Transcript of Most Replayed Moment: Insulin Is The Reason You're Gaining Fat! How To Lower It Now New

So when you say this is an insulin problem, can you explain this to me like I have no idea what glucose and insulin are? For any of my listeners out there that have an inexperienced understanding of these terms and what they do and mean.

It's crucial. Everybody needs to understand the relationship between sugar, which is glucose, and insulin. When you consume sugar, or glucose, the body has to get rid of that glucose very quickly from the bloodstream because glucose actually is toxic inside the bloodstream. Even though it is what the body uses for energy, in the bloodstream, it glycates all the blood vessels and the walls and the components in blood and the hemoglobin as well, glycates it. That means the glucose attaches itself to that molecule. So now that molecule can't work properly. That is why the higher your blood glucose, all your chemicals don't work well. Your enzymes don't work well, your hormones don't work well, nothing works well and you age prematurely because you're getting glycation. A glycated molecule can't work normally, it doesn't function normally. So when you consume the glucose, the glucose has to come out of the bloodstream and how does the body do it? It sends a message to the pancreas. The pancreas says, "Aha, I'll make some insulin." It pours insulin into the bloodstream. Insulin comes into the bloodstream, pushes the glucose into the cells. And where does it push it in? Into the liver, into the muscles, into every cell in the body.

Insulin will push glucose out. Now, how much insulin is the question. If I'm eating every 3 hours, and I'm consuming glucose or I'm consuming starchy foods or I'm consuming carbohydrates. Now watch where I'm going with this because you're already beginning to know where I'm going with this. I'm consuming glucose and carbs every 2, 3 hours, I'm stimulating my pancreas, I'm stimulating my insulin. My insulin goes up, it comes down, but before it even gets a chance to come down, it goes up again. So the repeated consumption of and frequent consumption of glucose is causing my insulin to stay up because insulin stays up stays a little bit longer in the bloodstream than the glucose. The glucose will come down in about 2 to 3 hours, but the insulin stays higher for about 4 hours. Now what happens is that you continue this lifestyle for a few years. Now the body, because these are all hormones, will say, well, you know, it's— I'm gonna need to make more insulin now. You become insulin resistant. Any hormone that stays in your body for a long time, the body becomes immune to it. So the next time I eat the sugar, I'm going to have to make more insulin to produce the same effect.

That is called insulin resistance. So now, you got this patient who's been eating carbs, sugar, processed foods. What does that mean, processed foods? That means foods that are quickly absorbed into the bloodstream, processed foods. These are products without fiber, so the absorption is very quick. So the poor pancreas has to react just like that, produces a whole bunch of insulin, and then the frequent eating and the frequent consumption makes you insulin resistant, so now you produce a whole bunch of insulin in order to bring that sugar level down. So then you say, okay, well, it doesn't matter because the insulin is bringing the sugar level down, so what's the harm done? Because your A1c is still good, you're not diabetic. No, but it's that background high insulin that is destroying your metabolism. It's that high insulin level in the background. So insulin pushes glucose into the liver and you develop a fatty liver. It pushes the calories into production of new fats around your viscera. The viscera means in your belly, around your pancreas. You get visceral fat. Now, this fat is produced from glucose. It's a different kind of fat. Look, if I gave you a high-calorie diet right now of all sorts of foods, you put on weight everywhere, okay?

But if I give you glucose, you put it on mostly in your stomach, and your stomach will protrude, and that's called visceral fat. It's on the inside. You can't pinch it. It's on the inside.

Around your organs.

Around the organs. This— is very detrimental fat. And that's the epidemic that we have today.

And that's a direct result of eating, you know, starchy glucose carbohydrates, which creates insulin, which creates this downstream effect on—

Wrong foods and eating too frequently.

Too frequently, okay.

Because remember, it's also the frequency of eating, because before that insulin gets a chance to come down, you're already popping yourself with more food. And hence you develop insulin resistance. You get a very high insulin— it takes this much insulin now just to bring that sugar level down. And then the one day Okay, when you cannot control that sugar, now that sugar will go out and now your doctor will say you're a diabetic. But by that time, you've already had 10 years of hyperinsulinemia. So what happens if by the time you make a diagnosis of diabetes to say, well, now your sugar is really high, it is high because your body has not had the ability to keep it down. Why? Because even that high insulin could not keep your sugar level down, you became a diabetic. You lost that whole opportunity of prevention. It's those 10 years. Look, by the time you're a diabetic and you come and see Dr. Jay in his cardiac clinic, you already have coronary artery disease. Like that 28-year-old. That 28-year-old didn't have diabetes, he already has coronary artery disease. By the time you are diagnosed as having diabetes, you already have coronary artery disease.

