The Metabolic Health Crisis Is Not a Supplement Deficiency

America's Metabolic Health Problem Is Real

The numbers are difficult to dismiss.

The Centers for Disease Control and Prevention estimates that 40.1 million Americans have diabetes. Another 115.2 million adults have prediabetes, representing more than two in five American adults. Most people with prediabetes do not know they have it.

Another statistic appears frequently in discussions of metabolic health: roughly 88% of American adults are said to be metabolically unhealthy.

That number comes from a 2019 analysis of National Health and Nutrition Examination Survey data collected between 2009 and 2016. Researchers defined optimal metabolic health quite strictly. Participants had to meet favorable criteria for waist circumference, fasting glucose and hemoglobin A1c, blood pressure, triglycerides and HDL cholesterol without taking medication for those conditions. Only 12.2% met every criterion.

That does not mean 87.8% of American adults had diabetes or a diagnosed metabolic disease. It means they failed to meet at least one criterion in a stringent definition of optimal metabolic health.

A later analysis using a broader cardiometabolic definition was hardly reassuring. Using NHANES data through 2017–2018, researchers found that only 6.8% of American adults met optimal levels across adiposity, glucose, blood lipids, blood pressure and absence of clinical cardiovascular disease.

The exact percentage changes depending on the definition. The public-health problem does not disappear with the definition.

Blood Sugar Is an Outcome. It Is Also a Treatment Target.

There is a popular way of describing insulin resistance that goes something like this: blood glucose is merely the downstream result, so treating glucose misses the real problem.

There is some useful physiology behind that idea. Fasting glucose can remain normal for years while the pancreas produces more insulin to compensate for worsening insulin resistance. By the time fasting glucose or A1c rises substantially, metabolic dysfunction may already have been developing for some time.

It does not follow that blood glucose is clinically unimportant.

Chronic hyperglycemia contributes directly to the microvascular complications of diabetes involving the retina, kidneys and peripheral nerves. Glycemic targets remain a central part of evidence-based diabetes care for good reason.

The better approach is to look upstream without ignoring downstream consequences.

Someone with rising glucose may need evaluation of body composition, visceral adiposity, physical activity, diet, sleep, medications and other contributors to insulin resistance. If hyperglycemia is already present, it also deserves treatment.

Metabolic medicine becomes weaker when it chooses between the two.

What Actually Drives Insulin Resistance?

Insulin resistance is not one biochemical switch that becomes defective because a particular nutrient is missing.

Skeletal muscle, liver and adipose tissue all participate in glucose and energy metabolism. Dysfunction can develop differently in each tissue.

In muscle, physical inactivity and impaired metabolic flexibility can reduce glucose disposal. In the liver, insulin resistance can allow excessive glucose production even when circulating insulin is already elevated. In adipose tissue, particularly when fat storage capacity is exceeded, increased fatty-acid flux and abnormal signaling can contribute to insulin resistance elsewhere.

Genetics influence susceptibility. Age changes the metabolic environment. Menopause can alter body-fat distribution. Certain medications can worsen glucose regulation. Sleep apnea and insufficient sleep are associated with impaired metabolic health. Chronic stress can affect appetite, sleep and activity. Food availability, neighborhood design, work schedules, socioeconomic conditions and the modern food environment influence behavior long before anyone reaches for a supplement bottle.

Inflammation and oxidative stress are often present in insulin-resistant states, but they are woven into this physiology rather than sitting outside it as two isolated abnormalities waiting for an antioxidant formula.

Treating the mechanism therefore requires knowing which part of the physiology is actually abnormal in the person sitting in front of us.

Muscle Is Part of Glucose Regulation

Skeletal muscle is a major destination for glucose after a meal. When muscle contracts, glucose uptake can increase through mechanisms that are not entirely dependent on insulin. Regular physical activity also improves insulin responsiveness over time.

This is one reason metabolic health and muscle health belong in the same clinical conversation.

It is also why exercise cannot be reduced to calorie burning.

Aerobic exercise improves cardiorespiratory fitness and glucose regulation. Resistance training helps preserve or increase muscle strength and lean tissue. Current American Diabetes Association guidance recommends resistance exercise two to three times per week for adults with diabetes, alongside regular aerobic activity.

For people losing substantial weight, maintaining muscle becomes even more relevant. The 2026 ADA Standards specifically emphasize muscle-strengthening exercise for people using obesity pharmacotherapy or undergoing metabolic surgery because of its potential role in preserving lean body mass.

More on this relationship is available in Muscle Matters. But Longevity Is Bigger Than Muscle.

