Insulin Sensitivity Webinar

Thank you for viewing our webinar!

Listed below are links where you can download the files discussed during the webinar – the exercise tip sheet and the Module 1 Guide.

A link to enroll in the HPI Diabetes Academy, as discussed during the webinar, is also below.

Click here to download the slides used during the webinar.

Purpose of the Webinar: Stress the importance of improving insulin sensitivity, which is not done by conventional treatment methods.

Exercise Tip Sheet

Module 1 Guide

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See you there!

You’re doing eggs all wrong!

Image from


You’ve heard it before, maybe even believe it yourself:

Eat the egg whites and trash the yolks!

Egg yolks are full of saturated fat and cholesterol – they are bad for you!”

The list goes on…

It’s hard not to get caught up in this line of thinking because it seems to be everywhere. After all, nearly every restaurant that serves breakfast has a “healthy breakfast option” that removes the yolks from the eggs.

Thinking this way is doing eggs all wrong. It’s time to stop the egg-yolk-phobia!

Yolk is the healthiest part of the egg!

Look at the image below. From a single egg yolk (17 grams), it’s easy to see yolks are loaded with micronutrients!

These restaurants and their healthy egg options are getting rid of the healthiest part of an egg. Compare the nutrient density of the egg white from a single egg below.

Not much of a comparison. In fact, there are bunch of zeros when it comes to nutrient density of the egg white.

Beyond the direct comparison, the protein in egg whites is more difficult to digest when the fats from the egg yolks are not available to help your body digest them.

But, but saturated fat and cholesterol!

Yes, we all know the drill. Eating saturated fat raises cholesterol, which increases heart attack risk. This is simply not true. Although eating a “saturated” fat like Crisco certainly increases your risk, it’s not really a saturated fat.

Further, study after study after study has repeatedly shown that dietary cholesterol and saturated fat has little impact on your cholesterol levels. Cholesterol levels are internally regulated, when you consume more, your body makes less. And vice-versa.

Finally, studies show that consuming whole eggs improves cholesterol profile, increases HDL and improves metabolic syndrome here, here and here.

Beyond all of that, high cholesterol is (supposedly) a risk factor indicating an increased risk for cardiovascular disease. Some would argue against that.

See? Eggs aren’t so bad!

In fact, they are one of the best foods you can eat. Their awesome micronutrient profile means they go a long way to filling your satiety bucket, which means your body will stay full longer.

What about the calories?

What about them? A single, large boiled egg contains 70-80 calories, depending on size. So if you eat two boiled eggs for breakfast, you are consuming 150-160 calories. Compare that to a medium, plain bagel at nearly 300 calories! And the nutrient density in the whole egg completely blows away the bagel. So you are eating fewer calories and doing a better job of feeding your body.

Not much of a comparison!

Tell’em they’re doing eggs all wrong!

The next time someone tells you the egg yolk should be thrown out, tell them they are doing eggs all wrong. Then proceed to recite everything in this article.

And the next time you have breakfast at a restaurant, tell your waiter you want the healthy eggs, those WITH the yolk!

Type 2 Diabetics and the Disposition Index

When most of us think about type 2 diabetes, we think about several things: problems with blood sugar control, insulin sensitivity, difficulty in losing weight, struggling with exercise, etc… Most of us, however, rarely, if ever, think about an obscure term known as the disposition index.

It is so obscure, it doesn’t even have its own Wikipedia page!

While most of the things we think about regarding type 2 diabetes are part of the condition, the reality is they are just individual pieces of the same puzzle.

That one thing that encapsulates all of this is the disposition index.

Why Type 2 Diabetes Occurs

The typical progression from normal blood glucose control to type 2 diabetic goes something like this:

Over time, our insulin begins to lose sensitivity. This can be due to a number of factors but is typically the result of chronically elevated blood sugar (glucose) as a result of our diet. As our insulin loses sensitivity, our pancreas starts to secrete more insulin to deal with the elevated blood sugar. Somewhere during this progression, most people start gaining weight, typically when insulin first starts losing sensitivity.

