**Insulin Resistance Doctor: This Ends Insulin Resistance Over 40 — Transcript & Summary | SozAI** Source: https://sozai.app/transcript/insulin-resistance-doctor-over-40/ Dr. Thomas DeLauer explains insulin resistance over 40, emphasizing muscle building, reducing sugar, and debunking calorie restriction myths. ## Key Takeaways - Building and maintaining muscle is the most effective strategy against insulin resistance. - Avoid added sugars and focus on macronutrient quality rather than calorie counting. - Calorie restriction often leads to metabolic slowdown and weight regain. - Women require special attention due to accelerated muscle loss with age. - Gut health supports overall metabolic improvements. ## What the video covers - Insulin resistance is caused by chronic insulin exposure, primarily affecting the liver first. - Glycemic variability, not just glucose spikes, plays a key role in insulin resistance development. - Muscle mass is critical for metabolic health and longevity, especially after age 40. - Calorie restriction alone is ineffective long-term due to metabolic adaptation and loss of muscle. - Resistance training and strategic macronutrient intake, especially prioritizing protein, are essential. - Weight loss should focus on fat loss and muscle gain rather than scale weight alone. - Women face more severe muscle loss with age, especially post-menopause. - Gut health is an important foundational aspect of improving metabolic health. - The traditional calories in/calories out model is overly simplistic and biologically inaccurate. - Lifestyle changes should be personalized, addressing hormones, inflammation, and environment. ## Chapters 1. 00:00 Understanding Insulin Resistance and Glycemic Variability 2. 03:10 Muscle Loss and Metabolic Health Differences by Gender 3. 07:03 The Myth of Calorie Restriction and Importance of Resistance Training 4. 10:06 Intermittent Fasting and Glucose Monitoring Insights 5. 14:16 Practical Strategies for Insulin Resistance Over 40 6. 20:57 Hormones, Environment, and Personalized Metabolic Health 7. 27:10 Role of Gut Health and Lifestyle Adjustments 8. 30:00 Summary and Final Recommendations Answers ## Questions about this video What is the primary cause of insulin resistance according to the video? Insulin resistance is primarily caused by chronic exposure to insulin, which damages insulin receptor signaling, especially in the liver. Why is calorie restriction not recommended as the sole strategy for metabolic health? Calorie restriction often leads to metabolic adaptation, reducing basal metabolic rate and causing weight regain, making it an ineffective long-term solution. What role does muscle mass play in managing insulin resistance? Muscle mass is crucial as it acts as an organ of longevity and metabolic health; building and maintaining muscle improves insulin sensitivity and overall metabolic function. ## Full Transcript — Download SRT & Markdown 00:00 Speaker A If you think of, say, like a Ring doorbell as being the insulin receptor. I have a little daughter. You have a little daughter. When she was two, she figured out the Ring doorbell at our house and thought it was amazing. She presses the Ring doorbell, makes a sound, someone comes running, right? So what does she do? She starts dinging the doorbell, right? Infinitely. 00:12 Speaker A We have chronic exposure to insulin. Insulin's that my daughter's finger. The doorbell is the insulin receptor. When you have chronic exposure, and this is where I think the key part of the puzzle is, chronic exposure to what we talk about glycemic variability. It's not the glucose spike, it's how high is the spike, how long is the spike, how variable is the spike, highs and lows, right? And then how often is that happening during a day? Every one of those spikes, the body has to deliver insulin. So now you get higher and higher levels of circulating insulin, fingers on the doorbell all the time. 00:18 Speaker A That's circuitry. This is the true mechanism of insulin resistance. That circuitry starts to go bad. And where does it start to go bad first? It's not in muscle. It's in the liver. Dr. 00:31 Speaker A Jonathan Chef, let's pretend that I'm 50 years old. I just got my lab work back. 00:45 Speaker A I have high HbA1c. My doc tells me I have insulin resistance. What would you tell me to do? 00:52 Speaker A Well, for starters, that's one data point out of hundreds that I do think are worth looking at. We have to understand that age-related decline, while it's an inevitable process as we've thought of it in the past, is not at all inevitable and is very much controllable. But by the age of 50, if you're an American, there's likely a lot more going on than simply understanding your metabolic health. There's way more tied to it than that. So having the complete picture and understanding what are the key or principal drivers and then looking strategically at what are the low-hanging fruit, what are the things that are going to move the needle most for you as an individual. Insulin resistance, we can say diet, exercise, but that's way oversimplified for what we need to really accomplish. We have to look at hormone health. We have to look at the environment with which your body is existing. Is it pro-inflammatory? Are there other conditions going on? Then we have to really look at what are you doing day in, day out to directly impact on that. I think the answer to insulin resistance starts very simply. 01:01 Speaker A If you want two things, move more. Well, I'll make it three, okay? Move more, build muscle, and get rid of added sugar. You start there. That's probably 75% of the way to being metabolically healthier. That other 25% is where we really have to look more strategically across the whole human body and how can we influence, pull levers, adjust dials accordingly. But muscle, if you were going to make it all about one thing, muscle is medicine. Muscle's the organ of longevity. And it's also the most critical performance metric that we can seek to live longer, better lives. 01:07 Speaker A I noticed you didn't mention calorie restriction. What would your strategy be from a diet perspective? 01:14 Speaker A Gosh. Well, I mean, that's true. I'd definitely want to restrict them like a thousand calories a day because that works really well. No, really, the calorie— we've had this discussion already, but the calorie conversation is antiquated and it's myopic. It's way oversimplified to how the human body exists. And let's just get it out in the open. Calories in, calories out. Energy balance. First law of thermodynamics. It's science. Yes, it's science in a vacuum in a lab, but not in a biological organism because there's one word that changes everything. That entire dynamic. Why calories and calories, that doesn't work. 01:30 Speaker A It's adaptation. A biological organism adapts. It's a complex interaction between hormones, peptides, right? Naturally occurring peptides. How the minute-to-minute changes in each individual cell influence the organism. So calories in, calories out loses the big picture. And you know my perspective on why we got so hung up on it was 10, 20 years ago. One, we had no concept of body composition and we really didn't have any analytics to expose body comp readily available. I think like Lifetime Fitness now, every Lifetime Fitness has an InBody scale. 01:46 Speaker A You could get on there and you can tell total body fat mass, skeletal muscle mass, SMIs, those kinds of data points. 02:01 Speaker A Before we had that, all we had was a scale in your bathroom. So, calories in, calories out works for the scale to a point, but scale weight is a terrible metric to follow anyone anyway. When you talk about metabolic health and performance, right? I mean, losing weight, it'd be beyond me that we have those conversations or the weight loss clinics because weight loss is a detrimental endpoint if you use it as a single data point, right? If I said to you today, "Hey, to get you healthy, I want you to lose three pounds on the scale." You'd look at me and you'd be like, "Zach, I mean, I don't think that's going to cut it." You know, I was at my best 20 pounds lighter. Were you? How can you say that? If we lose 30 pounds of fat mass and put on 11 pounds of skeletal muscle mass, your scale weight is not going to change significantly. I see that every day. And yet, your metabolic health is going to skyrocket. Literally flip the script. So calories in, calories out misses the whole point that we're biological organisms. And we know this. We see this time after time after time. The best example of energy balance, an epic fail, is The Biggest Loser. Yeah. I mean, we have one of the world's greatest longitudinal studies on calorie restriction ever made on live TV. If you look at the metabolic adaptation six years post filming, right? 