HRM Assessment and Metabolic Health

The Health Results Metabolic (HRM) Score provides a convenient, reliable and easy to understand indicator of metabolic (inner) health.

The purpose of the score is to provide a physiological outcome measure of insulin resistance. (1) This can be used to assess current metabolic health and then track the impact of dietary and lifestyle interventions - if necessary it can track medical interventions too.

The algorithm created has been developed by leading doctors working on behalf of Health Results. It uses five widely available and accepted biomarkers of insulin resistance to provide a relative measure of metabolic health. (2) Improvements to your score are possible with effective dietary and lifestyle interventions.

This approach enables the use of quality improvement methodology to drive improvements in the metabolic health of individuals and populations.

The five measurements taken are:
  • Waist to height ratio
  • Blood pressure
  • Blood glucose level
  • Blood triglyceride level
  • HDL cholesterol (HDL-C)

(1) A physiological outcome measure means results are based on measurements related to anything to do with bodily systems or physical measurements, rather than being assessed via self-reporting questionnaires or observations by a third party.
(2) A relative measurement means it only has significance in relation to something else.

Health Results Metabolic Score

When the five HRM measurements have been collected, they are entered into the Health Results software or app and a current score is calculated. Rather than receiving a score of just one figure, the score you receive is a range of plus or minus 10. This allows for variables such as: time of day, how relaxed you were when taking your blood pressure, or if you were bloated while doing your waist to height measurement.

So, for example, if your score was 45, then your range is 35 to 55.

As you make dietary and lifestyle changes, the aim is to keep steadily improving your range by scoring higher up the scale.

Scoring system created by leading doctors with a special interest in metabolic health.

A breakdown of the scoring system follows. There are further guides on how to take these measurements in our other Health Results handbooks.

NOTE for people with T1 Diabetes:

  • Fasting glucose scoring for people with T1D: if they know their last HbA1c %, our practitioner may use this number in place of their fasting blood glucose measure.
  • If their HbA1c is unknown, we then score their ‘fasting glucose score’ as an average of their other 3 domain scores (rounded to the nearest whole number).

So, you know how we score your metabolic health and we know your HRM score can be improved. But what is exactly is metabolic health and metabolic syndrome and why do they matter?

Metabolic health is a phrase used a lot in medical circles today, relating to how most chronic illnesses we face in Great Britain (including cancer, heart disease, Alzheimer’s, type 2 diabetes, strokes, obesity, and more) can all, in part, be related to the release of too much insulin.

This modern onslaught of insulin is mainly caused by the food choices we make, our stress levels, and lifestyle.

This is how the NHS describes metabolic syndrome

“Metabolic syndrome is the medical term for a combination of diabetes, high blood pressure (hypertension) and obesity.

It puts you at greater risk of getting coronary heart disease, stroke and other conditions that affect the blood vessels.

On their own, diabetes, high blood pressure and obesity can damage your blood vessels, but having all 3 together is particularly dangerous.

Metabolic syndrome may be diagnosed if you have 3 or more of the following:

  • being very overweight or having too much fat around your waist
  • high triglyceride levels (fat in the blood) and low levels of HDL (the ‘good’ cholesterol) in your blood, which can lead to atherosclerosis(where arteries become clogged with fatty substances such as cholesterol)
  • high blood pressure that’s consistently 140/90mmHg or higher
  • an inability to control blood sugar levels (insulin resistance)”
    NHS metabolic syndrome explanation

As you will discover throughout our website, we believe insulin resistance is the root cause of most chronic illness and consequently you could simply interchange ‘metabolic syndrome’, with ‘insulin resistance syndrome’.

What is the meaning of ‘syndrome’? A syndrome is simply an occurrence of factors that occur together more often than by chance alone.

Insulin’s key role is to regulate blood sugar levels. Let us start with a flowchart of equations:

Looking at the above equation, it’s logical to conclude that type 2 diabetes is in fact the intolerance of too much processed foods, sugar, and carbohydrates.

