What is insulin resistance? Why call it "Diabesity"?
70 % of Americans are genetically prone to insulin resistance! A benefit to our ancestors in an environment of scarcity of food and little if any sugar, it is a curse in an environment of plenty, especially processed food with added sugar and refined carbohydrates.
Our genes cannot change fast enough to adapt to a toxic diet of processed foods designed to make us crave more processed food. Google “bliss point” to understand how our food supply is being manipulated to our detriment.
The cells of the muscles, fat , and liver become insensitive or tolerant to insulin causing the body to produce higher insulin levels to compensate. Eventually insulin production fails and blood sugar levels begin to rise. We then declare: Diabetes, the final stage of "Diabesity."
Before rising glucose levels are detected, insulin resistance and high insulin levels raise blood pressure, cause harmful lipid changes and create inflammation and arterial damage,. We call this damage atherosclerosis and it leads to heart attack, stroke, dementia and death. It is enabled by a form of "tolerance" to the toxic effects of sugar and insulin, causing us to crave more sugar, driving our insulin levels higher.
This graph illustrates the relationship between insulin resistance, rising insulin levels and blood glucose levels associated with the progression from prediabetes to Type 2 Diabetes. It should be labeled "The Natural History of "Diabesity."
What are some of the indicators of Insulin Resistance/Diabesity?
Insulin resistance produces a large waistline, high blood pressure, elevated blood sugar, high triglycerides, low HDL cholesterol (Metabolic syndrome), heart attack or stroke, gestational diabetes, polycystic ovary syndrome, erectile dysfunction, ananthosis nigricans, and periodontal disease for starters.
How do we identify Insulin Resistance/Diabesity?
The traditional "gold standard" is a two hour oral glucose tolerance test. Blood is drawn before and after drinking a sugary liquid to see how your body responds to the glucose. Certain high cutoffs define diabetes and prediabetes. But truly normal glucose levels should be below 125 at 1 hour and 120 at 2 hours.
Usual lab reference values consider a fasting glucose of less than 100 to be normal. But fasting glucose levels above 90 should raise concerns about insulin resistance till other measures are used to rule it out.
We perform body composition analysis on all our patients. Elevated visceral fat can be detected in a few minutes, revealing some of the earliest evidence of insulin resistance/diabesity. Even those who are thin can be "skinny fat", "Thin on the Outside, Fat on the Inside" or "TOFI." These healthy looking individuals, particularly sedentary women after menopause, have low muscle mass, known as sarcopenia.
The information from the InBody 570 is a game changer. We Measure to Motivate and Maintain Momentum for change. A healthier kind of M&M's!
You should know if you have insulin resistance/diabesity as early as possible, when a low glycemic diet, fasting/time restricted feeding and exercise can prevent the complications of insulin resistance.
How do we Reverse Insulin Resistance/Diabesity?
First, cut out sugar from your diet. Excess sugar in your daily diet is stored as fat, worsening insulin resistance. Avoid sugar, bread, white potatoes, pasta, white rice and processed foods. Avoid artificial sweeteners. They raise insulin levels even in the absence of calories and they perpetuate cravings for sweets.
Eat vegetables, protein and good fat. Get your carbohydrates from vegetables. Fruit contains sugar, especially if juiced. Eat whole fruit in limited amounts. Avoid dried fruit. They are basically concentrated sugar.
Exercise, preferably high intensity interval training. Build muscle with resistance training.
Get off the Carbs and off the Couch!!
What Part of Sugar and Sitting cause Chronic Disease do we not understand!
Try Time Restricted Feeding/Fasting. We see the best results in those who restrict their good food intake to an 8 hour window each day, drinking only water or unsweetened beverages for the other 16 hours. For more information about this approach we recommend Youtube videos by Jason Fung and his books “The Obesity Code” and “The Diabetes Code.” You can also get a wealth of information from his blog at Intensive Dietary Management about the science behind fasting.
Get enough sleep each night. Find ways to relieve stress to reduce cortisol levels that raise glucose and insulin.
Finally, commit to being measured for your results, every 1-2 weeks when starting and at least every 1-2 months to stay on track. Being accountable is key, and seeing results perpetuates the process. We call it the M&M’s: Measure & Motivate & Maintain Momentum
Supplements and Medications for Insulin Resistance and Stubborn Visceral Fat
Sometimes insulin resistance is so stubborn that a low carbohydrate diet and exercise do not achieve the reduction in fat that one might expect. This can be due to an incomplete commitment to carbohydrate restriction and insufficient patience. We cannot out prescribe a bad diet. But sometimes a little help is needed.
The highest reported visceral fat measurement on our InBody is 20. This can represent a plateau which may be reflecting visceral fat burdens much higher. Therefore, perseverance and focus on body fat mass reduction is the key to maintaining motivation and momentum until that number drops below 20.
Insulin resistance and high insulin levels are a vicious cycle. Rising insulin levels cause ingested glucose to be stored as fat, worsening insulin resistance and leading to rising insulin levels.
Medications used to treat insulin resistance include pioglitazone and rosiglitazone. Used in established diabetes, their side effects have limited their use. But when prescribed “off label” to patients with prediabetes, they are well tolerated and are associated with benefits, including dramatically improved arterial disease related outcomes. The weight gain reported with these medications is mostly due to salt and water retention and is rare in prediabetics with healthy hearts.
Pharmacists and others who undermine patient confidence by trying to advise our patients that these drugs pose a threat to them would be wise to stick to their license and learn more before they exert more authority than they merit.
Effective supplements include cinnamon, chromium, vanadyl, alpha lipoic acid and biotin. All support noninsulin dependent pathways for glucose to enter the cell. This creates less signaling for higher insulin levels and less glucose stored as fat. This would make fat reduction more likely for any given level of glucose intake reduction.
Therefore, for those who are struggling to see any decline in their fat we offer these supplements or medication. One that we stock in our office, Diaxinol, contains all these supplement ingredients. Bergamot BPF offers improvements in insulin sensitivity in addition to improved lipids and reduced arterial inflammation.
Eventually, these supplements may not be needed. But they can provide a kickstart for difficult cases.
Intermittent Fasting and Insulin Resistance
We have seen incredible results with intermittent fasting. See our blog post A Ton of Weight Lost, Literally for more specific details. The work of Dr Jason Fung and his team at IDM prompted us to implement fasting strategies into the prevention plan for our patients. We used the information from The Obesity Code to test a fasting group that we tracked with body composition analysis and saw loss of visceral fat, lower percent body fat, and increase in muscle mass. Studies show an increase in growth hormone with fasting. Growth hormone injections are seen by some as a way to slow aging at a very high cost. Fasting makes it free!
The information provided by Dr Fung and his team can have a massive impact on your health. To learn more about intermittent fasting click the link for Intensive Dietary Management.