'The secret to freedom is obedience to the unenforceable.”- Lord Moulton
I know a man, let’s call him “Charles”, who can’t seem to get over the hump. He works out almost every day with “machines”, tries to eat healthy and is conscious of his doctor appointments. But for some reason, he can’t seem to lose any weight and become healthier and more energetic. His doctor told him that at 5’7, 217 pounds, even though his physical exam results came back ok, he is too heavy and that at 48 years of age it’s going to start affecting his life.
It’s hard not to like Charles. He has an infectious smile, keen wit, and he loves people. He is one of the most fun people in the world to play golf with, with his mildly inappropriate jokes, and his ability to make crazy shots on occasion. His 3 kids are precious, and his wife, who struggles with her weight too really loves him. What’s the problem? Why can’t he seem to make any changes?
He wants to be leaner. We wants to have more energy. He wants to be more confident. He wants to feel better. Why can someone like Charles who is disciplined at work and is a good parent, and who seems to have everything going for him, not seem to make any changes in his body?
Millions of Americans are just like Charles in that they are struggling with inherent insulin resistance which is tied up in their excess weight, eating habits, and they don’t even know it. We vie with Mexico for the most obese nation. 2/3 of our country is overweight and 1/3 is obese which ends up costing us hundreds of millions of dollars per year. We hear so much about obesity that it gets tiring hearing about it. I’m tired of it. You’re tired of it. We’re all tired of it. But the real problem is bigger than obesity.
What is causing this weight problem and what can we do about it? Insulin resistance, in my estimation, is the single largest physical health problem in the US. It starts small and adds up, eventually causing all sorts of other health problems.
Insulin resistance is often but not always part of a larger health phenomena called “Metabolic Syndrome”, a name for a large number of health risk factors which often interact with each other and contribute eventually to heart disease.
First, a little education:
What is insulin? (From www.nih.gov)
Insulin is a hormone made in the pancreas, an organ located behind the stomach. The pancreas contains clusters of cells called islets. Beta cells within the islets make insulin and release it into the blood.
Insulin plays a major role in metabolism—the way the body uses digested food for energy. The digestive tract breaks down carbohydrates—sugars and starches found in many foods—into glucose. Glucose is a form of sugar that enters the bloodstream. With the help of insulin, cells throughout the body absorb glucose and use it for energy.
Insulin's Role in Blood Glucose Control
When blood glucose levels rise after a meal, the pancreas releases insulin into the blood. Insulin and glucose then travel in the blood to cells throughout the body.
- Insulin helps muscle, fat, and liver cells absorb glucose from the bloodstream, lowering blood glucose levels.
- Insulin stimulates the liver and muscle tissue to store excess glucose. The stored form of glucose is called glycogen.
- Insulin also lowers blood glucose levels by reducing glucose production in the liver.
What is insulin resistance?
Insulin resistance is a condition in which the body produces insulin but does not use it effectively. When people have insulin resistance, glucose builds up in the blood instead of being absorbed by the cells, leading to type 2 diabetes or prediabetes.
Most people with insulin resistance don't know they have it for many years—until they develop type 2 diabetes, a serious, lifelong disease. The good news is that if people learn they have insulin resistance early on, they can often prevent or delay diabetes by making changes to their lifestyle.
Insulin resistance can lead to a variety of serious health disorders.
What happens with insulin resistance?
In insulin resistance, muscle, fat, and liver cells do not respond properly to insulin and thus cannot easily absorb glucose from the bloodstream. As a result, the body needs higher levels of insulin to help glucose enter cells.
The beta cells in the pancreas try to keep up with this increased demand for insulin by producing more. As long as the beta cells are able to produce enough insulin to overcome the insulin resistance, blood glucose levels stay in the healthy range.
Over time, insulin resistance can lead to type 2 diabetes and prediabetes because the beta cells fail to keep up with the body's increased need for insulin. Without enough insulin, excess glucose builds up in the bloodstream, leading to diabetes, prediabetes, and other serious health disorders.
What causes insulin resistance?
