Where Does Insulin Resistance Come From? with Dr. Ben Bikman
Ringkasan
TLDRIn this week's metabolic classroom, the focus is on understanding the origins of insulin resistance, a major global health issue. The discussion categorizes the causes of insulin resistance into primary and secondary causes. Primary causes include inflammation, stress hormones (like cortisol and epinephrine), and chronically elevated insulin levels. These factors are shown to cause insulin resistance in cell, animal, and human models. Secondary causes, such as seed oils and uric acid, may be less direct, often acting through inflammatory pathways. Inflammation leads to insulin resistance by activating pathways within cells, while stress hormones increase blood glucose, prompting insulin resistance. Chronically high insulin levels cause the body to become less responsive to insulin. The role of enlarged fat cells is crucial, as they become insulin resistant to stop growing, establishing a feedback loop of insulin resistance. Starvation, distinct from fasting, also causes insulin resistance through stress responses, but is unique because insulin levels are low. The lecture further explores misconceptions about diet's role, particularly the effect of saturated fats and plant-based diets, in managing or causing insulin resistance. The complex interplay of these factors highlights the challenges in mitigating insulin resistance and underlines the importance of comprehending these causes to improve metabolic health.
Takeaways
- ๐ Understanding insulin resistance is crucial for global health.
- ๐งช Primary causes include inflammation, stress hormones, and chronically high insulin.
- ๐ Inflammation diminishes cells' response to insulin.
- ๐ Stress hormones increase blood glucose, leading to resistance.
- ๐ฝ๏ธ Chronic insulin spikes from diet can cause resistance.
- ๐ Animal and cell studies show similar insulin resistance development.
- ๐ญ Uric acid and seed oils are potential secondary causes via inflammation.
- ๐ฅ Plant-based versus ketogenic diets are debated for insulin effects.
- ๐ง High LDL doesn't necessarily mean high heart disease risk in healthy metabolic profiles.
- ๐งช Experiments reveal unique metabolic effects at cellular levels.
Garis waktu
- 00:00:00 - 00:05:00
The lecturer thanks the audience for participating in this metabolic classroom session, focusing on understanding the origins of insulin resistance. He encourages watching a previous episode defining insulin resistance within metabolic health. Today, the focus is on understanding what drives insulin resistance, drawing attention to a recent study in rats about sugar consumption affecting satiety, hinting at insulin resistance without directly using the term.
- 00:05:00 - 00:10:00
Insulin resistance is highlighted as the world's most common health problem, with two categories of causes: primary and secondary. Primary causes are confirmed in cells, rodents, and humans, while secondary causes either lack evidence across all three models or rely on a primary cause. The session proceeds to discuss primary causes: inflammation, stress, and chronically elevated insulin. Each factor is capable of independently causing insulin resistance.
- 00:10:00 - 00:15:00
Inflammation is discussed as a primary cause of insulin resistance, affecting nearly all cell types by diminishing their response to insulin. The lecturer describes how the presence of inflammation can be detected clinically via markers like C-reactive protein. The link between inflammation and insulin resistance is demonstrated through experiences in humans and animals.
- 00:15:00 - 00:20:00
The discussion shifts to stress as another primary cause of insulin resistance, emphasizing stress hormones like cortisol and epinephrine. It highlights how these hormones elevate blood glucose, requiring insulin to work harder, which contributes to insulin resistance. Causes of stress include sleep deprivation and caffeine consumption, both increasing the body's resistance to insulin as demonstrated in cell and animal studies.
- 00:20:00 - 00:25:00
Chronically elevated insulin is presented as the third primary cause, described as particularly pernicious because regular spikes in insulin levels can lead to resistance. Examples include frequent carbohydrate consumption. Unlike other causes, elevated insulin can be swiftly corrected, suggesting dietary changes are an immediate lever to improve insulin sensitivity.
- 00:25:00 - 00:30:00
Secondary causes include seed oils, which need more human study to be proven as a primary cause, and uric acid, which causes insulin resistance only through inflammation. The lecturer emphasizes that primary causes like inflammation can cause insulin resistance independently, while secondary causes need another mediator to have an effect.
- 00:30:00 - 00:35:00
Starvation is presented uniquely, as it causes insulin resistance through a necessary survival mechanism when the body has no fat to burn, thereby protecting brain function. Unlike other situations, insulin levels are low during starvation-caused resistance. Additional explanations will be explored in future sessions.
- 00:35:00 - 00:40:00
The lecturer transitions to discussing creeping insulin resistance beginning with fat cells. As fat cells expand, they may become insulin resistant to avoid overgrowth. Stress and lack of proper nutrient delivery lead to further complications, including inflammation. The importance of adipose tissue and its interaction with insulin is a critical factor. Seed oils are implicated in promoting unhealthy fat cell growth patterns.
- 00:40:00 - 00:45:00
The lecture also touches on dietary elements like seed oils contributing to insulin resistance by promoting fat cell growth. He provides a detailed explanation connecting the dietary influences with metabolic health outcomes. There is emphasis on how dietary composition can influence insulin and ultimately health.
- 00:45:00 - 00:53:14
In the Q&A session, the lecturer discusses queries related to plant-based diets, diet soda's impact on insulin, and sugar substitutes like allulose. He counters claims on cholesterol and plant-based dietary efficacy, advocating for understanding nutrient needs and physiological impacts rather than following dietary dogma zealously.
Peta Pikiran
Pertanyaan yang Sering Diajukan
What are primary causes of insulin resistance?
Primary causes include inflammation, stress hormones (cortisol and epinephrine), and chronically elevated insulin levels.
How do stress hormones impact insulin resistance?
Stress hormones like cortisol and epinephrine raise blood glucose levels, making insulin work harder, which can lead to insulin resistance.
What is the role of inflammation in insulin resistance?
Inflammation activates pathways in cells, causing them to have a diminished response to insulin, contributing to insulin resistance.
How does elevated insulin cause insulin resistance?
Chronically high insulin levels lead to the body becoming less responsive to insulin, hence causing insulin resistance.
What are secondary causes of insulin resistance mentioned?
Secondary causes include factors like uric acid and potentially seed oils, which act through primary causes like inflammation.
Can diet soda contribute to insulin resistance?
Diet soda itself does not cause an insulin spike, but it may increase appetite in some individuals, leading to overeating.
How does the fat cell's size contribute to insulin resistance?
As fat cells enlarge, they may become insulin resistant to stop growing larger, thus contributing to insulin resistance.
What is the difference between fasting and starvation in terms of insulin resistance?
Fasting happens when the body burns fat for energy, whereas starvation occurs when the body runs out of fat and starts using lean mass, causing insulin resistance due to stress hormones.
Why is it challenging to address stress and inflammation as causes of insulin resistance?
Both are influenced by complex factors including lifestyle and genetic predispositions, making them harder to control than dietary influences like insulin.
Can elevated uric acid levels cause insulin resistance?
Yes, uric acid can cause insulin resistance, but it typically acts through inflammatory pathways.
