I must have watched literally 100s of nutrition and health videos over the last 5 years and this is without doubt the absolute BEST. Clear, well explained with no food tribe drama. I hope as many people as possible can see this so that they are better educated and can steer away from the hype and nonsense being pedalled to them by YT "experts" and "doctors" interested in promoting their books or extreme lifestyles. THANK YOU SO MUCH.
Appreciate you taking the time to provide feedback. Particularly because you spell out some of the reasons that motivated me to start this channel. I am so tired of diet tribalism, and literally sick to my stomach about all of the influencers out there on RU-vid and other social media who mostly line their pockets with sponsored posts and affiliate deals that end up promoting some processed crap, or some extreme views that inevitably lead to a supplement. Best, Mario
Probably one of two best nutritional RU-vid channel. The other being the weight loss videos of Renaissance Periodisation. Incredible that this is free. This kind of web is amazing.
@@sheila7814 Per Stacy Sims, PhD, who specializes in women's nutrition, this may not be a good idea for women, especially older women, or even younger women in the luteal phase of their cycle.
I truly wish this video was shared in biology classes everywhere; I think it would really help decrease obesity if people were exposed to this kind of information and explanation from a young age.
Another amazing video - thank you! It is great to get some detail about why BMI only gives us limited information about insulin resistance. And I love the graphics showing the fat cells and their changes.
One of the best scientist on YT. Mario is extremely rational in arriving at his determinations. Nothing is taken for granted or at face value and is properly (as far as this layman can tell), analyzed. He sites credible sources of scientific studies and journals. End result: a VERY high level of confidence in his material. I'd love to see Dr. Katz and Dr. Becky Gillaspy, another very credible YT doctor, in a long form discussion. 👍👍👍
I am a recently retired nursing professor. I wish I would have known about you to share with my students. Blessings to you and prayers for your continuing work
Brilliant is the only word that comes to my mind . I am a lean but belly fat person with hba1c of 11. I was always been a lean person. But chronically stressed and sleep deprived. I vouch for every thing this gentleman had said.
Aha, stress and sleep deprivation! I look forward to hearing him dive into that element as it is a huge contributor to all sorts of health issues, esp metabolically.
After changing my diet, my blood sugar is now normal, but insulin resistance is still high. Since doctors generally recommend to "just" lose weight (which almost ended in an eating disorder) and don't give much insight into the other possible reasons of me having high insulin resistance, I appreciate the insight you provide.
If you are eating a low carb diet, the fats in the diet will drive insulin resistance. I followed LCHF for over 8 years & my body became so fat-saturated I couldn’t get my blood sugar down even with loads of insulin. As my ability to digest animal protein had also collapsed, I had no option but to go plant based. I just juiced initially for the first month to give my poor digestion a break, & although my BG stayed high, probably as my body cleared some of the ectopic fat, suddenly, around the end of the month my BG started to drop, my insulin sensitivity returned & I had to cut the insulin intake by more than half. I also lost some of the extra weight I’d gained on Keto. Fats definitely drive my insulin resistance. The more fat I consume, the more resistant I become.
You explain very complicated information in a very understandable way. There are some brilliant doctors on RU-vid who also cover these same topics as you but I think your videos are the best. You often apologise at the end for how long the video is but we completely understand that you really need more time to properly explain this information. Many thanks!
This video is the best single resource on this topic I've seen, and will be useful to share with loved ones as a primer on the often quiet path to pre-diabetes via insulin resistance. ❤ Thank you for being one of the very best channels I've ever seen on RU-vid! This is a rare glimpse of humanity and the internet at its best! ❤
This is a brilliant exposition of insulin resistance in itself. And, as I've found after watching very many talks/videos about metabolic syndrome/diseases, this description is absolutely necessary not only for understanding the part that IR plays in the progression towards T2D but, more broadly, the role of uric acid, fructose, nitric oxide, etc. when describing the various processes resulting in metabolic distress. The complexity of these relationships often means that presenters gloss over and short circuit explanations of the meaning of insulin resistance. Here, however, Dr Kratz has squared the circle for me and provided all the missing relationships for a pretty good understanding of the broader aspects of metabolic health. Bravo!
