Insulin Resistance Solution

www.InsulinResistanceCure.
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The Insulin
Resistance Solution
CopyrightMartinMalmberg.
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Table of Contents
Foreword .................................................................................................................................... 6
Introduction................................................................................................................................ 8
Whatisinsulinresistance?..................................................................................................... 8
Howdoesinsulinresistanceleadtodisease?........................................................................ 9
Insulinresistancecanleadtohighbloodsugar,too(prediabetes,type2diabetes) .......... 10
Whatarethedangersofhighbloodsugar?......................................................................... 11
Insulinsensitiveorinsulinresistant?Thatsthequestion ................................................ 12
Howtodiagnoseinsulinresistanceandtrackprogress....................................................... 13
Howtogetthemostoutofthisbook .................................................................................. 16
Chapter1BodyFatandInsulinResistance .......................................................................... 17
BeyondBodyMassIndex ..................................................................................................... 18
WaisttoHipRatio................................................................................................................ 19
Waistcircumference ............................................................................................................ 20
RedefiningobesityUnderstandingmetabolicobesity................................................... 21
Whatcausesacentralfatdistribution? ............................................................................... 23
Determiningifyouhaveexcessfat ...................................................................................... 23
Whattodoifyouhaveexcessfat(LOSEIT)......................................................................... 24
Cancentralfatbespecificallytargetedforfatloss?............................................................ 26
Canyouhavetoolittlebodyfat? ......................................................................................... 26
Fatlosstips ........................................................................................................................... 26
Summary .............................................................................................................................. 27
Chapter2IronandInsulinResistance.................................................................................. 29
Vegetarianshavelowerinsulinresistance........................................................................... 30
Blooddonorshavelowerinsulinresistance ........................................................................ 30
IronandIRareassociated,butdoesironreductionactuallyhelp? .................................... 31
Howdoesironcauseinsulinresistance? ............................................................................. 33
Whoshouldlowertheirironandhowlow? ........................................................................ 34
Ironreductionandothermarkersofhealth/disease .......................................................... 35
Howtoreduceironlevels .................................................................................................... 36
Lowironavailablediet..................................................................................................... 37
Whatkindofresultscanyouexpectfromsuchadietaryintervention?......................... 38
Exercise............................................................................................................................. 38
Phlebotomy(bloodletting) .............................................................................................. 39
Blooddonation................................................................................................................. 39
IP6.................................................................................................................................... 39
Puttingittogether ............................................................................................................ 40
Summary .............................................................................................................................. 40
Chapter3ExerciseandInsulinResistance ........................................................................... 42
Ishigherintensitybetterthanmoderateintensity?Iswalkinggoodenough?................... 44
Aerobicexercise,strengthtrainingorboth?Howoftenandhowmuch? .......................... 45
AwordaboutHIIT(a.k.a.HIIE) ............................................................................................. 46
Thenittygrittydetailsoftraining ........................................................................................ 47
Chapter4SupplementsAgainstInsulinResistance .............................................................. 51
3
Magnesium(Mg) .................................................................................................................. 51
Magnesiumsupplements ................................................................................................. 52
FoodsHighinMagnesiumper200calorieservingbycategory .......................................... 53
SelectCerealGrainsandPasta......................................................................................... 53
SelectVegetables ............................................................................................................. 53
SelectFruits ...................................................................................................................... 54
SelectSeedsandNuts ...................................................................................................... 54
FinfishandShellfish.......................................................................................................... 54
Beverages ......................................................................................................................... 54
Chromium............................................................................................................................. 54
VitaminK .............................................................................................................................. 55
VitaminD.............................................................................................................................. 56
Chapter5SleepandInsulinResistance................................................................................ 59
Background........................................................................................................................... 59
Studiesonsleepandinsulinresistance................................................................................ 60
Qualityofsleepmatters....................................................................................................... 62
Awordaboutsleepdisorderedbreathing ........................................................................... 63
Howdoesshortsleepcauseinsulinresistance? .................................................................. 64
Doeslongsleepcauseinsulinresistance? ........................................................................... 65
Howmuchshouldyousleep? .............................................................................................. 66
Howtosleepwell ................................................................................................................. 67
Summaryoffindings ............................................................................................................ 67
Chapter6DietandInsulinResistance.................................................................................. 69
Minimizinghighpostmealinsulinandbloodsugarlevelsbydiet ...................................... 71
DoIhavetoeatlowcarb? ................................................................................................... 74
Exerciseandcarbohydrates ................................................................................................. 75
Highcarb,highfiberdiets(HCFdiets) ................................................................................. 76
Howyoupreparefoodmatters............................................................................................ 79
Docarbohydratescauseinsulinresistance? ........................................................................ 79
GlycemicIndexandGlycemicLoad ...................................................................................... 80
Dietaryfatsandinsulinresistance ....................................................................................... 80
Dairyandinsulinresistance ................................................................................................. 82
Doesfructosecauseinsulinresistance?Whyitdoesntmatter ....................................... 82
Awordaboutdarkchocolate............................................................................................... 84
Caffeine/coffeeandinsulinresistance................................................................................. 84
Additionaldiettips ............................................................................................................... 86
Puttingitalltogether ........................................................................................................... 87
Dietwheninsulinsensitive................................................................................................... 88
Goodcarbsourcesforahighcarbdiet ................................................................................ 89
AppendixA:WhatEveryInsulinResistantPersonShouldKnowAboutLosingWeight ......... 90
Introduction.......................................................................................................................... 90
NutritionBasicsUnderstandingCalories,Protein,Carbs,FatsandAlcohol ..................... 90
Calories ............................................................................................................................. 91
Protein .............................................................................................................................. 91
Carbohydrate.................................................................................................................... 91
Fat..................................................................................................................................... 92
Alcohol(a.k.a.ethanol) .................................................................................................... 92
TheDifferenceBetweenPercentageofWeightandPercentageofEnergy.................... 92
InsulinResistantIndividualsDoNotHaveAHarderTimeLosingFat .................................. 94
OnlyCaloriesCountSoCountCalories.............................................................................. 94
HowToDetermineYourTotalDailyEnergyExpenditure .................................................... 95
HowToDetermineYourBodyFatPercentage ................................................................ 96
TotalDailyEnergyExpenditure=BMRxActivityFactor.................................................. 97
HowManyCaloriesShouldIEatPerDay? ........................................................................... 98
DeterminingYourMacronutrients(Proteins,Carbs&Fats)................................................ 99
HowmuchproteinshouldIeat?.................................................................................... 100
HowmuchcarbohydrateshouldIeat? .......................................................................... 100
HowmuchfatshouldIeat? ........................................................................................... 101
Anexample..................................................................................................................... 101
HowmuchalcoholshouldIconsume?........................................................................... 102
Awordaboutmacronutrientratios ............................................................................... 103
WhichFoodsToFocusOn .................................................................................................. 103
Proteinrichfoods........................................................................................................... 103
Carbohydraterichfoods ................................................................................................ 104
Carbohydraterichsmallamounts............................................................................... 104
Fats ................................................................................................................................. 104
Alcohol............................................................................................................................ 105
WhichFoodsToLimit ......................................................................................................... 105
AWordAboutIronReduction............................................................................................ 106
UnderstandingtheIIFYMPhilosophy................................................................................. 106
ConstructingYourDiet ....................................................................................................... 106
AreThereAlternativesToCalorieCounting?..................................................................... 108
IntermittentCalorieRestriction ......................................................................................... 109
MyExperienceWithIntermittentCalorieRestriction ................................................... 112
Exercise............................................................................................................................... 112
PreandPostWorkoutNutrition....................................................................................... 113
Summary ............................................................................................................................ 113
Terminology............................................................................................................................ 115
References.............................................................................................................................. 119
Foreword
Thisbookismyattempttosummarizetheimportantfindingsinthescientificliteratureand
myownexperiencesastheyrelatetogettingridofinsulinresistance.
Itisnotatextbookonexplaininginsulinresistance;suchbookscanbefoundelsewhere.
Noonefullyunderstandsinsulinresistanceyet.Thereisjustsomuchthatsciencehas
uncoveredaboutthesubject.Manyquestionsstillremain,sonoonecanreallyclaimto
knowtheentirefieldbecausemanythingsaresimplynotknownyet.
Whatisknown,though,isthatthisisahugehealthproblemwhichcontributesto,ordirectly
causes,numerousseriousailments.Fortunately,weknowalotabouthowtoreversethis
condition.
Asbadasitistobeclassifiedasinsulinresistant,thisdiagnosis,ifyouhaveit,isactually
quitehopefulbecauseinsulinresistanceislargelyacauseofadversefactorswithinyour
control,suchaslifestyle.Infact,insulinresistancerespondsverywelltolifestylechanges.
IknowbecauseIveseenithappeninmyownlife.
Soinsteadofbeingdisheartenedatthiscondition,behappythatyoureatleastafflicted
withsomethingyoucanchange.Everyoneisnotsolucky.
Personally,Ithinkitsaprivilegetoliveahealthylifeand,yes,therearesomesacrificesand
worktobedone,butitsbetterthanthealternative.
Sodontbelazy,behealthy.Andbethankfulthatyouatleast1)haveaconditionthat
respondstolifestylechanges(thingscouldbemuchworse)2)havefoundthisbookthatwill
setyouontherighttrack.
Awordofwarning,though:Thestrategiesinthisbookarequitepowerfulandmay
necessitatereductionordiscontinuationofmedicationsthatyoumaybetaking.Always
worktogetherwithyourdoctorifyoudecidetomakeanylifestyleordietarychanges.All
disclaimersapply.
Iwishyougreatsuccessonyourjourney.AndIdreallylikeyourfeedbackonmybook(good,
badorugly).Youknowhowtoreachme.
Yoursinhealth.
MartinMalmberg
Introduction
Iwilltrytoexplainthiscomplexfieldineasytounderstandterms.Moreimportantly,Iwill
trytoexplainhowtogetridofinsulinresistance.
Ifyoureunfamiliarwithanyterms,youcanalwaysrefertothechaptercalledTerminology.
Onthatnote,whenIwritecaloriesImeankilocalories,alsoknownaskcal.Caloriesisusually
thewordthatpeopleuseforconveniencewhentheymeankilocalories.Ihaveusedthat
styleaswell.
What is insulin resistance?

Insulinresistanceissimplyalessthannormalresponseinvarioustissuessuchasmuscle
andlivertoinsulin.
Insulinresistanceitselfisnotadisease,butmerelyastateabadone,Imightadd.Much
likeobesityisnotadisease;itsastatethatcanleadtodisease.
Beforewegoonyoushouldunderstandthefollowing:
Insulinsensitivityisgood
Insulinresistanceisbad
Itmayseemabitcounterintuitive,soletmeexplain.Normallywhenweresensitiveto
something,itsbad.Ifweresensitivetonuts,orsunexposure,orpollenitsbad,right?
However,whenweretalkingaboutinsulin,youwanttobeassensitiveaspossible.
Why?
Becausewhenyoureinsulinsensitive,thecellsinyourbodyaresensitivetotheeffectsof
insulinandonlyasmallamountofinsulinisrequiredtogetitsjobdone.Thisjobisamong
otherthingskeepingbloodsugarincheck.
Sowhatwereallymeanwhenwesaygetridofinsulinresistanceisincreaseinsulin
sensitivity.Itsmoreorlessthesamething.
How does insulin resistance lead to disease?

Whatfollowsisanextremelysimplifiedversionofevents,withmanybitsleftout,relating
insulinresistancetoovertdisease,butitshouldhelpyouunderstandinsulinresistance
better.
Thebestknown,butfarfromonly,jobofinsulinistokeepbloodsugarfromgoingtoohigh,
andthisisacriticaltaskbecausehighbloodsugarisdangerous.
Intheinsulinsensitivestate,onlyacomparativelysmallamountofinsulinisrequiredtokeep
bloodsugarincheckandregulatevariousotherbodilyfunctions.Ourbodiesworkbestin
thisstate.Intheinsulinsensitivestate,insulinlevelsarecomparativelylowbuttheresponse
ofvariouscellstotheinsulinisstillnormalbecausethecellsarequitesensitivetoinsulin.
Intheinsulinresistantstate,ontheotherhand,sometargettissueshaveabluntedresponse
toinsulin.Thiscanbecausedbyvariousfactors,aswillbeexploredinthisbook.When
insulinresistanceispresent,itbecomesdifficultforinsulintokeepbloodsugardowninthe
normalrange.Theexpectedresponsewouldbeelevatedbloodsugar.
Butnotsofast!
Topreservenormalbloodsugar,thepancreaswillattempttoproduceandsecretemore
insulin.Thisprocessiscalledcompensatoryhyperinsulinemia,i.e.highinsulinlevelsto
compensateforthepoorresponseoftargetcellstoinsulin.Thisisonlylogicaland,if
successful,thisprocesswillmaintainprettynormal(althoughusuallynotoptimal)blood
sugar.
Sowhatstheproblem,then,aslongasbloodsugariskeptincheck?
Well,thepriceforkeepingbloodsugarincheckthiswayishighinsulinlevels,alsoknownas
hyperinsulinemia.
Sowhat,youmayask.Iftherearehighinsulinlevelsintheblood,butthecellsrespond
poorlytothem,wouldnttheoverallresponsebenormal?
Yes,butnotalltissuesbecomeinsulinresistanttothesamedegree.Insulinsignalingmaybe
bluntedinsomebiologicalpathways(processes),whileitispreservedinothers[8][10].
Theendresultisanimbalance,wherebyinsulinsignalsasymmetrically,andthisisnotcool.
Highinsulinlevels/insulinresistancewithsometimesresultinghighbloodsugar(see
below)havebeenimplicatedincausingorexacerbatingthefollowing.
Prediabetes(highfastingand/orpostmealbloodsugar)(seebelow)
Type2diabetes(veryhighbloodsugar)[8](seebelow)
heartdisease[8]
Alzheimersdisease[7]
acne
aging(?)[12][13][14]
malepatternbaldness(mostcommonformofhairloss),especiallyifclearly
noticeablebeforeage35
certainformsofcancer(notablyprostate,breastandcolon[11])orpossiblyall
cancers[10]
PCOS(polycysticovarysyndrome)[19][23]
4of5componentsofthemetabolicsyndrome[9][16][22]:
o depressedHDLcholesterol
o highbloodsugar
o highbloodpressure[21]
o hightriglycerides
o (the5thcriteriaexcessfatisnotaconsequenceofIRbutincreasesthe
chancethatapersonwillbeinsulinresistant[18])
andmore
Whydoesnteveryinsulinresistantpersongetalloftheabove?Probablyduetoindividual
geneticmakeupandotherenvironmentalfactors.Most,ifnotall,oftheaboveailmentscan
alsobecausedbyfactorsotherthaninsulinresistance/hyperinsulinemia.Nevertheless,high
insulinlevels/insulinresistancehavebeenlinkedtoalloftheabove.
Insulin resistance can lead to high blood sugar,

too (prediabetes, type 2 diabetes)
Insulinresistancecommonlyleadstohighbloodsugar,butthisdoesnthappeninall
individuals.Thereareplentyofindividualswhoareinsulinresistantbutretainvirtually
normalbloodsugarlevels,butatthecostofhighinsulinlevels,asexplainedabove.
Nevertheless,ifinsulinresistanceworsensand/orthepancreascantsecreteenoughinsulin
tocompensatefortheinsulinresistantstate,bloodsugarwillstarttorise,
Thiscanleadtoastateofprediabetes,whichmeansabovenormalbloodsugar,butnot
enoughtobeclassifiedasatype2diabetic,althoughprediabetesoftenprogressestoT2D.
Whattypicallyhappensfirstisthatyourbodyhastroublekeepingdownbloodsugar
immediatelyafteryoueatcarbohydrate.Ifthingsdeterioratefurther,yourbodywillhave
troublekeepingdownbloodsugarevenwhenyouhaventeatenanythingfor812hours.In
otherwords,postmealbloodsugarcontrolusuallybreaksdownbeforefastingbloodsugar
control[6,page20].
Butevenbeforethishashappened,thepersonhasusuallybeeninsulinresistantforaperiod
oftime,whilsthavinghadnormalbloodsugarbuthighinsulin.
Highbloodsugaristheabnormalitymostcloselyrelatedtoinsulinresistance[18].Evenwith
arelativelymilddegreeofinsulinresistance,bloodsugarcanbegintorise.
10
Ifinsulinresistanceprogressesfurther,type2diabetesdevelops.Type2diabetesis
diagnosedwhenveryhighbloodsugarispresent,sotype2diabetes=veryhighbloodsugar.
Type1diabeticscanalsogethighbloodsugar,becausetheirpancreashascompletely
stoppedproducinginsulin,butthatisanotherthing.
Ontheotherhand,mosttype2diabeticssecreteplentyofinsulin,butaresoinsulin
resistantthatithaslittleeffect.Theendresultishighbloodsugar.
Incidentally,sincetype2diabetesischaracterizedandusuallycausedbyinsulinresistance,
Illbereferringtomanyscientificstudiesperformedontype2diabetics,becausetheyserve
asagoodgroupforstudyinginsulinresistance.
What are the dangers of high blood sugar?

Chronicallyelevatedbloodsugarcausesdiabeticcomplications.Doesntsoundtoobad,
doesit?However,whatitmeansis:
Nervedamage(neuropathy).Itisusuallyfeltfirstinthefeetasatinglingorburning
sensation,typicallyinbothfeet.Itcanalsoaffectfingersandarms.Eventuallythe
affectedareascangonumb,andthewholeprocesscaneventuallyleadto
amputationoftoes,feetandfingersduetogangrene.[6,page41]
Impotence.Itmightbecausedbynervedamage.[6,page41]
Gastroparesis,i.e.thefailureoffoodtoleaveyourstomachaftereating,alsocanbe
causedbynervedamage.[6,page41]
Kidneydamage/failure(nephropathy).Highbloodsugaristhoughttoplayamajor
roleinthis,andcanleadtototalkidneyfailurewhichwillrequireregulardialysisora
kidneytransplant.
Pancreaticbetacelldysfunctionanddeath.Thisisreallyatragicandunfair
consequenceofhighbloodsugar.Pancreaticbetacellsaretheverycellsthat
produceinsulintokeepbloodsugardown.However,theyarevulnerabletohigh
bloodsugaranditwilldamageorkillthem.Atthatpoint,theycannolongerproduce
anyinsulin,leadingtoevenhigherbloodsugar,andthetype2diabeticwillhaveto
injectinsulinfromanoutsidesource.[6,page4345]
Permanentblindness(duetoretinopathy).Theretinaisvulnerabletohighblood
sugarandcanbedestroyedbyit.[6,page45]
Thesecomplicationscanbegintooccurevenintheprediabeticrange,beforebloodsugar
risesintothetype2diabeticrange[6].Sojustbecauseapersondoesnthavetype2
diabetesdoesnotmeantheyresafe.
Moreover,manypeoplehaveprediabetesortype2diabeteswithoutknowingit.Ifyou
haventtestedyourbloodsugarlevelslately,howdoyouknowyoudont?Whenapparent
symptomsarise,irreversibledamagemayalreadyhaveoccurred.
Torecap:
11
Chronicallyhighinsulinlevels(duetoinsulinresistance)arebad,whetherinthe
fastedstate(afternofoodfor812hours)oraftereating.
Chronicallyhighbloodsugarlevelsarebad,whetherinthefastedstate(afternofood
for812hours)oraftereating.
Transientinsulinandbloodsugarspikesimmediatelyaftereating,whicharequicklyreduced,
arenormalandnotdangerous.
Insulin sensitive or insulin resistant? Thats the

question
Eveninthenormal,apparentlyhealthypopulation,insulinsensitivityvariesasmuchas600
800%[16]ormorebetweenthemostinsulinsensitiveandthemostinsulinresistant
individuals,andthethirdthatismostinsulinresistantreportedlyhaveanelevatedriskof
developingovertcomplicationsofinsulinresistance[17].Thatisahugepartofour
populationwhenyouthinkaboutit.
Mosteveryonehassomedegreeofinsulinsensitivity.Ifapersonhaslowinsulinsensitivity
thepersoncanbesaidtobeinsulinresistant.Ifapersonhashighinsulinsensitivity,the
personcanbesaidtobeinsulinsensitive.
Thinkofitlikethis:
Asyoucansee,wecouldsaythatinsulinresistance=lowinsulinsensitivity.
Becomingmoreinsulinsensitiveisthefocusofthisbook,andgettingoutofthatstatethat
wemightcallinsulinresistant.
ButasfarasIknow,therearenotruedefinitions,noobjectivecutoffpointsbetweenthese
states,justacontinuumthatyoucanmoveyourselfalong[15].Wecouldcall,forinstance,
theleastinsulinsensitivethirdofthepopulationinsulinresistant.Butthatwouldmerelybe
anoperationaldefinition,notnecessarilyabiologicaltruth.
WhatImtryingtosayisthathigherinsulinsensitivityisalwaysbetter[22]anditminimizes
theriskoftheentireclusterofproblemsdescribedabovecausedbyhighinsulinandhigh
bloodsugarlevels.
Whenyouvegottenoutoftheinsulinresistantstate,great.Butwhynotgoontobecome
evenmoreinsulinsensitive?
12
Highinsulinsensitivitywillkeepbloodsugarandinsulinlevelsdowninthenormalrange,but
notdangerouslyorinappropriatelyso.
How to diagnose insulin resistance and track

progress
Itmaybehelpful,althoughnotrequired,toknow:
Yourcurrentdegreeofinsulinsensitivity
Yourprogressorlackofprogresstowardsincreasedinsulinsensitivity
Thetestsdescribedbelowwouldtypicallybeadministeredbyyourdoctor,ifnothingelseis
stated.
Thegoldstandardformeasuringinsulinsensitivity,isamethodknownastheeuglycemic
hyperinsulinemicclamp.
Briefly,itworksbyinfusinginsulinintoaveinuntiladesiredandknownlevelofinsulinis
reachedintheblood.Atthesametime,glucose(bloodsugar)isinfusedinaveinuntila
steadybloodsugarlevelisreached.Thebetterapersonsinsulinsensitivity,thehigherthe
rateofglucoseinfusionwillbesincetheinsulinleveliskeptconstant.Inotherwords,ahigh
glucoseinfusionrateshowsthattheinsulineffectivelyhelpsclearbloodsugarfromthe
blood.Alowglucoseinfusionratemeansthattheinsulinhasalessthannormaleffect(i.e.
insulinresistance)[1].
Theeuglycemichyperinsulinemicclamptest,though,ismostlyusedforresearchpurposes,
butitistheonlytruewaytomeasureinsulinsensitivity.
Therearealternatives,though.
ArelativelysimpletestthatyourdoctorshouldbeabletohelpyouwithistheHOMAIR
(homeostaticmodelassessmentofinsulinresistance)[2].Tocalculatethisyouneedto
measurefastinglevels(i.e.afternofoodordrinkfor1012hours)ofinsulinandplasma
glucose,whicharethenenteredintoanequationlikethis:
HOMAIR=InsulinxGlucose/22.5
InsulinshouldbeinsertedinmU/Landplasmaglucoseinmmol/L.Ifyourglucosevalueis
giveninmg/dl,usethefollowingformula:
HOMAIR=InsulinxGlucose/405
HOMAIRmeasuresyourinsulinsensitivitybycheckinghowmuchcirculatinginsulinis
requiredtokeepyourbloodsugaratacertainlevel.Lowerinsulinorlowerglucose,orboth,
wouldthusgivealowerinsulinresistance.Thiscorrelateswellwiththehyperinsulinemic
13
euglycemicclampmethod.Avalueof1isgood[2]butisprettystringent.IfyourHOMAIR
declines,itsasuresignthatinsulinsensitivityhasincreased.
AsurrogatewayofmeasuringinsulinresistanceistheOGTT(oralglucosetolerancetest).Itis
typicallyperformedbydrinkinginthefastedstate75grams(roughly20teaspoons)of
glucosedissolvedin250mlofwater.Sinceglucoseisthesameasbloodsugaritdoesnt
needtobemetabolizedandentersthebloodstreamrapidly,obviouslyleadingtoincreased
bloodsugarlevels.Yourbodysabilitytobringdownthebloodsugarintothenormalrange
givesanindicationofyourinsulinsensitivity.
Typically,bloodsugarismeasured2hoursafterdrinkingthesolution,aftersittingquietlyfor
2hours.
However,itmustbementionedthattheOGTTdoesntexclusivelymeasureinsulin
sensitivity.Yourbodysabilitytobringdownbloodsugarisdependentlargelyon
Insulinsecretionfromthepancreas
Insulinsensitivity(i.e.theresponseofcellstothatinsulin)
Ifanyoftheseareimpaired,yourbloodsugarcontrolwillbeimpaired.Soahigh2hour
OGTTvalueindicateseitherimpairedinsulinsensitivityorimpairedinsulinsecretion,or
both.Therefore,itsnotaperfectmeasureofinsulinsensitivityperse.Nevertheless,ahigh
2hourOGTTvalueisusuallyastrongsignofinsulinresistance[16].A2hourOGTTblood
sugarvalueinthenormalrangedoesntnecessarilyexcludeinsulinresistance,however.It
couldjustmeanthatyourpancreasissecretinglotsofinsulintocompensateforyourinsulin
resistance,whichwouldleadtonormalbloodsugar.Twentyfivepercentofthosewith
normal2hourOGTTvaluesarestillinsulinresistant[22].
Anormal2hourOGTTbloodsugarvalueshouldbe<140mg/dl(<7.8mmol/l),while
impairedglucosetolerance(prediabetes[5])existsifthe2hourreadingis140200mg/dl
(7.811.1mmol/l).A2hourvalueabove200mg/dl(11.1mmol/l)isenoughtodiagnose
diabetes,accordingtothe1999WorldHealthOrganizationcriteria[3].Thefasteryourblood
sugarreturnstobaselineafteranOGTTthebetter.
IshouldmentionthatbeforeyoutakeanOGTT,youwanttoconsumeahighcarbohydrate
dietforatleast1daybeforethetest.ThereasonisthatalowcarbdietfollowedbyanOGTT
canyieldunusuallyhighbloodsugarreadings,resultinginafalsepositivediagnosisi.e.you
failthetestwhenyoushouldvepassedit.Thisdoesntalwayshappen,andseemstobedue
tothebodyhavinganeasiertimeprocessingamealwiththesamecompositionasthe
backgrounddiet.SinceanOGTTisessentiallyahighcarbmeal,itshouldbeprecededbya
highcarbbackgrounddietforafewdays.[4]
Insummary,ahighOGTTisastrongindicationofinsulinresistance,butanormalOGTT
doesntnecessarilyruleoutinsulinresistance.
Thecrudestandleastreliablewayofestimatinginsulinresistanceisasimplefastingblood
sugartest.Thisiseasilyadministeredbyyourdoctororbyyourselfwithaglucosemeter.A
14
perfectlynormalfastingbloodsugarvalueisinthe7085mg/dlrange(3.94.7mmol/l)[6,
page11].Fastingbloodsugarvaluesinthe100125mg/dlrange(5.557.0mmol/l)are
consideredprediabetic[5]andasignofinsulinresistance.Butmostinsulinresistant
individualshaveafastingglucoseconcentrationlowerthan110mg/dl(6.1mmol/l)[20].Any
consistentreadingsabove90mg/dl(5mmol/l)areacauseofconcernandshouldbe
investigatedcloser.
However,alowfastingbloodsugardoesntmeanmuch,becausethepersonmaystillhave
elevatedinsulinlevels,indicatinginsulinresistance.
Moreover,ahighfastingbloodsugardoesntnecessarilymeaninsulinresistance,either,
because,aswiththeOGTT,ahighreadingcouldalsosimplymeanthatinsulinsecretionis
impaired.Therefore,thistestisquitecrude,butwhencombinedwithafastinginsulintest,it
canbecombinedtocalculatetheHOMAIR(describedabove)whichismuchmorereliable.
Ifyouwanttobecertainthatyoureprogressingtowardsbetterinsulinsensitivity,youll
havetouseoneofthesemeasuresregularly.
Forinstance,ifyouweretotakeanOGTTtomorrowandyour2hourbloodsugarvaluewas
150mg/dl(8.3mmol/l),thenthatwouldindicateprediabetesorinsulinresistance.Ifyou
implementedtheideasinthisbookand,say,3monthsfromnowtookanotherOGTTand
thattimeyour2hourreadingwas110mg/dl(6.1mmol/l)(normalrange),yourbloodsugar
controlwouldbebetter.Andthiswouldmorethanlikelybethankstoimprovedinsulin
sensitivity,sincethestrategiesinthisbookareforemostaimedatincreasinginsulin
sensitivity,notinsulinsecretion(althoughsomestrategiesinthisbookmayalsoimprove
insulinsecretioncapacity,whichisgoodtoo).
Likewise,ifyourfastingbloodsugarwouldfallfromhightonormal,thatwouldalsoindicate
increasedinsulinsensitivity.
Youmightalsonoticeimprovementsinabnormalities(suchashighbloodpressure)thatcan
becausedbyinsulinresistance.Or,ifyoureondiabetesmedications,youmightneedto
discontinueorreducedosages.Triglycerides,ifelevated,mayfall.HDLcholesterol,iflow,
mayincrease.
Look,Iknowitshardtodetermineinsulinsensitivityexactly,butdontshootthemessenger,
ok?Ididntmakeuptherulesabouthowthebodyworks.
Whetheryoumeasureprogressornot,themethodsIdescribeinthisbookarescientifically
validatedandshouldimproveyourinsulinsensitivitywhetheryoutrackitornot.Morethan
likelyyouwillnoticeyourhealthimprovedramaticallyinanumberofwaysifyouimplement
thestrategiesinthisbook.
15
How to get the most out of this book

Somethingscauseinsulinresistancetransiently,suchascaffeine.Onceitleavestheblood,
afterafewhours,theinsulinresistancegoesaway.Untilnexttimeyouconsumeit,
obviously.
Othercausesofinsulinresistancearemorechronic.Likehighironlevels.Ifyouhavetoo
muchironinyourbody,insulinsensitivitycanbeimpaired.Ironasacauseofinsulin
resistanceismorechronicinnatureandcausesinsulinresistance24/7(itcanbefixed,
though).
Itsimportanttoremovethechroniccausesofinsulinresistance,ortheywillbeeverpresent
andalwaysimpairyourinsulinsensitivity.Ifyoudontgetridofthem,youmaystillbeinsulin
resistantnomatterwhatyoudo.Itsimportanttoavoidinducingshortterminsulin
resistanceonaregularbasis,too,ofcourse.
Onthatnote,Ihavestrungtogetherthechaptersinthisbookinageneralorderof
importance,basedonmypersonalexperiencewithinsulinresistance.Ofcourse,individual
needswillvary,butformostpeopleIguessthattheywillneedtoprioritizeaccordingtothe
followinglist:
1. Losebodyfat(ifapplicable)
2. Getridofexcessiron(ifapplicable)
3. Exercise
4. Taketherightsupplements
5. Sleepwell
6. Manipulateyourdiet
7. Additionally,appendixAcontainsacompleteguidetoweightlossspecificallyfor
insulinresistantpeople,ifyoudontknowwhattodo.
Inmyexperience,dietistrulytheleastimportantthingforimprovinginsulinsensitivity.
Dietisstillimportant!Justnotasimportantasmanyotherauthorsthink.
Dietsupportstheotherinterventions,andagooddietbyitselfcanimproveinsulin
sensitivity.Yourdietwillhelporhinderalltheotherareas,butitdoesntmakesensetotry
toimproveyourinsulinsensitivitywiththeperfectdietwhenyoure45kg(100pounds)
overweight,orhaveexcessiveironstores,orneverexercise.Itwouldbebettertofixthose
thingsfirst.Noamountofdietarymaneuverswillgetridofyourinsulinresistanceintheface
of15abovebeingscrewedup.
Iwouldactuallyworkon16allatthesametime,butifIhadtoprioritizeIddoitinthe
orderabove.
Withthatsaid,letsexaminehowtoimproveinsulinsensitivity.
16
Chapter 1
Body Fat and Insulin
Resistance
Fact:Notalloverweightorobesepeopleareinsulinresistant.
Fact:Notallinsulinresistantpeopleareoverweight/obese.
Ifaninsulinsensitive(notinsulinresistant)overweightindividuallosesfat,notmuchofan
improvementwillbeseeninhisorherinsulinsensitivity.[26]
Butifaninsulinresistantoverweightindividuallosesfat,bigimprovementswilltypicallybe
seen.[26]
Moreover,alotofpeoplesufferfromhiddenobesity,whichisfarfromapparent.They
looklean,buttheyareactuallyobese,asweshallsee.
Formostofmyreaders,thiswillbethemostimportantchapterofthebook.Sopay
attention,evenifyouthinkyouknowwhatImabouttosay.
Eightyfivepercentoftype2diabeticsareoverweighti.e.haveaBMIof25ormore.[1]
Overweight(BMI2530)andobesity(BMIgreaterthan30)areassociatedwithahigherrisk
ofinsulinresistance,prediabetes,elevatedfastingbloodsugarandtype2diabetes[3]and
higherBMIstranslatetogreaterriskoftheaforementionedconditions.Insulinresistancein
turnincreasestheriskofheartdiseaseandstroke[15]etc.andIRisonelinkbetweenexcess
weightandheartdiseaseandstroke.
YoucancalculateyourownBMIhere:http://www.nhlbisupport.com/bmi/
InsulinresistanceisnotrestrictedtopeoplewithBMIgreaterthan25;riskofIRandrelated
complicationsincreaseseveninthe2025rangeandbeyond[5].
Notonlyisinsulinresistancemorecommonamongoverweightindividuals,overfeeding
directlypromotesIR.
17
Ina2010study,36healthyindividualswereoverfedby1250caloriesperdayfor28days.
Fastinginsulinandbloodsugarbothincreased,causingadecreaseofinsulinsensitivityby
11%.Interestingly,fatmassincreasedonlyby1.1%,indicatingthatevenasmallfatgaincan
causeadeteriorationofinsulinsensitivity.Theweaknessofthisstudywasthelackofa
weightstabilizationperiodaftertheweightgain;suchaperiodmayhavediminishedtheloss
ofinsulinsensitivitysomewhat.Nevertheless,thisstudyclearlyshowsthatoverfeedingleads
tofatgainandlossofinsulinsensitivity.[21]
Beyond Body Mass Index

BMIisnotthebestwaytomeasurethepresenceofexcessfatonaperson.Apersoncan
haveahighBMIthankstoplentyofmusclemass,yethavelittlebodyfat.Conversely,itis
possibleforapersontobeintheBMI2025range,conceivablyevenlower,andstillcarry
excessfatthatcausesinsulinresistance.
Sincethe1980sithasbeenincreasinglyrecognizedthatfatdistributionisamoreimportant
determinantofinsulinresistancethantotalamountofbodyfat.Fatcanbestoredin
differentlocationsinthebody,forexample:
intheliver(intrahepaticfat)
insidethemuscles
subcutaneously(undertheskin,outsidethemuscles;thisisthefatrightunderneath
yourskinthatyoucanpinchwithyourfingers)
intraabdominally(insidethecavityformedbytheabdominalmusclesinthefront
andthebackmusclesintheback,i.e.aroundtheinternalorgans.Youcannotseeor
feelthisfatdirectly.)
otherplaces
Everyonehasabitoffatineachoftheseplaces,ofcourse.
Dependingonwherethefatisstored,itwillhavedifferenteffects.Itisestablishedthata
centralfatdistributionismoredangerousthanaperipheralfatdistribution[2].Central
fatdistributionreferstofatbeingstoredpreferentiallyasintraabdominalfatand
subcutaneousfatonthebelly.Aperipheralfatdistributionreferstofatbeingstored
preferentiallyassubcutaneousfatonthebuttocks,hips,legs,andotherplaces,whilelessis
storedintraabdominallyorassubcutaneousabdominalfat.
Moreover,intraabdominalfatseemsmorecloselyassociatedwithinsulinresistancethan
doessubcutaneousabdominal(belly)fat[6][7][8][9],althoughthisisnotundisputable.
Nevertheless,acentralfatdistributionremainsabiggerriskfactorforinsulinresistancethan
totalbodyfat,whetherthatfatisstoredintraabdominallyorsubcutaneouslyonthebelly.
Visceralfatisasubtypeofintraabdominalfatandagedratswhosurgicallyhavetheir
visceralfatremoved,increasetheirinsulinsensitivitymarkedly.Thisistosomeextentalso
seeninagedratswhohavethesameamountofsubcutaneousfatremovedsurgically,but
thepositiveeffectoninsulinsensitivityismuchgreaterwhenvisceralfatisremoved[25].
Thisindicatesthatdeteriorationofinsulinsensitivityseeninagingmaynotbeduetoage
18
itself,butduetoaccumulationofvisceralfatfirstandforemost,whichluckilycanbe
counteractedasweshallsee.
Somedifferentmeasurementshavebeenproposedtodeterminewhetherapersonhastoo
muchcentralfatornot.
ThemostaccuratewaystodetermineamountsofintraabdominalfatisbyCTscan
(computedtomography),MRI(MagneticResonanceImaging)orultrasound.Thesearehigh
techmeasurements,andaretheonlyonescapableofdistinguishingbetweeninternaland
externalfat,butbeforetheywereinventedresearchersreliedonothermeasures.
Twosuchmeasuresarewaisthipratio(WHR)andwaistcircumference.However,noneof
themcancomparetotheaccuracyofCTscan,MRIorultrasound.
Waist-to-Hip-Ratio
Thewaisttohipratioiscalculatedbyfirstmeasuringyourwaistcircumferenceanddividing
thatnumberbyyourhipcircumference.E.g.ifyourwaistcircumferencewas30in(76.2cm)
andyourhipcircumferencewas32in(81.3cm),yourWHRwouldbe:30/32=0.94
Itdoesntmatterifyourmeasurementsareincentimetersorinches,becausethisisaratio.
AhighWHRmeansthatthepersonhasalotoffatstoredcentrally(aroundthebelly)
comparedtothehips,whichisconsidereddangerous.Proposedthresholdvalues,i.e.above
whichanincreasedriskofIRisbelievedtoexist,are0.85forwomenand0.95formen[2],
butothervalueshavealsobeenproposed.AlowerWHRratioisneverthelessbetter.
InastudyamongwomenfromSweden,WHRaswellasbodyweight,BMI,waist
circumferenceandmorewasmeasured.Twelveyearslaterthewomenwerefollowedupon,
anditwasconcludedthatahigherWHRatbaselinewasastrongpredictorofsufferingheart
attack,chestpain,strokeordeathduringthefollowing12years[4].Inthesamestudy,itwas
foundthatWHRincreasedwithage.Also,amongthe10%ofwomen(140individuals)with
thelowestWHRnotasinglesufferedaheartattackorstrokeduringthose12years!
Inasimilarstudyitwasfoundthat,among54yearoldmenfromSweden,WHRratioproved
tobeabetterpredictorthanBMIorskinfoldmeasurementsforriskofheartdisease,stroke
ordeaththefollowing13years.Quotedfromthestudyamongthe10%withthelowest
waisttohipcircumferenceratiosnotasinglemandevelopedstroke.[22]
YoucanreadmoreabouthowtoaccuratelymeasureWHRhere:
http://en.wikipedia.org/wiki/Waisthip_ratio
EventhoughWHRisbetterthanBMIforestimatingthepresenceofdangerouscentralbody
fat,itisstillfarfromperfect.Forinstance,inthestudyreferencedinthebeginningofthis
chapter[21],WHRdidnotincreaseinresponsetooverfeeding,eventhoughBMI,waist
circumferenceandpercentbodyfatallincreased,showingthatWHRdidntpickupthefat
gainthatledto11%decreasedinsulinsensitivity.
19
Another,better[2],waytoestimateyourlevelsofdangerouscentralfatissimplyby
measuringyourwaistcircumference.
Waist circumference
Thehigherthewaistcircumference,themorecentralfatapersontendstohave,andthe
worsetheinsulinsensitivity.Thus,aswithWHR,alowerwaistcircumferenceisbetter.
Youcanreadmoreabouthowtomeasurewaistcircumferencehere:
http://en.wikipedia.org/wiki/Waisthip_ratio
Outofthesetwoestimatesofintraabdominalfat,waistcircumferenceissuperiortoWHR
[2].However,neitherWHRnorwaistcircumferencecandistinguishbetweenintra
abdominalfatandsubcutaneousabdominalfat,i.e.ifthepersonsfatisinternalor
subcutaneous;theyjustshowthatapersonhasalotofcentralfat.
AmongKoreanmenandwomen,onlywaistcircumference(notBMI)inmenwasariskfactor
fortype2diabetes,whileforwomenbothwaistcircumferenceandBMIwereriskfactors
butWCwasmoreaccurate[24],showingthesuperiorityofwaistcircumferenceoverBMI.
AswithWHR,therehavebeenattemptstodevelopcutoffpointsforadangerouslyhigh
waistcircumference.However,thiseffortiscomplicated,reportedly[2],byvaryingeffectsof
waistcircumferenceonIRindifferentpopulationsandgenders.Inotherwords,whatmaybe
adangerouslyhighwaistcircumferenceforoneperson,maynotbeaproblemforanother
person,andthismayvarybygenderorethnicity.
Somecutoffpointsforwaistcircumferencehaveneverthelessbeenproposed,forexample
morethan100centimeters(39.4inches)[2]inmenandwomen.However,increasedriskof
obesityassociatedcomplicationshavebeenfoundalreadyatwaistcircumferencesof94cm
(37inches)and80cm(31inches)inmenandwomen,respectively[2].
Anotherpointworthmentioningaboutwaistcircumferenceandinsulinresistanceisthat
somepeoplehavealargewaistcircumference,yetretaingoodinsulinsensitivity.Thisis
probablybecausewaistcircumferencecannottakeintoaccountwhetherfatisstored
subcutaneouslyorintraabdominally.
Thiswasillustratedina2010studycarriedoutinGermany[8].Theresearchersexamined30
morbidlyobesemenandwomenwithaBMIaround45(extremelyfat).Theyhad50percent
bodyfatandtheiraveragewaistcircumferencewas132cm(52inches),sotheyshouldhave
beenprofoundlyinsulinresistant,right?Interestingly,theyhadgoodinsulinsensitivity,
althoughnotsuperb.
Whencomparedto30equallymorbidlyobesemenandwomenofthesameage,percent
bodyfatandgender,butsufferingfromIR,itwasfoundthattheIRgroupofmorbidlyobese
peoplehadonlya6cm(2.4inches)greaterwaistcircumference,whichwasstatistically
significant.However,thisisquiteasmalldifferenceanyhow.
20
Torecap,theinsulinsensitiveobesepeoplehadanaveragewaistcircumferenceof132cm
whiletheaveragewaistcircumferenceoftheinsulinresistantobesepeoplewas138cm.
Bothgroupsweremixed,consistingoftwothirdsmen.Aswecansee,everyoneswaist
circumferencewasfar,farabovethecutoffpointsmentionedearlier,yetsomeofthese
morbidlyobesepeopledidnothaveIR.Whatgives?
UponexaminationbyCTscan,itwasrevealedthatthemaindifferencebetweentheinsulin
sensitiveandinsulinresistantpeoplewastheamountofvisceralfat.Whiletheinsulin
resistantobesehadonlya6%greaterwaistcircumference,theyhad129%morevisceralfat
asrevealedbyCTorMRIscan.Thus,wewitnessagainhowintraabdominalfatseemsto
haveamoreprominentroleincausingIRthandoessubcutaneousfat.Avisualexampleof
individualsfromthe2differentgroupscanbeseenhereandisquiterevealing:
http://ajpendo.physiology.org/content/299/3/E506/F3.large.jpg
Howreliablearewaistcircumferencecutoffpointsreallywhensomepeoplearefarabove
andstillretainnormalinsulinsensitivity?
Theoppositecanbetrueaswell.Apersoncanbequiteleanbyallregularmeasures,suchas
BMI,WHRandwaistcircumference,yetstillbeeffectivelyobese.Thatswherethe
conceptofmetabolicobesitycomesin.
Redefining obesity Understanding metabolic

