Why Your Insulin Resistance Isn't Permanent (And How to Fix It) - Transcript

Emma  0:00
Can I reverse insulin resistance?

Dr. Mark Hyman  0:02
Thousand percent. I I've taken people who are type two diabetics, who are on insulin for ten years, who are so sick and massively overweight. And within three days, they're off the insulin. In three months, they're completely normal blood sugar. The a one c went from 11, which is insane, to five and a half, which is normal.

In three months, no drugs. So it's possible. Welcome back to Office Hours. Today, I'm here with my producer, Emma, and we're gonna talk about something that everybody gets tested, but very few people actually understand, blood sugar.

Emma  0:35
Today, we're talking about something that most of us see every year on our blood work, but I honestly probably don't think much about it. And I don't think many of the audience members do either, That's our blood sugar. So we get our fasting glucose back, maybe our a one c. They're all marked normal, and I assume that everything's gonna be fine. But what I really wanna understand today is whether those numbers actually tell us the whole story because, apparently, you can have normal blood sugar and still already be insulin resistant.

So I want you to unpack that for me today. So the main goal with this conversation is how do I actually know if my blood sugar's healthy? But as we unpack that, I wanna start at something super, super basic. What is blood sugar, and what is it supposed to be doing in my body?

Dr. Mark Hyman  1:17
This is such an important issue, and I I just wanna highlight what you said, which is that a lot of people walk around and are told their blood sugar is, quote, normal. And yet they are severely metabolically unhealthy. They have severe insulin resistance, and they have high levels of insulin while their blood sugar may be normal. And why does that happen? Because your blood sugar is the last thing to go up when you're in a metabolic dysfunction.

It's the last thing to go up. The first thing up is your your insulin. And and so I'll unpack all of this, but I've seen people who are incredibly insulin resistant with normal blood sugars, and their health is a mess even with a normal blood sugar. And it's it's not just something people deeply understand. This episode is brought to you by Function Health, empowering you to live a 100 healthy years with over a 160 lab tests for just $365 a year.

And use the code Mark twenty twenty six to get $50 off your membership. Before we jump into today's episode, I wanna take a moment to share some really exciting news with you. The Doctor. Hyman show has just won four signal awards. Our conversation with doctors Ray Dorsey and Michael Okin about rethinking Parkinson's, well that took home the goal for thought leadership.

And our live conversation with Hallie Barry at Eudaimonia won silver for best live podcast recording. And what makes this especially meaningful is that both episodes also won listener's choice awards voted on by you, our audience. I wanna say a huge thank you to everyone who listens and shares our episodes and supports the show. And of course, to our incredible guests and the team behind the scenes who make these conversations possible. Our mission is to empower you to take charge of your help, and I'm so grateful you're part of this community.

If you haven't had a chance to listen to either of these award winning conversations, we'll include links to both episodes in the show notes below so you can check them out. Now let's get into today's episode. So what is blood sugar? How does it work? It's basically sugar.

You know, glucose is sugar. Actually, table sugar is glucose and fructose, but glucose is the main sugar we use in our bodies. It's broken down from the food we eat, from starchy foods, grains, from beans, from, you know, actual sugar. And it's an important fuel for our bodies. The pancreas will produce insulin once you eat sugar or starch, and it will create, basically, a way for your body to actually use the energy inside your cells.

So insulin will be increased when you eat sugar or starch, and that helps the fuel get inside your cells. If you're overeating sugar, it puts more insulin, and you're gonna end up storing the fat. So that's the bad thing. So that's basically how sugar works. It's normal to have a little spike after eating.

It shouldn't go up too much. And we do glucose tolerance tests so we can actually measure how fast the glucose goes up at thirty minutes, sixty minutes, one hour, two hours. And and we see basically this this rise, and it shouldn't it shouldn't go way up and down. And when you start being dysregulated, you do these glucose tolerance tests, which I used to do on almost every patient because I was like, this is an epidemic. Ninety plus percent of Americans have this problem.

Ninety plus percent now. When I started in practice, it was far, far less. But now it's almost everybody. And so I wanna see how bad it is, how their body's responding, what their insulin's like. And what you'll see is just often a normal sugar, but you'll see super high levels of insulin that are trying to keep the sugar down.

The problem over time is when you keep eating starch and sugar, which is most of our diets in America. You know, we, I think that at its peak, we ate a 152 pounds of sugar and a 133 pounds of flour per person per year. That's almost a pound of sugar per day and starch and sugar per day per person. It's it's not it's not a normal dose. It's a pharmacologic dose, and it's extremely harmful.

And when you eat that much, your body's trying to compensate by keeping your blood sugar normal, and your insulin starts to go up and up and up. And when that happens, you... Your cells become resistant to insulin. It doesn't work as well. You need to make more insulin.

The pancreas pumps out more and more insulin. And what insulin does ultimately is store that fat in your fat cells. It locks the fat in there. So as long as your insulin's high, you can't break down fat. And it also makes you hungry, and it drives cravings and wanting more sugar.

It's almost like you're starving in the midst of plenty. Even though you have all this massive storage of fat on your body, how could you be hungry with all this extra energy? Because your body can't access it. And so you're starving and you actually feel like you need more food. So when you when you keep having this over and over and over again, over time, you become very insulin resistant.

