If you exercise regularly I would consider easing off the metformin as it has been shown to decrease muscle gain. Metformin seems to have less of a benefit for active individuals.

Switch to very low fat diet, and you will be cured. Preferably plant-based.

David Sinclair still takes metformin, last I heard, but not on days that he works out.

no @@erastvandoren

How do you find a doctor like that 😂 my doc had my fasting glucose in the pre diabetes range and never told me anything. Then wen I bring up wanting to test my Apob he says no

Congrats for your success.

Well done! That's big accomplishment.

Congrats! Did you make changes to your diet (e.g. more fat / less carbs / different kinds of carbs)?

heroic

Well, Peter often had charlatans on.

@@erastvandoren *[citation required]

@@erastvandoren who? I know he interviewed Jason Fung who’s a quack IMHO but most of them are pretty good

@@Eldooodarinowhy is Fung a quack?

still waiting for that citation a year later 🤣@@erastvandoren

Vitamin B1 Benfotiamin could help with nerve damage especially for diabetics. It's a fat soluble B vitamin unlike B complex vitamins which are water soluble. Good luck 😃

@@gtm5650 I have been taking that on and off for the past year or so. Thank you so much

Fasting, low intensity exercise, low carb diet, no vegetable oils, eat more eggs for the choline. Also red light therapy for your neuropathy and general health.

@@Artzimer1958 Do your own research. There's a bunch of research and practicing physicians that help their insulin resistance patients with Keto diet, like Dr. Fung, Dr. Berry, and Dr Berg. Dr Berg has a recent video on the best diet for peripheral neuropathy : kzfaq.info/get/bejne/lZ5dmM923J3YioE.html

Remember your nerves need proper nutrition so removal or grains and refined/processed goods of ALL kinds is key. Is it Reynauds Syndrome? Do your hands turn purple/blue etc? I second following dr fung and also dr sarah hallberg and dr Westman. I recommend a video by dr sten eckberg called "the mathematics of weight loss". It spells out the basics as a good review. 🙏 you got this!!

And lipids can be caused by stuffing faces with calories. Problem solved in under 20s.

tl;dw

Is the flow of fat from plasma into muscle cells controlled in some way similar to glucose?

Good question. It doesn't look like that's understood yet. But a super interesting paper ties insulin resistance due to a high fat diet to a lack of omega 3 acids. So a high fat keto diet with 10% of the fats being omega 3 would be sufficient to prevent causing insulin resistance (if a lot of the fat is polyunsaturated, then fish oil long chain omega 3 is needed, otherwise plant omega 3 ALA is sufficient. I don't trust fish omegas not to be rancid so best to me seems saturated fat heavy + plant omega 3) Influence of Dietary Fat Composition on Development of Insulin Resistance in Rats, 1991 (Edit: the paper points out that you don't want to dilute the ALA with linoleic acid because they are used competitively, so Flax seed oil would be a much better option than hemp oil)

Same here... I just try to listen to these while I'm running or driving so it doesn't bother me as much that there's no video. I'll watch ones with video if I'm just sitting down to watch and have time to just chill

kzfaq.info/get/bejne/o9ighMiDvp3OiIk.html here is the 2018 Banting lecture by Schulman showing an earlier version of the slides.

@@davidblackwell1753 awesome thanks

Same

However, Attia still fails to make the transition to the diet.

Vit d is valuable fat soluble vitamins. Along with low carb diet E helped me reverse my mafld.

Shulman might be frustrated but Peter is a promoter of time-restricted diets and has had Jason Fung among others on his podcast.

He made a nanoparticle formulation of dintrophenol that homes in on the pancreas and leaves the rest of the body undosed. DNP was a diet drug in the 20s and 30s. It worked and people lost weight like crazy but it caused a lot of heart attacks. The new drug bypasses the heart so it should be safe. He claimed that it cured diabetes in rats

You may be correct. We likely wouldn't have wanted to get fat in the summer.

@Mr, yes, he's saying it evolved as a survival mechanism in the face of starvation.

Basically what you want is low fatty acid level in the blood. For that, you need a low fat diet and not being overweight.

Insulin gets the cells to take in the glucose for either energy usage or energy storage. If a person is overfed they will add to their energy storage (Fat). What I'm having a hard time understanding is when insulin resistance is finally developed, and the cells are not allowing glucose to enter within, therefore not adding to the storage, how does a person gain weight? Is the liver taking in the glucose and turning it into fat and then distributing it throughout the body? Or does the predicament cause even more over eating due to cell starvation and eventually with enough insulin the cells respond and now you end up with more energy then needed and therefore additional fat added to the body? Any thoughts?

