Causes of Insulin Resistance: The Personal Fat Threshold

[@marcdaniels9079]

I must have watched literally 100s of nutrition and health videos over the last 5 years and this is without doubt the absolute BEST. Clear, well explained with no food tribe drama. I hope as many people as possible can see this so that they are better educated and can steer away from the hype and nonsense being pedalled to them by YT "experts" and "doctors" interested in promoting their books or extreme lifestyles. THANK YOU SO MUCH.

[@nourishedbyscience]

Appreciate you taking the time to provide feedback. Particularly because you spell out some of the reasons that motivated me to start this channel. I am so tired of diet tribalism, and literally sick to my stomach about all of the influencers out there on KZbin and other social media who mostly line their pockets with sponsored posts and affiliate deals that end up promoting some processed crap, or some extreme views that inevitably lead to a supplement. Best, Mario

[@edoardo849]

Probably one of two best nutritional KZbin channel. The other being the weight loss videos of Renaissance Periodisation. Incredible that this is free. This kind of web is amazing.

[@janetmoy6127]

Totally agree! No doctor has been able to explain these valid points to me. Thank you!!

[@Daniele__D9]

AGREE ! Thank You !!

[@stepheniekinsey6311]

​@@nourishedbyscienceq

[@peterbedford2610]

Fasted work outs in the morning really helped me drop the last few pounds

[@harani4446]

Good

[@sheila7814]

Thank you for sharing is method

[@Smz8wq]

@@sheila7814 Per Stacy Sims, PhD, who specializes in women's nutrition, this may not be a good idea for women, especially older women, or even younger women in the luteal phase of their cycle.

[@sunbeam9222]

I work out in the evening and it also helped shed these last stubborn few pounds. I guess keeping active is key.

[@Carterofmars]

One of the best scientist on YT. Mario is extremely rational in arriving at his determinations. Nothing is taken for granted or at face value and is properly (as far as this layman can tell), analyzed. He sites credible sources of scientific studies and journals. End result: a VERY high level of confidence in his material. I'd love to see Dr. Katz and Dr. Becky Gillaspy, another very credible YT doctor, in a long form discussion. 👍👍👍

[@nourishedbyscience]

Thank you for the praise. Didn't know Dr. Becky; I'll check out her channel. Cheers Mario

[@2009raindrop]

Another amazing video - thank you! It is great to get some detail about why BMI only gives us limited information about insulin resistance. And I love the graphics showing the fat cells and their changes.

[@johannel8104]

Thanks Dr K. This was very illuminating and seems to explains the weird cases where skinny people have diabetes and very overweight people do not.

[@n0tthatserious433]

So I’m this case, is you’ve reached and/or past your fat threshold should you eat low fat? Or would keto/low carb high fat still be useful in reducing the visceral fat?

[@DennisNowland]

Roy Taylor's work is the benchmark. Professor at Newcastle University.

[@cathleenwitt2790]

I am curious to know if the number of subcutaneous fat cells an adult is mostly determined by birth? I understand that we can create SOME new ones, but the connection to body type (pear vs apple) seems to indicate that we get what we get!

[@PeppermintPat]

I concur! They rarely address these body differences

[@adriananis2]

Excellent video Dr Kratz. One of the only few channels that actually asks the right questions and looks at root causes.

[@MadhaviSardeshpande]

Thank you, Mario, for such a beautiful explanation of how fat develops in our bodies. It also makes sense why so many chubby people I know don’t have insulin resistance. I’m also keen to know what happens when we lose fat. Do the enlarged fat cells reduce in size? Do some of them go back to pre-adipocyte stage? This is a valuable video, and I’m sharing it!

[@nourishedbyscience]

Great questions. Yes, fat cells can shrink again, but they never go back to the pre-adipocyte stage once they are fully mature adipocytes. Also, and that is a bit of a problem, while weight gain can fairly quickly lead to a loss of liver and muscle fat and an improvement in insulin sensitivity in these tissues, it does seem to be harder to fully restore insulin sensitivity in fat tissue. That is because even if we lose weight, we still have dead fat cells lying around, and macrophages, and low-grade inflammation, and these things do not disappear rapidy. It does seem that we need to lose quite a bit of weight and some time needs to pass until that inflammation resolves and adipose tissue insulin sensitivity is fully restored. Cheers Mario

[@MadhaviSardeshpande]

Thank you for the detailed response, Mario! ❤

[@CynthiaArmstrong7]

Mario your response reminds me of the work Dr. Roy Taylor has done at Newcastle University. Thank you so much for your detailed explanations.

[@timreynolds2264]

@@nourishedbyscience That is where Autophagy plays a key role in cleaning up those cells?

[@lynlawley8903]

So it means we need to do fasting, I have cancer and trying keto as now have after chemo a leaky heart valve ,, so not sure if I have probs to esy keto also have sleep apnea,,, trying to ballance, all this so I'm thinking I need to eat like I have before , which was lowfat n carbs now have been doing keto , I think I have isulin sensitive and metabolic syndrome not picked up and now trying to help with food so how do I help myself with what diet, as so many opposite diets are posted by too many specialists , so which one is true,,

[@wcg66]

I’m obese and I have no doubts that my type 2 diabetes is related to that. Let’s be perfectly clear, most overweight people know they’re fat and don’t need reminders of that fact. Also, let’s be clear that reducing body fat is not easy for some people. Medical intervention is not a weakness and people able to overcome diabetes through lifestyle aren’t morally superior.

[@honestreviewscanada]

This is one of the clearest and best presented overviews of this topic I have ever seen. Extremely informative. I am curious to know your views on reversing insulin resistance, diabetes and whether lost beta cells still make this possible.

[@nourishedbyscience]

Much more content coming. Just laying the foundation here ... Cheers Mario

[@alisonjane5364]

If you look at the research done by Roy Taylor at Newcastle university uk you will see that it is possible to revive beta cell function. They did this by using a very low calorie diet to empty out all excess fat from the places it should not be. They found that once the fat was depleted from the pancreas the beta cells started working properly again.