When we want to improve our metabolic health, lose weight, or even reverse type 2 diabetes, individual authors, experts, and doctors all offer varying advice on how many CARBS we should consume each day.

Some will say 70g
Some will say 100g
Some will advise very specific amounts such as 73g

But the reality is: the body doesn’t actually need any CARBS at all!

Put simply, the fewer processed foods and CARBS we eat, the quicker we both lose weight and regain our metabolic health.

Once we reach our ideal weight, if we want to add the occasional apple or banana again, then we can go for it. If we start gradually eating too many CARBS (known as CARB creep)and our weight starts to increase again, we simply need to take notice, and cut them down again.

It really is as straightforward as that.

Well, straightforward in principle, but of course sometimes harder to execute.

And that’s why we are here to support you at Health Results.

But what is metabolic health all about?

First, let’s take a look at what metabolism means.

Metabolism is the process of converting food and drink into energy and unlocking nutrition. As humans, we are designed to eat a certain diet: the evolution of our species hasn’t yet progressed to consume the manufactured and lab-created stuff that we all too often put into our body. We were designed to eat free-roaming animals and ‘in season’, naturally growing plants (collectively known as real food). It’s that simple. After all, fresh plants and wild animals were the only food available to our ancestors.

As we eat food, our body digests each meal and breaks each macronutrient down into a smaller component. For example: fat is actually made up of fatty acids; the smallest component of proteins is amino acids (the good stuff that builds muscles); and CARBS simply become sugar.

The body processes different nutrients in a particular order, based on how easy the task is. Alcohol is absorbed very quickly around a quarter of what we drink can be transferred into the bloodstream and hit the brain in less than one minute! Next come CARBS, which easily break down into sugar, followed by the conversion of protein into amino acids. Fats are left until last, as it is quite a complex task for our body to break them down into fatty acids.

Let’s park that for a moment and get a basic understanding of insulin.

Your standard granulated sugar is actually two sugars in one.

But there is a problem with both sugars when over-consumed.

Let’s just focus on glucose for now.

There’s approximately 5 litres of blood circulating round your body, but it can only suspend around 1 teaspoon of glucose.

Any more than this and it is detrimental to health.

Eat a 12” Subway and the bread will turn into around 15 teaspoons of sugar. Drink a can of Coke and the body has to quickly deal with 7 teaspoons of sugar.

The body now needs to rapidly either burn it for energy or dispose of it.

At this point, glucose levels are too high, causing the pancreas to release a hormone known as insulin that binds to the liver and muscle cells, signalling for them to remove glucose from the bloodstream and store it as insoluble glycogen in your liver and muscles. Glucose is soluble within the bloodstream, made up of a single glucose unit, whereas glycogen is the stored form of glucose, made up of several glucose units. The problem is that, depending on our build, the liver and muscle stores combined only hold around 300–500g of glycogen: in terms of calories this equates to just 1200-2000, after which all excess glucose becomes stored as body fat (also known as adipose tissue).

Conversely, when our blood sugar levels are too low, the pancreas releases a hormone known as glucagon that breaks down insoluble glycogen into soluble glucose, releasing glucose into our bloodstream for use as energy. When it breaks down glycogen in a muscle that itself needs energy, it uses it as its own fuel.

Glucagon Sometimes referred to as the slender hormone, works in opposition to insulin. The two of them need to work in partnership to ensure the right amount of glucose is in the blood.

Glucose Soluble form of sugar within the bloodstream.

Glycogen Stored form of sugar in both the liver and muscles, made up of several glucose molecules

The trouble is, when we continually have high levels of insulin over a prolonged period, cells eventually become insulin resistant. It’s a bit like being in a noisy office – we notice the distraction at first, but eventually we just block it out. For those who eat too frequently, and who consume lots of CARBS, the end result might be hyperglycaemia (high blood sugar level) or hyperinsulinemia (high amounts of insulin in the blood).