Ultimately, you'll get diabetes, but that's a very late stage phenomenon. Diabetes happens, you know, decades after. This has been going on for for years and years, and it can start in childhood. I mean, mean, sometimes people get diabetes younger, like in their teenage hood, if they're just drinking soda and the average American diet, this can be pretty bad. So we really want to understand that, you know, when you get your blood sugar measured at the lab, it's not the whole story.

Even the reference ranges are so off. In America, we say, well, when I when I started medical school, the normal blood sugar was like a 140, up to a 140. And then after that was diabetes. Now it's one twenty six is diabetes. Used to be like 100 and I think fifteen was prediabetes.

Now it's 100. But when you look at the evidence, there was a large Israeli study where they looked at cardiovascular risk and other, you know, these risks with blood sugar. And they found that anything over 87, there was a really linear increase in your risk of heart attacks, strokes and so forth over that, above 87. So I think an optimal sugar should be between seventy and ninety. If above that, you're starting to get into danger zone.

Emma  6:59
I wanna circle back to something you said at the beginning there, and it's talking about when I am eating food, there will be spikes in my glucose. Yeah. Is that correct? So I'm not... I naively thought that I always wanted to have kind of a flat glucose line.

Is that false?

Dr. Mark Hyman  7:11
You don't want to have a flat glucose line. It goes up and down. It's normal. When you eat, it goes up. But it shouldn't go up too much.

When you overeat or when you eat too much sugar and starch, it can spike higher. But it really should stay within a range. So typically on a glucose tolerance test, your blood sugar after two hours should never go over 140. That's the upper limit. That...

That's considered type two diabetes. That's by definition. But that's even still too high. Probably shouldn't go over a 110 if it's optimally. If your metabolism is tuned up and I give you two Coca Colas, essentially, which is a glucose tolerance test, you know, your blood sugar will go up.

I mean, it might go up from, like, 75 to a 110. That's okay. But if it goes up to, like, a 140 or 200, that's not good.

Emma  8:00
So then I wanna unpack essentially this further. How can I look at my labs and it says that my glucose is, quote, unquote, normal, but I'm still insulin resistant? Can you dive into that further?

Dr. Mark Hyman  8:13
What doctors don't test and should test and that we measure at function are two really important numbers that are important to understand your metabolic health. One is insulin, and the other is something called hemoglobin A1C. That's the average blood sugar over three months. The insulin is tested probably less than one percent of all blood tests. It's the most important test.

So I had one test to check, see what your health risk was for heart disease, for cancer, for dementia, for diabetes, obviously, for obesity. I would check insulin. It's it's probably the most important indicator of your health, and yet it's never checked. And that's why when I developed the panel at Function Health, I made sure everybody checked it. And it's literally pennies.

It says, I don't know. It's like probably less than a dollar in test to test it. It's not very expensive, but it's so revealing. What happens normally is, and this is the sequence of events, you normally use use... You start getting into metabolic crisis.

So you start initially by having your insulin raise after you have a meal. But your fasting insulin and fasting glucose are normal. Then your insulin starts to go up high after a meal to try to keep the blood sugar down. Right? That's the first thing.

The second thing is it starts to go up fasting. So normal fasting insulin on a reference range in Quest is 18. That's because we're all a sick population. If you were a Martian in Latin America, it's normal to be overweight. Seventy five percent of us are overweight.

That's, quote, normal. Right? If you did a bell curve. The truth is that's not optimal. Same thing for insulin.

Even though 18 is considered quite normal, it's not. It should be five or less. Mine is two or three. Wow. And I'm, you know, 66 and, you know, most of my age have insulin resistance.

And I don't because I know what to do. It's not rocket science. I exercise, I eat well. I had Greek frozen yogurt last night, sure, but I also worked out and, you know, I did a lot of things. Did heavy workout class.

So I think, you know, it's really about understanding your metabolism. And you can have more freedom the healthier metabolic function is. I call metabolic degrees of freedom. I can have Greek yogurt because it's not gonna kill me because I basically... My...

I'm highly tuned. My metabolic system is highly tuned. But if you're not, you're gonna start seeing these rising insulin after eating, then you'll see rising at fasting, and then you'll see your glucose rise after eating or a glucose tolerance test. And then lastly, your blood sugar goes up. It's the last absolute thing to go up, and your hemoglobin C tracks with your average blood sugar you can see how you're doing.

But this is something that should be tested on everybody. And I think even starting young, like, think we see kids with... And this... And when you're younger, are the ones who have to see their pancreas is still healthy. And so these are the ones that are pumping out like, you know, instead of 18 on their insulin, it's a 100 or 200 or two, 300.

It's like, woah. And I was like, I'm shocked to see these numbers. And I and I had a woman who was really one of my most profound patients early on when I was practicing. I gave her I gave her, you know, basically, had glucose tolerance test, which is the equivalent of two Coca Colas. And she had this big belly.

She was very overweight. She had high triglycerides, low H. I knew she was insulin resistant. But her blood sugar was perfect. Never went over a 110 even despite having the equivalent of two Coca Colas.

