Dr. Boz [Annette Bosworth, MD] - How To Tell If You Are STILL Insulin Resistant

This is what insulin resistance looks like. I don't look like that anymore, but the years of insulin resistance still affect me, and I can spot it in others across the room. So how do you get rid of it? For that, we're going to have to take a deeper look into those cells.

At first glance, this might look like a piece of ham and a bone, but really it's a drawing of muscle cells. As you look at the sequence of smaller and smaller cells, you will find that at the end are these very two tube-like looking cells. If I would have started here, you would have thought I was talking about a hot dog, and I didn't want that confusion. This is a muscle cell, and when we look deep inside a muscle cell, it has a very common lining found in almost every cell in our body. It is called a bilayer phospholipid layer. That's where these yellow balls on the outside, with some sticks on the inside, meet up and hold this cell together, along with lots of communication devices that keep the outside of the cell and the inside of the cell separate.

Here in this muscle cell, I've put four mitochondria in blue, and you've got two nuclei, or the command center of the cell. When teaching about muscle cells and their insulin resistance, we've got Mr. Insulin right up there on the left, and an insulin receptor. That insulin receptor will be sitting in the lining of this cell, along with any cell in our body that is under the rule or the dictatorship of insulin. Here are the other players: we've got glucose and we've got something called a GLUT4 receptor. I'd like you to think about this as a straw or a siphon that will connect the outside to the inside of the cell when we're talking about glucose. Let's put that insulin receptor in the cell lining, and it will sit and wait for the instruction from insulin.

Let's start with a patient who does not make insulin. This would be a type 1 diabetic, where their pancreas no longer makes insulin, and they would need to come to me for a prescription before adding insulin back to their system. Their body would not allow glucose to enter the cell. That glucose would stay in circulation and outside the muscle cell, because the signal to pull glucose inside the cell is from insulin, and in this case there is none.

Now let's move to a healthy person who makes insulin. We have some glucose in circulation, and we have a muscle cell that is kind of hungry. Insulin comes along and says, let's put that glucose inside the cell. Here, both of those insulin receptors are filled with insulin, sending a signal that these straws, or these receptors, move to the cell lining and allow the glucose to siphon into the cell. With both of these straws hanging out in that cell lining, the glucose will be siphoned from the outside of the cell to the inside of the cell. Halfway through the process, you will see one of those insulins dissociate, but because this patient is so insulin sensitive, in other words, because they're so healthy, that one signal of insulin still keeps the other receptor waiting until its job is done. This is a very healthy patient.

Now let's move to someone not so healthy. This patient has insulin resistance, and they have been building this insulin resistance for several decades. You'll notice there are now five insulin receptors along the way, and you'll notice that the shape of our insulin looks a little different. He's got flames and an angry face, because this is what insulin resistance looks like. There is a ton of insulin in their body, and when there is enough glucose in their circulation, five insulins bind to those receptors, yet only one straw makes it to the edge of that muscle cell. As that straw tucks into that cell lining, it will allow several of those glucose to come in, but as soon as that glucose drops, one of the insulins takes off to another job. After the fifth insulin leaves the scene, those four insulins are still trying to say, hey, there's plenty of glucose here, why don't you go inside the cell? But because of the insulin resistance, that straw will not migrate to the edge of the cell without all five of those insulins present in their parking spots. Now the blood glucose goes even higher, and only when the fifth insulin comes back will they be able to lower the glucose again. This leaves a chronically deprived muscle cell. It cannot get enough glucose for what it's asking for.

So what happens when I put an insulin-resistant patient on a ketogenic diet? Well, the first thing is we drop their intake of carbohydrates, a very low-carb, high-fat diet that results in less insulin. Take a look: with lower carbohydrates coming into this insulin-resistant patient, only three of those insulins are now parking in those receptors, and that results in no sugar getting to the inside of that muscle cell. Those mitochondria get hungry. They want energy, and they begin to signal, hey, any type of fuel, we would take it right now. This signal to make ketones is heard loud and clear by your liver cells, and they do turn strings of fat into ketones. Those ketones do not need the permission of Mr. Insulin to get inside the cell. After two or three days of that low-carb, high-fat fuel, the muscle cells are finally getting energized by these ketones entering the cell. With less carbohydrates coming in, there's less glucose in circulation, and over the next two or three weeks that blood sugar lowers more and more. Finally, some of those insulin receptors disappear, and within a few weeks, three insulins will deliver the message to that straw that will pull glucose back into that muscle cell. So the first step of reversing insulin resistance is to deliver ketones inside that muscle cell.

Okay, this can be a little confusing, so let me give you two examples of patients trying to reverse insulin resistance: one who's doing a good job and one who cannot seem to break the plateau. The one who did a good job lowered that insulin by, you guessed it, eating sardines every day for 30 days. Now, I'm not promoting that, and I don't think I could eat sardines for that long, but I got this message from a patient who said, "I just couldn't keep my blood sugars down, and I kept falling off the wagon, so I put myself on a sardine-only diet for 30 days, and Doc, look what happened." As you watch the progress of his fasting sugars, that improvement didn't happen much the first week, but week after week after week, his blood sugars lowered, and his ketone production stayed above one. This is a good signal that his liver continued to produce the fuel that did not require insulin to get inside those muscle cells. In the meantime, he was using sauna and going for a walk for the first time in years.

Now let's look at a different approach. This patient decreases her carbohydrates to 20 or less and cuts her eating window down to four hours a day. She's able to hold that eating window for five or six days. A couple of times she even made it over a week, and then she falls off the wagon. She has cravings and really can't say no, and eats far too much for her insulin resistance. This primes the pump, and her pancreatic cells absolutely remember how to make that much insulin. She's living in a cycle where she's able to cut her eating window and be disciplined for a few days, but is not able to stay the course.

When you compare this to the first example, that patient was able to steadily stay under 20 total carbohydrates, or less. In fact, it was probably under 10, and the amount of insulin produced with that sardine-only diet kept his glucose low and his ketones in high production. In contrast, this insulin-dependent woman was only able to keep her menu strictly in a four-hour window for a short period of time before she would fail and then have to start over.

Well, insulin isn't that forgiving. Patients write in and say, "Dr. Boz, why do you fast every week?" The answer is, I've been insulin resistant, and the only way I could keep the volume of food and the insulin production low enough in my own life was to have at least a 48-hour fast every week. Then, the other days of the week, my eating window was something I could live with. Don't want to eat sardines for a whole month? Check out that video where I give you the seven best foods for insulin resistance.