Metabolic Scoring: Using Metrics to Motivate Change
Author: Ron Hunninghake, MD
This July marks my 31st year at Riordan Clinic. My goodness! Where did all that time go? Now, say you, what has the good doctor learned? Well, I believe I have learned a great deal about one’s personal quest for better health. Over the years, I have mentored many wonderful people in the process of discovering better health.
This year we are taking a bold new step to formalize this process. We will soon be launching the Discovery Program. The Discovery Program promises to be more affordable, more flexible, and more practical for growing numbers of medical patients who are ready to become what Dr. Hugh Riordan called “co-learners.” The foundation of real health discovery for every co-learner is a fundamental and recurring process called Metabolic Scoring.
Before I define this term, let us explore a little of Riordan Clinic’s architectural history to better understand the theory and structure of Metabolic Scoring.
The Pyridomes Are a Message
When the clinic was built, Dr. Hugh wanted to let the architecture itself speak! Our iconic pyramid, while fascinating in one light, nevertheless seems weird to some, and oddly out of place in our modern world. But within the unusual Pyridome architecture lies a very important message and the foundation on which our method of care is built.
The Riordan Clinic logo reflects the two-story pyramid that highlights our Wichita campus along with the eight geodesic domes. From time immemorial, the pyramid has served humankind as a symbol of aspiration. The broad base of the pyramid grows “star-ward” to form a foundation that progressively builds to a pinnacle, which, in Dr. Hugh’s mind, was optimal health.
To achieve optimal health, one must walk the sometimes difficult path of lifestyle improvement. Indeed, the original name of Riordan Clinic was The Center for the Improvement of Human Functioning. The seven domes encircling the larger, central dome represent the seven elements of an ever-healthier lifestyle:
- Connectivity (healthy relationships)
- Stress management
- Quality sleep
- Regular exercise
- Real food
- Toxin control
The Eighth Dome
Every year, through great effort and expense, Dr. Hugh created an amazing series of International Conferences on Human Functioning. He generated 15 of these ground-breaking conferences during his tenure. He launched each meeting with the Epictetus quote:
“It is impossible to begin to learn that which one thinks one already knows.”
So much wisdom emerged from these conferences, but I want to highlight one concept in particular, and that is Dr. Hugh’s warning to all clinicians who strive to engender nutrition as a foundation of their medical practice: “measure, measure, measure!”
How can we, as clinicians, ever learn anything about the importance of proper nutrition if we never measure our patient’s nutritional status? How can our co-learners ever learn anything about their biochemical uniqueness without repeatedly investigating it through the power of biochemical testing? In this spirit, the eighth and largest dome at Riordan Clinic represents the fundamental importance of measuring what we call health-markers. Measurement is the essence of Functional Medicine.
My Quest for Better Health
Against this historical and architectural backdrop, I arrived to join Dr. Hugh in July 1989. Selfishly, my primary motive was to get healthier! I came from a long family history of diabetes. I was overweight, tired, and often depressed. Having been an extremely busy family doctor, I was thoroughly sleep-deprived and severely addicted to caffeinated diet pop. Like so many patients that I have seen over these years, I did not know how truly sick I was!
Fortunately, in my early days at Riordan, I became friends with Jack Challem, a medical nutrition reporter. Jack was a co-author of Syndrome X, a book about the consequences of prediabetes, which is now more commonly referred to as Metabolic Syndrome. Jack and I went on to co-write a book: Stop Prediabetes Now. As we worked on this book together, it became eminently clear to me that, ironically, I was thoroughly prediabetic myself.
My fasting blood sugar was typically running in the 105-112 range at that time, which predicted that I was moving headlong into type 2 diabetes. Technically speaking, a type 2 diabetes diagnosis isn’t given until one’s fasting blood sugar hits 126 mg/dl or higher. By then, it is often too late to reverse the process. Once diagnosed with type 2 diabetes, a person is already entrenched in Metabolic Syndrome. At this time, terrible consequences of this treacherous illness begin to surface, and modern medicine has little to do but heavily medicate symptoms.
Defining Metabolic Syndrome
- Metabolic Syndrome centers around five, early-warning risk factors:
- Increased blood pressure greater than 130/85 mm Hg or taking blood pressure medication.
- High blood sugar levels due to insulin resistance or taking diabetes medication.
- Excess fat around the waist measuring > 102 cm for men, and > 88 cm for women.
- A high triglyceride level measuring > 150 mg/dl.
- A low level of HDL measuring < 40 mg/dl in men, and < 50 mg/dl in women
- Keep in mind that even just one of these factors increases your risk of future chronic illness. Having three or more of these factors determines a diagnosis of Metabolic Syndrome, carrying with it an alarming rise in future complications.
The Complications of Metabolic Syndrome
As your metabolic system silently and progressively deteriorates, there is an ever-increasing likelihood of developing the following severe diseases: obesity, heart disease, diabetes, stroke, dementia, peripheral artery disease, cancer, autoimmune disorders, and nonalcoholic fatty liver disease. In time, eye damage (retinopathy), nerve damage (neuropathy), kidney disease (possibly requiring dialysis), and the amputation of limbs may result.