Brilliant explanation! I have heard a lot about insulin resistance, the high level understanding of what causes it and the negative effects on the metabolic system, but did not understand the mechanics of when and how insulin resistance is caused. Was also aware that there are thin people who are insulin resistant and overweight people who are insulin sensitive, but this explanation of the underlying reason was the best I have heard. Thank you!
Wow... What an amazing video. This is extremely high quality stuff right here. It makes sometimes seemingly contradictory epidemiology very digestible and explainable to the average person. We need more videos like this across more domains which people often get confused in (mainly due to social media)
100% agree with this concept ... i am small person, yet my fat storing threshold is very low. i am not obese but i am highly insulin resistant. Doesnt take many carbs or calories of any type to cause my body to pack on the fat. In other words i have to manage carb intake AND overall calorie intake.
I am in the exact same boat. I workout several times a day and walk 5-8 miles a day. Seems to be working now for me…. One benefit, I am getting quite strong!
Great video Dr. Please continue with more videos on other related issues. I am 73yrs. Old and T2 and always trying to improve my insulin sensory. Watching from Botswana.
I thought I already knew quite a lot about this stuff, but this was soooo fascinating! It's actually very inspiring, because once you know how something works, you know what you can do about it.
I'll make one more video about causes of insulin resistance, because not only do we need to understand how the body works, but also what the specific cause of insulin resistance in any one person may be. If someone is insulin resistant because they are chronically stressed and sleep deprived, the lifestyle change needed will be different than in someone who has fatty liver or medication-induced insulin resistance. Thank you for the feedback. Cheers Mario
Masterclass!!!! Thank you Mario for your detailed explanation, I finally feel that I have a grasp of my condition. I am an ancient Brit but live in Czech Rep. and was diagnosed with T2D about 9 years ago and unfortunately my doctor speaks almost no English so your postings are invaluable to me. Thanks again, superb work and very good luck with the channel.
This is an excellent podcast, Dr. Mario. You have explained perfectly with the examples in real life. In my practice, I have seen many diabetics having a good amount of subcutaneous fat compared to the visceral fat. They have less muscle mass. There are also some patients with a huge percentage of visceral fat, yet remain nondiabetic. Anyway, your way of narration is very good. Thanks once again. Dr. Bipin Deshpande, India.
Thank you, Dr. Deshpande! I don't doubt you are correct. However, remember the role of the pancreatic beta cell, i.e., the ability of the patient to make enough insulin for their level of insulin sensitivity. Therefore, the relationship that is strongest for visceral and ectopic fat is with insulin resistance, not glucose tolerance, based on several high-quality clinical studies. Sure someone could have a lot of visceral and ectopic fat and be very insulin resistant as a result, and still not have diabetes if their beta-cells can make enough insulin to compensate for the insulin resistance. Similarly, someone may have quite little or even no visceral fat and still develop diabetes, if their beta-cells are unable to produce much insulin at all. Hope this makes sense!? Warm wishes to India! Cheers Mario
I'm so happy I came across your channel. I have been doing intermittent fasting and low carb and this clinical explanation makes so much sense to my journey. Thank you so much, definitely have subscribed. Also the amount of script and research and diagrams in your videos are commendable 💯👍🏻
I am obsessed with IR and have watched hundreds of videos and have gone to conferences explaining this, and this videos in my opinion is one on the best ones. Thank you!!
This is one of the clearest and best presented overviews of this topic I have ever seen. Extremely informative. I am curious to know your views on reversing insulin resistance, diabetes and whether lost beta cells still make this possible.
If you look at the research done by Roy Taylor at Newcastle university uk you will see that it is possible to revive beta cell function. They did this by using a very low calorie diet to empty out all excess fat from the places it should not be. They found that once the fat was depleted from the pancreas the beta cells started working properly again.
