Normal Blood Sugar But Still Insulin Resistant? Here's Why

Your doctor says your blood sugar is normal, so you assume everything is fine. But what if your body is already showing signs of insulin resistance and your routine blood tests aren't catching it? Today, I break down what your blood sugar numbers actually reveal, the critical markers most doctors aren't testing, and how to spot metabolic dysfunction before it develops into something more serious. Here's what we discuss in today's episode: Why normal blood sugar doesn't necessarily mean you're metabolically healthy The overlooked blood test that may reveal insulin resistance years before your glucose rises What your fasting glucose, insulin, and A1c numbers actually mean and what to look for How sleep, stress, meal timing, and even the order you eat your food can affect blood sugar The surprising signs of insulin resistance, even in people who appear thin and healthy Simple changes you can make today to improve your metabolic health Insulin resistance can develop silently for years before showing up on a standard blood test. The sooner you understand what's happening in your body, the sooner you can take action. And the good news is that many of the most powerful ways to improve your metabolic health start with simple, everyday habits. Our Award-Winning EpisodesThe Dr. Hyman Show just won four Signal Awards! Thank you to our listeners for your incredible support. Check out our award-winning conversations: Gold & Listener's Choice: Rethinking Parkinson's Disease with Drs. Ray Dorsey and Michael Okun Silver & Listener's Choice: Live with Halle Berry at Eudemonia Visit ⁠functionhealth.com for 160+ lab tests at just $365 a year. Have a question you’d love answered on Office Hours? Submit it here. 0:00 Blood Sugar and Insulin Resistance 3:09 How Glucose and Insulin Work 8:13 Why Normal Glucose Can Mislead 19:24 Meals, Spikes, and Metabolism 29:03 Skinny Fat and Hidden Risk 38:14 Rapid Fire Blood Sugar Questions

Speaker names marked ? are inferred from speaking time and the show’s known hosts — they are not voice-verified.

• 0:00Speaker 00

  Can I reverse insulin resistance?

• 0:02Dr. Mark Hyman?

  Thousand percent. I've taken people who are type 2 diabetics, who are on insulin for 10 years, who are so sick and massively overweight. And within three days, they're off the insulin. In three months, their completely normal blood sugar, the A1C went from 11, which is insane, to five and a half, which is normal, in three months, no drugs. So it's possible. Welcome back to Office Hours. Today, I'm here with my producer, Emma, and we're going to talk about something that everybody gets tested, but very few people actually understand, blood sugar.

• 0:35Speaker 00

  Today, we're talking about something that most of us see every year on our blood work, but I honestly probably don't think much about it. And I don't think many of the audience members do either. And that's our blood sugar. So we get our fasting glucose back, maybe our A1C, they're all marked normal, and I assume that everything's going to be fine. But what I really want to understand today is whether those numbers actually tell us the whole story, because apparently you can have normal blood sugar and still already be insulin resistant. So I want you to unpack that for me today. So the main goal with this conversation is, how do I actually know if my blood sugar is healthy? But as we unpack that, I want to start at something super, super basic. What is blood sugar? And what is it supposed to be doing in my body?

• 1:17Dr. Mark Hyman?

  This is such an important issue, and I just want to highlight what you said, which is that a lot of people walk around and are told their blood sugar is quote, "normal." And yet, they are severely metabolically unhealthy, they have severe insulin resistance, and they have high levels of insulin while their blood sugar may be normal. And why does that happen? Because your blood sugar is the last thing to go up when you're in a metabolic dysfunction. It's the last thing to go up. The first thing up is your insulin. And so I'll unpack all of this, but I've seen people who are incredibly insulin resistant with normal blood sugars, and their health is a mess, even with a normal blood sugar. And it's, it's not just something people deeply understand. So this episode is brought to

• 2:01Dr. Mark Hyman?

  you by Function Health, empowering you to live 100 healthy years with over 160 lab tests for just $365 a year. And use the code MARK2026 to get $50 off your membership. Before we jump into today's episode, I want to take a moment to share some really exciting news with you. The Dr. Hyman Show has just won four Signal Awards. Our conversation with Doctors Ray Dorsey and Michael Okin about rethinking Parkinson's, well, that took home the goal for thought leadership. And our live conversation with Halle Berry at Udemonia won silver for best live podcast recording. And what makes this especially meaningful is that both episodes also won Listener's Choice Awards, voted on by you, our audience. I want to say a huge thank you to everyone who listens, shares our episodes, and supports the show. And of course, to our incredible guests and the team behind the

• 2:46Dr. Mark Hyman?

  scenes who make these conversations possible. Our mission is to empower you to take charge of your health, and I'm so grateful you're part of this community. If you haven't had a chance to listen to either of these award winning conversations, we'll include links to both episodes in the show notes below, so you can check them out. Now, let's get into today's episode. So what is blood sugar? How does it work? It's basically sugar. You know, glucose is sugar. Actually, table sugar is glucose and fructose, but glucose is the main sugar we use in our bodies. It's broken down from the food we eat, from starchy foods, from grains, from beans, from, you know, actual sugar. And it's an important fuel for our

• 3:26Dr. Mark Hyman?

  bodies. The pancreas will produce insulin once you eat sugar or starch, and it will create basically a way for your body to actually use the energy inside your cells. So insulin will be increased when you eat sugar or starch, and that helps the fuel get inside your cells. If you're overeating sugar, it produces more insulin, and you're going to end up storing the fat. So that's the bad thing. So that's basically how sugar works. It's normal to have a little spike after eating. It shouldn't go up too much. And we do glucose tolerance tests, so we can actually measure how fast the glucose goes up at 30 minutes, 60 minutes, one hour, two hours. And we see basically this, this rise, and it shouldn't, it shouldn't

• 4:07Dr. Mark Hyman?

  go way up and down. And when you start being dysregulated, you do these glucose tolerance tests, which I used to do on almost every patient, because I was like, this is an epidemic. 90 plus percent of Americans have this problem. 90 plus percent now. When I started in practice, it was far, far less. But now it's almost everybody. And so I want to see how bad it is, how their body's responding, what their insulin's like. And what you'll see is just often a normal sugar, but you'll see super high levels of insulin that are trying to keep the sugar down. The problem over time is when you keep eating starch and sugar, which is most of our diets in America, you know, we, I think that at its peak, we ate 152 pounds of sugar and 133 pounds of flour per person per year. That's almost a pound

• 4:48Dr. Mark Hyman?

  of sugar per day, and starch and sugar per day, per person. It's, it's not, it's not a normal dose. It's a pharmacologic dose, and it's extremely harmful. And when you eat that much, your body's trying to compensate by keeping your blood sugar normal, and your insulin starts to go up and up and up. And when that happens, you, your cells become resistant to insulin. It doesn't work as well. You need to make more insulin. The pancreas pumps out more and more insulin. And what insulin does ultimately is store that fat in your fat cells. It locks the fat in there. So as long as your insulin's high, you can't break down fat. And it also makes you hungry, and it drives cravings and wanting more sugar.