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- 00:00:00hello everyone thank you so much for
- 00:00:03being a member of the insulin IQ
- 00:00:05community and in particular thank you
- 00:00:08for joining me for this week's metabolic
- 00:00:11classroom that is a title that I've
- 00:00:13always been particularly pleased with
- 00:00:15this idea of me learning and
- 00:00:20teaching all right um thanks again um so
- 00:00:24today uh the focus of the classroom
- 00:00:27today is to help you better understand
- 00:00:30understand the origins of insulin
- 00:00:32resistance um last time and and if you
- 00:00:34haven't make sure you go back and watch
- 00:00:36that episode we discussed what insulin
- 00:00:37resistance is so we really defined it
- 00:00:40particularly in the context of metabolic
- 00:00:43Health uh and different ways of defining
- 00:00:45metabolic Health including metabolic
- 00:00:47syndrome and metabolic flexibility and
- 00:00:49then actually revealing pulling back the
- 00:00:52curtain and showing you that really at
- 00:00:54the heart of both of those problems is
- 00:00:56insulin resistance so we explained the
- 00:00:57scope of the problem and why it matters
- 00:00:59matters and why it matters in particular
- 00:01:02that idea is something we'll focus on
- 00:01:04more next week um so for now uh before
- 00:01:08we get started I I kind of like making
- 00:01:10it a habit of sharing with you guys uh a
- 00:01:13little piece of some newly published
- 00:01:15research there was a paper that was
- 00:01:17published just recently in the journal
- 00:01:19cell reports and what's interesting
- 00:01:22about this is that it shows this to
- 00:01:25invoke a concept of Economics this
- 00:01:27diminishing returns when it comes to
- 00:01:30satiety and our consumption of sweet
- 00:01:33things so the study utilized rats I know
- 00:01:36of no evidence in humans to support or
- 00:01:40refute this so for now we'll assume it's
- 00:01:42relevant in humans until we learn
- 00:01:44otherwise but they fed the the rats a
- 00:01:47diet that had high levels of sugar in
- 00:01:49the water now of course that's how a lot
- 00:01:52of people get sugar right any of these
- 00:01:54sugary sodas or even juice has a lot of
- 00:01:57sugar in it and so they had the animals
- 00:02:00drinking uh the sugar water and then
- 00:02:02they tested the animals response to a
- 00:02:05load of glucose so then gave them a
- 00:02:07bunch of glucose to eat and they found
- 00:02:10that before they had started um this
- 00:02:13high sugar diet the high sucrose uh they
- 00:02:17had a very substantial response to the
- 00:02:21uh glucose and it induced a sense of
- 00:02:24satiety in other words they got the
- 00:02:26glucose load and they felt really full
- 00:02:28however with with this sugar diet with
- 00:02:31the diet that was higher in sugar it
- 00:02:34didn't work as well when they gave the
- 00:02:35animals this load of of carbohydrate
- 00:02:38they didn't have that same degree of
- 00:02:40satiety that signal that sensitivity to
- 00:02:43the carbohydrate load had been
- 00:02:45diminished now they're not using the
- 00:02:47word insulin resistance there and I'm
- 00:02:49not going to either they didn't really
- 00:02:50test it but I will just say they found
- 00:02:53that there was a diminished ability to
- 00:02:55sense the the the the calories or the
- 00:02:59energy coming from from that
- 00:03:00carbohydrate and the animals um would
- 00:03:02have been inclined to just continue to
- 00:03:04eat
- 00:03:04more all right so that's a little bit of
- 00:03:07the science corner of the metabolic
- 00:03:09classroom now let's get into the actual
- 00:03:11meat of the lecture if you will the
- 00:03:13classroom session for today so where
- 00:03:15does insulin resistance come from just
- 00:03:17as a reminder it is insulin resistance
- 00:03:20is the single most common health problem
- 00:03:22worldwide so it is worth talking about
- 00:03:25it is worth devoting a career to
- 00:03:28understanding and and just appreciating
- 00:03:31in in our life and at a global level all
- 00:03:34right so I have
- 00:03:36classified in my understanding in my
- 00:03:38exploration and study of insulin
- 00:03:40resistance really two categories when it
- 00:03:43comes to understanding the causes of
- 00:03:46insulin
- 00:03:48resistance and I use the terms primary
- 00:03:51and secondary now the primary insulin
- 00:03:54resistance is a term that um I use very
- 00:03:58specifically in fact both of these terms
- 00:03:59are very specific with primary I
- 00:04:02consider the cause to meet that to fall
- 00:04:05into that category if it has if it is
- 00:04:08based on Research that has been
- 00:04:10confirmed in all three commonly used
- 00:04:13biomedical research models now what do I
- 00:04:16mean by that as a biomedical
- 00:04:18scientist I will use and have in fact
- 00:04:21published papers on all of this three
- 00:04:24models or three ways of doing
- 00:04:27experiments at the kind of simplest
- 00:04:30um it is just growing cells in a little
- 00:04:34petri dish in in a lab so we have a
- 00:04:36little incubator that will grow cells
- 00:04:38we'll put muscle cells on the petri dish
- 00:04:39or liver cells or neurons or fat cells
- 00:04:42and then we do experiments on those
- 00:04:45cells next you can do experiments in a
- 00:04:48whole organism like in the case of
- 00:04:51laboratory rodents so this is mice or
- 00:04:53rats where you can knock out genes or
- 00:04:55overexpress genes and then you can get
- 00:04:57all of the tissue to study the fat and
- 00:04:59the heart and the Brain stuff that you
- 00:05:02just couldn't get from humans of course
- 00:05:04in a perfectly controlled
- 00:05:06environment in the lab and then next is
- 00:05:09experiments done in humans so these are
- 00:05:11the three commonly used biomedical
- 00:05:13models cells rodents
- 00:05:15humans so the primary causes of insulin
- 00:05:19resistance are those noxious stimuli
- 00:05:22that have been shown to cause insulin
- 00:05:24resistance in all three of those
- 00:05:26models the secondary causes of insulin
- 00:05:29resistance that I'll share with you are
- 00:05:32those that maybe have been shown to
- 00:05:34cause insulin resistance in two of the
- 00:05:37three as we will highlight one
- 00:05:39particular example of that or it is
- 00:05:43actually there's evidence to support all
- 00:05:45three but it does so it causes insulin
- 00:05:48resistance by taking advantage of one of
- 00:05:51the primary causes so it's not
- 00:05:54independent of the primary cause I hope
- 00:05:56that makes sense so that would call it
- 00:05:58Con that would um count it as a
- 00:06:01secondary cause again if it requires the
- 00:06:03involvement of one of the primary causes
- 00:06:05so it's still coming back to the primary
- 00:06:07that if you eliminate the primary then
- 00:06:09you've eliminated the insulin resistance
- 00:06:12but again with the three primary causes
- 00:06:14that I'll talk about in a moment each of
- 00:06:16them is capable of causing insulin
- 00:06:17resistance on their own all right now
- 00:06:20let's go through the three primary
- 00:06:22causes these are the big pillars that
- 00:06:25really contributes to insulin resistance
- 00:06:28in cells rodents and
- 00:06:31humans first one is inflammation this is
- 00:06:35one that I feel pretty strongly about
- 00:06:38and I'm quite familiar with because it
- 00:06:40was largely the focus of my
- 00:06:42post-doctoral fellowship research many
- 00:06:45many years ago and work that I had
- 00:06:47continued and have since then and
- 00:06:49continue to contribute to now so in this
- 00:06:52case of the inflammation it's important
- 00:06:56for you to appreciate that when I say
- 00:06:58inflammation I don't necessarily I don't
- 00:07:00mean an immune response and I don't mean
- 00:07:04an angry red oozing scratch on your arm
- 00:07:08that's gotten
- 00:07:09infected when we when I say inflammation
- 00:07:12I actually just want you to think that
- 00:07:14of of a pathway within virtually every
- 00:07:17cell of the body and that when this
- 00:07:20pathway is activated it it is part of a
- 00:07:23if it were if we were talking about an
- 00:07:25immune cell it would be part of a normal
- 00:07:26immune response but for example muscle
- 00:07:30cells muscle cells have an inflammatory
- 00:07:32pathway or multiple and those aren't
- 00:07:34immune cells fat cells have an
- 00:07:37inflammatory pathway and those aren't
- 00:07:39immune cells those aren't white blood
- 00:07:41cells that are part of an immune
- 00:07:42response to defend the body against
- 00:07:44infection but all of these cells have
- 00:07:48these inflammatory Pathways and what's
- 00:07:50interesting in the muscle for example
- 00:07:52that you activate the inflammatory
- 00:07:54pathway and the muscle isn't going to
- 00:07:55start producing antibodies but it
- 00:07:58actually then show shows this
