I wish I could find a youtuber as evidence based, knowledgable, thorough and rational as Dr. Katz on every topic. That set of channels would be all I’d need to look at! We need professional advice like this, not the opinions of lay people building narratives from anecdotes which is the standard for youtube. Thank you Mario!
Most videos discussing insulin resistance out there are akin to grifts trying to sell you there brand and particular product. I rarely even comment on a youtube video, but I am blown away by the quality of information in your videos. They are unbiased, thorough, educational, and just high quality. I'm very impressed, and thank you for delivering this educational content.
I really appreciate your balanced approach to medical studies and was particularly impressed with another of your videos where you noted that in ine reported research study, the original study plan was for 40 people, and it was intended to monitor blood sugar rises, while the study, as published, only included 8 participants and did not include the blood sugar levels. That type of evaluation is what all medical and science personnel should be doing Thank you. Maybe you cover this later in other videos, but Dt. Jason Fung shows very compelling research about fasting and notes that simply allowing 12 hours without food intake is one type of fast. My own personal experience is that I started having swollen ankles, especially my left during covid, I also became short of breath with almost any activity. I was checked for kidney function and given a stress test, all came back fine. In the years since, I have become exhausted to the point of taking a nap from 3 to 6pm almost every day. I had to beg to get a CBC with diff, a CRP and an A1C done, all norm. So according to those results I'm just fine, and have been basically dismissed. The only thing is, my ankles are still swollen and painful, I am physically exhausted and recently noted that with slight activity I would be sweating like the humidity was 100%, yet others didn’t seem to be affected. I decided that probably I had some sort of heart or kidney issue that would kill me, and at 67 and overweight, no one would be surprised. I decided that Dr. Fung's idea about fasting might be right, and certainly worth a try. Perhaps my liver was never able to use the glucagon, perhaps my insulin levels are always high and if I just give myself some time to fast every day, things can improve. I started Intemittent fasting on 9/11 and today is 9/28. Last week it dawned on me that I havent taken a nap since I started this, and my ankles arent swollen. I also went walking for almost an hour yesterday with my friend and wasnt even out of breath. If you have already covered this, forgive me for asking, but I would love to see your input on using intermittent fasting to resolve insulin resistance. I am simply not eating until 3 pm at the earliest every day. After 3, I have whatever I want. I truly am amazed at the difference. I know this is simply a personal experience and only a few weeks of IF, but it has made a believer out of me.
Thanks for sharing. Interesting story, even though I am sorry you had to go through this. Long story short, yes, IF/TRE can improve insulin sensitivity. I will make another video about this shortly, with a particular focus on insulin sensitivity. There will also be many other videos on how to reverse insulin resistance, so I am hoping you will find these helpful. Cheers Mario
I am just now reading your question. I started the intermittent fasting in Sept and it is now March 25th. All the improvements that I mentioned have continued. I lost some weight, but then no more. I was allowing myself to eat anything I wanted after 3. Just last week, I decided to add the Keto diet to this plan too,basically for weight loss..so far I have lost a few pounds. I can't give any real insight into how this will succeed long term, but for now it is going really well.
@@nourishedbyscience I am interested in what you think about the Mastering Diabetes method which is high carb for Type 1 and 2 and 1.5 Diabetics. They have continuous glucose monitors and are in range with very high carb and eating lots of fruits. Even mangoes, etc.
I am on lowcarb/keto not because of quicker weight drop, lower insulin levels, etc but this in only way of eating that doesn't trigger me to overeating. I tried vegan, wegetarian, mediterraean, dash and all of them make me miserable by only thinking about food, I could eat to almost ripping my stomach but still was thinking about food. Meat and fat is not my prefered way of eating but I feel free mentally when eat keto. I can eat eggs in the morning and do other things for few hours without obssesive thoughts.
I am hearing this from so many people, and I do think this is one reason why low-carb diets work well for some. Interestingly, I even think that the fact that eating mostly fat and protein is not your preferred way of eating is part of the secret here. Hedonic eating, i.e. eating just for pleasure or because we are bored, is one main reason why we overeat, and if the foods you allow yourself are all so-so, then it becomes much harder to eat beyond real hunger. Cheers Mario
@@williewonka6694 Your example is a very good one, as a great illustration that it's not necessarily carbs per se that are addictive, but the combination of carbs with fat and salt. Try overeating on unsalted boiled potatoes, and you'll quickly realize that it isn't the carbs that are addictive. There is a lot of research supporting this, and the food industry understand this very well, which is why most of the processed foods in our grocery stores are some combination of carbs, usually refined grains and/or sugar, with salt and/or fat. Best, Mario
I’m totally a carb addict too. I think Keto works because I don’t really like eating meat, eggs, fish, or yogurt, or cruciferous vegetables. Nuts, seeds, and beans are fine, and don’t really trigger over-eating either. After a year of “no sugar, no grains” I like eating all the various animal proteins and vegetables more than I used to, but I’ll never be tempted to eat any more of those foods than I need to to get an adequate amount of protein, vitamins and minerals. I still eat too much fruit though.
Also, i appreciate the information, but I would never be that comfortable letting my BG spike to 170. Even 140 seems too high. I prefer to eat foods that keep my BG between 70 and 120.
I watch a lot of youtube channels on diet (and specifically insulin resistance and blood sugar and weight loss) and this one is the most detailed and shows the science more than all the others. Some cite studies, but you really explain them and show details and it's clear you put in a lot of analysis before presenting the results and filter out anything that is not useful. THANK YOU! This video in particular is fascinating. I'm an obese, T2 diabetic (for 19 yrs), 69 yr old woman and decided about 5 months ago I was sick and tired of being sick and tired and decided to take control. I've lost 60 lbs (mostly through cutting out sugar, lowering carbs, supplementing, intermittent fasting and being more active), but blood sugar is still my constant nemesis. In the first few weeks it dropped to near normal levels, but then a month or so ago it dramatically increased (both fasting and average) and I have no real clue why...which is why I'm spending Saturday watching youtube videos right now. The last week it's leveled off and started to go down, but is still well above what I would expect given my diet and eating patterns. I am trying to figure out if I'm just extremely insulin resistant or if maybe I have low levels of insulin after years of eating far too many refined carbs and sugars. Wondering if there is a test that could help me figure it out (if anyone reading this has a suggestion). I asked my doctor for a fasting insulin test and he refused because, he said, they only give them to diabetics on insulin to monitor it (or something???...it didn't make sense to me). In any case, your videos are an inspiration and extremely informative and you are a great resource.
you appear like you care about your health. Dr. Mario is one of the handful reliable sources of information for evidenced based scientific data. You should not advocate for yourself based on celebrity or social media influencers on UA-cam. In addition to talking to your MD and asking for clarification (or go to another one who can help you better) seek the guidance of a registered dietitian, as one myself, I can tell that there is a lot of confusion on this note. Best to you.
Congratulations on taking control of your life. 60 pounds is an amazing achievement! I am on this channel because I have LONG Covid (would NOT recommend) which caused my BG to spike (again). Several years previously I had elevated A1C and BG and dropped 40 pounds (that I had gained relatively quickly). Now I struggle with high morning BG (dawn effect) and I suspect that when I went low-carb and intermittent fasting I started "releasing" long-standing reserves of ?? glucose ?? glucagon ?? fat?? My BG goes UP from waking for about 2 - 3 hours. Is this what is happening to you? 95 - 105 on waking and rises to 110- 115 before dropping, even if I am able to go for a walk (although the walk brings it down quicker). A1C of 5.6% (avg BG of 105 - 110). MY Covid experiences (like oh so many others!) have taught me that doctors don't like if you question them or even take charge of your own health! (When they clearly don't have a handle on it).
@@capnkirk5528My fatherm at age 70, experienced similar symptoms. Not 100% convinced that his covid is LONG, but it’s the only smoking gun, so to speak, as he (unvaxed) came down w/ “something”, minor in Feb ‘22, and never recovered energy (semi-permanently extremely insulin resistant, it seems) since that time. Covid antibodies (IgG) show YES, exposure & response at some point; he’s also been adequately controlling hyperglycemia since 2014 w/ low carb diet & both acute and chronic exercise routines. Never been even close to obese, though he can accumulate a round tummy of fat (max weight 175 lb, 6’ tall). Sounds similar situation, and we’ve not solved the fatigue issue now ... been 20 months straight...
If you want a fasting insulin test you dont need a doctors order you can order that yourself and it's cheap out of pocket. You should look into getting a Kraft test done. Look up dr pradip jamnadas "bittersweet truth" video he covers Kraft tests in first 30min or so of the lecture.
I am so impressed by your honesty and careful analysis of the studies you provide. Unlike so many on youtube, you aren't wedded in advance to any particular theory. Thank you so very much for this unbiased, helpful video.
This guy is so sweet and such a dedicated presenter I get a sugar spike just listening to him!!! My fav so far is fat threshold ---- while I appreciate the info --- I'm on the edge of my seat waiting for evidence based approaches to reversing insulin resistance.
I tried keto, lost weight but absolutely hated it (it was easy, because I despise meat and fat). I eat now everything, but really healthy overall my weight is normal and stable, and love my foods. Thank you for the clear and concise message!! ☀️
I know a bunch of ppl heavier than me who can handle loads of carbs somewhat well, which I (being slightly overweight) instead can not. The personal fat threshold hypothesis appears therefore applicable. Furthermore a closer look into mitochondria would be super interesting and to see in how far those little guys play a role in the whole game...
Mario. Love your channel! It’s better than any CME I’ve had in my career. For this topic I keep asking myself ‘what about all the added high fructose corn syrup hidden in almost everything we consume?’ It seems processed foods and sugars in our modern diet are the culprit. Look at before/after BMI in countries that begin importing western diets. Always rises!
In my experience, by far the biggest benefit of low carb, which is often not discussed (as with video), is incredibly low hunger so I don't eat as much. This effect is so powerful I sometimes forget to even eat a meal but didn't suffer any ill effects afterwards from not eating. Compare this to a single very high carb meal. As my blood glucose drops rapidly, after the spike, I get profound hunger. From using a continuous glucose monitor I observe that this doesn't seem to be when glucose is low, rather it is when glucose levels are dropping rapidly and there is no overcorrection observed either. So, for me at least, low carb makes eating less much more EASY. This practical reality often seems to be overlooked in the technical arguments comparing diets. Find what works for your own body. Low carb seems to suit my body, but not as well for some other people I know. Thankyou for the excellent videos.
So the more carbs in a meal the more hungry I get afterwards, whereas on low carb the more fat & protein in the meal the more likely I'll skip the next meal or just eat something small. I'm surprised this is not talked about more. A really big serve of fat and protein will just crush hunger for half a day, try that with the same calories in carbs... Very different result! (For me, anyway).
Hi Steve, I hear this from many people, and I actually know this from my own experience as well. Particularly with breakfast, if I have a higher-carb breakfast, I get hungry again by mid-morning, whereas if I eat a protein and fat-based breakfast, I may forget to have lunch. However, this effect is not borne out in long-term randomized controlled trials comparing high-carb vs. low-carb diets because, by and large, weight loss is pretty similar with both approaches (as long as both are high-quality diets). It's, therefore, a bit difficult to reconcile the personal experiences of many people with the research data. It is possible that many people have negative effects mostly with refined grains, which are mostly excluded from high-carb diets in research studies, or it's possible that some people do not share our experience of greater satiety with high-protein/fat meals. I'll talk about this a lot more in a separate video later. Independent of what the research suggests, I always feel that we should also listen to what our own experience tells us, and stick to whatever works. Let me also clarify that I made this video specifically to investigate whether high-carb and low-carb differentially affect insulin sensitivity. I think this is an important question because low-carb influencers often claim that carbs are the main cause of insulin resistance, which I don't think is supported by the totality of the data. Thanks for sharing your experience. Cheers Mario
Thanks! I appreciate your balanced approach to this topic and linking the studies you cite in your blog. It takes time to pull all these studies and examine them for quality of design, etc. Great Job Mario!
Terrific channel! I just found you and have already shared your links. You are a breath of fresh air. Great job Doc, keep those videos coming. You are making a difference. Thank you for sharing your knowledge with us. 🙏💕
Your point about what foods are included in a high carb diet is, in my opinion, the important point. Claims regarding high vs. low carb are often overly simplistic. What we eat, how we combine our foods, when we eat/exercise, all have an impact on how our bodies will respond. Also, from studies I have read, I noticed that how many carbs is considered high or low seems to vary considerably. I will definitely check out the studies you listed. I currently eat what I consider a low carb diet:
Hi Mario! I just wanted to say that I found your channel this morning and I’m now binging on your videos!! I like to learn and understand how things work especially when it comes to our bodies and health, and you go so deep and explain it all so well that I must compliment you and I must let you know that I appreciate you very much. I’m sure many others feel the same way and find your presentation very useful and life saving at times. These are the things that doctors should explain to their patients but it doesn’t happen… Thank you so so much you are so appreciated xxx 😊
Thank you for your thoughtful presentations. This is the most down to earth and clear presentation I've found so far (also the previous video you refer to).
Appreciate your videos. When I did some research on what were low carb diets, that was 100-20 grams of carbs per day including some highly processed foods. In my book those studies were invalid. They may be lower card levels than normal but fall way short of low carb diets. I believe a major contributor to insulin resistance are snacks that many people eat. Between meals and after the evening meal and before bedtime. The meals and snacks keep insulin levels higher over a longer period of time. Another contributor for many are what they believe serving sizes are. Most pre-sliced bread is a single slice, breakfast cereals are typically in the 1/3 to 1/3 cup range. As young adult I was eating two sandwiches (4 slices) for lunch each day and having slice or two with dinner. A GCM would have let me know that this was unhealthy, even if was whole bread.
I am open to your argument that constant snacking keeping insulin levels elevated all day could make a high-carb diet insulin desensitizing. However, we currently have no evidence of this. As to the amount of carbs included in these studies, yes, some still contained a lot of carbs, but I didn't include most of these in the table I showed. Most of the studies in the table had less than 10% of energy from carbs, which would translate to less than 50-60g per day. Best, Mario
Thanks for the post. Key is though how does low carb versus high carb affect appetite and metabolism. This would affect weight in a significant way I would guess. The personal fat threshold makes sense. It seems to me that the key is to do whatever it takes to keep weight low enough to limit visceral fat.
I like your nuanced approach. 😊 Do you have any videos on the possible effects of saturated fats (palmitate vs stearic acid vs unsaturated) and fiber on fatty liver and insulin sensitivity? Can palmitate increase NAFL when in a calorie deficit?
Like most commenters here I'm so appreciative of your approach! I accept your conclusion that carbs don't cause insulin resistance. But that just leaves me with more questions. Can I be insulin sensitive but glucose intolerant? After 7+ years of mostly annual bloodwork from my doctor showing fasting glucose of 101-112 and HgbA1c of 5.7 to 6.2 I took matters into my own hands to find out why my numbers were so high. I got a cgm and have been wearing one for 5 months now. I'm able to keep my glucose in range but it does mean keeping carbs pretty low. I had some lab work done about a month ago. Insulin was 4.4, glucose was higher than most mornings at 103, giving me a HOMA IR of 1.1. This snapshot would say I'm insulin sensitive. I'm trying to re-introduce healthy carbs but it's obvious I have to be very careful, which seems to suggest I'm still glucose intolerant. The big question is can I eventually overcome this? If so, how? I watched the video on causes of IR. Will I be able to overcome glucose intolerance with the same things that help with insulin resistance? Increasing exercise and muscle mass, for example. (I'm 69 yo female with solid normal BMI.) I'm hoping you have a future video that addresses this.
Hi Laurie, Excellent question. The short answer is that yes, you can be glucose intolerant, even if you are perfectly insulin-sensitive. That would be the case in someone who cannot make enough insulin, for whatever reason. It's great that you calculated your HOMA-IR. HOMA-IR has one important limitation that may be relevant in your case: because it's based on fasting glucose and insulin, it measures mostly the insulin resistance of the tissue that regulates your blood sugar levels in the fasting state: the liver. So what we know from your normal HOMA-IR is that your liver is not insulin resistant, and you almost certainly do not suffer from a fatty liver. In most people, HOMA-IR also correlates highly with insulin resistance in other tissues, such as the muscle and fat tissues. However, there could be a disconnect in some cases, and maybe that's something for you to consider. For example, someone who is very lean, and with low muscle mass and high physical inactivity, would be expected to have low HOMA-IR, but could still have some muscle insulin resistance simply because there is too little active muscle to help remove sugar from the blood after the meal. And the muscle tissue is the major tissue that removes glucose from the blood after a meal. In short, there are many possibilities, but two could be (a) low beta-cell insulin production capacity; and/or (b) some muscle insulin resistance. You can learn more about the interplay between insulin sensitivity, beta-cell insulin production, and glucose tolerance here: ua-cam.com/video/Yg9AS2sfY9Y/v-deo.htmlsi=-aGXfkCUwCmk5BZv Of course, none of this is an attempt to 'diagnose' your situation here. I therefore strongly suggest you consult with a physician to discuss this further. Best wishes, Mario
Thanks so much for your reply. That does make sense and I was already wondering if my insulin was keeping up with my glucose intake. With so much demonization of insulin on the internet I had started out thinking that I probably had insulin resistance and had initially not considered that I might not have enough insulin. I know some of the medications will boost insulin production but I really want to avoid going down that road. Again, thank you for your extraordinarily well informed non gimmicky content.@@nourishedbyscience
From my own N=1 and wearing a CGM, I have learned that my body does not like/prefer carbs. I have tried several diets and lifestyle changes throughout the years. I have been "too" skinny most of my life. As per my friends circle. It wasn't till my late 20s i started putting on weight. Diets have come and gone. I do not have the resources to have most of these tests. So, i have created my own scientific research. Two years ago i started keto and the first week of less than 20 carbs per day, was in my opion, hell week. Lol After that i maintained 20 or less carbs per week for over a year. I got carbs from berries and green veggies. Within the beginning of this year, I started carnivore lifestyle. It was not hard to make the change due to low carb intake. I finally broke my plateu and I do not get "hungry" anymore. I usually only eat once per day. As of today, I am down 98 lbs. lost 12 in. in my waist and feel great. All my little aches and pains have disappeared. My blood work is all in the middle. On the other hand, i have learned that my body does not handle carbs well. My stomach aches and my inflammation in my joints comes back. I have also learned that it does not help with my sleeping. My sleep score is usually 80 or higher when i consume zero carbs. When i consume carbs, from other that veggies or fruit, i feel like crap and do not sleep well. My only regret is, my choice of going carnivore earlier in life when beef was cheaper...on the good side, I save a lot of money not eating processed foods and can afford the grass fed cuts.
