Welcome to Extend with me, Dr. Darshan Shah, a podcast dedicated to cutting-edge science, research, tools, and protocols designed to help you extend your health span. Having become one of the youngest doctors in the country at the age of 21 and trained in board-certified at the Mayo Clinic, I've accumulated three decades of practice as a board-certified surgeon and longevity expert. Over that time, I've discovered that a mere 20% of health knowledge yields 80% of the results when it comes to your health span. We are living in a new era where we are creating a new healthcare system no longer focused on disease management but achieving optimal health and vitality. Join me as I interview world-renowned experts offering you a step-by-step guide to proactively avoid disease and most importantly, extend your health span. Metabolic Health is the foundation that determines how well your body produces energy, regulates your hormones, manages inflammation, and actually protects you from chronic disease. When metabolic health begins to break down, symptoms and diagnosis often appear, but this happens years later, long after the underlying problem has taken hold in your biology. This is a special Best of episode of Extend where I've curated the most important clips and insights from the conversations we had last year in metabolic health and longevity by the experts. These include experts that you've heard on my show like Cynthia Thurlow, Benazotti, Mark Hyman, Casey Means, Josh Clemente, and Karan Rajan. These moments were selected to highlight the patterns I see over and over again in clinical practice and what these experts are thinking at the top of their field. Long before diabetes or metabolic disease is formally diagnosed, we see certain patterns in our blood markers in symptomatology that we can really understand where the disease is developing decades before it turns into diabetes and leads to a higher risk of Alzheimer's disease, cardiovascular disease, and cancer. Across these conversations, we're going to break down why waiting for a diagnosis is far too late, how insulin resistance quietly develops over years and why over 90% of Americans are already metabolically unhealthy and they don't even realize it. You're going to hear why fasting insulin often matters more than standard labs, how glucose and insulin dysregulation affect your gut health, inflammation, skin hormones, and muscle mass. You know, tools like a continuous glucose monitor can change how you understand your metabolism and your foot choices. If you want a clearer understanding of a truly drives energy aging and long-term disease and how to intervene early rather than react later, this episode is going to bring together the best of in the science perspectives and practical insights needed to take ownership of your metabolic health. To shut off this episode, I want you to hear from Cynthia Thurlow. She's going to explain why waiting until diabetes shows up on labs is already way too late and what early markers matter long before most people are ever flagged as at risk. So let me move on to metabolic health. So this is a rhetorical question, of course. Do you think that we should start thinking about metabolic health once we get diagnosed with diabetes or should we be looking at things earlier? So I can assure you that I am so proactive about helping patients avoid ever developing prediabetes or diabetes because I think that if you look at the research on what diabetes does to our risk factors for just about everything, atherosclerotic cardiovascular disease, stroke risk, cancer risk, etc., you should avoid diabetes like your life depends on it because it does. It's not like a switch is turned on all of a sudden when you get diagnosed with diabetes, now your risk factors start going up. It's been a way. The entire time you're developing diabetes, you're increasing your risk of everything else. And here's the thing, like if you wait until your fasting glucose is 95, 98, 102 to intervene, you're already there. Right. Like I think it was Robert Lustig that said on my podcast, when you're fasting glucose is between 90 to 99, you are at 30% greater likelihood of developing diabetes. So fasting insulin is important. Your acid is important. A1c, do I put a lot of credence in that? I think it could be valuable, but that to me is certainly not as important. It's HDL to triglyceride ratio, super important. Your waist to hip ratio, super important. What a lot of people fail to recognize is there's many different things that start to happen as your fasting insulin is worsening. And it could be something like your blood pressure starts to fluctuate a bit. It could be that you're getting more frequent urinary tract infections. I mean, there's so many things that we just don't think about as a whole constellation. And then just forget about navigating perimenopause. I mean, that you're losing insulin sensitivity just like you're losing muscle mass. And all these things coming together are like the perfect toxic brew for developing diabetes if you don't work against it. But GLP ones are definitely for me a mainstay now and people that are struggling with their metabolic health. And we could talk about weight loss separately and completely differently. But I think metabolic health, 90% of Americans right now have some degree of metabolic health issues and has to be addressed because it is the root cause of almost every other problem out there. It upsets me enormously when we see people with very large platforms speaking up about GLP ones as if we are offering people poison. When I'm like, first of all, if 90% of us are not metabolically healthy, it is a public health crisis. We need public health crisis interventions. I give every patient on a GLP one to continue as glucose monitor, on an nutritionist consult. I think those two go