​@@Copperline828 Insulin is the hormone that makes you gain weight. All you have to do to make a patient gain weight is prescribe them insulin. (Look up diabetic lipohypertrophy for an an example). When people are insulin resistant the body makes more insulin than normal because Glucose levels are high and Not Going Down. The brain signals the pancreas to release increased concentrations of insulin (to control sugars preventing hyperglycemia) making it more likely that insulin binds to its receptors allowing glucose clearance. An oversimplified explanation of what Dr. Shulman is saying is that insulin resistance begins with a transport problem of glucose from your bloodstream into glycogen stored by the liver and cells (like skeletal muscle). When people are very very late stage such as with DKA you get the opposite - the pancreas has shut down insulin production (think of it like long term work related stress). Glucose has nowhere to go and quickly shoots up. With those patients - glucose cannot enter the cells at all, the cells starve, you get rapid unexplained weight LOSS leading up to emergency ketone production (alternative fuel). The excess glucose in this emergency causes the three polys because glucose is way overconcentrated: Uria to extrete hyperconcentrated glucose, phagia because your cells are literally starving, dypsia to replace water you're losing.

Seems the problem here is that this scient only adheres to the current accepted lifestyle and not looking outside the box. He needs to check on what causes these fats(mostly linoleic) to disrupt themetabolism in the mitochondria. Perhaps they are actually not meant to be consume at the levels we are currently doing due to our fear of animal fats.

Bikman is an idiot, forget Bikman.

The cause of the cell being fat is that you are constantly bombarding it with insulin and not exercising or fasting enough to reverse it.

Yeah, that's obvious! But I was asking about the mechanism of DAG's accumulation. It will be good to know why.

What I see here is a pattern. When you have higher saturation of glucose and lipids in the blood at the same time, then the problems starting to appear.

DAGs block IRS-1, which is the first step in the insulin signaling. GLUT-4 translocation is farther downstream. "But what is the reason for accumulation of the DAG's" 1. High-fat diet -> High level of fatty acids in the blood -> Too much of fatty acids in cells. 2. High fat diet -> Insulin too low -> muscle LPL too high -> too much TGs are unloaded in muscles 3. Hardly any exercise -> overfed cells -> too much fat in cells

@@erastvandoren A lot of people are saying that a diet rich in carbohydrates, especially in a form that quickly raises blood sugar nad fructose tend to eventually lead to diabetes. You are basically saying the opposite?

Just forget Fung, Bikmann, Lustig. They are either morons, or not honest, and I don't know which is worse.

@@erastvandoren Dude you don't match up to any of them, so calm down

I think he said fat-derived DAGs in muscle cells cause them to resist glucose. Some can reverse diabetes on a potato-only diet.

Shulman? He said essentially whatever works - he is diet agnostic. Peter Attia would recommend time-restricted or keto if you can adapt your lifestyle to long-term adherence.

Intermittent fasting and exercise.

Obviously, his work shows that fats are toxic. Do low-fat plant-base.

It doesn't work like that at all. Insulin resistance isn't obesity and you can be very fat without being insulin resistant and losing weight won't necessarily help at all. Reducing the CARBS does not need to reduce calories and the point is not to lose weight. These people are insulin resistant in the first place largely due to eating way too much carbohydrate especially simple carbs. Simple carbs are not good for you and should not be eaten in the very large amounts. If you ate 300 grams of carbs eating beans you would probably not have too much problem but if you eat the RDA of 300 grams of carbs with bread, soda and the other garbage most people do then you can be almost 100% sure you are overeating carbs unless you are extremely active. Insulin resistance is mostly caused by the liver becoming overstuffed and then fatty. If your liver is not fatty you don't have insulin resistance, if you do you are on the fast track to t2 diabetes. Fructose and alcohol are very very hard on the liver and can only be processed in the liver. If your liver glycogen is full then there is nowhere else for the fructose and alcohol to go but turn into fat. The more fat you have in your liver the more sugar your liver shoots out and the smaller the glycogen store becomes because it is damage. So to lose insulin resistance forget about weight loss, it doesn't matter how much your weight is only your liver fat. To fix this reduce carbs FOREVER to much more reasonable levels or even down to zero for a while and NO SIMPLE CARBS AT ALL. Exercise as well as this will get rid of the excess sugar and liver fat. Do some fasting as ALL the weight you lose in this manner will come from your liver fat directly. DO NOT do a low calories diet for long periods, though you can do it for short periods of a week or less at a time without reducing the metabolism too much. High insulin reduces your metabolism as well so if you can reduce carbs then fat will naturally tend to come off anyway so if you are too fat this should help in that regard as well. When you fast it actually raises your metabolism for the first three days so if you want to get rid of t2 diabetes and insulin resistance then doing a schedule of fasting like eating every other day is the fastest way. Eating foods like egg with choline also reduces liver fat. Vegetable oils also cause insulin resistance and are one of the big problems with processed foods. So if you avoid these bad foods and eat some of the better ones like egg and do occasional fasting then you can eliminate this problem basically right away. If your actual pancreas is ruined it is much harder to recover but if it's still OK then t2 diabetes can be eliminated basically overnight if you change your behavior to stop eating modern garbage food.