11 of the 13 that were followed regained the weight and then some, right? And if you look at their body composition, but more importantly, you look at their basal metabolic rates, I mean, that's the crux of metabolic adaptation, right? Six years post massive weight loss with calorie restriction only. What did it show? Up to a thousand calorie reduction in basal metabolic rate six years later. You've already gained all the weight back. And initially, people looked at that and said, "Oh, well, they lost muscle along the way." That doesn't account for that discrepancy. So that's the net failure of calorie restriction. And by the way, restrict calories, more cardio. That's the standard gold standard 2026. People still come in like, "Doc, I'm doing all my cardio." Yeah. Stop. Do some resistance training, intentional movement, and look strategically at what you consume, not in the form of calories, but in the form of macronutrient distribution. 02:15 Speaker A I am a principal guy. It's calories, carbs, early fuel with a purpose. You know, protein is a non-negotiable. 02:28 Speaker A Protein is a priority in a diet largely if you consider it very simply put, it's thermic effect and also the importance of being in a positive nitrogen balance to support muscle health, right? That's where the magic happens. But it's way more simple and it's way more sustainable. You know this to be true. Building muscle early. 02:45 Speaker A Sustaining it over time is the key. And you, you're talking about the 50-year-old male. We're not talking about the 50-year-old female yet. 03:01 Speaker A Yeah. Because the 50-year-old female is 10 times worse off if there's no early intervention. 03:10 Speaker A You look at the per decade loss of skeletal muscle in a female relative to a male, it's devastating. 03:15 Speaker A Yeah. And then women, I mean, menopause, that's a whole topic to itself, but what happens in menopause? And people are like, "Oh, it's my metabolism slowing up." No, you're sarcopenic. 03:30 Speaker A Super simple. After today's video, I popped a link down below for Seed Daily Synbiotic. So, if you're trying to make any kind of dietary change or different lifestyle at all, one of the first things you want to focus on is your gut health. A lot of things start there. And 03:47 Speaker A not in a biological organism because there's one word that changes everything. That entire dynamic. Why calories and calories that doesn't work. 03:55 Speaker A It's adaptation. A biological organism adapts. It's a complex interaction between hormones, peptides, right? Naturally occurring peptides. um how the minute-to-minute changes in each individual cell influence the organism. So calories in calories out loses the big picture. And you know my perspective on why we got so 04:21 Speaker A hung up on it was 10 20 years ago. One we had no concept of body composition and we really didn't have any analytics to expose body comp readily available. I think like Lifetime Fitness now every Lifetime Fitness has an inbody scale. 04:36 Speaker A You could get on there and you can tell total body fat mass, skeletal muscle mass, smis, those kinds of data points. 04:42 Speaker A Before we had that, all we have was a scale in your bathroom. So, calories in, calories out works for the scale to a point, but scale weight is a terrible metric to follow anyone. Anyway, when you talk about metabolic health and 04:56 Speaker A performance, right? I mean, losing weight, it's be beyond me that we have those conversations or the weight loss clinics because weight loss is is is a detrimental end point if you use it as a single data point, right? If I said to 05:13 Speaker A you today, hey, to get you healthy, I want you to lose three pounds on the scale. You'd look at me and you'd be like, Zach, I mean, I don't think that's going to cut it. You know, I I I was at 05:25 Speaker A my best 20 lbs lighter. Were you? How How can you say that? If we lose 30 pounds of fat mass and put on 11 pounds of skeletal muscle mass, your scale weight is not going to change significantly. I see that every day. And 05:39 Speaker A yet, your metabolic health is going to skyrocket. Literally flip the script. So, so calories in, calories out misses the whole point that we're biologic organisms. And we know this. We see this time after time after time. The best 05:54 Speaker A example of energy balance, an epic fail is the biggest loser. Yeah. I mean, we we have one of the world's greatest longitudinal studies on calorie restriction ever made on live TV. If you look at the metabolic adaptation, six years post filming, 06:15 Speaker A right? 11 of the 13 that were followed regained the weight and then some right and if you look at their body composition but more importantly you look at their basil metabolic rates I mean that's the crux of metabolic 06:30 Speaker A adaptation right 6 years post massive weight loss with calorie restriction only what did it show up to a th00and calorie reduction in basil metabolic rate 6 years later you've already gained all the weight back and initially people looked at that and said oh well it's 06:45 Speaker A they lost muscle along the way. That doesn't account for that discrepancy. So that's the net failure of the calorie restriction. And by the way, restrict calories, more cardio. That's the standard gold standard 2026. People still come in like, "Doc, I'm doing I'm 07:03 Speaker A doing all my cardio." Yeah. Stop. Do some resistance training, intentional movement, and look strategically at what you consume, not in the form of calories, but in the form of macronutrient distribution. 07:21 Speaker A I am a principal guy. It's calories, carbs, early fuel with a purpose. You know, protein is a non-negotiable. 07:27 Speaker A Protein is a priority in a diet largely if you if you consider it very simply put, it's thermic effect. and also the importance of being in a positive nitrogen balance to support muscle health, right? That's where the magic 07:42 Speaker A happens. But it's way more simple and it's way more sustainable. You know this to be true. Building muscle early. 07:50 Speaker A Sustaining it over time is the key. And you you you're talking about the 50-y old old male. We're not talking about the 50-y old female yet. 07:58 Speaker A Yeah. Because the 50-y old female is 10 times worse off if there's no early intervention. 08:05 Speaker A You look at the per decade loss of skeletal muscle in a female relative to a male, it's devastating. 08:11 Speaker A Yeah. And then women, I mean, menopause, we that's a whole whole topic to itself, but what happens in menopause? And people are like, "Oh, it's it's um you know, my metabolism slowing up." No, you're you're psychopenic. 08:25 Speaker A Super simple. After today's video, I popped a link down below for Seed Daily Symbiotic. So, if you're trying to make any kind of dietary change or different lifestyle at all, one of the first things you want to focus on is your gut 08:37 Speaker A health. A lot of things start there. And we look at the world of the microbiome, it's pretty complicated, right? We're just starting to scratch the surface some of the science there. The cool thing is is Seed is paving the way for a 08:48 Speaker A lot of that research. They've got multiple clinicals. They've really looked at the data and how this stuff works. So, so that symbiotic down below, that is a 20% off discount link for their prebiotic and probiotic that's inside one capsule. So, you get proper 09:01 Speaker A absorption throughout the right areas of the digestive system. So, you're getting a prebiotic that breaks down first and then you have the probiotic that potentially colonizes a little bit later in the gut. So, again, that link down below gets you 20% off seeds daily 09:14 Speaker A symbiotic. What about I mean people get so concerned with especially over the age of 40 even with fasting versus like caloric restriction when when you back the data out and you look at like what's your net calories over the course of the 09:28 Speaker A week like there's a there might be a an equal deficit just kind of split up in different ways. So you know if you have someone that's 45 50 years old that's coming to you with metabolic issues what would you say to them in terms of a 09:40 Speaker A fasting strategy? So fasting to me, one, let's unpack fasting. One of my biggest pet peeves on social media is fasting equals eating windows, intermittent fasting. That's all there is to fasting. 