Susan Merenstein, Pharmacist/Owner

(412) 586-4678

Insulin Resistance: A Key to Diabetes

Hello Friends,

Last month we shared Dr. Michael Greger, MD’s thoughts on saturated fat and Type 2 Diabetes, but keep in mind that the Sad American Diet of most people is not the same as eating 100% GRASS fed Organic beef or humanely pastured chicken, more of a Ketogenic diet.

This month I want to delve further into Insulin Resistance as Dr. Greger, a vegetarian I might add, did not cover over consumption of processed refined carbohydrates and their effect on Insulin secretion in the body.

The new year is upon us and Spring is around the corner, along with our resolutions to lose weight!

How is it possible that only 2 short months ago we were making these promises only to not be able to keep them?

The answer is simple! INSULIN RESISTANCE! Stick with me for a little endocrinology education about Insulin, Glucose, and some general eating guidelines that will help you live a longer healthier life.

Type 2 Diabetes is a growing epidemic in nearly every nation in the world that has adopted Western dietary and lifestyle patterns. In the US, there are over 30 million individuals that meet the diagnostic criteria for Diabetes (over 95% of which is Type 2); of those, over 7 million remain undiagnosed.

As Dr. Jason Fund, MD states in his book The Diabetes Code, “Type 2 Diabetes is fully reversible and is largely a dietary disease, and diet and lifestyle changes-NOT medications-will reverse this disease.

Type 2 Diabetes develops gradually over many years and progresses in an orderly manner from normal to Pre-Diabetes to full blown Type 2 Diabetes. The risk increases with age and obesity. Hyperglycemia (too much glucose in the bloodstream) occurs due to Insulin Resistance, rather than the lack of insulin, as in Type 1 Diabetes. When researchers first developed insulin assays, they expected Type 2 Diabetes patients to show very low levels, but to their surprise, insulin levels were HIGH, not LOW.

The failure of insulin to lower blood glucose is called Insulin Resistance. The body overcomes this resistance by increasing insulin secretion to maintain normal blood glucose levels. The outcome is high insulin levels. The compensatory mechanism has its limits however, and when insulin secretion fails to keep pace with increasing resistance, blood glucose rises, leading to a diagnosis of Type 2 Diabetes.

Hyperinsulinemia precedes obesity!!

Hyperinsulinemia is the reason for recurring cravings and hunger and causes fat storage.

We must lower our insulin levels by reducing our dietary intake of sugar and refined carbohydrates (a form of sugar).

If you are like me and could live off a round loaf of bread and good butter you may be a carbohydrate addict. The only way I can lose weight is to avoid ALL grains, even NON-GLUTEN grains.

Signs and Symptoms of Carbohydrate Addiction

Do you ever experience these symptoms?

  1. A frequent focus on eating. Do you spend a great deal of time thinking about food, dieting, or your weight?
  2. Lack of satisfaction or the desire to eat again a couple of hours after eating. Do you get the feeling you aren’t really satisfied after eating, no matter what you eat? Are you hungrier two hours after eating than if you hadn’t eaten at all?
  3. A sense of fatigue or tiredness. Do you get a sensation of sluggishness, almost of feeling drugged after eating? Do you feel like lying down, perhaps even drifting off for a nap? Do you put off work or planned activities because you just don't have the energy for them? Do you get hungry/tired in the middle of the afternoon?
  4. An unexplained feeling of anxiety or anger. Do you have a certain unexplained nervousness or irritability? A desire to be alone? Do you find that you are angry at or blaming yourself?
  5. A heightened emotionality. Do you find yourself feeling sad or weepy without reason? Do you ever experience a feeling of hopelessness; an intense feeling of loneliness; a generalized feeling of fear? Do you ever go to extremes, with a feeling of euphoria or heightened happiness, only to feel later inexplicably sad or hopeless?

If you are overweight or are constantly fighting the battle of the bulge and recognize some of the preceding symptoms, you may be a carbohydrate addict. Many of these symptoms have been cited in thousands of interviews with people looking for weight-loss programs. In most cases, the symptoms above can be attributed to carbohydrate addiction.

