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Klimis-Tavantzis | McNeill | > Rosedale | Nicholson | Sears Debate
Ron Rosedale, M.D.
Insulin and It's Metabolic Effects
Presented at Crayhon Research Institute's BoulderFest August 1999
Seminar      
       Let's talk about a couple of case histories. These are actual
patients that I've seen; let's start with patient A. This patient who
we will just call patient A saw me one afternoon and said that he had
literally just signed himself out of the hospital "AMA," or against
medical advice. Like in the movies, he had ripped out his IV's. The
next day he was scheduled to have his second by-pass surgery. He had
been told that if he did not follow through with this by-pass surgery,
within two weeks he would be dead. He couldn't walk from the car to
the office without severe chest pain. He was on 102 units of insulin
and his blood sugars were 300 plus. He was on eight different
medications for various things. But his first by-pass surgery was such
a miserable experience he said he would rather just die than have to
go through the second one and had heard that I might be able to
prevent that. To make a long story short, this gentleman right now is
on no insulin. I first saw him three and a half years ago. He plays
golf four or five times a week. He is on no medications whatsoever, he
has no chest pain, and he has not had any surgery. He started an
organization called "Heart Support of America" to educated people that
there are alternatives to by-pass surgery that have nothing to do with
surgery or medication. That organization, he last told me had a
mailing list of over a million people, a large organization, "Heart
Support of America."
       Patient B is a patient who had a triglyceride level of
2200. Patient B was referred by patient A. He had a triglyceride of
2200, cholesterol of 950 and was on maximum doses of all of his
medications. He was 42 years old, and he was told that he had familial
hyperlipidema and that he had better get his affairs in order, that if
that was what his lipids were despite the best medications with the
highest doses, he was in trouble. He was not fat at all, he was fairly
thin. Whenever I see a patient on any of those medications, they're
off the very first visit. They have no place in medicine. He was taken
off the medications and in six weeks his lipid levels, both his
Triglycerides and his cholesterol were hovering around 220. Six more
weeks they were both under 200, off of the medications. They have no
place in medicine. I should mention that this patient had a CPK that
was quite elevated. It was circled on the lab report that he brought
in initially with a question mark by it because they didn't know
why. The reason why was because he was eating off his muscles, because
if you take (gyinfibrozole) and any of the HMG co-enzyme reductase
inhibitors together, that is a common side effect that is in the PDR,
and they shouldn't be given together. So he was chewing up his
muscles, including his heart which they were trying to treat. So if
indeed he was going to die, it was going to be that treatment that was
going to kill him.
       Let's go to something totally different, a lady with severe
osteoporosis. She is almost three standard deviations below the norm
in both the hip femeral neck and the cervical vertebrae, and she is
very worried about getting a fracture. A fairly young woman and she
was put on a high carbohydrate diet and told that would be of benefit,
and placed on estrogen, which is a fairly typical treatment. They
wanted to put her on some other medicines and she didn't want to, she
wanted to know if there was an alternative. Although we didn't have as
dramatic a turn around, we got her to one standard deviation below the
norm in a year, taking her off the estrogen she was on, anyway.
       Let's go to calaudication. That is severe angina of the leg
when you walk, same thing as angina of the heart except of the
leg. While walking, after walking a certain distance, there is
pain. There was a gentleman who had extremely severe calaudication,
who happens to be my stepfather. It was a typical case, he would walk
about fifty yards and then he would get severe, crampy pain in his
legs. He was quite well off and was going to see the best doctors in
Chicago, and they couldn't figure out what was wrong with him
initially. He went to a neurologist, they thought it might be
neurological pain or back pain. He finally went to a vascular surgeon
who said he thought it was vascular disease, so they did an
artheriogram and sure enough, he had severe vascular disease. They did
Doppler studies on his anko-bracheal ratio on one side and it was 0.6,
normal is around 1.1. 0.4 and you are in trouble for gangrene, so it
was pretty bad, and they wanted to do the typical by-pass surgery that
they normally do on this. He was thinking of going in for the surgery
for one reason, they had a trip planned to Europe in two weeks, and he
wanted to be able to walk since they normally do a lot of walking. Ten
years previously he'd had an angioplasty for heart disease. At the
time ten years ago, I told him he had to change his diet and he didn't
of course. But this time he listened. I said that if he was not going
to have a by-pass, then do exactly what I tell you to do and in two
weeks you'll be walking just fine because by modulating this one
aspect of his disease, I have never seen it not work, and it works
very quickly to open up the artery.
       We can talk about a patient with a very high cancer risk. She
had a mother and a sister who both died of breast cancer and she
didn't want to, so she came in and I put her on the exact same
treatment as the other cases I just mentioned. They were all treated
virtually identically because they all had the same thing wrong with
them.
What would be the typical treatment of cardiovascular disease? First
they check the cholesterol. High cholesterol over 200, they put you on
cholesterol lowering drugs and what does it do? It shuts off your
CoQ10. What does CoQ10 do? It is involved in the energy production and
protection of little energy furnaces in every cell, so energy
production goes way down. A common side effect of people who are on
all these HMG co-enzyme reductase inhibitors is that they tell you
their arms feel heavy. Well, the heart is a muscle too, and it's going
to feel heavy too. One of the best treatments for a weak heart is
CoQ10 for congestive heart failure. But they have no trouble shutting
CoQ10 production off so that they can treat a number. And the common
therapies for osteoporosis are drugs, and the common therapy for
calaudication is surgery. For cancer reduction there is nothing. But
all of these have a common cause.
The same cause as three major avenues of research in aging. One is
called caloric restriction. There are thousands of studies done since
the fifties on caloric restriction. They restrict calories of
laboratory animals. They have known since the fifties that if you
restrict calories but maintain a high level of nutrition, called
"C.R.O.N.'s:" Caloric restriction with optimal nutrition, or adequate
nutrition, which would be CRAN"S, these animals can live anywhere
between thirty and two-hundred percent longer depending on the
species. They've done it on several dozen species and the results are
uniform throughout. They are doing it on primates now and it is
working with primates, we won't know for sure for about another ten
years, they are about half way through the experiment, our nearest
relatives are also living much longer.
Then there are Centenarian studies. There are three major centenarian
studies going on around the world. They are trying to find the
variable that would confer longevity among these people. Why do
centenarians become centenarians? Why are they so lucky? Is it because
they have low cholesterol, exercise a lot, live a healthy, clean life?
