Do Carbs Cause Insulin Resistance? 

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.

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.

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 RU-vid. 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.

Thank you for your kind comment. Best, Mario

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Thank you for your kind feedback. Best, Mario

Thank you for leaving such a kind feedback. Best, Mario

You can listen to the Fat Emperor too.

Thank you for the kind words, and your support. Cheers Mario

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.

I know few cases from lowcarb forum where people cured fatty liver with eating only meat, leafy vegetables and saturated fats.

Thanks for sharing. Cheers Mario

I imagine appetite affect would have to do with protein and fiber

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. ru-vid.com/video/%D0%B2%D0%B8%D0%B4%D0%B5%D0%BE-cP57oM8lBaU.htmlsi=aAVq9r6L_1pYH6Cw Best, Mario

Love your thoughtful comment. Thank you. Best, Mario

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

Excellent comment. I had similar questions.

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

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

Have you seen my video entitled "The Regulation of Blood Sugar" (link below). In it, I talk about gestational diabetes a bit. ru-vid.com/video/%D0%B2%D0%B8%D0%B4%D0%B5%D0%BE-Yg9AS2sfY9Y.html Cheers Mario

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

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: ru-vid.com/video/%D0%B2%D0%B8%D0%B4%D0%B5%D0%BE-LVw60RIhbzg.htmlsi=2_RHvSl1HGeyEOOL ru-vid.com/video/%D0%B2%D0%B8%D0%B4%D0%B5%D0%BE-kxUP0zzBECA.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: ru-vid.com/video/%D0%B2%D0%B8%D0%B4%D0%B5%D0%BE-yg0Y3eNSANg.htmlsi=IMKMDYIk7L8oN1Hw Cheers Mario

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

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.

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

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).

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: ru-vid.com/video/%D0%B2%D0%B8%D0%B4%D0%B5%D0%BE-Yg9AS2sfY9Y.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'.

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...

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?

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: ru-vid.com/video/%D0%B2%D0%B8%D0%B4%D0%B5%D0%BE-HYtnlRCq83s.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

Yes, both type 1 and type 2 diabetes have a strong genetic basis. However, for both, we also have major environmental triggers, and for type 2 diabetes clearly dietary triggers. A common issue in people who are genetically predisposed to type 2 diabetes is low pancreatic beta-cell function, i.e., the beta-cells cannot produce enough insulin. The solution to addressing this is to improve insulin sensitivity, such that the limited amount of insulin that can be produced is sufficient to keep blood glucose in the normal range. Here's a video that explains all that in detail: ru-vid.com/video/%D0%B2%D0%B8%D0%B4%D0%B5%D0%BE-Yg9AS2sfY9Y.htmlsi=VBmLZimoWCT4OlQr Cheers Mario

I'm opposite of you. Healthy fats settle me. Healthy carbs I feel not satisfied, not pleased. How we all differ..

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 :)

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: ru-vid.com/video/%D0%B2%D0%B8%D0%B4%D0%B5%D0%BE-cP57oM8lBaU.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

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

Fructose doesn’t cause an insulin response. The liver metabolize it and stores it as fat in the liver. You can measure the fat in the liver -> fatty liver index!

You're right to know that increasingly higher insulin is a risk factor. Unfortunately, you can't test it at home, and very few doctors ask for a fasting insulin test. The best you can do on your own is look at your BMI and also triglyceride/HDL ratio. If either is high, you are insulin-resistant. The higher the worse IR. cheers

Yes, but to my knowledge, there are exactly zero data showing that fruit increases liver fat. Those data are all based on fructose- or sugar-sweetened beverages, consumed in massive calorie excess. Big difference. Cheers Mario

Thanks for the fast replies

@@nourishedbyscience "zero data showing that fruit increases liver fat. Those data are all based on fructose." Bears get huge by eating large amounts of berries in the Fall. Humans aren't that different. Fruit can get you fat, it depends on the amount of fructose and also its fiber to slow its absorption. Drink a lot of OJ and you will get a fatty liver!

Yes, good point. Fiber intake was matched in a few studies, but in most it was not. I actually think it's a difficult question whether fiber intake should be matched between low-carb and high-carb diets, because the amount and type of fiber consumed will naturally be very different in people eating these diets. As to other factors, such as genetics or physical activity, that is a big advantage of conducting a randomized controlled trial: if done right, all of these factors should be balanced out between intervention groups (and in the rare cases where they are not, one can conduct sensitivity analyses adjusting for them). So I don't think this is a likely factor here. Cheers Mario

@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.

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

If you watched the video he addressed it at the end. Lower glycemic load helps conditions like t2d where there's already glucose intolerance.

But in the other video, he speaks about the development of T2D as shown in the Nursing Health Study@@Fresh_N_Fit

minute 18:30

I try not to have any opinion on any colleague, but instead evaluate their claims one by one. Any specific claim of Dr. Bernard you are curious about? Cheers Mario

@nourishedbyscience thanks for your response. If you are not familiar with his work, he suggests that fat interferes with insulin signaling within the cell. Therefore, insulin can't do its job because of all the fat gumming up the cell. He believes that a very low fat diet can help restore the function of insulin working in the cell thereby healing insulin resistance...have you heard of this?

