The core of our existence

How is your metabolic health?
In order to be able to answer this question, it is necessary to know what the term ‘metabolic health’ means. This is often where the shoe pinches.
Interviewing Tim Schreuder, GRAM’s expert in the field of metabolic health, therefore seems like an obvious way to clear up some ambiguities.

“Metabolic health can be viewed as the core of our existence, namely the extent to which our metabolism functions. If we take the definition of the World Health Organisation (WHO), we can see that it puts forward five criteria to determine whether someone is metabolically healthy or not.” 

What are these criteria?

“They are metabolic-related criteria. For example, one looks at the ‘lipids’, ‘HDL cholesterol’, ‘blood pressure’ and ‘waist circumference’. If you score outside reference values on three or more of these criteria, you are considered metabolically unhealthy.”

And what consequences does being metabolic unhealthy have?

“Many chronic diseases, such as cardiovascular diseases, diabetes, etc., have their origin in a disturbed metabolism. But various musculoskeletal disorders can also stem from this. A study by Araújo from 2019 described that approximately 12% of the US population fulfills the criteria for a good metabolic health. Which means that over 85% of the US population is at risk to develop chronic diseases.”

So prevention plays a big part in this vital challenge?

“Definitely. Identifying the risk factors as early as possible in order to respond appropriately is often the basis for this. One can think of interventions in nutrition, exercise and mental health. In the GRAM program participants are intensively guided by coaches and experts in this field in a face-to-face fashion.”

Speaking of GRAM, during the Kick-Off Screening an intake interview will determine whether there is a need for a microbiome analysis. How do you frame that in the metabolic story?

“Simply put, a disturbance in your microbiome, the trillion intestinal bacteria in your body, is a major co-factor in giving rise to chronic diseases. The gut’s microbiome is a vivid environment with extensive functions with respect to digestion, immune defence and emotion regulation. Once your microbiota are deranged the risk of developing symptoms e.g. fatigue, depression, cardiovascular disease increases.”

So how can one achieve a normal metabolic health?

“I have always had a holistic view on this. On the one hand, you have to ensure that risk factors in the areas of nutrition, exercise, sleep and stress are discovered and dealt with as early as possible. In this way, you will already have a great impact on some criteria such as cholesterol, waist circumference. But on the other hand, mental resilience also plays a crucial role, because your gut bacteria will respond directly to your mental state of health and vice versa.”

So there is no such thing as a golden rule in the world of metabolic health?

“We are talking about lifestyle medicine where there are so many factors that we can influence our well-being. Last years, the numbers of scientific publications on lifestyle have increased tremendous. Due to these different factors associated with a healthy lifestyle, one size doesn’t fit all. It goes without saying that it then becomes difficult to demonstrate whether a certain treatment or intervention works effectively.

It is remarkable what impact the mental aspect has on one’s metabolic health. I can imagine that many of our GRAM captains have to deal with stressful situations on a daily basis, which puts their mental resilience to the test.

“Definitely. Stress causes different physiological changes; for instance, a continuous peak in cortisol levels. But also changes in sleep patterns and composition in your gut’s bacteria.”

Can stress also cause changes in your microbiome?

“A lot of studies have been done on this and what do they show? The composition of your microbiome is indeed affected by your mental health. Even there is a strong communication between your gut and brain, the so-called gut brain axis. For example, in depression (a severe condition of mental stress) significant changes in bacterial composition has been demonstrated.”

So is it possible to treat depression by addressing the altered composition of the microbiome?

“This is a difficult question. Tackling depression solely by influencing the microbiome is too much of a good thing. From a theoretical point of view, but also seen in animal studies, changing the microbiome results in changes in the production of neurotransmitters (substances involved in depression). These changes might have positive effects. It does show that there is a link between your brain and your gut.”

Are there also positive consequences to this link?

“Yes, the gut-brain axis is not all doom and gloom. For example, certain gut bacteria can influence the production of serotonin, which is a neurotransmitter that creates a feeling of happiness. Interventions with probiotics to improve specific bacteria have shown to normalise or increase serotonin production.”

The fact that some bacteria produce positive substances, does that open the gate to bio-hacking?

“The use of pre- and probiotics is already being applied. However, studies are still on-going to unravel this phenomenon. So bio-hacking might be something for the future.”

Treating such metabolic complications is thus very individualised and often trial and error.

“You have to work in a hyper-individualised way in this field because the complaints are so non-specific. You can’t possibly blame every complaint on stress.”

To conclude; as a metabolic expert, do you have certain tips for people who have to face stressful situations on a daily basis?

“You don’t always notice yourself that you are in stressful situations every day, it is only by talking about it with others that it starts to dawn on you that your situation is not healthy. By talking to experts you often discover aspecific physical symptoms (e.g. palpitation, extreme fatigue, dizziness) that you did not consider to be complaints before. From then on, you can start looking for triggers, anticipatory actions and possible treatments. What those actions and treatments are varies from person to person. Hence, only this holistic and individualistic approach will sustainably produce a healthy and productive human system.”



  • J. Araújo, J. Cai, J. Stevens. Prevalence of Optimal Metabolic Health in American Adults: National Health and Nutrition Examination Survey 2009-2016. February 2019. Metabolic Syndrome and Related Disorders.