We have a great opportunity here to actually start screening these patients with insulin levels very early on, but most doctors don't have the ability or knowledge to do the insulin level testing, but it should be done.

In someone like me, I'm 33 years old now, when does the damage begin?

It starts right now. It starts right now. As soon as you're around 30, you're already starting to have trouble. You have to, but you know, this is what I do. I look at that patient walking into my room, and if I see that he's got a belly sticking out, I already know he's probably got insulin resistance because all the fat is in here. Because the fat that's in the stomach, sideways he looks terrible, from the back he looks great, his waist is increased, hmm? He doesn't have— all the fat everywhere else in his body, that's the phenotype of somebody who has hyperinsulinemia. That same person goes on a cruise, he'll come back 5 to 10 pounds more because he's got so much insulin in his body. Insulin is a storage molecule, puts everything away, and it's very hard for him to lose weight.

Why is it harder?

The only thing that will make you lose that fat very quickly is to change your diet, of course, but you have to do fasting. Because fasting brings your insulin level. See, this is where fasting comes in. So what does fasting do?

Do you mean fasting or a calorie deficit? Is it, or is it the same thing in your view?

No, they're not the same thing. They are not the same thing. You see, when you don't eat, your insulin levels come down because you're not stimulating your pancreas anymore. So you wanna bring your insulin levels down, the best thing you can do in the world is to do fasting. Because there's no— look, if I just simply cut down on my calories, then there's a different physiology that's going to take place in the body. And when you fast, there's a totally different physiology. When you cut down on calories, the body senses that there's caloric deficit. Your metabolic rate changes, actually slows down. And the body will start breaking down everything. Muscles included. So you lose fat and you also lose muscles. On the other hand, when you're fasting, it's a different physiology. Fasting is, I've put on fat, now I'm gonna take it out of the bank. Now the bank is gonna be available for me to pull out my calories and use it now, and you start burning the fat. So in the first 12 hours of a fast, you take out all the glucose in the form of glycogen from your muscles and your liver, After 12 hours, you start pulling the fat out.

And the first place the fat comes out of is going to be visceral fat. That is why fasting benefits you so much because it gets rid of that worst fat, the fat that is very inflammatory. You see, if I did a biopsy of your visceral fat versus a biopsy of, let's say, a fat from on your buttock, two different types of fat. One is full of inflammatory molecules. The other one is not full of inflammatory molecules. One is producing interleukin-6 and tumor necrosis factor, and this other fat is not. These are two different fat storages. Visceral fat is very toxic, it's very inflammatory, and that is why patients who have visceral fat make all these molecules. So when I do the blood test, I see that, oh, you've got so much inflammation, you've got interleukin-6 is high, tumor necrosis factor is high, your CRP is running high, And one of the reasons for this is not just leaky gut and other things that I look at, but in your case, it is also because you have a lot of ectopic fat. Ectopic fat. Ectopic fat is now we're realizing is not just only around the liver and around your pancreas, it's also around your heart.

So when we look at the coronary arteries and we see all those fat around the coronary arteries, you had a very nice diagram right there. And you can see that around each artery is that yellowness. That yellow is all plaque. Fat. There's fat around that and it's plaque-forming. It's plaque-forming. It stimulates plaque. It's inflammatory. And now we can do CT scans that will actually detect how much inflammation is in the fat around the arteries as well. Ectopic fat is in the— around the coronary arteries, it's in your liver and in your pancreas, and it is very inflammatory.

On this point of fasting, so if you have someone come to you and they have that physique where there's a bit more of that protruding belly fat, you said that fasting is a much better approach than just sort of a calorie restriction. I was looking at some studies that said research shows that calorie deficits of any kind can reduce visceral fat, but fasting, will give it an edge because of the insulin sensitivity stuff that you talked about as well. What kind of fast should one be doing? Because there's so many different names for these fasts. People do these 40-day water fasts and they do intermittent fasting.