Although the exact causes of insulin resistance are not completely understood, scientists think the major contributors to insulin resistance are excess weight and physical inactivity.
Some experts believe obesity, especially excess fat around the waist, is a primary cause of insulin resistance. Scientists used to think that fat tissue functioned solely as energy storage. However, studies have shown that belly fat produces hormones and other substances that can cause serious health problems such as insulin resistance, high blood pressure, imbalanced cholesterol, and cardiovascular disease (CVD).
Belly fat plays a part in developing chronic, or long-lasting, inflammation in the body. Chronic inflammation can damage the body over time, without any signs or symptoms. Scientists have found that complex interactions in fat tissue draw immune cells to the area and trigger low-level chronic inflammation. This inflammation can contribute to the development of insulin resistance, type 2 diabetes, and CVD. Studies show that losing the weight can reduce insulin resistance and prevent or delay type 2 diabetes.
Many studies have shown that physical inactivity is associated with insulin resistance, often leading to type 2 diabetes. In the body, more glucose is used by muscle than other tissues. Normally, active muscles burn their stored glucose for energy and refill their reserves with glucose taken from the bloodstream, keeping blood glucose levels in balance.
Studies show that after exercising, muscles become more sensitive to insulin, reversing insulin resistance and lowering blood glucose levels. Exercise also helps muscles absorb more glucose without the need for insulin. The more muscle a body has, the more glucose it can burn to control blood glucose levels.
Other causes of insulin resistance may include ethnicity; certain diseases; hormones; steroid use; some medications; older age; sleep problems, especially sleep apnea, excess alcohol intake can slow metabolism and blunt the effectiveness of insulin, and cigarette smoking.
-Does sleep matter?
Yes. Studies show that untreated sleep problems, especially sleep apnea, can increase the risk of obesity, insulin resistance, and type 2 diabetes. Night shift workers may also be at increased risk for these problems. Sleep apnea is a common disorder in which a person's breathing is interrupted during sleep. People may often move out of deep sleep and into light sleep when their breathing pauses or becomes shallow. This results in poor sleep quality that causes problem sleepiness, or excessive tiredness, during the day.
Many people aren't aware of their symptoms and aren't diagnosed. People who think they might have sleep problems should talk with their health care provider.
How does insulin resistance relate to type 2 diabetes and prediabetes?
Insulin resistance increases the risk of developing type 2 diabetes and prediabetes. Once a person has prediabetes, continued loss of beta cell function usually leads to type 2 diabetes. People with type 2 diabetes have high blood glucose. Over time, high blood glucose damages nerves and blood vessels, leading to complications such as heart disease, stroke, blindness, kidney failure, and lower-limb amputations.
What are the symptoms of insulin resistance and prediabetes?
Insulin resistance and prediabetes usually have no symptoms. People may have one or both conditions for several years without knowing they have them. Even without symptoms, health care providers can identify people at high risk by their physical characteristics, also known as risk factors.
People with a severe form of insulin resistance may have dark patches of skin, usually on the back of the neck. Sometimes people have a dark ring around their neck. Dark patches may also appear on elbows, knees, knuckles, and armpits. This condition is called acanthosis nigricans.
What are the symptoms of prediabetes?
Risk factors for prediabetes—in addition to being overweight or obese or being age 45 or older—include the following:
- being physically inactive
- having a parent or sibling with diabetes
- having a family background that is African American, Alaska Native, American Indian, Asian American, Hispanic/Latino, or Pacific Islander American
- giving birth to a baby weighing more than 9 pounds
- being diagnosed with gestational diabetes—diabetes that develops only during pregnancy
- having high blood pressure—140/90 mmHg or above—or being treated for high blood pressure
- HDL cholesterol level below 35 mg/dL or a triglyceride level above 250 mg/dL
- having polycystic ovary syndrome (PCOS)
- having prediabetes, impaired fasting glucose (IFG), or impaired glucose tolerance (IGT) on an earlier testing
- having other conditions associated with insulin resistance, such as obesity or acanthosis nigricans
- having CVD
In addition to weight, the location of excess fat on the body can be important. A waist measurement of 40 inches or more for men and 35 inches or more for women is linked to insulin resistance and increases a person's risk for type 2 diabetes. This is true even if a person's BMI falls within the normal range.
