Lecture 40 in Dr. Bikman’s Metabolic Classroom
Dr. Ben Bikman
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In today’s Metabolic Classroom, the discussion centers on addressing insulin resistance, marking the final part of a series that viewers are encouraged to catch up on if they haven’t already. Previous episodes have delved into the nature, origins, and implications of insulin resistance, highlighting its association with various diseases. Despite the somber tone of these revelations, the current discussion offers a ray of hope by focusing on solutions to this pervasive issue, emphasizing its solvability and preventability.
Before delving into strategies for combating insulin resistance, Dr. Bikman takes a moment to outline methods for assessing one’s own insulin resistance status, recognizing limitations in traditional approaches that solely focus on glucose levels. He stresses the importance of understanding insulin’s broader role beyond glucose regulation, highlighting the significance of elevated insulin levels as an early indicator of resistance. The discussion moves to practical considerations, such as interpreting fasting insulin levels, with values below six suggesting insulin sensitivity, while higher readings may indicate varying degrees of resistance, requiring further evaluation.
Learn more at: https://www.insuliniq.com
#insulinresistance #metabolicsyndrome #metabolichealth #type2diabetes #type1diabetes #weightloss #intermittentfasting #intermittantfasting #fasting
Transcript
0:01good day everybody who is joining me today for the metabolic classroom the
0:06discussion that we have today is continuing and indeed It’s the final part of our discussion about insulin
0:12resistance uh to this point in the previous episodes which you definitely need to listen to or watch if you
0:18haven’t yet we introduced uh uh this topic and you are now more familiar
0:25having watched them or listened to them on what insulin resistance is and and
0:30where it comes from and uh why it matters namely all of the diseases that
0:35it contributes to and we did a kind of overview of some of the big ones and then as sobering as all of that is we
0:42end with a bit of a happy uh ending which is today’s discussion on what to
0:48do about it so as much as we’ve been discussing the problems with insulin resistance the scope the the prevalence
0:54and relevance if you will uh now it really is the resolution which is um comforting because because it is
1:00something that is so solvable or even so preventable now so the focus of today’s
1:07class is really um how to how to fix insulin resistance but before I discussed that I thought I would take a
1:14few minutes to share with you ways that you could just know where you’re at with regards to your insulin resistance um
1:22just a generally kind of helpful overview where you may be listening to this and not
1:27know um your own insulin resistance or the insulin resistance um state of the
1:34loved one that you have in mind as you’ve been listening to these discussions so firstly let me just um
1:41revisit a topic um that we discussed earlier namely the problem with the
1:46traditional view of insulin resistance the traditional view of insulin resistance is very glucose
1:53Centric um because we have assigned the hormone insulin to having no more
1:58relevance than than diabetes we purely look at it through the lens of glucose
2:05and so most conventional clinical tests that are attempting or speculating on
2:12the nature of insulin resistance or pre-diabetes which is the same thing are only looking at the glucose the problem
2:18with that view is that remember insulin’s most famous job but not its
2:24most important insulin does all kinds of important things and many critical things insulin most famous effect is to
2:32correct what is a steady increase in insulin sorry glucose so if glucose is
2:37going up insulin will sense this it will be mobilized it will come up and then
2:43open the doors of cells throughout the body allowing the glucose to come down which then uh allows the insulin to come
2:49back down uh but they’re not the same thing glucose is not insulin insulin is
2:55not glucose that seems very obvious um but even still there’s this weird uh
3:01inability to disconnect the two ideas where it’s important for you to remember
3:07that insulin resistance is a state where insulin is elevated that says nothing
3:13about the glucose we don’t know what the glucose is in fact glucose can be normal
3:18and therein lies the rub that’s the problem right if we have a glucose Centric Paradigm of insulin resistance
3:24it’s possible that the individual that we may be moving through the years get
3:29an annual blood test and we are measuring our only ever our glucose and the glucose is staying normal all the
3:35while insulin is getting higher and higher and higher working harder and harder in an effort to keep the glucose
3:41in check but it is doing it and then it’s only once the body becomes so
3:47resistant to its insulin that even though insulin is still multiples higher than it should be now the glucose starts
3:53to climb and now we detect the problem 10 or even 20 years after the insulin
4:00had already been fighting so insulin is the more sensitive signal it’s the canary and the coal mine if you will it
4:05gives us the earlier warning now that brings us back to
4:11measuring uh what are the actual tests now that we can measure um uh to
4:16determine your insulin resistance State one of them is fasting insulin uh insulin is a marker of insulin
4:23resistance ideally that number is less than six in a fasted state so if you’re
4:29doing a 12ish hour fast you would love for that number to be six micro units