I am a big believer in the personal fat threshold hypothesis. It is the only thing that explains my situation. I do low carb, so for me, it is not intake. My sugars are great at 165 lbs but not so good at 180. When I see thin diabetics, usually you see a bit of a pooch if abdominal fat.
yep - Im in a similar boat. Im 6'8, 245lbs with a lot of muscle mass and a little fat. Im not the healthiest eater and I just hit the pre-diabetes mark. I know my body would totally give out before I could hit 280. Im not genetically fit to be morbidly obese. the only place Im able to store a bit of subcutaneous fat is in my lower back and gut, but by then my belly is filled with fat beneath the abdominals. I'd die a long time before Id hit 300
Thank you, Mario, for such a beautiful explanation of how fat develops in our bodies. It also makes sense why so many chubby people I know don’t have insulin resistance. I’m also keen to know what happens when we lose fat. Do the enlarged fat cells reduce in size? Do some of them go back to pre-adipocyte stage? This is a valuable video, and I’m sharing it!
Great questions. Yes, fat cells can shrink again, but they never go back to the pre-adipocyte stage once they are fully mature adipocytes. Also, and that is a bit of a problem, while weight gain can fairly quickly lead to a loss of liver and muscle fat and an improvement in insulin sensitivity in these tissues, it does seem to be harder to fully restore insulin sensitivity in fat tissue. That is because even if we lose weight, we still have dead fat cells lying around, and macrophages, and low-grade inflammation, and these things do not disappear rapidy. It does seem that we need to lose quite a bit of weight and some time needs to pass until that inflammation resolves and adipose tissue insulin sensitivity is fully restored. Cheers Mario
So it means we need to do fasting, I have cancer and trying keto as now have after chemo a leaky heart valve ,, so not sure if I have probs to esy keto also have sleep apnea,,, trying to ballance, all this so I'm thinking I need to eat like I have before , which was lowfat n carbs now have been doing keto , I think I have isulin sensitive and metabolic syndrome not picked up and now trying to help with food so how do I help myself with what diet, as so many opposite diets are posted by too many specialists , so which one is true,,
I waited almost impatiently for your new video! Great explanation, understandable and very teaching about our conditions who may concerns! On many similar RU-vid sites, I always try to redirect people to this channel! Many explain well in general terms, but as you do, is all different level! Thank you!
Thank you for this excellent explanation, something that other 'experts' only hint at. Interesting and well done - without dietary dogma. Thank you so much - I have been searching for this kind of information.
Finally a new video, was eagerly waiting for this. 👍 Interesignly the channel 'what i've learned' covered the same topic recently. Thanks, Mario. Pls keep up making these videos, you're surely helping a lot of people with this.
Which doctor? Me? I doubt it, or you have a very fine eye. I have been at my current weight, or within 2 pounds of it, for well over 10 years. But thanks for the compliment. Cheers Mario
Immediately subscribed and pressed bell icon after watching this video. The most clear way of explanation which everyone can understand. Got confidence that i can improve my health
Dr. Kratz - Thanks for another great video! I love your evidence-based approach, and the fact that you don’t push anything - but rather - you just state scientifically grounded opinions, as your lifetime of experience has informed you, and then let the viewer decide for themselves. After watching this video highlighting the dangers of excessive fat, I am wondering if you have looked at research to see whether any of today’s “miracle” weight loss drugs can help to reverse a lifetime of neglect - not as a substitute for good nutrition, but to turn back the clock a bit, and then follow a healthy lifestyle? This information could be particularly helpful to older viewers.
That's a great question. Once someone has accumulated a lot of excess visceral and ectopic fat, the data are clear that we can reverse it by diet and lifestyle change, but it can be hard to maintain that reduced body weight in the long term. It's clear that the new class of obesity medications can offer tremendous help to many people with obesity, and I am therefore not against considering them. However, I also do feel strongly that these drugs should be paired with dietary and lifestyle changes, specifically resistance training (to prevent loss of muscle mass) and an adoption of a very micronutrient-dense diet (because the lower overall food intake makes vitamin and mineral deficiencies more likely). I'll make a video about these medications at some point soon. Best, Mario P.S.: Thank you for your generous support! Much appreciated!
Watched this video and you have again added another piece of the jig-saw picture showing and giving me the information and knowledge not to be mislead and mis-treated - medically for my T2D condition. Big Thank You.
