Thursday, December 26, 2019

Retrospective #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 nearly half (so far) of Americans who have developed a degree of Insulin Resistance. Insulin Resistance is what causes Type 2 diabetes, but it is a relative term. It develops slowly on a continuum and worsens progressively if no dietary changes are made. 
Most clinicians who treat Type 2 diabetes and its associated obesity do not test for Insulin Resistance. Instead they measure your blood glucose, either fasting (FBG) or with a surrogate, the A1c test, that counts the percentage of glucose on the surface of your red blood cells. The A1c test is preferred now because it gives a better indication of your Insulin Resistance, thus your carbohydrate intolerance. It incorporates the “excursions” (ups and downs) that your blood glucose takes, after meals, for example, 24/7, over the 3-month life of your red blood cells.
For all intents and purposes, Insulin Resistance = Carbohydrate Intolerance. The degree of your Insulin Resistance is directly correlated with the degree to which you have become Carbohydrate Intolerant. To mitigate your Insulin Resistance, and thus to increase its inverse, “insulin sensitivity,” there are several things you can do: 1) eat a low carbohydrate or very low carbohydrate diet, 2) exercise (to increase insulin sensitivity, NOT to lose weight), and 3) take Metformin, an oral anti-diabetic medication. Metformin improves insulin sensitivity as a secondary outcome. The primary reason to take Metformin is to suppress unwanted glucose produced by the liver from stored amino acids.
Insulin Resistance is also the cause of weight gain, NOT gluttony or any other “character fault.” In brief, when you are always hungry, it is because your Insulin Resistance caused an elevated circulating 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, as long as your circulating insulin is elevated, your liver “thinks” 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 to restore your “energy balance” (homeostasis).
This, unfortunately, can go on for days, months, years, a lifetime. Once you’ve developed Insulin Resistance and continue to eat a “balanced” diet (including beaucoup carbs), your blood insulin will be continuously elevated and your body will be unable to utilize its own body fat for energy. So, you will always be hungry and crave carbs. So, you eat, and overeat, but only because your body is unable to use its own body fat for energyThe only way to interrupt this cycle is to lower the level of insulin circulating in your blood. And that will only happen, after a few days of eating very low carb or low carb, when stored glucose (called glycogen) in your liver and muscles is all 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. Stored fat, broken down to fatty acids, is now the “Energy In” part 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 for “Energy In,” you will lose weight. Remember to be mindful and don’t eat if you are not hungry. You will soon discover that three or even two small meals a day, of healthy animal protein and fat, will provide all the energy you want. No snacks are needed!
In addition to weight loss, your glucose metabolism (A1c’s) will improve. As you lose weight, your blood pressure will too. And your HDL cholesterol should increase (mine doubled) and triglycerides should plummet (mine by 2/3rds). Your systemic inflammation marker (hsCRP) should also improve, and you will need to take few if any meds.
You will in fact feel totally energized. Your body wants to eat high quality, nutrient dense, real food, and it likes to use 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.

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