4:34per Mill I’m of course in the US so I’m giving us units you can convert to pees
4:40as needed and I believe the conversion would be around 30ish or or high 20s maybe 27 peao um for those outside the
4:48US um so six micro units per Mill now however what if it’s a little higher
4:54than that what if it is up to the mid teens for example so I kind of have this
4:59other cut off which is a little you can be a little loose with this but if someone has a fasted insulin between say
5:067 to 17 or so that doesn’t necessarily mean they’re insulin resistant now why
5:12do you ask um elevated insulin is a sign of insulin resistance it’s because insulin has a rhythm to it like so many
5:20hormones do not all hormones but many insulin will it will it’ll EB and it’ll
5:26flow throughout the day and it’s entirely possible that you get your insulin your blood drawn at a moment
5:32when insulin was starting to climb up a little bit for example insulin will climb in the morning and then it may do
5:37so again in the midafternoon just as a n even in a purely fasted State it’s just part of its
5:43Rhythm um now that I mentioned that second kind of category if insulin is
5:48six or below that’s a really good sign that you’re insulin sensitive if it’s in that intermediate realm 7 to 17 that
5:55suggests there’s a problem but not absolute and then if it’s High Teens 18
6:00and above it’s very likely that you are in fact insulin resistant and you’ve detected a true problem there now what
6:08if it is in that middle range in fact even if it isn’t we don’t need to stop with just fasting insulin insulin is
6:14volatile it changes so are there markers that are a little more stable there are albeit now we get into the realm of a
6:20little indirect with this one but it is surprisingly accurate and that is the
6:26triglyceride to HDL ratio the glyceride divided by HDL number so you take your
6:32fasted triglycerides which you get at every blood test that’s the benefit of this it’s not common to get insulin
6:38measured at a blood test whereas we always will get our lipids measured so you look at your blood test and you see
6:44your triglycerides and then you divide triglycerides by the HDL number and you
6:49always get HDL cholesterol that will give you this ratio and if it is less than
6:551.5 that’s a really good sign if it’s a above 1.5 that starts to get into the
7:02realm of being Troublesome it’s a little problematic um so you’d want to be a little more cautious and assume that you
7:09have some degree of insulin resistance so that’s the triglyceride to HDL ratio now the last test that I want
7:17to mention remember and we’re all just s of kind of framing the conversation of how to fix insulin resistance but again
7:24my purpose in having this bit of a pre quill tangent is to help you understand
7:30where you’re at the last one is my favorite one which is called the atpo IR
7:36score atpo just for adapost so it’s the adapost insulin resistance score this is
7:43a test that is looking at the insulin resistance at the fat cells now why does
7:49that matter do you recall from our earlier conversation of the tissue that I said likely starts insulin resistance
7:57throughout the body when you have this progress iive and uh steady insulin
8:02resistance that’s creeping into the person’s life throughout the years I submit that it’s the fat tissue that
8:08becomes insulin resistant first and thus if you have a way of determining insulin
8:13resistance at the fat tissue then you are detecting it potentially at its earliest possible stages that’s what the
8:21atopos insulin resistance score will tell us now something that’s so interesting about this is just the
8:27Elegance of the biochemistry of what’s Happening the fat cell or the the biology of the fat cell now we know that
8:33the fat houses fat cells house this big droplet I mean relatively big
8:39microscopically big but big by cell standards a big bubble of fat if you will an insulin is largely the signal
8:47not the only one but is a primary signal that’s influencing the growing or the
8:52shrinking of that what’s called a lipid droplet that big bubble of fat within the fat
8:58cell if insulin is elevated it is preventing the fat cell from breaking
9:04down its fat through a process called lipolysis insulin inhibits lipolysis now
9:10the product of lipolysis or the evidence of lipolysis in the blood is something
9:16called free fatty acids also sometimes referred to as nonesterified fatty acids they’re the same thing ffas or nefas
9:24it’s the same I’m just going to call them free fatty acids to cut out a couple syllables for the sake of the
9:29discussion so if insulin is elevated free fatty acids should be down because
9:35insulin’s inhibiting lipolysis in contrast if insulin is down through say
9:41a fasted state or low carb diet then You’ expect free fatty acids to be higher because insulin is not present to
9:48inhibit lipolysis and that’s indeed what you’d get uh so high insulin should be
9:55leading to reduced free fatty acids low insulin would lead to elevated free fatty acids that’s what this test is
10:02attempting to determine the two parts of this formula is fasted insulin and
10:09fasted free fatty acids now measuring free fatty acids is not common it can be done but it is not a common test so
10:16you’d have to either go in and pay for it directly at lab core or Quest or something um or convince your clinician
10:23to check that box and hope hope your insurance will cover it but it’s a fascinating test um one of the reasons
10:30I’m so fascinated in it is it’s its sensitivity of actually indicating metabolic problems now I’m going to come