[@SaSPonchICo]

After changing my diet, my blood sugar is now normal, but insulin resistance is still high. Since doctors generally recommend to "just" lose weight (which almost ended in an eating disorder) and don't give much insight into the other possible reasons of me having high insulin resistance, I appreciate the insight you provide.

[@alisonbamford6723]

If you are eating a low carb diet, the fats in the diet will drive insulin resistance. I followed LCHF for over 8 years & my body became so fat-saturated I couldn’t get my blood sugar down even with loads of insulin. As my ability to digest animal protein had also collapsed, I had no option but to go plant based. I just juiced initially for the first month to give my poor digestion a break, & although my BG stayed high, probably as my body cleared some of the ectopic fat, suddenly, around the end of the month my BG started to drop, my insulin sensitivity returned & I had to cut the insulin intake by more than half. I also lost some of the extra weight I’d gained on Keto. Fats definitely drive my insulin resistance. The more fat I consume, the more resistant I become.

[@playpianotoday6223]

@@alisonbamford6723thanks so much for sharing this - very helpful

[@ytubechannel997]

So how do people prevent extra fat to be stored viscerally rather than subcutaneously?

[@nourishedbyscience]

By avoiding weight gain. I know this is frustrating, but as far as I know, there is no way to gain weight and make sure that it's not stored in the visceral or ectopic depots if you have crossed your personal fat threshold. Best, Mario

[@eugeniebreida1583]

@@nourishedbyscienceAs a naive follow up idea . . . perhaps creating xtra poundage of muscle weight, and then becoming a sloth might help keep fat subcutaneous rather than visceral ?? (A reason I caution men to avoid ‘bulking up’ a la US football body types.). Am I out to lunch? : )

[@mariomenezes1153]

Brilliant explanation! I have heard a lot about insulin resistance, the high level understanding of what causes it and the negative effects on the metabolic system, but did not understand the mechanics of when and how insulin resistance is caused. Was also aware that there are thin people who are insulin resistant and overweight people who are insulin sensitive, but this explanation of the underlying reason was the best I have heard. Thank you!

[@B.Robinson19]

So liposuction is probably a terrible idea? Sucks out the sub-q fat cells, then you have no choice but to store fat in visceral and ectopic depots.

[@katashley1031]

Lipo was an obvious abomination from day one. I feel for the people who did that to themselves.

[@anuraghere4997]

Brilliant is the only word that comes to my mind . I am a lean but belly fat person with hba1c of 11. I was always been a lean person. But chronically stressed and sleep deprived. I vouch for every thing this gentleman had said.

[@katashley1031]

Aha, stress and sleep deprivation! I look forward to hearing him dive into that element as it is a huge contributor to all sorts of health issues, esp metabolically.

[@laylapersia]

This video is the best single resource on this topic I've seen, and will be useful to share with loved ones as a primer on the often quiet path to pre-diabetes via insulin resistance. ❤ Thank you for being one of the very best channels I've ever seen on KZbin! This is a rare glimpse of humanity and the internet at its best! ❤

[@nourishedbyscience]

Thanks so much, both for the support and the kind feedback. Best, Mario

[@Ronlawhouston]

I am a big believer in the personal fat threshold hypothesis. It is the only thing that explains my situation. I do low carb, so for me, it is not intake. My sugars are great at 165 lbs but not so good at 180. When I see thin diabetics, usually you see a bit of a pooch if abdominal fat.

[@Jay-kk3dv]

You should look more into this. New studies are showing the low-carb insulin resistance association

[@vincent21212]

yep - Im in a similar boat. Im 6'8, 245lbs with a lot of muscle mass and a little fat. Im not the healthiest eater and I just hit the pre-diabetes mark. I know my body would totally give out before I could hit 280. Im not genetically fit to be morbidly obese. the only place Im able to store a bit of subcutaneous fat is in my lower back and gut, but by then my belly is filled with fat beneath the abdominals. I'd die a long time before Id hit 300

[@bugabutu]

​@@Jay-kk3dvusually related to high fat diets too

[@MightyElemental]

The adbominal "pooch" of fat could be caused by insulin injections.

[@keylanoslokj1806]

​@@bugabutuyou plant chompers must stop coping so hard. Low carb high fat diets do none of what you say

[@lazarus6983]

Wow... What an amazing video. This is extremely high quality stuff right here. It makes sometimes seemingly contradictory epidemiology very digestible and explainable to the average person. We need more videos like this across more domains which people often get confused in (mainly due to social media)

[@nourishedbyscience]

Glad you enjoyed it!

[@justsaying7065]

Thank you for the video! Please do videos on insulin resistance in the liver and muscle.

[@avval07]

This video is GOLD!!

[@felicecaccamo68]

Fantastic and clear! One of the best resources on KZbin.

[@debmurray2734]

100% agree with this concept ... i am small person, yet my fat storing threshold is very low. i am not obese but i am highly insulin resistant. Doesnt take many carbs or calories of any type to cause my body to pack on the fat. In other words i have to manage carb intake AND overall calorie intake.

[@h.4727]

Muscles can consume + store a lot excess calories! Build muscle!

[@sheila7814]

I am in the exact same boat. I workout several times a day and walk 5-8 miles a day. Seems to be working now for me…. One benefit, I am getting quite strong!

[@nravishankar2]

I am a physician and am this is the best explanation I have heard regarding Insulin resistance. Thank you.

[@nourishedbyscience]

Thank you!

[@sunbeam9222]

Just as we now see a surge of fatty liver in slim people we're going to have more and more slim looking diabetic. With low efficiency metabolism. Like in China. And what some people call toffee. Slim outside, fat inside. Genetics can only help us so far. Lifestyle is the most telling in the long run i guess.

[@wstockall]

This all seems very interesting. I'm curious, though, if liposuction has an impact on insulin resistance. I assume the process actually reduces the number of subcutaneous fat cells and if this logic holds it should make the insulin resistance higher, no?