09:55 Speaker A Now, it's it's that idea and the reference point when I say fasting, what I'm talking about is strategic sustained water only fasting. 10:06 Speaker A Again, black coffee, fine. We can unpack that piece. but greater than 24 hours. Why does that matter? Well, when you look at the intermittent fasting data, I'll be the first to agree that it is no different in long-term outcomes than any 10:21 Speaker A other form of calorie restriction. There is a modest impact on insulin sensitivity. It does. Calorie restriction over time does modestly improve insulin sensitivity. Does it radically reverse insulin resistance? 10:34 Speaker A No, not at all. because it's not a targeted therapy. Sustained fasting, achieving the same calorie deficit in an abbreviated or an abrupt period of time does something that chronic calorie restriction can never do. It reverses or flips the insulin glucagon ratio on its 10:54 Speaker A head. It presents it presents such an acute stress and this is an important concept that I I try to share with my clients every day is acute stress good the body acute stress adaptation is the most powerful impressive god-given 11:10 Speaker A cellular response that we have chronic stress adaptation is maladdaptation 100% of the time you present someone with chronic calorie deficit they metabolically adapt you present someone with acute metab metabolic at metabolic um calorie restriction they metabolically optimize but the crux of it is that shift 11:35 Speaker A strategically in insulin balance if you consider that probably upwards of 90 plus% of Americans today are insulin resistant based on critical metrics and based on all comers I go into most conversations with a 50-year-old male assuming there's probably an element of 11:55 Speaker A that on board. That's a pretty safe assumption, right? Maybe you don't have insulin resistance, but the general public does. So, I think we have to approach it that way. So, I use strategic fasting as a mechanism to optimize metabolic health and 12:09 Speaker A performance. And I I really pare it down to two categories. Moderate to high insulin resistance, moderate to high visceral fat load is sort of that metabolically diseased or dysfunctional individual. Those individuals need a really a complete reset to their 12:29 Speaker A metabolic system. That typically looks like longer duration fasting than someone who is modestly insulin resistant has a baseline skeletal muscle mass indicy that's appropriate for age related cohorts. That person we can really engage a very strong aggressive stimulus. So until we've really reset 12:50 Speaker A and kicked out of that high-grade insulin resistance, I don't think you can convert over to more of what I call an accelerator protocol. 12:57 Speaker A Yeah. But the difference in all of these conversations for me is it's all data driven. That's what I think is the greatest gap in understanding in the general public. How many times do you hear or do you get a a question 13:13 Speaker A about like, hey, I'm fasting for 48 hours or 72. Why? For what? To what end? 13:20 Speaker A How do you know for you what the optimal fasting window is? Well, first of all, we have to understand what data we can collect real time to define a a again a datadriven fasting protocol. What are we trying to 13:34 Speaker A accomplish? For me, the principal issue is radical glycogen depletion. That's needs to happen upfront, right? In order to really engage the body's hormonal response to strategic fasting, we want to wipe glycogen. 13:54 Speaker A Principle number one. Principle number two, we want to drive ketosis. And the only way to drive ketosis that no, this isn't ketogenic dieting. This is acute control, measurable control of ketosis. 14:08 Speaker A Only way to drive that is to eliminate insulin. The only way to eliminate insulin is glucose glycogen depletion. 14:16 Speaker A Is that fair? Y again, that may be slightly oversimplified, but it's really not rocket science. And the beauty of today, I mean, look, I can continuously monitor my glucose levels. 14:31 Speaker A Coolest thing out there, by the way, that's on the horizon. I can continuously monitor my ketone levels. 14:36 Speaker A Yeah. So, I have all the data right in front of me. And so we can look at inflection points and what I call the crossover point between serum glucose and serum ketones. 14:48 Speaker A Yeah. To define strategically where is that point where the body is actually shifting into lipolysis. 14:56 Speaker A Yeah. Your GKI kind of your glucose. Exactly. How does the regular person uh like what would you say that feels like? 15:03 Speaker A Right. Because let's say I know right. That's where it can get a little bit tough is I I love the data. I know we can't get everyone to wear a continuous ketone or a continuous glucose monitor, but I 15:14 Speaker A think over over the years, you start to feel like you know when that feeling is happening, right? And the best way that I could describe it is like it's that feeling when you get up in the morning, you're fasted, you you work out, and 15:24 Speaker A you're about halfway through your workout and you just feel like you can flip between being aerobic and anorobic very well. So, for like maybe for the person that's not clicked in from a fitness perspective, maybe they haven't been, you know, they're just getting 15:39 Speaker A started, it's almost like it feels like when you're in that fasted workout and you're no longer gassed and winded and you feel like the wheels are turning. You just feel like you're in that groove. 15:49 Speaker A There's almost like an energy uptick, right? And you can follow it. What's really cool is with highly insulin resistant clients that I work with, there's a what I see is there's sort of a a gap period where they you really 16:06 Speaker A start to feel like you're hitting that wall just energetically and then it all sudden flips. And for some people, again, that's 24 4872. the you see my kind of hesitation with answering how does it feel because that is one of the hardest things I think 16:24 Speaker A people latch on to that really kind of distracts from the the end goal because it is it's hard to put a finger on that's why I find with clients we typically you know we'll do high resolution data collection for the first 16:40 Speaker A two maybe three fasts for most clients from then on they know exactly how it feels It's that it's hard though coming out of the gate. One, if you've never been in ketosis, you are going to feel that drop off. Some people find it, I've 16:56 Speaker A even found it, you feel a little bit shaky, just kind of a little bit. 17:00 Speaker A It gets worse before it gets better. Correct. Yeah. It's almost like there's a little drop off and that's where most people fail. 17:07 Speaker A Yeah. They react. They react in that point and then we we're conditioned to like you get a little bit hungry, you get a little I mean it's like what you're boiling it down to is the person that is metabolically they come to you. 17:16 Speaker A We come back back to that initial question. Okay, your HBA1C is high. You're just told you were insulin resistant like you don't what to do now, right? 17:22 Speaker A Like for one, it's like maybe you have to become a little bit comfortable with discomfort for a little bit. You have to be okay with being a little bit hungry for a little bit and not through the means that most people 17:33 Speaker A would tell us in terms of not hungry through restricting your calories or,200 calories a day. No, but a little hungry in the sense that maybe you're going to be skipping breakfast and and lunch and it might feel a little weird and it 17:44 Speaker A might feel emotionally uncomfortable because every signal in your body is going to be telling you to eat because it's getting a cattywampus signal in the first place. 17:51 Speaker A Yep. Well, I'm going to say something that people may or may not like to hear, but as a strategist, as a physician, I'm going to tie this to big picture, cuz I hear this all the time on social media. 