Homeostatic model assessment

Okay.

If you want, what do they call it? HOMA, IR, which is an insulin resistant test.

They're resistant to do it.

They're resistant.

Sleep that actually works, it restores insulin sensitivity through cortisol rhythm normalization.

The early detection through fasting insulin and HOMA-IR, not HbA1c, by the way, which is a three-month trend.

It's garbage.

HbA1c is a garbage number.

HOMA-IR, do the math.

None of which that wearable can ever deliver or detect in any capacity, not even slightly.

The disease is molecular.

So we always have to remind ourselves of that and look at the actual details.

A couple other metrics like LDL cholesterol and insulin resistance using the HOMA-IR model.

seemed to be improved in all groups or at least trending towards improvement but no significant difference between the groups the investigators also looked at side effects adverse effects of the interventions and the most common one was hypoglycemia so sugar levels being too low this happened in about four to five percent of participants in all three groups so this is one reason i always recommend that people with type 2 diabetes who are doing these interventions either getting on a new drug or doing a substantial dietary regime, changing their diet substantially, always do this.

Work with your doctor so that you can keep an eye on these metrics and avoid these hypoglycemic episodes.

Now, on that previous video with the other trial, a lot of you guys asked a very intelligent question.

is hemoglobin a1c being lower kind of artificial is this happening just because these people are fasting these people are cutting their calories so they're eating less so their glucose is going to be elevated less is that all that's going on or is there an actual metabolic improvement in other words are they still diabetic but their glucose just isn't spiked as much because they're eating less so it's kind of masked or did they actually improve their metabolism so that it's no longer diabetic this is a great question and my answer for this trial is very similar to what it was for the previous trial i suspect there is a metabolic improvement because other metrics other than hemoglobin a1c also corroborate this so fasting glucose for example as we said in the completers in the participants that actually finished the trial fasting glucose was reduced in all three groups and more so on 5-2 so that can't be as easily explained by less eating, less glucose spikes because fasting glucose is more a function of hepatic insulin resistance and how much intra hepatic triglyceride there is and then the results with weight loss also align with this weight loss in all three groups more so on 5-2 so it kind of aligns with this idea that there is an overall metabolic improvement that is delivered by this dietary regime.

It's interesting that HOMA-IR was not significantly different between the three groups.

So looking at kind of a general measure of insulin resistance.

So low carb generally in the low carb community is 50 to 100 grams, which would give you 10 to 20% of calories from carbohydrates.

so keto versus low carb versus high carb is a continuum and depending on your situation your genetics your lifestyle your history you're going to be at a different place a different place is going to be appropriate for you so anywhere from two percent carbs on the low end up to maybe fifty percent carb could be appropriate for a certain person and it depends on how insulin resistant are you so while there's a carb continuum there's an insulin resistance continuum and we measure this with something called HOMA-IR homeostatic model assessment of insulin resistance and what it does it takes your fasting glucose it multiplies it by your fasting insulin it divides by a constant and you get a score a HOMA-IR score and an optimum value is one plus or minus a few tenths so if you're in that range you have a very very good balance between insulin resistance and insulin sensitivity so normal value could be a fasting glucose of a hundred and an insulin level of four divided by a constant of four or five gives you approximately one Once you get up to 1.5, you're still okay, but you're starting to develop slight insulin resistance.

And by the time you get up to two or three or four, you start having moderate to severe insulin resistance.

At the high end of the scale, we could have people like diabetics that are untreated, meaning they haven't changed anything in their lifestyle.

So you're going to have to play around with that.

And what happens if you're too lean, then you don't have enough reserves.

If you get a sickness if you get a cold or a flu then you don't have a lot of reserves and you also don't have a lot of fat soluble vitamins to help your immune system so there is such a thing as too lean and too insulin sensitive so the homa ir is an excellent way of assessing insulin resistance but it doesn't tell us the whole picture so let's look at a couple of examples here If we take a diabetic and let's say they wake up with a fasting glucose of 200 and we measure their insulin and it's 20, we compute the score and their HOMA-IR is 10, meaning very insulin resistant.

And there's no surprise there because every one of those markers tell us that they're insulin resistant.

First, fasting insulin with fasting glucose.

Together, they give you HOMA-IR, an estimate of insulin resistance.

Many clinicians flag values above about 2.5, though cutoffs vary.

If it's failing, the storage switch is turning down.

So when the scale slows, check these instead.

Is your waist shrinking? For women, 35 inches or more signals metabolic risk.

Are your periods more regular? Are your triglycerides, hemoglobin A1c and HOMA-IR improving? Are you getting stronger? Your clothes and waist often change before the scale does.

Those aren't consolation prizes.