• 5:30Dr. Mark Hyman?

  It's almost like you're starving in the midst of plenty, even though you have all this massive storage fat on your body. How could you be hungry with all this extra energy? Because your, your body can't access it. And so you, you're starving, and you actually feel like you need more food. So when you, when you keep having this over and over and over again over time, you become very insulin resistant. Ultimately, you'll get diabetes. But that's a very late stage phenomenon. Diabetes happens, you know, decades after. This has been going on for, for years and years, and it can start in childhood. I mean, I mean, sometimes people get diabetes younger, like in their teenagehood, if they're just drinking soda and the average American diet, this can be pretty bad. So we really want to understand that, you know, when you get your blood sugar measured at the lab, it's not the whole story. Even the

• 6:14Dr. Mark Hyman?

  reference ranges are so off. In America, we say, well, when I, when I started in medical school, the normal blood sugar was like 140, up to 140. And then that, after that was diabetes. Now it's 126 is diabetes. It used to be like 100, I think 15 was pre-diabetes. Now it's 100. But, but when you look at the evidence, there was a large Israeli study where they looked at cardiovascular risk and other, you know, disease risks with blood sugar. And they found that anything over 87, there was a really linear increase in your risk of heart attacks, strokes, and so forth, over that, above 87. So I think an optimal sugar should be between 70 and 90. If it's, if it's above that, you're starting to get into danger zone.

• 6:59Speaker 00

  I want to circle back to something you said at the beginning there, and it's talking about when I am eating food, there will be spikes in my glucose. Is that correct? So I'm not, I naively thought that I always wanted to have kind of a flat glucose line. Is that false?

• 7:11Dr. Mark Hyman?

  You don't want to have a flat glucose line. It goes up and down. It's normal. When you eat, it goes up, but it shouldn't go up too much. When you overeat, or when you eat too much sugar and starch, it can spike higher, but it really should stay within a range. So typically, on a glucose tolerance test, your blood sugar after two hours should never go over 140. That's the upper limit. That, that's considered type 2 diabetes. That's by definition. But that's even still too high. It probably shouldn't go over 110 if it's optimal. If your metabolism is tuned up, and I give you two Coca Colas, essentially, which is a glucose tolerance test, your blood sugar will go up, but it might go up from

• 7:51Dr. Mark Hyman?

  like 75 to 110. That's okay. But if it goes up to like 140 or 200, that's not good.

• 8:00Speaker 00

  So then I want to unpack essentially this further. How can I look at my labs, and it says that my glucose is quote unquote, "normal," but I'm still insulin resistant? Can you dive into that further?

• 8:13Dr. Mark Hyman?

  What doctors don't test, and should test, and that we measure at Function, are two really important numbers that are important to understand your metabolic health. One is insulin, and the other is something called hemoglobin A1C. That's the average blood sugar over three months. The insulin is tested probably less than 1% of all blood tests. It's the most important test. If I had one test to check, to see what your health risk was for heart disease, for cancer, for dementia, for diabetes, obviously for obesity, I would check insulin. It's probably the most important indicator of your health, and yet it's never checked. And that's why when I developed the panel at Function Health, I made sure everybody checked it. And it's literally pennies. It says, I don't know, it's like

• 8:57Dr. Mark Hyman?

  probably less than a dollar to test this test. It's not very expensive, but it's so revealing. What happens normally is, and this is the sequence of events, you normally you start to get into metabolic crisis. So you start initially by having your insulin raised after you have a meal. But your fasting insulin and fasting glucose are normal. Then your insulin starts to go up high after a meal to try to keep the blood sugar down, right? That's the first thing. The second thing is it starts to go up fasting. So normal fasting insulin on a reference range in Quest is 18. That's because we're all a sick population. If you were a Martian in land in America, it's normal to be overweight. 75% of us are overweight. That's quote, "normal," right? If you did a bell curve. The truth is, that's not optimal. Same thing for insulin.

• 9:44Dr. Mark Hyman?

  Even though 18 is considered quite normal, it's not. It should be five or less. Mine is two or three. And I'm 66 and most of you in my age have insulin resistance. And I don't because I know what to do. It's not rocket science. I exercise, I eat well. Did I have, I had Greek frozen yogurt last night? Sure, but I also worked out and I did a lot of things. I do heavy workout class. So I think it's really about understanding your metabolism. And you can have more freedom, the healthier your metabolic function is. I call metabolic degrees of freedom. I can have Greek yogurt because it's not going to kill me because I basically, I'm highly tuned. My metabolic system is highly tuned. But if you're not, you're going to start seeing these rising insulin after eating.

• 10:25Dr. Mark Hyman?

  Then you'll see rising at fasting and then you'll see your glucose rise after eating or a glucose tolerance test. And then lastly, your blood sugar goes up. It's the last absolute thing to go up. And your hemoglobin C tracks with your average blood sugar. So you can see how you're doing. But this is something that should be tested on everybody. And I think even starting young, like I think we see kids with, and when you're younger are the ones who I see their pancreas is still healthy. And so these are the ones that are pumping out like, you know, instead of 18 and their insulin, it's 100 or 200 or 2, 300. It's like, whoa. And I was like, I'm shocked to see these numbers. And I had a woman who was really one of my most profound patients early on when I was practicing. I gave her, I gave her, you know, basically she had glucose tolerance test, which is the equivalent of two Coca Colas.