- 00:08:00intersection of the immune system or the
- 00:08:03inflammatory system and the metabolic
- 00:08:06system so anytime you activate
- 00:08:10inflammatory Pathways within a cell you
- 00:08:13cause that cell to have a diminished
- 00:08:15response to insulin resistance so at
- 00:08:18cell at a cell level you can just
- 00:08:21incubate cells with an inflammatory
- 00:08:23protein like for example C reactive
- 00:08:25protein have you heard of that does that
- 00:08:27one sound familiar CR P or C reactive
- 00:08:30protein is a protein that has been
- 00:08:32increasingly measured in clinical tests
- 00:08:35because it's such a good marker of
- 00:08:37inflammation and just overall cardi
- 00:08:39metabolic health so if I have muscle
- 00:08:42cells or fat cells or liver cells or
- 00:08:44brain cells and I put C reactive protein
- 00:08:47in that little culture bath with the
- 00:08:49cells and then I test how the cells
- 00:08:52respond to insulin it will be diminished
- 00:08:55the insulin response will be turned down
- 00:08:58same thing goes for animals
- 00:08:59if you induce an inflammatory response
- 00:09:01in animals they become demonstrably
- 00:09:03insulin resistant and the same thing
- 00:09:05happens in humans in fact it has been
- 00:09:07fascinating for me to notice during this
- 00:09:11period of time over the last few years
- 00:09:12where everyone's much more mindful of
- 00:09:15their immune Health that people and at
- 00:09:18the same time people are wearing more
- 00:09:19continuous glucose monitors it's been
- 00:09:22interesting to see how people can almost
- 00:09:24predict that they have a cold or a flu
- 00:09:27coming on because they know notice that
- 00:09:29their blood glucose levels start to
- 00:09:31climb and get more variable a general
- 00:09:34sign of insulin resistance and indeed
- 00:09:37that is the case in humans if you induce
- 00:09:39an immune response the body will become
- 00:09:42more insulin resistant if you activate
- 00:09:44those inflammatory Pathways in in fact
- 00:09:46there's some fascinating Publications
- 00:09:48that have touched on this before that
- 00:09:50have looked at rheumatoid
- 00:09:53arthritis like every autoimmune disease
- 00:09:56rheumatoid arthritis has an EB and a
- 00:09:59flow to it it will it will have periods
- 00:10:01of time where it's really active and
- 00:10:03aggressive and painful and other periods
- 00:10:05of time where it starts to retreat and
- 00:10:07settles down a little bit you can
- 00:10:09actually track the insulin resistance
- 00:10:11that goes with it that as the body is
- 00:10:13activating an immune response inflam or
- 00:10:16insulin resistance goes with it so to
- 00:10:18sum all of that up inflammation is we
- 00:10:21could call that the first primary cause
- 00:10:23of insulin resistance now unrelated to
- 00:10:26insulin
- 00:10:27resistance is
- 00:10:29stress now stress is a big term it's a
- 00:10:33kind of blanket term that within pop
- 00:10:35culture has taken on a lot of
- 00:10:38Dimensions that uh that are sometimes
- 00:10:41used inappropriately and other times uh
- 00:10:44precisely so with stress this is when I
- 00:10:48say stress I really mean the stress
- 00:10:50hormones I can't help but think about
- 00:10:52stress as a hormone response or an
- 00:10:55endocrine in situation and specifically
- 00:10:58there are two primary stress hormones in
- 00:11:01the body cortisol and epinephrine also
- 00:11:04known as adrenaline I'll call it
- 00:11:06epinephrine that's the more technical
- 00:11:08term that's used so cortisol and
- 00:11:11epinephrine these hormones are actually
- 00:11:14totally unre unrelated they are produced
- 00:11:17in different cell types they are moved
- 00:11:20through the they're produced very
- 00:11:22differently they're very different types
- 00:11:23of hormones they move through the blood
- 00:11:25in different ways they actually act on
- 00:11:28different cells throughout the body in
- 00:11:30different ways and have different
- 00:11:31effects throughout the body the one
- 00:11:33thing they have in common is that they
- 00:11:36both want to increase blood glucose and
- 00:11:39so if you have these stress hormones
- 00:11:41that are trying to push glucose up
- 00:11:43there's another hormone that now has to
- 00:11:45work even harder to bring the glucose
- 00:11:47down and of course that's insulin and so
- 00:11:50it's no surprise then that if these
- 00:11:51stress hormones are continually pushing
- 00:11:54up the glucose the body's becoming more
- 00:11:57insulin resistant
- 00:12:00now what are some of the causes of
- 00:12:01stress uh this can be something as
- 00:12:03benign as sleep deprivation and insomnia
- 00:12:07one bad night of sleep will
- 00:12:09significantly increase cortisol the next
- 00:12:11day which causes insulin resistance that
- 00:12:13next day now thankfully one good night
- 00:12:15of sleep wipes that all out but sleep
- 00:12:18deprivation is a simple and very common
- 00:12:20cause of stress on the body which has a
- 00:12:22metabolic consequence
- 00:12:25similarly um for example if we drink
- 00:12:27there are even more seemingly benign
- 00:12:30things but tragic when you couple it
- 00:12:32with poor sleep which is excessive
- 00:12:34caffeine consumption that if someone's
- 00:12:36taking in too much caffeine perhaps to
- 00:12:38try to make up for their or to feel
- 00:12:40better with the lack of sleep then that
- 00:12:42increases the other stress hormone the
- 00:12:45epinephrine and when epinephrine goes up
- 00:12:47now it's trying to push up glucose which
- 00:12:50then makes insulin work harder and so
- 00:12:52it's easy to see how a person can fall
- 00:12:54into this vicious cycle of sleeping
- 00:12:57poorly taking caffeine to make up for it
- 00:12:59which just continues to drive this
- 00:13:02insulin resistance and again this is
- 00:13:04something that happens in humans you
- 00:13:06give humans a load of of cortisol or or
- 00:13:09cortisol like molecule give them
- 00:13:11epinephrine and then try to treat them
- 00:13:13with insulin they'll need much more
- 00:13:15insulin to bring their glucose down to
- 00:13:17what would have been just a nor a modest
- 00:13:19amount of insulin prior to the
- 00:13:21introduction of the stress hormones same
- 00:13:23with animals and same with cells having
- 00:13:26done those experiments myself you treat
- 00:13:28the cells with those molecules and they
- 00:13:30become insulin
- 00:13:32resistant now the third and final of the
- 00:13:35primary causes I leave in the final pole
- 00:13:39position if you will um in order to uh
- 00:13:42just really emphasize it because it's
- 00:13:44the one that I believe is over time
- 00:13:47chronically the most relevant of all of
- 00:13:49them and that is chronically elevated
- 00:13:52insulin now let me just introduce a
- 00:13:56brief tangent where some people
- 00:13:59will say or they'll want to think that
- 00:14:02I'm saying any insulin spike is bad and
- 00:14:05should be avoided at all costs that's
- 00:14:07not what I'm saying but I want someone
- 00:14:09to appreciate the impact of multiple
- 00:14:12insulin spikes that are stacked together
- 00:14:15now to to elaborate on that if someone
- 00:14:17eats a load of carbohydrate because
- 00:14:19protein and fat are generally going to
- 00:14:21have no uh elicit no insulin response if
- 00:14:23someone eats pure carbohydrate insulin
- 00:14:25will come up and the insulin will take
- 00:14:27usually about 2 hours hours to come back
- 00:14:29down in an insulin sensitive person
- 00:14:31maybe you know between two and three
- 00:14:33hours until the insulin comes back down
- 00:14:34to
- 00:14:35normal now remember the reason I'm
- 00:14:37talking about this is because too much
- 00:14:39insulin causes insulin resistance you
- 00:14:42can do this in humans you can do this in
- 00:14:44rodents and in cells and I've done it in
- 00:14:47not in humans but others have give
- 00:14:49humans an infusion of insulin and then
- 00:14:52give them a few hours and the insulin
- 00:14:53starts working worse and worse and worse
- 00:14:56so it's increasingly resistant the body
- 00:14:58is to to it so you have the person who
- 00:15:01gets an insulin response to a
- 00:15:02carbohydrate load unfortunately the
- 00:15:05average person not only eats a very
- 00:15:08starchy sugary breakfast but they do the
- 00:15:10same thing with a midm morning snack and
- 00:15:12so right around the time insulin's about
- 00:15:14to come back down to its fasted levels
- 00:15:17we have a culture of incessant snacking
- 00:15:19and eating they spike it right back up
- 00:15:21then they spike it right back up and
- 00:15:23they do it again they do it for lunch
- 00:15:24they do it for an afternoon snack they
- 00:15:26do it for U dinner they do it for
- 00:15:28evening snack so every waking moment is
- 00:15:31spent in a state of elevated insulin
- 00:15:34elevated insulin causes insulin
- 00:15:37resistance the nice thing about all