[@caroldillon790]

This is interesting and makes sense, but I wonder if it is really a fat threshold thing or has some serious relation also to age and what that does to bodies. I say this because I've been obese my entire life, cresting in my mid 30s when I got up to 380 lbs. At that point my blood sugar was fine as was my blood pressure. Then when I was about 48 I was diagnosed with metabolic syndrome and high blood pressure and by then I had gotten down to about 260 lbs. Then the next year, I was diagnosed with type 2 diabetes and have had it now for about 20 yrs. My weight has fluctuated somewhat and after a hip replacement ended up creeping back up to about 300 (and right now I am 4 months into a determined effort to get a grip on my weight and diabetes and have lost 55 lbs so far with no end in sight). What puzzles me in my new efforts is that after dropping to near normal for a couple of months, my blood sugar has suddenly bounced back to morning sugars around 185-225 (which is as high as they've ever been even before I was doing 16/8 intermittent fasting, extreme low carb eating or controlling portions), and even worse, if I test my blood at random times during the day, the blood sugar doesn't seem to drop much (the lowest I've seen is about 145)...and yet my weight keeps dropping. I'm baffled (and alarmed)...is my insulin resistance getting worse... is my body producing less insulin? I'm confused and disappointed. Having said that, I feel fine, have more energy, the minor neuropathy that I'd started to develop in my feet is gone, blood pressure is averaging 110/57, triglycerides are 100, total cholesterol 138 with 59 for both HDL & LDL, etc. But those blood sugar numbers are freaking me out. Any thoughts on what could cause this?

[@danasamu5404]

Fascinating! Exceptional video, as always. Thank you. I'm curious if you are aware of any evidence based methods of losing weight that preferentially target ectopic fat over subcutaneous?

[@nourishedbyscience]

Thank you. Will cover this in detail as we discuss the different weight loss modalities, but yes, in general we tend to lose ectopic fat and particularly liver fat first when we lose weight. Cheers Mario

[@rabbitgirlz4380]

With intermittent fast and 10k steps and adding salads and eliminating rice from my diet i was able to loose a lot of weight.

[@azdhan]

@@rabbitgirlz4380 I can only speak from my experience . At my worst, due to very poor diet and excess calorie consumption, I was obese, with a waist size of 42 inches, 34% body fat, and 190 lbs. I was diagnosed with NAFLD. I ckeaned up my diet combined with calorie restriction which with lots of successes and failures along the way, finally helped me get down to 29” waist, total fat loss of 22%, and weight to 123 lbs. I got a dexxa recently and fibroscan. The fibroscan confirmed I had totally reversed my NAFLD, my total body fat % was optimal at 11.7% and my visceral fat % was also ideal/optimal at 0.1%. Normal is anyting form O.0% to 1%. I did not do anything drastic. Just incorporated healthier food with much less junk food, and engaged in 10000 steps walked daily and a combination of cardio and resistance training exercise. No intermittent fasting, no keto diet., etc. And if truth be told while I greatly minimized highly palatable ultraproceesed foods, I did not and could not fully eliminate them due to my sweet tooth Yet, I still managed to pull this off. Dosage makes the poison

[@tames307]

Very informative video, thank you. A couple of things I don't remember catching in the video, however, are: 1. Once a fat cell becomes insulin-resistant, is there a way to reverse it or shed the fat cell through healthy eating and exercise? 2. When losing weight, and specifically reducing fat in the body, will ectopic fat cells be eliminated first (before subcutaneous fat) or at the same time? I know you probably don't have time to answer every question in the comments section of your video, but these are a couple of questions I was left with. I've been on my own path for weight loss this year by changing my diet to reduce carbs and manage things which may cause "insulin spikes". So far in just over 3 months I've lost 30lbs but I feel like I've plateaued a bit (just in the last week).

[@nourishedbyscience]

Great questions. Re: question #1, fat cells can shrink when we lose weight, and then they should also become more insulin sensitive though. I am saying 'should' because one issue is that the low-grade chronic inflammation in fat tissue that is the result of dead and overwhelmed fat cells does not immediately resolve when we start losing weight. It seems to take quite a bit of time, and that would suggest that it would also take some time until we fully regain our insulin sensitivity in that fat tissue. However, and that relates to your question #2, when we start to lose weight, we usually first lose fat in the liver, and that means our hepatic insulin sensitivity usually improves quite quickly with weight loss. I'll cover question #2 more as we discuss different weight loss modalities. Cheers Mario

[@Hertz2laugh]

For your first question: Insulin resistance is 100% reversible, and can be accomplished in less than a year. The fastest and safest way to reverse insulin resistance is to keep your blood sugar levels as minimally elevated as is possible for as long as possible. Minimal blood sugar elevation + time = insulin resistance reversal So, how do you minimize blood sugar elevation? Control (1) what you eat, (2) how often you eat, and (3) what time you eat. 1) What you eat: • Fat = least sugar • Protein = moderate sugar • Carbs = most sugar Keeping carbs low is one key way to keep blood sugar low which will kick start insulin resistance reversal. Everyone is different but keeping total carbs below 20g per day is a good starting point. And there are no "special" carbs - all carbs are treated the same way by your body whether they come from a vegetable, fruit, or candy. Eating lots of healthy fats is a great way to stay full without spiking your blood sugar. 2) How often you eat: The more often you eat in a day, the more often your blood sugar will be elevated. Eating one huge meal in a day is *_MUCH BETTER_* than snacking all day or eating three meals per day. The "one meal a day" protocol (OMAD) gives your body the most time to stay at un-elevated blood sugar levels. Fasting (a.k.a. 0 meals a day) is the ultimate way to reduce blood sugar elevations but you can only do that so much, you know? 3) What time you eat: • Eating within a few hours of sleep or sundown is the least optimal time to eat. • Eating early in the morning is fine. • Waiting to around mid day is ideal because it allows you to move around in a fasted state which results in maximum fat burning. Please keep in mind that you will probably experience serious sugar (carb) withdrawals if you suddenly reduce your carb intake and the number of times you eat in a day. You will experience pretty much the same withdrawal symptoms as if you suddenly cut caffeine or nicotine. You'll also probably get diarrhea from suddenly increasing how much healthy fat you are eating. All these symptoms will pass in one to four weeks depending on how f▪︎cked up your body is when you make the change. Feel free to ask me any questions if you are interested in what I am presenting. For your second question: Yes; your body will use up fat in the reverse order you gained it - you will start with the fat in the liver, then burn up the fat around your organs ("visceral fat"), then you'll start losing the fat that is above your muscles (love handles, arm fat, thigh fat, etc)