18:04 Speaker A Evidencebased medicine. Well, the evidence says this. Well, the guidelines say this, okay, at the end of the day, we know this to be true. Optimized hemoglobin A1C, optimal fasting insulin, let's call it what it is. Hemoglobin A1C less than 5.2 two 18:21 Speaker A fasting insulin less than seven optimized five high performance optimized less than two. Is there such a thing as too low of fasting insulin in my professional experience? No. 18:32 Speaker A Your body shouldn't be producing insulin at at rest. So when you look at those those parameters and you you consider all that the endgame is those parameters. We know that correlates again across large volume population series to longer better life. 18:49 Speaker A In my mind, as a physician, we need to do what we need to do to get to that point. 18:53 Speaker A Yeah. Here's where I actually use GLPS as a strategic tool to support fasting protocols because I know the most aggressive and also most likely to succeed protocol to rapidly reverse insulin resistance is through strategic fasting. It's simple, very simple. Where 19:14 Speaker A do people fall out? food noise, the physical discomfort as glucose regulation shifts, right? Their bodies never, A lot of people have lived a lifetime and never Think about this. A lot of Americans have lived a lifetime and never experienced a glucose level on 19:33 Speaker A average less than 100. Yeah. Wild. That's crazy. I don't know about you, I feel best with a glucose level in the 70s, right? with ketone three three and a half millm moim moim moim moim moim moim moim moim moim moimles you feel very 19:48 Speaker A clean lasered in focused but you got to go from this all the way over there that's a that's a leap so I use GLPs quite commonly in that context actually bullish GLPs around a fasting protocol specifically strategically quiet food noise balance provide a more 20:10 Speaker A balanced uh um homeostatic level of insulin and glucose and allow that person to build the self-confidence and also have the physiologic experience of cuz you know once you get over that hump you're like whoa all of a sudden like 20:26 Speaker A you're struggling in that workout all of a sudden you've got that it's not even a second wind it's that clean fuel your body starts using fat which is an excellent energy source and you actually feel more energized but that getting 20:40 Speaker A through that process especially if you're doing blind without data is not not a pleasant experience. So this is where as a physician I believe very strongly in the role of GLPs. Um specifically tzepide you know dual aagonist is a potent mechanism in bolus 20:57 Speaker A fashion. Do I think you need to be on a GLP for life? Absolutely not. 21:02 Speaker A No. But a GLP can play a powerful role in what I would term a metabolic reset. 21:07 Speaker A Yeah. Agreed. Yeah. It's allowing you to get into that into that state. I think we were talking about with that metabolic flexibility which is rather than staying on a GLP1 is or any kind of receptor agonist is or even a triple 21:19 Speaker A agonist for that matter staying on it is just a it's just a synthetic form of caloric restriction. That's essentially what you're doing. I mean you're staying on it for a long time. I mean you're just artificially I mean the GIP is a 21:30 Speaker A little bit different obviously but when you get into that world if you're doing it for prolonged periods of time I mean yes you're restricting calories. as you're um you know reestablishing a you know glucose homeostasis for sure but 21:42 Speaker A the bless fashion by using it to train the body to be able to get into these extended fasts because I think what what you're saying which I appreciate so much about a fasting perspective because it's exactly how I look at it is fasting 21:54 Speaker A should be the acute stressor not the norm correct like intermittent fasting is and I've caught so much crap for this because it's just like I have a lot of fasting people that watch my but I'm not pro 168 22:05 Speaker A like I feel like skipping Breakfast every day is just another means of caloric restriction. 22:09 Speaker A Exactly. That's all it is. Acute stressor being able to occasionally once a week, once every couple weeks, go 24 hours, go 36 hours, go an extended period of time. 22:18 Speaker A But what people don't often understand is that if you don't have the metabolic flexibility to do that, that is almost torture for them because some it's not even tor I mean it it it is going to be not just challenging. I 22:32 Speaker A mean, get the the mental toughness. You know, I've been criticized for suggesting using a bullish GLP strategy. 22:38 Speaker A Well, what about the self-discipline and all that stuff? Well, listen, that's great and I'm obviously I believe very strongly in self-discipline, but if I can't get someone over the hump, self-discipline is not even part of convers. It doesn't matter. It's 22:50 Speaker A irrelevant. You're you're a unicorn in the sense that you are talking about um you know, not buying into calories in calories out BS yet at the same time still condoning the use of a GLP, right? That makes you that 23:01 Speaker A makes you a unicorn because I think which I think people should listen to that because you're talking about it from this is a strategy metabolically not just to reduce your caloric intake to talk about those things from two 23:15 Speaker A different perspectives is very unique and to be able to kind of because that's exactly how I view GLPs. I'm not opposed to them. 23:20 Speaker A I don't like Ozic. I don't like the I don't like that stuff. I don't like the fact that it's monetized the way it's monetized. I don't like the the the pharmaceutical aspect of it. But mechanistically, these things have been 23:30 Speaker A used in diabetes and in these metabolic conditions for a very long time before they were ever even talked about for general weight loss. 23:37 Speaker A Right? So using that to allow someone to be able to achieve metabolic flexibility through fasting faster so that then they can adopt the fasting lifestyle without the use of it faster. 23:49 Speaker A I see it as a pretty appropriate tool. And that's and that's all it is. Fasting is a tool. GPS are a tool. Hormone health. I mean we could unpack that whole segment of the conversation. 24:01 Speaker A They're tools for performance output. And if you look at it from that perspective, then I think it all ties to a strategy. And then something I obsess over as a 48-year-old father of two, multiple businesses, you know, efficiency is everything. I believe I I 24:23 Speaker A say this outright to my clients. I get 90 days to have radical impact on your health and performance or there's there's the likelihood that you know you really buy in and stick with the plan is pretty low. That's just human nature, 24:38 Speaker A right? So why wouldn't I use every tool, every advantage possible? And this is my biggest challenge for especially a lot of physicians now who have kind of shifted in this coaching role. I don't quite get it. If I'm taking care of you 24:55 Speaker A from afar and I can't do anything more than say give you suggestions, that becomes hard for me as a physician. I don't feel like I can add enough value to justify my existence. What's really cool is when I get to work with you 25:08 Speaker A one-on-one, it's we can get so into the weeds, it's crazy, right? But all of these become tools in a think of it as like a massive tool shed that you're ultimately working towards is in fasting of all the things 25:26 Speaker A we could talk about muscle health and fasting. If that's all you dialed in, there's really not a lot outside of genetic predisposition that's going to trip you up. Do you agree? 25:38 Speaker A Yeah, absolutely. I mean, and that's where I would say it's a lot less magical or mystical or you know um scary than I think a lot of what people have in their mind and people hear fasting and again a lot of clients first time I 25:55 Speaker A bring up fasting with a client you know they they have sort of a visceral reaction it's either I've tried it before I've failed oh yeah know I intermittent fast I skip breakfast every day and it it it hasn't really worked 26:06 Speaker A well that's not fasting I mean we got to get away from that alto together but when you explain fasting and then you say And someone asked me this the other day. They were like, you know, what percent of your clients actually 26:18 Speaker A complete their fasting protocol and even go on to adopt that as part of a lifestyle um management piece 100%. 