The 99 Percent Block
Jeremy London is a cardiac surgeon. He spends his days unblocking arteries. He exercises. He eats clean. No smoking. Blood pressure steady. By every metric that matters in standard medicine, London shouldn’t have had a heart attack.
He did anyway.
One morning the chest pain hit. Shortness of breath followed. At the hospital they found an artery clogged to ninety-nine percent. Nearly shut. As a surgeon, London knew all the rules. He was current on every recommended screening for his age and risk profile. It didn’t save him. Not early enough, at least.
Two years later he had an epiphany. It came from his son.
“Wear this. See what it shows.”
His son handed him a Continuous Glucose Monitor. London agreed, mostly to prove he was doing it right. He expected boring, flat lines. Proof of his perfect habits.
He got a warning.
Within two days the device screamed red. His glucose levels were chronically high. It didn’t matter what he ate. It didn’t matter that he was fasting. The numbers stayed elevated. That’s when it hit him. His standard bloodwork—fasting glucose, basic metabolic panels—had missed the engine of his disease. They had checked for the fire. They hadn’t checked for the sparks.
The spark was insulin resistance.
The Invisible Crisis
Standard labs give you a snapshot. A single frame. Fasting glucose tells you your blood sugar after an overnight break. That’s it.
But the body tells a longer story.
London realized he never asked for two things: Hemoglobin A1c and fasting insulin. When he finally showed the CGM data to his internist, he got orders for blood work the next morning. His A1c came back at a 5.9. That’s the upper tier of pre-diabetic. On the edge. Years of standard checks had left this invisible.
Why does this happen?
London’s pancreas is a workhorse. It is resilient. When cells stop responding to insulin, the pancreas just pumps more. It overcompensates. Glucose levels stay in the “normal” range. Labs look clean. You walk out of the doctor’s office thinking you’re healthy.
Meanwhile, your insulin is climbing.
Chronically high insulin drives vascular inflammation. It eats away at artery walls. Plaque builds up in the quiet.
The Data Doesn’t Lie
London isn’t alone in this. He’s a doctor, but his experience is data, too.
A study in PLOS Medicine found that for women with normal glucose levels, fasting insulin was a better predictor of heart disease and stroke risk. Better than glucose. Better than A1c. Another meta-analysis looked at 26,00 adults who didn’t have diabetes. High fasting insulin linked to higher death rates. Both from heart issues and from everything else.
The pancreas hides the struggle until it can’t. Insulin resistance often predates Type II diabetes by a decade or more. You’re in the danger zone while the machines say “All Clear.”
What to Measure Now
London believes fasting insulin should be the new routine. It isn’t yet. Most guidelines don’t require it. But he thinks they should.
His personal target for fasting insulin is 5 or lower.
If you want to test, consistency is key. Labs vary. Methodologies shift. London says pick one lab. Stay with it. Treat the numbers like a relative trend, not an absolute truth.
“You weigh on the same scale every morning,” he says. “Don’t switch scales and expect the number to mean anything.”
Beyond insulin, London looks at the whole board. Standard cholesterol is blurry. Here is his checklist for prevention:
- Fasting Insulin: Target is under 5. Track trends.
- Hemoglobin A1c: Target under 5.5. The margin is thin here. A 0.1 point shift matters.
- ApoB: Target under 80. This measures the actual number of plaque-forming particles. LDL total can lie. ApoB tells you how many bricks are building the wall in your artery.
- Lp(a): Genetic. Unchangeable. If this is high, you fight everything else harder. London’s was near zero. Lucky him.
- Triglycerides: Still useful context.
London had to switch meds for his ApoB. He injected Repatha. Diet changes followed. Maybe statins next. It wasn’t pretty, but it was precise.
The Bottom Line
Heart disease doesn’t appear out of thin air. It creeps in. It builds up while you’re looking at a “Normal” label on a piece of paper.
The leverage is in the details.
Ask for the fasting insulin. It’s just another blood draw after your morning coffee-free fast. It might cost a bit out of pocket if insurance pushes back, but clarity has value. Pair it with A1c and ApoB. Track them.
Or keep waiting. See who finishes the sentence first.