- 00:15:39three of those primary causes and this
- 00:15:42is an upcoming topic before the end of
- 00:15:45the month of about how to resolve
- 00:15:46insulin resistance but I'm sort of
- 00:15:48getting a little bit ahead of myself it
- 00:15:50is that of all three of these primary
- 00:15:52causes again inflammation stress and
- 00:15:54elevated insulin it's the elevated
- 00:15:56insulin that can be corrected so quickly
- 00:15:59for example if you had someone who you
- 00:16:01were a clinician or you're talking to a
- 00:16:02loved one and you found out that they
- 00:16:04had all of those things high stress High
- 00:16:06inflammation High insulin you would say
- 00:16:09hey your stress is high you need to
- 00:16:11lower your stress hormones well you
- 00:16:13don't know exactly how they're doing it
- 00:16:15or maybe you know that they're sleeping
- 00:16:16poorly and you say I know you're
- 00:16:18Insomniac you have insomnia um you're
- 00:16:20not sleeping well you need to sleep
- 00:16:22better and they're going to say oh
- 00:16:23thanks now I'm going to be stressed even
- 00:16:25more than I was before about my lack of
- 00:16:27sleep and so it's difficult to really
- 00:16:29get a firm grasp on stress to turn it
- 00:16:32down same same with inflammation that if
- 00:16:35someone has an elevated C reactive
- 00:16:37protein for
- 00:16:38example uh knowing how to reduce that
- 00:16:41can be a little tricky they might not
- 00:16:44know it might not be something that
- 00:16:45they're even doing in their lifestyle it
- 00:16:47could be a result of their fat cells
- 00:16:49which I'll get to in just a moment but
- 00:16:51insulin we know what spikes insulin and
- 00:16:54so it becomes a lever that we can grab
- 00:16:56whereas the other two are slippery and
- 00:16:58it's difficult ult to grab them this one
- 00:17:00we can grab it and immediately start
- 00:17:02pulling it down within a day improving
- 00:17:04insulin resistance as a
- 00:17:06result so those are the three primary
- 00:17:09causes now let's go on where again just
- 00:17:11to reiterate we have evidence multiple
- 00:17:15Publications across all three commonly
- 00:17:17used biomedical models that these are
- 00:17:19all on their own capable of causing
- 00:17:20insulin resistance now some of you may
- 00:17:23be thinking that there are some
- 00:17:25conspicuously absent causes here for
- 00:17:27example why haven't I mentioned seed
- 00:17:29oils well now I will let's transition
- 00:17:32from the primary causes to the secondary
- 00:17:34causes and I speak about seed oils with
- 00:17:36enormous respect in all sincerity um the
- 00:17:39the amount of papers I've now been
- 00:17:41introduced to despite not being an
- 00:17:42expert on seed oils is is remarkable and
- 00:17:45these are definitely contributing to
- 00:17:46diseases across the
- 00:17:48board I just of course focus on my area
- 00:17:51of expertise namely insulin resistance
- 00:17:53there is evidence in cell cultures that
- 00:17:56linolic acid the primary omega-6
- 00:17:59polyunsaturated fatty acid that
- 00:18:00constitutes linolic a that constitutes
- 00:18:02soybean oil and the other refined seed
- 00:18:04oils that in cells it can cause insulin
- 00:18:09resistance kind of there's mixed
- 00:18:12evidence there um next in animals if you
- 00:18:15have an animal eat a high uh animals
- 00:18:17will eat a high soybean oil diet as
- 00:18:19opposed to say coconut oil the soybean
- 00:18:22oil diet consumers will get um more
- 00:18:26insulin resistant than the coconut oil
- 00:18:28so there's something more uniquely
- 00:18:30pathogenic but in humans I've just never
- 00:18:33seen a study in humans where you have
- 00:18:35the person eat soybean oil specifically
- 00:18:37independent of any other types of fats
- 00:18:40and then they become insulin resistant
- 00:18:42that's why I haven't quite been able to
- 00:18:44graduate seed oils into the primary
- 00:18:46cause I I believe it's contributing in
- 00:18:49fact I'll mention a reason that it might
- 00:18:50be a bit indirect in in a moment with
- 00:18:53regards to fat cells but um the direct
- 00:18:56effect of just eating the linolic acid
- 00:18:59do you get it um do you get the insulin
- 00:19:03resistance uh no no I've not seen the
- 00:19:06studies on that but again I'll revisit
- 00:19:09that in just a
- 00:19:10moment all right now the other secondary
- 00:19:12cause of just two that I'm going to
- 00:19:14mention and then I'll mention the last
- 00:19:16one which is very unique is uric acid um
- 00:19:21thanks in large part to my good friend
- 00:19:23Rick Johnson at the University of
- 00:19:25Colorado the world has really woken up
- 00:19:27to the dangers of your acid and just as
- 00:19:29a reminder as much as the world has
- 00:19:32focused on meat as a sole cause of uric
- 00:19:34acid because of some of the unique um
- 00:19:38molecules within it fructose will
- 00:19:40increase uric acid far more than any
- 00:19:44amount of meat will and that's primarily
- 00:19:46what Rick has focused on this fructose
- 00:19:48um every time you metabolize a molecule
- 00:19:50of fructose you're producing some uric
- 00:19:53acid so it's a heavy heavy contributor
- 00:19:55now interestingly uric acid has been
- 00:19:58shown to cause insulin resistance in all
- 00:20:00three biomedical models you treat cells
- 00:20:02with uric acid they become insulin
- 00:20:04resistant you increase the uric acid in
- 00:20:06the animals they become insulin
- 00:20:07resistant if you block uric acid
- 00:20:09production they don't become insulin
- 00:20:11resistant and the exact same thing is
- 00:20:13seen with humans more uric acid as you
- 00:20:16spike it up more insulin resistance you
- 00:20:18block uric acid production insulin
- 00:20:20resistance gets better it's pretty
- 00:20:22robust evidence now why don't I put it
- 00:20:24in the category of primary because if
- 00:20:27you block the influx
- 00:20:29effect of the uric acid there's no
- 00:20:31insulin resistance or you wipe it out
- 00:20:34and so this is the case that I alluded
- 00:20:36to earlier where you have a trigger a
- 00:20:38stimulus but it is acting through
- 00:20:41another mediator and that if you take
- 00:20:43away this mediator so it's dependent on
- 00:20:46specifically inflammation and in the
- 00:20:48absence of inflammation there's no
- 00:20:50insulin resistance so it's dependent so
- 00:20:53uric acid causes insulin resistance
- 00:20:55dependent on its ability to increase
- 00:20:58increase inflammation or activate these
- 00:21:00immune path these inflammatory Pathways
- 00:21:02that's why I put it in the secondary
- 00:21:04realm because remember with the primary
- 00:21:06all of those are capable of causing
- 00:21:08insulin resistance on their own in the
- 00:21:10absence of any other signal they're not
- 00:21:12dependent on anything but
- 00:21:15themselves now in all of these what all
- 00:21:18of these have in common is that they
- 00:21:21will manifest with class all the signs
- 00:21:24of insulin resistance and remember there
- 00:21:26are two real aspects it's the
- 00:21:29analogy where you will have cells that
- 00:21:31aren't responding well to insulin and in
- 00:21:33the whole body insulin levels will be
- 00:21:36elevated which makes the elevated
- 00:21:38insulin cause of insulin resistance
- 00:21:40particularly vicious because if elevated
- 00:21:43insulin is a cause of insulin resistance
- 00:21:46which is then causing more elevated
- 00:21:48insulin which then contributes to
- 00:21:50further insulin resistance you can see
- 00:21:51how this becomes a positive feedback and
- 00:21:53a vicious cycle so the last one that is
- 00:21:56totally unique is
- 00:21:58starvation now I need to Define that
- 00:22:01term because too often people will think
- 00:22:03of starvation as just fasting no there's
- 00:22:07a big divide between fasting and
- 00:22:10starvation in fact that divide is
- 00:22:12something we can pinch and jiggle namely
- 00:22:14our body fat that if you have body fat
- 00:22:17to burn this is a topic for another time
- 00:22:19so I'll be a little sparse on it then
- 00:22:21you're fasting the moment you are
- 00:22:24restricting calories and you've run out
- 00:22:26of fat now you're burning your lean mass
- 00:22:29you're burning muscle for energy in
- 00:22:31particular and even bone and everything
- 00:22:32else you'll start eating away at your
- 00:22:34body to just continue to make enough
- 00:22:37energy for the brain to survive and in
- 00:22:40that state the body becomes very insulin
- 00:22:43resistant which is primarily
- 00:22:45interestingly a stress response but it's
- 00:22:48unlike the earlier stress response that
- 00:22:50I spoke about because in this instance
- 00:22:52where the body is wasting away you are
- 00:22:54insulin resistant but insulin levels are
- 00:22:57low
- 00:22:58the body can't afford to keep insulin
- 00:23:00High because if insulin's High then the