This is what often causes type 2 diabetes; when overconsumption of CARBS(3) leads to the cells shutting up shop and not letting insulin do its job. Incidentally, type 1 diabetes is rarer and is a very different medical condition, known as an autoimmune disease. For those suffering with type 1, the body isn’t able to generate sufficient or any insulin to transport sugars out of the blood, and therefore most sufferers have to inject themselves with insulin.

(3) CARBS stands for 'Carbs Are Really Bad Sugars'.

The medical profession once regarded type 2 diabetes as a chronic, progressive, and irreversible disease. Nowadays, thousands of people in Great Britain are putting their type 2 diabetes into remission by learning more about metabolic health and taking the necessary steps to correct it.

Before we start chastising insulin, we should remember that the hormone is only doing the job Nature designed it to do! When we are eating healthily, rather than seeing it as a prison officer escorting a villain to the fat cells, we should view insulin as an usher in a church, accompanying energy to each and every seat.

Insulin is one of the most critical hormones in the metabolism of food, and our cells are unable to process glucose without it. As long as we don’t consume too much sugar, ultra-processed foods, and refined CARBS, our insulin system functions perfectly, just as it has for more than two million years.

There are other causes of insulin resistance too, such as stress, lack of sleep and a sedentary lifestyle. You will find our 'Insulin Resistance Tree' appear several times on this website, as we believe it conveys the message well.

At Health Results we believe we should not submit to chronic illness. Some say that most of the modern diseases that finish us off are because we are simply living longer (though even the fact that we are living longer is not true). Others say ‘we have to die of something’. While, of course, they are right: wouldn’t you rather - just like the centenarians in places like Ikaria and Okinawa, die just of old age?

To live longer and healthier we have to prioritise our metabolic health. Another way of looking at this is how we can improve our inner health.

We can improve our inner health

  • To improve our inner health we need to take action to make ourselves more insulin sensitive.
  • We also need to eat fewer foods that excessively challenge our blood glucose all the time.
  • We need to help our body to maintain homeostasis.
  • If we help our body to maintain homeostasis it will be able to look after itself much better.
  • We are more likely to avoid getting modern diseases.
  • We will feel better.
  • We can even reverse conditions such as type 2 diabetes.

We can measure our inner health

There is no single test that can tell us exactly what state our inner health is in.

Health Results has brought together a range of scientifically established inner health tests. These include:

  • measurement of waistline (at the level of your belly button);
  • blood pressure;
  • blood test for the glucose level;
  • blood test for the levels of some fats (triglycerides and HDL-cholesterol).

The Health Results Metabolic (HRM) Score uses all these measurements to calculate an overall inner health score out of 100.

We recommend you download and read our resource all about your HRM score here, to find out more.

The HRM Service

HRM Score Document

Metabolic Health and Insulin document




  • Alberti et al. ‘Harmonizing the Metabolic Syndrome,’ Circulation 120(16):1640-5
  • Jayedi A, Soltani S, Zargar MS, Khan TA, Shab-Bidar S. ‘Central fatness and risk of all cause mortality: systematic review and dose-response meta-analysis of 72 prospective cohort studies,’ BMJ. 2020;370:m3324. Indices of central fatness including waist circumference, waist-to-hip ratio, waist-to-height ratio, waist-to-thigh ratio, body adiposity index, and A Body Shape Index, independent of overall adiposity, were positively and significantly associated with a higher all cause mortality risk.
  • Brown KF, Rumgay H, Dunlop C, Ryan M, Quartly F, Cox A, et al. ‘The fraction of cancer attributable to modifiable risk factors in England, Wales, Scotland, Northern Ireland, and the United Kingdom in 2015,’ British Journal of Cancer. 2018;118(8):1130-41. Population attributable fractions (PAFs) were calculated for combinations of risk factor and cancer type with sufficient/convincing evidence of a causal association. Overweight/obesity has the second-highest PAF after smoking because it affects a high proportion of the UK population and is also linked with many cancer types.

Waist to height ratio

  • Ashwell M, Gibson S, ‘Waist to height ratio as an indicator of “early health risk”: simpler and more predictive than using a “matrix” based on BMI and waist circumference,’ BMJ Open 2016;6:e010159.