Visceral Fat and Ectopic Fat Change the Metabolic Environment

Body weight is an imperfect metabolic measurement because fat distribution varies considerably between people.

Visceral fat surrounds the organs within the abdomen and is more strongly associated with insulin resistance and cardiometabolic risk than subcutaneous fat stored beneath the skin. Fat accumulation in organs such as the liver can also disrupt normal metabolism even when a person does not appear markedly obese.

This helps explain why two people with the same BMI can have very different metabolic profiles.

It also explains why meaningful fat loss can improve glucose regulation before someone reaches a theoretically ideal body weight.

The Diabetes Prevention Program demonstrated the power of fairly ordinary interventions. In people at high risk of developing type 2 diabetes, the lifestyle program targeted approximately 7% weight loss and at least 150 minutes of moderate physical activity each week. Participants who achieved the physical-activity target without achieving the weight-loss goal still experienced a substantial reduction in diabetes incidence.

Current ADA guidance continues to recommend approximately 5–7% weight loss for many adults with overweight or obesity who are at high risk for type 2 diabetes, alongside regular physical activity and an evidence-based dietary pattern.

At HormoneSynergy®, DEXA and SECA body-composition testing may be useful when knowing the amount and distribution of fat and lean tissue can change the clinical strategy.

See Body Composition and Longevity Medicine.

Sleep Is Metabolic Care

Sleep is sometimes treated as wellness advice added after the serious metabolic discussion has finished. That no longer fits the evidence particularly well.

Sleep duration, quality and timing influence glucose regulation, appetite, sympathetic activity and endocrine function. Obstructive sleep apnea is especially relevant because it frequently coexists with obesity and insulin resistance and may remain undiagnosed for years.

The ADA now includes sleep alongside nutrition and physical activity within the behavioral foundations of diabetes prevention and treatment.

A person sleeping five fragmented hours every night with untreated sleep apnea does not simply need another insulin-sensitizing ingredient. The sleep disorder itself deserves attention.

Where Supplements Actually Fit

Rejecting supplement-centered medicine does not require pretending supplements never have value.

Deficiency is the clearest example. A person who is genuinely magnesium deficient should have the deficiency addressed. Someone taking metformin may require monitoring for vitamin B12 deficiency. Restrictive diets, gastrointestinal disease, medications and other clinical circumstances can create legitimate nutritional needs.

Some compounds also have pharmacologic effects even when they are sold as supplements. Berberine is a good example. Randomized trials and meta-analyses suggest effects on fasting glucose, post-meal glucose and other metabolic measurements.

That does not turn insulin resistance into a berberine deficiency.

The American Diabetes Association does not recommend routine supplementation with magnesium, chromium, herbs or spices for glycemic benefit in people with diabetes. The issue is not that no study has ever produced a favorable result. The total evidence has not established these products as reliable substitutes for the interventions that consistently improve metabolic outcomes.

Targeted supplementation is easiest to defend when there is a documented deficiency, a specific physiological reason for its use, or enough clinical evidence to justify an adjunctive role.

What About Popular Insulin-Sensitivity Ingredients?

Berberine and Dihydroberberine

Berberine has considerably more human clinical research than many metabolic supplements. A 2024 systematic review of randomized trials found reductions in fasting glucose, post-meal glucose and several lipid measures, with additional improvement in HbA1c when berberine was combined with glucose-lowering medication.

The literature still contains substantial variation in study quality, formulation, dose, population and background treatment.

Dihydroberberine is a metabolite of berberine marketed partly on the basis of improved oral bioavailability. Pharmacokinetic data are interesting, but improved delivery of a molecule does not automatically establish superior long-term clinical outcomes. Claims about HbA1c, diabetes prevention or cardiovascular outcomes require direct clinical evidence for the formulation making those claims.

Alpha-Lipoic Acid

Alpha-lipoic acid has antioxidant and metabolic effects and has been studied in people with diabetes. Meta-analyses have reported modest improvements in some glycemic markers, including fasting glucose and HbA1c.

Magnitude deserves attention. In one dose-response meta-analysis, the estimated HbA1c reduction was modest, and the authors noted that changes in several outcomes were below commonly used thresholds for clinical importance.

Alpha-lipoic acid may have a role in selected situations, including its better-established history in diabetic neuropathy research, without becoming a primary treatment for insulin resistance itself.

Magnesium

Magnesium participates in hundreds of enzymatic reactions and is relevant to normal insulin signaling. Inadequate magnesium intake is common enough to deserve attention.

