Providing independent clinical excellence since 2005
Posted on Sunday July 13, 2025 in Muscle, Protein and Metabolic Resilience
This article was written by Dr Edward Leatham, Consultant Cardiologist © 2026 E.Leatham. It is an abbreviated version of a chapter from VAT-TRAP: The GLP-1 Advantage.
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If you have been diagnosed with coronary heart disease or high blood pressure, and carry excess weight — especially around your middle — you are not alone. Due to the interaction between our genes, modern lifestyles and diet, visceral fat deposition has become an almost universal feature of ageing. In addition, many people affected also show signs of glucose dysregulation — often referred to as non-diabetic hyperglycaemia — which is associated with insulin resistance. Together, these factors can significantly affect your healthspan.
The current accepted medical practice is to reserve modern medicines and treat once someone develop diabetes. However it can be argued that the key should be to prevent non diabetic hyperglycaemia state developing into full blown diabetes, which is often associated with multiple complications. Metabolic dysfunction -associated steatotic liver disease MASLD, also known as fatty liver/NAFLD-non alcoholic liver disease, is a condition commonly associated with being overweight. Fatty changes are seen within the liver which could lead to chronic liver disease. In both non diabetic hyperglycaemia and MASLD, the focus should be reversing the glucose dysregulation and reducing visceral fat at the onset rather than waiting for the complications to develop.
These conditions often occur together and are linked by a common underlying issue: metabolic dysfunction. The encouraging news is that we now understand this process can often be slowed — and in many cases, even reversed. Better still, we are learning to do this more effectively through a powerful combination of modern medication, technology, and lifestyle change.
In this blog, I will introduce an approach we started at my clinic in 2025 referred to as the Metabolic Reset — a structured 8-month programme that uses modern tools such as GLP-1 mimetic injections, continuous glucose monitoring (CGM), a food analysis app, resistance training, and a protein-forward diet. The aim is to reduce visceral fat, build muscle strength, and reboot your metabolism — with the ultimate goal of minimising the need for long-term medication.
It is worth noting that, prior to joining the programme, many of our patients undergo a metabolic health assessment wearing a CGM and keeping a detailed food diary. This helps us assess the degree of glucose dysregulation and carbohydrate sensitivity present. In milder cases of non-diabetic hyperglycaemia, patients can use our toolkit to address these issues without the need for GLP-1 mimetic therapy — with the option to escalate to a pharmacologically assisted Metabolic Reset, only if needed.
Two key, modifiable drivers of poor metabolic health are:
As we age, our body composition gradually changes. Because of anabolic resistance ( a topic covered in another blog) both muscle mass and strength decline from 30 years of age, while visceral fat — the fat stored around internal organs — tends to increase. Many people also carry a genetic predisposition that makes them more vulnerable to metabolic problems when exposed to modern diets and sedentary lifestyles. Over time, this combination drives higher blood pressure, rising cholesterol and triglycerides, and worsening blood sugar control — the cluster of problems known as metabolic syndrome.
Visceral fat is not just passive storage; it is metabolically active and inflammatory. As fat cells enlarge and become overfilled, they begin releasing free fatty acids (FFAs) into circulation. These FFAs interfere with insulin signalling in muscle and liver tissue, reducing the body’s ability to process glucose efficiently. This can create a self-reinforcing cycle — sometimes described as a “metabolic doom loop” — where insulin resistance leads to further fat mobilisation and ongoing metabolic disruption.
The encouraging news is that this process is often reversible. Reducing visceral fat, rebuilding skeletal muscle, and creating a sustainable energy deficit can improve insulin sensitivity and restore metabolic health.
This reset is not a fad diet or quick fix. It is a structured intervention we use in our cardiometabolic clinic designed to change your body from the inside out, addressing the root causes of your metabolic problems. Here is what it involves:
Continuous glucose monitoring (CGM) provides real-time insight into how blood glucose responds to food, activity, stress, and sleep. Many people are unaware of how differently their bodies respond to specific meals until they see these patterns displayed continuously. A small wearable sensor measures interstitial glucose throughout the day, allowing personalised feedback rather than relying solely on occasional blood tests.
Glucose excursions after meals are common, even in individuals without diabetes. However, larger or more prolonged postprandial glucose rises may reflect reduced metabolic flexibility and early insulin resistance, where skeletal muscle and liver are less able to efficiently clear incoming glucose. In response, insulin secretion increases to facilitate glucose storage and suppress hepatic glucose output. When energy intake persistently exceeds immediate requirements, the liver can convert excess carbohydrate into fatty acids and triglycerides, which are exported as very-low-density lipoprotein (VLDL) particles and stored within adipose tissue.
In some non-diabetic individuals with normal HbA1c levels, CGM may still reveal periodic glucose excursions above 7.8 mmol/L after carbohydrate-rich meals — a pattern that is not uncommon and may indicate early metabolic stress rather than overt disease.