• 11:09Dr. Mark Hyman?

  And she had this big belly. She was very overweight. She had high triglycerides, low cholesterol. I knew she was insulin resistant, but her blood sugar was perfect. Never went over 110, even despite having the equivalent of two Coca Colas. But her insulin just was through the roof. Her insulin was like 300 because it was managing to keep the blood sugar down, but it was doing so much work. Eventually it'll poop out and she would, she would, she would get diabetes. But it was really interesting to see that, that even though she had a perfectly normal blood sugar, even with a glucose tolerance test, which is what doctors will do. They're missing a huge amount of these cases.

• 11:41Speaker 00

  Okay. So I want to go into the difference between fasting glucose and fasting insulin. Essentially my question is, what's the difference between them?

• 11:49Dr. Mark Hyman?

  Well, fasting glucose is basically what your resting blood sugar is without eating. And fasting insulin is the same thing. What your resting insulin is without eating. Insulin, if, if you're, you're looking at insulin, you'll often see fasting insulin start to go up if you become insulin resistant. So that's the first clue, other than doing a glucose tolerance test, which most people don't want to do. We have a new test, which I would like to mention, which is kind of a uniquely available through function that almost nobody's doing, but is scientifically the best way to check for insulin resistance, which is an insulin resistance score, where they use a technology called mass spectrometry to measure insulin and something called C peptide.

• 12:34Dr. Mark Hyman?

  And it gives you the best indicator of your degree of insulin resistance on a scale of zero to 100. And so that's a really important biomarker that people miss. And glucose, insulin, A1C are all important, but this other one is actually becoming, I think, really even more important.

• 12:49Speaker 00

  And what is the C peptide that they're measuring there?

• 12:52Dr. Mark Hyman?

  C peptide is a, is a, is a, is a sort of precursor of insulin. So it's like how much insulin your pancreas is making.

• 12:58Speaker 00

  Is that what makes this test unique? That function's doing is?

• 13:00Dr. Mark Hyman?

  Yeah, measures C peptide and insulin, but it also measures it using a very accurate technique, like a laboratory technique called mass spectrometry, which doesn't really matter, but the point is it's a super accurate test. It's as good as the research tests they use to measure insulin resistance in the lab, which is something called the euglycemic clamp test, which no one would do in real life, unless you're like in the lab with rats or something.

• 13:21Speaker 00

  That's your Mark Hyman.

• 13:22Dr. Mark Hyman?

  No, no, I wouldn't do that. I've never, I've never done it because it's like, it's, it's something that's not done in, in medicine. It's just like in research.

• 13:27Speaker 00

  And sorry sidebar, that is, it's available now with Function?

• 13:30Dr. Mark Hyman?

  It's available now through, through as an add-on on Function. Insulin and glucose and A1C are part of the standard Function panel on functionhealth.com. It's only a dollar a day for a year's membership and you get all these tests and more. But I think it's important for people to know the numbers. I think there's a big lesson we can learn from breast cancer screening. Think about it. You don't have to wait for symptoms to get a mammogram. We've learned the value of looking and getting information about your body, even when you feel perfectly fine. And I think that idea is bigger than breast health because there's so much happening inside your body that you simply can't see from the outside. Your blood sugar can change, your hormones can shift, inflammation can rise. Some of those changes you might feel, some of them you won't. You can't necessarily feel a number changing.

• 14:14Dr. Mark Hyman?

  You can't feel a risk building up before it shows up. And that's one of the reasons I help build Function. You get access to over 160 lab tests each year, covering your heart, hormones, metabolism and more. You shouldn't need a reason or a diagnosis to want a deeper look at your own health. This isn't a radical idea. It's a new standard because the goal isn't to collect more numbers. It's to have better information while you still have time to use it. Check your health at functionhealth.com/mark. And if you're one of the first thousand people this week, use the code MARK2026 for a $50 credit toward your $365 a year annual membership.

• 14:49Speaker 00

  So we're talking about Function offering these tests, but when I go to my annual physical and I'm getting my blood tests and these markers aren't there, why is insulin not part of these annual exams that I'm getting?

• 15:01Dr. Mark Hyman?

  That's a very good question, Emma. I've been asking that question for 30 years. I have been testing this for 30 years because the science has been there. I mean, we often say in medicine, it takes 17 to 20 years for discoveries to become practice. It's even longer than that. 30 years I've been measuring this. And I think doctors, and a part of the reason is the solution is nutrition, not a drug. And so if you don't have a drug to prescribe it, there's nobody promoting it, right? Nobody's saying, oh, everybody's got to check their LDL cholesterol because we have a statin and that drug lowers LDL cholesterol. But there's no good drug to really lower insulin. Not really. So it's really about diet.

• 15:45Dr. Mark Hyman?

  Metformin works a little bit. Some of the GLP ones help a little bit, but that, but basically, and if you lose weight, obviously it'll, it'll help. But the, the, the key is that food is the biggest driver and we'll bring that down like that. I just had a patient whose insulin was like 70 and within a few months it went to perfectly normal by changing his diet. And his insulin resistance score was 100 and it went down to normal. I'd never seen 100 before.

• 16:11Speaker 00

  Through, just through changing his diet and lifestyle?

• 16:13Dr. Mark Hyman?

  Yeah, just changing his diet and exercise. Yeah.

• 16:15Speaker 00

  Okay. So we've briefly touched on A1C. I want to dive deeper in there. What is that measuring in my tests?

• 16:23Dr. Mark Hyman?

  So A1C is like, like, like oscillated hemoglobin. So basically what it's measuring is your hemoglobin that's been altered by sugar. And think of it like when you combine protein and, and sugar in, in, and you have like creme brulee or a crust on a bread. That's a chemical reaction called a Maillard reaction. That also happens with your, when your blood sugar is too high, it damages your hemoglobin in a way that creates this marker called hemoglobin A1C that measures the average two to three month blood sugar. So you really are getting a longer range view of your blood sugar. They just, because your blood sugar goes swinging up and down every day, but the average is important.