What it comes down to it, what is causing insulin resistance?
A Negative Feedback Loop:
- Eat Unhealthy Food (processed carbs, processed meats, fats, sugar)
- Food Becomes Glucose in Bloodstream
- Pancreas releases insulin into the bloodstream to facilitate the delivery of this glucose into the cells of the muscles, organs, and other tissues
- Due to a lack of physical activity, and an overload of caloric intake, the cells of the body are not responding to the insulin and taking the glucose into storage, resulting in even harder work by the pancreatic cells to release insulin
- Cellular metabolism not functioning properly, and not full of energy, so soon hunger returns ->
- More food eaten, and higher blood glucose
- Process repeats resulting in damage to the body’s cells, nerves and other tissues, less fat used as energy, increased estrogen and testosterone, increased cholesterol, and increased body weight.
What about insulin resistance and other hormones?
Hormones are a tricky subject to understand. They are the messengers of the body and rely on a balance to function properly. Insulin is a hormone, so it is understandable that when you increase insulin significantly it may cause problems in the overall balance of hormones. High levels of insulin could initially increase testosterone, but over time insulin resistance could be associated with low testosterone. It is difficult to say whether low testosterone contributes to insulin resistance or vice versa, but the two are associated. High abdominal fat is also associated with low testosterone but again, research is inconclusive as to exactly how the two are related. The key point is that we want our bodies to be responsive to insulin. We want food to be eaten, taken up by the body as insulin is released, and we want high insulin sensitivity. This is our goal.
Problems / Challenges: What is causing insulin resistance to be such an epidemic?
- Lack of Awareness
Many people who walk around struggling with their weight are simply not aware of what a terrible trap they are caught in.
- Industrialization of Everything
- Hormonal Changes & Addiction
- Lack of Activity
- Cultural Excess
The human body, mind, and spirit simply cannot handle everything that is being thrown at it right now.
We live in a culture of excess: too much work, entertainment, food, violence, media, debt, and anger. You name it, and we have just too much of it. Plus, the only cultural norm we have left is this: You will not judge me, restrict me, or tell me no, and nothing is too much. This is a problem with insulin resistance as well: The body can’t take this much sugar and caloric intake without starting to break down. We must learn to say no sometimes.
Solutions for Insulin Resistance
This is a serious problem. I believe serious circumstances call for serious measures:
- Shrink the stomach by eating less. Save your self thousands of dollars on a “lap band” surgery by severely restricting your calories 3 days per week to less than 1000. Even shoot for 500 if you can. This is extreme but your stomach will shrink and you will become fuller easier. Over time, your body’s hormones will come back into balance.
- Fasting. Try to only eat one meal per day for 2 days per week. This will train you to be disciplined, and help you lose weight, shrink your stomach and it will not be a long enough amount of time to cause your metabolism to slow down, which would ultimately make weight loss harder.
- Stand up desk, or Standing Up. Buy a stand up desk.
- Pedometer. Shoot for 10,000 or more steps per day.
- Walking. Every time you get the chance, take a walk instead of riding a bike or driving.
- No refined carbs, sugars, etc. Cut this stuff out completely and start eating fruit for desert.
- Food Logs. Use a food log to track your intake. This will ALWAYS work for weight loss.
- Reorient Desires Towards Something Greater than Your Impulses.
- Your life matters and you are here for some reason.
- Feeling lousy all the time and tired is not good for anyone.
- Life is better if not lived in excess: One cup of coffee is better than 4, 40 hours of work is better than 80. 2 drinks is better than 6. 20 Minutes in the sun is better than 2 hours. Learn to look at eating this way. Enjoy moderation and simplicity.
- Train yourself to desire the best things in life like the creator, family, fun, education, music, free experiences, the outdoors, friendship, travel, and you can learn to control bad habits which lead to insulin resistance.
My wish is for all of us to learn about insulin resistance, be constantly aware of it, and be more like Jan than Charles.
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