining metabolic health for overall well-being. Dr. Cohen's analysis addresses the mechanisms underlying metabolic dysfunction, its consequences, and strategies for maintenance and optimization. Through his expertise, the article aims to offer a comprehensive perspective on metabolic processes, emphasizing the significance of an efficient metabolic system in sustaining health and preventing disease.

7 mins

By: Dr. Richard Cohen


Think of your body as a vehicle, with metabolism as its engine, smoothly converting fuel to energy. Just like a car, your body needs proper care to run efficiently. But what if it starts to sputter and falter, more like an old, struggling vehicle than a sleek electric car?

Just as a high-performance car like a Tesla demonstrates efficiency and power, an optimally functioning metabolism is crucial for our well-being. However, when this metabolic process starts resembling an outdated, inefficient vehicle struggling uphill, it signals a drift towards metabolic dysfunction.

In this Research Review article, Healthspan’s Dr. Richard Cohen, a physician and performance medicine doctor with over twenty years of experience in the medical field, will guide us through the nuances of metabolic dysfunction and offer insights into maintaining and optimizing our metabolic engine. Through his expertise, we aim to provide a comprehensive understanding of how to keep this vital process running smoothly, ensuring overall health and well-being.

Introduction to Metabolism and Metabolic Health

Metabolism encompasses the cellular mechanisms that convert carbohydrates and fats from our food, along with oxygen from the air, into energy. This energy is vital for powering every process in the human body.

But metabolism doesn't just stop at energy production; it also involves the generation of waste products, including free radicals. It's a bit like a well-oiled machine that not only produces the desired output but also has by-products that need to be managed. Effective regulation of this process is crucial for metabolism to function properly.

The term "metabolic health" refers to the efficiency of energy production and processing in our cells' mitochondria. Ideally, we want our metabolism to operate smoothly and efficiently, similar to a high-performance electric car (like a Tesla) climbing a hill without producing exhaust. In contrast, a less efficient metabolism can be likened to an old, underpowered car struggling uphill, producing excessive exhaust. This analogy underscores the importance of maintaining a well-tuned metabolic "engine" for optimal health.

Metabolic Dysfunction: Causes and Consequences

As we age, factors like unhealthy lifestyles, poor diets, nutritional deficiencies, toxin buildup, and aging itself can impair our metabolic efficiency. This leads to a state known as metabolic dysfunction, characterized by inadequate energy production and poor waste processing. This dysfunction can result in chronic inflammation, a primary cause of numerous modern diseases.

Signs of Metabolic Dysfunction include:

  • Excess visceral fat

  • Diminished muscle mass

  • Spikes in blood glucose levels

  • Insulin resistance

  • Elevated lipid levels

  • High blood pressure

  • Fatty liver disease

  • Kidney dysfunction

Alarmingly, over 90% of the American population exhibits at least one sign of metabolic dysfunction, a strikingly high percentage compared to historical norms. Historically, the primary health challenges people faced were infectious diseases and starvation. However, in a significant shift, today's health landscape is largely dominated by metabolic diseases. This change underscores a critical shift in our health priorities and challenges.

This rise in metabolic dysfunction is intrinsically linked to an array of chronic diseases. Conditions such as cancer, heart and vascular diseases, immune disorders, cognitive impairments, type 2 diabetes, infertility, and accelerated aging can often trace their roots back to metabolic issues. Moreover, the repercussions of poor metabolic health extend into everyday life, impacting not only severe health conditions but also essential aspects of daily living. Brain function, energy levels, memory, mood, skin health, and fertility are all adversely affected, illustrating the extensive influence of metabolic health on our overall well-being and highlighting the imperative need to address this growing health concern.

Evaluating Metabolic Health: Key Markers

Evaluating metabolic health involves the analysis of various biomarkers, which play a crucial role in revealing the efficiency and functionality of the body's metabolic processes. The importance of assessing these markers lies in their ability to identify specific areas where metabolic dysfunction may be occurring. Gaining an understanding of these trouble spots enables the development of targeted interventions, tailored to address and rectify these specific issues.