[@nourishedbyscience]

The big question is: does lowering carb intake indeed improve insulin sensitivity per se, i.e., without any change in body fat mass or distribution, or is the insulin sensitizing effect of low-carb diets dependent upon weight loss? And that's related to the reverse question: do carbs cause insulin resistance? That's the topic of the very next video ... If you have any authoritative papers that you think I should consider @reaplays8851, feel free to post the links here. Cheers Mario

[@Hertz2laugh]

@@nourishedbyscience It's not that carbs cause insulin resistance per se, it is that hyperinsulinemia causes insulin resistance. So, anything - not just carbs - that elevates blood sugar levels over a prolonged period of time induces insulin resistance. Stress, frequency of eating, mold-induced inflammation, auto-immune diseases, etc etc all contribute to hyperinsulinemia which, if left unchecked, will result in insulin resistance, visceral fat increae, diabetes, and eventually death. The more severe the blood sugar elevation and the more prolonged the duration of elevation, the more rapidly insulin resistance is developed. You basically explain it yourself in this video when you describe the body controlling blood sugar levels by storing it as progressively less healthy forms of fat. The body's attempt to control chronically elevated blood sugar levels results in insulin resistance and visceral fat build up. And the theory of each person's individual fat threshold explains why you can be very thin but also a Type II diabetic - a person who has a very low threshold will not pack on the pounds of subcutaneous fat, but will more readily store visceral fat. It explains the "Asian Diabetic" phenomenon - the fact that countries like India and China have extremely low rates of obesity but also high rates of diabetes. I'll try to drum up related studies. After my kid goes down for nap time.

[@sssoup]

Easily one of the best in explaining complicated material in simple fashion. Thanks ...very very helpful

[@nourishedbyscience]

Thank you!

[@trend0000]

I waited almost impatiently for your new video! Great explanation, understandable and very teaching about our conditions who may concerns! On many similar KZbin sites, I always try to redirect people to this channel! Many explain well in general terms, but as you do, is all different level! Thank you!

[@nanhc9118]

Love the content! Thanks for sharing your knowledge! I came across your channel when looking for information to prevent glucose peaks. That video on GI and GL is excelent, I have since watched all your other videos. If I may suggest a topic, I'd say gestacional diabetes :)

[@nourishedbyscience]

Thank you for the feedback. And: good suggestion. Noted! Cheers Mario

[@bipindeshpande2043]

This is an excellent podcast, Dr. Mario. You have explained perfectly with the examples in real life. In my practice, I have seen many diabetics having a good amount of subcutaneous fat compared to the visceral fat. They have less muscle mass. There are also some patients with a huge percentage of visceral fat, yet remain nondiabetic. Anyway, your way of narration is very good. Thanks once again. Dr. Bipin Deshpande, India.

[@nourishedbyscience]

Thank you, Dr. Deshpande! I don't doubt you are correct. However, remember the role of the pancreatic beta cell, i.e., the ability of the patient to make enough insulin for their level of insulin sensitivity. Therefore, the relationship that is strongest for visceral and ectopic fat is with insulin resistance, not glucose tolerance, based on several high-quality clinical studies. Sure someone could have a lot of visceral and ectopic fat and be very insulin resistant as a result, and still not have diabetes if their beta-cells can make enough insulin to compensate for the insulin resistance. Similarly, someone may have quite little or even no visceral fat and still develop diabetes, if their beta-cells are unable to produce much insulin at all. Hope this makes sense!? Warm wishes to India! Cheers Mario

[@bipindeshpande2043]

@@nourishedbyscience Dr. Mario, I appreciate your prompt and rational response. I agree with you totally. Cheers, Dr. Bipin

[@littlebitmckee8234]

I am a recently retired nursing professor. I wish I would have known about you to share with my students. Blessings to you and prayers for your continuing work

[@montourigirl]

Wow, best explanation i have listened to! I think I finally understand this complexity.

[@CapucineAbadie]

I thought I already knew quite a lot about this stuff, but this was soooo fascinating! It's actually very inspiring, because once you know how something works, you know what you can do about it.

[@nourishedbyscience]

I'll make one more video about causes of insulin resistance, because not only do we need to understand how the body works, but also what the specific cause of insulin resistance in any one person may be. If someone is insulin resistant because they are chronically stressed and sleep deprived, the lifestyle change needed will be different than in someone who has fatty liver or medication-induced insulin resistance. Thank you for the feedback. Cheers Mario

[@jamescurtis6217]

Masterclass!!!! Thank you Mario for your detailed explanation, I finally feel that I have a grasp of my condition. I am an ancient Brit but live in Czech Rep. and was diagnosed with T2D about 9 years ago and unfortunately my doctor speaks almost no English so your postings are invaluable to me. Thanks again, superb work and very good luck with the channel.

[@aao449]

You live in Czech Rep., should he be talking to you in English or should you be speaking to him in the local language there?😅

[@jamescurtis6217]

@@aao449 Good luck to anyone of my age (81) attempting to learn the Czech language and its medical terminology 😅

[@alexmacleod9727]

can honestly say that i have never found anything that has made any significant difference to aiding fat loss

[@kirstygreenfield1926]

Hi can I ask question please? You probably have lots of plans for your future videos, but I was wondering about a couple of things. Are you able to assess for us the evidence for cold water therapy/open water swimming on metabolic syndrome - I have come across reduction of inflammation suggested as a possible feature lf cold water immersion but am unsure how strong the evidence is, and whether there is likely to be a measurable effect on glucose handling and/or insulin sensitivity? Also, what are the mechanisms by which gut microbes affect glucose handling, and how big an effect do you think this is? Many thanks again for this fantastic series of videos which I have just recently found, and find extremely clear and pitched at a great level for someone with an interest in science but not necessarily a professional in this field. I have already shared widely amongst family and friends, and thankyou for your service to global awareness of this complex area and therefore to public health.