10:36back I’m not done with this but as an example one of the very first papers I ever saw that used this study was
10:43looking at the degree of insulin resistance in healthy in otherwise healthy women who had PCOS so they had
10:50women with in without with and without polycystic ovary syndrome the most common infertility and it’s metabolic go
10:56to the previous lecture metabolic classroom and listen for more details on that we talked about it in more detail
11:02so two groups of ladies controlled for age and even body weight and body fat so they were the same overall body type and
11:10yet and and in the women with PCOS in this particular study they did not detect they did not see signs of whole
11:17body insulin resistance but when they looked at the fasted insulin in combination with the fasted free fatty
11:25acids then or in other words the atpo IR score they detect a significant increase
11:30in these in these women with PCOS so the insulin resistance wasn’t even manifesting at the level of the whole
11:36body but it was evident at the level of the first tissue that becomes insulin resistant namely the fat tissue so if
11:44you gotten those numbers fasted insulin in micro units per Mill and the the the the units are important here so micro
11:52units per Mill and you multiply that number fasted insulin and micro units per Mill times free fatty acids in Millo
11:59now thankfully that’s going to be Millo anywhere in the world so that’s going to be a pretty consistent unit and you want
12:06that number to be below a certain cfff but it’s different for men and women now
12:12another little tangent here to explain why at any given moment women will have
12:18a free fatty acid level in her blood that can be up to 40 or even 50% higher
12:23than it is in a man so if a man is manifesting with um a free fatty acid of
12:29one Millar his healthy female counterpart is very likely going to be one and a half Millar free fatty acids
12:36women are constantly mobilizing fat from her fat cells much more than her male
12:42counterparts and that’s entirely a product of sex hormones particularly the
12:47estradiols um or sorry estrogens estradiol being the main one the estrogens estrogens are promoting this
12:54higher rate of turnover of the fat cells so at any moment there’s more fat coming out of the fat cell and indeed at any
13:00moment a female is burning more fat this will be the topic of another of a future
13:06metabolic classro um but suffice it to say women are fat burning machines relative to her male counterparts now of
13:12course the woman is rolling her eyes thinking well why do I have more fat because you’re also putting more in to
13:18those fat cells but again you’re taking more out so there’s that’s where I what I meant by the higher turnover more
13:24going in but more coming out and that’s evidenced as the higher free fatty acids
13:30so what are the cut offs in a man that atpo IR score is ideally less than five
13:38if his atpo IR score is less than five that suggests that his fat tissue is
13:44insulin sensitive in a woman that cut off is eight it’s higher she has a
13:49little more room there because her free fatty acids are naturally higher men and women will have generally similar levels
13:54of insulin um but when it comes to free fatty acids no not similar females will
14:00be higher because they’re fat burning machines because of the estrogens and so her atpo IR score has to account for
14:07that and thus the cut off is higher so women if it’s less than eight thumbs up your fat tissue is insulin sensitive men
14:15if it’s less than five thumbs up high five you’re doing well okay so those are some tests maybe a final one if you
14:23don’t want to wait for um getting any kind of blood draw because all of these are dependent on a blood draw and maybe
14:28don’t have access to that or you don’t have the data on hand there’s a bit of a quick and dirty
14:34way as well but emphasis on dirty because it’s going to be very very indirect but one is simply do you have
14:40high blood pressure if you have high blood pressure it’s very likely you have insulin resistance I know that’s a very
14:46kind of dramatic statement for what’s a fairly common problem but it really holds true um or you can do some
14:53circumference measurements measure the biggest part around your belly and if you multiply LLY that number by two and
15:01if that number is higher than your height that’s a problem let me say that
15:07again in a slightly different way measure your height and measure your waist circumference times two if your
15:13waist circumference times two is a bigger number than your height that suggests you’re storing fat in a healthy
15:20way and you like and it would likely be contributing to insulin resistance if your height is a bigger number than your
15:27waist circumference times two that suggests that you’re likely doing fine all right now let’s really dive
15:34into the solutions here um firstly let me just remind you of the three primary causes of insulin resistance stress
15:41inflammation and hyperinsulinemia when I introduced those three in an earlier classroom I
15:48emphasized how the problem with stress and inflammation is that it can be difficult
15:53to change those numbers because you don’t know what’s causing them let’s say you measured your EP nephrine or
15:59adrenaline and or your cortisol a stress hormone markers and you had a marker of inflammation like C reactive protein and
16:05it was high you might not necessarily know how to lower them it’s not clear what’s contributing to them so just for
16:11the sake of time I’m not going to spend too much time on those um other than
16:16perhaps to say when it comes to stress very very often poor sleep is going to
