#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. 

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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.

How a stubborn case of insulin resistance connected Peter with Ronesh [7:15]

How Peter and Ron connected:

• Peter had a patient from India who had an unusually stubborn case of insulin resistance
• There was something about it that looked a little different from the usual hyperinsulinemia (there was an “impressive degree” of inflammation)
• This particular case led Peter to Ron’s book, The South Asian Health Solution
• Peter and Ron eventually connected (thanks to an introduction by Mark Sisson)

Ronesh’s clinical treatment focus of metabolic illnesses in South and East Asian patient populations [8:45]

• In medical training, diabetes and cardiovascular disease case studies are typically African American, Caucasian, history of smoking, etc.
• Based in the  Bay Area/ Silicon Valley,  East and South Asian heritage were predominant population with early onset or family history of diabetes
  • Realized there was a gap in resources between how physicians are educated and the populations most afflicted with metabolic diseases (e.g., insulin resistance, diabetes, cardiovascular disease)
  • Decided to create East and South Asian population-specific educational materials and protocols 
• Around the same time, Ronesh personally developed metabolic syndrome 
• Prompted him to step outside nutrition guidelines and look more closely at insulin resistance 
  •  He was following low fat, low-calorie model diet (eating meat, fish, healthy starch Bengal-style diet of his heritage)
• Gradually tinkered with personal and patient macronutrient meal composition 
  • Tracked triglycerides (TGs) between making changes
  • Patients had high carbohydrate diet 
  • Relationship between carbohydrate (CHO) and fat revealed that high triglycerides (a.k.a: blood fat) were not reduced by a low fat diet
  • Cut down on dietary CHO and prescribed more liberal dietary fat intake 
• By contrast, African American patients can present with normal TGs and have diabetes 
  • Prompted Ronesh to look at patient habitus …

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Ronesh Sinha, M.D.

Dr. Ronesh (Ron) Sinha, author of The South Asian Health Solution, runs a medical consult practice focused on preventing and reversing insulin resistant conditions in predominantly Asian Indians, who have some of the highest rates of type 2 diabetes and early heart disease in the world.  He also designs corporate health education and wellness programs for major Silicon Valley companies like Oracle, Amazon, Google and more. More recently he has been focusing his energy on teaching busy families how to achieve better mental and metabolic health through talks/workshops at schools and corporations and online programs.

Instagram: @roneshsinhamd

Twitter: @roneshsinha