- 00:23:03body is attempting to store energy which
- 00:23:06would deprive the brain because the
- 00:23:07brain can't handle a state if energy is
- 00:23:10just being stored stored stored because
- 00:23:12it doesn't store energy it needs to be
- 00:23:14pulling it from the blood we'll talk
- 00:23:16we'll revisit this idea when we talk
- 00:23:18about the metabolic origins of
- 00:23:19Alzheimer's disease in in up in an
- 00:23:21upcoming lesson but
- 00:23:23nevertheless just to reiterate this
- 00:23:26unique metabolic state starvation is
- 00:23:29insulin resistance through stress
- 00:23:31hormones but it's Unique because insulin
- 00:23:34levels are low and any other instance of
- 00:23:37insulin resistance that I'm aware of and
- 00:23:38I think I'm aware of all of them insulin
- 00:23:40will be elevated if the body has insulin
- 00:23:45resistance including physiological
- 00:23:48insulin resistance and we'll we can talk
- 00:23:49about we'll talk about that at a future
- 00:23:51time all right now let's move on um to a
- 00:23:57next sort of segment as I wind up the
- 00:23:59lecture classroom part of this before we
- 00:24:00do some
- 00:24:01Q&A all of these stimuli that I've
- 00:24:04talked about are Direct effects if you
- 00:24:06directly increase inflammation due to
- 00:24:08illness for example or a food
- 00:24:10sensitivity the body becomes insulin
- 00:24:12resistant but if you remove that
- 00:24:14stimulus they're insulin sensitive same
- 00:24:16with stress same with elevated insulin
- 00:24:18so these are Direct effects direct
- 00:24:20noxious stimuli causing insulin
- 00:24:22resistance but there's a more creeping
- 00:24:25version of insulin resistance which now
- 00:24:28brings us back to the fat cell there are
- 00:24:31multiple theories of which tissue of the
- 00:24:34body becomes insulin resistant first
- 00:24:37some will say that it is the muscle that
- 00:24:39becomes insulin resistant first some
- 00:24:41will say that it's the liver others will
- 00:24:43say that it's the fat cells um anyone
- 00:24:46who says it's other than the fat cells
- 00:24:47is totally wrong now I expect it say the
- 00:24:50same thing about me but I'm right fat
- 00:24:52cells are the beginning that is the
- 00:24:54first Domino to fall you know probably
- 00:24:57by now of my affection for alliteration
- 00:24:59fat Falls first when it comes to insulin
- 00:25:03resistance and the now so what makes the
- 00:25:05fat cell get big this is actually a
- 00:25:08topic that I just spoke at um at a
- 00:25:10recent meeting a low carb meeting in the
- 00:25:12upcoming metabolic Health Summit uh at
- 00:25:14the time I'm recording this and I will
- 00:25:16post this lecture um at a future point
- 00:25:20on the insulin IQ site but it's
- 00:25:22basically the name of that is shrinking
- 00:25:24fat cells energy versus insulin and so
- 00:25:27when a fat cell is uh when a fat cell
- 00:25:29starts to grow that's that's a process
- 00:25:32called hypertrophy and as the fat cell
- 00:25:34continues to grow it it starts to
- 00:25:37experience two problems first it can't
- 00:25:39grow anymore it's actually reaching the
- 00:25:42limit that the cell membrane can hold
- 00:25:44together it's like a water balloon
- 00:25:46that's getting so full that it's about
- 00:25:48to burst it's going to pop and then
- 00:25:51everyone gets messy and we get water all
- 00:25:52over the house now one solution let's
- 00:25:55just stick with the the analogy
- 00:25:57comparing the fat cell to the to a water
- 00:25:59balloon if we can't disconnect the
- 00:26:02balloon to the tap that is filling the
- 00:26:04balloon what if we could just poke a
- 00:26:07small little hole in the balloon without
- 00:26:09popping the whole balloon now it's
- 00:26:11starting to leak out some of the water
- 00:26:14to match the fat that's coming in that's
- 00:26:16really analogous to what's happening
- 00:26:18with the fat cell is it gets too big
- 00:26:20insulin is continually telling it to
- 00:26:22grow mostly by inhibiting its ability to
- 00:26:25release the fat but but also by force
- 00:26:28feeding it and so the fat cell basically
- 00:26:32says insulin you're not letting me break
- 00:26:34down this fat I'm not listening to you
- 00:26:36anymore and so I'm going to become
- 00:26:37insulin resistant and so it becomes
- 00:26:40insulin resistant to stop growing this
- 00:26:43this is why people on average can't
- 00:26:45limitlessly get fat there is this point
- 00:26:48Beyond which they can't get any fatter
- 00:26:50now there are some exceptions where some
- 00:26:51people genetically have the ability to
- 00:26:53make new fat cells they can multiply
- 00:26:55their fat cells those are people who
- 00:26:57continue who can continue to get fat but
- 00:26:59that's uncommon so the big fat fat cell
- 00:27:03the hypertrophic fat cell becomes
- 00:27:04insulin resistant to stop future
- 00:27:07growth second as it gets so big it
- 00:27:10starts to get pushed further and further
- 00:27:12away from capillaries which is the
- 00:27:14essential blood vessel where a cell gets
- 00:27:17all of its oxygen and all of its
- 00:27:19nutrients and then dumps all of its
- 00:27:21waste products into the blood to be
- 00:27:22eliminated from the body through the
- 00:27:24kidneys or the liver or the breath in
- 00:27:26some instances like CO2 so it's the
- 00:27:29capillary and so the fat cell that's
- 00:27:31getting so big is getting pushed too far
- 00:27:34from the capillary and that becomes
- 00:27:36what's called hypoxic in other words
- 00:27:38it's running out of oxygen in one
- 00:27:40response to that the fat cell is saying
- 00:27:43hey I'm suffocating here it will start
- 00:27:45releasing pro-inflammatory
- 00:27:48proteins what are called cyto now
- 00:27:51through the body this begins to turn on
- 00:27:54all of those inflammatory Pathways that
- 00:27:55will then cause insulin resistance
- 00:27:58but at the level of the fat cell one
- 00:28:00effect of one of these pro-inflammatory
- 00:28:03proteins will be to tell the capillaries
- 00:28:05to start making new capillaries so it
- 00:28:08will increase the vascular the
- 00:28:10vascularization of the fat cell helping
- 00:28:13it start to breathe better it can get
- 00:28:14oxygen again but again a consequence is
- 00:28:18that it's spilling the inflammatory
- 00:28:19proteins throughout the body now what is
- 00:28:22it that makes the fat cell get
- 00:28:24big there are two essential elements to
- 00:28:27this you cannot have one without the
- 00:28:30other in the whole body it is impossible
- 00:28:33and again you'll have to watch the talk
- 00:28:34in the future um in order to in order to
- 00:28:37understand it so you must have an
- 00:28:40elevated insulin level to signal to the
- 00:28:44fat cell that it needs to grow that's
- 00:28:46the stimulus telling the fat cell grow
- 00:28:49and then you must have sufficient energy
- 00:28:52or enough calories available to fuel
- 00:28:55that growth I hope that you can
- 00:28:57appreciate the difference a fat cell
- 00:29:00that is swimming in a sea of calories in
- 00:29:02the absence of insulin will not store
- 00:29:04any of those calories it is totally
- 00:29:08completely physically impossible for a
- 00:29:11fat cell to not only grow but even stay
- 00:29:14big if insulin is low it cannot hold on
- 00:29:17to its
- 00:29:18energy so you need an insulin stimulus
- 00:29:21and you need sufficient energy to fuel
- 00:29:24that stimulus to grow now you have a
- 00:29:26hypertrophy or fat fat cell and then you
- 00:29:29have this kind of more in creeping
- 00:29:32Insidious version of insulin resistance
- 00:29:34that you know that's sort of settling in
- 00:29:36over time as the person's gaining this
- 00:29:38weight in a unique Way by making the fat
- 00:29:40cells get big so that is the sort of
- 00:29:43final sentiment here now one other point
- 00:29:47where I mentioned I would bring back the
- 00:29:48soybean oil or the linolic
- 00:29:51acid linolic acid contributes to insulin
- 00:29:54resistance in part through this fat cell
- 00:29:57effect because linolic acid will inhibit
- 00:30:01the fat cell's ability to multiply and
- 00:30:04so as a fat as the fat tissue elevated
- 00:30:06insulin sufficient energy is being told
- 00:30:09and fueled to grow if there's linolic
- 00:30:12acid coming in it accumulates in the fat
- 00:30:14cell converts becomes this other
- 00:30:17molecule called 4 h& for hydroxy nonanol
- 00:30:204 h& and 4 h& will basically dictate to
- 00:30:24the fat tissue and say fat tissue you've
- 00:30:27been told to grow I'm going to tell you
- 00:30:30how to grow and that's specifically
- 00:30:32through hypertrophy now insulin does
- 00:30:33that too um insulin will also
- 00:30:36selectively promote hypertrophy but
- 00:30:38linolic acid contributes to that so this
- 00:30:40is another unique mechanism whereby it
- 00:30:43contributes to insulin resistance by
- 00:30:46selectively influencing the way the body