It's a great question. So there are many, many different types of fasting depending on your goal, on what do you want for that particular patient. So if a patient is just simply looking to reduce his visceral fat, then I start with 12:12, which means 12 hours you don't eat anything, you just drink liquids with no calories in it, and then 12 hours is your feeding period. We start with that and we do that for about 2 to 3 weeks, then we quickly move to 18:6. 18:6 means 6 hours you get to eat, 18 hours it's only Water, black tea, black coffee, green tea, no calories. 18:6, 18:6. And then, that's one type of fasting. Now, if a patient is very overweight, a patient has diabetes and your goal is to reverse the diabetes, the patient needs to lose 60 pounds, then those patients have a special type of need. For them, I will take them to a 48-hour fast once a week. Sometimes I'll go to a 3-day water fast every 9 days. Every 9 days you will do OMAD. OMAD means one meal a day only every day for 9 days. And then you're gonna give me a 3-day water fast.

Is the same advice applicable to women? Because obviously they're contending with a variety of hormone fluctuations and estrogen, and I know that the, the female body responds differently to these kinds of stresses like fasts?

I've been asked that question so many times from patients as well. Most of the women can actually handle it. The only women that cannot are those who are trying to become pregnant or they have— or they're already pregnant. I think that women are not that different when it comes to the fasting programs. So in my experience, I've been able to get women to fast. I just finished a fast on one lady just now for 72 days. 72 days. She was terribly overweight. She had diabetes, she had hypertension, she had hyperlipidemia. She was having hip replacements, knee replacements, joint problems, she had skin problems, and we fasted her for 72 days.

What did she have in those 72 days in terms of drinks, electrolytes, coffee? What was she—

Great question. So she would have black tea, black coffee, water. And in the water, once a day, I tell her to put some electrolytes in there. So there's an electrolyte called LMNT, or sometimes I just tell them to go buy some Celtic salt and put half a teaspoon in there, and once a day you take that. If you get cravings and you feel really, really hungry, take some MCT oil, a teaspoon, and put it in your water and you can drink that as well.

I think it's worth saying that probably you shouldn't try this at home, ladies and gentlemen, because obviously medical supervision is critical here. But in the case of that lady, what was the before and after of that 72-day fast?

So diabetes gone, blood pressure normalized, weight loss, tremendous weight loss. I mean, I think she lost about 55, 60 pounds.

Wow.

Okay? And not only did she lose all that weight, yes, all that weight from her belly was gone, but even her face, under the arms. So, when you lose weight in a fasting program, it's very different from losing weight when you are restricting calories. You actually retract your skin, so you get real changes in your entire body. These patients— I had one patient that fasted for 183 days. Under supervision. Okay. So he went from 400 pounds to 210 pounds. And when he walked into the office, you would not recognize that he's just lost all this weight because he did not look like skin on top of bones and then having to have surgery to remove all that excess skin. Fasting is a totally different physiology. In fasting, you— the body is doing a whole lot of things that are very different. And we can go into the physiology of fasting That's fascinating. It's a physiology that has not been used by us. We've lost it. So one of the things about modern living, modern living, we have lost this physiology of fasting. First of all, why do we still have that physiology in us? It's because it's supposed to serve a purpose.

Because we're supposed to be fasting and feasting. But now we're only feasting all the time and we're not fasting. In order to go back to normal, You should be fasting. Fasting is supposed to be a normal part of your existence. That's the way you were designed. Not this modern industrialized living that we've been doing in the last fraction of a millisecond in the total existence of the human race. We've changed our lifestyle so much, modern man has, but our genetics and our physiology has lagged behind. We are supposed to use fasting and feasting as part of our normal program, as our normal physiology. That's why we still have it. That is why after 12 hours you start making some more ketones in your body. And the ketones come from fat. You're moving that fat out of storage.

What is a ketone?

Ah, ketones. So ketones are an energy molecule produced by the liver. How does it make it? It makes it from fat. So the fat gets liberalized. And by the way, the fats only start moving when your insulin levels are down. So because of fasting, your insulin levels are really low now, okay? 'Cause you've been fasting, right? So now the fats start dissolving. So you get free fatty acids. The free fatty acids float into the bloodstream. Free fatty acids are fat products. They float into the bloodstream, they go to your liver. Your liver converts those into ketones. Now ketones are an energy source of the body. An alternative source to glucose. So in general terms, you are either going to be running on glucose and glucose metabolism, or you're running on ketones, okay?

And so ketones basically show up in the— when glucose isn't around.

