Chapter one
What is metabolic health?
Imagine a thread running through your body. It connects your energy levels to your blood sugar, your stress response to your sleep quality, your gut health to your hormones. That thread is your metabolism.
When it holds, you feel like yourself. When it frays, you feel it everywhere, often before tests pick up anything definitive. Many women I see in clinic describe feeling that something is off, without a clear picture of why. That is what this guide is for.
What we are measuring
Metabolic health is assessed through a cluster of markers rather than a single test. These include:
Insulin resistance may show up as one of these markers initially, alongside symptoms such as fatigue, poor sleep, and mood changes. But many people experience metabolic strain before reaching that clinical threshold, often from their late 30s and 40s, and for women more acutely through the perimenopause transition.
How it shows up day to day
You might recognise some of these:
“The thread between these symptoms is almost always metabolic. When we find the root cause, we can address the whole picture rather than each symptom in isolation.”
Chapter two
Why does this happen?
In clinic, I see the same three patterns appearing together, often from the late 30s and becoming more pronounced through perimenopause. I call this the Triad of Dysfunction. It is my clinical framework for understanding how metabolic imbalance develops, not a formal medical diagnosis.
1. Visceral fat
Fat stored around the organs rather than under the skin. Unlike subcutaneous fat, visceral fat is metabolically active. It releases inflammatory signals and fatty acids that directly disrupt insulin signalling. Oestrogen helps direct fat storage away from the abdomen. As oestrogen declines through perimenopause, fat distribution can shift substantially towards the midsection.
2. Insulin resistance
Insulin is the key that unlocks your cells to let glucose in. When cells stop responding to that key efficiently, blood glucose rises, and the pancreas has to produce more insulin to compensate. Over time this becomes a feedback loop. Blood sugar becomes harder to regulate. Energy becomes less stable. Fat storage increases.
What is well established is that nutrition, activity, sleep, and stress all have a direct, documented influence on how your cells respond to insulin.
3. Sarcopenia (muscle loss)
Muscle is the largest site in your body for glucose disposal. The more functional muscle mass you have, the more efficiently your body manages blood sugar. Muscle mass tends to decline from around age 30, a process that can accelerate through and after menopause, partly due to hormonal changes and partly due to reduced activity. This makes strength and movement one of the most important metabolic levers available.
The vicious cycle
These three patterns reinforce each other. Visceral fat drives insulin resistance. Insulin resistance promotes further fat storage. Reduced muscle reduces the capacity to clear glucose from the blood. Poor blood sugar control worsens fatigue, which reduces activity, which accelerates muscle loss.
The thread frays at multiple points simultaneously, which is why addressing one lever in isolation rarely produces lasting change. The RESET framework below addresses all five contributing factors together.
Blood sugar and how it feels
A destabilised blood sugar pattern creates a predictable daily arc. A high-carbohydrate meal or skipped meal triggers a sharp rise in blood glucose, followed by insulin release, followed by a drop. That drop triggers cortisol release, which creates urgency, cravings, and irritability, and signals the liver to release stored glucose, which restarts the cycle.
This is why the mid-afternoon slump, the 4pm craving, and the difficulty falling asleep are so often connected. They are signals from the same underlying pattern.
Chapter three
The RESET framework
RESET is my clinical framework for metabolic recalibration, not a protocol or programme with set rules. Health sits on a spectrum. It is about fine-tuning five interconnected areas over time.
Each lever is both a root cause contributor and a practical intervention area. Turning all five up simultaneously is rarely realistic or necessary. What matters is knowing which ones are lowest for you and starting there. That is what a Root Cause Clinic appointment is designed to identify.
The five sections that follow cover each lever: the root cause, the metabolic thread connection, and the practical steps to reset it.
R · Restore
R — Restore: your nervous system and your joy
Chronic stress is a metabolic disruptor, not only a psychological one. Understanding this changes how we approach it.
The root cause
The stress response is designed for short-term survival. Cortisol mobilises glucose from the liver for immediate energy, raises blood pressure to increase blood flow to muscles, and suppresses digestion, immunity, and reproductive function. Useful in a moment of acute danger. Damaging when it runs continuously at low grade.
Sustained cortisol elevation has a direct metabolic consequence: it releases glucose into the bloodstream even when you have not eaten. That glucose has to go somewhere. If it is not absorbed by muscle activity, insulin manages it instead. This contributes directly to the insulin resistance and blood sugar instability described in Chapter Two.
The metabolic thread: high cortisol tells your liver to release glucose. If your muscles are not active enough to absorb it, the insulin response does the work instead, and that cycle repeats every time you are under pressure.
E · Eat well
E — Eat well: nutrition that stabilises and nourishes
Not restriction, not calorie counting, not diet rules. Eating in a way that keeps blood sugar stable, supports muscle, and fills the nutrient gaps that become more significant after 40.
The root cause
Two patterns drive most of the nutritional problems I see in clinic. First, blood sugar instability caused by eating patterns that lean heavily on refined carbohydrates without sufficient protein, fat, or fibre to slow glucose absorption. Second, widening nutrient gaps as the body’s needs shift through perimenopause and absorption efficiency changes.
