Does keto improve insulin resistance, or just mask it? A metabolic MD perspective.

In this video I discussed the factors to and frequently discussed or thought of that can aggravate some resistance besides refined carbohydrate, as well as distinguish refined versus minimally processed and unrefined carbohydrate.
The appropriate and inappropriate contexts for using and interpreting fasting insulin are discussed. I explain why it is that how you get to a healthy low fasting insulin with excellent fasting blood sugar matters.

[@TeresaW-n4e]

Nice video Tom!
It was really a honor to meet you in Orlando ADA!

[@DrTomMD]

Thank you and very much likewise!

[@Zoe.TheBody360]

Great Video Tom...can you explain though, for someone low carb with low glycogen stores and therefore low insulin, are you talking physiological insulin resistance or pathological (potentially?) - how do you differentiate, by giving them glucose? Can you do a video explaining the reasons for physiological insulin resistance at menopause - and how without HRT - lowering estrogen induces this phenomenon, and what women who are not eligible for HRT can do about it. For men with ferritin levels above 300, with type II diabetes, would you recommend phlebotomy? Many thanks. :-).

[@DrTomMD]

Thank you, Zoe. Feel free to share the videos far and wide.
Strictly speaking everything is physiological. That said if by physiological you mean with no untoward risk associated, keto can drive insulin resistance that is physiologically pathological. Keto doesn’t buy definition necessarily do so because there are ways to do keto without overload of saturated fat, valine and iron, for instance. But most people don’t follow that type of keto
One could argue that even though the insulin resistance is there, the low carb approach prevents it from being “triggered“. Fair enough on that, but the manner by which people follow low-carb is typically one that does not improve, and often worsens, dyslipidemia, particularly apolipoprotein B levels, as well as less impressive improvement and blood pressure per weight loss.
Regarding mitigating age related insulin resistance, there’s nothing special. It’s a simple, but more urgent, focus on all of the things that we know drive insulin sensitivity: Calorie balance as reflected by healthy eating, physical activity. Avoiding excess iron (foreign occasionally we find people regularly cooking in cast-iron skillets, which is great for someone with low iron but not so much for someone with high), which can be an issue in postmenopausal women because they’re no longer losing blood every month.
In that regard, if someone has insulin resistance, particularly any level of glucose intolerance (why restrict only type 2 diabetes?), whether male or postmenopausal female I would encourage blood donation (not therapeutic phlebotomy, let someone benefit from the blood) if their ferritin was even over 200 , but certainly over 200 in a female and definitely if >300 in a man, all in the process of developing a lifestyle that doesn’t cause the type of hyperabsorption and accumulation of insulin resistance aggravating levels of iron.

[@Zoe.TheBody360]

@@DrTomMD thank you so much for such a detailed response.