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Short Summary
Main recommendation: Consider measuring fasting insulin and checking how insulin responds after a meal, not just blood glucose, because high insulin can drive many metabolic problems even when glucose and A1c look normal. Dr. Eric Westman and Amy Berger argue this under-tested issue is linked to conditions including hypertension, gout, cardiovascular disease, and possibly Alzheimer's. Dr. Westman notes that testing makes most sense if someone has been doing low-carb or fasting keto and is still struggling, since fasting insulin may already be low in others.
Key Points
- Many people have normal blood sugar and A1c because very high insulin is keeping glucose in check; these people may not suspect a problem.
- Conditions the speakers link to high insulin, even with normal glucose, include PCOS, hypertension, gout, cardiovascular disease, erectile dysfunction, and abdominal obesity.
- Amy Berger credits Ivor Cummins ("The Fat Emperor") for popularizing Dr. Kraft's work; Dr. Kraft used oral glucose tolerance tests extended to five hours with insulin measured, testing several thousand people, according to Amy Berger.
- Amy Berger says that in Dr. Kraft's work, only about 20% of people had a normal insulin response, where insulin rose at 30 minutes and then came down quickly.
- A normal fasting insulin level can hide high post-meal insulin, which may stay elevated most of the day after a high-carbohydrate meal.
- Amy Berger says insulin also affects the heart, blood vessels, and kidneys independently of blood glucose, and she links chronically high insulin to a possible long-term dementia risk, while emphasizing this is only a potential link.
Details Worth Noting
- Concrete instructions: A fasting insulin test is suggested as a reasonable step, since an elevated result signals a problem. If fasting insulin is normal, it does not rule out high post-meal insulin. Testing makes most sense if you already follow a low-carb or fasting keto approach but still aren't losing weight or your health problems aren't improving, since your fasting insulin may already be low and the test may be less informative. In the medical field, a glucose tolerance test can add insulin measurements at 30 minutes, one hour, two hours, and sometimes five hours after drinking 75 grams of sugar; the speakers note low-carb keto followers often find this unappealing.
- Metformin is described as a tool that some keto-practicing doctors add to target high insulin, with relatively low side effects. Dr. Westman says he does not typically use it and instead reassures patients that they don't need carbs or extreme discipline.
- The speakers say that finding high insulin early in younger people could allow changes that might potentially delay or prevent later dementia, though they stress this is only potential.
- Amy Berger notes that insulin is not just a blood sugar hormone; it has broader effects, and rising blood glucose is what triggers insulin to rise.
Bottom Line
Normal blood sugar and A1c don't rule out chronically high insulin, and testing insulin, especially after meals, may reveal problems that routine tests miss.
