Transcript of Most Replayed Moment: The First Warning Signs Of Insulin Resistance! Check Your Skin For This New

So when I'm— you're 54 years old. When I'm 54 years old, I wanna be as young and energetic and articulate and cognitively astute as you are. So what should I be doing now to make sure that I don't decline, decay in all those areas I described?

Well, what'd you have for breakfast?

Today?

Yeah.

I have not eaten breakfast yet.

That's okay, that's not a bad thing, but when you're 54, you should probably put the calories in the morning, not at night.

Okay.

We know that as you age, the cost of a calorie turns into timing. If you eat that food, one bite of food after 6 o'clock is worth 10 bites of food before noon. So, if you're trying to say, how do I get the best out of the nourishment, but also eating's fun, if you only get one bite after 6 o'clock and 10 before, Move that food towards morning. When you're your age, what'd you have for— what's the last meal you ate?

Yesterday?

Yeah.

For dinner, I had this cod and I had salad. I also had pasta.

Okay.

But I ate pretty late, which is a bit messy.

Yeah, what did you have the rest of the day before that? Was that your first meal?

Just a salad.

Okay.

Just a big salad.

Was that more towards lunch or noon or?

Probably about 4 o'clock.

So waited all the way till 4 o'clock to eat. Very common. This is a really common pattern of people doing, what we would say intermittent or time-restricted eating. They put that eating window in this, but it's got that balloon at the end of the day. And it really does, I mean, what you're stimulating is an excessive production of insulin and you're gonna wake up the next morning. What time did you wake up this morning?

Today? I went to bed fairly, relatively early for me. I woke up at about 7:30 AM. Usually it's later.

And do you have, did you have a solid sleep? 7, 8 hours of sleep or how?

Yeah.

So during that time, you finish eating around 10 o'clock then, it sounds like?

Yeah.

Okay, so then it's 7—

Maybe a bit later.

Okay, so 11 o'clock and you've got 7:30 in the morning is when you woke up, so that's about 8 hours since you've eaten. Your insulin is still churning, especially if the meal was large and there was carbs in it. So now you've got these processed foods late at night and you're at the beginning of the disease, right? You're at the beginning of the chronic inflammatory churn of how do you age faster and faster, you don't do that. You don't have high insulin throughout the night.

So can you explain to me, like I'm a 12-year-old, what insulin is and the role it's playing? Because, you know, I guess we're focused here on how to, I guess, longevity, aging.

Yeah.

For a second. But how does insulin play a role in all of this, and what is insulin?

So insulin insulates, okay? So think of it as it makes you fluffy. It makes you— it puts the fat on. It's got some other roles too, but we're going to talk about chronic diseases here where it's not a scarcity problem. You make plenty of it. And when it's in excess, it will store energy for when you go through a famine. It will also cause you to grow. Now, grow means get a little fatter, but it also means things like their skin gets a little thicker, they have skin tags. And what I always think about is what's going on in their brain. And when that insulin is high for years and years and years, just like yours, because if you didn't eat the rest of today and then you got up tomorrow morning, it would be about that long after a late meal last night. That's how long it would take you to say, okay, we're back down to where we started from or where we should be in the morning.

For someone that's never heard the word insulin before, there's some context to give in terms of what it's doing. So it's coming out like a— Transporter in helping put away the sugar or deal with the excess sugar.

Right, so it is what lifts— yeah, it lifts glucose or sugar from the circulation into a cell. That's its first primary job. But if all the cells are full, their storage is full, it's going to start to pack it into the liver. Let's say all those stores are full too. This job of insulin, this hormone, oozes into every part of your body, to say, make sure it's got fuel, make sure it's got that sugar. But most people are like what I would guess you are. Most of the time, you aren't in a shortage of sugar. And so, it tops things off, and then it will turn things into fat. It's too much sugar, they can't store it, all the storage is full. So, you can send the signal out, make me some more cells, I need some more storage units. This guy's eating more than he thinks he is. And we're gonna be prepared to live through The famine. But in the meantime, turn it into fat, make him a little fluffier.

Is that the only consequence of high insulin, is that I'm gonna— I might be a bit more fat?

No, that's just the one people hear about the most. When you look at chronic disease management, it is the growth of, of the diseases, of the inflammation. It's the making of the trash. So I keep saying, you know, you need to take the trash out routinely, which means That insulin, which has been smoldering higher than you think it is because you live in today's world, because you eat processed food, because you eat super late at night, you don't go 2 to 3 days without eating, you've got storage filled in your body. The high insulin levels in a healthy person hides that the debris is being made and you don't know it.

It hides it?

Yeah, it's going to put it in between 2 cells in your brain, it's going to put it in between the skin cells. The trash doesn't get taken out until the— Insulin gets lower. And unfortunately, most people have been making buckets of insulin without knowing it.

