MDAE E45 – The Insulin Resistance Checklist

Article written and reviewed by Cyrus Khambatta, PhD and Robby Barbaro, MPH
Published November 20, 2018

Podcast Transcript

Cyrus Khambatta, PhD: Welcome to the Mastering Diabetes Audio Experience, where we teach you how to sit in the driver's seat of your diabetes health for the rest of your life. We'll teach you how to reverse insulin resistance, achieve your ideal body weight, gain energy and get your best A1c following more than 85 years of evidence-based research in the Mastering Diabetes Program.

Robby Barbaro: Our program teaches you how to reverse prediabetes and type 2 diabetes, and how to simplify your life with type 1 diabetes by maximizing your insulin sensitivity, using food as medicine.

Cyrus Khambatta, PhD: We're on a bold mission to reverse insulin resistance in 1 million people. We're glad to have you joining us.

Robby Barbaro: Welcome back to the Mastering Diabetes Audio Experience. We have another terrific interview today. This one is with Joel Kahn, MD, and it comes from our 2018 Mastering Diabetes Online Summit. If you have not listened to that event, I highly, highly, highly suggest signing up on our website. So you just click summit in the navigation bar, go to www.masteringdiabetes.org, you click summit, you can register there.

Cyrus Khambatta, PhD: Insulin resistance is the name of the game. We've talked about it a lot on this Podcast, and we're going to continue talking about it again today. It's really important to understand not only what causes insulin resistance, and what you can do to reverse it, but also how you track your improvement in insulin sensitivity over the course of time.

In our Coaching Program we have people asking us all the time about “How do I know that I'm becoming less insulin resistant? What do I measure? Is it just my fasting blood glucose? Is it my need for insulin? Is it in my body weight? Is it all of the above? My blood pressure? What is it?” And so, after having received these questions over, and over, and over again, my wife, Kylie Buckner, who's a Registered Nurse, and has a Master's degree in Nursing Education, took it upon herself to solve this problem, and to really give a fantastic answer.

And so, in today's Podcast, you're going to learn about the insulin resistance checklist, which is a foolproof way of you being able to track and measure your improvement in insulin sensitivity over the course of time. She teaches you the acronym PILAF, which stands for Pressure, Ideal body weight, Lipids, A1c, and Fasting blood glucose. And shows you how you can track these metrics over the course of time, to really understand how your metabolic health is improving from many different aspects.

Yes, your diabetes health is important. Yes, your muscle health is important. Yes, your liver health is important. But your blood vessel health is also important. Your blood pressure is important. Your lipids are important. Your body weight is important. It's a multifactorial equation that doesn't have one particular answer, but many answers. One thing that we talked about a lot is that your A1c value is an incomplete marker of your diabetes health. So, if you're simply just using A1c value as an indicator as to whether you’re insulin resistant or not, then you might be missing the bigger picture. So in today's podcast, we'll go into more detail about how you can use PILAF, the PILAF acronym to set you up for success. And we truly hope you enjoy what you're about to hear.

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Cyrus Khambatta, PhD: Understanding insulin resistance can be somewhat challenging, but the good news is that it doesn't have to be. Here at Mastering Diabetes we define insulin resistance as the storage of fat in tissues that are not designed to store fat. Now, when you become insulin resistant, your risk for the development of chronic disease increases tremendously.

The reality is that most people learn about insulin resistance when they are first diagnosed with either prediabetes or type 2 diabetes. The truth is that as you become more insulin resistant, you increase your risk for conditions like high cholesterol, hypertension, coronary artery disease, stroke, heart attack, cancer, Alzheimer's disease, and other chronic inflammatory conditions.

Now, when reversing insulin resistance using your diet, the goal is to become as insulin sensitive as possible, to prevent against the development of all of these chronic conditions that I mentioned earlier.

Kylie Buckner, RN: As a coach with Mastering Diabetes, I hear the following questions all the time, “My A1c is now in the non-diabetic range. Does that mean that I have reversed insulin resistance completely? If not, what am I supposed to do now?” Another question that we receive a lot is, “How do I know if I'm insulin resistant?”

