Exercise to Avoid Insulin Resistance: A Journal Club Book Review

Have you heard of the book Outlive by Dr. Peter Attia?

I participate in a monthly journal club with PT friends of mine from graduate school. The goal is to learn and be better providers than we were the day before. We recently discussed this book and its lessons. I highly recommend you give it a try. See below for what lessons we learned.

Dr. Attia describes life’s big aging “icebergs” (things to avoid) as cancer, heart disease, metabolic disease (including diabetes), and Alzheimer’s disease. The best way to avoid these icebergs is by avoiding insulin resistance, and the best way to avoid that is through consistent, diverse exercise.

He cites that the presence of insulin resistance increases your risk of cancer by 12x, Alzheimer’s disease 5x, and heart disease risk 6x. Insulin resistance means the body is less able to respond to insulin’s cues, which typically lowers your blood sugar. As a result, your blood sugar remains high after meals, which can damage your arteries, eyes, kidneys, nerves, and numerous other areas. This ultimately leads to diabetes mellitus, which places excess fat in your organs, muscles, and abdomen, further exacerbating insulin resistance. It’s a vicious cycle.

You can test your blood sugar easily with a home glucometer by measuring your blood sugar 60 minutes after drinking a sugary drink. If your insulin hormones are working well, your blood sugar should be similar to what it was pre-drink consumption. If it remains elevated, you may be suffering from insulin resistance and should seek further medical attention.

Given the vicious cycle, the best medicine truly is PREVENTION! Yes, positive and consistent diet choices can be extremely helpful in managing your blood sugar, but Dr. Attia argues physical exercise is actually more important than diet. If you exercise a minimum of 90 minutes per week, you reduce your mortality risk by 14%, just like that!

So what sort of exercise should you participate in? Dr. Attia advocates for a variety of Zone 2 training, VO2 max training, and strength training. Zone 2 training is aerobic exercise where you can barely hold a conversation. It should be “almost hard but without significant muscle burn.” This uses fat as fuel, helping with good weight loss. VO2 max training is very challenging aerobic exercise, such as doing interval running very quickly for 4 minutes before recovering, then repeating. When you go from below-average VO2 max numbers for your age group to above-average VO2 max, your mortality risk can decline as much as 50%, so this is a great marker for longevity. Last but not least is strength training. Lean muscle mass absorbs glucose (“blood sugar”) and strength training builds your lean muscle mass, so this can help reduce your risk of metabolic disease. Additionally, Dr. Attia says folks with low muscle mass and strength have a 3x increased mortality risk compared to those with high muscle mass, not to mention an elevated risk of falling.

So the best recommendation is to participate in a variety of exercise types, including Zone 2 aerobic exercise, VO2 max exercise, and strength training. Different people need different percentages of each, and of course please check with your physician before beginning an exercise regimen, especially if it includes high intensity VO2 max exercise. Prevention truly is the best medicine; it’s the cheapest and healthiest option that is clinically proven to increase your quality of life well into your 9th decade of life. Try to exercise a minimum of 4x/week for a total of 200 minutes, varying your exercise choices as best fits your individual needs. See what you think!

Any questions? Let us know! Happy exercising!