Strikingly, these disease states now constitute 75% of total U.S. health care cost expenditures! The American health care system is seriously floundering because of the dramatic growth of this many-headed dragon: Metabolic Syndrome.
A Lifestyle Illness
Doctors use the numerical thresholds of Metabolic Syndrome listed above to determine when to initiate pharmacologic interventions. Drugs can improve Metabolic Syndrome numbers and may serve to reduce the risk of future illness somewhat. Unfortunately, taking a drug often serves as a “medical excuse” to perpetuate the very lifestyle behaviors that give rise to and exacerbate these risk factors.
I had to come to grips with my own adverse behavioral patterns. These did not make me a bad person, but they did compel me to be a more responsible person. Through the years of utilizing my own Metabolic Scoring system, I began to wake up and recognize my own “lifestyle illness.”
Treating the Symptom, Not the Cause
In a busy medical practice, it may be easier to treat Metabolic Syndrome risk factor numbers with medication alone. However, under the tutelage of Dr. Riordan, I learned that it is far wiser (although more challenging) to address the seven elements of a healthier lifestyle that I listed earlier.
Risk factor management is grossly undervalued in the actual practice of medicine. It often goes ignored because of two beliefs commonly held by medical providers:
Only drugs can change the numbers and reduce the risks.
Patients are incapable of changing their cherished (but dangerous) lifestyle habits.
Granted, changing the medical drug paradigm will be a slow evolutionary process. Though difficult, changing your personal “health care paradigm” can take place much faster…IF you have the proper motivation.
Using Numbers to Motivate Change
The real problem with lifestyle change is that it happens in such sloooooow motion! It is happening to you as you read this article right now, and you are probably not aware of it. As humans, we want to do something, and then expect to see a result immediately. Lifestyle change is more like gardening: patiently till the soil, plant the seed, water, hoe, weed, and wait – and wait – and wait. Finally, sprouts appear!
Our efforts to turn the Titanic-like ship of Metabolic Syndrome around also happens in the same slow way. We must grow our garden of new lifestyle habits gradually. It takes incredible patience and a strong will. Hence, the need for a tracking system. As humans, we like reliable information. It informs us and motivates us over the long haul. Metabolic Scoring is that tracking system.
Every 6-12 months, we will track a comprehensive profile of Metabolic Syndrome risk factors. We are tracking numerical changes to help you maintain motivation.
Track Your Numbers Regularly
Our medical care system is characterized by three modes of care:
Acute: sudden illness, trauma, immediate need for medical attention
Chronic: the illness has become chronic and requires recurrent visits to manage it
Episodic: routine visits to our provider to prevent illness
Episodic care can also go by another, more familiar name: wellness!
Wellness means staying well. Do not wait to get sick. Intervene daily to prevent illness.
Metabolic Syndrome is very sneaky: it comes on so slowly that its victim is almost always caught by surprise. Prevention relies on a metabolic-wellness tracking system involving episodic medical care that QUANTIFIES the nearly imperceptible progression of this disease syndrome.
Calculating your Metabolic Score
Metabolic scoring is the method we have implemented to track and prevent the progression of Metabolic Syndrome and other complications. Calculation of the metabolic score is based on subjective data about symptoms and severity gathered from the patient, and a comprehensive record of objective measurements such as weight, blood pressure, waist circumference, and lab results, etc. (See below for all of the details) The goal is to continually maintain (if you are already in good health) or improve your score at each visit.
Resting Pulse Waist Circumference
Systolic Blood Pressure Diastolic Blood Pressure
Fasting Blood Sugar Fasting Triglycerides
Fasting HDL Fasting Triglycerides/HDL
Fasting Insulin Reverse T3
Ferritin Vitamin D3
C-Reactive Protein Fasting Glucose
HOMA Uric Acid
Alkaline Phosphate ALT + GGT
LDH (Hypoglycemia) Grip Strength
VO2 Max BMI (Body Mass Index)
% Body Fat (Impedance) Visceral Fat Rating
Metabolic Age Muscle Mass
Mid to late afternoon fatigue Headaches
Puffy ankles Trouble losing weight
Numbness in hands or feet Shaky when hungry
Snoring at night Heartburn (or on meds)
Sweets, carbs, snack cravings Meals tend to be starchy
Dieting Often feeling too warm
Often having cold hands Energy crashes
To effectively prevent Metabolic Syndrome, you must first become aware of your risk factors and then track their progression over time. Annual Metabolic Scoring and episodic medical care will increase your awareness, your motivation, and your ongoing success. By implementing better lifestyle choices and adopting a model of selfcare, you can successfully stave off the slow, but dire consequences of Metabolic Syndrome. Metabolic Scoring has made a huge difference in my life. Now I hope it can be the key difference in yours.