It's crazy how much industrial food prices have gone up in only a few years. Interestingly, the local farmers near me haven't raised their prices nearly as much, so a quarter cow of grassfed beef from my local farmer is actually just a bit more expensive than buying factory farmed meat at Walmart, at least where I live. And considering the difference for my health and the environment (and flavor), I'm grassfed beef all the way baby.
The ketogenic diet is not a healthy way to eat. Eating a carnivore diet is downright stupid. You will almost surely be consuming high levels of saturated fat. Overtime this will greatly increase your risk of cardiovascular disease. Eating once per day is also unhealthy. It is highly unlikely you will regularly eat all the vitamins, minerals, protein, fiber and other nutrients that is necessary in a single meal. Almost EVERYTHING high fat low carb diet advocates say is completely bogus.
Another excellent video. Thank you! Had a question. Did the studies give an indication of the health of the people at the beginning of the study? After all insulin resistance can take a decade or more to develop. I am assuming that healthy people can process insulin better than pre diabetics. People prone to pre-diabetes and those not prone may potentially show similar results if tested at peak health. Running these tests on pre diabetics and seeing if their health improved or got worse may have been a better indication of whether carbs are a factor in improving the health of this set of people.
Very interesting. And great video! I love the clear explanation of the claim, the explanations of what the claim is not, and the blog post with all relevant studies and longer explanations. The claim is that there seems to be no compelling evidence that eating a high-carb diet (healthy, complex, not simple sugars) increases insulin resistance in comparison to a low-carb diet, for individuals who are not losing weight (either due to calorie control or otherwise). Some questions: 1) The studies seem to have different motivations and don't even cite each other much, though the claim here is that they are all related. Why don't they cite each other? Is it possible to make the blog-post a formal paper (or a letter to a journal) that is peer-reviewed (or commented upon) so that one can have more confidence in the claims? Or are there peer-reviewed articles that already make this claim? Or is this a new observation? Or is it folklore among researchers? (contd. on next comment)
2) Is it possible that people recruited for these studies typically snack less during the study than they normally do? Perhaps when people snack more often, a high-carb diet would spike insulin more close to a "chronic" level (like in clamp studies or insulinoma where IR does increase)? This would suggest a low-carb diet could still end up being beneficial for such people. 3) I understand this question asked here is scientifically interesting, but is it practically useful? Won't most people on a low-carb diet be losing weight as well? Also, are there reasons to choose between a low-carb diet and a high-carb diet other than weight loss or insulin resistance?
4) Your blog mentions that the result may not hold for people with diabetes and pre-diabetes. Do the studies explicitly exclude prediabetics? If the studies do exclude them, given that close to half the people in the US are probably prediabetic (or diabetic), does the conclusion not hold for them? 5) Most of these studies are fairly short in duration (except Gardner et al). Is there any reason to believe that insulin resistance increases over short periods of time? If not, can most of these studies be irrelevant? Anecdotal evidence suggests a slow increase (people start out fine, with insulin resistance increasing over a long time, spanning years).
Hey Curious Cat (great user name, very fitting, it seems)! Great questions. Quick answers: 1.) I could write this up as a formal paper, but I could instead make 3-4 more videos, which I'd rather do. 2.) Possible, but not likely. It wasn't prescribed in any of the studies, as much as I remember, how many meals participants could have. Is it possible that constant snacking of high-carb foods leads to more chronic hyperinsulinemia, and that this could promote insulin resistance? Possible, but that theoretical consideration doesn't seem to pan out in the data from the actual dietary intervention studies, which I value more than theoretical considerations. 3.) Yes, people on low-carb usually lose weight, but so do people on high-carb low-fat (take a look at the Gardner et al study, as one example). Also, people can only lose so much weight, and we do know that the weight loss stops at some point. I think it's important to also understand what happens to insulin sensitivity under weight stable conditions. 4.) I am not sure if it holds for people with pre-diabetes or diabetes. There were too few studies of this nature done in patients with diabetes, so that's why I didn't include them here, but I would think that the impacts of the diet in insulin sensitivity may be similar to people without diabetes. However, in diabetes, we need to consider the glycemic impacts of carbs, so eating a high-carb diet can be a concern in people who are glucose intolerant. 5.) Possible that it takes longer, but several studies were 1 month-12 months, and by and large they don't support the idea that chronic exposure to a high-carb diet triggers insulin resistance. Still, we can't rule out the idea that exposure to a high-carb diet will eventually cause insulin resistance over many years (maybe like interest + compound interest, where the impact on insulin resistance gets stronger and stronger over time). However, at best, we can guess at that, and I am hesitant to do that if the available shorter-duration studies do not support the insulin desensitizing effect of carbs at all. I think it's great to question the available data from all angles, but I also do think we need to be careful not to be too much in love with our hypotheses. I see this trend, particularly in the various diet tribes, to constantly question all of the scientific data that don't fit the tribal narrative, whereas I see those same people not applying the same level of critical thinking and rigor to research results that do fit their narrative. In other words, yes, the data at this point are not fully conclusive that carbs do not cause insulin resistance, but neither do they suggest even slightly that carbs may be the cause of insulin resistance. We should weigh both options equally and not be swayed too much by our own preconceived notions or biases. Sorry for pontificating, and I didn't mean this as a criticism of your questions, all of which polite and justified, and a welcome sign of scientific curiosity. I am just explaining my mindset here to clarify why I think that if something looks like a duck and quacks like a duck, it may at some point be adequate to at least consider that it may be a duck ...;-) Best wishes, Mario
Loving your work!! So perhaps regular snacking could mimic the action of a clamp? Not allowing blood sugar to fall back to the point where lipolysis would kick in?
Yes, I am very open to that idea. Particularly when someone mostly eats refined and/or highly addictive carbs, as in ultra-processed foods, soda, sweets, or pastries/cake/cookies/chips/ice cream, and then develop a habit of having a snack every two hours or a soda, it is certainly possible that this creates something similar to chronic hyperinsulinemia that one would expect to trigger insulin resistance. Sadly, I have not been able to find a single study that tested this, so we need to be a bit careful in not drawing firm conclusions based on a theory. Cheers Mario
@@paulantoine1696 Well, to do it well, you would need to randomnize people to consume junk food all day for several weeks, which at this point would be unethical. And probably not fundable, because no one thinks anyways that eating this way has health benefits. So one could argue that testing whether eating a high-carb junk food diet causes insulin resistance is irrelevant, because no matter what such a study would show, we still would feel strongly that we shouldn't regularly be eating such foods, for other reasons. Cheers Mario
Healthy Whole Food Ketogenic/Low Carb lifestyle has helped me lose and maintain my weight! I do incorporate fruits some starchy foods such as white, sweet and purple potatoes! I consider myself a 90/10 which allows me indulge and enjoy the culinarily life a little! It’s all about thriving for that golden balance! Thanks for the contents!! Cheers
Dr Mario, kudos to you for another good vid. The more I study about "all that stuff" the more confused Im.. this is all not black & white... my layman takeaway conclusion is eating various whole food & regular excercise and you should be good ❤
This shoots a hole in the glycemic index discussion. The elephant in the room is food addiction. If you eat large quantities of food and often or snack often, you're going to get fat and insulin resistant. Smokers are sometimes thin. They substituted another addiction for food addiction.
My friend's dad was lean his entire life. He died from diabetes. On the day he passed away his blood sugar was over 800. He also was not the type that lead a sedentary life either.
Type 1 diabetes? Or at least an autoimmune component? At the same time, it is possible to be 'lean' and still have excessive visceral and liver fat, which would contribute to insulin resistance and - potentially - glucose intolerance. ua-cam.com/video/cP57oM8lBaU/v-deo.htmlsi=aAVq9r6L_1pYH6Cw Best, Mario
I strongly suggest you check out this video to understand the major causes of insulin resistance: Insulin Resistance: Top Causes and Contributing Factors ua-cam.com/video/HYtnlRCq83s/v-deo.htmlsi=L6O4VR7wcieL5f_2 For many people nowadays, it's excessive visceral and ectopic fat, which I explain in the video linked below, but for others, it's chronic stress, a chronic inflammatory disease, a micronutrient deficiency, or low muscle mass. To really normalize insulin sensitivity, we need to address all of these potential causes. Causes of Insulin Resistance: The Personal Fat Threshold: ua-cam.com/video/cP57oM8lBaU/v-deo.htmlsi=Jk5DapfLAwMcTKAU Cheers Mario
Dear Mario, thanks a lot for the very helpful videos and your time. I have one question, during my pregnancy I was diagnosed with gestational diabetes and after giving birth still some days in a week I have fasting blood sugar btw 100 and 105, so I want to change my diet to low carb. However in a low carb I need to consume more eggs 2-3 per day and high fat diary. Do you recommend eating 20 eggs per week? Thank you in advance 😊 Greetings from Freiburg
I cannot give you dietary advice here, but let me just share that I probably eat about 20 eggs a week myself ... Obviously, I always recommend that people consult with a healthcare professional and keep an eye on all of their chronic disease risk biomarkers. Cheers Mario
I would like to know if age is considered in these studies. I had My twenty three grandson eat two of those bars with lots of sugar in them and very high in carbs. I checked his bg 1hr later and it was 84. I used to be very sensitive in my 20s up to my late 30s with normal fasting and post ranges like my grandson, regardless of foods eaten. Fast forward at 66 I was dx pre diabetic. I went into moderate keto and two meals a day. My pre diabetes resolved. I run the experiment eating the same as my grandson, but my bg at the hour mark was 110s and back to base at two, which I consider a normal # but still higher than his. Had I done this experiment in before my 30s; My bg would have remained below the 100 #. There is much more to insulin resistance than this diet that diet and how many carbs and kinds of food. I know we humans are different in the way we tolerate and digest foods; also age, genes, life style, medications, sleep, stress are also determinants in the way our bodies mange our nutrients. In my youth I was very active and always healthy, never overweight. I am still fairly healthy and never overweight, but in the last 10 to 15 years my lifestyle mostly work and family demands and genes were playing tricks with my health. That's why, these studies are not 100 or even 90% reliable in my opinion. There are too many variables that are usually not considered. Otherwise good standard information!
Good question. All studies were done in adults, and most in older adults, with some variation between the studies. Couldn't detect a patter, however, that the impact of the high-carb vs. low-carb diets differed depending on age. Cheers Mario
great I keep 20min videos for my morning routine cyclette (before breakfast) It would be interesting to know the effect of exercise on insuline resistance
The timing of eating might play a significant role. If I reduce my eating window (to 6 hours) I am losing weight rapidly and the other way round I am gaining weight (over time), even if I am eating approximately the same amount and kind of food.
Few thoughts and questions ... It is not necessary for the converse to be true if induction of hyperinsulinimeia was observed to cause insulin resistance. Such an effect could have been temporary i.e. observation of insulin resistance. For this, one needs to understand mechanistic connection between low carb and increasing insulin sensitivity. Can Insulin resistance be reversed? How was it handled in those case clamp studies? 5:13 At levels of constant insulin infusion one is to also expect counter hormonal responses from glucagon, cortisol and other glucose releasing processes into the blood stream. So euglycemlic clamp then becomes a function of body's response to insulin infusion as well. 11:17 Hypothesis of connection between low carb intake and insulin sensitivity is inconclusive In the cross clinical study analysis demographics of sample study needs to be considered.
Another great video by Dr Kratz!!! There are obviously plenty of populations that eat carbohydrate-based diets and don't have insulin resistance or type 2 diabetes. What we find in many Western countries is constant daily energy surplus and frequent eating mixed with highly glycemic processed carbs. So glucose and insulin levels are constantly being spiked. There are, however, people who are, for whatever reason, very sensitive to carbohydrates, even whole-food forms, particularly if eaten alone. A single banana eaten by itself, for example, can send my glucose up to 180. A bread roll will put me in the 200's. This is despite HOMA-IR of 0.3, LPIR of zero, and fasting insulin
yeah, but how long are you elevated to 180 or 200 glucose levels? I've seen mine jump up to 300, panicked, waited a few minutes and was down to 150... You are safe to be up post feeding, to a degree...
Yes, there will be many such videos. The most important factor in this regard is that you first try to figure out whether you are indeed insulin resistant, and why that is. And then you can address your specific root cause to reverse it. I recommend these videos here, in this order: To fully understand how blood sugar levels are regulated, and what goes wrong when we become glucose intolerant: ua-cam.com/video/Yg9AS2sfY9Y/v-deo.htmlsi=bPwzv93nh9y_rU_V To assess whether you may be insulin resistant: ua-cam.com/video/OZtxodqOBbw/v-deo.htmlsi=--mcOsqrBULXIazy To identify the potential cause(s) of any insulin resistance: ua-cam.com/video/HYtnlRCq83s/v-deo.htmlsi=xOOtruXRnJyYxn76 Best wishes, Mario
Hello sir, your videos on the topic of insulin resistance are really informative. I was expecting some scientifically proven ways to reduce insulin resistance (other than exercise) from your videos. Are there any? Can dietary interventions improve or reverse IR? Pls share some insights.
I have many videos planned. First discussing the causes, however, because to reverse insulin resistance, we first need to know what causes it. Cheers Mario
@erastvandoren Gerald et al at Yale have worked very hard to uncover correlations, and will continue excellent work to get to mechanisms. One other important fact about metabolic pathways is appreciating the idiosyncratic slight differences between individuals, and this type of research is not even being conducted in 2023. Still population-based, and the cohorts are rough (skin color, male v female, obese v non-obese, egs), and in appalling tiny numbers. That’s why, probably, NIH quickly re-worded from “personalize medicine” to “precision medicine” ... just more of the same population-based average outcomes. Glad you give props 🙌 to Gerald’s team, but don’t fool yourself that insulin resistance is defined & known. Instead, keep learning & promote wonder 😮 & enthusiasm for well-formulated hypotheses 😃
> Telling that you prefer the elixir to come “not including exercise” @@OlehenryI don't think OP was trying to dismiss exercise. It's just that exercise is obvious by now. Someone may already exercise and look for ways to maximize the benefit.
@@jb_1971 Oh yes, I did not think of that. Writing "...in addition to exercise/movement..." might have helped me. I will edit my comment to snip out my admittedly short & bitter response (to those seeking elixirs when the evidence simply isn't in).
For some reason, when I eat high fat foods (nuts, avocado, cheese) I can an urge to eat as much of it as I can, kinda cram it in. With complex carbs it’s not like this for me. I can eat an appropriate portion of beans, salsa and white rice and be completely satisfied. But add guoc and cheese and I can’t/don’t want to stop eating it.
I follow Dr. Ben Bikman and Dr. Jason Fung. I daily measure my blood glucose. I adopted intermittent fasting and a lower carb diet (no bread, pasta, rice, cookies, chips, juice, etc.). I strive to avoid processed foods. My hunger went down and lost 30 pounds. For a 69 yo male - I'll take those results. And I'm very active. Blood pressure good as is my blood panel.
Congrats! That sounds like a major success! It's important to understand, however, that your story is not in contrast to what I presented in this video. There is little question that if people eat a lot of poor-quality carbs, such as added sugars and syrups, refined grains, or carbs in ultra-processed junk foods, they gain weight. And if they gain too much weight and the extra body fat can no longer be safely stored in the subcutaneous fat tissue, they become insulin resistant and potentially glucose intolerant. I explain this idea, called the Personal Fat Threshold, in the video linked below. ua-cam.com/video/cP57oM8lBaU/v-deo.htmlsi=M47CvkUFTx-Wg5NL And, of course if someone cut out these poor-quality carbs and they lose weight, the entire thing also works in reverse. However, it is important to understand that "carbs" per se never made you insulin resistant or glucose intolerant. If you had consumed the same amount of carbs in the form of lentils, beans, whole grains, starchy vegetables, berries, and fruit, you would not have gained weight, and in the absence of weight gain, the cumulative evidence as shared in this video shows that even very high-carb diets do not result in insulin resistance. This is important because it also means that we have other options to treat insulin resistance and glucose intolerance, such as very-low fat plant-based diets or high-protein high-satiety mixed macronutrient diets.
You need to consider the personal carbs threshold hypothesis, not everyone reacts to cards the same way. There's, in deed, a large set of people who can't simply eat carbs and maintain healthy blood sugar levels. Those glucose spikes can create inflammation and lead to atherosclerosis.
Yes, for sure. It's called glucose intolerance and is the basis of diabetes. And that is exactly what we are talking about here: insulin sensitivity is one key determinant of glucose tolerance, and the research shows that eating carbs does not make insulin resistance worse. That doesn't mean that someone could not be insulin resistant and potentially glucose intolerant for another reason. Best, Mario
Рік тому
@@nourishedbyscience The question is could IR be created without high insulin ? If not, what drives insulin high ? Carbohydrates (I know, I know protein too )? If someone eats carbohydrates 3 times a day and that produce insulin spikes , nothing happens. But if some is eating carbohydrates whole day with continues snacking, insulin stays high whole day and we have scenario as in study and IR is created. And need to constant snacking is driven by carbohydrates. Protein can spike insulin too, but is very hard to overeat protein. I see it this way, carbohydrates muss not drive IR, but if IR exist , reason are probably (misused) carbohydrates. I had for 10 years very bad liver results. No doctor could help me. I got instruction eat 5 times a day and exclude all fat. And base of my diet were carbohydrates. Problems accumulated, high blood pressure, psoriasis, psoriatic arthritis and so one. Than I tried to do all otherwise, I eat only 2 times a day and eat more fat and less carbohydrates. I think all know how the story goes :)
Hi Mario! I really enjoy your videos! Would you please make a video about gestational diabetes? Why does someone with normal weight and otherwise no blood sugar issues develop diabetes during pregnancy?
Have you seen my video entitled "The Regulation of Blood Sugar" (link below). In it, I talk about gestational diabetes a bit. ua-cam.com/video/Yg9AS2sfY9Y/v-deo.html Cheers Mario
So much nuance and clarity in your content! Glad you pointed out the limitations of identifying the quality of diets by their macronutrient content. An interesting and important distinction you made: a higher 'carb' diet may be problematic for those who are already glucose intolerant because the carbs are highly glycemic, NOT because they trigger insulin resistance (because there isn't evidence that they do) . Maybe you will cover this later: do low carb diets compared with high carb diets more reliably help people lose visceral and ectopic fat? And therefore improve insulin resistance? (I'm thinking energy balance is key, and protein, fiber and fat help with satiety....) It's so interesting the way all these factors and parameters interact... Thank you for bringing your scientific expertise and excellent communication skills about these important topics to the public!! ~ Marian Blum
I‘m a big fan of your videos. Thank you!! I startet to eat loooow carb and intermittent fasting 5 months ago when my Insulin was 17. It is now 9 and I‘ve lost 4kg (now 68kg) BUT what worries me is that my fasting glucose stays high at an average of 110 and HbA1c of 5.5 I don’t know what to do about it… Kind regards from Tirol!
everything is going along perfect for u! Dr MIndy Pelz says all that fasting glucose staying high is your still emptying your built up storage of sugar out of your body...this is good!! keep going ...your winning! it will eventually reduce when your body spends it all.
