Why muscle may not fix insulin

Philip Pape 0:00

I've mentioned on this show that insulin resistance is often a muscle problem, that building muscle is one of the best things you can do for your metabolic health, and I truly believe that. But my guest today, a diabetes specialist with 22 years of clinical experience, says you can lift heavy, you can have solid muscle mass, and still be insulin resistant. Today she's gonna walk us through at least five warning signs that your metabolism is in trouble even if you train hard. We get into muscle mass versus muscle quality, how to test for insulin resistance proactively long before A1C becomes a problem, and midlife changes to your body composition and sexual health that have nothing to do with your effort in the gym. Plus, the one thing almost every lifter is undereating that directly affects how your muscles handle glucose. That's all coming up. Welcome to Wits and Weights, where in every episode we put a popular piece of fitness advice under the microscope, find the hidden reason it doesn't work, and give you the deceptively simple fix that does. I'm your host, Philip Pape, and today's premise that we're going to challenge is build muscle and you'll fix your insulin resistance. It's advice I've given on this show. It's backed by evidence, but it's not quite the whole story. So my guest today is Amber Wilhoit, a registered dietitian and certified diabetes care and education specialist who's spent over two decades working with patients in clinical diabetes care. She's the host of the Diabetes Podcast, which you should go follow right now and check out the episode we did together, the Diabetes Podcast, and the founder of Empowered Diabetes, where she helps adults with type 2 diabetes and prediabetes achieve remission through lifestyle changes. So today, Amber is going to walk us through at least five signs that you might be insulin resistant even if you lift weights, including muscle mass versus muscle quality. We'll talk about proactive blood work. We'll talk about early signs to look for and some tips you can implement this week. Amber, welcome to the show.

Amber Wilhoit 2:12

Thank you. Thank you for having me. I'm so excited.

Philip Pape 2:15

I've said on this show, I talk a lot about insulin resistance and sensitivity related to a lack of muscle, related to a lack of movement, aka fitness, you know, not just as a carb or blood sugar problem, but given that you've worked with diabetes patients for a long time now, right? That's your expertise. How big of a factor in like the pie is fitness when it comes to insulin resistance?

Visceral fat and waist-to-hip

Amber Wilhoit 2:39

Oh my gosh, it's a huge factor because skeletal muscle plays such a predominant role in taking in glucose in the absence of the I think of the way the body takes in insulin, is uh insulin is the key that unlocks the door to this body's cell and lets the glucose get inside where energy can be made. So when you have excess adiposity, especially around the midsection, especially around your visceral organs, which are your lungs, your heart, your liver, your intestines, then you are more resistant to the insulin that your body produces. So then the pancreas gets the signal, we need more, we need more, and it puts out more insulin. But the muscles can act like a sponge and use other pathways beyond, you know, needing that insulin key to the lock, one being the GLUT4 pathway, where it can act like a sponge and take in that excess glucose from the bloodstream. So skeletal muscle is really key in fixing part of that problem.

Philip Pape 3:49

Okay. And that's good to know, right? Because we are on one hand saying like that is important. And on the other hand, I do want to cover what other things are important because that's not the whole story. But two things I want to unpack there. The first is the excess adiposity you mentioned, visceral fat around the organs, which a lot of people want to get rid of for multiple reasons, including aesthetics, but also it's super uh uh important to your health. I like what you said though. You are more resistant to insulin when you have it. So it's almost this vicious cycle. The more you have it, the more you can get until is that kind of how it works?

Amber Wilhoit 4:24

Absolutely. I often refer to it as a snowball effect that one leads into the next, which leads into the next. And and so it's it's also about when we talk about genetics and the role that it plays, it's not as much as most people think. It has more to do with where you store your fat genetically than it does a genetic predisposition because genes take thousands of years to really change, but then you do have something called epigenetics. So you have like a dimmer switch that can be moved up or moved down, but your environment really shapes whether that dimmer gets moved up or down. Yeah. So you could be a person who stores more fat around your hips and butt and thighs. We call that a pear body shape, and your insulin resistance, your diabetes risk would be lower than someone who tends to store more fat around their abdomen that what we call an apple body shape. And we have something called a waist to hip ratio, which is one way to measure that. And typically in women, you want a waist-to-hip ratio that's below 0.85. So you you measure the smallest part of your waist and the largest part of your hips, and you divide one into the other, whichever one makes sense. I'm just kidding, but you you divide the larger to the smaller, and then you get your ratio. And for men, and you want it less than 0.9. So if it's greater than that, you're at a greater risk for cardiovascular disease, insulin resistance, diabetes, and so on.

