Article from www.sensible-alternative.com.au

Insulin Resistance

Insulin Resistance - The Metabolic Time Bomb

What you know about insulin could save your life. This little hormone is not simply a problem for diabetics. Chronically elevated insulin causes Insulin Resistance, otherwise known as Impaired Glucose Tolerance, Metabolic Syndrome or Syndrome X, and is absolutely the number one health issue in Australia.

Untreated, Insulin Resistance leads to adult onset diabetes, which affects 1 in 200 Australians. It directly causes:

• high cholesterol
• high blood pressure
• heart disease

It is a risk factor for:

• obesity
• faulty leptin signalling
• polycystic ovarian syndrome
• breast cancer
• underactive thyroid
• premature ageing.

Experts estimate that, as many as 25% of Australians may suffer from this underlying metabolic time bomb, but are unaware of the risk. The good news is that insulin resistance is reversible with diet and lifestyle. If you are overweight and have high cholesterol, it is vital that you understand insulin resistance before you start a diet or cholesterol- lowering medication.

What is insulin?

Insulin is an ancient, anabolic hormone, which is found in all forms of animal life. Its function appears to be mainly nutrient storage, but it has many other functions including the limitation of lifespan of primitive organisms. In humans, insulin is involved in many metabolic processes, and has been demonstrated to accelerate the rate of ageing. It many ways it is harmful, and yet, as we know from diabetics, it is essential to life. At this stage, researchers do not fully understand all the many roles of insulin, but we do know this: In moderation, insulin is good. In excess, it is very, very bad.

What causes Insulin Resistance?

Under normal circumstances, insulin is tightly controlled by a natural homoeostatic feedback mechanism. With every meal, insulin is released as carbohydrates enter the blood stream. In a healthy body, the insulin receptors in the cell membranes respond to the hormone, and take up carbohydrates and other nutrients. This, in turn, reduces the production of insulin.

The problem starts when the tissue fails to respond to insulin. When this happens, the sugar in the blood remains high despite the presence of insulin, and the body has no choice but to release more insulin. It becomes a vicious cycle because it is actually the presence of insulin that makes the tissue more and more resistant to it. This is how insulin exposure determines the rate of ageing: with every insulin release, cell membranes become a little bit more insulin resistant. A gradual increase in insulin concentration over time is normal, but the current epidemic of severe insulin resistance is a modern phenomenon.

• Pollution: A study published in Diabetes Care has found that people who have the highest level of stored toxins were 38 times more likely to have diabetes than people with a lower level of stored toxins. Even if they were overweight, people with low level of toxins did not develop diabetes.  An editorial about the study published in the Lancet made the following statement: 'This finding might imply that virtually all the risk of diabetes conferred by obesity is attributable to persistent organic pollutants, and that obesity is only a vehicle for such chemicals. This possibility is shocking.  (Obesity is a vehicle because fat stores and concentrates the toxins.)
• Smoking: Toxins in cigarette smoke damage the insulin receptor, and cause distinctive weight gain around the waist. No more smoking to stay thin!
• Inflammation: New research from the University of Maryland has correlated inflammatory products in the blood with insulin resistance. This means that inflammation caused by infection, stress and pollution may be a direct contributor to insulin resistance and its outcomes: obesity, diabetes and heart disease.
• Carbohydrate: Carbohydrate intake compared to protein has increased dramatically in the last century. Since the onset of large-scale flour refinement in the 1890's, the average person consumes more fibre-free carbohydrate in a week than a nineteenth century person did in a year!
• Fructose: Studies have shown that fructose is a particularly harmful type of carbohydrate. It inactivates the insulin receptor, and it interferes with the way the brain responds to leptin (the anti-hunger hormone). The result is constant hunger, and a progression towards insulin resistance and fatty liver. Fructose is in modern sweeteners such as high-fructose corn syrup and sucrose (table sugar). It is in prepared foods like fizzy drinks and baked goods, and even so-called healthy foods like yoghurt and muesli bars. Whole pieces of fruit do contain fructose, but it is balanced by healthy fibre, so fruit is ok to eat in moderation. Care should be taken with dried fruit and fruit juice.
• Thrifty Gene: Carbohydrates are not healthy for anyone, but some people are very sensitive to carbohydrates. About 25% of people are genetically predisposed to a heightened insulin response. They have inherited a 'thrifty gene', which allowed their ancestors to survive famine, but which now makes them gain fat very easily!
• Trans Fat: Trans fats are damaged polyunsaturated fatty acids, found in processed vegetable oil such as margarine, deep-fried food, or commercially prepared oil. Conventionally touted as the healthy oils, these Frankenstein molecules have become a large part of the modern diet. They are damaged, distorted molecules, and when they are incorporated into the cell membrane, then interfere with the functioning of the insulin and other receptors.

Diagnosis of Insulin Resistance

The most characteristics symptoms of insulin resistance are apple shaped obesity with high cholesterol and high blood pressure. There is usually a family history of heart disease and/ or diabetes, and a strong craving for bread.

Measure your waist: Research has found a waist measure to be as reliable as blood test for predicting insulin resistance. At the navel, men should be less than 100cm. Women should be less than 90cm.  For other symptoms, see Insulin Resistance Quiz.