26:28 Speaker A Because I'm hellbent on doing whatever it takes to allow you to get over that hump, which you and I both know once you're over that hump, fasting's fasting's a workhorse. I mean, I feel consistently better when I fast. 26:45 Speaker A Not just from a health standpoint, but even from a logistical standpoint. Yeah. The other thing I heard someone say recently was like, you never realize how much time, especially as Americans, we spend every day related to food. 27:01 Speaker A thinking about food, where are we going to get our next meal, making the reservation at at at the um restaurant, getting takeout, going to the grocery, planning, prepping. The amount of time Americans invest in food is is shocking. 27:17 Speaker A And the only way to understand that fully is to spend a day not eating. And all a sudden, you've got two, three hours of time you didn't know you had. 27:26 Speaker A Yeah. Right. And so for me it's it's it's even strategy in terms of daily logistics that frees it up. But the metabolic impact if you consider most Americans are metabolically deranged. 27:40 Speaker A The answer to me is pretty simple. It's extract value from strategic fasting. I think and you mentioned something at the very beginning which was the sort of inflammatory state of the body in the first place. 27:53 Speaker A Right. I think people have a misconception that insulin resistance is a glucose problem, right? 27:59 Speaker A And that's the glucose is a that's a that's a further down the cascade, right? That's that's a response, right? 28:06 Speaker A The response is your inability to manage glucose because insulin is the insulin dynamics are messed up. And I think when you start looking at it, I think people oftentimes put this cart before the horse where they're just they're so 28:18 Speaker A overly fixated on carbs becoming the carb being the problem. Sure. And insulin being the problem, right? 28:26 Speaker A That it can get twisted because like what you're saying could absolutely be misconstrued through the wrong lens of like, oh, this guy's saying insulin is bad. This guy's saying I should never spike my insulin. I should never. But 28:39 Speaker A you said something very clear which was you're there's no reason that you should have a fasting insulin level above essentially zero at baseline. Right. 28:48 Speaker A Right. Now obviously when you consume food you should have some level of insulin. Can we talk about kind of the balance that you think people should follow? If they are insulin resistant and they are trying to lower their 29:02 Speaker A fasting insulin levels. What they should do to not be afraid of insulin? Let's yet still leverage these low dips in insulin that are going to allow them that metabolic flexibility because the goal should be you should be able to have carbs without 29:16 Speaker A a problem. Like you should carb carbs are are freaking jet fuel. Carbs are great if you can use them. 29:23 Speaker A Right. Right. Well, here I mean oh I see this going off in in a couple directions. One thing I want to say not not at all in disagreement but I think in today's today's understanding of insulin resistance people hear insulin 29:43 Speaker A and they think insulin bad. Yeah. I think of insulin like you remember the Goonies. I think of of insulin as like your big dumb older brother. Okay. It's not bright but it's well-intentioned. 29:54 Speaker A Insulin's doing its job. And plain and simple. I'm going to say something uh that's going to sound like heresy. I think Gary Brea has one reasonable point which is insulin really has three roles in the human body. It's it's it's 30:11 Speaker A ultimately about glucose homeostasis and glucose free glucose in the bloodstream is toxic. That is a true statement. 30:19 Speaker A Right. Yes. Now carbs and glucose are not one and the same. There's a relationship. 30:25 Speaker A So this is where it gets nuanced. But what does insulin do? Yeah, it activates glute 4 receptors in myioytes, hpatocytes, adapocytes to uptake glucose. Okay, get it out of the bloodstream. It activates ultimately can activate denovoatic lipogenesis, use 30:41 Speaker A glucose, convert it to different substrates, get it out of the bloodstream. Right. Yep. And ultimately, yes, it is very true to say insulin and its relationship with atyposytes, fat cells, is very linear. 30:55 Speaker A It is the most potent inhibitor of lipolysis. It's a true statement. Now people get all the, you know, pseudocientists get into the weeds of well that's happening at the cellular level. That's not whole body lipolysis. 31:08 Speaker A Well, where does whole body lipolysis start at the cellular? At the cellular level, you know, you know what I mean? Like these are what these guys like, guys, you don't have to make it this complicated. Insulin has a 31:18 Speaker A much higher affinity for atyposytes than it does elsewhere. Right. So, so if we agree on that then we have to understand the relationship between glucose and insulin it's very simple glucose once it achieves a certain threshold in the bloodstream 31:34 Speaker A it's by the way this is chemistry it's pancreatic beta eyelet cells don't have brains they don't you know how we present things like what wants to do this no this is basic chemistry when there is a glucose threshold in met 31:47 Speaker A insulin is secreted by pancreatic beta cells now it's fascinating by the way insulin and man insulin in the body and the glucose relationships between you know non-inssulin dependent glute glute uptake right so glute channels in I'm sure you know this but there are 32:04 Speaker A non-inssulin dependent glucose channels in beta cells glucose is actually cytotoxic to beta eyelet cells kills them just like it does neurons just like it does you know ocular cells kidney cells so on and so forth but free glucose in the bloodstream 32:23 Speaker A cytotoxic we have to that that is a true statement and then that you understand the relationship between glucose and insulin. So now we have to get more strategic because yes while insulin we'll say generically um has a a storage 32:39 Speaker A and an anti- lipolysis mechanism. We also know it's the most potent stimulator of muscle growth. So here here we come right back to that word strategy. How do we use our knowledge of human biology to strategize towards optimal health? Because having high 32:58 Speaker A levels of insulin following a workout where you have adequate building blocks amino acids available is the most potent indeector of mTor activation and MPS muscle protein synthesis. Agreed. 33:11 Speaker A Agreed. Y we have to use it strategically. So insulin's not bad nor is glucose bad. 33:17 Speaker A all these things. It's not a good bad situation. It's all about strategy. So when you're insulin resistant, if we can do that tangent briefly, the simplest way I can present insulin resistance to people is this. 33:34 Speaker A There are there are insulin receptors on muscle cells, liver cells, fat cells. That's the predominant resource for insulin receptors. Obviously, there's insulin receptors all over the body. But if you think of say like a Ring doorbell as being um the insulin receptor, 33:53 Speaker A I have a little daughter. You have a little daughter. When she was two, she figured out the Ring doorbell at our house and thought it was amazing. She press Ring doorbell, makes a sound, someone comes running, right? So, what's 34:03 Speaker A she do? Starts dinging the doorbell, right? Infinitely. As you know, I'm a surgeon. So, my my my phone's going off 30, 40 times a minute. And at first I'm like, man, is the Amazon guy just losing his mind or something? Then of course 34:16 Speaker A they show me the little video and there she is smiling and going nuts. So what happens when we have chronic exposure and this is the that the the tie to carbohydrates, specifically glucose. We have chronic exposure to insulin, right? 34:32 Speaker A Insulin's that my daughter's finger. The doorbell is the insulin receptor, right? And then you have postproducts, right? 34:39 Speaker A So you have chemical reactions taking place with intracellular communicators. Think of that as the wiring to the doorbell itself, right? And then the glute 4 channel, think of it as you, me rushing to the door, throwing it open to 34:53 Speaker A allow glucose in. That is the insulin dependent physiology of glute 4 channels. Glucose uptake into muscle cells for example. 