Insulin Resistance is Real! (Gerald Shulman's 2018 Banting Lecture on IR Mechanism)

Learn how to predict & prevent heart attack & stroke:

Learn how to reduce & reverse arterial plaque:
--

ABOUT THIS VIDEO: When Ivor Cummins posted Gerald Shulman’s 2018 Banting Lecture, suddenly, 16,000 people learned an immense amount about insulin resistance—in just a week! Gerald Shulman was the recipient of the 2018 Banting Medal for Scientific Achievement.

In this video, I will highlight the key concepts of Shulman’s lecture, including:
- triglyceride HDL ratio;
- body mass index (BMI)/relative body fat (RFM);
- weight loss;
- the role of exercise in reversing insulin resistance;
- metformin, pioglitazone (Actos), and the future of diabetes medication;
- a brief background on Sir Frederick Banting and his insulin discovery.

ABOUT DR. BREWER:
Dr. Brewer started as an Emergency Doctor. After seeing too many preventable heart attacks, he went to Johns Hopkins to learn Preventive Medicine. While there, he went on the run the post-graduate training program (residency) in Preventive Medicine. From there, he made a career of practicing and managing preventive medicine and primary care clinics. His later role in this area was Chief Medical Officer for Premise, which has close to 1,000 primary care/prevention clinics. He was also the Chief Medical Officer for MDLIVE, the second largest telemedicine company. More recently, he founded PrevMed, a heart attack and stroke prevention clinic.

At PrevMed, we focus on heart attack, stroke, and cognitive decline. We serve patients who have already experienced an event as well as those who have not developed a diagnosis or event. Dr. Brewer provides services via telemedicine or in person if you're in the Lexington, KY area. We find a lot of undiagnosed prediabetes or insulin resistance. Treating unrecognized risk factors like prediabetes allows reduction of risk and prevention of disease.

You can also follow us on different social media sites:

Products mentioned are available through these Amazon Associate links.

[DegreesWest]

Thank you doc- as you know- this whole topic of Triglycerides to HDL is very near and dear to my heart. I beg anyone, especially men, to really take this seriously- and wives- stay in your husband about it- you will be glad you did.

[petervafeades]

I thank you for focusing my attention on prediabetes. Even with a fasting glucose under 90, an HbA1c of 5.3%, a fasting insulin of 7, a HOMA-IR under 2, a TRG/HDL under 1 my OGTT has my glucose spiking to 200 before returning to the initial level by 2 hrs and remaining there. I suspected that I have type 2 prediabetes, my doctors do not want to hear of this and consider me a bit of a hypochondriac.
I have been wearing an Abbot CGM from which I have learned a lot about how I react to particular foods.
My most pleasant surprise was how well I manage ice cream, a food I have written off my diet.
The most dramatic discovery is how different a reaction I have to certain foods on an empty stomach as contrasted to having the same food after a meal
Certain fruits raise my glucose from 90 to 180 when consumed on an empty stomach while they do not seem to have any significant effect when I enjoy them post meal
Yesterday I enjoyed something like a baked pretzel covered with sesame seeeds. I could hardly believe that my glucose shot up to 215 - I only consumed less than 50g!
The Glycemic Index is useful but it is based on an average of many responses, only the CGM can identify the foods that affect you most.
The CGM has also enabled me to identify patterns, such as the importance of having dessert/fruit only after a meal and the incredibly beneficial effect of postprandial walks

[pawpawforhealth]

This is one of your key videos. Thanks so much for taking the time to share with us

[lanceh.]

Thank you for this video. My father was diagnosed with type 1 diabetes in 1929 at the age of ten, not long after the discovery of insulin therapy. He lived to be 70. He never was diagnosed as such but in retrospect I think he probably developed type 2 as well in his later years. My mother was a type 2 in her later years and died at 67. My older sister 65 who is mentally slow also has type 2 along with bad kidney problems from it I assume. I am 57 and have been athletic and healthy all my life. I am 5' 6" and I weigh 162 pounds and have noticed recently that my fating glucose levels have been between 100 and 120 fairly consistently so I have started eating a keto diet. I am continuing my HIIT exercise as well as some strength training.

[davidjones]

When I watched this video a couple weeks ago I was really impressed. I hope you picked up the part of how metformin works.

[spacejaime]

Dr. Brewer - superb!. I've had a TG/HDL of >10 - to -1 for decades (sometimes even higher). Tricor + Omega3 (>2mg EPA/ DHA per day) help a lot. Pre-diabetic for 9 years now, so Met x2 day really helps too. Both conditions related, for sure.

[kardste]

I’m just learning this stuff. Why is there a problem with Whole Food Plant Based diet?? If people avoid exogenous fats, oils, refined sugar and excess salt? I’m trying to figure this all out. 🤷‍♀️

[erikjanse]

Thanks again for the VDO, very well explained! Can you please help me understand the following: You as well as Gerald Shulman indicates that Exercise is very very important to prevent IR. If I remember well you have exercised the most part of your life, e.g. doing Marathons. How can it be that you have developed IR??

