Paul Saladino· MD
90 of the US population has sub-optimal metabolic Health has some degree I think you're confusing insulin resistance with like hypertension no I'm not because hypertension we know is essentially synonymous with insulin resistance those are connected I have plenty of patience I'm sure you do too that that are have hypertension and obesity and are no and have like an A1C of 4.4 that doesn't mean A1C is not a metric of insulin sensitivity what is their fasting insulin I I don't know I've been checked exactly you haven't checked you don't know how much is A1C if someone's A1C is 4.4 it's highly unlikely that they have a fasting incident of 30 or 80 or you know 15 or above four whatever it is I disagree with you very unlikely I disagree with you so this is I think is where Western medicine is missing the boat that out we are not and you said this we are not checking fasting insulin on our patients so we don't understand that there is fasting glucose but it's not as good as fasting insulin right because it's pretty cool it's not even close at all no you can't use fasting insulin without a fasting glucose you have to relate the two oh somebody's related to but somebody's glucose is 80 fasting glucose 80 and then and they're fasting insulin is like 30. they have a problem and that happens we see people who have a fasting glucose of 80 any fasting insulin of even 10 or 11. I would say that any fasting insulin above 5 micro IU per ml is too high if you look at a gaussian distribution of fasting insulin in the U.S population the average is nine the average is nine and so what we know is that if you look at these metrics I would say that this is probably the most important point for us to try and communicate to each other I know we're getting a little bit excited about this and kind of talking I'm not I'm not getting excited at all I mean I mean that's fine I'm telling you that like like you said 90 of people or whatever percentage that was have hypertension have obesity you know all of that is corroborated you don't even need to study for that I mean just look at the CDC statistics super easy you don't even need to study it it's it's absolutely you know the vast majority of people have one of those things or all those things are a combination and that's how most of those people end up being cardiac patients in addition to at least from my perspective that their APO B was high and for the longest time we had such a high Target for April B and we didn't lower it um but of course you know you can have you can I think you have a different view but without that April B being up there they wouldn't have heart attacks and strokes they might have smoking lung cancer you know retention sleep apnea that's that's right and I'll show you a study that that conch that that contradicts the point you just made so here's what we're saying so there there is something called Dunnigan familial partial lipidystrophy and I'll show you this study and these people have a monogenic mutation at the lmna gene it's a single Gene polymorphism and they have insulin resistance and they do not have elevated apob traditionally speaking and they have massive aggressive cardiovascular disease so to say that people who have insulin resistance without elevated apob are not going to get cardiovascular disease is wrong but circling back because we see that it's a single gene on the nuclear envelope of a cell that changes and causes insulin resistance profound insulin resistance these people have light dystrophy they have abs but they have visceral fat because they have insulin resistance due to their monogenic condition they do not have elevated LDL and they have massive aggressive atherosclerosis so let's just and you also no but real quick real quick you also have people with hypo beta lipoproteinemia these are people with like uh no beta you know LDL particles vldl IDL um they have no they have almost no atherosclerosis depending on which Gene is knocked out you have no April B you have almost no atherosclerosis so I mean we're probably talking about different populations with different things um but either way I mean we can go back and forth on this but maybe you had some other topics you wanted to discuss too no no I have a lot of things so let's just talk about that for a moment I want to get back to veins and arteries because we got off track but I do want to talk about that as well but I think it's just important that we understand that what you are describing I think is is one of the issues with Western medicine and and the reason that I think it's important we have this conversation because if doctors see patients with hypertension obesity low HDL high triglycerides and an impaired or an impaired fasting glucose and they don't consider those patients insulin resistant We are failing our patients all of those patients likely have some degree of insulin resistance and need a fasting insulin to be ordered and so I think that we are blind to this epidemic of insulin resistance within our populations and even the AHA even the American Heart Association is blind to this I have the same statistics that you have saying 10 of us adults have diabetes 30 15 to 30 have pre-diabetes