Scientists writing in The New England Journal of Medicine, The Lancet, The Journal of Clinical Investigation, and many other journals have reported a physiological dysfunction that leads to obesity in many people. This dysfunction results in the wrong amount of insulin in the blood. Although obesity may be caused by a number of different disorders, an insulin imbalance appears to be very important to understanding some of the underlying mechanisms involved in many people who are overweight.

A huge amount of scientific research suggests that overweight people differ in physical ways from their thinner counterparts. Their bodies respond differently to many foods they eat, producing an increased or recurring hunger, a seeming drive to eat, and a tendency to store fat.

If carbohydrate consumption continues for a prolonged period of time, additional insulin is released from the pancreas. Remember that the amount of insulin is appropriate to what is eaten at that particular time.

FUN FACT: Your bloodstream has only about 2 teaspoons of glucose (blood sugar) circulating in it to maintain equilibrium BEFORE you eat; anything else must be either burned or stored.

Imagine your body as a big sugar bowl. At birth, the bowl is empty. Over several decades, you eat sugar and refined carbohydrates and the bowl gradually fills up. When you eat next, sugar comes in and spills over the sides of the bowl because the bowl is already full.

The same situation happens in the body. When you eat sugar, your body secretes the hormone insulin to help move the sugar into your cells, where it’s used for energy. If you don’t burn off that sugar sufficiently, then over decades your cells become completely filled and cannot handle any more. The next time you eat sugar, insulin cannot force any more of it into your overflowing cells, so it spills out into the blood. Sugar travels in your blood in a form called glucose, and having too much of it-known as high blood glucose-is a primary symptom of Type 2 Diabetes. This cycle goes on and on and there is too much glucose in the entire body. At some point, the body cannot force any more glucose into the cells.

Pay attention here, this is very important but may need to be read twice to really understand.

When a normal person consumes carbohydrates, his or her body releases insulin within a few minutes of eating. This is called the Preload Phase and a fixed amount of insulin is released. It is determined by the amount of carbs eaten at the previous meal. In the second phase, insulin release is 75-90 minutes after eating and is dependent on the ACTUAL amount of carbohydrates consumed at the meal. If the preload insulin is not sufficient to handle the amount of carbs, then adjusted release of insulin occurs.

So you start your day with processed cereal, a banana, and skim milk (the worst milk of all by the way because all fat is removed and therefore all that is left is milk SUGAR!) and your blood sugar will spike to the moon, needing much more insulin at the second meal of a burger and fries and shake which needs a lot of insulin to deal with. So, your Preload Phase release is not nearly enough to deal with breakfast let alone lunch! Now your poor pancreas has to adjust and release much MORE insulin! If your dinner is MORE carbohydrates, (i.e. pizza, pasta, rice, you get it) there is a need for mega amounts of insulin!

In order to understand what goes wrong, let’s learn what happens in someone who is NOT a carbohydrate addict (see signs and symptoms of Carbohydrate Addiction above)

As in most processes in the body, there is a symphony of effect with perfect timing and amazing function.

Carbs are eaten and an increase in glucose occurs.

The Pancreas, an elongated narrow organ the length of a human hand and located behind the stomach (see how much sense this makes), releases just the right amount of Insulin to help deliver the carbohydrate energy (in the form of the blood sugar glucose) to the liver and to muscle or fat cells throughout the body.

The cells take in the energy and the level of insulin falls.

Serotonin, the brain chemical, is released as insulin levels fall.

The presence of serotonin produces a feeling of satisfaction.

Insulin is sometimes called the HUNGER HORMONE because it stimulates people to eat.

When insulin is released in normal people minutes after they start eating, it may cause them to feel hungrier than they thought they were when they started eating. But upon completing their meal they feel satisfied—their insulin level drops and their brains get the signal to stop eating.

Hours later, after the body has used some of the glucose that remains in the blood, the insulin-to-glucose ratio in blood changes. It appears that this increase signals the body to eat again. We recognize this signal as the sensation of hunger. The normal person then eats, and the whole process begins again.

The One Test Your Doctor Isn’t Doing That Could Save Your Life

Insulin resistance doesn’t happen overnight. When most of your diet includes empty calories and an abundance of quickly absorbed sugars, liquid calories, and carbohydrates like bread, pasta, rice, and potatoes, your cells slowly become resistant to the effects of insulin.

Your body increasingly demands more insulin to do the same job of keeping your blood sugar even. Eventually your cells become resistant to insulin’s call, resulting in insulin resistance.

