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Why insulin resistance matters 06/26/2020 by Brad Lemley

When it comes to monitoring your health, it’s easy to get lost in the weeds.

Iron levels. Blood pressure. Cholesterol. Vitamin D3 status. Calorie intake…

This list of health markers physicians track could literally contain hundreds of terms. The logical response to being presented with such a list might be, “Forget it. Who can manage all that? I’m going to live my life.”


But more or less under the public’s radar, a new idea has been gaining traction among leading health authorities. It is that one indicator leads the rest in its ability to predict long-term health or illness.

While this does not absolve any of us from monitoring important indicators such as vitamin D3 status or blood pressure, it does suggest one health measure we must consider if we wish to live a long, healthy life.

It is insulin resistance.

I’m fairly new to the job of Editorial Director here at Vital Choice, but I’ve been writing in the health space for 30 years, and I want to introduce you to what I regard as a seminal article that made the centrality of insulin resistance to health crystal clear.

It is a review article meaning that it examined the results of many studies.

Provocatively titled “The cholesterol and calorie hypotheses are both dead — it is time to focus on the real culprit: insulin resistance”, the article appeared in The Clinical Pharmacist. Two of the authors are leading pioneers of low-carb-diets for improved health: Robert Lustig, M.D., and Aseem Malhotra, M.D.

Cholesterol skeptics

Lustig and Malhotra begin by casting doubt on what many regard as the most reliable long-term health marker: blood levels of LDL-C, the so-called “bad” cholesterol. As they put it:

“…there are 44 randomised controlled trials (RCTs) of drug or dietary interventions to lower LDL-C in the primary and secondary prevention literature, which show no benefit on mortality.”

In other words, numerous trials show no lifespan benefit to taking drugs or changing one’s diet to lower LDL-C. Considered in light of well-known side effects of cholesterol-lowering statin drugs including muscle and liver damage, one may at least doubt whether low LDL-C is desirable - especially if problematic drugs are required to drop it (Statin Side Effects, 2020).

The authors go on to state that tracking calorie consumption and asking patients to reduce intake without regard to what kind of calories – that is, whether they are from protein, carbohydrate or fat – also has a poor track record of improving overall health.

What matters? Insulin resistance.

Insulin resistance is a measure of how effectively your cells allow the hormone insulin to do its main job – conducting blood sugar into the cell.

Chronically high blood sugar tends to cause insulin resistance as the cells essentially say, “No more sugar!” to avoid toxic sugar concentrations inside the cells. So the excess sugar remains in the blood.

That chronically elevated blood sugar can damage artery linings, which the authors assert can in turn can lead to cardiovascular disease (CVD) and complications from type 2 diabetes.

Cardiovascular disease is the leading cause of death in the U.S, claiming about 859,000 lives, accounting for one in three deaths (Heart Disease and Stroke, 2019). Diabetes is officially the seventh leading cause of death, claiming at least 84,000 lives in 2017, but the American Diabetes Association contends deaths from the condition “may be underreported,” as only about 15 percent of diagnosed diabetics are listed as dying from the condition (Statistics About Diabetes, accessed 2020).

An important predictor

Lustig and Malhotra state: “We propose that insulin resistance is the most important predictor of CVD and type 2 diabetes…” and go on summarize several studies. For example, one study examined a group of healthy people who were insulin-sensitive – the healthful condition that’s the opposite of insulin resistant - and free from heart disease.

After five years they found that none of the people who remained insulin sensitive developed heart disease, whereas 14 percent of people in the highest 20 percent of insulin resistance developed heart disease in the same period.

In another study of several cited, up to 69 percent of patients who were admitted to hospital with acute heart attacks were found to have metabolic syndrome, a diabetes precursor, which was associated with increased risk of death or readmission over the following 12 months.

How to measure

Actually, insulin resistance is expensive and challenging to measure directly. Such tests usually happen only in research settings, not clinics. Physicians use the fasting blood glucose (FBG) or A1C test to measure blood glucose. These are both usually closely associated with the patient’s degree of insulin sensitivity.

There’s some dispute over where these numbers should be, but the Mayo Clinic indicates that if your FBG is over 100 or your A1C is over 5.7 percent, these may need to come down. (A1C Test, 2018) (Diabetes, accessed 2020).

Talk with your physician about which numbers are appropriate, and if you decide together that yours are too high, set about lowering them. A low-carbohydrate diet has been shown to be an effective measure (Webster, CC et al., 2019)

In terms of diet and lifestyle, here are the basics:

  • Restrict carbohydrate, especially flour and sugar, and seed-oil consumption
  • Emphasize fish, eggs, unprocessed meats and vegetables that grow above the ground
  • Exercise daily – weightlifting, walking, biking, whatever activity suits you best

So there’s no need to remain lost in the weeds.

Resisting insulin resistance – in other words, remaining in the state metabolism scientists term insulin sensitive via a prudent mix of diet and exercise – is the best long-term move you can make for a lifetime of robust health.


The cholesterol and calorie hypotheses are both dead — it is time to focus on the real culprit: insulin resistance. Clinical Pharmacist. 2017. doi:10.1211/cp.2017.20203046

Heart Disease and Stroke. Centers for Disease Control and Prevention. Published March 21, 2019. Accessed June 24, 2020.

Statistics About Diabetes. Statistics About Diabetes | ADA. Accessed June 24, 2020.

Statin side effects: Weigh the benefits and risks. (2020, January 14). Retrieved June 23, 2020, from

A1C test. Mayo Clinic. Published December 18, 2018. Accessed June 20, 2020.

Diabetes: Testing for Early Indicators. Mayo Clinic. Accessed June 20, 2020.

Diabetes: Testing for Early Indicators. Mayo Clinic. Accessed June 20, 2020.

Webster CC, Murphy TE, Larmuth KM, Noakes TD, Smith JA. Diet, Diabetes Status, and Personal Experiences of Individuals with Type 2 diabetes Who Self-Selected and Followed a Low Carbohydrate High Fat diet. Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy. 2019;Volume 12:2567-2582. doi:10.2147/dmso.s227090


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