I found these types of questions to be more complex to answer, because I often needed more information to help provide feedback to our members. Why? Because there are many factors that contribute to your level of insulin resistance. And it's important to understand multiple biomarkers in order to get a full picture of your metabolic health.

As a nurse for over 18 years, I've loved developing and using checklists in my practice, in both clinical and hospital settings. And so, I created The Insulin Resistance Checklist to help you understand how, and what to measure, to track your level of insulin resistance. Simply tracking your A1c is not enough information to determine whether you are becoming more insulin sensitive. Why? Because your A1c value is an incomplete marker of insulin resistance.

Your A1c is used as a biometric marker of your average blood glucose control. And is typically used to diagnose type 1 diabetes, type 1.5 diabetes, prediabetes or type 2 diabetes. It's very important to understand that your A1c value is simply an indicator of your blood glucose control, and only provides you with information about your level of insulin resistance, when interpreted in the context of other biomarkers. Understanding your level of insulin resistance can be challenging because it requires examining multiple biomarkers, each of which is on a continuum. A simple way to track insulin resistance is by using the mnemonic, a checklist called “PILAF”. The mnemonic PILAF stands for Pressure, Ideal body weight, Lipids, A1c, and fasting blood glucose.

Cyrus Khambatta, PhD: Please note, with each of these biomarkers, being free of oral medication to achieve these results is a key piece in understanding how insulin resistant you truly are. On the checklist, you'll see “Free of oral medication” as a checklist item. And one goal is to check that box for every biomarker.

Kylie Buckner, RN: Let's dive into each of these letters individually. P stands for pressure, or blood pressure. Your blood pressure is a measurement of the effort it takes for your heart to circulate blood throughout your cardiovascular system. The higher your blood pressure, the harder your heart must work to push blood throughout your body.

In most cases, hypertension or high blood pressure, is caused by the hardening of blood vessels which creates resistance against your heart. Over time, hypertension can become life threatening, because it increases your risk for heart attack or stroke.

Most doctors prescribed medication to treat hypertension. I'm aware that simple dietary changes are more helpful, and free of dangerous side effects. The evidence-based research shows that hypertension is an independent risk factor for insulin resistance, reducing your blood pressure to less than 120 over 80, your systolic pressure over your diastolic pressure without medication is essential in helping you reverse insulin resistance.

Our recommended blood pressure range is having a systolic pressure of around 100 to 120 millimeters of mercury over a diastolic pressure of 60 to 80 millimeters of mercury.

Cyrus Khambatta, PhD: Great. Next up on our list is your body weight. Achieving your ideal body weight is an essential component of gaining insulin sensitivity. Therefore, I stands for Ideal body weight.

Kylie Buckner, RN: Being overweight elevates your risk from those chronic diseases, and is caused by the accumulation of fat in your adipose tissue, as well as in tissues that are not designed to store fat, like your muscles and liver. By losing excess weight, you burn stored fat in adipose tissue, as well as fat stored inside your muscles and liver.

Now, you can simply monitor your body weight on an inexpensive bathroom scale, it's very easy to do. This is how you calculate your ideal body weight. If you're a female, the first five feet of height is equal to 105 pounds, and every inch thereafter is equal to approximately four pounds. If you're a male, the first five feet of height is equal to 115 pounds, and every inch they're after is equal to approximately five pounds.

Cyrus Khambatta, PhD: These ideal body weight calculations target a body mass index, or BMI, between 20 and 23%. If you feel that your ideal body weight is actually out of reach for you. Then aim for slow and consistent weight loss, until you approach your ideal body weight, and simply don't get caught up in hitting a certain number. When it comes to weight loss, slow and steady definitely wins the race. Remember, weight loss is not a sprint, this is marathon.

Kylie Buckner, RN: L stands for Lipids. When your lipid panel is elevated, this often indicates an insulin resistant liver, or fatty liver. Fatty Liver is usually diagnosed via imaging, or elevated liver enzymes, resulting in an enlarged liver that is engorged with excess fat. As you gain insulin sensitivity, your cholesterol panel is likely to normalize.