Philip Pape 6:01

So that's important. I love that you went right to data and measurements. I literally just recorded a walkthrough video of a physique tracker that I have, and in one of those things is waist to hip, and then like weight to height and different things. So I have a quick question. Is waist to hit hip ratio like pretty much the simplest, best way to go? Or do you also look at like the body roundness index is one that I've seen that's replacing BMI? Like, do you have any others that you use?

Fasting insulin, the underused test

Amber Wilhoit 6:26

I really like waist-to-hip ratio. It's so simple and it it's one of the most researched when it comes to visceral adiposity to look at that. And then if you're if you're really looking at biomarkers like early intervention for things like prediabetes and type 2 diabetes, which I believe people should be looking at because the statistics around this are amazing. So one in two adults in the United States has either prediabetes or type 2 diabetes, which is just phenomenal when you think of the greater your age, the more your risk for diabetes. But we're so if you really took another slice of that older population, it's definitely going to be greater than one in two. So one way to know your risk really early on, there are things like your A1C, which if you if you go on the American Diabetes Association website, you can see different like clinical markers to diagnose prediabetes and diabetes. One is your A1C test, which measures the glucose levels that are attached to your red blood cells. And your red blood cells live about three months, so they can measure that and then get an idea of how the sugar's been circulating in your bloodstream for three months. But that's not really going to be elevated until you've already had a great degree of insulin resistance and you've already had a great degree of fasting insulin levels. So that it starts with those fasting insulin levels being higher. So that's another test that's completely underutilized. So back to your question, I like waist-to-hip ratio because it's cheap. You can do it today, you know, you could do it in the next five minutes. But fasting insulin levels are another pretty inexpensive test that you could get done. And if the number is five, if it's under five, you're good. If your number is five to 10, then you've got some level of some early insulin resistance that could be possible. If it's 10 to 20, it would be moderate insulin resistance. And then greater than 20, you've probably got some very significant insulin resistance going on. And that's going to affect your inflammation levels and that avalanche effect.

Philip Pape 8:50

So fasting insulin is that typically tested as part of normal labs that people get, or do you have to ask for it?

Amber Wilhoit 8:56

You have to ask for it. It's not typical, very underutilized.

Philip Pape 9:00

And is it affected by the environment of the study, or you know what I'm trying to say? The situation, like what you've eaten and all that? Because it's fasting, right?

Amber Wilhoit 9:08

Right. So you want to who knew fasting would be like no part of it.

Philip Pape 9:13

That part seemed obvious, but yeah.

Amber Wilhoit 9:14

No, it's okay. No, I think it is important to spell it out because if if people are going to be doing this, it's important that they know what they're asking for and they know how they would show up for the lab test. And so it's a blood draw. And you would want to be fasted for eight to 12 hours prior to that test. And with this one, you actually would not want to do your wits and weights workout before that lab. You don't want to exercise day of. And you wouldn't want to have caffeine, coffee, even though it's no sugar, no cream. You wouldn't want that before that test as well, because that could increase the insulin levels.

Philip Pape 9:49

That actually makes sense, right? Because when you work out, you're changing the dynamics of the insulin in your bloodstream and where they go. And I think that is related to the GLUT4 transporter as well that you mentioned. Yeah, the pathway. Maybe we could dive into that a little bit so people know what that is.

Exercise pathways, stress, and sleep

Amber Wilhoit 10:06

Well, it's just essentially an alternate route. You know, if if you think of, I like to use Waze and some people hate it, some people love it. I really enjoy it to get me where I'm going and avoid traffic jams and and the like. So think of insulin resistance as the traffic jam. And Waze is going to divert your path around this. So it's another way to get glucose into the cells, which is what your body needs to have happen, in the absence of, you know, it overcomes that resistance. It is a way to get it directly into the muscle where the energy is needed. Create ATP, you get your all that Krebs cycle goodness that we learned. Whew, huh? I don't want to say how many years ago, almost 30 years ago. But yeah, it's just allows your muscles to get the energy that it needs. And the more the better trained you are, the better that glute four pathway is going to be. The more skeletal muscle you have, the more sponges you have, the more water you're going to be able to soak up.

Philip Pape 11:10

So that's a good point, right? Because sometimes we think about transitory effects and then long-term effects. And I know we talk about training a lot as having both benefits of like while you're training, amazing things happen in the process of when you're in the gym and right after as you're recovering and as you adapt the next few days, and then long term. So when it comes to insulin resistance, you mentioned the GLUT4 is, I guess, amplified when you have more muscle tissue, is because you have just have more of those or or more that are switching on.