Well the longest recorded known person who has ever lived, Jean
Calumet of France who died last year at 122 years, smoked all of her
life and drank. What they are finding on these major centenarian
studies is that there is hardly anything in common among them. They
have high cholesterol and low cholesterol, some exercise and some
don't, some smoke, some don't. Some are nasty as can be and some nice
and calm and nice. Some are ornery, but they all low sugar, relatively
for their age. They all have low triglycerides for their age. And they
all have relatively low insulin. Insulin is the common denominator in
everything I've just talked about. They way to treat cardiovascular
disease and the way I treated my stepfather, the way I treated the
high risk cancer patient, and osteoporosis, high blood pressure, the
way to treat virtually all the so-called chronic diseases of aging is
to treat insulin itself.
The other major avenue of research in aging has to do with genetic
studies of so-called lower organisms. We know the genetics
involved. We've got the entire genes mapped out of several species
now, of yeast and worms. We think of life span as being fixed, sort
of. Humans kind of have an average life span of seventy-six, and the
maximum life-span was this French lady at one-hundred and
twenty-two. In humans we feel it is relatively fixed, but in lower
forms of life it is very plastic. Life span is strictly a variable
depending on the environment. They can live two weeks, two years, or
sometimes twenty years depending on what they want themselves to do,
which depends very much on the environment. If there is a lot of food
around they are going to reproduce quickly and die quickly, if not
they will just bide their time until conditions are better. We know
now that the variability in life span is regulated by insulin.
One thinks of insulin as strictly to lower blood sugar. Today in the
clinic there was a patient listing off her drugs, she listed about
eight drugs she was on and didn't even mention insulin. Insulin is not
treated as a drug. In fact, in some places you don't even need a
prescription, you can just get it over the counter, it's treated like
candy. Insulin is found as in even single celled organisms. It has
been around for several billion years. And its purpose in some
organisms is to regulate life span. The way genetics works is that
genes are not replaced, they are built upon. We have the same genes as
everything that came before us. We just have more of them. We have
added books to our genetic library, but our base is the same. What we
are finding is that we can use insulin to regulate lifespan too.
If there is a single marker for lifespan, as they are finding in the
centenarian studies, it is insulin, specifically, insulin
sensitivity. How sensitive are your cells to insulin. When they are
not sensitive, the insulin levels go up. Who has heard of the term
insulin resistance? Insulin resistance is the basis of all of the
chronic diseases of aging, because the disease itself is actually
aging. We know now that aging is a disease. The other case studies
that I mentioned, cardiovascular disease, osteoporosis, obesity,
diabetes, cancer, all the so-called chronic diseases of aging,
auto-immune diseases, those are symptoms. If you have a cold and you
go to the doctor, you have a runny nose, I did Ear, Nose and Throat
for ten years, I know what the common treatment for that is, they give
you a decongestant. I can't tell you how many patients I saw who had
been given Sudafed by their family doctors for a cold and they came to
see me after because of a really bad sinus infection. What happens
when you treat the symptom of a runny nose from a cold and you take a
decongestant? It certainly decongests you by shutting off the
mucus. Why do you have the mucus, because you are trying to clean and
wash out the membranes, and what else? What else is in mucus?
Secretory IgA, a very strong antibody to kill the virus is in the
mucus. If there is no mucus, there is no secretory IgA. Decongestants
also constrict blood vessels, the little capillaries, or arterioles
that go to those capillaries, the cilia, the little hair-like
projections that beat to push mucus along to create a stream, they get
paralyzed because they don't have blood flow so there is no more
ciliary movement. What happens if you dam a stream and create a pond?
In days you've got larvae growing. If the stream is moving, you are
fine. You need a constant stream of mucus to get rid of and prevent an
infection. I am going in to this in some detail because in almost all
cases if you treat a symptom, you are going to make the disease worse
because the symptom is there as your body's attempt to heal
itself. Now, the medical profession is continuously segregating more
and more symptoms into diseases, they call the symptoms
diseases. Using ENT for example, that patient will walk out of there
with a diagnosis of Rhinitis which is inflammation of the nose. Is
there a reason that patient has inflammation of the nose? I think
so. Wouldn't that underlying cause be the disease as opposed to the
descriptive term of Rhinitis or Pharyngitis? Some one can have the
same virus and have Rhinitis or Pharyngitis, or Sinusitis, they can
have all sorts of "itis's" which is a descriptive term for
inflammation. That is what the code will be and that is what the
disease will be. So they treat what they think is the disease which is
just a symptom.
It is the same thing with cholesterol. If you have high cholesterol it
is called hypercholesterolemia. Hypercholesterolemia has become the
code for the disease when it is only the symptom. So they treat that
symptom and what are they doing to the heart? Messing it up.
So what you have to do if you are going to treat any disease is you
need to get to the root of the disease. If you keep pulling a
dandelion out by it's leaves, you are not going to get very far. But
the problem is that we don't know what the root is, or we
haven't. They know what it is in many other areas of science, but the
problem is that medicine really isn't a science, it is a business, but
I don't want to get in to that, we can talk hours on that. But if you
really look at the root of what is causing it, we can use that cold as
a further example. Why does that person have a cold? If he saw the
doctor, the doctor might tell him to take an antibiotic along with the
decongestant. You see this all the time because the doctor wants to
get rid of the patient. Well we all know that in almost all cases of
an upper respiratory infection it is a virus, and the antibiotic is
going to do worse than nothing because it is going to kill the
bacterial flora in the gut and impair the immune system, making the
immune system worse. The patient might see someone else more
knowledgeable who will say no, you caught a virus, don't do anything,
go home and sleep, let your body heal itself. That's better. You might
see someone else who would ask why you caught a virus without being
out there trying to hunt for viruses with a net. We are breathing
viruses every day; right now we are breathing viruses, cold viruses,
rhinoviruses. Why doesn't everybody catch a cold tomorrow? The Chinese
will tell you that it is because the milieu has to be right, if the
Chinese were to quote the French. Your body has to be receptive to
that virus. Only if your immune system is depressed will it allow that
virus to take hold.