Love the content! Thanks for sharing your knowledge! I came across your channel when looking for information to prevent glucose peaks. That video on GI and GL is excelent, I have since watched all your other videos. If I may suggest a topic, I'd say gestacional diabetes :)
I’m obese and I have no doubts that my type 2 diabetes is related to that. Let’s be perfectly clear, most overweight people know they’re fat and don’t need reminders of that fact. Also, let’s be clear that reducing body fat is not easy for some people. Medical intervention is not a weakness and people able to overcome diabetes through lifestyle aren’t morally superior.
Thank you Mario. I always look forward to your videos. You do such a great job teaching. The way you explain things and the teaching aides you use sure do help to make this subject easier to understand. Thank you
Aaawwwesoooome video!!!!!! Thank you very much! I loved it - as all the other videos! You truely have a unique way and talent to make complex topics easy digestable eve to people with no scientific background! Well done! 👏👏👏
Thank you for your science based approach to nutrition and being our own best doctor for myself. I am lowing my A1C with medication and behavior changes.
This is great to know!!! I switched to a ketogenic diet due to type 1 diabetes. I had the typical hyper responder values (low triglycerides) but after a while I gained 5 kg (to just 75 kg!) and since then my triglycerides are always above 100 no matter what I do. I notice my insulin resistance due to my insulin shots. I’ll also try to get the CRP measured and reduce my fat. Thank you for sharing this!
Excellent video! Thank you so much for sharing your knowledge. It makes sense that im underweight and have diabetes eventhough i eat much healthier while my friends who are so unhealthy yet have no major health consequences. Liked, subscribed, shared!
Thank you. Can you share which specific content was particularly helpful to you, and which additional questions or challenges you still have? Warm wishes, Mario
This was a very good video. Thank you for this and for the large amount of effort that was clearly put into this. I learned a lot from this. Subscribed 😊
i think this is the best channel i have found on the internet in the past few years related to this topic. just please make the videos shorter. break it down in few pieces so we can follow up because those of 40 or more minutes are very hard to follow.
Thank you for your kind feedback I appreciate your critique, and I apologize. I am still fairly new to making content for the general public after 30 years in academia, and it's fair to say that I am still learning how to make these videos scientifically rigorous and an accurate reflection of the science while also making them more accessible. I am working on it, but making scientifically correct videos that are also short and entertaining is a tall order. Thanks for your patience while I am working hard to get better at this new skill. Best, Mario
Dear Dr Kratz, Thank you for your detailed presentation concerning the two type of fats and its structure effecting the insulin resistance component/outcome! before my usage of the CGM, I would probably have gone with this theory! please do not take me wrong as I am not suggesting this theory has no element of facts! BUT since I started using my CGM almost constantly I have discovered NEW WORLD of diet verses Type 2 and BGL! I can say with 100% certainty based on my own experience as Type 2 sufferer, that Not all Type 2 sufferer have insulin resistance! Not all Type 2 sufferers react the same to carbohydrate enriched food! AND not all Type 2 have the type of issues relating to the two type of fat storage. My BMI is within normal range, My C-peptide level is within normal range! I don't have NAFLD, I walk 5 KM a day minimum , I am fairly active more so than many people I know, my diet is mostly vegetable combined with dairy product, meat and fish etc. Yet when I woke up in the morning my BGL is always high, I wait till midday/afternoon and my sugar level starts to drop, further more when I eat some fruits such as dates or grapes with my meal I noticed my Blood Sugar level starts to drop within minutes!!!!! when I hungry my BGL is around 10 but as soon as I eat it drops to around 7! when I am sleeping is around 6 to 7!!!! So where does the personal thrush hold theory fits?! Since my CGM usage I sincerely no longer believe in the Glycemic Index and no longer believe in any tablets and for SURE no longer believe that I have to wait two hours after meal to see how my body reacts to that meal! I react within minutes! Have a lovely day and keep up the good work!