obesity
Listenup,becausethisisacriticallyimportantconcepttograsp.Asreportedmorethan30
yearsagoandsummarizedneatlybyRudermanandcolleaguesin1998[5],theoccurrenceis
quitecommoninthegeneralpopulationofthesocalledmetabolicallyobese,normal
weightindividual,whoisinsulinresistantandalsodisplayotherfeaturesoftheinsulin
resistancesyndrome,yethasaBMIaslowas20andconceivablyevenlower.Inessence,
metabolicallyobesepeopleareeffectivelyinsulinresistantyethavealowornormalBMI.
Whatcausesmetabolicobesity?
Theansweryoumayhaveguesseditbynowseemstobealargeproportionofcentral
abdominalfat.Inotherwords,intraabdominalfatandsubcutaneousfatonthebelly.[5]
Howdoyouknowifyousufferfrommetabolicobesity?
Itcanbequitedifficulttorecognize,butaquestionnaireformenandwomenaged2055
yearswithaBMIof2027hasbeensuggestedandcanbeviewedonpage6ofthefollowing
PDF:http://diabetes.diabetesjournals.org/content/47/5/699.full.pdf(Letmeknowifthelink
stopsworkingandIwillfixit.)Isuggestyoufamiliarizeyourselfwiththisquestionnaireand
takeittoyourdoctorifnecessary.
So,firstofall,metabolicobesityofnormalweightindividualsonlyappliestopeoplewhoare
NOTtraditionallyconsideredobeseoroverweight.IthasbeenfoundthatevenintheBMI
21
rangeof2027theriskofmetabolicobesityincreaseswithhigherBMI.TheloweryourBMI,
theloweryourriskofmetabolicobesity.[5]
Personally,metabolicor,asIliketocallit,hiddenobesitywasmymainsourceofinsulin
resistance,andacauseofmuchpersonalfrustration.Ialwaysusedtobequiteleanwitha
BMIcloserto20than25,yetdisplayedinsulinresistanceeveninadolescence.WhereverI
wouldpinchmyselfonthebodyIwouldgetquiteasmallskinfoldmeasure,i.e.therewas
notmuchsubcutaneousfat.However,Ialwayslookedpregnant(IremindyouthatImmale),
andIcouldneverunderstandwhy.Evenonphotosfrommyearlyyears(4yearsoldetc.)I
wouldhaveanexcessivelylargebellythatprotrudedunnaturallyfrommybody.Ilookedlike
Ihadswallowedabasketball.ButIneverunderstoodwhatcausedthisIputitdownto
largeorgans,orbigmeals,becauseIhadneverheardofanddidnotunderstandthe
conceptofmetabolicobesity.Thefactthatnooneelsenotdoctors,notparentstook
noticemademethinkitwasnormal.
Specifically,Ididnotunderstandthat1)apersoncanstorefatintraabdominally2)aperson
canotherwisebeveryleanyethaveaverylargeproportionandmassoffatstoredintra
abdominally.Thiswaswhatcausedmybellytoprotrude.LaterwhenIstartedstrength
trainingatage23IgottothepointwhereIevenhadvisiblesixpackabs,indicatingalow
subcutaneousbodyfatpercentage.However,mybellystillprotruded,becauseIhada
propensitytostorefatintraabdominally.
Ithinkalotofpeopleareinthissituation,thatswhyImstressingthispoint.Ifyourevisibly
overweightorobese,atleastitsapparent.Butinthecaseofleanindividuals,itmustbe
clarifiedthattheytoocaneffectivelybeobese,duetoexcessabdominalfat,andthisis
rarelyapparent.
Furthermore,metabolicobesityofnormalweightindividualsseemstobequiteadangerous
state.Forinstance,onestudyamong54yearoldmenfoundthatthegreatestriskofdeath
wasfoundinmenwhohadthelowestBMIcombinedwiththehighestWHR;inotherwords,
thesemenwereoverallquiteleanbuthadahighproportionofcentralfat[22],andwould
probablybeclassifiedasmetabolicallyobese,normalweightindividuals.
Forsuchametabolicallyobeseperson,waistcircumferencecutoffpointsof71.1cm(28
in)and86.4cm(34in)forwomenandmen,respectively,havebeenproposed[5].This
wouldindicatethatanywaistcircumferencebelowthosevaluesisfine,butIdisagree.Ido
thinkthequestionnairereferredtoaboveisagoodstartingpoint,though.
Oneadditionalcommentmustbeinterjectedhere.NoteveryleanindividualwhohasIRhas
excessintraabdominalfat.ThereAREothercausesofIRnotrelatedtobodyfat.Butifyou
areleanandinsulinresistant,beveryobservantofanyexcessintraabdominalfatyoumay
have.
Ifwegobacktowaistcircumferenceforamoment,wecanseethatthereareinsulin
sensitivemorbidlyobesepeoplewith50%bodyfat,BMI45andwaistcircumferencearound
132cmormore,aswellasinsulinresistant,normalweightpeoplewithaBMIinthelow20s
andawaistcircumferencefarbelow100andevenfarbelow90.
22
Thisshowsthatwaistcircumferenceisnotaperfectmeasuretogoby,either.
What causes a central fat distribution?

Everyonehasabitofcentralfat,itisonlynatural.Thequestionis,whydosomeindividuals
storealargeproportionoftheirfatcentrallymorespecifically,asintraabdominalfatand
canthisbechanged?
Itisnotfullyknownwhythishappens,butthereasonitatleastpartiallygenetic,perhaps30
55%isexplainedbygenetics[2].Also,vanLentheandcolleaguesfailedtofindmuchsupport
fortheroleofenvironmentalfactorsinthedevelopmentofcentralfatingirlsandboys
followedfrom13to27yearsofage,andconcludedthatacentraldistributionofbodyfat
wasmainlydeterminedbygeneticandhormonalfactors[23],i.e.notsomethingthatis
easytoinfluence.
Anothercommonfindingisthatmenhaveamorecentralbodyfatdistributionthanwomen
[19][20],whichlikelycontributestothefactthatmenhaveworseinsulinsensitivitythan
womenwiththesameBMI[19][20],eventhoughwomenhavemoretotalbodyfat.
Overconsumptionofcaloriesalongwithahighproportionofcaloriesfromfructose(fruit
sugar)cancausepreferentialstorageofintraabdominalfat,accordingtoarecentstudyon
humans(reportedin[16]).However,goingsofarastoavoidfruitsbasedonthisis
premature,inmyopinion.Rather,basedontheresearchersresults,itseemsamuchwiser
choicetoavoid1)sugarsweetenedbeverages2)tablesugar(alsoknownsimplyaswhite
sugar;itcontains50%fructose)andhighfructosecornsyrup.
Anothercauseofpreferentialstorageoffatintraabdominally,maybeinactivityandalow
leveloffitness[5].Ifyouperformaerobicexercisewhilelosingweightitmayenhancelosses
ofintraabdominalfat,asreportedbyRudermanandcolleagues[5].
Whileshortsleepmayleadtoweightgain,itdoesnotseemtopreferentiallyleadtointra
abdominalfatgain[17].
Chronicstressmayhavesomethingtodowithintraabdominalfatstorage[18]andarecent
studyinmenfoundthatthestresshormonecortisolcorrelatedwithincreasedamountsof
visceralfat(asubtypeofintraabdominalfat)[11]but,asfarasIknow,theconnectionisnot
conclusivelyprovenanditisnotcertainwhatcouldbedoneaboutit.
Smokingalsoseemstocauseacentralpatternofbodyfat,asdiscussedin[23].
Determining if you have excess fat

Iwillstatethissimplywithoutovercomplicating:
23
Ifyouareapparentlyfat,byallmeansyoushouldlosefat.Thisisselfevident,
andithasbeenshownthatfatlossleadstoimprovedinsulinsensitivity.
Ifyouarenotapparentlyfat,i.e.yourBMIis2025orevenless,youneedtodetermine
whetherornotyoustillsufferfrommetabolicobesity,whichischaracterizedbyexcess
abdominalfatandinsulinresistanceevenwhenthetotalamountofbodyfatislow.
Itcanbedifficulttorecognizemetabolicobesity,butaquestionnaireformenandwomen
aged2055yearswithaBMIof2027hasbeensuggestedandcanbeviewedonpage6of
thefollowingPDF:http://diabetes.diabetesjournals.org/content/47/5/699.full.pdf(Letme
knowifthelinkstopsworkingandIwillfixit.)Isuggestyoufamiliarizeyourselfwiththis
questionnaireandtakeittoyourdoctorifnecessary.
Metabolicallyobese,normalweightindividualsaretypicallyyounger,butifyouareolder
than55andunsurewhetherornotyouhaveexcessfat,youcanstilltrythequestionnaire.
SinceWHRandwaistcircumferencecutoffpointsarentreliable,andBMIdefinitelyisnt
reliable,Isuggestyoudontpaytoomuchattentiontothese,otherthanformeasuringyour
progress.Ifyourwaistcircumferencedrops,youreontherighttrack,evenifyourbody
weightdoesnotdecline.Thiscanbethecase,forinstance,ifyoustartatrainingprogramto
buildmusclemassandlosefatyoumaygainmuscleweightwhilelosingabdominalfat.
CTscan,MRIandultrasoundmayofcoursebeusedtodeterminethedegreeofintra
abdominalfatyouhave,buttheyarenotalwaysreadilyavailable.Thepointatwhichvisceral
fatarea(ameasurementofdangerousintraabdominalfat)asindicatedbyCTorMRI
becomesdangerousisnothigherthan133cm2(butcouldbeless),justtogiveyouanidea.
Soifyouhavemorethan133cm2ofvisceralfatmeasuredbyCTscanorMRI,youre
definitelyinthedangerzone,buttheproblemsmaymanifestatevenlowerlevels.
Anothermethod,perhapsthebest,fordeterminingifyouhaveexcessfatissimplyby
lookingandfeelingatyourself.Ifyourbellyprotrudesfromyourbodywhenyouarestanding
up,relaxedandexhaled,givingyouapregnantlookorswallowedabasketballlook,thisis
usuallyasignofcentralobesity.Inmyopinion,aftervoiding,whenstandinguprelaxedand
exhaledyourbellyshouldnotprotrudeoutsidethefrontmostpartoftheribcage.
Also,ifyouhavelargeskinfoldsonyourbellythatyoucanpinchwithyourfingers,thisisalso
asignofcentralobesity.
IfyouhaveIR,youshouldactuallyexpecttofindthatyouhavetoomuchfat,becausethisis
usuallythecase,althoughnotalways.Soyoucanalmostassumethatyouhaveexcessfat,
unlessyouhavespecificreasontodoubtit.
What to do if you have excess fat (LOSE IT)

Ifyouvecometotheconclusionthatyouhaveexcessfat,payingspecialattentiontothe
presenceofanyhiddenormetabolicobesityifyouarenormalweight,itistimetodo
24
somethingaboutit.Canyouguesswhatyoushoulddoaboutit?Thatsright,youshouldlose
thefat.Infact,itshouldformostpeoplebetheir#1priorityforimprovinginsulinsensitivity.
Ifyoureunsurewhetherornotyouhaveexcessfat,youcangoonafatlossprogramtosee
ifyourinsulinsensitivityimproves.Ifitdoes,youreontherighttrack.
Everythingpointstofatlossbeingbeneficialforinsulinresistantindividuals.
Forinstance,when15womenaged5873yearswithBMIsinthe29.643.8range
underwentjusta5%fatloss(4.7kgor10.4pounds),byeating500calorieslessthantheir
expenditureandwithoutexercise,theirinsulinresistancefellbyalmost17%.Thiswas
accompaniedbyareductionofwaistcircumferenceaswell[10].
Inanotherstudy,8obesemenwithanaverageBMIof38andage2854yearswereassigned
toa3monthfatlossprogramconsistingofdietonly(noaddedexercise).Theyweregivena
liquiddietwhichsuppliedonly1000caloriesperday,whichisverylittleforobesemen.They
lostsignificantamountsoffat(32%comparedtobaseline),andlostmoreintraabdominal
fat(51%)thansubcutaneousfat(34%)inpercentageterms.Afterthe3monthdiet,they
hada3monthweightstabilizationperiodduringwhichsolidfoodwasconsumedandweight
maintained.Thankstothisintervention,insulinsensitivitydoubledcomparedtobaseline.
[11]
Inanotherstudy,9obesemen(BMIover30)underwenta1yearweightlossprogramand
lostmorethan4kg(8.8pounds)ofbodyweight;meanweightlosswas10.8%.Fastinginsulin
levelsfellby59%,andmeasuresofinsulinsensitivityincreasedsignificantly.[12]
Thesameresearchersconductedasimilarstudywithobesewomen.Thirtyfiveobese
womenwithBMIgreaterthan30underwenta1yearweightlossprogramandlostmore
than4kg(8.8pounds)ofbodyweight,withameanweightlossof9.6%.Measuresofinsulin
resistanceweremarkedlyimproved[13].
Fourmajorexperimentalstudieshavetestedtheassertionthatdiabetescanbepreventedor
delayedbylifestylechanges,asreviewedbyDeborahL.Burnetandcolleaguesin[14].They
concludedthatstrongevidenceexistsforthepreventionordelayoftype2diabetesthrough
lifestylechangesandthatlifestylechangesweremoreeffectivethanmedicationfor
preventingtype2diabetesandshouldbeusedasafirstlinestrategy.Eventhoughthese
trialswerenotpurelyweightlossbasedtheyalsoincludedincreasedexerciseandchange
indietcompositionoverweightindividualswereencouragedtoloseweight.The4studies
werecarriedoutinindividualsathighriskfordevelopingdiabetes,andriskreductionsfor
developingtype2diabetesrangedfrom3163%over36years,eventhoughweightlosswas
quitemodest.Althoughwedontknowforsurehowmuchoftheresultswerethankstofat
loss,ascomparedtoexerciseorimproveddietquality,itishighlylikelythatlossoffatwas
animportantcontributingfactor.Asstatedbytheauthorsin[14]Theoverallgoalfor
diabetespreventionistoreachandmaintainanactive,healthyweightwithatendency
towardahypocaloricdiet[adietthatsupplieslesscaloriesthanyouuse].
25
Fatlossshouldalsohelpthosemetabolicallyobese,normalweightindividuals,whoalready
havealowBMI(2025),butmorethanlikelyhaveahighproportionofabdominalfat.
Indeed,IwasoneofthemandthemostimportantinterventionIusedpersonallyagainstmy
insulinresistancewasfatloss.
Itmaybehelpfulifyoucantestyourinsulinsensitivity(byoralglucosetolerancetestor
HOMAIR)beforeandafter5%ormorefatlosstoseeifyouaremakingprogress.Butifyou
haveinsulinresistance,youwillalmostcertainlybemakingprogressbylosingfat,sotracking
insulinsensitivitymayberedundant.
Can central fat be specifically targeted for fat

loss?
Asyoulosetotalfat,youwilllosecentralfataswell.Losingtotalfatandcentralfatareboth
beneficial.Onethingthatmayhelpinlosingalargerproportionofcentralfatisaerobic
exercise[5][23],addressedinthechapteronexerciseandinsulinresistance.
Can you have too little body fat?

Generallyspeaking,aslongasyourfatlossesareaccompaniedbyimprovementsininsulin
sensitivity,youcancontinuelosingfat.However,bodyfatisnotcompletelywithoutvalue,
anditISpossibletogotoolow.Menshouldprobablynotbeleanerthan5%bodyfatinthe
longterm,whilethefigureforwomenmaybe12%orso.Buttheseareverylowlevels,that
mostpeopleneverachieve.
Fat loss tips

AcompleteguidetoweightlossisavailableinappendixA.Herearesomeshorttipstoget
youstarted:
Createacaloriedeficit.Regardlesswhichdietcompositionyouchoose(highcarb,
lowcarb,mixed,vegetarian,Mediterraneanetc.)youabsolutelymustcreatea
caloriedeficitifyouaregoingtolosefat.Yousimplymustconsumelesscaloriesthan
youburn.
Countingcaloriesisnotabadidea,althoughnotarequirementtofatloss.Learn
howtodothisifyouresoinclined.Itsagoodskilltoknow,anyhow.
Dontlosemorethanaround2pounds(1.0kg)perweek.Losingfasterthanthat
increasestheriskofdevelopinggallstones,rampantmuscleloss,bonedensityloss,
reactivebingeeating,slowedmetabolism(reducedcalorieburn)andnutrient
deficienciesbecauseyoueatsolittlefood.
Aimforadailycaloriedeficitinthe3001000calorierange.Thehigherendofthe
rangeisreservedformoreoverweight/obesepeople.Theleaneryouget,orthe
smallerpersonyouare,thesloweryouwanttogotopreservemusclemassand
metabolism.
26
Eatalotofprotein.Notonlyisitmoresatiating,itisalsomusclesparing.Oneofyour
goalswhilelosingweightshouldbetopreservemusclemassandlosefatspecifically.
Musclemassisnotonlypleasingtotheeye,itisusefulforeverydaytasksandthe
moremusclemassyouhavethemorecaloriesyouwillburnperdaybecausemuscle
burnsmorecaloriesthanfat,evenwhenyoudontusethemuscles.Losingalotof
musclemasswillslaughteryourcalorieexpenditure,makingithardertomaintaina
lowamountofbodyfat.Somusclepreservationiskey.
Eataround2gramsofproteinperdayperkgofbodyweight,or1gramofproteinper
dayperpoundofbodyweight.Ifyouareoverweightorobese,youcanadjustthese
figuresdownwardabit,i.e.eatabitlessprotein.
Strengthtrainingwillhelpyoupreservemusclemasswhilelosingweight,increase
yourcalorieburn,andwillimproveyourinsulinsensitivity.Thisiscoveredfurtherin
thechapteronexercise.
Aerobictraining.Thisreferstoendurancetraining,i.e.activitiesthatgetyourheart
rateupandmaintainedforagoodwhile.Examplesincludebriskwalking,running,
cycling,swimming,dancingetc.Intervaltrainingisnotabadthingtothrowintothe
mix,either.Thisiscoveredmoreinthechapteronexercise.Thereareindications
thatexercisemayhelpwithlossofintraabdominalfatspecifically[5].Inanycase,
thebenefitsofaerobicexercise,especiallyforinsulinresistantindividuals,aretoo
numeroustomention.Youshoulddothisregularly,period.
Eatmorefiberandfat.Thesenutrientswilltypicallymakeyoufeelmoresatiated
comparedtocarbohydrates,althoughIdonotthinkthatcarbsareevil.Thiswillbe
coveredmoreinthechapterondiet.
Avoidsimplecarbohydratesandjunkfood.Simplysaynoto(orgreatlyreduce)
sugarladenpseudofoodsandindustriallyprocessedjunk.YouknowwhatImtalking
about:sodas,pizza,Frenchfries,snacks,chocolate(exceptdarkchocolate),sweets,
icecreametc.etc.etc.adinfinitum,aswellaspremadefrozendinnersetc.
Cookhealthymealswithrealingredientsfromscratch.Moreinfointhechapteron
diet.
Avoidrestaurants.Peoplewhoeatalotatrestaurantsaretypicallyfatterthanthose
whodont.Cookfoodinadvanceandbringtoworkifyouhaveto.
Dietresponsibly.Makesureyougetenoughvitaminsandminerals,proteinand
omega3fatsetc.Thelessyoueatthebetteryourdietaryqualityshouldbe,soyoure
certaintogetenoughmicronutrients.Avoidcrazyfaddiets,fasting,dietsbasedon
mealreplacementpowdersetc.
Summary
Most,butnotall,insulinresistantpeopleareoverweight/obese.
Beingoverweight/obeseincreasestheriskthatapersonisinsulinresistant.
Ifyoureoverweight/obeseandinsulinresistant,losingfatwillprobablybethesinglemost
importantthingyoucandotoincreaseyourinsulinsensitivity.
27
Themostdangerouskindoffatdistributionisabdominalfat,specificallyintraabdominalfat.
Menhavemoreintraabdominalfatthanwomen,andsomelifestylefactorscanaffectbody
fatdistribution,althoughalotseemstobedeterminedbyhormonesandgenes.
Thereexistsinthegeneralpopulationquitealotofpeoplewhoaremetabolicallyobese,
normalweight,characterizedbyaBMIinthe2027range,i.e.normalorclosetonormal
weightbystandardmeasures,butsufferingfrominsulinresistance,probablycausedbya
largeproportionofabdominalfat.Suggestionsforidentifyingwhetheryouaresuchaperson
havebeenpresentedinthischapter.Thisisrarelyanapparentconditionandmustbe
screenedforcarefully.Infact,Iliketocallithiddenobesity.Payspecialattentiontothe
existenceofexcessintraabdominalfatthatyoumayhave.
Waisttohipratioandwaistcircumferencehavebeendiscussedandthese,togetherwith
BMI,arentreallythebestmeasuresofabdominalobesity,andcantrickapersoninto
believingthatheorshedoesnothaveexcessfat,whiletheoppositemaybetrue.
Ontheotherhand,CTscan,MRIorultrasoundcanidentifythepresenceofanunusuallyhigh
amountofintraabdominalfat.
Alloverweightandmetabolicallyobese,normalweightpeopleshouldgoonafatloss
programconsistingofacaloriedeficitcreatedbylimitingcalorieconsumptiontogetherwith
strengthtrainingandaerobicexercise.Fatlossshouldcontinueaslongasneededtorestore
goodinsulinsensitivity,butifbodyfatlevelsof5%and12%formenandwomen,
respectively,areachievedandIRpersists,theproblemmaybesomethingelse.
Fatloss,whiletypicallythemainstrategyforimprovinginsulinsensitivity,isnottheonly
strategyandtheothermethodsinthisbookshouldalsobeimplementedorconsidered.Its
worthrepeatingthattheretrulyareothercausesofIRexceptexcessfat,aswillbeexplored
furtherinthisbook.Noteveryinsulinresistantindividualneedstodiet.
Iwaspersonallyoneofthosemetabolicallyobesenormalweightindividuals,andwentona
fatlossprogramuntilIwasveryleanwhichgreatlyenhancedmyinsulinsensitivityand
reversedmyinsulinresistance(withhelpfromtheotherstrategiesinthisbookaswell).
28
Chapter 2
Iron and Insulin
Resistance
Thereisalotofevidencethatbodyironstores,inotherwordshowmuchironyouhave
storedinyourbody,areassociatedwithinsulinresistanceandtype2diabetes[7].Stated
anotherway,thehighertheironlevels,thegreaterapersonsriskofdevelopingdiabetes
andinsulinresistance.
Theproblemsseemtostartevenatironlevelsconsideredbymostdoctorstobenormal.In
thewordsofresearcherJosManuelFernndezRealandcolleagues:Itisincreasingly
recognizedthatironinfluencesglucose[bloodsugar]metabolism,evenintheabsenceof
significantironoverload.[emphasisadded][13]
Oneproblemwhenstudyingthepotentiallinkbetweenironandinsulinresistanceisthe
differentwaysofmeasuringbodyironstores.Bodyironstoresareusuallymeasuredbythe
bloodtestserumferritin(SF)whichmeasurestheamountofferritinintheserum.Ferritinis
astorageproteinforironatoms.Itisagoodindicatorofbodyironstoresundermost
circumstancesbutnotall.Forexample,ifchronicdiseaseorinflammationispresent,serum
ferritincanbeelevatedevenwhentotalironlevelsarenot.
Dependingonwhichagencyyouask,irondeficiencyasmeasuredbySF(irondeficiencycan
alsobemeasuredbyotherbloodtests)isbelowthe1530ng/mlrange.Normallevelsare
usuallyconsideredbetween30and300but,aswewillsee,itseemsthatironcancause
insulinresistanceevenatanySFlevelabove40,eventhoughmostdoctorswouldconsider
thatinthecompletelynormalrange.
InalargesampleofGermanmenandwomen,peoplewithhigherserumferritinlevelshada
greaternumberofinsulinresistanceelements.Inthisstudy,insulinresistanceelements
weredefinedas:BMIover25,diagnoseddiabetes,hightotalcholesterol,lowHDL
cholesterol[goodcholesterol],highbloodpressure.[4]
Prediabeticshavealsobeenshowntohavehigherserumferritinthanthosewithnormal
bloodsugarcontrol.Higherserumferritinhasbeenfoundtocorrespondwithhigherfasting
bloodsugar,higherbloodpressure,highercholesterolandhighertriglycerides.Inonestudy,
thosewithhighferritinhad3timestheriskofhavingprediabetes.[6]
29
Vegetarians have lower insulin resistance

Ithasalsobeenshownthatvegetarianshaveincreasedinsulinsensitivityandloweriron
storescomparedtomeateaters[14].Thirtyleanlactoovovegetarians,definedasthose
whohadconsumednomeatfortheprevious5years,werecomparedto30leanmeat
eaters,definedasthosewhohadreportedeatingmeatatleastoncedailyfortheprevious5
years.
Itwasfoundthatmeateatershadtwicethebodyironstoresoflactoovovegetarians(as
indicatedbyserumferritinlevels),andhadamuchhigher(68%)steadystateplasmaglucose
level,averygoodindicatorofinsulinresistance.Inotherwords,themeateatershadalot
higherironstoresandalotmoreinsulinresistance.
Totestwhetherornotitwasthelowerironstatusthatgrantedincreasedinsulinsensitivity
tothevegetarians,sixofthemalemeateaterswereselectedforironreductionby
phlebotomy(bloodletting).Thesixmeateatershadaninitialaverageserumferritinlevelof
85andthiswasreducedto27afterphlebotomy.Steadystateplasmaglucosewas41%
lowerafterphlebotomy,i.e.theyweremuchlessinsulinresistantafterironreduction.
Blood donors have lower insulin resistance

Frequentblooddonationshavebeenshowntobeaprotectivefactoragainstthe
developmentoftype2diabetes[16].
Menwhodonatebloodfrequentlyhavelowerbodyironstores(asmeasuredbyserum
ferritin)andenhancedinsulinsensitivitycomparedtononblooddonors[5].Inonestudy,
theseresultswereprimarilyfoundinthosewhodonatedbloodatleast2timestheprevious
5years,andhighernumberofblooddonationscorrespondedtohigherinsulinsensitivity,
indicatingacauseandeffectrelationship.However,itmustalsobeconsideredthatonly
healthypeopleareallowedtodonateblood,whichcouldmeanthatblooddonorsareon
averagehealthierthantherestofthepopulationandthushavebetterinsulinsensitivity.
However,itstilldoesntexplainwhythosewhodonatedfrequentlyhadbetterinsulin
sensitivitythannonfrequentdonors.
Theblooddonorsinthisstudy[5]hadaverageserumferritinlevelsof101vs.162among
nonblooddonors.Bothofthoselevelsareunnecessarilyhighandassociatedwithincreased
riskofIR.
Inanotherrecentstudy[15],21highfrequencyblooddonors(morethaneightdonationsin
thepast2years)werecomparedto21lowfrequencyblooddonors(12donationsinthe
past2years)andtheirserumferritinwas23vs.36respectively.Nodifferencewasfoundin
insulinsensitivityasmeasuredbyoralglucosetolerancetest(OGTT)betweenthetwo
groups.Norelationshipwasfoundbetweeninsulinsensitivityandnumberofblood
donationsorserumferritin,either.
Approximatelyonethirdoftheparticipantshadbloodsugarproblemsasevidencedby
abnormalOGTTresults,despiteverylowserumferritinlevels.[15]
30
Inmyview,thismeansthat:
bodyironisnottheonlydeterminantofbloodsugarregulation;itispossibletohave
bloodsugarproblemsandinsulinresistancedespitelownormalironlevels
Nofurthereffectofironreductiononinsulinsensitivityisseenbelowserumferritin
levelsof36(inthisstudy),soitmaybeunnecessarytolowerserumferritinmuch
below40.
Lookingatmorestudies,inanationallyrepresentativesampleofmenandpostmenopausal
women,amodestassociationbetweenserumferritinlevelsandperipheralarterialdisease
wasfound.PADisakindofbloodvesselailment.Theassociationwasgreaterinthosewith
highcholesterollevels.[2]
Onerecentstudyfoundthatpeoplewiththehighestserumferritinlevelshada74%higher
riskofdevelopingdiabetestype2,butthisfindingwasexplainedbyotherfactors[10].The
researchershypothesizedthat,inthisstudy,thehigherserumferritinlevelsseeninthose
whowentontodevelopdiabetesmayhavebeenaresultofthecondition,sincedisease
statescancauseanelevationofserumferritinevenwhennoironoverloadexists.Insuch
cases,serumferritindoesnotaccuratelyreflectbodyironstores.
Inanotherstudyonmales,thosewiththehighestSFconcentrationshada70%greaterrisk
ofdevelopingdiabetescomparedtothosewiththelowestSFconcentrations[27].HigherSF
wasassociatedwithhigherbloodsugarandinsulinlevels,i.e.insulinresistance,inastudyof
1013Finnishmen[24].Inhealthypeople(freeofdisease),serumferritinwenthandinhand
withinsulinresistance[26]andinthesamestudy,italsowenthandinhandwithdiabetes
severity(indicatedbyHbA1c)intype2diabetics.Finnishmenwithhighstoresofironhave
beenfoundtobe2.4timesmorelikelytodevelopdiabetesthanmenwithlowerstoresof
iron[25].Elevatedserumferritinhasbeenfoundtobeassociatedwithinsulinresistanceand
fattyliverinpatientswithnoothersignofironoverload[1].
Iron and IR are associated, but does iron

reduction actually help?
Theideathatreducingbodyironstoresfromhighornormaltoneardeficientwouldimprove
insulinsensitivityorothermarkersofbloodsugarcontrolhasbeentested.
Inaspecialstrainofmice,thesocalledobeseob/oblep/mouse,whichisveryproneto
developingdiabetes,anironrestricteddietwasfoundtoprotectagainstthedevelopmentof
diabetesandinsulinresistance[20].Lowertriglycerideswerealsoseeninthemiceonthe
ironrestricteddiet.Thisdietwashighenoughinirontonotleadtoanemia.Theresults
seemedtobethankstoimprovedpancreaticbetacellfunction(i.e.insulinsecretion)and
insulinsensitivity.Whenmiceinitiallyfedtheironrestricteddietwereswitchedtothe
higherirondiet,thepositiveresultsweregraduallylost.
Luckily,wealsohaveexperimentaldataonironreductionsinhumans.
31
Asmallstudy[17]performedon10healthyblooddonors,testedtheeffectonbloodsugar
andinsulinconcentrationsfourweeksafterasinglebloodwithdrawalof500ml.Serum
ferritinlevelswerecutinhalf,from75to38andconcentrationsofinsulinandbloodsugar2
hoursafteranOGTTwerereducedby37%and19%respectively.Thisfindingshowsthat
evenblooddonorscanstillhaveexcessiveironstores,that75serumferritinmaystillbe
excessivelyhigh,andthatreductionofironstoresimprovesbloodsugarandinsulin.The
mostlikelyexplanationoftheseresultsisthatreducedironlevelsledtoreducedinsulin
resistanceandperhapsimprovedbetacellfunction.
In2002,astudy[8]wascarriedouton31carbohydrateintolerantpatientswithnormal
ironstoresnotclosetodeficiency.Afterironreductionbybloodlettingtoironlevelscloseto
deficiency,tolevelscommonlyseeninpremenopausalwomen,thefollowingimprovements
werenotedinthepatients:
IncreasedHDLcholesterol(thegoodcholesterol)
Reducedbloodpressure
ReducedtotalandLDL(bad)cholesterol
Reducedtriglycerides,reducedfibrinogen
ReducedglucoseandinsulinresponsestoOGTT(mostlikelythankstoreducedinsulin
resistance)
Thesearegreatresultsanditdoesntgetmuchbetterthanthat.Aftera6monthperiodof
ironrepletion,duringwhichironstoreswereincreasedagain,theseimprovementswere
largelylost.
Asalreadynoted,bigimprovementsininsulinsensitivitywereseenwhenbodyironstoresof
lean,healthymeateaterswerereducedtothoseofvegetarians[5].
Bloodlettingshouldalsohelpthosealreadysufferingfromtype2diabetes,butresponses
havebeensomewhatmixed.In1994,22type2diabeticsdonatedseveralunitsofblood
(oneunitis450ml)resultinginasignificantdecreaseofserumglucose[bloodsugar],
cholesterol,triglyceride,andapoproteinBconcentration.Theseresultswerenotseenin
thenondonatingcontrolgroup,exceptadecreaseofbloodsugar.[12]Allthesechangesare
beneficialfromahealthperspective.
Ina2002study,ironreductionbyphlebotomyof28maletype2diabeticsresultedin
reducedHbA1c(amarkerofdiabetesseverity)from6.27%to5.66%wherelowerisbetter.
Theseresultswereachievedbyextracting500ml(quart)ofblood3timesat2week
intervals.However,inthisstudyserumferritinwasonlyreducedfrom460initiallyto232
aftertreatment.232isstillmuch,muchhigherthanthelevelsseeninpremenopausal
womenorvegetarians,soevengreaterresultsmaypossiblyhavebeenachievedbyfurther
ironreduction.[9]
In1989,PaulCutler,M.D.,[18]hadgoodresultswhenusingdeferoxaminetotreattype2
diabeticswithhighironstores.Deferoxamineisanironchelatorusedintravenously;itbinds
toironinsidethebodyandtransportsitoutofthebodythusloweringironstores.Nine
32
diabeticpatientswithserumferritinlevelsbetween343and824weretreatedtwiceweekly
withdeferoxamineuntilnormalferritinlevelswereseen,i.e.below330.MeanSFlevels
beforetreatmentwere595whichdroppedto295aftertreatment.Fastingbloodsugar,
HbA1candfastingtriglyceridesdroppedsignificantlyaftertreatmentandeightofnine
patientsstoppedtakingdiabetesmedications.
Inacontrolgroupconsistingof8normalirontype2diabetics,serumferritinwasalso
reducedwithdeferoxaminefrom196to140,butthisproducednochangeincholesterol,
HbA1cortriglycerides,buttherewasatrendtowardsreducedbloodsugar.Thelackoflarge
treatmenteffectsinthecontrolgroupwasprobablybecausetheirdiabeteswasntassevere
(asmeasuredbycholesterol,triglyceridesandHbA1canddiabetesmedications),andthe
treatmentonlyreducedironlevelsmodestly.Probably,inmyopinion,agreaterreductionin
serumferritinwouldhaveproducedbetterresults.
Anothergroupofresearcherstriedin1993toreplicateCutlersfindings,usingthesame
procedure[19].However,theyfoundnoevidencethatironreductionhadanyrelevant
beneficialeffectsintype2diabeticsexceptasmallreductionofHbA1c,amarkerofdiabetes
severity.Thestudieswerealmostidentical.Howeverinthe1993studytheserumferritin
wasntquiteashighinitiallyandwasntreducedasmuchinpercentageterms.Whetherthis
explainswhyironreductiondidntworkinthesepatientsisuncertain.
Inpatientswithnonalcoholicfattyliverdisease,anailmentcloselyassociatedwithinsulin
resistanceandconsideredbysomeexpertstobeapartofthemetabolicsyndrome,blood
lettinghasalsoprovenbeneficial.
SixtyfourpatientswithNAFLDwhohadundergone4monthsofnutritionalcounseling,i.e.
dietaryrecommendations,andstillhadsignsofNAFLDorelevatediron(asmeasuredby
serumferritin)wentthroughirondepletionbybloodletting,whilestillfollowingdietary
recommendationsforNAFLD.Whencomparedto64NAFLDpatientswhoreceivedonly
dietarycounselingforthesametimeperiod,theirondepletedpatientshadsignificantly
lowerinsulinresistance.Moreover,ironreductionwasmorebeneficialinpatientswiththe
highestinitialironlevels(indicatedbyserumferritin)indicatinggreaterbenefitoflowering
ironamongthosewiththehighestironlevels.Interestingly,inthedietonlygroupserum
ferritinlevelsdeclinedaswell.Perhapstheironreducingeffectofthedietiswhatmakesit
effectiveagainstNAFLD.Nevertheless,ironreduction+dietwasmoreeffectivethandiet
alone.[11]
How does iron cause insulin resistance?

Ironcausesinsulinresistanceviaanumberofmechanisms,thatmaynotbefully
understood.Intheirreviewofthesubject,FernndezRealandcolleagues[13]explained
that:
Normally,insulinsignalsthelivertoslowdownorturnofftheliversproductionof
newbloodsugar(gluconeogenesis).However,ironinterfereswiththissignalling
whichleadstohighbloodsugar.
33
Normally,theliverworksonreducingexcessiveinsulinlevels.However,iron
interfereswiththisprocessalso,leadingtohighinsulinlevels.
Highinsulinlevels,inturn,increaseabsorptionofironfromthediet,causingavicious
circle.
Excessiveironlevelscancausetheproductionofsocalledreactiveoxygenspecies
thatcancausecelltissuedamageand,byextension,contributetocomplicationsof
type2diabetes.
ItalsoseemsthatironcontributestoelevationsofHbA1cduetoincreasedreactive
oxygenspecies.
ResearcherFernndezRealandcolleaguesstate[5]that:Reactiveoxygenspeciesinterfere
withinsulinsignalingatvariouslevels,impairinginsulinuptakethroughadirecteffecton
insulinreceptorfunction.Thiswouldessentiallycauseinsulinresistance.
TheabovestatementsareechoedbySwaminathanandcolleagues[3]who,intheir2007
reviewentitledTheRoleofIroninDiabetesandItsComplications,statethatironmaycause
type2diabetesthrough3keymechanisms,namely:
Insulindeficiency(i.e.impairedinsulinsecretionbythepancreas)
Insulinresistance
Liverdysfunction
Insulindeficiency,theyreport,maymaterializeduetoironsproductionofreactiveoxygen
speciesthatinturnattackspancreaticbetacellsleadingtotheirdysfunctionanddeath,as
foundinamousestudy.Impairedbetacellfunctionwouldleadtoreducedproductionand
secretionofinsulin,causinghighbloodsugaranddiabetes.
Who should lower their iron and how low?