So maybe a depressed immune system is the disease. So you can be given
a bunch of vitamin C because your immune system is depressed and it is
likely that the person has a vitamin C deficiency. That's where most
of us are at right now, where we would give a bunch of vitamin C to
try to pick up the immune system. But why is the vitamin C not
working. Vitamin C is make in almost all living mammals except humans
and a couple other species. Vitamin C is made directly from glucose
and actually has a similar structure and they compete for one
another. We've known for many years that sugar depresses the immune
system. We have known that for decades. It was only in the 70's that
they found out that vitamin C was needed by white blood cells so that
they could phagocytize bacteria and viruses. White blood cells require
a fifty times higher concentration at least inside the cell as outside
so they have to accumulate vitamin C. There is something called a
phagocytic index which tells you how rapidly a particular macrophage
or lymphocyte can gobble up a virus, bacteria, or cancer cell. It was
in the 70's that Linus Pauling knew that white blood cells needed a
high dose of vitamin C and that is when he came up with his theory
that you need high doses of vitamin C to combat the common cold. But
if we know that vitamin C and glucose have similar chemical structure,
what happens when the sugar levels go up? They compete for one another
upon entering the cells. And the thing that mediates the entry of
vitamin C into the cells is the same thing that mediates the entry of
glucose into the cells. If there is more glucose around there is going
to be less vitamin C allowed into the cell and it doesn't take much. A
blood sugar value of 120 reduces the phagocytic index seventy-five
percent.
Here we are getting a little bit further down into the roots of
disease. It doesn't matter what disease you are talking about, whether
you are talking about a common cold or about cardiovascular disease,
or osteoporosis or cancer, the root is always going to be at the
molecular and cellular level, and I will tell you that insulin is
going to have its hand in it, if not totally controlling it.
What is the purpose of insulin? As I mentioned, in some organisms it
is to control their lifespan, which is important. What is the purpose
of insulin in humans? If you ask your doctor, they will say that it's
to lower blood sugar and I will tell you right now, that is a trivial
side effect. Insulin's evolutionary purpose, among others at least
known right now, we are looking at others, is to store excess
nutrients.
We come from a time of feast and famine and if we couldn't store the
excess energy during times of feasting, we would all not be here,
because we all have had ancestors that encountered famine. So we are
only here because our ancestors were able to store nutrients, and they
were able to store nutrients because they were able to elevate their
insulin in response to any elevation in energy that the organism
encountered. When your body notices that the sugar is elevated, it is
a sign that you've got more than you need right now, you are not
burning it so it is accumulating in your blood. So insulin will be
released to take that sugar and store it. How does it store it?
(Someone in the audience suggest the answer glycogen)?Glycogen? How
much glycogen do you store? Do you know how much glycogen you have in
your body at any one time? Very little. All the glycogen stored in
your liver and all the glycogen stored in your muscle if you had an
active day wouldn't last you the day. Once you fill up your glycogen
stores how is that sugar is stored, as what particular kind of
triglyceride, or fatty acid? Palmitic acid. Saturated fat,
ninety-eight percent of which is palmitic acid.
So the idea of the medical profession to go on a high complex
carbohydrate, low saturated-fat diet is an absolute oxymoron, because
those high complex carbohydrate diets are nothing but a high glucose
diet, or a high sugar diet, and your body is just going to store it as
saturated fat. The body makes it into saturated fat quite readily.
What else does insulin do? It doesn't just store carbohydrates, by the
way. Somebody mentioned that it is an anabolic hormone, it absolutely
is. Body builders are using insulin now because it is legal, so they
are injecting themselves with insulin because it builds muscle, it
stores protein too.
A lesser known fact is that insulin also stores magnesium. We
mentioned it's role in vitamin C, it stores all sorts of
nutrients. But what happens if your cells become resistant to insulin?
First of all you can't store magnesium so you lose it, that's one
effect, you lose it out the urine. What is one of magnesium's major
roles? To relax muscles. Intracellular magnesium relaxes muscles. What
happens when you can't store magnesium because the cell is resistant?
You lose magnesium and your blood vessels constrict, what does that
do? Increases blood pressure, and reduces energy since intracellular
magnesium is required for all energy producing reactions that take
place in the cell. But most importantly, magnesium is also necessary
for the action of insulin. It is also necessary for the manufacture of
insulin. So then you raise your insulin, you lose magnesium, and the
cells become even more insulin resistant. Blood vessels constrict,
glucose and insulin can't get to the tissues, which makes them more
insulin resistant, so the insulin levels go up and you lose more
magnesium. This is the vicious cycle that goes on from before you were
born.
Insulin sensitivity is going to start being determined from the moment
the sperm combines with the egg. If your mother, while you were in the
womb was eating a high carbohydrate diet which is turning into sugar,
we have been able to show that the fetus in animals becomes more
insulin resistant. Worse yet, they are able to use sophisticated
measurements, and if that fetus happens to be a female, they find that
the eggs of that fetus are more insulin resistant. Does that mean it
is genetic? No, you can be born with something and it doesn't mean
that it is genetic. Diabetes is not a genetic disease as such. You can
have a genetic predisposition. But it should be an extremely rare
disease.
What else does insulin do? We mentioned high blood pressure, if your
magnesium levels go down you get high blood pressure. We mentioned
that the blood vessels constrict and you get high blood
pressure. Insulin also causes the retention of sodium, which causes
the retention of fluid, which causes high blood pressure and fluid
retention: congestive heart failure.
One of the strongest stimulants of the sympathetic nervous system is
high levels of insulin. What does all of this do to the heart? Not
very good things.
There was a study done a couple of years ago, a good, down to earth
nicely conducted study that showed that heart attacks are two to three
times more likely to happen after a high carbohydrate meal. They said
specifically NOT after a high fat meal. Why is that? Because the
immediate effects of raising your blood sugar from a high carbohydrate
meal is to raise insulin and that immediately triggers the sympathetic
nervous system which will cause arterial spasm, constriction of the
arteries. If you take anybody prone to a heart attack and that is when
they are going to get it.
What else does insulin do? Insulin mediates blood lipids. That patient
who had a triglyceride of 2200, one of the easiest things we can do is
lower triglyceride levels. It is so simple. There was just an article
in J.A.M.A. an article and they were saying that the medical
profession doesn't know how to reduce triglycerides dietarily, that
drugs still need to be used. It is so ridiculous because you will find
that it is the easiest thing to do. They come tumbling down. There is
almost a direct correlation between triglyceride levels and insulin
levels. In some people more than others. The gentleman who had a
triglyceride level of 2200 while on all the drugs only had an insulin
level of 14.7. That is only slightly elevated, but it doesn't take
much in some people, all we had to do was get his insulin level down
to 8 initially and then it went down to six and that got his
triglycerides down to under 200.