[@Gianmarco77]

This is a life changing video. Must watch over and over.

[@obfuscatid]

Maybe, once you complete a series, you can devote one or two videos to explaining how GLP-1 agonist products like Ozempic/Mounjaro (also GIP) work. Seems a bit complicated ... for instance how they work, although they also increase insulin and reduce glucagon, which seems contrary since insulin normally inhibits conversion of fat cells' triglycerides for energy.

[@juliapace2845]

Thank you for this excellent explanation, something that other 'experts' only hint at. Interesting and well done - without dietary dogma. Thank you so much - I have been searching for this kind of information.

[@karolina8367]

Glad to have found your channel, so much valuable knowledge, thank you so much!

[@dee9692]

This is a brilliant exposition of insulin resistance in itself. And, as I've found after watching very many talks/videos about metabolic syndrome/diseases, this description is absolutely necessary not only for understanding the part that IR plays in the progression towards T2D but, more broadly, the role of uric acid, fructose, nitric oxide, etc. when describing the various processes resulting in metabolic distress. The complexity of these relationships often means that presenters gloss over and short circuit explanations of the meaning of insulin resistance. Here, however, Dr Kratz has squared the circle for me and provided all the missing relationships for a pretty good understanding of the broader aspects of metabolic health. Bravo!

[@nourishedbyscience]

Thank you. Glad you found it helpful. Best, Mario

[@jensissons5709]

great video . can you do the same video for weight loss ? is visceral fat loss first? are toxins stored in fat? why excess skin after weight loss . with cartoons too please ! thanks

[@vixdivum]

Aaawwwesoooome video!!!!!! Thank you very much! I loved it - as all the other videos! You truely have a unique way and talent to make complex topics easy digestable eve to people with no scientific background! Well done! 👏👏👏

[@benfromaustria]

SOOO great explanations…👏🏻👏🏻👏🏻

[@wigglywrigglydoo]

I would love to know more about diabetes type 1. It's under researched. Thank you for this video!

[@Finn959]

Do people with less visceral and more subc fat need to go a different way when it comes to losing fat compared with the other group?

[@nourishedbyscience]

Mostly, no. However, there are a few factors that predispose to storing fat in visceral and ectopic depots, as we'll discuss in future videos, and minimizing these factors would be particularly important for people with excess visceral and ectopic fat. Cheers Mario

[@NicoMatthijs]

This was a very good video. Thank you for this and for the large amount of effort that was clearly put into this. I learned a lot from this. Subscribed 😊

[@nourishedbyscience]

Glad it was helpful!

[@renhermsen8062]

Many thanks for sharing! Very well explained and well done!

[@gloriaharbridge4986]

Prof Ben Bikman is one of the best I have heard. He has done 10 years of studying and teaching Insulin.

[@janborkowski9494]

That was a very informative and well prepared materiał. Keep up decoding how the body function and how we can avoid all that mess❤

[@KoiRun50]

Awesome animated graphics. I find this is the best way for me to learn.

[@nourishedbyscience]

Thank you. I am still learning how to make these (and mostly need to learn how to make these quickly; these here took way too long ...;-) Cheers Mario

[@VincentConti-m5j]

This guy is very good! The basics and very understandable! Mario?????

[@kamalkishore6358]

Hello Dr Kratz, I was wondering if it is possible that a particular food item or sugar can cause the fat to become ectopic before an individual reaches his/her personal fat threshold? Or fat deposition always follow this sequence i.e. first subcutaneous, then an individual reaches personal fat threshold and after that ectopic?

[@nourishedbyscience]

Great question. Short answer is yes, there are definitely dietary and other factors that can lead to the accumulation of fat in visceral and/or ectopic depots even before the subcutaneous fat tissue is 'full'. Long answer: see the next 20 or so videos ...;-) (sorry, not trying to tease, but it's just too much to type down here, plus, I need to do more in-depth research on the most recent publications before I speak about this publically). Cheers Mario

[@donbrown7694]

This is great to know!!! I switched to a ketogenic diet due to type 1 diabetes. I had the typical hyper responder values (low triglycerides) but after a while I gained 5 kg (to just 75 kg!) and since then my triglycerides are always above 100 no matter what I do. I notice my insulin resistance due to my insulin shots. I’ll also try to get the CRP measured and reduce my fat. Thank you for sharing this!

[@luccalus]

I have seen a lot of videos on this subject and this one by Dr Kratz is by far the clearest in its explanation.

[@nourishedbyscience]

Thank you for your kind feedback! Cheers Mario

[@Gamvrelis]

A brilliant and well-paced presentation - thank you!

[@marcoantoniosundfelddagama7690]

Brilliant, Dr. Kratz! There is one thing I still cannot undestand: How can someone delevop morbid obesity if their fat cells are expected to become insulin resistant (first in the subcutaneus and then in other tissues as you explained) as they gain weight? Is it because fat cells from some people remain (for some reason) insulin sensitive despite the progressive fat accumulation in their subcutaneous and visceral tissues? I mean, if your fat cells become insulin resistant, we should expect that fat accumulation slows down, right? Could you please comment on that? Thanks and congrats again for another great video.