@@alpha7ization Yes, and he has published a few nice papers from his randomized controlled trials showing that indeed a low-fat plant-based diet improves insulin sensitivity and glucose tolerance (modestly). However, in all such studies that I am aware of, the primary effect was that people lost weight, and IMO the entire effect of the interventions is due to the weight loss, not the lower fat content of the diet per se. That is because low-carb high-fat diets show a very similar effect: if they lead to weight loss, they lead to a similar improvement in insulin sensitivity, in spite of an actual INCREASE in dietary fat content. That observation is hard to reconcile with the idea that dietary fats are the cause of insulin resistance. The common denominator in both cases is the weight loss. Further of note, as I discuss in this video, low-fat or high-fat diets on which body weight is experimentally kept stable do not differentially affect insulin sensitivity. Dr. Bernard and others are correct to point out that fat-derived substances are a major contrinbutor to insulin resistance in muscle and liver. However, it is important o be clear that these are primarily derived from fatty acids that come to liver and muscle tissues as free fatty acids from subcutaneous adipose tissue, as I explain in the video below. There is no consistent evidence that I know of that suggests that a high-fat diet causes insulin resistance (unless it causes weight gain, in which case the weight gain is the culprit, not the fat content of the diet). The frustrating part about all of this is that diet tribe-related dogma too often gets in the way of having an objective discussion of the science. The low-fat vegans claim that dietary fat is the cause of insulin resistance, and the low-carb crowd claims that carbs are the cause. IMO, the data are pretty clear that carbs and fats per se have no, or little, impact on insulin sensitivity, and that weight gain leading to excess fat storage in ectopic and visceral depots along with the low-grade chronic inflammation that comes with it is the primary culprit. ru-vid.com/video/%D0%B2%D0%B8%D0%B4%D0%B5%D0%BE-cP57oM8lBaU.htmlsi=XK_f0IgBghqBkp_P Best, Mario

@@nourishedbyscience ok thanks indeed there is so much confusion on this topic...and people desperate for answers have found salvation in their food camps headed by gurus that are idolized....Mastering Diabetes headed by Cyrus khambatta is another proponent of this way of eating villifying fat....good to know at the end of the day calories matter. Thanks

Note that I am not saying that low-fat whole-foods plant-based diets are a bad choice. These are clearly a massive improvement over how most people eat, and if they lead to weight loss, which they often do, they will improve insulin sensitivity and glucose tolerance. I'll talk about this more in detail in a future video. Cheers Mario

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 body stores about 400g (1600 kcal) of carbs in the liver and muscles. In addition the way fat is stored as triglycerides allows the liver to release about 5% energy as carbs while breaking the triglycerides and releasing fat to the bloodstream. So basically short of high intensity exercise there is no need to eat any carbs to maintain blood sugar on a normal level. I lost 10% bodyweight within 2 month by eating protein/high fat/low carb in a 16/8 intermittent fasting diet while at the same time doing daily 90min of low intensity exercise in fasted state before lunch. My body fat dropped from 27% to 21% during that time. Despite confusing people with contradicting studies, the mechanism is simple. Elevated sugar in the blood is dangerous. As long as there is high sugar in the blood the body tries to get rid of it (by burning, store in muscles or convert to fat). The way to loose fat is keep sugar levels normal/low and do low intensity exercise so that the body withdraws from fat stores. High intensity draws from carb stores, lets your blood sugar drop and makes you hungry for new carbs.

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

I used the teach an advanced graduate class in nutrition methods for seven years at the University of Washington, and trust me that I know about the difference and choose my words very carefully. If you find one incorrect use of any of these terms in any of my videos, point me to it, please. I am only talking about 'cause' in this video as I am citing social media influencers and several nutrition book authors who claim that carbs 'cause' insulin resistance. Best, Mario

Yes. Please view this video here for a better understanding as to why this could happen: ru-vid.com/video/%D0%B2%D0%B8%D0%B4%D0%B5%D0%BE-cP57oM8lBaU.htmlsi=Cr_--MUXac3FEpNH In addition to what is mentioned in the video, people can also develop a fatty liver if they consume a lot of alcohol or sugar-sweetened beverages. However, in those situations, people usually also are at least overweight. Cheers Mario

That may well be correct. More to come on refined vs. whole food carbs in the future ... Cheers Mario

I see you watched the video about the causes of insulin resistance, in which I express that I am open to the idea that repeated snacking on highly glycemic foods could cause the kind of hyperinsulinemia that triggers insulin resistance. We do not have good evidence for that though, so the theory suggested by some low-carb influencers does remain an unproved theory at this point. I am involved with an organization that conducts independent expert reviews of nutrition books, to assess the degree to which a book's claims are consistent with the scientific evidence. You can see here how The Obesity Code fared: www.redpenreviews.org/reviews/the-obesity-code-unlocking-the-secrets-of-weight-loss/ Best, Mario

Maybe not, but I still cannot detect a clear pattern, if we also consider the diets that showed greater insulin sensitivity on either diet. Cheers Mario

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 :-)