35:02 Speaker A When you have chronic exposure, and this is where I think the the key part of the puzzle is chronic exposure to what we talk about glycemic variability, it's not the glucose spike, it's how high is the spike, how long is the spike, how 35:18 Speaker A variable is the spike, highs and lows, right? And then how often is that happening happening during a day? Every one of those spikes, the body has to deliver insulin. So now you get higher and higher levels of circulating 35:29 Speaker A insulin. fingers on the doorbell all the time. That's circuitry. This is the true mechanism of insulin resistance. That circuitry starts to go bad. And where does it start to go bad first? It's not in muscle. It's in the liver. 35:41 Speaker A Mhm. Right. Yep. Which is also the metabolic supercomput. We can get in to those weeds cuz I think it's fascinating. But when you keep dinging that doorbell, those channels ultimately stop opening, right? And in so it takes more rings of the doorbell 35:56 Speaker A to get the same net effect. Yeah. Agreed. So what's the body do? it's producing more insulin. So that's we have to understand that relationship to understand how to reverse that relationship because indeed carbohydrates by themselves do indeed ultimately convert to glucose. That's 36:13 Speaker A the only currency that's distributed into the body. But how rapidly that occurs and based on how rapidly occurs, how high does that glucose spike go and thereby how high is the insulin surge in response. That is the differentiator. 36:32 Speaker A So control your glucose spikes and this is what I think is freaking fascinating. You actually, true story, you turned me on to this concept I think um a while back. But the idea that those channels in muscle cells specifically 36:50 Speaker A Mhm. are not actually uniformly insulin dependent right? Correct. Yeah. They actually function incredibly well in an insulin independent manner strategy. 37:04 Speaker A How do we regulate blood glucose without insulin? Very possible. Yeah. And it's not purely a dietary conversation. Now, yes, if you keep pumping sugar into your bo body, you will continue to have those spikes. You will continue to have the insulin 37:20 Speaker A response. It's a it's a net effect, right? But my the thing that I've come to realize, and this is through again hundreds of clients, high level glucose monitoring right? 37:33 Speaker A The human body is actually incredibly well positioned to manage glucose and the the structure that does it best is arguably I would say muscle skeletal muscle. Why? And we talked about this AMK EMPK activation upregulates glute 4 expression. 37:51 Speaker A Mhm. And transllocation. So you can actually completely control your blood sugar simply by moving. It's that simple. And so what's cool is when you follow glucose curves, right? If you understand that some quantity of carbohydrates that you're going to 38:13 Speaker A consume, say it's 30 gram of moderate glycemic index carbohydrates, right? You you and I both know this. I'm sure you don't actually ever see a glucose spike if you move immediately following consumption. And it doesn't even have to 38:31 Speaker A be you can literally do isometrics is what's cool. Exactly. So you could be sitting at your desk and you could be flexing your quad and doing quad extensions. 38:40 Speaker A Yep. And signaling that same glucose. You can be sitting on a plane. Yeah. Right. And people look at me and they're like, "What is this guy doing?" Yep. 38:48 Speaker A I'm moving. You're absolutely right. Asometrics. Um walking is great. Okay. Why? Why? If I like I said, intentional movement. If you said, "What's the one intervention I can do today, Doc, to improve metabolic flexibility?" Move intentionally after every single 39:07 Speaker A meal. That impact is so profound. Now, again, I geek out over the data. I love It's not because I love the numbers, but when when a client sees those trends, sees that uptick in glucose and does 20 air 39:23 Speaker A squats. Yep. And all of a sudden, their glucose levels off for sure. Yeah, that's it's not rocket sciss I really think it I attribute it to something you said I think on on a post. Yeah, I've been big 39:36 Speaker A I've been big on that for a while cuz I think like it's and you know much to the frustration of some of my low carb audience honestly because it's just like this is a place for you to have your 39:45 Speaker A cake and eat it too like you can actually and the way that I look if we come back to your doorbell analogy okay let's just say go to the doorbell insulin's ding ding ding ding ding ding ding if one person is in that house and 39:55 Speaker A that let's say that one person is you have one glute 4 okay let's just hypothetically say you have one glute four in that house that glute four hears the doorbell and it's going to You you said the word transllocation 40:07 Speaker A which for layman's terms has come to the surface right? Expression means creating more. So you have this transllocation of the small glue 4 receptor. 40:16 Speaker A Okay, eventually that insulin receptor is going to get saturated. It's going to get like white noise. It's just like, okay, stop ringing the doorbell. I'm not coming to the door anymore. Okay, expression means you just created more people in that house that maybe haven't 40:29 Speaker A heard that doorbell before. So it's like they're not used to the doorbell yet. So they might actually so when you do this kind you actually start the more glute for you can express the more potential you have to get glucose 40:42 Speaker A into the cell without insulin being present right so that's why people think about okay like movement's going to transllocate glute 4 it's going to allow glucose to get in yes that's great but what we really want is more glute for expression 40:53 Speaker A and when you say like do something like squats I just filmed a video last week that the more muscle that you move even in short order if you had a pair dumbbells and if you wanted to be a total weirdo like if 41:05 Speaker A you're at home and you wanted to pump out 10 thrusters like where you have dumbbells and you're doing squat to press it's I can't remember the number it's ridiculously more glute for expression because it's globally signaled the more muscle you move it's not about 41:20 Speaker A going to failure it's about more muscle you move so grab some dumbbells move the full body squat all the way to a press and then you're getting total global glute 4 expression so then you're then the area under the curve for glucose 41:33 Speaker A is lower for like 2 hours, not just immediately. So, it's like the way that I look at it is the more you train your body to use glucose independent of insulin, it's almost like you're putting more people in that house that haven't heard 41:44 Speaker A the doorbell before. So, it's like you have a higher chance even outside of exercise, you have a higher chance of insulin coming back online in a proper fashion. Right. Does that make sense? 41:54 Speaker A Yeah. No, I love that. I love that analogy. Um, if you don't mind, I I'm going to start using it. Right? More people can hear the medical. 42:02 Speaker A But it's it's spot on. And here's here's kind of where I take that even further. 42:08 Speaker A And I've come to realize we've always talked about muscle as at least I've talked about the metabolic engine. You know, muscle increases BMR. Muscle does all this kind of stuff. So that's a fuel utilization conversation. But we need to 42:24 Speaker A based on this conversation and this is where my mindset's changed. We need to see muscle as way more impactful than just fuel use. 42:32 Speaker A Agreed. Agreed. It's actually a fuel management system. Think of think of skeletal muscle as a glucose management system. Very complex glucose management. What I mean by that is this. 42:44 Speaker A It's a true statement to say. Now, what I have, what I'm excited about on the near horizon, again, I geek out on the data, continuous insulin monitoring, right? We have continuous glucose monitoring, but the relationship between glucose and insulin is fascinating, 42:59 Speaker A right? Um, but here's the thing. If if muscle is porous, spongelike, you've increased the expression of glute 4 and those glute 4 channels are being pushed to the surface, right? It's simply put parocity. It's just bunch of open doors. 43:18 Speaker A It's like if you live in a safe neighborhood in America somewhere and everybody just leaves their front door open, an Amazon guy just comes by and just throws things from the the street. 