If you don't carb load, your fasting glucose may be higher if you are doing a lot of fasting and calorie restriction. Eat a lot of carbs 3 days before this test, and it should come down.
Once again a fascinating review of the science. I’m going to buy a couple peaches! They may spike my glucose but not eating them is not going to improve my insulin sensitivity.
Insulin resistance is very complex. Over nutrition leading congested mitochondria is imo a good contender for being the culprit. It's got plenty to do with available food. If there's not much, we're fine almost no matter what the meagre supply consists of.
I have been IF for a few months and have done a few 24 hour fasts. After my last 24 hour fast my sugar was 164. My previous 24 hour fast was 174. Any idea what I’m doing wrong? I do have NCFL and have bmi over 35. 66 year old female. 3:23
@UnCoolDad, go to the Playlists on my channel. I have published the first video in the series on how to prevent or reverse insulin resistance. The first four videos will all focus on preventing or reversing excess visceral and ectopic fat, because that's a major cause of insulin resistance in most people. After that, I'll address other causes of insulin resistance. Cheers Mario
@@nourishedbyscience thank you. "Lose weight" seems like it is the magic bullet with regard to prevention and control of T2. I look forward to further videos in that series.
@@UnCoolDad I realize that can be frustrating, but for someone who is insulin resistant due to excess body fat and specifically excess visceral, liver, and muscle fat, there is no alternative to addressing this root cause. Best, Mario
@@nourishedbyscience it is what it is. Nothing like a health issue (T2D) to focus the mind on making changes. Will you be making some evidence based videos dispelling some of the diet and fat loss myths out there - particularly with regard to "extreme" diets, and perhaps ketogenic diets? In the end I believe that you must expend more than you consume to metabolise fat, but some "influencers" are saying that is a myth, and calories "don't count". I'd love to see some objective evidence based discussion on this.
I’m trying to sort out my diet. I’ve read that if you don’t give yourself some carbs, your body will increase blood glucose as a reaction. It’s hard to know what to believe. I’m trying to stay low-card, with all those carbs coming from whole fruit with low GL.
That is incorrect. Your body doesn't need carbs, and a zero carb diet can be just fine. That said, low-carb certainly is not the only healthy option, and carbs per se are not the cause of weight gain or insulin resistance. Of course, carbs in the form of added sugar or syrup, refined grains, or carbs in ultra-processed foods can lead to overeating of calories and weight gain, and that weight gain can then cause insulin resistance; no one is denying that. However, eating the same amount of carbs as whole, unprocessed or minimally processed legumes, fruit, berries, starchy vegetables, and whole grains would make it quite difficult to overeat calories and gain weight. Unless you are glucose intolerant, my suggestion is to just eat a mixture of mostly unprocessed or minimally processed foods that you enjoy.
Ive been eating a low carbohydrate diet for a couple of years. At this point, if I eat a small bit of carbs, such as a cracker, or a bit of potato, within about 15 minutes, I get a rush, feel flushed and warm. This seems to pass in about an hour. I'm very curious to know if this is part of the body's insulin response to a glucose spike in the blood. Wish I had a CGM to try out.
It is possible that you develop an overly strong and rapid increase in your blood sugar levels (a 'spike', which I define as an increase to 180 mg/dL or 10 mmol/L, or higher). And that can sometimes be followed by a rapid dip (hypoglycemia=low blood sugar levels). Either of these could explain your reaction. A spike is more likely to develop in someone on low-carb because your general low-carb diet reduces the amount of insulin your pancreatic beta-cells produce in the first-phase insulin response. Usually, people who eat carbs regularly keep pre-formed insulin ready in the beta-cells, and that insulin can be secreted into the blood within seconds to prevent a spike. In someone who eats a low-carb diet, it would be a waste to keep pre-formed insulin (which is protein) in the beta-cells that never gets used, right? So the body reduces the amount of pre-formed insulin while someone is eating a low-carb diet, and that leads to a much more substantial and faster blood sugar response should that person ever eat any carbs. You can learn more about this here: ua-cam.com/video/LVw60RIhbzg/v-deo.htmlsi=2_RHvSl1HGeyEOOL ua-cam.com/video/kxUP0zzBECA/v-deo.htmlsi=BaRnGMoGtzIaotMa One suggestion to consider is that if you eat any carbs, you may want to eat them as part of a meal that also contains fiber and protein, or even at the end or after such a meal, as I describe here: ua-cam.com/video/yg0Y3eNSANg/v-deo.htmlsi=IMKMDYIk7L8oN1Hw Cheers Mario
Wouldn’t energy toxicity be the problem. For example fat + processed carbs would raise insulin the most and the lowest would be lean protein and fiber (leafy green vegetables) ideally fish and leafy greens. Carbs or fats aren’t the whole issue both can help or hurt depending on your needs.
Yes, you are correct. It's a complex problem, and I think the main take away from the video should be that the data do not support the overly simplified narrative we hear so often that high-carb diets always trigger insulin resistance, or that low-carb reverses insulin resistance. The variability we see in the studies may partly be related to factors such as those you mention, because these were not standardized between studies or even - in some cases - diet arms. Cheers Mario
Thanks so much for such evidence base answer to this very crucial question Along the same line of thought, i wonder if you have given any thoughts of life time use of GLP-1 drug (for waste loss and/or diabetes). Arguably the drug itself can emulate a “insulin clamp” Depends upon the patient behavior, their glucose intake might boost (fault sense of security) or lower (due to brain rejection phenomenon of GLP-1) Bottom line How does GLP-1 drugs affect Insulin Resistance? Love to hear your take on this very important topic (as America is having a tidal wave of Ozempic)
When sugar high carbs are present the body I am told has to process the glucose first either as energy or store as fat for later use, if one constantly eats sugar directly or indirectly in high glycaemic food then you ain't going to burn fat so, I am sticking to low carb but hope to keep as normal diet as I can and maintain the benefits of Leto as a tool, my hba1 c improved and I am not considered pre diabetic anymore,
This turned out long, sorry. Thanks to the use of a BG monitor, I know I can reliably elevate my blood sugar and keep it there continuously for many (10+) hours by combining high carb with fat, for example eating ice cream. Presumably my insulin is also elevated the whole time. A self-induced clamp scenario? When I eat high carb and low fat meals, my BG falls quickly back to normal. Marty Kendall has it right imo, when he says insulin is not merely about storing energy, it's also a way of stopping the liver and the fat cells from releasing their energy stores when the blood already has a lot of energy-in that sense insulin is not making deposits, it's preventing withdrawals. I take those premises to mean that health and insulin sensitivity are mainly about keeping energy stores, aka body fat, down. In other words, the bodybuilders are right: caloric deficit + strength training is how to get lean and strong, and it doesn't matter so much what you eat. (See Sam Sulek, e.g.) Finally, eating crap and staying lean is bad not necessarily because "you're eating crap", but because your activity is drawing down nutrient reserves and you're not replacing them. Thank you for your video, thought provoking! :)
I try not to have any opinion on any colleague, but instead evaluate their claims one by one. Any specific claim of Dr. Bernard you are curious about? Cheers Mario
@nourishedbyscience thanks for your response. If you are not familiar with his work, he suggests that fat interferes with insulin signaling within the cell. Therefore, insulin can't do its job because of all the fat gumming up the cell. He believes that a very low fat diet can help restore the function of insulin working in the cell thereby healing insulin resistance...have you heard of this?
@@alpha7ization Yes, and he has published a few nice papers from his randomized controlled trials showing that indeed a low-fat plant-based diet improves insulin sensitivity and glucose tolerance (modestly). However, in all such studies that I am aware of, the primary effect was that people lost weight, and IMO the entire effect of the interventions is due to the weight loss, not the lower fat content of the diet per se. That is because low-carb high-fat diets show a very similar effect: if they lead to weight loss, they lead to a similar improvement in insulin sensitivity, in spite of an actual INCREASE in dietary fat content. That observation is hard to reconcile with the idea that dietary fats are the cause of insulin resistance. The common denominator in both cases is the weight loss. Further of note, as I discuss in this video, low-fat or high-fat diets on which body weight is experimentally kept stable do not differentially affect insulin sensitivity. Dr. Bernard and others are correct to point out that fat-derived substances are a major contrinbutor to insulin resistance in muscle and liver. However, it is important o be clear that these are primarily derived from fatty acids that come to liver and muscle tissues as free fatty acids from subcutaneous adipose tissue, as I explain in the video below. There is no consistent evidence that I know of that suggests that a high-fat diet causes insulin resistance (unless it causes weight gain, in which case the weight gain is the culprit, not the fat content of the diet). The frustrating part about all of this is that diet tribe-related dogma too often gets in the way of having an objective discussion of the science. The low-fat vegans claim that dietary fat is the cause of insulin resistance, and the low-carb crowd claims that carbs are the cause. IMO, the data are pretty clear that carbs and fats per se have no, or little, impact on insulin sensitivity, and that weight gain leading to excess fat storage in ectopic and visceral depots along with the low-grade chronic inflammation that comes with it is the primary culprit. ua-cam.com/video/cP57oM8lBaU/v-deo.htmlsi=XK_f0IgBghqBkp_P Best, Mario
@@nourishedbyscience ok thanks indeed there is so much confusion on this topic...and people desperate for answers have found salvation in their food camps headed by gurus that are idolized....Mastering Diabetes headed by Cyrus khambatta is another proponent of this way of eating villifying fat....good to know at the end of the day calories matter. Thanks
Note that I am not saying that low-fat whole-foods plant-based diets are a bad choice. These are clearly a massive improvement over how most people eat, and if they lead to weight loss, which they often do, they will improve insulin sensitivity and glucose tolerance. I'll talk about this more in detail in a future video. Cheers Mario
I would be curious to see what the meal frequency was in each study. Having a high carb diet with many meals will cause insulin to be higher for longer than eating a couple high carb meals a day.
Some standardized meal frequence, but many don't. I also think that the carb quality may matter. I have discussed in this video here that I agree that constantly snacking on refined grains and added sugars could quite possibly lead to the type of hyperinsulinemia that triggers insulin resistance: ua-cam.com/video/HYtnlRCq83s/v-deo.htmlsi=hFMiMB3jNqFZ2mAf The issue is that none of the clinical studies tested this. We all know that eating mostly refined grains and added sugars is bad, so clinical human investigations usually do not test this type of diet because it would be unethical to expose people to this over an extended period of time. As a result, the high-carb diets I reviewed in this video were mostly based on whole food-sources of carbs, such as legumes, whole grains, vegetables, and fruit. I still think this is relevant, however, because it shows quite clearly that eating more carbs per se does not trigger insulin resistance, as is so often asserted. Cheers Mario
Insulin resistance and diabetes develop over many years, even decades, but these studies only lasted a few months, so we would not expect to see much change in insulin resistance. That would explain the lack of consistent results.
Thanks for chiming in. It is possible that a high-glycemic load-induced pulsatile hyperinsulinemia may take longer to induce insulin resistance. I think this is an open question, but my best guess based on these data would be that it's unlikely. First, the notion that insulin resistance takes years to develop is incorrect. Glucose intolerance and type 2 diabetes can take years or even decades to develop, yes, but that has to do with the fact that initially, the pancreatic beta-cell can compensate for insulin resistance and simply produce more insulin. Insulin resistance itself can develop in a severe form within minutes in someone who is stressed or who develops inflammation. For example, if you had back surgery tomorrow, you would be severely insulin-resistant within hours of the surgery. Not a little bit, severely, such that if your beta-cells cannot compensate completely, you'll be diabetic for a few days after the surgery. So the argument that insulin resistance takes a long time to develop is not particularly convincing. The argument would need to be that this particular trigger of insulin resistance (carb-induced hyperinsulinemia) for some reason is different from others and takes months to years, in a way that is not detectable in these studies. Note, however, that some of the null studies were 8 weeks and even 12 months long, and it seems unlikely to me that effects that are not consistently detectable in weeks to months would meaningfully show up after years (again, assuming no changes in body weight, which we know can be a major driver of insulin resistance). Cheers Mario
@@nourishedbyscience Thank you for your reply. Prof. Roy Taylor, who proposed the twin-cycle theory of T2 diabetes, says that it does take many years to develop, and I haven't seen this disputed before your post. One possibility is that IR becomes worse because of ageing, which IS a very slow process, in which case IR would be expected to increase very slowly with time, even if it never reaches pre-diabetes or full diabetes.
@@Alan_Clark Alan, yes, I agree that the development of insulin resistance due to the accumulation of visceral and ectopic fat is a slow process. That is because most people can initially store some or most of their excess body fat in their subcutaneous adipose tissue, and only once that is filled to capacity do we see low-grade inflammation and the gradual accumulation of visceral and ectopic fat, all of which contribute to the development of insulin resistance (and probably also beta-cell dysfunction due to accumulation of fat in the pancreas). However, this is not what I am talking about here. Of course, if we gain weight, this can lead to insulin resistance. However, there are numerous other causes of insulin resistance that have nothing to do with visceral and ectopic fat as I summarize in the video linked below. And, in my opinion, a high-carb diet or the stimulation of pulsatile insulin secretion is not one of these. Now, you may say that if people eat a poor diet characterized by refined grains and tons of added sugars, or ultra-processed foods enriched in these, they will gain weight. Yes, again, I am not disputing that. This video was about whether we have evidence that - in the absence of weight change - the relative consumption of carbs vs. fat would acutely trigger insulin resistance due to the proposed impact of carbs triggering hyperinsulinemia. This does not seem to be the case. Best, Mario
An interesting analysis. I’m not sure I would give too much credence to the dietary studies. Observation would seem to suggest that things take decades. Many people gradually put on weight as they exit adolescence. Even just 2lbs (which we would barely notice) per year adds up over 30 years. So, expecting to see a dietary change influence insulin resistance in a few weeks or months in a healthy person seems unrealistic. Even in a diabetic, whilst low carb will definitely reduce glucose almost immediately, the evidence seems to indicate that once we have insulin resistance, going back to higher carb will ultimately push glucose back up - which to me means that the insulin resistance is still there. Fortunately, as a diabetic, I don’t need to listen to the ‘science’ as a CGM tells me whether or not I have a problem eating something!
I think you misunderstand. Yes, the accumulation of body fat, more specifically visceral and ectopic fat (see my prior video) takes years to decades. However, hormones, inflammatory cytokines, and some dietary factors can trigger insulin resistance in a few hours to days, so it's certainly possible that the composition of our diet could affect insulin sensitivity in a much shorter time frame. And the whole point of the video is that we are only interested in the body weight-change independent effect. The video was in response to numerous influencers and several very popular diet books that claim that eating carbs causes insulin resistance. Hope this makes more sense now!? Cheer Mario
@@nourishedbyscience it’s not that I have misunderstood. I like the way Dr Unwin describes it - ‘a long silent scream from the liver’. The modern diet is not 3 spikes a day, but closer to 6. A single snack is frequently 50+ grams of carbs (mostly refined). Over decades, this builds up. Over production of insulin as a result of insulin resistance are likely two sides of the same coin. I’m sure you have heard of Ben Bickman - he suggests that hyper insulinemia and insulin resistance cannot be separated. I’m fairly sure that gradual weight gain starts once the metabolism becomes disregulated. This then exacerbates the situation. It can happen from childhood or only from a more advanced age. All I am trying to say is that short term studies are probably misleading when we are considering a ‘chronic’ problem. Even a slight excess presence of insulin in the body constantly over decades may be the same as a high presence over a shorter period. Anyway, keep up the good work - I appreciate your videos :-)
A diet of 3 carb-heavy meals per day seems indeed unlikely to cause insulin resistance (Asians have been eating rice forever, and used to be free of obesity and diabetes.) But what about a carb-heavy breakfast + a sugary mid-morning snack + a carb-heavy lunch + a sugary mid-afternoon snack + a carb-heavy dinner? (+ I've heard that there is such a thing as 10 PM snacks in the US, although being French, I find that inconceivable, so I've a hard time believing it). Such a way of eating looks kind of like chronic insulinemia to me... It leaves a few hours of low insulin every night, but is it enough? I'm just pointing that out because I've just read Dr Jason Fung's Obesity Code and Diabetes Code, and I tend to find his theory compelling.
I see you watched the video about the causes of insulin resistance, in which I express that I am open to the idea that repeated snacking on highly glycemic foods could cause the kind of hyperinsulinemia that triggers insulin resistance. We do not have good evidence for that though, so the theory suggested by some low-carb influencers does remain an unproved theory at this point. I am involved with an organization that conducts independent expert reviews of nutrition books, to assess the degree to which a book's claims are consistent with the scientific evidence. You can see here how The Obesity Code fared: www.redpenreviews.org/reviews/the-obesity-code-unlocking-the-secrets-of-weight-loss/ Best, Mario
Please make clear distinctions between 'linked to' or 'associated with' and 'causes'. They seem to be used in the same sentences and just muddy the waters
I used the teach an advanced graduate class in nutrition methods for seven years at the University of Washington, and trust me that I know about the difference and choose my words very carefully. If you find one incorrect use of any of these terms in any of my videos, point me to it, please. I am only talking about 'cause' in this video as I am citing social media influencers and several nutrition book authors who claim that carbs 'cause' insulin resistance. Best, Mario
Dr Robert Lustig has shown reversal of insulin resistance in obese adolescents without weight loss by reducing fructose intake but adding starch to their diets such that their weights remained constant. He believes that the influence of fructose on hepatic insulin resistance rather than high carbohydrate per se is by far the more important, but of course, once you have developed insulin resistance, carbohydrate, a potent stimulant of insulin compared with protein, will tend to produce hyperinsulinaemia because of the insulin resistance, which will itself stimulate MORE insulin resistance.