- 00:30:49gains
- 00:30:50fat all right that is
- 00:30:54it let's now thanks for listening
- 00:30:57hopefully you took some notes and again
- 00:30:59that talk that I referred to shrinking
- 00:31:01the fat cells insulin versus energy um
- 00:31:03that's one that will'll get posted here
- 00:31:05soon and you will really enjoy it you'll
- 00:31:08like it it's really me diving into these
- 00:31:10last points that I was just talking
- 00:31:12about namely taking the big fat cell and
- 00:31:14shrinking it all right let's move over
- 00:31:17to the
- 00:31:18Q&A and thank you for those who have
- 00:31:20joined live and those who watch later I
- 00:31:23hope you come to another session with
- 00:31:25some of your questions um but those who
- 00:31:27are here live um Rich uh thanks for
- 00:31:31tuning in Ben so glad you're talking
- 00:31:33about insulin resistance an old but new
- 00:31:35Theory out in the plant-based world is
- 00:31:37that fat actually is a cause of insulin
- 00:31:39resistance they're trying to show that
- 00:31:40plant-based diets are more effective
- 00:31:43yeah yeah so a common um refrain in the
- 00:31:47plant-based Community is that fat causes
- 00:31:50in well specifically saturated fat in
- 00:31:53fact they will use these really
- 00:31:54scientific terms like gum up or clogs up
- 00:31:58the insulin
- 00:32:00receptor which is just silly um but
- 00:32:03there's a there's an oun there's a speck
- 00:32:05of Truth in what they've found and and
- 00:32:08in fact I've contributed to this so
- 00:32:10whether they know it or not in some
- 00:32:12instances they're actually invoking my
- 00:32:14own work um from my earlier research
- 00:32:16during my post-doctoral time so if you
- 00:32:19take cells or you infuse treat them with
- 00:32:23saturated fats or you infuse them with
- 00:32:27or you infuse an animal rather with
- 00:32:29saturated fat they will become insulin
- 00:32:31resistant that's not the case if you say
- 00:32:35um treat the cells or Infuse the animals
- 00:32:37with oleic acid the monounsaturated fat
- 00:32:40and then it's kind of varying responses
- 00:32:43in the case of the omega-6
- 00:32:45polyunsaturated fat linolic acid from
- 00:32:48soy oil for example or any refined seed
- 00:32:51oils um so in this case the there is
- 00:32:53some evidence um but remember INF using
- 00:32:57saturated fat you know me having Rich
- 00:32:59you come into my lab and we stick an IV
- 00:33:01in you and Infuse some palmitate that is
- 00:33:03not the same as you eating palmitate and
- 00:33:06so now we go to the human studies like
- 00:33:08some of the work from Jeff volik at the
- 00:33:10University at the Ohio State University
- 00:33:12and he has found that in his work you
- 00:33:15can have a a low carb group that is
- 00:33:17eating multiples more saturated fat than
- 00:33:21a low fat group and they not only have a
- 00:33:24greater reduction in inflamm
- 00:33:27but they have this significant
- 00:33:29Improvement in insulin resistance so at
- 00:33:31the level of what goes into your mouth
- 00:33:34which is where we should care um where
- 00:33:37this
- 00:33:37happens um especially if carbohydrates
- 00:33:40are restricted the saturated fat is not
- 00:33:42causing insulin resistance now to
- 00:33:45complicate it a little bit if you have
- 00:33:48someone eating a high carb diet and then
- 00:33:51you add to that high carb diet saturated
- 00:33:53fat or monounsaturated fat the SAT
- 00:33:56saturated fat does have cause greater
- 00:33:59insulin resistance um but of course
- 00:34:02that's in the context of a high carb
- 00:34:04diet which does not apply of course to a
- 00:34:06ketogenic diet that's the opposite of a
- 00:34:08ketogenic diet so these plant-based
- 00:34:11plant-based Advocates that are vilifying
- 00:34:12saturated fat they're just selectively
- 00:34:15taking some lines of evidence and
- 00:34:16applying it to fit their ideas now what
- 00:34:19happens when you take a plant-based diet
- 00:34:22and compare it to a ketogenic diet um
- 00:34:26which generally is to be on the opposite
- 00:34:28end of saturated fat
- 00:34:29consumption there is not a single study
- 00:34:32to show that a plant-based diet
- 00:34:33outperforms um the ketogenic diet now
- 00:34:36that is not the same as like the
- 00:34:37Stanford twin study that was just
- 00:34:38published that was not ketogenic they
- 00:34:40had a plant-based group and then they
- 00:34:42had an omnivore Group which was eating
- 00:34:44lasagna and hamburgers you know all
- 00:34:47kinds of stuff not not ketogenic
- 00:34:49whatsoever so it was heavily heavily
- 00:34:51skewed to find the result that they
- 00:34:53wanted to that they wanted to get and of
- 00:34:56course immediately Netflix made a
- 00:34:58documentary about it I can highlight
- 00:35:00that study in the future metabolic
- 00:35:02classroom just specific to that report
- 00:35:05um which which I will do from time to
- 00:35:07time we'll just do uh metabolic
- 00:35:09classroom that's based on just analyzing
- 00:35:10a popularly published manuscript and
- 00:35:12that would fit the bill so anyway um the
- 00:35:15plant-based diets only improve insulin
- 00:35:18resistance because they restrict energy
- 00:35:21um because you just start to have a
- 00:35:23calorie restriction as you only eat
- 00:35:25plants um and so that's how it works if
- 00:35:28you try to put them on a higher calorie
- 00:35:30version of it they won't have any
- 00:35:31Improvement um in fact some of the
- 00:35:33studies that have compared plant-based
- 00:35:35diets to just normal standard American
- 00:35:37diet show modest improvements or no
- 00:35:39improvements whatsoever if you're not
- 00:35:41make forcing them to go into a low
- 00:35:43calorie state but remember the fat cell
- 00:35:46if it's really really big or one thing I
- 00:35:48didn't talk about but I do in this talk
- 00:35:50that I will direct everyone to once it
- 00:35:52gets once I share it on insulin IQ if
- 00:35:55you start restricting energy in the diet
- 00:35:57as you do so every single study that's
- 00:35:59ever looked at a plant-based diet has
- 00:36:01taken people from their standard
- 00:36:04American diet that they were eating
- 00:36:05which is high carb high calorie and then
- 00:36:08lowered the calories and put them on a
- 00:36:10plant-based diet even lowering the total
- 00:36:12amount of carbs they're eating which
- 00:36:15sounds crazy and so any of these studies
- 00:36:18that look at lowfat plant-based diets if
- 00:36:19you actually look at the insulin it goes
- 00:36:22down because you're taking them from
- 00:36:24this high calorie standard American into
- 00:36:27the plant-base you do anything to those
- 00:36:29people and they're going to get better
- 00:36:31including a plant-based diet the problem
- 00:36:34the more your plant-based diet the more
- 00:36:36nutrient deficient you become so this
- 00:36:38this Stanford twin study for example
- 00:36:41even after just a couple weeks the
- 00:36:42people were getting low and nearly
- 00:36:44deficient in vitamin
- 00:36:46B12 uh so uh that's that's a problem of
- 00:36:49course um where B12 is essential
- 00:36:51throughout the body all right Rich
- 00:36:53hopefully that helps um Carly thanks for
- 00:36:56joining Lindsay this may be a dumb
- 00:36:58question but will you see
- 00:36:59hyperinsulinemia when the underlying CL
- 00:37:01causes inflammation or stress yep yep so
- 00:37:03I I mentioned that uh with those primary
- 00:37:06causes well of course with insulin
- 00:37:08that's one that one's obvious but yes if
- 00:37:10you induce insulin resistance through
- 00:37:12stress response or an inflammatory
- 00:37:14response as the body becomes insulin
- 00:37:16resistant elevated insulin is soon to
- 00:37:18follow in that case in that instance
- 00:37:20it's a consequence of the insulin
- 00:37:22resistance but it is an Inseparable
- 00:37:25consequence there's no splitting that
- 00:37:29apart Carol thanks for tuning in yes to
- 00:37:32ask more about Rich's comment from the
- 00:37:34mastering diabetes perspective they
- 00:37:35promote a no Animal product and no fat
- 00:37:37diet the claim is that this is the
- 00:37:38method to lower IR yeah again Carol you
- 00:37:41note this further down anytime you start
- 00:37:44depriving the body of energy insulin
- 00:37:46comes down and thus it's no surprise
- 00:37:49that the body will become insulin
- 00:37:50resistant my counter to that is how long
- 00:37:53can you continue to restrict the energy
- 00:37:56and how long can you afford to deprive
- 00:37:58yourself of essential nutrition like ham
- 00:38:00iron or vitamin B12 for example or
- 00:38:03omega-3 fatty acids the essential ones
- 00:38:06that you cannot get from plants so the
- 00:38:08more I have very strong feelings about
- 00:38:10the plant-based diet because I just
- 00:38:12generally view it as an anti-human view
- 00:38:15that the more you try to force humans to
- 00:38:17only eat plants the more you are