16:22be the main aggravator if it’s not sleep then it’s likely going to be excessive caffeine consumption can increase your
16:29epinephrine or adrenaline numbers so perhaps a reason to focus on sleep um
16:34and better sleep habits and be mindful of your caffeine consumption all right now the elevated
16:41insulin this is the one to focus on because it can it can yield such immediate results now in talking about
16:49the elevated insulin I wanted to frame this in a bit of a a bit of a metaphor
16:55where if we think of an insulin sensitizing lifestyle change we can think of it as a
17:02journey and a as we stand at the beginning of this journey with the end result being I want to reduce my insulin
17:10um or or or to say that another way the end result being I want to shrink my fat cells because remember
17:16Progressive um path pathogenic insulin resistance is usually starting at the fat cell because the fat cells are
17:22growing too big they’re undergoing hypertrophy so the solution then simply well simple in concept if not practice
17:29is to shrink those fat cells so there we are at the beginning of this fat cell shrinking Journey we have 2 feet we can
17:37take one of two steps first each of these steps could be reflected in two different ideas namely calories and
17:46Insulin the traditional view of improving insulin sensitivity through shrinking fat cells or weight loss is
17:53the caloric view namely eat less exercise more so that’s the first step step that most people take with no
18:00regard on insulin but let’s say the person is going into this journey with elevated insulin as virtually all of
18:06them would be and if if you take a first step we reducing the calories coming in
18:13is the first step and insulin is not dropping quickly that creates a bit of
18:18an energetic crisis for the following reasons if less energy is coming in and
18:24insulin is still elevated then insulin is pushing what ever energy is available
18:29in your blood out of your blood pushing it to be stored in tissues throughout the body like fat tissue like muscle
18:37tissue like liver Etc all of these tissues that are now being told to store the energy unfortunately the brain
18:44doesn’t store energy it really needs to rely almost constantly on any energy that’s being provided from the blood
18:51what in other words what are the calories in the blood that can feed the brain and if less calories are coming in
18:56but insulin is a little sticky and it’s staying elevated because you’re just dropping your fat consumption to lower
19:02calories but you’re still eating plenty of carbs because they’re lower calorie which is what everybody does on a low calorie diet it’s always cut the fat
19:10which uh won’t affect um insulin at all and focus on the carbs which will increase insulin so they are restricting
19:18calories coming in but in the presence of high insulin The Limited calories that are available in the blood are
19:23being pushed into cells and so the brain who must constantly rely on the blood blood for its energy is looking at the
19:30reduced energy in the blood and it panics and it starts to tell the body
19:35you need to eat in other words it stimulates hunger now let me just I in
19:41the midst of this metaphor of a fat cell shrinking journey in which Step is first let me introduce another metaphor so
19:47we’re going one level deeper um or just an example here let’s imagine that I am
19:52inviting all of you listening um to a dinner we’re going to meet and we are
19:57going to be be fed by the world’s most famous chefs preparing the most delicious foods and as I’m inviting you
20:05to this dinner I want you to be able to try all of it and so I say to one and all come hungry because you’re going to
20:12want to eat some of everything what would you do to come as hungry as
20:18possible to this Grand and beautiful Buffet I submit you do two things in the
20:25days before this beautiful Buffet you would eat a little less and you would
20:30exercise a little more and it would work you would come hungry eating a little
20:35less exercising a little more would be the perfect recipe to come to my Grand Buffet as hungry as possible but do you
20:42see the problem that’s also the two pillars that’s the the two um pillars of
20:48strategy that has existed since uh for 50 or 60 years on how to lose weight or
20:53how to shrink fat cells every professional will tell this person who’s trying to shrink their fat cells you
20:59need to eat less and exercise more the problem is is because the consequence
21:05will be the same thing as is as would happen in the example I’m presenting which is you coming and meeting me to
21:11eat as much as we can you’re going to be as hungry as possible it’s going to stimulate ever more hunger and thus you
21:19will fail um last part of that how many times have you guys seen a reunion tour
21:25for the contestants on that morbid game show the biggest loser you don’t these
21:31people don’t they don’t put them back on screen you don’t see them again because they gain it all back um that can be a
21:37topic for another time the metabolic consequences of the severe restriction that they go through actually have
21:43lasting effects and they’re negative unfortunately they’re negative consequences to that so back to the fat
21:51cell shrinking Journey if the first step is immediately pushing down the calories
21:56without addressing the insulin it’s going to be a very short Journey you’ll get you’ll get a little down the road
22:02you’ll lose some weight shrink some fat cells but inevitably you’re going to find yourselves back at the beginning