Yes, thank you for your comment, I know that study well. The issue is, however, that fructose is the one sugar that does not trigger a strong insulin response. So, in my opinion, fructose is somewhat of a special case, and findings based on fructose should not be generalized to “carbs” in general. As to your second point, I would encourage you to watch the next video published after this one here in which I talk about this in particular, it’s a reasonable hypothesis to assume that excessive carb consumption-induced hyperinsulinemia could play a role in causing or worsening insulin resistance, but the experimental evidence in favor of that hypothesis is very sparse at this point. Therefore, while I would not recommend anyone snack on highly glycemic carbs all day, it remains unclear whether this could indeed be responsible for the development of insulin resistance (independent of any weight change). Cheers Mario
Thankyou for your prompt reply. I wasn’t trying to undermine you re fructose, more that in the real world ‘high carb’ diets usually contain fructose in sucrose or high fructose corn syrup. In your video on causes of insulin resistance number 2 is chronic hyperinsulinaemia - did this only refer to those with an insulinoma or while using an insulin clamp, as in this video? If that is the case it is a bit misleading to a lay person (I’m a medical doctor) as neither of these situations occur in the normal world. I certainly would like to see your next video on this as I am a big fan, but I’m not sure which one it is? Keep up the good work! Ps - Re fructose not raising insulin I remember reading that unscrupulous processed food and drink companies used to claim that their products contained fructose and were ‘healthier’ because of this!
Chronic hyperinsulinemia, as in a hyperinsulinemic clamp or in patients with an insulionma, has been shown to trigger insulin resistance. I'd say that part is solid. To my knowledge, it has never been shown whether, for example, constant snacking on refined grains or other highly glycemic foods could lead to chronic hyperinsulinemia that could similarly trigger insulin resistance. That's a claim often made by proponents of low-carb diets. In the video on causes of insulin resistance, I mention that I am open to the idea, but that at this time there are no data to support that, so it remains a hypothesis at this point IMO. I still thought it worthwhile to discuss the idea of insulin resistance triggered by hyperinsulinemia to differentiate clearly between what is known and what is - as yet - a hypothesis. In Germany, where I am from, most grocery stores used to have a special section with 'foods for people with diabetes' that would include jams, hazelnut spreads, sweets, chocolates, etc. that were sweetened with 100% fructose, because of it's low glycemic index. Glad this is a thing of the past for sure ... Cheers Mario
I’m really curious as to what I should eat then. Almost 49, lifting weights plus cardio a few times a week plus counting my macros (weighing everything). Whole, unprocessed foods. No sugar unless it was from berries or sweet potato. Started gaining weight like a freight train I couldn’t stop. 40 pounds in 8 months without changing anything! Turns out I’m insulin resistant. Clearly higher carb wasn’t working for me. Also, as it turns out low carb is working - although barely. Very slow and excruciating. By that I mean it’s taken me months to lose 5 pounds and now am stuck. It’s so frustrating when you hear and find studies masking up one thing and studies backing up another. There seems to be a subset of us that neither really apply to!!
Sorry to hear of your struggles. I understand how frustrating this must be. Now, 40 pounds in 8 months is so much that - if I was you - I would suspect an underlying medical condition, particularly because you stated that you are already eating very carefully. Have you discussed this issue with a doctor? I would definitely recommend that very strongly if you haven't. For example, you may have low thyroid function, which all by itself would explain the weight gain. Best, Mario
@@nourishedbyscience yes menopause and insulin resistance is what I’m told. Have a statin. I used to have a low thyroid but was taken off of it when I lost all of my weight previously which I successfully kept off for 14 years before this happened. I do have Sjögren’s syndrome but I’ve known about that for the last 2 years so I don’t think that’s it. That is why my diet is so careful because the only way I can manage my Sjogrens symptoms is by following the AIP protocol and tracking what I eat. Thanks for taking the time to respond though. I appreciate it!
@@melindawilson7693 Just to advocate for you, I doubt that menopause and insulin resistance alone can explain 40 pounds in 8 weeks. If I were you, I would request another TSH test soon. If you once were hypothyroid, has it been ruled out in the last 8 months that the condition has re-emerged? Also would ask about treatment options for the menopausal changes in hormone status. Must be frustrating, because it sounds like you are doing aeverything right and the medical system is not making a serious attempt to identify the cause of the rapid weight gain. Sorry, I don;'t want to mess with your medical care and certainly can't give you advice here, but just saying that "insulin resistance" would not sound like a satisfying explanation to me, and I would want a better diagnosis and a treatment plan if I was you. Best wishes, Mario
There was a video released by the channel "Type One Talks" showing that his insulin sensitivity was over 6 times higher on a high carb vegan diet versus a low carb diet. And the sensitivity was three times higher than a relatively high carb SAD diet. What are your thoughts on this? I know it's anecdotal but the results are pretty significant and I think warrant a look. The video is titled "Diabetic goes vegan for 180 days. This happened."
Type One Talks makes engaging videos, but what he shared there would be called an anecdote. I talk here about why we need to be careful with them: ua-cam.com/video/s5qApN0o-Hk/v-deo.htmlsi=LID89Onc20QHSe9s If we didn't have any other evidence, then we could form a hypothesis based on such an anecdote. However, we do have about 20 high-quality RCTs on the subject, and in those well controlled for changes in body weight, and measuring insulin sensitivity by the gold-standard clamp technique, we don't see a difference in insulin sensitivity between high-carb or high-fat diets. Cheers Mario
Yes, both type 1 and type 2 diabetes have a strong genetic basis. However, for both, we also have major environmental triggers, and for type 2 diabetes clearly dietary triggers. A common issue in people who are genetically predisposed to type 2 diabetes is low pancreatic beta-cell function, i.e., the beta-cells cannot produce enough insulin. The solution to addressing this is to improve insulin sensitivity, such that the limited amount of insulin that can be produced is sufficient to keep blood glucose in the normal range. Here's a video that explains all that in detail: ua-cam.com/video/Yg9AS2sfY9Y/v-deo.htmlsi=VBmLZimoWCT4OlQr Cheers Mario
No. If blood sugar levels ever rise to 180 mg/dL, that's probably a sign of glucose intolerance, as I explain here: ua-cam.com/video/DVND90vQ0xI/v-deo.htmlsi=RfA660cUhm41bcgf The point of this video is to clarify that while it's clear that blood glucose rises in response to eating carbs, carbs per se are not the cause of insulin resistance or glucose intolerance. Big difference.
@nourishedbyscience but that is the point as well, it's either no carbs so as not to spike blood glucose or eat carbs and suffer the myriad of things that goes along with high blood glucose.
@@s12_22g You mix up cause and effect here. Very dangerous and misleading. If someone is glucose intolerant, yes, they will have an increased risk of chronic disease partly due to the elevated blood glucose levels. We know for sure that chronically elevated blood glucose levels, and likely also frequent spikes to 180 mg/dL and higher, are associated with an increased risk of chronic disease. However, what is to blame for these elevated blood glucose levels: carbs per se, or glucose intolerance? I argue it's the latter. Further, that person will also have an elevated risk of chronic disease for other reasons that have nothing to do with elevated blood glucose. This is because all of the major causes of glucose intolerance, such as excess visceral and ectopic fat, chronic stress, sleep deprivation, low muscle mass, a sedentary lifestyle, and inflammatory conditions, they all ALSO increase the risk of chronic disease independent of their impact on blood sugar levels. At the same time, let's consider my case. My HbA1c is 4.7%, and when I wear a CGM, my blood glucose is in the 70-140 mg/dL range 99+% of the time, even on my fairly high-carb diet. Do I suffer negative consequences of eating carbs? I know of no evidence that even suggests that fluctuations of blood glucose within the normal range are associated with an elevated risk. If you suggest I do please share a peer-reviewed publication, a single one, that demonstrates this.
not all carbs are equal. The problem may be high insulogenic food rich in sugar or white floor and poor in fiber aka processed food. You could eat a high carb but very rich in fiber and avoiding sugar and processed food. But most metabolically compromised people don t eat like that.
you confirmed what I said, Most people eating a high carb diet eat a lot of sugar and flour, leadind to a metabolic syndrome. But in theory if you are insulin sensitive and eat a clean high carb diet, no prcessed food and low GI carbs, you should be OK, it depends on the metabolic context.
I believe there are 3 monosaccharides. Glucose, fructose and galactose. The carbohydrates we ingest, is either these individually, or chains of these or combinations of these. Your tablesugar, sucrose is one glucose and one fructose molecule. Starches are chains of glucose. Curiously enough, while glucose plays a vital role in our body, too much is a problem for the arteries. We produce insulin to transport glucose away from the blood. Into the muscles, the liver or into our adipose tissues. Unless you are physically active, is there no room in the first 2 stores (they have limited capacity, approx 500g in the muscles, 100g in the liver). That goes for the glucose found in white flour, as well as the glucose found in whole grains and potatoes. The only difference is the speed with which your bloodsugar rises. The “slow” carbs might not elevate bloodsugar as much, but does so for a prolonged time, and the “area under the curve” is most likely the same. Fructose, commonly found in fruits and honey, does not cause an insulin spike. It is metabolized mainly in the liver, and is linked to insulin resistance. So yes, not all sugars are created equal. By far, is fructose probably the worst. Glucose is glucose, whether it’s from white bread or potatoes. It differs only by the rate of digestion. “Slow” carbs might prolong satiety, but the damage to the arteries is most likely the same in a given amount of glucose. If “slow” carbs make you eat fewer carbs, that is most likely a good thing. Look into the work of Rick Johnson. Simon Hill (and Petter Attia) have a lengthy interview with him.
In spite of this video, a low-carb diet can be a good tool to lower blood sugar levels, because while you are glucose intolerant, any carbs you eat will result in high blood glucose levels (most carbs are broken down to glucose). However, that a low-carb diet can be helpful for people who are glucose intolerant should not be seen as evidence that carbs cause the glucose intolerance. What is going to be most important for you is to try to identify the root cause of why you are glucose intolerant. If you carry extra weight and body fat, that may be a major contributor, because it can make you insulin resistant. Look around on my channel; I have many more videos about this very topic. Best, Mario
Unfortunately no info is given as to what constitutes a high carb diet in these quoted studies, in most cases. How many calories, what types of carbs, how many meals per day, ratio of fat to carbs, these are all questions that are unanswered.
I personally think that it’s not carbs in general but rather the type of carbs and the lack of activity. If you eat a diet high in processed carbs, you’re eventually going to see negative results. If you combine that with low activity levels, you’re basically asking to get sick. However if you are someone who eats whole food carbs, well that’s completely different, and then you’re active…
Hi. I am a self-biohacker who works out in a top gym around 6 days a week, 2 hours a day; sleeps over 8 hours a night well, and has a good "low-carb, slow-carb" diet (but could be better). Also, wearing a very good Chinese-made Bluetooth-based CGM that integrates well with my iPhone. This channel @nourishedbyscience has great information, much more factual and science -based that the vast majority of "opinion-based" YT misinfomation out there in social media-land. However, I tend to disagree with the hypothesis in this video that visceral fat is a primary cause of insulin resistance. As shown in this video, visceral fast is a primary effect of insulin resistance, not a primary cause. In other words, insulin resistance originates in the subcutaneous and muscular tissues (when overloaded) and that (overloaded subcutaneous and muscular fat), in return, causes visceral fat. Of course, visceral fat is bad, and surely contributes to insulin resistance, but this is a secondary effect based on the primary cause in most cases (overloaded subcutaneous fatty tissue). Great work here. Please do not take my comments as criticism of this channel, @nourishedbyscience . Subscribed!
Hi Tim, Thank you for your kind feedback. I do not take this as criticism of my work at all. Disagreement on how to interpret the available data is a normal part of the scientific process, and I actually love engaging this way, as long as it's handled respectfully and with an argument. You do have a point, because - if we apply the most rigorous scientific requirements - there are no conclusive data that show it is the visceral fat that causes insulin resistance. You may note that throughout the video, I avoid saying that. Instead, I would say that we have the strongest causal data for fat accumulation in ectopic depots, particularly the liver and muscle, and low-grade chronic inflammation in adipose and liver tissues (and that includes visceral fat inflammation). The key problem is that in all cases that I know about, visceral fat is elevated whenever we also have low-grade inflammation in fat and liver, and accumulation of fat in liver and muscle, i.e., I know of no case where we have in increase or decrease in visceral fat mass without a concurrent change in ectopic fat or measures of low-grade inflammation in metabolically active tissues. It's therefore IMO not possible with current data to isolate the relative contribution of visceral fat to systemic insulin resistance. How do we know that liver fat causes insulin resistance? There are instances where experimentally the fat content in the liver is reduced (through short-term major calorie restriction), and that leads to an improvement in insulin sensitivity even though measures of inflammation in fat tissue or visceral fat mass are unchanged. Also, we have papers showing how an increase in liver fat in the absence of an increase in visceral fat or fat inflammation decreases insulin sensitivity. So it's these kinds of data that strongly suggest that liver fat per se causes insulin resistance. How do we know that low-grade inflammation in adipose tissue causes insulin resistance? As I discussed, there are a few drug trials that lower the degree of inflammation in adipose tissue (albeit also in other tissues), and these improve insulin sensitivity even if ectopic fat and visceral fat don't change. There are also several dozen mouse studies in which the mice were genetically manipulated to specifically block adipose tissue inflammation, and they by and large show an improved insulin sensitivity phenotype. I have actually summarized that evidence in a comprehensive research paper a few years ago with other members of my lab: pubmed.ncbi.nlm.nih.gov/30549014/ For visceral fat, we have no similar evidence where visceral fat mass increased or decreased without a concurrent change in measures of adipose tissue inflammation or ectopic fat, so I agree with you that we cannot be similarly certain that visceral fat plays a causal role in insulin resistance. My best guess would be, however, that inflammation in expanded visceral fat is particularly bad, because uninhibited lipolysis (free fatty acid flow) and inflammatory cytokines that leave most visceral tissues would drain directly to the liver, something that is not the case for subcutaneous adipose tissue. We need to be clear though, that inflammation would not immediately develop in visceral adipose tissue, but only once that tissue has reached it's storage threshold and the adipocytes become too large. So, in other words, visceral fat with mostly small fat cells and no inflammation may be partly inert, while it becomes disastrous from a metabolic perspective once fat cells have reached their storage capacity limit and trigger inflammation. As to your assertion that insulin resistance comes first and plays a role in fat accumulation in visceral fat depots, I think that yes, inflammation in subcutaneous adipose tissue resulting in insulin resistance in that tissue probably comes first. That then leads to uninhibited free fatty acid flux to visceral and ectopic depots. Besides that, however, I know of no strong evidence that hepatic and muscle insulin resistance occur prior to the accumulation of visceral fat. I hope this helps clarify my position. Best wishes, Mario
Great points, both. I think OP meant “dismissive” or “conclusive rebuttal” when he wrote “don’t take my critique as criticism”. lol Criticism requires critical thinking skills, and the OP demonstrated understanding & calm articulation. This is exactly what we all need, plenty of critique to balance our personal (arguably naive) “aha!” moments. Applausa 👏 to you both. No offense taken too 😊
I came across a study a few years ago to the effect that in the USA resting insulin levels of insulin had risen from circa 1950 to 1970/75 by as much as sixty percent. In which case the correlation between increased carb consumption in that time may be relevant in that it may be time in exposure which is relevant. I.e. years not days or weeks. Sorry no reference available.
It is possible that a very long duration of exposure, particularly if including constant snacking on highly glycemic foods, could play a role in the development of insulin resistance. Even if that were the case though, no one recommends constant snacking on pastries, cookies, cakes, donuts, toast with jam, or sugary cereal anyways. Of course that would not be such a great way of eating, and I am not holding my breath that such a diet will ever be studied to see if it causes insulin resistance. However, I think it's important to be clear that the currently available high-quality evidence does not support the idea that eating a diet high in carbs from whole, largely unprocessed or minimally processed foods causes insulin resistance. Many of the studies discussed in this video were really well controlled, some with follow-up periods of up to 1 year, and most included gold-standard measurements of insulin sensitivity. Cumulatively, there just is no signal of greater insulin resistance on high-carb diets, as well as there is no signal of greater insulin resistance on high-fat diets. Still, the 1-2 studies supporting the idea that high-fat diets trigger insulin resistance continue to be cited by low-fat vegans who claim that fat is the cause of insulin resistance. And, vice versa, the 1-2 studies supporting the idea that high-carb diets trigger insulin resistance continue to be cited by adherents to a low-carb diet. That's not how science should work, and if we look at all 21 RCTs cumulatively, there just isn't a signal one way or the other. And that's a good thing in my book, because it gives us more freedom in our dietary choices, Best, Mario
It is so refreshing to see you explaining the science in stead of using science to promote a narritive.
I wish I could find a youtuber as evidence based, knowledgable, thorough and rational as Dr. Katz on every topic. That set of channels would be all I’d need to look at! We need professional advice like this, not the opinions of lay people building narratives from anecdotes which is the standard for youtube. Thank you Mario!
Thank you for leaving such a kind feedback.
Best,
Mario
You can listen to the Fat Emperor too.
Most videos discussing insulin resistance out there are akin to grifts trying to sell you there brand and particular product. I rarely even comment on a youtube video, but I am blown away by the quality of information in your videos. They are unbiased, thorough, educational, and just high quality. I'm very impressed, and thank you for delivering this educational content.
Thank you for your kind comment.
Best,
Mario
I really appreciate your balanced approach to medical studies and was particularly impressed with another of your videos where you noted that in ine reported research study, the original study plan was for 40 people, and it was intended to monitor blood sugar rises, while the study, as published, only included 8 participants and did not include the blood sugar levels. That type of evaluation is what all medical and science personnel should be doing
Thank you. Maybe you cover this later in other videos, but Dt. Jason Fung shows very compelling research about fasting and notes that simply allowing 12 hours without food intake is one type of fast. My own personal experience is that I started having swollen ankles, especially my left during covid, I also became short of breath with almost any activity. I was checked for kidney function and given a stress test, all came back fine. In the years since, I have become exhausted to the point of taking a nap from 3 to 6pm almost every day. I had to beg to get a CBC with diff, a CRP and an A1C done, all norm. So according to those results I'm just fine, and have been basically dismissed. The only thing is, my ankles are still swollen and painful, I am physically exhausted and recently noted that with slight activity I would be sweating like the humidity was 100%, yet others didn’t seem to be affected. I decided that probably I had some sort of heart or kidney issue that would kill me, and at 67 and overweight, no one would be surprised. I decided that Dr. Fung's idea about fasting might be right, and certainly worth a try. Perhaps my liver was never able to use the glucagon, perhaps my insulin levels are always high and if I just give myself some time to fast every day, things can improve. I started Intemittent fasting on 9/11 and today is 9/28. Last week it dawned on me that I havent taken a nap since I started this, and my ankles arent swollen. I also went walking for almost an hour yesterday with my friend and wasnt even out of breath. If you have already covered this, forgive me for asking, but I would love to see your input on using intermittent fasting to resolve insulin resistance. I am simply not eating until 3 pm at the earliest every day. After 3, I have whatever I want. I truly am amazed at the difference. I know this is simply a personal experience and only a few weeks of IF, but it has made a believer out of me.
