Peter Attia· MD
the metabolic syndrome the whole syndrome is not a syndrome of insulin resistance it's a syndrome of hyperinsulinemia and that's a way better way to think about it
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The headline is broadly defensible, but the qualifications matter. Effect sizes vary by population, the strongest claims rest on shorter trials, and credible voices push back on how it's typically framed.
the metabolic syndrome the whole syndrome is not a syndrome of insulin resistance it's a syndrome of hyperinsulinemia and that's a way better way to think about it
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hyperinsulinemia plays a role in the same thing because what happens of course is that if you have this overflow paradigm this liver is now busy exporting out tons and tons of the fat right it's got too much glucose because of too much insulin so it's too much glucose too much insulin so therefore the liver is jam-packed and it wants to get rid of all this extra fat so it's actually putting out tons of triglycerides so that's why you get hypertriglyceridemia and then of course as triglycerides go up we know that HDL goes down so HDL goes down as you're exporting out all of this fat this fat goes into all kinds of places where it's not supposed to go into the pancreas into the omental fat and you get this abdominal obesity not because of dietary fat because remember dietary fat doesn't go into the liver it goes into the chylomicrons which goes into the blood vessels was just taken out by the adipocytes right never goes into the liver it's the fact that the liver is pouring out all this new fat that gets taken up in all the organs around it so you get fatty pancreas for example which i wanted to talk about it in a second but that's abdominal obesity and we know that insulin has an effect on blood pressure because insulin causes reabsorption of sodium at the site of the proximal tubular