Why? What are they doing to create buckets of insulin? All the things you said about—

Carbs, foods that come from boxes and barcodes and bags instead of whole foods, instead of a fat-forward diet, which would then push that body into Making ketones. So you can't— you cannot make a ketone if your insulin's high.

Are there any signs that I might have high levels of insulin or insulin resistance?

Abdominal girth is the first thing that— it's the first place that the fat goes. So you do this really great part where you don't eat until later in the day. How does that feel during the day?

During the day, I feel really focused. I actually don't even know that I'm not eating.

So that's really good. So what I would love to know is, Show me what your blood sugars are doing during the day and show me if you make ketones. That'll be the answer is when you have excess insulin, which is this chronic disease maker, it is what makes cancer, it is what makes high blood pressure, it is what makes debris in the brain where, call it depression or brain fog or Parkinson's, it's the aging of the brain.

It's linked to all of those things.

All of those things. And that excess insulin nobody tells you about. But the symptoms are, dang, I feel like I got to eat every 2 to 3 hours. Their debris or their fuel keeps running out. When you say, boy, I can eat once at the end of the day and I'm pretty good, my focus stays really good, what I want you to prove is what are your ketones during the day? So when you've got a patient who has done that, their ketones will be 0.7, 1.0. And they're taking out the trash all day long.

So there's these 2 energy sources. One of them is the glucose, one of them is, which is from like eating pasta, which I ate last night. So that probably put a lot of glucose in my blood. I probably had a high glucose spike and then insulin came out to deal with that. And then there's ketones, which start to appear when I'm fasting or when I haven't been eating carbs for a while and my body's looking for an energy source.

Right. Yeah, so think of it as, Your short-term, easy-to-access sugar has to decrease, and that means your insulin has decreased, that hormone for insulate. They both run in tangents. You're emptying glycogen, your insulin's going down.

So how do I know if I have insulin resistance? What are the key signs? You mentioned skin tags. I've never heard that term before.

Yeah, skin tags are not moles. So moles, you can feel this bump on your skin, right? But a skin tag has a neck, and like a little mushroom. And it's the most annoying thing when patients come and say, well, I just tried to cut them all off, but they kept bleeding. I'm like, do not cut them off. They'll fall off when your insulin's lower. So, that's the first place. It'll be found in their armpits or places where the skin rubs, so armpits and their groin. And once insulin starts to grow them, it's like a crop, a crop of little baby cauliflower hanging out in their armpits.

You talked about velvety skin as well being an indicator.

Velvety skin is this Latin word, Acanthosis nigricans, which is a fancy word that means the skin is darker and thicker. So, the places it usually happens is the back of the neck. And you'll hear, you know, stories of, I tried to wash my neck, it's dirty all the time. It's not dirt. It is the way the skin is under the curse of high insulin. And you see it in teenagers all the time now. They put on weight and their growth hormones are already doing that teenage thing. Now you put high insulin in there and they have this dirty neck syndrome or on the creases of their elbow, it's just darker here. That is pathology, that's not normal from high insulin.

You talked about weight changes as well. What's this thing about hairy toes that I was reading about?

Right, so as my patients age, so most of my 55-year-olds that have had high insulin, I will tell them, look at your toes, they're supposed to have hair on them. And when your body has had that high insulin state for a couple of decades now, it will start to say, we don't send resources to a couple parts of the body anymore. And the follicles in their toe are one of them. Like, you just stop growing hair on your toes. And there's an ascending problem with this where the toe starts, then it's the ankles, then it's up to the knees, and they don't have hair anywhere on their lower extremities. It is a process. That started from high insulin.

So you have this idea of this keto continuum. What is the ketone continuum? I read about it. I mean, it's a, it's a book here I have which you published in 2020 called The Ketone Continuum: Consistently Keto for Life.

Right.

So the keto continuum is this 12-step process, right, to get into a consistent keto.

Consistently keto, yeah, that you're constantly taking out the trash. The first part is the beginner.

Okay, so the first part, the beginner section, has 4 stages to it.

Right.

What are those 4 stages?

Well, I like to tell patients that you never fall all the way off of the continuum. So, the first step is really not keto, but it is that they're eating every 2 to 3 hours, and if they fall off the wagon, that's usually where they land. So, that's what most people start at. They're eating every 2 to 3 hours, they are not keeping their carbs less than 20. Step 2 is cut your carbs to 20. That's the only thing I need you to measure. And you're going to be able to use a ketone strip, you know, measure ketones in your urine, and that will ride— you'll ride a wave. When that ketone production is happening, the fat-based hormones in your body are starting to resurrect. They're starting to do the things that they need to do. And there'll be this magical moment in the not-too-near future where you skip a meal.

And this— that beginning stage, how long does that last? I'll put this on the screen so everybody can see.

Sure.