Thanks for sharing. Interesting story, even though I am sorry you had to go through this. Long story short, yes, IF/TRE can improve insulin sensitivity. I will make another video about this shortly, with a particular focus on insulin sensitivity. There will also be many other videos on how to reverse insulin resistance, so I am hoping you will find these helpful.
Cheers
Mario
Hi, it's been five months now,
how is it going?
I am just now reading your question. I started the intermittent fasting in Sept and it is now March 25th. All the improvements that I mentioned have continued. I lost some weight, but then no more. I was allowing myself to eat anything I wanted after 3. Just last week, I decided to add the Keto diet to this plan too,basically for weight loss..so far I have lost a few pounds. I can't give any real insight into how this will succeed long term, but for now it is going really well.
@@nourishedbyscience I am interested in what you think about the Mastering Diabetes method which is high carb for Type 1 and 2 and 1.5 Diabetics. They have continuous glucose monitors and are in range with very high carb and eating lots of fruits. Even mangoes, etc.
I am on lowcarb/keto not because of quicker weight drop, lower insulin levels, etc but this in only way of eating that doesn't trigger me to overeating. I tried vegan, wegetarian, mediterraean, dash and all of them make me miserable by only thinking about food, I could eat to almost ripping my stomach but still was thinking about food. Meat and fat is not my prefered way of eating but I feel free mentally when eat keto. I can eat eggs in the morning and do other things for few hours without obssesive thoughts.
I am hearing this from so many people, and I do think this is one reason why low-carb diets work well for some.
Interestingly, I even think that the fact that eating mostly fat and protein is not your preferred way of eating is part of the secret here. Hedonic eating, i.e. eating just for pleasure or because we are bored, is one main reason why we overeat, and if the foods you allow yourself are all so-so, then it becomes much harder to eat beyond real hunger.
Cheers
Mario
Yes, carbohydrates are addictive. As the old Lay's Potato Chip jingle says; "Betcha can't eat just one!", well, no one can.
@@williewonka6694 Your example is a very good one, as a great illustration that it's not necessarily carbs per se that are addictive, but the combination of carbs with fat and salt. Try overeating on unsalted boiled potatoes, and you'll quickly realize that it isn't the carbs that are addictive. There is a lot of research supporting this, and the food industry understand this very well, which is why most of the processed foods in our grocery stores are some combination of carbs, usually refined grains and/or sugar, with salt and/or fat.
Best,
Mario
I’m totally a carb addict too. I think Keto works because I don’t really like eating meat, eggs, fish, or yogurt, or cruciferous vegetables. Nuts, seeds, and beans are fine, and don’t really trigger over-eating either. After a year of “no sugar, no grains” I like eating all the various animal proteins and vegetables more than I used to, but I’ll never be tempted to eat any more of those foods than I need to to get an adequate amount of protein, vitamins and minerals. I still eat too much fruit though.
Also, i appreciate the information, but I would never be that comfortable letting my BG spike to 170. Even 140 seems too high. I prefer to eat foods that keep my BG between 70 and 120.
Excellent, clear, un-fussy explanation. And no silly gimmicks either. How refreshing!
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I watch a lot of youtube channels on diet (and specifically insulin resistance and blood sugar and weight loss) and this one is the most detailed and shows the science more than all the others. Some cite studies, but you really explain them and show details and it's clear you put in a lot of analysis before presenting the results and filter out anything that is not useful. THANK YOU!
This video in particular is fascinating. I'm an obese, T2 diabetic (for 19 yrs), 69 yr old woman and decided about 5 months ago I was sick and tired of being sick and tired and decided to take control. I've lost 60 lbs (mostly through cutting out sugar, lowering carbs, supplementing, intermittent fasting and being more active), but blood sugar is still my constant nemesis. In the first few weeks it dropped to near normal levels, but then a month or so ago it dramatically increased (both fasting and average) and I have no real clue why...which is why I'm spending Saturday watching youtube videos right now. The last week it's leveled off and started to go down, but is still well above what I would expect given my diet and eating patterns. I am trying to figure out if I'm just extremely insulin resistant or if maybe I have low levels of insulin after years of eating far too many refined carbs and sugars. Wondering if there is a test that could help me figure it out (if anyone reading this has a suggestion). I asked my doctor for a fasting insulin test and he refused because, he said, they only give them to diabetics on insulin to monitor it (or something???...it didn't make sense to me).
In any case, your videos are an inspiration and extremely informative and you are a great resource.
It is called C-Peptied! Just stop the carbs i.e starch sweet bread etc.
you appear like you care about your health. Dr. Mario is one of the handful reliable sources of information for evidenced based scientific data. You should not advocate for yourself based on celebrity or social media influencers on UA-cam. In addition to talking to your MD and asking for clarification (or go to another one who can help you better) seek the guidance of a registered dietitian, as one myself, I can tell that there is a lot of confusion on this note. Best to you.
Congratulations on taking control of your life. 60 pounds is an amazing achievement!
I am on this channel because I have LONG Covid (would NOT recommend) which caused my BG to spike (again). Several years previously I had elevated A1C and BG and dropped 40 pounds (that I had gained relatively quickly).
Now I struggle with high morning BG (dawn effect) and I suspect that when I went low-carb and intermittent fasting I started "releasing" long-standing reserves of ?? glucose ?? glucagon ?? fat??
My BG goes UP from waking for about 2 - 3 hours. Is this what is happening to you? 95 - 105 on waking and rises to 110- 115 before dropping, even if I am able to go for a walk (although the walk brings it down quicker). A1C of 5.6% (avg BG of 105 - 110).
MY Covid experiences (like oh so many others!) have taught me that doctors don't like if you question them or even take charge of your own health! (When they clearly don't have a handle on it).
@@capnkirk5528My fatherm at age 70, experienced similar symptoms. Not 100% convinced that his covid is LONG, but it’s the only smoking gun, so to speak, as he (unvaxed) came down w/ “something”, minor in Feb ‘22, and never recovered energy (semi-permanently extremely insulin resistant, it seems) since that time. Covid antibodies (IgG) show YES, exposure & response at some point; he’s also been adequately controlling hyperglycemia since 2014 w/ low carb diet & both acute and chronic exercise routines. Never been even close to obese, though he can accumulate a round tummy of fat (max weight 175 lb, 6’ tall).
Sounds similar situation, and we’ve not solved the fatigue issue now ... been 20 months straight...
If you want a fasting insulin test you dont need a doctors order you can order that yourself and it's cheap out of pocket. You should look into getting a Kraft test done. Look up dr pradip jamnadas "bittersweet truth" video he covers Kraft tests in first 30min or so of the lecture.
I am very happy to have found this channel today. I appreciate how much preparation went into this concise video. Thank you for your work
I am so impressed by your honesty and careful analysis of the studies you provide. Unlike so many on youtube, you aren't wedded in advance to any particular theory. Thank you so very much for this unbiased, helpful video.
This guy is so sweet and such a dedicated presenter I get a sugar spike just listening to him!!! My fav so far is fat threshold ---- while I appreciate the info --- I'm on the edge of my seat waiting for evidence based approaches to reversing insulin resistance.
I tried keto, lost weight but absolutely hated it (it was easy, because I despise meat and fat). I eat now everything, but really healthy overall my weight is normal and stable, and love my foods.
Thank you for the clear and concise message!! ☀️
Thanks for sharing.
Cheers
Mario
I know a bunch of ppl heavier than me who can handle loads of carbs somewhat well, which I (being slightly overweight) instead can not.
The personal fat threshold hypothesis appears therefore applicable.
Furthermore a closer look into mitochondria would be super interesting and to see in how far those little guys play a role in the whole game...
Mario. Love your channel! It’s better than any CME I’ve had in my career.
For this topic I keep asking myself ‘what about all the added high fructose corn syrup hidden in almost everything we consume?’ It seems processed foods and sugars in our modern diet are the culprit. Look at before/after BMI in countries that begin importing western diets. Always rises!
In my experience, by far the biggest benefit of low carb, which is often not discussed (as with video), is incredibly low hunger so I don't eat as much. This effect is so powerful I sometimes forget to even eat a meal but didn't suffer any ill effects afterwards from not eating. Compare this to a single very high carb meal. As my blood glucose drops rapidly, after the spike, I get profound hunger. From using a continuous glucose monitor I observe that this doesn't seem to be when glucose is low, rather it is when glucose levels are dropping rapidly and there is no overcorrection observed either. So, for me at least, low carb makes eating less much more EASY. This practical reality often seems to be overlooked in the technical arguments comparing diets. Find what works for your own body. Low carb seems to suit my body, but not as well for some other people I know.
Thankyou for the excellent videos.
So the more carbs in a meal the more hungry I get afterwards, whereas on low carb the more fat & protein in the meal the more likely I'll skip the next meal or just eat something small. I'm surprised this is not talked about more. A really big serve of fat and protein will just crush hunger for half a day, try that with the same calories in carbs... Very different result! (For me, anyway).
Hi Steve,
I hear this from many people, and I actually know this from my own experience as well. Particularly with breakfast, if I have a higher-carb breakfast, I get hungry again by mid-morning, whereas if I eat a protein and fat-based breakfast, I may forget to have lunch.
However, this effect is not borne out in long-term randomized controlled trials comparing high-carb vs. low-carb diets because, by and large, weight loss is pretty similar with both approaches (as long as both are high-quality diets). It's, therefore, a bit difficult to reconcile the personal experiences of many people with the research data. It is possible that many people have negative effects mostly with refined grains, which are mostly excluded from high-carb diets in research studies, or it's possible that some people do not share our experience of greater satiety with high-protein/fat meals. I'll talk about this a lot more in a separate video later. Independent of what the research suggests, I always feel that we should also listen to what our own experience tells us, and stick to whatever works.
Let me also clarify that I made this video specifically to investigate whether high-carb and low-carb differentially affect insulin sensitivity. I think this is an important question because low-carb influencers often claim that carbs are the main cause of insulin resistance, which I don't think is supported by the totality of the data.
Thanks for sharing your experience.
Cheers
Mario
Thanks! I appreciate your balanced approach to this topic and linking the studies you cite in your blog. It takes time to pull all these studies and examine them for quality of design, etc. Great Job Mario!
Thank you for the kind words, and your support.
Cheers
Mario
Terrific channel! I just found you and have already shared your links. You are a breath of fresh air. Great job Doc, keep those videos coming. You are making a difference. Thank you for sharing your knowledge with us. 🙏💕
Thank you for your kind feedback.
Best,
Mario
Now that‘s how you talk about nutrition. Immediately subscribed
Your point about what foods are included in a high carb diet is, in my opinion, the important point. Claims regarding high vs. low carb are often overly simplistic. What we eat, how we combine our foods, when we eat/exercise, all have an impact on how our bodies will respond.
Also, from studies I have read, I noticed that how many carbs is considered high or low seems to vary considerably. I will definitely check out the studies you listed.
I currently eat what I consider a low carb diet:
Love your thoughtful comment. Thank you.
Best,
Mario
the content is really needed, thanks for sharing! And please take up high quality research based content and a critical and scientific approach ❤
Hi Mario! I just wanted to say that I found your channel this morning and I’m now binging on your videos!! I like to learn and understand how things work especially when it comes to our bodies and health, and you go so deep and explain it all so well that I must compliment you and I must let you know that I appreciate you very much.
I’m sure many others feel the same way and find your presentation very useful and life saving at times. These are the things that doctors should explain to their patients but it doesn’t happen…
Thank you so so much you are so appreciated xxx 😊
Thank you for your thoughtful presentations. This is the most down to earth and clear presentation I've found so far (also the previous video you refer to).
Amazing work! Thank you for the profound knowledge and the excellent presentation consistently labeling your videos!
Appreciate your videos. When I did some research on what were low carb diets, that was 100-20 grams of carbs per day including some highly processed foods. In my book those studies were invalid. They may be lower card levels than normal but fall way short of low carb diets. I believe a major contributor to insulin resistance are snacks that many people eat. Between meals and after the evening meal and before bedtime. The meals and snacks keep insulin levels higher over a longer period of time. Another contributor for many are what they believe serving sizes are. Most pre-sliced bread is a single slice, breakfast cereals are typically in the 1/3 to 1/3 cup range. As young adult I was eating two sandwiches (4 slices) for lunch each day and having slice or two with dinner. A GCM would have let me know that this was unhealthy, even if was whole bread.
I am open to your argument that constant snacking keeping insulin levels elevated all day could make a high-carb diet insulin desensitizing. However, we currently have no evidence of this.
As to the amount of carbs included in these studies, yes, some still contained a lot of carbs, but I didn't include most of these in the table I showed. Most of the studies in the table had less than 10% of energy from carbs, which would translate to less than 50-60g per day.
Best,
Mario
Thanks for the post. Key is though how does low carb versus high carb affect appetite and metabolism. This would affect weight in a significant way I would guess. The personal fat threshold makes sense. It seems to me that the key is to do whatever it takes to keep weight low enough to limit visceral fat.
I imagine appetite affect would have to do with protein and fiber
I'm amazed that I could find such kind of information for free. Thank you.
I like your nuanced approach. 😊
Do you have any videos on the possible effects of saturated fats (palmitate vs stearic acid vs unsaturated) and fiber on fatty liver and insulin sensitivity?
Can palmitate increase NAFL when in a calorie deficit?
I know few cases from lowcarb forum where people cured fatty liver with eating only meat, leafy vegetables and saturated fats.
Thx Mario for your amazing work on this channel. You provide evidence based information in a clearly presented way. Pls keep up the great work. 20:56
Not quite to do with carbs and insuline (maybe...), but what about menopause symptoms and dietary choises? Thank you for these videos! 👌
Thank you for all your kind effort you have put into sharing this information. Very exciting. X
Thanks for a evidence based, clear presentation.
Like most commenters here I'm so appreciative of your approach! I accept your conclusion that carbs don't cause insulin resistance. But that just leaves me with more questions. Can I be insulin sensitive but glucose intolerant? After 7+ years of mostly annual bloodwork from my doctor showing fasting glucose of 101-112 and HgbA1c of 5.7 to 6.2 I took matters into my own hands to find out why my numbers were so high. I got a cgm and have been wearing one for 5 months now. I'm able to keep my glucose in range but it does mean keeping carbs pretty low. I had some lab work done about a month ago. Insulin was 4.4, glucose was higher than most mornings at 103, giving me a HOMA IR of 1.1. This snapshot would say I'm insulin sensitive. I'm trying to re-introduce healthy carbs but it's obvious I have to be very careful, which seems to suggest I'm still glucose intolerant. The big question is can I eventually overcome this? If so, how? I watched the video on causes of IR. Will I be able to overcome glucose intolerance with the same things that help with insulin resistance? Increasing exercise and muscle mass, for example. (I'm 69 yo female with solid normal BMI.)
I'm hoping you have a future video that addresses this.
Hi Laurie,
Excellent question. The short answer is that yes, you can be glucose intolerant, even if you are perfectly insulin-sensitive. That would be the case in someone who cannot make enough insulin, for whatever reason.
It's great that you calculated your HOMA-IR. HOMA-IR has one important limitation that may be relevant in your case: because it's based on fasting glucose and insulin, it measures mostly the insulin resistance of the tissue that regulates your blood sugar levels in the fasting state: the liver. So what we know from your normal HOMA-IR is that your liver is not insulin resistant, and you almost certainly do not suffer from a fatty liver.
In most people, HOMA-IR also correlates highly with insulin resistance in other tissues, such as the muscle and fat tissues. However, there could be a disconnect in some cases, and maybe that's something for you to consider. For example, someone who is very lean, and with low muscle mass and high physical inactivity, would be expected to have low HOMA-IR, but could still have some muscle insulin resistance simply because there is too little active muscle to help remove sugar from the blood after the meal. And the muscle tissue is the major tissue that removes glucose from the blood after a meal.
In short, there are many possibilities, but two could be (a) low beta-cell insulin production capacity; and/or (b) some muscle insulin resistance.
You can learn more about the interplay between insulin sensitivity, beta-cell insulin production, and glucose tolerance here:
ua-cam.com/video/Yg9AS2sfY9Y/v-deo.htmlsi=-aGXfkCUwCmk5BZv
Of course, none of this is an attempt to 'diagnose' your situation here. I therefore strongly suggest you consult with a physician to discuss this further.
Best wishes,
Mario
Thanks so much for your reply. That does make sense and I was already wondering if my insulin was keeping up with my glucose intake. With so much demonization of insulin on the internet I had started out thinking that I probably had insulin resistance and had initially not considered that I might not have enough insulin. I know some of the medications will boost insulin production but I really want to avoid going down that road.
Again, thank you for your extraordinarily well informed non gimmicky content.@@nourishedbyscience
P.S. Will definitely work on bulking up my muscles, which I think are pretty scrawny but much stronger than most of my friends'.
Love your videos! Very informative and thorough!
From my own N=1 and wearing a CGM, I have learned that my body does not like/prefer carbs. I have tried several diets and lifestyle changes throughout the years. I have been "too" skinny most of my life. As per my friends circle. It wasn't till my late 20s i started putting on weight. Diets have come and gone.
I do not have the resources to have most of these tests. So, i have created my own scientific research.
Two years ago i started keto and the first week of less than 20 carbs per day, was in my opion, hell week. Lol
After that i maintained 20 or less carbs per week for over a year. I got carbs from berries and green veggies. Within the beginning of this year, I started carnivore lifestyle. It was not hard to make the change due to low carb intake. I finally broke my plateu and I do not get "hungry" anymore. I usually only eat once per day.
As of today, I am down 98 lbs. lost 12 in. in my waist and feel great. All my little aches and pains have disappeared. My blood work is all in the middle. On the other hand, i have learned that my body does not handle carbs well. My stomach aches and my inflammation in my joints comes back. I have also learned that it does not help with my sleeping. My sleep score is usually 80 or higher when i consume zero carbs. When i consume carbs, from other that veggies or fruit, i feel like crap and do not sleep well. My only regret is, my choice of going carnivore earlier in life when beef was cheaper...on the good side, I save a lot of money not eating processed foods and can afford the grass fed cuts.
Amazing how old r u
It's crazy how much industrial food prices have gone up in only a few years. Interestingly, the local farmers near me haven't raised their prices nearly as much, so a quarter cow of grassfed beef from my local farmer is actually just a bit more expensive than buying factory farmed meat at Walmart, at least where I live. And considering the difference for my health and the environment (and flavor), I'm grassfed beef all the way baby.
