How Long Does It Take To Reverse Insulin Resistance?

How long does it take to reverse insulin  resistance? In order to answer that question,  

there are several things that we need  to understand, like what are some of  

the mechanisms of insulin resistance and  how can we measure and keep track of them,  

so we know if we're making progress. What  if we'd like to make it happen faster? Then,  

what are some things that we can do to  speed it up? Is there even such a thing as  

a complete reversal? What do we have to look  forward to, and after we have reversed it,  

what kind of lifestyle do we have to  adopt to stay insulin sensitive? Today,  

we're going to talk about all those things so that  you have a really clear picture, coming right up.

I'm Dr. Ekberg. I'm a holistic doctor and a  former Olympic decathlete, and if you want to  

truly master health by understanding how the body  really works, make sure that you subscribe and  

hit that notification bell so that you don't miss  anything. This is one of the most common questions  

I've received, so I decided to make a video to  try to answer as many aspects as possible. And  

when people ask, they want to know, "Why is my  glucose still high? How long is it going to take  

for my glucose, my fasting glucose readings, to  change? How long is it going to take for my A1C  

to come down? My doctor says my glucose, my A1C,  is too high. They want to keep giving me meds. How  

long do I have to take those meds?" And then they  ask, once they've understood a little bit more,  

maybe they start asking about, "Well, what about  insulin and HOMA-IR? How long is it going to take  

for that to change?" And then they want to know  about setpoint. Does the body have a tendency to  

go back to a certain weight? Does it change its  metabolism to get back to its setpoint? It's like  

there's a cell memory. And then, finally, there is  the issue of genetics. So, all of these things are  

criteria that influence the mechanism or the  measurement of insulin resistance. So, we'll  

deal with those in some more detail, but just a  real quick review to understand the mechanism:  

that this is a long-term process. There's a lot of  people, whether it's diabetes or whether it's neck  

pain or some other ailment, and people say, "Oh,  well, it just happened. I was diagnosed just last  

week. This is a new thing." And when it comes to  health, unless there was a trauma, unless you fell  

down the stairs or you were in a car accident,  there is no such thing as a new thing. It has  

developed over time. It is an adaptation.  Blood sugar, insulin, insulin resistance,  

it's an adaptation. We exposed it to something,  it does its best to balance things out despite the  

things we're doing to it, but in the end, it can't  keep up with the adaptations. We want to think of  

the body and insulin as having a carbohydrate  tolerance machine. You have a machine that can  

process carbohydrate. It has a certain threshold,  a certain endurance of how long and how much it  

can do that, and if you just push it too far,  too long, then you basically broke it. And if  

you broke it, then you have to take some more  forceful steps, some more dramatic steps in order  

to reverse it, then you would have to do just to  maintain it. You eat something, and your glucose  

goes up. Your blood glucose increases. Then the  body produces insulin in an appropriate amount,  

in a sufficient amount to get the glucose  out of the bloodstream and into the cell,  

and maintain a normal glucose level. Ultimately,  the goal of even having blood glucose is to  

deliver it to the cells. So the goal itself is  not a certain level of glucose; it's to maintain  

a certain level to maintain a steady fuel delivery  to the cells of the body. But insulin is necessary  

to get the glucose from the bloodstream and into  the cells. Initially, there is a balance. There's  

only a little bit of insulin required for a little  bit of glucose, and we are what we call insulin  

sensitive. But as the years go by, the more sugar  we eat, the more carbs we eat, the more frequently  

we eat, the more blood sugar there is, the harder  it is for the insulin to get the sugar into the  

cells because there's more sugar, and eventually,  the cells don't want it, so the insulin goes up  

and up and up. So after five or ten years, then  the glucose might still be normal because the body  

is producing enough; it's succeeding at keeping  the glucose at a certain level. And the diabetes,  

it doesn't happen until we've come so far that the  insulin isn't sufficient. There is no amount of  

insulin, almost, that will get the sugar into the  cell because the cells have become so resistant,  

and that's where we get severe insulin resistance,  with pre-diabetes and diabetes. But the thing to  

understand is that this did not happen overnight.  We're talking decades, for the most part.  