The way you control blood lipids is by controlling insulin. We won't
go into a lot of detail, but we now know that LDL cholesterol comes in
several fractions, and it is the small, dense LDL that plays the
largest role in initiating plaque. It's the most oxidizable. It is the
most able to actually fit through the small cracks in the
endothelium. And that's the one that insulin actually raises the
most. When I say insulin, I should say insulin resistance. It is
insulin resistance that is causing this.
       Cells become insulin resistant because they are trying to
protect themselves from the toxic effects of high insulin. They down
regulate their receptor activity and number of receptors so that they
don't have to listen to that noxious stimuli all the time. It is like
having this loud, disgusting rap music played and you want to turn the
volume down. You might think of insulin resistance as like sitting in
a smelly room and pretty soon you don't smell it anymore because you
get desensitized. You can think about it, its not that you are not
thinking about it anymore. But if you walk out of the room and come
back, the smell is back. You can get resensitized is what that is
telling you. It would be like you are starting to go deaf and your are
telling others to speak up because you can't hear them, so if I was
your pancreas, I would just start talking louder, and what does that
do to your hearing? You would become deafer. Most cases of deafness,
especially in old age is due to excessive noise exposure. All the
noise exposure your ears have been exposed to, well the hair cells
that end up triggering your brain to allow you to hear eventually get
killed. Sometimes it just takes a single firecracker.
This is the same thing with insulin resistance. What happens is that
if your cells are exposed to insulin at all they get a little bit more
resistant to it. So the pancreas just puts out more insulin. I saw a
patient today, her blood sugar was 102 and her insulin was 90! She
wasn't sure if she was fasting or not, but I've seen other patients
where their blood sugar was under 100 and their fasting insulin has
been over 90. That is a fasting insulin. I'm not sure how many people
are familiar with seeing fasting insulins. But if I drank all the
glucose I could possibly drink my insulin would never go above
probably 40. So she was extremely insulin resistant. What was
happening was she was controlling her blood sugar. Statistically she
was not diabetic. She is not even impaired glucose tolerant. Her
glucose is totally normal supposedly. But her cells aren't listening
to insulin, she just has an exceptionally strong pancreas. Her islet
cells that produce insulin are extremely strong and are able to
compensate for that insulin resistance by producing thirty times more
insulin than what my fasting insulin is. And just by mass action her
pancreas is yelling so loud that her cells are able to listen, but
they are not going to listen forever. Her pancreas is not going to be
able keep up that production forever. Well the usual treatment once
she becomes diabetic, which would be inevitable, once her production
of insulin starts slowing down or her resistance goes up any more,
than her blood sugar goes up and she becomes a diabetic. For many
years, decades before that her insulin levels have been elevated. They
have been elevated for thirty years probably and have never been
checked. That insulin resistance is associated with the
hyperinsulinemia that produces all of the co-called chronic diseases
of aging or at least contributes to them. As far as we know in many
venues of science, it is the main cause of aging in virtually all
life. Insulin is that important. So controlling insulin sensitivity is
extremely important.
How else does insulin affect cardiovascular disease? We've only just
touched upon it. Insulin is a so-called mytogenic hormone. It
stimulates cell proliferation. It stimulates cells to divide. If all
of the cells were to become resistant to insulin we wouldn't have that
much of a problem. The problem is that all of the cells don't become
resistant. Some cells are incapable of becoming very resistant. The
liver becomes resistant first, then the muscle tissue, then the
fat. When the liver becomes resistant, what is the effect of insulin
on the liver, it is to suppress the production of sugar. The sugar
floating around in your body at any one time is the result of two
things, the sugar that you have eaten and how much sugar your liver
has made. When you wake up in the morning it is more of a reflection
of how much sugar your liver has made. If your liver is listening to
insulin properly it won't make much sugar in the middle of the
night. If your liver is resistant, those brakes are lifted and your
liver starts making a bunch of sugar so you wake up with a bunch of
sugar.
The next tissue to become resistant is the muscle tissue. What is the
action of insulin in muscles? It allows your muscles to burn sugar for
one thing. So if your muscles become resistant to insulin it can't
burn that sugar that was just manufactured by the liver. So the liver
is producing too much, the muscles can't burn it, and this raises your
blood sugar.
Well the fat cells become resistant, but not for a while. It is only
after a while that they become resistant. It takes them longer. Liver
first, muscle second, and then your fat cells. So for a while your fat
cells retain their sensitivity. What is the action of insulin on your
fat cells? To store that fat. It takes sugar and it stores it as
fat. So until your fat cells become resistant you get fat, and that is
what you see. As people become more and more insulin resistant, they
get fat and their weight goes up. But eventually they plateau. They
might plateau at three hundred pounds, two hundred and twenty pounds,
one hundred and fifty pounds, but they will eventually plateau as the
fat cells protect themselves and become insulin resistant.
As all these major tissues, this massive body becomes resistant, your
liver, muscles and fat, your pancreas is putting out more insulin to
compensate, so you are hyperinsulinemic and you've got insulin
floating around all the time, 90 units, more. But there are certain
tissues that aren't becoming resistant such as your endothelium, the
lining of the arteries do not become resistant very readily. So all
that insulin is effecting the lining of your arteries.
If you drip insulin into the artery of a dog, there was a Dr. Cruz who
did this in the early 70's by accident, he was doing a diabetic
experiment and found out that the femeral artery that the insulin was
being dripped into was almost totally occluded with plaque after about
three months. The contra lateral side was totally clear, just contact
of insulin in the artery caused it to fill up with plaque. That has
been known since the 70's, it has been repeated in chickens, in dogs,
it is really a well-known fact. Insulin floating around in the blood
causes a plaque build up. They didn't know why, but we know that
insulin causes endothelial proliferation, that's the first step, it
causes a tumor, an endothelial tumor.
Insulin causes the blood to clot too readily. Insulin causes the
conversion of macrophages into foam cells, which are the cells that
accumulate the fatty deposits. Every step of the way, insulin's got
its fingers in it and is causing cardiovascular disease. It fills it
with plaque, it constricts the arteries, it stimulates the sympathetic
nervous system, it increases platelet adhesiveness and coaguability of
the blood. Any known cause of cardiovascular disease insulin is a part
of. It influences nitric oxide synthase. You produce less nitric oxide
in the endothelium. We know that helps mediate vasodilatation and
constriction, i.e. angina.