Amber Wilhoit 11:41

Yeah, but I think it really comes down to what you see in terms of like for my experience, it's been people who have altered glucose metabolism, who have type 2 diabetes mostly, sometimes pre-diabetes, but in these individuals that you really can more than most see the effect of a response to exercise on blood sugar levels. You see for 48 hours the blood sugars being more level than days where they don't have their normal activity or workout. And it was my very first introduction to this was maybe 19, 20 years ago when I was counseling someone and their glucose levels were just gorgeous. Like morning fastings were in a non in the range of somebody who didn't have diabetes. All the two-hour post-meal glucoses that this person recorded, so two hours would be when you would expect it that the insulin would peak and kind of get out of the system after the meal. So the two-hour post-meal levels you would want to see less than 140 in people who have diabetes. And so all of those were under 140. Beautiful. And then there was this one day where, or like a couple of days in there where the fastings were in were in the 180s, 190s, and then they got up to 220, 280 after meals. And I'm like, what happened here? And he was like, oh, that was a really stressful time, and I wasn't able to get my workout in, and I didn't get much sleep. And it just goes to prove what the research also supports that stress and high cortisol levels and low sleep can really have an impact on your glucose levels and and the way that you utilize, you know, the inflamed nature that you are in that situation. So a lot of outputs and and it's neat to see the proof in the pudding.

Philip Pape 13:40

So the Glute4 thing, just just to nerd out on it one more time, is you know, when you're strength training and using your muscles, uh, it activates those, but also walking does, right? Like just movement in general. How do they compare? Do you know?

Amber Wilhoit 13:52

I don't know offhand. I would say that it has more to do with how you're like your VO2 max and how trained you are across time. Talk about transient effects. Like if you look at, for example, the fats that is in a muscle cell, the fat stored in there, your myofascial fat stores. You can take somebody who is very well trained and they would have more than an untrained person in some circumstances, have more fat in their muscle, but they're not gonna have the typical results you would see with people with a lot of fat in their muscle because they're well trained. So the pathways are just different in how it utilizes it, and they haven't fully extrapolated like what's causing that exactly. But you have in, especially in endurance athletes, they have a lot of fat stored in their muscle. And if you think about it, the liver can store around 250 grams of glucose. And so if you're doing a marathon and you're using massive amounts of glucose both during the race and then even afterwards, as you're repairing and rebuilding from the race, you're using more glucose than you can really kind of eat. And most people eat about 200 to 250 grams of glucose a day or carbs a day, that it makes sense to be able to store it in the muscle and have it directly where it is needed for more endurance base. Now, it's not going to help you in a sprint necessarily because you use a different pathway, but to be able to utilize that, it it just shows that people who are well trained don't have that same negative response to fat storage in and around the muscle cells that you do with people who are not.

Philip Pape 15:38

Okay, this is really fascinating. So you're talking about like fat infiltration in the muscles, which we don't talk about a lot here. And what comes to mind for me is clients I've worked with who are very well muscled and they are, you know, super strong, very well muscled, and their blood work looks pretty good, actually, even if they're carrying a lot of extra body weight, but like they might not have a great resting heart rate because they're not walking or something like that. It's interesting, these different health variables and what they're affected by. So are you saying that? Well, I'm gonna make two assumptions. You could tell me if I'm wrong.

Amber Wilhoit 16:11

The first assumption I will try. I didn't read that study yesterday, but I'll try.

Philip Pape 16:17

Somebody with more muscle, despite having more fat in general, which also means in their muscles, is still gonna have a slight advantage uh for some of the health outcomes we're talking about. That's assumption one. And then assumption two is is there a difference then in someone who's well muscled who has more versus less fat in their muscles?

Amber Wilhoit 16:40

Okay. Yes. So what I was referring to before was sort of the this study I read a while a while ago about like a meta-analysis of looking at people who were endurant well-trained endurance athletes versus lean individuals versus obese individuals, overweight obese individuals. And they found that just in the lean individuals who are well-trained, that excess fat in the muscle was not detrimental to their overall health. In fact, the opposite was true versus the lean and the lean untrained and the overweight obese didn't have those same positive benefits from the fat and the muscle is actually a negative effect.

Philip Pape 17:27

So I was thinking, I've seen data suggesting that total muscle mass isn't significantly different between metabolically healthy and metabolically unhealthy people. And that could be a matter of when you're overweight, you have more muscle, even though you're not going to be able to do that. Right.

Amber Wilhoit 17:43

You're carrying more weight. Yeah. Yeah, that makes sense.

Philip Pape 17:46

Yeah. And then and then there's this muscle quality issue. Is that something that you could tell us more about?