But her insulin just was through the roof. Her insulin was like 300 because it was managing to keep the blood sugar down, it was doing so much work. Eventually, it'll poop out and she would she would she would get diabetes. But was really interesting to see that, that even though she had a perfectly normal blood sugar, even with a glucose tolerance test, which is what doctors will do

Emma  11:39
Mhmm.

Dr. Mark Hyman  11:39
They're missing a huge amount of these cases.

Emma  11:41
Okay. So I want to go into the difference between fasting glucose and fasting insulin. Essentially, my question is, what's the difference between them?

Dr. Mark Hyman  11:49
Well, fasting glucose

Emma  11:51
is

Dr. Mark Hyman  11:52
basically what your resting blood sugar is without eating, and fasting insulin is the same thing, what your resting insulin is without eating. Insulin, if if you're you're looking at insulin, you'll often see fasting insulin start to go up if you become insulin resistant. So that's the first clue other than doing a glucose tolerance test, which most people don't wanna do. We have a new test, which I would like to mention, which is kind of a uniquely available through function that almost nobody's doing, but is scientifically the best way to check for insulin resistance, which is an insulin resistance score where they use a technology called mass spectrometry to measure insulin and something called C peptide. And it gives you the best indicator of your degree of insulin resistance on a scale of zero to 100.

And so that's a really important biomarker that people miss. In glucose, insulin, a one c are all important, but this other one is is actually becoming, I think, really even more important.

Emma  12:49
And what is the c peptide that they're measuring there?

Dr. Mark Hyman  12:51
C peptide is a is a is a is a sort of precursor of insulin. So it's like how much insulin your pancreas is making.

Emma  12:58
Is that what makes this test unique, that function's doing?

Dr. Mark Hyman  13:00
Yeah. Measures C peptide and insulin, but it also measures it using a very accurate technique, like a laboratory called mass spectrometry, which doesn't really matter, but the point is it's a super accurate test. It's as good as the research test they use to measure insulin resistance in the lab, which is something called the euglycemic clamp test, which no one would do in real life, unless you're like us in the lab with rats or something.

Emma  13:21
Unless you're Mark

Dr. Mark Hyman  13:21
Hyman. No. No. I wouldn't do that. I've never I've never done it because it's like it's it's something that's not done in in medicine.

It's just like in research.

Emma  13:27
And sorry, Sidebar, that is... It's available now with Function?

Dr. Mark Hyman  13:30
It's available now through through as an add on on Function. Insulin and glucose and a one c are part of the standard function panel at functionhealth.com. It's only a dollar a day for a year membership and you get all these tests and more. But I think it's important for people to know the numbers. I think there's a big lesson we can learn from breast cancer screening.

Think about it. You don't have to wait for symptoms to get a mammogram. We've learned the value of looking and getting information about your body even when you feel perfectly fine. And I think that idea is bigger than breast health because there's so much happening inside your body that you simply can't see from the outside. Your blood sugar can change, your hormones can shift, inflammation can rise.

Some of those changes you might feel, some of them you won't. You can't necessarily feel a number changing. You can't feel a risk building up before it shows up. And that's one of the reasons I help build function. You get access to over a 160 lab tests each year covering your heart, hormones, metabolism, and more.

You shouldn't need a reason or a diagnosis to want a deeper look at your own health. This isn't a radical idea. It's a new standard because the goal isn't to collect more numbers. It's to have better information while you still have time to use it. Check your health at functionhealth.com/mark.

And if you're one of the first thousand people this week, use the code mark twenty twenty six for a $50 credit towards your $365 a year annual membership.

Emma  14:49
So we're talking about function offering these tests, but when I go to my annual physical and I'm getting my blood tests and these markers aren't there, why is insulin not part of these annual exams that I'm getting?

Dr. Mark Hyman  15:00
That's a very good question, Emma. I've been asking that question for thirty years.

Emma  15:05
Okay.

Dr. Mark Hyman  15:06
I've been testing this for thirty years because the science has been there. I mean, we often say in medicine, it takes, you know, seventeen to twenty years for discoveries to become practice. It's even longer than that. Mhmm. Thirty years I've been measuring this.

And I think doctors... And a part of the reason is the solution is nutrition, not a drug. And so if you don't have a drug to prescribe it, there's nobody promoting it. Right? Nobody's saying, oh, everybody's gotta check their LDL cholesterol because we have a statin, and that drug lowers LDL cholesterol.

But there's no good drug to really lower insulin. Not really.

Emma  15:43
Mhmm.

Dr. Mark Hyman  15:43
So it's really about diet. Metformin works a little bit. Some of the GLP ones help a little bit. But but basically... And if you lose weight, obviously, it'll it'll help.

But the the the key is that food is the biggest driver and will bring that down like that. I just had a patient whose insulin was, like, 70. And within a few months, it went to perfectly normal by changing his diet. And his insulin score was a 100, and it went down to normal. I'd never seen a 100 before.

Emma  16:11
Through... Just for changing his diet and lifestyle?

Dr. Mark Hyman  16:13
Yeah. Just changing diet and exercise. Yeah.

Emma  16:15
Okay. So we've briefly touched on a one c. I wanna dive deeper in there. What is that measuring in my tests?