22:07and maybe even 10 yards further back than you were at the start so keep that foot firmly planted don’t worry about
22:14calories let the first step be I’m going to lower my insulin now if you lower insulin why
22:22don’t you have to focus on calories you well you have some adaptations that begin to occur as insulin comes down
22:29your body is now a little looser with all of its stored energy it is now in fact mobilizing more energy to be burned
22:36so the brain has an abundance of energy it has sufficient glucose because the liver is providing everything else that
22:42you’re not getting from your diet and now all of a sudden it has access to all these beautiful ketones remember ketones
22:48are simply products of fat burning and if insulin the very first a metabolic classroom in this sort of re-released
22:55version we spoke about metabolic flexibility and how it’s insulin that dictates whether your body is sugar
23:00burning or fat burning if insulin is low and you’re fat burning you may start you may get to a point where you’re burning
23:06so much fat that you start creating ketones from that fat and again the brain loves ketones if the brain has any
23:13preferred fuel it is in fact ketones not glucose so the we have this state where
23:19the brain is very adequately fed um no no Panic signal no signal to try to
23:25increase the energy of the blood and thus reduced sense of hunger so the person has greater satiety but at the
23:31same time when insulin is down you not only are you have an elevated metabolic
23:36rate so low insulin means higher metabolic rate insulin suppresses the metabolic rate it wants to reduce the
23:43idle of your metabolic engine so when insulin is down the engine just starts revving up a bit it’s like you’re
23:48starting to press the metabolic accelerator of that metabolic engine so uh that’s one and then the
23:55final part of it is when you start creating ketones remember remember ketones have a caloric value um and you start excreting them
24:02from your breath and from your urine so every breath as you’re breathing out ketones every urination when you’re
24:08urinating out ketones those are Cal caloric were once caloric molecules that
24:14would have otherwise had to be burned or stored not anymore now you’re just wasting energy which is good if you’re
24:19trying to shrink fat cells that are overfilled with energy now how can you lower insulin if that is the step you
24:26want to take that’s a little easier said than done you’ve heard me give these three pillars before and they’re always
24:32worth emphasizing if for no other reason then they just roll off the tongue so well first control carbs this is I put
24:41it first because I deem it the most important you you want to make sure you’re whatever carbs you’re getting uh
24:47that you’re focusing on sources that are not coming from bags and boxes with barcodes whole fruits and vegetables eat
24:53them don’t drink them are generally going to all be good there’s different levels we could could go with different depths and and defining that a little
25:00more clearly depending on the beginning but just at its simplest form just control carbs eat fruits and vegetables
25:06and enjoy them liberally next prioritize protein make sure you’re getting abundant high quality which means and
25:14preferably animal Source protein every day third don’t fear fat in particular
25:20Don’t Fear The Fat that comes with the protein in nature there is no exception
25:26to this every protein comes with fat don’t be afraid of it we I understand we
25:32have a fat phobic culture now you need to reject it fat is not only essential we need it there are some fats that are
25:38necessary for human survival but they also have no effect on blood sugar or blood insulin so it’s a nice nourishing
25:45option you have to get over the fear of fat especially the fat that comes with protein so those are the three steps
25:51control carbs prioritize protein don’t fear fat that will really help you lower insulin so that is that insulin step
25:57that really moves you down the journey very very far indeed that step alone only focusing on lowering insulin never
26:04worrying about calories may be sufficient for anyone listening to shrink their fat cells as much as they
26:09need to and as much as they want to and some people they may Plateau a little earlier
26:16than they’d like by focusing only on the insulin they’ll get some benefit indeed maybe a
26:21lot but they know they got a little further to go now you are ready to take that other step that other foot that’s
26:27been so firmly planted and you just had one really big step that got you farther down the road with the insulin uh
26:33lowering now you can take that next step which is addressing the energy explicitly usually the energy corrects
26:40itself for reasons I mentioned earlier that when insulin’s low your body is using its own stored energy all of those
26:46energy bars if you will that you’ve had stashed away in your fat cells are finally being opened up to be used which
26:52is what they’re there for so sometimes people will begin restricting their they’ll have greater TIY and start
26:58eating less just on their own without even doing it deliberately indeed that is what usually happens but if you need
27:04to now you can explicitly address the energy part of it but don’t do so by
27:10counting calories do so rather by structured fasting so that’s that fourth part of
27:16the three parts I gave earlier the fourth could be frequently fasting and
27:22that can take any form um we’ll have more discussion in the future about specific versions of fasts but suffice
27:28it to say a period of structured fasting and then eating can be a very very good way to overall restrict energy in a in a