Amber Wilhoit 17:52

The only things I've seen regarding muscle quality, because I am a one-trick diabetes pony. So it for me, it's is the muscle well trained? Can it act like a better sponge to soak in excess glucose? And that's gonna come from in general, it's gonna come better from people who exercise at least 30 minutes, at least five days a week, from people who have less central adiposity, meaning they have less visceral fat and fat stored around their internal organs, and they manage their sleep and stress well. I am a little too removed from all the exercise physiology studies to do a better job than that.

Philip Pape 18:36

That's helpful to know, right? Because you're connecting everything we just talked about with now. I always tell people look, wherever you're starting from, you have some advantage. If you're overweight, your advantage is you have extra body fat to draw from and you'll probably respond better, you know, to certain things, right?

Protecting muscle during fat loss

Amber Wilhoit 18:52

Yes. And so speaking to the part that you said about more muscle in in people who are overweight or obese, that is true. And I I agree with what you said to use it to your advantage. And in fact, one little trick up our sleeve that we've used with people that we work with is if you have lost five pounds in the past two weeks, guess what? You're gonna now walk with a rucksack with an extra five pounds in it. If you've lost 15 pounds, you're gonna walk with a rucksack with that, because that it tends to go, it tends to be true that as you lose weight, it's not all fat loss. You lose muscle with it, you lose your bone mass, lean body mass type stuff. So the idea behind that is we wanna keep your brain, keep your body thinking that you're still that same weight muscle-wise. You gotta hold on to that muscle because it still benefits you. But let's let go of the fat, the extra fat, you know. Um, and of course, that comes from the composition of the foods. We look at um processed foods in the diet and trying to increase fiber intake and just the overall quality of nutrition with the exercise. And I know your part of your program also encompasses that, which I think is amazing. So I think you can out-eat any medicine, you can out-eat any exercise, and that's why you have to also pay attention to nutrition on top of the exercise and and movement portion. It's crucial though.

Philip Pape 20:31

Yeah, and I love that hack too. That that's actually a really good hack that people should pay attention to. Of like, even if you're not extremely overweight, anybody in a fat loss phase, what if you just start adding that weighted vest or that rucksack or you know, making things a little bit harder from a load perspective, not going overboard with understanding you have recovery capacity issues and things. But if you are overweight, one of the advantages, you shouldn't have as much recovery sapped from you because you have those fat stores to draw from. At the same time, you know, you you may not have the work capacity or the cardio capacity yet too. So you got to balance it all for the person, right?

Perimenopause shifts and visceral gain

Amber Wilhoit 21:08

Yes. And and we we use it more than just for that purpose. We use it, we call it a gratitude pack because if you've lost 10 or 15 pounds and at the end of that walk, you take that 15 pounds off, you feel so light. And it's like, whoa, I used to carry that around all the time. You know, so it's just a shift in perspective. And I think anytime you can get outside of your head and outside of just what you always do and do something different, think of something differently, then you can really experience change for the positive in that space. So that's also helping you so that's awesome.

Philip Pape 21:50

Shifting a little bit here, you know, we talked a little bit about the visceral fat component of it. And I know a lot of listeners, a lot of my listeners are women in their 40s and 50s. And they're dealing with perimetopausin changing hormones that have their own independent effects, especially the decline in estrogen, on that extra, even more fat storage. Um, and they haven't changed anything, right? So they're super frustrated. They're like, and maybe they are training, maybe they're all doing all the things. So what's happening at the metabolic level that's maybe relevant to what you brought up already about adiposity for the hormone stuff? Yeah.

Amber Wilhoit 22:26

Well, I mean, it's definitely estrogen and the way that it shifts where you tend to store fat, you know, it it does have an effect on whether you store fat in your legs and your butt and your hips versus your abdomen. And it is, it is more likely uh around and after menopause to be stored around your internal organs. And that is the most dangerous place to store it. And so unfortunately, it's not enough to do what you've always done and have the same outcomes or look the same way. Unfortunately, you have to think like, what more can I do? What other fine-tuning knob can I adjust here? And sometimes it feels like I'm already doing it all. What more could I add in? So it's you really have to look at what is the impact of stress and sleep. Because if you're fighting against cortisol all the time and stress hormones, you're just gonna be pushing that rock up a hill like Sisyphus, and you've got to find ways to to manage and look at that. And I think a lot of that can come into play. I'm 40, almost 49. So that's I'm at that peri stage. And and it is important about I have to spend more time and attention thinking about what I'm doing to set myself up for success, to get a good bedtime and get good sleep and wake up around the same time every morning to help with the circadian rhythms and in that as well. And just it takes more focus, but not always more effort, if that makes sense. It takes better systems, which I think you're all about and intention. Yeah.