Theideallevelofbodyironstoresis:justenough,butnomore.
Aswehaveseen,evenbodyironstoresconsiderednormalbymostdoctorscanbeacause
ofinsulinresistance.Sinceirondeficiencyasmeasuredbyserumferritinisusuallydefinedas
levelsbelow30,asafelevelwouldbearound40,i.e.nearirondeficiency(NID).Thiswould
putanindividualclosetothoselevelsseeninvegetariansandfrequentblooddonors,groups
thathavelowerratesoninsulinresistance.Asmentioned[15],SFbelow36doesnotseem
tobeassociatedwithfurtherimprovementsininsulinsensitivity.
Thisisalowriskstrategy;iftheresearchlinkingironstorestoinsulinresistanceultimately
provestobewrong,youhavelostnothingbecauseyoustillhavemorethanenoughiron.If,
ontheotherhand,irondoesindeedcauseinsulinresistanceandyouhaveexcessiveiron
levels,youwillpayahighpricefordoingnothing.
EvenaclosetodeficientSFlevelof40shouldbesufficientforathletes.Forsedentaryfolks,
serumferritinmayevenbereducedto25,asrecommendedbyE.D.WeinbergoftheIron
DisordersInstituteinhisbookExposingTheHiddenDangersofIron.
34
Oneconfoundingfactor,though,isthatserumferritinissometimeselevateddespitelow
bodyironstores.Thiseffectcanbeseeninsomeinflammatorystates.Therefore,youshould
alwaysconsultwithyourdoctortodeterminewhetheryouareagoodcandidateforiron
reduction,i.e.verifythatyoutrulyhavehighornormalasopposedtoneardeficientiron
stores.
Agoodindicationthatyourironlevelstrulyareexcessiveandthatyoureagoodcandidate
forironreductiontothe2540SFlevelisthecoexistenceofserumferritinabove40,normal
orelevatedtransferrinsaturationandanyofthefollowing:
Highbloodpressure
LowHDLcholesterol
Hightriglycerides
Highfastingbloodsugar
Highfastinginsulinlevels
InsulinresistanceasmeasuredbyHOMAIRorsimilar
Elevatedpostmealbloodsugarlevels(asmeasuredbyOGTT)
Elevatedpostmealinsulinlevels(asmeasuredbyOGTT)
Fattyliverdisease
Type2diabetesorprediabetes
OthersignsofIR
Whenhighironstorescoexistwithinsulinresistance,asindicatedbythelistabove,iron
reductionshouldprovemostbeneficial,andwouldlikelyimprovemanyoftheabove
conditions,too[8].Thehigheryourironlevelsare,themoreimportantitistolowerthem.
Therefore,ifyoutakemedicationsfortheaboveconditions,youandyourdoctorshould
monitorthemandadjust(reduce)medicationsaccordingly.Dontbesurprisedifother
ailmentsthatyoumayhavearereducedorvanishasyoureduceyourironstores.
Theminimumlevelforsedentarypeople(SF)shouldbearound25,whileifyourehighly
physicallyactive,SFlevelsupto50areprobablyallrightandshouldprobablynotgomuch
below35.Anythingabove50ng/mlSFisexcessiveandshouldbelowered,exceptinsome
rarecircumstanceswhereSFmaybeelevatedeventhoughbodyironstoresarenot
excessive.Alwaysdiscussironreductionwithaknowledgeabledoctortomakesureitsnot
harmfultoyou.
Iron reduction and other markers of

health/disease
AsexplainedinhisbookTheIronFactorofAgingWhyDoAmericansAgeFaster?,
FrancescoS.FacchiniM.D.,Ph.D.describeshowoxidationifoneofthemaincausesofage
relateddiseases(diabetes,heartdisease,canceretc.),andhowoxidationisacceleratedby
thepresenceofexcessbodyiron.
35
Onthesamenote,DouglasB.Kellinhisextremelycomprehensive2008article[23]oniron
andinflammatoryanddegenerativediseasesmakesthecaseforironexcessbeingimplicated
inthefollowingconditions:
preeclampsia
Diabetes
Metabolicsyndrome
Obesity
Heartfailure
Atherosclerosis
Alzheimers
Parkinsons
Multiplesclerosis
Friedrichsataxia
ALS/LouGehrigdisease
Rheumatoidarthritis
Asthma
Chronicobstructivepulmonarydisease(COPD)
Psoriasis
Gout
Renal[kidneyproblems]
Alcoholicandotherliverdiseases
Cancer
Malaria
Antimicrobials
SepsisandSIRS
Aging
Longevity
Frailty
Lupus/SLE
Inflammatoryboweldisease
Thatsnottosaythatallthoseailmentswillbecuredorevenimprovedbyironreduction.
Butironreductionmayhelppreventthedevelopmentofthem,andinmanycasesimprove
symptomsoncetheyhavemanifested.
How to reduce iron levels

Principally,thereare3waystoreduceironstores:
1. Reduceyourintakeofiron
2. Increaseyourlossesofiron
3. Both
36
Adultsloseabitofiron(11.5milligrams)perdaythroughurine,feces,perspirationblood
lossfrommenstruationetc.,soanytimeyouabsorblessironthanthat(fromdiet,beverages,
inhalationandthroughyourskin),yourironlevelswilldecline.
Hence,itisoftenpossibletoreduceyourironlevelsjustbyreducingyourironintake.The
fastestwaytoreduceiron,though,isbyreducingironintakeandincreasingironlosses.
Thereareseveralstrategiesyoucanemploytoreduceironlevels.Briefly,theyinclude:
Vegetariandietordietlowinavailableiron
Blooddonation
Phlebotomy(bloodletting)
Exercise
Medicalironchelators(drugsthatreduceiron)
IP6(nonprescription,naturalsupplementthatreducesironlevels)
Letsfirstlookathowtoreduceyourintakeofiron.
Lowironavailablediet
Igenerallydonotrecommendavegetariandiet.Norisitnecessarytoreduceironlevels.
Adheringtoadietlowinavailableironisthemainwaytoreduceironabsorption.Heresa
summaryofstrategiesthatwouldbehelpful:
Replaceredmeatwithpoultryorfishoreggs.Thisisthemostimportantstep.
Donteattoomuchwildmeat,sincetheycontainmuchmoreironthandofarm
raisedanimals.Buyhighquality,pasturefedmeatwheneverpossible,eventhough
thisisnotnecessaryfromanironreductionpointofview.
Discontinueanyironsupplementsyoutake,includinganyironinyourmultivitamin/
multimineraltablets.
DonttakevitaminCsupplementswithmeals.Takethembetweenmealsifyou
needthem.VitaminCincreasesabsorptionofironwhenconsumedwithmeals.
Drinkredwineortea(withoutsugar)withmealswheneverpossible.Thesedrinks
containcompounds(polyphenols,tannins,respectively)thatreduceabsorptionof
ironfromthatmeal.
Ifyouaddfattoyourmeal,useextravirginoliveoil.Itcontainscompoundsknown
aspolyphenolsthatreduceabsorptionofironfromthatmeal.
Anythingcontainingcalcium,suchasmilkandcheese,reducesabsorptionofiron
fromotherfoodstuffseatenatthesametime.
Eggs(seeabovepoint)
Dontdrinksodasoranythingelsethatisacidicwithmeals.Allsodasareacidicand
acidfoodsanddrinkswillincreaseabsorptionofironwhentakenwithameal.Infact,
itsbetternottodrinksodasatall(surprise,surprise).
Dontdrinkfruitjuiceswithmeals.TheirvitaminCandsugarcontentwillincrease
ironabsorption.Infact,itsbetternottodrinkfruitjuiceatall.
Dontdrinkalcoholwithmeals(exceptredwine).Itwillincreaseabsorptionofiron
frommeals,undermostcircumstances.
37
Whatkindofresultscanyouexpectfromsuchadietaryintervention?
In2003,alowironavailabledietwasgivento191type2diabetics[21]inthehopesthatit
wouldslowtheprogressionofdiabeticnephropathy,i.e.kidneydiseasecommonlyseenin
diabetics,comparedtoanormalproteinrestricteddiet.Theexperimentaldiethad3specific
characteristics1)lowinavailableiron2)carbohydraterestricted3)polyphenolenriched.
Onthisdiet,serumferritinlevelsfellfrom301to36over2years.After1year,SFlevelshad
declinedtoabout125.
Specificcharacteristicsofthisdietincluded:
50%reductionofcarbohydratesfrompreviouslevelsofintake
Redmeatwasreplacedwithfish,eggs,poultry,dairyandsoy[note:Idont
recommendsoy]
Eliminationofallbeveragesexcepttea,waterandredwine.Milkwasrecommended
forbreakfast.Teawashighlyrecommended.Nomorethan150mlofredwinewith
lunchandnomorethan150mlofredwinewithdinner.Onlywaterallowedoutside
ofmealtimes.
Exclusiveuseofpolyphenolenrichedextravirginoliveoilforbothdressingandfrying
Withregardstoiron,thecarbohydraterestrictionwasprobablyunimportant.Itwasincluded
inthedietforotherreasons.
Wecanseethatsuchadiettendedtostabilizeironstoresaroundoptimallevels(SF:36),
nearirondeficiency,whilenotincreasingratesofanemiainthetreatmentgroup[21].Also
ofinterest,thedietdescribedabovedidimprovekidneyandtotalsurvivalratesby4050%
comparedtoastandardproteinrestricteddiet.
NotethatImnotrecommendingalowironavailabledietperse;Iammerelymentioningit
asonetoolthatcanhelpyouloweryourironlevels.Byaddingotherstrategies,youcan
continueeatingredmeatifthatswhatyouwant.
Exercise
Exerciseincreaseslossesofiron.Maleenduranceathleteslosearound1.75mgofirondaily,
comparedto1mgcitedforaveragemales,whilefemaleenduranceathletesloseabout2.3
mgofirondailycomparedto1.4mg/dayforotherfemales[22].Thegreaterironlossesin
femalesareduetomenstruation.
Lowironismorecommoninthosewithhigherleveloffitness,andhighironislesscommon
inthesamegroup[27].
Themoreyouexercise,themoreironyoulose.Thisisonestrategythatcanbeusedtohelp
reduceironlevels.
38
Phlebotomy(bloodletting)
Onewaytoloweryourironlevelsistodiscussphlebotomywithyourmedicaldoctor.A
withdrawalof500mltypicallyresultsinadropofserumferritinofaround30points.These
cantypicallybedoneevery34weeks,sometimesmoreoften.
Blooddonation
Ifyourmedicaldoctorwonthelpyouwithphlebotomy,youmaylookintoblooddonationas
analternativestrategy.Malesareusuallyallowedtodonateblood4timesperyear,while
femalesmaydonateblood3timesperyear.Thismayormaynotbeenoughasastandalone
treatmenttoreduceyourirontoappropriatelevels.Itcancertainlybeanaid,sincedonating
1unitofblood(450ml)wouldreduceSFanaverageofalmost30points.
Blooddonationfacilitiestypicallydonottestyourserumferritin,soyoustillhavetoget
separatebloodteststokeepaneyeonyourserumferritinlevels.
IP6
IP6isaninterestingsupplement.Alsoknownasphyticacid,phytate,inositol6phosphate
andinositolhexaphosphate,itisanantinutrientratherthananutrient.Itisderivedfrom
naturalplantsources.Indeed,itisfoundinmanyofthemostcommonfoodstuffsweeat,
suchaswholegrainsandunrefinedrice.Forourpurposes,itisusedtoreducebodyiron
stores.
IP6,whenconsumedorally,bindstocertainsubstancesinsidethebodyandescortsthem
out(throughtheurine).Theusefulnessofthissupplementliesinitsabilitytobindtoiron
andformacompoundwhichisthenlostthroughtheurine.Inotherwords,IP6canbeused
toreduceironstores.ThedownsidetousingIP6isthatiscanalsobindtootherminerals
suchasmagnesium,zincandselenium.Itcanalsointerferewithabsorptionofnutrients
fromfoodandbeverages,aswellasmedications.Thereforeitisbesttakenin1singledose
perday,firstthinginthemorningonanemptystomachswallowedonlywithtapwater.
Thereafter,itsbesttowaitonetothreehours(closerto23hoursisbetter)beforeeatingor
drinkinganything,whiletheIP6doesitswork.
IP6,asstated,actuallyexistsnaturallyinunrefinedgrains,beansandnuts,buttoloweriron
storesyouneedtousepurifiedIP6asasupplement.IhavetestedJarrowFormulasIP6and
itworks.ThereareotherIP6productsonthemarketthatalsowork.
WhiletakingIP6,itisrecommendedtoalsotakeextrazinc,magnesiumandseleniumbutdo
NOTtakethoseatthesametimeofdayasIP6.
OnlytakeIP6IFyouneedtobringyourserumferritinlevelsdown.Ihavepersonallyused
IP6tobringdownmyserumferritinfromover100to40,inthemannerdescribedabove.If
youchoosetoloweryourironstoreswithIP6,youneedtokeepacloseeyeonyourserum
ferritinlevels(thesamethingholdstrueforanyironreductionprocedure).
Suggesteddose:30005000mgperdayuntiloptimalSFisachieved.
39
Puttingittogether
Foralloftheaboveironreducingstrategies,youllneedtokeepaneyeonyourserum
ferritinlevels.Ifyourferritinisveryhigh,youcouldimplementanaggressiveprogramof
blooddonation/phlebotomy,IP6and,exerciseandlowavailableirondietforawhile.But
thecloseroptimalironlevelsyouare,themorecarefulyouhavetobesoyoudontlower
themtoofar,althoughthisisusuallynotaproblembecauseironabsorptionfromdiet
automaticallyincreasesatlowbodyironlevels.Nevertheless,aggressiveironreductioncan
ofcourseleadtoirondeficiency.
Thereisnobeststrategy,butalowironavailabledietseemstostabilizeironintheright
range.However,ifyouexercisealot,alowironavailabledietmayleadtoirondeficiency.So
withlargevolumesofexercise,youmayhavetoeatmoreironrichanimalfoods.
Acombinationoftheabovestrategiescoupledwithregularserumferritinbloodtestswill
getyourironlevelsintotherightrangeandkeepthemthere.
Ifyouwanttolearnmoreaboutironlowering,orneedevidencetoconvinceyourmedical
doctororyourself,readExposingtheHiddenDangersofIronbyE.D.Weinbergaswellas
TheIronFactorofAgingWhyDoAmericansAgeFaster?byFrancescoS.Facchini.
Summary
Manystudieshaveshownanassociationbetweenbodyironstoresandinsulinresistance.
Notonlyishighironmorecommonintype2diabeticsthaninthehealthypopulation,but
ironisalsohigherinpatientswithinsulinresistanceandprediabetes,ascomparedtothe
healthypopulation.Moreover,eveninhealthypeople,whoarenotdiagnosedwithhigh
bloodsugarproblems,thereexistsanassociationbetweeninsulinresistanceandbodyiron
stores.
Ironstartstocausebloodsugarproblemsevenatlevelsconsideredcompletelynormalby
mostdoctors.
Onewaytomeasureironlevelsisbytestingserumferritin;ferritinbeingoneofthestorage
moleculesforironatoms.Onaverage,thehighertheserumferritin,thehighertheinsulin
resistance.However,thisrelationshipseemstostopatSFlevelsbelow3040,i.e.closeto
irondeficiency.Dependingonwhichagencyyouask,irondeficiency,asmeasuredbySFis
belowthe1530ng/mlrange.Fromaninsulinsensitivitypointofview,thereseemstobe
littlepointinloweringironbelow3040ng/mlSF,astheadvantagesbelowthatarelikely
negligible.
Inmanyofthestudiescitedinthischapter,ironreductionnotonlyimprovedbloodsugar
levels,butalsohadabeneficialeffectonothermarkersofhealthsuchasHDLcholesterol,
LDLcholesterol,totalcholesterol,fastinginsulinlevels,bloodpressureetc.
Noteveryoneisacandidateforironreduction,e.g.peoplewithirondeficiency,butformost
peoplewithelevatedserumferritincoexistingwithinsulinresistance,bringingSFdownto
40
2540(50maybeanokcompromise)andkeepingthemthereshouldbehighlybeneficial.
Strategiestoachievethishavebeendescribedinthischapter.
41
Chapter 3
Exercise and Insulin
Resistance
Exerciseisaninexpensiveandeffectiveweaponagainstinsulinresistance.Itissomething
thatshouldbeperformedonaregularbasisbyeveryone.
Manystillmistakenlyholdtheviewthatexercisemerelyenhancesfatloss.Infact,exercise
helpsagainstinsulinresistanceinseveralways,forinstance:
Makesmuscletakeupbloodsugarwithoutinsulin(ashorttermeffectafter
exercise).Thishelpskeepbloodsugarandinsulinlevelsincheck.
Buildsmuscle,whichhelpswithbloodsugarcontrolsincemusclesusebloodsugar
forfuel.Moremuscle=easierforthebodytoclearbloodsugar,whichisgood.
Canhelpfatlossefforts.Thisclearlyhelpsagainstinsulinresistance,asexplainedin
thechapteronbodyfat.
Leadstogreaterdailylossesofiron,whichhelpskeepironlevelsdown.
Counteractsageanddiseaserelatedmuscleloss,whichotherwiseincreasetherisk
ofbloodsugarproblems[37].
Helpsmaintainahighercalorieintakewhiledieting,soyoucangetmorevitamins,
mineralsetc.throughfood.Also,asmallstudyfoundthatweightlossinducedby
exerciseledtobetterfitness,greaterfatlossandpreservationofbonemass
comparedtoequivalentweightlossbydietaryrestriction[19].Exercisecanhelp
staveoffweightgainandleadtolossesofthedangerousintraabdominalfat,despite
nooverallweightloss[19].
Helpspreventweightregainafterweightloss.Ithasbeenfoundthatpeoplewho
successfullymaintainalargeweightlossreportexercisingabout7hours/week[38].
Amongwomenwhohadrecentlylost12kgs(26pounds)ormore,thosewhowere
morephysicallyactiveweremuchlesslikelytoregainsubstantialweightoverthe
next12months[9].Theresearchersfoundthat80minutesormoreofmoderate
exerciseor35minutesormoreofvigorousexerciseperdaywassufficientfor
maintainingweightloss.
Inmen,followingsubstantialweightloss,thegroupofmenwhoexercisedduringthe
subsequent36monthskepttheweightoff,whereasthosewhodidnotexercise
regainedallweightpreviouslylost.[10]Theamountofexerciserequiredtobe
42
classifiedasexerciserwasatleast3sessionsperweekandatleast500calories
burnedpersession.
Increasesfitness,whichisassociatedwithalowerriskofdeath,regardlessofBMI
orbodyfat.Inotherwords,greaterfitnessisalwayshealthier,eveninlean
individuals[11][14][15].Goingfromlowtohighfitnessleadstoalowerriskofdying
[14].
Beingamongthe20%leastfitmencomparedtothe40%mostfitincreasestheriskof
developinginsulinresistanceandtype2diabetesby90%and270%,respectivelyand
higherdegreeoffitnessismoreprotective[12].
Exercise,evenwithoutsignificantweightloss,for4560min/session,4times/week
for6monthswasfoundtoimprovebloodsugarcontrol,decreaseinsulinresistance,
decreasebloodpressureandexertantiinflammatoryeffectsintype2diabetics[18].
Improvedinsulinsensitivityof21%wasfoundafter9monthsof4day/weekaerobic
trainingexpending300caloriespersession,despitenofatlossorincreaseinfitness
[33].
Exerciseasastandalonetreatment,orcombinedwithdiethasbeenfoundto
significantlypreventprogressionofinsulinresistancetotype2diabetes[36].
Whetheryoureahealthypersonwhowantsevenbetterinsulinsensitivity[32],oralready
sufferingfrominsulinresistance[2]ortype2diabetes[38],exercisehelps.
Immediatelyafterexercise,bloodsugartransportintomuscleisenhancedandthiseffectis
independentofinsulin.Thisisgoodnewsforthosewhosufferfromhighbloodsugarand/or
highinsulinlevels(i.e.insulinresistance)becauseithelpskeepbloodsugarlevelsdown
withoutsendinginsulinlevelsskyhigh.[1]
Moreover,thiseffectisnotdifferentbetweentype2diabeticsandnondiabeticindividuals
[2],indicatingthateventhosewithinsulinresistanceortype2diabetesgetthefullbenefits
ofexercise.
Intype2diabetics,just7consecutivedaysofaerobicexercise,at400caloriespersession,
improvedinsulinsensitivitywithoutalteringfitnessorbodyfatlevels[20].Similarresults
havebeenfoundbyotherresearchersaswell[25].Althoughaftersuchshortperiodsofdaily
exercise,theimprovementseenininsulinsensitivityisprobablydueinparttothelatest
exercisesession,whichisknowntoproduceatransientshorttermincreaseofinsulin
sensitivity.Thisstressestheneedforregulartraining.
Overweight/obesetype2diabeticswithpoorlycontrolledbloodsugarwhocycledatahigh
intensityfor45min2times/weekwithone(1)additionalexercisesessionperweekfor2
monthsincreasedtheirinsulinsensitivity46%[35].Theinterventionsignificantlyreduced
thedangerousvisceralfatwithoutalteringbodyweight.
Eightpercentweightlossand46timesweeklyaerobictraining,3040min/sessionfor16
weeksincreasedinsulinsensitivityby49%inobesenondiabeticmenandwomen.Thiswas
incontrasttoasimilargroupwholostasimilaramountofweightonlythroughcalorie
restriction,whoonlyimprovedtheirinsulinsensitivityby22%[30].
43
Is higher intensity better than moderate

intensity? Is walking good enough?
DavidP.Swain,Ph.D.andBarryA.Franklin,Ph.D.,in2006wroteapaperentitled
ComparisonofCardioprotectiveBenefitsofVigorousVersusModerateIntensityAerobic
Exercise[7].Afterreviewingnumerouspopulationlevelstudiesoftheassociationbetween
exerciseintensityandhealthaswellasexperimentalstudiescomparingvigorousvs.
moderateintensityexerciseandhealth,theyconcludedthatifthetotalenergyexpenditure
ofexerciseisheldconstant,exerciseperformedatavigorousintensityappearstoconvey
greatercardioprotectivebenefitsthanexerciseofamoderateintensity.Thesamewas
generallyfoundforinsulinsensitivity:moreintenseexerciseproducedlargerimprovements
ininsulinsensitivityandgreaterriskreductionsofdevelopingtype2diabetes.[7]
Inotherwords,itsbettertoburn,forinstance,900caloriesin1hourratherthan3,without
changingtrainingfrequency(howmanytimesperweekyouexercise).
Walkingisoftenmentionedasagoodmodeofexerciseforhealth.Indeed,walkinghasbeen
associatedwithadecreasedriskofdevelopingtype2diabetesamongwomen,withgreater
walkingdistanceperweekconferringagreaterprotection[13].However,inthesamestudy,
fasterusualwalkingpacewasalsoassociatedwithareducedriskofdevelopingT2D,
indicatingthemeritsofmoreintenseexercise[13].Iamnotopposedtowalking.Infact,Ido
alotofitmyself.Butasastandaloneexercisemodality,itisnotoptimal.Ifyoudowalk,its
bettertopushyourselftowalkabitfaster.
Moreevidencethatvigoroustrainingisbettercomesfroma2007randomisedcontrolled
trialexaminingtheeffectsofamodifiedTaiChiform,TaiChiforDiabetes.TaiChiisavery
mildformofexercise,andthistrialfailedtoshowanybenefitoninsulinsensitivityandblood
sugarcontrol.Astheauthorsconcluded,moreintenseformsofTaiChimayberequiredto
producethebodycompositionchangesassociatedwithmetabolicbenefitsintype2
diabetes.[17]Agreed,orjustditchTaiChianddomoreintensestrength,enduranceand
HIITtraining(describedbelow).
Lightcalisthenicsandgentlestretchingdidnotimprovehealtheither,asevidencedbythe
controlgroupwhodidjustthatandhadnoimprovements[17].Thiswasnotthefirststudy
tofindTaiChiineffectiveagainstinsulinresistance,asreportedin[17];itsimplydoesnt
seemintenseenough.
In18sedentaryadults,meanage52years,walkingfor37daysperweek,30min/sessionat
moderateorhigherintensityfor6monthsimprovedinsulinsensitivityby74%without
weightloss[31].However,theseadultswereoverweight(meanBMI29)andsedentary,and
itsalwayseasiertoimproveinsulinsensitivitythemoreoutofshapeapersonis.Walking
wouldprobablynotbeagoodideaforfurtherimprovinginsulinsensitivityinanendurance
athlete
Highintensity(above75%ofmaximumweightyoucanlift)isbetterthanlowerintensity
strengthtraining[37].Highervolumeandhigherintensitystrengthtrainingmayprovide
superiorgainsinstrength,insulinsensitivityandglucose(i.e.carbohydrate)tolerance[37].
44
Aerobic exercise, strength training or both? How

often and how much?
EventhoughImnotahugefanofmetaanalysing,i.e.poolingtogetherdatafrommultiple
studiesandlookingattheresultasawhole,a2006metaanalysisexaminingtheeffectsof
trainingonbloodsugarcontrolintype2diabeticsisworthmentioning.Lookingprimarilyat
theeffectsoftrainingonbloodsugarcontrol(HbA1C),27studiesofstrengthtraining,
aerobictrainingorcombinedtrainingincluding1003patientswithameanageof55years
wereanalyzed.Itwasfoundthatallformsofexercisetrainingproducesmallbenefitsinthe
mainmeasureofglucose[bloodsugar]control:A1C.Theeffectsaresimilartothoseof
dietary,drug,andinsulintreatments.[4]
Furthermore,positiveeffectsonfastingbloodsugar,postmealbloodsugar,insulin
sensitivityandfastinginsulinwereseen,withgreaterbenefitsofcombinedtraining(aerobic
+resistance)[4].Additionally,somewhatgreaterbenefitswereseeninthosewithmore
severetype2diabeteswhichisreassuringtothisgroup[4].
Strengthtrainingwiththegoalofcontinuouslyincreasingstrengthcanoffersome
advantagesthataerobictrainingcannot,i.e.largerincreasesinmusclemassandbone
densityaswellasbeingamorerealisticmodeoftrainingforsomepeople.Thereisevidence
thatprogressivestrengthtrainingisbeneficialforHbA1c,insulinsensitivity,fastinginsulin
levelsandpostprandialinsulinlevelsintype2diabetics[5][6].Intype2diabetics,strength
trainingaddedtomoderateweightlossimprovedbloodsugarcontrolcomparedtoonly
moderateweightloss[27].Insulinsensitivityimproved48%intype2diabeticsafter46
weeksofmoderateintensity,highvolumestrengthtraining5daysperweek[28].Inyet
anotherstudyintype2diabetics,after16weeksofstrengthtraining3timesperweek,
HbA1cdeclinedby1.1percentagepointinthestrengthtraininggroupcomparedto
sedentarycontrols.Also,exerciserscouldreducetheirmedicationsby72%whereasthe
controlgroupincreasedtheirmedsby42%[29].Insomestudies,improvementinblood
sugarcontrolhasbeenrelatedtoincreasesinmusclemass,buttraininghasbeneficial
effectsevenwithoutbuildingmuscle[6].
Strengthtrainingcanreducethedangerousabdominalandvisceralfatinpatientswithtype
2diabetes[37].Strengthtrainingdoesreduceinsulinresistanceinnondiabeticsaswell[37].
Inone16weekrandomizedcontrolledtrialonoverweightlatinoadolescentmales,insulin
sensitivitywasincreasedby45%afterjust2strengthtrainingsessionsperweek,andthis
effectwasnotexplainedbychangesinbodycomposition(bodyfatandmusclemass)[26].
Aerobicexercise,too,increasesinsulinsensitivity[20][32][33][34],whendoneatmoderate
tovigorousintensity,andpreferablyatahighvolume.
Thepositiveeffectsofexerciseoninsulinsensitivitytendtobeshortlived,soyoushould
exerciseregularly.Itisknownthatanacuteincreaseininsulinsensitivityafteratraining
sessionisusuallyseen,andthistypicallywearsoffwithin24hours,butafterlongterm
exerciseincreasedinsulinsensitivitycanlastlonger.Inastudyof8healthymen(1825y.o.),
insulinsensitivityincreasedby32%after6weeksofaerobictrainingfor5days/weekat
moderateintensity,andthiseffectwaspreserved1weekaftertrainingcessation[32].
45
Inolderwomenwhodidaerobicexercise4times/week,burning300caloriespersessionfor
9months,elevatedinsulinsensitivityof21%wasseen72hoursafterthelastexercise
session,indicatingbenefitsbeyondtheimmediateshorttermeffects[33].Inthisstudy,
moreintenseexerciseburningthesameamountofcaloriesaslessintenseexerciseledto
greaterimprovementsininsulinsensitivity[33].
Insedentary,overweight/obesemenandwomenassignedtodo8monthsofaerobic
exerciseof1200or2000caloriesperweekatmoderateorhighintensity,insulinsensitivity
wasimproved1624hoursafterthelastexercisesession,aswellasafter15daysofno
exercise.However,insulinsensitivityhaddeclinedmarkedly15daysafterthelastsession
comparedto1624hoursafterthelastsession[34].
Allthisindicatesthatyoushouldexerciseregularly.
A word about HIIT (a.k.a. HIIE)

Inrecentyears,popularityofsocalledHighIntensityIntervalTraining(HIIT)hasrisen.This
typeoftrainingisalsoreferredtoasHighIntensityIntermittentExercise(HIIE)and
sometimesmerelyasintervaltraining,andtheideaistovaryextremelyintenseburstsof
exercisewithlowintensityorrestperiods.Thelengthofthesprintsandrestperiodsvary
considerably,fromafewsecondstoafewminutes.
Thistypeoftrainingmaysoundattractivebecauseitpromisesverybigresultsforverylittle
timeexpenditure.Butdoesitholduptotheclaims?A2010reviewbyStephenH.Boutcher
ofavailableHIITstudiessaysyes.
WhatisHIITallabout?Onecommonprotocol,theWingatetest,consistsof30second
sprintsinterspersedby4minutesofrecovery,whichisrepeated4to6times[8].Thisis
usuallyperformedonastationarybike,butcanbeperformedrunningoutdoorsorinother
ways.Thistypeoftraining,tobeeffective,hastobeextremelyhardandyoumustreally
pushyourselfduringthesprints.
HIITproponentsusuallyclaimthatHIITisverytimeefficient,sinceonlyafewminutesof
totalsprintingisusuallyperformed.However,iftherestingperiodsarealsotakeninto
account,thetotaltimespentistypically15to30minutes.Inthattime,youdtypicallyburn
morecaloriesfromdoingsteadystateaerobicexercise.SoHIITisactuallynotthattime
efficientanddoesnotburnmorecaloriesthansteadystateaerobicexerciseinthesame
time.However,theextremeperiodicintensityofHIITofferssomeuniqueadvantages,
namelylargerincreasesinmusclemass,highercalorieburnafterexercise(socalledEPOC)
andsomeuniquehormonalresponsesthatmayenhancethelossofintraabdominalfat
specifically.
Regardinginsulinsensitivity,ithasbeenfoundthat[8]:
Insulinsensitivityisconsistentlyenhancedafter2to16weeksofHIITby1958%.In
mostofthesetrials,HIITledtomoderateweightloss[8]
46
Insulinsensitivitymayimprovemoreinindividualswithtype2diabetes,butalso
improvesinhealthyindividuals
HIITmayleadtopreferentiallossesofabdominalfat,thankstothehormonal
responsestoHIITthatmaymobilizethisfatforfuel
HIITimprovesfitness
TheintensityofHIITmayleadtodecreasedpostexerciseappetite,whichmayhelp
fatlossefforts
HIITappearssafeeveninoverweightindividuals,type1diabetics,olderadults,type2
diabetics,cardiacrehabilitationpatientsandotherspecialgroups
IthinkHIITisagreatformofexercisetothrowintothemixofaerobicandstrengthtraining,
beingsomewhereinbetweenthose.
IwouldnotgosofarastosaythatHIITisthebestandonlyformofexercise.Norshouldyou
takeclaimsseriouslyofburningagazillionofcaloriesafterHIITexercise.Sure,HIITelevates
calorieexpenditureaftertrainingcomparedtosteadystatecardio,buttheeffectisnot
terriblybig.
Insummary:HIITisagreatformofexercisetoperformonaregularbasis,butdontletitbe
youronlytypeofexercise.HIITdoesntleadtomagicfatlossyoumaystillhavetowatch
calorieintake.Allinall,definitelydoitbuteaseintoitespeciallyifyourenotusedtointense
exercise.
The nitty-gritty details of training

ArecentjointpositionstatementbyTheAmericanCollegeofSportsMedicinewiththe
AmericanDiabetesAssociationgaveadviceontrainingfortype2diabetics[38].Tosumit
up:
Type2diabeticsshoulddomoderatetovigorousaerobicexerciseonatleast3
differentdaysoftheweek,atleast150minutestotaltime,withnomorethan2days
betweensessions.Greaterbenefitsarelikelygainedathigherintensities.Engagingin
differentkindsofaerobicexerciseisrecommended(e.g.cycling,walking,swimming
etc.)
Type2diabeticsshouldalso,inadditiontotheabove,domoderatetovigorous
resistancetrainingatleast23days/week.
Aminimumof510exercisesinvolvingthemajormusclegroupsarerecommended,
withatleast1setthatreachesvoluntaryfailure(thepointwheretheweightcanno
longerbemovedwithproperform)in1015repetitions,progressingto34setsof8
10repetitionsforgreaterbenefit.Heavierweightsmaybebetter(7580%ofmaximal
strength).[Whatthismeansisthatifthemaximumweightyoucan,forinstance,
benchpress1timeis100kg(220pounds),youshoulduse7580%ofthatfor
exercising]
Increasedphysicalactivityreducesriskofdevelopingtype2diabetes,evenifno
weightlossisachieved.
47
Inadultsathighriskfordevelopingtype2diabetes(thatsyou,mydearreader,if
youreinsulinresistant)atleast2hoursperweekofmoderatetovigorousphysical
activityperweekshouldbeimplemented,aspartoflifestylechanges,toreducethe
riskoftype2diabetes.
Flexibilitytrainingisfine,butshouldnotreplaceothertypesofphysicalactivity.
Iwouldagreewiththeabove,andaddthataerobicexerciseshouldbesweatinducing
wheneverpossible,andthatmoreexerciseisbetter.Thesameguidelinesaregoodevenfor
insulinresistantpeoplewhoarenottype2diabetics.
HIITcanalsobethrownintothemix13timesperweek,butbeawarethatthiskindof
exerciseisextremelydemanding.Itshouldbedoneinadditiontosteadystateaerobic
exercise.Inallkindofstructuredtraining,trytoimproveintensityorvolumeandamountof
weightliftedastimegoesby.
Ithinkthatstrengthtraining(resistancetraining)isbestdoneinagym,unlessyouhavea
decenthomegymwithabarbell,dumbbells,squatrack,benchforbenchpressing,chinup
baretc.Ithasbeenshownthatexercisingatagymcomparedtohomecanleadtobetter
bloodsugarcontrol[16][24],thankstothesuperioravailabilityofequipmentatagym[16]
resultinginintenserworkouts.Butifyouhaveagoodhomegym,thatwouldalsowork.
Ifyoudonthaveaccesstoagymorhomegym,youcanstillworkoutusing
unconventionalequipment,suchasbottlesfilledwithprogressivelymorewater,bagsfilled
withprogressivelymoresand,pushups,crunches,pullupsataplayground,climbingstairs
etc.butthatisoutsidethescopeofthisbook.
Aerobicexercise,ofcourse,canbeperformedonalmostanybicycle,orbyswimmingor
running,orevenwalkingbrisklyalthoughthelatterbyitselfisnotoptimalunlessveryout
ofshape.Gymsusuallyofferawiderangeofequipmentforperformingaerobicexercise.
HIITcanbeperformedoutsidebysprintingandwalkingintermittently,orswimmingorona
stationarybikeetc.
YoucanexperimentwithvariousHIITprotocolsandchangethemup.ThecommonWingate
testhasbeendescribedabove.Theimportantthingistohaveaveryintensesprint,usually
notmorethan30secondsto2minutes,butcanbeaslittleas8seconds,followedbya
recoveryoflowintensityexerciseorcompleterestfor12secondsto4minutes,typically.A
goodstartingpointmaybelongerrestthansprints,repeatedafewtimes.Asyourfitness
increases,youcan
shortentherestbetweensprints
increasethenumberofsprints
increasetheintensityofthesprints
anymixoftheabove
Thepossibilitiesareendless,andthereisnoneedtosticktoonlyoneprotocol.Asfor
frequency,youcannotexpecttodoHIITeverydaysinceitstoodemanding.Onetothree
48
timesperweekmightbeappropriate,onnonconsecutivedays.Duringthosedays,youcan
stillperformlessintensesteadystateaerobicexerciseand/orstrengthtraining.
Regardingstrengthtraining,therearemanygoodtrainingprogramsforfreeonline,andyou
caneithertrainyourentirebodyeverysessionatthegymordoasocalledsplit,whereyou
dividethemajormusclesintoonlyafewpersession.
HerearethebigexercisesbymusclegroupthatIrecommendyoudoregularly.Thereareof
courseothers,butthesewillgetyoufar.
Chest
BenchPress
InclineBenchPress
Shoulders
Militarypress
Dumbbellpress
Triceps
Skullcrusher(maybegentlerwith
dumbbells)
Pushdowns
Biceps
Barbellcurls
Dumbbellcurls
Abs
Crunches
Lats
Chins
Pulldowns
Rowexercises(notaerobicrowing)e.g.one
armrow
Quadriceps(frontsideoflegs)
Squats(optional)
Legpress
Legextension
Hamstrings(backsideoflegs)
Straightleggeddeadlift
Legcurl
Calves
Calfraise
Deadliftorstraightleggeddeadlift
Lowerback
Traps(musclesaroundneckandupperback) Yougetthisautomaticallyfromdoingany
kindofdeadlifting
Forearms
Yougetthisautomaticallyfromdoingany
kindofdeadlifting
Youcanalsotrainthesemusclegroupsinmachinesifthatsuitsyoubetter,althoughIprefer
dumbbellsandbarbells.Agoodsitetolookforexercisesis
http://www.exrx.net/Lists/Directory.html
Mostgymsoffersomekindofintroductionthatwillhelpyouconstructatrainingprogram.
Thepopulargymroutineofdoing3setsofeachexercisewith8repetitionsineachset(3x8)
isagoodstartingpoint.Weightshouldbesufficientlyheavysothatyoustruggletocomplete
8repetitionsinthe3rdset.Ifyougetthemall,youshouldincreaseweightnexttime.An
appropriaterestperiodmightbe90secondsbetweensets.Butnoneofthisissetinstone.
49
Ifyouvebeensedentary,youshouldstartwithlighterweights,perhapsfewersetsandmore
repetitions(1015perset)andperhapsgetapreexerciseevaluationbyadoctor.
Itismyopinionthatmanypeople,especiallywomenandolderadults,trainlessintensethan
requiredinthegym.Yourenottheretopickthelowestresistanceonthemachinesor
dumbbells/barbellsandmerelymovearmsandlegs.Youactuallyneedtoexpendsome
effortinorderforthistopayoff.Yourmuscles,insulinsensitivityandbonedensitywillallbe
betterforit.Butthereisnoneedtokillyourselfinthegym,either.Tooextremeeffortsmay
beharmful.
Sincemusclehelpswithbloodsugarregulation,thankstobeingaprimarysiteofglucose
uptake,itisagoodideatobuildsomemuscleaswell,althoughitscertainlyoptional.Todo
that,eat2gramsofproteinperkgofbodyweightperdayor1gramperpoundof
bodyweight.Thiswillsupplythebuildingblocksforbiggermuscles.Youdo,however,get
benefitsfromtrainingevenwithoutaddingmusclemass,butifyoufeellikepackingonsome
mass,goahead.Althoughbecarefulthatyoudontgainanysubstantialamountofbodyfat
intheprocess,asdoingsowillbedetrimentaltoyourinsulinsensitivity.
Asforunstructuredphysicalactivity,IoftentrytomakeapointofwalkingwhenIhangout
withfriends.Walkingorbikinginsteadoftakingthecarisalsogood,aswellasclimbingstairs
insteadoftakingtheelevatoretc.
Ina2003studyamongpreviouslysedentarywomenundergoingweightlossbymeansof
calorierestrictionandexercise,itwasfoundthatwomenwhospentmorethan200minutes
perweekexercisinglostsignificantlymoreweightafter12monthscomparedtowomen
spending150min/weekorlessexercising,althoughinthisstudynoextraeffectofintensity
oftrainingonweightlosswasfound[21].Interestingly,inthisstudyalmostallweight
(roughly8kgsor17pounds)waslostwithinthefirst6months,afterwhichweightloss
stalled.Afterthefirst6months,participantsdrasticallydecreasedtheirleisuretimephysical
activity,i.e.physicalactivityaboveandbeyondthatprescribedasexerciseinthestudy.So
whentotalphysicalactivitydeclined,weightlossstalledaswell.Otherresearchersaswell
havefoundthattotaltimeexercisingperweekcorrelateswithimprovedinsulinsensitivity
[22].Inlightofthisitmakessensetokeepupsomeunstructuredphysicalactivity.Beactive,
notsedentary.
Thebetteryourinsulinsensitivityalreadyis,themoreintenseandhighervolumeexercise
youllhavetodotofurtherincreaseit.Thisiswhyyoushouldtrytoprogressinyourtraining.
50
Chapter 4
Supplements Against
Insulin Resistance
ThereareonlyafewsupplementsIseeapointintakingagainstinsulinresistance.Theresa
lotofoverpricedgarbageoutthereIsthedifferencebetweenaninsulinresistantandan
insulinsensitivepersonhowmanyexoticherbstheyaregulpingdown?Notnecessarily.I
usedtotakealotofsupplementsthatwouldsupposedlyhelpwithbloodsugarregulation,
butIdidntstarttoseebigimprovementsuntilIstartedwithfatloss,exercise,ironreduction
etc.Nevertheless,someimportantnutrientscanbedifficulttogetinsufficientamounts
throughdietalone,andareworthconsideringassupplements.Butsupplementsshould
neverreplaceahealthydiet,onlyaugmentit.Ialsorecommendthatyoubeveryskeptical
aboutvariousherbsandconcoctionsthatclaimtoimproveinsulinresistance.Atleast,you
shouldfirstdothethingsinthisbookbeforeyougolookingforexotic(andexpensive)
supplements.
Somenutrientdeficienciescancauseinsulinresistance.Ifyouredeficient(orborderline
deficient),increasingintakeofthosemicronutrientswillimproveyourinsulinsensitivity.
However,largerdosesbeyondthepointwhereyouhaveoptimallevelsofthose
micronutrientswillnotprovidefurtherbenefits.
So,correctingmicronutrientdeficiencieswillimproveinsulinsensitivity,butnotprovide
additionaladvantagesonceyouhaveenough,andmegadosesmaybeharmful.Withme?
Magnesium (Mg)
Magnesiumdeficiencycancauseinsulinresistance,sincemagnesiumisneededforinsulinto
workproperly.Thiscancauseinsulintobecomeelevated,whichfurtherleadstolossesof
magnesiumthroughtheurine,creatingaviciouscycle.Threelargestudieshavereportedly
foundthatthosewiththehighestdietarymagnesiumintakehadthelowestriskof
developingdiabetes.Magnesiumdeficiencymayalsodepressinsulinsecretionfromthe
pancreas,whichcanleadtoprediabetesandtype2diabetes.[2]
Thestandardwesterndietdoesnotprovideadequateamountsofmagnesiumformost
people[1].Thisisbecausethestandardwesterndietcontainsalotofrefinedsugar,refined
51
flourandrefinedfats.Thesearesocalledemptycaloriestheycontainenergybutverylittle
vitaminsandminerals,suchasmagnesium.
Unlessyoueatadiet(includingwater)richinmagnesium,youwillneedmagnesium
supplementationtoachieveoptimallevels.Infact,itshardevenwithagooddiettoget
enoughMgfromit,especiallyifyoureonacalorierestrictedweightlossdiet.Also,some
conditions,suchasbeingchronicallyillorexercisingorbeingunderstress,increasethedaily
needsofMg.[1][2]
Mgisusedinabout300reactionsinthebody,soitsimportanttooptimizeyourMglevels
forseveralreasonsbesidesinsulinresistance.
HowmuchMgdoweneed?
Thetotalamountyoushouldbeaimingatgettingthroughdiet,beveragesandsupplements
is610milligramsperkg(34.5milligramsperpound)ofbodyweightperdayformenand
slightlylower,perhaps4.58milligramsperkg(23milligramsperpound)bodyweightfor
women.Whatyoudontgetthroughdiet,youllwanttotakeassupplements.
Magnesiumsupplements
Ifyoudogetenoughmagnesiumfromdietandbeverages(includingtapwater),youdont
needmagnesiumsupplements.ThatswhyIveincludedalistofmagnesiumrichfoodsatthe
endofthissection.ButitsquitedifficulttogetahighamountofMgthatway,andinsulin
resistantortype2diabeticindividualsneedmoretobesafe.ThatswhyMgsupplements
canbeanexcellentidea.
Magnesiumisaverysafesupplementformostpeople.Itisalmostimpossibletooverdoseit
iftakenorally.Asitentersthebloodstream,itwillbetransportedtocellsandtissuesaswell
asboneswhereitsneeded.Iftheresasurplus,thekidneyswillexcreteit.Also,ifyoutake
toomuchasasingledoseorally,itwillsimplycausealaxativeeffectandbeexcreted
throughthebowelsinstead.So2mechanismsprotectyouagainstoralmagnesiumoverdose.
However,ifyouhavekidneydysfunctionyouMUSTNOTtakemagnesiumsupplements.Also,
ifyoureoncertainmedications,youshouldnttakeMg.Askyourmedicaldoctoraboutthis
beforetakingit.
OnewordofcautionaboutMgsupplements:Youcanstillgetthelaxativeeffectevenwhile
youremagnesiumdeficient.Itsimplymeansthatyoutooktoomuchasasingledose.Thats
whyyoushoulddivideandspreadoutmagnesiumsupplementsinto24smallerdosesper
day,forbetterabsorptionandavoidanceofdiarrhoea.
TherearemanydifferentkindsofMgsupplements.Morecorrectly,Mgcanbeboundtoa
largevarietyofcompounds,whichaffectabsorption.Thosecompoundsthemselvescanalso
havevariouseffectsinthebody.Someexamplesinclude:
MgSO4(Magnesiumsulphate)
MgO(Magnesiumoxide)
MgCl2(Magnesiumchloride)
52
Someoftheseareborderlineworthless,othersarewellabsorbed,soitscrucialwhichone
youchoose.
ThebestMgsupplement,consideringavailability,absorptionandcost,maybemagnesium
citrate.
Personally,myfavoriteismagnesiumchloride.Itisthebestabsorbed,butcanbehardto
findandexpensive.www.iHerb.comdocarryoralmagnesiumchloridesupplements.
WithanMgpoordietyoucanaimfor350milligramssupplementeddaily.WithanMgrich
diet,youcanaimfor150milligramsorlessdaily.Increasetheselevelsifyoureabigperson,
exercisinghardorgoingthroughstressorsufferfromtype2diabetes.Whatyouwantisthe
properamountofelementalmagnesium,soreadlabelscarefully.
Foods High in Magnesium per 200 calorie