hand in hand. You can change your relationship with food, which will eventually lead to maybe you don't need the GLP one anymore, but let's at least get your metabolic health under control. Now let's bring Mr. Benazotti into the conversation. He's going to break down the staggering cost of diabetes on our healthcare system and explain how insulin resistance can develop quietly for years before blood sugar ever changes. What's interesting about that $4.6 trillion we spent on healthcare, one out of every $4 is from spent on diabetes, primarily type two, which is a metabolic disease that is 100% preventable. I'm talking about type two diabetes and 100% reversible. Okay. So, you know, one of the things I did not realize is the breakdown that one out of every $4 spent on diabetes type two. Primarily, it's diabetes total, but like 95% is type two. Primarily, yeah. The prevalence of type two versus type one is massive. There's a study that I put in the book. It's called the White Hall two study, which shows you could have full blown insulin resistance for six to 14 years without your blood sugar shifting a bit because your body, and for those who don't know, when you eat food, especially carbohydrates, there's an increase in glucose and then the pancreas produces insulin to clear that. And when that happens from time to time, you're good. And your body's really good at doing that. Acutely, but when it's chronic, that's the issue. So you could have insulin resistance for six to 14 years and you're not checking your fasting insulin. So you have no idea. So a fasting insulin is the most important test, I believe, to get done for most people, especially if you're a beginner here. We traditionally in Western medicine, we check hemoglobin A1c, which is a three month average of your blood sugar level. This will be literally the last thing that changes in the spectrum of metabolic health, right? The first thing that's going to change is your fasting insulin because your body is disposing of glucose using this hormone insulin and it only usually need a little bit of it, not a lot of it. Once you start secreting a lot of it, it means that your body's getting hard and harder for your body to handle the glucose levels, right? So the first biomarker to change, you said three to 16 years. Is that right before? Six to 14 years on average before you see the blood sugar shift. Yes. Let's talk about some of these causes because we've said carbohydrates a couple of times. There's a time and a place for carbs and I'm not, I love keto, but I'm not a dogmatic, do keto forever sort of guy. I think there's a role for it. However, 93% of Americans, according to a 2022 study I have in the book, are metabolically unhealthy. They are sugar burners and there's nothing wrong with using sugar as a fuel source unless you're always using sugar as a fuel source for years and decades. So if you're in that category of 93% of people being unhealthy, we need to, I recommend lowering that total carbohydrate intake, increasing protein and fat protein has a very moderate insulin response, fat, very minimal. So if you just made that swap right there, you'll start to regulate blood sugar. Shifting gears now, let's talk about the gut. Dr. Kern Rajan is an expert gastroenterologist who's going to walk us through how an unhealthy microbiome drives inflammation through the body, including skin conditions like acne, eczema, psoriasis, and why diet and metabolic health play a much bigger role than most people realize. So all of these problems stem from sounds like leaky gut inflammation, etc. Sounds like it just, they stem from having an unhealthy microbiome then. Sometimes it's difficult to tease like, you know, whether unhealthy microbiome is causing X or is X causing an unhealthy microbiome. What I've seen so many times in my clinic is when we start treating the leaky gut and we eliminate it, the skin condition goes away without a drop of any skin ointment or anything to locally treat the skin problem. So this is a massively important topic is, you know, so many people out there are suffering from psoriasis, eczema, many skin rashes that come up out of nowhere and they don't know what's causing it, look in the gut. And what you just said as well about treating that gut, it correlates with data we have on rosacea, for example, in certain cases of rosacea when they're given antibiotics to target specific pathogenic bacteria, not only does their skin condition clear up as well, but their gut also seems to settle. It's interesting. What about acne? There's an inflammatory component within that, but now we've come full circle to understanding that, yes, diet does have a huge role to play in acne, especially like, you know, high glycemic load foods, which can worsen acne potentially or exacerbate it. I don't think we can say that diet causes acne or directly causes in any way, but certainly exacerbates and contributes to it. And the really interesting thing is, if we look at some of these non-industrialized populations, people in those places, you know, like the the Kitavan Islands, I think in Papua New Guinea, they have incredibly low rates of acne, almost zero percent incidence of acne because they live on a wholly, you know, unprocessed diet. But when those people migrate to Western countries, they start to develop modern metabolic disorders, including high incidence of skin conditions. Now, that's not genetic, that's an environmental influence, and that's likely contributing to their acne, the change in their food. Having an unhealthy microbiome leads to systemic inflammation. So an over activity of your immune system, systemically meaning throughout your body, your skin being part of your body, but also inflammation can affect your brain and your heart and your immune system and your joints, all of it. And so how do you get from