• 17:09Dr. Mark Hyman?

  So, you know, we see the lab test as if it's over 5.7, you're prediabetes. And they moved it over to 6.5 for diabetes. It used to be six was diabetes. They moved it, you know, these professional societies are changing the reference ranges all the time. But I talked to our partner, Quest, and I talked to the cardiologist there and they have massive data sets. And they said that the people who've started having A1Cs over 5.1, right? And remember the 5.7 is the cutoff, but 5.1, and this is a logarithmic scale. It's not like a linear scale so that every point one is a big change. Anybody over 5.1, the risk of cardiovascular disease went up in a linear fashion.

• 17:49Dr. Mark Hyman?

  And the, the risk of their cardiac, their lipid abnormalities or cholesterol abnormalities are all driven by this. And by the way, your glucose and your insulin resistance are driving most of the abnormal cholesterol that's causing heart disease. And insulin resistance, not fat, sugar, not fat, is the major driver. And I say sugar, I mean sugar and starch, the major driver of cardiovascular disease and heart attacks and strokes and high blood pressure. Yeah, it's crazy.

• 18:15Speaker 00

  So say I get my tests back and it says that my A1C is normal. Am I in the clear?

• 18:20Dr. Mark Hyman?

  No, absolutely not. Absolutely not. No sugar, A1C, because if your sugar is normal or A1C is normal, you could still be running an insulin of 100, you know? And you're in big doo doo. And if you don't check your insulin, you won't know what's going on. So insulin, insulin, insulin, insulin, insist on it. I met with the, I met with the dean, the dean of a medical school, a doctor herself, who was East Indian and had listened to this podcast. And she was like, I went to my cardiologist because I know genetically I'm more susceptible to insulin resistance. And I went to my cardiologist and I said, can you please measure my insulin? And he said, no.

• 18:58Dr. Mark Hyman?

  This is malpractice in my view. I mean, this is just, this is like dark ages. We know the science is there because you don't know anything about nutrition, doesn't mean you shouldn't check it. Bottom line, insulin, check your insulin.

• 19:10Speaker 00

  So as we've been talking about blood sugar, we've talked a lot about fasting, but I spend a lot of my day not fasting. I'm eating between normal hours of the day. Why are we not paying attention to what happens to my bloods after I eat?

• 19:24Dr. Mark Hyman?

  Well, we should, and that's what a continuous glucose monitor will tell you. And that's why I do a glucose tolerance test to measure the levels of spiking of glucose after a meal. So I want to know how your body's handling it. Are you metabolically healthy? Are you metabolically broken? Like what's happening? And, and, and you know, there's a lot of things that actually affect how your blood sugar rises or doesn't rise after a meal. So you could eat a meal. For example, if you eat bread and wine at the beginning of a meal, your blood sugar will go through the roof. But if you eat protein and fat and fiber and then have a little bread and wine, it won't have an impact. So the meal composition, the order of foods you're eating really matters. And also

• 20:08Dr. Mark Hyman?

  fiber matters a lot. So the amount of fiber you're having matters. You can literally take a Coca-Cola and you could put in this thing called glucomannan, which comes from a Japanese root called cognac. And, and you know, it won't raise your blood sugar because it basically soaks up all this water and it acts like a sponge and it really, I mean, I'm not encouraging you to do that.

• 20:30Dr. Mark Hyman?

  If you put metamucil in your Coca-Cola, it'd be better for you, you know?

• 20:34Speaker 00

  We won't slip that one.

• 20:39Dr. Mark Hyman?

  And I think eating whole food matters because the structure and the composition, for example, if you have a bean, which has a certain amount of carbohydrate, or even a whole grain like buckwheat or brown rice, it will be, it's harder for the body to break it down and in digest it. And then it has, has a slower absorption rate. So it's the rate, if you drink a Coca-Cola or a fruit juice, it's just sugars going like this. But if you have, you know, these foods that are complex, if you have a piece of fruit instead of fruit juice, it has a different effect on your blood sugar. Also, fat and protein and fiber greatly modify the rate of glucose absorption. So having a, a meal that you design and compose to actually have a, to mitigate the rise in blood sugar, it

• 21:23Dr. Mark Hyman?

  can also work. Really important. And then, and then portion size matters. So this happened to me. I went to visit my friend in Martha's Vineyard and he ordered this unbelievable meal from this like organic place with lamb and this and that. And there was some stretchy stuff, but it was like healthy, whole grains with potatoes, whatever. I think even I had dessert. And I actually was, it was my first time wearing a CGM, a glucose monitor. And he wore one too. And we're both like, you know, very athletic, very thin, you know, healthy guys. And we, he called me like at 10 o'clock at night freaking out because we way over ate. Like I really stuffed myself, which I don't normally do, but it was so good. And our, both our sugars were like 140 or 150. We were like,

• 22:08Dr. Mark Hyman?

  what the heck? You know? So portion size matters and it will, independent of like having, you know, sugar, it will, it will have an effect. Sleep has an effect. So if you don't sleep, you're going to crave more carbohydrates, your appetite's going to be increased, it'll affect your metabolism. Stress, cortisol is a hormone that's pumped out when you're stressed. Cortisol will raise your blood sugar. Why? Because when you're stressed, you want to have a lot of fuel to run from a tiger. If you're, if you, your body's designed under stress to pump out a lot of glucose from stores, from your liver, from glycogen. And you're basically, even if you haven't eaten, your blood sugar will go up because you have about 2,500 calories of sugar stored in your muscle. So your body will start to pump out sugar. Exercise plays a really important role. Like there's a lot of

• 22:53Dr. Mark Hyman?

  science around how if you just take a 10 to 20 minute walk after eating, everything will smooth out and you won't have these spikes in sugar and you'll really improve your metabolism. Just a simple walk after dinner. And then of course, there's genetics. Like if I, you know, if, if a Native American has a Coca-Cola and they're healthy, their blood sugar will tend to go up higher, their insulin will go up higher. Mine won't because I'm, I'm just genetically different. So it's, there's genetic variability, but those are the things that really affect, affect your blood sugar. So you can really design your, your diet and your life, even to enjoy, you know, good food, but like, you know, if I, for example, I had last night, I had, you know, lots of protein, I had lots of veggies. And then I wanted like this, I'm in LA and I wanted this frozen Greek yogurt

• 23:34Dr. Mark Hyman?

  that's really good. And it's so yummy. And I was like, I'll have it. And I mean, yogurt has protein, it has fat. It's like, it's not just pure sugar. So I'm like, you can have fun.

