Do Carbs Cause Insulin Resistance?
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- čas přidán 8. 07. 2024
- A common claim on social media and nutrition books is that a high-carb diet causes insulin resistance. We review whether scientific evidence supports this claim.
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- VIDEO DESCRIPTION -
A common claim in many CZcams videos and other posts on social media as well as numerous nutrition books is that eating a high-carb diet is a major cause of insulin resistance. The argument is that eating a high-carb diet leads to regular increases not just in blood sugar, but also in blood insulin levels and that the cells of the body become ‘numb’, i.e. resistant, to the effect of insulin over time due to this excessive exposure to insulin.
In this video, we are assessing whether this claim is supported by scientific evidence.
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- TIMESTAMPS -
00:00 Introduction
03:26 Does Hyperinsulinemia Cause Insulin Resistance?
03:56 Insulin Resistance as a Result of Hyperinsulinemia in Clamp Studies
06:46 Insulin Resistance as a Result of an Insulinoma
07:37 Conclusion: Does Insulinemia Cause Insulin Resistance?
09:10 Do High-Carb Diets Cause Insulin Resistance, and Do Low-Carb Diets Improve Insulin Sensitivity?
14:43 Summary & Conclusions
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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.
It is so refreshing to see you explaining the science in stead of using science to promote a narritive.
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 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.
Thank you again Mario, your videos are so thought provoking.
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 CZcams. 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.
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.
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).
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
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 😊
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
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.
Love your videos! Very informative and thorough!
the content is really needed, thanks for sharing! And please take up high quality research based content and a critical and scientific approach ❤
I'm amazed that I could find such kind of information for free. Thank you.
Amazing work! Thank you for the profound knowledge and the excellent presentation consistently labeling your videos!
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...
Now that‘s how you talk about nutrition. Immediately subscribed
Thanks for a evidence based, clear presentation.
Thank you for all your kind effort you have put into sharing this information. Very exciting. X
Thank you for your work. Bringing science in mass on such an important topic will directly impact people's lives.
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.
Excellent, clear, un-fussy explanation. And no silly gimmicks either. How refreshing!
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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
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
Thank you Dr. I am always learning from your videos.
Such information broadens our thinking horizons.
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
Great presentation. Thanks
Great information! Many thanks for sharing
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
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.
czcams.com/video/cP57oM8lBaU/video.htmlsi=aAVq9r6L_1pYH6Cw
Best,
Mario
brilliant video again, thank you.
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
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
Good video, well done!
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
Thank you for this information. I have insulin resistance and I am trying to figure it out.
Not quite to do with carbs and insuline (maybe...), but what about menopause symptoms and dietary choises? Thank you for these videos! 👌
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.
Yes. Your welcome
Great content.
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 ❤
Great video, I'll be watch this a couple more times ... .with my notepad. 🙂
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.
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
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.
Your summary 👌👌👌
I love your channel! 🤗
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...
1 Regarding continuous vs spikes insulin, would be interesting to see Insulin Resistance performance in intermitting-fast people, compared to the general population.
2 Is this true??
Insulin Resistance is usually defined using glucose measure in the blood of a fasting person. If you use this definition, you can manipulate your carb's consume so to keep your glucose level low enough not to ever be considered as having IR, even if in fact it is the case. So, it may be that you are IR without knowing it.
No, just fasting glucose alone will not be informative about insulin resistance. One needs at least also fasting insulin.
I have a video entitled "Measuring Insulin Resistance" that explains this in detail.
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
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:
czcams.com/video/Yg9AS2sfY9Y/video.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'.
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.
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
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.
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.
czcams.com/video/Yg9AS2sfY9Y/video.html
Cheers
Mario
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
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.
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,
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 :)
Insulin resistance is developed over many years, sometimes decades. A study lasting weeks or even months isn't enough to trigger note measure insulin resistance.
Respectfully, I do not think what you are saying is based on a misunderstanding, and not backed by any evidence.
In fact, massive insulin resistance can develop within hours, for example in response to major surgery, acute stress, or an infection. Or, as I outline in the video, in a couple of days in people on a hyperinsulinemic-euglycemic clamp. So, there is no doubt that insulin resistance can develop very rapidly.
However, most people do not know that they are insulin resistant under these circumstances (i.e., when they are stressed in their office, or when they are sleep-deprived, or when they have the flu). And even people who gain weight slowly over 20 years may not know that they are insulin resistant until they develop diabetes or prediabetes, because in primary care, we usually don't measure insulin resistance.