having an unhealthy microbiome to having systemic inflammation? Yeah, it's really interesting. So again, there's multiple routes by which this unhealthy microbiome leads to inflammation. One is, you know, you're not feeding the bacteria well enough. And just simply not feeding them, as we suggested, it causes them to sort of just go rogue and start to switch on this pro-inflammatory cascade. When your gut bacteria is unhealthy, it exposes your cells of your gut to all the toxins at a much higher level that come into our diet. And that can also be very inflammatory to our gut cells, which cause them to separate, and you already talked about this, cause them to separate, which is also known as leaky gut. And when leaky gut happens, toxins flow easily through the gut lining to our immune system, which then causes massive inflammatory reaction too. Hi, Dr. Shah here. I want to take a minute to talk to you about cellular health. So in my clinics, I've actually seen 30-year-old people with cells that look like they're pushing retirement. And I've also seen 60-year-olds with cells that look like they're 40 years old. So what's the difference? It's really about how fast their telomeres are breaking down. Your cells, you see, are like phones, and they have limited cell phone battery. Poor sleep, stress, processed foods, all of these things can drain that battery way faster than it should. So this is the reason why I partnered with IMA. IMA powers that cellular battery. It's not just another multivitamin, it's a comprehensive 92-ingredient formula designed specifically for cellular health and longevity. I'm talking 900 milligrams of vitamin C. That's like 20 oranges worth DNA protection. The clinical dose of CoQ10 that you need to power your cellular engine. You also get zinc, selenium, vitamin E, alpha-lipoic acid. All of these works synergistically for cellular repair and protecting your telomeres. So instead of taking a handful of pills every day and all these supplements, IMA actually gives you everything that you need in one scientifically formulated system. And this isn't just a theory anymore. IMA had partnered with Oxford University, the International Space Station, San Francisco Research Institute, and they've done studies and they've gotten this NSF certified to truly power your health. Most people are aging twice as fast as they should, unfortunately. You don't have to be one of them. Try IMA. I actually have a discount secured for you if you go to drshaw.com slash IMA or go to imahealth.com slash discount slash drshaw and you can get 20% off with my discount code DrShaw. You can also find the link below. This episode was also brought to you by Vitaboom. Vitaboom is a revolutionary company that sends you a custom supplement protocol based on your needs using blood-based biomarkers. You can either send them your latest blood test or they will send you a finger stick test for blood analysis. Vitaboom then curates and ships you an extremely convenient monthly box of daily supplement packs that have your custom protocol in them. What's great is that they also provide all the best brands like Timeline, Trunyagen, and many others for your custom daily packs. I love mine especially for travel since I don't have to bring 10 bottles of supplements with me and just open up a daily pack for every day that I'm taking my vitamins and supplements. Go to vitaboom.com and check it out. Now you're going to hear from Josh Clemente. He's a CEO founder of Levels Health. He does a great job explaining metabolic health as a foundation of underlying physical and mental health and why energy production at the cellular level determines how every system in the body functions. 90% of Americans on average have some level of poor metabolic health. I have a lot of patients coming to me and they're asking me like, do I have poor metabolic health? It's important to understand whether or not you're headed towards diabetes but also headed or also in a state right now of metabolic disease. I think for listeners at this podcast, I would love for you to just give a big picture explanation of what metabolic disease is. What I really believe is that we think about physical health and mental health, both of these sit on a foundation which is metabolic health. Basically, how your cells take in the environment, nutrients, etc. that we provide and turn it into energy. That's metabolism. If your cells, so every cell in the body, needs to have energy production available to it. If the cells in certain compartments of the body, certain systems are unable to produce energy in a clean and efficient way, it starts to produce byproducts that are damaging not just to that cell, not just to that system, but also cascade into the wider system and create inflammation, oxidative stress, and long-term breakdown. When that starts to deteriorate, neither mental health nor physical health can long-term be possible because metabolic health is not there. I think the more ways people think about their metabolic health in hearing it from different people, the more they understand the seriousness of it because it is the foundation of health. Energy is life. When you cannot make energy efficiently or the system is thrown off, which is basically saying that your metabolism is off, you cannot live life to the fullest. It leads to every kind of chronic disease, whether it be cancer or heart disease or diabetes, Alzheimer's or even thousands of other diseases out there, autoimmune diseases, all of them have a foundation in metabolic health. It is the one data point, in my opinion, that makes the most difference. That's why the continuous glucose monitor is so important because it is a direct way to influence that foundational level of your health, which then influences everything else after it. If you want to avoid disease, just get your blood glucose levels. I think it's super critical. Yeah, it can't be overstated how important it is. Next up, we have Dr. Mark Hyman. He breaks down why insulin is rarely tested, why glucose changes happen late in the disease process, and how muscle loss accelerates inflammation, insulin resistance, and hormonal breakdown. People should know their insulin level. I can tell you, I was a 99.9% of doctors out there don't test this. If you're not managing your insulin from a young age, maybe even your 20s, I think, tracking where it's going directionally, you have no idea you're headed towards diabetes, metabolic... 