serving by category
Mostlistsofmagnesiumrichfoodsaresortedbymagnesiumcontentfor100gramsofthat
food.However,thatisnottherightapproachThelistsbelowaresortedbasedonhow
muchmagnesiumisina200calorieserving,whichmakesmuchmoresense.Iveonly
includedfoodsthatIfeelarerealistictoconsume.Thereareexoticfoods,unpalatablefoods,
rarefoodsetc.thatcontainalotofMgbutIhaveexcludedthose.
SelectCerealGrainsandPasta
Amaranthgrain,cooked.Magnesium:127mg
Buckwheatgroats,roasted,cooked[kasha].Magnesium:111mg
Quinoa,cooked.Magnesium:107mg[oneofmyfavorites;makesureitsWHITE
quinoa]
Oats.Magnesium:91mg
SelectVegetables
Spinach,cooked,boiled,drained,withsaltMagnesium:756mg
Seaweed,kelp,rawMagnesium:563mg
Kale,scotch.Magnesium:419mg
Okra,raw.Magnesium.368mg
Squash,zucchini,baby,raw.Magnesium:314mg[anysquashorzucchiniisMgrich]
Taro,tahitian,cookedwithoutsalt.Magnesium:232mg
Broccoli.Magnesium:179mg
Sauerkraut,canned,solidsandliquids.Magnesium:137mg
Pumpkin,canned,withoutsalt.Magnesium:135mg
Tomatoes.Magnesium:122mg
Cauliflower,raw.Magnesium:120mg
Peppers,sweet,yellow,raw.Magnesium:88mg
53
SelectFruits
Pricklypears,raw.Magnesium:415mg
Rhubarb,frozen,uncooked.Magnesium:171mg
Acerola,(westindiancherry),raw.Magnesium:113mg
Kiwifruit,(chinesegooseberries),heldinstorage,raw.Magnesium:98mg
Blackberries,raw.Magnesium:93mg
Melonballs,frozen.Magnesium:85mg
Raspberries,raw.Magnesium:85mg
Mulberries,raw.Magnesium:84mg
Strawberries,raw.Magnesium:81mg
SelectSeedsandNuts
pumpkinandsquashseedkernels,roasted,withsaltadded[pepitas].Magnesium:
205mg
flaxseed.Magnesium:147mg
safflowerseedkernels,dried.Magnesium:137mg
sesameseeds,whole,roastedandtoasted.Magnesium:126mg
Nuts,brazilnuts,dried,unblanched.Magnesium:115mg
Nuts,cashewnuts,raw.Magnesium:106mg
Nuts,almonds,dryroasted,withsaltadded.Magnesium:96mg
FinfishandShellfish
Fish,caviar,blackandred,granular.Magnesium:238mg
Fish,halibut,AtlanticandPacific,cooked,dryheat.Magnesium:153mg
Fish,ling,cooked,dryheat.Magnesium:146mg
Fish,pollock,Atlantic,cooked,dryheat.Magnesium:146mg
Mollusks,oyster,eastern,wild,cooked,moistheat.Magnesium:139mg
Crustaceans,crab,alaskaking,cooked,moistheat.Magnesium:130mg
Fish,turbot,European,cooked,dryheat.Magnesium:107mg
Beverages
Cocoamix,nosugaradded,powder[hotchocolate].Magnesium:110mg
SourceofMgcontentoffoods:
FoodshighestinMagnesium(basedonlevelsper200Calorieserving).Retrievedfrom
http://nutritiondata.self.com/foods000120000000000000000.html
Chromium
Chromium,likemagnesium,isanutrientandcorrectingachromiumdeficiencyor
suboptimallevelwillimproveinsulinandbloodsugar.However,megadosingwonthelp.
Chromiumdeficiencyleadstoglucoseintolerance(highbloodsugaraftereating
carbohydrate)andthisimproveswhenchromiumisaddedtothedietagain[3].Unlikewhat
54
youmayhaveheard,chromiumisnotamagicnutrientthatautomaticallyreversesinsulin
resistance[4].Ithasbeenshowninsomebutnotalltrialstoimproveinsulinandbloodsugar
measures[3].Itseemsmosteffectiveintype2diabeticsorpeoplewithinsulinresistance.
Thebestformseemstobechromiumpicolinate,anddosesof200microgramsperdayseem
adequateforsupplementation.Theriskofknowntoxicityislow,butifyouwanttotry
chromiumthemostprudentthingtodoseemstobeatrialperiodduringwhichyoutake200
microgramsdailyfor26monthsandwatchwhathappenstoyourbloodsugarandinsulin
levels.AccordingtoBelindaS.OConnellinher2001paper[3],resultsshouldbeevident
within612weeks.Regardless,ifnobenefitisseenfor6monthsatmost,youmay
discontinueuseofchromium,duetothepotentialofunknownsideeffectswithlongterm
usage.Oryoucouldtakealowmaintenancedoseof200microgramsperweek,preferablyin
divideddoses.
Chromiumrichfoodsincludecheese,nuts/seeds,mushrooms,beefandbroccoli[3].
Personally,IusedtotakechromiumbutIhavediscontinuedtakingitforthetimebeing.But
thisshouldnotbeinterpretedasasignthatIthinkitsworthless.Itcanbegoodforsome
people,butInoticednobenefit.
Vitamin K
Areducedriskofdevelopingtype2diabeteshasbeenassociatedwithhighervitaminK
intakes.ItwasfoundthatvitaminK2wasmoreeffectiveinthisregardthanvitaminK1,and
riskoftype2diabetesdecreasedinlinearfashionwithhighervitaminK2consumption[5].
HighervitaminK1intakefromdietandsupplementsisalsorelatedtobetterinsulin
sensitivity[6].
PhylloquinoneistheplantformofvitaminK,alsocalledvitaminK1.Itisprimarilyfoundin
greenvegetables.However,thisdoesnotseemtobetheoptimalformforthehumanbody,
whichseemstoprefervitaminK2mk4,alsoknownasmenatetrenone.Goodsourcesof
vitaminK2aremeat,eggs,cheese.InonestudyofDutchmenandwomen,cheeseandmilk
productscombinedcontributed72%ofdietaryvitaminK2intake,withmeatmakingup17%
[5].EatingmoreoftheseforbiddenfoodswouldincreasevitaminK2intake.
VitaminK1whengivenasasupplementas0.5milligramsperdayfor36months,improved
insulinsensitivityandreducedfastinginsulinlevelsinmenonly[7].Inanotherstudy,for12
months,21postmenopausalwomenweregiven1milligramperdayofvitaminK1,while21
postmenopausalwomenweregivenplacebo.Insulinresistancewasnotreducedinthis
study[8],althoughIRwasmeasuredrathercrudely.Nevertheless,womenmaynotstandto
benefitasmuchfromvitaminK1supplementationasmen.Furthermore,asmentioned,the
realformofvitaminKforhumansismenatetrenone(vitaminK2mk4).Inarecenttrial,30
mgvitaminK2mk4givendailyfor4weekstoyoung,healthymen,significantlyimproved
insulinsensitivity[9].Again,thiswasastudyonmen,andthedosewasveryhigh.
VitaminKisrarelyincludedinmultivitaminpreparations,andifitis,itsprobablynotinthe
right(menatetrenone)form.
55
Basedonthelimiteddata,itsprematuretogiveabroadrecommendationforsupplemental
vitaminK2mk4.Theproblem,inmyopinion,isthatvitaminK2mk4supplementstypically
containverylargedosesofthevitamin,suchas10005000microgramsperserving,whilea
normaldietaryintakeofvitaminK2throughdietisperhapsinthe30microgramrange.
However,ifyouresoinclined,youcouldtake15milligrams(10005000micrograms)daily
foraperiodofafewweeksuptoayearandseeifyourbloodsugarorinsulinlevelsimprove.
Thereareafewsupplementsavailableatwww.iHerb.comifyousearchformenatetrenone.
OrseeifyoucanfindavitaminK2mk4supplementwithmorerealisticdoses,suchas3050
microgramsdaily.
Anotheroptionistosupplementphylloquinone,thatisvitaminK1ortheplantformof
vitaminK.VitaminK1isinalllikelihoodperfectlysafetotakeindailydosesof1000
microgramsperday(1mg/day)becausethoselevelsareachievablethroughdiet.Just
bewarethatvitaminK1isnotaseffectiveasvitaminK2.
Otherwise,justincreasetheproportionofmilk,cheeses,eggyolk,butter,meat,poultryand
liverinyourdiet.
VitaminKcanantagonize(oppose)theeffectsofbloodthinningmedications
(anticoagulants).Asalways,firstconsultyourdoctorbeforetakinganysupplementsor
makinganychangestoyourdiet.
Vitamin D
LowvitaminDlevelsseemtoincreasetheriskofdevelopingtype2diabetesand
carbohydrateintolerance.ThiscouldbeduetoanegativeeffectofvitaminDdeficiencyon
insulinsecretionbythepancreas,whichwouldcausehighbloodsugarlevelssinceinsulinis
neededtobringdownbloodsugar,orvitaminDdeficiencycouldcauseresistancetoinsulin,
orboth.
Inagroupofhealthyyoungmenandwomenofvariousethnicities,itwasfoundthatthose
withhighervitaminDlevelshadbetterinsulinsensitivity.Conversely,lowervitaminDlevels
werenegativelyassociatedwithpancreaticbetacellfunction.Inotherwords,thosewith
lowervitaminDlevelshadapoorerinsulinsecretionfromthepancreas,acontributing
factortohighbloodsugarandtype2diabetes[10].Additionally,thosewithvitaminD
deficiencyhadagreaternumberofmetabolicsyndromesymptoms[10].Thisstudy
suggestedthatincreasingvitaminDlevelsfrom10ng/ml(deficient)to30ng/mlmay
increaseinsulinsensitivityby60%,althoughsuchconclusionsmustbeviewedasestimates
only.
AsignificantpartofthepopulationisvitaminDdeficient,especiallynonwhites[10].Even
vitaminDlevelsconsideredsufficientmaynotbeoptimal,accordingtosomeexperts.
NoonereallyknowstheoptimalbloodlevelsofvitaminD[11].Onedefinitionofdeficiency
isbelow20ng/ml,insufficiencybeinginthe2029ng/mlrange[11].AccordingtoThe
VitaminDCouncil,anotforprofitorganizationwhoseaimitistoendtheworldwidevitamin
56
Ddeficiencyepidemic,Studiesindicatethatforproperhealth,serumvitaminDlevelsshould
beaminimumof50ng/mL(125nmol/L),withoptimallevelsfallingbetween5080ng/mL
(125200nmol/L).Thesevaluesapplytobothchildrenandadults.[12]
EffectsofvitaminDsupplementationoninsulinsensitivityhavebeenmainlypositive.Some
studieshavefoundsupportforvitaminDsupplementationforimprovinginsulinresistance
[13][14][15][16][18][21][23][24],whileothershavenot[17][19][20][22]
Forinstance,500mgofcalcium+700IU(internationalunits)ofvitaminDperdayfor3years
slowedprogressionofinsulinresistanceamongthosewhohadIRatthestartofthestudy.
AmongthosewhodidnothaveIR,noeffectwasseen.Butthisstudycouldnotseparatethe
effectsofcalciumandvitaminD,sinceitwasgiventogether.[13]
Ina2010study,4000IU/dayvitaminDwasgivenfor6monthstoinsulinresistantand
vitaminDdeficientSouthAsianwomenaged2368years.Insulinresistancewasreduced,
andtheeffectwasgreatestamongthosewhoachievedhighervitaminDbloodlevels,inthe
3248ng/mlrange(whichisstillconsideredinsufficientaccordingtotheVitaminDCouncil).
Interestingly,noeffectwasseenoninsulinsensitivityafter3months,butasignificant
improvementwasnotedafter6months,eventhoughtherewasnochangeinvitaminD
bloodlevelsbetweenthosetimepoints.ThismayindicatethatvitaminDmayneed
sufficienttimetoworkitsmagicagainstinsulinresistance.[14]
Intype2diabetics,dailyintakeofavitaminDfortifiedyogurtfor12weeksledtoimproved
bloodsugarstatus.ThiswasnotseenwithayogurtwithoutaddedvitaminD.[16]
Generally,itseemstomethat:
VitaminDsupplementationleadstobetterresultsamongthosewithlowervitaminD
levels(thisseemslogical,too).
Thosewithinsulinresistanceorbloodsugarproblemsmaybenefitmorethanthe
healthypopulation.
LowerdosesofvitaminDmaybeinsufficient.Somestudiesthatfoundnoeffectof
vitaminDuseddosesinthe400800IU/dayrange.
BloodlevelsofvitaminDshouldprobablyberaisedto40ng/mlormoretobe
effective
VitaminDsupplementationissafeandwelltolerated,butshouldnotbeexcessive
sinceitcanbedangerous
Large,singledosesmaynotbeasgoodaslower,dailydoses.Large,singledosesmay
evenbeharmful.
Asstatedbefore,nooneknowstheoptimalvitaminDlevelsyet.Moreresearchisneededon
thissubject.However,ItendtoleantowardstheopinionoftheVitaminDCouncil,which
recommendsbloodlevelsofvitaminDbekeptabove50ng/mlyearround,foradultsand
children.Theriskofsideeffectsinthe5080ng/mlseemssmall,andthepotentialdangersof
lowervitaminDlevelsseemfarworse,tome.
57
Whatwecansaywithcertaintyisthatnoone,especiallynotsomeonesufferingfrominsulin
resistance,shouldbevitaminDdeficient.Therefore,everyoneshouldhavevitaminDlevels
above20ng/mlattheveryleastandabove30ng/mlaswell,sincethe2029ng/mlrangeis
consideredinsufficient[11].
YoullneedabloodtesttodetermineyourvitaminDlevelsandthistestiscalled25
hydroxyvitaminDor25(OH)Dnot1,25dihydroxyvitaminD.Askyourdoctortogive
youthistestandmakesureyougettherightone.
Thereare2differentunitsthatvitaminDbloodlevelsisreportedas,eitherng/mlornmol/l.
Toconvertng/mltonmol/l,simplymultiplyby2.5,andtoconvertnmol/ltong/ml,divideby
2.5.Thus,50ng/ml=125nmol/l.SupplementalvitaminDistypicallymeasuredinIU,
internationalunits.
TogetyourvitaminDlevelsup,therearebasically2options:sunlightand/orsupplements.
DietcanprovideabitofvitaminD,butnotverymuch.
ItsimpossibletogiveaonesizefitsallrecommendationforvitaminDsupplementation,
becauseyourneedswillvarydependingonyourage,bodyfatlevels,sunexposure,dietary
vitaminDintakeandsoon.AfterexperimentingwithdifferentvitaminDintakes,andblood
testsatregularintervals,youshouldknowyourdailydosetokeepyourselfintherangethat
youchoose.Adultswhowanttostayabove50ng/ml,probablyneedaround5000IU/day,
unlesstheyspendtimeinthesun.After8monthsof5000IUperday,andwithverylittlesun
exposure,myvitaminDlevelswere68ng/ml(171nmol/l).
Theformyouwantiscalledcholecalciferol,alsoknownasvitaminD3.Thisistheformyour
skinproducesnaturallyfromsunlight.Itiswidelyavailableasasupplement,andverycheap.
TheVitaminDCouncilhasagreatarticleonsupplementationthatIstronglyrecommendyou
read:http://www.vitamindcouncil.org/aboutvitamind/howtogetyourvitamind/vitamin
dsupplementation/
58
Chapter 5
Sleep and Insulin
Resistance
InourWesternsociety,sleepisviewedbymanypeopleasanecessaryevil.Sleepingfew
hourspernightisoftenseenasanadmirabletrait,anderraticsleeppatternsabound.Many
peoplevoluntarilyrestricttheirsleepinfavorofleisuretimeactivitiesorareforcedto
restrictthedurationorqualityoftheirsleepduetoworkorothercommitments.
Theconceptofsleepdebtisveryreal.Ifyouconsistentlysleeplessthanyouneedto,your
bodyandmindgetmoreandmoretired,resultinginastateofsleepdebtwhichcanbemore
orlesssevere.Aswewillsee,restrictingsleepforaslittleasonenightmayhaveanegative
impactonhormonelevels.
Moreover,didyouknowthatpoorsleepisactuallylinkedtooverweightandinsulin
resistance?
Theideathatyoucansleepyourselfthinandimproveyourinsulinsensitivitymayseem
toogoodtobetrue,butitsalmostcertainthatyoucansleepdepriveyourselffatand
sleepdepriveyourselfinsulinresistantbysabotagingyoursleep.
Thischapterwillhelpexplainhowsleep,bodyfatandinsulinresistancearelinked.
Background
NinetyyearsagoAmericanadultssleptanaverageof8hoursand46minutespernight
(reportedbycollegeagedadults).40yearsago,thatfigurehaddeclinedto7hoursand41
minutespernight.In2001,Americanadultsselfreportedsleepwasdownto6hoursand51
hours,accordingtoasurveybytheNationalSleepFoundation.
In2001,38%ofAmericansreportedsleeping8hoursperday,whereasin2009thefigure
haddeclinedto28%.
Furthermore,thepercentofworkerswhoreportsleepinglessthan6hourspernight,has
risenfrom24%to30%inthelast20years[21].Thechangesinsleepdurationareinfluenced
59
byvariousfactorsincludingenvironmentallight,tryingtogetmoreworkdone,nightshift
workandspendingtimewatchingtelevisionorontheInternet[19].
Whilethishashappened,ourneedforsleephasprobablynotdeclined.Severalstudieshave
investigatedthepossiblehealthconsequencesofshortorlongsleepduration.
Studies on sleep and insulin resistance

Anassociationbetweenshort(andlong)sleepdurationandinsulinresistance,aswellas
type2diabeteshasbeenclearlydemonstrated.Sleepdeprivationisalsoassociatedwith
obesityasevidencedbydatafromseveralstudies[10][14][19].Thereisalsoevidencethat
pointstosleepdisorderedbreathing,i.e.difficultybreathingduringsleep,beingassociated
withinsulinresistance[1][13][16][17].
Researchershavetestedunderwellcontrolledconditionshowshorttermsleeprestriction
affectsbloodsugarcontrolandinsulinsensitivity.
Inonestudy,elevenhealthy,sedentaryadults,fivemen&sixwomen,withanaverage
normalsleepdurationof7hourspernight,completedtwo14dayperiodsofeither8or5
hourbedtimeswhiletheywereallowedtoeatfreely.Theshorterbedtimeledtoreduced
insulinsensitivityandhigherbloodsugarafteraglucosetolerancetest,i.e.worseblood
sugarcontrol.[11]
Thesecondstudyfoundthatonesinglenightofpartialsleepdeprivationcancauseinsulin
resistance.Theresearchersexamined9healthyindividuals,fivemenandfourwomen,after
onenightofnormalsleep(approximately8hourstimeinbed)andafteronenightoffour
hourstimeinbed.Resultsshowedthatsleepdeprivationdisruptedtheparticipantsblood
sugarregulation,leadingtoaslowerabilitytolowerbloodsugar,aswellasanincreased
endogenous(i.e.insidethebody)glucoseproductionandareductionofinsulinsensitivityof
1925%.Noeffectwasseenoncortisollevels.Theirfindingssuggestthatjustonenightof
poorsleepcanmakeotherwisehealthyindividualstemporarilyinsulinresistant.[4]
Thestudywasmoreorlessreplicatedbythesameresearchers,butwithtype1diabetics
insteadofhealthypersons.Theresponseamong7patients3menand4womentoone
nightof4hourstimeinbed(3hours42minutesactualsleep)weresimilar:decreasedrate
ofglucosedisposalanddecreasedinsulinsensitivity[5].
Afourthstudy[2]examinedtheeffectsofoneweekofsleepdeprivationinhealthymen,
andtestedifthenegativeeffectsofsleeplosscouldbecounteredwiththemedicaldrug
modafinil.Modafinilisaprescriptiondrugthatimprovesalertnessduringthewakingstate.
Thehypothesisbeing,Iguess,thatthenegativeeffectsofsleeplossmightbecounteracted
byadrugthatincreasesalertness.
Twentyhealthymenwereinvolvedinthestudy,andwerefirstallowedtosleepuntilfully
rested,afterwhichtheyweresleepdeprivedforoneweek(7days)with5hourspernight
timeinbed.Duringdaytimeunderthesleepdeprivedcondition,theparticipantsweregiven
eithermodafinilorplacebo.Itturnedoutthatmodafinildidntdomuchtooffsetthe
60
negativeeffectsofsleeplossonbloodsugarcontrol.Onceagainitwasfoundthatshortterm
partialsleeprestrictionsignificantlyreducesinsulinsensitivityandglucose[carbohydrate]
tolerance.
Studiesonthelongtermeffectsofsleephavefoundsimilarresults.Althoughstudiesshow
thatadultsgettinglessthan7hoursofsleepeachdayhaveanincreasedriskofinsulin
resistance,therearealsostudieswhichsuggestsleepingmorethan9hoursperdayis
associatedwithincreasedriskofinsulinresistanceanddiabetes.
Arecentstudyfoundthatthosewhoreportedsleeping910hoursperdayhada58%
increasedriskofdiabetestype2orimpairedglucosetolerance(IGTcharacterizesa
prediabeticstate)comparedtothosewhoslept78hours.Thosereporting56hoursof
sleephada109%increasedrisk.[3]Itwasfoundthatshortsleepersweremoreinsulin
resistantthanlongsleepers.Theresultsalsoshowedthat3hoursafteranoralglucose
tolerancetest,bloodsugaramongthosereporting56hoursofsleepfelltoexcessivelylow
levels.InplainEnglish,suchaneffectmaytriggeranepisodeoflowbloodsugar3hoursafter
amealamongshortsleepers,whichmayleadtorenewedhungerandeating.
Inthesamestudy,fastinginsulinlevelswerelowestwith78hoursofsleep,followedby9
10andthen56,whichhadthehighest.ThesamewasseenintheHOMAIRIndex(a
measureofinsulinresistance;lowerisbetter),andfastingbloodsugarconcentrations.So
thosewhosleptanormalamount(78hours)hadtheleastinsulinresistance.
TheNursesHealthStudyandtheMassachusettsMaleAgingStudy,bothdemonstratedthat
menandwomenwithshortorlongselfreportedsleepdurationcomparedtonormalhad
asignificantincreaseindiabetesrisk[10][19].
Inwomen,theNursesHealthStudyfoundaUshapedrelationofsleeptimeanddiabetes.
70026nurses,whowerefreeofdiabetesansweredquestionnairesabouttheirhealth,
includingtheirdailysleepduration.Tenyearslater,1969ofthemhaddevelopeddiabetes.It
wasfoundthatbothalongandshortselfreportedsleepdurationpredictedanincreased
riskoftype2diabetestenyearslater.Moreshiftworkwasreportedamongthenurseswho
sleptless.
TheMassachusettsMaleAgingStudyconfirmedtheseresultsinmen.Alargenumberofmen
whowerefreeofdiabetesatthefirstyearwerefollowedfor15years.Thedatashowedthat
menwhoselfreportedasleepdurationoflessthan5orlessthan6hourspernightwere
twiceaslikelytodevelopdiabetescomparedtomenwhoreportedsleeping7hoursper
night.Interestingly,italsoshowedthatmenwhosleepmorethan8hourspernighthave
morethanthricetheriskfordiabetescomparedtomenreporting7hoursofsleeppernight.
[19]
Severalstudiesonchildrenhavefoundthatshortsleeppredictsbeingoverweightsome
yearslater[9].Excessweight,ofcourse,isamajorriskfactorforinsulinresistance.
61
Onestudyfoundthatextremesofsleepareassociatedwithinsulinresistanceandobesity
amongminorities,i.e.AfricanAmericans&Hispanics,butonlyinthoseunder40yearsofage
(inthisparticularstudy).[7]
ItwasfoundthatAfricanAmericansandHispanicsyoungerthan40whohadreportedless
thanorequalto5hoursofsleepormorethanorequalto8hoursofsleepperdayhad
increasedvisceralfat,subcutaneousfat,bodyweightandinsulinresistance5yearslater.
Thosereporting5hoursofsleeporlessperdayhadhighercaloricintake.Shortsleepwas
associatedwithworseoutcomesthanexcessivelylongsleepinthisstudy.
InthesocalledSleepHeartHealthStudy,itwasfoundthatmenandwomensleeping9
hoursormorepernightor6hoursorlesspernightbothhadincreasedriskfordiabetesand
impairedglucosetolerance(prediabetes)[6].inthisstudy,participantswere5393yearsold,
indicatingthatshortandlongsleepmaybeariskfactorforinsulinresistanceeveninthe
olderpopulation.
Takentogether,thesestudiesclearlyshowthatshortsleepcanleadtofatgain,increased
appetiteandinsulinresistance.Longsleepisanotherissue,aswelldiscusslaterinthis
chapter.
Quality of sleep matters

Durationofsleepisnottheonlythingthataffectsbloodsugarcontrol.Asitturnsout,sleep
qualityalsomatters.
Inanexperimentconductedin2008,theeffectsofsocalledsleepfragmentationwere
studied,i.e.sleepdurationwasmaintainedfornormalhoursbutsleepqualitywasreduced.
Specifically,deepsleepwasinterruptedbyplayingsoundsofvaryingfrequenciesand
intensitiestoreplacedeepsleepwithshallowsleepforthreenightsinarow.Resultsshowed
thatasdeepsleepwasreplacedbyshallow,insulinsensitivitydecreased.Inotherwords,
reducedsleepqualitycancauseinsulinresistance[20].
Moreover,anothersleepfragmentationexperimentshowedthatfragmentedsleep
negativelyaffectsbloodsugarcontrolinhealthyvolunteersevidentbyareductionofinsulin
sensitivityandglucoseeffectivenessby20to25percent.[15]
Inthatstudy,participantswereallowedtheirnormalbedtimes,onaverageatleast7hours,
sototalsleeptimedidnotchangecomparedtonormalconditions.However,sleepwas
fragmentedtwonightsinarowbyuseofsoundsandvibrationsofthebeds.Thisledto30or
moresocalledmicroarousalsperhour.Afterthistreatment,insulinsensitivity
decreasedby25%andmorningcortisollevelsincreasedby12.5%.
62
A word about sleep disordered breathing

Sleepdisorderedbreathingcanbedefinedasdisturbedbreathingduringsleep.Itisoften
seenamonginsulinresistantindividuals.
Onetypeofsleepdisorderedbreathingiscalledobstructivesleepapnea(OSA),acondition
characterizedbyfrequentpausesofbreathduringsleep,whichdisruptsleepquality,
althoughdonotusuallyleadtoawakening.
Onestudy[1]foundthat77%ofdiabeticshadobstructivesleepapnea,andthattheworse
theirsymptomsofOSA,theworsetheirdiabetes.Anotherstudy[24]estimatedthat86%of
obesetype2diabeticshaveOSA.ThosewithOSAareonaveragemoreoverweightandolder
withagreaterwaistcircumference.Themajorityofcasesareundiagnosedanduntreated.
Itstypicallymen,asopposedtowomen,thatsufferfromsleepapneaandsleepapneicmen
havesignificantlyhigherlevelsofintraabdominalfatcomparedtoobesemenwithoutsleep
apnea.Onestudyfoundthatapneicshave50%morevisceralfatcomparedtononapneics
withthesameBMI[18].Womentendtohaveahigherbodyfatpercentageoverall,buta
lowerwaistcircumferenceandalowerwaisttohipratio[3].Waistcircumferenceisclosely
correlatedtotheseverityofOSA.
Obstructivesleepapneaisgradedaccordingtoitsseveritybythesocalled
apnea/hypoapneaindex,whichisthesumofthenumberofapneaandhypoapneaevents
thepersonexperiencesperhourofsleep.Apneaistypicallydefinedasacomplete
cessationofairflow(thepersonstopsbreathing)for10secondsorlonger,while
hypoapneaisdefinedasa50%orgreaterreductioninairflowfor10secondsorlongerora
discerniblereductioninairflowaccompaniedeitherby
adecreaseinoxyhemoglobinsaturationofmorethan3%(areductionintheoxygen
contentoftheblood)
anarousal.
SleepapneicscanhaveanAHI(apnea/hypoapneaindex)of5to50ormoreeventsperhour.
Hypothetically,theseeventsofdisturbedsleepinapneicsmightaggravateinsulinresistance
iftheyleadtoarousals/microarousals,sincequalityofsleepwouldbereducedleadingto
decreasedinsulinsensitivity.Sleepapneaisalsoassociatedwithdaytimesleepinessand
fatigue,possiblyindicatingthatnighttimesleepqualityisreducedinindividualswithOSA.
Itishardtoseparatecauseandeffecthere.ItseemstomethatvisceralobesitycausesOSA
aswellasinsulinresistanceinsomeindividuals.ButonceOSAhasdeveloped,itmayhave
additionaldetrimentaleffectsonapersonsinsulinsensitivity.
Whattodoaboutit?A2009study[25]showedclearlythatweightlossleadstosignificant
reductionsintheseverityofOSA,andinmanycasestocompleteremissionofthedisorder.
Therefore,itseemsthatexcessfatcausesOSAandinsulinresistance,andlosingfathelps
reversebothconditions.Nevertheless,OSAmightstillexacerbateinsulinresistance.
63
How does short sleep cause insulin resistance?

Anumberofmechanismshavebeensuggestedtoexplainhowshortsleepdurationcauses
insulinresistance.Innoparticularorderofimportance,theyare:
Shortsleepmaydecreasespontaneousphysicalactivityduetolowenergylevels.
Inactivityinturnmayleadtofatgainandobesity,whichcauseinsulinresistance.
Furthermore,asedentarylifestylepersemayreduceinsulinsensitivityeveniffat
gaindoesnotoccur.
Shortsleepmaycausefatgainduetoovereating,causedbymultiplemechanisms.
Appetiteisinfluencedbyanumberoffactors,twoofwhicharethehormonesghrelinand
leptin.
Ghrelinisahungerhormonereleasedbythestomach.Leptinisasatietyhormone
releasedbyfatcells.
Sufficientsleepseemstohelpkeepghrelinlevelsdown,atnormallevels.However,sleep
deprivationorfragmentationorlowqualitysleep,cancausethelevelsofghrelintoremain
elevated,signallinghunger.Sleepdeprivedindividualshaveincreasedappetite,which
essentiallyleadstoweightgainandobesity[9].
Arecentcarefulreviewofthesubject[17]reportedthatleptinlevelsamongmaleyoung
adultswere19%lowerafter6daysof4hourtimeinbedthanafter7daysof12hourtimein
bed,eventhoughenergyintakeandenergyneedswerethesame.Wecouldexpectthatto
translatetoincreasedhungeramongtestsubjectsafterthe6daysof4hourbedtimes.
Experimentalstudiesconsistentlyshowadecreaseofleptinandanincreaseofghrelinafter
sleeprestrictionforseveralnights.Takentogether,thechangeinthesehormonescausea
signaltoovereatevenwhenthereisnoreasonto.Moreover,mostlongtermstudieshave
foundanassociationbetweenshortsleeptimeandgreatersubsequentweightgainsome
yearslater,asreportedbyVanCauter[17].
Othermechanisms,apartfromghrelinandleptinmayalsobebehindthetendencyofshort
sleeperstoovereat.
InastudypublishedintheAmericanJournalofClinicalNutrition[12],researcherstestedthe
effectsofsleeprestrictiononvoluntaryfoodintake.Elevenhealthypersons,5women&6
men,slightlyoverweight(BMI26.5)withameanageof39yearscompletedtwo14daystays
inasleepresearchlaboratorywheretheyhadunlimitedaccesstotastyfoodandsnacks.
Theywereallowed5or8hoursinbed,respectively,onthetwooccasions.Theyslept122
minuteslesswiththeshorterbedtime.Foodintakefrommealswassimilar,butshorter
sleepledtoincreasedintakeofsnacksandahighercarbohydratecontentofsnacks.There
wasnosignificantincreaseinphysicalactivitywiththeshorterbedtime,meaningthata
shortsleepdurationinanobesitypromotingenvironmentcouldleadtofatgain.However,
therewasnodifferencebetweenthetwobedtimeconditionsintheamountofghrelinand
64
leptin,suggestingthatsomeotherreasonwasresponsiblefortheincreasedfoodintake
fromsnacks.
Tobefair,thegroupasawholegainedweightevenwiththelongerbedtime,justnotas
muchaswiththeshorterbedtime.Thereasontheshorterbedtimeledtoalargercalorie
consumptionmayhavebeensimplybecausetheparticipantshadmoretimetosnack,the
researchershypothesized.
Whateverthereason,thestudyshowedthatshortersleepfor14daysledtoincreased
energyconsumptioninanenvironmentthatallowsforinactivityandunlimitedaccessto
foodandsnacks,whichareprettyrealisticlivingconditionsformanypeople.
Ithasalsobeensuggested[3]thatshortsleepmayleadtoareactivehypoglycemicresponse
aftereating(bloodsugarfallsverylowafewhoursaftereating),somethingthatmayleadto
hungerandovereating.
Shortsleepmayincreasecortisollevels
Elevatedcortisollevelsdirectlycauseinsulinresistance[23],andcortisolmightalsoleadto
increasedintraabdominalfat,whichfurtherpromotesinsulinresistance.Changesincortisol
duetosleeprestrictionhavebeenmixed,withsomefindingincreasedlevelswhileothers
havefoundnochanges.
Aswecansee,therearemanywaysthatshortsleepcancontributetoinsulinresistance.
However,sleeprestrictionintheshorttermrarelyaffectsbasallevelsofinsulin&blood
sugar,ratherpostprandial(afteryoueat).Therefore,theeffectsofsleeprestrictionmaynot
showupifyoujustmeasureyourfastingbloodsugarorfastinginsulinlevels.Butinastate
ofsleepdebt,yourpostmealbloodsugarand/orinsulinlevelsmaybeelevated(asignof
insulinresistance)comparedtoafullyrestedstate.
Does long sleep cause insulin resistance?