43:27 Speaker A The beauty is once glucose is out of the bloodstream, it is not going to stimulate insulin secretion. That's a that's a chemical reaction. So managing glucose, the beauty is muscle then is making the decision. Do I need it for active fuel 43:46 Speaker A or am I going to store it? I mean skeletal muscle 80% of glycogen is stored in skeletal muscle, right? 43:54 Speaker A The one thing that I learned in way back when in medical school is the human body is way smarter than the smartest physician scientist in the world. Let the human body um veer off and talk about like toxic 44:09 Speaker A exposure. That's a big one. Microplastics, all stuff. The the human body has this thing called the liver and the kidneys and they're the most powerful cleansing agents known to mankind. Let the human body function. 44:22 Speaker A So, let skeletal muscle run the show. Once, and you know this to be true, it's a one-way door. When we valve into skeletal muscle, once glucose is in skeletal muscle, it doesn't move freely in and out of the muscle, once it's 44:38 Speaker A intracellular inside the cell, it's it's fixed. And now the muscle can choose, do I need to push it down the pathway of fuel to energy, ATP, or do I store as glycogen there? We know it's a demand phenomenon, right? And it's an ATP ADP 44:55 Speaker A ratio. All that's all kind of the high level science, but very simply put, the beauty of looking at muscle from a non-inssulin perspective is it can actually almost override the insulin response if we use it strategically. So level up, we talk about moving after 45:13 Speaker A food consumption, move before. Yes. As well. Yep. Yep. And again, this is me as a physician, a scientist. I geek out over the stuff. I love to see the data curves and all, but it's really fascinating. 45:29 Speaker A Do 20 air squats before you sit down for dinner. Take a 30 minute walk afterwards. I love the thruster idea. Whatever it is, movement and it's non-intensive, by the way, because the other key to this conversation is I don't want to 45:44 Speaker A force an anorobic environment. We're not talking about going and doing sprints. No, just move. 45:50 Speaker A And this is the fundamental issue with Americans. We're under muscled and undermoving the society. 45:57 Speaker A Those are two problems that are pretty dog on easy to fix, right? Yeah, for sure. I mean, it's in and and so we we think of ourselves at the mercy of this insulin resistance. Well, the real issue is build more muscle and then put that 46:13 Speaker A to strategic use. Become intentional. And yeah, okay. So, it looks a little bit goofy. You'll see me at a restaurant like doing some air squats or I'll run to the bathroom. But if you follow those glucose curves, it's fascinating. You 46:29 Speaker A literally said you can have your cake and eat it too. Yeah, it's literal. It's actually literal. Go to Cheesecake Factory, right? Right. It's so funny cuz it's, you know, it's something that I've worn CGMs for years and the biggest net 46:47 Speaker A effect that I've ever had from glucose is when on my glucose is when we walk. 46:52 Speaker A We my wife and I have always done this like and we do with our kids like destination dinners or destination treats like go walk to get ice cream and then walk back. 47:00 Speaker A Yeah. Such a difference from like going to driving to ice cream and then even just doing squats afterwards. That has an effect. that preload of your exercise that actually triggers that expression that triggers like that massive load of 47:11 Speaker A glute 4. So that combination and I think that's just something that Europe does that we don't. Right. 47:16 Speaker A I was going to say that they it's not like I understand and I recognize that in the United States we are not exactly the best like pedestrian friendly environment to just go walk to dinner. I totally respect that. But I 47:27 Speaker A also think that we can find ways to make it an activity and make it fun. If we're somewhere, you know, I live in suburbia where it's not exactly like I can't just go with like my fi my six and 47:37 Speaker A eight-year-old and just go. We're gonna have to walk two miles to really go each way to go. That's not always practical. 47:41 Speaker A But what we will do is say why don't we go drive to XYZ and then from there we'll go walk to get dinner and make it make it an adventure. Make it an excursion lit literally and metabolically a glucose excursion. 47:53 Speaker A Right? So when you actually have that this is again what Europe has and why they don't have the same problems we have. I don't think it's anything crazy. I think it's the fact that they have the movement piece nailed. Yep. 48:05 Speaker A And they have an infrastructure and a public transportation system that influences that. Right. Even if you take a train somewhere or whatever, you're you're going to get off and then you're going to walk, you know, a half a mile 48:14 Speaker A to go eat and then you're going to walk a half mile back to the train. It just it it lends itself nicely to set yourself up for for that movement. 48:20 Speaker A And it's it's not I mean, yes, you can get into so many different weeds of it, but it really truly is that simple. 48:27 Speaker A Yeah. And the more muscle that you have, the more impactful said walk is going to be. 48:32 Speaker A Exactly. More capacity, right? I mean, you have the issue of the global storage or management capacity. That's more muscle skeletal muscle mass indices. 48:44 Speaker A Intentional movement extracting value from that muscle mass. So, if you're strategically aligned, I mean, people talk about managing the obesity epidemic and so on and so forth. 48:58 Speaker A This is where someone like Gabrielle Lion, I I'm I think she says it best. I mean, we're an under muscle society. 49:06 Speaker A It's not so much an issue of being over fat. It's simply that we live in a sedentary society that doesn't move intentionally, nor do we put enough emphasis on muscle health. So, going all the way back to the 50-year-old guy with 49:22 Speaker A metabolic dysfunction, fast move muscle, that's where it's at. Now, the caveat I would make to that is within that context, I'm going to apply every amount of science tool and and avenue to optimize those categories. I mean, when a 50-year-old 49:44 Speaker A male comes and sees me and their skeletal muscle mass indices are in the sixes, their total testosterone's 200, their fasting insulin's 18, right? You got a lot going on, but at the core, the strategy is still the same. 50:03 Speaker A Yeah, it's these three pillars and then you work supplementation, you work everything from there, right? It's like without the pillars, none of that works. in every single supplement, you know, TMG, bourberine, all these things. These amplify each of 50:15 Speaker A those pillars, correct? Because they're all bourberine can amplify faster fasting. Bourberine can amplify that walk. Bourberine can amplify glute 4 when you have more muscle. So, right, they're all amplifiers. And I think people get they get hung up on these individual pieces. 50:31 Speaker A Like, and I'm partially to blame for that. Like, I love doing videos on the TMG and carnosine, what these things do, right? But it's only because I'm excited about the mechanism and I know what it can how it can amplify these same 50:43 Speaker A pillars. Right. So without those that framework that foundation, right? Those might make a little dent, but they're going to make a significant dent if they have these pillars there. 50:54 Speaker A Right. Right. And that gets to the efficiency piece. Why not further optimize these pathways to support these key areas of change? 51:05 Speaker A Right? you dihydro bourberine or or bourberine um it's a powerful tool to upregulate activity you still but still the most potent mechanism we have is fasting but if you can find synergies and go back to what I said if I've got 90 days 51:24 Speaker A to move the needle I'm going to pull every lever I possibly can again why does hormone health matter if you've got a you've got a total testoster es testosterone 250 free testosterone I see in men less than five 51:39 Speaker A um that switch is effectively off. So the idea this guy may be highly motivated he may be willing to go after it in the gym but just in the same token that could you possibly summit Mount Everest butt 51:54 Speaker A naked? I mean yeah in theory likelihood close to zero. You got a total testosterone of five, which by the way, the principal driver of hypogonatal low tea in men today is insulin resistance. That that link is abundantly clear. So people get into these 52:13 Speaker A women too honestly. I mean now they just saw they just changed PC PCOS, right? 