Over 40% of US Adults have Insulin Resistance

Test 3 times? Are you insane. I've never had one of my doctors run tests 3 times! In fact, I've never had them run any tests more than once unless there was some reason to (i.e. lab had an issue, results were skewed, symptoms of something but not matching with blood tests, etc.).

Given how prevalent false positives are with any number of tests, your shock here seems feigned. If there is some reason that the tests used here don't have a substantial false positive risk, why not share that information? This is just one reason to be extremely skeptical of the significance of numbers based on speculation about undiagnosed conditions.

Plus, since the argument here is that people will not be able to lose weight using common place advice, you'd need to show that these undiagnosed populations fall into that category. But plenty of diagnosed people do not--even people with full fledged Type II can lose based largely on CICO (this is true for people I know, anyway), although watching blood sugar and controlling carbs is of course important.

But beyond that, if people are struggling because of carbs, that's something that tracking and logging and paying attention to one's diet will reveal. I don't believe I'm IR (although I've not been tested and was fat, so under your theory we should assume I am), but I did modify my consumption of carbs to make it easier to lose weight--I consider that to be in many cases just common sense.

Can we just stick with the issues at hand rather than discussing the prevalence of false positives for disease in general, especially that may not apply?

Is testing for diabetes prone to false positives? Not from any literature I've seen. If anything I've seen it prone to false negatives. Do you have any information that says that it is prone to false positives? If not, you're just throwing out general issues that don't necessarily apply. That seems to be unnecessarily muddying the waters.

yea, I didn't see it as an attack but as what I see as happening. I'm just being honest... I didn't know where your point was or where it was going because most of what I see/saw was hyper-defensive and unwillingness to see anything else. My favorite thing to do is debate and get better information than what I already have-- I'll even play the devils advocate and argue the position opposite of what I actually believe so that I can hear responses better than my own and learn from them. When the argument gets emotionally defensive the actual point is unclear.

Hmmm...interesting. So when it's you, it's just an honest observation. But, when it's me, it's hyper defensiveness. Interesting that your sensitivity meter is so sensitive in one direction but so insensitive in the other. I'd say my hyper defensiveness is just enthusiastically countering arguments/assertions presented -- like yours that the findings were shaky.

I'll try to break it down as simply as possible:

1. The ADA numbers are based on an NHANES survey, which included one physical exam at one point in time. A fasting glucose or A1C test at one point in time is not enough to diagnose someone. Which is what I pointed out when I discussed gestational diabetes tests in pregnant women, in which a 1 hr fasting glucose test is performed, and if a positive result is returned, the patient returns for a 3 hr fasting glucose test before a diagnosis is made. Because a positive result on one test and the additional factor that could point to gestational diabetes (being pregnant) isn't enough - it has to be repeated at another point in time to establish it as a concern and not a fluke.

For the vast majority of people, one exam and one blood test is all that is needed for diagnosing someone with insulin resistance (especially when that test is the A1C) because the symptoms align with the expected blood result. I don't know where you've found information otherwise.

I agree with you on the gestational diabetes issue, but (1) do you have any reason to believe that gestational diabetes sufferers were included in these numbers? I couldn't find anything either way. And (2), even if we excluded all pregnant women in the US, that's still only about 6.7 million. So even if you counted all those women (which is obviously silly since that mean every pregnant woman would have had to been incorrectly diagnosed with gestational diabetes and counted in this study), it still means that you'd have 108 million people with insulin resistance. That would only drop the 43.3% to around 41%, right (and with recent numbers it's even higher -- these were in 2010 -- 2012 the numbers are higher)?

In the end, the conclusion is the same: A LOT of people in the US have insulin resistance.

2. Concerning the oversampling, the NHANES study oversampled certain populations. I covered the issues concerning sampling minority populations, low income, and elderly populations that should be considered as impacting the results. The same reasons I listed for those populations are also widely known as increasing the likelihood of obesity and less than optimal health in general - income, food availability, education, language barriers, age. While they may have oversampled in hopes of obtaining more minority samples, the act of doing so in light of the other issues makes their results and application to the general population questionable.

Once again, you don't say anything about how the oversampling was done incorrectly. Minority populations are oversampled intentionally so that they can get accurate numbers for that minority. Then those numbers are weighted according to the minority's share of the total population. As far as I can tell, that is EXACTLY what happened here.

As for other factors contributing to obesity, absolutely that's true. But what does that have to do with whether they have insulin resistance AT ALL? If I were making the argument that insulin resistance was the only factor in obesity, sure, that would make sense. But otherwise, it doesn't matter at all. Sure, fatter populations likely have higher incidents of insulin resistance -- and that is perfectly in line with these studies. But that doesn't negate the fact that insulin existence exists.