Although,studiesshowthatadultsgettinglessthan7hoursofsleepeachdayhave
increasedriskofinsulinresistance,therearealsostudieswhichshowthatsleepingmore
than89hoursperdayincreasesriskforinsulinresistanceanddiabetes.
TheNursesHealthStudyandtheMassachusettsMaleAgingStudybothdemonstratedthat
menandwomenwithshortandlongselfreportedsleepdurationhadasignificantlyhigher
riskofdiabetes[10][19].Specifically,theMMASfoundthatmenwhosleepmorethan8
hourspernighthavemorethanthricetheriskfordiabetescomparedtomenreporting7
hoursofsleeppernight[19].
IntheQuebecFamilyStudy,itwasfoundthattheriskofdevelopingtype2diabeteswas
higheramongpeoplewhosleep9to10hoursperdaycomparedtopeoplewhosleepfor7
to8hours.Thisassociationwasnotexplainedbyotherfactorsmeasuredbesidessleep.[3]
IntheSleepHeartHealthStudy,itwasfoundthatmensleepingmorethan9hourspernight
haveincreasedriskofdiabetesandimpairedglucosetolerance[6].Thefindingsofthese
65
studiessuggestthatbothshortandlongsleepdurationisariskfactorfordiabetes(andby
extension,insulinresistance)inmen.
However,noplausibleexplanationhasbeenofferedtoexplainwhylongsleepduration
wouldcauseinsulinresistance.
Wehaveseenthatsleepdisorderedbreathingsuchasobstructivesleepapnea(OSA)
reducessleepqualityandcouldthereforeleadtolongersleepdurationtocompensatefor
thereducedquality.OSAseemsinlargepartcausedbyvisceralfat,somethingthatisnot
easytopickuponbymeasuringBMI.
Therefore,itcouldbethatpeoplewithvisceralfatsleeplonger,butwithreducedquality
becauseofsleepdisorderedbreathing,andhaveagreaterriskofdevelopinghighblood
sugarnotbecauseoftheshortsleep,butbecauseofthevisceralfat.Thiswouldshowupin
populationlevelstudiesaslongsleepleadstodiabetes,whilethatisnotproven.
Longsleepisalsoassociatedwithdepressionwhichcommonlyprecedesweightgain.So
maybesomepeoplearedepressed,sleepalot,eatalotandsubsequentlygainweightwhich
causesillhealthandinsulinresistance.
AsfarasIknow,thereisnoevidenceatthistimethatvoluntarilyrestrictingsleepwouldlead
toimprovedinsulinsensitivityordecreasedappetite.
How much should you sleep?

Topreventthenegativeeffectsofshortsleepduration,theNationalSleepfoundation
recommendsthatadultssleep79hourspernight.Toddlers,accordingtotheNSF,require
11hourspernightplusa2hournapeachday.Preschoolersneed1112hours/daywhile
schoolchildrenshouldget10hoursofsleeppernightandadolescentsshouldget9.
Themostprudentcourseofactionrightnowistosleepasmuchasyourbodyrequires.Itis
probablyimpossibletooversleep,sinceextendingbedtimesbeyondwhatyourbodyneeds
doesnotcauseyoutosleepmore.Forinstance,ifyouspend12hourspernightinbedbut
youonlyrequire8hoursofsleeppernight,youwillonlysleep8hours,not12.
Ifyouvebeenknowinglyrestrictingsleep,youshouldmakeitaprioritytosleepmore.
Compensatingshortsleepduringtheweekdaysbysleepinglongerontheweekendsisntthe
bestsolution,either,asitcanmakefallingasleepharderwhenyoureconstantlychanging
bedtimes,andyoudbespendingalotofyourlifeinastateofsleepdebt.Ifyoudo
accumulateastateofsleepdebtoverthecourseofoneormoredaysorweeks,thatsleep
debtshouldberepaid.Howdoyourepayasleepdebt?Byallowingyourselftosleepuntil
youwakeupnaturallyforseveraldaysinaroworuntilyounoticesleepingshorterhours
despitelongertimeinbed.
Forexample,aftersomenightsof5hourssleeppernight,youmaysleep910hoursper
nightforawhilewhenyouallowyourselfunlimitedtimeinbed.Afterafewnights,your
66
sleepneedsmaydeclineto78hourspernight,indicatingthatthesleepdebthasbeen
repaid.
Ifyouhaveanysleepdisordersuchasinsomniayoushouldseekprofessionaladvicefroma
competentdoctor.
Ifyoufindyourselfsleepinganaverageofmorethan89hours,youmaywanttoexamine
yourlifeandseewhatthereasoncouldbe.Doyouhaveaphysicallydemandingjobor
exercisealot?OrcouldyoubesufferingfromanunderlyingconditionsuchasOSAor
visceralobesitythatcancauseexcessivelylong,butinsomecaseslowquality,sleep?Ifso,
thatconditionshouldbeaddressed.
How to sleep well

TheNationalSleepFoundationhasalistofproventipstohelpyousleepbetter:
http://www.sleepfoundation.org/article/sleeptopics/healthysleeptips
Additionaltipswouldinclude:
Losefat(especiallyifyouhaveexcessintraabdominalfat)
Makesleepapriority.Itsnotanecessaryevilthatshouldbeminimizedwiththeuse
ofcaffeineetc.Itsanimportantpartoflifeandhealthandyoursleepneedsshould
behonored.
Summary of findings
Insummary,researchersfoundthatshorttermsleeprestrictionforaslittleasonenight
causesinsulinresistance.Insulinresistancecanalsobecausedbyfragmentedsleep,i.e.poor
sleepqualityduetodistractionsuchassoundandlight,orpossiblysleepdisordered
breathing.
Byvoluntarilyrestrictingsleep,individualscanplacethemselvesatincreasedriskofinsulin
resistance,diabetesandobesity/overweight.
Theassociationbetweensleepandinsulinresistancehasbecomeincreasinglyimportantin
todayssocietysincemanypeopleoptforshortsleepdurationratherthanobtainingnormal
sleephours.AccordingtotheNationalHealthFoundation,adultsneed8hoursofsleepeach
day.ButAmericanadultsgetless.Thedecreaseinsleepdurationisobservednotjustin
adults,butinchildrenandadolescentsaswell[9].Thisshortsleepdurationandhabitual
sleepdeprivationlikelycontributestotheincreasedprevalenceofdiabetesintheWestern
world.Sleepdeprivationmediatesitseffectsthroughchangesinlevelsofappetite
hormones,increasedfoodintake,reductionofenergyexpenditureandpossiblychangesin
thelevelsofcortisolandotherfactors.
67
Theassociationbetweenlongsleepandsubsequentincreasedriskofdevelopingtype2
diabetesislikelyduetoothercauses,suchasvisceralfat,sleepdisorderedbreathing,long
butlowqualitysleep,ordepression.Noplausibleexplanationhasbeenofferedwhylong
sleepwouldleadtopoorerhealthoutcomes.Therefore,restrictingsleepisnot
recommended.
Morestudiesareneededtoseeifextendingsleeptimesleadstoimprovementsininsulin
resistanceandbodycompositionandoverallhealth,butfornow,itsprudenttohonoryour
sleepneedsinfull.
68
Chapter 6
Diet and Insulin
Resistance
Seemslikeyoucantopenabookabouttype2diabetes,insulinresistanceorthelike,
withoutasignificantpartbeingdedicatedtodiet.
WhileIwillgiveyoualotofusefultipsaboutdiet,Idisagreewiththeideathatdietary
qualityandcompositionaresupremelyimportantinreversinginsulinresistance.Thatvery
ideaisdangeroussinceitdivertsattentionfromtheotherstrategiesmentionedinthisbook,
whichusuallyaremoreimportant.
Thedifferencebetweenaninsulinresistantpersonandaninsulinsensitivepersonisrarely
dietaryqualityalone.Itsnotthatpeoplewithprediabetesortype2diabetesortheinsulin
resistancesyndromemakereallypoordietarychoices,whileeveryoneelseknowexactlythe
rightproportionsofmacronutrients,andpreparereallyhealthymealsfromscratchusing
onlythehighestqualityorganicallygrowningredients.No.Rather,thosewithinsulin
resistancetendtoconsume,orhaveconsumedinthepast,anexcessiveamountofcalories
coupledwithasedentarylifestylethatcanleadtonutrientdeficiencies,excessbodyfat,and
highironlevels.
Thatbeingsaid,dietaryqualitydoesaffectinsulinsensitivity!
Butasacounterweighttoallthosewhothinkthatcompositionofthedietissupremely
importantforreversinginsulinresistance,Imustcontendthat,inmostcases,itonlytakesa
backseattotheotherthingsmentionedinthisbook.Getridofexcessbodyfatandiron,
engageinenduranceandstrengthtrainingregularly,sleepwellandtakesomekey
supplementsandyouwillfindthatdietarycompositionandqualitydonotmatterasmuchas
youmaythink.
Entirebookshavebeenwrittenonthesubjectofmacronutrientcomposition(i.e.the
proportionofprotein,carbohydrate,fatsandalcohol(ethanol))ofthediet,withdifferent
authorsreachingdiametricallyopposedconclusionsfromthelowcarbcampassertingthat
insulinresistanceiscausedbycarbohydrateconsumptionandmustbeavoided,tothe
politicallycorrecthighcarbsemivegetarianlowfatcrowdwhichassertthatinsulin
resistancewillgoawaywithadietfocusedonwholegrainsandbeans.
69
I,too,usedtotrytofindtheoptimalinsulinsensitizingdiet,becauseIthoughtthatdiet
compositionwastheonlyimportantthingtobeinghealthy.ButInevergotridofmyinsulin
resistancewithdietalone.
Besides,evenifweknewtheoptimaldietforimprovinginsulinsensitivity,wouldwebeable
tomaintainit?Inmostcasestheanswerisno.Theproblemwithfaddiets,eventhosethat
aremorescientificallysound,isthattheyusuallyaskyoutomakehugedietarysacrifices.In
theend,ithasbeenshownthatcompliancewithlowcarbandlowfatdietsispoor,with
mostpeoplegraduallyrevertingbacktotheirbaselinediet,oftenafteronlyafewmonths.It
islittlewonder,becausethosedietsaskyoutoseverelylimitanentiremacronutrient,i.e.
carbohydrateorfat,whichisveryboringandconstraininginthelongrun.
Somecrusadersgoonsuchdietsandproclaimhowdelicioustheyare,howeveryoneshould
beeatinglowcarborlowfatorwhateverbecauseitssooohealthyandtastessooogood.
Ironically,whenabirthdaycelebrationorholidaycomesaround,thosepeoplearethefirstto
cheatbyeatingforbiddenfoods(carbohydrateorfat).Iftheirdietwassoawesome,whydo
theytakeabreakfromitthefirstchancetheyget?HmmMoreover,strictdietsarehardto
implementbecauseeatingatrestaurantsbecomesdifficultand,byextension,sodoes
travelling.
Itendedtostayinthelowcarbcampformanaginginsulinresistance,eatingwholefoods
suchasmeat,fish,eggs,vegetables,fats,andsomeberriesandfruit.Whenstartingona
lowcarbdiet,fromamixed,eatwhateverIfeltlikekindofdiet,Iimmediatelyhad
someimprovementsinmyIRrelatedsymptoms.However,thingssoonstoppedgetting
betterandsettledonanewstatusquo,whichwasbetterthanbefore,butfarfromperfect.
Ialsomadeexcursionstothelowfat,highcarbcamp,butthisworsenedmyinsulinand
bloodsugarimmediately.
Nevertheless,alowcarbdietnevercuredmyinsulinresistance.NotevenifIatealotof
superhealthyveggies,berries,wildsalmon,freerangeeggs,healthyfats,spicesetc.The
truthisthatIdidntstartmakingseriousprogressonimprovingmyinsulinsensitivityuntilI
placedLESSfocusondietandmorefocusonlosingfat,exercising,optimizing(lowering)my
ironlevelsetc.,i.e.thethingsthatIhavedescribedelsewhereinthisbook.
Inhindsight,Ithinkthatitwouldhavebeenimpossibleformetofindadietthatwouldve
curedmyinsulinresistance,inthefaceofhavingexcessbodyfatandironandasedentary
lifestyle,coupledwithvitaminDandmagnesiumdeficiencies.Isimplydonotthinkthatany
dietcouldhaveoverriddenthosenegativethings.
Again,beforeanyonequotesmeoutofcontext,dietisstillimportant!ButIviewitmoreasa
meanstoanend.Dietcanhelporhinderyoureffortstolosefat,optimizeironlevels,sleep
better,trainharder,anddietalsoaffectsyourneedforsupplements.
Itisimportanttounderstandthatwhiledietbyitselfrarelyreversesinsulinresistance,itCAN
helpminimizethenegativeeffectsofinsulinresistance.
70
Minimizing high post-meal insulin and blood

sugar levels by diet
Thisistheareawheredietreallyshines.
RememberintheintroductorychapterwhereIsaidthatchronicallyhighinsulinandblood
sugarlevelsarebad?Insulinandbloodsugarrisesfarabovefastinglevelsaftereating,but
howhightheyrisedependslargelyondietarycomposition.
Whileyoureinsulinresistant,itsimportanttoassistyourbodyinhelpingkeepyourinsulin
andbloodsugarlevelsinthenormalrangeaftereating,sincethesefunctionsareimpairedin
theinsulinresistantstate.
Tounderstandthefollowingitisnecessarytoknowabitaboutmetabolism.Pleasebearwith
me.
Whenapersoneatscarbohydrate,itwillbeconvertedtobloodsugarwhichwillstarttorise.
Insulinwillbesecretedfromthepancreasintothebloodstreamtohelpkeeptheblood
sugardowninthenormalrange.
Inaninsulinsensitiveperson,thecellswillrespondwelltoinsulinandthepancreaswillonly
havetosecreteacomparativelysmallamountintothebloodtoclearthebloodsugarfrom
thecirculation.Thus,therewillbeaanincreaseincirculatinginsulinANDbloodsugarlevels
aftereatingcarbohydrate.Butinsulinandbloodsugarwillsoonreachapeak(within1hour
ofeating,typically)andthendeclinetonormallevelswithinabout2hoursofeatingameal.
Thepeakswillbetransientandnotveryhigh
Inaninsulinresistantpersontheprocessissimilarbutexaggerated.Whentheinsulin
resistantpersoneatsthesameamountofcarbohydrateitwillalsobelargelyconvertedinto
bloodsugarandhisorherpancreaswillalsorespondbysecretinginsulininordertobring
downthebloodsugarlevels.However,sincethecellsinthispersonhaveabluntedresponse
toinsulin,thepancreaswillproduceandreleasemoreinsulintobringdownbloodsugar
levels.Sonowthispersonhasexcessivelyhighpostmealinsulinlevels,abadthing.Thiswill
neverthelesshelpbringbloodsugardown.However,beyondacertainseverityofinsulin
resistance,thecompensatoryhighinsulinlevelsarestillnotenoughtoquicklybringdown
bloodsugar,becausetheresponsetoinsulinissopoor.Theresultisexcessivelyhighinsulin
levelsANDhighbloodsugarlevelsaftereatingameal,whichtendtopersistforalongtime
(severalhours)aftereating.Inmanytype2diabetics,bloodsugarNEVERgoesbackto
normallevels.Itisalwayselevatedbecauseofinsulinresistance(andinadvancedcases,
poorinsulinsecretion).
Onceagain,itsnormalforinsulinandbloodsugarlevelstoincreasetogetheraftereatinga
meal.Butthisriseshouldbeaslowandshortaspossibleasinsulineffectivelydoesitsjobof
loweringbloodsugar.Thereafter,insulinandbloodsugarlevelsshouldgobacktotheir
normal,fastinglevelsagain.
71
Asyouimproveyourinsulinsensitivity,youwillhavemoreandmoreofanormal
carbohydratemetabolism.Sinceyourcellsrespondbettertoinsulin,lessinsulinwillbe
requiredtoloweryourbloodsugaraftereatingcarbohydrate,andyourbloodsugarlevels
willnotriseashighandwillreturntobaselinelevelsfaster.Thisisgreat.
Butwhileyouareinsulinresistant,youstillhaveaproblemwithcarbohydratemetabolism.
Andwhileyoureworkingonfixingthatproblem,itisbesttodecreasetheamountof
carbohydrateyoueat,becauseitistheprimarysourceofbloodsugarbloodsugar,inturn,
beingtheprimarydriverofinsulinsecretion.So,justbycuttingdownoncarbsyoucan
instantlyloweryourpostmealinsulinandbloodsugarlevels,whichisaverygoodthing.
Notethatwhilealowcarbdietreducespostmealinsulinandbloodsugar,andtherefore
leadstolowerdaylonginsulinandbloodsugarlevels,itdoesnotcuretheunderlying
problem:insulinresistance.Thisisthemistakethatmuchofthelowcarbcampismaking.
Theythinkthatcarbohydratecausesinsulinresistance,andalowcarbdietreversesinsulin
resistance.Nottrue.
Ifyouwereinsulinresistantbeforegoingonalowcarbdiet,youlllikelybeinsulinresistant
onalowcarbdiet,too.Butbyreducingcarbohydrate,theprimaryprecursor(i.e.building
block)ofbloodsugar,postmealbloodsugarandinsulinlevelswillbereducedeventhough
theinsulinresistantstatestillpersists[37].
Thisshouldalsoleadtoreducedsymptomsorprogressionofsymptomsofinsulinresistance.
Sincetheovertailmentscausedbyinsulinresistanceareactuallycausedbyhighinsulin
and/orhighbloodsugarlevels,goingonalowcarbdietwillinstantlyimprove(orslow
progressionof)complicationsofinsulinresistance,suchasdiabeticcomplicationsandmany
more.
Ihopethismakessensesofar.
Whenyoureducecarbohydrate,youlleitherhavetoincreaseproteinorfatorboth,oryou
canchoosenottoreplacecarbswithanything,whichwillcreateacaloriedeficitandleadto
weightloss.Ifyoudoreplacethemwithsomething,Idrecommendprimarilyprotein.
Forinsulinresistantpeople,thechangesseenwhenreducingcarbohydrateinfavorof
proteinarebeneficial.[5][15][16][19][21][22][27]Mealswithmoreproteinandless
carbohydratedonotelevatebloodsugarasmuchasmealswithmorecarbs[19][21],since
dietarycarbohydrateistheprimaryprecursor(buildingblock)ofbloodsugar.Astudythat
replacedsomecarbohydratewithproteinfoundatrendtowardsreducedinsulinresistance
withproteinandincreasedinsulinresistancewithcarbohydrate[5].Similarfindingswere
evidentinasimilarstudy[16].
However,proteinDOEScontributetoraisinginsulinlevelsafterameal.However,yourestill
aheadbyreplacingcarbohydratewithprotein,sinceyourbloodsugarwillatleastbebetter.
Dontbeafraidoffat,either,ifyouneedtoconsumemorecalories.Youknow,thatevil,
arteryclogging,cancercausing,insulinresistanceinducingnutrientthatwedieifwedont
72
eat.Fatdoesnotcausegreatelevationsofinsulinorbloodsugarandwillhelpkeepthosein
check.
Bygoingonamoderatetohighfat,highbutnotextremeprotein,reducedcarbohydrate
andcalorierestricteddiet,youllbecuttingoutmuchofthefuelthatdrivesinsulinand
bloodsugarlevels,whichwillleadtoimmediateimprovementsinbloodsugarandinsulin
levels.
Inonestudy,whencarbohydratewas40%ofcaloriesandfatwas45%comparedto60%
carbsand25%fat,fastinganddaylonginsulinlevelsweresignificantlyreducedonthe
higherfatdiet[24].
Again,Imuststressthatthiskindofdietwillnotnecessarilyreversethecellularmechanism
ofinsulinresistanceperse(though,itmighthelpwiththat),butitwillsidesteptheproblem
ofhighinsulinandbloodsugarwhicharetherealculpritsbehindtheSYMPTOMScausedby
insulinresistance.
AndImnotsayingthiskindofdietisperfect,northatyoushouldstayonitfortherestof
yourlife.Rather,Iviewthiskindofdietasanecessaryevilthatpeoplewithinsulin
resistanceshouldadheretowhilefixingtheotherproblemsthatarethetruecauseofinsulin
resistance.
Sowhileyoureonthisdiet,youneedtoworkonimplementingtheotherstrategiesinthis
book,mentionedinchapters15.Then,onceyourinsulinsensitivityisrestored,youllbe
abletoeatmorecarbohydratebecauseyouwillbeabletotolerateitbetter.Butwhile
youreinsulinresistantyoudonotprocesscarbohydrateandproteinoptimally,andwould
benefitfromreducingatleastcarbohydrates.
ThereasonIstillrecommendahighproteindiet,eventhoughdietaryproteindrivespost
mealinsulinlevelsup,isthatproteinismusclesparingandverysatiating(causesafeelingof
fullness)whicharebothveryhelpfulwhenattemptingtolosefat.[19][22]
IhopeIhavemademystanceclear.LetslookatsomemoreevidenceforwhatIhavebeen
saying.
A2009metaanalysisanalyzedtheresultsofstudiesexaminingtheeffectofdifferent
proportionsoffatandcarbohydrateontype2diabeticpatients,whileproteinwasheld
constantandenoughcalorieswereprovidedtomaintain(notlose)bodyweight.Outof2203
potentiallyrelevantpublications,19wereselectedthatmetthesecriteria.Theywere
dividedintolowfathighcarb(LFHC)vs.highfatlowcarb(HFLC).TheLFHCdietswere58%
carb24%fat,whiletheHFLCdietswere40/40.Aswecansee,thesesocalledhighfat,low
carbohydratedietscontained40%carbohydrate,whichisnottypicallyconsideredlowcarb
atall.
Nevertheless,itwasfoundthattheLFHCdietsincreasedfastinginsulinlevelsby8%,
increasedtriglyceridesby13%andloweredHDLcholesterolby6%comparedwiththeHFLC
diets.Itwasconcludedthatreplacingfatwithcarbohydratecoulddeteriorateinsulin
73
resistance.Postmealbloodsugarandinsulinlevelswerealsoworsewiththelowfathigh
carbdiet.Whencarbohydratewasmorethan60%ofthedietandfatlessthan20%,the
increaseinfastinginsulinlevelswasevenmorepronounced(17.1%).[1]
Thisispreciselymycontention,sinceitsobviousthatincreasedcarbohydratewillleadto
increasedpostmealbloodsugarsandinsulinlevels[37].Butitdoesntmeanthatcarbsin
andofthemselvesarebad,justthatinsulinresistantpeople(e.g.type2diabetics)dobetter
byrestrictingthem.Thismetaanalysis,though,excludeddietshighinfiber,whichmayhave
separate,positiveeffectsoninsulinsensitivity.Therefore,highcarb,highfiberdietsmaydo
betterthanthehighcarbdietsinthecurrent[1]metaanalysis.Nevertheless,itcouldalso
betheorizedthatadditionalbenefitswouldbederivedfromrestrictingcarbohydrates
further,i.e.lessthantheaverageof40%inthelowcarbtrialsinthismetaanalysis.
Do I have to eat low-carb?

No,butitshouldbequitebeneficialtodosowhileyoureinsulinresistant.
Typically,almostanydiet,regardlessofdietarycomposition,thatisrestrictedincaloriesand
leadstosufficientbodyfatlosswillimprovebloodsugarandinsulinsensitivityrelated
markers[10][25][35][54].Typically,themorebodyfatislost,thegreatertheimprovement
ininsulinsensitivity.Also,weightlosstendstoimprove(reduce)bloodpressureindependent
ofdietcomposition[35].
Thereisalsoevidencethatcalorierestrictionimprovesbloodsugarlevelsevenbefore
significantweightlossoccurs[25][35].Inaslittleas12weeksofcalorierestriction,blood
sugarcanfallsubstantially.
Theabovenotwithstanding,thereisanabundanceofevidencethatlowcarbdietsaremore
favorableforinsulinresistantpeopleandoftenproducegreaterspontaneousweightloss
andmorefavorableeffectsonbloodsugarcontrolandinsulinsensitivityorotherinsulin
resistancesyndromeabnormalitiesoften,butnotalways,aboveandbeyondtheeffectsof
weightlossperse.[1][3][4][5][7][8][9][11][12][13][14][16][17][18][19][20][21][22]
[23][24][27][28][29][30][31][32][33][35]
Whendiabeticswereplacedonacalorierestricted25%carbohydratedietfor8weeks,their
HbA1candfastingbloodsugarfellsignificantly(from262mg/dlto172mg/dlindiabeticsnot
treatedwithmedications).Nineteenpatientsweretakingoralmedicationsagainstdiabetes
andeveryonecoulddiscontinuethem.Whentheyweresubsequentlyplacedona55%
carbohydratediet,theirbloodsugarcontroldeterioratedagain.[28]
Inastudyonobesesubjects,halfwereassignedtoa15%carbohydratedietwhichreduced
fastingbloodsugarby17%andfastinginsulinby46%.Theotherhalfwereassignedtoa45%
carbohydrateanddietwhichreducedtheirfastingbloodsugarby7%butdidnot
significantlyreducetheirfastinginsulinconcentrations.[30]Againthelowcarbdietwon.
Manypeoplefinditeasiertoreducecaloriesspontaneouslyonacarbrestricteddiet.[6][7]
[8][9][14][18][22]Proportionsofprotein,carbohydrate,fatandalcoholdonot,however,
74
determinefatloss;thecaloriegapdoes[35].Butthismaybeeasiertoachieveonalowcarb
diet.
Popularlowcarbdiets,suchasAtkins,maybelowinsomevitaminsandmineralssuchas
vitaminE,A,thiamine,B6,folate,calcium,magnesium,iron,potassiumandfiber[35],while
lowfatdiets(2030%)maybedeficientincalcium,iron,zinc,magnesium,iron,vitaminB12
andfiber[35].However,withamorereasonableapproachtocarbohydraterestrictionthan
Atkins,adequatevitaminandmineralintakeispossibleonalowcarbdiet.
Awordofwarningaboutlowcarbdiets,though:Theycanleadtoshorttermimpaired
glucosetolerancebecausecarbohydrateisbettermetabolizedagainstahighcarb
backgrounddiet[23][26]butthisisnotalwaysfound[33].However,inonestudy[26],after
consumingalowcarbdietfor1dayfollowedbyanOGTT,bloodsugarsweremuchhigher
comparedtoanOGTTafterahighcarbdietfor1day.Whensubjectswentbacktothehigh
carbdiet,noneofthemhadhighbloodsugaranymoreafteranOGTT.
Exercise and carbohydrates

SinceIhaverecommendedbothexerciseandcarbohydraterestrictioninthisbook,Ithought
Idcommentonthat.Thereisnodoubtthatexerciseperformance,especiallyintense
endurancetraining,isimpairedwheneatingaloworrestrictedcarbdiet.Itsalsomore
difficulttobuildmusclemass.
However,gettingthroughstrengthtrainingsessionsdoesnotrequirealargeamountof
carbohydrateperse,duetothenatureofstrengthtraining.Endurancetrainingrequires
morecarbohydrate.Itcanbeperformedonalowcarbdiet,butperformancewillbe
impaired.Strengthtrainingaswellasendurancetrainingimproveinsulinsensitivity,and
immediatelyaftertrainingtemporarilyactivatemechanismsthathelptransportbloodsugar
intothemuscleswithoutuseofinsulin.
Ifyoureexercisingalot,especiallyendurancetraining,youcangetawaywitheatingmore
carbohydrate,becauseyourinsulinsensitivitywillbeheightenedcomparedtoasedentary
state.However,youmaystillbeinsulinresistant,forexampleifyouhaveexcessbodyfator
ironlevels,andexercisemaynotbeenoughtocompensateforthat.
So,whileyoureinsulinresistantitsbesttorestrictcarbsevenifyoureexercisingregularly,
asIrecommend.Yes,performancewillbeimpaired,butitsthepriceyoupaywhileyoure
insulinresistant.
Asyouworkonimprovingyourinsulinsensitivity,youlleventuallygettothepointwhere
youcaneatmoreandmorecarbswithoutraisingyourinsulinandbloodsugarlevels
excessively,butwhileyoureinsulinresistantIrecommendyourestrictcarbs,evenwhile
workingoutregularly.
Youcantautomaticallyassumethattheimprovedinsulinsensitivityfromexercisewilllet
youeatunlimitedcarbohydrate,sinceyoumaystillbeinsulinresistantduetoothercauses
(e.g.iron,bodyfat)evenwhileworkingoutregularly.
75
High-carb, high-fiber diets (HCF diets)

Highcarbohydrate,highfiberdiets(HCF)havebeensuggestedbysomeasthetreatmentof
choiceforinsulinresistantpeople[39].Whendiabeticsweregiveneithera70%
carbohydrateand70gramfiber/daydiet(veryhighfiber)ora39%carbohydrateand10
gramfiber/daydiet,theHCFdietproducedincreasedinsulinsensitivitycomparedtothe
lowcarbdiet.Thedietsweredesignedtobeweightmaintenancedietsidenticalinenergy,
sotheseresultsoccurredwithoutsignificantweightloss[38].Inasimilarstudy,insulinusing
type2diabeticsplacedona70%carbohydrate,65gfiber/daydietforaround16dayscould
discontinueorreducetheirinsulintherapywhileimprovingormaintainingtheirbloodsugar
levels.Thepatientswereweightstable.Muchofthefiberinthisstudycamefromwhole
grainsandbread,but40%camefromvegetablesandfruit[40].
Somediabeticstreatedwithsuchadietwithoutweightlosscanreduceordiscontinuetheir
diabetesmedicationsorinsulin,andimprovetheirfastingandpostmealbloodsugar.In
otherwords,aHCFdietapparentlyimprovesinsulinsensitivity[39].Improvedbloodsugar
controlisreportedlymaintainedonadietwith5560%carbohydrate,1520%protein,20
30%fatand25gramsoffiberper1000calories.
Highcarbhighfiberdietsdonotleadtohightriglyceridelevels.Highcarbhighfiberdiets
leadtodecreasedinsulinandbloodsugariftheyareenergyrestricted.[35]
Theseresults,whileimpressive,areprobablynotattributabletothehighercarbohydrate
contentorlowerfatcontent.Whenhighorlowcarbdietswithouthighfibercontentwere
comparedindiabetics,itwasfoundthatlowcarbdietsweresuperior[1].Onlywhenlotsof
fiberisaddedtoahighcarbdietcanitbegintocompetewithalowcarbdietforinsulin
resistantindividuals.
Itisnosecretthatconsumptionoffiberrichfoodscanhavepositiveeffectsagainstdiabetes,
suchasimprovedinsulinsensitivityandbloodsugarcontrol[49][50]by,forexample,
slowingdowndigestionandleadingtolowerpostmealbloodsugar[41].Moreover,
consumingfiberprovidesnutritionforbacteriainthecolonthatdigestthefiberandturnit
intoshortchainfattyacids(i.e.fats)suchaspropionate,butyrateandacetate,whichmay
thenbereabsorbedintothebloodandleadtobeneficialeffectsagainstdiabetes[41].
Resistantstarch,akindofinsolublefiber,hasbeenfoundtoimproveinsulinsensitivity[45]
andreducepostmealbloodsugarandinsulinwhencombinedwithbetaglucan(afood
constituentfound,forexample,inoats).[46]
Thismayhavebeentheprocessesatworkbehindtheapparentsuccessofthesehighcarb,
highfiberdiets.Other,unknownprocessesmayalsoberesponsiblefortheapparentinsulin
sensitizingeffectsofinsolublefiber[41].Notwithstanding,highcarbdietswithouthighfiber
contentareinferiortolowcarbdietsforinsulinresistantpeople[1].
Itisalsonotunproblematictoeatadietwithlotsandlotsofwholegrainsandbeans(orany
atall).Herearesomereasonswhy.
76
Itemphasizesthewrongkindoffiberrichfoods,namelywholegrains,insoluble
cerealfiberandbeans.Thisemphasisishardlybenign.Whilewholegrainsandbeans
docontaindecentamountsofvitaminsandmineralsonpaper,theyalsocontain
plentyofsocalledantinutrientsthattheplantusestostarveitsattackers,i.e.those
whowanttoeattheplant.Theantinutrientssuchasphyticacid,lectins,enzyme
inhibitors[43]bindtothemineralsinthegrainsandbeansandincreaselossesof
thosenutrientsthroughfaecesandurine.[42]Thisleadstoonlymarginallyimproved
oreventoworsenedmineralstatus[43].
VitaminB6isabsorbedlessefficientlyfromcerealgrainsthananimalfoods[43]
WholegrainspromotevitaminDdeficiency[43]
TheonlyrandomizedcontrolledtrialIamawareofthatexaminedtheadvicetoeat
moregrainsonhardendpoints(e.g.riskofdeath)wasconductedwith2033
heartdiseasepatients.Inthegroupthatgottheadvicetoincreaseintakeofcereal
fiber(i.e.thetypefoundinwholegrains)therewasatrendtowardsahigherdeath
ratecomparedtothegroupgivennoadvicetoincreasecerealfiber.[44]
Therearenouniqueessentialnutrientsinwholegrains,beans,legumesandlentils.
Allthevitamins,minerals,essentialfattyacidsandproteinsyouneedareavailable
fromotherfoodsourcessuchasmeat,fish,eggs,dairy,fruits,veggies,berries,nuts,
potatoesetc.
Wholegrainsandbeanscontainlectins,aclassofparticlesthathavebeen
hypothesizedtocauseleptinresistanceinhumans,whichwouldessentiallyleadto
increasedappetiteandweightgain,amongothernastythings[53].
Thelatterhypothesiswastestedin2007,whenaPaleolithic(stoneage)dietwaspitched
againstapoliticallycorrectMediterraneandiet.Twentynineheartdiseasepatients,most
withhighbloodsugar,wererandomizedtoeat1ofthe2dietsfor12weeks.ThePaleodiet
wasbasedonleanmeat,fish,fruits,leafyandcruciferous[e.g.broccoli]vegetables,root
vegetablesincludingrestrictedamountsofpotatoes,eggsandnuts.TheMediterraneanlike
dietwasbasedonwholegraincereals,lowfatdairyproducts,potatoes,legumes,
vegetables,fruits,fattyfishandmonounsaturatedrefinedfatsandalphalinolenicacid[a
typeofplantderivedomega3fat].ThePaleodietgroupwasnotalloweddairy,cereals
includingrice,beans,sugar,bakeryproducts,softdrinkorbeer,andonlymoderateamount
ofpotatoes,eggs,nutsandrapeseedoroliveoil.
Bothgroupslostsimilaramountsofweightbutwaistcircumferenceandpostmealblood
sugardecreasedmoreinthePaleogroup.Thedecreaseinpostmealbloodsugarwasnot
explainedbyreducedweightorwaistcircumference,hintingthatdietarycompositionwas
responsible.
ThedietaryadvicegiventothePaleogroupledtoincreasedintakesoffruits,vegetablesand
nutsanddecreasedintakeofcereals,milkanddairyproductsandoilsandmargarines,which
ledtoareducedcarbohydrateintakeandspontaneouslyreducedcalorieintake.
12of14heartdiseasepatientsplacedonaPaleodiethadhighbloodsugarlevelstobegin
with(10ofthose12haddiabeticbloodsugar).After12weeksonthediet,allofthemhad
normalbloodsugar.Insulinsensitivityimprovedaswell.Thiswasmuchbetterthanthe15
77
patients,ofwhich13hadhighbloodsugaratbaseline,whowereplacedonaMediterranean
dietfor12weeks.Afterthatdiet,7ofthemstillhadelevatedbloodsugar.
Quotedfromthestudy[theresult]suggeststhatavoidingWesternfoodsismore
importantthancountingcalories,fat,carbohydrateorprotein.Thestudyaddstothenotion
thathealthydietsbasedonwholegraincerealsandlowfatdairyproductsareonlythe
secondbestchoiceinthepreventionandtreatmentoftype2diabetes.[7]
Moreover,inaseparateanalysisofsatiety(feelingoffullness)ofthe2diets,itwasfound
thatthosewhoconsumedthePaleodietwerejustassatiatedasthosewhoconsumedthe
Mediterraneandiet,eventhoughthePaleogroupconsumedfarlesscalories,lending
supporttotheideathatlectinsinwholegrainsinterferewithappetiteregulationandmay
leadtoincreasedappetite[6].
Insummary,thePaleodietdefeatedtheMediterraneandietand,ifanything,thisdoesNOT
supportthecaseforwholegrains.
CompliancewithHCFdietswouldbeexpectedtobelowinthelongterm.
OneoftheleadingproponentsofHCFdietsadmitsthatcareshouldbetakennotto
increasefiberintakepredominantlyfrominsolublesourcessuchaswheatbransince
theevidenceisnotstrongthatthenonviscousfibersourcesbenefitglycemic[blood
sugar]control.[50]
TheHCFproponentsseemtomissthepointwhich,asexplainedintherestofthis
book,isthatdietisonlysecondaryintreatinginsulinresistance.
IntheHCFdietscited,intakeoffiberwasincreasedfrombothcerealgrainsandbeans,as
wellasfromfruitsandveggies.Theresnowayforsuretoknowifthebeneficialresultswere
thankstotheformerorlatterfoodgroups.
Wheninsulinresistanthumansweregiveneither24gramsoffiberfromawholewheat
cerealproduct,oracontrolcerealwithvirtuallynofiber,withnootherchangeindiet,body
weightorexercisehabitsfor1year,noimprovementwasfoundinfastingbloodsugaror
insulinnorpostmealbloodsugarorinsulin,althoughpostmealbloodsugartendedtobe
slightlyworseinthelowfibergroup.[47]
Supposedlyinsupportofinsulinsensitizingeffectsofwholegrainfiberwasa2007studythat
hadmenandwomenwithelevatedbloodsugarconsume,togetherwiththeirnormaldiet,
eitheramealreplacementpowderwithwholegrainwheatfiber,oramealreplacement
powderwithpredominantlyinulin,afiberfoundinvegetables.55%oftheenergyconsumed
inthewholegraingroupwasderivedfromthemealreplacementpowder.Itwasfoundthat
thewholegraingroupimprovedinsulinsensitivityandfastinginsulinmore.Theresultswere
mainlyattributedtothesupposedlysuperiorpropertiesofwholegrainfiber.However,the
wholegrainmealreplacementpowdercontaineddoubletheprotein,doublethefat,less
carbohydrate,andthecarbohydrateinthecontrolpowderwaspredominantlyrefinedsugar.
Withalltheseconfounders,itwasneverproventhatitwasthewholegrainfiberthatwas
responsiblefortheimprovedinsulinsensitivity[48].
78
Promotersofthepoliticallycorrecthighcarb,lowfatdietwilloftenadmitthatahighcarb
dietcanbedetrimentalifitishighinrefinedcarbs(refinedflour&sugar),butwillclaimthat
ahighcarbdietrichinunrefinedgrainsandbeansissuperiortoanyotherdiet.Ina2011
studyexaminingtheeffectofeitherahighproteindietvs.ahighcarbhighfiberdietrichin
minimallyprocessedwholegrainsandlegumesbutnotdifferentintheamountandkindof
fat,thoseonthehighproteindietlostmorefatandloweredtheirbloodpressuremore.
ReductionsinLDLcholesterol,triglyceridesandfastingbloodsugarweresimilar.The
principaldifferencebetweenthedietswasthatthehighproteingroupatenobeansand
legumes,lessbreads,lesscerealsandgrainsandmoreleanproteinfoods.[2]
How you prepare food matters

Interestingly,itisnotonlywhichfoodsyoueatthataffectinsulinsensitivity,butalsohow
thosefoodsareprepared.Sixtytwoyoungandhealthyvolunteerswererandomizedtoeat
eitheradietconsistingpredominantlyofhighheattreatedfoodsoradietpreparedwith
lightercookingmethods(e.g.steaming).Thedietswereconsumedincrossoverfashionfor4
weekseach,i.e.theyconsumeddiet1followedbydiet2for4weekseach,ordiet2followed
bydiet1,witha10daywashoutperiodbetweendiets.Thehighheatdietwasprepared
withmethodssuchasgrilling,frying,androastingandwasrichinfoodsknowntobehighly
cooked,suchasextrudedcornflakes,coffee,drycookies,andwellbakedbreadwithbrown
crust.Incontrast,theSTMD[steameddiet]comprisedsomerawfoodandfoodsthatwere
cookedwithsteamtechniquesonly.
Theresults?
After4weeksofthesteameddiet,insulinresistancewas17%lowerthanafterthehigh
heatdiet.Thehighheatdietreducedbloodconcentrationsofomega3by17%,vitaminCby
13%andvitaminEby8%whileincreasingcholesterolby5%andtriglyceridesby9%,
comparedtothesteameddiet.[34]
Thereasonforthisisthathighheatcookingcreatessomenastyparticlesevidentfor
examplebybrowningofmeatduringfryingbutalsopresentwhencookingfatsor
carbohydratesathightemperatureandtheseparticlesseemtopromoteinflammationand
insulinresistance.Thisshouldnotbetakenassupportforgoingonarawfooddiet;rather,
uselightcookingtechniquessuchassteaming,eatsomefoodraw,anddontovercookfood.
Also,itmaybewisetoavoidbread,breakfastcerealsandcookies,whichweremajor
contributorsofdangerousparticlesgeneratedbyhighheatcooking.[34]ThankstoStephan
Guyenetforturningmeontothisstudyonhisexcellentblog:
http://wholehealthsource.blogspot.com/
Do carbohydrates cause insulin resistance?