52:17 Speaker A They finally acknowledged just changed something that's always been a metabolic disease. Crap I caught for years talking about the link between PCOS and insulin resistance which was so clear and now they finally change it to PMOS like which is purely a metabolic condition 52:31 Speaker A like anyway. So the point is it's not just men it's like it's the same with women too. a thousand% a thousand% and like I said earlier the challenge with women is they're already 50 steps behind my perspective and we could do a whole 52:47 Speaker A whole conversation around women's health. I mean we have it is truly one of the greatest tragedies or disservices we've seen in the modern era of of medical therapy. I I did a had a conversation recently about this. Read a 53:02 Speaker A statistic that and and this is not a criticism of physician training. This is not where I'm going with the conversation, but only 31% of OBGYn residencies in the United States today report having a structured curriculum around menopausal hormone care. 53:21 Speaker A Yeah. A third. Yeah. Right. And we're talking about an entire society that has been severely impacted by that. A lot of a lot of um misrepresentations, a lot of misunderstanding, so on and so forth. 53:38 Speaker A But like I said, imagine the 50-year-old women woman who's, you know, maybe going into menopause or maybe, you know, maybe had early menopause, right? And now those individuals, you want to talk about accelerating insulin resistance. 53:54 Speaker A Talk about a uh like a, you know, flipping calories on its head, right? When you start looking like flipping that whole model even uh you should talk to Dr. Bill Campbell. Have you know who he is? Yeah. I mean, it's funny because 54:06 Speaker A he is for decades has just been like, you know, a calorie guy and it's like I had him sitting right where you are and it's so interesting when we talk about, you know, women and like he's talking about his 54:18 Speaker A wife and he's just like the calories just didn't work. It just didn't work anymore. And here I have a guy that's just like and I Bill's so awesome, but he's just like he's like I spent my whole career saying it's like it's all 54:28 Speaker A calories in, calories out. He's like and now and I still he's like I still believe that. He's like, "But now I have serious questions because this is not working." Yep. 54:36 Speaker A And it illuminates just this whole other equation. Yeah. Well, it's it's the once again, are we in a vacuum in a lab or are we in a biological organism? Yeah. And that's where the whole energy balance first law 54:51 Speaker A of thermodynamics. Yes, that's true in a textbook, but it misses the entire reality of a biologic organism that adapts that is sensitive to constant changes in hormonal millu again environmental lifestyle factors that contribute. But women especially, I mean, at least men, we have this, you 55:14 Speaker A know, slow, relatively slow decline of hormone production. women. I mean, it's you look at it just goes and falls off a cliff. What do you think the impact of that is? And I agree with you that I mean, I've been using GLPS and PCOS for 55:32 Speaker A years. It's an incredible tool. GLPs and fasting. It's wild how you can radically improve hormone production in a woman who's been diagnosed with PCOS. And I can't tell you how many women come in on metformin in 2026 and it's like, wow, we we are 55:54 Speaker A missing the boat. Totally missing the boat. And even if it wasn't about GLPs, again, I would strongly say that fasting and muscle optimization are principal treatment modalities for PCOS PMOS. 56:11 Speaker A Because it's it's not just a relationship to insulin resistance. It is that is the driver. 56:17 Speaker A It's a metabolic disease that's been horribly misunderstood, mistreated, so on and so forth. Just put them on birth control. 56:25 Speaker A Yeah. Right. Throw on an anti-depressant if if you know if you're feeling frisky, right? 56:30 Speaker A Um no, I I think this is I love what you said too. Um and I'm going to adopt it. We live in the BBS too in Denver and so we don't have immediate access. We ride bikes a lot in 56:43 Speaker A the summer. Um but uh and I've been known to load the kids up in my little trailer. Yeah. 56:49 Speaker A Cheesecake factory, which I'm a big fan of. True story. It was a scratch kitchen. So you can ask them to make anything. That's what's kind of cool. But I want give me a plain burger with some goat cheese on it and 56:59 Speaker A some broccoli. Okay. So that's about eight maybe 8 10 miles from my house. So I feel good about riding the kids all the way there. We get our slice of cheesecake ride back. You'll never know the difference, right? But I love the 57:16 Speaker A idea of strategically going to proximity but then then walking because you're absolutely right the the European culture embraces movement. I saw I saw something recently. I think it was real where like you could get a free bus ticket a if you 57:39 Speaker A did like x number of air squats. So I it may have been AI generated but it was it wouldn't surprise me everything somewhere in Europe where like the people are sitting there in this little um there's a little camera 57:52 Speaker A lens and they do x number of air squats. It counts them. Dude, well you think I mean it's a ticket. A lot of Europe is, you know, somewhat socialized healthcare and you think it's like, okay, if we get people 58:02 Speaker A healthier, it's amazing then this, you know, and obviously it's it depends on where you are, but it's just like I don't we this different topic for a different day. I mean, I socialized healthcare has it has its issues, but at the same time it's like 58:14 Speaker A at least there is a common theme to like okay less burden on the system if people are healthy, right? 58:19 Speaker A That's what I do like about that. So it's like okay, if so that doesn't surprise me one bit and there is less burden on that system comparatively, right? So, um, and especially when you equate for actual longevity data and 58:31 Speaker A like who's like living longer really, like who's got the bigger burden, right? So, you know, and we could go all day with this, but uh, Dr. Chef, where can everyone find you, man? 58:41 Speaker A So, love to connect with people through social media. Um, YouTube is actually something we're growing. I started long form video about two months ago now. Um, so YouTube channel Johnef or excuse me at Dr.jchef and then on Instagram, Tik 58:59 Speaker A Tok, Johnfeff, just my name. Um, I think connecting with people, understanding where people are at, that has been probably the greatest net benefit to me of getting involved in social media. 59:14 Speaker A Yeah. Is it's removed in good ways and bad, but it's removed the barrier of doctor, patient. Yeah. 59:22 Speaker A And it's made it I mean the cool thing is never before could you just ping a doctor and say hey what's your thoughts on this right hierarchy and I'll say one other caveat about social media that I personally 59:37 Speaker A love is accountability because it's one thing to kind of put on a show in a structured strategic fashion but it's really challenged at least the way I've taken it challenged me to be on all the time. 59:52 Speaker A Yeah. Right. Cuz it's wild. People, whether it's AI or whether it's really intelligent people, they'll call you out on your BS. 60:01 Speaker A Yeah. And that's the coolest thing about social media is you can't get away with, you know, in the old days, you know, the doctor says and that's just it's like gospel. 60:09 Speaker A Yeah. Now you have to actually be Yeah. be legit. That's where you have to get real patient data, too, right? Yep. Yeah. So, love to connect with people, man. We'll link out to all that stuff down below, brother. Thanks, man. Topics: insulin resistance muscle building metabolic health calorie restriction glycemic variability protein intake resistance training weight loss menopause gut health Study this video - [Flashcards from this video](https://sozai.app/tools/ai-flashcard-generator/?from=transcript&id=73282) - [Quiz on this video](https://sozai.app/tools/quiz-generator/?from=transcript&id=73282) Free, made by AI from this transcript. No signup. --- This is the markdown twin of https://sozai.app/transcript/insulin-resistance-doctor-over-40/ — the same content, without the markup. 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