Dr. Mark Hyman  16:23
So a one c is glycolic glycosylated hemoglobin. So, basically, what it's measuring is your hemoglobin that's been altered by sugar. And think of it like when you combine protein and and sugar, and and and you have, like, creme brulee or a crust on a bread. That's a chemical reaction called a Mallard reaction It also happens with your... When your blood sugar's too high, it damages your hemoglobin in a way that creates this marker called hemoglobin a one c that measures the average two to three month blood sugar.

So you really are getting a longer range view of your blood sugar that just because your blood sugar will swing up and down every day, but the average is important. So, you know, we see the lab tests as if it's over 5.7, you're prediabetes, and they moved it over to 6.5 for diabetes. It used to be six was diabetes. They moved it. These professional societies are changing the reference ranges all the time.

But I talked to our partner, Quest, and I talked to the cardiologist there, and they have massive data sets. And they said that the people who started having A1Cs over 5.1 right? Remember, the 5.7 is the cutoff. But 5.1 and this is a logarithmic scale. It's not like a linear scale so that every 0.1 is a big change.

Anybody over 5.1, the risk of cardiovascular disease went up in a linear fashion. And the the risk of their cardiac, their lipid abnormalities or cholesterol abnormalities are all driven by this. And by the way, your glucose and your insulin resistance are driving most of the abnormal cholesterol that's causing heart disease. And insulin resistance, not fat, sugar, not fat is the major driver. And I say sugar, I mean sugar and starch, the major driver of cardiovascular disease and heart attacks and strokes and high blood pressure.

Yeah. It's crazy.

Emma  18:15
So say I get my tests back and it says that my a one c is normal. Am I in the clear?

Dr. Mark Hyman  18:20
No. Absolutely not. Absolutely not. No. Sugar, a one c.

Because Because if your sugar is normal, your A1c is normal, you could still be running an insulin of a 100, you know, and you're in big doo doo. And if you don't check your insulin, you won't know what's going on. So insulin, insulin, insulin, insulin. Insist on... I I met with the I met with the dean, the dean of a medical school, a doctor herself who was East Indian and had listened to this podcast.

And she was like, I went to my cardiologist because I know genetically I'm more susceptible to insulin resistance. And I went to my cardiologist and I said, can you please measure my insulin? And he said, no. This is malpractice in my view. I mean, this is just...

This is like dark ages. We know the science is there because you don't know anything about nutrition doesn't mean you shouldn't check it. Bottom line, insulin, check your insulin.

Emma  19:10
So as we've been talking about blood sugar, we've talked a lot about fasting. But I spend a lot of my day not fasting. I'm eating between normal hours of the day. Why are we not paying attention to what happens to my bloods after I eat?

Dr. Mark Hyman  19:24
Well, we should, and that's what a continuous glucose monitor will tell you. And that's why I do a glucose tolerance test to measure the levels of spiking of glucose after a meal. So I wanna know how your body's handling it. Are you metabolically healthy? Are you metabolically broken?

Like, what's happening? And and and, you know, there's a lot of things that actually affect how your blood sugar rises or doesn't rise after a meal. So you can eat a meal. For example, if you eat bread and wine at the beginning of a meal, your blood sugar will go through the roof. But if you eat protein and fat and fiber and then have a little bread and wine, it won't have an impact.

So the meal composition, the order of foods you're eating really matters. And also fiber matters a lot. So the amount of fiber you're having matters. You can literally take a Coca Cola and you could put in this thing called glucomannan, which comes from a Japanese root called cognac. And and, you know, it won't raise your blood sugar because it it basically soaks up all this water and it acts like a sponge.

And it it really... I mean, I'm not encouraging to do that, but but if you want Metamucil in your Coca Cola, it'd be better for you.

Emma  20:33
You know? We won't clip that one. I think

Dr. Mark Hyman  20:39
eating whole food matters because the structure and the composition. And for example, if you have a bean, which has a certain amount of carbohydrate or even a whole grain like buckwheat or brown rice, it will be... It's for the body to break it down and and digest it, and then it has has a slower absorption rate. So it's the the rate... If you drink a Coca Cola or a fruit juice, it's your sugars are going like this.

But if you have, you know, these foods that are complex, if you have a piece of fruit instead of fruit juice, it has a different effect on your blood sugar. Also, fat and protein and fiber greatly modify the rate of glucose absorption. So having a a meal that you design and compose to actually have a... To mitigate the rise in blood sugar can also work. Really important.

And then and then, portion size matters. So this happened to me once. I went to visit my friend in Martha's Vineyard, and he ordered this unbelievable meal from this, like, organic place with lamb and this and that. And there was some starchy stuff, but it was, like, healthy. Was whole grains, with potatoes, whatever.

I didn't even have dessert. And I actually was... It was my first time wearing a CGM, a glucose monitor, and he wore one too. And we were both, like, you know, very athletic, very thin, you know, healthy guys. And we...

He called me, like, at 10:00 at night freaking out because we way overate. Like, I really stuck myself, which I don't normally do, but it was so good. And our... Both our sugars were, like, a 140 or a 150. We're like, what the heck?

You know? So portion size matters. And it will, independent of, like, having, you know, sugar, it it will have an effect. Sleep has an effect. So if you don't sleep, you're going to crave more carbohydrates.