Agree with Pottinger's Human. Completely. An addition, humans were meant to have subcutaneous fats, not visceral. Humans were meant to eat when it was available and fatten up, and then use fats for ketones efficiently to support our very large brain size and our reproductive capabilities. The whole point is that we evolved tapping into both amd we need to emulate our ancestors. Agriculture is relatively new and metabolically healthy people are hard to come by. Top 4 changes are 1) eliminate refined sugars 2) eliminate refined grain, especially wheat 3) eliminate processed factory fats 4) eliminate transfats. High fructose foods should only be consumed if having intensity exercise and in small amounts..and best in some ancestral form, like honey.

@@LTPottenger no one said all obese people are insulin resistance, nor that insulin resistance always leads to obesity (e.g., “skinny fat”). But insulin resistance can indeed lead to obesity. To deny that is to deny facts. Fasting can help reverse the condition, but it must be done carefully. Simply putting people on unsustainably low calorie diets and then blaming them when the “edit” fails may make thin people feel smugly superior, but it doesn’t solve the problem.

@@dana102083 well, you can continue to insist that the only reason people get fat is because they eat too much and exercise too little, or you can actually update your prejudices to bring them more in line with facts.

@@DeniseCummins You are wrong, not much else to say. If the 'calories in calories out" nonsense worked no one would be obese in the first place, it is just a slogan made up by a coca cola thinktank to make stupid people think it's ok to eat sugar but it's not, it's very unhealthy. When people eat low carb or fast they don't flame out and rebound, they break their dependence. If you are insulin resistant it is the only way to get over it with a reasonable success rate. When you get a t2 diabetes diagnosis the average life expectancy is ten years, that is all you will get out of the CICO mantra. Do the same thing you get the same result, what a shock. Expecting otherwise is the definition of insanity.

People want to enjoy Micky D's without Metabolic Mayhem.

I think you have it backwards - its not because they're 'overfed and overfat'. Diabetes is a hormone problem. These people who are insulin resistant overeat because they are starving on a cellular level. Hormones such as leptin (known to increase insulin sensativity) don't act the same way in resistant people. Dr. Shulman and his wife Dr. Petersen have published countless papers on issues such as this. Tldr: You don't get fat because you eat to much. You eat too much because you're fat (or insulin resistant). Also, uncontrolled/elevated blood glucose IS clinically shown to be a major health detriment - its horrible for your arteries and veins. Poor blood supply to the eyes: retinopathy. Poor supply to the feet - infection, gangrene, necrosis, amputations. Effect on the heart: Cardiac diseases explode.

@@stoopz3634 , Yep, this is also what Gary Taubes and David Ludwig have been saying for years. No one listens. This is because the solution to controlling hunger is eating less carbohydrates, particularly refined ones. Why, then, are we talking about "glucose disposal" from the blood stream rather than not eating glucose producing foods in the first place?

@@martinirving3824 I'd agree restricting carbs helps some people or consuming alot more fiber. There are also populations that do quite ok on high carb diets like the Japanese. Their culture is different and consume a lot less sucrose.

@Erast Van Doren no need for derogatory name calling. 😞

Yes they did.

It's not a version, it's the truth. The scientific consensus. Fats are bad. kzfaq.info/get/bejne/m9R5qcl0np6ZhWw.html

go away@@erastvandoren

Also, when he talks about being able to find IR four hours after introducing fatty acids, he is referring to glucose being used up by four hours, and NOW glucose is gone, fat is now being burned and is BLOCKING the burning of glucose, AKA, looks like IR, the glucose cannot be cleared because fat is burning. That is not insulin resistance, that is the Randle Cycle!!!

Oh yh this is without any insuline metformine and statins anyone interested in how ive got rid of the fatty liver just pm me obviously im not a doctor or anything just wanna share my experiences

Doctors have used low-fat diet as a cure since the 1940s. Look up rice diet and Walter Kempner. Also, DAGs and blocking of insulin signaling pathways are known for a while.