[@nourishedbyscience]

Hi Marco! Thanks for the great question. I think that the evidence really does support exactly what I stated in the video: that as long as we can store fat safely in small fat cells in subcutaneous adipose tissue, we are metabolically OK. In my lab, we have seen extremes of this: one lady had a BMI of about 70 (no typo). She had no diabetes, and was only mildly insulin resistant. I was in the operating room when she had bariatric surgery, so I can confirm that she had a lot of subcutaneous fat tissue. Some people simply seem to have a very high personal fat threshold ... Best wishes, Mario

[@marcoantoniosundfelddagama7690]

Hi Mario, thanks for your comment. Perhaps looking at the adipose tissue metabolism in those people may help us better understand and manage insulin resistance and T2D, don't you think? All the best. @@nourishedbyscience

[@sam2wmc]

Dr. Kratz - Thanks for another great video! I love your evidence-based approach, and the fact that you don’t push anything - but rather - you just state scientifically grounded opinions, as your lifetime of experience has informed you, and then let the viewer decide for themselves. After watching this video highlighting the dangers of excessive fat, I am wondering if you have looked at research to see whether any of today’s “miracle” weight loss drugs can help to reverse a lifetime of neglect - not as a substitute for good nutrition, but to turn back the clock a bit, and then follow a healthy lifestyle? This information could be particularly helpful to older viewers.

[@nourishedbyscience]

That's a great question. Once someone has accumulated a lot of excess visceral and ectopic fat, the data are clear that we can reverse it by diet and lifestyle change, but it can be hard to maintain that reduced body weight in the long term. It's clear that the new class of obesity medications can offer tremendous help to many people with obesity, and I am therefore not against considering them. However, I also do feel strongly that these drugs should be paired with dietary and lifestyle changes, specifically resistance training (to prevent loss of muscle mass) and an adoption of a very micronutrient-dense diet (because the lower overall food intake makes vitamin and mineral deficiencies more likely). I'll make a video about these medications at some point soon. Best, Mario P.S.: Thank you for your generous support! Much appreciated!

[@amarug]

this was a truly amazing video. excellently researched and presented. thank you so much for your efforts!

[@jackgoldman1]

Thank you for your science based approach to nutrition and being our own best doctor for myself. I am lowing my A1C with medication and behavior changes.

[@bobslawson1623]

I kept thinking of a question while watching: What then might be the effect of subcutaneous adiposity reduction by liposuction on the future susceptibility for developing insulin resistance? Liposuction reduces the number of subcutaneous fat cells available lowering the (hypothetical) personal fat threshold which, in the absence of dietary lifestyle change, would lead to excess fat being stored in visceral fat depots and increased insulin resistance. Has this been studied?

[@tonynoonan3723]

Yes.Liposuction is a very bad idea for the reason you mentioned.The number of fat cells is under genetic control and epigenetic control up to the cessation of the growth phase.If one was a skinny kid/teenager one will have fewer fat cells as an adult.Not all adults will induce fat cell hyperplasia,it is thought only 20% can( but there is very little research in this area )and these would be the morbidly obese cohort.Any surgeon who does liposuction for weight loss should be criminally liable for the negative health consequences.

[@rajeshjyotsna1184]

Immediately subscribed and pressed bell icon after watching this video. The most clear way of explanation which everyone can understand. Got confidence that i can improve my health

[@diannefitzmaurice9813]

Quite good just would like the concluding info to be a little more succinct since it is so involved. Start with conclusion and pull out main point at the beginning and then go into the detailed explanation . Then repeat the conclusion at the end . But thanks for a great video and explanation. Concl: Not all body fat causes insulin resistence . Insulin resistance develops when personal fat threshold is crossed. Supporting point 1 : crossed when energy toxcity develops because the sub cutaneous fat storage reaches limit. Supporting point 2: energy toxicity creates chronic low grade inflammation across whole body (because of where it goes to be stored ie around organs ) . However once I got the argument to its lowest common denominator it is clear that the fat threshold hypthesis is the indicator . But what is not clear is the relationship of insulin resistance to inflammation. I probably need to watch it again and maybe a couple of times to understand the whole process better, as there are a few points relating to the inflammation that need clarification. Given all of this it doesn't necessarily mean we need to lose weight but to monitor our energy metabolim and inflammation, especially as we age. But thank you again . I look forward to more videos .

[@nourishedbyscience]

Good suggestion. Thank you for the feedback. It is a challenge to convey the complex science to a lay audience in a video format, and I am admittedly an apprentice in that craft. Always happy to receive feedback. In terms of weight loss: the one big reason I shared this is that these data suggest that people can benefit greatly from just losing a few pounds if that fat comes right out of liver and visceral fat depots. We'll discuss these studies, and best strategies to do that, very soon. Cheers Mario

[@maebellinekang]

I'm so happy I came across your channel. I have been doing intermittent fasting and low carb and this clinical explanation makes so much sense to my journey. Thank you so much, definitely have subscribed. Also the amount of script and research and diagrams in your videos are commendable 💯👍🏻

[@maralfniqle5092]

Cortisol is the biggest factor

[@camelcase811]

Just over a year ago I started intermittent fasting (16/8 method) and have dropped from 100lg to 85kg. Do we know on average how long it takes for the inflamation to disappear and to restore insulin sensitivity in the adipose fat tissue?

[@nourishedbyscience]

Great question. It does seem that acutely, i.e., while you are losing weight, the inflammation in fat tissue does not resolve. The best estimate we have (the data are not perfect) is that it'll take a few months and/or stabilizing at a new, lower body weight plateau. However, the good news is that your liver and muscle insulin sensitivity improve almost immediately, and that can make a huge difference. Cheers Mario

[@r-type4945]

Finally a new video, was eagerly waiting for this. 👍 Interesignly the channel 'what i've learned' covered the same topic recently. Thanks, Mario. Pls keep up making these videos, you're surely helping a lot of people with this.

[@kamalsahabi]

Thank you very much sir, please i need your advice I have type 2 diabetes for four years now and I lost weight but I could not control it till. my fasting blood sugar as at last week friday is 14.1mmol/l please sir tell what i should do to control it and would I gain my weight back if the sugar level is well control?

