September 2, 2019


#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

“The way we raise our kids early on might actually set a pattern for how much of an accelerated life, or how much of a stressed out nervous system they might have later on. . . a lot of the behavioral patterns that we're instilling in our kids are kind of setting the foundation for insulin resistance and inflammation early on.” —Ronesh Sinha

Read Time 36 minutes

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. 


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.


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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

Disclaimer: This blog is for general informational purposes only and does not constitute the practice of medicine, nursing or other professional health care services, including the giving of medical advice, and no doctor/patient relationship is formed. The use of information on this blog or materials linked from this blog is at the user's own risk. The content of this blog is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Users should not disregard, or delay in obtaining, medical advice for any medical condition they may have, and should seek the assistance of their health care professionals for any such conditions.
  1. The Randle Cycle must be adhered to or insulin resistance will follow. This is why low fat vegans can lower their blood sugars and high fat carnivores can also lower their blood sugars even though these diets are completely different from each other. Everything else is happening downstream (hyperinsulinemia & fatty liver). Everyone is trying to fix the downstream symptoms ignoring the fact that the mitochondria can’t efficiently burn fatty acids and glucose at the same time causing the body to park this energy in the blood (triglycerides & blood sugars). Choose your energy source (fat/glucose) and stick with it.

    • Take a look at the work of Andy Galpin here . He argues in favor of the concept of metabolic flexibility . I am not a physiologist but rather a primary care doc so I naturally gravitate to the idea of flexiblity.
      Perhaps some of the folks that get stuck in IR have a metabolic/genomic disability – they cannot switch very well .
      Thanks Peter and Ronesh for taking on a very important area with lots of application to primary care .

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