The leap from physiological importance to universal supplementation is not supported by current clinical evidence.

A 2026 systematic review and meta-analysis of 15 randomized trials involving people with diabetes or prediabetes found no statistically significant overall improvement in insulin or HOMA-IR with oral magnesium supplementation. Response may vary according to baseline metabolic status, and correcting genuine deficiency remains appropriate.

Chromium

Chromium has been marketed for glucose metabolism for decades. Individual trials and meta-analyses have produced mixed results, with substantial differences between populations and study designs.

Current ADA guidance does not recommend chromium supplementation for glycemic benefit.

Curcumin and Other Antioxidant Strategies

Curcumin and related compounds have biological effects relevant to inflammatory and oxidative pathways, and clinical studies continue to explore those effects.

Metabolic disease, however, cannot be reduced to an antioxidant deficit. Lowering a marker of oxidative stress does not necessarily translate into prevention of diabetes, cardiovascular disease or the complications of chronic hyperglycemia.

Current diabetes guidelines do not recommend routine curcumin or herbal supplementation for glycemic management.

What Has the Strongest Evidence?

The interventions with the deepest evidence base are not especially novel.

Physical activity improves insulin sensitivity and cardiovascular fitness. Resistance training improves muscle function and contributes to glucose disposal. Dietary patterns built around minimally processed foods can improve energy balance and cardiometabolic risk. Meaningful loss of excess body fat can substantially improve glucose regulation in people with overweight or obesity.

Sleep disorders should be treated. Smoking should be addressed. Blood pressure and atherogenic lipoproteins require attention because cardiovascular disease remains central to the long-term risk carried by diabetes and insulin resistance.

When lifestyle treatment is not enough, medication is not evidence of failure.

Metformin remains useful in appropriate patients. GLP-1 and GIP/GLP-1 therapies can produce large improvements in weight and metabolic health in selected people. Other diabetes medications are chosen according to glucose control, cardiovascular disease, kidney disease, heart failure and the individual clinical situation. Metabolic surgery remains one of the most effective treatments for severe obesity and can produce profound metabolic improvement.

The common feature is not that these interventions all work through one pathway. It is that they have been tested against meaningful clinical outcomes.

Fasting Glucose Is Useful, but It Is Not the Whole Metabolic Evaluation

Fasting glucose can remain normal while insulin resistance is developing. A1c adds information about longer-term glycemia, and triglycerides, HDL cholesterol, waist circumference, blood pressure and body composition provide additional clues about metabolic health.

Fasting insulin and HOMA-IR can sometimes add context, particularly when the clinical picture suggests insulin resistance before glucose becomes clearly abnormal. They are not universally standardized diagnostic tests, and a HOMA-IR number should not be interpreted in isolation.

Continuous glucose monitoring can reveal patterns in glucose response that a fasting measurement cannot, although glucose excursions still need to be interpreted in clinical context rather than treated as a diagnosis by themselves.

For a deeper discussion, see What Blood Tests Detect Insulin Resistance? and HOMA-IR and Insulin Resistance.

The Bottom Line

America's metabolic health problem is large enough that it naturally attracts products promising to fix insulin sensitivity, mitochondrial function, inflammation, oxidative stress or glucose metabolism.

Some of those products contain biologically active compounds, and some have human clinical evidence. They can be useful in the right setting.

They do not explain why more than 115 million American adults have prediabetes.

Insulin resistance emerges from the interaction of adipose tissue, muscle, liver, diet, physical activity, sleep, genetics, medications, hormones and the environment. Once glucose begins to rise, both the underlying physiology and the hyperglycemia deserve attention.

The most effective metabolic strategy is therefore rarely a search for the largest number of insulin-sensitizing ingredients. It is a careful assessment of what is driving metabolic dysfunction in that person, followed by the interventions most likely to change it.

Sometimes a supplement belongs in that plan. It should not be mistaken for the plan itself.

Frequently Asked Questions

What is metabolic health?

Metabolic health generally refers to favorable regulation of glucose, blood pressure, blood lipids, body fat distribution and related cardiometabolic risk factors. Definitions vary between research studies, which is why estimates of how many Americans are metabolically healthy also vary.

Is it true that 88% of Americans are metabolically unhealthy?

A widely cited NHANES analysis found that 12.2% of American adults met every criterion in a strict definition of optimal metabolic health. Saying that the remaining 87.8% all have metabolic disease overstates what the study showed. They failed to meet at least one of the study's optimal criteria.

How many Americans have prediabetes?