• 23:44Speaker 00

  There's worse things you could eat in LA. We know that for sure. So if you were looking at my bloods, would you be more concerned about like how high my glucose goes or how quickly it comes back down?

• 23:56Dr. Mark Hyman?

  Both. I mean, they're both, both important. They're both important metrics. I think if your, if your blood sugar spikes really a lot, that's means you're really not able to manage it. If it, if it stays up for a long time, that's also a problem. So I think it's, those are just, you know, things to notice. But bottom line, I don't, I don't think you have to worry so much about that. You know, check your insulin, like make sure you check your metabolic health. You want to do insulin resistance score, function health, that's a good marker. And there are other, of course, markers that help give a full picture because it's not, when your glucose and your insulin resistant go off, it's not just your blood sugar or A1C or insulin that becomes a problem. You can get fatty liver, so your liver tests go up. You can get kidney issues, so you can approach in your urine. Your sex hormones are affected. If you're a guy, you're this guy who I was telling you about

• 24:41Dr. Mark Hyman?

  with a high insulin score, his testosterone was 160 and he was 29 years old and it should be 800 then. You know, normal's over 500. His, his, you see high uric acid, which can cause scout. You see also lots of inflammation, high CRP because the visceral fat causes inflammation in the body. You see all these different variables that change, not just the glucose or insulin. So it's important to look at everything. And by the way, we test all of that with function health.

• 25:08Speaker 00

  So we've been curtin kind of around and mentioning some of the things that we are checking in these tests. I want to go more specific. What numbers should I actually know? So I have a couple of things I want to hit you with, if you could walk me through what I should look for. So can you walk me through fasting glucose? What should I look for?

• 25:24Dr. Mark Hyman?

  Your fasting glucose should be 70, 90. Your fasting insulin should be ideally under five, but under 10, you know, five to 10 to start to, start paying attention, but not terrible, but definitely under five is ideal.

• 25:36Speaker 00

  What about my A1C?

• 25:37Dr. Mark Hyman?

  It's a good question. Probably a good A1C is five, 5.1, 5.2 maybe, but I wouldn't go much higher than that if you can.

• 25:44Speaker 00

  The last one I want to know is what should my post meal glucose be?

• 25:47Dr. Mark Hyman?

  Shouldn't probably go up over 110 ideally, 120 at the most.

• 25:52Speaker 00

  If my glucose hasn't gone up yet, is there anything else that might make you suspicious?

• 25:57Dr. Mark Hyman?

  Yeah, like I said earlier, there's a lot of side effects of high insulin or of insulin resistance. And what we'll often see, just looking at someone, I can tell if they're insulin resistant because they have belly fat. I, I tell people the cheapest test is the mirror test. You take you off your shirt, you stand in front of a mirror, you jump up and down. If your stomach jiggles, you have a problem. You should check. And, and I think a DEXA scan is really helpful, but even a waist circumference, if you just check a tape measure and measure around your belly button, that's a, if you're, measure around your widest point of your hips and around your belly button. And if you're a man, you should have a ratio of less than point eight. If you're a woman, it should be less than point nine. And, and this is really important. It's an easy thing to measure. I also

• 26:42Dr. Mark Hyman?

  see high triglycerides over 100, 150, even more. Low HDL, which is one of the cholesterol biomarkers. High number of lipid particles, too many small lipid particles. Again, these are things that are not checked on a normal test. We do check at function health. We see fatty liver, which can be from a high ALT, high GGT. These are numbers we can easily measure. Sometimes the liver tests don't actually check that. You might need a liver scan, call a fibroscan, which measures fatty liver, which is a little more sensitive. We're a, a full body MRI, which we offer at function because you can often get a fatty liver without actually having abnormal liver function tests. And so, you know, we do the scans to really help identify things like that. And it's one of the

• 27:24Dr. Mark Hyman?

  most common disease. I think it affects 90 million people. It's really bad. And then PCOS, we see, we see high testosterone women and we see high DHEA, we see high levels of androstenedione, other biomarkers we also measure with function. And we also see, you know, the high LH to FSH ratio, which is female hormones. We can, we can kind of tell these clues from this. And then we see, you know, other, other manifestations of it. It's quite bad. We see, you know, darkening skin and in the armpits and in the neck, all the acanthosis nigrans. We see, you know, family history is helpful. You know, people get sleep apnea, which often is a cause of insulin resistance, but also

• 28:00Dr. Mark Hyman?

  worsens it if you have it. And you know, if you have a family history of just initial diabetes, or you've had it yourself, or a family history of diabetes, those are all kind of clues you might be in trouble. And certain medications, you know, might, might worsen in statins, which is the most commonly prescribed medication in the world, cause insulin resistance and cause diabetes and cause insulin to go up. And, and actually the studies have been pretty clear that it does increase your risk of diabetes. So I think, you know, these are really important. And people also just have symptoms that are like, if you're, if you're craving stuff, I mean, I, I don't think I ever get cravings. Like I really, I mean, maybe if I haven't slept and that dysregulates my hormones and my appetite hormones, which I know it does.

• 28:44Dr. Mark Hyman?

  I will crave sugar, but, but I normally I don't crave it. I'll eat it because I like it, but I won't. I don't like, oh my God, I gotta have this. I don't, I don't have those because your, your body is just balanced.

• 28:55Speaker 00

  You mentioned belly fat there and how that is like a clear sign, but could someone be thin and still have insulin resistance?

• 29:03Dr. Mark Hyman?