- 00:38:20weakening them and even killing them for
- 00:38:23example and ruining the species if you
- 00:38:25put men on a lowfat diet guess what
- 00:38:28happens to their testosterone guess what
- 00:38:30happens to their sperm production and
- 00:38:33motility down and the more a woman is
- 00:38:36deprived of vitamin B12 the more
- 00:38:38incapable she is of carrying a fetus
- 00:38:40carrying a baby fullterm so you
- 00:38:42literally start to kill the human
- 00:38:44species and that to me is pretty telling
- 00:38:48all right Jerry alosis touted as not
- 00:38:50causing a glucose response but does it
- 00:38:52raise insulin wonderful question it does
- 00:38:54not in fact we are sick 6 weeks into an
- 00:38:57animal study on alilo and we're just
- 00:38:59about to start a human study so anyone
- 00:39:01living in Utah Valley if you're wanting
- 00:39:04to participate I'll be making an
- 00:39:05announcement soon about that but no
- 00:39:08there is no insulin response to alose at
- 00:39:10all one of the other reasons I'm a
- 00:39:12little enthusiastic about allulose is
- 00:39:16that it's more than just a replacement
- 00:39:18for sugar like every other sweetener is
- 00:39:20whether it's Stevia or rral and those
- 00:39:21are fine um monk fruit extract they're
- 00:39:25all fine in my book uh but they just act
- 00:39:29by replacing sugar the thing about alos
- 00:39:31is it also replaces table sugar as a
- 00:39:34rare sugar itself but it increases
- 00:39:37glp1 um and glp1 helps not only keep
- 00:39:41keep glucagon in check which is why it's
- 00:39:43likely so helpful with people with type
- 00:39:441 diabetes but it also delays gastric
- 00:39:47emptying making you feel Fuller for
- 00:39:50longer which is of course very
- 00:39:53beneficial all right jack um Shar 's a
- 00:39:56question from a follower um Ben from one
- 00:39:59of our followers I heard Dr Vickman
- 00:40:01talking about diet soda he sounded like
- 00:40:02he was saying people overeat from
- 00:40:04drinking diet soda because it makes one
- 00:40:07Hungry Jack let me see if I can expand
- 00:40:09that okay I think that's the end of the
- 00:40:11question oh I believe some weight
- 00:40:12gainers are not overeating due to the
- 00:40:14soda it's the insulin effect alone so no
- 00:40:17there is uh diet soda alone the
- 00:40:20aspartame in the diet soda will not
- 00:40:22cause an insulin Spike I have I've
- 00:40:24really looked into that to because I
- 00:40:27know it's such a commonly enjoyed
- 00:40:30sweetener because of its presence in in
- 00:40:32diet sodas there is no insulin
- 00:40:35effect however there is something that's
- 00:40:38referred to as the calic effect where
- 00:40:41you taste something sweet and then the
- 00:40:44body is expecting the calories from that
- 00:40:48sweetness um and that's understandable
- 00:40:51especially from carbohydrate it wants a
- 00:40:53glucose load because in nature there is
- 00:40:55nothing that is sweet unless it is a
- 00:40:58carbohydrate there's no sweet fats
- 00:41:00there's no sweet proteins it's only
- 00:41:02carbohydrate and so the body's expecting
- 00:41:04a glucose load because of that and so
- 00:41:08but not everyone appears to feel this so
- 00:41:11my general sentiment on diet soda is if
- 00:41:14you are in your most honest moment
- 00:41:18capable of enjoying a diet soda and you
- 00:41:23don't start snacking you don't have this
- 00:41:25kind of per iive effect on the back end
- 00:41:27of it then it's fine what do I mean by
- 00:41:29that if you're sipping on a diet soda
- 00:41:34and then you feel I'm gonna get the
- 00:41:35fries too and I'm gonna get this big
- 00:41:37hamburger and I'm gonna eat the bun you
- 00:41:38know whatever um because I have the diet
- 00:41:41soda or you you feel like you need to
- 00:41:44eat just because it makes you hungry
- 00:41:46then it's a problem and I think you
- 00:41:48should wean yourself off of diet soda if
- 00:41:50you're able to enjoy a diet soda and it
- 00:41:52stops with the diet soda and mind you
- 00:41:54that's not something that necessarily
- 00:41:55happens hour an hour after it could be
- 00:41:58that you have the diet soda at noon and
- 00:42:00maybe you're getting really snacky and
- 00:42:02hungry in the evening um then you need
- 00:42:05to monitor your consumption more but
- 00:42:07again just to confirm there or reiterate
- 00:42:10there is no direct effect to the
- 00:42:12aspartame increasing insulin which is
- 00:42:14inre increasing fat gain it's a it's a
- 00:42:17consequential effect BEC uh in some
- 00:42:20people if they start to eat more or
- 00:42:22indulge more
- 00:42:24after all right Right Carly on a hangout
- 00:42:28yesterday we talked about alos and the
- 00:42:29source matters since some sources come
- 00:42:31from corn anything you can add to this
- 00:42:33conversation yeah yeah as far as I know
- 00:42:36there's no difference um whether it
- 00:42:38comes from figs or corn it is allulose
- 00:42:42and not in any other way
- 00:42:44adulterated um I'm pretty confident on
- 00:42:47that as I've become more familiar with
- 00:42:49alos I'm unaware of any evidence fact
- 00:42:51this I can state conclusively I'm
- 00:42:53unaware of any evidence but you may say
- 00:42:54well that's just because you're ignorant
- 00:42:55I'm pretty pretty sure there's nothing
- 00:42:57out there um that suggests the source is
- 00:42:59going to
- 00:43:01matter um Joseph one of my clients
- 00:43:03mentioned how every time their blood
- 00:43:05sugar goes up she gets knee pains could
- 00:43:07this be the inflammation you talked
- 00:43:09about
- 00:43:10um it could be Joseph it could be it
- 00:43:14could be inflammation but it's difficult
- 00:43:16I always try to be careful in the order
- 00:43:18of events when I talk about these things
- 00:43:21and the way I spoke about inflammation
- 00:43:23in the context of metabolic Health was
- 00:43:25from the position of inflammation then
- 00:43:29creating the metabolic problem not the
- 00:43:32metabolic problem creating the
- 00:43:34inflammation if that makes sense so in
- 00:43:36this case of the knee pain I actually
- 00:43:38would be more
- 00:43:40inclined to think of the a
- 00:43:44possible this I might be really kind of
- 00:43:47getting a little kooky here but it was
- 00:43:49the first thought that came to mind so
- 00:43:50I'll go with it it might be a systemic
- 00:43:53vasil constriction and a relative blood
- 00:43:55flow restri restriction so one of the
- 00:43:57interesting things about the knee and
- 00:43:59these joints is that um they they
- 00:44:02generally have very little blood flow
- 00:44:04and so if you compromise the blood flow
- 00:44:06even a little more they go from Little
- 00:44:08to almost nothing and if you eat a big
- 00:44:12spike you get a big spike of glucose
- 00:44:14that that activates your sympathetic
- 00:44:15nervous system um this is one of the
- 00:44:18reasons why many people sleep so poorly
- 00:44:20it's because they indulge on glucose
- 00:44:23spiking starches and sugars in the
- 00:44:25evening and they go to bed hyperglycemic
- 00:44:27wondering why they're anxious well
- 00:44:28you're not anxious you've just activated
- 00:44:30your sympathetic nervous system so
- 00:44:31you're hot you're sweaty your heart is
- 00:44:33beating hard but another effect related
- 00:44:36to the heart beating is that you get
- 00:44:38what's referred to as a systemic Vaso
- 00:44:40constriction so in the sympathetic
- 00:44:42nervous system is turned on it starts to
- 00:44:44restrict the blood vessels um and that
- 00:44:47might be what is contributing if I had
- 00:44:50to guess that's actually where I think
- 00:44:51it would fall Joseph I think it would be
- 00:44:53more on this acute response to the hyper
- 00:44:56glycemia and the restricted blood
- 00:44:58flow Rich Ben the plant-based diets also
- 00:45:01tout that it lowers cholesterol is there
- 00:45:02a benefit in lowering cholestrol no I do
- 00:45:05not believe there is in fact many many
- 00:45:07lines of um admittedly correlational
- 00:45:11evidence which is the only kind there is
- 00:45:12when it comes to longevity show that the
- 00:45:14longest lived people typically have high
- 00:45:17cholesterol levels now a lot of these
- 00:45:19plant-based people will of course invoke
- 00:45:20the idea of blue zones and we'll address
- 00:45:22that in a future classroom but I firmly
- 00:45:25believe the whole Blue Zone phenomenon
- 00:45:27is based on fraudulent uh it's all a
- 00:45:30fraud actually there's some pretty
- 00:45:32convincing evidence the only the only
- 00:45:34evidence that exists that in every one
- 00:45:36of these so-called Blue zone areas
- 00:45:38whether it's Okinawa or whether it's
- 00:45:40Sardinia they actually paradoxically on
- 00:45:43average have among the lowest life
- 00:45:45expectancies and among the lowest
- 00:45:47literacy rates within their respective
- 00:45:49countries and what this person has
