Ep. 191 - Insulin resistance: reversible or not? | If insulin is so important, why isn't it tested? | Why insulin matters for your weight & health | Which foods have the best (and worst) effect on insulin levels? | CGM to improve insulin & blood sugar

Uncategorized Aug 22, 2023


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In today’s episode, Dr. Scott and Tommy explore insulin's role in health and the benefits of fasting, how insulin resistance affects blood sugar levels, and link it to conditions like diabetes and heart disease.


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Fasting For Life Ep. 191 Transcript

Hello. I'm Dr. Scott Watier.

And I'm Tommy Welling.

And you're
listening to the Fasting for Life podcast.

This podcast is about using fasting
as a tool to regain

your health, achieve ultimate wellness,
and live the life you truly deserve.

Each episode is a short conversation
on a single topic

with immediate, actionable steps.

We cover everything from fat loss

and health and wellness
to the science of lifestyle design.

We started fasting for life because of how
fasting has transformed our lives

and we hope to share the tools
that we have learned along the way.

Hey everyone,
welcome to the Fasting for Life podcast.

My name is Dr. Scott Water and I'm here.

As always, my good friend and colleague,
Tom Welling.

Good afternoon to you, sir.

Hey, Scott,
How are you? Fantastic, my friend.

Excited for today's conversation.

We're going to be
talking all things insulin.

What are normal levels?

Why don't we test it more
and why it's so dang important?

So if you are listening in

and this is one of your first times
or second times

listening, we just got to welcome you in
and thank you for giving us a shot

at becoming
your part of your fasting journey.

If you want to learn more about myself
or about Tommy, about our journey

with fasting and how it's transformed
our lives, head back to episode one.

Give it a listen and we really appreciate
you listening in today.

What a great episode to start to
because we're going to talk about

keeping the main thing, the main thing,
which is why fasting is so powerful

and how it affects insulin
and ultimately weight loss and weight loss

resistance as well as a whole host
of other health related metrics.

So if you're a longtime listener and OG,
as we like to say,

thank you for continuing to listen,
your downloads and reviews continue

to tell the podcast world and podcast gods
and goddesses that we are bringing value

each and every week.

So we appreciate you continuing to show up
and continue to be on this fasting

for life journey with us.
All right, Tommy.

So insulin, insulin and some more insulin,
that's where we're going to start.

But I want to set the stage first
and foremost

before we get into the normals
and why it's not tested.

And kind of explaining a little bit
more about it is really why it matters.

So we did an episode back in episode 143,

Yes. Okay.

Eight out of the top ten leading causes of
death are related to high blood sugar.

And we're not just talking about
diabetes, right?

We're talking about stroke cancers,
cardiovascular disease,

chronic lower
respiratory diseases, Alzheimer's disease,

obviously diabetes, influenzas,
pneumonias, kidney disease.


All of these things
have a strong relationship

to high elevated, long term,
elevated levels of blood sugars.

So beneath that or upstream from that
is this thing called insulin.

And it is not the only player
in this equation.


So there is there to be fat gaining weight

You need to have or weight loss resistance
or fat loss resistance.

We need to take into account
both the hormonal side using insulin

and then also the consumption
side, the food choice.


why we say fasting is a two part equation.

Fasting, you can fast, you set the timer,
you limit your foods, you don't eat time,

restricted feeding or excuse me, time
restricted eating for a period of time.

And then on the other end is, okay, well,
what food choices

are you making when you break your fast?

And one of the biggest things we see,
one of the biggest mistakes

is you don't intentionally put decisions
into that window.

And it's just kind of an all
you can eat buffet, right?

So when we look at insulin,
there is also an insulin resistance side

and an insulin sensitivity side,

meaning the effectiveness
of how your insulin works.

So as we walk through
what is normal levels of insulin,

the takeaway here is what are we going to
eventually be able to do to reduce,

prevent and control
this thing that really isn't understood

well in mainstream medicine
and or tested for often?

Yeah, and we get a lot of questions
about it too.

We just got one

just a few days ago,
which was something along the lines of,

Hey, what about this whole
insulin resistance thing?

If I'm insulin? It came in this morning.