Your appetite's going be increased. It'll affect your metabolism. Stress, cortisol, is a hormone that's pumped out when you're stressed. Cortisol will raise your blood sugar. Why?

Because when you're stressed, you want to have a lot of fuel to run from a tiger. If you're if you're... Your body's designed under stress to pump out a lot of glucose from stores, from your liver, from glycogen. And you're basically... Even if you haven't eaten, your blood sugar will go up because you have about 2,500 calories of sugar stored in your muscle.

So your body will start to pump out sugar. Exercise plays a really important role. Like, there's a lot of science around how if you just take a ten to twenty minute walk after eating, everything will smooth out and you won't have these spikes in sugar and you'll really improve your metabolism. Just a simple walk after dinner. And then, of course, there's genetics.

Like, if I... You know, if if a if a Native American has a Coca Cola and they're healthy, their blood sugar will tend to go up higher, their insulin will go up higher, mine won't because I'm I'm just genetically different. So it's... There's genetic variability, but those are the things that really affect affect, your blood sugar. So it's...

You can really design your your diet and your life even to enjoy, you know, good food. But, like, you know, if I... For example, I had last night, I had, you know, lots of protein. I had lots of veggies. And then I wanted, like, this...

I'm in LA, and I wanted this frozen Greek yogurt that's really good. And it's so yummy. And I was like, I don't have any... I mean, yogurt has protein. It has fat.

It's like, it's not just pure sugar. So I'm like, you can have fun.

Emma  23:44
There's worse things you could eat in LA. We know that for sure. So if you were looking at my bloods, would you be more concerned about, like, how high my glucose goes or how quickly it comes back down?

Dr. Mark Hyman  23:56
Both. I mean, they're both both important. They're both important metrics. I think if your if your blood sugar spikes really a lot, that means you're really not able to manage it. If it if it stays up for a long time, that's also a problem.

So I think it's... Those are just, you know, things to notice. But bottom line, I don't I don't think you have to worry so much about that. You know, check your insulin. Like, make sure you check your metabolic health.

You want your insulin resistance score, function health. That's a good marker. And there are other, of course, markers that that help give a full picture because it's not... When your glucose and your insulin resistant go off, it's not just your blood sugar or A1C or insulin that becomes a problem. You can get fatty liver, so your liver tests go up.

You can get kidney issues, you can get protein in your urine. Your sex hormones are affected. If you're a guy or... This guy who I was telling you about with a high insulin score, his testosterone was a 160 and he was 29 years old and it should be 800 then. Normal is over 500.

His his, you see high uric acid, which can cause gout. You see also lots of inflammation, high CRP because the visceral fat causes inflammation in the body. You see all these different variables that change, not just the glucose or insulin. So it's important to look at everything. And by the way, we test all of that with Functional Health.

Emma  25:08
So we've been curting kind of around and mentioning some of the things that we are checking in these tests. I wanna go more specific. What numbers should I actually know? So I have a couple of things I wanna hit you with if you could walk me through what I should look for. So can you walk me through fasting glucose?

What should I look for?

Dr. Mark Hyman  25:24
Your fasting glucose should be 70 to 90. Your fasting insulin should be ideally under five, but under 10, you know, five to 10, you start to start paying attention, but not terrible. But definitely under five is ideal. What about my

Emma  25:36
a

Dr. Mark Hyman  25:37
one c? It's a good question. Probably a good A1C is five. 5.1, 5.2 maybe, but I wouldn't go much higher than that if you're again.

Emma  25:44
The last one I want to know is what should my post meal glucose be?

Dr. Mark Hyman  25:47
Shouldn't probably go up over 110, ideally, 120 at the most.

Emma  25:52
If my glucose hasn't gone up yet, is there anything else that might make you suspicious?

Dr. Mark Hyman  25:57
Yeah. Like I said earlier, there's a lot of side effects of high insulin or of insulin resistance. And what we'll often see, just looking at someone, can tell if they're insulin resistant because they have belly fat. I tell people the cheapest test is the mirror test. You take off your shirt, you stand in front of a mirror, you jump up and down.

If your stomach jiggles, you have a problem. You should check. And and I think a DEXIS scan is really helpful, but even a waist circumference. If you just check a tape measure and measure around your belly button, that's a... If you measure around your widest point of your hips and measure your belly button.

And if you're a man, you should have a ratio of less than point eight. If you're a woman, it should be less than point nine. And and this is really important. It's an easy thing to measure. I also see high triglycerides over 100, 150, even more.

Low HDL, which is one of the cholesterol biomarkers. High number of lipid particles, small lipid particles. Again, these are things that are not checked on a normal test. We do check at function health. We see fatty liver, which can be from a high ALT, high GGT.

These are numbers we can easily measure. Sometimes the liver tests don't actually check that. You might need a liver scan called a FibroScan, which measures fatty liver, which is a little more sensitive, or a full body MRI, which we offer at Function. Because you can often get a fatty liver without actually having abnormal liver function tests. And so, you know, we do the scans to really help identify things like that.

It's one of the most common diseases. I think it affects ninety million people. It's really bad. And in PCOS, we see high testosterone women, we see high DHEA, we see high levels of androstenedione, other biomarkers we also measure with function. And we also see the high LH to FSH ratio, which is female hormones.

