Peter Attia· MD
when we think about an insulin resistant obese person with metabolic syndrome so this is what 20 of the u.s population maybe even more we've clearly established they are insulin resistant in the muscle we've established that they are insulin resistant in the hepatocyte they are obese so would we still say they are insulin resistant at the fat cell because they are correctly undergoing lipogenesis in the fat cell they're at least taking up esterified fat and they're presumably impairing lipolysis which is why they retain adipocel mass in other words there's a the flux through the fat cell is negative they're holding on to fat correct yeah but i think and this is a question a very important question we're going to next i would still predict if you do careful studies of measuring rates of lipolysis by definition they will have insulin resistance in the fat cell and that's because the reason they're doing everything you just said they're holding on to fat they're not happy about the doctor's not happy about it is because it's at hyperinsulinemia so their insulin concentrations are two to three fold so again their curve is right shifted insulin is doing the thing but if you brought them down to normal levels of insulin then you might see more lipolysis