@@mariabyrne1954 56
The ketogenic diet is not a healthy way to eat. Eating a carnivore diet is downright stupid. You will almost surely be consuming high levels of saturated fat. Overtime this will greatly increase your risk of cardiovascular disease. Eating once per day is also unhealthy. It is highly unlikely you will regularly eat all the vitamins, minerals, protein, fiber and other nutrients that is necessary in a single meal. Almost EVERYTHING high fat low carb diet advocates say is completely bogus.
Great reply. I also experienced simular benefits with LCHF eating.
Another excellent video. Thank you! Had a question. Did the studies give an indication of the health of the people at the beginning of the study? After all insulin resistance can take a decade or more to develop. I am assuming that healthy people can process insulin better than pre diabetics. People prone to pre-diabetes and those not prone may potentially show similar results if tested at peak health. Running these tests on pre diabetics and seeing if their health improved or got worse may have been a better indication of whether carbs are a factor in improving the health of this set of people.
Excellent comment. I had similar questions.
Thank you for your work. Bringing science in mass on such an important topic will directly impact people's lives.
Very interesting. And great video! I love the clear explanation of the claim, the explanations of what the claim is not, and the blog post with all relevant studies and longer explanations.
The claim is that there seems to be no compelling evidence that eating a high-carb diet (healthy, complex, not simple sugars) increases insulin resistance in comparison to a low-carb diet, for individuals who are not losing weight (either due to calorie control or otherwise).
Some questions:
1) The studies seem to have different motivations and don't even cite each other much, though the claim here is that they are all related. Why don't they cite each other? Is it possible to make the blog-post a formal paper (or a letter to a journal) that is peer-reviewed (or commented upon) so that one can have more confidence in the claims? Or are there peer-reviewed articles that already make this claim? Or is this a new observation? Or is it folklore among researchers?
(contd. on next comment)
2) Is it possible that people recruited for these studies typically snack less during the study than they normally do? Perhaps when people snack more often, a high-carb diet would spike insulin more close to a "chronic" level (like in clamp studies or insulinoma where IR does increase)? This would suggest a low-carb diet could still end up being beneficial for such people.
3) I understand this question asked here is scientifically interesting, but is it practically useful? Won't most people on a low-carb diet be losing weight as well? Also, are there reasons to choose between a low-carb diet and a high-carb diet other than weight loss or insulin resistance?
4) Your blog mentions that the result may not hold for people with diabetes and pre-diabetes. Do the studies explicitly exclude prediabetics? If the studies do exclude them, given that close to half the people in the US are probably prediabetic (or diabetic), does the conclusion not hold for them?
5) Most of these studies are fairly short in duration (except Gardner et al). Is there any reason to believe that insulin resistance increases over short periods of time? If not, can most of these studies be irrelevant? Anecdotal evidence suggests a slow increase (people start out fine, with insulin resistance increasing over a long time, spanning years).
Hey Curious Cat (great user name, very fitting, it seems)!
Great questions. Quick answers:
1.) I could write this up as a formal paper, but I could instead make 3-4 more videos, which I'd rather do.
2.) Possible, but not likely. It wasn't prescribed in any of the studies, as much as I remember, how many meals participants could have. Is it possible that constant snacking of high-carb foods leads to more chronic hyperinsulinemia, and that this could promote insulin resistance? Possible, but that theoretical consideration doesn't seem to pan out in the data from the actual dietary intervention studies, which I value more than theoretical considerations.
3.) Yes, people on low-carb usually lose weight, but so do people on high-carb low-fat (take a look at the Gardner et al study, as one example). Also, people can only lose so much weight, and we do know that the weight loss stops at some point. I think it's important to also understand what happens to insulin sensitivity under weight stable conditions.
4.) I am not sure if it holds for people with pre-diabetes or diabetes. There were too few studies of this nature done in patients with diabetes, so that's why I didn't include them here, but I would think that the impacts of the diet in insulin sensitivity may be similar to people without diabetes. However, in diabetes, we need to consider the glycemic impacts of carbs, so eating a high-carb diet can be a concern in people who are glucose intolerant.
5.) Possible that it takes longer, but several studies were 1 month-12 months, and by and large they don't support the idea that chronic exposure to a high-carb diet triggers insulin resistance. Still, we can't rule out the idea that exposure to a high-carb diet will eventually cause insulin resistance over many years (maybe like interest + compound interest, where the impact on insulin resistance gets stronger and stronger over time). However, at best, we can guess at that, and I am hesitant to do that if the available shorter-duration studies do not support the insulin desensitizing effect of carbs at all.
I think it's great to question the available data from all angles, but I also do think we need to be careful not to be too much in love with our hypotheses. I see this trend, particularly in the various diet tribes, to constantly question all of the scientific data that don't fit the tribal narrative, whereas I see those same people not applying the same level of critical thinking and rigor to research results that do fit their narrative. In other words, yes, the data at this point are not fully conclusive that carbs do not cause insulin resistance, but neither do they suggest even slightly that carbs may be the cause of insulin resistance. We should weigh both options equally and not be swayed too much by our own preconceived notions or biases.
Sorry for pontificating, and I didn't mean this as a criticism of your questions, all of which polite and justified, and a welcome sign of scientific curiosity. I am just explaining my mindset here to clarify why I think that if something looks like a duck and quacks like a duck, it may at some point be adequate to at least consider that it may be a duck ...;-)
Best wishes,
Mario
Loving your work!!
So perhaps regular snacking could mimic the action of a clamp? Not allowing blood sugar to fall back to the point where lipolysis would kick in?
Yes, I am very open to that idea. Particularly when someone mostly eats refined and/or highly addictive carbs, as in ultra-processed foods, soda, sweets, or pastries/cake/cookies/chips/ice cream, and then develop a habit of having a snack every two hours or a soda, it is certainly possible that this creates something similar to chronic hyperinsulinemia that one would expect to trigger insulin resistance.
Sadly, I have not been able to find a single study that tested this, so we need to be a bit careful in not drawing firm conclusions based on a theory.
Cheers
Mario
It’s somewhat shocking that it’s not been studied though…
@@paulantoine1696 Well, to do it well, you would need to randomnize people to consume junk food all day for several weeks, which at this point would be unethical. And probably not fundable, because no one thinks anyways that eating this way has health benefits. So one could argue that testing whether eating a high-carb junk food diet causes insulin resistance is irrelevant, because no matter what such a study would show, we still would feel strongly that we shouldn't regularly be eating such foods, for other reasons.
Cheers
Mario
Thank you for this information. I have insulin resistance and I am trying to figure it out.
Healthy Whole Food Ketogenic/Low Carb lifestyle has helped me lose and maintain my weight! I do incorporate fruits some starchy foods such as white, sweet and purple potatoes! I consider myself a 90/10 which allows me indulge and enjoy the culinarily life a little! It’s all about thriving for that golden balance! Thanks for the contents!! Cheers
Great information! Many thanks for sharing
Dr Mario, kudos to you for another good vid. The more I study about "all that stuff" the more confused Im.. this is all not black & white... my layman takeaway conclusion is eating various whole food & regular excercise and you should be good ❤
Such information broadens our thinking horizons.
Great presentation. Thanks
Great video, I'll be watch this a couple more times ... .with my notepad. 🙂
Good video, well done!
Thank you Dr. I am always learning from your videos.
This shoots a hole in the glycemic index discussion. The elephant in the room is food addiction. If you eat large quantities of food and often or snack often, you're going to get fat and insulin resistant. Smokers are sometimes thin. They substituted another addiction for food addiction.
My friend's dad was lean his entire life. He died from diabetes. On the day he passed away his blood sugar was over 800.
He also was not the type that lead a sedentary life either.
Type 1 diabetes? Or at least an autoimmune component?
At the same time, it is possible to be 'lean' and still have excessive visceral and liver fat, which would contribute to insulin resistance and - potentially - glucose intolerance.
ua-cam.com/video/cP57oM8lBaU/v-deo.htmlsi=aAVq9r6L_1pYH6Cw
Best,
Mario
Great stuff Bro!
Now escaping from this terror called IR... is gambling with low and high fat diet... Right?
I strongly suggest you check out this video to understand the major causes of insulin resistance:
Insulin Resistance: Top Causes and Contributing Factors
ua-cam.com/video/HYtnlRCq83s/v-deo.htmlsi=L6O4VR7wcieL5f_2
For many people nowadays, it's excessive visceral and ectopic fat, which I explain in the video linked below, but for others, it's chronic stress, a chronic inflammatory disease, a micronutrient deficiency, or low muscle mass. To really normalize insulin sensitivity, we need to address all of these potential causes.
Causes of Insulin Resistance: The Personal Fat Threshold:
ua-cam.com/video/cP57oM8lBaU/v-deo.htmlsi=Jk5DapfLAwMcTKAU
Cheers
Mario
Dear Mario, thanks a lot for the very helpful videos and your time. I have one question, during my pregnancy I was diagnosed with gestational diabetes and after giving birth still some days in a week I have fasting blood sugar btw 100 and 105, so I want to change my diet to low carb. However in a low carb I need to consume more eggs 2-3 per day and high fat diary. Do you recommend eating 20 eggs per week? Thank you in advance 😊
Greetings from Freiburg
I cannot give you dietary advice here, but let me just share that I probably eat about 20 eggs a week myself ...
Obviously, I always recommend that people consult with a healthcare professional and keep an eye on all of their chronic disease risk biomarkers.
Cheers
Mario
I would like to know if age is considered in these studies. I had My twenty three grandson eat two of those bars with lots of sugar in them and very high in carbs. I checked his bg 1hr later and it was 84. I used to be very sensitive in my 20s up to my late 30s with normal fasting and post ranges like my grandson, regardless of foods eaten. Fast forward at 66 I was dx pre diabetic. I went into moderate keto and two meals a day. My pre diabetes resolved. I run the experiment eating the same as my grandson, but my bg at the hour mark was 110s and back to base at two, which I consider a normal # but still higher than his. Had I done this experiment in before my 30s; My bg would have remained below the 100 #. There is much more to insulin resistance than this diet that diet and how many carbs and kinds of food. I know we humans are different in the way we tolerate and digest foods; also age, genes, life style, medications, sleep, stress are also determinants in the way our bodies mange our nutrients. In my youth I was very active and always healthy, never overweight. I am still fairly healthy and never overweight, but in the last 10 to 15 years my lifestyle mostly work and family demands and genes were playing tricks with my health. That's why, these studies are not 100 or even 90% reliable in my opinion. There are too many variables that are usually not considered. Otherwise good standard information!
Good question. All studies were done in adults, and most in older adults, with some variation between the studies. Couldn't detect a patter, however, that the impact of the high-carb vs. low-carb diets differed depending on age.
Cheers
Mario
great I keep 20min videos for my morning routine cyclette (before breakfast) It would be interesting to know the effect of exercise on insuline resistance
The timing of eating might play a significant role. If I reduce my eating window (to 6 hours) I am losing weight rapidly and the other way round I am gaining weight (over time), even if I am eating approximately the same amount and kind of food.
Few thoughts and questions ...
It is not necessary for the converse to be true if induction of hyperinsulinimeia was observed to cause insulin resistance.
Such an effect could have been temporary i.e. observation of insulin resistance. For this, one needs to understand mechanistic connection between low carb and increasing insulin sensitivity.
Can Insulin resistance be reversed? How was it handled in those case clamp studies?
5:13 At levels of constant insulin infusion one is to also expect counter hormonal responses from glucagon, cortisol and other glucose releasing processes into the blood stream. So euglycemlic clamp then becomes a function of body's response to insulin infusion as well.
11:17 Hypothesis of connection between low carb intake and insulin sensitivity is inconclusive
In the cross clinical study analysis demographics of sample study needs to be considered.
Another great video by Dr Kratz!!! There are obviously plenty of populations that eat carbohydrate-based diets and don't have insulin resistance or type 2 diabetes. What we find in many Western countries is constant daily energy surplus and frequent eating mixed with highly glycemic processed carbs. So glucose and insulin levels are constantly being spiked. There are, however, people who are, for whatever reason, very sensitive to carbohydrates, even whole-food forms, particularly if eaten alone. A single banana eaten by itself, for example, can send my glucose up to 180. A bread roll will put me in the 200's. This is despite HOMA-IR of 0.3, LPIR of zero, and fasting insulin
yeah, but how long are you elevated to 180 or 200 glucose levels?
I've seen mine jump up to 300, panicked, waited a few minutes and was down to 150... You are safe to be up post feeding, to a degree...
Can you make a video about what to eat in a day to reverse insulin resistance
Yes, there will be many such videos. The most important factor in this regard is that you first try to figure out whether you are indeed insulin resistant, and why that is. And then you can address your specific root cause to reverse it.
I recommend these videos here, in this order:
To fully understand how blood sugar levels are regulated, and what goes wrong when we become glucose intolerant:
ua-cam.com/video/Yg9AS2sfY9Y/v-deo.htmlsi=bPwzv93nh9y_rU_V
To assess whether you may be insulin resistant:
ua-cam.com/video/OZtxodqOBbw/v-deo.htmlsi=--mcOsqrBULXIazy
To identify the potential cause(s) of any insulin resistance:
ua-cam.com/video/HYtnlRCq83s/v-deo.htmlsi=xOOtruXRnJyYxn76
Best wishes,
Mario
I love your channel! 🤗
brilliant video again, thank you.
Great content.
Hello sir, your videos on the topic of insulin resistance are really informative. I was expecting some scientifically proven ways to reduce insulin resistance (other than exercise) from your videos. Are there any? Can dietary interventions improve or reverse IR? Pls share some insights.
I have many videos planned. First discussing the causes, however, because to reverse insulin resistance, we first need to know what causes it.
Cheers
Mario
@@nourishedbyscience Have you read Gerald Shulman? We do know what causes it.
@erastvandoren Gerald et al at Yale have worked very hard to uncover correlations, and will continue excellent work to get to mechanisms. One other important fact about metabolic pathways is appreciating the idiosyncratic slight differences between individuals, and this type of research is not even being conducted in 2023. Still population-based, and the cohorts are rough (skin color, male v female, obese v non-obese, egs), and in appalling tiny numbers. That’s why, probably, NIH quickly re-worded from “personalize medicine” to “precision medicine” ... just more of the same population-based average outcomes. Glad you give props 🙌 to Gerald’s team, but don’t fool yourself that insulin resistance is defined & known. Instead, keep learning & promote wonder 😮 & enthusiasm for well-formulated hypotheses 😃
> Telling that you prefer the elixir to come “not including exercise”
@@OlehenryI don't think OP was trying to dismiss exercise. It's just that exercise is obvious by now. Someone may already exercise and look for ways to maximize the benefit.
@@jb_1971 Oh yes, I did not think of that. Writing "...in addition to exercise/movement..." might have helped me. I will edit my comment to snip out my admittedly short & bitter response (to those seeking elixirs when the evidence simply isn't in).
For some reason, when I eat high fat foods (nuts, avocado, cheese) I can an urge to eat as much of it as I can, kinda cram it in. With complex carbs it’s not like this for me. I can eat an appropriate portion of beans, salsa and white rice and be completely satisfied. But add guoc and cheese and I can’t/don’t want to stop eating it.
I'm opposite of you. Healthy fats settle me. Healthy carbs I feel not satisfied, not pleased. How we all differ..
Extremely underrated comment.
Much we could learn from this
I follow Dr. Ben Bikman and Dr. Jason Fung. I daily measure my blood glucose. I adopted intermittent fasting and a lower carb diet (no bread, pasta, rice, cookies, chips, juice, etc.). I strive to avoid processed foods. My hunger went down and lost 30 pounds. For a 69 yo male - I'll take those results. And I'm very active. Blood pressure good as is my blood panel.
Congrats! That sounds like a major success!
It's important to understand, however, that your story is not in contrast to what I presented in this video. There is little question that if people eat a lot of poor-quality carbs, such as added sugars and syrups, refined grains, or carbs in ultra-processed junk foods, they gain weight. And if they gain too much weight and the extra body fat can no longer be safely stored in the subcutaneous fat tissue, they become insulin resistant and potentially glucose intolerant. I explain this idea, called the Personal Fat Threshold, in the video linked below.
ua-cam.com/video/cP57oM8lBaU/v-deo.htmlsi=M47CvkUFTx-Wg5NL
And, of course if someone cut out these poor-quality carbs and they lose weight, the entire thing also works in reverse. However, it is important to understand that "carbs" per se never made you insulin resistant or glucose intolerant. If you had consumed the same amount of carbs in the form of lentils, beans, whole grains, starchy vegetables, berries, and fruit, you would not have gained weight, and in the absence of weight gain, the cumulative evidence as shared in this video shows that even very high-carb diets do not result in insulin resistance. This is important because it also means that we have other options to treat insulin resistance and glucose intolerance, such as very-low fat plant-based diets or high-protein high-satiety mixed macronutrient diets.
Nice document from new Zealand
You need to consider the personal carbs threshold hypothesis, not everyone reacts to cards the same way. There's, in deed, a large set of people who can't simply eat carbs and maintain healthy blood sugar levels. Those glucose spikes can create inflammation and lead to atherosclerosis.
Yes, for sure. It's called glucose intolerance and is the basis of diabetes. And that is exactly what we are talking about here: insulin sensitivity is one key determinant of glucose tolerance, and the research shows that eating carbs does not make insulin resistance worse.
That doesn't mean that someone could not be insulin resistant and potentially glucose intolerant for another reason.
Best,
Mario
@@nourishedbyscience The question is could IR be created without high insulin ? If not, what drives insulin high ? Carbohydrates (I know, I know protein too )? If someone eats carbohydrates 3 times a day and that produce insulin spikes , nothing happens. But if some is eating carbohydrates whole day with continues snacking, insulin stays high whole day and we have scenario as in study and IR is created. And need to constant snacking is driven by carbohydrates. Protein can spike insulin too, but is very hard to overeat protein. I see it this way, carbohydrates muss not drive IR, but if IR exist , reason are probably (misused) carbohydrates. I had for 10 years very bad liver results. No doctor could help me. I got instruction eat 5 times a day and exclude all fat. And base of my diet were carbohydrates. Problems accumulated, high blood pressure, psoriasis, psoriatic arthritis and so one. Than I tried to do all otherwise, I eat only 2 times a day and eat more fat and less carbohydrates. I think all know how the story goes :)
Hi Mario! I really enjoy your videos! Would you please make a video about gestational diabetes? Why does someone with normal weight and otherwise no blood sugar issues develop diabetes during pregnancy?
