Retrospective #462: Insulin Resistance and the TG/HDL Ratio

“Dr. Jay” is Jay Wortman, MD, a Canadian clinician, Very Low Carb advocate and political activist who I first found in 2012 at Franziska Spritzler’s old Low Carb Dietitian. Both he and I are among a very good list of links and resources there. That was only two years after I had started blogging, so when I visited Dr. Jay's Blog, I left a comment on his “The Story So Far….” And, as shameless self-promotion, I also left a link to my blog’s website. It has since garnered a few hundred hits. I also get lots of page views from Franziska’s blog list.

Jay Wortman has become very active on Facebook. A while ago when I offered wishy-washy advice to a newly diagnosed type 2 looking for help on a popular Facebook group, Dr. Jay intervened with a reply comment to mine. He blasted my lame advice, telling the hapless newbie to face facts. The newbie had Insulin Resistance and was therefore Carbohydrate Intolerant. I was embarrassed by my half-baked input, but very grateful he is lurking, or more likely, following the group. Dr. Jay is both passionate and selfless, and dedicated to helping. 

Dr. Wortman also keeps up with the most relevant medical research. He recently posted on Facebook this PubMed Central (PMC) mouse study, “The Failing Heart Relies on Ketone Bodies as Fuel.” The study concluded, “These results indicate that the hypertrophied and failing heart shifts to ketone bodies as a significant fuel source for oxidative ATP production.” Translation: the ketogenic diet is good for the failing heart, in mice.

Another Facebook post by Dr. Jay is this study from Malaysia appearing in PMC. Looking for “an easy to use, precise and low-cost diagnostic test to predict Insulin Resistance,” 271 overweight and obese children were “stratified by tertiles using the homeostasis model assessment (HOMA), a good surrogate for the gold standard for measuring IR, the hyperinsulinemic euglycemic clamp.” “The children were analyzed for fasting glucose, lipids, insulin and waist circumference. The children were then stratified by tertile of TG:HDL-C ratio.”

The study’s conclusion: “the odds of having IR was about 2.5 times higher (OR=2.47, 95%CI, p=0.01) for those in the highest tertile of TG:HDL-C ratio. Hence, TG:HDL-C may be a useful tool to identify high risk individuals.” Dr. Jay’s endorsement/imprimatur of this conclusion was, “I calculate this for all my patients.”

Below is a chart of my 82 TG/HDL-C ratios since 1980. The first 17 ratios were while I was eating the “Standard American Diet” (SAD) and, since diagnosed in 1986, treated for type 2 diabetes with antihyperglycemic drugs. The last 65 ratios are since I began to eat Very Low Carb in 2002. A TG/HDL ≤ 1.0 is ideal, a ratio of ≤2.0 is good, anything over 3 is “indicates significant risk of heart attack and stroke.”  Note almost all of mine since #17 are ≤1.0.

This metric has been in use by non-cholesterol-phobic physicians for years. I wrote about in 2011 in my Retrospective #27 “...the strongest predictor of a heart attack.” I hope more physicians, like “Dr. Jay,” start to routinely use it.