@@erastvandorenwhat are the DAGs coming from though? Dietary fat or denovo lipogenesis?

@@allanchino35 There is never much DNL

DAG are synthesized then body is in calorie excess. Over 90% fats in DAG's comes from fatty acids, also body can synthesizes from carbohydrates if body have calorie excess. One fatty acid molecule in DAG's is saturated fatty acid another unsaturated. Peter hypothesis is incorrect, not going deep peroxide generated in mitochondria from electron transfer chain complex 3, can only reach cytoplasm and regulate insulin sensitivity. Not from complexes 1 or 2 about which Peter talks. So it's irrelevant how that fatty acids are metabolized, because complex don't discriminate between NADH or FADH2, because it receive electrons from ubiquinol (kzfaq.info/get/bejne/bsqfoZODyLfOfIE.html ). All boil down to energy balance.

@@liutasx weird :) consistently one fatty acid of the 2 is unsaturated? i'd guess monounsat then? i thought the body generally preferred making triglycerides out of sat fat. are there any other conditions than just calorie excess where DAGs might be made? Very interesting. I'm just a computer programmer, but this biochem stuff is so interesting.

@@SteveHazel en.wikipedia.org/wiki/Diglyceride#Metabolism : Since diacylglycerol is synthesized via phosphatidic acid, it will usually contain a saturated fatty acid at the C-1 position on the glycerol moiety and an unsaturated fatty acid at the C-2 position. It's not clear cut. DAG is energy source in muscle. Athletes have higher content of DAG, but have normal insulin resistance. www.ncbi.nlm.nih.gov/pmc/articles/PMC3178290/ : Total myocellular DAGs were markedly higher in highly trained athletes, corresponding with higher insulin sensitivity, and suggest a more complex role for DAGs in insulin action. In one context DAGs are energy source in another they block insulin signaling. I think that insulin sensitivity depends on energy status of cell. I don't know how much you have understood from Peter from, but I recommend to read this article, I hope will understand something :DDD (www.ncbi.nlm.nih.gov/pmc/articles/PMC3313496/ ). I'm opposite, I was biochemist, but now have transitioned to programming :D

@@liutasx i won't be transitioning to biochemist :) but it sure is interesting - thank you so much for the links and info - i'll be studyin' up :)

Saturated fat is nothing to do with anything in fact it is the safest energy form you can eat. There is no reason to care about DAGs or even triglycerides from the layman's standpoint. If your insulin is very low and triglycerides very high for example, you could be fooled to think you are storing a lot of fat which is what makes triglycerides bad, but in a low insulin state you are not. So it is basically useless info to try and optimize just like most blood tests are. When you eat excessive carbs especially simple carbs, you get insulin resistance. Same with vegetable oils. Basically your liver eventually gets fatty from eating these and then it shoots out lots of sugar into your system and the rest of your body simply cannot soak it all up and you get insulin reistance. Once this happens to the extent your liver is damaged and you cannot store glycogen in the liver then you immediately get t2 diabetes, like flipping a switch. You are just constantly shooting out sugar. To solve this exercise at moderate to low intensity or with HIIT training, eat lower carb and eliminate simple carbs especially fructose, remove vegetable oil from the diet, do some intermittent fasting, avoid alcohol. Do all this and you can very quickly reverse the issue but if you just try and do what the typical doctor says or to "lose weight" you will eventually wind up on insulin if you already have a problem.

Seriously Peter, your guest explains all the time how fats are bad, and you ask him at the end twice if sugar restriction might be beneficial? It's an insult.

I will wait for your video with this depth and quality.. Or are you just being lazy?

@@dana102083 does Peter pay his defenders? They seem to feel as if they speak and defend him. Wtf?

Hhm, as much I would like to see a video & faces I am so grateful that Peter shares all these gems for FREE with us here!

JT, It is highly disturbing that there isn't a single bit of appreciation in your post for all the immense work, effort, and time Peter Attia is putting into his interviews with world-class researchers to share their knowledge with us for free right-away.

I'm GLAD these aren't videos. I can put them on and listen while going about my day and not feel like I'm missing anything; not feel compelled to anchor myself to a screen. I think it makes them way more accessible and convenient.

@@farshidbondar2497 amazing how easily people get disturbed these days. Did someone die and make you the grand Peter Attia protectorate? Peter ignore the fools and create value at the same pace as the likes of say Lex Fridman.. Stop being lazy...

There is lecture from Gerald Shulman on things they talk from 2019 (kzfaq.info/get/bejne/itSmoKiGutrTiqs.html ). Enjoy.

That would be an awesome Christmas gift!

Pre Covid they were in person

yes & With Slides as much as possible !