I mentioned that insulin increases cellular proliferation, what does
that do to cancer? It increases it. And there are some pretty strong
studies that show that one of the strongest correlations to breast and
colon cancer are with levels of insulin.
Hyperinsulinemia causes the excretion of magnesium in the urine. What
other big mineral does it cause the excretion of? Calcium. What is the
cause of osteoporosis? There are two major causes, one is a high
carbohydrate diet which causes hyperinsulinemia. People walking around
with hyperinsulinemia can take all the calcium they want by mouth and
it's all going to go out in their urine.
Insulin is one of the first hormones that any organism ever developed,
and as I mentioned in genetics, things are built upon what was there
before. So all the other hormones we have in our body were actually
built upon insulin. In other words, insulin controls growth
hormone. How does growth hormone work? The pituitary produces growth
hormone, and then it goes to the liver and the liver produces what are
called IgF 1 thru 4, there are probably more. What does IgF stand for?
Insulin-like growth factor. They are the active ingredients. Growth
hormone has some small effects on its own, but the major growth
factors are the IgF's that then circulatge that is associated with
that day. We have accumulated more damage during that day, that is
called senescence. What causes that damage? There is often an example
of test tubes in a laboratory. You don't think of test tubes as aging,
yet if you mark test tubes with a little red dot and counted the
number of test tubes there were at the end of the year with a little
red dot left, there would hardly be any, why, because they have
encountered damage. They've broken, so even though there is not aging
they do have immortality rates. Aging is an increase in the rate of
mortality. In humans, the rate of mortality doubles every eight
years. That is really how you gauge the rate of aging. We found in
animal studies that the rate of aging can be largely controlled by
insulin. But the damage that accumulates during that aging is caused
by largely by sugar.
The two major causes of accumulated damage are oxygenation, and
glycation. I'm not going to spend my time talking about
oxidation. Most of you know all about that. What is oxidation? There
are several definitions but we can use a very common one, whenever
oxygen combines with something, it oxidizes. Oxygen is a very
poisonous substance. Throughout most of the history of life on Earth
there was no oxygen. Organisms had to develop very specific mechanisms
of dealing with high levels of oxygen before there could ever be life
with oxygen. So we evolved very quickly, as plants arose and developed
a very easy means of acquiring energy, they could just lay back and
catch rays, and they dealt with that oxygen with the carbon dioxide by
spitting it out, they didn't want it around. So the oxygen in the
atmosphere increased. All the other organisms then had to cope with
that toxic oxygen. Many perished if they didn't have ways of dealing
with it. One of the earliest ways of dealing with all that oxygen was
for the cells to huddle together, so that at least the interior cells
wouldn't be exposed to as much. So, multi-celled organisms arose after
oxygen did. Of course, with that came the need for cellular
communication.
So let's talk about glycation. Everyone knows that oxygen causes
damage, but unfortunately, the press has not been as kind to publicize
glycation. Glycation is the same as oxidation except substitute the
word glucose. When you glycate something you combine it with
glucose. Glucose combines with anything else really, it's a very
sticky molecule. Just take sugar on your fingers. It's very sticky. It
sticks specifically to proteins. So the glycation of proteins is
extremely important. If it sticks around a while it produces what are
called advanced glycated end products.
That acronym is not an accident; it stands for A.G.E.'s. If you can
turn over, or re-manufacture the protein that's good, and it increases
the rate of protein turnover if you are lucky. Glycation damages the
protein to the extent that white blood cells will come around and
gobble it up and get rid of it, so then you have to produce more,
putting more of a strain on your ability to repair and maintain your
body.
That is the best alternative; the worst alternative is when those
proteins get glycated that can't turn over very rapidly, like
collagen, or like a protein that makes up nerve tissue. These proteins
cannot be gotten rid of, so the protein accumulates, and the A.G.E.'s
accumulate and they continue to damage. That includes the collagen
that makes up the matrix of your arteries. A.G.E.'s are so bad that we
know that there are receptors for A.G.E.'s, hundreds of receptors for
every macrophage. They are designed to try to get rid of those
A.G.E.'s, but what happens when a macrophage combines with an
A.G.E. product?he mechanisms for applotosis, which is the medical term
for chemical suicide. So we know that it plays a role.
Let's get to diet. Diet really becomes pretty simple. Carbohydrates we
started talking about. You've got fiber and non-fiber and that's real
clear-cut. Fiber is good, non-fiber is bad. Fibrous carbs, like
vegetables and broccoli, those are great. What is a potato? A potato
is a big lump of sugar. That's all it is. You chew a potato, what are
you swallowing? Glucose. You may not remember, but you learned that in
eighth grade, but the medical profession still hasn't learned that.
What is the major salivary enzyme? Amylase. What is amylase used for?
To break down amylose which is just a tree of glucose molecules. What
is a slice of bread? A slice of sugar. Does it have anything else good
about it? Virtually no. Somebody emailed me who had decided to do a
little research. And there are fifty-some essential nutrients to the
human body. You know you need to breathe oxygen. It gives us life and
it kills us. Same with glucose. Certain tissues require some
glucose. We wouldn't be here if there were no glucose, it gives us
life and it kills us. We know that we have essential amino acids and
we have essential fatty acids. They are essential for life, we better
take them in as building blocks or we die. So what he did is he took
all the essential nutrients that are known to man and plugged it in to
this computer data bank and he asked the computer what are the top ten
foods that contain each nutrient that is required by the human
body. Each of the fifty-three or fifty-four, depending on who you talk
to, essential nutrients that there are were plugged in, and did you
know that grains did not come up in the top ten on any one.
What is the minimum daily requirement for carbohydrates? ZERO. What is
the food pyramid based on? A totally irrelevant nutrient.
Let's go beyond Carbohydrates. Let's back up even further? Why do we
eat? One reason is energy. That's half of the reason. It is very
simple, there are two reasons why we eat, one is to gather energy. We
need to obtain energy. The other essential reason (Not just for fun!
Fun is a good one, but you won't have much fun if you eat too much.)
Is to replace tissue, to gather up building blocks for maintenance and
repair. Those are the two essential reasons that we need to eat. We
need the building blocks and we need fuel, not the least of which is
to have energy to obtain those building blocks and then to have energy
to fuel those chemical reactions to use those building blocks. So what
are the building blocks that are needed, proteins and fatty acids. Not
much in the way if carbohydrates. You can get all the carbohydrates
you need from proteins and fats. So the building blocks are covered by
proteins and fats.