Have you seen my video entitled "The Regulation of Blood Sugar" (link below). In it, I talk about gestational diabetes a bit.
ua-cam.com/video/Yg9AS2sfY9Y/v-deo.html
Cheers
Mario
So much nuance and clarity in your content! Glad you pointed out the limitations of identifying the quality of diets by their macronutrient content. An interesting and important distinction you made: a higher 'carb' diet may be problematic for those who are already glucose intolerant because the carbs are highly glycemic, NOT because they trigger insulin resistance (because there isn't evidence that they do) . Maybe you will cover this later: do low carb diets compared with high carb diets more reliably help people lose visceral and ectopic fat? And therefore improve insulin resistance? (I'm thinking energy balance is key, and protein, fiber and fat help with satiety....) It's so interesting the way all these factors and parameters interact... Thank you for bringing your scientific expertise and excellent communication skills about these important topics to the public!! ~ Marian Blum
I‘m a big fan of your videos. Thank you!!
I startet to eat loooow carb and intermittent fasting 5 months ago when my Insulin was 17.
It is now 9 and I‘ve lost 4kg (now 68kg) BUT what worries me is that my fasting glucose stays high at an average of 110 and HbA1c of 5.5
I don’t know what to do about it…
Kind regards from Tirol!
everything is going along perfect for u!
Dr MIndy Pelz says all that fasting glucose staying high is your still emptying your built up storage of sugar out of your body...this is good!! keep going ...your winning! it will eventually reduce when your body spends it all.
Ditch low carb
If you don't carb load, your fasting glucose may be higher if you are doing a lot of fasting and calorie restriction.
Eat a lot of carbs 3 days before this test, and it should come down.
Hi, I've been doing the same regimen also for 5 months. My insulin has dropped from 16.3 to 10.1
My FG ranges 98-108
My target insulin is
@@rubix01 What regimen are you doing exactly?
Once again a fascinating review of the science. I’m going to buy a couple peaches! They may spike my glucose but not eating them is not going to improve my insulin sensitivity.
Insulin resistance is very complex.
Over nutrition leading congested mitochondria is imo a good contender for being the culprit.
It's got plenty to do with available food.
If there's not much, we're fine almost no matter what the meagre supply consists of.
Your summary 👌👌👌
Arent proteins more insulinogenic compared to unprocessed carbs?
I have been IF for a few months and have done a few 24 hour fasts. After my last 24 hour fast my sugar was 164. My previous 24 hour fast was 174. Any idea what I’m doing wrong? I do have NCFL and have bmi over 35. 66 year old female. 3:23
Yes. Your welcome
When might we see a video on improving insulin sensitivity?
@UnCoolDad, go to the Playlists on my channel. I have published the first video in the series on how to prevent or reverse insulin resistance. The first four videos will all focus on preventing or reversing excess visceral and ectopic fat, because that's a major cause of insulin resistance in most people. After that, I'll address other causes of insulin resistance.
Cheers
Mario
@@nourishedbyscience thank you. "Lose weight" seems like it is the magic bullet with regard to prevention and control of T2. I look forward to further videos in that series.
@@UnCoolDad I realize that can be frustrating, but for someone who is insulin resistant due to excess body fat and specifically excess visceral, liver, and muscle fat, there is no alternative to addressing this root cause.
Best,
Mario
@@nourishedbyscience it is what it is. Nothing like a health issue (T2D) to focus the mind on making changes. Will you be making some evidence based videos dispelling some of the diet and fat loss myths out there - particularly with regard to "extreme" diets, and perhaps ketogenic diets? In the end I believe that you must expend more than you consume to metabolise fat, but some "influencers" are saying that is a myth, and calories "don't count". I'd love to see some objective evidence based discussion on this.
I’m trying to sort out my diet. I’ve read that if you don’t give yourself some carbs, your body will increase blood glucose as a reaction. It’s hard to know what to believe. I’m trying to stay low-card, with all those carbs coming from whole fruit with low GL.
That is incorrect. Your body doesn't need carbs, and a zero carb diet can be just fine.
That said, low-carb certainly is not the only healthy option, and carbs per se are not the cause of weight gain or insulin resistance. Of course, carbs in the form of added sugar or syrup, refined grains, or carbs in ultra-processed foods can lead to overeating of calories and weight gain, and that weight gain can then cause insulin resistance; no one is denying that. However, eating the same amount of carbs as whole, unprocessed or minimally processed legumes, fruit, berries, starchy vegetables, and whole grains would make it quite difficult to overeat calories and gain weight. Unless you are glucose intolerant, my suggestion is to just eat a mixture of mostly unprocessed or minimally processed foods that you enjoy.
@ Thank you!
Ive been eating a low carbohydrate diet for a couple of years. At this point, if I eat a small bit of carbs, such as a cracker, or a bit of potato, within about 15 minutes, I get a rush, feel flushed and warm. This seems to pass in about an hour. I'm very curious to know if this is part of the body's insulin response to a glucose spike in the blood. Wish I had a CGM to try out.
It is possible that you develop an overly strong and rapid increase in your blood sugar levels (a 'spike', which I define as an increase to 180 mg/dL or 10 mmol/L, or higher). And that can sometimes be followed by a rapid dip (hypoglycemia=low blood sugar levels). Either of these could explain your reaction.
A spike is more likely to develop in someone on low-carb because your general low-carb diet reduces the amount of insulin your pancreatic beta-cells produce in the first-phase insulin response. Usually, people who eat carbs regularly keep pre-formed insulin ready in the beta-cells, and that insulin can be secreted into the blood within seconds to prevent a spike. In someone who eats a low-carb diet, it would be a waste to keep pre-formed insulin (which is protein) in the beta-cells that never gets used, right? So the body reduces the amount of pre-formed insulin while someone is eating a low-carb diet, and that leads to a much more substantial and faster blood sugar response should that person ever eat any carbs.
You can learn more about this here:
ua-cam.com/video/LVw60RIhbzg/v-deo.htmlsi=2_RHvSl1HGeyEOOL
ua-cam.com/video/kxUP0zzBECA/v-deo.htmlsi=BaRnGMoGtzIaotMa
One suggestion to consider is that if you eat any carbs, you may want to eat them as part of a meal that also contains fiber and protein, or even at the end or after such a meal, as I describe here:
ua-cam.com/video/yg0Y3eNSANg/v-deo.htmlsi=IMKMDYIk7L8oN1Hw
Cheers
Mario
Wouldn’t energy toxicity be the problem. For example fat + processed carbs would raise insulin the most and the lowest would be lean protein and fiber (leafy green vegetables) ideally fish and leafy greens. Carbs or fats aren’t the whole issue both can help or hurt depending on your needs.
Yes, you are correct. It's a complex problem, and I think the main take away from the video should be that the data do not support the overly simplified narrative we hear so often that high-carb diets always trigger insulin resistance, or that low-carb reverses insulin resistance. The variability we see in the studies may partly be related to factors such as those you mention, because these were not standardized between studies or even - in some cases - diet arms.
Cheers
Mario
Thanks so much for such evidence base answer to this very crucial question
Along the same line of thought, i wonder if you have given any thoughts of life time use of GLP-1 drug (for waste loss and/or diabetes).
Arguably the drug itself can emulate a “insulin clamp”
Depends upon the patient behavior, their glucose intake might boost (fault sense of security) or lower (due to brain rejection phenomenon of GLP-1)
Bottom line
How does GLP-1 drugs affect Insulin Resistance?
Love to hear your take on this very important topic (as America is having a tidal wave of Ozempic)
Does grazing or constant snacking cause insulin resistance? Limiting food to meals causes insulin to spike rather than high over time.
When sugar high carbs are present the body I am told has to process the glucose first either as energy or store as fat for later use, if one constantly eats sugar directly or indirectly in high glycaemic food then you ain't going to burn fat so, I am sticking to low carb but hope to keep as normal diet as I can and maintain the benefits of Leto as a tool, my hba1 c improved and I am not considered pre diabetic anymore,
This turned out long, sorry.
Thanks to the use of a BG monitor, I know I can reliably elevate my blood sugar and keep it there continuously for many (10+) hours by combining high carb with fat, for example eating ice cream. Presumably my insulin is also elevated the whole time. A self-induced clamp scenario?
When I eat high carb and low fat meals, my BG falls quickly back to normal.
Marty Kendall has it right imo, when he says insulin is not merely about storing energy, it's also a way of stopping the liver and the fat cells from releasing their energy stores when the blood already has a lot of energy-in that sense insulin is not making deposits, it's preventing withdrawals.
I take those premises to mean that health and insulin sensitivity are mainly about keeping energy stores, aka body fat, down. In other words, the bodybuilders are right: caloric deficit + strength training is how to get lean and strong, and it doesn't matter so much what you eat. (See Sam Sulek, e.g.)
Finally, eating crap and staying lean is bad not necessarily because "you're eating crap", but because your activity is drawing down nutrient reserves and you're not replacing them.
Thank you for your video, thought provoking! :)
What is your opinion of Neal Benard
I try not to have any opinion on any colleague, but instead evaluate their claims one by one. Any specific claim of Dr. Bernard you are curious about?
Cheers
Mario
@nourishedbyscience thanks for your response. If you are not familiar with his work, he suggests that fat interferes with insulin signaling within the cell. Therefore, insulin can't do its job because of all the fat gumming up the cell. He believes that a very low fat diet can help restore the function of insulin working in the cell thereby healing insulin resistance...have you heard of this?
@@alpha7ization Yes, and he has published a few nice papers from his randomized controlled trials showing that indeed a low-fat plant-based diet improves insulin sensitivity and glucose tolerance (modestly). However, in all such studies that I am aware of, the primary effect was that people lost weight, and IMO the entire effect of the interventions is due to the weight loss, not the lower fat content of the diet per se. That is because low-carb high-fat diets show a very similar effect: if they lead to weight loss, they lead to a similar improvement in insulin sensitivity, in spite of an actual INCREASE in dietary fat content. That observation is hard to reconcile with the idea that dietary fats are the cause of insulin resistance. The common denominator in both cases is the weight loss. Further of note, as I discuss in this video, low-fat or high-fat diets on which body weight is experimentally kept stable do not differentially affect insulin sensitivity.
Dr. Bernard and others are correct to point out that fat-derived substances are a major contrinbutor to insulin resistance in muscle and liver. However, it is important o be clear that these are primarily derived from fatty acids that come to liver and muscle tissues as free fatty acids from subcutaneous adipose tissue, as I explain in the video below. There is no consistent evidence that I know of that suggests that a high-fat diet causes insulin resistance (unless it causes weight gain, in which case the weight gain is the culprit, not the fat content of the diet).
The frustrating part about all of this is that diet tribe-related dogma too often gets in the way of having an objective discussion of the science. The low-fat vegans claim that dietary fat is the cause of insulin resistance, and the low-carb crowd claims that carbs are the cause. IMO, the data are pretty clear that carbs and fats per se have no, or little, impact on insulin sensitivity, and that weight gain leading to excess fat storage in ectopic and visceral depots along with the low-grade chronic inflammation that comes with it is the primary culprit.
ua-cam.com/video/cP57oM8lBaU/v-deo.htmlsi=XK_f0IgBghqBkp_P
Best,
Mario
@@nourishedbyscience ok thanks indeed there is so much confusion on this topic...and people desperate for answers have found salvation in their food camps headed by gurus that are idolized....Mastering Diabetes headed by Cyrus khambatta is another proponent of this way of eating villifying fat....good to know at the end of the day calories matter. Thanks
Note that I am not saying that low-fat whole-foods plant-based diets are a bad choice. These are clearly a massive improvement over how most people eat, and if they lead to weight loss, which they often do, they will improve insulin sensitivity and glucose tolerance. I'll talk about this more in detail in a future video.
Cheers
Mario
I would be curious to see what the meal frequency was in each study. Having a high carb diet with many meals will cause insulin to be higher for longer than eating a couple high carb meals a day.
Some standardized meal frequence, but many don't. I also think that the carb quality may matter. I have discussed in this video here that I agree that constantly snacking on refined grains and added sugars could quite possibly lead to the type of hyperinsulinemia that triggers insulin resistance:
ua-cam.com/video/HYtnlRCq83s/v-deo.htmlsi=hFMiMB3jNqFZ2mAf
The issue is that none of the clinical studies tested this. We all know that eating mostly refined grains and added sugars is bad, so clinical human investigations usually do not test this type of diet because it would be unethical to expose people to this over an extended period of time. As a result, the high-carb diets I reviewed in this video were mostly based on whole food-sources of carbs, such as legumes, whole grains, vegetables, and fruit.
I still think this is relevant, however, because it shows quite clearly that eating more carbs per se does not trigger insulin resistance, as is so often asserted.
Cheers
Mario
Insulin resistance and diabetes develop over many years, even decades, but these studies only lasted a few months, so we would not expect to see much change in insulin resistance. That would explain the lack of consistent results.
Thanks for chiming in.
It is possible that a high-glycemic load-induced pulsatile hyperinsulinemia may take longer to induce insulin resistance. I think this is an open question, but my best guess based on these data would be that it's unlikely.
First, the notion that insulin resistance takes years to develop is incorrect. Glucose intolerance and type 2 diabetes can take years or even decades to develop, yes, but that has to do with the fact that initially, the pancreatic beta-cell can compensate for insulin resistance and simply produce more insulin. Insulin resistance itself can develop in a severe form within minutes in someone who is stressed or who develops inflammation. For example, if you had back surgery tomorrow, you would be severely insulin-resistant within hours of the surgery. Not a little bit, severely, such that if your beta-cells cannot compensate completely, you'll be diabetic for a few days after the surgery. So the argument that insulin resistance takes a long time to develop is not particularly convincing. The argument would need to be that this particular trigger of insulin resistance (carb-induced hyperinsulinemia) for some reason is different from others and takes months to years, in a way that is not detectable in these studies. Note, however, that some of the null studies were 8 weeks and even 12 months long, and it seems unlikely to me that effects that are not consistently detectable in weeks to months would meaningfully show up after years (again, assuming no changes in body weight, which we know can be a major driver of insulin resistance).
Cheers
Mario
@@nourishedbyscience Thank you for your reply. Prof. Roy Taylor, who proposed the twin-cycle theory of T2 diabetes, says that it does take many years to develop, and I haven't seen this disputed before your post. One possibility is that IR becomes worse because of ageing, which IS a very slow process, in which case IR would be expected to increase very slowly with time, even if it never reaches pre-diabetes or full diabetes.
@@Alan_Clark Alan, yes, I agree that the development of insulin resistance due to the accumulation of visceral and ectopic fat is a slow process. That is because most people can initially store some or most of their excess body fat in their subcutaneous adipose tissue, and only once that is filled to capacity do we see low-grade inflammation and the gradual accumulation of visceral and ectopic fat, all of which contribute to the development of insulin resistance (and probably also beta-cell dysfunction due to accumulation of fat in the pancreas).
However, this is not what I am talking about here. Of course, if we gain weight, this can lead to insulin resistance. However, there are numerous other causes of insulin resistance that have nothing to do with visceral and ectopic fat as I summarize in the video linked below. And, in my opinion, a high-carb diet or the stimulation of pulsatile insulin secretion is not one of these.
Now, you may say that if people eat a poor diet characterized by refined grains and tons of added sugars, or ultra-processed foods enriched in these, they will gain weight. Yes, again, I am not disputing that. This video was about whether we have evidence that - in the absence of weight change - the relative consumption of carbs vs. fat would acutely trigger insulin resistance due to the proposed impact of carbs triggering hyperinsulinemia. This does not seem to be the case.
Best,
Mario
An interesting analysis. I’m not sure I would give too much credence to the dietary studies. Observation would seem to suggest that things take decades. Many people gradually put on weight as they exit adolescence. Even just 2lbs (which we would barely notice) per year adds up over 30 years. So, expecting to see a dietary change influence insulin resistance in a few weeks or months in a healthy person seems unrealistic.
Even in a diabetic, whilst low carb will definitely reduce glucose almost immediately, the evidence seems to indicate that once we have insulin resistance, going back to higher carb will ultimately push glucose back up - which to me means that the insulin resistance is still there.
Fortunately, as a diabetic, I don’t need to listen to the ‘science’ as a CGM tells me whether or not I have a problem eating something!
I think you misunderstand. Yes, the accumulation of body fat, more specifically visceral and ectopic fat (see my prior video) takes years to decades.
However, hormones, inflammatory cytokines, and some dietary factors can trigger insulin resistance in a few hours to days, so it's certainly possible that the composition of our diet could affect insulin sensitivity in a much shorter time frame. And the whole point of the video is that we are only interested in the body weight-change independent effect.
The video was in response to numerous influencers and several very popular diet books that claim that eating carbs causes insulin resistance.
Hope this makes more sense now!?
Cheer
Mario
@@nourishedbyscience it’s not that I have misunderstood. I like the way Dr Unwin describes it - ‘a long silent scream from the liver’.
The modern diet is not 3 spikes a day, but closer to 6. A single snack is frequently 50+ grams of carbs (mostly refined). Over decades, this builds up. Over production of insulin as a result of insulin resistance are likely two sides of the same coin.
I’m sure you have heard of Ben Bickman - he suggests that hyper insulinemia and insulin resistance cannot be separated.
I’m fairly sure that gradual weight gain starts once the metabolism becomes disregulated. This then exacerbates the situation. It can happen from childhood or only from a more advanced age.
All I am trying to say is that short term studies are probably misleading when we are considering a ‘chronic’ problem. Even a slight excess presence of insulin in the body constantly over decades may be the same as a high presence over a shorter period.
Anyway, keep up the good work - I appreciate your videos :-)
A diet of 3 carb-heavy meals per day seems indeed unlikely to cause insulin resistance (Asians have been eating rice forever, and used to be free of obesity and diabetes.) But what about a carb-heavy breakfast + a sugary mid-morning snack + a carb-heavy lunch + a sugary mid-afternoon snack + a carb-heavy dinner? (+ I've heard that there is such a thing as 10 PM snacks in the US, although being French, I find that inconceivable, so I've a hard time believing it). Such a way of eating looks kind of like chronic insulinemia to me... It leaves a few hours of low insulin every night, but is it enough?
I'm just pointing that out because I've just read Dr Jason Fung's Obesity Code and Diabetes Code, and I tend to find his theory compelling.
I see you watched the video about the causes of insulin resistance, in which I express that I am open to the idea that repeated snacking on highly glycemic foods could cause the kind of hyperinsulinemia that triggers insulin resistance. We do not have good evidence for that though, so the theory suggested by some low-carb influencers does remain an unproved theory at this point.
