#69 - Ronesh Sinha, M.D.: Insights into the manifestation of metabolic disease in a patient population predisposed to metabolic syndrome, and what it teaches us more broadly

In this episode, Dr. Ronesh Sinha, a physician, author, and educator based in Silicon Valley, shares his many insights into metabolic illness that he has gleaned from his South Asian patient population. In this conversation we focus on hyperinsulinemia, insulin resistance, metabolic dysregulation, inflammation, blood pressure, obesity, etc. and ways to address them with nutrition, sleep, exercise, stress management, and more. We also take a deep dive into insulin resistant phenotypes, evolutionary theory and geographic determinants of insulin resistance which provides insight into the genetic architecture and pathophysiology of metabolic syndrome. Additionally, we discuss the surprisingly interrelated topic of stress, and how we might be inadvertently passing this on to our children, leading to mental and physical sickness down the road.

We discuss:

• How a stubborn case of insulin resistance connected Peter with Ronesh [7:15];
• Ronesh's clinical treatment focus of metabolic illnesses in South and East Asian patient populations [8:45];
• The distinction between visceral fat and subcutaneous fat stores [15:00];
• Shortcomings of a body mass index (BMI) calculator for evaluating metabolic disease risk [17:15];
• Cortisol and blood glucose variability [28:30];
• Insulin's role in elevated blood glucose: A symptom of metabolic syndrome [33:25];
• Mechanistic explanations of insulin resistance (there may be more than one) [35:15];
• Theories on origins and evolutionary reasons for insulin resistance [40:00];
• The inverse relationship between the amount of brown adipose tissue and rates of insulin resistance, and the role of climate in patterns and prevalence of insulin resistance [49:50];
• Vitamin D levels, hyperinsulinemia, and other effects [53:45];
• The evolutionary benefit of being able to turn fructose into fat (and the price we are now paying for it) [58:00];
• The VO2 max relationship to insulin resistance and familial metabolic health [59:30];
• Using zone 2 fitness test to evaluate mitochondrial performance [1:01:15];
• Exercise for long-term functional health [1:06:00];
• Lifestyle changes to improve insulin resistance and other metabolic phenotypes [1:14:00];
• Is PCOS a manifestation of insulin resistance? [1:21:00];
• The impact of stress on adiposity, and Peter's treatment regimen for overweight females resistant to typical nutritional approaches [1:23:45];
• How a culture of achievement and expectations can lead to undue stress, unhappiness, and health problems in our children (a Silicon Valley case study) [1:35:00];
• The negative impact of devices and social media on children [1:48:45];
• How you can help yourself, your family, and your community without being an MD or PhD [1:55:00]; and
• More.

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