Metabolic Syndrome | Part 1

The Metabolic Gang

Why Your Health Problems Travel Together


Posted in

Dr. Hartman
& Dr. Jenski

Adapted from an interview (linked below).

August 6, 2025

The Metabolic Gang Article 1

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    Dr. Aaron Hartman leans back in his chair and delivers what sounds like a detective’s approach to medicine:

    “If someone has anything on this list, all of a sudden I’m looking for all the buddies. I’m looking for the crowd. I’m looking for the gang that comes with them.”

    This isn’t your typical medical consultation. When Sarah came to see Dr. Hartman for sleep issues, he didn’t just focus on her snoring. Within minutes, he was asking about her periods, her energy levels, whether she’d ever had kidney stones. When her labs came back, the picture crystallized: elevated uric acid, signs of insulin resistance, and markers suggesting PCOS.

    “It’s amazing,” Dr. Hartman explains to his colleague Dr. Christian Jenski during one of their clinical discussions. “You’ll find, you do organic acid testing, your oxalates are elevated, your uric acid levels are 7.7, you snore a little bit at night and all of a sudden it’s like the picture fits. The picture fits.”

    What Sarah discovered—and what millions of people don’t realize—is that her “separate” health problems weren’t separate at all. They were members of the same metabolic gang, operating together in a coordinated assault on her health.

    “Where there’s smoke, I look for the fire,” Dr. Hartman says, and that fire is metabolic syndrome—but not the limited version your doctor learned about.

    The official medical definition of metabolic syndrome requires you to have three of five criteria: a large waist, high triglycerides, low good cholesterol, elevated blood pressure, and high fasting glucose. Check three boxes, get the diagnosis, maybe get some medication recommendations. Case closed.

    Except Dr. Hartman puts it bluntly: “I want to start with the definition and the concept of how lacking the definition is.”

    Because while you’re waiting to check those three boxes, the metabolic gang is already wreaking havoc throughout your body—in your liver, your brain, your ovaries, your joints, even affecting your risk for cancer and Alzheimer’s disease. The gang operates in the shadows, and by the time conventional medicine notices them, they’ve already established their criminal network throughout your entire system.

    This isn’t a story about metabolic syndrome as your doctor understands it. This is about recognizing the gang before they take over completely—and understanding why your seemingly unrelated health problems might not be unrelated at all.


    The Incomplete Wanted Poster:

    What Doctors Actually Check

    The current diagnostic criteria for metabolic syndrome reads like a wanted poster with half the criminal’s face missing. According to the National Cholesterol Education Program (NCEP), you need three of these five criteria: central obesity (waist circumference greater than 40 inches for men, 35 for women), triglycerides over 150, HDL cholesterol below 40 for men or 50 for women, blood pressure above 130/85, and fasting glucose over 100.

    “This condition, this diagnosis, this criteria, didn’t exist when we were in medical school,” Dr. Jenski recalls. “Metabolic syndrome doesn’t predate that. It’s developed over time, secondary to all the trends that we’ve seen in lack of exercise and sedentary lifestyle, poor diet, not managing stress, not managing other hormones, not sleeping appropriately.”

    But here’s where the official criteria reveals its fundamental flaw: it’s based on a population that’s already metabolically compromised. “The range is too big because it’s predicated on the general population, which is overweight and obese or overweight and diabetic and metabolically inflexible,” Dr. Jenski explains. “And so that’s a problem.”

    Take fasting glucose, for example. The official cutoff is 100, but Dr. Hartman points to more revealing research: “If you’re fasting glucose, I believe it’s 86, if it’s over 86, for every point it goes up over 86, you have a 6% increased chance of developing diabetes in the next 10 years.” So while medicine waits for you to hit 100, your risk is already climbing significantly at 87, 88, 89.

    The triglyceride story is even more telling. “Triglycerides greater than 150 for us, greater than 70 is deemed to be too much,” Dr. Jenski explains. “I mean, really this is the difference between normal and optimization. If you have triglycerides less than 150 you don’t meet diagnostic criteria for metabolic syndrome. In my practice, it’s not optimal. We want those less than 70.”

    There’s also the ethnic variation that standard criteria completely ignore. “It’s interesting how some ethnic groups will hold more visceral fat than others. Asians, for example, will hold more fat around the organs than their skin. So you can see someone who looks skinny and be metabolically obese,” Dr. Hartman explains.

    “Versus African Americans will actually hold body fat more in their skin so they can look overweight, but not have as much visceral fat.”

    This means you could be a normal-weight Asian person with dangerous visceral fat accumulation, flying completely under the diagnostic radar while your metabolism deteriorates.

    The gap between standard criteria and optimal health becomes even more apparent when you understand the advanced testing strategies that reveal metabolic dysfunction years before conventional medicine would catch it.