Some people that are a little bit genetically  predisposed, they have less tolerance, they might  

break the machine in five years, but other people,  it probably takes 20 years, for the most part, to  

break the machine, if you will. So now, let's come  back and talk about some of these criteria. So,  

we know that the problem is too much sugar, too  much carb, driving insulin. The cells resisted,  

so the glucose stays in the bloodstream, and we  get high blood glucose. So, people want to ask,  

"When is that coming down?" It's gonna vary  a lot. For some people, as soon as they stop  

eating sugar, if they just don't put sugar in  their mouth for a week or a couple of weeks,  

then their blood sugar goes down. Other people  have to be more dramatic. They might cut out all  

sugar, they might go into ketosis, they might  do fasting, and that will bring it down. But  

some people do that, and it still stays high  for weeks or even months. Even if the glucose  

stays relatively high, even if it's reading a  hundred and fifty, hundred and sixty, even 170,  

but you have stopped eating carbohydrate,  your body is reversing the process, even if it  

takes months to get there. Because once you stop  putting carbohydrates and sugar into your system,  

then the body doesn't have to fight so hard to get  it out, so it's not gonna make more insulin, until  

you eat something else. So we've talked about  this in some other videos on dawn phenomenon,  

but the point is, that is still the thing that  comes down the fastest. Whether it happens in  

days or weeks or months, it's still the thing that  changes the fastest. The second fastest thing is  

your A1C, which is a three to four-month average  of blood glucose. Glucose changes by the hour;  

A1C changes by the month. So even if your blood  glucose goes from a hundred and sixty to ninety  

almost in a few days, almost overnight, it's still  gonna take... There's no point in measuring A1C a  

week later because it'll have changed maybe zero  point something. But in four to six weeks, you'll  

see a significant change, and in several months is  when you start seeing dramatic differences where  

you can get into a normal range. Then people ask,  "Well, how long do I have to take medication?" And  

I'm not a medical doctor, so I can't give you  advice on medication, but just understand that  

they gave you the medication because your blood  sugar was too high. But once your blood sugar  

comes down, or once you stop putting sugar into  your system, you basically don't need the meds,  

or don't need as much. But that's a discussion  that you have to take up with your medical  

doctor. But the need for meds essentially follows  the glucose and the A1C because that's what the  

meds are there for, to lower glucose, and that's  why they were prescribed, because you had a high  

glucose or in high A1C. But now we're getting  to insulin and the HOMA-IR, the measurement,  

the blood test, to measure how much insulin,  how hard does the body have to work, how much  

insulin does it have to produce to keep the blood  level, blood glucose level where it is right now.  

And this is something that takes years, decades.  Remember, the glucose only came up at the end,  

once pre-diabetes turned into diabetes. Glucose  really shot up. That's at the end of a 20-year  

process. But now, you've had 20 years of becoming  insulin resistant, so therefore, this is going  

to change very, very slowly. We're talking months  for some people who are not so insulin resistant,  

but for people who are very insulin resistant,  even if you do all the things right, you can  

probably expect it to take years to truly get that  insulin resistance down. Some people might have to  

do fasting, for extended fasts, three, four,  five days, a week, maybe two weeks, and every  

time they do that, the insulin levels will drop  a little bit, but you might have to do that many,  

many times to get it down into a normal range.  Then, number five, cell memory and setpoint. So,  

this is more of a conceptual thing. That it's not  something we can measure specifically, like where  

is your setpoint, but we know that there is such  a thing because people's metabolism change. That  

if you are burning a certain amount of calories,  and then you eat fewer calories, but you maintain  

insulin levels, then your body will lower its  metabolic rate. It will adjust to try to get back  

to that setpoint, and you will have a ravenous  hunger. The body will do everything it can to  

get back to the point where it thinks you need  to be. And we want to think of this as a habit.  