  Absolutely. There's something called TOFI, metabolicly obese, normal weight, or TOFI is thin on the outside, fat on the inside. And you see a lot of people who are like this, particularly older people, you know, like little ladies, they have like, they look thin, but if you did a DEXA body composition, they'd be just like, uh, like a ribeye steak, or maybe a wagyu, or Kobe, even worse Kobe beef. And they're basically marbled fat. And that, that's, you can't really see that by the scale. You can look at it by a DEXA scan. I think also there's certain populations, the East Indians, like from India, and also Asians at lower body weights and normal body weights without a normal, without an M R B M I,

• 29:44Dr. Mark Hyman?

  maybe tiny bit of belly fat, they, they will get insulin resistant. And, and, and you, we will see a high, high levels of even diabetes in these people. And what's interesting is these, a lot of these people even have a higher risk of cardiovascular disease in their normal weight. So we call this TOFI, or I call it skinny fat. You look skinny, but you're actually fat.

• 30:04Speaker 00

  Is that a real word? Or have you made that up?

• 30:06Dr. Mark Hyman?

  Skinny fat?

• 30:07Speaker 00

  No.

• 30:07Dr. Mark Hyman?

  I don't know. I made it up years ago. TOFI, yeah, no, it's a medical thing. I mean, you can read about it. It's like tofu, but with an I.

• 30:14Speaker 00

  I know. Yes. Okay. I've heard you mentioned it before, and I apologize. I haven't looked it up, if I'm honest. You mentioned a continuous glucose monitor earlier. And so I'm curious, are those actually useful? Like, is it something that everyone should try out and use regularly?

• 30:30Dr. Mark Hyman?

  You know, I think it's good to get a benchmark. I mean, if you're a diabetic, for sure, important to know where you're at. And especially if you're type one, it's essential. I think, you know, I used it because I wanted to see, you know, if I ate bread, what happened? Or if I ate, you know, a piece of fruit, what happened? And like, I think there's a lot of individual variation. There was a large Israeli study that looked at the microbiome and how much the microbiome influences individual variability when it comes to what your glucose will be. And so even the same food in a different person will have a different response depending on the differences in their microbiome. So it's very complex. And that's why it's important

• 31:12Dr. Mark Hyman?

  to know what's good for you. Some people can eat a plum, some people can't eat a plum. You know, say we're gonna have, you know, a piece of bread and finds a piece of bread, it's like a disaster. So I think it's important, at least for a few weeks, to track what's happening in your biology. So you know, and then you can say, oh, okay, well, I'm understanding this. And maybe periodically, if you, if you want to see how you're doing, if you improve. But I don't think it's something people need all the time. But I think, I think it's, it's important to understand what's happening in your body. And I believe we need to have data-driven healthcare. I think for much of medicine, we're basically just like roping around in the dark, you know, physical exam, it's not that great. A few very rudimentary lab tests, and we don't really take a deep dive. So in function health, I believe we, we really are creating the first real data-driven healthcare model, which is where people are

• 31:57Dr. Mark Hyman?

  getting lots of data on their bodies from imaging, from lab testing, from their history, from the wearables, will be doing genetics, all this stuff will be just available. So you really understand your body and then can work with it rather than against it.

• 32:08Speaker 00

  Say you were looking at my labs and they were starting to move in the wrong direction. What advice would you give me to start doing today?

• 32:14Dr. Mark Hyman?

  Well, if I start seeing insulin resistance, I mean, sugar and starch are the things that you should be aware of. So I basically increase fat, like avocados, olive oil, nuts and seeds, have adequate protein, increase fiber to, you know, 30 grams at least a day, which is lots of vegetables. So unlimited amounts of vegetables. I never tell people how much to eat. I always tell them what to eat. If folks on the what, they don't have to worry about how much calories don't matter in the way that we think they do. In fact, the literature is quite clear on this, that we've seen a flattening or a decrease in our calorie consumption and an increase or flattening of our exercise over the last 20 years. And we've seen an increase in obesity. So the whole calories in, calories out, exercise more, eat less, doesn't work because our biology is screwed up. And it has to do with our microbiome,

• 32:59Dr. Mark Hyman?

  with our metabolic rates and other things that, that are really, really key. But, but I think it's important that people really cut down or reduce or eliminate starch and sugar. The second is, you know, take a walk after eating. The third is, you know, exercise is so powerful. Muscle is a sink. Muscle is a sink for glucose. And so it actually even has mechanisms that allow you to absorb glucose without insulin. So if your muscle is, is smart, and what I mean by smart muscle is trained muscle is, is, I mean, I remember, Emma, when I was 50, and I'm like 60, almost 67, when I was 50, I couldn't do 10 pushups. I would do 10 pushups and my chest would hurt for like a week. I'd be like so sore.

• 33:41Dr. Mark Hyman?

  And I, I was so weak. And, and I didn't have conditioned muscle. I could run 10 miles, but I couldn't, I, I know my muscles, I didn't train at all. And so basically muscle is the sink for glucose. So building muscle, exercise, strength training, aerobic exercise also helpful. And, and also sleep, you know, sleep is such a key factor. People think that sleep's not important, but if you sleep adequately, you're not going to be craving the foods, your hormones are right. Vistral fat will naturally go away, the belly fat, when you do all these things that I said. And I think it's important to really double down on this. It's not rocket science. You know, I've had people lose 100, 150 pounds. No, no GLP-1 drugs, no GLP-1 drugs, just using food and following these simple principles.

• 34:26Dr. Mark Hyman?

  It's, I mean, I was just met someone and I was at an event and I just met someone, she said, I read your book, Dr. Time, and thank you. I just lost 40 pounds by following your advice. It's not that hard. And, and I know GLP-1s are a quick fix, and they may be helpful for some people. But, but honestly, we're just a few bites away from fixing our hormones and our biochemistry. And it's, it's really possible.

• 34:46Speaker 00

  So if I was gonna go for my physical tomorrow, and I want a stronger picture of what my metabolic health looks like, can you build out what your ideal panel would be for me to get tested?

• 34:58Dr. Mark Hyman?

