Reversing Insulin Resistance


     Lately there has been a lot of talk and programs and TV Commercials that talk about Insulin Resistance.  So, What is it and how does that affect my weight and ability to lose weight?.  When you've finished reading this, you'll understand it.  
The hormone and metabolic functions of our body are very complex and certainly not totally understood at this time.
     Insulin Resistance has an underlying genetic component to it.  The ability to become insulin resistant is found in our DNA.  It's not an either / or issue.  There are varying degrees of Insulin Resistance.  It is acquired and can be made worse or better based on our lifestyle and behavior.
     Our body uses mostly two fuels.  Glucose or sugar as we often call it and fat or actually ketone bodies which are the useable fuels broken down from fat.  Glucose is readily available fuel and fat must be converted to ketones for burning.  Our body works very hard to maintain a steady level of glucose in the blood available for use as fuel.  Our body's primary objective is to supply glucose to our brain.  Without adequate fuel for our brain, we die quickly.
     In order to have a ready supply of glucose for our brain we keep a very regulated level of glucose in our blood.  In our fasting state (no food for 12 hours) our blood sugar should be between 70 and 99 mg/dl.  We usually just say 70 to 99.
If our blood sugar level goes below 70, we start to have a decrease in our brain function.  The lower it drops the less we are able to think, act, or respond.  When it drops too low (below around 30) we will start to lose consciousness and will eventually pass out.  If glucose levels continue to drop, our brain will start to die within minutes.  Oxygen is the most important substance for our brain followed by glucose.
     Now our brain can function without a lot of glucose, if ketones are available for fuel.  Again, ketones are derived from fat.   Specifically they are a breakdown product of fatty acids which are stored in a molecule of triglyceride or storage fat.
The three ketone bodies we use for fuel are acetoacetic acid, beta-hydroxybutyrate, and acetone which is a breakdown product of acetoacetic acid.
     Getting back to our blood sugar levels which we maintain in a very tight range,  After we eat a meal our blood sugar will rise.  Our body does not tolerate high blood sugar levels so the post eating normal blood sugar range is also controlled.  Our blood sugar is highest at about 1 hour after a meal and should be coming back toward normal from 2-4 hours after a meal.  Our blood sugar should never go above 200mg/dl and even when challenged with a high sugar meal should come back below 140 at 2 hours after eating this meal.
     If someones fasting blood sugar is over 127 or their two hour post eating blood sugar is over 200, they are considered diabetic.  If their fasting glucose is over 100 or a 2 hour post eating glucose over 140 they are considered pre-diabetic. So, where does this insulin resistance come in?
     The main hormones our body uses to control these tight glucose levels are insulin and glucagon.  Insulin is a peptide hormone that acts to direct our blood glucose.  I call it the air traffic controller of our blood sugar.  When we eat our blood sugar goes up, but so does our insulin level.  Insulin tells our blood sugar where to go.  One direction is into the cell to be used for fuel.  Another direction is to be stored in muscle or liver as stored glucose called glycogen.  The third place it is directed is to be turned into storage fat through a series of processes that end up with triglyceride formation.  Triglycerides are our storage fat.
     When we overeat, or gain too much body fat our tissues and cells require more and more insulin to do this direction work.  Over time this higher level of insulin is perpetuated and our body has a lower effect from the insulin.  We call this Insulin Resistance.  It takes more insulin to get the job done.  In time the pancreas which produces our insulin starts to wear out,  In our body's attempt to control our tight blood sugar, we produce higher levels of insulin.
     These high levels of insulin do several things.  Put the glucose we need into our cells, turn the excess sugar in our blood to fat, and make us more hungry.  The cycle continues.  The more glucose, the more insulin, the more fat, the more hunger, the more eating, the higher glucose and so on.
     Insulin resistance left to continue will end with diabetes and all the negative effects it has on our body.  How then do we combat Insulin Resistance?
     First, we decrease both food volume and carbohydrate and sugar intake.  Then we burn fuel better through physical activity increase.  We next must drop excess body fat which will assist in lowering insulin levels.  In patients who have had insulin resistance for some time I recommend use of Metformin or an herbal therapy called Berberine.  These two substances make our energy burning factories inside our cells, called Mitochondria, more efficient at burning glucose and ketones.
     Insulin Resistance is reversible.  Our fasting insulin levels should ideally be below 10.  Doctors don't commonly track fasting insulin, but we use it as a tool to let patients know how well they are doing at beating their insulin Resistance.  Following blood sugar levels and triglyceride levels will also tell us a great deal about insulin resistance.
     We can't change our genetics but we can beat them if we work at it.  Below is a summary of the treatment of Insulin Resistance.
1.  Reduced Carbohydrate Diet
2.  Reduction in simple sugars
3.  Exercise with progression to 6 days weekly
4.  Body fat reduction through weight loss
5.  Increase water intake
6.  Metformin or Berberine
     When our insulin level is reduced our entire body becomes more efficient at using its fuel and we create more energy and feel better overall.  Our body fat goes down more quickly and we are able to keep our blood sugar in normal range without great effort. 
     There is no magic in treating Insulin Resistance.  The 5 and possibly six steps above will work for almost anyone.  If your waistline measurement is over 35 inches for women and 40 inches for men, you are likely already Insulin Resistant.  Get started today treating this problem and you can prevent a future with diabetes, heart disease, and all the negative effects of being overweight.

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