Your cells have habits. They develop. There's a  certain momentum after you've done something for  

20 years. There's a lot of momentum, there's a lot  of memory, there's a lot of habit in the body. And  

these things are good and they're bad. For someone  who has been in really good shape physically,  

for someone who has had a lot of muscle, and then  they get out of shape, it's gonna be pretty easy  

for them to get back in shape because the body  remembers. It knows that, "Hey, I used to do  

that. I used to be that." But unfortunately,  the same thing holds true for being overweight  

and insulin resistance. The body remembers. And  here, we have to understand that this is going  

to be years to change this. And the longer it's  been there, and the more severe it's been there,  

the more dramatic and the longer, the more patient  we have to be to reverse it. There is a very  

strong genetic component to insulin resistance.  That some people are just born into having an  

easy time to gain weight. For one example, the  Pima Indians lived in North America, and they  

had no diabetes. But as soon as they were exposed  to processed foods, they developed over 50 percent  

type-2 diabetes. So, they had a very strong  component. So, that's unfortunate if you have  

the genetics for it. But the good news is that  you can still reverse the insulin resistance. You  

can still develop a lifestyle where you don't have  to have diabetes. The unfortunate thing though is  

that whatever genes you have, they're yours. You  were given them at conception. You've had them all  

your life. There's really nothing that you can do  about that. You can't change genetics, but you can  

change epigenetics. You can change how you express  those. And if you don't give your body sugar,  

then it's not going to become diabetes. So, the  main theme to understand there is that there is  

a huge variation between people, but that there's  still sort of an order between these different  

criteria. So, if we look at insulin resistance on  the vertical scale here, so if we start off with  

a lot of insulin resistance, and then we start  creating a lifestyle to reverse it, then the first  

thing that's going to go is glucose, and that's  going to happen relatively fast. That can happen,  

like we said, in days or weeks. Sometimes it'll  take a little bit longer. Insulin is going to  

take longer. It'll be months and years. But then  finally, if you want to sort of totally reverse  

insulin resistance, I don't know that it is 100%  reversible. I think, based on the setpoint and the  

cell memory, we probably always retain a little  bit of what has been. But the longer that we go,  

the more the body sort of forgets. The longer we  go without doing something, and we have another  

lifestyle, the more the body replaces the old  memory with the new. So, there's no definite  

time here, but we're definitely, certainly talking  years. What if we want to speed it up? If we want  

this to happen as fast as possible, then wherever  we are, whatever our personal circumstances are,  

we can still make it happen faster for us by  understanding the order of the powerful tools  

that we have. So, the first tool we have is  exercise. Just putting your body into motion,  

increasing circulation, increasing energy  expenditure, changing hormones. We've done  

lots of videos on that, so understand how to  exercise the right way to maximize the good  

hormones and to minimize the bad hormones. We also  talked a lot about cortisol and stress, and we've  

got videos on that. But you want to reduce stress.  If you have a lifestyle that has a lot of stress,  

you could make cortisol that drives insulin and  blood sugar. So, if that's a big factor for you,  

then work on reducing stress. And again, learn how  to exercise so you minimize stress and maximize  

the benefits. And these are in order of the power.  So, the further down the list here we go, the more  

powerful they become. So, in this order, exercise  is the least powerful. Your stress reduction is  

next. Now we're getting into the really powerful  ones, and that's a low-carb high-fat diet,  

to teach your body to go from carbohydrate  metabolism to fat-burning metabolism. And  

that's done by reducing the carbs in that the  primary fuel available is fat, and eventually,  

the body starts using the fat. Keto is just a  very strict version of low carb high fat. Keto  

is low carb high fat, but low carb high fat isn't  necessarily keto. Keto is when you put your carbs  

so low that your body burns fat, and a byproduct  of that is something called ketones. Ketones  

become brain fuel; they become an alternate fuel  for the body. And if we can measure ketones,  

then that's proof that the body has switched  from carbs to fat very significantly, that  

the vast majority of energy that we're burning is  ketones, is fat, and ketones as a by-product. And  

the most powerful tool we have is fasting. So, we  can start with intermittent fasting, or we can do  

longer fasts. I recommend people do it gradually  and look up some of the other videos on fasting.  

In order of importance, you want to exercise, you  want to reduce stress and cortisol, you want to  

reduce your carbs, get into ketosis, and do some  fasting. That's how you make it happen faster. But  

is it even possible to reverse it completely? We  have to understand, what does it mean to reverse  

it? And that comes back to the criteria. So,  your medical doctor, he's going to be happy.  

He's going to consider it reversed as soon as  your glucose and your A1C is normal. But does  

that mean that you can go back to eating normal?  That's a very common question. So, I'm doing this  

now. When can I go back to eating normally again?  So, this depends on what we think normal food is.  