In order to significantly reduce your risk for a heart attack, we recommend achieving the following fasting lipid panel: Total cholesterol less than 160 milligrams per deciliter, LDL cholesterol less than 100, ideally as close to 70 as possible. Triglycerides less than 150, HDL cholesterol greater than 50 for women, and greater than 44 men.

Cyrus Khambatta, PhD: One technicality that's important to pay attention to is your HDL cholesterol. You've probably been told that your HDL is the most important biomarker in your lipid panel, and that if your HDL is low, it's important to drink fish oil, or consuming an Omega 3 supplement. We have observed the same thing as we many professionals have as well, which is that when you adopt a low-fat, plant-based, whole-food diet, your HDL cholesterol can often drop below the recommended level of, 50 for women, and 44 men.

But more, and more scientific evidence is now showing that raising your HDL cholesterol is actually less effective, than lowering your LDL cholesterol. What this means is simple. If your total cholesterol, LDL cholesterol and triglycerides are at, or below the range that we specified, then don't worry if your HDL cholesterol is low. It's simply not as important. An easy way to think about this is that if there's less bad cholesterol, then you simply need less good cholesterol. It's actually just that simple.

Kylie Buckner, RN: A stands for A1c. As we discussed earlier, your hemoglobin A1c is often the first indicator that you are living with any form of diabetes. The evidence-based research indicates that the lower your A1c value, the better your blood glucose control, and the lower your risk for long term complications. When following a low-fat, plant-based, whole-food lifestyle, a lower A1c is a strong indicator of reduced insulin resistance. In fact, a low-fat, plant-based, whole-food diet is one of the most effective ways to reduce your A1c value, and improve your glycemic control.

Cyrus Khambatta, PhD: Now, here's where it gets confusing. When following a low carbohydrate or ketogenic diet, a lower A1c does not indicate a lower level of insulin resistance. In fact, those eating low carbohydrate, or ketogenic diets are the most insulin resistant people, as we've explained in previous videos. You'll see people with diabetes all over the internet reporting an A1c value in the fours, or in the low fives, claiming that their insulin sensitivity is actually increasing. This is not true, your A1c is simply a measurement of your blood glucose average, not of your insulin sensitivity.

That's exactly why it's really helpful to interpret your A1c in the context of other biomarkers. It's important to understand that your A1c is simply an indicator of your level of insulin resistance, if and only if, you're eating a low-fat diet, and not if you're eating a high fat diet.

Kylie Buckner, RN: According to the American Diabetes Association, the A1c value of someone living with type 2 diabetes is 6.4% or above. The A1c value of someone living with prediabetes is between 5.7 and 6.4%. The A1c value of someone living free of diabetes is below 5.7%.

At Mastering Diabetes, we recommend keeping your A1c below 5.7% for one year, in order to fully reverse diabetes.

Cyrus Khambatta, PhD: And last, but certainly not least, is F which stands for “Finally, you guys are almost done with this less!”, right. Actually, F stands for fasting blood glucose.

Kylie Buckner RN: Your fasting blood glucose value is a key indicator of your level of insulin resistance, and is important to monitor daily, when living with any form of diabetes. As you become more insulin sensitive, your fasting blood glucose level is likely to decrease. Monitoring your daily fasting blood glucose is a simple way to measure how your diet is affecting your glycemic control.

The goal is to achieve a consistent fasting blood glucose between 80 to 100 milligrams per deciliter. As you transition to a low-fat, plant-based, whole-food diet, you're likely to experience fluctuation in your fasting blood glucose, but an overall downward trend is a great indicator of increased insulin sensitivity.

Cyrus Khambatta, PhD: But here's the good news, eating a low-fat, plant-based, whole-food diet containing between 10 to 15% of your calories from fat, is the most effective way to reverse insulin resistance ever discovered by the scientific community.

If one or more of your biomarkers explained above are out of range, then this could indicate that you're living with some version of insulin resistance. And that's why this checklist is helpful to understand where you are on the continuum.