In this non -diabetic patient with a normal HbA1c, there are an average of 2 glucose excursions of blood glucose > 7.8 mmol/L per day related to carbohydrate intake, a pattern seen in many similar patients.
For individuals with prediabetes or early glucose dysregulation, CGM can be a powerful educational tool. It helps patients to:
In this programme, CGM serves as both a learning tool and a motivator, empowering you to take control of your food choices with immediate feedback. Our clinic also operates direct access CGM testing with a professional report.
As visceral fat is reduced, it is vital to protect and build muscle mass and strength — particularly for individuals over the age of 50. This requires two key elements:
Most people do not consume sufficient protein for metabolic health. In this programme, we aim for:
Importantly, protein also stimulates your own natural GLP-1 production. That means that over time, your body begins to regulate appetite more effectively — helping you transition off medication.
Muscle does more than move the body — it acts as a metabolic powerhouse. Stronger muscle means better insulin sensitivity, improved glucose control, and greater calorie expenditure at rest.
Even basic resistance training (2–3 times per week) can:
You do not need to join a gym. Simple home-based exercises using body weight, resistance bands, or light dumbbells are a great place to begin. The priority is consistency and progression. We recommend a 10 minute routine at home 5 – 7 days a week as a basic, longterm lifestyle change.
GLP-1 mimetics are a class of medications, typically administered as once-weekly injections, that replicate the action of the naturally occurring hormone glucagon-like peptide-1 (GLP-1). These medications:
For patients with cardiovascular disease or glucose dysregulation, GLP-1–based therapies can offer both metabolic and cardiovascular benefit when used appropriately within a supervised clinical framework.
Within this programme, GLP-1 mimetics are used for a defined period — typically around eight months — alongside sustainable dietary and lifestyle change. Treatment often starts at low (even micro) doses, with gradual dose escalation according to tolerance and clinical response. Importantly, the goal is not indefinite pharmacological weight management. Instead, these agents are used strategically to help reduce visceral fat at the centre of the metabolic “doom loop,” support metabolic resetting, and create a physiological and behavioural springboard for lasting lifestyle change.
Expected outcomes: Appetite reduction, 2–5% waist circumference and weight loss, early visceral fat reduction, improved post-meal glucose responses
Expected outcomes: 5–10% total body weight loss, increased insulin sensitivity, improved energy levels, lowered blood pressure
Expected outcomes: Stable lean mass, reduced visceral fat, better metabolic flexibility, readiness to stop medication
This programme looks beyond the bathroom scales. We track:
There are also options to also track:
Body composition — low dose VAT CT or DEXA scans. Smart scales can provide useful additional data as long as taken in context (GLP-1 mimetics alter muscle glycogen that can disrupt body composition readings).
CGM trends — with fewer glucose spikes after meals.
It is important to note that for older patients, tracking muscle volume may be misleading and can be a poor indicator of good progress, which is why strength, linked to metabolic function is a better metric to track.
No — this is not a “slimming club” or crash diet.
The Metabolic Reset is a clinically designed, time-limited intervention aimed at reversing the biological causes of weight gain, glucose problems, and high blood pressure. By reshaping body composition and restoring metabolic balance, we are not just treating symptoms — we are tackling the root cause.
In many cases, yes — that is the intended goal.
If, by the end of the programme, you have:
…then it may be appropriate to gradually taper off GLP-1 mimetics with minimal rebound weight gain or deterioration in metabolic markers. Any dose reduction or discontinuation is undertaken under medical supervision, with a personalised plan agreed at the end of the programme.
This plan may include ongoing monitoring and, in some cases, intermittent low-dose GLP-1 use triggered by early warning signs of metabolic drift — for example, increasing waist circumference or rising glucose variability.
The key principle is that medication acts as a bridge, not the destination. The aim is to use pharmacological support to create metabolic momentum while long-term habits, muscle preservation, and lifestyle change become the primary drivers of continued success.
There may be periods — such as winter months or festive seasons — when metabolic control becomes more challenging despite best efforts. In selected cases, short-term reintroduction of low-dose GLP-1 support may be considered as part of a structured long-term strategy rather than continuous treatment. For example , over wintertime feasting months when metabolic health can slip despite our best efforts, there may be a need for some temporary return to GLP-1 support. We all know “Dry January”; some patients jokingly refer to a short metabolic reset period as “Jab January.”
Every week I meet patients who feel stuck — in a cycle of weight gain, fatigue, medication, and worsening blood pressure or blood sugar. But your body is capable of change. With the right tools, knowledge, and support, you can rebuild a healthier metabolism.
If you have cardiovascular disease, carry excess weight, or have signs of insulin resistance, you do not need to wait until diabetes develops. This structured reset can change your trajectory.
It is not easy — but it is achievable. And it is worth it.
Speak to your doctor or see our GLP-1 mimetic clinic to discuss:
We are no longer just managing numbers. We are restoring metabolic health from the inside out.
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