What about fuel? That's the other reason we eat. There are two kinds
of fuel that your body can use with minor exceptions, sugar and
fat. We mentioned earlier that the body is going to store excess
eneght now should be almost all fat.
But what happens if you eat sugar. Your body's main way of getting rid
of it, because it is toxic, is to burn it. That which your body can't
burn your body will get rid of by storing it as glycogen and when that
gets filled up your body stores it as fat. If you eat sugar your body
will burn it and you stop burning fat.
We talked about a lot of the effects of high insulin. We talked about
insulin causing the formation of saturated fat from sugar. Another
major effect of insulin on fat is it prevents you from burning
it. What happens when you are insulin resistant and you have a bunch
of insulin floating around all the time, you wake up in the morning
with an insulin of 90. How much fat are you going to be burning?
Virtually none. What are you going to burn if not fat? Sugar coming
from your muscle. So you have all this fat that you've accumulated
over the years that your body is very adept at adding to. Every time
you have any excess energy you are going to store it as fat, but if
you don't eat, where you would otherwise be able to burn it, you
cannot and you will still burn sugar because that is all your body is
capable of burning anymore. Where is it going to get the sugar? Well
you don't store much of it in the form of sugar so it will take it
from your muscle. That's your body's major depot of sugar. You just
eat up your muscle tissue. Any time you have excess you store it as
fat and any time you are deficient you burn up your muscle.
Getting back to the macronutrients, fuel, fat is your best fuel by far
and the fuel that your body wants to use. So there are two reasons to
eat, you need to gather the building blocks for maintenance and
repair, that's protein and fat, no carbohydrate needed, and you eat
for fuel, without question, fat is your most efficient fuel and the
fuel that your body desires the most. So where do carbohydrates come
in? They don't. There is no essential need for carbohydrates. SO why
are we all eating carbohydrates? To keep the rate of aging up, we
don't want to pay social security to everyone.
I didn't say you can't have any carbs, I said fiber is
good. Vegetables are great, I want you to eat vegetables. The
practical aspect of it is that you are going to get carbs, but there
is no essential need. The traditional Eskimo diet for most of the year
subsists on almost no vegetables at all, but they get their vitamins
from organ meats and things like eyeball which are a delicacy, or
were. So, you don't really need it, but sure, vegetables are good for
you and you should eat them. They are part of the diet that I would
recommend, and that is where you'll get your vitamin C. I recommend
Vitamin C supplements, I don't have anything against taking
supplements, I use a lot of them.
Fruit is a mixed blessing. You can divide food on a continuum. There
are some foods that I really can't say anything good about since there
is no reason really to recommend them. And the other end of the
spectrum are foods that are totally essential, like omega 3 fatty
acids for instance which most people are very deficient in, and even
those have a detriment because they are highly oxidizable, so you had
better have the antioxidant capacity. So if you are going to supploods
do to their blood sugar. It doesn't take much. What is very surprising
to these people once they really measure is what little carbohydrate
it takes to cause your blood sugar to skyrocket. One saltine cracker
will take the blood sugar to go over 100 and in many people it will
cause the blood sugar to go to 150 for a variety of reasons, not just
the sugar in it.
(Someone in the audience asks an illegible question to which
Dr. Rosedale responds?)
When you are eating a high carbohydrate diet, when you are born, your
mother, everbody is telling you to eat a bowl of Cheerios for
breakfast. You eat that bowl of cheerios and that turns to sugar, and
your sugar goes up very rapidly and that causes a big rush of insulin
and your body all of a sudden senses a huge amount of sugar being
delivered to it at once, of which it was never used to, in an
evolutionary sense.
We only have one hormone that lowers sugar, and that's insulin. Its
primary use was never to lower sugar. We've got a bunch of hormones
that raise sugar, cortisone being one and growth hormone another, and
epinephrine, and glucagon. Our primary evolutionary problem was to
raise blood sugar to give your brain enough and your nerves enough and
primarily red blood cells, which require glucose. So from an
evolutionary sense if something is important we have redundant
mechanisms. The fact that we only have one hormone that lowers sugar
tells us that it was never something important in the past.
So you get this rush of sugar and your body panics, your pancreas
panics and it stores, when it is healthy, insulin in these granules,
ready to be released. It lets these granules out and it pours out a
bunch of insulin to deal with this onslaught of sugar and what does
that do? Well the pancreas generally overcompensates, and it causes
your sugar to go down, and just as I mentioned, you have got a bunch
of hormones then to raise your blood sugar, they are then released,
including cortisone. The biggest stress on your body is eating a big
glucose load. Then Epinephrine is released too, so it makes your
nervous and it also stimulates your brain to crave carbohydrates, to
seek out some sugar, my sugar is low. So you are craving
carbohydrates, so you eat another bowl of cheerios, or a big piece of
fruit, you eat something else so that after your sugar goes low, and
with the hormone release, and with the sugar cravings and carbohydrate
craving your sugars go way up again which causes your pancreas to
release more insulin and then it goes way down. Now you are in to this
sinusoidal wave of blood sugar, which causes insulin resistance. Your
body can't stand that for very long. So you are constantly putting out
cortisone.
We talk about insulin resistance. We hear a lot about insulin
resistance, but stop and think a little bit, do you think our cells
only become resistant to insulin? The more hormones your cells are
exposed to, the more resistant they will become to almost any
hormone. Certain cells more than others, so there is a
discrepancy. The problem with hormone resistance is that there is a
dichotomy of resistance, that all the cells don't become resistant at
the same time. And different hormones affect different cells, and the
rate of hormone is different among different cells and this causes
lots of problems with the feedback mechanisms. We know that one of the
major areas of the body thand it only made sense to me that you don't
want to feed these people carbohydrates, so I put him on a low
carbohydrate diet. He was an exceptional case, after a month to six
weeks he was totally off of insulin. He had been on 200 some units of
insulin for twenty-five years. He was so insulin resistant, one thing
good about it is that when you lower that insulin, that insulin is
having such little effect on him that you can massively lower the
insulin and its not going to have much of an effect on his blood sugar
either. 200 units of insulin is not going to lower your sugar any more
that 300 mg/deciliter. You know that the insulin is not doing much. So
we could rapidly take him off the insulin and he was actually cured of
his diabetes in a matter of weeks. So he became sensitive enough, he
was still producing a lot of insulin on his own, then we were able to
measure his own insulin and it was still elevated, and then it took a
long time, maybe six months or longer to bring that insulin down. It
will probably never get to the point of the sensitivity of a ten year
old, but yes, your number of insulin receptors increases, and the
activity of the receptors, the chemical reactions that occur beyond
the receptor occur more efficiently. Tyrosine kinase.