Okay. Was it this morning.


I'm insulin resistant or if I am insulin
resistant is that forever

will always be that way.

Can it be reversed.

To what extent, how long does it take
all of the, the nitty gritty.

You know, this correlated
to a number of other things,

including the weight,
but also food choices like you mentioned.

And so there's a lot to unpack there.

But the reason why I brought that up
was because just understanding that it's

almost like you can think about it
as your your cellular sensitivity to

a hormonal compound that's coming out
for a lot of different reasons in the body

from the pancreas in relation
to what you're doing, what you're eating,

how much blood sugar has risen
or has dropped over time

and it's correlated with things
like food choices

like sleep and sleep
deprivation, cravings, exercise level,

how much fat you actually have
around your midsection, your visceral fat.

Those are hormonal, reactive,
active fat cells that actually influence

the release of more insulin.

So you have a bit of a positive
feedback loop, if you will, with insulin

resistance as well.

So the point here being that, no, it's
if you're insulin resistant

now, you are not doomed to stay that way.

But it's it's a matter of like
progressive numbness, if you will, like,

like cellular numbing
to the signal of the insulin.

So it's like your cells have seen it
so much of it

so often for so long
that they start to become numb to it.

And it's it's a process that can take
some time and correlated to the weight.

Do start to reverse that kind of peel back
those layers of the onion

to get back to healthier levels
of sensitivity over time.

I want to talk about a study

and it was the effect of sustained
physiologic hyperinsulinemia

and hyperglycemia on insulin secretion
and insulin sensitivity in man,

that's a mouthful.

I want to come right back to that.

First, I want to describe what insulin is.

So it's a hormone.

It's a chemical messenger,

circulates through your bloodstream,
triggers physiological events.

It has an effect

on every single cell in your body,
including bone, brain, muscle and skin.

And, of course, all of the cascades
that happen with stabilization

of energy, energy storage versus fat
burning versus fat storage.

So insulin, brain ears, heart muscle

fat, liver reproductive organs, nerves.


So insulin's anabolic in nature,
it promotes growth

in bones and skeletal muscles
in other tissues in the brain.

It can govern cognition.

why we're starting to see, you know,

type three diabetes

being Alzheimer's and dementia is falling
into the category of it being an insulin

and a blood sugar problem,
not a plaque development problem.

And in the liver, which is a huge place
that we need to put some focus or shine

a light on when it comes to insulin
is it helps synthesize

alternative energy sources
such as glycogen and fatty acids.

So fat production and short
term 24 hour energy stores.

So when we think about this,

you know, your digestive tract,
when you eat or break down carbohydrates

and food and produce energy, so carbs
stimulate insulin,

the most protein,
the second and fats the least.


So glucose is the primary source
chemical energy in body.

We're not talking about ketones or or key
to production or if you've been fasting

and you're getting into ketosis
or maybe you're doing the keto diet,

but just on an A normal
like everyday process you eat, it

breaks down an energy and then the insulin
is secreted by the pancreas, which helps

glucose from the blood into your cells

for energy use or storage.


So you were talking about these blood
sugar spikes and you were talking

about the symptomatology of what insulin
resistance can be on a day to day basis.

Yeah, but these big spikes
cause repeated insulin surges

and doesn't necessarily
have to be a big spike from like,

you know, the Dairy Queen blizzard. Right.

It can be repeated spikes from snacking

in grazing and keeping your fasting window
open too long.

Even some forms of medication
take even a protein shake right

quick, absorbing boom goes right in.

So that's why we talk a lot
about in our programs,

making sure that we're putting protein
and fat first.

And then or fiber protein fat. Right.

So each of these each protein fat
and then on the back end consume

the carbohydrates because it blunts that
that blood sugar response.

But the more and more the way
you described it is, I think, a bit

like the the Muppet babies, like back
in the day when the nanny would come in

and it would just you just hear like,
what was it like?

I think that was the sound. Right.

And you
you couldn't make out her words, right?

It was just this numbing sound. Right.

But what happens is eventually,
after repeated exposures are want

what's right
and you're not your body's not hearing it,

your cells aren't producing it, your body
can't keep up or make enough insulin

to keep up with the glucose production
or the glucose ingestion

or the glucose, the blood sugar
that's floating around in your body.