[@nourishedbyscience]

Hello, Sorry to hear of your blood sugar issues. Importantly, in my response below, I am just stating the scientific facts. I cannot diagnose what your health issues are. Please discuss this with a doctor or nutritionist, who is able to take your entire health history into consideration. At a blood sugar level above about 10 mmol/L (180 mg/dL), the kidneys are unable to keep all of the sugar in the blood, and we start excreting sugar in our urine. If the blood sugar level exceeds 10 mmol/L for much of the day, then we would be urinating lot and losing a lot of sugar (=calories) in the urine. This would be expected to lead to weight loss, and weight loss should stop once the blood sugar is kept under 10 mmol/L all day. Warm wishes, Mario

[@playpianotoday6223]

You explain very complicated information in a very understandable way. There are some brilliant doctors on KZbin who also cover these same topics as you but I think your videos are the best. You often apologise at the end for how long the video is but we completely understand that you really need more time to properly explain this information. Many thanks!

[@sw6118]

Finally an explanation that makes sense.

[@rolitiwari0909]

I have lost 8.5 kgs weight in last 4 months. I am 54 kgs now but I am still insulin resistant. Why? 😭

[@nourishedbyscience]

Sorry to hear. I obviously cannot comment on your health issues here. So just a few questions and suggestions that may help you further in your discussions with your doctor: First, how do you know that you are insulin resistant? Make sure to not confuse insulin resistance with glucose intolerance, which can also be caused primarily by poor insulin production (which we call beta-cell dysfunction). If this is not clear, I'd encourage you to watch this video here: kzbin.info/www/bejne/j5iccoZoqMuMb7ssi=-E7YdJ8_EUsNznFG Second, it is possible even for people with normal body weight to have excessive visceral and ectopic fat. So even someone who is not overweight or obese could have insulin resistance for the reasons explained in this video. Or you could have insulin resistance for reasons other than excessive fat. This is something for you to talk to your doctor about specifically: poor sleep/sleep apnea, excessive stress, PCOS, certain medications are all possible alternative causes of insulin resistance. For the rest of the year, all of my videos will deal with insulin resistance, it's varied causes, and how to reverse it, so if insulin resistance is really the problem, then I am hoping this content will be useful for you. Warm wishes, Mario

[@rolitiwari0909]

@@nourishedbyscience thanks for replying.. I'll watch that video

[@Sparkling-Cyanide]

This was great! The only time I really understand insulin resistance, blood sugar, diabetes, etc. is when you explain it. Then everything makes sense!

[@sunbeam9222]

Wonderful video. Answered many aspects of fat functioning that I always wondered about. Thank you 🎉

[@Kris_2535]

Any research on whether fasting or prolonged fasting increases the number of pre adipose cells available for sub cutaneous fat storage?

[@deekap8387]

Very nice video. I am 5’5” tall, slim vegetarian with a flat abdomen (no one believes I am diabetic) and my weight in my 30s was at 120 and now in my 50s is at 117. However I am now diabetic with an A1c of 7, and trying to figure out if I should try keto to bring it down. My Homa ir is high at 5, and all other markers like crp, bmi and triglycerides are within range. I tried to eat healthy for the past 10 years but in my 40s I have eaten lots of pizzas and fast foods when kids were young. What would be the best way to get the visceral fat down? If I lose any more weight I look like a stick😂. If I lose a couple of pounds will the A1c come down? In your non medical opinion, would it be a better choice to go on Metformin? My dr doesn’t believe in any alternative methods and suggesting metformin soon. However I thought if I can do short periods of intermittent fasting and with keto, what if I might be able to bring the IR down. For some reason as soon as I eat even good complex carbs with good protein, the sugar still high rockets. Any opinion is highly taken. Thank you!

[@DM-ql6ps]

What about trying to build muscle? Skeletal muscle is an important sink for glucose and regulator of blood sugar. If you are very slender you may have little muscle and would benefit most from something like strength training.

[@deekap8387]

@@DM-ql6ps true. I have very little muscle. And it’s hard to gain muscle in my late 50s. I have been trying. I get tired very fast bec of high sugar and tough to get motivated to resistance training bec of the body pain. I do aerobics but it’s not even budging. I get 10 K from walking too. I think I will start in band training and see if that works. Thanks for the reminder.

[@eugeniebreida1583]

@@DM-ql6psI second your idea.

[@eugeniebreida1583]

I would research Berberine.

[@deekap8387]

@@eugeniebreida1583 Thank you!

[@kirstygreenfield1926]

Fantastic video, clearest and most comprehensive explanation I have come across, and I really appreciate your evidence based approach.

[@fractalbeans9513]

I need to watch it again and again; so many questions. This is an eye opener - THANK YOU!

[@Overlord1241]

Woahh! The knowledge, the animation, and the tids and bits of information that I had, everything makes so much sense now! Thanks!!!

[@brianwalls9253]

Hi Mario, please would you do a video on people with lipodystrophy and the metabolic chaos it creates. 🙏

[@galaxywanderer5945]

Dear Dr Kratz, Thank you for your detailed presentation concerning the two type of fats and its structure effecting the insulin resistance component/outcome! before my usage of the CGM, I would probably have gone with this theory! please do not take me wrong as I am not suggesting this theory has no element of facts! BUT since I started using my CGM almost constantly I have discovered NEW WORLD of diet verses Type 2 and BGL! I can say with 100% certainty based on my own experience as Type 2 sufferer, that Not all Type 2 sufferer have insulin resistance! Not all Type 2 sufferers react the same to carbohydrate enriched food! AND not all Type 2 have the type of issues relating to the two type of fat storage. My BMI is within normal range, My C-peptide level is within normal range! I don't have NAFLD, I walk 5 KM a day minimum , I am fairly active more so than many people I know, my diet is mostly vegetable combined with dairy product, meat and fish etc. Yet when I woke up in the morning my BGL is always high, I wait till midday/afternoon and my sugar level starts to drop, further more when I eat some fruits such as dates or grapes with my meal I noticed my Blood Sugar level starts to drop within minutes!!!!! when I hungry my BGL is around 10 but as soon as I eat it drops to around 7! when I am sleeping is around 6 to 7!!!! So where does the personal thrush hold theory fits?! Since my CGM usage I sincerely no longer believe in the Glycemic Index and no longer believe in any tablets and for SURE no longer believe that I have to wait two hours after meal to see how my body reacts to that meal! I react within minutes! Have a lovely day and keep up the good work!