You can increase sensitivity by diet, that is one of the major reasons
you want to take Omega 3 oils. We think of circulation as that which
flows through arteries and veins, and that is not a minor part of our
circulation, but it might not even be the major part. The major part
of circulation is what goes in and out of the cell. The cell membrane
is a fluid mosaic. The major part of our circulation is determined by
what goes in and out. It doesn't make any difference what gets to that
cell if it can't get into the cell. We know that one of the major ways
that you can affect cellular circulation is by modulating the kinds of
fatty acids that you eat. So you can increase receptor sensitivity by
increasing the fluidity of the cell membrane, which means increasing
the omega 3 content, because most people are very deficient. They say
that you are what you eat and that mostly pertains to fat because the
fatty acids that you eat are the ones that will generally get
incorporated into the cell membrane. The cell membranes are going to
be a reflection of your dietary fat and that will determine the
fluidity of your cell membrane. You can actually make them over
fluid. If you eat too much and you incorporate too many omega 3 oils
then they will become highly oxidizable (so you have to eat Vitamin E
as well and monounsaturates as well) There was an interesting article
pertaining to this where they had a breed of rat that was genetically
susceptible to cancer. What they did was they fed them a high omega 3
diet, plus iron, without any extra Vitamin E and they were able to
almost shrink down the tumors to nothing, because tumors are rapidly
dividing. This is like a form of chemotherapy, and the membranes that
were being formed in these tumor cells were very high in omega three
oils, the iron acted as a catalyst for that oxidation, and the cells
were exploding from getting oxidized so rapidly. So omega 3 oils can
be a double edged sword. Most food is a double edged sword. Like
oxygen and glucose, they keep us alive and they kill us, eating is the
biggest stress we put on our body and that is why in caloric
restriction experiments you can extend life as long as yres, or at
least estimate it by their activity level. The book Protein Power
actually went very well in to this. You have to calculate how much
protein is required by their activity level and their lean body
mass. There is still some grey area as to how many grams per kilogram
of lean body mass, depending on the activity that person
requires. Anywhere perhaps one to two grams of protein per kilogram of
lean body mass, maybe even a little bit higher if someone is really
active. You don't want to go under that for very long. I'd say that it
is better to go over than to go under that amount for very long. But I
especially don't want my diabetic patients, which means all of us,
because in a very real sense we really all have diabetes, it is just a
matter of degree, we all have a certain degree of insulin
resistance. If you can cure a diabetic of diabetes, you can do the
same thing to a so-called non-diabetic person and still improve that
person. I want to improve my insulin sensitivity just as much as I do
my diabetics because insulin sensitivity is going to determine for the
most part how long you are going to live and how healthy you are going
to be. It determines the rate of aging more so than anything else we
know right now.
(Question: What about supplements such as Chromium for example?)
Chromium, it depends on who you are dealing with, but are we talking
about a diabetic patient which is supposed to be the topic of this
talk, yes, all my diabetics go on 1,000 mcg. Of chromium, some a
little bit more if they are really big people. Usually 500mcg for a
non-diabetic. It depends on their insulin levels. I don't care so much
what their sugar levels are, I care what their insulin levels are,
which is a reflection of their insulin sensitivity. We are talking
about hyperinsulinemia or non-hyper-insulinemia. Its insulin we should
be concerned about.
I use a lot of supplements. What you really want to do, and my purpose
mostly is to try to convert that person back into being an efficient
burner of fat. We talked about when you are very insulin resistant and
you are waking up in the morning with an insulin that is elevated, you
cannot burn fat, you are burning sugar. They don't know how to burn
fat anymore and that is your best fuel. One of the reasons that sugar
goes up so high is because that is what your cell is needing to burn,
but if it is so insulin resistant it requires a blood sugar of 300 so
that just by mass action some can get in to the cell and be used as
fuel. If you eliminate that need to burn sugar, you don't need such
high levels of sugar even if you are insulin resistant.
So you want to increase the ability of the cells in the body to burn
fat. You want to make that glucose burner into a fat burner. You want
to make a gasoline burning car into a diesel burning car. Did anyone
ever look at the molecular structure of diesel fuel in your spare
time? It looks almost identical to a fatty acid. There is a company
right now that can tell you how to alter vegetable oil to use in your
Mercedes. It's just a matter of thinning it out a little bit. It is a
very efficient fuel.
(Question)
You can look at other variables that will give you some idea too such
as triglycerides. If they are very sensitive to high levels of
insulin, they come in with insulin levels of 14 and they have
triglycerides of 1000, then you would treat them just as you would if
they had an insulin level of 50. It gives yoding before an event. What
happens if you eat a bowl of pasta before you have to run a
marathon. What does that bowl of pasta do? It raises your
insulin. What is the instruction of insulin to your body? To store
energy and not burn it. I see a fair amount of athletes and this is
what I tell them, you want everybody, athletes especially, to be able
to burn fat efficiently. So when they train, they are on a very low
carbohydrate diet. The night before their event, they can stock up on
sugar and load their glycogen if they would like. They are not going
to become insulin resistant in one day. Just enough to make sure, it
has been shown that if you eat a big carbohydrate meal that you will
increase your glycogen stores, that is true and that is what you
want. But you don't want to train that way because if you do you won't
be able to burn fat, you can only burn sugar, and if you are an
athlete you want to be able to burn both. Few people have problems
burning sugar if they are an athlete, but they have lots of problems
burning fat, so they hit the wall. And for a certain event like
sprinting it is less important, truthfully, for their health it is
very important to be able to burn fat, but a sprinter will go right
into burning sugar. If you are a 50 yard dash man, whether you can
burn fat or not is not going to make a huge difference in your final
performance. Beyond your athletic years if you don't want to become a
diabetic, and if you don't want to die of heart disease and if you
don't want to age quickly?It is certainly not going to do you any harm
to be able to burn fat efficiently in addition to sugar.
(Question)
Carnitine? Carnitine is a shuttle. It takes fatty acids into the
cell. You can't burn fat without it. I say they should take as much
carnitine as they can afford.
