#149 - AMA #20: Simplifying the complexities of insulin resistance: how it's measured, how it manifests in the muscle and liver, and what we can do about it

The Peter Attia Drive

In this “Ask Me Anything” (AMA) episode, Peter and Bob discuss all things related to insulin resistance by revisiting the important points made in the fascinating, yet quite technical, episode of The Drive with Gerald Shulman. They devote the entire discussion to understanding the condition known as insulin resistance, how it’s measured, how it manifests in the muscle and liver, and ultimately, what we can do about it.

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We discuss:

• Explaining the format of this AMA: Extracting insights from Gerald Shulman’s masterclass on insulin resistance (2:00);
• The basics of insulin, defining insulin resistance (IR), and gold-standard methods of quantifying IR in the muscle (7:15);
• Practical ways to test for insulin resistance in a normal clinical setting (15:45);
• How insulin resistance manifests in the muscle (23:00);
• The biochemical block in glycogen synthesis—drivers and mechanisms resulting in insulin resistance in the muscle (30:45);
• The disparity in fat oxidation between insulin-sensitive and insulin-resistant individuals (44:45);
• The fate of the ingested carbohydrate in someone who is insulin resistant (51:00);
• The prevalence and clinical phenotype of insulin resistance (1:00:15);
• The role of exercise in mitigating and reversing insulin resistance (1:05:00);
• How insulin resistance manifests in the liver (1:09:15);
• Biggest takeaways: what we can do to mitigate and prevent insulin resistance (1:20:45); and
• More.

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