Why A1C Isn't Enough: Insights from Dr. Ben Bikman with Dr. Ken Berry

Summary

The transcript discusses the importance of understanding insulin, particularly endogenous insulin produced by the pancreas, in managing type 2 diabetes. It challenges the misconception that beta cells fail in type 2 diabetes, emphasizing that insulin resistance and high insulin levels are often overlooked. The conversation also delves into the limitations of A1C as a diabetes indicator, the potential for diet-induced changes in red blood cell lifespan affecting A1C readings, and the role of fructose in glycation and uric acid production, highlighting the need for a more comprehensive approach to assessing metabolic health.

Takeaways

• 💉 The speaker emphasizes the importance of understanding endogenous insulin, which is produced by the pancreas, as opposed to exogenous insulin, which is administered to diabetic patients.
• 🔍 There's a misconception among many primary care practitioners that in type 2 diabetes, beta cells burn out and stop producing insulin as the disease progresses, which the speaker refutes.
• 📉 The speaker argues that even when insulin production decreases in type 2 diabetes, it remains higher than the initial levels before metabolic issues arose.
• ⚠️ The conventional focus on glucose levels in diabetes management overlooks the significance of insulin levels, which can be a more sensitive and early indicator of metabolic health.
• 🩺 The speaker advocates for measuring fasting insulin levels early in a patient's metabolic assessment and suggests that levels below 6 micro units per milliliter indicate insulin sensitivity.
• 🚫 There's criticism of the clinical norm that considers any fasting insulin level below 25 as normal, which the speaker believes represents severe hyperinsulinemia.
• 📚 The speaker promotes the use of the oral glucose tolerance test, which provides more detailed information than the A1C test, despite the latter being more commonly used.
• ⏳ The A1C test measures glycation, which is not solely a result of hyperglycemia but also influenced by the lifespan of red blood cells, potentially leading to false readings.
• 🍽️ A shift towards a carnivore diet may lead to longer-lived red blood cells, which could falsely elevate A1C levels, despite improved metabolic health.
• 📈 The speaker suggests using fructosamine tests or monitoring uric acid levels as alternative indicators of glycation in patients with potentially skewed A1C results due to diet changes.

Q & A

What is the main focus of the discussion in the transcript?

The main focus of the discussion is the importance of understanding endogenous insulin production by the pancreas, its role in type 2 diabetes, and the misconceptions in mainstream medical practice regarding insulin and glucose metabolism.

Why does the speaker believe that primary care practitioners are often oblivious to the insulin produced by the pancreas?

The speaker believes that primary care practitioners are often oblivious to the insulin produced by the pancreas because their training and focus are primarily on managing glucose levels and administering exogenous insulin, rather than understanding the intricacies of endogenous insulin production and its impact on health.

What is the speaker's bold statement regarding beta cells in type 2 diabetes?

The speaker's bold statement is that in type 2 diabetes, beta cells never completely disappear. Instead, insulin production may decrease due to insulin resistance, but it is still higher than before the onset of metabolic issues.

Why does the speaker argue against the common treatment approach of pushing insulin levels higher to lower glucose in type 2 diabetics?

The speaker argues against this approach because it can lead to increased insulin resistance and does not improve outcomes. The more insulin that is given, the higher the risk of mortality in type 2 diabetics.

What does the speaker suggest as a more effective clinical marker than fasting glucose for assessing insulin resistance?

The speaker suggests that fasting insulin levels are a more effective clinical marker than fasting glucose for assessing insulin resistance, as it provides an insulin-centric view of metabolic health.

What fasting insulin levels does the speaker consider to indicate insulin sensitivity or resistance?

The speaker considers fasting insulin levels of six micro units per milliliter or less to be a very good sign of insulin sensitivity, while levels in the high teens to 20s indicate compromised health due to insulin resistance.

Why does the speaker criticize the reliance on A1C as a primary marker for metabolic health?

The speaker criticizes the reliance on A1C because it can be falsely elevated or decreased due to factors affecting red blood cell lifespan, not just glucose levels. This can lead to misdiagnoses and an incomplete understanding of a patient's metabolic health.

What alternative test does the speaker recommend for patients who follow a carnivore diet and have slightly elevated A1C levels?

The speaker recommends a fructosamine test for patients on a carnivore diet with slightly elevated A1C levels, as it measures glucose glycation without being influenced by red blood cell lifespan.

Why is there no clinical test available to measure fructose glycation, according to the speaker?

The speaker indicates that there is no clinical test available to measure fructose glycation, which is a significant oversight since fructose is more reactive than glucose and can lead to increased glycation and inflammation.

What role do ketones play in mitigating the inflammation caused by uric acid, as discussed in the transcript?

Ketones are discussed as having anti-inflammatory properties that can counteract the pro-inflammatory effects of uric acid, potentially explaining why some individuals on a ketogenic diet may have elevated uric acid levels but improved metabolic and inflammatory markers.