Philip Pape 24:08

Okay. So two things came up in my brain. The first is related to insulin resistance at that age and specifically in that population. So is there an independent increase that we see in insulin resistance because of those hormonal changes, independent of the other factors?

Amber Wilhoit 24:28

So um what I will just speak in general statements is that as people age in general and especially worsened by estrogen and where it causes women to store fat more around the internal organs, that's gonna increase insulin resistance. That's going to increase the shuttling of the triacyl glycerols to the liver. That's gonna put someone at greater risk for fatty liver. And all of those things are are going to be going against blood sugar levels and against metabolic homeostasis where it is now. So it would get worse with age, but mostly because also with age, we tend to lose lean body mass. So it's a couple of factors.

Philip Pape 25:18

Yeah, that that makes sense. So then the trap I think a lot of women have told me they find themselves in is like the weight loss resistance combined with the stress, combined with now I feel more desperate to do something about it. And they all seem like counteracting forces. You know, my program's called Eat More Lift Heavy for a reason because I'm trying to encourage people to think differently, not just to eat more at limitum, whatever, but more of let's support the fuel side of things rather than restricting that side, but then fix the other stuff like training and like you said, sleep. So, like, where would you stack the priority of those pillars? Obviously they're all important, but when you've got sleep, managing stress, food as in eating enough food, or also versus trying to diet and lose fat? Because losing fat and what could also be good for your health, depending. Like, how would you stack those in general?

Amber Wilhoit 26:12

Um, I'm gonna go from bottom up instead of top to bottom, if I may.

Philip Pape 26:15

Like a pyramid, you mean, or or like the least priority?

Amber Wilhoit 26:18

Least priority first.

Philip Pape 26:19

Okay, got it, got it.

Amber Wilhoit 26:21

I would say because there's only one of those when you were saying, I was like, ooh, I don't really like that one. The rest were fine. Um, but I don't like restrictive eating styles in general. Like most women are over-restricting, at least to some degree. And if they're under-restricting most of the time, then that also can bring about some binge eating at other times. And then you get things like cheat days. And there's a fantastic app. Your app, of course,

Stop over-restricting nutrition

Amber Wilhoit 26:53

there's a any app that can track your calories. If you wanted to do that, I would recommend anybody do it for two weeks. It's not really fun, but it's good to just kind of have a marker of where you are. And it's so eye-opening to see, like you could be in a calorie deficit Monday, Tuesday, Wednesday, Thursday, Friday, and in let's say you were under by 200 calories all those days. So you got a thousand calorie deficit going into the weekend, but then you have a brunch, you've got a baby shower, you've got something sketched, some event scheduled, and you easily eat those thousand calories between Saturday and Sunday and different events. And so you think, oh, it's not I've been so good during the week, and food does not have a moral value. I think it's important to say that. And then you then you've suffered, if you will, this entire week and just to have a little bit of fun on the weekend, if you will, and it just completely came out dead even, which is okay. Depends on what your goals are. You know, your goal might just be keeping it dead even. You know, it might be that I'm restricting here so that I can have this fun on the weekend and eat things that I want. I think where people get into trouble is if they overfocus on everything and they think they have shame within themselves for what they eat, or label different foods as something that they never eat, they don't eat. Um like I said, food doesn't have a moral value. I think that's where people get into trouble. I think also when you have a lot of processed foods in your diet, and by diet I just mean the food that you eat in a day in your lifetime. And processed foods would be anything that you can't go into your pantry and normally find. Like you don't have xanthan gum in your pantry, you don't have kerogenin in your pantry. So that sort of thing. You you just want to keep it with things you you could have in your pantry. And and I don't want to say the less ingredients the better, but as a general rule, that works well too. But really looking of how I can add things, and we talked about this before, and and I'm a strong proponent of looking at where you are, and instead of thinking of restriction and cutting back, and that none of those words are fun, you know, like how do you add in more fiber? How do you add in more fruits and vegetables? How do you add in more color? So nutrition is way up there for me. So in that, I want you to add nutritious foods. I want to take away things that are really stealing joy from your life in terms of restrictive types and behaviors of ways of eating. And I mean, for me, exercise is super important. I'm I schedule in my activity in my week and in my day before anything else. Like that's what I do first thing in the morning because I just want to get it. Not that I want to get it done because I really enjoy it. It's not one of those things like swallow that frog. I want to get it over and done with. I want to move my body. I feel the best when I move my body. I eat better when I think of it in terms that I've moved my body and now I want to fuel my body well. So nutrition, exercise, those are the top two for me. Sleep is important, of course, because I can't move my body well if I'm dragging along, you know, performance-wise. That's and that's also why, you know, the things that I have cut out of my nutrition are, you know, I used to have the occasional drink here and there. And and people, you know, if you enjoy that, fine. But for me, when I would drink the night before and then run, even if it was just a glass of wine, when I would run the night the next morning, my performance would suffer. And it just didn't pass the worth it line for me. So for others, it does. It wasn't when I can notice my performance suffer because of something I've done through sleep or or nutrition, I'm gonna, I'm gonna cut it out. That's my personal preference.