27:35healthy way um now one comment on that though uh is that um fat uh with with
27:45fasting how you end a fast is more important than how long you fast so the
27:53Temptation is to obsess over a 48 hour fast or something like that and then you
27:58get so hungry that you just binge and then you stuff yourself full of food that came from likely bags and boxes
28:04with barcodes and you feel miserable mentally and physically uh and that
28:11basically leads into a disordered eating pattern of of almost kind of a binge Purge um cycle you don’t want that so
28:18how you end your fast matters more than how long you fast have a very specific meal plan in mind for when you are um
28:26ending your fast now let’s talk a little bit about exercise um to kind of wrap it up
28:33exercise is very important at improving insulin sensitivity one primary reason for this is it really lowers insulin
28:41when you exercise insulin is antithetical to what the body’s trying to do metabolically when you’re
28:46exercising you want to be moving or mobilizing and burning energy insulin upor mobilizing and burning energy it
28:54only wants to store energy and thus it’s no surprise as the body starts to demand
28:59exercise insulin will Retreat into the background knowing that it’s not its turn to be active the body needs to use
29:06the energy insulin Retreats and so it will lower insulin also remember the main stimulus for insulin is elevated
29:13blood glucose and the nice thing about exercise is that muscle is the main
29:18consumer of glucose so muscle is in other words the
29:23the most hungry tissue that up to 80% of the clearance of glucose from the
29:30blood after a meal is glucose that’s going into the muscle so the muscle eats the Lion Share of glucose from the blood
29:38and so when you’re exercising the muscles are eating a lot of it and that lasts for several hours after exercise
29:45and then if you happen to be engaging beyond the acute benefit over a day or
29:50so of improving insulin sensitivity with exercise if you are increasing your muscle mass now at any given moment you
29:57have more of these mouths to feed and and the muscle will greedily pull in and
30:03use glucose every time you’re moving them and the nice thing is when you move the muscle it doesn’t need to rely on
30:09insulin to eat the glucose in a rested state if you’re sitting down now any
30:15glucose that would be going into your muscles would be doing so because insulin comes and knocks on the door most especially if you’re listening to
30:21this in a postprandial state or a state after you just ate then insulin goes up it then Knocks on the door of the muscle
30:28cells in particular and and a few others and opens those doors to allow the glucose to come in when you’re
30:34exercising remember insulin cannot tolerate that it can’t be elevated but the muscle is so hungry that it has an
30:40insulin independent mechanism in other words it can open those glucose doors without insulin
30:48without needing to wait for insulin to come and knock there is if you will a back door exercise opens the back door
30:54allowing the glucose to come in through an unconventional route there thereby helping lower blood glucose which helps
30:59lower insulin in the long term which then improves insulin sensitivity directly and by shrinking fat cells now
31:07with that in mind you may be thinking well then Ben what’s the most important or best exercise I can do my answer and
31:14I hope it’s not too pithy is the one you’ll do whatever you can do to just
31:20get out and be mobile that’s what you should stick with now if you have options and sufficient motivation my
31:28strong recommendation is resistance training over endurance training endurance training is not going to do
31:34too much to help maintain muscle mass indeed it may start to work against you maintaining muscle mass um you want
31:41resistance training as much as you can anything you can do to fatigue your muscles even something as simple as
31:48push-ups and chair squats until you start to feel a little bit of burn and
31:53do that just a few times a day is going to be depending on where you’re at is going to be a a stimulus to help you
31:59increase your muscle mass and remember more muscle means greater insulin sensitivity
32:06usually now the great big elephant in the room on ways to improve insulin
32:12sensitivity are drugs but here you’re going to be disappointed because that’s the topic
32:19starting next month that’s going to be februaries metabolic classrooms all about the cardiometabolic drugs and the
32:27options for and we’re going to go across a few different cardi metabolic complications including weight loss
32:33including diabetes and a handful of others high blood pressure and we’re going to just look at the um generally
32:39do a bit of an overview but also Focus um a little directly on the on the
32:45cardiometabolic ones all right that is it for today’s
32:50metabolic classroom um and now let’s move on to the Q and A and you guys as
32:56usual thank you so much for joining and listening and for your support um it is
33:02something that I really enjoy doing I love the idea of having a bit of a bigger classroom if you will than just
33:09what I may get um at at my University
33:16okay all right let’s start with the first one Carly um sharing a question
33:21from Tracy can a young active person develop insulin resistance in and she
33:27continues could they develop insulin resistance and have the numerous Health consequences including insulin
33:32resistance in the muscle and limit their energy storage and release um that would be unlikely um uh