[@sheila7814]

My body also reacts within minutes but it does match the glycemic index of foods. I think there are several factors that affect a person’s blood sugar and regulation. There are so many linked hormones…. [produced in the pituitary gland, adrenal and pancreas] If one is off for some reason (like mine - I am on anastrazole), then it affects your glucose because they are linked. When they say wait 2 hours and check your blood glucose that was before CGMs and it was to check to see if a certain food kept your blood glucose level high, longer … like the two hour period. Most meals I eat (but not all) rise in a spike or gentle hill and then within about 30 minutes it has fallen back to my baseline unless it was very high in carbs…. Then my baseline glucose stays at a higher level for hours or until I go exercise. ❤

[@Trudysaccount]

How can I lose the ectopic fat?

[@sheila7814]

@@Trudysaccount I am working on this as well. I think I have lost some. I used to weigh 175 a few years ago…. Now I am at 142. Cancer kicked my but into gear and I exercise off and on almost all day. In other words, I am active most of the day. I have gotten rid of fatty / sugary foods and no longer eat processed foods. I am slowly losing a pound or two a week and it feels great. ;) Good luck.

[@Memento2mori]

So, the number of sub-cutaneous fat tissue (cells?) laid down, in childhood, is extremely significant? Childhood diet seems key here.

[@32starsandsugar]

I am not even on the bmi scale you showed. I’m bmi 19 and A1C 5.8 :(

[@kostar500]

Yes but what is your body shape?

[@sunbeam9222]

You are. It says less than 22 BMI range

[@lisbetchristensen5951]

🥱

[@nanrod3201]

Between 20-25 bmi 5”7 diabetic. Cannot ever get my numbers down. Just a super hard time.😢

[@GenExTech]

That is crazy, because the average US BMI is 29 and already quite high on that chart..

[@samuele.marcora]

I have lost 15 kg and normalised my insulin resistance. Cunningly similar to the trials based on the pft hypothesis

[@tam8479]

Excellent video! Thank you so much for sharing your knowledge. It makes sense that im underweight and have diabetes eventhough i eat much healthier while my friends who are so unhealthy yet have no major health consequences. Liked, subscribed, shared!

[@aimanmazloum9561]

Great information!! can you please let us know how and what happens when we lose weight or be in (fasting vs calorie deficit vs low blood sugar) in healthy vs insulin resistance individuals

[@mhossain400]

Hi Mario, this is a fantastic explanation. thank you. Could you please clarify 2 things for me. 1) does the body when healthy store energy/fat subcutaneously first, then when full or becomes IR, it starts to store in the visceral fats. 2) if the first is true, then under long term high stress situations where the body releases lots of Cortisol (and i understand triggers a fight-flight threat energy storage situation) the body stores energy/fat in Visceral fat first instead of subcutaneously, meaning that stress plays a vital part of how all this works - is this correct? Thank you!

[@nourishedbyscience]

This is a great question, and one I need to do a bit more research on to answer with full confidence. I'll definitely have several pieces of content in the near future that will touch on this. The short answer, without going into any specifics, is that yes, it seems clear that some nutritional and hormonal factors can lead to visceral and ectopic fat deposition before the subcutaneous fat tissue is 'full'. Cheers Mario

[@mhossain400]

Thanks Mario, looking forward to your finding on this topic. It would be really useful for all to know what triggers visceral fat deposit before subcutaneous, and to what extent. Thank you!

[@thewellnessroom6574]

I am obsessed with IR and have watched hundreds of videos and have gone to conferences explaining this, and this videos in my opinion is one on the best ones. Thank you!!

[@write2anishs]

Best video ever . Glad to hear your findings . Amazing it is !!

[@matlepak9694]

Excellent information. Very thought provoking

[@malib1234]

You say in the video that glucose in the presence of insulin is converted to fat. This is not factually correct as after a meal glucose goes to glycogen stores and the body switches to burning glucose as the main fuel substrate to burn off excess carbs. Experiment have shown that converting glucose to fat is not energetically favoured in humans in normal conditions and it takes excessive overload of carbs for several days before carbs are converted to fat. In the presence of carbs insulin keeps fat in storage and upscales glucose metabolism.

[@abdulwali7578]

So can someone here please let me know the summary of the video please as i have very little knowledge of medical, insulin etc although i suffer from it. I will also appreciate if someone can also let let me know what solution Mario gave at the end to aviod all these fat storage? thanks

[@rmararj]

Wow, this is the best explanation about insulin resistance in YT, congratulations and thanks

[@shantishanti1949]

I am 9% body fat and my coronary arteries are shot. A score of 485 on a CAC score. I look like Popeye with a fully muscle body. So I am not well even if I look so. I am a heart attack waiting to happen and everything hurts. Being lean isn’t always good.

[@nourishedbyscience]

Sorry to hear. Have you rules out a genetic predisposition, i.e., do you have massively elevated apo B and/or Lp(a)?

[@shantishanti1949]

@@nourishedbyscience actually no my doctor just offered statins and said nothing to be done as cannot reverse sclerosis. At 72 I was written off.

[@nourishedbyscience]

​@@shantishanti1949 Argh, that is so upsetting. I am very sorry to hear this. Now, for one, if I was you, I would insist that both apo B and Lp(a) are measured. Apo B is the key protein in LDL particles, and one of the causal factors in the development of atherosclerosis. That should guide treatment. Lp(a) is less well known, and is elevated in some people due to genetic factors. You may want to know about whether you have elevated Lp(a) even if just for the benefit of any kids you may have, who may inherit this. Treatment options for elevated Lp(a) are limited at this point, but there are some, and they will imporove over time. Beyond this, have you seen my video about reversing heart disease? Have a look, and please don't hesitate to be in touch should you have any questions: kzbin.info/www/bejne/habRoIObrdR8l6Msi=Q8G-NcOE9kWMR_mK Best wishes, Mario

[@erastvandoren]

​@@shantishanti1949 Read How not do die by Michael Greger

[@donwinston]

👏 (for the algorithm)