Philip Pape 31:13

I'm gonna requote you right now. Does it pass the worth it line? Does it pass the worth it line? That's so good. Some of this stuff is binary. Like you mentioned training. I would tell no one that zero trainings is acceptable. Like, you know, like you have to train. I would agree. But then it's a matter of degrees and like frequency and all that. Sleep, everybody has to sleep, but then it's a function of okay, now where do you make the trade-off between your schedule for training, for sleep, and then like just fitting fun stuff in for stress? Like, how does somebody make all that work, Amber, when your population you deal with is just like stressed out of their mind?

Amber Wilhoit 31:50

Yeah, no kidding. Uh, because in in general, I work with a group of people who have a lot of stress because there's so many more decisions they have to make in a given day that somebody without type one, type two, pre-diabetes, type C, you know, monogenic diet, any of these types of diabetes has to worry about because they're thinking about, okay, I'm gonna eat how much insulin should I take for that amount of carbs? What's my ratio of insulin to carbs? So if I'm having 45 grams of carbs and I'm on a one to eight, then I need to give this many units, and then my sugar, I need to add those many units in. So I'm giving nine units for that, but then oh, I'm gonna exercise afterwards, and I don't want my sugar to go low, so I have to take it away, which is why um technology has really helped in this space ease a lot of the burden with continuous glucose monitors and automated insulin delivery devices, your GLP1 class of medications, your SGLT2 receptor agonists. So all of these are, I'm sorry, SGLT2 inhibitors, forgive me, GLP1 receptor agonists, all of these help. But you know, I I'm a firm believer in doing as much as you can through nutrition, exercise, sleep, stress management. And then if you need the scaffolding to support the other, um, unfortunately, people who have type 1 diabetes, that scaffolding is needed forever. You know, they have to have insulin to survive. But if you could not have it and get away with it, wouldn't you want to do that? You know?

Philip Pape 33:26

What about? I know one thing that you've covered, I think you've covered on your podcast is like sexual health and diabetes, which, you know, erectile dysfunction and uh arousal and all those things that are important. We don't talk about it enough sometimes. I talk about libido in the context of hormones and stress and energy, but where does this connect with the diabetes world?

Amber Wilhoit 33:47

Yeah, well, I think it's important to understand that in the diabetes world, if you are over age 80, there's something like a 98% chance that you have erectile dysfunction. And if you're over age 70, it's still somewhere like a 75% chance. I haven't looked at the numbers recently, but it is an astounding number of people. So you have this chronic disease that showed up in your life when you're 65. And on top of that, you've noticed your libido is in the toilet and your your quality of life has thus decreased.

Sexual health as metabolic signal

Amber Wilhoit 34:28

And so I see so many men, especially, but you know, it's not necessarily just men. Women have some of the same sexual dysfunction issues, but they're like, well, gotta die somehow. And and they're they're just don't always have a lot to live for once the spice of life, if you will, has been taken away. So, but now let's talk about more people in their 40s and 50s. If you think of the the risk of type 2 diabetes and cardiovascular disease, so they are ugly best friends, they go hand in hand. And a lot of people who come in with a heart attack are then diagnosed with type 2 diabetes because it's all that metabolic disease process. And erectile dysfunction can be an early sign that something cardiovascular is not firing on all cylinders, that there's some issues there. And so when we talk about insulin resistance and that excess fat shuttling to the liver, it also shuttles to the arteries and can get in the intermedia there in the blood vessel walls, and it makes these foam cells in there that are highly inflammatory very sticky, and people can throw a clot. And so it's very important that cardiovascular health is looked at in this whole picture because heart disease is the number one killer in the United States. And I think it would be real, we would be really remiss to not look at disease risk there and the way that insulin resistance plays a role in that, and the fact that half of all adults have either diabetes or prediabetes, half. So as you age, it's gonna be more. And then if diabetes and heart disease are interlinked and cardiovascular dysfunction and sexual dysfunction are interlinked, you see it's all it all matters.