So it stays chronically high.

And that's when we see diabetes,
heart disease, cognitive decline,

reproductive issues, cancers and more.

The problem is, is that insulin
resistance can start in the muscle

cell long
before it shows up in the bloodstream.

So one of the things
why insulin resistance

hasn't been looked at very often
and it's not part of routine bloodwork

is because some people

still don't see insulin as a precursor
to other health problems.

And then we have the well,
if you actually do test for it, then

what the heck do you do with the test?
How do you interpret it?

We'll get into that in just a minute.

Yeah, I mean, that's that's going
to always limit the actual utilization

of figuring this stuff out,
like what's going on under the hood.

If the

if the next step is kind of a question
mark or an unknown, I mean, what provider

is going to want to be,
you know, face to face like, okay, well,

now we have some new information, great.

But I'm not really sure
what to do with it.

So we're we're left
knowing that this is an important thing.


So, so what to do about it,
You know, so when we start understanding,

okay, blood sugars related, we have blood
sugars sensors all throughout our body

and they understand
what's happening with our blood sugar.

They know if it's on the rise
or on the decline.

And then this is leading to more
or less of bolus and and dripping

out of insulin from the pancreas,
from the beta cells in the pancreas.

And so then if we can understand it
like that, then it starts to make sense

why a few of the things
that you've alluded to already, like

how long is my eating window
open on a given day?

What are some of my food choices
even down to ha

if I have a particular plate
or a particular meal, but it's

in a different order, it might have
a different effect on my blood sugar,

on my insulin response,
which is kind of crazy, I'd say is crazy

when you're in the tracking world,
because as long as I stayed

in the tracking world, that right
there never felt like big enough

to feel like a big needle mover was like,
No, I got my I have my calories.

I even have my macros. I'm already
tracking those.

The order of the food
that I'm actually eating, it can't matter.

It can't matter enough to move the needle
and move the scale.

But in fact, it does,
because your body is actually constantly

seeing what's going on with your blood
sugar and and how you actually eat that,

how it comes
in actually does have a big effect.

So if I break a fast with a higher
more like a faster acting blood sugar

spiking agent,
you know, simple carbohydrates

that is going to immediately
start rising or raising my blood sugar,

which is going to immediately shoot out
insulin that can't really be turned down.

You know, that already happen.

The blood sugar is already starting
to spike at that point.

Whereas if I had started it
in a different way with some protein,

with some good fat,

and left that for later in the meal
or even just a few minutes later,

it can definitely have a different effect
on blood sugar, which is great.

And that yeah, I mean,

and that's why I so want to go back

to that research article
that I mentioned in just a second.

But the insulin dysfunction
and the insulin resistance,

the root contributing factor
to what we mentioned,

all those different disease processes,
more than 133 million Americans add up

to 88% of adults

have an issue with this process
that we're talking about right now.

Let's stop metabolic health like it's
the way our bodies make and use energy.

And that's where insulin comes into play.

It's the gatekeeper, right?

This is why the CGM has been
so incredibly impactful

at different stages of my fasting
weight loss and health journey.

And right now I'm in part of a six month
tracking period

and we've partnered with Nutrisense.

So Nutrisense combines cutting edge tech

and expert dietitian experts.

So the human component.

So you get to see what you were
just talking about,

how your body responds to different food,
exercise, stress and sleep, right?

So not just the food component
and the instant component

because it's not testing insulin.
I'll explain that in just a second.

But it's looking at how your blood sugar
varies, which means insulin is there,

like trailing it, Right.

Blood sugar
trails, the insulin response. Right.

So nutrition has the ability in real time
by pairing the technology,

which is the continuous glucose monitor
that you wear in your arm.

Completely painless to apply.

Last for two weeks

and you get a package of sensors

when you sign up for a six
or a 12 month subscription.

And it actually shows
you am I moving closer or farther away

to getting my insulin under control?

Because is my area under the curve
with my blood sugar response?

Is it getting smaller or bigger?
How big are my spikes?

How long do they last? What if I eat this?
What if I eat that?

