Catch Metabolic Disease a Decade Before It Shows up on Standard Labs

5 tests that will screen for early metabolic disease.

Cancer, diabetes, fatty liver disease, and autoimmune diseases have a higher risk if there’s underlying metabolic disease. And since there’s no one test that can check for it, this is the approach we take in my practice.

TL;DR

• Start with insulin, not glucose.

• Look at how your body responds to glucose/stress.

• Measure fat distribution, not just weight or BMI.

• Liver fat is an important metabolic signal.

• Simple tests like waist measurement still matter.

1. Fasting Insulin (HOMA-IR)

Insulin levels change before glucose does. That’s because major glucose spikes can be dampened by secreting more insulin.

You can get your fasting insulin and glucose done separately and calculate a HOMA-IR score using an online calculator. Ideally this should be ~1.5, not much higher.

Note: Fasting, exercise, or a late-night high-carb meal can all affect your HOMA-IR score. We follow a strict protocol when measuring this to avoid noise.

2. OGTT

This is the oral glucose tolerance test. Think of it as the treadmill stress test for your metabolism. This is how your body handles a hefty glucose load.

For an added layer of accuracy, you can get this test done with both glucose and insulin levels.

Medical Biochemistry Page

In our practice, we look at the curve but also how the person feels after ingesting the Glucose Drink. We check at 30, 60, and 120 minutes.

Note: If you’re keto, fasting, or slept bad, your numbers won’t be accurate.

3. Visceral Fat

I like DEXA scan because it’s cheap and easy. But MRI’s are becoming more popular.

Bioimpedance devices do a good job of overall fat but they can’t localize it to the fat that accumulates around the organs.

Note: DEXA/MRI are accurate but not 100%. If you’re borderline, follow up with other tests. Trends matter more than absolute numbers here.

4. Liver Fat (ALT)

You can’t have a normal cardiometabolic system without a healthy liver. Your liver’s ALT enzyme is one of the more accurate tests for this.

We still get a liver scan to be sure but if someone has a high ALT and it drops with the right lifestyle changes, no need to check further.

Note: You can have fatty liver disease with normal ALTs. And exercise, statins, and other drugs can falsely elevate your ALT.

5. Waist-to-Height Ratio

I don’t know any other practice that uses this. I’ve never met a patient who’s calculated their WtHR. It’s not sexy but it has incredibly solid evidence behind it.

All you need is a tape measure. More than 50% and your risk is high. Lower, and chances are your metabolic health isn’t too bad.

Strong Secondary Markers for Metabolic Disease

Many don’t know that your lipid numbers are often an accurate reflection of your metabolic health. Poor metabolic health will lower your HDL, raise your Triglycerides and your LDL.

• Triglyceride / HDL ratio

• ApoB

• Uric acid

• High-sensitivity CRP

• Blood pressure

Who We Test

If your diet, exercise, stress, and sleep aren’t optimized, testing is a good idea.

Before any testing we ask: “What changes can we or are we willing to undergo if the result is abnormal?”

The Goal of Testing

I test for metabolic disease early because if we intervene then we potentially prevent:

• Diabetes

• Heart disease

• Cancer

• Autoimmune disease

We test so that we have data to take action on. But we don’t obsess over absolute values and instead focus on how to get the results to trend lower over time.

Taking New Health Coaching Clients!

If you’ve been looking for a partner to help you solve a health mystery, this is your chance. Below are 3 ways to work together to help you reach you get started or perfect the last 10% of your health.

1. One-Time Deep Dive (60 minutes)
   This is a focused session to review your symptoms, labs, and lifestyle. In this physician-led health coaching hour you can pick my brain. I’ll share my experience and the latest research relevant to you.

2. Monthly Coaching
   Ongoing support with one live session per month plus direct messaging.
   This is best for making steady progress with accountability.

3. Weekly Coaching
   This is much more hands-on, with weekly live 1-hour sessions and close guidance.
   Ideal if you want faster and more structured change.

Find out more at https://drashori.com/health-coaching/

Disclaimer:

Dr. Mohammad Ashori is a U.S.-trained family medicine physician turned health coach. The content shared here is for education and general guidance only. It is not personal medical advice, diagnosis, or treatment, and it does not create a doctor–patient relationship. Humans are complicated and context matters. Always talk with your own healthcare team before making medical decisions, changing medications, or ignoring symptoms. This information is to help you add more depth to those conversations.

Follow me on:
Instagram
YouTube
Facebook
Reddit