#19 - Rethinking Hemoglobin A1C and Are You Truly Prediabetic?

I'm feeling an urge to shift my content in a new direction. I'm not giving up on discussing metabolism since that's a topic that is still very close to my heart, but at the age of 52 and after digging deep into insulin resistance for well over a decade, I'm sensing a different pull.  In this episode I discuss my internal transformation and how you too might have a different voice inside that is longing for a new direction. 

This episode takes a fresh look at the 3 fundamental molecular root causes of insulin resistance using some familiar storylines from prior episodes combined with some new story hooks to help you understand the science of insulin resistance. We cover the following: Quick review of insulin mechanism of action Summarizing the 3 root causes or what I call "-emias" of insulin resistance The inflammation-insulin resistance link explained using a busy ER analogy Using lifestyle changes to manage the 3 root causes

This episode digs deep into protein and more specifically amino acids (protein building blocks) and their role in metabolism, weight control, insulin resistance, and overall health. We cover some of the following: Quick overview of mitochondrial metabolism Introducing protein and amino acids The role of amino acids in energy production Fasting and ketosis Can excess protein intake lead to fat/weight gain? The link between amino acids and insulin resistance  

I've selected 2 key metabolic ingredients, Acetyl CoA and Citrate, to explain nutrition metabolism in further detail. I've also selected a different storyline, the mitochondrial amusement park and the Kreb's merry-go-round, to help you visualize some of the most fundamental steps of metabolism. In this episode we cover: Acetyl CoA's role as a key metabolic conductor The metabolic merry-go-round used to explain Kreb's cycle The importance of the Citrate sensor in switching between anabolism and catabolism How these concepts are tied to the root cause for weight gain and insulin resistance A critique of B-vitamin supplements as "energy producers"

The mental and metabolic impact of human beings predominantly or exclusively working from home has been profound. I've noticed significant increases in insulin resistant conditions including premature heart disease and a deterioration in mental health. All of these risks existed pre-pandemic, reflecting our modern digital lifestyles, but post-pandemic these risks have intensified to an even worse public health crisis. In this episode I cover some of the following: Overall impact of WFH (work from home) on metabolic and emotional health Evidence-based guidelines for MED (minimum effective dose) of daily walking steps and strength training minutes per week MED for minutes of aerobic training with tips on improving adherence Digging into the science of ZEF (Zoom Exhaustion Fatigue) based on Stanford University research Impact of WFH on stress and sleep

I see lots of patients in my clinic who aim to lose body fat and have become well versed in the different types of body fat, specifically subcutaneous adipose tissue (aka SAT) and visceral adipose tissue (aka VAT). Although VAT and SAT are both fat, they represent different health risks and there are some differences in terms of which strategies are more effective for VAT vs SAT loss. This episode is a good follow-up to Episode 16 (Getting Your Body to Burn Fat), which provides the scientific foundation for fat loss (aka lipolysis) along with providing practical suggestions as well. In this episode, we cover: Overview of SAT (subcutaneous fat) vs VAT (visceral fat) How to measure SAT vs VAT Dietary approaches to tackle SAT vs VAT Deep dive on which exercises and routines address SAT vs VAT Other lifestyle factors that address SAT and VAT

GLP-1 drugs have been all over the headlines and the global demand for using these drugs for weight loss has been significant. GLP-1 belongs to a family of gut-based hormones called incretins. In this episode I'll teach you about the fascinating incretin system and how you can influence it naturally to promote weight loss. I cover the following: Understanding the incretin system and how the gut communicates with the brain How the incretins affect the pancreas and other major organs Benefits and risks of GLP-1 agonist drugs My thoughts on using GLP-1 for what I call "cosmetic" weight loss Non-drug lifestyle strategies to increase GLP-1 to lower weight and lower glucose

The pentose phosphate pathway, which I refer to as P3, is one of my favorite metabolic pathways and one that gets far less attention than glycolysis, gluconeogenesis, and Krebs, yet plays such a key role in our body. In this episode we go over the following: Brief refresher on glycolysis and coenzymes using James Bond storytelling Deeper dive into oxidation, reduction, and free radicals (aka reactive oxygen species or ROS) Understanding and remembering the key functions of P3 How P3 is tied to obesity, insulin resistance, heart disease, and cancer How erythritol is tied to P3 and the fallacy of a study linking it to heart disease

In this Metabyte (shorter episode), I review the interaction of the insulin hormone and its receptor on the surface of the muscle cells using a slice of chocolate cake, a lock and key, and a reference to Indiana Jones. 

Call it holistic, functional, metabolic, integrative, longevity, or whatever, but this episode expresses some of my concerns about the direction of what I refer to as the rising "alt health" movement. Interestingly, I'm part of both alt health and mainstream medicine, so I'll share my take from both sides. I'll discuss: The story of "Dr.Bob," a fictional alt health practitioner whose practice is rife with hypocrisy and questionable practices The story of "Diane," a fictional patient anecdote based on patient and audience feedback, who is going bankrupt purchasing alt health services.  How the supplement industry is morphing into its own version of "Big Pharma" Defending mainstream doctors, an unfortunate target of the alt health movement Blindspots and potential harms of alt health messaging Some thoughts on how alt health and mainstream medicine can collaborate better