The higher your insulin levels are, the worse your insulin resistance.

Your body starts to age and deteriorate. In fact, insulin resistance is the single most important phenomenon that leads to rapid, premature aging and all its resultant diseases, including heart disease, stroke, dementia, and cancer.

Insulin resistance and the resulting metabolic syndrome often comes accompanied by increasing central obesity, fatigue after meals, sugar cravings, high triglycerides, low HDL, high blood pressure, problems with blood clotting, as well as increased inflammation.

Even without these warning signs, one test can determine high insulin levels years or even decades before Diabetes develops. Early detection can help you reverse these symptoms, yet doctors rarely use this crucial test that can detect high insulin levels.

Why Doctors Miss the Initial Warning Sign of Insulin Resistance

Doctors have been trained to measure a person’s fasting blood sugar, or the glucose levels present in your blood, at least eight hours after your last meal. Most don’t express concern until results show blood sugar levels reaching 110 mg/dl. That’s when they start “watching it.” Then, once your blood sugar reaches 126 mg/dl, your doctor will diagnose you with Diabetes and put you on medication.

The important thing to note is that blood sugar is the last thing to increase…so for many people, a fasting glucose test detects Diabetes too late. Long before your blood sugar rises, your insulin spikes. High insulin levels are the first sign that can precede Type 2 Diabetes by decades. Damage begins with even slight changes in insulin and blood sugar.

A two-hour glucose tolerance test can help detect high insulin levels. This test measures not only glucose but also insulin levels, yet doctors rarely order it. Instead, they usually don’t express concern until blood sugar is over 110 or worse, over 126, which is Diabetes!!

Many patients have normal blood sugar levels but very high insulin levels and other signs of pre-Diabetes, yet when they come to see their doctor they have not been diagnosed with pre-Diabetes.

Even when they have a blood sugar level over 100 mg/dl and a two-hour glucose tolerance test result of over 140 mg/dl, 90 percent of patients who display these conditions have not been diagnosed. That’s because doctors don’t measure insulin.

Think about this. Insulin resistance contributes to most chronic disease in America, a country with world-renowned health care, yet 90 percent of people who have this condition have not been diagnosed. One test could change all that.

Dr. Mark Hyman MD, Director of the Cleveland Clinical Center for Functional Medicine recommends early insulin testing for everyone:

-Over age 50

-With a family history of Type 2 Diabetes

-With central abdominal weight gain or abnormal cholesterol

-With any risk of insulin resistance (even children)

Ask your doctor for a 2-Hour Insulin Glucose Challenge Test. This should be done when fasting, with blood sugar and insulin levels checked at fasting, then again at one- and two-hour intervals.

Your blood sugar levels should be less than 80 mg/dl fasting and never rise above 110 or 120 mg/dl after one- and two-hour checks. Your insulin should be less than 5 uIU/mL fasting and should never rise above 30 uIU/mL after one and two-hour checks.

If your results show high insulin, you need to eliminate the things that are sending your biology out of balance and include what’s needed to help your body rebalance itself. These eight interventions (I am sounding like a broken record here as these same 8 interventions are paramount to helping all disease and increasing longevity) can become extraordinarily powerful to normalize insulin:

1. The best way is by eating healthy. Cut out white flour, sugars and processed foods and eat whole, fresh foods. Food is information that controls your gene expression, hormones, and metabolism. Choose low-glycemic real foods including fresh vegetables, fruits, legumes, non-gluten grains, nuts, seeds, and high-quality animal protein.

2. I also recommend learning to read the food label, and putting the grams of sugar in perspective and its impact on your body, by converting this number to teaspoons.

FOUR grams equals 1 TEASPOON of sugar.

On average we are consuming 22 teaspoons of added sugars a day in the form of sweetening agents in processed foods and sugar added to foods and drinks-and some people consume much more!

Avoid packaged foods and drinks that list a sugar content of over 4 grams per serving and do not use recipes that go above that, either.

And you also need to watch out for small doses that accumulate in processed foods, condiments, and drinks grabbed on the run.

