Sunday, January 31, 2016

Type 2 Diabetes, a Dietary Disease #313: What Does Insulin Resistance Have to Do With It?

This blog and this column in particular are intended for the recently diagnosed Pre-Diabetic, Type 2 Diabetic, or family member or friend of someone who thinks they or another they care about may be one of the one-in-three Americans who have developed a degree of Insulin Resistance (IR). Insulin Resistance is a relative term. It is a continuum and worsens progressively if no dietary changes are made. 
Most clinicians who treat diabetes and obesity do not measure IR or even serum insulin; instead they measure your blood glucose, either fasting (FBG) or with the HbA1c test that counts the percentage of glucose cells on the surface of your red blood cells. The A1c test is preferred today because it gives a better indication of your overall glucose metabolism. It incorporates the “excursions” (height and duration) that your serum glucose has taken, thus measuring fasting and after meal (postprandial) values, 24/7, over the 3-month life of red blood cells.
For all intents and purposes, however, Insulin Resistance = Carbohydrate Intolerance. The degree that you have IR is directly correlated with the degree to which you have become Carbohydrate Intolerant. To mitigate and potentially reverse IR, and thus to increase your “insulin sensitivity” (the inverse of IR), there are several things you can do: 1) eat a low carbohydrate, or ideally, a very low carbohydrate diet, 2) exercise, and 3) take certain oral anti-diabetic medications. For Pre-diabetics and Type 2 Diabetics, the most commonly prescribed oral medication, Metformin, appears to work in this way, as a secondary outcome. The primary outcome is to suppress unwanted hepatic (liver) glucose production from excess amino acids.
As explained in #308 here, Insulin Resistance is also the cause of weight gain, not gluttony or any other “character fault.” In brief, your body craves carbs (which convert to glucose) because your insulin resistance leads to elevated circulating (serum) insulin. Your pancreas produced the extra insulin because it sensed you needed it to help your cells take up the circulating glucose accompanying the transporter/gateway hormone insulin. And, so long as your circulating insulin is elevated, your metabolism signals that the body does not need to break down stored fat for fuel. As a result, you have an energy deficit. Put simply, you are hungry, so you scarf down more carbs (“energy in”) for quick energy and to restore your “energy balance.”
This, unfortunately, can go on for days, months, years, and even decades. So long as you have an elevated serum insulin, your body will be unable to utilize its own body fat for energy, and you will be hungry and crave carbs. So you eat, and overeat, but only because your body is unable to use its own fat for energy.  The only way to interrupt this syndrome is to lower the level of insulin circulating in your blood. And that will only happen after a few days in of low carb intake so that your stored glucose (called glycogen) in the liver and muscles is used up.
Then, when your serum insulin level is sufficiently lowered, other hormones will signal the brain, and your body will automatically switch to breaking down and burning stored fat for energy balance. Your stored fat is now part of the “Energy In” in the formula “Energy In = Energy Out.” And when you are burning your own fat, you will not be hungry. You will not crave carbs. And because you are using stored fat as part of “Energy In,” you will lose weight – so long as you don’t eat more food than you need to be satisfied. If you are aware of your “hunger” and you’re flexible, you will discover that three or even two really small meals a day, of healthy animal protein and fat (“no” carbs), will provide all the energy you need or want. No snacks are needed!
In addition to weight loss, your glucose metabolism, as measured 4 times a year with an A1c test, will improve. As you lose weight, your blood pressure should improve too. And with a low carb or very low carb Way of Eating, your HDL cholesterol should increase (mine doubled) and your triglycerides should plummet (mine by 2/3rds). Your systemic inflammation markers should also improve, and you will need to take fewer meds.
You will in fact feel totally energized. You body likes to eat high quality, nutrient dense, real food, and it likes to consume its body fat reserves, the stores it put aside for that very purpose. The body is a self-healing organism. It wants to be healthy. It is the natural state of the mammalian species to be lean and strong. Why not give it a chance to be all that it can be? All you need to do to be healthier is to cut back on the carbohydrates in your diet.
That’s why we say that Type 2 Diabetes is a Dietary Disease.

1 comment:

  1. I handed out a few of these at the Metabolic Therapeutics conference in Tampa Bay this week. I was well received, but I was preaching to the (all-star) choir.

    ReplyDelete