I am involved with an organization that conducts independent expert reviews of nutrition books, to assess the degree to which a book's claims are consistent with the scientific evidence. You can see here how The Obesity Code fared:
www.redpenreviews.org/reviews/the-obesity-code-unlocking-the-secrets-of-weight-loss/
Best,
Mario
This man is very impressive.
Please make clear distinctions between 'linked to' or 'associated with' and 'causes'. They seem to be used in the same sentences and just muddy the waters
I used the teach an advanced graduate class in nutrition methods for seven years at the University of Washington, and trust me that I know about the difference and choose my words very carefully. If you find one incorrect use of any of these terms in any of my videos, point me to it, please.
I am only talking about 'cause' in this video as I am citing social media influencers and several nutrition book authors who claim that carbs 'cause' insulin resistance.
Best,
Mario
Dr Robert Lustig has shown reversal of insulin resistance in obese adolescents without weight loss by reducing fructose intake but adding starch to their diets such that their weights remained constant. He believes that the influence of fructose on hepatic insulin resistance rather than high carbohydrate per se is by far the more important, but of course, once you have developed insulin resistance, carbohydrate, a potent stimulant of insulin compared with protein, will tend to produce hyperinsulinaemia because of the insulin resistance, which will itself stimulate MORE insulin resistance.
Yes, thank you for your comment, I know that study well. The issue is, however, that fructose is the one sugar that does not trigger a strong insulin response. So, in my opinion, fructose is somewhat of a special case, and findings based on fructose should not be generalized to “carbs” in general.
As to your second point, I would encourage you to watch the next video published after this one here in which I talk about this in particular, it’s a reasonable hypothesis to assume that excessive carb consumption-induced hyperinsulinemia could play a role in causing or worsening insulin resistance, but the experimental evidence in favor of that hypothesis is very sparse at this point. Therefore, while I would not recommend anyone snack on highly glycemic carbs all day, it remains unclear whether this could indeed be responsible for the development of insulin resistance (independent of any weight change).
Cheers
Mario
Thankyou for your prompt reply. I wasn’t trying to undermine you re fructose, more that in the real world ‘high carb’ diets usually contain fructose in sucrose or high fructose corn syrup.
In your video on causes of insulin resistance number 2 is chronic hyperinsulinaemia - did this only refer to those with an insulinoma or while using an insulin clamp, as in this video? If that is the case it is a bit misleading to a lay person (I’m a medical doctor) as neither of these situations occur in the normal world. I certainly would like to see your next video on this as I am a big fan, but I’m not sure which one it is? Keep up the good work!
Ps - Re fructose not raising insulin I remember reading that unscrupulous processed food and drink companies used to claim that their products contained fructose and were ‘healthier’ because of this!
Chronic hyperinsulinemia, as in a hyperinsulinemic clamp or in patients with an insulionma, has been shown to trigger insulin resistance. I'd say that part is solid. To my knowledge, it has never been shown whether, for example, constant snacking on refined grains or other highly glycemic foods could lead to chronic hyperinsulinemia that could similarly trigger insulin resistance. That's a claim often made by proponents of low-carb diets. In the video on causes of insulin resistance, I mention that I am open to the idea, but that at this time there are no data to support that, so it remains a hypothesis at this point IMO. I still thought it worthwhile to discuss the idea of insulin resistance triggered by hyperinsulinemia to differentiate clearly between what is known and what is - as yet - a hypothesis.
In Germany, where I am from, most grocery stores used to have a special section with 'foods for people with diabetes' that would include jams, hazelnut spreads, sweets, chocolates, etc. that were sweetened with 100% fructose, because of it's low glycemic index. Glad this is a thing of the past for sure ...
Cheers
Mario
👍🏼
I’m really curious as to what I should eat then. Almost 49, lifting weights plus cardio a few times a week plus counting my macros (weighing everything). Whole, unprocessed foods. No sugar unless it was from berries or sweet potato. Started gaining weight like a freight train I couldn’t stop. 40 pounds in 8 months without changing anything! Turns out I’m insulin resistant. Clearly higher carb wasn’t working for me. Also, as it turns out low carb is working - although barely. Very slow and excruciating. By that I mean it’s taken me months to lose 5 pounds and now am stuck. It’s so frustrating when you hear and find studies masking up one thing and studies backing up another. There seems to be a subset of us that neither really apply to!!
You might look at videos from low carb nutritionist Amy Berger, author of "The Stall Slayer".
Sorry to hear of your struggles. I understand how frustrating this must be.
Now, 40 pounds in 8 months is so much that - if I was you - I would suspect an underlying medical condition, particularly because you stated that you are already eating very carefully. Have you discussed this issue with a doctor? I would definitely recommend that very strongly if you haven't. For example, you may have low thyroid function, which all by itself would explain the weight gain.
Best,
Mario
@@JSroid thank you I will do that
@@nourishedbyscience yes menopause and insulin resistance is what I’m told. Have a statin. I used to have a low thyroid but was taken off of it when I lost all of my weight previously which I successfully kept off for 14 years before this happened. I do have Sjögren’s syndrome but I’ve known about that for the last 2 years so I don’t think that’s it. That is why my diet is so careful because the only way I can manage my Sjogrens symptoms is by following the AIP protocol and tracking what I eat. Thanks for taking the time to respond though. I appreciate it!
@@melindawilson7693 Just to advocate for you, I doubt that menopause and insulin resistance alone can explain 40 pounds in 8 weeks. If I were you, I would request another TSH test soon. If you once were hypothyroid, has it been ruled out in the last 8 months that the condition has re-emerged? Also would ask about treatment options for the menopausal changes in hormone status.
Must be frustrating, because it sounds like you are doing aeverything right and the medical system is not making a serious attempt to identify the cause of the rapid weight gain.
Sorry, I don;'t want to mess with your medical care and certainly can't give you advice here, but just saying that "insulin resistance" would not sound like a satisfying explanation to me, and I would want a better diagnosis and a treatment plan if I was you.
Best wishes,
Mario
There was a video released by the channel "Type One Talks" showing that his insulin sensitivity was over 6 times higher on a high carb vegan diet versus a low carb diet. And the sensitivity was three times higher than a relatively high carb SAD diet. What are your thoughts on this? I know it's anecdotal but the results are pretty significant and I think warrant a look.
The video is titled "Diabetic goes vegan for 180 days. This happened."
Type One Talks makes engaging videos, but what he shared there would be called an anecdote. I talk here about why we need to be careful with them:
ua-cam.com/video/s5qApN0o-Hk/v-deo.htmlsi=LID89Onc20QHSe9s
If we didn't have any other evidence, then we could form a hypothesis based on such an anecdote. However, we do have about 20 high-quality RCTs on the subject, and in those well controlled for changes in body weight, and measuring insulin sensitivity by the gold-standard clamp technique, we don't see a difference in insulin sensitivity between high-carb or high-fat diets.
Cheers
Mario
Do you have any info on inheriting a diabetic gene?
Yes, both type 1 and type 2 diabetes have a strong genetic basis. However, for both, we also have major environmental triggers, and for type 2 diabetes clearly dietary triggers.
A common issue in people who are genetically predisposed to type 2 diabetes is low pancreatic beta-cell function, i.e., the beta-cells cannot produce enough insulin. The solution to addressing this is to improve insulin sensitivity, such that the limited amount of insulin that can be produced is sufficient to keep blood glucose in the normal range.
Here's a video that explains all that in detail:
ua-cam.com/video/Yg9AS2sfY9Y/v-deo.htmlsi=VBmLZimoWCT4OlQr
Cheers
Mario
So a high carb diet that raises blood glucose to 200 is ok? as long as you are not insulin resistant?
No. If blood sugar levels ever rise to 180 mg/dL, that's probably a sign of glucose intolerance, as I explain here:
ua-cam.com/video/DVND90vQ0xI/v-deo.htmlsi=RfA660cUhm41bcgf
The point of this video is to clarify that while it's clear that blood glucose rises in response to eating carbs, carbs per se are not the cause of insulin resistance or glucose intolerance. Big difference.
@nourishedbyscience but that is the point as well, it's either no carbs so as not to spike blood glucose or eat carbs and suffer the myriad of things that goes along with high blood glucose.
@@s12_22g You mix up cause and effect here. Very dangerous and misleading.
If someone is glucose intolerant, yes, they will have an increased risk of chronic disease partly due to the elevated blood glucose levels. We know for sure that chronically elevated blood glucose levels, and likely also frequent spikes to 180 mg/dL and higher, are associated with an increased risk of chronic disease. However, what is to blame for these elevated blood glucose levels: carbs per se, or glucose intolerance? I argue it's the latter.
Further, that person will also have an elevated risk of chronic disease for other reasons that have nothing to do with elevated blood glucose. This is because all of the major causes of glucose intolerance, such as excess visceral and ectopic fat, chronic stress, sleep deprivation, low muscle mass, a sedentary lifestyle, and inflammatory conditions, they all ALSO increase the risk of chronic disease independent of their impact on blood sugar levels.
At the same time, let's consider my case. My HbA1c is 4.7%, and when I wear a CGM, my blood glucose is in the 70-140 mg/dL range 99+% of the time, even on my fairly high-carb diet. Do I suffer negative consequences of eating carbs? I know of no evidence that even suggests that fluctuations of blood glucose within the normal range are associated with an elevated risk. If you suggest I do please share a peer-reviewed publication, a single one, that demonstrates this.
not all carbs are equal. The problem may be high insulogenic food rich in sugar or white floor and poor in fiber aka processed food. You could eat a high carb but very rich in fiber and avoiding sugar and processed food. But most metabolically compromised people don t eat like that.
you confirmed what I said, Most people eating a high carb diet eat a lot of sugar and flour, leadind to a metabolic syndrome. But in theory if you are insulin sensitive and eat a clean high carb diet, no prcessed food and low GI carbs, you should be OK, it depends on the metabolic context.
I believe there are 3 monosaccharides. Glucose, fructose and galactose. The carbohydrates we ingest, is either these individually, or chains of these or combinations of these. Your tablesugar, sucrose is one glucose and one fructose molecule. Starches are chains of glucose.
Curiously enough, while glucose plays a vital role in our body, too much is a problem for the arteries. We produce insulin to transport glucose away from the blood. Into the muscles, the liver or into our adipose tissues. Unless you are physically active, is there no room in the first 2 stores (they have limited capacity, approx 500g in the muscles, 100g in the liver). That goes for the glucose found in white flour, as well as the glucose found in whole grains and potatoes. The only difference is the speed with which your bloodsugar rises. The “slow” carbs might not elevate bloodsugar as much, but does so for a prolonged time, and the “area under the curve” is most likely the same.
Fructose, commonly found in fruits and honey, does not cause an insulin spike. It is metabolized mainly in the liver, and is linked to insulin resistance.
So yes, not all sugars are created equal. By far, is fructose probably the worst. Glucose is glucose, whether it’s from white bread or potatoes. It differs only by the rate of digestion. “Slow” carbs might prolong satiety, but the damage to the arteries is most likely the same in a given amount of glucose. If “slow” carbs make you eat fewer carbs, that is most likely a good thing.
Look into the work of Rick Johnson. Simon Hill (and Petter Attia) have a lengthy interview with him.
i am fat and have diabetes how do i get rid of this insulin resistance than? help
In spite of this video, a low-carb diet can be a good tool to lower blood sugar levels, because while you are glucose intolerant, any carbs you eat will result in high blood glucose levels (most carbs are broken down to glucose). However, that a low-carb diet can be helpful for people who are glucose intolerant should not be seen as evidence that carbs cause the glucose intolerance.
What is going to be most important for you is to try to identify the root cause of why you are glucose intolerant. If you carry extra weight and body fat, that may be a major contributor, because it can make you insulin resistant. Look around on my channel; I have many more videos about this very topic.
Best,
Mario
I had to be on a very low carb diet (
Unfortunately no info is given as to what constitutes a high carb diet in these quoted studies, in most cases. How many calories, what types of carbs, how many meals per day, ratio of fat to carbs, these are all questions that are unanswered.
Did you watch the video? It’s all in there … (see the table, and what I said afterwards about the types of high-carb foods included).
I personally think that it’s not carbs in general but rather the type of carbs and the lack of activity. If you eat a diet high in processed carbs, you’re eventually going to see negative results. If you combine that with low activity levels, you’re basically asking to get sick. However if you are someone who eats whole food carbs, well that’s completely different, and then you’re active…
That may well be correct. More to come on refined vs. whole food carbs in the future ...
Cheers
Mario
Hi. I am a self-biohacker who works out in a top gym around 6 days a week, 2 hours a day; sleeps over 8 hours a night well, and has a good "low-carb, slow-carb" diet (but could be better). Also, wearing a very good Chinese-made Bluetooth-based CGM that integrates well with my iPhone. This channel @nourishedbyscience has great information, much more factual and science -based that the vast majority of "opinion-based" YT misinfomation out there in social media-land. However, I tend to disagree with the hypothesis in this video that visceral fat is a primary cause of insulin resistance. As shown in this video, visceral fast is a primary effect of insulin resistance, not a primary cause. In other words, insulin resistance originates in the subcutaneous and muscular tissues (when overloaded) and that (overloaded subcutaneous and muscular fat), in return, causes visceral fat. Of course, visceral fat is bad, and surely contributes to insulin resistance, but this is a secondary effect based on the primary cause in most cases (overloaded subcutaneous fatty tissue). Great work here. Please do not take my comments as criticism of this channel, @nourishedbyscience . Subscribed!
Hi Tim,
Thank you for your kind feedback. I do not take this as criticism of my work at all. Disagreement on how to interpret the available data is a normal part of the scientific process, and I actually love engaging this way, as long as it's handled respectfully and with an argument.
You do have a point, because - if we apply the most rigorous scientific requirements - there are no conclusive data that show it is the visceral fat that causes insulin resistance. You may note that throughout the video, I avoid saying that. Instead, I would say that we have the strongest causal data for fat accumulation in ectopic depots, particularly the liver and muscle, and low-grade chronic inflammation in adipose and liver tissues (and that includes visceral fat inflammation). The key problem is that in all cases that I know about, visceral fat is elevated whenever we also have low-grade inflammation in fat and liver, and accumulation of fat in liver and muscle, i.e., I know of no case where we have in increase or decrease in visceral fat mass without a concurrent change in ectopic fat or measures of low-grade inflammation in metabolically active tissues. It's therefore IMO not possible with current data to isolate the relative contribution of visceral fat to systemic insulin resistance.
How do we know that liver fat causes insulin resistance? There are instances where experimentally the fat content in the liver is reduced (through short-term major calorie restriction), and that leads to an improvement in insulin sensitivity even though measures of inflammation in fat tissue or visceral fat mass are unchanged. Also, we have papers showing how an increase in liver fat in the absence of an increase in visceral fat or fat inflammation decreases insulin sensitivity. So it's these kinds of data that strongly suggest that liver fat per se causes insulin resistance.
How do we know that low-grade inflammation in adipose tissue causes insulin resistance? As I discussed, there are a few drug trials that lower the degree of inflammation in adipose tissue (albeit also in other tissues), and these improve insulin sensitivity even if ectopic fat and visceral fat don't change. There are also several dozen mouse studies in which the mice were genetically manipulated to specifically block adipose tissue inflammation, and they by and large show an improved insulin sensitivity phenotype. I have actually summarized that evidence in a comprehensive research paper a few years ago with other members of my lab:
pubmed.ncbi.nlm.nih.gov/30549014/
For visceral fat, we have no similar evidence where visceral fat mass increased or decreased without a concurrent change in measures of adipose tissue inflammation or ectopic fat, so I agree with you that we cannot be similarly certain that visceral fat plays a causal role in insulin resistance. My best guess would be, however, that inflammation in expanded visceral fat is particularly bad, because uninhibited lipolysis (free fatty acid flow) and inflammatory cytokines that leave most visceral tissues would drain directly to the liver, something that is not the case for subcutaneous adipose tissue. We need to be clear though, that inflammation would not immediately develop in visceral adipose tissue, but only once that tissue has reached it's storage threshold and the adipocytes become too large. So, in other words, visceral fat with mostly small fat cells and no inflammation may be partly inert, while it becomes disastrous from a metabolic perspective once fat cells have reached their storage capacity limit and trigger inflammation.
As to your assertion that insulin resistance comes first and plays a role in fat accumulation in visceral fat depots, I think that yes, inflammation in subcutaneous adipose tissue resulting in insulin resistance in that tissue probably comes first. That then leads to uninhibited free fatty acid flux to visceral and ectopic depots. Besides that, however, I know of no strong evidence that hepatic and muscle insulin resistance occur prior to the accumulation of visceral fat.
I hope this helps clarify my position.
Best wishes,
Mario
Great points, both.
I think OP meant “dismissive” or “conclusive rebuttal” when he wrote “don’t take my critique as criticism”. lol Criticism requires critical thinking skills, and the OP demonstrated understanding & calm articulation. This is exactly what we all need, plenty of critique to balance our personal (arguably naive) “aha!” moments. Applausa 👏 to you both. No offense taken too 😊
I came across a study a few years ago to the effect that in the USA resting insulin levels of insulin had risen from circa 1950 to 1970/75 by as much as sixty percent. In which case the correlation between increased carb consumption in that time may be relevant in that it may be time in exposure which is relevant. I.e. years not days or weeks. Sorry no reference available.
It is possible that a very long duration of exposure, particularly if including constant snacking on highly glycemic foods, could play a role in the development of insulin resistance. Even if that were the case though, no one recommends constant snacking on pastries, cookies, cakes, donuts, toast with jam, or sugary cereal anyways. Of course that would not be such a great way of eating, and I am not holding my breath that such a diet will ever be studied to see if it causes insulin resistance.
However, I think it's important to be clear that the currently available high-quality evidence does not support the idea that eating a diet high in carbs from whole, largely unprocessed or minimally processed foods causes insulin resistance. Many of the studies discussed in this video were really well controlled, some with follow-up periods of up to 1 year, and most included gold-standard measurements of insulin sensitivity. Cumulatively, there just is no signal of greater insulin resistance on high-carb diets, as well as there is no signal of greater insulin resistance on high-fat diets. Still, the 1-2 studies supporting the idea that high-fat diets trigger insulin resistance continue to be cited by low-fat vegans who claim that fat is the cause of insulin resistance. And, vice versa, the 1-2 studies supporting the idea that high-carb diets trigger insulin resistance continue to be cited by adherents to a low-carb diet. That's not how science should work, and if we look at all 21 RCTs cumulatively, there just isn't a signal one way or the other. And that's a good thing in my book, because it gives us more freedom in our dietary choices,
Best,
Mario