33:41Tracy and Carly that would be unlikely if a if a young active person is generally going to be insulin sensitive
33:47now let me clarify um a topic for another time um is going to be
33:53discussing the differences between physiological and pathological insulin resistance and depending on the age of
33:59the person if this person is um an adolescent still so up to Mid teens in
34:05girls up to late teens or even early 20s in boys um that’s the Adolescent phase
34:10and there’s a natural insulin resistance there um which is the insulin resistance that accompanies growth um interestingly
34:18um but no if a person is Young and active in their healthy body weight they’re not going to have insulin
34:24resistant um in in a pathological sense but let’s just go a little further because the question addresses very
34:30specifically the muscle if you did have a person whose muscle was insulin
34:35resistant they would they would have a potential problem with energy storage um particularly um they may have a problem
34:42with glycogen uh the muscle is very greedy and it will store its own glucose
34:48and its own fat both of that is dependent on on insulin mind you it
34:53stores those nutrients to burn them it doesn’t share them with the body if these if these energy Depot are in the
34:59muscle they’re going to stay in the muscle and feed only the muscle if the muscle becomes insulin resistant its ability particularly to make glycogen
35:07could absolutely become compromis and if muscle glycogen is down that could limit
35:12intensity interestingly um one of a study from a couple years ago found that even very staunch ketogenic adherence
35:20that are trained athletes they have as normal muscle glycogen as a a non-
35:25ketogenic athlete as a conventional high carb athlete that’s how greedy the muscle is that even if you’re not eating
35:31carbs it’s still going to pull in all the glucose it needs to from the from the blood which came from the liver in
35:36this case and have its own storage of
35:42glycogen okay another one from Carly if someone is active and eats poorly but a normal BMI could they still be living
35:49with all the issues um yeah with all the metabolic problems and the plagues of prosperity it depends on how active they
35:57are but in general um and they have a normal BMI um in general diet is going to dictate
36:04disease state that exercise can only make up for so much now age can also make up for a fair amount but I have
36:11seen it now multiple times that even in people who are normal weight and this
36:17becomes particularly problematic across various ethnicities um like for example
36:22Hispanic and Asian ethnicities who can be very normal weight but have fatty liver dis disase or elevated um visceral
36:29adapost tissue which is much more pro-inflammatory and we’ll talk all about fat tissue more explicitly later
36:35in a future episode a lot of future episodes but we got a lot to talk about um but even in Caucasians and in Blacks
36:43who are a little more healthy with their fat storage some I’ve seen it now too many times where someone is generally
36:51lean um but they’re just not storing their weight in a healthy way either through osy hypertrophy or through liver
36:58fattening they begin to experience metabolic disruption so exercise can only make up for so much diet dictates
37:04disease State all right Carol um what if a person is on a Statin does that make the
37:10triglyceride HDL ratio a little less reliable or is it still informative it is still informative because uh statins
37:16don’t really influence those statins certainly don’t influence triglycerides and they have a very modest effect on
37:22HDL um so you know I have pretty strong feelings about statens and I’m not really an advocate but we’ll talk more
37:29about that next month um uh but it is certainly not it’s not
37:35going to move it too much Carol I mean stattin do have other consequences particularly
37:42mitochondria all right um Lindsay shares um an anecdote her standard American
37:48diet patients all have high adapost IR scores and low carb fasting patients have normal scores I assume this leads
37:55one to believe it is quick to reverse atopos with diet it is indeed yep in this is why I focus on insulin so much
38:02rather than stress and inflammation because you can move that lever you know I’ve I’ve used this analogy before but
38:08it’s like these levers on the wall that contribute to insulin resistance and stress and inflammation are really
38:14slippery you just can’t really get a good grip on them insulin you can grip it and pull it down you just change your
38:21diet all right from Tony I swim but have tried doing it fast the last two times
38:27I’ve come out of the pool it’s as if I’m drunk I’m unable to walk straight that’s not good uh Tony um now it could be that
38:38um have you well I mean it may be a low blood sugar phenomenon but I would suspect that’s a little unlikely um
38:45usually if people fast what they may have found is that their blood pressure has dropped so um now I’m not of course
38:51giving any kind of medical advice but one recommendation could be to try drinking a little more and load it with
38:57electrolytes um that might be an option that you could use in order to see if
39:03you feel a little better typically that lightheadedness um it could be low glucose but that’s not too common um
39:11especially for swimming unless you’re really sprinting swimming um uh I suspect you may have a better benefit by
39:17focusing on the water and electrolytes Rich um what impact does
39:25fructose have on insulin that’s a great question fructose does not directly have an impact fructose does not induce an