Philip Pape 36:31

All those are linked with obesity, right? Which is also linked with the upstream root causes of obesity, which is, you know, for whatever reason full of controversy, because there's always talk of the end of the stream, like diet and exercise and nutrition and all that, or or you know, calories and calories out. But at the end of the day, these these diseases of aging, they probably didn't exist at all at a certain point in human history, and now they do, and it's not just a function of longevity because people could have lived to the 90s a long time ago. People, there's a myth about that for some reason. But yeah, it's it's because of the lifestyle, right?

Amber Wilhoit 37:08

I don't know. I think you also need to look at the environment. The environment plays a huge role. And the reason I think the environment is so important is because if you look in the 19, just 100 years ago, just a hundred years ago, but if you look at that time period, you didn't have the prevalence of heart disease and type 2 diabetes that you have now. You know, 11 and a half, 11.7% of the population has diabetes, but in 1920, it was less than 1%. So what has changed the most? I would say it's the environment. Then and then that comes into the food supply and policies and just so many things, industrialization, lots of stuff.

Philip Pape 37:54

At which point in the stream, like when I say lifestyle, I'm thinking the environment affects your lifestyle, but then you could go one step further and say, well, where does this environment come from? And can we do something about it? But okay, to make it maybe a little more positive here, let's switch to nutrition a little bit because there was a note that I had we didn't get to, and that is we talk about protein a lot, but I want to hear your take on fiber because that is super, super important. Yes. And maybe more important for some people, is it? I don't know, you tell me.

Amber Wilhoit 38:23

Yeah. Well, the our national guidelines recommend 25 to 35 grams of fiber a day. World Health Organization guidelines recommend 25 grams of fiber a day. If you have type 2 diabetes, they recommend 30 grams of fiber a day. The average person in the world gets about 20 grams of fiber a day, but then when you cut the United States pie into that, we're looking at 10 to 15 grams of fiber a day. And the studies are robust on the effect of fiber on cholesterol. The greater the fiber in your diet, the better the cholesterol numbers, the less the risk of heart disease, and even all cause mortality.

Fiber, gut health, and glucose control

Amber Wilhoit 39:04

So it's very important to have add fiber into your diet.

Philip Pape 39:12

Wasn't there a very recent big retraction of an LDL study that had to do with some of this stuff in terms of like the carnivore and keto crowd? Because one of the things that really irks me about that crowd is the dismissal of fiber. Like you don't need it, or it's associated with these toxic killer plants that exist in the world. You know, plants kill you and like weird stuff like that.

Amber Wilhoit 39:32

I I say weird, but yeah, when they're talking about plants kill you, most of the time when I see that they're talking about lectins. And and lectins are the plants defense chemicals that that prevent other plants from invading their space. You know, like this is what this is what I need for my roots to grow. Stay away, stay away, you know. But that and then there have been some in vitro studies, test tube studies that that cells can be damaged by these. And then there's also like the anti-nutrient data, but that's really old data. Like I learned that when I took my courses at UF in nutrition. And but thankfully, science evolves and changes. And if you're looking at that, you're looking at like 30-year-old nutrition data, and really it is beneficial, and they're finding more and more benefits of that through roughage. So your intestinal lining has these finger-like projections, these villi, and each one is very important for nutrient absorption. And you need the fiber to be like that, the straw broom to sloth off all the old cells and keep it fresh and vibrant and and able to absorb all the nutrition from the food that you eat, which you do absorb all the nutrition from the food that you eat, but it just keeps it all healthy because if you don't absorb all of your fat, for example, like you can do a fecal fat test, where even if you lose six grams of fat, you have some degree of fat malabsorption, maybe from cystic fibrosis or from um some kind of bowel condition. So fiber is important because it helps with your prosprandial glucose, it helps with the intestinal health, and it feeds the microflora of the gut. And lots of research has come out now regarding the immunity that is in your gastrointestinal system, especially your your small intestine, and that you you get this nutrition that the the bacteria really like you've got your bacteroides and your fermicutes, and and you want more of the good bacteria to proliferate the good colon bacteria that's gonna keep you healthier than the bad.

Philip Pape 41:56

Sometimes I just want to make it a matter of it's gonna keep you more full, it's actually gonna reduce your calories, it's going to be associated with healthier, you know, more nutritious foods anyway, like fruits and vegetables and grains and such. But you point out also the gut health aspects of it that are that cannot be underrated at all. And having a diverse microbiome, uh, you mentioned gut issues, right? There's people with um ulcers of chloritis and all and IBS and all that, where there's a whole gut connection. And then I think my brain went to LDL just because there's also correlation with reduced LDL cholesterol and things like that with fiber. Um so meaning it's important to do that.

Amber Wilhoit 42:34

Yeah, there's so many things. And I and I do believe we haven't even elucidated all of the things, you know.