Metabolic pairing
The most effective single change most women can make is pairing carbohydrates with protein, fat, or fibre at every meal. This slows glucose release, extends satiety, and prevents the blood sugar spike-and-crash cycle. A metabolically healthy plate looks like this:
Building protein
Adequate protein intake is the most underrated metabolic lever for women over 40. It preserves muscle mass, supports satiety, and has a minimal effect on blood sugar compared to carbohydrate. Aim for 1.6–2g per kg of ideal body weight per day. Small additions throughout the day accumulate quickly:
Key nutrients to prioritise
S · Sleep
S — Sleep: recovery and metabolic repair
Sleep is the period when the body does its most critical metabolic maintenance work. Disrupting it disrupts everything downstream.
The root cause
During sleep, insulin sensitivity resets, growth hormone repairs muscle tissue, cortisol drops to its lowest point, and the hunger hormones ghrelin and leptin recalibrate. When sleep is insufficient or fragmented, all of this shifts simultaneously.
Poor sleep raises ghrelin (increases hunger) and suppresses leptin (reduces satiety signals). The day after a disrupted night, you are metabolically primed to eat more, crave more carbohydrate, and feel less satisfied by what you eat. Research consistently shows that sleep-deprived individuals consume substantially more calories the following day, and that this pattern compounds over time.
Perimenopause disrupts sleep through night sweats, increased wakefulness, altered circadian timing, and changes in deep sleep architecture. This is not something to simply push through.
The metabolic thread: one night of poor sleep can reduce insulin sensitivity by a similar margin to several months of poor diet. Sleep is a metabolic priority.
E · Exercise
E — Exercise: move to manage your metabolism
Muscle is the largest glucose disposal site in your body. Building and maintaining it is one of the most powerful things you can do for long-term metabolic health.
The root cause
Sedentary muscle is metabolically inflexible. Without regular activation, muscle cells become less responsive to insulin. This means more insulin is needed to clear glucose from the blood after meals, contributing directly to insulin resistance.
When muscle is working, the opposite happens. Contracting muscle draws glucose out of the bloodstream independently of insulin, through a separate uptake mechanism. A single bout of resistance training or brisk walking improves glucose uptake for up to 24 hours afterwards.
The metabolic thread: muscle is the metabolic sink. The larger and more active it is, the more effectively it absorbs the glucose that would otherwise remain in circulation.
T · Timing
T — Timing: when you act matters as much as what you do
Your body has an internal clock that governs when it expects to eat, move, rest, and repair. Working with that clock rather than against it is one of the least-discussed and most impactful metabolic levers.
The root cause
The circadian system controls the timing of insulin secretion, cortisol rhythms, melatonin release, gut motility, and cellular repair processes. It is calibrated primarily by light and food timing. When your external cues are inconsistent, the internal clock drifts.
A misaligned circadian system makes you more insulin resistant in the evening than in the morning. The same meal eaten at 8am and at 8pm produces a meaningfully different blood glucose response, with the evening meal producing higher and more prolonged elevation. This affects when to eat your largest meals.
The metabolic thread: your cells are more receptive to glucose in the morning and less receptive in the evening. Eating in alignment with that pattern reduces the metabolic cost of the same food.
Your first week
My first 7 days
The most important thing about the first week is that you start. Not perfectly, not all five levers at once. Start with the lever that feels most accessible and let one win build on another.
RESET 7-Day Tracker
A printable weekly tracker — one tick per lever, one day at a time. Print a fresh copy each week and keep it somewhere visible.
Download tracker ↗The RESET self-assessment
RESET Self-Assessment
Five statements, one per lever. Rate each on a Never–Always scale. Repeat weekly — over time you will see the shifts in your metabolic health more clearly.
Download self-assessment ↗“Metabolic health can always be improved. You don’t need to be perfect, just consistently nourishing yourself as best you can.” — Dr Rebecca Hiscutt
Important
When to seek medical help
This guide is a lifestyle resource, not a substitute for medical care. There are symptoms that warrant a conversation with your GP regardless of what your lifestyle looks like.
Speak to your GP if you experience:
- Unexplained significant weight loss
- Persistent fatigue that does not respond to lifestyle changes over several weeks
- Chest pain, palpitations, or shortness of breath at rest
- Severe or worsening low mood, anxiety, or panic
- Irregular or very heavy periods beyond typical perimenopausal variation
- Any sudden or dramatic change in symptoms
- Symptoms that feel new, alarming, or that you cannot explain
Please contact your GP.
Ready when you are
Ready to find your root cause?
This guide gives you the framework. A Root Cause Clinic appointment gives you the specific picture of which levers are most relevant to you right now, and the actions most likely to move them.
The Root Cause Clinic
30 minutes, one focused issue, a personalised health action plan you leave with. Dr Rebecca Hiscutt, PhD Dietitian and Metabolic Health Specialist. In person at The Beacon Hub, Portishead, or virtually.
Launch offer: from £48 for March appointments. Regular price £60 from April.
Bookings online only. A short questionnaire goes out ahead of your appointment so every minute counts.
Book a clinic appointment
rootcauseclinic.co.uk