What if I do change the order
that I eat my food and.


So the key here is your blood
sugar levels are going to vary

based on your body's ability
to produce insulin, which is then going

to have a level of effectiveness
you're going to see in real time.

It's going to allow you
to see it on your app.

You're going to have expert

dietician guidance from their team
to explain what the heck the ratings are.

When you look in one's green and one's
red, you're like, Why do I get a red?

My blood sugar was low.

Well, your variability wasn't
where it needed to be.

And it's really simple to walk out
because it makes it easy to identify

and control what you're doing well
and where there's room for improvement.

So yeah, especially for me, it's been key
at this point in my journey as it wasn't

previous points
where now I'm really working on

keeping that area under the curve,
like keeping my blood sugar pretty stable

for as long as I can
because I'm really working

on some visceral fat,
some visceral adiposity, right?


And for me, I've been doing Carnivore,
I've been trying to control my cravings

and get that insulin number down

that we're going to talk about here
in just a minute.

So if you go to

you get a $30 off code

and you'll get one month
free of dietitian support.

And I just really encourage you,
as we're talking about insulin, the reason

it fits so perfectly with today's
conversation is because there is no

at home insulin test, like there is a test
for blood sugar which nutrition starts,

but we can still get insight
into what our insulin's doing

while you then go strategize.


how am I going to get my fasting
insulin number

and then what am I going to do
to interpret it?

So that's the next piece of today's

conversation that I want to talk about is
why is this not something that's ordered?

Why is fasting insulin? Well,
there's two main reasons.

There's no scientific consensus
on optimal insulin levels

because it was always thought
as a lag measure, not a lead measure.

When it comes to disease.


And secondarily,
there was some issues with accuracy

during the with the testing process.

So as of late,
there has definitely been it's

how do I say this more accurate,
the more variables you have.

So for instance,
this woman asked about once

I get my insulin tested, what's my number?

We'll talk about numbers here in
just a second. Is a high is it low?

Where should it be?

Well, it's
not the entire piece of the puzzle.

We also need to look at waist
circumference, high

waist ratio, triglycerides, HDL, apob.


There's other factors CRP,
inflammation, familial history, right.

Those types of things as well.

So it is a powerful piece
because once you have an insulin number

and a blood sugar number,
then you can look at something

called the Homa IRR,
which is the gold standard.

But I'm putting the cart before the horse.

So let's take a step back
for just a second and talk about Tommie.

The the discrepancy right between.

Dr. Mark.

Come in. Dr.

D'Agostino, Dr. Poor Mudder, Dr.

Ben Brickman and Dr.

Robert Lustig all have different levels
of where they think A

And these are researchers and pioneers
in this space, right?

And where they think
the normal levels should be.

And, you know, to be honest,
I had a client recently who was like,

I won't ask for this test,
and my doctor refused to order it.

And I said, okay, we'll go to any labs
tests now here in Houston,

order it yourself.

Okay, great.

Now I have the result.
What do I do with it? I googled it.

Now I'm confused.

that's actually what I ended up having to.

I actually utilized a neutral science
at home lab kit to get mine rechecked.

And so, you know, it's that can be
a frustrating part of the process.

I guess it's

it's part of why we
we hear these kind of questions

a lot because, you know, like you
just alluded to, we have five different

PhDs and clinicians here as well in a mix

and no consensus on exactly
what the best number is.

Although, you know,

when I look back at some previous lab work
and some friends of mine

shared with me theirs
while they were on their weight

gain journey and now trying to figure out
how to get the weight off, a few of them

showed me some alarming insulin numbers
that their doctors had recently ordered.

For them,

this was they were trying to decide

if they were putting them
into the pre-diabetic bucket or the.

you're you're right on the edge here.

Do we need to get, you know, a medication
involved. Right. Right.

For this.

And a few of them had we're like
right there on the line because what

we what we do normally see is, well,
you're going to want it under 25.

And so what that's meaning
is that sometimes on the on the lab work,

if it's at 24.8, it's
not showing up as any sort of a red flag.

And that's a problem
because that is crazy, crazy high.

But that's even if it gets ordered.

Yeah, well, right.