Eventually, insulin struggles to reduce blood sugar so the pancreas secretes more insulin. At some point, our pancreas is unable to continue secreting more insulin. This is when people get diagnosed as type 2 diabetic. They go to the doctor, get a blood test and find their blood glucose is too high. They then go through an OGTT (Oral Glucose Tolerance Test) and get diagnosed as a type 2 diabetic because blood sugars are not reduced appropriately.

In the two paragraphs above, insulin and blood glucose were mentioned frequently. So it it understandable when these things are mentioned as part of the Type 2 Diabetes condition. Notice that we haven’t even mentioned disposition index.

There is a good reason for that because the disposition index encompasses something else we haven’t mentioned: the pancreatic beta cells.

Pancreatic Beta Cells and Insulin

Insulin is released from the pancreas; more specifically, it is released from the beta cells of the pancreas. When your blood sugar is under control and insulin sensitivity is high, everything functions normally.

You eat a meal or a snack, your blood sugar elevates, your pancreas senses this, the beta cells secrete insulin, insulin does its job by reducing blood sugar and then insulin goes back to normal levels.

This entire relationship can be described with a mathematical function in both normal blood glucose control and type 2 diabetics. This function is known as the disposition index. See figure below.

Source: Bergman et all, Diabetes, 2002, Figure 1, page S213.
Note: Red lines added.

The horizontal axis is insulin sensitivity and the vertical access is insulin secretion. What we can note from this figure is that as insulin sensitivity increases, insulin release decreases. We also note the opposite: As insulin sensitivity decreases, insulin release increases.

Based on research, we know the following: The work required by the pancreatic beta cells changes as insulin sensitivity changes – this can be seen by in the graph above by noting the increase in insulin release as we move left along the horizontal axis (insulin sensitivity).

As noted above (2nd italicized paragraph), at some point the pancreatic beta cells are unable to secrete more insulin in response to elevated blood sugar as insulin sensitivity decreases.

Note the two boxes in the graph above. We have zoomed in on them in the figure below. The two bottom numbers in the figure below in each of the boxes is 800 and represented by DI, which is the disposition index. So both have a disposition index of 800 but occupy different places on the function. How can this be?

The other numbers in the boxes give us the answer. “S” refers to insulin sensitivity and “AIR” refers to insulin release. The insulin release value in the left box is 2,000 pmol/l while it is 400 pmol/l in the right box. This means, for all practical purposes, that to achieve an optimal level of blood sugar control, when insulin sensitivity is 2.0 pmol/l (right box) we have to release 400 pmol/l of insulin. If insulin sensitivity decreases to 0.4 pmol/l, we have to release 2,000 pmol/l of insulin – a fivefold increase in insulin release.

What this means is that as insulin sensitivity decreases, the pancreatic beta cells have to do more work by secreting additional insulin to deal with the elevated blood sugar. The beta cells adapt to this additional work and over time, they reach an “insulin secretion limit.” This results in chronically elevated insulin and blood sugar, also known as type 2 diabetes.

But it is clear the dysfunction in pancreatic beta cells is the first domino to fall in this string of events.

So the main question is, what causes the beta cells to reach their limit? Why and/or how do they reach a point where they can no longer secrete insulin (or enough insulin)?

This is an active area of research, with new answers frequently. While there are answers to many questions, the precise mechanism has not been identified. And it may just be there are several factors that lead to this pancreatic beta cell dysfunction.

In our next post, we will cover some of the more promising areas of research. Included will be things you can do to increase the health of your pancreatic beta calls.

By implementing some of these suggestions, your insulin sensitivity will certainly change. This will also lead to an improvement in insulin release. Overall, this will lead to an improvement in your control of type 2 diabetes.

That’s something all of us want.

Can losing fat from the pancreas reverse type 2 diabetes?


This summary says it can.

The summary comes from this article, which paints a slightly different picture, but important nonetheless.

