We’ve received multiple questions this month regarding insulin resistance and carbohydrate intolerance. Since it seems to be on the front burner in many people's minds, I decided I would try to give you some insight into what is insulin resistance.
Insulin resistance is a decreased ability of the body's cells to respond to insulin. It's the beginning of the body not wanting to deal with glucose. Now remember, glucose is the carbohydrate that breakdowns to sugars in our bodies. One of insulin's primary actions is to get certain body cells to absorb or take in glucose more accurately to store it as fat.
Insulin resistance happens when the cells don't want to open the gate (receptor) to where insulin allows glucose into the cell, instead glucose begins to increase in your blood. When insulin tries to open the gate but fails, the body puts out more insulin until the gate opens in order to stabilize the blood glucose so the cells can use it. Over time, this results in a condition known as hyperinsulinemia which is too much insulin in the blood.
Hyperinsulinemia causes more problems than we care to go into in this short newsletter. Most importantly, though, hyperinsulinemia makes it very difficult for the body to use stored fat for energy!
Let's look at a few facts about what happens with insulin resistance.
1. Insulin resistance is a condition in which the cells of the body become resistant to the hormone insulin.
2. Insulin presents and precedes the development of type II diabetes.
3. While there are genetic risk factors for insulin resistance, it can be managed with diet, exercise and proper medications. Learning how to eat is a key factor.
4. Insulin resistance is associated with other medical conditions including fatty liver disease, atherosclerosis, acanthosis nigricans, and reproductive abnormalities in women.
Let's discuss insulin a little further. Insulin is a hormone that is produced by the beta cells of the pancreas. Pancreas beta cells are scattered throughout the pancreas in small clusters known as islets of Langerhans. Insulin is produced in these islets; then it is released into the bloodstream as it travels throughout the body.
Insulin is an essential hormone that has many functions within our bodies. Most of these are directed at our metabolism or the control of carbohydrates (sugars and starches), lipids (fats), and proteins. Insulin regulates the function of the body cells, including their growth and the use of glucose stored as energy. Many patients with obesity suffer from insulin resistance. This condition is when the body cells become resistant to the effect of insulin. The pancreas produces more and more insulin. Soon the pancreas can no longer produce sufficient insulin that the body demands and then blood sugar rises. Insulin presents a direct factor in developing diabetes, heart disease and morbid obesity.
So what is the relationship between insulin resistance and type II diabetes? Type II diabetes is a disease that occurs later on in life or with the gaining of weight at any age. Insulin resistance can be caused by genetic factors. Some medication contributes to insulin resistance. In addition, insulin resistance is often seen with the following conditions: metabolic syndrome is a group of conditions involving excessive weight, (especially around the waist) high blood pressure, elevated cholesterol and triglycerides in the blood, or high blood sugar levels. Having just one of these conditions doesn't mean you have metabolic syndrome. However, any these conditions increases the risk of serious disease. If you have more than one of these conditions, your risk is even greater.
So what are the symptoms of insulin resistance? Usually there are no visual symptoms. However, with severe forms of insulin resistance dark patches of skin called acanthosis nigricans which can develop on the back of your neck, sometimes on your hands, knees, knuckles or in your armpits. More importantly, insulin affects the metabolic reactions throughout the body, including converting calories and fat. Insulin resistance influences liver enzymes that produce the cholesterol that acts on the kidney that can contribute to high blood pressure. High insulin levels play a role in the process that regulates the inflammatory response. In time, insulin resistance leads to type II diabetes, itself a risk factor for heart disease. There are genetic factors that can contribute to the development of insulin resistance, including a family history of diabetes, high blood pressure or heart disease. However, lifestyle plays the most important part. Weight loss and exercise are considered the best treatment for restoring the body's ability to respond to insulin. Smoking can also contribute to insulin resistance. Quitting is recommended to bring the condition under control as well as to improve your overall health.
Watch your carbohydrate intake. The classic low-fat, high-carb diet, which was the standard recommendation for preventing heart disease for years, actually worsens insulin resistance! If you follow a low carbohydrate diet and focus on the low glycemic index sources of carbohydrates, you will see your weight and your insulin resistance both decrease. Eat a variety of non-starchy vegetables, cheese, and a variety of fish. This regime has been a standard at The Weigh Station for some time now. Choose cold water fish which are high in omega-3 fatty acids such as Alaskan salmon. The omega-3's can help you decrease the rate of the pro-inflammatory effects of insulin. They also seem to improve the cells’ response to the hormone. And last but not least, vigorous exercise decreases cells’ resistance to insulin; a 30 to 45 minute walk is perfect.
Prognosis: Losing your weight, getting enough exercise and following the program to the letter, will cause you to lessen your insulin resistance and reduce the inflammatory response of obesity. Some patients have returned who have gone back to their old habits. They say to us, "I wish I just would've stuck with the program." We are here to help you, so please take advantage of all of the resources that are available to you. As you enter The Weigh Station you read a quote above the check-in window: "I can do all things in Christ who strengthens me." Philippians 4:13. Make that part of your life, and you'll see things change dramatically.
Blessings to all!
Chuck Shaffer MD