Hardly[36].Theresabigdifferenceincausingatemporaryelevationofbloodsugarand
insulin,asseenaftereatingcarbohydrate,orcausingthecellularresponsetoinsulinto
becomeblunted.
79
Glycemic Index and Glycemic Load

Allcarbohydratesourcesarenotcreatedequal.Dependingonhowfastacarbohydrate
sourceisbrokendownandabsorbedintothebloodstream,itwillvaryinitseffectonyour
bloodsugarandinsulinlevels.Thesloweritisbrokendownandabsorbed,theloweryour
postmealbloodsugarandinsulinlevelswillrise.Carbohydratesourcesthatraiseblood
sugarlittlearesaidtohavealowglycemicindex(GI).Examplesincludemostvegetables,as
wellasquinoa.Carbsourcesthatraisebloodsugaralot,suchaswhitebreadorboiled
potatoeshaveahighGI.
Thiscanbeusedtoanadvantageforinsulinresistantpeople.Simplybyselecting
carbohydratesourceswithalowerglycemicindex,youcanhelpkeepyourinsulinandblood
sugarundercontrol.
ItisalsopossibletoreducetheglycemicindexofahighGIfoodbyeatingitwithalowGI
food,orafiberrichfoodoramoderateamountoffat.Forexample,ifyouwanttoeata
boiledpotatoafoodthathasahighGIyoucanreduceitsGIbyeatingitwithbroccoli
(fiberrichfood)orsomebutter(fat)orboth.
Dietary fats and insulin resistance

Firstofall,Ihopeeveryonerealizesthateatingfatdoesnotmakeyoufat.Excesscalories,
regardlessifthosecaloriescomefromcarbohydrate,protein,fatoralcohol,makesyoufat.
Second,dietaryfatphobiaiscommonamongdiabeticorganizationssuchastheAmerican
DiabetesAssociationandEuropeanAssociationfortheStudyofDiabetes[50]tonamebuta
few,andgoeshandinhandwiththecarbohydrateandwholegraincraze,whichIhave
alreadyshownisaBADideatofollowforaninsulinresistantperson.
Third,itsimportanttoseparatetheeffectsofdietaryfatcontentforinsulinresistantpeople
comparedtohealthypeople.Insulinresistantpeoplehaveaproblemfirstandforemostwith
metabolizingcarbohydrate,duetotheverynatureofIRwhichisabluntedresponseto
insulin,thehormonethatisrequiredtoreducebloodsugaraftereating.
Changingtheamountoffatinthe2040%rangedoesntseemtohaveanymajoreffectson
insulinsensitivity[51].Butindiabetics,onestudyfoundthatdecreasingfatfrom40%to20%
andreplacingitwithstarchyfoodsworsenedinsulinsensitivitybecauseofglucotoxicity,in
otherwordstoxiceffectsofcarbohydrateconsumptionseenininsulinresistantpeopledue
tohighpostmealbloodsugars(referencedin[51]).
Ina2001studyonhealthypeople,dietswitheither83%,41%or0%fatcontentfailedto
yieldanyconclusiveresultsregardinginsulinsensitivity[23].
Although,itmustbesaidthatconsumingahighcarbmealafterstayingonalowcarb,high
fatdietcanleadtoexcessivelyhighbloodsugarspikes[26],butthisisnotundisputable[33].
Ifthiseffectoccurs,itislikelybecauseamealismoreefficientlydigestedifithasthesame
compositionasthebackgrounddiet.Soitmightbeapoorideatowildlyvaryyourdietfrom
80
daytoday,eatinglowcarbfollowedbyhighcarbinahaphazardmanner.Yourbodywillnot
havetimetoadapttothechanges.
Thisdoesnotmeanthatyourbodywilleventuallyadapttoahighcarbdietwhenyoure
insulinresistant;theinsulinresistantstateitselfischaracterizedbypoorcarbohydrate
tolerance.Itjustmeansthat,intheshortterm,suddenlyeatinghighcarbmealsafteralow
carbbackgrounddietmayspikebloodsugarlevelsevenhigherthanifthebackgrounddiet
washighcarb.
Someevidencepointstoinsulinsensitivitybeingimpairedwithconsumptionofsaturated
fat,andimprovedbyconsumptionofunsaturatedfat[51],butthiswasfoundinnon
diabetics.Theproblemwithincreasingunsaturatedfatsisthatyoullmorethanlikelyget
youromega6:3ratiooutofwhack.Almosteveryvegetableoilsuchascornoil,sunfloweroil,
rapeseed(canola)etc.exceptpalmkerneloil,palmoil,coconutoilandmacadamiaoil
containsexcessiveamountsofpolyunsaturatedomega6fatswhichmaycontributeto
inflammation,andarealsoveryvulnerabletoheatandlightandeasilydamaged,inwhich
casetheyareevenmoredangerous.Sohowwouldyouincreaseyourintakeofunsaturated
fats?Monounsaturatedfatsareoneoption,suchasthosecontainedinolives(andoil)and
avocadoes(andoil)andmacadamiaoil,butmostofthesestillcontaintoomuchomega6for
mytasteandtoolittleomega3.Eatingmorefattyfishonaregularbasisisagood
alternative,though,asitcontainsalotofunsaturatedfatbutdontoverdoit.
However,dailyfishoil(i.e.omega3)supplementationhasfailedtoimproveinsulin
sensitivityintype2diabeticswhengivenfor226weeksinvarioustrials[51][52].
Someofthefatsyoueatendupinthecellmembranes,butthisprocessisnotinstantsince
themembranesneedtimetorenew.Therefore,someoftheeffectsofdietaryfat
compositionmaynotbeevidentinshorttermstudies.
Inpredominantlyhealthysubjects,consumingfor3monthsadietwithahigherproportion
ofsaturatedfatcomparedtoadietwithahigherproportionofmonounsaturatedfat,insulin
sensitivityworsenedonthesaturatedfatdiet.Theamountofcalories,protein,
carbohydrate,totalfat,polyunsaturatedfatorfiberdidnotchange,sotheresultsweredue
tothequalityoffatalone.Thedifferenceininsulinsensitivitywasmorethan10%,butthis
wasonlyseeninpeoplewhoconsumedlessthan37%oftotalcaloriesasfat.Inthoseabove
37%,nodifferenceininsulinsensitivitywasfoundbetweengroupsregardlessofproportions
ofsaturatedormonounsaturatedfat.However,thedifferenceinthelowfatsubgroup
(lessthan37%ofcaloriesfromfat)wasevenmorestriking,withagreaterthan20%
differencebetweenhighorlowproportionofsaturatedtomonounsaturatedfat.Theresults
demonstratethatreplacingsaturatedfatwithmonounsaturatedfatshouldsubstantially
improveinsulinsensitivity,butonlywhentotalfat%iskeptlow(i.e.below37%).[52]
SinceIdontrecommendalowfatdietforinsulinresistantindividuals,avoidingsaturated
fatbecomesamootpoint.Seealsotheendofthischapterforafurtherdiscussionofthe
applicabilityofthesefindings.
81
Dairy and insulin resistance

Whiledairyandmilkproductshavebeenassociatedwithalowerriskofdevelopingthe
insulinresistancesyndromeorcomplicationsthereof[55],Ihavenotatthispoint
ascertainedwhetherornotdairy,calciumandmilkproductsactuallyprotectagainst
developingIR,orwhethertheassociationisexplainedbyotherfactors.Onesuchfactormay
bethevitaminDfortificationofdairyproducts,whichwouldleadtoanimprovedvitaminD
statusamongfrequentdairyconsumers.Anotherexplanationcouldbeoverallhealthier
habitsamongfrequentdairyconsumers,whichwouldconfoundtheanalysisandmakeit
looklikethedairyitselfishealthywhiletheimprovedhealthmaybethankstootherhealthy
behaviors.
TheproblemIhavewithdairyisthatitishighlyinsulinogenic,i.e.itcausesalotofinsulinto
besecretedfromthepancreas.Insulinresistantindividualstypicallyalreadysufferfrom
hyperinsulinemia,i.e.highinsulinlevels,andtypicallythelastthingyouwanttodoisto
driveyourinsulinlevelsevenhigher.
Sincedairy,tothebestofmyknowledge,doesnotcontainanysensationalinsulinsensitizing
properties,Ithinkitsanotheroneofthosefoodsthatarebetteravoidedwhileyoureinsulin
resistant,butisnotinherentlybadandcanbeconsumedonceyourenolongerinsulin
resistant.
Does fructose cause insulin resistance? Why it

doesnt matter
Lately,fructose(fruitsugar)hascomeunderattackandissaidtopromote,amongotherbad
things,insulinresistanceand,byextension,type2diabetes.Thereisnodoubtthathigh
fructosefeedingcausesinsulinresistanceinrodents[57]evenmoresounderconditionsof
magnesiumdeficiency[58].
Sincefructoseisfoundinfruits,thishadleadsomecommentatorstothesensational
conclusionthatfruitisbadforhumans!Butisit?
Ithelpstoknowalittlebitaboutsugars.Whilefructoseisindeedfoundinfruits(andfruit
juices),fructoseisalsofoundinsucrose.Sucroseistablesugar,thewhitestuffthatwe
commonlycallsugar.Sucrosecontains50%fructoseand50%glucoseinotherwords,1
sucrosemoleculeismadeupof1glucoseand1fructosemoleculechemicallybonded.This
bondisbrokenduringdigestion.
Glucoseistheverysamemoleculethatiscalledbloodsugarinsidethebody.Outsidethe
bodyitscalledglucoseintheblooditscalledbloodsugar.
Sowhenyoueatsugar(i.e.sucrose),youreactuallyeating50%fructose.Formostpeople,
therefore,thebiggestsourceoffructosewillnotcomefrombingeeatingfruits.Rather,they
willgetALOToffructosejustbyconsumingregularsugar(i.e.sucrose)whichiscontainedin
prettymucheverythingthesedays,suchassoda,icecream,cakes,cookies,junkfood,bread
etc.etc.adinfinitum.
82
Inhumans,gainingweightbydailyoverfeedingbyextracaloriesfromeitherfructosedrinks
comparedtoglucosedrinksledtoincreasedintraabdominalfatandimpairedinsulin
sensitivity,eventhoughtotalweightgainwassimilar(referencedin[56]).Thisisclearlya
baddevelopmentinducedbyfructosefeedinginhumans.
However,forourpurposes,thisisamootpoint,because
Idontrecommendthatanyonewhoisinsulinresistantgainsfat
Idontrecommendthatanyoneconsumesemptycalories(glucoseandfructoseare
bothrefinedsugars)
Thecomparisonwasbetweenfructoseandglucose,noneofwhicharecommonly
usedassweetenersisolatedfromeachother.
Whenyoubuy,forinstance,sodaitistypicallysweetenedwithsucrose,whichis50%
fructoseand50%glucose,orsweetenedwithHFCS(highfructosecornsyrup)whichis
typically55%fructoseand45%glucose[57].But,asfarasIknow,insugarladenjunkaswell
asinhomecookedfood,fructoseandglucoseareusedtogetherforsweeteningpurposes
(e.g.sucroseorHFCS).Sowhat,then,iffructoseisworsethanglucose,whentheyare
usuallyfoundtogetherandcannoteasilybeseparated?
Moreover,asstatedabove,Irecommendavoidingemptycalories.Therefore,itdoesnt
matterwhichisthelesserevilofglucoseorfructose.Theonlyconclusionthatmakessense
inlightofthisistoavoidsugarladenjunk,sincethatisabigsourceoffructosewithoutany
ofthebenefitsoffruit.
Sugarisvirtuallydevoidoffiber,minerals,vitaminsandotherhealthycompounds.Fruit,on
theotherhand,isagoodsourceofthosethings.Fruitmaybeconsumed,butkeepinmind
thatfruitsarehighincarbohydrateandmayinitiallyhavetobelimitedforthatreason.But
fruitisnotinherentlyunhealthy,onthecontrary.
Highfructosecornsyrup,bytheway,isamisleadingnamebecauseitcontainsonly55%
fructose(45%glucose)[57]whilenormalsugarcontains50/50.Fromthenamehigh
fructose,youdthinkitwasalotmorethan55%fructose.
Thebottomlineisthatyoushouldavoidallemptycaloriesincludingsugarladenfoods,
whichwillsimultaneouslyreduceyourintakeoffructose.
TheremayormaynotbeapartofthepopulationthatisfructoseintolerantIhavent
lookedintothatyet.Ifyouhavespecificreasontobelievethisisyou,thengoaheadand
avoidsugaraswellasfruit.
Infact,somethingscouldbesaidinthedefenseoffructoseaswell;itdoesntraisepost
mealbloodsugarandinsulinasmuchasglucose.
Fruitjuices,bytheway,shouldbeavoided.
83
A word about dark chocolate

Feedingflavanolrichhighpolyphenoldarkchocolatefor15daystoinsulinresistantmen
andwomenwithhighbloodpressure,ledtodecreasedinsulinresistance,improved
pancreaticbetacellfunctionanddecreasedbloodpressure.Theseeffectswerenotseen
withflavanolfreewhitechocolate.[59]Thebarsconsistedof99.9%cocoamassand100
grams/daywasconsumed,equivalentto561calories.Participantsreducedotherfoodsby
thesamecaloricamounttokeepbodyweightconstant.
Similarresultswereobtainedinhealthypeople,indicatingthatdarkchocolatecanbeused
toimproveinsulinsensitivityfurther,evenwhenovertinsulinresistanceisnotpresent[60].
Thedosesinthesestudieswerequitelarge,consideringthatanormalpersonconsumes
around2000+/500calories.Itwouldmeanthatdarkchocolatewouldbeasubstantialpart
ofapersonsdiet,evenmoresoonacalorierestrictedweightlossdiet.However,someof
thesebenefitsmaybeseenatlowerintakesofdarkchocolate,anddarkchocolatedoes
containgoodamountsofmanyminerals,soitsfarfromemptycalories.Justbeawarethat
itsquitecaloriedenseandyoumustdecreaseotherfoodsbyanequivalentamountof
calories.Ifyouhaveroomforitinyourdailycaloriebudget,consuming10to100gramsof
reallydarkchocolateinplaceofemptycaloriesseemslikeagoodidea.
Caffeine/coffee and insulin resistance

Sincecoffeeisoneofthemostcommonlyconsumedbeverages,andithasbeenboth
claimedtopreventandcauseinsulinresistance,IthoughtIdcommentonit.
WhenIsaycoffee,Imeanthestuffwithcaffeineinit.Otherwise,Illexplicitlysaydecaf.
Many,butnotall[61],longtermpopulationlevelstudieshavefoundthatcoffee
consumptionisinverselyassociatedwithdevelopingtype2diabetes.Inotherwords,coffee
consumers,onaverage,havealowerriskofdevelopingtype2diabetesthannoncoffee
consumers.
However,isthiseffectthankstocoffeeconsumptionitself,oristheresomeother
explanation?Whichpartofcoffeewouldberesponsible?Therearesome600compoundsin
coffee,andanyoneofthosecouldberesponsible.Isthereadifferencebetweencaffeinated
coffeeordecaf?Iscoffeeconsumption,perhaps,relatedtosomeotherhealthybehavior
(suchasfatloss)whichwouldexplainwhycoffeeseeminglyprotectsagainsttype2
diabetes?Insupportofthelatterhypothesis,onestudyexamining7006individuals
representativeoftheU.S.populationfoundthatcoffeeconsumptionwasonlyassociated
withdecreasedriskoftype2diabetesamongthosewhohadlostweight[62].So,perhaps
coffeeconsumptionleadstoweightlossinsomeindividuals,anditistheweightlosswhich
protectsagainstdiabetes.Ornot.Thisisallspeculationatthispoint.Nevertheless,it
highlightsthedangersofjustassumingthatincreasedcoffeeconsumptionwouldprotect
againstdiabetes,especiallyinlightofstudiesthatdemonstrateshorttermimpairedinsulin
sensitivityaftercoffeeconsumption.
84
Epidemiologicalstudiescannotprovecausality,theycanmerelyprovideahypothesisthat
mustsubsequentlybetestedinatrial.
Trialshavebeenconductedwherevolunteerswerefedcaffeineorcaffeinatedcoffee,and
theresultshaveconsistentlyshownthatcoffeeinducesshortterminsulinresistancein
healthy(i.e.noninsulinresistant)[63][64][66]aswellasinsulinresistant[65]people.
Theeffect,though,isusuallytransientandseemstolastonlyaslongascaffeineisinthe
blood.Caffeinehasahalflifei.e.thetimeittakesforbloodconcentrationstobehalved
of46hours,soregularcoffeeconsumptionthroughoutthedaywouldupholdacertainlevel
ofinsulinresistance.After8weeksof5cupsperdayofcaffeinatedinstantcoffeegivento
type2diabetics,nodeleteriouseffectswereseenonglucose(carbohydrate)tolerance,
insulinsensitivityandinsulinsecretion,andtherewerenodifferencesintheseparameters
comparedtotheothertreatmentgroups(decaffeinatedcoffeeorwater,respectively).In
fact,bloodtestsrevealedsomeimprovementsinsubstancesthatmayreducetheriskof
insulinresistance.However,thetestswereonlytakenaftera12hourfast,whennofoodor
coffeehadbeenconsumedfor12hours[67].
Thethingisthatcoffeecouldconceivablycauseinsulinresistanceforafewhours,ashas
beenshownrepeatedly,butafterthecaffeineleavesthebloodtheinsulinresistancecould
alsogoawayor,possibly,evenbereducedfurther.Theresultswoulddependonwhatyou
measure:insulinandbloodsugarwithorwithoutcaffeineintheblood.
Therearemanyhypothesisregardingcoffeeandinsulinresistance,butthefactisthat
coffee,orisolatedcaffeine,hasrepeatedlybeenshowntoacutelycauseinsulinresistance.
Iwouldnotliketotakeregular,dailyhitsofadrugthatwasshownbeyonddoubtto
induceacuteinsulinresistancewithaccompanyingelevatedinsulinandbloodsugar
responsesafterameal,inthehopesthatitwould,somehow,protectagainstinsulin
resistanceinthelongrun.Ithinkitscompletelyprematuretorecommendcaffeineinany
formasameansofreducingdiabetesrisk,andIthinkitssafertoabstainfromcoffeeand
caffeine.However,decaffeinatedcoffeeissomethingelseandcontainsmanyoftheother
compoundsincoffeewhichmayberesponsibleforprotectingagainstinsulinresistance.
Infact,thewholeordealremindsmeofthatwithwholegrains,whereepidemiological
studiesconsistentlyshowthatpeoplewhoeatmorewholegrainshavebetterhealth,but
whenthishypothesisisputtothetestundercontrolledconditions,itfails.
Bottomlineisthatifyourerelyingoncoffeeconsumptiontoprotectyourselfagainstinsulin
resistance,youmaybesorelydisappointed,andmayevenbedoingyourselfharmby
regularlyinducingacuteinsulinresistancewithaccompanyingelevationsofpostmealblood
sugarandinsulin.
Fortherecord,coffeeconsumptionwontcausetype2diabetes,either.Type2diabetesis
characterizedbyeverpresentinsulinresistance,whilecaffeinecausestemporaryinsulin
resistance.However,ifyoukeepdoingsomethingtemporaryallthetime,theeffectismore
orlesschronicaslongasyoukeepitup.
85
Ithasbeenarguedthatperhapsadaptationtocaffeineoccurs,wherebytheinsulin
resistanceinducingeffectswouldgoaway.Perhaps.However,whentype2diabetics,most
ofwhomwereregularcaffeineconsumers,abstainedfromcaffeinefor48hoursfollowedby
consumptionofeitherplaceboorcaffeinecapsulesfollowed60minuteslaterbyanoral
glucosetolerancetest,insulinandbloodsugarwaselevatedafterthecaffeinecapsules
comparedtoplacebo[65].Thisisinlinewiththeevidencethatcaffeinecausesshortterm
insulinresistance,anditalsoshowsthatifthereisanyadaptationtocaffeinebyregular
consumption,suchadaptationislostafterabstainingfromcaffeineforjust48hours.
Allinall,Ithinkitssafesttoavoidcaffeine,butyoudonthavetoexaggerateeither.
Additional diet tips
Consumeoilyfish3timesperweek.Justbecausefishoilsupplementshavenotbeen
proventoreduceinsulinresistancewhengivenfor226weeks,itdoesntmeanthat
oilyfishisbad.Aucontraire.Oilyfishwillprovideyouwithessentialomega3fatty
acids,thatmayimproveinsulinsensitivityinthelongrun,orjusthelpkeepyou
healthyinotherways.
Avoidmostvegetableoils.Wewerenevermeanttoconsumesignificantamountsof
mostvegetableoils.Theyhaveonlybeenmadeavailableinthelastcoupleof
hundredyearswithmodernextractionandrefiningmethods.Mostofthemcontain
fartoomuchomega6fattyacids,whichinandofthemselvesarentbadbut
contributetoasevereimbalancebetweenomega3andomega6,whichmay
contributetocancer,heartdiseaseandinflammation.Imtalkingaboutfatssuchas:
canolaoil,rapeseedoil,cornoil,sunfloweroil(higholeicsunfloweroilisdecent),
saffloweroil,soybeanoil,mostnutoilsandalmostallotheroilsexcept:coconutoil
(refinedorunrefined),palmkerneloil,palmoil,macadamiaoilandoliveoil(OOstill
contains10xasmuchomega6asomega3andisbestconsumedinlimited
quantities).
Goodsourcesoffatinclude:butter,cream,thehealthyoilsmentionedabove,fat
fromruminantssuchasbeefandlamb,fatineggs(preferablyfromfreerangehens
fedtheirnaturaldiet).Porkfatandchickenfataresoso,sincetheycontainalotof
omega6fattyacids.Alltheotherfatsmentionedcontainalowamountofomega6.
Donotworryaboutgettingtoolittleomega6;itsvirtuallyimpossibleunlessyougo
onaverylowfatdietwhichIrecommendagainst.
Eatplentyoffiber,fromvegetables,berriesandfruit.Thesearegoodsourcesof
solublefiber[41].JustbecauseyoureonacarbrestricteddietoralowGIdietdoes
notmeanyouhavetoabandonfiber.Onthecontrary,Isuggestyougetalotoffiber
dailybyeatingavarietyofvegetables,suchasbroccoli,Brusselssprouts,cauliflower
andothers(notbeans).Evenwithalow75gramcarbintakeperday,youcanstillget
3040gramsoffiberwithoutsupplementsbyeatingplentyofveggies.
Nutsarefineinmoderation.
Alcoholisfineinmoderation.
Avoidmanmadetransfats.Youcanspotthesebylookingforhydrogenatedor
partiallyhydrogenatedonlabels.
86
Liverisagoodweeklydish.Liverishighlynutritious.ItsloadedwithBvitamins,
vitaminA,copperandisagoodsourceofseleniumandalsocontainsrealvitaminK
(theK2mk4kind).However,itdoescontainALOTofiron,sobecarefulwitheating
toomuchofthisifyouneedtoreduceyourironlevels.
Avoiddelimeats.Theyreloadedwithcancercausingpreservatives,andoftenover
cooked.Asanexample,hardfriedbaconisabouttheworstdietarychoiceyoucan
make:cancercausingpreservatives,omega6fatsandinsulinresistanceinducing
particlesfromhighheatcooking
Putting it all together

IhopeapictureemergesbynowofwhatIamtryingtosay.
Dietwillrarelycureinsulinresistance.Manydietse.g.ahighcarbdietcancausehigh
postmealinsulinandbloodsugarlevels.Thisisnotthesameascausinginsulinresistance.
Dietarymaneuverscaneffectivelybedeployedtosidestepthenegativeeffectsofinsulin
resistance,i.e.highinsulinandbloodsugar.Thesedietarymaneuversarerecappedbelow.
Whileyoureinsulinresistantyoushouldhaveanotherdietthananinsulinsensitiveperson.
Themoreinsulinresistantyouare,themoreyoushouldlimitcarbohydratesandthemore
proteinandfatshouldbeyourmainsourcesofcalories.
Restrictcarbohydrates,butdontgomuchbelow75gramsotherwiseyouwillnothaveroom
forveggieswhichcontainimportantfiber.Ifyouexercisealot,especiallyifyoudohigh
intensityendurancetraining,youcaneatmorecarbs,perhapsupto200gramsperday.
SeventyfivegramstheminimumIrecommendisasmallamount,somakeitcount.Eat
plentyofcrunchy,highfiber,lowcalorievegetablessuchasbroccoli,Brusselssproutsand
cauliflower,amongothers,toreachahighfiberintake.
Overall,sticktolowglycemicindexsourcesofcarbohydrateinordertoreducepostmeal
insulinandbloodsugar,whileyoureinsulinresistant.
Asaruleofthumb,eat2gramsofproteinperkgbodyweight(1gramofproteinperpound
bodyweight),unlessyoureseverelyoverweightinwhichcaseyoucaneatabitlessprotein.
Ifyouneedtoaddmorecalories,eathealthyfats.Thesehavebeendetailedinthischapter.
Ithinkdairyisbestavoidedorlimitedwhileinsulinresistant,becauseitcontributestohigh
postmealinsulinlevels.
Thesamegoesforcaffeineinanyform,asitcausestransientinsulinresistance.Saveitfor
whenyoureallyneedit.
Avoidemptycaloriesmostofthetime.Examplesincluderefinedoraddedsugar,refined
flourandrefinedfats.
87
Avoidmostvegetableoils.Alistofexceptionshasbeenprovidedinthischapter.
Eatoilyfish3timesperweek.
Avoidorlimitwholeorrefinedgrainsandbeansandlentilsandlegumes(includingpeanuts).
ThisissomethingIrecommendforlife(literally).However,itmustbesaidthatwholegrains
canbealrightifpreparedcorrectly,whichincludesthingslikesoaking,sieving,fermenting,
heattreatingetc.,butthisisoutsidethescopeofthisbook.
Remember,howyoucookyourfoodmattersagreatdeal!Icertainlydontrecommenda
rawfooddiet,butdontovercook,andusesteamingwheneveryoucan.
Dontforgetaboutironlowering,either.Alowironavailablediethasbeendescribedinthe
chapteroniron.
Buildyourinitialdieton(innoparticularorder):meat,organs,fish(especiallyoily),eggs,
vegetables,fruit,berries,nuts(inmoderation),healthyfatsandgoodcarbohydratesources
(detailedbelow).Stillstickwithyourtargetcarbohydraterange.Evenhealthysourcesof
carbohydratesuchasfruitandquinoaWILLelevateyourpostmealinsulinandbloodsugar
levels.
Thebetteryourinsulinsensitivitygets,themorecarbsyoullbeabletoeat,withahigher
glycemicindex,aswellasaddingindairyandevencaffeine,althoughthelatterisreserved
inmyopinionforthosewithexcellentinsulinsensitivity.
Evenwhenyouhaveexcellentinsulinsensitivity,Inaturallyrecommendyoueathealthy.
Specifically,Idkeepavoiding:delimeats,omega6richoils,manmadetransfats,whole
grains,beans,lentils.AndIwouldnotoverconsumenuts,either.
Mostimportantly,keepinmindthatinmostcasesyouwontcureinsulinresistancebydiet
alone.Focusonweightreduction(ifneeded)moresothandietcomposition[37],anddont
forgettheotherchaptersinthisbook.
Diet when insulin sensitive

Onceyouhaverestorednormalinsulinsensitivity,asindicatedforexamplebylow2hour
OGTTvaluesorlowHOMAIRorreversalofovertsymptomsofIR,yourefreetoeatamuch
higherproportionofcarbs,aswellasdairyandmilkproducts,becauseyourbodycanhandle
themnormally.
Iwouldstillsticktomostoftheguidelinesgiveninthischapter.However,forimproved
sportsperformanceandmusclebuildingpotential,itwouldbeagoodideatoincreasethe
proportionofcarbsandreducetheproportionoffat.
Ihesitategreatlytogiveaonesizefitsalldiet.Nevertheless,thefollowingshouldserveyou
wellifyouredoingsweatinducingendurancetrainingandstrengthtrainingonaregular
88
basis(whichIrecommend),butthisdietshouldonlybeimplementedonceyourealready
insulinsensitive.
2gramsofproteinperkgbodyweightor1gramperpoundbodyweight
Keepfatsinthe2535%range,withapreferenceformonounsaturatedfats,because
theyhavebeenshowntoimproveinsulinsensitivitycomparedtosaturatedfats,but
onlywhentotalfatintakeisbelow37%[52].Macadamiaoilseemslikethebestoilto
useonthisdiet.Oilyfishisstillgoodandshouldbeconsumedregularly.
Small/moderateamountsofalcoholmaybeconsumedifdesired;15gramsperday
forwomenand30gramsperdayformen;abstainifyourdoctortellsyouto.
Eattherestofyourcaloriesfromcarbs
Thisdietwill,asmentioned,improveexerciseperformancewhichwillleadtogreatermuscle
gainsandhigheraerobiccapacityandintenserworkouts,whichwillfurtherincreaseinsulin
sensitivity,nottomentionthatithelpskeepirondown.Themaneuverswithdietaryfatwill
alsohelpfurtherimproveinsulinsensitivity.
Good carb sources for a high carb diet

ThereasonImincludingtheselast,isbecauseofthedetrimentaleffectsofahighcarbdiet
forinsulinresistantpeople.Therefore,youdontneedtoworryabouttheseuntilyouhave
goodinsulinsensitivity.Nevertheless,Ithinkthefoodsbelowarefine,eveninlarge
proportions,onceinsulinsensitivityishigh.
Whiterice(inmoderation)
Quinoa(highmineralcontent,highmagnesiumcontentandlowantinutrient
content.LowGI)
Oatmeal(withoutextrafiber)
Fruit(unlessyouhavereasontothinkyoudonttolerateit)
Vegetables(dontforgetthese!)
Potatoes,anykind.(Peeledandcooked)
Buckwheat
Amaranth
Carbohydratesupplementafterendurancetraining,suchasdextrose,maltodextrin.
89
Appendix A:
What Every Insulin
Resistant Person
Should Know About
Losing Weight
Introduction
Thisappendixbuildsontheknowledgeintheotherchaptersinthisbook.Herearethenitty
grittydetailsofputtingtogetherasimpleandeffectiveweightlossprogramtailoredexactly
toYOU.
Doinsulinresistantindividualsreallyneedtheirownfatlossadvice,aboveandbeyondwhat
isalreadyoutthere?Yes,becauseinsulinresistantindividualshavecertainproblemswith
theirmetabolisms.
Additionally,ImsickofalltheBSoutthereregardingfatloss.Imtalkingaboutmyths,lies,
scams,bogussupplements,worthlessgimmicks,faddietsandfadtrainingprograms.Idont
wantyoutofallforthat.Icantchangetheworld,butIwillatleastmakesurethatmy
customersgetadvicethatworks.
Nutrition Basics Understanding Calories,

Protein, Carbs, Fats and Alcohol
Imnottryingtoinsultanyofmyreadersintelligence,butIvecometotheconclusionthat
manypeoplearecompletelycluelesswhenitcomestothebasicbuildingblocksoffood.
Whileitscompletelypossibletoloseweightdespitebeingignorantonthissubject,its
helpfultohaveagrasponit.
Thereare,atthemostfundamentallevel,4macronutrients:
90
Protein
Carbohydrate
Fat
Alcohol(yes,alcoholisactuallyaseparatenutrient)
Thosefouraretheonesthatcontaincalories.Wealsoneedmicronutrientssuchasvitamins
andminerals.
Calories
Caloriesarejustameasureofenergy.Consumingmorecaloriesthanyouburnwillmakeyou
gainweight.Consuminglesscaloriesthanyouburnwillmakeyouloseweight.Thisistrue
whetherthecaloriesyouconsumecomefromprotein,carbohydrate,fatsoralcohol.In
everydayterminology,whenwesaycalorieweactuallymeankilocalorie,i.e.1000calories.
Mostaveragehumansrequiresomewherearound15002500caloriesperdaytokeeptheir
weight.
Protein
Proteinisusedinthebodytorepairandbuildvarioustissues,suchasskeletalmuscle.
Proteinismadeupofamixofvariousaminoacids.Proteinrichfoodswillvaryintheir
compositionofsuchaminoacids.Thatswhysomefoodsarecalledcompleteproteinfoods,
whileothersarereferredtoasbeingincomplete;thosewhichareincompletecontainlowor
noamountsofoneormoreaminoacids.Mostanimalsourcesofproteinarecomplete.
Examplesincludemeat,fish,eggs,poultry,organs,milk,cheese.Thesearethesourcesof
proteinthatIprefer,andIonlycountproteinfromcompleteproteinfoodsinmydaily
intake.Forexample,ifImaimingateating150gramsofproteindaily,Iwantmostorallof
thistocomefromcompleteproteinfoods(animalproducts).AnyextraproteinthatIget
fromvegetables,nuts,seeds,carbohydratesourcesetc.isjustabonustome.
Onethingtonoteaboutproteinrichfoodsisthattheytypicallyonlycontainasmallor
moderateamountofprotein.Imamazedhowsomepeopledontunderstandthis.They
seemtothinkthat100grams(3ounces)oflean,uncookedmeatcontains100gramsof
protein.Thisisnotthecase.Rather,lean,uncookedredmeatcontainsabout2022%ofits
weightasprotein;therestiswater.So,toactuallyeat100gramsofprotein,youdhaveto
eataround500grams(17ounces)ofleanmeatifweighedinitsuncookedstate.Thesame
istrueforfish,eggs,poultry,milk,etc.eventhoughtheyarehighproteinfoodstheyonly
containasmall/moderateamountoftheirweightasprotein.Exactvalueswillvaryandwill
oftenbeprintedonthelabel,orcanbelookedupinanutritiondatabasesuchas
www.nutritiondata.com
Eachgramofproteincontains4calories.Thisistrueregardlessifitscompleteor
incompleteprotein.
Carbohydrate
Carbohydraterichfoodsinclude:fruit,potatoes,vegetables,berries,grainsincludingrice,
andanythingmadewithsubstantialamountsofflourorsugar.Insulinresistantpeoplehave
troublemetabolizingcarbohydrate,soitsbettertolimitit.However,carbsarefineto
consumeforaninsulinsensitiveperson.Aswithprotein,onlypartoftheweightof
91
carbohydraterichfoodswillbeactualcarbohydrate,therestmaybemadeupofwater,
fiber,proteinandfat.Unpreparedoats,forinstance,afoodthatwewouldperhaps
erroneouslyconsiderpurecarbohydrate,actuallyonlyconsistsofaround60%ofitsweight
ascarbohydrate.Therestisprotein,fatandfiber.
Carbsareactuallynotessential.Wecansurvivewithouteatingthematall.Nevertheless,
theyarebeneficialinmanyways,likeimprovingsportsperformance.Besides,mostpeople
wouldagreethattheyreprettytasty!
Eachgramofcarbohydratecontains4calories.
Fat
Fatsarefoundinmanyfoods:oils,butter,margarines,visiblefatonmeat,milk,cheese,oily
fishandmanyothers.
Eachgramoffatcontains9calories.
Alcohol(a.k.a.ethanol)
Alcoholisneitheraprotein,carbohydratenorfat.Itsactuallyaseparatenutrientwhich
contains7caloriespergram.Thisiswhyalcoholicbeveragestypicallycontainalotof
calories.Alcoholshouldonlyconstituteaverysmallpartofthediet,ornoneatall.Aswith
theothernutrients,onlyasmallpartofmostalcoholicbeveragesisactualethanol.Therest
isusuallywaterand,possibly,carbohydrate.
TheDifferenceBetweenPercentageofWeightandPercentageofEnergy
Aconfusingaspectofdietrecommendationsismacronutrientratiosandtheirrelationto
foodlabels.Macronutrientratiosarealmostuniversalindietbooksaswellas
recommendationsfromgovernmentbodiesandorganizations.Macronutrientratiosare
advicesuchasaimingfor15%protein,55%carbohydrateand30%fat.
Whatthismeansisthat,forinstance,around30%ofcaloriesconsumedshouldcomefrom
fat.
Incontrast,labelsonfoodsalmostalwaysstatepercentageoffatintermsofweight.
Heresanexampletohighlightthisdiscrepancy.
Letssaywetake99gramsofwaterand1gramoffatandnothingelseandmixtogetherand
marketitasdressing.Howmuchfatdoesthissocalleddressingcontain?Wecouldsay
thatitcontains1%fat,sinceits1gramof100.Butwecouldalsosaythatitcontains100%
fat,since100%ofthecaloriesconsumedwouldbefromfat.
Bothofthesestatementsaretechnicallycorrect.
However,statingfataspercentageofweightis,Ifeel,adishonestpracticebyfood
manufacturerstotricktheconsumerintothinkingthatahighfatfoodisactuallylowfat.The
percentageofcaloriesfromfatinANYfoodwillALWAYSbehigherthanthepercentageof
weightasfat.Thatswhyfoodcompaniesgowiththelowernumber.
92
Letstakeanotherexample:uncookedbacon.
Mostfolkswouldintuitivelyagreethatuncookedbaconisaveryfattyfood,right?
Nutritiondata.comstatesthat100grams(3ounces)ofuncookedbaconcontains(data
retrievedonMarch18,2012):
458calories
12gprotein
1gcarbohydrate
45gfat
Fortyfivegramsof100gramsdoesntsoundextremelyhighinfat,doesit?Notevenhalfis
fat.However,thisamountoffatisstatedaspercentageofweight.Ifwewanttoknow
percentageofenergy,wehavetodoasimplerecalculation.Weknowthateachgramoffat
contains9calories.Thus,thereare
45gramsx9caloriespergram=405caloriesfromfatin100gofbacon.
405of458is88%.
Therefore,theuncookedbaconcontains88%ofenergyasfat.Quiteanotherpicture,eh?
Likewise,theproteincontentexpressedaspercentageofenergycanbecalculatedsincewe
knowthateachgramofproteincontains4calories.12gramsx4caloriespergram=48
calories.48of458is10%.Sotheproteincontentaspercentageofweightis12%(12grams
of100grams)butintermsofcalories,itsjust10%.
Ifyouthinkthisisconfusing,yourecorrect.Whythediscrepancy?Asstated,Ibetits
somethingthatfoodmanufacturersdotomaketheirhighfatfoodslooklikemoderateor
lowfatfoods.
Manytimeswhenthelabelstatesthatafoodis,forinstance,5%fat,thepercentofcalories
fromfatcanbeinthe1050%rangeorhigher.Weveevenseenthata1%fatproductcan
technicallycontain100%ofcaloriesasfat.Somethingtothinkabout.
Fortherecord,Iamnotfatphobic.Irealizetherearehealthyfatsandnotsohealthyfats.In
fact,foraninsulinresistantperson,fatisusuallypreferableovercarbohydrate.
Imjustpointingoutthisdiscrepancybetweenmacronutrientrecommendationsfrom
authors/experts/organizationswhicharestatedaspercentofcalories,andlabelsonfoods
whicharealmostalwaysstatedaspercentofweight.Atleastnowyouknowthedifference.
93
Insulin Resistant Individuals Do Not Have A

Harder Time Losing Fat
AnotuncommonstatementissomethinglikeIcantloseweightbecauseIminsulin
resistant!
Butisittrue?
Luckily,thisideahasbeentestedinhumans,soweknowpreciselywhathappenswhen
insulinresistantindividualsattempttolosefat.
When31obese,nondiabeticwomenwithaBMIof2835wereunderfedby1000calories
perday(totaldailycalorieintakewasnotallowedtogolowerthan1200,though),theylost
anaverageof9.2kg(20.3pounds)over60days.Thedietwasnotalowcarbdiet.When
analyzingthedata,theparticipantswereplacedin1of2categories,eitherinsulinsensitive
orinsulinresistant,basedontheirinsulinsensitivity.Therewasnodifferenceinweightloss
betweengroups,neitherinabsolutenumbers,i.e.kgsandpounds,oraspercentofinitial
bodyweight.[1]
Ina2006study,76obesepatientswereplacedona1200calorie/daydietfor3monthsand
theirwaistcircumference,bodyweight,BMI,systolicbloodpressure,totalcholesterol,LDL
cholesterol,bloodsugarandHOMAIR(measureofinsulinresistance)weremeasured.When
thepatientsdatawereplacedinto3groups(low,medium,high)basedonbloodsugar,no
differenceinweightlosswasseenbetweengroups.Thesamewasrepeatedwith3groups
accordingtoinsulinresistance.Nodifferenceinweightlosswasseenbetweengroups.They
hadlostthesameamountofweightregardlessoftheirbloodsugarorinsulinresistance.[2]
Theseresultsshowthatinsulinresistantpeopledonothaveahardertimelosingfatin
responsetocalorierestriction.
Only Calories Count So Count Calories

