<p><a href="https://peterattiamd.com/geraldshulman/?utm_source=podcast-feed&utm_medium=referral&utm_campaign=221121-pod-geraldshulman&utm_content=221121-pod-geraldshulman-podfeed"> View the Show Notes Page for This Episode</a></p> <p><a href="https://peterattiamd.com/subscribe/?utm_source=podcast-feed&utm_medium=referral&utm_campaign=221121-pod-geraldshulman&utm_content=221121-pod-geraldshulman-podfeed"> Become a Member to Receive Exclusive Content</a></p> <p><a href="https://peterattiamd.com/newsletter/?utm_source=podcast-feed&utm_medium=referral&utm_campaign=221121-pod-geraldshulman&utm_content=221121-pod-geraldshulman-podfeed"> Sign Up to Receive Peter's Weekly Newsletter</a></p> <p>Gerald Shulman is a Professor of Medicine, Cellular & Molecular Physiology, and the Director of the Diabetes Research Center at Yale. His pioneering work on the use of advanced technologies to analyze metabolic flux within cells has greatly contributed to the understanding of insulin resistance and type 2 diabetes. In this episode, Gerald clarifies what insulin resistance means as it relates to the muscle and the liver, and the evolutionary reason for its existence. He goes into depth on mechanisms that lead to and resolve insulin resistance, like the role of diet, exercise, and pharmacological agents. As a bonus, Gerald concludes with insights into Metformin's mechanism of action and its suitability as a longevity agent.</p> <p>We discuss:</p> <ul> <li>Gerald's background and interest in metabolism and insulin resistance (2:30);</li> <li>Insulin resistance as a root cause of chronic disease (6:30);</li> <li>How Gerald uses NMR to see inside cells (10:00);</li> <li>Defining and diagnosing insulin resistance and type 2 diabetes (17:15);</li> <li>The role of lipids in insulin resistance (29:15);</li> <li>Confirmation of glucose transport as the root problem in lipid-induced insulin resistance (38:15);</li> <li>The role of exercise in protecting against insulin resistance and fatty liver (48:00);</li> <li>Insulin resistance in the liver (1:05:00);</li> <li>The evolutionary explanation for insulin resistance—an important tool for surviving starvation (1:15:15);</li> <li>The critical role of gluconeogenesis, and how it's regulated by insulin (1:20:30);</li> <li>Inflammation and body fat as contributing factors to insulin resistance (1:30:15);</li> <li>Treatment approaches for fatty liver and insulin resistance, and an exciting new pharmacological approach (1:39:15);</li> <li>Metformin's mechanism of action and its suitability as a longevity agent (1:56:15); and</li> <li>More.</li> </ul> <p>Connect With Peter on <a href="https://twitter.com/PeterAttiaMD">Twitter</a>, <a href="https://www.instagram.com/peterattiamd/">Instagram</a>, <a href="https://www.facebook.com/peterattiamd/">Facebook</a> and <a href="https://www.youtube.com/channel/UC8kGsMa0LygSX9nkBcBH1Sg">YouTube</a></p>
Actionable Insights
Focus on fixing your metabolism to delay the onset of chronic diseases like atherosclerosis, cancer, and dementia, as these conditions are significantly amplified by metabolic dysfunction.
2. Implement Diet and Exercise for Weight Loss
Actively pursue diet and exercise as the primary means for weight loss, as this is described as the best way to reverse type 2 diabetes and address underlying metabolic issues.
3. Find a Sustainable Weight Loss Strategy
Choose a weight loss approach that you can adhere to long-term, as consistent adherence is more crucial for preventing weight regain than short-term success.
4. Engage in Regular Aerobic Exercise
Perform regular exercise, such as three 15-minute bouts on a StairMaster at approximately 65% MVO2 max for six weeks, to normalize insulin-stimulated muscle glycogen synthesis and reverse insulin resistance.
5. Utilize Acute Exercise for Glucose Disposal
Incorporate a single 45-minute bout of exercise to immediately improve glucose uptake into muscle, reduce de novo lipogenesis, and lower liver triglycerides.
6. Combine Carbohydrate Restriction with Exercise
Pair reduced carbohydrate consumption with exercise to activate AMPK and enhance insulin-independent glucose uptake, effectively managing glucose even with minimal insulin.
7. Consider Carbohydrate Restriction or Fasting
Explore carbohydrate restriction or periodic fasting as effective strategies for weight loss, especially if insulin resistant, as these methods can be easier to adhere to than general caloric restriction.
8. Re-evaluate Personal Health Norms
Shift your understanding of ’normal’ health parameters by comparing your metrics to those of truly insulin-sensitive individuals, rather than relying on population averages.
9. Consult on GLP-1 Agonists for Weight Loss
Discuss with a doctor the use of GLP-1 agonists, which can aid weight loss by reducing food intake through central mechanisms that decrease appetite.
10. Consult on SGLT-2 Inhibitors for Glucose/Weight
Talk to a doctor about SGLT-2 inhibitors, which promote glucose loss in urine (around 400 calories/day) and can lead to mild weight and liver fat reductions.
If insulin resistant, metformin can be a beneficial agent, but if you are lean, insulin-sensitive, and vigorously exercising, it may not provide benefit; always consult a doctor.
12. Explore Podcast Membership for Deeper Learning
Subscribe to the podcast’s membership program for comprehensive show notes, AMA episodes, ad-free listening, short ‘Qualies’ summaries, and product discounts to deepen your knowledge.
13. Listen to AMA #20 for Insulin Resistance
Access AMA #20, ‘Simplifying the Complexities of Insulin Resistance,’ with Bob Kaplan for a more detailed explanation of complicated areas of this topic.
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