The Metabolic Health Hierarchy by Ricky Du Plessis
A Biology-First Framework for Real Health
When it comes to health, most of us will not ‘bat an eye’ at the notion of having to sort out our nutrition and exercise – these two lifestyle factors are widely accepted as being pivotal parts of the ‘health equation’, but are they the full picture? It has been my experience that they are in fact not…
The phrase “eat less – move more” will be widely familiar, but as anyone who has truly walked down the myriads of metabolic health rabbit holes will be able to attest to; it’s not quite that simple or straightforward and there’s many factors at play…
Over the last 7-years of going down the various rabbit holes in pursuit of correcting my own health and all the associated self-experimentation with lifestyle change, I have developed what you might describe as a deep passion for metabolic health and the lifestyle factors involved – especially the science which explains not just ‘what works’ but unveils the mechanisms of ‘how and why it works’ – it absolutely fascinates me!
By far the most powerful lessons I have learned so far are that:
Human metabolic health is far more complex than just diet & exercise…
The numerous lifestyle factors which influence human metabolic health may all be helpful, but they are certainly not all equal.
People tend to get easily distracted by the ‘sexy’ new stuff and neglect the ‘less sexy’ fundamentals.
There’s tremendous utility in understanding how best to structure lifestyle approach for optimal metabolic health outcomes.
My fascination has led me on to continue learning as much as I can about the fundamentals, which I have come to conceptualize and refer to as “The 5-Pillars of Metabolic Health”, something I have published about a fair bit. In fact, “The 5-Pillars of Metabolic Health” are the focus of my upcoming book which I am aiming to have published in the summer of 2025.
However, I also kept coming back to the 4 lessons above and wondering “what is the best way to go about deciding what to do & when” and this has led me to develop my “biology-first” perspective, which was the subject of last week’s article, as I believe if people appreciate and approach lifestyle factors in a biology-first logical sequence, they stand the best chance to achieve optimal health outcomes.
What If We’ve Been Looking at Health Upside Down?
The health world loves complexity but complexity without a logical guide is confusing and less than useful... People love gadgets, diagnostics, trends, therapies and biohacks. They throw layers of technology and tracking into their strategies while quietly letting go of the biological basics - the things our species actually evolved doing and still need as part of our fundamental daily inputs.
Modern health thinking is obsessed with optimisation but rarely asks what normal should be in the first place. So, I have stepped back and started re-examining everything through a different lens - not what’s trendy, but rather what’s biologically true and necessary because it has been with us since time immemorial…?
What has emerged from that shift in thinking is a concept I call the “Metabolic Health Hierarchy” - the four-level framework depicted below which I have created which is inspired by Maslow’s Hierarchy of Needs and aims to help people rebuild their health by focusing on what matters most, in the order which makes the most sense through a “biology-first” lens.
The Core Idea: Start Where Your Biology Starts
Maslow laid out a simple truth: humans are layered beings, and we need to have the fundamentals (things like food, water, sleep, and safety) sorted before we can worry about the higher order things like self-expression or meaning… In fact, he demonstrated quite clearly that when those foundational needs go unmet, everything else starts to wobble and fall apart.
Maslow’s hierarchy has stood the test of time and proven true and you know what - human metabolic health works in the exact same sort of way – there are fundamentals we must have in place because our very biology require and expect these…
At its core, your body is always scanning for inputs - environmental signals that tell it:
What to do?
What time it is?
Whether you have moved?
Whether you are fed?
Whether you are safe?
Whether you are exposed to light?
Whether your nervous system should be calm or on edge?
These signals, both by their presence or absence, shape everything from inflammation to immune function to fertility to cognition to fat storage, etc. - they are the foundation upon which everything else that you are is built.
That’s why my Metabolic Health Hierarchy puts those inputs at the base of the pyramid and why everything else, from supplements to saunas to wearables, stacks on top of that base - let’s walk through it and help you see the biology-first logic fold out.
Level 1 - The 5 Pillars of Metabolic Health
This is where the real work begins - this is where healing happens.
These five pillars are what I call biological expectations. They're not wellness fads and are not optional - they are the default environmental conditions your body evolved in and still depends on.
Nutrition – Species-appropriate, nutrient-dense food that supplies what your cells actually need: not just energy, but essential amino acids, fatty acids, vitamins, minerals, cofactors. Modern processed diets are energy-rich but nutrient-poor, creating metabolic confusion and hormonal dysfunction (Monteiro et al., 2019; O’Hearn et al., 2022).
Movement – Not exercise as punishment, but natural movement throughout the day. Walking, lifting, squatting, carrying, playing - movement is a metabolic necessity. It enhances insulin sensitivity, improves mitochondrial function, sustains bodily function, and regulates appetite and energy (Booth et al., 2012).
Sleep – Deep, consistent, high-quality sleep underpins everything from hormone regulation to cellular repair to emotional stability. Sleep disruption is strongly linked to obesity, insulin resistance, and chronic inflammation (Spiegel et al., 2009).
Light – Sunlight exposure regulates circadian rhythms, boosts mood via serotonin pathways, and triggers vitamin D production and much, much more (Czeisler and Gooley, 2007; Buxton et al., 2012).
Grounding – Direct skin contact with natural earth surfaces regulates inflammation, improves sleep, and rebalances autonomic nervous system function (Chevalier et al., 2012).