3. Taking into consideration single point in time testing, oversampling of populations who are more likely to be overweight/obese or less than optimal health, and the last post I shared concerning how the oversampled populations are at greater risk for insulin resistance in general, I find the 40% estimate to be questionable.

I don't think any of the concerns listed above are invalid and I believe that members of the MFP community should take them into account when reviewing the information presented in this thread.

Well, I think your conclusions don't make much sense in the totality of the circumstances. And, at best, only reduce the numbers slightly. In fact, since you appear to be rather intelligent and well-spoken, I'd think that this is an intentional attempt to obscure facts in order to dismiss a problem. But, maybe you just really can't see the forest for the trees.

The overall conclusion still holds --- this is a BIG problem in the US that affects a LOT of people.

I'm not of one those people who believes insulin resistance doesn't exist. I absolutely believe it exists, and I agree with you that how you set up your macros can impact your success with losing weight. I've never said anything to the contrary on that matter. However I have seen people claim that insulin resistance was the cause of their weight gain - some with actual medical conditions that cause insulin resistance and therefore would play a role in their weight gain, and others who have gained weight and want to believe that they are insulin resistant and it's the carbs, and not that they were overeating high calorie foods. I felt the link accurately covered both the lifestyle choices that lead to insulin resistance as well as factors that are out of our hands that cause it as well.

Now, concerning the statistics, it has been repeated several times in this thread that the purpose is to raise awareness of insulin resistance based on the 40% statistic and how that is a significant portion of the population. But when the surveys that statistic was extrapolated from have methodological errors and oversampling of populations who are predisposed to insulin resistance anyway, one has to question the validity of the estimate and whether this is really a significant issue that people need to be concerned about first and foremost.

Fair enough. Personally, I try not to get bogged down in the statistics on issues like this, in large part because I don't think it's relevant to the ultimate conclusions I tend to draw from this data. When I read those statistics, that says to me that "a lot" of obese people have some degree of insulin resistance. Is it 40%? 20%? 60%? I don't know, but either way it's a substantial number. And given that it's a substantial number, that says to me that people (not you specifically, but just speaking generally) should be more careful when broadly proclaiming there's no point in following a LCHF diet, as a substantial number of obese individuals may actually see much better results from such a diet. That's my big takeaway here and it applies regardless of how accurate those statistics are.

The other takeaway would be that, if someone does suffer from this condition, then the positive aspect is that it may improve as they lose weight and become more active. And that sort of cuts against the whole "if you can't eat low carb for the next 10 years, it's not sustainable!" advice I see repeated on these boards all the time. If someone can use it as a tool to reach a healthy body weight and improve their insulin sensitivity, they may be in a much better place to reintroduce carbohydrates into their diet than they were when they first restricted them. But you're absolutely right that obesity-induced insulin resistance didn't cause the initial obesity (how could it?) and it's still not an excuse for not losing the weight.

Ultimately, I think we agree and we're just looking at it from different perspectives. I see it as a relevant counter to a lot of the derpy anti-LCHF posts I see on boards every day. But to the extent anyone thinks OI insulin resistance is an excuse for why they aren't losing weight, I'm with you on calling BS.

I think you and I have basically the same viewpoint as well, just differing on the value of the statistic.

FWIW, I don't have an issue with LCHF diets. I think they can be very beneficial to those with health issues or who find the diet fits well into their lifestyle and encourages adherence. My only issue with LCHF is that it is often promoted on the boards as being a magical solution to weight loss, and generally by people who don't seem to know much about it. We see a lot of recommendations right off the bat to cut carbs, eliminate this food or that, and it's only when people like LadyMiseryAli* and hookilau* find the post that we actually get some information about the proper way to do a LCHF diet as far as macro settings, starting LC, what to expect, how to know if it's a good fit for you, etc.

*No offense to the other LCHF people on the boards, those two just pop into my head immediately as posters who I frequently see giving solid information and realistic advice about LCHF (I know LMA is also keto) without necessarily pushing the OP towards that dietary change, especially if it doesn't sound like it would be a good fit for that person.

I agree with you for those that push LCHF as a magic bullet (or any other diet as a magic bullet). It's not, but it does have some benefit and considerable benefit for some (as do other approaches). And if in this thread, there were people claiming that, I can understand your counter to those specific attacks.

What drives me nuts are these sort of pre-emptive counters. No one on this thread said that (or at least not the OP), so pre-emptively attacking a non-existent argument seems totally silly.

And you see this a lot on here -- whether it's a Paleo thread, LCHF thread, etc. When people get self-righteous or are making outrageous claims, sure, counter them. But to start bashing things or tearing down other arguments as a pre-emptive strike against a later imagined, but as of yet non-existent argument just doesn't make much sense to me.