    The Complete Criminal Network:

    Conditions That Run Together

    The real metabolic gang is far more extensive and dangerous than the official wanted poster suggests. When Dr. Hartman and Dr. Jenski look at the research and their clinical experience, the list of associated conditions is staggering—and most patients have no idea these seemingly separate problems are actually coordinated attacks from the same underlying dysfunction.

    The Core Gang Members

    The obvious suspects include type 2 diabetes, obesity, and cardiovascular disease. But here’s what shocks patients: “Half the people who go to the ER with the first heart attack have normal cholesterol,” Dr. Hartman points out. The metabolic gang doesn’t always announce itself through the markers doctors typically check.

    Non-alcoholic fatty liver disease—now called metabolic-associated fatty liver disease (MAFLD)—is another core member that patients don’t see coming. “The concept is, with some of the triglyceride issues, your body can’t appropriately store and move around fat, and so let’s just put it in the liver and see what happens,” Dr. Hartman explains.

    The casual dismissal of this condition infuriates both doctors. “Early in my career I would see patients… they don’t have diabetes or pre-diabetes, and you do an ultrasound as part of the workup… it comes back with heterogeneous liver consistent with fatty liver disease and they’re like, okay, well you’re okay ’cause we see this all the time,” Dr. Hartman recalls.

    Dr. Jenski is even more direct about this dangerous complacency: “We used to call these things incidentalomas… that should be a flare gun going off saying, Hey, we gotta do something about this.”

    Sleep apnea is another gang member that operates in the shadows. Most doctors use limited screening criteria—neck thickness, BMI, obvious snoring—but Dr. Jenski takes a more aggressive approach: “If any of my patients have any of these and they’ve never had a sleep study, I order a sleep study. Like it doesn’t matter if they have a thick neck or what their mouth looks like.”

    The connection between sleep apnea and metabolic dysfunction runs deep, particularly through testosterone. “There’s a close association with sleep apnea and low testosterone, especially in men,” Dr. Hartman explains. Yet how many men getting testosterone therapy have been properly screened for sleep apnea?

    The Shocking Extended Family

    Here’s where the gang’s reach becomes truly disturbing. PCOS (polycystic ovarian syndrome) might seem like a “women’s problem,” but it’s actually a metabolic issue affecting every organ.

    “Part of that is insulin resistance. When you develop insulin resistance as a part of metabolic syndrome, you get it in every organ in your body except for two, one that is your ovaries and one of them your kidneys,” Dr. Hartman explains.

    Gout and kidney stones represent another coordinated attack. “If uric acid level is greater than six, you’re still accumulating in your tissues whether or not you have flares,” Dr. Hartman notes.
    Most doctors only pay attention to uric acid when patients have obvious gout attacks, missing the systemic tissue damage happening silently.

    But perhaps most shocking is the connection to brain health. Alzheimer’s disease is now being called “type 3 diabetes” by researchers who understand the metabolic connection. “There’s a correlation with mitochondrial dysfunction, with insulin resistance, with metabolic syndrome, and with Alzheimer’s,” Dr. Hartman explains.

    Mood disorders round out this extended criminal family. While psychiatry has been stuck with neurotransmitter theories from the 1950s, these doctors see the metabolic connection:

    “What are we doing now that we’ve done for more than three to five years? The answer is mental health. The neurotransmitter theory of mental health disease came out in the fifties. And we’ve been basing all of our therapies on since then, and we have not had breakthroughs.”

    Even cancer belongs to this metabolic gang. “Back in the twenties and thirties they were having research showing that cancer actually wasn’t issue with energy production. The cells stopped using oxygen and we’d actually start using glucose for energy and create acids,” Dr. Hartman explains, referencing the Warburg effect that was largely forgotten when genetics took center stage.


    How to Spot the Gang:

    Signs They’re Operating in Your Body

    The metabolic gang leaves calling cards throughout your body, but you have to know how to read the signs. These aren’t the dramatic symptoms that send you to the emergency room—they’re the subtle indicators that dysfunction is taking root.

    Energy and Cognitive Signatures

    Persistent fatigue despite adequate sleep is often the first sign patients notice, but they rarely connect it to metabolic dysfunction. This isn’t the acute exhaustion from a busy week—it’s the chronic, unexplained energy drain that coffee can’t fix and rest doesn’t restore.

    Brain fog follows closely behind. Patients describe it as feeling like they’re thinking through cotton, struggling to find words, or losing mental sharpness they once took for granted. Dr. Jenski experienced this personally:

    “I was 39 when I started my medical journey. I thought I had dementia. My brain stopped working.”

    The afternoon energy crash—that 3 PM wall that hits regardless of what you ate for lunch—is another gang signature. This isn’t normal tiredness; it’s your metabolism struggling to maintain stable energy production throughout the day.