39:30insulin release the problem with fructose why you you could someone have they could drink pure fruit juice which
39:37is just fructose and then have a spike in glucose is because the body can convert the fructose to glucose very
39:43very well and indeed the liver does that very well and so pure fructose will in
39:49fact give a high glucose Rise um usually which is why a type 1 diabetic will say
39:54give me some give me some juice because it will correct blood
40:00sugar yeah so rich we do want to be strict on fruit juice in particular okay
40:05um Evette exercise with some dang good music is winning it sure is in fact my
40:12world lately is filled with Taylor Swift because I have teenage girls um even
40:17though I don’t listen to her while I’m working out actually I listen to podcasts and books if um but music is a
40:24good way to do it all right Marsha has question been keto for 2 years and lost a lot of weight blood pressure has gone
40:30through the roof it is 170 over 80 and nothing helps is there anything you can suggest that is surprising uh Mara that
40:38is not common um not to make you feel I hope you feel special um usually blood
40:44pressure pressure drops and it drops so quickly that a person has to change their medication I can’t
40:51um I have to speculate here because I’m not familiar with any papers Mara that have identified
40:57mechanism one mechanism could be that when we restrict carbs or fast
41:03epinephrine goes up um or adrenaline that’s because it wants to start telling
41:10the liver to release more glucose in order to make up for the glucose that’s no longer coming in through the mouth um
41:16the another effect of adrenaline or epinephrine is that it will increase blood pressure now that’s a high blood
41:22pressure in this case um and then alternatively then it might just be excessive caffeine although that would
41:28be a lot of caffeine to increase blood pressure that high but Mara that is a high number and it may be worth you just
41:35having a visit with your clinician because that is pretty high 170 over 80
41:40especially if you’re in a fasted State when fasting usually will lower that um
41:47but yeah I mean you that that’s that’s awfully High Carol if I need more insulin as a
41:53type 1 diabetic when I lift weights is that a problem I guess resistance training leads to glycogen release yeah
41:59any kind of training any movement will stimulate the liver uh the muscle to start oh well breaking down its own
42:06glycogen but also the liver breaking down its glycogen especially if you aren’t eating if you’re not eating during the workout then the liver is
42:13going to be releasing glycogen into the blood um but yeah and remember Carol Of
42:18course you are constantly struggling with your elevated glucagon um and in that case uh an insulin dose
42:26would be absolutely appropriate for type 1 diabetes all right Dave um can you
42:31possibly give a good animal-based protein to use I have won occasionally two protein shakes daily and you’ve been
42:37using Z works thanks um yeah I mean there are some good options indeed um
42:42health code complete meal is a good option although that’s more of a full meal replacement than just protein um in
42:48general if you can be getting your protein if you’re not going to get it from that I mean whey protein is a good
42:54source that’s an animal so so basically Dave I mean the the short and skinny of it is if it’s meat or eggs or dairy
43:02that’s an animal protein now it doesn’t have to be a shake of course it can be a
43:07full meal of of say hamburger or chicken or eggs or you know whatever but the
43:13animal Source proteins are any of the above meat eggs dairy dairy is the
43:19easiest because it’s been powdered into so many different types of whey and Whey is very very good source of protein that
43:26you can get from all kinds of sources all right last question Amanda
43:32UA what is the best practice for type one to regulate glucose insulin yeah Amanda of course remember guys I’m not
43:38giving medical advice but now I can cite studies there are now multiple papers
43:44finding phenomenally good glucose control in type 1 diabetics with the use of a low carb diet so as everyone with
43:51type 1 diabetes knows or the loved one you’re thinking of often they suffer from this just massive variability in
43:58their glucose levels throughout the day which is an enormous source of not feeling well and being anxious um as the
44:04person adopts a low carb diet and any of the type 1 diabetics listening can attest to this it just starts to
44:09Flatline which is much more comforting and at the same time you dose with significantly less insulin so the
44:16insulin needs drop dramatically as carbs are restricted and remember that used to
44:23be the standard of care in type 1 diabet we call type one it wasn’t called it was just called severe diabetes at the time
44:31it used to be that you would put them on a carbohydrate restricted diet and they would feel better um until we discovered
44:36insulin and once insulin became a therapy thankfully thank goodness it is life-saving then all of a sudden it
44:42became the Mantra of eat whatever you want and just inject yourself with insulin and that is not a good way to have stable blood sugars in anyone let
44:49alone a type 1 diabetic all right now speaking of insulin and medications join me next
44:56time um and then all of next month’s episodes will be all about diet sorry
45:02drugs all of the episodes will be about drugs and that’ll be the focus uh the focus looking across various
45:09cardiometabolic disorders you guys thanks again for joining um and I will see you next week be smart and stay
45:17healthy