Co Q 10 is a biggie, it is involved in the energy production of all
cells. It protects the mitochondria from electron leakage and
damage. Give anywhere from 100 to 500mg, depending on the kind of Q10,
some are more absorbable than others.
Vanadyl Sulfate is an insulin mimic, so that it can basically do what
insulin does by a different mechanism. If it went through the same
insulin receptors, then it wouldn't offer any benefit, but it doesn't,
it actually has been shown to go through a different mechanism to
lower blood sugar, so it spares insulin and then it can help improve
insulin sensitivity. On someone who I am trying to really get their
insulin down I go 25mg 3X/day temporarily.
B Vitamins are necessary in the conversion of all energy, so they all
get extra B Vitamins, usually in a multi.
I put people on glutamine powder. Glutamine can act really as a brain
fuel, so it helps eliminate carbohydrate cravings while they are in
that transition period. I like to give it to them at night and I tell
them to use it whenever they feel they are craving carbohydrates. They
can put several grams into a little water and drink it and it helps
eliminate carbohydrate cravings between meals.
(Question)
It is a high protein diet that will increase an acid load in the body,
but not necessarily a high fat diet. Vegetables and greens are
alkalinizing, so if you are eating a lot of vegetables along with your
protein it equalizes the acidifying effect of the protein. I don't
recommend a high protein diet. I recoquires. We just have one name for
fat, we call it fat or oil. Eskimos have dozens of names for snow and
east Indians have dozens of names for curry. We should have dozens of
names for fat because they do many different things. And how much of
which fat to take is still open to a lot of investigation and
controversy.
My take on fat is that if I am treating a patient who is generally
hyperinsulinemic or overweight, I want them on a low saturated fat
diet. Because most of the fat they are storing is saturated fat. When
their insulin goes down and they are able to start releasing
triglycerides to burn as fat, what they are going to be releasing
mostly is saturated fat. So you don't want to take anymore
orally. There is a ration of fatty acids that is desirable, if you
took them from the moment you were born, but we don't, we are dealing
with an imbalance here that we are trying to correct as rapidly as we
can. You have plenty of saturated fat. Most of us here have enough
saturated fat to last the rest of our life. Truthfully. Your cell
membranes require a balance of saturated and poly-unsaturated fat, and
it is that balance that determines the fluidity. As I mentioned, your
cells can become over-fluid if they don't have any saturated
fat. Saturated fat is a hard fat. We can get the fats from foods to
come mostly from nuts. Nuts are a great food because it is mostly
mono-unsaturated. Your primary energy source ideally would come mostly
from mono-unsaturated fat. It's a good compromise. It is not an
essential fat, but it is a more fluid fat. Your body can utilize it
very well as an energy source.
(Question)
Animal proteins are fine and are good for you, but not the ones that
are fed grains. Grainfed animals are going to make saturated fat out
of the grains. Saturated fat in nature occurs to a very tiny
degree. Not in the wild there is very little saturated fat out
there. If you talk about the Paleolithic diet, we didn't eat a
saturated fat diet. Saturated fat diets are new to mankind. We
manufactured a saturated fat diet by feeding animals grains. You can
consider saturated fat to be second generation carbohydrates. We eat
the saturated fats that other animals produce from carbohydrates.
(Question)
Zone was a good diet compared to the American diet it was unusual. Is
it an optimal diet? No. Is it optimal for what is known today about
nutrition, it is not. He is stuck in this mold he can't get out of but
now he is trying to get out of it through the back door. Initially the
author spoke about how it made no difference if you got your
carbohydrate from candy or vegetables. The Volkswagen was a good car,
but eventually they had to change it to keep up with modern
technology. What he is doing now is changing his recipes so that the
40% carbohydrates are coming primarily from vegetables, and the
carbohydrates are going way down because he knows that if he doesn't
it's not as good a diet.
(Question)
I would go 20% of calories from carbs. Depending on the size of the
person, 25 to 30% of calories from protein, and 60-65% from fat. You
can get non-grain fed beef. Lasater beef is non-grain fed, and buffalo
is non-grain fed.
Insulin is not the only cause of disease. There are other
considerations such as iron. We know that high iron levels are bad for
you. If a person's ferritin is high, red meat is out for a while, till
we get their iron down. SO there are other things involved about if we
are going to allow a person to eat red meat or not.
(Question)
There is a great deal of difference between a non-grain fed cow and a
grain fed cow. Non-grain fed will have only 10% or less saturated
fat. Grain fed can have ovepending on what their gut can tolerate. I
like I.V. magnesium to replenish them.
Vitamin E, big fan of Vitamin E, I would go to 2000mg.
Zinc, 30 to sixty mg, balanced with 2mg of copper per 15 mg of zinc,
usually 4mg of copper sebacate.
Taurine: 1gm twice a day.
Chromium 1000mcg
Vanadium 25mg for about two to three months. Then down to 71/2 mg
three times a day, then I'll go down further, then I take them off
completely once they are better.
They can have as much glutamine as they want and as much carnitine as
they can afford. The more the better
I use gymnema sylvestre a lot.
I like sardines if they will eat them. Sardines are a very good
therapeutic food. They are baby fish so they haven't had time to
accumulate a bunch of metal. They are smoked so they are not cooked
and the oil is not spoiled in them. You have to eat the whole
thing. Not the boneless and skinless. You need to eat all the organs
and they are high in vitamins and magnesium.
DNA glycates. So if people are worried about chromosomal damage from
chromium, what they should really be worried about instead is high
blood sugar. DNA repair enzymes glycate as well. Insulin is by far
your biggest poison. They disproved that study that was against
chromium many times. They showed that it only happens if you put cells
in a petrie dish with chromium but in vivo studies prove
otherwise. The lowering of insulin is going to be better than any
possible detriment of any of the therapies you are using. Insulin is
associated with cancer, everything.
Insulin should be tested on everybody repeatedly, and why it is not is
only strictly because there hasn't been drugs till recently that could
effect insulin, so there is no way to make money off of it. Fasting
insulin is one way to look at it, not necessarily the best way. But it
is the way that everybody could do it. Any family doctor can measure a
fasting insulin. There are other ways to measure insulin sensitivity
that are more complex that we do sometimes. We use intravenous insulin
and watch how rapidly their blood sugar crashes in a fasting state in
15 minutes and that assesses insulin sensitivity, then you give them
dextrose to make sure they don't crash any further. There are other
ways that are utilized to directly assess insulin sensitivity, but you
can get a pretty good idea just by doing a fasting insulin.
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