So then you order it and you're like,
Oh, I'm at 22.

Okay, I guess I'm normal. Well,
guess what?

I was at 22 and I was fat and I was sick
and I had a ton of visceral fat

and my blood pressure was up
and my liver enzymes are off.

And I was on my way to nonalcoholic fatty
liver disease and diabetes.

And it was like, what the heck? Right?

So the chronically elevated
and I was counting I was doing CrossFit.

I had a $10,000 functional nutrition

I was working out.

I was not stopping and getting fast food
and Dairy Queen and pizza on the way home.

I was literally doing this program
with my wife, right?

Like I wasn't a bad patient, right?

I was walking it out for six months
and the needle barely moved.

But once I started adding fasting in,
then I really started

to see some incredible change
really quickly.

So I mentioned this research article
because there's this thing with insulin

and they did this in a lab test,
like why this matters, Why someone

without blood sugar or diabetes
related issues would worry about insulin.

Sure. Well, here's the thing.

So they did this test
and they were looking at 72 hour, 96 hour

hyper insulin anemia status,
meaning high levels of insulin.

And it was done in a lab.

And what their takeaway was that
these results demonstrate

that chronic physiologic hyperinsulinemia
elevated insulin,

whether created by EXONDYS infusion,
which is what they were doing in the lab

or by stimulation of endogenous meaning,
your own body's

production of insulin leads
to development of insulin resistance

in which is characterized by a specific
defect in your glycogen synthetic pathway.

So how your body literally uses energy,
there's a defect in your cell,

in your muscle cells, in your liver.

It's not processing the energy properly.

So limit your calories.


Start working out more.

Great. The needles move month after month.

Well, guess what?

There's a resistance there, right?

So they say that these findings indicate
that Hyperinsulinemia should be considered

not only a compensatory response
to the resistance,

but also as a self-perpetuating
cause of the defect in itself.

So all of that word jargon that I just
said means it's a negative feedback loop.

So how are we going
to get off of that crazy train, right?

If they're able to do that
in just 48 hours inside of a lab,

inside of humans And these were in healthy
individuals, right?


To be able to create that,
then we need to start looking at

how do we get the test,
where's our number?

And then that becomes part of our tracking
every three, six, nine

or 12 months rather than you just routine
yearly bloodwork,

which isn't even going to have this on it.
Does that make sense?

So let's go over the ranges that we see,

So 2252268 less than eight.

Dr. Ben Beckman Less than ten.

Dr. Rob Lustig Less than ten.
We like to see.

I know personally for me when I got
my number under

five is
when I really started to see change.

My wife's at two point something.

Tommy you're in the threes now, right?

I am, yeah.

I started at 22.

Right. Study of Chinese men.

They looked at it, found the insulin
levels ranged, their average was about 16.

There was another study that said

without diabetes found that people
with insulin levels around ten.

So there isn't an actual gold
standard for this.

But if you get sure we like to see
and what we see in most of our folks

is that the cravings, the lifestyle,

the lab work,
all the other related labs improve.

When you get into that around that 5
to 6 range.

Yeah, right.

The cool thing is if you get a fasting
blood sugar with that, you

then can put that into the homa
IRR equation.

And the Homa air equation has absolute
data to back up that if your number is

one and under you are a healthy
non insulin resistant individual.

Mm hmm.

It varies on the high end, 1.7, 1.8.

But if you take that fasting
insulin number, combine it with your blood

sugar number,

now you get a homa air, which you've done
a whole podcast episode on as well.

Okay, Now we have something
as a reference range,

not just one data point
that is going to confuse us

because there's no medical standard
for it,

because it's seen as a lag measure,
not a lead measure in disease.

And then the doctors in the system
don't have any way to help you do it.

Well, guess what?

That's why we fast

that's what transformed our lives
with the process of how we started.

The one word to you that we like to use
is always consistent, intentional fasts.

Yeah, it absolutely.

That's a great point to highlight,
because if we're actually looking back at

what those numbers were doing over time,
I want to say this

When my insulin was at three,
it got into the threes.

I didn't have all the weight off.

I wasn't at the perfect number, so

I still got a few pounds of visceral fat
and my numbers in the fives.