My body also reacts within minutes but it does match the glycemic index of foods. I think there are several factors that affect a person’s blood sugar and regulation. There are so many linked hormones…. [produced in the pituitary gland, adrenal and pancreas] If one is off for some reason (like mine - I am on anastrazole), then it affects your glucose because they are linked. When they say wait 2 hours and check your blood glucose that was before CGMs and it was to check to see if a certain food kept your blood glucose level high, longer … like the two hour period. Most meals I eat (but not all) rise in a spike or gentle hill and then within about 30 minutes it has fallen back to my baseline unless it was very high in carbs…. Then my baseline glucose stays at a higher level for hours or until I go exercise. ❤
@@Trudysaccount I am working on this as well. I think I have lost some. I used to weigh 175 a few years ago…. Now I am at 142. Cancer kicked my but into gear and I exercise off and on almost all day. In other words, I am active most of the day. I have gotten rid of fatty / sugary foods and no longer eat processed foods. I am slowly losing a pound or two a week and it feels great. ;) Good luck.
Let's gather and appreciate the fact that such important information is being shared freely out to us (especially Me and everyone who is desperate to lose and manage weight) i started my weight loss journey April 2023, by December 2023, i had lost 22kgs, i took a break from December 2023 to February 15th 2024, i regained 2kgs (during my break time my eating habits became very bad 😂😂😂😂😂i lost control especially night time) so i wasn't surprised to have regained 2kgs, and on 15th February I started the journey again, after a very few days, i started seeing a change tho not on the scale yet (in short i started from 85kgs, i dropped 22kgs becoming 63kgs, regained 2kgs becoming 65kgs, now have restarted Until i become 50kgs i won't take a break).........i want to encourage someone out there struggling to lose weight, you can do it, don't give up, don't procrastinate and don't compromise ❤....... Thanks Doctor Mario 😊
First time i land on a video from this channel and instantly subscribed and sepparated this video to share with my group of friends that I’m trying to improove they’re health! Fascinating content on fat phisiology. Thank you for takong your time to help others with that. There is so much crap on YT, but this is Gold… i’ve seen hundreds of videos about health and weight loss on YT that helped me to improove my otherwise bad health condition i carried over for the last 2 decades and now i see clearly what happened! I crossed my personal fat treshold and I’m starting to even figure out when and wich is my weight thet causes it to cross and make me inflamed. I’ve done muscle biopsy in the past during my chronic inflammation investigation and this is the second and moat accurate hint of what a strange corpuscle was in my muscle: globs of accumulated energy off course!
Thank you, Humberto, for the kind feedback. One reason I started this channel is that I felt there was way too much diet tribalism and misinformation on RU-vid (and other social media). I have about 30 years of clinical research experience, running my own lab for 14 years, all in the area of nutrition as it relates to obesity, type 2 diabetes, fatty liver disease, and cardiovascular disease. So I do know this field well, and I can read and interpret the literature, but the biggest asset I hope to bring to RU-vid is that I have learned to appreciate the complexities of human nutrition and biology, and don't easily subscribe to oversimplified solutions (lectins cause all chronic diseases, carbs cause obesity and type 2 diabetes, fat causes heart disease etc etc) and the diet tribalism that comes with that. We need to pay a lot more attention to nuance, and evaluate the scientific findings with all of their pros and cons, because very often, the most plausible mechanistic insights don't pan out like that when we test them in human randomized trials. What this leads to is that in many cases, I am not all that certain myself, and I want to communicate that as well if I see that we still have specific gaps in our knowledge. That's not for everyone, as I have learned that many people prefer quick and simple, and a clear message rather than the sometimes inconclusive reality of actual science. Glad you are on board, and hope you will continue to find this content valuable. Best wishes, Mario
Fascinating! Exceptional video, as always. Thank you. I'm curious if you are aware of any evidence based methods of losing weight that preferentially target ectopic fat over subcutaneous?
