AMA #20: Simplifying the complexities of insulin resistance: how it's measured, how it manifests in the muscle and liver, and what we can do about it

**Peter Attia** (0:11)
Hey, everyone, welcome to a sneak peek, Ask Me Anything or AMA episode of the Drive podcast. I'm your host, Peter Attia. At the end of this short episode, I'll explain how you can access the AMA episodes in full, along with a ton of other membership benefits we've created. Or you can learn more now by going to peterattiamd.com forward slash subscribe. So without further delay, here's today's sneak peek of the Ask Me Anything episode.
Hey, everyone, welcome to Ask Me Anything AMA episode number 20 As always, I'm joined by Bob Kaplan. And for this AMA, we do something a little bit different.
We actually devote the entire episode, which is a little bit longer than usual, to sort of the deconstruction, reconstruction of a podcast that many of you have said was simultaneously one of the most interesting and yet difficult to comprehend, specifically the podcast with Gerald Shulman, which is the masterclass on insulin resistance.
We felt because this content is just so important, meaning understanding insulin resistance is just paramount to being healthy, as I hopefully make the case in this podcast. You simply can't be healthy if you're insulin resistant, and tragically about 88% of people harbor some amount of insulin resistance or metabolic dysregulation, maybe more broadly. This is something everybody really needs to understand. So we go really deep on trying to explain a lot of the stuff that was discussed in this podcast, and hopefully doing so in maybe a slightly less technical manner, and also spending a little bit more time on things that we in the podcast probably glossed over a little bit quickly. So if folks enjoy this format, this might be something worth doing a little bit more of where we take some of the more complicated and important subjects covered in the podcast and revisit them in this way. So without further delay, please enjoy AMA number 20

**Bob Kaplan** (2:15)
Peter, ready for another exciting AMA?

**Peter Attia** (2:19)
I am, Bob. This is a different one. This is the first time I think we've embarked on what we're about to do.
And if folks like it, maybe it's an interesting thing to do every once in a while. But why don't you give folks a sense of what we're about to do today and why we're gonna do it.

**Bob Kaplan** (2:34)
Sure. So you did a podcast with Gerald Shulman, which I thought was amazing.

**Peter Attia** (2:41)
Stop. Just stop.

**Bob Kaplan** (2:45)
You might've said it best in the intro for that, where you said, this was fascinating.
And you didn't say this, but you said it before. It was probably like drinking through a fire hose, that there was a lot of information, a lot of mechanisms, a lot of stuff coming in, and that you would have to go back and listen to it probably a few times to gain the insight from it. And a bunch of listeners, I think, expressed those thoughts. It was like, more or less, people would say, that was amazing.
I wish I could understand it. Which means like they probably understood it to a certain percentage, but there was probably a lot there that they thought if this could be a little bit simpler to understand and synthesized, that would be awesome. And that is, I think, one of your superpowers.
So not to put you on the spot, but actually to put you on the spot or us on the spot.
I think the goal today is to try to synthesize this information and make it a little more digestible. And what are the insights? What's the so what from all of this?

**Peter Attia** (3:45)
Yeah, I think you're absolutely right. I think people probably deserve more credit than they're giving themselves. And the comments on social media and such were, oh my God, like, this is such an amazing discussion that Shulman was able to give all of these insights. But I'm going to have to listen to this three times. And I'm not sure I'll ever fully understand it, which probably says, look, I understand enough of this to know how important it is, but it would be great to revisit this maybe with a slightly different lens.
So I think that's what we're going to try to do today. I think we're going to basically go through the important points of that podcast, slow it down a little bit, and sort of unlock a little bit of that stuff. So if folks like this, I think every once in a while, maybe, I don't know, every 10th podcast, I think is a Shulman like podcast where the subject matter is so important to health that it's worth investing in it. And if we can do anything to facilitate that beyond the interview itself, then I think we need to think about it. So I guess the other thing to explain is how you and I thought about preparing for this, which is putting together a bunch of notes, right? We kind of went through the podcast and pulled out various ideas that Jerry discussed, coupled them at points with slides, either figures that we found separately or more often figures that he had used in his Banting lecture, which often spoke to the same points.