Yeah, yeah. So that's the really cool.

Of course you're beginning. Thanks.

Oh, yeah.

Hey. Hey. Who's counting?

I love a good competition, but I just love
that, you know, you got a test done.

Sneaky. It's good stuff.

You don't have to have
the perfect body composition.

You don't have to have all the weight off

to start getting a really,
really good handle on that, you know?

But the consistency is going to matter.

And hey, that's that's what a CGM
helped me get some of that consistency

under my belt, even just like being
really intentional about my fast

this isn't always about hitting home runs.

This is about multiday fast.

Those rolling 70 two's seven day fast
once a month.

Unless you're trying to like
I don't know man.

That's just that's not sustainable, right?

What do you do when you stop fasting?

There's a lot of decisions whenever you
whenever you stop the fasting.

So it can almost be like,
if I feel like I'm avoiding decisions,

then I know
I need to be doing some shorter fast,

but I need to be getting those right
more often, more of the time,

because we're talking
about fasting insulin levels.

I mean, that's stuff
that's baked into the system in your

in your blood work that's going to be over
the last 30 to 60 days.

I mean, it's going to take a while
to move the needle on that

and it's going to take some consistency

to get somewhere different 30 or 60 days
from now when you retest.

There was an article that I was rereading
and what disagreed on whether or not

in my own head whether or not we should do
an article or an episode on it.

And it was talking about the differences,

and we've written this a few times
in the past too,

about whether or not we should actually be
looking at certain lab metrics

in a fast or non fasted
state over the last 10 to 15 years.

It's like, well,
we should actually be looking

at some metrics in a fasted state
and some not.

When you have your routine bloodwork
done, well, guess what?

There's no disparity here.

Fasting, insulin, go get it done.

And now you have an interpretation, right?

You have a number that you can track
that you know is moving the needle away

from metabolic disease
and all of the conditions we mentioned

earlier metabolic syndrome, diabetes,
heart disease, cancer, stroke, etc.

and again, just a piece of the puzzle.

But the easiest way to get control of this
and stop the want

that want that numbing that you mentioned
is to fast, consistently

and make better food choices
when you break your fast.

And if you're looking for guidance
on that, you can head to the show notes

and grab our blueprint
to fasting for fat loss.

It's a free 20 page PDF.

It gives you some schedules, outlines
the what the why talks big picture,

but also give you some tangible actionable
things you can do as well.

And if you want a subjective quiz,
we have an insulin assessment as well

where it tracks and it allows you to
score it and it tracks your total score.

If you say yes or no to the questions on
some of the other symptoms

that go along with having
insulin resistance or elevated insulin

while you're trying to figure out
how to get your fasting insulin test time.

So one takeaway from today, Tommy, for you
as we wrap up today's episode,

head to the show notes.

Fasting for Fat Loss Blueprint.

The insulin assessment is on our website,
the Fasting for life icon.

You can also head and click the link
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and talk all things fasting. 24 seven.

So one takeaway, Tom,
as you wrap up today.

Yeah, I love it.

A takeaway for me
is let me get some consistency going here.

So regardless of how much experience
you have with fasting or what your longest

fast is, we're looking for consistency
here in both my ability to set my timer

and then complete the intended fast
as well as the choices

that I'm putting on my plate
when I whenever I am breaking my fast.

Because those are the two things
that are going to add up the most,

they are going to have the biggest impact
on my insulin

resistance and my fasting insulin number
whenever I do have it checked.

So writing those two

and checking those boxes consistently
rather than swinging for the fences,

especially if you haven't been knocking it
out of the park lately, then absolutely.

Go, go do that. Go focus on consistency.

Make one or two better food choices today
and tomorrow and keep that ball rolling

and you're likely to see an improvement
here in some of the things

that we've been talking about today
that are so important.

Absolutely. Love it. Tommy, as always,
appreciate the conversation.

Sure. Head to the show notes,
Check out Nutrition.

Been inspirational.

It's now
part of a signature piece of our programs.

We've been working with them for a while.

Just an incredible experience.

Tommy, as always,
thank you, sir. We'll talk soon.

Thank you. Bye.

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