So what is going on?

Well, it is part truth and part sensational, attention-grabbing headlines.

Gastric Bypass, Insulin sensitivity and Type 2 Diabetes

In the actual study, the authors evaluated both type 2 diabetics and non-diabetics, matched for age, sex and weight, before and 8 weeks after gastric bypass surgery (laproscopic RYGB).

The results were interesting.

Both groups lost weight after surgery (not surprising) and both groups lost a significant amount of body fat (also not surprising). However, the type 2 diabetic group also lost a significant amount of pancreatic fat, which did not happen in the non-diabetic group. See figure below.

This led to significant improvements in all measures of insulin sensitivity for the type 2 diabetic group, which means a significant improvement in controlling type 2 diabetes. In other words, they improved.

It’s also likely why the authors of the summary had such a sensational headline.

Can you spot reduce visceral fat?

So what happened here?

The type 2 diabetic group had a higher level of pancreatic fat before surgery. This is internal fat, known as visceral fat. Subcutaneous fat is the fat right underneath your skin. It’s the fat you can pinch. Studies have repeatedly shown that visceral fat is more detrimental to your health than subcutaneous fat.

If you are type 2 diabetic, you might wonder if you can specifically reduce visceral fat and improve your insulin sensitivity. And based on the questions I’ve had, many of you are wondering this.

The answer is kind of.

You can do this through diet and exercise and probably by sleeping better and managing stress.

We will focus on exercise and diet.

Exercise, Type 2 Diabetics and Visceral Fat

Higher intensity exercise has repeatedly been shown to decrease visceral fat, whether type 2 diabetic or not. And, while both low and high-intensity exercise have been shown to also reduce subcutaneous fat, it is high intensity exercise that can do so more preferentially.

Given that the type 2 diabetics had higher amounts of visceral fat at the beginning of the study, exercise might be a plausible explanation for the significant reduction in pancreatic fat after surgery. It’s unlikely, though, since surgery can be rough and assessment was only 8 weeks after surgery.

Diet, Type 2 Diabetics and Visceral Fat

It is likely the significantly reduced caloric intake after surgery was the main reason for reduction in pancreatic fat. Prior to the surgery, the average weight of the type 2 diabetics was 266 pounds. Eight weeks after surgery it was 230 pounds. This is an average weight loss of 36 pounds or 4.5 pounds per week. And…of those 36 pounds of weight loss, 30 of them were fat, which means they were losing 3.75 pounds of fat per week.

To lose 4.5 pounds per week, you need a daily caloric deficit of 2,250 calories per day (going by the 3,500 calories per pound, which is questionable). That’s a HUGE caloric deficit!

Which brings us back to diet and visceral fat. A caloric deficit this large will lead to significant visceral fat reduction. And without surgery, I’m not sure anyone can subject themselves to a caloric deficit of this magnitude.

Outside of gastric bypass surgery, what can you do, at least nutritionally, to decrease visceral fat? The research is fairly clear on this. A diet that severely limits processed foods – particularly processed carbohydrates will help. A low-carb, high-fat diet (which may be the same thing) will also do the trick.

But it won’t work as fast as surgery.

So what does is all mean?

Well, the diabetes wasn’t reversed in this population but it was significantly improved. And it corresponded to a decrease in pancreatic fat. This most likely happened because of a massive reduction in caloric intake after gastric bypass surgery.

Outside of surgery, are there things you can do to preferentially target pancreatic or visceral fat? Yes!

If you are a type 2 diabetic you should consider two things: 1) a diet lower in processed carbohydrates and 2) work to improve your fitness level. Diets lower in processed carbohydrates (or low-carb, high-fat diets) have repeatedly been shown to reduce visceral fat (and subcutaneous fat too). Improving your fitness level through any means of physical activity so that you can perform higher intensity activity is also important. And at some point, you probably need to make sure you are getting enough sleep and managing stress.

These two things will accomplish the same as the surgery, just not as quickly or severe.