Such a proactive approach is critical, not only in preventing the development of diseases related to metabolic dysfunction but also in managing existing conditions and optimizing overall health. Regular monitoring of these biomarkers provides an early warning system, allowing for the timely detection of potential issues. This early detection affords the opportunity to implement necessary lifestyle or treatment changes, potentially averting more serious health complications down the line.

Targeted Markers to Evaluate Metabolic Health.

Serum Markers:

  • Insulin

  • Iron Saturation %

  • Uric Acid

  • SHBG

  • Liver Enzymes

  • Glucose with a CGM

  • Lactate

  • RDW

Metabolic Markers:

  • Muscle Mass

  • Visceral Fat 

  • Liver Iron via MRI

  • Respiratory Exchange Ratio 

  • Anaerobic Threshold 

  • Submaximal Vo2Max

  • CO  Production

  • Body Temperature

  • Blood Pressure

Mitochondrial Markers

  • DNA Deletion 4977

  • PGC-1alpha

  • Nrf2

  • Qualitative Function of Cytochrome 1,4,5

Key Steps to Optimizing Metabolic Health

Achieving optimal metabolic health is a multifaceted endeavor, requiring a comprehensive approach that encompasses various aspects of lifestyle and wellness. The following key steps are designed to holistically enhance metabolic function, addressing different factors that contribute to metabolic health. Each step focuses on a specific area of improvement, from dietary habits to physical activity and beyond, collectively working towards the goal of a more efficient and healthier metabolic system.

Reduce Visceral Fat: Focus on lowering the amount of fat around your internal organs. Visceral fat is linked to numerous health issues, so reducing it can significantly improve metabolic health.

Gain Muscle: Work on increasing your muscle mass through targeted exercise routines. Building muscle not only enhances strength and appearance but also improves metabolic rate and insulin sensitivity.

Proper Breathing: Emphasize practicing breathing techniques to ensure optimal oxygen intake. Proper breathing can enhance energy levels and overall well-being.

Modulate Stress: Engage in various techniques to manage stress effectively. Stress has a direct impact on metabolic health, so managing it can lead to significant improvements.

Adequate Deep Sleep: Make sure you get enough high-quality sleep. Adequate deep sleep is crucial for metabolic health, aiding in the regulation of hormones and overall bodily functions.

Ancestral Diet: Adopt a diet that mirrors what our ancestors ate, focusing on whole, unprocessed foods. This approach to eating supports a more natural and balanced metabolic state.

Movement: Participate in a combination of long, slow exercises and short, intense activities. This varied approach to physical activity ensures a comprehensive impact on your overall fitness and metabolic health.

Hypoxia/CO2 Rebreathing: Practice controlled breathing techniques to adapt to lower oxygen levels. This can help improve your body's efficiency in using oxygen and enhance metabolic functions.

Hormesis: Integrate practices like fasting, cold exposure, High-Intensity Interval Training (HIIT), and intermittent use of mitochondrial nutrients. These hormetic stressors can strengthen your body's resilience and metabolic efficiency.

Small Molecules/Botanicals: Consider using supplements such as Rapamycin, Acarbose, DihydroBerberine, and SGLT2 inhibitors. These small molecules and botanicals can support various aspects of metabolic health, from glucose management to aging processes.

By diligently implementing these steps, you can make meaningful strides in improving your metabolic health, leading to enhanced overall wellness and a reduced risk of metabolic-related conditions.


Just as a high-performance vehicle requires regular maintenance and the right kind of fuel to function at its best, our bodies need a balanced approach to diet, exercise, and lifestyle to maintain an efficient metabolic engine.

Understanding the intricacies of our metabolic processes and recognizing signs of dysfunction enables us to proactively maintain a smoothly running metabolic engine. This approach is similar to performing regular diagnostic checks on a vehicle, where monitoring key biomarkers helps us identify and address issues before they become more significant.

The strategies we've outlined, which range from reducing visceral fat and adopting an ancestral diet to engaging in varied physical activities, managing stress, and ensuring quality sleep, collectively form a comprehensive maintenance plan for our metabolic health. Each of these steps is akin to the regular servicing of a car, crucial in preventing breakdowns and promoting longevity. Together, they ensure that our metabolic engine remains in optimal condition, driving our overall health and well-being. Adopting this holistic approach to metabolic care goes beyond basic health maintenance, paving the way for enhanced well-being and a better quality of life.


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