Nowthatthatexcuseisoutoftheway,itisapparentthatonlycaloriesmatter.Thecalorie
deficit,orcaloriegap,willdeterminetherateatwhichyouloseweightinthelongrun.Short
termyoucanloseorgainwaterweightbyreducingorincreasingcarbintake,respectively,
butinthelongruncalorieswilltakeprecedence.
Theexceptionisthatwithahighproteinintake,moremusclemasscanbepreservedand
morefatmasscanbelost,specifically.Itsstillcaloriesthatcount,though,butitisofcourse
bettertopreferentiallylosecaloriesfrombodyfatinsteadofmusclemass.
Withcaloriesbeingtheultimatedeterminantofweightloss,Iwouldliketomakeacasefor
countingcalories.
Itdoesntnecessarilymeanthatyouhavetomeasureandweigheverythingyouconsume,
buthavingabasicgraspofcaloriecountingcanbeahelpfulskillforlosingweight.Infact,it
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willgiveyouanentirelynewlevelofconfidencethatyouveneverhadbeforewhenitcomes
toweightloss.
Alotofpeoplethinkthateatinghealthyautomaticallyleadstoweightloss.Thisis,ofcourse,
FALSE.Itisentirelypossibletogainweightwhileconsumingsuperhealthyfoods,justasitis
entirelypossibletoloseweightonjunk,candyandsnacksonly.Itsonlycaloriesthatcount.
Therefore,dietslikeAtkins(verylowcarb),lowfatdiets,vegetariandiets,oranyotherdiet,
onlyworkwhencaloriesarerestricted.TheAtkinsdiet,forinstance,frequentlybutnot
alwaysleadstoaspontaneouslyreducedcalorieintake.However,somepeoplemistakenly
thinkthattheycaneatANYamountofcaloriesaslongastheysticktosomemagicfaddiet,
andendupsorelydisappointed,frustratedandevenmoreoverweight.
Whenyoucountcalories,twoveryrelievingthingshappen:
1. Yougainthatallimportantconfidencethatthedietisworking,becauseyouknow
youreinacaloriedeficit.Thescalecanvarywidelyfromdaytoday.Butifyoure
countingcalories,youknowthatyoureinacaloriedeficitanditwillshowonthe
scaleandwaisteventually.
2. Yourefreetoeatalmostanything,aslongasyourespectyourcaloriedeficit.
Moreover,countingcaloriesisnotdifficult.Infact,mostpeopleeatthesamemenuoverand
overagainwithoutverymuchvariation.Soonceyouknowthecaloriesforyourfavorite
foods,itseveneasier.
Inordertoknowhowmanycaloriesyoushouldeat/drink,youcalculateyourtotaldaily
energyexpenditure,i.e.thetotalamountofcaloriesyouburninaday,andsubtracta
givennumberdependingonhowfastyouwanttoloseweight.
How To Determine Your Total Daily Energy

Expenditure
Therearemanywaystoestimatethis.Thefigureyouarriveatwillalwaysbeanestimate
only.Itsverydifficulttodeterminepreciselyhowmanycaloriesyouuseperday,anditsnot
necessaryeither.
Firstyouwillcalculateyourbasalmetabolicrate(BMR).Thiswouldbeyourcalorie
expenditureifyouwereinacoma,i.e.justtheenergyrequiredtokeepyouwarm,tokeep
yourheartbeatingandyourlungsbreathingetc.
WhenyouknowyourBMR,youmultiplythatbyanactivityfactordependingonhow
physicallyactiveyouare.
HerearetheequationsforestimatingBMR.Therearetwobasicformulastousehere.
TheMifflinStJeorformula[3]:
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Men:
BMR=[10xweight(kg)]+[6.25xheight(cm)][5xage(years)]+5
Women:
BMR=[10xweight(kg)]+[6.25xheight(cm)][5xage(years)]161
Ifyouknowyourbodyweightinpounds,simplymultiplyby0.4536toarriveatyourweight
inkg.Thus,150pounds=150x0.4536kg=68kg
Ifyouknowyourheightinfeetandinches,everyfeetis30.48cmandeveryinchis2.54cm.
So,forinstance,5feet8incheswouldbe
5x30.48=152.4
8.5x2.54=21.6
152.4+21.6=174cm
So,withthosenumbersa55y.o.manwouldhaveaBMRof10x68+6.25x1745x55+5=
1497
TheBMRforawomanwiththosestatswouldcomeoutto1332.
Thereisanother,moreaccurateequationfordeterminingBMR.But,inordertouseit,you
havetoknowyourleanmass,a.k.a.yourfatfreemass.Thatisyourentirebodyweight
minustheweightofallyourfat.
TheKatchMcArdleformula[3]:
BMR=370+21.6xleanbodymass(kg)
Thisformulaisthesameformenandwomen,becauseatthesamelevelofleanbodymass,
basalmetabolicrateisessentiallythesame.
Inordertousetheformulaforour68kg(150pound)person,wedhavetoknowthe
personsamountofleanbodymass.Inordertoknowthis,wehavetodeterminethe
personsamountoffatmass.Letssayitis18%.Thatmeansthatthepersonhas0.18x68=
12.2kgfatmass.Thepersonsleanbodymassistherefore6812.2=55.8kg
HisorherBMRwouldbe,accordingtotheKatchMcArdleformula:370+21.6x55.8=1575
calories.
HowToDetermineYourBodyFatPercentage
Therearemanywaystoestimateormeasurebodyfatpercentage.Itsnotmandatoryto
knowthis,butifyouwanttousetheKatchMcArdleformulayoullneedit.
Manywaystomeasurebodyfatareexpensiveduetoexpensiveequipment,orinaccurate
duetocheapbutreadilyavailableequipment.Somemethodsrequireaskilledpractitioner
togetanaccurateresult.
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Iwillsuggestasimplemethodtoassessbodyfat:visually.
Simplybylookingatyourbody,youcangetanideaofhowmuchbodyfatyouhave.How
accurateisthismethod?Idsayitsprettygoodwithabitofpractice,anditsfree.
Tostartlearningaboutvisualbodyfatassessment,youcanusetheseresources:
http://www.leighpeele.com/bodyfatpicturesandpercentages
Goodblogpostthatwillgiveyouagoodideaofwhatdifferentbodyfatlevelslooklike,
separateformenandwomen.
http://thisiswhyyourejacked.com/abodyfatpercentpictureguide
Heresanotherpictureguidetobodyfat,thisoneismoreforbodybuilders,butcanstillbe
useful.
Ifyoureover30%bodyfat,youcansimplyusetheMifflinSt.Jeorformulathatdoesntneed
bodyfatintheequation.
Thenextstepinyoureducationafteryouvegraduatedfromtheabove2blogpostsisgoing
tohttp://forum.bodybuilding.com/forumdisplay.php?f=29
ThisisthepostyourpicturespartoftheBodybuilding.comforums.Peoplefrequentlypost
picturesofthemselvesthere,askingthecommunityforhonestvisualbodyfatpercentage
assessments.Ifyouregisterafreeaccountyoucanlookatotherpeoplesattachedphotos,
orpostyourown.Butjustgoingthroughsomebodyfatestimatethreadsandseeing
picturesandpeoplesguesstimateswillgiveyouabetterideaofwhatswhat.
Asmentioned,youcanevenpostyourownpictureandaskforabodyfatestimate,butyou
certainlydontneedto.
Womenmayhavemoresuccesslookinginthissubforumspecifically:
http://forum.bodybuilding.com/forumdisplay.php?f=39
Mostpeopleselfratetheirbodyfatpercentagemuchlowerthanitreallyis.Thisleadstoan
overestimationofleanbodymassand,hence,anoverestimatedBMRwhichcanscrewup
yourfatlossefforts.TheresourcesIhavelinkedaboveshouldhelpyougetadecent
estimateofwhereyoustand.
TotalDailyEnergyExpenditure=BMRxActivityFactor
NowthatyouhaveyourestimatedBMR,eitherbyusingtheMifflinSt.Jeorequationorthe
KatchMcArdleformula,itstimetoestimateyourTOTALdailyenergyexpenditure.
ThemostcommonwaytodothisistomultiplyyourBMRbyanactivityfactor,depending
onhowphysicallyactiveyouare.
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Thesetypicallyvarybetween1.3and2.0,butforveryactivepeopletheycouldbeeven
higher,butitsrare.
Heresaroughbreakdownofactivityfactorsascommonlycited[4]:
Sedentary
1.2
Lightexercise(13daysperweek)
1.375
Moderateexercise(35daysperweek)
1.55
Heavyexercise(67daysperweek)
1.725
Veryheavyexercise(twiceperday,extraheavyworkouts)
1.9
Ithinkthefirstnumberisactuallyabitlow.Ithinkitsrarethatpeoplewhocanmovefreely
andhaveoccupationsandsomeinterestoractivitybesideswatchingTVwouldhavealower
activityfactorthan1.4.
Ifyoujusthaveanormallifewithnoexercise,butsomeformofoccupationoractivities
outsideyourhome,Iwouldstartoffwith1.41.5.Higheractivityfactorsarereservedfor
peoplewhoexerciseorhavephysicaljobs.
Thus,ifapersonhadanestimatedBMRof,say,1450calories,andanormalamountof
activityrequiredforajoboutsidehisorherhomeplusalleverydayactivitiessuchasgrocery
shopping,cooking,cleaningetc.thenyoudmultiply1450by,say,1.5toarriveat2175.
OnceyouvemultipliedyourBMRbyanactivityfactor,youhaveafigurethatwecancall
yourestimatedtotaldailyenergyexpenditureorTDEE.UsethisnumberasaSTARTING
POINTforhowmanycaloriesyouneedtomaintainyourweight.
How Many Calories Should I Eat Per Day?

NowyouhavetosubtractanumberofcaloriesfromyourestimatedTDEEtoarriveatthe
numberofdailycaloriesyoushouldeat.
Howmanycaloriesyousubtractisreallyuptoyou,butitsprudenttoaimforadailycalorie
deficitofatleast500.Apoundofhumanfatisroughly3500calories.Ifyoucreateadaily
caloriegapof500,youdlose1pound(0.45kg)offatperweek.
Ifyoureobese,youcanloseweightatdoublethatrateormore.Losingtwopoundsoffat
perweekwouldrequireadailycaloriegapof1000calories,whichcanbeprettybrutalto
maintain,butcertainlynotunheardof.
Theleaneryouget,thesloweryouwanttogoinordertopreservemusclemass,buteven
relativelyleanindividualscanlose1poundperweek.
Themoreyoureduceyourcalorieintakethemoreyourinsulinandbloodsugarlevelswill
fall,andthiseffectwillbeapparentfast,evenbeforesignificantweightlossoccurs.Thisis
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justaconsequenceoflessfoodenteringthesystemandthustherewillbelessneedfor
insulinandlessbuildingblocksforbloodsugar.
Formostpeoplenotonmedications,lowbloodsugarwillrarelybeaproblemevenona
calorierestricteddiet.Thebodycanmakeitsownbloodsugarevenifyoudonteat
anything,soitsrarethatitwouldfalltoolow.
Butifyoureonmedicationsespeciallydiabetesmedsandsuddenlystartcuttingdeeply
intoyourcalorieintake,thenlowbloodsugarcancertainlydevelop.Thesamecanhappen
withbloodpressurebecausebloodpressureisfrequentlyreducedbycalorierestriction.Just
bewareofsucheffectsandalwaysworkwithyourdoctor.
Itisoftenrecommendedthatyoudonteatbelow1200caloriesperday.Doingsocan
increasetheriskofnotgettingenoughproteins,fats,carbsandmicronutrients.Ifyoufind
yourselfneedingtoreducecaloriesbelow1200toloseweightatanacceptablerate,its
probablybettertoaddmorephysicalactivitythaneatingbelow1200caloriesperday.
Determining Your Macronutrients (Proteins,

Carbs & Fats)
Nowthatyouknowhowmanycaloriestoeatperday,itstimetobreakthatdowninto
macronutrients.
Asexplained,weightlosshappenswheneveryoureducecaloriesbelowyourtotaldaily
energyexpenditure,i.e.whenyoucreateacaloriegap.Itdoesntmatterwhichproportionof
fat,carbohydrate,fatoralcoholyouconsumecaloriesareking.
Nevertheless,asexplainedinchapter6,aninsulinresistantpersonbenefitsfromeatinga
dietwhichis
moderatetohighinprotein
lowtomoderateincarbs
moderatetohighinfats
caloriedeficient
Asexplainedinchapter6,itsbetterforaninsulinresistantindividualtostayonalowor
moderatecarbdiet.
Proteinisthemostsatiatingmacronutrientandwillallowyoutoloseweightwithless
hunger.Itwillalsohelppreservemusclemasswhichisimportantforaesthetics,functionality
andpreservingcalorieburn.Theamountofcaloriesyouburnperdayatrestisdirectly
relatedtoyouramountofleanmassorfatfreemass.RemembertheKatchMcArdle
formula?Thatswhyyoushouldtrytopreserveasmuchfatfreemass,i.e.muscle,as
possiblewhilelosingweight.
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Dietaryfatsdonotcauselargeelevationsofinsulinorbloodsugarandaretherefore
acceptabletoeat.Specifictypesoffatstoeatoravoidhavebeendescribedinchapter6.
Withalloftheabovesaid,stickingtoaperfectdietisntalwayseasy.Whicheverdietyouare
eatingrightnow,whetheritslowcarborlowfatorhighproteinorjusttheSAD(Standard
Americandieti.e.prettyunhealthy),simplyeatinglesswillgiveyoubetterinsulinand
bloodsugarintheshorttermandlongtermbecauselessinsulinisrequiredtometabolizea
smallerfoodintakeandtherewillbelesscarbswhicharetheprimarydriverofhighblood
sugar.
So,your#1priorityifyouhaveexcessfattoloseshouldbetoeatfewercaloriesthanyou
burn.
Your#2priorityshouldbetogetenoughprotein.
HowmuchproteinshouldIeat?
Forweightloss,itisrecommendedthatyoueatabout1gramsperpoundofleanbodymass
perday,or2.2gramsperkgleanbodymassperday.
Thatswhyithelpstoknowyourbodyfatpercentage,sothatyoucancalculateyourlean
bodymass.Forexample,ifyourbodyweightis220pounds(100kg)andyouhave30%body
fat,yourleanmassis70%ofyourbodyweight,i.e.0.7x220=154.Youshouldthereforeeat
154gramsofproteinperday.Trytohitthiswithin10%moreorlesseveryday.
HowmuchcarbohydrateshouldIeat?
Totellthetruth,carbohydrateisnotanessentialmacronutrient.Withoutproteinorfatyou
willdie.Butthebodycansurvivewithoutcarbohydrate.Thisisthankstoaprocesscalled
gluconeogenesiswherebytheliversynthesizesnewbloodsugarfromproteinandfat.
Therefore,evenifyounevereatanycarbsyourbloodsugarwillnotfalltozero.
Thedownsidetorelyingongluconeogenesisisthatitsasomewhatslowprocessandit
breaksdownmuscletissuetoconvertintocarbohydrate.Itwillalsoonlymaketheminimum
requiredamountofcarbs.Imsayingallthisjusttoconveythatcarbohydratesarentstrictly
necessarytoconsume.Insulinresistantpeoplehaveaproblemprimarilywithmetabolizing
carbohydrateandthatswhytheyshouldrestrictit.However,Ithinkthatevenaninsulin
resistantpersonshouldbeallowed75200gramsofcarbohydrateperday.
Withverylittlecarbohydratethedietwillbeoverlyrestrictive,blandandboring.Also,since
dietaryfiberiscontainedincarbohydraterichfoods,ifyoucutoutcarbsyouwillalsocutout
fiber.Nocarbsmeansnofiberfromvegetables,nuts,fruits,potatoesandselectedgrains.
Whilefiberisntexactlyessentialeither,itisbeneficialforinsulinresistantpeopletoget
healthyfiberfromtheaforementionedsources,nottomentionvitaminsandminerals
containedincarbohydraterichfoods.
Thehigherendoftherange,i.e.200grams,shouldbereservedforpeoplewhodomore
endurancetrainingorhaveacomparativelymildcaseofinsulinresistance.Themore
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sedentaryandinsulinresistantyouare,thehigheryourbloodsugaris,thelesscarbsyou
shouldideallyconsume,downto75gramsperdayorso.
Bewarethatifyoureeatingmorecarbsnowandstartcuttingyourcarbintake,youmay
experiencelowbloodsugarifyoureondiabetesmedicationsorinjectedinsulin.Peoplewho
arenotonmedicationsorinjectedinsulinwillveryrarelygetlowbloodsugaronalowor
moderatecarbdiet,thankstogluconeogenesiswherebynewbloodsugariscreatedfrom
muscleproteinandfattopreventitfromfallingtoolow.
Ultimately,theamountofcarbohydrateyoueatisuptoyou.Biggerbenefitsinbloodsugar
andinsulinwhichareimportantgeneralhealthindicatorswillbeachievedwithlower
carbintakes,whilesportsperformancewillsufferandthedietwillbequiteboringand
bland.
HowmuchfatshouldIeat?
Dontbeafraidofeatingfat,aslongasitstherightkind.Itsactuallyagoodthingwhen
youreinsulinresistantbecauseitdoesnotcausebigelevationsofinsulinorbloodsugar.
Gettingenough,andtherightkind,offatisactuallymoreimportantthangettingyour
carbohydrates,sincethereareessentialfattyacidsinfoodthatyouwilldieifyoudontget.
Also,eatingtoolittleornofatwillcauseyourbiletostagnateinthegallbladderbecausebile
isonlysecretedwhenyoueatfat.Thiscancausegallstones,andcanbeaproblemwhen
dietingwithaverylowfatdiet.
Ithinkitsprudenttoaimforanintakeofatleast50gramsoffatperday.Thiscaneasilybe
achievedevenifyoudropyourcalorieintakeaslowas1200perday.Makesureyougetthis
amount,evenattheexpenseofcarbohydrates.
Therestofthecaloriesthatyouneedaftereatingyourcalculatedproteinandcarbohydrate
intakeshouldalsocomefromfats.
Anexample
LetsassumethatBobis220pounds(100kg),with30%bodyfat.Hisleanmasswouldbe
154poundsor70kg.
Hisbasalmetabolicratewouldbe:371+21.6x70=1883calories.
Letssayhessomewhatactive,withanactivityfactorof1.5.Histotaldailyenergy
expenditurewouldthereforebe1883x1.5=2824calories.
Hewantstodietsomewhataggressivelysincehehasafairamounttolose,andaimsfora
selfselecteddailycaloriedeficitof800.2824800=2024.Thisistheamountofcalorieshes
allowedperday.
Sincehisleanmass(fatfreemass)is154poundsor70kg,he154gramsofproteinperday.
Everygramofproteincontains4calories.154x4=616calories
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Thenheadds50gramsoffatjusttogettheminimum.
Everygramoffatcontains9calories.50x9=450
Hesnowupto616+450=1066caloriesandhas958lefttoconsume.
Hecandividethose958caloriesashewishesbetweencarbsandfat.Hechoosestoadd100
gramsofcarbs.
Everygramofcarbohydratecontains4calories.100x4=400
Histotalintakeisnow1066+400=1466.Sincehewasaimingfor2024calories,hecanstill
eat20241466=558.
Heshouldaddthisasfat,whichcomesoutto558calories/9caloriespergram=62grams.
Healreadyhad50gramsoffatinhiscalculation,sothetotalisnow112grams.
Histotalmacronutrientgoalforthedayis:
154gramsofprotein
100gramsofcarbohydrate
112gramsoffat
2024calories
HowmuchalcoholshouldIconsume?
ThereisonemacronutrientthatIhaventmentioned:alcohol(a.k.a.ethanol).
Myattitudeisthatalcoholisfineinmoderationifyoutrulydonothaveaproblemwithit.I
wouldnotadviceanyonetostartdrinkingalcohol,butifyourealreadyconsumingadaily
lowdose,itsfinetocontinue.
Bingedrinkingshouldalwaysbeavoided,asitisharmfulnotonlyinsideyourbodybutalso
increasestheriskofseriousaccidents.
Typically,whatisconsideredamoderatealcoholintakeis30and15gramsperdayformen
andwomen,respectively.
Everygramofalcoholcontains7calories,soalcoholismorecaloriedensethanproteinor
carbs.Ifyoudoconsumealcoholyouwillofcourseneedtoreduceyourintakeofeither
carbohydrateorfat(preferablycarbohydrate),elseyouwillendupwithanexcessivecalorie
intake.
Forexample,ifyouconsume15gramsofalcoholperday,thatcomesoutto15x7=105
calories.Itwouldthenbeprudenttoreduceyourcarbintakeby105/4=26grams.
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Awordaboutmacronutrientratios
Ihavepurposelyleftoutanyrecommendationsforratios(percentages)of
protein/carbs/fat/alcohol.Itisalmostuniversaltoseerecommendationsindietbookscalling
forX%protein,Y%carbs,Z%fat,Q%alcohol.Thisisusuallyastupidandirrational
approach.
Theproblemwiththisapproachisthelackofscalability.
Letsexamine,forinstance,a20%proteinintake.Ona1200caloriediet,thatwouldcome
outto0.2x1200=240calories.Sinceeverygramofproteinis4calories,thatcomesoutto
240/4=60grams.Thisistoolittleformanypeople(especiallymen)duringaweightloss
diet.
However,letssaysomeoneisveryactiveandburns3000caloriesperdayandwantsto
reduceintakeby500andthusaimsforanintakeof2500caloriesperday.
0.2x2500=600caloriesfromprotein.
600/4=150gramsofproteinperday.Thiswouldbeclosertoanappropriateintakeforthe
averagemale.
Thesamewouldbetrueforratiosofcarbs,fatandalcoholbutIwillspareyouthemath.
Someonewhohasahighcalorieexpenditurecouldendupwithexcessiveamountofcarbs
andalcohol,andsomeonewithalowcalorieexpenditurecouldendupwithtoolittleprotein
etc.
Sodontworryabouthowyourratiosendupfornow,itsnotimportantrightnow.
Which Foods To Focus On

Nowthatyouknowyourdailymacronutrientandcaloriegoal,itistimetosetupyourown
menu.
Again,Ihaveavoidedanyonesizefitsallplans,becauseIdontknowwhichfoodsYOU
enjoyandtolerate.SoIllletyoupickandchooseyourself.ThesearefoodsthatIfind
preferablebecausetheyarelargelywhole,unrefined,naturalandweevolvedtoeatthemor
cantoleratethemwell.
Proteinrichfoods
Eggs
Oilyfish(salmon,mackereletc.)
Anyotherfish
Pork(preferablylean)
Beef(withorwithoutitsfat)
Anyotherredmeat
Organs
Poultry
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Proteinpowder(preferablyeggproteinforaninsulinresistantperson,butwheyandcasein
arealsookinsmallamounts)
Carbohydraterichfoods
Broccoli
Brusselssprouts
Cauliflower
Spinach
Squash
Zucchini
Sauerkraut
Pumpkin
Greenpeas
Onion
Garlic
Greenleafyvegetables
Avocado
Cucumber
Tomato
Bellpeppers(excellent,underratedvegetable,especiallyredandorange)
Virtuallyanyothervegetable
Berries,anykind
Carbohydraterichsmallamounts
Fruits,anykind
Carrots
Oatmealwithoutextrafiber/bran
Quinoa(white)
Potatoes,anykind
Sourdoughbread
Whiterice
Buckwheat
Amaranth
Dextrose/glucosepowder
Maltodextrinpowder
Thereasonthislatterlistshouldideallybelimitedwhileyoureinsulinresistantisthatit
doesntprovidemuchbangforthebuck.Thesefoodsareprettycarbdenseandcalorie
densesoitwillquicklyfillupyourcarballowance,whilenotaddingterriblymuchfiberor
vitaminsandminerals.Vegetablesandberriesaresuperiorinthatregard;theyallowyouto
eatmuchgreatervolumesandgetmorefiber,mineralsandvitaminswithoutgoing
overboardwithcarbsandcalories.
Forexample,youcouldeatalotmorevolumeandweightofcauliflowerthanpotatoes
withoutexceedingyourcalorieandcarbohydrateallowance.
Fats
Oliveoil(moderateamounts)
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Macadamiaoil
Fatfrombeefandlamb
Butter
Cream
Coconutoil(canberefinedsothecoconuttasteisgone)
Palmoil
Palmkerneloil
Oilyfish
Omega3supplements(dontgooverboardwiththese)
Fatfromeggs
Nuts,anykind(smallmoderateamounts)
Alcohol
(Onlyinmoderateamountsandifyoutrulydonthaveaproblemwithit!)
Wine
Beer
Liquor,preferablywithouttoomanyadditives
Which Foods To Limit

Therearesomefoodswhicharebetteravoidedorlimitedforinsulinresistantpeople,andin
general.Herearesomeofthose.
Wheyproteinpowder(veryinsulinogenic,willcauselargeelevationsofinsulin)
Caseinproteinpowder(insulinogenic)
Milk(insulinogenic)
Cheese(insulinogenic)
Derivativesofmilk,suchasmilkshakesandicecream
Fastacting,lowfibercarbohydratessuchasrefinedsugar,dextrose,maltodextrin,
honey
Cakes,cookies,candy,sweets,deserts
Whiteflour
Prepackagedorfrozenorreadytoeatorprocessedfoodwhichisoftenfullof
preservatives,additives,thewrongkindoffats,toomuchcarbohydrateandtoolittle
fiber.Additionally,oftentreatedwithhighheattobecomeevenunhealthier
Anyjunk
Mostrestaurantfoodsusuallyimpossibletocountcalories.
Mostvegetableoilssuchascanola,rapeseed,corn,soybean,sunflower,mostnut
oils.
Beansandlegumes
Whole,unrefinedgrainproducts
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A Word About Iron Reduction

Whenviewingthelistsabove,keepinmindtoselectappropriatefoodsifyouneedtoreduce
ormaintainyourironlevels.Anironreducingdiethasbeenpresentedinchapter2andwill
notberepeatedhere.
Understanding the IIFYM Philosophy

TheresadietaryphilosophysometimescalledIIFYMifitfitsyourmacros.Whatthisrefers
toisthatyoucaneatANYTHINGwhileyouredieting,aslongasitfitsyourmacronutrient
andcalorieallowance.Itscompletelyuptoyouwhatyouwanttoeat.Youwillloseweight
aslongasyoucreateacaloriegap.However,thelistsIhavepresentedabovewillhelp
reduceyourbloodsugar,insulinandhunger,andpreservemusclemass.
Nevertheless,somepeoplemightwanttotakesomelibertiesandeatwhatevertheyplease.
Thebenefitsofthatmayincludeincreasedsanityandincreasedadherencetothecalorie
gap.Thatwayyouneverhavetofeeldeprivedofanythingonyourdiet,exceptcaloriesthat
youwillhavetodepriveyourselfofinordertolosefat.
Ontheotherhand,eatingjunkfood,sugarandsnackswiththeintentiontokeepitwithin
yourcalorieallowancecaneasilyspiraloutofcontrolandleadtouncontrolledbingeeating.
Somepeopledobetteronahealthydiet,evenifitssomewhatblandandboring,because
theylosecontroleveniftheyeatalittlebitofjunk/sugar/snacks.Otherpeoplecaneatthose
foodsandstillsticktotheircalories.
Youllhavetodecidewhatworksbestforyou.Irecommendyousticktohealthyfoods,but
Imthefirsttoadmitthatitsentirelypossibletoloseweightevenonajunkfooddiet.
Constructing Your Diet

Nowitsuptoyoutoconstructyourownfatlossdiet.Itsactuallynothardatall,because
youlllikelybeeatingyourfavoritefoodsoverandoveragain.
Useadatabasesuchaswww.nutritiondata.comtosearchforfoodsthatyouwishtoeat,and
howmanycaloriesandmacronutrientstheycontain.Thenyousimplyweighormeasure
everythingyoueatandwriteitdownonasheetofpaperorinyoursmartphoneandtryto
hityourcaloriesandmacronutrients.
Forexample,letssayBobenjoyseatingeggs,blueberries,skinlesschickenbreast,broccoli
andbutter.
Heaimstohitthesemacronutrients:
154gramsofprotein
106
112gramsoffat
2024calories
Hestartsbylookingupeggsonnutritiondata.com.Hefindsthat1largeeggis6gramsof
protein,0gcarbs,5gfat,71calories.Heenjoyseating5boiledeggsperdaywhichcomes
outto30gprotein,25gfat,355calories.(Seetablebelow)
Helooksupskinlesschickenbreastandfindsthat100gramscontains23P,0C,1F,110
calories.Heneeds15430=124gramsofprotein.
Itcomesoutto124/23=5.39servingsof100gramseach,or539grams(19ounces),which
equals593calories.
Hesteamsthiswithapound(450grams)ofbroccoli.100gramsofbroccolicontains3P,7C,
0Fand34calories,sothatcomesoutto13P,31Cand153calories.
Note:Imnotcountingtheproteininthebroccolitowardsthetotaldailygoal,becauseplant
proteinisnotcompleteandisntidealforbuilding/preservingmuscle.
Afteraddingthebroccoli,hestillhas10032=68gramsofcarbtoeat.
Headds250grams(8.8ounces)blueberries,thetotalofwhichcanbeseeninthetable
below.
Headds40gramsofbuttertothebroccoli.
HestillhascaloriesleftanddecideshewantstoeataBigMac.
Afteraddingthis,heseesthathesabithighinproteinforthedayandcutsdownonthe
chickenfrom19ounces(539g)to400g(14.1ounces)
Food
Protein Carbs Fat Calories
5largeeggs
30
0
25
355
14.1ounces(400g)skinlesschickenbreast
92
0
4
440
1pound(450g)broccoli
14
32
0
153
250g(8.8ounces)blueberries
3
35
0
143
40g(1.4ounces)butter
0
0
32 287
1BigMac
25
45
29
540
Total
164of
112 90
1918
which147
ofanimal
origin
Hehithistargetsprettywellwiththissimplemenu.Again,theywere:
154gramsofprotein
107
112gramsoffat
2024calories
Ifhewantedto,hecouldaddsomemorefatandcalories,forexamplebyaddingan
appropriateamountofwhippedcreamtotheblueberries.
Seehowthisworks?Iliterallyputthismenutogetherin20minutes,andthisisnothinglike
whatIusuallyeat.Itsnothardtodoatall,andonceyougetusedtoityouwillseethat
youreprobablyeatingthesamefoodsregularlysoitgetseveneasierwithtime.Thebest
partisthatyoucanaddANYTHINGyouwanttoeat,ifitfitsyourmacros.
Remember,themostimportantthingstohitareyourcaloriesandyourproteinintake,and
thebulkofyourproteinintakeshouldcomefromcompleteproteinfoods.
Are There Alternatives To Calorie Counting?

Ofcourse.Youcouldjusteatlessfood.Smallerorfewerportions.Youcanlosealltheweight
youwantbyjustlimitingcalorieintakeorincreasingphysicalactivity,orboth,whilebeing
cluelessaboutnutritionorcalories.
Thefollowingisanexampleofaprovendietthatleadtoanaverage5.0kg(11pounds)
weightlossover12weekswithoutcountingcaloriesinmalevolunteerswithlargewaist
circumference.[Alsomentionedinchapter6]
APaleolithic(stoneage)dietwaspitchedagainstaMediterraneandiet.Twentynineheart
diseasepatients,mostofwhomwereinsulinresistantasevidencedbyhighbloodsugaror
knowntype2diabetes,wererandomizedtoeat1of2dietsfor12weeks.ThePaleodietwas
basedonleanmeat,fish,fruits,leafyandcruciferous[e.g.broccoli]vegetables,root
vegetablesincludingrestrictedamountsofpotatoes,eggsandnuts.TheMediterraneanlike
dietwasbasedonwholegraincereals,lowfatdairyproducts,potatoes,legumes,
vegetables,fruits,fattyfishandmonounsaturatedrefinedfatsandalphalinolenicacid[a
typeofplantderivedomega3fat].
ThefollowingadvicewasgiventothePaleodietgroup:
Increaseintakeofleanmeat,fish,fruitsandvegetables
Avoidallkindsofdairyproducts,cerealsincludingrice,beans,sugar,bakery
products,softdrinksorbeer
Thefollowingwereacceptedinlimitedamounts:eggs(oneorfewerperday),nuts
(preferentiallywalnuts),potatoes(twoorfewermediumsizedperday),rapeseed
oroliveoil(oneorfewertablespoonsperday)
Theintakeofotherfoodswasnotrestrictedandnoadvicewasgivenwithregardto
proportionsoffoodcategories
Bothgroupslostsimilaramountsofweight(5.0kg(11pounds)inPaleovs.3.8kg(8.4
pounds)inMediterranean;notastatisticallysignificantdifference)butwaistcircumference
andpostmealbloodsugardecreasedmoreinthePaleogroup.Thedecreaseinpostmeal
108
bloodsugarwasnotexplainedbyreducedweightorwaistcircumference,hintingthatdiet
compositionwasresponsible.
ThedietaryadvicegiventothePaleogroupledtoincreasedintakesoffruits,vegetablesand
nutsanddecreasedintakeofcereals,milkanddairyproductsandoilsandmargarines,which
ledtoareducedcarbohydrateintakeandspontaneouslyreducedcalorieintake.
12of14heartdiseasepatientsplacedonaPaleodiethadhighbloodsugarlevelstobegin
with(10ofthose12haddiabeticbloodsugar).After12weeksonthediet,allofthemhad
normalbloodsugar.Insulinsensitivityimprovedaswell.Thiswasmuchbetterthanthe15
patients,ofwhich13hadhighbloodsugaratbaseline,whowereplacedonaMediterranean
dietfor12weeks.Afterthatdiet,7ofthemstillhadelevatedbloodsugar.
Quotedfromthestudy[theresult]suggeststhatavoidingWesternfoodsismore
importantthancountingcalories,fat,carbohydrateorprotein.Thestudyaddstothenotion
thathealthydietsbasedonwholegraincerealsandlowfatdairyproductsareonlythe
secondbestchoiceinthepreventionandtreatmentoftype2diabetes.[5]
Moreover,inaseparateanalysisofsatietyofthe2diets,itwasfoundthatthosewho
consumedthePaleodietwerejustassatiatedasthosewhoconsumedtheMediterranean
diet,eventhoughthePaleogroupconsumedlesscalories.[6]
Thereyouhaveit,agreatexampleofahealthy,simpledietthatleadtoweightlosswithout
caloriecounting.Ofcourse,youCOULDstillgainweightonsuchadiet,ifyoureallytried
hardtostuffyourselfwithcalories,butthepointisthatmostlikelyyouwouldspontaneously
reducecaloriesbystickingtosuchadiet.Moreover,youdmorethanlikelyimproveinsulin,
bloodsugar,waistcircumferenceetc.
Intermittent Calorie Restriction

Traditionally,mostweightlossmethodshavebeenbasedonchroniccalorierestriction
(CRR),theideabeingthatcaloriesarerestrictedeveryday.AnalternativetoCRRis
intermittentcalorierestriction(ICR),whichrevolvesaroundrestrictingcaloriesperiodically.
Acommonformofintermittentcalorierestrictioniscalledalternatedayfasting(ADF).There
aredifferentvariationsbut,typically,youdconsumenocalorieseveryotherdaywhilebeing
allowedtoeatadlibitum(asmuchasyouwant)everyotherday.AvariationofADFisMADF:
modifiedalternatedayfasting.Itbasicallymeansthatyoureallowedtoeatasmallamount
offoodonthefastingdays,whileeatingadlibitumonthefeedingdays.
OtherformsofICRhavealsobeentested,suchas2consecutivedaysofcalorierestriction
followedby5daysofadlibitumeating.
Intermittentcalorierestrictionmaybeattractivetosomeindividuals,becauseyoudont
havetorestrictcalorieseveryday.Thismaybeeasiertohandleforsomepeople.
109
ArecentreviewbyVaradypublishedin2011comparedstudiesonCCRversusthoseonICR
toseewhichwasmosteffectiveforweightloss.Itsimportanttonotethatthereview
examinedonlystudiesonoverweightorobeseadultswithoutdiabetes.Mostofthestudies
restrictedcaloriesby75100%ofcalorierequirementsonthefastingdayandallowedad
libitumeatingonthefeedingday.
Weightlossvariedbetween1and8percentover2to12weeksandtendedtobegreaterthe
longerthestudieslasted.
Theseresultswerecomparabletochroniccalorierestriction.Ontheotherhand,itwas
concludedthatICRmayleadtoincreasedfatlossspecificallyandreducedlossoffatfree
mass(muscle,bone,organs,wateretc.),whichmightbeabenefitofICRoverCCR.[7]
Arecenttrialsubjected16obese,lightlyactivevolunteersto8weeksofMADFprecededby
a2weekweightmaintenancephase[11].Theywereinstructedtoeat25%oftheirbaseline
energyrequirements(basalmetabolicratewithoutaddedactivitymultiplier)everyotherday
andadlibitumeveryotherday.Theyreceivedinstructiononhealthyfoodchoices,suchas
lowfatdairyandmeatandmorefruitandveggies,forthefeedingdays.
Theylostaround5%oftheirinitialbodyweightover8weeksandmaintainedtheirinitial
activitylevels(theywereprettysedentary).
Interestingly,ratingsofhungerwerehighduringthefirsttwoweeksofthemodified
alternatedayfastingphase,butsubsequentlydeclinedandremainedsignificantlylowerfor
theremaining6weeks,indicatinganadaptationtothefeedingpattern.Satisfactionwiththe
dietalsoincreasedfromweek4,butratingsoffullnessremainedlowthroughoutthediet.
Truealternatedayfasting,wherenocalorieswereallowedonthefastingdaybutadlibitum
intakewasallowedonthefeedingday,hasalsobeentestedinhumans.Sixteennonobese
individualsunderwentADFfor22days.Theywereinformedthattheywouldhaveto
consumedoubletheirnormalintakeonthefeedingdaytomaintaintheirweight,butwere
allowedtoeatasmuchoraslittleastheywantedonthefeedingday.
Theylost2.5%oftheirbodyweightand4%bodyfat.Fastinginsulinandbloodsugardidnot
changeasmeasuredafterfastingfor12hours.Unfortunately,ratingsofhungerincreasedon
day1andremainedelevatedonthefastingdaysduringtheentirestudy.
Nevertheless,thisstudysuggeststhathumansmightnotfullycompensateduringthe
feedingdayforenergylostduringthefastingdayintheshortterm(22days).[12]
Anotherwayofimplementingintermittentcalorierestriction,whichhasbeentestedin
humans,is2daysofseverecalorierestrictionfollowedby5daysofcaloriebalance(neither
weightlossnorweightgain).
Inarecentstudy[10],107womenbetween30and45yearsandaBMIbetween24and40
(overweightorobese)whohadgainedsubstantialweightsinceage20wererandomly
assignedtoeither2dayperweekcalorierestrictionor7day/weekchroniccalorierestriction
110
for6months.Incidentally,thisisthelongestintermittentcalorierestrictionstudyforweight
lossinhumansthatIamawareof.
Thechroniccalorierestrictionwasdesignedtoreducethewomensenergyintakeby25%
belowtheirrequirementseveryday,whiletheintermittentcalorierestrictionwasdesigned
toreducecalorieintakeby75%belowestimatedrequirementsfor2daysperweek.The
womenintheICRgroupwereinstructedtoeat100%oftheirestimatedcalorierequirements
theother5daysoftheweek.
Bothgroupslostacomparableamountofweight(about78%in6months)andfat,but
therewasatrendtowardsagreaterreductionofwaistcircumferenceintheintermittent
calorierestrictiongroup.
BothgroupshadcomparablereductionofLDLcholesterol,totalcholesterol,triglyceridesand
bloodpressure,andnochangeinHDLcholesterol,buttheICRgroupachieved16%lower
fastinginsulinlevelsand45%lowerinsulinresistancethantheCCRgroup.
TheICRgroupreportedreducingcaloriessomewhatmorethantheCCRgroup.Afterthe
study,58%intheICRgroupintendedtocontinuethediet,comparedto85%intheCCR
group.
Therewerenomajornegativesideeffectsofeitherdiet,butmorecomplaintsofhungerin
theICRgroup:15%ofparticipantsvs.0%intheCCRgroup.
Fewpeopleexperiencehealthrelatedsideeffectsduringthefastingperiods,andmostcan
sticktothem.However,hungerhasreportedlybeenaproblemforsomepeople[10].
Alternatedayfastingmaynotbeagoodideatoimplementforaveryextendedtime,
however.
Whenratswerekeptoneitheralternatedayfastingornormaladlibitumeatingfor6
monthsstartingat4monthsofage,theADFratsdevelopeddiastolicdysfunction[8],aheart
problem.ThisisclearlyanegativedevelopmentafterADFintheserats.However,itshould
benotedthattheseratsliveonly2436months[9],sotheequivalentforhumanswouldbe
alternatedayfastingforperhaps16years.Moreover,theseratswerestartedonADFquite
earlyinlife.Nevertheless,thestudyshowsthatweshouldbecautiousaboutADFinthelong
term.
Overall,Imnottruingtoarguefororagainstintermittentcalorierestriction.Immerely
presentingitasanalternativethatmaybeeasiertoimplementforsomepeople.
Insummary,ICRpresentsanewweightlossmethodthatmayresonatewithsome
individuals.Ithasbeenshowntobesafeandeffectiveinhumansforupto6months.The
downsidetoICRmaybereducedsportsperformanceandincreasedriskofaccidentsonthe
fastingday,duetolessenergyandslowedreflexes.Also,hungermaybeaproblembut
mightbereducedovertimeasthebodyadaptstothispatternofeating.Peoplewhoare
usingoraldiabetesmedicationsorinsulinshouldrefrainfromthistypeofeatingpatternor
111
getclearancefromtheirdoctor,becauseitmightcauselowbloodsugarevents.Thesame
goesforindividualsonothermedicationsthatmaybeaffectedbydiet.
Overtheverylongterm,itmaybewisetoavoidintermittentcalorierestrictionuntilwe
knowmoreabouttheeffects.Butasatoolforweightloss,itdoespresentaviable
alternative.
MyExperienceWithIntermittentCalorieRestriction
Iveattemptedmodifiedalternatedayfasting,i.e.eatingveryfewcaloriesmainlyintheform
ofproteineveryotherday,andeatingconsiderablyaboveenergyrequirementseveryother
day.
Ionlylasted1weekonthisprotocol:4fastingdaysand3feedingdays.
Theproblemwiththisapproachformewas
1. Myactivelifestyle.Isimplycouldntexerciseasusualduetotheverylowcalorie
intakeeveryotherday
2. Lowheartrateandbloodpressure.WhenItriedMADF,Iwentintoitwithlowblood
pressureandlowheartratealready,duetoprolongeddieting.Inmyexperience,
MADFwasevenharsheronthesevariablesthanchroniccalorierestriction,even
whentheaveragedailycaloriegapwasequal.TheMADFslaughteredmyBPandHR
andmyabilitytoexerciseandIcouldnotsticktoit.
Ithinkalternatedayfasting,modifiedalternatedayfasting,andotherintermittentcalorie
restrictionregimensarebettersuitedforpeoplewithnormalorhighbloodpressureand
heartrate,whoarealsooverweightorobeseandprettysedentary.Underthose
circumstances,intermittentcalorierestrictionmightprovetobemuchmorefeasible.
Exercise
Strengthtrainingandendurancetrainingarebeneficialagainstinsulinresistanceeven
withoutweightlossandshouldbeimplemented.Theamountofexerciseyoudowill
influenceyouractivityfactor.
Whenitcomestoweightloss,apartialreductionofcalorieintakeandapartialincreasein
expenditureisusuallymorerealisticthanreducingcaloriesalone.Thatswhereexercise
comesin,too,becauseitisthetoolforincreasingcalorieexpenditure.
Ifyoudoalotofhighintensityendurancetrainingorsports,youcanallowyourselfmore
carbohydrates.Justkeepinmindthatwhileyoureinsulinresistantyoustillhaveaproblem
metabolizingcarbohydrates.Youcandoit,butattheexpenseofhighinsulinandblood
sugarlevelsbadthings.Trytosticktolowglycemicindexcarbohydrates.
112
Pre- and Post-Workout Nutrition