CDC's 2026 National Diabetes Statistics Report estimates that 115.2 million American adults have prediabetes. The CDC also estimates that 40.1 million Americans have diabetes.

Can insulin resistance occur with normal fasting glucose?

Yes. The pancreas can compensate for insulin resistance by producing more insulin, allowing fasting glucose to remain within the normal range for a period of time. Fasting glucose is therefore useful but does not describe every aspect of insulin sensitivity.

Is blood sugar only a symptom of insulin resistance?

No. Rising glucose can result from underlying insulin resistance and beta-cell dysfunction, but chronic hyperglycemia also contributes directly to diabetes complications. Clinical care addresses both the causes of dysglycemia and glucose itself.

What is the best supplement for insulin resistance?

No supplement has been established as the universal treatment for insulin resistance. Some compounds, including berberine and alpha-lipoic acid, have human clinical evidence, while others have inconsistent or limited data. Treatment should focus first on the metabolic drivers present in the individual.

Does magnesium improve insulin resistance?

Magnesium is physiologically important, and deficiency should be corrected. A 2026 meta-analysis of randomized trials in people with diabetes and prediabetes did not find a statistically significant overall improvement in insulin or HOMA-IR from magnesium supplementation.

Does berberine lower blood sugar?

Randomized trials and meta-analyses suggest that berberine can reduce fasting and post-meal glucose and may improve other metabolic markers. Study quality and treatment protocols vary, and berberine should not be considered a replacement for established diabetes or obesity treatment.

Does exercise improve insulin sensitivity?

Yes. Both aerobic activity and resistance training improve aspects of glucose metabolism and are recommended in current diabetes prevention and treatment guidelines. Muscle-strengthening exercise is particularly relevant for maintaining lean mass during weight loss.

Can prediabetes be reversed?

Prediabetes can return to normal-range glucose values in some people, particularly with meaningful improvements in weight, physical activity, diet and other metabolic factors. Risk does not necessarily disappear permanently, so continued monitoring remains appropriate.

Related HormoneSynergy® Reading

• Metabolic Health and Longevity Medicine
• Insulin Resistance Explained
• What Blood Tests Detect Insulin Resistance?
• HOMA-IR and Insulin Resistance
• Body Composition and Longevity Medicine
• Best Diet for Insulin Resistance and Visceral Fat
• Muscle Matters. But Longevity Is Bigger Than Muscle.

Selected Research

• Centers for Disease Control and Prevention. National Diabetes Statistics Report. Updated 2026.
• Araújo J, Cai J, Stevens J. Prevalence of Optimal Metabolic Health in American Adults: National Health and Nutrition Examination Survey 2009–2016. Metab Syndr Relat Disord. 2019;17(1):46-52. PMID: 30484738.
• O'Hearn M, et al. Trends and Disparities in Cardiometabolic Health Among U.S. Adults, 1999–2018. J Am Coll Cardiol. 2022;80(2):138-151. PMID: 35798448.
• American Diabetes Association Professional Practice Committee. Prevention or Delay of Diabetes and Associated Comorbidities: Standards of Care in Diabetes—2026. Diabetes Care. 2026;49(Suppl 1).
• American Diabetes Association Professional Practice Committee. Facilitating Positive Health Behaviors and Well-being to Improve Health Outcomes: Standards of Care in Diabetes—2026. Diabetes Care. 2026;49(Suppl 1).
• American Diabetes Association Professional Practice Committee. Obesity and Weight Management for the Prevention and Treatment of Diabetes: Standards of Care in Diabetes—2026. Diabetes Care. 2026;49(Suppl 1).
• Wang J, et al. Effects of administering berberine alone or in combination on type 2 diabetes mellitus: a systematic review and meta-analysis. Front Pharmacol. 2024;15:1455534. PMID: 39640489.
• Jibril AT, Jayedi A, Shab-Bidar S. Efficacy and safety of oral alpha-lipoic acid supplementation for type 2 diabetes management: a systematic review and dose-response meta-analysis of randomized trials. Endocr Connect. 2022;11:e220322. PMID: 36006850.
• Amiri A, et al. Oral magnesium supplements and insulin resistance in individuals with diabetes and pre-diabetes: an updated systematic review and meta-analysis of randomized controlled trials. BMC Nutr. 2026. PMID: 42426860.

Important Notice: This article is educational and is not a substitute for individualized medical care. Diabetes and prediabetes require appropriate medical evaluation. Supplements can interact with prescription medications and may affect glucose levels, blood pressure, bleeding risk and other aspects of health.