  Yeah. I mean, the first thing you want to know is your metrics that don't require a lab. So you want to check your waist to hip ratio, or you can do waist to height ratio. You ideally would check your blood pressure. You'd ideally do a DEXA body composition to see your body composition really important. Then you do all the things we talked about. You look at fasting glucose, fasting insulin, hebo, L M C. You look at an advanced lipid panel, which looks at not just total LDL, HgL triglycerides, but you look at the particle size, the particle number, and look at small, large particles. And you look at your liver function test, you look at protein in your urine, you look at ApoB, which is a very important cardiovascular risk marker. It's the most important predictor of cardiovascular risk. And it is an indicator of insulin resistance. If your ApoB is high, you are likely insulin

• 35:43Dr. Mark Hyman?

  resistant because it measures all the dangerous lipid particles, which are produced by eating sugar and starch that damage your lipids. So people think it's fat and saturated fat, it's not. You know, some saturated fat does influence your lipids to some degree. But my point here is that the, the dangerous kind of cholesterol you get, nobody's looking at. It's, it's the lipid particle size and number, not just the weight of the cholesterol, which is what we typically measure. So all these tests are done by function health. You don't even have to think about it. You just go and they'll measure everything, including protein in your urine, including your liver, including your hormones, which affect it, and which are important to check as well. Because your testosterone and sex hormones and things are affected by, very much by insulin resistance. So all these things you

• 36:28Dr. Mark Hyman?

  should, you should do at least once a year. I think a DEXA body composition is important to do as a baseline. And then as you change, obviously checking your, you're looking at your waist size is pretty obviously easy. These are things that, you know, people can do. But I think people focus on weight. I don't really, I don't really care about your weight. I care what your body composition is. I want, I want to know where the fat is, where it's distributed, you know, not what the scale says, you know, you have someone like Dwayne Johnson, The Rock, and he's got a, he's got a body mass index of somebody who's obese, because he's got so much muscle. He's 279 pounds, six foot tall. That's, you see, that's, that's a fat person, but they're not. He's, he's just solid rock muscle.

• 37:11Speaker 00

  Comparing the labs that you just presented, what is already on my annual physical? And what ones would I have to ask about?

• 37:20Dr. Mark Hyman?

  Most of the things I'm saying are not on your annual physical. The only thing that's there is, is glucose and your lipid panel. And maybe your liver test. That's it. Everything else is not checked. So honestly, the current annual checkup panel is so outdated, it should be thrown in the garbage. And people should just do function. I know I'm co-founder of function, and I'm selling it hard. But I'm telling you, fighting with your doctor to get these is such a pain in the ass. And it's a dollar a day, $365, less than a cup of coffee a day. And it's your health. And if your doctor's willing to do it, and is open to do it, great. But the chances are, they're not likely going to order everything that's on there. And they're likely not going to know how to interpret everything on there.

• 38:04Dr. Mark Hyman?

  So if you have a good doctor that does that, great. But if, if not, make sure you take your health into your own hands.

• 38:09Speaker 00

  Okay. I want to transition into some rapid fire questions now. Is a glucose spike always bad?

• 38:14Dr. Mark Hyman?

  Not necessarily. I mean, it'll happen, like if I were to drink a can of Coke right now, my glucose would spike. But I, you know, if it's temporary, it's not going to be a problem. It's more the persistent, long-term elevations from a continually bad diet and lack of exercise. It's a problem.

• 38:30Speaker 00

  Can eating fruits spike my blood sugar too much?

• 38:33Dr. Mark Hyman?

  If you're metabolically healthy, no. If you're metabolically unhealthy, yes. The same food will have a different effect on different people, depending on their metabolic resilience. So if you're insulin resistant and you have a piece of fruit, it might be a problem. If you have berries, I mean, maybe not. If you have pineapple or melon, maybe yes.

• 38:49Speaker 00

  I think I know the answer to this one, because you mentioned it before. But does eating protein before carbs actually matter?

• 38:54Dr. Mark Hyman?

  It does. I mean, you're basically eating protein and putting that in your stomach. It's harder to digest. It's, it's kind of, it blocks the spikes in glucose. Having protein, fat and fiber is better combo, but no, that still works.

• 39:09Speaker 00

  What about fasting? Is it good for insulin resistance?

• 39:12Dr. Mark Hyman?

  The data is pretty good with people who do an overnight fast. And I think, you know, people talk about, you know, time restricted eating. But, you know, if you do 14 hours, That's eating dinner at 6:00 PM and eating breakfast at 8:00 AM. It's not too hard, right? It's not that hard. It's just not snacking at night, not eating first thing when you wake up if you're up early, and just giving yourself that break. You know, longer periods, maybe up to 16 hours if you're really, if you're really diabetic or in some reason, it can be helpful, but you don't have to do that. Even just, just an overnight 12, 14 hours is plenty. And most Americans never do that.

• 39:45Speaker 00

  Is that the same for men and women as well?

• 39:47Dr. Mark Hyman?

  Yeah. I mean, the data around prolonged fasting is, that's challenging for women is, is true, but, but this is not prolonged fasting. This is just eating dinner and breakfast.

• 39:57Speaker 00

  Right. Reducing snacks, which you're not a snacker.

• 40:01Dr. Mark Hyman?

  It's cutting out, I mean, yeah. Snacks are a really dumb invention. I don't know who invented them, but they're like, I don't know what, what the thing is with snacks.

• 40:08Speaker 00

  Can poor sleep raise your glucose the next day?

• 40:10Dr. Mark Hyman?

  Yeah, I mean, poor sleep just regulates your hormones. It regulates grayly and PYY and cortisol. And it just regulates your whole biology. And so, yeah, you can have more cravings and you can even have higher blood sugar.

• 40:23Speaker 00

  Can my stress raise my blood sugar even if I haven't eaten?

• 40:27Dr. Mark Hyman?

  Absolutely. As I said, you know, when you're stressed, your body is designed to, to do a number of different discrete functions. It doesn't matter what you're stressed from your boss yelling at you or from a tiger chasing you, your body has only one way of responding, and that's to increase cortisol, adrenaline, and orpirin. And when you do that, you're releasing glucose from your stored glucose in your muscles, glycogen, and you're ending up with, you know, high levels of glucose in your bloodstream just from stress alone, even if you haven't eaten.

• 40:55Speaker 00

  Is my morning fasting glucose sometimes higher even if I'm healthy?

• 40:59Dr. Mark Hyman?