That's absolutely right. So ketones, and ketones are actually a cleaner fuel for the body. And in terms of producing reactive oxygen species in the metabolism, the way your mitochondria work, You actually produce less reactive oxygen species, which is damaging to your physiology when you're in ketones. And ketones are signaling molecules that also change your physiology in a number of ways. Number 1, it causes the production of brain-derived neurotrophic factor that occurs under ketogenesis. Brain-derived neurotrophic factor, which means that you become smarter, you're growing new cells, your reflexes are better, your visual acuity is better. Why? Because nature wants you to become a better specimen so you can go out and get your next kill.

So why don't we all just stay in a state of ketosis then if it's so miraculous?

Well, that's a great question. You don't want to be in ketosis all the time, because that's not what our physiology was made for, because then you'll just be burning fats, burning fats, burning fats all the time, and that's not a good state to be in constantly either. So you want to be able to do both. You're supposed to get your current account and your deposit account. You're supposed to work with both of them. That's the normal physiology. So not only brain-derived neurotrophic factor increases, but also stem cells. Stem cells are amazing. And in my patients, of course, I see that—

What is a stem cell?

Ah, stem cells. So stem cells are, we all have stem cells. And we all still make stem cells. And they're produced by the bone marrow. These are pluripotent cells, cells made that will then go out and become whatever they need to become. So they can go out into your circulation, become a muscle cell, they can become a retinal cell, a skin cell, they can transform into anything. So what happens is when you break your fast, you get a surge of stem cells coming out of your bone marrow. Some of them become immunocytes. That is why we know that fasting also boosts your immunity. People who fast get less infections, get less sore throats and coughs and colds and the viruses that are going around. The immunity is better. The stem cells are not— I'm particularly interested in the stem cells because of a thing called the progenitor cells, endothelial progenitor cells. Progenitor cells are, you see, you're always hurting your blood vessels, the lining of the blood vessels. And the lining of your blood vessels have to be constantly repaired, and they are repaired by the progenitor cells. When you do intermittent fasting and time-restricted feeding, you will produce more, and this has been shown in numerous studies, more progenitor cells.

And these progenitor cells go and repair your blood vessels. So I do what, why am I interested in this? Because I'm a vascular doctor. I want my blood vessels to constantly be repairing themselves from the damage that we do in day-to-day life. So stem cell mobilization, brain-derived neurotrophic factor, growth hormone, you make more growth hormone in fasting. So when should you exercise when you're fasting? At the peak of your fast. So if I'm gonna break my fast at 6:00 PM, I tell patients to go out to the gym at 4:00 in the afternoon. But they say, "But doc, how can I do that?" you will find that you will put on more muscle and you'll retain more muscle as well, 'cause you have higher growth hormone. The fastest way and the best way to actually increase your growth hormone production is to do intermittent fasting.

When I sat with Dr. Stacy Sims, who does a lot of work on women's physiology and women's performance, one of the things she said to me is that if a woman in particular tries to do a workout fasted, the body will break down the muscle in a woman because she said a woman's body is much more— the hypothalamus is much more sensitive to changes in a woman's glucose levels because it's trying to defend against, you know, pregnancy and, you know, all these kinds of things. So it shuts down the menstrual cycle if there's not enough glucose in the blood. And, and so she said for women in particular, you do, you do want to have eat something before you work out or it will your body will take from the muscle and it will definitely won't, the body's very sensitive. It won't want to help you build muscle if there's not enough glucose energy in the body. She said for men it's slightly different because we're a little bit more robust and we were meant to hunt. So if we were fasted, our body is designed to kind of keep up its normal processes to help us complete a hunt per se.

So I guess I threw this question out to you about women exercise and fasting.

00:22:19

Yeah, I think that's a great observation. So again, it's what kind of exercise is the woman doing, you see? Now, there's two kinds of basic exercises. One is aerobic activity and one is resistance exercises. And you can also throw into that high-intensity interval training. So when it comes to the training that I'm talking about in a fasting state, I like resistance training. So in resistance training, that glucose issue is not going to become a problem. Now, if you're going to put that female patient on a treadmill and make her run for a long period of time, let's say you're going to make her run for 40 minutes on the treadmill, I think that yes, you're absolutely right, you are going to deplete her glucose and you may cause some problems and then the muscle will start breaking down. But I do believe from all the experience that I've had with my patients, that when I tell them to do HIIT, which is high-intensity interval training, all the women do just as well as the men. Because all you're doing is you're intensely working the muscles and you're doing some resistance exercise and then you're totally resting as well.

And I see fantastic results with that.