More importantly, insulin resistance that develops because someone is gaining body weight and fat mass develops only once someone has crossed their own personal fat threshold. This means that most people can gain weight and body fat mass for years without negative consequences for their insulin sensitivity, and then suddenly they start to accumulate fat in their visceral and ectopic depots and their insulin resistance develops. Feel free to check out this video for more detail:
czcams.com/video/cP57oM8lBaU/video.htmlsi=ZcE3VYPGiF2vG68Q
With regard to the weight gain/weight loss-independent effect of high-carb diets on insulin resistance, the often-stated hypothesis is that carbs cause hyperinsulinemia and that this hyperinsulinemia causes insulin resistance. That would be expected to develop over a time frame of days, in my opinion, or at least weeks, not decades. So the body of evidence from mostly very high-quality randomized controlled trials is pretty strong that the amount of carbs and fats people eat does not per se, i.e., independent of effects on body weight, trigger insulin resistance.
Best,
Mario
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..
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
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 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
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).
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:
czcams.com/video/HYtnlRCq83s/video.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
It's not just carbs, its lifestyle as a whole. If you eat a lot of carbs you could move more or way less with makes huge difference.
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
If people take low-carb diet without losing weight, then what are in their diet added to maintain the body weight? Are such added components be the culprit of insulin resistance too?
"Real science is often a lot more messy and less conclusive"
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?
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:
czcams.com/video/LVw60RIhbzg/video.htmlsi=2_RHvSl1HGeyEOOL
czcams.com/video/kxUP0zzBECA/video.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:
czcams.com/video/yg0Y3eNSANg/video.htmlsi=IMKMDYIk7L8oN1Hw
Cheers
Mario
I'm low fat and sugar, and high fiber and protein. I have a hiatal hernia and LPR
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
👍🏼
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 :-)
Great
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
The goal is not to improve insulin sensitivity, but rather to keep blood sugar and blood insulin levels low. Both can be achieved through a low-carb diet.
What evidence is there that this should be one’s goal?
That is a dangerous misconception IMO. If someone is insulin resistant, then they usually also suffer from something that causes this insulin resistance, such as excess visceral and ectopic fat, low-grade chronic inflammation, chronic stress, physical inactivity, low muscle mass etc etc., and it is my position that for our best long-term health, we should address both the insulin resistance and whatever causes it.
Now, that said, a low carb diet that leads to weight loss may well do that if the cause of the insulin resistance was excess weight, while also minimizing blood glucose and insulin spikes acutely. However, if insulin resistance is caused by one of the other factors listed above, I suggest one will still want to tackle that.
Best,
Mario
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.
Its the omega 6 pufas, the vegetable oils. but nobody controls for that
What is your evidence that omega-6-fatty acids or 'vegetable oils' are a cause of insulin resistance?
This is what I was facing for 20yrs from my first pregnancy when i was 28. Because of the ordinary of medication I am now on Metformin from 1/2 twice to 1 pill twice a day. I recently have convinced my dr to check my C peptide test it's coming back about 500 that's is what my doctor told me. I was watching many different doctor videos and looking for help. I was try all different way to control my sugar but I found out my body just gave me sugar even I am try to fasting start from 12 -24 then I stop because I lose weight and muscle, also I am skinny my whole life never gained weight to 100lbs max is 96 except after given birth is 105lbs. Now i am able to wear blood glucose senior have found out that not what i eat during the day but because of my stresses that elevate my glucose to over 9-11 in the morning as soon as i get up. I f i lying down its drop slowly back
I eat organic grass fed 20% fat mince beef every day for 20 years. My cholesterol is good. I don’t consume carbohydrates in the evening
I mean, I'd imagine visceral fat depot, etc being far worse than just carbs per se on that.
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.
High carbs like 45 to 60 per meal, and snacks, kept me diabetic. Intermittent fasting and low carb i am now pre diabetic
Yes, I wouldn't doubt that. If someone is glucose intolerant, then it would make sense to lower the glycemic load (amount of carbs times the glycemic index of these carbs) of the diet. That is a clear benefit, but that's not to be confused with an improvement in insulin sensitivity or glucose tolerance. Unless you lose weight on that low-carb diet, there is no indication that your insulin sensitivity improves on a low-carb diet.