The continuum. How long does that initial beginner stage last for people?

If they've been severely insulin resistant, this is the ones where I've said they took their carbs to 20 for 2 weeks before they peed a ketone. So I use some other steps if that's how severe that is. But let's just take the average person. That's like not— they're not £100 overweight, they're hitting menopause and they've put on £25. When they drop their carbs to 20, they're peeing a ketone by the end of the week and they are missing their first meal by day 10.

Okay, so day 10. And then it says when we get to stage 5 in the keto continuum, it says 16:8. Is that—

Yeah. So then we start to use time-restricted eating where I want— I mean, we're going to— your body will adapt. People say you can't stay on the keto diet because they go to step 4 and then they think that that's all they needed to do. There are several steps to reversing this problem, and you'll know you have the right step if the ketones are still present in your blood. Your body will adapt, though. So, we start to say, all right, we're going to learn some new behaviors. We're going to learn what the nothing burger looks like, at least for 16 hours out of the day.

What does that mean?

You do not eat a thing in those 16 hours. Now, I give them a little hedge because most people come in like you. They don't start eating until 2 o'clock in the afternoon and then they eat until 10 o'clock. And I want them fat forward. I want lots of fat going in because insulin resistance, that high insulin state, means they've locked or they've insulated their fat on their body.

And then we get to stage 7 where it says 23:1. Is that fasting for 23 hours a day?

Yeah.

And eating for 1 hour a day?

And there's a little bitty line between 16:8 And 23:1, but there's a whole bunch of life there. Meaning we don't actually have patients go from 16 hours of fasting to 23. We have them slide it down by an hour, slide it down by an hour, and then we do that harder thing, which is move it towards sunrise, quit eating so late at night.

And then the last stage here, so step 9, 10, 11, and 12 is prolonged fasting between 36 and 72-hour fasting.

Right, so those folks that have high insulin for 20, you know, 15, 20 years, they're going to have to do a nothing burger for 36 hours in most of them to really give a good reset of their metabolism. And although you look at other folks saying, oh, you should never do that if you're a woman, you should never do that over the age of 50, I'm saying you have too much insulin in your body, you have to do that to get the pancreas to make less insulin over time.

On that point, between men and women, are there metabolic differences that need to be mentioned here, because, you know, when I— sometimes when I do ketogenic fasting, my girlfriend, she takes much longer than me to get into a ketogenic state, and I'm wondering if her body is in some way trying to defend the switch.

Have you ever seen the, the reality show Alone?

Oh no, I'm not a reality show guy.

Oh, I'm not either, but they drop these people off in the middle of nowhere and they starve them to death, and you watch the fat come off of them. And the men, the fat just melts off of them, and the women They do what your girlfriend does. It just holds on to them. That we are designed to have that fat on them. So, asking them to do a ketogenic state, you'll hear people say, oh, it's going to ruin your hormones. Oh, it's going to— you can't do that. And I would say, you can have all those conversations once their insulin is normal. I have lots of women in childbearing years that are excessive producers of insulin, and their vitamin D is low, their estrogen is low, they have hair loss on the top of their head, they have skin tags throughout their body. Or maybe the first sign was they had PCOS. Okay, all of these are a sign that insulin came in and it's too high in their body. So, lowering it has rules. And if you want to have a baby, carry a baby, have the weight come off after you've gestated a baby, have weight not be your enemy during menopause, you have to be making ketones at a routine and regular interval.

And start with the food. Start with the menus in the kitchen. Don't run to the gym first.

I've noticed in women in my life that they've told me that their menstrual cycles become more synced up when they are in a lower carbohydrate diet.

Right, their hormones can hear each other. I mean, when insulin is high, insulin dictates what that sugar does, but it also is the dictator for every morsel of fat. And estrogen, testosterone, vitamin D, they're all a derivative of fat, of cholesterol, and they are— they're put into the fat cells. If you biopsy an obese woman and say, can I see, is there any vitamin D hidden in there? Is there any estrogen? Is there any— yes, they're all in those fat cells. You start to lower their insulin and the fat mobilizes. So the hormones that are naturally communicated between women, they can actually hear them again. I mean, that tribal thing.

If a woman were to stay in a ketogenic state permanently, would there be any disruption to her metabolic health?

You mean like me?

Yeah, like, you know, her menstrual cycles, her, uh, yeah, anything.

No, I think it's— you're going to find people that it shouldn't be extreme, meaning I've been on this for 15 years. The ketogenic phase is at least 20 out of 30 days in a month the first few years I was on it. Now at 55, menopause in the last year, I'm like, without a ketone, my brain doesn't work right now. Without a ketone, my energy goes to pot. And I've been walking women through menopause for 25 years. It is not a fun story when they're insulin resistant. So prepare, have the flexibility of that mitochondria to use both ketones and glucose And that's what a ketogenic state is.

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