23-year-olds would type to diabetes. Two-year-olds? Three-year-olds. Yeah, men and American kids drinking soda from the time they're born. Glucose elevation is a late-stage phenomenon. Your first thing that happens is your insulin goes up after you have a meal, then fasting insulin goes up, then your sugar goes up after a meal, then your fasting sugar goes up. Right. So the time you're fasting sugar is up, you're already four stages down the road. I think that loss of muscle is the beginning of the end for people, and you get more inflammation, you get more insulin resistance, you get more just hormonal dysregulation, and all that is totally preventable. And when you, for example, you lose muscle, you get lower testosterone, you get higher cortisol, you get lower growth hormone, you get more inflammation, you get less ability to take up insulin. We measure it when it's already a problem, and now it's all of a sudden like, let's focus on your insulin and monitoring it so we can figure out how much insulin to give you versus way at the beginning. So it's like this medical education system is so still stuck in that, you know, like from the same medical education system that we had, it's crazy that it's not advanced since then. And it's really just about diagnosing disease and what's the pill to treat the symptoms of that disease. Yeah, you don't have to treat all the disease individually. Right. Right. When people have like these whole concept of comorbidities in medicine, which is like, you know, you have five different diseases, they're all separate, they're all in different drugs, I'm like, this is the most stupid idea I've ever heard. They're all connected. Right. It's not random that you have all these different conditions, they're all connected by common root causes. And finally, I want you to hear from Casey Means. She brings everything together by focusing on mitochondrial health, energy production, and why so much chronic disease comes down to how well our cells are powered in a modern environment. Death is the absence of metabolism. So when we stop powering the body, we're dead. And one of the interesting things I think about metabolic dysfunction and one of the things that empowers me to be so passionate about is that the fact that so many Americans are metabolic dysfunctional, it's basically like our environment in our modern American Western world is hurting these energy factories, our mitochondria synergistically through our toxic food system and our sedentary behavior and environmental toxins and our lack of sunlight, all this stuff. So it's kind of like we're all living a little bit dead while we're alive, which is really sad. What is the one kind of big overarching factoid that you want to give to the audience to say this is out of all the things out there, if you're going to look at the Pareto principle, the 20% of the information that's going to make 80% of the difference. Yeah. I mean, we have to all be focusing on the mitochondria, this part of our body that makes the energy that is the foundation of all health. I think just reorienting this crazy health journey that so many of us are on, trying all the different things and orienting around what is supporting the mitochondria. I think that's the key message that people, if they understood that and knew the basic ways to track the function of this beautiful little part of our bodies and also know how to support it, we would get so much farther in our efforts. We're just throwing a lot of spaghetti at the wall, but if we threw it towards mitochondrial health, that would really help. The amazing thing is that, and this is sort of a key factoid that I think can really help people, is that there are some very simple tests that can give us sort of a gestalt of what's going on with this aspect of our health. I really hope you enjoyed this format of the best of and learned a lot more about metabolic health today. I really think these experts really drive clear information about how we can protect ourselves from metabolic health. I'm going to be doing this type of format on a more frequent basis, because I feel like we have so many guest lectures that we bring on to talk about these very important topics and bringing the top moments from these podcasts together help a lot. So in 2026, look out for more best of episodes of the Extend Podcast. Thank you so much for listening this year. We've grown to one of the top podcasts on Apple, and I look forward to providing more incredible content for you in 2026. Thank you so much for listening to the podcast today. Please remember to subscribe if you like this episode and give us a good review and share a link with your friends. It really helps to support all of our efforts. I also want to remind you that the information shared on this podcast is for educational purposes only and is not intended to replace professional medical advice, diagnosis, or treatment. Please consult with your healthcare provider or physician before making any decisions or taking any action based on what you hear today, especially if you have any underlying health conditions or on any medications. Your doctor knows your personal health situation the best and is always important to seek their guidance.