- 00:45:51concluded this was an Australian
- 00:45:53scientist it is that um this these are
- 00:45:56people who are fraudulent in reporting
- 00:45:59their birth dates and they can because
- 00:46:01of poor recordkeeping the areas are very
- 00:46:03generally a little more impoverished but
- 00:46:05they're doing this to um get um
- 00:46:08retirement benefits earlier and so I I
- 00:46:12actually think that's all pretty
- 00:46:13validated because the evidence is so
- 00:46:14hard to reconcile these are areas with
- 00:46:16poor literacy overall lower mortality
- 00:46:20rates in the rest of the country so on
- 00:46:21average people are dying more and then
- 00:46:23we're expected to believe that there are
- 00:46:24these paradoxical anomalies in their
- 00:46:26midst where they're suddenly living to
- 00:46:28well over a 100 I think it's all based
- 00:46:30on fraud indeed they're poor which is
- 00:46:33why they aren't eating a lot of meat um
- 00:46:36and then in fact in some of the longest
- 00:46:37lived countries on on the planet like
- 00:46:39Hong Kong they have the highest per
- 00:46:42capita consumption of meat so that
- 00:46:44doesn't quite work with that idea um and
- 00:46:48again high cholesterol might be part of
- 00:46:49the benefit um interestingly a paper was
- 00:46:53just published and I'm going to do a
- 00:46:54little Instagram post on this in a bit
- 00:46:57where just today where they found that
- 00:46:59um people who adopt a ketogenic diet
- 00:47:01there's this big concern you eat all
- 00:47:03that saturated fat and your cholesterol
- 00:47:04is going to go through the roof what
- 00:47:06this group found was that this is a
- 00:47:07phenomenon that only happens in people
- 00:47:10who are already fairly lean this is part
- 00:47:13of the lean mass hyperr phenomenon that
- 00:47:16Dave Feldman has really posited and now
- 00:47:18continues to grow in attention and
- 00:47:20evidence that if someone is
- 00:47:23overweight they don't appear to have
- 00:47:25have this LDL increased effect in
- 00:47:28response to the ketogenic
- 00:47:30diet all right Mindy um do you know
- 00:47:34anything about a sugar called treos that
- 00:47:36you can share with us that's a great
- 00:47:39question um I am familiar with
- 00:47:43treos um that it's a it's a very
- 00:47:47uncommon sugar and I just am going to
- 00:47:49kind of look up how what it gets
- 00:47:51digested into and I think it's just too
- 00:47:54I think it's a
- 00:47:56it's a basically a starch or a glucose
- 00:48:00molecule bound together with a What's
- 00:48:02called the glycos two glucoses bound
- 00:48:04together with a glycosidic bond that the
- 00:48:06body has a hard time digesting um that
- 00:48:09we don't split that Bond very well we
- 00:48:11have an amalay enzyme that can split
- 00:48:13lots of other glucose bonds um taking
- 00:48:16that bread that polymer of starches and
- 00:48:18turning it into a lot of glucose but
- 00:48:20with Tre hos we don't split that very
- 00:48:21well now I'm speculating a little um I
- 00:48:24can't totally remember it even though
- 00:48:26I've become I've been familiar with it
- 00:48:28in the past but I believe that's how it
- 00:48:29acts we basically don't digest it very
- 00:48:31well and thus we taste the sweetness as
- 00:48:35it hits our mouth and yet we don't have
- 00:48:36any um glucose impact but I'm kind of
- 00:48:40speculating there Mindy I'm sorry that
- 00:48:41I'm not more familiar with it I'll I'll
- 00:48:43bone up on that um all right another one
- 00:48:46Tanya how does Hong Kong Stack Up on the
- 00:48:48rates of heart disease yeah yeah super
- 00:48:50low um you can look up the incidence and
- 00:48:53mortality especially mortality of heart
- 00:48:55disease and Longevity and it's one of
- 00:48:57the longest lived countries on the
- 00:49:00planet so that's pretty impactful but
- 00:49:03also you guys just as a just as a
- 00:49:05counter to that whole narrative that
- 00:49:06meat is causing these diseases of
- 00:49:09civilization or what I call the plagues
- 00:49:10of prosperity look at what has happened
- 00:49:13to red meat consumption in the last 120
- 00:49:16years in the United States it went down
- 00:49:19a lot from the early 1900s through the
- 00:49:221960s 1970s um what was up up up up and
- 00:49:26then it plummeted in the 1970s and it's
- 00:49:28come back a little bit and then
- 00:49:30flatlined and it's been flatlined for
- 00:49:32about 20 30 years so we're not eating
- 00:49:35more and more meat every year but what
- 00:49:37is happening during the same time span
- 00:49:39with heart disease with Cancers with
- 00:49:41diabetes they're all skyrocketing they
- 00:49:44continue to go higher and higher so just
- 00:49:46at this Global superficial 10,000 foot
- 00:49:50view the whole thing falls
- 00:49:52apart I hope that anyone who listens to
- 00:49:55this so those tuned in now can be honest
- 00:49:59in looking at this that way that if you
- 00:50:02again if you look at meat consumption
- 00:50:04red meat consumption it has gone down
- 00:50:07since 120 years ago per person and
- 00:50:11during the same span heart disease and
- 00:50:13diabetes in particular have just
- 00:50:15skyrocketed and continued to climb red
- 00:50:18meat does not continue to climb so again
- 00:50:21even at just the simplest glance this
- 00:50:24whole story starts to fall
- 00:50:26apart Jackie we'll say this is the last
- 00:50:29question for today and please join me
- 00:50:31next week so I'm overweight and my LDL
- 00:50:33is Skyhigh but low triglycerides and
- 00:50:35high LDL and Insulin below three so
- 00:50:38Jackie interestingly you are probably
- 00:50:41among those few people who have what's
- 00:50:43called hyperplastic fat growth so this
- 00:50:47is the process whereby fat cells
- 00:50:49multiply so when there's elevated
- 00:50:51insulin and sufficient energy to fuel
- 00:50:53the growth that insulin stimulating
- 00:50:56rather than each individual fat cell
- 00:50:57getting bigger and bigger and bigger
- 00:50:59there are people who have this ability
- 00:51:02to make a new fat cell so before this
- 00:51:05fat cell gets too big we have a new one
- 00:51:07that can start to carry some of that
- 00:51:09metabolic burden and so none of the fat
- 00:51:11cells ever end up getting too big and
- 00:51:14thus they prevent the insulin resistance
- 00:51:16and thus they prevent the
- 00:51:18inflammation so the fact that you are
- 00:51:20overweight now and just as a reminder
- 00:51:22women naturally have more fat than men
- 00:51:24as a consequence sex hormones it's
- 00:51:26natural it's by Design and it's
- 00:51:28healthier for women because of how women
- 00:51:30store fat including a little more
- 00:51:33hyperplasia a little more multiplication
- 00:51:35of fat cells at the butt and hips areas
- 00:51:38those are areas that can get bigger by
- 00:51:40making new fat cells which helps the
- 00:51:41woman stay more insulin sensitive
- 00:51:43despite the fat Mass Jackie in your
- 00:51:46instance it could be what's that's
- 00:51:48what's happening you have this ability
- 00:51:50to make fat cells so you have more fat
- 00:51:53cells but they're smaller and so you're
- 00:51:56insulin sensitive the fact that your
- 00:51:57triglyceride to HDL ratio is so low to
- 00:52:00me matters way more than your LDL and
- 00:52:02this is supported in published research
- 00:52:05that LDL doesn't predict the heart
- 00:52:07disease um risk but triglyceride to HDL
- 00:52:10ratio does much much better than LDL um
- 00:52:15there's in fact one particular study
- 00:52:16that highlights this looking at
- 00:52:17triglyceride to HDL ratio and LDL and
- 00:52:20plotting them on this kind of
- 00:52:21threedimensional curve or or plot
- 00:52:24finding that across all of the LDL
- 00:52:26levels if triglyceride to HDL ratio is
- 00:52:28low there's no increase in heart disease
- 00:52:30risk but the moment you look at the
- 00:52:32triglyceride to HDL ratio going up now
- 00:52:34all of a sudden heart disease risk goes
- 00:52:36up regardless of whether LDL is high or
- 00:52:39low and the fact that your insulin is
- 00:52:41below three suggests in combination with
- 00:52:43the triglyceride to HDL ratio that your
- 00:52:45body is very insulin sensitive and of
- 00:52:47course as a reminder never giving
- 00:52:49medical advice just your friendly
- 00:52:50neighborhood scientist you guys thanks
- 00:52:52for tuning in I hope that you feel that
- 00:52:55you are much more familiar with the
- 00:52:57causes the origins of insulin resistance
- 00:52:59primary secondary and the unique ones
- 00:53:01and the contributing role of the fat
- 00:53:03cell and I look forward to you tuning in
- 00:53:06next week where we'll discuss more about
- 00:53:08the consequences of insulin resistance I
- 00:53:11will see you
- 00:53:13then
- insulin resistance
- metabolic health
- primary causes
- inflammation
- stress hormones
- elevated insulin
- fat cells
- starvation
- diet
- metabolic flexibility