    Mood instability that doesn’t respond to standard treatments is another red flag. When antidepressants don’t work, when anxiety seems to come from nowhere, when emotional regulation becomes difficult, the metabolic gang might be disrupting the neurochemical balance that determines how you feel.

    Physical Territory Markers

    Central weight gain, particularly around the midsection, is the gang marking its territory. But remember Dr. Hartman’s insight about ethnic variations—this isn’t always obvious. Some people can look relatively normal while carrying dangerous visceral fat around their organs.

    Skin changes offer another clue. Acanthosis nigricans—dark, velvety patches around the neck, armpits, or groin—signals insulin resistance. Skin tags, particularly multiple ones, can indicate the same underlying dysfunction. These aren’t cosmetic issues; they’re metabolic warning signs.

    Sleep disruption and snoring might seem unrelated to metabolism, but they’re often gang activity. “If you’re 50 or over, you should get a sleep study,” Dr. Hartman recommends, treating sleep apnea screening like preventive care rather than waiting for obvious symptoms.

    Digestive issues and food sensitivities that seem to multiply over time are another gang signature. When your gut can’t properly process foods you used to tolerate easily, it’s often a sign of systemic inflammation and metabolic dysfunction.

    The Lab Value Gang Signs

    Here’s where the gang’s sophistication becomes apparent. They can operate while keeping your lab values in the “normal” range—but trained detectives know how to spot the patterns.

    Multiple “normal” values at the high end of ranges create a concerning picture. Your glucose might be 98 (normal, but remember that 86+ increases diabetes risk). Your triglycerides might be 145 (normal, but far from the optimal <70). Your blood pressure might be 128/82 (normal, but trending toward the metabolic syndrome cutoff).

    More importantly, trending changes over time reveal gang activity even when individual values look acceptable. “It’s amazing. You’ll find, you do organic acid testing, your oxalates are elevated, your uric acid levels are 7.7, you snore a little bit at night and all of a sudden it’s like the picture fits. The picture fits,” Dr. Hartman explains.

    This is pattern recognition medicine—seeing how seemingly separate markers create a coherent story of metabolic dysfunction spreading throughout your system.

    If you’re spotting these patterns in your own health, you’ll want to understand the comprehensive testing approach that reveals the full scope of metabolic dysfunction before it becomes established disease.


    The Underground Network:

    What Connects These Conditions

    Understanding why the metabolic gang operates together requires looking at the underground network that connects them. These aren’t random health problems that happen to occur in the same people—they’re manifestations of the same underlying energy crisis playing out in different organ systems.

    The Energy Production Crisis

    “Metabolic syndrome, energy production issues, not creating enough energy, not having enough good energy,” Dr. Hartman explains. At the cellular level, every condition on the gang’s roster traces back to problems with energy production and utilization.

    When your cells can’t efficiently produce or use energy, each organ system responds differently. Your liver starts storing fat it can’t properly process. Your pancreas struggles to manage glucose fluctuations. Your brain can’t maintain optimal neurotransmitter production. Your cardiovascular system becomes inflamed trying to cope with metabolic byproducts it can’t clear.

    This isn’t a problem with individual organs—it’s a system-wide energy crisis that manifests as different “diseases” depending on which organs are most affected and how far the dysfunction has progressed.

    The deeper you understand this cellular energy crisis, the more you realize why mitochondrial dysfunction is the master controller of your metabolic fate. These cellular powerhouses don’t just make energy—they coordinate every aspect of metabolic health.

    The Inflammation Highway

    The gang also operates through systemic inflammation, using what researchers call the “inflammation highway” to spread dysfunction throughout your body. Gut dysfunction plays a central role here, releasing inflammatory molecules into your bloodstream that travel to every organ system.

    “When you have them start checking their oral microbiome, it’s acidic. And just changing the pH,” Dr. Hartman notes, illustrating how dysfunction in one area cascades throughout the system. The portal circulation carries inflammatory signals from your gut directly to your liver, while systemic circulation distributes these signals everywhere else.

    Environmental toxins amplify this inflammatory cascade, affecting multiple systems simultaneously. The petroleum distillates Dr. Hartman discusses don’t just affect one organ—they disrupt cellular membranes throughout your body, creating system-wide dysfunction that manifests as multiple seemingly separate conditions.

    The Hormonal Communication System

    Insulin resistance affects every organ, not just your pancreas and liver. Cortisol dysregulation from chronic stress cascades through every hormonal pathway. Sex hormone imbalances create feedback loops that worsen metabolic dysfunction.

    This creates what both doctors recognize as a complex web of interconnected dysfunction. You can’t effectively treat PCOS without addressing insulin resistance. You can’t resolve fatty liver disease without managing systemic inflammation. You can’t optimize brain function without supporting cellular energy production.