Whilenotterriblyimportantinthebigpicture,howyoueatbeforeandafteraworkoutcan
makeadifference,especiallyinthelongrun.
Briefly,itisalwaysagoodideatoeatsomecompleteproteinsuchasmeat,fish,poultryor
eggsbeforeanyexercise,beitstrengthtrainingorendurancetraining.
Itdoesnthavetobeimmediatelybefore,acoupleofhoursbeforeshouldbefineaslongas
itsafairamountofcompleteandslowdigestingproteinlikemeat,fish,eggsorpoultry.
Afterstrengthtrainingitsagoodideatodrinkaproteindrinkimmediatelyafterthe
workout,asthiswillhelptorecoverandrepairthemusclesandhelpthemgrow.Themost
commonandpopularchoiceiswheyproteinpowdermixedwithwaterormilk.However,
thatwillcauseahugeinsulinspike,whichistypicallynotwhataninsulinresistantindividual
wants.Therefore,itsbestforaninsulinresistantpersontoconsumeeggproteinmixedwith
water,astheinsulinspikewouldbelower.Twentyfivegramsofproteinisagoodstarting
pointimmediatelyafterastrengthtrainingsession.
Afterthat,trytoconsumeaproteinrichmealwithin60120minutesasthiswillfurtheraid
yourrecovery.However,alwayskeepinmindthatcaloriesareking;alwayssticktoyour
calorieallowanceevenifthatmeanssacrificingsomeproteinbefore/afteraworkout,
althoughifyouveplannedcorrectlythisshouldnotbeaproblem.
Summary
Insulinresistantindividualsandthosewithhighbloodsugarlosejustasmuchweightfrom
calorierestrictionasothers.
Acaloriedeficitwillalwaysleadtoweightloss.Withoutacaloriedeficitnoweightloss(from
bodyfat)willoccur.Ifyourenotlosingbodyfat,youneedtocreateacaloriedeficit.
Themostimportantthingwhileattemptingtolosefatistorespectyourcaloriedeficit.The
nextimportantthingistogetenoughprotein.Itisalsoessentialtogetenoughfats,including
omega3fats.Itsbesttolimitcarbohydrateaslongasyoureinsulinresistant,butsome
carbohydratecanbeconsumed.
Irecommendstickingtohealthyfoods,butyoucaneatanythingaslongasyoucreatea
caloriedeficit.Eatinghealthywillnotautomaticallyleadtoweightlossacaloriedeficit
mustalsobecreated.Ifyouregoingtoeatunhealthy,Irecommendyousupplementwith
vitaminsandmineralsandpossiblyfishoil.
Youcanuseformulastoestimateyourtotaldailyenergyexpendituremultipliedbyan
activityfactordependingonhowphysicallyactiveyouare.Thiswillgiveyouanideahow
manycaloriesyouneedtomaintainyourweight.Toloseweight,subtractanappropriate
amountofcaloriesfromyourTDEE.
113
Youcanconstructyourowndietwithanyfoodsyouwantwhenyoucountcalories.You
donthavetocountcalories,however.Manypeoplewillspontaneouslyloseweightona
healthydiet.Anexampleofsuchadiet(Paleolithic)hasbeenpresentedinthischapter.Its
alsopossibletoloseweightjustbyeatingsmallerorfewerportionsand/orincreasing
physicalactivity.
Intermittentcalorierestrictionisanalternativetochroniccalorierestrictionthatmightsuit
somepeoplebetter.
Exerciseorphysicalactivityisusuallyhelpfulforlosingweight,becauseitallowsyoutoeat
morefoodsoyoudonthavetofeelsodeprived,whilestillcreatingacaloriedeficit.
Rememberthatevenamodestamountofweightloss,like5%ofbodyweight,willbeginto
havepositiveeffectsonyourhealth.
Mostofall,achievingandmaintainingahealthybodyweightisalongtermchallenge,soits
importanttoestablishbehaviorsthatyoucanstickto.
114
Terminology
Adlibitumatonespleasure.Eatingadlibitummeanseatingasmuchoraslittleasyoufeel
like.
(Pancreatic)betacellsCellsinthepancreasthatproduceandsecreteinsulin.Iftheyare
damaged,deadordysfunctional,bloodsugarproblemscanariseduetolackofinsulin.
BloodsugarcontrolYourbodysabilitytokeepbloodsugarinthenormalrange.Itis
dependentuponinsulinsecretionbythepancreasyourcellssensitivitytosaidinsulin,aswell
asotherfactors.
BMIBodyMassIndex;acrudesurrogatemeasureofapersonsdegreeofbodyfat.A
personsbodyweight(inkilograms)isdividedbyhisorherheight(inmeters)squared.
Example:Givenabodyweightof70kg(154pounds)andaheightof1.74meterstheBMI
wouldbe70/(1.74x1.74)=23.12.ThereareBMIcalculatorsonlinethatdoalltheworkfor
you.2025isconsiderednormal;2530overweight;30andupobese;below20underweight.
CentralfatdistributionWhenapersonstoresmuchofhisorherfatontheabdomen(belly
fat)orintraabdominally.Theoppositeisperipheralfatdistribution.
CPAPContinuouspositiveairwaypressure,atreatmentagainstobstructivesleepapnea
(OSA).
FastingorfastedstatedWhennofoodorbeveragehasbeenconsumedinalongwhile,
usually1012hours.
Ferritinaproteinthatactsasastoragedepotforironatoms.Itcanbemeasuredbythe
bloodtestserumferritin.Itis,undermostcircumstances,indicativeofapersonstotalbody
ironstores,i.e.highserumferritinmeanshightotalbodyironstores.Theexceptionisunder
conditionsofchronicoracutediseasewhenserumferritincanbeextrahighwithouttotal
ironstoresbeingelevated.
GlucoseAsimplesugarthatthebodyusesforenergy.Itisidenticaltobloodsugar.Outside
thebodyitiscalledglucose,whileinwholeblooditiscalledbloodsugarandinplasmaitis
calledplasmaglucose.ThechemicalformulaisC6H12O6.Itcanbepurchasedandusedasa
sweetener.Itisalsousedintheoralglucosetolerancetest(OGTT).
115
HbA1CAparticleinthebloodmeasuredbyabloodtestwiththesamename.Diabetics
usuallyknowtheirHbA1Cvalue,whilenondiabeticsusuallydonot.Itmeasures
predominantlylongtermbloodsugarlevels.AhighHbA1Cmeansthepersonhashadhigh
bloodsugarforthelast120days.Lowerisbetter.Itcanbesaidtobeamarkerofdiabetes
severity.
HepaticSomethingthatrelatestotheliver
HOMAIRHomeostaticModelAssessmentofInsulinResistance.Arelativelysimple
measureofinsulinresistancecalculatedbymultiplyingfastinginsulinbyfastingplasma
glucose.Tocalculatethisyouneedtomeasurefastinglevels(i.e.afternofoodordrinkfor
1012hours)ofinsulinandglucose,whicharethenenteredintoanequationlikethis:
HOMAIR=InsulinxGlucose/22.5
InsulinshouldbeinsertedinmU/Landglucoseinmmol/L.Ifyourglucosevalueisgivenin
mg/dl,usethefollowingformula:
HOMAIR=InsulinxGlucose/405
HOMAIRmeasuresyourinsulinsensitivitybycheckinghowmuchcirculatinginsulinis
requiredtokeepyourplasmaglucoseatacertainlevel.Lowerinsulinorlowerglucose,or
both,wouldthusgivealowerinsulinresistance,andalowerHOMAIRvalueisbetter.This
correlateswellwiththehyperinsulinemiceuglycemicclampmethod.
ImpairedglucosetoleranceElevatedbloodsugar2hoursafteranoralglucosetolerance
test(OGTT).Impairedglucosetoleranceischaracteristicofaprediabeticstate.
Insulinahormone,producedandreleasedbythepancreas,whichhasmanyrolesinthe
humanbody.Itisperhapsbestknownforbringingdownbloodsugar.
InsulinresistantThestateofhavinginsulinresistance,orreferringtoapersonwhohas
insulinresistance.Thereisnotruedefinitionofthisstatesince,eveninthehealthy
population,insulinsensitivityvaries600800%amongindividuals.Wecouldcallpeople
insulinresistantwhoare,forinstance,amongthe25%leastinsulinsensitiveinthe
population,butthatwouldjustbeanoperationaldefinition.
InsulinsensitivityAmeasureofhowwellyourcellsrespondtoinsulin.Sensitivitytoinsulin
varies600800%amongindividualseveninthehealthypopulation.Higherinsulinsensitivity
meanslowerinsulinresistanceandviceversa.Highinsulinsensitivityisthereforegood.
IntraabdominalfatFatwithinthecavityformedbytheabdominalmusclesandtheback
muscles,i.e.fataroundtheinternalorgans.Asubtypeofintraabdominalfatiscalled
visceralfat.IAFcausesabloatedappearanceandalargewaistcircumference,evenifthe
individualisotherwiselean.Thisisthemostdangerouskindoffatanditcausesinsulin
resistance.
116
IntrahepaticInsidetheliver
IRInsulinresistance.Alessthannormalresponseofvariouscellsortissuestotheeffects
ofinsulin.
Metabolicallyobese,normalweightindividual(MONW)Apersonwhoisnotobeseornot
evenoverweight,i.e.typicallyintheBMI2025range,giveortake,yetdisplaysIRand
possiblyrelatedcomplicationsandcarriesexcessintraabdominalfat,evenwhentotalbody
fatislow.Itseemstobethepredominantlycentralbodyfatdistributionthatcausesthe
condition.
OGTT;OralGlucoseToleranceTestAdiagnostictestthatyourdoctorcanorderthat
measuresyourbloodsugarcontrol.Alsoasomewhatcrudewaytomeasureinsulin
sensitivity.Itinvolvesdrinkinginthefastedstate75grams(roughly20teaspoons)ofglucose
dissolvedin250mlofwater.Sinceglucoseisthesameasbloodsugaritdoesntneedtobe
metabolizedandentersthebloodstreamrapidly,obviouslyleadingtoincreasedbloodsugar
levels.Yourbodysabilitytoclearthebloodsugarfromthebloodstreamgivesanindication
ofyourinsulinsensitivity.Typically,bloodsugarismeasured2hoursafterdrinkingthe
solution,aftersittingquietlyfor2hours,andthevaluewillgiveindicationsaboutyourblood
sugarcontrol.
However,itmustbementionedthattheOGTTdoesntexclusivelymeasureinsulin
sensitivity.Yourbodysabilitytobringdownbloodsugarisdependentupon(primarily)
Insulinsecretionfromthepancreas
Insulinsensitivity(i.e.theresponseofcellstothatinsulin)
Ifanyoftheseareimpaired,yourbloodsugarcontrolwillbeimpaired.Soahigh2hour
OGTTvalue,i.e.alotofglucoseleftintheblood2hoursaftertheglucosedrink,indicates
eitherimpairedinsulinsensitivityorimpairedinsulinsecretion,orboth.Therefore,itsnota
perfectmeasureofinsulinsensitivityperse.Nevertheless,ahigh2hourOGTTvalueisoften
astrongsignofinsulinresistance.Itsbestusedfordiagnosingprediabetesortype2
diabetes.Additionally,ifyoukeepimprovingintheOGTTyoureprobablyincreasingyour
insulinsensitivity.Seetheintroductorychapterformoreinfo.
OSAObstructiveSleepApnea.Aconditioninwhichapersonhastroublebreathingduring
sleep,oftencompletelyunknowingly.Commonintype2diabeticsandmaybecausedby
excessintraabdominalfat.
PeripheralfatdistributionWhenapersonstoresmostofhisorherfatonthehips,
buttocks,legsandupperbodyexceptontheabdomenandintraabdominally.Theopposite
iscentralfatdistribution.
PhlebotomyBloodletting/withdrawal.
PostprandialTheperiodaftereatingsomething
117
SubcutaneousfatFatimmediatelyundertheskin.Thisisthefatresponsibleforlargeskin
foldsthatyoucanpinchwithyourfingers.
VisceralfatAsubtypeofintraabdominalfat.Believedtobeamaincauseofinsulin
resistance.
WHRWaisttohipratio.Anestimateofhowmuchdangerousintraabdominalfataperson
has.Ahigherratioisworse.
118
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14.MasternakMM,PaniciJA,BonkowskiMS,etal.InsulinSensitivityasaKeyMediatorofGrowthHormoneActionson
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15.KimSH,ReavenGM.InsulinResistanceandHyperinsulinemia.Youcanthaveonewithouttheother.DiabetesCare
2008;31:14331438.http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2453638/?tool=pubmed
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Chapter 1 Body fat and insulin resistance

1.DoYouKnowTheHealthRisksofBeingOverweight?[Internet].WeightInformationNetwork:U.S.DepartmentofHealth
andHumanServicesNationalInstituteofHealth;November2004[updated2010April7;cited2011December27].
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2.WajchenbergBL.SubcutaneousandVisceralAdiposeTissue:TheirRelationtotheMetabolicSyndrome.Endocrine
Reviews2000;21:697738.http://edrv.endojournals.org/content/21/6/697.full
3.BurkeGL,BertoniAG,SheaS,etal.TheImpactofObesityonCardiovascularDiseaseRiskFactorsandSubclinicalVascular
Disease:TheMultiEthnicStudyofAtherosclerosis.ArchInternMed2008;168:928935.
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4.LapidusL,BengtssonC,LarssonB,etal.Distributionofadiposetissueandriskofcardiovasculardiseaseanddeath:a12
yearfollowupofparticipantsinthepopulationstudyofwomeninGothenburg,Sweden.BrMedJ(ClinResEd)1984;289:
12571261.http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1443498/
5.RudermanN,ChisholmD,PiSunverX,etal.TheMetabolicallyObese,NormalWeightIndividualRevisited.Diabetes
1998;47:699713.http://diabetes.diabetesjournals.org/content/47/5/699
6.HayashiT,BoykoEJ,McNeely,MJ,etal.VisceralAdiposity,NotAbdominalSubcutaneousFatArea,IsAssociatedWithan
IncreaseinFutureInsulinResistanceinJapaneseAmericans.Diabetes2008;57:12691275.
http://diabetes.diabetesjournals.org/content/57/5/1269.abstract
7.RossR,AruJ,FreemanJ,etal.Abdominaladiposityandinsulinresistanceinobesemen.AJPEndo2002;282:E657E663.
http://ajpendo.physiology.org/content/282/3/E657.long
8.KltingN,FasshauerM,DietrichA,etal.InsulinSensitiveObesity.AJPEndo2010;299:E506E515.
http://ajpendo.physiology.org/content/299/3/E506.long
9.PreisSR,MassaroJM,RobinsSJ,etal.AbdominalSubcutaneousandVisceralAdiposeTissueandInsulinResistanceinthe
FraminghamHeartStudy.Obesity(SilverSpring)2010;18:21912198.
10.MazzaliG,DiFrancescoV,ZoicoE,etal.Interrelationsbetweenfatdistribution,musclelipidcontent,adipocytokines,
andinsulinresistance:effectofmoderateweightlossinolderwomen.AmJClinNutr2006;84:11931199.
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11. PurnellJQ,KahnSE,SamuelsMH,etal.Enhancedcortisolproductionrates,freecortisol,and11betaHSD1expression
correlatewithvisceralfatandinsulinresistanceinmen:effectofweightloss.AJPEndo2008;296:E351E357.
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12.AasenG,FagertumH,HalseJ.EffectoflossofregionalfatassessedbyDXAoninsulinresistanceanddyslipidaemiain
obesemen.ScandinavianJournalofClinicalandLaboratoryInvestigation2010;70:547553.(abstract)
http://informahealthcare.com/doi/abs/10.3109/00365513.2010.525660?journalCode=clb
13.AasenG,FagertumH,HalseJ.EffectofregionalfatlossassessedbyDXAoninsulinresistanceanddyslipidaemiain
obesewomen.ScandinavianJournalofClinicalandLaboratoryInvestigation2010;70:229236.(abstract)
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14.BurnetDL,ElliottLD,QuinnMT,etal.PreventingDiabetesintheClinicalSetting.
JGenInternMed.2006;21:8493.http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1484626/
15.RaderDJ.EffectofInsulinResistance,Dyslipidemia,andIntraabdominalAdiposityontheDevelopmentof
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17. HairstonKG.,BryerAshM,NorrisJM,etal.SleepDurationandFiveYearAbdominalFatAccumulationinaMinority
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18.BoseM,OlivnB,Laferrre,B.Stressandobesity:theroleofthehypothalamicpituitaryadrenalaxisinmetabolic
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19.GeerEB,ShenW.GenderDifferencesinInsulinResistance,BodyCompositionandEnergyBalance.GendMed.2009;
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20.FerraraCM,GoldbergAP,NicklasBJ,etal.Sexdifferencesininsulinactionandbodyfatdistributioninoverweightand
obesemiddleagedandoldermenandwomen.ApplPhysiolNutrMetab.2008;33:784790.
21.TamCS,ViardotA,ClmentK,etal.ShortTermOverfeedingMayInducePeripheralInsulinResistanceWithoutAltering
SubcutaneousAdiposeTissueMacrophagesinHumans.
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22.LarssonB,SvrdsuddK,WelinL,etal.Abdominaladiposetissuedistribution,obesity,andriskofcardiovasculardisease
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24.PaekKW,ChunKH.SexDifferencesofType2DiabetesAffectedbyAbdominalObesityversusOverallObesity.Yonsei
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AnAdipokineMediatedProcess?.Diabetes2002;51:29512958.
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26.ReavenG,AbbasiF,McLaughlinT.Obesity,InsulinResistance,andCardiovascularDisease.RecentProgHormRes2004;
59:207223.http://rphr.endojournals.org/cgi/content/full/59/1/207
ElksCE,LoosRJ,SharpSJ,etal.GeneticMarkersofAdultObesityRiskAreAssociatedwithGreaterEarlyInfancyWeight
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Chapter 2 Iron and insulin resistance

1.BrudevoldR,HoleT,HammerstrmJ.HyperferritinemiaIsAssociatedwithInsulinResistanceandFattyLiverinPatients
withoutIronOverload.PLoSONE2008;3:e3547.
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2.MenkeA,FernndezRealJ,MuntnerP,etal.Theassociationofbiomarkersofironstatuswithperipheralarterialdisease
inUSadults.BMCCardiovascularDisorders2009;9:34.http://www.biomedcentral.com/14712261/9/34
3.SwaminathanS,FonsecaVA,AlamMGetal.TheRoleofIroninDiabetesandItsComplications.DiabetesCare2007;30:
19261933.http://care.diabetesjournals.org/content/30/7/1926
4.WredeCE,BuettnerR,BollheimerLC,etal.Associationbetweenserumferritinandtheinsulinresistancesyndromeina
representativepopulation.EurJEndocrinol2006;154333340.http://ejeonline.org/content/154/2/333.long
5.FernndezRealJM,LopezBermejoA,RicartW.IronStores,BloodDonation,andInsulinSensitivityandSecretion.
ClinicalChemistry2005;5:12011205.http://www.clinchem.org/content/51/7/1201.abstract
6.SharifiF,NasabNM,ZadehHJ.Elevatedserumferritinconcentrationsinprediabeticsubjects.DiabetesandVascular
DiseaseResearch2008;5:1518.http://dvr.sagepub.com/content/5/1/15.refs
7.VantyghemMC,GirardotC,BoulogneA,etal.Ironoverloadandinsulinresistance.LaPresseMdicale2005;34:1391
1398.http://www.emconsulte.com/article/102515
8.FacchiniFS,SaylorKL.Effectofirondepletiononcardiovascularriskfactors:studiesincarbohydrateintolerantpatients.
AnnalsoftheNewYorkAcademyofSciences2002;967:342351.(abstract)
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6632.2002.tb04290.x/abstract;jsessionid=C85DEC54A82FA1D10F45036E3ADB5048.d02t02
9.FernndezRealJM,CastroA,GarciaBragadoF,etal.BloodLettinginHighFerritinType2Diabetes.Diabetes2002;51:
10001004.http://diabetes.diabetesjournals.org/content/51/4/1000.full
10.JehnML,GuallarE,ClarkJMetal.AProspectiveStudyofPlasmaFerritinLevelandIncidentDiabetes:The
AtherosclerosisRiskinCommunities(ARIC)Study.Am.J.Epidemiol2007; 165:10471054.
http://aje.oxfordjournals.org/content/165/9/1047.long
11.ValentiL,FracanzaniAL,DongiovanniP.Irondepletionbyphlebotomyimprovesinsulinresistanceinpatientswith
nonalcoholicfattyliverdiseaseandhyperferritinemia:evidencefromacasecontrolstudy.TheAmericanJournalof
Gastroenterology2007;102,12511258.http://www.nature.com/ajg/journal/v102/n6/full/ajg2007242a.html
12.BofillC,JovenJ,BagesJ,etal.Responsetorepeatedphlebotomiesinpatientswithnoninsulindependentdiabetes
mellitus.Metabolism1994;43:614620.
http://www.sciencedirect.com/science/article/pii/0026049594902046
13.FernndezRealJM,LopezBermejoA,RicartW.CrossTalkBetweenIronMetabolismandDiabetes.Diabetes2002;51:
23482354.http://diabetes.diabetesjournals.org/content/51/8/2348.full
14.HuaNW,StoohsRA,FacchiniFS.Lowironstatusandenhancedinsulinsensitivityinlactoovovegetarians.British
JournalofNutrition2001;86:515519.
http://journals.cambridge.org/action/displayFulltext?type=6&fid=891724&jid=BJN&volumeId=86&is
sueId=04&aid=891720&bodyId=&membershipNumber=&societyETOCSession=&fulltextType=RA&file
Id=S0007114501002203
15.ZhengH,PatelM,CableM.InsulinSensitivity,VascularFunction,andIronStoresinVoluntaryBloodDonors.Diabetes
Care2007;30:26852689.http://care.diabetesjournals.org/content/30/10/2685.full
16.AscherioA,RimmEB,GiovannucciE.BloodDonationsandRiskofCoronaryHeartDiseaseinMen.Circulation
2001;103:5257.http://circ.ahajournals.org/content/103/1/52.long
17.FacchiniFS.EffectofPhlebotomyonPlasmaGlucoseandInsulinConcentrations.DiabetesCare1998;21:219.
18.CutlerP.DeferoxamineTherapyinHighFerritinDiabetes.Diabetes1989;38:12071210.
19.RedmonJB,PyzdrowskiKL,RobertsonRP.NoEffectofDeferoxamineTherapyonGlucoseHomeostasisandInsulin
SecretioninIndividualsWithNIDDManndElevatedSerumFerritin.Diabetes1993;42:5449.
20.CookseyRC,JonesD,GabrielsenS.DietaryIronRestrictionorIronChelationProtectsFromDiabetesandLossofBeta
/
CellFunctionintheObese(ob/oblep )mouse.AmJPhysiolEndocrinolMetab2010;298:E1236E1243.
21.FacchiniFS,SaylorKL.ALowIronAvailable,PolyphenolEnriched,CarbohydrateRestrictedDiettoSlowProgressionof
DiabeticNephropathy.Diabetes2003;52:12041209.
http://diabetes.diabetesjournals.org/content/52/5/1204.long
22.WeaverCM,RajaramS.Exerciseandironstatus.J.Nutr1992;122:782787.
23.KellDB.Ironbehavingbadly:inappropriateironchelationasamajorcontributortotheaetiologyofvascularandother
progressiveinflammatoryanddegenerativediseases.BMCMedGenomics2009;2:2.
24.TuomainenTP,Nyyssnen,K,SalonenR,etal.BodyIronStoresareAssociatedWithSerumInsulinandBloodGlucose
Concentrations:Populationstudyin1,013easternFinnishmen.DiabetesCare1997;20:426428.
http://care.diabetesjournals.org/content/20/3/426
122
25.SalonenJT,TuomainenTP,NyyssnenK,etal.Relationbetweenironstoresandnoninsulindependentdiabetesin
men:casecontrolstudy.BMJ1998;317:727730.http://www.ncbi.nlm.nih.gov/pmc/articles/PMC28662/
26.FernndezRealJM,RicartEngelW,ArroyoE,etal.Serumferritinasacomponentoftheinsulinresistancesyndrome.
DiabetesCare1998;21:6268.http://www.ncbi.nlm.nih.gov/pubmed/9580307
27.LeTuanD,BaeS,HsuCE,etal.EffectsofCardiorespiratoryFitnessonSerumFerritinConcentrationandIncidenceof
Type2Diabetes:EvidencefromtheAerobicsCenterLongitudinalStudy(ACLS).RevDiabetStud2009;5:245252.
http://www.soc
bdr.org/content/rds/archive/5/4_winter/original_data/serum_ferretin_and_type_2_diabetes/index_
en.html?showfulltext=1
deValkB,MarxJJ.Iron,Atherosclerosis,andIschemicHeartDisease.ArchInternMed1999;159:15421548.
http://archinte.amaassn.org/cgi/content/full/159/14/1542
GillumRF.AssociationofserumferritinandindicesofbodyfatdistributionandobesityinMexicanAmericanmenthe
ThirdNationalHealthandNutritionExaminationSurvey.IntJObesRelatMetabDisord.2000;25:639645.
http://www.nature.com/ijo/journal/v25/n5/full/0801561a.html
FlemingDJ,JacquesPF,TuckerKL,etal.Ironstatusofthefreeliving,elderlyFraminghamHeartStudycohort:aniron
repletepopulationwithahighprevalenceofelevatedironstores.AmJClinNutr.2001;73:63846.
ZacharskiLR,ChowBK,HowesPS,etal.ReductionofIronStoresandCardiovascularOutcomesinPatientsWithPeripheral
ArterialDisease.ARandomizedControlledTrial.JAMA2007;297:603610.http://jama.ama
assn.org/content/297/6/603.long
MoirandRA,MortajiAM,LoralO,etal.Anewsyndromeofliverironoverloadwithnormaltransferrinsaturation.Lancet.
1997;349:9597.http://www.thelancet.com/journals/lancet/article/PIIS01406736%2896%2906034
5/fulltext
E.D.Weinberg.ExposingTheHiddenDangersofIron.Nashville,TN:CumberlandHousePublishingInc.;1997.
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Chapter 3 Exercise and insulin resistance

1.HolloszyJO.Exerciseinducedincreaseinmuscleinsulinsensitivity.JournalofAppliedPhysiology2005;99:338343.
http://jap.physiology.org/content/99/1/338.full
2.HenriksenEJ.InvitedReview:Effectsofacuteexerciseandexercisetrainingoninsulin.JApplPhysiolresistance2002;93:
788706.http://jap.physiology.org/content/93/2/788.full
3.SteeleRM,BrageS,CorderK,etal.Physicalactivity,cardiorespiratoryfitness,andthemetabolicsyndromeinyouth.J
ApplPhysiol2008;105:342351.http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2494842/?tool=pubmed
4.SnowlingNJ,HopkinsWG.EffectsofDifferentModesofExerciseTrainingonGlucoseControlandRiskFactorsfor
ComplicationsinType2DiabeticPatients.DiabetesCare2006;29:25182527.
http://care.diabetesjournals.org/content/29/11/2518.long
5.WilleyKA,Singh,MA.BattlingInsulinResistanceinElderlyObesePeopleWithType2Diabetes.Bringontheheavy
weights.DiabetesCare2003;265:15801588.http://care.diabetesjournals.org/content/26/5/1580.long
6.EvesND,PlotnikoffRC.ResistanceTrainingandType2Diabetes.Considerationsforimplementationatthepopulation
level.DiabetesCare2006;29:19331941.
7.SwainDP,FranklinBA.ComparisonofCardioprotectiveBenefitsofVigorousVersusModerateIntensityAerobicExercise.
AmJCardiol2006;971:141147.http://www.ajconline.org/article/S00029149%2805%29016991/abstract
8.BoutcherSH.HighIntensityIntermittentExerciseandFatLoss.JObes2010;868305.
9.SchoellerDA,ShayK,KushnerRF.Howmuchphysicalactivityisneededtominimizeweightgaininpreviouslyobese
women?AmJClinNutr1997;66:551556.http://www.ajcn.org/content/66/3/551
10.PavlouKN,KreyS,SteffeeWP.Exerciseasanadjuncttoweightlossandmaintenanceinmoderatelyobesesubjects.Am
JClinNutr1989;49(5Suppl):11151123.www.ajcn.org/content/49/5/1115.full.pdf
11.ChurchTS,ChengYJ,EarnestCP,etal.ExerciseCapacityandBodyCompositionasPredictorsofMortalityAmongMen
WithDiabetes.DiabetesCare2004;27:8388.http://care.diabetesjournals.org/content/27/1/83.full
12.WeiM,GibbonsLW,MitchellTL,etal.TheAssociationbetweenCardiorespiratoryFitnessandImpairedFastingGlucose
andType2DiabetesMellitusinMen.AnnInternMed1999;130:8996.
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13.HuFB,SigalRJ,RichEdwardsJW,etal.WalkingComparedWithVigorousPhysicalActivitiyandRiskofType2Diabetes
inWomen:AProspectiveStudy.JAMA1999;282:14331439.http://jama.ama
assn.org/content/282/15/1433.full
rd
14.BlairSN,KohlHW3 ,BarlowCE,etal.ChangesinPhysicalFitnessandAllCauseMortality.AProspectiveStudyof
HealthyandUnhealthyMen.JAMA1995;273:10931098.http://www.ncbi.nlm.nih.gov/pubmed/7707596
15.McAuleyPA,MyersJN,AbellaJP,etal.ExerciseCapacityandBodyMassasPredictorsofMortalityAmongMale
VeteransWithType2Diabetes.DiabetesCare2007;30:15391543.
http://care.diabetesjournals.org/content/30/6/1539.full
16.DunstanDW,VulikhE,OwenN,etal.CommunityCenterBasedResistanceTrainingfortheMaintenanceofGlycemic
ControlinAdultsWithType2Diabetes.DiabetesCare2006;29:25862591.
17.TsangT,OrrR,LamP,etal.EffectsofTaiChionglucosehomeostasisandinsulinsensitivityinolderadultswithtype2
diabetes:arandomiseddoubleblindshamexercisecontrolledtrial.AgeAgeing2007;37:6471.
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18.KadoglouNPE.IliadesF,AngelopoulouN,etal.Theantiinflammatoryeffectsofexercisetraininginpatientswithtype2
diabetesmellitus.EurJCardiovascPrevRehabil2007;14:837843.(abstract)
19.RossR,DagnoneD,JonesPJH,etal.ReductioninObesityandRelatedComorbidConditionsafterDietInducedWeight
LossorExerciseInducedWeightLossinMen.ARandomized,ControlledTrial.AnnalsofInternalMedicine2000;133:92
103.http://www.annals.org/content/133/2/92.1
20.WinnickJJ,ShermanWM,HabashDL,etal.ShortTermAerobicExerciseTraininginObeseHumanswithType2Diabetes
MellitusImprovesWholeBodyInsulinSensitivitythroughGainsinPeripheral,notHepaticInsulinSensitivity.JClin
EndocrinolMetab2008;93:771778.
21.JakicicJM,MarcusBH,GallagherKI,etal.EffectofExerciseDurationandIntensityonWeightLossinOverweight,
SedentaryWomen.ARandomizedTrial.JAMA2003;290:13231330.http://jama.ama
assn.org/content/290/10/1323.long
22.HoumardJA,TannerCJ,SlentzCA,etal.Effectofthevolumeandintensityofexercisetrainingoninsulinsensitivity.
JournalofAppliedPhysiology2004;96:101106.
23.CuffDJ,MeneillyGS,MartinA,etal.EffectiveExerciseModalitytoReduceInsulinResistanceinWomenWithType2
Diabetes.DiabetesCare2003;26:29772982.http://care.diabetesjournals.org/content/26/11/2977.long
24.DunstanDW,DalyRM,OwenN,etal.HomeBasedResistanceTrainingIsNotSufficienttoMaintainImprovedGlycemic
ControlFollowingSupervisedTraininginOlderIndividualsWithType2Diabetes.DiabetesCare2005;28:39.
25.KirwanJP,SolomonTP,WojtaDM,etal.Effectsof7daysofexercisetrainingoninsulinsensitivityandresponsivenessin
type2diabetesmellitus.AmJPhysiolEndocrinolMetab2009;297:E151156.
26.ShaibiGQ,CruzML,BallGD,etal.EffectsofResistanceTrainingonInsulinSensitivityinOverweightLatinoAdolescent
Males.MedSciSportsExerc2006;38:12081215.http://www.ncbi.nlm.nih.gov/pubmed/16826016
27.DunstanDW,DalyRM,OwenN,etal.HighIntensityResistanceTrainingImprovesGlycemicControlinOlderPatients
WithType2Diabetes.DiabetesCare2002;25:17291736.
28.IshiiT,YamakitaT,SatoT,etal.ResistanceTrainingImprovesInsulinSensitivityinNIDDMSubjectsWithoutAltering
MaximalOxygenUptake.DiabetesCare1998;21:13531355.
29.CastanedaCA,LayneJE,MunozOriansL,etal.ARandomizedControlledTrialofResistanceExerciseTrainingtoImprove
GlycemicControlinOlderAdultsWithType2Diabetes.DiabetesCare2002;25:23352341.
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Appendix A: What Every Insulin Resistant

Person Should Know About Losing Weight
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responsetohypocaloricdietsinhealthyobesewomen.JClinEndocrinolMetab.Feb1999;84(2):578581.
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responsetohypocaloricdietsinobesepatients.ClinNutr.Feb2006;25(1):117122.
3.http://en.wikipedia.org/wiki/Basal_metabolic_rateAccessedonFebruary12,2012.
4.http://en.wikipedia.org/wiki/HarrisBenedict_equationAccessedonFebruary13,2012.
5.LindebergS,JonssonT,GranfeldtY,etal.APalaeolithicdietimprovesglucosetolerancemorethanaMediterraneanlike
dietinindividualswithischaemicheartdisease.Diabetologia.Sep2007;50(9):17951807.
http://www.springerlink.com/content/h7628r66r0552222/
6.JonssonT,GranfeldtY,ErlansonAlbertssonC,AhrenB,LindebergS.Apaleolithicdietismoresatiatingpercaloriethana
mediterraneanlikedietinindividualswithischemicheartdisease.NutrMetab(Lond).7:85.
7.VaradyKA.Intermittentversusdailycalorierestriction:whichdietregimenismoreeffectiveforweightloss?ObesRev.
Jul;12(7):e593601.
8.AhmetI,WanR,MattsonMP,LakattaEG,TalanMI.Chronicalternatedayfastingresultsinreduceddiastoliccompliance
anddiminishedsystolicreserveinrats.JCardFail.Oct;16(10):843853.
9.http://www.taconic.com/userassets/Documents/spraguedawley_booklet.pdfAccessedonMarch12,2012
10.HarvieMN,PegingtonM,MattsonMP,etal.Theeffectsofintermittentorcontinuousenergyrestrictiononweightloss
andmetabolicdiseaseriskmarkers:arandomizedtrialinyoungoverweightwomen.IntJObes(Lond).May;35(5):714727.
11.KlempelMC,BhutaniS,FitzgibbonM,FreelsS,VaradyKA.Dietaryandphysicalactivityadaptationstoalternateday
modifiedfasting:implicationsforoptimalweightloss.NutrJ.9:35.
12.HeilbronnLK,SmithSR,MartinCK,AntonSD,RavussinE.Alternatedayfastinginnonobesesubjects:effectsonbody
weight,bodycomposition,andenergymetabolism.AmJClinNutr.Jan2005;81(1):6973.
TrepanowskiJF,CanaleRE,MarshallKE,KabirMM,BloomerRJ.Impactofcaloricanddietaryrestrictionregimenson
markersofhealthandlongevityinhumansandanimals:asummaryofavailablefindings.NutrJ.10:107.
132

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www.InsulinResistanceCure.

What is insulin resistance?

How does insulin resistance lead to disease?

Insulin resistance can lead to high blood sugar,

What are the dangers of high blood sugar?

Insulin sensitive or insulin resistant? Thats the

How to diagnose insulin resistance and track

How to get the most out of this book

Beyond Body Mass Index

Redefining obesity Understanding metabolic

What causes a central fat distribution?

Determining if you have excess fat

What to do if you have excess fat (LOSE IT)

Can central fat be specifically targeted for fat

Can you have too little body fat?

Fat loss tips

Vegetarians have lower insulin resistance

Blood donors have lower insulin resistance

Iron and IR are associated, but does iron

How does iron cause insulin resistance?

Who should lower their iron and how low?

Iron reduction and other markers of

How to reduce iron levels

Is higher intensity better than moderate

Aerobic exercise, strength training or both? How

A word about HIIT (a.k.a. HIIE)

The nitty-gritty details of training

Foods High in Magnesium per 200 calorie

Studies on sleep and insulin resistance

Quality of sleep matters

A word about sleep disordered breathing

How does short sleep cause insulin resistance?

Does long sleep cause insulin resistance?

How much should you sleep?

How to sleep well

Minimizing high post-meal insulin and blood

Do I have to eat low-carb?

Exercise and carbohydrates

High-carb, high-fiber diets (HCF diets)

How you prepare food matters

Do carbohydrates cause insulin resistance?

Glycemic Index and Glycemic Load

Dietary fats and insulin resistance

Dairy and insulin resistance

Does fructose cause insulin resistance? Why it

A word about dark chocolate

Caffeine/coffee and insulin resistance

Additional diet tips

Putting it all together

Diet when insulin sensitive

Good carb sources for a high carb diet

Nutrition Basics Understanding Calories,

Insulin Resistant Individuals Do Not Have A

Only Calories Count So Count Calories

How To Determine Your Total Daily Energy

How Many Calories Should I Eat Per Day?

Determining Your Macronutrients (Proteins,

Which Foods To Focus On

Which Foods To Limit

A Word About Iron Reduction