  It can be. It can be. Sometimes what happens is a morning cortisol spike. So normally your, your cortisol is up in the morning and goes down at night and then it's low. And then early in the morning to wake you up, cortisol starts to rise. When cortisol starts to rise, it can cause glucose release. And so sometimes you'll get a higher glucose in the morning. I don't worry about that. I want to see the whole picture.

• 41:21Speaker 00

  Are artificial sweeteners better for my blood sugar?

• 41:24Dr. Mark Hyman?

  I mean, a little, but they, but they do cause complications and, and they do affect the microbiome in ways that have been shown to increase weight gain, to cause other issues. So I think, I think artificial sweeteners are not a hall pass. And they do increase your cravings for sugar. They're a thousand times sweeter than regular sugar. They've been shown to have, you know, other effects on brain, like aspartame is a toxic, neurotoxic amino acid. So I think there's just, there's just problems with it. I think if people want something sweet, eat something sweet. Don't, don't have those things. Monk fruit is probably an exception, maybe a little stevia, but all like things like all the other artificial sweeteners, the sugar alcohols, the aspartams, the, all the, all the non-nutritive sweeteners are problematic.

• 42:06Speaker 00

  Can I reverse insulin resistance?

• 42:08Dr. Mark Hyman?

  Thousand percent, thousand percent. I mean, I, I've taken people who are type 2 diabetics, who are on insulin for 10 years, who are so sick and massively overweight. And within three days, they're off the insulin, in three months, they're completely normal blood sugar. The A1C went from 11, which is insane, to five and a half, which is normal in three months, no drugs. So it's possible and it doesn't take that long.

• 42:35Speaker 00

  Okay. If you could only pick one, what is the most important blood test that you would pay attention to?

• 42:39Dr. Mark Hyman?

  Insulin by far.

• 42:40Speaker 00

  I've hit you with a lot of questions. So to wrap up here, I want to know if someone's listening and their doctor's always told them, your glucose is normal, you're totally fine. What is the one kind of take home message that you'd want them to understand?

• 42:53Dr. Mark Hyman?

  I think it's important people understand that knowing your blood sugar is not enough and that you need to do a deeper dive, measure your fasting insulin, your A1C, all the other biomarkers we talked about, and check your waist circumference, check your, your body composition, really know what's happening in your body. And then if you find you have some degree of insulin resistance, follow just the simple principles we talked about. Cut out starch and sugar for the most part, have protein, fat and fiber and improve your meal composition, walk for 10 to 20 minutes after a meal, build strength training, get enough sleep, navigate your stress response so you're not constantly stressed. These are just simple things, but they have profound effects. Hey everybody, it's Dr. Mark here. I'm so excited to share that my new book is officially available for preorder today.

• 43:37Dr. Mark Hyman?

  After more than 30 years of practicing medicine and caring for tens of thousands of patients, I've written the book that brings everything together that I've learned about helping people get healthy and stay healthy as they age. It's called 100, What to Do Today to Live 100 Healthy Years. It's a whole body guide to living 100 healthy years. It's grounded in a new understanding of how our bodies work. It's the new map of the body. And inside, I walk you through the seven core systems that drive your health from your gut and hormones to how your cells make energy and help you understand the signals your body's been sending you all along. Now, a lot of what's in the book, I learned the hard way through my own body. When I got sick, the medicine that I trained in did not have any of the answers I needed. So I had to go look for them myself.

• 44:21Dr. Mark Hyman?

  And that search became my life's work. This book brings together decades of my learning from my patients, from the scientific research and scouring that, from the things I got wrong and the things I had to rethink along the way. I don't want you to have to struggle the way I did to find those answers. So much of our health is shaped by what happens outside your doctor's office. And I want you to feel confident knowing how to care for yourself every day. I put so much of myself into this book and I'm really excited to finally share it with you. It's really my life's work. It's my capstone of my career. I put everything I know. It's finally available for order today, preorder, everywhere books are sold. Go get a copy. Please support me and this is my life's work. So I think you're going to love it. If you love this podcast, please share it with someone else you think would also enjoy it. You can find me on all social media channels at Dr. Mark Hyman.

• 45:06Dr. Mark Hyman?

  Please reach out. I'd love to hear your comments and questions. Don't forget to rate, review and subscribe to the Dr. Hyman Show wherever you get your podcasts. And don't forget to check out my YouTube channel at Dr. Mark Hyman for video versions of this podcast and more. Thank you so much again for tuning in. We'll see you next time on the Dr. Hyman Show. This podcast is separate from my clinical practice at the Ultra Wellness Center, my work at Cleveland Clinic and Function Health, where I am Chief Medical Officer. This podcast represents my opinions and my guests' opinions. Neither myself nor the podcast endorses the views or statements of my guests. This podcast is for educational purposes only and is not a substitute for professional care by a doctor or other qualified medical professional. This podcast is provided with the understanding that it does not constitute medical or other professional advice or services.

• 45:50Dr. Mark Hyman?

  If you're looking for help in your journey, please seek out a qualified medical practitioner. And if you're looking for a functional medicine practitioner, visit my clinic, the Ultra Wellness Center at ultrawellnesscenter.com and request to become a patient. It's important to have someone in your corner who is a trained, licensed healthcare practitioner and can help you make changes, especially when it comes to your health. This podcast is free as part of my mission to bring practical ways of improving health to the public. So I'd like to express gratitude to sponsors that made today's podcast possible. Thanks so much again for listening. When it comes to supplements, you only want the best for your body, the kind with the highest quality, cleanest and most potent ingredients you can get. That's exactly what you'll find at my supplement store, where I've hand selected each and every

• 46:32Dr. Mark Hyman?

  product to meet the most rigorous standards for safety, purity and effectiveness. These are the only supplements I recommend to my patients and they're also what I use myself. Whether you want to optimize longevity or reduce your disease risk, or you're looking to improve your sleep, blood sugar, metabolism, gut health, you name it, drhyman.com has the world's best selection of top quality, premium supplements, all backed by science and expertly vetted by me, Dr. Mark Hyman. So check out drhyman.com because when it comes to your health, nothing less than the very best will do. That's drhyman.com, D R H Y M A N dot com.