Low-Fat Fruit Yogurt: 6-12 cubes

Ketchup: 1 cube

BBQ sauce: 3-4 cubes

Vanilla Latte: 9 cubes

Sweetened Iced Tea: 6-7 cubes

Bottled Fruit Smoothie: 10-15 cubes

Granola: 3-6 cubes

Sports Drinks: 8-9 cubes

Orange Juice: 5-6 cubes

Protein Bar: 5-6 cubes

*Note: 1 cube equals 1 teaspoon sugar

2. Remove all artificial sweeteners, especially Aspartame a neurotoxin. ABSOLUTELY avoid cane sugar, brown sugar, brown rice syrup, beet sugar, date sugar, grape sugar, glucose, sucrose, maltose, maltodextrin, dextran, dextrose, sorbitol, corn syrup, fructose, high fructose corn syrup, fructose syrup, corn sugar, fruit juice, fruit juice concentrate, barley malt, caramel, carob syrup, and sorghum syrup. Limit intake of coconut sugar, honey, maple syrup, coconut water, fruit juice, and agave too. Even Xylitol and Stevia should be used in moderation. Xylitol, however, has been shown to have added benefits for a person's teeth, namely preventing tooth decay.

Far from the free pass some people consider them, artificial sweeteners can raise insulin levels and contribute to insulin resistance. One study in the journal Diabetes Care found sucralose (Splenda) could raise glucose and insulin levels. Give up sugar but also, Sucralose (Splenda), sugar alcohols like Maltitol, and all of the other heavily used and marketed sweeteners unless you want to slow down your metabolism, gain weight, and increase insulin resistance. Many of us have lost touch with what constitutes “sweet,” and we have to retrain our taste buds to appreciate the natural sweetness of, say, natural vanilla or roasted almonds.

3. Control inflammation. Dietary sugars of all kinds and refined vegetable oils are the biggest contributors to inflammation. They increase insulin levels and turn on genes that lead to chronic inflammation, creating a downward spiral into more inflammation, poor blood sugar control, and chronic disease. Besides removing the offending foods, address food sensitivities and allergies to control inflammation. Incorporate plenty of anti-inflammatory foods including wild-caught fish, freshly ground flax seed, and fish oil.

4. Increase fiber-rich foods. Whereas our Paleolithic ancestors got 50 – 100 grams of fiber a day, we now average less than 15 grams. Studies show high-fiber foods can be as effective as Diabetes medications to lower blood sugar without the side effects. Fiber slows sugar absorption into the bloodstream from the gut. Eat a wide variety of fiber-rich plant-based foods including nuts, seeds, fruits, vegetables, and legumes (watch Lectins though, they can cause Leaky Gut.)

5. Get enough sleep. A study in The Journal of Clinical Endocrinology and Metabolism found in healthy subjects, even a partial night of poor sleep contributes to insulin resistance. Make sleep a top priority to normalize insulin levels. Avoid eating three hours before bed and take a Magnesium Hot Bath to raise your body temperature and relax your muscles. Go to bed and wake up at consistent times, only use your bed for sleep and sex, and try herbal therapies or melatonin if necessary.

6. Address nutrient deficiencies. A number of nutrients play a role in insulin management, including vitamin D, chromium, magnesium, and alpha lipoic acid. Deficiencies in any nutrient can stall your biochemical machinery, knocking your blood sugar levels out of balance and making you more insulin resistant.

7. Incorporate the right exercise. Exercise might be the most powerful medicine to manage blood sugar levels and make your cells more insulin sensitive. When it comes to exercise, time becomes a huge hurdle for many people. That’s why I recommend high-intensity interval training (HIIT), also called burst training, which you can do in just minutes a day. A study in the Journal of Obesity found among its other benefits, burst training helped decrease fasting insulin and reduce insulin resistance. Combining burst training with weight resistance provides the most effective, efficient way to normalize blood sugar and insulin levels.

8. Control stress levels. Chronic stress elevates cortisol, your main stress hormone. Increased cortisol levels elevate blood sugar and promote the accumulation of belly fat that I commonly see in patients with insulin resistance or Diabetes. You can’t eliminate stress, but you can reduce its impact. Find what works for you. That might be meditation, yoga, deep breathing, or exercise.

I know this is a lot of information to process, take it all in and sit with it for a while, then read again so you understand. It could literally save your life!

To a Sweet (without sugar) Spring,

Susan Merenstein, Pharmacist and Owner

Murray Avenue Apothecary