Thread by @tednaiman

RANT THREAD 🧵

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‘INSULIN RESISTANCE’ has nothing whatsoever to do with ‘HYPERINSULINEMIA’.

‘HYPERINSULINEMIA’ is the energy toxicity or overfatness that results from chronically choosing foods with low satiety per calorie—typically high density carbs AND fats.

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‘INSULIN RESISTANCE’ used to be nearly synonymous with hyperinsulinemia in the medical literature, but now we all understand the major distinction between the two.

In the absence of elevated insulin, this insulin resistance is perhaps better named ‘adaptive glucose sparing’.

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This type of adaptive glucose sparing, or LOW INSULIN ‘insulin resistance’, is the normal state of EVERY SINGLE MAMMAL THAT IS NOT EATING CARBOHYDRATE FOR ANY REASON.

Humans on a high carb diet are more ‘insulin resistant’ in the morning after an overnight fast.

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Any human on an extended fast just gets progressively more ‘insulin resistant’.

After prolonged starvation, all humans will have extreme ‘insulin resistance’ to the point of severe glucose intolerance and diabetic level blood glucose with the ingestion of any carbohydrate.

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Note that these people DO NOT HAVE HYPERINSULINEMIA AND IN FACT HAVE EXTREMELY LOW INSULIN LEVELS and absolutely no energy toxicity at all, so they are the literal opposite of overfatness and type 2 diabetes!

And humans are nothing special in this regard.

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Any carnivorous animal, on a low carbohydrate diet by definition, will have extreme ‘insulin resistance’.

Felines 🐆 have notorious ‘insulin resistance’ and will exhibit glucose intolerance. But these animals, on a proper carnivorous diet, almost never develop obesity / T2D.

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Dolphins 🐬 are some of the most ‘insulin resistant’ mammals on the planet, with nearly instantaneous diabetic level blood sugar when given carbohydrate. And dolphins get EVEN MORE ‘insulin resistant’ after an overnight fast, as one would predict.

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Interestingly, if you overfeed feed dolphins in captivity by giving them regular carbohydrates, they can actually develop hyperinsulinemia, just like any other improperly fed animal under human care. Believe it or not, they will then develop some of the classic

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…medical problems we see in hyperinsulinemic humans—like kidney stones, iron overload with high ferritin, and other findings of ‘metabolic syndrome’.

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THE REALITY?

Any mammal on a low carbohydrate diet will require PROFOUND INSULIN RESISTANCE TO MAINTAIN GLUCOSE HOMEOSTASIS, particularly during reproduction!!

THIS IS NORMAL PHYSIOLOGY FOR ANY MAMMAL WITHOUT REGULAR QUANTITIES OF DIETARY CARBOHYDRATE.

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During the last two million years of human evolution, humans were increasingly carnivorous. Those able to generate a greater degree of insulin resistance on a low carb diet had a reproductive and survival advantage.

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This selective pressure relaxed with the advent of agriculture, and we see lower type 2 diabetes in European populations who have had longer exposure to post-agricultural high glycemic load diets.

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This also explains why we see the highest type 2 diabetes in populations that have recently and rapidly transitioned from low-glycemic load diets to the modern high glycemic load diet (Pima, etc).

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Rather than trying to reclaim the term ‘insulin resistance’ as a synonym for ‘hyperinsulinemia’, I suggest that we let this term go and allow it to be synonymous with the ‘adaptive glucose sparing’ that allowed our species to survive the glaciations of the Pleistocene.

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We should appreciate ‘insulin resistance’ as the harmless state that everyone wakes up with in the morning. We should use a different term for the dangerous state of overfatness that causes hyperinsulinemia: I would humbly submit ‘Energy Toxicity’ as one possibility.

END RANT