Adopting a low-fat, plant-based, whole-food diet, performing regular exercise, and intermittent fast, and doing so in a constructive community of other people, will maximize your insulin sensitivity, and minimize your risk for chronic disease. And that's a fact.

Kylie Buckner, RN: Download the insulin resistance checklist below, and post it in a visible location to help you achieve your most insulin sensitive self. Use the checklist as a way to help guide your path toward insulin sensitivity. As you check off the boxes, continue to use the tools that we provide in our Program to work your way towards the best help you ever had, and enjoy the fruits of your labor all along the way.

Cyrus Khambatta, PhD: We hope you enjoyed this episode, and can apply some of these principles to your personal life. Now, we have an Online Group Coaching Program that has helped thousands of people living with all forms of diabetes, reverse insulin resistance, drop their A1c, lose weight, and gain tons of energy. And also reduce their need for oral medication and insulin using, their food as medicine.

We like to call ourselves the world's most robust, and ridiculously affordable, Online Coaching Program for people with diabetes. And we've helped people living with type 1 diabetes, type 1.5 diabetes, prediabetes, type 2 diabetes, and gestational diabetes living all around the world.

Now we provide you with three tools that are specifically designed to put you in the driver's seat of your diabetes health. The first is an Online Course that gives you step by step instructions on how to change your diet. Starting with breakfast, then lunch, then dinner.

We teach you exactly which foods to increase, which foods to limit, and which foods to avoid entirely. The course is designed with you in mind. We provide you with relevant information, and we do our best to reduce overwhelm, because we know just how confusing the internet can be these days, when searching for simple ways to improve your blood glucose control.

The second tool is even better than the first. We provide you with access to our online community, with thousands of people that are going through this process with you. You'll be able to interact with our team of coaches, including Kylie Buckner, a Registered Nurse who is brilliant. She also happens to be my wife, and is one of the most kind and compassionate human beings that I've ever met. Adam Sud. He reversed type 2 diabetes. He lost more than 160 pounds and he de-addicted himself from both food and prescription medication at the same time.

You'll also get to interact with Mark Ramirez, who lost more than 50 pounds, reversed type 2 diabetes, and is a certified Food For Life Instructor, through the Physicians Committee for Responsible Medicine. You'll also get the ability to interact with both Robby and myself in the online community. And we guarantee that we’ll answer your question within 24 hours to help you solve problems in real time.

The third tool is a twice monthly Q&A video conference, where you can ask our team of coaches any question that you have about your personal program, and meet others that are going through this process with you. Now, we're proud to say that our coaching program is very popular, and because of that, we've instituted a waiting list to join. The reason we created the waiting list in the first place is because we have more than 2000 active members in our program and want to provide excellent service to our existing members.

You can still join the program, but in order to do so you have to put yourself on the waiting list and you'll be notified of when we open next. When we do, we'll send you a personal invitation to join.

To join the waiting list simply go to www.masteringdiabetes.org and click on Coaching in the navigation bar at the top of the screen, or click the link below in the show notes. We can't wait to help you transform your diabetes health from the inside out. We hope to see you on the inside.

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About the author 

Cyrus Khambatta, PhD and Robby Barbaro, MPH

Cyrus Khambatta, PhD, and Robby Barbaro, MPH are the coauthors of the New York Times bestselling book Mastering Diabetes: The Revolutionary Method to Reverse Insulin Resistance Permanently in Type 1, Type 1.5, Type 2, Prediabetes, and Gestational Diabetes. They are the cofounders of Mastering Diabetes, a coaching platform that teaches people how to reverse insulin resistance via low-fat, plant-based, whole-food nutrition. Cyrus has been living with type 1 diabetes since 2002, and has an undergraduate degree from Stanford University and a PhD in Nutritional Biochemistry from UC Berkeley. Robby was diagnosed with type 1 diabetes in 2000, and has been living a plant-based lifestyle since 2006. He worked at Forks Over Knives for 6 years, and earned a Master’s in Public Health in 2019.