We can kind of tell these clues from this. And then we see other manifestations of it. It's quite bad. We see darkening skin in the armpits and in the neck called acanthosis nigrans. We see family history is helpful.

People get sleep apnea, which often is a cause of insulin resistance, but also worsens it if you have it. And if you have a family history of gestational diabetes or you've had it yourself or a family history of diabetes, those are all kind of clues you might be in trouble. And certain medications, you know, might might worsen in statins, which is the most commonly prescribed medication in the world, cause insulin resistance and cause diabetes and cause insulin to go up. And and actually, the studies have been pretty clear that it does increase your risk of diabetes. So I think, you know, these are really important.

And people also just have symptoms that that are like, if you're if you're craving stuff... I mean, I I don't think I ever get cravings. Like, I really... I I mean, maybe if I haven't slept Mhmm. And that dysregulates my hormones and my appetite hormones, which I know it does, I I will crave sugar.

But but I... Normally, I don't crave it. I'll eat it because I like it, but I won't... I don't... Like, oh my god, I gotta have this.

I don't I don't have those because your your body is just balanced.

Emma  28:56
You mentioned belly fat there and how that is like a clear sign. But could someone be thin and still have insulin resistance?

Dr. Mark Hyman  29:03
Absolutely. There's something called toffee, metabolically obese normal weight, or toffee is thin on the outside, fat on the inside. And you see a lot of people who are like this, particularly older people, you know, like little ladies, they they have like, they look thin, but if you did a DEXA body composition, they'd be just like a a like a rib eye steak or maybe a Wagyu or Kobe, even worse, Kobe beef. And they're basically marbled fat. And that...

That's you can't really see that by the scale. You can look at it by a DEXA scan. I think also, there's certain populations, the East Indians, like from India and also Asians, at lower body weights and normal body weights without a normal... Without an abnormal BMI, maybe a tiny bit of belly fat, they they will get insulin resistant. And and and you...

We will see a high high levels of even diabetes in these people. And and what's interesting is these... A lot of these people even have a higher risk of cardiovascular disease in their normal weight. So we call this toffee, or I call it skinny fat. You look skinny, but you're actually fat.

Emma  30:04
Is that a real word, or have you made that up?

Dr. Mark Hyman  30:06
Skinny fat? No, toffee. Don't know. Made it up years ago. Toffee, yeah, no, it's a medical Okay.

Mean, can read about it. It's like tofu but with an I.

Emma  30:14
I know. Yes. Okay. I've heard you mentioned it before, and I apologize. I haven't looked it up, if I'm honest.

You mentioned continuous glucose monitor earlier. And so I'm curious, are those actually useful? Like, is it something that everyone should try out and use regularly?

Dr. Mark Hyman  30:30
You know, I think it's good to get a benchmark. I mean, you're a diabetic, for sure, it's important to know where you're at. And especially if you're type one, it's essential. I think, you know, I used it because I wanted to see, you know, if I ate bread, what happened? Or if I ate, you know, a piece of fruit, what happened?

And, like, I think there's a lot of individual variation. And there's a large Israeli study that looked at the microbiome and how much the microbiome influences individual variability when it comes to what your glucose will be. And so even the same food in a different person will have a different response depending on the differences in their microbiome. So it's very complex, and that's why it's important to know what's good for you. Some people can eat a plum, some people can't eat a plum.

You know, say, we're gonna have, you know, a piece of bread and fine. Some, boom, they had a piece of bread. It's like a disaster. So I think it's important at least for a few weeks to track what's happening in your biology so you know. And then you can say, oh, okay, well, I'm understanding this.

And maybe periodically if you if you want to see how you're doing, if you improve. But I don't think it's something people need all the time. But I think I think it's it's important to understand what's happening in your body. And I I believe we need to have data driven health care. I think for much of medicine, we're basically just like roping around in the dark with, you know, physical exam that's not that great, a few very rudimentary lab tests.

And we don't really take a deep dive. So in Functional Health, I believe we really are creating the first real data driven health care model, which is where people are getting lots of data on their bodies from imaging, from lab testing, from the history, from wearables, And we'll be doing genetics. All this stuff will be just available so you really understand your body, and then can work with it rather than against it.

Emma  32:08
Say you were looking at my labs, and they were starting to move in the wrong direction. What advice would you give me to start doing today?

Dr. Mark Hyman  32:14
Well, if I start seeing insulin resistance, I mean, sugar and starch are the things that should be aware of. So I basically increase fat, like avocados, olive oil, nuts and seeds. I have adequate protein, increase fiber to, you know, 30 grams at least a day, which is lots of vegetables, so unlimited amounts of vegetables. I never tell people how much to eat. I always tell them what to Folks on the what, they don't have to worry about how much calories don't matter in the way that we think they do.

In fact, the literature is quite clear on this that we've seen a flattening or a decrease in our calorie consumption and an increase or flattening of our exercise over the last twenty years, and we've seen an increase in obesity. So the whole act... Calories in, calories out, exercise more, eat less doesn't work because our biology is screwed up. And it has to do with our microbiome, with our metabolic rates, and other things that that are really, really key. But but I think it's important that people really cut down or reduce or eliminate starch and sugar.