These aren’t fringe concepts - these are the environmental and lifestyle conditions human physiology was built under and if you ignore them, it doesn’t matter what else you try, your results will be suboptimal because your biology is starting from place of deficit.
Level 2 - Enhancements
Once the 5 pillars are in place, enhancements help you stay aligned in modern life.
We don’t all live in pristine environments, some of us live in high-rises, work night shifts, or have nutrient deficiencies due to past damage. This level is about meeting the pillars halfway when the natural option isn’t available and using modern advancements to aid, rather than replace or distract.
Light therapy boxes when sun exposure is limited.
Grounding mats if you can’t get barefoot outdoors.
Magnesium, iodine, or organ meat supplements to close known nutritional gaps.
These aren’t magic pills – they are practical bridges that let you continue honouring biology, even when your environment doesn’t cooperate, and they emphasise the fact that the 5-pillars are foundational, not optional!
Level 3 - Modern Biohacks
Now we move into the territory of performance enhancement.
This is where things we have learned to do and/or invented which are separate from the 5-pillars, but still helpful fit in - things like:
Cold exposure.
Sauna therapy.
Intermittent fasting.
Breathwork.
Ketone esters.
These do not replace the fundamental biological need for the 5-pillars, but they do help take your physiology beyond baseline - these are add-ons, not foundations.
Biohacks can’t fix chronic sleep debt.
They can’t undo ultra-processed eating.
They don’t override misaligned circadian rhythms.
They work their best when the pillars underneath are solid.
That’s the mistake most people make – they want to ‘hack’ their way out of dysfunction, but understanding the hierarchy helps you avoid this mistake.
Level 4 - Tech-Enabled Optimisation
At the top of the pyramid are the refinement tools - technology-driven systems that help you personalise and optimise what’s already working.
This might include things like:
Continuous glucose monitors
HRV trackers and wearables
AI-driven health dashboards
Peptide protocols and advanced diagnostics
This is where you dial in the margins but again, only once the fundamentals are solid.
If you’re living on convenience food, barely sleeping, and indoors under artificial light all day, then a £300 smartwatch isn’t going to change your health... It might help make you ‘more aware’ but it won’t fix anything.
That’s why the hierarchy is important: it restores order to help you sequence your efforts in a way that makes biological sense and is best placed to yield optimal outcomes because it honours your biology instead of trying to ‘hack’ it...
Why This Model Works
The bottom line is that your biology doesn’t care about trends - it cares about signals.
Your metabolic system is a reactive, responsive, adaptive network and it doesn’t respond to ideology, fads or trends - it responds to the foundational inputs which shaped it over eons.
This hierarchy simply says: “start where the inputs start and give your body what it expects!”
Remove the noise.
Build from the ground up.
Then, optimize from a solid foundation.
Build the engine first - don’t waste time or effort polishing the mirrors on a car that won’t run…
This is Biology-First Thinking
My Metabolic Health Hierarchy is more than just another framework - it’s a way of seeing metabolic health with purpose and in pursuit of optimal outcomes!
It’s a call to return to what makes us human and to remember that health isn’t built in labs or apps, but in alignment with the environment & lifestyle factors which shaped our species over eons.
So, if you are tired of chasing fixes that don’t stick, and you are ready to reclaim what your body’s been trying to tell you… Start here!
Start with the Metabolic Health Hierarchy and honour your biology first, before then building up from there in pursuit of optimal.
Lay the foundations right – Biology first!
References
Booth, F.W., Roberts, C.K. and Laye, M.J. (2012) ‘Lack of exercise is a major cause of chronic diseases’, Comprehensive Physiology, 2(2), pp. 1143–1211.
Buxton, O.M. et al. (2012) ‘Adverse metabolic consequences in humans of prolonged sleep restriction combined with circadian disruption’, Science Translational Medicine, 4(129), 129ra43.
Chevalier, G. et al. (2012) ‘Earthing the human body influences physiologic processes’, Journal of Environmental and Public Health, 2012, Article ID 291541.
Czeisler, C.A. and Gooley, J.J. (2007) ‘Sleep and circadian rhythms in humans’, Cold Spring Harbor Symposia on Quantitative Biology, 72, pp. 579–597.
Mattson, M.P. et al. (2017) ‘Impact of intermittent fasting on health and disease processes’, Ageing Research Reviews, 39, pp. 46–58.
Monteiro, C.A. et al. (2019) ‘Ultra-processed foods: what they are and how to identify them’, Public Health Nutrition, 22(5), pp. 936–941.
O’Hearn, M. et al. (2022) ‘Trends and disparities in diet quality among US adults by supplemental nutrition assistance program participation status’, JAMA Network Open, 5(5), e2210120.
Spiegel, K. et al. (2009) ‘Sleep and metabolic function’, PLOS Medicine, 6(10), e1000167.
Nice overview! I like the visualization, I just think that the great opportunity in healthtech right now is to make the "general population" way more conscious and aware of their behaviour. I agree that most healthtech wearables, like Whoop and Oura, are targeted towards the healthy population that already had the basics under control. But to change behaviour, you need to be aware of that behaviour first, and I think that is something healthtech could play a big role in! So the pyramid might become a circle soon :).
If you're interested, I write about nutrition, gut health and how AI can help us optimize our health; https://maudkarstenberg.substack.com/p/tech-driven-nutrition-using-chatgpt?r=5jzxka
Great article Ricky. I can definitely sign under the overriding tenet of your approach as well as the majority of details. And I wish I had thought of the pyramid myself!