Best,
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
Someone needs to show this video to Dr. Ben Bikman..
Most that have health issues, body compromised etc. try keto et al and are successful, I'm 77, weight train and feel healthy and have no internal issues so eating everything in moderation. To diet and do nothing else, in the end just does not work.
Hello Dr Kratz, Thank you for another insight of type 2 diabetes in relation to food intake in general! Here is my take;
I think this presentation is yet the most realistic approach to type 2 diabetes! One thing is missing thou from this data and that is the age of the participant! The reason I am saying that is when you are in your thirties your body react completely different to when you are in your sixties! I can say this with FULL confidant and personal experience! Diet has nothing to do with insulin resistance! but it has everything to do with way your body handle the type of food intake!
If you eat carbs your blood glucose level WILL go up regardless! if you eat less carbs your body will not react the same! Those who has a doubt, Try the CGM and see! Also another factor effect Type 2 sufferers is if they are suffering from any type of illness chronic or otherwise your body will automatically elevate the blood sugar level.
Iow intake of cabs ie bread and extra will elevate your blood sugar levels and verses verse, so the question is how do one come off medication or be better thanks 😂
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
Ich bin auch im wesentlichen Ihrer Meinung. Das aber erklärt nicht , warum fast 50% der Erwachsenen erhöhte rr Werte haben. Andererseits , Sie haben nicht über den Unterschied zwischen Fructose und Glucose in diesem Zusammenhang gesprochen . ( Ich glaube, der Fruchtzucker spielt die Hauptrolle in der Entstehung der Insulinresistenz ). Zu erwähnen auch ist die Mitochondriadysfunktion durch die oxidierte Omega 6 Fettsäure, die auch eine wesentliche Rolle in der Verursachung des metabolischen Syndroms spielt.).
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
Perhaps it's the combining of animal protein and carbs at the same meal.
Low carb diets that cause abdominal fat loss definitely seems to reduce insulin resistance. I think it is important to discuss how much fructose is in the carbs. China had a
Overweight rate increased a lot over the years as well in China as the rest over the world. Science knows that being overweight is the major cause for T2D.
Dr. Kratz, I doubt if limited participant studies could show conclusively that the magnitude of carbs in a diet would impact insulin resistance. I have used both TRE and low-carb to reduce my weight from 102 kg down to 67 kg in a matter of less than 4 months. I can't whether or not my insulin sensitivity improved. Referring to your 'Personal Fat Threshold' video, I can tell you that I have quite skinny limbs, naturally. At 102 kg, I had a large protruding mid-section, with skinny limbs. At 67 kg, that large mid-section is gone.
I can't agree or disagree with you, however, I might want to say that what works for one individual would not be the same for another.
Why do you say 'limited participant studies'? I reviewed 21 publications, many using gold-standard measures. What would convince you?
The doctors on you tube that treat thousands of patients and reverse and correct health issues without medications is the best current evidence we have. Studies can be carried out and interpreted in whatever way someone may want them to. The daily grind of working with many people to improve their health trumps all studies. I have listened to many studies that promote a conclusion only to have someone who understands how to interpret the findings show the flaws and weaknesses in the supposed results.
@@robertshook3639That's a view I have never heard, and quite honestly cannot follow.
First of all, the fact that carbs don't cause insulin resistance and low-carb diets don't improve insulin sensitivity in a weigh loss-independent manner does not mean that a low-carb diet could not reverse diabetes. It quite possibly could, in motivated people.
Second, the papers are not that hard to read and understand, and conduct and reporting standards for randomized controlled trials are very strict, due to the need for pre-registration. The data are pretty clear IMO.
Third, a doctor who treats patients can contribute to the evidence base on a given topic, but only if they report their success rates using all exposed cases. In other words, if someone runs a clinic, they should report on the success rate of every patient they see, not just those they treat successfully. Otherwise, it's a highly biased assessment. Does any of the doctors you follow do this in full transparency? Or do they just highlight their success stories? And which other motives do they have? Do they have a book on the market on the topic, for example (many do)? I'd be much, much more sceptical about this type of evidence. Anecdotal observational evidence at best. Not totally worthless, but nothing compared to a randomized trial.
My 5 cents.
Cheers
Mario
@@nourishedbyscience Appreciate your response. We’re all learning!🥓🥩🍗!!!