  • da Luz PL, Favarato D, Faria-Neto JR, Jr., Lemos P, Chagas ACP, ‘High ratio of triglycerides to HDL-C predicts extensive coronary disease,’ Clinics (Sao Paulo). 2008;63(4):427-32. Elevation in the ratio of TG to HDL-C was the single most powerful predictor of extensive coronary heart disease among all the lipid variables examined.
  • Miller et al., ‘Triglycerides and Cardiovascular Disease: A Scientific Statement From the American Heart Association,’ Circulation 2011:123:2292–2333.
  • Alberti et al. ‘Harmonizing the Metabolic Syndrome’, Circulation 120(16):1640-5.

Triglycerides : HDL-C

  • Boizel et al., ‘Ratio of triglycerides to HDL cholesterol is an indicator of LDL particle size in patients with type 2 diabetes and normal HDL cholesterol levels,’ Diabetes Care 2000 Nov; 23(11): 1679-1685.
  • Kaze AD, Santhanam P, Musani SK, Ahima R, Echouffo-Tcheugui JB. ‘Metabolic Dyslipidemia and Cardiovascular Outcomes in Type 2 Diabetes Mellitus: Findings From the Look AHEAD Study,’ Journal of the American Heart Association.0(0):e016947. In a large sample of overweight/obese adults with T2DM, we observed that low HDL-C and metabolic dyslipidemia were each associated with higher risks of atherosclerotic CVD events.

Blood Pressure

  • Williams B et al., ‘2018 ESC/ESH Guidelines for the management of arterial hypertension,’ European Heart Journal, Volume 39, Issue 33, 01 September 2018, Pages 3021–3104.
  • Collaborators GBDRF, Forouzanfar MH, Alexander L, Anderson HR, Bachman VF, Biryukov S, et al. ‘Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks in 188 countries, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013,’ Lancet. 2015;386(10010):2287-323. In terms of global attributable deaths, years of life lost, years lived with disability, and disability-adjusted life-years (DALYs) in 2013, six risks or clusters of risks each caused more than 5%: dietary risks accounting for 11.3 million deaths and 241.4 million DALYs, high systolic blood pressure for 10.4 million deaths and 208.1 million DALYs.

T1D HbA1c to eAG


Fasting glucose and T2Diabetes

  • Kaze AD, Santhanam P, Musani SK, Ahima R, Echouffo-Tcheugui JB. ‘Metabolic Dyslipidemia and Cardiovascular Outcomes in Type 2 Diabetes Mellitus: Findings From the Look AHEAD Study,’ Journal of the American Heart Association.0(0):e016947. In a large sample of overweight/obese adults with T2DM, we observed that low HDL-C and metabolic dyslipidemia were each associated with higher risks of atherosclerotic CVD events.
  • Alberti et al. ‘Harmonizing the Metabolic Syndrome,’ Circulation 120(16):1640-5.
  • Nathan DM, Davidson MB, DeFronzo RA, Heine RJ, Henry RR, Pratley R, et al. ‘Impaired fasting glucose and impaired glucose tolerance: implications for care,’ Diabetes Care. 2007;30(3):753-9.
  • Dugani SB, Moorthy MV, Li C, Demler OV, Alsheikh-Ali AA, Ridker PM, et al. ‘Association of Lipid, Inflammatory, and Metabolic Biomarkers With Age at Onset for Incident Coronary Heart Disease in Women,’ JAMA Cardiology. 2021. In this cohort study, diabetes and insulin resistance, in addition to hypertension, obesity, and smoking, appeared to be the strongest risk factors for premature onset of CHD.
  • Zhang AMY, Wellberg EA, Kopp JL, Johnson JD. ‘Hyperinsulinemia in Obesity, Inflammation, and Cancer,’ Diabetes Metab J. 2021. Recent evidence demonstrates that hyperinsulinemia may play a role in inflammation, ageing and development of cancers.


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