    The gang operates through these underground networks because your body is designed as an integrated system, not a collection of separate organs. When dysfunction strikes at the foundational level—energy production, inflammation control, hormonal communication—it inevitably manifests as multiple conditions that conventional medicine treats as separate diseases.


    Building Your Case:

    What to Do When You Spot the Gang

    Once you recognize that the metabolic gang might be operating in your body, the investigation needs to become more sophisticated. This isn’t about self-diagnosis or panic—it’s about understanding what questions to ask and what kind of medical support you need.

    The Investigation Protocol

    “You really need to take a deep dive looking at these other associated issues,” Dr. Hartman advises. This means screening for the whole gang, not just the obvious members. If you have sleep apnea, you need evaluation for insulin resistance, fatty liver disease, and hormonal dysfunction. If you have PCOS, you need screening for sleep disorders, cardiovascular risk factors, and autoimmune markers.

    The gang detective approach means tracking patterns and connections, not isolated symptoms. Keep a symptom journal that looks for relationships: Does your brain fog worsen after meals? Do your energy crashes correlate with stress levels? Do your sleep disturbances coincide with digestive issues?

    Most importantly, find practitioners who understand the network approach. “If someone has anything on this list, all of a sudden I’m looking for all the buddies,” Dr. Hartman explains.
    This is the mindset you need from your healthcare team.

    Understanding which specific tests to request is crucial—you’ll find the complete guide to upstream testing strategies that catch dysfunction before it becomes disease.

    Warning Signs You Need a Better Detective

    Unfortunately, not all medical practitioners understand the gang mentality of metabolic dysfunction. Here are the red flags that indicate your current doctor might not be equipped for this investigation:

    • They dismiss connections between conditions, treating each problem in isolation without looking for underlying patterns.
    • They rely only on standard diagnostic criteria without considering optimization ranges or early dysfunction markers.
    • They don’t investigate root causes, focusing only on symptom management.
    • They don’t take a comprehensive history that explores how your various health issues might be related.

    If your doctor has never asked whether your sleep problems, digestive issues, and mood symptoms might be connected, you’re not getting the detective work you need.

    The Functional Medicine Advantage

    This is where functional medicine practitioners like Dr. Hartman and Dr. Jenski offer a fundamentally different approach. Instead of waiting for you to meet diagnostic criteria for individual diseases, they’re looking for early signs of systemic dysfunction that connects multiple symptoms.

    They understand that “where there’s smoke, I look for the fire,” as Dr. Hartman puts it. The smoke might be fatigue, brain fog, and irregular periods. The fire might be insulin resistance affecting multiple organ systems. Conventional medicine treats the smoke; functional medicine addresses the fire.

    This doesn’t mean rejecting conventional medicine—it means finding practitioners who can see the forest, not just the trees. The most effective approach often integrates both perspectives, using conventional diagnostics when appropriate while maintaining the broader systems view that catches the gang in action.


    Don’t Let the Gang Run Your Health

    The metabolic gang thrives in darkness, operating undetected while patients and their doctors focus on individual symptoms rather than the underlying network of dysfunction. But once you understand how they operate—how sleep apnea connects to hormonal dysfunction, how fatty liver disease relates to brain health, how seemingly separate conditions are actually coordinated attacks from the same metabolic breakdown—you can begin to fight back effectively.

    Immediate Gang-Busting Steps

    Start by auditing your current health conditions for gang connections. Make a list of every health issue you’ve experienced in the past five years, from major diagnoses to nagging symptoms you’ve dismissed as “just getting older.” Look for patterns and relationships you might have missed.

    Screen for the gang members you might not have considered. If you have any metabolic dysfunction, consider sleep apnea evaluation regardless of whether you fit traditional risk categories. If you’re a woman with irregular periods or difficulty losing weight, explore PCOS screening even if you don’t have obvious symptoms. If you have digestive issues, investigate the connection to brain fog and mood symptoms.

    Most importantly, seek practitioners who understand the network approach to metabolic health. You don’t have to go it alone in this investigation, but you do need detectives who know how to recognize the gang’s coordinated operations.

    The Path Forward

    The metabolic syndrome gang has been operating in the shadows for too long, devastating health while conventional medicine treats each symptom in isolation. But their days of unchallenged control are numbered.

    As Dr. Hartman and Dr. Jenski have discovered through their clinical work, there’s a single thread connecting this entire criminal network—a root cause that, once addressed, can unravel the gang’s hold on your health. The question is: are you ready to discover what that thread is, and how to use it to reclaim your metabolic future?

    Understanding the gang is just the beginning. Next, you’ll want to discover how mitochondrial dysfunction controls your metabolic fate and learn the science behind lasting metabolic recovery. Then, advanced testing strategies will reveal what’s really happening in your body, followed by the complete treatment protocols that can transform your health.

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