In terms of ketosis, do you cycle in and out of a ketogenic diet? And just for anyone that doesn't know, a ketogenic diet is a diet that's very, very low in carbohydrates, so less than 50 grams of carbohydrates a day typically. Do you cycle in and out of that diet?

Yes. Yes, you have to. Because I don't want them to stay in a ketogenic state all the time. So I do, I do, I do. I tell them, look, look, what is your goal here? What is your goal? If your goal is that, okay, I need to lose 70 pounds, then you're going to do this till you get to your goal. Once you get to your goal, then you're going to go back to time-restricted feeding, which means 18:6. So you'll still make some ketones, and then intermittently you can still do a 36-hour fast. That means normal healthy people, you and me, We should still be doing one 36-hour fast at least once a month. So we'll go to that. We'll go to that. Fasting must still become part of your program, but you don't need to stay in ketogenesis all the time. Remember also that when you are in ketogenesis, you are also in autophagy. How much autophagy can you do? That means you're recycling all your organelles inside your cells.

What does that mean in simple terms for someone that doesn't know the term?

Okay, so bottom line is the cell senses that there is no new parts coming in here. So it takes the redundant organelles inside the cells and breaks them down, packages them up into these little packets, and exports them out of the cells. So these cells, all your cells in the body, now are functioning at a much more efficient level. So, mitochondria also have autophagy. So, you're getting new mitochondria, you're repairing your mitochondria, and you know it's all about mitochondria, right? Your energy— mitochondria are those organs, organelles inside each cell, and we just think of them as only an energy source that, "Oh, yeah, my mitochondria, they make ATP." That's not the whole story. Yes, they produce ATP, but they also produce the single reactive oxygen species, and thereby, they influence the metabolism of your cell as well. They send signals. They send signals to your chromosomes so that you start producing new proteins, you start producing new molecules. So, your mitochondria are very important. If you have old mitochondria, you're going to have Fatigue, tiredness. But when you get mitophagy, one reason why you feel so good after a fast, because you have new mitochondria, they are much more efficient in producing ATP and less reactive oxygen species.

So you have mitophagy, recycling of your parts, cellular function improves, toxins get out of the cells as well. Toxins.

Do you think there's a preferable or a best exercise for heart health? Like if you were gonna say, Stephen, to make, you know, I think my family has a history of heart-related issues. One of my, my uncle died from a heart attack. So I'm very aware of my own susceptibility to heart-related illnesses. I think there's other people in my family that have heart-related issues as well. Is there a particular exercise that is best for the heart? 'Cause I'm guessing resistance training, i.e., strength training, might not be the, the number one recommendation for good heart health? You mentioned HIIT, I'm wondering if that's—

Yes. So I'm just going to tell you broadly speaking what I see in my practice. I see that people who do overly do aerobic activity, that means they cycle 100 miles a day or they're running on the treadmill for 2 hours at a time every day, or they're doing a lot, a lot of marathon training all the time, they actually end up with more inflammation in their body and they end up with more coronary artery disease than patients who do short sprints and patients who do resistance exercises and patients who do HIITs. So in terms of cardiology, you— look, you need some aerobic training. Why? Because you want to develop some endurance, right? You don't want to be running behind the bus and get short of breath just in a few hundred feet. For some endurance, you do aerobic activity. How much aerobic activity, which is running on the treadmill, for example, or just sprinting? Only about 15 to 20 minutes. That's it. So I tell patients, you want to run on that treadmill, you want to bicycle, 15 to 20 minutes. And then you got to go into resistance exercises. The resistance exercises that I have seen work best in my patients is simple things.

You don't have to go crazy. You do floor exercises, you use your own body weight. As resistance, so you can do the planks and leg lifts and all these other exercises, and you can do HIIT, but they have to be very specific. So you exercise really hard for about 30 seconds to 45 seconds, and then you completely rest for another 30 to 45 seconds.

Okay.

And that's allowing your body to clean up the reactive oxygen species you just created through that exercise, because your rate-limiting step in cleaning up the metabolic mess that you get when you get too much exercise. It's a rate-limiting step. Your glutathione production, your superoxide dismutase production, these are chemicals that clean up the metabolic mess that you get when you get too much activity. That's a rate-limiting step. So when you rest, you exercise and you rest, you exercise, you rest, you are going to get a cleaner physiology.

What you just listened to was a most replayed moment from a previous episode. If you want to listen to that full episode, I've linked it down below. Check the description. Thank you.