Insulin Resistance

INSULIN RESISTANCE

Insulin is a master hormone with many functions, some of which include:

Moving the nutrients into the cells
Stopping the glucose production by the liver
Stopping the release of fat from fat stores
Causing inflammation
Signaling of hunger
When a person is Insulin Resistant, the first three functions get impaired, while the last two functions get accelerated.
Insulin resistance is a condition, where the body produces more insulin than required amount, making the cells resistant to it.
IR is most often the root cause of all the lifestyle diseases (LSDs) like Diabetes / BP; Heart diseases / Stroke / High uric acid / PCOS etc., including many forms of cancer. A survey in China found that Smokers without IR had the same risk of lung cancer as non-smokers. But the lung cancer risk increased by 300 % in smokers who had IR. It is probably true with other diseases also because metabolically healthy obese people (people who are obese but have normal lipid profiles) are not as susceptible to LSDs as others. (Churchill, who looked heavier than a Grade 3 obese person lived healthily up to a ripe old age probably is the best example).
IR is the inability of the body to effectively regulate the blood sugar levels with normal insulin level, which shows up as:
High Fasting Blood Sugar (> 100 mg/dl) and/or high Post-Meal blood sugar (125 mg/dl)
And/or
High Insulin as indicated by its surrogate marker Triglycerides / HDL ratio {>1.65 (Female) and 2.75 (Male)}

Two types of IR:

Note: *: Jargon explained at the end of the note

1.IR due to excess insulin called Hyperinsulinemia: It shows up as high fasting sugar but almost normal Post-Meal blood sugar. It happens due to the following reasons:

1.1. Insulin-resistant liver: High phase 2* insulin and or lack of storage capacity in the liver continues to pump sugar / glucose into the blood when it is not needed.

2. Subdued Phase 1* release of Insulin by the fat-laden Pancreas.

3. Phase 2 release of Insulin which happens in response to the Meal is not blunted by the fat in the pancreas. That is the reason for high sugar noticed in the morning becoming normal after a Meal in the early stages of Diabetes.

This is the type of IR / Diabetes that most Indians have. Treating this only with insulin-increasing medicines can perpetuate Diabetes by making the pancreas fattier.

The best treatment for it is the prudent use of medicines with adequate lifestyle changes in the form of appropriate nutrition, physical activity, stress management, and restful sleep as suggested by the World Health Organization. Not taking medicines at this stage, as a course of action by many, can be a health hazard, because diabetes can be reversed but the organ damage caused by it cannot be reversed. Medications can be withdrawn as per the health care provider’s recommendation once the parameters are in the healthy range and lifestyle changes have been made consistently.

1. IR due to inadequate insulin production which shows up as high post-meal blood sugar: This type of IR happens when the body cannot produce sufficient insulin to move the sugar into the muscles. This type is most prevalent in populations where protein is a main source of calories and in Indians when Pancreas loses its capacity due to many years of poorly managed diabetes.

Causes of Hyperinsulinemia (HI):

The overfilled fat cells are the main reason for causing HI. They are not overfilled due to excess eating as many people strongly believe. The normal grain dominant Indian meal is about 600 to 700 Cals with a high glycemic load, which causes hunger & frequent eating either in the form of Meals or nibbling in between meals, which does not give the body a chance to live on its fat which is the favorite fuel of all the organs (the heart is healthier when it can get 85 % of its fuel as fat) except the brain which prefers to live on Sugar/glucose. The following figure illustrates the damage caused by the overfilled fat cells.

Overfilled fat cells cause visceral fat. Visceral fat is the fat accumulated in the abdomen, more specifically, around the organs like the heart, liver, and pancreas) and overfilled liver cells lead to fatty liver, heart diseases, diabetes, bp, and inflamed muscle.

1. Lipotoxicity means poisoning caused by the over-filled fat cells which initiate irreversible damage to the Heart that may show up as Angina after several years or even decades of abuse. So emptying the fat cells at the first sign of IR is necessary to prevent damage to the heart and also to keep away diabetic condition.
2. Inflammation weakens the immune system and increases the risk of viruses like flu / Dengue, etc.
3. High Visceral fat is an indication that the fat cells are over-filled.
4. Insulin Resistance shows up as high blood sugar or as high as insulin. TG/HDL ratio is a surrogate marker for insulin.

Causes of over-filled Fat Cells:

1. Indians eat very low fat but have one the highest fat percentages in the world which is because Carbs in the refined grain dominant Indian diet are turned into Fat in the Liver.
2. Whether that fat is unhealthy Saturated Fat (SF) or healthy Monounsaturated Fat (MF) depends on the Glycemic Load (GL) of the Diet. The higher the GL, the more SF.
3. Since the GL of the Indian diet is high, it produces more SF which overfills the fat cells that increases and causes other lifestyle diseases LSDs.
4. Eating less of a high GL Indian diet leads to malnutrition and its ill effects without reducing the IR.
5. Burnable Fat from the fat-burning plate keeps away the IR and LSDs by preventing the over-filling of Fat cells.

Our Support:

Provide a low glycemic balanced nutrition program that supports the Indian palette for Indians across the world.
Recommend physical activity that supports releasing of fat from the fat-filled cells
Educate clients about their condition and ways to sustainably manage their reversal
Help make least damaging healthy choices in all contexts of the clients life viz. travel, parties, socializing etc.
Support with effective stress management

A Case history:

A doctor approached us for losing weight. He gave us his blood report with a comment that all the parameters are in the healthy range except for slightly high Triglycerides and LDL for which he was taking Statins. When we went through his blood reports, we found the following:

1. His blood sugar was kept normal by producing excess insulin which was revealed by a high TG/HDL ratio. It means he is suffering from hidden Diabetes.
2. High Insulin while controlling the blood sugar, created insulin resistance in the Liver, because of which the Liver was producing more VLDL and Triglycerides (TGs).
3. We explained to him that reducing IR by emptying the fat cells will solve all his problems i.e. weight, high TGs, and hidden Diabetes.
4. With his cooperation we managed to solve all the problems within 3 months.

Note on some terms used:

Glycemic Load: The glycemic load (GL) of food is a number that estimates how much the food will raise a person’s blood glucose level after eating it. One unit of glycemic load approximates the effect of eating one gram of glucose.

Phase 1 Insulin:

Failure of Phase 1 insulin due to excess fat in the pancreas causes high fasting blood sugar.
Fasting blood sugar higher than 115 mg/dl is an indication that the Phase 1 insulin is below normal and hence Diabetes may happen in near future.
At this stage, Diabetes can be prevented by reducing fat in Pancreas through Diet and Lifestyle changes which will restore Phase 1 Insulin to healthy level.

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