Philip Pape 42:40

So don't cut carnivore. Okay, so all right, to kind of wrap it up, because we talked about a lot of things, but I think it's the audience also wants to know like, is there something they're not doing, something specific, something actionable related to insulin sensitivity? I know we got some tips today, like test your fasting insulin. I think that's a super easy tip.

Amber Wilhoit 43:04

Yeah.

Philip Pape 43:04

And a few other things. Is there something we didn't cover? Something you're like, yeah, you guys do this thing. It's easy, it's simple, it's gonna help you out.

Amber Wilhoit 43:11

The obvious one would be move after meals. That's gonna increase your sensitivity to insulin for sure. Lifting, because the more lifting you do, the more trained your muscles, the the more sponge effect, if you will, they're gonna have. And the post-meal walking is very research-based, especially in the world of diabetes.

Philip Pape 43:34

Actually, I want to ask you about the movement after meals, because yeah, um, I usually tell people like, you know, step one, move. Doesn't matter when. Step two, move after meals if you can. Like specifically.

Amber Wilhoit 43:45

The timing, yeah.

Philip Pape 43:46

Um, but what about not moving? Uh, in other words, what's the impact? Because I I I've I've seen a few studies on this, but the impact of not moving on insulin resistance.

Amber Wilhoit 43:57

Yeah, it's bad. Don't not move. Like, even if you're training and getting like let's say you got enough steps and you're training, but then you're sitting for hours and hours and hours because your job Yes, you could be you could get your daily workout in, but if you're sedentary the entire rest of the day, it's gonna have deleterious effects for sure. And and that is also backed by research that is just it's your sedentary lifestyle as a whole, even if you've got that time picked out that you run around like a maniac and get stuff done. You know, you still it's cumulative.

Philip Pape 44:35

And does it come down to like the mechanisms like the GLUT4 transporters specifically, or is there a specific mechanism of like sitting for a long time? Do you know what I mean? Like with the blood flow or something.

Amber Wilhoit 44:45

I mean, there's so many different things. You you've got P par gamma, you've got GLUT4 pathway, you've got like I I wouldn't say that's the thing. It it's it's cumulative movement and keeping your body you know, people have used the term keeping your sword sharp, and I love that term personally. I just think it's important to to look at where you are and think, where can I add more? Very much like with our nutrition discussion, where can we refine this and fine-tune it and just be the best you that you can be and do the best that you can with your movement. I think um it's gonna help you with your knees and your back and like we weren't made to sit hours upon hours of the day staring at a screen. I think you and I are both standing and we're doing that for on purpose, you know?

Philip Pape 45:36

Yep, yep. Exactly. So funny. Yeah, yeah, yeah. I stand all the time. It's great. All right. So as we wrap up, I want folks to know, you know, you've got you guys have a podcast, the diabetes podcast. I was on it, but you've also got fantastic episodes. I think you're up to over 50 episodes now. Is there one that's like a really good one we want to point folks to?

Amber Wilhoit 45:57

Oh, um, I would say I did one that really specifically looks at the environment and its role in diabetes and policy change. I would love for people to take a look at that one because it is out of control. And there are lots of reasons why. And I don't think that it can be fixed by any one thing or any one person, and that's kind of why we moved our role from just consulting to the podcast. Because, like, how do we get the message out to reach the most people that they really understand that it's it's not just personal responsibility? Like, personal responsibility is number 30 on the list of things that got us where we are. So there's that one, and then there's also one that's called pre-diabetes is diabetes, and I think that's a really, really important one, especially for your listeners.

Philip Pape 46:52

What I really like about your podcast uh with Richie is the episodes are like very thoughtfully constructed and really deep into that topic, and you cover like all the things people want to know. And so that's episode 47, pre-diabetes is diabetes, which is a good look at like if you don't do the things, where are you gonna end up? And then episode 51, the diabetes epidemic, um, is probably a really good understanding of we've alluded to the whole pie chart of you talk about fiber and like no PE in schools and screen time and you know, butyrate and inflammation, all the things. So, guys, check that out. There you go. I hear you, I hear you. All right, so check those out. We're gonna throw the links. Any anywhere else we want to send folks to Amber?

Amber Wilhoit 47:35

The diabetespodcast.net is where you can find all the notes, all the other episodes. Um, there's things on fiber, carbohydrates, all sorts of stuff.

Philip Pape 47:45

Great. So if whether you have diabetes or not, it's you guys need to check Amber's podcast out. And Amber, thank you so much. This was a lot of fun. Uh time flew by, and thank you for coming on the show. Thank you, Philip.