Second is, you know, take a walk after eating. Third is, you know, exercise is so powerful. Muscle is a sink. Muscle is a sink for your glucose. And so it actually has mechanisms that allow you to absorb glucose without insulin.

So if your muscle is smart, and what I mean by smart muscle is trained muscle is... I mean, I remember Emma when I was 50, and I'm like 60, almost 67, when I was 50, I couldn't do 10 push ups. I would do 10 push ups, and my chest would hurt for like a week. I'd be like so sore. And I I was so weak.

And and I didn't have conditioned muscle. I could run 10 miles, but I couldn't... I know my muscles, I didn't train at all. And so basically, muscle is the sink for glucose. So building muscle, exercise, strength training, aerobic exercise, also helpful.

And also sleep, you know, sleep is such a key factor. People think that sleep's not important. But if you sleep adequately, you're not going to be craving the foods, your hormones are right. Mistral fat will naturally go away, the belly fat, when you do all these things that I said. And I think it's important to really double down on this.

It's not rocket science. You know, I've had people lose a 100, a 150 pounds. No no GLP one drugs. No GLP one drugs. Just using food and following these simple principles.

It's... I mean, I was just met someone in... I was at an event, and I just met someone. She came over and said, I read your book, doctor Diamond. Thank you.

I just lost 40 pounds by following your advice. It's not that hard. And and I know GLP ones are a quick fix, and and it may be helpful for some people. But but, honestly, we're just a few bites away from fixing our our hormones and our biochemistry, and it's it's really possible.

Emma  34:47
So if I was gonna go for my physical tomorrow and I want a stronger picture of what my metabolic health looks like, can you build out what your ideal panel would be for me to get tested?

Dr. Mark Hyman  34:58
Yeah. I mean, the first thing you want to know is your metrics that don't require a lapse. So you want to check your waist to hip ratio, or you can do waist to height ratio. You ideally would check your blood pressure. You'd ideally do a DEXA body composition to see your body composition, really important.

Then you do all the things we talked about. You look at fasting glucose, fasting insulin, hemoglobin A1c. You look at an advanced lipid panel, looks at not just total LDL, HDL triglycerides, but you look at the particle size, the particle number, and look at small large particles. And you look at your liver function test. You look at protein in your urine.

You look at APO B, which is a very important cardiovascular risk marker. It's the most important predictor of cardiovascular risk, and it is an indicator of insulin resistance. If your APO B is high, you are likely insulin resistant because it measures all the dangerous lipid particles which are produced by eating sugar and starch that damage your lipids. So people think it's fat and saturated fat, it's not. You know, some saturated fat does influence your lipids to some degree, but my point here is that the dangerous kind of cholesterol you get, nobody's looking at.

It's it's the lipid particle size and number, not just the weight of the cholesterol, which is what we typically measure. So all of these tests are done by function health. You don't even have to think about it. You just go and they'll measure everything, including protein in your urine, including your liver, including your hormones, which affect it, which are important to check as well, because your testosterone and sex hormones and things are affected by very much by insulin resistance. So all these things you should you should do at least once a year.

I think a DEXA body composition is important to do as a baseline. And then as you change, obviously, checking your your... Looking at your waist size is pretty obviously easy. These are things that, you know, people can do. But I I think people focus on weight.

I don't really I don't really care about your weight. I care what your body composition is. I want I want to know where the fat is, where it's distributed, you know, not what the scale says. You know, you got someone like Dwayne Johnson, The Rock, and he... He's got a he's got a body mass index of somebody who's obese because he's got so much muscle.

He's two hundred seventy nine pounds, six foot tall. That's... See, that's some... That's a fat person, but they're not. He's he's just solid rock muscle.

Emma  37:11
Comparing the labs that you just presented, what is already on my annual physical and what ones would I have to ask about?

Dr. Mark Hyman  37:20
Most of the things I'm saying are not on your annual physical. The only thing that's there is is glucose and your lipid panel and maybe your liver test. That's it. Everything else is not checked. So, honestly, the current annual checkup panel is so outdated.

It should be thrown in the garbage, and people should just do function. I know I'm cofounder of function, and I'm selling it hard. But I'm telling you, fighting with your doctor to get these is such a pain in the ass. And it's a dollar a day. $365 is less than a cup of coffee a day, and it's your health.

And if your doctor is willing to do it and is open to do it, great. But the chances are they're not likely going to order everything that's on there, and they're less likely not going to how to interpret everything on there. So if you have a good doctor that does that, great. But if not, make sure you take your health into your own hands.

Emma  38:09
Okay. I want to transition into some rapid fire questions now. Is a glucose spike always bad?

Dr. Mark Hyman  38:14
Not necessarily. I mean, it'll happen... Like, if I were to drink a can of Coke right now, my glucose would spike. But I, you know, if it's temporary, it's not gonna be a problem. It's more the persistent long term elevations from a continually bad diet and lack of exercise that's a problem.

Emma  38:30
Can eating fruits spike my blood sugar too much?

Dr. Mark Hyman  38:33
If you're metabolically healthy, no. If you're metabolically unhealthy, yes. The same food will have a different effect on different people depending on their metabolic resilience. So if you're insulin resistant and you have a piece of fruit, it might be a problem. If you have berries, maybe not.