[nomitakumar]

I’ve learned so much from your videos Dr. Brewer. Thanks a lot.
About fasting insulin levels...my labs normal range is 2.6 to 24.9 to you what is an optimal fasting insulin level.
Secondly, I live in Singapore and Malaysia....haven’t been able to find a cardiologist that is willing to listen to any of the information I have gathered through videos like yours. Very frustrating

[nandiux]

Nice topic as always doc, but thoses pauses in your latest videos are giving me insulin resistance...

[spacejaime]

Some time ago had a free (new French-made ultrasound machine) liver test done and came out as having fatty liver. Tried to get accepted into a Stage 1 trial for new fatty liver treatment (seems many Big Pharma companies are into this epidemic condition). Got rejected as my liver function panel was not off the standard parameters. Anyway, read somewhere that Berberine may help fatty liver...any thoughts?

[seymau]

Is there a connection of insulin resistance and iron overload /hemochromotosis ?

[MrJoeyBoombotz]

I'm curious as to why IR is the term given for all of this rather than hyperinsulinemia. Blood insulin levels can reach over 10 times their normal level and can be monitored. If my my blood insulin levels are ten times too high, my goal should be to decrease them to normal by having a blood test every few months until they are normal. I don't know how to keep track of my 'insulin resistance', but I can measure my fasting blood insulin levels. Once my fasting blood insulin levels are normal, other reducing carbs to zero, I know of no other better treatment. All the metformin, bererine, even chromium do is SHOVE the sugar into the most delicate tissues that will eventually rot them. I don't understand why they are pushed so much. Faithful, consistent OMAD or longer fasting and low to zero carb are the 2 biggest consistent things people can do to affect their hyperinsulinemia/IR/Blood glucose. If the masses are going to understand this, they will understand it better through high blood insulin levels regardless of age, weight or apparent fitness. A low resting pulse below 60, a waistline that is less than 50% of a person's height, blood pressure at or beow 120/80, the ability to be able to run an 8 minute mile or less, and normal blood insulin levels are the biggest indictators of health.


Second, I'm curious as to why everyone advocates 'paying' for a carb holiday afterward by walking for a half hour. How about doing glute/ham/quad/calf excercises for an hour BEFORE you have that 'carb holiday' and EARN IT by draining the glycogen out the muscles to handle the carb intake initially and then 'pay' for it as well by walking off most of the rest. I keep promising my self I'm going to have a carb holicay but in 21 months I have not had the nerve to do it. I feel I need a bigger health reserve and I may never get there. I had a CT scan of heart 13 years ago and it was over 1300. I didn't know what to do about until 21 months ago so I'm pretty sure that score doubled or more because my diet became worse after that.


I use a Walmart plastic $8 folding 12 inch stool next to a indoor dorway as a poor man's stepping/calf/step machine. I do step ups that focus on glutes/hams/quads, and hang my heels over the edge for a calf/stepping machine. I do them at all times of the day, especially when listening to lectures like this and kill 2 birds with one stone. I use the doorway trim as handles to hold onto. I also use the powerblock dumbells to do dumbell deadlifts. 100lbs of dumbells is enough because they are closer to floor than a barbell making a longer moment arm. Using your elbows slightly in front of knees when loading accents the glutes/hams/ having your elbows. alongside or slightly behind the knees accents the quads. I do up to 10 sets of 15 every other day and do other exercises on the other day. I walk for 2 hours everyday. I do other other excercises for my arms shoulds and back, like bent over rows. But the powerblocks and the little stool is the best home gym workout center I ever had, and I've had everthing. And it takes up the space of about 2 large loaves of bread with the stool folded.

[sapelesteve]

Extremely interesting video Dr. Brewer! I forwarded this video to my cousin who also was an ER Doc & is now concentrating on what he terms "Hidden Heart Disease". Like me, he had 2 stents after an acute MI. To bad that you guys couldn't hook up. Anyway, keep up the great work. BTW, I had included a link to his face book page in a recent video of yours. He is located in Thanks!

[Radnally]

Ive been using a glucose monitor for about a month (thanks to your suggestion) and i seem to have a pretty strong insulin response.
I think fasting has really helped. Got my BMI down to 21.
How do i get insulin values?

[farrokhfarr]

this video answered many of my questions thank you.

[petervafeades]

ectopic means displacing - displacing healthy tissue that is

[hdtsoft]

What TG/HDL ratio would you classify as "significantly" over one. My fasting TG are 62 and HDL is 44 which equals a ratio of 1.4 HbA1c of 4.9, i am also rather young ( in my 20s). Would you consider that a problem?

[Percyfaith]

Find a better way to test because Oral Tolerances Test (OGTT) is counterproductive according my former triple board certified MD Dr. Zach Bush.

[Jollyprez]

Exercise isn't everything, though. I exercised a LOT - and had an MI at mile 10 of my 11 mile bike ride. ( my diet, however, was pitiful )