What does that mean? The majority of people in the  Western world think that normal is the way that  

we've eaten for the last two, three generations.  But that is very, very different from how we ate  

the previous several thousand generations. So,  the way we've been eating, normal, the standard  

American diet, is not something that you're ever  going to go back to, because that's the diet,  

that's the diet full of chemicals and sugar and  processed foods, that forced your body into this  

adaptation in the first place. So, if you do  something to reverse it, to undo the adaptation,  

you can't go back and doing the thing that caused  the problem in the first place. So, in that sense,  

if you think that's what the goal is, then it is  not reversible. You will not be able to go back to  

eat normal. What you will be able to do is to eat  real food and maintain a healthy lifestyle. So,  

standard American diet is terrible. It has tons of  sugar, tons of chemicals, tons of processed foods.  

The USDA recommendation suggests that you eat  whole food, that you eat at least 50% of grains  

from whole grains, and so forth, but they still  tell you to eat about 300 grams of carbohydrate.  

And based on their recommendations of added sugar,  no more than 10% of calories, 3 cups of dairy,  

6 ounces of grain, and so on, so much fruit, more  than half of this 300 grams is actually sugar. So,  

even though the USDA is an improvement on the  standard American diet, it is not enough. It's  

not enough of a change to keep you insulin  sensitive after you have reversed this. The  

USDA diet may work for a very small percentage who  are physically active and who have never developed  

insulin resistance, and for people who lead an  active lifestyle and don't eat too many meals.  

But it is not recommended. I don't recommend  that. And if you have insulin resistance,  

then this will push you toward more insulin  resistance. So, while it is slightly better  

than the SAD because it tells people to  some of the soda and the processed foods,  

it is only slightly better. There's only a nuance  difference, really, between the standard American  

diet and the USDA. So, we have to understand that  the food we have been eating is not going to work.  

You will not go back to that normal lifestyle  because it isn't normal. That's not food. It  

is fake food. It is chemicals. It's processed  foods. It's imposter food. It's frankenfoods.  

We need to start understanding what real food is.  So, meat and vegetables, some, for some people,  

some beans and tubers, roots, thinks that grow on  the planet. I think a lot of people will be able  

to go back to what's called a low-carb diet, that  might be about a hundred grams of carbohydrate.  

But you still want to eat mostly whole food. I put  a question mark there because that's not going to  

be everybody. If you have a stubborn setpoint and  if you have a genetic predisposition, then that's  

probably not going to be strict enough. I think  most people are going to be able to maintain their  

insulin sensitivity if you do these things for  a few years and you get your blood values too,  

and your insulin to where you want it to be.  I believe you'll be able to maintain it on  

a low-carb diet, which I think starts around 75  grams of net carbs per day. And for some people,  

again, they might start gaining weight, they might  start increasing their insulin resistance, their  

HOMA-IR, even on 75 grams. And then you want to  learn how to find the balance in your situation,  

with low-carb, high-fat, keto, and how much  intermittent fasting do you have to do? Some  

people might be able to do an 18-6, that they eat  for six hours a day, two or three meals, maybe,  

or two meals, and then it would be OMAD, one meal  a day. But whatever it is, you have to find out  

what the balance is for you. And on my previous  video, somebody commented and said that, "Oh,  

you throw so many options up there. It's like  you're just throwing enough up there to see if  

something is gonna stick. You don't seem very  sure of yourself." Well, I'm not. I'm sure of  

the principles, but no one can say what's going to  work for you. What we're... we fall into the trap  

where we want someone to do a study, and we want  someone to determine the one thing that's going to  

work, and biology doesn't work like that. If they  do a study and they put people through a low-carb  

program and they said that the average weight  loss, the average reduction in insulin was 20%,  

that doesn't mean that everyone had a 20%  reduction. That means some people got a 50%  

reduction, and some people got a 20% increase.  And you don't know which one you're going to be.  

That's why there is no one recommendation. That's  why they can never do research and find one thing  

that's going to work for everybody because there's  always a range. That's why we have to understand  

several different factors, and we have to be  patient, and we have to understand it's important,  

that it's worth it to learn and develop  this lifestyle, with trial and errors,  

that we find the balance that works for us. And  if you enjoyed this video, I think you're going  

to love that one too. Thank you so much for  watching, and I'll see you in the next video.