TLDR;
This podcast episode features Karan Sarin, author of "Sick Nation", who discusses the invisible crisis of metabolic dysfunction in India. He highlights the alarming rates of diabetes, cardiovascular diseases, obesity, and fertility issues, attributing them to insulin resistance. Karan explains how insulin resistance develops, its symptoms, and the concept of being "thin outside, fat inside" (TOFI). He also touches on the role of carbohydrates, the ketogenic diet, and the importance of prioritising protein and healthy fats. The episode concludes with practical advice on improving metabolic health through nutrition, exercise, and stress management.
- India is facing a metabolic dysfunction crisis with high rates of diabetes, heart disease and obesity.
- Insulin resistance is a key factor, often undiagnosed due to subtle symptoms and limitations in standard medical check-ups.
- Diet plays a crucial role, with excessive carbohydrate consumption driving insulin resistance.
- Lifestyle changes, including prioritising protein, managing stress, and regular exercise, are essential for improving metabolic health.
Intro [0:00]
The podcast begins by highlighting India's status as the "diabetes capital" of the world, with 101 million diagnosed diabetics and 136 million pre-diabetics. Cardiovascular diseases account for 27% of deaths in India, and projections estimate 450 million obese people by 2050 if current trends continue. Fatty liver disease affects one in three Indians, with a staggering 80% prevalence among IT professionals. The guest, Karan Sarin, is introduced as an expert in metabolic health, and the discussion aims to address the misconception that being thin equates to being healthy.
Metabolic Dysfunction [2:51]
Karan Sarin explains that India is facing a metabolic dysfunction crisis, characterised by a cluster of interconnected health problems beyond just diabetes. These include cardiovascular diseases, with Indians experiencing heart attacks a decade earlier than the global average, high rates of obesity (40% prevalence), widespread fatty liver disease, rising cases of neurodegenerative diseases like Alzheimer's, and increasing reproductive and fertility disorders. He stresses that these issues are connected and often stem from a common underlying problem, which is manageable and reversible.
What Is Insulin Resistance? [7:00]
Insulin resistance is identified as a central factor in metabolic disorders, with studies suggesting that one in three adults in India have it, and 90% of those are unaware. Karan clarifies that insulin is a hormone produced by the pancreas, essential for regulating blood sugar levels. When we consume carbohydrates, they are converted into glucose, raising blood sugar. Insulin is released to facilitate the uptake of glucose by tissues like muscles and fat cells, either for immediate energy use or storage. However, constant consumption of carbohydrates leads to chronically elevated insulin levels (hyperinsulinemia), causing tissues to become resistant to insulin's effects.
Progression of Insulin Resistance [18:58]
Karan explains the insidious nature of insulin resistance, highlighting the body's compensatory mechanism. Initially, the pancreas produces more insulin to manage the excess glucose, maintaining normal blood sugar levels for 5-10 years. However, eventually, the pancreas becomes exhausted, leading to beta cell dysfunction and a gradual increase in blood sugar. This can progress to pre-diabetes and eventually type 2 diabetes, often masked by glucose-lowering medications that don't address the underlying insulin resistance. Insulin's impact extends beyond blood sugar control, affecting every cell in the body, influencing energy processing, brain function, liver health, and reproductive hormones.
Signs That You Are Insulin Resistant [25:10]
Karan details clinical markers for detecting insulin resistance, some of which don't require blood tests. These include skin tags, dark patches on the neck, a waist size greater than half your height, high blood pressure, erectile dysfunction in men, and PCOS in women. He also recommends a fasting insulin blood test, cautioning that the reference ranges provided by labs are often too high. An optimal fasting insulin level should be five or below, with levels between five and ten indicating early resistance, and ten and above indicating insulin resistance.
TOFI – The “Thin Outside, Fat Inside” Phenomenon [32:40]
Karan discusses the "thin outside, fat inside" (TOFI) phenomenon, explaining that being thin does not necessarily mean being healthy. He highlights that BMI is a poor indicator of health for Indians, as they tend to develop metabolic disorders at lower BMIs compared to Western populations. This is because Indians are predisposed to storing fat in the visceral area, which is metabolically unhealthy. He explains that where fat is stored (subcutaneous vs. visceral) and the characteristics of fat cells (hyperplasia vs. hypertrophy) are crucial factors in metabolic health.