Insulin resistance is detectable with a blood test. The definitive pathology test for insulin resistance is the Glucose Tolerance Test (GTT) with insulin. One hour after the glucose load, normal insulin should be less than 60mU/L.

At Sensible-Alternative clinic, we use a simpler blood test: fasting insulin test. Normal fasting insulin should be less than 10mU/L. (Abnormal insulin response can also be inferred with a high blood sugar one hour after glucose load.

Treatment of Insulin Resistance

Intermittent fasting: Research from the Institute on Aging has shown that intermittent fasting improves insulin sensitivity. When participants skipped the evening meal, their fasting insulin improved, and they had fewer inflammatory markers on blood tests.

• How to do it: Always have a large breakfast and lunch. (As you become healthier, you will find that you regain an appetite for breakfast.) Then 1 to 3 nights per week, you must skip dinner, or replace dinner with a protein smoothie. They should not be consecutive nights. For more information, see Sensible News 46.

Reduce carbohydrates, especially fructose sweeteners. During the first couple of months of treatment, carbohydrate intake should be less than 50 grams per day. With a diet of meat and salad vegetables, this is not difficult. An average serving of broccoli, for example, contains only 13 grams of carbohydrate. Compare this to a serving of pasta, which contains over 40 grams of carbohydrate, or to refined sugar, the worst carbohydrate. A small can of soft drink contains at least 40 grams of carbohydrate. If you are addicted to a sweet taste, you can try the herbal sweetener Stevia, which has the added benefit of improving insulin sensitivity.

Eat protein regularly. Protein curbs the release of insulin and stimulates the production of the hormone glucagon, which opposes insulin. (Do not increase protein if you have kidney problems, and do not exceed 90-100 grams of protein per day.) Good sources include: 2 eggs (12 grams protein), 1 chicken breast (25 grams protein), 2 lamb chops (29 grams protein), 25 grams whey protein (23 grams protein).

Avoid Trans fat. Eliminate soy oil, corn oil, cottonseed oil or any generic "vegetable oil". Particularly bad are margarine, vegetable oil spreads and deep-fried food. Eat only naturally occurring fats such as butter, avocado, olive oil, coconut milk, meat, fish, and nuts and seeds. It can take up to 6 months to give your cell membranes an "oil change".

Exercise. Strength training dramatically improves insulin sensitivity. When the muscles increase their energy expenditure, they re-learn how to use carbohydrates rather than store them. Weight loss occurs not simply because of the calories burned, but because of a shift in metabolism. Exercise is also effective to relieve stress, a common cause of inflammation and insulin resistance.

Avoid Wheat. Lectins (proteins) in wheat mimic insulin, thereby worsening insulin resistance. Avoid flour-containing bread, pasta, cereal, and biscuits. If you do have flour, choose flour made from rice, oats, barley, spelt, and rye. Ordinary "flour" is wheat.

Nutritional supplements and herbs. Chromium, magnesium, selenium and omega 3 fatty acids will improve insulin's effectiveness at the cell membrane. B-vitamins and amino acids assist the liver to remove pollutants Antioxidants such as vitamin C and vitamin E will act as natural anti-inflammatories. Gymnema and Bitter Melon have been documented to improve insulin sensitivity.

Appointments at Sensible-Alternative

For professional advice regarding insulin resistance, please call to make an appointment...

   Sensible-Alternative Hormone Clinic
   Suite 1 Berry Rd Medical Centre
   1A Berry Rd, St Leonards NSW
   phone: 02 9438 3448
   email:

References:

• DelGiudice, ME et al. Insulin and Related Factors in Premenopausal Breast Cancer Risk. Breast Cancer Res Treat 47
• Eaton SB, et al. An evolutionary perspective enhances understanding of human nutritional requirements. Journal of Nutrition 1996:126:1732-1740.
• Ron Rosedale. Insulin and its Metabolic Effects. 1999. Designs for Health Institute.
• Wolk A. et al. Insulin-like growth factor 1 and prostate cancer risk: a population-based, case-control study. J Natl Cancer Inst. 1998 Jun 17;90(12):911-5
• Lee, DH et al. A strong dose-response relation between serum concentration of persistent organic pollutants and diabetes: Results from the National Health and Examination Survey 1999-2002. Diabetes Care. 2006: 29: 1638-1644.
• Porta, M. Persistent organics pollutants and the burden of diabetes. Lancet. 2006: 368: 558-559.
• Weitzman M et al. Tobacco Smoke Exposure Is Associated With the Metabolic Syndrome in Adolescents Circulation 2005 :S1524-4539
• Ryan, A. Inflammation linked to postmenopausal glucose metabolism. Diabetes Care 2004; 27: 1699-705
• Elliot, SS et al. Fructose, weight gain, and the insulin resistance syndrome1,2,3. American Journal of Clinical Nutrition 2002 76(5): 911-922
• Mattson, MP et al. Beneficial effects of intermittent fasting and caloric restriction on the cardiovascular and cerebrovascular systems. The Journal of Nutritional Biochemistry 2005. 16(3): 129-137
• Yevdokimova, N. and Andrej Yefimov. Effects of wheat germ agglutin and concanavalin A on the accumulation of glycosaminoglycans in pericelluar matrix of human dermal fibroblasts. A comparison with insulin. Acta Biochemica Polonica 2001, 48(2):563-572