If you have pineapple or melon, maybe yes.

Emma  38:49
Think I know the answer to this one because you mentioned it before, but does eating protein before carbs actually matter?

Dr. Mark Hyman  38:54
It does. I mean, you're basically eating protein and putting that in your stomach. It's harder to digest. It's kind of... It blocks the spikes in glucose.

Having protein, fat, and fiber is better combo, but, you know, that still works.

Emma  39:09
What about fasting? Is it good for insulin resistance?

Dr. Mark Hyman  39:12
The data is pretty good on people who do an overnight fast. And I think, you know, people talk about, you know, time restricted eating. But, you know, if you do fourteen hours, that's eating dinner at 6PM and eating breakfast at 8AM. It's not too hard. Right?

It's not that hard. It's just not snacking at night, not eating first thing when you wake up if you're up early, and just giving yourself that break. You know, longer periods may be up to sixteen hours if you're really if you're really diabetic or in some reason it can be helpful. But you don't have to do that. Even just just an overnight twelve, fourteen hours is plenty.

And most Americans never do

Emma  39:45
Is that the same for men and women as well?

Dr. Mark Hyman  39:47
Yeah. I mean, the the data around prolonged fasting is... That's challenging for women is is true, but but this is not prolonged fasting. This is just eating dinner and breakfast.

Emma  39:57
Right. Reducing snacks, which you're not a snacker.

Dr. Mark Hyman  40:01
It's cutting out mean, yeah. Snacks are a really dumb invention. I don't know who invented them, but they're like, I don't know what the thing is with snacks.

Emma  40:08
Can poor sleep raise your glucose the next day?

Dr. Mark Hyman  40:10
Yeah. I mean, poor sleep dysregulates your hormones. It degrades ghrelin and PYY and cortisol, and it just regulates your whole biology. And so, yeah, you can have more cravings, and you can even have higher blood sugar.

Emma  40:23
Can my stress raise my blood sugar even if I haven't eaten?

Dr. Mark Hyman  40:27
Absolutely. As I said, when you're stressed, your body is designed to do a number of different discrete functions. It doesn't matter what you're stressed from your boss yelling at you or from a tiger chasing you, your body has only one way of responding. And that's to increase cortisol, adrenaline, norepinephrine. And when you do that, you're releasing glucose from your stored glucose in your muscles, ligagen, and you're ending up with, you know, high levels of glucose in your bloodstream just from stress alone, even if you haven't eaten.

Emma  40:55
Is my morning fasting glucose sometimes higher even if I'm healthy?

Dr. Mark Hyman  40:59
It can be. It can be. Because sometimes what happens is there's a morning cortisol spike. So normally, your your your cortisol is up in the morning and goes down at night, and then it's low. And then early in the morning to wake you up, cortisol starts to rise.

When cortisol starts to rise, it can cause glucose release. And so sometimes you'll get a higher glucose in the morning. I don't worry about that. I want to see the whole picture.

Emma  41:21
Are artificial sweeteners better for my blood

Dr. Mark Hyman  41:24
I mean, a little, but they but they do cause complications. And and they do affect the microbiome in ways that have been shown to increase weight gain, to cause other issues. So I think I think artificial sweeteners are not a hall pass. And they do increase your cravings for sugar. They're a thousand times sweeter than regular sugar.

They've been shown to have, you know, other effects on brain, like aspartame is a toxic neurotoxic amino acid. So I think there's just there's just problems with it. I think if people want something sweet, eat something sweet. Don't don't have those things. Monk fruit is probably an exception, maybe a little stevia.

But all, like, things like all the other artificial sweeteners, the sugar alcohols, the aspartames, the... All the all the non nutritive sweeteners are are problematic.

Emma  42:06
Can I reverse insulin resistance?

Dr. Mark Hyman  42:08
Thousand percent. Thousand percent. I mean, I've taken people who are type two diabetics, who are on insulin for ten years, who are so sick and massively overweight, and within three days they're off the insulin, in three months they're completely normal blood sugar. The a1c went from 11, which is insane, to five and a half, which is normal, in three months. No drugs.

So it's possible. And it doesn't take that long.

Emma  42:35
Okay. If you could only pick one, what is the most important blood test that you would pay attention to?

Dr. Mark Hyman  42:39
Insulin by far.

Emma  42:40
I've hit you with a lot of questions. So to wrap up here, I want to know if someone's listening and their doctor's always told them, your glucose is normal, you're totally fine, What is the one kind of take home message that you'd want them to understand?

Dr. Mark Hyman  42:53
I think it's important people to understand that knowing your blood sugar is not enough and that you need to do a deeper dive. Measure your fasting insulin, your a one c, all the other biomarkers we talked about, And check your waist circumference, check your body composition, really know what's happening in your body. And then if you find you have some degree of insulin resistance, follow just the simple principles we talked about. Cut out starch and sugar for the most part. Have protein, fat, and fiber and improve your meal composition.

Walk for ten to twenty minutes after a meal. Build strength training. Get enough sleep. Navigate your stress response so you're not constantly stressed. They're just simple things, but they have profound effects.

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