Doctors Reveal a ‘Main Culprit’ for Heart Disease

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High blood cholesterol has been a central focus in cardiovascular disease for decades. However, doctors are now challenging this emphasis, proposing that this may have caused health practitioners to overlook a critical culprit: insulin resistance.

Why Insulin Resistance Is a Cause for Concern

Dr. Robert DuBroff, a cardiologist and professor from the University of New Mexico, had a patient who suffered multiple cardiovascular events. The patient underwent coronary artery bypass three times and had been treated aggressively with statin medications, but his cardiovascular events continued.

Dr. DuBroff noticed that his patient’s blood sugar was borderline prediabetic and that he was overweight. However, none of these risk factors was addressed by previous doctors. Once these factors were addressed, the patient stopped having additional problems.

Insulin resistance is the leading cause of Type 2 diabetes and an indicator of metabolic health. One study found that over 80 percent of Americans were metabolically unhealthy, with nearly half prediabetic.

Type 2 diabetics face at least a twofold risk of developing cardiovascular disease, and most die from cardiovascular events. However, this is often missed in the literature, professor Ian Givens, specializing in nutrition at the University of Readings, told The Epoch Times.

“The certification of death says cardiovascular disease; doesn’t say diabetes, which is technically true because that is what they’ve eventually died from,” clarified Mr. Givens. However, this perspective overlooks crucial information: It was diabetes that led the person to die from heart disease.

What Is Insulin Resistance?

Insulin, a hormone released into the bloodstream when blood sugar rises after a meal or sugary consumption, directs the body’s fat, liver, and muscle cells to absorb the blood sugar, restoring normal blood levels.

Insulin resistance occurs when the body’s cells no longer respond to insulin.

Consequently, the brain signals pancreatic beta cells, responsible for insulin production, to secrete more insulin to help.

Over time, the body’s insulin resistance intensifies, ultimately causing beta cells to deteriorate and die off. Then, blood sugar gets out of control.

Insulin Resistance and Heart Disease

In an article published in The Pharmaceutical Journal, the official journal of the Royal Pharmaceutical Society, renowned Drs. Aseem Malhotra and Robert Lustig wrote that insulin resistance is the “main culprit” of heart disease.

Insulin resistance contributes to all of the major heart disease risk factors.


Atherosclerosis involves the development of plaques within blood vessels and eventual cardiovascular events such as heart attacks.

Insulin resistance results in chronically elevated insulin levels in the body, which promotes chronic inflammation. This impairs blood vessel linings and fosters plaque creation. Additionally, inflammation heightens platelet activation, increasing vulnerability to blood clotting.

High insulin also contributes to dyslipidemia—an imbalance in blood lipids, or fats. Dyslipidemia manifests as high blood triglycerides, low HDL cholesterol, and high LDL cholesterol levels, with insulin influencing all three components.

As a storage hormone, insulin tells the liver to package ingested calories into triglycerides to be distributed across the body for storage, elevating blood triglyceride levels.

Insulin suppresses HDL particle formation, reducing the “good” HDL cholesterol. When insulin levels increase, proteins that break down HDL particles also increase, which can cause an increased clearance of HDL particles from the blood.

“The HDL particle’s job is to bring lipids from the body back to the liver,” where they will “be recycled,” explained Mr. Bikman, who has a doctorate in bioenergetics and is a cell biology and physiology professor specializing in metabolic disease and the pathological effects of insulin at Brigham Young University. “But the insulin doesn’t want energy to be returning.”

Insulin also promotes the generation of atherogenic, small, dense LDL particles instead of the more harmless, larger buoyant ones.


Insulin increases heart rate and blood pressure. One way it does this is by activating the sympathetic nervous system.

The sympathetic nervous system is responsible for activating the fight-or-flight response, usually activated during periods of stress. But insulin can trigger a similar reaction. During the fight-or-flight response, adrenaline and cortisol are released into the bloodstream, blood pressure rises, and the heart beats faster.

Apart from acting as a hormone for storage, insulin also promotes growth, which can cause the inner lining of the blood vessels to thicken, increasing blood pressure.


Elevated insulin levels lead to the storage of consumed sugar as fat instead of promoting its immediate consumption for energy, explained nephrologist and metabolic expert Dr. Jason Fung. This is also why meals high in carbohydrates, triggering insulin spikes, often induce hunger more quickly.

Preventing Insulin Resistance

1. Reduce Refined and Starchy Carbohydrate Consumption

Insulin is uniquely sensitive to glucose, so cutting down on sugary and starchy foods can prevent spikes in blood glucose and insulin levels. Any food that’s sweet, crunchy, or comes in packaging is usually high in carbohydrates, according to Mr. Bikman.

Complex carbohydrates such as vegetables, legumes, and low-glucose fruits primarily consist of dietary fiber and have a minimal impact on blood sugar levels and insulin resistance.

Consuming fat and simple carbohydrates together is worse than consuming only carbohydrates or only fat. Although fat is calorically dense, fat by itself does not trigger insulin. However, in the presence of sugar or starches, insulin levels rise and stay up longer, Mr. Bikman said. Studies show that foods that combine sugar and fat increase cravings, stimulating overeating.

2. Practice Fasting, Chew Thoroughly

During fasts, no food is ingested, meaning there is no rise in blood sugar or insulin.

Fasting promotes the breakdown of fat in fat cells for energy and improves insulin sensitivity, according to a 2021 review.

According to Mr. Bikman, insulin resistance usually first starts in the fat cells.

Fat cells are the body’s primary storage sites of calories, including sugar, acting as the energy warehouse.

Fat cells can also expand up to 20 times their original diameter to accommodate more energy. However, “when fat cells get too big,” Mr. Bikman explained, insulin wants the fat cell to continue growing, but the cell has reached maximum dimension. “They become insulin resistant.”

Breaking down fat in these fat stores frees up room in the warehouse, thereby improving insulin sensitivity.

Chewing food thoroughly also helps.

Eating too quickly can result in swift spikes in blood glucose, triggering a robust insulin response. It is also linked with poorer satiety, making the person more likely to snack after the meal.

3. Sleep, Build Muscle

Adequate sleep prevents stress and inflammation, which contribute to elevated blood glucose levels and insulin resistance.

Muscles are the primary consumers of glucose, utilizing up to 80 percent of ingested glucose daily. If an individual maintains their previous sugar intake while their muscle mass decreases, excess sugar cannot be entirely burned and gets stored as fat.

Resistance training is the most effective exercise for increasing muscle mass. These exercises stimulate the release of testosterone and growth hormones, facilitating muscle development and boosting metabolic rates.

Important Notice: This article was originally published at by Marina Zhang where all credits are due.


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