Why Indians Store Most Fat in Visceral Areas [37:27]
Karan delves into the historical reasons why Indians tend to store fat in the visceral area. He explains that during British colonial rule, India experienced 31 famines due to policies that prioritised cash crops over staples and disrupted traditional food storage systems. This led to epigenetic adaptations, making Indians efficient at storing fat, particularly in the visceral area, for survival during times of scarcity. However, in today's environment of abundance, these "survivor genes" have turned against us, contributing to insulin resistance and metabolic disorders.
Why Your Body Doesn’t Need Carbohydrates [45:52]
Karan asserts that the body needs zero grams of external sugar for survival, as the liver can produce glucose through gluconeogenesis. He points out that many people have reduced sugar intake but metabolic disorders are still rising due to "invisible sugars" in the diet, primarily from excessive carbohydrate consumption. He argues that the body treats sugar and carbohydrates similarly, as both are converted into glucose. He highlights that 70% of calories in the Indian diet come from carbohydrates, a non-essential macronutrient, while protein and fats, which are essential, are often under-consumed.
The Ketogenic Diet [57:53]
Karan briefly explains the ketogenic diet, which involves extremely low carbohydrate intake (less than 50 grams per day) and high fat intake. He notes that the ketogenic diet was originally developed as a treatment for epilepsy in the early 1900s, as ketones have a remarkable impact on improving epilepsy. He also mentions that it is used as a treatment therapy for diabetes, as it helps to lower insulin levels.
Why Are Carbohydrates Such a Big Part of Our Diet If They Aren’t Essential? [1:00:12]
Karan explains that for 1.8 million years, humans were hunter-gatherers, consuming primarily meat, fruits, and root vegetables. Agriculture, which introduced grains and carbohydrates, only emerged 10,000 years ago. In India, the Green Revolution in the 1960s and 70s aimed to increase agricultural production to feed the growing population. This involved hybridisation of grains, which increased yields but also changed the structure of the grains, increasing the amount of starch that readily converts into glucose. He also notes that fruits have been engineered to increase yield and sweetness, making them significantly different from their wild forms.
Two Grains That Are Better Than Wheat [1:07:21]
Karan suggests that not everything is bad, and there are better choices available. He shares his personal experience with testing different flours and finding that ancient grains like barley (jau) and millet (bajra) resulted in lower blood sugar spikes compared to wheat. He attributes this to less hybridisation and processing, resulting in higher fibre content. He advises choosing unpolished rice and being mindful of fruit consumption, treating it as a dessert rather than a main meal, and avoiding juices.
What Is Type 3 Diabetes? [1:14:25]
Karan explains that excessive sugar in the brain can lead to type 3 diabetes, also known as neurodegenerative diseases like Alzheimer's. Insulin resistance has a direct impact on brain health, impairing the brain's ability to clear proteins, affecting memory formation and learning, and compromising glucose supply. He cites research showing that people with dementia have defective insulin receptors in their brains.
What Is Type 4 Diabetes? [1:18:46]
Karan introduces type 4 diabetes, a term used to describe fertility issues, particularly PCOS in women. He notes that PCOS is becoming increasingly common among teenagers, with studies showing that one in five women in India of reproductive age have PCOS. Insulin resistance drives 70% of PCOS cases by promoting androgen growth, hindering the production of sex hormone-binding globulin (SHBG), disrupting the balance of luteinizing hormone (LH) and follicle-stimulating hormone (FSH), and impairing follicle maturation in the ovaries. In men, insulin resistance promotes the conversion of testosterone to oestrogen, leading to erectile dysfunction.
The Three Big Rocks of Metabolic Health [1:25:17]
Karan introduces the "Big Rocks Principle," inspired by a time management technique, to prioritise the most important aspects of metabolic health. He identifies three big rocks: nutrition, activity and exercise, and stress and sleep cycle. These three factors have a direct impact on insulin sensitivity and overall metabolic health. He recommends strength training as the optimal form of exercise and emphasises the importance of managing stress and prioritising sleep.
Focus on High-Protein Diet [1:32:49]
Karan clarifies that he is not necessarily advocating for an animal-based diet but rather prioritising protein, controlling carbohydrates, and incorporating healthy fats. He believes that a vegetarian diet can be good if these principles are followed, but it is often challenging due to the carbohydrate-loaded nature of many vegetarian diets and the difficulty of obtaining complete proteins.
BTS [1:35:46]
Behind the scenes chat.
Outro [1:36:38]
The host concludes the podcast by thanking Karan for his insights and encouraging viewers to subscribe to the channel, provide feedback, and share the episode with others.
