Issue 2: Overview

Issue #2: Beyond Keto: The Real Science of Insulin Resistance

There’s been a lot of hand-wringing and head-slapping in medical circles these days. “Who on earth would believe this nonsense?” my colleagues ask as headline after headline details some latest conspiracy theory. “Look what these crazy people are doing now!” It’s easy to dismiss self-diagnosing and treatment as indulgence in superstitious folk remedies but that just underscores the arrogance of the medical industrial complex. Big Pharma has bet on many a folk remedy (aspirin, digitalis and tamoxifen, to name a few) without crediting the sources. And the success of conspiracy theories is fostered by the germ of truth in them.

What we’ve missed in the discussion is the root issue: there is deep, deep distrust of the medical system by both patients and practitioners. The self-medication and influencer-led practices are symptoms of the growing understanding that current medical practice is predicated on you getting sick. Without sickness, no-one gets paid. This business model makes a mockery of “patient-centric care” and exposes it as thinly-disguised “sickness management”. And we all know that Management (capital M) is the ruling class in medicine (lowercase m).

What is necessary now isn’t denigration or derisive labeling of those whose views may seem “out there” to us or who are challenging the status quo. The problem is that America has become so estranged from freedom of thought that merely asking questions is subject to being “canceled” by the thought police.

<Long aside: The word ‘cancel’ comes from the Latin ‘cancellare’, which means to make a lattice or crossbars (Latin ‘cancellus’) over something. It is connected to the idea of prison bars (Latin ‘carcer’, prison). So canceling out someone for their beliefs is essentially the figurative act of imprisoning them for thinking what they think, the very antithesis of a free society. Something to think about, if we’re still able to.>

I didn’t plan to dedicate an entire issue of Wellth-e to insulin resistance and keto. Enough influencers and health coaches have been preaching keto on social media such that it’s pretty mainstream these days. But after hearing it explained incompletely time and time again, I wanted to offer a more complete picture of the condition.

At a meeting some years ago, attended by journalists, policymakers, and advocates for low-carb nutrition, the group was asked a simple but vital question: “What is insulin resistance?” The answer offered by two of the movement’s most recognized leaders was disappointingly simplistic. It was reduced to the idea that “insulin makes you fat, and if you reduce insulin, you stop being fat.”

This moment stuck with me. I don’t doubt the sincerity or good intentions of those individuals, but if we want the medical establishment to take low-carb nutrition seriously, we must also take the science seriously. We cannot demand credibility and then offer explanations that don’t withstand scrutiny.

As a board-certified physician in Internal Medicine and Obesity Medicine, I’ve dedicated my career to studying metabolism and body composition. I’ve treated patients whose health depends on us getting these details right. And over the years, I’ve also watched the conversation on nutrition become increasingly polarized. On one side, we have a culture of magical thinking—“one pill or one diet solves everything.” Contrast this with outdated dogmas, and rigid clinging to decades old science. Both sides are peppered with half-truths, blind spots, missing information and fragmented/siloed knowledge.

My goal with this issue is not to dismiss, but to bring clarity. To be scientifically rigorous, acknowledge what’s useful in both perspectives while challenging what is incomplete or misleading.

Insulin resistance is not simply “carbs bad, fat good.” It’s a metabolic mess of broken signaling pathways and the accumulation of toxic metabolites. Central to conditions as diverse as diabetes, heart failure, and even cancer, it affects the brain as much as the body. And yet, because the explanations offered are so often simplistic, the true complexity and opportunity for intervention get lost.

This issue of Wellth-e is my attempt to rebalance the conversation. To cut through the noise, dispel the myths, and show what insulin resistance really is, and why it matters.

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