Thank you. Will cover this in detail as we discuss the different weight loss modalities, but yes, in general we tend to lose ectopic fat and particularly liver fat first when we lose weight. Cheers Mario
@@rabbitgirlz4380 I can only speak from my experience . At my worst, due to very poor diet and excess calorie consumption, I was obese, with a waist size of 42 inches, 34% body fat, and 190 lbs. I was diagnosed with NAFLD. I ckeaned up my diet combined with calorie restriction which with lots of successes and failures along the way, finally helped me get down to 29” waist, total fat loss of 22%, and weight to 123 lbs. I got a dexxa recently and fibroscan. The fibroscan confirmed I had totally reversed my NAFLD, my total body fat % was optimal at 11.7% and my visceral fat % was also ideal/optimal at 0.1%. Normal is anyting form O.0% to 1%. I did not do anything drastic. Just incorporated healthier food with much less junk food, and engaged in 10000 steps walked daily and a combination of cardio and resistance training exercise. No intermittent fasting, no keto diet., etc. And if truth be told while I greatly minimized highly palatable ultraproceesed foods, I did not and could not fully eliminate them due to my sweet tooth Yet, I still managed to pull this off. Dosage makes the poison
This is the best video I've seen explaining the current understanding of how insulin resistance develops. Thank you for an informative and well-delivered presentation.
I’ll watch this again, so much good information. Unfortunately I’m slightly insulin resistant at A1c of 5.8 and mildly fatty liver. I’m working on reversing this. Currently wearing a CGM to see what triggers my glucose. So far, so good.
Incredible work Dr.Mario... 👏 PS: Sumo wrestlers usually aren't observed to suffer from insulin resistance even though they are extremely high up on BMI due to equally high muscle mass as well... so as you have rightly mentioned here superficial looks (apple, pear shapes) can often be deceiving...
Ah, I love that comment. Will need to research sumo wrestlers, as that's super fascinating. One thing I guess is that most active sumo wrestlers are young, right? So it may also fit with the idea that our personal fat threshold shrinks as we age, and maybe they are benefitting from their high personal fat threshold when they are young? Cheers Mario
@nourishedbyscience appreciate the prompt response Dr. Mario... it's a fascinating topic that requires thorough research, i suppose. Apart from their fat threshold, there might be factors counteracting insulin resistance, probably even in older sumo wrestlers due to the macro and micro constituent variations in their diet (seaweeds, mushrooms, hand made noodles etc) too.
Is there some research you can point to on this. Personally I would not consider a sumo wrestler to be healthy bearing in mind the variety of other conditions and diseases linked to extreme obesity despite their not having super high BF. They also do no cardio exercise. Health is multi-faceted. The muscle they are carrying is very specific to their sport.
True, though a big part of why that is will be because the people who can get to those sizes whilst remaining highly athletic will by necessity have low amounts of visceral fat in order for their organs and circulatory systems to keep up with the demand placed on them. Outside of the genetic side of things, the training they do will drain their muscles of glycogen on a regular basis and this does promote safer fat storage. The storing of fat is influenced by capacity and that goes beyond the amount of space in different deposit points, it's also the number of points where the fat can enter. With the glycogen expended from the muscles the glucose in the blood is going to be converted into glycogen and placed in the muscles as the first priority, then in subcutaneous fat. If the amount of glucose and fatty acids in the blood exceeds the body's perceived ability to store it in those two areas, that's when visceral fat gets deposited at higher levels. The variation is partly down to physiological factors, but there's also variations in how each body responds to inflammation and what the thresholds are for the cells to become resistant. It's also worth noting that people of Asian descent tend to have lower body fat percentages overall, but have the same prevalence of type 2 diabetes as other populations. I bring this up because being able to achieve the higher subcutaneous body fat levels associated with Sumo is uncommon and the fact that these athletes are that size may indicate that they were always going to have a favourable distribution of fat from a healthcare perspective, regardless of whether they decided to train for the sport.
Maybe, once you complete a series, you can devote one or two videos to explaining how GLP-1 agonist products like Ozempic/Mounjaro (also GIP) work. Seems a bit complicated ... for instance how they work, although they also increase insulin and reduce glucagon, which seems contrary since insulin normally inhibits conversion of fat cells' triglycerides for energy.
Just stumbled upon your channel, so good, personal story, 6 months keto/low carb, all blood work markers good except elevated ldl/total cholesterol, ideal weight, blood pressure ok...biggest remaining challenge getting that visceral fat from warning level into standard level, difficult to achieve, just entered retirement/male, great content
