Recovering our metabolic health is going to require some changes, along with feedback to tell us if those changes are having the desired effect. Below you will find some suggested steps that can help along the way.

1. Get baseline measurements on your markers of metabolic health:

• Waist circumference (measure your waist at the navel)
• Weight (keep a running five-day average)
• Blood pressure (check multiple times; it can drop quite a bit if you sit still for a few minutes: target is below 120 over 80). (You can buy a blood pressure monitor at the drugstore.)
• Fasting blood glucose (You can buy a glucose monitor at the drugstore; even better, you can get a continuous glucose monitor that lasts two weeks for $49 at HelloLingo.com )
• Fasting insulin level. (You can purchase the test at Walkinlab.com, and take the test at LabCorp or Quest.) You need to fast for at least 12 hours before taking the test.
• Lipid panel to get your triglyceride and HDL-C levels (You can purchase the test at Walkinlab.com, and take the test at LabCorp or Quest.) You need to fast for at least 12 hours before taking the test.
• Check your body fat percentage. You can use the Precision Nutrition Body Fat Calculator to get a ballpark estimate, which should be good enough for our purposes. If you want a more accurate measurement, many gyms have bioelectrical impedance scanners that give a reasonably accurate report on body composition. Or you could pay substantial dollars and get a DEXA scan.

2. Start eating real food. Though it may be tempting to try to change things all at once, an incremental approach is probably better for most of us. Making a couple of changes at time allows us to see progress and adapt to each stage. Here is a suggested path to changing your diet:

• Start with a real food breakfast. That would mean ditching things like cereal, instant oatmeal, toast, fruit juice, fruit smoothies, and low-fat yogurt and replacing them with things like eggs, sausage, berries, whole milk and plain Greek yogurt. (Toast can pass muster if it’s made from something like Ezekiel Bread.) Remember that protein is especially important in the first meal of the day.
• After acclimating to your breakfast changes, make the same changes at lunch. Eliminate sugar-sweetened beverages and eat only real foods. That means ditching things like French fries, chips, hamburger buns, and crackers and eating meat, cheese, vegetables and fruit.
• After acclimating to your lunch changes, make the same change at dinner. Remember that protein is also important in the last meal of the day.
• Eliminate snacking between meals. If you are genuinely hungry, eat a protein snack (e.g., boiled egg).
• Treat bread, pasta, dessert and other processed foods as special treats and occasional indulgences.
• Eat when you are hungry, eat enough to feel satisfied, and stop eating. Don’t eat when not hungry.

3. Structure your meals properly:

• Build your meals around protein. Determine how much protein you need in the meal and ensure you get it. (See the post on protein here.)
• Choose foods with a carbohydrate content that you can properly metabolize (and that varies greatly by individual; see steps 11 and 12 below on how to determine whether you are eating too many carbs). Remember that carbohydrates are not essential in the diet, and if you are needing to shed some weight limiting carbs is an effective way to do that.
• The remainder of the calories in your meal will come from fat. Here we have a lot of flexibility. If you are concerned about saturated fat and/or wish to eat a more Mediterranean-style diet, you can choose leaner cuts of meat and use more olive oil and eat more fish. If you need to adjust your calories up or down you can do that by adjusting the amount of fats in your meals (ensuring they come from natural sources). If needing to reduce calories it is best to start with carbohydrates, then move on to fat. Getting adequate protein should be non-negotiable. If we find ourselves getting hungry between meals, reducing carbohydrates and increasing natural fats is a good strategy to make our meals more satisfying.

4. Track your food intake (at least for a while)

• Keep a food diary of exactly what you eat, either on paper or using an app like “My Fitness Pal.” Do this long enough to get a good sense of what your dietary pattern looks like and how much of each nutrient you are eating.
• Get a food scale and weigh your food enough times that you have a good feel for how many ounces (or grams) a serving size is for you for the foods you commonly eat.

5. Find out how the foods you eat affect your blood sugar and avoid any that spike your glucose too high or for too long. You can do this a couple of ways:

• Use a glucose meter (the kind where you prick your finger). These can be had at any drug store. (You don’t need to do this all the time, just enough to get a good idea of how the foods you commonly eat affect your blood glucose.) Test about 60-75 minutes after eating to get the peak response, and test again at two hours. Ideally you glucose level will be back at baseline after two hours. ( I personally try not to eat anything which spikes my glucose over 120 and that takes over an hour to return to baseline, but that is not a recommendation for anyone else to follow.)
• Use a continuous glucose monitor. You can get one that lasts two weeks for $49 at https://www.hellolingo.com; I cannot emphasize enough how helpful this can be. You can see in real time how different foods affect your blood sugar, as well as how things like movement, sleep and exercise affect it. Two weeks is plenty of time to get an idea of what foods you can safely eat and which to avoid.

6. Increase your activity level: Spend less time sitting around and more time up and about. This will become easier as your metabolic health improves from your changes in diet.

7. Exercise more: Implement resistance training and endurance training. Start small if you haven’t been exercising. It can be beneficial to wait until you get some momentum on your weight loss before beginning an exercise program.

8. Get out in the sun every day, preferably soon after sunrise, at midday, and in the evening.

9. Improve your social connections.

10. Reduce stress if possible; if not, work on reducing your response to that stress.

11. Track your progress to see how the changes you are making affect your metabolic health markers. Use the values in the “Measuring Progress” post as your standard.

Check these weekly:

• Waist circumference
• Blood pressure
• Weight (or keep a running weekly average)

Check these every few months:

• Fasting insulin
• HDL (part of lipid panel)
• Triglycerides (part of lipid panel)
• A1c

12. If your markers are unsatisfactory, you can adjust your carbohydrate intake by removing the following foods:

• Grains, such as rice, oatmeal, and corn
• Starchy vegetables, such as potatoes, carrots, and sweet potatoes
• Milk
• High-sugar fruits, such as mangoes, bananas, apples, pears, and oranges (restrict fruit intake to berries, which are lower in sugar).

NOTE: If you take this step and you are taking medications to lower your blood sugar or blood pressure, be sure to let your doctor know; they may want to monitor and adjust your medications. You should never attempt to adjust your medications yourself.

If your metabolic health markers are still unsatisfactory after a few more months, you might engage a medical practitioner with the knowledge to guide you in implementing a ketogenic diet. You may need to go very low carb in order to improve your insulin sensitivity.

The Society of Metabolic Health Professionals website (https://thesmhp.org) has a provider directory. Many providers offer remote services.