From the Peter Attia Podcast #337. Ralph DeFronzo is a distinguished diabetes researcher and clinician whose groundbreaking work on insulin resistance has reshaped the understanding and treatment of type 2 diabetes.
From the show notes, at the 29 minute mark -- "The dangers of hyperinsulinemia, and the importance of keeping insulin levels within a physiological range"
If you were to take a type 1 patient, and they were lean, they would only need 35 or 40 units of insulin to get their glucose controlled, assuming you gave the doses at the right time. Ralph showed this long ago when he was at Yale.
But we have a lot of people who are taking 100 units of insulin, both type 1 [diabetics] and type 2s. That’s 3x the physiologic dose. That’s hyperinsulinemia.
There’s evidence to support that 100 units of insulin per day is atherogenic.
Now we have a problem: can you have the glucose remain high?
"If you were only doing this [treating diabetes] with insulin, you’d have a problem
It’s an awful trade-off: you’d die very quickly from hyperglycemia if left untreated, but if we overdo it with insulin to maintain normal glycemia, we’re going to kill you slowly."
Just a note here: those of us who choose to eat a low-carb diet (see Dr. Richard K. Bernstein who recommends 30 g carbs per day) typically inject far less than 35 or 40 units total insulin per day. Just saying: you can argue the pros and cons, and I realize that you do not favor the low-carb diet. This is just additional info.
Awesome stuff as always Dan! Thank you for doing what you do.
Bit of a tangent but, with the context of "too much insulin can increase cardiovascular risk", I'm wondering what your thoughts are on prolonged fasts? In the biohacker space, prolonged fasts (24-72 hours) every 1-3 months are often cited. IIRC Peter Attia even has/had a fasting protocol, though he may have stopped the practice (?) due to adverse effects on muscle mass.
I guess I'm curious if, for us T1Ds, the benefits of fasting (reducing bolus insulin for a period of time) may outweigh the detriment of reducing muscle mass. Or if there's some other optimal protocol for T1Ds, like doing a protein-only "fast", etc.
Hey walker! yes, peter attia, once a huge fan of fasting, has tapered off, and (from what I vaguely recall) doesn't recommend it to his patients anymore, except for people looking to lose weight. As a one-time thing (or "as needed to lose weight"), it's fine, he says. But the harms it does seem to outweigh the benefits. Loss of muscle mass is a big deal, as he points out, not just because it's unhealthy, but it takes a disproportionate amount of work (and time) to gain it back.
And that's for non-T1's. I would never consider fasting because both health AND glycemic control rely on a very stable routine of daily exercise and metabolic stability. Once you drift outside of that routine, your body goes into all sorts of contortions to keep things normalized, and of course, it can't. So dinnerware just starts flying off the shelves, and you've got a mess to clean up.
As for the reduction of insulin during fast... remember that too much insulin has to be sustained for decades before it leads to cardiovascular risk. A periodic reduction won't help if levels just rise again after the fact.
Phew! Now I can go back to drinking a Diet Coke everyday!
Thank you so much for this post! I was wondering, where in the Attia podcast does Dr. DeFronzo describe that 36unit upper limit?
From the Peter Attia Podcast #337. Ralph DeFronzo is a distinguished diabetes researcher and clinician whose groundbreaking work on insulin resistance has reshaped the understanding and treatment of type 2 diabetes.
From the show notes, at the 29 minute mark -- "The dangers of hyperinsulinemia, and the importance of keeping insulin levels within a physiological range"
If you were to take a type 1 patient, and they were lean, they would only need 35 or 40 units of insulin to get their glucose controlled, assuming you gave the doses at the right time. Ralph showed this long ago when he was at Yale.
But we have a lot of people who are taking 100 units of insulin, both type 1 [diabetics] and type 2s. That’s 3x the physiologic dose. That’s hyperinsulinemia.
There’s evidence to support that 100 units of insulin per day is atherogenic.
Now we have a problem: can you have the glucose remain high?
"If you were only doing this [treating diabetes] with insulin, you’d have a problem
It’s an awful trade-off: you’d die very quickly from hyperglycemia if left untreated, but if we overdo it with insulin to maintain normal glycemia, we’re going to kill you slowly."
Just a note here: those of us who choose to eat a low-carb diet (see Dr. Richard K. Bernstein who recommends 30 g carbs per day) typically inject far less than 35 or 40 units total insulin per day. Just saying: you can argue the pros and cons, and I realize that you do not favor the low-carb diet. This is just additional info.
Thanks for your discussion of aspartame.
edit: "...those of us T1Ds who choose..."
Awesome stuff as always Dan! Thank you for doing what you do.
Bit of a tangent but, with the context of "too much insulin can increase cardiovascular risk", I'm wondering what your thoughts are on prolonged fasts? In the biohacker space, prolonged fasts (24-72 hours) every 1-3 months are often cited. IIRC Peter Attia even has/had a fasting protocol, though he may have stopped the practice (?) due to adverse effects on muscle mass.
I guess I'm curious if, for us T1Ds, the benefits of fasting (reducing bolus insulin for a period of time) may outweigh the detriment of reducing muscle mass. Or if there's some other optimal protocol for T1Ds, like doing a protein-only "fast", etc.
Hey walker! yes, peter attia, once a huge fan of fasting, has tapered off, and (from what I vaguely recall) doesn't recommend it to his patients anymore, except for people looking to lose weight. As a one-time thing (or "as needed to lose weight"), it's fine, he says. But the harms it does seem to outweigh the benefits. Loss of muscle mass is a big deal, as he points out, not just because it's unhealthy, but it takes a disproportionate amount of work (and time) to gain it back.
And that's for non-T1's. I would never consider fasting because both health AND glycemic control rely on a very stable routine of daily exercise and metabolic stability. Once you drift outside of that routine, your body goes into all sorts of contortions to keep things normalized, and of course, it can't. So dinnerware just starts flying off the shelves, and you've got a mess to clean up.
As for the reduction of insulin during fast... remember that too much insulin has to be sustained for decades before it leads to cardiovascular risk. A periodic reduction won't help if levels just rise again after the fact.
Thanks Dan.